bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Menstrual Abnormalities and its Effect among Undergraduate Students
Authors: Muskan Vitasta , Shrestha Ramesh , Prasad Pravin , Prasad Archana
Published: November 2024

Background: Menstrual abnormalities are menstrual problems that women face during their reproductive years. Globally, they are the most prevalent disorders affecting quality of life in females. This study aimed to assess the prevalence of menstrual abnormalities, its effects and health seeking behaviour of the respondents. Methods: A cross-sectional study of 30 days was conducted among the undergraduate female students of BP Koirila Institute of Health Sceince who were more than 18 years and had attained their menarche. Total number of responses recorded were 137. Data was collected online via google forms and descriptive analysis was done using SPSS 23.Results: Out of 137 participants, 94.89% had menstrual abnormalities. Among which, 75.38% females sought treatment. Dysmenorrhea and Pre-menstrual syndrome were found to be the most prevalent abnormality. The quality of life was affected in most of the females in terms of lack of concentration in study (91.54%), missing the opportunity for socialization (95.39%), inability to perform physical exercises (82.31%), extra hours of confinement to bed (38.46%) and unable to attend lectures (30%).Conclusions: The prevalence of menstrual abnormalities were high. Quality of life was affected in all the subjects with menstrual abnormality but only few of them were seeking treatment with a professional doctor.Keywords: Menstrual abnormality effects; menstrual abnormality prevalence; menstrual abnormality medical students.
Awareness of Adverse Drug Reactions and its Reporting among Third-year Undergraduate Medical Students
Authors: Rauniyar Gajendra Prasad , Pandey Dipesh Raj , Rauniyar Nancy , Tiwari Amol , Aparajita  , Sah Kunal Kumar , Nivedita  , Mandal Prativa
Published: November 2024

Background: Drug is a double-edged sword. Though important, Adverse Drug Reactions under-reporting is real and is mainly due to lack of awareness. No published research has ever evaluated the perspective of third year medical students towards Adverse Drug Reactions reporting. The objective of the study was to evaluate awareness of Adverse Drug Reactions and its reporting among Third-year Medical Students of BP Koirala Institute of Health Science.Methods: It was a descriptive cross-sectional questionnaire-based survey using google form conducted between 09/01/2020 to 09/28/2020. Any consenting third-year medical student of BP Koirala Institute of Health Science was eligible. Descriptive analysis of the data was performed using Microsoft Excel. Ethical clearance was obtained from Departmental-Research-Unit which is under IRC.Results: Out of 80 eligible students, 79(98.75%) participated in the survey. 31.6(25%) had reported Adverse Drug Reactions. 36.7(29%) were aware of National Adverse Drug Reactions monitoring service. 12.7(10%) were aware of BPKIHS ADR monitoring. Again, 35(49.30%) were familiar with Adverse Drug Reactions to a particular drug whereas 29(40.85%) and 28(39.44%) were even familiar with Adverse Drug Reactions to a new product and Adverse Drug Reactions of serious (life or organ threatening) nature respectively. Regarding barriers to Adverse Drug Reactions reporting, 64(83.12%) were uncertain how to report; 39(50.65%) were unaware of existing National ADR system and 33(42.86) could not decide if it was an Adverse Drug Reactions. Regarding recommendations to improve Adverse Drug Reactions reporting, 73(94.81%) recommended education and training, 57(74.03%) stressed on collaboration among health professionals; 52(67.53%) said Adverse Drug Reactions reporting should be professional obligation whereas 51(66.23%) highlighted feedback from Monitoring Centers.Conclusions: We evaluated the awareness of Adverse Drug Reactions and its reporting among third-year medical Students of the institute which was relatively poor compared to other study population like doctors and pharmacists.Keywords: ADR; BPKIHS; MBBS; students.
Clinical Profile and Outcome of Corona Virus Disease-19 Infection in Pregnant Women
Authors: Subedi Kirtipal , Paudel Prajwal , Thakur Amitabh , Poudel Sandesh , Sharma Poonam , Adhikari Shree Prasad
Published: November 2024

Background: The corona virus disease 19 pandemic has affected the whole world with pregnant ladies being more vulnerable population. This study aimed to evaluate characteristics of corona virus disease 19 infection in pregnancy and neonates and whether close proximity to the mother increases the incidence of corona virus disease infection in neonates..Methods: This is a hospital based prospective cross sectional observational study done among pregnant women presenting to Paropakar maternity and womens hospital from 1st September 2020 to 31st march 2021 with confirmed corona virus disease 19 infection. Results: The total 160 cases were included in study. Most of the women (33.8%) were of 20- 25 years of age, 55 % were multigravida and 77.6 % were full term. Around 74 % of cases were symptomatic with predominant symptoms being cough, fever and sore throat present in 33.1 %, 18% and 14% respectively. Out of 125 deliveries 71 % of cases underwent cesarean section of which fetal distress was most common indication. Six newborns were positive for corona virus disease 19 infection within 48 hours of life. Mortality was seen in four mothers and three neonates. Conclusions: The clinical presentation of corona virus disease infection in pregnant ladies is similar to general population. There is no increased risk of vertical transmission to the baby. Keywords: corona virus disease 19; pregnancy outcome; vertical transmission.
Functional Outcome of Proximal Femoral Nailing in Intertrochanteric Fracture
Authors: Thakur Prashant , Khanal Krishna Raj , Amatya Isha
Published: November 2024

Background: Intertrochanteric fracture of femur is one of the commonest fracture seen in elderly, osteoporotic female. The main stay of treatment is fixation with dynamic hip screw or intramedullary device like Proximal Femoral Nail. Intramedullary devices are found to be more biomechanically advantageous. The functional outcome of these fractures depends on the type of fixation, age and stability of fracture. The objective of this study is to assess the functional outcome of Proximal Femoral Nail in intertrochanteric fracture. Methods: An observational study was conducted in Kathmandu Medical College, Sinamangal from January 2018 to May 2019. 32 patients with intertrochanteric fracture were treated with proximal femoral nail during this period. The functional outcome was measured at 6 weeks, 12 weeks and 6 months using Harris hip score.Results: There were 46.9% males and 53.1% females with mean age of 71.09 ±12.35 years. Most of the patients sustained injury after falling from standing height (53.1%). The functional outcome measured at final follow up (6 months) with Harris hip score was good in 62.5% and excellent in 28.1% patients likewise follow up in 12 weeks was good in 15.6%. Conclusions: Proximal Femoral Nail in trochanteric fractures seem to provide a good functional outcome at 6 months follow up. This technique, therefore appears to be a viable option in the management of intertrochanteric fracture of femur. Keywords: Harris hip score; Intertrochanteric fracture; proximal femoral nail.
Does Inclusion of Mental Agility Test in Admission Exam Help Better Student Selection in the Health Professions Education Programs?
Authors: Maharjan Babu Raja , Bhandary Shital , Shrestha Shrijana , Gongal Rajesh
Published: November 2024

Academic ability test has been used predominantly in student selection of medical and allied health profession education programs in Nepal. But the use of academic performance as the single selection criterion puts the students from low socioeconomic background at greater disadvantage despite equal suitability due to the lack of adequate guidance and support during their schooling. To address this limitation, use of aptitude test i.e. both the general cognitive and non-cognitive ability tests that measures fluid intelligence and personality traits respectively has been practiced. The measurement of non-cognitive traits has been found to predict the clinical examination score. In Nepal, for the first time, Patan Academy of Health Sciences implemented the assessment of aptitude test (both cognitive and non-cognitive ability test) for the student selection in the undergraduate medical program. Since the inception, Medical Education Commission in Nepal embraced Mental Agility Test, a component of an aptitude test, along with the academic ability test for the nationwide common entrance test in all the undergraduate Health Professions Education Programs. This indeed is an innovative approach in student selection, but in the context of Nepal whether the use of these tools is appropriate in the entrance exam requires psychometric evaluation and further validation through graduates’ performance after their enrolment.Keywords: Health professions education; mental agility test; student selection.
Comparison of Clinical and Functional Outcome of Cold Steel Dissection versus Coblation Technique in Tonsillectomy
Authors: Regmi Deepak , Bista Meera , Shrestha Sangita
Published: November 2024

Background: To ameliorate the intra and post-op morbidities associated with newer techniques for tonsillectomy like coblation has been introduced in the recent past. This study was aimed to compare the cold steel dissection with the coblation technique with regards to its effectiveness and safety.Methods: An observational comparative study was carried out in 90 patients undergoing tonsillectomy between July 2018 to December 2019. Forty-five patients in each group of cold steel dissection and coblation were compared between the operative time, intraoperative blood loss, post-operative pain, post-operative bleeding and return to work. Intraoperative blood loss was measured using a standard sized gauge piece whereas post-operative pain was measured using a visual analogue scale (0-10) at first and third day of surgery. Results: The age and sex were comparable between the groups. The mean operation time (31.40±4.52 min versus 17.02±3.11 min), intraoperative blood loss (27.20±7.16 ml vs 9.73±5.52 ml), post-operative pain in day 1 (8.02±1.27 vs 4.98±1.03), post-operative pain in day 3 (4.80±0.89 vs 2.76±0.74) and time needed to return to work in days (10. 31±1.29 vs 6.76±1.20) were statistically significant in coblation group (p<0.000). Primary and secondary post-operative haemorrhage rates were similar in both the groups. There was no return to theatre for hemostasis.Conclusions: Coblation tonsillectomy significantly reduces operation time, intraoperative blood loss, post-operative pain (day1 and 3) and time required to return to work . This technique doesn’t differ from cold steel dissection tonsillectomy in terms of primary and secondary post-operative hemorrhage.Keywords: Coblation, cold dissection, tonsillectomy
Successful pregnancy along with prevention of obstetric fistula in a subsequent pregnancy is possible if proper antenatal care and timely elective caesarean delivery are ensured. Keywords: Fistula recurrence; obstetric fistula
Authors: Poudel Rekha , Dangal Ganesh , Karki Aruna , Pradhan Hema , Shrestha Ranjana , Bhattachan Kabin
Published: November 2024

Successful pregnancy along with prevention of obstetric fistula in a subsequent pregnancy is possible if proper antenatal care and timely elective caesarean delivery are ensured.Keywords: Fistula recurrence; obstetric fistula
An Unusual Presentation of Squamous Cell Carcinoma of Kidney
Authors: Yadav Chandra Shekhar , Kasaju Atul , Batajoo Rajesh , Maharjan Sailuja
Published: November 2024

Primary squamous cell carcinoma of the renal pelvis is an extremely rare entity representing only 0.5% to 0.8% of all urothelial malignancies. Clinical suspicion is difficult due to its rarity and inconclusive clinical and radiological features. A 67-year-old lady with a history of hematuria presented to the hospital in a state of shock. After proper workup, a mass with heterogeneous density was seen in the lower portion of the left kidney. After radical nephrectomy, histopathological examination revealed squamous cell carcinoma of renal pelvis. Squamous Cell Carcinoma should be suspected in a patient with a long history of renal calculus and associated mass in non-functioning kidney.Keywords: Calculus; mass; pelvis; squamous cell carcinoma
Knowledge and Practice Regarding Self-care Management among Patients with Permanent Pacemaker at Cardiac Center
Authors: Rayamajhi Nirmala , Sharma Kalpana , Mahotra Narayan Bahadur , Aryal Basanti
Published: November 2024

Background: Permanent pacemaker can be implanted as a life shaving measures for the patients with cardiovascular disease. Complications of permanent pacemaker are preventable if the patients have adequate knowledge regarding its usage, complications, and precautionary measures. The objective of this study was to find out the knowledge and practice regarding self-care management among patients with permanent pacemaker.Methods: A descriptive, cross-sectional study was adopted among patients with permanent pacemaker at Outpatient Department of Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Kathmandu. A total of 98 patients were selected by using non-probability consecutive sampling technique. Data were collected using structured interview schedule. Results: The study revealed that 40.8% of patient had adequate knowledge and 32.7% of patient had good practice regarding self-care management of permanent pacemaker. There was significant association between level of knowledge with age (p=.006), sex (p=.005), ethnicity (p=.045), education status (p=<.001) and regular exercise (p=.031) after permanent pacemaker implantation (PPI). Likewise, level of practice was significantly associated with sex (p=<.001), education status (p=<.001), occupation (p=<.001) and regular exercise (p=<.001) after PPI. The knowledge score and practice score were moderately positively correlated.Conclusions: More than half of the patient had inadequate knowledge and nearly half of the patients followed poor practice regarding self-care management of permanent pacemaker.Keywords: Knowledge; permanent pacemaker; practice; self- care management
Cronkhite-Canada Syndrome: A rare Case Report from Nepal
Authors: Pokharel Nitesh  R. , Shrestha Prajwol , Sharma Vivek , Pandey Sumit
Published: November 2024

Cronkhite-Canada syndrome first described in 1955, is a rare clinical syndrome of unknown etiology. Since then, more than 500 cases have been reported worldwide in the literature. The disease is characterized by diffuse gastrointestinal polyposis, dystrophic changes of the fingernails, cutaneous hyperpigmentation, alopecia, diarrhea, weight loss, and abdominal pain. A 84-year-old woman was admitted in our hospital with severe dehydration following diarrhea and epigastric discomforts. She also had dystrophic change of fingernails, and pigmentation of the palm and alopecia, all of which began several months ago. Endoscopy showed numerous, dense, tiny red polyps throughout the stomach, and duodenum. Her clinical manifestations and endoscopy were consistent with Cronkhite-Canada syndrome. We prescribed oral corticosteroids, which dramatically improved her condition. We here report rare case of Cronkhite-Canada syndrome who presented to our hospital. Keywords: Cronkhite-canada syndrome; gastrointestinal polyposis; onychodystrophy nail
Medical Research Education
Authors: Baral Gehanath
Published: November 2024

Research for clinical practice becomes robust if appropriate researchers are identified and trained. Utilization of research findings and its ownership can assure the appropriateness and real time research in society. Research on felt need would carry the better applicability than the observed need by external researcher. Thus the structured education program in medical research would be worth to start with.Keywords: Education program; medical research; research gap
Health Impact Associated with Pesticides Use among Vegetables Farmers in Nepal: A Secondary Analysis
Authors: Bhattrai Saroj , Dhakal Neelam , Poudyal Anil , Dhimal Meghnath
Published: November 2024

ackground: The trend of pesticide use in market-oriented vegetables is steadily increasing in Nepal. Farmers in developing countries use hazardous pesticides taking few or no safety measures. This study is aimed to assess health effects of pesticide exposure among vegetable farmers in Nepal.Methods: Analysis of secondary data obtained from Nepal Health Research Council was performed. A cross-sectional study on “Health Effects of pesticide among vegetables farmers and adaptation level of integrated pest management program in Nepal 2013” was conducted by Nepal Health Research Council among 660 farmers in four selected districts of Nepal in 2013/2014. The secondary data obtained were statistically analyzed by student’s‘t’ test, one-way analysis of variance and Pearson correlation statistics.  For all tests used, 5% level of significance was considered.Results: Fungicide and insecticides were commonly used pesticides by vegetable farmers in Nepal. Around 51% of the pesticides used were moderately hazardous (II) while, 28% were highly hazardous (Ib). Nearly 12% participants did not use any type of Personal Protective Equipments while spraying pesticides in the field. The prevalence of self-reported poisoning and low Acetylcholinesterase levels among farmers was 51% and 10.3% respectively. Acetylcholinesterase level was found to differ significantly in male as compared to female (P < .05). Conclusions: Almost half of the research participants had self-reported poisoning. Low prevalence of depressed Acetylcholinesterase levels was associated with high use of fungicide compared to organophosphate.Keywords: Acetylcholinesterase; organophosphate; pesticide
Distance of Recurrent Laryngeal Nerve in Relation to Superior Parathyroid Gland During Thyroid Surgery
Authors: Shrestha Diva , Regmi Deepak , Shrestha Sangita , Bista Meera
Published: November 2024

Background: In thyroid surgery, it is essential to identify and preserve recurrent laryngeal nerve to avoid injury to the nerve which will lead to nerve paralysis or paresis. The meticulous dissection of recurrent laryngeal nerve is important for careful identification and preservation of the nerve to prevent post operative vocal cord paresis and hoarseness. Methods: A single centre prospective, cross sectional study was conducted from May 2019 to January 2021 in Department of ENT and Head and Neck surgery in Kathmandu Medical College Teaching Hospital. The data on distance between recurrent laryngeal nerve and superior parathyroid gland during thyroidectomy were collected.Results: The mean distance of recurrent laryngeal nerve in relation to superior parathyroid gland during thyroid surgery was 5.03±1.79 millimeters. The recurrent laryngeal nerve lies within 5mm of superior parathyroid gland in 83.05% cases and between 6 and 10mm in 15.25 % of cases.Conclusions: The recurrent laryngeal nerve is found in the close proximity to the superior parathyroid gland. The visual method of identification of recurrent laryngeal nerve can be widely adopted in thyroid surgery to prevent recurrent laryngeal nerve injury. Keywords: Anatomical location; recurrent laryngeal nerve; thyroid surgery
Clinical Profile of End Stage Renal Disease Patients Undergoing Hemodialysis in Chitwan, Nepal
Authors: Nepal Richa , Sapkota Kalyan , Paudel Mahesh , Sah Kamlesh Kumar , Adhikari Bishow Nath , Bajgain Sharmila , Khanal Nimesh
Published: November 2024

Background: There are very few researches from Nepal that have evaluated clinical profile of end stage renal disease patients. Our main objective was to study the clinical profile of end stage renal disease patients, who were under maintenance hemodialysis for at least three months duration in two dialysis centers located in Chitwan Nepal.Methods: This was a descriptive, cross-sectional study conducted among 138 end stage renal disease patients, who were undergoing maintenance hemodialysis at two government centers located in Chitwan, Nepal. Results: Among 138 patients in our study, 42 (30.4%) patients had diabetic nephropathy and 11 (8%) patients had hypertensive nephropathy as the leading causes of end stage renal disease; however the cause could not be ascertained in 63 (45.7%) patients. 47 (34.1%) patients had started hemodialysis within one month of diagnosis of their kidney disease. Fatigue and musculoskeletal pain were the commonest symptoms found in 78 (56.6%) patients, whereas hypotension and fever were the two most common intra-dialytic complications found in 73 (52.9%) and 61 (44.2%) patients respectively. Anemia was present in 127 (92%) patients, 41 (29.7%) had hyperkalemia, 54 (39.1%) had hypocalcemia, 116 (84.1%) had hyperphosphatemia and 43 (31.2%) had hyperuricemia. Regular use of erythropoietin analogs was significantly associated with higher hemoglobin levels (p value- 0.000) and lesser frequency of blood transfusions (p value- 0.000) in our study.Conclusions: Diabetic nephropathy was the leading cause of end stage renal disease in our study. Cause of ESRD could not be ascertained in nearly half of the total patients. Keywords: Chronic renal failure; end stage renal disease; hemodialysis; Nepal
Microalbuminuria in Patients with Hypertension Visiting Tertiary Care Centre, Western Nepal
Authors: Twayana Yuresh , Pokhrel Buddhi Raj , Tamang Binaya , Jha Amit Chandra , Gautam Narayan , Jayan Archana , Dubey Raju Kumar , Dhakal Pushpa Raj
Published: November 2024

Background: Renal complications of hypertension are associated with high morbidity and mortality. Prediction of such complications at the earliest is of utmost importance. We aimed to assess the prevalence of microalbuminuria in hypertensive patients.Methods: A total of 130 clinically diagnosed hypertensive patients were enrolled in the study. Biochemical parameters that included serum creatinine, urinary albumin, and urinary creatinine were measured using standard methods. Albumin Creatinine ratio and estimated glomerular filtration rate were calculated. Albumin Creatinine ratio values between 30-300 mg/g were considered as microalbuminuria. Statistical analysis was performed on 120 samples after excluding frank proteinuria.Results: The prevalence of microalbuminuria in hypertensive patients was 19.16%. Mean ranks of systolic blood pressure, pulse pressure, and serum creatinine levels were significantly higher in hypertensive patients with microalbuminuria. Mean estimated glomerular filtration rate was significantly low in hypertensive patients with microalbuminuria. Older age and increased duration as well as severity of hypertension were not associated with a higher prevalence of microalbuminuria.Conclusions: The prevalence of microalbuminuria was high in hypertensive patients. Serum creatinine and estimated glomerular filtration rate were significantly altered in patients with microalbuminuria. Early screening of microalbuminuria in such patients might help prevent renal complications.Keywords: ACR; creatinine; eGFR; hypertension; microalbuminuria
Association Between Internet Addiction, Depression and Sleep Quality Among Undergraduate Students of Medical and Allied Sciences
Authors: Paudel Luna , Sharma Pawan , Kadel Anuj Raj , Lakhey Kshitiz , Singh Swarndeep , Khanal Pratibha , Sharma Rachana , Chalise Pratikshya , Sharma Subash Chandra , Pradhan Sudarshan Narsingh
Published: November 2024

Background: The use of the internet is growing rapidly worldwide with easier availability and affordability in developing countries like Nepal. Apart from several benefits, it has also led to deleterious effects on certain individuals’ physical and mental well-being. The present study aimed to assess the burden of internet addiction among nursing, dental and medical undergraduates at a medical school, and examine its relationship with depression and sleep quality.Methods: A cross-sectional study among 494 students pursuing nursing, dental and medical undergraduate courses at the same medical college in Nepal was conducted. The burden of internet addiction, depression, and sleep disturbance was assessed using Young’s Internet addiction test, Beck’s depression inventory, and Pittsburgh Sleep Quality Index questionnaires respectively.Results: The majority of respondents reported either controlled use of internet or mild problem with internet use. However, 4.7% of respondents reported significant problems due to internet use. Further, about 42.3% reported poor sleep quality, and 8.9% screened positive for depression. In both chi-square and logistic regression analyses, internet addiction was significantly associated with poor sleep quality and depression.Conclusion: The study shows that about half of the participants experienced at least some problems and a small but significant proportion of them reported severe problems due to internet use. This warrants the need to address the issue of internet addiction among medical and allied sciences students in Nepal. Further, internet addiction is associated with both depression and poor sleep quality, highlighting a need to develop effective interventions targeting all three problems holistically.Keywords: Depression; internet addiction; sleep quality
Reorganizing Hospital Cancer Care In Nepal
Authors: Paudel Bishnu Dutta , Love Richard , Shrestha Deepak Sundar
Published: November 2024

While mortality rates for major common cancers— of the lung, breast, stomach, ovary, and lymphomas-- have declined significantly in high-income countries over the last decade, comparable rates for these malignancies have not fallen in Nepal. The explanations for the high-income country mortality trends are multiple and certainly include incidence reductions, but better treatments are also contributory. How to bring to Nepal the global lessons in achieving better cancer care is uncertain. We need to create an environment of ideas and a powerful vision to meet the needs for better major cancer management for Nepalis.Broadly, the Nepalese challenges are in creating more accessible and affordable care of sufficiently high-quality to make a difference. Hospitals are the major places where these issues have to be considered. To address these challenges, we offer a vision and suggest here strategies of major organizational changes in: Innovative staffing models, emphasizing teamwork, with increases in responsibilities, activities and work force percentages of non-physician health professionals; Increased outpatient care and tele-health; 3.Creating and following evidence-based diagnostic pathway and treatment clinical practice guidelines and checklists; 4. Increased application of information technology tools, particularly electronic medical records; and 5. Service implementation research evaluating quality based on structure, process and outcomes of care. Developing such effective changes requires strong community linkages, local institutional-specific coalition initiatives and experimentation, and national and international collaborations and financial support to effect practical and data-based plans and budgets.Keywords: Guidelines; improving treatment; information technology tools; outpatient services; staffing models; tele-health
Feto-maternal Outcomes in Placenta Previa with and Without Previous Cesarean Section
Authors: Pun Isha , Singh Alka
Published: November 2024

Background: Placenta previa is associated with poor maternal and fetal outcomes. Its complications are increasing due to the increased rate of cesarean deliveries. This study aimed to compare maternal and fetal outcomes in placenta previa with and without previous cesarean section.Methods: This study was conducted in the Department of Obstetrics and Gynecology at Patan Hospital, Nepal. Placenta previa cases were reviewed from 1st January 2010 to 31st December 2019, parted into Group 1 (placenta previa with previous cesarean section) and Group 2 (placenta previa with no prior cesarean section). Strength of association was measured as odds ratio and 95% confidence intervals. P-value at <0.05 was taken as statistically significant.Results: The total number of placenta previa were 348 (0.42%) of total deliveries (n=82,918) , but 72 charts/records were not found and six cases were excluded. Group 1 comprised 48 cases (0.86%) among prior cesarean section (n=5,581) and Group 2 consisted of 222 cases (0.28%) among those with no prior cesarean delivery (n=77,337) and it was statistically significant. Morbidly adherent placenta, postpartum hemorrhage, cesarean hysterectomy, and maternal deaths were higher in Group 1 and statistically significant. Preterm deliveries and neonatal intensive care unit admission were also more in Group 1 and statistically significant.Conclusions: Maternal and fetal morbidity were higher in placenta previa with previous cesarean section than with no prior cesarean delivery. Therefore, it is advisable to try to reduce the rate of cesarean section as far as possible.Keywords: Feto-maternal outcome; placenta previa; previous cesarean section.
Clinical Competency Retention after Mid-Level Practicum Training and It’s Associated Factors among Health Workers of Nepal
Authors: Bhusal Madhab Raj , Tamang Pakhrin Jonu , Chitrakar Deepa , Pradhan Amita , Tamang Suresh
Published: November 2024

Background: Mid-level health workers are deployed in a large proportion with the expectation of similar patient outcomes as with physicians. Mid-level practitioners are Health Assistants and Auxiliary Health Workers who provide clinical care at remote locations. National Health Training Center has been providing 60 days in-service Mid-level Practicum training since 2009 AD for the mid-level practitioners with the aim to enhance quality of patient care in Nepal. Methods: An observational study conducted using retrospective data from onsite follow-up assessment of 180 Mid-level Practitioner from 18 districts of Nepal between July 2015 to June 2019. The retention of competency onsite follow-up was calculated as percentage of assessment score at the end of Mid-level Practicum training. Percentage retention of competency and association of retention with factors were analyzed using independent t-test.Results: Majority of participants were male (85.6%), and working in a Health Post (84.4%). Average clinical competency retention in each domain at their work place was 68.79% in knowledge, 73.80% in patient encounter skill, 82.84% in clinical decision-making skill and 87.58% in clinical procedure skill. Higher age groups, longer years of experience and participants from Terai region found to be associated with lower retention of knowledge. A better enabling environment and higher case load retained higher patient encounter skill.Conclusions: The competency retention among Mid-level Practicum trained mid-level health workers was found to be higher. Factors found associated with competency retention were age, geographic region, years of experience, case load and enabling environment. Keywords: Competency retention; knowledge; MLP; skill.
Hepatic Encephalopathy Induced Transient Cortical Blindness
Authors: Pokhrel Shweta , Shrestha Pramesh Sunder , Pathak Rahul , Bhattarai Suju , Karki Bipin , Paudel Shachi
Published: November 2024

Hepatic encephalopathy describes a spectrum of potentially reversible neuropsychiatric abnormalities seen in a patient with severe liver dysfunction with porto-systemic shunting. Cortical blindness can be a rare presentation of hepatic encephalopathy and can even precede the onset of altered sensorium. We report a case of 57 years female with chronic liver disease who presented with bilateral loss of vision, with no focal neurological deficits. From clinical and laboratory examination, a diagnosis of hepatic encephalopathy with cortical blindness was proposed. Her visual disturbances gradually improved with the treatment of hepatic encephalopathy. Keywords: Cortical blindness; end stage liver disease; hepatic encephalopathy; papilledema.
Frontal Bone Osteomyelitis in Adult
Authors: KC Kapil Mani , Gnawali Gopal Prasad , GC Raju
Published: November 2024

Frontal bone osteomyelitis is a rare clinical disease which occurs as a result of frontal sinusitis, penetrating injury on head, post-operative complication after sinus surgery and hematogenous spread from distant site. Early diagnosis, appropriate surgical debridement and antibiotic are keys to prevent from life threatening intracranial complications. We report a 63 years old male patient with osteomyelitis of outer cortex of frontal bone. The wound was thoroughly debrided after computer tomography scan showed an osteolytic lesion on outer table of fontal bone and antibiotic was continued for 2 months until inflammatory markers become normal.Keywords: Frontal bone; Intracranial complications; osteomyelitis; pott’s puffy tumour.
Stress and Coping among Caregivers of Differently Able Children
Authors: Sharma Sharada , Subedi Jaya
Published: November 2024

Background: Caring differently able children can cause stress in the caregivers. They employ a variety of coping mechanisms to deal with stress. The aim of this study is to identify stress and different coping styles among caregivers of differently able children.Methods: A cross-sectional study was carried out in three organizations that accommodated differently abled children. A non-probability purposive sampling technique was used to recruit primary caregivers of children with developmental disabilities. This study examined caregiver stress and different coping styles by using the Parent Stress Scale and Brief COPE Inventory.  Face-to-face interviews were used to collect data, which was then analyzed using SPSS.Results: Among the total of 102 caregivers, mothers accounted for 60.8 percent, 57.8 percent child were boys whereas, 49 percent were the child with cerebral palsy. Total mean stress score was 57.17 ±8.808. High level of stress was reported by 58.8 percent of caregivers. Education and family income showed the statistically significant association with stress score P-value<0.05. Total mean coping score was 67.83 ±5.812. Caregivers’ stress had significant positive correlation with different coping styles; active coping, denial, behavioral disengagement, humor, acceptance religion and self-blame (P-value<0.05).Conclusions: More than half of the caregivers had high level of stress. The most frequently used coping styles were self-distraction, acceptance and positive reframing. Caregivers’ stress had significant positive correlation with different coping styles. Therefore, health professionals and service providers should focus on stress reduction and positive coping technique to help family adaptation.Keywords: Caregiver; coping; differently able children; stress.
High Suicide Rates among Nepalese Population: Need for Action
Authors: Pandey Achyut Raj , Paudel Sudip , Belbase Pradeep
Published: November 2024

Suicide is a global public health problem and the burden has remained stable for last decades. The age standardized suicide rate was 9.77 per 100,000 in 2019 with males and older population being more affected. Based on age, the highest suicide rate was observed in individuals of age 80 years with suicide rate of 64.9 per 100,000 in male, 18.2 per 100,000 in female and 37.4 per 100,000 in both sexes in this age group. In all age group, the suicide rates are higher among males compared to females. Universal, selective and indicative preventive strategies should be implemented to reduce the burden of suicide in Nepal.Keywords: Nepal; prevention; suicide.
Advancing Health Policy and System Research: Lessons for Resilient Health System in Nepal
Authors: Gyanwali Pradip , Dhimal Meghnath
Published: November 2024

N/A
Nutritional Status and Practices among Urban Children: A Hospital-based Cross-sectional Study
Authors: Uprety Sophiya , Khadka Anjita , Paudyal Alina , Shrestha Dhruba
Published: November 2024

Background: Child undernutrition has been a prevailing issue in Nepal and the burden still remains unacceptably high. It is important to look at how infants and young children’s feeding practices and nutritional status are affected by nutrition transitioning in rapidly urbanizing Nepal.Methods: A cross-sectional research design was employed with healthy children aged 6-23 months and their mothers visiting the hospital for regular immunization services as the study population. Data was collected from 305 children over six months from September 2019 to January 2020. Anthropometric measurements (weight and length) were collected of all children and their mothers’/care takers were interviewed on the Infant and Young Child Feeding practices. Data was analyzed using WHO Anthro Survey Analyzer, Microsoft Excel and STATA 15Results: Early initiation of breastfeeding was 47.9% and use of bottle was 48.5%. Minimum dietary diversity, minimum meal frequency and minimum acceptable diet were 66.2%,79.1% and 54.4% respectively. Consumption of nutrient-poor packaged foods was 63.0%with biscuits being the most common type (52.1%) and 32.8% of the children were found to be drinking tea. Overall,13.8% of the children were stunted,3.9% were underweight and1.7% were wasted while 2.3% were overweight.Conclusions: Practices related to breast feeding and diets of young children in urban areas of Nepal are not optimal with only around half meeting the minimum standards recommended by the WHO. Therefore, there is a pressing need to wake up to the rapidly changing dietary patterns among young children through necessary urban nutrition policies and programmatic interventions. Keywords: Breastfeeding; childnutrition; Infant and young child feeding; Nepal; nutrition intransition
Thoracic Complications in Supracostal Percutaneous Nephrolithotomy
Authors: Kunwar Ashok Kumar , Upadhyaya Amit Mani , Tiwari Kabir , Shrestha Sanjesh Bhakta , Yadav Chandra Shekhar , Dangol Bikkin , Shrestha Parash Mani
Published: November 2024

Background: Due to the risk of pleural injury leading to thoracic complications, many urologist still hesitate to perform supracostal puncture during percutaneous nephrolithotomy. Our aim of this study was to evaluate the thoracic complications in supracostal access percutaneous nephrolithotomy.Methods: This is a retrospective analysis of 101 patients who were treated with supracostal access percutaneous nephrolithotomy at our institute from September 2013 and December 2019. Indications for supracostal punctures were staghorn 28(27.7%), middle calyceal stones 10(9.9%), pelvic stones 29(28.7%), complex inferior calyceal stones 26(25.7%), upper calyceal stone 10(9.9%)and upper ureteric stone17(16.8%).The intercostal space between the 11th and 12th ribs was used in all the cases.Results: Among the 101 patients who undergone percutaneous nephrolithotomy by supracostal access, three patients (2.97%) had pleural injury. Among them one patient developed hydrothorax and needed chest tube insertion and remaining two patients had minimal pneumo thorax with blunting of costo-phrenic angle, which was managed conservatively. The lung parenchymal or other viscera injury was not observed in our study. Most punctures were, a single supracostal superior calyceal access 18(17.8%) and middle posterior calyceal access 88(82.2%), except for staghorn and multiple complex lower calyceal calculi needed multiple tracts 23(22.8%). Complete clearance was observed in 77(76.2%) patients.Conclusions: The supracostal puncture was a safe and effective approach with high stone clearance rate and acceptable morbidity in selected cases of staghorn, upper ureteral, and upper calyceal calculi. It should be adapted whenever needed and should not be avoided due to fear of chest complications.Keywords: Percutaneous nephrolithotomy; pleural injury; stone clearance; supracostal puncture
Quality of Life of Nurses Working in a Tertiary Level Hospital
Authors: Koju Ganga Keshari , Pandey Apsara
Published: November 2024

Background: Quality of life refers to persons’ sense of well-being based on their satisfaction with the important areas of their life. Work related stresses causes various physical and mental health problems to the nurses which reduces their quality of life. The study aimed to find out the quality of life of the nurses. Methods: A descriptive cross sectional, study was conducted among 135 nurses working in different units of a Tertiary Hospital, Kathmandu. Non-probability purposive sampling technique was used. Self- administered WHO Quality of Life–BREF Version tool was used to collect the data. Pearson Correlation was used to find out the relationship between actual quality of life and perceived quality of life of participants at p-value ?0.05.Results: More than two third (71.1%) of the participants had good perceived quality of life (Mean±SD=3.7±0.63) and 65.2% were satisfied with their health (Mean±SD = 3.52±0.80). Similarly, nearly half of the participants (48.1%) had below average mean score of quality of life. Overall mean score of quality of life obtained by participants was 60.74±9.02. The obtained mean score was highest in social domain (66.17±10.86) and lowest in environmental domain (52.8±10.6). There was significant correlation between actual quality of life and perceived quality of life of participants.Conclusions: As nearly half of the participants had below average quality of life, concerned authorities should pay attention to improve nurse’s working environment and physical health to improve their quality of life.Keywords: Nurses; quality of life; tertiary hospital; WHOQOL- BREF.
Factors influencing Successful Aging among Older Adults
Authors: Basnet Rajina , Shakya Neelima
Published: November 2024

Background: The rapid growth of older population has enhanced the number of people at lifetime risk of enduring from chronic diseases. Successful aging is a significant phenomenon for achieving a healthy and happy life for all elderly and aging society.Methods: A descriptive cross sectional study was carried out with the objective of assessing the factors influencing successful aging. Structured interview questionnaire using Successful aging scale and Self-esteem scale was used for data collection and obtained data was analyzed using descriptive statistics and inferential statistics at 0.05 level of significance. Participants of the research were considered in this study using purposive sampling technique.Results: The findings revealed that majority of elderly respondents (73.8%) had successful aging. Successful aging was significantly associated with marital status (p-value= 0.040), family type (p-value=0.002), family annual income (p-value=0.009), presence of children as support system (p-value=0.034), negative life events in last 12 months (p-value<0.001), subjective perception of health (p-value=0.001) and ability to remember things without difficulties (p-value<0.001).Conclusions: Thus, it can be concluded that successful aging is associated with several factors. So, individual factors must be taken into consideration while implementing intervention programs in order to bring about positive aging experience among elderly. Keywords: Older adults; self-esteem; successful aging.
Association Between Vitamin D Deficiency and Recurrent Tonsillitis
Authors: Shrestha Diva , Bista Meera
Published: November 2024

Background: Tonsillitis is defined as an inflammation of the tonsils characterized by signs of tonsillar erythema and exudates and recurrent tonsillitis is at least 7 episodes of acute tonsillitis in a year, or a minimum of 5 episodes in a year for 2 consecutive years, or at least 3 episodes in a year for 3 consecutive years. There are many research that have hypothesized the association of low level of Vitamin D and recurrent attacks of acute tonsillitis. Methods: A single centre prospective, cross sectional analytical study was conducted from 2021 June to 2022 March in Department of ENT and Head and Neck surgery in Kathmandu Medical College Teaching Hospital. The study participants were recruited from ENT Head and Neck OPD and the data on number of episodes of recurrent attacks of tonsillitis and serum level of Vitamin D were collected. Results: 78.8% of patients with tonsillitis had low level of serum Vitamin D (less than 30ng/ml) and 21.2% had optimal level of serum Vitamin D (more than 30ng/ml). The incidence of recurrent tonsillitis was 40.9% in patients with low level of Vitamin D where as the incidence of recurrent tonsillitis was 18.1% in patients with optimal level of Vitamin D. Conclusions: The low serum level of Vitamin D was found to be associated with recurrent episodes of tonsillitis.Keywords: Recurrent tonsillitis; vitamin D.
Day One Drain Amylase as a Predictor of Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy
Authors: Pradhan Sumita , Kandel Bishnu , Bhandari Ramesh Singh , Joshi Lakhey Paleswan
Published: November 2024

Background: Postoperative pancreatic fistula remains the most challenging complication following pancreaticoduodenectomy. As per the definition by the International Study Group on Pancreatic Fistula, post operative pancreatic fistula is diagnosed on or after postoperative day 3. However, several studies have demonstrated that drain fluid amylase on postoperative day 1 may be a better predictor. This study was conducted to determine the diagnostic value of day one drain amylase in predicting the development of post-operative pancreatic fistula.Methods: This was a prospective observational study of patients, who underwent pancreaticoduodenectomy between April 2016 and May 2017. Post operative pancreatic fistula was defined by the International Study Group on Pancreatic Fistula (2005) criteria. The diagnostic value of day one drain amylase was determined by doing a receiver operating curve analysis and compared with the postoperative day 3 value.Results: A total of 49 patients were included. Post operative pancreatic fistula developed in 28 patients (Grade A - 40.8%; B - 12.2%; C - 4.1%). Receiver operating curve analysis confirmed the predictive relationship of day one drain amylase with an area under the curve of 0.79 and kappa 0.5. For clinically relevant postoperative pancreatic fistula, day 3 drain amylase was the better predictor (AUC for DFA3 was 0.73 while AUC for DFA1 was 0.51). A day one drain amylase cut-off value of 350 U/L demonstrated a sensitivity of 75% and specificity of 77.8% with an accuracy of 76.2%. Conclusions: Day one drain amylase predicts postoperative pancreatic fistula in patients following pancreaticoduodenectomy but for clinically relevant postoperative pancreatic fistula, day three drain amylase is a better predictor.Keywords: Amylase; drain fluid amylase; pancreaticoduodenectomy; Pancreatic fistula
Trends in Surgical Management of Esophageal Cancer
Authors: Thakur Binay , Devkota Mukti , Thapa Asha
Published: November 2024

Background: Management of esophageal cancer has changed to a combined modality approach over the past two decades due to poor outcome. Recently, multimodal treatment has become the standard practice. The aim of this study was to evaluate the changing trends in management and outcomes of esophagectomy over 15 years from a single center in Nepal.Methods: Patients with squamous cell carcinoma and adenocarcinoma of esophagus/ gastroesophageal junction who underwent surgery between 2001-2018 were analyzed. Patients were grouped into three successive 5-year periods.Results: 547 patients underwent esophagectomy during 2001-2018. There was increased trend of neoadjuvant treatment from 9-13% to 52% (p<.001) and minimally invasive surgery (MIS) from 0% to 80% (p<.001). 30-day mortality decreased from 8% to 1% (p=.01). The 5-overall survival was 24% which increased from 17% to 27% (p=.003).Conclusions: Long term outcome has improved over last 15 years with decreasing mortality which appears to be due to incorporation of MIS and neoadjuvant treatment.Keywords: Esophagectomy; esophageal cancer; multimodality therapy