Journal of Chitwan Medical College

Implant dentistry – current trends in rehabilitation of missing teeth

Smriti Narayan Thakur — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23774

No abstract available.

Keywords: Implant dentistry

Prevalence of microalbuminuria and its association with glycemic control in type 2 diabetic patients: a cross sectional study at Kathmandu Medical College

Prabin Kumar Karki — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23775

Background: Diabetes mellitus has become one of the biggest health problems of this era. The resultant microvascular and macrovascular complications add to significant amount of morbidity and mortality. Urine microalbumin is considered as an early marker for microvascular complications among diabetic patients. The aim of this study was to find out the prevalence of microalbuminuria among type 2 diabetic patients attending Kathmandu Medical College and its relation with glycemic control, age, sex, duration of diabetes.

Methods: A total of 208 previously diagnosed type 2 diabetic patients attending medical outpatient department of Kathmandu Medical College, Sinamangal were included in the study over a period of 1 year (October 2017 - September 2018). Fasting and 2-hour postprandial venous blood for blood glucose and HbA1c measurement and early morning urine sample (after overnight fast) was collected for detection of microalbuminuria. Statistical analysis was done using SPSS version 23.

Results: The prevalence of microalbuminuria among the study population (mean age: 54.22 ± 11.76 years, mean HbA1c: 7.62 ± 1.53 %) was 42.8%. Microalbuminuria had significant correlation with HbA1c and duration of diabetes (p<0.001), but not with age, sex and type of medication. There was positive correlation between urine microalbumin and fasting and post-prandial blood glucose.

Conclusions: Our present study found high prevalence of microalbuminuria among diabetic patients with poor glycemic control. It is suggested that tighter glycemic control with regular urine microalbumin testing should be integral part of diabetic management plan to prevent long term complications such as diabetic nephropathy

Keywords: Diabetes, HbA1c, Microalbuminuria

Comparative studies of bone density by quantitative ultrasound (QUS) with dual-energy X-ray absorptiometry (DEXA) scan

Alark Devkota Rajouria — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23776

Background: The aim of the study was to establish the correlation quantitative ultrasound (QUS) between and dual-energy X-ray absorptiometry (DEXA) and to assess the ability of QUS as a screening tool for osteoporosis.

Methods: The study was conducted on 115 patients. All the patients underwent QUS of radius using Sunlight MiniOmni bone sonometer and DEXA screening for measurement of bone mineral density (BMD) at lumbar spine, total left & femoral neck and radius.

Results: Significant correlations were observed between QUS and DEXA T score.

Conclusions: QUS is a sensitive screening tool to detect changes in the bone mass and risk of osteoporosis.

Keywords: Dual energy X-ray absorptiometry, Osteoporosis, Quantitative ultrasound

Nurses’ knowledge and practice regarding intravenous therapy in a teaching hospital, Bharatpur

Sandhya Lamsal — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23777

Background: Intravenous (IV) therapy is a common procedure in clinical setting of any hospital and nurses are accountable for handling and management to the patient with IV therapy. However, various serious medical complications were arisen due to nurses having inadequate knowledge and practice on IV therapy. Therefore, this study was conducted to find out the nurses’ knowledge and practice regarding IV therapy in a teaching hospital, Bharatpur, Chitwan.

Methods: A cross- sectional study design was adopted with 177 nurses for assessment to knowledge and 53 nurses to observe practice on IV therapy. A systematic random sampling technique was used. Data were collected by using semi-structured, self-administered questionnaire for identifying knowledge and observation checklist for observing the practice of IV therapy among nurses. The data was analyzed using descriptive and inferential statistic.

Results: The level of knowledge was found inadequate and level of practice was found unsatisfactory on IV therapy. The associated factors with level of knowledge regarding IV therapy were age (p=0.012), professional qualification (p=0.001), professional designation (p=0.005), professional experience (p=0.002) and in-service education (p=0.003). Similarly, the associated factors with level of practice on IV therapy were professional qualification (p=0.020) and professional designation (p=0.04).

Conclusions: It is concluded that most of the nurses had inadequate knowledge and unsatisfactory practice on IV therapy. Hence, it is strongly recommended for need of protocol for IV therapy, in-service education, effective supervision and reinforcement for improvement of knowledge and practice regarding IV therapy among nurses.

Keywords: Intravenous Therapy, Knowledge, Nurses, Practice

Awareness of oral cancer and potentially malignant oral disorder among final year medical and dental undergraduate students of Chitwan Medical College, Nepal

Sushil Subedi — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23778

Background: Oral Cancer (OCA) is a common malignancy in South East Asia and the burden of the disease is increasing. OCA is usually preceded by Potentially Malignant Oral Disorder (PMOD). The early detection of these diseases may limit the high mortality and morbidity. The objectives of this study were to assess the awareness of burden, associated risk factors, early detection and prognosis of OCA and OPMD among final year medical and dental students..

Methods: This cross sectional study was conducted among final year Medical and Dental undergraduate students of Chitwan Medical College, Nepal in April 2017 using a pre tested self-administered questionnaires. All the final year students present at their respective classes (Dental= 50 and Medical=75 students) responded to the questionnaires after giving informed consent. Data entered in SPPS 20 software was analyzed using Pearson Chi Square test and Fisher exact test.

Results: Dental students had better awareness concerning PMOD. Yet, the dental students did not differ significantly from their medical counterpart in most of the responses related to OCA. Surprisingly, more Dental students had misconception that OCA is not preventable and early detection is difficult. Few of both groups were confident in having sufficient knowledge in OCA prevention and detection. Only 18.6% of Medical students had examined PMOD and few students of both groups had examined OCA.

Conclusions: This study revealed the deficient aspect in the knowledge concerning OCA and OPMD among Medical and Dental students indicating the need to emphasize on these aspects of medical education.

Keywords: Dental Education, Medical Education, Oral Cancer, Potentially Malignant Oral Disorder

Peripartum hysterectomy and its risk factors

Renuka Tamrakar — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23779

Background: Emergency Peripartum Hysterectomy (EPH) is an important lifesaving surgical procedure considered in cases of severe hemorrhage unresponsive to medical and conservative management. The objective is to review incidence, identification, intervention and impact of emergency peripartum hysterectomy.

Methods: The retrospective, cross-sectional study designed was to used. EPH data were collected from January 2014 to December 2018.Descriptive statistics was used to analyzed data and presented in tables and charts.

Results: Incidence of Emergency Peripartum Hysterectomies was 2.3% out of 252(2.6%) cases of obstetrical emergencies and 0.06% that is 1 in 1600 deliveries. Most common indications for EPH were uterine rupture (33.3%); placenta accreta (33.3%) followed by retained placenta (16.6%) and endometritis with pyometritis (16.6%). Estimated blood loss 1916 ml., timeliness from delivery to hysterectomy was 140 minutes; most common post-operative complication was surgical site infection (33.3%) and length of hospital stay 11.7 days. Maternal morbidity rate was 33.3%. There was no maternal mortality recorded.

Conclusions: The timely intervention improves the outcome in Peripartum Hysterectomy, which is frequently associated with abnormal placentation as a consequence of increasing caesarean deliveries rate.

Keywords: Cesarean hysterectomy, Peripartum hyterectomy, Postpartum hysterectomy

Pulmonary function tests of mongoloid and non mongoloid group of Dharan

Nisha Ghimire — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23780

Background: Ethnicity is seen to effect normal reference values and prediction equations of pulmonary function tests (PFTs). The normal reference of PFTs among mongoloid and non mongoloid group of Dharan is not available. The aim of the study was to find out the normal reference values of two groups in Dharan and also to find out the correlation of height, weight and body surface area with different PFT parameters.

Methods: This cross-sectional study was conducted among 250 (125 mongoloids and 125 non mongoloids) healthy male subjects. Convenient sampling technique was done. Every 5th patient attendant who was permanent resident of Dharan coming to clinical Physiology lab was selected as subject in each group. Portable PFT machine (CHESTOGRAPH, HI-101 Spirometry system) was used for measurement of our test. The test was conducted according to European Respiratory Society (ERS)/American Thoracic Society (ATS criteria.

Results: Independent sample t-test was used to compare means between two groups. There was significantly more height (165.30±8.21 vs 161.43±7.35), p <.05], weight [(59.29±11.64 vs 55.32±10.75), p<.05andbody surface area [(1.64±.172Vs1.57±.149), p<.05], in the non-mongoloid group compared to mongoloid group. PFT parameters were also higher in non-mongoloid group VC [(3.3982±.70725 Vs3.0982±.78832) p<.05], FVC [(3.2798±.74312 Vs 2.988±.81970), p <.05], and FEV1 [(3.0668±.72044 Vs 2.7861±.83061) p<.05]. The prediction equations were also calculated for both groups.

Conclusions: There was difference in PFT parameters between two groups. Prediction equations were also different in both groups.

Keywords: Mongoloid group, Non-mongoloid group, Pulmonary functional test

Compliance of surgical hand scrub in operation theatre of teaching hospital, Chitwan

Anish Paudel — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23782

Background: Surgical hand scrub is an important practice that forms the base in the prevention and control of surgical site infection. The objective of the study was to evaluate the compliance of surgical hand scrub among surgical team in Operation Theatre of Teaching Hospital, Chitwan.

Methods: Descriptive cross-sectional design was used. Data collection instrument (a checklist) was developed based on national and international standards of surgical hand scrub. Data was collected by observation of surgical team who were scrubbing in the Operation Theatre, Chitwan Medical College before proceeding to surgical procedures.

Results: A compliance with the standards for surgical scrub prerequisites (70%), scrub process (81.53%), time of scrub (27%) and overall compliance (75.95%) observed. The total score of compliance with the standard was only 13%. The main issues found in the study were not correctly wore surgical cap and mask (44.9%), using of timer/wall clock before starting scrubbing (91.3%), improper follow the continue rotational action down opposing arms working to the elbow for one minute (53.6%) and repeated blotted dry of skin area once it done (30.4%)

Conclusions: The results showed there was gap in the surgical hand scrub of the studied hospital and the compliance with the standard can be improved by simple surgical hand scrub intervention, periodical observation audit and feedback.

Keywords: Compliance, Operation Theatre, Surgical hand scrub

Stress and self-esteem among nursing students at private medical college, Chitwan

Swostika Shrestha — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23784

Background: Stress and self-esteem are common issues that everyone has to cope with at some time in their lives and they could also affect other things going on in a person’s’ life. The objective of the study is to identify the stress and self-esteem among nursing students.

Methods: A descriptive cross-sectional study was carried out among B.Sc. Nursing students, Chitwan Medical College. The data was collected by using structured questionnaire within 2 weeks. Obtained data were analyzed using IBM SPSS version 16.0. Descriptive statistics (mean, frequency, percentage and standard deviation) and inferential statistics (chi-square and correlation) were used for data analysis.

Results: Out of 116 respondents, 23.3%, 25.9%, 25.9% and 25.0% were from first, second, third and fourth year respectively. More than half i.e. 50.9% of the respondents had high stress. Respondents had faced higher (68.1%) in teacher related stress followed by peer stress 67.2% and self-inflict 66.0%. About 61.2% of the respondents had low self-esteem. There was higher stress in first year students then other. The fact is that as the academic year increases, students become more familiar to the learning environment and able to cope better. There was statistical significant association between stress among nursing students and habit of problem sharing (p=0.04).

Conclusions: It is concluded that respondents have high level of stress and low level of self-esteem. Therefore, intervention for increasing self-esteem and decreasing stress should be conducted by the college administration.

Keywords: Nursing Students, Self-esteem, Stress

Intranasal findings in unilateral primary acquired nasolacrimal duct obstruction

Sanjeev Kumar Thakur — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23785

Background: Primary acquired nasolacrimal duct obstruction (PANDO) is a common entity with associated different types of intranasal abnormalities. The pathogenesis of PANDO is unknown. The objective of the study was to describe the intranasal findings in cases of PANDO and find out any association of these findings to the disease.

Methods: A comparative cross-sectional study was designed consisting of 50 cases of unilateral PANDO with epiphora and 50 normal volunteers with no history of epiphora. Nasal Evaluation was done with anterior rhinoscopy and nasal endoscopy. Data was tabulated and analyzed using SPSS version 21.

Results: The mean age in the unilateral PANDO group was 33.6 years and 34.5 years in the normal volunteer’s group (P-0.84). Left sided dominance of PANDO was observed in 64% (32/50) cases. The odds of having Nasolacrimal duct (NLD) obstruction was1.6 times more among individuals having septal deviation versus no deviation (95% CI, 0.907–2.78). The laterality of septal deviation was corresponding to the side of NLD obstruction in 91% (31/34) cases. High located DNS was more common in the PANDO group which was significant (P-value 0.012). Turbinate hypertrophy, the presence of septal spur or rhinitis had no significant association with NLD obstruction.

Conclusions: Deviated nasal septum (DNS), turbinate hypertrophy, septal spur and rhinitis were the associated intranasal findings in cases of unilateral PANDO. A significant association exists between DNS and PANDO, although a cause and effect relation require further probing.

Keywords: Deviated nasal septum, Nasal endoscopy, Primary acquired nasolacrimal duct obstruction, Sino-nasal anomalies

Medical students’ perception regarding objective structured clinical examination in Medical College, Chitwan

Pratima Jaiswal — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23786

Background: Objective Structured Clinical Examination (OSCE) has been globally recognized as gold standard of performance based assessment that aids in evaluating the clinical competency of medical undergraduate students. Hence, it increases the confidence of students in their learning ability by helping them to identify areas of weakness and gaps in their competencies. This study was conducted to identify perception towards OSCE among medical students.

Methods: A descriptive cross-sectional study design was adopted and a total 173 respondents were selected from MBBS 4th and 5th year of Chitwan Medical College by using probability stratified proportionate random sampling technique. Self-administered questionnaire with 5-point likert scale were used to collect the data. Descriptive and inferential statistics was used to analyze data.

Results: About half of the Bachelor of Medicine and Bachelor of Surgery (MBBS) students had positive perception toward OSCE. There is significant association between the level of perception towards OSCE and year of study (p=0.002), choice of study MBBS (p=0.045) and evidenced based learning (p=0.041).

Conclusions: Thus, optimum emphasis should be given on formulating OSCE guideline and orienting student about it and also organization should create environment to facilitate actual objective structured clinical examination in order to increase positive perception in our context.

Keywords: Medical Students, Objective Structured Clinical Examination, Perception

Training workshop on performance-based assessment: feedback of the participants faculty

Rano Mal Piryani — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23787

Background: Performance-based assessment (PBA) concentrate on “Does” level of Miller’s Triangle Model of assessment and assess the ability of healthcare professionals to practice safely in different situations and context. It is essential to train faculty members how to conduct PBA.

Methods: One-day training workshop on PBA was organized at Liaquat University of Medical & Health Sciences Jamshoro, Sindh Pakistan in November 08, 2017 with objective “participants learn to apply PBA tools in practice”. There were two sessions of training; session one covered basics, levels and tools of assessment and blueprinting for assessment and session two PBA and its tools. Tutorial, brainstorming and activity based small group work were methods utilized for the training. Feedback of the participants was taken on semi-structured questionnaire. Descriptive analysis was done using SPSS.

Results: Twenty-two participants selected from basic, clinical, and dental sciences and nursing faculty. The participants rated workshop on scale of 1-10 (1=poor, 10=excellent) for usefulness of training (8.64 ± 1.62), content of training (8.27 ± 1.52), relevance of training & content (8.59 ± 1.40), facilitation of training (8.77 ± 1.34) and overall (8.77 ± 1.38). After training participants were very confident in developing blueprint for assessment (3.91±0.61), using mini-CEX (3.64±0.58), and confident using DOPS (3.63±0.73), MSF (3.55±0.74) and Portfolio (3.68±0.84). More than one third of the participants recommended to arrange more training workshop on different aspects of medical education.

Conclusions: It was observed from feedback that participants realize the importance of PBA training and stress to have trainings for various aspects of health profession education.

Keywords: Assessment, Faculty, Heath Profession Education, Performance-based assessment, Training

Endourological management of forgotten double J stents: case series

Chandra S. Yadav — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23788

Putting ureteral stents are an integral part of urological practice. However, stents that fragment or are forgotten for a long time pose a management challenge and also legal dilemma. Our series consists of a review of five patients with forgotten double J stents. All these cases were managed at Kathmandu Model Hospital and all the forgotten stents were retrieved endourologically. Management of such complicated ureteral stents requires a multimodal therapeutic approach incorporating the latest ESWL and endourological techniques. Proper counseling to the patient with reference from post-operative KUB X-ray may prevent this urological tragedy.

Keywords: Cystolithotripsy, Endourological management, Forgotten double J stent, PCNL

Temporal space infection secondary to recurrent buccal space infection from mandibular deciduous molar in 7-year-old child: a case report

Sourav Rout — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23789

Head and neck space infections are usually secondary to odontogenic infections due to translocation of oral microbes to fascial space via odontogenic route resulting in progression by enzymatic degradation of connective tissue. Various factors like microbiological, host, nutritional and socioeconomic factors are responsible for progression of fascial space infection that might take fatal course if not treated in time. The present case report describes a child with fascial space infection of oral and maxillofacial region who was treated by incision and drainage in department of oral and maxillofacial surgery of this hospital. Fascial space infections are one of the surgical emergencies and need to be addressed in early stage as it has rapid regional and systemic progression leading to fatal outcome. It is multifactorial and all need to be addressed. Incision and drainage with removal of cause with antimicrobial therapy is treatment modality of space infection. Inadequate drainage might lead to recurrence of infection and progression to distant secondary spaces.

Keywords: Antibiotic, Bacteria, Fascial space infection, incision and drainage

Fetal hepatic hemangioma: a case report

Manindra Shresth — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23790

Fetal liver tumors represent approximately 5% of all congenital tumors and hemangiomas account for approximately 15% of all fetal liver tumors. Hemangioma and hemangioendothelioma are benign vascular tumors but they are associated with a significant morbidity and mortality due to high output congestive heart failure and arteriovenous shunting. Ultrasound features of hepatic hemangioma can overlap with arteriovenous malformation. This is a case report of fetal hepatic hemangioma with aretriovenous shunting detected on routine anomaly scan at 20 weeks of gestation in 22 years old Nepalese women who was asymptomatic. Prenatally, a 3.2cm x 2.8cm multicystic mass was seen in the left hypochondrium of the fetal abdomen displacing the stomach. On color Doppler examination, the mass showed internal color flow and multiple tortuous dilated vessels noted around the lesion. After counseling regarding the lesion to the mother and her family; decision to abort the fetus was made. Autopsy was done for the final diagnosis of the lesion, which showed vascular mass in the left lobe of liver insinuating between stomach and spleen.

Keywords: Arteriovenous shunting, Fetal Hepati Hemangioma, Utrasonography

Nepalese National Formulary (NNF) 2018

Pathiyil Ravi Shankar — 2019-05-28

DOI: https://doi.org/10.3126/jcmc.v9i1.23791

No abstract available.

Keywords: Nepalese National Formulary