B. P. Koirala Institute Of Health Sciences Research Articles

A Comparative Study Between Patients with Community Acquired Acute Kidney Injury and Hospital Acquired Acute Kidney Injury from A Tertiary Care Hospital In Eastern Nepal

BACKGROUND Acute kidney injury is increasingly prevalent in both low and high income countries and is associated with increased morbidity and mortality. This study aims to compare the outcomes of community acquired AKI (CA-AKI) and hospital acquired AKI (HA-AKI) among patients admitted to the department of internal medicine, B.P.Koirala Institute Of Health Sciences (BPKIHS), Dharan. METHODS The study was a hospital based prospective, observational study conducted in internal medicine ward of a tertiary care hospital. The study duration was one year, from November 2019 to October 2020. A total of 100 patients were enrolled out of which 50 were patients with CA-AKI and 50 were patients with HA-AKI. Demographic and serum creatinine at baseline, on the day of discharge or 7th day and after 3 months were collected using pre-designed questionnaire and recorded in a structured porforma. Patients were followed up at 3months after discharge to evaluate treatment outcome as recovery from AKI, chronic kidney disease (CKD), requirement for Renal Replacement Therapy and mortality in both groups. RESULTS The mean age was 51.93±20.55 years with HA-AKI patients older than CA-AKI. Common co-morbidities were systemic hypertension(24% in CA-AKI and 34% in HA-AKI) followed by Diabetes mellitus(16% in CA-AKI and 28 in HA-AKI), CLD(6% in CA-AKI and 2% in HA-AKI), heart failure(6%in CA-AKI and 10% in HA-AKI).The mortality at 3 months was 20.00% in HA-AKI and 8.89% in CA-AKI. CKD was 8.88% in HA-AKI and 24.44% in CA-AKI. The need for hemodialysis was higher in CA-AKI patients than HA-AKI patients (14% vs. 2%; p=0.05). Most common cause of AKI in both the groups was infection. HA-AKI patients were found to have higher length of hospital stay than CA-AKI (8.5±6.8 days vs. 7.30±3.60 days; p=0.28) . CONCLUSIONS Patients with CA-AKI seem to have a higher requirement for renal replacement therapy. Mortality or incidence of CKD was similar in both the groups at 3 months. HA-AKI patients were found to have higher length of hospital stay than CA-AKI.

Effectiveness of Using Video Clip on Reduction of Anxiety During Venipuncture among Children in a Selected Hospital of Eastern Nepal

Introduction: Venipuncture can produce extreme anxiety to children who undergo it. Video clip as distraction is a simple technique which does not require any specific training and can be implemented by nurses, parents or other health staff members in any settings. Besides, it has a minimal cost and implies no risks for the children. This study aimed to assess the anxiety of children during venipuncture and determine the effectiveness of video clip in reducing anxiety. Methods: A posttest only experimental research was conducted in BP Koirala Institute of Health Sciences (BPKIHS), Dharan Nepal including 50 school age children undergone venipuncture. Random sampling technique was applied to recruit respondents. Respondents were randomly assigned either to the experimental or control group with 25 in each. The Experimental group were shown video clip 3 minutes prior to the venipuncture till 3 minutes after completion of venipuncture while Control group had gone a routine venipuncture procedure only during venipuncture. Pearson’s chi square test and Fisher’s exact test was used for the analysis of anxiety response of both group. Results: Showing video clips was effective in reducing venipuncture in children (p=0.001). Among the participants, 72% had high anxiety in control group while it was 24% in experimental group. In a same way 76% had low anxiety in the experiment group while it was 28% among control group. There is a significant difference in the anxiety level between the study and control group (p=0.001). Conclusion: This study suggests that video clip is safe and cost effective method in reduction of anxiety in children undergoing venipuncture.

A Visualization Towards Oral Histology and Pathology Practical Classes - Existing Scenario and Imminent Trends

Introduction: Detailed knowledge is necessary in order to use dental anatomy, histology, and pathology in academic and clinical settings. Despite a competent, uniform academic curriculum and a passable infrastructure, there is still a disconnect between student comprehension and teacher preparation. Objective: To evaluate the difficulties dental students have learning the subject. Methodology: A cross-sectional survey was conducted among Students at College of Dental Surgery, In B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. A semi-structured questionnaire was used to collect the socio-demographic data and to understand students’ interest in oral histology and oral pathology, to understand the difficulties encountered in slide identification and operating the microscope. Results: Out of 178 students, 161 participated in the study giving a response rate of 90.44%. Overall result shows a maximum positive response suggesting most of the students regularly attend classes and finish their assigned tasks. Here data suggests a mixed response, with some students having difficulty in slide identification and remembering the features although the students are quite comfortable with the use of microscopes. Conclusion: Understanding the slide and using the microscope effectively are a few of the difficulties that students encounter in oral biology and oral pathology. To improve student comprehension and proficiency in these areas, targeted interventions are necessary, as this study highlights these challenges.

Family caregiver experience of caring COVID-19 patients admitted in COVID-19 hospital of a tertiary care hospital in Nepal.

Informal caregivers played a significant role in caring for COVID-19 patients during hospitalization in Nepal. This study aimed to understand the experiences of family caregivers attending to their relatives in a COVID-19 hospital in Nepal. A descriptive phenomenological approach was adopted to understand the caregiver's experience in supporting their relatives admitted to the COVID-19 hospital of the BP Koirala Institute of Health Sciences (BPKIHS). Thirteen caregivers of COVID-19 positive patients were purposively selected from April to June, 2022. Face-to-face interviews were conducted at a caregiver residential facility using the interview schedule developed by the department for the purpose of data collection after obtaining ethical clearance from the Institutional review committee of BPKIHS. Data were audio recorded and manually analyzed. Among the 13 caregivers, six were male and seven were female. The findings were categorized into five domains: challenges encountered, changes in physical and mental health, changes in roles and responsibilities, positive experiences, and strategies to ease caregiving tasks. Major challenges included financial burdens, communication problems, stigmatization, Insecurity, substandard accommodation, and visitor restrictions. Caregivers reported negative emotions, unmet physical health needs, and shifts in family and occupational roles. Despite these challenges, caregivers attempted to cope positively and acknowledged the efforts of healthcare personnel and other family members. Suggestions for improving caregiving included providing essential medical and basic services within the hospital, enhancing accommodation facilities, establishing proper communication channels, and allowing visitations. Caregivers of COVID-19 patients face significant challenges during the caregiving process. Enhancing hospital services, promoting effective communication, fostering positive attitudes, and ensuring a safe environment can facilitate caregiving tasks.

Ethical Challenges Faced by the Healthcare Workers to Provide Health Service during COVID-19 Pandemic

Background: Managerial, administrative, and disease-related issues during COVID-19 pressurized the healthcare workers and challenged their ethical practice. This study attempted to shed light on the ethical challenges faced by the healthcare workers during the COVID-19 pandemic at B. P. Koirala Institute of Health Sciences (BPKIHS). Methods: Descriptive cross-sectional study using convenience sampling was conducted among 108 registered doctors and nurses working in BPKIHS. Data were collected using pretested, self-designed semi-structured online questionnaires and analyzed using descriptive statistics. Results: Majority (78.7%) of the respondents feared of contracting the disease while caring for the patient. Nearly 30% respondents reported that they had to frequently work with inadequate protective measures. Fifty-four percent respondents reported that sometimes they had to continue work with suspected symptoms due to shortage of manpower. Almost half (49.1%) of the respondents had to sometimes prioritize the care among the patients due to shortage of resources. Most (72%) of the respondents never had to force COVID positive patient for hospital admission. Around 20% of the respondents had to disclose COVID status of patients without consent. Around 14% of the respondents had sometimes refused care of COVID positive patients. More than half (55.6%) of the respondents had sometimes felt that the patients did not receive holistic care. Conclusion: The major ethically challenging situations faced by healthcare workers during the COVID pandemic included continuous work with suspected symptoms due to shortage of manpower, continuing work with inadequate protective measures, and prioritizing care due to shortage of resources.

Knowledge and attitude regarding the COVID-19 pandemic among undergraduate health science students of Nepal: An online survey.

This study aims to assess health science students' knowledge and attitude about COVID-19 epidemiology, management, and prevention; and the association of knowledge and attitude with various sociodemographic characteristics. An online survey was done among 524 undergraduate health science students using a pre-tested questionnaire across 19 health science institutions in Nepal from 30 June to 11 August 2021. All subjects were enrolled in the study after informed consent. Outcomes were Knowledge level, attitude level, and predictors of knowledge level and attitude level. Bivariate analysis was done to determine the association between variables. Of 524 students, 42.9% were male, and 57.1% were female. More than half (54.6%) and the majority (85.1%) participants had good knowledge and attitude, respectively. Approximately three-fifths (59.4%) of the participants were from the B. P. Koirala Institute of Health Sciences (BPKIHS). Students in BPKIHS (odds ratio = 1.774; 95% confidence interval = 1.243-2.533), junior years (odds ratio = 8.892; 95% confidence interval = 5.814-13.599), age less than 23 years (odds ratio = 2.985; 95% confidence interval = 2.089-4.266) were more likely to have good knowledge. Students under 23 years (odds ratio = 24.160; 95% confidence interval: 9.570-60.992) and those in junior years (odds ratio = 4.460; 95% confidence interval = 3.753-5.300) were likely to have a good attitude level. Students in BPKIHS (odds ratio = 0.443; 95% confidence interval = 0.272-0.722) were less likely to have a good attitude. Overall, health science students had adequate knowledge and a good attitude regarding COVID-19. However, students lacked knowledge regarding infectiousness, transmission, post-vaccination observation period, remdesivir use, convalescent plasma therapy, and awake-prone positioning. Knowledge and attitude scores were associated with age, stream, and study institution.

Analysis of Poor Perinatal Outcome During COVID-19 Pandemic Lockdown: A Cross Sectional Study

Fear of hospitalization in addition to uncertainties about appropriate treatment at the beginning of COVID -19 pandemic may have affected the health and outcome of pregnant women. Lack of transportation closed out -patient services, and lack of employment has directly linked to poor maternal and perinatal outcomes during nationwide lockdown. This study was aimed to find out the poor perinatal outcome during the first COVID-19 pandemic lockdown at BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. This was a descriptive cross-sectional study conducted in BPKIHS from 24th March 2020 to 23rd July 2020 during the first COVID- 19 lockdown for the duration of 4 months. The data were collected between 1st February to 15th February 2021 from the hospital records. Convenience sampling was done. Data analysis was done by SPSS version 24. Poor perinatal outcomes: perinatal death, preterm delivery, intrauterine growth restriction, newborn admission, and different reasons for admission were analyzed using descriptive statistics. There were a total of 2685 obstetric admissions and 2442 deliveries during the study period of 4 months. Mean age and gestational age of women with poor perinatal outcome were 27.16 ± 6.02 years and 36.38± 4.54 weeks respectively. The perinatal death rate was 26.2 per 1000 births. 128 newborns required neonatal admission and prematurity was the most common cause. The prevalence of poor perinatal outcome was like other studies done in similar settings. However, larger, comparative studies are needed to identify a definite association of COVID 19 pandemic lockdown with poor perinatal outcomes.

Awareness of cross-infection and its control measures among patients attending a tertiary dental hospital in Nepal

Introduction: Dental procedures frequently lead to exposure to blood and saliva which can carry a variety of pathogens. Aerosols produced during dental treatment procedures can further facilitate the transmission of these infectious agents. It is equally important for the patients to be aware of cross-infection and measures taken to prevent it in a dental setting.
 Objectives: The main objective of this study was to assess the awareness of cross-infection and its control measures among patients attending College of Dental Surgery, B.P. Koirala Institute of Health Sciences (BPKIHS).
 Methodology: A cross-sectional study was carried out among 362 patients who attended College of Dental Surgery, BPKIHS. Data was collected by administering a questionnaire that consisted of 4 questions intended to collect sociodemographic information and 10 close-ended questions designed to assess awareness of cross-infection and its control measures. The data was entered and analyzed using SPSS® software for Windows®.
 Results: The majority of the participants were aware that there was a chance for an infection to be transmitted from a dentist to a patient (82%), from a patient to a dentist (80.4%), and in between patients attending the same dental clinic (70%). Most of the participants considered wearing gloves (94.4%) and facemask (86%) by the dentist to be important. Only 40.3% of participants were aware of better methods of sterilization other than boiling in water. Awareness was higher among participants with higher education (p<0.05).
 Conclusion: The majority of the participants were aware that there was a chance for an infection to be transmitted from a dentist to a patient. However, the dental healthcare professionals should educate people about the possible risks of cross-infection and the importance of infection-control practices in dental clinics. Modern mass media and social media can be used to spread awareness to a large segment of the population.

COVID-19, Knowledge, Attitude and Practice among Students in a Tertiary Care Center, Nepal

Background: Health care professionals are thought to be knowledgeable about contemporary happenings in health around the world. We aimed to assess knowledge, attitude, and practice (KAP) regarding coronavirus disease 2019 (COVID-19) and compare it among dental and medical students of a University hospital, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. Methods: A cross-sectional study was conducted among dental and medical students of BPKIHS. A google form was designed using standardized validated 25 item questionnaire pertaining to knowledge, attitude and practice regarding COVID-19. Following ethical approval, the questionnaire was sent through email to all dental and medical students, reminder mail was sent for three times and the response was collected. The data was analyzed for frequency and percentage. Chi-square was imputed for proportion differences between streams. Results: Out of all 602 students of BPKIHS, one did not give consent and only 240 (BDS 116; MBBS 124) (39.93%) agreed and responded. Overall, 72.1% of correct responses were obtained from all the students on knowledge regarding COVID-19. Moreover, the correct response for each question was similar between BDS and MBBS students, (p > 0.05). Most of the students (87.91%) reflected a positive attitude and 91.83% abided by safe practices during this pandemic. Conclusion: Although only 72.1% of the responses on knowledge related questions were correct, the majority showed positive attitude and practiced to minimize the spread of COVID-19 infection. Moreover, dental and medical students had a similar level of knowledge regarding COVID-19.

Nerve Conduction and Surface Electromyography of Physically Active Healthy Medical Undergraduates of Nepal

Introduction: Physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure. Nerve conduction studies and surface EMG provides a comprehensive evaluation of nerve, muscle or neuromuscular impairment. However, such studies are mostly done on professional athletes. Methods: Healthy physically active (n=17) and non-active (n=17) medical undergraduate students from B.P. Koirala Institute of Health Sciences (BPKIHS), Nepal were enrolled in the study using convenient sampling technique. Anthropometric and motor nerve conduction parameters of common peroneal nerves and surface EMG of gastrocnemius muscle were recorded using standard technique in Neurophysiology Lab II, BPKIHS. Descriptive analysis was done. Unpaired t-test was applied for comparing the nerve conduction and surface EMG variables between the groups. Pearson’s correlation was applied between anthropometric and nerve conduction & surface EMG variables. Objectives: To compare nerve conduction parameters of common peroneal nerve and surface EMG of Gastrocnemius muscle between active and non-active individuals. Results: The distal and proximal amplitudes of left common peroneal nerve were significantly higher in physically active compared to non-active individuals (LCPDA-p value: 0.026, LCPPA-p value: 0.009). Anthropometric parameters showed significant correlation with nerve conduction parameters. Conclusion: Nerve conduction parameters are affected in the physically active individuals. Anthropometric variables showed significant relation with the nerve conduction parameters. Keywords: Nerve Conduction Velocity, Surface Electromyography, Peroneal Nerve, Gastrocnemius.

Knowledge and Attitude Regarding Infection Control among Undergraduate Dental Students at a Tertiary Care Hospital

Introduction: In academic institutes, dental students are not only involved in academic activities, but also in the management of patient care. This calls for inculcation of adequate knowledge and positive attitude among them so that a good clinical practice is implemented in the dental setting. Objective: To assess knowledge and attitude regarding infection control among undergraduate dental students of B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal. Methods: An online analytical cross-sectional study was conducted at BPKIHS from 2021 February to 2021 April among undergraduate students from third year, fourth year, and internship by using a self-administered questionnaire via Google Forms. Census method was used. Descriptive and inferential statistics were used to analyse the data. Results: A total of 136 undergraduate dental students participated out of which 107 (78.70%) were found to have adequate knowledge while 101 (74.30%) participants showed ‘positive’ attitude. Mean age of the participants with adequate knowledge was significantly higher than participants with inadequate knowledge (P=0.047). The difference in knowledge among participants was statistically significant (P=0.001) in academic years. Adequate knowledge was shown by 47 (90.4%) interns followed by 36 (83.7%) fourth year and 24 (58.7%) third year students. The difference in attitude was also statistically significant (P=0.011) across the academic years. Positive attitude was shown by 39 (90.4%) fourth year students followed by 28 (68.3%) third year students and 34 (65.4 %) interns. Conclusions: The present study reports adequate knowledge and positive attitude regarding infection control among undergraduate dental students in BPKIHS.

Mental and Behavioral Problems in Medical Students of a Health Science Institute in Eastern Nepal

Introduction: Literature shows a high prevalence of mental disorders among medical students. Psychiatric morbidity data help enhance all levels of management. We have limited data about 'mental and behavioural problems' in medical students.
 Objective: To see and sort out psychiatric problems among medical students of BP Koirala Institute of Health Sciences (BPKIHS), Nepal.
 Methodology: It is an institute based prevalence study. Twenty percentages of all medical students of all programs (1125) of academic year of 2008/9 were (systematic) randomly selected. After informed written consent, the subjects were enrolled. A semi-structured proforma was used to record socio-demographic and clinical profiles. The 'Structured clinical interview for DSM-IV Axis I disorders' (SCID-I) was used to diagnose major psychiatric disorders.
 Result: Out of the total sample students, 219 students were enrolled. Among the enrolled subjects, life time diagnosis of psychiatric problem (till the time of the study) was about 55%. At the time of the study, approximately 30% had psychiatric problem. During BPKIHS stay inclusive of current problem, slightly more than 40% had mental problems. The most common diagnosis was adjustment disorder.
 Conclusion: A great proportion of medical students suffer from mental and behavioural problems.

Perspective towards End-of-Life Care among Nurses Working in BPKIHS: A Cross-Sectional Study

Background: End-of-life care (EOLC) is the term used to describe the support and medical care given to dying patients and their families during the time surrounding death. It has a direct impact on the attitude of nurses towards the care of dying. We aimed to assess the perspective towards end-of-life care and its association with different socio-demographic variables among the nurses working in B.P. Koirala Institute of Health Sciences (BPKIHS).
 Methods: This cross-sectional study was carried out among 136 nurses working in the selected settings of BPKIHS. Simple random sampling was used to select staff nurses and purposive sampling to select senior staff nurses and senior Auxiliary Nurse Midwifes. Frommelt Attitude towards Care of the Dying (FATCOD-B) scale was used to assess the nurses' perspective towards care of dying. Data were analyzed using SPSS version 17.0. Descriptive statistics were used for describing sample characteristics. The Chi-square test was used to show the association between level of attitude and socio-demographic variables.
 Results: Almost two-third (64%) of the nurses had a fair attitude, 36% had a good attitude. The socio-demographic characteristics i.e.; marital status, ward/unit, level of education, designation, total duration of work, experience of caring for dying, and training on end-of-life care were significantly associated with the nurses' attitude towards care of dying.
 Conclusion: Overall, nurses had a fair attitude towards the care of dying; none had a poor attitude.

Biochemical Parameters in Confirmed Covid-19 Patients: A Hospital Based Study from Eastern Nepal

Background COVID-19 has posed a global threat to almost every part of the world. The disease has varied form of presentation and the modern medicine has still not been able to provide definite treatment for the disease.
 Objective To assess the biochemical parameters in confirmed patients of COVID-19 admitted at B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.
 Method This is a retrospective hospital based cross-sectional study conducted in the Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan from October to December, 2020. Convenient sampling technique was used to enroll the data of the patients for whom the biochemical parameters were requested by the clinicians. Routine biochemical tests were performed in Cobas c311 autoanalyzer.
 Result A total of 202 patients with confirmed COVID-19 infections and admitted at COVID Hospital, BPKIHS were enrolled. The findings depict an elevated liver enzyme (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma glutamyl transpeptidase and cardiac enzymes (creatine kinase-total and creatine kinase- MB) in the study population. Increased serum ferritin (1026.08±220.53), hs CRP (41.52±5.22) and lactate dehydrogenase 360 [303.50-526.75] was found in the patients. Also, majority of the patients (> 50%) had abnormal biochemical findings.
 Conclusion Biomarkers like C-reactive protein, lactate dehydrogenase and ferritin have shown significant clinical implications in effective management, monitoring, and assessment of the severity of disease in COVID- 19 patients. Simple and cost-effective markers like CRP, LDH, HbA1c could be used for monitoring the severity of COVID-19 infection.

Presentations and Psychiatric Diagnosis in A Psychiatric Out-Patient Clinic of Tertiary Care Hospital in Eastern Nepal

INTRODUCTION This study aimed to see common presenting complaints and psychiatric diagnoses among the patients visiting for the first time to the Psychiatric Out-patient Department (OPD) of a tertiary care hospital in Eastern Nepal. METHODOLOGY A cross-sectional study was conducted in the OPD of B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal during the study period of 3 weeks after the institute ethical approval. Patients were selected via convenience sampling technique. Face to face interview was conducted to collect socio-demographic data and the presenting complains (up to 5) according to the patients and their attendants. Psychiatric diagnoses were recorded as per the clinician. RESULT Among the first contact psychiatry out-patients; various physical/ somatic, anxiety and mood related symptoms were the commonest presenting complaints, as per the patients, attendants and clinicians. Behavioural symptoms were others mostly observed and reported. The commonest diagnoses were: Depression, Recurrent Depressive Disorder, Dysthymia (18.6%); Phobia, Other Anxiety and Obsessive Compulsive Disorder (17.9%); Schizophrenia, schizotypal and delusional disorders (13.8%) and Mental and Behavioural disorders due to Substance use (8.3%). Deliberate self harm and seizures were present in 7% each. CONCLUSION The commonest presenting complaint in psychiatry outpatient clinic was related to physical and somatic symptoms, followed by anxiety and mood related ones. Common diagnoses were Depression, Anxiety, Schizophrenia and Substance use/ related disorders.

Feasibility of learning dermatology among undergraduates through online means: the impact of COVID-19

Background: The outbreak of the deadly disease COVID-19 has shaken the entire world. The pandemic has resulted in a global lockdown affecting all areas of life, including medical education. This has impeded the traditional way of teaching and learning activities and forced educational institutions such as medical universities to shift rapidly to distance and online learning. Aims and Objectives: The aim was to find out the impact of COVID-19 and the perception of undergraduate students of B.P. Koirala Institute of Health Sciences (BPKIHS) of learning dermatology through online means. Methods: A cross-sectional study was conducted with a self-administered online questionnaire. The inclusion criteria were all MBBS third and fourth years students of BPKIHS willing to participate in the study. Result: A total of 151 participants agreed to complete the online survey questionnaire. The overall attitude toward online education was positive. The majority of students agreed that online learning material should be of high quality for online education (66.2%) and that online learning will bring new opportunities for organizing teaching and learning (62.3%). Zoom and Dudal were the most common online tools used by students. The geographic location, lack of past experience in using online tools, and communication barriers such as a poor Internet connection and frequent electricity cutoffs were identified by students as the main barriers to online education. Conclusion: Although the COVID-19 pandemic culminated in the lockdown of medical universities, it provided opportunities for bringing innovations into effect. Such large-scale studies are missing in developing countries such as Nepal, thus further research is needed to explore these possibilities nationwide.

Effectiveness of oral health education intervention among 12\u201315-year-old school children in Dharan, Nepal: a randomized controlled trial

BackgroundSchool-aged adolescents are in particular need of preventive program to ensure positive long-term oral health and hygiene. The objective of this study was to assess the effectiveness of an oral health education (OHE) intervention on oral hygiene knowledge, attitude and practices (KAP), plaque control and gingival health among 12–15 years old school children in Dharan sub-metropolitan city, Nepal.MethodsA randomized controlled trial was conducted with parallel study groups, comprising 12–15-year-old school children, 120 in each group. OHE was given to the experimental group at baseline, third and sixth months and to the control group after completion of the study. Interview of the participants were done using a 23-item questionnaire for assessment of oral hygiene KAP. For each question, correct answer was scored as 1 and wrong answer was scored zero. An overall composite score was then created, by adding the individual scores. Oral examination was done using mouth mirror and WHO probe to record Turesky–Gilmore–Glickman modification of the Quigley-Hein plaque index, Gingival index and Dentition status and treatment needs. Analysis was done using chi-square test for categorical data and independent t test, Mann–Whitney U test, repeated measures ANOVA and post hoc Tukey’s test for quantitative data. The level of significance was set at P < 0.05.ResultsThere was 54.58% improvement in overall oral hygiene KAP in experimental group (P = 0.001) whereas no improvement was seen in control group at the end of the study. The mean plaque score was improved by 57.67% (P = 0.001) in experimental group in comparison to 4.56% in control group. Gingival index was improved by 49.90% (P = 0.001) in experimental group in comparison to 0.7% in control group. Caries experience was increased in both groups but no significant difference was seen.ConclusionsThe study concluded that oral health education was effective in improving oral hygiene KAP, plaque control and gingival health.Trial registration The trial was retrospectively registered with Clinical Trial Registry India (CTRI) with identifier no. CTRI/2018/05/013985, registered on 05/21/2018. (http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=23651&EncHid=&modid=&compid=%27,%2723651det%27). Institutional Review Committee, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal provided the ethical approval (Ref. No.: 292/074/075-IRC).

A study on laparoscopic appendectomy at emergency theatre in B. P. Koirala Institute of Health Sciences

Background: Laparoscopic appendectomy is gaining its popularity as it has better patient compliance. Despite of not being “gold standard”, laparoscopic appendectomy is widely practiced in emergency setting and has become patient’s as well as surgeon’s choice of treatment. Our aim is to acknowledge the advantage and importance of laparoscopic appendectomy at emergency in a retrospective study. Our main objective was to study the efficacy of laparoscopic appendectomy, patients’ demographic profile as well as conversion rate of laparoscopic appendectomy to open appendectomy.Methods: This hospital based retrospective study was carried among 54 patients who had undergone emergency laparoscopic appendectomy at B. P. Koirala Institute of Health Sciences (BPKIHS) between March and April, 2016. The patient’s file was collected from medical record section, studied and analyzed.Results: During the study, it was observed that most of the patients were female (62.97%) and the patients were mostly between 20 to 40 years of age (Mean age 27 years±10.88 SD). Most of the patients presented within 24 hours of onset of symptoms, most commonly with pain in lower abdomen associated mostly with vomiting. Out of 54 patients, 48 patients (88.89%) were diagnosed with acute appendicitis. Frankly speaking, laparoscopic appendectomy was associated with shorter hospital stay (around 3 days) and also has less conversion rate (11.11%). There were minimal post-operative complications without any case of redo and mortality.Conclusions: Laparoscopic appendectomy is safe and efficient procedure with shorter hospital stay and less post-operative complication.

EFFECT OF THREE MINUTE STEP TEST ON COGNITION AMONG MEDICAL STUDENTS

Background: Regular physical exercise is linked to produce beneficial influence on cognitive functions. Cognition can be evaluated by Stroop test where a person's selective attention capacity, skills and processing speed are assessed. Limited work has been done to explore the acute effect of exercise on cognition. Objective: To assess whether acute exposure to submaximal aerobic exercise of three minutes can bring changes in the cognitive function (selective attention and cognitive processing ability). The secondary objective was to assess the physical fitness index of medical students. Methods: Twenty four apparently healthy third year male medical students of BPKIHS (B. P. Koirala Institute of Health Sciences) having mean age of 22.33 ± 1.09 years, body height and weight of 170.10 ± 5.85 cm of 65.38 ± 8.84 kg respectively were recruited. A computer based online version of Stroop Test was done to identify cognitive performance in resting sitting position. Then participants were asked to perform 3 min step test. A recovery time of 5 min was given post exercise and Stroop Test was assessed again. Statistical analysis was done using Paired T test. Data are expressed in mean and SD. Level of significance is considered at p&lt;0.05. Results: The reaction time to Stroop Test was significantly reduced after acute physical exercise (before exercise (43.37 ± 7.7s) vs after exercise (36.14 ± 3.6s), p = 0.001). However, no significant difference in the number of correct response to Stroop Test before (19.71 ± 1.08) and after (19.79 ± 0.51) the acute exercise (p=0.575) was observed. Conclusion: Acute bout of aerobic physical exercise improves attention and execution aspects of cognitive function as measured by Stroop Test in young medical students.

AWARENESS OF RISK FACTORS OF CARDIOVASCULAR DISEASE AMONG PATIENTS WITH DIABETES MELLITUS ATTENDING DIABETIC CLINIC OF BP KOIRALA INSTITUTE OF HEALTH SCIENCES

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Aware­ness of risk factors of CVD is the first step towards effective preventive strategies to combat the CVD burden in diabetes patients. This study aimed to assess the awareness of risk factors of CVD among patients with diabetes mellitus attending diabetic clinic of B.P Koirala Institute of Health Sciences (BPKIHS). Methods: A cross- sectional study was conducted among 112 patients with diabetes in diabetic clinic of BPKIHS. Convenient sampling was used for data collection over duration of six weeks using interview schedule by HDFQ II tool. The data were analyzed in the statistical package for social sci­ence software (SPSS) 16 versions and analyzed using descriptive and inferential statistics. Results: Majority of respondent were aware about common risk factors such as (83.9%) smoking, (78.6%) physical activity, (75%) increasing age, (75.9%) high blood pressure, (71.4%) overweight respectively. Whereas most of the respondents were not aware about high cholesterol, fatty diet, preventive strategies and association of diabetes with CVD. Awareness was statistically significant with educational status, monthly income, residence, CVD information received and co-morbid condition as a heart disease. Conclusions: Based on finding most of the respondents were aware about common risk factor even though they have inadequate level of awareness on overall risk factors of CVD among the risk factor they were poorly aware about cholesterol, gender and preventive aspect. So Effective education on diet and appropriate preventive strategies of CVD are indeed important to reduce CVD burden in diabetes patients.