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A Comprehensive Review on Curriculum in Reference to Bachelor of Dental Surgery Kathmandu University
(Kathmandu University, 2024) Rijal, AH; Rajbanshi, R; Humagain, M
ABSTRACT This review article provides a detailed analysis of educational curricula, focusing on their design, content, and teaching methods. It explores how a well-structured curriculum can support effective learning by balancing theoretical knowledge with practical skills. The article discusses key elements that make a curriculum successful, such as clear objectives, up-to-date content, and interactive teaching methods. It also identifies common gaps, like the need for regular updates and better alignment with current professional standards. By reviewing various curricula and comparing them to global best practices, the article suggests ways to enhance educational quality and ensure students are well-prepared for their careers. KEY WORDS Curriculum, Dental education, Effective learning
Pregnancy Complicated by Ovarian Cysts
(Kathmandu University, 2024) Shakya, S; Shrestha, A; Lama, S
ABSTRACT The incidence of adnexal masses during pregnancy varies between 0.2% and 2%, with the majority of these tumors being benign and a 1% to 6% chance of malignancy. Due to widespread use of ultrasound during the first trimester, it is quite common to detect incidental ovarian cysts. Once a tumor is identified, the primary goal is to determine whether it is benign or malignant. The ultrasound feature helps to determine that with a minimal help with the tumor markers, as it is altered due to pregnancy. Then, the next step is to decide if surgical intervention is necessary. If surgery is required, it is important to determine the safest time to perform it and whether to opt for laparotomy or laparoscopy. We present two case reports of pregnancies with ovarian cysts, both diagnosed incidentally, with the timing of the operation chosen based on the cyst type, size, symptoms, and gestational age. KEY WORDS Gravidity, Mucinous cystadenoma, Ovarian cyst, Pregnancy maintenance
A Rare Case of Sporadic Optic Pathway Glioma in a 7-year-old Female
(Kathmandu University, 2024) Gupta, S; Sinha, U; Raj, A
ABSTRACT Sporadic optic pathway gliomas (OPGs) are uncommon and have greater predisposition to severe clinical presentations and complications. Severe visual impairment is the most frequent presentation. The treatment is based on multiple factors and needs to be individualized. Precise assessment of visual function is one of the important factors to plan the management. We present a case of sporadic OPG in a 7-year-old female with severe visual decline. Visual functions were assessed ophthalmologically and electrophysiologically. Diagnosis was confirmed on the basis of clinical, radiological, histopathological and electrophysiologic findings. Surgical resection was planned owing to the poor visual functions and the mass effects. Patient is on regular follow-ups with no signs of deterioration so far. Appropriate visual assessment is crucial in young children with sporadic optic pathway glioma for planning the mode of treatment. Surgical resection in cases with severe visual impairment is helpful, however, irreversible visual impairment remains irremediable. KEY WORDS Optic pathway glioma, Sporadic, Visual
Diagnosis of Pancreatic Adenocarcinoma in a Case of 25-year-old Female from Nepal
(Kathmandu University, 2024) Bhattarai, K; Bhandari, A; Acharya, A; Uprety, S
ABSTRACT Pancreatic adenocarcinoma is one of the lethal form of malignant change involving the pancreas. The median age of diagnosis is 71 years and is uncommon below 40 years. Here we intend to report an uncommon case of a 25-year-old woman who presented to our institution with complaints of fever, severe abdominal pain. The laboratory workup showed bicytopenia with USG abdomen revealing a bulky pancreas. The Contrast Enhanced Computed Tomography and Magnetic Resonance Cholangiopancreatography suggested malignancy followed by Fine Needle Aspiration Cytology (FNAC) which confirmed the diagnosis of adenocarcinoma. Pancreatic adenocarcinoma is the 14th most common cancer and 7th most common cause of cancer death. Computed tomography is most useful modality of investigation used to diagnose and stage the cancer. This is supported by FNAC and CA19-9 tumor marker. The management includes surgical resection and chemotherapy. Although pancreatic adenocarcinoma is uncommon among the young population, it requires early management protocols. KEY WORDS CA 19-9 antigen, Case report, Nepal, Pancreatic cancer, Risk factors
Assessment of Clinical Outcomes and Patient Response to Gingival Depigmentation Using Gingival Trimming Ceramic Bur and Conventional Scalpel Technique
(Kathmandu University, 2024) Thapa, S; Humagain, M; Lamichhane, S; Subedi, G; Rijal, AH
ABSTRACT In this era, role of esthetic in dentistry has been an evolving concern. One of the major concern is the hyperpigmented gingiva in patients with high smile line or excessive gingival display. This varies in different individuals and is assumed to be dependent on cutaneous pigmentation. Therefore, there are various methods of depigmentation. Hereby, is a case report of depigmentation done on upper anterior gingival region and comparing the output and patient response where half of the segment was done by using scalpel and the other half by ceramic bur with a follow up of three months. And this report concludes that ceramic bur has more advantages over scalpel technique. KEY WORDS Depigmentation, Esthetics, Soft tissue trimming ceramic bur
Magic of Intravitreal Triamcinolone and Dexamethasone in a Patient with Uveitic Macular Edema with Treated Ocular Tuberculosis
(Kathmandu University, 2024) Agrawal, A; Kharel Sitaula, R
ABSTRACT A 40-year-old woman with uveitic macular edema (UME) in a treated case of ocular tuberculosis (TB) is the subject of our unusual case study. She had full remission with a single intravitreal injection of triamcinolone and dexamethasone. Anti- inflammatory drugs, topical steroids, and anti-tubercular therapy were used to address the patient’s history of recurrent anterior and intermediate uveitis in past. When intravitreal corticosteroids were administered, the big macular cysts and related retinal thickness that were seen on the optical coherence tomography (OCT) results disappeared. KEY WORDS Anterior uveitis, Dexamethasone, Intermediate uveitis, Intravitreal injection, Optical coherence tomography (OCT), Ocular tuberculosis Triamcinolone
Effects of Bauxite and Alumina Exposure on Mortality due to Cancer - Meta-analysis
(Kathmandu University, 2024) Thevi, T; Abas, AL
ABSTRACT Bauxite is an ore from which Aluminium is produced. Malaysia, once the leading producer of bauxite has reduced production as mining activity has caused community outrage. Due to concerns about health concerns, rising pollution and environmental hazards, the government has revoked the licenses of bauxite miners. We therefore did a meta-analysis to assess the relationship between exposure to Bauxite and Alumina with mortality of overall cancer as well as specific types of cancers. Participants of were individuals of all ages who were exposed to Bauxite and Alumina while working in Bauxite mines and Alumina refineries. Exposure to bauxite and alumina did not cause variations in mortality of overall cancer and specific types of cancer such as cancer of lip, cancer of the oral cavity and pharynx, cancer of digestive organs and others. We conclude that there is no evidence that bauxite or alumina exposure cause increase mortality due to cancer but due to the small number of studies included in this review, we recommend more cohort studies to be done in future. KEY WORDS Bauxite alumina exposure, Cancer mortality, Review
Use of Artificial Intelligence in Medical Research: A SWOT Analysis
(Kathmandu University, 2024) Jha, JP; Amgain, K; Joshi, LR
ABSTRACT As artificial intelligence (AI) tools are shaping our work, this article discusses a nuanced SWOT analysis, focusing on the applications of artificial intelligence in the area of medical research. It aims to evaluate the applications of artificial intelligence tools in medical research, discussing their implications for researchers, journals and the scientific community, addressing the growing concerns of using artificial intelligence tools in research and publication, evaluating its potential risks while harnessing the transformative potential. The analysis is complemented by a qualitative review of online resources, articles, blogs, interviews and podcasts, elucidating the prevailing themes in artificial intelligence-related considerations. The strengths highlight artificial intelligence’s capacity to accelerate research processes, particularly in diagnostics, drug production and data analysis. On the other hand, the weaknesses underscore concerns related to interpretability, biases, and ethical considerations, urging caution in artificial intelligence reliance. Opportunities arise in the form of explainable artificial intelligence, inclusive data practices, and enhanced model validation, while threats include issues of bias, privacy, overreliance and human exploitation. Such issues can be mitigated by collaboration from multiple experts and policymakers. The current state of artificial intelligence raises concerns about data quality, bias, transparency and ethical issues in its development and deployment. There is a need for collaborative efforts to establish ethical frameworks, regulations, and sustainability practices. A balanced approach, positioning AI as a collaborator that enhances human insights and creativity is recommended. KEY WORDS Artificial intelligence, Bias, Ethics, Medical research
Socio Demographic Profiling of Victims of Sexual Offense in Kavrepalanchowk District: a cross-sectional study at a tertiary care center, Nepal
(Kathmandu University, 2024) Khan, AS; Pokharel, S; Paudel, S; Poudel, P; Karki, A
ABSTRACT Background Sexual offence is an umbrella term referring to a classification of sexual acts and experiences that are imposed, pressured, coerced onto a person. The latest information from women children and senior citizen survey center of Nepal stated that about 2321 rape cases were recorded in the year 2020 to 2021. Objective This study is aimed at socio-demographic profiling of victims of sexual assault, identify the most vulnerable age group and the area with highest incidence for future sexual assault prevention. Method The descriptive cross-sectional study at Dhulikhel Hospital (December 2018 to June 2023) analyzed 136 sexual offense cases via convenience sampling. Data were collected from medical records, following ethical approval. Incomplete or unrelated cases were excluded, and hospital/national protocols were adhered to. Data analysis was conducted using Microsoft Excel with descriptive statistics. Result Out of 136 victims, most were aged between birth and 20 years (71.32%), while only 1.47% were aged 60-80 years. The youngest victim was 15 months old, and the oldest was 65 years. Females comprised 98.52% and males 1.48% where all the males were victims of sodomy. The type of offence most prevalent was rape (70.58%) followed by indecent assault (19.11%), with some cases of incest (7.35%). The municipality with the most number of cases was Panauti (16.16%), followed by Panchkhal (13.23%) and Bhumlu with 10.29%. The majority of the cases took place in the year 2077 BS rounding up to 39 cases in Kavrepalanchowk district. However, noting the numbers in the year 2080 BS, there seems to be a rapid rise of cases as there have already been 19 cases in four months. Conclusion The most vulnerable group for sexual offenses was the population below the age 20 and most of the cases occurred in Panauti municipality which emphasizes the need of sexual and moral education in that place and age group. The areas in Kavrepalanchowk district with increasing cases of sexual offenses should incorporate standardized protocols in implementing education as well as strict regulations of the community guidelines. KEY WORDS Gender-based violence, Kavrepalanchowk district, Nepal, Sexual education, Sexual offense
Pain-related Beliefs, Coping Strategies and Pain Catastrophization in Older People with Chronic Musculoskeletal Pain
(Kathmandu University, 2024) Bimali I,; Awal, K; Acharya, RS
ABSTRACT Background Chronic musculoskeletal pain is a major health concern among older people. The experience of chronic musculoskeletal pain is influenced by psychosocial factors such as beliefs, coping strategies, and pain catastrophizing. It is believed that culture can influence pain related factors and psychosocial factors vary across different cultures. Objective To identify the common pain-related beliefs, coping strategies and pain catastrophizing in older people with chronic musculoskeletal pain. Method A descriptive cross-sectional study was conducted in Dhulikhel among 150 older people. Semi-structured questionnaire gathered information on pain beliefs and coping strategies, while, pain catastrophizing scale was used to identify catastrophization. A convenient sampling was used and data were analyzed using SPSS, version 26. Result The median age of the participants was 69 years (IQR 10). The median pain score on facial pain rating scale was 6 (IQR 2). Participants believed that musculoskeletal pain was associated with aging (81%), past workload (64%) and karma (49%). They predominantly believed in doctors (78%) and physiotherapists (43%) for treatment. Nearly half also believed in spiritual healers. Commonly utilized coping strategies were self-statements like “I can handle anything” (89%) and it is not so bad, it’s normal” (81%), massage (88%), God (87%) and exercise (84%). The level of pain catastrophization was not statistically significant among the participants. Conclusion The findings of the study highlighted the significance of beliefs and coping strategies in influencing pain experiences, suggesting a strong need of implementation of bio- psychosocial approach in assessment and management of pain among older people. KEY WORDS Belief, Coping strategies, Chronic musculoskeletal pain, Older people, Pain catastrophization
Intrinsic Capacity of Older People in Panchkhal Municipality of Nepal: A cross-sectional study
(Kathmandu University, 2024) Shrestha, L; Neupane, R; Paudel, L; Manandhar, N
ABSTRACT Background With the global trend of rising ageing population, health care to the elderly needs special focus as absence of disease merely does not mean that older people are healthy and have full functional ability. So, WHO introduced intrinsic capacity to define healthy ageing. Objective To find the prevalence of decline in intrinsic capacity in older people of Panchkhal Municipality. Method A community based cross-sectional observational study was conducted in 5 simple randomly selected wards of Panchkhal Municipality of Nepal. Total sample sizes of 848 data were collected using proportionate convenience sampling. Data collection techniques were interview with observation using predesigned proforma containing WHO (Integrated Care for Older People-ICOPE) tool. Result The prevalence of decline in intrinsic capacity of older people in Panchkhal Municipality was 86.9%. The decline in individual domains was visual acuity 58.0 % followed by cognition 48.9%, locomotion 48.8%, hearing ability 38.6%, vitality 38.0% and psychology 28.5%. The mean age was 71.18 ±8.769 years (60-100). The majority of older people were male 55.8%, Hindu 91.7%, had joint family 77.7% and illiterate 60.3%. There was significant moderate positive correlation of age with decline in locomotion (r=0.469, p=0.029), hearing ability (r=0.312, p=0.032), cognitive ability(r=0.209, p=0.034) and low negative correlation of age with vitality (r=-0.161, p=0.035), psychology (r=-0.130, p=0.034),visual acuity (r=-0.126, p=0.034). Conclusion There was a high prevalence of decline in intrinsic capacity of the older people from Panchkhal Municipality. Special and focused care is required for older people from the government along with implementation of WHO-Integrated Care for Older People-ICOPEtool in every healthcare setting to promote healthy ageing. KEY WORDS Capacity, Integrated care for older people (ICOPE), Intrinsic, Nepal
Incidence of Accidental Awareness with Recall during General Anaesthesia: A Prospective Observational Study in a Tertiary Care Hospital
(Kathmandu University, 2024) Moktan, SL; Pradhan, R; Pradhan, A
ABSTRACT Background Accidental awareness during general anaesthesia, though rare, is a serious issue. It could lead to potential harmful psychological consequences. It has been reported that general surgical population has an incidence of awareness ranging from 0.1 to 0.2%. Objective To determine the incidence of awareness with recall under general anaesthesia by using modified Brice questionnaire in post-operative care unit. Method This was an observational study conducted on adult patients in a tertiary care hospital. A modified Brice questionnaire was used for the post-operative interview in 1,120 patients following the written informed consent. They were of American society of anaesthesiologists’ physical status I to III and had surgeries under general anaesthesia. The incidence of intraoperative awareness with recall was the primary outcome of the study. Result Among the total 1,120 patients, 678 patients were female and 442 were males. Most patients, 785 were of American society of anaesthesiologists’ physical status I, while 316 were II and 19 were III. While 1071 (95.6%) patients underwent elective surgery, 49 (4.3%) patients had emergency surgeries. The mean age of the study population was 40.31years with standard deviation of 12.12. Of the 1120 patients, two of them had definitive awareness. Conclusion The incidence of intraoperative awareness with recall after general anaesthesia in patients from a tertiary care hospital was 0.13%. KEY WORDS General anaesthesia, Intraoperative awareness, Modified brice questionnaire
Menstrual Hygiene Management among Nepalese Adolescent Schoolgirls: Results from a cross-sectional study
(Kathmandu University, 2024) Shrestha, A; Shrestha, S; Koirala, S; Subedi, P; Tiwari, D; Karmacharya, BM
ABSTRACT Background Adolescent schoolgirls in Nepal lack adequate support to manage menstruation. Little studies have been conducted to date to learn how menstruation affects daily lives of adolescents and how they were managing it. Menstruation also comes costly in rural Nepal and the majority of them do not have capacity to afford menstrual products due to high price. Objective The main objective of this study is to assess about menstrual challenges among adolescent girls of rural Nepal. Method We deployed descriptive, cross-sectional study to analyze adolescent girls’ experience of menstruation from purposively selected schools in Kavre and Sindhupalanchowk districts of rural Nepal. The data was collected from May to July 2024 among adolescent girls using semi-structured questionnaire of grade 8 and 9. The adolescents were questioned regarding their own experiences with menstruation. The interview included household related information, water, sanitation and hygiene practices, self-menstruation practices and management, challenges they had been facing, and sociocultural taboos about menstruation. Result All schools included in this study were government schools. 38% of an adolescents reported of starting their menstruation at an age of 12 years. 39% of the respondents reported of having an ability to challenge the existing social taboos relating to menstruation. Above 60% uses sanitary pads as a menstrual product and for the disposal of these products, 50% respondents reported of throwing them in the dustbin followed by burying (21%) and burning (16%). And 10% of the respondents reported of throwing the used menstrual products into Indrawati river. Majority of respondents reported of not being able to visit temples and performing any religious visits during menstruation and the main reasons behind was family prohibition and fear of divine retribution. Conclusion Access to management materials of menstruation is problematic in the surveyed schools especially in the rural areas where almost half of the girls do not have access to sanitary pads and they resort to the use of cloth. Lack of affordability for purchasing sanitary napkins were the most crucial predictors of menstrual hygiene management. The Government of Nepal should take an initiative to provide schoolgirls with sanitary pads in order to improve menstrual hygiene management in all across schools within Nepal, particularly in rural areas. KEY WORDS Menstruation, Menstrual hygiene management, Sanitary napkins
Stress Anxiety and Depression among Adolescents of Schools in Godawari Municipality, Lalitpur
(Kathmandu University, 2024) Ghimire, R; Adhikari Mishra, T; Sharma, P
ABSTRACT Background Adolescence is a critical phase of life marked by various physical, emotional, and intellectual changes. Emotional aspects of adolescents are often undetected, unaddressed, and untreated. Objective To find out the level and factors associated with stress, anxiety, and depression among adolescent students. Method A descriptive cross-sectional study among 513 adolescents from grades 9 and 10 in the Public Secondary Schools of Godawari Municipality was carried out using cluster sampling techniques. The participants were administered a validated Nepali version of the Depression, Anxiety, and Stress Scale 21. Descriptive statistics was used to assess the level of stress, anxiety, and depression, while binary logistic regression was used to identify predictors of these conditions among adolescent students. Result Findings revealed that mild level of stress (10.1%), moderate level of anxiety (21.2%) and mild level of depression (19.5%) were more prevalent among adolescent students. In a multivariate model, it was found that female adolescents were more likely to have symptoms of stress, anxiety, and depression. Similarly, witnessing domestic violence and experiencing abuse ever were significantly associated with stress; family health problems and witnessing domestic violence were significantly associated with anxiety and passed in previous examination, family history of mental illness, experiencing abuse ever and bedtime use of electronic devices were significantly associated with depression in adolescent students. Conclusion The severity of stress, anxiety and depression are increasing among adolescent students. Hence routine mental health screening, adolescent mental health awareness programs and counselling sessions should be conducted in schools. KEY WORDS Adolescents, Anxiety, Depression, Stress
Sinonasal Mucormycosis Amidst the Second Wave of COVID-19 Pandemic; Clinical Spectrum and Outcome in a Tertiary Care Center in Nepal
(Kathmandu University, 2024) Gurung U; Dongol K; Paudel S; Thapa, NM; Pradhananga, RB; Gyawali, BR; Shrestha GS
ABSTRACT Background Mucormycosis is an angioinvasive opportunistic fungal infection which surged during the second wave of COVID-19 pandemic. Objective This study assessed patient demographics, risk factors, clinical characteristics, and outcomes of sinonasal mucormycosis during the second wave of COVID-19 pandemic. Method The clinical records of patients with histologically proven sinonasal mucormycosis, admitted between May 2021 to October 2021, in a tertiary center were reviewed. Result There were 25 patients (18 males, 7 females). The age ranged from 16 to 70 years (mean 51 ± 9.5 years). Uncontrolled diabetes mellitus detected in 23 patients was the most common co-morbidity. COVID-19 infection was documented in 20 patients. The mean time of diagnosis was 12 days after the onset of COVID-19 infection. Based on the disease extent, six patients had sino-nasal, seven had rhino-orbital, and 12 had rhino-orbital-cerebral involvement. The most common first presenting symptom was orbital (17/25) followed by facial (5/25) and orodental (3/25). All patients received intravenous amphotericin B for 2 to 8 weeks. Maintenance with posaconazole ranged from 3 to 9 months. Sixteen patients underwent surgical debridement. Out of the 25 patients, 14 (56%) had good recovery. Poor outcome was observed mostly with intracranial involvement. Conclusion Uncontrolled diabetes mellitus was a common risk factor. Advanced disease at presentation was frequently encountered due to rapid extrasinus spread. Nearly 50% of patients had good recovery whilst poor outcome was observed, mostly with intracranial involvement. Adequate blood sugar control, early administration of antifungals, and aggressive surgical debridement are the mainstay of treatment. KEY WORDS COVID-19, Hyperglycemia, Mucor, Mucormycosis, Pandemic
Community-based Screening of Cervical Cancer in an Urban Setting in Nepal: A Cross-sectional Study
(Kathmandu University, 2024) Shrestha, A; Poudel, L; Khanal, B; Poudel, K; Shakya, S; Timsina, P; Shakya, P; Shrestha, S; Paneru, B
ABSTRACT Background In Nepal, cervical cancer is among the most prevalent cancers among females, yet only about 8% of women have undergone screening, highlighting significant barriers to access in low-resource settings. Objective To assess and report the outcomes of a community-based cervical cancer screening with visual inspection of acetic acid and an active follow-up program in Budhanilkantha municipality, Kathmandu Valley. Method We conducted a cross-sectional study in Budhanilkantha Municipality among 1360 women aged 30 to 60 who attended community-based cervical cancer screening camps. Trained research assistants collected socio-demographic and reproductive health data through interviews, abstracted medical records about Visual Inspection with Acetic Acid outcomes, and made follow-up calls to those who screened positive. We conducted descriptive analysis and logistic regression to assess associations between screen positivity and women’s characteristics. Result A total of 1,360 women visited the camp, with 98.3% undergoing visual inspection with acetic acid, and 7.25% screening positive. Among those referred, 78% followed up at the recommended hospital; diagnostic tests indicated that 12.3% had low- grade lesions and 1.36% had high-grade pre-cancerous lesions. The adjusted model revealed no statistically significant associations between Visual Inspection with Acetic Acid positivity and variables such as age, ethnicity, education, and reproductive history. Conclusion This study demonstrates that the community-based Visual Inspection with Acetic Acid (VIA) cervical cancer screening method was highly acceptance and had high treatment follow-up among women in urban Nepal. KEY WORDS Cervical cancer, Screening, Visual inspection with acetic acid
Gastric Neoplasm: A Clinicopathological Study in the Tertiary Care Center of Nepal
(Kathmandu University, 2024) Basnet, D; Makaju, R; Gurung, RB; Gautam, N; Shrestha, B; Maharjan. PB; KC, P
ABSTRACT Background Gastric carcinoma is the commonest upper gastrointestinal malignancy contributing to global burden of cancer morbidity and mortality. Objective The objective is to study distribution of the gastric neoplasm according to age, sex, symptom, gross appearance, histological type and degree of differentiation. Method This was a retrospective study done from January 2022 to December 2023 in the Department of Pathology, Dhulikhel Hospital - Kathmandu University Hospital (DH - KUH). Relevant clinical data of the patients were obtained from the histopathological records of the patient from the pathology department and biopsies stained with Haematoxylin and Eosin were studied under the light microscope. Result A total of 40 cases of gastric neoplasm were studied out of which 36(90%) were malignant and 4(10%) were benign epithelial tumors and precursor lesions. Most frequent presentation was dyspepsia, abdominal pain, vomiting, dysphagia, anemia, anorexia and weight loss. Male to female ratio was 1.4:1. The age of the patient ranged from 33 to 89 years with mean age of 63.3 ± 13.4 years. Most common site of gastric neoplasm was pyloric antrum. Ulceroproliferative growth was most common gross morphology. Malignant neoplasm were more common. Intestinal type adenocarcinoma consisted of 28 (70%) cases followed by diffuse type 6 (15%) and mixed type 1 (2.5%). Diffuse adenocarcinoma was more common in females. Moderately differentiated adenocarcinoma was the most common differentiation. Conclusion The present study provided a fair insight into the clinciopathological features of gastric neooplasm in our institution. KEY WORDS Adenocarcinoma, Diffuse type, Gastric, Intestinal type
Assessment of Range of Motion of Temporomandibular Joint among Dental Students of Dhulikhel Hospital
(Kathmandu University, 2024) Luitel, A; Bali, H; Gautam, P; Shrestha, R; Singh, N; Gurung, K
ABSTRACT Background Restriction in mandibular range of motion (ROM) is one of the main signs of mandibular dysfunction and an important criterion for evaluation of functional state of the masticatory system. Objective The objective of this study was to evaluate the normal ROM of Temporomandibular Joint (TMJ) among dental students of tertiary care hospital at central region of Nepal. Method After ethical clearance, cross- sectional study was conducted between August to September 2022 among all dental students who gave consent. The inter-incisal opening, bilateral lateral excursion and protrusion were measured thrice using 15 cm metallic scale and an average was considered to reduce ambiguity. The data was entered in Microsoft excel and transferred to SPSS version 20 for statistical analysis. The descriptive statistics was calculated and independent t test was applied to compare the mean between genders. Result Total of 145 students (25 males and 120 females) were included with the mean age of 21.32 ± 1.29 years. The overall mean inter-incisal opening was 44.82 ± 5.80 mm, right lateral excursion was 8.23 ± 2.11 mm, left lateral excursion was 8.70 ± 1.80 mm and protrusion was 5.65 ± 1.87 mm. There was statistically significant difference in right and left lateral excursion and protrusion among genders. Conclusion The inter-incisal opening of participants in our study appeared towards lower range of normal mouth opening while lateral excursion appeared consistent with those described in the literature. The protrusive movement of our participants was decreased, compared to those recorded in the literature. KEY WORDS Inter-incisal opening, Lateral excursion, Protrusion, Temporomandibular joint
Musculoskeletal Ultrasonography of Baker’s Cyst in Primary Osteoarthritis of Knee: An Observational study
(Kathmandu University, 2024) Shakya, S; Amatya, SP; Singh, J; Shrestha, B; Sharma, BP; Gelal, R
ABSTRACT Background Knee pain and limitation of joint movement are common compliant in pain clinic due to knee osteoarthritis and often associated with Baker’s cyst. These are usually asymptomatic during the initial phase and might be missed during clinical examination and later may present in complicated form. Musculoskeletal ultrasonography might be helpful in detecting asymptomatic Baker’s cyst during the early course of the disease. Objective To observe the incidence of Baker’s cyst in patient with primary osteoarthritis of knee with the help of routine musculoskeletal ultrasonography of knee during clinical evaluation of patient. Method A total of 114 patients with unilateral or bilateral knee pain diagnosed as primary osteoarthritis of knee were included in this study. Musculoskeletal ultrasonography was performed on all patients to look for the presence of Baker’s cyst. The incidence of Baker’s cyst was the primary outcome of this study. Depending upon the presence/ absence of Baker’s cyst, two groups were formed, and variables were compared between these groups to find the factors associated with Baker’s cyst. Statistical analysis was done using student t-test, ANOVA test and Chi-square test. Result The incidence of Baker’s cyst in this study was 21.1% of the patients and 89.28% were asymptomatic. Baker’s cysts were strongly associated with joint effusion and synovial hypertrophy. Conclusion Baker’s cyst was a common finding in the patient with knee osteoarthritis. Musculoskeletal ultrasound would be a valuable tool to detect such asymptomatic cysts early. KEY WORDS Baker’s cyst, Knee osteoarthritis, Synovitis, Ultrasonography
Audiological Outcome of Endoscopic Stapedotomy in Nepalese population
(Kathmandu University, 2024) Subba Rai, S; Shrestha, BL; Pradhan, A
ABSTRACT Background Otosclerosis is a complex disease of otic capsule that mainly affects the stapes footplate causing conductive hearing loss, sometimes mixed hearing loss. Microscope stapes surgery was used traditionally but endoscopic stapedectomy has ushered a new revelation. Objective To report the audiological outcome of solely endoscopic trans canal stapedotomy surgery for otosclerosis in Nepalese population. Method This retrospective case series study analysed pre and post operative pure tone average of air conduction (AC) and bone conduction (BC) threshold and air bone gap (ABG) at 0.5, 1, 2 and 4 kHz. Postoperative ABG ≤ 10 dBHL (decibels hearing level) and ABG ≤ 20 dBHL was used to consider surgical success and improvement respectively. Paired t-test was used to test the significance of the audiological outcome of the study group pre and post operatively. Result The study included 9 patients, 10 operated ears with male to female ratio of 1:2. Mean age was 37.60 ± 9.28 years and mean postoperative air bone gap was 19.00 (± 5.89) and gain in air bone gap 18.75 (± 8.70) which was found to be statistically significant (p < 0.000). Audiological outcome in each of the four frequencies, 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz was also found to be statistically significant. Conclusion This limited series study concludes that because of its favourable audiological gain and closure of the air bone gap postoperatively and better intraoperative view, it can uplift other surgeons to choose this as preferred technique. KEY WORDS Audiological outcome, Endoscopic stapedotomy, Otosclerosis, Stapes surgery

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