Medical Journal of Shree Birendra Hospital <p>Official Journal of NAIHS (Nepalese Army Institute of Health Sciences). Full text articles available.</p> <p>MJSBH is now accepting online submission of manuscripts.We recommend that you review the <a href="/index.php/MJSBH/about">About the Journal</a> page for the journal's section policies, as well as the <a href="/index.php/MJSBH/about/submissions#authorGuidelines">Author Guidelines</a>. Authors need to <a href="/index.php/MJSBH/user/register">register</a> with the journal prior to submitting, or if already registered can simply <a href="/index.php/index/login">log in</a> and begin the 5 step process.</p> en-US (Dr Bikash Shrestha) (Sioux Cumming) Thu, 16 Jan 2020 11:02:06 +0000 OJS 60 Rejected <p class="p1"><span class="s1">Rejection is faced by all of us; it is upon us to take it in one’s stride. If we consider rejection as a step in scientific writing, handling a rejection becomes easy and bearable. The very fact that most of the well known scientific authors have faced rejection somewhere down their academic career would perhaps help most of the academicians to take rejections logically. It is no wonder to many academicians that even Albert Einstein had been rejected for the post of Lecturer in numerous universities and worked as a clerk in a Patent office.</span><span class="s2"><sup>1</sup></span></p> <p class="p1"><span class="s1">The letter of rejection might state various reasons, common ones being lack of originality, incomprehensibility, poor scientific reasoning or unsuitable to that journal’s readership. No matter what the reason may have been, a set format of polite rejection mail from the most journals is quite familiar to most of us. This is a very important guiding principle for improvement of the quality of the article. This should be taken as a stepping-stone in the process of acceptance for publication. </span></p> <p class="p1"><span class="s1">The rejection rate of journals can vary tremendously. Generally, the higher the academic value of the journal, the higher the rejection rate. Most of us are discouraged by the higher rejection of the highly reputed journals. Many reputed journals have a rejection rate of 80 to 85%.</span><span class="s2"><sup>2 </sup></span><span class="s1">However, the best part of highly reputed journals is that along with their polite mail of rejection, they also send the expert opinion of the reviewers why the particular article would have been rejected. In this regards, it is sometimes more logical to consider such reputed journals for ones submission. If the rejection mail arrives in less than a month, then it is probable that it was not sent to a reviewer and was rejected by the editors, in view of basic formatting not being in consonant with the journal or the substance matter not fitting in with the scope of the </span><span class="s3">journal.</span></p> <p class="p1"><span class="s1">It is upon the author to decide whether to reform the article or send it to a new journal after the rejection. Generally, the pool of reviewers for many reputed journals have many names common. So, if the author does not modify the article and submit it to another journal, very likely, the reviewer’s comments also remain the same. Usually if the reviewer has sent some comments, amending the article according to the critical comments and resubmitting is wise and more scientific rather than hunting exasperatedly for optional journals. It is always advisable to rethink and spend some time reforming your article according to the journal’s guidelines and the reviewer checklists. And many of the times, it would be much prudent to take the reviewer’s comments seriously and it would surprise the author how his/her article can turn out so beautiful after modifications. If you are not ready to accept the reviewer’s comments, it is better to give reason validating your writing but continuous letter of rejection demands serious rethinking of the whole approach.</span></p> Shavana Rajya Laxmi Rana ##submission.copyrightStatement## Tue, 14 Jan 2020 00:00:00 +0000 A Retrospective Descriptive Study of Anaesthesia in Mobile Surgical Camps in Nepal <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Mobile medical and surgical camps are one of the means of providing medical and surgical facilities to people living in rural areas of developing country like Nepal.</p> <p><strong>Methods:</strong> An observational cross-sectional descriptive retrospective study was done collecting data from surgical camps done by Nepali Army in six years from February 2013 to February 2019 AD. Total number of surgical cases requiring anaesthesia along with type of anaesthesia, American Society of Anaesthesiologist physical status classification and anaesthesia related complications were collected.</p> <p><strong>Results:</strong> In a six year period, total 12 mobile surgical camps were conducted by Nepali Army. Out of which, two were done in collaboration with Ministry of Health, Government of Nepal. Total 703 surgical cases were conducted. Out of which, 583 were general surgical cases and 120 were gynaecological cases. 262 cases were done in local anaesthesia, 242 cases were done in spinal anaesthesia, 108 cases were done in total intravenous anaesthesia and 91 cases were done in general anaesthesia. Hypotension, nausea, vomiting, shivering, failed spinal and difficult airway were the complications noticed during intra-operative and postoperative period.</p> <p><strong>Conclusions:</strong> Surgical outreach camps are beneficial in providing surgical care to unaffordable people living in rural and remote areas where health care facilities are limited and inaccessible. Safety of patient is the key concern in such camps. Proper organised plan is required selecting target group of populations with target surgeries per day for successful conduction of safe surgeries in such camps.</p> <p><strong>Key words:</strong> anaesthesia; camps; mobile; surgical</p> </div> </div> </div> </div> Bishwo Ram Amatya, Bhubhan Raj Kunwar, Sunita Panta, Santosh Khadka; Mallika Rayamajhi, Puja Thapa ##submission.copyrightStatement## Tue, 14 Jan 2020 00:00:00 +0000 Cadaveric Temporal Bone Dissection Workshop in a Tertiary ENT- HNS Centre: Is Our Teaching Satisfactory? <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Teaching learning skills are developed through various skill lab procedures. In the Department of ENT and HNS, Temporal Bone Dissection (TBD) is one of the methods of teaching. The TBD workshop conducted in the Department caters to most of the postgraduate students in the country. This study was conducted in the Department of ENT and HNS to evaluate the participants’ satisfaction on TBD course conducted in the Department.</p> <p><strong>Methods:</strong> The TBD participants who had undergone TBD course in the Department of ENT and HNS were asked to fill up the questionnaire regarding the satisfaction of the TBD course and suggestions for the improvement of the course. The participants provided the response of the questionnaire in the email or in hand filling of the forms.</p> <p><strong>Results:</strong> Total of 42 students responded to the questionnaire regarding the TBD course. 88% of the students graded it as good, 11% replied as satisfactory and 1% of them graded it as needs improvement. Maximum number of students commented on the inadequate time for dissection. Few participants replied the need of live demonstration in the course. 9.5% of the participants who had come for the course more than once commented on the great help done by the course in performing live otology surgery.</p> <p><strong>Conclusions:</strong> Maximum participants were satisfied about the TBD workshop which helped them to know the intricate temporal bone anatomy.</p> <p><strong>Key words:</strong> otology; questionnaire; Temporal Bone Dissection (TBD)</p> </div> </div> </div> </div> Pabina Rayamajhi, Susmita Shrestha, Rabindra B Pradhananga, Hari Bhattarai ##submission.copyrightStatement## Tue, 14 Jan 2020 00:00:00 +0000 Causality Assessment of Adverse Drug Reaction Using Naranjo Probability Scale: A Retrospective Study <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Globally, Adverse Drug Reaction (ADR) has been listed as the sixth leading causes of death. Recognition of ADR and establishment of relationship of drug with the symptom is the first step to the management of the problem. In this study, Naranjo algorithm has been used which is one of the most accepted tools for the assessment of causality of ADR with the suspected drug.</p> <p><strong>Methods:</strong> A retrospective descriptive study was done which included 35 reported cases of ADRs in Drug Information Unit (DIU) in tertiary care teaching institute of Nepal from Dec 2015 to Oct 2016. Based on the information in the reported ADRs forms, categorisation was done using Naranjo’s ADR Probability scale. The data was analysed using SPSS version 16.0 and descriptive statistics was used.</p> <p><strong>Results:</strong> It was seen that ADRs were more common in male (n=20) as compared to female (n=15). Amongst male, ADRs were more common in age group 50-75 years (n=8). ADRs were most commonly seen with antimicrobial agents (40%) followed by Non-Steroidal Anti-inflammatory Drugs (NSAIDs) (20%) and immunosuppressants (20%). Within the antimicrobial agents, anti-tubercular drugs (20%) contributed the most in ADRs and hepatotoxicity was the most common ADR seen. Majority of ADRs were categorised under possible (n=29) followed by probable (n=6).</p> <p><strong>Conclusions:</strong> Naranjo algorithm could be a useful tool for causality assessment of ADR which can help physicians to guide the therapy.</p> </div> </div> </div> </div> Sangha Ratna Bajracharya, Rakesh Ghimire, Pradip Gyanwali, Anjan Khadka ##submission.copyrightStatement## Tue, 14 Jan 2020 00:00:00 +0000 Chest Ultrasonography in Diagnosing Etiology of Acute Respiratory Failure <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Lung ultrasonography (LUS) is a useful diagnostic tool in critical care setting. Lung ultrasound at bed side is relatively easy to perform, cost effective and reproducible. Analysis of various sign and profile, alone or in combination is as accurate as gold standard test like Computed Tomography scan of the chest in detection of etiology of acute respiratory failure. The aim of our study was to perform bed side lung ultrasound in patent with ARF and to find out the diagnostic accuracy of lung ultrasound when compared with diagnosis made by the clinician.</p> <p><strong>Methods:</strong> This descriptive observational study was conducted at tertiary care teaching centre in Nepal between February 2019 and July 2019. Consecutive samples of acute respiratory failure patient were included. Lung ultrasound was performed at bed side by fellows of pulmonary critical care medicine. Specific 10 signs of blue protocol were assessed in six different sites of both the chest. Findings of LUS was recorded and analysed to formulate a diagnosis, and finally compared with the final diagnosis.</p> <p><strong>Results:</strong> Forty eight patients of acute respiratory failure with median age of 66 years (17 to 89 years) were included with 66.7% being females. 97.9 % of the patient presented with acute shortness of breath of less than one week duration. A total of 13 different diagnosis was made at the end of the treatment for all the patient. LUS accurately diagnosed them in 43 cases, with an overall accuracy of 89.6 %. Chronic obstructive pulmonary disease, pulmonary edema, pneumonia, pleural effusion, pneumothorax were accurately diagnosed with LUS however in acute respiratory distress syndrome and interstitial lung disease, lung ultrasound had poor diagnostic accuracy.</p> <p><strong>Conclusions:</strong> Lung ultrasound is useful tool in diagnosing etiology of acute respiratory failure. Diagnosis made by lung ultrasound was 89.6% correct when compared with final diagnosis made by clinician.</p> </div> </div> </div> </div> Chiranjibi Pant, Anusmriti Pal, Manoj yadav, Bishow Kumar Shrestha, Suraj Rana ##submission.copyrightStatement## Tue, 14 Jan 2020 13:12:24 +0000 Disability and Deformity in Patients of Hansen’s Disease Attending a Tertiary Care Center in Nepal <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Leprosy is responsible for disability and deformity among patients. Nerve damage is one of the main features of leprosy and it is the main cause of disability in the patients. Developing deformity leads to restriction in professional work and hence reduced income as well as it also acts adversely on social wellbeing. The aim of this study was to study the spectrum of Grade 2 disability among all leprosy patients attending outpatient and inpatient according to WHO grading and to find the association with Ridley Joplingclassification.</p> <p><strong>Methods:</strong> It was an observational cross sectional hospital based study. All the inpatients and outpatients of leprosy getting treatment and were on follow up in the Department of Dermatology between December 2017 to November 2019 were included. Details of disability and deformity were recorded and were Classified as per WHO grading and Ridley Jopling classification. Cross tab was used in descriptive analysis to compare between different variables and data was analysed in percentage.</p> <p><strong>Results:</strong> A total of 88 patients were included in the study. Maximum number of patients 41 (46.7%) belonged to 30 to 50 years of age group. Various degrees of loss of sensation was seen in all patients and total number of patients with Grade 1 disability were 68 (77.3%) and Grade 2 disability were 20 (22.7%). Maximum number of patients 11 (12.5%) with Grade 2 disability was seen in Lepromatous Leprosy.</p> <p><strong>Conclusions:</strong> Disability and deformity can occur in any spectrum of disease and intervention as early as possible will help reduce the incidence.</p> </div> </div> </div> </div> Sagar Mani Jha, Nabin Bhakta Shakya, Sunil Shakya, Manisha Maharjan ##submission.copyrightStatement## Tue, 14 Jan 2020 13:14:40 +0000 Infant and Young Child Feeding Practices Among Chepang Community, Chitwan <p><strong>Introduction: </strong>Infant and young child feeding practices play vital role for the growth and development. It is recommended to exclusively breastfed for first six months and thereafter receive complementary foods with continued breastfeeding. However Chepang, the indigenous community of Nepal depends primarily upon forest food. This study aims to determine the infant and young child feeding practices among Chepang children.</p> <p><strong>Methods: </strong>A cross sectional study was conducted among the mothers of 77 children aged six to 59 months through purposive sampling. Data was collected through face to face interview taking informed written consent. The collected data were analysed for descriptive and bivariate analysis using SPSS version 21.</p> <p><strong>Results: </strong>In this study, mean age of respondents was 25.92 (±7.04) years, 68.8% followed Christian religion, 51.9% were educated, only 45.5% of respondent’s spouse were educated and 51.9% belonged to nuclear family. Among the respondents, 65.7% had good breast feeding practice and 88.3% had good complementary feeding practice. Statistically significant relationship was found between breast feeding practice and educational status and also between complementary feeding practice and family type.</p> <p><strong>Conclusions: </strong>This study found that respondents had good breast feeding practice and complementary feeding practice. Among the respondent, seven out of 10 had good breast feeding practice and nine out of 10 had good complementary feeding practice. Association between breast feeding practice and educational status puts light upon the need for educating and empowering women for improved infant and young child feeding practices. &nbsp;</p> Iswari Luitel, Rita Kumari Ban, Sabika Munikar ##submission.copyrightStatement## Tue, 14 Jan 2020 13:16:49 +0000 Medical Students’ Perception on Joining Military Medical Services: A Mixed Method Study <p><strong>Introduction:</strong> Currently, in Nepal there are 19 Medical Colleges, most of them under Tribhuwan University and Kathmandu University. Nepalese Army Institute of Health Sciences (NAIHS) is Not-for-profit organization run by Nepal Army Welfare Fund, affiliated to Tribhuwan University. Excluding the medical graduates from abroad there are around 1500 doctors graduating from Nepal every year. After graduation they have the options joining as a Medical Officer in hospitals around Nepal or go abroad. Joining the Military Medical services seems appealing. However the options are broadening with the jobs in the private and other sectors becoming more lucrative. This study attempts to explore the perception of medical students on joining the Military Medical services.</p> <p><strong>Methods:</strong> The study was conducted during November 2016 to December 2017 among first and second year MBBS students of NAIHS. Comprehensive information about becoming a Military doctor in Nepal Army Medical Corps was provided. Student perceptions about joining Military Medical Services were studied using the semi-structured questionnaire. Informed written consent was taken from the students for the study.</p> <p><strong>Results:</strong> From the total (204) respondents, 64.7% (132) chose to join the Military medical services. Among the responses, serving the nation, job security and opportunity for career development were the most chosen. Reponses like; preferring private practice, less pay/salary, and deployment consideration were the reasons for not choosing to join the Military Medical Services.</p> <p><strong>Conclusion:</strong> Job as a Military Doctor seems attractive to majority of the Medical students. Male and Female medical students are equally interested towards becoming a military doctor in Nepal Army.</p> Bipin Kumar Shrestha, Rashmi Shrestha ##submission.copyrightStatement## Tue, 14 Jan 2020 13:19:19 +0000 Methemoglobinemia in a Newborn <p>Methaemoglobinaemia in a new born is a rare cause of cyanosis. We report a case of a new born presented with cyanosis and with normal cardio-pulmonary system. He was diagnosed as methemoglobinemia due to persistent cyanosis despite administration of oxygen and arterial blood gas collection appeared chocolate brown in colour. As methaemoglobin report was in mild range (11.7%), he was treated symptomatically.</p> Shristi Shakya, Nisha Jyoti Shrestha, Kalpana Upadhaya Subedi ##submission.copyrightStatement## Tue, 14 Jan 2020 13:28:34 +0000 Helping Babies Breathe (HBB) Program for Reduction of Neonatal Mortality: A Hospital Based Cost Effective Intervention in Nepal <p>Helping Babies Breath (HBB) is an evidence based educational curriculum practiced worldwide to teach neonatal resuscitation. It is famous and cost effective intervention in resource limited setting. In this regard, we have been implementing HBB program in Nepal through hospitals where delivery rate is higher. In this program, a pair of trainers have been trained as Master Trainer. These trainer back to hospital and train their colleagues in own facility. We have already produced more than seven hundred master trainers from hospital, nursing college, medical colleges and university in Nepal. Through the program, it aims to reduce the neonatal morbidity and mortality so that the country will achieve the target set by SDGs.</p> Kanchan Thapa, Robert B. Clark, Michael K. Visick, Yubanidhi Basaula, Rakesh Hamal, Naresh Pratap KC ##submission.copyrightStatement## Tue, 14 Jan 2020 00:00:00 +0000