Annapurna Journal of Health Sciences

Integration of Allopathy and Traditional Medicine: New Horizons of Health

2024-03-22T06:00:05+00:00

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Single Dose versus Multiple Doses Antibiotics Prophylaxis in Patients Undergoing Elective Laparoscopic Cholecystectomy

2024-03-22T06:18:19+00:00

Introduction: Laparoscopic cholecystectomy, a minimally invasive procedure for gallbladder removal, is favored for its reduced postoperative pain and faster recovery. However, the risk of surgical site infections (SSIs) can lead to increased morbidity and healthcare costs, necessitating effective antibiotic strategies.

Methods: We conducted a prospective comparative study at Birat Medical College Teaching Hospital from 11 June 2023 to 11 September 2023. A total of 238 patients undergoing elective laparoscopic cholecystectomy were enrolled consecutively and assigned to the single dose (SD) or multiple dose (MD) group on a roll basis. The SD group received a preoperative injection of ceftriaxone (1gm) before anesthesia induction, while the MD group received plus three additional doses postoperatively, spaced 12 hours apart. Data were collected and analyzed using SPSS version 23.

Results: The mean hospital stay duration was mean±SD=3.06±0.72 and 2.60±0.81 in the MD group. While patients receiving single preoperative antibiotics experienced fewer SSIs than those in the multiple dose group, there was no statistically significant association (p-value 0.775).

Conclusion: This study found no significant difference in terms of surgical site infection rates between patients receiving single or multiple doses of antibiotics during laparoscopic cholecystectomy.

Work Life Balance among Medical Doctors of Selected Teaching Hospitals of Kathmandu

2024-03-22T09:56:21+00:00

Introduction: Work-life balance among doctors impacts personal and professional growth, patient care, and hospital performance. Since there are noticeably few studies assessing the same, this study aims to assess the work-life balance among medical doctors working in selected teaching hospitals of Kathmandu.

Methods: A cross-sectional descriptive study was conducted among medical doctors in Nepal, involving 372 participants. Self-administered survey questionnaires were used for data collection during the study period from March 15, 2022, to July 20, 2023. The collected data underwent manual editing and coding before being transferred to SPSS for analysis. Ethical clearance was obtained from IIHMR University, India, and NHRC, Nepal.

Results: The study highlights diverse effects of personal life on work, with a median score of 10 within 4 to 20 range. "Work/personal life enhancement" shows moderate balance (median 12.00) within 4 to 20 scores. "Work interference with personal life" has median 25.00, impacting life across 7 to 35 scores. This insight has implications for personal-professional life, patient care, and hospital performance.

Conclusion: Study showed the requirement to manage job demands for preventing burnout and fostering a healthier work-life balance. Prioritizing initiatives addressing identified work-life conflicts within the medical profession will enhance and promote a more balanced and effective work environment.

Nerve Conduction Studies in Type-II Diabetic Mellitus with and without Metformin Therapy & its Association with Vitamin B12

2024-03-22T10:22:16+00:00

Introduction: Type II Diabetes Mellitus (T2DM) is a heterogeneous group of metabolic disorders characterized by insulin resistance & and impaired insulin secretion. Metformin is a first line treatment oral hypoglycemic agent for patients with T2DM. Conversely, it has been found that the use of metformin is associated with malabsorption of vitamin B12, which may lead to more detrimental effects on peripheral nerves.

Methods: A comparative cross-sectional study was conducted enrolling type II diabetic patients (Group A) with metformin therapy for more than 6 months (n=30), type II diabetics (Group B) without metformin exposure (n=11) and healthy controls (n=30). Nerve conduction study parameters of median, tibial, common peroneal & and sural nerves, serum glucose and serum vitamin B12 levels were measured. A way ANOVA (post hoc: Tukey) test was used to compare the variables using SPSS. 22.0.

Results: T2DM with metformin therapy showed significantly longer latencies and lower amplitudes of both sensory and motor nerves when compared to healthy controls and T2DM without metformin therapy. NCS parameters showed more deleterious effects on the median, tibial and sural nerves of diabetic patients with metformin therapy. Diabetics undergoing metformin treatment had reduced vitamin B12 levels as compared to those without metformin therapy [194.03 (164.86-223.53) vs. 297.82 (258.99-363.00), p=0.001] and healthy controls [194.03 (164.86-223.53) vs. 287.50 (204.25-351.50), p=0.001]. Serum vitamin B12 level showed a strong negative correlation (significant at p<0.01 level) with duration of metformin exposure/ treatment in metformin-exposed diabetics.

Conclusion: Long-term metformin therapy in diabetic patients is associated with significant vitamin B12 depletion, leading to alteration in motor and sensory NCS parameters. Thus, we recommend regular vitamin B12 screening and oral/ parenteral vitamin B12 supplementation to diabetic patients on metformin therapy.

Oral Health-Related Quality of Life after Fixed Partial Denture among Patients Visiting a Tertiary Care Hospital

2024-03-22T10:39:35+00:00

Introduction: Fixed Partial Dentures (FPDs) are the most common choice for dental rehabilitation after tooth loss. These dentures can impact oral health and quality of life among patients. This study thus aims to know the oral health-related quality of life with the help of the Oral Health-related Impact Profile -14 questionnaire among the patients with FPDs in Kathmandu.

Methods: A descriptive cross-sectional study was carried out among 250 patients with FPDs in the Department of Dental Surgery, Trichandra Military Hospital. The participants were selected by convenient sampling after obtaining informed consent between April 2023 to September 2023 among the individuals with tooth-supported fixed partial dentures. The oral health-related quality of life was assessed with the help of the Oral Health-related. Impact Profile questionnaire which consists of 14 question items and is the standard tool used globally for assessing the oral health related quality of life SPSS-16 version was used to know the distribution of various responses in each of these question items.

Results: Among 250 cases of fixed partial dentures, the maximum number of participants experiencing adverse impacts had painful aching in the mouth (11.6%), feeling self-conscious (10%), and uncomfortable eating any foods (8.8%). The distribution of severity of the adverse impacts was mostly in the none category (51.6%), little (23.6%), moderate (7.2%) and great (1.6%).

Conclusion: The distribution of severity of the adverse impact of tooth-supported Fixed partial dentures on oral health-related quality was none to little as per the oral health impact profile questionnaire-14. This is supportive of the success of fixed partial dentures in the study population.

Trend of Chromosomal Disorders in Patients Referred for Chromosomal Analysis in Cytogenetic Lab of BPKIHS: An Institutional Based Retrospective Study

2024-03-25T04:36:43+00:00

Introduction: Chromosome abnormalities are the results of alterations in the number or structure of chromosomes causing significant human morbidity and mortality. Cytogenetic analysis is crucial in identifying these abnormalities and guiding genetic counseling and clinical management. The main objective is to describe the patients having chromosomal analysis on the basis of their demographic profile, cause of referral and referral central; and to estimate the distribution of different chromosomal aberration among those patients who underwent chromosomal analysis.

Methods: All the patient referred to the cytogenetic lab of B.P Koirala Institute of Health Sciences, Nepal between 2004 and 2015 for chromosomal analysis were assessed from the record of lab. Demographic data, referring department/ clinic, patients karyotype and frequency of distribution of various karyotype was assessed.

Results: Most of the patients were between 20 and 50 years old, and 64% were male. The most common reasons for referral were suspected Chronic myeloid leukemia (CML) (n=215), Down's syndrome (n=27), amenorrhea, and ambiguous genitalia. BPKMCH was the most common referral center to refer the cases in cytogenetic lab (63.7% of cases). Philadelphia-positive CML, Down's syndrome, and Turner's syndrome were the most common cytogenetic diagnoses made.

Conclusion: Suspected CML was the primary reason for referral. Most patients were aged between 20 to 50 years, with males comprising 64% of the cohort. Philadelphia positive CML was the most common cytogenetic diagnosis. Referrals peaked in 2005 AD, primarily from BPKMCH.

Herbal Medicine Associated Casualty And Fatality In South West Nigeria: A Retrospective Analysis

2024-03-25T04:54:01+00:00

Introduction: Several studies have indicated that use of herbal medicines (HMs) in Nigeria and other parts of the world may harm human health. Contamination, adulteration, and the likely presence of toxic constituents in HMs have raised serious concerns regarding their safety. As a result, hospital records in Ekiti state, Nigeria, were analyzed to determine the extent to which HMs contribute to the number of hospital admissions (casualties) and deaths (fatalities) in the area.

Methods: A 5-year (2010 to 2014) retrospective analysis of patient data was carried out by examining HM-associated paediatric, adult medical, and obstetric casualty and fatality figures. The findings were then triangulated with available secondary data.

Results: During the studied period, out of 23,363 pediatric cases, 0.5% of casualties and 3.2% of fatalities were associated with HM use. Similarly, among 52,871 adult cases, 0.06% of casualties and 0.2% of fatalities were linked to HM use. Of the 668 obstetric stillbirth cases, 3.9% involved the use of HM. The highest number of casualties and fatalities were observed in male patients aged between 30 to 49 years, who were Christians and self-employed.

Conclusion: While the number of deaths associated with HM is relatively low, the possible complications that can arise from its use make it necessary to test and promote awareness of possible dangers of HM use to prevent hospitalizations and fatalities. Better awareness and documentation of patients' HM use by healthcare providers will help gain a better insight into their usage.

Knowledge and Practice of Patients with Epilepsy on Vehicle Driving and Epilepsy at a Tertiary Neurological Center in Kathmandu

2024-03-25T05:10:30+00:00

Introduction: Patients with epilepsy are instructed to avoid driving to prevent harm to themselves and others. The Motor Vehicle And Transport Act 2049(1993)- Nepal Law Commission regarding driving license Chapter 4/47/C disqualifies driver license to People With Epilepsy. This study aims to find out the Knowledge and Practice of Patients with Epilepsy in vehicle driving at the Tertiary Neurological Center of Kathmandu Nepal.

Methods: A Cross-sectional prospective study was conducted among the patients diagnosed with epilepsy who were seeking treatment at Annapurna Neurological Institute and Allied Science (ANIAS). Structured questionnaire was administered among 102 participants regarding knowledge and practice on driving during the study period. All data were entered in MS Excel and descriptive analysis was done using SPSS Version 21.

Results: Among 102 participants, 40.1% of participants with epilepsy frequently drive the vehicle whereas 79.4% of participants had encountered accidents due to epilepsy in the past. 56% of the participants could control the vehicle beforehand after they felt an aura of epileptic seizure.

Conclusion: This study showed that the majority of the participants didn’t report their epilepsy condition to the driving management department which should be made to improve awareness and education among license applicants and instructors on driving by people with epilepsy. The majority of participants did not have adequate access to information on epilepsy and driving licenses. Legislations on driving by people with epilepsy should be strictly followed.

Incidental Idiopathic Proximal Tibial Distal Fibular Synostosis: An Unusual Case Report

2024-03-25T05:36:23+00:00

Tibiofibular Synostosis is one of the rare causes of pain in the knee joint. Conservative treatment is the recommended treatment of choice. A 30-year-old male footballer came to our clinic complaining of knee joint pain, with no history of trauma. Pain is increasing on walking, no abnormality was detected, but a marginal increase in the girth of the left calf muscle compared to the contralateral right side. Imaging results revealed Proximal Tibial-Distal Fibular Synostosis.

Hind Brain in Mature Cystic Teratoma Ovary: A Case Report

2024-03-25T05:51:35+00:00

Mature cystic teratoma is the commonest benign neoplasm occurring in the ovary, comprising for 27-44% of all ovarian tumors and most cases in reproductive age women. Here we report the case a 26-year-old female presented with complain of lower abdominal pain for six months which on ultrasound evaluation and Computed Tomography showed dermoid cyst measuring 7x5.3x5 cm with non-enhancing soft tissues predominantly containing fat and few calcifications. Microscopic examination showed a cyst wall lined with stratified squamous lining including adnexal structures (sebaceous glands) and glial tissue, along with a focal area lined by respiratory epithelium. There was no immature component. Well-differentiated cerebellum within ovarian teratoma is extremely rare entity in literature.

Escitalopram induced Tremors- A Rare Side Effect

2024-03-25T05:57:45+00:00

Selective serotonin reuptake inhibitors (SSRIs) which includes escitalopram is used to treat various psychiatric disorders such as depression, anxiety, obsessive compulsive disorder and premenstrual dysphoric disorder. All SSRI’s have common pharmacological feature that is selective inhibition of serotonin reuptake. However, it can lead to various side effects among which tremors can occur as a drug induced movement disorder. Here, a case of escitalopram induced tremor has been described in patient who was being treated with the same for anxiety disorder. This case gives an insight on a way to move forward if patients develop tremors upon initiating SSRI to treat their underlying psychiatric condition.