bluuebunny/crossref_metadata_2025 huggingface dataset:
Late Presentation of Hypoxic Injury of Brain in an Infant
Authors: Regmi Pradeep Raj , Yadav Aalok Kumar , Koirala Bibek , Yadav Shreelal , Amatya Isha
Published: November 2024

Perinatal asphyxia is one of the leading causes of hypoxic-ischemic encephalopathy. In a developing country like Nepal, home delivery is the leading cause of perinatal asphyxia. Neuroimaging remains the diagnostic modality of choice. We present a case report of a 10-month-old infant who presented to the pediatric Out-patient-department with complaints of being unable to hold his head and unable to sit without support. Detailed history, physical examination, and developmental assessment along with lab investigation flash visual evoked potentials and Magnetic Resonance Imaging of the brain was performed. Hypoxic ischemic injury has common five types of imaging patterns in neonates. There are a few imaging differentials to be considered while evaluating the case for hypoxic injury. Clinicians and radiologists must go hand in hand to narrow down the possibilities which can fasten the treatment thereby decreasing morbidity and mortality.Keywords: Hypoxic ischemic encephalopathy, Infant, Magnetic Resonance Imaging
Perceived Burden of Care among Parents of Children with Sickle Cell Disease
Authors: Nai Saraswoti , Ranjitkar Uma Devi , Pandey Apsara
Published: November 2024

Background: Children affected with Sickle Cell Disease mostly depend on their parents for assistance which creates physical, emotional, social, and financial burdens among the parents. The objective of this study was to find out the level of perceived burden of care among parents of children with sickle cell disease in a hospital. Methods: A descriptive cross-sectional research design was used with a quantitative approach. The data were collected using a structured interview schedule using the Zarit Burden Interview scale among 152 parents attending the social service unit of Bheri Hospital, Nepalgunj. A nonprobability purposive sampling technique was used. Data were analyzed using Statistical Package for Social Science (SPSS), version 20. The Chi-square test was used to measure the association between the level of burden of care and selected variables. Results: One hundred and fifty-two parents were included in the study, among which more than half (58.6%) were fathers. More than half (52.0%) of parents perceived mild to moderate burden with a Mean±SD score of level of burden is 1.26±0.44. A significant statistical association was found between the level of burden of care and the relationship to the child (p=0.002), and the type of family (p=0.04). Conclusions: The study showed that the majority of the parents’ perceived a mild to moderate burden. Keywords: Burden of care; parents; sickle cell disease; zarit burden interview
Depression and its Associated Factors among Faculties of Academic Institutions
Authors: Sharma Bimala , Shrestha Nirmala , Sah Saurabh Kishor
Published: November 2024

Background: Depression is one of the common mental disorders occurring frequently in the community. The study aimed to find out the prevalence and correlates of depression among faculties of academic institutions in Pokhara Metropolitan, Kaski, Nepal.Methods: A cross-sectional study was conducted among 416 faculties selected from six academic institutions of Pokhara Metropolitan. A self-administered structured questionnaire method was applied to assess depression and explanatory variables among respondents. Beck Depression Inventory (BDI) was used to measure depression. The BDI score was classified into normal, mild, moderate and severe depression using the standard classification; and the depression levels were dichotomized into “absent” and “present”. Descriptive statistics, bivariate analysis and multivariate logistic regression analysis were computed. Level of significance was set at 5%.Results: Of the total, 21.6% of respondents had depression including 6.7% moderate and 2.9% severe type depression. The likelihood of reporting depression was significantly higher among those who had physical health problems (AOR, 2.88; 95% CI, 1.16-7.13), consumed vegetables less than 2 times a day (AOR, 2.34; 95% CI, 1.07-5.08), had limited access to teaching aids in workplace (AOR, 2.00; 95% CI 1.19-3.33), had higher job stress and higher COVID-19 fear. Depression did not differ by the socio-demographic characteristics of the respondents and type of institution. Conclusions: Improving physical health conditions, promoting vegetable consumption, ensuring access to basic facilities, and creating an enabling environment at workplace may help to address depression among faculties. Regular screening programs may help for timely identification and management of the cases.Keywords: Academic institutions; depression, faculties; job stress
Womens Autonomy and Utilization of Maternal Health Care Services
Authors: Dahal Tulasha , Neupane Sarswati , Chapagain Pratikshya , Khanal Ranjeeta
Published: November 2024

Background: Maternal health care means the health care that a woman receives during pregnancy, childbirth and postnatal period. Utilization of above service is crucial for the wellbeing of a mother and new born. The objective of the study is to find out women’s autonomy and maternal health care utilization in a community of Morang district.Methods: Cross-sectional study was conducted in the Gramthan Rural municipality which is located at Morang district. Study population was married women having at least one child under 12 month of age. Simple random sampling techniques was used to select the wards whereas purposive sampling technique was used to collect data with semi- structured interview schedule.Data analysis was done through binary logistic regression was used to findout the association between maternal health care utilization service with autonomy and demographic variables. All variables with a p-value 0.10 included in multivariate logistic regression. Results: Out of 318 women 36.5% had high level of autonomy and maternal health service was utilized by 29.2%. In bivariate analysis, women’s high level of autonomy was 2.033 times higher utilization of maternal health services than women’s with low autonomy. Respondents with unemployment, 0.528 times higher utilization of maternal health services than employment (p-value 0.011, CI 0.322-0.866). Ethnicity was also associated with utilization of maternal health services. In multivariate analysis education remained associated with utilization of maternal health services (p-value 0.004, 0.015, 95% CI 1.830-23.342, 1.197-5.184). It was found that the respondents with primary and secondary level education were 65% and 24% more utilized maternal health services than illiterate.Conclusions: Both level of autonomy and maternal services utilization are not satisfactory and poor specially illiterate women in a community of morang district. Women’s autonomy should be enhance to increase maternal health care utilization.Keywords: Autonomy; maternal health care; utilization
Effectiveness of Focused Obstetric Ultrasound Training to Nurses from Remote Health Posts to Improve Pregnancy Outcome and Reduce Morbidity
Authors: Joshi Jagadish , Sherpa Mingmar Gyelzen , Sherpa Lhamo Yangchen , Lama Neema , Maharjan Manju , Lama Igroom Dolma , Khadka Smita
Published: November 2024

Background: A rural ultrasound program was started in Nepal in order to detect complicated pregnancies early in health post where radiologists are not available to provide their services. The study aims to investigate whether focused obstetric ultrasound trained nurses were capable of detecting high risk pregnancy at an early stage in their health post and refer them to higher centre timely so that they are taken care properly.Methods: The study site for research were health posts and hospitals where the rural ultrasound program had been conducted in districts of Sudurpashchim province. The referral centres within Sudurpashchim province were assessed for cross verification of diagnosis and pregnancy outcome of referred cases. Quantitative data was collected from health posts and hospitals ultrasound log book where women who had accessed obstetric ultrasound services during pregnancy. Qualitative data was collected from nurses who have completed training. The data was verified from log-book registered in the health post and hospitals. All the quantitative data was entered and analysed. Results: Cross verified data revealed that focused obstetric ultrasound received nurses identified cases been verified same diagnosis in referral hospitals with 66 cases. In-depth interview with 28 nurses revealed that training received by them was effective in minimizing preventable maternal and neonatal mortality and morbidity.Conclusions: Focused obstetric ultrasound in rural and under-resources communities like in Nepal has the potential to improve access and quality of health care services and can result in an increased uptake of antenatal care service utilisation. Keywords: Complicated pregnancies; health post; nurses; obstetric ultrasound
Comparison of Spirometric Parameters in different Postures among Young Healthy Volunteers
Authors: Mahotra Narayan B , Shrestha Lava , Kandel Sabita , Chaudhary Sonam
Published: November 2024

Background: Spirometry is the most common pulmonary function tests that specifically measures volume and flow of air during respiration. It helps to identify obstructive and restrictive diseases of the lungs. The alterations of the results in spirometry can happen even in normal health due to change in body postures that alter lung volumes and muscle biomechanics. So, the objective of this study is to determine the effects of change of postures mainly supine, sitting and standing on pulmonary parameters of young healthy volunteers.Methods: A cross-sectional analytical study was conducted among young medical students of Maharajgunj Medical Campus in the department of Clinical Physiology. A total of 31 students were selected by convenient sampling technique. Pulmonary parameters: Forced Vital Capacity (FVC), Forced Expiratory Volume in 1st second (FEV1), FEV1/FVC, Peak Expiratory Flow(PEF), EF2575 were collected from spirometry. The spirometry was done in supine, sitting and standing postures and the best value of each posture was selected for the comparison and obtained data were analyzed using repeated measures ANOVA with confidence interval of 95%.Results: The pulmonary parameters recorded in different postures showed that the mean of these variables comparatively increased in standing posture than others with mean FVC 3.98±0.66 L, mean FEV1 3.53±0.55L, mean FEV1/FVC 89.23±5.60%, mean PEF 8.60±1.62L/s and mean PEF2575 4.46±1.08 L/s. The mean comparisons of these pulmonary parameters in supine, sitting and standing postures showed statistically significant differences with P value < 0.05.Conclusions: The pulmonary parameters are affected by body postures. Those parameters are recorded highest during standing posture and lowest during supine posture.Keywords: Postures; pulmonary parameters; spirometry
Bacteriological Profile and Drug Susceptibility in Mucosal type Chronic Suppurative Otitis Media
Authors: Maharjan Rajesh , Sigdel Brihaspati , Nepali Rajendra
Published: November 2024

Background: In Chronic Suppurative Otitis Media, mucosal type, most common organisms are Pseudomonas aeruginosa and Proteus species (P. mirabilis and P. vulgaris). It is important to prescribe culture-directed antibiotics to prevent resistance. This study was conducted to determine the bacteriological profile and drug susceptibility in patient with chronic suppurative otitis media.Methods: This is a hospital-based descriptive study done at Gandaki Medical College, Pokhara, Nepal from July 2019 to June 2020. Under aseptic condition, the swab specimens were obtained from patients with history of ear discharge of >12 weeks duration and findings central perforation of the tympanic membrane. The sample was labeled and immediately transferred to the microbiology lab for culture/sensitivity test according to the guidelines of the Clinical and Laboratory Standards Institute.Results: Out of total 127 patients, 48 (37.8%) were male and 79 (62.2%) were female. One hundred and seven samples (84.3%) had positive culture while 20 samples (15.7%) had no growth. Staphylococcus aureus (43%), was the most common isolate followed by Pseudomonas aeruginosa (23.4%), Proteus mirabilis (9.3%), and Escherichia coli (8.4%). All the organisms isolated were 100% sensitive to imipenem followed by 96.2% sensitive to gentamicin and 95.3% to amikacin. Conclusions: Staphylococcus aureus (43%) was the most predominant isolate followed by Pseudomonas aeruginosa (23.4%), Proteus mirabilis (9.3%), and Escherichia coli (8.4%). Imipenem was the most sensitive antibiotic (100%) followed by gentamicin (96.2%), amikacin (95.3%), and ofloxacin (88.78%).Keywords: Antibiotic susceptibility; bacteriology; chronic suppurative otitis media
Clinical Profile of Patients of Pelvic Organ Prolapse and Its Associated Factors
Authors: Pudasaini Sangita , Dangal Ganesh
Published: November 2024

Background: Prolapse is among the most common indication for gynaecological surgery. It is difficult to estimate prevalence of pelvic organ prolapse even in developed countries due to lack of epidemiological studies. This study was done to find the prevalence, risk factors and common presenting complaints of women with pelvic organ prolapse.Methods: Women with pelvic organ prolapse visiting Paropakar Maternity and Women’s Hospital during 4 months duration in 2021 were approached and after obtaining an informed consent, all the patient information on various risk factors and clinical profile(age,parity,body mass index,smoking etc.) for pelvic organ prolpase were collected in a pre-developed proforma. Pelvic Organ Prolapse was classified by Pelvic Organ Prolapse Quantification system. Data analysis was done using statistical package for the social sciences-25. Ethical approval was taken from Institutional Review Committee- National Academy of Medical Sciences.Results: Out of 58 cases enrolled in the study, prevalence of pelvic organ prolapse was found to be 1.28%. Women belonging to age group ? 49 years was 91.4%. Bulge symptom was the most common presenting complain among the women, 98.3%. 50% of women (n=29) were grand multipara. 53.4% (n=31) of women had delivered their first baby before 20 years of age. Multiparity,vaginal birth and menopausal age were the common risk factors.Conclusions: Menopausal age, multi-parity, vaginal births, age at first vaginal delivery of less than 20 years were significant risk factors for development of prolapse. Bulge symptom was the most common presenting complaint. However,Smoking habit, overweight were not related to pelvic organ prolapse.Keywords: Pelvic organ prolapse; prevalence; risk factors
Effect of Music Therapy on Intensity of Labor Pain among Primigravid Mothers admitted in a Tertiary Level Hospital
Authors: Gautam Samjhana , Dhakal Chalise Gita , Bharati Mamata , Shrestha Sarala
Published: November 2024

Background: Childbirth is a most welcomed and positive life experience for the majority of women, despite the pain. Most of them manage it well with minimal assistance while few of them require some intervention to reduce the pain. The objective of this study was to find out the effect of music therapy on intensity of labor pain among primigravid women.
Methods: A quasi-experimental pre-test post-test non-equivalent control group design was used. Sample consisted of 42 primigravid women admitted in labor room of a teaching hospital in Kathmandu. The intensity of labor pain was measured using Visual Analogue Scale and Behavior Rating Scale in latent and active phase of labor in both experimental and control groups. Then 30 minutes of music therapy was provided to the experimental group in the latent and active phase of labor. The post-test was carried out in both groups after the music therapy to experimental group during the latent and active phase using the same instruments. The collected data was entered in Statistical Package for Social Sciences version 16. Descriptive statistics and inferential statistics were used to describe the findings.
Findings: The mean difference of total pain between experimental and control groups during latent phase was 1.9 (t=2.31, p=0.023) in pre-test and 6.57 (t=3.91, p=0.000) in post-test. The mean difference of total pain between experimental and control groups during active phase was 1.00 (t=1.08, p=0.286) during pre-test and 6.95(t=3.744, p=0.001) during post-test.
Conclusions: Music therapy tends to reduce labor pain both during the latent and active phase of labor.
Predictors of Depression and Anxiety among Medical Students
Authors: Thapa Bipin , Sapkota Suman , Khanal Anil , Aryal Binod Kumar , Hu Yifei
Published: November 2024

Background: Medical undergraduates are more prone to emotional distress in comparison to the general population and non-medical undergraduates. This study aimed to identify the prevalence and factors associated with depression and anxiety symptoms among undergraduate medical students. Methods: A cross-sectional study was conducted among 204 medical students in a medical institute in Kathmandu. Depression, Anxiety and Stress Scale-42 was used to identify the prevalence of depression and anxiety symptoms. The data were analyzed using multivariable logistic regression models.Results: The prevalence of depression and anxiety symptoms was 30.9% and 38.7% respectively. Depression symptoms were more likely to be prevalent among fourth and fifth-year students, with an adjusted odds ratio (aOR 1.96, 95% CI: 1.03-3.75) compared to second and third-year students, and those who failed in the last academic examination (aOR 2.55, 95% CI: 1.28-5.09). Anxiety symptoms were more prevalent among male students (aOR 2.11, 95% CI: 1.04-4.27), those who were from the relatively less advantaged ethnic group (aOR 2.08, 95% CI: 1.04-4.16) and those who stayed outside the dormitory (aOR 2.90, 95% CI: 1.46-5.78). Conclusions: The prevalence of depression and anxiety symptoms among medical students was high. Psychological support is needed to ensure the mental well-being of medical students. Keywords: Anxiety; DASS-42; depression; medical students.
Short and Long Term Impact on Oral Health Related Quality of Life After Maxillofacial Trauma
Authors: Mahat Arun Kumar , Panta Niranjan , Shrewastwa Mukesh Kumar , Puri Reecha , Basnet Lila Bahadur
Published: November 2024

Background: Maxillofacial fracture cases require detailed diagnosis, planning and timely restoration of the proper function and aesthetics of the traumatized tissues, as well as appropriate physical, psychological and social rehabilitation to achieve the best possible treatment outcome. Oral health related quality of life allows oral healthcare professionals to evaluate the efficacy of treatment protocols from patients’ perspectives and allows clinician to address and measure the clinically meaningful changes.Methods: The study was carried out in 86 patients with fracture of any one facial bone from September 2020 to March 2022 in Department of Dental Surgery, Nepalgunj Medical College Teaching Hospital, Kohalpur, Nepal. The quality of life was assessed by using Nepali version of Oral Health Impact Profile (OHIP-14) questionnaire, modified to address maxillofacial injury/treatment.Results: A total of 86 patients (male: Female ratio=40:3) were included in the study with mean age of 30.69±11.88 years. Patient with fracture of mandible and midface showed complete recovery on OHIP-14 Scale after 6 months whereas, in patient with panfacial fracture some residual effect in quality of life (0.13±0.50) was seen in two domains psychological discomfort (0.06±0.25) and social disability (0.06±0.25) even after 6 months.Conclusions: Impact of maxillofacial fracture on quality of life is long lasting and huge on patients. Referral to a psychiatrist or psychologist might be beneficial in addition to open reduction and internal fixation of maxillofacial fractures as early as possible to achieve better quality of life in maxillofacial fracture cases.Keywords: Maxillofacial fractures; OHIP-14; quality of life
Diagnostic Accuracy and Safety Between two Needle Sizes in Percutaneous Trans-Thoracic Biopsy for the Evaluation of Pulmonary Lesions
Authors: Yodying Jirawadee , Sunmahakhun Chantham , Ghimire Pradesh , Bista Neha
Published: November 2024

Background: Percutaneous trans-thoracic lung biopsy has a crucial role in diagnosing lung lesions including lung cancer. However, there is no clear guideline regarding the needle size in percutaneous trans-thoracic lung biopsy. This study aims to evaluate the diagnostic accuracy and complication rate between two needle sizes for percutaneous trans-thoracic lung biopsy.Methods: A retrospective review of patients with lung lesions who underwent percutaneous trans-thoracic lung biopsy between November 2010 and December 2019 was performed. The demographic data, imaging finding, biopsy technique, complication and histologic outcome were recorded and analyzed. Propensity score matching was done to reduce bias in baseline characteristics.Results: Of 377 patients who underwent percutaneous trans-thoracic lung biopsy, 331 patients had complete information. The patients were divided in two groups, comprising of 153 patients in 18G needle group and 178 patients in 20G needle group. After propensity score matching, there were 126 patients left in each group. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value for 18G needle group were 92.9%, 98.1%, 65.0%, 93.7% and 86.7%, respectively. For 20G needle group, the diagnostic accuracy, sensitivity, specificity, predictive value and negative predictive value were 96.0%, 99.0%, 83.3%, 96.2% and 95.2%, respectively. The immediate complication rate was 35.7% and 31.7% in 18G and 20 G needle groups (p= 0.505), respectively.Conclusions: There was no difference in diagnostic accuracy and immediate complication rates between 18G and 20G needle use for percutaneous trans-thoracic lung biopsy.Keywords: Complication rates; diagnostic accuracy; needle sizes; percutaneous lung biopsy; propensity score matching.
Free Basic Healthcare in Nepal: Can the Dream be Turned into Reality in the Pursuit of Universal Health Coverage?
Authors: Aryal Krishna K
Published: November 2024

N/A
Lip Print Pattern among Children Visiting Dental Out patient department
Authors: Rai Amita , Chaulagain Rajib
Published: November 2024

Background: Lip print patterns are unique in every individual. The uniqueness of lip print pattern assists in the personal identification. The objectives of the present study were to study the different lip print patterns among the children visiting Kanti Children’s Hospital, and to compare the distribution of lip print patterns based on gender and race.Methods: A cross-sectional study was conducted among 300 children visiting the Dental Outpatient Department of Kanti Children’s Hospital, Kathmandu, Nepal. Convenience sampling method was used to choose the study subjects. Digital photography method was used to record the image of lips.Results: The study showed ‘Long vertical’ (Type I) as the most frequent (41%) type of lip print pattern, whereas ‘Unspecified’ (Type V) was the least frequent (2.7%) type. Prevalence of ‘Type I’ pattern was significantly higher in males as compared to females (p=0.007) whereas prevalence of ‘Type IV’ pattern was significantly higher in females as compared to males (p=0.006). ‘Type I’ pattern was the commonest lip print pattern among both Caucasians and Mongolian, whereas ‘Type V’ (2%) and ‘Type IV’ (3.7%) were the least common lip print patterns in Caucasians and Mongolian children respectively.Conclusions: ‘Long vertical’ (Type I) was the most common lip print pattern among the children visiting the Dental Outpatient Department of Kanti Children’s Hospital, Kathmandu, Nepal. Nevertheless, in higher or lesser numbers, all kinds of lip print patterns as described by Suzuki and Tsuchihashi were seen in the study population. Keywords: Children; gender; lip print patterns; race.
Interrater Variability among Anaesthesiologists Using American Society of Anesthesiologists Physical Status Classification System
Authors: Sharma Bhattarai Amit , Bista Navindra Raj , Basnet Madindra Bahadur , Joshi Deepak Raj , Shrestha Anil
Published: November 2024

Background: The American Society of Anaesthesiologists Physical Status classification is deployed by the anaesthesiologists worldwide to classify operative surgical patients. Many studies have found moderate degree of interrater variability among anaesthesiologists. The general objective of the study was to find out interrater variability among Nepalese anesthesiologists using this classification system in Nepal. The specific objectives of the study were to find out the correctness of assignment and inter-rater variability among anaesthesiologists based on their experience. Methods: Ten clinical cases were distributed among 130 registered anaesthesiologist practitioners of Nepal after validation with the experts. Respondents were asked to assign each of ten cases to a specific physical status class. Anaesthesiologists were classified to two classes based on clinical experience as having more or less than five years of experience. Results: We found substantial agreement among < 5 year’s (0.66) and > 5 year’s experience group (0.753) and among all raters (0.736). The mean score of the group with less than 5 years of experience was more. There was no significant difference between the mean score (p = 0.595). Overall mean score for the both groups was 5.66 with SD 1.66. There was no significant difference between the groups. Conclusions: The study shows that there is very less variation among registered practising anaesthesiologists of Nepal using American Society of Anesthesiologists Physical Status classification system.Keywords: ASA-PS; interrater; variability.
Use of Statin and Target Low-density lipoprotein cholesterol attainment among post-ST elevation myocardial infarction patients in Shahid Gangalal National Heart Centre, Kathmandu, Nepal
Authors: Adhikari Chandra Mani , Prajapati Dipanker , Timalsena Birat , Bogati Amrit , Khan Barkadin , Safi Sajjad , Adhikari Jagat , Ghimire Vijay
Published: November 2024

Background: and objective: Lipid-lowering is an important intervention to reduce cardiovascular morbidity and mortality in the secondary prevention of STEMI. There is no study to analyze the use of statin and LDL-C treatment target attainment among STEMI patients in Nepal. This study aims to assess the use of statin and LDL-C treatment target attainment among STEMI patients.Methods: It was a prospective observational single-center study conducted at the Shahid Gangalal National Heart Centre, Kathmandu, Nepal outpatient department. An outpatient department-based survey was conducted among STEMI patients who have lipid profile levels at the time of admission for STEMI and after 4-13 weeks of the index event. Lipid profile levels, diagnosis, and risk factors were collected during the outpatient follow-up.Results: Our study included 280 post-STEMI patients; the mean age was 57.5±11.7 years with the majority being male. The mean duration of follow-up was 6.7 ± 0.1 weeks. Rosuvastatin was the preferred statin with 82.1%. The most common dose of statin used was Rosuvastatin 20mg (70%), followed by Atorvastatin 40mg (12.5%). LDL-C levels of <1.4mmol/l were achieved in 44.6% of cases and LDL levels of <1.8mmol/l in 71.8% of cases. In 36.8% of the study population, there was a greater than 50% decline in LDL-C levels. Diabetic patients (55.1% and 83.1%) only have the significant achievement of LDL goal of both <1.4mmol/l and <1.8mmol/l respectively, when compared to those without diabetes (44.9% and 16.9%).Conclusions: Most of the post-STEMI patients were treated with high doses of statins and achieved the target LDL-C levels.Keywords: Atorvastatin; Low-density lipoprotein cholesterol; Rosuvastatin; STEMI.
Left Atrial Enlargement as a Predictor of Atrial Fibrillation in Rheumatic Mitral Valve Disease: An Echocardiography-based Retrospective Cross-sectional Study
Authors: Suryabanshi Anil , Timilsina Binita , Shakya Smriti , Khanal Shambhu , Yadav Vijay , Joshi Amir
Published: November 2024

Background: Rheumatic heart disease is a major cause of cardiovascular morbidity and mortality in developing nations and is a leading cause of hospital admission due to cardiac problems in our country. This study will evaluate the association between left atrial size and the occurrence of atrial fibrillation and describe the clinical characteristics along with complications related to Rheumatic Mitral valve disease.Methods: A retrospective cross-sectional study was conducted at a tertiary care center from January 2018 to December 2019. Reports of 207 patients admitted to medical and/or surgical wards with echocardiographic diagnosis of rheumatic mitral valve disease with or without atrial fibrillation were reviewed. Data were collected, entered, and analyzed using the Statistical Package for the Social Science version 25.0.Results: Among 207 patients, atrial fibrillation was present in 90 (43.5%) patients. Atrial fibrillation was higher in patients with mixed mitral valvular lesions compared to isolated mitral stenosis or mitral regurgitation. Univariate and multivariate analysis revealed left atrial size [aOR=1.067, 95% CI: 1.023 – 1.113, P= 0.002] and age [aOR = 1.073, 95% CI: 1.042 – 1.105, P<0.001] as an independent predictor of atrial fibrillation.Conclusions: Larger left atrium was an independent predictor of atrial fibrillation. Besides this, atrial fibrillation was associated with increasing age, mixed mitral valvular lesion, and moderately reduced left ventricular ejection fraction, but not associated with gender and mitral stenosis severity. Left atrial clot was significantly higher in patients with atrial fibrillation than in sinus rhythm. Keywords: Atrial fibrillation; left atrium; mitral valve; rheumatic heart diseases.
Epidemiology of Spinal Trauma and Related Complication
Authors: Kathayat Tufan Singh , Rokaya Poojan Kumar , Rawal Mangal , Marasini Pawan , Karki Prashanna Dip , Nath Mohan
Published: November 2024

Background: Traumatic spinal injury is leading cause of mortality and morbidity among the people of productive age group. This study aim to find the cause of spinal injury, site ,and mode of injury, treatment option given so that a preventive measures and create awareness among people of this region. Methods: This is a prospective observation study done in Karnali Academy of Health Sciences from December 2021 to January 2023. Performa was filled to collect data. Data were entered in excel sheet and transported to SPSS 16.0 and statistical analysis was done .Results: Out of 117 patients male population had higher incidence of spinal trauma (69.2%) with average age 43.9 years . Fall injury was the commonest mode of injury. 65.8% had injury at the thoracolumbar junction followed by lumbar, thoracic and cervical respectively. Cervical injury patients had higher incidence of neurological deficit. The average duration of trauma to hospital presentation was 10.9±11.2 hours. 19.7 % were operated and 6.8 % of patients were referred to other center.Conclusions: Fall injury being the commonest mode of injury in this art of world, prevention and awareness should be raised about the spinal trauma and its consequences. Adequate equipment with health facilities to the distant hospital may reduce the referral rate and duration of presentation to the hospital which ultimately prevent the further damage to the cord.Keywords : Fall Injury; spinal trauma; western Nepal.
Functional Outcome of Arthroscopic Suture Pull-Out Fixation in Tibial Spine Avulsion of Anterior Cruciate Ligament
Authors: Hamal Bhadra , Regmi Utsav , Bhandari Dinesh , Thapa Pralhad , Chaurasia Roshan Bhagat , Yadav Sanjay Kumar
Published: November 2024

Background: Tibial spine avulsion of the anterior cruciate ligament is a rare intraarticular injury of the knee. In this condition, the tibial attachment site of the anterior cruciate ligament is detached from the knee. The mechanism of the injury is hyperextension of the knee and rotation with valgus force. There are so many treatment options. This study aims to find out the functional outcome of Arthroscopic Suture pull-out fixation in this injury.Methods: This is a retrospective study done from August 15, 2019, to August 14, 2022. The outcome was analyzed by comparing the preoperative and 12-month postoperative International Knee Documentation Committee Score, Tegner Lysholm Score, Knee Range of motion, and Visual Analog Scale Score.Results: Twenty-two patients were included with a mean age of 18.95 (13-31). Among them 15(68.2%) were male and 7(31.8%) were female. Arthroscopic suture pull-out fixation was done in all the cases. The knee range of motion was improved from preoperatively 35.00±7.86 to 135.68±3.50 at the final follow-up. The Tegner Lysholm score was improved from preoperatively 34.68±1.28 to 94.54±2.97 at the final follow-up. Preoperatively the VAS score was 8.04±1.27 which improved to 0.60±0.50 at the final follow-up. The IKDC score was 23.86±1.42 preoperatively which improved to 92.72±3.28 at the final follow-up with p-value < 0.001 Conclusions: Arthroscopic Suture pull-out fixation of tibial spine avulsion of the Anterior cruciate ligament is a good technique that restores the functions of the knee and has an excellent outcomeKeywords: Anterior cruciate ligament; suture pull-out fixation; tibial spine avulsion.
Putting Patient Safety First for the Quality Care: An Essential Component at all Healthcare Settings
Authors: Dangal Ganesh , Dangal Ojash
Published: November 2024

N/A
The Impact of Pelvicalyceal System Anatomy on Stone Formation in Patients with Single Lower Pole Calyceal Stone on Computed Tomography Urography
Authors: Adhikari Kapil , Regmi Niraj , Devkota Karun , Koirala Sapana
Published: November 2024

Background: To compare various lower pole pelvicalyceal anatomical factors of stone bearing kidney with contralateral normal kidneys and determine whether these factors predispose to stone formation in one kidney. Methods: A descriptive study was done with Computed Tomography of 54 patients with solitary lower pole calculus in one kidney and normal contralateral kidney were included. Various lower pole pelvicalyceal anatomical factors like infundibulopelvic angle, infundibular width, infundibular length and calyceopelvic height of both stone bearing and contralateral kidneys were measured and compared for any differencesResults: The mean infundibular width was 5.4±1.9mm on stone bearing kidneys and 5.2±2.05mm on contralateral normal kidneys. The mean infundibular length was 18.9±4.4mm on stone bearing kidneys and 18.8±3.9mm on contralateral normal kidneys. The mean infundibulopelvic angle was 47.9±10.8° on stone bearing kidneys and 47.6±11.2° on contralateral kidneys. The mean calyceopelvic height was 15.7±4.6mm on stone bearing kidneys and 15.5±3.9mm (range 7.5to 23.1mm) on contralateral kidneys. There were no statistically significant differences between stone bearing and contralateral normal kidneys in respect to these pelvicalyceal anatomical factors.Conclusions: In this study, we found no significant difference in lower pole pelvicalyceal anatomical factors between stone bearing kidneys and contralateral normal kidneys and therefore these factors do not seem to have significant role in stone formation in one kidney compared with the other.Keywords: Lower pole calculus; pelvicalyceal anatomical factors; urography.
Choroidal Thickness Measurement in Systemic Lupus Erythematosus Patients with or Without Ocular Manifestation
Authors: Khadka Prajita , Kharel (Sitaula) Ranju , Mishra Sanjeeb Kumar , Jha Saket , Lamichhane Srijana , Gyawali Parash , Chandan Aayush
Published: November 2024

Background: Systemic Lupus Erythematosus is a multi-systemic disease that has a high morbidity rate. Choroids usually have a distinct structural makeup in different systemic disorders which makes it easier to be used as a potential tool for the study of disease activity.Methods: This study was an observational cross-sectional prospective study with a total of 51 Systemic Lupus Erythematosus patients and 51 normal controls were included. The choroidal thickness values were determined using the Spectralis Spectral Domain Optical Coherence Tomography instrument (Heidelberg Engineering).Results: The results showed that the mean subfoveal, nasal, and temporal choroidal thickness in Systemic Lupus Erythematosus patients with ocular manifestations had thinner choroidal thickness compared to normal controls with p<0.001, p=0.008, and p<0.001, respectively. On the other hand, Systemic Lupus Erythematosus patients without ocular manifestations had relatively thicker subfoveal choroidal thickness compared to normal controls (p<0.001) but nasal and temporal choroidal thickness were not statistically significant (p=0.264 and p=0.347 respectively).Conclusions: The findings suggested that choroidal thickness measurement may serve as an indicator of disease activity and prognosis in Systemic Lupus Erythematosus patients, as well as a potential tool to predict the occurrence of ocular manifestations. Thinning of the choroid may be associated with factors such as decreased blood flow leading to atrophy or chronic inflammation, while thickening of the choroid may indicate active stage of the disease and the possibility of severe ocular manifestations in the future.Keywords: Choroidal thickness; SLE; spectral-domain optical coherence tomography; ocular manifestation.
Service Readiness for Safe Abortion Services
Authors: Dangol Deeb Shrestha , Gyawali Nisha , Kumar Lal Bibek , Joshi Nisha Kumari , Karki Sujan , Lamichhane Kritee , Phuyal Parash Prasad , Joshi Shipra , Ghimire Jagadishwor , Powell Bill , Dhillon Jina , Lynam Anna
Published: November 2024

Background: Health service readiness is a prerequisite to accessing quality services. This study analyzes the readiness of health facilities in Nepal to provide comprehensive abortion services by focusing on the availability and quality of care.? Methods:  This is a cross-sectional study, and a multi-stage sampling approach was used to select health facilities. A total of 767 health facilities were surveyed from 30 Municipalities across the country.  Results: In a study of 767 health facilities surveyed, only 223 (29%) offered abortion services. Among them, 92% offered medical abortion, 48% provided manual vacuum aspiration, 18% offered dilation and evacuation and 18% offered medical induction. Approximately 7% of health facilities lacked trained providers yet still provided services and 29% of health facilities providing abortion services were not compliant with legal requirements. Interestingly, 13% of these facilities lacked short-acting contraceptives.  Conclusions:  Most health facilities in Nepal lack readiness for Safe Abortion Services (SAS), failing to meet minimum criteria, including to provide abortion legally. Urgent collaborative efforts among policymakers, administrators, and healthcare providers are needed to align with Nepal's Sustainable Development Goals and address gaps in safe abortion service availability. This includes policy updates, strengthening Public-Private Partnerships (PPPs), and ensuring comprehensive SAS implementation and financing as part of essential health services.Keywords: Health facility; listed facility; post abortion care; safe abortion; service readiness.
Fetomaternal Outcome in Antepartum Hemorrhage After 34 Weeks of Gestation
Authors: Ranabhat Bijay Kumar , Dangal Ganesh , Poudel Sandesh , Adhikari Shreeprasad , Khadka Chiranjivi
Published: November 2024

Background: Antepartum hemorrhage is defined as any bleeding from or into the genital tract during pregnancy, after the period of viability until delivery of the fetus. APH complicates 2-5% of pregnancies and is a primary cause of perinatal and maternal mortality globally. Aim of this study is to evaluate maternal and perinatal outcome in patients with APH at a tertiary care hospital.Methods: The present study was a cross sectional study conducted in Obstetrics and Gynaecology department of Paropakar Maternity and Women’s Hospital, during a period of 5 months from December 2022 to April 2023. 50 cases of APH were enrolled with gestational age ? 34 weeks of gestation.Results: Incidence of APH after 34 weeks of gestation was 0.51%. The most common type of APH was abruption placenta (44%) followed by placenta previa (32%) and undetermined (24%). The age range of 26 to 30 years old accounted for the highest number of APH patients i.e., 21(42%). In placenta previa, 75% and in abruption placenta 63.64% were multigravida. APH was presented mostly between 37-40 weeks. Around 26% of the patients had anemia at the time of admission. Most common mode of delivery was cesarean section (82%). Most common maternal complications were PPH (40%), blood transfusion (28%), DIC (4%), cesarean hysterectomy (4%). Low birth weight and preterm were the most common causes of fetal complications. Maternal mortality was 2% and perinatal mortality was 18% overall.Conclusions: APH is primary cause of maternal and perinatal morbidity and mortality. In our study, an abruption placenta was the most frequent cause of APH. Cesarean section was the most commonly used mode of delivery. PPH with blood transfusion was the most prevalent maternal complication, while fetal complications included low birth weight and preterm..Keywords: Abruptio placenta; antepartum haemorrhage; placenta previa.
Awareness of Menstrual Hygiene Management Rights and Perception of Risks, Self-Efficacy, and Behavior
Authors: Yadav Ram Naresh , Joshi Shrijana , Park Ji Sun
Published: November 2024

Background: Menstrual Hygiene Management stands as a critical health concern for girls entering reproductive age on a global scale. This transition often induces fear and anxiety due to inadequate knowledge about menstruation and a lack of resources to comprehend bodily changes. Notably, school-aged girls in marginalized communities face formidable barriers to MHM, given the insufficient facilities, supplies, and awareness in educational institutions. Methods: A Mixed method study was conducted adopting a mixed-methods approach. It engaged 562 respondents across five local levels of Bajura district, including three municipalities (Badimalika, Budhiganga, and Tribeni) and two rural municipalities (Gaumul and Khaptad Chhedaha).Results: The study unveiled over 90% awareness on on five out of seven MHM rights related statements and over 85% self-efficacy on 5 out of 8 statements regarding MHM among female adolescent respondents. However, their actual practices fell short of expectations, marked by the prevalence of restrictive norms and perceived risks pertinent to MHM. Notably, 27% (N=154) expressed fear of divine consequences for not adhering to menstrual customs. Malpractices were observed, including 66% using cloth during menstruation, inadequate pad changing frequencies, and some girls staying in Chhaugoth during menstruation. Despite a high awareness (97%) of menstrual rights, behavioral practices did not consistently align with this awareness.Conclusions: The study highlights high awareness and self-efficacy in menstrual hygiene management among female adolescents, yet challenges persist due to cultural norms, perceived risks, and insufficient infrastructure, necessitating multifaceted solutions for behavioral change and access to resources. Keywords: Adolescent girls; awareness on MHM rights; behaviour; perception of risks; self-efficacy.
Risk Factors and Clinico-laboratory Characteristics of Scrub Typhus in Children Admitted to a Tertiary Pediatric Hospital of Nepal
Authors: Chapagain Ram Hari , Adhikari Santosh , Bista Bihungum , Bhattarai Tribhuwan , Thapa Prabhat
Published: November 2024

Backgrounds: Scrub Typhus is a re-emerging illness with considerable morbidity and mortality and affected children have nonspecific sign symptoms. This study was conducted to find out the risk factors, clinical characteristics and laboratory profile and treatment outcome of scrub typhus among the children admitted in tertiary level pediatric hospital for febrile illness. Methods: A case control study was conducted among hospitalized children with acute febrile illness in a government pediatric referral hospital of central Nepal for two years (2021 to Sept 2023), who were tested using Scrub Typhus Antibody Rapid Test Kit.Results: We recruited 137 participants, comprising 68 cases of scrub typhus and 69 controls who had fever as a presenting complain, tested negative for scrub typhus and are matched with case in terms of age, gender, place of residence, and most importantly devoid of chronic health issues like leukemia, solid tumor, tuberculosis or kala-azar. Almost all cases i.e. 98.5% (n=67) had fever which is followed by abdominal pain 19.1% (n=13), headache 11.8%(n=8), vomiting 10.3%(n=7) and abdominal distension 8.8%(n=6). Hepatomegaly was commonest finding among scrub typhus positive cases comprising 50% (n=34) followed by lymphadenopathy 29.4% (n=20), splenomegaly 27.9% (n=19), eschar 17.6% (n=12) and rashes 10.3% (n=7). Cases having thrombocytopenia and leukocytosis were 51.5% (n=35) and 32.3% (n=22) respectively. Among scrub typhus cases, 17.6% (n=12) needed pediatric intensive care, 20.6% (n=14) had some sort of complications (i.e., meningitis, acute kidney injury, septic shock, acute respiratory distress syndrome), 46.3% (n=31) became afebrile within 24 hours of therapy, 29.8% (n=20) needed 48 hours to become afebrile. There were about 80% cases with the habit of taking naps on the ground. Those who reside other than cemented houses were with an increased risk factor of about 72%. Those who were not having good beds were at an increased risk factor of almost 100%. There were 62% of cases with bushes near their home and about 100% cases where they store animal fodder in their home. There were 63% who have any sort of animal in their bedroom.Conclusions: Engaging in agricultural work like working on fields, planting and livestock, working with bare hands/ feet, and having naps on the ground and living in houses made of mud dung and wood are the risk factors for the scrub factor. Fever, lymphadenopathy, hepatomegaly, splenomegaly are the common signs and symptoms and thrombocytopenia and increased levels of creatinine are the significant laboratory finding of scrub typhus in children. Keywords: Children; clinico-laboratory; Nepal; risk factor; scrub typhus.
Effectiveness of Video-assisted Distraction Therapy on Childrens Pain Perceptions during Peripheral Venous Cannulation
Authors: Bhandari Menuka , Rai Munawatee , Gartaula Puja
Published: November 2024

Background: Relief of pain is a basic need and right of all children; effective pain management requires health professionals to be able to apply several interventions to achieve optimal results. The current study aimed to discover the Effectiveness of Video-assisted Distraction Therapy on Childrenâ€™s Pain Perceptions during Peripheral Venous Cannulation in Pediatric Wards of Biratnagar, Nepal.Methods: A quasi-experimental study was conducted at Pediatric Wards of different hospitals in Biratnagar. Data collection was done from Feb 27, 2023, to April 28, 2023. Non-probability purposive sampling technique was adopted in selecting the desired sample size. Data was collected through an interview questionnaire and a standard observational checklist, the FLACC pain rating scale. The experimental group received video-assisted distraction therapy as an intervention, while the control group received routine intravenous care from the nurses. Results: There is a significant difference between the pain perception score in the experimental and control group during peripheral venous cannulation (p= <0.001) during and after two minutes of cannulation. Similarly, the level of pain was also different in both groups, 42.5% of children in the experimental group perceived moderate pain, 37.5% perceived mild pain and 20% reported severe pain whereas 92.5% of respondents perceived severe pain and only 7.5% perceived moderate pain during peripheral venous cannulation. Conclusions: Video-assisted Distraction Therapy was very efficient at distracting children from their pain during intravenous cannulation. Keywords: Distraction therapy; pain perceptions; peripheral venous cannulation.