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, 22 Mar 2021 19:46:43 +0000 OJS 60 Hearing outcome following ossicular reconstruction for incus defects using partial ossicular replacement prosthesis <p><strong>Background:</strong> Situation of incus erosion is common while performing tympanoplasties for cases of chronic otitis media. As none of the available techniques is said to be gold standard, a cost effective and easily available partial ossicular replacement prosthesis is employed and the postoperative hearing outcome is presented.</p> <p><strong>Objectives:</strong> To assess the hearing results of ossiculoplasty using partial ossicular replacement prosthesis during tympanoplasty.</p> <p><strong>Methodology:</strong> A descriptive cross-sectional study was carried out in a tertiary referral hospital of Nepal from June 2018 to September 2019. Twenty-eight consecutive patients who underwent tympanoplasty for chronic otitis media (inactive/mucosal) with incudostapedial discontinuity were operated using polytetrafluoroethylene partial ossicular replacement prosthesis without removing the incus. Pure tone averages, air-bone gap and air conduction gain were calculated pre and post-operatively.</p> <p><strong>Results:</strong> There was no extrusion of prosthesis. The post-operative air-bone gap less than 20 dB was achieved in 23 (77%) cases. All the patients had post-operative air-bone gaps of ?25dB. There were no major complications.</p> <p><strong>Conclusion:</strong> Polytetrafluoroethylene partial ossicular replacement prosthesis is a safe, reliable and efficient alternative for ossiculoplasty during tympanoplasty surgery.</p> Deepak Regmi, Ashik Rajak, Nain Bahadur Mahato Copyright (c) 2020 Journal of Kathmandu Medical College Tue, 30 Jun 2020 00:00:00 +0000 Effect of dry cord care versus chlorhexidine cord care on cord separation time in healthy newborns: A comparative study <p><strong>Background:</strong> Umbilical cord infection (omphalitis) is a major cause of neonatal mortality and morbidity in a developing country like Nepal. Detached umbilical stump is an important colonizing site for different types of bacteria and it also provides direct access to bloodstream. Hence, inadequate cord care may lead to omphalitis as well as neonatal sepsis.</p> <p><strong>Objectives:</strong> This study aims to compare two different cord care regimens (dry cord care versus chlorhexidine cord care) on their cord separation time and the incidence of omphalitis.</p> <p><strong>Methodology:</strong> This is a comparative observational study conducted at the Neonatal unit of Kathmandu Medical College over a three months period (August 2019 to October 2019). All newborn babies born between 37 to 42 weeks of gestation were enrolled. Randomization for dry cord care and chlorhexidine cord care group was done via computer generated numbers. Statistical package for social sciences 19 version was used for statistical analysis. Results: Among 514 term babies, 256 babies were included in the dry cord care group while 258 babies were enrolled in the chlorhexidine cord care group. The two groups had similar baseline characteristics. The mean cord separation time in the dry cord care group was 7.70±1.2 days (range 3-15 days), whereas in the chlorhexidine group, it was 7.77±1.4 days (range 4-18 days).</p> <p><br /><strong>Conclusion:</strong> There was no significant difference between the cord separation times in dry and chlorhex</p> Rydam Basnet, Sunil Raja Manandhar, Anwesh Bhatta, Rakesh Kumar Shah, Ritika Basnet Copyright (c) 2020 Journal of Kathmandu Medical College Tue, 30 Jun 2020 00:00:00 +0000 Use of indocyanine green fluorescence during hepatobiliary surgery <p><strong>Background</strong>: Indocyanine green fluorescence image has been used in hepatobiliary surgery, which was mainly started by Japanese surgeons to visualize hepatobiliary structures probably because it is regarded as a reagent for estimation of hepatic function.</p> <p><strong>Objectives</strong>: The objective of this study is to see the feasibility of use of indocyanine green in our setting during hepatobiliary surgery and its potential applications in the surgical treatment of benign and malignant liver pathology along with its selective use during difficult cholecystectomy to visualize extrahepatic biliary radical.</p> <p><strong>Methodology</strong>: This is a prospective cross sectional observational study performed including all consecutive patients who were posted for liver resection, both benign or malignant and selectively used in biliary surgery when biliary anatomy was uncertain.</p> <p><strong>Results</strong>: A total of thirty-nine patients had usage of indocyanine green, with a mean age of 51.6 ± 11.6 years (range, 31-75 years). In all our patients we were able to visualize the biliary system and liver parenchymal lesion.In the selective use of indocyanine green during difficult biliary anatomy during laparoscopic cholecystectomy 15/400 (3.75%), we were able to delineate biliary tree and hence five patients (1.2%) had to be converted to open cholecystectomy further preventing injury to the bile duct.</p> <p><strong>Conclusion</strong>: Indocyanine green fluorescence imaging can be used safely and easily to identify liver tumors, hepatic segments, and extrahepatic bile ducts in real time during open and minimally invasive surgery. This allows surgeons to map the anatomical variations, status of resection margin and prevent surgical complications.</p> Dhiresh Kumar Maharjan, Prabin Bikram Thapa Copyright (c) 2021 Journal of Kathmandu Medical College Tue, 30 Jun 2020 00:00:00 +0000 Neonatal outcome of maternal premature rupture of membranes more than 18 hours <p><strong>Background:</strong> Premature Rupture of Membranes has been known to complicate pregnancy since ages. Several risk factors may be associated with occurrence of premature rupture of membranes. It is associated with varied neonatal complications, neonatal sepsis and prematurity being the most hazardous ones.</p> <p><strong>Objectives:</strong> This study was conducted to evaluate the incidence of neonatal sepsis following premature rupture of membranes, risk factors and neonatal complications associated with premature rupture of membrane of more than 18 hours in the neonates admitted in a tertiary care center.</p> <p><strong>Methodology:</strong> Descriptive observational study was undertaken for 18 months from August 2013 to January 2015 in the College of Medical Sciences, Chitwan, Nepal. This study included 82 neonates admitted to the Neonatal Intensive Care Unit with maternal history of premature rupture of membranes of more than 18 hours with medical conditions excluded.</p> <p><strong>Results:</strong> The incidence of premature rupture of membranes in this hospital was 8.9%. Frequently associated maternal risk factors were history of prior abortion (16, 19.5%), urinary tract infection (7, 8.5%), and antecedent coitus (7, 8.5%). In the study population, 68 (83%) neonates had complications and 14 (17%) neonates had no complication. The incidence of neonatal sepsis following PROM in present study was 6.1%. Neonatal sepsis was significantly associated with chorioamnionitis (p&lt;0.001). The most frequently occurring complication was probable neonatal sepsis (53, 64.6%), followed by prematurity (31, 37.8%) and perinatal asphyxia (15, 18.3%). There was a directly proportional relation of neonatal sepsis, chorioamnionitis, respiratory distress syndrome and mortality with duration of premature rupture of membranes.</p> <p><strong>Conclusion:</strong> Commonly occurring maternal risk factors with PROM were prior abortion, UTI and antecedent coitus. In the study population, infectious morbidity was highest. Chorioamnionitis was significantly associated with culture proven neonatal sepsis. Prolonged duration of premature rupture of membranes increased the risk of neonatal sepsis, meningitis, respiratory distress syndrome and perinatal death. Prevention of these risk factors, appropriate and timely management including improved obstetric and neonatal care can provide intact survival of the neonates.</p> Amshu Shakya, Sweta Kumari Gupta Copyright (c) 2020 Journal of Kathmandu Medical College Tue, 30 Jun 2020 00:00:00 +0000 Knowledge and attitude of nursing staff on baby-friendly Hospital Initiative practices in a Tertiary Hospital <p><strong>Background:</strong> Within a hospital setting, health professionals play a key role in providing the right information on breastfeeding and often this source are the nurses who have the primary opportunity to counsel, support and educate mothers on breastfeeding. The Baby Friendly Health Initiative (BFHI) has helped to motivate facilities providing maternity and newborn services worldwide to better support breastfeeding.</p> <p><strong>Objective:</strong> The aim of this study was to help identify the knowledge gaps on the BFHI practices among nursing staff in a tertiary care center in Kathmandu.</p> <p><strong>Methodology:</strong> A total of 27 nursing staff who encounter pregnant women admitted in the hospital up until post-delivery discharge were selected for the study. Data on knowledge of baby-friendly hospital initiative and attitude towards breastfeeding practices was collected using a structured interview between October and December 2019. Statistical analysis was done using SPSS version 20.</p> <p><strong>Results:</strong> Only 41% were acquainted with the ten steps to successful breastfeeding of BFHI, out of whom more than half (55%) had a good level of knowledge. Majority of the participants showed a fairly correct attitude towards BFHI practices, except for the belief that there is no harm in introducing pre-lacteal feeds to babies. The opinion on demand feeding and the time of introduction of complementary feeding seemed to vary.</p> <p><strong>Conclusion:</strong> There is an urgent need to re-evaluate the present knowledge of our nursing staff and to ensure they impart the right information. The only way to achieve this is through advocacy and training to promote, support and protect breastfeeding.</p> Smriti Mathema, Sabina Shrestha Copyright (c) 2020 Journal of Kathmandu Medical College Tue, 30 Jun 2020 00:00:00 +0000 Ocular morbidity among children of Baglung, Nepal <p><strong>Background:</strong> Development of the visual system occurs during childhood and is completed by eight years of life. Ocular disorders occurring during this period can lead to visual impairment which can have a lifelong impact on the life of the child. Early detection and treatment of ocular problems among children minimizes the risk of visual impairment and amblyopia.</p> <p><strong>Objectives:</strong> This study aimed to determine the pattern of ocular morbidity among children attending the health camp in Baglung.</p> <p><strong>Methodology:</strong> This was a descriptive cross-sectional study conducted to determine the pattern of ocular morbidity among children in the western region of Nepal, Baglung district. The study was conducted in the month of December 2019 for 2 days after receiving ethical approval. All data obtained were analyzed according to age, sex and pattern of ocular morbidity and were expressed in frequency, percentage and mean as applicable. Convenience sampling technique was used.</p> <p><strong>Results:</strong> Five hundred and thirty two children were evaluated in the study. Among them, 143 (26.87%) had ocular morbidity. The mean age of children with ocular morbidity was 9.6± 5.4 years. The total male to female ratio was 1.18:1 and that amongst those with ocular morbidities was seen to be 2.04:1.1. The most common ocular morbidity was refractive error in 43(8.08%) followed by conjunctival in 32(6.01%) and lid disorders in 29(5.45%) respectively.</p> <p><strong>Conclusion:</strong> Most of the morbidities observed were either preventable or treatable, therefore, eye health camp is an effective method to identify them.</p> Dikchhya Sharma, Ashik Rajak, Sabina Shrestha Copyright (c) 2020 Journal of Kathmandu Medical College Tue, 30 Jun 2020 00:00:00 +0000 Effectiveness of educational intervention on knowledge regarding cervical cancer and its prevention among married women in Chandragiri Municipality, Kathmandu <p><strong>Background:</strong> Cervical cancer is the leading cancer and the leading cause of cancer deaths in women in low and middleincome countries. There is lack of knowledge regarding cervical cancer and its prevention among Nepalese women which leads to inadequate screening. Although cervical cancer is acknowledged as a preventable disease, it is still a major health burden for women in many developing countries because an adequate scale of screening programs is lacking.</p> <p><strong>Objective:</strong> To evaluate the effectiveness of educational intervention on knowledge regarding prevention of cervical cancer among married women in Chandragiri Municipality.</p> <p><strong>Methodology:</strong> Pre-experimental research design (One-group pretest-posttest design) was used. Through nonprobability purposive sampling, 65 married women of Chandragiri municipality, ward no. 04 were included in the study. The final sample size was 62 as three samples were lost during post-test. Structured questionnaire was used for data collection via an interview method. The educational intervention was administered after pretest. Posttest was done with the same instrument two weeks after intervention. Data analysis was done using SPSS version 20. Descriptive statistics and inferential statistics (paired t-test) were used, hypothesis was tested at 5% level of significance.</p> <p><strong>Results:</strong> Out of 62 respondents, 54.8% of the respondents had adequate knowledge in the pre-intervention phase and 62.9% had adequate knowledge in the post-intervention phase regarding cervical cancer and its prevention. There was a significant increase in mean score of overall knowledge from 15.82 to 25.75 after educational intervention (p&lt;0.001).</p> <p><strong>Conclusion:</strong> Mean knowledge score of the respondents increased significantly after educational intervention indicating that the educational intervention was effective.</p> Bipsana Shrestha, Narayani Paudel Copyright (c) 2020 Journal of Kathmandu Medical College Tue, 30 Jun 2020 00:00:00 +0000 Complications of inguinal hernia repair in children: A tertiary hospital experience <p><strong>Background:</strong> Repair of inguinal hernia is one of the most frequently performed procedures in pediatric surgery.</p> <p><strong>Objectives:</strong> The aim of this study was to evaluate the complications we encountered following repair of inguinal hernia in children.</p> <p><strong>Methodology:</strong> This was a retrospective study done in children aged 15 years and below who had complications following inguinal hernia repair (both emergency and elective) at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria, between January 2014 and December 2018.</p> <p><strong>Results:</strong> A total of 1243 cases of pediatric inguinal hernia repairs were performed during the study period. Out of this, 123 patients developed complications, accounting for 9.9% of the total cases. There was male predominance with a median age of 1 year. Most of the complications were noted in infants undergoing emergency repairs. Scrotal complications were the most common complications which resolved on non-operative treatment. Other complications in descending order of frequency included wound infection, hernia recurrence, testicular atrophy and sensory disturbances in the inguinal region. There was no mortality following the surgeries.</p> <p><strong>Conclusion:</strong> Pediatric inguinal hernia repair is a procedure with potential complications more so in infants following an emergency repair. Preoperative parental counseling and timely referral are mandatory.</p> Kevin Emeka Chukwubuike Copyright (c) 2020 Journal of Kathmandu Medical College Tue, 30 Jun 2020 00:00:00 +0000 Prevalence of hypertension and its associated risk factors among bank workers of Kathmandu <p><strong>Background:</strong> Bank workers are exposed to risk factors which make them a potential occupational risk group for hypertension and information on the prevalence and risk factors of hypertension among bank workers in Nepal is very scarce.</p> <p><strong>Objective:</strong> The aim of the study was to estimate the prevalence and associated factors of hypertension among bank employees in Kathmandu district.</p> <p><strong>Methodology:</strong> A descriptive cross-sectional study was conducted among 416 bank employees of commercial banks of Kathmandu district. The information was obtained using a self-administered questionnaire in the workplace which included demographic information of individuals and other risk factors like alcohol,tobacco use and physical activity. Anthropometric measurements and blood pressure were recorded and hypertension was defined as per Joint National Committee VII criteria. Data analysis was performed using the Statistical Program for Social Sciences version 23.</p> <p><strong>Results:</strong> Prevalence of hypertension was found to be 11.3%. Of the 47 participants with hypertension, 40(85.1%) were known cases while 7(14.9%) were newly diagnosed. Age, gender, marital status, overweight (BMI ?25), smoking, alcohol consumption, having diabetes, and family history of -hypertension were found to have significant association with hypertension in univariate analysis. The multivariate logistic regression analysis revealed that gender, having diabetes and physical activity had independent and significant association with hypertension.</p> <p><strong>Conclusion:</strong> Based on the findings from the study, we can conclude that hypertension is significantly associated with gender, physical activity and diabetes. Measures for early detection of hypertension and diabetes are required and health education regarding lifestyle modifications is recommended.</p> Jagdish Chataut, Sumira Dahal, Abha Shrestha, Mukta Singh Bhandari Copyright (c) 2020 Journal of Kathmandu Medical College Tue, 30 Jun 2020 00:00:00 +0000 Reduction of blood loss after total knee arthroplasty by tranexamic acid <p><strong>Background:</strong> Total knee arthroplasty is associated with significant peri-operative blood loss. Various studies have shown that the use of tranexamic acid reduces post-operative blood loss and need for allogeneic blood transfusion in total knee arthroplasty.</p> <p><strong>Objectives:</strong> To assess the effect of tranexamic acid in the reduction of the postoperative blood loss in total knee arthroplasty.</p> <p><strong>Methodology:</strong> An analytical cross-sectional study was carried out in 14 patients who underwent primary total knee arthroplasty during the study period of 12 months at Kathmandu Medical College. Seven patients were allocated to the case group and received one gram (gm) of tranexamic acid thirty minutes prior to the incision and five hundred milligram (mg) orally three times a day till the drain was removed. Tranexamic acid was not given to the seven patients in control group. The haemoglobin of the patient was recorded on the day of surgery and the total amount of drain output was recorded on postoperative period until the drain was removed.</p> <p><strong>Results:</strong> Out of 14 patients operated, it was found that the average amount of drain in the patients in case group was 628 ± 234 millilitre (ml) which was significantly lower than the control group 1028 ± 183 ml (p&lt;0.05). Though there was difference in the amount of drain output, there was no significant change in the postoperative haemoglobin level in both<br />the groups (p = 0.381).</p> <p><strong>Conclusion:</strong> Tranexamic acid, an antifibrinolytic agent, can be effective to reduce blood loss in patients who undergo major surgeries like total knee arthroplasty.</p> Sashmit Sharma, Kiran Rijal, Tanup Prasai, Amit Poudel Copyright (c) 2020 Journal of Kathmandu Medical College Tue, 30 Jun 2020 00:00:00 +0000 Implications of COVID-19 in healthcare and medical education <p>Not available</p> Sanjaya Mani Dixit, Eurek Ranjit, Hemang Dixit Copyright (c) 2020 Journal of Kathmandu Medical College Tue, 30 Jun 2020 00:00:00 +0000