Kathmandu Medical College Research Articles

Surgical Outcome of Exvivo Preserved Autologous Cranioplasty - A Novel Approach

Autologous cranioplasty is an increasingly common procedure performed in neurosurgical centers following a decompressive craniectomy. Available evidence on the safety of autologous bone flap preservation and cranioplasty is limited due to a large diversity in study conducted, nature of pathology and reported outcomes. In this Institutional Review Board-approved retrospective observational study, patients who underwent neurosurgical intervention as“craniectomy followed by cranioplasty” at the Department of Neurological Surgery, Kathmandu Medical College Teaching Hospital were enrolled retrospectively from 1st May 2012 to 30th April2019. The craniectomy bone flap was preserved exvivo, dipped in spirit solution in deep freeze, then autoclaved prior to cranioplasty. Data were collected from the hospital’s electronic database. Information analyzed included patient age, sex, indication forcraniectomy, interval between craniectomy and cranioplasty, length of hospital stay, peri-operativecomplications and mean time of follow-up. Patients who underwent a cranioplasty following removal of an infected bone flap after a craniotomy were excluded from the study. Associated complications were assessed and statistical analysis was performed using a Fisher’s exact test. There were a total of 210 patients with 92vascular, 58 post traumatic. With all these surgeries undergone we had 9% complication rate, all of whom underwent cranioplasty later than four weeks of primary surgery (p = <0.0001).Ex-vivo preservation and autoclaving of bone flap is a simple technique with significant benefits in our hospital and national scenario with significantly less financial burden to patients

Is Pre-operative Clipping of Scalp Hair Necessary for Craniotomies?

Pre-operative clipping of scalp hair has-been practiced before craniotomies to decrease surgical site infections. In developing countries like ours, due to poor hygiene this may look genuine. However, with regular pre-operative part preparation practices we have tried avoiding clipping of hair in routine craniotomies.
 This study retrospectively studied patients undergoing craniotomies during the last four years at Kathmandu Medical College Teaching Hospital and compared two groups of patients; pre-operative part preparation practices group who did not have pre-operative hair clipped and the other group who had pre-operative hair clipped. Only patients who could be studied for over two weeks were included in the study. Patients with pre-existing scalp injuries were excluded. Endpoints studied were post-operative surgical site infections and need for debridement and re-suturing.
 Of the total 726 patients studied, 246underwent craniotomies with pre-operative part preparation practices and 480 had their hair clipped. Of the pre-operative part preparation practices group, three had surgical site infections compared to eight who had their hair clipped (p=0.641). The infection led to debridement and re-suturing in two patients of pre-operative part preparation practices and four in hair clipped group (p=0.946). These two groups were comparable for age (p=0.210), however, there was statistically significant differences in gender (p=0.001), type of lesion (p=0.000), pneumocephalus (p=0.000), skull base fracture (p=0.000) and use of peri-operative antibiotics (p=0.000). However, all the above mentioned significant parameters did not have any statistical significant relation with surgical site infection {gender (p=0.255), type of lesion (p=0.264), pneumocephalus (p=0.787), skull base fracture(p=0.584) and use of peri-operative antibiotics(p=0.100)}.Pre-operative clipping of hair does not avoid surgical site infections. Protocol based part preparation practices of scalp and post-operative head hygiene are important to avoid the surgical site infections.

Knowledge on Toothbrush Contamination and Disinfection Practice among Students of a Dental Institution in Nepal

Introduction: Toothbrush is the most common oral hygiene aid used by millions of people all around the world. Toothbrushes can either be discarded at an interval of three months or can be disinfected by different methods.
 Objective: This study was conducted to assess the knowledge on toothbrush contamination and practice of disinfection among dental students and interns of a dental institution of Kathmandu, Nepal.
 Methods: A descriptive cross-sectional study was conducted among 212 undergraduate dental students and interns of Kathmandu Medical College, Duwakot, Nepal using a self-administered questionnaire. Mean, standard deviation, percentage were calculated for descriptive statistics.
 Results: Mean age of the study participants was 21.28±1.897 years. Most of the interns 18 (69.2%) had some knowledge regarding toothbrush cleaning and disinfection. Majority of the participants 186 (87.73%) reported bacteria as most susceptible microorganisms causing toothbrush contamination and sharing the toothbrush as common mode of transmission of infection. Most of them, 147 (69.34%) did not have any idea about toothbrush disinfection methods for general population. However, they felt it necessary in special needs patients.
 Conclusion: This study concluded that there is variable knowledge regarding toothbrush contamination and disinfection practice among undergraduate dental students and interns due the difference in their academic level and experience in the clinical work

Metoclopramide and acute dystonia: A case report

Metoclopramide is one of the frequently used antiemetic and prokinetic. The aim of this case report is to emphasize the occurrence of metoclopramide induced acute dystonic reaction. Its prevalence is increasing and can be life threatening. We present a case of 18 years old female, who presented to the emergency of Kathmandu Medical College with the complaints of pain and stiffness of the neck and inability to keep her tongue in her mouth. She developed acute dystonic reactions after her fourth dose of Metoclopramide; which was prescribed for her vomiting associated with dysmenorrhea. The drug was discontinued and 25 mg of intravenous Chlorpheniramine was administered. The symptom subsided in two hours and was discharged with oral Chlorpheniramine. Metoclopramide can cause severe adverse reaction such as acute dystonic reaction, which is of unpredictable nature, physicians should be aware of this bizarre effect and the treatment.

Correlation between Iron Parameters and Platelet Parameters in Iron Deficiency Anemia

Introduction Iron deficiency anemia is the most common type of anemia and is diagnosed by iron studies. Reactive thrombocytosis is usually seen in iron deficiency anemia. The objectives of the study is to correlate between iron parameters and platelet parameters in patient with iron deficiency anemia.
 MethodsThis was a cross-sectional study done in Department of Pathology at Kathmandu Medical College, Sinamangal between December 2018 to May 2019. Blood samples of 81 iron deficiency anemia patients were analysed to determine iron parameters and platelet parameters. SPSS version 20 was used to analyse the data.
 ResultsThrombocytosis was seen in 62 (76.5%) patient with iron deficiency anemia. Platelet count was negatively correlated with serum iron, percentage saturation and platelet distribution width (p˂0.001, for all) while positive correlation was obtained between platelet count and plateletcrit (p<0.05). Plateletcrit showed negative correlation with serum iron (p˂0.001) and platelet distribution width (p<0.05) while positive correlation was obtained with mean platelet volume, total iron binding capacity and platelet (p<0.05, for all). There was negative correlation between mean platelet volume and platelet count (p<0.001). Positive correlation was obtained between mean platelet volume and plateletcrit (p<0.05). Correlation was not found between mean platelet volume and iron parameters (p>0.05). Platelet distribution width showed negative correlation with total iron binding capacity, platelet (p˂0.001, for both), plateletcrit (p<0.05).
 ConclusionThrombocytosis is more commonly observed as compared to thrombocytopenia in patient with iron deficiency anemia. Serum iron and percentage saturation are the most important parameters affecting the platelet count.

ANATOMICAL VARIATION OF INTRAHEPATIC BILIARY DUCT IN CADAVERIC LIVER

Background: Hepatobiliary system has many variations. Use of cadavers, intraoperative data and various imaging modalities are the commonly employed techniques for determining the anatomy of intrahepatic bile ducts. The vivid picture of hepatobiliary system is a must for hepatobiliary surgery and identification of frequency distribution of typical and atypical pattern and different types of atypical pattern are vital. This study aimed to uncover its frequency distribution and also to recognize the variations therein.
 Methods: An observational study was conducted in the Department of Anatomy, Kathmandu Medical College Teaching Hospital from July 2013 to June 2014 by taking 50 complete human cadaveric livers without evidence of injuries or previous operations. Livers were dissected, duct traced, colored, photographed and the findings were entered in a proforma.
 Results: Out of 50 dissected livers, 32 showed typical pattern (Type A, 64%) whereas 18 liver showed atypical pattern of confluence (36%). The type B pattern was seen in 6 (12%) and type C was seen in 8 of them (16%). Of these 8 cases, subtype C1 was observed in 6 livers (12%) and subtype C2 was found in 2 livers (4%). Type D was seen in 3 livers (6%). and all of them were of the subtype D1. There were no cases of subtype D2 and of type E. Type F was observed in a single case (2%).
 Conclusions: An accurate knowledge of the anatomical variations of the intrahepatic biliary tree is important for a successful hepatobiliay surgery.

Anatomical variation of intrahepatic biliary duct in cadaveric liver

Background: Hepatobiliary system has many variations. Use of cadavers, intraoperative data and various imaging modalities are the commonly employed techniques for determining the anatomy of intrahepatic bile ducts. The vivid picture of hepatobiliary system is a must for hepatobiliary surgery and identification of frequency distribution of typical and atypical pattern and different types of atypical pattern are vital. This study aimed to uncover its frequency distribution and also to recognize the variations therein.
 Methods: An observational study was conducted in the Department of Anatomy, Kathmandu Medical College Teaching Hospital from July 2013 to June 2014 by taking 50 complete human cadaveric livers without evidence of injuries or previous operations. Livers were dissected, duct traced, colored, photographed and the findings were entered in a proforma.
 Results: Out of 50 dissected livers, 32 showed typical pattern (Type A, 64%) whereas 18 liver showed atypical pattern of confluence (36%). The type B pattern was seen in 6 (12%) and type C was seen in 8 of them (16%). Of these 8 cases, subtype C1 was observed in 6 livers (12%) and subtype C2 was found in 2 livers (4%). Type D was seen in 3 livers (6%). and all of them were of the subtype D1. There were no cases of subtype D2 and of type E. Type F was observed in a single case (2%).
 Conclusions: An accurate knowledge of the anatomical variations of the intrahepatic biliary tree is important for a successful hepatobiliay surgery.

Clinical Profile of Patients with Seizure in Kathmandu Medical College Teaching Hospital.

Background: Seizure is a common clinical condition. It represents a majority of patients visiting neurology OPD as well as inpatient department in Kathmandu Medical College Teaching Hospital. While the number of patients with seizure is increasing in Nepal, data on the clinical profile of patients with seizure is scarce. Thus, this study aims to find out the relative frequency of seizure in different age and sex groups. It also aims to find out the common causes of seizure in our Nepalese population.
 Materials and Methods: A descriptive cross sectional study was carried out in patients attending outpatient and inpatient of Neurology department of Kathmandu Medical College Teaching Hospital between periods of July 2018 to December 2018. Demographic characteristics, radiographic findings, EEG findings and drugs taken by patients were recorded according to the proforma.
 Results: Data from one hundred patients were collected and analyzed. Most of the patients were less than 41 years of age. Most of the patients were male. The prime cause of seizure was found to be neurocysticercosis (25%). Majority of the patients were on monotherapy.
 Conclusion: Our data regarding the frequency of seizure in different age and sex groups is comparable to data in South East Asia region whilst, different from the western data. In our population, neurocysticercosiswas the most common cause of seizures. Also, most seizures were controlled with monotherapy.

Factors Affecting Satisfaction Regarding Maternity Services Among Postnatal Mothers in a Tertiary Hospital of Kathmandu

Background: Maternal satisfaction towards care provided during pregnancy, childbirth and puerperium is one of the key outcome measures for quality of care. In order to provide satisfactory maternity services health workers should focus on mother-friendly care. Various factors may affect on mothers' satisfaction regarding maternity services.The objective of this study was to assess the factors affecting satisfaction regarding maternity services among postnatal mothers.
 Materials and Methods: A descriptive, cross-sectional study was conducted in postnatal ward of Kathmandu Medical College Teaching Hospital. A total of 180 postnatal mothers were purposively selected for the study. Ethical clearance was obtained from the institutional review committee of Kathmandu Medical College. Face to face interview technique was used to collect the data using pre – designed structured questionnaire. Data collection was done from June to July 2019. Data were analysed using Statistical Package for Social Science 20.0 version. Both descriptive and inferential statistics were used for data analysis.
 Results: Majority (83.9%) of the mothers were satisfied with overall maternity services. The level of satisfaction was higher in (82.8%) environmental factor, (80%) health care delivery system of hospital and (73.3%) communication. There was significant association between sexes of current child with maternal satisfaction. Mothers having current child male were more satisfied with maternity services provided by the hospital (COR: 4.90 with 95% CI: 1.97, 12.18).
 Conclusion: The study concluded that majority of postnatal mothers were satisfied with maternity services provided at hospital. Current child male was significantly associated with satisfaction level of mothers on maternity services.

Assessment of Patient Safety Culture among Nurses at a Tertiary Level Hospital in Kathmandu

Introduction: Patient safety is a fundamental and critical dimension of quality health care. Globally it is becoming a major challenge in achieving universal health coverage. The challenge is even more serious in Low and Middle Income Countries like Nepal because safety related harm is more in these countries rather than in developed countries. This study aims to assess the patient safety culture among nurses.
 Methods: A descriptive cross-sectional study was conducted at Kathmandu Medical College Public Limited to assess the Patient Safety Culture within the organization among nurses. The data was collected using Agency for Health Care Research and Quality (AHRQ) Hospital survey on patient safety culture questionnaire. Mean score was calculated in different dimensions and Mann-Whitney U test was used to assess the association between safety dimension and demographic variables.
 Result: Among 12 areas of patient safety, teamwork within units and organizational learning had the highest mean score whereas the lowest reported score was in staffing followed by supervisor’s expectation and action promoting patient safety. While rating the extent of patient safety, 84% of respondents reported it as average in the organization. Study showed significant association of management support, organizational learning and frequency of event reported with age of respondents and overall perception of patient safety and hands-off/transition with working area.
 Conclusion: Since the patient safety culture is average within organization, attention needs to be paid to make it adequate in all areas of safety.

Quality of Life and Disability in Stroke Survivors

Background: With advancing treatment of stroke patients, their mortality has decreased but morbidity and disability has increased. Hence, it becomes increasingly important to find the measures to improve these areas. The study aims to assess the quality of life (QOL) and disability in stroke survivors at least six months post stroke.
 Methods: Descriptive, cross sectional design was used to assess the QOL and disability in stroke patients attending Neuromedicine and Neurosurgery out-patient departments of Kathmandu Medical College. Data was collected purposively using interview from 155 respondents. QOL was assessed using Health Related Quality of Life in Stroke Patients (HRQOLISP-40) and disability was measured by using World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Analysis was done using Pearson’s correlation and Mann Whitney U test.
 Results: The QOL was found to be best in the ‘ecosocial’ and worst in the ‘soul’ domain. In disability, patients scored the best in ‘Getting along with people’ and ‘self-care’ domains and worst in the ‘life activities: school/ work’ domain. Respondents with hemorrhagic stroke, only one admission and those who did not exercise had better QOL. Patients with less than 10 years of formal education, those not earning and those with comorbidities had more disability. Correlation analysis showed better QOL with lesser age, higher monthly family income and higher Barthel index whereas higher disability was found in respondents with higher age and lower Barthel index.
 Conclusions: Disability in stroke patients needs to be addressed inorder to improve their QOL. The domains affected should be given attention during rehabilitation of stroke patients.

Etiological spectrum of Heart Failure in a tertiary health care facility of Central Nepal

Background and Aims: High-income countries have reported common causes of heart failure as ischaemic heart diseases, hypertension, valvular heart diseases, and cardiomyopathies. There are limited data available about epidemiology of heart failure in low-income countries like Nepal. The main objective of this study is to explore etiological spectrum of heart failure in Nepal.
 Methods: This cross-sectional study was conducted at the cardiology department of Kathmandu Medical College from April 15, 2019, to July 15, 2019. Data were collected from patients diagnosed as heart failure following the European Society of Cardiology criteria and having left ventricular ejection fraction less than 50% and classified into Heart failure with midrange or reduced ejection fraction. Diastolic heart failure, Cor-pulmonale, and stroke were excluded. The data were entered and analyzed in Statistical Package for Social Sciences 20.0 using descriptive and inferential statistics.
 Results: Among 132 heart failure patients (mean age: 63.9±13.9 years), around two-thirds (65.2%) had heart failure with reduced ejection fraction (ejection fraction of less than 40%) and one third (34.8%) had heart failure with mid-range ejection fraction (40 to 49%). Dilated cardiomyopathy was the leading cause of heart failure among nearly half (47.7%) of study participants, followed by valvular heart disease (19.7%), hypertensive heart disease (14.4%) and ischaemic heart disease (13.6%). Almost half of the study participants with dilated cardiomyopathy had severe left ventricular systolic dysfunction. (p<0.05).
 Conclusion: Dilated cardiomyopathy was the most prevalent cause of heart failure, followed by valvular heart disease in our study.

Clinical Profile of Severe Cutaneous Drug Eruptions in a Tertiary Care Hospital

Background: An adverse cutaneous reaction caused by a drug is any undesirable change in the structure or function of the skin, its appendages or mucous membranes and it encompass all adverse events related to drug eruption, regardless of the etiology. 
 Methods: This is a retrospective descriptive cross-sectional study done fom April 2017 to March 2019 at dermatology department of Kathmandu Medical College Teaching Hospital. Sample size was calculated as 42 with prevalance of severe cutaneous drug eruption as 3%. After the medication history was taken, all suspected causative drugs were discontinued. For the initial 5 to 7 days, all patients were treated with intravenous corticosteroids and oral antihistamines. Follow up after one week, 2 weeks and one month were suggested for assessment of outcomes.
 Results: Out of 42 patients, 22 (52.38%) were females and 20 (47.62%) males. Most were in age groups 16-39 & 46-60 counting to 14 (33.33%) in each group. Acute morbilliform eruption was the most common presentation 20 (47.6%) followed by Steven Johnson Syndrome-Toxic Epidermal Necrolysis in 16 (38.1%). The most common offending drug group in this study was antileptics 9 (21.43%), followed by NSAIDs 8 (19.05%), antibiotics 7 (16.67%), allopurinol 4(9.52%%). Patients were discharged after 7 days with tapering dose of oral prednisolone upto 6 weeks for all patients. However, three patients died due to Toxic Epidermal Necrolysis along with comorbid conditions like intracerebral hematoma, COPD with pneumonia.
 Conclusion: Adverse cutaneous drug reactions should be recognized early for timely intervention. Previously sensitized patients should be made aware about fatal outcomes, symptoms, cross reactivites as well as over the counter preparations.

ASSOCIATION OF HYPERTENSION AND ISCHAEMIC ECG CHANGES IN TYPE II DIABETES MELLITUS

Background: Type 2 diabetes mellitus (T2DM) is one of the most common metabolic disorders to the current generation. It usually leads to multi-systemic complications such as cardiovascular diseases, proteinuria, micro albuminuria, retinopathy, hypertension, ischaemic changes and chronic kidney disease. These complications increase the morbidity and mortality of patients. The prolonged hyperglycemia leads to vascular damage. It causes insufficient blood flow to the cardiac muscles which may cause myocardial or cardiac ischaemia. The aim of this study was to find out the prevalence of hypertension and ischaemic ECG changes in T2DM patients attending Kathmandu Medical College.
 Methods: Total 360 type 2 diabetic patients were included. Blood pressure was measured and electrocardiogram (ECG) was recorded by 12 leads ECG. Statistical analysis was done using SPSS version 16. P<0.05 was considered to be statistically significant.
 Results: The mean age of the patients was 66.88 ± 1.52 years, age ranging from 40 – 95 years. In this study 168 patients (46.66%) had systolic hypertension, 204 patients (56.67%) had diastolic hypertension and 126 (35%) had both systolic and diastolic hypertension. About 103 (28.61%) showed ECG changes in hypertensive patients. Only 4 (1.11%) non- hypertensive had ECG changes. This study showed statistically significant relation of hypertension and ischemic ECG changes in type 2 diabetes mellitus cases with p- value 0.03.
 Conclusions: There is a high prevalence of hypertension among T2DM patients. In these patients, there is a statistically significant association between hypertension and ischaemic ECG changes.

Association of Hypertension and Ischaemic ECG Changes in Type II Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) is one of the most common metabolic disorders to the current generation. It usually leads to multi-system­ic complications such as cardiovascular diseases, proteinuria, micro albumin­uria, retinopathy, hypertension, ischaemic changes and chronic kidney disease. These complications increase the morbidity and mortality of patients. The pro­longed hyperglycemia leads to vascular damage. It causes insufficient blood flow to the cardiac muscles which may cause myocardial or cardiac ischaemia. The aim of this study was to find out the prevalence of hypertension and isch­aemic ECG changes in T2DM patients attending Kathmandu Medical College.
 Methods: Total 360 type 2 diabetic patients were included. Blood pressure was measured and electrocardiogram (ECG) was recorded by 12 leads ECG. Statistical analysis was done using SPSS version 16. p<0.05 was considered to be statistically significant.
 Results: The mean age of the patients was 66.88 ± 1.52 years, age ranging from 40 – 95 years. In this study 168 patients (46.66%) had systolic hyperten­sion, 204 patients (56.67%) had diastolic hypertension and 126 (35%) had both systolic and diastolic hypertension. About 103 (28.61%) showed ECG changes in hypertensive patients. Only 4 (1.11%) non- hypertensive had ECG changes. This study showed statistically significant relation of hypertension and isch­aemic ECG changes in type 2 diabetes mellitus cases with p- value 0.03.
 Conclusions: There is a high prevalence of hypertension among T2DM pa­tients. In these patients, there is a statistically significant association between hypertension and ischaemic ECG changes.

Perception of nurses regarding family needs of critically ill patients in a tertiary hospital of Kathmandu: A cross-sectional study

Background: Getting serious illness and being admitted in critical care unit is always stressful to patient and family members. Meeting the needs of family members of patients in the intensive care unit is a primary responsibility of intensive care unit staff and an important criterion in assessment of quality of care.
 Objectives: The aim of this study was to assess the family members’ needs of critically ill patients as perceived by nurses.
 Methodology: A descriptive cross sectional study was conducted among 50 nurses from different critical care unitsof Kathmandu Medical College Teaching Hospital using purposive sampling technique. Structured questionnaire was developed by referring to “Critical Care Family Needs Inventory”in our context for data collection and collected data was analyzed by using Statistical Package for Social Sciences version 16.
 Results: The mean age of the respondents was 24.98 ± SD 2.77.Regarding education and experience, 58% respondents had proficiency certificate level and 42% had bachelor level education and mean working experience in critical care unit was 37.54 months. Regarding the importance of family needs, 86% nurses perceived “explanation about the critical care unit environment before admitting the patient in critical care unit” as very important need for the relatives. Likewise, 58% nurses perceived “to know which staff members could give what type of information” and “to be alone at any time” as the least important needs.
 Conclusion: The study found that clear explanation about the critical care environment to the relatives is very important to gain co-operation from them in treatment of critically ill patients. Hence, staff of critical care unit needs to be aware in meeting the needs of relatives.

Use of C-reactive protein level in diagnosis of tubercular pleural effusion

Background: C-reactive protein in both pleural fluid and serum has been found to be higher in tubercular pleural effusion than in other causes of pleural effusion.
 Objectives: The main aim of this study was to find out the diagnostic value of C-reactive protein in patients withlymphocytic pleural effusion.
 Methodology: A cross-sectional study was conducted in 90 patients with pleural effusion who underwent thoracocentesis at Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal. The complete biochemical tests of pleural fluid and serum were performed. The C-reactive protein concentrations of both pleural fluid and serum were then measured from samples from patients with lymphocytic exudative pleural effusion.
 Results: Ninety patients with exudative lymphocytic pleural effusion were included. Male patients were 56 (62.2%) and female were 34 (37.8%) with the male to female ratio of 1.64. Mean age of the patients was 51±21.54 (Mean ± Standard Deviation). The pleural fluid C-reactive protein levels in tubercular pleural effusion were higher (48.87±24.19 mg/dl) compared to non-tubercular group (38.30±17 mg/dl; p<0.001). Similarly, the serum fluid C-reactive protein levels in tubercular pleural effusion were higher (29.60±13mg/dl) compared to non-tubercular group (18.14±9.2mg/dl; p< 0.001). The sensitivity of pleural fluid C-reactive protein level in diagnosing tubercular pleural effusion was 86%.
 Conclusion: Simple and inexpensive test like C-reactive protein is useful in the diagnostic workup of lymphocytic pleural effusions. High C-reactive protein levels are very suggestive of tubercular pleural effusion.

The Pattern of Injury from Road Traffic Accident Presenting at Emergency Department of Kathmandu Medical College.

Road traffic accidents are the major public health problem. The objective of the study was to analyze road traffic accidents presenting in Kathmandu Medical College Emergency Department. The data from all consecutive road traffic accident cases brought to Emergency Department Kathmandu Medical College Teaching Hospital were collected from 2018 Jan-2018 June. Factors like age of the patients, time of the accident, influence of illicit substances and type of injury were documented. Males (74) were common victims than the females (26). Eldest patient was 65 years of the age while youngest patient was 4 years. Most common type of injury was fracture in male 28 (37%)and laceration in females8 (38%). Alcohol intoxication was evident by positive alcohol smell test in 10 (13.6%) males and 6(23%) females. Road traffic accidents are major health concern in Kathmandu Medical College Teaching Hospital and preventive measures should be considered to reduce such health burden.

Prevalence of Bilateral Asymmetry of Tibial Bones Length in MBBS Students of A Medical College

A wide variability of bilateral asymmetry in human has been observed within the population. However sufficient attention has not been given to the difference present in the limbs especially the tibial bones. It is generally assumed that the both limbs of the individual are with insignificant differences. The objective of the study is to find the prevalence of bilateral asymmetry of the tibial bone length of the same individual and distribution in between the two genders. This descriptive cross-sectional study was conducted on 150 students of Kathmandu Medical College and Teaching Hospital after obtaining ethical approval. Simple Random Sampling technique was used. The right and the left tibial length were recorded for different genders Results: Bilateral asymmetry in the tibial bone length was observed in 66 (44%) [41.58%- 46.42% at 95% CI] of the subjects which was recorded more in males 98 (65.15%) than in females. The minimum and maximum differences between the tibial length present was 0.1mm and 0.8 mm respectively with a mean of 0.2136 mm. Among the three age groups, tibial length asymmetry was observed highest 67 (45.56%) in Group B (20-22 years). Asymmetry in length was seen more in the right tibia with male preponderance over female. Asymmetry in the tibial bones length should be given proper attention and proper diagnosis and treatment of leg discrepancies should be done.

Electronic health-literacy skills among nursing students.

BackgroundThe Internet has become a major source of health-related information. In order to provide better health services and health-care education to society, nurses should have acceptable electronic health (eHealth) literacy.ObjectiveThe main aim was to measure eHealth-literacy skills among nursing students of Kathmandu Medical College Teaching Hospital, Nepal.MethodsA cross-sectional study was conducted among 152 Bachelor of Science nursing students at the hospital. Data were collected using the self-administered eHealth Literacy Scale. This is an eight-item tool that is assessed on 5-point likert scale to measure consumers’ perceived skills at finding, evaluating, and applying eHealth information to health problems. Demographical and personal variables were collected to explore their relationship with eHealth literacy.ResultsA total of 152 nursing students with mean age of 19.84±1.62 years participated in the study. While 44.7% perceived that they had average Internet skills, 65.1% found the Internet useful in helping them make decisions about their health. Nursing students had a moderate self-perceived level of eHealth literacy (median 3.69, IQR 0.87). Related factors included students’ Internet skills, frequency of using the Internet for health related purposes, and self-perception of the usefulness and importance of the Internet.ConclusionThis study represents a baseline reference for eHealth literacy among nursing students. Students have some basic necessary skills, while other skills still need to be improved. There is a need to pay attention to eHealth-literacy needs of nursing students.