Journal of Kathmandu Medical College

Grey literature: Additional source facilitating a balanced view of evidence

Prakash Poudel — 2021-12-28

Not applicable.

Perinatal mortality trend and classification of causes at a tertiary care centre of western Nepal

Junu Shrestha — 2021-12-28

Background: Identifying causes of perinatal death is important to reduce perinatal mortality rate.

Objectives: To determine trend of perinatal mortality rate (PMR), ascertain causes, and find out changes in causes of death over period of seven years.

Methods: This retrospective study, conducted after ethical approval, included stillbirths and early neonatal deaths at Manipal teaching hospital from April 2014 to April 2021, after 28 weeks of gestation or of foetuses weighing more than 1000 grams. Perinatal mortality rate of each year was calculated. Cause of death was assigned according to International Classification of Disease – Perinatal Mortality classification. Data analysis was done to find out trends and causes of perinatal mortality using SPSS v.21. Frequency and percentages were used to calculate causes of deaths.

Results: Perinatal mortality rate decreased from 35.5 to 21.1 per 1000 births over seven years. Antepartum hypoxia (103, 45%) was commonest cause of antepartum deaths, commonly associated with maternal medical conditions. This remained as main cause of antepartum death over years. Acute intrapartum events resulted in three-fourths of intrapartum deaths; were associated with complications of labour and delivery. Decline in this has resulted in overall decrease in intrapartum deaths. Low birth weight and prematurity (73, 42.2%) was the common cause of neonatal deaths and has remained same over years.

Conclusion: Perinatal mortality has decreased over years. Antepartum hypoxia as cause of antepartum deaths and prematurity as cause of neonatal deaths remained same over years. There is decrease in intrapartum deaths due to declining acute intrapartum events.

Assessment of poisoning survivor cases at a tertiary care teaching hospital

Arbin Shakya — 2021-12-28

Background: Poisoning is one of the most common causes of increased morbidity and mortality worldwide and also one of the common causes of Emergency Department visits. It has now become a major public health issue.

Objectives: To assess the poisoning survivor cases and various associated parameters like most common poison, the circumstance of poisoning, age and gender distribution, and triggering factors.

Methods: A retrospective study was done in 94 cases of poisoning, from whom reliable history could be obtained, admitted to Kathmandu Medical College, over the period of 12 months, from April 2019 to March 2020. After obtaining ethical clearance secondary data were collected from the medicolegal examination reports. The data were entered and analysed in Statistical Package for Social Sciences (SPSS) v.18.

Results: Majority of the victims were females (9, 62.8%), mostly homemakers (31, 33%). The mean age of the population was 30.35 ± 13.48 years and median age 26 years. Organophosphorus was the most frequent agent (44, 46.8%). The commonest triggering factor was a quarrel with family members (56, 65.1%) and in most cases the agent was already present in their home. The act of poisoning was impulsive in these cases.

Conclusion: In this study, the most common agent causing poisoning was still organophosphorus which was already present in their homes. Most poisoning cases were intentional. Females especially homemakers were the most common victims. Cases of poisoning can be reduced if the authorities properly monitor the buying and selling of these common agents of poisoning.

Assessment of accuracy of three different generations of electronic apex locators in different environments of root canal system: An in vitro study

Santosh Man Rajbhandari — 2021-12-28

Background: Endodontic treatment encompasses cleaning, shaping, disinfection, and three-dimensional obturation of entire accurate length of root canal system. Hence, accurate determination of working length plays very important role for clinical success of endodontic treatment.

Objectives: To assess the accuracy of three different generations of electronic apex locators (EALs) in different environments of root canal system.

Methods: A descriptive cross-sectional study was done in 60 single-rooted mandibular premolars for three months from 2021/12/21 to 2021/03/18 at Kantipur Dental College. Non-carious teeth were collected (excluded if more than one canal) by convenience sampling after ethical clearance. Access opening with occlusal reduction of cusp tips were performed. Before, electronic measurement of root canal length, reference length: Actual Length (AL) was recorded. Samples were divided into four groups with different environment (I = dry Canal; II = 3% NaOCl; III = 2% CHX; IV = blood Plasma) with 15 samples each. Electronic measurements were obtained using all three EALs: Rootor (fourth generation), Propex Pixi (fifth generation), and Apex ID (sixth generation). Recorded AL was compared with value obtained with EALs and their differences were tabulated with Microsoft Excel.

Results: Accuracy in working length measurement by Rootor was 80%, 80%, 60%, 53.3%, Propex Pixi was 46.7%, 80%, 86.7%, and 100% and Apex ID was 100%, 93.3%, 86.7%, 100% in Group I, Group II, Group III, and Group IV respectively of AL.

Conclusion: Accuracy of Rootor was high in dry canal, Propex Pixi in moist environment whereas, Apex ID in both dry canal and moist environment.

Significance of Candida species in patients with coronavirus disease

Kishor Gurung — 2021-12-28

Background: Respiratory fungal infection is a severe clinical condition especially in immune-compromised individuals. Secondary fungal infections as complications of severe coronavirus disease 2019 are on the rise.

Objectives: This study was carried out to isolate the Candida species from coronavirus disease 2019 patients, identify different species of Candida and to show the significance of Candida species in coronavirus disease 2019 patients attending a dedicated hospital for coronavirus disease management.

Methods: A hospital-based descriptive cross-sectional study was done in a period between 2nd Jestha to 23rd Ashad 2077 (16th May to 7th July 2021) in Nepalgunj Medical College, Kohalpur, Banke. The study included 100 Coronavirus disease 2019 patients. Sputum samples were taken and subjected to direct microscopy, cultured onto Sabouraud Dextrose Agar. Candida species were determined by standard microbiological methods. Informed consent was taken prior to participation in study. Data were analysed for simple descriptive analysis using Microsoft Office Excel.

Results: Out of 100 sputum samples, 78 (78%) men and 22 (22%) women were included; Candida species were isolated from 36 (36%) patients. This study shows Candida species isolated higher in male and from 31-60 years of age group.

Conclusion: We recommend that the investigation and identification of Candida may be routinely followed in the microbiology laboratories.

Evaluation of the parenting styles and other social variables influencing behaviour of child in dental clinic

Parajeeta Dikshit — 2021-12-28

Background: Parents play a major role in the physical and emotional development of children. The parenting style has influence over child behaviour in the dental office. Other factors like family type, presence of siblings as well as position of child in the family may also affect the behaviour of the child in the dental clinic.

Objectives: To evaluate the parenting styles and other social variables influencing child dental behaviour.

Methods: One hundred and fifty-one healthy children aged 4-12 years were recruited by convenience sampling during their regular dental visits to Paediatric Dentistry Department, Kantipur Dental College from April to July 2021 after ethical clearance. Family and child demographic data were evaluated through a questionnaire. The accompanying parent completed the Parenting Styles and Dimensions Questionnaire (PSDQ). The behaviour of the children was evaluated during the routine non-invasive dental procedure using Frankl behaviour rating scale.

Results: All three parenting styles were identified among Nepalese parents, including authoritative (136, 90.06%), authoritarian (6, 3.97%), and permissive parenting styles (9, 5.96%). Most of the children showed positive behaviour (98, 64.9%). Significant associations were detected with age (p = 0.027) and gender (p = 0.015) and their behaviour, but not between parenting styles, type of family, number of siblings, and position of child in the family with behaviour.

Conclusion: The behaviour of the child was significantly associated with the age of the child, with younger children exhibiting more negative dental behaviour than older ones. However, other factors did not have association with child behaviour.

Steroid injection in Orthopaedics: Does addition of lidocaine actually reduce pain?

Krishna Raj Khanal — 2021-12-28

Background: Local corticosteroid preparations are conventionally mixed with local anaesthetic agents to reduce pain during injection for various soft tissue affections in Orthopaedics. Although it can anaesthetise the area after injection, the infiltration process itself can be more painful because of low pH of the lidocaine.

Objectives: To assess whether addition of lidocaine actually reduces pain during local steroid injection.

Methods: This was a prospective comparative study conducted at Kathmandu Medical College over a period of nine months from June 2020 to February 2021 after obtaining ethical clearance. Patients requiring local corticosteroid injection for various indications in Orthopaedics were included by convenience sampling and divided into two groups. Out of 147 patients, 75 received steroid with lidocaine and 72 with normal saline. The Visual Analogue Score was recorded immediately along with injection in a scale of 0 to 10 where 0 meant no pain at all and 10 meant maximum pain imaginable. The difference in median Visual Analogue Score and the mean cost of injection between two groups was compared. Findings were analysed using SPSS v.20.

Results: Median Visual Analogue Score in lidocaine group was 5 whereas in normal saline group was 4 (p-value = 0.33, Mann-Whitney U test). The mean cost of injection in lidocaine and normal saline groups were Nepali Rupees 339.3 ± 37.7 and 282.3 ± 36.7 respectively (p <0.001, Student’s t-test)

Conclusion: Removal of lidocaine from steroid preparations in orthopaedics does not make it more painful if not less. It also reduces the cost of injection.

Knowledge, attitude, and practices regarding periodontal health in patients visiting a dental teaching hospital

Deepa Aryal — 2021-12-28

Background: Periodontal diseases, despite being preventable have an increasing prevalence worldwide. Mechanical plaque control methods are most effective to prevent and control these diseases.

Objectives: To assess the knowledge, attitude, and practices regarding periodontal health among patients visiting department of Periodontics, Kantipur Dental College and Hospital.

Methods: An analytical cross-sectional study was conducted by administrating pretested questionnaire to 384 patients in Kantipur Dental College and Hospital from Sep 2020 to Aug 2021. The study was conducted for one year after taking ethical clearance. All the patients who first visited the department of Periodontics were requested to participate by convenience sampling method. Statistical analysis was done to correlate among knowledge, attitude, and practices.

Results: Positive attitude and practices towards dental floss 165 (43%), tongue cleaning 273 (71.1%), replacing tooth brush 268 (69.8%), and regular dental visits 202 (52.6%) was demonstrated. There was lack of knowledge on interdental brushes 79 (20.52%), probiotics 52 (13.5%), gingival massage, and their use to improve periodontal health 17 (4.4%).

Conclusion: The majority of the respondents had good oral hygiene practices with favourable knowledge and attitude with respect to periodontal health and its measure to control the disease. Various preventive programs must be conducted regularly to brush up their knowledge. Further improvements should be focused on knowledge and attitude which can increase and improve the practice of oral health.

Clinical perspective of myths about oral health in patients visiting tertiary hospital in eastern Nepal: A descriptive cross-sectional study

Ajit Yadav — 2021-12-28

Background: Nepalese population consists of people from different cultural backgrounds having strong influence of the various myths on health seeking behaviour. Myths are defined as stories shared by a group of people which are a part of their cultural identity. They have a strong influence in the life of individuals and their way of living including seeking treatment during illness.

Objectives: The objective of this study was to assess the prevalence of myths related to oral health.

Methods: A descriptive cross-sectional study was conducted in Nobel Medical College and Teaching hospital after obtaining ethical clearance from January 2021 to March 2021 using convenience sampling technique. Patients above 15 years visiting dental OPD were included and refused to participate were excluded. SPSS Statistics for Windows, version 21.0 was used for statistical analysis.

Results: There were total 250 participants: 103 (41.2%) male and 147 (58.8%) female with mean age 34.43 ± 10.75 years and ranging from 18 to 62 years. Among the participants, 178 (72.1%) regarded fomentation of swelling with hot water while 72 (21.9%) were against it. Among all the participants 36 (14.4%) supported that there was presence of worm in decayed tooth whereas 214 (85.6%) were against it.

Conclusion: The prevalence of myths about dentistry was high among study population which could be associated with poor early health seeking behaviour and poor compliance with treatment.

Cystic partially differentiated nephroblastoma in infant: A case report

Anil Kumar Sah — 2021-12-28

Cystic partially differentiated nephroblastoma is a variant of the multilocular cystic renal tumour, considered as the bridge between cystic nephroma and cystic Wilm's tumour. It usually occurs in children below the age of two years with predominance in male. Histopathology is considered a diagnostic modality. Neoadjuvant chemotherapy and adjuvant radiotherapy may benefit the patient in selected cases. Here, a five-month-old boy who presented with painless gradually increasing right sided abdominal mass is reported. Imaging and fine needle aspiration cytology findings were inconclusive to reach the diagnosis. The histopathology after a radical nephrectomy concluded the diagnosis of cystic partially differentiated nephroblastoma.

Metastatic osteogenic sarcoma or multifocal osteosarcoma: A case report

Sunit Dahal — 2021-12-28

Multifocal osteosarcoma is a rare condition in which multiple osteogenic sarcoma at various regions are present at diagnosis. These account for 1-3 percent of all osteogenic sarcoma. A thirteen-year-old female presented with pain and swelling over her right thigh for a duration of three months with no history of trauma. The diagnosis of osteosarcoma was suspected through radiology which incidentally also showed the other femur to have involvement while getting the MRI scan. A suspicion of either metastatic osteogenic sarcoma or multifocal osteosarcoma was made and CT of the chest was done to look for pulmonary metastasis. The diagnosis was confirmed by biopsy from the right thigh. The diagnosis was confirmed as metastatic osteogenic sarcoma. There is always suspicion whether these tumors represent osseous metastasis or are of multicentric origin. This case is of interest because there was high suspicion that it could be multifocal osteosarcoma which would have been a very rare case.