Chitwan Medical College Research Articles

LIPID ABNORMALITIES IN PATIENTS SUFFERING FROM MIGRAINE

Background: Migraine is a primary headache disorder causing social and economic impact worldwide. Many studies have suggested an association between migraine and various co morbidities, including cardiovascular disorders and lipid abnormalities. However, there is limited research on lipid abnormalities in migraineurs in Nepal. Therefore, this study was aimed to assess lipid abnormalities in migraine sufferers attending the outpatient clinic at a tertiary care hospital of Nepal. Methods: This observational study was conducted in the outpatient departments of Chitwan Medical College & Hospital from August 15, 2021, to February 15, 2022. A total of 309 patients diagnosed with migraine were involved in the study. The patients' body weight, height, blood pressure was measured and BMI calculated. Fasting lipid, such as total cholesterol, triglycerides, and LDL-C, were obtained. Results: Out of the 309 participants, 79.9% were females, and 20.1% were males. The mean age of the participants was 34.48±10.97 years. The majority of the participants (65.3%) had a normal BMI, while 22.3% were overweight, and 12.4% were obese. 32.7% of the participants had hypertension. 61.16% patient had normal cholesterol level and only 26(8.41%) had high cholesterol level. Similarly, more than 50 % of patient had normal TG level and 24.59 % patient had high TG level. Conclusion: The study found that most of the migraineurs attending our center had normal levels of Cholesterol, Triglycerides, and LDL-C suggesting that migraine patients may not have an increased risk of developing cardiovascular disorders.

THICKNESS MAPPING OF NEPALESE CALVARIA USING COMPUTERIZED TOMOGRAPHY

Background: The bony skeleton of the head is termed skull. Skull composed of cranial vault and base. Cranial vault is known as Calvaria. Cranial vault (Calvaria) is the superior view of skull (Norma Verticalis). Calvarium consists of frontal, parietal, temporal and occipital bones. Total thickness of calvarial bones includes outer table, diploe and inner table. Diploe is made up of spongy bone. Outer and inner table made up of compact bone. This study aims to measure the image assisted measurement of thickness of Calvaria and to observe the variation in thickness with age, gender and ethnicity. Methods: This was a descriptive cross-sectional study conducted at Department of Radiology, Chitwan Medical College Teaching Hospital Bharatpur-13, Chitwan. Patient of age 15 to 50 years with normal CT finding were included in the study. Using the axial view of brain CT, the thickness of Calvaria was measured and recorded in millimeter. Results: Hundred calvarial thickness was measured using computerized tomography scan. Thickness of frontal bone; parietal bone and occipital bone ranges from 0.37 mm to 0.97mm with mean value 0.6991±0.311mm;0.36mm to 0.99 with mean 0.6772±0.15058 mm and 0.30 to 0.95mm with mean 0.68±0.15236 respectively. No significant correlation between thickness of frontal, parietal and occipital bone is observed using Pearson coefficient. Conclusions: There is slight variation of calvarial thickness of frontal, parietal and occipital bone. The frontal, parietal and occipital bone thickness are not significantly correlated with each other.

Factors Associated with Postpartum Care during the Fourth Stage of Labor in Nepal: A Hospital-based Cross-sectional Study

Postnatal care is an important part of maternal and neonatal care, and life-threatening complications can occur during the postpartum period. Empirical information on the level of postpartum care services is generally scarce in Nepal. Key elements of postpartum care during the fourth stage of labor include providing proper nutrition, promoting breastfeeding, and helping the mother manage any physical discomforts or challenges that may arise. This study investigated the level of postpartum care services delivered during the fourth stage of labor in a tertiary-level hospital in the Chitwan district of Nepal. A descriptive cross-sectional hospital-based study was conducted among 148 women admitted for vaginal delivery. A set of structured observation checklists was developed and finalized based on the WHO Recommended Interventions for Improving Maternal and Newborn Health: Integrated Management of Pregnancy and Childbirth. The structured observation checklist had twenty-two items, including twelve critical steps. A good level of care was valid with a score of ≥ 90% based on total items, including all twelve critical steps of care, and a poor level of care was valid with a score <90%. The purpose of the study was explained to and written informed consent was obtained from all respondents. Ethical approval was received from the Institutional Review Committee of Chitwan Medical College. One third (33.8%) of the women received a good level of postpartum care services. Women’s residence (<em>p</em> = .021), number of pregnancies (<em>p</em> =.002), and number of antenatal visits (<em>p</em> =.029) were significantly associated with the level of postpartum care during the fourth stage of labor. Going forward, it will be important for Nepal to enhance the capacity of clinicians or nurses to provide postpartum care as per WHO guidelines.

Metabolic syndrome and life style factors among diabetes patients attending in a teaching hospital, Chitwan.

Metabolic syndrome (MetS) is associated with an increased incidence of chronic complications and mortality of diabetes patients. Prevention and treatment of MetS is important means of lowering the risk of cardiovascular diseases and mortality. This study aimed to find out metabolic syndrome and life style factors among diabetes patients. A cross-sectional survey was carried out among 296 patients with type 2 diabetes mellitus attending Chitwan Medical College Teaching Hospital. Consecutive sampling technique was used to select sample. Data were collected from 15th December 2021 to 15th March, 2022 using Interview Schedule, bio-physiological measurement and record review. Obtained data were analysed in SPSS version 20 for window using descriptive and inferential statistics. Chi-square test was applied to measure the association between the variables. Logistic regression analysis was performed to identify the factors associated with metabolic syndrome. Findings revealed that the prevalence of MetS was 66.2% and 58.4% in patients according to International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria respectively. The most common MetS parameters were raised fasting plasma glucose (94.6%) and abnormal waist circumference (78.4% in IDF criteria) while the least prevalent parameter was reduced HDL level (43.2%). Majorities of the patients were non-vegetarian (85.5%), had poor dietary compliance (poor-46.3%, very poor-32.1%), overweight/obese (65.5%), and suffered from moderate stress (90.1%). Bivariate analysis showed that MetS as per NCEP ATP criteria was significantly associated with gender (p = 0.006), occupation (p = 0.007), presence of other co-morbid condition (<0.001) and sleep problem (p = <0.001). However, MetS as per IDF criteria was significantly associated with age (p = <0.028), duration of diabetes (p = <0.001), follow-up visit (p = <0.030), blood sugar monitoring (p = <0.009) and physical activity of diabetes patients (p = <0.001). Further logistic regression analysis revealed that sleep problem (AOR = 21.812;95%CI = 8.512,55.894) and presence of other comorbidities (AOR = 4.024;95%CI = 2.220,7.295) were the significant factors of metabolic syndrome. Metabolic syndrome is high in patients with type 2 diabetes mellitus. Therefore, treating physicians and other health workers need to monitor MetS parameters regularly to reduce the risk of cardiovascular diseases, stroke and premature death.

Utility of the Parkland Grading Scale to determine intraoperative challenges during laparoscopic cholecystectomy: a validation study on 206 patients at an academic medical center in Nepal

BackgroundMost of the scoring systems to predict difficult laparoscopic cholecystectomy are based on pre-operative clinical and radiological findings. Recently the Parkland Grading Scale system was introduced as a simple intra-operative grading scale. This study aims to utilize the Parkland Grading Scale system to assess the intraoperative challenges during laparoscopic cholecystectomy.MethodThis was a prospective, cross-sectional study done at Chitwan Medical College and Teaching Hospital, Chitwan, Nepal. All the patients underwent laparoscopic cholecystectomy from April 2020 to March 2021. Based on the initial intra-operative finding, Parkland Grading Scale was noted and at the end of the surgery, the level of difficulty was given by the operating surgeon. All the pre-operative, intra-operative, and post-operative findings were compared with the scale.ResultsOut of 206 patients, there were 176 (85.4%) females, and 30 (14.6%) males. The median age was 41 years (Range 19–75). The median body mass index was 23.67 kg/m2. There were 35(17%) patients with a history of previous surgery. The rate of conversion to open surgery was 5.8%. According to Parkland Grading Scale, 67(32.5%), 75(36.4%), 42(20.4%), 15(7.3%), and 7(3.4%) were graded as grade 1, 2, 3, 4, and 5 respectively. There was a difference in the Parkland grading scale in patients with a history of acute cholecystitis, gallbladder wall thickness, pericholecystic collection, stone size, and body mass index (p < 0.05). The total operative time, level of difficulty in surgery, rate of help needed from colleagues or replacement as the main surgeon, bile spillage, drain placement, gallbladder decompression, and conversion rate all increased with an increase in scale (p < 0.05). There was a significant increase in the development of post-operative fever, and post-operative hospital stay as the scale increased (p < 0.05). The Tukey-Kramer test for all pair-wise comparisons revealed that each grade was significantly different from each other (p < 0.05) on the difficulty of surgery except for grade 4 from 5.ConclusionParkland Grading Scale system is a reliable intra-operative grading system to assess the difficulty in laparoscopic cholecystectomy and helps the surgeon to change the strategy of surgery. An increase in scale is associated with an increased difficulty level of the surgery.

Stone Free Rate of Lower Pole Calyceal Stone Versus Other Calyces in Retrograde Intrarenal Surgery

Background: Miniaturization of endoscopic instruments has gained wide popularity in the treatment of renal calculi. Retrograde intra-renal surgery (RIRS) and laser in combination has already proven their superiority when compared to other modalities in the treatment of renal calculi. This study was conducted to assess the stone-free rate (SFR) of lower pole calyceal stone versus other pole calyces in RIRS. Methods: This retrospective study analyzed the stone free rate of lower pole calyx stone versus other pole calyces in retrograde intra renal surgery (RIRS) adults above 15 years of age from March 2021 to February 2022 at Chitwan Medical College and Teaching Hospital, Nepal. The stone-free rate was assessed descriptively on post operative complications, stone size, operative time, hospital stay, and need for the second procedure. Results: A total of 62 patients underwent retrograde intrarenal surgery. The mean age of the study population was 38.41 ± 10.54years in the lower caliceal group against 39.09 ±13.53 years with p value of 0.829.The mean hounsfield of lower caliceal stone was 1023.31±252.96 to that of other caliceal stones 1004.00±349.22 with p value of 0.806. The sizes of the stones were 11.07±2.10 mm in lower caliceal stones versus 10.67±2.51mm in other caliceal stones with p value of 0.507. The duration of operation time in 1st group was 63.82±23.57minutes to that of 65.93±28.96 in 2nd group with p value of 0.756. The hospital stay in lower caliceal stones were 6.13±1.43days to that of other caliceal stones 5.87±0.99 with significant p value of 0.412. There were no major complications in both arms. The stone free rate was 25 (86.2%) in lower caliceal stones as compared to 31(93.93%) in other caliceal stones with no significant p value of 0.405. Conclusions: Retrograde intrarenal surgery is a better procedure that continues to undergo significant advancements. It is a technically safe and effective procedure for the treatment option for treating the lower pole calyx calculus with optimal post-surgical morbidity and stone-free rate.

Variations in Shape of Tongue among Students attending Chitwan Medical College

Introduction: The need for a new biometric system is gaining importance. Tongue print is also getting acceptance as a system for biometric authentication. The tongue is an extremely muscular organ used for communication, taste, and deglutition. Studies have shown variations in the morphology of the tongue. Studies pertaining to the morphology of the tongue is lagging in Nepal. Hence this study was carried out to assess the various morphological variations of the tongue such as shapes, borders, and color among the bachelor level students in a tertiary care center in Nepal Methods: A descriptive cross-sectional study was conducted among 312 bachelor-level students of Chitwan Medical College. The convenience sampling method was used to collect the data. All the data was recorded in a proforma. The sociodemographic details of the participants were recorded. The borders, colors, fissures, and shapes of the tongue’s morphology were documented. The collected data were entered into Microsoft excel 2019 and transported into Statistical Package for Social Science (SPSS) version 16. The data was then analyzed using descriptive statistical methods. The data was also calculated in form of frequency and percentage and later on, they were presented in form of a table. Results: Among 312 students who took part in the study, 126 (40.4 %) of the participants were male and 186 (59.6 %) of them were female. The mean age of participants was 22.38 ±2.008 years. U-shaped tongue was prevalent followed by V-Shape tongue and bifid tongue. More than half of the participants 180 (57.7 %) had partially scalloped tongues. While comparing gender wise U-shaped tongue was more common in both males and females. The bifid tongue was observed more in males 11 (8.7 %) while the V-shaped tongue was more in females 52 (28 %). Conclusions:

SATISFACTION TOWARDS NURSING SERVICES AMONG ADMITTED PATIENTS AT A TEACHING HOSPITAL, CHITWAN, NEPAL

Background: Patient satisfaction with nursing care is the degree of convergence between the patient’s expectation with the ideal nursing care and their perception of the nursing care they received. Patient satisfaction with nursing care is an important determinant of quality of care in healthcare facility settings. The objective of this study was to assess satisfaction towards nursing services among admitted patients in Chitwan Medical College &amp; Teaching Hospital (CMCTH).Methods: A descriptive, cross-sectional research design was conducted among 157 patients admitted in medical and surgical units of CMCTH. Data were collected by non-probability, convenience sampling technique using structured interview schedule and analyzed using descriptive and inferential statistics.Results: The study revealed that 45.9% of patients were young adults, 51% were male, 86.6% were Hindu, 44.6% were Brahmin/ Chhetri, 61.8% were from municipality and 42% had studied up to secondary education and above. More than half (52.2%) of patients had good satisfaction towards nursing services and association between level of satisfaction towards nursing services and mode of admission was statistically significant (p=0.036).Conclusions: Considerable proportion of respondents are dissatisfied with nursing services. Therefore, effective strategies need to be planned and implemented to improve quality of nursing services so that level of satisfaction towards nursing services can be improved.

PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN COVID-19 PATEINTS

Background: Coronavirus Disease 2019 is global pandemic having high morbidity and mortality. It is thought that COVID-19 can predispose high thrombus burden and lead to Acute Coronary Syndrome. The aim of this study was to compare the symptoms, angiographic characteristics and procedural outcome in COVID-19 positive and COVID-19 negative patient undergoing percutaneous coronary intervention for acute coronary syndrome. Methods: All the data of 121 patients who were admitted at Chitwan Medical College on April 2020 to September 2020, suffering from acute coronary syndrome who underwent PCI were collected and compared with COVID-19 positive and negative patients using SPSS version 22. The categorical variables were presented as numbers or percentages (%) and continuous variables were presented as mean ± standard deviation. Results: Patient suffering with acute coronary syndrome with concurrent COVID-19 infections have more symptoms of fever (27.3% Vs 0.9%) and cough (27.3% Vs 2.8%, complications (45.5% Vs 7.3%), Mortality (36.4% Vs 0.9%), multi vessels thrombosis (27.3% Vs 2.8%) glycoprotein IIb/IIIa inhibitors use (27.3% Vs 0.14%) than non-COVID infection. Conclusions: Patient with acute coronary syndrome with concurrent COVID-19 infections have high complication rate, multivessel thrombosis and death.

ATYPICAL PRESENTATION OF PULMONARY TUBERCULOSIS

Tuberculosis may have wide range of clinical presentation. Here, we present one of atypical presentation of pulmonary tuberculosis. A 41 years male presented to Medical OPD of Chitwan Medical College &amp; Teaching Hospital, tertiary level hospital located in central Terai region of Nepal with chief complaints of generalized body swelling for 4 days and failure to pass urine for 10 hours. Clinical findings revealed pulse 80 bpm, BP 110/70 mmHg and gross edema present all over body. On investigation, his urine examination showed protein +, pus cells plenty and serum albumin 1.4 gm/dl. So, initial diagnosis of Nephrotic syndrome and Urinary Tract Infection was made. 24 hour urinary protein was sent which didn’t suggest Nephrotic syndrome. Patient was treated initially with antibiotics for UTI, potassium supplement and diuretics. In addition, he developed fever on 3rd day of admission which did not subside even after 5 days of antibiotic therapy. His chest examination revealed crackles bilaterally on infraclavicular and subscapular regions. Initially chest X-ray and later on CECT chest were done which showed multiple enlarged intrathoracic lymph nodes. His initial clinical examination had not revealed any enlarged peripheral lymph nodes but after doing CECT, retrospective clinical examination revealed enlarged right supraclavicular lymph nodes, FNAC of which suggested tubercular lymphadenopathy. Anti-Tubercular Therapy was started on 2023/01/25 and after 5 days of treatment his fever subsided, appetite and general health being also improved. So, generalized intrathoracic lymphadenopathy can be atypical presenting feature of tuberculosis which is generally confused with malignancy and sarcoidosis.

OUTCOMES AND SAFETY OF RETROGRADE INTRA RENAL SURGERY FOR RENAL STONES

Background: Renal stones are one of the most common urological problems requiring surgical interventions. Retrograde intra-renal surgery is a minimally invasive surgical technique with minimal complications and a good stone-free rate. In the present study we aimed to assess the outcomes and safety of retrograde intrarenal surgery. Methods: A retrospective study was performed at Chitwan Medical College Teaching Hospital in the span of two years from Dec 2019 to Nov 2021. Patient demographics; stone burden, stone density, and location were collected from the medical records and evaluated. The data was collected in a proforma which was then entered into SPSS version 20. The data was presented in form of frequency and percentage. Results: One hundred and seventy patients were subjected to retrograde intrarenal surgery, out of which 32 were converted to mini- percutaneous nephrolithotripsy, 12 were presented and total of 126 were subjected to retrograde intrarenal surgery. The major complications were pyrexia in 21(16.67%) patients followed by hematuria in 4(3.17%) patients, and sepsis in 2(1.58%) patients. The stone-free rate was 94.4%. 2 (1.58%) patients underwent mini- percutaneous nephrolithotripsy and5 (3.96%) of them showed stones of varying size 2-6mm, non-obstructive with none of cases planned for staged retrograde intrarenal surgery. Conclusions: Primary Retrograde intrarenal surgery is the safe and effective treatment for the intrarenal stones.

CORONARY ARTERY ANOMALIES IN PATIENTS UNDERWENT CORONARY ANGIOGRAPHY IN A TERTIARY HOSPITAL OF CENTRAL NEPAL

Background: Coronary artery anomalies are infrequent findings during coronary angiography and may result in longer radiation time and increase the risk of complications. Insufficient knowledge of coronary anomaly may lead to accidental damage of vessels during cardiac surgery. This study aimed to estimate the prevalence of coronary artery anomalies among the patients underwent coronary angiography at our center. Methods: A retrospective study was conducted at Chitwan Medical College. Coronary angiography records of all patients from 1st April 2020 to 30th April 2022 were analyzed by two interventional cardiologists. Statistical analysis was done using Statistical package for social survey, Version 20.0 for windows. The categorical variables were presented as numbers or percentages (%) and continuous variables were presented as mean ± standard deviation. Results: A total of 1015 patients who underwent coronary angiography for various indication were included. Coronary artery anomalies were observed in 21 (2.1%) patients. Among anomalies most common was anomalies of origin 16 (76.2%) followed by anomalies of intrinsic coronary artery 5 (23.8%). Separate origin of the conus branch was the most common coronary artery variation 103 (10.1%). Conclusions: The prevalence of coronary artery anomalies in present study was similar to many large sample size previous studies from different geographical area. However present study reflects scenario of our population, which may be helpful for interventional cardiologist and cardiac surgeon during coronary angioplasty and cardiac surgery.

Assessment of Serum Electrolyte in Hypothyroid Patients Attending Chitwan Medical College

INTRODUCTION: Hypothyroidism is a clinical condition resulting from inadequate synthesis of the thyroid hormones. Thyroid hormone has an influence on renal hemodynamics, glomerular filtration, as well as the renin angiotensin aldosterone system and renal electrolyte handling. The aim of present study was to find out the serum concentration of electrolytes sodium and potassium in hypothyroid patients attending a tertiary care hospital. MATERIALS AND METHODS: A hospital-based descriptive cross-sectional study was conducted from 24th July 2019 to November 30th 2019 at Chitwan Medical College Teaching Hospital. A venous blood sample was collected and T3, T4 and TSH levels were measured by using chemiluminescence technology. Sodium and potassium levels in blood were investigated by ion selective electrode (ISE) method. Data were analyzed using IBM SPSS 21 software. RESULTS: In our study parameters (T3, T4 &amp; TSH and Na+) were significant (P&lt;0.05) in hypothyroidism subjects (group II) as compared to control subjects (group I) except for electrolyte potassium which was non-significant at P&lt;0.05. T3 and T4 were found significantly decreased whereas TSH was found elevated in subjects of hypothyroidism (group II) as compared to controls. The level of potassium was within the normal range but it was found not significant as compared to healthy controls. CONCLUSIONS: The study concluded that there was increase in TSH with decrease in T3 and T4 in hypothyroid subjects but the electrolyte sodium was found to be statistically significant.

Anatomy and Variants of Hepatic Arteries in 120 Patients Studied with 128 Slice Volumetric Scan in Nepalese Population

Introduction: Modern advances in radiology, imaging, and novel surgical methods have greatly aided doctors in making both surgical and non-surgical decisions. During surgery, anatomical variances are frequently encountered by surgeons, making operation complex and occasionally challenging. The purpose of our study was to evaluate the hepatic artery and its variants, including the length and diameter of the right and left hepatic arteries. This information is vital for patients undergoing major hepatic surgeries and hepatic transplantation Methods: A total of 120 patients who underwent contrast-enhanced Triphasic CT of the abdomen were evaluated with the consent of the ethics committee at Chitwan medical college. Study subjects were selected on a random basis, who had no previous abdominal or hepatic surgeries, and without the known hepatic disease. Results: Out of 120 participants, 63 (52.5%) were male and the rest 57(47.5 %) were females. Normal anatomy was observed in 104 cases (86.7%) and the rest of the 16 cases showed an anomalous hepatic arterial pattern, which consisted of Michel’s type III in 6 cases (5%), Type IV in 1 case (0.8%) and Type X in 3 cases (2.5%); and 5 cases (4.2%). did not fall under Michel’s Classification. Supply to segment IV of the liver was observed from Left hepatic artery in 97 cases (80.8%) and from the right hepatic artery in 23 cases (19.2%). Conclusions: Many hepatic arterial variants which did not fall under Michel’s classification were observed in our population.

STUDY OF A VARIATION OF LUMBOSACRAL PLEXUS: SCIATIC NERVE AND ITS CLINICAL SIGNIFICANCE

Background: The pelvis is a home to pelvic parts of the sympathetic and parasympathetic nervous systems, the sacral and coccygeal plexuses, and the lumbosacral trunk. The lower spine’s sciatic nerve is made up of a combination of motor and sensory fibers from spinal nerves fourth lumbar to third sacral segment (ventral rami). The objective of study was to determine morphological variations in origin and formation of branching pattern of sciatic nerve. Methods: A descriptive cross-sectional study was conducted on twenty-four (forty-eight lower limbs) cadavers available in the Department of Anatomy at School of Basic Sciences, Chitwan Medical College. All damaged cadavers were excluded. The cadavers for undergraduate first year medical students dissected as per Cunningham’s Manual. The branching pattern of the sciatic nerve was noted. All Variation of each sacral plexus was photographed. Statistical analysis was done using Microsoft Excel and SPSS version 20. Both gluteal regions were studied for the locations and variation of the sciatic nerve. Results: Forty-eight lower limbs were examined. Among them forty-two lower limbs (87.5 percent) showed a normal anatomy of the sciatic nerve. Six lower limbs (12.5 percent) showed variations in the sciatic nerve. Conclusions: The study concluded that there are variations in origin and formation of branches of sciatic nerve. Variations of sciatic nerve observed could be beneficial for various surgical interventions like nerve release and pain management in compressed nerve.

CLINICAL AND BLOOD PARAMETERS IN RELATION TO THE OUTCOMES OF COMMUNITY ACQUIRED PNEUMONIA

Background: Risk stratification of Community acquired pneumonia (CAP) is challenging for physicians. Though various biomarkers are available, they are costly or not readily available in all health care settings. This study aimed to analyze the prognostic value of routinely available clinical and blood parameters in relation to the outcome of patients admitted with community acquired pneumonia. Methods: This was a hospital-based observational study of the patients admitted to Chitwan Medical College (CMC), Nepal between August 2021 and December 2021. We enrolled patients 18 years old and above with the diagnosis of CAP in the study and excluded patients with COVID and active pulmonary tuberculosis. The outcomes of the patients were recorded as improved, not-improved, or dead. Fischer exact, Kruskal-Wallis or Mann-Whitney tests were used for analysis wherever appropriate. Results: Total 92 patients with mean age 58.2 years were enrolled in the study. Patients who were not improved or were dead had higher age (p=0.029), respiratory rate (p&lt;0.001), shock index (p=0.013), total leukocyte count (TLC) (p=0.019), urea (p=0.046), creatinine (p&lt;0.01), potassium (p&lt;0.001), bilirubin (p=0.029), and lactate (P&lt;0.05) and lower SpO2 (p&lt;0.01), SpO2/FiO2 (p=0.018), pH (p=0.0497), and PaCO2 (p&lt;0.001). Patients with nervous (p&lt;0.001), cardiovascular (p=0.032) and renal system (p=0.019) involvement were also found to be associated with poor outcome. Conclusions: CAP patients with higher TLC, urea, creatinine, bilirubin and lactate, with lower SpO2, SpO2/FiO2, pH and PaCO2 and with involvement of more than one organ systems were found to have unfavorable prognosis. Higher potassium level was also found to be a potential marker of CAP severity.

Assessment of Inter-Incisal Distance among the Bachelor Level Students of a Tertiary Care Centre of Nepal

INTRODUCTION: The inter-incisal distance at maximum mouth opening has been referred to as normal mouth opening. Variations in the inter-incisal distance exists among different age groups, sex, gender, race and ethnicity. The mean inter-incisal distance is required during the treatment of maxillofacial fractures, temporomandibular joint disorders, oral malignancies, reconstructed mouth anomalies, and craniofacial syndromes. The aim of this study was to determine the maximal inter-incisal distance among bachelor level students of tertiary care center of Nepal. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among the 320 bachelor level students of Chitwan Medical College. Convenience sampling method was used. Sex and ethnicity of the patient were recorded. Inter-incisal distance was measured in all the participants with the help of tongue depressor. The data were entered in Microsoft Excel 2019 and later transported to Statistical Package for Social Science (SPSS) version 16 for the statistical analysis. Descriptive statistical analysis was done. RESULTS: In this study among the 320 participants 131 (40.9 %) were male and 189 (59.1 %) were female. The mean age was 22.34 ± 2.02 years. The mean inter-incisal distance of male and female was 48.69 ± 6.92 mm and 46.51 ± 6.24 mm respectively. The mean inter-incisal distance was maximum in Muslims who had inter-incisal length ie.51.24± 3.54 mm, followed by Buddhists 48.86± 5.89 mm. CONCLUSIONS: This study concluded that the mean inter-incisal distance of male was more than that of female. On the basis of religion, Muslim students had maximum inter-incisal length followed by Buddhists, Hindus and Christians. On basis of ethnicity this study documented the maximum inter incisal distance in Chhetris and minimum in Newars.

Study of Point of Care Lung Ultrasound in Patients with Acute Respiratory Failure

Introduction: An acute dyspnea has been a common cause of hospital admission throughout history. When formulating a treatment plan based on limited clinical information, a rapid diagnosis is important. Bedside maneuvers and tests that deliver rapid and reliable results represent a cornerstone of diagnostics medicine. Methods: This was a one-year cross-sectional research conducted at Chitwan Medical College Teaching Hospital. Consecutive patients with acute dyspnea whom were admitted for ≤ 6 hours were included in the study. A 5MHz micro-convex probe was used as the optimal single probe. Data entry and descriptive analysis were done in IBM SPSS version 20.0. Point estimate at 95% confidence interval was calculated along with frequency and descriptive statics. Results: Pneumonia was the most common overall ultrasound diagnosis with combined frequency of 47%. With a Positive Predictive Value of 94.11% and Negative Predictive Value of 97.01%, anterior pneumonia exhibited a sensitivity of 94.11% and specificity of 97.11%. Similarly, Posterior Lateral Alveolar Points (PLAPS) pneumonia had a sensitivity of 94.11% and specificity of 98.08%, with a PPV of 94.11% and NPV of 98.80% respectively. The clinical accuracy for pulmonary edema was the greatest with 96.77%. while COPD/asthma had least accuracy with 81.25%. Conclusions: POCUS of the lung, has a high sensitivity and specificity, especially for evaluation of acute causes of dyspnea such pulmonary edema and pneumonia. It is more sensitive than Chest X ray alone and should be integrated while making clinical diagnosis.

DETERMINATION OF SCAPULAR INDEX IN HUMAN SCAPULA

Background: Scapula is the important flat bone which plays important role in movement of shoulder girdle. Scapular index can be used in comparative anatomy and manufacturing prosthetic products. Present study was carried out with objective to determine the scapular index. Methods: Fifty adult scapula were collected from Department of Anatomy, Chitwan Medical College for study. Gender and ethnicity of scapula were undefined. Bony landmarks are well located. Scapular breadths and lengths were measured using digital vernier caliper. Scapular index was calculated. Statistical analyses were done using SPSS 16 software. Results: Among the fifty scapulae, 52% contributes right sided scapula and 48% left sided scapula. Mean and standard deviation for scapular breadth were 95.84 mm and 3.843 mm respectively. Maximum number (48%) of scapula was found in the range of 90-&lt; 95 mm breadth followed by 95-&lt;100 mm (19%) and 100-&lt;105 mm (14%). Mean and standard deviation for scapular length was 129.28 mm and 11.83 mm respectively. Maximum (22%) of scapula was found in range of 120-&lt;125 mm followed by 125-&lt;135 mm (18%) and 135-150mm (5%). Mean and standard deviation for scapular index were 75.32 mm and&amp; 7.32 mm respectively. Maximum value (46%) of scapular index was found in the range of 70-&lt;75% followed by 65-&lt;70% (16%); 80-85% (14%); 90-&lt;95% (10%); 60-65% (4%) and 85-90% (2%). Conclusions: Scapular breadth, length and indices like scapular index can be used in comparative anatomy and manufacturing prosthetic products and procedure like prosthesis positioning.

BURDEN AND COPING STRATEGIES AMONG CAREGIVERS OF MENTALLY ILL PATIENTS ADMITTED IN TEACHING HOSPITAL

Background: The family member is an important support system in the care of patient with chronic mental illness. The caregivers experience from a number of significant stresses and burden and need concern from the mental health professionals. The objective of the study was to assess the extent of burden and coping strategies among caregivers of mentally-ill patients. Methods: Descriptive cross-sectional study design was used among 102 caregivers of mentally ill patients admitted in Psychiatric ward of Chitwan Medical College, Teaching Hospital. Non-probability consecutive sampling technique was used to select the sample. Ethical approval was taken from the Institutional Review Committee. Data were collected from 27 January 2020 to 29 May 2020 using a structured interview schedule and record review. Data was analyzed using Statistical Package for Social Sciences version 20 and analyzed by using descriptive statistics and inferential statistics. Results: Among 102 caregivers, it was found that 47.1% caregivers perceived moderate to severe burden, 41.2% of the caregivers experienced mild to moderate and 11.8% experienced minimal burden. The highest median percentage of caregivers reported financial burden (50%) where 41.66% reported burden in the relationship. The most frequently used strategies were use of informational support (62.5%), venting (62.5%), positive reframing (62.5%), acceptance (62.5%), and religion (62.5%). Conclusions: The highest percentage of caregivers experienced moderate to severe burden. So, mental health professionals should develop training programs that include counseling to support both patients and family caregivers to reduce the family burden and improving coping skills.