Nepal Medical Journal

Incidence, Aetiology and Pattern of Maxillofacial Injuries in a Tertiary Trauma Hospital, Nepal: A 5-year Retrospective Study

Mahendra Maharjan — 2023-12-31

Introduction: The aim of the present study was to evaluate the incidence, aetiology and patterns of maxillofacial injuries in a tertiary trauma hospital in Nepal.

Methods: A retrospective analysis of all the maxillofacial trauma patients operated at the Department of Plastic, Cosmetic and Maxillofacial Surgery, B and B Hospital, Lalitpur, Nepal between 1st March, 2015 and 31st December, 2020 was performed. Data were collected for each patient in regards to age, gender, cause and nature and type of the injury and the treatment provided.

Results: Among 409 patients operated in this period for maxillofacial injuries, 83% (n=356) were male and 17% (n=73) were female. Patients in the second and third decade of life were found to be more prone to sustain maxillofacial injuries. Road traffic accident was the most frequent cause (n=331; 77%) followed by physical assault (n=46; 10.7%) and falls (n=42; 9.7%). Mandible was the most commonly fractured bone (n=125; 26.5%). Fracture of parasymphysis, combined symphysis and condyle fracture and parasymphysis and angle fracture were the most common patterns of mandible fracture.

Conclusions: The major cause of maxillofacial injuries among patients operated in our hospital was road traffic accident which directly reflects the poor traffic system and improperly planned roads.

Prevalence of Knee Pain Pathologies Diagnosed By Musculoskeletal Ultrasound In Nepal Police Hospital

Archana Yadav — 2023-12-31

Introduction: One of the most frequent cause of orthopedic consultancy in Nepal Police Hospital is acute and chronic knee pain. The purpose of this study was to demonstrate how musculoskeletal ultrasonography aids in the low-cost identification of knee diseases and using ultrasound to compare with the contra lateral knee can be quite beneficial when developing a treatment plan.

Methods: A cross sectional study was conducted on 260 patients with clinically confirmed knee pain. All patients were examined by using Sonasite ultrasound machine with linear probe (7-11MHz). The ultrasound examination of the knee started with examination of anterior aspect, followed by medial aspect, lateral aspect in supine position and then in prone position for examination of posterior aspects. The data were collected, tabulated and statistically analyzed using SPSS11.1. Categorical variables were presented in number and percentage, and continuous variables were presented as mean ± SD.

Results: In our study, among the 260 cases there were 164 male patients (63.07%) and 96 females (36.93%) with their age ranged between 25-55 years with the mean age of 40 years. Among 260 cases, 103 patients (39.61%) with knee pain had normal finding and 157 patients (60.39%) had knee pathologies. We found joint effusion (8.91%), quadriceps tendinopathy (3.82%), patellar tendinopathy (1.91%), medial meniscal tear (11.46%), lateral meniscal tear (4.45%), synovial hyperplasia (5.73%), medial collateral ligament tear (10.82%), lateral collateral ligament tear (7%), baker,s cyst(2.54%) and osteophytes(43.31%).

Conclusions: An efficient imaging technique that may be used as a screening tool for individuals experiencing knee pain is musculoskeletal ultrasound.

Preference of Chalkboard or PowerPoint Teaching as a Teaching Tool in Undergraduate MBBS students in Anatomy: A Comparative Study

Ashwini Gupta — 2023-12-31

Introduction: Traditional chalkboard lectures and modern PowerPoint presentations are integral components of medical education, each possessing distinct attributes and advantages. The primary objective is to ascertain whether students exhibit a preference for one method over the other in terms of facilitating better understanding and ensuring long-term retention. This study investigates the preferences of 2nd and 3rd-year Bachelor of Medicine, Bachelor of Surgery students at B.P. Koirala Institute of Health Sciences, Dharan, Nepal, regarding the teaching methods employed in anatomy classes.

Methods: The study was conducted in the Department of Human Anatomy of B.P. Koirala Institute of Health Sciences as a part of coursework. The research duration extended from April 21st to May 18th, 2019. Ethical clearance was obtained, and data collection utilized a pre-validated questionnaire, employing simple random sampling with an expected size of 120 among the 150 students. Statistical analysis was performed using Statistical Package for the Social Sciences version 11.5.

Results: The study revealed varied student preferences for chalkboard and PowerPoint teaching methods. PowerPoint was favored for structured lectures, content clarity, and visual aids, while chalkboards were preferred for natural pauses, facilitating note-taking, and promoting long-term retention. Advantages cited included simplicity, interest stimulation, and ease of notetaking or diagram creation.

Conclusions: The analysis of data led to the conclusion that both methods have unique merits in anatomy teaching. PowerPoint excels in clarity, organization, and visual aids, while chalkboards shine in student engagement, note-taking, and lecture continuity. A holistic, integrative approach that harnesses the strengths of both methods is recommended for optimal understanding and effectiveness in teaching anatomy.

Common Health problems and Satisfaction of Health Services among Elderly in Nepal

Saraswati Basnet — 2023-12-31

Introduction: Every country in the world is seeing an increase in the number and proportion of elderly people. Aging is on pace to be one of the most major societal changes of the twenty-first century which affects all sectors of society. The aim of the study was to assess factors affecting the utilization of health services among the elderly of Koshi Province, Nepal.

Methods: A quantitative descriptive cross-sectional study was conducted among 357 elderly. A multistage sampling technique was used for the selection of eight municipalities and wards for obtaining a representative sample from each ward. A semi structured interview schedule was used for data collection procedure. Descriptive statistics and inferential statistics were used after the normality test to measure the association of selected variables and utilization of health services.

Results: The study finding revealed that more than two-third (70.3%) of the respondents was young old age. More than half of the respondents were female. Less than half (44.0%) of the respondents were hypertensive. Less than one-thirds (27.1%) and (16.8%) of the respondents had hypertensive in urban and rural respectively. More than half (57.4%) of the elderly people were neutral (satisfactory satisfied) whereas one-tenth (8.7%) of the elderly were highly satisfaction.

Conclusions: The study concludes that two-thirds of the elderly were satisfied with health care services facilities. Although one-thirds of elderly were still not satisfied with the health care facility; so enhance to provide quality service to elderly is essential.

The Incidence of Cerebral Edema in Pediatric Diabetic Ketoacidosis

Dikshya Pant — 2023-12-31

Introduction: Cerebral edema is an uncommon but devastating consequence of diabetic ketoacidosis occurring more in children than adults. Younger children and those with newly diagnosed diabetes are at highest risk. The objective of this study is to determine the frequency of cerebral edema in pediatric diabetic ketoacidosis at Children’s Hospital, Lahore in children with type 1 diabetes mellitus.

Methods: This descriptive study was carried out in the pediatric intensive care units and medical wards of the Children’s Hospital and the institute of Child Health, Lahore from 2nd Feb 2016 to 2nd Aug 2016. A total of 150 patients fulfilling the inclusion criteria were enrolled. After taking consent from parents, demographic information including name, age, sex, address, and date of admission were recorded. Fundoscopic findings were recorded before initiating diabetic ketoacidosis treatment and neurological examination was conducted at presentation. Cerebral edema was labeled as per operational definition and sampling was done as per hospital DKA management protocol.

Results: In our study, out of 150 cases, 58.67%(n=88) were between 1-7 years of age while 41.33%(n=62) were between 8-14 years of age, mean + sd was calculated as 6.92+3.12 years, 51.33%(n=77) were male and 48.67%(n=73) were females. Frequency of cerebral edema in pediatric diabetic ketoacidosis at children’s hospital Lahore in the child with type 1 diabetes mellitus was calculated in 18.67%(n=28) while 81.33%(n=122) had no findings of cerebral edema.

Conclusions: Frequency of cerebral edema is high in pediatric diabetic ketoacidosis at Children’s Hospital Lahore in the child with type 1 diabetes mellitus.

High-Grade Chondrosarcoma of Mandibular Molar Region- A Case Report and Review of Literature

Mala Kamboj — 2023-12-31

Chondrosarcomas are malignant tumors of cartilaginous origin with only 5-10% reported in the head and neck region. Intraorally it has higher incidence of occurrence in anterior maxilla followed by posterior mandible. The 5-year survival and metastases rates are adversely affected by the grade of tumor, which necessitates its early diagnosis. Histopathology and immunohistochemistry are vital for its accurate diagnosis. Chondrosarcomas being radio-and chemoresistant are treated surgically although adjuvant radiotherapy helps in prevention of local recurrences. A case of high-grade chondrosarcoma of the mandibular molar region is presented, along with pertinent review of literature.

Variations in the Branching Pattern of Facial Nerve

Santosh Kumar Nirala — 2023-12-31

The seventh cranial nerve, known as the facial nerve, is situated in the head and neck region and governs the mimic muscles responsible for facial expressions. The anatomy of the facial nerve exhibits variations, a matter of particular interest for surgeons operating in the head and neck areas. Incidents of facial nerve injury during such surgeries are frequent and can significantly impact the patient’s quality of life, potentially leading to facial nerve paralysis. The facial nerve’s main trunk emerges from the stylomastoid foramen which passes through the parotid gland, and divides into upper (temporofacial) and lower (cervicofacial) divisions which further gives rise to five terminal branches: temporal, zygomatic, buccal, marginal mandibular, and cervical. A comprehensive understanding of the branching and anastomosis patterns of the facial nerve is of significant importance for the surgeons to avoid inadvertent injury to the facia nerve which has devastating effects.

Marginal Mandibular Branch of Facial Nerve - A Literature review

Santosh Kumar Nirala — 2023-12-31

The Marginal Mandibular Nerve, a branch of the seventh cranial nerve (facial nerve), exhibits notable variability in its branching and course. Incorrect identification of the nerve and its branches poses a risk of injury during head and neck surgeries. The muscles supplied by the Marginal Mandibular Nerve are essential for maintaining facial symmetry. Preserving the functional integrity of the MMN is challenging during head and neck surgeries, and inadvertent injury to it can have significant consequences. Such an injury has the potential to distort facial expressions, underscoring the importance of careful consideration and preservation of the nerve during surgery. Therefore, meticulous attention to the anatomy of the Marginal Mandibular Nerve is crucial to minimize the potential for harm during surgical procedures in the head and neck region