bluuebunny/crossref_metadata_2025 huggingface dataset:
Antibiotic Susceptibility of Staphylococcus Aureus with VanA and MecA Genes
Authors: Ghimire Lata , Banjara Megha Raj , Abdulla Abdelkodose MH
Published: November 2024

Background: Staphylococcus aureus (S.aureus) is an emerging antibiotic resistant bacterium responsible for various infections in human. Resistance to methicillin and vancomycin are of prime concern in S. aureus. The study aims to determine the minimum inhibitory concentration (MIC) of Vancomycin and evaluate the existence of mecA and vanA genes, associated with antibiotic resistance.Methods: Clinical specimens from three Kathmandu hospitals were processed and S. aureus was identified using conventional microbiological procedures. MRSA was phenotypically identified with cefoxitin (30µg) disc diffusion, while vancomycin susceptibility was assessed using the Ezy MICTM stripes. The mecA and vanA genes were detected by polymerase chain reaction (PCR). Results: Out of 266 S. aureus samples from various clinical specimen subjected for analysis, 77 (28.9%) were found methicillin-resistant (MRSA) and 10 (3.8%) were observed vancomycin-resistant (VRSA). Vancomycin resistant isolates showed a significant correlation between resistance to ampicillin, chloramphenicol, and cefoxitin. The mecA gene was found in 39 of the MRSA isolates, having 50.64% of MRSA cases, while the vanA gene was detected in 4 of the VRSA cases, constituting 40% of VRSA occurrences.Conclusions: The strains with higher vancomycin minimum inhibitory concentration values (? 1.5 ?g/ml) displayed increased resistance rates to various antibiotics compared to strains with lower minimum inhibitory concentration values (< 1.5 ?g/ml). The presence of vanA genes was strongly associated (100%) with vancomycin resistance, while the 10.3% mecA gene was identified from MRSA having resistance towards vancomycin also.Keywords: Methicillin resistance; minimum inhibitory concentration; staphylococcus aureus; vancomycin resistance.
Mental Health of Mothers with Malnourished Children in Nepal: A Prospective Observational Study
Authors: Sharma Asmita , Sharma Yograj , Thapa Asha , Kar Nilamadhab
Published: November 2024

Background: Maternal mental health may influence the nutritional status of their children. It was intended to assess the mental health status of the mothers of children admitted to a nutrition rehabilitation center. We specifically explored the relationship between maternal mental health and malnutrition of the child; to observe any change of maternal depressive/anxiety symptoms and weight gain in the child following admission.Methods: In a prospective observational study, malnutrition of children was assessed based on weight for height z scores using the WHO Anthro-Survey-Analyser. We evaluated anxiety using the Generalized Anxiety Disorder Scale (GAD-7) and depression by Patient Health Questionnaire (PHQ-9). Demographic and clinical variables were collected. Results: The degree of malnutrition of the children at admission and discharge was: mild (3.6% v 31.7%), moderate (37.7% v 26.3%), severe (58.7% v 8.4%), and no malnutrition (0.0% v 33.5%) (p<0.001). At admission, 12% of mothers had anxiety, depression, or both, which decreased to 3.0% at the time of discharge. There was no difference in malnutrition scores among children of mothers with or without anxiety/depression at admission or discharge, except that children of depressed mothers continued to have significantly greater levels of malnutrition at discharge compared with the mothers without depression. Maternal anxiety or depression was not associated with the severity of malnutrition. Conclusions: A proportion of mothers of children with malnutrition had clinical anxiety and depression; and maternal mental health concerns, especially depression may influence the nutrition of children. It is imperative to explore maternal mental health routinely for malnourished children. Keywords: Anxiety; children; depression; malnutrition; mothers.
Clinical Outcome for Lumbar Disc Herniation Treatment with Intradiscal Oxygen-ozone Therapy
Authors: Yadav Rupesh Kumar , Sherpa Tshering , Hamal Pawan Kumar , Pokhrel Nabin , Thakur Jay Prakash , Amatya Shirish Prasad , Piya Roshan
Published: November 2024

Background: Low back pain due to disc herniation is a common problem causing frequent hospital visits and loss of working days with major socio-economic impact. Conservative treatments like analgesics, physiotherapy do not work in all patients. Surgical treatment has been main stay of treatment when indicated but is associated with anesthetic and surgical complications. Intradiscal oxygen-ozone chemonucleolysis is minimum invasive procedure done under local anesthesia and has promissing role in shrinking the bulged disc and reducing nerve root compression and related symptoms. This retrospective study was done to see how intradiscal oxygen-ozone chemonucleolysis reduces the pain severity in patient with discogenic low back pain.Methods: Retrospective data were retrieved of those patients who underwent fluoroscopy guided intradiscal oxygen-ozone chemonucleolysis with 5-6 ml of an O2-O3 mixture (concentration of 30 microgram/ml) during the period of two years in Nepal pain care and research center. Numerical pain scale (NRS) at various follow ups were compared to preprocedural NRS.Results: Preprocedural NRS was 8± 1. NRS at three hours, one week, one month, three months and six months were 2± 0.3 (73.44 percent reduction), 2.5± 2 (68.85 percent reduction), 2.3± 2 (72.13 percent reduction), 1.8± 1.7 (77.87 percent reduction) and 1.67± 1.4 (79.51 percent reduction) respectively.Conclusions: Intradiscal oxygen-ozone chemonucleolysis can be useful modality of treatment for discogenic low back pain when failed to respond to the conservative management and in whom surgery is not indicated. Keywords: Chemonucleolysis; disc prolapse; fluoroscopy; low back pain; ozone.
Fetomaternal Outcome of Pregnant Women at Term Undergoing Cesarean Section
Authors: Bharati Sonu , Dangal Ganesh , Tiwari Kenusha Devi , Maharjan Sunita , Bhandari Srijana , Karki Aruna , Pradhan Hema Kumari , Shrestha Ranjana , Bhattachan Kabin
Published: November 2024

Background: Cesarean section is one of the most common procedures performed in obstetric practice today and is a lifesaving surgery for mother and fetus. Cesarean sections are classified traditionally, as elective cesarean section or emergency cesarean. The purpose of this study is to compare the maternal and neonatal outcomes in elective and emergency cesarean section so that measures can be taken to reduce maternal and neonatal morbidity and mortality.Methods: A descriptive study including 400 pregnant women who underwent caesarean section were included in this study. Patients were subjected to elective or emergency cesarean section as per the indication and protocol of institute. were included in the study.Results: During the study period there were total 1080 deliveries. The average age of the women was 29.21±4.07 years. Of the 400 cesarean section cases, only 2.8% had wound infection, 3.8% had fever, 4.8% urinary tract infection (UTI) whereas no women had observed with post-partum hemorrhages (PPH) and maternal death. Regarding fetal outcome, neonatal intensive care unit (NICU) admission was observed in 16%, birth asphyxia was 2.3% poor Apgar score 2.5% and neonatal death was not observed. Rate of fever, UTI, wound infection, need of resuscitation and poor Apgar score was significantly high in emergency section than elective caesarean section whereas NICU admission was not statistically significant. The most common indication of emergency cesarean section were fetal dress and for previous LSCS. Conclusions: Emergency cesarean was associated with increased maternal and perinatal complications than in elective cesarean section.Keywords: Caesarean section; elective caesarean section; emergency caesarean section; neonatal morbidity and mortality.
Cutaneous Lymphoma in a Tertiary Skin Hospital and Referral Centre in Nepal
Authors: Adhikari Ram Chandra , Shah Mahesh , Kempf Werner , Jha Anil Kumar
Published: November 2024

Background: Primary cutaneous lymphomas are a distinct group of rare lymphoid neoplasms with absence of extracutaneous lymphomas at the time of presentation. They are rare in Nepal and no data on cutaneous lymphoma have been published from this country till date.Methods: This retrospective study included 15 cases of cutaneous lymphomas retrieved from the records of department of Dermatopathology, DI Skin Hospital and Referral Centre, Bansbari, Kathmandu, Nepal. Patients were diagnosed according to the current WHO classification for cutaneous lymphoma. Results: A total of 15 cases were studied with median age of 45 years (range: 22 to 81 years) and male to female ratio of 1.5:1. Primary cutaneous lymphomas constituted 13 cases out of 15 and the most common type of cutaneous lymphoma was mycosis fungoides and variants 5 (33%), followed by CD30 positive primary cutaneous anaplastic large cell lymphoma constituting 2 (13%). T-cell cutaneous lymphoma constituted 13 (87%) and B-cell cutaneous lymphoma 2 (13%). Conclusions: Cutaneous T-cell lymphomas were more frequent than cutaneous B-cell lymphomas in Nepalese patients. Mycosis fungoides and variants are commonest type of primary cutaneous lymphomas. Keywords: Histopathology; mycosis fungoides; primary cutaneous t-cell lymphoma; WHO classification.
Knowledge, Practice and Factors associated with Utilization of Cervical Cancer Screening Services
Authors: Bhattarai Nancy , Bajracharya Siddhi Laxmi
Published: November 2024

Background: Cervical cancer is treatable with regular screening and follow-up practices. The utilization of cervical cancer utilization services is found to be unsatisfactory in the context of Nepal. The objective of this study was to assess the factors that influence knowledge, practice, and utilization of cervical cancer screening among women in the Dhulikhel Municipality, Nepal.Methods: A cross-sectional study was conducted on 156 married women residing in Dhulikhel Municipality. The study participants were selected using the convenience sampling method. A standard questionnaire was used to collect the information. This study examined socio-demograhic data, knowledge, practice, and factors associated with cervical cancer screening. Descriptive and inferential statistics were used to analyze the data.Results: Only one-fifth (17.9%) of the participants had received a cervical cancer screening. Most participants possessed a sufficient level, 134 out of 85.9%, of information about cervical cancer and cervical cancer screening. Annual healthcare visits (p=0.00), participant knowledge (p=0.014), and perceived barriers (p=0.001) were statistically significant factors in the uptake of cervical cancer screening. Out of those who felt they were highly susceptible, just one-fourth, or 25%, had undergone cervical cancer screening services.Conclusions: The number of medical visits, participants' knowledge, and perceived barriers had a significant impact on the uptake of cervical cancer screening. However, there was not found any relationship between the use of cervical cancer screening and perceived susceptibility and other socio-demographic factors.Keywords: Cervical cancer; cervical cancer screening; perceived barriers; perceived susceptibility.
Clinical Characteristics of Proliferative Diabetic Retinopathy and Outcome of Pars Plana Vitrectomy in Proliferative Diabetic Retinopathy
Authors: Thapa Raba , Sharma Sanjita , Pradhan Eli , Duwal Sushma , Paudyal Govinda
Published: November 2024

Background: Proliferative diabetic retinopathy is a leading cause of blindness among people with diabetes. The study aimed to assess the clinical characteristics of proliferative diabetic retinopathy and outcome of pars plana vitrectomy in Proliferative diabetic retinopathy. Methods: A prospective study was conducted from September 2019 to December 2021 among consecutive cases of proliferative diabetic retinopathy who underwent pars plana vitrectomy at a tertiary eye care center. Study was conducted after ethical approval from Institutional Review Committee. Detailed systemic and ocular history, visual acuity, ocular findings under mydriasis, surgical procedures, and outcome following pars plana vitrectomy were recorded. Cases were followed up regularly until one year after the pars plana vitrectomy. Results: Total of 83 cases (89 eyes) of proliferative diabetic retinopathy were enrolled in the study. The mean age was 53 years ±9.7 SD, ranging from 26 years to 72 years. Males comprised of 62.7% cases. Type two diabetes comprised of 94% of cases. Indications for pars plana vitrectomy were; mixed vitreous hemorrhage and tractional retinal detachment (38.2%), non-clearing vitreous hemorrhage (38.1%), and tractional retinal detachment only (24.7%). Pre-operative intra-vitreal anti-vascular endothelial growth factor was given in 78.65% eyes and pan retinal photocoagulation in 58.42% eyes. The anatomical success was achieved in 95.5% eyes, visual improvement in 68.54%, static in 14.6% and worsened in 16.86% of eyes. About 15.7% of eyes had some form of post- operative complications.Conclusions: Vitreous hemorrhage with tractional retinal detachment, persistent vitreous hemorrhage and tractional retinal detachment involving macula were the common indication of pars plana vitrectomy among cases of Proliferative diabetic retinopathy. Anatomical success and visual acuity improvement can be achieved in majority of the eyes following PPV in Proliferative diabetic retinopathy. Keywords: Anatomical outcome; pars plana vitrectomy; proliferative diabetic retinopathy; visual outcome.
Obstetric Characteristics and Functional Outcomes in Women with Obstetric Anal Sphincter Injury
Authors: Adhikari Shree Prasad , Poudel Sandesh , Baidhya Sapana Amatya , Yadav Manisha
Published: November 2024

Background: Obstetric anal sphincter injury is a complication of vaginal delivery, if left untreated, causes significant maternal morbidities; urinary problems and fecal/ flatus incontinence. The aim of this study was to determine the incidence and describe the obstetric characteristics and functional outcomes of women who had vaginal delivery at Paropakar Maternity and Women’s Hospital Nepal and sustained Obstetric anal sphincter injury. Methods: This retrospective descriptive study included women who had vaginal delivery, irrespective of parity, in the labor room or birthing unit of Paropakar Maternity and Women’s Hospital from April 2018 to September 2020, and sustained Grade III or IV Obstetric anal sphincter injury after 28 weeks period of gestation. Maternal characteristics, obstetric details and perineal status after vaginal delivery were noted after review of hospital records. The patients were further inquired via telephone for their current status of fecal and/or urinary incontinence. Results: The incidence of OASI was 106 (0.33%) among 31, 786 Nepalese women with vaginal birth over a 2-year period. The mean age women with Obstetric anal sphincter injury was 24.6 ± 4.3 years and 45(52.9%) cases belonged to Janajati ethnicity. Fifty two (61.2 %) were primipara and 77 (90.6%) had spontaneous vaginal deliveries. Episiotomy was not performed on most of the patients (63, 74.1%). Problems with flatus holding, stool holding and urine holding was reported by 28.3%, 13.2% and 22.6% women respectively.Conclusions: The incidence of Obstetric anal sphincter injury among Nepalese women with vaginal birth over a 2-year period was 0.33%, which was lower than other South Asian studies. Grade III Obstetric anal sphincter injury was the frequent most type. The injuries were more common in women with Janajati ethnicity, primipara and women who did not have episiotomy. Problems with flatus holding and urine holding were present in almost one-fourth of the women with Obstetric anal sphincter injury at follow up.Keywords: Augmentation; episiotomy; induction; obstetric anal sphincter injury.
Clinical Profile of Thoracoscopic Bullectomy in Treatment of Pneumothorax
Authors: Gautam Pratima , Sapkota Ranjan , Shrestha Suraj , Mainali Prakash
Published: November 2024

Background: In pneumothorax patients requiring surgery for various indications, thoracotomy was the traditional approach until the advent of video-assisted thoracoscopic surgery. In the last decade, role of thoracoscopy in the surgical management of pneumothorax has been consolidated and established. In this study, we aim to report our experience of thoracoscopy in the surgical management of pneumothorax.Methods: A descriptive review of prospectively maintained data on all the patients undergoing thoracoscopic bullectomy for pneumothorax was done.Result: Over the period of 9 years, a total of 120 patients underwent thoracoscopic bullectomy. Among them, 95 entered final analysis. Most common age group was 21-40 years, with male predominance (80%); most common diagnosis was primary pneumothorax (67%), first episode (74%), and on the right (65%) side; commonest symptom was shortness of breath (84%) of a median duration of 7 days. A chest tube was placed in 96% of patients before the operation. Commonest radiological finding was multiple bullae (45%) in the apical region (71%). Majority of patients underwent surgery via 3 ports, and a single bulla in the apical region was the most common intraoperative finding. Among the postoperative complications which occurred in 17%, an air leak was present in 9%. The median intensive care stay was 23 hours, the median chest tube duration was 3 days, and the median hospital stay was 9 days.Conclusions: Thoracoscopy can be used as a safe, feasible, and effective procedure in patients presenting with pneumothorax with minimal postoperative complications. Keywords: Bullectomy; pneumothorax; video-assisted thoracoscopic surgery.
Epidemiological and Spatial Distribution of COVID-19 Morbidity and Mortality in Nepal
Authors: Poudyal Amod Kumar , Shakya Karuna Laxmi , Sapkota Vishnu Prasad , Paudel Rajan , Myia Salau Din , Pradhan Pranil Man Singh , Upadhyaya Dipak Prasad , Joshi Naresh , Shrestha Shital
Published: November 2024

Background: The Coronavirus (SARS-CoV-2) infection termed as COVID-19 was first detected in Wuhan, Hubei Province of China, in December 2019 and has been declared as a pandemic by the World Health Organization on January 30, 2020. The study aims to understand the time, place and person distribution of covid-19 morbidity, mortality of COVID-19 in Nepal.Methods: The analysis produces the descriptive epidemiological features of COVID-19 pandemic in Nepal. The data was analysed to produce disaggregated case rate and case fatality rate across various time, place and personal characteristics aggregated at national and subnational levelResults: The study found that the observed case rate was significantly higher among males compared to females. Similarly, case rate was the highest among males of 31-40 years and females of 51- 60 years. Case fatality rate increased with age group. Above the age of 41-50 years, case fatality rate was higher among males compared to females. We observed that case fatality rate was disproportionately concentrated among the poor districts in terms of GDPConclusions: The observed case rate is significantly higher among males compared to females, however case fatality rate increased with age group. Case rate was found the highest in the Bagmati province followed by the Gandaki Province. However, case fatality rate was found the highest in hilly and mountain districts of Province 1, Gandaki and Karnali. Case fatality rate was disproportionately concentrated among the poor districts in terms of GDP. Keywords: COVID19; morbidity; mortality; Nepal.
Comparison of Recovery Rate of Otomycosis using One-Percent Gentian Violet and One-Percent Clotrimazole Topical Treatment
Authors: Dhakal Srijana , Bagale Gyanendra , Nepal Ajit , Yadav Deepak , Khadka Chetan , Joshi Deepa
Published: November 2024

Background: Otomycosis is a fungal infection of external auditory canal with worldwide prevalence of 9% to 30%. Treatment includes elimination of predisposing factor, thorough canal cleaning and topical or systemic antifungal agents. Clotrimazole is a specific topical antifungal agent with effectiveness varying from 95% to 100%. Gentian violet is an aniline dye and its use as antifungal has been mentioned in literature with effectiveness up to 80%. This study was aimed at comparing the effectiveness of these two commonly used treatments in otomycosis.This is a conducted in Department of ENT-HNS, Patan Academy of Health Sciences, Lalitpur, Nepal over one-year period after approval from institutional review committee. Patients with otomycosis were randomized into arm A and arm B group. Arm A patients were treated with one percent clotrimazole topical drops. Patients in Arm B were treated with application of one percent Gentian Violet paint.Effectiveness was measured on the basis of clinical response and recovery at end of second week. Data analysis was done with Epi Info application. Chi-square test was used and p-value less than 0.05 was considered significant.Results: Total 90 patients were treated for otomycosis over one year. Recovery was better in clotrimazole group at second week i.e., 86.84% vs 71.43%.Conclusions: Clotrimazole was more effective in treatment of otomycosis compared to Gentian Violet paint, though the result was not statistically significant.Keywords: Antifungal agent; external auditory canal; otalgia.
Status of Abortion-Related Stigma in Nepal using Stigmatizing Attitudes, Beliefs, and Actions Scale
Authors: Ghimire Jagadishwor , Lal Bibek Kumar , Mehata Suresh , Joshi Nisha Kumari , Timilsina Amit , Lamichhane Kritee , Phuyal Parash Prasad , Dotel Bhogendra Raj , Gautam Manish , Maharjan Sanju , Karki Sujan
Published: November 2024

Background: Despite substantial improvements in the accessibility of safe abortion services nationwide, a noticeable underutilization of these services persists, primarily attributable to the presence of social stigma. This stigma leads to discrimination, abuse, and poor healthcare. This study aims to understand and address abortion stigma among Nepali women of reproductive age.Methods: This cross-sectional study involved 2286 women of reproductive age across Nepal. SABAS was used to measure abortion stigma, which includes 18 questions. Quantitative data was collected through face-to-face interviews using structured questionnaires on kobo collect. Stata 15.0 software was used for data analysis.Results: The mean SABAS score was 46.5 out of 90, indicating moderate abortion stigma in Nepal. Negative stereotypes and beliefs about abortion were more prevalent, with over 80% believing a woman's health deteriorates after abortion. Discrimination tendencies were lower, with less than 10% endorsing teasing, pointing fingers, or disgrace. Fear of contagion was also relatively low, with less than 20% agreeing that women who had abortions made others ill. Factors such as age, caste/ethnicity, education, marital status, wealth, and provinces were associated with varying levels of stigma, and women of higher age group, Madhesh, Dalit, Muslim, lower education levels, widowed, poor, Madhes province were linked to higher stigma scores. The study found that stigma levels varied among different groups.Conclusions: The stigma level on abortion is higher in upper age group, Madheshi, Dalit, Muslim, lower education levels, widowed, poor, Madhesh province women in Nepal. Similarly, the negative stereotype and discrimination and exclusion is also high while the fear of contagion is low among Nepalese women and girls.Keywords: Abortion-related stigma; attitudes; Nepal.
Assessment of fluoride level in drinking water sources in Sudurpaschim Province, Nepal
Authors: Joshi Naresh Prasad , Joshi Jagadish , Singh Abanish
Published: November 2024

Background: Fluoride, a naturally occurring element found in varying concentrations in water, confers preventive effects in dental caries around a concentration of 1 ppm. The study aimed to assess the level of fluoride in drinking water sources in the Sudurpashchim Province of Nepal.Methods: A cross-sectional study was conducted from April to July 2023 with water samples from natural, municipal, and packaged sources collected in polypropylene plastic bottles from all 9 districts of the province. Three samples from each district's two most populous municipalities (one urban and one rural municipality) were taken. Water samples from the only sub-metropolitan city in the province (Dhangadhi) were also included. Fifty-seven samples were sent to a Nepal Standard-certified lab in Kathmandu for fluoride estimation using the American Public Health Association-approved method. Data were entered in Microsoft Excel and analysed using the Statistical Package for Social Sciences v 22. A p-value less than 0.05 was taken as significant. Results: Most of the water samples had fluoride levels below 0.1 ppm. The highest fluoride concentration was seen in a sample from a hand pump in the rural municipality of Kanchanpur (0.9 ppm). No significant differences were observed between water samples according to different water sources, geographical regions, or categories of water resources.Conclusions: Fluoride concentration in water sources of Sudurpashchim is well below the recommended level for caries protection. Measures should be taken to ascertain people get adequate fluoride as needed.Keywords: Fluoride; Nepal; sudurpashchim; water fluoridation; water sources.
Post-partum Symphysis Pubis diastasis
Authors: Rai Sangam , Pradhan Peru , Dangal Ganesh , Shrestha Sona , Rajbhandari Subrina , Yadav Ranjana , Shah Ranjana , Sherpa Sona , Ansari Rawab
Published: November 2024

Pubic symphysis is a non-synovial joint, made up of a fibrous cartilage disc connecting the two sides of pubic rami in the midline. During pregnancy under the influence of hormones particularly relaxin, the gap increases by 2 to3mm. When the diameter is more than 10 mm, it is considered as pubic symphysis diastasis. Pregnancy and childbirth are the most common causes of pubic symphysis diastasis followed by traumatic causes. Women with post-partum symphysis diastasis present during puerperium with inability to bear weight owing to severe supra-pubic and groin pain. They have complaint of severe excruciating pain while standing up or to perform any movement involving hip abduction. For the diagnosis, proper history regarding delivery should be sought followed by physical examination and radiological imaging. Most cases can be treated with conservative management which includes- use of analgesia and anti-inflammatory medicines for the pain management and stabilization of pelvis using brace/pelvic belt. Some may benefit from physiotherapy. In extreme cases, operative fixation may be required with the involvement of orthopedic surgeon.Keywords: post-partum symphysis diastasis; pubic symphysis; rare presentation.
Short-Term Outcome of Patients in Delirium at Medical Intensive Care Unit
Authors: Khatri Roshni , Dhungana Saraswati , Ojha Saroj Prasad , Khatri Sushila , Khadka Santosh , K.C. Prakash
Published: November 2024

Background: Delirium is highly prevalent in the Intensive Care Unit (ICU), and managing it in critically ill patients with severe comorbidities is challenging due to transient nature of symptoms. However its significance is underestimated, often overlooked and misdiagnosed by healthcare providers. In Nepal, limited studies has been done on delirium in medical ICUs hence this study aims to assess short-term outcome of admitted patients in delirium.Methods: Descriptive cross-sectional observational study was conducted among 92 patients referred from medical ICU with history of disorientation and altered sensorium, assessed during consultation liaison and meeting the criteria for delirium. Data were collected using semi-structured proforma. Richmond Agitation Sedation Scale and Delirium Rating Scale-Revised 98 were used to know the pattern and severity of delirium at day 0 and seven respectively and phone follow-up was done at three months. Data were tabulated and analyzed using SPSS version 25.0.Results: Hyperactive delirium (57.6%) was most common in medical ICU. Out of total patients, 63.2% improved, 23% became worse and 13.8% remain static with treatment. Mean length of hospital stay was 11.1 days. Hypoactive delirium was associated with longer hospital stay and increased mortality. Significant association was found between length of ICU stay and outcome in terms of mortality and response to treatment. Conclusions: Study underscores the prevalence of hyperactive delirium as the predominant pattern in MICU settings. However, it is crucial to highlight the significance of hypoactive delirium due to its poor treatment response and prolonged ICU stays compared to other forms. Keywords: Delirium; length of ICU stay; mortality pattern; outcome.
Intraoperative Variations of the Gastrocolic Trunk of Henle noted in Gastrointestinal Surgeries
Authors: Ghimire Roshan , Thapa Nishant , Acharya Bidur Prasad , Sah Bed Prakash , Limbu Yugal , Regmee Sujan , Maharjan Dhiresh Kumar , Thapa Prabin Bikram
Published: November 2024

Background: The gastro-colic trunk of Henle is a venous trunk that comprises the veins draining the stomach and colon and is an important landmark for various gastro-intestinal surgeries. Understanding the anatomy of these vessels may enhance the surgical outcome. The aim of this study is, to assess the Intraoperative variations of the Gastrocolic Trunk of Henle noted in gastrointestinal surgeries in a tertiary care center.Methods: A descriptive cross-sectional study was conducted at Kathmandu Medical College Public Limited, a tertiary center in Nepal during the period of one year (1st January 2022, to 31st December 2022). All patients undergoing right hemicolectomy, gastrectomy, and pancreaticoduodenectomy were included in the study. Based on per-operative findings, the type of The gastro-colic trunk of Henle was noted during surgery.Results: A total of 49 patients underwent the above-mentioned surgeries during the study period. The gastro-colic trunk was found in 45 out of the 49 patients intraoperatively (91.84%), and the variations were distinguished. The most common configuration noted was the union of the right gastro-epiploic vein, the anterior superior pancreaticoduodenal vein, and the superior right colic vein (Type I), which was noticed in 46.67% of the patients.Conclusions: The intraoperative identification of the anatomy of The gastro-colic trunk of Henle is challenging because of its variable combinations of tributaries. Knowledge of variations in The gastro-colic trunk of Henle is important in preventing intraoperative bleeding, and during identification, the meticulousness of surgery is redefined.Keywords: Gastrocolic trunk of Henle; hemicolectomy; venous drainage.
Comparison of Surgical Outcomes Following Percutaneous Pedicle Screw Fixation and Traditional Open Pedicle Screw Fixation for Thoracolumbar Fractures Without Neurological Deficit
Authors: Paudel Kumar , Lamichhane Somraj , Jha Rajiv
Published: November 2024

Background: Traumatic thoracolumbar fractures are frequently encountered in blunt trauma patients. The Open pedicle screw fixation has been proven to be effective in stabilizing fractures, deformity correction, early mobilization and improving long term quality of life of patients with thoracolumbar fracture. Percutaneous pedicle screw fixation is a minimally invasive approach that minimizes the tissue injury, enhances early recovery and facilitates rehabilitation program. Objectives: To compare the surgical outcomes of percutaneous versus open pedicle screw fixation for thoracolumbar fractures without neurological deficit. Single center, Prospective, Comparative studyMethods: A total of 34 patients with thoracolumbar fractures with intact neurology were treated with either percutaneous or open pedicle screw fixation between February 1st 2023 to March 1st 2024 at the National trauma center , Kathmandu. There were 17 patients in each group. The perioperative clinical and radiological parameters were collected using a preformed pro forma. Postoperatively follow-up was conducted at post op day 1, during discharge and 3 months. The clinical and radiological outcomes of percutaneous and open pedicle screw fixation were analyzed and compared.Results: This study included 24(70.6%) males and 10(29.4%) females. The mean age was 40.73 Â±15.44 years. There was a statistically significant difference between percutaneous and open pedicle screw with regard to intraoperative blood loss, fluoroscopy time, operative duration, deambulation day and overall hospital stay (p<0.05). Overall, there was a statistically significant improvement in overall pain perception at discharge and three month follow up in both groups. The kyphosis correction in percutaneous group was similar to open pedicle screw fixation technique (mean cobbs angle correction of 4.7 degree).Conclusions: The percutaneous approach has several advantages over the open pedicle screw fixation with regard to less intraoperative blood loss, less postoperative pain, early deambulation, no was a statistically complications and shorter hospital stayKeywords: Open pedicle screw; percutaneous pedicle screw fixation; thoracolumbar fracture.
Mapping the Health and Medical Research Excellence in Nepal: A Study of High-Cited Papers During 1994-2023
Authors: Vaishya Raju , Gupta Brij  Mohan , Mamdapur Ghouse Modin Nabeesab , K.S. Ali , Vaish Abhishek , Joshi Pramod , Hamal Pawan Kumar
Published: November 2024

Background: A bibliometric analysis was performed to map the current status and development trends in medical research in Nepal. It aims to visualize research hotspots within this field and provide effective guidance for future research directions.Methods: A systematic search of the Scopus database was performed to identify high-cited papers (HCPs) on medical research in Nepal between January 1, 1994, and December 31, 2023. Bibliometrics techniques were applied to analyze the publication dates, countries, institutions, journals, authors, and research hotspots. Statistical analysis and visualization were carried output by MS-Excel and VOSviewer software.Results: A total of 326 HCPs were identified that have received 100 to 10719 citations and registered 223.05 Citations Per Paper (CPP). The 47.54% and 95.40% share of the 326 HCPs have received external funding support and are involved in international collaboration, respectively. The 15892 (417 from Nepal) authors, affiliated to 12830 (177 from Nepal) organizations and published in 138 journals participated in 326 HCPs from Nepal. USA (60.45% share) and India. (51.45% share) were the most collaborative countries, while Spain (1609.15 CPP) and Mexico (1597.08 CPP) made the largest citation impact in collaboration with Nepal. C.L. Ranabhat (n=27) and B. Sathian (n=26) were the most productive authors, while D. Acharya (3652.29 and 16.5), and S. Bhattarai (2880.11 and 13.01) registered the highest citation impact (CPP and RCI). Tribhuvan University, Kathmandu (n=72) and Nepal Health Research Council, Kathmandu (n=34) were the most productive organizations, while Kathmandu University (3652.29 and 16.5) and Nepal Academy of Science and Technology, Lalitpur (2941.67 and 13.29) registered the highest citation impact (CPP and RCI). The Lancet (n=75) and British Medical Journal (n=11) were the most productive journals, while The Lancet Neurology (1749.5 CPP), and The Lancet (1371.13 CPP) registered the highest average citations impact. B. Basnyat has the most citation as first author in health and medical research.Conclusions: The present study offers an overview of research characteristics and trends of medical research output in Nepal. It identifies main contributors, core journals, and significant subject topics. The study hopes to assist researchers and practitioners in comprehending the development and trends of medical research in Nepal and discovering potential directions for future research. Keywords: Bibliometric methods; citations; collaboration; high-cited papers; medical research.
Unintended Consequences: A Critical Analysis of Nepals Rape Law Reform and Its Impact on Juvenile Justice
Authors: Atreya Alok , Acharya Apurba , Paudel Sudip , Nepal Samata
Published: November 2024

The increase of the age of consent to 18, with the Muluki Penal Code that came into effect in 2017, created an unintended burden on the juvenile justice system in Nepal. The amendment, drafted to protect minors from sexual exploitation by adults, resulted in the criminalisation of consensual relationships between adolescents. The surge of inmates aged 16 to 18 years is leading Nepal into a crisis in its juvenile correction centres, with overcrowded facilities, decrepit conditions, and increased violence. This crisis was underlined by three deaths in juvenile correction centres at Bhaktapur, Parsa, and Banke up to September 2023. This article explores the legal, social, and ethical dilemmas generated by Nepal's reforms of rape law and advocates for a more nuanced approach in safeguarding vulnerable populations without moralising normal adolescent sexual conduct. This approach is based on the consideration of pending challenges for the juvenile justice system and the development of strategies to reconcile child protection goals with the realities of adolescents' relationships.Keywords: Informed consent; juvenile delinquency; Nepal; rape.
Capacity Building at Nepal Health Research Council for Ethical Research
Authors: Adhikari Ramesh Kant , Ghimire Namita , Joshi Pramod
Published: November 2024

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Assessment of Antenatal Care Services Utilization and Its Associated Factors
Authors: Paudel Nabaraj , Paneru Damaru Prasad , Pahari Sandip , Poudel Arati , Sharma Yam Prasad
Published: November 2024

Background: Every pregnant woman supposed to have Antenatal care visits at least four times during 4th, 6th, 8th and 9th month of gestation. This contributes to the reduction in maternal mortality. The main objective of the study was to assess the utilization of antenatal care services and its associated factors in Pokhara Metropolitan.Methods: A community based cross-sectional analytical study was conducted in Pokhara Metropolitan between 16th May 2019 to 30th June 2019 among 325 mothers using probability proportional to size sampling and face to face interview. Ethical approval was obtained from Nepal Health Research Council. Data analysis was done using SPSS version 22 and Chi-square test and binary logistic regression analysis was performed. Results: A total of 97.2 percent mothers had at least one time visit for ANC checkup while 88.6 percent mothers received four ANC visits as per protocol. A total of 94.6 percent mothers got counseling on early detection and management of complications, 95.9 percent consumed iron and folic acid and 94.3 percent consumed de-worming tablets. Mothers health literacy mobile phone ownership (AOR=11.26, 95% CI: 9.70-13.03), husbandâ€™s attitude towards ANC (AOR=6.71, 95%CI: 1.60-28.10), awareness on pregnancy complications (AOR=4.62, 95% CI: 2.53-21.73), and which isdecision making on household expenditure by self (AOR 8.57%, 95% CI: 3.64-9.48) history of abortion (AOR=5.22, 95%CI: 1.71-15.30) were the factors associated with ANC service utilization. Conclusions: Majority of the pregnant women were found to be utilizing ANC services. Mobile phone ownership, health literacy, husband's attitude towards ANC, decision making on household expenses, awareness on pregnancy complications and history of abortion were the significant factors associated with ANC service utilization.Keywords: Antenatal care; factors associated; Pokhara; utilization.
Maternal and Neonatal Factors Associated with Neonatal Mortality: a Prospective Follow-up Study in Selected Hospitals of Nepal
Authors: Yadav Dilip Kumar , Shukla Girija Shankar , Gupta Neena , Shrestha Naveen , Singh Jitendra Kumar , Kaphle Hari , Yadav Pratima , Yadav Dipendra Kumar
Published: November 2024

Background: Neonatal mortality, a sensitive indicator which indicates the availability, utilization, and effectiveness of maternal and child health services in the community, are major global public health challenges. The objective of the study was to find out the maternal and neonatal factors associated with neonatal mortality in selected hospitals of Nepal.Methods: This was a hospital based prospective follow up study conducted among babies nested for case control study design. Among 1104 babies, 368 babies with LBW and 736 babies with normal birth weight were followed up after 28 days of birth and mortality was assessed. Results: Neonatal mortality was about 10/1000 live birth. In multivariable logistic regression analysis, father with no formal education [AOR:12.54, 95% CI:(2.61-60.13), p=0.002], multi parity [AOR:11.26, 95% CI:(1.25-100.89), p=0.030] and depressed (<7) APGAR score at 5 minutes of birth[AOR:7.44, 95% CI:(1.18-46.80), p=0.032] were significantly associated with neonatal mortality. Conclusions: The study identified â€˜father with no formal education, multi parity and low APGAR score at 5 minutes of birthâ€™ as the major contributors to neonatal mortality. Improving parental education, and access to child health care will help to improve neonatal outcome.Keywords: Maternal factors; neonatal factors; neonatal mortality; Nepal.
Understanding the Knowledge, Attitude, Practice and Intention regarding Abortion among Federal and Provincial Policymakers
Authors: Bajracharya Madhabi , Gyawali Nisha , Bhattarai Tejaswee , Joshi Shipra , Devkota Jivan , Devkota Bishnu , Rai Jayashree , Tandukar Samasti , Timilsina Amit , Dangol Deeb Shrestha
Published: November 2024

Background: For more than two decades abortion is legalized in Nepal, recognizing unsafe abortion as one of the leading but preventable cause of maternal morbidity and mortality. To safeguard safe abortion as womenâ€™s rights, several policies, guidelines, training manuals have been developed along with training human resources and increasing access to abortion services across Nepal. However, access to safe abortion services remains a challenge. Hence, to unravel the possible reasons behind these challenges, this study explored the knowledge, attitudes, practices and intentions of policymakers of Nepal towards abortion.Methods: Mixed methodology was used incorporating self-administered questionnaire for quantitative data collection and semi-structured interview guidelines to interview twenty local leaders from federal and provincial level, identified through purposive sampling. The ethical approval was taken from Nepal Health Research Council prior to data collection. After transcription and translation to English, Dedoose application was used for qualitative thematic analysis while the quantitative data was analysed using SPSS version.â€¯Results: 70% understand that international health and human rights frameworks support abortion. Also, a majority (85%) believe that policies limiting abortion access create negative attitudes toward abortion. All the participants mentioned that they possess a good knowledge of safe abortion services. Majority of the participants had good attitude, confident in advocating, and had positive intention towards safe abortion services. However, existing socio-cultural barriers, lack of awareness, legal barriers and maintaining privacy were identified challenges to seek safe abortion and related services.Conclusions: Despite strong positive intentions, policy implementation gaps and lack of accountability have resulted in poor awareness, access, and acceptability of abortion related services. Further budget allocation, safe abortion prioritization, continuous advocacy, integration of abortion in preservice curriculum and community engagement and awareness will bridge these gaps â€“ to ensure equitable access to quality services including women and girls from marginalized community and adolescents. Keywords: Intention; knowledge; policy gaps; policymakers; safe abortion.
Prevalence of Caudal Block and Duration of Analgesia of Caudal Dexmedetomidine Adjunct in Pediatric Lower Abdominal Surgery
Authors: Baral Bidur Kumar , Poudel Puspa Raj , Shah Malla Sadichhya
Published: November 2024

Background: Caudal block is a commonly used method of postoperative pain management in children. However, single shot caudal block has shorter duration of analgesia that can be extended by addition of adjuncts like opioids, clonididine, and dexmedetomidine along with local anesthetics. Recently, dexmedetomidine has been used as an adjunct for prolonging the duration of analgesia. This study aimed to find out prevalence of the caudal block and the duration of analgesia with dexmedetomidine adjunct among children undergoing lower abdominal surgeries.Methods: A cross-sectional, observational study was conducted among the children admitted to the tertiary care children hospital of Nepal during the period of six months. Children of age 2 to 7 years, who had undergone lower abdominal surgeries under general anesthesia were enrolled in the study. We observed the prevalence of the caudal block and duration of analgesia of caudal dexmedetomidine with ropivacaine Results: Throughout the study period, 449 children were posted for lower abdominal surgeries. Out of which 226 children (50.03%) received caudal block. Among the caudal block, 51 children (22.56%)) were administered ropivacaine with dexmedetomidine, 45 children (19.91%) received ropivacaine alone, 43 children (19.02%) were given bupivacaine alone, 46 children (20.35%) received a combination of bupivacaine and fentanyl, and 41 children (18.14%) received bupivacaine and dexmedetomidine. Dexmedetomidine with ropivacaine provides 840.35Â±14.97 minutes of postoperative pain relief. Conclusions: The prevalence of the caudal block was 50.03%, and the combination of Dexmedetomidine with ropivacaine provides longer duration of postoperative analgesia. Keywords: Analgesia; caudal block; children; prevalence.
Pengaruh Latihan Shooting Dengan Bola Bergerak Terhadap Tingkat Ketepatan Shooting Siswa Putra Ekstrakurikuler Futsal SMP Nurul Huda Kota Bengkulu
Authors: Akbar Refo , Pujianto Dian , Prabowo Andika , Afrillian Arrendi , Muslimah Ningrum Nurul Fajar
Published: November 2024

Penelitian ini bertujuan untuk mengetahui pengaruh Latihan Shooting Dengan Bola Bergerak Terhadap Tingkat Ketepatan Shooting Siswa Putra Ekstrakurikuler Futsal SMP Nurul Huda Kota Bengkulu. Penelitian ini mengacu pada pendekatan penelitian kuantitatif dengan jenis penelitian yang digunakan adalah eksperimen. Populasi dalam penelitian ini berjumlah 25 siswa dan sampel penelitian menggunakan total sampling yakni sebanyak 25 siswa. Instrument yang digunakan adalah tes ketepatan shooting. Hasil pengujian menunjukkan bahwa ada Pengaruh Latihan Shooting Dengan Bola Bergerak Terhadap Tingkat Ketepatan Shooting. Uji hipotesis menunjukkan nilai t hitung 5.68 > t tabel 1.711, sehingga hal tersebut menunjukkan Ho ditolak dan Ha diterima yang berarti bahwa ada pengaruh yang signifikan terhadap peningkatan ketepatan shooting setelah diberi perlakuan dengan metode latihan shooting dengan bola bergerak.
ABSTRACT
This study aims to determine the effect of shooting exercises with moving balls on the level of shooting accuracy for male students in extracurricular futsal at Nurul Huda Middle School, Bengkulu City. This study refers to a quantitative research approach with the type of research used is an experiment. The population in this study amounted to 25 students and the research sample used a total sampling of 25 students. The instrument used is a shooting accuracy test. The test results show that there is an effect of shooting practice with a moving ball on the level of shooting accuracy. Hypothesis testing shows the value of t count 5.68 > t table 1.711, so it shows Ho is rejected and Ha is accepted, which means that there is a significant effect on increasing shooting acc