Journal of Kathmandu Medical College

Capacity building: A missing piece in Nepal’s plan for prevention and control of non-communicable diseases

Abhinav Vaidya — 2019-05-26

DOI: https://doi.org/10.3126/jkmc.v7i4.23295

Not available.

Keywords: non-communicable diseases, prevention and control

Prospective randomized controlled trial comparing the functional outcome of olecranon osteotomy versus triceps tongue elevation for surgical exposure of distal humerus in adults

Asish Rajak — 2019-05-26

DOI: https://doi.org/10.3126/jkmc.v7i4.23296

Background: Fractures of the distal end of the humerus are difficult to treat. The goal of treatment is to achieve a stable, painless elbow with early adequate range of motion. They are operated mainly by posterior approach among which olecranon osteotomy (bony component violation) and triceps tongue elevation (soft tissue component breach) were used in this study.

Objectives: The aim of this study was to compare olecranon osteotomy and triceps tongue elevation in terms of functional outcome (Mayo elbow performance index), rates of complications and others.

Methodology: A randomized control trial was conducted including 39 eligible adults (20 in triceps tongue elevation and 19 in olecranon osteotomy group) presenting to B.P. Koirala Institute of Health Sciences during the study period of 12 months duration. All skeletally mature adult patients with isolated traumatic closed intra-articular or distal end fracture of humerus without distal neurovascular deficit were included. Patients with polytrauma, refractures, compartment syndrome and patient not giving consent were excluded from the study. They were operated and followed up at 2, 6, 12 and 24 weeks.

Results: The demographic profiles of the two groups were comparable. There was significant difference between the intraoperative time between the two groups (p=0.009). At final follow up, there were no significant differences in functional outcome and complications.

Conclusion: The approaches are comparable in terms of union, post-operative function and complications. There was increased intraoperative time in the olecranon osteotomy approach suggesting that patients who cannot tolerate longer intraoperative time may benefit from triceps tongue elevation approach.

Keywords: Mayo elbow performance index, Olecranon osteotomy, Triceps tongue elevation

Changes in children’s diet and physical activity as perceived by their mothers: Impact of a health promotion intervention for mothers in a sub-urban area of Nepal

Natalia Oli — 2019-05-26

DOI: https://doi.org/10.3126/jkmc.v7i4.23298

Background: Unhealthy diet and physical inactivity contribute to the growing burden of cardiovascular diseases in Nepal. Lifestyle is formed in childhood and in the Nepalese context influenced mainly by mothers, it is to date unknown how influential mothers are.

Objectives: To assess changes in children’s diet and physical activity as perceived by their mothers after a health promotion intervention.

Methodology: The Heart-Health Associated Research, Dissemination and Intervention in the Community is a community trial conducted in the Jhaukhel-Duwakot Health Demographic Surveillance site, in Bhaktapur district of Nepal. We conducted a health promotion intervention on diet and physical activity targeted at mothers with children aged one to nine years old in August-November 2016. Duwakot was randomized as the intervention site and Jhaukhel as the control. We conducted a follow-up study after three months to determine the outcome of the intervention. Nine trained enumerators conducted door-to-door visits to all households with eligible mothers. We calculated mean, frequency and

percent changes for children’s behavior.

Results: As responded by mothers, children in Duwakot consumed more healthy snacks after the intervention compared to Jhaukhel. Children in Duwakot increased consumption of water and milk. Children’s consumption of packet juices and soft drinks was decreased by 30% and 4% respectively. There was 21% increment in the duration of outdoor playing among the children at Duwakot during follow-up.

Conclusion: The Heart-Health Associated Research, Dissemination and Intervention in the Community that focused on mothers showed indirect positive impact on their young children’s diet and physical activity behavior. In future, the longterm effects of such intervention should be assessed.

Keywords: Behavior, Children, diet, Health promotion, Physical activity

Twin block appliance: Effect on pharyngeal airway

Vivek Bikram Thapa — 2019-05-26

DOI: https://doi.org/10.3126/jkmc.v7i4.23299

Background: Mandibular retrusion is the main cause of Skeletal Class II malocclusion characterized by skeletal retrusion of mandible with skeletal or dentoalveolar protrusion of maxillary.

Objectives: This study was conducted to evaluate effect of treatment with twin-block appliances on pharyngeal dimensions.

Methodology: This study was conducted in in the Department of Orthodontics & Dentofacial Orthopedics in Kathmandu Medical College. Twenty patients of age group 7 to 14 years with skeletal class II malocclusion with mandibular retrusion were selected. Variables evaluated were depth of nasopharynx; height of nasopharynx; depth of oropharynx; depth of hypopharynx; soft palate length; soft palate thickness and soft palate inclination. The lateral cephalograms were obtained for all subjects before the start of treatment and after a follow-up period of approximately three months in treatment.

Results: Results showed that depth of nasopharynx increased by 1 mm, height of nasopharynx increased by 0.78 mm, depth of nasopharynx increased by 1.97 mm, depth of hypopharynx increased by 0.79 mm, soft palate length decreased by 4 mm, soft palate thickness increased by 2 mm and soft palate inclination decreased by 7.01 mm. The results for depth of pharynx and soft palate thickness were statistically significant.

Conclusion: This study concluded that the use of twin block appliance for class II patients corrects sagittal dimension of oropharynx and hypopharynx. Early intervention for mandibular retrognathism in class II malocclusion helps enlarge the airway dimensions and decrease potential risk of obstructive sleep apnea syndrome for growing patients in the future.

Keywords: Airway dimension, Class II malocclusion, twin block appliance

Patterns of partial edentulism based on Kennedy’s classification among patients reporting to Nepal Medical College and Teaching Hospital

Samskar Bickram Rana — 2019-05-26

DOI: https://doi.org/10.3126/jkmc.v7i4.23313

Background: Edentulism is a sequel of tooth loss which leads to impairment of normal function, comfort, aesthetics and speech. It also leads to various undesirable consequences like occlusal discrepancies, migration and spacing of surrounding teeth, supra eruption, loss of space, temporomandibular disorders and other unwanted changes. Little is known about the prevalence of patterns of edentulism in Nepal.

Objectives: To assess the prevalence of Kennedy’s classification on partially edentulous patients.

Methodology: A prospective cross-sectional study was carried out among 300 patients within the age of 18-80 years visiting the Department of Oral Medicine and Radiology, College of Dental Science and Hospital -Nepal Medical College with at least one missing tooth from Jan 2018-March 2018.

Results: Out of 300 patients enrolled, a majority were female (178; 59.3%). The patients mostly affected by partially edentulous condition were among the age group of 51 to 60 years (78; 26%). The distribution of partially edentulous areas were similar in maxillary (80; 26%) and mandibular (85; 28.3%) arches and 45% of the patients (n=135) had one or more missing tooth/teeth on both arches. Kennedy’s class III was found in more than 31% of the patients (n=94) in the maxillary arch and 30% (n=91) in the mandibular arch. Likewise, Kennedy’s class III with modification 1 was seen in 21% (n=62) cases in the maxillary and 24% (n=72) cases in the mandibular arch.

Conclusion: Kennedy’s class III and Kennedy’s class III with modification 1 were the most common type of pattern of partially edentulous area on both arches.

Keywords: Applegate rule, Kennedy’s class, Partial edentulism

Awareness and involvement of fathers in care of their under five children in Jorpati, Kathmandu: A cross Sectional Study

Sabitra Poudel — 2019-05-26

DOI: https://doi.org/10.3126/jkmc.v7i4.23316

Background: Children are not just mini human creatures, they are different entities and have unique need for care, nourishment, play, interaction and harmonious environment. Both parents are equally responsible for providing such environment for optimum growth and development of children. Involvement of fathers in care not only promotes their physical development but also fosters social, cognitive, language and motor development.

Objectives: To assess the awareness and involvement of fathers in care of their under five children.

Methodology: A community based cross sectional study was conducted at Anandanagar tole Gokarneshwar Municipality-8 Jorpati among 128 fathers with children under five years of age. Information was collected through face to face interview using structured questionnaire consisting of statement regarding awareness and involvement in care of their under five years children. Data analysis was done by using statistical package for social science version 16.

Results: Majority (60.1%) of the fathers had average level of awareness about child care. Regarding involvement, 44.5 % of the fathers had poor involvement followed by average involvement i.e. 41.4% in physical care. Around two third (68.9%) of the fathers showed average involvement in psychological and intellectual developmental activities of their children.

Conclusion: This study shows that though most of the fathers had average awareness regarding childcare, their involvement in the same was less especially in physical care activities.

Keywords: Awareness, Involvement of fathers, Care of child

Prevalence of work related musculoskeletal disorders among canteen staff of Kathmandu University

Nishchal Ratna Shakya — 2019-05-26

DOI: https://doi.org/10.3126/jkmc.v7i4.23318

Background: Work related musculoskeletal disorders are common complaint at workplace and is a leading cause of illness. A kitchen worker’s work consists of continuous long standing hours, awkward positions, lifting heavy loads and repetitive activities. The prevalence of musculoskeletal disorders is related to demographic factors, occupational, psychosocial factors and ergonomic risk factors at workplace. Canteen staffs are considered to be at higher risk of having musculoskeletal disorders.

Objectives: To evaluate the prevalence of work related musculoskeletal disorders among the canteen staffs of Kathmandu University and to find association between risk factor and musculoskeletal disorders among the canteen staffs.

Methodology: We carried out a cross-sectional descriptive study interviewing 40 participants for filling the demographic data and the standardized Nordic questionnaires for assessing the prevalence of musculoskeletal disorders among the canteen staffs of Kathmandu University. Data were analyzed using Statistical Package for the Social Sciences version 16.

Results: We found that out of 40 participants, 60% reported having at least one work related musculoskeletal symptoms in the past 12 month. Back pain (35%) was most commonly reported disorder followed by neck (27.5%) and ankle pain (27.5%).

Conclusion: Prevalence of work related musculoskeletal disorder among the canteen staffs of Kathmandu University was found to be high. So it is essential to take necessary steps to minimize musculoskeletal disorder and develop preventive strategies.

Keywords: Canteen, Musculoskeletal disorder, Nordic questionnaires

Bronchoscopy and fine needle aspiration cytology aided diagnosis of suspected lung malignancy- A prospective observational study

Subash Pant — 2019-05-26

DOI: https://doi.org/10.3126/jkmc.v7i4.23320

Background: Flexible bronchoscopy is the main modality of diagnosing lung malignancy as per the location of lesion in our setup. Accurate diagnosis and categorization into various types is vital for its prognostic and management point of view.

Objectives: The study was conducted to find out yield of bronchoscopy and FNAC in suspected lung lesion and to know the various subtypes of bronchogenic carcinoma.

Methodology: The study was conducted in Kathmandu Medical College Teaching Hospital from December 2016 to May 2018. This was a prospective observational study conducted in 90 radiological suspected lung lesions. Radiological, bronchoscopy, histopathological and cytopathological findings were analyzed and evaluated. Data were recorded on a pre-designed proforma and entered into Statistical Package for the Social Sciences version 20.

Results: Among 90 suspected lung lesions who underwent contrast enhanced computed tomography, chest mass lesion was seen in 57(63.3%) subjects, nodular in 8 (8.9%), consolidation in 7 (7.8%), fibrosis in 7 (7.8%), collapse in 6 (6.7%) and pleural effusion in 3 (3. 3%).The most common malignancy was squamous cell carcinoma (53.48%). Lung malignancy was more common among endobronchial growth. The tendency of lesion to be malignant however tended to be significant at right upper lobe (p=0.02). When the suspected lesion was mass, the occurrence of malignancy was significantly higher (p<0.05).

Conclusion: The diagnostic yield increases with presence of right upper lesion with endobronchial growth. When the lung lesion presents as mass, the yield of having malignancy is also higher.

Keywords: Bronchoscopy, Histopathology, Lung malignancy

Comprehensive study of ovarian tumours in Kathmandu University Hospital

Suman Raj Tamrakar — 2019-05-26

DOI: https://doi.org/10.3126/jkmc.v7i4.23322

Background: Ovarian tumours account for 15% to 25% of all primary malignancy and the leading cause of death from gynaecolgical malignancies. There are limited publications related to ovarian tumours from Nepal. Ovarian related surgeries are the common surgeries in Kathmandu University Hospital. This study aims to provide basic information related to ovarian tumours from this geographical region of Nepal.

Objectives: To review the nature of ovarian problems and certain socio-demographic information namely: caste, age, address and co-morbid condition of the patients presenting with ovarian problems.

Methodology: This is a retrospective study of patients seeking surgical treatment of ovarian lesions in Kathmandu University Hospital from January 1, 2011 to June 30, 2018. This study was undertaken by reviewing the inpatient, outpatients and OT records in the Department of Obstetrics and Gynaecology and the records from Department of Pathology. All the files and computer records were reviewed and analyzed for nature of ovarian problems and certain demographic variables.

Results: Out of the 860 cases, about 61% were non-neoplastic while benign ovarian tumours and malignant ovarian tumours were 35% and 3.7 % respectively. Almost one third of the cases were of Brahmin/Chhetri (37.3%) and 58.3% of the patients were from Kavre district. Mean age of the patients with ovarian problems was 34.89±11.15 years (range 12-72 years). There was no statistically significant difference between the mean age of patients with non-neoplastic ovarian lesions and neoplastic ovarian lesions (p value = 0.3371). There was statistically significant difference between the mean age of patients with benign ovarian tumours and malignant ovarian tumours (p value = 0.0001). And malignant ovarian tumours were significantly high among patients above 41 years in comparison to benign ovarian tumours of same age group (p value = 0.0008). Out of 32, ten malignant ovarian tumours occurred in relatively young age group. Of the 860 ovarian lesions, 438 and 422 ovarian lesions were removed through open technique and laparoscopic techniques respectively. Mature cystic teratoma (64.1%) was the commonest benign tumor and serous cyst adenocarcinoma (43.8%) was the commonest malignant tumour in this study.

Conclusion: Ovarian tumours are one of the gynaecological diagnoses in Kathmandu University Hospital. If only ovarian neoplasms are considered, most of the ovarian tumours are benign and few are malignant. Minimal invasive surgeries are possible, except that for malignant ovarian tumours.

Keywords: Adenocarcinoma, Laparoscopy, Ovarian tumour

Knowledge regarding HIV/AIDS among Armed Police Force – Banke, Nepal

Roshan Kumar Roy — 2019-05-26

DOI: https://doi.org/10.3126/jkmc.v7i4.23323

Background: A global pandemic threat HIV/AIDS is a matter of concern for developing countries like Nepal. The first case was identified in July 1988 and later became epidemic and then concentrated epidemic among risk group for HIV. Several studies reflected that HIV is associated with many factors among which literacy rate and socio-economic conditions hold the highest rank. Armed Police Force of Nepal are generally with less educational background and very few with higher educational status are at higher level. Thus knowledge regarding HIV/AIDS among this group needs to be assessed.

Objectives: The overall objective of our study was to assess knowledge regarding HIV/AIDS among Armed Police Force in Banke, Nepal.

Methodology: A cross-sectional descriptive study with population size of 295 Armed Police Force was performed which covered the entire population of an Armed Police Force camp in Banke starting from 18th June to 27th July, 2018. A pretested questionnaire containing structural, semi-structural and open ended questions were made as data collection tool. All the soldiers in Armed Police Force camp were interviewed after receiving consent as an ethical clearance.

Results: All 295 armed police forces of our study were aware about HIV/AIDS mainly via mass media (83%). One hundred and fifty eight respondents still did not know about availability of its treatment. Misconception about its complete cure and vaccination was seen in 23 (7.79%) and 61 (20.67%) respondents respectively. Two hundred and one respondents were found knowing about the free health services by government. 287 (97.28%) respondents knew certain things about prevention. Twenty four respondents admitted of having multiple sex partners and only 19 (79.16%) among them used preventive measure.

Conclusion: Though all the respondents of our study had known about HIV/AIDS, still they had misconception regarding its treatment and prevention. Many respondents did not even know about the free health services of government. Few of them still do not use any preventive measure.

Keywords: Armed Police Force, HIV/AIDS, Knowledge, Misconception, Prevention

A case report on an unusual degeneration of uterine leiomyoma: Myxoid degeneration

Rupa Paneru — 2019-05-26

DOI: https://doi.org/10.3126/jkmc.v7i4.23325

Background: Leiomyomas are benign smooth muscle neoplasm that typically occurs from the myometrium. Most of the women with uterine leiomyoma remain asymptomatic. Various degeneration including hyaline, cystic, myxoid and red degeneration and dystrophic calcification occur in leiomyoma, among them myxoid degeneration occurs rarely. Here is a case report of 40 years with one living child and two abortions who came with complaints of feeling of heaviness and pain at lower abdomen for six months, palpable lower abdominal mass for four months and difficulty in passing urine since 15 days. Multiple fibroids with cystic degeneration were suspected in Computed Tomography scan report. The patient underwent Total Abdominal Hysterectomy with Bilateral Salphingectomy. On cut section there was a cystic area on the body of uterus containing 1. 1 liter of straw coloured fluid. Final histopathological findings concluded multiple leiomyoma with myxoid degeneration.

Keywords: Degeneration, Leiomyoma, Myxoid

Do-Not-Resuscitate (DNR)

Rano Mal Piryani — 2019-05-26

DOI: https://doi.org/10.3126/jkmc.v7i4.23327

Do-Not-Resuscitate (DNR) is well conceptualized, understood and implemented in developed countries in comparison to developing countries. DNR, DNAR (Do-Not-Attempt-Resuscitation), and AND (Allow-Natural-Death) are the same instructions or orders with an equal meaning. DNR is a therapeutic decision made before incident of cardiac or respiratory (cardiopulmonary) arrest with the consent of patient, or proxy consent of next of kin or authorized person if patient is not competent and sound. In this case, healthcare professionals provide no requisite CPR (Cardiopulmonary Resuscitation) without stopping any degree of normal care and therapy given to the patient. It is essential to consider who should discuss the DNR status and with whom, what and when it should be discussed, how should discussion be done and documented and who shall sign the DNR consent. Documentation in the patient’s medical record of a decision with regard to DNR and not to perform CPR must be incorporated both in clinician’s order and in the progress notes of the patient. The Nepal Medical Council’s guidelines for DNR are very clear and well spelt out but the implementation process is not documented. Healthcare decision must be taken on ethical ground besides clinical and technical ground. Healthcare professionals must be trained to become ethically competent. To effectively use and prevent misuse of DNR order, health professional must be educated about DNR.

Keywords: Allow-Natural-Death (AND), Cardiopulmonary Resuscitation (CPR), Do-Not-Attempt-Resuscitation (DNAR), Do-Not-Resuscitate (DNR), Healthcare Professionals