Journal of Kathmandu Medical College

Authorship: An academic currency?

Sujaya Gupta, Aakanksha Khadka — Sat, 01 Oct 2022 00:00:00 +0545

Prevalence of thyroid nodules in patients undergoing thyroid ultrasonography at a tertiary care centre

Arbind Chaudhary, Sagar Khadka, Sushil Dulal, Narayan Bikram Thapa — Sat, 01 Oct 2022 00:00:00 +0545

Background: Thyroid nodules are common diseases, and have been detected up to 50% of the general population. Imaging plays a key role in the diagnosis and characterisation of thyroid diseases, and the information provided by imaging studies is essential for management planning.

Objectives: To assess the prevalence of thyroid nodules in patients undergoing Thyroid ultrasonography in a tertiary care centre.

Methods: A descriptive cross-sectional study was done among 86 patients. Data were collected from October 2021 to March 2022 after ethical clearance. Thyroid Imaging, Reporting and Data System were used to access the thyroid nodules. Descriptive statistics were applied using SPSS v.20.

Results: The prevalence of thyroid nodules was seen in 98 (88%) individuals in total distributed in 15 (15.3%) males, and 83 (84.7%) females. Among total 98 patients, 66 (67.3%) patients had right thyroid nodules: benign 50 (51%), malignant 16 (16.3%) and 52 (53.7%) had left thyroid nodules: benign 36 (36.7%), malignant 16 (16.3%). The composition of thyroid nodules among majority participants was cystic type, anechoic type of echogenicity. Significant relationship was seen among female gender and malignancy, solid composition of thyroid nodules, and ill-defined margin.

Conclusion: The prevalence of thyroid nodules was higher in comparison to other studies. Sonographic features like consistency, margin, and echotexture could differentiate benign and malignant thyroid nodules by using Thyroid Imaging Reporting and Data System.

Study on probable aetiological factors of subfertility in a tertiary care hospital

Suman Raj Tamrakar, Manoj Lamsal — Sat, 01 Oct 2022 00:00:00 +0545

Background: Subfertility refers to describe women or couple who are not sterile but exhibit decreased reproductive efficiency even after 12 months of regular unprotected intercourse.

Objectives: To find probable aetiological factors in subfertile couples attending Dhulikhel Hospital.

Methods: This descriptive cross-sectional study was conducted among 140 subfertile couples in Dhulikhel Hospital from March 2016 to December 2017 after ethical clearance. The participants were recruited by convenience sampling, data were entered in Microsoft Excel Sheet and analysed using SPSS v.23. Descriptive statistics like frequency, percent, mean, and standard deviation have been presented.

Results: Among 140 subfertile couples, mean duration of subfertility was 5.55 ± 3.96 years. About two-thirds (95, 67.9%) of them were of primary subfertility. Most subfertile clients (both) were of 26-30 years age group and about three-fifths (83, 59.3%) were of Janajati caste. The most common cause of subfertility was female factor (72, 51.4%) only. Ovulatory dysfunction (49, 35%) followed by tubal abnormalities (24, 17.1%) were major female contributory factors. Thyroid disorder was noted in 19 (13.6%) clients and hyperprolactinaemia was observed in 14 (10%) subfertile female clients. Two (1.4%) female clients had diabetes mellitus and 24 (17.1%) had evidence of different forms of genital infection. Only male factor contributed was seen in 16 (11.4%) clients and asthenozoopermia was the commonest abnormal semen parameters. Six (4.3%) males with abnormal semen parameter were working abroad.

Conclusion: Ovulatory causes was found to be the commonest cause of subfertility in Dhulikhel Hospital. Asthenooospermia was the most common male factor.

Mental stress among patients undergoing orthodontic treatment during coronavirus-19 global pandemic

Prabesh Sherchan, Dr. Deepa Gurung, Dr. Subekshya Bogati, Dr. Sujaya Gupta — Sat, 01 Oct 2022 00:00:00 +0545

Background: Coronavirus disease 2019 (COVID-19) is the most recent disease of corona virus family that impacted people all over the world. Subsequent lockdown and fear of disease transmission greatly affected the orthodontic appointments, treatments, as well as mental health.

Objectives: To assess the mental stress among patients undergoing orthodontic patients during COVID-19 pandemic.

Methods: A descriptive cross-sectional study was conducted among individuals undergoing orthodontic treatment in the department of Orthodontics and Dentofacial Orthopaedics in Dental Hospital of Kathmandu Medical College from 2020 December to 2021 February after institutional ethical approval. Data were collected from 108 participants by convenience sampling technique using questionnaire. Exclusion criteria included patients who answered <75% questions and those who did not sign the informed consent form. Data were analysed for descriptive statistics in SPSS v.22.

Results: Among all 108 patients, nine (8.3%) were very much worried that COVID-19 outbreak might cause teeth not to move as expected and 40 (37.1%) participants were very much depressed. Regarding perception of individuals concerning COVID-19 pandemic, 44 (40.7%) participants thought they had adequate knowledge about COVID-19. Almost half (48, 44.4%) patients in this study felt very much nervous that nothing could calm them. When participants were asked what were their main concerns for COVID-19 outbreak, more than half (60, 55.6%) responded risk of infection and 71 (65.7%) reported the impact on their work or study as their main concerns.

Conclusion: As Orthodontists we must be aware of similar threats in future and take measures to improve the accessibility to dental practice.

Association between clinical, radiological, and haematological profile of children with pneumonia

Mukunda Timilsina, Sahisnuta Basnet, Aparna Mishra — Sat, 01 Oct 2022 00:00:00 +0545

Background: Patients with pneumonia present with varying symptoms, X-ray features and changes in the blood parameters.

Objectives: To find out the association between clinical, radiological, and haematological profile of children with pneumonia.

Methods: An analytical cross-sectional study was conducted in 130 children aged two to 60 months admitted to the paediatric ward of Manipal Teaching Hospital, who were chosen by convenience sampling technique from December 2019 to November 2020, and clinical, radiological and haematological parameters compared. The observed data were analysed using SPSS 20.

Results: . Of the 130 children studied, 80 (61.5%) were male and 50 (38.5%) were female. History of prior admission for respiratory illness was seen in 75 (57.7%) patients Bronchopneumonia was seen in 72 (55.4%) patients and lobar pneumonia in 37 (28.5%) patients. Cough 122 (93.8%), Noisy breathing 86 (66.15%), Fever 70 (53.84%) and Fast breathing 67 (51.54%) were the most common presenting complaints. Patients with lobar pneumonia were more likely to present with fever than those with Bronchopneumonia (p-value 0.015). Those with history of prior admission were more likely to present with wheeze (p-value 0.035) and crepitations (p-value 0.024) than those admitted for the first time. Also, those presenting with crepitations as lung finding, were found to present with significantly lower total White blood cells (WBC) counts (p-value 0.012).

Conclusion: There seems to be a significant association between fever as presenting complaint and lobar pneumonia. Also, those with history of prior admission are more likely to have lung signs (wheeze/crepitations) at presentation.

Comparative evaluation of geneXpert MTB/RIF assay and Ziehl-Neelsen staining for the diagnosis of tuberculosis

Sat, 01 Oct 2022 00:00:00 +0545

Background: Ziehl-Neelsen (ZN) staining for the diagnosis of tuberculosis is frequently used. Since ZN smear technique has poor sensitivity, molecular tool like GeneXpert assay have recently been introduced in Nepal. This study compared GeneXpert MTB/RIF assay with ZN stain microscopy for the diagnosis of tuberculosis.

Objectives: To compare and evaluate GeneXpert MTB/RIF assay and Ziehl-Neelsen staining for the diagnosis of tuberculosis.

Methods: An analytical observational study was conducted in Manipal Teaching Hospital, Pokhara from February 2020 to August 2021 after ethical clearance. A total of 355 clinical specimens (Sputum, Broncho-alveolar lavage, pus, lymph node aspirate etc) were collected and processed for Zeihl-Neelson staining and GeneXpert assay as per the recommended guidelines.

Results: Zeihl-Neelson staining detected acid-fast bacilli (AFB) in 17 (4.78%) specimens, while GeneXpert assay showed positivity in 37 (10.42%). All the 17 smear positive sputum samples yielded positive result by GeneXpert also. AFB were not detected in any of the 318 samples negative by GeneXpert. Fifteen (83.3%) of the 18 specimens that showed high to medium density of bacilli by GeneXpert were positive by Ziehl-Neelsen staining. Only two (10.5%) of the 19 specimens with low bacillary density by GeneXpert were positive by Ziehl-Neelsen Staining. These differences were statistically significant (p <0.001). Out of 37 positive specimens, one yielded rifampicin resistant Mycobacterium tuberculosis.

Conclusion: ZN smear, though, rapid, lacks sensitivity. GeneXpert, on the other hand, can be relied upon, as it detected significantly higher number of cases, demonstrated bacillary density and drug resistance.

Type of partial edentulousness among patients visiting the department of prosthodontics in a dental college

Dilesh Pradhan, Ram Kumar Adhikari — Sat, 01 Oct 2022 00:00:00 +0545

Background: There are various combinations of partial edentulism pattern in mandible and maxilla. Documenting the pattern of tooth loss is important for health care planning as it indicates the health of people and satisfaction of oral health care system.

Objectives: To find out different types of partial edentulism among patients who come to the Department of Prosthodontics for prosthesis.

Methods: A descriptive cross sectional study was carried out in 350 patients at Kathmandu Medical College and Teaching Hospital (KMCTH) visiting Department of Prosthodontics over the period of three months (July 2021 - September 2021) by convenience sampling method with complaint of partial edentulism. Ethical approval for the study was granted by Institutional Review Committee of KMCTH on 8th June 2021. The data obtained were entered and analysed using Statistical Package for Social Sciences (SPSS) v.18.

Results: Single most common reason for tooth loss was found to be dental caries (102,29.14 %). Multiple most common reason for tooth loss were dental caries and periodontal disease (117,33.43 %). Partial edentulism in maxillary arch only 112(32%), in mandibular arch only 172(49.14%) and in both arches 66(18.86%). Kennedy’s Class III type of edentulism was most common in both maxillary arch 104 and mandibular arch 157.

Conclusion: Kennedy’s Class III is most common type of partial edentulism in both maxillary and mandibular arch. Preventive programs targeted at reducing tooth loss need to be developed and implemented at national level since most prevalent cause of tooth loss is preventable.

Morphological variation of coronoid process, sigmoid notch, and condylar process among patients of tertiary care centre of Nepal

Rajib Chaulagain, Sanjeeb Chaudhary, Prashamsa Poudel, Ajeevan Gautam — Sat, 01 Oct 2022 00:00:00 +0545

Background: Mandibular ramus undergoes remodelling with time. The remodeling is also influenced by factors such as ageing, dental status, gender, stress, trauma, force exerted during occlusion, and joint diseases. Studies have reported variations in morphology of coronoid process, condylar process, and sigmoid notch of the mandible.

Objectives: To assess the morphological variations of processes of mandible and the sigmoid notch in a tertiary care centre of Nepal.

Methods: A retrospective study was conducted at Chitwan Medical College. This study included 310 orthopantomograms (OPGs) retrieved from the archives of the hospital data from 2022 May-June. All OPGs were taken with same radiographic equipment. Data taken in predesigned proforma were entered and analysed in SPSS v.16. Descriptive statistics was used to explain the results in tabulated form.

Results: Among 310 OPGs assessed, 188 (60.6%) were female and rest male. Angled mandibular condyle was prevalent on both right 123 (39.7%) and left side 134 (43.2%). More than 50% of sigmoid notch was of sloping shape on both right and left side. Triangular type of coronoid process was present 185 (59.7%) on right side and 183 (59.0%) on left side. Among the coronoid process types, triangular was found more in male and females on both right and left sides.

Conclusion: This study concluded that the angled type of condylar process, sloping type of sigmoid notch, and triangular type of coronoid process were more prevalent on both right and left side. All three parameters were also observed to be prevalent in females suggesting gender variation.

Association of physical activity and feeding preferences of children with their nutritional status: A school based crosssectional study

Smriti Pant, Prof. Vaidya — Sat, 01 Oct 2022 00:00:00 +0545

Background: People who are obese have a higher risk of acquiring many severe diseases. Feeding preferences and physical activities are deemed to play an important role in obesity in children.

Objectives: This study aimed to find out the prevalence of over nutrition among primary level children in selected private schools of Kathmandu Metropolitan City (KMC). It also assessed the impact of physical activity level and feeding preferences on their nutritional status.

Methods: An analytical cross-sectional study was done among 488 children and their parents, in six schools of KMC between May and August 2016. Children with written permission were included in the study, while absentees or hostel dwellers were excluded. Multistage cluster sampling was used for sampling. Ethical clearance was obtained from Institutional Review Committee of Kathmandu Medical College Public Limited and informed consent was taken from all participants. The questionnaire contained questions regarding socio-demographic details, modified Child’s Feeding Questionnaire and Child Physical Activity Questionnaire. Data was entered and analysed using SPSS v.20.

Results: The prevalence of overweight was 4.5% (22) and obesity was 2.5% (12). Similarly, 135 (27.7%) children had adequate physical activity per day. Those with adequate physical activity were 1.5 times more likely to be overweight. Parent’s perception of their child’s weight and their concern about their child being overweight were both predictors of the child’s actual weight.

Conclusion: Nutritional status of children was affected by feeding preferences of their parents, so they need to be educated about the importance of healthy eating and physical activities.

Role of anti-craving drugs baclofen and topiramate in the maintenance of abstinence in alcohol dependence syndrome

Vijay Kaul, Prithi Bahadur Rai — Sat, 01 Oct 2022 00:00:00 +0545

Background: Alcohol craving is psychological condition related to motivation. Craving is risk factor for relapse in alcohol dependence syndrome. No gold standard therapy is available; many therapeutic agents are under various evaluation stages.

Objectives: To evaluate role of anti-craving drugs baclofen and topiramate in maintenance of abstinence in alcohol dependence syndrome

Methods: From March to October 2018, an open-label interventional study with 70 sample size was conducted at Nobel Medical College, following ethical clearance. Age range for inclusion was 20-60, with no history of psychotropic use, whereas history of psychiatric illness and use of substance, excluding nicotine were excluded. After written informed consent patients were admitted for detoxification, and after detoxification, anti-craving therapy was started with topiramate and baclofen and asked for follow-up at two, four, and six weeks. Clinical withdrawal assessment scale was used for withdrawal symptoms and obsessive-compulsive drinking scale (OCDS) for progress in craving. Baclofen at 20 mgs/day, topiramate at 50 mgs/day, were prescribed and increased as required at follow-up.

Results: Maximum daily dose of baclofen was 24.29 ± 2.19 mg and topiramate 120 ± 33.21 mg. Baclofen group patients had significant improvement in second week (OCDS T score 16.41± 9.52) while topiramate group showed significant improvement (OCDS T score 17.70 ± 7.57) after four weeks. Major side effects were tremors 8.10% in topiramate group, headache was 5.40% in both groups.

Conclusion: Baclofen and topiramate were equally effective at six weeks for controlling cravings. Baclofen started to show significant improvements after two weeks of trial.

Choriocarcinoma with atypical presentations causing diagnostic dilemma

Pooja Paudyal, Suniti Rawal, Neeta Katuwal, Sanyukta Rajbhandary, Asma Kunwar — Sat, 01 Oct 2022 00:00:00 +0545

Respectful Maternity Care

Narayani Paudel — Sat, 01 Oct 2022 00:00:00 +0545