Journal Issue: Volume: 46, No. 3 (2024)
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Volume
Number
Issue Date
2024
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Applications of Generative Artificial Intelligence in Medicine: Opportunities and Ethical Considerations
(Institute of Medicine, Tribhuvan University, 2024) Sharma, Mohan Raj
Abstract:
Generative Artificial Intelligence (AI) has emerged as a transformative tool in various domains, including medical sector. Generative AI models like ChatGPT offer unparalleled potential in diagnostics, prognostications, and research assistance. However, their integration necessitates careful scrutiny of risks, including privacy violations and the propagation of inaccuracies. Establishing clear guidelines for their use in academic medicine and research is imperative for the responsible use of these tools. This article explores the foundational concepts of generative AI, highlights its applications in medicine, research, and academia, and addresses ethical and practical concerns.
Effectiveness of Student-Facilitated Problem-Based Learning in Integrated Basic Medical Sciences: A Retrospective Quantitative Analysis of Academic Records
(Institute of Medicine, Tribhuvan University, 2024) Joshi, Lok Raj; Nembang, Penchha; Hamal, Deependra; Thakur, Chandan Kumar; Anu, Anuraj; Jha, Jay Prakash; Amgain, Kapil
Abstract:
Introduction
Problem-based learning (PBL) is considered as a historic innovation in medical education. However, shortage of experienced faculty tutors for PBL is a major challenge in resource-limited settings. We aimed to assess effectiveness of student-facilitated PBL in content knowledge at a medical college of Nepal.
Methods
This observational study analyzed the outcome and experience of the PBL modules. This article reports the quantitative analysis which compared pretest and posttest results of the students on multiple-choice questions to assess content knowledge. The maximum possible score was 30 for each test and pass score was set as per modified Angoff method.
Results
Pretest and posttest results of 53 medical students were analyzed. The results showed that 39 (74%) students passed the pretest and 48 (91%) passed the posttest. This improvement was statistically significant (McNemar's chi-squared=4.27, p=0.04). The median (interquartile range) of the pretest scores was 19(17-21) and that of the posttest scores was 23(21-25) with a significant increase after the PBL module (Wilcoxon signed rank test, p<0.001, effect size=0.67). The posttest scores of the first year students were comparable to the posttest scores of the second year students (Wilcoxon rank sum test, p=0.40).
Conclusion
The student-facilitated PBL module was effective for improving content knowledge. Future, prospective experimental design with control group may rule out the role of other extraneous variables.
Correlation of Cervical Pap Smear with Cervical Biopsy in Lesions of Cervix
(Institute of Medicine, Tribhuvan University, 2024) Tiwari, Archana; Khanal, Anupa; Sapkota, Pratima; Karki, Asmita
Abstract:
Introduction
Cervical cancer is the leading cause of mortality for women in underdeveloped nations and the 4th leading cause globally. Pap smears are non-invasive method, but are unable to pinpoint their location. However, cervical biopsies are an invasive but gold standard procedure.
Methods
An analysis of all pap smears obtained during a one-year period, from April 14, 2022 to April 12, 2023 was carried out in the Department of Pathology, LMC, Palpa. But only the cases that had undergone both pap smear and cervical biopsy were compared. Only 64 of the 337 pap smears that were obtained for cytological analysis also had a biopsy.
Results
Out of 64 pap smear, 32.81% had normal cytology, 25% had ASC-US, 4.68% had atypical glandular cells, and 9.37% had HSIL. The most pap smears were done on people between the ages of 31 and 40. In 64 biopsies, 23 (35.93%) had HSIL, 20 (31.25%) had LSIL, and 7 (10.93%) had chronic cervicitis, according to the histological diagnosis of biopsies. Four individuals had a cancer diagnosis, including two (3.12%) squamous cell carcinomas and two (3.12%) adenocarcinomas. The Pap smear showed a sensitivity of 25.92%, specificity of 94.59%, PPV of 77.77%, NPV of 63.63%, and a diagnostic accuracy of 65.62%.
Conclusion
The Pap smear test, had poor sensitivity but good specificity in detecting premalignant and malignant cervical abnormalities. Pap smear is a noninvasive method; however, cervical biopsy is a gold standard but invasive technique.
Speciation and Fluconazole Susceptibility of Candida Isolates from Clinical Samples in a Tertiary Hospital in Nepal
(Institute of Medicine, Tribhuvan University, 2024) Sapkota, Jyotshna; Aryal, Kiran; Adhikari, Ram Prasad; Khadka, Sushila; Pandey, Ritu; Khanal, Laxmi Kant; Shrestha, Deepti; Sharma, Manisha
Abstract:
Introduction
Candida species, commonly present as human commensals, are notable opportunistic pathogens responsible for superficial and invasive infections, particularly in hospitalized patients. This study aimed to characterize the distribution and antifungal susceptibility patterns of Candida species isolated from various clinical specimens at a tertiary care hospital in Nepal.
Methods
A descriptive cross-sectional, laboratory-based study was conducted in the Clinical Microbiology Laboratory of Nepal Medical College Teaching Hospital between July 2023 and June 2024. Clinical specimens yielding Candida species over the one-year period were included. Growth on Sabouraud dextrose agar was analyzed for colony morphology, Gram staining, germ tube production, and urea hydrolysis. Speciation of Candida isolates was performed using CHROMagar. Additionally, fluconazole susceptibility testing was conducted following Clinical and Laboratory Standards Institute guidelines.
Results
A total of 72 Candida isolates were identified from samples such as sputum, urine, and high vaginal swabs. Candida albicans was the most prevalent species 45 (62.5%), followed by non-albicans Candida (NAC) species, including C. glabrata 14 (19.4%), 9 C. tropicalis (12.5%), and 4 C. parapsilosis (5.6%). Fluconazole resistance was observed in 22.2% of total isolates of Candida, with C. glabrata exhibiting the highest resistance 12, (86%), whereas 4 (9%) of C. albicans demonstrated resistance to it.
Conclusion
The findings highlight a shift in epidemiology toward NAC species and raise concerns about rising fluconazole resistance. These results underscore the need for routine species identification and antifungal susceptibility testing to guide effective management strategies. The study advocates for antifungal stewardship programs and ongoing surveillance to address emerging resistance trends in Candida infections.
Early Experience of Minimally Invasive Tubular Lumbar Microdiscectomy at a Tertiary Care Centre in Nepal
(Institute of Medicine, Tribhuvan University, 2024) Pradhanang, Amit; Sedain, Gopal; Karki, Anjan Singh; Bohara, Sandeep; Shrestha, Dipendra Kumar; Sharma, Mohan Raj; Shilpakar, Sushil Krishna; Jha, Prabhat
Abstract:
Introduction
Lumbar disc herniation is a leading cause of low back pain and radiculopathy. Open microdiscectomy, though effective, involves muscle dissection and longer recovery. Minimally invasive tubular microdiscectomy aims to reduce these drawbacks. This study evaluates its early outcomes in Nepal.
Methods
Our observational study included patients who underwent MIS tubular lumbar microdiscectomy at our hospital from August 2023 to July 2024. Data on operative duration, blood loss, and return to work time were collected. Functional outcomes were assessed at three months using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for spinal and radicular pain.
Results
A total of 22 patients were included. The mean operative duration was 121.5 ± 31.67 minutes, and mean intraoperative blood loss was 60 ± 20.17 mL. The mean return to work time was 1.86 ± 0.2 weeks. At three months, the mean ODI score significantly improved from 54.36 ± 8.8 to 0.91 ± 1.47 (p < 0.001). VAS scores for spinal pain decreased from 3.05 ± 0.84 to 1.5 ± 0.3 (p < 0.001), and radicular pain from 4.91 ± 0.86 to 1.36 ± 0.65 (p < 0.001). No major complications occurred, and 5% of patients had transient paresthesia, which resolved spontaneously.
Conclusion
MIS tubular lumbar microdiscectomy is an alternative procedure for lumbar disc herniation, offering short-term functional improvement. Long-term comparative studies are needed to assess its durability against open microdiscectomy.