Journal of Nobel Medical College <p>Published by the Research and Publication Unit of Nobel Medical College, Biratnagar. Full text articles available. JoNMC is also available on its own <a href="" target="_blank" rel="noopener">website</a>.</p> <p>The journal is now accepting online submissions. For information on the process <a title="Author Info" href="/index.php/JoNMC/information/authors" target="_self">click here</a>.</p> <p>JoNMC is indexed in <a href="" target="_blank" rel="noopener">DOAJ</a> and on <a title="Index Copernicus" href="" target="_blank" rel="noopener">Index Copernicus</a><a title="Index Copernicus" href="" target="_blank" rel="noopener"></a>.</p> en-US <p>JoNMC applies the Creative Commons Attribution <strong>(CC BY)</strong> license to works we publish. Under this license, authors retain ownership of the copyright for their content, but they allow anyone to download, reuse, reprint, modify, distribute and/or copy the content as long as the original authors and source are cited.</p> (Dr. Ram Hari Ghimire) (Sioux Cumming) Sun, 02 Jan 2022 00:00:00 +0000 OJS 60 Guillain-Barre Syndrome Following Ad26.Cov2.S Covid-19 Vaccine: A Case Report <p>Guillain-Barre Syndrome has been reported as a rare side effect in the recipients of Johnson &amp; Johnson®'s Janssen Ad26.COV2.S COVID-19 vaccine. We report a case of Guillain-Barre Syndrome in a 50 years old female following the administration of the aforementioned vaccine.</p> Sushmita Khanal, Sunil Babu Khanal Copyright (c) 2021 Fri, 31 Dec 2021 00:00:00 +0000 Peripheral Odontogenic Fibroma- Case Series of a Rare Benign Tumor <p>Peripheral odontogenic fibroma (POdF) is a rare benign odontogenic tumor of ectomesenchymal origin which is composed of fibrous connective tissue containing islands, strands or cords of odontogenic epithelium. The lesion is more common among females, commonly seen between the second to fourth decades of life, mostly affecting the anterior region of mandible. Clinically, it may present similar characteristics with other more common gingival lesions such as pyogenic granuloma, peripheral ossifying fibroma and peripheral giant cell granuloma. So, histopathological examination is required for accurate diagnosis. We present here three rare clinical cases of peripheral odontogenic fibroma and their management by complete excision of the lesion with good postoperative outcomes.</p> Asmita Dawadi, Simant Lamichhane, Manoj Humagain, Pratibha Poudel, Sita Bhusal Copyright (c) 2021 Sun, 02 Jan 2022 00:00:00 +0000 Clinico-Mycological Profile of Dermatophytosis in a Tertiary Care Hospital of Eastern Nepal <p><strong>Background: </strong>Dermatophytes are keratinophilic and keratinolytic fungi which are responsible for dermatophytosis. There are three genera of dermatophytes; <em>Trichophyton, Microsporum</em> and <em>Epidermophyton</em>. As they have affinity to keratin rich tissue, they produce dermal inflammatory response, intense itching and cosmetically poor appearance. The varied clinical presentation of tinea results in delay in diagnosis, poor compliance in follow up of cases, and consequently spread of infection in the community has rekindled interest in rapid identification of species.</p> <p><strong>Materials and Methods: </strong>A hospital based cross sectional study was carried out in the department of Microbiology, Nobel medical college from January 2019 to December 2019. Clinically suspected 200 cases of dermatophytosis attending Out Patient Department were studied. Isolation and identification was done by various tests like macroscopic, microscopic and biochemical tests.</p> <p><strong>Results: </strong>Out of 200 specimens, 138 (69%) were skin scraping, 42 (21%) were nail clipping and 20 (10%) were hair stubs. Highest incidence was seen in the age group 21-40 years with 115 (57.5%) cases followed by 41-60 years 46 (23%) cases. In our study male preponderance of 158 (79%) and female of 42 (21%) were seen. Tinea corporis was found to be the commonest clinical type with 96 (48%) cases followed by tinea unguinum, 42 (21%), Tinea cruris 10 (11.36%), Tinea capitis 5 (5.68%), Tinea faciei 4 (4.54%), Tinea pedis 2 (2.27%). Among the fungal isolates <em>Trichophyton rubrum </em>(67.04%) was the most common etiological agent followed by <em>Trichophyton mentagrophytes</em> (13.63%), Epidermophyton 10 (11.36%), Trichophyton violaceum 4 (4.54%) and Epidermophyton floccosum 3 (3.4%).</p> <p><strong>Conclusion: </strong>The most common clinical presentation was tinea corporis followed by tinea unguinum. <em>T. rubrum</em> was the most common etiological agent of dermatophytosis</p> Kewal Shrestha, Sujit Kumar Bhattacharjee, Kumari Ragani Yadav Copyright (c) 2021 Fri, 31 Dec 2021 00:00:00 +0000 Video Assisted Thoracoscopic Surgery in Exudative Pleural Effusion and its Complication Management: An Experience in a Community Hospital <p><strong>Background</strong>: Exudative pleural effusions are common presentation of pleural disease. Long standing pleural effusion might complicate with loculations and cortex formation. Video assisted thoracoscopic surgery can be a useful tool for the diagnosis and the management of the complications. The aim of the study is to determine the cause and treat the complications related to the exudative pleural effusions.</p> <p><strong>Materials and Methods:</strong> It is a retrospective analysis of prospectively collected data of all patients with exudative pleural effusions subjected to surgical management. Data were collected over a period of four years in a community hospital in Kathmandu.</p> <p><strong>Results: </strong>Of 38 patients who underwent Video assisted thoracoscopic surgery only 33 were eligible for analysis. Male to female ratio was 2.3:1 with male (23) dominance. Twenty six (78.8%) had lymphocyte predominance and 23 (69.7%) had Adenosine deaminase level of more than 40 International unit in pleural fluid analysis. In histopathological examination most common finding was granulomatous inflammation 13 (39.4%), 9 (27.3%) were malignancy and 9 (27.3%) were nonspecific chronic inflammation. Of malignancies adenocarcinoma 3 (9.09%) was the most common finding, mesothelioma 2(6.06%) and 4 (12.12%) other.</p> <p><strong>Conclusion: </strong>Video assisted thoracoscopic surgery has a role to play in diagnosis of exudative pleural effusions, particularly when there is dilemma in diagnosis. Video assisted thoracoscopic surgery definitely has a role in diagnosis and treatment of the complications related to pleural effusions.</p> Ravi Kumar Baral Copyright (c) 2021 Fri, 31 Dec 2021 00:00:00 +0000 Lipid Profile in Patients with Lichen Planus in a Tertiary Care Hospital: A Descriptive Cross-Sectional Study <p><strong>Background: </strong>Lichen planus is an immune mediated disease that affects the skin and the mucous membranes. Although the etiology and pathogenesis are not fully understood, it is believed that lichen planus represents a T-cell-mediated inflammatory disorder which produces disturbances of lipid metabolism.</p> <p><strong>Materials and Methods: </strong>Patients with the clinical diagnosis of lichen planus were included in the study after taking informed written consent. In total 40 patients were included in the study. Serum lipid profile was performed in the medical laboratory of Nobel Medical College Teaching Hospital.</p> <p>&nbsp;<strong>Results: </strong>Out of 40 patients, 13(32.5%) patients had dyslipidemia. Overall dyslipidemia was seen more in female patients (53.8%) than in male patients (46.2%). In our study, hypertrophic (32.5%) followed by eruptive (27%) and mucosal (25%) lichen planus were the most common variant.</p> <p><strong>Conclusion: </strong>This study demonstrated that about one-third of lichen planus patients showed deranged lipid levels in blood so for patients presenting with lichen planus physicians should consider screening them for dyslipidemia.</p> Sunita Karki, Anjan Rai, Manish Pradhan Copyright (c) 2021 Fri, 31 Dec 2021 00:00:00 +0000 Study of Health Care Practices and Comorbidities in Diabetic Population at Small Community Level in Biratnagar: A Cross-Sectional Descriptive Study <p><strong>Background: </strong>Death in diabetes mellitus occurs mostly due to co-morbidities and complications resulting from diabetes. To reduce morbidity and mortality, awareness regarding diabetes and its complications is necessary. The aim of the study is to assess the health care practices and co-morbidities associated with the disease.</p> <p><strong>Materials and Methods: </strong>A descriptive cross-sectional study was conducted at community level (Kharji ward number 4) at Biratnagar. All diagnosed patients of type II diabetes mellitus ≥ 18 years of age were enrolled for the study.&nbsp; Data for socio-demographic factors and clinical status were collected by pretested semi structured Questionnaire. Random blood sugar was measured using a portable glucometer. Anthropometric measurements were done by measuring height and weight of participants and body mass index was calculated by standard formula. The data was analyzed using SPSS version 21.0.</p> <p><strong>Results: </strong>Out of the total 205 participants, 55.7% were found to be within the age group of 45-64 years i.e. middle aged (55.6%). Almost equal participants of the male and female were found, 50.7% and 49.3% respectively. More participants were found of below poverty line 67.31%. More than half 47.8% of the participants were suffering from the diabetes for less than 5 years of duration. All most all participants 98.5% knew about diabetes and its complications. Majority of the respondents 62.4% were having co-morbidity, among them 34.6% of participants were having hypertension. Majority of the participants were utilizing private health care service 79%.</p> <p><strong>Conclusion: </strong>The diabetic participants were mostly of middle age with almost equal number of male and female having adequate knowledge about diabetes. Hypertension was the most common co morbidity among participants and they preferred private health care service mostly.</p> Rimu Mishra, Alok Acharya, Amar Kumar Yadav, Kaushal Sigdel Copyright (c) 2021 Fri, 31 Dec 2021 00:00:00 +0000 Assessment of Safety of Vaginal Repair of Pelvic Organ Prolapse in Elderly at Birat Medical College Teaching Hospital, Nepal <p><strong>Background: </strong>Pelvic organ prolapse in elder women causes sufficient morbidity and decreased quality of life. Despite age related comorbidities and decreased physiological capabilities, elder women with pelvic organ prolapse may be benefitted by surgical repair via vaginal route.The purpose of this study is to evaluate the safety of vaginal repair of pelvic organ prolapse in women of age 60 years or older.</p> <p><strong>Materials and Methods: </strong>This hospital based analytical study was carried out in Birat Medical College Teaching Hospital from September 2020 to September 2021. Fifty-four patients aged 60 years or older with third and fourth degree pelvic organ prolapse were recruited for the study. Necessary information was obtained by self-structured questionnaire and entered into Microsoft Excel. Data was analyzed by SPSS version 22.</p> <p><strong>Results: </strong>Fifty-four women with third or fourth degree prolapse with cystocele and rectocele underwent vaginal hysterectomy with anterior colporrhaphy with posterior colpoperineorrhaphy. No organ injury occurred during operation. There was no mortality or severe intraoperative or postoperative complications.</p> <p><strong>Conclusion: </strong>Vaginal hysterectomy with pelvic floor repair for pelvic organ prolapse in women of 60 years or older is safe.</p> Bhanubhakta Neupane, Gyanendra Man Singh Karki, Hanoon Pokhrel, Ashim Adhikari Copyright (c) 2021 Fri, 31 Dec 2021 00:00:00 +0000 Predictors of Obesity among Type 2 Diabetes Mellitus Patients Attending a Tertiary Care Center of Province 1, Nepal <p><strong>Background:</strong> Obesity and Diabetes Mellitus type 2 have a known association. Yet, the socio-demographic predictors of obesity in special populations like ours (Asian) who have DM remain unclear. The purpose of this study was to determine the socio-demographic predictors of obesity among newly diagnosed Diabetes Mellitus in adults.</p> <p><strong>Materials and Methods:</strong> This was a descriptive cross-sectional study conducted in endocrine OPD of Nobel medical college. Total 124 subjects were enrolled who were newly diagnosed Diabetes Mellitus over a period of 1 year. Detailed history was taken for demographic and clinical variables. Height, weight, waist circumference and blood pressure were measured. Besides, Body Mass Index, the dependent variable, was calculated. Subjects were considered to have diabetes based on their fasting and postprandial blood sugar level for the first time.</p> <p><strong>Results:</strong> The prevalence of obesity among the study population was 39.5%, overweight was 45.2%. Predictors for this study for obesity were found as abnormal blood pressure and hospital visit after symptoms development.</p> <p><strong>Conclusion:</strong> Obesity is a important risk factor for Diabetes Mellitus and higher prevalence of obesity among type 2 diabetes was observed. Predictors for this study for obesity were found as abnormal blood pressure and hospital visit after symptoms development</p> Pratap Kumar Roy, Dharanidhar Baral, Arjun Gautam, Sarita Subedi Copyright (c) 2021 Sun, 02 Jan 2022 00:00:00 +0000 A Study of the Safety and Efficacy of Alternate Day vs. Daily Rosuvastatin Dosing in Hypercholesterolemia Patients at Tertiary Care Hospital <p><strong>Background: </strong>Many of the patients with coronary heart disease require lifelong statin administration. Patients usually discontinue the medicine either due to side effects like myalgia, hepatotoxicity or due to the cost of the medicine.&nbsp; The aim of this study is to see the scope of adjustment of the regimen to alternate-day dosing as an option to be considered in patients for whom adverse effects or cost are issues.</p> <p><strong>Materials and Methods: </strong>A comparative, prospective, parallel group and open study was performed on forty- two patients of both genders with dyslipidaemia within the age group of 30 to 60 years attending the out – patients department of Medicine of Nobel Medical College and Teaching Hospital from February 2020 to March 2020. Mean reductions in different lipid fractions in the two treatment groups over the eight-week study period was calculated and then compared. Frequencies of patients developing different side effects was also calculated and compared between the two groups.</p> <p><strong>Results: </strong>Baseline characters of both the groups were well balanced. Low density lipoprorein-C was reduced by 33.8 % in once-daily group and 31.3 % in alternate-day group, respectively. Changes were also recorded for the other lipid parameters. Such changes were found to be of no significant difference when compared between the two groups (p&gt;0.05).</p> <p><strong>Conclusion</strong>: An alternate-day regimen of statin in patients of hyperlipidaemia showed similar effect on the lipid panel compared to daily regimen.</p> Rajesh Yadav, Gaurav Chhetri Copyright (c) 2021 Fri, 31 Dec 2021 00:00:00 +0000 Status of Vitamin D among People Visiting a Tertiary Care Center of Eastern Nepal: A Hospital-Based Study <p><strong>Background: </strong>Vitamin D deficiency is a serious health-problem worldwide and the estimation of its plasma concentration is crucial. The study aims to determine the circulating levels of vitamin D in patients visiting Birat Medical College Teaching Hospital, one of the tertiary care centers of Eastern Nepal.</p> <p><strong>Materials and Methods: </strong>It was descriptive cross-sectional study conducted in the Department of Biochemistry at Birat Medical College Teaching Hospital, Nepal. From the hospital registry, clinical data of 250 patients including their age, gender and serum 25-hydroxy vitamin D was retrieved for the four months of May – August, 2021. The vitamin D status was classified as deficiency (&lt;10 ng/mL), insufficiency (10–30ng/mL), sufficiency ≥ 30ng/mL) and toxicity (≥ 100 ng/mL).</p> <p><strong>Results: </strong>Out of total subjects (<em>n=250</em>), none of them showed toxic serum concentrations of vitamin D, 38% had sufficient, 57% had insufficient and 5% had deficient levels of this vitamin. Among affected individuals, vitamin D insufficiency had predominated in 41% population who were 41-60 years old. Gender-wise comparison of vitamin D status in the insufficiency group showed around 33% males and 67% females having insufficient levels of this vitamin.</p> <p><strong>Conclusion: </strong>With the vitmain D inssufficieny present in more than half of the study population, it becomes paramount to further scrutinize the associated factors apart from the age and gender. To this end, further studies are needed. &nbsp;</p> Chandra Prakash Gaire Copyright (c) 2021 Fri, 31 Dec 2021 00:00:00 +0000 Modified Coronally Positioned Flap for Isolated Gingival Recession, Evaluated with Root Coverage Esthetic Score System <p><strong>Background:</strong> Various modifications of the coronally displaced flap have been proposed in the literature with the attempt of treating gingival recession. This study is undertaken to evaluate the predictability of the modified coronally positioned flap in isolated gingival recession not only in terms of root coverage but also with the esthetic outcome.</p> <p><strong>Materials and</strong> <strong>Methods:</strong> Fifteen isolated gingival recessions with at least 1mm of keratinized tissue apical to the defect were treated with a modified coronally advanced flap. All recessions fall into Miller class I. The clinical re-evaluation was performed 3 months and 1year after the surgery. Statistical analysis was performed using statistical application software (SPSS16.0). Multivariate ANOVA was used for analysis.</p> <p><strong>Results:</strong> At the 1-year examination, the average root coverage was 94.6% of the pre-operative recession depth. There was a mean clinical attachment gain of 3.3±0.1 mm at 1 year follow-up.The average increase of keratinized tissue between the baseline and the 1-year follow-up amounted to 1.53±0.13 mm. Root coverage esthetic score (RES) was recorded at the end of follow-up period. 13/15 cases showed RES score of 9 and 2/15 cases showed RES score of 6.</p> <p><strong>Conclusion:</strong> The modified coronally advanced surgical technique is effective in the treatment of isolated gingival recession in the upper jaw.</p> Dhirendra Kumar Giri, Ajit Kumar Yadav Copyright (c) 2021 Fri, 31 Dec 2021 00:00:00 +0000 Short Term Clinical Outcome of Micro Lumbar Discectomy in Tertiary Care Center <p><strong>Background: </strong>Minimal invasive open lumbar microdiscectomy has been associated with good success rate and low morbidity. The present study is aimed to evaluate the clinical outcome of patients who underwent open minimal invasive open lumbar microdiscectomy for herniated intervertebral disc.</p> <p><strong>Materials and Methods: </strong>This is a prospective observational hospital based study of prolapsed lumbar intervertebral disc operated in the department of neurosurgery at Nobel Medical College Teaching Hospital, Biratnagar, Nepal from January 2018 to June 2021. All patients of lumbar herniated intervertebral disc subjected for surgery were included. Recurrent prolapsed intervertebral disc, Disc surgery requiring stabilization was excluded from the study. During surgery types of prolapsed intervertebral disc, level and operative time were noted. In the post-operative period Visual Analogue Scale was used to assess the change in severity of pain. Duration of hospital stay and the complications occurred were also noted.</p> <p><strong>Results: </strong>The mean age of the study population was was 41.50 (±14.56) years ranging from 20 years to 79 years. The commonest lumbar prolapsed intervertebral disc was at L4-L5 level. The mean operative time was 42 minutes excluding the time for anaesthesia preparation. There was statistically significant difference (p&lt;0.001) in pre-operative and post-operative Visual Analogue Scale. Mean duration of hospital stay was 5.58 (1.87) days.</p> <p><strong>Conclusion: </strong>A through workup and surgical planning is associated with better outcome avoiding complications in minimal invasive open micro lumbar discectomy. &nbsp;</p> Pramod Chaudhary, Prakash Kafle, Narendera Joshi, Ujwal Gautam Copyright (c) 2021 Fri, 31 Dec 2021 00:00:00 +0000 Thyroid Dysfunction and its Effect on Red Blood Cell Parameters <p><strong>Background: </strong>Thyroid hormones are necessary for the growth and development, cellular differentiation, physiological function and metabolic regulation of almost all tissues in our body. Thyroid disorders are accompanied by alteration in hematological profile. This study aims to evaluate the effect of thyroid dysfunction on red blood cell parameters.</p> <p><strong>Materials and Methods: </strong>This case-control observational study was conducted in the Department of Clinical Biochemistry, KIST Medical College and Teaching Hospital (KISTMCTH), Lalitpur, Nepal from January 2021 to June 2021.Total number of recruited subjects was 248, out of which 67 were labeled as hypothyroid, 7 were hyperthyroid and 174 were euthyroid as control. Subjects for all three groups were between 16-93 years old. Thyroid hormone profile of patients was determined by Siemens ADVIA Centaur CP immunoassay analyzer and hematological parameters by automated hematology analyzer Sysmex XN-550. Results were analyzed by SPSS 21 software and a chi-square test was applied to see significant differences among the groups.</p> <p><strong>Results: </strong>The mean age of all study participants was 42.08±17.27 years and female constituted 74.6% of total subjects. Analysis of the data obtained a statistically significant difference in the mean hemoglobin (p&lt;0.001) between hypothyroid and euthyroid groups. The difference was not significant for hemoglobin (p=0.252) among hyperthyroid and euthyroid groups. There was no statistical significant difference between thyroid cases and control for MCV, MCH and MCHC.</p> <p><strong>Conclusion: </strong>The current study concluded that thyroid dysfunction have a significant effect on red blood cell parameters. Hematological parameters should be evaluated in patient with thyroid dysfunction.</p> Samir Singh Copyright (c) 2021 Fri, 31 Dec 2021 00:00:00 +0000 Clinical Profile of Migrant Workers Admitted in Medical Ward at Tertiary Care Hospital <p><strong>Background: </strong>One of the defining elements of Nepal's socioeconomic environment is labor migration. Migrant workers are more likely to develop occupational diseases because they do dangerous tasks and have limited access to occupational health care. The purpose of this paper is to produce clinical profile of migrant workers admitted in medical ward at tertiary care hospital.</p> <p><strong>Materials and Methods: </strong>This was a descriptive cross-sectional study carried out in Nobel Medical College Teaching Hospital on migrant workers patients admitted in medical ward from October 2018 to September 2019. The sample enrollment process was consecutively who were admitted under medical ward. Pre-designed questionnaire was used to collect data for clinical profile of the patients. Data were entered in Microsoft Excel and analyzed.</p> <p><strong>Results: </strong>The migrant workers in this study mainly came from Malaysia, United Arab Emirates, Saudi Arabia, Qatar and Kuwait. They are almost male (97.1%) in this study with mean age of 30.3±7 years in age. The commonest age group of migration was 20-29 year. The highest number of workers 22 (31.1%) had visited to Malaysia in the seek of work. The most common symptoms among them were weakness 15 (21.7%) and headache 13 (18.8%). The highest diagnosis among them was diabetes mellitus 13 (18.8%) and hypertension 11(15.9%). The highest number of workers was involved in their job at different foreign countries as a labor at factories or at construction site 32 (46.4%).</p> <p><strong>Conclusion: </strong>Male from younger age group were mainly observed as migrant worker with their proclivity to work in Malaysia. The most common diagnosis among them was diabetes mellitus and hypertension. Most migrant workers worked as workers in factories and construction sites</p> Farmud Ansari, Sushil Yadav, Ram Hari Ghimire Copyright (c) 2021 Fri, 31 Dec 2021 00:00:00 +0000 Orphan Enzyme Project: A Review Message as an Attempt of Diverting the Trend of Our Clinical Researches <p>Not Available</p> Arambam Giridhari Singh Copyright (c) 2021 Fri, 31 Dec 2021 00:00:00 +0000