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 Monkeypox Outbreak - 2022: A Brief Review <p>Monkeypox is a zoonotic viral disease caused by Monkeypox virus belonging to Orthopoxvirus. The virus is present in monkeys and small rodents such as squirrels, ant-eaters and others. First human case was reported from Democratic Republic of the Congo in 1970 and had been reported only from central and western African countries before 2022. This year, the first human case of monkeypox was confirmed on May 7, 2022 in UK who travelled to Nigeria. Thereafter, the disease has caused a multi-country outbreak involving all continents outside Africa. As of August 28, 2022, a total of 47,652 monkeypox cases have been reported from 99 countries that have not historically reported monkeypox and in 7 countries that have historically reported monkeypox. Of the total, 47,209 cases have occurred in countries that have not historically reported monkeypox with a highest numbers of cases (17,431) in USA. Keeping in view of an increasing number of cases “monkeypox emergency” has been declared by US government on August 4, 2022. Second highest numbers of cases have been reported from Spain (6,459), Brazil (3,984), France (3,421), Germany (3,405), Britain (3,207) and following by other countries as of August 28, 2022. No cases has been reported from Nepal as of August 28, 2022.</p> Junu Richhinbung Rai Shiba Kumar Rai Copyright (c) 2022 Nepal Medical College Journal 2022-09-28 2022-09-28 24 3 262 266 10.3126/nmcj.v24i3.48622 Study of Maternal Near Miss Events at Nepal Medical College and Teaching Hospital <p>Maternal near miss (MNM) is defined as woman who nearly died from complication during pregnancy, childbirth or within 42 days of termination of pregnancy but survives either due to care she receives or due to chance. Maternal near miss and maternal deaths share many characteristics and pathological processes and MNM being more frequent than death, review of MNM gives us an opportunity to assess the quality of obstetric care in the institutions and area of improvement. As maternal morbidity precedes maternal deaths, the study of near miss cases provides understanding of the determinants of maternal morbidity and mortality and help in reducing it. The aim of this study was to assess the MNM events in our institutions based on WHO organ dysfunction-based criteria. A descriptive cross-sectional study was carried out in a tertiary care hospital in Kathmandu over two years period from July 2020 to June 2022 after taking ethical clearance from Institutional Review Committee. During the study period, there were 3493 live births, 40 maternal near miss cases and no maternal deaths. The MNM ratio was 11.45/1000 live births and the prevalence of MNM was 1.13%. Postpartum hemorrhage 11 (27.5%), early pregnancy complications 8 (20%) and hypertensive disorder of pregnancy 5 (12.5%) were the major contributor of MNM. Coagulation/ Hematological system dysfunction 22 (55%) was the most common organ involved in MNM. ICU admission and blood transfusion more than five units were the common intervention done. Effective use of critical care, evidence-based intervention and timely referral will help to reduce maternal morbidity and mortality.</p> Amrita Giri Biloni Vaidya Abhushan Siddhi Tuladhar Sama Shrestha Manita Upreti Copyright (c) 2022 Nepal Medical College Journal 2022-09-28 2022-09-28 24 3 181 187 10.3126/nmcj.v24i3.48589 Impact of COVID-19 on the heart: Insight and current evidence based knowledge among Physicians <p>COVID 19 and its impact on the heart is a must to understand the disease in order to diagnose and manage the disease in time with a purpose of curbing down the fatality. This study aims to test and identify the gaps if any between the “Insight” and “current evidence based Knowledge” on the Impact of COVID-19 on the heart. A questionnaire based qualitative cross sectional descriptive study was conducted among Physicians all over Nepal directly or indirectly involved in COVID-19 management. Data was collected via google forms via email or viber/ whattsapp and laid in excel file. Proportion of response from each linked question in two sets containing 11 questions, was compared under the domain “Insight” versus “Current Evidenced based knowledge” having 5 various subtopics. One hundred doctors participated in the study. Overall positive difference of 19% was noted between insight and evidence based knowledge. The highest positive difference was noted regarding atrial fibrillation in COVID-19 (38%), rise in NT pro BNP and its prognosis in heart failure (35%), role of ACE-2 receptor in COVID-19 and acute lung injury (30%) and prevalence and type of arrhythmia in COVID-19 (25%) and lowest (-1%) in regard to preferred reperfusion therapy in STEMI in COVID-19. There were substantial gaps identified between insight and current evidence based knowledge which can be bridged by training, webinar, review article dissemination, peer clinical discussion at government and non-government level in all the states throughout the nation.</p> Kunal Bikram Shaha Prashant Kumar Shah Copyright (c) 2022 Nepal Medical College Journal 2022-09-28 2022-09-28 24 3 188 192 10.3126/nmcj.v24i3.48590 Outcome of Therapeutic Penetrating Keratoplasty in R.M. Kedia Eye hospital - A Retrospective Study <p>Infectious keratitis is the major cause of vision threatening condition and the leading cause of corneal blindness in developing countries. Therapeutic keratoplasty is the procedure for terminating or improving an actively infectious corneal disease. This study was carried out to determine the outcome of therapeutic keratoplasty for infective keratitis at R.M. Kedia eye hospital. This was retrospective study where all cases that underwent TPK for active infective keratitis from May 2019 to April 2020 were included in the study. Data were collected about demographic parameters, indication for surgery, details of donor tissue in terms of donor size, graft size and endothelial density. The outcome of TPK was measured in terms of anatomic stability, eradication of disease, graft clarity and development of cataract and glaucoma. 30 eyes of 30 patients underwent TPK for infective keratitis. 73.3% were male. Average age of the patients was 42. In 60% of patients organisms were isolated as follows: 11 cases of fungus, 3 cases of bacteria and 4 cases of mixed bacteria and fungus. Two surgeries (6.6%) were combined with extracapsular cataract extraction without posterior chamber intraocular lens. The eradication of infection after primary TPK was 23 (76.8%). Twelve eyes (40%) had documentation of variable grades of cataract. One case had secondary glaucoma. Six cases (20%) had graft failure. Therapeutic keratoplasty is the procedure for terminating or improving an actively infectious corneal disease. It helps to save the eye and preserve vision in severe infective keratitis. There is a high incidence of postoperative glaucoma, cataract, and graft failure in such a surgery.</p> Leesha Shrestha Joshi Chunu Shrestha Bibhuti Thapa Reeta Rajbhandari Copyright (c) 2022 Nepal Medical College Journal 2022-09-28 2022-09-28 24 3 193 196 10.3126/nmcj.v24i3.48591 Seroprevalence of COVID-19 among health workers in the Kathmandu Valley, Nepal: a longitudinal cohort study <p>Coronavirus Disease 2019 (COVID-19) burden, often underestimated by case-based incidence reports, can be accurately estimated by measuring the population that has developed antibodies following an infection. Here, we report the prevalence of COVID-19 antibodies among health workers in Kathmandu, Nepal. This seroepidemiology of COVID-19 was a longitudinal survey of hospital-based health workers working in 20 hospitals in the Kathmandu Valley. A total of 800 participants were chosen in December 2020 by a two-stage cluster-stratified random sampling method and administered a questionnaire eliciting COVID-19 related history. A blood sample was also obtained from the participants and tested for COVID-19 IgG antibodies using a Chemiluminescence Immunoassay (CLIA). We then used a probabilistic multilevel regression model with post-stratification to correct for test accuracy, the effect of hospital-based clustering, and to ensure representativeness. The final analytic sample included 800 participants; 522 (65.2%) of them were female, 372 (46%) were between ages 18-29, 287 (36%) were nurses. Of the total 800, 321 (40.1%) individuals tested positive for COVID-19 antibodies. Adjusted for test accuracy and health-worker population, the seroprevalence was 38.2% (95% Credible Interval (CrI) 29.26%–47.82%). Posterior predictive hospital-wise seroprevalence ranged between 38.1% (95% CrI 30.7.0%–44.1%) and 40.5% (95% CrI 34.7%–47.0%). Our study suggested that about two in five health workers in the Kathmandu Valley were seropositive against SARS-CoV-2 by December 2020; a substantial proportion of them did not have a documented infection.</p> Kiran Raj Pandey Aseem Bhattarai Suman Pant Rimmy Barakoti Janaki Pandey Anup Subedee Prabhat Adhikari Diptesh Aryal Prakash Jyoti Pokharel Gentle Sunder Shrestha Kamal Pandit Narendra Timalsina Sameer Thapa Roshan Parajuli Pradip Gyanwali Copyright (c) 2022 Nepal Medical College Journal 2022-09-28 2022-09-28 24 3 197 205 10.3126/nmcj.v24i3.48592 Ocular disorders and associated factors among the first year health professional students at a medical college in Kathmandu <p>The human eye is an important organ as it provides sight and proper coordination in various tasks. The function of the eye is mediated by the 2nd cranial nerve or the optic nerve. Damage to any part of the optic nerve usually results in poor vision, dyschromatopsia (colour blindness), diminished sensitivity to bright light, poor contrast sensitivity, defective afferent pupillary and visual field defects. The commonest ocular disorders are usually attributed to refractive errors such as: myopia, hypermetropia and astigmatism. A healthy eye is necessary for a conducive learning and teaching environment in any academia. Eye screening to rule out any ocular disorder is of utmost importance, especially in medical education, because these students need to be detected early and treated on time to ensure their optimal academic work. Therefore, this study was attempted to determine the proportion of visual disorders among the first year health professional students at Nepal Medical College, and to identify factors associated with it. A total of 115 students were enrolled for this study, where males accounted for 51.3%, while females accounted for 48.7%, respectively. The minimum age was 18 years and maximum was 23 years, with a mean of 19.69 years, and a standard deviation of ±1.14. Almost eight out of ten students (78.3%) had some form of ocular disorders, with many of them having more than one disorder. Females outnumbered the males (51.1%; 48.9%) with respect to the occurrence of eye disorders. The commonest eye disorders were: refractive errors in 60 (52.7%) students, followed by dry eye disease in 23 (20.0%) students, cataract in 2 (1.7%) students, Duane’s retraction syndrome in 1, color vision defect in 1 student and 2 students had other manifestations. Based on ethnicity, slightly more than half of the participants were Khas-Aryans (60.0%), while Adibasi-Janjatis and Madhesis had similar participation of 20.9% and 19.1% respectively. More than three quarters of the participants were MBBS students (82.6.%), followed by BDS students (13.0%) and BSc Nursing students (4.4%). The association between ocular disorders and gender was not statistically significant(p value = 0.35). However, a statistically significant association was observed between gender and refractive errors (p value=0.002). There was no association observed between the status of students’ refractive error and parental status of refractive error (p value =0.099)</p> Aparna Rizyal Rajesh Kishore Shrestha Anu Mishal Jay Sundar Sunrait Copyright (c) 2022 Nepal Medical College Journal 2022-09-28 2022-09-28 24 3 206 212 10.3126/nmcj.v24i3.48595 Assessment of Alveolar Bone Height and Width in Maxillary Anterior teeth - A Radiographic Study Using Cone Beam Computed Tomography <p>Cone beam computed tomography (CBCT) can be used for determining the height and width of alveolar bone surrounding the implant site which are important factors in implant planning. This study was done to evaluate and compare alveolar bone height and width in maxillary anterior teeth based on CBCT images from Nepalese population. This retrospective study included patients who had done CBCT scan between January 2019 to December 2020. Sagittal section views perpendicular to alveolar ridge were taken in the middle of maxillary left and right central incisor, lateral incisor, and canine regions and the linear measurements were done to measure alveolar height (between floor of nasal fossa and alveolar crest) and width (between buccal and palatal cortical plate). The result revealed no significant difference in alveolar height among maxillary anterior teeth. Mean alveolar width for maxillary right central incisor (11), lateral incisor (12), and canine (13) were 12.09 ± 2.36, 8.27 ± 1.37 and 9.99 ± 1.44 mm, respectively and for maxillary left central incisor (21), lateral incisor (22), and canine (23) were 9.51 ± 1.47, 8.27 ± 1.32 and 10.35 ± 1.85 mm, respectively. Lateral incisors have less width as compared to other maxillary anterior teeth. Pearson’s correlation analysis for correlating alveolar height with width showed p&lt;0.05 among 13, 12, 21 and 22. There is weaker correlation between the mean of alveolar height and width. The alveolar height as well as width was greater in male than female in all the six anterior teeth except for the alveolar width in relation to 11.</p> Asmita Dawadi Manoj Humagain Simant Lamichhane Sushmit Koju Copyright (c) 2022 Nepal Medical College Journal 2022-09-28 2022-09-28 24 3 213 218 10.3126/nmcj.v24i3.48596 Gender Specific Correlation between Lip Print, Fingerprint and Blood Groups among Adults aged 20-30 Years attending a Tertiary Health Care Centre <p>A cross-sectional study was conducted to determine gender specific correlation between lip print, finger print and blood group among 120 adult clinical cases in a tertiary hospital in Kathmandu. Lip prints were collected using lipstick and cellophane sheet. Thumb print was collected using commercially available ink pad and white paper and analyzed using hand held magnifying lens. Blood group was noted at the time of recording lip and thumb print. A statistically significant association of gender with fingerprint (p=&lt;0.001) and lip print (p=0.001) was found. A strong co-existing relation have been found between gender and the loop fingerprint-lip print type I’- blood group O and arch fingerprint–lip print type I’– blood group ‘O’.</p> Pratikshya Ghimire Sima Ghimire Adarsha Khanal Anju Khapung Copyright (c) 2022 Nepal Medical College Journal 2022-09-28 2022-09-28 24 3 219 226 10.3126/nmcj.v24i3.48597 The Incidence of Systemic Inflammatory Response Syndrome and Urosepsis following Retrograde Intrarenal Surgery (RIRS) in a Tertiary Care Hospital of Kathmandu, Nepal <p>In recent years, the use of retrograde intra renal surgery (RIRS) for the management of nephrolithiasis is on the rise worldwide. It is commonly considered a safe procedure with lesser complications. The current study aimed to study the incidence of systemic inflammatory response syndrome and urosepsis following retrograde intra renal surgery (RIRS). This is the retrospective observational study among 356 patients who underwent RIRS and 52 were readmitted as 36 developed SIRS and 16 developed urosepsis as a complication in last 5 years (July 1st 2016 –June 30th 2021) in department of Urology of B&amp;B hospital, Kathmandu. It is found that only post-operative urine culture had significant association with SIRS with p- value (&lt; 0.00). There was no normality in the data so Mann Whitney U test was applied to test the significant difference in the median values of some quantitative variables between the SIRS and No SIRS group. There was significant difference between the median values of stone volume and duration of fragmentation with p values 0.001 and 0.002 respectively. There was no variables that was found to be associated with urosepsis.</p> Rajesh Batajoo Chandra Shekhar Yadav Atul Kasaju Jagdish Lal Baidya Copyright (c) 2022 Nepal Medical College Journal 2022-09-28 2022-09-28 24 3 227 233 10.3126/nmcj.v24i3.48598 Determinants of immediate adverse pregnancy outcomes: A hospital based study <p>Adverse pregnancy outcomes are a major public health problem which can lead to serious short and long- term health effect to the mother and the newborn. Hence, the objective of this study is to find out the determinants of immediate adverse pregnancy outcomes in tertiary care hospital in South India. The study comprised of antenatal mothers admitted for delivery in selected tertiary care hospital in Belgaum, Karnataka, India from 10th November, 2021 to 20th January 2022. All registered deliveries in the study period have been included, comprises of 101. Bivariate logistic regression was used to determine the factors associated with outcome variables. A significance level of 5% was used to decide the significance of statistical tests. The mean age in years (± SD) of the mother was 24.6 (± 3.9). The average cost invested for a family health check-up in a year was Rupees 18,099. The average birth weight of the newborn was 2.7 kg, while the minimum weight of the newborn was 1.4 kg, and the maximum weight was 3.8 kg. The average week of gestation for the first-time with respect to antenatal care visit of pregnant women was 9.6 weeks. The average weight of the women was 47.6 kg during first antenatal care visit and 61.5 kg during last antenatal care visit. Adverse outcomes reported were post-partum hemorrhage was 7.9%, low birth weight 26.7%, preterm delivery 28.7%, anemia 53.5%, neonatal physiological and jaundice 15.8%. However, use of mode of transportation during antenatal care visit was found to be significant factor for preterm delivery. Every fourth baby was low birth weight, and every fourth women have preterm delivery and every second woman was anemic. Socioeconomic, demographic and chronic illness was associated with immediate adverse pregnancy outcomes.</p> Jaya Koirala Sudha A Raddi Anita Dadi Dalal Copyright (c) 2022 Nepal Medical College Journal 2022-09-28 2022-09-28 24 3 234 244 10.3126/nmcj.v24i3.48599 Medico-Legal Cases Registered in the Casualty Department of a Teaching Hospital in Nepal <p>Medico-Legal Case (MLC) refers to any case of injury or ailment where some criminality is involved. The injury cases suggestive of criminal offense, burn injuries, vehicular accidents, suspected homicide, poisoning, and sexual assault are medico-legal cases. We conducted a descriptive study in Casualty Department of Teaching Hospital, Kathmandu, Nepal from May 1, 2019 to October 31, 2020. A total of 487 cases were registered. The cases were categorized according to the type of treatment they required. The record was obtained after informed consent of participants and with due assurance of confidentiality, ethical regulations and repute of the institution and individual. The data obtained was analyzed in SPSS version 21. Out of the total, 317 were male and 170 were female. The highest recorded cases were due to road traffic accidents (RTA) accounting for 167 (34.3%). The second highest was physical assault comprising 146 cases (30%) followed by fall injury 81 cases (16.6%). The study showed 48 poisoning cases (9.6%), followed by 14 cases (2.9%) of electric shock. Alcohol intoxication and trauma were eight (1.6%) each. Similarly, suicide and blast cases were six (1.2%) each. Likewise, occupational hazard and sexual assault were found one (0.2%) each, during this study period. The most common age group for medico-legal cases was 21-30 years and above 60 years were the least common. RTAs account the major part of Medico-legal cases in our study. By imparting proper education and awareness among public and medical students the frequency of these cases can be reduced.</p> Barsika Katwal Deepika Karki Asim Shrestha Copyright (c) 2022 Nepal Medical College Journal 2022-09-28 2022-09-28 24 3 245 249 10.3126/nmcj.v24i3.48619 Prevalence of Periradicular Radiolucencies and its Association with the Quality of Root Canal Treatment and Coronal Restorations in an Adult Nepali Population <p>Although root canal treatment is carried out to eliminate the existing microorganism and create favorable environment for healing and prevent reinfection, the occurrence of post treatment disease poses a significant challenge in general population. Cross sectional studies from different countries shows that there is varying degree of prevalence of periradicular radiolucencies (PR) in root filled teeth. Since no such prevalence studies have been done in Nepal, we are unaware of the existing problem in our population. Thus, aim of this study was to investigate the prevalence of periradicular radiolucencies and its association with the quality of root canal treatment and coronal restorations in an adult Nepali population. Among 350 patients, 40.8% (389) presented with PR. Significantly better outcome was seen in teeth with adequate qualities of root filled teeth and coronal restoration. The prevalence of PR in Nepali population was seen relatively high and the considerable efforts to improve the length control during the procedure followed by proper restoration, to lessen the development of PR cannot be over emphasized.</p> Suman Gautam Asha Thapa Rojin Joshi Barsha Joshi Copyright (c) 2022 Nepal Medical College Journal 2022-09-28 2022-09-28 24 3 250 256 10.3126/nmcj.v24i3.48620 Knowledge regarding Teenage Pregnancy among Adolescene Girls of Secondary School of Sindhuli <p>Teenage pregnancy is a global problem mostly occurring in poor and marginalized community. Teenage pregnancy increases when girls are denied the right to make decisions about their sexual and reproductive health and well-being. The objective of this study was to assess knowledge regarding teenage pregnancy among adolescence girls of secondary school. A descriptive cross sectional study was conducted with sample size of 100 by using probability stratified sampling technique. Pretested (r=0.74) structured and semi structured questionnaires (lowest 1 and highest score 34) were used as instrument for data collection. Data was collected through self administered technique. Data analysis was done from descriptive (mean, SD, frequency, percentage) and inferential (independent t test, ANOVA test) statistics using SPSS version 16. The findings of the study showed that respondents were age group 13-15 years (51%), hindu (91%), chhetri (36%), class 9 and 10 (41%) and family (71%) as a source of information. The overall mean knowledge score of respondents was 25.81±3.46 with the minimum score 14 and maximum score 34. The mean knowledge about contributing factors was 12.34±1.82, consequences were 6.69±1.82 and preventive measures were 6.78±1.17. The knowledge score regarding teenage pregnancy was significant in relation to age and education status of respondents where p value were 0.002, 0.000 respectively. It is concluded that respondents had adequate knowledge. According to findings, teenage pregnancy awareness program should be carried out in school and community through mass media to prevent teenage pregnancy in adolescence.</p> Rupa Laxmi Shrestha Laxmi Khadka Copyright (c) 2022 Nepal Medical College Journal 2022-09-28 2022-09-28 24 3 257 261 10.3126/nmcj.v24i3.48621