Nepal Medical College Journal

Assessment of factors influencing operating time during retrograde intrarenal surgery for renal stone in tertiary care hospital of Nepal

2023-03-19T05:39:46+00:00

Retrograde intrarenal surgery (RIRS) is an effective and safe method for the management of intrarenal stone showing high stone-free rates. Its main advantage is decrease in operative morbidity for the patient, as well as a faster recovery. The current study aimed to study the factors influencing operating time during retrograde intrarenal surgery for renal stone in tertiary care hospital. It is an observational descriptive cross sectional study using purposive sampling method which was conducted among 188 patients who underwent retrograde intrarenal surgery (RIRS) for management of nephrolithiasis in Department of Urology of B&B hospital, Lalitpur, Nepal. The baseline information of the factors affecting operating time were obtained like age, gender, site of renal stone, prestented or not, body mass index (BMI), ureteral access sheath (UAS) use, stone volume and stone density. The mean operating time was high in renal stone with calcium ammonium urate composition. On linear regression analysis, operative times significantly increased with greater stone volumes and also pre-stenting and ureteral access sheath use did significantly difference on operative time. It revealed stone volume to be the most significant predictor of operative time. Thus, the present study provides valuable information regarding the factors influencing operating time during retrograde intrarenal surgery for renal stone.

Attitude and practice of dental interns towards the use of rubber dam in different dental colleges of Kathmandu

2023-03-19T05:45:56+00:00

Rubber dam application during routine clinical procedures enhance the dental treatment. Attitude and practice of rubber dam application among dental interns during clinical procedure plays an important role in providing quality treatment and avoiding medicolegal consequences. The aim of this study was to determine the attitude and practice of dental interns towards rubber dam use. A questionnaire-based study was conducted using pre-structured questionnaire among 138 dental interns of three different colleges affiliated to Kathmandu University of Kathmandu District. The results showed that 97.1% study participants believe rubber dam gives good isolation, moisture control and safety. Positive attitude was shown by 55.1% of intern toward rubber dam use during all procedures and 64.5% during root canal treatment. Of the total, 73.2% believed they lacked training and 92.2% were willing to take more training. Most of the interns (85.5%) believe rubber dam as helpful tool. In conclusion, majority of the interns believe rubber dam gives good isolation, moisture control and safety but their lack of rubber dam use in clinical practice could be due to insufficient training, patients’ objection and extra time needed for placement. To overcome this, more trainings, preclinical and clinical demonstration and mandatory use during all clinical posting should be done in dental colleges.

Knowledge and practice regarding myocardial infarction prevention among the visitors of Manmohan Cardio-Thoracic Vascular and Transplant Center, Kathmandu, Nepal

2023-03-19T05:51:31+00:00

Myocardial infarction the most common form of coronary heart disease is a growing health issue in developing countries. The number and magnitude of the disease is expected to grow without awareness and preventive interventions. Therefore, this study was carried out to find out knowledge and practice regarding myocardial infarction prevention among the visitors of cardiac center. A descriptive cross sectional study was conducted among 278 patient’s visitors attending Manmohan Cardio-Thoracic Vascular and Transplant Centre from June 2021-August 2021. The selection of the study area and data collection was done using Convenient sampling technique. SPSS version 16 was used for data entry and analysis. Descriptive statistics such as median, frequency and inferential statistics such as chi-square tests were used. The study revealed over 2/5th (42.8%) of respondents were between age group of 41-50 years. Majority (92.1%) were literate among which over a third (37.5%) had secondary level of education. The practice of blood pressure measurement, blood sugar and blood cholesterol measurement was reported by 76.1%, 59.1% and 31.4% respectively. Level of knowledge was adequate in 24.2% of respondents. Significant association was found between level of knowledge and sex (P=0.015), religion (P=0.009), occupation (P=0.017), and literacy status (P=0.001). Level of knowledge was found to be adequate in low percentage of the respondents. As myocardial infarction is a trending non-communicable disease, nationally there is the necessity of conducting extensive health awareness program, campaigns regarding its prevention.

Evaluation of leukocyte esterase reagent strip test for rapid bedside diagnosis of spontaneous bacterial peritonitis

2023-03-19T07:05:51+00:00

Spontaneous bacterial peritonitis (SBP) is a common complication of cirrhosis with high morbidity and mortality. Early diagnosis and treatment improve survival. Diagnosis is made by ascitic fluid Polymorphoneuclear leukocytes (PMNL) count of >250/mm3 which takes hours and may not be available in rural settings. Leukocyte esterase reagent strips (LERS) test have shown high sensitivity, specificity, and negative predictive value in the diagnosis of SBP. This study was conducted to find the utility of the LERS test for the diagnosis of SBP. This was a prospective hospital-based study conducted at the National Academy of Medical Sciences, Bir Hospital, Nepal. LERS test was performed on ascitic fluid from 140 cirrhotic patients. Colorimetric grading was compared with PMNL count for diagnosing SBP. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for diagnosing SBP calculated for grade 3 and grade 4 as cut-offs. Among 140 patients, SBP was diagnosed in 27. Grade 3 as cut-off, sensitivity, specificity, PPV, and NPV for the LERS test were 96.3, 90.2, 70.3, and 99 percent respectively. For grade 4 as cut-off, sensitivity, specificity, PPV, and NPV were 81.5, 99.1, 95.6, and 95.7 percent respectively. Accuracy were 91.4 and 95.2 percent for grade 3 and 4 as cut-off respectively. LERS test has shown high sensitivity, specificity, and negative predictive value for the diagnosis of SBP in cirrhotic ascitis. Being simple, rapid, and cost-effective, it can be useful at bedside to start early antibiotic therapy before availability of the PMNL count report.

The predictivity of serum biochemical markers in acute biliary pancreatitis

2023-03-19T07:13:54+00:00

Acute pancreatitis (AP) is the most common gastrointestinal disease requiring hospital admission. Among the etiology of AP gallstones (45%) and alcohol abuse (20%) are the most frequent causes of AP. Sixty-nine patients of AP who met the inclusion criteria were evaluated from July 2021- June 2022. The predictivity of serum biochemical marker alanine transaminase (ALT) in acute biliary pancreatitis and the mean serum biochemical markers (ALT, aspartate transaminase, alkaline phosphatase, bilirubin, amylase and lipase level) in AP were evaluated. Total 69 patients with the diagnosis of AP were included. Forty-six (66.7%) were male and twenty-three (33.3%) were female out of which 12 (17.3%) were diagnosed as biliary pancreatitis and 57 (82.7%) had non-biliary pancreatitis. In non-biliary pancreatitis there were 41 male and 16 females. Non-biliary pancreatitis was more common in male and biliary pancreatitis was more common in female. There was no significant difference in mean levels of amylase in biliary and non-biliary pancreatitis (i.e. in non-biliary pancreatitis; mean ± SD = 387.14 ± 419.53, in biliary pancreatitis mean ± SD = 535.5 ± 533.51, p-value= 0.235 >0.05), the mean lipase was not significantly different in biliary and non-biliary pancreatitis (i.e.in non biliary pancreatitis; mean ± SD=1287.75±894.37, in biliary pancreatitis mean ± SD =1666.41 ± 1150.47, p-value =0.289 > 0.05). There was a significant difference seen among the mean levels of all other parameters (Bilirubin T&D, ALT, AST and ALP) the mean was found to be significant in biliary and non-biliary pancreatitis (i.e. p-value=0.000<0.05). Liver function test mainly ALT may predict biliary etiology of AP.

Prevalence and molecular characterization of methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant Staphylococcus aureus (VRSA) in a tertiary care hospital

2023-03-19T07:21:34+00:00

Resistance shown by Staphylococcus aureus to methicillin; mediated by mecA, and vancomycin; mediated by vanA, has led to difficulty in treatment of related infections. Despite reports showing methicillin resistant S. aureus (MRSA) and vancomycin resistant S. aureus (VRSA) in Nepal, and need for their regular surveillance, no study has been conducted on it in our hospital. So, this study is aimed to determine prevalence of MRSA, VRSA and their molecular characterization along with antibiogram. A descriptive cross-sectional study was conducted from August to December, 2022 in Clinical Microbiology Laboratory of NMCTH among S. aureus (n=160) isolated from various clinical specimens after receiving ethical approval from NMC-IRC. AST was done by modified Kirby-Bauer’s disc diffusion method. MRSA and VRSA were detected by cefoxitin disc method and agar dilution method respectively. Inducible clindamycin resistance was detected by D-test. Resistant genes (mecA, PVL, and vanA) were detected using conventional PCR. Prevalence of MRSA was found to be 31.2% (50/160) but none of the isolates were resistant to vancomycin. Total 7 (46.6%) mecA and 7 (46.6%) PVL genes were detected among 15 selected MRSA isolates but vanA was not found. All the MRSA isolates were susceptibile to co-trimoxazole, tigecycline, chloramphenicol, vancomycin, teicoplanin and linezolid. The resistance rate against ciprofloxacin, ofloxacin, and clindamycin was 52.0%, 44.0%, and 68.0% (20.0% iMLSB, 28.0% cMLSB and 16.0% MS-phenotypes) respectively. Prompt implementation of hospital antibiotic policy and AMR Act by government along with regular surveillance of MRSA and VRSA seems essential to contain MRSA infections. Co-trimoxazole could be treatment option against MRSA in our setting, keeping vancomycin in reserve. However, large scale studies are required to establish this conclusion.

Prophylactic role of Timolol to prevent rise of intraocular pressure after Nd-YAG laser posterior capsulotomy

2023-03-19T07:29:48+00:00

This study was conducted to know the effectiveness of topical 0.5% timolol maleate for the intraocular pressure rise after Nd-YAG laser posterior capsulotomy. Ninety-six eyes of 92 patients undergoing Nd-YAG laser posterior capsulotomy were randomly selected for pretreatment with topical 0.5% timolol maleate, 48 patients (Group A) or control 48 patients (Group B). The mean IOP of the group A was 14.8±3.0 mmHg before capsulotomy and 15.7±3.4 mmHg after capsulotomy (P >0.05), whereas 15.1±3.3 mmHg and 17.2±4.3 mmHg (P <0.05) of the group B. There was no statistically significant difference between the two groups with regard to mean IOP before capsulotomy (P >0.05), but statistically significant difference between two groups after capsulotomy (P <0.05). Pretreatment with topical 0.5% timolol maleate is effective in preventing IOP elevation after Nd-YAG laser posterior capsulotomy.

Knowledge and practices on dengue prevention among the people of Buddhabhumi Municipality of Nepal: a cross-sectional study

2023-03-19T07:36:07+00:00

Dengue infection is transmitted to humans through the bite of infected Aedes mosquitoes and about half of the world’s population now in risk of the dengue infection. The objective of the study was to assess the level of knowledge and practices on dengue prevention among the people of Buddhabhumi Municipality of Kapilvastu district of Nepal. A Cross-sectional study was done among randomly selected 181 households. Head of the households were the respondents for face to face interview. Pretested and validated tool was used for data collection. Statistical Package for Social Sciences version 20 used for data analysis. Percentages, frequency, mean the calculated and Chi-square test applied to measure level of association. Overall knowledge about dengue was good among 30.9% and overall 38.1% of the respondents had good dengue prevention practices. Caste/ethnicity and family type of the respondents are the factors associated with overall knowledge on dengue. Caste/ethnicity and educational status of respondents are associated with dengue prevention practices. For success of dengue prevention, programs should be designed to increase level of knowledge and also the translation of knowledge domain into real preventive measures.

Estimation of gestational age specific amniotic fluid index in normal pregnancy in Nepalese women

2023-03-19T07:49:22+00:00

Amniotic fluid volume (AFV) is estimated in almost all the antenatal scans referred for ultrasonography (USG). It has proven to be a very good predictor for poor pregnancy outcomes. Several standard text books have quoted normal range of amniotic fluid index (AFI). These reference range may not be applicable to all the population as over the years different studies have shown that it varies among different population. Since such variations has been postulated, our aim is to formulate a reference range of gestational age specific AFI in normal pregnancy among Nepalese women. Therefore, a cross-sectional study was carried out among 537 normal pregnancies who attended the out-patient department of Nepal Medical College Teaching Hospital. Women with any maternal and fetal complications were excluded from the study. Subsequently median, the 5th, 50th and the 95th percentile values were calculated for each gestational week and were compared with studies among other population. Among the 537 women enrolled in the study, the mean maternal age was 26.5 years with the estimated fetal weight (EFW) at term pregnancy ranged from 2372 grams to 3750 grams with the mean being 3261 grams. The mean AFI at preterm was found to be 12.6 cm ± 2.36 and at term 11.0 cm ± 2.82. The percentiles values for first to 99th percentile of the entire data was calculated and the normal range of the AFI was estimated to be between 6 – 17 cm. As studies have shown the variance in AFI range among different population. It is imperative to formulate a reference of AFI among different population. In our study we found they are lower as compared to the Caucasian population, similar to Indian population and higher than the Chinese population.

Prevalence of Michel’s Type 1 hepatic arterial anatomy on CT angiography in Nepalese population

2023-03-19T08:00:02+00:00

Multidetector Computed Tomography (MDCT), with an accuracy of 95-100%, is the modality of choice for preoperative assessment of hepatic artery anatomy in this era of modern hepatic surgeries. Celiac trunk is the first anterior branch of the abdominal aorta and trifurcates into left gastric, splenic, and common hepatic artery which branches into gastroduodenal and proper hepatic artery which then divides into right, middle and left hepatic arteries. Superior mesenteric artery (SMA) originates from abdominal aorta one centimeter below the celiac trunk. This “classic” anatomy pattern is seen only in approximately 61.3% of patients. This study aims at establishing prevalence of hepatic artery anatomical variations on MDCT in Nepalese population since such study has not been published in context of Nepal yet. Cross-sectional descriptive study was performed on MDCT images of all patients undergoing CT abdomen and pelvis with angiography between November 2018 and October 2022 (four years) at Nepal Medical College and Teaching Hospital. The Type of variation was categorized according to Michel’s classification. The values were further grouped under male and female categories. Data obtained was compiled and analyzed using SPSS 16. Out of 504 patients, 258 were males (51.2%) and 246 were females (48.8%). Youngest was nine years and the eldest was 93 years old with mean age of 48.1 years. The commonest variation was Michel’s Type 1, seen in 371 (73.6%) followed by Type 2 in 61 patients (12.1%) and Type 3 in 46 (9.1%). Type 4 was seen in 11 patients (2.2%) and Type 5 variant in nine patients (1.8%). Only one patient each had Type 6 and 7 (0.2 % each). Two had Type 9 (0.4%). We did not find Type 8 and 10. Statistically significant difference between male and female was found only in Type 2 with females having higher prevalence. Two patients showed celiac trunk and SMA arising from single celiomesenteric trunk of abdominal aorta, accounting for 0.4% of total cases which was tabled under unclassified category. MDCT is excellent modality to depict normal and variant hepatic arterial anatomy. Michel’s Type 1 is the commonest hepatic arterial anatomy variant and should be considered as normal “classic” pattern.

Histochemical study of acid mucins in osteoarthritic menisci of the human knee joint

2023-03-19T08:12:09+00:00

Knowledge regarding changes of proteoglycans (acid mucins) in human osteoarthritis (OA) meniscus may help in understanding development of meniscal degeneration. Therefore, present study was planned to know changes in acid mucins in human knee OA menisci by histochemical analysis of different parts of medial and lateral menisci of both legs. Medial and lateral OA menisci were collected from 110 human knee joints of both sexes. Normal meniscal tissue of sheep was taken as control and studied for histological stain with alcian blue pH 2.5, to find acid mucins changes in OA menisci. Data were analyzed by bivariate and one-way ANOVA using MS-Excel. Osteoarthritis is more common in females than males. OA changes were found to be more on right side in females and on left side in males, while OA was more common in both legs in number of cases in 60-69 years. Further, decreased staining intensity for acid mucins was observed in different parts of medial and lateral OA menisci of both legs than control meniscus. A significant change in level of acid mucin was observed at anterior, middle, and posterior parts of medial and lateral OA menisci of both legs (P-value=0.0306). Significant changes in acid mucins in human OA meniscus provide information on scientific evidence of OA progression, which could help health professionals in development of structure-modifying drugs for OA therapy.

Largest dengue outbreak (2022) in Nepal

2023-03-19T08:51:29+00:00

Dengue virus infection, transmitted by Aedes aegypti (also by Ae. albopictus) mosquito, is an increasing health problem. The number of dengue cases has increased over eight-fold over the last two decades, from 505,430 cases in 2000, to over 2.4 milli on in 2010, and 5.2 million in 2019 with deaths accounting in thousands. Currently, 3.9 billion people in 129 countries mainly in Asian countries are at the risk of dengue infection. Most of the new cases are reported from Brazil, Vietnam, Indonesia, the Philippines, Sri Lanka and others. First case of dengue was reported from Nepal in 2004 and in 2006 a small outbreak was reported with 32 cases throughout the country. In Nepal, dengue epidemic occurred in 2010, 2013, 2016, 2017, and 2019; of them 2019 epidemic was largest one with reported 17,992 cases. This year (2022) largest outbreak occurred with a total of 54,784 cases recorded from all 77 districts in 7 provinces. Of the 7 provinces Bagmati Province was hardest hit (77.4%) followed by Lumbini Province (9.2%), Province 1 (4.2%), Gandaki Province (3.6%), Sudur Pashchim Province (2.5%), Madhesh Province (1.8%) and Karnali Province (1.2%). Most of the patients were aged 15-59 years and slightly more than half were males. Of the four serotypes existed in Nepal, DENV-1 DENV-2 and DENV-3 were common this year’s outbreak (DENV-1 was predominant: 57.1%). This demands a precise mapping of dengue through integrated disease surveillance and evaluation of the dynamics of population-level immunity on evidence-based policy-making in days to come.

A study of prophylactic low dose ketamine and granisetron for prevention of shivering during spinal anesthesia

2023-03-19T08:59:17+00:00

Spinal anesthesia significantly results in shivering and hypothermia as unwanted effect. Shivering increases oxygen consumption which may be deleterious in patients who have low cardiac and pulmonary reserve. We conducted this study to evaluate the efficacy of Ketamine and Granisetron for prevention of shivering under spinal anesthesia. In this randomized prospective study, 90 Patients aged 18-60 years of ASA physical status I & II undergoing various surgical procedures were included and allocated alternately to one of the 3 groups; Normal saline (Group P), Ketamine 0.25mg/kg (Group K) and Granisetron 40μg/kg (Group G). Incidence of shivering, effect on haemodynamics, nausea, vomiting, and sedation were recorded. The patients were comparable in terms of demographic variables, baseline temperature, and median level of sensory blockade. Shivering was present in 10 (33%), 3 (10%), 1 (3%) respectively in Group P, G, K. In Group P, 8 (26%) patients experienced shivering at Grade 3 and this was significantly higher than Groups G and K (P = 0.0003). None of the patients were sedated in Group G and P. The sedation was seen in 8 cases (26%) in Ketamine group, most of them were sedated to grade 2 and only 3 were of grade 3 (P<0.05). No hallucination was seen in any of the patients. Low dose ketamine and Granisetron are effective for prevention of shivering in comparison to placebo during spinal anesthesia and ketamine is more effective than granisetron.