Kathmandu Medical College Teaching Hospital Research Articles

Assessment of Third Molar-related Symptoms Affecting Quality of Life using Nepali Version of Oral Health Impact Profile-14: A Descriptive Cross-sectional Study

Introduction: Impacted third molars often cause pain, infections, swelling, and functional limitations. This study is an attempt to assess impacted third molars-related symptoms affecting quality of life using standardised Nepali version of oral health impact profile-14 (OHIP-14) questionnaire.Methods: This descriptive cross-sectional study was conducted at Kathmandu Medical College Teaching Hospital from October 2021 to February 2022 after institutional ethical approval. Patients with impacted third molars were included by convenience sampling technique. Patients with psychiatric illness, taking psychotropic drugs, pregnant, and lactating females were excluded. third molars-related symptoms were recorded in OHIP-14 questionnaire. Data entered in Microsoft Excel sheet were analysed. The findings have been presented as frequency, percent, mean, and standard deviation. The point estimate was calculated at a 95% Confidence Interval. Results: Mean OHIP-14 score of participants was 21.77±11.59. Due to TM, “pain in the mouth” had score of (2.33±1.24) and followed by “uncomfortable experience on eating food” (2.12±2.15). Among seven OHIP-14 dimensions, “physical pain” with two items OHIP3 and OHIP4 had score of 4.53±2.19 implying most participants had “quite a lot" of physical pain due to TM: OHIP3 = 194 (50.2%) and OHIP4 = 183 (47.3%).Conclusions: Impacted third molars-related symptoms were affecting quality of life of participants.

Outcome of laparoscopic vs open appendectomy in the management of acute appendicitis

The worldwide trend of appendectomy is shifting from conventional open to the laparoscopic technique. The study’s objective was to compare laparoscopic and open appendectomy in terms of various operative and postoperative parameters to find the best operative technique. A prospective comparative study was conducted on 142 patients undergoing laparoscopic (n=43) or open appendectomy (n=99) from 1st February 2022 to 30th January 2023 under the Department of Surgery of Kathmandu Medical College Teaching Hospital (KMCTH). In five patients, laparoscopic appendectomy was later converted to open and excluded from the study. The mean operating time for the open appendectomy group was 44.1±13.1 minutes while for the laparoscopic appendectomy group, it was 48.4±14.0 minutes (p=0.047). Visual analogue score taken on 1st, 7th and 30th post-operative day for open and laparoscopic appendectomy were 4.0±2.2 vs 3.6±1.9 (p=0.160); 1.4±1.3 vs 0.6±0.9 (p<0.001) and 0.2±0.5 vs 0.02±0.15 (p=0.107) respectively. The total days of postoperative hospital stay were 1.57±0.96 for open appendectomy and 1.58±1.07 for laparoscopic appendectomy (p=0.843). However, laparoscopic appendectomy group had an earlier return to normal activity (7.30±1.15 days) when compared to the open appendectomy group (8.05±2.42 days) (p=0.023). The laparoscopic appendectomy group also had fewer postoperative complications than the open appendectomy group (18.6% vs 24.2%) (p=0.411). Thus, laparoscopy is a safe and effective method of removal of appendix for acute appendicitis.

Patients’ perception of infection control in dentistry

Background: Dentistry is a high-risk profession for infections due to exposure to contaminated materials like blood, saliva, and instruments. Both dental staff and patients can contract diseases via person-to-person contact or contaminated objects. Objectives: To assess patient perception of infection control practices in dentistry which will help in planning effective public health care delivery. Methods: A descriptive cross-sectional study was carried out in 170 patients visiting Kathmandu Medical College Teaching Hospital (KMCTH) over the period of three months (2022 June to 2022 August) for any form of dental treatment. Ethical approval was granted by Institutional Review Committee of KMCTH on 8th June 2021. Data obtained were entered and analysed using SPSS v.21. Results: Majority of the participants believed dentists should wear gloves (164, 96.7%), face masks (159, 93.8%), and eye goggles (105, 61.9%) while treating patients, and 152 (89.6%) of participants agreed that dentist should change gloves between patients. However, nearly half of the participants were not hesitant to receive treatment from the dentist not wearing gloves (82, 48.3%) and mask (86, 50.7%). In total, 119 (70.2%) agreed that it was possible to catch an infection during dental treatment and 121 (71.3%) did take interest in sterilisation of instruments but only 21 (12.3%) always asked their dentist about the method of sterilisation. Conclusion: Patients possess a strong awareness of the importance for infection control in dental practice, however, this study underscores the importance of implementing effective infection control measures in dental settings to ensure the safety and well-being of patients.

Study of blood group and platelet counts in ER and ENT patients with epistaxis

Background: Epistaxis is one of the most common emergencies and a very difficult problem to tackle especially in Primary Health Centers or Health Posts in rural areas of Nepal. The objective of the study was to identify blood group and platelet count with the occurrence of nasal bleeding. Materials and Methods: A prospective study was carried out among 96 patients visiting Kathmandu Medical College and Teaching Hospital in Emergency Department and ENT Department with epistaxis from October 2021 to October 2022. Ethical clearance was obtained from IRC Kathmandu Medical College Teaching Hospital (reference no: 0609202105). A blood sample was sent for blood groups and platelet count. Convenience sampling was used. Data were entered in Microsoft Excel 2016 and analyzed in Statistical Package for Social Sciences version. Results: The age group of 20-29 years was found to be the commonest age group presented with epistaxis. The commonest blood group with epistaxis was found to be O+ve and platelet count was found to be within the normal range in the majority of the cases. Conclusions: Epistaxis was found to be more common among patients with O+ve than non ‘O’ blood groups. Patients with Blood group O+ve need to be investigated further for coagulation profile before any kind of procedure.

Psychological status and coping measures of individuals living with chronic obstructive pulmonary diseases

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and imparts substantial economic burden on individuals and health systems. Anxiety and depression were almost three times more common in COPD patients compared to the participants from the general population. Objectives: To assess the psychological status and coping measures of individuals living with chronic obstructive pulmonary diseases. Methods: Analytical cross-sectional research was conducted in medical outpatient department of Kathmandu Medical College Teaching Hospital from 2019 Nov 20 to 2020 May 20 after institutional ethical clearance. Total 185 individuals diagnosed with chronic obstructive pulmonary disease seeking medical care were included in the study by using purposive sampling. Data collection was done through face-to-face interview technique using Hopkins Symptoms Checklist-10 and Brief Cope inventory. The collected data were analysed using SPSS software version 20. Results: Based on a cut-off value of ?1.85 of Hopkins symptoms checklist-10, almost all (180, 97.3%) patients had mental distress. Frequently used approach coping subscales by the patients were emotional support (82, 44.2%), religion (81, 42%), planning (80, 41.8%), and active coping (80, 41.7%). Similarly, mostly used avoidance coping were: denial (80, 41.8%), venting (79, 41.1%), and self-blame (78, 40.6%). Conclusion: Almost all patients living with chronic obstructive pulmonary diseases had predicted mental distress and they were using both approach and avoidance coping measures.

Indocyanine green fluorescence imaging in gastrointestinal surgery

Background: Prevention of post-operative anastomotic leak (AL) is significant challenge for surgeons, with roughly half of all AL cases linked to insufficient vascular supply, often undetectable during anastomosis. Recently, indocyanine green fluorescence (ICG) emerged as promising tool in visceral surgery due to its low cost, ease of use, wide availability, and low toxicity. In gastrointestinal surgery, ICG is primarily used for real-time intraoperative angiography, allowing surgeons to assess anastomotic stumps' perfusion before and after procedure. Objectives: To assess efficacy of ICG as an adjunct in preventing AL. Methods: This descriptive study conducted after ethical approval at Kathmandu Medical College Teaching Hospital from 2022 February 15 to 2023 January 30 included 111 patients enrolled via convenience sampling. During operation, surgeon used ICG fluorescence angiography on patients to determine perfusion status, which allowed for evaluation of transection line and post-anastomotic viability. Data were entered in Microsoft Excel sheet 2019 and descriptive analysis done regarding demographic data, changes in the transection line, and post-operative anastomotic leaks. Results: Total 111 patients with age 55.41 ± 13.63 years and male-female ratio of 2:1 participated in this study. ICG use resulted in changes to proximal resection margin for five (4.5%) patients. Clinical judgment and ICG fluorescence imaging showed a difference in bowel transection line of 0.5-1.5 cm. None of the patients who underwent proximal resection margin revision with the assistance of ICG experienced post-operative anastomotic leaks. Conclusion: ICG fluorescence can be used as an adjunct in determining the viability of anastomosis and prevent post-operative anastomosis leak.

Experience of Providing Kangaroo Mother Care at a Tertiary Hospital

Introduction: Hypothermia is a major problem in newborns particularly among low birth weight (LBW) babies and it is one of the major cause of mortality and morbidity among LBW babies. Kangaroo Mother Care (KMC) is a simple method of maintaining temperature by keeping the LBW babies normothermic and indicated especially for LBW babies without using costly equipment. Dr Edgar Rey Sanabria introduced Kangaroo Mother Care (KMC) in Bogotá, Colombia in 1978 as an alternative to incubators for LBW infants to keep small babies warm. WHO defines KMC with its four components: early, continuous, and prolonged skin-to-skin contact between the newborns and mother; exclusive breastfeeding; early discharge from the health facility and close follow-up at home. Objective: To share the experience of Kangaroo Mother Care (KMC) at Kathmandu Medical College Teaching Hospital (KMCTH)
 Materials and Methods: At neonatal unit, 5 bedded an air-conditioned room were allocated as the KMC room and the temperature of this room was maintained at 28 0C. Before starting KMC, orientation on KMC, its procedures and benefits were explained to the mother or caregivers. Premature /LBW babies were kept over the mother’s chest with the help of cotton-made slings (Nyano Angalo wrap). The study period was of a one-year duration (Nov 2018- October 2019) .
 Results: 35 babies born in KMCTH received KMC during 12 months period (Nov 2018- October 2019) using Nyano Angalo wrap. The mean birth weight of babies kept on KMC was 1340 gms and mean gestational age was 33.6 wks. Each baby received KMC for 14.5 hrs average duration.
 Conclusion: Kangaroo mother care is a simple, feasible and non expensive intervention. It enhances breast feeding and bonding between the mother and the newborn babies. Its extensive use will help in the reduction of present high neonatal mortality, particularly among LBWs due to hypothermia.

Evaluation of the knowledge of sun exposure and sun protective measures in healthcare workers

Introduction: Solar ultraviolet (UV) radiation has a great impact on human life. The sun has always played an important role in Asian culture, so much so, that it is often prayed to as a God. Prolonged sun exposure can cause extensive and chronic harmful effects. Healthcare personnel is supposed to have good knowledge regarding sun protection as they play a key role in society disseminating knowledge to the general public. There are limited data regarding the knowledge of sun protection and sunscreen practice among health care workers. Methods: This descriptive cross-sectional study was carried out from June to October 2020 on healthcare workers (medical staff) in Kathmandu Medical College Teaching Hospital. A questionnaire was distributed to the target study population without disturbing or hampering the healthcare worker’s duty. Results: Out of a total of 264 participants in the study, 84 (31.8%) were male and 180 (68.2%) were female. The knowledge of proper terminology for SPF (Sun Protection Factor) was noted in 196 (74.2%) and 57 (21.6%) agreed that the value of SPF was related to age. No significant difference was noted regarding knowledge about the time of sun exposure for Vitamin D synthesis. No significant differences were found in practices of sunscreen use for purposes of fairness, or prevention of tanning, wrinkle, mole, and skin cancer. Conclusion: A higher level of education was associated with better knowledge and proper abiding practices regarding sunscreen use. As healthcare workers play a key role in distributing information in society, they should be targeted in education campaigns regarding sun exposure and sun protection measures; with these efforts focused more on nurses and medical officers.

Association Between Vitamin D Deficiency and Recurrent Tonsillitis.

Tonsillitis is defined as an inflammation of the tonsils characterized by signs of tonsillar erythema and exudates and recurrent tonsillitis is at least 7 episodes of acute tonsillitis in a year, or a minimum of 5 episodes in a year for 2 consecutive years, or at least 3 episodes in a year for 3 consecutive years. There are many research that have hypothesized the association of low level of Vitamin D and recurrent attacks of acute tonsillitis. A single centre prospective, cross sectional analytical study was conducted from 2021 June to 2022 March in Department of ENT and Head and Neck surgery in Kathmandu Medical College Teaching Hospital. The study participants were recruited from ENT Head and Neck OPD and the data on number of episodes of recurrent attacks of tonsillitis and serum level of Vitamin D were collected. 78.8% of patients with tonsillitis had low level of serum Vitamin D (less than 30ng/ml) and 21.2% had optimal level of serum Vitamin D (more than 30ng/ml). The incidence of recurrent tonsillitis was 40.9% in patients with low level of Vitamin D where as the incidence of recurrent tonsillitis was 18.1% in patients with optimal level of Vitamin D. The low serum level of Vitamin D was found to be associated with recurrent episodes of tonsillitis.

Digital Eye Strain in Medical Undergraduate Students during COVID-19 Pandemic.

Digital devices have been an integral part of our daily lives. With the emergence of COVID-19 pandemic we have gone through strict lockdowns. Most educational institutions conducted classes virtually. This increased the symptoms of digital eye strain. This study aims to assess the prevalence, symptoms, and level of awareness regarding digital eye strain in medical undergraduate students following the COVID-19 pandemic. Our study was a questionnaire-based cross-sectional study with a duration of 3 months. All the undergraduate medical students studying at Kathmandu Medical College Teaching Hospital were included in the study. A self-administered questionnaire was sent to each student electronically via google forms. Descriptive statistics, frequency tables, and percentages were calculated. A total of 208 students were included in the study. The mean age of participants was 22.7±1.6 years (Mean ± SD) with a mean duration of online classes being11.39 ± 5.2 months (Mean ± SD) . The average screen time of students before the start of online classes was 4.14 (SD=2.13) hours. The average screen time after the start of online classes was 7.93 (SD=2.44) hours, an increase of 91.54%. The overall prevalence of digital eye strain among the respondents was 90.8% (n=189). The prevalence of digital eye strain in our study was high. The average screen time increased significantly following COVID-19. Therefore, it is important to create awareness regarding digital eye strain and practices that decrease the symptoms of digital eye strain.

Effectiveness of iron-based phosphate binders in reduction of hyperphosphataemia in chronic kidney disease patients

Background: Ferric citrate is novel iron-based phosphate-binding drug for management of hyperphosphataemia and iron-deficiency anaemia in chronic kidney disease (CKD) patients. Objectives: To evaluate impact of ferric citrate therapy on reduction of phosphate levels and improvement in haematological parameters in CKD stages 3-5. Methods: This analytical, observational study was conducted at Kathmandu Medical College Teaching Hospital from 2020 July-December after ethical clearance using convenience sampling method. Non-dialysis dependent patients at CKD stages 3-5, having hyperphosphataemia (serum phosphate >=4.6mg/dL) and anaemia (serum haemoglobin <12 gm%, transferrin saturation <=30%, ferritin <=300ng/mL) were administered with 2gm twice daily dose of ferric citrate for 12 weeks and evaluated on outcomes in terms of reduction in serum phosphate levels and improvement in haematological parameters as study endpoints. Data were entered in Microsoft Excel and analysed in SPSS v.25. Significance level was set at p <0.05. Results: Of 84 study participants, majority had CKD stage 4 (46, 54.76%). A significant reduction (p <0.001) in mean serum phosphate levels of 6.21 ± 1.062 mg/dL from baseline to 4.89 ± 1.100 mg/dL in 12-weeks was observed. Patients with CKD stages 3, 4, and 5 had mean reduction of 1.67 (p = 0.005), 1.40 (p <0.001), and 1.04 mg/dL (p = 0.002) of serum Phosphate level respectively. Significant (p <0.001) improvements in hemoglobin level, serum iron, ferritin, total iron binding capacity, and transferrin saturation were reported. Conclusion: Ferric citrate is effective and well-tolerated phosphate-binder to improve hyperphosphataemia and iron deficiency anaemia in non-dialysis CKD stage 3, 4, and 5.

Evaluation and surgical outcome of inverted nipple at Kathmandu Medical College Teaching Hospital

Introduction: Inverted nipples are related to multifactorial aspects, relating with aesthetic, biological, and psychological to the patient. The treatment depends on the patient’s symptoms and aesthetic complaints caused by the inverted nipple. The objective of this study was to evaluate the grading of inverted nipple and the surgical outcome by using Sakai method for its correction. Methods: It is a hospital based descriptive study conducted to assess age, sex, site, shape, grading. The history of peri-areolar abscess, recurrence and treatment outcome by Sakai method for its correction. Results: A total of 20 patients were included with 26 cases of inverted nipple in which six cases of bilateral, nine cases of left sided and five cases of right sided. The mean age was 30±8.399 years ranging from 18 to 52 years. Most of them were females 19(95%). We found grade II inverted nipple on 16(80%) of patients and grade III inverted nipple on 4(20%). Most of them were round shape 16(50%), rest were rectangular 4(20%), slanting 3(15%), omega 2(10%) and one with cup shape nipple. Patients were followed up for three months for observation. Conclusions: The common type of inverted nipple was Grade II followed by Grade III and the defects were successfully corrected using Sakai method.

Assessment of cardiorespiratory fitness among medical students: a prospective study

Background: Physical activity and fitness level of fitness decline mostly between adolescence and early adulthood. This leads to risks of non-communicable diseases in the future. Medical students, assumed to have an extensive understanding of physical exercise and its benefits, are less active than they were before attending graduate school. This study aimed to assess changes in physical fitness and physical activity of students over-time. Methods: This was a prospective study undertaken at Basic Science Complex of Kathmandu Medical College Teaching Hospital in Nepal. In total, 72 medical students were put through a modified Harvard step test during their first year and then three years later during their third year at medical school. Maximum aerobic capacity (VO2 max) was calculated subsequently by plotting the average pulse rate on the Astrand-Rhyming Nomogram. Results: The mean value of relative maximum aerobic capacity (VO2 max) decreased from first year to the third year. When the mean values of body mass index and relative maximum aerobic capacity were compared between first year and third year, the difference was found to be statistically significant (p-value=0.000). The physical fitness index and relative maximum aerobic capacity in both years were positively correlated r (70) = +.59, p<0.001(first year); r (70) = +.47, p<0.001(third year). Meanwhile, body mass index and relative maximum aerobic capacity in the third year were negatively correlated and statistically significant with r (70) = -0.23, p=.045. Conclusions: Cardiorespiratory fitness of the students steadily declined as they progressed through their academic years. Positive correlation between cardiorespiratory fitness and physical fitness index was established along with negative correlation between body mass index and cardiorespiratory fitness. The findings in this study expose the lack of fitness in youth as they focus more on academics, giving the impression that they forget to implement a fitness routine in their lifestyle.

Knowledge and perception towards COVID-19 vaccination among health care workers at a tertiary care centre

Background: Coronavirus disease 2019 (COVID-19) has caused an enormous impact on the health care system. The most effective way of controlling infectious diseases like COVID-19 is often vaccination. Health care workers have a key role in reducing the burden of the pandemic, role modeling preventive behaviours, and helping to vaccinate others. Objective: The aim of the study was to find the knowledge, and perception towards COVID-19 vaccination among health care workers. Methods: A descriptive cross-sectional study was conducted at Kathmandu Medical College Teaching Hospital from 1st June 2021 to 30th June 2021. Ethical clearance was taken from the institutional review committee (Ref. 2005202101). Convenience sampling was done. All the health care workers of the hospital who provided consent for the study were included in the study. Collected data were entered and analysed using SPSS v.24. Results: In this study, 270 health care workers were included, out of which 90 (33.3%) were male and 180 (66.7%) were female. The majority (176, 65.2%) of the health care workers got vaccinated to boost their immunity. The most common factor causing COVID-19 vaccine hesitancy in health care workers initially was the safety of the vaccine (133, 49.3%). Conclusion: The majority of the participants had good knowledge and positive perception of the COVID-19 vaccines. It demonstrates the need for effective education and communication designed to enhance knowledge about the COVID-19 vaccine and to teach vaccine counselling skills to the health care workers.

Persistent otorhinolaryngological symptoms in patients following COVID-19 infection

Background: Patients having coronavirus disease 2019 (COVID-19) may have persistent symptoms even after weeks or months of recovery. Although there are several studies on persistence of general symptoms, research primarily focussing on post COVID otorhinological symptoms are scarce. Objective: The aim of study was to assess the persistent otorhinolaryngological symptoms among the patients within a period of three months of recovery from COVID -19 infection. Methods: An analytical cross-sectional study was carried out in the ENT OPD of Kathmandu Medical College Teaching Hospital Nepal from July 2021 to September 2021. Ninety-one consecutive patients who recovered from COVID-19 were evaluated. The frequency of otorhinolaryngological manifestations at the time of presentation and during the active COVID-19 illness were interpreted and classified as nasal, aural, and throat symptoms. Results: The commonest persistent nasal symptoms were the nasal obstruction in 15 out of 43 patients during COVID (15/43, 34.88 %), followed by nasal discharge (2/12, 16.66%), loss of smell (12/73, 16.43%), and frontal headache (8/40, 20%). Twenty patients had persistent aural symptoms and all of them had tinnitus (8/8, 100%) followed by earache (4/7, 57.14%), hearing loss (3/6, 50%) and dizziness (4/14, 28.57%). Thirty-four patients had persistent throat symptoms. The most common was sore throat (23/49, 46.93%) followed by itching (4/13, 30.76%), hoarseness (3/25, 12%), and dry cough (3/52, 5.7%). Conclusion: Many ENT OPD patients had variable nasal, aural, and throat complaints at the time of infection which was still persisting in majority of them within three months of recovery from COVID-19.

Impact of second wave of COVID-19 related lockdown on patients undergoing fixed orthodontic treatment in a dental teaching hospital

Background: Lockdown due to second wave of COVID-19 was implemented, in Kathmandu from April 29, 2021. In most of the dental hospitals, patients’ regular appointments were temporarily suspended and only emergency treatments were considered. Objectives: To assess the impact of the COVID-19 related lockdown on the treatment among patients undergoing fixed orthodontic treatment. Methods: A descriptive cross-sectional study was conducted among 170 individuals undergoing fixed orthodontic treatment at Kathmandu Medical College Teaching Hospital from 1st July to 30th September 2021 after obtaining ethical approval. A standard pretested self-administered online questionnaire having questions regarding impact of COVID-19 on orthodontic treatment was sent to all the study participants. Data were entered in Microsoft Excel Sheet and analysed in Statistical Package for Social Sciences version 20. Descriptive statistics like mean, standard deviation, frequency, and percentage were calculated depending upon the nature of data. Results: Majority of the study participants (113, 66.5%) did not visit orthodontist for more than one month due to second wave of COVID-19 and were very worried (84, 49.4%) for not getting to go for regular follow-ups for their treatment. Most of them were worried thinking that their treatment time will be extended (134, 78.8%), and some (97, 57.1%) participants faced problems like broken brackets and elastics. Conclusion: This study concluded that second wave of COVID-19 had some impact on orthodontic patients. This study highlighted the importance of teledentistry for orthodontic consultation and also the need for preparing the patients to deal with orthodontic appliances if required to prevent trauma.

Utility of reporting urine cytology samples as per the Paris system

Background: Urinary tract cytology is an accurate test for the detection of urothelial malignancy especially high-grade urothelial carcinoma. The Paris System for Reporting Urinary Cytology was introduced to standardize urinary tract cytology reporting. We aim to evaluate the utility of reporting urinary cytology as per this system and correlate with histopathology. Materials and Methods: This is a descriptive cross-sectional prospective study conducted on urine samples submitted for cytological examination at Kathmandu Medical College Teaching Hospital, Sinamangal, Nepal between 1st November 2020 to 31st July 2021. Ethical consent was taken from the Institutional Review Committee. Urine cytology was reported as per The Paris System for Reporting Urinary Cytology and correlated with the histopathologic diagnosis. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the high-grade and low-grade urothelial lesion. Results: A total of 104 urine samples were evaluated. Biopsy specimens were available for 38 cases. Urine cytology consisted of 1.92% non-diagnostic cases, 69.23% negative for high-grade urothelial carcinoma, 5.76% atypical urothelial cells, 5.76% suspicious for high-grade urothelial carcinoma, 13.46% high-grade urothelial carcinoma, and 3.84% low-grade urothelial neoplasm respectively. Sensitivity, specificity, negative predictive value and positive predictive value were 90.48%, 82.35%, 86.37% and 87.5% respectively for high grade urothelial carcinoma and 40%, 93.9%,50% and 91.17% respectively for low grade urothelial lesions. Conclusions: Our study shows that reporting urine cytology as per The Paris System for Reporting Urinary Cytology provides high sensitivity for the detection of high-grade urothelial lesions.

Use of 10-Point Operative Scoring System (G10 Score) in Predicting Conversion of Laparoscopic Cholecystectomy to Open

Introduction: Laparoscopic cholecystectomy is the most common minimally invasive surgery performed at Kathmandu Medical College Teaching Hospital (KMCTH), Nepal. This study aims to externally validate the 10-point gallbladder operative scoring system (G10 score) in predicting conversion of Laparoscopic Cholecystectomy (LC) to Open Cholecystectomy (OC), an assessment of surgical difficulty.

Assessment of patient satisfaction after implementing an Enhanced Recovery After Surgery (ERAS) protocol for elective Caesarean sections

Background: Enhanced Recovery After Surgery (ERAS) is a multimodal patient centred perioperative care pathway aimed at accelerating patient recovery, improving patient satisfaction, decreasing length of hospital stay, and post-operative complications. Objectives: To assess patient satisfaction with ERAS protocol in the most common surgical procedure in the world, elective Caesarean Section. Methods: A descriptive cross-sectional study was carried out in the department of Obstetrics and Gynaecology at Kathmandu Medical College Teaching Hospital (KMCTH) from July 2020 to February 2021 after ethical approval. The study included all pregnant ladies undergoing elective Caesarean section under ERAS protocol by convenient sampling and their satisfaction with the treatment received was recorded using a pre-validated questionnaire at the time of discharge. Data was analysed using SPSS. Results: A total of 140 patients were enrolled in the study. Majority of the patients considered the introduction of feeding (100, 71.4%) and ambulation (115, 82.1%) to be on time. Seventy-three patients (52.1%) considered themselves fit for discharge on the second post-operative day and 70 (50%) were discharged on the second post-operative day itself which is earlier compared to the hospital protocol of discharge on the third or fifth post-operative day. Most of the women (136, 97.1%) were satisfied with the care they received and 132 (94.3%) of them would prefer to undergo surgery under the ERAS protocol in the future. Conclusion: Most women were satisfied with the surgical experience and would prefer to undergo surgery under the same protocol in the future.

Factors associated with unintended pregnancy at a tertiary hospital, Kathmandu, Nepal: A case-control study

Background: Despite the widely available family planning efforts to reduce the proportion of unwanted pregnancies, the rate of unintended pregnancies is still significantly large in Nepal. Objectives: To find out the factors associated with unintended pregnancy. Methods: A case-control study was conducted in Kathmandu Medical College Teaching Hospital. Cases were the women seeking safe abortion services for unintended pregnancy and women with intended pregnancy were controls. Eightyone cases and eighty-one controls (total 162 women) were included in the study purposively. Face-to-face interview was done to collect data using structured questionnaire. Data were collected from 15th January 2019 to 30th August 2019. Ethical clearance was obtained from institutional review committee of Kathmandu Medical College. Permission for data collection was obtained from the head of the department of Obstetrics and Gynaecology and written informed consent was taken from each respondent. Data were analysed using statistical package for social sciences 20.0 version. Results: Age below 20 years (AOR: 5.14; 95% CI: 1.14, 23.06) and above 30 years (AOR: 2.59; 95% CI: 1.10, 6.08); primary level education (AOR: 4.46; 95% CI: 1.27, 15.62); and secondary level education (AOR: 2.97; CI: 1.39, 6.34), student by occupation (AOR: 11.40; 95% CI: 3.07, 42.25), three and more gravidity (AOR: 13.82; 95% CI: 4.56, 41.87)) and perceived ideal number of child one (AOR: 4.63; 95% CI: 1.18, 18.10) were associated with increased risk of unintended pregnancy. Conclusion: Age, education, occupation, gravidity, and perceived ideal number of children were the factors significantly associated with unintended pregnancy.