Challenges of evidence based medicine in clinical practice

Evidence-based medicine (EBM) is an approach by clinicians that involves conscientious, explicit, and judicious use of available evidence in deciding on the care of individual patients. With the digital revolution and easy access to the available literature, EBM, which was not very practical a few decades ago due to the difficulty in assessing the resources, has been practiced with increasing success nowadays, even in the developing world. The revolution brought about by EBM with regard to the practice of medicine over the past few decades has been remarkable. Because of the individualized treatment based on external evidence, EBM leans towards justifying the action with accountability; hence being labeled as the fourth revolution in American Medicine

Pattern of malocclusion in orthodontic patients at a tertiary care centre

Introduction: Malocclusion is the most common dentofacial abnormality in human population, which can cause dental caries, periodontal disease and aesthetic problems. It is closely related to psychosocial wellbeing. The prevalence of malocclusion varies among different age and ethnic groups. The aim of this study was to assess the pattern of malocclusion occurring in orthodontic patients. Method: A 4 year data from 14 Apr 2018 to 13 Apr 2022 were collected retrospectively by the principal investigator (PI) from the pre-treatment record and an acceptable study cast from the Dental Department at Patan Hospital, Patan Academy of Health Sciences. Angle’s classification of malocclusion was used to classify malocclusion. The collected data were entered, and statistical analysis was carried out by using SPSS version 25. Chi-square test was applied to test the significant differences. The comparison was made between male and female and age group 6-12 years and 13 years and above for the Angle’s classification. Result: A total of 384 patients included in the study, female patients were 263(68.5%). Prevalence for malocclusion was 267(69.5%) of Angle’s class I, while Class II and Class III were 111(28.9%) and 6(1.6%) respectively. The study revealed not statistically significant. Majority 372(96.9%) belong to 13 y and above age group while only 12(3.1%) belong to 6-12 y age group. Conclusion: Angle’s Class I malocclusion was most prevalent with the least common being Angle’s Class III malocclusion. No statistically significant relationship was found. Almost all subjects were 13 years and above age group

Delivery site preferences and associated factors among married women of Panauti Municipality, Kavrepalanchok district, Nepal

Introduction: Maternal mortality is a top global developmental agenda. The main cause of being underutilization of available delivery services especially in a developing country like Nepal. Various socio-demographic, socio-cultural and health service-related factors affect the utilization of these services. Thus, the study aims to identify the delivery site preferences and its associated factors among the married women of Panauti municipality of Kavrepalanchok district. Method: A cross-sectional study was conducted among the married women between the ages of 15-49 y residing in Panauti municipality. The face-to-face interviews were conducted using semi-structured questionnaires. The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21. Result: A total of 106 women of 15-49 y were included in the study. The proportion of institutional delivery among the participants was 68%. 90.6% of total participants would prefer health facility for their future deliveries; 7.5% were not sure about their preferences and very few (1.9%) preferred to deliver at home. The factors like knowledge regarding safe-motherhood program and age at marriage were found to be significantly associated with their delivery site preference (p<0.05). Conclusion: In a country like Nepal, home delivery is still in practice and pregnancy and childbirth are regarded as normal life events. Thus, efforts should be made to change that perception, increasing utilization of available services and improving maternal and child health. This in turn will help to achieve the Sustainable Development Goal target in reducing the Maternal Mortality Rate

Evaluation of effectiveness of locking compression plates in internal fixation of proximal humerus fractures: a prospective study

Introduction: Locking compression plate (LCP) provides significant biological and biomechanical advantages in the management of proximal humerus fracture (PHF) by providing greater stability, vascular preservation, superior healing, and fewer complications. However, the translation of these properties to functional benefits for patients remains to be elucidated. The objective of the study was to evaluate the effectiveness of LCP in internal fixation of PHF in terms of rate of healing and functional outcomes. Method: This prospective study enrolled 30 Proximal Humerus Fracture patients aged >18 years, from both genders, and treated them with LCP. They were followed up regularly for 1 year and assessed clinically and radiologically using Neer’s criteria and Constant-Murray score. Results were analysed using Chi-square test, p≤0.05 indicated statistical significance. Result: With a mean age of 45.20±15.02 y and M:F ratio of 2.3:1, most patients showed right-sided injuries 18(60%) and Neer 4-part injuries 13(43.33%), predominantly due to road traffic accidents 19(60%), with a satisfactory Neer’s score 26(86.67%) and a good Constant-Murray score 16(53.33%).  The mode of injury showed significant association with age (p=0.013) but not with gender (p=0.866). Over follow up, 27(90%) patients maintained humeral head height and 24(80%) patients showed good humeral neck-shaft angle. Radiological union of PHF took 12 weeks in 12(43.33%) of patients with no dislocation in 27(90%) of patients. However, 1(3.3%) patient showed no union. Conclusion: LCP is associated with favorable clinical, functional and radiological outcomes in PHF patients by providing rapid healing and good rigidity, angular stability, and torsional strength

Incidence and outcome of transurethral resection of prostate syndrome at a tertiary care hospital: Incidence and outcome of TURP

Introduction: Monopolar transurethral resection of prostate (M-TURP) is rarely complicated with the dreaded syndrome the TURP syndrome due to absorption of larger amount of non-electrolyte hypo-osmolar irrigation fluid (1.5% glycine), longer duration of surgery and larger amount of tissue resection. This study aims to find out the incidence and perioperative outcome of TURP syndrome after monopolar TURP. Method: This was a cross sectional study of retrospectively collected data during the period of 4 years from June 1st 2018 to 30th May 2022, in Department of Urology of Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal. Ethical approval was obtained from NAMS ethical committee. Microsoft Excel was used for descriptive analysis of the incidence of TURP syndrome, its relation with amount of resected tissue, duration of resection time, and the outcome (need of blood transfusion, length of hospital stay, mortality). Result: Out of 208 cases of monopolar TURP, 8/208(3.8%) had TURP syndrome. Patients with TURP syndrome were age group 70-85 y. Duration of surgery was >60 min was in 5/8(62.5%), resection weight >20 gm 6/8(75%), blood transfusion 1/8(12.5%), and hospital stay >3 days in all 8/8(100%) cases. Mortality was nil in patients with TURP syndrome. Conclusion: The TURP syndrome was observed in 8/208(3.8%) and it was more common in older (>60y) with longer duration (>60 min) of surgery, and larger amount of prostatic tissue (>20gm) resection

Knowledge and practice of sunscreen use among medical students at Patan Academy of Health Sciences, Nepal

Introduction: Sunscreen is essential in preventing skin damage caused by harmful ultraviolet radiation. Regular and appropriate sunscreen application delays photoaging and reduces skin cancer risk. This study aims to assess the general knowledge and practice of sunscreen among medical undergraduates in Nepal. Method: A cross-sectional, descriptive study was conducted among medical students in Nepal, after obtaining ethical approval. The census sampling method was used among all currently enrolled medical students, N=328. Data regarding knowledge and practice of sunscreen were collected through an electronic survey. A descriptive analysis of the number and frequencies was done. The knowledge scoring and chi-square test were done to see the difference in knowledge between male and female students. Result: More than half of the students (52.6%) showed poor knowledge about sunscreen. Among them, female students and those who had completed their dermatology posting had higher knowledge than their counterparts (p=<0.001). Although those who had dermatological posting exhibited good knowledge, still 1/3rd of them needed better knowledge scores only 47% of them applied it every day. When 90% of them applied sunscreen on their face, only 8.5% applied it on all exposed areas, and only 20% used it with the correct timing before sun exposure. Conclusion: This study found that most medical students needed more knowledge about sunscreen, highlighting the need for proper education about sunscreen and its appropriate application among medical students. To better equip future healthcare providers with this education, incorporating a focused education into their curricula could aid in better preparing them

Pattern of coronary artery occlusion in patients undergoing coronary angiography at Birat Medical College Teaching Hospital

Introduction: Coronary artery disease (CAD), is the leading cause of death globally. Among different diagnostic and treatment procedures, coronary angiography is considered the gold standard. Birat Medical College Teaching Hospital (BMCTH) is also providing cardiovascular services to people from eastern Nepal and from the neighboring country India. We aim to analyze the pattern of coronary artery occlusion in patients undergoing coronary angiography. Method: A hospital based observational cross-sectional study was conducted at BMCTH from 10 Sep 2022 to 10 Jan 2023. A total of 220 patients were enrolled by consecutive sampling techniques. Ethical approval was obtained from the Institutional Review Committee of BMCTH.  Data was collected on baseline characteristics, risk factors, clinical presentation and degree of coronary artery occlusion. Collected data was entered in Microsoft Excel and analyzed by Statistical Package for Social Sciences version 23. Frequency, mean, percentage were calculated. Result: Nearly half (49.1%) patients had significant, 6(2.7%) had intermittent CAD and 14(6.4%) had non critical CAD. Three patients (1.4%) had left main coronary artery disease. Left anterior descending artery 66(30%) was the most commonly involved. Single vessel disease was present in most patients 49(22.27%).  Double vessel disease 15(46.8%) and triple vessel disease was more common 14(51.8%) in above 65 y of age. Conclusion: The coronary angiography revealed presence of significant coronary artery disease and multiple vessel involvement with increasing age

Lithium toxicity: A case report

Lithium is a commonly used drug for bipolar disorders and requires therapeutic dose monitoring due to its narrow therapeutic index. Acute lithium toxicity frequently occurs due to intentional intake of an excessive amount or due to its interaction with various medicines and medical conditions which alter its absorption or excretion. It may present primarily with neurological and gastrointestinal symptoms. We report a case of lithium toxicity in a patient with bipolar disorder probably due to dehydration and decreased intake of food and fluids. Frequent monitoring of serum lithium level while maintaining hydration and electrolyte balance successfully treated lithium toxicity. &nbsp

Demographic profile of patient with acute watery diarrhea during monsoon 2022: Patan Hospital, Nepal

Introduction: Diarrhea is the passage of three or more loose or liquid stools per day or more. Acute watery diarrhea is a major public health problem worldwide.  In Nepal, diarrhea is among the top 10 inpatient morbidity. This study’s objective is to monitor demographic characteristics and laboratory findings of stool specimens of diarrhea. Method: This is a cross-sectional descriptive study done at Patan Hospital. Ethical approval was taken from the Ethical committee. Data for Monsoon 2022 (June to September 2022) were collected from the Patan Hospital record system. Cases from within the Lalitpur district were included. Result: Out of 119 cases, 50(42%) were male and 69(58%) were female. The mean age±SD was 33.28±25.38 (p=0.083) with maximum cases observed during June and a peak observed during the fourth week of June. Out of 119, 4(3.3%) were stool culture positive. Two cases of Vibrio cholera, one case of Shigella sonnei, and one case of Salmonella parathypi B were isolated. In the etiological profile, 14 Entamoeba histolytica were isolated. Conclusion: During the outbreak of diarrhea in Monsoon 2022, adults were affected most. The culture of acute watery diarrhea showed two cases of Vibrio cholera

Workplace violence among nurses of a teaching hospital

Introduction: Workplace violence is a significant issue in the health sector with high prevalence. Workplace violence among nurses is an alarming and fundamental human rights issue with its negative impacts on nurses as well as organizational achievement. This study aimed to explore workplace violence among nurses. Method: Cross-sectional study design with a total enumerative sampling technique was used to find out the prevalence of workplace violence among 402 nurses of a teaching hospital in Lalitpur, Nepal. Data was collected by using “Workplace Violence in the Health Sector country case studies research Instruments” from September 2019 to November 2019. Collected data were analyzed based on objectives using Statistical Package for Social Science version 16. Descriptive statistics were used to find out the prevalence, types of violence, perpetrators, and socio-demographic information. Result: The prevalence of workplace violence was 227( among which verbal abuse was 215(94.5%), physical violence 40(17.6%), and sexual harassment 9(4%). Among the perpetrators, 107(40.53%) of workplace violence was done by patients’ relatives, 77(29.16%) by patients, 64(24.24%) by staff, and 16(6.06%) by management. Conclusion: The prevalence of workplace violence is high. Verbal abuse is the dominant type of violence, followed by physical violence and sexual harassment. The main perpetrators of workplace violence were patients’ relatives. Management was also found to be the perpetrator in a small fraction of violence