Journal of College of Medical Sciences-nepal最新文献

{"title":"Comparative Study of Intravenous Dexamethasone and Methylprednisolone in Severe COVID -19 Patients Requiring Respiratory Support in Intensive Care Unit","authors":"L. Rajbanshi, A. Rayamajhi, A. Bajracharya, R. Shah","doi":"10.3126/jcmsn.v18i3.47897","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.47897","url":null,"abstract":"Introduction: Numerous steroids have been used to combat the intense cytokine storms in severe COVID pneumonia. The study compares the use methylprednisolone and dexamethasone as an adjuvant steroid therapy in severe COVID-19 pneumonia.\u0000Methods: Prospective comparative study including total of 190 COVID-19 severe pneumonia cases admitted in intensive care unit with 93 patients randomly allocated to receive dexamethasone 6 mg and 97 patients allocated to receive methylprednisolone 1mg/kg in two divided doses both by intravenous route for 7 days. Mortality was compared as primary objective while oxygenation parameters and inflammatory markers, need for invasive mechanical ventilation, duration of ventilation, length of ICU-stay, incidence of multiorgan failure were assessed as secondary variables.\u0000Results: At day zero, the patient in methylprednisolone group had significantly lower PaO2/FIO2 ratio (258.3950.36 vs 285.1868.62, P=0.002). At day seven, methylprednisolone significantly improved PaO2/FIO2 ratio (266.5260.73 vs 244.8175.36, P=0.029) and there was substantial decrease in inflammatory markers CRP, Ferritin (P<0.05). PEEP requirement was significantly less with methylprednisolone (P=0.007). Methylprednisolone significantly reduced the incidence of multiorgan failure, need of invasive mechanical ventilation and duration of mechanical ventilation (P<0.05). However, there was no significant difference in terms of duration of ICU stay and 30 days in hospital mortality between the two groups\u0000Conclusions: Intravenous methylprednisolone significantly improved the oxygenation of COVID -19 pneumonia patients and decreased the inflammatory reactions as compared to similar dose of dexamethasone when given for week duration. However, methylprednisolone did not seem to be superior to dexamethasone in terms of improving mortality.","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":"47192766","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":"Awareness on Prevention of Complication Related to Immobility among Caregivers of Bedridden Patients in Tertiary Health Care Center in Chitwan","authors":"Binita Dhakal","doi":"10.3126/jcmsn.v18i3.47833","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.47833","url":null,"abstract":"Introduction: Immobility is a condition in which a person is unable to move freely or movement is restricted for medical reasons. Prolonged bed rest and immobilization inevitably leads to complications. Caregivers play a vital role in preventing the complications of immobilization and avoiding discomfort for the patient. This study aims to assess awareness on prevention of complications of immobility among caregivers of bedridden patients admitted in tertiary health care center.\u0000Methods: A descriptive cross-sectional research design was used to assess 66 caregivers of college of medical sciences by using non-probability convenience sampling technique. Data was collected by using self-administered questionnaire to assess awareness through face-to-face interview method. Obtained data were analyzed by using descriptive and inferential statistics using IBM SPSS 16.\u0000Results: Study findings revealed that the mean age of the respondents was 18 years with mean age 18 ± 11.87 and majority (54.5%) were female with higher percentage of respondents’ involvement in agriculture (28.3%). Majority (68.2%) of the respondents stayed in hospitals for 1 to 5 days and 51.5% respondents had no previous experience of hospital stays. Among the total respondents, majority (83.3%) had inadequate awareness on prevention of complication related to immobility which varied with respondent’s gender (p=0.047), educational level (p=0.001), occupation (p=0.0026) and information from television (p=0.005).\u0000Conclusions: Majority of the respondents had inadequate awareness on prevention of complication related to immobility. Findings emphasize that awareness programs should be implemented time to time in hospital settings to update the caregivers in relation to preventive measures of complications of immobilization.","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":"42599810","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":"Peritonsillar Infiltration of Ropivacaine and Pain Control in Immediate Postoperative Period Following Tonsillectomy Surgery in Adult Patients","authors":"C. Bhandari, A. Pokharel, Naganavalachil Jayaprakash Mayya, A. Thapa","doi":"10.3126/jcmsn.v18i3.47527","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.47527","url":null,"abstract":"Introduction: To study about the efficacy of Peritonsillar infiltration of Ropivacaine and pain control in immediate postoperative period following tonsillectomy surgery in adult patients.\u0000Methods: 80 patients were included in the study of age 18 to 50 years. After informed consent, patients were divided into two groups. In Group R 0.5%Ropivacaine with 1:100000 Adrenaline and in Group C 0.9%normal saline with 1:100000 Adrenaline was injected into the tonsillar fossa following tonsillectomy. Surgery duration, blood loss, time to demand for 1st analgesia, analgesic consumption in 24 hours, and VAS score in 1hr, 2hr, 4hr, 6hr, 12hr, 24hr were noted.\u0000Results: We observed significant pain control during first 4 post-operative hours with Value of <0.01, <0.01 and 0.019 respectively in first, second and fourth post-operative score. We also observed significant difference in the time for first analgesia request in two groups with the study group requesting for first analgesic at 518±175 postoperative minutes and control group at 132±47.95 postoperative minutes (P value <0.01). Total analgesia requirement was 61±22.48 in the study group and 102±27.84 in control group (P value < 0.01).\u0000Conclusions: It is concluded that intraoperative Peritonsillar infiltration of Ropivacaine causes analgesia in the immediate postoperative hours with the decrease in the requirement of analgesia in the first 24 postoperative hours. It is therefore recommended to use it in adult patient undergoing Tonsillectomy.","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":"47861161","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":"Relationship of Handgrip Strength and Endurance Time With Body Mass Index in Medical Students","authors":"C. Rai, Sarbada Makaju","doi":"10.3126/jcmsn.v18i3.46679","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.46679","url":null,"abstract":"Introduction: The sedentary lifestyle, unhealthy eating habits and obesity are major health problems of current generation. High body mass index is directly related with high mortality rate, cardiovascular diseases, mental issues and difficulty in physical functioning. Normal weight and strength of muscle are indications of good health. Handgrip strength and endurance are the important parameters to assess the upper extremity muscular strength.\u0000Methods: This is a descriptive cross-sectional study in 400 medical students in Kathmandu Medical College, Bhaktapur (October 2021 to March 2022) with Institutional Review Committee approval (Reference no. 0106202102). The sample was collected by simple random sampling method. Height and weight were measured by Prestige stadiometer and body mass index was calculated. Student’s dominant hands grip strength and endurance time was measured by manual Grip Dynamometer. Data was analyzed by Statistical Package of Social Science (SPSS) software version 16 with Chi-square test.\u0000Results:  Among 400 samples, female 217 (54.25%) and 183 (45.75%) were males. Female students with normal, overweight and pre-obese BMI had maximum and highly significant (p value = 0.00, 0.001 and 0.003 respectively) relationship with grip strength. Normal, pre-obese and obese male had highly significant relation with grip strength (p = 0.004, 0.00 and 0.002 respectively). Normal body mass index samples had maximum endurance time along with overweight male.\u0000Conclusion: The normal body mass index samples had significant relation with hand grip strength and highest endurance time","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":"48022255","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":"Prevalence and Correlation of Hypertension, Obesity and Diabetes Among Adults Visiting Community Based Screening Programs","authors":"Prerna Bansal, A. Shrestha, Srijana Panthi","doi":"10.3126/jcmsn.v18i3.48700","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.48700","url":null,"abstract":"Introduction: According to the World Health Organization, diabetes, hypertension and obesity are one of the top five continuing risk factors for cardiovascular deaths in the world. Hypertension and obesity increase the risk of long-term vascular complications of type 2 diabetes mellitus. This study aims to find the prevalence and correlation of hypertension, obesity and diabetesamong the adults incentral part of Nepal.\u0000Methods: An analytical cross-sectional study was conducted among 233adults visiting the community based screening programs in Bharatpur-10, Nepal organized by College of Medical Sciences during July 2022 to August 2022. Descriptive analysis was done to find the frequency, percentage and mean.To find the association between continuous variables correlation was used (p-value <0.05).\u0000Results: The mean age was 53.71±12.42 years, 60.9% males and 39.1% females. The prevalence of hypertension was found to be 25.7%, obesity was 21.8% and diabetes was 36.5%.The FBS was positively correlated with age, SBP, DBP and BMI. The correlation of FBS with age (p-value 0.05) and SBP (p- value 0.01) was found to be statistically significant.\u0000Conclusions: The prevalence of hypertension, obesity and diabetes were found to be high both in male and female adults visiting the community based screening programs. Fasting blood glucose was found to be positively correlated with age, body mass index, systolic and diastolic blood pressure measurements of the patient. Thus, level of fasting blood sugar level increases with increasing age, increasing body mass index, increasing systolic and diastolic blood pressure levels of the patient. ","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":"48279685","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":"Case of Self-Mutilation –Lesch-Nyhan Syndrome","authors":"Sweta Gupta, Samanata Dallakoti, R. Sapkota, Niraj Sangroula","doi":"10.3126/jcmsn.v18i3.47979","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.47979","url":null,"abstract":"Lesch-Nyhan syndrome involves a congenital error of purine metabolism, due to the absence (or very low levels) of hypoxanthine-guanine phosphoribosyltransferase (HPRT) enzyme. The classic clinical phenotype of LNS was first described by Michael Lesch and William Nyhan in 1964 and is characterized by hyperuricemia, intellectual disability, severe motor deficiency, and recurring self-mutilation . Here we present a case of a 4-year-old male child with features of self-mutilation, aggression, and poor neck control and unable to sit and stand. we diagnosed him as a case of Lesch-Nyhan syndrome based on clinical features and slight hyperuricemia. Due to the lack of medical facilities, many cases of Lesch-Nyhan syndrome undergo unnoticed in many underdeveloped countries.","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":"45304094","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":"Facultative Anaerobic Bacterial Profile of Bacteremia and Septicemia among ICU Patients and its Antibiotic Susceptibility Pattern in Central Nepal","authors":"B. Jha, S. Mahaseth, R. Sanjana","doi":"10.3126/jcmsn.v18i3.29691","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.29691","url":null,"abstract":"Introduction: Bacteremia and septicemia is a life threatening condition resulting in major cause of morbidity and mortality in patients. The aim of this study was to determine prevalence of bacteremia and septicemia among surgical ICU patients and its antibiotic susceptibility pattern.\u0000Methods: A cross-sectional study was carried out among the suspected cases from surgical ICUs of COMS-TH from July 2017 to December 2020. Blood samples were collected, processed, isolated and identified according to standard methodology. Multidrug resistance in Gram negative bacterial (MDR) and methicillin resistant S.aureus (MRSA) screening was done by following the standard protocol.\u0000Results: A total number of 450 samples were processed, 48(10.7%) bacterial isolates from patients’ blood sample showed positive by culture from department of surgical ICUs, College of Medical Sciences Teaching Hospital, Nepal. This study showed more incidences of gram negative isolates which are responsible for septicemia as compared to gram positive isolates.\u0000Most frequently used drugs like Ciprofloxacin (83.9%), Gentamycin (74.2%), Ceftrixone and Ampicillin (71.0%), Cefazolin and Chloramphenicol (67.7%), Ofloxacin (67.7%), Amikacin (64.5%), Amoxyclave (61.3%), showed high rate of resistance among the isolates. Cefotaxime and Co-Trimoxazole (58.1%) showed second highest resistance pattern among GNB isolates from ICU patients. The least resistance pattern among the GPC was found in drugs like Amikacin and Azithromycin (47.1%) and Vancomycin (35.3%) Meropenem (29.4%). Coagulase negative Staphylococcus (CONS) had shown MDR 66.6% showed highest resistance pattern among Enterococcus spp, CoNS and S.aureus. This indicates most of the organisms were either moving towards resistance or already acquired resistance against antibiotics.\u0000Conclusions : Blood culture positive rate of the isolates from surgical ICUs of COMS-TH was 48(10.7%) of the total 450 samples. Pseudomonas aeruginosa and S.aureus were most common pathogen causing bacteremia and septicemia. None of the antibiotics were 100% sensitive for P.aeruginosa, even Meropenem showed reduced sensitivity. Among all antibiotics Ampicillin and Amikacin followed by Ciprofloxacin has lowest sensitivity towards the organisms.","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":"49346818","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":"Perceived Hindering Factors of Exclusive Breastfeeding among Lactating Mothers of Itahari","authors":"Rita Pradhan, B. K. Karn, Ramanand Chaudhary, U. Yadav, Sunita Bhandari","doi":"10.3126/jcmsn.v18i3.44242","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.44242","url":null,"abstract":"Introduction: World Health Organization recommends first 6 months of exclusive breastfeeding after birth. It helps in proper growth and development of child. At the same time, it reduces infant mortality by preventing common childhood illnesses and helps for a quicker recovery during illness. So, the study aimed to identify the perceived hindering factors of exclusive breastfeeding among lactating mothers.\u0000Methods: A community-based, descriptive cross-sectional study was conducted in Itahari Sub-Metropolitan City. Convenience sampling technique was used to select a total of 123 lactating mothers having infants 0-6 months. A pretested questionnaire was used to interview mothers. Collected data were analyzed using descriptive and inferential statistics.\u0000Results: Although nearly all mothers (97.6%) had knowledge about exclusive breastfeeding and 93.5% of them had correct knowledge of recommended duration of EBF, the prevalence of exclusive breastfeeding was only 17.6%. Breastfeeding was initiated within 1 hour by 68.3% of mothers. Half of the mothers perceived that only mother’s milk is not sufficient to their child and about 22% of the mother’s perceived that their child is thirsty and should give water to the infant. Ethnicity and EBF duration to first child in multiparous mother was significantly associated with exclusive breastfeeding practice.\u0000Conclusions: Majority of the mothers do not practice EBF although they had known the recommended duration. The major hindering factor of EBF was the perception of the mother that the mother’s breastmilk only is not sufficient to the infant.","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":"48606755","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":"HRCT Chest in Patient of COVID-19 Pneumonia at a tertiary College of Medical Sciences, Bharatpur, Nepal","authors":"R. Acharya, P. Chhetri, V. Prasad, Kalim Akhtar, K. Thapa, M. Mishra, Arati Ghimire","doi":"10.3126/jcmsn.v18i3.48715","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i3.48715","url":null,"abstract":"Background: COVID19 pneumonia is caused by novel corona virus. The HRCT chest is helpful in identification of COVID-19 Pneumonia. CT chest play a crucial role in assessing the pattern of manifestation and severity of lung involvement in COVID-19. The objective of this study is to described high resolution computed tomography (HRCT) chest findings in COVID-19 Pneumonia patients in college of medical sciences Bharatpur Nepal.\u0000Method: A prospective, HRCT Chest findings were analaysed in 375 patients. Patients with high CORADS score and suspicious for COVID-19 pneumonia were further tested positive in PCR examination. The study was done for a year period of time\u0000Result: A total 375 patients suspected for COVID-19 pneumonia in HRCT, 341 were PCR positive. The mean age affected by viral pneumonia was 51.9 (51-60 year group). The male were 240 and female were 135. Ground glass opacities is noted in 188 patients, followed by GGO and consolidation in 177, consolidations only in 7 and others findings chest findings in 3 patients.\u0000Conclusion: HRCT chest can help in early detection of COVID-pneumonia. It can also asses the percentages of lung involvement and severity of disease that can guide physician.","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":"48948383","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":"Comparative Cytomorphometric Study of Exfoliated Oral Epithelial Cells from a Population of Smokers, Tobacco Users and Gutkha Chewers","authors":"Nishant, B. Sharma","doi":"10.3126/jcmsn.v18i2.43689","DOIUrl":"https://doi.org/10.3126/jcmsn.v18i2.43689","url":null,"abstract":"Introduction: Tobacco remains one of the most important preventable cause of addiction, sickness and mortality in the world as it affects the oral epithelium. Normal epithelium undergoes continuous exfoliation or shedding of its superficial cells, and it is replenished by new crop of cells from the basal layer. The rationale of exfoliative cytology lies in the epithelial physiology. The purpose of this study is to conduct quantitative cytomorphometric studies on squames obtained from a population of Tobacco and Gutkha users, to assess the cytomorphometric changes in Nuclear Area (NA) and Cytoplasmic Area (CA) of squames from tobacco smokers, tobacco chewers, gutkha chewers, to compare the results with control group normal healthy individuals and among themselves.\u0000Methods: Oral smears were taken from buccal mucosa of total 200 individuals. The smears were histochemically stained and cytomorphological assessment was done. Groups were compared by one way analysis of variance (ANOVA) and the significance of mean difference between the groups was done by Tukey’s post hoc test after ascertaining normality by Shapiro-Wilk test andhomogeneity of variances by Levene’s test.\u0000Results: The mean Nuclear area of tobacco chewer (C) was the highest and the normal individual (N) was the least. The mean Cytoplasmic area of normal individual (N) was the highest and the tobacco chewer(C) was the least.\u0000Conclusions: This study supports and extends the view that cytomorphometric evaluation of keratinocytes can serve as a useful diagnostic adjunct for early detection of oral cancer. \u0000Keywords: exfoliative cytology; cytomorphometric; tobacco users; gutkha users.","PeriodicalId":15436,"journal":{"name":"Journal of College of Medical Sciences-nepal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42288046","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}