Comparative study of cast immobilization of wrist in functional position versus conventional palmar flexion in Colles’ fracture

Background: Colles’ fracture is a common injury in the elderly population. Although it can be easily reduced, it is difficult to maintain the reduction in the conventional position of the wrist in palmar flexion with a poor functional outcome. Thus our study aimed to compare the radiological and functional outcome of such fractures with the wrist in two different posi­tions of dorsiflexion and palmar flexion. Methods: A prospective, observational study was conducted from April 2019 to March 2020 in the Orthopedics and Emergency department of KIST Medical College Teaching Hospital, Lalitpur, Ne­pal. Sixty-two patients, 31 in each group, all above 45 years with Colles’ fracture underwent close reduction and below elbow cast immobilization under hematoma block. Maintaining palmar flex­ion and ulnar deviation at the fracture site, the wrist was immobilized in dorsiflexion and palmar flexion attitude alternatively. During the respective follow-ups, the Demerit Scoring System of Saito was evaluated. Data collection and entry was done using the statistical package for social science version 16 and analyzed by using descriptive and inferential statistics. Results: All fractures were united. At the end of twelve weeks, Saito Scoring System of good to ex­cellent was markedly better in dorsiflexed group 29(93.5%) patients as compared to palmar flexed group 22(71.0%) patients, similarly grip power was also superior in dorsiflexed group 19(61.3%) patients than in palmar flexed group 11(35.5%) patients. Conclusions: Cast immobilization of Colles’ fracture with the wrist in dorsiflexion prevents re-dis­placement of the fragments resulting in significantly better radiological and functional outcomes.

Omental lymphangioma: a rare case report

Lymphangioma is a common pediatric problem. Most of the lymphangiomas occur in head and neck region. Lymphangioma arising from omentum is extremely rare. It is a benign condition butis locally invasive. Symptoms usually arise from its mass effect or complications. Complete excision including removal of all loculi is necessary for cure. We report such a case of omental lymphangiomain a six-year boy.

Uplifting maternal health in Nepal

No abstract available.

Assessment of awareness of oral cancer among nursing students at BPKIHS, Nepal

Background: Early recognition of oral cancer is essential for higher cure rate and better prog­nosis. Nurses can play a significant role in the early diagnosis of cancers. The study aimed to assess the awareness of oral cancer among nursing students. Methods: A cross-sectional survey was conducted among Bachelor of Nursing Students at College of Nursing, B.P. Koirala Institute of Health Sciences. A semi-structured questionnaire was used to collect the sociodemographic data and awareness of cancer. Descriptive statistics were calculated using Statistical Package for Social Sciences version 22.0. Results: Out of 116, 89 (76.7%) students were of age 21-25 years. One hundred and twelve stu­dents (96.6%) were aware that various form of tobacco increases risk of oral cancer; however, only 55 (47.4%) students knew alcohol drinking as a risk factor. Only 29 (25.0%) students were aware of loose-fitting denture as a risk factor for oral cancer. Ninety-six (82.8%) students knew white or red patch as possible signs of oral cancer; however, only six (5.2%) students were aware of the most common site of oral cancer. Only 16 (13.8%) students considered that they are adequately trained to screen oral cancer. One hundred and fifteen (99.1%) students demanded more education on oral cancer. Conclusions: This study revealed that nursing students’ awareness of risk factors and the impor­tance of screening of oral cancer is suboptimal. It highlights a need for basic education on oral can­cer to make them more aware and further competent toward oral cancer screening and referral.

Knowledge, attitude and practice of self-medication among medical students during exam time

Background: Medical education is one of the toughest education systems where the stu­dents are under intense physical and mental pressure especially during the exam time. They have information of different drugs that can cope with their medical conditions and also aware of different cognitive enhancers. Self-medication results in wastage of resource, ad­verse effects, drug dependence and increase chances of resistance of pathogens. Hence, this study was undertaken to determine the knowledge, attitude and practice of irrational drug use among the medical students during the exam time. Methods: This was descriptive cross-sectional using semi-structured questionnaire in the one of the medical school located inside Kathmandu Valley. A total of 90 students participated in the study. The data was analyzed with SPSS version 20, by using descriptive statistics. Results: Among the total respondents,20 (17.7%) were practicing self-medication during the exam time. Of the participants who practiced the self-medication, most common drug used was NDAIDs. Most of the respondents 87(96.7%) were aware of the possible adverse consequences. About 75(83.3%) participants thought the self-medication practice during the exam time is acceptable while 15(16.7%) regarded this as unacceptable. Conclusions: Although low incidence of self-medication was found among students during exam time, the false prerogative of being medical students can lead to meager practice and awful con­sequences.

Psychosocial problems among school going adolescents in Ghorai sub metropolitan city of Dang

Background: A psychosocial problem is a mental illness caused or influenced by life experiences, as well as maladjusted cognitive and behavioral processes. Psychosocial problems i.e. internalizing dis­orders, externalizing disorders and substance abuse are more prevalent among adolescents because of their rapid physical and physiological changes that occur in their body during this stage. The aim of the study was to identify the magnitude of psychosocial problems among school-going adolescents. Methods: Present study was a descriptive cross-sectional study conducted in the ward no. 15 of Gho­rahi sub metropolitan city of Dang District, Nepal. A total of 325 adolescents were chosen from multi-staged random sampling. Pre-tested self-administered questionnaire was used to collect data. Part I and part II of questionnaire was self-constructed and Part III was adopted from standard tool of Youth Pediatric Symptoms Checklist. Descriptive (percentage, frequency, interquartile range and minimum and maximum values) and inferential analysis (chi-square test) was done through this IBM SPSS soft­ware version 20. Results: The prevalence of psychosocial problems among school going adolescents was 26.8%. Socio-demographic characteristics such as age, ethnicity, occupational status of respondent’s father and mother were found to be significantly associated with psychosocial problems. The relation with teach­er and academic grade of respondent were found to be highly associated with psychosocial problems. Conclusions: The study reported an alarming situation of psychosocial problems among adolescent students in Nepal where more than one quarter of participants found having psychosocial problems. The study may suggest the need of proper parenting and maintenance of an appropriate level of teacher-student relationship.

Initiation of contact tracing for Covid-19 at an academic institution for health science: initial experiences

Transmission of COVID-19 cases has been found in clusters and sporadic form in different parts of Nepal, which swiftly strained the healthcare system. Contact tracing is a strategy to prevent further transmission of the COVID-19. It reduces the overwhelming burden in a health system. Academic institutions are the best alternative in contact tracing, not only in terms of task shifting but their training in epidemiology and research also best suits them. Besides, they can also train the health workers assigned for contact tracing in rural and urban settings. Multi-sectoral involvement from academia, community health workers, and effective information flow are instrumental for effective contact tracing in resource-limited settings.

Recurrence and progression of non-muscle invasive bladder cancer following trans-urethral resection of bladder tumour with adjuvant intravesical chemo-immunotherapy

Background: Trans-urethral resection of bladder tumor is an essential diagnostic tool as well as effective treatment modality for non-muscle invasive bladder cancer. We aimed to evaluate the recurrence and progression of the non-muscle invasive bladder cancer in Nepalese patients. Methods: This was a retrospective study of 43 patients with non-muscle invasive bladder cancer, who underwent trans-urethral resection of bladder tumour followed by adjuvant intravesical instilla­tion of chemo or immunotherapy between January, 2013 to December, 2018. Patients were divided into low, intermediate and high-risk groups according to the clinical and pathological factors used by the European Organization for Research and Treatment of Cancer scoring system. Outcomes were calculated in terms of recurrence and progression in each group. Results: Out of 43 patients, 11 (25.58%) patients had low risk, 18 (41.86%) patients had intermediate risk and 14 (32.56%) patients had high risk of recurrence categories. No recurrence and progression of the disease noted in low risk group. In the intermediate risk group, out of 18 patients, 4 (22.2%) patients developed recurrence and 2 (11.1%) patients had progression of disease. In high risk group, out of 14 patients, 4 (26.8%) patients developed recurrence and 2 (14%) patients developed progres­sion of the disease. Conclusions: Even in a low volume centre of bladder cancer, effective treatment for non-muscle inva­sive bladder cancer with trans-urethral resection of bladder tumour followed by adjuvant intravesical chemo or immunotherapy can be given safely to reduce recurrence and progression of the disease.

Reverse sural artery fasciocutaneous flap in soft tissue reconstruction in lower extremity

Background: Soft tissue defect around distal leg, ankle and heel region is a challenging task for an orthopaedic surgeon. Sural artery reverse fasciocutaenous flap has been widely used and is a successful method for soft tissue reconstruction in such situation. This study aimed to find out the result of sural artery distal based pedicle flap in managing soft tissue recon­struction around the ankle and distal leg. Methods: This was a retrospective study of 12 cases of sural artery based fasciocutaenous flap done between January 2015 to December 2019. Medical records were used to find the details of demographic data, operative details and post-operative status of the patients. Patients were contacted for the final follow up at minimum of 6 months after operation for assessment of the outcome. Demographic and clinical data were entered in excel chart and the clinical result was analyzed using SPSS software version 20.0. Results: There were total of 12 patients who underwent sural artery flap procedure. Among them, 10 were male and 2 females with mean age of 39 (range, 25-52) years. Eleven flaps survived with satisfactory functional outcome. One had complete flap necrosis, two had patchy margin necrosis and two had superficial infection which healed well with minor debridement and antibiotics. Conclusions: Sural artery based reverse fasciocutaenous flap is good and technically easier option for an orthopaedic surgeons for the soft tissue reconstruction around ankle, heel and distal leg in traumatic, infective or other etiology with satisfactory outcome in most of the patients.

Students’ perception on educational environment of the postgraduate programme in selected nursing colleges of Nepal

Background: Student’s positive perception towards the academic environment determines the quality of education. This study aimed at finding students’ perception on educational environ­ment of the postgraduate nursing programme of Nepal. Methods: Descriptive cross-sectional design was conducted among 104 masters level nursing stu­dents from four selected nursing campuses under Institute of Medicine, Tribhuvan University. Enu­merative sampling technique was used to select the sample. Data were collected using validated standard tool Dundee Ready Educational Environment Measure (DREEM) scale and analyzed using descriptive statistics. Results: Most of the nursing students (81.7%) had positive level of perception on their educational environment and few had excellent perception. Total DREEM mean score was 134.37± 21 out of 200. Specifically, mean score of learning was 31.93 ± 5.1 out of 48, students’ perception of teachers was 30.02 ± 5.072 out of 44; students’ academic self-perception was 22.32 ± 3.54 out of 32; students’ perception of atmosphere was 32.26±5.1 out of 48 and mean score for students social self-perception was 17.82± 3.3 out of 28. Lower mean score < 2.0 was identified on teaching factual learning, oppor­tunities to memorize learning, supporting during stress, time management of programs, well prepara­tion for classes and student’s self-perception. Conclusions: The findings indicate more positive perception on educational environment among post­graduate nursing students. Still some aspects such as teaching factual learning, memorizing learning, supportive students during stress, and social environment need to be emphasized to enhance the students’ educational environment of post-graduate nursing program by the academic institution.