Journal of Nepal Medical Association http://www.jnma.com.np/jnma/index.php/jnma <p><strong>About JNMA<br></strong>Journal of Nepal Medical Association (JNMA) is an internationally peer-reviewed, MedLine/PubMed indexed,&nbsp;a general medical journal of Nepal Medical Association. JNMA is the first and oldest medical journal from Nepal since 1963 AD. JNMA is available at <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=JNMA">PubMed</a>, <a href="https://doaj.org/toc/1815-672X?source=%7B&quot;query&quot;%3A%7B&quot;filtered&quot;%3A%7B&quot;filter&quot;%3A%7B&quot;bool&quot;%3A%7B&quot;must&quot;%3A%5B%7B&quot;term&quot;%3A%7B&quot;index.issn.exact&quot;%3A&quot;1815-672X&quot;%7D%7D%2C%7B&quot;term&quot;%3A%7B&quot;_type&quot;%3A&quot;article&quot;%7D%7D%5D%7D%7D%2C&quot;query&quot;%3A%7B&quot;match_all&quot;%3A%7B%7D%7D%7D%7D%2C&quot;from&quot;%3A0%2C&quot;size&quot;%3A100%7D">DOAJ</a>, <a href="https://scholar.google.com/scholar?q=%22jnma+j+nepal+med+assoc%22&amp;btnG=&amp;hl=en&amp;as_sdt=0%2C5">Google Scholar,</a>&nbsp;Index Copernicus, EBSCO, EMBASE and other repositories.&nbsp;<br>JNMA abide by:<br>1. International Committee of Medical Journal Editors for Uniform Requirements for Manuscripts Submitted to Biomedical Journals<br>2. World Association of Medical Editors for best editorial practice<br>3. 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Committee on Publication Ethics for practising good publication ethics<br>You can also view our author guideline (printed version) from&nbsp;<a href="http://jnma.com.np/files/submission/Author%20Guidelines.pdf">HERE</a>&nbsp;[You need to have Acrobat Reader installed on your computer]<br>*Please go through&nbsp;<a href="https://youtu.be/4lgkWBgrN2s" rel="noopener">Author Guideline Video</a>&nbsp;| <a href="https://www.youtube.com/watch?v=PqqzoiCrxcU" rel="noopener">Manuscript Preparation Video</a>&nbsp;for Nepalese Authors.&nbsp;</p> <p>JNMA is included and associated with</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed?term=%22JNMA%3B%20journal%20of%20the%20Nepal%20Medical%20Association%22%5BJournal%5D"><img src="https://www.nlm.nih.gov/about/logos_nlm_photos/pubmed_logo.png" alt="Member of OASPA" height="75"></a>&nbsp;,<img src="https://doaj.org/static/doaj/images/logo_cropped.jpg" alt="Search JNMA article in DOAJ">&nbsp;,&nbsp;&nbsp;<a href="https://scholar.google.co.uk/scholar?as_q=&amp;as_epq=&amp;as_oq=&amp;as_eq=&amp;as_occt=any&amp;as_sauthors=&amp;as_publication=jnma&amp;as_ylo=&amp;as_yhi=&amp;hl=en&amp;as_sdt=0%2C5"><img src="https://upload.wikimedia.org/wikipedia/commons/2/28/Google_Scholar_logo.png" alt="Search JNMA article in Google Scholar" height="75"></a>,<img src="http://www.oaspa.org/logos/oaspa_logo.png" alt="Member of OASPA" width="121" height="75">,<img src="http://nntdm.net/wp-content/uploads/2016/10/index_copernicus.png" alt="" height="75">,</p> <h1><a href="http://mjl.clarivate.com/cgi-bin/jrnlst/jlresults.cgi?PC=D&amp;Full=journal%20of%20nepal%20medical%20association" target="_blank" rel="noopener">Science Citation Index</a></h1> en-US <p>JNMA allow to read, download, copy, distribute, print, search, or link to the full texts of its articles and allow readers to use them for any other lawful purpose. The author(s) are allowed to retain publishing rights without restrictions. The JNMA work is licensed under a <a href="http://creativecommons.org/licenses/by/4.0/" rel="license">Creative Commons Attribution 4.0 International License</a>. More about <a href="http://jnma.com.np/jnma/index.php/jnma/about">Copyright Policy</a>.</p> editor@jnma.com.np (Dr. Angel Magar) support@jnma.com.np (Technical Support Team) Fri, 31 Aug 2018 00:00:00 +0000 OJS 3.1.1.4 http://blogs.law.harvard.edu/tech/rss 60 Prevalence and Its Associated Risk Factors in Tooth Wear http://www.jnma.com.np/jnma/index.php/jnma/article/view/3644 <p><strong>Introduction:</strong> Tooth wear is described as loss of hard tooth tissue with no occurrence of dental caries or trauma. Basic Erosive Wear Examination, a new scoring system, is a partial scoring system recording the most severely affected surface in a sextant and the cumulative score guides the management of the condition for the practitioner. The objectives of this study were to determine the prevalence of tooth wear and its association with its risk factors like gender, oral hygiene, diet, general health and life style.</p> <p><strong>Methods:</strong> A cross-sectional study was done in 364 dental patients of Kathmandu Medical College. A questionnaire was filled by interview and Basic Erosive Wear Examination was done. The data so collected were entered in Statistical Package for Social Sciences. Descriptive statistical analysis and Chi-square tests were done at confidence interval of 95% and statistical significance was set at P=0.05.</p> <p><strong>Results:</strong> The prevalence of tooth wear was 218 (60.1%) with no significant gender difference. A significant association was observed between tooth wear and age group (P&lt;0.01), duration of brushing (P=0.05), method of brushing (P&lt;0.01), swishing of soft drinks before swallowing (P&lt;0.01) and tobacco chewing (P=0.02).</p> <p class="p2"><span class="s2"><strong>Conclusions: </strong></span>The prevalence of tooth wear in the study population was high.</p> Deepti Shrestha, Prerisha Rajbhandari ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3644 Fri, 31 Aug 2018 00:00:00 +0000 Correlation of Uric Acid with Glomerular Filtration Rate in Chronic Kidney Disease http://www.jnma.com.np/jnma/index.php/jnma/article/view/3700 <p><strong>Introduction:</strong> Chronic Kidney Disease is a worldwide public health problem that affects millions of people from all racial and ethnic groups. Identification of a Chronic Kidney Disease is a major risk factor for cardiovascular morbidity and mortality and is attributed to hyperuricemia. Evidences show that high serum uric acid contribute directly to glomerulosclerosis, interstitial fibrosis and atherosclerosis that correction of hyperuricemia associated with Chronic Kidney Disease will slow the progression of chronic renal failure.&nbsp;</p> <p><strong>Methods:</strong> A hospital based cross-sectional study on chronic kidney disease patients including 57 patients on conservative treatment attending Bir Hospital with diagnosis of chronic kidney disease was performed. Detailed clinical history, examination and investigations including uric acid were done. Chronic Kidney Disease staging was done according to estimated glomerular filtration rate estimated by Cockcroft-Gault equation. Prevalence rate of hyperuricemia in Chronic Kidney Disease and its stages were calculated and compared with each other.</p> <p><strong>Results:</strong> A total of 57 Chronic Kidney Disease cases were enrolled, with male to female ratio of 2:1 and mean age 51.63±17.75 years. Hyperuricemia was present in 55 (96.49%) of study population. Though prevalence of hyperuricemia increased with Chronic Kidney Disease stage, there was no significant difference in mean value of uric acid in different stages. Hyperuricemia and stages of Chronic Kidney Disease had negative correlation which was statistically significant.</p> <p><strong>Conclusions:</strong> Hyperuricemia is highly prevalent among Chronic Kidney Disease patients with conservative management. The severity of hyperuricemia increases as Chronic Kidney Disease stage progresses.</p> Milan Khadka, Binod Pantha, Lochan Karki ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3700 Fri, 31 Aug 2018 00:00:00 +0000 Effectiveness of Herbal Mouthwash among Visually Impaired Residential School Students http://www.jnma.com.np/jnma/index.php/jnma/article/view/3654 <p><strong>Introduction:</strong> Visually impaired patients are unable to visualize the plaque on tooth surfaces resulting in inadequate plaque removal and therefore the progression of dental caries and inflammatory disease of the periodontium. The objective of the study was to assess the effectiveness of herbal mouth wash in reduction of plaque and gingivitis among visually impaired children.</p> <p><strong>Methods:</strong> Randomized controlled clinical trial was conducted with parallel groups study, comprising 6 to 20 year old visually impaired children, 20 in each group (herbal mouth wash or chlorhexidine mouthwash or placebo mouthwash). Plaque and gingival index were recorded at baseline and at the end of the study. Children were asked to use the mouth wash twice daily for two weeks. Analysis was done using Chi-square test for categorical data and Mann-Whitney U test/independent t-test and one way analysis of variance/Kruskal-wallis H test for quantitative data. The level of significance was set at P&lt;0.05.</p> <p><strong>Results:</strong> Participants showed fair oral hygiene (mean plaque scores of 1.14±0.53) and moderate gingivitis (mean gingival scores of 1.12±0.45) with no significant difference between three groups (P=0.47 and 0.84, respectively). Significant reduction of plaque and gingivitis was seen at follow-up with no significant difference between herbal and chlorhexidine mouthwash. However, significant difference was found between placebo and herbal/chlorhexidine mouthwash.</p> <p><strong>Conclusions:</strong> Herbal mouthwash showed significant effect on reducing plaque formation and gingivitis in visually impaired students. The effectiveness of herbal mouthwash was analogous to the gold standard chlorhexidine.</p> Sirjana Dahal, Ashish Shrestha, Tarakant Bhagat ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3654 Fri, 31 Aug 2018 00:00:00 +0000 Perception of District Judges and Lawyers Towards Medico-legal Reports, Medical Certificates and Medical Expert Opinion http://www.jnma.com.np/jnma/index.php/jnma/article/view/3410 <p><strong>Introduction:</strong> The medico legal reports and certificates prepared by doctors can be used as valuable documentary evidence in the court of law. The study was designed with objectives to explore the perception of judges and lawyers about the quality of medico legal reports prepared by the doctors and their competence in providing the expert evidence in the court.</p> <p><strong>Methods:</strong> It is a questionnaire based cross sectional study conducted among the district judges and government attorneys of 75 districts of Nepal from March to May 2016. The data obtained was analysed by SPSS version 16.0.</p> <p><strong>Results:</strong> Among a total of 78 participants who responded the questionnaire, 40 (51.3%) were district judges and 38 (48.7%) district attorneys. Most of them graded that the reports prepared by the doctors were just average. Among them, 49 (63.6%) strongly agreed and 28 (36.4%) partially agreed that the reports were useful in deciding the cases. A total of 44 (56.4%) respondents strongly agreed and 34 (43.6%) partially agreed that expert opinion of the doctors in the courts were useful to decide the cases. Seventy one (92.2%) of them rated general doctors as moderately competent.</p> <p><strong>Conclusions:</strong> The medical reports prepared by the Nepalese doctors were just average as perceived by judges and lawyers and the competency in presenting the evidence in courts was moderate as rated by them.</p> Nuwadatta Subedi, Hima Raj Giri ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3410 Fri, 31 Aug 2018 00:00:00 +0000 Knowledge of Use of Antibiotic, Its Resistance and Consequences Among Students in Private Schools. http://www.jnma.com.np/jnma/index.php/jnma/article/view/3672 <p><strong>Introduction:</strong> Self-medication among adolescents has become a serious global problem that plays an important role in irrational use of medication and tends to increase with the age of adolescents. Limited research has been done in Nepal regarding antibiotic knowledge among non-medical students. Hence, this study aims to assess the knowledge of higher secondary non-science students regarding antibiotic use, resistance and its consequences.</p> <p><strong>Methods:</strong> A cross-sectional descriptive study was done during antibiotic awareness week 2017 among 471 grade 11 and 12 non-science students of private schools in Kathmandu. Convenience sampling technique was used. Data was collected through self-administered questionnaires. Descriptive statistics was utilised to find out the knowledge level of the students.</p> <p><strong>Results:</strong> The mean age of the students 245 (52%) male, 226 (48%) female) was 17.19 years and 335 (71.1%) were from grade 12. Approximately all 462 (98.1%) the participants had inadequate knowledge regarding antibiotic and their knowledge mean score was 5.8±2.56. More than half 277 (58.8%) of the students had not heard about antibiotic resistance, among those who have heard 113 (24%) said that doctor and nurses were the source of information.</p> <p><strong>Conclusions:</strong> Almost all of the participating students lacked adequate knowledge regarding antibiotic. Thus, it is imperative to create school and community based awareness programs by policy makers for adolescents to upgrade their knowledge on safe use of antibiotics as well as to prevent the consequences of antibiotic resistance during their adult life.</p> Satish Kumar Deo, Sita Rijal, Sita Devi Kunwar, Anuja Dahal, Sujaya Gupta ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3672 Fri, 31 Aug 2018 00:00:00 +0000 Efficacy of Use of Triamcinolone Ointment for Clean Intermittent Self Catheterization following Internal Urethrotomy. http://www.jnma.com.np/jnma/index.php/jnma/article/view/3704 <p><strong>Introduction:</strong> Internal urethrotomy is recommended for the treatment of urethral strictures shorter than 1.5 cm but has been associated with high recurrence rates. The aim of this study was to evaluate the efficacy of use of triamcinolone ointment for clean intermittent self catheterization in the prevention of urethral stricture recurrence after internal urethrotomy.</p> <p><strong>Methods:</strong> Total of 60 male patients undergoing internal urethrotomy were assigned into two groups and clean intermittent self catheterization was performed using either triamcinolone ointment or a water-based gel for lubrication of the catheter in this randomized clinical trial. Clean intermittent self catheterization regimen was continued for 6 months and patients were followed for 12 months. Urethrocystoscopic evaluation was done 6 and 12 months postoperatively.</p> <p><strong>Results:</strong> The recurrence rates were compared between the two groups. There were no significant differences in patient characteristics and etiology of the stricture between the two groups. There was a 6 (22.22%) recurrence rate in the patients of the triamcinolone group against 13 (46.42%) in those of the control group after the first internal urethrotomy (P=0.04). After second internal urethrotomy, the urethra was stabilized in 5 (83.3%) of the patients in the triamcinolone group and 8 (61.5%) those in the control group (P=0.05). We also found a significant correlation between recurrence and stricture length (P=0.02) but the time to recurrence was not statistically significant (P=0.16).</p> <p><strong>Conclusions:</strong> The use of triamcinolone ointment in patients on CISC regimen after internal urethrotomy significantly decreased the stricture recurrence rate.</p> Sunil Regmi, Sunil Chandra Adhikari, Saroj Yadav, Rabin Raj Singh, Ravi Bastakoti ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3704 Fri, 31 Aug 2018 00:00:00 +0000 Clinical Experience with Frame Based Stereotactic Biopsy for Intracranial Space Occupying Lesion http://www.jnma.com.np/jnma/index.php/jnma/article/view/3665 <p><strong>Introduction:</strong> Preoperative diagnosis of intracranial space occupying lesion based solely on clinical and neuroimaging evaluation may not be sufficient to institute treatment plan without histopathological certainty. Frame based stereotactic biopsy is a technique of retrieving biopsy specimen to determine the histopathology. The aim of this study is to assess the efficacy and accuracy of frame based technique.</p> <p><strong>Methods:</strong> This is a cross-sectional study conducted among 80 patients who underwent computed tomography guided frame based stereotactic biopsy during a period of 6 years. All operations were performed under local anesthesia. Histopathology reports were retrieved and accuracy of biopsy technique analyzed.</p> <p><strong>Results:</strong> Out of 80 patients, 58 were male with male to female ratio of 2.6:1. Median age of patients were 50 years with range from 16 to 75 years. Most lesions were in deeper location lesions that was 49 (61.3%). Most common location was Parietal, 15 (18.8%) followed by Thalamic, 12 (15%). Mean size of lesion was 2.88±0.71cms ranged from 2 to 5cms. Biopsy was accurate to retrieve target in 74 (92.5%) patients. Histopathology revealed glial tumor in 41 (51.2% ) of cases. Overall morbidity was observed in 3 (5.5%) patients. There is no procedure related mortality in this study during study period.</p> <p><strong>Conclusions:</strong> Frame based biopsy of intracranial space occupying lesion is safe and efficacious procedure with high diagnostic yield.</p> Suresh Bishokarma, Shikher Shrestha, Munu Napit, Dinesh Nath Gongal ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3665 Fri, 31 Aug 2018 00:00:00 +0000 Correlates of Selected Biochemical Markers of Bone turnover among Post-Menopausal Women http://www.jnma.com.np/jnma/index.php/jnma/article/view/3604 <p><strong>Introduction:</strong> Bone turnover leading to osteoporosis and poor quality of life is common during post-menopausal period. Study of bone&nbsp;turnover&nbsp;markers&nbsp;that contribute to non-invasive assessment of&nbsp;bone-metabolic disorders holds an important of research in low income country like Nepal.&nbsp;</p> <p><strong>Methods:</strong> A hospital-based cross-sectional study conducted during the period of November 2016 to December 2017 among 354 women. Blood samples for calcium, inorganic phosphorus, alkaline phosphatase and vitamin D were collected and analyzed using a validated and calibrated tools. Data were analyzed using Statistical Package for the Social Sciences software version 20.</p> <p><strong>Results:</strong> Mean±Standard deviation of age of post-menopausal women was significantly higher compared to pre-menopausal women (post-menopausal women, (57.98±8.08) vs. pre-menopausal, (31.35±5.83), (P&lt;0.001). Selected biochemical markers of bone-turnover such as alkaline phosphatase levels were significantly higher with year since menopause (P&lt;0.001), whereas serum calcium, and vitamin D were decreasing with year since menopause among post-menopausal women. In addition, calcium and vitamin D were significantly negatively correlated with year since menopause (P&lt;0.01) while body mass index, inorganic phosphorus and alkaline phosphatase were significantly positively correlated with year since menopause (P&lt;0.01).</p> <p><strong>Conclusions:</strong> Our study revealed that body mass index, inorganic phosphorus and alkaline phosphatase positively correlated with year since menopause while calcium and vitamin D were negatively correlated suggesting for a medical supervision of hormonal changes and periodic dosing of calcium and vitamin D among post-menopausal women to reduce the problem of bone health.</p> Bikram Khadka, Mohan Lal Tiwari, Ravi Gautam, Binod Timalsina, Nandu Prasad Pathak, Krishna Kharel, Shanta Sharma, Dilaram Acharya ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3604 Fri, 31 Aug 2018 00:00:00 +0000 An Audit of An Intensive Care Unit of A Tertiary Care Hospital http://www.jnma.com.np/jnma/index.php/jnma/article/view/3703 <p><strong>Introduction:</strong> The patients with the most severe and life threatening illnesses requiring constant monitoring and support are admitted in the intensive care unit. Tribhuvan University Teaching Hospital is the oldest and tertiary referral center hospital in the country with eleven-bedded level III mixed medical surgical ICU. This audit was performed to study the profile of critically ill patients under different headings like diagnosis at admission, primary specialty, outcome of the patients, etc.</p> <p><strong> Methods:</strong> A descriptive cross-sectional study was designed and all patients admitted to the intensive care unit of our center between 13 April 2017 and 13 April 2018 (1st Baisakh 2074 to 30th Chaitra 2074) were selected for this study.</p> <p><strong>Results:</strong> A total of 813 patients were admitted in TUTH ICU over a period of one year (2074 B.S.) with male patients being more common. Neurosurgical cases were most common at 199 (24.48 %), followed by respiratory cases at 149 (18.32%) and so on. The overall mortality was 246 (32.8%). The overall surgical cases were more common than medical cases with better outcomes.</p> <p><strong>Conclusions:</strong> This audit presents the profile of patients admitted in a tertiary level hospital in Nepal, their indications and mortality. The most common patients being admitted were Neurosurgical patients and the mortality was significantly higher compared to ICUs in developed countries.</p> Subash Prasad Acharya, Adheesh Bhattarai, Binita Bhattarai ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3703 Fri, 31 Aug 2018 00:00:00 +0000 Impact on Quality of Life in Patients who came with Androgenetic Alopecia for Hair Transplantion Surgery in a Clinic http://www.jnma.com.np/jnma/index.php/jnma/article/view/3500 <p><strong>Introduction:</strong> Androgenetic alopecia, also known as as male pattern baldness, affects up to 50% of men and 10% females worldwide. Patients with baldness seem to have a great impact on quality of life including their self-esteem, confidence, relationship as well as work.</p> <p><strong>Methods:</strong> This is a cross-sectional descriptive study on dermatology quality of life index in patients with androgenetic alopecia who came for hair transplantation surgery at Aavaran Skin Clinic Pvt Ltd, Battisputali, Kathmandu between 15th July 2017 to 15th February 2018. Ethical clearance was taken from ERB of Nepal Health Reasearch Council Reg No 113/2017. All cases enrolled for transplant surgery during the study period and meeting the inclusive criteria were included.</p> <p><strong>Results:</strong> A total of 120 patients participated in the study. Age of the patients ranged from 19 to 49, mean age being 31.87±6.8. Maximum number of patients was in age group 25 to 34. Mean dermatology quality of life index score was 2.79. Maximum score was 14 &amp; minimum score was 0. Maximum effect was seen in question number 2 of self-consciousness, which had impact on 58 (48.33%) patients at some level. Minimum impact on quality of life was seen in sexual activity where only 4 (3.33%) of patients were affected.</p> <p><strong>Conclusions:</strong> Androgenetic alopecia had a small effect on quality of life of our patients, but for some it had a great psychological impact not only with their personal feelings but also with the social response towards their problems.</p> Rupak Bishwokarma Ghimire ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3500 Fri, 31 Aug 2018 00:00:00 +0000 Assessment of the Attitude and Knowledge of the Principles and Practices of Orthodontic Treatment Among the Non-orthodontic Specialists and General Practitioner Dentists http://www.jnma.com.np/jnma/index.php/jnma/article/view/3674 <p><strong>Introduction:</strong> General practitioner dentists and non-orthodontic specialties ought to have the knowledge of the basic principles and practices of orthodontics in order to educate the patients, diagnose their problems correctly and for proper referral. The objective of the present study is to assess the attitude and knowledge of the general practitioner dentists and non-orthodontic specialists towards the basic principles and practices of orthodontics.</p> <p><strong>Methods:</strong> This study was performed by presenting a closed questionnaire to a total of 78 participants out of which 46 were general practitioners and 32 were non-orthodontic specialists. A questionnaire consisting of a total of 21 questions was distributed and each question was allocated 0.5 marks for correct response whereas no deduction for wrong answer.</p> <p><strong>Results:</strong> In this present study, the total mean score of the evaluation of the questionnaire came out for general practitioner dentist and the non-orthodontic dental specialists was 13.92 and 16.69 respectively. The present study showed a statistically highly significant knowledge and attitude difference between Group A and Group B ( P&lt;0.001).</p> <p><strong>Conclusions:</strong> This study shows a need for a increased clinically oriented education in the undergraduate courses and a multi-disciplinary inter department seminar presentations and forums set up for the post graduation courses for them to understand the scope of each other’s specialties.</p> Deepika Kapoor, Sandeep Bhatia, Deepanshu Garg ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3674 Fri, 31 Aug 2018 00:00:00 +0000 Evaluation of Graft Uptake and Hearing Assessment after Palisade Myringoplasty http://www.jnma.com.np/jnma/index.php/jnma/article/view/3699 <p><strong>Introduction:</strong> Cartilage as a graft for closure of tympanic membrane has got superior benefits than other usual grafts (temporalis fascia and perichondrium). Cartilage supported myringoplasty with palisade technique has good result of graft uptake rate, even under difficult conditions. This technique brings very good functional and better long-term results. This study is done to assess graft uptake rate and hearing improvement after myringoplasty with cartilage palisade technique.</p> <p><strong>Methods:</strong> It is a descriptive, hospital based observational study done at Manipal Teaching Hospital, Pokhara between 2014-2017. A total of 45 patients aged between 13 years and 44 years diagnosed with chronic otitis media-mucosal were taken. Pure tone audiometry was done before and six months after surgery. Graft uptake and Post-operative hearing gain was evaluated after six months. Statistical analysis was done by Statistical Package for Social Sciences version 16.0. Statistical significance was set at P&lt;0.05.</p> <p><strong>Results:</strong> Graft uptake rate was 41 (91.1%). The mean pre-and post-operative pure tone average were 26.88dB and 8.44dB respectively. The post-operative hearing gain was 18.36dB. Hearing improvement after surgery was found to be statistically highly significant with P&lt;0.001.</p> <p><strong>Conclusions:</strong> Cartilage supported myringoplasty using palisade technique is preferred for chronic otitis media-mucosal with large and sub-total tympanic membrane perforation.</p> Poonam KC ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3699 Fri, 31 Aug 2018 00:00:00 +0000 An Experience of Video Based Training on Basic Life Support http://www.jnma.com.np/jnma/index.php/jnma/article/view/3645 <p><strong>Introduction:</strong> Basic life support is foundation to save lives. In contrast to the developed countries, there is still no national standard BLS training module in Nepal. Basic life support training is being provided by various institutions but lack in consistency and coordination. The Nepal basic life support Course is the video based training in Nepali language with reference to recent advances which was intended for all health care personnel of Nepal in urban as well as rural setting. We aimed to describe the features of this video based training module in local language, to analyse the differences of knowledge and find out the participants perception and satisfaction with this course.</p> <p><strong>Methods:</strong> This is a descriptive cross-sectional study based on data of trainings conducted over the study period. Ethical approval was taken. The post-test score was recorded and compared with the occupational using ANOVA. On the spot and delayed feedbacks from the participants were collected voluntarily and summarized.</p> <p><strong>Results:</strong> Total of 576 participants (435 clinical doctors, 92 nurses/paramedics, 18 non-clinical doctors and 41 intern doctors) successfully completed the training. The difference in post test scores (mean = 12.9±1.8) among the different occupational background was not significant (P=0.159). The feedbacks from the participants were mostly positive and encouraging.</p> <p><strong>Conclusions:</strong> The knowledge of basic life support improved significantly irrespective of the occupation of the participants. A universal, nationwide video based training module in Nepali language should be developed focusing all health care personnel of urban as well rural Nepal.</p> Roshana Shrestha, Ashis Shresha, Kabita Hada Batajoo, Rashmi Thapa, Samita Acharya, Suman Bajracharya, Sanij Singh ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3645 Fri, 31 Aug 2018 00:00:00 +0000 Estimation of Transmission of Porphyromonas Gingivalis from Mother to Child through Saliva http://www.jnma.com.np/jnma/index.php/jnma/article/view/3475 <p><strong>Introduction:</strong> Chronic periodontitis is an infectious disease. Porphyromonas gingivalis is the major pathogen associated with it and can be found in all ecosystems in the oral cavity. The presence of this organism is highly correlated with preterm and low birth weight babies. So, this study aimed to assess vertical transmission of P.gingivalis from pregnant women to their new born.</p> <p><strong>Methods:</strong> Forty six pregnant women with chronic periodontitis were recruited for this cross-sectional study. Whole unstimulated saliva was collected from them before delivery and from their new-borns within forty eight hours of birth. Quantification of P.gingivalis in the saliva samples was carried out by quantitative real time polymerase chain reaction. The obtained data were analysed by SPSS 16 program.</p> <p><strong>Results:</strong> The results showed a significant correlation (P=0.002) between the number of P.gingivalis present in the mother’s saliva with that of the new-borns’ saliva. DNA copies of more than 5000/μl of P.gingivalis was found in 20 (43.5%) maternal saliva and 21 (45.7%) in new-borns’ saliva. Both Plaque index and Extent and Severity index showed no correlation (P&gt;0.05) with DNA copies of P.gingivalis in new-borns’ saliva.</p> <p><strong>Conclusions:</strong> The DNA copies of P.gingivalis found in new-borns’ saliva are in par with mother saliva, as the saliva sample obtained from new-borns’ were within forty eight hours of birth, no other environmental factor can have a direct role in its transmission. Thus, it can be concluded that P.gingivalis is vertically transmitted from mother to child.</p> Khushbu Adhikari, Charanjeet Singh Saimbi, Birendra Prasad Gupta ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3475 Fri, 31 Aug 2018 00:00:00 +0000 Ultrasonographic Elasticity Contrast Index of Palpable Breast Lumps http://www.jnma.com.np/jnma/index.php/jnma/article/view/3536 <p><strong>Introduction:</strong> Elastrography used in addition to grey scale sonography increases its specificity. Elasticity contrast index (ECI) is based on strain elastrography and being a quantitative parameter, maybe more easy to obtain and reproducible while researches has been done in ECI in thyroid lesions, this is the first study, to the best of our knowledge to evaluate in breast lesions. This study was done to evaluate the diagnostic accuracy of Elasticity Contrast Index (ECI) in differentiating benign from malignant lesions of breast and to determine its cutoff value.</p> <p><strong>Methods:</strong> This is a descriptive cross-sectional study done at tertiary health care centre, which involved retrospective evaluation of data collected from September 2016 to March 2017. Conventional sonography was done followed by elastography on commercially available ultrasound machine. ECI was calculated in thyroid protocol available in the unit. Histopathological diagnosis was obtained for all the lesions and taken as gold standard.</p> <p><strong>Results:</strong> A total of 89 breast lumps were evaluated, of which was 61 (69.3%) were benign and 27 (30.7%) malignant on histopathology. Independent t test revealed the average ECI value of benign lesions was 2.48 and malignant 5.1. Receiver operating curve showed ECI value of 3.25 as the cutoff, above which the lesions were malignant.</p> <p><strong>Conclusions:</strong> ECI is a quantitative elastography technique which can be easily used as an adjunct during breast sonography and can increase its specificity for diagnosing a lesion as malignant. This could reduce the number of false positive biopsies.</p> Anamika Jha ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3536 Fri, 31 Aug 2018 00:00:00 +0000 Location of Mental Foramen in Dentate Adults using Orthopantomogram http://www.jnma.com.np/jnma/index.php/jnma/article/view/3692 <p><strong>Introduction:</strong> Understanding the anatomical variations in the position of mental foramen are significant for different dental procedures. This study identified the position of the mental foramen among a sample of Nepalese population visiting a dental college in Kathmandu.</p> <p><strong>Methods:</strong> Total 417 panoramic radiographs (orthopantomograms) were selected from a total of 567 radiographs. The mental foramen location was determined by drawing imaginary line parallel with the long axis of the lower premolars . The mental foramen location was then classified into six classes.</p> <p><strong>Results:</strong> In the study population, the mental foramina were located mostly between the lower premolars 163 (39.1%), followed by in line with second premolar 148 (35.5%) of the mental foramen was located under the second premolar apex.</p> <p><strong>Conclusions:</strong> The study shows that the anaesthetic solution should be injected between the lower premolars or below the lower 2nd premolar in the Nepalese population for successful and secure mental nerve blocking.</p> Barsha Ghimire, Sujaya Gupta ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3692 Fri, 31 Aug 2018 00:00:00 +0000 Perinatal Outcome of Vaginal Breech Delivery versus Caesarean Breech Delivery in a Tertiary Care Center http://www.jnma.com.np/jnma/index.php/jnma/article/view/3697 <p><strong>Introduction:</strong> Breech delivery has always been matter of interest in obstetrics. Cesarean breech delivery has been preferred method of delivery. We aim to find out any differences in outcome between vaginal breech delivery and cesarean breech delivery in our setup.</p> <p><strong>Methods:</strong> Data were collected from record book of Department of Gynaecology and obstetrics, Pokhara Academy of Health Sciences, Kaski, Nepal. Pregnant with breech presentation who had delivery in the centre from 2074 Baishak to 2074 chaitra were enrolled in the study. Data of 174 patients were analysed among which 74 underwent vaginal delivery for breech and 110 underwent cesarean breech delivery.</p> <p><strong>Results:</strong> Only 1 (1.6%) of newborn delivered by vaginal route were admitted to NCU vs 17 (15.5% )in cesarean group which was significant (odds ratio= 0.071, 95% C.I 0.009-0.574; p= 0.004). There was only one death of newborn which was delivered by vaginal route. Mean APGAR score at 1 and 5 minute in vaginal breech delivery was 6 and 7 and in cesarean breech delivery was 6 and 8.</p> <p><strong>Conclusions:</strong> Though perinatal morbidity was more with cesarean breech delivery but further study with more sample size is needed before reaching conclusion.</p> Rajendra Kumar Chaudhary, Rajan Ghimire, Deepak Raj Kafle ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3697 Fri, 31 Aug 2018 00:00:00 +0000 Awareness Level of Radiation Protection among Dental Students http://www.jnma.com.np/jnma/index.php/jnma/article/view/3651 <p><strong>Introduction:</strong> Dental radiographs have always been the mainstay of the diagnosis of oral diseases. Even if the radiation hazard posed by the dental radiographs is low but still accumulation of such low level radiation in human body over a time period can pose a threat to the overall health of the individual. The aim of this study is to assess the knowledge of dental students about radiation protection and hazards.</p> <p><strong>Methods:</strong> The present cross sectional study was conducted by enrolling one hundred 4th year dental students from the two teaching hospitals in Chitwan district of Nepal. A questionnaire consisting of a total of 20 questions was distributed and each question was allocated 0.5 marks for correct response whereas no deduction for wrong answer.</p> <p><strong>Results:</strong> The results of the present study depicted that 85 (85%) of the total students enrolled in the study had “good” knowledge about the radiation physics, protection and hazards whereas only 15 (15%) of them had “poor” knowledge.</p> <p><strong>Conclusions:</strong> The study concluded that teachers should involve in imparting more and more knowledge as well as training about the topic and dental curriculum should be altered so as to train the budding dentists about all aspects of radiation.</p> Deepanshu Garg, Deepika Kapoor ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3651 Fri, 31 Aug 2018 00:00:00 +0000 Male Breast Cancer: A Rare Entity http://www.jnma.com.np/jnma/index.php/jnma/article/view/3662 <p>Male breast carcinoma is a rare malignancy (&lt;1% of all breast carcinomas, 0.2% of all male malignancies). Its common histopathological type is infiltrating carcinoma, not otherwise specified. Three male patients aged 56 (stage –IIIB), 64 (T4bN0M0) and 78 (T2N0MO) years presented with a breast lump within a year. Their hematological and biochemical parameters were within normal limits. Two of them had palpable regional lymph nodes. Male breast carcinoma occurs in older males as in our cases. Two cases showed infiltrating ductal carcinoma, not otherwise specified on histopathological evaluation, and one showed special type with apocrine differentiation. Their two-year follow-up was uneventful after modified radical mastectomy and chemotherapy. Male breast carcinoma is associated with risk factors different from and overlapping with female breast carcinoma. Male breast carcinoma differs from female breast carcinoma on clinical presentation, biological behaviour and prognosis.&nbsp;</p> Swotantra Gautam, Brikha Raj Joshi, Shailesh Adhikary, Sudeep Regmi, Anju Pradhan ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3662 Fri, 31 Aug 2018 00:00:00 +0000 Abdominal Cocoon Syndrome following Primary Subfertility Management with IVF-ET http://www.jnma.com.np/jnma/index.php/jnma/article/view/3683 <p>Abdominal cocoon syndrome is a rarely encountered surgical emergency first described by Foo et al. in 1978. This condition is characterised by a thick fibrous membrane which encases the small bowel partially or completely. Diagnosis of this condition is usually made per operatively and the treatment of choice is surgical release of entrapped bowel.</p> <p>This is a case report of abdominal cocoon syndrome diagnosed during laparotomy done with the provisional diagnosis of abdominal pregnancy following In vitro fertilization- embryo transfer. A 30 Years lady was admitted at Kathmandu Medical College for suspected ovarian hyper stimulation syndrome following IVF-ET.&nbsp;</p> <p>Sub fertility is a common gynecological problem. Its management may sometimes produce challenging health hazards. Thorough screening for medical and surgical illness is very important before proceeding to any kind of assisted reproductive technologies. A multidisciplinary approach is very important to manage such cases.</p> Asmita Pandey, Chanda Karki, Meena Thapa ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3683 Fri, 31 Aug 2018 00:00:00 +0000 Atypical Kawasaki Disease in a 4 Years Old Child with Mumps http://www.jnma.com.np/jnma/index.php/jnma/article/view/3482 <p>Kawasaki disease is an acute febrile condition seen in children. However, it is also well recognized that some patients do not fulfill the classic diagnostic criteria for the diagnosis of Kawasaki disease. The incomplete form of Kawasaki disease is termed as ‘Incomplete KD’ or ‘Atypical KD’. This is a case of 4 years old child with fever and mumps. He had bilateral cervical adenitis. Patient failed to respond to IV antibiotics fulfilled the criteria of incomplete Kawasaki disease. The child was managed with high dose aspirin until the child was afebrile for 48 hours. Kawasaki disease is a common vasculitis in children. Atypical cases might be missed if there is concomitant viral illness. Hence the identification and management of Kawasaki disease is paramount to decrease the mortality related to the cardiac disease.</p> Prakash Banjade, Karan Subedi ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 http://www.jnma.com.np/jnma/index.php/jnma/article/view/3482 Fri, 31 Aug 2018 00:00:00 +0000