Journal of Nepal Medical Association

Peptic Ulcer Disease among Patients Undergoing Upper Gastrointestinal Endoscopy in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Shova Sapkota, Saurav Sen Oli, Mamata Karki, Prerana Singh Rokaha — Sun, 31 Mar 2024 00:00:00 +0000

Introduction: Peptic ulcer is a common disease of gastrointestinal tract usually present with epigastric pain and discomfort. Upper gastrointestinal endoscopy is its gold standard investigation. There has been limited study on the prevalence of peptic ulcer disease among patients undergoing upper GI endoscopy especially in Nepal. Our study aimed to find the prevalence of peptic ulcer disease among patients undergoing upper GI endoscopy at our centre.

Methods: A descriptive cross-sectional study was conducted among patients undergoing upper gastrointestinal endoscopy at a tertiary care centre from October 1, 2022 to March 31, 2023. Data was retrieved from hospital records using a preformed proforma and sample size of 219 was calculated and data of 273 cases was collected using the convenience method of sampling.

Results: Among 273 patients, peptic ulcer disease was found in 29 (10.62%) of patients among which 28 (10.25%) had antral ulcer and only 1 (0.36%) had duodenal ulcer.

Conclusions: The prevalence of peptic ulcer disease is lower in our study centre compared to other studies and further studies can be conducted on the associated risk factors and socio-demographic distribution of peptic ulcer disease.

Post-discharge Outcomes of COVID-19 Patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Sun, 31 Mar 2024 00:00:00 +0000

Introduction: Understanding the post-discharge outcomes of COVID-19 patients is essential for informed healthcare planning and support services. This study aimed to assess the physical health status of COVID-19 patients three months after discharge from a tertiary care hospital in Kathmandu, Nepal.

Methods: A descriptive follow-up study design was used, involving 200 COVID-19 discharged patients. Data were collected from healthcare facilities and participants through structured questionnaires and telephonic interviews. The study duration was between November 2020 to April 2021.

Results: Persistence of COVID-19-related symptoms was reported by 49 (24.50%) of participants reported at follow-up, while 41 (20.50%) indicated previous symptoms from discharge.

Conclusions: After discharge, most of patient returned to normal activities within three months.Persistence of symptoms and test positive rate was less in those patients.

Etiological Profile of First Episode Seizures in Paediatric Patients at a Tertiary Care Centre: A Descriptive Cross-sectional Study

Madhu Shah, Saurav Poudel, Bivusha Parajuli, Niranjan KC, Rumi KC — Sun, 31 Mar 2024 00:00:00 +0000

Introduction: Seizures are the most common neurological emergency and one of the most common reasons for paediatrics hospital admissions. This study aimed to identify the etiology, clinical profile, and immediate outcome of children with the first episode of seizure in Eastern Nepal.

Methods: This was a prospective descriptive study carried out in the Tertiary Care Centre from September 2022 to August 2023. Ethical clearance was taken from the Institutional Review Committee (Ref no:654/2022). Convenience sampling was done to include 170 children presenting with the first episode of seizure at age 6 months to 15 years. Variables collected were demographics, clinical presentations, family history, trauma history, laboratory tests, neuroimaging, EEG, final diagnosis, and immediate outcome.

Results: A total of 170 patients were admitted with the first episode of seizure with 123 (72.36%) males and 47 (27.64%) females. The mean age of the patients was 5.13±2.95 years with 104 (61.18%) patients under 5 years of age. The most common seizure was generalized tonic-clonic type in 132 (77.64%) patients. The most common associated symptom was fever in 150 (88.23%) children. Neuroimaging was abnormal in 52 (30.59%) patients, with neurocysticercosis seen in 27 (15.88%). The most common etiology was febrile seizure in 92 (54.17%) patients, neurocysticercosis in 27 (15.88%), and meningitis in 12 (7.05%).

Conclusions: Febrile seizures, neurocysticercosis, infection, and trauma were the major causes of seizures in children. When simple febrile seizures were unlikely, lumbar puncture, neuroimaging, and laboratory tests were useful tools for diagnosing etiologies of seizures.

Pattern of Facial Laceration at Tertiary Care Centre in Eastern Nepal: A Descriptive Cross-sectional Study

Gopal Gurung, Mona Pokharel — Sun, 31 Mar 2024 00:00:00 +0000

Introduction: Facial lacerations are a source of concern as these can be life threatening at times due to extensive haemorrhage and also leave lifelong scars. The objective of this study was to find out the pattern of facial lacerations in the Nepalese population visiting a tertiary care centre in eastern Nepal.

Methods: A descriptive cross-sectional study was conducted among the maxillofacial trauma patients visiting the Emergency department and department of Dental Surgery at a tertiary care centre from 1 October 2022 to 30 September 2023. Ethical approval was taken from the Institutional Review Committee . All patients attending the Dental outpatient department and Emergency department for the management of facial laceration in the study period were included in the study.

Results: Out of 236 patients, there were 199 (84.32%) male and 37 (15.67%) female patients. The most common age group was of 21-30 years 88 (37.29%) and Road Traffic Accidents 183 (77.54%) was the main aetiology. Facial lacerations and maxillofacial fractures both were seen in 98 (41.53%) patients. There were a total of 358 facial laceration sites among 236 patients and chin region 76 (21.22%) was the most common followed by forehead region 54 (15.08%).

Conclusions: Facial lacerations were mostly seen in males, younger adults and road traffic accidents were the main aetiology for these injuries. Facial lacerations showed predominant T-shaped distribution with chin being the most common site.

Clinico-Demographic Profile of Children and Adolescents with Attention Deficit Hyperactivity Disorder Presenting to a Tertiary Care Centre: A Descriptive Cross-sectional Study

Utkarsh Karki, Supriya Sherchan, Anil Sharma, Amit Jha — Sun, 31 Mar 2024 00:00:00 +0000

Introduction: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children. ADHD leads to significant impairment in overall functioning of the child. There is limited information concerning the clinical scenario of ADHD within Nepal. The study aims to determine the clinico-demographic profile and pattern of medication use in the treatment of ADHD.

Methods: This study retrospectively examines the records of children diagnosed with ADHD at the Child and Adolescent Psychiatry (CAP) Unit, Kanti Children’s Hospital (KCH), Nepal. Approval for the study was granted by KCH's Institutional Review Board. The analysis focused on data extracted from hospital records of ADHD patients spanning from 1 January 2021 to 30 June 2023 encompassing two and a half years.

Results: A total of 585 children were diagnosed with ADHD, with a mean age 7±3.04 years. The majority 501 (85.64%) were male, and 377 (64.44%) were from the school going age group (6 to 11 years). The prevalent psychiatric comorbidities included Autism Spectrum Disorder (ASD) at 102 (17.43%), Intellectual Disability (ID) at 93(15.89%), and Oppositional Defiant Disorder (ODD) at 36 (6.15%). The commonly used medication was Clonidine 165 (28.20%) followed by Atomoxetine 154 (26.32%) and Risperidone 65 (11.11%).

Conclusions: The study indicates that ADHD is highly prevalent in Nepal. Comorbidities like ASD and ID are frequently seen which further necessitates the need for structured assessments and multidisciplinary approaches to address ADHD. In our context with limited treatment options, the management of ADHD is extremely challenging.

Assessment of Third Molar-related Symptoms Affecting Quality of Life using Nepali Version of Oral Health Impact Profile-14: A Descriptive Cross-sectional Study

Sun, 31 Mar 2024 00:00:00 +0000

Introduction: Impacted third molars often cause pain, infections, swelling, and functional limitations. This study is an attempt to assess impacted third molars-related symptoms affecting quality of life using standardised Nepali version of oral health impact profile-14 (OHIP-14) questionnaire.

Methods: This descriptive cross-sectional study was conducted at Kathmandu Medical College Teaching Hospital from October 2021 to February 2022 after institutional ethical approval. Patients with impacted third molars were included by convenience sampling technique. Patients with psychiatric illness, taking psychotropic drugs, pregnant, and lactating females were excluded. third molars-related symptoms were recorded in OHIP-14 questionnaire. Data entered in Microsoft Excel sheet were analysed. The findings have been presented as frequency, percent, mean, and standard deviation. The point estimate was calculated at a 95% Confidence Interval.

Results: Mean OHIP-14 score of participants was 21.77±11.59. Due to TM, “pain in the mouth” had score of (2.33±1.24) and followed by “uncomfortable experience on eating food” (2.12±2.15). Among seven OHIP-14 dimensions, “physical pain” with two items OHIP3 and OHIP4 had score of 4.53±2.19 implying most participants had “quite a lot" of physical pain due to TM: OHIP3 = 194 (50.2%) and OHIP4 = 183 (47.3%).

Conclusions: Impacted third molars-related symptoms were affecting quality of life of participants.

Workplace Violence against Nurses Working at Private Teaching Hospitals of Kathmandu: A Descriptive Cross-sectional Study

Sun, 31 Mar 2024 00:00:00 +0000

Introduction: Workplace violence in hospitals is a global concern and is considered as a major occupational hazard for all health care providers including the nurses. The aim of this study was to assess the status of workplace violence against nurses at hospitals in Kathmandu and determine the actions taken to investigate its cause.

Methods: A descriptive cross-sectional study was conducted among a convenient sample of 100 registered nurses employed in Nepal Medical College and Teaching Hospital, and Kathmandu Medical College and Teaching Hospital. All eligible nurses who were willing to participate irrespective of their academic fulfilment, from all different shifts and of age below 45 years were included. Data were collected using a structured questionnaire and analysed using SPSS software. Ethical approval was taken from the Institutional Review Committee (IRC) of Nepal Medical College and Kathmandu Medical College.

Results: Among 100 participants, the prevalence of workplace violence was 72 (72%) (62.13-80.52, 95% Confidence Interval). Verbal abuse accounted to 50 (69.44%), followed by physical violence accounting 17 (23.61%). Action was taken to investigate the causes of both physical violence 5 (29.41%) and verbal abuse 2 (4%) by the hospital administration 3 (60%) in physical violence and 2 (100%) in verbal abuse and police 2 (40%) in physical violence.

Conclusions: The study reveals a troubling reality, as the vast majority of nurses reported experiencing various forms of violence in their workplace. So, addressing this issue immediately could protect nurses' well-being and ensure quality care which benefits both healthcare professionals and patients.

Congenital Heart Disease among Children Undergoing Echocardiography in the Department of Paediatrics of Tertiary Care Centre: A Descriptive Cross-sectional Study

Sun, 31 Mar 2024 00:00:00 +0000

Introduction: Congenital heart disease in children are a major cause of infant mortality and morbidity. It is important to detect and manage these disorders timely as they are preventable. The objective of this study was to find out proportion of congenital heart disease in children in paediatric department in a tertiary hospital.

Methods: This is a descriptive cross-sectional study carried out in the Department of Paediatric at Nepal Medical College and Teaching Hospital where all children (0-18 years) suspected to have congenital heart disease who underwent echocardiography were studied over a period of 1 year (2020-2021). The presence or absence of congenital heart disease were confirmed by echocardiography performed by paediatric cardiologist. The socioeconomic variables,clinical features and echocardiography findings were noted.

Results: Out of total 249 patients,the proportion of patients diagnosed to have cardiac disorders was 73 with male predominance of 165 (66.26%). The most common age group was found to be neonates 111 (44%).The notable clinical features were murmur 47 (18.87%), tachypnoea 27 (10.84%) ,tachycardia 27 (10.84%) and cyanosis 9 (3.61%), clubbing 2 (0.80%), oedema 1 (0.40%), hypertension 9 (3.65%), murmur 47 (18.87%).Out of the total, there were 49 (19.67%) cases of acyanotic congenital heart disease, and 27 (10.84%) cases of cyanotic congenital heart disease.

Conclusions: Our study focuses on early recognition of cardiac diseases which is crucial for preventing morbidity and mortality.

Thyroidea Ima Artery in Cadavers of a Medical College in Nepal: A Descriptive Cross-sectional Study

Mina Jha, Shaligram Dhungel, Ashwini Kumar Jha, Sudeep Kumar Yadav — Sun, 31 Mar 2024 00:00:00 +0000

Introduction: Thyroidea ima artery is a variant arterial branch of arch of aorta supplying the thyroid gland. Understanding the anatomic variances and correctly identifying the thyroidea ima artery is crucial to preventing serious complications both before and after neck surgery. The aim of this study was to find out the prevalence of thyroidea ima artery in cadavers of a medical college in Nepal.

Methods: A descriptive cross-sectional study was carried out at the department of anatomy in Janaki Medical College, Dhanusha, Nepal from 27 December 2022 to 30 June 2023 after ethical clearence from the same institution. Origin of thyroidea ima artery was observed, recorded and photographed. Convenience sampling method was used. Data was analyzed using Microsoft Excel.

Results: Out of 35 cadavers, thyroidea ima artery was present in 2 (5.71%), arising from brachiocephalic trunk just proximal to its bifurcation and there was absence of inferior thyroid artery.

Conclusions: Findings from our study showed that thyroidea ima artery originated from brachiocephalic trunk with absence of inferior thyroid artery.

Acute Post-infectious Glomerulonephritis in Children Admitted to a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Sun, 31 Mar 2024 00:00:00 +0000

Introduction: Post infectious glomerulonephritis remains the most common cause leading to the majority of hospital admissions in children of developing countries like ours. The aim of our
study was to find the prevalence of post infectious glomerulonephritis, study the clinical profile, biochemical changes and its complication in children admitted in a tertiary care hospital of Nepal.

Methods: This descriptive cross-sectional study of children admitted at a tertiary care hospital was done from May 2020 till May 2023. A census sampling method was used and sample of 1554 children was taken. Detailed socio demographic data, clinical findings and laboratory investigations were done. Data analysis was done using SPSS software and the results obtained are shown in the form of frequencies along with percentages.

Results: Among 1554 patients, the prevalence of acute post-infectious glomerulonephritis was found to be 63 (4.05%) (3.07-5.03 at 95% Confidence Interval). The mean age of the patients was 9.06±3.48 years. Antistreptolysin O titer was raised in 34 (54%) patients, while low serum C3 was observed in 39 (61.90%) patients with acute post-infectious glomerulonephritis.

Conclusions: Acute post-infectious glomerulonephritis (APIGN) remains a notable health concern in children, particularly in developing countries like Nepal. This highlights the need for ongoing surveillance, prevention strategies, and effective management protocols to address this burden effectively.

MIS-C Like Features in a Patient of Atypical Kawasaki Disease: A Case Report

Anisha Karki, Abhishek Jha, Shova Sapkota, Nikita Kashyap, Sunil Raja Manandhar — Sun, 31 Mar 2024 00:00:00 +0000

Kawasaki Disease is multisystem vasculitis affecting young children and infants. While the diagnosis of a typical form of Kawasaki Disease is obvious, there are some patients who do not fulfill the classic diagnostic criteria for the disease which is termed as 'incomplete Kawasaki Disease' or 'Atypical Kawasaki Disease'. We present a case of a 6 months old child with fever who after failing to respond
to IV antibiotics showed considerable improvement after administering aspirin and Intravenous Immunoglobulin thus diagnosed as Atypical Kawasaki Disease. Moreover, due to sharing of similar features by both Kawasaki Disease and Multiple Inflammatory Syndrome in Children, the case posed a diagnostic dilemma.

Primary Solitary Uterine Hydatid Cyst Mimicking an Intramyometrial Cyst: A Case Report

Sun, 31 Mar 2024 00:00:00 +0000

Like many agricultural countries, cystic echinococcal zoonotic disease is endemic in Nepal. Incidence of hydatid cyst in liver and lungs are common among the adult population but hydatid cyst of the uterus is an extremely rare entity. We report a case of a 76-year-old menopausal lady who presented with lower abdominal pain for 4 months and underwent laparotomy for provisional diagnosis of myometrial cyst, as shown by MRI scan, however the cyst was found to be primary hydatid cyst of
uterus. Postoperatively serological test for hydatid cyst was positive for echinococcus granulosus, further confirmed by histopathological diagnosis. Hence in endemic areas like ours, there should be high index of suspicion of the possibility of hydatid cyst as a differential for cystic pelvic masses.

Crohn’s Disease Previously Mistreated as Intestinal Tuberculosis Complicated with Ileocecal Lump: A Case Report

Shriya Sharma , Pasang Sherpa , Ganesh Giri — Sun, 31 Mar 2024 00:00:00 +0000

In Southeast Asia, the higher prevalence of Intestinal tuberculosis (TB) challenges the diagnosis of Crohn’s disease (CD) due to their overlapping symptoms. This case involves a 25-year-old male misdiagnosed with Intestinal tuberculosis presenting with abdominal pain, weight loss, and bowel ulceration. Recurrence after anti-tubercular therapy led to further investigation paving to right hemicolectomy and histopathological analysis confirming Crohn’s disease. This case highlights the
complexity of the diagnosis of Crohn’s disease in tuberculosis-prevalent areas, stressing the clinical importance, advanced diagnostics tools, and multidisciplinary approach for effective intervention.

Mayer-Rokitansky-Kuster-Hauser Syndrome Type II with Fused Kidneys in Pelvic Cavity: A Case Report

Suman Paudel, Prerana Singh Rokaha, Pankaj Kafle — Sun, 31 Mar 2024 00:00:00 +0000

Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) also known as Müllerian agenesis, is caused by embryologic underdevelopment of the Mullerian duct, with resultant agenesis or atresia of the vagina, uterus, or both. Patients usually present with primary amenorrhea with normal growth and pubertal development. Here we present a case of a 29-year-old woman presented with primary amenorrhea. Secondary sexual characteristics and hormone evaluation were normal. Ultrasound and MRI were conducted and revealed complete absence of uterus, small vaginal canal. Bilateral renal
fossa were empty and both the kidneys were located in the pelvic cavity fused to one-another with single renal pelvis giving pancake appearance.

Medical Student Syndrome and Imposter Syndrome: Are They Real?

Deekshya Devkota — Sun, 31 Mar 2024 00:00:00 +0000

Medical Student Syndrome and imposter syndrome are rampant in the medical profession, especially among young medical students. Medical Student Syndrome, also known as the third-year syndrome is a hypochondriacal concern in inexperienced medical students regarding the disease they are studying. Usually, it arises as a result of incomplete knowledge about the disease and regular exposure to new information about diseases. Imposter syndrome, on the other hand, refers to the behavioral pattern where medical students doubt their abilities and are constantly afraid of being exposed as a fraud. Imposter syndrome might occur due to unrealistic expectations in this highly competitive medical profession.

Vol. 62 No. 272 (2024): JNMA: Published Monthly

Journal of Nepal Medical Association — Sun, 31 Mar 2024 00:00:00 +0000

Journal of Nepal Medical Association