Journal of Nepal Health Research Council最新文献

Background: Intraocular pressure measurement is one of the important and commonly performed examination in Ophthalmology. Goldmann applanation tonometer has been gold standard for measurement of Intraocular pressure. Intraocular pressure measurement is known to be affected by Central corneal thickness. It has been stated that thinner cornea leads to false low Intraocular pressure while thicker cornea leads to false high Intraocular pressure interpretations.

Methods: A total of 920 patients of forty and above years with no any anterior segment pathology like corneal diseases, corneal oedema and opacities, uveitis, ocular surgery, ocular trauma or evidence of glaucoma were included. This was cross sectional, descriptive, hospital based study. Ultrasonic pachymeter was used to measure Central corneal thickness and Goldmann applanation tonometer was used to measure Intraocular pressure. A correction factor was applied and corrected Intraocular pressure values were calculated.

Results: The mean Central corneal thickness was 538.70 ± 29.17 µm and Intraocular pressure was 14.72 ± 2.58 mmHg. The mean Central corneal thickness of the females was thinner and mean corrected Intraocular pressure was higher than male. There were statistical significant differences in the mean Central corneal thickness and corrected Intraocular pressure between genders (p= 0.029, p=0.04) respectively. There was a significance difference in mean Central corneal thickness between different age groups (p= <0.001). Corrected Intraocular pressure is negatively correlated with Central corneal thickness (r= - 0.49, p= <0.001). In this study there was a significant association between Central corneal thickness and Intraocular pressure, age, gender and refractive error.

Conclusions: A thick cornea leads to an overestimation of Intraocular pressure while thin cornea leads to an underestimation of Intraocular pressure. We recommend that Intraocular pressure measurement should be associated with a pachymetry correction to avoid inaccurate readings.

Background: Complete edentulism is terminal outcome of tooth loss which itself is multifactorial entity. The periodic comparison of demographic variables in the complete edentulous cases attending dental hospital can give an insight into the status of oral health care, awareness of dental treatment and burden of disease in the community.

Methods: This is a hospital-based study on secondary data of all the cases attending for complete denture therapy from January to December of three years viz. 2012, 2017 and 2022. Proportion of gender, age-specific distribution, geographic residence of patients is presented in percentage. The mean age of patients among three years is compared using One-way ANOVA at 95% confidence interval at level of significance at 0.05.

Results: A data of 830 patients were extracted for analysis. The demographic parameters were obtained and analysed using SPSS 11.5. In all years, male and female patients were almost equal. The number of patients has increased markedly from 2012 to 2017 but plateaued towards 2022. The mean age of patients being edentulous (65.71±10.38 years in 2012, 66.44±8.75 years in 2012 and 66.38±8.83 years in 2022) has not changed significantly (p >0.05) over ten years.

Conclusions: In ten years' time, demand of conventional complete denture has slightly increased, mean age of edentulism remained stagnant and patients from remote hill areas had to visit faraway hospitals for denture therapy. Large scale studies in community are needed to find out the disease burden and determinants of complete edentulism in Nepalese population.

Background: An important anatomical factor in injuries to the inferior alveolar nerve is the spatial relationship between the mandibular canal and the corresponding third molars. This study was designed to classify the anatomic three-dimensional relationship between mandibular third molars and the mandibular canal on cone-beam computed tomography mages.

Methods: A cross-sectional study was conducted by using CBCT images of 100 individuals visiting the Dental Outpatient Department of X hospital from Jan 2022 - Oct 2022. The images were used to classify the threedimensional relationship between the mandibular canal relative to the roots of the mandibular third molar according to Liqun Gu et al 2018 classification. In this classification, four anatomical positions were considered: buccal, lingual, apical and inter-radicular. The second factor considered was the contact and non-contact relationship between the inferior alveolar nerve canal and the mandibular nerve. The data was analyzed via SPSS version 20. Chi square test was performed to determine the contact relationship of the mandibular third molar root with the mandibular canal.

Results: Most of the mandibular canals observed via CBCT (45.0%) were located on the buccal side of the mandibular third molar followed by the apical side (26.0%), between the roots (23.0%) and very few (6.0%) on the lingual side. A significant association was found between the position of the mandibular third molar and the mandibular canal (p<0.001) when the position was lingual and interradicular.

Conclusions: The findings of this study revealed that the majority of mandibular third molars were located on the buccal side. There was a significant relationship between the position of the mandibular third molar and the mandibular canal.

Background: To evaluate clinical characteristics and visual outcome of Vogt-Koyanagi-Harada disease patients in Nepal.

Methods: Retrospective series of all the cases of VKH treated at Tilganga Institute of Ophthalmology from 1st July 2017 to 31st June 2022.

Results: Fifty-four cases were included, 18(33.33%) were male and 36 (66.67%) were female. Mean age was 41.47±15.57 years and median age was 38 years. All cases were bilateral. Two patients had a complete presentation (3.7%), thirty an incomplete presentation (55.5%) and twenty-two had a possible syndrome (40.7%). Fortysix (85. 1%) patients presented at acute uveitic stage and eight (14.8%) presented at chronic recurrent stage. The most common extraocular finding in our patient population was headache (59.2%). Posterior segment findings included exudative retinal detachment in 40(74%), disc edema in 33(61.1%) and sunset glow fundus in 3(5.5%).

Conclusions: Bilateral panuveitis is the most common ocular manifestation of VKH and majority of eyes present with exudative retinal detachment. Oral prednisone with or without immunomodulatory therapy was the primary treatment.

Background: Hepatic encephalopathy presents a significant clinical challenge in individuals with advanced liver dysfunction, manifesting as confusion, altered consciousness, and personality changes. This study aimed to compare the efficacy of lactulose and polyethylene glycol in managing Hepatic encephalopathy.

Methods: The study is conducted at Tribhuvan University Teaching Hospital in Nepal; the study enrolled 45 cirrhotic patients with altered mental status in each study group. Ethical approval and informed consent were obtained. The basic demographic and clinical data were collected, including laboratory investigation and precipitating factors for Hepatic encephalopathy. The severity of Hepatic encephalopathy was assessed using the West Haven Criteria.

Results: In this study there was significant difference between two groups in terms of mean time taken for complete resolution of hepatic encephalopathy, with mean of 2.98 ± 2.129 days in Polyethylene Glycol group compared to mean of 4.67 ± 3.076 days in Lactulose group, with a significant p-value of 0.004. There was also significant difference in length of hospital stay between two groups, with a mean hospital stay of 6.36 ± 3.654 days in Polyethylene Glycol group compared to 9.70 ±5.388 days in Lactulose group, with a significant p-value of 0.001.

Conclusions: In conclusion, polyethylene glycol showed promising results in the treatment of Hepatic encephalopathy compared to lactulose polyethylene glycol. demonstrated an improvement and quicker resolution of Hepatic encephalopathy symptoms, highlighting its potential as a cost effective and safe alternative for managing Hepatic encephalopathy in cirrhotic patients. Keywoards: Hepatic encephalopathy; lactulose; polyethylene glycol.

 Background : Efficient evaluation of research proposals is crucial for ensuring ethical standards and scientific rigor in healthcare. This study aims to analyze the proposals submitted to the Institutional Review Committee (IRC) of the Institute of Medicine (IOM) to determine the trends in health-related research conducted in a major institute.  Methods: This is a retrospective review of research proposals submitted to the IRC of IOM from May 2019 to April 2021. The analysis focused on the institutional/departmental affiliation of investigators, gender of the principal investigator (PI), funding sources, ethical issues, types of proposals, and research design. Results: Out of 769 proposals submitted, seven were rejected (acceptance rate of 99.1%). There was a steady increase in the number of submissions over the study period. Descriptive cross-sectional studies were the most frequent 630 (82.6%) followed by randomized controlled trials. More than half [403, 52.9%] proposals were related to health promotion.  The clinical departments contributed 443 (58.1%) submissions. Males outnumbered females (54.2% vs 45.8%) and only 53 (7.0%) were funded.   Conclusions: Cross-sectional studies with a focus on health promotion were the most common submissions for ethical approval at the IOM. Policymakers in our institute and other institutions can use this research to set priorities for promoting research. Keywords: Ethical review, Institutional Review Board, Researchers, research proposal.

Background: While dentistry in the past focused primarily on prevention and treatment of dental diseases, modern dentistry has evolved to place greater emphasis on appearance of teeth, gums, and the overall smile. Since gingival pigmentation significantly impacts a patient's aesthetics, it has recently become a prominent topic of interest. Objective was to determine the prevalence of gingival pigmentation among Nepalese people in terms of its extent and distribution and to correlate it with age, gender, and gingival biotype.

Methods: This cross-sectional analytical study was conducted on Nepalese patients who visited the 'Department of Periodontology and Oral Implantology' at Dhulikhel Hospital from June 20, 2024 to September 20, 2024 after obtaining ethical approval. Data was collected via convenience sampling, and intraoral examinations focused on gingival biotype and pigmentation in the anterior labial region, a key aesthetic area. The data was entered into MS EXCEL and analyzed using the latest version of SPSS.

Results: Total 380 patients were examined in this study, including 173 (45.5%) males and 207(54.5%) females. Most had pigmentation in the attached gingiva followed by interdental papillae. There was a statistically significant relationship (p<0.05) between gingival pigmentation and the patient' age, as well as between gingival pigmentation and gingival biotype (p<0.05) However, there was no significant relationship (p=0.59) between gingival pigmentation and the patient's gender.

Conclusions: Knowledge regarding the distribution and extent of gingival pigmentation will be a valuable asset for clinicians during various depigmentation procedures, to choose the most appropriate technique for a particular type of gingival pigmentation.

Background: School nurses play a crucial role in promoting health and well-being among students. In Nepal, the school nursing program in public school started since five years and there is a need for a study on their job satisfaction. Therefore, this study aims to investigate the job satisfaction and its determinants among school nurses in Nepal.

Methods: A descriptive cross-sectional study was conducted among 1011 school nurses working in public schools from all provinces in Nepal. The study utilized Paula L. Stamp's modified Index of Work Satisfaction, assessing six domains: pay, autonomy, task requirements, organizational policy, professional status, and interaction. Data were collected through a questionnaire distributed electronically; bivariate and multivariate logistic regression were used to find out determinants.

Results: All school nurses were approached, but only 545 (53.9%) participated. Among them 51.7% expressed overall job satisfaction. Among the six domains, the highest job satisfaction was observed in the professional status (85.3%), interaction (72.8%), and task (61.8%) component while the lowest was in the pay (3.7%) component. Logistic regression revealed the significant determinants were working solely as school nurse (0.001), bachelor and above academic qualification (0.031) and family type p= absent in bot "working solely as school nurse (0.001), bachelor and above academic qualification (0.031).

Conclusions: School nurses with minimum bachelor degree, has better job satisfactions. Similarly, the program implementer needs attention to enhance pay for school nurses and allow autonomy in workplace to increase job satisfaction.

This review discusses the prevalence of these unethical behaviours, their far-reaching consequences on patient care, and the Orthopaedic field's credibility. It highlights the need for effective strategies to promote ethical standards, emphasizing the importance of awareness among researchers and clinicians. The article outlines specific unethical practices, including data manipulation, which distorts treatment efficacy, and plagiarism, which diminishes originality and wastes peer review resources. Additionally, it addresses biased reporting and conflicts of interest, which can compromise objectivity in research findings. The review advocates for collaborative efforts among institutions and journals to foster accountability and transparency, ultimately encouraging a culture of ethical conduct within the Orthopaedic community. By ensuring rigorous standards and practices, the future of Orthopaedic research can be aligned with patient safety and trust, propelling the field toward meaningful advancements in patient care and treatment outcomes. Keywords: Conflict of interest; data fabrication; ethics; plagiarism; research; research Integrity.

Background: The advent of minimally invasive techniques has revolutionized liver surgery, with improvement in postoperative outcomes while maintaining oncological efficacy. Achieving tumor-negative resection margins remains critical for optimal oncological outcomes. Considering the adversity of tactile feedback in minimally invasive surgery complicating margin assessment, this study evaluated the efficacy of near-infrared indocyanine green fluorescence imaging in real-time surgical margin delineation during the hepatic resection.

Methods: This is a single-centered, prospective, descriptive study conducted between 15th March 2022 and 15th March 2024 as per the revised STROBE guidelines. Patients were enrolled by convenient sampling and received 0.5 mg/kg of indocyanine green one day before surgery intravenously. During surgery, near infrared-indocyanine green imaging was recorded and utilized to assess the surgical margins along with the white light as well. The findings were compared and confirmed with the final histopathology report.

Results: A total number of 21 patients were included in this study who underwent laparoscopic liver resection. Majority of cases were of colorectal liver metastasis (90%), and most of them were located at segment 4 (80%). Participants had a normal preoperative liver status with a median tumor size of 28 mm and a median number of 1.2. Indocyanine green fluorescence successfully delineated resection margins in all cases, and final histopathological assessment confirmed R0 resection status. No adverse reactions to the indocyanine green were reported.

Conclusions: Near infrared-indocyanine green provided significant benefit regarding R0 resection in all cases confirmed with histopathology results for the intra-operative identification and demarcation of margins during laparoscopic hepatic resection.