Journal of College of Medical Sciences-nepal最新文献

{"title":"Retrospective Study of Autologous Arteriovenous Fistula Creation as Vascular Access for Hemodialysis","authors":"B. Sah, Lokesh Shekhar Jaiswa, R. Kumar Gupta","doi":"10.3126/jcmsn.v19i1.48945","DOIUrl":"https://doi.org/10.3126/jcmsn.v19i1.48945","url":null,"abstract":"IntroductionAn autologous arteriovenous fistula (AVF) creation is a common vascular procedure forhemodialysis (HD) patients. This surgical procedure aim is to design a vascular conduct thatwithstands hemodialysis for a durable period. However, the functional outcome of this procedurevaries and depends on patients’ various predictors. .MethodsA retrospective observational study was carried out to evaluate the functional outcome of AVFcreation at the cardiothoracic vascular surgery unit of the surgery department of B.P KoiralaInstitute of Health Sciences from February 2019 to February 2020. The medical file of the patientswas studied, relevant data entered and analyzed in SPSS statistical software.ResultsThere were a total of 112 autologous AVF created during the study period. The mean age ofthe patients was 48.66±15.64 years. There were 75(67%) males and 37(33%) females. The mostcommon limb of fistula creation was left non-dominant upper limb 95(84.8%) and right upper limb17(15.2%). The most common type of AVF was radiocephalic fistula 66(58.9%) and brachiocephalicfistula 46(41.1%). There were 92(82.1%) mature fistula at eight weeks follow-up. These include54(48.2%) radiocephalic fistulas and 38(33.9%) brachiocephalic fistulas. There were 20(17.8%)delayed matured fistulas at 12 weeks (12 radiocephalic and 8 brachiocephalic AVF).ConclusionsThe creation of an autologous AVF for hemodialysis in the upper limb has fewer complications andthe maturation of the AVF depends on the vessel’s diameter. Radio-cephalic and BrachiocephalicAVF usually matures between six to eight weeks duration","PeriodicalId":15436,"journal":{"name":"Journal of College of Medical Sciences-nepal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46295500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S.T.O.N.E. Score in Prediction of Stone Clearance in PCNL","authors":"Sudeep Raj K.c, B. Timilsina, Dipesh Kumar Kushwaha, S. Giri","doi":"10.3126/jcmsn.v19i1.54271","DOIUrl":"https://doi.org/10.3126/jcmsn.v19i1.54271","url":null,"abstract":"ABSTRACT\u0000Background\u0000S.T.O.N.E. score has been considered as standard scoring system for prediction of complication and to state the clearance of the stone. The objective of this research is to find out STONE score in predicting percutaneous nephrolithotomy (PCNL) success in stone free rate.\u0000Methods\u0000A cross sectional study was conducted in the department of urology in College of Medical Sciences and Teaching Hospital. Seventy five case of patient who underwent PCNL were included in the study and S.T.O.N.E. score was gathered like stone size, tract length (skin-to-stone distance), degree of obstruction (presence of hydronephrosis), number of involved calyces and stone essence (stone density). Collected data was entered and analyzed using SPSS.\u0000Results\u0000Among the total of 75 patients 40% (with 95% CI as 28.91% to 51.08%) had  residual stone while remaining had no residual stone. 90.7% patients had 0-399 mm stone size,  97.3% had less than 100 mm tract length and likewise 29.3% had moderate to severe dilatation. Majority (68%) had 2-3 calyces involment and 72% had more than 950 HU stone density.\u0000 Conclusion\u0000S.T.O.N.E. nephrolithometry is highly predictive of stone free status in patients undergoing PCNL and provides a quick, easy-to-apply method for grading the complexity of PCNL","PeriodicalId":15436,"journal":{"name":"Journal of College of Medical Sciences-nepal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42935769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial Sensitivity Pattern of Causative Agents of Urinary Tract Infection in Children Between 1 to 15 Years","authors":"V. Sah, S. Yadav, A. Giri, S. Singh","doi":"10.3126/jcmsn.v19i1.51019","DOIUrl":"https://doi.org/10.3126/jcmsn.v19i1.51019","url":null,"abstract":"Background: The presence of actively multiplying organisms in the urinary tract implies urinary tract infection. Although it is infrequently associated with mortality, it is still an important cause of morbidity in the pediatric age group. Prompt diagnosis and early initiation of appropriate antibiotics in children reduce the morbidities associated with urinary tract infection. The objective of the study was to find out the causative agents of urinary tract infections and their antibiotic sensitivity pattern in pediatric patients. \u0000Methods: This was a cross-sectional study conducted in the department of pediatrics over a period of 12 months and 80 patients fulfilled the inclusion criteria. The modes of presentation, laboratory investigation reports which included urine routine microscopy, bacterial isolates with colony count from the urine culture, and antibiotic sensitivity pattern were documented. Descriptive statistics were used for analysis of data. \u0000Result: Escherichia coli was the most common organism isolated (55.9%). Most of them were sensitive to amikacin.The highest degree of resistance was noticed with ampicillin. \u0000Conclusion:  Aminoglycosides like amikacin can be considered as first-line drugs in urinary tract infection.  \u0000Keywords: antibiotics, children, urinary tract infections.","PeriodicalId":15436,"journal":{"name":"Journal of College of Medical Sciences-nepal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43116257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Anatomy Learning in a Medical College in Eastern Part of India during Pandemic","authors":"Sunandita Nath, Satarupa Paul Ghosh, Sumita Sinha","doi":"10.3126/jcmsn.v18i3.47042","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.47042","url":null,"abstract":"Introduction: The fundamental cornerstone of medical education is Anatomy which specially requires a 3D visualization of human body by traditional mode of teaching. During covid-19 pandemic it was forcefully stopped by introducing newer virtual teaching program. This had offered an opportunity to explore blending of newer methods with traditional one. To find effectiveness of online classes in anatomy during pandemic. And to find out whether online teaching hampers inter-personal relationship. \u0000Methods: Data obtained through questionnaire from 230 first year MBBS students’ responses at R.G. Kar Medical College and Hospital were recorded and analysed.\u0000Results: 50% of the students were in favour of virtual learning process, 34% were satisfied with online mode as independent mode of learning, 61% responded that online teaching will be helpful for the advancement of their career.\u0000Conclusions: The pre-recorded online demonstration classes are better appreciated by the students than hand role playing (which is important in NMC criteria) online classes. Some topics are better taught through online mode than offline method. ","PeriodicalId":15436,"journal":{"name":"Journal of College of Medical Sciences-nepal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45350181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Sequelae of Untreated Dental Caries using PUFA index in Children Visiting a Tertiary Center in Kathmandu","authors":"S. Khanal, Priyanka Shah, A. Khapung","doi":"10.3126/jcmsn.v18i3.47222","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.47222","url":null,"abstract":"Introduction: Dental caries is still a major health problem in most countries as it school-aged children and adults also. Dental caries continues to be a major public health problem, especially in low- and middle- income countries. It can be prevented and treated with proper utilization of dental services. Untreated dental caries can have pain and infection with significant impact on general health.\u0000Method: This study was conducted to assess the untreated dental caries in children using the pufa/PUFA index. A hospital based cross sectional study was carried out in 297 children aged 2-12 years old. Caries status was assessed by dmft/DMFT index and untreated caries by pufa/PUFA index.\u0000Results: The “untreated caries PUFA ratio” of the population was 30.69%. The mean dmft index was 5.51+3.59, mean pufa 1.39+1.48 and mean DMFT 0.43+1.03 mean PUFA 0.11+0.46 respectively for primary and permanent teeth. Primary dentition had more caries and pufa score than the permanent teeth.\u0000Conclusion: There were untreated caries present in the children showing lack of timely utilization of dental services.","PeriodicalId":15436,"journal":{"name":"Journal of College of Medical Sciences-nepal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42611998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Aging on HbA1C: A Cross-Sectional Study on Diabetic Population Attending a Tertiery Care Center of Central Nepal","authors":"M. Adak, H. Upadhyay","doi":"10.3126/jcmsn.v18i3.45504","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.45504","url":null,"abstract":"Background: Diabetes mellitus is increasing day by day throughout the globe. So, early diagnosis of diabetes is crucially important in reduction of the complications. This study was conducted to determine the correlation between glucose monitoring by fasting blood glucose and two hours postprandial blood glucose with glycated hemoglobin (HbA1c) in diabetic patients and evaluate whether glycohemoglobin levels increase with age in both sexes\u0000Methods: A hospital-based analytical cross-sectional study was carried out from March 2020 to December 2021 in diabetic patients attending at outpatient department (OPD) of College of Medical College and Teaching Hospital, Bharatpur, Chitwan. The total number patients was 696 people. HbA1c, fasting blood sugar (FBS) and postprandial blood sugar (PPBS) were analyzed.\u0000Results: Both postprandial blood glucose and fasting blood glucose significantly correlated with HbA1c. Postprandial blood glucose showed better correlation to HbA1c than fasting blood glucose (r = 0.630, P <0.001 vs. r =0.452, P = 0.05).\u0000Conclusions: These results show that postprandial blood glucose correlated better than fasting blood glucose to HbA1c. Thus, postprandial blood glucose predicted overall glycemic control better than fasting blood glucose. Based on our study, we may concluded a significant correlation exist between age and HbA1c in Nepalese population.","PeriodicalId":15436,"journal":{"name":"Journal of College of Medical Sciences-nepal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44222532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional And Radiological Outcome of Schatzker Type V and VI Tibial Plateau Fracture Treated with Closed Reduction and Ilizarov Fixation with or without Minimally Invasive Screw Supplementation","authors":"S. Pandey, S. Bidary","doi":"10.3126/jcmsn.v18i3.47475","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.47475","url":null,"abstract":"Introduction: Controversy exists as to the best treatment approach for high-velocity tibial plateau fractures. This study was done to assess the functional and radiological outcome of Schatzker type V and VI tibial plateau fractures treated with closed reduction and Ilizarov ring fixation with or without cancellous screw supplementation.\u0000Methods: An analytical cross sectional study was conducted among 25 cases of both closed and open Schatzker type V and VI tibial plateau fractures treated with closed reduction and Ilizarov ring fixation with or without minimally invasive cannulated cancellous screw supplementation. The outcome variables analyzed were union time, knee range of motion, American Knee Society Score (AKSS), Rasmussen’s Radiological Score (RRS), and complications. Data analysis was done using SPSS-20. P-value <0.05 was considered as statistically significant.\u0000Results: There were 15 type V fractures, 10 type VI fractures, 21 closed fractures, and 4 open fractures. All the fractures united with a mean union time of 15.88 weeks (range 12-24). The mean American Knee Society score was 77.8 (range 68-95), Rasmussen’s radiological Score (RRS) 15.12 (range 10-18), and mean range of motion was 112.40 (range 90-135). Superficial pin site infection was present in 7 (28%) of the cases. There was no case of nonunion, deep infection, repeat surgery other than implant removal, or nerve palsy.\u0000Conclusions: Closed reduction and Ilizarov ring fixation with or without minimally invasive screw supplementation give rise to good to excellent functional and radiological outcomes in most of the cases in the treatment of Schatzker type V and VI tibial plateau fractures with minimal bone or soft tissue related complications.","PeriodicalId":15436,"journal":{"name":"Journal of College of Medical Sciences-nepal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48072053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological Study of Organophosphorus Poisoning at College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal","authors":"M. Pradhan, H. Upadhyay, A. Shrestha, Alok Pradhan","doi":"10.3126/jcmsn.v18i3.48994","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.48994","url":null,"abstract":"Introduction: Poisoning is an acute medical emergency. Organophosphorus (OP) poison, being easily available and relatively cheaper, is mostly used by people for suicide. It is a major health problem worldwide also a major cause of suicide in Nepal. The purpose of this study was to assess the overall profile of patients with Organophosphorus (OP) poisoning.\u0000Methods: A Prospective hospital based descriptive cross-sectional study was conducted on patients of organophosphorous poisoning in the emergency department (ER) of College of Medical Sciences and Teaching Hospital during one year period from 1st January 2020 to 31st December 2021. Data analysis was done using SPSS-16 software. Categorical variables were presented in the form of tables with frequency and percentage. Data was analyzed by using descriptive statistical tools.\u0000Results: A total of 123 OP poisoning cases attended in the emergency department of College of Medical Sciences over a period of one year. The overall female to male ratio was 1.19:1. Most poisoning occurred in the age group 15-25yrs. Majority of the patients were married and were students. Oral route (87.83%) was the most common route of administration. The main reason was family and personal issues. Majority of the patients stay 3-7 days in the hospital. The mortality of poisoning was 3.25%.\u0000Conclusions: Majority of the intentional poisoning occurred in the female, married & students of younger age group. The main reason was family and personal issue.","PeriodicalId":15436,"journal":{"name":"Journal of College of Medical Sciences-nepal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49126921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microscopic Assistance in Cold Dissection Tonsillectomy – Does it Improve Surgical Outcome?","authors":"A. Dhakal, B. Shrestha, M. Pokharel, K. Shrestha, L. Khadka","doi":"10.3126/jcmsn.v18i3.42487","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.42487","url":null,"abstract":"Background: Tonsillectomy is one of the commonest surgical procedure carried out by ENT surgeon. In the post-operative period, rate of life-threatening post-operative bleeding varies between 0 and 20 % of the patients. The use of magnifying devices like microscopes or magnifying glasses is still in the focus of clinical investigation as it is hypothesized that precise vision of vessels during surgery allows precise coagulation and therefore reduces post-operative bleeding. Furthermore, precise coagulation should reduce post-operative pain too. The study aims to compare the surgical outcome between microscopic assisted tonsillectomy and traditional cold dissection tonsillectomy.\u0000Methods: This prospective study was conducted on 32 patients who had undergone tonsillectomy from March 2020 to December 2021. The patients included in the study underwent cold dissection tonsillectomy where one tonsil was removed with Microscopic assistance and other with traditional cold dissection method with unsupported vision. Intraoperative blood loss was calculated. Post-operative pain score was measured with Wong- Baker FACES® Pain rating scale till 7th post-operative day. Post-operative complications if present were noted.\u0000Results: Total of 32 patients were enrolled in the study with age ranging from 16-42 years. There were total 18 male (56.3%) and 14 females (43.8%) in the study. Intraoperative time for Microscopic assisted cold dissection (16.44 ± 3.46 minutes) was longer than Conventional dissection technique (13.94 ± 2.86 minutes) (p=0.04). Amount of blood loss during MCD technique was 16.47 ± 4.58 ml whereas in CD group it was 18.22 ± 4.54 ml (p=0.02). Pain score in both methods were higher during early post-operative period and gradually decreased with time. During rest, there was no statistically significant difference in pain between the two methods during first three post-operative days, after which pain was significantly reduced in MCD through day 4-7 (p <0.05). None of the patient had post- operative hemorrhage requiring intervention in operation room.\u0000Conclusions: Microscopic assisted cold dissection showed statistically significant results for reduced intraoperative blood loss and post-operative pain score than Conventional dissection method.","PeriodicalId":15436,"journal":{"name":"Journal of College of Medical Sciences-nepal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48704978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescribing Pattern of Antibiotics in ENT Outpatients of Tertiary Care Hospital in Bharatpur, Nepal","authors":"A. Giri, A. Pokharel, Anjan Palikhey, H. Upadhyay, Bijaya Laxmi Giri","doi":"10.3126/jcmsn.v18i3.47444","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.47444","url":null,"abstract":"Introduction: Upper respiratory tract infection (URTI) like pharyngitis, tonsillitis, sinusitis, laryngitis and otitis media are the most common infections encountered in ENT outpatients. As these infections are caused by the microorganism they should be treated with the antimicrobial agents. The aim of this study was to determine the prescribing pattern of antibiotics in ENT outpatients of tertiary Care Hospital in Bharatpur, Nepal.\u0000Methods: It was prospective observational study which was carried out in the ENT Department of College of Medical Science, Bharatpur, Chitwan, Nepal. Total 267 prescriptions were studied. Patient of all age groups and sex were included in the study. Prescriptions were evaluated based on the World Health Organization (WHO) core drug prescribing indicators. Results on categorical measurements are presented in numbers and percentage which was used to generate tables and graphs. Data analysis was done by SPSS software version 20.0.\u0000Results: A total of 267 prescriptions were collected and analyzed during the study. Average number of drugs per prescription was 3.12 in which average number of antibiotic per prescription was 1.041. Commonly prescribed antibiotics belongs to the penicillin group (52%) followed by macrolide (27%). Most of the drugs were prescribed by their brand names (92%). Besides antibiotics the common adjuvant drugs that are being prescribed were nasal decongestant (44%) followed by anti-histaminics (27.7%).\u0000Conclusions: The present study highlights the wide use of Amoxicillin and clavulanic acid combination for ENT infections. Measures to emphasize the use of generic names are necessary to promote rational drug use.","PeriodicalId":15436,"journal":{"name":"Journal of College of Medical Sciences-nepal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41843320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}