Chitwan Medical College Research Articles

Assessment of Residual Ridge Morphology among Edentulous Patients at A Tertiary Care Center of Nepal

Background The morphology of the residual ridge is one of the predominant factors influencing denture retention, stability, support and the masticatory function in edentulous patients thereby affecting both the planning and treatment prognosis. This study was aimed to assess the different types of maxillary and mandibular residual ridge in the group of edentulous population in Chitwan, Nepal. MethodsA descriptive cross-sectional study was conducted in total of 107 completely edentulous patients within the age of 55-85 years’ in Prosthodontic department of Chitwan Medical College. The type of maxillary and mandibular residual alveolar ridge in both male and female patients were noted in a predesigned proforma according to American College of Prosthodontists (ACP) classification system. The collected data was entered into Microsoft Excel and later transferred into SPSS version 26 and analyzed for descriptive statistics.ResultsIn this study, 107 completely edentulous patients both male 63 (58.9%) and female 44 (41.1%) participated in the study. In the maxillary arch, Type B was most prevalent residual ridge type 55 (51.4%) whereas Type C in mandibular arch around 35 (32.7%). In male patients, Type B was most common 36 (57.1%) whereas Type A in female 20 (45.5%). Conclusions From this study it can be concluded that there is variation in the residual ridge. In maxillary arch, type B residual ridge was most prevalent followed by type A while in the mandibular arch type C was prevalent followed by type B.

Association of Platelet Count with Severity of Chronic Liver Disease

Introduction: Chronic liver disease (CLD) is a significant global health concern, encompassing a range of liver pathologies with varying degrees of severity. This cross- sectional study aims to investigate the relationship between platelet count and the severity of CLD. Platelet count is a readily available and cost-effective clinical parameter that may serve as a valuable prognostic marker for CLD progression.  Materials and Method: The study included 122 patients in Chitwan Medical College Teaching Hospital (CMCTH) diagnosed with CLD during one year starting from March 2022. Data were collected using the proforma specially designed for this study. Parameters like age and gender, as well as brief clinical data, including liver function tests, imaging findings, and platelet count, were collected. Patients were then classified into different stages of severity based on established criteria, i.e. child Pugh Score system (CTP score). Statistical analyses were performed using a statistical package for the social science (SPSS); statistical program version 20.0, to explore the association between platelet count and CLD severity.  Results: The majority of patients who had chronic liver disease were found to be high in the age group of 40-60 years. Thrombocytopenia was found in 72.1% of chronic liver disease patients. After classifying the severity of chronic liver disease, it was found that 55.7% of patients had a severe disease that was CTP-C, 36.1% were found to be CTP-B and 8.2% were CTP-A. In patients with normal platelet count, 44.1% had CTP-B, 41.2 had CTPC and 14.7% had CTP-A score. In patients with thrombocytopenia, 61.4% had CTP-C, 33.0% had CTP- B and 5.7% had CTP-A score.  Conclusion: This study provides a valuable snapshot of the potential association between platelet count and the severity of chronic liver disease. The prevalence of thrombocytopenia across different disease stages underscores its clinical relevance. The platelet count is decreased in chronic liver disease, however, it cannot be defined as the sole predictor for the severity of CLD.

Evaluation of the Sofa Score in Predicating Outcome of Sepsis Patients Admitted to a Tertiary Care Center in Nepal

Background Sepsis is a major health burden with life- threatening conditions, which leads to a high rate of mortality in patients. The Sequential Organ Failure Assessment (SOFA) score, which assesses organ dysfunction across multiple systems, has been considered a reliable indicator of the severity of critical illness. We have carried out this study to evaluate the predictive value of the SOFA score in assessing the mortality of patients with sepsis on admission.  Methods Our study was a cross-sectional, descriptive study carried out in patients with sepsis who were admitted to the medical ICU of Chitwan Medical College from December 15, 2021, to December 14, 2022. Patient sampling was done based on a non-probability convenience sampling technique.  Results In a study of 130 patients, 54.6% were male and 45.4% were female. The mean SOFA score was 7.1, with a median of 7. 38.5% (50 patients) died due to sepsis. The mean SOFA score was higher among deceased patients (9.3) than survivors (5.8). Higher SOFA scores were associated with increased mortality. 46% of patients required inotropes/Vasopressor support for shock. Patients requiring vasopressor support had a significantly higher mortality rate (53.3%) compared to those who did not need support (25.7%). 13.1% of patients required mechanical ventilatory support, and the majority of these patients (70.6%) had mortality.  Conclusion SOFA score is a valuable tool to assess organ dysfunctions and it can predict the outcome of patients admitted with sepsis.

Assess the Serum Lipid Profile in Patient with Acute Ischemic Stroke at Tertiary Care Center in Nepal

Introduction: Ischemic stroke takes place when the blood flow cessation endures for more than a few minutes leading to brain tissue infarction. After ischemic heart disease, ischemic stroke is the second most common cause of death worldwide and one of the top five diseases based on DALYs (disability-adjusted life years) in Nepal. Though dyslipidemia is a major risk factor for coronary heart disease, it has an unclear role in the pathogenesis of ischemic stroke. In a patient with a previous ischemic stroke, statins reduce the risk of ischemic stroke. So, this study analyses the plasma prevalence of total cholesterol (TC), low-density lipoprotein (LDL), High-density lipoprotein (HDL), and triglyceride (TG) in patients with acute non-cardioembolic ischemic stroke and their association with different non-modifiable risk factors (age, gender & family history) and modifiable risk factors (diabetes, hypertension, obesity, smoking & alcohol intake).  Materials and Method: This is a descriptive and analytical cross-sectional hospital-based study carried out from December 5th, 2021 to December 4th, 2022 including 80 patients admitted to Chitwan Medical College, Chitwan, with a diagnosis of acute ischemic stroke. All the patients underwent a detailed history, physical examination, and baseline investigations including fasting lipid profile along with CT- scan/MRI head. The fasting lipid profile was done within the first 24 hours of hospitalization. Data was entered in MS Excel 2013 and converted it into SPSS 26 for statistical analysis.  Result: A total of 80 patients with the diagnosis of acute ischemic stroke were enrolled. Out of them, 37 (46.25%) were female and 43 (53.75%) were male. A total number of 71 (88.75%) patients were from more than or equal to 55 years of age group and 9 (11.25%) patients were from less than 55 years of age group. The mean age ± standard deviation of male and female patients was 66.69 ±9.14 years and 68.54 ±14.96 respectively. Overall, derangement in serum lipid profile (dyslipidemia) was present in 63.75% of the patients. Among the total cases, high TC is found in 18 patients (22.5%), TG in 24 patients (30%), high LDL is found in 16 patients (20%), and low HDL is found in 23 patients (28.75%).  Conclusion: The study highlights hypertriglyceridemia as the leading dyslipidemia in ischemic stroke patients, showing gender and age variations in prevalence. It confirms dyslipidemia's role in brain vascular changes, notably in the Middle Cerebral Artery, and its link to carotid artery stenosis severity. Despite common risk factors, their direct association with dyslipidemia remains statistically insignificant, stressing the need for focused lipid management to mitigate stroke risks.

Knowledge on Uterine Prolapse among the Married Women in Banepa Municipality, Kavrepalanchowk

Background Uterine prolapse is a prevalent issue among women, particularly in low- and middle-income countries like Nepal, significantly impacting their quality of life. Despite its impact, there is a lack of comprehensive knowledge and awareness about this condition among the affected population, leading to delayed interventions and suboptimal healthcare-seeking behaviors. This study aimed to assess the knowledge about uterine prolapse among married women of reproductive age group in Banepa, Kavrepalanchowk.MethodsA cross-sectional study was conducted in Banepa Municipality, Nepal, from July to September 2019 after obtaining ethical approval from the Chitwan Medical College Institutional Review Committee. Face-to-face interviews with a total of 251 married women of the reproductive age group were done using a semi-structured questionnaire. Descriptive statistics, Chi-square tests, and multivariate logistic regression models were performed.ResultsThe study revealed that among all the respondents 86.3% had heard about uterine prolapse, with 42.5% demonstrating satisfactory knowledge. Religious affiliation, education, average monthly income of the family and prime source of knowledge on uterine prolapse were found to be significantly associated in bivariate logistic regression while taking them to the multivariate analysis education status (AOR=6.342, p=0.010) and religious affiliation (AOR=6.138, p=0.003) were found significantly influencing the knowledge level.Conclusions The study revealed significant knowledge gaps on uterine prolapse among married women in Banepa Municipality, Nepal, highlighting the imperative for targeted educational interventions. Socioeconomic factors and healthcare access influence awareness, emphasizing the need for culturally sensitive initiatives.

Clinical Outcome of Open Reduction and Internal Fixation of Mandibular Condyle Fracture: A Prospective Observational Study

Introduction: Condyle of mandible plays crucial role in functioning of jaw. Untimely and inadequate treatment leads to deformity of face along with range of complications. The purpose of this study was to assess outcomes of open reduction and internal fixation of mandibular condyle fractures in terms of mouth opening, facial nerve function and occlusion.Methods: This was a prospective observational study conducted at Chitwan Medical College. Thirty-two patients of mandibular condyle fracture were treated by open reduction and internal fixation via retromandibular approach and evaluated for mouth opening, facial nerve function, and occlusion on 2nd day, 10th day and 25th day postoperatively. All collected data were entered on SPSS version 21 and analyzed using descriptive statistical methods. The results were presented as graphs and tables.Results: Of 32 patients, 7 patients show abnormal occlusion while 25 patients show normal occlusion. A gradual improvement in mouth opening and facial nerve function was also seen on 25th day.Conclusion: Open reduction and internal fixation gives superior clinical outcomes in terms of mouth opening, facial nerve function and occlusion. It also allows good anatomical repositioning and early function.Keywords: Facial nerve function, Mouth opening, Occlusion, Open reduction internal fixation Layman summary: The mandible is largest and strongest bone of face. However, it is also most common facial bone that is fractured. Condyle of the mandible is highly prevalent site of mandibular fracture. The fracture of mandible is managed by open or closed reduction. Both of the methods have their own merits and demerits. In this study, we planned to assess the outcomes of open reduction and internal fixation of mandibular condyle fractures at a tertiary care center of Nepal. We found that ORIF has a good clinical outcome in mandibular fracture in terms of mouth opening, facial nerve function and occlusion.

HEMATOCRIT AS AN EARLY PREDICTOR OF SEVERE ACUTE PANCREATITIS: A PROSPECTIVE OBSERVATIONAL STUDY IN TERTIARY CARE CENTRE OF NEPAL

Background: The predictor system for acute severe pancreatitis is complex and takes up to 48 hours to complete. This study aimed to investigate the role of admission hematocrit in predicting acute pancreatitis severity. Methods: This was an observational study, conducted at Chitwan Medical College where 112 patients who met the inclusion criteria and were diagnosed with acute pancreatitis were examined. The patients were followed for 48 hours by evaluating the admission hematocrit and were categorized to have mild to moderately severe pancreatitis or severe pancreatitis according to the modified Atlanta criteria. All analyzes were performed using SPSS statistical software, version 26. Descriptive and inferential statics, sensitivity and specificity were calculated. Results: The mean age was 44.72 ± 14.5 years and 70.5% were male. The most common etiology was ethanol (52.2%), followed by gallstone disease (26.5%). The prevalence of severe pancreatitis in patients in the high-risk group was 88.89%, and the incidence of severe pancreatitis in patients in the low-risk group was 10.59%. The detection sensitivity of hematocrit level >/= 44% for severe acute pancreatitis was 72.73%, the specificity of 96.2%, the positive predictive value of 88.89%, the negative predictive value of 89.41%, the accuracy of 89.3%, likelihood ratio for positive test result of 19.14 and likelihood ratio for negative test result of 0.283. Conclusions: Patients with high hematocrit on admission were associated with the occurrence of severe acute pancreatitis, so these patients should be considered as a high-risk group for development of severe acute pancreatitis and monitored meticulously.

FACULTY-STUDENT MENTORSHIP PROGRAM FOR PRE-CLINICAL MEDICAL STUDENTS AT CHITWAN MEDICAL COLLEGE, NEPAL: A TEACHER’S PERSPECTIVE

Mentorship program has become a proven educational strategy in the context of contemporary medical education. The idea of mentorship is based on personal relationship in a professional setting where the mentor helps the mentee in realizing their full potential in attaining both personal and professional goals. The individualized guidance and support provided to the students not only enhances academic knowledge but also creates lasting relations and nurtures confidence and character. This viewpoint aims to shed light on the commendable initiatives taken by Chitwan Medical College on Faculty-Student Mentorship program tailored for preclinical undergraduate medical-students in their journey through medical school. The program is designed to help students navigate the early challenges of medical school and provide them with guidance and support to develop their professional identity.

ASSESSMENT OF NUMBER AND LEVEL OF ATTACHMENT OF BUCCAL FRENUM IN THE EDENTULOUS OLD AGE PEOPLE IN A TERTIARY CARE CENTER OF NEPAL

Background: Frenum is a fold of mucous membrane that encase muscle fibers. Frenum are important anatomical structure during complete denture fabrication. There is paucity of data related to buccal frenum. This study aimed to assess the number and level of buccal frenal attachment among the edentulous age groups and genders in both the maxillary and mandibular arches. Methods: A descriptive cross-sectional study was conducted in the Department of Prosthodontics & Maxillofacial Prosthetics of Chitwan Medical College. In total 97 patients of within the age of 55-85 years’ old participated in the study. In this study demographic details of participants followed by level and number of buccal mucosa in the oral cavity were noted in a predesigned proforma. The collected data was then transferred into SPSS and was analyzed for descriptive statistics using SPSS version 26. Results: In this study, in total 97 complete edentulous patients participated in which 59 (60.8%) were males and rest were females. Single buccal frenum was mostly observed in the maxillary arch. About 49(50.5%) of the participants showed single buccal frenum on right side of maxillary arch, while on the left side 40 (41.2%) of the participants had single buccal frenum. In the mandibular arch, 62 (63.9 %) on the right side and 68 (70.1%) on the left side had no frenum at all. Conclusions: From this study it can be concluded that there is variation in the buccal frenum too. In order to provide proper retention, stability, and support with the least amount of post-placement corrections, a solid understanding of the morphological variation of frenum is thus necessary.

Experience of Mindfulness Meditations Based on Stress Reduction among Undergraduate Nursing Students, Chitwan, Nepal.

Undergraduate nursing students are frequently vulnerable to stress during their education with a high rate of attrition. Mindfulness Mediations based on Stress Reductions have been found to promote psychological well-being and mental health among nursing students. Therefore, the objective of the study was to explore the experiences of Mindfulness among undergraduate nursing students. Qualitative Hermeneutic Phenomenology research design was adopted. Data were collected from under graduate nursing students from Chitwan Medical College, Institute of Medicine who had been practicing Mindfulness Meditation for 6 weeks. The duration of data collection was January to June 2022. Data were collected after obtaining ethical approval from Nepal Health Research Council. Focused Group Discussions were conducted to collect data by the researcher using the Focused Group Discussion guide in Nepali language. A total of three Focused Group Discussions was carried out among 12 participants in each Focused Group Discussion with a total of 36 participants. Data were analyzed by thematic analysis technique based on Giorgi's qualitative data analysis technique. Five developed themes were stress managed well in daily life and during examination time, present moment awareness and positivity, self-realization of inner peace and more self-acceptance, and feeling of developed future role for advocating mindfulness meditations. Mindfulness-based mediations have been found effective strategies among undergraduate nursing for the management of stress during daily living and during examinations, development of self-realization, increase inner peace, self-acceptance and developed skills for future role for advocating mindfulness meditations.

Outcomes of Premature Rupture of Membrane Among Women Admitted in Teaching Hospital, Chitwan, Nepal

Background: Premature rupture of membranes is defined as rupture of membranes after 28th weeks of gestation before the onset of labor is called preterm PROM when it occurs after 37 completed weeks of gestation and before onset of labor, then it is term PROM. Spontaneous rupture of the membrane any time beyond 28th weeks of pregnancy but before the onset of labor is called Premature Rupture of Membrane (PROM). The management of maternal and fetal outcome in PROM is very important to decrease maternal as well as neonatal mortality and for better management and prevention of complications which has essential significance for the further fate pregnancy. Thus, the study aims to find out the factors and outcomes of PROM among the women who will be admitted in maternity ward at Chitwan Medical College. Methods: A descriptive cross-sectional study was conducted in a teaching hospital of Chitwan, Nepal during the study period of six months from 13th Feb 2023 to 14th August 2023 after getting ethical approval from Chitwan Medical College- institutional Review Committee (Reference number-CMC-IRC/079/080). Women were selected via convenience sampling technique. Face to face interview was conducted to gather socio-demographic and obstetric data by structured interview schedule whereas, data related to the feto maternal outcomes were obtained from patient charts and delivery record books. Statistical Package for Social Sciences version 20 was used for data analysis. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Result: The prevalence of premature rupture of membrane was found to be 15.3% out of 503 delivered mothers during six-month period. More than half (67.5%) of postnatal mother were between age of 35-45 years. More than half (57.1%) of mother were at 33-35weeks of gestation. Only 3.9 % of mother has Postpartum hemorrhage as maternal outcome. Only 2.6% of fetus have meconium aspiration syndrome as fetus outcome. Conclusion: The burden of premature rupture of membrane was found quite higher as compared to other similar studies done in Nepal. Hence, awareness, early screening, and treatment are necessary for the hospital attended pregnant women to minimize the risk of premature rupture of membrane. Keywords: Outcomes, premature and Rupture of membrane

Standardizing Normal Reference Value for Thyroid Uptake of Technetium-99m Pertechnetate in Nepalese Population.

Objective Changes in normal reference values of thyroid uptake for iodine have been reported due to geographical and chronological fluctuations in dietary iodine intake in different populations. Nepal is a country with mixed ethnicity, with access to dietary iodine in the form of successful universal salt iodination program by the government of Nepal since 1973. The aim of this study was to establish the normal reference values for thyroid uptake of technetium-99m (Tc-99m) pertechnetate in the Nepalese population in iodine sufficiency era. Methods We prospectively evaluated 52 clinically and biochemically euthyroid participants (46 females and 6 males) with age range from 20 to 71 years who underwent a thyroid Tc-99m pertechnetate scan and uptake between December 2019 to November 2023 in the Department of Nuclear Medicine, Chitwan Medical College fulfilling inclusion/exclusion criteria. Biochemical thyroid function tests were reviewed and Tc-99m pertechnetate thyroid uptake values were determined for each patient. Blood was withdrawn for thyroid hormone assessment. Euthyroid participants were then administered 3.5 to 4.5 mCi of Tc-99m pertechnetate intravenously and their percentage thyroid uptake was calculated after 20 minutes. Results The mean and median uptake of Tc-99m pertechnetate in euthyroid patients were 1.26 and 0.85%, respectively, and the interquartile range was 0.7 to 1.7%. The normal reference uptake value for Tc-99m pertechnetate in the studied population ranged between 0.3 and 3.6%. The fifth and 95th percentiles for pertechnetate uptake were 0.5 and 2.9%, respectively. Conclusion The normal reference range for Tc-99m pertechnetate thyroid uptake in Nepalese population was 0.5 to 2.9% that is lower than the currently accepted international standard of 0.75 to 4.5%. Uptake also increased with increasing age. This study highlights the importance of periodically redefining the geographic location specific normal thyroid uptake reference values.

Effect of self-management intervention on patients with chronic obstructive pulmonary diseases, Chitwan, Nepal.

Self-management skills are important for patients with Chronic Obstructive Pulmonary Disease (COPD) who are responsible for their day to day care. Poor self-management behaviours have a significant influence on symptoms, functional impairments and quality of life. Evidence has shown that self-management interventions support patients to respond to changing symptoms and thereby make appropriate decisions regarding their self-management. This study aimed to find out the effect of self-management interventions in patients with COPD in terms of self-management practice, inhaler practice, COPD symptoms burden, functional ability, self-perceived dyspnoea and emotional symptoms. Quasi-experimental pre-test post-test design was carried out among patients with COPD attending respiratory units of Chitwan Medical College Teaching Hospital (CMC-TH), Nepal. Convenience sampling technique was used to select the 70 patients with COPD for the study. Baseline data was collected from the participants using (i) Semi-structured interview schedule for socio-demographic and clinical variables, (ii) COPD Self-Management Practice Questionnaire, (iii) Borg Dyspnoea Scale, and (iv) Six Minute Walking Distance (6MWD) Test (v) Pulmonary Function Test (PFT) and (vi) Observation Checklist. Self-management Intervention given was 2 ½ hour sessions per week for 6 weeks along with information booklets distribution. Participants were re-evaluated after 3 months of intervention using same tools. Data analysis was performed using IBMSPSS version 20.0 for window. Wilcoxon signed-rank test was performed to find the effectiveness of the self-management interventions on outcome parameters. Self-management interventions (2 ½ hour session per week for 6 weeks) elicited a statistically significant change on self-management practice (z = -7.215, p<0.001), inhaler practice (DPI practice z = -6.731, p<0.001, MDI practice, z = -1.816, p = 0.005), functional ability (z = -4.243, p<0.001), self-perceived dyspnoea (z = -4.443, p<0.001), COPD symptom burden (z = -7.009, p<0.001) and emotional symptoms (depression, z = -6.856, p<0.001, anxiety, z = -6.675, p<0.001) of patients with COPD. Self-management intervention acts as powerful equipment to improve self-management practice, COPD symptoms burden, functional ability, self-perceived dyspnoea and emotional symptoms of patients with COPD. Hence, clinician and policy maker need to plan and intervene the rehabilitation program for the patients with COPD to enhance the effectiveness of therapy, self-management practice and general longevity.

The Relationship of Plasma Glucose Level and HbA1c among Diabetic Patients attending Chitwan Medical College

INTRODUCTION: Type 2 diabetes mellitus is a complex heterogeneous group of metabolic conditions characterized by an increased level of blood glucose, due to impairment in insulin action and/or insulin secretion. Normally the level of HbA1c is less than 6%. HbA1c level reveals the mean glucose level over the previous 10-12 weeks. HbA1c has become a very important part of the management of patients with diabetes mellitus. In addition, the HbA1c is a better indicator of chronic glycemic levels and has a better index to determine the risk for long-term complications as well. So for the screening or diagnosing DM by using glycated hemoglobin (HbA1c) level is very important. The aim of the study was to correlate the plasma glucose level and HbA1c in diabetic patients attending in Chitwan Medical College and Teaching Hospital. MATERIALS AND METHODS: The study was a cross sectional study carried out in Department of Biochemistry in collaboration with Department of Medicine, Chitwan Medical College, Nepal. The standard screening procedures such as fasting blood sugar (FBS), post prandial blood sugar (PPBS) and HbA1c were the parameters taken into account for the research work. RESULTS: It was found that both FBS and PPBG strongly correlated significantly with HbA1c values (r = 0.79, p &lt;0.001 and r = 0.75, p &lt;0.001). CONCLUSIONS: The results suggest that both fasting and postprandial blood glucose significantly correlated with HbA1c. However, our data suggest that HbA1c values may be a weak parameter to identify pre-diabetes cases. HbA1c threshold of ≥ 6.8% can be considered a relatively sensitive marker for the diagnosis of diabetes in the study population.

WAITING TIME AMONG PATIENTS UNDERGOING EMERGENCY SURGERY IN A TERTIARY HOSPITAL OF NEPAL

Background: Managing emergency surgical services and availing prompt treatment on time is one the most important aspects in the delivering quality healthcare services. Prior the average time waiting for emergency surgery from this healthcare setting is unknow. Therefore, this study was delineated to evaluate average waiting time among patients undergoing emergency surgery. Methods: This descriptive observational study was conducted at Chitwan Medical College from 15 March 2023 to 15 July 2023. Self -structured proforma was developed to document waiting time in each phase of delivering healthcare services, including triage time, consultation time, investigation order and report time, shifting the client from ER to OT for emergency surgery. Data was analyzed using IBM SPSS 20, and were interpretated in terms of descriptive statistics. Results: Among 122 cases, the longest waiting time was seen in oral maxi facial surgery with the average time 8 hours 27 minutes. The major surgeries had longest waited hours on an average 6 hours 19 minutes, compared to minor and intermediate surgeries. Overall, the average waiting time form patient admitted to emergency department to start of the surgery was found to be 4 hours 43 minutes. Conclusions: In this study, the commonest delays were evidenced were, delay in transfer to pre-operative area, delay in second consultation, OT busy, and delay in providing consent and financial incapability. Further improvements can be done by analyzing root cause, modifying the system and formulating standard operating procedure and maintaining a tracking system of patients requiring emergency surgery.

Comparison of various nasal parameters in different anteroposterior jaw relationships and growth patterns

Introduction: Evaluation of the patient soft tissue is one of the most important considerations in the diagnosis and customized treatment plan to enhance the facial esthetics of the patient. Hence, the present study was conducted to evaluate the nasal parameters in different anteroposterior jaw dysplasia and its association with different growth patterns and any gender dimorphism. Materials and Method: This study was conducted at the Chitwan Medical College in the Department of Orthodontics. Lateral Cephalogram of 100 patients with age ranging from 18-27 years were collected and traced manually. Various nasal parameters were then measured and descriptive statistics were performed followed by ANOVA tests to find out any statistical differences. Result: Among 100 subjects, 48 had average growth pattern, 26 had horizontal pattern, and 26 had vertical pattern. Likewise, 41 samples had skeletal class I, 39 had skeletal class II, and 20 had skeletal class III relationship. Nose length was greater in vertical growth pattern and skeletal class I. Nasolabial angle was greater in vertical growth pattern and skeletal class II. Nasal depth was greater in horizontal growth pattern and skeletal class II. Lower nose to Frankfurt horizontal angle was greater in average growth pattern and skeletal class III. All the parameters showed greater value in males with no statistically significant difference between gender. Conclusion: The present study showed that although different parameters showed variation among different malocclusions and growth pattern but it was not statistically significant.

Depressive disorder among the end-stage renal disease patients undergoing maintenance hemodialysis at Chitwan medical college

Background: Patients with End stage renal disease (ESRD) suffer from a variety of losses, including renal function, family role, work role, sexual function, as well as time and mobility, all of which have a substantial influence on their lives. Physical manifestation of the End-Stage Renal Disease patients receiving dialysis treatment may be obvious but studies have found that they are also at increased risk of clinical and subclinical Depressive Disorder for a variety of reasons; which might be overlooked in our routine clinical assessment. Depressive Disorder has been associated with impaired recovery and increased mortality in many diseases including End-Stage Renal Disease patients. Objectives: To assess the magnitude of depressive disorder among the patients undergoing hemodialysis of duration &gt;3 months at Chitwan Medical College Teaching Hospital (CMCTH) and to determine the association between explanatory variables with depressive disorder. Methods: Patients undergoing maintenance hemodialysis at CMCTH after meeting inclusion criteria were enrolled by consecutive sampling technique. Diagnoses were assessed on the basis of the ICD-10 Classification of Mental and Behavioral Disorders- Diagnostic Criteria for Research (ICD-10 DCR). To stratify the severity of the Depression into mild, moderate and severe categories, we used Hamilton Depressive Disorder rating scale. Seventy-four (74) patients undergoing maintenance hemodialysis were assessed. Interviews with patients and informants were taken and filled in a self-designed demographic datasheet. Obtained data were analyzed by using descriptive and inferential statistics. Results: The prevalence of the depressive disorder among patients undergoing maintenance hemodialysis was 75.70%. Positive correlations were found between depressive disorder and gender, age group and occupation(p&lt;0.05). Conclusion: The present study showed that the prevalence of depressive disorder was higher in ESRD patients compared to study done in Nepal where prevalence of depressive disorder in ESRD patients was 51.8%.

ANTIMICROBIAL PROPHYLAXIS IN SURGERY: A CROSS-SECTIONAL STUDY IN THE SURGICAL WARD OF A TERTIARY CARE CENTRE IN CENTRAL NEPAL

Background: Surgical Antimicrobial Prophylaxis is administration of a short course of antimicrobial agent prior to surgery. It has long been recommended for routine use in preventing occurrence of surgical site infections. The choice of drug, dosage, route, duration and timing of antimicrobial prophylaxis has been specified in the clinical practice guideline issued by American Society of Health-System Pharmacists. In the present study, we aim to seek the practice of antibiotic prophylaxis at a tertiary care centre in central Nepal and report the adherence to American and National Antimicrobial Treatment Guideline where applicable. Methods: This hospital-based cross-sectional study was conducted between January to June 2023 among 232 patients undergoing surgery at Chitwan Medical College Teaching Hospital. Data collection tool prepared with slight modification from previous studies recorded the demographic details, surgical data, surgical antimicrobial prophylaxis usage data and assessment of Prophylaxis data. Data analysis was done using SPSS-20. Results: We observed compliance to selection of drug, route of administration, dosage of antimicrobial prophylaxis with American guideline. All (100%) prophylaxis was administered parenterally for more than 72 hours in over 40% cases. Choice of drug was appropriate in over 84% of cases and dosage adequacy was observed in over 61% cases. Surgical antimicrobial prophylaxis was administered most frequently 30 minutes before surgery (52.59%). Conclusions: All the surgical patients were found to receive surgical antimicrobial prophylaxis. Ceftriaxone was the most commonly administered drug followed by combination of piperacillin and tazobactam. The duration of treatment post-surgery was found to be unnecessarily broader than recommended guideline.

ERRATUM of Issue 45 JCMC 2023

The online version and print version of Issue 45 of the Journal of Chitwan Medical College had a type error of only one number in the first page of all the original articles. The year of the journal of issue 45 should have been 2023 but it was written as 2022. The Journal confirms that the correct year is 2023 of Issue 45. The online version has been updated accordingly.

PREVALENCE OF DENTAL CARIES ON PERMANENT FIRST MOLARS AMONG CHILDREN OF AGE GROUP 6-14 YEARS

Background: Dental caries currently represents the most common chronic disease among children. Early detection of caries is very important as it helps in the prevention and control of carious diseases. This study was aimed to assess the prevalence of dental caries on permanent first molars among children of age group 6-14 years. Methods: This descriptive cross–sectional study was conducted among 270 children coming to Department of Pedodontics of Chitwan Medical College. The children of age 6-14 years were included in the study. Caries status was noted using DMFT index and the data was presented using descriptive statistical tool. This was analysed using SPSS version 26. Results: A total of 270 children of age group 6-14 years (Mean ± SD: 9.84 ± 2.24 years, median 10 years) participated in the study. The prevalence of dental caries of left mandibular first permanent molar was high 108 (40%) among the studied teeth. The prevalence of dental caries was high in mandibular arch. Conclusions: Among the permanent first molars, prevalence of dental caries was higher in mandibular arch than maxillary arch.