Janaki Medical College Journal of Medical Science

A teacher is not just a teacher

Satyam Prakash — 2019-05-30

DOI: https://doi.org/10.3126/jmcjms.v6i02.22066

No Abstract

Use of local corticosteroid injection in the treatment of plantar fasciitis

Deb Narayan Sah — 2019-05-30

DOI: https://doi.org/10.3126/jmcjms.v6i02.22054

Background and Objectives: Plantar fasciitis is a common pathological condition that affects the hind foot. Management of plantar fasciitis employs use of various non-surgical and surgical treatment methods. The aim of this study was to evaluate the efficacy of steroid injection in the treatment of plantar fasciitis in adults.

Materials and Methods: From January 2016 to June 2017, fifty patients aged >18 years with plantar fasciitis symptomatic for three months or more were injected with a single dose of methylprednisolone acetate with 2% lignocaine. Assessment was done using visual analogue scale (VAS) and foot function index (pain sub-scale). Patients were followed-up for a period of 6 months.

Results:There was significant reduction in VAS score and improvement in foot function index at 1 and 3 month follow-up (p<0.001) as compared to pre-injection score but this VAS reduction or improvement in foot function index was not significant at 6 month follow-up (p=0.057 and 0.729 respectively). There were no major adverse effects of the steroid injection.

Conclusion: A single dose of corticosteroid injection provides only a short term benefit in plantar fasciitis.

Keywords: Plantar fascilitis, Steroid, Injection

Eclampsia at a tertiary care hospital of Nepal: A five year study

Shraddha Rana — 2019-05-30

DOI: https://doi.org/10.3126/jmcjms.v6i02.22056

Background and Objectives: Eclampsia poses a global threat in terms of feto-maternal morbidity and mortality and all medical practitioners fear the ailment. It is one of the major causes behind preventable maternal death. Etio-pathogenesis of the disease condition is ambiguous and is considered to be multi-factorial. This study was done to analyze cases of eclampsia in relation to maternal and fetal outcomes at a tertiary level care hospital.

Materials and Methods: A descriptive cross-sectional observational study was carried out in patients developing eclampsia over a period of five years starting from July 2011 to June 2016 at National Medical College and Teaching Hospital, Birgunj. Relevant data were collected from the statistics section of hospital reviewing the case sheets.

Results: There were 291 cases of eclampsia out of 16,445 deliveries and prevalence of eclampsia was calculated to be 1.77%. Fourty-five percent of eclamptic women had age less than 20 years and two-third was primigravida. Approximately 84% of women were unbooked. Antepartum eclampsia was observed in 78.8% followed by postpartum eclampsia (14.8%) and intrapartum eclampsia (6.5%). At the time of admission systolic blood pressure more than 140 mmHg and diastolic blood pressure more than 90 mmHg were noted in 79% and 92.1% cases respectively. Caesarean section was the preferred mode of delivery and was performed in 62.9% cases. ICU admission was required in 35.7% and remaining cases were managed in general/eclampsia ward. Renal failure was the most common cause of maternal mortality seen in 29.4%. Still birth was noted in 13.4%.

Conclusion: Institutional obstetric patients are gradually facing eclampsia as prime cause of maternal death and unfortunately most of the cases are primigravid at younger age. All health care professionals should be proficient to manage eclamptic women instantaneously.

Key words: Eclampsia; Fetal Mortality; Maternal Mortality; Pre-Eclampsia

Estimation of ulna length as a predictor of height in Nepalese female adult population: An anthropometric study

Rajendra Prasad Sah — 2019-05-30

DOI: https://doi.org/10.3126/jmcjms.v6i02.22057

Background and Objectives: Stature estimation has a valuable importance for the anatomist, anthropologist and the forensic experts. Long bones are usually used for the estimation of individual height for the said purpose since 1952. The purpose of this study is to formulate a linear regression equation for the estimation of the stature of living female adult population from the length of ulna.

Materials and Methods: This research was conducted at M.B. Kedia Dental College Birgunj on 150 subjects who were chosen from among the patients and their attendants in the OPD. The height was measured from the crown to the heel and the length of the ulna was measured from the tip of the olecranon process to the tip of the styloid process. The recorded data was calculated by the standard statistical software.

Results: The correlation coefficient (r) was found to be 0.55(p<0.001) for the left ulna with stature and it was 0.463 (p<0.001) for the right ulna with stature after analyzing the data. Supportive regression equations and scatter-plot diagrams could successfully interpret the height from the ulnar length of the population.

Conclusion: The ulna length can be used for estimating the height of an individual. The regression equation which were proposed in this study will be useful for forensic esperts, clinicians, anatomists, archeologists, and anthropologists . Such evidence provides the investigator to gauge that aspect of an individual’s physical description.

Keywords: Forensic experts, Height, Stature, Ulna

Outcome of ureteric stone treatment with tamsulocin

Rakesh Kumar Pandit — 2019-05-30

DOI: https://doi.org/10.3126/jmcjms.v6i02.22058

Background and Objectives: Though medical expulsive therapy for ureteric stones is increasingly used these days, some recent randomized controlled trials have questioned its benefit. This study evaluates the result of treatment of ureteric stones with tamsulosin.

Materials and Methods: This prospective study involved ultrasonographically confirmed cases of uncomplicated unilateral ureteric stones. All patients received tamsulocin 0.4 mg daily for 2 to 6 weeks. The primary end point was stone expulsion. The secondary endpoints were the use of analgesics and adverse events.

Results: One hundred and sixty two patients completed the study. Ninety seven patients were male and male to female ratio was 3:2. The mean age was 34.9 ± 9.8 (range: 18-71) years. The mean stone size was 6.17 ± 1.68 (range: 3.3-11.2) mm. By the end of 2, 4 and 6 weeks, cumulative stone expulsion rate was 110 (69.1%), 121 (74.7%) and 126 (77.8%) respectively. For the 49 stones of size £ 5 mm, the expulsion rate was 47 (95.9%) by the end of 6 weeks. The expulsion rates for stones of size > 5 - 7 mm, > 7 – 9 mm and ³ 9 mm were 59 (85.5%), 17 (53.1%) and 3 (25%) respectively by the end of 6 weeks. Lower ureteric stones had the highest expulsion rate of 106 (87.6%) by the end of 6 weeks, and the rate was lowest for upper ureteric stones (34.6%). Ten (6.1%) patients required additional analgesics during the course of treatment. Eleven (6.8%) patients complained of mild light-headedness and dizziness which subsided in a few days.

Conclusion: Tamsulocin appears to facilitate expulsion of ureteric stones especially the distal ones. The benefit of tamsulocin seems to be maximum for the stones of size up to 9 mm. Further large scale randomized controlled trial should better define the real benefit and more rationale use of tamsulocin in routine clinical practice.

Keywords: Medical expulsive therapy, Tamsulocin, ureteric calculi

Microbial air contamination with air borne bacteria in the outdoor environment at Janakpurdham, Nepal

Nagendra Prasad Yadav — 2019-05-30

DOI: https://doi.org/10.3126/jmcjms.v6i02.22059

Background and Objectives: Bacteria can cause allergic asthma and seasonal allergies, diseases which are increasingly prevalent in developing nations. Allergic asthma is currently affecting millions of people in Nepal. Therefore, the objective of this study was designed to measure the bacterial load in outdoor air.

Materials and Methods: Airborne outdoor bacteria were assessed during the spring season using conventional methods to investigate the enumeration of airborne microorganisms. This was determined by sampling air using the ‘settle plate technique’. The air samples were collected during the spring season (February-March) from 10 different areas of Janakpur. Counts of airborne bacteria were measured as CFUs collected by gravity onto Nutrients Agar plates. Samples were taken periodically over a period of 2 months of February and March 2017.

Results: A total of 7,404 bacterial colonies were counted on 30 Petri plates that were exposed for 1 hour. The maximum number of colonies of bacteria was 412. Similarly, the least number of bacterial colonies was 32. Higher numbers of CFUs were found in the petri plates which were exposed for 1 hour in comparison to the petri plates which were exposed for 30 minutes. According to the measurement, 36.6% of total CFUs of bacteria were collected during morning hours, 28.4% during day time and 35% during evening hours. Also, the highest numbers of colonies of bacteria were found in the petri plates that were exposed in ward number 7 and the least number of bacterial colonies were obtained in ward number 9.

Conclusion: The bacteriological quality of air in janakpur was very poor. Very high microbial load was found in the outdoor air in Janakpur. The microbial count was found higher in morning than the noon and evening.

Keywords: Airborne, Colony forming unit, Microorganism, Settle plate

Effectiveness of reminiscence therapy on health related quality of life among the old age people residing at a selected old age home, Bengaluru, India

Lata Kusum Shah — 2019-05-30

DOI: https://doi.org/10.3126/jmcjms.v6i02.22060

Background and Objectives: The well being of oneself, happiness with one’s situation in life and ability to perform and control the different situation of life is HRQoL. Reminiscence therapy is a way for residents of assistant living facilities to become better acquainted with one another and strengthen the personal value and self esteem. The objective of this study was to assess the HRQoL while application of Reminiscence Therapy among the old age people who are residing at a selected old age home in Bengaluru, India.

Materials and Methods: For this study quasi experimental research design was selected and convenient sampling technique was used to collect data from 60 samples staying at old age home by using the SF-36 scale. The samples in experimental group receive 10 sessions of reminiscence therapy each session last for 45 minutes to 1 hour. The experimental group was divided into 6 groups each group having five members for group discussion related to the topics like childhood memories, education pattern, first job and first salary, marriage, first child etc. Post test data was collected after a week of implementation of Reminiscence Therapy. Then the data was analyzed and interpreted.

Results: The findings of the study with regard to pretest HRQoL reveals that 86.7% has poor HRQoL, 13.3 % moderate HRQoL and no one was having good HRQoL in experimental group. In control group 56.7% has poor HRQoL, 43.3% moderate HRQoL and no one was having good HRQoL. But in posttest, only in experimental group there was significant improvement in HRQoL as 83.3% has good HRQoL, 13.3% moderate HRQoL and 3% poor HRQoL.

Conclusion: This study concluded that with significant improvement in the SF-36 Scale score after administration of the reminiscence therapy and seen improvement in HRQoL.

Keywords: Health Related Quality of Life (HRQoL), Old age home, Old age people, Reminiscence Therapy

A correlation of trans cerebellar diameter by ultrasonography and gestational age in second and third trimester

Ankur Shah — 2019-05-30

DOI: https://doi.org/10.3126/jmcjms.v6i02.22090

Background and Objectives: Increased perinatal mortality incidence has been seen amongst patients whose precise gestational age is unknown. Trans cerebellar diameter is a newer parameter in the estimation of gestational age. Therefore, the present study was conducted with the aim to determine the accuracy of trans cerebellar diameter in predicting gestational age during second and third trimester of pregnancy.

Materials and Methods: The present study was conducted in the Mithila Hospital,Janakpurdham for a period of 1 year. The study included a total of 160 females with singleton pregnancies during their 2^nd or 3^rd trimester. The characteristic butterfly appearance of the cerebellum hinted the location of posterior fossa. All the data was arranged in a tabulated form and analyzed statistically. Data was expressed in the form of mean with standard deviation. SPSS software16 was used for the analysis of the data.

Results: The present study enrolled 160 subjects, out of which 80 were in their second trimester and 80 were in their third trimester. The mean transcerebellar diameter of subjects in second trimester was 20.22±4.87 and it was 36.01±2.89 amongst subjects in their third trimester. As the gestational age advances, the transcerebellar diameter also increases with it in a linear manner.

Conclusion: Transcerebellar diameter can be used as a reliable parameter to estimate the gestational age and is also not altered in cases of intrautering growth restriction.

Keywords: Gestational age, Trans cerebellar diameter, Ultrasonography

Challenges in conducting small group sessions in pharmacology – a Caribbean perspective

Pathiyil Ravi Shankar — 2019-05-30

DOI: https://doi.org/10.3126/jmcjms.v6i02.22091

Background and Objectives: Offshore Caribbean medical schools (OCMS) face various challenges with regard to learning practical and prescribing skills in pharmacology. These challenges range from short curricular time, low number of faculty, problems with early clinical exposure and geographically separated clinical sites.

Materials and Methods: The author highlights these challenges using his personal experience and articles from the published literature. The search terms used were pharmacology, Caribbean, medical students, prescribing skills and medical schools.

Results: Among the problems mentioned are lacunae in the teaching-learning of prescribing skills, teaching pharmacology as a discipline during a particular semester, excessive focus preparing students for licensing exams, low number of faculty, shortage of time, challenges with providing early clinical exposure, problems with assessing skills, lack of integration with essential medicines and standard treatment guidelines, among others.

Conclusion: There are a number of challenges in teaching pharmacology and therapeutics in OCMS. Most schools concentrate on the theoretical aspects of pharmacology which are tested during the licensing exams.

Keywords: Caribbean, medical schools, pharmacology, practical, prescribing skills

Feedback of the participants on assessment sessions conducted in faculty development training at National Center for Health Professions Education Nepal

Rano Mal Piryani Piryani — 2019-05-30

DOI: https://doi.org/10.3126/jmcjms.v6i02.22092

Background and Objectives: It is essential for health professions educators to be cognizant and coached on what level, assessment is being conducted according to Blooms Taxonomy or Miller’s Pyramid and trained to conduct assessment. The objective of this study was to take feedback of the participants on sessions of assessment.

Materials and Methods: Six-hours assessment sessions conducted in faculty development training organized by National Centre for Health Professionals Education, Tribhuvan University Institute of Medicine, Kathmandu Nepal in August 12-17, 2018. Principal author conducted three sessions (2 hours each)- 1) educational evaluation & assessment and fundamentals of assessment, 2) assessment of knowledge & understanding and 3) OSCE and OSPE in training. The methods utilized were tutorial, brainstorming and activity based small group work. Feedback 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 of seven schools. The participants rated assessment sessions on scale of 1-10 (1= poor, 10= excellent) for usefulness (8.42 ± 1.53), content (8.08 ± 1.61), relevance of session & content (8.50 ± 1.53), facilitation (8.00 ± 1.56) and overall (8.42 ± 1.31). They gained confidence for developing blueprint for assessment (2.96±0.86), developing MCQs (3.67±0.76), developing SAQs (3.42±0.93), constructing OSCE/OSPE (2.92±0.97) and conducting OSCE/OSPE (2.92±0.77) rated at Likert scale1-5 after participating in training. Sufficient number of participants suggested to allocate more time for assessment sessions and increase time for group work.

Conclusion: It is noticed that participants recognize and acknowledge the importance of assessment and their confidence level has increased for developing blueprint, MCQs, SAQs, OSCE/OSPE and conducting OSCE/OSPE examination.

Keywords: Assessment, Faculty development training, feedback, health professional education, Nepal