Journal of Kathmandu Medical College最新文献

{"title":"Management‌ ‌of‌ ‌dentofacial‌ ‌trauma‌ ‌in‌ ‌an‌ ‌adolescent‌ ‌patient:‌ ‌The‌ ‌ conservative‌ ‌and‌ ‌the‌ ‌preservative‌ ‌approach‌","authors":"A. Rai, B. Koirala, M. Dali, S. Shrestha","doi":"10.3126/jkmc.v9i4.38097","DOIUrl":"https://doi.org/10.3126/jkmc.v9i4.38097","url":null,"abstract":"Mandibular fractures are one of the most frequent occurrences in maxillofacial trauma. Age of the patient, presence of additional injuries, co-morbid diseases of the patient, trauma type, and localization of the fracture must be considered while choosing the treatment strategy. A 12-year-old female patient reported with the complaint of fallen teeth due to trauma three days back. Clinical and radiographic findings revealed symphysis fracture with left sided parasymphysis and subcondylar fracture along with avulsion of 11 and 21. Intermaxillary fixation was done with Erich arch bars and elastics for the management of mandibular fracture, and rehabilitation of edentulous space was done using the avulsed teeth as pontics which were bonded to the adjacent abutment teeth using fiber-reinforced composite.","PeriodicalId":254049,"journal":{"name":"Journal of Kathmandu Medical College","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131326011","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":"Apical tissue resection in triangle operation during Whipple’s surgery","authors":"D. Maharjan, R. Ghimire, Y. Limbu, S. Regmee, A. Parajuli, P. Thapa, S. Shrestha","doi":"10.3126/jkmc.v9i4.38094","DOIUrl":"https://doi.org/10.3126/jkmc.v9i4.38094","url":null,"abstract":"Background: In pancreatic ductal adenocarcinoma, standardised concepts of radical surgical clearance have not been universally applied. \u0000Objectives: The main objective of this study is to reveal the status of circumferential resection margin of the apical tissue of the triangle namely the confluence of SMA and coeliac trunk in relation to circumferential resection margin of triangle tissue bounded by superior mesenteric artery, common hepatic artery and portal vein when performing the TRIANGLE operation. \u0000Methodology: This was a hospital-based cross-sectional study conducted at Kathmandu Medical College and Teaching Hospital, from September 2020 to December 2020. The study was done after ethical clearance from the Institutional Review Committee of Kathmandu Medical College. All consecutive patients who were subjected for Whipple’s operation for pancreatic head and uncinate process were included. \u0000Results: Fifteen patients underwent the “TRIANGLE” operation during a four months period. Median age of the patients was 65 ± 13.34 years (range 32–84 years). Medianpreoperative BMI 21.75± 2.5 (range: 18 to 26.7). Regarding histopathological results, an R0 resection was achieved in 9/15 patients. In nine patients,circumferential resection margin(CRM) of both the apical tissue and the rest of the triangle was negative. In the next three patients, the CRM of apical tissue was negative but  the triangle tissue  was positive whereas in the other three patients CRM of both the apical tissue  and the triangle tissue  were positive. \u0000Conclusion: This study emphasises the importance of inclusion of apical tissue dissection at the confluence of SMA and coeliac trunk in order to achieve R0 resection without significant short-term morbidity. However, a long-term follow is awaited.","PeriodicalId":254049,"journal":{"name":"Journal of Kathmandu Medical College","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124317425","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":"Antibiotic susceptibility pattern of bacterial isolates from quantitative culture of bronchoalveolar lavage fluid in patients with clinical suspicion of pneumonia","authors":"B. Jha, Manisha Sharma, J. Sapkota, Subash Pant, A. Neopane","doi":"10.3126/jkmc.v9i4.38091","DOIUrl":"https://doi.org/10.3126/jkmc.v9i4.38091","url":null,"abstract":"Background: The common bacterial pathogens isolated from bronchoalveolar lavage (BAL) include Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa and Coagulase negative Staphylococcus. \u0000Objectives: This study was conducted to identify pneumonia causing organisms and to determine their antibiogram. \u0000Methodology: A descriptive cross-sectional study was carried out at Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal over a period of one year (Aug 2019-Jul 2020). Ethical approval (Reference Number:1004201810) was taken and convenience samplin g was done using Clinical and Laboratory Standards Institute(CLSI) guidelines. Data were analyzed using Statistical Package for Social Sciences(SPSS) version 19. \u0000Results: Out of 32 BAL samples, 14 were culture positive. The commonest bacterial pathogens isolated were Klebsiella Pneumoniae 6(42.85%), followed by Acinetobacter baumanii 5(35.71%), Pseudomonas aeruginosa 2(14.28%) and Coagulase negative Staphylococcus 1(7.14%). The isolates were 100% sensitive to Tigecycline and Polymixin B followed by Colistin(92.85%). Cotrimoxazole was 100% resistant to these isolates followed by Azithromycin (92.85%. \u0000Conclusion: Klebsiella pneumomiae, Acinetobacter baumanii were the most common bacterial pathogens isolated from BAL.","PeriodicalId":254049,"journal":{"name":"Journal of Kathmandu Medical College","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126019027","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":"Academic journal indexes and metrics: What are they?","authors":"Ashik Rajak, Aliza Bajracharya","doi":"10.3126/jkmc.v9i4.38089","DOIUrl":"https://doi.org/10.3126/jkmc.v9i4.38089","url":null,"abstract":"Not available.","PeriodicalId":254049,"journal":{"name":"Journal of Kathmandu Medical College","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114625305","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":"Risk factors for visceral leishmaniasis in selected high endemic areas of Morang, Nepal: A case control study","authors":"P. K. Mandal, R. Wagle, S. Uranw, A. K. Thakur","doi":"10.3126/jkmc.v9i3.36406","DOIUrl":"https://doi.org/10.3126/jkmc.v9i3.36406","url":null,"abstract":"Background: Visceral leishmaniasis is a major public health concern in Nepal. During the last few years, several Kala-azar outbreaks have been reported from Terai region including Morang district, Nepal. \u0000Objectives: The aim of this study is to determine the risk factors associated with Kala-azar at individual and household levels in selected highly endemic areas of Morang district of eastern Nepal. \u0000Methodology: A case control study was conducted in five endemic village development committees of Morang district with 62 cases already treated from B.P. Koirala Institute of Health Sciences and Koshi Zonal Hospital. Two hundred and forty eight controls were selected randomly from the same village at the ratio of 1:4. Data was collected between September and November 2013 using structured questionnaires. Bivariate and multivariate analysis were done and the final model was selected using the backward elimination strategy. \u0000Results: This study showed that the majority of cases (29.0%) were from the 13-25 years age group, males are more than females and indigenous caste (74.2%) were affected more than other caste. Living in thatched house (OR 4.57, 95% CI 1.91-10.93), ownership of animal (OR 3.95, 95% CI 1.87-8.37), sleeping on the ground floor (OR 3.90, 95% CI 1.83-8.31),  history of migration to India and proximity to other Kala-azar cases within 50 metres distance of household were significant risk factors for visceral leishmaniasis. The association with socioeconomic status remained significant and there was a clear dose – response effect.  \u0000Conclusion: Living in thatched house, ownership of animals, sleeping on the ground floor, history of migration to India, proximity to other Kala-azar cases within 50 metres distance and poverty are the main risk factors associated with visceral leishmaniasis transmission.","PeriodicalId":254049,"journal":{"name":"Journal of Kathmandu Medical College","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121897324","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":"Learning preferences of undergraduate dental students using VARK analysis","authors":"A. Shrestha, V. Marla, Sushmita Shrestha, J. Rimal","doi":"10.3126/jkmc.v9i4.38093","DOIUrl":"https://doi.org/10.3126/jkmc.v9i4.38093","url":null,"abstract":"Background: Learning preference is a complex character in which learners most efficiently perceive, process, store, and recall what they are learning. \u0000Objectives: This study was conducted with an objective to identify the preferred learning styles of undergraduate dental students such that suitable modification in the teaching learning environment could be made. \u0000Methodology: An analytical cross-sectional study was carried at B.P. Koirala Institute of Health Sciences, Nepal among undergraduate dental students from June to December 2019 after getting ethical approval. Convenience sampling method was used to include all undergraduate students from first to final year; of which 252 provided consent. VARK questionnaire (version 7.8) comprising 16 multiple choice questions were used to analyse the learning preferences and were accordingly categorised for further statistical analysis. \u0000Results: Out of 280 students, a total of 252 students (90%; 90 males, 162 females) responded to the questionnaire among whom 89 (35.3%) had uni-modal learning preferences. Of the total, 55 (21.8%) had bi-modal, 39 (15.4%) had tri-modal, and 69 (27.3%) had quadri-modal learning preferences. Among the uni-modal preferences, 'K mild' was most common (36, 14.3%) followed by 'A mild'. Among bi-modal learning preferences 'AK type' (35, 13.9%) was most common and VAK type was common among tri-modal learning preferences. 'VARK type two' (33, 13.1%) was common quadri-modal learning preferences. \u0000Conclusion: This study highlighted the variations in learning preferences among dental students suggesting the need for a flexible learning environment. Understanding learning preferences can help to plan lessons effectively and help to manage students in a better way.","PeriodicalId":254049,"journal":{"name":"Journal of Kathmandu Medical College","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116473367","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":"Subungual exostosis of the great toe: A case report","authors":"P. Kafle, Nishchal Rijal, A. K. Pandey","doi":"10.3126/jkmc.v8i4.32391","DOIUrl":"https://doi.org/10.3126/jkmc.v8i4.32391","url":null,"abstract":"Subungual exostosis is typically a rare benign, acquired tumor of cartilaginous bone occurring on the medial surface of the distal hallux of toes or fingers. These are usually associated with secondary changes such as elevation of the nail plate, ulceration or subungual hyperkeratosis and hyperpigmentation. On histological examination, the lesion consists of mature bone at the base with proliferating fibrocartilaginous cap. A 14-year-old male presented with a solitary firm swelling gradually increasing in size for three months on the distal part of the right great toe. On physical examination, a firm, non-tender, non-mobile, whitish nodule was noted in the distal dorsomedial aspect of the right great toe distorting the adjacent nail. Radiographs demonstrated a dorsal bony outgrowth that was continuous with the distal phalanx. Excisional biopsy was done and on histopathological examination, a characteristic trabecular pattern of mature bone covered with a hyaline and fibrocartilaginous cap was seen. There was lack of true anaplasia, thereby confirming the diagnosis of subungual exostosis. There was no recurrence over six months. This topic is underrepresented in the orthopaedic literature, because many of the important clinical series have been published in journals from other branches of medicine i.e. mainly by dermatologists and pathologists. This reflects the fact that the condition is treated by many kinds of non-orthopaedic providers. We, as orthopaedic surgeons, must be careful while evaluating lesions of distal phalanges, always keeping in mind the possibility of subungual exostosis. Radiographs are helpful in diagnosis but confirmation can be done by histopathological examination. En bloc excision with minimal nail plate deformation can help prevent recurrence or deformity.","PeriodicalId":254049,"journal":{"name":"Journal of Kathmandu Medical College","volume":"304 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122091853","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":"Posterior reversible encephalopathy syndrome in a patient with diabetic ketonuria","authors":"I. Sharma, Prakash Banjade, S. Chellamuthu, Faisal Saeed, Prajut Dallakoti","doi":"10.3126/jkmc.v8i4.32390","DOIUrl":"https://doi.org/10.3126/jkmc.v8i4.32390","url":null,"abstract":"Posterior reversible encephalopathy syndrome is a condition presenting with non-specific symptoms like nausea, vomiting and headache along with neurological manifestations like altered mental status, seizure, visual impairment and even coma. These symptoms are coupled with characteristic radiological findings of vasogenic edema in the bilateral parieto-occipital lobe which is usually reversible. We present here, a young 30 years old male, with dizziness, vomiting, generalized weakness, altered mental status with cortical blindness and focal and generalized tonic-clonic seizures in the background of first presentation of type 2 diabetes mellitus with ketonuria. Characteristic findings in Magnetic Resonance Imaging and reversal of the symptoms helped to reach the diagnosis of posterior reversible encephalopathy syndrome in our patient. The patient was discharged in stable condition after reversal of the symptoms and treatment of type 2 diabetes mellitus.","PeriodicalId":254049,"journal":{"name":"Journal of Kathmandu Medical College","volume":"226 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122043048","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":"Mean Leeway space in Nepalese children attending a tertiary care hospital, Bhaktapur: A radiographic evaluation","authors":"M. Pradhan, Shweta Dhital, Ujjwal Joshi, S. Poudyal","doi":"10.3126/jkmc.v8i4.32389","DOIUrl":"https://doi.org/10.3126/jkmc.v8i4.32389","url":null,"abstract":"Background: Leeway space becomes important during the change of dentition and occlusal development. Objectives: The study was designed to measure the mean leeway space of maxilla and mandible of Nepalese children using Orthopantomogram radiographs and also to compare the difference between mean leeway space in male and female children. Methodology: After ethical approval, 270 OPG (Orthopantomogram) radiographs of age groups 6-12 years Nepalese children exhibiting mixed dentition were selected for the study after following the inclusion and exclusion criteria by convenience sampling method. A digital measurement in the OPG software was used to measure the mesiodistal width of deciduous canine and molars along with permanent canine and premolars in all quadrants. Results: The mean leeway space on maxilla was seen to be (0.86 ±1.97mm) while for mandible was (2.45± 1.85 mm).The leeway space in both maxilla and mandible was seen to be more in females (0.87 ± 1.87 mm) and (2.52 ± 1.85 mm) than in males (0.85 ± 2 mm) and (2.40 ± 1.90mm)respectively. Conclusion: The mean leeway space in Nepalese children was found to be less than the standard “Leeway space of Nance” which could be due to population tooth crown differences and various environmental factors. Further studies could be recommended in the future both radiographically and clinically for obtaining a standardized leeway space for Nepalese population.","PeriodicalId":254049,"journal":{"name":"Journal of Kathmandu Medical College","volume":"160 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128982058","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":"Volar versus dorsal surgical approaches in fractures of proximal radius in adults: A prospective randomized controlled trial","authors":"Nishchal Rijal, B. Shrestha, Rosan Ps Kalawar, B. Pokharel, P. Baral","doi":"10.3126/jkmc.v8i4.32388","DOIUrl":"https://doi.org/10.3126/jkmc.v8i4.32388","url":null,"abstract":"Background: Open reduction and internal fixation with plates and screws is the standard treatment for both-bone forearm fractures in adults. For fractures of the proximal one-third or half of the radius, both the volar (Henry) and dorsal (Thompson) approaches are employed and each one has its own advantages and disadvantages. Objectives: The aim of the study was to compare the functional outcome, intraoperative parameters, complications and duration of union between the two approaches. Methodology: The randomized controlled trial was conducted in the Department of Orthopaedics, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, over a period of 12 months (October 2017 to September 2018). Fifty patients with proximal radius fractures were randomized into two groups: Group A and Group B. Patients in Group A (n=25) underwent surgery via the volar approach whereas those in Group B (n=25) via the dorsal approach. They were evaluated on the second postoperative day and at 2, 6, 12 and 24 weeks postoperatively with regards to functional outcome, clinical and radiologic signs of fracture union and complications. Results: The difference in the intraoperative parameters (length of incision, duration of surgery, tourniquet time) was not statistically significant between the two groups (p-values > 0.05). There was a progressive increase in range of motion (ROM) and a progressive decrease in the Disabilities of the Arm, Shoulder and Hand (DASH) scores, signifying improving functional outcome in both the groups during patient follow-up (p-values > 0.05). Three cases of posterior interosseous nerve (PIN) palsies (one in the volar group and two in the dorsal group), one case of deep surgical site infection in the volar group and one case of nonunion in the dorsal group were encountered. Conclusion: The surgical approaches were comparable in terms of functional outcome, intraoperative parameters, complications and time to union. Though cases with PIN palsy were seen in both the groups, the difference in the occurrences was not statistically significant. As both the approaches were associated with a low rate of complications, either can be used based on the preference of the operating surgeon. However, large scale multicenter studies are necessary to recommend guidelines on the choice of surgical approach for proximal radius fractures in adults.","PeriodicalId":254049,"journal":{"name":"Journal of Kathmandu Medical College","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115824822","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}