Journal of College of Medical Sciences-Nepal

Resection Urethroplasty for Urethral Stricture: Preliminary Findings from a Tertiary Care Hospital of Central Nepal

2019-05-21T11:19:24+00:00

DOI: https://doi.org/10.3126/jcmsn.v15i1.22351

Background: Urethral stricture is relatively common problem that we encounter in urological practice. As urethral stricture causes progressive narrowing of the urethral lumen, signs and symptoms of urinary obstruction arise. These patients experience obstructive symptoms like poor stream, straining to urinate, incomplete voiding, end dribbling, urinary retention and recurrent urinary tract infections. Methods: A prospective cohort study was carried out in College of Medical Sciences, Chitwan, Nepal. All the patients who were operated with end to end anastomosis for urethral stricture with stricture length not more than 2.5cm from January 2015 to June 2016 was included in this study. These patients were followed up for two year period for recurrence of the stricture and complications. Results: Mean age of patient in this study was 50.55 years, average length of stricture was 1.3 cm. 66.67% (12 patients) had complete success with no recurrence of the stricture. 33.33 % (6 patients) had recurrence of stricture. Out of those 6 patients, 3 had undergone DVIU with no further recurrence of the stricture until the follow up period, one patient was treated with dilatation, two had complete failure and needed re-procedure. Conclusions: End to end anastomosis for short segment stricture had a fairly satisfactory result.

Keywords: DVIU; end to end urethroplasty; urethral stricture.

Cervical Posture and Skeletal Malocclusions – Is there a Link?

2019-05-21T11:19:02+00:00

DOI: https://doi.org/10.3126/jcmsn.v15i1.20509

Background: The present study was conducted in order to determine cervical posture in different skeletal sagittal malocclusions as well as to assess whether a correlation existed between cervical posture and skeletal relationships. Methods: Cervical curvature and inclination of 63 subjects was assessed using their lateral cephalometric radiographs. Cervical inclination was assessed using the cervicohorizontal postural variables namely OPT/HOR and CVT/HOR whereas cervical curvature was determined by measuring the angle OPT/CVT. Sagittally, the subjects were also categorized into skeletal Class I, II and III based on the angle ANB. One way ANOVA was used for the comparison of cervical posture in different skeletal sagittal malocclusions. Pearson’s correlation was used to evaluate the correlation of cervical posture with different skeletal sagittal jaw relations. Statistical significance level was set at p≤0.05. Results: Statistically significant differences were found between the different skeletal malocclusions for the cervical curvature angle OPT/CVT (p=0.025). A weak correlation of cervical curvature angle OPT/CVT (r=0.305, p=0.016) with sagittal malocclusion was found. Conclusions: Skeletal sagittal malocclusions differ in their cervical postures, especially cervical curvature. Skeletal Class III subjects have significantly straighter cervical columns than skeletal Class I subjects. Cervical curvature is correlated with sagittal jaw relations.

Keywords: cervical curvature; cervical posture; skeletal sagittal malocclusions .

Clinical Evaluation of Topical Metronidazole and Chlorhexidine Gel following Scaling and Root Planing in Patients with Chronic Periodontitis

2019-05-21T11:18:39+00:00

DOI: https://doi.org/10.3126/jcmsn.v15i1.19197

Background: Chronic periodontitis is the most prevalent form of periodontitis with a multifactorial etiology, dental plaque being the primary etiologic agent. The removal of such etiologic factor through scaling and root planing builds the foundation of treatment. In addition, the use of an antimicrobial adjunct augments elimination of microbes leading to subsequent control of the disease. Chlorhexidine and Metronidazole have been found to be active against several periodontopathogens. In this study, the use of these antimicrobial gels has been made. To evaluate and compare the clinical efficacy of subgingival application of 1% Metronidazole, 1% Chlorhexidine and Combination gel when used as an adjunct to non-surgical therapy. Methods: A total of 120 patients, age group 30-60 years with chronic generalized periodontitis were included in the randomized, controlled, double blinded study. The patients were randomly divided into four groups and treated with scaling and root planing along with antimicrobial adjunct. The antimicrobials used were Chlorhexidine, Metronidazole, Combination of Chlorhexidine and Metronidazole, and Placebo. Clinical parameters (plaque index, gingival index, probing pocket depth and clinical attachment level) were recorded at baseline, 1 month and 3 months. Results: In all the groups, there was a statistically significant reduction in all the clinical parameters at different time intervals. Inter-group comparison with respect to clinical changes showed that Combination gel was the best. Conclusions: Long term, controlled randomized trials with more samples are suggested to further validate the efficacy of these antimicrobial drugs.

Keywords: chlorhexidine; chronic periodontitis; metronidazole; root planing; scaling.

Impact of Iron Status on Thyroid Function: A Community Based Cross-Sectional Study in Eastern Nepal

2019-05-21T11:18:19+00:00

DOI: https://doi.org/10.3126/jcmsn.v15i1.21022

Background: Iron deficiency is the most common nutritional deficiency in the world. The relation between thyroid hormones and iron status is bidirectional. The aim of this study was to assess iron nutrition status and evaluate its relationship with thyroid hormone profile among children of Eastern Nepal. Methods: A community based cross-sectional study was conducted in eastern Nepal. A total of 200 school children aged 6-12 years were recruited after taking informed consent from their guardians. Blood samples were collected and assayed for free thyroid hormones (fT₃ and fT₄), thyroid stimulating hormone (TSH), serum iron, total iron binding capacity (TIBC) concentration and percentage transferrin saturation was calculated. Results: The mean serum iron and TIBC was 74.04 µg/dl and 389.38 µg/dl respectively. The median transferring saturation was 19.21%. The overall prevalence of iron deficiency (Transferrin saturation < 16%) was 34% (n=68). The mean concentration of fT₃ and fT₄ was 2.87 pg/ml and 1.21 ng/dl respectively, while the median TSH concentration was 3.03 mIU/L. Median TSH concentration in iron deficient group (3.11 µg/dl) and iron sufficient group (2.91 µg/dl) was not significantly different. Among iron deficient children 5.9% had subclinical hypothyroidism (n=4). Iron status indicators were not significantly correlated with thyroid profile parameters in the study population. Conclusions: The prevalence of iron deficiency is high and iron deficiency does not significantly alter the thyroid hormone profile in the study region.

Keywords: iron deficiency; thyroid hormones; school children; subclinical hypothyroidism.

Histopathological Study of Ovarian Tumors at a Tertiary Care Hospital of Central Nepal

2019-05-21T11:17:57+00:00

DOI: https://doi.org/10.3126/jcmsn.v15i1.21646

Background: Ovarian tumors are histogenetically varied and complex tumors spanning all age groups. They account for 30% of all gynaecologic cancers. Malignant tumors carry a high mortality due to its late detection and ineffective screening programs. Current study aims at finding association between age at presentation and size of tumor with behavior of tumors and also association between category of tumor and age at presentation. Methods: This Hospital record based cross-sectional (historical) study was carried out on 158 cases of ovarian tumors received in Department of Pathology, College of Medical Sciences and Teaching Hospital during a time period of five and a half years from January 2012 to June 2017. Results: Age of the patients ranged from 12 to 88 years with maximum cases 96 (60.8%) in 20 – 40 years age group. The mean±SD of age was 36.6±14.4 years. Majority of the cases 137 (86.7%) were benign. Sixteen (10.1%) cases were malignant and 5 (3.2%) cases were borderline. Majority of both benign and malignant cases were seen in 20 – 40 years age group. Size of the tumors ranged from 2 – 30 cm with mean±SD of 9.9±5.0 cm and maximum 93 (58.9%) cases in the size range of 5 – 10 cm. Majority of both benign and malignant tumors were in the size range of 5 – 10 cm. There was no association of age at presentation and size of tumor with behavior of tumor (p > 0.05). Sevety five (47.5%) cases were germ cell tumors, 72 (45.6%) cases were surface epithelial-stromal tumors, 9 (5.7%) cases were sex cord-stromal tumors, 1 (0.6%) was bilateral with surface epithelial tumor in right ovary and germ cell tumor in left ovary and 1 (0.6%) case was soft tissue tumor not specific to ovary. Majority of cases of germ cell tumors were seen below 40 years age whereas significant proportion of surface epithelial-stromal tumors was seen after 40 years with significant association between category and age at presentation (p < 0.05). Most common histopathological diagnosis overall was dermoid cyst in 43.7% cases. Conclusions: Benign ovarian tumors were more common than malignant ones. Malignancy was seen in all age groups and in any size tumor. Surface epithelial-stromal tumors and germ cell tumors were roughly equal in frequency with slight predominance of latter. Germ cell tumors were common in younger whereas surface epithelial-stromal tumors were more common in older individuals. Histopathological examination in any ovarian tumor at any age with any size is mandatory

Keywords: benign; borderline; germ cell; histopathology; malignant; ovarian tumor; surface epithelial-stromal; sex cord-stromal.

Effect of Air Pollutants on Peak Expiratory Flow Rate of Public Bus Drivers in Bhaktapur, Nepal

2019-05-21T11:16:56+00:00

DOI: https://doi.org/10.3126/jcmsn.v15i1.20753

Background: Rapid increase in number of vehicles in Kathmandu valley over past decade and never ending road expansion projects has aggravated air pollution. People involved in transportation jobs for long duration like bus drivers, conductors are more vulnerable to ill effects of air pollutants. The purpose of the present study was to assess lung function of public bus drivers exposed to outdoor air pollution by means of PEFR. Methods: Fifty healthy, non smoking bus drivers were selected randomly from bus parks of Bhaktapur district. Anthropological records were taken. PEFR value was obtained by Mini Wright’s peak flow meter. Their mean PEFR was compared with 50, age matched control group involved in other office works. Results: The PEFR value was significantly lower among bus drivers than the control group (p<0.001). Mean PEFR decreased with increasing age and increased duration of bus driving. Conclusions: Our study concluded that PEFR value among bus drivers who are exposed to air pollutants for long period of time was significantly reduced.

Keywords: air pollution; bus drivers; PEFR.

An In-Vitro Study on the Influence of Ceramic Thickness in the Color of Titanium Ceramic Restoration

2019-05-21T11:16:35+00:00

DOI: https://doi.org/10.3126/jcmsn.v15i1.19677

Background: Various factors such as metal alloy, thickness of the opaque porcelain, different methods of condensation of ceramic, thickness of the dentine ceramic, different ceramic firing condition affect the color of final ceramic restoration. It is not considered significant while taking single variable into account but several subtle changes in these factors lead to discernible color change. Purpose: The aim of this study was to evaluate the influence of ceramic thickness over color of ceramic layered on the titanium casting. Methods: Ultra low fusing ceramics of different thickness (0.5mm,1mm,1.5mm and 2mm) was veneered over a metal substrate of pure titanium and spectrophotometric analysis of 20 such discs was done to determine parameters (CIELAB system). One-way ANOVA and multiple comparison results of ANOVA were performed for statistical analysis. Results: The different thickness of ceramic significantly influences the ΔE value. There was significant change in the L* value (P<0.05) with different thickness of titanium metal ceramic tabs. There was also significant difference in C*ab values with different thickness of ceramic. Conclusions: The thickness of the ceramic has significant effect in the L* value of the titanium ceramic restoration. The thicker restoration appeared darker than the thinner one. There was also significant effect in the color saturation or chroma with different thickness of ceramic. Chroma decreased with increased thickness. Color difference between groups were significant. Overall thickness had effect on the final color of the titanium ceramic restoration.

Keywords: color difference ΔE; commercially pure titanium; low fusing ceramic; spectrophotometer.

Bacterial Load Reduction in Guheswori Sewage Treatment Plant, Kathmandu, Nepal

2019-05-21T11:16:11+00:00

DOI: https://doi.org/10.3126/jcmsn.v15i1.19914

Background: Water sources such as lakes, ponds, river etc. have been continuously contaminated by the micro organisms and chemicals. The former can pose a significant threat to human health. This work aims at detecting the bacterial load before and after the sewage treatment and hence isolating pathogens from the sewage before primary treatment and secondary treated effluent. Methods: Grab sampling (50mL sewage before primary treatment and secondary treated effluent) was performed for 20 days in the Guheswori sewage treatment plant. The reduction in microbial load was determined through heterotrophic plate count. Pathogens were screened from the effluent obtained from the secondary treatment plant. Results: Bacterial load reduction was found to be about 48.02% on average. The observed bacterial load reduction might have been caused by bacteriophage flocculation and sedimentation. Pathogens isolated from the treated effluent were Escherichia coli, Salmonella Typhi, Enterococcus faecalis, Staphylococcus aureus, Coagulase negative Staphylococcus (CONS), Citrobacter fruendii, Enterobacter aerogenes, Proteus mirabilis, P. vulgaris, Pseudomonas aeruginosa. Conclusions: It has been found that the sewage treatment plant helps to reduce the bacterial load which is, however, not capable of effluent polishing where all pathogens are killed.

Keywords: bacterial load; pathogens; sewage treatment.

Self-Medication Practices in Surrounding Communities of Birat Medical College and Teaching Hospital of Eastern Nepal

2019-05-21T11:15:45+00:00

DOI: https://doi.org/10.3126/jcmsn.v15i1.23021

Background: Self-medication is the use of drugs to treat self-diagnosed disorders/symptoms, or the intermittent/continued use of a prescribed drug for chronic/recurrent disease/symptoms (WHO). It is the cause for antibiotic resistance, inappropriate treatment, financial burden and many deaths. WHO listed self-medication as one of the priority research area at the local context. The objective of the study was to find the prevalence and pattern of self-medication in surrounding communities of Birat Medical College and Teaching Hospital. Methods: A community-based cross-sectional study was conducted at the surrounding communities of Birat Medical College from 1^st August 2018 to 15^th December 2018. Multistage sampling was used to collect information from 348 household having family members aged 16 years and above. Ethical approval was taken from Institutional Review Committee of Birat Medical College. Pre-tested semi-structured questionnaire was used. Results: The mean age of the participants was 40.5±15.9 years. Prevalence of self-medication was 44.04%. Majority took self-medication for headache 43.6% followed by common cold 39.1% etc. Majority used allopathic drugs 82.7% followed by traditional healers 9.8%. Common medication were antipyretics 18.8%, antibiotics 16.5%, proton pump inhibitor 7.5%, antihistamines 6.8% etc. The reason behind self-medication were low cost 30.1%, time saving 24.1%, illness too trivial/mild for consultation 18.8%, quick relief 18.1%, high doctor fee 15 %, lack of awareness 13.5 %, familiar with treatment options 12.8%, long waiting line in hospital 12% etc. Out of them 8.3% noticed side effects of self-medication. Out of all 59.5% felt the need of awareness program on rational use of medicines. Age, sex, marital status, ethnicity, religion, education and occupation of participants, education and occupation of head of household, poverty status, family type, house residence type, type of house has no significant association with self-medication. Participants residing in alani/rent households were 1.93 times more likely to self-medicate than those residing in their own and participants having negative attitude were 1.90 times more likely to self-medicate than those who had positive attitude and both were statistically significant. Conclusions: The burden of self-medication was present and allopathic drugs including antibiotics were common. Adverse drug reactions were reported but participants were unaware about the place to report. Participants had negative attitude towards self-medication which is harmful for their health. As pharmacy was the common source of self-medication, the prescription based medicine dispensary should be advocated.

Keywords: AMR; hospitals; Nepal; self-medication.

Pencil Grip Patterns of Students and Skilled Workers

2019-05-21T11:15:24+00:00

DOI: https://doi.org/10.3126/jcmsn.v15i1.19286

Background: Pencil grip can be defined via detailed descriptions of the variables constituting the grip and it commences in the preschool years with writing instruments and therefore relevant to graphologists, forensic medicine and anthropology. The purpose of this investigation was to describe the diversity of pencil grip patterns among students and skilled workers in Delta State, Nigeria. The research also aimed at determining the effects of sociodemographic factors, handedness,and handwriting speed on pencil grip patters. Methods: Stratified random sampling was employed in this cross sectional observational study. Five hundred and fourty three volunteers between the ages of 11-77 years were investigated. Students were observed while writing from their textbooks and skilled workers were observed writing from any available news paper. Photograph of the writing hand was captured with the digital canon camera. The data was analysed using the Statistical Package for Social Sciences (SPSS) 20. Kruska wallis test was used to establish relationship between pencil grip patterns and sociodemographic factors. Handwriting speed was determined by a speed score (letters per minute) and timed for 60 secounds for each participant. A self administered questionnaire was used to obtain data on sociodemographic factors. Results: This investigation demonstrates that gender had a significant effect on pencil grip patterns among secondary students (p<0.05)(K.W=7.54. df=1. p=0.01). Further observation showed that age and profession had a significant effect on pencil grip patterns among skilled workers at p<0.05 (K.W= 43.09,134.69 ,df=3,3, p=0.00,0.00). Conclusions: Findings from this investigation present the dynamic tripod grip as the most predominant grip pattern in the studied population.

Keywords: dynamic tripod, pencil grip, delta state, students, skilled workers

Preventive Practices of Tuberculosis Patients in a Municipality of Chitwan District, Nepal

2019-05-21T11:14:58+00:00

DOI: https://doi.org/10.3126/jcmsn.v15i1.23165

Background: Tuberculosis (TB) is one of the top 10 causes of death worldwide and sixth leading cause of death in Nepal. Preventing new infections of Mycobacterium tuberculosis is crucial to reduce TB burden and death. The source of infection is an open (sputum positive) case of pulmonary tuberculosis. Poor management of TB-related waste like disposal of sputum by patients has been reported as a risk factor for increasing susceptibility to active TB infection. The present study was undertaken to assess preventive measures practiced by TB patients. Methods: A cross-sectional study was conducted among 82 tuberculosis patients who visited the five different DOTs centres of Bharatpur Municipality of Chitwan district, Nepal during December 2016 to February 2017. To find the association between variables, chi-square test was used. P-value less than 0.05 were considered as statistically significant. Results:The Mean ± SD of age of patients was 37.02±18.90 years. 67.10% of the patients received health education on preventive measures. 59.8% of the respondents had good practice on prevention measures of TB. Only 3.70% used burning method for the sputum disposal after diagnosis of TB. None of the respondents used boiling method for the disposal of sputum. Among all only 6% practiced safe method of sputum disposal. The statistically significant variables with health education were preventive measures like self isolation (ᵪ2 = 7.54, p = 0.006), covering face while coughing and sneezing (ᵪ2 = 4.113, p = 0.043) and keeping surrounding clean (ᵪ2= 7.880, p = 0.005). Conclusions: Patients and family members should be well educated on practicing different preventive measures by further strengthening the preventive measures strategy in the transmission of tuberculosis if we envisioned to end TB by 2035.

Keywords: health education; preventive measures; preventive practices; sputum disposal; tuberculosis.

Knowledge and Acceptability of Cervical Cancer Screening among Adult Women Visiting in Gynecological OPD

2019-05-21T11:14:31+00:00

DOI: https://doi.org/10.3126/jcmsn.v15i1.21128

Background: Cervical cancer is the most common form of cancer among women developing countries. Pap smear is a very significant screening test for reduction of incidence and mortality from cervical cancer. The pap smear test detect precancerous cell change on the cervix that might become cervical cancer if they are not treated appropriately. The objective of this research is to find out the knowledge and acceptability of cervical cancer screening among adult women. Methods: A cross-sectional research design was conducted among 425 gynecological patients of Bharatpur hospital OPD of 30 to59 years of age. Semi structured questionnaire was used in data collection. Results: The mean age of participants was 40.07±7.9 years. Majority of the respondents, 247 (58.1%) had good knowledge in cervical cancer screening and 282 (66.4%) of the respondent accepted Pap smear test. Mean knowledge score on sign and symptom of cervical cancer was 62.1%, in risk factor was 72.8% and in preventive measure was 82%. Study showed the association between respondents knowledge of cervical cancer screening with educational status (p=0.04), religion (p=0.01) at 0.05 level of significance. There was association between respondents’ level of knowledge and acceptability of cervical cancer screening (p=0.02) at 0.05 level of significance. Conclusions: Majority of participant had never screened for cervical cancer, information get from health care provider was poor and acceptability rate is low. So the study recommends that health care provider should provide the information education and communication (IEC) at all level of delivery towards cervical cancer screening.

Keywords: acceptability; adult women; cervical cancer screening.

Management of Traumatic Inflammatory External Root Resorption

2019-05-21T11:14:02+00:00

DOI: https://doi.org/10.3126/jcmsn.v15i1.22238

Inflammatory external root resorption is one of the major complications after traumatic dental injury. It is characterized by the loss of mineralized dental tissue which may, ultimately, result in loss of the tooth. However, with appropriate treatment, prognosis for these teeth may be greatly improved, by preventing or arresting resorption. This is a case report of an 18-year-old male patient presented with root canal treated maxillary central incisors associated with pain; with history of trauma. Radiographic examination revealed periradicular lesion and associated pathologic resorption of the apical region of the root with respect to 11 and calcification of the root canal with inadequate obturation with respect to 21. After removal of the root canal filling, 11 was disinfected with intracanal double antibiotic paste. After 2 weeks, antibiotic dressing was removed, and apical third was sealed with mineral trioxide aggregate (MTA). Canal was obturated with custom-fit gutta-percha and accessory cones with AH plus sealer and restoration was done with composite resin. Retreatment was also done with respect to 21 and obturated with custom-fit gutta-percha. Both teeth were restored with E-max crown. No clinical symptoms were apparent, significant osseous healing of the periradicular region was observed with arrest of external root resorption with respect to 11 and no periapical changes were apparent with respect to 21 on subsequent follow-up.

Key words: double antibiotic paste; external root resorption; mineral trioxide aggregate.