Birat Journal of Health Sciences

Journeys, Frontiers and Medical Education

Robert Roseby — Mon, 27 May 2019 02:49:05 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23924

Not Applicable.

Keywords: NA

Oxygen Saturation as a Predictor of Adverse Maternal Outcomes in Women with Preeclampsia

Sweta Rani, Pallab Kumar Mistri — Mon, 27 May 2019 02:48:10 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23926

Introduction: In preeclampsia, hypoxemia may result from a number of mechanisms. Preeclampsia remains a complex and poorly understood disease. Currently, there are no reliable predictors of preeclampsia for early diagnosis to avoid adverse maternal or perinatal outcomes.

Objective: The objective was to evaluate the efficacy of oxygen saturation (SpO₂) as a predictor of adverse maternal outcome in women with preeclampsia.

Methodology: We conducted the cross-sectional study on 182 preeclamptic women selected by random sampling technique. They were divided into two groups on the basis of oxygen saturation: 29 preeclamptic women (Group L) having oxygen saturation 95% or below and 153 women (Group H) having oxygen saturation 96% or above. The groups were statistically compared with respect to age, gestational age, proteinuria, severity of hypertension and developing different adverse effect of preeclampsia. Women with any medical disorders were excluded.

Results: After statistical analysis, it was seen that the women having Spo₂ ≤ 95% (L-Group) had experienced more adverse 2 outcomes. They were more hypertensive and more proteinuric, had higher liver enzyme levels, lower platelet counts, and were more likely to have experienced cardio-respiratory symptoms. Women with adverse outcomes were also more likely to have had therapeutic interventions, including corticosteroids, antihypertensives, and magnesium sulphate.

Conclusion: Women having SpO₂ ≤ 95% (L-Group) had more adverse 2 outcomes in comparison to SpO₂ ≥96%(H-Group).

Keywords: Pre-eclampsia, oxygen saturation, predictors

To Compare the Functional Outcome of Intra Articular Distal end of Radius Fracture Treated by Conventional pop cast and External Fixatator Fixatation

Pradeep Kumar Gupta, Ajay Kumar Yadav — Sun, 26 May 2019 11:32:02 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23927

Introduction: Distal end of radius fractures frequently have a high degree of comminution, instability, and associated with soft tissue injuries. Treatment of this distal radius fracture is controversial and there is no single definitive treatment method that is considered the standard of care.

Objective: 1. To compare the functional results of the conventional POP cast and external fixator fixation of intra articular distal end of radius fracture. 2. To compare the radiological changes with that of functional outcome.

Methodology: It was a prospective study comparing the functional outcome of distal intra-articular radius fracture when managed by conventional POP cast and external fixatator fixation. The final outcome was decided on the basis of modified Gartland and Werley scoring system. Total 50 patients (19 – 54 years) were recruited. 30 were treated by closed reduction and POP cast and 20 by external fixation. Radiological parameters were graded according to Schecks criteria and fracture comminution was classified according to Frykman's classification.

Results: The functional outcome of the treatment was a subjective evaluation in which 80% of the patients had pain in external fixation as compared to 63% in closed reduction POP cast group. The restriction of activities was in 10% of the patient in external fixation group as compared with 33% in closed reduction POP cast group. The final scoring system as modification of Gartland and Werley point system had 5 ± 3 conventional pop cast group and 4 ± 4 in external fixation group. (p = 0.3764). On radiological evaluation, there was no significant difference in radial length, radial angle and volar tilt in two groups.

Conclsion: The results show no statistically significant difference between the two modes of interventions. External fixation provides easy mobilization of fingers and reduces edema and stiffness of joints. The active ranges of movements at the wrist joints were significantly better in external fixation group.

Keywords: Fractures, distal end radius, intra-articular, conventional POP cast and external fixator.

Perceived Benefits, Knowledge about Cancer and Attitude towards Promotion of Gutkha Amongst Gutkha users from Nepal

Bishal Babu Basnet, Khem Raj Sharma — Sun, 26 May 2019 11:33:25 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23928

Introduction: Gutkha, a mixture of areca nut pieces, tobacco and slaked lime, is a potential carcinogen. It causes oral submucous fibrosis. Many people do not possess this knowledge and thus consume gutkha daily. The consumption is highly prevalent in Nepal because of easy availability of this material. Although ban of advertisement is implemented in Nepal in electronic media, the impact has not been significant.

Objective: To find the prevalence of different beneficial effects cited, to determine awareness about cancer and attitude towards ban of advertisement, production and sale in current gutkha users from rural Terai dwellers of Nepal.

Methodology: We interviewed 1217 households in a community survey in which 151 were current gutkha consumers, their responses about perceived benefits, cancer knowledge and views on ban of its sale and promotion was analyzed. The relationship with demographic variables were tested with Chi-square test with level of significance set at 0.05.

Results: Among the current users, the reason of consuming gutkha was mostly 'feeling of well-being' (38.4%), about 40% thought it can cause cancer. The knowledge was not associated with gender, age group and literacy but statistically related with marital status (p<0.05). Majority were in favor of ban on advertisement (74.2%) and on production, sale and consumption (70.2%).

Conclusion: The level of knowledge of cancer causation is very low and education level had not been significantly associated to knowledge. More gutkha users were in favor of its ban which is a positive finding.

Keywords: Attitude, knowledge, smokeless tobacco, oral cancer

Changes in Astigmatism Before and After Pterygium Surgery

Rojeeta Parajuli, Leena Bajracharya — Sun, 26 May 2019 11:34:30 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23929

Introduction: Pterygium is a degenerative condition of the subconjuctival tissue, which proliferates as vascularised granulation tissue to invade the cornea resulting in destruction of the superficial layer of the corneal stroma and bowman's membrane. This change in cornea leads to corneal opacity, visual impairment and significant induced astigmatism. The ensuing pathologic changes consist of elastoid degeneration of collagen and the appearance of subepithelial fibrovascular tissue

Objective: To measure the change in corneal astigmatism after pterygium surgery and the relationship of astigmatism with respect to size of pterygium.

Methodology: Hospital based prospective, non-randomized study, comprising 61 eyes of 56 patients who underwent pterygium excision and autologus conjuctival graft during the period October 2009 to September 2010. A total of 56 participants were enrolled and followed upto 3 months after surgery. Corneal topography was used to measure corneal astigmatism before and after pterygium surgery.

Results: The mean age of patient was 46.11 years, standard deviation was 18.86 Male: female ratio: 0.8:1 Preexisting induced astigmatism among study group patients was 2.6D and mean astigmatism after pterygium surgery was 0.8D. This finding was found to be statistically significant(P value <0.001). Over all change in mean astigmatism was 1D in our study. In grade I Mean astigmatism before surgery was 0.96D and Mean astigmatism after surgery was 0.46D, Changes in mean astigmatism after surgery was 0.50D. In grade II Mean astigmatism before surgery was 1.99D and Mean astigmatism after surgery was 0.54D, Changes in mean astigmatism after surgery was 1.45D. In grade III Mean astigmatism before surgery was 10.71D and Mean astigmatism after surgery was 3.10D, Changes in mean astigmatism after surgery was 7.61D. The change in mean astigmatism is greatest in patients with grade III pterygium.

Conclusion: After pterygium surgery astigmatism significantly reduces and astigmatism increases with the grade of pterygium.

Keywords: Primary pterygium, astigmatism, autologus conjuctival graft, grading of pterygium.

Effectiveness of Duloxetine in Treating Early Stage of Somatoform Disorder at Koshi Zonal Hospital

Sun, 26 May 2019 11:35:21 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23930

Introduction: Somatoform disorder (SD)is group of psychiatric disorders that disrupt multiple physical symptoms, accompanied by disturbance in thoughts, impairing activities of daily living due to muscle and joint pain, low back pain, headache, chronic tiredness, palpitation, stomach upset, dizziness and sleeplessness which may cause occupational and social dysfunction.

Objective: Evaluation of patients by Numeric Pain Rating Scale (NPRS), Pain Disability Scale (PDS) and complications duloxetine medication during treating of patients with somatoform disorder at Koshi Zonal Hospital.

Methodology: A total of 50 patients with first time diagnosis of SD were selected by in this cross sectional study on the basis of diagnostic and statistical manual (DSM-5), pain and other symptoms, were treated with Duloxetine medication in early stage of Somatoform Disorder and results were evaluated at 2^nd week, 6^th week and 12^thweek. The study was conducted from March 2016 to July 2017 at Koshi Zonal Hospital.

Results: Out of 50 early SD patients, total mean age was 41.38 years (range 20-60), 21 patients recovered at 6^th week and 22 patients recovered at 12^thweek but 7 patients needed other medications after 12 weeks. Duloxetine was well tolerated with nausea and headache being the most common complaint following use of duloxeting.

Conclusion: Duloxetine can be both effective and well tolerated in the treatment of early stage of somatoform disorder.

Keywords: Duloxetine, pain, somatoform disorder

Efficacy of Short Course Antibiotic Prophylaxis in Surgical Treatment of Closed Fracture

Subash Chandra Jha, Pramod Baral, Prakash Shakya — Sun, 26 May 2019 11:36:32 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23931

Introduction: Unnecessary and rampant use of antibiotic for perioperative prophylaxis are not only increasing cost of treatment but also are hazardous in terms of increasing antibiotic resistance, super infection with resistant pathogens and antibiotic toxicity.

Objective: Our primary objective is to assess the efficacy of short course antibiotic prophylaxis in preventing surgical site infection (SSI) in surgery of closed orthopedic fracture.

Methodology: Patients fulfilling all the inclusion criteria and willing and able to give informed consent were included in the study. All participants were treated by standard surgical technique following standard surgical protocol. Short course antibiotic prophylaxis was administered in peri-operative period to all patients in given format: Three divided dose of intravenous 1.5 gram cefuroxime during peri-operative period followed by no intravenous or oral antibiotics; 1^st dose half an hour before incision; 2^ndand 3^rd dose repeated at 12 hours interval.

Results: Of total 100 patient included, three developed surgical site infection till one year follow-up. All three patients with surgical site infection were treated successfully with intravenous antibiotic based on the culture sensitivity report. The average cost of antibiotic for short course antibiotic prophylaxis was 1500 NPR for each patient.

Conclusions: There was no significant increase in rate of surgical site infection with short course antibiotic prophylaxis, rather it was less expensive and may have less adverse effect, in terms of antibiotic resistance and antibiotic side effects on long run.

Keywords: Cefuroxime; closed fracture; short course antibiotic; surgical site infection

Effectiveness of Intra-articular Steroid Injection in Treatment of Idiopathic Frozen Shoulder Followed by Physiotherapy and Home Exercise Program.

Sun, 26 May 2019 11:37:16 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23932

Introduction: Idiopathic frozen shoulder (IFS) is a common chronic and disabling condition of shoulder pain characterized by progressive loss of active and passive range of motion (ROM) with unclear pathogenesis. The ideal treatment protocol is still controversial but commonly used treatment includes single agent or combination of oral non-steroid anti- inflammatory drugs (NSAIDS), oral steroids, intra-articular steroid injection and physiotherapy.

Objective: The objective of this study was to evaluate the effectiveness of intra-articular methylprednisolone injection for pain and ROM in patients suffering from idiopathic frozen shoulder who did not respond to oral NSAIDS with or without oral steroid.

Methodology: A total of 70 patients suffering from IFS were enrolled in this cross sectional study from May 2017–October 2018 from outpatient department of orthopaedic and physiotherapy of Koshi Zonal Hospital. All the patients underwent treatment protocol that comprised of Intra-articular steroid injection followed by five days of oral NSAIDS along with five days regime of physical therapy at the physiotherapy centre, followed by home exercise program. Each patient was followed up at every two weeks interval from intra-articular injection till 6^th week. Each patient was evaluated for range of motion (ROM), Numerical Pain Rating Scale (NPRS) and Shoulder Pain and Disability Index (SPADI) before the treatment protocol and at every follow up visit. Data was analyzed using Microsoft Excel Program.

Results: All patients enrolled for the study had satisfactory response. The mean age of the patient was 51.8 years (range 40-65 years). The mean age of the 26 male patients was 54 years (range 45-65), whereas the mean age of 44 female patients was 50.5 years (range 45-60). Mean duration of illness was 26.5 weeks (range 18-32 weeks), SPADI before medication was 83.14, at 2^nd week was 50.92, at 4th week was 38.63 and at 6^th week was 27.22.

Conclusion: Combination of intra-articular methylprednisolone injection, physiotherapy and home exercise program is effective in IFS for rapid improvement in pain and ROM.

Keywords: Disability index, frozen shoulder, idiopathic

Comparison of Maternal and Perinatal Outcome in Elective and Emergency Cesarean Section in a Tertiary Care Centre

Sun, 26 May 2019 11:38:10 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23933

Introduction: Cesarean delivery is the birth of a fetus via laparotomy and then hysterotomy. There are increased maternal and fetal morbidities and mortalities associated with such delivery, more in emergency cesarean section. Various studies have shown increasing trend of this mode of delivery worldwide leading to an increase in its associated risks and cost to the patients.

Objective: The objective of the study was to compare the maternal and perinatal outcome in elective and emergency cesarean section.

Methodology: It was a prospective comparative study conducted in the department of obstetrics and gynecology, Manipal Teaching Hospital from March, 2018 to September, 2018. All the patients undergoing cesarean section either elective or emergency were enrolled in the study after their consent. After collecting data from patients, maternal and perinatal outcomes were analyzed by using SPSS software.

Results: There were total 1254 deliveries in the study duration, out of which 461(36.76%) were cesarean section (cs). The incidence of emergency cs was 86.5% and elective cs was 13.5%. Majority of women (75.7%) undergoing cs had no any antenatal visit. Around 81% of cases undergoing emergency cs were unbooked whereas only 48.4% of unbooked cases underwent elective cs (P-value 0.000). The most common indication for cs in both elective and emergency category was previous cs. There was no maternal complication in elective cs group but there were 8 cases (2%) in emergency cs (P value-0.293). In emergency cs group, 7 babies had poor Apgar score whereas all babies had good Apgar score in elective group (P-value-0.057). There was increased rate of NICU admission in emergency group than in elective group (3% vs 0%, P value-0.166).

Conclusion The study showed that the incidence of cesarean section was high in our centre. The maternal and fetal risks were higher in emergency cs than in elective cs, but these were not statistically significant.

Keywords: Cesarean section, pregnancy, perinatal, tertiary care centre

Ear Findings in Post Surgical Cleft Palate Patients

Sun, 26 May 2019 11:39:13 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23934

Introduction: Cleft lip and palate is one of the most common congenital anomaly, which contributes to eustachian tube dysfunction leading to impaired middle ear ventilation and middle ear pathology. It has been stated that the timely repair of cleft palate reduces the incidence of otitis media with effusion.

Objective: To describe the ear findings in cleft palate patients who have undergone repair of cleft palate.

Methodology: A total of 36 (20 male and 16 female) post cleft repair patients underwent Otoscopy and Tympanometry between January to December 2018. Cases with isolated cleft lip, ears with perforation of tympanic membrane and attico-antral disease were excluded.

Results: The age range was from 4 years to 24 years, with a mean of 11.34 years. Maximum patients were of the age group of 10- 20 years (18, 50%) followed by that of 5-10 years range (15, 41.66%). Total number of ears examined were 72. Out of a total of 72 ears, 70 (97.2%) had abnormal otoscopic finding with dull tympanic membrane in 37 (51.39%) ears, retracted in 31 (43.05%) and bulging tympanic membrane in 2 (2.78%) cases. Type B curve was the commonest (36, 50%), followed by Type As (24, 33.3%). Type C curve was found in 11(15.3%) ears. Type A curve was found only in one ear. The duration of post-repair of cleft palate ranged from 6 months to up to 16 years with a mean of 8.52; 11 cases(30.56%) had history of repair of cleft palate of more than 10 years duration.16 cases (44.44%) had that of more than 5 years and 9 cases (25%) had less than 5 years history of duration of repair. When correlation was done statistically, the tympanometry findings and duration of repair had a very low correlation (Table 5). The time period of repair had no significant effect on tympanometric ear findings.

Conclusion Abnormal otoscopic findings and tympanometric findings were common in post cleft palate repaired patients. The duration of cleft palate repair had low correlation to the tympanometric ear findings.

Keywords: Cleft palate, middle ear, otoscopy, tympanometry

Comparative Study of Heart Rate, Blood Pressure and Selective Attention of Subjects Before and After Music

Nisha Ghimire, Renu Yadav, Soumitra Mukhopadhyay — Sun, 26 May 2019 11:20:05 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23935

Introduction: Studies have shown different views regarding the effect of music in vitals e.g Heart rate (HR), Blood pressure (BP) and atiention. The effect of preferred music with lyrics in vitals and reaction time in stroop test has not been performed in Nepalese students so, we conducted the study.

Objective: To find out the change in HR, BP and reaction time in Stroop test before and after their preferred music with lyrics.

Methodology Thirty male medical and paramedical students aged 25.27 ± 2.0 participated in study. The vital signs and reaction time in Stroop test before and after music was taken.

Results Paired-t test was used to compare means before and after exposure to music. The means are expressed as Mean ± SD. Heart rate (HR) increased after exposure to music (66.33±9.51 Vs 67.2±8.44) (p<.05). The error in Stroop test was less after music (.66±.49 Vs.63±.66) (p<.05). The reaction time after error correction decreased post exposure to music (24.117±4.61Vs23.29±4.45) (p<.05).

Conclusion The heart rate increased after exposure to music. The errors decreased after listening to music which also decreased reaction time.

Keywords: Error, heart rate, music, reaction time

Multiple Organ Dysfunction Syndrome- Clinical Profile, Associations and Outcome in Critically ill Children Aged 1 Month to 14 Years Admitted to PICU in Nobel Medical College Teaching Hospital in Biratnagar

Arun Giri, Sunil Kumar Yadav, Vijay Sah, Niraj Niroula, Binayak Singh — Sun, 26 May 2019 11:21:20 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23936

Introduction: Multiple organ dysfunction syndrome (MODS), characterized by a progressive physiologic dysfunction involving two or more organ systems after an acute threat to systemic homeostasis, is not a rare entity among patients admitted to the pediatric intensive care units. Despite recent advances made in the medical technology and newer treatment strategies, large numbers of deaths in the PICU are attributable to MODS.

Objective: To describe the clinical profile of MODS among children admitted in PICU and to observe its associations and outcome.

Methodology: A hospital based prospective observational study was conducted in PICU of Nobel medical college teaching hospital, Biratnagar, Nepal from June 2017- May 2018. Children aged 1 month to 14 years admitted in the PICU with various medical and surgical illnesses were included in the study. All variables defining MODS and the data showing the presence or absence of sepsis were collected within 1 hour of admission (day 0) and then every day until transfer or discharge from PICU or until patient's death.

Results: Out of 150 admissions in the PICU, 103 fulfilled the inclusion criteria, and were enrolled in the study. A total of 53 patients (51%) developed MODS at some time during their stay at PICU and 88.7% of them had it at the time of admission. Of 103 cases under study, 26 died (mortality rate = 25.2%) and 92.3% of deaths were attributable to MODS. Children with neurological involvement had the highest risk of death [odds ratio (OR), 19.8; 95% confidence interval (95%CI), 4.37-90.30]. 75.5% of children with MODS had some sort of infection and 49% of them had sepsis. Conditions like SIRS, Sepsis, Severe sepsis, Septic shock and ARDS in the study patients were found significantly associated with MODS.

Conclusion: A MODS is a common clinical entity among patients admitted to the PICU and are associated with significant mortality and morbidity. In children, MODS usually seem to develop early and in a simultaneous way. In developing countries like ours, morbidity and mortality associated with MODS in the PICUs is higher than that in the developed countries. Prevalence of sepsis in children with or without MODS is greater in the developing countries. Sepsis is further responsible for larger number of deaths in PICU.

Keywords: MODS, PICU mortality, sepsis

Efficacy of 10% Ichthammol Glycerine Pack and Steroid-antibiotic Pack for Relieving Pain in Acute Otitis Externa. A Comparative Study.

Karuna Shrestha, Rajeev Shah, Srijana Sapkota — Sun, 26 May 2019 11:22:33 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23937

Introduction: Otitis externa is a common painful condition presents with generalized infection of external auditory canal, typically reveals erythema and edema of the skin. Aural packing plays an important role in relieving the pain and edema. For packing, either we impregnated with 10% Ichthammol glycerine or steroid-antibiotic ointment.

Objective: To compare the efficacy of 10% Ichthammol Glycerine pack with steroid-antibiotic ointment pack for relieving the pain in acute otitis externa.

Methodology: A prospective, non-randomized clinical trial was carried out in 94 patients at Birat Medical College and Teaching Hospital, Biratnagar, Nepal from February 2018 to July 2018. Patients diagnosed with acute otitis externa were included in this study, where 47 patients were treated with 10% IG pack and remaining 47 patients treated with a combination steroid antibiotic ointment pack. Before aural packing was carried out, pain was assessed using visual analogue scale (VAS). Both groups of patients were evaluated after 48 hours for assessment of pain.

Results: The total number of patients included in this study was 94. Among them 41 (43.6%) were male and 53(56.4%) were female where male and female ratio was 1:1.29. Majority of the patients were below 40 years (83%). Treatment with steroid-antibiotic ointment pack had significant reduction in pain after 48 hours post treatment, none of them had severe pain, 4(8.5%) had moderate pain remaining and 43(91.4%) had only mild pain. Whereas in patients treated with 10% IG pack 1(2.1%) had severe pain, 14(29.7%) had moderate pain and 32(68%) had mild pain. There was statistically significant decrease in pain with steroid-antibiotic pack.

Conclusions: Both treatment modalities are effective but this study showed steroid-antibiotic ointment pack, the combined therapy is more effective than 10% IG pack for relieving the pain in acute otitis externa.

Keywords: Acute otitis externa (AOE), steroid-antibiotic pack, 10% ichthammol glycerine (IG) pack

Correlative Analysis Between Serum Anti-mullerian Hormone Concentration and LH:FSH Ratio as Women's Age Advances: A Hospital-based Study

Sun, 26 May 2019 11:23:24 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23938

Introduction: A term 'ovarian reserve' is described as quantity of ovarian follicular cohort and quality of oocytes. The assessment of an individual's ovarian reserve comprises evaluation of certain variables like age, follicle stimulating hormone, leutinizing hormone, LH:FSH ratio and prolactin as main task. Recently, scientists have reported anti-mullerian hormone as potential test for ovarian reserve. Recently, it is observed that higher levels of AMH correlate positively with greater number of oocytes with then the improved embryo morphology in in vitro fertilization (IVF) cycles. However, controversy still exists between correlation of AMH and other hormonal tests.

Objectives: To investigate correlation of AMH, FSH, LH, LH:FSH ratio and PRL in women who attended the local hospital.

Methodology: Venipuncture was performed to collect venous blood samples (n=110) under informed written consents. Following separation of sera, circulating levels of AMH was carried out by ELISA and assessment of FSH, LH and PRL were done using Dry chemistry immunoassay analyzer. Data were analyzed using SPSS software version 16.

Results: Our data demonstrated for existence of significant negative correlation between serum LH:FSH ratio and age. Here, the pattern of changes was in accordance to that of serum AMH concentration. So when we compared serum AMH concentrations with values of LH:FSH ratio in relation to age, the existence of a significant correlation was observed. Further, our findings demonstrate a degree of variations among other variables (such as LH, FSH and Prolactin) and are imperative in analytical point of view.

Conclusion: Our findings behind significant correlation between serum LH:FSH ratio and AMH level suggest that LH:FSH ratio can be a marker for ovarian reserve and applied to clinical evaluation with AMH for diagnostic purpose.

Keywords: AMH, FSH, LH, LH:FSH ratio

Accuracy of GRK-2200T Auto-refkeratometer in Subjective Acceptance for Refractive Errors

Sun, 26 May 2019 11:24:11 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23939

Introduction: Globally, the most common cause for diminution of vision is refractive errors and the number of patients with refractive errors is increasing day by day. The Auto-refraction (AR) is quick and patient friendly procedure as compared to retinoscopy and subjective refraction in finding out refractive errors. Hence, the accuracy of Auto-refractometer in terms of subjective acceptance (SA) should be taken into account before prescribing optical correction based on findings of that particular model of Auto-refractometer. So, this study is directed towards analysis of the accuracy of GRK-2200T Auto-retieratometer in terms of acceptance by comparing findings of AR with that of SC.

Objectives: The aim of this study was to assess the refractive status of patient's eyes using auto refractometer (GRK-2200T auto-retierato meter) and to estimate the agreement of it in terms of accuracy in acceptance of subjective correction by the patient.

Methodology: A hospital based prospective comparative study conducted on 226 eyes of 113 patients who visited out-patient department (OPD) of Ophthalmology at Nobel Medical College and Teaching Hospital (NoMCTH), Biratnagar diagnosed with Myopia, Hyperopia and Astigmatism. Duration of study was 4 months from 2^nd October, 2018 to 2^nd February, 2019. All data thus collected was subjected to statistical analysis by using SPSS version 22.

Result The mean age of the study subjects was 26.91±7.79 years with male to female ratio of 0.47. When spherical power, cylindrical power and the axis are taken into consideration together, only 13.3% of the total tested eyes subjectively accepted the AR values unchanged. On subjective correction, 32.7% of the tested eyes accepted spherical power while 46.5% accepted cylindrical power and 50.9% accepted axis of AR unchanged. About 52.2% of the total eyes examined fall within the deviation of spherical equivalent (SE) of ±o.25D and up to 67.3% of them fall within the deviation of ±o.50D.

Conclusion The auto refraction by GRK-2200T auto-retieratometer was found to be satisfactory for a preliminary refraction but not satisfactory as substitutes for conventional subjective refraction. However, auto refraction values obtained by GRK-2200T auto-retieratometer could be important in order to accurately prescribe the cylindrical power as well as its axis than the spherical component.

Keywords: Refractive errors, auto-retieratometer, auto-refraction, subjective refraction, spherical equivalent, subjective acceptance

Association of Thrombocytopenia and Mortality in Critically ill Children Admitted to PICU in Tertiary Hospital In Biratnagar

Vijay Kumar Sah, Arun Giri, Milan KC, Niraj Niraula — Sun, 26 May 2019 11:25:08 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23940

Introduction: Thrombocytopenia is a clinical condition characterized by decrease in number of platelets below the normal range. It is associated with bleeding tendency, hemodynamic instability, impaired inflammatory process and thus affecting host defence mechanism. There has been only few studies published till date in pediatric intensive care units suggesting thrombocytopenia is associated with increased mortality.

Objectives: To determine the prevalence of thrombocytopenia in the critically ill children and its relationship with mortality in Pediatric intensive care unit (PICU) admitted children.

Methodology: A prospective observational study was performed over a period of 12 months on 102 critically ill children admitted in PICU who fulfilled the criteria. Two patients left the study due to financial problems and as outcome could not be assessed on them, they were excluded from the study. Platelet count was noted at the time of admission and consecutively for the initial four days at PICU. Thrombocytopenia was defined as platelet count less than 150/nL. Mortality in PICU was recorded as primary outcome.

Results: The prevalence of thrombocytopenia during consecutive 4 days was 34% (n=34) and at the time of admission in PICU was 16% (n=16) among 100 children analysed in the study. The mortality in the PICU was 27% (n=27). Mortality among thrombocytopenic children was 61.7% (n=21) as compared to 7.6% (n=5) in non-thrombocytopenic children (p=<0.001). Mortality was 18 times more for those who were thrombocytopenic at the time of admission as compared to those who subsequently developed thrombocytopenia during course of stay in PICU.

Conclusion: Thrombocytopenia has significant association with increased mortality. Thrombocytopenic children at the time of admission have more likelihood of mortality than nonthrombocytopenic children in intensive care units.

Keywords: Mortality, platelets, thrombocytopenia

Sexual Dimorphism in Permanent Maxillary and Mandibular Canine of Medical Students in Gandaki Medical College, Nepal

Bijayata Shrestha — Sun, 26 May 2019 11:26:02 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23941

Introduction: Gender determination is important for identification in forensic practice. Odontometrics plays an important role in sex determination in young individuals where secondary sexual characters are yet to be developed.

Objective: The objective was to re-evaluate the previous finding of the sexual dimorphism in Mesiodistal (MD) and Buccolingual (BL) dimension of maxillary and mandibular canine in the study population being Medical Students of Medical College in province 4 of Nepal.

Methodology: This is a cross sectional study conducted on the study cast of 40 male and 40 female medical students of academic year 2017/18 of Gandaki Medical College, Nepal, of age group 18-24 from October to December 2017. The MD and BL dimensions of all the four canines were measured using digital vernier's caliper. Data were compared using descriptive statistics, student's t-test and paired sample t test. P<0.05 was found statistically significant.

Results: Statistically significant sexual dimorphism was found in MD and BL dimension of maxillary and mandibular canine with males' canine measuring larger than females'. The left mandibular canine was found to be the most dimorphic in term of BL dimension among the canines.

Conclusion: The present study exhibited the buccolingual dimension of the left mandibular canine as the most dimorphic tooth. Further studies using large representative sample from all the provinces has to be conducted to quantify and generalize the result among the Nepalese Dentition.

Keywords: Human identification, permanent dentition, sexual dimorphism

Hospital-based Analytical Study of Anti-thyroid Peroxidase Titre Among Type-2 Diabetic Patients Suffering from Thyroid Disorders

Rajneesh Jha, Amit Mishra, Meena Kumari Mishra, Ram Lala Mallick — Sun, 26 May 2019 11:26:53 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23948

Introduction: Thyroid hormones control growth, development and metabolic processes. Either excessive or deficient secretion of these hormones interfere with metabolism. Thyroid hormones, therefore, can alter a person's blood sugar. Relatively, thyroid peroxidise enzyme plays a key role in thyroid hormone production. The individuals who suffer from autoimmune thyroid diseases produce auto antibodies against thyroid peroxidise (called anti-TPO).

Objectives: We aimed to investigate an association of anti-TPO titer among type-2 diabetic patients suffering from thyroid disorders attending the local hospital.

Methodology: Based on findings of thyroid variables [such as total triiodothyronine (TT₃ ), thyroxine (T₄ ) and thyroid stimulated hormone (TSH)], type-2 diabetic patients were categorized into Euthyroidism, Subclinical hypothyroidism and Hypothyroidism. In this hospital-based prospective study, venipuncture was performed to collect anti-cubital venous blood samples (n=100) from January to December, 2018. After separation of sera, estimation of certain parameters such as TT₃, T₄ , TSH and anti-TPO were carried out for correlative analyses. In this aspect, based on WHO guidelines, the patients who had fasting as well as postprandial blood sugar levels > 126 and 200 mg/dl were confirmed for diabetes mellitus. In addition, if these patients exhibited HbA₁C levels > 10.8 %, they were enrolled into the 1 study. The patients who were hyperglycemic (with fasting as well as post-prandial blood sugar levels < 126 and 200 mg/dl) were excluded.

Results: In the three groups as stated above, we observed that more a rise in level of glucose, greater were the values of TSH and anti-TPO.

Conclusion Such findings emphasize and put an impact in situations of thyroid abnormality among type-2 local diabetic population.

Keywords: Anti-TPO, thyroid stimulating hormone, total triiodothyronine, thyroxine, type-2 diabetes.

Knowledge and Awareness of Basic Life Support among Medical Staffs of Birat Medical College and Teaching Hospital

Batsalya Arjyal, Lalit Kumar Rajbanshi, Kanak Khanal, Akriti Bajracharya — Sun, 26 May 2019 11:27:36 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23949

Introduction: It is essential that all the medical professionals should have adequate skill for basic life support (BLS) for better outcome of cardiac arrest patients. The objective of the study is to assess the knowledge and awareness of BLS among the medical doctors, nursing staffs and health care paramedics working in Birat Medical College and Teaching Hospital, Biratnagar.

Methodology: A three-month duration observational questionnaire-based survey was conducted at Birat Medical College and Teaching Hospital, Biratnagar to assess the knowledge, awareness of basic life support among the medical doctors, nursing staffs and health care paramedics. A total of ten questions were designed to assess the knowledge and awareness regarding BLS skill. Three questions were designed to assess the previous experiences on cardiac arrest situation and BLS training. Similarly, two additional questions were added to assess the self-grading of BLS knowledge which included poor, below average, good and excellent.

Result: It was observed that only 14% participants had previous BLS training. Surprisingly, 76% of the participants had encountered cardiac arrest situation in their clinical practice but they were managing those cases with limited knowledge on BLS. The correct answer to the self-structured questionnaire were ticked by less than 50% of participants and majority of the participants came below average on self-grading of the knowledge and awareness suggesting the need of easy accessibility of BLS training centers in the eastern part of Nepal.

Conclusion: This study revealed that the knowledge and awareness of basic life support skills among the various staffs was mostly below average to poor. Significant amount of cost effective BLS trainings must be conducted so as to develop competent staffs by various training centers

Keywords: Awareness, basic life support, cardiopulmonary resuscitation, knowledge

Incidence of Acute Renal Failure in Full Term Neonates with Birth Asphyxia

Chandra Bhushan Jha, Akhil Tamrakar — Sun, 26 May 2019 11:28:25 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23950

Introduction: Birth asphyxia is an eventuality having far reaching consequences in the neonatal period. Hypoxia and ischemia can cause damage to almost every tissue and organ in the body and various target organs involved. Renal insult is a recognized complication of birth asphyxia and carries a poor prognosis. Timely detection of renal dysfunction and appropriate management may favorably alter the prognosis in many neonates with birth asphyxia.

Objective: The present study was done to find out the incidence of acute renal failure in the full term neonates with birth asphyxia.

Methodology: A cross sectional study was conducted at Birat Medical College Teaching Hospital, Morang, Nepal from 1^st September 2017 to 28^thFebruary 2018. Fifty full term neonates born with Apgar score of <6 at 5 minutes and fulfilling inclusion criteria were enrolled in the study. Asphyxiated neonates having Serum creatinine >1.5gm/dl or urine output<1ml/kg/hr were labeled as cases of Acute Renal Failure. Blood sample for serum creatinine was collected at 24hrs, 48 hrs and 72 hrs of life.

Results A total of 50 term asphyxiated neonates were enrolled in the present study. Among them 54% and 46% were males and females respectively with male to female ratio of 1.2:1. In the present study 62% of cases developed acute renal failure in either of the first three days of life with mean urine output 1.02±0.27ml/kg/hr and mean serum creatinine of 1.49±0.32 mg/dL. The incidence of oliguric renal failure was 52% and non oliguric renal failure was 48%.The association between serum creatinine and urine output was statistically significant.

Conclusion: In the present study birth asphyxia has been an important cause of neonatal acute renal injury, revealing 31 (62%) cases. Monitoring urine output and serum creatinine has helped in detecting the asphyxiated neonates with acute renal injury in the early stage.

Keywords: Acute renal failure, birth asphyxia, neonates

'Selfie Elbow'- A Public Health Problem among Mobile Users

Laxman Khanal, Gulam Anwer Khan, Anup Pandeya — Sun, 26 May 2019 11:29:21 +0000

DOI: https://doi.org/10.3126/bjhs.v4i1.23952

Introduction: While taking a selfie picture, a person is in a position in which the arm is fully extended or sometimes a little bent and maintained until the picture of choice is adjusted in the camera frame. One Person must have a firm grip on phone to hold it and hit click. When the process is repeated for a few photos, it causes repetitive strain injury, resulting in various signs, including pain in the elbow joint, which has now been named 'selfie elbow.' Doctors assume that as many as 25% of cell phone users in Kolkata are suffering from this problem (selfie-elbow).

Although a selfie is generally seen as an expression of self to others, the American Psychiatric Association (APA) has officially confirmed that taking 'selfies' is seen as a mental disorder and has been given the term 'selfitis.' Selfie elbow is a condition due to overuse injury caused by extending and twisting one's arm for too many phone selfies. Like tennis elbow or golfer's elbow, an addiction to selfie-taking and clicking too many can cause pain in your primary picture-snapping elbow and may affect the upper limb, elbow, and shoulder muscles – which leads to degradation in function. Joints involved in the process of selfie-taking are the shoulder joint, the elbow joint, and the wrist joint, all of which help the hand attain a perfect frame for the picture. However, most of the strain is referred to the elbow, because the person extends (or sometimes bends) the elbow in an extremely strained position during the selfie. Selfie elbow is more of an abnormal and repetitive loading of muscles around the elbow, leading to microruptures, and resulting in inflammation and pain; this ultimately heals with scarring, but causes recurrent pain. As stated, it is a form of repetitive stress injury, similar to carpal tunnel syndrome (or the compression of the median nerve in the wrist, usually due to overuse of the hand) and tendonitis (which occurs when the tendon becomes inflamed).

Keywords: Elbow Joint, overuse injuries, inflammation, carpal tunnel syndrome, tendonitis

Chicken Pox Associated Bilateral Retinal Vasculitis in an Immunocompetent Young Male; an Unusual Case Report

Rajya Laxmi Gurung

DOI: https://doi.org/10.3126/bjhs.v4i1.23953

Chicken pox is considered as benign infectious disease with variable ocular manifestations. We report a case of bilateral retinal vasculitis following chicken pox in a healthy 17-year-old male. The retinal manifestation is stabilized by treatment with oral acyclovir in combination with systemic steroids.

Keywords: Acyclovir, chicken pox, steroids, vasculitis