Journal of Kathmandu Medical College

Factors associated with psychological distress, fear, and coping strategies during coronavirus disease 2019 pandemic among community members in Nepal

Natalia Oli — 2023-04-01

Background: Coronavirus disease 2019 (COVID-19) pandemic had huge impact on social, psychological, and economic well-being of general community people in Nepal.

Objectives: To assess the extent of psychological distress, fear, and level of coping strategies among community members in Nepal.

Methods: A nationwide analytical cross-sectional study was conducted among Nepali residents aged >=18 years using an online structured questionnaire during 2020 December to 2021 January. Kessler Psychological Distress Scale (K10), Fear of COVID-19 scale (FCV-19S) and Brief Resilient Coping Scale (BRCS) were used in this study. Univariate and multivariate logistic regression analyses were conducted to adjust for potential confounders. Ethical clearance was obtained from institutional review committee of Kathmandu Medical College.

Results: Among 311 respondents, 167 (53.7%) were female. Median age (IQR) 31.3 (13) years with age range 18-69 years. Mean age was 31.4 ± 10.3 years. Being above 30 years old (AOR 3.8, 95% CI 2.13-6.84) were associated with higher levels of psychological distress. Being a female (AOR 0.55, CI 95% 0.30-0.99), moderately improved working situation due to change of employment (AOR 0.39, CI 95% 0.20-0.76), having little perceived distress due to change of employment status (AOR 0.52, 95% CI 0.27-0.97), having positive impact of COVID-19 on financial situation (AOR 0.28, 95% CI 0.13-0.61) were associated with lower levels of fear based on the FCV-19S scale.

Conclusions: This study identified individuals who were at higher risk of psychological distress, level of fear, and low coping strategies during COVID-19 pandemic in Nepal. These findings would assist in exploring the strategies to support mental health of vulnerable population during pandemic and post-pandemic periods.

Effectiveness of iron-based phosphate binders in reduction of hyperphosphataemia in chronic kidney disease patients

Anil Pokhrel — 2023-04-01

Background: Ferric citrate is novel iron-based phosphate-binding drug for management of hyperphosphataemia and iron-deficiency anaemia in chronic kidney disease (CKD) patients.

Objectives: To evaluate impact of ferric citrate therapy on reduction of phosphate levels and improvement in haematological parameters in CKD stages 3-5.

Methods: This analytical, observational study was conducted at Kathmandu Medical College Teaching Hospital from 2020 July-December after ethical clearance using convenience sampling method. Non-dialysis dependent patients at CKD stages 3-5, having hyperphosphataemia (serum phosphate >=4.6mg/dL) and anaemia (serum haemoglobin <12 gm%, transferrin saturation <=30%, ferritin <=300ng/mL) were administered with 2gm twice daily dose of ferric citrate for 12 weeks and evaluated on outcomes in terms of reduction in serum phosphate levels and improvement in haematological parameters as study endpoints. Data were entered in Microsoft Excel and analysed in SPSS v.25. Significance level was set at p <0.05.

Results: Of 84 study participants, majority had CKD stage 4 (46, 54.76%). A significant reduction (p <0.001) in mean serum phosphate levels of 6.21 ± 1.062 mg/dL from baseline to 4.89 ± 1.100 mg/dL in 12-weeks was observed. Patients with CKD stages 3, 4, and 5 had mean reduction of 1.67 (p = 0.005), 1.40 (p <0.001), and 1.04 mg/dL (p = 0.002) of serum Phosphate level respectively. Significant (p <0.001) improvements in hemoglobin level, serum iron, ferritin, total iron binding capacity, and transferrin saturation were reported.

Conclusion: Ferric citrate is effective and well-tolerated phosphate-binder to improve hyperphosphataemia and iron deficiency anaemia in non-dialysis CKD stage 3, 4, and 5.

Evaluation of dental anxiety in school going children using modified dental anxiety scale and facial image scale

Sanskriti Khanal — 2023-04-01

Background: Dental anxiety refers to patient’s response toward stresses associated with dental procedures. It can present problem for both dentist and patient, particularly in paediatric dentistry. Hence, it is important to identify anxious patients for improved patient management and development of better treatment strategies.

Objectives: To evaluate the prevalence of dental anxiety in schoolchildren using Modified Dental Anxiety Nepali version (MDAS-N) and Facial Image Scale (FIS).

Methods: An analytical cross-sectional study was carried out in 401 schoolchildren (11.34 ± 1.85 years) using convenience sampling method from 2022 June to 2022 August after ethical approval was obtained from Nepal Medical College. The dental anxiety was assessed by questionnaire provided in MDAS-N and FIS. Independent t-test was done in SPSS v.20.0 to analyse the data.

Results: The data have shown that 375 (93.52%) had dental anxiety (mean MDAS-N = 11.83 ± 3.59) with low and moderate anxiety in 153 (38.15%) and 140 (34.92%) respectively. Seventy (36.08%) females presented with moderate anxiety and 92 (44.44%) males had low anxiety. The mean score difference was statistically significant (p-value <0.001) between the genders. Statistically significant difference (p-value = 0.023) was found between FIS mean score of primary and middle school level students. Injection and drilling the tooth were the procedures with high anxiety score in both scales. There was a moderate positive correlation between MDAS-N and FIS (r = 0.574).

Conclusion: Assessing dental anxiety and factors provoking fear and anxiety in dental clinic is useful, as behaviour management can be applied accordingly for child patients.

Knowledge of scope of oral and maxillofacial surgery amongst medical students at a tertiary hospital in Kathmandu, Nepal

Anuja Panthee — 2023-04-01

Background: Diagnosis and surgical treatment of varieties of traumatic, pathologic, functional, and aesthetic disorders of stomatognathic system are included in the scope of oral and maxillofacial surgery (OMFS). Although this speciality plays a significant part in dentistry and medicine; dental and medical professionals still do not fully comprehend the exact depth.

Objectives: To understand the level of knowledge amongst medical students of different levels, to promote the scope of OMFS among health care communities, and establish a fair understanding of the speciality’s contribution.

Methods: This questionnaire based descriptive, cross-sectional survey was done on purposive sampling technique. Data were collected from 2022 October to 2022 December among medical students and interns of Nepal Medical College via questionnaire after receiving institutional ethical clearance. Data were entered, coded, and edited using Microsoft Excel 2010 and analysed using SPSS v.20. Descriptive statistics are presented in frequency, percentage, and mean.

Results: A total of 254 study participants were included of which 149 (58.66%) were male and 105 (41.34%) were female. Of all, 99 (38.98%) were first year medical students, 80 (31.50%) were second year students, and 75 (29.53%) were interns. Mean knowledge score in preclinical students was 6.27 ± 1.73 and 7.12 ± 1.85 in interns. The result shows adequate knowledge for both groups.

Conclusion: Findings of this study assesses the level of knowledge of medical students at a tertiary hospital which will help to highlight the need for awareness and education regarding OMFS, promoting its development, contribution, and impact among the health care professionals.

Effect of professional oral hygiene measures on the periodontal health of patients undergoing fixed orthodontic treatment

Nidhi Giri — 2023-04-01

Background: Plaque accumulate on orthodontic appliances when proper oral hygiene is not maintained, leading to destruction of periodontal tissues. Good oral hygiene during fixed orthodontic therapy will prevent periodontal disease, which eventually will reflect final outcome of orthodontic treatment.

Objectives: To find out whether professional prophylaxis midway during fixed orthodontic treatment will reduce adverse changes on periodontal health due to poor oral hygiene maintenance when compared to homecare measures only.

Methods: This analytical cross-sectional study was conducted from 2022-05-06 to 2023-02-05 after institutional ethical approval among 24 patients (eight males, 16 females) undergoing fixed orthodontic treatment in Orthodontics department, Nobel Medical College. The effect of regular homecare measures only, as compared to professional prophylaxis during orthodontic treatment in addition to regular homecare on the periodontal health was evaluated on two separate visits over a nine-month period. SPSS 11.5 was used for statistical analysis.

Results: This study showed improved periodontal health in “experimental group” when oral prophylaxis was done in fifth month of fixed orthodontic therapy and worsened periodontal health in “control group” during a nine-month study period.

Conclusion: Significant improvement of gingival and periodontal health with an improvement in plaque control with professional prophylaxis was observed which was in accordance with most previous studies. Plaque control with professional prophylaxis after initial alignment is also of utmost importance in the maintenance of periodontal health as well as the prevention of periodontal disease during fixed orthodontic treatment. It can be considered key to good periodontal health of patients undergoing fixed orthodontic treatment.

Patients’ perception of infection control in dentistry

Dilesh Pradhan — 2023-04-01

Background: Dentistry is a high-risk profession for infections due to exposure to contaminated materials like blood, saliva, and instruments. Both dental staff and patients can contract diseases via person-to-person contact or contaminated objects.

Objectives: To assess patient perception of infection control practices in dentistry which will help in planning effective public health care delivery.

Methods: A descriptive cross-sectional study was carried out in 170 patients visiting Kathmandu Medical College Teaching Hospital (KMCTH) over the period of three months (2022 June to 2022 August) for any form of dental treatment. Ethical approval was granted by Institutional Review Committee of KMCTH on 8th June 2021. Data obtained were entered and analysed using SPSS v.21.

Results: Majority of the participants believed dentists should wear gloves (164, 96.7%), face masks (159, 93.8%), and eye goggles (105, 61.9%) while treating patients, and 152 (89.6%) of participants agreed that dentist should change gloves between patients. However, nearly half of the participants were not hesitant to receive treatment from the dentist not wearing gloves (82, 48.3%) and mask (86, 50.7%). In total, 119 (70.2%) agreed that it was possible to catch an infection during dental treatment and 121 (71.3%) did take interest in sterilisation of instruments but only 21 (12.3%) always asked their dentist about the method of sterilisation.

Conclusion: Patients possess a strong awareness of the importance for infection control in dental practice, however, this study underscores the importance of implementing effective infection control measures in dental settings to ensure the safety and well-being of patients.

Laparoscopic cholecystectomy in the elderly

Dinesh Adhikari — 2023-04-01

Background: The prevalence of laparoscopic cholecystectomy in Nepal ranges from 2.44% to 6.45%. The prevalence of gallstones increases with age. Age is considered to be one of the major risk factors in determining the results of morbidity and mortality during laparoscopic cholecystectomy. Laparoscopic cholecystectomy is the gold standard modality for the management of gallstones.

Objectives: The aim of this study was to determine the clinical outcome of laparoscopic cholecystectomy in the elderly.

Methods: This was a descriptive cross-sectional observational study done after ethical clearance. Retrospective data were included of all the patients’ aged ?60 years who underwent laparoscopic cholecystectomy at Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal from 2021 July to 2022 June using convenience sampling. Data were entered in Microsoft Excel Sheet and descriptive findings are presented.

Results: A total of 1688 laparoscopic cholecystectomies were performed during the study duration. Consecutively, 250 elderly patients who underwent were included in the study. The mean age of the elderly was 67.88 years. The incidence of the elderly at the institute was 26.7% (452/1688). In the present study, 95 (38%) elderly patients had some kind of comorbidities. Isolated intraoperative complications were seen in 26 (10.4%) patients. Post-operative complications were seen in 53 (21.2%) patients. The need to convert laparoscopic cholecystectomy to open cholecystectomy was observed in 3 (1.2%).

Conclusion: For the elderly, laparoscopic cholecystectomy is a safe and reliable modality. They benefit from this mode of treatment without increasing the risk of surgery.

Incidence of difficult laparoscopic cholecystectomy at a tertiary care hospital in eastern Nepal

Amit Bhattarai — 2023-04-01

Background: Laparoscopic cholecystectomy (LC) is the gold standard modality for the treatment of gall bladder diseases. Sometimes LC needs to be converted to open due to intraoperative complications. A few factors like age, body weight, comorbidities, ASA score, and surgeons’ experience will warn about the possible complications and need for conversion to open. Prior prediction of the difficulties will warn the surgeon to prepare accordingly. The patient’s family will also be counseled regarding it.

Objectives: To identify the possible factors for predicting difficult LC.

Methods: This was a descriptive cross-sectional study conducted in the general and laparoscopic surgery department at Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Simple random sampling technique was utilised in this retrospective analysis. Data were taken from 2021 May to 2022 May after institutional ethical clearance. Descriptive statistics were assessed done using SPSS v.26.

Results: A total of 230 cases were included and analysed in the study. The incidence of difficult LC was 17.8%. An overall conversion rate of LC to open cholecystectomy in difficult LC was seen in 1.3% of the cases. Intraoperative complications were not seen in 87.8% of the patients. The mean duration of hospital stay in difficult LC cases was five days.

Conclusion: Predicting difficult LC will not only warn surgeons to be prepared for the possible difficulties but will also help in counseling patients’ families regarding the intraoperative complications and the possible need for the conversion to open.

Antibiotic abuse: A cross-sectional study on knowledge, attitude, and behaviour among undergraduate students of western Nepal

Satish Kumar Deo — 2023-04-01

Background: Antibiotic abuse has drawn the attention of public health experts, stakeholders, and medical science due to the substantial economic loss that it causes to individuals and nation.
Objectives: To assess the knowledge, attitude, and behaviour on antibiotic abuse among undergraduate level students of Pokhara, Nepal.
Methods: This analytical cross-sectional study was conducted after ethical clearance in 361 undergraduate level students of Pokhara, Nepal from 2022 November to 2023 January. Convenience sampling technique was utilised for data collection. Data were analysed primarily by Chi-square test to find the associated factors using SPSS v.21.
Results: A total of 361 respondents participated, and 61.77% were female. Most of the respondents (67.31%) were from health sciences, while 32.68% of the respondent was of non-health sciences. The mean age of the respondents was 20.97 ± 1.56 years. More than half of the respondents had inadequate knowledge and unfavourable attitude towards antibiotics while the prevalence of self-medication was found to be 72.6%.
Conclusion: This study recommends for further large-scale research to understand the current state of antibiotic use and misuse among general population. Self-medication rate was high regardless of perceived knowledge and positive attitude. So, this study urges for the need of behavioural interventions that aims at raising awareness and establishing effective use of antibiotics.

Correlation between hand grip strength and anthropometric measurement among undergraduate medical students

Pragya Shrestha — 2023-04-01

Background: Hand grip strength is a simple procedure of assessing the function of hand and forearm. It can be used as a tool to evaluate nutritional status of individual, neurological disorder and to assess the post-operative status of the patient. The grip strength is affected by different variables such as geographical variation, gender, height, weight, body mass index and handedness of the individual.
Objective: This study aims to correlate hand grip strength with gender, height, weight, body mass index and handedness among Nepali population.
Methods: The study was analytical cross-sectional study conducted in students of Kathmandu University School of Medical Sciences. Convenience sampling was used. The height of the participants was taken by using Stadiometer in centimeter and weight was taken by using weighing machine in kilogram and body mass index was calculated. Hand grip strength was obtained by using Dynamometer measured in kilogram. The data were entered in Microsoft Excel Sheet and analysis was done in SPSS version 16.0.
Results: Hand grip strength showed moderate positive correlation with both height and weight both in both dominant and non-dominant hands. Hand grip strength was positively correlated in underweight, normal weight and obese category of body mass index whereas overweight category was negatively correlated.
Conclusion: Hand grip strength shows correlation with the gender, height, weight and body mass index.

Comparison of stroop colour-word test among male and female students in a medical college of Nepal

Yubina Gautam — 2023-04-01

Background: The Stroop Colour-Word Test is a widely used neuropsychological test. This test is designed to assess impaired concentration and the struggle to stay focused despite of distractions. There are conflicting data on the gender difference in Stroop test.
Objectives: To make a gender comparison of the reaction time by Stroop Colour-Word Test in young healthy medical students.
Methods: This was a cross -sectional analytical study conducted at the Department of Physiology, Kathmandu University School of Medical Sciences from 2022 August to 2022 October. Stroop Color Word test was done in healthy medical students with three different cards, a control card (colour word written in black color), congruent card (colour word written in same color as written word) and incongruent card (colour word written in different colour then word written). The number of errors made and reaction time was noted. Paired t-test was applied. Gender comparison was made and independent sample t-test was done.
Results: Out of total 130 participants, 68 were females and 62 were males. The number of errors made was 0,0 and 12.8 ± 2 and the reaction time was 38.3 ± 2.3, 37.2 ± 2.8 ,72.5 ± 5.6 seconds for control, congruent and incongruent card respectively which was statistically significant for incongruent card. There was no significant difference between males and females.
Conclusion: Reaction time by Stroop Colour-Word Test is longer for incongruent words. There is no gender difference in errors made or reaction time in Stroop Colour-Word Test.