Birat Journal of Health Sciences

Impact of Educational Intervention on Cervical Cancer and HPV Vaccine Knowledge, Attitudes, and Acceptance among First-Year Medical Students of Birat Medical College

Parth Guragain — 2024-04-28

Introduction: Cervical cancer poses a significant health burden, particularly in developing nations, with notable incidence and mortality rates. However, there exists a notable gap in understanding the knowledge, attitudes, and acceptance surrounding cervical cancer and the Human Papillomavirus (HPV) Vaccine. This study aims to evaluate the current awareness, attitudes, and acceptance levels of HPV Vaccine among first-year medical students, alongside assessing the effectiveness of an educational intervention on these aspects.

Objectives: To evaluate current knowledge, attitude and acceptance of cervical cancer and HPV Vaccine and evaluate the impact of educational intervention.

Methodology: 2 An analytical cross-sectional study was conducted among 96 first-year medical students at a medical college in Nepal from December 24, 2023, to February 28, 2024, after receiving Ethical Approval. Total enumeration sampling technique was applied, and a structured self- administered questionnaire, validated for data collection, was employed. Data were collected at baseline and after an educational intervention class to assess the impact on the knowledge, attitude, and acceptance toward cervical cancer and the HPV Vaccine.

Result: Pre-intervention scores (mean=5.90, SD=1.73) significantly increased after the intervention (mean=11.65, SD=1.44) with p<0.001, indicating a 97.46% increase. Willingness to receive HPV vaccination increased from 47.9% to 88.5%, and willingness to recommend vaccination increased from 88.54% to 96.88%. No significant differences were found in vaccination willingness.

Conclusion: Educational interventions significantly enhanced medical students' willingness to receive and recommend HPV vaccination, suggesting potential for future healthcare provider influence on vaccination behaviors.

Stress Among Undergraduate Medical Students in a Medical College of Nepal

Ajita Paudel — 2024-04-28

Introduction: Medical education imposes significant stress on students, affecting their psychosocial well- being and academic performance. However, the stressor and its impact vary from person to person.

Objectives: To assess stress level and its association with years of medical education.

Methodology: This was a cross-sectional study conducted in medical students at Birat Medical College Teaching Hospital. Demographic and academic details were collected using semi-structured proforma. The Medical Student Stressor Questionnaire was used to assess Academic Related Stressor (ARS), Intrapersonal and Interpersonal related stressor (IRS), Teaching and Learning Related Stressor (TLRS), Social Related Stressor (SRS), Drive and Desire Related Stressor (DRS) and Group Activities Related Stressor (GARS).

Results: A total of 324 students were enrolled in the study out of which 181(55.86%) were males and 143 (44.14%) were females. The age of the participants ranged from 18 to 27 years (Mean = 22.05 years, SD = 1.8). Majority of participants were from first year (29%) followed by second year (21.6%). About 47% of the participants had high level of ARS, 63.27% participants had moderate level IRS, 51.23% participants had moderate level TLRS, 56.79% participants had moderate level SRS, 46.9% participants had moderate level DRS whereas 42.28% participants 3 had mild level of DRS. Significant association was found among different domains of stressors and years of medical education.

Conclusion: Results from our study showed that all the students had some form of stress ranging from mild to severe. This emphasizes on providing mental health support to medical students.

Study of impact of assessment of estrogen receptor, progesterone receptor, Her2 neu receptor and Ki-67 at diagnosis in management of breast cancer patient at Birat Medical College Teaching Hospital (BMCTH)

Shivraj Sharma — 2024-04-28

Introduction: Breast cancer is the most common cancer in Nepal. Treatment of breast cancer includes combined therapy based on hormonal receptors within breast tissue and is linked to prognosis and survival.

Objective: To evaluate hormonal factors preoperatively and assess the impact of how it would change the management practices of treating breast cancer in our setup.

Methodology: This descriptive prospective study was conducted from March to October 2023 in the department of surgical oncology BMCTH in patients with breast mass suggestive of carcinoma meeting inclusion criteria and willing for treatment. Patients demographic data, detailed history and clinical examination was done at the time of diagnosis entered in excel sheet and calculation done by SPSS. Ethical clearance was taken from the institutional review committee of BMCTH (Ref: IRC-PA-296/2023 ).

Results: In 80 female patients with mean age 46.15 years, Left breast cancer (60%) was more common than right side (40 %). Most common site of presentation was the upper outer quadrant (UOQ- 47.%). Invasive ductal carcinoma was the commonest type (47.5%) of all histological variants. 67.5% patients had ER positive receptor, 67.5% had PR positive and 2 Her2 neu was present in 28.7 %. TNBC reported 18.75% (15 patients out of 80 patients). Ki- 67 prognostic value ranged from 10 to 70 with mean 29.91+-20.795%. Among all 36.3% underwent neoadjuvant chemotherapy prior to surgery and 63.7% underwent upfront surgery for breast cancer.

Conclusion: Screening of Triple negative and luminal type B breast cancers preoperatively is essential. Evaluation of hormonal factors ER, PR, Her 2 neu and Ki-67 preoperatively is must as it changes the management practices of treating breast cancer.

Clinical and Epidemiological Profile of Otorhinolaryngology Diseases at a Tertiary Hospital in Morang District: A Descriptive Cross-Sectional Study

Shiva Bhushan Pandit — 2024-04-28

Introduction: Otorhinolaryngology, dealing with disorders of the ears, nose, throat, and related structures, poses significant health challenges. However, there is a dearth of extensive clinical and epidemiological data on these ailments in the specific geographic area under study. Understanding the characteristics of otorhinolaryngology diseases is crucial for effective healthcare planning and resource allocation.

Objective: This study aimed to determine the clinical and epidemiological profile of otorhinolaryngology diseases at a tertiary hospital in Morang District, Nepal.

Methodology: An observational descriptive cross-sectional study was conducted at the Otorhinolaryngology department of a tertiary hospital in eastern Nepal from January 15 to February 15, 2024. Data from 600 patients presenting at the department over one month were meticulously analyzed.

Results: The median age of patients was 28 years, with the most prevalent age group being 21- 30 years (23%). A majority (56%) were male, and belonged to the Brahmin/Chhetri caste (44.3%). Most patients (85%) initially visited the hospital through OPD, with ear-related issues (35.2%) being the most common complaint. Epistaxis (10.3%) was the most frequent diagnosis, followed by allergic rhinitis (9%) and ear wax issues (8.2%). The prevalence of carcinoma was 12(2%). The majority (77.3%) underwent medical treatment. Outpatient admissions were observed in 68(13.3%) of cases, with emergency admissions accounting for 42(62.6%).

Conclusion: Epistaxis, allergic rhinitis, and ear wax problems were commonly encountered. Most patients underwent medical treatment, with only a minority requiring hospital admission, primarily through outpatient services.

Outcomes of Titanium Elastic Nails (TENS) for Unstable Femoral Shaft Fracture Among children aged 6-13 years in Nepal: A Prospective Study

Rajan Panthee — 2024-04-28

Introduction: Because of the innate fracture healing capacity in pediatric age group Titanium Elastic Nailing System (TENS) is an ideal stabilization method for diaphyseal femur fractures, especially in length stable fractures (transverse and short oblique) owing to its load sharing properties and minimum complications. However, the outcome of TENS in axially unstable pediatric femoral diaphyseal fractures (long oblique, spiral and comminuted) is not uniform and is still debated.

Objectives: Analysis of radiological and functional outcomes of length unstable pediatric femoral fractures treated with titanium elastic nails (TENS) in the age group of 6–13 years.

Methodology: A prospective study of 42 unstable pediatric femoral fractures treated with TENS from November 2022 to October 2023 at Birat Medical College Teaching Hospital, Biratnagar, Nepal was conducted and analyzed with functional and radiological outcomes. Results: As per Flynn's criteria 37 patients (88.1%) had excellent results, 4 patients (9.5%) had successful results, and 1patient (2.3%) had poor result. The mean time to full weight bearing after radiological fracture union was 8.1 weeks.

Conclusion: Closed reduction and TENS fixation is an effective surgical procedure even for length unstable femoral diaphyseal fractures in children if appropriate surgical techniques and post-surgical care are followed.

Ultrasonographic Evaluation of the Effect of Patient Position on Size of Subclavian Vein: An Observational, Prospective Study

Deepak Poudel — 2024-04-28

Introduction: The use of real time ultrasound guided cannulation of the subclavian vein is increasing in critically ill and surgical patient population. The larger diameter of the veinduringcannulationhelps to reduce the frequency of associated complications.

Objectives: To compare change in the diameter of the subclavian vein in 15° head down and 15° head up position with that of the supine position.

Methodology: A prospective observational study was conducted among the patients visiting Department of Anesthesia and Critical Care in Birat Medical College Teaching Hospital for elective surgery from April 2023 to January 2024.

Results: The diameter of subclavian vein increased by 18.38±9.1% in head down (Trendelenburg) position and decreased by 15.8±9.8 % in head up position compared to supine position when evaluated by real time ultrasound.

Conclusion: The head down (Trendelenburg) increases the diameter of the subclavian vein, so this position is advisable during cannulation or any other procedures.