Journal of Kathmandu Medical College

Drug resistant paediatric tuberculosis: An emerging but neglected global threat

Basant Kumar Shah — 2023-04-04

Artificial intelligence and radiology – Where are we headed?

Ashik Rajak — 2023-01-01

Knowledge and practice regarding retinopathy of prematurity among paediatricians

Priyanka Shrestha — 2023-01-01

Background: Retinopathy of prematurity, a vision threatening disease of the preterm occurs due to abnormal retinal vasculature development. Early detection and timely management, prevents blindness. Paediatricians, the primary care providers, require good knowledge of risk factors, time for screening, and referral to an ophthalmologist for their management.

Objectives: To study knowledge and referral practices for retinopathy of prematurity followed by registered paediatricians in Nepal.

Methods: This study was a questionnaire-based descriptive cross-sectional study among 81 paediatricians of Nepal from October 2021 to December 2021. A self-administered questionnaire was sent to all registered paediatricians in Nepal via Google Forms. The paediatricians who did not respond were excluded from the study. Descriptive statistics, frequency tables, and percentages were calculated using SPSS. Ethical clearance was obtained from Institutional Review Committee of Kathmandu Medical College.

Results: Eighty-one paediatricians participated in the study. All of them were aware of retinopathy of prematurity. Eighty (98.8%) were aware that low gestational age was an important risk factor. Only 23 (28.4%) of the paediatricians stated that the first screening should be done within 30 days of life. Eighty (98.8%) paediatricians responded that retinopathy of prematurity is treatable. Lack of well-equipped transportation system for sick babies to eye centres was the major barrier reported.

Conclusion: Awareness regarding risk factors, screening, and referral protocols for retinopathy of prematurity among paediatricians is needed. Multidisciplinary team, formulation and implementation of guidelines to prevent blindness secondary to retinopathy of prematurity is important.

Knowledge and disposal practises of unused and expired medicines among medical and dental undergraduate students

Binaya Shrestha — 2023-01-01

Background: Majority of the patients do not consume their medicines exactly as prescribed and thus leave behind unused medicines at the place of stay. The improper disposal of these unused medicines has led to environmental as well as health hazards.
Objectives: To assess the knowledge, awareness, and practice of the first and second year medical and dental undergraduates towards the disposal of unused and expired medicines.
Methods: This descriptive cross-sectional study was conducted among 206 medical and dental students of a medical college in Kathmandu valley, Nepal. Data were collected by census method from 2022 March to 2022 May after ethical clearance. It was based on an online structured questionnaire to assess the knowledge, awareness, and practice about the disposal of leftover medications. Data analysis was done using Microsoft Excel 2016.
Results: A total of 206 students participated in the study of which 161 (78.2%) were from MBBS and 45 (21.8%) from BDS stream. It was noted that 118 (57.3%) students obtained their medicines on prescription, 76 (37.1%) directly from the counter, and 11 (5.3%) obtained from their friends or relatives. Majority (179, 86.9%) of the students checked the expiry date before buying the medicines, 134 (65%) students were aware about the harmful consequences of inappropriate disposal of medicines on health and environment.

Conclusion: Proper knowledge on disposal practises of unused and expired medicines among medical and dental students’ needs much improvement. Educational interventions may help improve awareness of proper methods of medicine disposal.

Correlation of quality of life and severity in patients with melasma

Eliz Aryal — 2023-01-01

Background: Melasma is a disorder of acquired facial hyperpigmentation, typically affecting young females. It is known to cause a great psychological impact and a significant negative effect on a patient’s quality of life.
Objectives: To explore the correlation between the quality of life in melasma patients and the severity of melasma.
Methods: This hospital-based, analytical, cross-sectional study was conducted from 2020 October to 2021 December in the Department of Dermatology, Venereology and Leprology of Kathmandu Medical College after institutional ethical clearance, in 101 patients recruited by convenience sampling. The quality of life was calculated using the Nepali version of the Dermatology Life Quality Index (DLQI) questionnaire and severity of melasma was calculated using modified Melasma Area and Severity Index (mMASI). Data analysis was done by SPSS v.24.
Results: The study included 101 patients of melasma with a young female preponderance. Seventy-eight (75.7%) being female and 43 (42.6%) being between the age of 21-30 years. The mean DLQI score was 10.39 ± 3.22; interpreted as having a ‘very large effect on a patient’s life.’ While the mean mMASI score was calculated to be 5.53 ± 2.69; interpreted as a melasma severity score (MSS) of ‘moderate severity.’ A significant positive moderate correlation r = 0.431 (p <0.001) was observed between mMASI and DLQI.
Conclusion: Melasma is a common pigmentary disorder that has a very large effect on the patient’s quality of life and this correlates directly with the severity of melasma.

Sonographic assessment of thickness of normal diaphragm by B mode ultrasound

Karun Devkota — 2023-01-01

Background: The thickness of diaphragm and diaphragmatic thickness fraction can be assessed by ultrasonography which can be used in early detection of the neuromuscular conditions and follow-up.
Objectives: To measure the thickness of diaphragm during inspiration and expiration; and diaphragmatic thickness fraction by B mode ultrasound in healthy patients.
Methods: An analytical cross-sectional study was conducted in 260 patients. Data were collected from 2020 July 10 to 2021 July 9 in Department of Radiology, BPKIHS after ethical clearance. Patients who were referred for sonographic evaluation and without neurological complains were included. Purposive sampling was done. Inferential statistical analysis was done applying SPSS v.11.5.
Results: Mean diaphragmatic thickness on deep inspiration was found to be 2.80 ± 0.57 mm (95% CI 2.73-2.87 mm) and 2.71 ± 0.53 mm (95% CI 2.64-2.77 mm) on right and left side respectively. Mean diaphragmatic thickness on end expiration was found to be 2.01 ± 0.41 mm (95% CI 1.96-2.06 mm) and 1.97 ± 0.40 mm (95% CI 1.92-2.01 mm) respectively on right and left side. Mean diaphragmatic thickness fraction was observed 40 ± 7.79% (22-67%) and 38 ± 7.98% (22- 60%) on right and left side respectively. The mean difference between right and left side on inspiration was found to be statistically significant. A weak positive correlation of diaphragmatic thickness with BMI on both sides and on both during inspiration and expiration was seen. There was no statistically significant correlation of diaphragmatic thickness fraction with age and BMI.
Conclusion: Sonographic diaphragm thickness measurement and diaphragm thickness fraction can provide both anatomical and physiological evaluation quickly.

Risk factors of uterine prolapse in a sample of rural women of central Nepal

Pratima Manandhar — 2023-01-01

Background: In Nepal, 9-35% of Nepali women suffer from uterine prolapse, and 200,000 are in need of immediate surgical treatment.
Objectives: To assess risk factors of uterine prolapse among women of Hariharpurgadhi-2, Sindhuli district, Nepal.
Methods: This community-based analytical cross-sectional study was conducted among 60 married women of Hariharpurgadhi-2, Sindhuli district, which is central rural area of Nepal. Samples were selected through snowball sampling technique. In the sample, the women who have been diagnosed with uterine prolapse and interested were included. Data were collected during 2020 January 20th to 2020 February 24th, through face-to-face interview method using structured interview schedule questionnaire which included structured and semi-structured questions. Collected data were analysed in SPSS v.16 by using descriptive and inferential statistics.
Results: The study found 21 (35%) respondents had first degree uterine prolapse. One-fifth (15, 25%) of them had asthma, 46 (76.7%) had constipation, 26 (43.3%) had chronic cough, 19 (31.7%) had reproductive infection, and 23 (38.3%) of them were smoker. The degree of uterine prolapse was significantly associated with marriage <20 years (p = 0.004), first childbirth <20 years (p = 0.01), higher the number of pregnancy (p = 0.007), and higher the number of childbirth (p = 0.007).
Conclusion: The study findings show that marriage age of below 20 years, first childbirth age of below 20 years, higher number of pregnancy, and higher number of childbirth were the major factors for uterine prolapse. Therefore, public awareness on these factors would be the first step to reduce uterine prolapse.

Prevalence of metabolic syndrome in patients attending general practice outpatient department at a community hospital

Binita Pradhan — 2023-01-01

Background: Metabolic syndrome, a cluster of metabolic abnormalities which bears increased risk for cardiovascular diseases and diabetes mellitus, requires early screening, diagnosis, and timely intervention. Prevalence varies with age, gender, degree of obesity, and increased propensity for type 2 diabetes mellitus.
Objectives: To find out the prevalence of metabolic syndrome among individuals with hypertension and/or diabetes seeking medical evaluation in general practice outpatient department of Kathmandu Medical College Community Hospital.
Methods: This cross-sectional analytical study was conducted among 100 participants collected by convenience sampling at general practice outpatient department of Kathmandu Medical College Community Hospital, Duwakot, Bhaktapur, Nepal. Physical examination was done and investigations were sent. Metabolic Syndrome was diagnosed using US National Cholesterol Education Program Adult Treatment Panel. Data collection was done from 2019 July to 2019 December. Study population was patients with either hypertension and/or diabetes seeking medical evaluation, age of 18 years or above, both genders, no known comorbidity other than those under medication for hypertension and diabetes. Data analysis was done with SPSS v.16 and two-sample t-test or Chi-square test applied as appropriate. A p-value <0.05 taken as statistically significant.
Results: Out of 100 individuals, 73 were found having metabolic syndrome. It was more common among male (38, 52.1%), obese people of age 40-59 years (42, 57%), and among patients with high body mass index (26.93±2.74).
Conclusion: The prevalence of metabolic syndrome was found significantly high among patients with hypertension or diabetes. Therefore, it is important to diagnose this condition on time to prevent subsequent complications.

Functional outcome of long-arm cast versus double sugartong splint in acute paediatric distal forearm fractures: A randomised controlled trial

Deepak Banjade — 2023-01-01

Background: The treatment of choice for paediatric distal forearm fractures has been a long-arm cast (LAC) following closed reduction. An alternative treatment is to use a double sugar-tong splint (DSTS), found equally effective to provide three-point fixation and comparable outcomes to cast.
Objectives: To compare the functional outcome between LAC and DSTS for the treatment of paediatric distal forearm fractures.
Methods: A randomised controlled trial was done among 36 patients of 5-15 years with acute distal forearm fractures without neurovascular deficit treated with LAC and DSTS recruited by convenience sampling at a tertiary care centre after ethical approval. Acceptability of reduction, loss of reduction, union rates, cast comfort, range of motion and complications were studied at follow-up upto 12 weeks and analysed using SPSS v.11.5.
Results: Among a total of 36 patients, 18 cases were treated by the LAC method and others by the DSTS method. Both LAC and DSTS were comparable in the maintenance of reduction, the remanipulation rate was 8.3% (n = 3), not significant (p-value = 0.967). All had a union at six weeks follow-up. No statistical difference in mean VAS score (p-value = 0.524), mean loss of flexion (p-value = 0.397), and mean loss of pronation/supination (p-value = 0.814). No statistically significant difference in activities of daily living was noted. No complications were encountered.
Conclusion: DSTS is safe and as effective as LAC in the treatment of distal forearm fractures in children, identical in terms of functional outcome, maintenance of reduction, complications, and time to union.

Comparison of left ventricular global longitudinal strain by speckle tracking echocardiography in patients with and without diabetes mellitus asymptomatic for coronary artery disease at a tertiary hospital in Nepal

Sanjaya Kumar Shrestha — 2023-01-01

Background: Diabetes mellitus is a major risk factor for cardiovascular events. A significant proportion of diabetics are asymptomatic for ischaemic heart disease either because of the early stage of ischaemia or silent myocardial ischaemia. Global longitudinal strain (GLS) of the left ventricle measured by speckle tracking echocardiography (STE) is a novel method of detecting left ventricular dysfunction due to myocardial ischaemia.
Objectives: This study aimed to compare the GLS of type-2 diabetes mellitus (T2DM) and non-diabetic patients who were asymptomatic for coronary artery disease (CAD).
Methods: An analytical cross-sectional study was conducted among 52 diabetic and 49 non-diabetic individuals asymptomatic for CAD presenting to a tertiary hospital, between 2022 September to 2022 October. The STE was performed to measure left ventricular GLS of the participants. Their blood and urine samples were sent for measuring glycosylated haemoglobin (HbA1c), total cholesterol, and microalbuminuria. Data were entered and analysed using SPSS v23.
Results: Twenty-five (48.1%) diabetics had left ventricular dysfunction (GLS ?18) compared to two (4.1%) non-diabetics. GLS was significantly lower among the diabetic patients, and exhibited significant inverse correlation with the duration of diabetes, age, HbA1c, and microalbuminuria (p <0.001). In multiple linear regression model for GLS, only the duration of diabetes (B = -0.27, p <0.001) and the age of patients (B = -0.057, p = 0.004) retained statistical significance, after adjusting for other covariates.
Conclusion: Left ventricular GLS has a significant negative correlation with the duration of diabetes and age of the patients.