Journal of Kathmandu Medical College

Perfusion Index Use of Perfusion index as a predictor of successful caudal block in pediatric patients in tertiary care center: Prospective comparative study

2025-07-28T20:36:36+0545

Introduction: Caudal block is a common regional anesthesia technique in children, especially for lower abdominal surgeries. However, its success can be variable. The perfusion index (PI), a non-invasive parameter, has been suggested as a potential early indicator of block effectiveness.
Objectives: To evaluate whether the PI can serve as an early, non-invasive predictor of successful caudal block in pediatric patients and to compare hemodynamic parameters between those receiving general anesthesia with or without a caudal block.
Methodology: Sixty children undergoing elective lower abdominal surgery were divided into two groups of 30 each. Group C received a caudal block after general anesthesia, while Group G received general anesthesia alone. PI, heart rate (HR), and mean arterial pressure (MAP) were recorded at baseline and at 5, 10, 15, and 20 minutes after induction.
Results: Group C showed a significantly higher PI from 5 minutes post-induction compared to Group G. At T5, the mean PI was 5.63 ± 1.217 in Group C versus 4.57 ± 1.431 in Group G (P = 0.003), with similar trends at subsequent intervals (P < 0.05). Group C also demonstrated significantly lower HR and MAP, indicating better hemodynamic stability.
Conclusion: The perfusion index is an early and reliable indicator of caudal block success in pediatric patients. Its routine monitoring may enhance clinical assessment and support timely anesthetic decision-making.

Functional outcome of metacarpal and phalangeal fractures treated with open reduction and internal fixation using plates and screws in a tertiary level hospital

2024-05-15T15:45:56+0545

Introduction: Metacarpal and phalangeal fractures are common injuries encountered in orthopaedic practice. Traditionally, these fractures needing operative treatment have been managed with closed reduction and percutaneous pinning with various wire positions/configurations. Operative treatment, plate and screw fixation provides superior biomechanical strength compared to k wire.
Objectives: To evaluate the functional outcome of metacarpal and phalangeal fractures treated with open reduction and fixation with screws with or without plates.
Methodology: The study was conducted in KMC Teaching Hospital, Sinamangal, Department of Orthopaedics. The study included 36 metacarpal and 11 phalangeal fracture cases in 38 patients. All included patients were operated with open reduction and internal fixation with 1.5 mm mini plate systems. Both metacarpal and phalangeal fracture were treated with dorsal approach. Patients were discharged on second post operative day after wound inspection. Functional outcome was evaluated with DASH scoring system at six weeks, three months, and six months post operatively.
Results: Out of 38 patients two were lost to follow-up. Among 36 patients at six weeks post-surgery, average DASH score was 63.18±15.3. This score improved to an average of 32.62±16.15 and 4.23±5.97 at three months and six months respectively. Among 44 bones fixed, 31 bones showed radiological union at the end of three months. One case did not show union at six months.
Conclusion: Mini plate and screw constructs provide superior biomechanical strength. Hence, rigid stable fixation provided by plating allowed early mobilization and achieved good functional results. Proper preoperative planning and sharp dissection with meticulous handling of soft tissue minimize complications.

Evaluation of Typhoid antigen test for qualitative and differential detection of Salmonella Typhi and Salmonella Paratyphi in human blood culture

2024-11-17T20:14:15+0545

Introduction: Typhoid and Paratyphoid fever are enteric infections caused by the bacteria Salmonella enterica serovar Typhi (S. Typhi) and S. Paratyphi A, B and C respectively. This research evaluated an immunochromatographic rapid diagnostic tests (RDT) Typhisure ©, for detection of S. Typhi and S. Paratyphi antigen in blood culture.
Objectives: To test for qualitative and differential detection of S. Typhi and S. Paratyphi antigen in human blood culture specimen by Typhisure .
Methodology: A descriptive cross-sectional study was conducted in a tertiary care hospital from August- October, 2024 after obtaining ethical clearance. Blood sample from 758 patients were collected aseptically. Rapid diagnostic test was performed by Typhisure on blood culture positive specimen and in parallel, conventional subculture, isolate identification was done.
Results: Among 758 blood culture specimen, 100 blood culture broth showing evidence of growth were further evaluated. Among these, Salmonella Paratyphi A was identified from 4 patients and Salmonella Typhi from 6 patients. The Typhisure RDT by Koshibio Diagnostics showed a sensitivity of 100% and specificity of 100% in detection of Salmonella Typhi from blood culture broth. Similarly, in all 4 Blood culture positive Salmonella Paratyphi, antigen was detected by Typhisure (Sensitivity 100%). However, one test came as false positive. two tests were considered invalid as the control line failed to appear in the kit.
Conclusion: Conventional blood culture broth with the RDT for antigen detection could pave a pathway forward for early diagnosis of enteric fever in resource limited setting like ours where Bactec, biochemical tests and Serotyping is not available in primary healthcare settings.

Timing of passage of first stool and urine by newborn delivered at a tertiary level hospital

2025-08-05T18:12:25+0545

Introduction: Passage of first stool and urine is considered as one of the reassuring indicators to exclude some important congenital anomalies of gastrointestinal and genitourinary tract. Also, it is a sign that the newborn is healthy. Different studies from different geographical reasons have shown varying results in the timing of first passage of it. Hence this study aims to assess timing of passage of first stool and urine by newborn in our setting.
Objectives: To assess the timing of passage of first stool and urine by newborn.
Methodology: A descriptive observational study was carried out among 210 newborns born at Kathmandu Medical College Teaching Hospital, for the period of six months using convenient sampling technique. Data were analyzed by using frequency percentage and Mann-Whitney U test to see the associations.
Results: Study showed that 92.9% of newborns passed their first stool within eight hours of life and remaining 7.1% within 16 hours. Most of them i.e., 66.7% of newborns passed urine within 8 hours of life where as 6.7% of newborn passed their first urine beyond 24 hours. There was significant association between type of delivery and timing of passage of first stool (p = <0.05) and urine (p = <0.05). Timing of passage of first stool was significantly associated with type of oral feeding (p = <0.05).
Conclusion: Most of the newborn pass their first urine and stool within 24 hours of birth but few of them can go beyond 24 hours for urine without subsequent abnormality.

Clinical versus sonological methods of fetal weight estimation at term pregnancy in a tertiary level hospital

2025-05-17T21:09:11+0545

Introduction: Various clinical and sonological methods are used for estimation of fetal weight at term with varying accuracy.
Objectives: To compare clinical and sonological methods of fetal weight estimation at term.
Methodology: A prospective cross sectional study was conducted in the Department of Obstetrics and Gynaecology, Tribhuvan University Teaching Hospital, for a duration of one year. Women with term, singleton pregnancy admitted for delivery were enrolled. Fetal weight was estimated by two clinical methods -Insler-Bernstein’s and Johnson's formulae as well as by ultrasonography using Hadlock’s method. After delivery actual birth weight of newborns was compared with weights estimated by clinical and sonological methods. Frequency, percentage, mean, mean difference, standard deviation were calculated for descriptive analysis; for inferential statistics, p value was calculated by use of paired t test and association was calculated using the Pearson correlation coefficient.
Results: Total of 213 cases were enrolled. Difference of mean of weight estimated by sonological method compared to actual birth weight was statistically significant (p < 0.001) whereas there were no significant differences in mean values calculated by two clinical methods compared to actual birth weight (p =0.98 and 0.96). Insler-Bernstein’s formula showed strongest positive linear correlation with the actual birth weight (r=0.76) among all three methods.
Conclusion: Estimation of fetal weight by clinical methods was more accurate compared to sonological method. Among the two clinical methods Insler-Bernstein’s formula was closer to actual birth weight.

Quality of life of postmenopausal women residing in selected area of Dhulikhel, Kavre: A community based cross-sectional study

2024-12-19T01:30:00+0545

Introduction: Menopause, marked by the permanent cessation of menstruation and a decline in ovarian hormone production, brings various physical and psychological symptoms that impair the overall quality of life.
Objective: To assess the quality of life in postmenopausal women.
Methodology: A descriptive cross-sectional study was carried out among 188 postmenopausal women at Dhulikhel municipality, Kavre. Menopause- specific Quality of Life questionnaire was used to evaluate quality of life. Data were collected through face-to-face interviews from October 2022 to January 2023. Descriptive statistics were used to analyse the socio-demographic information and quality of life, and inferential statistics were used to identify the difference in quality-of-life domain scores.
Results: The study revealed that 109 (58%) of postmenopausal women faced moderate to severe physical symptoms and 85(45%) reported significant vasomotor symptoms. Physical and psychosocial symptoms worsen in women over 55 years. Non-smokers had better quality of life, while smokers experienced more severe symptoms. Obesity was associated with more physical (mean score: 3.3) and psychosocial symptoms (mean score: 2.9), whereas underweight women struggled with sexual issues (means core: 3.1). A positive correlation existed between vasomotor, psychosocial, and physical domains. There was significant association of age, education, and health conditions with menopausal women's quality of life.
Conclusion: The findings of the study revealed the multifaceted nature of menopausal symptoms and the need for targeted interventions, emphasizing health education and lifestyle changes for postmenopausal women.

Ocular biometry and refractive characteristics in patients with retinal vein occlusion: A cross-sectional comparative study

2025-02-21T14:07:01+0545

Introduction: Retinal vein occlusion is characterized by retinal and subretinal haemorrhages, macular oedema, and a varying degree of retinal ischemia. There is an increased risk with cardiovascular diseases but not all people with retinal vein occlusion reflect aggressive form of systemic diseases. In that situation, the role of ocular biometry and refraction is still essential to be studied.
Objectives: To compare the ocular biometry and refractive error of affected eyes of patients with retinal vein occlusion to their fellow eyes and the control group.
Methodology: This is a cross-sectional comparative study carried out at B.P. Koirala Lions Centre for Ophthalmic Studies. Ethical clearance was obtained from the institutional review committee of institute of Medicine. The calculated sample size was 60. After obtaining informed consent, 67 patients with retinal vein occlusion and 67 controls were enrolled using purposive sampling technique. Refractive error was determined using an auto-refractometer (Topcon KR-800). Keratometry, Anterior chamber depth, and Axial length were measured using IOL-Master-500. Different statistical test like t-test, chi-square test and ANOVA were used to analyse the data.
Results: The eyes with retinal vein occlusion were not significantly different either from fellow eyes or the control group in biometric indices like average keratometry, anterior chamber depth, and axial length. Significant hyperopia was found among central retinal vein occlusion group as compared to the fellow eye.
Conclusion: Biometric indices and refractive error in retinal vein occlusion cases were not significantly different from the control group. Central retinal vein occlusion was found to be significantly predisposed in more Hyperopic eyes as compared to fellow eyes.

Comparison of root resorption between extraction and nonextraction orthodontic treatment

2025-07-04T10:35:22+0545

Introduction: Apical root resorption is a common consequence of orthodontic treatment, usually asymptomatic, arising from various biological and mechanical factors. Its severity may differ between extraction and non-extraction therapies.
Objectives: To evaluate and compare apical root resorption in patients with Angles Class I bimaxillary malocclusion treated with extraction versus Class I malocclusion treated with non-extraction orthodontic approaches using panoramic radiographs.
Methodology: This cross-sectional observational study included 120 patients (60 extraction, 60 non-extraction) treated in the Department of Orthodontics, Kantipur Dental College, Kathmandu. Apical root length (ARL) was calculated as the difference in root length between the pretreatment and post-treatment Orthopantomograms. All permanent teeth (11 to 47) were measured with Image J software, with intra-examiner reliability assessed via the Intraclass Correlation Coefficient (ICC). Statistical analysis was performed with independent t-tests for group comparisons.
Results: The ICC values ranged from 0.85 to 0.99, indicating excellent intra-examiner reliability. Root resorption was significantly greater in the extraction group (p < 0.05) for 20 of 24 teeth with 12, 35, and 45 showing the highest mean differences. In the non-extraction group, significant resorption was observed in 15 teeth, although with lower overall values. Four teeth (25, 27, 37, and 47) showed no significant difference between groups.
Conclusion: Apical root resorption was more pronounced with extraction-based orthodontic treatment, although resorption was also evident in non-extraction cases, underscoring its multifactorial nature.

Correlation of hard and soft tissue among different sagittal malocclusion

2024-11-13T15:00:25+0545

Introduction: The essential determinant for facial aesthetics is an understanding of the relationship between the facial bones and soft tissue. A proportionate relationship among the different structures of a face is the key to its aesthetic and pleasing appearance. The facial profile is determined by the facial soft tissue thickness (FSTT) and dental and skeletal characteristics. Face contours are traditionally considered to be a result of the position of basic hard dental and skeletal tissues followed by the soft tissue.
Objective: To correlate the hard and soft tissue in different skeletal malocclusion.
Methodology: A descriptive cross-sectional study was conducted from 2023 September to 2024 May after ethical approval. Convenient sampling method was used to collect 105 samples who were divided into three groups I, Class II, Class III. Patients aged 18-30 years were included in this study. Patients undergoing orthodontic treatment and with no craniofacial deformities were included in the study. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, N.Y., USA).
Result: In this study, in hard tissue parameter, mean value of LI to A-pog, UI to PP plane, UI to SN plane, Interincisal angle, IMPA is 4.458 mm, 118.08 ◦,112.16◦, 115.64◦ and95.98◦ respectively. Whereas in soft tissue parameter, mean value of ULSNpog’, LL-SNpog’, LLSMe, Sn-ULI, Sline to lower lip, upper lip thickness andLower lip thickness are 2.91mm, 3.34mm, 41.2, 15.36mm, 2.136mm, 13.964 mm and 12.42mm respectively.
Conclusion: There is correlation of hard tissue to soft tissue. Hence clinicians and researchers must give due considerations while working on these parameters.