Browsing by Author "Bhusal, M"
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Publication Acquisition of history taking, physical examination and communication skills through early clinical exposure among pre-clinical students(Institute of Medicine, 2015) Khanal, S; Bhusal, M; Sigdel, MR; Bajracharya, SRAbstract Introduction: Early Clinical Exposure (ECE) has been shown to be an effective method in teaching history-taking, physical examination and communication to pre-clinical students. Medical students in their preclinical years at IOM, MMC have been undergoing two year ECE course since 1978, but there is no provision of formative and summative assessment to check its effectiveness. This cross-sectional study was undertaken to fill this gap in evidence. Methods: A 17-station Objective Structured Clinical Examination was administered to 17 pre-clinical students. Of the 17 stations, seven, six and four stations were designed to test their skills in history- taking, clinical-examination and communication domains respectively. Modified borderline regression method was used to calculate the pass-marks for each station. The pass-marks of all the stations were averaged to determine the pass-marks for the entire OSCE. Results: One student passed the entire OSCE whereas four and eight students passed the history taking and communication skills domains; while none could pass the physical examination skills domain. Repeated measure one-way Analysis Of Variance (ANOVA) and post-hoc test using the Bonferroni correction showed that scores in history taking (M = 44.36, SD = 11.09) and communication skills (M= 44.40, SD = 12.12) were significantly better than in physical examination (M = 29.35, SD = 10.50), (p < 0.001 and p = 0.007, respectively). Conclusions: Despite enormous teaching hours allocated to the ECE course, pre-clinical students’ performance in an OSCE did not meet the expectation of the curriculum suggesting that the ECE course at MMC, IOM is not fulfilling its objectives. Keywords: Communication, early clinical exposure, medical history taking, physical examination, medical educationPublication Association of Allergic Biomarkers in Patients with Chronic Rhinosinusitis With or Without Asthma(Kathmandu University, 2025) Pangeni, RP; Pokharel, M; Vaidya, N; Sapkota, P; Karki, S; Bhusal, M; Basnet, D; Dhakal, A; Sapkota, B; Madhup, SABSTRACT Background Chronic rhinosinusitis and asthma are considered under unified airway diseases which describes the shared epidemiologic and pathophysiologic relationship among the chronic inflammatory diseases of the upper and lower airways Objective To assess the asthma in patients with chronic rhinosinusitis and determine the relationship of allergic biomarkers, tissue eosinophilia and radiological bone changes in patients with chronic rhinosinusitis with or without asthma. Method Prospective study involving 74 adult patients attending the Department of Otorhinolaryngology and Pulmonology at the Kathmandu University Dhulikhel Hospital for treatment of chronic rhinosinusitis and / or asthma and for functional endoscopic sinus surgery between May 2023 and May 2024. Absolute eosinophil count, total serum IgE and spirometry tests were performed. Radiological evidence of osteitis and tissue eosinophilia from surgical samples was evaluated. Correlations between allergic biomarkers,spirometry values, tissue eosinophilia, and radiological bone changes were determined in patients of chronic rhinosinusitis with or without asthma using the Mann Whitney U test, Student t test and the chi square test. Result A positive association was observed between the radiological bone score with tissue eosinophilia (p=.018), and smoking (p < 0.001) in between the two groups. Chronic eosinophilic rhinosinusitis was observed in 39 (52.7%) patients. 15 patients with Chronic rhinosinusitis had asthma ,and among these asthmatic patients 11 had eosinophilic chronic rhinosinusitis. Mild osteitis was evident in 34 (45.9%) ,moderate osteitis in 39 (52.7%) and severe in 1 (1.4%). Among 15 asthmatic patients, 10 had moderate osteitis and 5 had mild osteitis. Conclusion A rigorous exentration of osteitic bony nidus appears necessary for successful treatment outcomes in all chronic rhinosinusitis patients and to prevent acute exacerbation in the asthmatic group of chronic rhinosinusitis patients. KEY WORDS Asthma, Chronic rhinosinusitis, Osteitis