Birat Journal of Health Sciences 2023-08-21T08:34:37+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> Knowledge of Oral Biopsy Procedure among Dental Interns at a Tertiary Hospital in Eastern Nepal 2023-08-03T00:45:51+00:00 Shashi Keshwar Ashish Shrestha Deependra Prasad Sarraf <p><strong>Introduction: </strong>Various diagnostic procedures are available to reach a diagnosis in case of oral lesions. Biopsy is one of the important tools for confirmatory diagnosis. It becomes imperative not only for dentists but future dentists to have adequate knowledge regarding oral biopsy procedures.</p> <p><strong>Objective: </strong>To assess the knowledge of oral biopsy procedure among dental interns.</p> <p><strong>Methodology: </strong>A web-based cross-sectional study was conducted among interns at College of Dental Surgery, B.P. Koirala Institute of Health Sciences. A questionnaire was prepared and Google Form link was shared with the signed-up participants via messaging apps; Viber and WhatsApp. The descriptive statistics were calculated using Microsoft Excel 2016.</p> <p><strong>Results: </strong>Out of 54 participants, 53 (98.15%) and 50 (92.5%) of the interns knew about incisional and excisional biopsy respectively. Only 27 (50%) of them responded that every lesion should be sent for histopathological examination. Only 25 (46.3%) of the interns were aware that the removal of tissue by laser or electrosurgery can introduce artefacts or tissue distortion and 27 (50%) responded that punch biopsy generally produces few artefacts within the biopsied sample. Seventy seven percent of the interns responded that volume of the fixative should be two times the volume of the biopsy specimen, while 15 (27.78%) responded that normal saline could be used as a fixative.</p> <p><strong>Conclusion: </strong>The present study revealed, dental interns had a good understanding regarding oral biopsy and also highlighted the need for further training and modifications in curriculum.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Shashi Keshwar, Ashish Shrestha, Deependra Prasad Sarraf Effectiveness of Dextrose Prolotherapy in Chronic Plantar Fasciitis: A Cross-Sectional Study 2023-08-03T00:58:33+00:00 Ajay Mahato Mithlesh Kumar Gupta Rajan Panthee Manish Raj Pathak Santosh Nepal <p><strong>&nbsp;</strong></p> <p><strong>Introduction: </strong>Plantar fasciitis is a very common musculoskeletal condition encountered in the outpatient department of orthopedics. It's the most common cause of heel pain. Patients have pain on weight-bearing, which limits their activities. Usually, plantar fasciitis is diagnosed on the basis of history and clinical examination; however, X-ray and USG can be helpful in atypical presentations. Mostly, plantar fasciitis is managed conservatively, which includes stretching exercises, footwear modification, ultrasonics, and injections. Prolotherapy is a very cost-effective, and OPD-based procedure that has shown promising results in many tendinopathies. There are no other risks involved in this procedure, and patients can start light activities immediately after the injection.</p> <p><strong>Objective: </strong>To evaluate the efficacy of dextrose prolotherapy in the treatment of chronic resistant plantar fasciitis (PF).</p> <p><strong>Methodology: </strong>This prospective, cross-sectional study, was conducted from July 2021 to December 2021 at Birat Medical College and Teaching Hospital after taking permission from the Institutional Review Committee (IRC). Patient selection was done using inclusion and exclusion criteria. A total of 66 patients were included in the study, who received two prolotherapy injections in a gap of two weeks and were followed up after 12 weeks. Patient’s clinical (Visual Analogue Score for pain at rest and activities), functional (Foot Function Index), and ultrasonograhic (plantar fascia thickness) findings were noted pre- and post-test and were evaluated.</p> <p><strong>Results: </strong>There were 66 adult patients included in the study, out of which 39 patients (59.1%) were female and 27 patients (40.1%) were male. Their age ranged from 26 to 68 years, with a mean age of 43.91 and a standard deviation (SD) of 10.225. The mean BMI was 25.758 with an SD 2.69 (range: 19.6-33.2). The clinical score (VAS-R and VAS-A), functional score (FFI), and ultrasonographic findings (PF thickness) yielded significant outcomes following prolotherapy.</p> <p><strong>Conclusion: </strong>Prolotherapy is a safe, economical, and effective treatment module for plantar fasciitis that has shown significant improvement in pain, functional outcomes, and patient satisfaction.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Ajay Mahato, Mithlesh Kumar Gupta, Rajan Panthee, Manish Raj Pathak, Santosh Nepal Pattern and Outcome of Otolaryngological and Facial Injury in Road Traffic Accidents at a Tertiary Care Centre in Eastern Nepal 2023-08-03T01:08:08+00:00 Sanjeev Kumar Thakur Gyan Raj Aryal Rishikesh Thakur Nisha Ghimire <p><strong>Introduction: </strong>Otolaryngological trauma is prevalent in road traffic accidents (RTA), with or without multiple organ injuries.</p> <p><strong>Objective: </strong>The aim was to report the number and pattern of otolaryngological injuries in cases of road traffic accidents (RTA) and their outcome.</p> <p><strong>Methodology: </strong>&nbsp;A prospective study over one year of cases of RTA was done. The pattern and outcome of the otolaryngological and facial injury was recorded.</p> <p><strong>Result: </strong>Out of 90 cases, 69(76.66%) were male, 21 (23.33%) were female. The mean age was 32.33 ±13Yrs.The mean time of presentation to emergency was 16.24 ±19.61hrs. Motor vehicle accident was more common, 75 (83.33%). Multiple injury was found in 68(75.55%) cases. Among 89 cases with ear problem, common complaints were hearing loss, 20(22.47%), otalgia, 17(19.1%) and laceration of pinna 13(14.6%). Ear complications were seen in16 (17.97 %) cases . Among 55 cases of nose/face injury, common presentation were epistaxis, 20 (36.36%) and nasal bone fracture, 12 (21.81%).&nbsp; Nasal complications were found in 8 (14.54%) cases. In 32 cases of neck/throat trauma, laceration was found in 11 (34.37%) cases. 4(12.5%) cases had undergone tracheostomy. &nbsp;Complications (stenosis and hoarseness) were found in 6(18.75%) cases. Patients who required admission were 81(90%).</p> <p><strong>Conclusion: </strong>Motor vehicle accidents were more common. It was commoner in male. Ear was most commonly affected by injury and complications.&nbsp; The complication of nose and neck/throat was associated with prolonged admission.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Sanjeev Kumar Thakur, Gyan Raj Aryal, Rishikesh Thakur, Nisha Ghimire Role of Diagnostic Rigid Nasal Endoscopy in the evaluation of bleeding points and management of Epistaxis 2023-08-03T01:15:27+00:00 Pradeep Rajbhandari Bikash Lal Shrestha Monika Pokharel Ashish Dhakal <p><strong>Introduction: </strong>Epistaxis is one of the most common ENT emergencies. Causes of epistaxis can be idiopathic, local, or associated with systematic conditions. Anterior rhinoscopy gives a limited view of the nasal cavity. Difficulty in the localization of bleeding points on anterior rhinoscopy is commonly encountered. We often face difficulty in the localization of bleeding points, especially the hidden areas. Nasal endoscopy helps to identify the hidden bleeding points and specifically control the bleeding.</p> <p><strong>Objective:</strong> The main aim of our study was to visualize bleeding points and demonstrate the efficacy of nasal endoscopy in identifying the bleeding site and controlling epistaxis without nasal packing.</p> <p><strong>Methodology</strong> This is a cross-sectional study done on patients who presented to the ENT Outpatient Department with complaints of nasal bleeding. They were evaluated by rigid nasal endoscopy for localization of bleeding points as well as control of epistaxis.</p> <p><strong>Results: </strong>Highest number of cases were seen in the 26-35 years of age group. 69.7% (n=53) patients presented with anterior epistaxis and 28.9% (n=22) had posterior epistaxis. Most of the patients i.e.,57.9 %(n=44) had no obvious abnormality associated with epistaxis, followed by Deviated Nasal Septum with septal spur i.e.,34.2%(n=26). On localizing the bleeding points, 77.6% (n=59) of bleeding points were seen on the septum. 57.9% (n=44) of patients developed epistaxis on the right side. 58% (n=52) of patients were managed with endoscope-assisted chemical cauterization followed by endoscope-associated electro-cauterization using bipolar cautery.</p> <p><strong>Conclusion:</strong> Rigid nasal endoscopy not only helps in localizing bleeding points but also in managing the cases and is gradually replacing conventional techniques like anterior and posterior nasal packing.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Pradeep Rajbhandari, Bikash Lal Shrestha, Monika Pokharel, Ashish Dhakal Outcome and Safety of Thulium Fiber Laser for Urinary Stone Diseases - a Cross-sectional Study 2023-08-03T01:19:14+00:00 Dipak Kumar Thakur Imran Ansari Chandra Shekhar Agrawal <p><strong>Introduction: </strong>Thulium fiber laser (TFL) was introduced into the urological armamentarium as an alternative to Ho:YAG as an energy source. This study aims to assess the outcome and safety of RIRS using TFL in patients with proximal ureteric and renal stone requiring intervention.</p> <p><strong>Methods: </strong>It was a hospital based cross-sectional study conducted in the Department of Urology of of Birat Medical College- Teaching Hospital over a period of 6 months (September 2022 to February 2023) in adults patients with stone size upto 20mm. The outcome and safety of the procedure was assessed for stone clearance, operative time, hospital stay and procedure related complications.</p> <p><strong>Results: </strong>We included initial 50 cases. Mean age, calculus size, calculus volume and calculus density were 40.02± 13.97 years, 14.45±3.36mm, 534.46±209.53 mm<sup>3</sup>, 1046.96±236.88 HU respectively. Complete stone clearance was achieved in 92% (46 cases) with 8% CSRF (4 cases). Procedure related complications occurred in 12% (8) cases.</p> <p><strong>Conclusions: </strong>The TFL as a newer energy source is safe and effective for lithotripsy during RIRS with acceptable complications.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Dipak Kumar Thakur, Imran Ansari, Chandra Shekhar Agrawal Admission Pattern and Outcome in Paediatric Intensive Care Unit of Tertiary Level Teaching Hospital in Eastern Nepal 2023-08-03T01:23:56+00:00 Manoj Chaudhary Hem Sagar Rimal Ram Bhakta Subedi Tara K Kafle <p><strong>Introduction: </strong>Paediatric Intensive Care Unit (PICU) is a relatively new concept with rapidly growing paediatric subspecialty in resource limited-countries. Introduced in Nepal in the 1980s, the first PICU was established in 1986 in Kanti Children’s Hospital, Kathmandu with 4 beds. Later in BPKIHS in Eastern Nepal. Currently only a few dedicated PICU running in Nepal. Our PICU was started in 2021 with 8 beds in the private sector for the management of critically ill children.</p> <p><strong>Objectives: </strong>&nbsp;To study the admission pattern and outcome of the children at our paediatric intensive care unit.</p> <p><strong>Methodology: </strong>This was a Cross Sectional Descriptive study conducted at PICU of Birat Medical College Teaching hospital in Eastern Nepal. From August 2021 to July 2022, records of all possible admissions in PICU were reviewed. Demographic profile, diagnosis, outcome and duration of stay were analysed.</p> <p><strong>Results: </strong>Out of 260 analysed data, there were 156 (60%) males and 104 (40%) females. Age wise distribution was 101 (38.85%), 82 (31.5%), 38 (14.6%) and 39 (15%) for 1 months-1 year, 1-5 year, 5-10 year and 10-15 year respectively. Disease wise distribution was 129 (49%) respiratory, 49 (18.8%) neurological and 26 (10%) gastrointestinal, mostly infective causes like Pneumonia (78, 30%), Bronchiolitis (34, 13.1%), febrile convulsion (29, 11.2%) meningitis/encephalitis (19, 7.3%), Sepsis (12, 4.6%), dengue (6, 2.3%) other infections (19,6.3 %). In outcome, discharged (231,88.85%), DOPR (5,1.92%), LAMA (4,1.54%), Death (16,6.2%) and Referral (4,1.54%). Mortality was high (11, 38.6%) in under five years. Sepsis (4, 33.3%), Meningitis / encephalitis (3, 15.8%) and pneumonia (4, 5.1%) were the common causes. Mean duration of PICU stay was 2.73 days (median=2). Overall mortality rate was 6.2% (16). Sepsis, LOS and need of mechanical Ventilation were significant predictors of mortality.</p> <p><strong>Conclusion: </strong>Respiratory illnesses including infections were common causes of admission with low mortality (6.2%). Sepsis, Meningoencephalitis and pneumonia were common causes of death in our PICU. Sepsis, LOS and need of mechanical Ventilation were significant predictors of mortality.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Manoj Chaudhary, Hem Sagar Rimal, Ram Bhakta Subedi, Tara K Kafle Quality of life in individuals with spinal cord injury treated in tertiary care centers in Nepal 2023-08-03T01:29:43+00:00 Bikash Parajuli Khagendra Acharya Jemina Shrestha Raju Dhakal <p><strong>Introduction: </strong>Traumatic spinal cord injury (SCI) constitutes a significant challenge to the quality of life (QoL). People with SCI perceive the overall QoL at a lower level in comparison to normal individuals.</p> <p><strong>Objective: </strong>This study aims to access the QoL among individuals with SCI and identify factors affecting the QoL.</p> <p><strong>Methodology: </strong>This prospective cross-sectional study was done in Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), and Spinal Injury Rehabilitation Center (SIRC), Sanga, Nepal. All the individuals above 18 years with SCI of at least 3 months from trauma seeking treatment in DH, KUH, or SIRC from June 2019 to May 2021 were included. We utilized the WHO quality of life questionnaires (WHOQOL–BREF) for assessing the QoL.</p> <p><strong>Result: </strong>The mean age was 32.95 ± 11.7 years with the majority being males (74.5%). The majority had ASIA Impairment Scale grade A. The social health domain had the highest mean raw and transformed score (13.87 ± 3.13 and 61.7 ± 19.59 respectively). The transformed total QoL score was 50.76±29.76. Only 22 individuals (15.6%) had a transformed total score of &gt; 60 signifying good/ satisfactory QoL.</p> <p><strong>Conclusion:</strong> There is a high rate of poor/ unsatisfactory QoL in individuals with SCI in Nepal. Female gender, married status, loss of relative during trauma, ASIA injury severity (AIS) A or B during admission, and no improvement in AIS grade after treatment are significant predictors of poor/ unsatisfactory QoL. Physical health, compared to psychological, social, and environmental health, correlates highest with the transformed total score.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Bikash Parajuli, Khagendra Acharya, Jemina Shrestha, Raju Dhakal Stress and Coping Mechanism among Nurses Working at Nobel Medical College Teaching Hospital Nepal during Covid 19 Pandemic 2023-08-03T01:33:37+00:00 Sita Chapagain <p><strong>Introduction: </strong>Novel Corona Virus (SARS-CoV-2) is a highly contagious respiratory disease caused by a severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). Nurses at the frontline of caring for COVID-19 patients are sure to face frequent experiences of mental health challenges. Hence they need special supportive coping strategies to control and reduce their stress.</p> <p><strong>Objective: </strong>The aim of this study was to identify level of stress and coping mechanisms used to deal with stress among nurses at Nobel Medical College and Teaching Hospital, Biratnagar, Nepal.</p> <p><strong>Methodology: </strong>A cross-sectional study was conducted from August 2021 to February 2022. A total of 300 nurses were selected by using a non-probability consecutive sampling technique. Ethical clearance was taken from the Institutional Review Committee of Nobel Medical College and IRC Registration Number 505/2021. Data was collected by using self-administered questionnaire. The collected data were entered in MS Excel and statistical analysis were processed by the SPSS Version 23. Chi-square test was used to show the association between variables.</p> <p><strong>Results: </strong>The findings of the study revealed that out of 300 nurses 91.7% nurses reported moderate and 5.3% reported high level of stress and 92% of nurses used moderate level of coping strategies and only 3.3% of nurses used high level of coping strategies to reduce perceived stress. There was statistically significant association of stress in nurses with marital status, duty schedule and monthly income. Likewise, there was a significant association between living condition of the nurses and coping strategies.</p> <p><strong>Conclusion: </strong>The research finding showed all working nurses having some level of stress during the COVID-19 Pandemic. Moreover, about 96% nurses having moderate or high level of stress and in contrast they were also following moderate level of coping strategies. However, they need high level of coping strategies to overcome the persisting stress level.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Sita Chapagain A 4 year retrospective study of facial dog bite injuries in patients reported to pediatric emergency, BPKIHS, Nepal. 2023-08-03T01:36:24+00:00 Mamta Dali Bandana Koirala Sneha Shrestha Gajendra Birajee <p><strong>Introduction: </strong>Dog bites facial injuries are a significant health care problem and their sequelae ranges from minor to fatal injuries.</p> <p>&nbsp;</p> <p><strong>Objectives: </strong>To determine the incidence of facial dog bite injuries and to assess the outcome as well as presentation of facial injuries among the children reported to the pediatric emergency, BPKIHS, Nepal.</p> <p>&nbsp;</p> <p><strong>Methodology:</strong> A study was conducted where the clinical records of children with facial dog bite injuries reported from 2015 to 2018, were assessed and analyzed.A proforma was designed to extract relevant clinical data from the case records. Information such as age, gender of the victims, anatomical site of the injury, interval between injury and presentation to the hospital, nature of injuries,profile(stray or pet)and immunization status the of dog ,outcome and complications were extracted.</p> <p>&nbsp;</p> <p><strong>Results:</strong> The incidence of facial dog bite injuries has significantly increasedpointing maleschool going children injured predominantly(70%).Seventeen(81%) victims had presented within 24 hrs of injury whereas two(9.5%) patients had reported after 24 hours and 72 hours of the injury. Nineteen patients were treated on the same dayunder local anesthesia, one under general anesthesia where thorough wound lavage with meticulous reapproximation followed by suturing was done. Full recovery was evident in eighteen (86%) cases with primary wound closure whereas two (14%) patients had undergone healing with secondary intention.</p> <p><strong>Conclusion:</strong> There is an increase in incidence of dog bite facial injuries among children in our tertiary health care centre. Satisfactory healing outcomes were achieved with a thorough wound lavage and primary closure of non-infected wounds under appropriate rabies prophylaxis and proper antibiotic regimen.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Mamta Dali, Bandana Koirala, Sneha Shrestha, Gajendra Birajee A Comparative Study of Intramuscular Ketamine and a Combination of Intramuscular Dexmedetomidine and Ketamine as Premedication in Paediatric Anesthesia 2023-08-03T01:43:50+00:00 Riya Singh Barkha Pradhan <p><strong>Introduction: </strong>Preoperative anxiety is an issue of concern in paediatric anaesthesia practice. Forceful transfer of children into the operating room can cause long-term psychological trauma. This clinical study compares intramuscular ketamine and a combination of intramuscular dexmedetomidine and ketamine as anaesthetic premedicants in terms of +anxiolysis, sedation and ease of IV cannulation.</p> <p><strong>Objectives:</strong> To compare the level of preoperative anxiety, sedation and ease of cannulation following premedication between intramuscular ketamine and a combination of intramuscular dexmedetomidine and ketamine.</p> <p><strong>Methods:&nbsp; </strong>Total of 60 patients belonging to American Society of Anaesthesiologists physical status I-II, in the age group of two to ten years, scheduled for elective surgery under general anaesthesia were included in the study; Group A patients received ketamine 3mg/kg body weight while Group B patients received ketamine 2mg/kg body weight and dexmedetomidine 1mcg/kg body weight intramuscular. The outcome variables were sedation score (Richmond Agitation Sedation Scale), IV cannula acceptance (IV cannula Acceptance Score), and parental separation (Separation Score).</p> <p><strong>Results:</strong> The groups were comparable in patient characteristics and hemodynamic parameters between the groups. Median (IQR) sedation score at 10 min were -1 (-2—0) and 0(-1—1) (p&lt; 0.001); mean parental separation scores were 3.76± 0.43 and 3.36±0.55 (p&lt; 0.001); IV cannula acceptance score were 3.73±0.44 and 4.53±7.27 (p= 0.001) in Group A and Group B respectively.</p> <p><strong>Conclusion:&nbsp; </strong>Combination of dexmedetomidine and ketamine is superior to ketamine alone in terms of sedation at 15 min and ease of IV cannulation but comparable in terms of anxiolysis.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Riya Singh, Barkha Pradhan Comparison of Spot Urinary Protein Creatinine Ratio and 24 hour Urinary Protein Excretion in Children presenting with Nephrotic Syndrome in Tertiary Care Hospital of Eastern Nepal 2023-08-03T01:46:59+00:00 Arun Giri Sunil Kumar Yadav Vijay Kumar Shah Niraj Niraula Anand Rauniyar <p><strong>Introduction: </strong>Nephrotic syndrome is an important chronic disorder in children and it’s one of the important diagnostic criteria is presence of heavy proteinuria (&gt; 40 mg/m<sup>2</sup>/hour).</p> <p>As 24-hour urinary protein estimation is cumbersome, inconvenient, time consuming and expensive, a more convenient and accurate method of urinary protein estimation is needed.</p> <p>24-hour urinary protein estimation and urine protein/creatinine in a child with nephrotic syndrome correlates well but there are very few studies done in Nepal to prove this correlation. Hence, this study is undertaken with objective of evaluating usefulness of urine protein/creatinine (UP/UC) in random sample of urine as a rapid and reliable test for quantification of proteinuria and to know their correlation with 24hour urinary protein excretion.</p> <p><strong>Objectives: </strong></p> <p><strong>Primary Objective: </strong>To evaluate accuracy of urine protein creatinine ratio (UP/UC) in early morning sample in comparison with 24 hours urinary protein excretion in children of nephrotic syndrome having normal Glomerular Filtration Rate.</p> <p><strong>Secondary Objective:</strong></p> <ol> <li>To evaluate usefulness of urine protein / creatinine ratio (UP/UC) in random sample of urine as rapid and reliable test for quantification of proteinuria.</li> <li>To evaluate biochemical and other laboratory abnormalities in children with nephrotic syndrome.</li> <li>To study varied clinical presentation of Pediatric nephrotic syndrome</li> </ol> <p><strong>Methodology: </strong>This is a descriptive cross-sectional study conducted in pediatric unit, Nobel Medical College Teaching Hospital, Biratnagar for 12 months. In this study, 50 patients of both sexes, ranging from one to fifteen years of age were studied. The modes of presentation, laboratory investigation reports which included urine routine microscopy, 24-hour urine protein estimation, urine protein / creatinine in random sample of urine were documented and data was analyzed by linear regression.</p> <p><strong>Results: </strong>Linear regression revealed that as timed 24-hour urine protein in gm/24 hour increased, Random urine/protein creatinine ratio mg/mg also increased linearly with correlation coefficient of r = 0.56 which was highly significant (p &lt; 0.001).</p> <p><strong>Conclusion: </strong>This study concludes that UP/UC ratio in a spot urine reflects the amount of protein in 24-hour urine collection. UP/UC ratio &gt; 2 in patients with normal renal function represents nephrotic range proteinuria.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Arun Giri, Sunil Kumar Yadav, Vijay Kumar Shah, Niraj Niraula, Anand Rauniyar Clinical Profile and Outcome of Children with Empyema Thoracis in Tertiary Hospital 2023-08-03T01:53:08+00:00 Vijay Kumar Sah Sandip Kumar Singh Sunil Kumar Yadav Arun Giri Praveen Kumar <p><strong>Introduction:</strong> &nbsp;Empyema thoracis (ET) is an accumulation of pus in the pleural space. It is a common condition in childhood having significant morbidity and mortality. The clinical manifestations of empyema are high grade fever with chills and rigors, cough, breathlessness, chest pain. The present study analyses the epidemiological aspects of the disease, etiological agents, clinical features and associated lesions in diagnosis of empyema and the outcome of early Video-assisted thoracoscopic surgery (VATS) on morbidity of disease in children.</p> <p><strong>Objectives: </strong>To study various demographic characteristic and to evaluate various management strategies and outcome in children with empyema thoracis.</p> <p><strong>Methodology:</strong> This is a prospective hospital based observational study, conducted at Nobel Medical College Teaching Hospital Biratnagar, from December 2021 to November 2022. All children in the age group of 1month to 16 years diagnosed pyogenic empyema by lights criteria during the study are included in the study. Children below 1 month of age and pleural effusion not meeting the criteria for exudative pleural effusion by Light's criteria are excluded from the study.</p> <p><strong>Results:</strong> Majority of the study population are in the age group of &gt;5 years. Males are more common than females. Most common clinical feature was fever followed by cough, chest pain and shortness of breath. Culture is positive in 68% out of which 32% is staphylococcus aureus, 20% is mycobacterium tuberculosis ,16% is streptococcus pneumonia. Duration of illness is &lt;1week in 48% of the children, 1-2weeks in 40% and &gt;3weeks in 12% of the children. In 80% of the children there is unilateral involvement in the x- ray chest. In the children who are uncomplicated all of them had intercoastal chest tube drain (ICD) usage,76.4% had urokinase therapy and 5.8% had undergone thoracotomy and none of them had need for surgery. In the children with complication 87.5% had ICD usage and urokinase therapy,25% of them had undergone thoracotomy and 12.5% had need for surgery.</p> <p><strong>Conclusion:</strong> Empyema thoracis is more commonly seen in the males of the group&gt;5 years with duration of illness &lt;1 week maned mostly by ICD usage, where there was mostly unilateral involvement in x ray chest.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Vijay Kumar Sah, Sandip Kumar Singh, Sunil Kumar Yadav, Arun Giri, Praveen Kumar Bladder Lesions in Cystoscopic Bladder Biopsies-A Clinicopathological Study 2023-08-03T02:02:35+00:00 Sapana Sedhain Sushil Dhakal Punam Poudyal Anju Pradhan Paricha Upadhyay Chandra Shekhar Agrawal <p><strong>Introduction: </strong>In urinary bladder lesions, the clinical presentation is quite variable, the nonneoplastic lesions can mimic neoplastic and vice-versa bothering both clinicians and patients. The present study aims to study the clinic-pathological and histological features of various lesions of the urinary bladder in the specimens received through cystoscopic biopsy or transurethral resection.</p> <p><strong>Objectives: </strong>The objectives of this study were to study the clinicopathological features of various bladder lesions and their frequencies and to correlate the clinical diagnosis with histological diagnosis.</p> <p><strong>Methodology: </strong>The study was a descriptive cross-sectional involving patients with urinary bladder lesions requiring cystoscopic biopsy or transurethral resection conducted in the Department of Pathology of BP Koirala Institute of Health Sciences, Dharan over a period of one year (November 2016 to October 2017) .</p> <p><strong>Results: </strong>Among 40 patients, mean age was 56.40 years and male and female ratio was 1.5:1. The mean duration of symptoms was 3.49 months. The most common presenting feature for both neoplastic and non-neoplastic was 75%, but hematuria was (86.36%) presenting feature in neoplastic cases and dysuria (88.88%) in non-neoplastic with each group accounting 55% and 45% respectively. Urothelial carcinoma (86.36%) was the commonest neoplastic lesion while cystitis (72.22%) was the commonest non-neoplastic lesion. NMIBC was the predominant lesion (78.95%) in urothelial tumor. Grading showed low grade (63.15%) and high grade (36.85%) respectively. The correlation analysis between clinical diagnosis and histological diagnosis revealed perfect correlation for non-neoplastic lesions and strong correlation for neoplastic&nbsp; lesions having highly significant result (p&lt;0.001)</p> <p><strong>Conclusion: </strong>Urinary bladder is a common site of diverse lesions; with neoplastic being more common. Urothelial carcinoma was the most common type of neoplastic lesion and cystitis was the most common type of non-neoplastic lesion. Non-neoplastic lesions can mimic neoplastic lesions clinically. &nbsp;Histological diagnosis differs significantly from the clinical diagnosis indicating the importance of histological diagnosis in planning treatment.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Sapana Sedhain, Sushil Dhakal, Punam Poudyal, Anju Pradhan, Paricha Upadhyay, Chandra Shekhar Agrawal Periodontal Practice and Referral of Patients by General Dental Practitioners in Province No.1 Nepal 2023-08-03T02:11:00+00:00 Pujan Acharya Ujwal Gautam <p><strong>Introduction: </strong>General dental practitioners and periodontists working in a close alliance is considered to bestow effective outcome in the context of diagnosis and management of periodontal diseases. Recently, general practitioners are inclined to render the majority of non-surgical procedures by themselves and avoid surgical part. This obscures functional as well as esthetic demand contributing to periodontally challenged conditions. In advanced stages, no matter how efficiently a skilled periodontist handles the case, redemption is not possible.</p> <p><strong>Objectives: </strong>To assess the periodontal practice and referral of patients by general dental practitioners to periodontists.</p> <p><strong>Methodology: </strong>An online survey using Google Forms was conducted among the general dental practitioners working in private clinics in province no.1, Nepal from November 2021 to January 2022. A total of 64 general dental practitioners were surveyed using a self-administered questionnaire. Descriptive statistics were calculated.</p> <p><strong>Results: </strong>The response rate for the present study was 51.2% out of which only 17.2% referred patients to periodontists for non-surgical periodontal therapy and scaling was the most performed procedure by all the practitioners themselves. However, 92.2% referred patients to periodontists for surgical procedures and a majority of the referrals were for mucogingival surgeries. Majority of them expressed satisfaction regarding the number of continuing dental education programs being conducted despite minimum participation.</p> <p><strong>Conclusion: </strong>&nbsp;Majority of the general dental practitioners seemed to perform non-surgical periodontal therapy by themselves while considering referral for surgical interventions. Also, minimum participation despite remarkable satisfaction in the conduction of continuing education programmes calls for a need to explore the inadequacy.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Pujan Acharya, Ujwal Gautam Problem Based Learning: An emerging method of teaching learning in medical education 2023-08-03T00:43:11+00:00 Parth Guragain <p>No abstract available.</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Parth Guragain Amniotic Band Sequence: A Rare Case Seen In Birat Medical College 2023-08-03T02:18:39+00:00 Sudhan Neupane Sabin Shrestha Mukunda Kumar Jha Nirajan Shakya Pratik Neupane <p>N/A</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Sudhan Neupane, Sabin Shrestha, Mukunda Kumar Jha, Nirajan Shakya, Pratik Neupane A rare incident of intraoral formalin injection 2023-08-03T02:25:01+00:00 Sumana Sulu Iccha kumar Maharjan Pragya Regmee Sagar Adhakari Abhinaya Luitel Kripa Khatiwada <p>Formalin is a hazardous chemical that needs careful handling and special storage. It is generally used in dentistry because of its disinfectant and fixative properties. Negligence on part of the dental professionals by accidentally injecting formalin rather than the original anesthetic can lead to internal tissue damage and also may induce a life threatening situation. The general practice of storing formalin in the original anesthetic bottles and being supported by untrained assistants is the most common reason for this mishap to happen. The operating dentist should be careful and apprehensive of the medicines and chemicals available in the operatory and re-check the solution being injected in the case as to not land up in complications because of the negligence. Successful management can be done by cautious debridement and empirical medicine therapy.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> 2023-08-21T00:00:00+00:00 Copyright (c) 2023 Sumana Sulu, Iccha kumar Maharjan, Pragya Regmee, Sagar Adhakari, Abhinaya Luitel, Kripa Khatiwada