Birat Journal of Health Sciences 2021-11-04T09:21:30+00:00 Professor Dr. Hem Sagar Rimal Open Journal Systems <p>Official journal of Birat Medical College and Teaching Hospital.</p> <p>Author submissions should be made on the journal's own website <a title="BJHS" href="" target="_blank" rel="noopener"></a></p> Socio-demographic and Clinical Profile of Children with Asthma attending Chest Clinic at B. P. Koirala Institute of Health Sciences, Nepal 2021-10-10T00:56:01+00:00 Satish Yadav <p><strong>Introduction:</strong> Asthma in children is one of the most common chronic diseases and little information available on factors associated with this disease in our part of the world.</p> <p><strong>Objective:</strong>&nbsp; The present study is an attempt to find out the socio-demographic and clinical profile of children with asthma.</p> <p><strong>Methodology: </strong>This was a retrospective analysis of data of asthmatic children below 14 years attending pediatric chest clinic from July 2014 till March 2016.</p> <p><strong>Results:&nbsp; </strong>Of the 200 children, there were 142 (71%) males. The median age of presentation was 3 years and 139 (69.5%) from the age group 1-5years One third had poorly controlled asthma. Comorbidity was present in 59(29.5%) and allergic rhinitis (7%) was the most common. 90.5% had onset of wheezing before 5 years of age. Family history of asthma and/or atopy and smoking was present in 24% and 31%, respectively. 22% had exposure to pet animals. Upper respiratory tract infection (URTI) (37%) was the most common trigger for exacerbation. Cough (99%) and fast breathing (98%) were the most common symptoms.</p> <p><strong>Conclusion: </strong>The majorities were males of young age with rhinitis as most common co-morbidity and many of them had a history of parental smoking at home. One third of them had poorly controlled asthma which shows the need for proper management of asthma including its comorbidity in younger children and changing certain habits like parental smoking at home.</p> 2021-11-04T00:00:00+00:00 Copyright (c) 2021 Satish Yadav Knowledge of Basic Life Support among Final Year Dental Students of BPKIHS 2021-10-10T00:59:57+00:00 Anjani Kumar Yadav Mehul Rajesh Jaisani Ashok Dongol Pradeep Acharya <p><strong>Introduction:</strong> The chance of survival of a victim after cardiac arrest/foreign-body airway obstruction is doubled by early institution of Basic Life Support (BLS). Besides medical doctors, dental doctors might also encounter the patients in emergency situation requiring BLS, especially during peripheral district teaching hospital posting in internship.</p> <p><strong>Objectives:</strong> The objective of this study was to assess the level of knowledge about BLS among final year dental students of BPKIHS.</p> <p><strong>Methodology:</strong> In this cross-sectional study, structured questionnaires were distributed to BDS final year students (purposive sampling, sample size=53). Each question responded correctly was awarded as point +1 and total points were calculated by adding all the correct answers. The collected data were entered in Microsoft excel 2010 and descriptive analysis was done by SPSS 16.</p> <p><strong>Results: </strong>Out of 53 questionnaires distributed, 49 were responded and returned (response rate= 92.45%). Twenty participants were male and twenty-nine were female. Four participants had taken BLS training in the past. Only twenty participants scored ≥ 50% and none of the participant scored ≥75%. Only one question was responded correctly by 100% participants. Ten questions were responded correctly by ≥50% participants. Although 65.3% participants were aware about high quality CPR, only 49% knew the exact location of chest compression. The chest compression to ventilation ratio for each of single rescuer and two rescuers was known by 20 participants (40.8%) and 28 participants (57.1%) respectively.</p> <p><strong>Conclusion: </strong>Knowledge of&nbsp; BLS is poor among BDS final year students.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Anjani Kumar Yadaav, Mehul Rajesh Jaisani, Ashok Dongol, Pradeep Acharya Influence of Gender on Total Serum Creatine Kinase and Creatine Kinase-Mb Levels of Nigerian Hypertensives 2021-10-10T01:17:49+00:00 Henry Afamuefuna Efobi Iya Eze Bassey <p><strong>Introduction: </strong>Hypertension is a long-term medical condition which when not detected and managed properly and on time often results to complications leading to disabilities and mortality. Gender has been known to affect the interpretation of some variables necessitating the need for gender-specific ranges.</p> <p><strong>Objectives:</strong>This study evaluated total creatine kinase (CK) and creatine kinase-MB (CK-MB) isoenzyme activities of hypertensive subjects in Calabar, Nigeria and to assess if gender has influence on the activities of these enzymes.</p> <p><strong>Methodology:</strong>One hundred and two participants were consecutively enrolled in this case control study. Serum total serum CK and CK-MB activity were evaluated in fifty one hypertensive and 51 normotensive subjects. The total CK levels were assessed using a spectrophotometric method while immunoinhibition method was used to determine the activity of CK-MB. Data was analyzed using Student’s t-test and Pearson’s correlation. Statistical significance was set at p&lt;0.05.</p> <p><strong>Results:</strong>The total creatine kinase activities of the hypertensives did not differ significantly from those of the normotensive controls (p = 0.428) while the serum CK-MB activities of the hypertensive subjects were significantly higher than those of the normotensive controls (p=0.000). The body mass index of the hypertensives was significantly higher than those of the normotensive subjects (p=0.030). Gender had no effect on the blood pressure, body mass index and levels of CK and CK-MB (p&gt;0.05). There was also no significant correlation (p&gt;0.05) between blood pressure, body mass index and the levels of CK and CK-MB.</p> <p><strong>Conclusion:</strong>CK-MB activities were significantly higher in hypertensive subjects compared to normotensive controls. There were no gender specific differences in the CK-MB levels of male and female hypertensives. This cardiac marker should be included in the routine assessment of hypertensives and gender-specific considerations may not be necessary in the interpretation of the data.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Henry Afamuefuna Efobi, Iya Eze Bassey Management and Awareness on Health Hazards of Household Waste: A Community based study 2021-10-10T01:33:00+00:00 Naresh Manandhar Syed Ataullah Rishav Raj Pallabi Chakraborty Supriya Raya Adhikari Deeksha Sharma <p><strong>Introduction: &nbsp;</strong>Waste is physical things or unwanted materials that are of no use to the human beings.<sup>1</sup> Waste management is the activities and actions required to manage waste from its inception to its final disposal.</p> <p><strong>Objectives: </strong>The objective of study is to assess the management and awareness on health hazards of household waste in a community of Khopasi, Kavrepalanchowk district.</p> <p><strong>Methodology: </strong>&nbsp;The study design was descriptive cross-sectional and it was conducted from 10<sup>th</sup> November to 15<sup>th</sup> November 2019 at Khopasi, Kavrepalanchowk using convenience sampling technique in 281 households. The statistical package for social sciences (SPSS) version 20 was used for data entry and analysis. Descriptive statistics like frequency, mean, percentage etc was calculated.</p> <p><strong>Results: </strong>&nbsp;The mean age of 281 respondents was 44.89 years. Similarly 43.8% of respondents considered waste management as a major issue and 84.3% had knowledge about health hazards due to improper waste disposal. Forty-seven percentages of the respondents disposed of their waste through waste collecting vehicle, 26% by burning, 17% threw their waste by riverbank, and 9% threw their waste indiscriminately in the surrounding area.</p> <p><strong>Conclusion:</strong> The majority of respondents were aware about adverse effect on their health due to improper waste disposal. However the knowledge of waste management program is poor. They throw waste in the river bank or indiscriminately in open places.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Naresh Manandhar, Syed Ataullah, Rishav Raj, Pallabi Chakraborty, Supriya Raya Adhikari, Deeksha Sharma Utility of Triglyceride-Glucose index in predicting glycemic control in type 2 diabetes mellitus 2021-10-10T01:40:51+00:00 Santosh Timalsina Shishir Mahato Sandesh Nepal <p><strong>Introduction: </strong>Insulin resistance (IR) and glycemic control are two very important aspects to be considered during management of patients with Type 2 Diabetes Mellitus (T2DM). The triglyceride-glucose (TyG) index has been proposed as a simple and inexpensive parameter that correlates well with IR and glycemic control.</p> <p><strong>Objectives: </strong>To explore the association of TyG index (and other TyG derived indices) with glycated hemoglobin (HbA1c) and evaluate their predictive ability for glycemic control in patients with T2DM.</p> <p><strong>Methodology: </strong>This cross-sectional study comprised of 160 adult patients diagnosed with T2DM visiting the medical outpatient department of Chitwan Medical College, Bharatpur, Chitwan between July–December 2019. Socio-demographic data and anthropometric measurements were collected. Glycemic control was assessed by HbA1c. TyG index was calculated by the formula: ln [fasting TG (mg/dl) x fasting glucose (mg/dl)/2]. Receiver operating characteristic (ROC) curve analysis was performed to analyze the predictive ability of TyG-index for poor glycemic control.</p> <p><strong>Results: </strong>One hundred and sixty patients (mean age: 53.6 ± 10.7 years, 55.0% males) were included in the study. Eighty (50.0%) had good glycemic control (HbA1c &lt;7.0%). TyG index, along with TyG-BMI and TyG-WC (other TyG derived indices) were significantly increased in the poor glycemic control group. TyG index had a good predictive ability for poor glycemic control (AUC: 0.803, 95% CI: 0.731 – 0.874). A TyG cutoff ≥ 9.12 was optimal for predicting poor glycemic control, with 86.1% sensitivity and 61.5% specificity.</p> <p><strong>Conclusion: </strong>TyG index could be a simple and cost-effective screening tool for assessment of glycemic control in patients with T2DM.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Santosh Timalsina, Shishir Mahato, Sandesh Nepal Outcomes of corticosteroid injection and percutaneous release in treatment of trigger finger at tertiary hospital of Eastern Nepal. 2021-10-10T01:47:01+00:00 Mithilesh Kumar Gupta Ajay Chaudhary Ajay Mahato <p><strong>Introduction:</strong> Trigger finger or stenosing tenosynovitis is a common cause of painful fingers and thumb that result in painful triggering, snapping or locking of fingers on flexion and extension of involved digit. Available treatment options for this condition are NSAID, splints, intralesional steroid injection, percutaneous release and open release of tendon sheath.</p> <p><strong>Objectives:</strong> To study the clinical and functional outcomes and complications of corticosteroid injection and percutaneous release in management of trigger finger.</p> <p><strong>Methodology:</strong> In this prospective study, sixty patients who presented with Grade 2 to Grade 3 trigger finger were placed into two groups. Group A(30 patients) were treated with intralesional steroid (40 mg of methylprednisolone) injection. Group B (30 patients) underwent percutaneous surgical release of affected tendon sheath. Both group of patients were treated in outpatient department. Patients of both groups were then asked to follow on scheduled time interval of two-week, six-week, three-months and six-months of period and their progress were recorded.</p> <p><strong>Results:</strong> The baseline VAS score before intervention in group A (5.82) and group B (6.12) was statistically significant. In group B there was significant improvement of VAS score till 6 months of follow up. However, in group A there was significant improvement of VAS score by 3 months of follow-up, but by end of 6 months it again raised to 2.14. Yet it was far better than baseline VAS score.</p> <p><strong>Conclusion:</strong> In our study both corticosteroid injection and percutaneous trigger finger release were found to be much effective in management of trigger finger.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Mithilesh Kumar Gupta, Ajay Chaudhary, Ajay Mahato Knowledge and practice modifications regarding COVID-19 among dental practitioners of Nepal 2021-10-10T23:47:46+00:00 Rebicca Ranjit Pratik Manandhar Soni Bista Elijma Ranjit <p><strong>Introduction: </strong>COVID-19 has adversely gridlocked many sectors including dentistry. A good knowledge regarding the disease eventually determines the preparedness of dentists to provide relatively safe dental services.</p> <p><strong>Objectives: </strong>This research was conducted to evaluate knowledge and relevant practice modifications among dental practitioners of Nepal during COVID-19 pandemic.</p> <p><strong>Methodology: </strong>A cross-sectional online questionnaire survey was conducted among dental practitioners of all the provinces of Nepal. They were enquired for sociodemographic details and their knowledge, and the modifications they adopted while practising dentistry during this pandemic. The scores were summed up, and mean scores for knowledge and practice were calculated respectively which were further expressed as a percentage. Inferential statistics (Independent t-test and ANOVA, <em>p </em>&lt; 0.05) were used to examine differences between study variables.</p> <p><strong>Results: </strong>Out of 422 participants, most of them belonged to 31-40 years age group (178, 42.2%) and majority were females (246, 58.3%). Mean knowledge scores were significantly higher among practitioners of age ≥51 years, males, specialists, those working in both clinic and hospital, and those who have been practising dentistry for ≥10 years.&nbsp; Mean practice scores were significantly better among specialists.</p> <p><strong>Conclusion: </strong>The overall mean scores for knowledge was good (81.3%) while for practice, overall mean score was poor (44.6%). The main reason behind the poor practice modifications despite good knowledge score could be the lack of minimum requirements for infection control in developing countries like Nepal.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Rebicca Ranjit, Pratik Manandhar, Soni Bista, Elijma Ranjit Head and Neck Swelling: A Cytopathological Perspective in a Hospital Based Study. 2021-10-10T23:57:29+00:00 Sujan Shrestha Dinesh Khadka Sujita Bhandari <p><strong>Introduction</strong>: Fine Needle Aspiration Cytology is a simple, relatively less painful, cost-effective minimal invasive procedure commonly employed in the evaluation of head and neck swellings. There are limited studies on cytological findings of head and neck swelling in Nepal.</p> <p><strong>Objectives</strong>: The objective of this study was to study cytological findings of head and neck swellings. This study further intends to classify the nature of the swelling and use standardized international reporting system wherever required.</p> <p><strong>Methodology</strong>: This is a retrospective hospital-based study done in the Department of Pathology at the Helping Hands Community Hospital, Kathmandu between 1 January 2019 and 32 December 2019. Slides of all FNAC from head and neck swelling done during this period was retrieved and evaluated for the study. Chi-Squared (χ2) test was used to investigate the significance of epidemiological and cytological parameters.</p> <p><strong>Results</strong>: Males (56%) had more head and neck swelling than females (44%). The younger age group of less than twenty-five (&lt; 25) years had more frequency of head and swelling followed by the older age group of more than fifty (&gt;50) years. The most common site for Fine needle aspiration was lymph nodes (58%) followed by thyroid swelling (23%). Salivary gland swellings were the least frequent (5%). Of all the swelling, 17% of cases were attributed to malignant causes. Infective/Inflammatory causes (55%) were the most common cause of lymph node swellings. Metastatic carcinoma was more prevalent in the older age group of more than fifty (&gt;50) years with a prevalence of 21% of total cases studies. Most of the thyroid swellings were found to be benign (58%) whereas 16% of thyroid swellings belonged to the malignant category. The total numbers of salivary gland swelling were the least with 55% of cases having benign neoplastic etiology. Diagnosis of developmental anomalies like a thyroglossal cyst, lymphangioma, branchial cyst, though relatively less common (10%) were also made with the help of cytologic studies.</p> <p><strong>Conclusion</strong>: Fine Needle Aspiration is a useful method to differentiate benign and infective cases of head and neck swelling from neoplastic cases.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Sujan Shrestha, Dinesh Khadka , Sujita Bhandari Epidemiology of risk factors of various morphological types of age-related cataract in eastern region of Nepal 2021-10-11T00:18:30+00:00 Namrata Gupta Poonam Lavaju Sangeeta Shah Badri Prasad Badhu <p><strong>Introduction:</strong> Age related cataract is the leading cause of preventable blindness globally, with multifactorial risk factors. Multiple mechanism contributes to the progressive loss of lens transparency.</p> <p><strong>Objective: </strong>The purpose of this study is to determine the risk factors for different morphological types of senile cataract in eastern region of Nepal.</p> <p><strong>Methodology: </strong>&nbsp;A hospital based cross sectional study was conducted in a tertiary care hospital. Four hundred patients aged ≥ 50 years with senile cataract attending eye out patient department for one year were enrolled and divided into two groups based on Lens Opacities Classification System (LOCS) III grading. Group A consisted of ‘<em>no-moderate’</em> cataract and group B consisted of ‘<em>severe</em>’ cataract. The parameters studied were age, gender, education, occupation, smoking, alcohol consumption, diabetes and hypertension, body mass index and use of topical or oral medication. Statistical analysis was conducted to find an association of various parameters to different morphological type of cataract.</p> <p><strong>Results: </strong>The mean age of presentation was 61±9.07 years. Male to female ratio was 1:02. Group A had 154 and group B 246 patients respectively. Statistically significant association was seen between older age group and severe cataract (p &lt;0.002). Household activities and moderate alcohol consumption alcohol was seen associated with moderate nuclear sclerosis (p &lt;0.001) and posterior sub-capsular cataract (p &lt;0.003) respectively. High blood pressure was associated with severe Nuclear Sclerosis and Posterior Subcapsular Cataract (p &lt;0.014).</p> <p><strong>Conclusion: </strong>Older age groups, household activities, moderate alcohol consumption and high blood pressure were found to have significant association with age-related cataract.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Namrata Gupta, Poonam Lavaju, Sangeeta Shah, Badri Prasad Badhu Validity of Ottawa Knee Rules at a Teaching Hospital of Eastern Nepal 2021-10-11T00:44:48+00:00 Bibhuti Nath Mishra Santosh Nepal Surya Bahadur Parajuli <p><strong>Introduction: </strong>Knee injuries are encountered frequently in Orthopedic emergency and Outpatient departments. Radiographs are routinely ordered in them, but not all of them demonstrate clear fractures. The decision for radiography based on subjective evaluation can help to reduce cost, decrease waiting time, and unnecessary radiation exposure. We lack this information in our context.</p> <p><strong>Objective: </strong>The objective of this study was to find the validity of the Ottawa knee rule (OKR) in patients presenting with acute knee injuries at a teaching hospital in eastern Nepal.</p> <p><strong>Methodology: </strong>A cross-sectional study was conducted from March 2018 to February 2019 including 210 cases of acute knee injuries. The patients were evaluated as per OKR and their X-rays were evaluated too. Collected data were entered in MS Excel and analyzed by SPSS for validity.</p> <p><strong>&nbsp;</strong></p> <p><strong>Results: </strong>Out of the total of 210 eligible patients (122 males and 88 females) with a mean age of 43.97 years, the radiography rate was 100% but the yield rate was only 10.5%. Overall 69% of patients presented to the hospital within 24 hours of the injury and direct hit/trauma was the commonest mode of injury. Patella fractures were commonest followed by proximal tibia fractures. There was a high sensitivity of 100% and a specificity of 42.02%.&nbsp; The rule yielded a Positive and Negative Predictive value of 16.79% and 100%, respectively. The OKR, if applied correctly, could result in radiography rate reduction by 37.61%. The Fisher exact test result was significant at p&lt;0.05.</p> <p><strong>Conclusion: </strong>OKRs is a valid tool to predict fractures in patients who has a history of acute knee injuries without chances of missing fractures. This rule can reduce unnecessary radiography in our setup as well.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Bibhuti Nath Mishra, Santosh Nepal, Surya Bahadur Parajuli Morphometric Study of Pituitary Gland with Correlation of Age and Gender using Magnetic Resonance Imaging 2021-10-11T00:56:18+00:00 Sunima Maskey Dil Islam Mansur Subindra Karki Pragya Shrestha <p><strong>Introduction:</strong> The pituitary gland is the master gland of the body. It’s size varies with age and gender. MRI is the safest and effective diagnostic tool for pituitary gland examination.</p> <p><strong>Objectives:</strong> This study was aim to determine the anteroposterior, height and transverse dimensions of normal&nbsp; pituitary gland in different age groups of both sex with MRI.</p> <p><strong>Methodology:</strong> It was a descriptive cross-sectional study. It consisted of 567 images of individuals (242 males and 325 females) of various age from 20 to 70 years from the Department of Radio- diagnosis, Dhulikhel Hospital<strong>.</strong></p> <p><strong>Results:</strong> The mean anteroposterior, height and transverse dimension of pituitary gland is 9.74±1.18 mm, 5.95±1.11 mm and 11.65±2.15 mm respectively in which females have higher value. Independent sample t test showed highly significant differences (p&lt; 0.05) between the mean anteroposterior dimension in males and females. The present study showed the mean value of anteroposterior dimension is maximum at age group 50-59.&nbsp; The mean value of height, transverse dimension and volume of males and females is maximum at 20-29 age group and minimum at 70-79 age group. One way ANOVA shows that there is significant difference between in height, transverse dimension and volume at different age group (p&lt; 0.05).</p> <p><strong>Conclusion:</strong> It was concluded that the height and volume of pituitary gland is maximum at second decade of life then it gradually decreases with age. The mean value of anteroposterior, height and transverse dimension showed greater value of females than males.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Sunima Maskey, Dil Islam Mansur, Subindra Karki, Pragya Shrestha Outcome of Tobacco Smoking Habit on Lipid Peroxidation and Antioxidant parameters in Anemic Individuals 2021-10-11T23:59:45+00:00 Nirjala Laxmi Madhikarmi Madhav Gautam <p><strong>Introduction: </strong>Globally tobacco smoking is considered as a foremost public health problem. Erythrocytes membrane lipids are rich in polyunsaturated fatty acids and the oxidative effects of oxygen on its membrane are greater than other tissues and the condition is heightened by tobacco smoke.Free radicals present in the tobacco increases peroxidation products in blood and vascular tissues are chiefly responsible for harmful effects.</p> <p><strong>Objective: </strong>The present study was designed to investigate the impact of stress induced by tobacco smoke on lipid peroxidation and antioxidant parameters in patients with anemia.</p> <p><strong>Methodology: </strong>A hospital-based case-control study was carried out in Kantipur Dental College Teaching Hospital, included 150 tobacco smoking anemic and 150 healthy volunteers. The stress parameter was assessed by the determination of malondialdehyde, lipid hydroperoxide and nitric oxide. The non-enzymatic antioxidants such as vitamins A, C and E and total antioxidant activity and enzymatic antioxidants were catalase, superoxide dismutase and glutathione peroxidase were also determined.</p> <p><strong>Result: </strong>Hemoglobin level in anemic smokers showed raised level as compared to healthyindividualsbut there was diminished antioxidants status and elevated free radical parameters in anemic smokersdespite their raised hemoglobin status.We found statistically increased malondialdehyde, lipid hydroperoxide and nitric oxide levels and decreased enzymatic and non-enzymatic antioxidant status, thus increasing the oxidative stress.</p> <p><strong>Conclusion: </strong>The present study showed high concentration of hemoglobin, low status of non-enzymatic antioxidants and high levels of oxidants as compared to controls reflecting the destructive and oxidative effects of tobacco smoke.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Nirjala Laxmi Madhikarmi, Madhav Gautam Assessment of Sexual Dimorphism from the Mastoid Triangle Using 3d CT scan in Nepalese Population 2021-10-12T00:11:04+00:00 Pankaj Kumar Singh Raj Kumar Karki Abdul Sami Khan Dhiraj Kumar Shah Sushant Bhardwaj <p><strong>Introduction:</strong> Skull plays an important role, second only next to pelvis for sex determination. In skull, mastoid and occipital region due to its anatomical location is the most protected region, offering high resistance to decomposition and any form of tempering. With the intension of studying sexual dimorphism in the mastoid region involving mastoid process, we initiated this study. The technique we adopted was first introduced by Paiva and Segre, i.e. measuring the distance between three cranio-metric land mark (Porion, Mastoidale, and Asterion) and calculating the area of the triangle to study sexual dimorphism.</p> <p><strong>Objective:</strong> The objective of this study is to determine sex based on mastoid triangle dimensions measured in 3D reconstructed computed tomography of the skull.</p> <p><strong>Methodology:</strong> The study included 196, 3D reconstructed CT scan images of skull, 98 of which were males and 98 of which were females. The three craniometric points were marked to demarcate the mastoid triangle on both side (mention the software used).Heron’s formula was used for measurement of mastoid triangle areas.</p> <p><strong>Result:</strong> Descriptive statistics and the student t-test revealed that males have larger mastoid triangle dimensions in all measurements than females, with a significant difference (<em>p&lt;0.000</em>) between them. The paired t-test revealed no statistically significant difference (<em>p&lt;0.05</em>) between the right and left sides. Apart from angle asterion (<em>p&lt;0.05</em>) on the right side, no other mastoid triangle angles on either side showed a significant difference. The predictability of mastoid triangle measurements and areas was determined using a discriminant function and ROC curve analysis. The calculated mastoid triangle measurements and areas were 72.5 % of Asterion to Porion, 74.5 % of Asterion to Mastoidale, 86.3 % of Mastoidale to Porion, and 88.2 % of areas, respectively.</p> <p><strong>Conclusion:</strong> The study findings suggest that mastoid triangle could be used to determine gender in the case of fragmentary skull remains by the forensic experts in the course of investigation. In order to generalize the data nationally, an autopsy-based, large sample size study on different age groups should be conducted.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Pankaj Kumar Singh, Raj Kumar Karki, Abdul Sami Khan, Dhiraj Kumar Shah, Sushant Bhardwaj Sexual Dimorphism in Maxillary First Molar among Nepalese Population of Eastern Nepal 2021-10-12T01:35:03+00:00 Sanjib Kumar Sah Suman Pokhrel Umesh Kumar Mehata Raju Kumar Chaudhary Rajesh Kumar Shah <p><strong>Introduction: </strong>Sexual dimorphism refers to differences in size, stature and appearance between male and female. It is a known fact that tooth crown is formed to full size in childhood even before eruption into oral cavity. The shape and size of the teeth permits an interesting dimension of study for sexual dimorphism, we aimed to delineate the sexual dimorphism by measuring the mesiodistal (MD) and buccolingual (BL) diameters of permanent maxillary first molar in Nepalese population of Eastern Nepal.</p> <p><strong>Objectives: </strong>The aim of this study was to evaluate the sexual dimorphism in maxillary first molar among Nepalese population of eastern Nepal</p> <p><strong>Methodology:</strong> 100 participants of either sex (50 males &amp; 50 females) aged between 17 to 25 years were enrolled in the study. After thorough dental examination, impression of the maxillary arch was made and MD diameter and BL diameters were measured with the help of vernier caliper. A P value of &lt;0.05 was considered as statistically significant.</p> <p><strong>Results:</strong> Sexual dimorphism was found in MD and BL diameters of maxillary first molar in males measuring higher than females. Right mesiodistal showed the highest sexual dimorphism, whereas right buccolingual showed the least.</p> <p><strong>Conclusions:</strong> This study confirms that permanent maxillary first molar shows significant sexual dimorphism, out of which mesiodistal measurement stands out to be the best parameter in Nepalese population of Eastern region.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Sanjib Kumar Sah, Suman Pokhrel, Umesh Kumar Mehata, Raju Kumar Chaudhary, Rajesh Kumar Shah Mortality from Burn: An Autopsy Based Study from Nepal 2021-10-12T08:33:10+00:00 Madan Prasad Baral Sidarth Timsinha <p><strong>Introduction: </strong>In developing countries like Nepal&nbsp;burn deaths are a major public health problem due to their increased mortality, morbidity and long-term disability. A few clinical studies on burns have been reported from Nepal however, autopsy based studies on burns are limited.</p> <p><strong>Objectives: </strong>To study the socio-demographic characteristics of victims of burns and evaluate the cause and magnitude of fatal burn injuries retrospectively.</p> <p><strong>Methodology: </strong>A two years retrospective analysis of burn deaths brought for autopsy was conducted from January 2017 to December 2018 in a central level hospital of Nepal.</p> <p><strong>Results: </strong>Out of 775 total cases autopsied 38 (4.90%) cases were burn related deaths. The majority of the deaths 17(44.70%) occurred in the age group 21-30 years with a preponderance in females 22(57.89%). Majority of the victims were married females 25(65.78%) and most of them were housewives 14(36.84%). Flame burn 23(60.52%) was the most common cause of all burns. The Total Body Surface Area (TBSA) Burn between 50-69% was observed in majority of the cases 27(71.05%).Most of the victims 15(39.47%) survived over 10 days post injury. Burn incidents were mainly accidental 33(86.84%) in nature followed by suicidal burns 5(13.15%). The main cause of burn death was septicemic shock 16(42.10%) followed by neurogenic shock 10(26.31%).</p> <p><strong>Conclusion</strong>: The results of this study show that burns injuries are mostly accidental in nature; therefore, the risks of burn injuries should be rightly addressed and appropriate burn prevention strategies should be developed to reduce the frequency and burn related deaths.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Madan Prasad Baral, Sidarth Timsinha The Incidence of Atlanto-Occipitalization and Additional Foramina Present in The Dry Skulls of Nepalese Population 2021-10-12T09:00:43+00:00 Rubina Shakya Nirju Ranjit Shamsher Shrestha <p><strong>Introduction: </strong>Atlanto-occipitalization(AOZ) is one of the congenital anomalies related to craniovertebral synostosis. The clear understanding of its anatomical features and cranial foraminal variants plays a critical role in finding the possible coping mechanism with its pathogenesis such as segmental instability or neurologic deficits.</p> <p><strong>Objective: </strong>This study aimed to investigate the incidence of occipitalization of Atlas and related variant foramina, as the baseline awareness of these conditions among the Nepalese population is yet to be documented.</p> <p><strong>Methodology: </strong>A retrospective study was performed for the total 86 dry skulls available in the department of Anatomy in Katmandu University of Medical Sciences, Institute of Medical Science, and B.P. Koirala Institute of Health Sciences. The skulls were examined thoroughly to evidence the occurrence of cranio-vertebral variations.</p> <p><strong>Result: </strong>Out of 86 human adult skulls, 2 cases (2.32 %) were found with partial AOZ presenting posterior spina bifida close to the midline. Sphenoidal emissary foramen (SEF) was also observed in 17 skulls (19.76 %), an additional foramen lying anteromedial to the foramen ovale. Moreover, one of the skulls (1.16 %) was found with the presence of pterygospinous bar creating an additional foramen ‘foramen of Civinini’ in the lateral pterygoid plate of the sphenoid bone.</p> <p><strong>Conclusion: </strong>The incidence of AOZ and pterygospinous bar seems to be quite low as compared to the cases of SEF. However, the knowledge of such variations and the presence of additional foramina carry great significance for orthopedists and neurosurgeons to have prognostic implications and an accurate surgical approach.&nbsp;</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Rubina Shakya, Nirju Ranjit, Shamsher Shrestha Lumbosacral Transitional Vertebrae in patients attending a Tertiary Care Hospital of Nepal 2021-10-12T09:10:03+00:00 Sanzida Khatun Diwakar Kumar Shah <p><strong>Introduction: </strong>Lumbosacral Transitional vertebrae are congenital anomalies of lumbosacral vertebral junction. It may present either as sacralization of fifth lumbar vertebrae or lumbarization of first sacral vertebrae. Various secondary pathological spinal conditions such as intervertebral disc herniation and/or degeneration, facet joint arthrosis and spinal canal or foraminal stenosis are associated with the presence of LSTV. The failure in the identification may lead to clinical consequences such as errors in diagnosis of disease and lumbosacral procedures.</p> <p><strong>Objective: </strong>The aim of this study was to determine the prevalence and patterns of LSTV in patients presenting to Department of Radiology of Nobel Medical College Teaching Hospital, Nepal..</p> <p><strong>Methodology: </strong>A descriptive cross-sectional study was conducted in Department of Radiology of Nobel Medical College Teaching Hospital, Nepal.Plain radiographs including Antero-posterior (AP) and Lateral views of lumbosacral spine of 343 patients referred for the scan were analyzed for the presence of lumbosacral vertebrae.</p> <p><strong>Result: </strong>Out of 343 patients, LSTV was found in 61 (17.8%) subjects. Thirty-eight subjects (11.1%) exhibited sacralization and 23 (6.7%) showed lumbarization.Out of total LSTV subjects,&nbsp; type I A was present in 8 (13.1%), type I B in 21 (34.4%), type II A in 10 (16.4%), type II B in 5 (8.2%) , type III A in 6 (9.8%) , type III B in 9 (14.8%) and type IV in 2 (3.3%).</p> <p><strong>Conclusion: </strong>The LSTV is prevalent in almostone-fifth of subjects presenting to department of radiology of Nobel Medical College and Teaching Hospital, Biratnagar for lumbosacral scan.. Sacralization occurs more frequently than lumbarization, both of which alter the morphology of anatomical structures in spine. The presence of anomaly in this region may be related to occurrence of various pathological and clinical conditions.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Sanzida Khatun, Diwakar Kumar Shah Fetal Outcome of Term Pregnancy with Non-Reactive Non-Stress Test at Birat Medical College Teaching Hospital 2021-10-12T09:23:52+00:00 Amit Deo Raj Deb Mahato Ram Bhakta Subedi Tarun Pradhan <p><strong>Introduction</strong><strong>: </strong>Non-stress test (NST) in pregnancy helps to detect fetuses which are at risk of developing hypoxia. In general, reassuring NST indicates good fetal outcome while non-reassuring NST may result in abnormal perinatal outcome.</p> <p><strong>Objectives: </strong>The objective of this study is to detect the fetal outcome among term uncomplicated pregnancies with Non-reactive NST in Birat Medical College Teaching Hospital.</p> <p><strong>Methodology: </strong>A cross-sectional study conducted for 6 months in the department of Obstetrics and Gynaecology at Birat Medical College Teaching Hospital. Singleton pregnancies with longitudinal lie and cephalic presentation between 37 to 42 weeks Period of gestation were included in the study. All participants were advised for a NST as an institutional protocol for 20 minutes at the time of admission. Participants with Non-reactive NST were counselled and planned for emergency LSCS as per hospital protocol. Participants were followed up for intraoperative findings such as colour of liquor and umbilical cord abnormality and outcome of fetus were assessed for APGAR score and need for NICU. The collected data was entered in Microsoft Excel and analyzed by using SPSS version 22.</p> <p><strong>Results: </strong>Out of 115 pregnant women, the mean age and standard deviation of 24.93±4.68 years. Decelerations was found in 35(30.4%), Decreased baseline variability was found in 33(28.7%), Persistent fetal tachycardia was found in 23(20%) and Decreased baseline fetal heart was found in 24(20.9%). Intraoperative meconium-stained liquor was found in 39(33.9%) of patients. All babies born were shown APGAR score &gt; 7 at 5 minutes. 14(12.2%) babies were admitted to the Neonatal intensive care unit (NICU). Correlation of admission NST was not found statistically significant with fetal outcome.</p> <p><strong>Conclusion: </strong>LSCS for abnormal NST does not show adverse fetal outcome.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Amit Deo, Raj Deb Mahato, Ram Bhakta Subedi, Tarun Pradhan Lymphocyte-Neutrophil Ratio in the Diagnosis of Tubercular Pleural Effusion in a Tertiary Care Centre: A Descriptive Cross Sectional Study 2021-10-13T06:32:09+00:00 Rajneesh Jha Ram Kumar Mehata Puru Koirala <p><strong>Introduction: </strong>Tuberculosis is a common infection in our community. Tubercular pleural effusion is the second most common form of extrapulmonary tuberculosis. Among the several causes of exudative pleural effusison tubercular remains the most common form in clinical practice. The aim of this study was to evaluate the significance of lymphocyte-neutrophil ratio(LN ratio) in cases of exudative effusion for diagnosis of tubercular effusion.</p> <p><strong>Methods: </strong>This was a hospital based cross sectional studydone in Patients at tertiary care hospital from 1<sup>st</sup> September 2020 to 1<sup>st</sup> april 2021after taking ethical clearance from institutional reviw committee. Convienience samplingwas done. Statistical Analysis of data like percentages and frequencies&nbsp; were used for categorical variables. Mean and SD (standard deviation) were used for describing continuous variables. Inferential statistical tools like Chi-Square test and Student’s t-test were used. P-value of &lt;0.05 was considered statistically significant.</p> <p><strong>Results: </strong>out of 200 cases 75% were tubercular pleural effusion and these cases were found have high levels of LN ratio (0.89 ± 0.11 for females and 0.97 ± 0.14 for males) and ADA (137.79 ± 44.61for females and 147.61 ± 51.64 for males) and more than 90% sensitivity and specificity of LN ratio and ADA level.</p> <p><strong>Conclusion: </strong>Exudative pleural fluid L/N ratio &gt;0.75 is an efficient means of diagnosing tuberculous pleural effusion and its combination with ADA level gives us more accuracy and surety about the diagnosis of tubercular pleural effusion.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Rajneesh Jha, Ram Kumar Mehata, Puru Koirala Perception of Online Lectures among Undergraduate Medical, Dental and Nursing Students during COVID-19 Pandemic: a Cross-Sectional Study at a Tertiary Teaching Hospital 2021-10-13T06:44:03+00:00 Deependra Prasad Sarraf Gajendra Prasad Rauniar Basant Kumar Karn Ramayan Prasad Kushwaha Shashi Keshwar <p><strong>Introduction: </strong>The COVID-19 pandemic significantly affected medical education and has forced educators to switch to online teaching-learning activities worldwide. Online teaching-learning activities has ensured the safe delivery of the lectures to the students.</p> <p><strong>Objective:</strong> To assess the perception of students towards online lectures and to analyze the perceived barriers to online learning in our context during the COVID-19 lockdown period.</p> <p><strong>Methodology: </strong>A cross-sectional online descriptive study was conducted among undergraduate students at a tertiary teaching college in Eastern Nepal during September-November 2020. The link of the Google form consisting of the semi-structured questionnaire was sent to the students through email. Descriptive statistics frequency and percentage were calculated using Microsoft Excel 2010. The study was approved by the Institutional Review Committee (IRC/2069/20).</p> <p><strong>Results: </strong>A total of 211 students participated in the study. Mean age of the students was 20.5±1.5 years. Out of 211, 130 (61.61%) students used smartphones to attend online lectures and 176 (83.41%) students had not attended any online classes before the COVID-19 pandemic. The most common perceived advantage of the online lectures was availability of recorded lectures (186, 88.15%) whereas reduced interaction (179, 84.83%) was the most common disadvantage. More than half (126, 59.72%) of the students disagreed/strongly disagreed that online lectures are more effective than traditional face-to-face lectures.</p> <p><strong>Conclusions: </strong>Most of the students had negative perception towards the online lectures. The study findings recommend using a hybrid of conventional face-to-face classroom based teaching and newer online teaching-learning activities for delivering medical education.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Deependra Prasad Sarraf, Gajendra Prasad Rauniar, Basant Kumar Karn, Ramayan Prasad Kushwaha, Shashi Keshwar Histopathological Distribution of the Gastrointestinal Tract Lesions 2021-10-13T07:10:25+00:00 Mrinalini Singh Santosh Upadhyaya Kafle Neeta Kafle Amrita Sinha Prasun Rajbhandari <p><strong>Introduction: </strong>Gastrointestinal (GI) diseases are common and can affect any portion of the gastrointestinal tract from the mouth to the anus<strong>.</strong>&nbsp; Diseases can just shows clinical conditions like stomach pain, constipation, diarrhea which can be self- limiting. But sometimes disease may be life-threatening like malignancy. Biopsy is necessary for confirmatory diagnosis and further treatment of the patient. So histopathologic examination is &nbsp;a must for all surgical procedures for confirmation and categorization of GI disorders.</p> <p><strong>Objectives: </strong>This study was done to find out the various patterns of lesions of the gastrointestinal tract with its commonest age group and sex involvement</p> <p><strong>Methodology</strong><strong>: </strong>This was a prospective study of all the surgically resected GI tissue received in the Department of Pathology Histopathology unit in Birat Medical College and Teaching Hospital (BMCTH) from 1<sup>st</sup> February 2021 to 30 <sup>th</sup>April 2021.The hematoxylin and eosin stain slides of the GI tissue received were studied and the lesions were diagnosed on their histomorphology.&nbsp; According to organ, age and sex, the lesions were categorized. The data were entered in Microsoft excel and the percentage value was calculated.</p> <p><strong>Results: </strong>Out of the total 344 cases 146(42.44%) were male and 198(57.56%) were female patients. The most common age range for GI lesions was 41 to 60 years comprising of 126(36.62%) of total cases. Maximum numbers of cases 160 (46.50%) were of cholecystectomies followed by appendectomies 95(27.60%). Inflammatory and benign lesions comprised 332(96.51%), 9(2.61%) were malignant tumor and 3(0.88%) were premalignant lesions. The most common inflammatory lesions and malignant tumors were chronic cholecystitis and gastric adenocarcinoma respectively</p> <p><strong>Conclusions: </strong>The study identifies that gastrointestinal lesions comprise of the most common biopsies received in the histopathology department. Early diagnosis of premalignant and malignant lesions can improve the overall survival rate of patients.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Mrinalini Singh, Santosh Upadhyaya Kafle, Neeta Kafle, Amrita Sinha, Prasun Rajbhandari Association Between Body Mass Index and Blood Pressure Among Medical Students of Tertiary Care Teaching Hospital in Birgunj 2021-10-13T07:22:34+00:00 Esha Shrestha Shreesh Shrestha Prashanna Shrestha Nirjala Laxmi Madhikarmi <p><strong>Introduction:</strong> Body mass index is an important parameter associated with a variety of disease processes. The risk of hypertension and cardiovascular diseases increases with an increase in body mass index. The study was conducted to compare the relationship between body mass index and blood pressure.</p> <p><strong>Objective: </strong>To evaluate the prevalence and correlate the Obesity and Hypertension in&nbsp;&nbsp;&nbsp; medical students</p> <p><strong>&nbsp;Methodology:</strong> The study was conducted in 200 students (113 males and 87 females). Height, weight and blood pressure were recorded from all participants and body mass index was calculated. The recorded body mass index was utilized to divide the student into underweight, normal, over weight and obese category according to the World Health organization body mass index classification. Hypertension was determined from the measure of blood pressure. Then comparison of blood pressure with body mass index was made.</p> <p><strong>Results:</strong> Among 200 students 6% were obese, 22% were overweight, 65% were normal and 7% underweight. The mean height was 163cm and mean weight 60.48kg. The mean value of systolic blood pressure (105.85, 115.45, 134.95, 137.16 mmHg) and diastolic blood pressure (70.14, 76.15, 90.72, 93.33 mmHg) increased with increasing body mass index.</p> <p><strong>Conclusion:</strong> Overweight and obesity increases the risk of hypertension among students.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Esha Shrestha, Shreesh Shrestha, Prashanna Shrestha, Nirjala Laxmi Madhikarmi A survey of nurses’ opinions about delirium in ICU 2021-10-13T07:31:14+00:00 Nikeshmani Rajbhandari Naba Raj Koirala Lalit Kumar Rajbanshi Batsalya Arjyal <p><strong>Introduction: </strong>Delirium is underdiagnosed especially in ICU. In a study done in the Netherlands investigators found not only ICU nurses but also intensivists had difficulty in diagnosing delirium. With the impact that delirium has on patients’ health, its monitoring and detection should be considered an integral part of patient care in critical care medicine, Knowledge and attitude are one of the primary unmet needs regarding early detection and treatment of delirium. Since nurses are the first line assessors in any ward we would like to carry out this cross-sectional survey on a group of nurses.</p> <p><strong>Objective: </strong>To assess the nurses’ knowledge about delirium &amp; to compare the knowledge between those that have worked in ICU or critical care to those who haven’t.</p> <p><strong>Methodology: </strong>This was a cross-sectional survey carried out at Birat medical college and teaching hospital. Here all nurses were requested to fill a questionnaire that consisted of 15 questions. A time-frame of 1 week was taken to gather the data.</p> <p><strong>Results: </strong>We collected data from 124 nurses, who had varying educational degrees, Eighty-four were currently working in an ICU and 32.5% of those not working had previously worked in an ICU. Over all knowledge level for nurses was poor where 94 of 124 nurses had less than 50% scores. About 27% of those who had worked in an ICU setting had good knowledge compared to 17.5% of those who had not. &nbsp;</p> <p><strong>Conclusion: </strong>Training regarding delirium is required to increase identification and adequate management to decrease morbidity due to delirium.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Nikeshmani Rajbhandari, Naba Raj Koirala, Lalit Kumar Rajbanshi, Batsalya Arjyal Prevalence of Anemia among Children Diagnosed with Pneumonia Attending Birat Medical College Teaching Hospital, Morang, Nepal 2021-10-13T07:44:44+00:00 Chandra Bhushan Jha Hem Sagar Rimal Ram Bhakta Subedi <p><strong>Introduction: </strong>Childhood pneumonia is the leading cause of serious illness and death worldwide. In developing countries, pneumonia is the biggest single cause of childhood death under the age of 5 years. Globally, anemia is a major nutritional problem of immense public health significance. Iron deficiency anemia in children occurs most frequently between the age of 6 months and 3years, the same period of age when repeated infections occur.</p> <p><strong>Objective: </strong>The main objective of this study is to determine the prevalence of anemia among children diagnosed with pneumonia.</p> <p><strong>Methodology: </strong>This is a hospital based cross sectional study carried out in the Department of Paediatrics, Birat Medical College Teaching Hospital, from 15<sup>th</sup> February 2020 to 15<sup>th</sup> August 2020. This study was performed on 150 pneumonic children between 6 to 60 months of age. History regarding fever, cough and fast breathing was taken.&nbsp; All the data were recorded in the preformed proforma. Data was analyzed using SPSS version 16.</p> <p><strong>Results:&nbsp; </strong>This study was performed on 150 pneumonic children, in which male babies (n=93; 62%) outnumbered the female babies (n=57; 38%). The majority of children were in the age group of 6 to 24 month (n=85; 56.7%). The mean hemoglobin level was 9. 49±1.39 gm/dl. The hemoglobin level less than 11 gm/dl was seen in 102 (68%) cases. Microcytic hypochromic anemia was present in 73 (71.6%) children.</p> <p><strong>Conclusion: </strong>The prevalence of anemia among the pneumonic children of 6-60 months is 68% that is higher than the national data (52.6%) of prevalence of anemia in the same age group. While treating childhood pneumonia, checking hemoglobin on regular basis will be very useful to diagnose and manage concurrent anemia</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Chandra Bhushan Jha, Hem Sagar Rimal, Ram Bhakta Subedi Attitudes of Health Care Professionals on Parental Presence During Invasive Procedures and Resuscitation: A Cross-sectional Study in Eastern Nepal 2021-10-13T07:59:26+00:00 Shyam Prasad Kafle Mukesh Bhatta Namu Koirala Anupam Koirala <p><strong>Introduction: </strong>Trends are changing to allow parents and families to be with their child during invasive procedures. Because of the intense workload, there is a tendency to overlook the parents’ feelings. Attitudes of physicians and nurses are the common obstacles for this.</p> <p><strong>Objective:</strong> To determine health care professionals’ attitudes toward parental presence during invasive procedures.</p> <p><strong>Methodology: </strong>A cross-sectional study was conducted among the health professionals in the department of Paediatrics and Adolescent Medicine of a tertiary care center in Eastern Nepal. Ethical clearance was obtained from the Institutional Review Committee of the institute. Total sample size was 112 (83 nursing staff and 29 physicians). Attitudes of physicians and nursing staff towards parental presence during various invasive procedures were recorded in the predesigned proforma. Data was entered in MS Excel and analysed using SPSS version 21.0. Frequency, percentage, mean, standard deviation, chi-square test, independent t-test and one-way ANNOVA were used for data analysis at p&lt;0.05.</p> <p><strong>Results: </strong>Simple procedures like intravenous blood sampling and the simple wound repair or suture majority of the health professionals (71.1% to 79.3%) agreed for parental presence. Other major procedures including resuscitations, majority (69.0 % to 85.5%) disagreed for the parental presence. The most important factors considered was the child’s request (62.1% to 80.7%) for parental presence. The major likely reason for declining was unjustly blaming the medical staff for common/ simple complications (69.9%). Only for the simple wound repair, statistically significant differences were noted between the physicians and the nursing staff (p= 0.033) on the basis of years of experiences where the physicians preferred for the parental presence.</p> <p><strong>Conclusion: </strong>Both the physicians and the nursing staff preferred not to allow the parents in the major invasive procedures including resuscitations whereas when the level of invasiveness decreased, the rate of approval increased in both the groups.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Shyam Prasad Kafle, Mukesh Bhatta, Namu Koirala, Anupam Koirala Study on Estimation of Serum Prostate Specific Antigen Level and Prostate Volume with Trans-Abdominal Ultrasonography Finding in Benign Prostate Hypertrophy at Tertiary Care Hospital : A Cross Sectional Descriptive Study 2021-10-13T08:12:22+00:00 Chandra Prakash Gaire <p><strong>Introduction: </strong>The periurethral and transition zones of the prostatic gland develop benign prostatic hyperplasia and represent an inevitable phenomenon for the ageing male population. Prostatic specific antigen, is a serine protease, level rises in the blood if the barrier between thelining epithelium and the blood stream is damaged. Benign prostatic hyperplasia, prostatic carcinoma and prostatitis are three common diseases where PSA in the serum is raised. Prostate volume also increases according to age, which can be estimated by trans-abdominal ultrasonography.</p> <p><strong>Objective: </strong>The aim of the study is to estimate the PSA level in blood and its relationship with prostate volume in benign prostatic hyperplasia patients.</p> <p><strong>Methodology: </strong>It is a descriptive cross-sectional study which was carried out between a periods of 1<sup>st</sup> April 2018 to 31<sup>st</sup> March 2019 at <strong>Birat Medical College Teaching Hospital</strong>. All the patients diagnosed with benign prostate hyperplasia at the department of urology were included in the study. Blood samples of patients were analyzed for Prostate specific antigen level estimation by chemiluminescence immunosorbent assay. Prostatic volume of the patients was measured by Transabdominal ultrasound technique. Data were entered and analyzed in Microsoft Excel.</p> <p><strong>Results: </strong>A total of 68 patients were diagnosed with benign prostate hyperplasia. The mean age of the patients was 61.8±12.3 years. The maximum number 23 of patients with BPH was there in age group 51-60. The maximum no of patients 38 were having their PSA level between the range of 4.0-10.0 ng/ml. The maximum no of patients 28 was having Prostate volume in the range of 40-60 gm. The maximum number of patients 31 was having diabetes mellitus as a co-morbid association. The maximum mean PSA level and prostate volume in the patients were observed in age group &gt;80 years,which was 20.1±8.6 ng/ml and &gt;80 gm respectively.</p> <p><strong>Conclusion: </strong>The prostate specific antigen level and prostate volume both increase in advance age group of patients suffering with benign prostate hyperplasia.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Chandra Prakash Gaire Loss of Sense of Smell and Taste among Reverse Transcriptase Polymerase Chain Reaction Positive COVID-19 Patients of a Tertiary Care Hospital: A Descriptive Cross-sectional Study 2021-10-13T08:22:58+00:00 Rajeev Shah Bipin Koirala Sangya Gyawali <p><strong>Results: </strong>A total of 166 patients were included in the study. The age of the patients ranged from 10 to 84 years with a mean age of 44.34 ± 23.059 years. Out of the 166 RT-PCR positive patients 103 (62%) had a loss of taste while 114 (68.7%) had a loss of smell. Nearly half of the subjects about 99 (51.6%) had dysfunction in both taste and smell.</p> <p><strong>Conclusions: </strong>The present study shows the strong association between the olfactory and gustatory dysfunction with that of COVID infection. Patients with loss of taste and smell should be evaluated properly at the time of COVID pandemic. Olfactory and Gustatory dysfunction can be the early and only manifestation of COVID infection.&nbsp;&nbsp; The prevalence of loss of smell and taste was similar to other studies done in similar settings.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Rajeev Shah, Bipin Koirala, Sangya Gyawali Identifying High Risk Pregnancy and Its Effectiveness in determining Maternal and Perinatal Outcome 2021-10-13T08:32:08+00:00 Junu Shrestha Sangeeta Devi Gurung Anjali Subedi Chandani Pandey <p><strong>Introduction: </strong>Identification of high risk pregnancy can be done by using various scoring systems which is highly predictive in determining maternal and perinatal outcome.</p> <p><strong>Objectives: </strong>The objectives of the study were to identify high- risk pregnancy and to compare the maternal and perinatal outcome of high-risk with low-risk pregnancies.</p> <p><strong>Methodology: </strong>This study was conducted in the department of obstetrics and gynaecology, Manipal Teaching Hospital, Pokhara, from 1st August 2020 to 31st January 2021. Study included pregnant women coming for delivery after 28 weeks of gestation.&nbsp; Antenatal scoring system involving various risk factors, was used to stratify women as low-risk (score 0-3), high-risk (score 4-6) and extremely high-risk group ( score ≥7). All women were followed up in intrapartum and postpartum period and complications noted. Neonates were also followed up. Maternal and perinatal outcome of three groups were compared.</p> <p><strong>Results: </strong>There were 67.3% women in low-risk, 20% in high-risk and 12.7% in &nbsp;extremely high-risk groups. Operative deliveries were 89.9% in extremely high- risk, 77.9% in high- risk as compared to 51% in low- risk group. Maternal complications, total amount of blood loss and duration of hospital stay was more in extremely high-risk and high-risk pregnancies. Low birth weight was more common in extremely high risk (60%) and high-risk (26%) pregnancies compared to low- risk pregnancies (15%). Neonates with low Apgar scores at 1 and 5 minutes were more in high-risk pregnancies. Thirty-two percent neonates in extremely high-risk pregnancy required neonatal intensive care admission which was significantly higher as compared to high-risk and low-risk pregnancies. Perinatal deaths were more frequent in extremely high-risk pregnancies.</p> <p><strong>Conclusions: </strong>Identifying high risk pregnancy using scoring system is useful to identify women at risk of developing maternal and perinatal complications.&nbsp;</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Junu Shrestha, Sangeeta Devi Gurung, Anjali Subedi, Chandani Pandey Association of Ultrasonography and Ultrasound-guided Fine Needle Aspiration Cytology in the Diagnosis of Thyroid Nodules 2021-10-26T00:51:42+00:00 Binit Dev Ajay Kumar Yadav Sushil Taparia Roshana Khadka Shripad J Walavalkar <p><strong>Introduction:</strong> Ultrasound (USG) is the most commonly used imaging method to evaluate thyroid nodules. The sonographic features of thyroid nodules are very important to determine whether the nodule is benign or malignant. Fine Needle Aspiration Cytology (FNAC) is the gold standard to determine whether the nodule is benign or malignant.</p> <p><strong>Objective:</strong> The purpose of this study was to compare ultrasound and color Doppler features of thyroid nodules with ultrasound-guided FNAC results to determine the relative importance of these features in predicting the risk of malignancy.</p> <p><strong>Methodology: </strong>This prospective cross-sectional study was conducted in Birat medical college teaching hospital in Tankisinuwari, Morang, Nepal. The study was conducted from September 2019 to April 2021.&nbsp; In total sixty-one patients with thyroid nodules were evaluated for sonographic characteristics. Finally, USG guided FNA for cytopathological examination was performed. Both descriptive and inferential statistics were used to analyze the result.</p> <p><strong>Results: </strong>Out of the 61 patients, 34 (55.7%) were females and 27 (44.2%) were males. Majority of the malignant nodules were solid 11 (91.6%), whereas cystic and mixed nodules were predominantly seen in benign nodules 18 (36.7%) and 30 (61.2%) respectively. In malignant nodules 10 (83.3%) were heterogeneous and 2 (16.6%) were isoechoic. In benign nodules 29 (59.1%) were heterogeneous and 15 (30.6%) were anechoic with comet-tail artifact and 5 (10.2%) were isoechoic. Among 12 malignant cases, internal and peripheral vascularity were equally present in six cases each. Benign nodules showed peripheral vascularity in 48 (97.9%) and internal vascularity was noted in only one nodule. All of the malignant nodules showed calcification. None of the benign nodules showed micro-calcification. In malignant cases, cervical lymph nodes were present in 7 (58.3%) and absent in 5 (41.6%). In benign cases, cervical lymph nodes were present in 4 (8.1%) and absent in 45 (91.83%).</p> <p><strong>Conclusion: </strong>The ultrasound features associated with malignancy in thyroid nodules are predominantly solid component, presence of micro-calcifications and internal vascularity. Enlarged cervical lymph nodes are good predictors for malignancy. USG guided FNAC confirms the suspicious features of thyroid nodules seen on USG.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Binit Dev , Ajay Kumar Yadav, Sushil Taparia, Roshana Khadka, Shripad J Walavalkar Traumatic Ulcerative Granuloma with Stromal Eosinophilia: Sinister Appearing Innocuous Lesion 2021-10-13T08:45:50+00:00 Shashi Keshwar Toniya Raut Mehul Rajesh Jaisani Ashish Shrestha <p>Trauma within the oral cavity is one of the common incidence of occurrence which can be an inducer as well as propagator for wide range of oral lesion of diverse course. A unique combination of formation of granulomatous lesion with reactive eosinophilic stromal infiltration in response of trauma is “traumatic ulcerative granuloma with stromal eosinophilia (TUGSE)”. It is a reactive, infrequent, self-limiting condition of oral mucosa. The commonly involved site and the clinical presentation might click to suspect it as a lesion of oral cancer. Clinical history and examination guide through the diagnosis whereas histopathology forms the basis of the diagnosis.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Shashi Keshwar, Toniya Raut, Mehul Rajesh Jaisani, Ashish Shrestha Dilemma in diagnosing Metabolic Disorder: A case of Galactokinase Deficiency with an unusual presentation 2021-10-13T08:53:35+00:00 Prasun Rajbhandari Hem Sagar Rimal Sonia Dahal <p>An infant with metabolic disorder can have vague presentations like repeated chest infections, feeding intolerance and failure to thrive. This may lead to a diagnostic dilemma.&nbsp; Detailed clinical history together with biochemical investigations are must to reach a diagnosis. Galactokinase Deficiency (GKD) has a varied presentation with some features like microcephaly, juvenile cataracts and failure to thrive. We encountered a case of GKD in an infant in which there was an absence of cataracts. Raised Immunoreactive Trypsinogen (IRT) in Newborn Screening was strongly suggestive of&nbsp; Cystic Fibrosis (CF), however Genetic Analysis revealed a heterozygous missense variation in EXON4 of the GALK1 GENE, confirming the diagnosis of GKD. Hence, this case highlights the importance of considering different metabolic disorders as differential diagnoses of one another even in absence of a typical feature of a particular disorder.</p> 2021-11-03T00:00:00+00:00 Copyright (c) 2021 Prasun Rajbhandari, Hem Sagar Rimal, Sonia Dahal Challenges for Journal Editors 2021-10-10T00:43:22+00:00 Rajeev Kumar Shah Sulav Sapkota Prabin Chhetri <p>No abstract available.</p> 2021-11-04T00:00:00+00:00 Copyright (c) 2021 Rajeev Kumar Shah, Sulav Sapkota, Prabin Chhetri