Medical College Teaching Hospital Research Articles

Prescription Pattern of Cholelithiasis at Surgery Ward in Tertiary Care Hospital

Background: Cholelithiasis is a chronic recurrent disease of the hepatobiliary system. The impaired metabolism of cholesterol, bile acids and bilirubin are characterized by gallstone formation.The number of surgical procedures for cholelithiasis has risen markedly in developed countries since 1950. An estimated 90% of cholecystectomies are now performed by the laparoscopic approach worldwide. Objectives: The aim of the study was to study prescription pattern of Cholelithiasis at surgery ward in B&C medical college teaching hospital and research Centre Pvt. Ltd. Materials and Methods: A Retrospective study was conducted and data of Cholelithiasis cases admitted at Surgery ward from 2077/01/01 BS to 2077/12/31 BS were collected. Coding of data , result and interpretation of data were drawn using SPSS version 16 and MS Excel 2016 . Result: The present study included 137 patients.Among them,80.3% were females and 19.7% were males. The high incidence of cholelithiasis was found in the age group 30-39 years (27%). 98.5% of total hospitalized patient were prescribed with antibiotics followed by Proton Pump inhibitors (93.4%) and NSAIDS(92%) .Among antibiotics, Ceftriaxone (65.7%) were the most prescribed one. During discharge , antibiotics (98.5%) were the most prescribed group of medicine followed by Proton Pump Inhibitors (88.3%) and NSAIDS(67.9%). And among antibiotics, Cefixime (52.6%) were mostly prescribed. While analyzing prescription pattern of discharge medication it was found that percentage of drugs prescribed by generic name was 13.86% and percentage of drugs prescribed from essential drug list was 43.36%. Conclusion: The present study revealed that there was greater incidence of Cholelithiasis in females (80.3%) than in males and in the age group 30-39 years (27%) .The results obtained from this study showed that most commonly prescribed medicines were antibiotics. Prescription through generic name and essential drug list was low. Therefore, prioritization on prescribing drugs by generic name and from essential drug list needs to be encouraged.

Knowledge on First Aid Management of Epistaxis among Medical Students of a Medical College: A Descriptive Cross-sectional Study

Introduction: Epistaxis, a global Otorhinolaryngology emergency, often requires hospital admission, posing health concerns for all ages. Evaluating medical students' knowledge helps identify strengths and areas for improvement, ensuring future healthcare providers are well-prepared. Our study aimed to assess knowledge on first add management of epistaxis among medical students of a medical college. Methods: This descriptive cross sectional study was conducted among medical students in Birat Medical College Teaching Hospital after ethical approval was obtained. Data was collected electronically using google form from 109 medical students from 15 January 2024 to 15 March 2024. Results: The mean age of students was 20.71±1.44 years. The mean knowledge score of first aid management of epistaxis was 11.33± 5.24. Out of all students, 68 (62.38%) students had above-average knowledge on first aid management of epistaxis. Conclusions: The study emphasizes the varied knowledge levels among first and second-semester medical students regarding epistaxis. While more than half demonstrated above-average understanding, targeted educational interventions are warranted.

Clinico-demographic characteristic and outcome of adult acute organophosphorus (OP) poisoning in Teaching Hospital of Madhesh Province, Nepal

Background & Objectives: Organophosphorus (OP) poisoning is a major health problem worldwide, especially in developing countries. This study aimed to find out the demographic, clinical presentation and outcome of OP poisoning patients. Materials and Methods: A cross-sectional study of two years duration was conducted on patients presenting to Emergency Department (ER) with clinical features of OP poisoning at Janaki Medical College Teaching Hospital (JMCTH), a tertiary care hospital. Results: A total of 84 cases of acute poisoning were reported in ER-JMCTH. Patient ages ranged from 15 to 60 years. The highest number of poisoning cases was observed in the 15-25 years age group (44 cases 52.4%) male = 33 (39.3%) and female = 51(60.7%), ratio M: F = (1:1.5). Most cases of poisoning were due to suicidal intention (n = 63, 75%), most common toxic substances used for suicidal purposes of OP were chlorpyriphos (n = 56, 66.7%) and dichlorvos (n = 17, 20.2%). Most of the cases belonged to illiterate (n = 26, 31%) and primary education (n=19, 22.6%). About 79.8% of the patient’s symptoms were cholinergic effect (muscarinic), 9.5% nicotinic and 10.7% central nervous system (CNS) effect. Nearly 93% (n = 78) patients survived and 7% resulted in death. Conclusion: The majority of OP poisoning patients were of young age and OP poisoning was more common in women compared to men. Suicidal poisonings were more frequent than accidental ones. The research team's a treating physicians noted miosis as the most common symptom, whereas patients most frequently complained of nausea and vomiting.

Influence of Fixed Orthodontic Treatment Duration on the Prevalence and Severity of Gingival Enlargement

In patients undergoing fixed orthodontic therapy, favorable conditions for plaque stagnation as well as difficulty in performing usual oral hygiene measures have been associated with poorer periodontal health among orthodontic patients. So this study aims to assess the effect of the duration of fixed orthodontic treatment on presence of gingival enlargement in adolescents and young adults. This cross sectional descriptive study was conducted in the dental hospital of Nepal Medical College Teaching Hospital. Patients under fixed orthodontic therapy for at least 3 months were examined for the presence of gingival enlargement (GE). Demographic variables and the details of duration of the fixed orthodontic therapy was recorded along with presence of gingival enlargement and its grading. The oral hygiene habits like frequency of brushing, use of interdental cleaning aids were recorded along with plaque index. Gingival enlargement was present in 204 (63.7%) out of total 320 patients taken, among which 124 patients (38.8%) had gingival enlargement of score 1 and 80 (25.0%) patients had gingival enlargement of score 2. Gingival enlargement was observed in 101 (73.2%) in 20-30 years old patients which was more prevalent in this age group. Oral hygiene habits like frequency of brushing and use of interdental aids also seem to affect the occurrence of gingival enlargement in patients. Among those who were undergoing orthodontic therapy for more than 2 years, 48 (82.8%) had presence of gingival enlargement. Mean of plaque index was seen to be statistically associated with presence of gingival enlargement. Thus, this study showed that the duration of orthodontic treatment duration significantly influenced the occurrence of GE. Therefore, oral hygiene instructions and motivations should be reinforced for patients undergoing orthodontic treatment.

Outcome of Real Time Self-visualization of Rigid Cystoscopy Procedure on Procedural Pain in Male Patients

In patients undergoing fixed orthodontic therapy, favorable conditions for plaque stagnation as well as difficulty in performing usual oral hygiene measures have been associated with poorer periodontal health among orthodontic patients. So this study aims to assess the effect of the duration of fixed orthodontic treatment on presence of gingival enlargement in adolescents and young adults. This cross sectional descriptive study was conducted in the dental hospital of Nepal Medical College Teaching Hospital. Patients under fixed orthodontic therapy for at least 3 months were examined for the presence of gingival enlargement (GE). Demographic variables and the details of duration of the fixed orthodontic therapy was recorded along with presence of gingival enlargement and its grading. The oral hygiene habits like frequency of brushing, use of interdental cleaning aids were recorded along with plaque index. Gingival enlargement was present in 204 (63.7%) out of total 320 patients taken, among which 124 patients (38.8%) had gingival enlargement of score 1 and 80 (25.0%) patients had gingival enlargement of score 2. Gingival enlargement was observed in 101 (73.2%) in 20-30 years old patients which was more prevalent in this age group. Oral hygiene habits like frequency of brushing and use of interdental aids also seem to affect the occurrence of gingival enlargement in patients. Among those who were undergoing orthodontic therapy for more than 2 years, 48 (82.8%) had presence of gingival enlargement. Mean of plaque index was seen to be statistically associated with presence of gingival enlargement. Thus, this study showed that the duration of orthodontic treatment duration significantly influenced the occurrence of GE. Therefore, oral hygiene instructions and motivations should be reinforced for patients undergoing orthodontic treatment.

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

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

CLINICAL PROFILE AND OUTCOME OF INFANT OF DIABETIC MOTHER IN A TERTIARY CARE CENTRE

Background: Diabetes poses risks during gestation, with 80% attributed to gestational diabetes mellitus. It leads to complications from pre-conception to long-term. Infants born to diabetic mothers face various challenges, from spontaneous abortions to congenital anomalies. The study aimed to assess the clinical profile and outcome of the infants born to diabetic mothers at Nobel Medical College. Methods: This was a prospective observational study carried out in the Department of Pediatrics, Nobel Medical College Teaching Hospital, Biratnagar from September 2022 to August 2023. Consecutive sampling was done to include infants born at our institute to diabetic mothers. Variables like demographic and obstetric profile of the mothers, sex of the newborn, mode of delivery, birth weight, complications, and outcome were collected. Descriptive data analysis was done using SPSS Version 29. Results: A total of 79 infants born to diabetic mothers at our institute were studied. Of them, 18 (21.52%) were born to prediabetics and 61 (78.44%) to mothers with gestational diabetes. There were 42 (53.16%) male and 37 (46.84%) female. Twenty-six (32.91%) were born preterm, and LSCS was required in 41 (51.89%) cases. Sixteen (20.25%) were large for gestational age. Fifty-five (69.62%) developed one or multiple complications while 44 (55.7%) required NICU admission. The most common was hypoglycemia, followed by respiratory complications seen in 19 (24.05%) and 16 (20.25%) respectively. Conclusions: Diabetes during pregnancy is associated with various complications for the infant. A timely diagnosis and proper glycemic control of the mother are of great importance in the reduction of complications.

A study of nutraceutical prescription pattern among patients in an out-patient setting at Birat medical college teaching Hospital

The demand for nutraceutical has been increasingly rapidly which can be due to increasing awareness regarding health benefit of nutraceutical product. This study aims to understand the prescription pattern and find out knowledge, attitude of patients regarding nutraceutical product. A cross-sectional study was conducted at Birat Medical College Teaching Hospital, Budiganga, Nepal to assess the demographic characteristic as well as level of knowledge and attitude towards nutraceutical product and further total cost patients spent on nutraceutical alone was also assessed. Pearson Chi-square test (x2) was used to investigate the association between demographic variables and patients’ knowledge and attitude towards nutraceuticals. One-way ANOVA was performed to compare the cost of nutraceutical among the different outpatient departments. Nearly half of the patients (49.25%) had inadequate knowledge whereas more than half of the patients (67.75%) had moderate positive attitude. The mostly prescribed nutraceuticals were minerals (45%) followed by multivitamins (23%). More than two-third patient believed nutraceutical can be used when person feel tired and rundown. The average amount that a patient spent on nutraceutical product was found out to be NPR. 746.88 per prescription. No significant association was found in the cost of nutraceutical among the various Out Patient Department (OPD) wise. (P=0.281, P>0.05). Moderate positive attitude and inadequate knowledge regarding nutraceutical product among the patient's addresses the need to develop regulation, educational strategy regarding nutraceutical use and further increase general public awareness on rational use of these products.

Comparison of outcomes in buried versus exposed Kirschner wire for treatment of paediatric supracondylar humerus fracture

Introduction: The treatment options for paediatric supracondylar distal humerus fractures include close reduction and above elbow slab application, close reduction and percutaneous K-wire fixation, and open reduction and internal fixation using K-wire. For displaced supracondylar fracture closed reduction and percutaneous K-wire fixation, under C-arm guidance, is the current gold standard treatment option. Leaving the K-wire exposed or buried under the skin is decided as per the discretion and convenience of the operating surgeon. Objectives: The objective of this study is to evaluate and compare the outcomes of buried and exposed K-wire for treatment of paediatric supracondylar humerus fractures. Methodology: This study is a prospective, comparative, observational study conducted among the paediatric patients visiting Birat medical college teaching hospital OPD/ emergency department with supracondylar humerus fracture. The sample size was calculated to be 90 (45 in each group) on the basis of convenience sampling and samples were collected using systematic random sampling technique. After data collection, all reports are entered in a predetermined Performa and analysed using SPSS version 21. Results: The overall complications rate was 20%. In the exposed K-wire group, 6 patients (13.33%) had surgical site infection at 4 weeks. Among them, 5 patients (11.11%) had superficial infection and 1 patient (2.22%) had deep infection. In the buried K wire group, only 2 patients (4.44%) had skin perforation and superficial infection. None of the patients had deep infection. There were 2 patients (4.4%) with hyper granulation tissue formation in exposed K wire group which were associated with superficial infection. There were 8 patients (17.8%) with skin irritation/ K wire prominence but without K wire perforation in the buried K wire group which was statistically significant (p value 0.006). Conclusion: There is no significant difference between the exposed K wire group and buried K wire group.

Gender variation in operative findings and outcome in patients undergoing laparoscopic cholecystectomy at Birat Medical College Teaching Hospital

Introduction: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis. Despite advancement in surgical instrument and operating technique, conversion to open cholecystectomy is still worrisome concern to surgeons. There are various preoperative factors impacting on conversion. Male gender as an independent risk factor for conversion is still debatable. Ojectives: This study aims to study the role of male gender, its impact on operative findings and conversion.Methodology: A total number of 131 patients diagnosed as symptomatic cholelithiasis and who fulfilled the inclusion criteria underwent laparoscopic cholecystectomy. Data related to patients demographics like age sex, intraoperative complications like bleeding, bile leak, duration of surgery, conversion if any was noted. Reason for conversion was also noted. Postoperative complications like pain, surgical site infection and duration of hospital stay was noted. Results: In this study, A total of 130 patients participated in this study of which 64 (51.70%) were male (M) and 66 (44.89%) were female (F). Mean age of presentation was 48.25 years, youngest being 23 years and elder being 78 years of age. Mean operating time was 40.66 minutes. Bile leak was seen in 2 patients in male (M) group while no such event was observed in the female group (p value 0.240). There was no organ injury observed in either group. 1 patient in the female (F) group had postoperative pancreatitis (p value 1.00). Postoperative obstructive jaundice was noted in 2 patients in female group (F), p value 0.496. It was observed that 7 male patients had conversion to open during the procedure while only 3 cases were converted in the female gender group, p value of 0.203. Bile duct injury was seen in 1 patient in male (M) gender group, p value 0.492. However, this injury was not seen in the conversion group. All cases undergoing conversion had mean operating time of 75.3 minutes and this was more in male (M) group. Conclusion: Laparoscopic cholecystectomy is difficult in male (M) gender group compared to females and operating time is also longer, however male gender is not an independent risk factor for conversion.

Uric acid level in Chronic Kidney Disease patients and its association with other established CKD risk factors

Introduction: Chronic Kidney Disease (CKD) is a rising global health concern with increased cardiovascular risks. Hyperuricemia, linked to CKD and related conditions, warrants investigation. Objectives: This study examines the uric acid in different stages of CKD and the association between uric acid levels and established CKD risk factors. Methodology: A hospital-based prospective cross-sectional study was conducted at Birat Medical College Teaching Hospital from 10 June 2023 to 30 August 2023. We enrolled 90 patients with non-dialytic chronic kidney disease (CKD) by complete enumeration sampling method. Ethical approval was obtained from the institutional review committee of the college. Written informed consent was obtained from each participant. Data was collected by means of a self developed questionnaire. Blood samples were obtained for estimation of serum creatinine and uric acid level and recorded in Microsoft excel sheet and analyzed by using SPSS software version 23. Results: Hyperuricemia was seen in 33(36.7%) ranging from 3.5-12 mg/dl with an average uric acid level of 6.38 mg/dl and a standard deviation of 1.43 mg/dl of total 90 patients. The mean serum uric acid level was highest in stage 2 CKD which includes 6.88±2.10 ranging from 4.3-12 mg/dl. CKD patients with a history of alcohol intake had increased risk of hyperuricemia and it was statistically significant (p value 0.005). Different stages of CKD (p value: 0.70), age groups, (p value 0.17), gender(P value 0.082), diabetes(p value 0.954), hypertension(p value 0.364), other CVDs(p value 0.649)and anemia(p value 0.0602)had no statistical significant association with hyperuricemia. Conclusion: In conclusion, hyperuricemia prevalence was observed in CKD patients, with the highest levels in stage 2 CKD. Notably, alcohol intake significantly correlated with hyperuricemia, while other studied factors did not show significant associations.

Knowledge Attitude And Practice Regarding Superficial Fungal Infections In Dermatology Patients In Eastern Nepal

Introduction: Superficial fungal infection is one of the most common diseases in dermatology evolving like an epidemic. Hence further research is necessary to minimize the occurrence and prevention of the disease. Objectives: To assess the knowledge, attitude and practice about superficial fungal infection and implicate the result in educating the patients thereby minimizing its further recurrence and re-infections. Methodology: A hospital based observational descriptive quantitative crosssectional study was conducted in all patients with superficial fungal infections attending dermatology outpatient department at Birat Medical College Teaching Hospital. A selfdesigned questionnaire which was double translated by two individuals in different translations and validated was used to assess knowledge, attitude and practice (KAP) regarding superficial fungal infections. Data were entered in Microsoft excel and analyzed in terms of proportions and percentage. Results: Out of total 162 patients participating in the study, less than half of the study population was aware that it was a fungal infection; majority did not know how to apply medication in an appropriate technique. They strongly believed that hot weather was the cause. They practiced daily bath, but did not change their clothes often. They preferred taking over the counter medications and visited dermatologists less often and did not complete the total dose of prescribed medication and shared their prescription with their family members for similar problem. Consclusion: All clinicians treating with superficial fungal infection should emphasize on counseling the patients regarding behavioural changes which will not only aid in treatment but will also focus on its preventive aspect.

Outcomes of Wide Awake Local Anaesthesia no Tourniquet (WALANT) In Soft Tissue Surgeries Of The Hand

Introduction: Hemostasis in hand surgery can be achieved by use of an arm tourniquet but it has its own disadvantages like tourniquet-related pain, muscle and nerve injury, post-tourniquet thrombosis, and bleeding. Another method can be the use of epinephrine locally, but surgeons are concerned with digital ischemia and necrosis as seen with use of procaine in the 1970s. Recently Wide Awake Local Anesthesia No Tourniquet (WALANT) is being popular among hand surgeons in which a mixture of local anesthetic with adrenaline and sodium bicarbonate is used. Despite the absence of tourniquet related complications in WALANT technique, surgeons are reluctant to use lignocaine with epinephrine in hand surgery.
 Objectives: The objective of this study is to observe the outcomes of WALANT technique in various surgical procedures of hand.
 Methodology: This prospective study involved 103 patients undergoing soft tissue surgery of the hand at Birat Medical College Teaching Hospital. Patients meeting inclusion criteria and willing to participate in study were included. A proforma was filled by the operating surgeon and another proforma was to be filled by patient at home after discharge which was retrieved at follow-up visit. A mixture of 10 ml of 2% lignocaine with adrenaline diluted in equal volume of normal saline and 2ml of 8.4% sodium bicarbonate was used for local anesthesia.None of our patients developed digital ischemia or necrosis, one patient developed surgical site infection which recovered with oral antibiotics. The mean VAS score at the time of administration of local anesthesia was 3.8+1.2, intraoperatively it was 1.8+ 1.1 and at 2 hours postoperatively it was 2.3+1.3. VAS score at 6 hours, 12 hours and 24 hours postoperatively was 3.2+1.2, 3.4+1.4 and 3.7+1.1 respectively. Hemostasis control was excellent in 33 cases, very good in 58 cases, good in 8 cases, and poor in 4 cases.
 Conclusion: We conclude that WALANT technique is safe to use in various soft tissue surgeries of hand surgery in terms digital ischemia, necrosis or wound infection and effective in providing excellent control of hemostasis at surgical site.

Evaluating The Accuracy Of Fine Needle Aspiration Cytology Of Breast Lesion Using International Academy Of Cytology Yokohama System: A Study In Eastern Nepal

Introduction: Breast Carcinoma is the most common cancer in females worldwide. In developing countries, it is the most common cause of cancer-related deaths in women. The IAC Yokohama breast FNAB reporting system was developed as a multidisciplinary approach to have a standardized and structured report, for improvement in interpretation of breast cytology. Objectives: This study aims to classify Fine needle aspiration cytology of breast lesion according to the IAC Yokohama system and assess diagnostic accuracy of different categories. Methodology: This was a hospital based prospective cross-sectional study conducted in the Department of Pathology, Birat Medical College Teaching Hospital from August 2022 to May 2023.All patient with Breast lesions who underwent FNAB were included in the study. FNAB were categorized using IAC Yokohama reporting system. Considering histopathology as a final diagnosis sensitivity, specificity, PPV, NPV, Diagnostic accuracy and Risk of Malignancy were calculated. Results: One hundred and fifty-six patients underwent FNAB during the study period and 124 patients had histopathological reports available. Frequency of FNAB using Yokohama System were: Inadequate -1.9%, Benign- 59%, Atypical 14.7%, Suspicious- 11.5%, Malignant- 12.8% respectively.The Risk of Malignancy for each category were 33%, 1.51%, 22.22%, 94.11% and 100% respectively. Maximum sensitivity (97.56%) and NPV (98.48%) was achieved when considering Atypical, Suspicious for Malignancy and Malignant category as Positive. Whereas highest specificity (100%) and PPV (100%) was achieved when considering only the Malignant category as Positive. Conclusion: The IAC Yokohama System is a standard tool for diagnosing Breast FNAB with greater reproducibility and maximum diagnostic accuracy.

Effect of self-management intervention on patients with chronic obstructive pulmonary diseases, Chitwan, Nepal.

Self-management skills are important for patients with Chronic Obstructive Pulmonary Disease (COPD) who are responsible for their day to day care. Poor self-management behaviours have a significant influence on symptoms, functional impairments and quality of life. Evidence has shown that self-management interventions support patients to respond to changing symptoms and thereby make appropriate decisions regarding their self-management. This study aimed to find out the effect of self-management interventions in patients with COPD in terms of self-management practice, inhaler practice, COPD symptoms burden, functional ability, self-perceived dyspnoea and emotional symptoms. Quasi-experimental pre-test post-test design was carried out among patients with COPD attending respiratory units of Chitwan Medical College Teaching Hospital (CMC-TH), Nepal. Convenience sampling technique was used to select the 70 patients with COPD for the study. Baseline data was collected from the participants using (i) Semi-structured interview schedule for socio-demographic and clinical variables, (ii) COPD Self-Management Practice Questionnaire, (iii) Borg Dyspnoea Scale, and (iv) Six Minute Walking Distance (6MWD) Test (v) Pulmonary Function Test (PFT) and (vi) Observation Checklist. Self-management Intervention given was 2 ½ hour sessions per week for 6 weeks along with information booklets distribution. Participants were re-evaluated after 3 months of intervention using same tools. Data analysis was performed using IBMSPSS version 20.0 for window. Wilcoxon signed-rank test was performed to find the effectiveness of the self-management interventions on outcome parameters. Self-management interventions (2 ½ hour session per week for 6 weeks) elicited a statistically significant change on self-management practice (z = -7.215, p<0.001), inhaler practice (DPI practice z = -6.731, p<0.001, MDI practice, z = -1.816, p = 0.005), functional ability (z = -4.243, p<0.001), self-perceived dyspnoea (z = -4.443, p<0.001), COPD symptom burden (z = -7.009, p<0.001) and emotional symptoms (depression, z = -6.856, p<0.001, anxiety, z = -6.675, p<0.001) of patients with COPD. Self-management intervention acts as powerful equipment to improve self-management practice, COPD symptoms burden, functional ability, self-perceived dyspnoea and emotional symptoms of patients with COPD. Hence, clinician and policy maker need to plan and intervene the rehabilitation program for the patients with COPD to enhance the effectiveness of therapy, self-management practice and general longevity.

ANTIMICROBIAL PROPHYLAXIS IN SURGERY: A CROSS-SECTIONAL STUDY IN THE SURGICAL WARD OF A TERTIARY CARE CENTRE IN CENTRAL NEPAL

Background: Surgical Antimicrobial Prophylaxis is administration of a short course of antimicrobial agent prior to surgery. It has long been recommended for routine use in preventing occurrence of surgical site infections. The choice of drug, dosage, route, duration and timing of antimicrobial prophylaxis has been specified in the clinical practice guideline issued by American Society of Health-System Pharmacists. In the present study, we aim to seek the practice of antibiotic prophylaxis at a tertiary care centre in central Nepal and report the adherence to American and National Antimicrobial Treatment Guideline where applicable. Methods: This hospital-based cross-sectional study was conducted between January to June 2023 among 232 patients undergoing surgery at Chitwan Medical College Teaching Hospital. Data collection tool prepared with slight modification from previous studies recorded the demographic details, surgical data, surgical antimicrobial prophylaxis usage data and assessment of Prophylaxis data. Data analysis was done using SPSS-20. Results: We observed compliance to selection of drug, route of administration, dosage of antimicrobial prophylaxis with American guideline. All (100%) prophylaxis was administered parenterally for more than 72 hours in over 40% cases. Choice of drug was appropriate in over 84% of cases and dosage adequacy was observed in over 61% cases. Surgical antimicrobial prophylaxis was administered most frequently 30 minutes before surgery (52.59%). Conclusions: All the surgical patients were found to receive surgical antimicrobial prophylaxis. Ceftriaxone was the most commonly administered drug followed by combination of piperacillin and tazobactam. The duration of treatment post-surgery was found to be unnecessarily broader than recommended guideline.

Morbidity Pattern in Psychiatry Ward in a Tertiary Care Hospital

Background: Worldwide mental health conditions are in increasing trend. South Asian countries report the highest prevalence of common mental disorders globally, which accounts for 8.8% to 16.6% of the total burden of disease. In Nepal, the prevalence of mental disorders among adults and children is 13.2% and 11.2%, respectively. In Nepal, there is limited data on the pattern of morbidity in inpatient psychiatric wards. Hence, the need is felt to carry out this study to monitor the psychiatric morbidity patterns of patients admitted to the psychiatric ward. Methods: This is a retrospective, cross- sectional study conducted in Kist Medical College. After ethical approval from Institutional Review committee, the data of all patients admitted to Psychiatry Ward of Kist Medical College Teaching Hospital from 14 th April, 2022 to 13 th April, 2023 were collected from Record section. We used ICD-10 and CDDG criteria for the diagnosis of mental and behavioral disorders. Data was analyzed using SPSS version 16. Results: Out of 285 patients 70.40% patients belonged to age group 25-54 years .The mean age with standard deviation was 55.4±72.3 years. Most of the patients were Male (72.60%) and Janajati (44.80%). The most common diagnosis was Alcohol Dependence Syndrome. The duration of hospital stay of most (46.90%) of the patient was 1-2 weeks. Conclusion: The most common diagnosis for which admission was made in Kist Medical College was Alcohol Dependence Syndrome. This indicate that the alcohol related disorder may have important implications for care and planning in the community. The overall outcome was satisfactory.

Depression and anxiety among patients with cardiovascular disease in a tertiary care centre

Background: Years of investigation have unveiled numerous connections between cardiovascular diseases (CVDs) and anxiety and depression, and there is even a suggestion that they could mutually contribute to each other. Recent research is starting to reveal a significant occurrence of behavioral risk factors among individuals with anxiety and depression, which could potentially lead to the development of cardiovascular disease. A descriptive cross-sectional study was conducted with the aim of determining the occurrence of psychiatric coexisting conditions among individuals with cardiovascular diseases and identifying the behavioral risk factors among this group Material and Methods: The study took place between May 17, 2022, and January 31, 2023, at Nobel Medical College Teaching Hospital in Biratnagar. To achieve this, a semi-structured questionnaire, which included the Self-Reporting Questionnaire (SRQ-20) developed by the World Health Organization, was employed to screen for psychiatric symptoms in a sample of 200 individuals who were purposefully selected for the study. Results: Out of the 200 patients examined, 160 (which accounts for 80%) were found to be positive on the SRQ screening, with the majority of them being males, totaling 65.62% (n=105). A significant portion of these patients fell within the age range of 19 to 39 years 50% (n=80). The behavioral risk factors include smoking at 76.25%, alcohol abuse at 73.75%, physical inactivity at 60%, and obesity at 70%. The distribution of cardiac conditions in the sample included ischemic heart disease in 54.50% of cases, heart failure in 10.50%, cardiomyopathy in 9.00%, rheumatic heart disease in 11.00%, and post-cardiac intervention in 15.00%. Among those with cardiac diseases, 51.25% were experiencing symptoms of depression, 48.75% had anxiety disorders. Conclusion: There was a notable prevalence of depression and anxiety among patients with cardiovascular diseases.

Laser Hemorrhoidoplasty for Treatment of the Hemorrhoids in Eastern Nepal

Background: Millions worldwide are affected by hemorrhoids (prevalence 2.9%-27.9%), causing symptoms in over 4% of individuals. These anorectal disorders result from enlarged anal hemorrhoidal cushions, often due to constipation. Internal or external, they're graded by prolapse severity, with common symptoms including painless rectal bleeding. Treatment options range from conservative to surgical, with the gold standard, Milligan-Morgan hemorrhoidectomy, associated with postoperative pain. Laser hemorrhoidoplasty, a minimally invasive diode laser approach, shows promise, offering less postoperative pain, shorter hospital stays, and fewer complications than traditional surgical methods.&#x0D; Materials and Methods: A prospective observational study of 40 adults undergoing laser hemorrhoidectomy for symptomatic Goligher’s grade II and III hemorrhoids at Nobel Medical College Teaching Hospital, Biratnagar, Nepal, from June 2022 to June 2023. Outcomes included pain scores, bleeding, operative time, postoperative complications, hospital stay length, return-to-work time, and patient satisfaction measured by QOL SF36 scoring.&#x0D; Results: Among 40 patients, 16 were male and 24 females, averaging 42.32 ± 12.26 years. Grade III hemorrhoids were found in 31 patients, Grade II in 9. Operative time averaged 17.22 ± 2.14 minutes, with one case of managed intraoperative bleeding. Postoperative symptoms included pain, skin tags, and wound infection, but no reactive bleeding, urinary, or stool/flatus incontinence. Two cases experienced recurrence. Patient satisfaction in general health evaluation scored 65.11 ± 10.35.&#x0D; Conclusion: Laser hemorrhoidoplasty is associated with less complications, quicker operative time, quick recovery and similar patient satisfaction when compared to surgical methods of hemorrhoidectomy.

Impact of Tailored Intensive Rehabilitation on Functional Independence and Quality of Life in Brain Tumor Patients: A Prospective Observational Study

Background: Brain tumors are a heterogeneous group causing disability. They significantly impact functional independence and quality of life. This study aims to investigate how tailored intensive rehabilitation affects brain tumor patients using the functional independency measure score.&#x0D; Materials and Methods: This is a prospective observational correctional study conducted in the department of Neurophysiotherapy and Neurosurgery at Nobel Medical College Teaching Hospital, Biratnagar over a period of 18 months. A total of 96 brain tumor patients who underwent surgery at a tertiary care centerduring the study period were included. Along with the demographic data, the diagnosis ofbrain tumor functional independency was assessed using the Functional Independence Measure Index.&#x0D; Results: A total of 96 brain tumor patients (44 males, 52 females, average age 55.6 years) were studied. The tumors' distribution showed variations, with glial tumors being the most frequent (36.4%). The Functional Independence Measure (FIM) Index was used to assess functional independence, yielding an average score of 82.5. Patients with meningioma had higher FIM scores (84.3) compared to glial cell tumor patients (80.1), although not statistically significant (p = 0.122).The study also explored correlations between FIM scores, hospital stay duration (average 9 days), and patient satisfaction. A weak positive correlation (r = 0.25) existed between FIM scores and hospital stay duration.A moderate positive correlation (r = 0.65) was found between FIM scores and patient satisfaction, suggesting higher satisfaction among patients with better functional independence.&#x0D; Conclusion: Intensive rehabilitation therapy shows promise in improving functional independence in brain tumor patients.