Outcomes of Microvascular Free Flap Reconstruction after Major Head and Neck Ablative Surgery at a Tertiary Teaching Hospital in Eastern Nepal.

Background Reconstruction with free flaps has significantly changed the outcome of patients with head and neck cancer. Microsurgery is still considered a specialized procedure and is not routinely performed in the resource-constrained environment of developing country like Nepal. Objective To evaluate the clinical outcomes in patients who underwent different microvascular free flap reconstructions of head and neck defects after major ablative surgery. Method A retrospective study was conducted to review and analyze the data of patients with head and neck cancer who underwent microvascular free flap reconstruction after major ablative surgery from November 2017 to April 2021. The descriptive statistics were calculated using Microsoft Excel 2010. Result Out of 207 patients, 129 (62.32%) were males. Mean age was of 55.17±13.44 years. About 133 (64.25%) tumors were on gingivobuccal complex. Anterolateral thigh flap was the most common flap 112, (54.11%) used for the reconstruction. Facial artery was used in 174 (84.06%) patients for anastomosis. The overall success rate was 97.5%. Re-exploration was done in 22 (10.63%) cases out of which 11 (50%) cases were having flap compromise. Delayed flap failure occurred in 5 cases (2.5%) and salvage surgery was done with pectoralis major myocutanuos flap with a salvage rate of 54%. Minor complications were observed in 39 cases (18.84%) out of which donor site graft loss was observed in 19 (9.18%) patients. Conclusion In spite of advanced set up, with trained dedicated manpower the microvascular free flap reconstruction of head and neck defects is safe with high success rate even in resource constrained country like Nepal.

Effect of Weekly Text Messaging Reminders on Medication Adherence in Hypertension and Type 2 Diabetes Mellitus at a Tertiary Care Center in Eastern Nepal.

Background The short-message service (SMS) reminder techniques are found to be important in increasing medication adherence in non-communicable diseases. Objective To assess the effect of SMS on medication adherence in hypertension and/or type 2 diabetes mellitus. Method An observational study was conducted in the outpatient department using a semistructured questionnaire. Patients having hypertension and/or type 2 diabetes mellitus and taking at least one medication and having low to medium adherence were enrolled and short-message service was sent to them twice a week for up to two months reminding them to take medications as prescribed. At the end of two months, medication adherence was assessed using SPSS at P-value less than 0.05. Result Out of 105 patients, 64 (60.95%) were females. The mean age (±SD) was 51.15 ± 11.01 years. After two months of the short-message service reminders, majority of the patients were graded as having high adherence (73.33%) followed by medium adherence (20.0%) and low adherence (6.67%). The mean medication adherence scores on day one and after two months were 5.50 ± 1.14 and 7.50 ± 0.93 respectively (P-value=0.000). A high medication adherence was seen in individuals aged above 45 years (75.7%), males (78.0%) and those using a basic mobile phone (76.7%) after two months of follow-up; however it was statistically not significant (P-value > 0.05). Conclusion The SMS reminders had significantly improved the medication adherence in patients with hypertension and/or type 2 diabetes mellitus. However, none of the baseline variables were significantly associated with improvement in the adherence.

Evaluation of Antinociceptive Activity of Ficus Religiosa Root Extract in Swiss Albino Mice.

Background Ficus religiosa, commonly known as peepal, is widely distributed in Indian subcontinent. It has been used as an antiepileptic, aphrodisiac, analgesic, antiinflammatory and laxative in traditional medicine. Objective To explore the analgesic effect of aqueous root extract of Ficus religiosa using thermal and chemical models of pain in swiss albino mice. Method The aqueous aerial root extract of Ficus religiosa was prepared using soxhlet apparatus. The anti-nociceptive effect of the extract at doses of 50 and 100 mg/kg was evaluated using peripheral (acetic acid-induced abdominal writhing), spinal (tail flick) and supra-spinal (hot plate) behavioral models of pain. All data were presented as Mean ± SEM. Statistical differences between Ficus religiosa (50 and 100 mg/kg) and standard control groups were evaluated using Mann-Whitney U test. Result There was significant dose dependent increase in the mean reaction time compared to the vehicle control in hot plate and tail- flick test. In acetic acid induced writhing test, mice treated with Ficus religiosa (50 and 100 mg/kg) exhibited significant dose-dependent decrease in the mean number of writhes (57.45% and 79.20% respectively) compared to the vehicle control. The activity of Ficus religiosa extract at doses of 50 and 100 mg/kg was equipotent to Standard control (Morphine and Indomethacin) used in different test models. Conclusion The extract of Ficus religiosa possesses both central and peripheral analgesic activity thus validating the traditional use of this plant in the management of pain.

Knowledge, Attitude and Practice of Disposal of Unused, Unwanted and Expired Medicines among Healthcare Professionals.

Background Unused, unwanted and expired medicines stored at home pose threats to both health systems and environments. Healthcare professionals (HCPs) should be aware of the proper disposal methods of such medicines. Objective To assess the knowledge, attitude and practice of disposal of unused, unwanted and expired medicines among healthcare professionals. Method A web-based cross-sectional descriptive study was conducted among faculties and junior residents at B.P. Koirala Institute of Health Sciences, Dharan, Nepal using a semi-structured proforma. The data were collected through Google Form. Descriptive statistics were calculated. Chi-square test and Student's t test were used for analysis using statistical package for the social sciences at p value of 0.05. Result A total of 294 healthcare professionals with mean age 35.37± 6.630 years were participated out of which 231 (78.6%) were male and 151 (51.4%) were faculties. Mean knowledge score was higher in faculties (2.37±1.111) than the Junior residents (2.33±1.155) [F(1,293)=0.102, p=0.750]. Junior residents (140 out of 143, 97.9%) had a better attitude than faculties (141 out of 151, 93.3%) regarding the disposal of medicines [χ2 (1)=3.558, p=0.059]. Junior residents (36 out of 143, 25.1%) also had a better practice than faculties (24 out of 151, 15.8%) regarding the disposal of medicines [χ2 (1)=3.895, p=0.048]. Conclusion Majority of the Healthcare professionals had positive attitude but poor knowledge and practice regarding disposal of expired and unused medicines. There was a high practice of keeping medicines at home by healthcare professionals. The findings would be useful for planning strategies to minimize unused medicines and foster the appropriate disposal practice.

Study of Two Different Volumes of 0.75% Ropivacaine for Ultrasound Guided Supraclavicular Brachial Plexus Block on Successful Blockade and Diaphragmatic Motility.

Background Use of ultrasound guidance during supraclavicular brachial plexus block allows the usage of a lower anesthetics dose and minimizing unwanted effects of the anesthesia. Objective To compare the success of sensory blockade and the incidence of hemidiaphragmatic dysfunction in patients receiving two different volume of 0.75% Ropivacaine for ultrasound guided supraclavicular brachial plexus block. Method A prospective randomized double-blinded comparative study was conducted. Group A patients (n=30) received 20 ml and Group B (n=30) received 25 ml of 0.75% Ropivacaine for ultrasound guided supraclavicular brachial plexus block. Hemodynamic parameters, oxygen saturation, diaphragmatic excursion, onset of sensory blockade and time for completion of blockade were measured. Independent t-test, Chi-square test and Mann-Whitney U test were used to analyze the data at p value of less than 0.05 using Statistical Package for Social sciences (version 11.5). Result At 30 minutes, 29 (96.67%) patients in group B and 27 (90.0%) patients in group A had no sensation in median, radial, ulnar, musculocutaneous and medial cutaneous nerves teritories; however, it was not significant statistically (p value > 0.05). At 30 minutes in Group A, 25 (83.33%) patients had no diaphragmatic hemiparesis and five (16.67%) patients had partial diaphragmatic hemiparesis. However, three (10%) patients had no diaphragmatic hemiparesis in Group B, 25 (83.33%) patients had partial and two (6.67%) patients had complete diaphragmatic hemiparesis and it was statistically significant (p < 0.05). Age and sex had no effect on diaphragmatic hemiparesis in both groups (p value > 0.05). Conclusion The patients receiving lower volume of Ropivacaine had less incidence of hemidiaphragmatic dysfunction with similar sensory blockade as compared to the patients receiving higher volume of Ropivacaine.

Evaluation of Nicotine Dependence in Adult Population of Eastern Nepal.

Background Tobacco consumption is a leading cause of premature death in the world. Tobaccorelated deaths are associated with cardiovascular diseases, pulmonary diseases, oral potentially malignant disorders, cancer, others. Moreover there is also associated nicotine dependence which might result to numerous tobacco-associated diseases. Objective This study was conducted to analyze the degree of nicotine dependence considering its potential health risk, in the Eastern region of Nepal. Method A descriptive questionnaire based study was conducted among current tobacco users of six districts of Eastern Nepal. Fagerstrom Test for Nicotine Dependence (FTND) and Fagerstrom Test for Nicotine Dependency for Smokeless Tobacco (FTNDST) questionnaire were used for tobacco smokers and chewers, respectively. Result Of the total participants, 836 were males and 359 females, among whom 736 were active tobacco smokers and 432 chewers, 34.8% had tried to stop consuming tobacco and 306 (25.6%) had oral lesions in white or red forms. Very low nicotine dependence was found among 244 (31.47%) tobacco smokers and 37 (8.56%) chewers whereas 36 (4.71%) smokers and 103 (23.84%) chewers had very high nicotine dependence. The mean score for FTND was 3.73±2.37 and 5.74±2.12 for FTND-ST. A significant difference in duration and age group with FTND score was observed, however not with FTND-ST. Conclusion The information regarding degree of nicotine dependence can be used as baseline information for planning of preventive strategies and implementation of tobacco cessation and control programs.

Effect of Honey on Healing Process of Extraction Socket in Rabbits.

Background Honey is regarded as the oldest wound dressing. It accelerates wound healing in burn, infected and open wounds. Its effect on wound healing process in extraction socket is not fully established till today. Objective To evaluate the effect of honey on the healing process of socket after tooth extraction in New Zealand White rabbits. Method Extraction of first premolar tooth on both sides of lower jaw in six rabbits was done under general anesthesia produced by ketamine and Xylazine followed by local application of honey on one socket (honey group) and normal saline (control group) in the opposite socket. On 7th day, biopsy was taken from the extraction site and histopathological examination was done. Student's t-test was used for comparison between the groups and the differences were considered to be statistically significant at P-value less than 0.05. Result There was a significant difference between control group and honey group in terms of fibroblast proliferation (p = 0.0019) and bony trabeculae formation (p=0.0003). Inflammatory cells were also observed in both groups and it was statistically not significant (p=1.0000). Overlying epithelium was hyperplastic in the both groups. Conclusion Local application of honey promoted the healing process by increasing fibroblast proliferation and bony trabeculae formation. Further studies in larger animals and human should be conducted to confirm the efficacy of honey in extraction socket healing.

Pattern of Self-medication in Undergraduate Students at BP Koirala Institute of Health Sciences.

Background Self-medication is a growing health problem. It may lead to wastage of resources, emergence of antimicrobial resistance, adverse drug reactions and prolonged suffering. Little has been reported on the extent of self-medication practiced in medical students in Nepal. Objective To study the pattern, reason and perception of self-medication among undergraduate students. Method A cross-sectional study was conducted among all undergraduate students at BP Koirala Institute of Health Sciences, Dharan, Nepal between April and May, 2015. After obtaining ethical clearance, pre-validated questionnaire was used to collect data. The date were analyzed and presented as frequency and percentage using SPSS version 11.5. Result Total of 520 students participated in the study with a mean age of 21.2±1.7 years. Prevalence of self-medication was found to be 48.3%. Most common cause for self-medication was common cold (53.3%). Nonsteroidal anti-inflammatory drugs (78.9%) were the most commonly used medicine for self-medication. The students commonly approached their seniors (50.2%) for the drug information. The most common adverse drug reaction experienced by the students was drowsiness (50.9%). Approximately one third of the students (33.2%) used to prescribe medicines to others. More than half of the students (53.8%) opined that self-medication is a part of self-care. Around one-fifth of the students (21.5%) students opined that self-medication is recommended by WHO. Conclusion Self-medication is commonly practiced by undergraduate students. Nearly one third of the students also prescribe medicines to others. Nonsteroidal anti-inflammatory drugs are the most commonly used medicine as self-medication. The students need to be educated regarding appropriate safe-medication.