Journal of Kathmandu Medical College 2022-04-10T00:00:00+0545 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> Promote national journals for increased visibility of your research 2022-03-14T14:17:50+0545 Sujaya Gupta <p>Not Available.</p> 2021-12-31T00:00:00+0545 Copyright (c) 2022 Journal of Kathmandu Medical College Paper Mills for research writing and publication 2022-01-09T15:04:41+0545 Jay Shah Jenifei Shah <p>The reliability of publication affects evidence-based science. In recent years, science has come under increasing scrutiny for its trustworthiness because of the misconduct of a few researchers, authors, and publishers involved in the unethical behaviour of research writing and publication. There has been an exponential increase in research output worldwide, and many publications are of questionable credibility due to “Paper Mills.” These are profit-oriented, illegal, and unethical organisations working in the shadow to produce papers on demand, or sell readymade papers for a price. All stakeholders: researchers, authors, readers, journal publishers, and all of the academia need to be aware of “Paper Mills” to minimise scientific misconduct.</p> 2021-12-31T00:00:00+0545 Copyright (c) 2021 Journal of Kathmandu Medical College Ocular morbidity among school children of Pokhara valley 2021-10-25T15:55:58+0545 Jamuna Gurung Sarita Tuladhar Renu Poudel Kripa Joshi Priyanka Singh <p><strong>Background:</strong> Ocular morbidity is common among school going children. The uncorrected refractive error is an important cause of childhood blindness and visual impairment. School based eye screening programs help to identify the ocular abnormalities so that early intervention can be done and prevent children from permanent visual disability.</p> <p><strong>Objectives:</strong> This research was done to find the prevalence of ocular morbidity and their pattern among primary school children of Pokhara Valley, Nepal.</p> <p><strong>Methods:</strong> A descriptive cross-sectional study was conducted among children of three primary schools of Pokhara Valley from January to March 2021. Children who needed further evaluation were referred to ophthalmology department, Gandaki Medical College. After the ethical clearance from the institutional review committee, 1034 children were taken by convenient sampling method. Visual acuity, objective and subjective refraction, extraocular motility, cover test, anterior and posterior segment findings were documented in predesigned proforma. Point estimate at 95% confidence interval along with frequency and proportion were calculated. SPSS 20.0 was used for data analysis.</p> <p><strong>Results:</strong> A total 1034 children between 5-16 years were examined. Ocular morbidity was observed in 181 (17.5%) at 95% confidence interval (15.4-18.6). The mean age of children with ocular morbidity was 12.33 ± 2.39 years with male to female ratio of 1.18:1. The common type of ocular morbidity was refractive error 107 (10.35%), conjunctivital diseases 35 (3.38%) and eyelid diseases 26 (2.5%). Myopia 83 (8.02%) was the most common type of refractive error.</p> <p><strong>Conclusion:</strong> Refractive error was the commonest form of ocular morbidity among school children.</p> 2021-12-31T00:00:00+0545 Copyright (c) 2021 Journal of Kathmandu Medical College Burden among caregivers of geriatric people in Kavrepalanchok district, Nepal 2021-11-07T11:18:25+0545 Nirmala Manandhar Sophiya Shrestha Ajay Risal Dipak Kunwar Kedar Manandhar <p><strong>Background:</strong> Ageing is the natural phenomenal encompassing physical, psychological, and social changes. Today, people are living longer than ever before due to advances in education, technology, medicine, food distribution, and public health. Longevity has also resulted in a care giving burden in the family living together.</p> <p><strong>Objectives:</strong> To assess the caregiver’s burden among family of geriatric people in Kavrepalanchok.</p> <p><strong>Methods:</strong> Analytical cross-sectional study was done to assess the caregivers’ burden among family members of geriatric people in Kavrepalanchok. Total sample of 439 was selected using multistage random sampling technique. Among them 21 respondents did not respond. Data were collected from January and February 2019 using validated Nepali version of the Zarit Burden Inventory-22. Descriptive and inferential statistic (t-test and ANOVA) were applied using Statistical Package for Social Sciences 20 version. The scoring ?21 on ZBI-22 were considered as burden.</p> <p><strong>Results:</strong> The study showed that more than half respondents 256 (58.3%) had no or minimal burden, 183 (41.7%) experienced mild to severe burden while caring the older people at home. There was significant association between caregiver’s burden with age, education status, marital status, and occupation respectively.</p> <p><strong>Conclusion:</strong> Care giving to elderly is stressful task which affects physical, mental, social, and psychological state of caregivers. Therefore, it would be helpful, if community health organisations could conduct the educational programme for caregivers caring the older family members at home.</p> 2022-04-10T00:00:00+0545 Copyright (c) 2021 Journal of Kathmandu Medical College Relative position of mandibular foramen for inferior alveolar nerve block in children 2021-12-27T09:59:39+0545 Sumita Upadhyay Sijan Poudyal Swagat Kumar Mahanta Harleen Bali Abhinaya Luitel Deepa Niroula <p><strong>Background:</strong> For a successful inferior alveolar nerve block, good knowledge of position of mandibular foramen is imperative.</p> <p><strong>Objectives:</strong> To evaluate the position of mandibular foramen in relation to mandibular occlusal plane and anterior border of ramus in a selected population of children in Nepal using digital panoramic radiographs.</p> <p><strong>Methods:</strong> An analytical cross-sectional study was done after ethical approval in convenient sample of 180 children of 3-13 years in department of Paediatric and Preventive Dentistry, Dhulikhel Hospital from January 2021 to August 2021. Their digital panoramic radiographs were analysed using software Rainbow TM Image Viewer version Mean with standard deviation were calculated for linear measurements taken from mandibular foramen to mandibular occlusal plane and deepest point on the anterior border of ramus. Paired t-test was used to compare measurements between right and left sides. Student t-test was used to evaluate the difference between boys and girls. Pearson correlation was used to observe the correlation of age with the linear measurements.</p> <p><strong>Results:</strong> The mean linear measurements increased along with the increase in age (p &lt;0.05). There was statistically significant difference in linear measurements between the two sides of mandible except in 3-4 years children for mandibular foramen to anterior border of ramus which was not significant (p = 0.090). There was no significant difference in linear measurements between boys and girls.</p> <p><strong>Conclusion:</strong> For inferior alveolar nerve block, the needle should be placed below the occlusal plane in children up to seven years of age and above for higher ages.</p> 2021-12-31T00:00:00+0545 Copyright (c) 2021 Journal of Kathmandu Medical College Assessment of patient satisfaction after implementing an Enhanced Recovery After Surgery (ERAS) protocol for elective Caesarean sections 2021-06-14T17:39:17+0545 Dilasha Karki Rachana Saha <p><strong>Background:</strong> Enhanced Recovery After Surgery (ERAS) is a multimodal patient centred perioperative care pathway aimed at accelerating patient recovery, improving patient satisfaction, decreasing length of hospital stay, and post-operative complications.</p> <p><strong>Objectives:</strong> To assess patient satisfaction with ERAS protocol in the most common surgical procedure in the world, elective Caesarean Section.</p> <p><strong>Methods:</strong> A descriptive cross-sectional study was carried out in the department of Obstetrics and Gynaecology at Kathmandu Medical College Teaching Hospital (KMCTH) from July 2020 to February 2021 after ethical approval. The study included all pregnant ladies undergoing elective Caesarean section under ERAS protocol by convenient sampling and their satisfaction with the treatment received was recorded using a pre-validated questionnaire at the time of discharge. Data was analysed using SPSS.</p> <p><strong>Results:</strong> A total of 140 patients were enrolled in the study. Majority of the patients considered the introduction of feeding (100, 71.4%) and ambulation (115, 82.1%) to be on time. Seventy-three patients (52.1%) considered themselves fit for discharge on the second post-operative day and 70 (50%) were discharged on the second post-operative day itself which is earlier compared to the hospital protocol of discharge on the third or fifth post-operative day. Most of the women (136, 97.1%) were satisfied with the care they received and 132 (94.3%) of them would prefer to undergo surgery under the ERAS protocol in the future.</p> <p><strong>Conclusion:</strong> Most women were satisfied with the surgical experience and would prefer to undergo surgery under the same protocol in the future.</p> 2021-12-31T00:00:00+0545 Copyright (c) 2021 Journal of Kathmandu Medical College Use of herbal products and dietary supplements and its perception among people during the COVID-19 pandemic 2021-11-07T15:33:56+0545 Anna Acharya Marina Vaidya Shrestha Ashish Kumar Bhattarai <p><strong>Background:</strong> In Nepal herbal medicines are popular and are used along with or instead of allopathic medicines. Scarcity of efficient and new pharmacological treatment and vaccine for COVID-19 has made people find alternative ways to prevent or treat the disease, including measures like use of herbal products. Evidence-based use of herbal products should be implemented to ensure patient safety.</p> <p><strong>Objectives:</strong> To determine the prevalence of use of herbal products during COVID-19 and to find patients perception regarding their use.</p> <p><strong>Methods:</strong> A descriptive online cross-sectional study was conducted among adult Nepali population from 5th February to 6th June 2021 after ethical clearance at Kathmandu Medical College. Convenience sampling was used to request 292 adults who could be traced through social media, living in Nepal, one member from one household were included. Participants unable to respond to English were excluded. Questionnaires consisting of socio-demographic characteristics, use of herbal products, Likert scale to measure perception was used. Data were transferred into Excel sheet and exported to SPSS v.20 for analysis.</p> <p><strong>Results:</strong> Prevalence of use of herbal products during COVID-19 was 206 (70.5%). Most common used products were Lime, Turmeric, Ginger, Honey, and Garlic. Of all, 95 (32.5%) respondents indicated that they preferred herbal products over prescription medicine for prevention and treatment of COVID-19.</p> <p><strong>Conclusion:</strong> The prevalence of use of herbal products was high during the COVID-19 pandemic and almost half of the participants had perception that compared to prescription medicines herbal products were safer, had less adverse effects and were of better quality.</p> 2021-12-31T00:00:00+0545 Copyright (c) 2021 Journal of Kathmandu Medical College Measurement of quadriceps strength among patients of Dhulikhel hospital following anterior cruciate ligament reconstruction: A descriptive cross-sectional study 2021-10-21T12:02:54+0545 Umesh Adhikari Barsha Thapa Rajan Shrestha <p><strong>Background:</strong> Anterior cruciate ligament is the key structure of the knee joint. Quadriceps weakness in the involved leg is frequently seen in the rehabilitation setting even when an individual returns to their functional activity.</p> <p><strong>Objectives:</strong> To measure the quadriceps strength following an anterior cruciate ligament reconstruction and evaluate the functional activity level.</p> <p><strong>Methods:</strong> An analytical cross-sectional study was conducted among 30 anterior cruciate ligament reconstruction patients visiting physiotherapy outpatient department of Dhulikhel hospital between 2nd May 2019 to 4th May 2020. Nonprobability purposive sampling was used for the study. Participants with a history of primary unilateral anterior cruciate ligament reconstruction no less than six months were recruited for the study. Study excluded other lower limb surgeries, anterior cruciate ligament reinjury, multiligament injury, and pregnant women. Quadriceps muscle strength was assessed by using a handheld dynamometer, MicroFET2 and functional activity level with Lysholm scale. Independent sample t-test was done to assess the association between quadriceps strength and different variables.</p> <p><strong>Results:</strong> Quadriceps strength deficit in an involved limb was 17.5% and mean length physiotherapy follow up was 11.7 ± 5.9 days in six months. Quadriceps strength was significantly different between genders. There was no statistical significance between quadriceps strength and body mass index. Higher quadriceps strength had greater levels of function.</p> <p><strong>Conclusion:</strong> Quadriceps strength deficit was found after anterior cruciate ligament reconstruction. Functional activity was affected even after an individual returned to their normal daily activities.</p> 2021-12-31T00:00:00+0545 Copyright (c) 2021 Journal of Kathmandu Medical College Factors associated with unintended pregnancy at a tertiary hospital, Kathmandu, Nepal: A case-control study 2021-06-23T07:08:31+0545 Narayani Paudel <p><strong>Background:</strong> Despite the widely available family planning efforts to reduce the proportion of unwanted pregnancies, the rate of unintended pregnancies is still significantly large in Nepal.</p> <p><strong>Objectives:</strong> To find out the factors associated with unintended pregnancy.</p> <p><strong>Methods:</strong> A case-control study was conducted in Kathmandu Medical College Teaching Hospital. Cases were the women seeking safe abortion services for unintended pregnancy and women with intended pregnancy were controls. Eightyone cases and eighty-one controls (total 162 women) were included in the study purposively. Face-to-face interview was done to collect data using structured questionnaire. Data were collected from 15th January 2019 to 30th August 2019. Ethical clearance was obtained from institutional review committee of Kathmandu Medical College. Permission for data collection was obtained from the head of the department of Obstetrics and Gynaecology and written informed consent was taken from each respondent. Data were analysed using statistical package for social sciences 20.0 version.</p> <p><strong>Results:</strong> Age below 20 years (AOR: 5.14; 95% CI: 1.14, 23.06) and above 30 years (AOR: 2.59; 95% CI: 1.10, 6.08); primary level education (AOR: 4.46; 95% CI: 1.27, 15.62); and secondary level education (AOR: 2.97; CI: 1.39, 6.34), student by occupation (AOR: 11.40; 95% CI: 3.07, 42.25), three and more gravidity (AOR: 13.82; 95% CI: 4.56, 41.87)) and perceived ideal number of child one (AOR: 4.63; 95% CI: 1.18, 18.10) were associated with increased risk of unintended pregnancy.</p> <p><strong>Conclusion:</strong> Age, education, occupation, gravidity, and perceived ideal number of children were the factors significantly associated with unintended pregnancy.</p> 2021-12-31T00:00:00+0545 Copyright (c) 2021 Journal of Kathmandu Medical College Sex determination using mesiodistal width of permanent maxillary molar 2021-10-25T11:12:01+0545 Samarika Dahal Radha Baral Sanjay Prasad Gupta Gopal Kumar Chaudhary <p><strong>Background:</strong> Teeth are valuable material for forensic investigations since they are the strong and stable human tissue that is resistant to physical damage. Sex determination, which is usually the first stage in the human identification process, is one of the essential criteria of biological identity.</p> <p><strong>Objectives:</strong> To evaluate the potential of mesiodistal width of permanent maxillary molar in sex determination.</p> <p><strong>Methods:</strong> This analytical cross-sectional study was done in 120 dental casts prepared for different dental treatment purposes in Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal from 5th October, 2021 to 5th November, 2021. Convenience sampling technique was used. The mesiodistal dimension of the permanent maxillary molar was measured with the help of a digital vernier caliper (Digimatic Eco, Precise, India). The data were entered in a Microsoft Excel sheet and analysed statistically using Statistical Package for Social Sciences Statistics Version 21.</p> <p><strong>Results:</strong> The mean age of the patients was 21.05 ± 5.64 years. The mesiodistal dimension of maxillary first molar in males and females were not statistically significant on both the right and the left sides of the jaw. The sexual dimorphism percentage was 0.893% and 0.606% in right and left maxillary first molar respectively. Similarly, the frequency was 0.018 and 0.267 in right and left maxillary first molar respectively.</p> <p><strong>Conclusion:</strong> Mesiodistal dimension of maxillary first molar did not significantly differ between the right and left sides of the jaw. This study could not establish sexual dimorphism among the right and left sides of the jaw.</p> 2021-12-31T00:00:00+0545 Copyright (c) 2021 Journal of Kathmandu Medical College Mandibular parameters as a predictor of sex: A digital orthopantomogram study 2021-12-06T15:24:34+0545 Bidhata Ojha Dipshikha Bajracharya Sushmit Koju Nisha Maharja Ankit Saha Radha Baral <p><strong>Background:</strong> The determination of age and sex is required for forensic practice and medicolegal purposes. Because the mandible is typically recovered intact, it plays a crucial role in determining sex. Orthopantomogram X-rays can be used to thoroughly examine the mandible. The availability of a large number of antemortem orthopantomograms could be extremely beneficial in terms of evaluating and developing population-specific sex determination standards.</p> <p><strong>Objectives:</strong> To evaluate the usefulness of the mandibular ramus in sex determination by evaluating linear and angular measurements of the mandibular ramus on digital panoramic radiographs.</p> <p><strong>Methods:</strong> An analytical cross-sectional study was conducted on 216 digital orthopantomogram from March 2021 to June 2021 in Kantipur Dental College. A convenient sampling technique was used to collect the radiographs. Mandibular parameters were traced using Image J Software, and angular and linear parameters were calculated. Radiographs with high image quality and sharpness of patients with full permanent dentition, no radiographic evidence of trauma were included in the study. Descriptive analysis was done using IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, N.Y., USA). The measures were compared using an Independent t-test, and the results were subjected to discriminant function analysis.</p> <p><strong>Results:</strong> The male’s vertical parameters were found to be greater than the female’s. The coronoid height was shown to be the most dimorphic using discriminant analysis. The overall accuracy of the mandibular parameters was 63.4%.</p> <p><strong>Conclusion:</strong> Mandible can be used as an adjunct in sex determination.</p> 2021-12-31T00:00:00+0545 Copyright (c) 2021 Journal of Kathmandu Medical College Level of glycosylated haemoglobin in the first trimester in cases of gestational diabetes mellitus 2021-06-17T08:46:44+0545 Pratigyan Gautam Rachana Saha Sujata Maharjan Surendra Bhusal <p><strong>Background:</strong> Glycosylated haemoglobin (HbA1c) level during early pregnancy has been proposed as a predictor of gestational diabetes mellitus (GDM).</p> <p><strong>Objectives:</strong> To determine the mean value of first trimester’s glycosylated haemoglobin (HbA1c) in gestational diabetes mellitus cases.</p> <p><strong>Methods:</strong> An analytical cross-sectional study was conducted among GDM cases at the Obstetrics and Gynaecology Department of Kathmandu Medical College after ethical clearance. Purposive sampling was done to enrol 102 cases that presented over a period of August 2020 to January 2021. First trimester HbA1c levels were recorded. The HbA1c values were grouped into two taking 5.7% as a cut-off which is an established threshold for prediabetes in a normal population.</p> <p><strong>Results:</strong> The mean age of participants was 28.74 ± 4.1 years and mean body mass index was 29.13 ± 2.73 kg/m2. Mean value of HbA1c was 5.52 ± 0.44%. Mean value of fasting blood glucose and postprandial glucose after oral glucose tolerance test (OGTT) was 102.25 ± 7.36 mg/dl and 167.55 ± 10.91 mg/dl respectively. Out of total participants, only 40 (39.21%) had HbA1c value more than 5.7% while 62 (60.78%) had HbA1c value less than 5.7%. There was weak positive correlation between HbA1c and Fasting Blood Glucose (Pearson’s correlation coefficient r = 0.13). Similarly, correlation between HbA1c and blood sugar after OGTT (r = 0.17) was also insignificant.</p> <p><strong>Conclusion:</strong> This study concluded that the HbA1c value of first trimester is not very different than normal population. Hence, diabetic range of HbA1c value in first trimester is useful in diagnosing overt diabetes.</p> 2021-12-31T00:00:00+0545 Copyright (c) 2021 Journal of Kathmandu Medical College Determinants of infertility in couples attending maternity hospital 2021-11-26T10:14:36+0545 Snigdha Rai Bhaba Malla Preetam Chandra Upadhyaya <p><strong>Background:</strong> Infertility is defined as not being able to conceive after one year or longer period of regular unprotected sex. Infertility is an experience that not only strikes at the very core of a couple’s life but also the whole family and society.</p> <p><strong>Objectives:</strong> This study was aimed to establish the various determinants inclusive of diverse male and female factors that are responsible in causing primary or secondary infertility.</p> <p><strong>Methods:</strong> A descriptive cross-sectional study was conducted after ethical approval among 448 couples attending infertility clinic in a Tertiary Care Maternity Hospital from 16th July 2018 to 15th July 2019. Convenient sampling was done. All infertile couples who visited hospital’s infertility clinic during the study period were included in the study. Clinicodemographic and diagnostics details were recorded and analysed using SPSS 20.</p> <p><strong>Results:</strong> Majority of the couples had primary infertility (326, 74.4%). Mean age of the females was 28.08 ± 5.23 years and males was 31 ± 5.7 years. Most of the infertile couples had unexplained infertility followed by female and male factor. Most common female contributing factors was tubal factor (45, 35.16%), followed by ovarian factor (41, 32.2%). Only 104 (23.6%) of the semen analysis had abnormal result among which most common findings was asthenozoospermia.</p> <p><strong>Conclusion:</strong> Primary infertility is more common than secondary infertility. Tubal factor was the most common female contributory factor while asthenozoospermia was predominantly seen among male partners with abnormal semen analysis.</p> 2021-12-31T00:00:00+0545 Copyright (c) 2021 Journal of Kathmandu Medical College Analysis of a health camp at a rural set up in Nepal 2021-07-22T01:49:42+0545 Chandrima Karki Chanda Karki Rydam Basnet Punam Basnet Dixit Ashik Rajak <p><strong>Background: </strong><span style="font-weight: 400;">In Nepal where there is lack of health facilities in rural areas, health camps play an important role in providing health services. It is important to analyse health camps to determine the area of need and further planning. An analysis of a multispecialty health camp was done in Aurahi of Mahottari district which is one of the most rural areas of Nepal. </span></p> <p><strong>Objectives:</strong><span style="font-weight: 400;"> To quantitatively determine the population utilising the multispecialty health along with the patients’ demographic data and major health problems present in the area.</span></p> <p><strong>Methods:</strong> <span style="font-weight: 400;">A descriptive cross sectional study was conducted among 2560 people attending a health camp organised during 19</span><span style="font-weight: 400;">th</span><span style="font-weight: 400;"> to 25</span><span style="font-weight: 400;">th</span><span style="font-weight: 400;"> December 2019. Information was collected using registers with consent. Ethical clearance for the study was obtained from the Institutional Review Committee (IRC). The data were entered and analysed in Microsoft Excel.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">Two thousand five hundred and sixty people which comprised 8.06% of the total population of the municipality</span><span style="font-weight: 400;"> reached out for services at the health camp. The number and percentage of population attending respective speciality were Nutrition - 869 (33.93%), Dental - 429 (16.75%), Gynaecology - 398 (15.50%), Medicine - 268 (10.46%), Obstetrics - 218 (8.52%), non-specific symptoms - 152 (5.94%), Dermatology - 122 (4.77%), ENT - 82 (3.22%) and Surgery - 50 (1.97%) respectively.</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">The s</span><span style="font-weight: 400;">tudy shows presence of significant unmet health needs in this rural district of Nepal due to the lack of basic health services in the region.</span></p> 2021-12-31T00:00:00+0545 Copyright (c) 2021 Journal of Kathmandu Medical College