Nepal Medical College Journal <p>Nepal Medical College Journal is the official journal of Nepal Medical College Pvt. Ltd (NMC), Attarkhel, Gokarneshwor Municipality-8, Kathmandu, Nepal. P.O. Box 13344, Phone: +977 01 4911008 &nbsp;| &nbsp;4912118 &nbsp;| Extension 607, Email: <a href=""></a>.</p> <p>It is also available on its own website <a href="" target="_blank" rel="noopener"></a></p> Nepal Medical College Pvt Ltd en-US Nepal Medical College Journal 2676-1319 How Ultrasonographic Guided Thoracentesis Scores over Blind Procedures? <p>Thoracentesis is tapping of pleural fluid from the pleural cavity for either diagnostic or therapeutic purposes. These are the frequently encountered procedures in the medical practices. Many conditions warrant sending the cases of pleural effusion cases for intervention. Most of the cases had been tried blindly first in their respective departments but failed because of various reasons. It had been documented regarding the advantages and disadvantages of blind and ultrasonography (USG) guided procedures. The aim of the study was to highlight the advantages and benefits of USG guided thoracentesis. We carried out USG guided thoracentesis of fifty cases in our radiology section who were referred to us by various departments. There were 19 female (38%) and 31 male (62%) patients. All these candidates had failed in blind procedures, when tried first. All these cases underwent USG guided thoracentesis with almost negligible complications. These were found to be having pleural fluid collection due to different underlying pathologies. There was no major complication in any of the cases who underwent thoracentesis. We reiterate by this study that USG guided procedures in thoracentesis should be the first choice in the tapping of pleural fluid. This is a quick, affordable, and without any discomfort to the patient.</p> Bharat Bhushan Sharma Sagar Garg Abhivind Bhutani Mir Rizwan Aziz Monu Sarin Gagan Chauhan Surbhi Lathwal Manpreet Kaur Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 185 189 10.3126/nmcj.v23i3.35317 A Comparative Study of Tramadol and Ketorolac for Pain Management in Post-Operative Patients with Appendectomy <p>Appendectomy is one of the most common emergency surgical procedures performed in the world. The inflammation of the appendix triggers severe pain in the right lower quadrant of the abdomen. Additionally, the post-operative incision site pain may be distressing to the patients. Analgesic drugs like tramadol (opioid analgesics) and ketorolac (nonsteroidal anti-inflammatory drug - NSAID) are used to manage post-operative pain. The objective was to compare tramadol and ketorolac for pain management by observing the pain-free interval in post-operative patients with appendectomy. A descriptive cross-sectional study was conducted in the department of surgery from November 2019 to May 2020 to observe the duration of pain-free intervals between tramadol and ketorolac. The total number of appendectomy patients selected was 100. Fifty patients received tramadol and the next 50 patients received ketorolac. The data was entered in SPSS and an independent sample t-test was applied to determine the difference in duration of the pain-free interval between ketorolac and tramadol. The average duration of pain-free for the tramadol group was 4.95±1.19 hours (4 hours 57 minutes) while for the ketorolac group was 5.24±1.36 hours (5 hours 14 minutes). The difference was statistically insignificant. We also observed that the tramadol group (88%) received more anti-emetic drugs than the ketorolac group (24%). Therefore, post-operative pain management with ketorolac was found to be as effective as tramadol with comparable duration of the pain free interval.</p> Lujaw Ratna Tuladhar Nikhil Acharya Shailesh Maharjan Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 190 193 10.3126/nmcj.v23i3.40374 Assessment of Hypoxemia using Downes Score in Neonates with Respiratory Distress <p>Respiratory distress in newborn is a common problem leading to hypoxemia. Pulse oximetry is the tool for measuring oxygen saturation noninvasively and blood gas analysis is the gold standard for oxygen monitoring. Downes score can be used as an alternative to assess respiratory distress clinically and determine the need of oxygen supplementation when these facilities are not available. This study was done to evaluate the validity of Downes score to assess hypoxemia in newborn with respiratory distress. This is a cross sectional descriptive study conducted from June 2020 to February 2021 in Neonatal Intensive Care Unit of Nepal Medical College Teaching Hospital. Oxygen saturation of newborn with respiratory distress was measured by pulse oximetry. At the same time the neonate was assessed for respiratory distress clinically using Downes score. Downes score and oxygen saturation measured by pulse oximetry were compared. Hypoxemia was defined as oxygen saturation less than 90% in term/ post term newborn and less than 88% in preterm baby. Similarly, neonate was considered to be hypoxic when Downes score was ≥5. The accuracy of Downes score was assessed by its sensitivity and specificity in detecting hypoxemia. Altogether 121 neonates were included in the study. Sensitivity and specificity of Downes score of 5 was 94.12% and 93.10% respectively. In conclusion, Downes score can be used as a clinical diagnostic means for assessing hypoxemia in neonates with respiratory distress</p> Sabina Shrestha Sujit Kumar Shrestha Gentle Sunder Shrestha Madhu Sudhan Dhakal Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 194 197 10.3126/nmcj.v23i3.40375 Comparision of Coblation and Cold Dissection Techniques outcome among Tonsillectomy patients at Birat Medical College and Teaching Hospital <p>Tonsillectomy is the most commonly performed surgery. Cold dissection tonsillectomy remains as the gold standard for tonsil removal, although it may increase risk for complication. Coblation tonsillectomy is a new technique .There are studies comparing these two method of surgery and have shown coblation technique to cause less postoperative pain, less intra operative time along with less intra and postoperative blood loss. In contrary few studies have shown it to be ineffective in reducing postoperative bleeding. Hence more studies are still required. Thus the objective of the present study was to compare coblation and cold dissection techniques outcome among tonsillectomy patients at Birat Medical College and Teaching Hospital. The study intended to determine and compare the intraoperative time, intra operative blood loss and postoperative pain in coblation and cold dissection tonsillectomy. This is a hospital based cross sectional comparative study. Eighty six patients underwent tonsillectomy during the study period of one year (15th Feb 2020 to 14th Feb 2021) in the department of ENT HNS, Birat Medical College and Teaching Hospital. Among 86 patients, 43 underwent cold dissection and 43 coblation tonsillectomy. Method of surgery was based on odd and even serial number of the patients during presentation. This study showed that intra operative time, intraoperative blood loss and post operative pain score was 16.77±2.7mins, 36.51±128ml and 6.28 respectively in coblation method and 37.84±3.1 mins, 101.4±12.7ml and 7.88 respectively in cold dissection method. Hence coblation method is a safer and effective method of tonsillectomy compared to cold dissection which ultimately leads to less post operative analgesics demands and early recovery.</p> Bipin Koirala Rajeev Kumar Shah Karuna Shrestha Srijana Sapkota Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 198 203 10.3126/nmcj.v23i3.40376 Incidence of Symptomatic Internal Hernia following Minimal Invasive colorectal surgery: A Single Center Experience <p class="Default">Laparoscopy has been adopted in the surgical specialties and colorectal surgery for treatment of benign and malignant diseases. Recent reviews suggest that the incidence of symptomatic internal hernias after laparoscopic colorectal resection is from 0.39 to 0.65%. Unlike in open surgery, laparoscopic closure of a mesenteric defect is inherently challenging as inadvertent injury to the marginal vessels may compromise blood supply to the anastomosis. For these reasons, many surgeons leave the defect open during laparoscopic surgery. But this may lead to development of post-operative internal hernia through the defect. This is a retrospective study where we included 149 patients who underwent laparoscopic/ robotic colorectal surgeries from March 2019 to March 2020. Data pertaining for following variables were collected which included age, sex, indication for surgery, location of the pathology, splenic flexure mobilization. The incidence of internal hernia among these patients were calculated and assessed using SPSS 20. Incidence of internal hernia was found to be 0.67% which was diagnosed and treated on the 18th post-operative day of initial surgery. Internal hernia is a rare but important complication of laparoscopic/robotic colorectal surgery with a high mortality rate if not diagnosed early. Defect closure is still controversial during the initial surgery and probably not indicated for all patients and depends on surgeon’s preference.</p> Rajiv Nakarmi Tian Yu-Feng Khaa-Hoo Ong Muza Shrestha Sundar Maharjan Suman Bikram Adhikari Chhetri Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 204 209 10.3126/nmcj.v23i3.40377 Management of Pain with Morphine in Cancer Patients in a Tertiary Care Centre of Nepal <p>Pain is one of the most afflicting symptoms reported by cancer patients, mainly those with metastatic disease. The prevalence of cancer has increased, with an estimated projection of 17 million new cases in 2020. This means that there will be an increase in individuals with pain caused by the disease and by treatment. Morphine has been used to relieve pain in cancer patients for centuries. WHO, created a global health policy document for management of cancer pain entitled “Cancer Pain Relive,1 in which morphine was central. In a retrospective study of 1229 patients with cancer pain, the author reported that the analgesic ladder was effective in 71%. Many patients do not get adequate pain relief. Rationale of this study was to assess cancer related pain by using visual analogue pain scale and to prescribe optimal dose of morphine through dose titration to relieve pain and to improve quality of life. An interventional hospital-based study was done in fifty-two different types of cancer patients from 1st Jan, 2020 to 31st Dec, 2020 at Department of Oncology, Nepal Medical college and Teaching Hospital (NMCTH), Kathmandu. Among them 31 were male and 21 were female with mean age 63.87 and 58.19 respectively and SD +/- 12.10 in male and 16.07 in female with p value 0.152 significant. These patients were assessed for severity of pain through visual pain analogue. Improvement in daily activities after administration of morphine according to ECOG performance scale was done. Constipation was the most common complication induced by morphine 38.5%, sedation 32.7% and nausea in 25%. By understanding the context and social meaning surrounding the use of morphine to treat cancer pain, health care professionals can begin to anticipate, acknowledge and address some of the barrier to its use, thereby enhancing the pain control.</p> Rita Kumari Mahaseth Rashmey Pun Kriti Shrestha Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 210 215 10.3126/nmcj.v23i3.40379 A Simple Method to Type the Urinary Stones <p>The main aim of this study was to find an alternative method to type the urinary stones, which do not comply with the available method. For this study 100 stones were selected and were analysed by wet chemical method. The compositions of randomly selected 10 stones each among the stones typed based on the available and the new method were crosschecked by Fourier Transform infrared Spectroscopy (FTIR) method. Among the 100 stones, 46 stones were of Category I [21 stones Uric acid/Urate, 13 stones Oxalate, 12 stones Phosphate] while five were of Category II stones. Rest 49 stones, which cannot be typed by the available method, were typed by considering the ratios between the characterizing and indicating anions. To type the Oxalate stones, Oxalate to Urate ratio between 16.8:1 and 67.7:1; Urate stones, Urate to Oxalate ratio between 0.7:1 and 101.7:1 and Non- infection Phosphate stones, Phosphate to Oxalate ratio between 0.4:1 and 24.4:1 were considered. Based on the newly proposed method majority of the stones were of Oxalate type (n=41). Based on both the methods of stone typing, of the total 100 stones, 54 stones were Oxalate type, 25 stones were Uric acid/Urate type, 16 stones were Non-infectious Phosphate stones and 05 were Infectious stones. The compositions of the randomly selected ten stones of each typed from the available and the newly proposed method were similar to the results obtained by FTIR method. This study indicated that, the new method could be used as an alternative method to type the stones.</p> Sivarangini Sivagnanam Vasanthy Arasaratnam Mangala Gunatilake Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 216 222 10.3126/nmcj.v23i3.36383 Bifurcation of Common Carotid Artery in Relation to Vertebral Level in Nepalese: A Cadaveric Study <p>The principal arterial supply of the head and neck are the two Common Carotid Arteries (CCA), they ascend in the neck and each divides into two branches, the External Carotid Artery (ECA) supplying the exterior of the head, neck and the Internal Carotid Artery (ICA) supplying the cranial and orbital cavities. Atherosclerosis of the carotid arteries is a major cause of stroke and transient ischemic attack and it increases with age. The present study was observational based descriptive type, conducted to identify the CCA bifurcation in relation to cervical vertebral level. A total number of 18 cadavers (16 males and 2 females), right and left side of cadavers were studied by dissection method in the Department of Anatomy, NMCTH from February 2020 to February 2021. The ethical approval was taken from NMC- IRC (Ref no- 026-076/077). In present study the frequency of CCA bifurcation in sixteen male Nepalese cadavers (32 samples) on the right and left side was observed and found high level of bifurcation on 31.25% and 37.5% respectively and normal/ standard on the right and left on 68.75% and 62.5% and there were no findings of low bifurcation of CCA. In two female cadavers (4 observations) the level of bifurcation was same on both the side at the level of C3-C4. The Carotid artery injury is possible in different neurological and head and neck surgery. Therefore, the knowledge of variation in level of bifurcation of CCA in different population will be referential to reduce the iatrogenic injury.</p> Usha Chalise Allin Pradhan Chhiring Palmu Lama Shaligram Dhungel Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 223 227 10.3126/nmcj.v23i3.40380 The Cost of Treating Neonates in Intensive Care Unit in a Tertiary Level Teaching Hospital <p>Neonatal intensive care is associated with high costs world-wide and remains a matter of financial stress for families. This is an issue of great importance in a developing country like ours as financial burden may have a negative impact in the overall outcome of a newborn. The objective of this study was to evaluate the direct cost of treating newborns by family members in a neonatal intensive care unit (NICU). This was a prospective cross sectional study carried out in the NICU of Manipal Teaching Hospital, Pokhara, Nepal. There were 96 neonates included in this study over a period of 3 months from September to November 2020. The average cost per neonate per day was NRs. 5858 (USD 50). The highest health expenditure was incurred in neonates of gestational age of 32 to less than 37 weeks, and it was also significantly higher in neonates having birth weights less than 1.5kg. Preterms with hyaline membrane disease, followed by newborns with meconium aspiration syndrome resulted in maximum health costs. Maximum expenditure of the total bill was due to the cost of the bed charges. The median length of stay in the study was 5 days and the length of stay was directly and significantly related to the treatment costs.</p> Sahisnuta Basnet Suraj Adhikari Mukunda Timilsina Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 228 234 10.3126/nmcj.v23i3.40382 Ophthalmic Causes of Headache among Patients Attending Tertiary Care Center in Kathmandu, Nepal <p>The purpose of this study was to evaluate the ophthalmic causes of headache among patients attending tertiary care hospital. This was a descriptive, cross sectional hospital-based study. One hundred and thirty-two patients with ocular cause of headache excluding primary headache and pediatrics patients during one year were included. Detail ocular examination was done including visual acuity, refraction, binocular vision assessment like convergence insufficiency and fusional insufficiency, anterior and posterior segment examination. Among headache patients, female was 106 (80.3%) and male was 26 (19.7%). The prevalence of headache in female was 6.9% and in male was 2%. Headache was more common in age group 18-29 (59.8%). The mean age of presentation was 29.9 ± 10.2 years (range 18-61 years). Out of 132 patients with headache, 104 (78.8%) had refractive error, 15 (11.4%) had fusional insufficiency, 6 (4.5%) had convergence insufficiency, 10 (7.6%) had anterior segment diseases and 5 (3.8%) had posterior segment diseases. Among refractive errors, both eyes astigmatism was the commonest 48 (36.5%) followed by both eyes simple myopia 44 (33.4 %) which was statistically significant with ocular headache (p=0.000). Ocular anomalies other than refractive error may coexist with headache complaints. Therefore, thorough ocular examination should be done in all patients suffering from headache.</p> Pranisha Singh Anu Mishal Jay Sundar Sunarait Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 235 240 10.3126/nmcj.v23i3.40383 Antibiogram Profile of Bacteria Colonizing the Endotracheal Tubes (ETTs) of Patients Admitted to Intensive Care Units (ICUs) in a Tertiary Care Hospital of Nepal <p>Hospital acquired infection (HAI) in intensive care units (ICU) are responsible for high morbidities and mortalities worldwide due to emergence of resistant bacteria. In developing countries, due to lack of knowledge of proper surveillance, proper resources and proper guidance this burden was somewhat underestimated. Thus, the aim of this study was to look for the spectrum of bacteria colonizing the ETTs and to determine proper empirical antibiotic therapy. We collected endotracheal tube aspirates from 188 patients of admitted in ICU of Manipal Teaching Hospital, Pokhara. All bacteria were identified by conventional techniques. Antimicrobial sensitivity testing was performed on Mueller-Hinton agar plates with commercially available antibiotic discs using Kirby-Bauer disc diffusion techniques and interpreted as per the guidelines of CLSI. The antibiotic discs (conc.) used were: piperacillin/tazobactam (100/10mcg), ciprofloxacin (5mcg), amikacin (30mcg), imipenem (10mcg), gentamicin (10mcg), cefaperazone sulbactum(75/10mcg), for Gram negative bacteria and erythromycin (15mcg), amikacin (30mcg), gentamicin (10mcg), ciprofloxacin (5mcg), and clindamycin (2mcg) for Gram positive bacteria. A total of 188 ETTs investigated, 128(68.08%) yielded positive culture. Single type of organisms was found in 119 (63.29%) and 9 (4.7%) cases yielded mixed type of growth. <em>Acinetobacter </em>spp. were the most predominant organism among all gram-negative organisms, which was found to be in 71 (51.82%) cases, followed by <em>Klebsiella pneumoniae </em>in 27 (19.7%), <em>Pseudomonas aeruginosa </em>in 23 (16.78%), <em>Escherichia coli </em>in 5 (3.64%), <em>Enterobacter </em>in 2 (1.46%). Whereas, <em>Staphylococcus aureus </em>(4.37%) was the commonest among all gram-positive organism followed by coagulase negative <em>Staphylococcus </em>in 2 (1.46%) and <em>Enterococcus </em>in 1 (0.73%). Most of <em>Acinetobacter </em>spp. showed resistance to ciprofloxacin (84.5%), while 74.6% were resistant to amikacin, 73.2% to gentamicin, 71.83% to piperacillin-tazobactam and 42.2% towards imipenem. Out of the 6 strains of <em>S. aureus</em>, 5 (83.3%) were methicillin resistant. Due to the increasing incidence of organisms in ICUs, an early and correct diagnosis of ETT associated infections is a challenge for optimal antibiotic therapy. Therefore, the best approach to manage the respiratory infections following ETT application will be appropriate use of antibiotics with adaptation of proper infection control measures, which could help to prevent further spread of infection.</p> Rajani Shrestha Niranjan Nayak Dharm Raj Bhatta Deependra Hamal Shishir Gokhale Sulochana Parajuli Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 241 246 10.3126/nmcj.v23i3.36317 Normal coronary diameters in coronary angiogram at Patan Hospital, Nepal <p>This study aims to assess the normal coronary diameters of patient who underwent coronary angiogram in Patan Hospital. Angiographic and demographic data of a total of 307 patients (155 males, 152 females; mean age 62.09±11.06 years) who underwent elective coronary angiography in Patan Hospital due to suspicion of coronary artery disease between 2017 and 2020 and in whom coronary angiography documented normal coronary arteries without any intra-luminal irregularity were analyzed retrospectively. Proximal diameters of the main epicardial coronary arteries were measured quantitatively using automated software analysis (Allura, Philips). The mean diameter of unadjusted/adjusted left main coronary artery, proximal left anterior descending artery, proximal left circumflex artery, proximal right coronary artery were 4.87±0.85mm/2.8±0.54, 3.8±0.7/2.19±0.439, 3.4±0.7/1.98±0.44, 3.6±0.85/2.07±0.53 respectively. Our study findings contradict the traditional belief that females have narrower coronary arteries than males. Our study showed the females have statistically significant larger unadjusted Right Coronary Artery diameter and adjusted Left Main Coronary Artery diameter. We believe that our findings may contribute to the global data pool of normal coronary diameters and can be utilized in future studies as a database.</p> Ashok Adhikari Kunal Bikram Shaha Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 247 251 10.3126/nmcj.v23i3.40384 Cardiovascular Risk Assessment in Hemodialysis Patients <p>Cardiovascular diseases are the leading cause of death in hemodialysis patients. We aimed to evaluate non-traditional cardiovascular risk factors: homocysteine, high sensitive C-reactive protein, oxidized LDL antibodies, phosphate, and red cell distribution width in chronic kidney disease patients under maintenance hemodialysis along with traditional cardiovascular risk factors like age, hypertension, diabetes mellitus, among others. A total of 78 diagnosed chronic kidney disease patients under maintenance hemodialysis visiting a tertiary care center were included in the study, of which 59% were male. Hyperhomocysteinemia was present in 79.5% of the participants, with the median homocysteine level being 28.43 μmol/L. The median hsCRP level was 4.74 mg/L, and 59% and 24.4% of the total participants were at high and moderate cardiovascular risk respectively. The median oxidized LDL antibody level was 4235 U/mL, which is within the reference range. The median red cell distribution width was 14.05%, which is within the normal range. Left ventricular hypertrophy, a common cardiovascular disease in such patients, was found in 55.13% of the participants. Serum homocysteine level was significantly higher in patients with left ventricular hypertrophy, whereas serum C- reactive protein level was significantly lower in patients with left ventricular hypertrophy. The mean serum phosphate was 6.23 mg/dL (i.e. higher than normal) and hyperphosphatemia was seen among 76.9% of the patients. The mean age of the patients was 47.5 years, which is distinctly lower when compared to the hemodialysis patients in the Western population. The prevalence of hypertension, diabetes mellitus, and anemia were 95%, 18.25%, and 92.3%, respectively.</p> Asmita Pokhrel Buddhi Raj Pokhrel Prajwal Gyawali Deepak Regmi Madhav Khanal Ashim Bhattarai Prakash Poudel Anil KC Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 252 258 10.3126/nmcj.v23i3.40385 Efficacy Study of Mifepristone in Pre-induction Cervical Ripening and Induction of Labour <p>This study was carried out to see the safety and efficacy of mifepristine as pre-induction cervical ripening agent along with misoprostol in induction of labour. It was a study done from January to June 2020 in Department of Obstetrics and Gynecology, Nepal Medical College Teaching Hospital. Total 120 patients were included in this study. Out of which, 60 women were be kept in test group who were induced by mifepristone and misoprostol and 60 women were kept in control group induced by misoprostol only. Patient characteristics, improvement of bishop score, maternal and neonatal outcome was recorded. Chi- square and T- Test were used to compare the result. Patient characteristics and the Bishop score at zero-hour of both the groups were similar. The mean bishop score 48 hours after use of mifepristine in test group was significantly increased in test group vs control group (P&lt;0.0001). There were total 12(20%) patient who went in to labour with mifepristone only without the use of misoprostol. Total number of normal delivery was more (p value=0.003) and cesarean was less (p=0.013) in test group than in control group. The instrumental delivery in both test and control group were same. The adverse effect and neonatal outcome was similar in both the regime. Thus mifepristone as pre-induction cervical ripening agent is a safe and efficient drug</p> Sanita Kayastha Sunima Mainali Ritu Subedi Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 259 263 10.3126/nmcj.v23i3.40417 Unilateral Pyosalpinx in an Adult Female presenting with Features of Acute Abdomen: A Case Report <p>Pyosalpinx is defined as collection of pus in the fallopian tube and is a late manifestation of pelvic inflammatory disease. Pelvic inflammatory disease refers to a spectrum of inflammatory changes of the female genital tract. It comprises of endometritis, salpingitis, cervicitis, pyosalpinx, tubo-ovarian abscess and peritonitis. Pyosalpinx may progress to tubo-ovarian abscess which may rupture leading to peritonitis. In addition, pelvic inflammatory disease commonly affects both side of the tube. Thus, early diagnosis and proper intervention plays a great role in the management of pyosalpinx. We report a case of unilateral left sided pyosalpinx which presented with features of acute abdomen.</p> Shankar Poudel Upama Sangroula Ashik Rajak Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 272 274 10.3126/nmcj.v23i3.40419 Global Early Childhood Caries: A Review of Literature <p>Early Childhood Caries (ECC) is a major public health concern in the world. There is a high prevalence of ECC in developing countries. The review aimed to synthesise the published literature on the global prevalence of ECC and its associated factors. Researches conducted in Asian, European, American and African countries were included. The review included observational cross-sectional, case-control, cohort studies, and clinical trials. The ECC varies across countries and the continents. Several studies showed inequitable distribution of ECC within regions of a country. The result of this review provides global prevalence of ECC and associated risk factors. Despite the variation of prevalence of ECC, it remains a universal burden. Studies have demonstrated that even in developed countries, ECC represents a significant burden in preschool children. The S. mutans and , oral hygiene habits, breastfeeding and bottle feeding along with factors such as parental education are major risk factors for ECC. There have been limited studies conducted on ECC in Nepal.</p> Ashish Shrestha Ha Hoang Suzanne Gardner Archana Pradhan Leonard Crocombe Copyright (c) 2021 Nepal Medical College Journal 2021-10-17 2021-10-17 23 3 264 271 10.3126/nmcj.v23i3.40418