Kathmandu University Medical Journal最新文献

{"title":"Tele-colleaguography - Adjunct to Intraoperative Time Out for Safe Laparoscopic Cholecystectomy.","authors":"U Laudari, A Chaudhary, A Chaudhary, P B Thapa","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Laparoscopic cholecystectomy is a common surgical procedure, and strategies for preventing biliovascular injury include intraoperative time-out and intraoperative cholangiography. However, the feasibility of intraoperative cholangiography is limited in certain regions due to cost and training constraints. This article introduces the concept of \"Tele-colleaguography\" as an adjunct to intraoperative time-out during laparoscopic cholecystectomy, particularly in low-resource settings. Telecolleaguography, a term coined to signify remote consultation with senior surgeons using video applications like WhatsApp and Viber, presents a potential solution to prevent bile duct injuries. The viewpoint discusses the potential benefits of Telecolleaguography, and the role of modern technology such as 5G, and references key studies that support this approach.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 86","pages":"228-230"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355599","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":"Nail Changes Following Valproate Therapy.","authors":"S Shrestha, A Pandey, R Pathak","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Valproic acid is a widely prescribed medication for seizure disorders, mood disorders, and migraines. The adverse effects involving nails following the use of sodium valproate are rare. The nail changes reported so far include onycholysis, onychomadesis, the roughness of the nail, brownish-yellow discoloration, and a transverse yellow band. These changes are independent of the age of the patients, dose, and duration of medication. The nail changes are reversible following the discontinuation of the medication.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 86","pages":"238-240"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355592","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 Oral Health and Nutritional Status of School Teachers in Dharamshala City, Himachal Pradesh.","authors":"D Gurung, V K Bhardwaj, S Fotedar, A S Thakur, S Vashisth","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Nutrition is associated with oral health and any changes in dietary habits have impacted nutritional profiles which in turn influences oral health status. Objective To assess the oral health and nutritional status among school teachers in Dharamshala city, Himachal Pradesh. Method A descriptive cross-sectional study was undertaken with interviews and documented using a structured and adapted WHO proforma. The oral health was assessed by using WHO oral assessment form 2013 (by tooth surfaces) and the nutritional status by using five day dietary recall and scored according to dental health dietary score. The dental health dietary scores included food group scores (FGS), nutritional evaluation score (NES), decay promoting potential scores (DPPS) for all five days. Result Almost, two third of the school teachers in both types of schools had an excellent Food Group Score (FGS) on all five days of dietary recalls. The mean total Decay Promoting Potential Score (DPPS) was 23.33±3.20 (minute). Approximately onethird of the teachers in both types of schools had DPPS scores within the \"watch out\" zone of dietary recall, ranging 15 or more on each day. The mean DMFT was 3.79±2.52 with mean total decayed teeth as 1.35±2.03. Similarly, the mean DMFS was 9.68±7.95 with the mean total decayed surfaces as 1.81±2.94. Conclusion The frequency of essential food groups remained consistent throughout the fiveday dietary recall period. Carbohydrates formed the primary component whereas proteins were frequently missing from the diets. Frequent absence of protein intake in diet increased loss of attachment.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 86","pages":"215-220"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355583","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":"Assessing Drug Utilization in the Emergency Medicine Department at a Tertiary Care Teaching Hospital Using WHO Drug Use Indicators.","authors":"N Jha, T Manandhar, E Oli, P Kc, A K Jha, P S Karki, K Hada Batajoo, P R Shankar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Patients might need urgent care in critical cases. Limited resources and limited manpower are limitations seen in developing countries. Very few studies have been conducted on drug utilization in the emergency department in Nepal. Objective To find out the drug utilization pattern and the cost of medicines in emergency medicine department as per WHO drug use indicators. Method The study design was a hospital based retrospective cross-sectional study done at the emergency department of KIST Medical College and Teaching Hospital, Lalitpur, Nepal. The study population were patients visiting the emergency department. The data was collected during the period from April to June 2023. Data was collected for one month from each quarter for the year 2023 from the medical records of the patients from the medical records section. A structured proforma was used for the data collection process. Census sampling method was used. Result Maximum patients, 257 (25.1%) were from age group 21-30 years. Females were slightly more than males, 537 (50.5%). The top three diagnosis among the admitted patients were soft tissue injury, 148 (13.9%), dengue fever, 138 (12.9%) and viral fever, 51 (4.7%). Maximum patients, 346 (32.5%) were given two therapeutic classes of drugs, followed by only one therapeutic class of drug for 251 (23.6%) patients. The common classes of drugs prescribed for the patients were analgesics, 639 (60.1%) followed by intravenous fluids, 410 (38.5%) and antiulcer drugs, 377 (35.4%). The total cost of drugs used was calculated as Rs. 305126.4 (2280.99 USD) and the average cost per patient was Rs. 297.97 NPR; 2.23 USD. The WHO drug prescribing indicators showed maximum percentage, (85.4%) of encounters with injection prescribed followed by the percentage of drugs prescribed from the Nepalese National List of Essential Medicines 81.71%. Conclusion On the basis of the findings from this study injection prescribing, and the number of drugs prescribed per encounter showed considerable deviation from the standards recommended by the WHO. Hence, it is important for the hospital to design and implement a system to promote judicious prescribing and injection medication administration.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 86","pages":"149-153"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355581","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":"Differential Analysis of Heart Rate Variability in School Going Adolescents: Comparing Healthy Individuals with Those Experiencing Depression and Anxiety.","authors":"B Thapa, S Kumar, N B Laskar, S S Bhandari, S Gupta","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Adolescents often struggle with depression and anxiety, which can greatly affect their well-being and functioning. Early detection is crucial for timely intervention and long-term health. Objective The objective of this study is to compare heart rate variability between depressed and anxious adolescents and their healthy peers. Method In this cross-sectional study, adolescents aged between 13-18 years were randomly selected from various schools. Participants were assessed for depression and anxiety using the Revised Child Anxiety and Depression Scale-25 (RCADS-25). Heart Rate Variability was measured using Power lab, with recorded variables including Median normal to normal interval (NN), Standard deviation of the normal-to-normal interval (SDNN), Root Mean Square of the Successive Differences (RMSSD), Percentage of successive normal to normal interval differing by more than 50 milliseconds (pNN50), Low frequency power % (LF), High frequency power % (HF), and the LF:HF ratio. Result Reduction in certain time domain HRV parameters was observed among the subset of depressed students in Classes XI and XII, such as NN interval (p=0.019), SDNN (p=0.024), and RMSSD (p=0.034). Anxious adolescents showed a significant reduction in HRV compared to their healthy counterparts [(NN, p<.001), (SDNN, p=0.011), (RMSSD, p=0.017), (pNN50, p=0.016). Students with symptoms of both depression and anxiety demonstrated significantly reduced HRV parameters compared to the healthy group, affecting NN, (p<.001), SDNN, (p=0.003), RMSSD, ( p<.001), pNN50, (p< .001), HFP %, (p< .001) and LF: HF (p=.005). This association was observed in both males and females. Conclusion Adolescents with depression and anxiety have lower HRV than their healthy peers. Monitoring HRV may help to objectively detect these conditions.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 86","pages":"179-185"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355587","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":"Outcome of Endoscopic Myringoplasty Using Gelfoam Versus no Gelfoam in Tympanic Cavity and External Auditory Canal.","authors":"B L Shrestha, A Shrestha, A K Kc","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Absorbable gelatin sponge (gelfoam) is used routinely during myringoplasty as a scaffold that supports tympanic membrane grafts and ossicular chain and to promote hemostasis. However, gelfoam could cause fibrosis, adhesions, granulations, new bone formation within the middle ear cavity and could obstruct the tympanic ostium of the eustachian tube and affects inner ear function and also interferes with the healing process of neodrum and middle ear cavity. Objective To compare the outcome of endoscopic myringoplasty with and without use of gelfoam in external auditory canal and tympanic cavity. Method Fifty patients, with 25 patients in each group who underwent endoscopic myringoplasty with and without gelfoam packing in middle ear cavity and external auditory canal were enrolled in the study. The hearing outcome was assessed by comparing pre-operative ABG (Air bone gap) with post-operative air bone gap and air bone gap closure in speech frequencies (0.5kHz,1kHz, 2kHz,4kHz). The status of graft and hearing results was evaluated on 3months of follow-up in both the groups. Result Out of total 25 patients enrolled for study in both non gelfoam packing group (NGFPG) and gelfoam packing group (GFPG), 24(96%) had graft uptake in each group. The audiological gain in non gelfoam packing group was 11.15±2.4dB whereas in gelfoam packing group it was 12.45±0.81dB. The audiological gain between the two groups did not show any statistically significant (p= 0.190). However, the pre and postoperative hearing difference was statistically significant(p=0.001) in both non gelfoam packing group and gelfoam packing group. Conclusion This study concluded that non gelfoam packing group has similar graft uptake and hearing gain when compared with gelfoam packing group in endoscopic myringoplasty. Hence, myringoplasty can be performed safely without using any gelfoam in the middle ear cavity.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"93-98"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355542","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":"Predictors of Stone Free Rate and Application of the Size, Topography, Obstruction, Number and Evaluation of Hounsfield Units (S.T.O.N.E) Scoring System in Predicting the Outcome in Patients Undergoing Semi-rigid Ureteroscopic Lithotripsy for Ureteric Calculi at a University Hospital of Nepal.","authors":"B Shrestha, R Koju, S Makaju Shrestha, K Shrestha, R M Karmacharya","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Ureteric colic is common urological emergency in patients with urinary stone disease. Semi rigid ureteroscopic lithotripsy is a widely acceptable treatment modality for ureteric calculi. Objective To evaluate the predicting factors of stone free rate (SFR) and application of the Size, Topography, Obstruction, Number and Evaluation of Hounsfield units (S.T.O.N.E) scoring system in predicting success rate of ureteroscopiclithotrisy (URSL) for ureteric calculi. Method This was a prospective hospital based observational study conducted at the Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital from October 2021 to September 2022. Patients undergoing ureteroscopiclithotripsy using laser and/or pneumatic lithotripsy for ureteric calculi were included in the study. Informed consent was taken from each patient and data collection was done by filling the proforma. Result A total of 82 patients were included in the study. Mean age of patients was 35.89 ± 11.51 years. Overall stone free rate was 80.5%. Stone free rate were 96.67% and 71.15% in moderate (6-9) and high (10-13) S.T.O.N.E score groups respectively. Stone size and S.T.N.O.E score were found to be significantly high in patients with retained stone following ureteroscopiclithotrisy (p value < 0.05). Duration of surgery was significantly high in high S.T.O.N.E score group (p< 0.05). However no significant correlation was found between patient characters like age, sex, Body mass index and Hounsfield units of stone with stone free rate in this study. The area under the curve of the receiver operating characteristic curve for the S.T.O.N.E score and stone size were 0.693 and 0.660 respectively in this study. Conclusion Stone size and S.T.O.N.E score can be used as predictors of success following semirigid ureteroscopic lithotripsy. The value of S.T.N.O.E score has good predictive value for SFR and duration of surgery. There was no significant impact of patient's age, sex, Body mass index and Hounsfield units of stone in stone free rate following ureteroscopic lithotrisyin this study.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"31-35"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355560","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":"Specialist Periodontal Referral Knowledge, Attitude and Practice by General Dental Practitioner in Nepal.","authors":"A H Rijal, M Humagain, S Lamichhane, P Ghimire","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background To enhance the referral process, it is essential for the patient, referring practitioner, and specialist to establish effective communication and ensure they are wellinformed and educated about each other's requirements. Objective To assess the knowledge and attitude of general dental practitioners towards specialist periodontal referral. Method This cross-sectional study was carried out for 6 months from October 2022 to April 2023 using a self-administered questionnaire by general dental practitioners registered in Nepal Medical Council. Knowledge and attitude about periodontics, various diseases and referral to specialist for special treatment were analyzed. Result Total of 238 General Dental Practitioners (GDPs) participated in this web-based questionnaire survey. Majority of general dental practitioners (GDPs) reported that they always performed full-mouth and subgingival scaling (193, 81.09%), providing advice on proper brushing techniques (205, 86.13%), advising patients to stop harmful habits (212, 89.07%), and offering diet counseling (122, 51.26%) for patients displaying signs of gingival or periodontal diseases. Majority of GDPs also indicated that they occasionally consult a periodontist for specific periodontal problems, such as the presence of periodontal pockets (143, 60.084%), mobile teeth (150, 63.025%), gingival enlargement (145, 60.924%), periodontal abscess (146, 61.344%), and gingival recession (149, 62.605%). Conclusion General dental practitioners play a crucial role as the primary point of contact for patients seeking dental treatment. The periodontal health of the general population largely depends on the knowledge, attitude, and practice of GDPs.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"70-77"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355575","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":"Determinants of Overnutrition among Urban Adults in Yangon, Myanmar.","authors":"S S Tun, K Sornlorm, R K Mahato","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Over 1.9 billion adults who are 18 years old and older were overweight and more than 6.5 million adults were said to be obese. In 2014 National Step Survey of Myanmar stated that there were 16.9% and 5.5% of overweight and obesity in adults. Due to altering lifestyle and urbanization, it is important to detect the nutritional status and its most influencing factors among urban adults in Yangon. Objective To assess the determinants of overnutrition among urban adults in Yangon, Myanmar. Method This is a cross-sectional study with a sample of 453 adults aged 18-62 years and structured questionnaires were used. Overweight and obesity were defined according to the WHO classification for Asian adults. Multivariable logistic regression analysis was used to assess independent factors associated with overnutrition. Result A total of 453 participants were included for analysis. The prevalence of overnutrition was 49.89% (95% CI, 45.28-54.50). In multivariable analysis, being male (AOR = 3.56, 95% CI = 2.09-6.08, being married/divorced/widowed/ separated (AOR = 2.95, 95% CI = 1.82-4.77), family history of overnutrition (AOR = 6.49, 95% CI = 3.72-11.33, history of DM (AOR = 1.79, 95% CI = 1.11-2.89, consumption of starchy vegetables ≥5 days (AOR = 2.05, 95% CI = 1.27-3.30), not meeting the WHO recommended physical activity (AOR = 3.57, 95% CI = 2.24-5.70), and moderate and low perception (AOR = 2.15, 95% CI = 1.21-3.84) were associated with overnutrition. Conclusion We observed high prevalence of overnutrition in this study. Socioeconomic status, health behavior and perception were the factors behind overnutrition. These findings offer important information for establishment of appropriate public health interventions and policies to lessen the burden of overnutrition.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"36-44"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355534","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":"Knowledge and Attitude Regarding Human Milk Banking among Antenatal Mothers Attending Antenatal Clinic.","authors":"R D Dhakal, R Upreti, S Nepal, B D Dahal, P Adhikari","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Breast milk is the ideal food that has essential nutrients for the normal growth and development of infants. It contains antibodies that help to protect against many common childhood illnesses. For infants who cannot receive breast milk from their own mothers, due to maternal illness, death, medication, disability, insufficient milk production, allergies, or prematurity, donated breastmilk can become the ideal option. Objective To assess the knowledge and attitude regarding human milk banking among antenatal mothers. Method A cross-sectional analytical research was conducted among 422 antenatal mothers attending the antenatal outpatient department of Bharatpur hospital from date 04 November to 04 December 2022. Systematic random sampling was used to select the study unit. A semi-structured interview schedule was adopted to collect the data. Collected data were analyzed by using Descriptive statistics as well as inferential statistics. Result Out of 422 mothers, the majority 58.8 % had poor knowledge and 55.9% had a negative attitude toward human milk banking. There was a significant association between poor knowledge and negative attitude with some socio-demographic variables such as age (AOR=2.16; 95%CI= 1.372-3.401; p=0.001), history of adverse pregnancy outcome (AOR =6.202 95% CI=1.786-21.54;p=0.004), occupation (AOR= 1.906; 95% CI = 1.246-2.915; p=0.003). Conclusion It is concluded that the majority of the respondents had poor knowledge and a negative attitude regarding human milk banking.Knowledge and awareness of human milk banking, play a major role to remove misperceptions about human milk donation and banking. Therefore, proper dissemination of information about human milk bank services, is necessary.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"60-64"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355540","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}