Kathmandu University Teaching Hospital Research Articles

Comparison of inter-radicular distance and buccal cortical bone thickness in Class I and Class II skeletal malocclusion patterns

Introduction: Knowledge of the safe zone of mini-implant placement guides clinicians in choosing where to place mini-implants. Several studies evaluated the safe zone for mini-implants placement, but only a very few previous studies have taken different skeletal patterns into account when assessing measurements. Objective: The purpose of this cross-sectional, comparative study was to compare the inter-radicular distance and buccal cortical bone thickness in Class I and Class II skeletal malocclusion patterns. Materials and Methods: A total of 62 CBCT images of patients with Class I and Class II skeletal malocclusion were obtained from the records of the department of Oral medicine and Radiology, Kathmandu University Teaching Hospital. The inter-radicular distance and buccal cortical bone thickness were measured at four different heights (2, 4, 6 and 8 mm) from the CEJ towards the apex. These measurements were measured between different skeletal pattern and gender with independent t-test. The intergroup comparison at different height from CEJ was done with ANOVAfollowed by Tukey's post-hoc test to see the difference within the category. Result: There was a statistically significant difference observed in the inter-radicular distance between the maxillary first and second premolars at a height of 6 mm between Class I and Class II malocclusion patterns (p = 0.03). There were differences observed in the inter-radicular distance of the mandible at a different height based on skeletal malocclusion pattern, which was not statistically significant (p > 0.05). The buccal cortical bone thickness between the maxillary central and lateral incisors at the height of 2 mm from CEJ between Class I and Class II skeletal malocclusion patterns was statistically significant (p = 0.01). The buccal cortical bone thickness of the mandible at different heights based on skeletal malocclusion pattern there were differences observed which were not statistically significant (p > 0.05). Conclusion: The inter-radicular distance and buccal cortical bone thickness could be influenced by different skeletal patterns and tend to increase from the CEJ to the apex in both Class I and Class II skeletal patterns.

Accuracy of Broselow tape in estimating the weight of the child for management of pediatric emergencies in Nepalese population

BackgroundChildren with emergency conditions require immediate life-saving intervention and resuscitation. Unlike adults, the pediatric emergency drug dose, equipment sizes, and defibrillation energy doses are calculated based on the weight of the individual child. Broselow tape is a color-coded length-based tape that utilizes height/weight correlations for children. However, in low-income countries like Nepal, due to factors like undernutrition, the Broselow tape may not accurately estimate weight in all ranges of pediatric age group.MethodsThis study was conducted in the Department of Pediatrics of Dhulikhel Hospital, Kathmandu University Teaching Hospital, in children less than 15 years of age. Our study aims to prospectively compare the actual weights of urban and rural Nepalese children with the estimated weights using the Broselow tape (2017 edition) and the updated APLS formula. The errors in the selection of endotracheal tube size and adrenaline dose using the Broselow tape were also explored.ResultsThis study included 315 children with male to female ratio of 0.63:1. They were divided into 3 groups according to their estimated weight by the Broselow tape into < 10 kg, 10–18, and > 18 kg. There was a total agreement of the estimated color zone according to the Broselow tape with the actual weight in the gray zone (p = 0.01). There was a positive relationship between the actual body weight and the estimated body weight (correlation (r = 0.970, p = 0.01) and accuracy (r2 = 0.941)). Our analysis showed that the accuracy of estimated weight with the Broselow tape decreases with increasing weight of children. The precision of the tape was relatively high in the lower length zones as compared to the higher length zones. The estimated size of the endotracheal tube (p = 0.01) and adrenaline dose (p = 0.08) by the Broselow tape was in agreement with that estimated using PALS formula in weight group of less than 18 kg, but decreases as the estimated weight increases further.ConclusionsThe accuracy of the Broselow tape in estimating the weight of a child, endotracheal tube size, and dose of adrenaline is higher in weight group of less than 18 kg, and accuracy decreases as the weight of child increases. The Broselow tape should be avoided in children weighing more than 18 kg. Hence, PALS age-based formula for ET tube size estimation and weight-based formula for adrenaline dose calculation are recommended for children weighing more than 18 kg.

Comparison of Orthodontic Treatment Duration Among Extraction Versus Non Extraction Therapies

Introduction: Orthodontic treatment is usually perceived as a lengthy treatment as average treatment time usually last more than a year and may go up to even five years. So, in orthodontic practice the optimum treatment result with minimal treatment time should be the goal of clinicians. Treatment duration varies based on different clinico-environmental factors.&#x0D; Materials &amp; Method: Total 200 cases were randomly selected from the archives of debonded treatment records from the department of orthodontics, Dhulikhel Hospital, Kathmandu University Teaching Hospital. Out of the 200 records, 103 records were fit for the study based on previously set inclusion and exclusion criteria. The selected cases were divided into three different groups: extraction n= 28 (extraction of 4 premolars), partial extraction= 19, (extraction of 1-3 teeth) and non-extraction n=56. Furthermore, the cases were also divided into Class I, II and III malocclusion patterns. After doing the test of normality, descriptive statistics, independent samples t test and ANOVA test were performed to compare the treatment duration with respect to gender, malocclusion pattern and treatment modalities.&#x0D; Result: Out of the 103 selected cases, maximum number of cases were of Class I(60) followed by Class II(37) and Class III(6). There was no statistical significance on treatment duration among male and female subjects (p= 0.933) as well as among different malocclusion pattern ( p= 0.255). On the contrary, there was statistical difference on treatment duration among non extraction, partial extraction and extraction groups ( p=0.0004). The average treatment duration for non extraction, partial extraction and extraction group were 22, 28 and 29 months respectively.&#x0D; Conclusion: Orthodontic treatment duration is shorter for therapies done by non extraction than extraction. The average treatment duration for non extraction and extraction therapy is 22 and 29 months respectively. The treatment duration is not affected by gender and type of malocclusion.

Assessment of rotahaler inhalation technique among patients with chronic obstructive pulmonary disease in a teaching hospital of Nepal

Background: Inhalation mode of drug delivery is the mainstay treatment for chronic obstructive pulmonary disease, however; incorrect technique prevents patients from receiving maximal therapeutic benefi ts.Objectives: To assess usage technique of rotahaler among patients with chronic obstructive pulmonary disease and identify factors affecting its performance.Methods: Descriptive cross sectional study was conducted to assess rotahaler (single unit dose dry powder inhaler) inhalation technique among patients with chronic obstructive pulmonary disease in Kathmandu University Teaching Hospital. The study population consisted of 100 respondents using rotahaler for at least one year. Data collection was done by standard checklist, semi structured questionnaire via observation and interview methods respectively.Results: Correct inhalation technique was found in 37% of total respondents. Nearly two out of three respondents (61%) failed to breathe out deeply before inhaling. Majority of the respondents (59%) failed to hold breath for at least 10 second and 25% were unable to breathe in deeply. Age, occupation, source of inhalation instruction and re-demonstration of the technique were found to be signifi cantly associated with the correct inhalation technique (p &lt;0.05).Conclusion: More than half of the respondents had incorrect inhalation technique, so health education program targeting the common identifi ed errors should be carried out. Arrangements should be made for regular involvement of pharmacist in teaching and re-demonstration to ensure good inhaler technique. This would ultimately lead to a greater clinical response and improved patient compliance.Journal of Kathmandu Medical CollegeVol. 5, No. 1, Issue 15, Jan.-Mar., 2016, Page: 11-17

Prevalence of Maxillary Central Incisor Impaction and Supernumerary Teeth among Nepalese Orthodontic Patients

Introduction: Very few studies have been done on impacted maxillary central incisors and supernumerary teeth.Objective: To find the prevalence of maxillary central incisor impaction and supernumerary teeth among orthodontic patients attending Dhulikhel Hospital, Kathmandu University Teaching Hospital.Materials &amp; Method: The retrospective study consisted of 787 records of orthodontic patients of age 10-35 years. Dental model and orthopantomograph were retrieved and searched for impacted maxillary central incisors and supernumerary teeth. Incomplete records and patients with known syndromes were excluded from the study. Descriptive statistics was applied to find the prevalence rate and comparison between male and female was done by chi-square test.Result: Out of total samples, 14(1.8%) and 11(1.4%) samples were found to have impacted maxillary central incisors and supernumerary teeth respectively. There was no significant difference in prevalence of impacted maxillary central incisors between male and female samples (p=0.78), however there was significant difference in occurrence of supernumerary teeth between gender groups (p=0.025).Conclusion: The prevalence of impacted maxillary central incisor and supernumerary teeth among orthodontic patients attending Dhulikhel Hospital, Kathmandu University Teaching Hospital is 1.8% and 1.4% respectively. Male patients have higher chance of having supernumerary teeth than female patients

Outcomes of extra corporeal shock wave lithotripsy in renal and ureteral calculi.

Since the introduction in early 1980s, Extracorporeal Shockwave Lithotripsy (ESWL) became the accepted first line treatment modality for renal and upper ureteric stones. It is simple, safe and effective noninvasive procedure which can be performed without anaesthesia in outpatient basis. The objective of this study was to determine the efficacy of ESWL to achieve complete stone clearance in the patients with different sizes of renal and upper ureteric stones. The aim of this study was to assess the outcome, efficacy and complications of ESWL in the treatment for renal and ureteric stones in terms of the site and the size of the stone in the patients presented at Dhulikhel Hospital Kathmandu University Hospital. In this prospective study a total of 430 (214 renal and 216 ureteric) cases of urinary stone disease in 257 male and 173 female patients treated by ESWL at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of May 2010 to June 2012 were included. Data of patients with renal and ureteric stones were evaluated for stone site, size, and number of sessions. Data were analyzed using spss 13.0. Out of 430 cases, the overall stone free rate in after 1st session was 341 (79.3%) at one month and in three months follow up (3 sessions) it was increased up to 414 (96.3%). In 16 (3.7%) patients treatment was failed. Average size of the stone was 12.24 (SD± 3.65) mm. Stone free rate was 154 (72%) in the case of renal and 187 (86.6%) in the case of ureteric stones in first session. In three months follow up (three sessions) it was 204 (95.4%) and 210 (97.2%) respectively for renal and ureteric stones. In relation to size the stone free rate in <10 mm, 10-15 mm and > 15 mm was 97%, 97% and 90%. ESWL is the first line preferred choice for renal and upper ureteric stones which provides the maximum stone free rate in the case of stone size smaller than 1.5 cm.

Urinary bladder carcinoma: impact of smoking, age and its clinico-pathological spectrum.

Urinary bladder carcinoma is common urological malignancy. Although epidemiological evidence favors role of occupational exposure to chemical carcinogen as the aetiological factor of bladder carcinoma, many cases arise with no obvious occupational exposure to chemical carcinogen. Tobacco and cigarette smoking is common in both rural and urban areas of Nepal. The objective of this study was to determine the impact of smoking and age in urinary bladder carcinoma with related clinicopathological correlations. A total of 56 (44 males and 12 females) cases of urinary bladder cancer treated at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of January 2004 to December 2013 were included in the study. Data of patients with Urinary bladder cancer were obtained from hospital records and evaluated for age, sex, history of smoking, clinical presentations, cystoscopic findings and histopathological characteristics. Out of 56 cases, 51 (91.1%) of the patients had hematuria. History of smoking was found in 44 patients. Smoking was found much higher in males (88%) than females (41.66%). Transitional cell carcinoma (TCC) was the most common histological variety, which was seen in 51 (91.07%) patients. The significant impact of smoking was found in terms of grade of TCC. The incidence of bladder carcinoma is higher in male and TCC is the most common variety of Urinary bladder malignancy. History of smoking correlated with grade.

Clinical Profile and Outcome of Acute Encephalitis Syndrome in Dhulikhel Hospital of Nepal

Introduction: Acute encephalitis syndrome (AES) is a constellation of clinical signs and or symptoms i.e. acute fever with acute change in mental status. AES may be present as encephalitis, meningoencephalitis or meningitis. It can be associated with severe complication, including impaired consciousness, seizure, limb paresis or death. Materials and Methods: Study consisted of retrospective analysis of hospital records of children up to 16 years of age admitted with diagnosis of AES in the department of Paediatrics Dhulikhel Hospital, Kathmandu University Teaching Hospital, Dhulikhel Kavre from January 2010 to December 2011. Results: During the two years (January 2010 to December 2011), 47 patients of AES were admitted. Among the admitted cases there were 34 male and 13 female patients. Meningitis cases were 29, encephalitis cases were 14 and 4 meningoencephalitis cases. Among the meningitis cases, viral meningitis accounted for 12, bacterial meningitis accounted for 15 and 1 tubercular meningitis.One was eosinopilic meningitis in which the causative organism was found to be fasciolosis by ELISA. Viral encephalitis was found to be the most common cause of encephalitis. Sensorineural hearing loss was seen in 3 cases, subdural effusion in 1 and hydrocephalus in 1. One patient had intracranial hemorrhage with hemiparesis as a complication of eosinophilic meningitis. Conclusion: Acute encephalitis syndrome is one of the most common causes of PICU admission in Dhulikhel hospital. Bacterial meningitis was common among the acute encephalitis syndrome followed by viral meningitis. One case of eosinophilic meningitis with intracranical hemorrhage and hemiparesis was found. Sensorineural hearing loss was found to be commonest complication. DOI: http://dx.doi.org/10.3126/jnps.v32i3.6683 J. Nepal Paediatr. SocVol.32(3) 2012 201-205

Enteric fever in Children at Dhulikhel Hospital

Introduction: Typhoid fever is one of the most common public health problems in Nepal. It occurs in all parts of the world where water supplies and sanitation are sub-standard. In Dhulikhel hospital, this is one of the top acute febrile illnesses in inpatient department. The objectives of this study were to evaluate the clinical and laboratory parameters including culture and sensitivity, the response to therapy, and complications of enteric fever among child cases at Dhulikhel Hospital. Materials and Methods: This retrospective study was conducted at Dhulikhel Hospital, Kathmandu University Teaching Hospital from January 2009 to June 2011. Statistical analysis was done with SPSS. Results: There were total of 138 cases of enteric fever admitted. There were 73 (53%) male and 65 (47%) female. Eighty-one percent were above five years of age. The most common clinical presentation was fever (100%) followed by headache and G I symptoms. Hepatomegaly was the most common sign seen among the cases and was seen in 110cases (79.71%). Most of the patients had normal WBC count 100 (72.46%) Widal test was positive in 70 (50.72%) cases and blood culture was positive in 52(37.68%) cases. Nalidixic acid was found to be resistant in 26 (50%) cases. Complications were seen in only 7 (5%) enteric fever cases. Conclusion: Typhoid fever is predominant in school going children in Nepal with slight male predominance. Fever lasting over 3 days followed by headache and GI symptoms are the major presenting symptoms. In making the diagnosis, the isolation of bacteria from blood is the “gold standard”. Nalidixic acid resistant Salmonella typhi is on the increasing trend. Pneumonia was found to be the most common complication among all other complications seen in enteric cases. In Dhulikhel Hospital this is one of the top acute febrile illnesses in inpatient department. DOI: http://dx.doi.org/10.3126/jnps.v32i3.6682 J. Nepal Paediatr. SocVol.32(3) 2012 216-220

Ambispective study on Mac Donald suturing in pregnant ladies with cervical incompetence in Dhulikhel Hospital

Cervical incompetence is one of the main contributors to repeated pregnancy loss, accounting for approximately 25% of the cases. Typically it results in progressive cervical dilatation, leading to a painless second- or early-third-trimester abortion. The main objective of the study was to explore the benefit from cervical cerclage in pregnant women with anatomical cervical incompetence. In a review of the operation and labour registers from January 2006 till January 2010, a total of 38 cervical cerclage procedures were performed at Dhulikhel Hospital (DH). In the study caste, parity, gestational age, diagnostic criteria, postoperative complications and pregnancy outcomes of the cases were analyzed. Two of the 38 cases didn't come for delivery at Dhulikhel Hospital (Kathmandu University Teaching Hospital). Four women haven't delivered at the time of data analysis. So pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. Of them 18 cases (47%) were Brahmin, 22 cases (58%) were between 20-25 years old and 32 cases (84%) were from Kavre district. All cases were booked cases (they had antenatal care in the hospital) and 14 patients (37%) were third gravida. Most cases had 2 to 4 antenatal visits prior to suturing. Two cases were diagnosed with a bicornuate uterus. 21 cases (55%) had a previous history of at least one dilatation and evacuation. 33 cases (87%) were diagnosed with cervical incompetence clinically and confirmed by ultrasound. The remaining 13% were assessed, in the absence of a history of midtrimester abortion, of having a high suspicion of cervical incompetence after midtrimester scan with measurement of cervical length. In 18 cases (47%), cervical cerclage were done at 15 to 20 weeks of gestation. The postoperative period was uneventful in all 38 cases. All cases (32) delivered in DH were assisted by consultant obstetricians. 19 out 32 cases (59%) were delivered vaginally at term. 38 cases were included in the study. Pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. 31 out 32 cases were delivered with good foetal weight. It clearly shows pregnant women with anatomical cervical incompetence were benefitted from cervical cerclage. The authors recommend an early trans vaginal scan in any patient with a history of mid trimester abortion or preterm labour. The cervical cerclage procedure therefore should be available more widely to benefit those patients with proven or strongly suspected cervical incompetence.

Poisoning cases attending emergency department in Dhulikhel Hospital- Kathmandu University Teaching Hospital

The objective of the present study is to evaluate the characteristics of acute poisoning cases admitted to emergency department over a one year period. The demographic, clinical and psycho-social aspects of the patients were analysed. A hospital based study was carried out in the emergency department, Kathmandu University Teaching Hospital/ Dhulikhel Hospital, Dhulikhel analysing the data of the poisoning cases attended for one year. The study was carried out amongst inpatients attending emergency with acute poisoning. A total of 54 patients were admitted to the emergency department with acute poisoning. The female-to-male ratio was 1.34:1. Most poisoning occurred in the age group of above 40 years. The mean ages of female and male were 29.87 + or - 14.85 years and 35.54 + or - 15.02 years respectively. By occupation 40.38% of the cases were farmers. Only 35.29% of the patients were illiterate. 79.24% of the cases intentionally consume the poison. Organ phosphorus poisoning (OP) was the most common poisoning. Oral route was the commonest route of poisoning accounting 98.1%. Sixty-six percentage (66.66%) of the cases had the poison stored in their home with 27.7% bought from the market once needed. Among the cases of acute poisoning 5.55% were fatal. The following conclusions were reached: (1) females were at greater risk for poisoning than males, (2)self-poisoning cases constituted the majority of all poisonings, and (3) the main agents of self-poisoning were OP poisoning.

Prevalence of dry socket following extraction of permanent teeth at Kathmandu University Teaching Hospital (KUTH), Dhulikhel, Kavre, Nepal: A study

One of the most common postoperative complications following the extraction of permanent teeth is a condition known as dry socket. Although the aetiology of dry socket is debated, it is probably multifactoral, and its pathogenesis remains unknown. The aim of the study was to evaluate incidence of dry socket following extraction of permanent teeth at dental out-patient department (OPD) of Dhulikhel hospital, Kathmandu university teaching hospital (KUTH), Kavre, Nepal. Retrospective reviews of records of total 1860 no of patients were studied who underwent extraction of permanent teeth for various reasons since January 2007 to December 2008 period. There were 873(47%) male patients and 987 (53%) female patients. Information regarding indications for extraction, extracted tooth status, onset of symptoms, relevant findings of the examining clinician, interval between presentation, management given, and its outcome were retrieved and analysed. A total 1860 no of patients were studied who underwent extraction of total 2640 number of permanent teeth for various reasons. A total of 103 (3.9%) extractions were complicated by dry socket in patients aged 11 to 80 years with female predominance (54.4%). The etiology of dry socket is multifactorial and ultimately it is the host's healing potential which determines the severity and duration of the condition. The incidence of dry socket was found as 3.9% in this study. The incidence was higher in female patients (54.4%) and in mandibular teeth extraction cases (68.93%).

The pattern of tooth loss due to dental caries and periodontal disease among patients attending dental department (OPD), Dhulikhel Hospital, Kathmandu University Teaching Hospital (KUTH), Nepal

The aim of this study was to investigate the type of tooth usually associated with extraction due to caries or periodontal disease and its relation to age at which these were lost, among patients attending dental surgery outpatient clinic, Dhulikhel Hospital, Kathmandu University Teaching Hospital (KUTH). A total no of 626 patients (male-299 and female-327) attending at outpatient clinic, in the department of Dentistry, Dhulikhel Hospital were taken in over a period of six months. The details about the permanent teeth to be extracted regarding each tooth type, including age and sex of the patient, type of tooth extracted, cause of extraction were collected, causes other than dental caries and periodontal disease were excluded. The highest proportion of extraction due to caries occurred between 21-30 years of age, while that of periodontal disease was between 51-60 years of age. More than 80% of teeth lost were from below 40 years of age group. Mandibular first molar was by far the most frequently extracted tooth due to dental caries followed by maxillary first molar. Maxillary teeth were lost more than mandibular teeth due to periodontal disease. Dental caries and periodontal disease are the two most important factors for extraction or removal of tooth. In this study dental caries is the major cause for loosing tooth among young group of people.

Role of tiotropium in chronic obstructive pulmonary disease exacerbation

Introduction: Chronic obstructive pulmonary disease (COPD) remains a major public health problem. Many patients suffering from chronic obstructive lungs diseases are of poor economic status, mostly illiterate, therefore has a direct bearing on patient compliance. Tiotropium is a new anticholinergic therapy for chronic obstructive pulmonary disease that differs from ipratropium by its functional relative selectively for musarinic receptor subtypes and which allows single dosing a day. This study presents a cost-effectiveness, efficacy, and side-effects of Ipratropium bromide and Tiotropium in COPD. Methods: Prospective study was conducted In Kathmandu University Teaching Hospital, between the year 2008 and 2009 in terms of cost-effectiveness, efficacy, and side-effects of Tiotropium and Ipratropium amongst COPD patients. Results: Tiotropium and Ipratropium were prescribed in total of 57 patients (30 in ipratropium bromide and 27 in tiotropium bromide) for the management of COPD among outpatients. There were no significant differences in age, height, weight and baseline lung function parameters (FEV1 and PEF) between the two drugs i.e. ipratropium bromide and tiotropium bromide. Significant improvement in lung function parameters were found in each respective group of drugs after bronchodilator therapy. Tiotropium results in significant reduction of Chronic Obstructive Pulmonary disease exacerbations and significant improvement in quality of life, lung function, and dyspnoea compared to ipratropium. The additional cost to achieve these favorable outcomes was cheaper than Ipratropium bromide. (Nepalese Rs. 7.03 per day for tiotropium as compared to Rs. 9.06 for Ipratropium) Conclusions: Tiotropium results in significant reduction of chronic obstructive pulmonary disease exacerbations and significant improvement in quality of life, lung function and dyspnoea compared to Ipratropium. Keywords: Chronic obstructive pulmonary disease; ipratropium; tiotropium DOI: http://dx.doi.org/10.3126/joim.v32i2.4937 Journal of Institute of Medicine, August, 2010; 32: 5-10

Prevalence of Skin Diseases in Kavre District, Nepal

Background Skin is the major interface of human to the environment . It is the major susceptible organ for any disease. Wide prevalence of skin diseases in the community is a well established fact. Objectve The aim of this study is to determine the prevalence of skin diseases among the general population of Kavre District,Nepal . Methods This is a hospital based, retrospective study done among all the patients visiting Dhulikhel Hospital, Kathmandu University Teaching Hospital, in Dhulikhel, Kavre during the year 2007-2008 AD. Data were obtained from the hospital out-patient records and analyzed. The total number of patients who visited the hospital were 74,279 (male-30,809 female- 43,470), out of which 7374 (9 .92 %), male 4155, female 3219, visited the Dermatology Department. Among this total study population now comparative study of the prevalence of skin diseases was performed based on sex, age and type of dermatological condition. Results The overall prevalence of skin diseases were 9.92% with slight higher rates seen among males ( 56.34 %) than females (43.65 %).Non-infective conditions , 6063 ( 82.22% ) outweighed infective conditions 1311 (17.78 %), commonest one being the pigmentary disorders (32.56 %) and in the age group 16-35 years old (31.23% ). Conclusion This study demonstrates that skin diseases are one of the most prevalent disease condition among the general population, representing a major public health problem. Keywords Prevalence; infective diseases; non-infective diseases. DOI: http://dx.doi.org/10.3126/njdvl.v9i1.5761 NJDVL 2010; 9(1): 7-9