Nepal Medical College Journal最新文献

{"title":"Comparison of Collum Angle in Different Skeletal Growth Pattern using Cephalometric Radiographs among Orthodontic Patients in Tertiary Dental Care Center of Kathmandu","authors":"Anshu Piya, B. Shrestha, Anju Khapung, Prakash Bhattarai, Anita Ojha","doi":"10.3126/nmcj.v26i2.67198","DOIUrl":"https://doi.org/10.3126/nmcj.v26i2.67198","url":null,"abstract":"Collum angle has been previously studied in different types of sagittal malocclusion but very few studies have focused on vertical malocclusion in our population. Since collum angle is responsible for variation in torque expression, root resorption, fenestration and dehiscence, with prior knowledge of collum angle in high angle and low angle cases, operator can prevent above deleterious effects and accompanied better bracket positioning in future orthodontic treatment. Lateral cephalograms of all the patients of age group 13-30 years attending Department of Orthodontics in Nepal Medical College from October 2023 to March 2024, having clinically harmonious and symmetrical face, full complement of dentition except third molar, minimum crowding were taken. Based on the value of SNMP (Sella-Nasion and Mandipular plane), and Jarabak ratio, the samples were divided into high angle and low angle. Collum angle was drawn and measured in terms of degrees. The data were transferred to SPSS-17 for further analysis. A total of 60 study participants were included in the study with an equal number of male and females. (30 each with age ranging from 13 to 30 years with mean age 19.18±3.89 years) There was an equal distribution of study participants in horizontal and vertical growth patterns (30 each). There was no statistically significant difference in mean collum angle between study participants in horizontal and vertical growth patterns (p = 0.09). No statistically significant difference in mean collum angle between study participants in horizontal and vertical growth patterns in relation to gender was found (Male p = 0.08 and female - p-value 0.55).","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"11 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711079","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 Nebulized Lignocaine on Prevention of Postoperative Sore Throat following Laparoscopic Cholecystectomy","authors":"Ashis Ratna Bajracharya, G. R. Bajracharya, C. Thapa, Sabin Bhandari","doi":"10.3126/nmcj.v26i2.67206","DOIUrl":"https://doi.org/10.3126/nmcj.v26i2.67206","url":null,"abstract":"Post-operative sore throat (POST) is one of the common side effects of general anesthesia with endotracheal intubation. Several medications have been tried for the prevention of POST. Nebulized lignocaine is easily available, easily administered, cost-effective, and acts immediately with a short duration of action and minimal systemic effects with no long-term residual effects. We conducted this study to find the prevalence of POST when preoperative nebulization with 2% lignocaine is used in patients following laparoscopic cholecystectomy. We also studied the factors associated with POST. This study was done in 100 patients who underwent laparoscopic cholecystectomy and received preoperative lignocaine nebulization. The incidence of POST was measured at 0, 6, 12, and 24 hours postoperatively and various risk factors that might have predisposed for the development of POST were also studied. The mean age of the patients was 42.53±12.82 years. A total of 40 patients (40.0%) experienced POST at any time point during the study period. The majority of patients had mild i.e. Grade 1 POST (11-21%). Patients with a BMI > 30 kg/m2, CL grade 4, high cuff volume, airway trauma, higher duration of intubation, and higher pneumoperitoneum duration had a greater incidence of POST at all post-operative periods. We concluded that nebulization of 5 ml of 2.0% lignocaine decreases the intensity and treatment requirement for POST and has minimal side effects. A higher incidence of POST is seen in patients who had a higher CL grading, higher BMI, high cuff volume, airway trauma, higher duration of intubation, and longer pneumoperitoneum duration.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"3 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141703896","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":"Bilateral Complete Ureteral Duplication with Obstructing Stones in Both Left Ureters: A Case Report and a Review of Literature","authors":"Ashima Gautam, Bineet Thapa, K. K. Bhomi","doi":"10.3126/nmcj.v26i2.67215","DOIUrl":"https://doi.org/10.3126/nmcj.v26i2.67215","url":null,"abstract":"Congenital anomalies like duplex renal collecting systems are rare developmental conditions. Among these anomalies, ureteral duplication is rarely observed, with partial ureteral duplication comprising a majority of cases. Bilateral ureteral complete duplication, where fully duplicated ureters drain separately into the bladder via separate orifices, is extremely rare, making it a seldom-documented anomaly in the medical literature. A case of bilateral complete ureteral duplication complicated by calculi in both the upper and lower moieties of the left kidney presented to the urology outpatient department with complaints of left flank pain for one month. His computed tomography-urogram revealed complete duplication of bilateral collecting systems with bilateral double ureters with an 8.2×5.9 mm2 sized stone in the pelvi-ureteric junction of the left upper moiety and 11.9×5.6 mm2 sized stone in the proximal ureter of left lower moiety causing hydronephrosis of both upper and lower moiety pelvicalyceal system. Calculi in both the upper and lower moieties were cleared in a single setting using a Ureteroscopic Lithotripsy. Duplex renal systems, while often asymptomatic, are linked to a higher occurrence of treatable conditions like stones and renal reflux diseases. The duplicated structure may lead to stagnant urine, causing obstructions and consequently infections. Stones that obstruct the ureter for a prolonged period can cause renal impairment and require active intervention. Currently, flexible or semirigid ureteroscopy with laser lithotripsy is the standard procedure. Even in this case, both stones were effectively managed in a single session using a standard procedure.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"37 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141708794","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":"The Association between S.T.O.N.E. Nephrolithometry Score and Hemoglobin Drop in Patients Undergoing Percutaneous Nephrolithotomy","authors":"Mohan Khadka, K. K. Bhomi, Amit Shrestha, Bineet Thapa","doi":"10.3126/nmcj.v26i2.67190","DOIUrl":"https://doi.org/10.3126/nmcj.v26i2.67190","url":null,"abstract":"Nephrolithiasis is a very common condition with significant burden to patients. Percutaneous nephrolithotomy (PCNL) is safe procedure considered as gold standard for large renal stones. The most common complication of PCNL is bleeding which can require blood transfusion to angioembolization and may even need nephrectomy. The purpose of this study is to assess if STONE Nephrolithometry Score can predict hemoglobin drop in PCNL procedure. A total of 104 patients who underwent PCNL during one year period from October of 2022 to September of 2023 were taken using consecutive sampling method. All patients with renal stones underwent routine blood tests including complete blood counts, renal function and electrolytes. CT scans were then done and STONE nephrolithometry Score was evaluated. PCNL was performed and hemoglobin investigation was sent at 24 hours postoperatively. The two data were compared with the STONE nephrolithometry Score and other factors. More than three-fourths (78.8%) of the patients had comorbidities with hypertension being the commonest (76.9%). There was a significant association of drop of hemoglobin more than 1 g/dl with age <30 years (p <0.034), higher preoperative hemoglobin (p <0.046), larger stone size (p <0.001), shorter tract length (p=0.017) and STONE Score greater than 10 (p<0.001). On correlation study only STONE score (p = 0.015) and larger stone size (p = 0.002) were associated with hemoglobin drops of more than 1 g/dl. STONE Nephrolithometry score is a good predictor of bleeding complications during PCNL and higher score is associated with more drop in hemoglobin levels.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"15 37","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness Regarding Stroke among the Adult Population of Gokarneshwor Municipality","authors":"A. Sapkota, Sabitra Devkota","doi":"10.3126/nmcj.v26i2.67197","DOIUrl":"https://doi.org/10.3126/nmcj.v26i2.67197","url":null,"abstract":"A stroke is a medical emergency that occurs as a result of decreased blood supply or cessation of blood flow to the brain. Even though there are preventable risk factors still, it is one of the leading causes of disability worldwide. Awareness of the risk factors and early recognition of the symptoms can help the prevention and management of stroke. This study was conducted with an aim of assessing the awareness regarding stroke among adult population residing at Gokarneshwor Municipality. A descriptive cross-sectional study was conducted among 195 adult populations using a non-probability convenience sampling method. Data was collected by face-to-face interview technique with the self-constructed questionnaire. Data were entered and analyzed using the SPSS-16. Descriptive statistics like frequency, percentage, and inferential statistics such as the chi-square test were used and were considered significant at p< 0.05 (95% CI). The mean age of the respondents was 36.01±12.66 years. Of all, hypertension was prevalent in 32 respondents. Almost three fourth of the participants had heard about stroke. Top three stated risk factors were hypertension, alcohol consumption, and smoking. We concluded that providing informal education and conducting awareness programs on stroke would be helpful to promote awareness regarding this condition.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711952","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":"Nutritional Status and its Associated Factors among Government School-Going Adolescents of Birendranagar Municipality, Surkhet, Nepal","authors":"Bal Krishna Bhatta, Rupesh Tiwari, Swastika Ghimire, Renu Khadka, Aashish Malasi","doi":"10.3126/nmcj.v26i2.67211","DOIUrl":"https://doi.org/10.3126/nmcj.v26i2.67211","url":null,"abstract":"WHO recently published report reveals a large number of adolescents in the Southeast Asian Region, who constitute one-fifth (20.0%) of the population in these countries, suffer from malnutrition and anemia, which adversely impact their health and development. If adolescent malnutrition is not treated on time, it leads to major repercussions such as low birth weight and poor health in adulthood. A survey on the nutritional status of adolescents based in 13 districts of Nepal revealed that almost six out of ten male adolescents and seven out of ten(71.0%) of female adolescents were undernourished. The likelihood of undernutrition was high among adolescents residing in Terai (72.0%), followed by Hill (59.0%) and Mountain (54.0%). A cross-sectional descriptive study was carried out among the adolescents of grade 6 studying in the government school of Birendranagar Municipality from May to October 2023. A total of 240 students were selected from five constitute the sample size of the study. The selection was based on stratified random sampling, where each school was considered a stratum. Anthropometric measurement assesses nutritional status based on BMI. Attempts were made to determine the associations between the nutritional status and socio-demographic, behavioral hygiene and diet-related variables. Of the total adolescents, 55.8% were normal, 22.3% were thin and 22.9% were very thin. The nutritional status of the adolescents was observed to be significantly associated with their family type, family income, physical activities, and mother’s education. Encouraging physical activities and promoting healthy habits can enhance the nutritional status of adolescents in the population of students of grade 6 at governmental schools of Birendranagar Municipality, Surkhet, Nepal.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141712623","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":"The Safety and Feasibility of Segmental Thoracic Spinal Anesthesia above Umbilicus and Breast Surgery","authors":"S. Gautam, R. Yadav, Anupa Khanal, Sanam Dangol","doi":"10.3126/nmcj.v26i2.67196","DOIUrl":"https://doi.org/10.3126/nmcj.v26i2.67196","url":null,"abstract":"This study was conducted on 30 patients aged 16 to 70 years with American Society of Anesthesiology (ASA) physical status I, II, and III. Though general anesthesia (GA) is a universally accepted technique for most abdominal surgeries but not free from drawbacks including poly medicine side effects, prolonged recovery time, and unnoticed inadequate pain control, as well as risk to elderly patients with cardiopulmonary conditions, and safety issue limits the usefulness of general anesthesia. Thus, the new technique adopted attracts the attention of anesthesiologists, as thoracic segmental spinal anesthesia (TSSA) for several common surgeries where local anesthetic agents injected intrathecally above the termination of the spinal cord show value in patients with high risk for general anesthesia who need deep analgesia. The types of surgery were periumbilical hernia 7 (23.33%) in both age groups followed by epigastric hernia 8 (26.66%), neoplastic diseases of breast 6 (20%), laparoscopy cholecystectomy 4 (13.33%), open cholecystectomy 5 (16.66%). The analysis of intraoperative and postoperative mean systolic and diastolic arterial pressures (MAP) of patients up to 24 hours was found insignificant (P>0.05). Regarding the intraoperative hemodynamic changes, hypotension occurred in 3 patients and resolved with a single bolus of ephedrine, no tachycardia occurred, while bradycardia in 3 patients (15%). No patients need to be converted to general anesthesia due to inadequate block. On analysis complications, peri-operative or post-operative period showed that shoulder pain was experienced by 2 patients (6.66%) in the younger age group whereas in the older age group, two patients (6.66%) have hypotension and bradycardia was seen in 3 patients (13.33%). No respiratory complications, such as postoperative pneumonia or atelectasis were noted during the hospital stay with TSSA as well and no nausea/vomiting was noted. This study provides only preliminary evidence to support the feasibility and efficacy of segmental thoracic spinal anesthesia to be used effectively for safe anesthetic technique during routine laparoscopic surgery in normal patients as well as co-morbidity patients with stable intraoperative and post-operative hemodynamic and also avoidance of complications of general anesthesia with these benefits, decrease in length of stay in hospital, reduction of postoperative pain, and increased patients satisfaction. Thus, in future the segmental spinal anesthesia may become a good alternative to general anesthesia in normal patients as well as comorbid patients.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"14 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710440","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":"Discharge Against Medical Advice Among Neonates Admitted to the Neonatal Intensive Care Unit of a Tertiary Care Hospital","authors":"Dhirendra Prasad Yadav, Vivek Kumar, Manoj Kumar Gupta","doi":"10.3126/nmcj.v26i2.67213","DOIUrl":"https://doi.org/10.3126/nmcj.v26i2.67213","url":null,"abstract":"Discharge against medical advice is a condition where patient leaves the hospital against physician’s advice and is a serious public health issue, especially among neonates and a challenge faced commonly by physicians. It is a risk factor that can lead to adverse events like mortality and readmissions in neonatal units. To decrease neonatal mortality rate, it is necessary to investigate the causes leading to self-discharge. This study aimed to find out prevalence and reasons for discharge against medical advice among neonates admitted to neonatal intensive care units of a tertiary care hospital. A descriptive cross-sectional study was conducted among neonates admitted to the Neonatal Intensive Care Units who were discharge against medical advice (DAMA) from 15th March 2022 to 14th March 2023 after obtaining ethical approval from the Institutional Review Committee (Reference number: F-NMC/544/078-079). Neonatal demographic information and reason for self discharged were recorded. A convenience sampling method was used among neonates who met eligibility criteria. Data were presented as frequency with percentage. A point estimate with 95% confidence interval was calculated. Out of 910 neonates admitted to NICU, 86 (9.4%; 95% CI:7.62-11.53) were discharged against medical advice. Among these, 72 (83.7%) were outborn neonates and 51 (59.3%) male. The most common morbidity was sepsis 53 (61.6%). The common reasons for parents to take DAMA was poor financial condition 72 (83.7%). The prevalence of discharge against medical advice among neonates admitted in the neonatal intensive care units was similar to other studies done in similar settings.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"180 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141694864","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 of Tooth Discoloration and Tooth Bleaching amongst Adult Patients Visiting a Dental Hospital in Kathmandu, Nepal","authors":"Rojin Joshi, S. Gautam, Barsha Joshi","doi":"10.3126/nmcj.v26i2.67189","DOIUrl":"https://doi.org/10.3126/nmcj.v26i2.67189","url":null,"abstract":"A beautiful smile increases the self-confidence and well being of an individual. Tooth discoloration is one of the cause for a patient to stop smiling, be less interactive with other people and the person might feel neglected from the society. Many people don’t know about the various causes of tooth discoloration and the treatment options. Bleaching is a very conservative method to whiten the teeth. Until now limited studies have been done to assess the knowledge of tooth discoloration and vital tooth bleaching in context to Nepal. Hence, the objective of this study was to assess the knowledge of tooth discoloration and tooth bleaching amongst adult patients. This cross sectional study was done on 326 patients of 18 years and above. Personal interviews using a structured and validated questionnaire were conducted to collect the following information: demographic data, the participant’s level of satisfaction of their tooth color, the participant’s level of knowledge on tooth discoloration and tooth bleaching. Data were analyzed using Chi square test and descriptive statistics were calculated. It was found that majority of the study participants (63.8%) were satisfied with the color of their teeth and most of them (58.9%) had not heard about tooth bleaching. It was seen that there was no association of different aspects of bleaching as well as etiology of tooth discoloration with gender, age group, level of education and marital status.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"7 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141701281","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 Objective Structured Clinical Examination Among Undergraduates Medical Students","authors":"Srijana Pandey, Kshitij Gartoulla","doi":"10.3126/nmcj.v26i2.67194","DOIUrl":"https://doi.org/10.3126/nmcj.v26i2.67194","url":null,"abstract":"Objective structured clinical examination (OSCE) is a valuable assessment tool that enhances in-depth learning and preparation of students for clinical practice. The tasks to be assessed should be of different types and of varying difficulties. The tasks in OSCE depend on the level of students training. The aim of the study was to assess the perception of OSCE among under-graduates’ medical students. A mixed methods study (cross sectional exploratory and content analysis) was conducted with the simple random sampling, purposive sampling and content analysis technique among 86 undergraduates’ medical students at tertiary hospital. SPSS 16 was used for data entry. Frequency, percentage, Mean, Standard deviation, Mann-Whitney U-test and One Way Anova was used for data analysis. Most of the participants perceived that OSCE identified knowledge gaps (84.8%) and was educative (79.0%). There was no significant difference of perception of OSCE related to gender. There was no significant variation in participant’s perceptions of OSCE in relation to academic year regarding OSCE domain characteristics (p =0.333). However, regarding perception of OSCE domain structure in relation to their academic year, there was a significant difference as p =0.013. The overall perception of OSCE among medical students was positive. This study has identified a need for training, practice prior to an OSCE exam and allocation of adequate timefor each spot during the exam.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"23 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700196","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}