Journal of Kathmandu Medical College <p>The official journal of Kathmandu Medical College, Sinamangal, Kathmandu. Full text articles available. Content also available on the journal's own&nbsp;<a href="">website</a>.</p> <p>JKMC is a multidisciplinary, peer reviewed, open access, quarterly journal which publishes a wide range of scientific works including original research paper, case reports, reviews, editorials, book reviews and articles from medical students. It includes work from basic science, clinical science, dental, nursing and other related medical fields.</p> <p>Journal of Kathmandu Medical College does NOT charge authors for article submission and processing fees.</p> en-US (Prof. Dr. Abhinav Vaidya) (Dr. Ashik Rajak) Mon, 30 Sep 2019 00:00:00 +0000 OJS 60 Importance of sterilization in endodontics <p>Not available.</p> Babita Pradhan, Yuan Gao Copyright (c) 0 Mon, 30 Sep 2019 00:00:00 +0000 Reiterating rationale use of statistical tools in research articles <p>Not available.</p> Naresh Manandhar Copyright (c) 0 Mon, 30 Sep 2019 00:00:00 +0000 Cataract following electric shock - Case report <p>Ocular trauma is the under-recognized cause of unilateral blindness particularly in developing nations.The growing&nbsp;demand on generated electricity has also led to increase in electricity related occupational trauma. We report a case of&nbsp;bilateral cataract in a 22 years professional electrician. He survived a high voltage electric shock and sustained burn injury&nbsp;on the right side of his head. Ocular examination revealed typical anterior as well as posterior subcapsular cataract in&nbsp;right eye and visually insignificant early anterior subcapsular vacuoles in the left eye. There was a significant difference&nbsp;in lenticular opacification density in between these two eyes. Uneventful phacoemulsification and foldable posterior&nbsp;chamber intraocular lens implantation was performed in the right eye and the sufferer was rehabilitated with normal&nbsp;best corrected visual acuity. The possibility of ocular complications and importance of ocular screening is emphasized&nbsp;in the survivors of electrical injury. The lenticular opacities can be successfully managed with surgery, however the final&nbsp;visual acuity depends on damage to other vital ocular structures. The clinical features, pathogenic mechanism of these&nbsp;opacities and review of the literatures are discussed.</p> Simanta Khadka, Raghunandan Byanju, Sudha Ranabhat Copyright (c) 2019 Mon, 30 Sep 2019 00:00:00 +0000 Caudal block analgesia for paediatric infra-umbilical surgery: A prospective observational study <p><strong>Background:</strong> Caudal block is the most common regional anaesthesia technique used in children. It offers excellent perioperative analgesia in infra-umbilical surgeries. However, large-scale studies on caudal block in our paediatric population are not available.<br><br><strong>Objectives:</strong> We aimed to evaluate practice pattern, efficacy and safety of caudal block in paediatric infra-umbilical surgery.<br><br><strong>Methodology:</strong> Children (age less than 14 years) undergoing elective infra-umbilical surgery under general anaesthesia were included in this prospective observational study conducted over two years. Demographic characteristics, type&nbsp;of surgery, anaesthetic techniques and agents used, and details of caudal block were recorded. Perioperative events, complications and duration of analgesia were studied. Eligible children not receiving caudal block served as the control&nbsp;group. Analysis was performed using IBM Statistical Package for the Social Sciences version 20.<br><br><strong>Results:</strong> Caudal block was employed in 72 out of 183 children who completed the study. It was mostly preferred for children weighing less than 20 kilograms. Ketamine pre-medication was used in 123 children. Majority received Propofol&nbsp;induction and laryngeal mask. Halothane was preferred over Isoflurane for anaesthesia maintenance. Bupivacaine was the exclusively used local anaesthetic agent. Vascular puncture occurred in three children but no serious complication&nbsp;was observed. Need for supplement intraoperative analgesics was significantly lower, and duration of analgesia was significantly longer in caudal group. Intraoperative hypotension, laryngospasm during emergence and postoperative&nbsp;vomiting were the most frequent perioperative events.<br><br><strong>Conclusion:</strong> Pre-incisional single-shot caudal block is safe, effective and well accepted component of multi-modal perioperative analgesic regimen for younger children undergoing infra-umbilical surgery.</p> Binod Gautam, Manan Karki Copyright (c) 0 Mon, 30 Sep 2019 00:00:00 +0000 Placental thickness in third trimester and its correlation to gestational age and fetal weight in primigravida <p><strong>Background:</strong> Gestational age and fetal weight estimation by ultrasound is the most effective and accurate method&nbsp;to date pregnancy. Ultrasound has been used to characterize placental position and morphologic changes. Placental&nbsp;thickness could be one additional parameter to assess gestational age and fetal weight.</p> <p><strong>Objectives:</strong> This study aims to investigate the relationship between placental thickness with gestational age and fetal&nbsp;weight in third trimester of pregnancy in primigravida.</p> <p><strong>Methodology:</strong> Prospective hospital based cross sectional study was conducted including 111 primigravida in third&nbsp;trimester with normal singleton pregnancies in Department of Radiology of Kathmandu Medical College Teaching&nbsp;Hospital from November 2018 to February 2019. Patients with known medical and obstetrical complications were&nbsp;excluded from the study. Placental thickness in millimeters was measured at the level of insertion of the umbilical cord.&nbsp;Pearson’s correlation analysis was used for analyzing variables and p-value &lt;0.05 was considered statistically significant.</p> <p><strong>Results:</strong> Mean age of participants was 28.3 ± 4.79 years. Posterior location of the placenta was most common (35%).&nbsp;Placental thickness correlated well with the gestational age and fetal weight. Pearson correlation coefficient was found&nbsp;to be 0.645 for placental thickness with gestational age and 0.598 for placental thickness with fetal weight. P-value was&nbsp;&lt;0.001 in both, showing positive correlation of mentioned variables with placental thickness.</p> <p><strong>Conclusion:</strong> Placental thickness can be a new and reliable parameter for estimation of gestational age and fetal weight.&nbsp;It can be routinely used during antenatal checkup.</p> Muna Badu, Shankar Bahadur Singh Rajbhandari, Pashupati Regmi Copyright (c) 0 Mon, 30 Sep 2019 00:00:00 +0000 Anatomical study of canthal index: The morphometrical study <p><strong>Background:</strong> Anthropometry is the hallmark technique for biological anthropometry and has become increasingly&nbsp;important in health assessment across this century. Craniofacial anthropometry is study of face and skull. The local data&nbsp;on inner canthal distance, outer canthal distance and canthal index may signify the differential developmental pattern&nbsp;resulting from various factors such as gender, age, genetic and climate and may help in craniofacial surgery, orthodontists,&nbsp;congenital anomalies and forensic science.</p> <p><strong>Objectives:</strong> The objective of the study is to compare anthropometric dimension related to inner canthal distance, outer&nbsp;canthal distance and canthal index.</p> <p><strong>Methodology:</strong> The outer and inner canthal measurements of Nepali population wereobserved in 318 normal male and&nbsp;female. Out of total samples, 156 male and 162 female of age 17 – 25 years were taken for study since study was done&nbsp;in medical college preclinical students. The inner and outer canthal distances were measured by using a digital sliding&nbsp;caliper graduated in millimeters.&nbsp;The canthal index was calculated.</p> <p><strong>Results:</strong> There was statistically significant difference in inner canthal distance among female (31.84± 2.22)mm and male&nbsp;(34.48 ±3.35)mm (P&lt;0.001). We found statistically significant difference in the outer canthal distance among female&nbsp;94.30±3.42 mm and male 96.54±4.77mm (P&lt;0.001); moreover, there was significance difference in mean canthal index&nbsp;among female and male (33.77±2.42 and 35.79±3.76; P&lt;0.001) respectively.</p> <p><br><strong>Conclusion:</strong> This work has generated normative values for canthal dimensions of Nepali population. The study would be&nbsp;of benefit not only to anthropometrist, oral and maxillofacial surgeons, plastic surgeons, forensic medicine, but also to&nbsp;orthodontists and dysmorphologists.</p> Sanjay Kumar Yadav, Banshi Krishna Malla, Ashok Kumar Srivastava, Alok Kumar Copyright (c) 0 Mon, 30 Sep 2019 00:00:00 +0000 Pattern of skin diseases and common drugs prescribed in dermatology outpatient department of Kathmandu Medical College-Teaching Hospital, Duwakot <p><strong>Background:</strong> There is a wide variation in the pattern of skin diseases in different countries and the pattern even varies&nbsp;across different parts within the same country. For the treatment purpose different classes of drugs and combinational&nbsp;products are widely used in dermatology. Periodic prescription analysis in the form of drug utilization study can improve&nbsp;the quality of prescription and decrease irrational prescribing.</p> <p><br><strong>Objectives:</strong> The objective of the study was to find the pattern of skin diseases and the common group of drugs prescribed&nbsp;in Kathmandu Medical College Teaching Hospital at Duwakot.</p> <p><br><strong>Methodology:</strong> A prospective, observational, single center study was conducted at Dermatology outpatient department&nbsp;of Kathmandu Medical College Teaching Hospital at Duwakot, from December 2018 to June 2019 and a total of 300&nbsp;prescriptions were collected during the study period. The data were collected from patient card and details were filled in&nbsp;the predesigned proforma.</p> <p><br><strong>Results:</strong> A total of 300 prescriptions were collected and analyzed for demographic profile, disease incidence and drug&nbsp;prescription. Most common condition observed were dermatitis 50 (16.7%), tinea 43 (14.3%), urticaria 31 (10.3%).&nbsp;Antihistaminics (28.7%), corticosteroids (16.9%) antibiotics (14.8%), antifungals (14.8%) were the most common class of&nbsp;drugs prescribed. Drugs prescribed were mainly given by topical route (50.6%) followed by oral route.</p> <p><br><strong>Conclusion:</strong> The current study revealed that the mean number of drugs/prescriptions was slightly higher than the&nbsp;recommended limit of two approved by world health organization and the practice of poly-pharmacy was occasionally&nbsp;seen.</p> Binaya Shrestha, Prashanna Raj Shrestha Copyright (c) 0 Mon, 30 Sep 2019 00:00:00 +0000 An assessment of empathy levels of dental students’ in Nepal: A cross-sectional comparative study <p><strong>Background:</strong> Empathy is a behavioural aspect of understanding and communicating with a desire to help. Empathy in&nbsp;medical personnel with patient is one of the basic ingredients of good physician/dentist –patient relationships.</p> <p><strong>Objectives:</strong> To assess empathy level among dental undergraduate students, interns and dental postgraduate students of&nbsp;Nepal and to investigate the differences in empathy scores based on gender and year of dental training.</p> <p><strong>Methodology:</strong> A cross-sectional questionnaire study was carried out among 240 dental students of different dental&nbsp;colleges in Nepal. Eighty students were included in each group of third to final-year undergraduate dental students,&nbsp;interns and postgraduate students. Data was collected using a standard-validated, self-administered Jefferson Scale of&nbsp;Empathy-Health Care Provider Student Version (JSE-HPS). This questionnaire included 20 items with a seven-point Likert&nbsp;scale. This scale has relevant content that allows assessing empathy between students and their patients. The collected&nbsp;data was entered in Microsoft Excel and statistical analysis was done in Statistical Package for the Social Sciences version&nbsp;20.</p> <p><strong>Results:</strong> Out of 240 dental students, 74 (30.8%) were males and 166 (69.2%) were females with the mean age of 25.35 ±3.203. The mean empathy score was 79.59 ± 6.492.There was no significant difference in mean empathy level score by&nbsp;gender. The interns were the most empathetic (80.80 ± 6.147). The mean empathy score was found to be highest for the&nbsp;students with less than one year of experience of treating patient (81.85 ± 7.841).</p> <p><strong>Conclusion:</strong> Empathy should be given importance to in dental curriculum to improve dentist-patient relationship,&nbsp;thereby improving the treatment outcomes.</p> Siddharth Ghimire, Punam Basnet Dixit, Deepak Kumar Roy, Shweta Dhital, Sirjana Dahal Copyright (c) 2019 Mon, 30 Sep 2019 00:00:00 +0000 Median and ulnar nerve functions in taxi/microbus drivers and helpers in Kathmandu <p><strong>Background:</strong> Occupational drivers are exposed to various stressors such as ergonomic restriction, whole body vibration, vehicle exhaust and dust exposure. Drivers are reported to have higher rates of morbidities, especially of&nbsp;the musculoskeletal and peripheral nervous systems. Reports on drivers’ nerve functions by specific electrodiagnostic&nbsp;methods are lacking.</p> <p><strong>Objectives:</strong> To compare electrophysiologic parameters of median and ulnar nerves in drivers with other population.</p> <p><strong>Methodology:</strong> In a cross-sectional comparative study, nerve conduction study was performed in median and ulnar nerves&nbsp;in three groups of participants – Drivers (driving taxi/microbus for at least six months), Helpers (microbus conductors for&nbsp;at least six months) and Controls (college staff/students). Parameters for sensory nerve action potentials and compound&nbsp;motor action potentials were compared among groups by ANOVA and right versus left sides within groups by paired t&nbsp;test.</p> <p><strong>Results:</strong> The study involved 145 male participants – 51 Drivers, 34 Helpers and 60 Controls. Compared to drivers and&nbsp;helpers, conduction velocity of nerves was significantly higher in controls for sensory component of all nerves (p values&nbsp;for right median = 0.001, left median = &lt;0.001, right ulnar = &lt;0.001 and left ulnar = 0.019) and motor component of right&nbsp;ulnar nerve (p=0.002). In right-left comparisons, conduction was slower in left median sensory than right (p=0.001) and&nbsp;right ulnar sensory than left (p=0.015) in the helpers but not significant in other groups.</p> <p><strong>Conclusion:</strong> Electrophysiological evidences of afflictions of median and ulnar nerves are detectable in urban taxi/&nbsp;microbus drivers and helpers with at least six months’ occupational duration.</p> Mrigendra Amatya, Bibek Khanal Copyright (c) 2019 Mon, 30 Sep 2019 00:00:00 +0000 Evaluation of clinical effectiveness of topical 0.2% glyceryl trinitrate, topical 2% diltiazem and their combination in the treatment of chronic anal fissure <p><strong>Background:</strong> The longitudinal tear or defect in the epithelial lining of the anal canal distal to the dentate line is called&nbsp;anal fissure. It is of two types: acute and chronic. The break in the cycle of pain, spasm and ischemia is essential for&nbsp;successful treatment of anal fissure. Among multiple non-surgical treatment approaches, the appropriate approach with&nbsp;good patient compliance might be the use of topical agents as chemical sphincterotomy. However, the effectiveness of&nbsp;these agents has not been evaluated widely.<br><br><strong>Objectives:</strong> To evaluate clinical effectiveness of topical 0.2% glyceryl trinitrate, topical 2% diltiazem and their combination&nbsp;in the treatment of chronic anal fissure.<br><br><strong>Methodology:</strong> The study was prospective comparative type including total 158 patients. Initially, they were given first&nbsp;line therapy followed by chemical sphincterotomy agents. The study drugs were given to 84 patients (three groups - 0.2%&nbsp;glyceryl trinitrate, 2% diltiazem and their combination) who were not healed after initial therapy. Patients were assessed&nbsp;for pain using visual analogue scale and other symptoms prior to and after two and six weeks of therapy.<br><br><strong>Results:</strong> Complete healing rate was higher with combination (92.86%) than individual agents. The reduction of visual&nbsp;analog scale score within each group and between the groups in the period between before and after treatment was&nbsp;found to be statistically significant. Headache and hypotension were the common side effects seen during study.<br><br><strong>Conclusion:</strong> Anal fissures can be successfully managed by chemical sphincterotomy. The topical nitrates and calcium&nbsp;channel blockers in combination are found to be effective choice rather than individual agents.</p> Bikash Bahadur Rayamajhi, Anjan Khadka, Kabir Thakali, Bikash Bikram Thapa, Narayan Thapa, Bharat Bahadur Bhandari Copyright (c) 2019 Mon, 30 Sep 2019 00:00:00 +0000 Medical complications during inpatient rehabilitation in patients with ischemic stroke in a tertiary care hospital in Nepal <p><strong>Background:</strong> Complications are common in patients with ischemic stroke and hinder successful rehabilitation. Timely&nbsp;identification and management of complications are key factors in the management of patients with ischemic stroke.<br><strong>Objectives:</strong> The aim of this study is to find the occurrence of different types of complications in patients admitted with&nbsp;the diagnosis of ischemic stroke and to find the risk factors associated with the occurrence of complications.<br><strong>Methodology:</strong> The study is a cross sectional descriptive study. A total of 96 patients with ischemic stroke admitted to&nbsp;the Department of Neurology of Kathmandu Medical College Teaching Hospital over a period of six months (July 2018&nbsp;to December 2018) were recruited. Data was recorded according to a designed proforma and analysed using Statistical&nbsp;Package for the Social Sciences version 20.<br><strong>Results:</strong> The age group ranged from 25 to 91 years with the mean age of 64.36 years and 50 (52.1%)patients were male.&nbsp;A total of 62 (64.6%) patients developed at least one complication during hospital stay. Pneumonia and urinary tract&nbsp;infection were the most common complications occurring in 22(22.9%) patients. The occurrence of complications was&nbsp;positively correlated with National Institutes of Health Stroke Scale and Glasgow Coma Scale.<br><strong>Conclusion:</strong> Pneumonia and urinary tract infection were the most common complications in our study and were similar&nbsp;to those quoted in the western literature. Severity of stroke had positive correlations with occurrence of complications.</p> Krishna Dhungana, Dipesh Shakya, Rabindra Shrestha, Sabnam Bhatta, Sabbu Maharjan Copyright (c) 2019 Mon, 30 Sep 2019 00:00:00 +0000