Journal of Kathmandu Medical College

Predictors of choice of abortion method among women attending abortion clinic in a government hospital in Nepal

Bidhya Basnet — 2023-10-21

Background: Abortion has long been a method of terminating an unintended pregnancy globally and can be provided through either medical or surgical ways. Factors affecting the choice of abortion method appear to be numerous and complex.

Objectives: This study aimed to identify the predictors of choice of abortion methods among women attending abortion clinic.

Methods: A cross sectional analytical study conducted in Paropakar Maternity and Women’s Hospital, Thapathali among 132 clients, at nine weeks of gestation.Samples were selected using consecutive sampling technique. Data were collected for the period of one month (2016 February 27 to March 27) using a semi-structured questionnaire. Descriptive and Inferential statistics (bivariate analysis, multivariate analysis) were used to find the predictors of choice of methods of abortion and final model was selected.

Results: Among the women attending for abortion 68 (51.5%) had chosen surgical over medical method of abortion. Eight to nine weeks of gestation (OR: 6.043, 95% CI: 1.636-22.316), predetermined choice on surgical method of abortion (OR: 13.871, 95% CI: 2.419-79.528) and inconvenient to revisit the clinic (OR: 4.299, 95% CI: 1.127-16.397) were found to be the predictors of choice of abortion methods.

Conclusion: Predetermined choice of particular method, period of gestation and revisit to the clinic are the major predictors of choice of surgical over medical method of abortion. The choice of abortion methods is influenced by various factors so offering the choice will help in developing the women centered abortion care.

Application of 5% acetic acid as a diagnostic adjunct in the detection of oral potentially malignant disorders

Jyotsna Rimal — 2023-10-21

Background: Commercial vinegar (acetic acid) can be a good and cost-effective screening tool for Oral Potentially Malignant Disorders (OPMDs) in resource constraint countries.

Objectives: To assess the sensitivity, specificity, and accuracy of 5% acetic acid for the detection of epithelial dysplasia in OPMDs.

Methods: This study was an analytical cross-sectional study done to assess the diagnostic accuracy. It was done in hospital and field settings from, 2017 January to 2019 February, after ethical approval from IRC of BPKIHS. Convenience sampling technique was used and 114 individuals (57 participants with OPMDs and 57 participants with normal oral mucosa) were included. Acetic acid was applied and allowed to be in contact for one minute. A positive finding (acetowhitening) was designated in a lesion that changed its colour to opaque white, while a negative finding was designated for the lesion that showed no change. This was followed by biopsy and histopathology. Patients who were undergoing extraction at the community camps with normal oral mucosa were included as participants without target condition (OPMD). Sensitivity, specificity, and accuracy were calculated for 5% acetic acid in detecting oral epithelial dysplasia.

Results: Total number of patients included in the study was 114. Among the total sample, 54 had dysplasia on histopathological evaluation, 60 did not have dysplasia. Fifty-five patients had positive acetowhitening and 59 patients had negative acetowhitening reaction. The sensitivity, specificity, and accuracy were, 0.759, 0.766, and 0.763 respectively.

Conclusions: The sensitivity, specificity, and accuracy of commercially available vinegar in detecting oral epithelial dysplasia are good.

Dysmenorrhoea and its association with stress among nursing students of a selected medical college: A cross-sectional study

Babita Thapa — 2023-10-21

Background: Dysmenorrhoea is a painful menstruation often presented with other symptoms such as sweating, headache, nausea, vomiting, and diarrhoea which influence the quality of life and social activities among the undergraduate students. Psychological disorders like stress, anxiety and depression have bi-directional relationship with dysmenorrhoea.

Objectives: To assess the prevalence of dysmenorrhoea and its association with stress among nursing students of a selected medical college.

Methods: Analytical cross-sectional study was conducted among nursing students of NAIHS-CON from 2021 August 26 to 2021 September 2 after institutional ethical clearance. Total 154 nursing students were included in the study using proportionate stratified simple random sampling technique by lottery method. Data were collected using a semi-structured, self-administered questionnaire using Perceived Stress Scale (PSS). The collected data were analysed using SPSS software v.20.

Results: The study findings revealed that 131 (85.1%) of the nursing students had moderate perceived stress level and 14 (9.1%) of them had mild stress level. The mean perceived stress score with standard deviation was 19.27 ± 4.806. The findings of the study revealed that 115 (74.7%) of the nursing students had dysmenorrhoea. Dysmenorrhoea was found to be significantly associated with family history of dysmenorrhoea (p <0.001) and pattern of menstrual cycle (p = 0.04).

Conclusion: Most of the nursing students experience dysmenorrhoea which might result in psychological stress and bring negative effects on their physical health. As a result, it may impact on their academic performance. Therefore, it is important to enhance awareness regarding dysmenorrhoea to reduce physical and mental problems.

Physical activity among nursing students during coronavirus disease 2019 pandemic, Nepal

Punam Kumari Mandal — 2023-10-21

Background: Reduced physical activity is one of the major factors affecting health and has been a serious global problem during coronavirus disease 2019 (COVID-19). Prolonged homestays can lead to increased sedentary behavior and reduced physical activity.

Objectives: To assess the level of physical activity among nursing students.

Methods: An analytical cross-sectional study was carried out on nursing campuses of Tribhuvan University in 2020 September 15 to 2020 December 15 among undergraduate students after Institutional ethical clearance using a self-administered structured International Physical Activity questionnaire. Samples of 255 students using proportionate systematic random sampling were included. Data analysis was done using SPSS version 17.0. The total score of physical activity was calculated and the level was categorised as low, moderate, and high. Ordinal logistic regression was used to find the association between the level of physical activity and selected demographic variables.

Results: The study showed that engagement in vigorous physical activity was lower but the median time spent on moderate MET-Minutes/Week was 630 (1620-180). Likewise, (75, 29.4%) have low and (129, 49%) have a moderate level of Physical Activity. Furthermore, there is an association between the level of physical activity with the place of residence.

Conclusion: The study concludes that more than one-third of respondents have a low level of physical activity. Furthermore, there is an association between the level of physical activity and place of residence. This reflects the need to sensitise nursing students to adopt physical activity in everyday life to improve general health and well-being during the COVID-19 pandemic.

Knowledge, attitude, and practice of general dental practitioners towards oral biopsy procedures

Preeti Singh — 2023-10-21

Background: Oral biopsies are not routinely practised by general dental practitioners (GDPs) globally. However GDPs should perform the biopsy procedures for oral lesions. The clinical and histopathological correlation is needed for the diagnosis of certain oral lesions.

Objectives: To assess the knowledge, attitude, and practice of oral biopsy procedures among the GDPs.

Methods: A descriptive cross-sectional questionnaire study was conducted from 2021 October to December among GDPs who were graduates of Kathmandu Medical College and registered in Nepal Medical Council. Census method was used for data collection. After institutional ethical approval, a standard questionnaire was used using Google Forms, and emailed to the GDPs (N = 72). Initial information about the study was given through the phone calls from academic section of the hospital to all the participants and follow-up was done using social media. Descriptive analysis was done using Google Sheets.

Results: There was 100% response rate from the participants with predominance (45, 62.5%) of female respondents. Majority (54, 75%) of respondents were in age group of 25-29 years. Although 38 (52.8%) practitioners came across the oral lesions that needed biopsy, only two (2.8%) of them were able to perform biopsy on their own. The concept that biopsy is specialist-related procedure and lack of skill could be the main reasons for not performing the procedure.

Conclusion: Majority of GDPs lack skill and confidence for performing oral biopsies. Hence, in the undergraduate dental programme itself, the priority should be given to skill-based knowledge of various oral biopsy procedures.

Biofilm formation and slime production as virulence determinants among isolates from indwelling devices

Rajani Shrestha — 2023-10-21

Background: Biofilm is defined as an assembly of microorganisms which enclosed in a self-produced extracellular matrix principally of polysaccharide material and found in association with indwelling medical devices. This study was designed to determine the biofilm forming ability of isolates from devices associated infection.

Objectives: To compare and evaluate biofilm production with the virulence markers like multidrug resistance and slime production.

Methods: An analytical observational study was conducted in Manipal Teaching Hospital from 2020 June-2021 May after ethical clearance. A total of 106 clinical isolates were obtained from patients with indwelling medical devices. All bacteria were identified by conventional techniques. Antimicrobial sensitivity testing was performed on Mueller-Hinton agar plates with commercially available antibiotic discs using Kirby Bauer disc diffusion techniques and interpreted as per the guidelines of Clinical and Laboratory Standards Institute (CLSI). Biofilm and slime production were detected by two methods: Tissue culture plate method and Congo Red Agar method.

Results: Out of 106 total isolates, 79 (74.5%) isolates were detected in endotracheal tubes (ETTs). Besides, it was observed that 54 (68.3%) of the 79 ETT isolates were biofilm producers. Amongst the isolates, 90.4% (19/21) were Klebsiella species, 64.1% (25/39) Acinetobacter spp., 47.6% (10/21) Pseudomonas spp., and 54.5% (6/11) Staphylococcus aureus were biofilm producers.

Conclusion: Biofilm mediated persistence of infection in the nosocomial setting through indwelling devices. Significantly, higher number of the biofilm producers as well as slime producers were multidrug resistant (p-value <0.05).

Clinical consequences of untreated dental caries in youth population using pulpal involvement, ulceration, fistula, and abscess index

Smriti Kharel — 2023-10-21

Background: Dental caries is a major health problem worldwide despite improvements in oral health. It is one of the leading causes for extraction of teeth. Untreated caries may lead to pain and infection causing negative impact on a patient's personal well-being. Implementation of preventive strategies is the most cost-effective measure to prevent dental caries and its consequences.

Objectives: To find out the consequences of untreated dental caries in the youth population using pulpal involvement, ulceration, fistula, abscess index.

Methods: A descriptive cross-sectional study was carried out in 295 patients aged 15 to 24 years visiting the Department of Conservative Dentistry and Endodontics at Kathmandu Medical College with a complaint of dental caries from October 2021 to February 2023 after obtaining ethical approval. The data obtained were entered and analysed using Statistical Package for Social Sciences. Mean, median, standard deviation, frequency and percentage were calculated depending upon the nature of data.

Results: Among various consequences of untreated dental caries, pulpal involvement was the most common consequences followed by abscess. Pupal involvement was found in 57 (19.32%) individuals and abscess in two (0.68%) individuals. None of the participants presented with ulceration and fistula. There was no significant association seen between age and sex with presence of pulpal involvement, ulceration, fistula and abscess among the individuals examined.

Conclusion: Dental caries is a global issue that affects many people. It is possible to reduce the prevalence of caries and mitigate its associated consequences by increasing awareness and implementing preventive strategies on a national level.

Comparison between stool antigen test and rapid urease test for Helicobacter pylori diagnosis in symptomatic cases of peptic ulcer disease at a tertiary care centre

Jyotish Chandra Jha — 2023-10-21

Background: Peptic ulcer disease is defined as a breach in gastric epithelium of the inner lining of the gastrointestinal tract due to imbalance between destructive gastric acid, pepsin, and protective gastric mucosa. Helicobacter pylori (H. pylori) is a gram-negative, flagellated bacilli. H. pylori infection eradication is possible with antimicrobial therapy, so its prompt and appropriate diagnosis is very important.

Objectives: To compare between the results of stool antigen test (SAT) and rapid urease test (RUT), with assessment of sensitivity and specificity.

Methods: A hospital-based descriptive cross-sectional study in department of Internal Medicine at Birat Medical College and Teaching Hospital was conducted from 2023 January 2 to 2023 July 2 after institutional ethical clearance. Symptomatic gastritis patients visited in outpatient department, admitted and who gave consent were enrolled through consecutive sampling methods in this study. Biopsy sample obtained by upper gastrointestinal endoscopy of these patients were examined by RUT. ABON™ One Step H. pylori SAT Device was used for the detection of H. pylori antigens in the Stool Specimens obtained from these patients. Microsoft Excel sheet and SPSS v.23 were used for data analysis.

Results: More than two-thirds (105, 67.7%) were positive in upper gastrointestinal endoscopy and nearly two-thirds (100, 64.5%) had positive stool antigen tests.

Conclusion: This study showed the H. pylori stool antigen test is effective non-invasive way to find out H. pylori infection demonstrating no significant difference in specificity and sensitivity in comparison to RUT and can be considered as a routine diagnostic tool for surveying clinical significance as well as eradication of H. pylori.

A protocol for systematic review on global diversity of human immunodeficiency virus-1 subtypes

Mihir Bhatta — 2023-10-21

Background: Human Immunodeficiency Virus (HIV)-1 subtypes are heterogeneously distributed around the world. Recent works on near full-length genome sequencing of HIV-1 shows increasing events of different recombinant variants and subtype C viruses. The active change in HIV-1 subtype distribution patterns initiate global challenges for diagnosis, treatment and antiretroviral (ARV) drug design.

Objectives: Present study has been initiated to provide a summary of the current data on the HIV-1 subtype diversity and distribution by region.

Methods: The data will be extracted through data extraction form as per Population, Intervention, Comparison, Outcomes and Study (PICOS) framework. Risk of bias and quality assessment will be performed with the help of Egger’s test and modified Newcastle - Ottawa Quality Assessment Scale respectively. The protocol registration number was International Prospective Register for Systematic Reviews (PROSPERO) number CRD42023400199.

Results: The pattern of HIV-1 subtypes and Circulating Recombinant Form (CRF)/Unique Recombinant Form (URF) along with their geographical distribution around the world.

Conclusion: The future systematic review, which will be generated from the present protocol, may provide evidence of the diversity of HIV-1 subtypes around the world. The present protocol might be handy to conduct a systemic review (and meta-analysis, if possible) on the global diversity of HIV-1 subtypes.

Climate change and mental illness: Another pandemic post coronavirus disease 2019?

Rika Rijal — 2023-10-21

The emergence of coronavirus disease 2019 (COVID-19) as a pandemic was a stressful situation for all of us. With the limitation of social contact and shift in our work modality, many things changed and it became the new normal. While some found opportunities even in such situation, many became crippled to another silent pandemic of mental illness. After the widespread use of vaccine, things have started to return to normal, or have they?

Gagging and throttling by rice grains: An unusual case of asphyxia in the name of witchcraft

Ahana Shrestha — 2023-10-21

Witchcraft-related violence persists in Nepal, with accusations serving as cultural weapons against those deviating from norms, especially vulnerable individuals like the elderly, impoverished, widowed, or unmarried women. This case report aims to highlight the myths and consequences surrounding these beliefs. A 55-year-old woman, accused of witchcraft, was found dead under seven sacks of rice. Autopsy revealed death by asphyxia, caused by gagging from rice grains with throttling. This tragic incident underscores the urgent need to address and dismantle such harmful superstitions, ensuring the safety and dignity of all individuals within the community.