Kathmandu University Medical Journal最新文献

{"title":"Efficacy of Budesonide Nasal Irrigation in Comparison to Normal Saline Irrigation in Post-Operative Management of Functional Endoscopic Sinus Surgery.","authors":"B L Shrestha, D Sijapati, A Dhakal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Nasal irrigation with normal saline and topical steroid spray forms the mainstay of treatment in post endoscopic sinus surgery patients. However nasal sprays may not deliver optimum dosage of drug to the paranasal sinus mucosa. Budesonide nasal irrigation solves this problem by delivering drugs in a high-volume high-pressure system. Objective The main objectiveof this study will provide insight into the efficacy of budesonide nasal irrigation following functional endoscopic sinus surgery (FESS) surgery and will help to establish new protocols in future. Method Forty-four patients were included and divided into 2 groups of 22 each. One arm received normal saline nasal irrigation and the other arm received budesonide nasal irrigation (1 mg in 500 ml) twice daily. Patients were followed up at 1st post-operative week and 10th post-operative week and on each visit Sino-Nasal Outcome Test (SNOT) 22 and Lund Kennedy Endoscopic scores (LKES) were assessed. Result The mean scores in the first visit was SNOT 22 : 15.73 + 8.897 vs 12.73 + 16.110 (p < 0.05) and LKES : 2.82 + 1.097 vs 1.77 + 1.52 (p > 0.05) in the saline and budesonide groups respectively. The mean scores in the second visit was SNOT 22 : 7.09+3.87 vs 3.73 + 8.70 (p < 0.05) and LKES : 1.64 + 0.790 vs 0.18 + 0.501 (p < 0.05) in the saline and budesonide groups respectively. Thus the budesonide arm had statistically significantly better scores when compared to the normal saline group. Conclusion Budesonide nasal irrigation with a positive pressure high volume device was found to have better efficacy when compared to normal saline irrigation. Budesonide nasal irrigation may be used in the post-operative management of endoscopic sinus surgery patients.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 88","pages":"20-24"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217114","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":"Exploring the Job Satisfaction among Workforce Working in Four Medical Colleges in Nepal: a cross-sectional study.","authors":"D P Dahal, N Gupta","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Job satisfaction is a critical factor influencing healthcare quality, patient's outcomes and overall wellbeing in medical profession. Job satisfaction is an important component of improving job performance and maintaining overall quality of work in any organization. The result of job satisfaction will have an impact not only at the individual level but also in the institutional, societal, and national level. Objective To explore overall job satisfaction among the workforce of four different medical colleges in Nepal, as well as the factors associated with it. Method A cross-sectional study was conducted from August to December 2024 among medical, nursing, and administrative staff who had at least one year of teaching or working experience in their respective institutions. A 36-items job satisfaction questionnaire with 6-point Likert type responses was administered in-person. Data analysis was carried out with STATA version 18 software. Categorical variables were presented as frequencies and percentages, whereas continuous variables were described using means, standard deviations, medians, and ranges. Inferential statistical analyses comprised independent t-tests for comparisons between two groups and analysis of variance (ANOVA) for comparisons among multiple groups. A multivariable linear regression model was used to identify the significant factors associated with health workforce job satisfaction. Statistical significance was defined as p < 0.05, with results reported at a 95% confidence interval. Result This study analyzed job satisfaction among 533 health workers in four medical colleges. The average overall job satisfaction score was 122.24 (±15.17). Multivariable linear regression identified several significant determinants of overall job satisfaction among health workers in Nepal's teaching hospitals. Employees in Nursing (adjusted mean difference [AMD]: 5.35, 95% CI: 2.46 to 8.26) and Administration (AMD: 5.45, 95% CI: 2.20 to 8.71) departments reported higher OJS compared to those in the medical department. Contract staff had significantly lower job satisfaction (AMD: -4.23, 95% CI: -7.19 to -1.28), while differences for daily wage and other positions were not significant. Unexpectedly, employees without chronic diseases reported lower OJS (AMD: -2.66, 95% CI: -5.86 to -0.55). Higher organizational input factors were significantly associated with lower OJS (AMD: -0.37, 95% CI: -0.55 to -0.19). Conclusion This study revealed that health workforces had positive attitude towards their job however are dissatisfied with the benefits offered to them and the operating condition of their institutions. Expanding the teaching learning resources, continuing career opportunities through participation in professional development and regular promotion and increment of salary would be helpful in improving job satisfaction among health workforce in Nepal.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 88","pages":"9-14"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217116","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":"Palliative Care and Pain Management in a Resource-Limited Setting.","authors":"A Gautam, A Gautam, S Johnson, F A Rahman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Palliative care is a vital component of healthcare that aims to alleviate the suffering of patients with life-threatening conditions. This specialized medical care focuses on managing symptoms, addressing social, emotional, and physical needs, and enhancing the quality of life for patients and their families. Palliative care addresses the patient's medical, psychological, and spiritual requirements, and can be used as the primary focus of care or in conjunction with curative therapies. Pain management is a crucial aspect of palliative care, involving the control or reduction of pain through medication, therapy, and other treatments. However, pain is a subjective sensation, making quantification and effective relief challenging. This review highlights the complex issues associated with pain management in palliative care, emphasizing the need for improved training and accessible pain management techniques, such as the widely recognized \"Wong-Baker Face Pain Scale\", particularly in resource-constrained environments like Nepal. The complex nature of pain management in palliative care compromises patients' quality of life, influenced by factors like chemotherapy and terminal illness. Addressing this issue is imperative, especially in areas like Nepal where there is a shortage of appropriate training among medical personnel. Encouragingly, initiatives like mobile health teams, smartphone apps, and the establishment of a Palliative Care Training Center demonstrate progress in improving end-of-life care.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 88","pages":"113-118"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217133","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":"Thyroid Angiosarcoma : An unusual and challenging case report at B.P. Koirala Institute of Health Sciences.","authors":"U Lamichhane, P Paudyal, S Karki, A Pradhan, M Dahal, S P Shah","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Angiosarcoma is an uncommon malignant vascular tumor of endothelial origin and commonly described in soft tissue. Thyroid is an uncommon site for angiosarcoma and is a very aggressive tumor commonly occurring in elderly female, characterized by its prevalence in Alpine regions of central Europe. The main aim of this case report is to provide an insight on thyroid angiosarcoma (TAS) occurring in nonAlpine region, to know the major diagnostic features of thyroid angiosarcoma and distinguish it from anaplastic thyroid carcinoma with angiomatoid features. Due to its overlapping microscopic features diagnosis of primary thyroid angiosarcoma (TAS) was challenging. However, the combination of thorough microscopic findings and immunohistochemical studies (CD 31, Vimentin, Thyroglobulin and Thyroid Transcription Factor-1) are vitally important in differentiating these two tumors to achieve at a final diagnosis. This significantly helps to decide the best treatment option and predict the behaviour.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 88","pages":"103-105"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217143","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":"Laparoscopic Adrenalectomy for Adrenal Mass.","authors":"M B Adhikari, D K Yadav, B Maharjan, R K Gautam, P Mishra, B Basnet, A Khadga","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Adrenal gland tumors, including both benign and malignant forms, are increasingly detected due to advancements in imaging techniques. This prospective study, conducted at Nepal Mediciti Hospital evaluated thirteen patients diagnosed with adrenal masses, all confirmed benign via contrast-enhanced computed tomography. Functional assessment, preoperative endocrinological and anesthesiological evaluations and pharmacological preparations were conducted as needed. All patients underwent successful lateral transperitoneal laparoscopic adrenalectomy, performed by a single surgeon. The study population had a female predominance (9 females, 4 males), with tumor sizes ranging from 2 to 9 cm. No surgeries required conversion to open procedures, and postoperative outcomes were favorable, with no mortality or re-operations. Complications were minimal, including transient blood pressure elevation in one pheochromocytoma case and one postoperative chest infection. Histopathological findings included aldosterone-producing adenomas, cortisol-producing adenomas, and pheochromocytomas. The study supports the continued use of laparoscopic adrenalectomy as the preferred surgical method for adrenal tumors.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 88","pages":"99-102"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217117","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":"Status of Hypertension and Its Associated Factors Among Undergraduate Medical Students of a Private Medical College in Lalitpur District.","authors":"S K Sah, N Singh, S Pandey, A T Sherpa Lama, P P Panta, S Shah, K Ghising, N Rai","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Hypertension, a significant global health concern, warrants exploration within the unique context of medical student populations. Hypertension is a silent killer and is a leading cause of premature morbidity and mortality particularly in developing countries including Nepal. Medical students are prone to stress, long working hours, unsteady and unhealthy lifestyles such as lack of exercise, eating unhealthy food which are high risk factors contributing to hypertension. Objective To assess the prevalence of hypertension and its associated risk factors among undergraduate medical students. Method A Cross-sectional study was conducted between August to November 2023 among the undergraduate medical students from first-year to final-year and interns at a teaching hospital after obtaining ethical approval from the Institutional Review Committee. A total enumeration sampling technique was used. Chi square test was used to determine the association between variable and P value less than 0.05 was fixed for statistically significant. Result Out of 500 participants, 234 (46.80%) were reported to have hypertension according to the classification of the American Heart Association, 2023. Among them, 169 (72.22%) were male and 65 (27.78%) were female, with a male-to-female ratio of 2.6:1. Male participants had significantly higher odds of developing hypertension compared to females, with a crude odds ratio (COR) of 3.116 (95% CI: 2.144-4.53, p < 0.001) and an adjusted odds ratio (AOR) of 2.815 (95% CI: 1.914-4.139, p < 0.001). Participants categorized as \"Obese\" also had significantly higher odds of developing hypertension compared to \"Non-obese\" individuals, with a COR of 1.862 (95% CI: 1.189-2.916, p = 0.006) and an AOR of 1.636 (95% CI: 1.026-2.607, p = 0.039). Conclusion The high frequency of hypertension in this study could indicate a hidden epidemic among medical students. The results suggest that effective health screening and routine examinations are necessary, in addition to measures that support healthy lifestyles.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 88","pages":"85-90"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217140","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":"Liver Function Parameters and Validation of Health-Related Quality of Life Assessment of β-Thalassemia Cases at a Tertiary Care Hospital, Lumbini Province, Nepal.","authors":"N Gautam, P Risal, R T Gupta, K K Agrawal, D Chaudhary, M S Paudel, B Adhikari, B R Pokhrel, B Tamang, J Shrestha, B Sharma, S Ghimire","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Individuals affected by β-thalassemia experience complications such as hepatic hemosiderosis and fibrosis due to frequent blood transfusions, which can lead to iron overload. Multiple blood transfusion burdens in thalassemia, particularly in lowincome countries, impact health-related quality of life. Objective Liver function parameters and health-related quality of life were assessed using Nepali version 36 short-form survey instruments to reveal the vitality, physical, mental, emotional, pain, general health, and social functioning of β-thalassemia cases. Method In this cross-sectional study, forty β-thalassemia cases who had visited the Universal College of Medical Sciences tertiary care teaching hospital of Lumbini Province, Nepal were enrolled. The hemoglobin variant band percentage was estimated by D-10 BioRad high performance liquid chromatography (HPLC), Mentzer Index (Mean Cell Volume by Red Blood Cell count) by Beckman hematological analyzer, and serum liver parameters (Bilirubin, Total protein, Albumin, Alanine aminotransferase, Aspartate aminotransferase, Alkaline phosphatase) were estimated by using Diatron fully automated analyzer. The internal consistency of the Nepali version of 36 shortform survey instruments was checked by Cronbach`s alpha was found to be > 0.70 from the recoded value. Data are analyzed using the STATA/MP14, and ANOVA and t-test are applied to test the significance considering p-value < 0.05. Result The frequency of the β-thalassemia Trait (60%) was higher than β-thalassemia Major (30%) and 7.5% β-thalassemia Intermedia co-morbidities with Sickle cell (2.5%) and β/δ variants (2.5%). Higher frequency was found in ethnic groups Muslim (32.5%) followed by Terai indigenous-Tharu (30%) and Madheshi (27.5%). The transfusiondependent cases have significantly higher Total, Direct, Indirect Bilirubin, and Alkaline phosphatase levels than non-transfusion dependent cases (p < 0.001). The physical functioning, general health, emotional health, and vitality were significantly decreased in β-thalassemia Major as compared to β-thalassemia Trait (p < 0.001), and significantly correlated with Mentzer index and HPLC patterns (HBA2/HBF) (p < 0.05). Conclusion Transfusion dependent β-thalassemia Major and Intermedia had elevated Bilirubin and Alkaline phosphatase levels as compared to non-transfusion dependent β-thalassemia Trait, exacerbating health-related quality of life, emphasizing the preventable disparities for optimized transfusion protocols and psychosocial support.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 88","pages":"49-55"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217131","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 Microphthalmos with Papillomacular Retinal Folds and Pseudo Disc Edema.","authors":"R Shrestha, R K Shah, P Joshi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We report a rare case of posterior microphthalmos with prominent papillomacular folds, pseudo disc edema and high hyperopia in a 12 year old child with no systemic anomalies. The patient was diagnosed as high hyperopia two years ago but the posterior findings were missed. The anterior segment of the eye was normal on slit lamp examination but the appropriate diagnosis was missed. Hence detailed evaluation of every hyperopic child should be done for the timely management. This case report highlights the importance of detailed fundus and biometric evaluation to avoid missing the diagnosis of posterior microphthalmos in a high hyperopic child with no systemic anomalies.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 88","pages":"110-112"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217136","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":"Association of HBA1c and Plasma Glucose Levels with Diabetic Retinopathy.","authors":"P Shrestha, A Chaudhary, J K Shrestha","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Diabetic retinopathy is one of the leading causes of blindness worldwide. The relationship between glucose level and development of diabetic retinopathy has always been an area of interest and constantly evolving. Objective To determine the association of glycosylated hemoglobin and plasma glucose levels with different grades of diabetic retinopathy. Method A hospital based cross sectional study was conducted among 504 patients with type II diabetes mellitus attending the Department of Ophthalmology in a University Hospital for one year duration. Relevant history regarding diabetes mellitus was recorded for all patients. The status of diabetic retinopathy in each patient was diagnosed by detailed ophthalmological examination and classified according to International Classification of Diabetic Retinopathy Scale. All the patients were evaluated for their glycosylated hemoglobin, fasting and post prandial blood glucose levels. Bivariate analysis using t-tests and chi-square tests was used to measure the strength of association between the different variables. An Analysis of Variance (ANOVA) test was used to evaluate the association between the means of different variables. Result Total 504 patients constituted of 254 males (50.39%) and 250 (49.60 %) females. Almost half of the study population had poor glycemic control and deranged fasting and post prandial blood sugar levels. Diabetic retinopathy was observed in 124 (24.60%) patients and diabetic macular edema was observed in 42 (8.33%) patients. Poor control of glycosylated hemoglobin (> 7.6) was seen in 88 (70.96%) cases of diabetic retinopathy and 34 (80.95%) cases of diabetic macular edema. Uncontrolled fasting and postprandial blood sugar levels were associated with a significant number of cases of diabetic retinopathy and of diabetic macular edema respectively. A statistically significant association was observed between increasing grades of diabetic retinopathy and higher glycosylated hemoglobin and plasma glucose levels. Conclusion Higher the level of glycosylated hemoglobin and plasma glucose levels, more severe is the grade of diabetic retinopathy.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 88","pages":"56-62"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217111","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":"Physical Activity among Secondary Level School Students of Banepa Municipality.","authors":"E Malla, P Chalise","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Physical activity plays a crucial role in overall growth and development of adolescents. Physical inactivity (insufficient physical activity) has been identified as the fourth leading risk factor for global mortality (6% of death globally). Regular physical activity is recommended for the prevention of non-communicable disease and improvement of overall health. Worldwide, 81% of adolescents aged 11-17 years are physically inactive. Objective To assess physical activity and its association with selected variables among secondary level students of selected schools of Banepa municipality. Method A quantitative cross-sectional study was conducted using standard Global Physical Activity Questionnaire. Data were collected from 70 students using convenience sampling technique. Socio-demographic, environmental and lifestyle factor were also included in the questionnaire. Descriptive statistics (frequency, percentage, mean, median) and inferential statistics (Chi square test, Monte Carlo test) were applied using Statistical Package for Social Science Version 25 for data analysis. Result This study found that one sixth of the respondents reported low physical activity. Among males, the figure was 27.3% while in females it was 13.5%. Similarly, 72.7% of males met the World Health Organization recommendation for physical activity (≥ 600 Metabolic Equivalent for Task min/week) and 85.5% of females met the criteria. There was high contribution of recreational domain on physical activity. Conclusion This study concludes that most of the respondents had a high level of physical activity. Total physical activity score was largely contributed by recreational activity. This study did not find any association between levels of physical activity and selected socio-demographic, environmental and lifestyle related variables.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 88","pages":"44-48"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217134","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}