Nepal Medical College Journal

Availability, accessibility and affordability of diabetes health care facilities in Latur, India

2023-06-26T04:29:32+00:00

Despite the enormous burden, diabetes care in the community is still substandard. According to studies conducted in the Latur District, there is a significant gap between recommended and actual diabetes care, which results in poor health outcomes. A cross-sectional survey was undertaken in the Latur District of Maharashtra. A sample of 505 self-reported persons with diabetes from 413 households were interviewed from May to October 2017. The study used total samples of self-reported diabetes for the bivariate and multivariate analyses. Only 19% of respondents reported that they accessed government hospital facilities for treatments of diabetes. Elderly, belonging to SC/ST, working as a farmer/labour, and poor categories accessed government facilities for diabetes treatment. Most of the people could not access healthcare facilities because more than a third of respondents live more than 31km from hospital facilities because of poor transportation, lack of connectivity, and highly unaffordable healthcare expenses and time access to healthcare facilities. The adjusted odds ratios show that after controlling for important background factors find the link between unaffordability, distance, and poor transportation to healthcare institutions. The government and private sector must urgently decentralize healthcare facilities, and the government must enhance the health system by making health check-ups available at sub-centres, PHCs, rural hospitals, and special diabetic departments in the district and sub-district hospitals. Furthermore, the private sector and non-governmental organizations (NGOs) have to take steps to raise diabetes awareness and provide healthcare services at the grassroots level.

Relationship between Symptoms of Adenoid Hypertrophy and Adenoidal Nasopharyngeal Ratio in Children at a Tertiary Hospital

2023-06-26T04:35:32+00:00

Adenoid hypertrophy (AH) is a common problem in the paediatric age group causing nasal obstruction, snoring, waking up at night, nasal discharge, mouth breathing and decrease in hearing. This causes considerable morbidity in children along with various sequalae. The adenoidal nasopharyngeal ratio (ANR) is an objective method to assess AH and is calculated using a lateral neck x-ray. The study assessed the relationship between symptoms of AH and ANR. A cross-sectional, hospital-based study was conducted in children between the ages of 2 to 14 years. History of the symptoms was obtained and ANR was calculated using a lateral neck x-ray. There was a male preponderance of 1.3:1, with the majority of children between 6 to 10 years of age (67.3%). The common symptoms were nasal discharge (81.1%), mouth breathing (79.8%), snoring (76%) and decrease in hearing (66.3%). The largest mean adenoid size was 18.20 ± 2.63 mm in the 6-10 years, while the greatest mean nasopharyngeal depth was in the 11-14 years old age group (34.50 ± 2.88 mm). The maximum mean ANR of 0.71 ± 0.11 was in the 2-5 years old. All the symptoms of AH showed statistically significanct relationship with high ANR; snoring (p=0.003), waking up at night (p=0.001), nasal discharge (p=0.001), mouth breathing (p=0.034), decrease in hearing (p=0.030). It was seen that the highest number of children affected was in the younger age group where ANR was higher. ANR on nasopharyngeal x-ray (lateral view) correlated well and showed significant relationship with symptoms of AH.

Cytomorphological Study of Lymphadenopathy at a Tertiary Health Care Hospital in Kathmandu

2023-06-26T04:43:16+00:00

Lymphadenopathy is most commonly encountered problems in clinical practice. Various etiological factors can cause lymphadenopathy. Cytomorphological study of lymphadenopathy is a window for diagnosis of many disease processes. Aspiration cytology provides a reliable, safe, rapid and economical method of screening the patients with accuracy. It can differentiate neoplastic from non-neoplastic lesions and therefore influences patient management preventing patient from being subjected to unnecessary surgery. Hospital based descriptive study was carried out in the Department of Pathology of a tertiary health care hospital in Kathmandu over a period of three years (1st June 2019 to 30th May 2022). A total of 331 cases of lymphadenopathy were included in the study. The aim of this study was to evaluate the cytomorphological findings of lymphadenopathy. Out of 331 cases of lymphadenopathy, 281 (84.9%) of the cases were non-neoplastic and 47 (14.2%) were neoplastic. Among non neoplastic lesions, reactive lymphadenitis 113 (34.1%) was the most common diagnosis followed by tubercular lymphadenitis, granulomatous lymphadenitis, suppurative lymphadenitis and necrotizing lymphadenitis. Among neoplastic, 40 (12%) were metastatic carcinoma and 7 (2.1%) were lymphoma. Among metastatic carcinoma the most common was squamous cell carcinoma followed by breast carcinoma, adenocarcinoma, papillary carcinoma of thyroid. Other metastatic carcinoma were small cell carcinoma of lung and melanoma. This study showed that cytomorphological study of lymph node is a convenient procedure for accurate assessment of patients with lymphadenopathy.

Prevalence of incidental lumbosacral spondylolysis on multidetector computed tomography in Nepalese population

2023-06-26T04:50:46+00:00

Spondylolysis is aunilateral or bilateralanatomical defect of pars interarticularis of vertebral arch and commonly occurs at L5-S1 level (85-95%) and L4-5level (5-15%). It is one of the most common causes of lower back pain (LBP), is prevalent in approximately 6% of population and can progress to spondylolisthesiswhich in turn can cause radiculopathy. Although majority of patients may remain asymptomatic, symptomatic patients in early stages usually benefit from conservative treatment. Hence, early identification is very important and multidetector CT (MDCT) scan is the most sensitive technique to diagnose spondylolysis and spondylolisthesis. The prevalence and long-term prognosis of spondylolysis is still not known in the context of Nepal. This study aims to find out the prevalence of incidental lumbosacral spondylolysis on CT scan inNepalese population. Cross-sectional descriptive studydata was collected from 2629 CT abdomen and pelvis performed during four and half year’s period at Nepal Medical College and Teaching Hospital. Presence of spondylolysis was evaluated on multiplanar and volumetric images. Associated feature like spondylolisthesis was also noted. Data obtained was compiled and analyzed using Statistical Package of Social Services – 20 (SPSS-20). Out of total 2629 patients, 1135 were males (43.1%) and 1494 were females (56.9%). Youngest was 14 year and oldest was 102 year old. There was linear positive relation between the age of the patients and frequency of spondylolysis. Incidental lumbosacral spondylolysis was seen in 146 patients with overall prevalence of 5.5%. Out of which 71 were males with 6.2 % prevalence and 75 were females with 5.0 % prevalence.Females were nearly equally affected as males. Frequency of spondylolysis was more in below 60 year (57.5%) compared to above 60 year age group (42.5%). Commonest location was at L5-S1 level, seen in 134 patients (91.8%) followed by L4-L5 level in 8 patients (5.5 %) and both L4-L5 and L5-S1 levels in 4 patients (2.7 %). Spondylolisthesis was seen in 43 (29.5 %) out of 146 patients with spondylolysis, out of which 15 were males (34.9%) and 28 were females (65.1%). In presence of spondylolysis, females had more statistically significant prevalence of spondylolisthesis than males (p value<0.05). The overall prevalence of spondylolysis and at levels at which it occurs concur with that of established literatures. However, this study shows that females are only slightly less affected than males and is nearly equally prevalent in below 60 year age group unlike shown in previous studies.

Prevalence and risk factors of low back pain among commercial motorbike riders in Kathmandu Valley

2023-06-26T04:58:52+00:00

Low back pain is a major health problem because of its high pre valence and has a consequence for disability and burden in the use of health services. It has a great impact on an individual’s economic productivity and quality of life. Motorbike riders are the vulnerable population for musculoskeletal disorders including low back pain. The objective of the study was to find out the prevalence and risk factors for low back pain among motorbike riders in Kathmandu Valley. An analytical cross sectional study was conducted in 265 commercial motorbike riders in Kathmandu. To collect data, convenience sampling technique and face to face interview was employed by using structured interview questionnaire. Data was analyzed in IBM SPSS software. Descriptive statistics and regression analysis was calculated. The study findings demonstrated that 43.8% of the respondents had low back pain among them 31.1% experienced more than 3 episodes of pain in last year. Similarly, 38% of the respondents had low back pain in last seven days. Low back pain is associated with BMI (p = 0.004), duration of commercial motorbike rides (p = 0.000), mileage per day (p = 0.002) and total riding hour per day (p = 0.001). It is concluded that nearly half of the commercial motorbike riders had low back pain in last one year and a significant association was found between low back pain with BMI, duration of commercial motorbike riding duration, riding mileage and riding hour per day. As commercial motorbike riding is a trending business, there should be some government regulations on working hours and other safety measures for the riders.

Prevalence of Dental Caries and Associated Factors among Patients Visiting a Dental Teaching Hospital of Kathmandu

2023-06-26T05:02:34+00:00

Dental caries is the most common oral health issue for the general population. Dental caries not only affects the quality of life but also brings economic burden to individual and society. The aim of this study was to determine the prevalence of dental caries and associated factors among patients. An analytical, cross-sectional study was conducted among the patients visiting Department of Oral Medicine of Nepal Medical College Dental Hospital of Kathmandu. The results showed that overall prevalence of dental caries was 81.6%. Dental caries among participants between 25-34 years was highest (33.1%) and more among females (84.9%). Majority of the participants used toothbrush 96.8%, while 78.3% used fluoridated toothpaste. Even though most study participants claimed to use toothbrush and fluoridated toothpaste, prevalence of dental caries was high.

Combination of Granisetron and Dexamethasone for prevention of postoperative nausea and vomiting following laparoscopic cholecystectomy

2023-06-26T05:08:53+00:00

Postoperative nausea and vomiting (PONV) is the second most common complaint in postoperative period especially in high risk surgeries like laparoscopic cholelithiasis. Many pharmacological strategies has been used for its prevention as PONV may cause adverse effects. Drugs like granisetron and dexamethasone has been used alone and in combination for the prophylaxis of PONV. We observed the adequacy and safety of the combination of these drugs by injecting granisetron (40mcg/kg) with dexamethasone (6mg) after induction of anesthesia. The total number of cases enrolled was 115. During 0-2 hours postoperatively, nausea, retching or vomiting was not seen in 110 (95.7%) of patients. Four (3.5%) patients had nausea or retching and 1 (0.9%) had vomiting episode in 30 minutes duration. During 2-6 hours, no nausea, retching or vomiting was seen in 113 (98.3%) patients and an episode of nausea was present in 2 (1.7%) cases. There was no nausea, retching or vomiting in any patient during 6-12 and 12-24 hours. The prophylactic anti-emetic therapy with combination of granisetron and dexamethasone is effective and safe during the first 24 hours in the postoperative period after laparoscopic cholecystectomy.

A Survey on Patient Satisfaction with Perioperative Anesthesia Care in a Tertiary Care Centre

2023-06-26T05:13:56+00:00

Patient satisfaction is a well-established indicator of quality of medical care and an important tool for improving standards of health care. This study aimed to find the mean patient satisfaction with perioperative anaesthesia care they received. A descriptive cross-sectional study was conducted at post-anesthesia care unit (PACU) of a tertiary care centre from January 2022 to July 2022 after ethical approval from the Institutional Review Committee (Reference No.: 045-078/079). All the patients who underwent emergency and elective surgery under central neuraxial blockade, peripheral nerve blockade or general anesthesia with intubation were assessed using a 10-item predesigned questionnaire. A total of 330 patients completed the questionnaire. In our patients the interpersonal and emotional aspects related to patient satisfaction was similar with all the three types of anesthesia. But patients who received general anesthesia were less satisfied with postoperative pain and postoperative nausea vomiting management. We found that our patients were satisfied with the perioperative care in terms of interpersonal and emotional aspects. The patients who underwent surgery under general anesthesia were less satisfied in terms of physical aspects such as pain and nausea vomiting as compared to patients who underwent surgery under regional anesthesia.

Association Between COVID-19 Infection and New-Onset Diabetes in a Tertiary Care Hospital in Kathmandu

2023-06-26T05:17:51+00:00

In severe acute respiratory syndrome coronavirus 2 infections, reduced numbers of insulin secretory granules in beta cells and impaired glucose-stimulated insulin secretion have been observed, with insulin resistance and the onset of diabetes in them. This study was conducted to find the association between COVID-19 infection and new-onset diabetes. This was a cross-sectional study conducted in the Department of Internal Medicine at Nepal Medical College Teaching Hospital, for a duration of 6 months (July to December 2021). A total of 38 new-onset diabetes patients with a confirmed history of COVID-19 infection were enrolled in the study using a non-probability convenient sampling technique. Ethical clearance was taken from the Research and Institutional Review Committee, Nepal Medical College Teaching Hospital (Reference No.068- 077/078). Venous blood was collected and fasting blood glucose, post-prandial blood glucose, and HbA1c were measured. Data were analyzed in the Statistical Package for Social version 20.0. Analytical data were compared using Z- test for the parametric values and the Chi-Square test for the nonparametric values. Statistical significance was defined as a p-value of less than 0.05. As per clinical severity, 22 had mild, 13 had moderate and three had severe COVID-19 infection. The mean fasting blood sugar was 169.84 ± 40.72 mg/dl and the mean postprandial blood sugar was 249.92 ± 72.46 mg/dl. The mean HbA1c was 7.92 ± 1.11%. Out of 38 patients, 36 had a history of systemic steroid use and hyperglycemia was significantly associated with steroid use (Z=1.97, P=0.024).

Assessment of tongue cleaning habit among the patients visiting a dental hospital in Kathmandu

2023-06-26T05:20:46+00:00

The aim of this study was to assess the tongue cleaning habit among the people to maintain and improve the quality of oral hygiene. This cross-sectional study was conducted in outpatient department of People’s Dental college and hospital, department of Community Dentistry among 312 patients 185 female and 127 male between 18-60 years. The self-administered questionnaire consisted of two parts. The first part consisted of socio-demographic details of participants (age, sex, education and occupation). The second part consisted of 17 questions related to tongue cleanliness behavior. Self-constructed questionnaire adopted from previous study. Data analysis was done by using SPSS 20 version and descriptive statistics were calculated. Out of total 312 participants, 53.8% had a tongue cleaning habits. Sixty nine percent participants cleaned the tongue every day. About two-thirds 65% use toothbrush. Nearly 62% of the participants took 15- 30sec for tongue cleaning. Fifty percent clean the entire tongue. Eighty nine percent started the tongue cleaning about a year ago. Nearly 75% respondent clean tongue on their own without any suggestion from other persons. About 64.3% of the participants were not feeling unpleasant sensation after tongue clean. Nearly more than half 56 % had gagging reflex by using the tongue cleaner. About 53% (n=98) female were having a habit of tongue cleaning. About 30-39 age group 62.1% non-smokers and 57.4% had tongue cleaning habit. About 54.7% drinking tea / coffee had tongue-cleaning habits. In conclusion tongue cleaning habit helps to prevent halitosis, stains, tongue coating and maintain oral hygiene. In this population, more than half reported tongue cleaning habit.

Serum Aminotransferases in Chronic Kidney Disease Patients: A Hospital based Comparative Study

2023-06-26T05:24:43+00:00

Estimation of serum aminotransferase levels play important role in the diagnosis and monitoring of hepatic diseases. Studies suggest that in patients with chronic kidney disease, especially in those under hemodialysis, the reference ranges of the serum aminotransferases might not be reflective of hepatic function. Due to this, diagnosis and management of liver diseases in such patients becomes quite challenging. This study aims to estimate and compare serum aminotransferases levels of hemodialysis patients and healthy controls. Seventy-five patients undergoing hemodialysis in Nepal Medical College Teaching Hospital for at least three months were included in the study as cases and apparently healthy individuals with no active illness and regular medication use for the past three months and were recruited as controls. Predialysis blood samples were drawn and were analyzed for serum aminotransferases and other blood parameters. The median serum AST and ALT values for hemodialysis patients were 15 U/L and 21 U/L, while for the healthy controls, it was 30 U/L and 36 U/L and the differences were statistically significant (p < 0.001). Among the hemodialysis patients, serum AST was positively correlated with eGFR (ρ = 0.247, p = 0.033) and negatively correlated with serum creatinine levels (ρ = -0.307, p = 0.007). Hence, serum aminotransferases levels were found to be low in patients with impaired kidney function compared to those with normal kidney function.

Use of Oral Tramadol to Prevent Post-anaesthetic Shivering in Patients Undergoing Surgery under Spinal Anaesthesia

2023-06-26T08:52:11+00:00

Shivering is a common and distressing problem after spinal anaesthesia which occurs due to heat loss and core to peripheral redistribution of body heat, resulting in reduction of core body temperature. Post anaesthetic shivering has deleterious metabolic and cardiovascular effect which should ideally be prevented by pharmacological methods that are economically and practically feasible in all settings compared to many physical methods. Therefore, this study was conducted using a centrally acting analgesic, oral Tramadol hydrochloride prophylactically for the prevention of perianaesthetic shivering after spinal anaesthesia. This prospective observational study was carried out in 106 patients of ASA I or II, aged 15 to 70 yrs of age undergoing lower limb or lower abdominal surgery under spinal anaesthesia. Postanaesthetic shivering was evaluated during the surgery. Shivering was observed in 11 (10.4%) patients and among them 2 (1.9%) patients had grade 1, 6 (5.7%) patients had grade 2, 2 (1.9%) patients had grade 3 and 1 (0.9%) patients had grade 4 type of shivering. Sedation was observed in 19 (17.9%) patients. The result of this study concluded that oral tramadol is very safe and superior to various drugs studied till date and can be used prophylactically as a part of premedication for the prevention of postanaesthetic shivering in patients undergoing surgery under spinal anaesthesia.

Knowledge, Attitude, and Practice regarding Cervical Cancer Screening among Female Health Professionals of a Tertiary Care Hospital in Kathmandu District

2023-06-26T08:57:11+00:00

Cervical cancer is the cancer that forms in the tissue of cervix. It is usually slow growing cancer that may not have symptoms but can be found with regular Pap tests and proper screening. Hence it is absolutely necessary for the health workers especially female workers to have proper knowledge about cervical cancer and have a positive attitude to getting screening tests done as per the Cervical Cancer Screening guidelines so that early detection and diagnosis can be done leading to decrease in the incidence of the disease. We have conducted this study to see the knowledge, attitude and practice regarding cervical cancer screening among female health professionals of a tertiary care hospital in Kathmandu District. Overall score for adequate knowledge about cervical cancer among different health professionals was not significantly different (χ2 = 1.118, p-value = 0.572). However, there was a significant association between knowledge and those who underwent screening (χ2 = 8.481, p-value = 0.004). There was no association between Knowledge and attitude towards cervical cancer (χ2 = 3.144, p-value = 0.076). However, there was significant association between attitude and profession (χ2 = 4.568, p-value = 0.033).

A Case of Retinal Artery Macroaneurysm: A Ticking Time Bomb of the Eye

2023-06-26T09:01:22+00:00

Retinal arterial macroaneurysms are acquired, focal dilation of a retinal artery. Patients with retinal arterial macroaneurysms can present with an acute or gradual loss of vision as a result of vitreous hemorrhage, preretinal hemorrhage or macular edema. An 81 year old female, a known hypertensive since 12 years under regular follow-up visits, presented to us with vitreous hemorrhage secondary to ruptured retinal artery macroaneurysm in the right eye. She was managed with indirect argon laser treatment. Accurate diagnosis and co-management are crucial to save vision and help prevent life altering complications. This case report emphasizes the need of ocular examination in systemic diseases and further establishes ‘eye as the window of the body’.

Unilateral Vocal Cord Paralysis Post Covid-19 Infection: A Case Report

2023-06-26T09:06:53+00:00

Late-onset neurological complication post-SARS-COV-2 infection is an atypical feature of COVID-19 infection. Vocal cord paralysis is one such complication that can cause symptoms ranging from mild hoarseness of voice to severe dyspnoea requiring mechanical ventilation. In this case report, we describe a 51 years old male with sudden onset of hoarseness of voice six months after recovery from COVID-19 pneumonia without endotracheal intubation and no history of respiratory or any other new illness in between. Nasopharyngolaryngoscopy revealed the left vocal cord paralysis, and a CT scan showed fibrosis, an air cyst in the upper lobe of the left lung, and bilateral lung diffuse ground glass opacity. There was no significant improvement in voice on treatment with prednisolone for nine days and speech therapy. Thus, unilateral vocal cord palsy can present as sequelae of COVID-19 pneumonia.