bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Basic Police Training and Scale Diet on Body Composition and Aerobic Performance of Nepal Police Officers Trainees
Authors: Rajbhandari Bibek , Pant Suman , Adhikari Bikram , Gurung Minani , Poudel Lisasha , Shilpakar Olita , Karki Sukadev , Yonzon Tamang Motilal , Khadka Purushottam , Shrestha Bikash , Baniya Bhupal , Shrestha Bikal , Thakuri Bishal Jung , Maharajan Ashmita , Singh Ela , Gajmer Babita , Singh Sumi , Regmi Amuda , Maskey Prabina , Tiwari Bhuwaneshwor , Mali Anish
Published: November 2024

Introduction: Executing their daily duties, police officers are expected to perform complex, physically demanding activities, often at maximal levels of exertion. Given these criteria, training must be rigorous enough to ensure that when trainees graduate, they are competent in their response to crisis and flexible enough to sustain this for the span of their career. The present study aimed to determine the impact of scale diet and physical training (SDPT) on body composition and aerobic performance among Nepal police officer trainees.
Method: We conducted a cross-sectional analytic study among 570 Nepal Police recruits from Nepal Police Academy of Butwal and Kathmandu. Null hypothesis was created followed by an alternative hypothesis. Alpha (1 - ?) for the above-mentioned study design were set. Parametric statistical analysis was done with criteria set for acceptance or rejection of the null hypothesis. We collected the data from the field as per Nepal police basic exercise and diet  protocol to determine the effect of physical training and scale diet on body composition and aerobic performance. We enrolled all the recruits  from March to May, 2019 who met the eligibility criteria in the study. We used Microsoft Excel 2013 for data entry and R program (version: 4.0.3) for statistical analysis.
 Results:There was a significant rise in aerobic performance (4.51 ± 3.39 ml/kg/min) and remarkable reduction in body fat (-4.49 ± 2.33 %) and Body Mass Index (-0.433 ± 1.00 kg/m2) after SDPT among participants with normal BMI at the time of recruitment. Body fat was significantly reduced (-4.36 ± 2.3%) and aerobic performance was significantly increased (6.93±4.70 ml/kg/min) among overweight participants at the time of recruitment.
Conclusions: The methodology adopted in the physical training of Nepal Police was effective in reducing body mass index and fat, improving the physical capacity.
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Key words: Scale Diet; Physical Training, Body Fat; Aerobic Performance; VO2max, Body Mass Index
Comparative Study between the Precontoured Anatomical Locking Plate and Clavicle Brace for Displaced Mid-Shaft Clavicle Fractures
Authors: KC Kapil Mani , Acharya Parimal , RC Dirgha Raj , Marahatta Suman Babu , Niroula Ankit , KC Amuda
Published: November 2024

Background: Most of the midshaft clavicle fractures heal conservatively without further complications with union rate of 94 to 99.7%. Several recent studies recommend surgery for displaced midshaft fracture, to reduce risk of non-union malunion and clavicle shortening. So there is still dilemma for the optimal treatment for displaced midshaft clavicle fracture.Methods: This was the prospective comparative study performed in Civil Service Hospital, Nepal. Patients were divided into the two groups each containing 40 patients and were treated with figure of eight brace for group 1while group 2 patients were treated surgically.Results: Mean time to unite the fracture was 11.87±1.78 versus 11.55±1.46 weeks (P value 0.37). There were 14 (35%) cases of malunion more than 10 degree in group 1 and 1 (2.5%) malunion in group 2 (P value 0.001). Twenty nine (72.5%) patients in group 1 and 35 (87.5%) in group 2 were fully satisfied one year after treatment Constant and Murley score in group 1 were 75.22±2.85, 90.87±3.39 and 96.30±1.80 at the time of fracture union, six month and one year after surgery while that score in group 2 were 81.67±2.86, 93.87±2.17, 98.20±1.20 respectively ( P value <0.001).Conclusions: There is higher incidence of nonunion, symptomatic malunion and inferior perception of satisfaction in conservatively treated patients. Functional outcomes are comparable one year after surgery, however it is significantly better in operative group before that. Keywords: Figure of eight bandage; midshaft clavicle fractures; non-operative treatment; precontoured locking plate
Medical Humanities in the Nepalese context
Authors: Shankar Pathiyil Ravi
Published: November 2024

Medical humanities use the creative and intellectual strengths of the arts for specific purposes in medical education. The author read with great interest the Medical humanities program at the Patan Academy of Health Sciences and has been associated with Medical humanities since 2007. There are several factors favouring the development of Medical humanities in Nepal but the major challenge is there is no specific faculty and/or department involved and the discipline may be relegated to the background in the face of other pressing priorities. In the west humanities faculty had played an important role in popularizing Medical humanities. Clinical teachers can incorporate Medical humanities into their clinical teaching. Large student sizes and lesser number of faculty may be challenges in moving the discipline forward. Keywords: Medical humanities, medical schools, Nepal, undergraduate medical
Status of COVID-19 Patients and Associated Stigma After Discharge from Designated Health Facilities of Kathmandu Valley: A Telephonic Survey
Authors: Shrestha Bikal , Shrestha Dhan Bahadur , Budhathoki Pravash , Neopane Arun Kumar , Dangol Suman , Duwal Shrestha Sailendra Kumar , Mandal Jenny
Published: November 2024

Background: COVID-19 is a highly contagious viral disease. The anxiety, misinformation about COVID-19, and the fear of being infected by the virus have led to widespread stigma in local communities. Thus, we conducted a study to evaluate the status of patients and disease-associated stigma of patients who recovered from COVID-19.Methods: Status of discharged/ improved COVID-19 individuals were followed after their discharge within 2 months after COVID-19 status through telephonic interview. Data of interview was recorded in excel sheets, which was imported in Stata v. 15. Simple descriptive analysis performed and finding presented in appropriate tabulation. Further binomial logistic regression analysis was performed for post-treatment stigmatization.Results: Among 365 case details retrieved, 262 cases contained contact details. Among them, 221 total phone calls were made, of which only 94 could reach for phone interview. 50 (53.19%) were male; 59 (62.77%) were married; and 85 (90.43%) were Hinduism by religion. Majority (n=74, 78.72%) were asymptomatic. The average hospital/isolation stay of patients was 11.23±4.75 days. Among interviewed individuals, 24 (25.81%) reported some type of stigmatization. Individuals with comorbidities and tested for travel purpose has less chance of stigmatization comparing than others. Higher the age in years and longer the duration of hospital/isolation stay; higher the odds of having stigmatization.Conclusions: High level of stigma was seen among COVID-19 survivors. The stigma associated with COVID-19 was shown to increase with age and length of hospital stay while the stigma decreased with the presence of co-morbidities and was tested for travel purposes.Keywords: Anxiety disorders; COVID-19; social stigma; survivors; treatment outcome
Dorsal Vertebral Enhancement Mimicking Sclerosing Metastases in Lung Cancer
Authors: Giri Sandip , Ghosh Priya , Moses Arun Singh , Baral Dibash
Published: November 2024

We report cases of vertebral body enhancement in patients with superior vena cava and brachiocephalic venous obstruction appearing as sclerotic metastases in post-contrast CT.A 58-year-old male presented with right lung mass compressing the superior vena cava.Sclerotic areas seen involving few vertebrae in post-contrast scans.Another patient, 64-year-old female with right lung mass and narrowing of left brachiocephalic vein, sclerosis of lower cervical and upper dorsal vertebrae were seen in contrast studies. In both cases after resolution of pathology following treatment showed no enhancement in post contrast scan which was attributed to the collaterals arising due to obstruction, obviously not seen in metastases.Keywords: Brachiocephalic vein obstruction; computed tomography CT; superior vena cava SVC; vertebral enhancement; venous collaterals
Hematological and Biochemical Parameters along with IgG Antibody against SARS-CoV-2 in Patients visiting a referral laboratory for recovery check up after COVID-19 infection in Nepal
Authors: Pant Vivek , Gautam Keyoor , Pradhan Santosh , Pyakurel Devish , Shrestha Abha
Published: November 2024

Background: The laboratory abnormalities for hospitalized patients with the SARS-CoV-2 have been described in various studies. Limited data are available for the recovered patients. This study aimed to evaluate various laboratory findings in the recovered SARS-CoV-2 patients.Methods: In this cross sectional study, the laboratory findings of various hematological and biochemical parameters along with antibody against SARS-CoV-2 of 150 patients who visited Samyak Diagnostic Pvt. Ltd for recovery check up after SARS-CoV-2 were studied from October 2020 to March 2021.Results: Out of total 150 participants, 84% of SARS-CoV-2 recovered patients, who had mild or moderate illness, reported persistence of milder symptoms. Persistence of high serum inflammatory markers such as CRP, Ferritin and LDH along with abnormal cell count and morphology of leukocyte lineage was present in 45.4% of these patients. Similarly, 98.7 % had SARS-CoV-2 IgG antibody after 37 median days of recovery. Conclusions: Various laboratory abnormalities may persist after SARS-CoV-2 recovery in addition to the presence of SARS-CoV-2 IgG antibody. Follow up study is needed to determine the period up to which these abnormalities are present and the protection from antibody is conferred.Keywords: SARS-CoV-2; SARS-CoV-2 recovery; SARS-CoV-2 IgG antibody
Characteristics and Outcome of Patients with COVID-19 Undergoing Invasive Mechanical Ventilation for Respiratory Failure in a Tertiary Level Hospital in Nepal
Authors: Sharma Sachit , Paneru Hem Raj , Shrestha Gentle Sunder , Shrestha Pramesh Sunder , Acharya Subhash Prasad
Published: November 2024

Background: Corona virus disease 2019 has become a global health issue. The goal of this study was to investigate the characteristics and outcomes of patients with corona virus disease 2019 undergoing invasive mechanical ventilation and identify factors associated with mortality.Methods: Ninety four consecutive critically ill patients with confirmed corona virus disease 2019 undergoing invasive mechanical ventilation were included in this retrospective, single-center, observational study. The outcome variable was mortality of patients undergoing invasive mechanical ventilation and factors associated with it during intensive care unit stay.Results: Seventy nine (84%) out of 94 patients with confirmed corona virus disease 2019 who underwent invasive mechanical ventilation didn’t survive. Ninety four percent of patients who had Type 2 Diabetes Mellitus did not survive in comparison to 72 percent of patients who didn’t have Type 2 Diabetes Mellitus. Similarly, 48 (94.1%) out of 51 patients with a positive C-reactive protein value didn’t survive in comparison to 31 (72%) out of 43 patients with a negative C-reactive protein.Conclusions: The presence of Type 2 Diabetes Mellitus and a positive C-reactive protein value were strongly associated with mortality. Patients with a Sequential organ failure assessment score of more than eight at intensive care unit admission and peak D-dimer level of more than or equal to two during intensive care unit stay didn’t show significant association with mortality. These findings need further exploration through larger prospective studies.Keywords: COVID-19; critically ill patients; invasive mechanical ventilation; Nepal; outcomes
Stabilize First or Reperfuse Immediately: Concomitant STEMI and DKA Management
Authors: Mulia Eka Prasetya Budi
Published: November 2024

N/A
Use of Psychoactive Substance and its Associated Factors among School Adolescents in Rupandehi District of Nepal
Authors: Bhandari Tulsi Ram , Paudel Grish , Bestman Amy , Thapa Tarka Bahadur , Gwayali Chunna Prasad , Ghimire Bishnu , Sharma Shanta , Yadav Uday Narayan
Published: November 2024

Background: Psychoactive substance use among adolescents has been identified as an important health issue in Nepal. Therefore, this study examined the psychoactive substance use and factors associated with its use among adolescent students in the Rupandehi district of Nepal. Methods: A school-based cross-sectional study was conducted from December 2017 to July 2018 with 460 school students aged between 15 to 19 years across sampled public and private schools in the Rupandehi district of Nepal. Structured interview schedule was used to collect information on psychoactive substance use. The generalized estimating equation was used to identify the factors associated with the use of psychoactive substances.Results: Over a quarter (27.4%) of school-going adolescents used at least one type of psychoactive substance. Commonly used psychoactive substance included tobacco products (59.3%) followed by cannabis (55.6%), marijuana (35.8%), hashish (23.5%), alcohol (22.2%), heroin (18.5%), nitrogen tablets (14.8%), sulfa (13.6%) and opium (13.6%), respectively. Being male (AOR=2.0, 95% CI: 1.19-3.36), having peers (AOR=1.8, 95% CI: 1.13-3.03) or family members (AOR=2.2, 95% CI: 1.40-3.54) that used psychoactive substances and father’s education level (AOR=2.5, 95% CI: 1.05-5.78) were significantly associated with the psychoactive substance use. Conclusions: This study identified that over a quarter of school-going adolescents reported the use of at least one illegal psychoactive substance. This study provided details on the extent of behaviours, and can be used to develop a comprehensive prevention and control program. Such programs should address the socio-cultural factors that enable substance use and address gaps in knowledge to prevent and control of psychoactive substance use. Keywords: Alcohol use; drug abuse; psychoactive substance use; tobacco use
Evaluation of Breast Mass by Mammography and Ultrasonography with Histopathological Correlation
Authors: Devkota Ramila , Bhattarai Mamata , Adhikari Bikash Bikram , Devkota Rameshwor , Bashyal Saroja , Regmi Pradeep Raj , Amatya Isha
Published: November 2024

Background: Mammography, ultrasound and Magnetic Resonance Imaging are the available modalities for the evaluation of breast masses. Advances and ongoing improvements in imaging technologies have improved the sensitivity of breast cancer detection and diagnosis, but each modality is most beneficial when utilized according to individual traits such as age, risk factors, and breast density. However, pathological diagnosis is most crucial for the treatment of breast masses.Methods: A cross-sectional study were conducted from January 2017 to April 2018. There were total of 50 patients with clinically diagnosed palpable breast lumps who attended Gynaecological OPD/surgical OPD/medicine OPD in the study period. The patients above 30 years were evaluated by mammography and ultrasound in Department of Radiology, National Academy of Medical Sciences, Bir Hospital. The patients were then send for FNAC/biopsy and histopathology examination. Data were collected and analyzed using SPSS version 16. Specificity and sensitivity of MG and USG individually and in combination to determine the nature of breast lump in relation to histopathological findings were calculated. Results: Ultrasound had 88.90% sensitivity and 68.80% specificity whereas mammogram had 94.40% and 87.50% sensitivity and specificity respectively. When combined, both sensitivity of diagnosing malignant lesions increases up to 94.4% and specificity decreases up to 31.2%. Most of the variables of ultrasound and mammography (except density of the lesion) had significance in predicting nature of the lesion (p< 0.05).Conclusions: Combined Mammography and Ultrasound had higher sensitivity than sensitivity rate observed for either single modality. A combined Mammography and Ultrasound approach to detect breast diseases was significantly more helpful in accurate evaluation of breast pathologies.Keywords: Breast; histopathology; mammography; ultrasound
Barriers to Treatment Compliance of Directly Observed Treatment Shortcourse among Pulmunary Tuberculosis Patients
Authors: Marahatta Sujan Babu , Yadav Rajesh Kumar , Baral Sushila , Aryal Neeta , Paudel Srijana , Shah Naveen Prakash , Yadav Punita , Gurung Suman Chandra , Khatri Elina
Published: November 2024

Background: Treatment compliance is an important aspect for tuberculosis prevention and control. Poor compliance to treatment can lead to the development of drug-resistant tuberculosis. The aim of this study was to explore the factors affecting treatment compliance for tuberculosis patients. Methods: Facility based unmatched case control study was done among the forty non-compliance and eighty compliance pulmonary tuberculosis patients registered at selected directly observed treatment short-course centers of six districts. Data were collected using in-depth interview guideline with the tuberculosis focal person and Focus Group Discussion with tuberculosis patients. Results: A total of 120 respondents, 40 cases and 80 controls were enrolled in the study. About 72.5% of the cases and 56.2% of the controls were male. Five significant independent risk factors for non-compliance to TB treatment were identified. The qualitative session confirmed geographical barriers, inaccessibility to health facility, economic barriers, difficulty in convincing people, knowledge about Directly observed treatment shortcourse program, longer medication period, migration and stigma as a major barrier for treatment compliance. Conclusions: Wider ranges of barriers are prevalent in context of tuberculosis treatment pathway and outcome. Knowledge of the tuberculosis patients and attitude of the family plays a vital role in treatment compliance. Directly observed treatment shortcourse playing tremendous role to ensure treatment adherence has been identified as major barrier to adherence as well. Enablers of adherence need to be emphasized to address the barriers.Keywords: Barriers; DOTS; mixed method; Nepal; treatment compliance; tuberculosis
A Comparative Study on the Recording of Temperature by Thermo- Graphic Camera, Thermal Gun and Digital Clinical Thermometer in a Tertiary Hospital of Nepal
Authors: Poudyal Anil , Dhimal Meghnath , Rimal Ram prasad , Rimal Laxman prasad , Dhakal Neelam , Pandey Ashok , Gyanwali Pradip
Published: November 2024

Background: Body Temperature is one of the most common and an important sign of health and disease. Considering the need of keeping physical distance, newer methods have evolved such as; thermal imaging systems which have been used by several countries during epidemics. Therefore, the present study was conducted to compare body temperatures obtained with thermo graphic camera and commercially available thermal gun with reference to standard digital clinical thermometer.Methods: The study was comparative analytical in nature and quantitative method was used to collect data. Temperatures in degrees Fahrenheit were taken simultaneously using the three different thermometers in 101 patients at the outpatient fever screening clinic at Tribhuvan University Teaching Hospital, Kathmandu. The Bland Altman statistical test was used to assess the concordance by the 95% limits of agreement.Results: The thermo-graphic camera gave concordance (limits of agreement-0.0360 to 0.0440 °F) with standard digital clinical thermometer. Similarly, commercially available thermal gun gave the concordance (limits of agreement 0.0042 to 0.1293 °F) with standard digital clinical thermometer.Conclusions: The results of the present study show that both thermo-graphic camera and thermal gun were found to be concordant compared to digital clinical thermometer. Therefore, it could be a preferable option for the screening of fever in mass number of individuals as part of an initial check at entry points.Keywords: Nepal; non-contact infrared thermometers; temperature; thermometer
Assessment of Client Satisfaction in Labour and Delivery Services in a Tertiary Hospital in Western Nepal
Authors: Shrestha Deepak , Aryal Shreyashi , Khatri Resham , Shrestha Poonam
Published: November 2024

Background: Patient satisfaction is an individual’s positive evaluation of a distinct dimension of health care. This study aimed to assess client satisfaction with maternity care in a tertiary hospital in the western region of Nepal.Methods: This cross-sectional study was conducted among 405 delivered women. A structured questionnaire of 21 items was used as a tool during exit interviews at their discharge. Each item was assessed on 5 points Likert scale. Student’s t-test and one-way ANOVA tests were applied to analyse parametric data. Binary logistic regression analysis was applied to identify the association of predictors with the satisfaction level. Strength of association was interpreted using odds ratio and 95% confidence interval. Results: The mean waiting time was 16.94 +5.57 minutes. Education level of the clients was statistically significant with the mean satisfaction score (p<0.001). Women with unwanted pregnancies were more satisfied than those with wanted pregnancies (p<0.001). Lower complete satisfaction rates were observed for pain control (6.4%), information at discharge (14.6%) and the degree of privacy in the ward (13.6%). Mothers who underwent instrumental delivery were less satisfied with health worker’s attitudes than those having vaginal deliveries (odds ratio 0.20, 95% confidence interval:0.05-0.84). Those having uncomplicated deliveries were 3.5 times more likely to be satisfied (odds ratio 3.50, 95% confidence interval: 1.1-11.5) with health workers communication. Mothers with waiting time less than 15 minutes were more satisfied.Conclusions: Lower educational level, unwanted pregnancy and shorter waiting time were associated with higher maternal satisfaction. Keywords: Client satisfaction; delivery; labour services; maternal satisfaction; Nepal
Age Estimation Using Monoradicular Teeth by comparing Pulp/Tooth Area Ratios between Bucco-lingual and Mesio-distal Periapical Radiographs
Authors: Dahal Samarika , Forgie Andrew , Manica Scheila
Published: November 2024

Background: Age estimation is an integral tool in identification of the victims when visual identification is not possible. Secondary dentin deposition is a regular ageing process and can be utilized in dental age estimation when development and eruption parameters cannot be utilized.Methods: In total, 38 monoradicular teeth of Nepalese subjects were assessed for tooth pulp ratio. Intraoral periapical radiographs of these teeth were taken, and pulp tooth ratio was calculated and dental age was estimated.Results: The mean chronological age was 46.79 years and the mean estimated age was 44.32 years. The pulp/tooth area ratios calculated were in the range of 0.012 to 0.195, and 0.052 to 0.256 for mesio-distal and bucco-lingual planes respectively.Conclusions: Pulp tooth ratio of maxillary lateral incisors and mandibular lateral incisors showed the highest correlation with values of 90% and 76% respectively. Mesio-distal assessment was more accurate in dental age estimation than bucco-lingual view.Keywords: Age estimation by teeth; dental pulp; dental radiograph; pulp tooth ratio; secondary dentine
Aluminum Phosphide Poisoning, an Institutional Experience: Case Series
Authors: Basnet Angela , Thapa Ashok Jung , Khadka Manoj , Regmi Bishal , Khadka Manita , Adhikari Kabita , Thapa Anil Jung , Shrestha Dhan Bahadur
Published: November 2024

Background: The growing concern over pesticide use has been linked to self-harm and suicide especially in agricultural countries like Nepal.  Pesticides like organophosphorus and aluminum phosphide cause the majority of deaths. Although organophosphorus poisoning is common means for suicide, Aluminum phosphide poisoning is also encountered occasionally. Our case series aims to look after the intent of poisoning and the outcome of the patients following Aluminum phosphide poisoning.Methods: This hospital record-based study includes Aluminum phosphide poisoning patients presenting to the emergency department of Scheer Memorial Adventist Hospital from first January 2017 to 31st December 2020. Data were analyzed using SPSS version-22.Results:  Out of 25 total poisoning cases, most of them were female (60%) and married (56%).  The case fatality rate was 84% among which 20% cases were brought dead while 64% died in the hospital. All poisoning cases were suicidal in intent.Conclusions: Herein we report a case series on 25 Aluminum phosphide poisoning cases with high case fatality rate and all cases being suicidal in intent.Keywords: Aluminum phosphide; Nepal; pesticides; suicide.
Non Stress Test as a Predictor of Maternal and Fetal Outcome in Patients Presenting with Reduced Fetal Movement at Term
Authors: Joshi Sarita Kumari , Dangal Ganesh
Published: November 2024

Background: Establishing the predictive utility of Non stress test could be helpful to improve perinatal outcome especially in countries like Nepal, with heavy workload and limited resources. The aim of the study was to assess association between Non stress test abnormalities and fetal outcome in terms of Apgar score and newborn intensive care unit admission rate for patient with decreased fetal movement. Methods: The study included total 54 women with decreased fetal movement at term without any pregnancy complication not in labor admitted to paropakar maternity and women's hospital, Thapathali, Kathmandu from June 2020 to December 2020. Non stress test was done for 20 to 40 minutes and the readings were categorized in to three groups. The results were compared to see the relationship between normal, suspicious and abnormal Non stress test result in terms of mode of delivery, Apgar score, neonatal resuscitation and need for neonatal intensive care unit newborn intensive care unit admission.Results: Total 54 cases remained under inclusion criteria were included in this study. Mode of delivery on the basis of Non stress test result shows that 31.48% with abnormal Non stress test had a Lower segment Caesarian section, 1.8% had instrumental vaginal delivery and 14.8% had spontaneous vaginal delivery. While in reassuring Non stress test group 20.4% had spontaneous vaginal, 0% had Lower segment Caesarian section and 1.85% had instrumental vaginal delivery. There is statistically significant relationship between Non stress test result and Apgar score. In reactive Non stress test result only5.4% required neonatal resuscitation. However, in persistently non-reassuring or abnormal Non stress test result, 62.1% require neonatal resuscitation. Similarly, in reactive Non stress test result none of the neonate required newborn intensive care unit admission. However, in persistently non-reassuring or abnormal Non stress test result 46.1% neonates require newborn intensive care unit admission. There were 9 neonatal mortalities from abnormal Non stress test result.Conclusions: We concluded that the Non stress test is a good predictor of maternal and fetal outcome detecting fetal hypoxia already present or likely to develop in patient presenting with reduced fetal movement in term pregnancies without complication.Keywords: Decreased fetal movement, maternal outcome, fetal outcome, NST
Orbital Tumors and Tumor like Lesions: A Hospital Based Study
Authors: Poudyal Prija , Hamal Diwa , Shrestha Pawan
Published: November 2024

Background: Orbital tumors have rare incidence, still they play a significant role in terms of morbidity and mortality. Orbital tumors may be primary, secondary or metastatic. These consist of benign and malignant lesions with extreme variations in pediatric and adult groups. These lesions can have acute or chronic onset, slow to rapid progression with or without bony destructions leading to vision loss, deformity and sometimes death. Methods: This retrospective cross-sectional study was carried out in the Department of Ophthalmic Pathology and Laboratory Medicine in Biratnagar Eye Hospital. Fifty-one patients who underwent histopathological evaluation for their orbital lesions from June 2018 to December 2019 were included in the study. Results: Orbital tumor and tumor like lesions comprised 27 cases (52.94%) in adults and 24 (47.06%) in paediatrics. Histopathologically, the most common pediatric benign tumor was dermoid cyst and malignant was secondary to orbital extension of retinoblastoma. Also, the most common adult benign orbital tumor was cavernous hemangioma and malignant was non Hodgkins lymphoma. The clinico-pathological accuracy for diagnosis was 68.63%. Association between age groups and nature of orbital lesions and between clinical and histopathological diagnosis was found to be statistically significant (p<0.05). Conclusions: Orbital tumors and tumor like lesions are uncommonly encountered. These masses showed significant variation in incidence in children versus adults. Combined efforts by different specialties help in early and prompt management of the orbital tumors. Keywords: Adult; neoplasms; Nepal; orbit; pediatrics.
Online Speech Therapy for Cleft Palate Patients in Rural Nepal: Innovations in Providing Essential Care during COVID-19 Pandemic
Authors: Nakarmi Kiran Kishor , Mehta Kajal , Shakya Pramila , Rai Shiv Kumari , Bhattarai Gurung Kabita , Koirala Ruchi , Pradhan Bhawani , Rai Shankar Man
Published: November 2024

Background: Speech therapy is important for ideal functional outcome after cleft palate surgery. Nationwide lockdown due to outbreak of COVID-19 in Nepal restricted the ability of patients to travel to nearby outreach centers for regular speech therapy. The objectives were to assess the feasibility and challenges of conducting online speech therapy with postpalatoplasty children during COVID-19 pandemic; and evaluate the ways to overcome them.Methods: Patients with cleft palate surgery done at least 3 months prior were given online speech therapy. Feasibility, advantages and challenges of online speech therapy were evaluated through interviewing the guardians and speech therapy providers.Results: A total of 89 patients were included in the study. Only 11.2% had secondary palatine procedures. Almost all the children (97.8%) had face to face speech therapy prior to study period. Best use of time, use of audiovisual aid, no need to travel and rapid progress were the most commonly perceived strengths of online speech therapy. The most frequent challenges were internet connectivity, unclear voice, lack of direct interaction and unstable power supply. Recommended ways to improve online speech therapy were cited as better internet connectivity, having a fixed schedule and availing free or affordable Wifi. Conclusions: Despite the challenges, online speech therapy provided us with a way to reach out to the cleft palate children when face-to-face therapy was not possible due to COVID-19 pandemic. We see its role even during non-pandemic situations for the children who are unable to visit the speech therapy centers.Keywords: COVID-19; online speech therapy; palatoplasty
Adherence to Treatment among Patients With End-Stage Renal Disease Undergoing Hemodialysis In Selected Centers In Nepal
Authors: Sapkota Abja , Sedhain Arun , KC Tulza , Sigdel Surendra , Subedi Sulav
Published: November 2024

Background: Hemodialysis remains a commonly available treatment option for many patients with end-stage renal disease. In addition to regular hemodialysis, these patients require regular use of medicines, follow fluid restriction and dietary modification. Hence, adherence to treatment remains a major factor to improve survival and quality of life among these patients. Therefore, this study was carried out to identify the adherence to treatment among patients undergoing hemodialysis.Methods: A cross-sectional study was conducted among 160 patients undergoing hemodialysis at three centers of Bagmati province of Nepal from July to December 2020. We used End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) to record the adherence scores in different domains of treatment adherence. The scores were compared with different sociodemographic variables using nonparametric tests.Results: Out of a total score of 1200, the overall obtained mean score was 1084.07±125.58. The percentage of the respondents adhering to dialysis, medicines, fluid, and diet was 91.9%, 76.3%, 48.9%, and 43.0% respectively. Male patients scored significantly higher score in the diet. And the married patients scored higher in adherence to fluid. Patients with middle socio-economic status scored significantly higher score in adherence to hemodialysis treatment. Conclusions: More than half of the respondents were non adherent to fluid and diet. Periodic motivation by health care professional and dietary counseling by dietitians might be helpful to improve the adherence to treatment. Keywords: Adherence; ESRD-AQ; hemodialysis; treatment.
Psychosocial Well-Being of People Living with HIV/AIDS in Chitwan District, Nepal: a Mixed Method Study
Authors: Khatiwada Dipendra , Baral Rojina , Shrestha Shakti , Poudel Ramesh Sharma , Chalise Hari Prasad
Published: November 2024

Background: Along with many physical issues associated with the HIV/AIDS there are socio-psychological ill-effects including depression, anxiety and stress. The antiretroviral therapy has been successful in prolonging the life but not much information is available on the psychosocial issues and social support from Nepal.Methods: Sequential explanatory mixed method study design was followed. All the patients undergoing antiretroviral therapy in Bharatpur Hospital above 18 years of age and giving consent to participate were conveniently selected. Validated Nepalese version of Becks Depression Inventory and Becks Anxiety Inventory tool while translated and validated Multidimensional Scale of Perceived Social Support scale was used Purposive In-depth Interview was conducted with open ended questionnaire to obtain qualitative data. Chi-square and logistic regression were used for quantitative analysis while manual content analysis was used to analyze the qualitative data. Results: The totals of 288 participants were included in the study About 43% had some level of depression, 98% had very low level of anxiety and almost half of the people had high support. In binary logistic regression model, the significant variables were sex, marital status and occupation. Females had 2.622 times more odds of depression than males, the risk of having depression in occupation group- agriculture and household was 3.661 and 2.508 time more as compared to jobholder respectively. Similarly, single individuals had 2.815 higher odds of depression than couples. Emotional disturbances and fear of vulnerability, stigmatization, dealing with difficulties were the major problems in these groups with good familial and organization support.Conclusions: Clinicians, health and AIDS professionals should routinely screen for depression among other interventions to promote psychological health in HIV/AIDS-positive individuals. Keywords: Anxiety; depression; HIV/AIDS; perceived social support.
Correlation between neurologic status and spinal injury at the Cervicothoracic Junction
Authors: Dhakal Gaurav Raj , Sadiqi Said , Shah Gyanendra , Shrestha Sushil , Paudel Santosh , Kawaguchi Yoshiharu , Riew K.Daniel
Published: November 2024

Background: With limited studies on spinal injuries occurring at the cervicothoracic junction, there is currently a knowledge gap regarding the correlation between morphology of injury and neurology and whether surgery provides a favorable neurological outcome. The primary objective was to determine whether the neurological deficit correlated with the severity of injury at this region of the spine.Methods: All patients with injuries at the cervicothoracic junction from December 2015 to December 2020 in a government trauma hospital were included. Patient demographics, characteristics of the injury, neurological score, imaging findings, surgery details and neurological outcomes were analyzed. All patients had a minimum follow up of 2 years.Results: Of the total 30 patients, 23 were male and 7 female with mean age 42.4 years. 90% had fall injuries with 76.7% sustaining AO type C injury and 10% with AO B2 injury.73.4% had injury at C6-C7 level followed by 13.3% , C7-T1. Only 16.7% patients presented with intact neurology. Plain x-rays failed to detect cervicothoracic junction, injuries in 63.3% patients. Posterior stabilization was performed in 56.7%. Neurological improvement was observed in 9 patients.Conclusions: Though cervicothoracic junction injuries are uncommon, they are highly unstable injuries and difficult to diagnose by plain x-rays. These injuries also result in profound neurological deficit. Surgical stabilization of these injuries should be considered for a favorable neurological and functional outcome. Keywords: Cervico-thoracic junction; injuries; morphology; neurology; spine.
Antibiotic Susceptibility Pattern of Bacteria Causing Urinary Tract Infection
Authors: Sherchan Jatan Bahadur , Dongol Anjana , Humagain Sanjaya , Joshi Anish , Rana Magar Siddha , Bhandari Sarita
Published: November 2024

Background: Urinary tract infection is one of the commonest infectious diseases worldwide. This study was carried out to determine the antimicrobial susceptibility pattern of bacteria causing urinary tract infection visiting Kathmandu University Hospital.Methods: A total of 3,500 urine samples were processed and antibiotic resistance pattern was determined following Clinical Laboratory Standard Institute guidelines. Patients’ information was obtained after informed consent.Results: Total number of samples with positive growth was 434 (12.40%). 331 (76.27%) of the isolates were Escherichia coli followed by Klebsiella pneumoniae, Enterococcus spp., Pseudomonas aeruginosa, Staphylococcus saprophyticus, Proteus mirabilis, Enterobacter species, Klebsiella oxytoca, Citrobacter freundii, Proteus vulgaris, Staphylococcus aureus and Acinetobacter species. Over all 224 (51.61%) were multidrug resistant strains. All strains were sensitive to colistin, vancomycin and linezolid. Over all ampicillin and cefazolin had least sensitivity. Multidrug resistant strains were detected more among elderly patients with complicated urinary tract infection and diabetes which was 25 (83.33%) compared to elderly patients with uncomplicated urinary tract infection and having no diabetes or any other comorbid illnesses which was only 11(22.22%) (p-value<0.05). 21 (70.00%) of the pregnant females had multidrug resistant isolates and only 18 (36.73%) of pediatric age group patients had multidrug resistant isolates (p-value<0.05) Conclusion: Drug-resistant bacteria were observed in urine samples. Effective treatment and prevention of urinary tract infection need detailed microbiological diagnosis and drug susceptibility testing.Keywords: ESBL; MDR; UTI
Characteristics of Pregnant Women and Risk Factors of Their Newborn for Admission to a Neonatal Intensive Care Unit in Nepal
Authors: Pokhrel Sabi , Shrestha Dhruba , Shrestha Raj Kumar , Budhathoki Saraswati , Sah Ashok Kumar , Parajuli Pramila , Raya Ganendra Bhakta , Morimoto Konosuke , Dhoubhadel Bhim Gopal
Published: November 2024

Background: Nepal has progressed gradually in reducing under-5 mortality and neonatal mortality; however, they are still high at 30.8 and 19.8 per 1000 live births, respectively. Neonatal mortality constituted about 64% of the under-5 mortality in 2019, higher than the global average of 47%.Methods: This is a prospective study among pregnant women and their newborn babies in Siddhi Memorial Hospital, Bhaktapur, Nepal, from October 2017 to April 2018. Demographic and clinical data, high vaginal swabs of pregnant mothers, and umbilical cord blood were collected. High vaginal swabs were cultured, and umbilical cord blood samples were cultured and tested for inflammatory markers. After discharge to home, neonates were followed for 28 days of life by weekly phone calls.Results: Total number of pregnant mothers enrolled was 151. The median age was 26 years (IQR: 18-40), and the proportion of adolescent mothers was 4.7%. Half of the deliveries were done by the caesarian section, and 8.6% had gestational age <37 weeks. High vaginal swab cultures were positive in 8.2% of the samples (n=135), and Escherichia coli was the most common bacteria. Out of 153 newborn babies (2 were twins), 8 (5.2%) were admitted to the neonatal intensive care unit. The proportion of low birth weight was 13%, and it was independently associated with neonatal intensive care unit admission (adjusted OR=9.4, 95%CI 1.8-50.1; P value= 0.009).Conclusions: Adolescent pregnancies and Low Birth Weight babies were commonly observed. Both of these issues need to be addressed by effective measures that would improve the current situation of maternal and child health in Nepal.Keywords: Maternal health; morbidity neonates; Nepal; risk factors; morbidity
Minimum Service Standard: A Hospital Strengthening Program that Facilitates Hospitals’ Attainment of Quality-of-Care Standards
Authors: Dangal Ganesh , Kashim Shah Mohammad
Published: November 2024

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Antibiotics Use in a Tertiary Care Hospital Using Point Prevalence Survey Method
Authors: Kafle Kumud  Kumar , Jha Nisha , Kafle Sajala , Manandhar Tejendra , Bajracharya Omi , Devkota Pragya , Bajracharya Suraj
Published: November 2024

Background: Point prevalence survey on antibiotic use developed by WHO are already in use in acute care hospitals around the world. The aim of this study was to collect prescribing of antibiotics using Point prevalence survey method in KIST Medical College and Teaching Hospital.Methods: This was a cross sectional descriptive study and data collection was completed within 8 working days in the study site. The study was conducted among inpatients admitted at or before 8:00AM on the day of survey in various wards. Patient sampling was done as per the Point Prevalence Survey methodology. Data analysis was done and presented as frequencies and percentages. Results: Out of 32 patients, maximum patients were of age group 20-30 years and 19 (59%) patients were females. Most patients, 8 (32%) were from the surgery ward. There were patients from 8 different wards including a patient who had renal transplant. Blood, sputum, urine and CSF culture were done in 11 patients, only 2 urine cultures were positive. At least one antibiotic was used among 18 patients. Ceftriaxone (34.4%) was maximally used followed by levofloxacin (3%). One or two antibiotics were used in prophylaxis with a duration of one to five days. Conclusions: WHO Point prevalence survey methodology has been used in this study. Ceftriaxone was the most commonly used antibiotics. Parenteral administration was the commonest method of administration. At least one antibiotic was used among 18 patients. There is presence of a functioning Drugs and Therapeutics Committee, Infection Prevention & Control Committee and committee on pharmacovigilance. However, many indicators for hospital infrastructure, policy and practice and monitoring and feedback were not present. Keywords: Antibiotics; Nepal; point prevalence survey; tertiary care center.
Utilization of Antenatal Services among Postnatal Mothers
Authors: Gautam Bhattarai Saraswoti Kumari , Pahadi Nirmala , Chaulagain Sandhya , Mahat Shrijana , Pantha Asha , Khadka Rabin
Published: November 2024

Background: Antenatal care is medical supervision and care given to pregnant women to ensure, support and maintain maternal and fetal well-being throughout the pregnancy. Therefore, this study was done to find out the utilization of antenatal services among postnatal mothers.Methods: The descriptive cross sectional study design was used to identify the utilization of antenatal services among postnatal mothers who came in Maternal and Child Health Clinic for the immunization of baby. Total 367 postnatal mothers within one year of childbirth were recruited by simple random sampling technique, and data was collected with face-to-face interview by using semi structured interview schedule. Analysis was done by using descriptive and inferential statistics.Results: All postnatal mothers consumed iron and folic acid during pregnancy, 96.2% consumed until the childbirth, 94.0% got freely, 97.0% taken anti helminths drug, 98.1% did urine test, 98.1% did blood test, 97.8% got ultrasound service, and 96.5% received Td vaccine. Likewise, higher proportion had checked weight 98.6% and lower proportion had checked height 86.9%. Similarly, majority 90.2% received counselling on danger signs and only 26.2% received the counselling on preparation of items safe delivery and care of newborns. There is significant association of antenatal care service utilization with postnatal mothers’ educational level and her husband’s occupation (P<0.05 level).Conclusions: Although most of the postnatal mothers utilized antenatal care services, some aspect of antenatal education and counselling need to be improved such as preparation of item for delivery and new born care, finance, and blood donors. Keywords: Antenatal care; antenatal care utilization; satisfaction.
Perceptions Regarding Antimicrobial Resistance and Stewardship Programs among Healthcare Professionals
Authors: Jha Nisha , Mudvari Anish , Hayat Khezar , Shankar Pathiyil Ravi
Published: November 2024

Background: Antimicrobial resistance is an important global problem resulting in an improper response of infections to antimicrobials and an increase in the duration and cost of treatment. Healthcare professionals play an important role in addressing Antimicrobial resistance and positive perception is important for involvement in antimicrobial stewardship policies. Hence the perception of key Healthcare professionals, including physicians, nurses, and hospital pharmacists, towards Antimicrobial resistance antimicrobial stewardship policies was studied.Methods: A cross-sectional study was conducted in a tertiary care hospital at Lalitpur, from January to March 2021 using stratified random sampling. An online questionnaire was circulated to the selected Healthcare professionals. Median Antimicrobial resistance and antimicrobial stewardship policy scores were calculated and compared among different subgroups. Previous engagement with Antimicrobial resistance and antimicrobial stewardship policies programs was also noted. Descriptive statistics, Mann Whitney, and Kruskal Wallis tests were used for data analysis. Results: The response rate was 89.3% (202/226). Antimicrobial resistance was regarded as a serious problem in the Nepali community by participants with work experience of 1-5 years, 87 (75.6%, p=0.029), and female participants, 62 (45.5%, p<0.001). Most physicians, females, and participants with working experience 1-5 years believed inappropriate use of antibiotics can harm patients and is professionally unethical. Physicians supported the availability of local antimicrobial guidelines and protocols. The median scores for Antimicrobial resistance (p<0.001) and Antimicrobial resistance eradication (p=0.048) differed according to age groups. Conclusions: Healthcare professionals believed Antimicrobial resistance was an important issue. Antibiotic guidelines developed should be strictly implemented. Healthcare professionals also believed inappropriate use of antibiotics can harm patients and is professionally unethical.Keywords: Antimicrobial resistance; antimicrobial stewardship; healthcare professional; perception.