Introduction: The main blood supply for arm is provided by the brachial artery. It shows variation in branching and termination patterns in some individuals. Variation in brachial artery may cause ...difficulties during various clinical and surgical procedures. The present study aims to find out the prevalence of higher termination of brachial artery in cadavers in the department of anatomy of a medical college.
Methods: A descriptive cross-sectional study was carried out from 10th January 2020 to 20th April 2021 after the ethical approval was taken from the Institutional Review Committee of Nobel Medical College (reference number: IRC-NMCTH 280/2020). The study was done in 58 upper limbs of 29 properly embalmed cadavers. Convenient sampling was done. They were carefully dissected. The level of termination of brachial artery was noted. The length of the brachial artery and the distance between its termination and the intercondylar line of humerus was recorded.
Results: Higher termination of brachial artery was observed in 3 (5.17%) extremities; one (1.72%) at middle third of arm and two (3.45%) at lower third of arm. In 52 (89.66%) extremities, the site of termination was at the level of neck of radius. The brachial artery terminated a few centimeters below its usual site at the level of upper part of shaft of the radius in 3 (5.17%) extremities.
Conclusions: The prevalence of higher termination of brachial artery in cadavers is slightly lower than the studies performed in similar settings. It is not an uncommon finding. It may have impact on clinical and surgical procedures.
Introduction: Foot is a complex segmented structure formed by the articulation of 26 different bones which are held together by multiple ligaments, extrinsic tendons and the intrinsic muscles of the ...feet. The assessment of median longitudinal arch serves as an important reference in determining the degree of pes planus or pes cavus. This study aims to find the prevalence of pes planus among the undergraduate medical students of a medical college.
Methods: A descriptive cross-sectional study was carried out in the first- and second-year undergraduate medical students of a teaching hospital after taking ethical approval from Institutional Review Committee. The study was conducted from 15th November 2019 to 14th November 2020. Eighty-seven participants were involved in study using the random sampling technique. Foot prints were collected from the participants in the A4 size paper after applying ink over plantar surface of the foot. Measurements were done using the Autodesk Autocad software. Statistical Package for the Social Sciences was used. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.
Results: Out of the total subjects, 14 (8.04%) (5.14-10.94 at 95% Confidence Interval) presented with flat foot. Similarly, high arched foot was seen in 29 (16.67%) of subjects whereas normal arched foot was seen in 131 (75.29%) subjects.
Conclusions: From the current study we conclude that the prevalence of pes planus was slightly higher than that compared with the similar studies.
Background: Sciatic nerve, the thickest nerve of our body (around 2cm wide at its origin), leaves the pelvic cavity from the greater sciatic foramina below the piriformis muscle and between the ...greater trochanter of femur and ischial tuberosity. As variations have been reported in the level of division of sciatic nerve into its terminal branches, the current study aims to determine the most common site of division of sciatic nerve in Nepalese population.
Materials and Methods: The current study is a cross-sectional and descriptive study which was carried out in the Department of Anatomy, Nobel Medical College, where twenty-three cadavers were used and both the lower limbs were examined. Depending upon the level of division of the sciatic nerve into its terminal branches, it was categorized into six different groups (A-F).
Results: It was seen that the sciatic nerve had already divided into its terminal branches before its exit into the gluteal regionin 23.91% extremities. The second commonestsite for the termination of sciatic nerve into its terminal branch was found to be at the middle region of the back of the thigh in 19.57% followed by its division in the popliteal fossa in 17.39%.
Conclusion: From the current study we conclude that the level of division of sciatic nerve was variable and it is wise to go for other means to find out the level of termination of sciatic nerve before performing any procedure in that area.
Background The veins in the upper limb are classified as superficial or deep, with deep veins, such as the venae comitantes and axillary vein, coming after the major arteries. The subcutaneous tissue ...contains the superficial veins, which link to the deep veins. These veins include the basilic, cephalic, median cubital, and median antebrachial veins. These superficial veins are clinically significant for phlebotomy, transfusion, and cardiac catheterization, and it joins the median cubital vein at the elbow. It is essential to comprehend the structure and patterns of cubital superficial veins in order to design dialysis access and minimise hazards. Materials and Methods Studying the superficial venous organisation in the cubital fossa of 192 MBBS preclinical sciences students, ages 18 to 24, was a cross-sectional observational study carried out at the Nobel Medical College Teaching Hospital in Nepal. A tourniquet and skin marker/tailor's chalk were used in the study to examine 384 anterior aspects of the arms. Six sets of veins were distinguished from the skin's veins. Tiny veins, cubital wounds, or thick tissue layers disqualified students. Results A study of 192 preclinical sciences students at Nobel Medical College Teaching Hospital in Biratnagar found that type II variant was the most common venous pattern in the cubital fossa region, followed by type I in 24.75%, and the lowest being the type VI pattern in 3.35%. Conclusion It was discovered that the patterns of superficial veins at the cubital fossa did not significantly alter based on the gender or nationality of the individual. Overall, the most common venous pattern was type II, though type I was more frequently seen in female subjects but the difference was statistically insignificant.
Background: The placenta is a uterine organ in pregnancy which facilitates exchange of materials between maternal and fetal circulation. Decreased maternal hemoglobin decreases oxygen supplementation ...to fetus among anemic mothers which may cause low birth weight. The aim of this study was to compare the ratio of placenta to birth weight among anemic and non-anemic mothers.
Materials and Methods: A comparative cross-sectional study was conducted in 82 anemic pregnancies and 203 non-anemic pregnancies in Department of Obstetrics & Gynecology, Nobel Medical College Teaching Hospital, Biratnagar. Participants with haemoglobin concentration lower than 11 g/dl were included in anemic group and 11g/dl or more in non-anemic group. The difference of means of placental weight, birth weight and placenta to birth weight ratio in anemic and non-anemic groups was determined by Student’s t-test.
Results: In anemic group, mean placental weight was 578.78±141.80 g, mean birth weight was 2973.17±680.97 g and mean placenta to birth weight ratio was 0.20±0.05. In non-anemic group, mean placental weight was 575.96±128.88 g, mean birth weight was 3125.91±590.89 g and mean placenta to birth weight ratio was 0.19±0.05. Significant difference was observed in means of placenta to birth ratio in anemic and non-anemic groups (p-value 0.05).
Conclusion: Mean placental weight and mean ratio of placenta to birth weight was higher in pregnant women with anemia than in non-anemic pregnant women and significant difference was observed in means of placenta to birth ratio between anemic and non-anemic groups.
Appendicitis is one of the most common causes of acute abdomen. The clinical presentation of appendicitis and its susceptibility to acute inflammation may be affected by the length and position of ...vermiform appendix. Length and position of appendix are variable. The aim of the study was to find the prevalence of retrocaecal appendix among patients undergoing appendectomy for appendicitis.
A descriptive cross-sectional study was performed in 264 patients undergoing appendectomy in Department of Surgery, Nobel Medical College, Biratnagar, Nepal from 1st May, 2018 to 15th May, 2019. Ethical approval was taken. Simple random sampling was done. The position of appendix was noted before appendectomy. Subgroup analysis was done on the basis of gender and length of appendix recorded in centimeters with a measuring scale immediately after removal of appendix. Data was collected in excel and was analyzed in SPSS version 16.
Prevalence of retrocaecal appendix among patients with appendicitis was 95 (35.98%). Similarly, other positions noted were pelvic in 67 (25.37%), post-ileal in 61 (23.10%), pre-ileal in 11 (4.16%) and subcaecal in 30 (11.36%) individuals. The length of appendix ranged from 1.7 cm to 14.7 cm. The mean length was 8.67±2.44 cm.
The most common position of appendix in patients with appendicitis is retrocaecal position followed by pelvic position in both males and females.
Introduction: Lumbosacral Transitional vertebrae are congenital anomalies of lumbosacral vertebral junction. It may present either as sacralization of fifth lumbar vertebrae or lumbarization of first ...sacral vertebrae. Various secondary pathological spinal conditions such as intervertebral disc herniation and/or degeneration, facet joint arthrosis and spinal canal or foraminal stenosis are associated with the presence of LSTV. The failure in the identification may lead to clinical consequences such as errors in diagnosis of disease and lumbosacral procedures.
Objective: The aim of this study was to determine the prevalence and patterns of LSTV in patients presenting to Department of Radiology of Nobel Medical College Teaching Hospital, Nepal..
Methodology: A descriptive cross-sectional study was conducted in Department of Radiology of Nobel Medical College Teaching Hospital, Nepal.Plain radiographs including Antero-posterior (AP) and Lateral views of lumbosacral spine of 343 patients referred for the scan were analyzed for the presence of lumbosacral vertebrae.
Result: Out of 343 patients, LSTV was found in 61 (17.8%) subjects. Thirty-eight subjects (11.1%) exhibited sacralization and 23 (6.7%) showed lumbarization.Out of total LSTV subjects, type I A was present in 8 (13.1%), type I B in 21 (34.4%), type II A in 10 (16.4%), type II B in 5 (8.2%) , type III A in 6 (9.8%) , type III B in 9 (14.8%) and type IV in 2 (3.3%).
Conclusion: The LSTV is prevalent in almostone-fifth of subjects presenting to department of radiology of Nobel Medical College and Teaching Hospital, Biratnagar for lumbosacral scan.. Sacralization occurs more frequently than lumbarization, both of which alter the morphology of anatomical structures in spine. The presence of anomaly in this region may be related to occurrence of various pathological and clinical conditions.
Introduction: The human face is a symbol of artistic expression and identity, with the orbit being a crucial factor in evaluating facial attractiveness. Various orbital measures, such as ...interpupillary distance, nasal limbus to temporal limbus, inner intercanthal distance, and outer intercanthal distance, are significant in ophthalmology and can help diagnose naso-orbitoethmoid damage, hypertelorism, and traumatic telecanthism. Hence, this study aimed to determine inner and outer canthal distances, mean canthal index values, and compare these values in the Indian and Nepalese MBBS students of Nobel Medical College Teaching Hospital. Methods: A comparative cross-sectional study was conducted among 64 Indian and 128 Nepalese MBBS students aged 18 to 25 years in the Department of Anatomy at Nobel Medical College Teaching Hospital, Biratnagar from April to September 2023. The study used a convenience sample technique and involved measuring the inner canthal distance, outer canthal distance and calculating the canthal index. Results:The overall mean canthal index was 17.93±3.13, the mean outer canthal distance and inner canthal distance were found to be 110.66±12.34 mm and 19.85±4.24 mm respectively. The mean value of the canthal index for Indian and Nepalese students was found to be 18.09±2.99 and 17.85±3.21 respectively. Conclusions: The study found no significant differences in canthal distance or index between Nepalese and Indian students, possibly due to race and geographical habitat pattern similarities.
Background/Objective. Since the start of the pandemic, COVID-19 has been associated with several postinfection complications. Subacute thyroiditis (SAT) is an inflammatory disorder of the thyroid ...that has been reported in the literature following COVID-19 infection. We report a case of SAT following COVID-19 infection. Case Report. A 33-year-old female presented with neck pain two weeks after resolution of COVID-19 infection. Her thyroid function tests together with ultrasonographic pictures were consistent with SAT. She was treated with three rounds of medrol dose pack without relief. She then required oral prednisone 40 mg per day and ibuprofen 800 mg once daily for another several weeks that eventually resulted in improvement of her symptoms. Discussion. SAT most commonly occurs in females during or after viral infection. The usual course of the disease is hyperthyroidism then hypothyroidism followed by resolution. SAT is clinically diagnosed by lab findings of decreased TSH in the setting of negative thyroid-stimulating and thyroid peroxidase antibodies. All these data are consistent with our case. Conclusion. SAT following COVID-19 infection presents with a similar clinical presentation and course as the classic form of SAT, but we should consider the fact that a high-dose corticosteroid treatment might be necessary for such patients.
In 2017, India was home to nearly 20% of maternal and child deaths occurring globally. Accredited social health activists (ASHAs) act as the frontline for health services delivery in India, providing ...a range of reproductive, maternal, newborn, child health, and nutrition (RMNCH&N) services. Empirical evidence on ASHAs' knowledge is limited, yet is a critical determinant of the quality of health services provided. We assessed the determinants of RMNCH&N knowledge among ASHAs and examined the reliability of alternative modalities of survey delivery, including face-to-face and caller attended telephone interviews (phone surveys) in 4 districts of Madhya Pradesh, India. We carried out face-to-face surveys among a random cross-sectional sample of ASHAs (n = 1,552), and administered a follow-up test-retest survey within 2 weeks of the initial survey to a subsample of ASHAs (n = 173). We interviewed a separate sub-sample of ASHAs 2 weeks of the face-to-face interview over the phone (n = 155). Analyses included bivariate analyses, multivariable linear regression, and prevalence and bias adjusted kappa analyses. The average ASHA knowledge score was 64% and ranged across sub-domains from 71% for essential newborn care, 71% for WASH/ diarrhea, 64% for infant feeding, 61% for family planning, and 60% for maternal health. Leading determinants of knowledge included geographic location, age <30 years of age, education, experience as an ASHA, completion of seven or more client visits weekly, phone ownership and use as a communication tool for work, as well as the ability to navigate interactive voice response prompts (a measure of digital literacy). Efforts to develop a phone survey tool for measuring knowledge suggest that findings on inter-rater and inter-modal reliability were similar. Reliability was higher for shorter, widely known questions, including those about timing of exclusive breastfeeding or number of tetanus shots during pregnancy. Questions with lower reliability included those on sensitive topics such as family planning; questions with multiple response options; or which were difficult for the enumerator to convey. Overall results highlight important gaps in the knowledge of ASHAs. Findings on the reliability of phone surveys led to the development of a tool, which can be widely used for the routine, low cost measurement of ASHA RMNCH&N knowledge in India.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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