Journal of Kathmandu Medical College

Magnetic resonance imaging in Kallmann syndrome: A case report

Shankar Poudel — 2021-08-25

Kallmann syndrome is a rare genetically inherited condition characterized by hypogonadotrophic hypogonadism and anosmia or hyposmia. It is due to failure of migration of gonadotrophic releasing hormone neuron and olfactory neuron
to hypothalamus. This case reports a 39-year-old Maldivian adult with clinical features of Kallmann syndrome and magnetic resonance imaging brain showing absence of olfactory sulcus and bulb.

Endodontic management of dens invaginatus of maxillary lateral incisor: A case report

Ranjan Thapaliya — 2021-08-25

Dens invaginatus is a developmental malformation of teeth with the enfolding of enamel and dentin into the pulp chamber and sometimes into the root that most commonly affects the maxillary lateral incisors. This anomaly may increase the risk of pulpal disease and can potentially complicate treatment due to its aberrant anatomy, thus posing a diagnostic challenge. Similarly, the incomplete elimination of the invagination and debridement may create dead space within the canal leading to the failures. This case reports the endodontic management of the Oehler’s type II Dens invaginatus.

Routine immunisation services in Nepal during the COVID-19 pandemic

Smriti Mathema — 2021-08-28

Not applicable.

Antibiotic susceptibility pattern and risk factors associated with Acinetobacter and Pseudomonas infection at a tertiary care hospital

Jatan Bahadur Sherchan — 2021-08-28

Background: Infection due to Acinetobacter spp. and Pseudomonas aeruginosa is a major worldwide concern these days. Antibiotic resistance and predisposing factors among the patients for acquiring such infection is a major challenge globally and in Nepal.

Objectives: To determine antimicrobial susceptibility pattern of Acinetobacter spp. and Pseudomonas aeruginosa isolates along with predisposing factors.

Methods: A total of 9,705 clinical samples were processed in this analytical cross-sectional study from December 2019 to November 2020. Antibiotic susceptibility pattern was determined following Clinical Laboratory Standard Institute guidelines. Patients’ information was obtained after informed consent.

Results: Acinetobacter spp. and Pseudomonas aeruginosa isolates were 92 (0.95%). Fifty-three (57.61%) samples were respiratory samples. Thirteen (20%) Pseudomonas aeruginosa and 18 (66.67%) Acinetobacter spp. were multidrug-resistant (MDR). Eight (12.31%) Pseudomonas aeruginosa strains and 13 (48.15%) Acinetobacter spp. strains were sensitive only to Colistin. Twenty-two (95.65%) prolonged hospital stayers had MDR bacteria compared to only nine (13.04%) non-prolonged hospital stayers (p-value <0.001). Sixteen (94.12%) of diabetic patients had MDR bacteria isolates in comparison to only 15 (20%) of non-diabetic patients (p-value <0.001). Thirty-one (33.69%) were elderly patients (age ?65 years) and 61 (66.31%) were of age less than 65 years old. Seventeen (54.84%) of elderly patients had MDR isolates whereas only 14 (22.95%) of patients who are not elderly had MDR isolates (p-value =0.0047).

Conclusion: Acinetobacter spp. and Pseudomonas aeruginosa strain were isolated from various samples. For effective treatment of infection by such organisms detailed microbiological diagnosis and drug susceptibility testing is needed along with identification of predisposing factors.

Relationship between chronological age and skeletal maturity of wrist joint and hand in a sample of Nepalese population: A radiographic study of wrist joint and hand in Nepalese population: A radiographic approach

Sudhir Raman Parajuli — 2021-08-28

Background: The human body grows and matures with age, especially in children and adolescents. Skeletal age is determined from the development stage of bones.

Objectives: To determine the age of epiphyseal fusion of the lower end of radius and ulna in the Nepalese population which is important from a medicolegal point of view.

Methods: An analytical cross-sectional study was conducted on patients undergoing X-rays of hand and wrist attending Manipal Teaching Hospital, Pokhara in a one-year period from January 1, 2019 to December 31, 2019. Total sample was 90 cases. The X-rays were assessed as appearance and not-appearance of epiphysis and different phases of skeletal maturity were graded according to McKern and Stewart classification.

Results: Mean age was relatively higher in males in fusion of radius. Whereas in ulna, no difference was recorded in mean age in the fifth stage. In male the correlation coefficient for stage of fusion for radius and ulna with age (years) was 0.90 and 0.65 (p < 0.001), while for the females the correlation coefficient for stage of fusion of radius and ulna with age was 0.94 and 0.82 (p <0.001), both indicating a strong correlation.

Conclusion: Estimation of age is not only important for identification of the deceased victim but also in medicolegal issues where there are many cases in courts which are undergoing age assessment by experts in absence of birth certificate or counterfeit documents.

Study of relation of type of fracture with amount of postoperative fluid therapy and duration of hospital stay after surgery

Ritesh Sinha — 2021-08-28

Background: Post-earthquake in Nepal many patients were rescued by the Nepalese Army and transferred to Shree Birendra Hospital where they were managed and discharged postoperatively to the area with substandard care.

Objectives: This study aimed to establish the relation of type of fracture with the amount of fluid infused/transfused and postoperative hospital stay during earthquake victim resuscitation and care in April 2015.

Methods: Hospital based data registered during the period of 25th April 2015 to 15th May 2015 were collected for this analytical study design. Seventy-five orthopaedic cases were selected randomly and analysed with software Minitab 17.

Results: Fifty-three patients had long bone fractures, out of which 32 were infused with low, 18 with moderate, and three with high amounts of fluids. Similarly, 15 patients with non-long bone fractures were infused with low and seven patients with moderate amounts of fluid. The Chi-square association between type of fracture and amount of postoperative fluid therapy is 1.418, DF = 2 with p = 0.49. Similarly, the Chi-square association between the type of fracture and duration of hospital stay is 5.423 with DF = 4 and p = 0.247.

Conclusion: Long bone fractures are more debilitating but are not a cause for long hospital stay postoperatively. And there is no significant relationship between the type of fracture and the amount of postoperative fluid therapy. Hence during the time of disaster, patients can be cared for in the hospital ward for a certain time and shifted to other areas of sub-standard care. This in turn can accommodate large victims during such critical times.

Association between sleeping patterns, oral hygiene status, and self-reported academic performance among dental students

Sunita Khanal — 2021-08-28

Background: Sleep is very important for normal functioning and overall development of the body for all. Information on association between sleeping patterns, oral hygiene status, and self-reported academic performance among dental students is not available in Nepal.

Objectives: The aim of the study was to assess the association between sleeping patterns, oral hygiene status, and selfreported academic performance among dental students.

Methods: Analytical cross-sectional study was conducted among second year to final year students of Kantipur Dental College for a period of four months. Ethical approval was obtained from the institutional review committee of Kantipur Dental College before collecting the data. Convenience sampling was used. Data collection was done by using self administered, Pittsburgh Sleep Quality Index (PSQI) questionnaire for assessing sleep quality. For assessing oral hygiene status, Greene and Vermillion OHI-S index was used. Academic performance was measured by the performance of the students in their previous university exam. Data were entered in Microsoft Excel and analysis was done by using SPSS version 20 and p <0.05 was considered to be statistically significant.

Results: Altogether 138 students participated in the study. Self-reported sleep quality was fairly good among 82 (59.4%) students but the actual sleep quality determined by PSQI was good among 92 (67 %) students. Mean hours of actual sleep of participants was 7 ± 1.52 hours. The association between sleeping patterns, academic performance, and oral hygiene status was found to be statistically insignificant.

Conclusion: The sleeping patterns, oral hygiene status and academic performance had no significant association.

Drug utilisation pattern of antihistamines in upper respiratory tract infections in paediatric patients

Jyoti Prabha Bharati — 2021-08-28

Background: Upper respiratory tract infections (URTIs) are the most common infections in the paediatric population leading to health care consultations. Antihistamines are commonly prescribed medicines in children.

Objectives: This study attempted to assess the current prescription patterns of antihistamines used in the treatment of URTIs.

Methods: A descriptive cross-sectional study was conducted in the outpatient paediatric department of Kathmandu Medical College from January 2020 to April 2021. Ethical approval was taken from Institutional Review Committee of Kathmandu Medical College. A convenient sampling technique was used. The data were collected from the outpatient department prescription card into a suitably designed proforma. Drug use indicator developed by the World Health Organisation for Rational Use of Drugs was utilised. Data were analysed using SPSS v.20.

Results: Data from prescriptions of 345 patients aged less than 14 years were collected from the paediatric outpatient department of KMCTH. The most common condition was common cold (132, 38.26%). Most commonly prescribed antihistamines were Fexofenadine (156, 45.21%). Average number of drugs per prescription was 2.31. The total number of drugs prescribed by generic name was 128 (16%). Antibiotics made its place in prescriptions 279 (34.96%) times. No parenteral medication was used and 140 (17.5 %) of all drugs prescribed were from the National List of Essential Medicines.

Conclusion: Antihistamines, mostly second generation, were commonly prescribed in URTIs in paediatric patients. Majority of WHO indicators were within normal limits while some needed marked improvement. Different programmes can be implemented for improvement in prescribing patterns and promotion of rational drug use.

Comparison of combined intra-articular and sub-acromial injection with intra-articular injection in adhesive capsulitis

Rajeev Raj Manandhar — 2021-08-28

Background: The pain and limitation of shoulder function can disrupt daily activities of patients for months to years. Adhesive capsulitis is considered a self-limiting disease but the duration remains uncertain. The brunt of the disease is focussed on the inflamed joint capsule. On this basis, use of corticosteroid injection is justified. However, injection method is not conclusive.

Objectives: To compare clinical benefits of intra-articular injection alone versus combined intra-articular and subacromial injections in management of adhesive capsulitis.

Methods: Fifty-nine patients with diagnostic criteria for adhesive capsulitis were included in the study from March 2019 to September 2020. Patients were divided into two groups; patients who underwent intra-articular (IA) injection alone (Group 1) and those who received both intra-articular and sub-acromial (IA+SA) injection (Group 2). The injections were landmark guided. Patients were followed up at three, six, and 12 weeks. Pain was recorded using visual analogue scale (VAS) and subjective function using Constant-Murley score.

Results: Twenty-eight patients were included in Group 1 (IA) and 31 in Group 2 (IA+SA). Thirty-six patients were female (18 each in Group 1 and Group 2) and 23 patients were male (Group 1 = 13; Group 2 = 10). In the twelfth week, VAS score was reduced in both the groups. On comparing the mean value of Constant-Murley score between the two groups there is significant difference in value recorded at the sixth and twelfth week.

Conclusion: The IA+SA injection provides significant reduction in pain and better function in the short term over the IA injection.

Emotional intelligence among nursing students of a government campus in eastern Nepal

Melina Shrestha — 2021-08-28

Background: Emotional intelligence is the ability to recognise one’s own feelings and those of others, for motivating ourselves, and for managing emotions well in ourselves and others. It is important to identify the level of emotional intelligence among nursing students for effective nursing leadership and quality nursing care.

Objective: To assess the level of emotional intelligence of nursing students.

Methods: A cross-sectional, descriptive research design was used to assess the level of emotional intelligence among 132 nursing students at Biratnagar Nursing Campus, Nepal. Data were collected by census method using self-administered structured questionnaire from 2018-05-13 to 2018-05-27. Emotional intelligence was measured using the Schutte Self Report Emotional Intelligence Test. Descriptive and inferential statistics (Chi-square test) was analysed to find out the association between emotional intelligence and demographic variables.

Results: The findings showed that 96 (72.7%) of the respondents were from the 15 to 18 years age group. Similarly, 104 (78.8%) of the respondents had joined nursing education by their own choice. This study showed the majority 108 (81.8%) had a high level of emotional intelligence and 24 (18.2%) had a moderate level of emotional intelligence. There was no association between student’s level of emotional intelligence and their demographic variables.

Conclusion: The participating nursing students had high levels of emotional intelligence. Owing to growing complexity in the healthcare environment and increasing expectations of clients in today’s competitive health care marketplace, the nursing students should be provided with emotional intelligence training and concepts should be incorporated into the nursing curriculum.

Perceived stigma among caregivers of mentally ill patient: A descriptive cross-sectional study

Pratibha Khanal — 2021-08-28

Background: Stigmatising experience related to mental illness is not only confined to the patient but also experienced by their caregivers such as family members and friends. Caregivers feel down and helpless about their affiliation with stigma related to mental illness. Various research studies show that stigma related to mental illness have negative influence on caregivers which leads to concealing the status of mentally ill relatives.

Objective: This study aimed to assess the level of perceived stigma among the caregivers of mentally ill patients.

Methods: A descriptive cross-sectional study was conducted at Psychiatric outpatient and inpatient department of Psychiatry, Kathmandu Medical College from 30th January to August 30th 2020. Two hundred and sixteen respondents were chosen conveniently. Face to face interview was conducted using standard tool ‘Devaluation Consumers Families Scale’ to assess the perceived stigma among caregivers of mentally ill patients.

Results: Perceived stigma among the caregivers of mentally ill patients was found to be medium (mean score 15.8±2.8). The caregivers perceived the community looking down on the families with mentally ill relatives (community rejection). The mean score was low (2.1±0.8) on “uncaring parents” which indicates that the respondents did not agree that parents of mentally ill patients were less responsible and caring than others.

Conclusion: Caregivers of mentally ill patient perceive stigma in various forms which affects the usages of health facilities, care and support towards mentally ill relatives.

Extra canal in permanent maxillary first molar in patients undergoing root canal treatment at a tertiary care dental hospital, Nepal

Archana Gharti — 2021-08-28

Background: Permanent maxillary first molar normally has three root canals but it can have extra root canals for which several studies were done in many parts of the globe. However, this type of study to explore extra canal is lagging in the context of Nepal.

Objectives: The objective was to determine the percentage of extra canal in permanent maxillary first molar in patients undergoing root canal treatment and to compare the same between male and female.

Methods: The descriptive cross-sectional study was conducted in the department of conservative dentistry and endodontics of People’s Dental College and Hospital from 20th December 2019 to 20th December 2020 after receiving ethical approval from Nepal Health Research Council on 18th December 2019 (ERB protocol No 888/2019) . One hundred and eighty permanent maxillary first molar teeth without root canal calcification were enrolled. Convenient sampling was done. Access opening was done and all canal orifices were located and recorded. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0 with frequency table. Chi-square test was used for inferential statistics.

Results: Out of 180 teeth, extra canals were present in 44(24.4%) having more numbers in male than in females. Extra canal was present in the mesiobuccal root.

Conclusion: Extra canal in the permanent maxillary first molar is present in Nepalese population with greater number in male than in female. Thus, exploration of the pulp chamber in search of an extra canal is necessary to prevent failure of root canal treatment.