Journal of Kathmandu Medical College 2021-05-17T10:44:57+00:00 Prof. Dr. Abhinav Vaidya Open Journal Systems <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> COVID pandemic and online teaching in medical practice in developing country 2021-05-17T10:44:46+00:00 Dhiresh Kumar Maharjan Sujan Regmee <p>Not available.</p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Functional outcome of retrograde nailing versus locked plating of extra-articular distal femoral fractures in adults: A randomized controlled trial 2021-05-17T10:44:41+00:00 Chandra Bhusan Yadav Asish Rajak Bikram Prasad Shrestha Raju Rijal Rajiv Maharjan Rosan PS Kalawar Amit Limbu <p><strong>Background:</strong><span style="font-weight: 400;"> Distal femoral fracture constitutes the supracondylar and intercondylar fractures of femur. These are treated by locking plates as well as with nails. Despite the widespread use of both techniques, there are only few comparative studies. The two clinical techniques used to stabilize distal femur fractures are compared in this study.</span></p> <p><strong>Objectives: </strong><span style="font-weight: 400;">&nbsp;The aim of this study was to compare plating and nailing in terms of functional outcome using the Hospital for Special Surgery (HSS) Knee Score of operative fixation of extra-articular femur fracture.</span></p> <p><strong>Methodology: </strong><span style="font-weight: 400;">A randomized controlled trial was conducted with a total of 30 patients presenting to BP Koirala Institute of Health Sciences in a period of twelve months.</span> <span style="font-weight: 400;">All skeletally mature (&gt;16 years) adult patients with isolated traumatic closed extra-articular fracture of distal femur without distal neurovascular deficit and giving written and informed consent were included. Patients with re-fractures, poly-trauma, fracture dislocations, pathological fracture and compartment syndrome were excluded. They were operated and followed up at 2, 6, 12 and 24 weeks.&nbsp;</span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> The demographic profiles of the two groups were comparable. There was no significant difference in functional outcome (Hospital for Special Surgery score), union or complications between them.</span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> This study showed that there was no significant difference in terms of functional outcome (Hospital for Special Surgery score), union, fracture alignment, range of motion (knee, hip joint), infection, other outcome measures between plating and nailing in the treatment of distal femoral fracture in adults. Hence, further study is required to come to firm conclusions. </span></p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Variation in spirometry parameters in children with and without recurrent respiratory problems 2021-05-17T10:44:47+00:00 Eva Gauchan Ganesh BK Deepak Prasad Koirala <p><strong>Background: </strong><span style="font-weight: 400;">Children having recurrent episodes of respiratory symptoms account for a major source of hospitalization. These children have increased morbidities and if not identified in time can have impaired lung function as adults.&nbsp;</span></p> <p><strong>Objectives: </strong><span style="font-weight: 400;">The aim of our study was to compare the spirometry parameters and bronchodilator reversibility in children with and without recurrent respiratory problems.</span></p> <p><strong>Methodology: </strong><span style="font-weight: 400;">This was a prospective observational study conducted in the Pediatric department of Manipal Teaching Hospital comparing 35 children with recurrent respiratory problems and 35 children with no history of recurrent respiratory problems. After thorough instructions, baseline spirometry was done in all children and recordings were noted. Thereafter they were given two puffs of salbutamol (100 µg) and repeat testing was done 20 minutes later. Bronchodilator reversibility was calculated according to standard formula. Various statistical tests were used to compare the findings between the two groups.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">The recurrent respiratory problem group had 31 (88%) cases of bronchial asthma, two (5.7%) bronchiolitis obliterans, one (2.8%) pulmonary eosinophilia, and one (2.8%) common variable immunodeficiency syndrome. The median values of FEV</span><span style="font-weight: 400;">1 </span><span style="font-weight: 400;">(p=&lt;0.001), FVC (p=0.007), FEV</span><span style="font-weight: 400;">1</span><span style="font-weight: 400;">/FVC (p=0.005), PEF (p=0.042) and FEF</span><span style="font-weight: 400;">25-75</span><span style="font-weight: 400;">(p=0.026) were lower in the group with recurrent respiratory problems. Post-bronchodilator reversibility of FEV</span><span style="font-weight: 400;">1 </span><span style="font-weight: 400;">(p=0.001), FVC (p=&lt;0.001) and FEF</span><span style="font-weight: 400;">25-75</span><span style="font-weight: 400;"> (p=0.026) was higher in the groups with recurrent respiratory problems</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">We found that lung function parameters in children with recurrent respiratory problems show features of obstructive defect. The post-bronchodilator response is higher in the group with recurrent respiratory problems as compared to normal children.</span></p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Knowledge and attitude towards nursing profession among male secondary level students 2021-05-17T10:44:49+00:00 Asmita Khatri Regina Singh <p><strong>Background</strong><span style="font-weight: 400;">: Nursing profession is stereotyped worldwide.&nbsp; In Nepal, the enrollment of males in nursing education was initiated in 1986 AD with allocation of 10% seats, which stopped after enrollment of four batches only. Nepal Nursing council has announced 15% allocation of nursing seats to male students from academic year 2018/19 AD but only a few number of males have been enrolled.&nbsp;</span></p> <p><strong>Objectives:</strong><span style="font-weight: 400;"> The aim of this study was to determine the knowledge and attitude towards the nursing profession among male secondary level students.&nbsp;</span></p> <p><strong>Methodology: </strong><span style="font-weight: 400;">A descriptive cross-sectional study was conducted by employing multi-stage sampling technique in June, 2019. Random list of secondary schools of Kathmandu district was created followed by proportionate stratified random sampling among 80% of male students studying in grades nine and ten from initial ten schools from the randomized list. The sample size was 388. A self-structured questionnaire was administered. Data was analyzed in SPSS version 20 by using frequency, percentage, mean, chi-square test and pearson’s correlation coefficient.&nbsp;</span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> Out of 388 respondents, only 55.4% had adequate knowledge and only 53.4% had a more positive attitude towards the nursing profession. Significant association was found between knowledge towards the nursing profession with two of the socio-demographic variables grade of student and respondent’s family, friends and relatives in the nursing profession.</span></p> <p><strong>Conclusion</strong><span style="font-weight: 400;">: The study showed inadequate knowledge and less positive attitude towards the nursing profession. Educational programs regarding different aspects of nursing profession should be planned timely by professional nursing organizations, nursing colleges and secondary schools of Nepal which would create a positive impact in enrollment of male nursing students in coming academic years.</span></p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Predictors of inadequate bowel preparation using two liters of polyethylene glycol for colonoscopy 2021-05-17T10:44:54+00:00 Anuj Parajuli Niranjan KC <p><strong>Background: </strong><span style="font-weight: 400;">Inadequate bowel preparation can result in missed pathological lesions and cancellation of procedures thereby increasing the cost and delay in the diagnosis.</span></p> <p><strong>Objectives: </strong><span style="font-weight: 400;">Thes aim of the study was to identify the potential predictors of inadequate bowel preparation using 2 liters of </span><span style="font-weight: 400;">polyethylene glycol</span><span style="font-weight: 400;"> solution.</span></p> <p><strong>Methodology: </strong><span style="font-weight: 400;">A prospective study was done, which included 138 consecutive patients who underwent colonoscopy over a period of 6 months. Patient’s demographics, medical history, and preparation quality were collected and compared. Factors associated with inadequate bowel preparation were identified by univariate statistics and multivariate logistical regression analysis.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">Out of 138 colonoscopy procedure, 119 (86.2%) preparations were adequate and 19 (13.8%) were inadequate. The mean age of the patient was 52.62 (SD ±10.51) years. Out of which, 82 (59.4%) were male and 56 (40.6%) were female. In the multivariate regression analysis, constipation [adjusted OR 8.55, 95% CI 1.79-41.67] and non-compliance [adjusted OR 58.82, 95% CI 5.99-500] were independently associated with inadequate bowel preparation.</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Constipation, non-compliance, overweight, neurological disorders like stroke, dementia and age &gt;60 years were associated with inadequate bowel preparation. Early identification of patients with a high risk of inadequate preparation can be salvaged with change in bowel cleaning strategy.</span></p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Prevalence and pattern of lipid profile among patients with diabetes mellitus attending a tertiary teaching hospital in Nepal 2021-05-17T10:44:56+00:00 Rita Kafle Anuj Raj Kadel <p><strong>Background: </strong><span style="font-weight: 400;">Dyslipidemia, a well-known major risk factor for coronary heart disease, is commonly associated with macro-vascular complications in patients with diabetes mellitus. Increased level of triglycerides and reduced levels of HDL cholesterol are common lipid abnormalities in diabetes.</span></p> <p><strong>Objectives: </strong><span style="font-weight: 400;">The aim of the study was to study the prevalence and pattern of lipid abnormalities among diabetic patients attending general practice outpatient department in Kathmandu Medical College Teaching Hospital.</span></p> <p><strong>Methodology:</strong><span style="font-weight: 400;"> This is a descriptive cross-sectional study conducted in the Department</span><span style="font-weight: 400;"> of General Practice and Emergency of Kathmandu Medical College Teaching Hospital, Duwakot, Bhaktapur. </span><span style="font-weight: 400;">Convenience sampling technique was used.After obtaining informed consent, 120 diabetic patients from January 2020 to March 2020 were included. The data collected was entered in the Statistical Package for the Social Sciences software and analyzed. Ethical clearance was taken from</span><span style="font-weight: 400;"> the Institutional Review Committee of Kathmandu Medical College.</span></p> <p>&nbsp;</p> <p><strong>Results:</strong><span style="font-weight: 400;">The average TC, HDL, TG and LDL level among the female participants were 186.18 mg/dl, 41.91 mg/dl, 194.63 mg/dl, 111.88 mg/dl respectively and 186.30 mg/dl, 38.80 mg/dl, 205.60 mg/dl, 125.80 mg/dl among the male participants respectively.Eighty-five (71%) patients had a low HDL level. Total cholesterol was found to be high in 38(32%) participants. LDL cholesterol was high in 77(64%) participants. The triglyceride level was high in 85(71%) participants.</span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> This study showed that some diabetic individuals have a lipid abnormality while others did not. This shines light on the importance of regular testing for lipid profile in diabetic individuals because we cannot reasonably predict when a patient will develop dyslipidemia. </span></p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Total pancreatectomy and salvage completion pancreatectomy-early and late outcomes without Islet cell auto-transplantation 2021-05-17T10:44:57+00:00 Dhiresh Kumar Maharjan Prabin Bikram Thapa <p><strong>Background: </strong><span style="font-weight: 400;">Total pancreatectomy was abandoned for decades because of high peri and post-operative morbidity and mortality. However, with better peri-operative outcome and post-operative management of exocrine and endocrine insufficiency, the hesitancy to perform total pancreatectomy has been disappearing.</span><strong>&nbsp;</strong></p> <p><strong>Objectives: </strong><span style="font-weight: 400;">This study</span> <span style="font-weight: 400;">aims to study exocrinal and endocrinal effects of total pancreatectomy without Islet cell auto-transplantation and compare quality of life index among total pancreatectomy with Whipple patients.</span></p> <p><strong>Methodology:</strong><span style="font-weight: 400;"> This is a prospectively conducted matched-pairs study. Group A underwent total or completion pancreatectomy after non-salvageable complications of Whipple operation. A matched-pairs analysis of quality of life index of these patients by using SF-36 questionnaire were compared with Group B who underwent Whipple operation during the same period of time, according to age, gender and pre-operative diagnosis.&nbsp;</span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> In four years (from February 2016 to February 2020), 160 patients underwent Whipple operation. The mean age of the patients was 59.9 +/-14.3 years. A total of nine patients underwent total pancreatectomy, among which two had per-operative decision of total pancreatectomy and seven had completion pancreatectomy. Median post-operative hospital stay was 11 days with two mortalities. Median follow-up of 12 months and quality of life index of total pancreatectomy patients were comparable to Whipple patients, although a few single quality of life items were reduced.&nbsp;</span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> Exocrinal pancreatic supplements and long acting insulin have augmented control of diabetes despite of not using Islet cell auto-transplantation. Quality of life index of total pancreatectomy patients were comparable to that of Whipple patients. Hence, this study signifies the &nbsp; importance of completion pancreatectomy following non-salvageable complications after Whipple operation in order to save life.</span></p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Achieving negative margin in Bismuth III and IV hilar cholangiocarcinoma without major hepatectomy 2021-05-17T10:44:40+00:00 Roshan Ghimire Kapendra Shekhar Amatya Prabin Bikram Thapa <p><strong>Background:</strong> Several studies have proposed en bloc resection with major hepatectomy to achieve negative margin in hilar cholangiocarcinoma. These major hepatectomy have morbidity in some subgroups of patients with limited functional hepatic reserve.</p> <p><strong>Methodology:</strong> Patients with Bismuth type III and IV hilar cholangiocarcinoma with underlying early cirrhosis that underwent liver parenchymal preserving bilobar wedge liver resection between July 2017 to June 2020 were included in the study.</p> <p><strong>Results:</strong>&nbsp; Twelve patients underwent liver parenchymal preserving bilobar wedge liver resection between July 2017 to June 2020. Mean age of the study population was 70.83±3.58 years. Reconstruction of biliary tree was done with intrahepatic cholangiojejunostomy in Roux en Y fashion in multiple segmental hepatic stomas.</p> <p><strong>Conclusion:</strong> Liver parenchymal preserving surgery should be considered in hilar cholangiocarcinoma in selected cases to prevent suspicion increasing morbidity and mortality due to post-operative liver failure.</p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Traumatic pancreatic transection - Case reports 2021-05-17T10:44:43+00:00 Uttam Laudari Rosi Pradhan Ashik Rajak Anuj Parajuli Dhiresh Kumar Maharjan Prabin Bikram Thapa <p>Pancreatic injury following blunt trauma abdomen is presentation with significant morbidity and mortality. Our first case here is the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) Grade V pancreaticoduodenal injuries following penetrating injury managed with pancreaticoduodenectomy and the second case is blunt trauma to the abdomen with pancreatic tail transection which is American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) Grade III that was managed with Endoscopic Retrograde Cholangiopancreaticography (ERCP) and pancreatic duct stenting. The outcome depends on early diagnosis and needs a high index of suspicion due to subtle clinical and radiological findings initially. Hemodynamically unstable patients may have other associated visceral and vascular injuries, and damage control strategy will be a suitable option. Same sitting resection procedures like pancreaticoduodenectomy are rarely performed. Pancreatic injuries can often be managed non-operatively with percutaneous drainage and pancreatic duct stenting.</p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Epidural blood patch in post-dural puncture headache in parturients: A case series 2021-05-17T10:44:48+00:00 Babu Raja Shrestha Shyam Krishna Maharjan Ujma Shrestha Sushila Lama Moktan <p><span style="font-weight: 400;">This is a case series of six obstetric patients who had post-dural puncture headache, resistant to conservative treatment. The onset of post-dural headache in our series on average was on the 34th hour of the procedure. After confirmation of the diagnosis with a typical history of presentation and examination, the patients underwent pharmacological treatment. Post-dural puncture headache, in our series, not relieved by pharmacological treatment underwent epidural blood patch after persistent headache in an average of 5 days post-dural puncture. All patients receiving this therapy had a complete cure of headache at the earliest - from 45 minutes to as late as 11 hours post procedure. Epidural autologous blood instillation in an average of 10 to 11 ml completely relieved the ailment in the primary blood patch. Epidural blood patch is still considered gold standard therapy in persistent post-dural puncture headache. </span></p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Right extended hepatectomy for hilar cholangiocarcinoma: A case report 2021-05-17T10:44:50+00:00 Romi Dahal Krishna Mohan Adhikari Sumita Pradhan Ramesh Singh Bhandari <p>Radical resection in a case of hilar cholangiocarcinoma is the only curative option. However resection in a hilar cholangiocarcinoma is a challenging procedure because of the low resectability rate. Only a few cases of hilar cholangiocarcinoma are operable because of the advanced nature of disease at presentation. Furthermore, the extent of surgery makes it a complicated process to attempt. We recently had a patient who underwent an open extended right hepatectomy and hepaticojejunostomy for a type IIIa hilar cholangiocarcinoma.</p> <p>The tumor was 20 mm in diameter and was located between the right hepatic duct and common hepatic duct. Radiological examination showed that the hepatic artery was not involved but the right portal vein was invaded by the tumor. CT volumetry was done and the future liver remnant was only 20% in the jaundiced patient. Preoperative drainage was done with percutaneous transhepatic biliary drainage from the left side. Portal vein embolization was done to augment future liver remnant to 30%.</p> <p>The patient underwent an extended right hepatectomy (right trisectionectomy combined with caudate lobectomy). The operation time was nearly 300 min, and the intraoperative blood loss was about 500 ml. However, in the postoperative period, the patient developed post hepatic liver failure which was managed successfully with conservative treatment. The postoperative hospital stay was 23 days.</p> <p>The final diagnosis was hilar cholangiocarcinoma with no nodal metastasis (pT2bN0M0) stage II (American Joint Committee on Cancer, AJCC).</p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020