Birat Medical College Teaching Hospital Research Articles

Knowledge on First Aid Management of Epistaxis among Medical Students of a Medical College: A Descriptive Cross-sectional Study

Introduction: Epistaxis, a global Otorhinolaryngology emergency, often requires hospital admission, posing health concerns for all ages. Evaluating medical students' knowledge helps identify strengths and areas for improvement, ensuring future healthcare providers are well-prepared. Our study aimed to assess knowledge on first add management of epistaxis among medical students of a medical college. Methods: This descriptive cross sectional study was conducted among medical students in Birat Medical College Teaching Hospital after ethical approval was obtained. Data was collected electronically using google form from 109 medical students from 15 January 2024 to 15 March 2024. Results: The mean age of students was 20.71±1.44 years. The mean knowledge score of first aid management of epistaxis was 11.33± 5.24. Out of all students, 68 (62.38%) students had above-average knowledge on first aid management of epistaxis. Conclusions: The study emphasizes the varied knowledge levels among first and second-semester medical students regarding epistaxis. While more than half demonstrated above-average understanding, targeted educational interventions are warranted.

A study of nutraceutical prescription pattern among patients in an out-patient setting at Birat medical college teaching Hospital

The demand for nutraceutical has been increasingly rapidly which can be due to increasing awareness regarding health benefit of nutraceutical product. This study aims to understand the prescription pattern and find out knowledge, attitude of patients regarding nutraceutical product. A cross-sectional study was conducted at Birat Medical College Teaching Hospital, Budiganga, Nepal to assess the demographic characteristic as well as level of knowledge and attitude towards nutraceutical product and further total cost patients spent on nutraceutical alone was also assessed. Pearson Chi-square test (x2) was used to investigate the association between demographic variables and patients’ knowledge and attitude towards nutraceuticals. One-way ANOVA was performed to compare the cost of nutraceutical among the different outpatient departments. Nearly half of the patients (49.25%) had inadequate knowledge whereas more than half of the patients (67.75%) had moderate positive attitude. The mostly prescribed nutraceuticals were minerals (45%) followed by multivitamins (23%). More than two-third patient believed nutraceutical can be used when person feel tired and rundown. The average amount that a patient spent on nutraceutical product was found out to be NPR. 746.88 per prescription. No significant association was found in the cost of nutraceutical among the various Out Patient Department (OPD) wise. (P=0.281, P>0.05). Moderate positive attitude and inadequate knowledge regarding nutraceutical product among the patient's addresses the need to develop regulation, educational strategy regarding nutraceutical use and further increase general public awareness on rational use of these products.

Comparison of outcomes in buried versus exposed Kirschner wire for treatment of paediatric supracondylar humerus fracture

Introduction: The treatment options for paediatric supracondylar distal humerus fractures include close reduction and above elbow slab application, close reduction and percutaneous K-wire fixation, and open reduction and internal fixation using K-wire. For displaced supracondylar fracture closed reduction and percutaneous K-wire fixation, under C-arm guidance, is the current gold standard treatment option. Leaving the K-wire exposed or buried under the skin is decided as per the discretion and convenience of the operating surgeon. Objectives: The objective of this study is to evaluate and compare the outcomes of buried and exposed K-wire for treatment of paediatric supracondylar humerus fractures. Methodology: This study is a prospective, comparative, observational study conducted among the paediatric patients visiting Birat medical college teaching hospital OPD/ emergency department with supracondylar humerus fracture. The sample size was calculated to be 90 (45 in each group) on the basis of convenience sampling and samples were collected using systematic random sampling technique. After data collection, all reports are entered in a predetermined Performa and analysed using SPSS version 21. Results: The overall complications rate was 20%. In the exposed K-wire group, 6 patients (13.33%) had surgical site infection at 4 weeks. Among them, 5 patients (11.11%) had superficial infection and 1 patient (2.22%) had deep infection. In the buried K wire group, only 2 patients (4.44%) had skin perforation and superficial infection. None of the patients had deep infection. There were 2 patients (4.4%) with hyper granulation tissue formation in exposed K wire group which were associated with superficial infection. There were 8 patients (17.8%) with skin irritation/ K wire prominence but without K wire perforation in the buried K wire group which was statistically significant (p value 0.006). Conclusion: There is no significant difference between the exposed K wire group and buried K wire group.

Gender variation in operative findings and outcome in patients undergoing laparoscopic cholecystectomy at Birat Medical College Teaching Hospital

Introduction: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis. Despite advancement in surgical instrument and operating technique, conversion to open cholecystectomy is still worrisome concern to surgeons. There are various preoperative factors impacting on conversion. Male gender as an independent risk factor for conversion is still debatable. Ojectives: This study aims to study the role of male gender, its impact on operative findings and conversion.Methodology: A total number of 131 patients diagnosed as symptomatic cholelithiasis and who fulfilled the inclusion criteria underwent laparoscopic cholecystectomy. Data related to patients demographics like age sex, intraoperative complications like bleeding, bile leak, duration of surgery, conversion if any was noted. Reason for conversion was also noted. Postoperative complications like pain, surgical site infection and duration of hospital stay was noted. Results: In this study, A total of 130 patients participated in this study of which 64 (51.70%) were male (M) and 66 (44.89%) were female (F). Mean age of presentation was 48.25 years, youngest being 23 years and elder being 78 years of age. Mean operating time was 40.66 minutes. Bile leak was seen in 2 patients in male (M) group while no such event was observed in the female group (p value 0.240). There was no organ injury observed in either group. 1 patient in the female (F) group had postoperative pancreatitis (p value 1.00). Postoperative obstructive jaundice was noted in 2 patients in female group (F), p value 0.496. It was observed that 7 male patients had conversion to open during the procedure while only 3 cases were converted in the female gender group, p value of 0.203. Bile duct injury was seen in 1 patient in male (M) gender group, p value 0.492. However, this injury was not seen in the conversion group. All cases undergoing conversion had mean operating time of 75.3 minutes and this was more in male (M) group. Conclusion: Laparoscopic cholecystectomy is difficult in male (M) gender group compared to females and operating time is also longer, however male gender is not an independent risk factor for conversion.

Uric acid level in Chronic Kidney Disease patients and its association with other established CKD risk factors

Introduction: Chronic Kidney Disease (CKD) is a rising global health concern with increased cardiovascular risks. Hyperuricemia, linked to CKD and related conditions, warrants investigation. Objectives: This study examines the uric acid in different stages of CKD and the association between uric acid levels and established CKD risk factors. Methodology: A hospital-based prospective cross-sectional study was conducted at Birat Medical College Teaching Hospital from 10 June 2023 to 30 August 2023. We enrolled 90 patients with non-dialytic chronic kidney disease (CKD) by complete enumeration sampling method. Ethical approval was obtained from the institutional review committee of the college. Written informed consent was obtained from each participant. Data was collected by means of a self developed questionnaire. Blood samples were obtained for estimation of serum creatinine and uric acid level and recorded in Microsoft excel sheet and analyzed by using SPSS software version 23. Results: Hyperuricemia was seen in 33(36.7%) ranging from 3.5-12 mg/dl with an average uric acid level of 6.38 mg/dl and a standard deviation of 1.43 mg/dl of total 90 patients. The mean serum uric acid level was highest in stage 2 CKD which includes 6.88±2.10 ranging from 4.3-12 mg/dl. CKD patients with a history of alcohol intake had increased risk of hyperuricemia and it was statistically significant (p value 0.005). Different stages of CKD (p value: 0.70), age groups, (p value 0.17), gender(P value 0.082), diabetes(p value 0.954), hypertension(p value 0.364), other CVDs(p value 0.649)and anemia(p value 0.0602)had no statistical significant association with hyperuricemia. Conclusion: In conclusion, hyperuricemia prevalence was observed in CKD patients, with the highest levels in stage 2 CKD. Notably, alcohol intake significantly correlated with hyperuricemia, while other studied factors did not show significant associations.

Knowledge Attitude And Practice Regarding Superficial Fungal Infections In Dermatology Patients In Eastern Nepal

Introduction: Superficial fungal infection is one of the most common diseases in dermatology evolving like an epidemic. Hence further research is necessary to minimize the occurrence and prevention of the disease. Objectives: To assess the knowledge, attitude and practice about superficial fungal infection and implicate the result in educating the patients thereby minimizing its further recurrence and re-infections. Methodology: A hospital based observational descriptive quantitative crosssectional study was conducted in all patients with superficial fungal infections attending dermatology outpatient department at Birat Medical College Teaching Hospital. A selfdesigned questionnaire which was double translated by two individuals in different translations and validated was used to assess knowledge, attitude and practice (KAP) regarding superficial fungal infections. Data were entered in Microsoft excel and analyzed in terms of proportions and percentage. Results: Out of total 162 patients participating in the study, less than half of the study population was aware that it was a fungal infection; majority did not know how to apply medication in an appropriate technique. They strongly believed that hot weather was the cause. They practiced daily bath, but did not change their clothes often. They preferred taking over the counter medications and visited dermatologists less often and did not complete the total dose of prescribed medication and shared their prescription with their family members for similar problem. Consclusion: All clinicians treating with superficial fungal infection should emphasize on counseling the patients regarding behavioural changes which will not only aid in treatment but will also focus on its preventive aspect.

Outcomes of Wide Awake Local Anaesthesia no Tourniquet (WALANT) In Soft Tissue Surgeries Of The Hand

Introduction: Hemostasis in hand surgery can be achieved by use of an arm tourniquet but it has its own disadvantages like tourniquet-related pain, muscle and nerve injury, post-tourniquet thrombosis, and bleeding. Another method can be the use of epinephrine locally, but surgeons are concerned with digital ischemia and necrosis as seen with use of procaine in the 1970s. Recently Wide Awake Local Anesthesia No Tourniquet (WALANT) is being popular among hand surgeons in which a mixture of local anesthetic with adrenaline and sodium bicarbonate is used. Despite the absence of tourniquet related complications in WALANT technique, surgeons are reluctant to use lignocaine with epinephrine in hand surgery.
 Objectives: The objective of this study is to observe the outcomes of WALANT technique in various surgical procedures of hand.
 Methodology: This prospective study involved 103 patients undergoing soft tissue surgery of the hand at Birat Medical College Teaching Hospital. Patients meeting inclusion criteria and willing to participate in study were included. A proforma was filled by the operating surgeon and another proforma was to be filled by patient at home after discharge which was retrieved at follow-up visit. A mixture of 10 ml of 2% lignocaine with adrenaline diluted in equal volume of normal saline and 2ml of 8.4% sodium bicarbonate was used for local anesthesia.None of our patients developed digital ischemia or necrosis, one patient developed surgical site infection which recovered with oral antibiotics. The mean VAS score at the time of administration of local anesthesia was 3.8+1.2, intraoperatively it was 1.8+ 1.1 and at 2 hours postoperatively it was 2.3+1.3. VAS score at 6 hours, 12 hours and 24 hours postoperatively was 3.2+1.2, 3.4+1.4 and 3.7+1.1 respectively. Hemostasis control was excellent in 33 cases, very good in 58 cases, good in 8 cases, and poor in 4 cases.
 Conclusion: We conclude that WALANT technique is safe to use in various soft tissue surgeries of hand surgery in terms digital ischemia, necrosis or wound infection and effective in providing excellent control of hemostasis at surgical site.

Evaluating The Accuracy Of Fine Needle Aspiration Cytology Of Breast Lesion Using International Academy Of Cytology Yokohama System: A Study In Eastern Nepal

Introduction: Breast Carcinoma is the most common cancer in females worldwide. In developing countries, it is the most common cause of cancer-related deaths in women. The IAC Yokohama breast FNAB reporting system was developed as a multidisciplinary approach to have a standardized and structured report, for improvement in interpretation of breast cytology. Objectives: This study aims to classify Fine needle aspiration cytology of breast lesion according to the IAC Yokohama system and assess diagnostic accuracy of different categories. Methodology: This was a hospital based prospective cross-sectional study conducted in the Department of Pathology, Birat Medical College Teaching Hospital from August 2022 to May 2023.All patient with Breast lesions who underwent FNAB were included in the study. FNAB were categorized using IAC Yokohama reporting system. Considering histopathology as a final diagnosis sensitivity, specificity, PPV, NPV, Diagnostic accuracy and Risk of Malignancy were calculated. Results: One hundred and fifty-six patients underwent FNAB during the study period and 124 patients had histopathological reports available. Frequency of FNAB using Yokohama System were: Inadequate -1.9%, Benign- 59%, Atypical 14.7%, Suspicious- 11.5%, Malignant- 12.8% respectively.The Risk of Malignancy for each category were 33%, 1.51%, 22.22%, 94.11% and 100% respectively. Maximum sensitivity (97.56%) and NPV (98.48%) was achieved when considering Atypical, Suspicious for Malignancy and Malignant category as Positive. Whereas highest specificity (100%) and PPV (100%) was achieved when considering only the Malignant category as Positive. Conclusion: The IAC Yokohama System is a standard tool for diagnosing Breast FNAB with greater reproducibility and maximum diagnostic accuracy.

Prevalence of Thyroid Disorders among Pregnant Women at Birat Medical College Teaching Hospital

Background: Thyroid disorders (TD) are the second most common endocrine disorders seen in pregnancy. TD is known to be associated with adverse maternal and fetal outcomes.
 Materials and Methods: This was a hospital based descriptive cross-sectional study. All the pregnant women attending the antenatal clinic at Birat Medical College Teaching Hospital from 1st July 2021 to 30th June 2022 were enrolled in the study, irrespective of their gestational age and gravida status. Pregnant women with diagnosed thyroid disorder and are on medication, multiple gestation, Diabetes mellitus, Hypertension and pregnant women with age more than 35 years were excluded from study. Thyroid function status of pregnant women was assessed by measuring serum levels of thyroid stimulating hormone (TSH) and if the TSH value was deranged then they underwent free T3 and free T4 level. Based on the TFT reports they will be classified as euthyroid, subclinical hypothyroidism and overt hypothyroidism, subclinical hyperthyroidism and overt hyperthyroidism.
 Results: A total of 395 pregnant women were enrolled in this study. The mean age and standard deviation of pregnant women was 25.25± 4.76 years. Among 395 pregnant women 93(23.6%) pregnant women have thyroid disorder. Subclinical hypothyroidism and Overt hypothyroidism were 19% and 1.8% respectively. Subclinical and Overt hyperthyroidism were 1.5% and 1.3% respectively.
 Conclusion: The prevalence of thyroid disorder in pregnancy was 23.6%. The most common thyroid disorder observed was Subclinical hypothyroidism comprising 19% cases followed by overt hypothyroidism comprising 1.8% cases followed by Subclinical and Overt hyperthyroidism 1.5% and 1.3% cases respectively.

Correlation of Anthropometric Measurements with Hamstring Graft Size in Anterior Cruciate Ligament Reconstruction in Nepalese Population: A Prospective Observational Study

Background: The use of autologous hamstring tendon for arthroscopic Anterior Cruciate ligament (ACL) reconstruction is very common. The size of hamstring tendons varies significantly between individuals, and graft diameter is unpredictable. Anthropometric measurements may be a simple way to estimate hamstring tendon length and diameter. This study aims to determine the correlation between anthropometric measurements of patients with length and diameter of harvested hamstring autograft during ACL reconstruction.Methods: A prospective observational study was carried out after ethical approval. All patients who underwent arthroscopic ACL reconstruction from 1 March 2022 to 30 April 2023 in Birat Medical College Teaching Hospital were included. Fourty seven patients’ age, sex, height, weight and thigh length were recorded preoperatively. Hamstring tendons were harvested and length of the semitendinosus tendon and diameter of the quadrupled graft (doubled semitendinosus and doubled gracilis) was measured intraoperatively. We used Pearson’s correlation coefficient to observe the relationship between anthropometric measurements and graft variables.Results: Mean length of harvested semitendinosus tendon was 27.4 ± 1.8 cm and mean quadrupled hamstring autograft diameter was 7.4 ± 0.8 mm. A significant positive correlation between graft variables (semitendinosus tendon length and quadrupled hamstring autograft diameter) and patients’ height and thigh length was found.Regression equations for predicting Semitendinosus tendon length and quadrupled hamstring autograft diameter from thigh length in males and females are also derived.Conclusion: Height and thigh length of patients are useful parameters for predicting semitendinosus tendon length and quadrupled hamstring graft diameter before ACL reconstruction.

Indications and Findings of Coronary Angiography: A Descriptive Cross-Sectional Study

Introduction: Coronary artery disease is an important subset of cardiovascular disease that requires timely, accurate, and cost-effective diagnosis. Among several modalities practiced to evaluate this disease; coronary angiography is the gold standard.
 Objective: The objective of this study was to identify indications and findings of coronary angiography among patients admitted at Birat Medical College Teaching Hospital.
 Methodology: A descriptive cross-sectional study conducted at Department of Cardiology, Birat Medical College Teaching Hospital from 1 September 2021 to 30 June 2022 after taking ethical approval from Institutional Review Committee (Ref No: IRC-PA-167/2078-79). A total of 202 patients were included through consecutive sampling. Data was collected on baseline characteristics, indications and findings of coronary angiography. Frequency, percentage, mean and standard deviation was calculated.
 Result: Maximum percentage of patients were in the age group 60-69 years (20.8% males and 16.3% females) with mean± S.D(60.1± 11.1). The most common indication for coronary angiography was angina (34.1%) and treadmill test positive (24.3%). Nearly 62% had abnormal findings. Single vessel disease was present in 25.2%, double vessel disease in 5.9% and triple vessel disease in 20.6%. Other findings were cardiac bridging (2.9%), non-critical coronary artery disease (1.9%) and in-stent restenosis (0.5%).
 Conclusion: The most common indication of coronary angiography was chronic stable angina and the majority had vessel diseases.

Comparative Study of Clinical Outcome of Low Pressure Versus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy at Birat Medical College Teaching Hospital (BMCTH)

Introduction: Laparoscopic cholecystectomy at standard pressure pneumoperitoneum ( 12-15 mmHg of Co2) is standard of practice among surgeons. The increase in intraabdominal pressure by insufflation of carbon dioxide during laparoscopy brings certain changes in function of cardiopulmonary systems and also leads to postoperative pain due to stretching of the diaphragm.
 Objective: To minimise this impact on human physiology there is increasing effort of performing laparoscopic cholecystectomy at low pressure pneumoperitoneum (8mm Hg) however its safety has not been established. This study aims to compare outcomes of laparoscopic cholecystectomy at low pressure pneumoperitoneum versus standard pressure pneumoperitoneum in people undergoing laparoscopic cholecystectomy in terms of intraoperative time, postoperative pain including shoulder tip pain and length of hospital stay.Methodology: This descriptive randomised prospective study was conducted from Feb 2023 to Aug 2023 in the department of general surgery, BMCTH in patients diagnosed with symptomatic gallstone disease meeting inclusion criteria and willing for laparoscopic cholecystectomy. All patients were prospectively randomized into two groups randomly by the lottery method. A convenient sampling method was used. Group A odd number patients underwent surgery under low pressure (LPPLC group), Group B patients at standard pressure pneumoperitoneum (SPPLC).
 Results:A total of 145 patients (114 female and 31 male) with mean age 44.99 years of presentation. 73 patients underwent surgery under LPPLC group and 72 under SPPLC group. Mean pain recorded as per VAS score at 6, 12, 24 and 36 hours postoperatively showed no significant difference in pain among two groups with p value 0.972,0.121,0.212,0.072 respectively. Shoulder tip pain and additional need of analgesia was significantly less in LPPLC group, p value 0.002 and 0.015 respectively. No significant difference was observed in terms of operating time p value 0.151.Conversion between two groups p value 0.494 suggested no significant difference between two group.
 Conclusion:LPPLC is feasible, safe and can be considered over SPPLC. LPPLC is non inferior to SPPLC in terms of postoperative pain including shoulder tip pain and additional need of analgesia.

Measurement of Serum Vitamin D Level and its association with Rheumatoid Arthritis, A prospective study at eastern region of Nepal.

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by synovitis. The etiology and pathogenesis of RA remain obscure and many factors may be associated with its pathogenesis. Recent findings support that low levels of serum Vitamin D is associated with an increased risk for the development of RA. Recently, the role of vitamin D deficiency in the pathogenesis of RA, as well as the relationship between vitamin D deficiency and the activity of RA has also been an area of interest for many researchers.
 Objectives: The objectives of this study is to analyse the vitamin D levels in RA patients and investigate the association between the serum levels of vitamin D and disease activity of RA patients from Eastern region of Nepal.
 Methodology: A prospective study was conducted at Birat Medical college teaching hospital, Tankisinwari from September 2022 to August 2023. A total of 150 patients, after fulfilling exclusion and inclusion criteria were enrolled with convenience sampling technique. A control group (n=97) of patients were also enrolled for comparison. After collection of all data, ANOVA test was used to compare continuous variables between control and vitamin D groups.
 Results: Vitamin D deficiency was found in 35 patients (23.3%), Vitamin D insufficiency found in 94 patients (62.6%), and is normal in only 21 patients (14%). Also patients with RA had significantly lower vitamin D levels in comparison to patients with control activity. The difference between these two groups was statistically significant (P<0.05).
 Conclusion: Our study finds a significant inverse relationship between blood vitamin D levels and RA activity. However, due to the small number of patients included in the current study, further research with a larger sample size is needed to gain a better understanding of the relationship between RA activity and vitamin D.

Cross Sectional study to evaluate Psychosocial impact of Covid 19 among medical students of BMCTH

Introduction: COVID-19, a profoundly contagious viral disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a devastating impact globally, leading to over 6 million fatalities worldwide. Covid 19 caused isolation, anxiety, grief, economic stress, and disrupted routines, leading to mental struggles, strained relationships, and increased demand for mental health services globally.
 Objectives: The objectives of this study were to find out psychosocial impact of covid 19 among medical students of BMCTH and to assess the factors associated with psychosocial impact of covid 19.
 Methodology: A cross-sectional study was carried out among all medical students of Birat medical college teaching hospital from August, 2022 to January 2023. Data was collected from 258 eligible participants using GHQ12 questionnaire. Chi-square test was applied for assessing association between dependent and independent variables and binary logistic regression analysis was used to find the determinants.
 Results: Present study was conducted among 258 medical students. Among them 43.0% had normal psychological status, 27.5% were in borderline 15.5% showed evidence of psychological distress and 14.0% were experiencing severe psychological distress. Bivariate analysis between socio-demographic characteristics and psychosocial status showed gender, work overload, work hours in covid ward, exposure to false covid information and covid quarantine were significantly associated with psychological distress at p- value < 0.05. Further important variables were run for multivariate analysis which revealed age (B=3.46, CI:1.45-8.23 and P=0.005), gender (B=3.20, CI: 1.61-6.37 and P=0.001) and work overload (B=9.63, CI: 4.32-21.49 and P=0.000) were found as significant predictors/determinants of psychological distress. Age greater than 24 years, female gender and higher work load were significantly associated with psychological distress.
 Conclusion: The psychological distress among the medical students due to covid 19 was in appalling situation. The study found age >24 years, female gender and higher workload were the predictor of the psychological distress Integrated efforts from medical college, parents, peers and faculties are to be initiated to address the existing problems.

Pattern of psychiatric referral in a tertiary care hospital

Introduction: Global mental health challenges persist amidst a rising trend of patients seeking consultations with non-psychiatric specialists, driven by stigma and a lack of awareness. This study aims to study the demographic profile of patients referred to the Department of Psychiatry and Mental Health from other departments, referral sources, prevalent psychiatric disorders, and explores potential associations with co-existing physical conditions. Material and Method: A six-month descriptive cross-sectional study (October 2022 to March 2023) was done at Birat Medical College Teaching Hospital using total enumeration sampling method. Patients referred to Psychiatry were assessed using the International Classification of Diseases, Tenth Revision, Diagnostic Criteria for Research (ICD-10 DCR). Data were analyzed with SPSS version 25, utilizing mean, standard deviation for continuous data, and frequency, percentage for categorical data. Odds ratios were computed for associations. Results: Among 160 patients, the majority were male (55%), Hindu (90%), married (78.1%), and educated up to secondary level. Department of Medicine accounted for the highest referrals (50%) primarily for fearfulness (21.3%). Neurotic, stress-related and somatoform disorders were most common (33.1%), followed by mood disorders (28.8%). No significant association was found between psychiatric disorders and physical illnesses. Conclusion: The Department of Medicine was the most common referring department, with neurotic stress-related and somatoform disorders being the prevalent diagnosis. Referral to Psychiatry facilitates early recognition and treatment of undiagnosed psychiatric conditions, advocating for routine practice among non-psychiatric specialists. Future research should target barriers and interventions to improve psychiatric service utilization in Consultation-Liaison Psychiatry settings.

Intradialytic Complications and its Associated Factors Among Chronic Kidney Disease Patients in a Tertiary hospital

IntroductionChronic kidney disease is a public health problem affecting millions of people worldwide. Hemodialysis is a life-saving renal replacement therapy for patients with chronic kidney disease(CKD), but it is not without risks. Intradialytic complications, which occur during hemodialysis sessions, can have a significant impact on patients' well-being, treatment outcomes, and overall quality of life. This article aims to identify the intradialytic complications and its associated factors in patients with chronic kidney disease undergoing hemodialysis in a tertiary hospital of eastern Nepal.MethodsAn observational cross-sectional study design was employed among 72 patients receiving hemodialysis treatment at Birat Medical College Teaching Hospital from 28 January to 20 May 2023. Total enumeration sampling technique with a structured questionnaire via interview and observation technique was used for data collection. Collected data was entered in Microsoft Excel sheet and transferred to SPSS version 17. Frequency, mean, range, and standard deviation was calculated. Chi square test was used to determine the association. P-value <0.05 was consideredstatistically significant.ResultsAll patients undergoing hemodialysis experienced at least one intradialytic complication. The most common complications reported were nausea/vomiting 59(81.9%) and chills/rigor 57(79.2%). Hypoglycemia was observed in 23.6% of patients, hyperglycemia in 12.5%, hypotension in 8.3%, and arrhythmia in 2 patients.ConclusionsIntradialytic complications are common among chronic kidney disease patients undergoing hemodialysis.The associations between age, dialysis frequency, preexisting diabetes, hypertension, and specific complications emphasize the need for individualized care and tailored interventions.

Pattern of coronary artery occlusion in patients undergoing coronary angiography at Birat Medical College Teaching Hospital

Introduction: Coronary artery disease (CAD), is the leading cause of death globally. Among different diagnostic and treatment procedures, coronary angiography is considered the gold standard. Birat Medical College Teaching Hospital (BMCTH) is also providing cardiovascular services to people from eastern Nepal and from the neighboring country India. We aim to analyze the pattern of coronary artery occlusion in patients undergoing coronary angiography. Method: A hospital based observational cross-sectional study was conducted at BMCTH from 10 Sep 2022 to 10 Jan 2023. A total of 220 patients were enrolled by consecutive sampling techniques. Ethical approval was obtained from the Institutional Review Committee of BMCTH. Data was collected on baseline characteristics, risk factors, clinical presentation and degree of coronary artery occlusion. Collected data was entered in Microsoft Excel and analyzed by Statistical Package for Social Sciences version 23. Frequency, mean, percentage were calculated. Result: Nearly half (49.1%) patients had significant, 6(2.7%) had intermittent CAD and 14(6.4%) had non critical CAD. Three patients (1.4%) had left main coronary artery disease. Left anterior descending artery 66(30%) was the most commonly involved. Single vessel disease was present in most patients 49(22.27%). Double vessel disease 15(46.8%) and triple vessel disease was more common 14(51.8%) in above 65 y of age. Conclusion: The coronary angiography revealed presence of significant coronary artery disease and multiple vessel involvement with increasing age.

Admission Pattern and Outcome in Paediatric Intensive Care Unit of Tertiary Level Teaching Hospital in Eastern Nepal

Introduction: Paediatric Intensive Care Unit (PICU) is a relatively new concept with rapidly growing paediatric subspecialty in resource limited-countries. Introduced in Nepal in the 1980s, the first PICU was established in 1986 in Kanti Children’s Hospital, Kathmandu with 4 beds. Later in BPKIHS in Eastern Nepal. Currently only a few dedicated PICU running in Nepal. Our PICU was started in 2021 with 8 beds in the private sector for the management of critically ill children.
 Objectives: To study the admission pattern and outcome of the children at our paediatric intensive care unit.
 Methodology: This was a Cross Sectional Descriptive study conducted at PICU of Birat Medical College Teaching hospital in Eastern Nepal. From August 2021 to July 2022, records of all possible admissions in PICU were reviewed. Demographic profile, diagnosis, outcome and duration of stay were analysed.
 Results: Out of 260 analysed data, there were 156 (60%) males and 104 (40%) females. Age wise distribution was 101 (38.85%), 82 (31.5%), 38 (14.6%) and 39 (15%) for 1 months-1 year, 1-5 year, 5-10 year and 10-15 year respectively. Disease wise distribution was 129 (49%) respiratory, 49 (18.8%) neurological and 26 (10%) gastrointestinal, mostly infective causes like Pneumonia (78, 30%), Bronchiolitis (34, 13.1%), febrile convulsion (29, 11.2%) meningitis/encephalitis (19, 7.3%), Sepsis (12, 4.6%), dengue (6, 2.3%) other infections (19,6.3 %). In outcome, discharged (231,88.85%), DOPR (5,1.92%), LAMA (4,1.54%), Death (16,6.2%) and Referral (4,1.54%). Mortality was high (11, 38.6%) in under five years. Sepsis (4, 33.3%), Meningitis / encephalitis (3, 15.8%) and pneumonia (4, 5.1%) were the common causes. Mean duration of PICU stay was 2.73 days (median=2). Overall mortality rate was 6.2% (16). Sepsis, LOS and need of mechanical Ventilation were significant predictors of mortality.
 Conclusion: Respiratory illnesses including infections were common causes of admission with low mortality (6.2%). Sepsis, Meningoencephalitis and pneumonia were common causes of death in our PICU. Sepsis, LOS and need of mechanical Ventilation were significant predictors of mortality.

Comparative analysis of ELISA, FEIA and CLIA techniques in diagnostic immunoassays for thyroid stimulating hormone: A cross-sectional study form Morang, Nepal

Background: TSH and circulating thyroid hormones are measured in serum as part of a thyroid function test (TFT), which evaluates the thyroid gland's ability to produce and regulate thyroid hormones. The objective of the current study was to compare the technical performance between ELISA, FEIA and the currently marketed automated CLIA for measuring the TSH level.
 Material and methods: A total of 1,200 participants were enrolled in the study. Subjects were chosen randomly, either OPD patients or inpatients of Birat Medical College Teaching Hospital. Chemiluminescence Immunoassay (CLIA), Enzyme-linked Immunoassay (ELISA) and Fluorometric Enzyme Immunoassay (FEIA) technologies were performed.
 Results: The total number of patients (1200) was categorized into group I, normal TSH (n = 680); group II, elevated TSH (n = 300); and group III, decreased TSH (n = 220). CLIA and FEIA based results were significantly more sensitive compared to ELISA results for TSH detection.
 Conclusion: Chemiluminescence assay system, when compared to FEIA and ELISA, is far superior in terms of accuracy and sensitivity for reporting both subnormal and above normal TSH levels and can be helpful in the detection of subclinical thyroid dysfunction (SCTD) and in the screening of thyroid diseases.

Risk Factors associated with Intrauterine Fetal Death at Birat Medical College Teaching Hospital

Background & Objective: Intrauterine fetal death is a tragic event, and despite efforts to reduce its incidence, it remains challenging to do so. Intrauterine fetal death is an important indicator of the maternal and perinatal health of a given population. This study aims to identify the maternal and fetal factors associated with intrauterine fetal death. Material and Methods: This is a descriptive cross-sectional study conducted in Obstetrics ward of Birat Medical College Teaching Hospital from 1st July 2021 to 31st August 2022. All pregnant women with ultrasound confirmed intrauterine fetal death after 28 or more weeks gestation who were admitted to the Obstetrics ward of Birat Medical College Teaching Hospital in the study period were enrolled in the study. Results: There were 4562 antenatal admissions and 3852 deliveries in the study period. Of these, 35 pregnant women were admitted with intrauterine fetal death. The intrauterine fetal death rate was 11 per 1000 deliveries in our institution. The mean age of women at presentation was 25.94±4.82 years, and 85.7% of pregnant women between the ages of 20-35 years. Of the study participants, 34.3% were Janajati and 82.9 % were Hindu. Out of 35 pregnant women, 37.1% had not received formal education, and all of them were housewives by occupation. Only one patient was smoker, and none of them were alcoholic. Among the 35 pregnant women, 40 % were preterm, 57.1% were term, and 2.9% were post-term. The majority (60%) of them were multigravida. Hypertensive disorder in pregnancy was the most common identified risk factor in 25.7% of pregnant women, and in 37.1 % of cases, causes were not identified. Out of the 35 pregnant women, 34 underwent vaginal delivery, while one underwent a caesarean section for placenta previa. Conclusion: Most of the pregnant women with intrauterine fetal death were illiterate housewives. The most commonly identified risk factor in this study was hypertensive disorder in pregnancy, which is preventable by regular antenatal care and timely intervention. Therefore, we should emphasize the importance of regular antenatal care for early detection and treatment of hypertension and other risk factors.