Journal of BP Koirala Institute of Health Sciences

Anesthetic Management of Carcinoma Breast during Third Trimester of Pregnancy: a Case Report

2023-06-15T08:48:39+00:00

Although malignancy during pregnancy is uncommon, if occurs, it adds challenge to ensure safety of both the mother and fetus. A 36-year lady was diagnosed with carcinoma breast and scheduled for modified radical mastectomy at 29 weeks of gestation. The case was conducted under general anesthesia with intraoperative pectoralis nerve block for postoperative analgesia. Care was taken to avoid hypotension, tachycardia and hypercarbia so that the placental perfusion was not hampered. The trachea was extubated and immediate postoperative obstetrician review revealed no abnormality in the fetal heart rate and activity. Postoperative course was uneventful. Pregnancy was continued till 34 weeks of gestation when elective cesarean section was done under subarachnoid block. A healthy baby was delivered without any adverse consequences. Anesthesia during last trimester of pregnancy can be safely performed, when precautions are taken with involvement of proper teamwork, and the benefit of surgery outweighs the risk of postponing it.

Orthodontic-Surgical Management of Impacted Maxillary Central Incisor Related to Supernumerary Tooth: a Case Report

2023-10-18T09:07:12+00:00

Anterior teeth play an important role in maintaining esthetics and phonetics in human beings. Missing anterior teeth might result in rotation, shifting, and root resorption of the adjacent teeth, loss of eruption space, underdevelopment of the anterior part of the maxilla, and crossbite. Adolescent patients are very conscious about how they look, and missing anterior teeth lowers their selfesteem. Due to the above reasons, missing anterior teeth should be managed as early as possible. The present case report highlights the orthodontic traction of the impacted maxillary central incisor caused by a supernumerary tooth. At the same time, the treatment outcome regained smile in an 11-year-old patient who had stopped smiling because his peers had started to call him by the name “toothless”.

Non-interactive Activities in Teaching-Learning

2023-12-26T09:45:58+00:00

A medical curriculum may have teaching learning modalities involving both large group and small groups. Fostering student Interaction, engagement and collaboration is relatively easier in small group. Many of the small group teaching strategies are also applied for effective collaboration and communication to a large group. However, student motivation is the key to student engagement and learning. This editorial explores some of the very simple strategies which allow students opportunities to prepare for their learning as well as to reflect upon their learning. The activities enlisted are simple methods like quiz, practice test, providing lecture slides and lecture videos and giving assignments to students. What is emphasized here is to carry out these activities in a nonthreatening manner without pressure of ‘grades’.The best way would do this is through an online platform hence the provision of learning management system in a teaching institute is emphasized. Using online medium for these activities has two advantages: (i) it will allow the students to carry out the given work in solitude and it will enable us teachers to give one to one feedback or feedback in the form of corrected response. (ii). There is also an advantage of students getting exposed to a blend of both physical teaching learning, during lectures and small group teaching and an opportunity for using online platforms for activities.

Knowledge and Practice of Face Mask Use and Handling during COVID-19 Pandemic among Dental Students and Intern at B.P. Koirala Institute of Health Sciences

2023-10-10T07:03:17+00:00

Background: The outbreak of Corona Virus Diseases (COVID-19) has been deemed a global public health emergency by the World Health Organization (WHO). Face mask is one of the prevalent used methods to reduce the spread of infection. Due to their widespread use, it is crucial to use these masks properly because improper use or disposal could potentially speed up the pace of transmission. The objective was to assess the knowledge and practice of face mask use and handing in undergraduate dental students.

Methods: A web based cross sectional study was conducted among BDS third, fourth, fifth year and interns at College of Dental Surgery, B. P. Koirala Institute of Health Sciences between May-June 2021. A structured proforma was prepared and modified based on relevant literature and expert’s advice. The Google Forms with questionnaires were created using docs.google.com/forms, and the link was shared with the signed-up participants via messaging apps Viber and WhatsApp. Statistical Package for the Social Sciences software, version 21 was used to analyse descriptive statistics such as frequency and percentage.

Results: A total of 144 participants responded to the questionnaire. Eighty-five (59.03%) participants responded that minimum numberof layers in face mask that work better to help stop the spread of COVID-19 outside health care setting is three. Sixty-seven (46.53%) participants responded that they touch front surface of the face mask while wearing it.

Conclusion: Campaigns to raise awareness about the proper use of face masks during this pandemic will be useful in educating dentistry students and interns.

Health Literacy among Diabetic Patients Visiting the Outpatient Department of a Tertiary Care Hospital: A Cross-Sectional Study

2023-05-09T09:04:51+00:00

Background: Diabetes Mellitus is a metabolic syndrome characterized by hyperglycemia either due to defective insulin secretion or defective insulin action or both. It is estimated to become the 7th leading cause of death by 2030. Health literacy play a significant role in self-care, adherence to medication and clinical outcomes in diseased individual. The objective of this study is to find the prevalence of poor health literacy among the diabetic patients visiting the outpatient department of a tertiary care hospital.

Methods: A descriptive cross-sectional study was conducted among 422 diabetic patients visiting the outpatient department of a tertiary care hospital from July 2020 to Jan 2021. Ethical approval was obtained from the Institutional Review Committee (Reference number: IRC/1805/020). Patients aged ≥18 years, irrespective of gender, diagnosed with Diabetes Mellitus at least 3 months before and presenting to the outpatient department for complications or follow-up were included in the study. Convenience sampling was used.

Result: Among 422 diabetic patients, poor health literacy was obtained among 165 (39.09%) (34.49-43.69 at 95% Confidence Interval). Low adherence to anti-diabetic medication was seen in 78 (47.27%) patients with majority 94 (56.97%) patients having diabetic range HbA1C level and a poor knowledge on diabetes.

Conclusion: There is poor health literacy among diabetic patients that is reflected in low adherence to anti-diabetic medication and overall diabetic self-care. Targeted intervention for health promotion of diabetic patients might be needed.

Practice of Healthcare Workers during the COVID-19 pandemic at the Emergency Department of Nepal

2023-01-13T12:36:00+00:00

Background: The study intends to explore the effects and practice of healthcare workers during COVID-19 pandemic at the emergency department of B. P. Koirala Institute of Health Sciences.

Methods: A cross-sectional study was done among the healthcare workers of the Emergency Department of B. P. Koirala Institute of Health Sciences from August 2020 to Jan 2021. Data were collected by using a semi-structured interview among all the participants in the survey. A convenient sampling method was used and analysed using descriptive statistics. A p value < 0.05 was considered statistically significant.

Results: Majority of the healthcare workers (90%) stated that their role has increased during COVID 19 first wave pandemic. A similar percentage (71%) noticed change in their duty hours and subsequently Isolation/ Quarantine. More than half (53%) stated that efforts been undertaken to bring additional health care workers to emergency department on basis of safety and preservation of workforce. The institute was able to train (47%) health care workers regarding proper handling of personal protective equipment despite of its insufficient (70%) supply.

Conclusion: The results take exceptions in the emergency department despite insufficient supply of personal protective equipment, longtime exposure to large numbers of infected patients and insufficient care to quarantine a majority of the healthcare workers during COVID-19 pandemic.

Prevalence of Tumor Budding and its Significance for Predicting Lymph Node Metastasis in Carcinomas at Tertiary Care Center

2023-11-05T09:22:06+00:00

Background: “Tumor budding” basically means the presence of clusters of less than 5 malignant cells in the tumor stroma, located ahead of the invasive front of tumor. Various studies have been carried out regarding tumor budding, its significance in tumor metastasis involving head and neck, breast, gastrointestinal tract, pancreas and cervix and is now evolving in cancer reporting templates. We conducted this study in regards to growing importance of tumor budding in cancer metastasis with objectives to find out the prevalence of tumor budding in carcinoma and to know the association of tumor budding with lymph node, perineural and lymphovascular invasion.

Methods: All the resected specimen with regional lymph node were examined for presence or absence of tumor buds. It was graded as high/ low grade based on the number of buds. Association of the tumor buds with lymph node metastasis, lymphovascular and perineural invasion was calculated. The study was conducted from January 2019 to January 2020. Purposive sampling was used. Ethical clearance was ensured from the institutional review board before the start of study (IRC 1322/ 018). All surgically resected specimen of carcinomas with regional lymph nodes were included in the study whereas autolysed specimen and patient who refused to give consent were excluded from the study.

Result: Total 37 cases of resected specimens of gastrointestinal tract, breast, head and neck were evaluated. The prevalence of tumor budding was 91.9%. In every instance where tumor budding existed, there was an observation of high-grade tumor bud. Tumor budding was strongly associated with lymph node invasion (p = 0.005). Significant value was not observed in the correlation of tumor budding with lymphovascular and perineural invasion.

Conclusion: Tumor budding holds an important role in predicting lymph node metastasis in carcinomas, highlighting its importance in the histopathological reports of resected specimen.

Acute Kidney Injury in Methotrexate treated Leukemia

2023-07-03T10:13:52+00:00

Background: The study was performed to know the incidence of acute kidney injury within 48 hours following High dose Methotrexate administration in children with high-risk B cell Acute Lymphoblastic Leukemia along with its risk factors and toxicities. Most studies have been conducted in adults and have included non-Hodgkin lymphoma along with leukemia. There is a paucity of data regarding the burden of Acute kidney injury with Methotrexate use in the pediatric age group with B cell Acute Lymphoblastic Leukemia.

Methods: It was a prospective observational study conducted at the pediatric ward of All India Institute of Medical Sciences, New Delhi between 2019 September to 2021 June. Children between 1 to 18 years with high-risk B lineage Acute Lymphoblastic Leukemia planned for high-dose Methotrexate at 3gm/m² were enrolled. The measurement of serum creatinine was done at baseline, 24 and 42 hours while serum methotrexate at 24 and 42 hours, adverse reactions were assessed till day 14 of methotrexate administration.

Results: The incidence of Acute Kidney Injury and severe Acute Kidney Injury (stages 2 and 3) at 42 hours of High dose Methotrexate infusion was 24.3% and 12.8% respectively. Low serum albumin was associated with an increased risk of Acute Kidney Injury (p=0.004). Transaminitis and thrombocytopenia were common toxicities.

Conclusions: Acute Kidney Injury is common following High dose Methotrexate administration in B cell Acute Leukemic Leukemia. Low serum albumin level increases renal toxicity following methotrexate infusion. The measures to prevent renal toxicity should be instituted promptly in high-risk groups.

Cryptococcomas: Diagnostic Dilemmas with Increasing Incidence

2023-12-26T05:03:38+00:00

Not applicable