Nepalese Medical Journal

Penile Cutaneous Horn Mimicking Carcinoma: A Rare Case

Amit Kumar Shah — 2022-12-30

Cutaneous horns are cornified hyperkeratotic lesions on the skin, usually present on photo-exposed areas such as the face and scalp. Its presence on the penis is very rare and represents the most unusual site. The role of chronic irritation, phimosis, surgical trauma, and radiotherapy have been implicated in penile horn formation. Penile horns present as elongated, keratinous, white or yellowish projections that range from a few millimeters to centimeters in size arising from the glans penis. Histopathology of the keratotic mass reveals nothing but keratin. One-third of cases of penile horns are associated with underlying malignancies. The standard treatment is electrosurgical excision with the removal of a broad base.

A Rare Case of Shared Delusion of Pregnancy in a Couple Undergoing Fertility Treatment

Anzu Giri — 2022-12-30

Pseudocyesis or phantom pregnancy is a false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy, which may include abdominal enlargement, reduced menstrual flow, amenorrhea, subjective sensation of fetal movement, nausea, breast engorgement and secretions, and labor. Though it is a very rare condition, it is often seen in women undergoing fertility treatment in developing countries. Isolated pseudocyesis in women and sometimes men have been reported before, but there are very few reports of shared delusions of pregnancy by a couple. No such report has ever been made before from Nepal. Therefore, this case report seeks to associate psychiatric/psychological, gynecological, and neuroendocrine mechanisms leading to the emergence of shared delusion of pregnancy (folie à deux) in a Nepali couple undergoing artificial reproductive techniques for the management of infertility. In this case, the couple firmly believed in their pregnancy against all medical evidence.

Acute Kidney Injury in Patients Using Polyethylene Glycol as Bowel Cleansing Agent for Colonoscopy

Gaurav Chhetri — 2022-12-30

Introduction: The use of polyethylene glycol-based solutions is the gold standard for bowel preparation for colonoscopy. However, polyethylene glycol use might be associated with the risk of acute kidney injury. We aim to find out acute kidney injury and risk factors associated with the development of acute kidney injury in patients using polyethylene glycol for colonoscopy.
Materials and Methods: This was an observational study conducted in the Department of Nephrology and Gastroenterology, Bir hospital. Patients who underwent colonoscopy using polyethylene glycol were included in the study and assessed for acute kidney injury; its incidence, association of risk factors with acute kidney injury, and outcome (complete recovery or no recovery) of acute kidney injury by 3 months.
Results: The mean age of the patients was 45.81 ± 18.60 years with the majority of the patients being male (60%). Out of 48 study participants, 4(8%) develop acute kidney injury. Multivariate regression analysis depicted that chronic kidney disease, chronic liver disease, congestive cardiac failure, and use of non-steroidal anti-inflammatory drugs, angiotensin receptor blockers, and diuretics drugs were the predictors which significantly influenced the occurrence of acute kidney injury in patients using polyethylene glycol.
Conclusions: The evidence strongly suggests that in patients without preexisting renal disease, comorbidities, or use of drugs; the risk of renal impairment is low after colonoscopy using polyethylene glycol as a bowel cleansing agent. In the presence of risk factors for renal dysfunction, polyethylene glycol should be used cautiously.

Out of Pocket Expenditure in Patients on Maintenance Hemodialysis: A Single Center Study

Krishna Kumar Agrawaal — 2022-12-30

Introduction: The government of Nepal has been providing free dialysis for a lifetime to its citizen since 2016. Most of the patients have to spend from pocket to meet their medical demands to sustain life. This leads to a financial burden and may lead to the sale of the property. The aim of this was study to look into different categories of expenses done by patients in the Bipanna nagarik free HD program provided by the government of Nepal.
Materials and Methods: This descriptive cross-sectional study was carried out from 9th February 2022 till 30th September 2022 under the Nephrology Unit, Department of Internal Medicine at Universal College of Medical Sciences, Bhairahawa, Nepal. Ethical clearance was taken from the Institutional Review Committee (IRC letter reference no. UCMS/IRC/049/22). Patients receiving free basic hemodialysis services under the Bippana Nagarik Scheme of the Government of Nepal and giving informed and written consent were enrolled in the study. Non-Probability Sampling Method – Convenience Sampling was done.
Results: In our study of 50 patients on HD, the mean age was 46.24 ± 15.31 years. The mean duration of dialysis of the study population was 126.80 ± 332.52 months. The average family income per annum was approximately NRs. 31000. The total out-of-pocket expenditure was approximately NRs. 35305/month. The cost of blood investigations was approximately NRs. 13000 in three months.
Conclusion: The monthly out of pocket expenditure was approximately NRs. 35000 which was directly related to hemodialysis in spite of free basic hemodialysis services by the Government of Nepal.

Gestational Trophoblastic Diseases at a Tertiary care Hospital in Nepal: A Five Years Retrospective Study

Nikita Gautam — 2022-12-30

Introduction: Gestational trophoblastic diseases, because of their diverse presentation and the malignant lesions being associated with recurrence, metastasis, and mortality, early diagnosis is important with the help of ultrasonogram preoperatively, serial Beta human chorionic gonadotropin, and histopathological examination for prompt treatment and timely management of the patients. The study aimed to identify the overall prevalence and relative frequencies of Gestational trophoblastic diseases and to assess the association of different gestational trophoblastic diseases with maternal age, parity, and gestational age.
Materials and Methods: This is a retrospective cross-sectional study conducted for five years from January 2016 to December 2020 in the Department of Pathology, and Department of gynecology and obstetrics of Dhulikhel Hospital, Kavre Nepal. This study included a spectrum of gestational trophoblastic diseases. All the details were obtained from the patient’s record file and register book.
Results: Out of 65 cases, the most common was Hydatidiform mole with 59 (90.78%) cases. Bleeding per vagina was the most common clinical presentation. The most commonly affected age group was 21-25 years. Most of the gestational trophoblastic diseases were detected in the first trimester and primigravida.
Conclusions: Any pregnant woman presenting with abnormal uterine bleeding should be evaluated for the presence of underlying Gestational trophoblastic disease. Beta-hCG is a sensitive marker, however, histopathology remains a gold standard modality for the detection of gestational trophoblastic diseases. The judicious use of ultrasonograms and appropriate clinicopathological approach helps the clinician to decide the treatment modalities, especially between evacuation and hysterectomy.

Knowledge About Intake and Output Documentation among the Nursing Staffs of Dhulikhel Hospital

Susmita Gyawali — 2022-12-30

Introduction: Documentation of intake and output is written or electronically generated information about client’s all the fluid that goes into and is eliminated from the patient’s body. Fluid balance monitoring and documentation is a challenging area in nursing practice, since patients’ management plan for surgery, renal, cardiac, and acute gastrointestinal disease depends on the nurse’s documentation, it is hence of medical and ethical importance. Thus, we intend to assess the knowledge about intake and output documentation among the nursing staff of Dhulikhel Hospital.
Materials and Methods: A simple descriptive cross-sectional study was conducted among the 100 nursing staff using the stratified random technique. A self-administered questionnaire was used. T-test was used for comparison. Respondents’ knowledge was analyzed by using the software SPSS 16.0.

Results: This study showed the mean knowledge percentage score of nursing staff working in Dhulikhel Hospital was 59.25%. There was a significant difference in mean knowledge score between respondents with a Certificate Level in Nursing and Bachelor level (p= 0.008), between respondents of Surgical Units and Non-Surgical Units (p= 0.001). Other variables like personal experience and previous in-service or education on intake and output documentation did not have any significant difference in mean knowledge score.
Conclusion: The findings of the study suggested that the knowledge regarding intake and output documentation among nursing staff was average.

Effect of Application, Duration and Dosing Frequency on the Efficacy and Adverse Effect of Adapalene in Acne Vulgaris: an Open-Label Randomized Controlled Study

Prasanna Kumar Jha — 2022-12-30

Introduction: Topical retinoids are the mainstay of treatment for mild and moderate acne but longer duration of application causes adverse effects. The study aimed to evaluate the effect of application, duration, and dosing frequency on the efficacy and adverse effect of Adapalene in Acne Vulgaris.
Materials and Methods: The study design was an open-label randomized controlled split-face trial. Patients with acne grades 1 and 2 were randomized into three groups using the split-face technique on the right and left sides. On the right side, patients applied adapalene daily in all the groups and alternately on the left face. The three groups of the study were overnight, 1 hour, and ½ hour application of adapalene. Follow up period was 4,8 and 12 weeks. Lesion count and side effects were evaluated at each follow-up.
Results: Out of 292 who completed the study, the decrease in total lesion count was highest in the overnight group. Regarding specific lesion count, the decrease in non-inflammatory lesions was highest in the overnight group. However, short contact therapy with 1-hour application showed comparable efficacy with the overnight group in regards to inflammatory lesion count. There was a significant reduction of lesions in all groups from baseline to 12 weeks, with ½ hour group having minimal side effects followed by 1 hour and overnight.
Conclusion: Short contact therapy for acne shows promising results in regard to efficacy and better tolerance.

Impact of Hearing Loss on the Quality of Life in Adults with Hearing Impairment

Sajana Aryal — 2022-12-30

Introduction: Hearing loss is the most common sensory deficit, which can impair the exchange of information. The impact of hearing loss may be profound, with consequences for the person's social, functional, and psychological well-being. This study aims to assess the overall impact of hearing loss on the quality of life in the adult population.
Materials and Methods: A cross-sectional study was conducted in a tertiary care-based hospital. Patients within the age range of 18-85 years were taken. Two hundred fifty patients presenting to ENT-OPD over six months and fulfilling the inclusive criteria were recruited for the study. All patients underwent detailed audiological evaluation, including otoscopy, tympanometry, and pure tone audiometry in two room setup following ANSI standards. Communication difficulties were assessed using a modified questionnaire from the Hearing Handicap Inventory and Self-Assessment of Communication.
Results: The impact of hearing loss on quality of life was associated with age, gender, and profession. The severity and type of hearing loss were significantly associated with a hearing handicap and self-reported communication difficulties. People with severe-profound hearing loss reported more handicapping conditions and communication difficulties than mild-moderate hearing loss. The impact of hearing loss was found to be more in functional and emotional aspects than physical ones.
Conclusions: Hearing loss is associated with reduced quality of life. Identifying individuals with hearing loss and supplying appropriate rehabilitation with coping strategies may positively affect the quality of life for adults.

Study of Relationship Between Platelet Parameters and Hyperlipidemia

Dipti Gautam — 2022-12-30

Introduction: Hyperlipidemia is emerging as a major risk factor for developing cardiovascular diseases like atherosclerosis and coronary heart disease. Hyperlipidemia in turn results in platelet activation and thrombotic events. Platelets have been shown to have a role in the thrombus consequences of atheromatous damage in hyperlipidemic individuals by initiating and propagating atherosclerotic plaques. Platelet activity can be evaluated with platelet indices, including platelet distribution width and plateletcrit.
Materials and Methods: This was a prospective study carried out over a period of one month in the Department of Pathology, Patan hospital. A total of 223 subjects with hyperlipidemia and 35 controls with normal lipid profiles and PDW were included. Statistical analysis was done using Pearson’s correlation test and data were expressed as mean ±SD for each parameter. A p-value of < 0.05 was considered to be significant.
Results: Maximum number of patients was in 41-60 years of age (42.6%). The male-to-female ratio was 1: 1.1 with 47% males and 53% females. The mean total cholesterol, mean LDL-C, and mean HDL-C of the study group were 230.4±26.7, 150.3±28.4, and 40.9±15.2 respectively. The mean platelet count and PDW were 288.9±230.5 and 14.1±3.3 respectively. There was a significant correlation between PDW with total cholesterol and LDL-C in a study group with a p-value of <0.001.
Conclusions: The present study indicates that PDWs are significantly higher in patients with hyperlipidemia. These indices are available without any additional cost to clinicians, pathologists, and patients and can be used to assess the risk associated with hyperlipidemia.

Prevalence and Pattern of Birth Defects in a Tertiary Hospital in Lalitpur, Nepal

Henish Shakya — 2022-12-30

Introduction: Birth defect is one of the least studied areas in most developing countries like Nepal where low birth weight, prematurity, sepsis, and perinatal asphyxia are still the leading causes of neonatal and infant mortality. However, studies have shown that the incidence of birth defects is increasing trend and has significant impacts on individuals, families, healthcare, and society. Awareness of birth defects is essential in both prevention as well as early intervention. The objective of this study was to find out the pattern and prevalence of birth defects presenting in newborns in KIST Medical College Teaching Hospital, Lalitpur, Nepal.
Materials and Methods: This is a hospital-based cross-sectional, descriptive study conducted in the NICU, Nursery, and postnatal wards of KIST Medical College Teaching Hospital, Lalitpur, Nepal from August 2018 to August 2020. The study population included all inborn newborns with birth defects, stillbirths, and IUFD of more than 22 weeks gestation with birth defects. Outborn babies admitted in Nursery/NICU and abortions of less than 22 weeks gestation were excluded from the study. The data was collected using WHO based surveillance system with a clinical
review. Data were analyzed using SPSS version 23. Prevalence and pattern of birth defects were expressed in frequency and percentages.
Results: In a total delivery of 3360, the incidence of the birth defect was 3.75% (n=126). Of the total birth defects, 28.9% (n=112) were born alive and 11.1% (n=14) were stillborn. Among the live births, 2.4% (n=3) died during their hospital stay. The commonly occurring birth defects were cardiovascular (35.7%, n=45) followed by oro-facial defects (23%, n=29), genitourinary (15.9%, n=20), musculoskeletal (15%, n=19), central nervous system (15%, n=19), various syndromes (7.1%, n=9), gastrointestinal (4.7%, n=6) and respiratory (0.8%, n=1).
Conclusions: The true magnitude of birth defects in Nepal is unknown due to the lack of national birth defect surveillance. The lack of proper data regarding birth defects is undermining its impact on perinatal health. Awareness about the birth defect and their prevalence can significantly affect the prevention strategy and the management plan in decreasing perinatal mortality and subsequent neonatal and infant mortality as well.

Dengue Diagnosis and Research: How Prepared are we?

Sujata Pudasaini — 2022-12-30

No abstract available.

Antimicrobial Activity of Turmeric: A Systematic Review

Abhishek Mehta — 2022-12-30

Turmeric or Curcuma longa is a popular healing herb in Ayurvedic medicine. Due to its potential health benefits including antimicrobial properties, it is being used in herbal medicines in the treatment of several systemic diseases, especially in the Indian subcontinent.

In this review, we have given an up-to-date overview of the anti-infective properties of the Turmeric plant with a special focus on its antibacterial activity. Published articles relevant to the research questions were searched in their database (PubMed, Scopus, Web of Science). Additionally, studies were searched through snowballing. The articles were included as per eligibility for data extraction. The included articles were assessed on quality reporting and results were presented using descriptive analysis. This literature review aimed to illustrate the therapeutic properties of the plant “Curcuma longa”.A total of 32 publications out of 671 articles were selected through online and snowballing literature searches. Out of these 32 articles, 22 were original research articles and 9 were systematic reviews after removing the duplicates and non-eligible studies. Most of the original articles analyzed were from India.

In view of rapidly emerging antimicrobial resistance amongst the prevailing pathogens, the present study highlights the need of exploring alternate preventive and treatment strategies that are safe, effective, and economical when compared to existing methods. There is immense scope of such studies focused on the possibilities of mining the antimicrobial potential of bioactive phytochemicals derived from herbal sources like Turmeric.