bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between Facet Joint Tropism with Lumbar Disc Herniation at A Particular Motion Segment
Authors: Shrestha Sandesh , Lakhey Rajesh Bahadur , Paudel Sharma , Paudel Sushil
Published: November 2024

Background: Lumbar disc herniation is one of the important and common causes of low back pain. There are various modifiable and non-modifiable risk factors for the development of lumbar disc herniation. Any change in the orientation or asymmetry of the facet joint i.e. facet tropism may lead to abnormal shearing stress on the intervertebral disc and may lead to development of disc herniation.Methods: This is a cross-sectional observational study of 46 patients aged 18-40 years with clinical features of Prolapsed Intervertebral Disc and Magnetic Resonance Imaging evidence of single level prolapsed disc who presented to Tribhuvan University Teaching Hospital from December 2019 to June 2021. MRI measurement of facet tropism of normal level (L4-L5 or L5-S1) adjacent to herniated level was used for comparison. The p - value ? 0.05 was considered statistically significant. Overall association of tropism with lumbar disc herniation in affected and normal level combined and at each individual level was studied using McNemar Test.Results: We found a highly significant association of facet tropism with lumbar disc herniation (p-value <0.001). Considering the individual levels, at L4-L5 level, the association between facet tropism and lumbar disc herniation was highly significant (p-value <0.001). However, at L5-S1 level the association was not significant (p-value <0.388).Conclusions: The results of our study show strong association between FT and lumbar disc herniation at a particular motion segment.Keywords: Facet tropism; inter-vertebral disc prolapse; lumbar disc herniation; magnetic resonance imaging
Serum Uric Acid to Creatinine Ratio with Estimated Glomerular Filtration Rate in Type 2 Diabetes Patients
Authors: Baral Sushil , Uprety Ananta Bhakta , Kshetri Rupesh
Published: November 2024

Background: Diabetes mellitus is a metabolic disorder associated with cardiovascular and renal complications. The serum uric acid to creatinine ratio and estimated glomerular filtration rate are important markers used to assess kidney function in patients with type 2 diabetes. This study aimed to find the correlation between serum uric acid to creatinine ratio and estimated glomerular filtration rate to various parameters among the diabetes patients.Methods: It is an observational hospital-based, cross-sectional study. Patients with a diagnosis of diabetes for three years or more duration were selected. This study designed to serum uric acid to creatinine ratio with estimated glomerular filtration rate and its relationship with other biochemical parameters. The Modification of Diet in Renal Disease formula was used to calculate estimated glomerular filtration rate (eGFR). eGFR (mL/min?1.73?m2)?=?186?×?(Scr) –1.154?×?(age) – 0.203?×?(0.742 female). Low eGFR was defined as eGFR<60 mL/min?1.73?m2. The data were analyzed by SPSS version 20. Mean values of different variables, standard deviations and p-values were calculated. Results: Mean serum uric acid to creatinine ratio was 6.09±1.71 and elevated among 49.1%. Mean blood urea and serum creatinine levels were 28.0±10.72 and 1.01±0.18, respectively. There was a significant positive correlation between eGFR and serum uric acid : serum creatinine ( r?=?0.246, p?=?0.007) in this study.Conclusions: The serum uric acid to creatinine ratio can serve as an early marker for renal injury, showing a positive correlation with estimated glomerular filtration rate (eGFR). Monitoring serum uric acid to creatinine ratio levels alongside eGFR can assistance in the identification and management of kidney damage in its early stages.Keywords: Creatinine; glomerular filtration rate; glycated hemoglobin; serum uric acid; type 2 diabetes
Anaesthetic Effects of Ropivacaine and Bupivacaine on Onset, Duration of Block and Changes in Hemodynamic Parameters in Patients Undergoing Below Elbow Surgeries Under Ultrasound Guided Supraclavicular Brachial Plexus Block
Authors: Amatya Bishwo Ram , Rayamajhi Mallika , Thapa Puja , Shah Aashish , Rijal Thaneshwar , Khadka Anjan , Shrestha Shova
Published: November 2024

Background: Supraclavicular brachial plexus block is commonly used regional anesthetic technique for below elbow upper limb surgeries. Ultrasound and nerve stimulator are used for higher success rates and fewer complications. Ropivacaine has been used as an alternative to Bupivacaine for rapid onset and longer duration along with lesser or no cardiac and neurotoxicity.The study was conducted with objective of assessing sensory and motor block characteristics of Bupivacaine and Ropivacaine in terms of onset, duration and adverse effects. Methods: A prospective observational study lasting three month duration from 15th February, 2022 to 14th May, 2022 was conducted among 60 patients divided by convenient sampling method into 30 in Group R (0.2% Ropivacaine 30 ml) and 30 in Group B (0.2% Bupivacaine 30 ml) undergoing below elbow orthopedic surgery under ultrasound and peripheral nerve stimulator guided supraclavicular brachial plexus block.Results: Block using Ropivacaine as compared to Bupivacaine had faster sensory onset in minutes (7±3.37 vs. 10.17±3.34; P value 0.0005), faster motor onset in minutes (10.17±5 vs. 22.33±5.04), shorter duration of sensory block in minutes (437.16±55.54 vs. 633.38±58.33), shorter duration of motor block in minutes (411±57.15 vs. 698.16±47.89), shorter time required for rescue analgesia in minutes (78.66±25.56 vs. 73.83±21.11) and no complications.Conclusions: 0.2% Ropivacaine can be used as an alternative to 0.2% Bupivacaine in below elbow upper limb orthopaedic surgeries under ultrasound and nerve stimulator guided supraclavicular brachial plexus block for rapid onset of sensory block and early regression of motor block.Keywords: Brachial plexus block; nerve stimulator; supraclavicular; ultrasound
Health Professionals and Pharmacists Awareness and Attitude Towards Counterfeit Medicine
Authors: Chaudhary Sabina
Published: November 2024

Background: Counterfeit medicine is not only illegal, but it is also an insidious threat and poses serious public health and safety concern. Health professionals can play an important role in campaign against counterfeit drugs by staying vigilant, reporting suspicious products and preventing the distribution of counterfeit medicine. The present study aims to assess the awareness and attitude towards counterfeit medicine among health professionals and pharmacists in Nepal.Methods: It was a cross-sectional study conducted among 264 health professionals and pharmacists of Saptari, Nepal. Samples were recruited by quota sampling technique and pretested, self-administered questionnaire were used for collecting data regarding socio-demographic, knowledge and attitude on counterfeit medicine. Descriptive & inferential statistics were used to analyze the data generated.Results: This study found that mean knowledge score of respondent was 12.11±4.3 and only 31.7% (n=39) of the respondents had good knowledge on counterfeit medicine while 44.7% (n=55) showed moderate and 23.6% (n=29) had poor knowledge levels. Nurses, paramedics and pharmacists scored statistically lower than doctors, however there was no significant difference in knowledge between nurses and pharmacists (p<0.001). Mean attitude score was 3.82 (±0.68) and majority of respondents (85.3%) showed favorable attitude towards counterfeit medicine. Respondents having poor knowledge level had statistically significant unfavorable attitude towards counterfeit medicineConclusions: The study highlighted the need for counterfeit medicine awareness campaigns and training to enhance the role of health professionals and pharmacists to recognize and report suspicious medicine and prevent counterfeit medicines-associated harms.Keywords: Attitude; counterfeit medicine; health professionals; knowledge; pharmacists
Outcome of Epidermal Growth Factor Receptor Mutated and Non Mutated Adenocarcinoma Lung to Standard Therapy
Authors: Dulal Soniya , Mishra Akshat , Shah Aarati , Acharya Bibek , Shilpakar Ramila , Chapagain Acharya Sandhya , Karn Ambuj , Sharma Rajeev , Gautam Balram , Paudel Bishnu Dutta
Published: November 2024

Background: Asian patients with adenocarcinoma of lung have higher incidence of epidermal growth factor receptor mutations which predict increased response and survival in patients to oral tyrosine kinase inhibitors. This study was conducted to study the frequency of epidermal growth factor receptor mutation in patients in Nepal and compare the outcome in epidermal growth factor receptor mutated versus non-mutated patients receiving standard therapy.Methods: This is an observational study conducted among newly diagnosed patients with stage IV adenocarcinoma of lung in Bir Hospital from April 2017 to June 2018. Demographic and clinical data collection along with epidermal growth factor receptor mutation testing was done. Patients with epidermal growth factor receptor mutations received Gefitinib while non-mutated patients received systemic chemotherapy. Response evaluation, progression free survival at 1 year, objective response rate and quality of life were compared. Follow up period was for 1 year.Results: Eighty three (33%, n=253) patients were diagnosed with adenocarcinoma of the lung with mean age at diagnosis being 59.4 years. epidermal growth factor receptor mutations were found in 29% patients. Complete response was achieved in 9.1% vs 3.0 % (p=0.46), objective response rate was 27.3% versus 15.2% (p=0.23), progression free survival at 1 year was 39% vs 27%, (p = 0.29) and mean score of global health status was 68.1 versus 61.6 in epidermal growth factor receptor mutated versus non-mutated (p = 0.036). Conclusions: The frequency of epidermal growth factor receptor mutation in patients with adenocarcinoma of the lung was lower than in Eastern Asian studies, but higher than in western populations. epidermal growth factor receptor mutated patients had improved survival, better treatment response and quality of life in comparison with non-mutated. Keywords: Adenocarcinoma of lung; EGFR; quality of life
Mentorship Programme for Undergraduate Medical Students
Authors: Daha Sunil Kumar , Regmi Saurav , Dahal Saurab , Jha Rishi Raj , Mandal Rajesh Kumar
Published: November 2024

Background: Mentorship is seen as a continuous journey of discovery, shared learning, and personal and professional development to achieve leadership and excellence. Medical schools can be monitored with respect to the provision of mentorships as a quality characteristic. So, the aim of our study was to know the prevalence and the impact of mentorship program in medical schools of Nepal and the need of this program in medical schools all over Nepal.Methods: A descriptive cross-sectional study was conducted among medical students in medical schools in Nepal. Ethical approval from the Nepal Health Research Council (NHRC) was obtained (Ref. 667). The cumulative data obtained nationwide was entered in computerized spreadsheet software (Microsoft Excel) and analyzed using MS Excel and SPSS 16.0.Results: Patan Academy of Health Sciences (PAHS) 131 (50.8%) had highest prevalence of mentorship program. Out of 258 students, 110 (42.6%) knew that there was mentorship program in their medical schools. The study found the role of mentors in building rapport with faculties (61.82%), developing professional skills (81.82%) and learning evidence-based medicine (74.55%). 98.8% participants soughed for the need of this program in their medical schools.Conclusions: The prevalence of mentorship program among medical school in Nepal was found to be low. Individuals involved in the mentor-mentee relationship found the role of mentor not only on academics but also on their personal and social enterprises. Medical students who were familiar with the concept of this program reported its need in medical school.Keywords: Medical students; mentor; mentorship program
Insomnia among Elderly People in a selected urban Community
Authors: Shrestha Shristika , Roka Tara
Published: November 2024

Background: Insomnia affects both physical and mental well-being of elderly people, also increasing risks of psychological problems such as depression and decreases quality of life. We assessed the proportion of elderly people with insomnia and associated factors in a selected community. Methods: We carried out a cross sectional study interviewing 110 elderly people residing in Shankarapur-7, Sankhu, Kathmandu using convenient sampling technique. We used a structured questionnaire and included Insomnia Severity Index to identify level of insomnia. We analysed insomnia as clinically significant and non-significant and present the results as proportion and further bivariate analysis. Results: About one third (29.1%) of the elderly had clinically significant insomnia. About half (53%) of the participants suffered from co-morbid disease conditions, mainly hypertension and diabetes mellitus. About 2 in 5 (38%) participants performed regular exercise for more than 15 minutes. Similarly, the proportion of clinically significant insomnia was higher among older age groups (50% among 70+ years & 21% among below 70 years), females 40% (males 19%), widowed 56% (currently married 21%), illiterate 42% (literate 13%). These were found to be significant during bivariate analysis. Conclusions: We found a substantial proportion of participants with clinically significant insomnia. Promoting the physical and mental health of elderly people is important for them to lead a quality life. Health promotion approaches with targeted interventions for elderly are important to cater the need of elderly population and this might help improve the quality of life of the elderly people.Keywords: Community; elderly; insomnia; Kathmandu; Nepal
A Glimpse of Research Output from Nepal and the Way Forward
Authors: Vaishya Raju
Published: November 2024

N/A
Arrhythmias: Its Occurrence, Risk Factors, Therapy, and Prognosis in Acute Coronary Syndrome
Authors: Khanal Raja Ram , Gajurel Ratna Mani , Shah Sangam , Poudel Chandra Mani , Shrestha Hemant , Devkota Surya , Thapa Sanjeev
Published: November 2024

Background: Patients with acute coronary syndrome may lead to various metabolic and electrophysiological changes that induce both asymptomatic and symptomatic life-threatening arrhythmias, which increases morbidity and mortality. Methods: This observational retrospective study was conducted at Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Maharajgunj, Kathmandu, Nepal. Three hundred ninety-five patients with a diagnosis of acute coronary syndrome were enrolled in the study. Results: A total of 395 patients were included in the study with a mean age of patients 61.29± 13.5 years and with male predominance. A total number of 115 cases of arrhythmia were recorded among which the most common were atrioventricular block (10%), reperfusion arrhythmia (9.6%) followed by ventricular premature complex (8%), atrial fibrillation/flutter (6%), and ventricular tachycardia/fibrillation (5%). There was a significant difference in the incidence of arrhythmia in acute coronary syndrome group. STEMI (39.7%), NSTEMI 26(20.8%) and unstable angina11(14.8%) respectively (p=<0.001). Reperfusion arrhythmia was present in 89.47% of STEMI and 10.4 % of NSTEMI/ unstable angina and was statistically significant (p-value <0.001). A total of three patients (0.7%) needed permanent pacemaker insertion in the acute coronary syndrome group. All of these patients were STEMI which was 1.5% of total STEMI, two in inferior wall STEMI (2.6%) and 1 in anterior wall STEMI (0.8%). The total in-hospital mortality was 20 (5.06%), 17(8.6%) among STEMI and 3(2.4%) among NSTEMI, and none in unstable angina (P =<0.001). Pulmonary edema (12.9%) was the most common in-hospital outcome followed by cardiac arrest (7.6%).Conclusions: Arrhythmia in acute coronary syndrome is a common problem and may lead to structural and functional impairment of myocardial function. Keywords: Arrythmias; coronary artery disease; STEMI
Ocular and Neuro-ophthalmic Manifestations Post COVID-19 Infection
Authors: Bista Bipin , Yadav Reena , Gupta Sharad , Das Sandip Sanyam , Rajak Ashik , Acharya Rajesh , Neupane Rasik , Bista Padam Raj
Published: November 2024

A 39-year-old male with a history of COVID-19 infection presented with ocular manifestations: dendritic ulcer in the left eye cornea followed by diplopia in the same eye. Extraocular motility was restricted in the levo-lateral gaze with maximum diplopia measuring 25? exotropia. Slit lamp biomicroscopy showed dendritic patterned lesion with diffused superficial punctate keratitis in the cornea. There are various reports associated with COVID-19 and the neuro-ophthalmic system. Although the clinicopathological aspect of COVID-19 and the neurological system is still to explicate. However, the patient showed gradual improvement with topical and systemic antiviral therapy and orthoptic exercise. This points to the need for detailed neurological and ophthalmic workup in symptomatic COVID-19 patients. Taking the risk of viral spread into serious consideration, a thorough evaluation is though mandatory.Keywords: COVID-19; dendritic ulcer; lateral rectus palsy; superficial punctate keratopathy
Distribution of MecA and Erm Genes among Methicillin-resistant Staphylococcus Aureus with Inducible Resistance to Clindamycin
Authors: Malla Thakuri Dudha Raj , Pokhrel Anil , Amatya Ritu , Sharma Bashyal Narayan , Neupane Mary , KC Sudeep , Joshi Dev Raj , Khanal Santosh
Published: November 2024

Background: The emergence of Methicillin-resistant Staphylococcus aureus and its ability to confer cross-resistance to macrolide-lincosamide-streptogramin B has complicated the treatment against it. Gene-based studies among phenotypic methicillin-resistant isolates with inducible resistance to clindamycin are less available in Nepal. This work was undertaken to detect the mecA and erm genes among such phenotypes isolated from clinical samples. Methods: S. aureus isolated from different clinical samples was identified by standard microbiological procedures (Gram-staining, colony morphology, and different biochemical tests). Methicillin-resistant and inducible resistant to clindamycin phenotypes were detected by using cefoxitin disc (30 µg) and a double disk diffusion test according to the Clinical and Laboratory Standards Institute guidelines and mecA and erm genes were detected by polymerase chain reaction.Results: Among 120 S. aureus isolates, 51.67% (n=62) were MRSA, and the prevalence of inducibly-resistant, constitutively-resistant and Macrolide-Streptogramin phenotypes were 15.83% (n=19), 28.33% (n=34) and 15.83% (n=19) respectively. While 35.84% (n=43) of isolates showed sensitivity to both antibiotics, erythromycin and clindamycin. Out of 14 inducibly-resistant phenotypes, 57.14% (n=8) were found carrying ermC and 28.57% (n=4) phenotypes contained both ermA and ermC. All phenotypes were positive for the mecA gene.Conclusions: Macrolides-Lincosamide-Streptogramin B resistance was predominant among methicillin-resistant S. aureus. While all isolates with inducible clindamycin resistance harbored mecA gene, most of them also harbored ermC gene. The higher prevalence of inducible-resistant to clindamycin indicated the need for rational use of antimicrobial agents.Keywords: Erm gene; iMLSB resistance; mecA; methicillin-resistance; MRSA
A Consecutive Series Study of the Frequencies, Intensities, and Natural History of Symptoms Following COVID-19 Infection in Nepali Men
Authors: Shrestha Deepak Sundar , Rahat Arafat Mahamood , Sridevi Parama , Chalise Bimal Sharma , Rajbhandari Sagar Kumar , Bastola Anup , Bhandari Parmananda , Ahamed Sheikh Iqbal , Love Richard R.
Published: November 2024

Background: In Nepal, approximately one million individuals, two-thirds men, have tested positive for COVID-19. The recovery picture from this infection is undescribed.Methods: At one major testing institution in Kathmandu, we attempted to contact men three-four months following documentation of a positive PCR Covid test. If the men contacted consented and reported that they had not completely recovered from their Covid infection, we then sought their answers about the presence and intensities of 23 symptoms.Results: Of 2043 consecutive test-positive men, we successfully contacted 1254 men/or family members. 14 men had died before our calls, and two reported having cancer or tuberculosis, providing 1238 individuals. 318 (25.7%) reported that they were unrecovered and 311 of these men were successfully interviewed. At a median of 3.5 months from diagnosis, 216 (17.4%) men reported fatigue, 153 (12.4%) pain, 134 (10.8%) difficulty remembering, 133 (10.7%) reduced physical activity, 114 (9.2%) shortness of breath, and 114 (9.2%) poor sleep. By 6 and 9 months, 108 (8.7%) and 55 (4.4%) of men respectively were still unrecovered.Conclusions: In this PCR Covid test-positive series of symptomatic men, recovery was significantly prolonged compared with other viral illnesses.Keywords: COVID-19; long-COVID; men; recovery; symptoms
Functional and Radiological Outcome of Short Same Segment Instrumentation in Thoracolumbar Burst fracture
Authors: Thapa Bishnu Babu , Shah Rajesh Pratap
Published: November 2024

Background: Thoracolumbar region is important biomechanics transition zone in which rigid thoracic and flexible lumbar spine meet. This area is highly vulnerable to traumatic spinal fracture.Among all spine fracture, compression type is most common and managed conservatively. Thoracolumbar spine fracture can be associated with neurological deficit, spinal instability. The optimal treatment for these injuries is still controversy and subject for research.Methods: This retrospective study included 30 patients with single level thoracolumbar fracture.All the patients clinical and radiological parameters were evaluated preoperative, post-operative and 1 year follow up. Clinical parameters were included Visual analogue score, Oswestry disability index. Radiologic measurement were regional kyphotic angle by cobb’s method and anterior vertebral body height loss (Mumford’ santerior body compression equation method) in X-ray. All the data were analysed in SPSS version 20.Results: A total of 30 patients were included in this study,19 were male.The mean age of the patients were 40.8±13.The main cause of injury was fall from height,26 patients. The most common level of fracture vertebra was L1,11 patients.The mean difference of preop and postop kyphosis was 11.70±50 with P<0.05.The mean difference of preop Oswestry disability index and postop Oswestry disability index score was 30.7±7.6 with T score 22(P<0.05).The preop and postop Visual analogue score score also improved ,mean difference was 2.8±1(P<0.05).Conclusions: Short segment instrumentation with placement of pedicle screw at fracture vertebra is one option in the treatment of thoracolumbar burst fracture.Keywords: Burst; instability; kyphosis; neurological; thoracolumbar
Screening of Peripheral Arterial Disease in Patients with Diabetes
Authors: Ghimire Mahesh Raj , Acharya Sumnima , Pandey Sundar , Aryal Deepak , Shah Pooja , Soti Binita , Ghimire Sulochana , Thapa Lekhjung
Published: November 2024

Background: Out of many atherosclerotic complications, peripheral arterial disease (PAD) is also important one. To prevent morbidity and mortality related with PAD, early detection is must, and is possible by duplex screening. This study aims at screening for PAD in patients with type 2 Diabetes mellitus.Methods: This study is single centered cross- sectional, observational study conducted in department of internal medicine of DMCRI- a tertiary care hospital. A total of 140, type 2 diabetes patients were screened for peripheral arterial disease by duplex ultrasound after taking informed consent and fulfilling inclusion and exclusion criteria.Results: In our study among 140 Participants, 50% are male and 50% are female with mean age of 57.6 ± 10.4 years standard deviation (SD) and mean duration of diabetes was 8.31± 5.9 SD years with 13.6% were alcohol consumer; 1.4% were smokers; 59.3% of them had high blood pressure; (28.6%) had dyslipidaemia and 11.4% had hypothyroidism. The prevalence of PAD in type 2 diabetes was 27.1% in our study. The mean of glycated hemoglobin (HBA1c) was 7.23 ± 1.75% and while performing analytical test {chi-square (?)}, we found there was no association between HBA1c level and presence of peripheral arterial disease.Conclusions: The prevalence of peripheral arterial disease is high almost more than one quarter (27.1%). Screening of diabetic patients is must especially those aged and high glycated hemoglobin for early detection and effective management of PAD. Keywords: Diabetes mellitus; glycated hemoglobin; peripheral arterial disease; screening
Bacteriological Profile of Surgical Site Infection Following Gastrointestinal Surgery and Their Antibiogram
Authors: Shrestha Neha , Sharma Sangita , Ghimire Bikal , Prasad Pravin , Das Debashis , Sherchand Jeevan Bahadur
Published: November 2024

Background: Surgical site infection is one of the common complication following abdominal surgery. It causes great morbidity and mortality, further increasing prevalence of multidrug resistant bacteria have made its management very challenging. The current study aims to identify causative agent responsible for surgical site infection and their antibiotic resistance patterns.Methods: This study was conducted among patients developing surgical site infection following gastrointestinal surgery in Tribhuvan university teaching hospital over a period of one year. The samples were collected and processed according to standard methods. The bacterial pathogens with their antimicrobial susceptibility were determined and resistant pattern like methicillin resistant Staphylococcus aureus and extended spectrum beta lactamase were further detected.Results: A total of 832 patients had under gone gastrointestinal surgery during the study period. Among them, 162 cases (19.5%) developed surgical site infection and 125 cases showed growth in culture. A total of 160 aerobic bacteria were isolated; Escherichia coli (29.9%) was the commonest organism with 40.8% being extended spectrum beta lactamase producer and 47.4% of Staphylococcus aureus were methicillin resistant. About 75.9% (85/112) of gram negative bacteria and 60.4% (29/48) gram positive bacteria were multi drug resistant.Conclusions: The burden of multi drug resistant bacteria causing surgical site infection is high which needs to be addressed timely. Good surveillance of bacterial antibiogram and rational antimicrobial use is necessary to reduce emergence and spread of resistant bacteria.Keywords: Extended Spectrum beta lactamase; gastrointestinal surgery; methicillin resistant staphylococcus aureus; multi drug resistance; surgical site infection
Correlation of Imaging Findings with Molecular Subtypes of Breast Cancer
Authors: Panta Om Biju , Dhakal Vivek , Gurung Bibek , Ghimire Ram Kumar
Published: November 2024

Background: Ultrasound and Mammography are first-line imaging in breast cancer. The management of malignant breast lesions depends on molecular biomarkers in the tumor cells. This study aims to correlate different imaging findings in breast carcinoma with immune-histology subtypes. Methods: The study was a retrospective study conducted between 2018 January to 2021 December. Patients with malignant breast lesions who underwent USG-guided biopsy of breast lesions were included in the study. Ultrasound and mammographic findings of these patients were retrieved in PACS and analyzed. Malignant breast lesions were classified according to molecular markers into Luminal A, Luminal B, Her- 2 enriched, and triple-negative breast cancers. The correlation between imaging findings and molecular subtypes of breast cancer was analyzed. Results: A total of 42 patients were included in the study. The mean age of the patients in our study was 52.24+/-13.54 years with median of 51 years (IQ range-19.5 years). The most common IHC subtype was Luminal type B (22, 52.4%), followed by triple negative (15, 35.7%), luminal type A (4, 9.5%) and least common was Her-2 enriched (1, 2.4%). Mammogram was non-diagnostic in 9.5% of case. Oval shape and well marginated margin in ultrasound were more frequently associated with triple negative breast cancer than other subtypes (P<0.05). Rest of the characteristics of triple negative and other malignancies were not significantly difference in our study. No significant difference is noted between mammographic findings between various subtypes.Conclusions: Triple negative breast cancer was more common in our population than in the west. Triple-negative breast cancers are more frequently well-defined and oval in shape mimicking benign lesions.Keywords: Breast cancer; mammography; molecular subtypes; ultrasound
Correlation of Endometrial Thicknessby Transvaginal Sonography with Histopathological Examination in Abnormal Uterine Bleeding in Perimenopausal Age Group
Authors: Sah Sadhana , Dangal Ganesh , Jha Meena
Published: November 2024

Background: Transvaginal sonography and endometrial biopsy are the two diagnostic tests, most frequently used to investigate the cause of abnormal uterine bleeding.The aim of this study is to correlate the findings between transvaginal sonography and histopathology for diagnostic evaluation in perimenopausal women with abnormal uterine bleeding.Methods: A descriptive observational study was carried out at Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu, Nepal during the period of one year (1st January 2019 to 30th December 2019) in 70perimenopausal women with abnormal uterine bleeding. Transvaginal sonography wasdone and endometrial thickness was noted. Endometrial biopsy was done under intravenous anaesthesia. Histopathological reports reviewed and analysis done. Results: The most common age group of women presenting with abnormal uterine bleeding was 40 to 43 years(42.9%) and the commonest clinical feature was menorrhagia (50%) followed by menometrorrhagia (27.1%). The transvaginal sonography showed that majority of women had endometrial thickness of 10-12mm(35.7%) followed by 7-9mm(27.1%). Proliferative endometrium (37.1%) was most common histopathologicalfinding followed by secretory endometrium (30%). 10 cases of proliferative endometrium was seen at ET 7-9mm and 1 case of endometrial carcinoma was seen at ET 13-15 mm with P-value <0.13.Conclusions: Transvaginal sonography and histopathological examination are the standard diagnostic procedures for the assessment of abnormal uterine bleeding and for early detection of precancerous lesion like endometrial hyperplasiaand endometrial cancer. Keywords: Abnormal uterine bleeding; histopathology; transvaginal sonography
Knowledge, Attitudes, and Practices Concerning COVID-19 in Nepal
Authors: Bhattarai Anil , Ranabhat Kamal , Saud Bhuvan , Bhattarai Suraj , Paudel Kiran , Acharya Devaka Kumari , Tripathi Sangita , Shah Sangam , Bhatta Nikita , Das Santa Kumar
Published: November 2024

Background: Coronavirus disease-2019 (COVID-19) severely affects patients with chronic diseases. Adequate knowledge, attitudes, and practice related to COVID-19 is associated with decrease morbidity and mortality. Therefore, this aimed to assess knowledge, attitudes, and practice toward COVID-19 disease among chronic diseases patients visiting tertiary hospitals in Kathmandu.Methods: A cross-sectional study was conducted among chronic disease patients who visited Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu. Structured questionnaire was used to collect patients’ socio-demographic data and perspectives on COVID-19.Results: Four hundred chronic disease patients participated in the study, with 53.2% female and 46.8% male, and 56.8% of age ?50 years. Overall, 55.5% of the participants had good knowledge, 56.2% had good practice, and 30.7% had positive attitude towards COVID-19. Younger patients, 18-34 years, were found to have higher odds of having good knowledge compared to other age groups (aOR: 2.5; 95% CI: 1.3-6.0). The patients with less than average family income and those unable to read and write had lower odds of having positive attitude towards COVID-19 (aOR: 0.6; 95% CI: 0.4-0.9 and aOR: 0.4; 95%CI: 0.2-0.9, respectively). A statistically significant correlation was found between the patients’ knowledge and practice, knowledge and attitude, and attitude and practice (p <0.001).Conclusions: Nearly half of the chronic disease patients in Nepal had poor knowledge and practice whereas more than two-third had negative attitude towards COVID-19 disease. Older age of the patient was significantly associated with poor knowledge and practice. Keywords: Attitudes; chronic diseases; COVID-19; knowledge; practice
Magnitude of Viral Load Suppression and Associated Factors among HIV-positive Patients Receiving Antiretroviral Therapy
Authors: Acharya Priti , Neupane Anil Prasad , Sigdel Brihaspati , Ghimire Laxmi , Pant Madhab Raj , Budhathoki Abiruchi , Poudyal Anil
Published: November 2024

Background: Viral load assessment is the preferred method for diagnosing and confirming virologic failure for patients on antiretroviral therapy. This study aimed to assess the proportion of viral load suppression and identify associated factors among HIV-positive patients receiving antiretroviral therapy at the Pokhara academy of health science in Nepal.Methods: This institution-based retrospective cohort study was conducted at Pokhara academy of health science in Pokhara, Nepal. The study included 567 HIV patients who were enrolled between January 2016 and December 2019 and had their viral load measured within a one-year period. Statistical analysis was performed using STATA version 13.0. The proportions of viral load suppression and non-suppression were determined. Bivariate and multivariate logistic regressions were performed to identify factors associated with viral load suppression. Statistical significance was determined at a 95% confidence interval and p < 0.05Results: Out of the 567 HIV patients, 95.76 % (95% CI: 94.10-97.42) achieved viral suppression. In multivariate analysis, longer duration of antiretroviral therapy treatment (> 3 years) was independently associated with higher odds of achieving viral suppression compared to those on antiretroviral therapy for less than 6 months (adjusted odds ratio [aOR] = 11.98, 95% confidence interval: 1.32-108.81, p < 0.0027). Conversely, individuals in second-line treatment had significantly lower odds of viral suppression compared to those in first-line treatment (aOR = 0.19, 95% CI: 0.05-0.66, p < 0.009).Conclusions: Our study demonstrated a high rate of viral suppression among HIV patients receiving antiretroviral therapy, exceeding the UNAIDS 90-90-90 target. Longer duration of antiretroviral therapy and being in second-line treatment were identified as factors influencing viral load suppression. These findings emphasize the importance of early initiation and adherence to first-line treatment for optimal outcomes.Keywords: ART; HIV/AIDS; viral load suppression
Early Outcome of Neonates Admitted with Meconium Aspiration Syndrome
Authors: Bhandari Isha , Karmacharya Malla Kalpana , Chaudhary Brajesh Raj , Ghimire Pukar
Published: November 2024

Background: Meconium aspiration syndrome is one of the commonest cause of respiratory distress in neonates. The incidence is still high in developing world. This study aims to study the clinical characteristics and early outcome of neonates admitted for meconium aspiration syndrome.Methods: This was a cross-sectional descriptive study done among neonates admitted to the neonatal Intensive Care Unit with a diagnosis of Meconium Aspiration syndrome. Relevant epidemiological, clinical and laboratory data were obtained. The early outcome of those neonate was studied.Results: Out of 140 neonates with a mean birth weight of 2865 + 543 grams,73.6% were male, of which 76.4% were referred cases while 23.6% were inborn. Of them 69.3% had history of thin type of meconium while 30.7% had thick type of meconium during delivery. Of all mothers, 74.3% were primigravida, 4.3% had intrapartum fever of unknown source,11.4% suffered from urinary tract infection while 2.8% had hypertension. Premature rupture of membrane had occurred among 7.9% and oligohydramnios was found in 10%. Half of them (50.7%) had spontaneous vaginal delivery, 44.3% had caesarian section, while 4.8% had assisted delivery. Around one third of the neonates (37.1%) were given supplemental oxygen via nasal prongs, 25.7% via head box, 27.1% via continuous positive airway pressure and 10% intubated. Around half of the neonates (42.1%) had no complications. Complication noted were sepsis, birth asphyxia, seizures and polycythemia in 35%, 14.3%, 5.7% and 2.9% respectively. Mortality occurred among 5.0% of them.Conclusions: Meconium aspiration syndrome is one of the commonest cause of respiratory distress in a neonate which is associated with common maternal risk factors especially in primigravida which included Urinary tract infection, hypertension and oligohydramnios.Keywords: Meconium; meconium aspiration syndrome; newborn
Translation and validation of Bristol Female lower urinary tract symptoms (BFLUTS) questionnaire for Nepali speaking women
Authors: Thapa Baburam Dixit , Chandra Regmi Mohan , Basnet Tulasa
Published: November 2024

Title: Translation and validation of Bristol Female lower urinary tract symptoms (BFLUTS) questionnaire for Nepali speaking women
Introduction: Bristol female lower urinary tract symptoms questionnaire (BFLUTS) was designed to identify the lower urinary tract symptoms (LUTS) in women. It aids in determining the severity of lower urinary tract symptoms and how they affect sexual function and quality of life.It can be employed in research and therapeutic practice. It is not available in Nepali version. As a result, our goal is to translate and validate the BFLUTS questionnaire in Nepali.
Methods: The BFLUTS questionnaire has been translated into Nepali. From March 1, 2020 to February 28, 2021, 225 Nepalese patients with lower urinary tract symptoms were evaluated using a Nepali version of the BFLUTS questionnaire adapted from the English version. Internal consistency, test-retest reliability, validity, and change responsiveness were all assessed.
Results: A total of 225   patients were enrolled in the study. The missing data was less than 2%. The Nepali version of the BFLUTS questionnaire showed good reliability (? = 0.76; ICC= 0.934). Test-retest reliability was assessed with weighted kappa (?) ranging from 0.71 to 0.83.It showed good sensitive to change before and after the treatment. Mean BFLUTS scores correlated strongly with the symptomsof lower urinary tract symptoms reported in the bladder diary with ? ranging from 0.689to 0.859.
Conclusions: The Nepali version of BFLUTS questionnaire is a reliable, valid and consistent for measuring lower urinary tract symptoms and their effect on sexual function and quality of life.
Keywords: BFLUTS; LUTS; Nepali; Reliability; Validity.
Pneumothorax, pneumomediastinum and subcutaneous emphysema as respiratory complications of COVID-19
Authors: Rawal Prabhat , Shrestha Surendra Man , Gurung Anju , Poudel Dipesh
Published: November 2024

Background: Pneumothorax, pneumomediastinum and subcutaneous emphysema are respiratory complications of Coronavirus disease 2019 occurring with noteworthy frequency in patients especially with severe disease. They can be life-threatening and often complicate patient managment.Methods: This was a retrospective, observational study of patients admitted in Nepal Armed Police Force hospital from 13/05/2020 to 28/12/2021 diagnosed with pneumothorax, pneumomediastinum or subcutaneous emphysema singly or in combination. Data were collected from clinical charts, imaging records and electronic medical records of Severe Acute Respiratory Syndrome Coronavirus-type 2 positive patients 18 years and older. The frequency and type of the defined complications, the inflammatory markers and ventilatory parameters just prior to their diagnosis, the duration of hospitalization and ICU admission and in-hospital mortality rate were studied. Results: Out of 4013 COVID-19 patients admitted in the hospital during the period, a total of 28 patients were observed to develop the complications, the overall incidence being 0.7% among hospitalized patients and 5.6% among ICU patients. The proportion of subcutaneous emphysema (64.3%) was highest followed by pneumomediastinum (46.4%) and then pneumothorax (39.3%) existing singly or in combination among the 28 patients, where four patients developed the complications spontaneously. Mean Positive End Expiratory Pressure of 12.1±2.6 cmH2O and Peak Inspiratory Pressure or Pressure Support of 30.9±10.3 cmH2O were observed for patients under positive pressure ventilation. Most of the patients who developed the complications (78.6%) died during treatment.Conclusions: Pulmonary air leak complications occur frequently in COVID-19 patients treated with or without positive pressure ventilation signifying increased disease severity, risk of ICU admission and high mortality rate. Hence, clinicians should be vigilant of these complications in all patients affected with COVID-19 and institute timely management. Keywords: Barotrauma; COVID-19; incidence; pneumomediastinum; pneumothorax.
Nepal needs Continuing Professional Development for Re-registration in Nursing and Midwifery
Authors: Simkhada Bibha , Van Teijlingen Edwin , Sharma Chandrakala , Pandey Apsara , Simkhada Padam
Published: November 2024

The nursing and midwifery profession needs to stay up to date with the latest developments.  In this Viewpoint, we shall be referring to ‘nurses’ and ‘nursing’ to mean ‘nurses and midwives’ and ‘nursing and midwifery’ respectively. Nurses must continue to update their skills and competences to meet changing future population health needs effectively and safely. However, the reality is that many staff are reporting difficulty accessing and completing Continuing Professional Development (CPD) in all settings.
Keywords: CPD; midwifery; nursing; post-registration education; training.
Application of Pediatric Risk of Mortality (PRISM) III Score in Predicting Mortality Outcomes
Authors: Joshi Prakash , Agrawal Sumit , Ghimire Jagat Jeevan , Shrestha Pun Narayan , Khatun Najala , Banjara Megha Raj
Published: November 2024

Background: Children admitted in a pediatric intensive care unit have a high risk of mortality. Pediatric risk of mortality III score in first 24 hours of admission has increasingly been used to predict mortality. The objective of this study was to evaluate the validity of Pediatric risk of mortality score in prediction of mortality among the patient admitted in pediatric intensive care unit.Methods: This prospective observational study was conducted at pediatric intensive care unit of a government pediatric hospital from January to June 2021. Patients between 1 month to 14 years of age and meeting the inclusion criteria were enrolled. Pediatric risk of mortality III score was calculated within 24 hours of admission. Patients were followed up for outcome measure as survivors and non survivors. Chi square test and logistic regression analysis were used to find the association of predictors and the score.Results: The mean Pediatric risk of mortality III score was lower in survivors than in non-survivors (4.67 ± 3.8 versus 14.10 ± 6.07; p<0.001). Those requiring inotropic and ventilator support have significantly higher mortality [49.4 versus 0.6 (p<0.001) and 81.8 versus 1.5 (p<0.001) respectively]. Minimum systolic blood pressure, abnormal pupillary reflex, increased blood urea nitrogen and decreased platelet were the significant (p<0.001) risk factors. The area under the Receiver Operating Characteristic curve was 0.916±0.024 (p<0.001) and goodness-of-fit test showed no significant difference between observed and expected mortalities (p=0.186). Conclusions: The Pediatric risk of mortality score constitutes a useful prognostic tool in predicting the mortality. Key words: Mortality; pediatrics; pediatric intensive care unit; risk score,
Variations in the Root Form and Root Canal Morphology of Permanent Mandibular canine
Authors: Shrestha Kriti , Shubham Snigdha , Ahmed Sageer , Gautam Vanita
Published: November 2024

Background: Mandibular canines are recognized as usually having one root and one root canal in most cases. However, many investigators have reported the anatomical variations associated with mandibular canines. Thus; the objective of this study is to determine the number of roots and morphology of the root canal system of permanent mandibular canine in a Nepalese population.Methods: Cone Beam Computerized Tomography images of 390 patients in a Nepalese population were selected, and a total of 780 mandibular canines were analyzed. The number of root and the canal configurations were investigated. Data were analyzed with descriptive analysis and Chi-square tests using the Statistical Package for the Social Sciences (SPSS) software version 20 (SPSS Inc, Chicago, IL, USA).Results: Out of the 780 mandibular canines, 741(95%) were single-rooted canines while only 39 (5%) were double-rooted canines. The most common type of Vertucci in single-rooted canines was Type I (1-1) in the percentage of 85.6% and the least type was Type IV (1-2) in the percentage of (2.5%). The Chi-square tests showed no significant association between gender and number of roots (P = 0.87) and gender and root canal configuration in single-rooted canine (P = 0.52). Conclusions: All mandibular permanent canines were single rooted but 5.2% of the permanent mandibular canines had two roots.Keywords: Canine; Cone Beam Computerized Tomography (CBCT); double root; root canals.