bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge, Practice and Barriers on Cervical Cancer Screening among Married Women
Authors: KC Heera , Gurung Alina , Katuwal Medina , Sharma Ruby , Parajuli Surya Bahadur
Published: November 2024

Background: Cervical cancer is a most common preventable public health problem. Despite availability of various screening services at Biratnagar, many barriers restrict its utilization. So, we aimed to assess the knowledge, practice and barriers of cervical cancer screening among 30-60 years married women in Biratnagar, Morang, Nepal.Methods: We conducted a community based cross sectional study in Biratnagar Morang from December 2020 to December 2021. Consecutive sampling technique was used to collect data from 280 married women of 30-60 years. Ethical approval was obtained from Nepal Health Research Council and informed consent was taken from study participants. Data was collected by face to face interview using a semi structured questionnaire. Results: All participants had heard of cervical cancer. Most (93.9%) responded to multiple sexual partners as a risk factor and 97.9% responded to excessive vaginal bleeding as a symptom. Most (97.1%) responded that cervical cancer is preventable and 44.1% were aware of pap smear test. Eighty-four (30%) participants had ever been screened for cervical cancer. Unavailability of health insurance (85.2%), high cost of treatment (83.1%), lack of nearby service availability (70.9%), embarrassment (44.8%), presence of male doctors (43.8%), problems in time management (28.01%), no advice from health care providers (22.9%), unaware of screening (15.8%) and beliefs on traditional healers (7.1%) were barriers.Conclusions: In comparison to knowledge, practice of cervical cancer screening is low suggesting existence of know-do gap. Various barriers that prevent cervical cancer screening were evident.Keywords: Barriers; cervical cancer; knowledge; practices; screening.
Translation, Cultural Adaptation and Validation of Cardiff Acne Disability Index in Nepali Language
Authors: Paudel Sushil , Parajuli Niraj , Shrestha Shraddha , Hirachan Shashi
Published: November 2024

Background: Acne causes significant impairment in the quality of life of patients, but clinicians in Nepal lack a simple validated tool to measure the psychological side of acne. We planned to translate and validate Cardiff Acne Disability Index, a five item questionnaire into Nepali language to address this need.Methods: A linguistic translation with semantic equivalence to the original English language Cardiff Acne Disability Index was achieved through standard forward and backward translation into Nepali language. All eligible patients were requested to fill the Nepali translated version of both Cardiff Acne Disability Index and Dermatology Life Quality Index questionnaires. Reliability and validity of the newly translated questionnaire were established, based on statistical analyses of factor structure, item correlations and concurrent correlations.Results: This validity study included 94 patients with male: female ratio of 1:3.27 and mean age 21.29 (±3.92) years. Reliability analysis revealed a Cronbach’s alpha of .72 and mean inter item correlation coefficient of .337. A single factor was extracted on Principal Component Analysis explaining 48.40% of variance. A strong correlation of Cardiff Acne Disability Index scores to the Dermatology Life quality Index score (rs>.7) indicated good concurrent validity.Conclusions: The newly translated Nepali Cardiff Acne Disability Index is a valid tool to measure the impact of acne in Nepalese patients. This short and simple assessment tool will help clinicians understand the patient’s perspective of her acne.Keywords: Acne; cardiff acne disability index; quality of life; validity.
Prevalence of Multidrug Resistant Pseudomonas aeruginosa Isolated from Clinical Specimens in Tertiary Care Hospital
Authors: Sharma Samikshya , Devkota Madhu Dixit , Pokhrel Bharat Mani , Banjara Megha Raj
Published: November 2024

Background: Pseudomonas aeruginosa is an opportunistic pathogen, which causes nosocomial infections in human. The rapid increase in drug resistance of this pathogen is a global concern. The aim of this study was to determine the clinical burden of P.aeruginosa, its antibiotic susceptibility pattern along with metallo-?-lactamase (MBL) detection.Methods: The descriptive cross-sectional study was conducted in Upendra Devkota Memorial National Institute of Neurological and Allied Sciences from January to August 2021. Isolation and identification of P. aeruginosa from clinical specimens was performed by using standard laboratory procedure. All bacterial isolates were phenotypically screened for multidrug resistance using Kirby Bauer disc diffusion method. All the multidrug resistant P.aeruginosa were phenotypically screened for MBL producer by Imipenem-EDTA combined disc diffusion test (CDDT).Results: A total of 770 samples were processed of which 36 isolates of P. aeruginosa were obtained. P.aeruginosa was isolated mainly from tracheal aspirates, sputum, blood and urine. Among 36 isolates, 50% were found to be multidrug resistant (MDR). More percentage of P.aeruginosa isolates were found resistant to aztreonam, ofloxacin and levofloxacin (52.8%). Furthermore, this study reveals antibiotics like piperacillin/tazobactam and carbapenem were found to be good choice for the treatment of infection caused by this organism. Among MDR isolates 66.7% were found to be MBL producer.Conclusions: The data in this study highlights the prevalence of multidrug resistant, MBL producer, and colistin resistant P.aeruginosa in clinical specimens. In this study, carbapenems and piperacillin/tazobactam were found to be most effective antimicrobial drugs for empirical therapy in P.aeruginosa infections.Keywords: Metallo-?-lactamase; multidrug resistant; prevalence; Pseudomonas aeruginosa.
Risk Stratification on Systemic Target Organ Involvement Associated with Hypertensive Retinopathy
Authors: Thapa Raba , Das Taraprasad
Published: November 2024

Background: Hypertensive retinopathy is a common complication among people with hypertension. The current study assessed the risk stratification on systemic target organ involvement of people with hypertensive retinopathy.Methods: In a hospital- based cross-sectional study conducted at a tertiary referral eye institute in Nepal, we included consecutive people ? 31 years with essential hypertension. Details of histories and systemic target organ involvements were documented. People with un-gradable retinal findings of hypertensive retinopathy and prior retinal surgery were excluded. All participants underwent comprehensive eye examination, including dilated fundus examination. Hypertensive retinopathy was classified by Modified Scheie classification. Multivariate analysis was performed to identify the risks for hypertensive retinopathy and target organ involvement. Results: The study recruited 312 subjects. The mean age was 63.68 ± 12.63 years. The mean duration of hypertension was 7.0 ± 6.5 years. Hypertensive retinopathy was detected in 83.7% (n=261) people and 63.5% (n= 198) had grade 1 hypertensive retinopathy. Target organ involvement was detected in 20.5% (n =64) people. These included cardiac (12.5%; n=39), central nervous (5.1%; n= 16), and renal (4.5%; n=14) systems. In multivariate analysis, concurrent hyperlipidaemia was significantly associated with hypertensive retinopathy and target organ involvement. Target organ involvement increased with the severity of hypertensive retinopathy. Conclusions: Over four-fifths of people with hypertension had hypertensive retinopathy and one-fifth had other systemic target organ involvements. Severity of hypertensive retinopathy and concurrent hyperlipidaemia were associated with target organ involvement. Hypertensive retinopathy can be considered for risk stratification to other target organ involvement in a clinical setting. Keywords: Hypertension; hypertensive retinopathy; Nepal; risk stratification; target organ.
Morphometric Study of Sub Axial Cervical Spine Pedicles in Nepalese Population
Authors: Baral Yadu nath , Thapa Shrawan Kumar , Marasini Rudra Prasad , Paudel Srijana , Gurung Subash , Ghimire Kathit raj , Yadav Rajesh Kumar , Baral Sushila
Published: November 2024

Background: Mal-positioning of cervical screws risks neurovascular injury so, it is necessary to understand cervical pedicle morphology for pedicle screw fixation in the region. The risks of pedicle screw insertion in the cervical spine can be mitigated by a three-dimensional appreciation of pedicle anatomy. The study aims to determine the morphology of the sub axial cervical spine pedicles in Nepalese Population based on computerized tomography. Methods: A cross-sectional study using computerized tomography scans of the spine was made among the randomly selected 87 patients who had visited National Trauma center, Kathmandu, Nepal with vertebral fracture other than cervical vertebrae. Patient was examined as per Advanced Trauma Life support protocol and neurological assessment. Measurement was done from the third cervical vertebra down to the seventh cervical vertebra in computer with standard software in the department of radiology from where all the computerized tomography scan reporting are done. Results: The mean pedicle length ranged from 4.41 mm at C3 to 4.96 mm at C7 where mean pedicle height ranged from 4.64 at C3 to 5.12 at C7. Pedicle length, pedicle height and pedicle width were observed to be statistically significant with gender. The pedicle axial length of C3 and C7 vertebra were found significant with gender. All parameters were found to be greater in male compared to female. Conclusions: The study revealed that pedicle length, pedicle height, pedicle width, pedicle axial length increased from third to seventh cervical however, transverse angulation increased up to fifth vertebra and decreased to seventh vertebra.Keywords: Morphology; sub-axial cervical spine; tomography.
Prevalence of Left Ventricular Diastolic Dysfunction in Patients with Essential Hypertension
Authors: Paudel Srijana , Gautam Mani Prasad , Baral Yadu nath , Poudel Rajendra , Adhikari Krishna raj , Yadav Rajesh Kumar , Baral Sushila
Published: November 2024

Background: Left Ventricular Diastolic Dysfunction is considered a critical link between hypertension and heart failure, particularly in individuals with heart failure and preserved ejection fraction. The aim of this study is to assess the prevalence and factors associated with clinical parameters of left ventricular diastolic dysfunction in patients with essential hypertension. Methods: A hospital-based cross-sectional study was done among 68 newly diagnosed and known hypertensive patients visiting out patientdepartmentat Bir hospital. Patients who meet the inclusion criteria were chosen alternatively by referring OPD register. Patients with hypertension had undergone echocardiography to see whether left ventricular diastolic dysfunction was present and was compared to other clinical parameters like age, sex, body mass index, and dyslipidemia using the student t-test/chi-square test.Results: The prevalence of left ventricular diastolic dysfunction in essential hypertensive patients was 33.8%. About 25% patients had grade 1; 7.4% and 1.5% of patients had grade 2 and grade 3 diastolic dysfunction respectively. Patients who had a duration of hypertension of more than five years were more than nine times (OR 9.14; 2.89-28.87) more likely to have Left ventricular diastolic dysfunction. Age and Body Mass Index were found statistically significant with diastolic dysfunction (P<0.05).Conclusions: Left ventricular diastolic dysfunction was found prevalent in hypertensive patients.  Age, Body mass index, Dyslipidemia and Duration of hypertension were found to be statistically significant with diastolic dysfunction Keywords: Diastolic dysfunction; hypertension; Nepal; prevalence.
Determination of Serum 25-Hydroxyvitamin D Levels in Patients with Alopecia Areata
Authors: Singh Basukala Manisha , Jha Ayush , Dawadi Roji , Shrestha Rima
Published: November 2024

Background: Alopecia Areata is a common non scarring alopecia with autoimmune etiology. In several previous studies, an insufficient level of 25 hydroxyvitamin D had been correlated with various autoimmune diseases. The current study aimed to determine the level of serum 25 hydroxyvitamin D in patients with alopecia areata.Methods: A cross-sectional study was conducted on 35 patients with alopecia areata who visited the outpatient department of Dermatology of KIST Medical College and Teaching Hospital, Nepal. A prior approval of the institute review committee was taken. Convenience sampling technique period for 3 months (March 2022-May 2022) was used to include the participants (informed consent was taken; in minors parental consent was prepared). The serum levels of 25 hydroxyvitamin D was estimated using Abbott Architect i1000 SR analyser. Result: In this study, Alopecia Areata was common in the age group of 16–30 years (Mean age: 31.65 ± 11.92 Years). The average duration of the disease in Alopecia Areata patients was close to 1 year. This study indicated a lower concentration of 25 hydroxyvitamin D in half of the studied AA patients (51.4%).The number of patches, Severity of Alopecia Tool scoring, serum 25 hydroxyvitamin D level, and age were found to be statistically insignificant with the disease activity. However, a significant positive correlation was found between the Severity of Alopecia Tool score and the number of patches.Conclusions: Although low levels of serum 25 hydroxyvitamin D may be seen among subjects with alopecia areata; No statistical correlation was observed. Hence, a larger study of similar nature is needed in the future to elucidate the exact correlation. Keywords: Alopecia areata; autoimmune; 25 hydroxyvitamin d.
Assessment of Thyroid Dysfunction During Different Trimester of Pregnancy
Authors: Prajapati Sunita , Prajapati Gayatri , Shrestha Vikram , Shrestha Sujata
Published: November 2024

Background: Thyroid dysfunction is frequently seen in pregnant women and is associated with complications like miscarriage, gestational hypertension, placental abruption, pre mature delivery and fetal growth retardation and even causes impaired neuropsychological development of fetus. This study is carried out to assess the prevalence of thyroid disorder during different trimester of pregnancy.Methods: Serum samples were collected from 124 pregnant women attending Patan Academy of Health Science for ante natal visit. Free thyroxine free triiodothyronine and thyroid stimulating hormone were performed by chemiluminescent assay.Results: Out of 124 pregnant women, euthyroidism was seen in 79% (n =98) followed by subclinical hypothyroidism (10%, n=13) and primary hypothyroidism (8%, n=10). Subclinical hyperthyroidism and primary hyperthyroidism accounts for 1% (n=1), and 2% (n=2) respectively. Although, thyroid disorder was found to be more prevalent in third trimester (38.4%, n=10) but the distribution in first and second trimester (34.6%, n= 9, 27%, n= 7 respectively) were also significant. Mean fT3 and fT4 level were found to be negatively correlated with trimester (r=-0.19, p=0.027 and r=-0.29, p=0.001 respectively) whereas positive correlation of trimester was seen with TSH (r=0.08, p=0.35).Conclusions: Hypothyroidism is more common in pregnant women visiting tertiary care hospital. Different complication can be minimized if diagnosis is done early. Keywords: Hypothyroidism; pregnant; thyroid stimulating hormone; trimester, gestational week
Prevalence of Microalbuminuria in Non-diabetic Hypertensive Patients and its Correlation with Changes in Left Ventricular and Left Atrial Characteristics
Authors: Bhusal Khema Raj , Devkota Surya , Pathak Surya , Khanal Pratik , Khanal Umesh , Thapalia Poojan , Neupane Srijana , Gyanwali Pradip , Simkhada Rabindra , Oli Krishna Kumar
Published: November 2024

Background: Microalbuminuria is urinary albumin excretion in the range of 30-300 mg per 24 hours and is considered as an abnormal albumin excretion rate. Microalbuminuria is associated with epithelial dysfunction and have a high risk for target organ damage resulting in stroke, retinopathy and adverse cardiovascular events. The objective of the study was to determine the prevalence of microalbuminuria in non-diabetic hypertensive patients and its correlation with cardiovascular changes. Methods: A quantitative cross-sectional study was done in 107 participants diagnosed as non-diabetic hypertensive patients visiting to Manmohan Memorial medical college and Teaching hospital and Manmohan Cardio-thoracic Vascular and transplant Centre. The assessed parameters were basic metabolic profile, urine evaluation and Echocardiography.Results:The results showed microalbuminuria in 28 study participants and not seen in 79 participants. Similarly, microalbuminuria was observed more comparable in those with presence of left ventricular hypertrophy as compared to the absence of left ventricular hypertrophy (29.3% versus 22.8%) (p value 0.469); those with presence of left ventricular diastolic dysfunction as compared to the absence of left ventricular diastolic dysfunction (31.1% versus 19%) (p value 0.170) and those with dilated left atrium as compared to normal left atrium (26.7% versus 23.9%) (p value 0.820). In case of left ventricular ejection fraction, those with normal left ventricular ejection fraction (26.3%) had slightly higher proportion of micro-albuminuria than those with mild to moderate left ventricular systolic dysfunction (20%) (p value= 0.755)Conclusions: There was no significant difference in the level of micro-albuminuria between non-diabetics, hypertensive patients with cardio vascular changes compared to patients with no cardiovascular changes.Keywords: Hypertension; microalbuminuria; non-diabetic
Suicidal Ideation Among Medical and Nursing Students
Authors: Atreya Alok , Nepal Samata , Menezes Ritesh G , Marhatta Anu , Ghimire Sristi , Shah Palak
Published: November 2024

Background: Suicidal ideation is a major predictor of suicide attempts. The present study was conducted to compare the prevalence of suicidal ideation and its risk factors among medical and nursing students in Nepal.Methods: An online survey was carried out among a cohort of medical and nursing students of Lumbini Medical College using questions derived from General Health Questionnaire-28 and Patient Health Questionnaire-9.Results:153 medical and 148 nursing students participated in the study. Lifetime suicidal ideation was present in 20.6%(n=62) medical and 13.95%(n=42) nursing students. Suicidal ideation in the last one year was present in 48 medical and 36 nursing students. There were higher odds of suicidal ideation in medical students who had parental neglect, psychiatric disorder, physical and sexual abuse, substance abuse, and academic performance dissatisfaction (p<0.05), whereas the odds were higher in nursing students with psychiatric disorder, parental demands, alcohol consumption, and academic performance dissatisfaction but was not statistically significant. Thematic analysis of the responses for open-ended question for reasons for previous suicide plans or attempts among four medical and eight nursing students revealed relationship issues, history of adverse childhood experiences, academics-related circumstances, and other individual problems as suicide antecedents.Conclusions: Periodic motivational speeches and counselling sessions during all the semesters of professional schooling would help decrease suicidal ideation. Mental health awareness programs for medical and nursing students should be aimed at reducing mental illness-associated stigma and promoting timely professional help-seeking behavior.Keywords: Medical students; Nepal; nursing students; suicidal ideation
Spectrum of Thyroid Disorders in Patients with Type-2 Diabetes Mellitus
Authors: Ghimire Sandip , Sangroula Prativa , K.C. Indu , Deo Rajeeb Kumar , Ghimire Sapana , Dhonju Kiran
Published: November 2024

Background: Diabetes mellitus and thyroid disorders are the two most common endocrine disorders and they mutually affect each other. There are very few researches from Nepal that have evaluated the association of type-2 diabetes mellitus and thyroid dysfunction. The main objective of this study was to evaluate the prevalence and spectrum of thyroid dysfunctions among type-2 diabetes mellitus patients.Methods: This was cross-sectional study conducted among 204 type-2 diabetes mellitus patients visiting the internal medicine department of a tertiary center located in Kathmandu, Nepal. Results: The prevalence of thyroid disorders in patients with type-2 diabetes mellitus was 27.94%. Subclinical hypothyroidism, which occurred in 14.71% of patients, was the most common thyroid disorder. The longer duration of diabetes, more than ten years, was associated with the increased thyroid disorders (p=0.025). The poor glycemic control, HbA1c ? 7%, was associated with significantly increased prevalence of thyroid dysfunction in type-2 diabetes mellitus patients (p=0.002). Female patients had higher prevalence of thyroid disorders than males, but this association was not statistically significant.Conclusions: The higher prevalence of thyroid disorders among patients with type-2 diabetes mellitus highlights the importance of screening type-2 diabetes mellitus patients for the presence of thyroid disorders.Keywords: Hyperthyroidism; thyroid disorders; Type-2 diabetes mellitus
Clinical and Laboratory Characteristics of Patients with Mono and Coinfection of Dengue and Scrub typhus
Authors: Banstola Hemanta , Shrestha Tirtha Man , Bhattarai Dipesh , Ghimire Manoj , Chhetri Surendra Bahadur
Published: November 2024

Background: Dengue is a neglected tropical disease, and Scrub typhus is an emerging tropical illness in Nepal. Coinfection between them is found in literature and clinical practice. The objective of this study is to describe and compare the demographic, clinical, and laboratory characteristics of patients with mono and coinfection of Dengue and Scrub typhus. Methods: This was a single-center hospital-based retrospective study, performed at Beni District Hospital, Nepal. The patient who was diagnosed with mono and coinfection of Dengue and Scrub typhus from 1st January 2020 to 16th September 2020 were included. Data regarding demographic characteristics, symptoms, signs, and laboratory parameters were collected and analyzed.Results: In 53 patients who fall under the inclusion criteria of our study, 12 patients had coinfection with dengue and Scrub typhus with headache being the most common symptom regardless of mono or coinfection followed by myalgia and arthralgia. Total platelet counts at the time of admission were lower in the coinfection group with increasing thrombocytopenia during the disease course in comparison to mono-infection. The maximum temperature recorded, elevation in hepatic enzymes, and duration of defervescence were more in the coinfection group in comparison to dengue and scrub mono-infection. Conclusions: Mono and coinfection of Dengue, Scrub typhus present with common clinical symptoms, laboratory findings. With limited resources for screening and diagnosis, clinical prediction based on symptoms alone or together with lab parameters is difficult which is further difficult in the presence of Co-infection.Keywords: Clinical; coinfection; dengue; laboratory parameter; scrub typhus
Dorsal Approach for Management of Complex Kaplans Dislocation
Authors: Khanal Siddhartha , Panthi Sagar , Shrestha Rishiswor , Neupane Bikash , Pradhan Jigyasu
Published: November 2024

Complex metacarpophalangeal dislocation is an uncommon injury where the index is the most commonly involved finger. The most common mechanism involves hyperextension of digits at the metacarpophalangeal joint. Such dislocation needs open reduction as the volar plate becomes entrapped between the metacarpal head and proximal phalanx making close reduction difficult. Approaches for open reduction can be dorsal, volar, and lateral. In our patient, we commenced a dorsal approach for reduction and additional stabilization done with K-wire. An early range of movement was initiated and resulted in good functional recovery.Keywords: Dislocation; metacarpophalangeal; plate; volar.
Prevalence of Depression and its Associated Factors among Inmates
Authors: Mahato Simran , Devkota Nishchal , Kafle Birat Raj , Singh Matrika , Dahal Harsha Raj
Published: November 2024

Background: Depression can cause suicidal attempts among prisoners and it is intimidating to speculate the deteriorating mental status of them. Since, there is very limited research on the depression of prisoners in Nepal and as prisoners have rights to health care without any discrimination, this cross-sectional study aimed to assess the prevalence of depression and its associated factors among inmates.Methods: An institute-based cross-sectional study was employed on 352 inmates selected by a systematic random sampling method from July 15 to August 15 2022. Face-to-face interview was conducted using the Centre for Epidemiological Studies Depression Scale (CESD). Data were entered into Epi - data version 3.1 and analysed using SPSS version 17.Results: The prevalence of depression among the inmates was 54.3%. About 4.3% reported suicidal ideation during imprisonment. Depression was significantly associated with previous occupation, drug use, duration of incarceration, number of prisoners per cell, family support, social support and suicidal thought during imprisonment.Conclusions: More than half of the prisoners have depressive symptoms & thus recommended for the confirmatory diagnosis and treatment of mental issues drawing the attention of concerned authorities toward prisoner’s mental health.Keywords: CESD; depression; inmates; Nepal
Perception of First-Year Medical Students Towards Cadaveric Oath
Authors: Singh Poonam , Phuyal Naveen , Khadka Sulochana , Thapa Trilok Pati , Thakur Sujit Kumar
Published: November 2024

Background: Cadaveric oath-taking is a special way of expressing respect and gratitude to the donors and their families of medical students. The cadaveric oath-taking ceremony was organized for the first time in our medical college. Our study was carried out with the aim of understanding the perceptions of the students after the oath-taking ceremony.Methods: This is a descriptive cross-sectional study conducted in the Department of Anatomy among first-year medical students of a medical college. The total sample size was 100. Data was collected using a pre-structured questionnaire among a group of students who took part in a cadaveric oath-taking ceremony, conducted for the first time in the medical college.Results: Sixty-eight percent of the respondents strongly agreed that cadaveric oath is important in anatomy learning. Eighty-four percent of respondents fully agree with the fact that cadavers are silent mentors. About 88.00% of respondents strongly agreed that they should be thankful to the family members for the noble gesture of body donation. Ninety-five percent of respondents strongly feel that cadavers should be treated with respect, compassion, care, and dignity.Conclusions: The cadaveric oath-taking ceremony holds significant importance in medical education, providing a unique opportunity and avenue to pay tribute to donors and acknowledge their generous contributions. Our study strongly supports integrating the cadaveric oath ceremony at the start of anatomy dissection, fostering ethical principles among aspiring doctors, and honoring the invisible guides in the field of medical education. Keywords: Anatomy; cadavers; cadaveric oath
Burden of enteric fever and antibiotic sensitivity in Nepalese Children Prior to Typhoid Vaccine in National Immunization Program
Authors: Chapagain Ram Hari , Adhikari Santosh , Bhattarai Tribhuwan , Basaula Yubanidhi , Bhattarai Srijana
Published: November 2024

Background: Enteric fever is a major public health problem in developing and under developed countries. Case fatality rate without treatment is 10-30% and with appropriate treatment is only 1-4%. Gold standard for diagnosis is isolation of Salmonella enterica from blood or bone marrow. Antibiotics resistance is skyrocketing with emergence of multidrug resistance S. typhi and extensively drug resistant S. typhi.Methods: The blood culture done in Kanti children hospital in last six years were taken from the data base and the culture positive cases were taken from which the salmonella species positive cases along with the drug sensitivity pattern were used in our study.Results: The culture positivity rate was 2.8% and 7.6% (n=136) among the culture positive cases were Salmonella species. Salmonella typhi (121; 88.9%) was the most frequently isolated species, followed by Salmonella paratyphi A (13; 9.5%) and Salmonella paratyphi B (2;1.4%). Children with age 5-10 years was the most affected age group for infection with Salmonella, 50.0% (n=68). Nalidixic acid is resistant in 89.9% Salmonella typhi; followed by ciprofloxacin (31.8%), ofloxacin (18.2%), ampicillin (9.6%), azithromycin (8.4%), chloramphenicol (8.2%), cotrimoxazole (5.4%), cefixime (4%), ceftriaxone (2.5%) and cefotaxime (0.0%). Cefixime, ceftriaxone, cefotaxime are 100% sensitive to Salmonella paratyphi, followed by cotrimoxazole (92.9%), ofloxacin (81.8%), chloramphenicol (75%), azithromycin (66.7%), ampicillin (60%), ciprofloxacin (50%) and Nalidixic acid (23.1%).Conclusions: Salmonella species culture isolatation are declining every year. Fluoroquinolones have more resistance than first line drugs of typhoid, azithromycin resistance is rising but 3rd generation cephalosporins are sensitive to Salmonella species.Keywords: Drug sensitivity; enteric fever; salmonella paratyphi; salmonella typhi; typhoid vaccine
Maxillofacial Injuries in an Eastern Nepal Tertiary Hospital
Authors: Jaisani Mehul R , Dongol Ashok , Acharya Pradeep , Yadav Anjani Kr , Pasvan Chandrakant , Rai Siddhartha , Laverick Sean
Published: November 2024

Background: Maxillofacial injury is a major health problem, and injury patterns vary in different societies. The purpose of the present study was to evaluate the pattern of maxillofacial injuries presenting to BPKIHS.Methods: Patients with age >15 years presenting with maxillofacial injuries from May, 2019 to April, 2020 were included in this cross-sectional descriptive study. Demographic profile, etiology, delay in presentation, pattern of soft tissue/ bony/ dental injuries, treatment modality were recorded and analyzed using Microsoft excel.Results: Within one year study period 190 patients with age group >15 years presented with facial injuries. There were 164 male (86.32%) and 26 female (13.68 %) patients (M:F=6.3: 1) with mean age of 34.96 years. Road Traffic Accident (RTA) (61.58%) was the most common etiology. Majority of the patients reported to hospital within 2-6 hrs of injury. Other associated injuries was present in 36.32 % of patients with orthopedic injury (60.87%) being common. Soft tissue injuries were seen in 80.53% patients, of which 49.02% were associated with facial fractures. Mandible fractures were seen in 56.19% of hard tissue injuries, of which 40.68% had multiple fractures followed by 28.81% with parasymphysis fracture. Within 37.14% patients with midface fractures, zygoma fracture (33.33%) was the commonest. Intervention was done in 80.95 % patients, with ORIF (72.38 %) being the commonest. Dentoalveolar injuries was seen in 22.63 % patients, of which 48.19% were associated with facial fractures.Conclusions: Our observations show that motor vehicle accidents were the most frequent cause of maxillofacial injury.Keywords: fracture; maxillofacial injuries; pattern
Genomic analysis of SARS-CoV-2 Circulating during Second and Third Wave of COVID-19 in Nepal
Authors: Tamrakar Dipesh , Katuwal Nishan , Adhikari Navin , Madhup Surendra Kumar , Dhimal Meghnath , Shrestha Rajeev
Published: November 2024

Background: In Nepal, since the first detection of COVID-19 case in January 2020, the total cases have rose to almost a million with more than 12,000 deaths. Till now, WHO has classified 5 variants of SARS-Cov2 as variant of concerns at different time points causing many waves in different countries and regions at different time points. Nepal had also faced three distinct waves of COVID-19 caused by different variant of COVID 19. The objective of this study was to perform whole-genome sequencing of SARS-CoV-2 circulating in different waves of COVID-19 in Nepal and investigate its variant or lineage.Methods: In this study, samples from 49 SARS-CoV-2 infected subjects from May 2021 to January 2022, were investigated. The methodology followed RNA extraction, real-time PCR for confirmation and whole-genome sequencing. The consensus genomes were interpreted with appropriate bioinformatics tools and databases.Results: Sequence analysis of 49 genomes revealed to be of Delta (n=27) and Omicron Variant (n=22). The mutations in the consensus genomes contained the defining mutations of the respective lineages/variants. There were 20 genomes of Omicron sub-lineage BA.2, 1 of BA.1.1 and 1 of B.1.1.529.Conclusions: This study provides concise genomic evidence of presence of Delta and Omicron variant of COVID-19 in Nepal. Delta and Omicron variants were driving the second wave and the third wave of COVID-19 respectively in Nepal. Therefore, the genomic surveillance must be increased to clearly map out the pandemic and strategize vaccination approaches in the country.Keywords: COVID-19; delta, omicron; Nepal;SARS-CoV-2; whole-genome sequencing
Clinical Profile, Radiological Findings, and Risk Factors Associated with Pneumonia among Children Admitted in Dhulikhel Hospital
Authors: Sharma Pradeep , Bhandari Roshan , Poudel Pranodan , Pandey Ghanashyam , Paudyal Richa
Published: November 2024

Background: Pneumonia is the commonest lung disease which is a major cause of mortality and morbidity in young children and is a common acute respiratory infection. The presentation varies among the cases. The study was done to know the risk factors, clinical profile, radiological findings, and short-term outcome of the admitted patients with pneumonia between six months to sixteen years at Dhulikhel Hospital.Methods: A hospital based observational prospective cross-sectional study done in 65 cases over the period of 17 months in children admitted with pneumonia at Pediatrics department of Dhulikhel Hospital. Socio-demographic variables, clinical profile, radiological profile, diagnosis, and short-term outcome were collected and analyzed using descriptive statistics. Results: Out of 65 patients, 76.9% cases were children between six months to five years. The most common clinical presentation was fever (98.5%) followed by cough (86.2%). Crepitation (78.5%) and subcostal retraction (29.2%) were common clinical findings. Disseminated intravascular coagulation, thrombocytopenia, sepsis, and right heart failure were associated with mortality. The requirement of mechanical ventilation, oxygenation, and inotrope support was more likely to have fatal outcome.Conclusions: Fever and cough were the most common clinical presentation and right middle zone consolidation was the most common finding in children admitted with pneumonia.Keywords: Cough; fever; pneumonia
Level and Trend of Child Health and Nutrition Status in Nepal: Evidence from Demographic and Health Survey (1996-2016)
Authors: Timsina Drishti , Chowhan Rushel , Sharma Sharad Kumar
Published: November 2024

Background: Child health and nutrition are key indicators of the country’s socioeconomic development and quality of life. The purpose of the paper was to examine the level, trend, and socio-demographic differences of selected child health and nutrition indicators and to provide policy recommendations for improvement.Methods: Desk review was conducted to compile secondary information on child health and nutrition status published in the Nepal Demographic and Health Survey reports prepared by Ministry of Health and Population from 1996 to 2016. Trend lines, bar diagram, and GIS maps were prepared to study and present the findings.Results: A substantial decrease in under-five mortality, from 118 to 39 (67% point decline) and neonatal mortality, from 50 to 21 (58% point decline) deaths per 1000 live births, was noted between 1996 and 2016. Full immunization coverage decreased from 87% in 2011 to 78% in 2016. 36% of children under the age of five were stunted, 25% were underweight, and 10% were wasted in 2016. Boys were more likely to receive treatment for diarrhoea (72%), compared to girls (56%). The majority of the children (74%) had their acute respiratory infections managed at private medical centers. Child health and nutritional status differed by geographic regions, being better in Gandaki and Bagmati and poor in Karnali and Madesh. Overall health and nutrition status of children were better among educated, and wealthier families. Conclusions: To further reduce childhood mortality and reach the targets for the Sustainable Development Goal, targeted interventions must be implemented to improve immunization coverage plus health and nutritional status among disadvantaged populations.Keywords: Child health; child mortality; Nepal; nutritional status
Morbidity and Mortality Profile of Neonates Admitted in Neonatal Intensive Care Unit
Authors: Paudel Pradip Kumar , Bhandari Prakreeti , KC Nawaraj , Devkota Bibek
Published: November 2024

Background: The neonatal period faces the greatest risk of death as they are vulnerable to sepsis, birth asphyxia, hypoxic injuries etc. A substantial disparity exists in NMR between Nepal and other developed countries and among different provinces of Nepal as well. This study was conducted to describe the pattern of neonatal admission, and immediate hospital outcomes from NICU located in a remote part of Nepal.Methods: This prospective study was conducted in The Province Hospital, Karnali, Nepal over a period of six months (June 2021 to Dec 2021 AD). The variables used were neonatal age, sex, gestation, birth weight, maternal age, mode and place of delivery. Neonatal morbidities and final outcomes at discharge were recorded in a predesigned proforma.Results: A total of 396 neonates included, the majority were inborn 283(71%), male 241(61%), term 301(76%) and had normal birth weight 279 (70.4%). Neonatal sepsis 188(37.2%), prematurity 95(24%), and birth asphyxia 55(15.2%) were main indications for hospitalization. The majority 337(85%) improved after treatment, while 33(8.3%) died, 12 (3%) left against medical advice and 14(3.5%) cases were referred. Preterm neonates had thrice the risk of mortality than term neonates (OR =3.27). Low birth weight (< 2500 grams) had higher odds of poor outcomes (OR =3.5). Low maternal age (<20 years), prematurity, LBW, mechanical ventilation and inotrope use were predictors of poor outcomes. Conclusions: Neonatal sepsis, prematurity and perinatal asphyxia were the most common causes of NICU admissions. Mechanical ventilation, inotropes use, extreme prematurity, low birth weight and younger age of the mother were predictors of poor outcome. Keywords: Karnali; morbidity; mortality; neonates.
Decadal Analysis of ESBL-Escherichia coli Antibiotic Resistance Patterns in Urine Samples from Nepal: A Systematic Review and Meta-Analysis
Authors: Chhetri Bibek Rana , Thapa Rajat , Banjara Megha Raj
Published: November 2024

Background: This systematic review aimed to determine the antimicrobial resistance pattern of the extended-spectrum ?-lactamases producing Escherichia coli (ESBL-EC) in urine samples in Nepal.Methods: Systematic literature review was conducted to locate all articles reporting ESBL-EC in urine samples published between January 2012 to December 2022. The Egger’s weighted regression analysis was done to assess the publication bias. A random-effects model was used to calculate the pooled prevalence and corresponding 95% confidence interval due to significant between-study heterogeneity. The strength of correlation between multidrug resistance and ESBL production in E.coli strains was determined using Pearson’s correlation coefficient. The data were analyzed using R-language 4.2.2. software.Results: The combined prevalence of E.coli in urine samples was found to be 14 % (95% CI, 11-18), while the overall pooled prevalence of ESBL E.coli and MDR E.coli were 30% (95% CI, 20-42) and 70% (95% CI, 38-90) respectively. A strong positive correlation of 0.99 (95% CI, 0.89-1.0) was found between ESBL production and MDR among E.coli isolates. Imipenem was the drug of choice against ESBL-E.coli in urine specimens.Conclusions: Our analyses showed the overall ESBL-EC and MDR-EC burden in Nepal is considerably high. Likewise, the study also infers an increasing trend of antibiotic resistance pattern of ESBL-EC in urine samples. Keywords: ESBL-E.coli; multi-drug resistance; Nepal; urine.
Efficacy of Native Bacillus thuringiensis against Mosquito Vector
Authors: GC Ganga , Parajuli Kshama , Gautam Ishan , Banjara Megha Raj , Ghimire Prakash , Rijal Komal Raj
Published: November 2024

Background: Larval source management is an effective measure to control mosquito-borne diseases. Bacillus thuringiensis produces specific insecticidal crystal proteins toxic to mosquito larvae. In many parts of the South East Asian region, Bacillus thuringiensis is used for larval source management. In Nepal, larvicidal Bacillus thuringiensis is not available. The study aims to isolate larvicidal Bacillus thuringiensis from soil samples of Nepal to control mosquitoes.Methods: Native Bacillus thuringiensis was obtained from soil samples by the acetate selection method. It was identified by observing crystal protein with Coomassie Brilliant Blue stain in a light microscope. The mosquito larvae were collected from different breeding habitats. A preliminary bioassay was performed by inoculating three loopful of 48 hours culture of spherical crystal protein producing Bacillus thuringiensis in a plastic cup containing 25 larvae and 100 ml of sterile distilled water. The cup was incubated at room temperature for 24 hours to observe the mortality of larvae. Further selective bioassay was performed with the isolate which showed 100% mortality, as described above in four replicates along with the negative and positive control. Results: Out of 1385 Bacillus thuringiensis obtained from 454 soil samples, 766 (55.30%) were spherical crystal protein producers, among them, a single strain (14P2A) showed 100% mortality against mosquito larvae. The lethal concentration doses required to kill 50% and 90% of the larval population were 32.35 and 46.77 Parts per million respectively. Conclusions: The native Bacillus thuringiensis produces the crystal protein effective in killing mosquito larvae. The native Bacillus thuringiensis should be included as a tool to control mosquito-borne diseases in Nepal.Keywords: Bacillus thuringiensis; mosquito; Nepal; tool.
Serum iron Profile of Patients with Sickle Cell Disease and its Association with Socio-demographic Characteristics and Duration of Diagnosis
Authors: Kamar Sher Bahadur , Pandey Hemraj , Puri Shurehraman , Shahi Ramesh , Bhatta Uttam , Khadka Sulochana , Yadav Gopal Kumar , Subedi Prativa , Amgain Kapil
Published: November 2024

Background : Sickle cell anemia is the most common hemoglobinopathy in the world. The study aimed to evaluate the iron profile and its association with socio-demographic characteristics in patients with sickle cell disease.Methods: A hospital-based descriptive cross-sectional study was conducted to know the iron profile and its socio-demographic association in patients with sickle cell disease.Results: The average serum iron, TIBC, and transferrin saturation were 16.75 ± 6.40 mcgMole/L, 69.46 ± 16.94 mcg/dl and 25.15 ± 12.51% respectively. The serum ferritin ranged from 10.00 to 3000.00 ng/ml. The proportion of participants with normal serum iron, TIBC, serum ferritin, and transferrin saturation were 86.10%, 0.00%, 33.90% and 36.40% respectively. All of the participants of this study had low TIBC (1005), and more than half of the participants had elevated serum ferritin (56.40%).Conclusions: Iron overload is a common complication of sickle cell disease. There was no association of age and sex with iron profile. The TIBC variation between the Chaudhary ethnic group compared to other ethnic groups signifies the ethnic role in the iron profile.Keywords: Ethnicity; iron overload; sickle cell disease; total iron binding capacity.
Epidemiology of Stress Fracture in Police Trainees
Authors: Lamichhane Norman , Dumre Arjun Prasad , Thakur Gopesh Kumar
Published: November 2024

Background: Military recruits and athletes have high occurrence of stress fractures, with very high incidence among military recruits. Symptomatic stress fractures can be disabling in some people. This study aims at identifying pattern and distribution of such fractures in Nepal Police trainee and assess the risk factors and demographics that may help to develop the local guidelines. Methods: This study analysed 65 police trainees who presented to the orthopaedic Out Patient Department at Nepal Police and Province Police Hospital diagnosed as a case of stress fracture from 29 December, 2020 to 29 December, 2021. Ethical approval was obtained and different variables analysed were age, sex, Body Mass Index, location of fracture, duration of pain, method of treatment, time to heal the fracture and time to pain free mobilisation of patient.Results: There were 65 trainees with 86 sites of fracture at different bones with 50.8% (33) of male population. The majority of fracture was located at tibia (58.1%) followed by pubic rami (33.7%) with potentially debilitating fracture neck of femur seen in 4.6% subjects. Mean duration of pain was 20.7±14.2 days with mean time for pain free mobilisation 42.2±17.7 days after presentation. 96.5% of those recovered with conservative treatment (activity restriction or cast).Conclusions: The location of stress fracture depends upon the type of training or activities. Modification of activities in early phase of training with early visit for medical care in case of trainees with increasing pain may decrease morbidities and complications requiring operative treatment.Keywords: Nepal Police; stress fracture; trainees.
Post-Transplant Fecal Carriage of Antibiotic Resistant and ?-Lactamases-Producing Enterobacteriales among Renal Transplant Recipients
Authors: Joshi Bindira , Yadav Santosh Kumar , Shakya Hada Manju Shree , Shrestha Sabina , Shrestha Kalpana Kumari , Shrestha Pukar Chandra , Awal Bal Krishna
Published: November 2024

Background: The intestinal colonization and transmission of antibiotic-resistant Enterobacteriales to renal transplant recipients may pose a threat to them because they are profoundly immunocompromised and vulnerable to infection. Hence, it is crucial to identify these antibiotic-resistant fecal Enterobacteriales harboring high-risk populations. The objective of this study was to determine antibiotic resistance as well as ?-lactamases production in fecal Enterobacteriales among renal transplant recipients.Methods: The stool samples, one collected from each transplant recipient, were processed for isolation and identification of Enterobacteriales and were tested for their antibiotic susceptibility, extended-spectrum ?-lactamase, and metallo-?-lactamase production by standard methods.Results: A total of 103 Enterobacteriales comprising of Escherichia coli (86.4%), Klebsiella species (11.7%), and Citrobacter species (1.9%) were isolated and more than 60% of the E. coli were found resistant to ceftazidime and ciprofloxacin and around half of the Klebsiella species were resistant to ceftazidime and fluroquinolones. The extended-spectrum ?-lactamase production was seen in 3.4% and 8.3% and metallo-?-lactamase production in 24.7% and 33.3% of E. coli and Klebsiella species, respectively. The high proportion of ?-lactamase-producers were resistant to piperacillin-tazobactam, meropenem, gentamicin, and amikacin than ?-lactamases non-producers.Conclusion: Since the antibiotic resistance is higher in fecal Enterobacteriales, each renal transplant recipient should be screened for these highly resistant intestinal colonizers after transplantation in order to prevent infections and to reduce the rate of transplant failure due to infections.Keywords: Antibiotic resistance; ?-lactamases; enterobacteriales; fecal carriage; renal transplantation.