the Cardio-respiratory Fitness in Medical Students by Queen’s College Step Test: A Cross-sectional Study

Introduction: Cardio-respiratory fitness indicates the ability of circulatory system to supply oxygen toworking muscles during continuous physical activity. Maximum oxygen uptake (VO2max) is a single bestmeasure of cardio-respiratory fitness and is considered gold standard to quantify aerobic capacity. Methods:Eighty students of age group 18-25 years were taken by simple random sampling. VO2max was estimatedindirectly by following the protocol of Queen’s College Step Test (QCST) method. Results: Mean value ofVO2max for male (51.61±6.26 ml/Kg/min) and female (36.02±3.71 ml/Kg/min) was compared, which wasfound significantly higher in males than in females (p<0.001). There was negative correlation of gender(r = -0.838), body mass index (BMI) (r = -0.339), obesity category (r = -0.275), obese vs non-obese (r =-0.264) and basal pulse rate (r = -0.456) with VO2max and positive correlation of height (r = 0.592) and hoursof study(r = 0.309) with VO2max. Conclusion: This study showed that increased BMI is associated withdecreased level of VO2max in young adults. One can improve VO2max by maintaining BMI within normallimits.

Depression and its Associated Risk Factors among Residents of a Geriatric Home in Western Nepal

Introduction: Elderly people suffer from many acute and chronic illnesses and also show higher prevalence of depression. The trend of old age homes is rising in Nepal. The aim of this study was to assess depression in the residents of a geriatric home and compare it to that in the elderly population living in their own homes. Methods: This was an observational cross-sectional study in which residents of a geriatric home above 60 years of age were selected as cases, and those living in their own homes were selected from the local community as a comparison group. Depression was measured with Geriatric Depression Scale (GDS) comprising 30 questions. Chi-square (or Fisher Exact) test was used to compare categorical variables. Results: There were 52 participants in both groups. Thirty-six (69.2%) participants from the study group had depression whereas only 10 (19.2%) from the comparison group had depression. This difference was statistically significant, the odds ratio being 9.45. Conclusion: Depression is significantly high in elderly population living in a geriatric home as compared to those living in their own homes.

Central Retinal Artery Occlusion Associated with Atrial Septal Defect: A Case Report

Introduction: Central retinal artery occlusion (CRAO) is characterized by sudden obstruction of the arterial blood flow in the retinal circulation with consequent ischemic damage to the retina resulting in vision loss. An interesting case of unilateral CRAO associated with atrial septal defect (ASD) in a young female is reported here. Case: A young female presented to emergency department with history of sudden and painless loss of vision in her right eye for one day. Her visual acuity at the time of presentation was perception of light in right eye and 6/6 in left eye. On examination, anterior segments of both the eyes were normal. However, relative afferent pupillary defect was positive in her right eye. On fundus examination, right eye showed pale retina and cherry red spot whereas left eye was unremarkable. Findings were suggestive of right eye CRAO. Ocular massage was done and oral carbonic anhydrase inhibitor was given. Patient was referred to a cardiologist for further evaluation and establishment of the etiology. All tests were within reference limit except a large ASD (secundum type with left to right shunt) with a diameter of 28 mm was revealed on transthoracic echocardiogram. Conclusion: The association between ASD and CRAO is rare. Intracardiac shunts through defect may predispose the disease. Detailed cardiac evaluation is mandatory to rule out possible causes to prevent ocular or systemic embolic events and associated morbidity.

Drug Utilization Pattern by Using WHO Core Prescribing Indicators in Orthopedics and Obstetrics / Gynecology Departments of a Tertiary Care Hospital

Introduction: Drug utilization research is an important tool to facilitate rational use of drugs. In low income countries irrational use of drugs is a common problem like overuse of drugs and inappropriate use of antibiotics, leading to poor treatment outcome and increased burden of treatment. This study was conducted to provide understanding of drug utilization pattern by using WHO Core Prescribing Indicator. Methods: This study was conducted in Orthopedics and Obstetrics / Gynecology departments. Patients visiting these Out Patient Departments with at least one drug on prescription form were included in the study. Further, information related to WHO Core Prescribing Indicators were collected in pre-designed proforma. Results: Average number of drugs prescribed per prescription was 2.6. Means of number of drugs prescribed in Orthopedics and Obstetrics / Gynecology departments were 2.9 and 2.3 respectively (p < 0.001). Drugs prescribed in generic name and from essential drug list was 41.4% and 34.3% respectively. Prescription forms with generic name in Orthopedics department were significantly more compared to Obstetrics / Gynecology department (p = 0.00002). However, there was an increased tendency to prescribe drugs from essential drug list in Obstetrics / Gynecology department compared to Orthopedics department (p < 0.001). Conclusion: Drugs were prescribed by generic name and from essential drug list, but this was not sufficient to meet the ideal values of WHO Core Prescribing Indicator. Therefore, prioritization on prescribing drugs by generic name and from essential drug list by respective departments to achieve the standards of WHO needs to be encouraged.

Hand Index- A Forensic Tool for Sexual Dimorphism

Introduction: Amongst the various parameters of identification, sex is one of the most important elements. Figuring out hand index from measurement of hand dimensions is a convenient way to determine sexual dimorphism. This study aims to find out sexual dimorphism from hand dimensions, obtain cut off points for male and female and check percentage accuracy of sex determination from hand dimensions in Nepalese population. Methods: The data was collected from 400 asymptomatic, healthy working staffs (229 males & 171 females) above 23 years in the department of Forensic Medicine and Toxicology of a tertiary care center of Western Nepal. Measurements of hand length and hand breadth were taken using standard instruments and hand index was calculated therefrom. Results: The mean (+SD) right hand lengths for male and female were found to be 17.87 cm (+0.87) and 16.93cm (+0.58) respectively. The mean (+SD) left hand lengths for male and female were 17.85 cm (+0.86)and 16.97 cm (+0.56)respectively. The average hand breadth for male was 1.00 cm greater for right hand and 0.96 cm greater for left hand as compared to female hand breadth. Differences in length and breadth of hands for both sexes were statistically significant (p<0.001) with no statistically significant difference of hand dimensions in the same sex. Cut off point for right hand index was found to be 42.32 cm and for left hand, 42.30 cm. Conclusion: Hand dimensions and hand index can be reliably used to determine sex in medicolegal cases, especially where isolated hand is obtained.

Trend of Breastfeeding and its Impact on Morbidity in Children in a Tertiary Care Hospital in Kathmandu

Introduction: WHO advocates for exclusive breastfeeding in infants till six months of age. Exclusive breastfeeding has been estimated to reduce 70% of infection related mortality in children. This study aims to elaborate the current trend of breastfeeding and its impact on common infectious morbidities in children. Methods: This study was a prospective longitudinal study done at Kathmandu Medical College Teaching Hospital with a sample size of 103 infants. Detailed proforma including sociodemographic data, breastfeeding related data and morbidities were collected at one and half months of life. The patients were followed up at 6 months of age again and the same proforma was again filled up. Statistical analysis was done with SPSS 20.0 and various associations were elucidated. Results: A total of 103 infants were analyzed. Males were 58 in numbers with mean birth weight of the infants being 3048±537 grams. Breast feeding was initiated within an hour in around 37%. At one and half months of age, 63% reported of exclusive breastfeeding which decreased to 23% at 6 months of age. Breastfeeding for at least 45 days decreased the incidence of Acute Respiratory Infections(ARI), Acute Otitis Media(AOM) and diarrheal diseases although statistically significant difference was found with only ARIs. Conclusion: Prevalence of exclusive breastfeeding is low in the study. The study has also shown that breastfeeding significantly reduces incidence of common infectious morbidities in infants.

Minimal Local Analgesic Dose of Intrathecal Bupivacaine and Ropivacaine in Patients Undergoing Cesarean Section: A Comparative Study

Introduction: Spinal anesthesia is a reasonable option for cesarean section. Bupivacaine and ropivacaine have been used as intrathecal drugs alone or in combination with various opiods. Ropivacaine is considered a valid and safe alternative to bupivacaine for intrathecal anesthesia. This study aims to determine the median effective dose (ED50) of intrathecal bupivacaine and ropivacaine for cesarean section and defines this as the minimum local anesthetic dose (MLAD). Methods: Forty pregnant women undergoing elective cesarean section were allocated and randomized into two groups. The initial dose was 13mg for both ropivacaine and bupivacaine groups and was increased or decreased of 0.3mg, using the up-down sequential allocation technique. Efficacy was accepted if adequate sensory dermatomal anesthesia to pinprick to T6 was attained within 20 minutes after intrathecal injection and required no supplemental epidural injection for procedure until at least 50 minutes after the intrathecal injection of test drugs. The MLAD for both bupivacaine and ropivacaine was calculated with 95% confidence interval using the formula of Dixon and Massey. Comparison of different variables between the groups was done using t-test with significant p value at < 0.05. Results: The two groups were comparable in terms of demographic profile and clinical characteristics. The MLAD of ropivacaine and bupivacaine were 11.63 mg (95% CI, 11.5-12.92) and 10.459 mg (95% CI, 10.12-10.87) respectively. The potency ratio between spinal ropivacaine and bupivacaine was 0.89. Conclusion: Ropivacaine provided clinically surgical anaesthesia of shorter duration without compromising neonatal outcome and can be used as a safe alternative to bupivacaine.

A Comparative Analysis Between RIPASA and Alvarado Scoring Systems for the Diagnosis of Acute Appendicitis- A Nepalese Perspective

Introduction: Various diagnostic criteria have been described for acute appendicitis. For decades the most commonly used one has been Alvarado score. RIPASA scoring system has also been developed for Asian population which has shown highest sensitivity and diagnostic accuracy. This study aimed to compare these two diagnostic criteria in Nepalese population attending a tertiary center. Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination was taken as the gold standard for diagnosis. Statistical analysis was done using McNemar's test as applicable. Results: Ninety nine (90 %) patients had histologically confirmed appendicitis. With the cut-off value greater than 7.5 for RIPASA score; sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 94.5%, 27.27 %, 92.16 %, 37.5 %, 88.18% and 7.84% respectively. With the cut-off value greater than 7 for Alvarado score, sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 71.72%, 72.73 %, 95.95 %, 22.22%, 71.82 %, and 4.05 % respectively. 94.5% of patients were correctly stratified by RIPASA under higher probability group while only 71.8 % were classified by Alvarado (p value= 0.0001). Conclusion: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, this method can be applied in Nepalese setting for the diagnosis of acute appendicitis.

Insomnia, its Prevalence, Associated Factors and Effects on Old Age: A Cross-Sectional Study

Introduction: Insomnia is a common problem among old age population. Almost half of all old age adults report difficulty in initiating and maintaining sleep. The objective of this study was to assess the prevalence of insomnia, its associated factors and effects in old age adults. Methods: This was an observational analytical study where adults above 60 years of age from a ward of a village development committee were included. Data were collected for a period of four months. Insomnia was measured by Athens Insomnia Scale and structured questionnaires were used to assess the effects of insomnia. Descriptive statistics were presented as frequency and percentages. Association between variables was assessed with Chi-square test or Fisher's Exact test as appropriate. Results: There were a total of 55 participants in the study. Insomnia was prevalent in 56.4% (n=31) of the study population. Among the studied socio-demographic variables, presence of medical illness was significantly associated with insomnia. Insomnia was significantly associated with morning headache, irritability, unhappiness, fatigue, lack of concentration, day time sleepiness, avoiding interaction with people, and need of sedative for sleep. Conclusion: Majority of the old age adults suffer from insomnia with night awakenings as the most common symptom. Insomnia significantly affects various aspects of life at an old age.