Kathmandu Medical College Research Articles

Reasons for Patients Preferring Extraction over Root Canal Treatment in a Tertiary Care Hospital

Introduction: Dental caries is a major global oral health issue, potentially progressing to irreversible pulpitis and causing substantial discomfort. Although advancements in materials, instruments and knowledge have improved the success rates of root canal procedures, some patients opt for tooth extraction instead of root canal treatment. This choice can result in tooth loss, necessitating costly prosthetic replacements. Objective: The objective of this study was to determine the reasons for patients choosing extraction over root canal treatment. Methods: A descriptive cross-sectional study was conducted among 205 patients visiting the Department of Conservative Dentistry and Endodontics at Kathmandu Medical College for the treatment of irreversible pulpitis, who ultimately opted for extraction. A structured questionnaire was utilized, and responses were recorded and analyzed using the Statistical Package for the Social Sciences. Mean, standard deviation, frequency and percentage were calculated depending upon the nature of data. Results: The study found that the primary reason for patients not undergoing root canal treatment (RCT) was the high cost of RCT and crown, accounting for 42.9% (88 patients), followed by the need for more appointments with pain, at 31.2% (64 patients). Conclusions: This study revealed the cost of RCT and crown to be the major factor for patients opting out from RCT. The study provides valuable insights into the psychology of patients regarding RCT, highlighting reasons for its rejection. Such understanding assists dentists and specialists in tailoring treatment plans that align with patient preferences and needs.

Indocyanine green fluorescence imaging: Assessment of perfusion at pancreatic resection margin during pancreatoduodenectomy: A cross sectional study.

Clinically relevant-postoperative pancreatic fistula (CR-POPF) is one of the dreaded complications of pancreatoduodenectomy. Vascularity of the stump of the pancreas during pancreatico-enteric anastomosis is considered one of the major determinants of POPF. Indocyanine green (ICG) is one of the modality for vascular assessment; hence, we aimed to evaluate the role of ICG fluorescence imaging to assess the vascularity of the pancreatic stump during pancreatoduodenectomy. The study was conducted at Kathmandu Medical College, Kathmandu, Nepal, during the period of 1 year (June 01, 2022-July 31, 2023). All of the patients who were undergoing pancreatoduodenectomy were included in the study. In all cases, intraoperatively, ICG fluorescence detection at the pancreatic stump margin was evaluated using near-infrared light. A total of 28 patients underwent PD during this period. The ICG fluorescence imaging was positive at the pancreatic stump margin in 25 out of the 28 patients (89%), and in three cases, the florescence was negative. In patients who had negative fluorescence, revision of the stump margin was performed. Clinically relevant POPF was noted in 2 out of 28 cases, which had a soft pancreas with a small duct, although the pancreatic stump margin had good ICG florescence per-operatively. ICG is inexpensive and a safe dye to use in clinical practice. We can objectively assess the pancreatic stump vascularity using intraoperative ICG fluorescence imaging, thereby potentially decreasing postoperative pancreatic fistula.

Impact of Corticosteroid on Covid-19 Pneumonia Patients

Background: Globally over 704,753890 had COVID -19 Out of which 7,010,681 died compared to 12031 death in Nepal out of1003450 cases Nationwide. Corticosteroids because of their anti- inflammatory effect may have beneficial effect/s on COVID-19 patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. Corticosteroids are a potential therapeutic agent for patients with COVID-19 pneumonia. The RECOVERY (Randomised Trials in COVID-19 Therapy) trial provided data on the mortality benefits of corticosteroids. Aim: The study aims to see the effect of Corticosteroids on COVID-19 patient outcomes concerning disease progression, length of hospital stay, 28-day mortality, and use of resources like Ventilator. Method: Single Hospital-based Prospective observational study among RT-PCR positive for COVID-19 patients admitted at Kathmandu Medical College Teaching Hospital from June 01, 2021 –July 31st, 2021 requiring oxygen therapy. Patients were grouped into either usual care, including symptomatic treatment only, or a group receiving both usual care and Corticosteroid. Results: This study included 160 RT-PCR-positive cases. There were 53 patients with mild symptoms and 107 with moderate symptoms. Patients with mild symptoms who received standard care had an odds ratio of 1.875 for progression to moderate and severe COVID-19 Compared to those who received both standard care and corticosteroid. Similarly, Patients with moderate symptoms who received standard care had an odds ratio of 1.8 for progression to severe and critical COVID-19 Compared to those who received both standard care as well as corticosteroids. Among patients with mild symptoms, the overall use of a ventilator was 35.85 % and mortality was 13.21 %. Similarly, in patients with moderate symptoms at presentation, a ventilator was needed in 33.64 % and mortality was 24.30 %. Conclusion: Though Corticosteroids seem to have a beneficial role in preventing disease progression, they failed to show a statistically significant reduction of ventilator use and mortality benefit amongst groups.

Comparative Efficacy of Wound Drainage and Non-Drainage in Posterior Spinal Surgery

Background: The recent trend has been toward recommendation of nondrainage in spinal surgery. However, the use of drains following posterior spinal surgery is still controversial. It has been claimed that wound drainage confers no significant advantages, increases the risk of infection and the need for blood transfusion with the attendant risks of this therapy. Suction drainage is used to minimize infection, prevention of wound swelling, improvement of the local wound environment, prevent hematoma and /or seroma formation. The aim of this study was to determine the incidence of post-operative complications after posterior lumbar instrumentation with and without a subfascial drain. Methods: This is prospective analysis of 32 adult (≥18 years old) spine patients that underwent elective and emergency posterior lumbar instrumentation at Kathmandu Medical College Teaching Hospital, from January to December 2023. There were randomly assigned 16 (50%) patients who had a post-operative drain and 16 (50%) patients who did not have a postoperative drain (No-Drain: n=16; Drain-Use: n=16). Patient demographics, comorbidities, intra- and post-operative complication rates were collected for each patient. The primary outcome investigated in this study was pain, the need for post-operative transfusion, dressing changes, surgery – discharge interval, the rate of post-operative complications, specifically surgical site infections (SSI) and hematoma formation. Data was analyzed using SPSS statistics version 29 (IBM Corp., New York). Results: Our study revealed that no significant differences regarding wound infection (P = 1), hematoma, neurological injury, estimated blood loss (P = 0.3), or dry and moderate dressing drainage between the groups. There were no 30-day hospital readmission or incidence of 30-day wound dehiscence, draining wound or bleeding between both patient groups. Conclusions: There is no obvious advantage of the application of suction drains for spinal surgery. There was no significant difference in the rate of infection or wound healing and no patient developed a postoperative neurologic deficit. However, a decision of wound drainage or wound non-drainage should be individualized for each patient because many factors affect the outcomes.

Comparative study on efficacy of benzoyl peroxide with adapalene versus plain adapalene in the treatment of acne vulgaris

BACKGROUND Acne vulgaris is a dermatological disorder of pilosebaceous unit, characterized by formation of comedones and inflammatory lesions. It is one of the most common skin manifestations among adolescents, also affecting the adult population. The treatment of acne basically involves reduction of lesions and prevention of permanent scarring. The current line of treatment for mild to moderate acne is topical medications with antimicrobials and retinoids. The present study assessed the efficacy of combination of adapalene and benzoyl peroxide in comparison to adapalene for topical treatment of mild to moderate acne vulgaris. OBJECTIVE The purpose of the study was to compare the clinical efficacy of topical adapalene and topical adapalene with benzoyl peroxide in treatment of mild to moderate cases of acne vulgaris. METHODOLOGY A prospective, comparative study was carried out among 84 patients with mild and moderate acne vulgaris visiting the Department of Dermatology, Kathmandu Medical College and Teaching Hospital, Bhaktapur, Nepal from December 2019 till March 2021. The patients fulfilling the inclusion criteria were divided into two groups. Group A received topical adapalene whereas Group B received topical adapalene with benzoyl peroxide. The efficacy of treatment in both groups were determined based on the reduction of total lesion count. Both inflammatory and non-inflammatory lesions were counted at 4th week, 8th week and 12th week. RESULTS All patients were assessed according to Global Acne Grading System (GAGS) and grouped as mild and moderate. The most frequent age group affected by acne vulgaris was 18-22 years. The mean age was 22.15 ± 5.315. Females (64.30%) were affected more commonly than males (35.7%). Majority of patients presented with moderate or inflammatory acne lesions. The face (90.5%) was most commonly affected site by acne vulgaris. The number of patients enrolled in the study were 84 out of which 63 (75%) completed the study. It was found that the reduction of non-inflammatory, inflammatory and total lesion count from the baseline were highly significant in between and both the group (P<0.001). A total of 52.4% had very good result of the treatment, 44.4% of them had good result and remaining 3.2% of the patients’ result was fair. However, the efficacy of benzoyl peroxide with adapalene was found to be better than adapalene alone. CONCLUSIONThis study concluded that topical benzoyl peroxide with adapalene is more efficacious to treat mild to moderate acne vulgaris.

Status of Primary Labeling of Medicines Manufactured by Nepalese Pharmaceutical Industries

Background Proper medication labeling is essential to meet regulatory requirements and guarantee the safety of patients using the medication. This study aimed to observe the status of primary labeling of medicines manufactured and marketed by Nepalese pharmaceutical industries.MethodsA prospective study was conducted between June 2022 to October 2022 in Kathmandu Medical College. Total of 372 primary labeling of medicines manufactured by Nepalese pharmaceutical companies were assessed as required by Drug Standard Regulation, 2043 (1986 AD) of Nepal.ResultsThis study assessed the primary labeling of 372 medications produced by 46 pharmaceutical companies in Nepal. Most of the primary labeling had stated manufacturing company's name, address, and country, the production serial number for the drug, and recommended storage methods. But only 22(5.9%) of them specified the sub-category and appropriate drug classification was found on 352(94.6%) primary label.Conclusions The current study revealed that the status of the primary labeling is satisfactory as majority of the label contained the essential criteria required by Drug Standard Regulation, 2043 (1986 AD) of Nepal.

First Trimester Abortion and Psychiatric Morbidity.

Early pregnancy loss is a traumatic event following which clients may experience psychological morbidities. Mental illness is associated with multiple obstetric and social factors surrounding the period of pregnancy loss. The aim of this study was to find the prevalence of depression and anxiety before and after undergoing spontaneous or induced first trimester abortion and to analyze demographic and obstetric factors associated with it. This is an observational study conducted as Kathmandu Medical College (KMC) for a duration of one year from September 2022 to August 2023. All clients with abortion were screened for psychiatric morbidity using the The Hospital Anxiety and Depression Scale (HADS). Each client was assessed at first hospital visit and then at two weeks and two months following abortion. Level of anxiety and depression was analyzed in relation to socio-demographic factors and the type of abortion. 171 clients with pregnancy loss were enrolled. Pre-abortion, severe anxiety was present in 6(13%) clients with spontaneous abortion. Pre-abortion, mild to severe anxiety was present in 31 (67.3%) clients and at two weeks and two months in 11 (23.9%) and 11 (23.9%) clients respectively. In clients undergoing induced abortion, varying levels of anxiety was present in 54(43.2%) pre-abortion, and 48(38.4%) and 54(43.2%) clients at two weeks and two months. Mild to moderate depression was seen in 21 (45.6%) among spontaneous abortion and 51 (40.8%) clients among induced abortion. Mean score on HADS decreased with time. Anxiety and depression were common following early pregnancy loss. Rate of anxiety seems to decrease with time in spontaneous abortion but in induced abortion it remains persistent. Rate of depression tends to decrease with time for both types of abortion.

Histopathologic Analysis of Gastrointestinal Tract Polypoidal Lesions in a Tertiary Care Centre

Introduction: Gastroinstestinal tract polyps are commonly encountered lesions in histopathological examination. It is necessary to examine these polyps and to determine its nature for the management of patient. Methods: A descriptive cross-sectional study was done in the Pathology department of kathmandu Medical College from 1st January 2023 to 31st July 2023 after obtaining ethical approval from the Instituitional review committe. All gastrointestinal tract polyps or polypoidal lesions indentified endoscopically as well as colonoscopically which was biopsied and received at pathology department for histopathological study was included in this study. The data was entered and analyzed using the statistical package for social science version 22.0. Results Among 96 polyps examined during the stidy period, 60.4 % were seen in males and 39.6 % were seen in females. The most common site was colon (56.2%) followed by stomach (23.0 . Tubular adenoma with low grade dysplasia was most common polyp identified at colon (17.8%) whereas hyperplastic polyp was most common polyp (19.8 %) and the common site was stomach (13.6 %) Conclusions Gastrointestinal tract polyps are of wide spectrum. Histoplathological examination is crucial to arrive at final diagnosis.

Prevalence and Causes of Blindness and Visual Impairment in Sudur Paschim Province of Nepal

Tonsillectomy is the complete removal of a tonsil from its bed and is one of the most common procedures in Otorhinolaryngology. The intensity of post-operative pain is severe enough to cause dysphagia which subsequently leads to infection of the fossa and other complications. Several studies on pain management have been conducted but not a single standard protocol currently exist. This study aims to evaluate the intensity of post tonsillectomy pain and to assess the efficacy of infiltration of Bupivacaine on the tonsillar fossa following tonsillectomy. A comparative study was conducted at Kathmandu Medical College, ENT-HNS department for a period of 18 months (January 2018 to June 2019). Ninety three patients were included. 2.5 ml of 0.5% Bupivacaine was infiltrated in right tonsillar fossa after tonsillectomy in all patients. The lateralization and intensity of pain at various post-operative period was assessed using visual analogue scale. The requirement of extra analgesics at various post-operative period was recorded. The pain score on the Bupivacaine side on the first and second post-operative day was decreased as compared to the other side. The pain score on the fourth hour and third post-operative day on Bupivacaine side was more than that of the other side. Infiltration of Bupivacaine over the tonsillar fossa has provided a good result with a significant reduction of pain in first post-operative day and in early post-operative period. However, other multi-centered and double blinded study is requires to provide better results.

Comparison of Post-operative Pain with and without Infiltration of Bupivacaine Hydrochloride in Tonsillectomy

Tonsillectomy is the complete removal of a tonsil from its bed and is one of the most common procedures in Otorhinolaryngology. The intensity of post-operative pain is severe enough to cause dysphagia which subsequently leads to infection of the fossa and other complications. Several studies on pain management have been conducted but not a single standard protocol currently exist. This study aims to evaluate the intensity of post tonsillectomy pain and to assess the efficacy of infiltration of Bupivacaine on the tonsillar fossa following tonsillectomy. A comparative study was conducted at Kathmandu Medical College, ENT-HNS department for a period of 18 months (January 2018 to June 2019). Ninety three patients were included. 2.5 ml of 0.5% Bupivacaine was infiltrated in right tonsillar fossa after tonsillectomy in all patients. The lateralization and intensity of pain at various post-operative period was assessed using visual analogue scale. The requirement of extra analgesics at various post-operative period was recorded. The pain score on the Bupivacaine side on the first and second post-operative day was decreased as compared to the other side. The pain score on the fourth hour and third post-operative day on Bupivacaine side was more than that of the other side. Infiltration of Bupivacaine over the tonsillar fossa has provided a good result with a significant reduction of pain in first post-operative day and in early post-operative period. However, other multi-centered and double blinded study is requires to provide better results.

Workplace Violence against Nurses Working at Private Teaching Hospitals of Kathmandu: A Descriptive Cross-sectional Study.

Workplace violence in hospitals is a global concern and is considered as a major occupational hazard for all health care providers including the nurses. The aim of this study was to assess the status of workplace violence against nurses at hospitals in Kathmandu and determine the actions taken to investigate its cause. A descriptive cross-sectional study was conducted among a convenient sample of 100 registered nurses employed in Nepal Medical College and Teaching Hospital, and Kathmandu Medical College and Teaching Hospital. All eligible nurses who were willing to participate irrespective of their academic fulfilment, from all different shifts and of age below 45 years were included. Data were collected using a structured questionnaire and analysed using SPSS software. Ethical approval was taken from the Institutional Review Committee (IRC) of Nepal Medical College and Kathmandu Medical College. Among 100 participants, the prevalence of workplace violence was 72 (72%) (62.13-80.52, 95% Confidence Interval). Verbal abuse accounted to 50 (69.44%), followed by physical violence accounting 17 (23.61%). Action was taken to investigate the causes of both physical violence 5 (29.41%) and verbal abuse 2 (4%) by the hospital administration 3 (60%) in physical violence and 2 (100%) in verbal abuse and police 2 (40%) in physical violence. The study reveals a troubling reality, as the vast majority of nurses reported experiencing various forms of violence in their workplace. So, addressing this issue immediately could protect nurses' well-being and ensure quality care which benefits both healthcare professionals and patients.

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

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. 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. 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%). Impacted third molars-related symptoms were affecting quality of life of participants.

FUNCTIONAL OUTCOME OF INTRAARTICULAR DISTAL RADIUS FRACTURE TREATED WITH OPEN REDUCTION AND INTERNAL FIXATION WITH DORSAL PLATE

Background: Distal radius fractures are among the most common fractures and there is considerable disparity among surgeons regarding the best way to treat these patients. Intraarticular fractures are treated with open reduction and internal fixation with either dorsal or volar plates. Dorsal plating is not much popular due to its reported complications of extensor tendon irritation and rupture. We conducted this study to assess the functional outcome of dorsal plating in intraarticular distal radius fractures. Methods: A clinical prospective observational study was conducted at Kathmandu Medical College,Sinamangal. A total of 26 patients (male: 14; female: 12) of intraarticular distal radius fractures were enrolled and underwent open reduction and internal fixation using the dorsal plate. The functional outcome of dorsal plating was measured at 3 weeks,3 months and 6 months follow up. Results: All patients achieved a functional range of motion, with greater than 50 degrees of wrist flexion, 25 degrees of wrist extension, and 60 degree arc of pronation and supination. The functional outcome measured was found to be good to excellent with a mean Mayo Wrist score of 89.23(75-100) and Quick Dash-9 score of 9.20(2.75 to 22). There were 3 cases of extensor tendon irritation, which completely resolved and no cases of extensor tendon irritation at final follow up. Conclusions: Dorsal plating is a safe and effective way of treating intra articular distal radius fracture with good functional outcome.

Effect of Covid-19 Vaccination on disease Severity among Covid-19 patients admitted in KMCTH

Background: The COVID-19 Pandemic has affected millions of people globally with significant morbidity and mortality. Though the overall case fatality rate (CFR) in Nepal was less than 1% during the initial peak, the CFR is expected to increase during the current second wave of the pandemic. Since no specific effective therapies exist, breaking the chain of transmission sounds logical. COVID-19 vaccine development is believed to be effective and safe in preventing disease adverse outcomes. Aim: Primary aim of the study was to know the COVID-19 vaccination status among the patients admitted with RT-PCR positive for COVID-19 and secondary aim of the study was to observe the difference between the outcome in terms of resources utilization LIKE NON-INVASIVE VENTILATION (NIV), Hi-flow nasal cannula (HFNC) and invasive mechanical ventilation (IMV) in vaccinated and unvaccinated patients. Method: This was a hospital-based Prospective Observational Study. All patients admitted at KMCTH from June 01, 2021 –July 31st 2021 with COVID-19 RT-PCR Positive meeting inclusion criteria were enrolled. Ethical Clearance was taken from KMC-IRC. Result: During the study period, a total of 160 RT-PCR Positive Covid-19 cases were admitted at Kathmandu Medical College Teaching Hospital (KMCTH). Out of the total patients, 74 (46.25%) were not vaccinated for covid-19 whereas 86 (53.75%) patients were vaccinated either with Vero cell (39.53%) or Covishield (60.47%) Covid-19 vaccine. The study showed 2.32% of vaccinated patients required ventilatory support compared to 13.50 % of unvaccinated patients requiring ventilatory support having significant ( p value <0.05) impact on outcome. The relative risk for unvaccinated patients going to ventilator was 5.81 times higher than for vaccinated patients. Conclusion: The authors found out that more than half of the individual admitted were vaccinated (53.75 VS 46.25). Moreover, Vaccination (either with Covishield or Vero cell) appears to be effective in limiting requirement of more advance services like NIV, HFNC, and invasive mechanical ventilator. We recommend a larger, multicenter, randomized study in the future.

Knowledge, Attitude, and Practice of Ergonomics Principles among Undergraduates Studying Bachelor of Dental Surgery

Introduction: Ergonomics is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance. Successful application of ergonomics, assures high productivity, evasion of illnesses and injuries, leading to increased satisfaction among workers. On the other hand, unsuccessful application can lead to work-related musculoskeletal disorders (MSDs) among dental professionals. Objective: The objective of this study was to assess knowledge, attitude, and practice of ergonomics principles among undergraduates studying bachelor of dental surgery. Methods: A descriptive cross-sectional study design was carried out among 172 students studying bachelor of dental surgery at Kathmandu Medical College, Kathmandu Nepal. Census technique was used to collect the data. A structured questionnaire was used as a data collection tool. Results: The study revealed that nearly (69) 40% of the students had a knowledge about the ergonomic principles. Whereas, (112) 65% students of all the years as a whole had a good attitude towards ergonomics. But only (34) 20% students as a whole were using the principles of ergonomics into practice. Conclusions: Although, (69) 40% had knowledge about ergonomics in dentistry. Only (34) 20% of the students had a practice of ergonomics . Thus, improvement in the level of knowledge is required but more importantly the application of knowledge into practice is recommended for better dental practice.

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.

Visual Functions among amplyopic patients

Apart from decreased visual acuity, amblyopia may be associated with alteration in color vision, contrast sensitivity and stereopsis. The study was conducted to assess visual functions among amblyopic patients. Cross sectional observational study was done with appropriate examination. Best corrected visual acuity, color vision, contrast sensitivity and stereopsis were done among 31 amblyopic patients of age 5-18 years, visiting Department of Ophthalmology in Kathmandu Medical College from October 2021 to March 2022. Among thirty-one patients, male is to female ratio was 1.81:1. Mean age of participants was 9.45±3.49 years. Among patients with stimulus deprivation amblyopia, visual acuity was <6/60, color vision and contrast sensitivity were decreased in 100% and moderate stereopsis (80-200 seconds of arc) was present. Among patients with strabismic amblyopia, visual acuity was decreased (6/12-6/18), color vision and contrast sensitivity were normal in 100% and good stereopsis (<60 seconds of arc) was seen. Among those with refractive amblyopia, visual acuity was 6/6-6/9 in 34.5%, 6/12-6/18 in 44.8% and 6/24-6/60 in 20.7%. Color vision was decreased in 27.3% in ametropic, 9.1% in meridional and normal in anisometropic type. Contrast sensitivity was decreased in 27.3% each in ametropic and anisometropic, and in 63.6% in meridional amblyopia. Good and poor (>200 seconds of arc) stereopsis was found in 24.1% each and moderate in 51.7% of refractive amblyopia. Contrast sensitivity was seen to be decreased with decrease in vision (40.0%, 42.8%, 50.0% and 100.0% in visual acuity 6/6-6/9, 6/12-6/18, 6/24-6/60 and<6/60 respectively). To conclude, visual functions are affected in different types of amblyopia.

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.

Knowledge, attitude, and practice of pesticide use among agricultural workers of Lamatar Village Development Committee, Lalitpur District: A cross-sectional study

Introduction: In this fast-developing world, food production has also been changing, making people suffer from various health issues because of pesticide poisoning. Unsafe methods in handling pesticides, especially in middle and low-income countries like Nepal are still practiced, although the deleterious health effects either go unnoticed or are missed or are diagnosed late. Few of the older less costly pesticides remain for years in soil and water although few of them have been banned they are still available in many developing countries. The study aimed to assess knowledge, attitude, and practice regarding pesticide use among agricultural workers and farmers' awareness of pesticide labels on pesticide bottles or packets. Methods: A cross-sectional study among 74 conveniently selected agricultural workers, who used or ever-used pesticides within the last six months was conducted in Lamatar Village Development Committee, Lalitpur District from January 2022 to February 2022. Ethical clearance was obtained from the Institutional Review Committee of Kathmandu Medical College. The questionnaire was adapted from literature about personal protective equipment with some modifications according to the local context. Data was collected through a face-to-face interview. Results: Among the total 74 respondents 49 (66.2%) were females and only 25 (33.8%) were males. Most of them had no formal education but could read and write. However, less than half 32 (43.2%) had adequate knowledge while the majority 49 (66.2%) had a negative attitude towards the use of pesticides. However, only 32 (43.2%) had good practice handling pesticides and its effect. Conclusion: This study showed low knowledge regarding pesticides, their health effects, and poor practice however, a negative attitude towards the use of pesticides. But pesticide is still widely used because of the demand for more earnings. So, we would recommend that there is a need for time-to-time regular community-based training regarding how to safely handle pesticides and the availability of less harmful fertilizers products at retailers or consultancies.

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.