Manipal Teaching Hospital Research Articles

Prevalence and Correlates of Vitamin B12 Deficiency among Depressive Patients Presenting in the Tertiary Care Hospital of Gandaki Province of Nepal

Introduction: The prevalence of vitamin B12 deficiency in depression is not clear and more research is needed.
 Objectives: The objective of this study is to find the prevalence of deficiency of vitamin B12 level in the depressed patient. The second objective is to find the prevalence of deficiency of vitamin B12 according to different socio-demographic variables.
 Methodology: The patients diagnosed as depressive episodes according to the International Classification of Disease – 10 Classification of Mental and Behavioural Disorders were selected from the Psychiatric Out-Patient Department of Manipal Teaching Hospital, Pokhara. The proforma was used to collect the socio-demographic profile of the patient. The serum sample of the 50 patients was sent for vitamin B12 estimation. Serum concentrations less than 239 pg/ml was considered deficient in this study.
 Results: The overall prevalence of vitamin B12 deficiency was 22% in the depressed patients. The mean age of the total patients were 39.2 years with the standard deviation of 13.75 years. Vitamin B12 deficiency was more prevalent in the socio-demographic variables like age above 61 years, Brahmin and Chhetri caste, female gender, unmarried groups, and in the patients living in the urban area as compared to other variables.
 Conclusion: The result shows that vitamin B12 deficiency is common in the patients with depression. Clinicians should be aware of the risk for vitamin B12 deficiency in depressive patients. As this study was done in limited geographical area and sample size being small, further larger studies are needed before generalizing these results.

Comparative Study of Cardiovascular Response to Laryngoscopy With Endotracheal Intubation and Laryngeal Mask Airway Insertion

Background: Airway management is the most essential manoeuvre during delivery of general anaesthesia. Traditionally, laryngoscopy and endotracheal tube (ETT) insertion has been the mainstay in providing adequate airway management and delivering anaesthesia. The laryngeal mask airway (LMA) offers a much less invasive way of maintaining the airway as it does not pass through the glottis and does not require the use of the laryngoscope. Laryngoscopy and ETT or LMA insertion are noxious stimuli which provoke a transient but marked sympathetic response manifesting as hypertension and tachycardia.
 Materials and Methods: A hospital based comparative study was conducted to determine the haemodynamic response elicited by laryngoscopy and ETT and compare it with that elicited by LMA in ASA I (American Society Anesthesiologist) and ASA II patients, undergoing elective surgeries at Manipal Teaching Hospital.
 Results: The change in hemodynamic parameters after laryngoscopy and ETT insertion were significantly greater than those elicited by LMA (p<0.0001). The increase took about 5 minutes to return to pre insertion values in the ETT group, whereas about 3 minutes in the LMA group. It took a significantly shorter time to insert an LMA (12.63 sec) compared to ETT (22.76 sec).
 Conclusion: The haemodynamic changes elicited by LMA are less and short lived compared to those elicited by laryngoscopy and ETT insertion. It takes a shorter time and is much easier to insert an LMA compared to ETT.

Clinico-epidemiological profile of Acinetobacter and Pseudomonas infections, and their antibiotic-resistant pattern in a tertiary care center, Western Nepal.

Background:Infections caused by Acinetobacter species and Pseudomonas species, especially multidrug-resistant (MDR) strains pose a serious management challenge with a public health threat.Materials and Methods:A hospital-based retrospective study of patients who were infected with Acinetobacter spp or Pseudomonas aeruginosa was carried out at Manipal Teaching Hospital from 2014 to 2016.Results:A total of 170 cases of infections with Acinetobacter spp. and 313 cases with Pseudomonas aeruginosa were studied. The rate of nosocomial infections was higher than non-nosocomial infections. ICU was found as the major hub for both the organisms; (53.5% of cases due to Acinetobacter spp. and 39.6% due to Pseudomonas aeruginosa). Most isolates were of respiratory tract origin (Acinetobacter 74.7% and Pseudomonas aeruginosa 65.8%). Percentage resistance of Acinetobacter spp. towards polymyxin B was found to be quite low (18.8%). Similarly, resistance rates of Pseudomonas aeruginosa against amikacin were also found to be low, i.e., 17.4%. A higher prevalence of multidrug resistance was seen among Acinetobacter spp than among Pseudomonas aeruginosa (75.9% vs. 60.1%). The hospital stay was longer for patients infected with MDR isolate (p=0.001 for Acinetobacter spp. and p=0.003 for Pseudomonas aeruginosa). The mortality rate was higher in infections due to Acinetobacter spp (15.9%) as compared to Pseudomonas aeruginosa (8.3%).Conclusion:This study reveals that infections caused by Acinetobacter species and Pseudomonas aeruginosa are associated with prolonged hospital stay and high in-hospital mortality. These emphasize the need for prudent use of antibiotics and aggressive infection control strategies.

Depression In Pregnancy: Prevalence And Clinical Correlates

Introduction: Pregnancy increases the risk of various psychiatric illness including depression. Such illness can result in prematurity, low birth weight and mother-child bonding. Depression is more common in women who have had negative experiences in previous pregnancies, have prior history of psychiatric disorder or are experiencing stressful life events. Unfortunately, psychiatric disorders among pregnant women are still undiagnosed and untreated, especially in developing country like Nepal. The aim of this study was to find out the prevalence and correlates of depression in pregnancy. 
 Material and Method: A cross-sectional, hospital based, descriptive study was conducted among 135 pregnant women attending Manipal Teaching Hospital’s antenatal clinic. Sociodemographic data and relevant clinical variables were collected using a predesigned proforma after obtaining informed written consent. The subjects were interviewed with Beck’s Depression Inventory (BDI). For the assessment of correlates, regression analysis was carried out. All statistical analyses were done using SPSS v 20.0. P values < 0.05 were considered significant. 
 Results: The prevalence of depression was 13.3 % according to BDI with additional 19% fulfilling criteria of mild mood disturbance. Factors such as history of sub fertility, pregnancy-induced illness and presence of domestic violence were found to be statistically significant predictors of depression during pregnancy. 
 Conclusion: Depression can occur frequently among pregnant women. Certain factors can be identified, which further increase the risk of such mental illnesses. Thus, pregnant women who are at high risk such as with pregnancy induced illness, have history of sub fertility, exposed to domestic violence etc., must be identified and diagnosed so that they can be treated timely.

Clinico-epidemiology of Hymenoptera Stings in and around Kaski District, Nepal.

Introduction: In Nepal, morbidity and mortality from Hymenoptera stings is mainly from three commonly encountered insects: hornets (local: aringal), wasps (local: barulo) and honey bees (local: mahuri). The present study documents the incidence of hymenoptera sting in Western Region of Nepal and explores the cause behind such unprovoked attack upon human subjects. Methods: This hospital-based study included all the patients with history of insect sting attending the Emergency Department of Manipal Teaching Hospital, Pokhara from May 2015 till November 2015. Results: Of total 16 cases during the study period three were brought dead cases. The alleged insect happened to be bee in two cases, hornet in two cases, and wasp in eight cases with a case of unidentified insect sting. Severe burning pain with swelling, redness and itching were the common presenting symptom in all the admitted patients (n=13). Conclusion: Agricultural activity during the day was the cause of most unprovoked stings followed by deliberate destruction of the insect hive. Immediate medical attention in the nearby health care facility to the victims will save mortality. The health care facility also needs to have surplus lifesaving medication to counteract the life-threatening anaphylaxis reactions from such stings.

Knowledge and Attitude on Abortion among women of Reproductive age group attending Manipal Teaching Hospital, Nepal

Background: Abortion was legalized in Nepal in September 2002 by the amendment to the “Muluki Ain”. Legal, moral and ethical issues surrounding abortion make research on all aspects of abortion difficult to undertake. The objective of this study is to assess knowledge and attitude regarding abortion among women of reproductive age group (15-45 years). Methods: This study was a descriptive and conducted in Manipal Teaching Hospital (MTH), Pokhara, Nepal. The tools were demographic proforma, knowledge questionnaire, and attitude scale on abortion. Data was collected by asking questions regarding abortion. The total sample was 100 and the sampling technique was purposive. The data were analyzed using Excel 2007, SPSS for Windows Version 16.0 Results: The majority (83%) of the participant were of age group 15-30years, most (70%) of them were married, most (82%) of them were Hindu. The majority of the participants (95%) had heard regarding Abortion. About half (55%) got information from mass media. Most (58%) of the women are having average knowledge regarding Abortion, and the remaining 4% is having poor knowledge. The majority (90%) of the women have a good attitude and no one is having an unfavorable attitude. There is a significant association between knowledge and level of education. There is a positive correlation between knowledge and attitude. Conclusion: Though the majority of the women had a good attitude regarding abortion, still few women i.e. 4% attending MTH don’t have good knowledge.

2151. Biofilm and Metallo-β-Lactamase (MBL) Production Among Imipenem-Resistant Pseudomonas aeruginosa and Acinetobacter spp.

Background Pseudomonas aeruginosa and Acinetobacter spp. head the list of hospital-acquired infections. Resistance to carbapenem as reserve drug is under threat with the emergence of Metallo-β-lactamase (MBL) and biofilm producing bacterial strains. This study was thus undertaken to determine the rate of MBL and biofilm production among imipenem-resistant P. aeruginosa (IRPA) and imipenem-resistant Acinetobacter spp. (IRAS) isolates.MethodsA total of 79 P. aeruginosa and 117 Acinetobacter spp. were isolated from different clinical specimens of patients visiting Manipal Teaching Hospital, Pokhara Nepal from July 2016 to January 2017. Isolation, identification and antibiotic susceptibility testing of the isolates were performed by standard microbiological techniques. Combined disc test and Epsilometer test (E-test) were employed to detect MBL in IRPA and IRAS isolates. Microtiter plate using crystal violet method was employed for detection of biofilm in imipenem-resistant isolates.Results9 (11.4%) of P. aeruginosa and 49 (41.9%) of Acinetobacter spp. were Multidrug Resistant (MDR). Similarly, 22 (27.8%) of P. aeruginosa and 23 (19.7%) of Acinetobacter spp. were Extensively Drug Resistant (XDR). Imipenem resistance was detected among 15 (19%) P. aeruginosa and 57 (48.7%) Acinetobacter spp. isolates. 8 (53.3%) of IRPA and 22 (38.6%) of IRAS isolates were MBL producers while all (100%) of IRPA and 47 (82.5%) of IRAS were biofilm producers. All the biofilm producer IRPA isolates were XDR and 62.5% of XDR IRAS strains were moderate biofilm producers. However, 80% of IRPA, 49.1% of IRAS and 63% of both MBL producer isolates were weak biofilm formers. Polymyxin B and ampicillin-sulbactam showed a better degree of susceptibility against MBL cum biofilm producer IRPA and IRAS isolates respectively.ConclusionThe study showed high propensity of IRPA and IRAS to form biofilm, which is strongly associated with higher drug resistance. Such high rate of MBL and biofilm producing P. aeruginosa and Acinetobacter spp. alarms the rapid spread of such strains in our hospital setting. Disclosures All authors: No reported disclosures.

Knowledge and Compliance with Standard Precaution among Critical Care Nurses

Critical care nurses are the health care professionals who have the compulsion to protect critically ill patients against infection especially those who are immune compromised, in order to enhance their recovery, prevent deterioration in their health, and achieve high quality nursing care. Therefore, critical care nurses should have sound knowledge and strict adherence to infection control standard precautions. The objective of the study is to evaluate the level of knowledge and compliance towards standard precaution. A descriptive cross-sectional research design and non-probability purposive sampling with self-administered questionnaire was adopted among 81 critical care nurses of Manipal Teaching Hospital, Phulbari-11. The obtained data was coded and entered in SPSS program version 23 with descriptive and inferential statistics. The study depicted that more than half of respondent (59.3%) had adequate knowledge and (40.7%) had inadequate knowledge. Majority of the respondent had high compliance (mean= 3.93) and average compliance (mean= 3.44). The use of protective suit or gown had low compliance (mean=2.17) and use of eye patch or goggle had very low compliance (mean=1.37). This study shows significant association between knowledge and compliance with standard precaution. Teaching approaches must be focused toward intensifying further compliance especially with the use of protective equipment. Furthermore, environment that promotes standard precaution practices should be developed by the faculty.

Laparoscopic Needle assisted Repair of Inguinal Hernia in Children in Manipal Teaching Hospital, Pokhara

Introduction: There are numerous minimally invasive surgical techniques for repair of congenital inguinal hernia (CIH) in children. We present a unique needle-assisted laparoscopic inguinal hernia repair using 20-gauge intravenous cannula. This study aims to evaluate the safety and feasibility of this technique.
 Methods: This prospective descriptive study was conducted in 50 patients; aged 1-13 years; from February 2018 to May 2019; either admitted with the diagnosis of CIH or detected incidentally when operated for some other surgical conditions. CIH was repaired using single supraumbilical port and 2-0 prolene suture passed through 20-gauge intravenous cannula. Statistical analysis was done using SPSS 20.
 Results: A total of 56 hernias were repaired in 50 patients out of which five cases were detected incidentally on patients undergoing laparoscopic appendectomy. The bilateral CIH was present in six cases. The mean operative time was 18.20 ± 4.57 minutes; 17.36 ± 3.83 minutes for unilateral hernia and 24.33 ± 5.20 minutes for bilateral hernia. There was no difference in operative time when compared between gender (p=0.26). The complications were recurrence in 1(1.78%) case, hematoma around deep ring in 2 (3.57%) cases and puncture site bleeding in 2 (3.57%) cases. There were 35 (70%) male and 15 (30%) female. The contralateral occult hernias were noted in 5 (10%) cases.
 Conclusions: Single port laparoscopic repair of inguinal hernia using a 20-gauge intravenous cannula with non-absorbable suture is a safe, effective and feasible in resource poor settings. The postoperative complications are minimal which is similar to past studies.

Factors affecting Mortality in Neurosurgical ICU of Manipal Teaching Hospital, Pokhara, Nepal

Introduction: Mortality is an important self-assessment tool in medical practice. This study assesses various factors associated with mortality in Neurosurgery ICU (NS-ICU).
 Methods: A prospective, cross-sectional study was carried out from January 2017 to December 2017 in 416 patients admitted to NS-ICU. The age, sex, diagnosis, GCS, pupil’s abnormality, vital parameters, laboratory parameters, comorbidities were compared in between mortality and survival group. The individual component of GCS was further evaluated.
 Results: Out of 416 patients, 374 (89.90%) patients were in survival group and 42 (10.10%) patients in mortality group. Trauma 188(45.20%) and Cerebrovascular accident 133(31.97%) were commonest diagnosis on admission. The GCS, eye-opening and motor component of GCS, abnormal pupils, hypertension (HTN), diabetes mellitus (DM), diastolic blood pressure (DBP), heart rate (HR), operated cases and serum urea levels were found to have significant difference between mortality and survival group. These parameters were further subjected to binary logistic regression which showed DBP (B-0.01, p=0.00), HR (B0.02, p=0.00), motor score of GCS (B-0.50, p=0.04), operated cases (B 1.13,p=0.00), abnormal pupils (B1.85,p=0.00), DM (B1.56, p=0.00) to have significant association with mortality.
 Conclusions: High heart rate, low diastolic BP, low motor score of Glasgow Coma Scale, abnormal pupils, diabetes mellitus and operated cases were found to be significantly associated with mortality.

Pattern of Occurrence of Ocular Injuries and their Forensic Aspects

Introduction: All penetrating or non-penetrating intentional ocular trauma causing loss of an organ or part of an organ and which have as a consequence the facial disfigurement or post trauma sequelae formation have forensic implications.
 Objectives: To study the pattern of ocular injuries its forensic implications and meticulous documentation in ocular medicolegal cases.
 Methodology: This hospital based cross sectional study was carried out by Forensic medicine personnel in Department of Ophthalmology and Emergency Department of Manipal Teaching Hospital Pokhara, Nepal. A total of 251 cases of ocular injury constituted the sample size. Cases were analyzed according to age, sex, type of trauma, causative agent, and manner of injury and ocular injuries having any medicolegal value. All data was evaluated and relevant information were extracted and entered into a database.
 Results: Male subjects 174 (69.32%) were more susceptible to ocular injuries and age group 21-30 years 66 (26.3%) were more predisposed to ocular injuries. The commonest cause of ocular trauma was due to fall on blunt objects 42(16.73%). The most common site of injury was cornea 120(47.81%) and corneal abrasion 65(54.16) was the most common ocular finding. Accidental manner of injury was observed in majority of the cases 230 (91.60%). Ocular injuries sustained were all simple in nature 251(100%) as a result no fatality was observed following ocular injury.
 Conclusion: Proper history taking and methodical documentation of injuries not only assist in diagnosis and management of the patient but also holds an evidentiary value in medico legal cases.

Drug Resistance and Biofilm Production among Pseudomonas aeruginosa Clinical Isolates in a Tertiary Care Hospital of Nepal

Clinical isolates of Pseudomonas aeruginosa often exhibit multidrug resistance due to their inherent ability to form biofilms. Drug resistance in Ps. aeruginosa is a major clinical problem, especially in the management of patients with nosocomial infections and those admitted to ICUs with indwelling medical devices. To evaluate the biofilm forming abilities of the clinical isolates of Ps. aeruginosa and to correlate biofilm formation with antibiotic resistance. A total of 90 consecutive isolates of Ps. aeruginosa obtained from various specimens collected from patients visiting the Manipal Teaching Hospital, Pokhara, Nepal between January 2018 - October 2018 were studied. Isolates were identified by standard microbiological methods. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion method. All the isolates were tested for their biofilm forming abilities by employing the tissue culture plate assay. Of the 90 Ps. aeruginosa isolates, maximum i.e 42 (46.6%) were from patients in the age group of > 50 years. Majority (30; 33.3%) of the isolates were obtained from sputum samples. However, percentage isolation from other specimens like urine, endotracheal tube (ETT), pus, eye specimens and blood were 18.9%, 16.7%, 16.7%, 7.8% and 6.7% respectively. All the isolates were sensitive to polymixin B and colistin, 91.1% of the organisms were sensitive to imipenem, and more than 80% to aminoglycosides (80% to gentamicin, 83.3% to amikacin). A total of 29 (32.2%) organisms were biofilm producers. Maximum numbers of biofilm producing strains were obtained from ETT (8 of 15; 53.3%), pus (8 of 15; 53.3%) and blood (2 of 6; 33.3%) i.e from all invasive sites. None of the isolates from noninvasive specimens such as conjunctival swabs were biofilm positive. Significantly higher numbers of biofilm producers (23 of 29; 79.3%) were found to be multidrug resistant as compared to non-biofilm (6 of 61; 9.8%) producers (p=0.000). Ps. aeruginosa colonization leading to biofilm formation in deep seated tissues and on indwelling devices is a therapeutic challenge as majority of the isolates would be recalcitrant to commonly used antipseudomonal drugs. Effective monitoring of drug resistance patterns in all Pseudomonas clinical isolates should be a prerequisite for successful patient management.

Pattern of glomerular diseases in biopsy proven native kidney in Western Nepal

Background and Aims: Kidney biopsy is decisive while evaluating for the diagnosis of glomerular, vascular, tubulointerstitial and genetic diseases. There is paucity of data on prevalence and pattern of various types of kidney diseases in Nepalese population. We describe various types of kidney diseases in patient population undergoing kidney biopsy at our centre.
 Methods: This is a prospective analysis of all patients, who underwent percutaneous renal biopsy at Manipal teaching hospital, over a duration of 30 months, i.e. August 2017 to January 2019. All kinds of kidney disease patients were included for kidney biopsy, irrespective of their clinical syndromes and underlying diagnosis.
 Results: A total of 175 consecutive biopsies were analyzed. The mean age of the patient was 35 } 15 years. Majority of the biopsy performed were in females. The majority of biopsy cases were age between 21-30 years of age. The youngest case to undergo renal biopsy was a child with asymptomatic isolated hematuria. The most frequent histological pattern observed in our study was IgA nephropathy (34.6%), followed by Focal segmental glomerulosclerosis (15.45%) and Membranous nephropathy (14.85%). Regarding complication macroscopic hematuria was seen in 15 (8.5%) cases and 8 (4.5%) cases had perinephric hematoma. There was no death related to renal biopsy.
 Conclusion: IgA nephropathy was the commonest histological pattern. Subnephrotic proteinuria was the commonest indication for biopsy. Complication of kidney biopsy is rare and considered safe procedure in clinical practice to determine diagnosis, prognosis and treatment.

Surgical Outcome of Isolated Extradural Hematomas Operated in a Teaching Hospital in Western Nepal

The aim of this determine the causes, frequency, location of isolated extradural hematomas in patients presenting with head injury and to find out the outcome of surgery in such patients. This is prospective observational study was conducted in the Neurosurgery Unit of Manipal Teaching Hospital from January 2012 to January 2017. All patients who presented with headinjury and had isolated extradural hematomas were included in the study. Total number of patients admitted with diagnosis of extradural hematomas during that time period was 169 among which 94 patients underwent surgical treatment. Descriptive statistics data including age, gender, causes of injury, severity of head injury and Glasgow outcome scale were studied. Results in proportion and percentages were calculated by using Microsoft Excel 2013.
 There were 169 patients who had isolated extradural hematomas. Among them, 75 patients were managed conservatively and 94 underwent craniotomy for evacuation of hematoma. This group of 94 patients who operative treatment was taken for this study. Male: female ratio was 1.6:1. Mean age was 23 years. Most of patients were in 20-40 age groups. Causes of extradural hematomas included motor vehicle accidents, falls and assaults. Mild and moderate head injury was present in 53 (56.38%) and 32 (34.0%) patients. Seventy nine patients (84.05%) of patients had good recovery while 3 (3.19%) patients expired.

Efficacy of Topical Cyclosporine 0.05% in the Treatment of Meibomian Gland Dysfunction: A Hospital Based Prospective Study

Purpose: To compare the efficacy of topical cyclosporine 0.05% with tobramycin 0.3% and dexamethasone 0.1% eye drop in reducing signs and symptoms of Meibomian gland dysfunction.
 Design: A hospital based randomized prospective study conducted at Manipal Teaching Hospital, Department of Ophthalmology, Pokhara, over a period of 18 months, from January 2012 to June 2013.
 Methods: 30 patients who were diagnosed as Meibomian gland dysfunction were recruited and randomly assigned into two groups i.e. Group- A received Cyclosporine 0.05% and Group-B received Tobramycin/dexamethasone. Before starting treatment ocular symptoms were recorded with help of OSDI score. All patients underwent examinations including visual acuity, intraocular pressure, Schirmer’s test, Tear break up time, Lissamine staining, slit lamp examination for lid telangiectasia, open and clogged meibomian glands, inclusions and meibomian secretion quality.
 Result: OSDI score significantly improved in cyclosporine group than in tobramycin/dexamethasone group. Other objective measurements like Schirmer value, Lissamine staining, meibomian secretion quality, number of lid telangiectasia and clogged glands improved in Cyclosporine group.
 Conclusion: The present hospital based study noted that Meibomian gland dysfunction can be more effectively treated with cyclosporine than tobramycin/dexamethasone.

Comparison of Maternal and Perinatal Outcome in Elective and Emergency Cesarean Section in a Tertiary Care Centre

Introduction: Cesarean delivery is the birth of a fetus via laparotomy and then hysterotomy. There are increased maternal and fetal morbidities and mortalities associated with such delivery, more in emergency cesarean section. Various studies have shown increasing trend of this mode of delivery worldwide leading to an increase in its associated risks and cost to the patients.
 Objective: The objective of the study was to compare the maternal and perinatal outcome in elective and emergency cesarean section.
 Methodology: It was a prospective comparative study conducted in the department of obstetrics and gynecology, Manipal Teaching Hospital from March, 2018 to September, 2018. All the patients undergoing cesarean section either elective or emergency were enrolled in the study after their consent. After collecting data from patients, maternal and perinatal outcomes were analyzed by using SPSS software.
 Results: There were total 1254 deliveries in the study duration, out of which 461(36.76%) were cesarean section (cs). The incidence of emergency cs was 86.5% and elective cs was 13.5%. Majority of women (75.7%) undergoing cs had no any antenatal visit. Around 81% of cases undergoing emergency cs were unbooked whereas only 48.4% of unbooked cases underwent elective cs (P-value 0.000). The most common indication for cs in both elective and emergency category was previous cs. There was no maternal complication in elective cs group but there were 8 cases (2%) in emergency cs (P value-0.293). In emergency cs group, 7 babies had poor Apgar score whereas all babies had good Apgar score in elective group (P-value-0.057). There was increased rate of NICU admission in emergency group than in elective group (3% vs 0%, P value-0.166).
 Conclusion The study showed that the incidence of cesarean section was high in our centre. The maternal and fetal risks were higher in emergency cs than in elective cs, but these were not statistically significant.

Internalized Stigma, Coping and Social Support with Mental Illness in Manipal Teaching Hospital, Pokhara, Nepal

Background: There are an increasing number of studies on the subjective experience of stigma amongst mentally ill persons but still few coming from Asian countries, and very few from Nepal. The objective of this study was to look into the experience of internalized stigma in mentally ill persons in Pokhara, Nepal and to compare this with similar studies using ISMI fromother socio-cultural contexts.Methods: A total of 136 patients with mentally ill people attending OPD of Manipal Teaching Hospital, Nepal responded to the Internalized Stigma of Mental Illness Scale. This is a 29-item self-report questionnaire with good psychometric properties.Results: Among the participant, majority 69.1% were 18-39 years age and majority 60.3% were female. Half of the participant 51.5% experienced high level of internalized Stigma. Regarding coping strategies, 86% of the participant response they does not avoid telling the health care professionals that they had a history of mental illness, Most 87.5% response they does not avoid going out with friends after receiving psychiatric treatment. Most 83.1% response they attempt to correct their friends if they hold negative views on people with mental illness. Most 65.44% were having High Social Support with Mental illness.Conclusions: Study findings show half of the participants (51.5%) experienced high level of stigma and more than half of the participant (65.44%) were having high social support with mental illness.Keywords: Coping; internalized stigma; mental illness; social support.

Internalized Stigma, Coping and Social Support with Mental Illness in Manipal Teaching Hospital, Pokhara, Nepal.

There are an increasing number of studies on the subjective experience of stigma amongst mentally ill persons but still few coming from Asian countries, and very few from Nepal. The objective of this study was to look into the experience of internalized stigma in mentally ill persons in Pokhara, Nepal and to compare this with similar studies using ISMI fromother socio-cultural contexts. A total of 136 patients with mentally ill people attending OPD of Manipal Teaching Hospital, Nepal responded to the Internalized Stigma of Mental Illness Scale. This is a 29-item self-report questionnaire with good psychometric properties. Among the participant, majority 69.1% were 18-39 years age and majority 60.3% were female. Half of the participant 51.5% experienced high level of internalized Stigma. Regarding coping strategies, 86% of the participant response they does not avoid telling the health care professionals that they had a history of mental illness, Most 87.5% response they does not avoid going out with friends after receiving psychiatric treatment. Most 83.1% response they attempt to correct their friends if they hold negative views on people with mental illness. Most 65.44% were having High Social Support with Mental illness. Study findings show half of the participants (51.5%) experienced high level of stigma and more than half of the participant (65.44%) were having high social support with mental illness.

Histopathological subtypes and demographic profile of cystic jaw lesions - A hospital based study

Background: Odontogenic cysts are defined as the epithelial cysts which arise from odontogenic epithelium and occur in tooth bearing regions of jaws. The objective of the present study was to analyze different histopathological types of cystic jaw lesions and to determine the distribution of their relative frequency according to site, sex, size and age group.
 Materials and methods: This study was a cross sectional hospital based observational study conducted in the Department of Pathology, Manipal Teaching Hospital. All cases with cystic jaw lesions on histopathology during the study period from January 2014 to December 2018 were included in the study.
 Results: Thirty-two cases of cystic jaw lesions were reported during the study period. Females were more commonly affected in our study with a male: female ratio of 1:1.9. The age range in the study was 9 to 71 years with a mean age of 33.3 years. The most frequent type was radicular cysts followed by dentigerous cysts, odontogenic keratocysts and cystic ameloblastoma. Radicular cysts showed the most female predilection with a ratio of 1:4.3. and a mean age of 35.6 years. Majority of dentigerous cysts were seen in patients below 30 years. Both radicular cysts and dentigerous cysts showed more involvement of maxilla but odontogenic keratocysts were more common in mandible
 Conclusions: The present study corroborate with other similar literature with respect to the frequency percentage of different types of jaw cysts.However, female predilection was seen in radicular and dentigerous cysts. Maxilla was the more common site except in odontogenic keratocysts.

Comparison of cross pinning versus lateral three pins in type three supracondylar fracture of distal humerus in children.

Background:
 Supracondylar fracture of distal humerus is the most common paediatric fracture. Type III supracondylar fractures should be treated with anatomical reduction and stable Kirschner wire (K- wire, pin) fixation to prevent the cosmetic deformity. The configuration of wires is debatable. Although two crossed K-wires are bio-mechanically stable, there is a risk of iatrogenic ulnar nerve injury. Lateral 3 K-wires is a good alternative. This study was done to compare the outcome of cross K- wire and lateral 3 K-wires in terms of stability.
 Materials and Methods:
 This is a prospective study done in Manipal Teaching Hospital. All the Gartland type 3 supracondylar fractures of the distal humerus were treated with closed reduction and stabilized with K wires. In Group I, fractures were stabilized with cross K wire fixation and in group II they were stabilized with 3 lateral K-wires. The patients were followed up at 4-5 weeks for wire removal and at 3 months and 6 months after surgery. Baumann's angle, a functional outcome as per Flynn's criteria, and range of motion were recorded in each visit. Outcomes were compared in term of displacement of fracture.
 Result:
 Seventeen children in each group were taken up for the study. There were no significant differences in term of patients and fracture character. No patients had significant loss of reduction at final follow up. There is no statistically significant difference seen in mean changes of Bauman's angle. According to Flynn's criteria good result was seen in more than 95% of cases in both groups.
 Conclusion:
 Both cross K-wires and Lateral 3 K-wires provide good stability. Fixation of supracondylar fracture from lateral side had an advantage of no risk of iatrogenic Ulnar nerve injury. Addition of third K-wire from lateral side provides good stability as that of cross K- wire fixation.