Distribution and Association of ABO and Rh Blood Group Antigens with BMI Among Nepalese and Indian Students Studied in a Medical College of Nepal

Introduction: Blood group antigens and body mass index of human are gaining importance for many diseases. Some attempts were reported to find any relationship between BMI and Blood groups with some contradictions. The possible association between BMI and blood groups of Nepalese and Indian medical students is yet to be established. Methods: Blood groups, ABO and Rh systems and body mass index (BMI) of participants, medical students of Nepalese and Indian origin were determined and analyzed statistically. Results: The distribution frequencies of 10.56%, 17.08%, 3.06%, and 20.28% females and 9.03%, 16.39%, 3.61% and 20.0% males of both the countries were present in A, B, AB and O blood groups, respectively. Rh-negative participants were predominantly present in O blood group. The observed frequencies of participants with different BMI group were distributed as 56.11%, 24.72%, 10.69% and 8.47% in Normal, Overweight, Underweight and Obese groups, respectively. Underweight participants were prevalent in O group and in females. The difference between the distribution of Nepalese females and males with Normal BMI was found significant in A and O. A distribution pattern of B>O>A>AB was observed for Overweight group. The occurrence of Obese is few folds higher among Indian participants than Nepalese and prevalent in males. Obese participants were found more associated with B and O blood group. Conclusions: Participants with A were more prevalent among Nepalese in respect to Indian. Rh-negative participants were distributed as 1.67% and 5.0% in Nepalese and Indians, respectively and predominantly present in O (4.44%) and are more prevalent in Indian males. In Normal BMI Nepalese were significantly more as compared to Indians. In the Underweight group females were significantly more prevalent as compared to males and found maximally associated with O blood group and most of them are Nepalese. In Overweight group males were more than females. Participants with obesity were mostly present in B and O blood group and most of them are Indian.

Detection of Human Papilloma Virus in Oral Potentially Malignant Disorders and Oral Squamous Cell Carcinoma

Introduction: Human Papilloma Virus 16 and 18 affects the keratinocytes of oral mucosa and skin and can lead to the development of dysplastic lesions and ultimately into invasive oral squamous cell carcinoma. The objective of the present study was to evaluate the presence of human Papilloma virus 16 and 18 DNA in already diagnosed oral potentially malignant disorders and oral squamous cell carcinoma. Methods: 200 biopsy specimens (50 each) of already diagnosed leukoplakia, oral lichen planus (OLP), oral submucous fibrosis (OSMF) and oral squamous cell carcinoma was included for the study. A total 50 control tissue sections, which were obtained during removal of impacted teeth were also included in the study. All 250 specimens were subjected to polymerase chain reaction (PCR) for the identification of HPV 16 and 18. The results are analyzed using Statistical Package of Social Sciences (SPSS) version 16 software and Pearson’s chi square test was used for statistical analysis. Results: HPV 16 and 18 was noted in all the OPMDS and oral cancer specimens but the results were not statistically significant. However, not even a single case of control tissue showed the presence of HPV 16 and 18. Conclusions: The results of the present study shows HPV 16 and 18 is present in oral cancer as well as OPMDS, therefore it could be implicated in the pathogenesis of the above mentioned conditions.

Awareness of Periodontal Diseases and its associated Adverse Pregnancy Outcomes among Pregnant Women attending a Tertiary Care Center

Introduction: Periodontal diseases are associated with high levels of gram-negative periodontal pathogens that apparently increase abundantly in the presence of pregnancy-associated hormones. Endotoxins from gram-negative bacteria enter the circulation at high levels to stimulate the production of inflammatory mediators, such as prostaglandins and other inflammatory mediators which are potent inducers of labor. The present study was conducted to assess oral health awareness and experience among pregnant women attending a tertiary care hospital. Methods: A cross-sectional study was conducted in 167 pregnant women visiting a tertiary care center using self- administered structured questionnaire consisting of questions related to knowledge and awareness regarding periodontal diseases and its possible associated adverse pregnancy outcomes. Results: Of the total participants, 55.7% said that they did not think gum disease can have adverse pregnancy outcomes. Only 35.9% had, at some point, consulted a dentist for bleeding gums and 36.5% of them had gingival enlargement during pregnancy but 46.1% said that they should wait for the delivery before they could do any dental treatment. Also, 40.1% did not know the safe trimester to undergo dental treatment and only 20.4% said the second trimester was the safest to undergo any dental procedure. Conclusions: The study showed that awareness and knowledge of periodontal health among pregnant women was not satisfactory. Keywords: Awareness; adverse pregnancy; periodontal disease; pregnancy outcomes.

Factors Associated with Discontinuing Exclusive Breastfeeding among Mothers of Infants Aged 0-6 Months

IntroductionKnowing breastfeeding is one of the easiest and cost-effective ways to maintain a good childhealth, majority infants are not exclusively breastfed for the recommended 6 months of age.Thus, the aim of the study was to find out the factors associated with discontinuing exclusivebreastfeeding (EBF) among mothers of infants’ aged 0-6 months. MethodsA analytical study design was used to find out the factors associated with discontinuing EBFamong mothers of infants’ aged 0-6 months in Nepal. A total of 380 mothers of infants whosechild were 0-6 months old were selected using non-probability purposive sampling techniquethrough online survey as people are advised to stay at home during the Covid-19 outbreak. Datawas collected using structured questionnaire with interview technique. ResultsStudy findings revealed that half (50.5%) of the mothers exclusive breastfed their infants withmother’s mean age being 27.39 ± 3.64 years. Discontinuation of EBF varied with mothers age,ethnicity, mother’s educational level, initiation of breastfeeding and sources of informationregarding EBF as newspaper/articles and relatives/friends/neighbors (p=<0.005). The factorsrelated to mother that are associated with discontinuation of EBF were found to be perceivedinsufficient milk, cesarean section delivery, jobholder mother (p= <0.001) respectively. ConclusionsOnly half of respondents exclusively breastfed their infants for the recommended age in whichonly factors related to mother were significant with discontinuation of EBF rather than infants’.Findings of the study emphasizes on counselling the mothers regarding the benefits of EBF toboth child and mother during hospital visits. Keywords: exclusive breastfeeding; factors; under 6 months; EBF.

Comparative Study of Non-descent Vaginal Hysterectomy with Total Abdominal Hysterectomy

IntroductionHysterectomy is the most common operation performed by gynecologist worldwide. In the present era emphasis is given on minimal invasive surgery so Non-Descent Vaginal Hysterectomy (NDVH) has gained more interest over Total abdominal Hysterectomy (TAH). NDVH has several benefits over TAH in terms of blood loss, operating time, post-operative complications, recovery and hospital stays. The objective of the study was to compare the clinical outcome of NDVH over TAH with respect to operating time, blood loss, hospital stays, intraoperative and early postoperative complication and to find out the most efficient route for hysterectomy. MethodsThe study was conducted at College of Medical Science-Teaching Hospital, Bharatpur, Chitwan, Nepal between May 2017- May 2020. Fifty cases each of NDVH and TAH group fulfilling the selection criteria were included in the study. Outcome was measured on the basis of operating time, blood loss, hospital stay and intra an d post-operative complications. ResultsBaseline characteristics were similar between both the groups. The most common indicationfor hysterectomy in both the group was fibroid uterus. There was no intra-operativecomplication in NDVH group but in TAH group bowel injury was encountered in 3 cases.The operating time, blood loss, hospital stay and post-operative complications were less inNDVH as compare to TAH ConclusionsNDVH is the better choice of surgery than TAH for the non-prolapsed uterus, size less than12 weeks with benign pathology.

Assessment of Knowledge regarding Vitamin D among Medical Undergraduate Students:

Introduction: It is estimated that one billion people in the world have vitamin D deficiency and observed as a public health problem. The main objective of this study is to assess and compare the Vitamin D knowledge among MBBS, BDS and BSc. Nursing students of Kathmandu Medical College, Duwakot (before and after educational training). Methods: This is a cross sectional study carried out at Kathmandu Medical College, Duwakot among 1st year MBBS, BDS and B.Sc Nursing students. Data was collected from 2nd -15th February 2020. A structured self designed multiple choice questionnaire was used. A written pretest assessment regarding vitamin D knowledge followed by a written posttest assessment was taken after a lecture class on vitamin D. Ethical approval was obtained from Institutional Review Committee of Kathmandu Medical College (Ref. 2812201809). The census data of students were taken. The data was analyzed using SPSS software version 20.0 Results: Mean differences between the pretest and posttest scores showed an increment of vitamin D knowledge among MBBS students (t = 22.155, p = 0.000), BDS students (t = 16.46, p = 0.000) and B.Sc. Nursing students (t = 18.615, p = 0.000). Conclusions: Interactive lecture class showed moderate gain on knowledge regarding vitamin D among the under graduate students. Health education interventions can improve the knowledge and increases self-efficacy of future doctors and nurses about vitamin D.

Fifteen Uninterrupted Years of Maternal Mortality Findings from a Tertiary Care Centre

Introduction Maternal mortality reflects reproductive health status and availability of good health care facilities at different levels of the healthcare system at a given period, influenced by globally adopted safe motherhood policies. The leading causes of maternal death in Nepal mainly comprise of hemorrhage, eclampsia, abortion-related complications, gastroenteritis and anemia. Although a declining trend has been noted in Nepal it has yet to meet the target set by the Sustainable Development Goal (SDG) 3.1 of reducing the global MMR to less than 70 maternal deaths per 100,000 live births by 2030. MethodsA cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Tribhuvan University Teaching Hospital (TUTH) from 1st Baisakh 2055- 30th Chaitra 2069 (15th April 1998- 14th April 2013). The study period of 15 years was divided into three parts, five years each: 2055-59 (14th April 1998-April 13th 2003) ; 2060-64 (14th April 2003- April 12th 2008) and 2065-69 (April 13th 2008 –April 12th 2013). MM was filled in Performa, discussed in morning conference and MM audit, computerized, analyzed, presented quarterly and yearly. Annual Maternal Mortality Ratio (MMR) expressed as MMR per 100,000 live births is calculated by dividing recorded (or estimated) maternal deaths by total recorded (or estimated) live births in the same period and multiplying by 100,000. ResultsTotal MM/maternal mortality ratio (MMR) in the first, mid and last five years were 39 (270 %); 37 (212% ) and 37 (188%) respectively giving overall total MM/MMR 113 (223.5%) attributing to Direct: 55 ( 48.6%), Indirect: 44 (38.9%) and Non maternal deaths: 14 (12.3%). Predominating cause of MM in the first/mid/last five years were sepsis and infective hepatitis each (17.6%) and PPH (18.5 %). While SP/E were almost same over the years, in decreasing trend were hepatitis and puerperal sepsis but in rising trend was PPH and criminally induced abortion (10.6%). Thenumber of maternal death has not changed much, the median age in each five years is surprisingly similar, set at 25 years and the adolescents who died were not very different in every five years. It’s unfortunate that many primigravida died during this period which is a matter of concern. ConclusionsMaternal mortality stresses the impact of timely health seeking behaviour and health providers making provision of prompt adequate services and referral to help so that all Nepalese mothers, especially the young and first-time pregnant thrive. Keywords: infective hepatitis, maternal mortality, maternal mortality ratio, PPH, sepsis.

Parasitic Leiomyoma: A Case Report

ABSTRACT: Parasitic or wandering leiomyoma are rare extra-uterine benign pedunculated sub-serous leiomyoma which after being detached from its primary location thrives in secondary location from blood supply from nearby feeding vessels. This case represents a multiparous woman, with one such parasitic leiomyoma encountered at laparotomy, proven by histopathological examination.

Isolation, Identification and Antibiotic Susceptibility Patterns of Listeria Monocytogens from Pregnant Women

IntroductionThe present study is made to determine the prevalence rate, isolation, identification and antibioticsusceptibility pattern of L. monocytogens isolated from pregnant women. This research not onlyguides to the clinician for treatment but also help laboratory worker to monitor susceptibilitypattern among the Listeria species. MethodsThe samples were collected from Gynecology department from January 2017 to December 2019and processed in the Department of Microbiology at College of Medical Sciences, Bharatpur Nepal.Two hundred thirty four antenatal mothers having age between 17 and 39 years of gestation periodbetween 7th weeks and 36th weeks patient with a flue like sign and symptoms were screened forL. monocytogens. Bacterial isolation identification and antibiotic sensitivity tests were done as perstandard microbiological guidelines. ResultsIn this present research, the prevalence of L. monocytogens was found 39/234 (16.7%), where high rate of Listeria infection was found 21(53.1%) among the patients of age between 25 and 32 who were mostly from urban area. We found eating meat 38(97.4%) and fish 39(100.0%), non-pasteurized simple boiled milk 39(100.0%) and vegetables like salad eater 32(82.1%) has highest rate of listeriosis. The results showed most of the listeriosis were occurring in a 3rd trimester 17(43.6%) compared with the 2nd and 1st trimester. Overall, the antibiotics resistance pattern found low in L. monocytogens. This investigation also showed less resistance in erythromycin 9(23.1%), ciprofloxacin 8(20.5%), chloramphenicol 16(41.1%). The increased resistance pattern among Listeria species were found in penicillin 31(79.5%), cotrimoxazole 20(51.3%), amoxicillin 21(55.1%) and vancomycin 29(74.4%). ConclusionsIt is very important to consider listeriosis in a clinical practice now a day. Maternal Listeriosis shouldbe considered in all age group of pregnant women. Regular surveillance of antibiotic susceptibility test is very much important for clinician to select best medicine to treat different cases of listeriosis.

Comparison of COVID-19 Antigen Test and HRCT Chest with RT- PCR Test for Diagnosis of COVID-19

Introduction: We aim to compare Rapid Antigen Test and HRCT chest with Reverse Transcriptase-Polymerase chain reaction (RT-PCR) for diagnosis of COVID-19. Methods: This was a cross-sectional analytical study that included patients tested with RT-PCR and at least one of Rapid Antigen test or HRCT chest, conducted at College of Medical Sciences, Bharatpur, from June 2020 to Feb 2021 after obtaining the ethical clearance. Data analysis was done using statistical packages for social sciences version 16. Results: 315 of 755(41.7%) patients had positive RT-PCR and 18.4% of 733 patients had positive antigen test. Of 600 patients, 106(14.0%) were found to have CO-RADS 1,152(20.1%) had CO-RADS 2, 77(10.2%) had CO-RADS 3, 18(2.4%) had CO-RADS 4 and 247(32.7%) had CO-RADS 5 score on HRCT. Rapid Antigen Test was found to have 43.6% sensitivity, 98.6% specificity, 95.6% Positive predictive value (PPV) and 72.1% negative predictive value (NPV).CO-RADS scoring system was able to distinguish between RT-PCR positive and RT-PCR negative results with an average Area under curve 0.787. CO-RADS 5 had a sensitivity of 71.6%, specificity of 85.1%, PPV of 80.6% and NPV of 77.6% for a positive RT-PCR result. A combination of CO-RADS 1 in HRCT chest and Negative Antigen test can predict PCR negative result with 23.6% sensitivity, 97.3% specificity, 90.5% PPV and 54.0% NPV. Conclusions: Rapid Antigen Test is a better tool for confirmation rather than screening of COVID-19. HRCT chest with higher CO-RADS can be useful to diagnose COVID-19 in suspected patients, even if RT-PCR is negative.