Journal of Kathmandu Medical College

Laparoscopic cholecystectomy in a patient with coronary artery disease: A case report

Rosi Pradhan — 2024-03-01

Laparoscopic cholecystectomy is a gold standard treatment for symptomatic cholelithiasis. Patients with cardiac dysfunction are at high risk of major cardiac events during such surgeries due to the haemodynamic effects of pneumoperitoneum. Patients of countries with low economies find difficulties as centre with high fidelity instruments, cardiology, cardiac services, specialist services are not readily available under one roof. Our case was patient with recurrent biliary colic who was deferred surgical intervention due to her coronary artery status multiple times and successfully managed at our centre with no perioperative complications and is doing fine six months after follow up.

Prophylactic abdominal drain- Assessing the timing for avoidance based on fistula risk score in pancreaticoduodenectomy

Dhiresh Kumar Maharjan — 2024-03-01

Background: Pancreaticoduodenectomy is technically challenging surgery with high complications rate, often requiring surgical drains for potential complication management. However, the necessity and effectiveness of routine drainage remain debated.
Objectives: To evaluate the utility of the fistula risk score in guiding abdominal cavity drain placement decisions for pancreaticoduodenectomy patients.
Methods: A single-centered, descriptive study was conducted during 1st February 2022 to 31st January 2023 among 33 patients undergoing pancreaticoduodenectomy. Intraoperative decision-making regarding drain placement was guided by fistula risk scores. We closely monitored clinical outcomes, duration of hospital and intensive care unit stays, and other postoperative complications including clinically relevant post operative pancreatic fistula.
Results: Drain placement was avoided in seven (21.2%) patients with negligible or low fistula risk score, and only one (3.0%) patient required subsequent intervention. Biochemical leaks and clinically relevant postoperative pancreatic fistulas occurred in five (15.1%) and three (9.1%) respectively. No significant difference was observed in hospital and intensive care unit stay between drain and no drain group.
Conclusion: Abdominal drainage after pancreaticoduodenectomy should be tailored to individual risk profiles. Routine drainage may not be necessary for low-risk patients but effectively manages complications when required.

Effects of the intramuscular administration of dexamethasone after the surgical extraction of impacted teeth

Rajesh Twyana — 2024-03-01

Background: Dexamethasone is frequently used for controlling oedema, trismus, and pain following oral surgical procedures and is one of the most researched corticosteroids in oral and maxillofacial surgery.
Objectives: To evaluate the efficacy of a post-operative intramuscular injection of dexamethasone (4 mg) in reducing pain, swelling, and trismus following tooth extraction.
Methods: A non-randomised trial was conducted from 2022 June to 2023 September by department of Oral and Maxillofacial Surgery, Kathmandu Medical College after institutional ethical approval. The participants with no known systemic diseases or drug allergies with age 18-40 years (40 males and 18 females) were enrolled by convenience sampling. Participants were explained about study details and assigned to either a control group or a study group after obtaining informed consent. The control group received an intramuscular 1 ml injection of normal saline solution, while the study group received 1 ml of dexamethasone (4 mg) administered into the deltoid muscle post-operatively. Postoperative pain, swelling, and trismus were assessed and compared between two groups using the Mann-Whitney U test.
Results: Dexamethasone significantly reduced post-operative facial swelling compared to the control group. The reduction in swelling was statistically significant immediately after extraction and continued to show significant differences through Day 2. On Day 7, the difference in swelling between the two groups remained mild but notable. Additionally, dexamethasone was effective in decreasing pain and improving mouth opening.
Conclusion: Intramuscular injection of dexamethasone into the deltoid muscle post-operatively is effective in reducing pain, swelling, and trismus following mandibular third molar extraction.

Comparison of pain intensity between lidocaine gel and intrauretral tramadol with lidocaine gel during rigid cystoscopy in men

Prajwal Paudyal — 2024-03-01

Background: Local anesthesia as lidocaine gel has long been used for cystoscopy using a rigid cystoscope. Recently, tramadol was discovered to also have a local anesthetic effect.
Objectives: We aimed to examine the difference in pain intensity between intraurethral injections of tramadol combined with lidocaine gel and sole lidocaine gel during cystoscopy.
Methods: A prospective comparative study was conducted in Kathmandu Medical College and Teaching Hospital, Kathmandu among 120 males who underwent rigid cystoscopy. All patients were divided into 2 groups, in which group 1 was given a combination of tramadol and lidocaine gel urethral injection 10 minutes before rigid cystoscopy, whereas group 2 was given lidocaine gel urethral injection 10 minutes before rigid cystoscopy. Patient tolerance during the procedure was assessed using visual analogue pain scale score. The scores were recorded three times, first during the entrance of the cystoscope, then during cystoscopy, and finally 15 minutes after removal of the cystoscope.
Results: The visual analogue pain Scale score at the commencement of the procedure, middle of the procedure, and 15 minutes after removal of the cystoscope in lignocaine group was 3.90 ±1.003, 5.75 ± 1.24 and 3.34 ± 1.024 respectively. Similarly, visual analogue pain scale score at the commencement of the procedure, middle of the procedure, and 15 minutes after removal of the cystoscope in lignocaine and tramadol group was 3.43 ±1.079, 5.5 ±1.33 and 2.73± 1.23 respectively. Mean pain scores in all stages were found to be significantly lower in the patients who received lidocaine and tramadol at the entrance of cystoscope, during cystoscopy and 15 min after end of cystoscopy as shown by p-value of 0.03, 0.028 and 0.03 respectively.
Conclusion: The combination of intraurethral tramadol and lidocaine gel can significantly decrease pain during rigid cystoscopy in men more effectively than sole intraurethral lidocaine gel.

Prevalence of eve teasing and its effects on school going adolescent girls of eastern Nepal

Unisha Rijal — 2024-03-01

Background: Eve-teasing is a pervasive social ill and a complicated issue. Teenage girls are the primary targets of eveteasing. All kinds of women experience eve-teasing through whistling, catcalling, touching or groping, flashing, blowing kisses, stalking, sexual posturing, or unauthorized photographing.
Objectives: To assess the prevalence of eve teasing and its effects among adolescent girls.
Methods: A descriptive cross-sectional study was conducted from October 9 to November 16, 2022, among the adolescent girls of Deumai Municipality Ilam. Ethical approval was obtained from the institutional review committee of Kathmandu Medical College (Ref.07102022/44) A nonprobability purposive sampling method was used to describe variables of interest. The collected data was analyzed using descriptive statistics (frequency, percentage, mean, median, and standard deviation), and inferential statistics (chi-square) was used to determine the association between independent variables and the prevalence of eve-teasing. Data was coded and placed into the SPSS program. The collected data were analyzed using descriptive statistics (frequency, percentage, mean, median, and standard deviation) and inferential statistics (chisquare) to determine the association between independent variables and the prevalence of eve-teasing.
Results: The study findings concluded that 327 (93.4%) of students had experienced eve teasing. A significant association was found between the prevalence of eve-teasing and age.
Conclusion: Prevalence of eve teasing was higher among the adolescents leading to several effects like, low self-esteem, anxiety and fear and activity of daily living.

Depression, anxiety and stress among pregnant women of Pokhara during COVID-19

Sirjana Pandit Pahari — 2024-01-01

Background: Public health concerns pertaining to depression, anxiety, and stress in expectant mothers are critical. Pregnancy is a sensitive period of a woman’s life. Various psychological factors can adversely affect her foetus and herself.
Objectives: To assess the status of depression, anxiety, and stress among pregnant women of Pokhara during the COVID-19 pandemic.
Methods: An analytical cross-sectional study was conducted in antenatal clinic of Pokhara Academy of Health Science, Kaski district among 400 pregnant women who were recruited by using convenient sampling technique. Data was collected through face-to-face interview technique with structured interview schedule from May to September 2021 after obtaining ethical clearance from Nepal Health Research Council (Ref. 180/2021P), Institutional Review Committee of Pokhara Academy of Health Sciences (Ref. 48.2022/078). Depression, anxiety and stress scale-21 was used to assess the depression, anxiety and stress among pregnant women. Descriptive statistics and inferential statistical analysis Chisquare, correlation, independent t-test and ANOVA were performed to analyse the data by using statistical package for social science.
Results: Slightly more than a fifth (21.3%) had depression, around one third (32.5%) had anxiety and 12.7% participants had stress. Age of respondents, the age of the spouse, the age difference, stress, anxiety, and depression scores all significantly correlate with each other (p <0.05). There was a significant difference in depression score among rural and urban and among primi and multigravida participants (p <0.05). With ANOVA, depression, anxiety, and stress had significant differences with occupation, husband’s education and occupation, and marital satisfaction (p<0.05).
Conclusion: Almost a quarter of participants had depression, a nearly one third had anxiety, and more than one tenth had stress. Various factors are associated with depression and anxiety among pregnant women. Psychosocial counselling should be conducted by focusing on rural pregnant women.

Prevalence and patterns of colour vision defect among school students in Bhaktapur municipality, Nepal

Kripa Joshi — 2024-01-01

Background: Colour vision deficiency is the commonest disorder of the eye that can be congenital or acquired. The colour vision disorders are usually undiagnosed due to unawareness of the disease, lack of screening, and adaptation by patients to environment to some extent.
Objectives: To find out the prevalence and pattern of colour vision defect among school students of ages nine years to 18 years in Bhaktapur municipality, Nepal.
Methods: This community-based, analytical, cross-sectional study done was among 1140 school students of Bhaktapur municipality of ages nine years to 18 years. Data collection was done from 2021 October to 2021 December utilising random sampling. The ethical clearance was obtained from Institutional Review Committee of Tilganga Institute of Ophthalmology. Assent and informed consent were obtained before data collection. Descriptive statistics such as mean, standard deviation, frequency, and percent were calculated.
Results: In total 596 (52.2%) were male students and 544 (47.7%) were female with the mean age of distribution 13.7±3.2 years. The prevalence of colour vision defect obtained was 3.6% in 41 cases, among 29 (4.8%) male and 12 (2.2%) female. Of the total colour vision defects, 19 (46.3%) were deuteroanomaly, 12 (29.2%) deuteroanopia, and 10 (24.4%) were protanomaly.
Conclusion: This study concludes that the prevalence of colour vision defect is significant. Early detection at school level helps to meet up with one’s potential build up in respective field and in counselling to step down from choosing certain profession in future.

Oral health myths among patients visiting a district level hospital in eastern Nepal: A cross-sectional study

Sirjana Dahal — 2024-03-01

Background: Developing countries face challenges like lack of awareness, poor accessibility, and false perception towards oral health. This has created blockade to good oral health. Southeast Asia countries have low oral health literacy and higher myths.
Objectives: To determine prevalence of oral health related myths and misconceptions among patients visiting Dhankuta district hospital of eastern Nepal.
Methods: An analytical cross-sectional questionnaire-based study was conducted from 2020 December to 2021 March among 395 individuals visiting study site. Convenience sampling method was used to select participants, after ethical approval. Interview was done to identify prevalence of oral health-related myths. Data were analysed in SPSS v.20. Mean, standard deviation, frequency, and percentage were calculated depending upon data. Chi-square test was done to determine association between categorical variables.
Results: Out of 395 individuals interviewed, 203 (51.4%) were males. Among them, 362 (91.7%) believed in at least one myth regarding oral health: 295 (74.7%) had at least one myth-related to dental caries, 271 (68.6%) regarding oral hygiene, 146 (37.0%) related to oral cancer, and 257 (65.1%) regarding general aspect of dentistry. Myths regarding dental caries were significantly associated with age (p = 0.034). Significant association was seen between educational level and myths regarding dental caries (p = 0.004), oral cancer (p ?0.001), and general dental aspect (p = 0.001).
Conclusion: Study findings concluded that myths related to dentistry were prevalent among study participants. Behavioural change through oral health awareness should be targeted for promoting oral health in the community and nation as a whole.

Prevalence of dental caries and its association with sugar consumption and oral hygiene practices among children studying in government schools of Kathmandu, Nepal

Sunanda Sundas — 2024-01-01

Background: Dental caries is highly prevalent public health problem affecting quality of life, and adding economic burden to family and nation. Primary preventive measures are good oral hygiene, diet counselling, and regular fluoride use.
Objectives: To assess prevalence of dental caries and its association with sugar consumption and oral hygiene practices among school children.
Methods: An analytical cross-sectional study was conducted from 2021 September-December, among 279 children aged 6-14 years in five government schools of Kathmandu using convenience sampling. A self-validated questionnaire was used to record 24-hour diet chart and oral hygiene practices. Diagnosis of caries was done using decayed-missing-filled teeth (DMFT/dmft) index.
Results: Prevalence of dental caries among the participants was 82.44% (230). Mean dmft and DMFT were 2.65 ± 2.73 and 0.57 ± 0.91 respectively. Among all children, 228 (81.72%) consumed ‘solid sugary’ food in past 24 hours. There was no significant association between caries prevalence and form of sugary food consumed, but prevalence was higher among those who consumed sugary food more than once in past 24 hours. Similarly, there was no significant association between prevalence of caries and oral hygiene practices, but prevalence was lesser among children who brushed twice daily using fluoridated toothpaste. There was significant association between dental caries prevalence and mouth rinsing habit (p = 0.037).
Conclusion: Prevalence of dental caries among study population was high and majority consumed sugary food. Prevalence of dental caries was higher among children who consumed sugary food more frequently, and brushed and rinsed their mouth less frequently.

Stress among students of a medical school: An analytical cross-sectional study

Prerana Singh Rokaha — 2024-03-01

Background: Psychological distress is high in medical undergraduate students which has a huge impact on their mental health and academic performance.
Objectives: This study aimed to assess the prevalence of stress among medical students and potential factors contributing to stress levels among undergraduate medical students at Kathmandu Medical College Teaching Hospital (KMCTH) in Nepal.
Methods: An analytical cross-sectional study was conducted among undergraduate medical students at KMCTH between 2023 August 13 to 2023 December 16 using convenience sampling. Ethical approval was obtained from the Institutional Review Committee of Kathmandu Medical College and the calculated sample size was determined to be 378. Data were collected with a questionnaire containing socio-demographic questions and the Perceived Stress Scale (PSS-10) to assess stress levels.
Results: Among the 378 participants, 48 (12.7%) reported high stress, 295 (78%) moderate stress, and 35 (9.3%) low stress. Gender differences were evident, with female students having significantly more preponderance to high perceived stress (36, 20.3%) than males (12, 6%). Final-year students reported the greatest percentage (7, 23.3%) of high perceived stress.
Conclusion: The study reveals a high level of stress among medical students at KMCTH, particularly in the final year and among female students. Strategies to reduce stress, such as aligning the curriculum with the duration of study and further investigating the causes of higher stress in females, are crucial for improving mental health and preventing stressrelated illnesses.

Computer-based dental and medical simulation: A future perspective

Preeti Singh — 2024-03-01