Universal College Of Medical Sciences Teaching Hospital Research Articles

Diabetes Mellitus & Thyroid Dysfunction in Vitiligo of Terai Regions of Nepal

INTRODUCTION Vitiligo is common acquired disease. Clinically it present with depigmented, macules and patches. Vitiligo has been shown association with many autoimmune diseases like Diabetes mellitus, Thyroid disorders, Graves disease, pernicious anemia, etc. This study was undertaken to assess the prevalence and association of diabetes mellitus and thyroid dysfunction in vitiligo patient. MATERIAL AND METHODS This study was a case control study carried out in Dermatology Department, Universal College of Medical Sciences – Teaching Hospital (UCMS-TH) from Dec 2022 to Nov 2023. 70 cases of Vitiligo and 70 control with same sex, ages and gender matched were enrolled. All patients in both the group, we performed thyroid function test and fasting blood sugar. RESULTS Out of 70 cases, 6 (8.6%) people has impaired FBS and 6 (8.6%) people have high T3 & T4 and 10 (14.3%) people have high TSH whereas 3 (4.3%) people have low T3 & T4 and 4 (5.7%) people have low TSH. Association with different age group in both case and control group with fasting blood sugar and thyroid function test was seen which was statistically not significant. CONCLUSION There were impaired fasting blood sugar and abnormal thyroid dysfunction in many cases. Therefore vitiligo patient needs to undergo thyroid function test and blood sugar level to prevent the complication.

Functional Outcomes of Open Reduction and Internal Fixation in Proximal Humerus Fractures by Philos Plate

INTRODUCTION Proximal humerus fractures are one very common and usually occur in elderly people. These fractures are usually associated with some degree of comminution and deformity. Therefore, good anatomical reduction of fracture fragments and early mobilization are the main component for optimal outcomes of involved limb. This study was intended to evaluate the functional outcome of proximal humerus fracture in adults managed by open reduction and internal fixation (ORIF) by proximal humerus interlocking osteosynthesis (PHILOS) plate. MATERIAL AND METHODS This prospective and observational hospital based study was carried out in Orthopedics Department of Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from October 2021 to September 2023. All patients with proximal humerus fractures who fulfilled the inclusion criteria and who underwent open reduction and internal fixation by PHILOS plate were enrolled in the study. Functional outcome was assessed according to Constant murley scoring system and Visual analogue score. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTS In this study of 60 cases, the mean age group was 55.38±11.40 years and male patients outnumbered female patients (39 males and 21 females). 36 cases (60%) were of right side and 24 (40%) were of left side. Majority of the fractures were due to fall injury (57%) followed by road traffic accident (35%). The mean Constant Murley Score was 78.15±5.620 and VAS (visual analogue score) was 1.88±0.865. CONCLUSION Open reduction and internal fixation by PHILOS plate is an effective procedure providing good anatomical restoration and early mobilization in proximal humerus fracture thus providing good functional outcome.

Functional Outcomes of Close Reduction and Percutaneous Pinning in Proximal Humerus Fractures

INTRODUCTION Proximal humerus fractures are usually sustained from trivial fall in elderly. These fractures are usually associated with severe degree of comminution and deformity. Therefore, anatomical reduction of fracture fragments, and early mobilization are key factors for optimal outcomes of involved limb. This study was intended to evaluate the functional outcomes of proximal humer- us fractures in adults managed by closed reduction and percutaneous pinning (CRPP). MATERIAL AND METHODS This prospective and observational hospital based study was carried out in Orthopedics Department, Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from July 2021 to June 2023. All patients with proximal humerus fractures who fulfilled the inclusion criteria and who underwent closed reduction and percutaneous pinning were enrolled in the study and functional outcome was assessed according to Constant murley scoring system and Visual analogue score. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTS In this study of 60 cases, the mean age group was 53.08±13.10 years and male patients outnumbered female patients (37 males and 23 females). Forty one cases (68.3%) were of right side and 19 (31.7%) were of the left side. Majority of the fractures were due to fall injury (53.3%), followed by road traffic accident (40%). The mean Constant Murley Score was 76.95 ± 5.53 and VAS (visual analogue score) was 1.97 ± 0.97. CONCLUSION Closed reduction and percutaneous pinning is simple, less invasive and effective procedure for proximal humerus fracture providing good functional outcome.

A Study of Functional Outcome of Retrograde Intramedullary Interlocking Nailing in Treatment of Supracondylar Femoral Fracture

INTRODUCTIONFractures of the distal femur are usually sustained from high velocity trauma in adults and trivial fall in elderly. These fractures are usually associated with severe degree of comminution and intra-articular involvement. Therefore, anatomical reduction of fracture fragments, restoration of limb length, and early mobilization are key factors for optimal outcomes of involved limb. This longitudinal study was intended to evaluate the functional outcome of distal femoral fracture in adults managed surgically by Retrograde Nail. MATERIAL AND METHODSThis prospective and observational hospital based study was carried out in Orthopedics Department, Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from July 2020 to June 2021. All patients with traumatic distal femoral fractures (AO/OTA type A) who fulfilled the inclusion criteria were enrolled in the study and were treated surgically by Retrograde Nail. Fracture was classified according to AO/OTA classification and functional outcome was assessed according to Neer’s scoring system. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTSIn this study of 30 cases, male to female ratio was 3:2 with mean age of 39.47 years. Road Traffic Accident (RTA) was most common mode of injury. The functional outcome evaluated according to Neer’s scoring system was found good result in 43.3%, excellent in 36.7%, fair in 16.7% and poor in 3.3%. The mean Neer’s score was 78.9. CONCLUSIONDistal femoral fractures (AO/OTA type A) when treated with retrograde nailing has good to excellent functional outcome in majority of cases with minimal manageable complication.

Clinical Profile and Outcome in Patients with Organophosphorous Poisoning

INTRODUCTIONOrganophosphorous poisoning is a prevalent emergency care problem found in Nepal. Nepal being agricultural country and pesticide being easily available, organophorous poisoning is most common cause of poison related morbidity and mortality in Nepal. Main objective of the study is to evaluate the clinical profile and outcome of patients on the basis of demographic profile, type of compound, presenting symptoms and outcome. MATERIAL AND METHODSOur study included 80 patients with organophosphorous ingestion, admitted in ICU and wards of Universal College of Medical Sciences Teaching Hospital (UCMS-TH), Bhairahawa, Rupendehi, Nepal from1th July, 2019 AD to 30th July 2020 AD. Ethical clearance was obtained along with consent from patient. Data was collected from patient’s visitor. RESULTSFemales (63%) were more common than males (37%). Age group 21-30 was most likely to ingest OP compound for suicidal attempts.Chlorpyriphos (80%) was most common compound ingested.41% cases consumed alcohol, 10% cases were smokers, 11% cases had diabetes and 22% cases had hypertension. Vomiting (90% cases) was most common symptom. 54% cases had hospital stay of less than 5 days and 43% cases had hospital stay of 5-10 days.Based on POP scoring 24 cases of moderate severity 1 case died where as 3 cases out of 8 severe cases died.74% had uneventful recovery,11% developed intermediate symptoms,10% needed ventillatory support and 5% died due to poisoning. CONCLUSIONOrganophosphorous poisoning was the most common acute poisoning in young female population.Strict policies against the free availability and sale of insecticides is required to control organophosphorus poisoning.

Myringoplasty graft uptake: Short and long term outcome

INTRODUCTIONMyringoplasty is surgical procedure to restore tympanic membrane perforation. The objective of the study is to compare overall success rate of myringoplasty after 6 weeks and 6 months post-operatively. MATERIAL AND METHODSThis is a retrospective, comparative study carried out in the Department of ENT (Ear, Nose and Throat) and Head and Neck Surgery (ENT-HNS), Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), Bhairahawa, Rupandehi, Nepal. All the data was collected from the operative notes and operative record book of our hospital which were done from October 2018 to September 2020 over a period of 24 months by single surgeon. A total of 77 patients with age range of 12-70 years including all gender with chronic otitis media (COM) mucosal type, inactive who underwent myringoplasty were studied. Graft uptake results were assessed after 6 weeks and 6 months following surgery. RESULTSThe age of the patients ranged from 12-70 years. The mean ± standard deviation (S.D) of age was 27.84 ± 13.16 years. There were 47 (61%) female patients and 30 (39%) male patients involved in the study. Graft uptake success rates were 84.4% (65) and 83.1% (64) after 6 weeks and 6 months respectively. CONCLUSIONNo statistical significance was noted in graft success and failure rates between 6 weeks and 6 months (p = 0.320).

Plasma CRP Level and its Association with Outcome in Patients with Severe Spinal Needles: A Comparative Study COVID-19 Pneumonia

INTRODUCTIONCorona virus disease 2019 (COVID-19) has become a global public health issue with unpredictable progression to ARDS. Therapy timing of anti-inflammatory agents and immune-suppressing medication is of utmost importance. Previous studies have consistently found elevated levels of C-Reactive Protein with disease severity. In this study, we aimed to investigate the relationship between C-Reactive Protein and severe SARS-COV-2 pneumonia. MATERIAL AND METHODSOur study included 55 patients with COVID-19, admitted in COVID Unit of Universal College of Medical Sciences Teaching Hospital (UCMS-TH), Bhairahawa, Rupendehi, Nepal from 16th June 2021 to 15th September 2021. We included COVID-19 cases confirmed by a RT-PCR test with severe pneumonia based on W.H.O criteria and those undergoing C-Reactive Protein levels. RESULTSMales (56%) were more compared to females (44%). Age group 41-60 years were likely to develop severe COVID-19 pneumonia. Cough (44%), dyspnea (42%) and fever (40%) were most common symptom. Hypertension (34%) and diabetis (24%) were common comorbidities present. Patients with severe COVID-19 pneumonia had average CRP value of 59.6 mg/l. CONCLUSIONElevated CRP level was associated with COVID-19 severity.

Functional Outcome of Proximal Humerus Fracture Managed Surgically by Joshi's External Stabilizing System

INTRODUCTION: The ideal management of proximal humerus fracture is still controversial despite various treatment options. Conservative treatment with slab is fraught with shoulder stiffness and malunion while surgical treatment with plates and nail is fraught with infection and blood loss. Therefore, Joshi External Stabilization System (JESS) being a minimally invasive percutaneous procedure can be the ideal treatment for these fractures. MATERIAL AND METHODS: This prospective and observational hospital based study was carried out in Orthopedics Department, Universal College of Medical Sciences Teaching Hospital (UCMS-TH) from December 2018 to January 2021. All patients with traumatic proximal humerus fracture who fulfilled the inclusion criteria were enrolled in the study and were treated with JESS. Fracture was classified according to Neer classification and functional outcome was assessed according to Constant Murley Score (CMS) system. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTS: There was statistically significant difference in VAS score (p<0.05) measured at six weeks, three months and six months; and CMS (p<0.05) at three months and six months. There was statistically significant difference between fracture type (Neer type) and fracture union (p<0.05). But the association between functional outcome and type of fracture was statically insignificant (p>0.05). CONCLUSION: Displaced proximal humerus fracture when treated surgically with JESS has good functional and radiological outcome. It produces less pain, less stiffness and greater Range of Motion (ROM).

Perceived Fear and Preventive Behaviors of Pregnant Women during COVID-19 Pandemic in Western Nepal

INTRODUCTION: The perceived fear of COVID-19 is expected to have a significant positive impact on preventive behaviors as it triggers people to prevent themselves against threats. People take necessary actions to engage in preventive behaviors if they perceive high fear of transmission of disease. MATERIAL AND METHODS: Cross-sectional analytical study was conducted to find out the perceived fear and preventive behaviors of pregnant women during COVID-19 pandemic. One hundred and fifty normal pregnant women attending Antenatal Checkup (ANC) out-patient department and ward of Universal College of Medical Sciences Teaching Hospital (UCMSTH), Rupandehi were selected by using purposive sampling technique. Structured interview schedule was used for data collection. Descriptive statistics and inferential statistics were used for analysis with Statistical Package for Social Science (SPSS) software version 16. RESULTS: The study findings revealed that more than half of the respondents had high level of fear regarding COVID-19. Although participants were largely engaged in all preventive behaviors like wearing facemask, hand washing, covering nose and mouth, cleaning and disinfecting and maintaining healthy diet, while maintaining social distance, avoiding public transport, avoiding crowd, exercising regularly and quitting tobacco and alcohol were the least. There was positive correlation between perceived fear and preventive behaviors although it was not proved significantly. CONCLUSION: The study findings concluded that more than half of the respondents had high level of fear regarding COVID-19. Adequate counseling and reassurance of these pregnant women in the current scenario might reduce their fears and increase the probability of adapting preventive measures against the spread of COVID-19.

Burden of Intestinal Parasitic Infections among Children from Five Schools in Bhairahawa, Nepal: A Comparative Cross-Sectional Study

INTRODUCTION: Intestinal parasites cause significant morbidity and mortality, particularly in the tropics including Nepal. The main objective of this study was to explore the burden of intestinal parasitic infections among children in 5 different primary schools in Bhairahawa, Nepal. MATERIAL AND METHODS: This was a cross-sectional comparative study among 408 children from 5 schools in Bhirahawa, Nepal. Stool specimens collected in a plastic container were transported to microbiology laboratory in Universal College of Medical Sciences Teaching Hospital (UCMSTH) immediately. Each sample was examined macroscopically and microscopically for the evidence of parasitic infection. All samples were re-analysed by sedimentation and floatation concentration techniques one after another. RESULTS: The overall prevalence of the parasitic infection was 46.5%. The prevalence varied by the methods that included routine microscopy (23.2%), sedimentation (41.6%) and flotation (8.3%). Ascaris lumbricoides was the most common (29.1%) parasite followed by Entamoeba histolytica (6.1%). Mixed infection was also seen in 7.8% of the samples. Factors such as children’s academic year, age, religion, existing illness, household water sources, meat consumed, domestic animals at house, and recent history of taking anti-helminthics were significantly associated with the intestinal parasitic infections. Prevalence of intestinal parasitic infection was higher in public school (61.1%) compared to private school (37%). Male students had slightly more infections (47.3%) than females (45.7%). CONCLUSIONS: Enteric parasitic infection was very high among the primary schools’ students in Bhairahawa, Nepal. Integrating concentration techniques in routine test can help to detect most of the enteric parasites in stool specimens.

SHORT SEGMENT FIXATION WITH TRANSPEDICULAR SCREWS IN TRAUMATIC THORACOLUMBAR SPINE FRACTURES

ABSTRACT Aim: The gold surgical treatment for an unstable thoracolumbar fracture is transpedicular screw fixation. Although traditional treatment supports long-segment posterior fixation (LSPF), more recent studies suggest short-segment posterior fixation (SSPF) with transpedicular screws, but incur higher failure rates. Thus, this study aimed to evaluate the effectiveness of SSPF in the management of traumatic unstable thoracolumbar injuries in terms of stability, deformation correction, neurological recovery, and pain relief. Methods: This prospective and observational hospital-based study was carried out in the Orthopedics Department of Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from August 2020 to July 2021. After Ethical clearance (UCMS/IRC/047/20) from the Institutional Review Committee (IRC) and informed written consent, all patients with a traumatic thoracolumbar fracture who fulfilled the inclusion criteria were enrolled in this study and were treated with SSPF. The fracture was classified according to Thoracolumbar injury classification and severity score (TLICS) and AO classification. Functional outcome was assessed according to neurological status, patient satisfaction, and pain assessment which was assessed by Frankel grading, Macnab grading, and Denis pain scale respectively. Post-operatively patients were regularly followed at 6 weeks, 3 months, and 6 months. The data was analyzed in SPSS 20 and descriptive statistics like frequency, percentage, mean and standard deviation were used to analyze the data. Chi-Square test, Independent sample t-test, and ANOVA tests were used as inferential statistics. Results: Thirty-one patients (16 females and 15 males) with traumatic thoracolumbar fracture were surgically managed with SSPF with a mean age of 38.61 ± 11.54 years. Twenty-seven patients (87.1 %) had fall injuries. The majority of cases (14 patients: 45.2%) had L1 vertebral fracture with a majority of the cases being wedge compression type (24 patients: 77.4%) and A1 type (24 patients: 77.4%). Posterior ligamental complex (PLC) was injured in 23 patients (74.2%) and 7 cases (22.6%) had neurological involvement. The majority of cases had a TLICS score of 4 (12 patients). The mean interval between trauma and surgery was 2.13 ± 0.71 days. The average duration of hospital stay was 13.10 ± 2.95 days and intraoperative average blood loss was 460±58.2 ml. In 16 cases, an additional screw was fixed through the intact pedicle of the fractured vertebra. Screw failure was the only complication seen in 2 cases (6.5%). Preoperatively, 20 cases (64.5%) had Frankel type E injury, mean Denis pain scale was 4.16±0.93, and mean preoperative kyphotic angle was 16.77±6.82 degree which improved to 26 cases (83.9%), 1.42±0.62, and 1.35±0.48 degrees at 6 months respectively. The mean loss of kyphotic correction angle was 0.58±0.88 (range 1-4) degrees. The majority of compression fracture cases had excellent to good patient satisfaction scores where 12(50%) and 10(41.7%) cases had excellent and good scores respectively (P 0.02). Concerning patient satisfaction score, a statistically significant difference was observed in mean TLICS score (P 0.101) and AO fracture type (P 0.034) while no difference was observed in PLC status (P 0.101) and additional screws (P 0.909). There was a statistically significant difference between the fracture type and improvement of Frankel grading at the end of six months follow up (P <0.001) where compression fracture managed with SSPF showed remarkable neurological recovery than burst fracture in terms of improvement of Frankel grading. Conclusions: Short segment transpedicular screw fixation is an effective treatment procedure for achieving better neurological recovery and good pain control in traumatic unstable thoracolumbar fractures. Keywords: Short segment, thoracolumbar spine fracture, transpedicular screw

Lipid Profile and Ultrasonographic Grading in Alcoholic and Non Alcoholic Fatty Liver Patients

Background Fatty liver disease (FLD) is a common and major chronic liver disease. It has been implicated that patients have disorders of lipid metabolism and are involved in the pathogenesis of fatty liver. Hence, it was designed to observe the association between lipid profile and fatty liver disease.&#x0D; Objective This study was undertaken to evaluate the association of lipid profile status, hemoglobin and albumin levels with fatty liver disease patients diagnosed based on ultrasonography (USG).&#x0D; Method This Cross-sectional study was undertaken in the Department of Internal Medicine with the collaboration of the Department of Radiology and Department of Biochemistry, Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), Bhairahawa, Nepal from March 2019 to February 2020 in a total of 100 patients diagnosed with fatty liver disease by ultrasonography. The fasting blood was collected for lipid profile and carried out in the automated analyzer following standard protocol.&#x0D; Result In 100 cases, the male to female ratio was 1.8:1. Fifty six percent of the total cases presented with alcoholic fatty liver disease (AFLD) while the remaining 44% with non-alcoholic fatty liver disease (NAFLD). The spectrum of lipid abnormality was observed with increased total cholesterol (TC), Low Density Lipoprotein (LDL), increased triglycerides (TG), Very Low Density Lipoprotein (VLDL) in alcoholic fatty liver disease cases as compared to non-alcoholic fatty liver disease cases. However, it has been observed that TG/HDL and Non-HDL/HDL were higher in non-alcoholic fatty liver disease as compared to alcoholic fatty liver disease. Moreover, a statistically significant difference was observed in HDL between AFLG2 and NAFLG2 (p-value: 0.012).&#x0D; Conclusion Dyslipidemia and decreased HDL have been implicated in fatty liver diseases. USG in conjunction with Non-HDL/HDL, TG/HDL, hemoglobin, and albumin can be useful in early screening and monitoring of dyslipidemia in fatty liver patients.

Surgical Management of Tibial Plateau Fractures with Locking Compression Plate

&#x0D; INTRODUCTION&#x0D; Tibial plateau fracture is a common fracture that accounts for 1-2% of all fracture. Various treatment options including proximal tibial plating with locking compression plates are available for the treatment of tibial plateau fracture. This study was done to determine the clinical profile and functional outcome of tibial plateau fracture following locking compression plating.&#x0D; &#x0D; MATERIAL AND METHODS&#x0D; This prospective and observational study was carried out in Orthopedics Department of Universal College of Medical Sciences-Teaching Hospital (UCMS-TH) from December 2018 to July 2020. After Ethical clearance (UCMS/IRC/224/18) from Institutional Review Board (IRB) of UCMS-TH and informed written consent, all patients with tibial plateau fracture (Schatzker II-VI) who fulfilled the inclusion criteria were enrolled in the study and treated with locking compression plate. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months for clinical, radiological and functional assessment. Descriptive statistics like frequency, percentage, mean and standard deviation were used to analyze the data.&#x0D; &#x0D; RESULTS&#x0D; In our study of 30 cases, the mean age was 37.77 ±15.65 years. Most of the cases were Schatzker type VI (13 patients) and type II (9 patients). The average duration for fractures union was 23.4 ±2.1 weeks. Superficial wound infection was the common complication seen in five cases. At six months, the mean knee society score (KSS) was 78 ±7.22 and majority of patients (19 patients) had good results.&#x0D; &#x0D; CONCLUSION&#x0D; Locking compression plate has an excellent functional and radiological outcome. It is an effective implant that can be adopted for the treatment of tibial plateau fractures in adults.&#x0D;

Preoperative Determination of Tibia Length Using Contralateral Tibial Tubercle-Medial Malleolar Distance (TMD) in Western Part of Nepal

INTRODUCTION&#x0D; Intramedullary (IM) nailing is most commonly preferred for adult tibial shaft fracture. The objective of this study was to find the accuracy of predicting the tibial nail length pre-operatively from contra-lateral tibial tubeorsity to medial malleolar distance (TMD) length.&#x0D; MATERIAL AND METHODS&#x0D; After ethical clearance (UCMS/IRC/239/19) from the Institutional Review Board (IRB) of Universal College of Medical Sciences, all patients with recent fracture of tibia, who fulfilled the inclusion criteria were enrolled in the study and the informed written consent was obtained. The study was conducted on 45 patients of aged more than 15 years who attended Universal College of Medical Sciences Teaching Hospital (UCMS-TH) over a period of one year (Nov 2019 to Oct 2020). The TMD length of contra-lateral leg were measured preoperatively using a measuring tape and the ideal length of IM nail were measured intra-operatively using IM tibial nail under fluoroscopic guidance.&#x0D; RESULTS&#x0D; Analysis showed that majority of patients were males (77.78%) out of total 45 patients. The mean length of TMD length of contra-lateral leg and the ideal length of IM nail were 33.067 ±1.60 and 33.11 ±1.68 respectively. The mean difference between these two measurements was 0.04 (95% CI, -0.64 to 0.72). The significant correlation was found between these two measurements i.e r=0.88 by Pearson’s correlation (95% CI, 0.79 to 0.93), (p&lt;0.001). Most of the TMD length were equal (37.78%) to ideal length of IM nail.&#x0D; CONCLUSION&#x0D; We recommended TMD length measurement of contralateral leg as an excellent anthropometric parameter for preoperative planning.&#x0D;

Healthcare workers' knowledge, attitude and practices during the COVID-19 pandemic response in a tertiary care hospital of Nepal.

COVID-19 is an ongoing pandemic, for which appropriate infection prevention and control measures need to be adopted. Healthcare workers' adherence to prevention and control measures is affected by their knowledge, attitudes, and practices (KAP) towards COVID-19. In this study, we assessed the KAP among healthcare workers towards the COVID-19 during the ongoing pandemic. A self-developed piloted KAP questionnaire was administered to the recruited healthcare workers involved in the COVID-19 response at the Universal College of Medical Sciences Teaching Hospital (UCMSTH), in Bhairahawa, Nepal. The knowledge questionnaire consisted of questions regarding the clinical characteristics, prevention, and management of COVID-19. Assessment on attitudes and practices towards COVID-19 included questions on behaviour and change in practices made towards COVID-19 response. Knowledge scores were calculated and compared by demographic characteristics and their attitude and practices towards COVID-19. Data were analysed using bivariate statistics. A total of 103 healthcare workers participated in the study. The mean age of the participants was 28.24±6.11 years (range: 20-56); 60.2% were females; 61.2% were unmarried; 60.2% had a medical degree, and 39.8% were the nursing staff. The mean knowledge score was 10.59±1.12 (range: 7-13), and it did not vary significantly when adjusted for demographic characteristics. The attitude was positive for 53.4% of the participants with a mean knowledge score of 10.35±1.19 and negative for 46.6% participants with a mean knowledge score of 10.88±0.98 (p = 0.02). The practice was good (≥3 score) for 81.5% participants with a mean knowledge score of 10.73±1.12 and poor for 18.5% participants with a mean knowledge score of 10.46±1.13 (p = 0.24). The attitude of the participants improved with increasing age (29.55±7.17, p = 0.02). There is comparably better knowledge regarding COVID-19 among healthcare workers. Appropriate practice correlates with better knowledge and positive attitude towards COVID-19 infection is seen with increasing age. Hence, training on protection and protective measures for having a positive attitude among healthcare workers is necessary against the fight with COVID-19 infection.

Prevalence of Metabolic Syndrome in Patients with Subclinical and Overt Hypothyroidism Visiting Tertiary Care Centre of Western Nepal

INTRODUCTION: Hypothyroidism is a syndrome resulting from thyroid hormone deficiency. Metabolic syndrome (MetS) is a cluster of metabolic abnormalities is associated with increased risk for atherosclerotic cardiovascular disease (CVS) and type 2 diabetes mellitus. Thyroid hormones are major regulatory hormones that control the rate of metabolic function; thus, alteration in the levels of these hormones may be associated with MetS. The objective of our study was to find out the prevalence of MetS in subclinical and overt hypothyroidism.&#x0D; MATERIAL AND METHODS: A hospital-based cross sectional study was conducted at Universal College of Medical Sciences Teaching Hospital (UCMS-TH) Bhairahawa from March to September 2019. A total of 222 hypothyroid patients were enrolled in this study. MetS was diagnosed by National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III; 2005) revision criteria. The anthropometric indices were recorded. fT3, fT4 and TSH were measured by chemiluminescence immunoassay (CLIA) method and other biochemical parameters were estimated by colorimetric method. Data were analyzed by using SPSS 16.0.&#x0D; RESULTS: Patients were aged between 10 and 60 years, with a mean age of 38.89 years. The prevalence of MetS was 44.1% of which 80.6% were females. Furthermore, the prevalence of MetS was found to be 43.7% in subclinical hypothyroidism and 46.6% in overt hypothyroidism.&#x0D; CONCLUSION: The prevalence of MetS is high in both overt and subclinical hypothyroidism. Screening for MetS in patients with hypothyroidism can reduce the risk for CVD, as well as the mortality rate and mortality associated with it.

Trend and Characteristics of Acinetobacter baumannii Infections in Patients Attending Universal College of Medical Sciences, Bhairahawa, Western Nepal: A Longitudinal Study of 2018.

BackgroundAcinetobacter baumannii is one of the major organisms causing nosocomial infections and is intrinsically resistant to multiple classes of antibiotics. The main objective of this study was to investigate the trend and characteristics of A. baumannii infections including its resistance pattern among patients attending Universal College of Medical Sciences, Teaching Hospital (UCMSTH) in Western Nepal, between January and December 2018.Patients and MethodsA total of 4862 clinical samples received at the microbiology laboratory of UCMSTH over a period of a year were analyzed. Following bacterial culture on the samples, culture-positive isolates were tested for antibiotic susceptibility using a modified Kirby–Bauer method. The demographic profile of the patient, information about samples, and the antibiotic profile of the A. baumannii isolated from different samples were recorded and analyzed.ResultsA total of 1180 (24.2%; 1180/4862) organisms were isolated from the total samples. Acinetobacter baumannii (12.4%; 147/1180) was the third most common organism. Prevalence of A. baumannii was found to be high in late summer/early winter (July: 15.9%; 18/113 and December: 18.8%; 13/69). The majority 71.4% (n=105) of A. baumannii isolates were multidrug resistant (MDR). None of the isolate was pan-drug resistant. Colistin, polymyxin B, and tigecycline were 100% sensitive to A. baumannii. MDR bacteria were significantly associated with the gender of the patients [female: 51.4% (54/105) versus male: 48.6% (51/105); p=0.05], clinical specimens [swab: 40% (42/105) sputum: 21.9% (23/105) and urine: 10.5% (11/105); p=0.02] and different wards of the hospital [surgery: 30.5% (32/105); ICU: 21.9% (23/105) and medicine: 19.0% (20/105); p< 0.03].ConclusionThe high burden of MDR Acinetobacter isolates in clinical specimens shows an alarming presence of antimicrobial resistance. Two-thirds of the specimens showed MDR and were associated with demographic and clinical characteristics of the patients. In the management of infectious diseases at UCMSTH, there should be a high suspicion of Acinetobacter infection, and isolation and treatment should be carried out based on an antibiotic susceptibility test.

Prediction of difficult intubation in apparently normal patients by combining modified mallampati test and thyromental distance: A prospective observational study

Introduction: Difficult intubation, often unexpected, remains a primary concern for the anesthesiologist. None of the bedside airway assessment tests have proven to be efficacious and highly predictive. This study was done to determine the sensitivity and specificity of Modified Mallampati test alone, Thyromental distance alone and in combination of both for predicting difficult intubation. Material and Methods: A prospective observational study was conducted in Universal College of Medical Sciences Teaching Hospital (UCMSTH), which involved 80 American Society of Anesthesiologist Physical Status (ASA PS) I patients undergoing elective surgeries under general anesthesia with endotracheal intubation. All patients were included for preoperative assessment by Modified Mallampati test alone and Thyromental distance measurement. The correlation between these tests and Cormack and Lehane laryngoscopic grading was done to find out the result. Results: Prediction of difficult intubation among 80 patients by Modified Mallampati test alone showed sensitivity of 72.7% and specificity of 98.6% whereas with Thyromental distance alone, showed sensitivity of 36.4% and specificity of 100%. When both predictors were combined, result showed sensitivity of 72.7% and specificity of 98.6% which was similar to that of Modified Mallampati test alone. Conclusion: This study concluded that sensitivity to predict difficult intubation was higher with Modified Mallampati test alone or in combination with Thyromental distance test whereas specificity was highest with Thyromental distance test alone.

Prevalence of Iron Deficiency Anemia in Anemic Patients: A Hospital Based Study

Introduction: In developing countries like Nepal, iron deficiency anemia (IDA) is one of the major concern. The high rate incidence has been related to insufficient iron intake, accompanied by chronic intestinal blood loss due to parasitic and malarial infections. Therefore, a study was conducted to evaluate the prevalence of IDA in anemic patients of Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), South Western region, Nepal.&#x0D; Material and Method It was a hospital based cross sectional study comprised of 100 anemic patients. Their detailed medical history and lab investigations, focusing on hematological parameters were documented. Peripheral smear examination and serum ferritin estimation were done to observe red cell morphology and iron status respectively.&#x0D; Results: This study revealed that out of 100 anemic patients, 35% were that of IDA. The most affected age group was 21-40 years with frequency 42.55%. IDA was more common in females (42.85%) than in male (21.62%). Out of 100 anemic patients, microcytic hypochromic anemia was predominant in 47% followed by macrocytic anemia (31%) and then normocytic normochromic anemia (22%). Out of 47 microcytic hypochromic anemic patients, 12 had normal serum ferritin. There was a statistical significant difference in Hb (p=0.011), MCV (p=0.0001), MCH (p=0.0001), MCHC (p=0.0001) and serum ferritin (p=0.0001) among all types of anemia. There was a statistical significant positive correlation of ferritin with Hemoglobin (0.257, p= 0.01), MCV (0.772, p= 0.0001), MCH (0.741, p=0.0001) and MCHC (0.494, p=0.0001).&#x0D; Conclusion: The peripheral smear in conjunction with serum ferritin estimation needs to be included for susceptible individuals to screen the IDA and other types of anemia.

A Comparative Study of Endoscopic Versus Otomicroscopic Myringoplasty

Introduction: Myringoplasty is one of the common surgical procedures done for closure of perforated tympanic membrane. Traditionally, it used to be performed with the help of operating microscope, however, the rigid endoscopes are being popular nowadays. So, we are comparing the success of graft uptake between endoscopic versus otomicroscopic myringoplasty.&#x0D; Materials and methods: This is a prospective, comparative and randomized study done in the Department of Otorhinolaryngology and Head and Neck Surgery (ORL-HNS), Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), Bhairahawa, Nepal. The study duration was for 18 months (1st December 2015 to 31st May 2017). There were 60 patients with age range of 12-60 years. All the patients fulfilling the inclusion criteria were included. Patients were randomized into Group A (endoscopic) and Group B (otomicroscopic).&#x0D; Results: Patient's age ranged from 12-60 years. The mean ± standard deviation (S.D) of age (years) between two groups was 27.07 ± 11.96 years and 27.20 ± 9.65 years respectively. There were 33.33% male and 66.67% female patients in group A and 43.33% male and 56.67% female patients in group B. The graft uptake success rate was 93.33% in group A and 90% in group B. Statistically no significant difference was observed in graft success and failure rates between two groups (p =0.640).&#x0D; Conclusion: Comparatively the rate of graft uptake was higher in endoscopic group without statistical significance. Thus, endoscopic myringoplasty can be a good alternative of microscopic myringoplasty.&#x0D;