Kathmandu University Medical Journal最新文献

{"title":"The Current State of Ambulances and Emergency Medical Services in the Hilly Region of Nepal.","authors":"S K Shresha, Y Weiner, C Therriault","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Pre-hospital care in Nepal has seen marked improvement in recent years. Emergency medical services means out of hospital acute medical care and/or transportation provided to a patient with an illness or an injury. It continues to lack centralization of resources and standardization across personnel and patient transport vehicles operating in the country. Objective To describe the current state of ambulances including on-board equipment, emergency medical services and driver training among ambulances servicing a hilly region of Nepal. Method A descriptive study was conducted among 117 ambulance drivers transporting patients to the Emergency Department at Dhulikhel Hospital in Kavre, Nepal. A convenience sampling was done to collect data using the self-structured questionnaire during a one-month period from 1st to 30th November 2021. The questionnaire contained 21 items to gather information about the status of ambulance services. Data was analyzed using descriptive statistics. Result The majority of ambulances lack basic and advanced life support equipment. None of the ambulance drivers surveyed had completed formal ambulance driver training and only 35% had received some form of medical training. Most ambulances (70.1%) did not have a licensed paramedic onboard during transport. Majority of the ambulances (91%) were functioning as patient transport vehicle only and these were classified as C-grade ambulances. Conclusion Ambulances remain poorly staffed and under-resourced and ambulance drivers largely lack formal training and credentialing. Targeted interventions and investment are required to bring emergency medical services into compliance with national standards.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"3-9"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355576","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 Resistance Pattern in Intensive Care Unit of a Tertiary Care Hospital, Nepal.","authors":"R Chaudhary, S Bhatta, C Pant, P Pathak, N Phuyal, L Shrestha","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Intensive care unit (ICU) is the especial department of the hospital where critically ill patients are treated with the unique type of technologies to revert back to functional by body's own mechanism. Therefore, there are lots of external intervention with chance of getting bacterial infections. Antibiotics are medicines used to prevent and treat such bacterial infections. However, due to selective broad spectrum antibiotic pressure there is great chances to develop antimicrobial resistance at any time during hospital stay in intensive care unit. Objective To find out the antibiotic resistance pattern among Gram negative bacteria in Intensive Care Unit. Method A Descriptive cross-sectional study was conducted in Department of Microbiology of Tertiary care center for 18 months On the basis of previous sample load census method was used to include 500 sample from intensive care unit during study period. Among them only Gram negative bacteria were included in the study. All the samples were processed following standard methodology. Result Out of 500 samples, growth was observed in 451 (90.2%) samples. Among all the isolates Escherichia coli (29.6%) was predominant organism. It had shown high resistance towards Ciprofloxacin (93.5%) even in urine sample Ciprofloxacin (86.9%). Conclusion Our study showed Escherichia coli as a major organism in intensive care unit. This was resistant to commonly used oral antibiotic leaving restricted option for use of higher antibiotics. Therefore, continuous surveillance of such bacterial pathogen is warranted with implementation of effective Infection Prevention and Control measures in Health Care setting with emphasis to critical care units.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"78-82"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355511","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":"Perception of Undergraduate Dental Students Regarding Teaching Learning Methods in Oral Pathology.","authors":"P Poudel, B R Adhikari","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Third year is considered crucial in undergraduate dental education as this is when students start to have clinical exposure and taught about various oral pathologies. Many a times, students fail to make proper clinical and pathological correlation. It is the responsibility of teacher to impart adequate knowledge to the students regarding a disease in most effective way. Understanding the students perception is an effective way of making new roadmaps for teaching. Objective To assess undergraduate dental student's perspectives regarding oral pathology along with the effectiveness of various teaching learning methods and assessment methods currently used by faculties of Department of Oral Pathology. Method This cross sectional study was conducted from June 2023 to July 2023 among 136 undergraduate dental students of Kathmandu University School of Medical Sciences by using the pretested questionnaire. Convenience sampling method was used. The data collected were entered into the Microsoft Excel Sheet and statistical analysis was done using Statistical Package for the Social Sciences version 20. Result A total of 136 students participated in the study. Among them, 46 (33.8) were from third year, 51 (37.5) were from fourth year and 39 (28.7) were from fifth year. Half of the students believed that oral pathology is an interesting subject. Most of students; 66 (48.5) participants strongly agreed that knowledge of oral pathology helps in clinical training. Except two students, all the participants said that integration of oral pathology teaching with clinical training will help in better understanding of diseases. More than half of the students 71 (52.2) agreed that lectures and demonstrations taken by faculties has stimulated interest in the subject. Most students 80 (58.8) believe that formative assessment serve the purpose of analyzing the cognitive skill. Sixty six (48.5) students agree that MCQs are an effective tool for analyzing cognitive skills. Conclusion The overall perception of undergraduate dental students regarding the oral pathology subject and the teaching learning method used by faculties is good. However, incorporation of case based learning, integration of oral pathology with other clinical subjects and taking regular feedback from students may be of great use in providing holistic and effective learning environment.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"83-86"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355543","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":"Dental Biofilm Accumulation and Gingival Health of Teeth with Fixed Single Prosthesis Fabricated by Various Prosthetic Materials.","authors":"A Pradhan, K Shrestha, S Aryal, S Shrestha","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Periodontal health plays an important role in maintaining the health of natural teeth as well as in the success of all dental procedures. Fixed single prosthesis (dental crown) can be fabricated with different types of prosthetic restorative materials like Metal, Ceramic, Ceramic fused to metal. These different materials have different affinity for plaque accumulation leading to the development of gingival inflammation and periodontal disease. Objective To determine the amount of Plaque accumulation and gingival health of teeth with a fixed single prosthesis fabricated by various Prosthetic materials. Method This quantitative cross-sectional study was carried out from July 2021 to March 2022. The patients who visited the hospital after six months of use of the prosthesis enrolled and were categorized into three groups according to the material used for the prosthesis metal, ceramic, and metal-ceramic. The periodontal condition was assessed using the plaque index and gingival index. Result A total of 136 patients (78 female and 58 male) were enrolled in the study, with a mean age of 39.44 ± 16.23 years (Range 19 - 70 years). There were 47 patients with ceramic crowns, 39 patients with metallic, and 50 patients with metal ceramic crowns. The mean plaque index of metal, ceramic, and metal-ceramic crowns was found 1.15 ± 0.546, 0.86 ± 0.479, and 0.93 ± 0.498 respectively. Similarly, the mean gingival index of metal, ceramic, and metal-ceramic crown were 1.22 ± 0.56, 0.91 ± 0.48, and 1.09 ± 0.55 respectively. Conclusion The dental biofilm (plaque) accumulation and hence gingival inflammation is less in ceramic crowns than in metal and metal-ceramic crowns.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"27-30"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355533","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":"Role of Intraoperative Cholangiogram in Major Liver Resection and Complex Bilio-enteric Bypass Surgery.","authors":"R Ghimire, P Pandey, B P Acharya","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Advances in surgery have decreased postoperative morbidities but bile leak is still a major issue. Intraoperative cholangiogram (IOC) is considered better in identifying bile leaks and anatomical delineation making its expanded use in hepato-biliary surgeries. Objective To assess the role of intraoperative cholangiogram in major hepatectomy and complex bilio-enteric bypass surgery. Method A single-centered, descriptive cross-sectional study between March 2022 to February 2023 among conveniently sampled 32 patients undergoing Hepato-biliary surgeries. One ampoule of meglumine diatrizoate was instilled into the biliary tract and intraoperative pictures were taken via C-arm to visualize the biliary tree and preoperative and intra-operative pictures were compared. Result A total of 32 patients were included in the study with a median age of 42 years and a male-female ratio of 1:1.67. During the bilio-enteric anastomosis, no intraoperative anastomotic leaks were detected. Two patients experienced postoperative bile leakage that was managed conservatively and eight cases had intraoperative bile leakage which was addressed during surgery. The average duration of hospital stay was 5 days. Conclusion An intraoperative cholangiogram is useful to delineate the biliary tract anatomy, reassure anastomosis, and identify bile leaks in difficult bilio-enteric anastomosis and from liver resection margins intraoperatively.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"10-14"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355574","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":"Effect of Humour on Pain Perception among Young Healthy Indian Adults Using Cold Pressor Task.","authors":"O P Rhea, D Savitha, T Anto","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Currently there is little research, especially in India, which has looked at the physiological effects of humour on pain perception. Objective To compare pain sensitivity across the three arms of intervention (control, neutral and funny videos). And to investigate the relationship between a) cardiovascular responses across and within each arm, b) pain sensitivity and resting blood pressure, pulse rate, c) humour trait with pain sensitivity. Method Subjects were exposed in random order to cold pressor task, during which they either watched a 'neutral video' or 'funny video' or did not watch any video. During the intervention, pain threshold and tolerance were recorded. Systolic and diastolic blood pressure, and pulse rate were measured before and after intervention. Pain unpleasantness was recorded post intervention. Result Neither humorous nor neutral videos had a significant effect on pain threshold, tolerance and unpleasantness and cardiovascular responses. There was significant difference between the pre and post values of cardiovascular measures within neutral and funny video arms. In the 'no video' arm, negative correlations were found between resting blood pressure and pain unpleasantness, and between delta diastolic blood pressure and pain threshold. Humour trait and subject's self-rating of pain tolerance had no effect on both pain sensitivity and cardiovascular responses to cold pain. Conclusion Humorous distraction had no effect on objective or subjective pain measures or cardiovascular responses to cold pain exposure. There was a significant difference in the pre-post values of cardiovascular measures within neutral and funny video arms.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"15-21"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355535","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":"Plexiform Schwannoma Clinically Masquerading as Thrombosed Vein.","authors":"D Basnet, R Makaju, N Gautam, B Shrestha, A Budhathoki","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Plexiform schwannoma is a rare benign nerve sheath tumor usually located in trunk, head, neck, upper extremities and occasionally in lower extremities. It is usually less than 2 cm in size and generally affects young adults. The tumour is composed of schwann cells and exhibit a plexiform growth pattern both in gross or histologic examination and is frequently accompanied by multinodularity causing serpentine distortion. Plexiform neurofibroma commonly mimics plexiform schwannoma and it is important to differentiate between them, as recurrence and malignant potential are more common with plexiform neurofibroma. We present the case of a 14-year-old female with history of a nodular soft tissue mass over his right foot measuring 11 cm in length. A Doppler scan of the foot was suggestive of thrombosed superficial vein in right foot. The histological evaluation of the mass revealed Plexiform schwannoma. S-100 immunostaining is diffuse and strong confirming the diagnosis of Plexiform schwannoma.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"127-129"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355559","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":"Thrombolysis with Tenecteplase for Basilar Artery Occlusion in Neuro and Allied Clinic: Importance of Clinical Assessment and Drip and Ship Model in Nepal.","authors":"L Thapa, M R Ghimire, S Bhattarai, A M Shrestha, N Rai, R Paudel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Tenecteplase, a new thrombolytic drug, is now widely recommended and used for treating acute ischemic stroke, and timely thrombolysis within 4.5 hours is crucial for better outcomes. However, due to limited stroke awareness, transportation difficulties, and inadequate access to experts and comprehensive stroke care centers, fewer than 15% of stroke patients in Nepal receive thrombolytic therapy. The \"drip and ship\" model, which involves starting thrombolysis at a noncomprehensive stroke care center and transferring the patient to another center for further care, can effectively overcome these obstacles, provided trained personnel are available at non-comprehensive stroke care centers. We report a case of acute ischemic stroke treated with thrombolysis within 4.5 hours of symptom onset at a non-comprehensive stroke care center, followed by transfer to another center for ongoing care, demonstrating the feasibility and potential benefits of the drip and ship model in resource-limited settings.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"120-122"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355578","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":"Philtral Column and Nostril Shape Pattern in Nepalese Population: Comparative Study between Two Ethnic Groups of Nepal.","authors":"N K Chaurasia, C Upadhyaya, S Mahantha, S Upadhyaya, M Shakya, S Upreti, B Bhandari, I Baral","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Knowledge of the normal appearance of lip-nose complexes in a particular ethnicity or race helps to plan and modify surgical techniques for their deformity. Objective To determine the shape of the philtral column and nostril in children of two ethnic groups (Aryans and Mongoloids) of the Nepalese population and compare them to see if any variation exists. Method The present prospective study was carried out between December 2021 to January 2023 among 200 children of age 5-12 years. The children meeting our inclusion criteria were divided equally into Aryan and mongoloid groups based on the caste system in Nepal. Facial photographs were obtained in frontal and basal views. They were analyzed to determine the shape of the philtral column and nostril shape based on Mori's classification system. Result Out of 200 children, 123 were males and 77 were females. The most common type of philtral and nostril shape in the Nepalese population was triangular and teardrop respectively. Triangular and concave type philtral shape was predominant in Aryans whereas triangular and parallel type was predominant in Mongoloids however the variation was not significant. Similarly, teardrop nostrils were most common in both ethnic groups. Conclusion The results provide a morphological pattern and variation in the philtral and nostril shape in the two major ethnic group of Nepalese population.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"55-59"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355558","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":"Is an Elective Neck Dissection Needed in Squamous Cell Carcinoma of the Maxillary Alveolus and Hard Palate?","authors":"S Bhandari, R C Michael, J Riju, M Thomas, A Irodi, J Rani, A J Tirkey, K Vidya, S S Mathew, K Madhavi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Squamous cell carcinoma (SCC) of the maxillary alveolus and hard palate is a rare site for oral cavity carcinoma. Much controversy is there regarding the management of this site and elective neck dissection due to rarity and complex lymphatic drainage. Objective To estimate the prevalence of neck nodal metastasis in squamous cell carcinoma of maxillary alveolus and hard palate and the factors influencing the nodal metastasis. Method This retrospective cohort study includes patients diagnosed with squamous cell carcinoma of maxillary alveolus and hard palate and who underwent surgical intervention between March 2017 and March 2022. Result The study included 53 patients among them majority were men (73.6%). Prevalence of neck nodal metastasis was 36.6% and occult nodal metastasis was noted in 16%. On multivariate analysis, clinical nodal positivity increases the odds of pathological nodal positivity by 9.4 times compared to no nodal involvement (95% CI 2.07-42.57, p < 0.004). A depth of invasion (DOI) of more than 10 mm increases risk by 7.4 times for pathological nodal positivity compared to less than 10 mm invasion (95% CI 1.53- 35.27, p=0.013). Conclusion Squamous cell carcinoma of maxillary alveolus and hard palate has a high risk of nodal metastasis. Depth of invasion is an important predictor for nodal metastasis. Due to the high risk of nodal metastasis elective neck dissection would be recommended in advanced stages. Squamous cell carcinoma of maxillary alveolus and hard palate with nodal metastasis has a poor survival.</p>","PeriodicalId":35493,"journal":{"name":"Kathmandu University Medical Journal","volume":"22 85","pages":"49-54"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355539","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}