bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between Mandibular Angle Fracture with Third Molar Positioning and Residual Bone Height
Authors: Haque Ishfa Banu , Joshi Sandhya , Bhandari Kishor , Karna Gaurav , Khanal Bandana
Published: November 2024

Background: Mandibular angle fracture are frequently associated with presence of third molar. This study aimed at assessing the role of third molar with angle fracture in relation to its positioning and the remaining bone between the apex of third molar and inferior border of mandible.Methods: A retrospective study of all patients who reported for treatment of mandibular fracture between January 2019 to January 2021 were undertaken. Patient’s data and orthopantamogram radiographs were obtained from there medical records. The collected data included presence/absence of mandibular angle fracture, presence/absence of mandibular third molar, angulation and positioning of third molar along with residual bone height. Statistical analysis was done in SPSS version 20 with p-value set at p<0.05Results: Total of 86 mandibular fracture reported in the study period, of which 34 (39.53%) had angle fracture. Third molar was present in 31 (45.6%) cases and was associated with angle fracture with statistical significance of p<0.026. Mesioangular impaction (86.4%) with class II (57%) ramus relation and position B (72.7%) in occlusal relation were associated with angle fracture in comparison to non-angle fracture group where angulation and occlusal position were statistically significant p<0.001 and p=0.002, respectively. Residual bone height was also found to be less in angle fracture group in comparison to other mandibular fracture group showing statistical significance (p<0.023).Conclusions: Patient with partially erupted mandibular third molar are more frequently associated with angle fracture and the residual bone height could also be a good predictor for risk of angle fracture.Keywords: Mandibular angle fracture; residual bone height; third molar impaction.
Performance and Cost-effectiveness of Pooling COVID-19 Samples Using Real time Polymerase Chain Reaction Test
Authors: Shrestha Ira , Maharjan Shreekrishna , Bhandary Shital , Prajapati Sunita , Chaurasiya Ajay , Bakhunchhe Rojina
Published: November 2024

Background: Rapid detection of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) by real-time polymerase chain reaction (RT-PCR) is the most reliable method used worldwide. Although the incidence of the disease has increased globally, the limited availability of PCR kits has become the major bottleneck for the diagnosis of COVID positive patients.Methods: Random samples were pooled for two months in group of two-five and tested for SARS-CoV-2. If the pool was negative, all individuals in the pool were reported negative. If the pool was positive, then the individual samples were retested to identify the positive individual.Results: The mean cycle threshold (Ct) value of pooled samples was not significantly different with that of individual samples for N, ORF-1ab and E genes. Also, pooling saved more than 60% of reagents, time and effort, workforce and cost.Conclusions: In this study, the positivity rate was around 5% and saving of reagent, cost, time and manpower was more than 60%.Keywords: RT-PCR; Sample Pooling; SARS-CoV-2
Inhaler Competence in Nepalese Patients with Asthma and Chronic Obstructive Pulmunory Disease: A Systematic Review
Authors: Sharma Poudel Ramesh , Shrestha Shakti , Erku Daniel Asfaw , Lamichhane Praves , Karki Sharad , Maskey Dipesh , Adhikari Shital
Published: November 2024

Background: Incorrect use of inhalers in patients with asthma and chronic obstructive pulmonary disease is prevalent internationally. This review aims to determine the prevalence and associated factors of incorrect inhaler use and effectiveness of intervention to improve the correct use among Nepalese patients with asthma and chronic obstructive pulmonary disease.Methods: The protocol was registered in PROSPERO. Systematic literature search was performed in PubMed, Embase, CINAHL,and Google Scholar using predefined search terms. Studies in patients with asthma or chronic obstructive pulmonary disease, reporting at least one overall or critical error, using dry powder inhalers and pressurized metered dose inhalers were included. The quality of included studies was assessed using the National Heart, Lung, and Blood Quality Assessment Tools. A descriptive narrative synthesis was undertaken.Results: Twelve studies were eligible for analysis. At least one overall and critical step of the inhaler technique was performed incorrectly by the large number of patients, ranging from 64-100% and 9-100%, respectively. The incorrect use was associated with factors related to patients, inhalers, and health care professionals. The interventions included a combination of verbal instruction, physical demonstration, and/or face-to-face training on correct inhaler use. Following the intervention, an improvement of 23-37% in the overall inhaler technique and 7-42% in the critical steps was achieved. Conclusions: Existing literature suggests that Nepalese patients with asthma and chronic obstructive pulmonary disease have high overall and critical error rates in the use of dry powder inhalers and pressurized metered dose inhalers. A well-designed educational intervention is necessary to improve the correct use of inhalers in this population.Keywords: Asthma; COPD; Dry powder inhalers; Metered-dose inhalers; Nepal
Anaesthetic Management of a Patient with Fontan Circulation for Laparoscopic Cholecystectomy
Authors: Parajuli Bashu Dev , Suwal Allen , Sharma Bhattrai Amit , Ghimire Basanta , Joshi Pankaj , Koirala Megha , Singh Kansakar Prasan Bir
Published: November 2024

Fontan circulation is a complex surgical procedure carried out in infants in a staged fashion, where caval circulation is connected to the pulmonary circulation, bypassing the heart. The ventricular activity will drive the blood to pulmonary circulation, which, after oxygenation, will return to heart and then will distribute through-out the body. The pulmonary vascular resistance determines the preload, which further depends upon the volume status of the body. This physiology is further complicated by the presence of arrythmia, liver cirrhosis, caval-pulmonary shunt thrombosis and low ventricular activity. Anaesthetic implication of such case includes challenges to manage preload, maintenance of pulmonary vascular resistance, preservation of the single ventricular function and avoidance of circuit thrombosis. Here we present a case of 15 years female who presented to our centre for laparoscopic cholecystectomy.Keywords: Cholecystectomy; Circulation; Laparoscopic.
Illness Perception of Women Living with Hypertensive Condition: A Qualitative Study
Authors: KC Deepti , Poudel Sharmila , Shrestha Shreejana , Hamal Thakuri Surya Bahadur
Published: November 2024

Background: Many facets of a patient's life are affected by hypertension. Also, attitudes, values, and experiences, as well as patients' social and cultural circumstances, all play an essential role in the treatment of hypertension. The study's primary objective was to explore hypertensive women's perceptions of their illnesses.Methods: The study was conducted using a qualitative phenomenological research approach from March 2021 to August 2021. A total of twelve hypertensive women were purposefully selected from the medical OPD of Gandaki Medical College Teaching Hospital and Research Centre (GMCTHRC). The necessary data were gathered using a semi-structured interview guide. In addition, the thematic analysis method was used to analyze the transcribed material. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used when drafting this paper.Results: Four major themes were generated; i) Perceptions towards hypertension, ii) Diagnosis, treatment, and management of hypertension, iii) Adherence to medications, and iv) Experiences with health care and recommendations. The majority of hypertensive women considered hypertension to be a treatable non-communicable illness. Family members greatly aided drug adherence. There were, however, certain financial hurdles to medication compliance. For half of the patients, the healthcare systems were unsatisfactory.Conclusions: The findings suggest that hypertensive women's non-adherence to medication is a common occurrence that reflects a conscious decision based on her knowledge and views of the medical illness and its treatment. The way women think about hypertension needs to alter. There were knowledge gaps discovered, emphasizing the need for more patient education.Keywords: Experiences; hypertension; perceptions; women.
Mucormycosis of the Middle Ear and Neck Post COVID 19
Authors: Dongol Kripa , Rayamajhi Pabina , Pradhananga Rabindra Bhakta , Dulal Malati , Sedhai Milan , Gurung Bikash
Published: November 2024

Mucormycosis is an opportunistic infection caused by fungi of order Mucorales and affect immunosuppressed patients. The cases of mucormycosis have surged during the COVID pandemic, especially in cases requiring steroids and mechanical ventilation. Here we present a case of a 40-year-old diabetic post COVID female patient. She presented with right earache, right facial paralysis (grade four) of two weeks duration and right sided neck swelling for ten days. Ultrasonography and computed tomography revealed multiple abscesses in the right side of the neck. Histopathological examination of tissue from the neck and middle ear confirmed the diagnosis of mucormycosis. This is a rare case of concurrent neck and middle ear mucormycosis in a post COVID patient.Keywords: Coronavirus; COVID 19; middle ear; mucormycosis; neck.
Utilization of Basic Health Services at Primary Health Care Facilities During COVID-19 Pandemic
Authors: Basnet Anita , Subedi Baburam , Bhushal Suraj , Baral Kedar Prasad
Published: November 2024

Background: COVID-19, a novel rapidly emerging respiratory disease has spread across the world in a short span of time, infecting millions of people around the world. Consequently, health systems are overwhelmed by both direct mortality from COVID-19 and indirect mortality from other treatable conditions. Though COVID-19 prevention and control is crucial, it is also equally important to continue basic health services. Therefore, the study aimed to explore the facilitators and barriers of basic health service utilization at primary health facilities during the COVID-19 pandemic.Methods: An exploratory qualitative study was conducted in the Bidur Municipality of Nuwakot district. Twenty-five telephone interviews were conducted from all the wards of the municipality and each lasted at least 20 minutes. The interviews were translated into English, coded using RQDA software, and analyzed using thematic analysis manually. Results: The participants shared basic health service was interrupted during the pandemic, especially in the first month. However, the prominent factors that were often crosscutting to many factors were socio-economic conditions and fear of acquiring COVID-19. Additionally, inadequate personal protective equipment, mental stress, shortage of health workers, supplies disruptions, social stigma and extended lockdowns come into play for determining the utilization of basic health services during pandemic.Conclusions: Basic health service was heavily compromised during the pandemic. Fulfillment of the sanctioned posts, enhancement in the use of digital technologies can be promoting options for basic health service utilization during pandemic.Keywords: Basic health services; COVID-19; Nepal; pandemic; utilization.
Fibrocalculous Pancreatic Diabetes - a Unique Differential among Diabetic
Authors: Shrestha Sabin , Sah Anisha , Yadav Anil , Koirala Sanjib , Parajuli Surya Bahadur
Published: November 2024

Fibrocalculous pancreatic diabetes is a unique variant of diabetes mellitus and also known as type 3c diabetes mellitus. It is related to the patient who is young, non-alcoholic and belonging predominantly from the tropical region. It is a severe form of diabetes which can also be linked to the fact that it predisposes to malignancy.1 Among the variants of diabetes that we commonly encounter, fibrocalculous pancreatic diabetes has been rarely diagnosed in the developing countries. With the advancement of diagnostic capacity, it can be identified clinically and managed efficiently. It should be considered in patients with typical features of diabetes, abdominal pain, and pancreatic calculi. There is limited reporting of this case in Nepal because of misdiagnosis, so we are reporting a 40 years male who presented with recurrent episodes of abdominal pain with mucus mixed stool for the last 28 years and was diagnosed as fibrocalculous pancreatic diabetes.Keywords: Blood glucose; eastern Nepal; fibrocalculous pancreatic diabetes; pancreas.
Feasibility of Telementoring as an Intraoperative Time-out Tool during Laparoscopic Cholecystectomy for Prevention of Biliovascular Injuries
Authors: Laudari Uttam , Pradhan Rosi , Shrestha Dibesh , Bhandari Shreya , Thapa Prabin Bikram
Published: November 2024

Laparoscopic cholecystectomy is commonly performed procedure for gallbladder diseases. Biliovascular injuries are well known complications and various standard and safe strategies have been developed for safe cholecystectomy. Intraoperative time out is one of the strategies where two or more surgeons stop during surgery before dividing any structure in Calot’s triangle. COVID-19 pandemic has expanded the horizon of telesurgery, teleconsultation, use of artificial intelligence and robotics in surgical training and execution. Easily available mobile applications like Facebook messenger, WhatsApp and Viber can be used for intraoperative time-out during difficult cholecystectomy with expert surgeon outside the vicinity of theatre. Such tools are cost effective and definitely boost the confidence of surgeons during surgery in case of any complexity, or help in stopping the procedure and in timely referral.Keywords: Cholecystectomy; laparoscopy; telementoring.
Water, Sanitation and Hygiene in Nepal and International Travellers’ Travel-Health Experiences
Authors: Bhatta Ramesh , Aryal Kabita , Thapa Pramila , Joshi Kumari Damayanti , Bhatta Chhavi Raj
Published: November 2024

Background: Tourism is one of the main sectors in Nepal, contributing in its economic growth. It is influenced by various factors including the situation of water, sanitation and hygiene and water, sanitation and hygiene practices. For travelers, poor water, sanitation and hygiene provisions are considered risk factors for different food and water-borne diseases. This study aims to describe the perceptions of international travelers regarding their experiences on WASH facilities or practices, and how it influences their health, and travel experiences.Methods: This is a cross-sectional pilot study conducted among 150 international travelers in Nepal. The travelers were selected conveniently from the Kathmandu valley. The data on different water, sanitation and hygiene related variables, travelers' health and travel experiences were collected using semi-structured questionnaire. The quantitative data was entered into SPSS for descriptive analysis and qualitative data was transcribed through thematic analysis.Results: Of 150 international travelers, about 2/3rd of the travelers had inadequate perception of water, sanitation and hygiene condition. Nearly 23% of them experienced gastrointestinal symptoms, including diarrhea in the past week during their visit. Among those travelers who experienced gastrointestinal symptoms, 21.4% of them reported of their travel plans being affected.Conclusions: Perception and experience with water, sanitation and hygiene facilities was found inadequate among international travelers visiting Nepal. Such facilities seem to have affected the travelers' health (nearly a quarter of them experienced gastrointestinal symptoms, including diarrhea) and their travel plan. Hence, this pilot study demonstrates that there is an urgent need to improve the water, sanitation and hygiene facilities in the travel and tourism sector of Nepal.Keywords: Nepal; travelers and travel health; water, sanitation and hygiene
Antimicrobial Susceptibility Pattern in Opportunistic Pathogens Isolated from Immunocompromised Patients
Authors: Basnet Ajaya , Chand Arun Bahadur , Pokhrel Nayanum , Acharya Sadikchya , Gurung Parbati , Khanal Laxmi Kant , Shrestha Kundu , Shrestha Lok Bahadur , Raghubanshi Bijendra Raj
Published: November 2024

Background: Brought with the advancements in transplantation science and the development of immunosuppressive agents, immunocompromised patients characterized with defective immunity have increased throughout the world with increased risk for opportunistic infections. This study provides an overview of the antimicrobial susceptibility pattern among opportunistic pathogens isolated from immunocompromised patients. Methods: Clinical and laboratory records of immunocompromised patients [patients with chronic kidney disease neutropenia, diabetes, rheumatic heart disease acquired immune deficiency syndrome hepatitis B, hepatitis C, who were subjected to microbiological culture analysis in the Department of Clinical Microbiology, KIST Medical College and Teaching Hospital, for 2 years (January 2019 and December 2020) were analyzed.Results: Out of 8,402 immunocompromised patients, 954 (11.4%) patients were subjected to microbiological culture analysis. Among 954 patients, 253 (26.5%) patients [median(interquartile range) age: 52(31-67) years; male 138 (54.5%)] were infected. A total of 295 pathogens were isolated from 1,331 cultured samples. Infections due to Escherichia coli (n=71, 24.1%), Klebsiella spp. (n=55, 18.6%), Acinetobacter calcoaceticus-baumannii complex (n=35, 11.9%), Candida albicans (n=30, 10.2%), and Staphylococcus aureus (n=28, 9.5%) were frequently observed. Among the bacterial isolates (n=239), 81.6% (n=195) of bacteria were ?-lactamase producers, 51.0% (n=122) were multi-drug resistant, 9.2% (n=195) were extensively-drug resistant, 0.8% (n=195) were pan-drug resistant, and 35.7% (n=10) of S. aureus were methicillin-resistant Staphylococcus aureus.Conclusions: The majority of infection in immunocompromised patients is caused by Gram-negative bacteria, and is often associated with a higher number of ?-lactamase producers and multi-drug resistant organisms. Prescriptions of antibiotics on the grounds of antimicrobial stewardship might help to reduce the burden of antimicrobial resistance.Keywords: Antimicrobial resistance; immunocompromised host; opportunistic infections.
Co-occurrence of Screen Time and Eating Behaviors among Young Children Aged 5 to 9 Years
Authors: Sharma Bimala , Shrestha Nirmala , Koirala Sharad , Tiwari Bishnu Raj
Published: November 2024

Background: High screen time, high energy dense food and low fruits and vegetables are important risk factors among children. The study aimed to find out co-occurrence of screen-time and unhealthy eating behavior among young children aged 5 to 9 years in Pokhara Metropolitan. Methods: A cross-sectional study was conducted among children. Face to face interviews were done with 352 parents of the selected children. The study was conducted from March to October, 2020. High screen time was defined as >2 hours screen viewing each day; low fruit vegetable defined as <3 servings a day; and ? one serving a day of energy dense food was categorized as high consumption. Results: Out of total, 33.0% did not met recommendation for single health behavior, 38.9% did not meet for two and 23.9% did not for three health behaviors; and 62.8% had two or more risk behaviors. Of total, 19.6% had low fruit vegetable and high energy dense intake, 17.0% had high screen time and low fruit vegetable, 2.3% high screen time and high energy dense and 23.9% had high screen time, high energy dense and low fruit vegetable. Proportion of co-occurrence of multiple risk behaviors was higher among those whose parents had higher screen time, offered screen devices to them; and the children who had television and television cable at home, and had personal screen device (P<0.05).Conclusions: About two-third children had multiple risk behaviors; proportion is higher among those who had access to screen devices and higher parental screen time. It may require a combination of efforts to improve healthy behaviors. Keywords: Children; co-occurrence; energy dense food intake; fruit vegetables intake; screen time.
Qualitative Analysis of Resident as a Teacher Module in Post Graduate General Practice Residency Program
Authors: Bajracharya Sumana , Shrestha Ashis , Joshi Arabind , Maharjan Rony
Published: November 2024

Background: Residents need to show their proficiency in clinical and teaching skills. A good amount of their time during residency is spent teaching their juniors. Moreover, once they graduate, their roles will be clinician and teacher. Therefore, the “Resident as a teacher” module was included in the curriculum of the general practice residency program at Patan Academy of Health Sciences. This study was designed to evaluate the change in the teaching skills of residents after going through the module. Methods: This was a qualitative study where three groups were interviewed. The first group was residents who underwent ‘Resident as Teacher Training’ and were involved in teaching their juniors. The second group was junior residents who were involved as learners and the third group was faculties. The questionnaire was used for interviewing and the thematic analysis was done and the findings of these three groups were analyzed.Results: There was a total of 25 general practice residents who were interviewed. The residents who were involved in teaching (N=11) stated that the training program increased their confidence 8(72.7%) and communication skills 8(72.7%). The residents who were learners (N=9) stated that they are more comfortable with the seniors in teaching and learning sessions. Faculties (N=5) stated that residents interacted well. Barriers to effective teaching were, difficult to manage time for preparation and supervision by faculty. Conclusions: General practice residents who went through the Resident as Teacher module stated that they were confident and had improvement in their teaching skills.Keywords: General practice resident; Nepal; postgraduate program; resident as a teacher; student as a teacher.
Cystinuria, an Atypical Presentation and Challenges of Establishing its Diagnosis in a Poor Resource Set Up
Authors: Mishra Bijaya , Bhatta Nisha Keshary , Pokhrel Anupam , Lamsal Madhab
Published: November 2024

Cystinuria is an autosomal recessive defect in re-absorptive transport of amino acids: cysteine, ornithine, arginine and lysine from renal proximal convoluted tubules leading to urinary excretion of these amino acids. The phenotypic manifestations are recurrent urolithiasis, hematuria, flank pain and frequent urinary tract infection. An eighteen years old boy, diagnosed case of cystinuria at the age of two years is presented in this case report highlighting the atypical presentation of recurrent infections with multiple organ involvement. The challenges in establishing the diagnosis and the role of simple biochemical tests in confirming the diagnosis in a poor resource setup is highlighted. Performance of simple biochemical tests in the urine sample of this patient was done for the utility of these tests for future diagnostic purpose in any suspected cases of cystinuria in our set up.Keywords: Case report; cystinuria; Nepal.
Clinical Profile, Disease Severity and Perinatal Outcomes of Laboratory-confirmed COVID-19 among Pregnant Women Delivering in a Tertiary Care Centre
Authors: Dwa Yam Prasad , Thapa Bibechan , Pandey Aakriti
Published: November 2024

Background: Pregnant women and their fetuses represent a high-risk population during coronavirus disease 2019 (COVID-19) pandemic. During pregnancy, body undergoes significant physiologic, mechanical, and immunologic alterations which increases susceptibility to infections. Thus pregnant women are at an increased risk for severe illness from COVID-19. This study explored the clinical profile, disease severity, and perinatal outcomes of pregnant women with COVID-19.Methods: A retro-prospective cross-sectional study was conducted at KIST Medical College after ethical approval. All women (1227) who delivered from 15 April 2020 to 15 October 2021 and underwent the COVID-19 screening by Reverse Transcriptase Polymerase Chain Reaction were studied. COVID-19 positive women (44) were further analyzed and classified as asymptomatic, mild, moderate, severe, and critical diseases. Data was collected in proforma by reviewing patients’ records. The data analysis were done in SPSS version 26. A descriptive statistical test and chi-square test were done. Results: The prevalence of COVID-19 among delivering pregnant women was 3.6% (44/1227). Majority were asymptomatic 79.5% (35). About 16% (7) had mild illness and 4.5% (2) had moderate illness. The caesarean rate was 34.1% (15/44) among COVID-19 positive women. Stillbirth and preterm birth was observed in 2.3% (1) and 4.5% (2) respectively. The COVID-19 infection rate in a neonate was 4.5%.Conclusions: The severity of COVID-19 among delivering pregnant women was less. The perinatal outcome was also favourable. The overall prognosis of COVID-19 among mothers and newborns was good. Further research is needed to understand the true magnitude of risks and management, more so with the emergence of new variants.Keywords: Asymptomatic; COVID-19; perinatal outcome; pregnant women; severity of disease.
Patient Perception of Bladder Condition after Treatment with Solifenacin and Tolterodine in Overactive Bladder Patients
Authors: Pradhan Tarun , Dhamala Jiba Nath , Yadav Siddartha Kumar , Deo Amit
Published: November 2024

Background: Solefinacin and Tolterodine are new generation antimuscarinics claimed to have bladder specific action and less adverse effect like dry mouth. The objective of the study was to compare the improvement in urinary symptoms among patients using solefinacin and tolterodine with overactive bladder symptoms.Methods: A hospital based cross-sectional comparative study was done for one year duration. All patients with overactive bladder symptoms were included and in every alternate patient’s solefinacin and tolterodine were given after taking note of baseline OAB symptoms, PPBC score and UPS score. Participants were followed up after one month and noted improvement in endpoint OAB symptoms. Comparison of baseline to end-point symptoms changes among each group of participants were analyzed for statistical significance.Results: Among 101 participants included in the study, 49 participants were in solefinacin group and 52 participants were in tolterodine group. The end-point comparison of urgency symptoms were improved by 20.1±6.76 (mean ± SD) units in solefinacin group and by 17.0 ± 9.18 units in tolterodine group. Urgency perception score improved to 2.1±0.66 for patients under solefinacin and 2±0.73 for tolterodine. Patient perception of bladder condition (PPBC) showed improvement in solefinacin group by 3.2±1.26 units and in tolteradine by 2.8±1.54 units (p = 0.165). Comparing the patient’s perception of treatment outcome, massive improvement was reported by 81.6% of those receiving Solefinacinand 65.4% receiving tolterodine, though not statistically significant ( p = 0.131).Conclusions: Solefinacin and Tolterodine showed improvement in urinary symptoms, UPS and PPBC. Both showed comparable efficacy without significant superiority over one another.Keywords: Antimuscarinic; overactive bladder; patient perceptions of bladder condition; urgency perception score.
Assessment of Understanding and Practices of Community Pharmacy Personnel to Tackle COVID-19 Pandemic
Authors: Khadka Sitaram , Neupane Gyata , Yadav Gopal Kumar , Sharma Arun , Giri Santoshi , Amgain Kapil , Bhushal Arjun , Basnet Bhaikaji
Published: November 2024

Background: The skill, accessibility, and knowledge of community pharmacists have been paramount in managing pandemics. This study was conducted to assess the knowledge, attitude, and practice of community pharmacy personnel towards tackling COVID-19 pandemic which might help concerned authorities to take effective actions to eliminate the gaps for the management of such pandemic in an efficient way.Methods: A cross-sectional study was conducted among 428 community pharmacy personnel from different community pharmacies in Kathmandu, Nepal from December 2021 to February 2022. Statistical analysis was done through SPSS® v21 and MedCalc for Windows v12.3.0. Results: Most of the participants (42.76%) had certificate-level degrees in their respective fields and one to five years of working experience (48.84%). Only 29.67% of the respondents had good knowledge towards tackling COVID-19, whereas good attitude and practice were demonstrated by 59.11% and 42.29% respectively. The participants with higher degrees and more working experience had better knowledge, attitude, and practice. Education level bachelor and above was independent predictor of good knowledge (OR 20.69, 95% CI 11.30-37.90). Knowledge and practice (Spearman’s rho: 0.135; P ?0.005) and attitude and practice (Spearman’s rho: 0.095; P = 0.049) scores were positively correlated.Conclusions: The significant association of community pharmacy personnel’s educational level with knowledge, attitude, and practices demands the necessity of policy-making bodies’ involvement for the mandatory presence of well-qualified pharmacists and regular training at the community pharmacy level. Furthermore, it is high time to reinforce the drug regulatory acts, regulations, and codes all over the nation. Keywords:  COVID-19; Nepal; pandemics; pharmacy; policy making.
Predictive Factors for the Peri-operative Outcome of Ureteroscopic Lithotripsy for Proximal Ureteric Stones
Authors: Mishra Udita , Shrestha Anil , Shrestha Parash Mani , Basnet Robin Bahadur , Shah Arvind Kumar , Shah Chittaranjan , Basnet Surendra , Adhikari Baikuntha
Published: November 2024

Background: Proximal ureteric stones are considered one of challenging location for lithotripsy using semirigid ureteroscopes. Aim of the study was to assess clinical and radiological characteristics associated with outcome of lithotripsy using semirigid ureteroscope for proximal ureteric stones.Methods: Prospective observational study was done on patients who underwent semirigid ureteroscopic lithotripsy for proximal ureteric stone. Stone and ureteral mormphomeric parameters were documented from computed tomography urogram. Stone free status and complication rates were studied. To determine predictive factors for outcomes, multivariate regression analysis and receiver operative curve were used.Results: One hundred patients were included in study. Demographic characteristics, stone size, density and mode of lithotripsy had no impact on stone free rate or complications. The mean ureteral wall thickness(p = 0.002), distance of stone from pelvi-ureteric junction(p = 0.005), degree of hydronephrosis(p = 0.0001) and peri-ureteric fat stranding (p = 0.038) were found to have significant association with stone free rate on univariate analysis. On multivariate analysis, mild hydronephrosis(p = 0.003) and distance of stone from pelvi-ureteric junction(p = 0.022) were significant for stone free rate.Conclusions: Mean ureteral wall thickness, stone distance from pelvi-ureteric junction, presence of peri-ureteric fat stranding and hydronephrosis affect stone free rate on univariate analysis. On multivariate analysis for stone free rate, stone distance from pelvi-ureteric junction and mild hydronephrosis were significant. There was no significant impact of any stone or ureteral morphometry on complication rate. Keywords: Complications; proximal ureteric stone; semirigid ureteroscopic lithotripsy; stone free rate
Genotype-Phenotype Profile of Beta-thalassemia
Authors: Roma Km , Pande Rajan , Shrestha Durga Laxmi
Published: November 2024

Background: Beta thalassemias are extremely heterogenous hereditary monogenic blood disorders and preventable genetic hemolytic anemia caused by >200 mutations in HBB gene. In Nepal, it is more prevalent in Tharu tribe but it seen in other communities as well. Out of more than 200 mutations of beta globin gene, approximate 20 different alleles are responsible for >80% of the mutations. Mutations vary in different geographic population and are responsible for manifestation of different phenotypes. This study was done to find common mutations of HBB gene in Nepal which were responsible for different phenotypic manifestations and to know clinical severity according to the mutations.Methods: This was a descriptive, cross sectional study conducted in the pediatric and medicine department of Nepalgunj Medical College and Bheri Zonal Hospital, Nepalgunj from January 2020 to December 2020. The genotype and phenotype profiles of thalassemia cases were reported. The data was analyzed by SPSS 20.Results: The results obtained showed that clinical presentation differed with different ?-globin gene mutations present. Individuals with HBB:c.47G>A and HBB:c.20A>T/ c.79G>A mutations showed milder presentation than those with HBB:c.47G>A/-619del and HBB:c.20A>T/c.47G>A.Conclusions: Therefore, these findings can be used to predict clinical severity so that we can take appropriate measures by early genotype identification for prenatal diagnosis of beta thalassemia. Keywords: Genotype phenotype; prenatal diagnosis; thalassemia
Computed Tomography Chest Findings in COVID-19 Patients
Authors: Tamang Ongden Yonjen , Paudel Sharma , Kayastha Prakash , Maharjan Santosh , Adhikari Govinda , Upadhyaya Rudra Prasad , Dawadi Kapil , Pradhan Prajina , Rehman Tanveer , Malla Saurav Krishna
Published: November 2024

Background:COVID-19 which has caused significant morbidity and mortality around the world has been declared by the World Health Organization to be a global health emergency. Our objective was to find out the lung parenchymal patterns commonly evident in high resolution Computed Tomography in patients with COVID-19 pneumonia.Methods: A retrospective cross-sectional study was conducted at a tertiary multi-specialty hospital in Kathmandu, Nepal. With ethical clearance from the institutional review board, a total of 235 patients with positive reverse transcriptase polymerase chain reaction for COVID-19 and having respiratory symptoms were included in the study. High Resolution Computed Tomography images of chest were retrieved from picture archiving and communication systems retrospectively and studied for the findings commonly attributed to COVID-19 pneumonia. The data was then analyzed using Stata version 14 (Stata Corp, College Station, TX, USA). Descriptive statistics were presented as mean and median while chi-square test was used to assess the association between socio-demographic characteristics and CT severity indices.Results: Out of 235 patients, 174 (74.0%) were males and 61(26%) were females with a mean age of 54.8±14.5 years. The most commonly encountered pattern of pulmonary changes was bilateral involvement in 222 (94.5%) patients followed by ground-glass opacities in 218 (92.8%) patients and peripheral predominance of ground-glass opacities in 211 (89.8%) patients. Conclusions: Chest Computed Tomography abnormalities are common in COVID-19 positive patients with respiratory symptoms. These findings can guide in the assessment of the severity of the disease as well as patient management. Keywords: Computed Tomography; COVID-19; ground-glass opacities; reverse transcriptase polymerase chain reaction
Prevalence of Diabetes and Diabetic Retinopathy in Far-western Province of Nepal
Authors: Bhatta Subash , Pant Nayana , Pant Suresh Raj
Published: November 2024

Background: Although diabetes is emerging as growing public health problem, there is limited population based data about the prevalence of the disease in Nepal.Methods: This cross-sectional population-based survey, conducted in the Far-western province of Nepal from April 2020 to April 2021, used standardized RAAB + DR methodology. Diabetes was diagnosed on the basis of treatment history and random blood sugar test results of greater than 200 mg/dl. Diabetic retinopathy screening was done by ophthalmologists. All relevant data were imported into the RAAB software package (RAAB V.6) for analysis.Results: Among 4615 study population, 2.8 % (n=129) had diabetes, and 35.7% (n=46) of the diabetics were newly identified cases. Of the known diabetics, 61.4% (n=51) never had an eye examination, and only 27.7% (n=23) of cases had their eye checked for DR in the last year. Fundus examination showed 13.2 % (n=17) of the diabetic patients to have some form of diabetic retinopathy and 6.2% (n=8) had diabetic maculopathy. Only 0.8% (n=1) of the cases were categorized as sight-threatening DR but a greater number of diabetes patients had severe visual impairment or blindness (3.9%) as compared to non-diabetic patients (1.8%).Conclusions: Prevalence of diabetes and DR were relatively lower in Far-western Nepal. However poor coverage of screening examinations have left many of these cases undetected in the communities. Effective community-based diabetes and DR screening and referral programs can help to detect and treat diabetes and DR early on to prevent vision loss and other diabetic complications. Keywords: Diabetes; diabetic retinopathy; maculopathy; rural Nepal, vision Impairment
Lung Ultrasound in Diagnosis of Interstitial Lung Disease
Authors: Manandhar Sagun
Published: November 2024

Background: Interstitial lung disease denotes a group of disorders which mainly affects pulmonary interstitium consisting of connective tissue fibers that support the lungs. High-resolution computed tomography is currently the main imaging modality of diagnosis, however except for few major cities in the country, availability of computed tomography scan facility is sparse in remote areas; thus relevant use of lung ultrasound in patients with suspected interstitial lung disease could be rewarding.Methods: A single center cross-sectional clinical diagnostic study was carried out at department of Radiology and Imaging, Patan Academy of Health Sciences after approval from institutional review committee. Lung ultrasound was done prior to patients undergoing high-resolution computed tomography chest. Senstivity, specificity, positive predictive value , negative predictive value , and accuracy of different echographic criteria–positive chest area score, total B lines score 5 and total B lines score 10 were calculated. Association of non-homogeneity of B lines and pleural line abnormalities with presence of interstitial lung disease, and association between B3 and B7 lines with alveolar and interstitial pattern were derived. Results: Sensitivity (97.4%) and negative predictive value (97.9%) of total B lines score 5 was the highest. Maximum specificity (70.7%), PPV (61.4%) and accuracy (77.2%) was ofpositive chest area score. Pleural line abnormalities showed highly significant association with interstitial lung disease(p=0.003). B3 and B7 lines illustrated very highly significant association with alveolar and interstitial pattern respectively (p<0.001).Conclusions: Lung ultrasound can be a valid and reliable additional imaging method in evaluation of ILD in appropriate clinical scenario.Keywords: B lines; high-resolution computed tomography; interstitial lung disease; lung ultrasound
Post-operative Pancreatitis as a Predictor of Postoperative Pancreatic Fistula in Patients Following Pancreaticoduodenectomy
Authors: Subedi Nirajan , Ghimire Bikal , Kansakar Prasan B S , Bhandari Ramesh S , Lakhey Paleswan J , Singh Yogendra P
Published: November 2024

Background: Postoperative pancreatic fistula remains the single most important determinant of morbidity and mortality following pancreaticoduodenectomy. A new entity was proposed by Saxon Connor “Post-Operative pancreatitis”, which is defined by raised serum amylase more than the upper limit of institutional serum amylase value on Post-Operative day 0 or 1. There has been shown to be an association between postoperative pancreatitis and postoperative pancreatic fistula. We have conducted this study to see the incidence of postoperative pancreatitis and its association with postoperative pancreatic fistula.Methods: This was a prospective observational study. All patients undergoing pancreaticoduodenectomy at a tertiary care center for one and a half years were included. A cut-off value of serum amylase 80U/L was used to make a diagnosis of postoperative pancreatitis. The patients were followed up for one month. Pancreas specific complications were defined according to the definition given by the International Study Group of Pancreatic Surgery. Results: A total of 49 pancreaticoduodenectomies were done in the given period. The incidence of postoperative pancreatitis was 31(63.3%) and postoperative pancreatic fistula was 19(38.8%). Postoperative pancreatic fistula was seen in 19(61.2%) of patients having postoperative pancreatitis (P<0.001). Post-operative pancreatitis was also significantly associated with post pancreatectomy hemorrhage, increased hospital stay, and mortality. In multivariate analysis, preoperative endoscopic biliary drainage and increased serum amylase on the first postoperative day came out to be an independent predictor of postoperative pancreatic fistula.Conclusions: Post-operative Pancreatitis was associated with an increased incidence of Post-operative pancreatic fistula and other postoperative complications like Post pancreatectomy hemorrhage and mortality. Keywords: Pancreaticoduodenectomy; postoperative pancreatitis; postoperative pancreatic fistula; post pancreatectomy haemorrhage
Induced Abortion: A Risk Factor for Adenomyosis
Authors: Pun Sunita
Published: November 2024

Background: Abortion, the medical and surgical termination of a pregnancy,is becoming a more common medical procedure among women in Nepal. Adenomyosis is one of the common gynecological problems among women of reproductive age. However, little is known about the relationship between abortion and adenomyosis. Therefore, our study aims to explorerisk factor for adenomyosis in among women who havehadabortions.Methods: A comparative study was carried out among women who visited at thedepartment of Obstetrics and Gynecologyof the Tribhuvan University of Teaching Hospital, Kathmandu, between 13th April 2016 to 14th July 2017. Adenomyosis were confirmed through histological examination after hysterectomy. Data wereanalyzed by using Statistical Package for Social Sciences (SPSS software)21.0 version. Odd ratio with their 95% confidence interval and P-value were calculated and analyzed. A P-value equal or below 0.05 was considered as statistically significant.Results: Of the total 255 women, 85were confirmed adenomyosisby histological examination. Of the 85 cases, 39% (33/85) had a history of abortion, while only 25 % (44/170)women had abortion among non-adenomyosis group. Overall, women who had abortion were1.8 timesmore likely to have adenomyosis (95% CI 1.04- 3.17, P value=0.03) compared to women who had no history of abortion. Women with surgical abortions were 2.5 times more likely to develop adenomyosis (95% CI- 1.03- 6.21, P value=0.03) compared towomen with no abortion history.Conclusions: This study found that women,who had abortions,aremore likely to have been diagnosed with adenomyosis compared to women without abortions.Further studies, however, need to be carried out in order toextend findings of this study. Keywords: Abortion; adenomyosis; risk factors
Impact of Case Based Learning on Teaching of Undergraduate Oral Pathology Course
Authors: Shrestha Bijayata , Subedi Sushil , Paudel Sabita , Subedi Nuwadutta , Parajuli Umesh
Published: November 2024

Background: Oral Pathology curriculum is taught as didactic lectures which promotes rote learning. This study intends to introduce and assess the impact of Case based Learning in student’s performance and to obtain the perception of students towards it.Methods: This cross-sectional study was conducted from March 2021 to January 2022 among dental undergraduate students (N=25) of Gandaki Medical College, Pokhara. The syllabus of Potentially Malignant Oral Lesions and Oral Cancer were covered for BDS third year students by didactic lectures, followed by Case Based Learning sessions (session I- Oral Leukoplakia, session II- Oral Squamous Cell Carcinoma). A pre-test and post-test, containing Multiple Choice questions relevant to the topics, were administered before and after the interventions. Students’ perceptions were collected using feedback questionnaire. The scores obtained in the pre and post-test were compared by Wilcoxon pair test and Mann Whitney U test. The level of significance was set at p <0.05.Results: Twenty and 21 students participated in session I and II respectively, and all (100%) of them felt that the case scenarios made the subject more interesting, and 19 (90.5%) students felt more such sessions should be added and be used along with lectures. Post test score after case-based learning was significantly higher (For Oral Leukoplakia p=0.028, for Oral Squamous Cell Carcinoma p<0.001) in comparison to didactic lectures.Conclusions: As case-based learning was positively perceived and preferred along with lectures, an attempt to incorporate it along with lectures in clinically important topics should be made. Keywords: Case based learning; dental undergraduate students; lecture; medical education; oral pathology
Ischemic optic neuropathy following craniotomy
Authors: Chaudhary Ranjit Kumar , Chaudhary Sanjib Kumar , Gupta Elina , Raghuram Karthikram
Published: November 2024

Ischemic optic neuropathy is one of the major causes of severe impairment of vision often leading to blindness. It has varied etiopathogenesis with limited management options and very often result in poor outcome. Perioperative ischemic optic neuropathy is rare and particularly seen in elderly patients with multiple comorbidities undergoing cardiac or spine surgery. We present a case of young patient who developed ischemic optic neuropathy following craniotomy for recurrent meningioma.Keywords: Ischemic optic neuropathy; optic nerve vasculature; painless vision loss; perioperative complications; perioperative optic nerve ischemia
Demographic Profile and Outcome of Pediatric Intensive Care Unit
Authors: Bastola Ramchandra , Shrestha Shree krishna , Sigdel Bhawana , Poudel Drishti , Ghimire Sunita , Ghimire Amrita , Khadka Khim Bahadur , Basnet Anjali
Published: November 2024

Background: Pediatric intensive care provides better observation as well as an intensive treatment, which helps to cure, support, and provide better outcomes for sick children. This study aimed to describe the demographic profile and the outcome of PICU patients, and evaluate the relationship of diagnostic categories with treatment and outcome.Methods: This retrospective cross-sectional study was conducted in a six-bedded PICU from 1 March 2021 to 1 March 2022. Bivariate analysis was used to identify the association between dependent and independent variables.Results: The infants admitted below 6 months of age were 63 (22.3%) and had male predominance accounting for 64%. The main portal of entry of the admitted cases was emergency ward 214(75.6%). Most of the patients 153(54.1%) were admitted for intensive monitoring of their abnormal vitals along with critical care according to our PICU protocol. Respiratory illness 122(43.1%), neurosurgical illness 59(20.8%), and primary infectious disease 52(18.3%) were the common reason for PICU admission. Post-major surgery 2(66.7%), hematological illness 3(37.5%), and cardiac disorders 1(20%) had high mortality rates. Among the portal of admission, the majority of the children (80.0 %) who were admitted to the PICU through the emergency ward died before exiting from the PICU (p<0.0001). Conclusions: Respiratory illness was the most common cause of admission and post-major surgery had the highest mortality rate. Portal of entry was statistically associated with patient characteristics and had a significant relationship with the outcome. Similar studies in other health institutions are required to further analyze the demographic profile and outcome of pediatric critical care in Nepal.Keywords: Infants; Intensive care; Patients; Pediatric