Journal of BP Koirala Institute of Health Sciences <p>Official journal of the BP Koirala Institute of Health Sciences. JBPKIHS replaces the journal <a title="HREN" href="/index.php/HREN" target="_blank" rel="noopener">Health Renaissance</a> as a result of a decision of the Senat of B.P. Koirala Institute of Health Sciences.</p> BP Koirala Institute of Health Sciences en-US Journal of BP Koirala Institute of Health Sciences 2616-0323 <p>No part of this journal can be reproduced, stored or transmitted in any manner, in any form, or for any purpose, without prior written approval of the editorial board.</p> Self care among Health Professionals <p>Not available.</p> Dhana Ratna Shakya ##submission.copyrightStatement## 2019-07-23 2019-07-23 2 1 1 3 10.3126/jbpkihs.v2i1.24959 Association of Helicobacter Pylori with Peptic Ulcer Perforation <p><strong>Background: </strong>Helicobacter pylori is found in more than 90% cases of peptic ulcer. This study examines the possibility of association of Helicobacter pylori in perforated peptic ulcer disease and its relation to persisting ulcer as well as the influence of other risk factors; namely: smoking, alcohol, current non-steroidal anti inflammatory drugs (NSAIDs) and steroid use.</p> <p><strong>Materials and Methods: </strong>In this prospective study, total of 50 cases of peptic ulcer perforation admitted in College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal were selected on the basis of the non-probability (purposive) sampling method. All patients who presented with suspected peptic ulcer perforation were included in the study and the perforations were repaired by Modified Graham’s Patch and were given triple therapy postoperatively. The age, sex, incidence, mode of presentation, precipitating factors, association with the risk factors and postoperative complications were all evaluated and compared.</p> <p><strong>Results: </strong>Of 50 patients studied, the age ranged from 17 to 75 years, mean age being 40.1 years with the peak incidence in the 3rd and 5th decades of life showing a male dominance (92%). H. pylori was seen in ulcer edge biopsy in 29 patients (58%). Most common clinical presentation was pain abdomen, the most common signs of perforation were tenderness, rebound tenderness and absent bowel sounds. The mean duration of stay in hospital in H. pylori positive patients was 12.07±8.15 days as compared with 11.1±5.12 days in H. pylori negative patients. The incidence of peptic ulcer perforation was higher in the patients consuming alcohol (64%) than smokers (48%), followed by NSAIDs user(22%). 20% of the patients with delayed presentation developed complications postoperatively. Perforated peptic ulcer was repaired by Modified Graham’s Patch Repair, followed by anti H. pylori therapy in all of them.</p> <p><strong>Conclusion: </strong>Peptic ulcer perforation is quite common among the patients with peptic ulcer disease with history of chronic smoking, alcoholism and analgesic intake, more commonly in males. There is association of H. pylori in 58% of patients with peptic ulcer perforation.</p> Sunit Agrawal D Thakur P Kafle A Koirala R K Sanjana S Kumar B N Patowary ##submission.copyrightStatement## 2019-07-23 2019-07-23 2 1 4 10 10.3126/jbpkihs.v2i1.24960 Comparison of Caudal Tramadol with different doses of Midazolam addon for Postoperative analgesia in Children Undergoing Inguinoscrotal Operations <p><strong>Background: </strong>Safe and effective postoperative analgesic modalities have remained a subject of contemporary clinical research, particularly in children. The present study aimed at comparing the effectiveness of pain relief in children undergoing inguinoscrotal surgery with caudal tramadol alone and in combination with different doses of midazolam.</p> <p><strong>Methods: </strong>Ninety children of either sex, aged one year to fifteen years, undergoing inguinoscrotalsurgical procedures under general anesthesia were recruited in a randomized double blinded fashion to receive one of the three study medications through caudal route. Group T (n= 30) received injectiontramadol 2mg/kg in a volume of 0.5ml/kg up to a maximum volume of 20ml, while group TM (n= 30)and TM/2 (n= 30) received additional midazolam 50mcg/kg and 25mcg/kg respectively. The study medications were administered immediately after induction of anesthesia. Postoperative analgesia was measured using a modified Hannallah 10 points Pediatric Objective Pain Scale described by Hannallah and colleagues. Pain score of ≤ 4 was considered effective analgesia. Duration of analgesia was defined as the time between caudal injection to the first need of analgesia.</p> <p><strong>Results: </strong>The duration of analgesia in group TM (1145±281.41 min) and TM/2 (1012.67±260.68 min)was significantly longer than that in group T (690.83±215.7 min) (p&lt;0.005). The sedation score was the highest in group TM and the least in group T. Nausea vomiting was the commonest side effect in all the three groups without any significant differences in the incidences between the groups.</p> <p><strong>Conclusion: </strong>Addition of midazolam to tramadol for caudal administration in children undergoinginguinoscrotal operations produces significantly longer duration of postoperative analgesia than produced by epidural administration of tramadol alone. </p> Siddhartha Koirala BK Bhattarai TR Rahman BP Sah ##submission.copyrightStatement## 2019-07-23 2019-07-23 2 1 11 17 10.3126/jbpkihs.v2i1.24961 Knowledge and Attitude towards Basic Life Support among Health Care Professionals Working in Emergency of BPKIHS <p><strong>Background</strong>: Basic Life Support (BLS) aims to maintain respiration and circulation in the cardiac arrest victim and involves a major focus on cardiopulmonary resuscitation (CPR) with minimal use of ancillary equipment. The raised standards of care demand that knowledge about BLS/ CPR be updated and include the lay persons as well as medical experts who have the potential to become the teachers of the skill. The objective of the study was to describe the knowledge and attitude of medical personnel (nurses and doctors) towards BLS/ CPR.</p> <p><strong>Methods</strong>: This cross sectional study was done among the doctors and nurses working in Department of General Practice and Emergency Medicine, BPKIHS, Nepal after ethical approval. A pre-validated questionnaire (Shrestha et al, WJEM, 2012) with pre-structured questions was used for assessing the knowledge and attitude. Attitude was measured using 5 point Likert. Designation, previous training and demographics were used as describing variables. For data recording and statistical analysis; Microsoft Excel, SPSS 11 and EPI Info were used.</p> <p><strong>Results: </strong>Total number of sample size was 84 medical personnel working in emergency department (consultant 12, junior resident 16, house officer 18, and senior nurse 3 and staff nurse 35). Nine (11%) respondents answered more than 10 questions, 57 (68%) answered 6-10 question and 18 (21%) answered less than 5 question. Average mean score (total 15) was 7.40 (SD 2.32, 95% CI 6.90-7.90).Mean score of the positive attitude (total 15) to CPR was 11.1807 (2.43, 10.65-11.71). The mean score for reluctance (total 5) to perform CPR was 3.25 (consultants and those who were certified in BLS or taken BEC course in the department had maximum score in knowledge (p&lt;0.001). Higher positive attitude score to BLS/ CPR was associated with an increasing age strata (p 0.001), senior designation (p 0.001), BLS course (p 0.048) and BEC department course (p 0.009).</p> <p><strong>Conclusion</strong>: Knowledge in BLS/ CPR was average. CPR/ BLS training and frequent assessments are recommended at our hospital.</p> Masum Poudel R Bhandari R Giri S Chaudhary S Uprety D D Baral ##submission.copyrightStatement## 2019-07-23 2019-07-23 2 1 18 24 10.3126/jbpkihs.v2i1.24962 Complications of Thyroid Surgery & Their Risk Factors: A Prospective Study at a Tertiary Care Center of Eastern Nepal <p><strong>Background: </strong>Thyroid surgery is one of the commonest surgeries performed by otolaryngologists. Currently, the main postoperative complications are hypocalcemia and recurrent laryngeal nerve (RLN) palsy. Extent of surgery, lack of identification of RLN/ parathyroid glands, malignancy, central compartment neck dissection, lateral neck dissection, previous surgery and size of goiter are the risk factors for complications. The objectives of this study were to determine the frequency of postoperative complications after thyroid surgery and to analyze the risk factors of complications.</p> <p><strong>Methods: </strong>It was a prospective study of 45 patients undergoing thyroid surgery in eastern Nepal from March 2014 to September 2015. The postoperative complications and the risk factors associated with these complications were evaluated.</p> <p><strong>Results: </strong>There were total of 45 cases of thyroid surgery, with the mean age of 39.04 years. The main postoperative complications were: hypocalcaemia (6 or 13.33% cases) and vocal cord palsy due to recurrent laryngeal nerve injury (5 or 11.11% cases). Temporary hypocalcaemia was observed in 3(6.67%) cases while permanent hypocalcaemia developed in other 3 (6.67%) cases. Similarly, the temporary and permanent recurrent laryngeal nerve palsy occurred in 3 (6.67%) cases and 2 (4.44%)cases respectively. The risk factors associated with hypocalcaemia were: malignancy, repeat operation, central compartment neck dissection and non-identification of parathyroid glands during surgery. Similarly, recurrent laryngeal nerve palsy was observed in cases of malignancy and central compartment neck dissection.</p> <p><strong>Conclusion: </strong>The major postoperative complications of thyroid surgery were hypocalcaemia and recurrent laryngeal nerve palsy. Malignancy and central compartment neck dissection had effect on incidence of complications. Sound knowledge of anatomy and meticulous surgical technique are needed to reduce the incidence of complications.</p> Niranjan Panthi S T Chettri S P Shah D Poudel S Manandhar K Acharya ##submission.copyrightStatement## 2019-07-23 2019-07-23 2 1 25 33 10.3126/jbpkihs.v2i1.24964 Knowledge about Neonatal Jaundice among Nepalese Mothers <p><strong>Background: </strong>Worldwide, Neonatal Jaundice is one of the most common disorders and causes of avoidable brain damage and physical and mental impairment, and probable death in newborns. It is an important contributor to the high neonatal morbidity and mortality in Nepal. Objective: To assess among mothers the knowledge about neonatal jaundice.</p> <p><strong>Method: </strong>A descriptive cross-sectional study was conducted among 177 mothers in selected village with convenient sampling technique.</p> <p><strong>Results: </strong>Findings revealed that around half of the mothers (49.90%) had low level of knowledge (score &lt;50%), 28.60% mothers had moderate level of knowledge (score 50-75%) and only 22%mothers had adequate level of knowledge (score &gt;75%) regarding neonatal jaundice. A large proportion of mothers (84%) believed that danger sign of neonatal jaundice was unable to feed the baby. Few 11% mothers believed that mental retardation and death was the complication of neonatal jaundice. Few mothers (12%) were aware about the cause of neonatal jaundice. Around 74% believed that exposing the baby to the sunlight is the primary management of neonatal jaundice but only 2%heard about the phototherapy.</p> <p><strong>Conclusion: </strong>Knowledge about neonatal jaundice was low among Nepalese mothers. Awareness should be created among the expecting mothers about neonatal jaundice and encourage them to take preventive measures to avert neonatal mortality and morbidity.</p> Sharmila Shrestha S Maharjan S Shrestha M A Petrini ##submission.copyrightStatement## 2019-07-23 2019-07-23 2 1 34 42 10.3126/jbpkihs.v2i1.24965 Serum Lactate Level as a Predictor of Outcome in Patients with Septic Shock <p><strong>Background: </strong>Sepsis and Septic shock are a common presentation in the Emergency Department with high morbidity and mortality. Serum lactate level increases substantially in the patients with septic shock. The objectives of this study were to determine serum lactate levels at the time of presentation, find out the outcome and correlate lactate levels with the outcome in the patients with septic shock.</p> <p><strong>Methods: </strong>It is a prospective cross-sectional study of patients presenting to the Emergency, who met the criteria for septic shock defined by Surviving Sepsis Guidelines 2012. Patients’ demographics, co morbidity, triage vitals, laboratory and radiological parameters were recorded. The primary outcome was mortality and secondary outcomes were duration of stay in hospital and complications, if any, developed during hospital stay.</p> <p><strong>Results: </strong>Eighty-four cases were enrolled, with male to female ratio of 1:1. Mean age was46.40 19.59 years. The significant variables were: serum lactate (p&lt;0.001), pH level (p= 0.001), serum creatinine (p= 0.002) and INR level (p= 0.001). Serum lactate was the significant factor that correlated with mortality after applying multivariate regression analysis (OR= 2.75, CI= 0.890- 4.041,p= 0.001).</p> <p><strong>Conclusion: </strong>Initial serum lactate level is independently associated with mortality of the patients presenting to ED with septic shock.</p> Rupak Bhandari R Bhandari M Paudel G B Malla ##submission.copyrightStatement## 2019-07-24 2019-07-24 2 1 43 51 10.3126/jbpkihs.v2i1.24968 Nosocomial Sepsis and its Risk Factors: A Cross-Sectional Study in a Neonatal Intensive Care Unit <p><strong>Introduction</strong>: Nosocomial sepsis is a common and serious infection of neonates who are admitted in intensive care unit. They lead to significant morbidity and mortality in both developed and resource limited countries. The neonatal intensive care unit (NICU) is a suitable environment for disseminating the infections and, hence, needs preventive intervention. The study was carried out to determine the risk factors for nosocomial sepsis in neonatal intensive care unit.</p> <p><strong>Material and Methods: </strong>This was a cross-sectional study conducted in a seven bedded teaching and referral hospital NICU. All neonates in NICU who did not have any sign of infection at admission and remained hospitalized for at least 48 hours were observed. Nosocomial sepsis was diagnosed according to the CDC criteria. Risk factors for nosocomial sepsis were analyzed with Chi-square test and Logistic regression model. P-value of &lt;0.05 was considered significant.</p> <p><strong>Results: </strong>Low birth weight (both preterm and IUGR) and mechanical ventilation were found to be related with nosocomial sepsis.</p> <p><strong>Conclusions</strong>: Low birth weight and mechanical ventilation were the most important risk factors fornosocomial sepsis.</p> Sunil Kumar Yadav SP Yadav P Kanodia N K Bhatta R R Singh B Khanal ##submission.copyrightStatement## 2019-07-24 2019-07-24 2 1 52 59 10.3126/jbpkihs.v2i1.24970 Transport and Pre-hospital Care Prior to Arrival in Tertiary Care Emergency Department of Eastern Nepal: a Cross sectional Study <p><strong>Introduction: </strong>Nepal has diverse terrain and the length of time taken by the patients to get medical help is often too long. Road linkage transport may not exist, inadequate or are unreliable and irregular.</p> <p><strong>Materials and Methods: </strong>After ethical clearance, this prospective observational study was done by convenient sampling, among 2211 patients arriving in the emergency ward of B. P. Koirala Institute of health science over a period of one month. A pre-tested validated questionnaire consisting of questions related to study objectives (i.e. demography, preferred mode of transport, reasons for choosing the transport, facilities available in ambulance, cost and time taken through ambulance service and any pre-hospital care received) was handed over to the patient or their relatives and their responses were collected. Descriptive analysis was done in SPSS software version 11.2.</p> <p><strong>Result: </strong>Out of the 2211 patients presented in emergency ward, 43.2% (955) came in an ambulance. Patients with ATS 2 (very sick) arriving in ambulance were 27.6%. The median time taken by ambulance is 2 hours (IQR 1-3hrs). The median distance covered is 55km ((IQR 38km- 80km). The median cost paid was USD 31.25 or NRs. 3500 (IQR NRs 2000- NRs 6000, USD 17.86- 53.57).Their main reason expressed for not choosing ambulance service was high cost, i.e. expensive (26%).About one third subjects (29.4%) had used some sort of pre-hospital care.</p> <p><strong>Conclusion: </strong>Patients preferred private vehicles to arrive in emergency ward of this hospital with high acuity triage score (ATS 2). Awareness needs to be raised among Nepalese population to enhance the practice of using ambulance service for patient transport.</p> Sonai Chaudhuri Giri G Malla R Bhandari M Poudel S Giri ##submission.copyrightStatement## 2019-07-24 2019-07-24 2 1 60 67 10.3126/jbpkihs.v2i1.24971 Tobacco Use and Dependence among Psychiatry Out-Patients of a Health Institute in Eastern Nepal <p><strong>Background</strong>: Assessment of nicotine dependence among tobacco users is essential as highly dependent individuals have greater risk of developing tobacco related physical and psychiatric problems. There is little information about the tobacco use and nicotine dependence among psychiatric patients in developing countries, including Nepal.</p> <p><strong>Objectives</strong>: To estimate the prevalence of tobacco use, the level of nicotine dependence and the psychiatric disorder specific prevalence among tobacco users visiting a psychiatry out-patient department.</p> <p><strong>Materials and methods: </strong>A cross-sectional study was conducted in Out-patient setting of Department of Psychiatry, B. P. Koirala Institute of Health Sciences (BPKIHS). Ninety cases (calculated sample size) were enrolled. The Fagerström Test for Nicotine Dependence (FTND) was applied to assess the level of nicotine dependence and the Mini International Neuropsychiatric Interview (MINI) for diagnosis of Psychiatric disorders.</p> <p><strong>Results: </strong>The prevalence of tobacco use was 55.6%. Tobacco use was more common among males (pvalue &lt; 0.05). Smokeless form was the common form of tobacco. Majority of them had started their consumption in their adolescence. Most users had moderate nicotine dependence. Major depressive disorder and Alcohol dependence were the most common diagnoses among tobacco users.</p> <p><strong>Conclusion: </strong>More than half of the psychiatry out-patients consumed tobacco. Future studies that help to understand the relationship and possible mechanism of increased tobacco use in patients with psychiatry disorders are required. Tobacco control and prevention strategies should be initiated targeting vulnerable populations such as male gender and adolescent.</p> Suren Limbu D R Shakya N Sapkota R Gautam Joshi ##submission.copyrightStatement## 2019-07-24 2019-07-24 2 1 68 76 10.3126/jbpkihs.v2i1.24972 Risk Factors for Intrauterine Growth Restriction: 9 Years Analysis in Tertiary Care Hospital <p><strong>Background: </strong>Intrauterine growth restricted (IUGR) fetuses are at higher risk of developing neonatal complications and also known to develop metabolic syndrome in adult life. So, an early antenatal detection, choosing the optimal time and method of delivery and intervention when required could minimize the risk significantly.</p> <p><strong>Objective</strong>: To find out the prenatal outcome and the maternal and placental risk factors.</p> <p><strong>Methods: </strong>A prospective study was conducted from January 2010 to January 2019, at a Teaching Hospital. A singleton pregnancy, above 28 weeks of gestation with clinical diagnosis of IUGR and confirmed by ultrasonography were included in the study. The statistical analysis was performed by Statistical Package of Social Sciences (SPSS) 23.0 software.</p> <p><strong>Results: </strong>Maternal risk factors like low pregnancy body mass index, preeclampsia, anaemia, hypothyroidism and placental factors like retro placental hemorrhage were mainly responsible for intrauterine growth restriction.</p> <p><strong>Conclusions: </strong>The early identification of risk factors and management of the same antenatal is an important issue to prevent adverse prenatal outcomes associated with IUGR.</p> Abha Shrestha N Pradhan B Kayastha ##submission.copyrightStatement## 2019-07-24 2019-07-24 2 1 77 82 10.3126/jbpkihs.v2i1.24973 Laryngeal Amyloidosis- an Unusual Cause of Hoarseness: a Case Report <p>Amyloidosis is a benign condition with abnormal deposition of extracellular protein in various parts of the body. Laryngeal amyloidosis is a rare clinical condition. Hoarseness of voice is one of the most common symptoms presenting to a clinician. The clinical appearance mimics the early laryngeal carcinoma. It remains a diagnostic challenge to the clinician. It is essential to differentiate laryngealamyloidosis from malignancy as most of the findings mimic laryngeal carcinoma. We report a case of laryngeal amyloidosis that presented with hoarseness, to differentiate it from laryngeal malignancy for effective management.</p> Sudeep Mishra S P Shah S T Chhetri R Shah A Sanjel ##submission.copyrightStatement## 2019-07-24 2019-07-24 2 1 89 92 10.3126/jbpkihs.v2i1.24976 Lymphangioma circumscriptum Associated with Port-Wine Stain <p>Lymphangioma circumscriptum (LC) is a rare benign disorder involving the deep dermal and subcutaneous lymphatic channels. We present a case of a 32-year old 26 weeks pregnant female with multiple fluid filled vesicles over the vulvae of one year duration with itching. The lesions had increased in size after the onset of pregnancy. The patient also had a large port-wine stain (PWS) over the right buttock extending up to the perineum. The biopsy report was consistent with LC.</p> Nidhi Shah A Rijal S Agrawal ##submission.copyrightStatement## 2019-07-24 2019-07-24 2 1 93 95 10.3126/jbpkihs.v2i1.24978 Understanding of ‘Equality, Justice and Equity’ among First Year Undergraduate Students of BPKIHS <p><strong>Background: </strong>Understanding of ‘Equality, Justice and Equity’ at the beginning of medical education will have a great bearing in future career.</p> <p><strong>Objectives: </strong>To assess understanding of ‘Equality, Justice and Equity’ among the first year undergraduate students of BPKIHS who were in the beginning of health science/ medical education</p> <p><strong>Methods: </strong>This is an academic institute based study carried out among the first year undergraduate students (BSc.- Nursing, BSc.- Allied, BDS and MBBS) of BPKIHS, based on convenient sampling. This included the responses of 181 subjects giving written informed consent. The ‘semi-structured proforma’ and the pretested ‘Bioethics Awareness, Knowledge and Attitude’ questionnaire were used to collect the responses.</p> <p><strong>Results: </strong>We had 55% female subjects, more from urban settings (65%). Many students were aware about Bioethics and willing to be a part of Bioethics group. Half of the participants felt the need to discuss their patients’ information with their colleagues. More of them (38%) were not sure not about charging more for service on the rich to compensate for the poor while one fifth (22%) favored and one fifth (20%) disagreed. Most of the participants believed that patient’s wishes should always be adhered to. A few respondent students (4%) also believed that doctors and nurses should refuse to treat violent patients. Majority of the participants had heard of taking informed consent and agreed unentertaining patient’s questions during their posting.</p> <p><strong>Conclusion: </strong>There should be various modes of enhancing the teaching learning opportunities for the medical students to learn about ethics and ethical principles including ‘Equality, Justice and Equity ‘and to enhance their positive view.</p> Sumit Sharma D R Shakya S Adhikari V A Chetri R R Singh ##submission.copyrightStatement## 2019-07-24 2019-07-24 2 1 83 88 10.3126/jbpkihs.v2i1.24975 PANCON in BPKIHS after 20 years...... <p>Not available.</p> Suraj Nepal D R Shakya ##submission.copyrightStatement## 2019-07-24 2019-07-24 2 1 96 97 10.3126/jbpkihs.v2i1.24980