bluuebunny/crossref_metadata_2025 huggingface dataset:
A Nationwide Prevalence of Common Mental Disorders and Suicidality in Nepal: Evidence from National Mental Health Survey, 2019-2020
Authors: Dhimal Meghnath , Dahal Sushma , Adhikari Kriti , Koirala Pallavi , Bista Bihungum , Luitel Nagendra , Pant Sagun , Marahatta Kedar , Shakya Suraj , Sharma Pawan , Ghimire Sailaja , Gyanwali Pradip , Ojha Saroj Prasad , Jha Anjani Kumar
Published: November 2024

Background: Mental disorders account for a large portion of burden of disease. In Nepal, the prevalence of mental disorders has been rising steadily, but national and province level prevalence is not available. This study aims to assess the prevalence of common mental disorders and suicidality in Nepal.Methods: We conducted nationwide descriptive cross-sectional community-based prevalence study of mental disorders and suicidality among adults (aged 18 years and above) and adolescents (aged 13 to 17 years) in Nepal. We included a total of 9200 adults and 5888 adolescents from seven provinces of Nepal by using a multistage Probability Proportionate to Size sampling technique. Mental disorders and suicidality were assessed using translated and adapted Nepalese version of Mini International Neuropsychiatric Interview (MINI) for disorders, English version 7.0.2 for Diagnostic and Statistical Manual of Mental disorders,5th Edition (DSM-5). Data were entered in CSPro v7.2. Weighted estimates for different mental disorders were calculated.Results: The overall weighted lifetime prevalence of any mental disorder among adults and adolescents was estimated at 10% and 5.2%, respectively. Suicidality was present among 7.2% of the adult and 4.1% of the adolescent participants. Among adult participants, the current prevalence of suicidal thoughts and lifetime suicidal attempts were found to be 6.5% and 1.1%, respectively. Conclusions: This survey indicated that mental health problems are major public health concerns in Nepal that should not be overlooked. Hence, a multisectoral approach is needed to address the burden of mental health problems among adults and adolescents in Nepal.Keywords: National Mental Health Survey, Mental Disorder, MINI, Suicidality, Nepal
Case of Late Recurrence in Early Stage Epithelial Ovarian Cancer
Authors: Singh Meeta , Bista Kesang Diki , Ojha Neebha
Published: November 2024

Epithelial ovarian canceris usually diagnosed in late stage with high recurrence rate and fatality. Long term survival in late recurrence is not very common. We present a case of 66 year woman who had come in early stage of epithelial ovarian cancer. She survived despite having recurrence after 13 years following staging laparotomy with TAH with BSO with infracolic omentectomy and six cycles of adjuvant chemotherapy in 2007. She underwent secondary cytoreduction twice, first in 2013 and second in 2020 after she developed large pelvic mass. First secondary cytoreduction histopathology was inclusion cyst and second time it serous adencarcinoma grade III consistent with the histopathology of 2007. Both times she received chemotherapy after secondary cytoreduction including neoadjuvant chemotherapy (NACT) in 2020. She is doing well on follow up and is on oral etoposide.Keywords: Chemotherapy; epithelial ovarian cancer; late recurrence; secondary cytoreduction
Primary Cutaneous Melanoma in a Tertiary Hospital: A Retrospective Study
Authors: Sharma Nisha , Adhikari Ram Chandra , Sayami Gita
Published: November 2024

Background: Malignant melanoma, the most aggressive form of skin cancer worldwide is much often talked about in the western world and in Caucasian population as it is seen to be a rare disease in South Asians. This study aims to provide a better assessment on the spectrum of cutaneous melanomas in our context.Methods: This was a retrospective, 11-year hospital-based study done in the Department of Pathology, Tribhuvan University Teaching Hospital. The data collected included age, sex, anatomical site, Breslow thickness in millimeter, Clark’s level of invasion, presence of ulceration, Tumor infiltrating lymphocytes and melanoma subtypes. The anova test was used to compare the relationship between age and staging, whereas pearson’s chi square test was used to determine the relationships of sex and histopathological subtype with staging.Results: Out of total, 44 cases of primary cutaneous melanoma were seen, 23 (52.27%) were males and 21 (47.27%) were females. The mean age was 61.29 year with the majority in the age groups 61–70 and 71-80 comprising 11 cases each (25%). Lower extremity was the most frequent site (23 cases, 52.27 %). The largest group (18 cases) was composed of Nodular melanoma, followed by acral melanoma (17 cases). Nodular melanoma tended to occur at a higher stage than other types. Age and sex showed no correlation with staging. A significant association was found with histopathological type. Conclusions: Primary melanoma is a commonly encountered malignancy. It is commomly appreciated equally among both gender among elderly populations. Nodular melanoma present late and is the commonest variety with lower extremity being the commonest site Keywords: Breslow thickness; clark’s level; cutaneous melanoma; nodular melanoma
Anxiety and Depression among Senior Citizens
Authors: Sharma Muna , Bhattarai Tilarupa , Sharma Prafulla
Published: November 2024

Background: Senior citizens are at risk of developing mental health problems and the most common are depression and anxiety, which are important public health problems. This study aimed to find out the mental health status and factors associated with it among senior citizens.Methods: The study design was a cross sectional survey. Among the senior citizens residing in Tansen Municipality, Palpa, 245 participants were selected randomly from the list of senior citizens, enrolled in senior citizen allowance scheme. Data was collected by doing face to face interviews using Geriatric Depression Scale -15 and Geriatric Anxiety Scale-10. The data was entered in Epi Data 3.1 and transferred to SPSS version 16 program for analysis.Results: The mean age of the participants was 78.33 years. Most of the participants were female (52.2%), 95.5% were physically independent and 68.2% had some physical problems. Regarding depression, 30.6% and 2% of the participants had the symptoms suggestive and indicative of depression respectively. Whereas, 8.2% had severe symptoms of anxiety. The anxiety and depression were correlated (rs = 0.615) and were associated with companion of living, education status, physical dependency, and comorbid physical problem. Conclusions: Senior citizens have symptoms of depression and anxiety. Having physical health problems, being physically dependent are likely to result in poor mental health in elderly. There is a need to recognize the mental health problem of elderly in community settings.Keywords: Anxiety; depression; elderly; mental health status; senior citizens
Prevalence of Chronic Kidney Disease, Its Risk Factors and Outcome in Nepal: A Systematic Review and Meta-analysis
Authors: Shrestha Dhan Bahadur , Budhathoki Pravash , Sedhai Yub Raj , Baniya Ramkaji , Gaire Suman , Adhikari Yuvraj , Marasini Anupama , Bhandari Shakar , Sedhain Arun
Published: November 2024

Background: Hypertension, diabetes, glomerulonephritis, obesity, and family history of kidney diseases are major risk factors for chronic kidney disease. Due to the paucity of data on a national level regarding the prevalence, risk factors, and complications of chronic kidney disease, we performed this meta-analysis. Methods: We searched online databases from January 2000 till October 2020. Two reviewers screened articles using Covidence software. Comprehensive Meta-Analysis Software version 3 was used for data analysis.Results: Among chronic kidney disease patients, 35.96% were found to have high LDL, 34.22% had hypercholesterolemia, 39.18% had hypertriglyceridemia, and 42.23% had low HDL. Pigmentary changes were reported in 37.71%, pruritus in 30.96%; and xerosis in 48.55%. Among the reported nail problems, the brown nail was reported in 7.19%, half and half nail in 6.07%, and white nail in 20.65%.Conclusions: The prevalence of chronic kidney disease among high-risk cohorts in Nepal was significant among risk group with hypertension and diabetes being the most common risk factors. The most common stage of chronic kidney disease was Stage V, and the common complications were skin problems and dyslipidemia.Keywords: Diabetes mellitus; glomerulonephritis; hypercholesterolemia; hypertension; hypertriglyceridemia; renal insufficiency chronic; risk factors
Awareness and Attitude Regarding Complementary and Alternative Medicine among Middle Aged Adults
Authors: Aryal Isha , Adhikari Sarita
Published: November 2024

Background: Complementary and Alternative Medicine is a group of diverse medical and health care practices and products that are not presently considered to be part of conventional medicine. The purpose of study was to assess the level of awareness and attitude of Complementary and Alternative medicine among middle aged adults and to find out the correlation between awareness and attitude.Methods: A descriptive, correlational study design was carried out on 63 subjects through convenient sampling technique. Data was collected through face to face interview method among middle aged adults of Kirtipur municipality in Kathmandu by using Nepali version of structured set of questionnaire for all respondents. Data were entered using SPSS-20 and analyzed using descriptive statistics for socio-demographic and study variables, and inferential statistics namely Spearman Rank correlation coefficient was used to assess the relation between awareness and attitude regarding Complementary and Alternative medicine. Results: Highest proportion (36.5%) of respondents was aged from 41-45 years. Majority (88.9%) of the respondents were literate. It was found that majority (71.4%) of the middle aged adults pose moderate knowledge and favorable attitude (93.7%) regarding complementary and alternative medicine, with negligible relationship between awareness and attitude(r=0.171).Conclusions: This study concluded that majority of the middle aged adults pose moderate knowledge and favorable attitude regarding complementary and alternative medicine, with negligible relationship between awareness and attitude. Keywords: Attitude; wwareness; complementary and alternative medicine; middle aged adults
Prevalence and Pregnancy Outcomes of Intrahepatic Cholestasis of Pregnancy
Authors: Sitaula Deekshanta , Timalsina Santosh , Sharma Basant , Pokharel Bandana , Thapa Rohit
Published: November 2024

Background: Intrahepatic cholestasis of pregnancy is a common pregnancy-specific liver disease associated with increased risk of adverse fetal and maternal outcomes. We sought to determine its prevalence, risk factors and feto-maternal outcomes.Methods: A retrospective review of data of 164 pregnant women diagnosed with intrahepatic cholestasis of pregnancy at Chitwan Medical College, Nepal from August 2018 to September 2020 was done. Socio-demographic data, clinic-laboratory profile and feto-maternal outcomes were obtained from clinical audit books and electronic records. A multivariate logistic regression analysis was used to evaluate the predictors of adverse neonatal outcome.Results: The prevalence of intrahepatic cholestasis of pregnancy was 2.5% (164 out of 6539 deliveries). The mean age was 27.5 ± 4.4 years and 51.2% were multigravida. The preterm delivery rate was 15.2% and Caesarean delivery rate was 69.5%. 22% of the neonates needed intensive care admission out of which Respiratory Distress Syndrome or Transient Tachypnea of Newborn was seen in half of them. There were 2 cases of Intrauterine Fetal Death. In multivariate analysis, delivery <34 weeks of gestation was only found to be a significant independent predictor of adverse neonatal outcomeConclusion: The prevalence of intrahepatic cholestasis of pregnancy among pregnant women is significant in our setting which is associated with adverse fetal outcome. Early diagnosis and timely intervention is necessary in order to reduce associated perinatal morbidity.Keywords: Intrahepatic cholestasis of pregnancy; liver function tests; neonatal outcome; obstetric cholestasis
Perception of Problem Based Learning by Undergraduate Dental Students in Basic Medical Science
Authors: Paudel Sabita , Subedi Nuwadatta , Sapkota Subash , Shrestha Bijayata , Shrestha Sanjeeb
Published: November 2024

Background: Problem based learning is self-directed form of learning. Problem of Diabetes Mellitus was chosen. The objective was to evaluate perception of students towards Problem based learning and test their understanding.Methods: A descriptive study was conducted from November 2019 till October 2020. An online Problem based learning session of a week was conducted to second-year Bachelors of Dental Surgery students using online applications. Tutors facilitated students in a group of five to six each. Pre-post testing of evaluation questions was done. At end of session, feedback of students on Problem based learning and tutor of Problem based learning were received with ‘Dolmans and Schmidt’ and ‘Dolmans and Ginns’ questionnaire.Results: There was increase in correct response in nine out of 12 evaluation questions. Most students agreed to influence of discussion, content tested, course objectives, lectures, tutor and reference literature. The students agreed that tutors facilitated active, self-directed, contextual and collaborative learning. Conclusions: The influence of discussion among participants, content tested, course objectives, reference literature during the Problem based learning session were agreed upon by majority of the students. The tutors’ role was accepted by participants in terms of stimulation to self-directed, active, collaborative and contextual learning.Keywords: Diabetes mellitus; problem based learning; tutor
Presenting Clinico-laboratory Characteristics, Hospital Course and Outcomes of Admitted Children with COVID19 in a Tertiary Pediatric Hospital of Nepal
Authors: Chapagain Ram Hari , Adhikari Santosh , Pokharel Sunita , Shrestha Susan Man , Bichha Ram Padarth
Published: November 2024

Background: COVID-19 pandemic hit all age group with different presentations and outcome. This study aimed at exploring the clinical characteristics, investigational findings, hospital outcome along with 90 days follow up of COVID-19 infection in children.Methods: This was longitudinal descriptive study among hospital admitted children with COVID-19 RT-PCR positive during first wave of Pandemic with 90 days telephonic follow up. Demographic and clinical characteristics, comorbidities, SPO2, investigations, need of oxygen , PICU admission, need of ventilator, outcome (improved and discharged, death) and duration of hospital stay were recorded and 90 days telephonic follow up was performed for any illness and hospital admission.Results: Out of 65 children admitted, male 44 (67.7%) and female 21 (32.3%), median age was 23 months ( IQR 6 days -14 years) with 52( 80.0%) without any comorbid conditions. The common signs were Fever 40(61.5%) vomiting 15 (23.1%) and Cough 11(16.9%).Thirteen (20.0%) children has platelets count less than 150000 and 16(24.6%) had C - reactive protein Positive .Mean duration of hospital stay 8 days (Range 1 -44 days), 20( 30.8% ) needed oxygen , 20(30.8%) needed Pediatric intensive care unit (PICU)admission and 6 (9.2%), needed ventilator. Forty seven (72.3%) recovered and discharged with death of 6.2% (n=4). Fifty six children (75.4%) has not experienced any problem after COVID -19 and only 2 children needed hospital admission in 90 days telephone follow up.Conclusions: In the first wave of the pandemic, Respiratory and Gastrointestinal symptoms were common presentation with few Severe and critical cases. Majority had good outcome. Majority has no other related illness till 90 days after discharge.Keywords: Children;COVID-19; follow up; hospital outcome; sign symptoms
Prevalence, Risk Factors and Outcome of Pregnancyinduced Hypertension in Nepal: A Meta-Analysis of Prevalence Studies
Authors: Shrestha Dhan Bahadur , Budhathoki Pravash , Malbul Kiran , Katwal Srijana , Jha Saroj Kumar , Prajapati Roshni , Srivastava Ayushi , Dangal Ganesh , Baral Gehanath
Published: November 2024

Background: Pregnancy induced hypertension is a major cause of global maternal mortality and morbidity. This review was conducted to fulfill the objective of evaluating the status of pregnancy induced hypertension in Nepal.Methods: The protocol for this review was registered in PROSPERO (CRD42020211210). Pubmed, Embase, Google Scholar, Scopus and Pubmed Central were searched using appropriate keywords for relevant studies. Data analysis was performed using Comprehensive Meta-Analysis Software version 3. Forest plot was used to visualize the prevalence and risk factors of Pregnancy induced hypertension. Random effect model was used and the level of heterogeneity was high. Joanna Briggins Institute bias assessment tool was used for the analysis of bias in the included studies.Results: Twenty studies were included in the review. The pooled prevalence of pre-eclampsia and eclampsia were 2.6% (95% CI, 1.2%-5.3%) and 0.5% (95% CI, 0.2%-1.1%) respectively. The majority of cases were young women and had not complete or unbooked antenatal visits. Cesarean delivery was the most common mode of deliveries in 50% of deliveries (proportion, 0.50; 95% CI, 0.40-0.60) among patients with PIH followed by vaginal deliveries in 43.1% (proportion, 0.431; 95% CI, 0.336-0.532); and rest 6.9% were vacuum/forceps assisted deliveries (proportion, 0.069; 95% CI, 0.050-0.093). Common maternal complications were abruption in 6.56% of Pregnancy induced hypertension cases, rest were pulmonary embolism, renal injury.Conclusions: The prevalence of pre-eclampsia and eclampsia in Nepal were 2.6% and 0.5%. Younger woman and women with poor antenatal checkups had increased risk of Pregnancy induced hypertension. Cesarean delivery was the most common route of delivery and common maternal complications were abruption placenta, pulmonary embolism, renal injury etc.Keywords: Eclampsia; hypertension; maternal mortality; Nepal; pre-eclampsia; pregnancy-induced
USG Guided Quadaratus Lumburoum Block and Low Dose Spinal Anesthesia in Abdominal Surgeries
Authors: Rayamajhi Anuj Jung , Dhungel Bidur Kumar , Paudel Subash , Paudel Prashanta
Published: November 2024

Background: The postoperative analgesic efficacy of trans-muscular quadratus lumborum block in abdominal surgeries is well established; however, its intraoperative safety and efficacy as an anesthetic is still being explored. This retrospective case review was conducted to investigate the efficacy and safety of combined quadaratus lumburoum block and low-dose subarachnoid block for anesthesia in complex abdominal operations.Methods: Perioperative data of 29 patients, who underwent abdominal operations during the period of June/2019 to October/2019 under the combined technique, was analyzed. The primary outcome was intra and postoperative pain scores with the conox as qnox and numeric rating scale respectively at different time points. The secondary outcomes were intraoperative sedation scores with conox as qcon and perioperative dosage of fentanyl, changes in mean arterial pressure and the incidence of adverse events.Results: The mean qnox scores at incision, viscera dissection, closure and before transport to the post anesthesia care unit were between 44.66 and 55.79. The mean numeric rating scale scores before bed on the operation day, at 8 am on the first postoperative day, before bed on the first postoperative day and at 8 am on the second postoperative day were between 3.41 and 3.86. The mean qcon scores during the operations were between 61.31 and 65.82 while it was 85.66 following the stoppage of all sedations. The mean total perioperative consumption of fentanyl was 38.7mcg. The proportion of patients having MAP changes of less than 20% from baseline was 85.72%. The incidence of peri-operative adverse events was low.Conclusions: For complex abdominal operations, a combination of ultrasound-guided QLB-TM and low dose spinal anesthesia achieves adequate analgesia and is a safe technique.Keywords: Conox; continuous transmuscular quadratus lumborum block; high risk patients; laparotomy; low dose spinal anesthesia
KRAS Oncogene Mutations in Colorectal Cancer Patients in a Nepalese Tertiary Care Hospital
Authors: Basnet Bhupendra Kumar , Gautam Balram , Ranabhat Kamal , Paudel Bishnu Dutta , Chapagain Acharya Sandhya , Bastola Sri Ram , Gyawali Bishal
Published: November 2024

Background: Colorectal cancer is one of the most common cancers in the world and ranks among top ten cancer in Nepal. Limited data have been reported in the literature regarding the prevalence of Kristen Rat Sarcoma viral oncogene mutation in Nepalese patients with colorectal cancer. In a low income country such as Nepal where majority of cancer patient pay for treatment out-of-pocket, it is important to ascertain Kristen Rat Sarcoma viral oncogene mutation status before starting treatment with these agents.Methods: We analysed 22 colorectal cancer specimens diagnosed histopathologically. Real Time Polymerase Chain Reaction was performed on extracted DNA using RoterGene from Qiagen. US Food and Drug Administration approved kit was used for detection of Kristen Rat Sarcoma viral oncogene mutation i.e. TheraScreen: K-RAS Mutation Kit: The K-RAS Kit detects seven Kristen Rat Sarcoma viral oncogene mutations in codons 12 and 13 of the Kristen Rat Sarcoma viral oncogene.Results: Kristen Rat Sarcoma viral oncogene mutation was observed in 13 (59%) of the samples studied. All samples had point mutation on codons 12 while 5 samples (38%) also had a point mutation on codons 13. No association was found between the presence of Kristen Rat Sarcoma viral oncogene mutation and gender or age or sidedness of the cancer. Conclusions: Kristen Rat Sarcoma viral oncogene was commonly present in colorectal cancer specimens. Further efforts towards establishment of diagnostic test, generation of new database, development and scale up of laboratory services are needed throughout the nation. Keywords: Colorectal cancer; KRAS oncogene; mutation analysis; Nepal; risk factors for CRC
Ninety Day Post Discharge Outcome in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Using the PEARL Score
Authors: Joshi Aishana , Shrestha Tirtha Man , Pant Pankaj , Shakya Yogendra Man
Published: November 2024

Background: Chronic obstructive pulmonary disease exacerbation is a leading cause of frequent hospitalizations imposing substantial global health burden. The 90 day post discharge period has been associated with higher readmission rates and substantial risk of death. The aim of this study was to assess post discharge 90 day outcome in patients admitted with acute Chronic obstructive pulmonary disease exacerbation using the PEARL score.Methods: A longitudinal study was conducted at Tribhuvan University Teaching hospital from February 2019 to November 2019. Patients admitted in respiratory ward with acute Chronic obstructive pulmonary disease exacerbation were stratified into low, intermediate and high risk groups using PEARL score and post discharge 90 day outcome was assessed. Data entry and analysis was done in SPSS version 20.0. Descriptive and inferential statistics were performed.Results: A total of 102 patients were included for final analysis. Mean age of patients was 70.54 ± 10.85 years. There were 53.9% male. Intermediate and high risk PEARL groups had the highest proportion of readmission within 90 days of discharge which was found to be 23 (52.3%) and 9 (50%) respectively. High risk PEARL group had the highest proportion of death within 90 days (11.1%). The difference in these outcomes among three PEARL groups was found to be statistically significant (p-value < 0.05).Conclusions: PEARL score is a simple tool that can be applied at bedside in assessing 90 dayrisk of readmission or death in acute Chronic obstructive pulmonary disease exacerbation. This can be beneficial in post-discharge planning and early referral especially in resource limited health care setting where advanced facilities are not available.Keywords: COPD; ninety day outcome; PEARL score
Steroid Stewardship in COVID-19
Authors: Shrestha Gentle Sunder , Rimal Ankit
Published: November 2024

Corticosteroids have transformed clinical practice in COVID-19 following the publication of the results of the RECOVERY trial. Despite available evidence, there is considerable disparity among physicians in the dose and duration of steroids they prescribe. Steroids have a fragile affiliation in clinical practice with the benefits frequently accompanied by distressing adverse effects. An institutional steroid stewardship program can help all physicians take advantage of what is the only proven therapy of benefit in this global crisis while avoiding its overuse and the numerous adverse effects associated with it.Keywords: COVID-19; corticosteroids; RECOVERY trial; steroid stewardship
Risk Factors, Clinical Features, and Outcomes among Stroke Patients Presenting to Spinal Injury Rehabilitation Centre
Authors: Dhakal Raju , Khadka Anjita , Groves Christine
Published: November 2024

Background: Worldwide, stroke is the second leading cause of death and disability. The burden of stroke in countries like Nepal is increasing. The purpose of this study is to describe the epidemiology, clinical features, and functional outcomes of individuals with stroke in a rehabilitation hospital in Nepal.Methods: A prospective descriptive study was conducted among individuals with stroke presenting for inpatient rehabilitation to the Nepal’s first interdisciplinary inpatient stroke rehabilitation unit over a one-year period; from 1 April 2018 – 30 March 2019.Results: Twenty-four individuals were enrolled, with average age of 56.8 years (SD 11.9, range 38-79). Seventeen patients (71%) presented with ischemic stroke. Hypertension was the most common modifiable stroke risk factor observed, present in 21 (88%) of individuals. Median rehabilitation length of stay was 32.5 days (IQR 15.3 – 68.8). Median Modified Barthel Index at admission was 25.0 (IQR 8.5-57.0) and at discharge was 67.0 (IQR 46.0-88.0), a statistically significant improvement (Z = -3.408, p = 0.001). Median Modified Rankin Scale on admission was 5.0 (IQR 4.0-5.0) and at discharge was 4.0 (IQR 3.6-4.8; Z = -3.276, p = 0.001).Conclusions: Most individuals with stroke admitted for interdisciplinary stroke rehabilitation demonstrated “severe” levels of disability and dependency on admission, and “moderate” levels of disability and dependency at the time of discharge. Hypertension represents a strategic target for primary and secondary prevention of stroke. With the burden of stroke increasing in Nepal, it is imperative to improve long-term availability and access to comprehensive stroke care for all affected individuals.Keywords: Nepal; rehabilitation; stroke
Internet Addiction and Associated Factors among Undergraduates
Authors: Adhikari Kishor , Dahal Sandhya , Ghimire Amrita , Khanal Gayatri , Koirala Subash , Bhusal Chet Kant , Singh Rakesh
Published: November 2024

Background: With the surge of internet-based smart gadgets worldwide in 21st century the problem of internet addiction is emerging as a major behavioural addiction pandemic of the contemporary era. Excessive Internet use has become significant mental health concerns especially among students. Internet use has many advantages if used in right fashion, it has an enormous amount of negative consequences as well such as depression, attention deficit and so forth.Methods: Descriptive cross-sectional study was done among 356 undergraduate students of Bharatpur Metropolitan City of Nepal. Multistaged random sampling was applied to select undergraduate students and semi structured self-administered questionnaire along with structured standard Young’s tool for Internet Addiction Test was used for collecting information during June 2019 to August 2019.Result: Alarmingly High proportions of participants (73%) were found addicted to Internet, where, 48%, 20.5% and4.5% had mild, moderate and severe Internet addiction respectively. Higher prevalence of Internet addiction was observed among those whose father’s occupation was ‘foreign employment’ as compared to agriculture. (AOR?=?2.34, 95% CI 1.02-5.33, p?=?0.04), Failed in the recent exam as compared to Pass in the recent exam. (AOR = 2.81 CI 1.40 – 3.561, and among non-science stream as compared to science stream (AOR?=?3.10, 95%CI 1.81-5.32), p=<0.001) Conclusions: The finding suggests that prevalence of Internet addiction was tremendously high among undergraduate students. There is critical need of awareness programmes targeted to the students as well as parents regarding the negative impacts of unwise Internet use.Keywords: Bharatpur metropolitan; internet addiction; undergraduate students.
X-linked Juvenile Retinoschisis in a Young Female
Authors: Ranabhat Sudha , Byanju Raghunandan , Khadka Simanta
Published: November 2024

X-linked juvenile retinoschisis has recessive inheritance which occurs due to RS1 gene mutation. We report an instance in a female managed with systemic and topical carbonic-anhydrase inhibitors.18-year female presented with bilateral blurred vision for two years. Best corrected vision was 6/24 right eye and 6/12 left eye. Fundus examination, ocular coherence tomography and fundus fluorescein angiography supported the diagnosis. Systemic and topical carbonic-anhydrase inhibitors were advised and followed for six months with scrutinization of possible adverse drug reaction.Juvenile retinoschisis being rare among females, prompt diagnosis and management helps for the restoration of the vision and foveal anatomy.Keywords: Carbonic anhydrase inhibitors; female; retinoschisin ; X linked juvenile retinoschisis.
Pattern of Tuberculosis, Trend and Outcome of Patients Registered at DOTS Centre of a Tertiary Care Hospital
Authors: Pant Pankaj , Joshi Aishana , Adhikari Yagya Raj , Rijal Yasoda , Ghimire Sharmila , Gautam Ashmita , Shah Sangam , Bam Niraj , Das Santa Kumar
Published: November 2024

Background: Tuberculosis is a common respiratory disease imposing significant health burden. Directly observed treatment short course strategy ensures patient compliance in tuberculosis treatment. The aim of this study was to assess pattern of tuberculosis, trend and outcome of patients registered at Directly observed treatment short course centre of Tribhuvan University Teaching Hospital.Methods: A retrospective observational study was conducted at Tribhuvan University Teaching Hospital. Tuberculosis patients of all age groups registered from July 2017 to June 2020 at Tribhuvan University Teaching Hospital Directly observed treatment short course centre were included. Data entry and analysis was done in SPSS version 20.0. Descriptive statistics was performed and results were interpreted in mean, frequency and percentage.Results: A total of 2790 tuberculosis patients were included for final analysis. There were 1736 (62.2%) males. Mean age of patients was 37.94±20.28 years. Pulmonary tuberculosis was the most common type of tuberculosis seen in 948 (34%) patients. Fifty percent of total tuberculosis cases were confined to thorax. Tubercular pleural effusion and pleurisy (14.6%), central nervous system (13.2%), bone and joint (12.2%) were common forms of extrapulmonary tuberculosis. The mean incident tuberculosis cases registered annually was 697.5±95.63. Nearly half (49.1%) of the patients completed tuberculosis treatment regimen while 43.3% were referred to other Directly observed treatment short course centre as per their convenience.Conclusions: This study reflects the trend and pattern of tuberculosis epidemiology at tertiary care hospital of Nepal. There is a huge burden of both pulmonary and extrapulmonary tuberculosis at Tribhuvan University Teaching Hospital with slight annual variation in incident tuberculosis cases. Despite implementation of Directly observed treatment short course, the problem of non-compliance persists among the tuberculosis patients. Keywords: DOTS; tuberculosis; tertiary centre.
Prevalence of Loss of Smell and Loss of Taste in COVID-19 Infected Patients
Authors: Shrestha Sujan , Paudel Asmita , Shrestha Sepiya , Gautam Amrit , Bhurtel Minraj , Adhikari Purushottam
Published: November 2024

Background: The clinical presentations of COVID-19 have been variable, with atypical presentations being reported worldwide. Different studies have shown that olfactory and gustatory symptoms are present in confirmed COVID-19 cases, who may not have had other nasal complaints earlier. The high prevalence of these symptoms, exhibiting olfactory dysfunction before the appearance of others, is a relevant finding to aid for early detection of COVID-19. In this study, we aim to find out about the prevalence of anosmia and ageusia in COVID-19 and its correlation with age, sex, and severity of disease in the Nepalese population.Methods: Patients with laboratory-confirmed COVID-19 infection by reverse transcription-polymerase chain reaction (RT-PCR) done at Shukraraaj Tropical and Infectious Disease Hospital, Kathmandu were recruited. Questionnaires based on loss of taste and loss of smell components including age, sex, ethnicity, comorbidities were prepared, and the patients were interviewed retrospectively by phone contact.Results: A total of 300 patients were enrolled in our study. The mean age of the patients was 38.36±14.24 years. Prevalence of loss of smell was 54%(N=162) and loss of taste was 53% (N=159). Both of the symptoms were present in 45% of patients. The severity of the disease has a statistically significant effect on the loss of smell and taste whereas gender and smoking history has no significant difference over it.Conclusions: More than half of the COVID-19 positive patients in our cohort had either loss of taste or loss of smell with the severity of disease having a significant effect on it.Keywords: Ageusia; anosmia; COVID-19; nepalese population.
Fecal Carriage of Extended-Spectrum beta-Lactamase Producing Escherichia coli among Health Science Students
Authors: Sharma Birat , Yadav Santosh , Khanal Avaya , Shakya Basu , Shrestha Kamal , Aryal Shiva , Kattel Hari , Parajuli Keshab , Mishra Shyam Kumar
Published: November 2024

Background: The incidence of antibiotic resistance in commensal bacteria is increasing with the production of extended-spectrum beta-lactamase. Therefore, this study was conducted to understand the status of fecal carriage of such enzyme producing Escherichia coli among health science students of seven different faculties of Institute of Medicine, Tribhuvan University.Methods: This was a cross-sectional study conducted over six months among the health science students. One stool sample collected from each student was cultured and Escherichia coli isolates were identified, antibiotic sensitivity profile was produced, and extended-spectrum beta-lactamase production was detected following Clinical and Laboratory Standards Institute guidelines. Results: A total of 156 students participated in the study, and Escherichia coli was isolated from all. Out of the total 156 Escherichia coli isolates, 11.5% were extended-spectrum beta-lactamase-producers and 14.7% were multidrug-resistant. The highest rate of fecal carriage of extended-spectrum beta-lactamase-producing Escherichia coli was found among Bachelor of Medicine and Bachelor of Surgery students (17.5%) and Bachelor of Science in Medical Imaging Technology (16.7%) students. Such enzyme producing Escherichia coli was found in the range of 6.9% to 25.0% among second- to fifth-year students. A significant number of extended-spectrum beta-lactamase-producing isolates were resistant to ciprofloxacin and gentamicin, apart from other extended-spectrum beta-lactamase substrate antibiotics, when compared with non-producers.Conclusions: A high rate of extended-spectrum beta-lactamase-producing Escherichia coli was detected from the gut of healthy health science students which indicates their possible dissemination throughout the wider community resulting in potential outbreak of infections caused by such organisms.Keywords: Escherichia coli; fecal carriage; health science students; multidrug-resistant.
Health Problems experienced by Peri-menopausal Women and their Perception towards Menopause
Authors: Chalise Gita Dhakal , Shrestha Sarala , Thapa Sumana , Bharati Mamata , Pradhan Subhadra , Adhikari Bibhav
Published: November 2024

Background: Perimenopause is a period of physiologic changes in the women's lives when they approach reproductive senescence along with temporal changes in health and quality of life. During this period, many women present with problems of hot flushes; altered mood and sleep; and vaginal and sexual changes. The objective of this study was to identify the health problems experienced and perception towards menopause among perimenopausal women of Kathmandu.Methods: This descriptive cross-sectional study was carried out among purposively selected 180 women from two wards of Nagarjun Municipality, Kathmandu, who were aged 45 to 55 years. By using a semi-structured interview schedule, face to face interview was taken at the respondents' residence. The collected data were analyzed using descriptive and inferential statistical techniques.Results: The mean age of the respondents was 48.98±3.908 years and their mean body mass index was 27.42±3.645 kg/ m2. About 35.0 % of the respondents had experienced cessation of menstruation and their mean age at menopause was 47.84±4.41years. The common physical problems reported by them were joint and muscle pain (17.2%), hot flushes (14.4%) and night sweats (13.3%). Vaginal itching (16.7%), loss of libido (10.6%) and dry vagina (5%) were commonly reported sexual problems. Anxiety (16.7%), poor memory (8.9%), and irritability (7.2%) were the psychological problems reported by them. Most (77.8%) of them had a positive perception and the rest (22.2%) had a negative perception towards menopause. Their perception status was significantly associated with their age and family type. Conclusions: Perimenopausal women experience several physical, sexual and psychological problems during the menopause transition. Keywords: Health problems; perception towards menopause; perimenopause.
Assessment of Modified Trans-umbilical Port Placement in Laparoscopy
Authors: KC Kamana , Shrestha Manish
Published: November 2024

Background: Primary port placement is a critical step in any laparoscopic procedure. Although the safety and efficacy of open versus closed technique has been much debated, no particular technique is considered as the best. Therefore, over the period of time different methods have been developed and applied in order to perform laparoscopy procedures, Midat hospital has been using a version of modified trans-umbilical open technique for primary port entry from 2 decades and this study is being carried out to evaluate the technique.Methods: Retrospective review was conducted. The patients who underwent laparoscopy surgery by modified trans-umbilical port placement at Midat hospital from June 2019- April 2020 were included in this study.Results: A total of 100 cases were studied. Cholelithiasis was the main indication of surgery. The mean time recorded to establish pneumoperitoneum was 3.4±1.3 minutes. The rate of umbilical swab culture growth was 1%, pre-peritoneal port placements was 2%. Post-operative primary port site infection rate was 4%. No intra-abdominal injury was noted during the entry of primary port and there was no port site hematoma or recorded hernia over the period of one year.Conclusion: This technique of modified trans-umbilical primary port placement is one of the safest, fastest and easiest techniques to enter the peritoneal cavity.Keywords: Laparoscopy, trans-umbilical primary port, open technique.
Prevalence and Contributing Factors of Gender-based Violence in SAARC Territories from 2010 to 2020: A Systematic Review and Meta-analysis
Authors: Dangal Ganesh , Shrestha Niki , Khanal Gayatri , Giri Subarna , Ghimire Anup , Aryal Shiva , Aryal Barun Babu , Adhikari Anurag , Paudel Ayusha , Budhathoki Pravash , Shrestha Dhan Bahadur
Published: November 2024

Background: Gender-based violence is a key global concern due to the high prevalence and increased socio-economic burden for survivors. However, estimation of the prevalence of gender-based violence is difficult due to differences in study design and underreporting of abuse, especially in developing nations. Therefore, we conducted this study to estimate the prevalence of Gender-based violence among women living in the SAARC region.Methods: The review protocol was registered in PROSPERO (CRD42020219577). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed throughout the review. A thorough database search was conducted to identify studies done in the SAARC region. Title and abstract screening were done in Covidence, followed by a full-text review. Data were extracted and pooled for analysis using the inclusion and exclusion criteria. Subgroup analysis was done where possible. Results: A total of 76 studies were included in the systematic review and metaanalysis. The community prevalence of domestic violence (DV) was 43.8% (95% CI, 35.1% - 52.9%), GBV prevalence was 34.9% (95% CI, 30.2% - 39.9%) and IPV prevalence was 39.8% (95% CI, 30.7% - 49.6%). GBV prevalence was highest in illiterate women [54.2% (95% CI, 46.8% - 61.5%)] and lowest among women with higher than secondary level education [23.1% (95% CI, 16.2% - 32.0%)]. The prevalence of GBV among women in pregnancy or postpartum period was 32.3% (95% CI, 25.1% - 40.4%, I2: 98.64), while among female sexual workers, the prevalence of Gender-based violence was 42.1% (95% CI, 28.1% - 57.5%, I2: 99.25).Conclusions: There is a high prevalence of Gender-based violence in the SAARC region. Higher socioeconomic status and educational status are protective factors for Gender-based violence. However, more studies using validated tools are needed to understand the true extent of the problem.Keywords: Domestic violence; gender-based violence; pregnancy; women.
Textual Organization of Hemodialysis Nursing Practice: An Institutional Ethnography
Authors: Acharya Devaka Kumari , Nilmanat Kittikorn , Boonyasopun Umaporn
Published: November 2024

Background: Nursing today deals with organizational changes and reforms within the increased demands of care amid competing resources. In some developing countries, dealing with text documents is a challenge in hemodialysis service organizations. This study aimed to explicate the social organization of textual nursing practices in a hemodialysis unit of a public university hospital in Nepal. Methods: This is a qualitative study that followed institutional ethnography design. Ten registered nurses who worked for at least six months in the hemodialysis unit were included for in-depth interviews. Data were also collected through 167 hours of observations, field notes, and two focus groups. Texts including policy, protocols, and record documents were incorporated in the analysis. Data analysis followed Smith's (1987) institutional ethnographic analysis. Results: Nepalese nursing work in a hemodialysis unit was mainly organized by the free hemodialysis policy of the government which was not available to the nurses at the hemodialysis unit, but it determined most of the nursing activities of patient care and documentation. Hemodialysis record form, hemodialysis schedule, and free hemodialysis claim form also had a great influence on nursing work. However, the nurses were not quite aware of how the textual documents determined their practices to meet the politico-economic interests of the hospital and government. Conclusions: The hospital and Nepal’s health ministry established the activities and recording requirements. Identification of texts and exploration of their influences on nurses’ decisions, patient care, and documentation are essential to find the optimal solutions in daily care and determine the appropriate support for nurses in hemodialysis settings. Keywords: Hemodialysis; institutional ethnography; nursing practice; textual organization.
Correlation of Multidetector Computed Tomography Peripheral Angiography with Color Duplex Sonography in Peripheral Arterial Disease
Authors: Devkota Rameshwor , Joshi Birendra Raj , Subedi Kamal , Chaudhary Ranjit , Devkota Ramila , Bashyal Saroja , Amatya Isha , Regmi Pradeep Raj
Published: November 2024

Background: With aging of the global population peripheral arterial disease is increasingly common. Arteriography, computed tomography angiography and magnetic resonance angiography are common modalities used for evaluation of peripheral arterial disease. However, they have limitations of being invasive, costly, limited availability or contraindicated in patients with renal impairment or contrast allergy. Duplex imaging, a method of evaluation of peripheral arterial disease is cost effective, widely available and safe even in patients with renal impairment and contrast allergy. Methods: A prospective cross sectional descriptive study involving 114 patients was conducted from November 2015 to October 2016. The patients were evaluated by Doppler ultrasound following multi-detector computed angiography in Department of Radiology, Tribhuvan University Teaching Hospital. The lower limb arteries were divided into 10 segments and stenosis or occlusion of each segment in Computed Tomography angiography were compared with findings in Doppler, Computed Tomography angiography being considered the gold standard. Data was collected in predesigned proforma in Microsoft Excel spread sheet.Results: Duplex imaging showed sensitivity 94.94%, specificity 98.54%, accuracy 97.54%, positive predictive value 96.15 % and negative predictive value 98.06 %. In assessment of 22 segments, partial stenosis seen in Computed Tomography angiography was overestimated as complete stenosis in Doppler. There was significant positive correlation of velocity ratio with degree of partial occlusion (r=0.918 for right lower limb and r=0.895 for left lower limb, p <0.01). Conclusions: Duplex imaging is safe cost effective and reliable method of evaluation of patients with peripheral arterial diseases.Keywords: Computed tomography; doppler ultrasound; peripheral arterial disease.
Functional Outcome of Arthroscopic Debridement of Mucoid Degeneration of the Anterior Cruciate Ligament
Authors: Hamal Bhadra , Karmacharya Mahesh , Mangal Joshi Kuldeep , Gorkhali Rajendra
Published: November 2024

Background: Mucoid degeneration of the anterior cruciate ligament is a rare pathological condition. This is a condition where the anterior cruciate ligament becomes bulky and seems like a celery stalk appearance. The most common symptom is a pain in the posterior aspect of the knee and consistent clinical finding is a mechanical block to an extension of the knee. This study aims to find out the functional outcome of arthroscopic debridement of this entity.Methods: This is a prospective observational study from Jan 1st 2021 to Dec 31st 2021 done in 17 patients. The outcome was measured in terms of preoperative and postoperative visual analogue scale, Tegner Lysholm score and International Knee Documentation Committee score.Results: Eleven females and six males were included in this study. The mean age of the patients was 51.41 years. Arthroscopic debridement of mucoid degeneration of the anterior cruciate ligament was done. Preoperative and 6 months postoperative VAS score was 8.12 and 2.00 respectively (p<0.05), preoperative and 6 months postoperative Tegner Lysholm score was 44.00 and 86.29 respectively (p<0.05), and preoperative and 6 months postoperative IKDC score was 29.06 and 79.94 respectively (p<0.05)Conclusions: Arthroscopic debridement serves as an effective way of treatment of mucoid degeneration of the anterior cruciate ligament.Keywords: Anterior cruciate ligament; arthroscopic debridement; mucoid degeneration.