bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Gestational Diabetes Mellitus in Nepal: A Systematic Review and Meta-analysis
Authors: Pokharel Pashupati , Pokhrel Kailash Mani , Lamichhane Pratik , Khanal Kapil , Rawal Suniti
Published: November 2024

Background: Gestational diabetes mellitus is a condition of glucose intolerance during pregnancy. The burden of Gestational diabetes mellitus is ever increasing including a lower middle-income country like Nepal. Methods: This meta-analysis was conducted in accordance to the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases of “Embase”, “Google Scholar”, “Scopus”, “Web of Science” were searched for observational studies in Nepal from 2000 to July 2021. Random effect model was used to estimate the pooled prevalence subgroup analysis.Results: This systematic review and meta-analysis analyzed 9 studies with a total of 20865 participants. Pooled prevalence of gestational diabetes mellitus was 2.61% (95% CI: 1.25- 5.37). From subgroup analysis, the prevalence of Gestational diabetes mellitus according to the diagnostic criteria were: International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria 6.56% (95% CI: 4.79-8.92), World Health Organization (WHO) criteria 4.81% (95% CI: 3.79-6.08), Diabetes in Pregnancy Study Group of India (DIPSI) criteria 4.71% (95% CI: 3.06-7.18), Carpenter and Coustan criteria (CC) 1.08% (95% CI: 0.43-2.71); prevalence according to the publication time: before 2015 1.20% (95% CI: 3.64-6.41), in and after 2015 4.84% (95% CI: 0.42-3.39); prevalence according to the place: within Kathmandu valley 2.70% (95% CI: 1.17-6.08), outside Kathmandu valley 2.28% (95% CI: 0.26-17.15).Conclusion: Our study revealed the increasing prevalence of GDM in Nepal. Further large observational studies at local levels are essential to measure the actual burden, risk factors and potential preventive measures for Gestational diabetes mellitus. Keywords: Diabetes in pregnancy; gestational diabetes mellitus; meta-analysis; Nepal; prevalence.
Effect of Intravenous Calcium Gluconate on Prevention of Post Spinal Hypotension during Spinal Anaesthesia for Caesarean Section: A Randomized Double-Blind Controlled Study
Authors: Agarwal Shilpa , Kumar Mahender , Gupta Anju , Rautela RS , Jain Nidhi
Published: November 2024

Background: Calcium, a physiological ion, causes vasoconstriction and has a positive ionotropic action on heart. Its use to prevent post-spinal hypotension has been suggested but never formally evaluated for patients undergoing caesarean section. This study investigated the hemodynamic effects of calcium administration in parturients with the primary aim of comparing the incidence of post-spinal hypotension.Methods: Sixty healthy full-term pregnant patients scheduled for caesarean section were randomly allocated to two equal groups to receive either calcium gluconate or normal Saline bolus over 20min by syringe infusion pump under electrocardiography monitoring immediately after the patient was turned supine following spinal anaesthesia. Blood pressure and heart rate were recorded at baseline, and at regular intervals following spinal. Maternal calcium levels were estimated before and after infusion. Neonatal blood gas analysis and calcium level were analyzed. Total mephentermine requirement was recorded in both groups.Results: The heart rate values remained comparable to baseline value in group calcium gluconate while in group normal Saline, it decreased significantly at 8,12 and 16min. Blood pressure decreased significantly as compared to the baseline value from 4min onwards in both the groups. However, it was comparable in the two groups at all time points(0.622). Nineteen patients(63.33%) required mephentermine infusion in group calcium gluconate as compared to 23 patients(76.6%) in group normal Saline for maintenance of systolic blood pressure.(p=0.791) Umbilical venous pH (p=0.038) and partial pressure of carbon dioxide(p=0.038) were significantly better in group calcium gluconate. Conclusions: Calcium used for prophylaxis of hypotension in healthy parturients undergoing caesarean section reduced the vasopressor requirements and total mephenteramine dose, but the difference did not attain statistical significance. Keywords: Cesarean section, fetal acidosis, hypotension, vasopressors.
Psychological Status of Nepalese Young Adults During The End of First Wave of COVID-19 Pandemic
Authors: Sharma Shristi , Qian Wu , Acharya Bipin Kumar , Kunwar Dipak
Published: November 2024

Background: Psychological problems increased during the period of COVID-19. Lockdown” is adopted in many countries of the world. It has also been seen that COVID-19 has led not only to an increase of infection and death but also vast change in the lifestyles of every individual especially in young adults causing various mental health issues. However, in Nepal, there are limited studies to address this issue.The main objective of this study is to generate evidence on the prevalence of symptoms of post-traumatic stress disorder, anxiety, and depression among young adults and the factors contributing to these outcomes in Nepal. Methods: Cross-sectional methods were employed using an online structured questionnaire in January 2021, among 1229 participants. Three logistic regression models were performed to examine the significant COVID-19 factors. Results: The prevalence of Depression, Anxiety and post-traumatic stress disorder related symptoms in this study were 255(20.4%), 240(19.2%)and 162(13.2%) respectively relate.COVID-19 diagnosis, COVID-related stress and exposure was significantly related to depression. Similarly, COVID-19 diagnosis, change in income during COVID-19, being exposed to 4 or more exposure factors had high chances of getting anxiety. Also, income change during COVID-19 and stressors during COVID-19 were related to post-traumatic stress disorder.Conclusions: This research shows that various COVID-19 related factors have contributed to the high prevalence of these outcomes. Keywords: Anxiety; COVID-19; depression; Nepal; post-traumatic stress disorder.
Investigation of Visceral LeishmaniasisTransmission in Selected Districts of Nepal
Authors: Basnyat Shaila , Banjara Megha Raj , Ghimire Prakash , Matlashewski Greg , Singh Anjana
Published: November 2024

Background: Visceral leishmaniasis is transmitted to humans by Leishmania donovani infected Phlebotomus argentipes sandflies. Nepal has successfully met the elimination target of less than 1 case per 10,000, although recently this threshold has been surpassed demonstrating ongoing transmission. The main objective of the present study was to investigate transmission of visceral leishmaniasis in 4 visceral leishmaniasis endemic districts of Nepal including Palpa, Morang, Saptari and Sarlahi.Methods: Human blood samples (331), domestic animals blood samples [goats (n =67), dogs (n =1), cows (n = 6), buffaloes (n = 16), and ox (n = 10)] and sandflies samples (3976 from 142 households) were collected from the villages of these 4 districts. Human blood samples were tested for VL antibodies using the rK39 rapid diagnostic test (InBios International, Seattle, WA). kDNA of L.donovani was amplified by PCR from DNA extracted from human blood, animal blood and sandfly samples.Results: Out of 331 screened across 4 districts,32 were positive on rK39 serology and 16 were positive by PCR amplification of kDNA from L. donovani. The majority of the positive serology and PCR tests were from the Ishworpur village in the Sarlahi district where there was an outbreak of 18 cases of VL. This study also revealed the presence of L. donovani DNA in female P. argentipes sandflies collected from the Ishworpur village of Sarlahi, 6 villages in the Saptari,10 villages in the Palpa, and from 9 villages in the Morang. Blood samples from domestic animals in the same villages were negative for kDNA detection by PCR.Conclusions: The results of human and sandfly findings strongly point towards local transmission of visceral leishmaniasis in these 4 districts of Nepal. Notably, there is a significant level of transmission in the Ishworpur village in the Sarlahi district. The observations from this study suggest that domestic animals are not a reservoir host for L. donovani in these districts in Nepal. Ongoing surveillance is needed to identify new outbreaks such as in the Sarlahi district.Keywords: Domestic animals; Nepal; phlebotomus argentipes; transmission; visceral leishmaniasis.
Functional Outcome and Quality of Life Following Total Hip Replacement Surgery
Authors: Regmi Rabindra , Shrestha Dipak , Shrestha Rohit , Raj Kayastha Sabik , Thapa Jagadish , Sharma Rajiv
Published: November 2024

Background: Total hip replacement surgeries are popular treatment modality for degenerative and traumatic hip condition which provides high degree of patient satisfaction and are mainly described in literatures among patient residing in western world. However activities of daily living of people in hilly area of developing country are different from western country but there are paucity of literature describing outcome of these people.Methods: Retrospective observational study was carried out in a university teaching hospital in Nepal. Patients residing in hilly region of Nepal who underwent total joint replacement of hip joint between 2017 to 2019 AD were included in the study. The functional outcome was measured using Harris Hip Score and the quality of life was assessed using SF-12 Patient Questionnaire preoperatively , 3 months , 6 months and 1 year follow up.Results: More than two-thirds of the patients were male. The mean age group of patients was 45.71 years. The most common indication of surgery was avascular necrosis of femoral head. There was significant improvement in Harris Hip Score upto 6 months postoperatively. Quality of life including both physical and mental component of SF-12 improved significantly upto 6 months. Conclusions: Total hip replacement surgery significantly improves functional outcome and quality of life of patients residing in hilly region of Nepal. However, long term follow up still is request to find out effect of joint replacement in activities of daily living in these group of people.Keywords: Harris hip score; mental component summary scores; pain component summary scores; total hip replacement.
Radiographic measurement of Lateral Capitellohumeral Angle and Baumann’s Angle among Children
Authors: Kumar Mukesh , Lakhey Rajesh Bahadur , Shrestha Binay Lal
Published: November 2024

Background: Baumann’s angle and Lateral capitellohumeral angle measurements are essential to check the degree of reduction in supracondylar fracture of humerus in children. Although the normal values of the angles are available for other populations, there is lack of study in our population for these angles. The objective of the study was to find normal values of these angles in in Nepalese children and to compare the findings with studies done elsewhere.Methods: The study is a prospective observational study.conducted at Department of Orthopedics and Trauma Surgery, Tribhuvan University Teaching Hospital. The study was conducted from July 2019 to June 2020. A total of 56 participants were included. Baumann’s angle and Lateral Capitellohumeral Angle were measured on Xrays. Results: The mean(+/-SD) Lateral Capitellohumeral angle in our study was 48.4°(±3.40) The mean(+/-SD) Baumann’s angle was 71° (±3.20). There was no significant difference in Lateral Capitellohumeral angle and Baumann’s angle between different genders, age groups and right or left elbow.Conclusions: The measurements for elbow Baumann’s and Lateral Capitellohumeral angles in our study were similar to other studies.Keywords: Baumann’s angle; elbow; lateral capitellohumeral angle; measurement; radiograph
Patterns of Perception of Cardiac Symptoms by Patients Presenting with ST-Segment Elevation Myocardial Infarction and their Knowledge of Coronay Artery Disease Risk Factors
Authors: Prajapati Dipanker , Sherpa Kunjang , Bogati Amrit , Manandhar Reeju , Dhungana Murari , Roka Madhu , Timalsena Birat Krishna , Acharya Anjana , Ghimire Ashutosh , Ghimire Vijay , Thapa Kavindra , Shahi Roshani , Dhungana Suraksha , Adhikari Chandra Mani
Published: November 2024

Background: Proper knowledge regarding Coronary Artery Disease and their risk factors is essential for the early recognition of the disease and its presentation. This study was conducted to identify pattern of clinical symptoms and knowledge regarding Coronary Artery Disease risk factors among ST-Elevation myocardial infarction (STEMI) patients. Methods: This cross-sectional, observational study was conducted among 340 ST-Elevation myocardial infarction patients in the inpatient Cardiology Department of Shahid Gangalal National Heart Centre Nepal, from November 2020 to February 2021. Baseline clinical characteristics, knowledge regarding Coronary Artery Disease risk factors, patterns of symptoms, and prehospital delay were collected and evaluated.Results: In our study, 299 (87.9%) had typical ischemic chest pain during the symptom onset, however, only 81 (23.8%) perceived chest pain as cardiac disease, and 311 (91.5%) of the patients presented to the nearby health care center within the recommended time of less than 12 hours for the reperfusion therapy of ST-Elevation myocardial infarction. Perception of symptoms as a cardiac origin and typical chest pain were not significantly associated with earlier presentation. Also, the typical chest pain was not significantly associated with the perception of the symptom as a cardiac origin. The history of Coronary Artery Disease was considered as a Coronary Artery Disease risk factor by 184(54.1%) of the study population and 137(40.3%), 132(38.8%), 110(32.4%), 105(30.9%) and 71(20.9%) considered hypertension, smoking, age, obesity, and diabetes mellitus as a Coronary Artery Disease risk factor respectively.Conclusions: Though most patients presented with typical chest pain, identification of the chest pain as a cardiac origin and the awareness of the Coronary Artery Disease risk factors was low. Keywords: Coronary artery disease; perception; risk factors; ST-elevation myocardial infarction; symptoms
Prevalence and Factors Associated with Tobacco Use among High School Students
Authors: KC Bhakta Bahadur , Khanal Pratik , Oli Laxmi Kumari , Dhital Shalik Ram , Pradhan Bandana , Pahari Durga Prasad , Paudel Keshav Raj
Published: November 2024

Background: Tobacco use is the leading cause of morbidity and mortality worldwide. Tobacco use among school-level students is a growing a public health problem in Nepal. A number of factors may be associated with tobacco use, but there is lack of literature showcasing an in-depth understanding of the growing prevalence of tobacco use in the Nepalese context. Therefore, our study aims to determine the prevalence of tobacco use and examine the factors associated with tobacco use among high school students at public schools in Budhanilkantha municipality, Kathmandu, Nepal. Methods: A cross-sectional survey was conducted, and 378 students were selected for this study. The schools were selected randomly. Data collection was carried out using the self-administered questionnaires adapted from the World Health Organization used Global Youth Tobacco Survey and the Center for Disease Control and Prevention used Youth Tobacco Survey.Results: Overall, 31.7% of the students ever consumed any tobacco products, and 20.1% were current tobacco users. One in five students started smoking when they were less than ten years of age. The proportion of students seeing at least one family member smoking and using smokeless tobacco was 52.1% and 47.1% respectively. Male and older students were significantly more likely to consume tobacco products than female and young students.Conclusions: This study showed that a significant proportion of school students had experienced tobacco use. Age and sex of the students were significantly associated with the status of current smoking and the use of smokeless tobacco.Keywords: Nepal; school; students; tobacco use
Quality of life in Nepalese Patients with Melasma: An Observational Cross-Sectional Study at a Tertiary Center
Authors: Paudel Sushil , Acharya Poudel Indu , Upadhyay Priti , Kumar Shah Manish , Pokharel Shruti , Sharma Rabindra
Published: November 2024

Background: Melasma is an acquired pigmentation disorder of the sun exposed parts of the body, particularly face. It is a significant cosmetic concern for the young adults, which is the most frequently affected age-group. Finding the level of impairment in quality of life in melasma patients and correlating with the severity. Methods: All consenting patients with melasma visiting our out-patient from December 2020 to June 2021 were enrolled. Clinical evaluation was done by the same single reviewer in all cases using modified Melasma Area and Severity Index. Dermatology Life Quality Index (Nepali version) was asked to complete to the patient. Data were collected and analyzed. Frequency and mean were calculated for all variables, comparison of means by Mann-Whitney U test and correlation analyses by Spearman’s correlation test were performed.Results: Females were 82.5%(99) of total cases. Among these 70.8%(85) were married, 68.3%(82) had family history of melasma and 65%(78) had centro-facial phenotype. Mean Dermatology Life Quality Index score was 10.25±0.54. Mean score of females was higher than that of males. The daily activities sub-domain was the worst affected with 50.67% of impairment. Females suffered significantly more than males in symptom and feeling sub-domain. Modified Melasma Area and Severity Index was significantly higher in males (7.12±.56 Vs. 5.66±.28). The severity and duration of melasma did not correlate to the quality of life.Conclusions: Melasma had a moderately negative impact in the quality of life of the patients. Females suffered more due to melasma. The clinical severity of melasma did not correlate with the quality of life impairment. Thus, psychological assessment to all the melasma patients seem to be an important aspect of management. Keywords: DLQI; melisma; mMASI; Nepal; quality of life
Electrodiagnostic Study of the Patients with Suspected Carpal Tunnel Syndrome
Authors: Limbu Rekha , Limbu Nirmala , Khadka Rita , Subedi Priza
Published: November 2024

Background: Various electrodiagnostic tests are employed for diagnosis of carpal tunnel syndrome reporting wide range of sensitivity and specificity for each test in clinical practice. Therefore, the aim of our study is to assess the sensitivity of electrodiagnostic tests used in our set up for the diagnosis of carpal tunnel syndrome.Methods: This cross-sectional study consisted of 21 patients suspected with carpal tunnel syndrome who were referred to neurophysiology lab for electrodiagnostic evaluation and 21 age-group gender matched healthy controls. Digit 4, lumbrical versus ulnar interossei latencies and conventional nerve conduction variables were recorded. A p value of less than 0.05 was considered significant.Results: The sensitivity of median versus ulnar digit 4 sensory latency difference was the highest (72.72 %) whereas the conduction velocity of median nerve was the lowest (45.45%). The lumbrical versus ulnar interossei latency difference was significant between groups; however the sensitivity was only 51.52%. The conduction velocity of median nerve was relatively slower in the suspected cases than controls (49.67±13.75 vs. 60.90 ±6.70; p=0.007). The distal sensory latency of median nerve was significant between groups (3.47 ±0.58 vs. 2.16±0.25; p=0.03). The distal and proximal latencies of motor median nerve were significant between suspected cases and controls (4.70±1.82 vs. 2.75±0.38; p=<0.001).Conclusions: The sensitivity of median versus ulnar digit 4 sensory latency difference was the highest in our set up therefore, addition of this test with conventional method can be helpful in achieving a higher diagnosis rate.Keywords: Carpal tunnel syndrome; nerve conduction study; sensitivity
Perceived Barriers to Publication in Scholarly Journals by Faculty from Maharajgunj Medical Campus
Authors: Dahal Samarika , Shrestha Gentle Sunder , Singh Shreejana , Raj Joshi Deepak , Situala Ranju , Raj Chalise Pawan , Raj Sharma Mohan
Published: November 2024

Background: Due to multiple reasons, the faculty members in Nepal devote less than expected time to research and publication. This could be attributable to various challenges unique to each faculty member and their institution. The present study aims to evaluate the potential barriers to publication faced by the faculty of Maharajgunj Medical Campus, Kathmandu, Nepal.Methods: This cross-sectional observational questionnaire-based study was conducted among the 139 faculty members representing various departments of MMC. Results: The significant barriers were: difficult coordination (43.2%), the response time of the reviewer (48.2%), overburdened with work (39.6%), lack of funds for research (44.6%), limited submission skills (33.8%), poor writing skills (35.3%), difficulties in starting to write (42.4%), lack of time to submit a paper (43.9%), and family commitment (36.7%). Conclusions: The findings of this study could be used to advocate for a prospective change in the work module to produce competent medical researchers generating high-quality publications. Keywords: Academia; low-income countries; publication, research
Cost Analysis of Diagnosis and Treatment of Tobacco-Related Cancer
Authors: Chand Ananda Bahadur , Thagunna Mohit Singh , Shah Bharat Vikram , Bom Amit Kumar , Prasai Devi Prasad
Published: November 2024

Background: Tobacco use is the leading cause of cancer, accounting for approximately 20% of all cancer deaths and 70% of lung cancer deaths worldwide. The use of tobacco has multiple consequences; it damages health and pushes the household below the poverty line. The treatment of cancer is very costly. The study attempts to determine the cost associated with the diagnosis and treatment of tobacco-related cancer in Nepal. Methods: A descriptive cross-sectional study was conducted among 103 patients from public and private hospitals in 2019. Patients with the second and third stages of cancer who had ever used tobacco were randomly selected for the study purpose. All patients who met the inclusion criteria were selected for interviews. The data were analyzed using SPSS version 22, and summarized in descriptive form only. Results: The total cost of tobacco-related cancer was NPR 9,81,370 per patient in 2019. A patient's average direct medical cost was found to be NPR 5,88,740 (60%), whereas the average direct non-medical cost was NPR 1,23,147(13%). The wage loss as a result of illness accounted for over one–fourth (27%) of the total cost. Approximately one-sixth of the patients sold their property for the treatment of cancer. The majority of the cancer patients were found to be illiterate or with primary education only, and financially dependent on their families.Conclusions: Treatment of cancer is costly and patients in Nepal can hardly afford the expenses. Enrolling clients in health insurance and increasing the government subsidy by raising the tax on tobacco products can be a long-term source of health financing to protect patients from sliding into poverty. The increased price of tobacco due to an increase in tax would reduce tobacco consumption, particularly among youth and the poor. Keywords: Cancer; direct medical costs; non-medical costs; tobacco use; wage loss.
Low Birth Weight among Deliveries, and Adolescent and Advanced Maternal Age Pregnancy
Authors: Yadav Gopal Kumar , Paudel Binod , Chaudhary Arjun Prasad , Mahato Gaurav , Pyakurel Prajjwal
Published: November 2024

Background: We did this study to evaluate the prevalence of low birth weight among deliveries, adolescent pregnancy and advanced maternal age pregnancy. We also assessed the factors affecting the low birth weight among institutional deliveries at the level of primary hospital.Methods: A hospital-based retrospective cross-sectional study was done in Grahun Primary Hospital of Syangja, Nepal using data maintained in register book over last five years. We excluded all those deliveries with multiple pregnancy and incomplete records, and included 2473 participants in final analysis using convenient sampling. The relevant information was filled up in Microsoft Excel 2019 v16.0 and descriptive and inferential statistics was calculated using statistical package for social sciences, IBM SPSS® v21 (IBM, Armonk, New York).Results: The prevalence of low birth weight at Grahun Primary Hospital was 11.08%. The prevalence of adolescent pregnancy and advanced maternal age pregnancy was 18.03% and 02.18% respectively. Male newborns had significantly higher mean birth weight as compared to the female newborns (3101.48 ± 506.60 v/s 2967.53 ± 484.97, P-value <0.001). Female newborns had higher odds of low birth weight as compared to those male newborns (11.99% v/s 8.29%, AOR=1.56, 95% CI= 1.17-2.07). Pregnant women with lower gestational age (<37 weeks or preterm) had a higher odds of low birth weight as compared to pregnant women with normal gestational age (37-42 weeks) (AOR = 11.59, 95% CI 8.49-15.83).Conclusions: The low birth weight depends upon gestational age of mother and gender of newborn. Local organizations should work to bring down low birth weight, and adolescent pregnancy and advanced maternal age pregnancy of mother.Keywords: Low birth weight; Nepal; primary hospital; teenage/adolescent pregnancy.
Pain Management Competency and its Associated Factors among Nurses
Authors: Shrestha Indu , Payakkaraung Sudaporn , Sanasuttipun Wanida
Published: November 2024

Background: Nurses play a vital role to handle the situation in the care of the patients especially for prioritizing and managing care of pain. Nursing competency attributes personal characteristics, professional attitude, values, knowledge and skills to demonstrate professional responsibility through practices. Nursing competency helps to provide high quality essential care to the patients at a right time. This study aimed to explore pain management competency and its associated factors among nurses in a tertiary hospital, Nepal.Methods: A cross- sectional survey with correlational predictive design was conducted with 203 staff nurses who had work experience related to pain for more than two months at Tribhuvan University Teaching Hospital in Nepal. They were working in medical, surgical, gynecology and obstetrics, pediatric and neonatal, emergency and intensive care departments. The participants were selected from inpatient departments by convenience sampling technique from December 2020 to February 2021. SPSS 18.0 version was used for data entry and analysis using descriptive statistics, chi-square and logistic regression. Significant factors reported at P<0.05.Results: In total participants, 67.5% of nurses were competent on pain management. Work experience [OR= 0.426 (95% CI: 0.205-0.887)] could significantly predict on nurses’ competency for pain management. However, there was no significant association educational level, working unit, nurse-physician relationship, and training on nurses’ competency. Conclusions: Based on the findings, two third (67.5%) nurses are competent on pain management and work experience is a factor contributed to the nurses’ competency for pain management, the researcher recommends nurses with lower work experience should provide pre-service training on pain management.Keywords: Competency; nurse; pain management.
Prevalence, Associated Factors, and Impact of Workplace Violence among Physicians
Authors: Adhikari Biplov , Subedi Roshan , Thakur Rahul Kumar , Thapa Milan , Karki Sauharda Singh , Dhungana Bibek , Devkota Amrit , KC Bibek , Thakurathi Mohan , Bhattarai Adheesh , Ray Barun Kumar , Phuyal Bijay , Sharma Prabhat , Devkota Saugat , Adhikari Jog
Published: November 2024

Background: There is a dearth of objective data and studies pertaining to the prevalence and consequences of workplace violence against physicians in Nepal. This study aims to assess the prevalence, associated factors, and implications of workplace violence on Nepalese physicians.Methods: We conducted a cross-sectional study from March 2021 to August 2021. Nepal Medical Council-certified physicians currently working in Nepal were included in the study. Baseline characteristics, types of violence experienced, patterns, psychosocial impacts, and changes in patient management were collected.Results: Out of 318 responses received, 302 responses met the inclusion criteria and were included in the final analysis. One-hundred and ninety (62.9%) respondents had ever faced workplace violence. Madhesh Province had the highest prevalence (81.5%). Verbal abuse (93.2%) was the most common type of violence encountered. We found a significant association between workplace violence and hours worked each week. We also found an association between workplace violence and years of experience. Our study found a significant increase in stress/depression/anxiety/idea of persecution, sense of defeat, job turnover, and loss of productivity/income with the increase in severity of workplace violence. Conclusions: Workplace violence is largely prevalent among Nepalese physicians. In the aftermath of workplace violence, a physician can undergo a multitude of adverse psychosocial consequences leading to a further decrease in productivity. More insights through research, formal training, and policy implementation are necessary to overcome this largely ignored problem of the medical fraternity in Nepal.Keywords: Abuse; Nepal; physicians; workplace violence.
High Altitude Illness among Rapidly Ascending Pilgrims to Kailash Mansarovar
Authors: Baniya Santosh , Lama Tai Anjuk
Published: November 2024

Background: High altitude pilgrims typically ascend rapidly, are not well prepared for the austere environment and tend to have multiple co-morbidities. Here, we list the trend of altitude and other illnesses who visited Humla district hospital (2,950 meters) following very rapid ascent to Kailash Mansarovar (4,500 meters).Methods: A prospective study was conducted among 55 patients at the Humla District Hospital from September 2019 – August 2022. Patients who fell ill during pilgrimage and brought to the hospital were included. The patients were assessed with medical history and clinical examination. Lake Louise Score Acute Mountain Sickness Score (2018) was used for the diagnosis of Acute Mountain Sickness.Results: A total of 56 evacuees visited the hospital which included 55 patients and 1 brought dead. The mean age was 50.63 ± 10.91 years. Sixteen patients (29.1%) developed symptoms within 24 hours and 15 patients (27.3%) within 48 hours of ascent. Headache 42 (76.4%) was the most common complain. Mild acute mountain sickness (30.9%; 17 patients) was the most common altitude related illness while 14 patients (25.4%) were diagnosed with non-altitude related illnesses. Twelve patients (21.8%) had co-morbidities like hypertension and diabetes mellitus.Conclusions: In the rapidly ascending pilgrims, majority of travelers requiring medical attention are suffering from some form of altitude illnesses. Hence, proper planning and public awareness about slow and gradual ascent profile is necessary to make the travel safer. Keywords: High altitude illnesses; high altitude pilgrimage; kailash mansarovar; rapid ascent.
Assessing Impact of Health Education in Improving Knowledge of Children on Child Sexual Abuse
Authors: Bansal Prerna , Shrestha Ayasha , Upadhyay Hari Prasad , Khadka Kamal , Koirala Pallavi
Published: November 2024

Background: Every year, millions of children around the world face sexual abuse and exploitation. Sexual and reproductive health education is an important form of health promotion action against it. This study aims to assess the impact of health education program in improving knowledge of the children on child sexual abuse. Methods: A school based pre-experimental study was done among 120 lower secondary level students of a private school in Bharatpur municipality of Chitwan District, Nepal during March 2021. An interventional health education program imparting knowledge on child sexual abuse and its preventive measures was given to the children. Their knowledge was assessed and compared before and after intervention using paired t-test. Data analysis was done using SPSS version 17 software. Results: The mean age of children was 13.77±0.65 years with 1:1.18 girls to boys ratio. The level of knowledge of the children on child sexual abuse and its preventive measures increased significantly post-intervention as compared to pre-intervention. The mean scores of post-test (29.80±4.53) was higher than pre-test (17.04±6.96). The intervention was proved effective with statistically significant t-test values (t=20.996, p=<0.001). About 6.7% children disclosed an experience of child abuse post-intervention. Conclusions: The school based health education program effectively increased the knowledge of the children on child sexual abuse, thus helping in preventing and protecting them from child sexual abuse and its harmful effects.Keywords: Child abuse; health education; school health services; sexual, touch.
Health Status and Management Practices of Home Isolated COVID-19 Adult Patients
Authors: Parajuli Kristina , Silwal Sashi , Acharya Astha , Poudyal Anil , Dhakal Neelam , Pandey Ashok , Neupane Tamanna , Bista Bihungum , Dhimal Meghnath , Gyanwali Pradip
Published: November 2024

Background: The worldwide containment strategy for COVID-19 outbreak includes laboratory-confirmed cases, and their isolation and management in health care institutions or at home. The spread of the COVID-19 virus has mandated home isolation for mild cases, as recommended by the Government of Nepal. Isolation is a situation that can have a substantial influence on physical and mental health of isolated people. This study is aimed to assess physical and mental well-being of COVID-19 home isolated patients, and their home management practices.Methods: A descriptive cross-sectional research using quantitative methods was carried out. Purposive sampling was used to select COVID-19 patients. Total 536 COVID-19 home isolated patients were included in this study. Telephonic interview was conducted to obtain the data. Descriptive analysis was done and interpreted. Results: About 34 % of the participants were symptomatic. The most common symptoms experienced were fever (22.6%), followed by cough (19.4%) and cold (16.1%). About 20 % indicated having difficulties isolating at home due to lack of separate room. Furthermore, 4 percent of the participants didn’t have anyone to take care of them at home. Also almost 2 percent of participants didn’t get family support when infected. Moreover, majorities of individuals had normal stress, depression and anxiety level.Conclusions: Most of the participants' physical and mental health was found to be normal though some of them experienced difficulties for management during home isolation. Hence, Interventions should focus resilience building by improving communication to address fears and concerns, encouraging routines and physical activities, and taking measures to reduce loneliness.Keywords: COVID-19; home isolation; mental; physical; social.
Prevalence of Myocardial Bridging in Angiography Study
Authors: Shakya Smriti , Gajurel Ratna Mani , Poudel Chandra Mani , Shrestha Hemant , Devkota Surya , Thapa Sanjeev , Manandhar Bhawani , Khanal Rajaram
Published: November 2024

Background: Myocardial bridging is a congenital anomaly in which a segment of epicardial coronary artery takes an intramyocardial course, the systolic compression of which could be asymptomatic or may lead to major hemodynamic changes such as myocardial ischemia, arrhythmias or sudden cardiac death. The prevalence is highly variable depending upon different investigational modalities to diagnose it. Here we have aimed to study the prevalence through invasive coronary angiography.Methods: This retrospective study was carried out at Manmohan Cardiothoracic Vascular and Transplant center, Kathmandu, Nepal. The invasive coronary angiography of 5096 patients were studied from March 2018 to April 2021 done for various indications.Results: Among all the patients, the myocardial bridging was identified in 257 (5.04%) patients. About 177 (68.9%) were males and 80 (31.1%) were females. The mean age of the patients having myocardial bridging was 54.52 ± 10.31years. Diabetes mellitus was found in 33(12.8%) and hypertension was found in 77(29.9%) patients with myocardial bridging. Stable angina (29.2%) was the most common clinical presentation. Treadmill test was positive in about 70 (27.2%) patients. Majority of patients had myocardial bridge in left anterior descending artery alone (89.9%) and located mostly in mid-part (74.9%).Conclusions: The myocardial bridging is not an uncommon finding on invasive coronary angiography in middle aged people who present with typical angina.Keywords: Coronary angiography; myocardial bridging; prevalence.
Application of the London Atlas of Tooth Development and Eruption in Panoramic Xrays for the Age Estimation
Authors: Dahal Samarika , Agrawal Nitin Kumar , Chaulagain Tekendra , Gosain Nabin , Natarajan Srikant
Published: November 2024

Background: The age estimation of the individual by the forensic experts ascertains the chronological age of an individual. The possibility that the person being examined may be younger or older than a certain age threshold makes this process crucial, as it will establish whether or not the person is an adult under the law. The aim of this study was to test the applicability of the London Atlas of tooth development and eruption in Nepalese subset population. Methods: The London Atlas for age estimation was tested in 350 digital panoramic radiographs from the patients between four and twenty-four years visiting Tribhuvan University Teaching Hospital, Institute of Medicine, Nepal. Results: The mean values of the estimated age were higher in both the sexes, which was statistically not significant. Both the sexes showed an excellent positive correlation, and was significant with a p value of <0.001. The age estimation upto 10 years group classification was nearly accurate with less than 1 and 2.5 years variation in males and females respectively. The accuracy was good in 16-18 years group with maximum deviation of ±2.5 years. The accuracy was poor in more than 18 years group, as the variability was more than 5 years. Conclusions: The London Atlas method was best suited for less than 18 years of age and was not very accurate in the age group of 13-14 and 14-15 years where most of the polymorphisms were noted. Keywords: Dental age estimation; London Atlas; Nepalese population.
Hemophagocytic Lymphohistiocytosis: an Under-recognized and Life-threatening Condition
Authors: Poudyal Bishesh Sharma , Poudel Bishal , Tuladhar Sampurna , Rijal Swarup Sharma , Shrestha Gentle Sunder , Joshi Utsav
Published: November 2024

Diagnosis of hemophagocytic lymphohistiocytosis is a challenge in Nepal because of limited resources and the high prevalence of tropical febrile illness mimicking hemophagocytic lymphohistiocytosis. We retrospectively reviewed medical records of 21 patients who were diagnosed with hemophagocytic lymphohistiocytosis from 2010 to 2015 at a single center in Nepal. Two patients had a mutation in their perforin gene and underwent successful haploidentical stem cell transplantation. Marrow hemophagocytosis was found only in 57% of the patients. Five patients had hematological malignancy and were treated with disease-specific chemotherapy. Seven patients developed hemophagocytic lymphohistiocytosis secondary to an infection, including visceral leishmaniasis, scrub typhus, and Epstein Barr virus. EBV-associated hemophagocytic lymphohistiocytosis was refractory to hemophagocytic lymphohistiocytosis 94 protocol, including the addition of rituximab. Malignancy and infection-associated hemophagocytic lymphohistiocytosis was more common. The most common clinical presentations included fever, splenomegaly, hyponatremia, liver function derangement, hyperfibrinogenemia, hyperferritinemia, and cytopenia. With a mortality of 29% in our study cohort, hemophagocytic lymphohistiocytosis should be considered a lethal disease, and clinicians should maintain a high index of suspicion to diagnose this disease. Keywords: Hemophagocytic lymphohistiocytosis; infection; malignancy.
Renal Hydatid Cyst in a Child Managed with Albendazole
Authors: Pandey Udesh , Timilsina Bhusan Raj , Acharya Samrachana , Paudel Ujjawal , KC Sudeep Raj , Pradhan Sulav
Published: November 2024

Primary Renal hydatid cyst is a rare entity. We report a case of isolated right renal hydatid cyst in a 13-year-old female who presented with pain in the right lumbar region for 4-5 months and a palpable mass in the right upper quadrant. The radiological features were suggestive of a hydatid cyst in the right kidney with no cyst in the liver, lungs, or left kidney. She was managed medically with oral Albendazole tablets (400 mg twice daily). A total of 6 cycles of Albendazole were given with each cycle lasting for 4 weeks and a drug-free period of 2 weeks in between two consecutive cycles and kept on follow-up for a year. Her condition improved with no recurrence on follow-up after one year. Keywords: Albendazole; echinococcus granulosus; renal hydatid cyst.
High Burden of Vitamin B12 Deficiency among Adults and Elderly
Authors: Gyawali Pratiksha , Bhatt Rajendra Dev , Karmacharya Robin Man , Pant Vivek , Khadka Ayesha
Published: November 2024

Background: Deficiency of vitamin-B12 is widespread. Adults and the elderly are particularly susceptible to vitamin-B12 deficiency. This study investigated the burden of vitamin-B12 deficiency and insufficiency among adults and the elderly attending a tertiary care hospital in Nepal. Methods: This is a retrospective chart review conducted at Dhulikhel hospital. We reviewed records of 1615 patients investigating Vitamin-B12 level (pmol/L) at the clinical biochemistry laboratory from laboratory management database MIDAS between June 2020 and December 2021. Vitamin-B12 level was measured using enzyme immunoassay in Abbott Architect i1000SR analyzer. The categorical variables are presented as frequency and percentage; and numerical variables as  means and standard deviations, or median and Interquartile range.  Pearson Chi-square test was used to determine association between categorical variables.  Mann Whitney test and Kruskal Wallis H test were used to compare Vitamin-B12 level by categories.Results: There were 1454 participants of which 33.5% of the patients were deficient, 27.9% were borderline deficient, while 38.7% had adequate vitamin B12 levels. Young adults(170.4 pmol/L) had a lower median vitamin B12 level than middle-aged adults (183.7pmol/L) and the elderly population (247.9pmol/L) (P<0.001). Compared to females (186.7 pmol/L), males(171.9 pmol/L) had lower vitamin B12 level (P <0.05).Conclusions: The study revealed that a significant proportion of young adults, middle aged adults and elderly population visiting a tertiary care hospital of Nepal are having vitamin B12 deficiency and borderline deficiency of public health concern. Keywords: Adults; deficiency; elderly, vitamin B12.
Laparoscopic Appendectomy versus Open Appendectomy in Acute Appendicitis
Authors: Nepal Yugal Jyoty , Paudyal Sanjaya , Shah Surendra , Giri Niraj
Published: November 2024

Background: Appendectomy is the most common emergency surgical procedure performed. Appendectomy is performed by either open or laparoscopic methods. However, there is lack of consensus regarding the most appropriate method. This study aimed to compare the outcomes of laparoscopic and open appendectomy in the treatment of acute appendicitis.Methods: Fifty-two patients undergoing appendectomy were analyzed in this prospective comparative study, with 26 patients each in laparoscopic and open group. The outcomes were measured in terms of operative time, postoperative pain at 4, 6 and 12 hours, length of hospital stay, postoperative complications according to modified Clavien Dindo classification and cost analysis.Results: Laparoscopic group had longer time after completion of surgery till exit from operation theatre (30 min in laparoscopic and 20 min in open, p<0.01) and significantly higher cost (Nrs. 26295 for laparoscopic and Nrs. 19575 for open, p<0.01) than open appendectomy. Operative time, time from entering operation theatre till being kept in operation table, time from being kept in operation table till initiation of anesthesia, postoperative pain at 4,6 and 12 hours and postoperative complications were insignificant in both groups.Conclusions: The results suggest that laparoscopic appendectomy group had longer recovery time after operation and was costlier than open appendectomy. Thus, the decision of the operative procedure can be based on the patient’s preference.Keywords: Appendectomy; laparoscopic appendectomy; open appendectomy
Effect of Group Psycho-Educational Interventions on Child birth fear and Child birth Self-efficacy among Primiparous women
Authors: Pandey Bista Archana , Shrama Chandrakala , Shrestha Uma , Timalsina Punjita , Devkota Kavita , Piya Kalpana , Neupane Beena
Published: November 2024

Background: Child birth related fear and low self-efficacy for child birth found common among primiparous women. Antenatal group psycho-educational interventions have been used as important strategies to address child birth fear and self-efficacy. Thus, this study aimed to find out the status of child birth fear among antenatal women and effect of group psycho-educational interventions among primiparous women.Methods:One group pretest-posttest design was adopted. Total 307 primigravida women attending antenatal outpatient department of two hospitals within Kathmandu valley were selected through purposive sampling technique. Data was collected from March to July 2020. Child birth fear was assessed by using validated tool i.e.Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and Child birth self-efficacy was assessed by using childbirth self- efficacy tool. Primigravida women with moderate level of child-birth fear, were intervened for group psycho-education based on PRIME Model by nurses who were research team members. Paired t-test was used to compare differences in mean scores on child birth fear and child birth self-efficacy before and after intervention. Results: Moderate level of child birth fear was found among 24.8% of participants. Low child-birth self-efficacy was found among 42.0% participants. The overall mean score before providing group psycho-educational interventions to experimental group on child-birth fear was 54.0±2.09 and on child birth self-efficacy was 78.0±28.64 with p<0.001 and after providing group psycho-educational interventions child-birth fear was reduced to 47.8±2.44 and child birth self-efficacy was 105.2±19.6 with p<0.001.Conclusions: Group psycho-educational interventions based on PRIME approach led by nurses have significant effects in reducing child-birth fear and increasing child-birth self-efficacy. Therefore, provision of group psycho-educational interventions along with routine antenatal service need to be considered in clinical settings in Nepalese context.Keywords: Child birth fear; child birth self-efficacy; primiparous women