Journal of Kathmandu Medical College

Predicting mortality in traumatic intracranial haemorrhage patients visiting tertiary level hospital

Bikram Shakya — 2024-07-21

Introduction: Traumatic intracranial haemorrhage is a major contributor to trauma-related morbidity and mortality.
Existing prognostic models often lack accuracy, generalizability, and ease of application due to the complexity of required variables.
Objective: This study aimed to develop a simple yet accurate risk stratification model for predicting mortality in patients
with traumatic intracranial haemorrhage.
Methodology: A prospective study was conducted at the Department of Neurological Surgery, KMCTH, from January first to December 31st, 2020. A total of 200 patients with traumatic intracranial haemorrhage who underwent neurosurgical intervention were included, while those with infections, open wounds, or multiple planned surgeries were excluded. Data collected included age, sex, blood pressure, Glasgow Coma Scale, Injury Severity Score, type of intracranial haemorrhage, and body mass index. Mortality outcomes were assessed within 30 days. Statistical analyses, including univariate and multivariate logistic regression, were conducted using IBM SPSS Statistics for Windows version 16 ( Chicago, SPSS Inc.)
Result: The overall mortality rate was 35%. Independent predictors of mortality included age (OR: 1.05, 95% CI: 1.02
– 1.08), GCS score (OR: 0.85, 95% CI: 0.75 – 0.94), and ISS (OR: 1.12, 95% CI: 1.04 – 1.20). Cases with Subdural hematoma
had the highest mortality (60%) and decompressive craniectomy was associated with the highest mortality (45%) . The
proposed model demonstrated excellent discriminative ability (AUC = 0.89).
Conclusion: This study presents a reliable risk stratification model for predicting mortality in traumatic intracranial
haemorrhage patients, emphasizing key clinical variables. These findings may improve decision-making, facilitate timely
interventions, and optimize trauma care resources.

Stress among caregivers of critically ill patients in a tertiary level hospital

Sabita Pandey Bashyal — 2024-07-21

Introduction: Different people react differently to stress in difficult circumstances. Patients who are hospitalized in the critical care unit typically have major medical conditions. They may be unconscious or kept on artificial ventilation, which could be stressful for the caregivers.

Objective: To assess the stress among caregivers of critically ill patients.

Methodology: A descriptive cross-sectional study was conducted among 126 caregivers of critically ill patients using convenient sampling at Kathmandu Medical College and Teaching Hospital, Nepal. Data was collected using the Kingston Caregiver Stress Scale through face-to-face interviews and analyzed using descriptive (frequency, percentage, mean and standard deviation) and inferential statistics (chi square test, p value significant at ?0 05 level).

Result: The results showed that about two-thirds, 83 (65.9%) of the caregivers had a moderate level of stress, and 15 (11.9%) had severe stress. Financial factors were found to be the main factor causing stress. There was a statistically significant association of stress level with family income (p=0.001), education status (p=0.021), and marital status (p=0.038), among care givers.

Conclusion: Since caregivers were more stressed due to financial factors, provision of insurance schemes can be implemented at all levels of hospitals to cover the health care expenses. It would be better if the government health service became more accessible to the general public, which is cheaper than the private sector.

Effectiveness of ultrasound guided erector spinae block for post-operative analgesia following laparoscopic cholecystectomy

Roshan Pradhan — 2024-07-21

Introduction: A minimally invasive method for the treatment of gallstone disease is laparoscopic cholecystectomy (LC).Varies strategies and methods are used to alleviate post-operative pain, and some patients still experience moderate to severe pain. Erector spinae plane block (ESPB) has been demonstrated to have beneficial post-operative analgesic effects when used as a part of multimodal analgesia.

Objective: To evaluate the post-operative analgesic effect of ultrasound guided bilateral erector spinae plane block in adult patients undergoing laparoscopic cholecystectomy.

Methodology: A prospective, randomized interventional study was carried out in 102 patients at Kathmandu Medical College from June 2023 to December 2023 after ethical clearance. Patients were randomized to receive either bilateral ESPB at T7 level or port site infiltration with 40 ml of 0.25% bupivacaine. Primary outcome measures were total opioid consumption and mean Visual Analogue Scale (VAS) in the first 24 hours post-operatively. The results were analyzed using the Statistical Package for the Social Sciences (SPSS) software. Continuous and categorical data were analyzed using appropriate statistical analysis. A p-value<0.05 was considered statistically significant.

Result: Bilateral ESPB significantly reduced post-operative pain score compared to port site infiltration. We observed statistically significant differences in VAS between two groups at 6, 12 and 24 hour’s time frame. The mean 24 hours opioid consumption in ESPB was 33.33±31.091 mg and in port site infiltration group was 112.75±42.241; p=0.000001.

Conclusion: Ultrasound guided bilateral ESPB provides effective post-operative analgesia and reduced opioid consumption after laparoscopic cholecystectomy compared to port-site infiltration.

Clinical profile of chest injuries in a teaching hospital: A prospective observational study

Om Bahadur Karki — 2024-07-21

Introduction: Chest is one of the common sites of injuries in trauma with significant morbidity and mortality. Thoracic trauma may be classi?ed as chest wall, pleura, pulmonary and. mediastinum injury. However, data on chest injuries are scarce.

Objective: This study aimed to review the clinical pro?les of patients with traumatic thoracic injury and to analyze the management approaches and outcome.

Methodology: A prospective study was carried out for chest injury patients in Manipal teaching hospital for eighteen months duration. Demographic pro?le, mode of injury, management, and outcomes were studied. The categorical variables were presented as frequencies, and were compared using the chi-squared test. Continuous variables were compared using the student's t test. P value of <0.05 was considered statistically significant.

Result: Total 112 patients were studied with mean age 47.98 ± 19.57 years. Road tra?c accidents (59.8 %) remained the most common cause of trauma followed by fall injuries (34.8%). The pattern of injuries observed were: rib fracture only in 27(24.1%), fractured rib with pneumothorax 35(31.3%), hemopneumothorax 22(19.6%), hemothorax 13(11.6%), flail chest 5(4.5%). Right 48(42.9%), left 29(25.9%) while 35(31.3%) of the patients had bilateral chest injuries. Mortality was in 4(3.6 %) patients. Hospital stay >5 days was significantly associated with presence of extra thoracic (p=0.023) and mechanism of injury (p=0.017)

Conclusion: Young males are usually a?ected in chest trauma. Road tra?c accidents are common cause of it however, most patients can be managed conservatively and length of hospital stay is dependent on presence of associated injuries and mechanism of injury.

Prevalence of abuse among school going adolescents in eastern Nepal

Sabitra Poudel — 2024-07-21

ABSTRACT

Pattern of alcohol consumption and its risk assessment among medical college students

Pujan Pokharel — 2024-07-21

Introduction: Alcohol consumption is a global concern due to its association with numerous diseases and health conditions. This study aims to assess alcohol consumption among medical students in Kathmandu Valley, Nepal, and evaluate its impact on their well-being. The prevalence of alcohol consumption among medical students and its correlation with various factors, including demographics and reasons for drinking, were analyzed.

Methodology: A descriptive cross-sectional study was conducted among medical students from different streams and years in Kathmandu Valley. A validated online questionnaire based on the Alcohol Use Disorder Identification Test (AUDIT) was used to collect data. Convenience sampling was employed, and the required sample size was determined. Descriptive and inferential statistics were utilized for data analysis using SPSS software.

Result: Out of 192 respondents, 56% reported consuming alcohol at least once in their lifetime. Among the alcohol consumers, 40.7% started drinking after joining medical college. Curiosity was the primary reason for initiating alcohol consumption among the students. The majority of students were classified as being at a low risk of drinking based on the AUDIT scores.

Conclusion: Alcohol consumption among medical students in Kathmandu Valley is prevalent, with a significant proportion starting drinking after joining college. The findings emphasize the importance of addressing alcohol-related issues among medical students and implementing preventive measures to promote their well-being and academic performance. Further studies encompassing a larger and more diverse sample are recommended to obtain a comprehensive understanding of alcohol consumption among medical students in Nepal.

Risk factors for ectopic pregnancy in a tertiary care hospital

Asmita Adhikari — 2024-07-21

Introduction: Ectopic pregnancy is associated with significant morbidity and mortality. Identifying its risk factors can help in reducing the incidence.

Objective: This study aimed to determine the risk factors for ectopic pregnancy in tertiary care hospital in Nepal.

Methodology: A hospital based prospective case control study was conducted in Department of Obstetrics and Gynaecology, TU Teaching Hospital, Kathmandu from14^th April 2019 to 12^th April 2020. Cases comprised of all the women with ectopic pregnancy undergoing laparotomy or laparoscopy and controls were women delivering on the same day after case enrollment, taken in ratio 1:2. Risk factors were compared and Odds Ratio was calculated. P-value <0.005 was considered significant. Multivariate analysis was done for those risk factors found to be significant from the univariate analysis.

Result: The sample size constituted 75 cases and 150 controls. The incidence of ectopic pregnancy was 1.72% of total deliveries. Mongolian ethnicity (AOR=4.61, 95% CI: 1.94-10.96, p value=0.001) and occupation other than house wife (AOR=2.71, 95% CI: 1.11-6.62, p value=0.028) were found to be associated with ectopic pregnancy. Multigravidity (AOR=4.01, 95% CI: 1.01-15.90, p value=0.048), multiparity (AOR=5.51, 95% CI: 1.03-29.29, p value=0.045), prior history of pelvic inflammation (AOR=20.86, 95%CI: 3.69-117.79, p value=0.001), use of contraceptives (AOR=5.52, 95% CI: 2.19-13.90, p value<0.001) were other factors associated with risk of ectopic pregnancy. Emergency contraceptives use was seen in 28(37.3%) patients.

Conclusion: Mongolian ethnicity, occupation other than house wife, increasing gravidity and parity, pelvic inflammation and emergency contraceptive pills were associated with ectopic pregnancy.

Prevalence of urinary tract infection among pregnant women attending tertiary care centre in first trimester of pregnancy

Swati Gupta — 2024-07-21

Introduction: Urinary tract infection (UTI) is one of the most prevailing clinical infection in pregnant women, due to the physiological and anatomical changes occurring during pregnancy, considering the increased risk

Objective: This study focuses on prevalence of UTI in pregnant women, its early detection and timely, adequate treatment to prevent any complications.

Methodology: A descriptive cross-sectional study was conducted among pregnant women in first trimester presenting in the outpatient department (OPD) of Obstetrics and Gynecology of a Tertiary care centre in Nepal. The study period was of 6 months. After obtaining consent from the patients, urine RE and urine culture were sent as part of routine antenatal investigations. Following verbal instructions, clean catch midstream urine samples were collected in two sterile containers. Samples were sent for microscopy and culture sensitivity. UTI was diagnosed either by significant bacteriuria (?10^5 colony-forming units [cfu] per mL) , by positive urine culture or both.

Result: The prevalence of UTI in total of 316 pregnant woman in first trimester was 15.18%. Among all positive cases, 89.58% were asymptomatic and only 10.41% were symptomatic. Primiparous woman (58.33%) were more affected compared to multiparous women (41.66%). More than half of the pregnant women of age 15 – 20 years old had UTI. The most common bacteria causing UTI was Escherichia coli (72.72%) and the most common sensitive antibiotic detected was Amoxi-clav (54.54%).

Conclusion: Pregnant woman have higher likelihood of having asymptomatic UTI. Without visible symptoms the only option is screening test for UTI during pregnancy, so it is important to provide appropriate management to prevent adverse outcome.

Efficacy and tolerability of escitalopram and duloxetine in patients suffering from depression

Prithi Bahadur Rai — 2024-07-21

Introduction: Depression is a leading cause of disability worldwide, with significant treatment gaps in low-resource settings like Nepal. Escitalopram, a selective serotonin reuptake inhibitor (SSRI), and duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), are widely used antidepressants, but their comparative efficacy and tolerability in diverse populations remain understudied.

Objective: This study aimed to compare the efficacy and tolerability of escitalopram and duloxetine in patients with moderate-to-severe major depressive disorder (MDD) over 24 weeks.

Methodology: A prospective, comparative study was conducted at Nobel Medical College Teaching Hospital, Nepal, involving 200 patients randomized to escitalopram (10–20 mg/day) or duloxetine (60 mg/day). Efficacy was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Depression Rating Scale-17 (HAM-D17), while tolerability was evaluated through adverse event reporting and dropout rates.

Result: Duloxetine showed superior efficacy, with greater MADRS reduction (15.8 ± 2.9 vs. 14.2 ± 3.1; p=0.02) and higher response (78% vs. 65%) and remission rates (55% vs. 42%). Escitalopram was better tolerated, with fewer adverse events (e.g., nausea: 12% vs. 34%) and lower dropout rates (6% vs. 16%).

Conclusion: Duloxetine is more effective for severe depression, while escitalopram offers better tolerability, making it suitable for elderly patients and those with comorbid conditions. These findings can guide treatment decisions in resource-limited settings.

Correlation of hard and soft tissue among different sagittal malocclusion

Rajiv Yadav — 2024-07-21

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 UL-SNpog’, 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.

Cardiac surgery in a patient with Glanzmann’s thrombasthenia

Prabhat Khakural — 2024-07-21

Cardiac surgery in patients with bleeding disorders like Glanzmann’s thrombasthenia is quite challenging because of the increased risk of postoperative bleeding resulting in higher transfusions and associated morbidity. Platelet transfusion and use of antifibrinolytic drugs help in achieving optimum haemostasis in the patients with Glanzmann’s thrombasthenia. Here, a case of six-year-old boy with Glanzmann’s thrombasthenia is reported, who underwent surgical closure of atrial septal defect and was managed with platelet transfusion and tranexamic acid. The patient recovered well without having significant bleeding in the post-operative period.