Janaki Medical College Journal of Medical Science

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https://imsear.searo.who.int/handle/123456789/149790

Executive Editor: Assoc. Prof. Kshitiz Upadhyay-Dhungel

ISSN: 2091-2358 (Online) 2091-2242 (Print)

Frequency: 2 issues a year

Language: English

Official journal of the Janaki Medical College.

Online Peer-reviewed journal

Web site: https://www.nepjol.info/index.php/JMCJMS/index/

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Now showing 1 - 20 of 110

Acardiac Acephalus Twin diagnosed at delivery: A case report
(Janaki Medical College, 2016-11) Jha, R
Abnormal placental vascular anastomoses in monochorionic twins can give rise to a rare congenital anomaly known as Acardiac twin. With the advancement of antenatal care and ultrasonography many such cases are diagnosed early. However, in underdeveloped country like Nepal where early antenatal care coverage rate is low such cases may be diagnosed late. I report one such case of Acardiac acepahalus twin diagnosed during delivery.
Alpha and Beta amylase activity of Fagopyrum esculentum (Buckwheat): A Medicinal Plant
(Janaki Medical College, 2013-03) Prakash, S; Deshwal, S
Background and Objectives: Fagopyrum esculentum, common buckwheat popularly known as mithe fapar is one of the staple food crops of the mountain region. Traditionally, it is used to treat constipation and bowel upsets. It is also used by diabetic in different parts of Nepal and India. Due to its high nutritive and medicinal value, medical scientist and researchers are interested in developing this as pharmaceutical plant. In this regard department of biochemistry, College of Applied Education and Health Sciences, C.C.S. University, Meerut, India is working to analyse the biochemical composition and benefits of this plant. So, as a part of a multidimensional project of analyzing various components and their impact on health and diseases, here we are reporting the amylase activity during germination of seed in Buckwheat (Fagopyrum esculentum) plant. Methodology: Common buckwheat (Fagopyrum esculentum) seeds were taken and germinated in dark at room temperature from 0 hours to 192 hours. Biochemical analysis for total amylase, alpha and beta amylase activities was measured by the standard method designed by Bernfeld (1955). Results: The seeds of buckwheat showed high level of amylolytic activity during different stages of germination. At 0 hours, negligible amylase activity was found. The first amylase activity was found at 24 hours and increases up to 96 hours. After 96 hours the total amylase activity starts decreasing and becomes almost negligible at 192 hours. Alpha and Beta –Amylase activity is reported separately. Conclusion: The amylases from the buckwheat showed different level of enzymatic activity during seed germination. Alpha amylase contributed a larger account to total amylase activity. The activity starts increasing and becomes maximum at 96 hours and starts decreasing and becomes lowest at 192 hours suggesting that alpha amylase plays a important role in starch metabolism in developing as well as geminating seeds which can be used for the drug discovery and treatment of several diseases like diabetes, polycystic ovary syndrome, constipation, bowel upsets, obesity and others.
Always there
(Janaki Medical College, 2017-01) Shankar, PR; Arya, S
Antimicrobial susceptibility test of pathogens isolated from urinary tract infection suspected cases
(Janaki Medical College, 2014-11) Yadav, K; Prakash, S; Serayi, RC; Shilpkar, T; Shrestha, S
Background and objectives: Urinary tract infection (UTI) is associated with multiplication of organisms in urinary tract and is defined by the presence of more than 105 organisms per ml in a midstream sample of urine (MSU). UTI is most commonly acquired bacterial infection in ambulatory and hospitalized populations. E.coli is the most predominant organism to colonise the urethral meatus and perineum before ascending to the bladder. Drug resistance of pathogens is a serious medical problem, because of very fast arise and spread of mutant strains that are insusceptible to medical treatment of UTI. Therefore, this study was carried out to determine the common pathogenic bacteria causing UTI and to determine their antibiotic susceptibility pattern. Material and Methods: Mid stream urine samples of the UTI suspected pateints were collected in the Mid Stream Urine (MSU) samples were collected in the sterile clean dry wide mouthed bottle. Standard protocol was followed to isolate and identify organism which was followed by disc diffusion antibiotic sensitivity tests. Results: A total of 100 samples were collected. Out of 100 samples, 25 samples showed a significant growth E.coli, Citrobacter diversus, Klebsiella pneumoniae, Staphylococcus aureus were isolated. E.coli (84%) was found to be the most prevalent causing UTI. Conclusion: UTI was found more common in female than male and E.coli was found to be main causes of UTI. Ciprofloxacin showed more effective drugs in the treatment of UTI.
Application of Cone-Beam Computed Tomography (CBCT) in diagnosis and evaluation of Supernumerary Teeth
(Janaki Medical College, 2017-08) Sah, Rishikesh Pratap; Dong, Fusheng; Gupta, Rahul
Background and Objectives: The aim of this paper is to describe the application of a newly developed three-dimensional imaging system, Cone-Beam Computed Tomography in the diagnosis and evaluation of supernumerary teeth.Material and Methods: One hundred and eighty-five patients with supernumerary teeth (134 males and 51 females) were included in this study. Patients ranged in age from 6 to 38 years. Supernumerary teeth were detected by clinical examination and conventional radiographs. Moreover, careful investigation for more details was made with the cone beam computed tomography. Supernumerary teeth which were detected with the examinations of the cone beam computed tomography images were analyzed according to the number, location, shape and position.Results: Males were affected more than females in a ratio of 2.6:1. 95 % supernumerary teeth were located in maxilla and 5 % in the mandible. 71.6% of supernumerary teeth were conical in shape. 93.6% supernumerary teeth were impacted and 6.4% were erupted. A total of 198 supernumerary teeth were found to be present in palatal/lingual side and 24 were found on the buccal side. 80.5 % of the patients had one, 18.9 % had two, and 0.5 % had three supernumeraries.Conclusion: Detailed examinations and evaluations of these teeth with Cone-Beam Computed tomography (CBCT) yields accurate 3-dimensional pictures of supernumerary teeth, local dental and bony structures which are very beneficial in terms of proper diagnosis and treatment planning and preventing complications which may occur.
Assessment of the level of knowledge regarding the intramuscular administration of medication among staff nurses
(Janaki Medical College, 2018-01) Ammu; Kumar, Sai Sailesh; Bashetti, Srilatha
Background and Objectives: Intramuscular injection is an everyday procedure which is not without its hazards. Although insuring bodies have pointed out that the lateral thigh is the least unsafe site for an IM injection. The commonly used sites in the adult are gluteal and deltoid muscle. The present study was undertaken to assess the level of knowledge related to intramuscular administration of medication among staff nurses.Material and Methods: 30 samples were selected and descriptive research approach was used in the study. The level of study was assessed using self-administered questionnaire.Results: 46.67 % had inadequate knowledge, 40% had moderate knowledge regarding g the administration of IM injection. Efforts were also made to find the association between the level of knowledge and selected demographic variables. There is significant association between knowledge and educational status and years of clinical experience.Conclusion: The present study assessed the knowledge of staff nurses regarding the administration of intramuscular (IM) medication and tries to find association between the level of knowledge and selected demographic variables. At the nd of the study, the investigators found that there is association between the level of knowledge, age, educational status and year of experience.
The best teacher is the one who does not 'teach'!
(Janaki Medical College, 2017-01) Shankar, PR
Biofilm production in relation to extended spectrum beta-lactamase production and antibiotic resistance among uropathogenic Escherichia coli
(Janaki Medical College, 2017-08) Khatri, Samip; Pant, Narayan Dutt; Neupane, Sanjeev; Bhandari, Suman; Banjara, Megha Raj
Bone marrow smear VS Blood smear in diagnosis of Kala-azar
(Janaki Medical College, 2016-11) Yadav, NP; Das, KD; Yadav, RK
Background and Objectives: Bone marrow specimen is considered as superior to the blood in the laboratory diagnosis of Kala-azar. The main objective of this study is to compare these two methods of diagnosis and determine the usefulness of the diagnostic techniques.Material and Methods: This prospective cross sectional study was conducted at Janakpur Zonal Hospital, Janakpur which was aimed to determine the usefulness of the bone marrow specimen and blood specimen in the laboratory diagnosis of Kala-azar. Bone marrow aspirate and venous blood was collected aseptically from the cases were processed simultaneously. The results of these two cultures were compared. Results: Total 60 cases of Kala-azar were included in the study of which 32 were male and 28 were female. Amastigote form of Leishmania donovani were detected in 56 (93.33%) samples with high titre of parasitemiae and 119 (18%) in the blood sample with low parasitemiae. Sensitivity and Specificity of the test was calculated of the bone marrow sample test have more sensitivity (98%) and specificity (100%) over the sensitivity (90%) and specificity (96%) of blood smear test.Conclusion: Bone marrow specimens were found to be more useful than the blood sample in the laboratory diagnosis of Kala-azar.
Brain drain and practice locations of Nepalese medical students
(Janaki Medical College, 2018-01) Shankar, Pathiyil Ravi
Carbon Monoxide Poisoning due to Gas Water Heater
(Janaki Medical College, 2018-01) Bista, Bidesh; Manandhar, Dhiraj; Mishra, Rupesh; Shrestha, Pradeep; Dhungel, Alok
Background and Objectives: Carbon Monoxide (CO) poisoning is a leading cause of injury and death due to poisoning in many parts of the world. Among numerous sources of CO, the gas water heater can be a potential under looked source causing an accidental Carbon monoxide poisoning. In the perspective of Kathmandu valley, where there are houses with small bathrooms, inadequate ventilation and absent CO detectors, gas water heaters can be extremely dangerous even if it liberates small amount of CO gas. Herein, we present a case of CO poisoning to increase awareness about the gas water heater use and the possible risk of CO poisoning in our community.Presentation of Case: A 34 years old healthy female from Patan, presented with the history of loss of consciousness for 15 minute while taking bath on a gas water heater. There was no spontaneous respiration, no cardiac activity and her body temperature was below normal.Discussion: CO is toxic to all aerobic forms to life. CO binds to hemoglobin 230 times faster than oxygen causing cellular hypoxic damage and death. CO poisoning is not uncommon in our society and many such cases are misdiagnosed for some other illness.Conclusion: Use of the gas water heaters and likelihood of CO poisoning should be notified as a public concern. People need to be aware of these hazards to prevent fatal events and likely death due to exploitation of gas water heaters.
Cardiopulmonary fitness test among Nepalese students
(Janaki Medical College, 2013-03) Hada, S; Amatya, S; Gautam, K
Background and Objectives: Maximum Oxygen uptake (VO2 max) is a good predictor of cardiopulmonary and muscle fitness. Maximum oxygen uptake is defined as the highest rate at which oxygen can be taken up and utilize by body during severe exercise. The present study aims to find out the level of VO2 max using Mc Ardle equation and to compare obtained values from Chatterjee’s equation in Nepalese population. Methodology: Maximum oxygen uptake was determined by using the Queen’s college step-stool of 16.25 inches and popular Mc Ardle equation. Stepping was done for a total duration of 3 minutes at the rate of 24 cycles per minute for males and 22 cycles per minute for females. After completion of the exercise, subjects remained standing while the carotid pulse rate was taken as heart rate. Maximum oxygen uptake was calculated using obtained heart rate. Results: Queen’s college step test (QCT) was used as a submaximal exercise and the estimated VO2 max in boys and girls was 48.8± 7.3 ml/kg/min and 37.4± 2.7 ml/kg/min respectively with Mc Ardle equation and the value was higher when compared with Chatterjee’s equations. The value of VO2 max was observed and found to be less in smokers and sedentary individuals. Conclusion: As the values of VO2 max obtained from different equations are different, this research strongly argues the need of developing a prediction equation specifically for the Nepalese population.
Cardiopulmonary resuscitation: knowledge amongst Nepalese health personnel
(Janaki Medical College, 2016-07) Amatya, M; Gorkhali, B
Background and Objectives: The role of effective basic life support (BLS) and cardiopulmonary resuscitation (CPR) is established. Reports on CPR knowledge assessment in Nepal are few and underline the gross lack of CPR knowledge.Material and Methods: A cross-sectional descriptive study was conducted among residents, students, and teachers in a few Nepalese health institutions. A questionnaire based on BLS guidelines 2010 was used, incorporating total 30 questions.Results: Total 145 complete responses (63 females, 82 males) were obtained and analyzed. Mean and median of correct answers was 18 out of 30 (60%, range 3-26); 9% could identify the correct sequence of action from a given set of 7 CPR steps. By ANOVA, score correlated significantly with the background of person (scores highest 19 in ‘clinical’ group and 18 in ‘dentistry’ to 16.38 in ‘nursing’ and 15.09 in ‘non-clinical’; p=0.000) but not with other variables (sex, age, designation, academic degree, institution, and previous CPR training).Conclusion: Lack in CPR knowledge and awareness are reported worldwide. Findings of this study are similar. Although those with clinical background had better knowledge, poor correlations with other variables indicate lack of importance being given to CPR knowledge and skill by most people, even those working in big health institutions of the country.
Catheterization related urethral injury in periphery due to improper technique
(Janaki Medical College, 2017-01) Pandit, RK; Chaudhary, S; Jha, VK; Sah, N; Thakur, PK
Background and Objectives: Catheterization related urethral injury (CRUI), particularly in men, is common and produces significant morbidity. However, it seems to have gathered little interest of concerned authorities towards prevention. The objective of the study is to reveal that many CRUI are usually due to improper technique.Material and Methods: This is a retrospective and descriptive study carried out at Janaki Medical College & Teaching Hospital, Janakpur between May 2013 and September 2016. It included 18 male patients presenting in emergency with acute CRUI. Re-catheterization was attempted by experienced surgeons in them unless there was history suggestive of urethral stricture and the outcome was analyzed.Results: Mean age of the patients was 62.9 ± 17.7 (range: 22 - 90) years. When the consultant attended them, 8 (44.4%) patients had catheter in place with intraurethral balloon inflation (IUBI), and 10 patients had catheter removed. One patient in each group had scrotal hematoma suggesting urethral perforation. Excluding two patients with typical history suggestive of urethral stricture, manual urethral re-catheterization was attempted by surgeon in 16 patients and succeeded in 12 (75%) patients, which was remarkable. Rest of the 6 patients had suprapubic catheterization.Conclusion: Most of the CRUI results from technical fault and are potentially preventable.
Challenges in conducting small group sessions in pharmacology – a Caribbean perspective
(Janaki Medical College, 2018-12) Shankar, Pathiyil Ravi
Background and Objectives: Offshore Caribbean medical schools (OCMS) face various challenges with regard to learning practical and prescribing skills in pharmacology. These challenges range from short curricular time, low number of faculty, problems with early clinical exposure and geographically separated clinical sites. Materials and Methods: The author highlights these challenges using his personal experience and articles from the published literature. The search terms used were pharmacology, Caribbean, medical students, prescribing skills and medical schools. Results: Among the problems mentioned are lacunae in the teaching-learning of prescribing skills, teaching pharmacology as a discipline during a particular semester, excessive focus preparing students for licensing exams, low number of faculty, shortage of time, challenges with providing early clinical exposure, problems with assessing skills, lack of integration with essential medicines and standard treatment guidelines, among others. Conclusion: There are a number of challenges in teaching pharmacology and therapeutics in OCMS. Most schools concentrate on the theoretical aspects of pharmacology which are tested during the licensing exams.
Challenges of Medical Education in Nepal
(Janaki Medical College, 2013-03) Shankar, PR
Chandra Anuloma Viloma Pranayama modifies Cardiorespiratory Functions
(Janaki Medical College, 2016-07) Prakash, S; Upadhyay-Dhungel, K
Background and Objectives: In recent years, there has been considerable interest in scientific research on yoga, especially on Pranayama. Nostril breathing exercises including Alternate nostril breathing, Left nostril breathing and right nostril breathing exercises is getting attention in the east and in the west. Left nostril breathing exercises is also called Chandra Nadisuddhi Pranayama or Chandra anulomaa vilomaa Pranayama (CAV). Very few have carried out research on Chandra Anuloma Viloma Pranayama (CAV). This study was carried out to see the effects of CAV on experienced yoga practitioners and naïves.Material and Methods: The study consisted of 36 subjects divided into two groups, first group consist of 26 medical students who were naïve and the next group consist of 10 yoga practitioners. All the subjects performed 12 rounds of Chandra Nadisuddhi Pranayama in each session for 24 days. Variables were entered into SPSS Program and were analyzed.Results: This study depicts fall in Pulse rate, respiratory rate, systolic blood pressure and Diastolic blood pressure after CAV Pranayama in both Naïves and Yoga practitioners. But the significant drop was observed in SBP only (at p < 0.05) among Naives and in all parameters except respiratory rate among Yoga Practitioners.Conclusion: The effect of the Chandra Anuloma Viloma (CAV) in this study was more eminent in the yoga practitioners than in the naïve group.
Chitta, The Mind-stuff as a Cognitive Apparatus: Model of mind and process of cognition as in Yogasutra of Patanjali
(Janaki Medical College, 2014-11) Upadhyay-Dhungel, K; Dahal, BK
Background and Objectives: Medical sciences have developed tremendously but yet it has to understand the brain, mind, consciousness and cognition process. In this article, authors have made an attempt to present a process of cognition with a model of mind explained in yoga sutra of Patanjali. Material and Methods: Understanding the mind with the modern scientific tools is often difficult. Here an attempt has been made to understand mind with the help of various literature in yoga especially in yoga sutra of patanjali, a valid text of yoga. Hermeneutical approach, a method used in qualitative method of inquiry is used for this study. Reading, re-reading the texts and finding the meaning out of the text is the process used. Results: A model of mind has been proposed as finding of the study. This model of mind has a ‘chitta’ (Mind stuff) as a cognitive apparatus and important component for cognition. ‘Chitta’ interacts with the external manifested world (Prakriti). ‘Chitta’ has Mana, Buddhi and Ego as Antakahrana (internal organ) and ‘Indriyas’ (Five Gyanendriyas and Five Karmaindriyas) as external organ. This concept of mind and cognition works for the plane of ‘chitta-vritti’ state where vrittis are the external world. But YSP also talks about next plane of cognition which is beyond the scope of this study. Conclusion: A cognitive model explaining the concept of mind forms a major finding of this research. This finding may initiate future researches in the field of understanding the mental processing and acts as links between ancient wisdom of yoga and modern concept on mind and cognition and how they can complement each other. This model of concept of mind can also be used as concept for psychological counseling and psychological therapy.
Chlamydia trachomatis among HIV infected patients using PCR technique
(Janaki Medical College, 2013-12) Shah, Y; Shrestha, A; Adhikari, N; Pant, KP; Khadka, KS; Acharya, B; Pandey, BD
Background and Objectives: Chlamydia trachomatis is a sexually transmitted organism and an important public health problem in the sexually active age group. Limited studies are found regarding the prevalence of Chlamydia trachomatis in Nepal. Moreover, no study in Nepal reports the association of Chlamydia and HIV infection. The current study attempts to determine the burden of Chlamydia on HIV positive patients. Material and Methods: A total of 117 HIV positive patients visiting a HIV clinic in Kathmandu, were screened for Chlamydia infection. For this, Urine samples were collected and analyzed using the Multiplex polymerase chain reaction technique (MPCR) and Agarose gel electrophoresis. DNA isolation was performed using QIAamp DNA and Blood mini kit handbook protocol. Results: C. trachomatis was detected in 4.27% of the total 117 HIV patients. Out of positive cases 60% were males and 40% were females. However, Chlamydia is found more prevalent among females (6.89%) than in males (3.4%). Eighty percent of positive cases were asymptomatic. Conclusion: Chlamydia infection was found less commonly among studied patients and most of those cases were asymptomatic. So there is difficulty in timely detection of C. trachomatis and track the clinical sequel, which might be devastating. Hence, routine checkup is recommended for all suspected cases for timely management of the disease.
Chronic recurrent multifocal osteomyelitis in a 9 year old girl: A Case Report
(Janaki Medical College, 2018-01) Gautam, Samaj; Pradhan, Nabees; Gyawali, Bidur
Background and Objectives: Chronic recurrent mutlifocal osteomyelitis (CRMO) is an extremely rare skeletal disorder in the younger population. It presents with multifocal bony lesions that often mimic more sinister diagnoses such as neoplasm. The cause of this condition remains unknown and there is limited evidence on effective treatment.Presentation of Case: A 9-year-old girl presented to our institution with non-traumatic onset of left leg pain. After failed conservative management, radiographs and MRI were obtained exhibiting a bony lesion of the proximal tibia resembling osteomyelitis. The patient was non-responsive to antibiotics, so corticotomy and drainage was done in which only blood came out of the lesion, no pus was seen. Patient improved dramatically but again she developed similar symptoms and signs on right leg. Biopsy from left leg suggested no significant findings.Discussion: Chronic recurrent multifocal osteomyelitis presents in patients with periodic fevers, bone pain and bone lesions that can develop anywhere in the body. This is a rare disease, which has been found to affect more girls than boys.Conclusion: CRMO should be considered as a differential diagnosis for chronic bone pain with affinity for the long bones of the lower extremity in children and adolescents.

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