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.
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.
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?
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.
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.
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.
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).
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.
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.
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.
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.
Kimura’s disease is a rare, benign chronic inflammatory disorder that manifests with abnormal proliferation of vascular endothelium and lymphoid tissues. Ten years back, then 15-year-old Nepali (Asian) male presented to the otorhinolaryngology department with swelling of approximately 5 cm x 6 cm on the left and 6 cm x 7 cm on the right post-auricular region. The patient consulted for cosmetic reasons. Fine-needle aspiration cytology revealed Kimura’s disease. A high index of suspicion is needed to diagnose this disease. Early diagnosis can have proper treatment and treatment of co-existing conditions related to this disease.
Background: Hand grip strength is a simple procedure of assessing the function of hand and forearm. It can be used as a tool to evaluate nutritional status of individual, neurological disorder and to assess the post-operative status of the patient. The grip strength is affected by different variables such as geographical variation, gender, height, weight, body mass index and handedness of the individual. Objective: This study aims to correlate hand grip strength with gender, height, weight, body mass index and handedness among Nepali population. Methods: The study was analytical cross-sectional study conducted in students of Kathmandu University School of Medical Sciences. Convenience sampling was used. The height of the participants was taken by using Stadiometer in centimeter and weight was taken by using weighing machine in kilogram and body mass index was calculated. Hand grip strength was obtained by using Dynamometer measured in kilogram. The data were entered in Microsoft Excel Sheet and analysis was done in SPSS version 16.0. Results: Hand grip strength showed moderate positive correlation with both height and weight both in both dominant and non-dominant hands. Hand grip strength was positively correlated in underweight, normal weight and obese category of body mass index whereas overweight category was negatively correlated. Conclusion: Hand grip strength shows correlation with the gender, height, weight and body mass index.
Background: Coronavirus disease 2019 (COVID-19) pandemic had huge impact on social, psychological, and economic well-being of general community people in Nepal. Objectives: To assess the extent of psychological distress, fear, and level of coping strategies among community members in Nepal. Methods: A nationwide analytical cross-sectional study was conducted among Nepali residents aged >=18 years using an online structured questionnaire during 2020 December to 2021 January. Kessler Psychological Distress Scale (K10), Fear of COVID-19 scale (FCV-19S) and Brief Resilient Coping Scale (BRCS) were used in this study. Univariate and multivariate logistic regression analyses were conducted to adjust for potential confounders. Ethical clearance was obtained from institutional review committee of Kathmandu Medical College. Results: Among 311 respondents, 167 (53.7%) were female. Median age (IQR) 31.3 (13) years with age range 18-69 years. Mean age was 31.4 ± 10.3 years. Being above 30 years old (AOR 3.8, 95% CI 2.13-6.84) were associated with higher levels of psychological distress. Being a female (AOR 0.55, CI 95% 0.30-0.99), moderately improved working situation due to change of employment (AOR 0.39, CI 95% 0.20-0.76), having little perceived distress due to change of employment status (AOR 0.52, 95% CI 0.27-0.97), having positive impact of COVID-19 on financial situation (AOR 0.28, 95% CI 0.13-0.61) were associated with lower levels of fear based on the FCV-19S scale. Conclusions: This study identified individuals who were at higher risk of psychological distress, level of fear, and low coping strategies during COVID-19 pandemic in Nepal. These findings would assist in exploring the strategies to support mental health of vulnerable population during pandemic and post-pandemic periods.
Background: Laparoscopic cholecystectomy (LC) is the gold standard modality for the treatment of gall bladder diseases. Sometimes LC needs to be converted to open due to intraoperative complications. A few factors like age, body weight, comorbidities, ASA score, and surgeons’ experience will warn about the possible complications and need for conversion to open. Prior prediction of the difficulties will warn the surgeon to prepare accordingly. The patient’s family will also be counseled regarding it. Objectives: To identify the possible factors for predicting difficult LC. Methods: This was a descriptive cross-sectional study conducted in the general and laparoscopic surgery department at Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Simple random sampling technique was utilised in this retrospective analysis. Data were taken from 2021 May to 2022 May after institutional ethical clearance. Descriptive statistics were assessed done using SPSS v.26. Results: A total of 230 cases were included and analysed in the study. The incidence of difficult LC was 17.8%. An overall conversion rate of LC to open cholecystectomy in difficult LC was seen in 1.3% of the cases. Intraoperative complications were not seen in 87.8% of the patients. The mean duration of hospital stay in difficult LC cases was five days. Conclusion: Predicting difficult LC will not only warn surgeons to be prepared for the possible difficulties but will also help in counseling patients’ families regarding the intraoperative complications and the possible need for the conversion to open.
Background: The Stroop Colour-Word Test is a widely used neuropsychological test. This test is designed to assess impaired concentration and the struggle to stay focused despite of distractions. There are conflicting data on the gender difference in Stroop test. Objectives: To make a gender comparison of the reaction time by Stroop Colour-Word Test in young healthy medical students. Methods: This was a cross -sectional analytical study conducted at the Department of Physiology, Kathmandu University School of Medical Sciences from 2022 August to 2022 October. Stroop Color Word test was done in healthy medical students with three different cards, a control card (colour word written in black color), congruent card (colour word written in same color as written word) and incongruent card (colour word written in different colour then word written). The number of errors made and reaction time was noted. Paired t-test was applied. Gender comparison was made and independent sample t-test was done. Results: Out of total 130 participants, 68 were females and 62 were males. The number of errors made was 0,0 and 12.8 ± 2 and the reaction time was 38.3 ± 2.3, 37.2 ± 2.8 ,72.5 ± 5.6 seconds for control, congruent and incongruent card respectively which was statistically significant for incongruent card. There was no significant difference between males and females. Conclusion: Reaction time by Stroop Colour-Word Test is longer for incongruent words. There is no gender difference in errors made or reaction time in Stroop Colour-Word Test.
Background: The prevalence of laparoscopic cholecystectomy in Nepal ranges from 2.44% to 6.45%. The prevalence of gallstones increases with age. Age is considered to be one of the major risk factors in determining the results of morbidity and mortality during laparoscopic cholecystectomy. Laparoscopic cholecystectomy is the gold standard modality for the management of gallstones. Objectives: The aim of this study was to determine the clinical outcome of laparoscopic cholecystectomy in the elderly. Methods: This was a descriptive cross-sectional observational study done after ethical clearance. Retrospective data were included of all the patients’ aged ?60 years who underwent laparoscopic cholecystectomy at Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal from 2021 July to 2022 June using convenience sampling. Data were entered in Microsoft Excel Sheet and descriptive findings are presented. Results: A total of 1688 laparoscopic cholecystectomies were performed during the study duration. Consecutively, 250 elderly patients who underwent were included in the study. The mean age of the elderly was 67.88 years. The incidence of the elderly at the institute was 26.7% (452/1688). In the present study, 95 (38%) elderly patients had some kind of comorbidities. Isolated intraoperative complications were seen in 26 (10.4%) patients. Post-operative complications were seen in 53 (21.2%) patients. The need to convert laparoscopic cholecystectomy to open cholecystectomy was observed in 3 (1.2%). Conclusion: For the elderly, laparoscopic cholecystectomy is a safe and reliable modality. They benefit from this mode of treatment without increasing the risk of surgery.
Background: Irrational practice of medicines use is a serious problem of health care setting. Objectives: The primary aim of this study was to assess rational use of drug (RUD) at a government hospital of central Nepal using World Health Organisation (WHO) core drug use indicators. Methods: This descriptive, cross-sectional study was conducted from 2022 November to December at Hetauda Hospital after ethical clearance. A total of 500 prescriptions were taken retrospectively by using systematic sampling method for prescribing indicators whereas 100 patient interviews were conducted prospectively to study patient care indicators. For facility-based indicators different departments of the selected hospital were visited to collect the data. Results: The mean values of prescribing indicators of RUD in the surveyed hospital compared with WHO values for prescription of generics, antibiotics, and injections was found to be 6.3% (n = 119) vs.100%; 28.4% (n = 142) vs. 20-26.8%; and 1.2% (n = 6) vs. 13.4-21.1% respectively. Another discrepancy reported was regarding the mean number of drugs per prescription which was found to be more than the WHO optimal value (3.77 vs. 1.6-1.8). The average consultation time and dispensing time was found to be 5.52 ± 4.49 minutes vs. 10 minutes and 111 ± 60.2 seconds vs. more than 180 seconds, respectively as compared with WHO value. Conclusion: According to the WHO/RUD core drug use indicators, rational medicine use is not attained in most prescribing and patient care components. It is recommended that health institutions should co-operate to promote the judicious use of medications.
Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and imparts substantial economic burden on individuals and health systems. Anxiety and depression were almost three times more common in COPD patients compared to the participants from the general population. Objectives: To assess the psychological status and coping measures of individuals living with chronic obstructive pulmonary diseases. Methods: Analytical cross-sectional research was conducted in medical outpatient department of Kathmandu Medical College Teaching Hospital from 2019 Nov 20 to 2020 May 20 after institutional ethical clearance. Total 185 individuals diagnosed with chronic obstructive pulmonary disease seeking medical care were included in the study by using purposive sampling. Data collection was done through face-to-face interview technique using Hopkins Symptoms Checklist-10 and Brief Cope inventory. The collected data were analysed using SPSS software version 20. Results: Based on a cut-off value of ?1.85 of Hopkins symptoms checklist-10, almost all (180, 97.3%) patients had mental distress. Frequently used approach coping subscales by the patients were emotional support (82, 44.2%), religion (81, 42%), planning (80, 41.8%), and active coping (80, 41.7%). Similarly, mostly used avoidance coping were: denial (80, 41.8%), venting (79, 41.1%), and self-blame (78, 40.6%). Conclusion: Almost all patients living with chronic obstructive pulmonary diseases had predicted mental distress and they were using both approach and avoidance coping measures.
Background: Ferric citrate is novel iron-based phosphate-binding drug for management of hyperphosphataemia and iron-deficiency anaemia in chronic kidney disease (CKD) patients. Objectives: To evaluate impact of ferric citrate therapy on reduction of phosphate levels and improvement in haematological parameters in CKD stages 3-5. Methods: This analytical, observational study was conducted at Kathmandu Medical College Teaching Hospital from 2020 July-December after ethical clearance using convenience sampling method. Non-dialysis dependent patients at CKD stages 3-5, having hyperphosphataemia (serum phosphate >=4.6mg/dL) and anaemia (serum haemoglobin <12 gm%, transferrin saturation <=30%, ferritin <=300ng/mL) were administered with 2gm twice daily dose of ferric citrate for 12 weeks and evaluated on outcomes in terms of reduction in serum phosphate levels and improvement in haematological parameters as study endpoints. Data were entered in Microsoft Excel and analysed in SPSS v.25. Significance level was set at p <0.05. Results: Of 84 study participants, majority had CKD stage 4 (46, 54.76%). A significant reduction (p <0.001) in mean serum phosphate levels of 6.21 ± 1.062 mg/dL from baseline to 4.89 ± 1.100 mg/dL in 12-weeks was observed. Patients with CKD stages 3, 4, and 5 had mean reduction of 1.67 (p = 0.005), 1.40 (p <0.001), and 1.04 mg/dL (p = 0.002) of serum Phosphate level respectively. Significant (p <0.001) improvements in hemoglobin level, serum iron, ferritin, total iron binding capacity, and transferrin saturation were reported. Conclusion: Ferric citrate is effective and well-tolerated phosphate-binder to improve hyperphosphataemia and iron deficiency anaemia in non-dialysis CKD stage 3, 4, and 5.
