bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinicopathological Profile of Dengue Infection in a Tertiary Care Centre in Nepal
Authors: Thapa Bibechan , Pandey Aakriti , Gautum Santosh , KC Sajana , Chhetri Prabha Devi , Pokhrel Estory , Poudel Sangeeta , Shankar P Ravi
Published: November 2024

Background:Dengue is a mosquito-borne viral disease with a wide spectrum of presentations ranging from subclinical disease to severe dengue. Dengue is endemic to the Terai of Nepal. Interestingly, an increasing incidence has been reported from hilly areas like Kathmandu valley. This study explored the clinicopathological profile of dengue infection. Methods:A total of 84 serologically confirmed dengue cases from September to November 2019 at KIST Medical College were recruited in a cross-sectional study after obtaining ethical approval. Dengue was categorized as dengue without warning signs, dengue with warning signs, and severe dengue. Clinicopathological information was recorded in the proforma by reviewing patients’ records. A descriptive statistical tool and chi-square test were carried out. Results: Out of 84 patients, 76% (64) were dengue without warning signs, 21.4% (18) were dengue with warning signs and 2.4% (2) were severe dengue. About 97.6% (82) presented with fever. During the course of illness, anemia was identified in 38.1% (32), thrombocytopenia in 65.5% (55), hemoconcentration in 6% (5), and leucopenia in 82.1% (69). Similarly, elevated aspartate transaminase and alanine transaminase (ALT) was observed in 67.7% (42) and 53.2% (33) respectively. The severity of dengue on presentation to hospital was significantly associated with thrombocytopenia, leucopenia, and elevated ALT. Similarly, the severity during course of illness in hospital was significantly associated with hemoconcentration, thrombocytopenia, leucopenia, and elevated ALT.Conclusions: Most common presentation of dengue infection was fever. The most common laboratory abnormalities were leucopenia, thrombocytopenia, hemoconcentration, anemia, and elevated liver enzymes. Awareness of these clinical and laboratory parameters is important for the prompt diagnosis, severity estimation, and overall management of dengue infection.Keywords: Biochemical; dengue; hematological; Nepal; serological
Efficacy and Safety of Intralesional Immunotherapy with Tuberculin Purified Protein Derivative among Cutaneous Wart Patients
Authors: Shrestha Sanju Babu , Bhusal Mohan , Jwarchan Jayanti , Gautam Sujan , Shrestha Prashanna Raj
Published: November 2024

Background: Cutaneous warts are common skin problems caused by Human Papilloma Virus. Conventional therapies are mostly ablative and limited by recurrences and side effects. Immunotherapy using bacterial, fungal, and viral antigens is an emerging and safer technique to treat warts at local and distant sites. The objective of this study was to measure the efficacy and safety of intralesional immunotherapy with tuberculin purified protein derivative among cutaneous wart patients in the dermatology department of a tertiary care centre.Methods: A cross sectional, time series design, was conducted between October 2019 and September 2020 among 77 patients of cutaneous warts attending Dermatology out-patient department using convenience sampling. Percentage response was evaluated for patients treated with tuberculin purified protein derivative for eight weeks at an interval of two weeks into complete response (100% clearance), partial response (50-99% clearance), no response (0-49% clearance). Side effects were also recorded. Statistical Package for the Social Sciences version 20.0 was used for data analysis. Results: Out of 77 patients, complete response (100%) was seen in 53.2% patients, partial response (50-99%) in 14.3% and no response (0-49%) was seen in 32.5%. Side effects noted were pain and erythema (19.50%), blisters (2.60%) and flu like symptoms (1.30%).Conclusions: Intralesional PPD is an effective and safer therapeutic option for the treatment of cutaneous warts.Keywords: Immunotherapy; intralesional injections; purified protein derivative of tuberculin; warts
Factors Associated with Utilization of Postnatal Care Services
Authors: Thapa Suraj , Choudhary Pradeep , Adhikari Rita , Thapa Kanchan
Published: November 2024

Background: Preventable causes of death accounts for 810 women per day. Care provided during the child-bearing and after the childbirth is of vital importance. Despite of the facts, many women in developing world deprive of this service. Therefore, this study aims to explore the contributing factors for Postnatal care service in urban areas of Chitwan, Nepal.Methods: A cross-sectional study was conducted among 212 mothers who delivered within last one year. Data collection was conducted through pre-tested questionnaire in Nepali language after taking ethical approval and informed consent. Descriptive and bi-variate statistics were applied in analysis.Results: Higher number of mothers (39.2%) were in 25-29 years age groups. Hindu were 89.6% and Janajati were 70.7%. Mothers (26.4%) reported to reach nearest health facilities on foot by 30 minutes or more. Nearest health facility had twenty-four hours seven days a week maternal health services for 57.5% of mothers. Antenatal visitors were 83.9% and 96.7% reported institutional delivery. About 27.8% mothers were aware about Postnatal care; 48.1% were aware about maternal complications; 98.1% mothers had at least one PNC visit; and 34.4% reported Postnatal care visit as per protocol. Lack of counseling (52.6%) was one of the main reasons for not completing Postnatal care. Age factor, husband’s education, health service-related variables, availability of essential drugs and equipment in health facilities influenced Postnatal care.Conclusions: Fewer mothers reported about complete Postnatal care service. Socio-economic factors, health service-related factors, experience of mothers on their previous childbirth also contributed to complete Postnatal care.Keywords: Health services; maternal and child health; Nepal; postnatal care
Detection of blaoxa-23 Gene from Carbapenem-resistant Acinetobacter Baumannii
Authors: Neupane Laxmi , Sah Anil Kumar , Rayamajhee Binod , Pokhrel Anil , Singh Anjana
Published: November 2024

Background: Antibiotic resistance is a great concern for public health and Acinetobacter baumannii-associated infections are increasing in many parts of the world, including Nepal. However, limited data is available on the prevalence of A. baumannii harboring blaOXA-23 from Nepal.Methods: A hospital-based cross-sectional study was designed to detect the blaOXA-23 gene from carbapenem-resistant A. baumannii isolates in Nepal. A total of 380 clinical specimens were collected and processed following standard microbiological procedures. Antibiotic susceptibility test was performed as per the protocol of the Kirby-Bauer disk diffusion technique and the CLSI guidelines, while screening of carbapenemase production was assessed by the Modified Hodge Test using meropenem (10µg) disc. The presence of the blaOXA-23 gene in carbapenemase-positive A. baumannii was confirmed by PCR.Results: Among 380 specimens analyzed, 210 (55.3%) samples were positive for bacterial growth, where 33(15.7% of total growth) of the isolates were A. baumannii, and most of them were isolated from the ICU patients (20/33, 60.6%) and sputum (16/33, 48.5%). Thirty-two isolates (97%) were colistin sensitive, while only four (12.1%) isolates were sensitive to meropenem and imipenem. Twenty-three (69.7%) of A. baumannii were carbapenemase positive as revealed by the Modified Hodge Test test, and 19 of them (57.6% of total A. baumannii) harbored the blaOXA-23 gene.Conclusions: A high prevalence of the blaOXA-23 gene among carbapenem-resistant A. baumannii isolates were found. Systematic network surveillance should be established to check the spread of such isolates, especially in the intensive care units of tertiary care hospitals in Nepal.Keywords: Acinetobacter baumannii; antibiotic-resistant; blaOXA-23; carbapenemase; Nepal
Effect of COVID-19 Pandemic on Emergency Department Admissions and Outcome
Authors: Tiwari Jagannath , Paudel Pramod , Adhikari Sujan , Lamichhane Sharmila , Basnet Anjali , Subedi Kirtipal , Bhattarai Pratiksha , Paudel Prajwal
Published: November 2024

Background: Emergency Department admissions have changed significantly during the COVID-19 pandemic. Understanding this variation may play a crucial role in rearranging hospital resources for better outcome. In this study, we aimed to assess the impact of COVID-19 pandemic on emergency department admission and outcome.Methods: This is a cross-sectional retrospective study conducted at Bharatpur Hospital, Nepal comparing pre- pandemic data of the 4 months (March 24 to July 21, 2019) with the initial 4 months of the pandemic (March 24 to July 21, 2020). Results: Admission in emergency ward decreased during covid period among female admission (47%vs43%), age-group(0-14)(18%vs12%), Dalit(17%vs11%) p<0.0001.Diagnosis increased during covid for acute abdomen(11%vs13%), animal and insect bite(10%vs13%), psychiatric illness(2%vs6%),poisoning and drug over dose(0.9%vs2.6%)(p<0.0001).The odds for referral(cOR 3.62,95% CI:2.70-4.84), Left against medical advice(cOR 6.03,95% CI:.06-8.94) and death(cOR 3.28,95% CI:1.64-6.68) increased during the covid respectively.Conclusions: There was decrease in rates of emergency department utilization during the Covid-19 pandemic. Admissions due to trauma, gastrointestinal, respiratory, neurological, musculoskeletal and coronary artery disease showed a decline whereas psychiatric disorders, diabetes and hypertension, animal and insect bites cases increased. Overall, mortality rate was increased.Keywords: Admission; Covid-19; emergency department
Factors Associated with Intimate Partner Violence among Married Women
Authors: Ghimire Sailaja , Ghimire Sushmita , Agrawal Sagtani Reshu , Upadhyay Shambhu Kumar
Published: November 2024

Background: Intimate partner violence refers to any behavior within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship. Various factors such as alcohol or substance abuse, history of violence in family, extra marital affair, educational status, socio-economic status, decision making power, and established gender role are linked with Intimate partner violence. This study aims to identify the prevalence of different forms of intimate partner violence and its associated factors among married women in Shankharapur municipality of Kathmandu District.Methods: A concurrent triangulation design was used. Quantitative data were collected from 602 married females while qualitative data was collected from 11 participants. Multivariate logistic regression was done using Stata MP13 version. Thematic analysis was done for qualitative data. Triangulation of both quantitative and qualitative findings waere done.Results: The prevalence of Intimate partner violence was found to be 22.1%. After logistic regression, it was found that women’s involvement in community groups had lower odds (AOR 0.67, 95%CI 0.6-0.7) of IPV as compared to those who were not involved in community groups. Additionally, findings from the qualitative study showed female being victims of different forms of violence. Conclusions: Still, Female are the sufferers of violence behind the closed doors and mitigation strategies should have to be adopted from different levels of government to control intimate partner violence.Keywords: Intimate partner violence; Kathmandu; mixed method; triangulation.
Child Marriage: Knowledge, Factors, Consequences and Utilization of Maternal Services among Early Married Women
Authors: Budha Magar Esther , Gupta Mala , Parajuli Ashya , Chaudhary Ranjana , Pandey Ashok , Bhattarai Sumesh
Published: November 2024

Background: In 2020, UNFPA estimated additional 13 million child marriage cases in Nepal after a decade of lockdown due to COVID-19 wherein 2020, the data of child marriage before the age of 18 reached 5 million where marriage done before the age of 15 years was 1.3 million as per UNICEF. In Nepal, the legal age for marriage is 20 years. As per the National Criminal Code 2074, article 173 (1,2 and 3), one is imprisoned for three years with a penalty of Rs. 30,000, if found to violate the law: marrying before reaching the legal age. Methods: An analytical cross-sectional study was conducted. The sampling design used for the study was simple random sampling. Out of 9 municipalities in Sindhuli district, Dudhauli municipality was selected by using lottery method. 8 wards out of 14 wards in Dudhauli municipality were selected by using purposive sampling. 160 participants were early married women within the age of 15 to 24 years. Three key stakeholders were selected for Key Informant Interview from the local government level worker, non-Governmental organizations working within the municipality, and Dudhauli Health Post. One focused group discussion was conducted with 6 early married women. All the collected data were analyzed through simple descriptive statistics such as frequency, percentage, mean and inferential statics by using chi-square. For a qualitative study, the information collected from the key stakeholders was documented in narrative form. Results: Seven out of 126 women suffered from miscarriage during their second delivery. There is a significant association between the age of marriage and the number of children (P-value 0.0520) and birth time after marriage (P-value 0.019). The majority, 32.6 percent believes that child marriage can be prevented by children’s counselingConclusions: Only 1.6 percent of early married women faced complications during delivery. Majority of physically active women engaged in agriculture sector (97.5%) did not face any difficulty during delivery. None of the early married women have ever suffered from obstetric fistula despite of early delivery.Keywords: Cause; child marriage; consequence; knowledge; Nepal
Comparison of Acute Physiology and Chronic Health Evaluation II, Bedside Index for Severity in Acute Pancreatitis and Modified Computed Tomography Severity Index Scores in Predicting the Outcome in Acute Pancreatitis in a Tertiary Care Centre in Nepal
Authors: Pandey Rajesh , Pathak Rahul , Jha Anurag , Gnawali Arun , Koirala Dinesh
Published: November 2024

Background: It is important to identify the severity of acute pancreatitis in the early course of the disease. Methods: This prospective observational study included 83 patients with acute pancreatitis. The Acute Physiology and Chronic Health Evaluation II and the Bedside Index for Severity in Acute Pancreatitis scores were assessed within 24?hours of admission, and the modified computed tomography severity index score was calculated in those patients who underwent contrast enhanced computed tomography.  The sensitivity, specificity, positive predictive value, and negative predictive value of scoring systems were calculated. The area under the curve was calculated for assessing the prognostic value of scoring systems. Results: The modified computed tomography severity index was the most accurate score in predicting severity and local complications with an area under the curve of 0.92 and 0.91, respectively. The Bedside Index for Severity in Acute Pancreatitis score was the most accurate in predicting organ failure and the need for intensive care unit admission with an area under the curve of 0.70 and 0.78 respectively.Conclusions: The results of this study demonstrate that modified computed tomography severity index and Bedside Index for Severity in Acute Pancreatitis scores had overall better predictive value than the Acute Physiology and Chronic Health Evaluation II score in predicting severity, organ failure, local complication, and need for intensive care unit admission.Keywords: Acute pancreatitis; APACHE II; BISAP; modified CTSI
Prevalence and Comparision of Conventional Risk Factors of Cardiovascular Disease Between Clinical and Nonclinical Staff
Authors: Khadka Sunita , Dhungana Suraksha , Prajapati Dipanker , Dhungana Murari , Dangol Prati Badan , Shakya Roji , Tamrakar Binita , Kandel Unnati , Adhikari Chandra Mani
Published: November 2024

Background: Cardiovascular disease is the leading cause of death around the globe. A number of studies have shown that hospital staff are vulnerable to cardiovascular disease due to a certain risk of shift duty. It is important to identify cardiovascular risk factors among hospital staff. The aim of this study is, to assess the prevalence of conventional risk factors of cardiovascular disease among hospital staff. Methods: A quantitative cross-sectional study was conducted among staff working at a Shahid Gangalal National Heart Center, a tertiary cardiac center in Nepal. Simple and multiple linear regression analyses were used to examine the association between independent variables and cardiovascular diseases. Statistical analysis was done using SPSS software version 20.Results: A total of 250 hospital staff participated in this study. Among them, 137 were clinical staff and 113 were non-clinical staff. The mean age of clinical staff and the non-clinical staff was 33.69 ± 7.02 years and 38.7 ± 10.58 years respectively with a total of 66.8% females. Prevalence of hypertension, diabetes mellitus, and dyslipidaemia was less in clinical staff compared to non-clinical staff. The mean systolic, diastolic BP was high in non-clinical staff ( P-value 0.001), moreover mean HDL-C was low (1.2 ± 0.2 mmol). BMI was significantly low in clinical staff. [standardized ?= -0.24; 95% CI: -2.90, -0.88].Conclusions: The prevalence of cardiovascular risk factors were high in non-clinical staff compared to clinical staff. Keywords: Cardiovascular disease; conventional risk factors; hospital staff
Learning Experiences of Frontline Nurses Combating COVID-19 in Public Hospitals
Authors: Bajracharya Rashmila , Pangeni Shesha Kanta
Published: November 2024

Background: Combating COVID-19 by frontline nurses is highly concerned to manage and maintain the health care delivery system through qualitative services to the infected people. If nurses do not agree to the frontline role to combat COVID-19, it might create massive crisis in health sectors. The purpose of this study was to explore the learning experiences of frontline nurses combating COVID-19 in the public hospitals of Kathmandu valley. Furthermore, this study has explored their stories of combating COVID-19.Methods: Philosophically, this study is guided by interpretive paradigm utilizing the qualitative design with narrative inquiry. Stories were collected using face to face interview with six frontline nurses (seniors and juniors) working at COVID special units in three different public hospitals of Kathmandu valley. I have interpreted shared stories of combating experiences and learning, using self-efficacy theory and resilience theory. Results: This study revealed that the participants faced many challenges related to physical, mental, emotional and psychological and various managerial issues. However, they were able to cope due to their self-willingness, nursing education, altruistic nature and support system. Likewise, they acquired various skills: patient care, managerial and leadership, similarly understanding philosophy of life. Conclusions: Frontline nurses were able to combat COVID-19 successfully. Nowadays, they are happy, satisfied and proud with their roles that they had during the health emergency of COVID-19 pandemic and the commitment they fulfilled.Keywords: Challenges; front line role; leadership skill; learning experiences; support system
Interarm Blood Pressure Difference in Young Healthy Adults
Authors: Karmacharya Poonam , Bhattarai Anshu , Tiwari Indu
Published: November 2024

Background: Inter-arm difference in blood pressure is the difference in the systolic and the diastolic blood pressure between arms of an individual. According to American heart association, interarm Blood Pressure difference of more than 10 mm of Hg are associated with peripheral vascular disease. The present study aims to determine the magnitude of interarm difference in young healthy individuals and to assess whether family history of hypertension, age, sex and Body mass index is related to higher interarm differenceMethods: A cross-sectional study was carried out among 270 students of Manipal College of Medical Sciences, Pokhara, Nepal. Blood pressure was measured in both the arms using a mercury sphygmomanometer. (Elko 300) Statistical analysis was done using paired t test, chi-square and Pearson’s correlation test using SPSS 23. Results: The absolute mean Inter-arm difference for systolic blood pressure was 11.03±0.67mm Hg and for diastolic blood pressure was 6.020 ±0.21 mm Hg. There is significant inter-arm difference for systolic blood pressure and diastolic blood pressure (p<0.001). Inter-arm systolic blood pressure difference was significantly associated with family history of hypertension, age and Body Mass Index (p<0.001) Meanwhile, there was no statistically significant association of sex, family history of hypertension, age and Body Mass Index with inter-arm difference for diastolic blood pressure.Conclusions: Significant inter-arm systolic and diastolic blood pressure differences was found in the young, healthy population. Positive correlation of increased Inter-arm difference in Blood Pressure with family history of hypertension was confirmed. This emphasizes the importance of measuring blood pressure in both arms to be a routine practice as we aim for early diagnosis and prompt treatment of hypertensive disorders.Keywords: Blood pressure; healthy adults; interarm difference
Evaluation of Quality Parameters of Light Sensitive Drugs Marketed in Nepal
Authors: Maharjan Sajan , Dhungel Subhash Kumar
Published: November 2024

Background: Photosensitivity is the response of drug or drug product to the exposure of solar, UV and visible light in the solid, semisolid, or liquid state that leads to a physical or chemical change. Exposure to light is a concern with numerous medications due to the potential for photo degradation or other chemical reactions that affect drug stability.Methods: Out of all the registered brands in Department of Drug Administration, 9 brands of Rabeprazole tablets, 5 brands of Promethazine tablets and 5 brands of methylcobalamin tablets were selected and were subjected for testing and analysis for various quality parameters as per pharmacopoeia. The labels of the collected medicine were analyzed. The obtained data were entered and analyzed in Microsoft office excel 2019.Results: Eleven products did not comply with the existing regulatory requirement on labeling system of medicine as per Regulation of Standard of drugs. There was no uniformity in mentioning the self-life. Similarly, large variation was seen on price of same generic drugs. Information regarding storage conditions, direction for use and category of the drug were lacking in the label of some brands of medicines.Upon Laboratory analysis, two brands of promethazine tablets and three brands of Rabeprazole tablets were found substandard. Drug content of all the brands of Methylcobalamin was found to contain overage.Conclusions: The result of this study indicates that substandard medicines are abundant in Nepalese market. There is weak regulation monitoring which have resulted in no uniformity in similar pharmaceutical products too. Hence, stringent regulatory monitoring is required to assessthe quality of pharmaceutical products in the Nepalese market.Keywords: Light sensitive drugs; substandard drugs; quality of drugs
Microbial Spectrum of Complete Denture Wearer in Old Age People of Chitwan
Authors: Chaulagain Rajib , Thakur Smriti Narayan , Khanal Bibek , Sapkota Srijana Mishra , Chaudhary Navin Kumar
Published: November 2024

Background: Human oral cavity contains many microorganisms, the habitat of which may be changed by complete denture among edentulous people. The complete dentures favor aggregation of microorganism. The aim of this study was to identify the microorganisms present in the complete dentures of old age people of Chitwan and assess the sensitivity pattern of the microorganisms to the common antibiotics. Methods: A descriptive cross-sectional study was conducted at Chitwan Medical College, Chitwan, Nepal among 45 old age people who have been wearing dentures above one year. The duration of the study was from 18th Nov 2021 to 12th May 2022. Swab was taken from the polished and tissue surfaces of both maxillary and mandibular dentures in the Department of Prosthodontics while the laboratory-based experiments were conducted in the Department of Microbiology. Antibiotic sensitivity was also done. The data was analyzed using Statistical Package for Social Science (SPSS) version 16.0. Descriptive statistics were used. The data was presented in form of frequency, percentage, mean and standard deviation. Results: Streptococcus spp. was predominant microorganism followed by Coagulase-negative Staphylococci and Staphylococcus aureus. The highest sensitivity pattern was observed to Amikacin, Nalidixic acid and Ciprofloxacin while the most resistant antibiotics were Amoxicillin/clavulanic acid and Cefixime. Escherichia coli was sensitive to all the tested antibiotics. Conclusions: In this study, Streptococcus spp. followed by Coagulase-negative Staphylococci and Staphylococcus aureus were the most frequently identified microorganisms from the dentures of old age people. Amikacin, Nalidixic acid and Ciprofloxacin were highly sensitive among the people of old age.Keywords: Antibiotic sensitivity; complete denture; microorganisms
Academic Stress among Adolescents of Rural Nepal: A Community-based Cross-Sectional Study
Authors: Pant Suman , Rajbhandari Bibek , Gurung Minani , Poudel Lisasha , Maharjan Ashmita , Nepal Sujita , Thapa Tek Bahadur , Malla Nabina , Lama Tashi , Sharma Dikshya , Gurung Chandani , Parajuli Yubraj , Panta Niranjan
Published: November 2024

Background: Adolescents are in the transition phase between childhood and adulthood. Their mental health influences many aspects in their life as they go through many physical and emotional changes. Adolescent mental health is harmed by changes in emotional and physical state, as well as increased academic pressure. This study aimed to assess academic stress and its associated factors among adolescents in rural Nepal. Methods: A community-based cross-sectional survey was conducted among 424 adolescents residing in Karnali Province, Nepal. Academic stress was measured using Student Assessing Academic Stress. Multivariate logistic regression analysis was used to examine associated factors at the significance level of 0.05. Results: Of the total students, 19.8% had moderate academic stress and 2.4% of them had high academic stress. Female students had thrice higher odds of having academic stress as compared to male students (Adjusted Odds Ratio:3.47; 95% Confidence Interval:1.91to 6.31, p-value:<0.001). Grade 10 students had higher odds of having academic stress as compared to grade 9 (Adjusted Odds Ratio:2.02; 95% Confidence Interval:1.13 to 3.61, p-value:0.017). Students of literate mothers were more likely to experience academic stress than those with illiterate mothers (Adjusted Odds Ratio:0.53; 95% Confidence Interval:0.29 to 0.96, p-value:0.036). Students with unsatisfactory academic performance had thrice higher odds of having academic stress as compared to students with satisfactory academic performance (Adjusted Odds Ratio:3.12; 95% Confidence Interval:1.46 to 6.67, p-value:<0.003). Conclusions: The findings of the study showed that high school students have academic stress, which is related to many factors at home and school. Understanding academic stress and parents and teachers providing the best support to the students could help lessen the burden.Keywords: Academic stress; adolescents; Nepal; prevalence
Correlation of Serum Uric Acid and Lipid Profile in Patients with Type 2 Diabetes Mellitus
Authors: Malla Pragya , Khanal Madhav Prasad , Pokhrel Asmita , Sah Bishesh , Pathak Sonam , Subedi Anukul , Sapkota Srijana
Published: November 2024

Background: Diabetes complication poses a new challenge in Nepal as the disease is becoming endemic. Identifying risk factor for diabetes can be an essential step in preventing complication related to diabetes. Abnormal Uric acid and lipid profile are the important risk indicators of diabetes mellitus complications, so the study was done to know the association between uric acid and lipid profile in type 2 diabetes. Methods: A cross-sectional study was done from 118 patients with type 2 diabetes mellitus visiting Nepal Medical College and Teaching Hospital. Three ml of venous blood was analyzed for fasting blood glucose, uric acid, and lipid profile. Correlational analysis was done between fasting blood glucose with triglycerides, high density lipoproteins and uric acid. Results: A significant positive correlation between fasting blood glucose and triglyceride (r =.211, p = .022) was found in diabetic. There was significant negative correlation of fasting blood glucose with uric acid (r = -.196, p =.034) and high-density lipoprotein cholesterol (r = -.181, p = .049). Uric acid was also found to have significant positive correlation with triglyceride (r = .235, p = .010) and negative correlation with high density lipoprotein cholesterol (r = -.420, p = .000).Conclusions: Negative correlation of serum uric acid with fasting blood glucose and high-density lipoprotein and positive correlation with triglycerides suggests a possible connection of uric acid as a risk factor for diabetes.Keywords: Diabetes mellitus;f blood glucose; lipid profile; uric acid
Awake Prone Positioning In COVID Positive Patients: A Retrospective Study
Authors: Dangol Shova , Poudel Dipesh , Shrestha Surendra Man , Rawal Prabhat , Shrestha Kundu
Published: November 2024

Background: While the advanced health care settings are struggling hard to handle the sudden surge of COVID-19 cases, resource poor settings in developing countries like Nepal can barely stand to fight the increasing number of severe cases. Easily available cost effective interventions would be great blessing for such settings. This study aimed to study if awake prone positioning can be used as such intervention in COVID 19.Methods: The retrospective study involved 150 patients admitted between November 2020 and January 2021 at Nepal Armed Police Force Hospital and met specific inclusion criteria. Data was obtained at four different time points in relation to prone position and was analysed using International Business Machines Statistical Package for the Social Sciences (SPSS) version 23. Results: It was found that among 150 patients, majority (109; 72.7%) were males and 60(40%) had some comorbidities. The mean oxygen saturation was found to increase significantly from 87.18 %(SD 3.531) to 91.08(SD 2.206) after fifteen minutes of prone positioning. One way ANOVA test showed that there was significant difference in oxygen saturation between at least two time points. (F (3,596) = [180.005], p=0.000). Games Howell Post Hoc test for multiple comparisons showed that the mean value of SPO­2 was significantly different across all four time points, at significance level 0.05. Conclusions: This study found Awake Prone positioning as a promising cost effective and feasible intervention for improving oxygenation in COVID 19 and thus could be a blessing to the resource poor health care settings.Keywords: Awake prone; COVID-19; oxygen saturation; resource-poor.
Factors Associated with Mothers Health Seeking Behavior among Newborn Illness
Authors: Bhusal Chet Kant , Bhattarai Sigma , Kunwar Ankita , Shrestha Saneep , Chhetri Pradip , Priyanka Jyoti
Published: November 2024

Background: Inappropriate, delayed and poor health seeking behavior increases the high risk of morbidity and mortality among newborns, infants and children. Newborns health status depends upon mothers’ health seeking behavior. This study aimed to determine the factors associated with mother’s health seeking behavior among newborn illness in Rupandehi District, Nepal. Methods: Community based cross-sectional study among 372 mothers aged 15-49 years was conducted in Rupandehi district Nepal from May to November 2019. Multistage probability random sampling was used as the sampling technique. Siddharthanagar municipality and Mayadevi rural municipality were selected randomly among 16 local units of Rupandehi district. Two wards from each unit were selected by stratified random sampling using non replacement lottery method. As the sample size was 372, ninety three respondents were selected randomly from each ward. Results: The mean age and standard deviation of mothers was 25.32±4.36 years respectively. Among 372 mothers, 21.24% had poor health seeking behavior. Mothers having more than one child (AOR=0.15; CI: 0.02-0.98), primary and above education (AOR=8.89; CI: 3.15-25.08), visited hospital after 24 hours of newborn illness (AOR=13.59; CI: 1.73-106.7), knew danger signs of newborn (AOR=18.74; CI: 5.65-62.23), practiced exclusive breastfeeding (AOR=8.20; CI: 3.36-20.03) were significantly associated with health seeking behavior.Conclusions: Almost 22 % of mothers had poor health seeking behavior regarding their newborn illness. Number of living child, education of mother, appropriate time for treatment, receive health services when there is dangers signs of newborn and exclusive breast feeding practice were independent factors associated with mother’s health seeking behavior. Hence, decision-makers and local administrator should provide specific intervention to newborns’ mother regarding family planning, identifying and preventing danger signs of newborn, importance of appropriate time of treatment and exclusive breastfeeding. Keywords: Health seeking behavior; illness; mother; newborn.
Immediate Effect of Physiotherapist-demonstrated Action Observation with Execution for Improving Upper Extremity Motor Function in Stroke: a Pre-post Pilot Study
Authors: Shrestha Shaj , Shrestha Nistha , Dhalachhe Shrestha Abhishek , Adhikari Shambhu Prasad
Published: November 2024

Background: Video-demonstrated action-observation-execution is an effective intervention for motor re-learning in stroke rehabilitation. But customization of video for each task repeatedly questions its feasibility within limited resources, particularly for daily routine practice and in community settings. Physiotherapist-demonstrated action-observation-execution is a practical intervention based on the principle of observation and consecutive repetitions of observed real, live movements. The main objective of this study was to investigate the immediate effect of Physiotherapist-demonstrated action-observation-execution in upper extremity motor training in stroke.Methods: Individuals with stroke were screened and 5 eligible participants were recruited. The research was a pre-post. A single session of Physiotherapist-demonstrated action-observation-execution was administered. A functional “Drinking” task was subdivided into simpler acts and trained. Pre and post intervention assessment of movement time using five hand-and-arm items of Nepali Wolf Motor Function Test were carried out. Global recovery was assessed in the form of Visual Analogue Scale.Results: Paired t-test provided statistically significant difference in total movement time (mean difference=5.04 seconds, standard deviation=1.92, p=0.004) with larger effect size (0.95) indicating impressive improvement in movement time with the training. Substantial difference in global recovery score was noted (mean difference=17.40, standard deviation=3.65, p<0.0001, effect size=1.00) signifying the increased confidence and improved performance of upper extremity post treatment.Conclusions: The findings indicated that Physiotherapist-demonstrated action-observation-execution could be a feasible intervention to train motor functions in participants with stroke. Large-scale studies are recommended to establish the effectiveness of the intervention. Keywords: Action-observation; action-execution; hand function; mirror neuron; stroke.
Clinicopathological Significance of Tumor Budding in Breast Carcinoma
Authors: Buch Archana , Jain Khushi , Rathod Hetal , Gore Charusheela
Published: November 2024

Background: Tumour budding Tuberculosis is a new prognostic marker whose role in breast cancer is still under evaluation. Our aim was to study Tuberculosis in breast carcinoma and correlate it with other prognostic markers.Methods: A descriptive cross-sectional study was conducted over 2 years on 75 invasive breast carcinoma specimens and biopsies. Hematoxylin and Eosin sections were examined for tumour grade, stage, molecular subtype, necrosis, lymphovascular invasion inflammation and counting of Tuberculosis. Lymph node metastasis was studied only in mastectomies. TB was defined as a cluster of 1-5 tumour cells and counted in 10 consecutive 400X fields. The cut-off for high grade TB was taken as ?10 per 10 HPFs. Immunohistochemical staining was done for molecular subtyping and differentiating Tuberculosis from mimickers. Statistical analysis was done using chi square test and Fischer’s exact test.Results: Tuberculosis was present in 66/75 cases; 53% (n=35) were high grade. Among these, majority were of T2 (74%, n= 26), grade 2 (52%, n= 18), luminal A (34%, n= 12), had 3+ inflammation (46%, n= 16) and peripheral tumour buds (54%). Necrosis and lymphovascular invasion were absent in 77% and 71%, respectively. Lymph node metastasis was seen in 63% (n= 25/28) cases. Statistically significant association (p= 0.016) was observed between degree of inflammation and Tuberculosis grade. However, no significant association was observed between TB and other prognostic markers of breast carcinoma.Conclusions: In our study, association of Tuberculosis with different prognostic markers was appreciated but was not statistically significant. However, it highlights need for standardization of Tuberculosis reporting.Keywords: Breast Neoplasms; epithelial-mesenchymal transition; prognosis; tumor budding.
Performance of Distress Thermometer: A Study among Cancer Patients
Authors: Thapa Sudip , Sharma Susmita , Gautam Nishim , Shrestha Sudip , Raj Ghimire Bijesh , Dahal Sanuja , Adhikari Bibhav , Maharjan Rubina , Thapa Sadiksha , Kattel Regina , Koirala Rishav
Published: November 2024

Background: The Distress Thermometer accompanied with Problems List is a commonly used screening tool for psychosocial distress. However, it’s cut-off score, performance and risk factors for psychosocial distress varies among studies. This is the first study conducted in Nepal to investigate the Distress Thermometer’s screening properties, its optimal cut-off score and evaluating the prevalence of psychosocial distress and its risk factors.Methods: This cross-sectional study enrolled 162 heterogeneous cancer patients. The English form of the Distress Thermometer was translated to Nepali using a forward and backward translation method. Questionnaires including socio-demographic, clinical characteristics, the Hospital Anxiety and Depression Scale and Distress Thermometer accompanied with Problems List were filled. Receiver Operating Characteristic analysis of distress thermometer scores was evaluated against Hospital Anxiety and Depression Scale-Total (?15). An Area Under the Curve, sensitivity, specificity, positive predictive value and negative predictive value were calculated at each Distress Thermometer cut-off score. Results: Receiver Operating Characteristic analysis showed an excellent discriminating performance (Area Under the Curve =87.4%). A cut-off score of 4 on Distress Thermometer was established and it yielded sensitivity (88.9%), specificity (71.1%), positive predictive value (75.4%) and negative predictive value (86.5%) respectively. Furthermore, 55.6% of participants were distressed and emotional problems (odd ratio = 28.00), practical problems (odd ratio = 12.152) and physical problems (odd ratio = 2.397) were found to be significant risk factors for PD.Conclusions: PD is a global burden in cancer patients. The DT with a cut-off score of 4 accompanied with PL is valid instrument for screening PD in Nepali cancer patients. PL identified the problems that causes of PD.Keywords: Cancer; Distress Thermometer; Nepal.
Cranial Base Measurements in Skeletal Malocclusion among Orthodontic Patients
Authors: Pant Bashu Dev , Rajbhandari Anjana , Pradhan Resina , Bajracharya Manju , Maharjan Surendra
Published: November 2024

Background: Facial growth and development is necessary for proper orthodontic diagnosis and treatment planning. Growth of cranial base is linked to the overall growth of facial bones, especially the maxilla and mandible. Any change in the amount and direction of growth of the cranial base can have direct or indirect effects on the developing maxilla and mandible. Thus the aim of this study was to determine the linear and angular cranial base measurements in different skeletal malocclusion in Nepalese population.Methods: Pretreatment lateral cephalograms of 225 patients aged between 17-30 years were collected. Linear measurements Sella-Nasion (S-N), Sella-Articulare (S-Ar), Articulare-Gonion (Ar-Go), Gonion-Gnathion (Go-Gn) and angular measurements Saddle angle (N-S-Ar), Articular angle (S-Ar-Go) and Gonial angle (Ar-Go-Gn) were measured.Results: In angular measurements statistically significant differences were found in the saddle and gonial angles between class I, II, and III skeletal pattern. In linear measurements, anterior and posterior cranial base lengths were not significantly different among groups however, ramal height and mandibular body length were significantly different among groups with a P value < 0.05.Conclusions: Skeletal class III has a larger gonial angle, ramal height and mandibular length. Males have larger linear measurements and females have larger angular measurements. Keywords: Cephalogram; Cranial base; Skeletal malocclusion
Health Promoting Behaviors among Adolescents at Selected Schools of Chitwan
Authors: Pokharel Silaja , Bajracharya Subina
Published: November 2024

Background: Health Promotion and maintenance are fundamental prerequisites to achieve optimum health in an individual and limit the illness. The objective of the study was to assess the health promoting behaviors among adolescents at selected schools. Methods: A descriptive cross-sectional study was conducted among 238 adolescents age 14-18 years of age studying in three different government schools of Bharatpur-10 Chitwan. Probability simple random method was used for selecting the required respondent. Data were collected using Adolescents Health Promoting Scale questionnaire through self-administered technique. Obtained data were analyzed using descriptive and inferential statistics.Results: The study revealed that 47.5% had high level of health promoting behaviors whereas 52.5% had low level of health promoting behavior. Regarding, the subscale, the highest score was obtained in the area of exercise (median percentage=72.5%) and lowest score was obtained in the area of stress management (median percentage=48%). Moreover, statistically significant variables for health promoting behavior were respondents age, availability of school health nurse, educational status of both the parents and and occupation of father (p<0.05).Conclusions: More than half of the adolescents in schools have low health promoting behavior, particularly in the area of stress management and nutrition. Adolescence is the period when most of the healthy and unhealthy habits are developed. Hence, it is necessary to focus on developing efficient health promotion and disease prevention strategies in collaboration with school teachers and school health nurse.Keywords: Adolescent; adolescent health; health promotion; health promoting behavior; school health.
Ruptured Endometrioma with Hemoperitoneum Requiring Emergency Laparotomy: A Case Report
Authors: Rai Sangam , Dangal Ganesh , Karki Aruna , Pradhan Peru , Shrestha Ranjana , Bhattachan Kabin , Maharajan Sunita , Bhandari Srijana , Basnyat Amog
Published: November 2024

Endometrioma is the localization of endometriosis in ovary which often develops as cyst. The condition can be complicated with infection, torsion and rupture leading to significant hemoperitoneum and ascites.We present here a 28-year female P2 L1 presented with the features of acute abdomen and severe anemia referred from other hospital where pain management was done. She had raised Ca-125 level, negative Urine Beta HCG and USG findings of left endometrioma with degenerating subserosal fibroid. The improvement of her general condition with analgesics was misleading however a static hematocrit level despite blood transfusion raised suspicion of ongoing pathology leading to blood loss and diagnostic paracentesis confirmed the hemoperitoneum while awaiting of CT report. She underwent Emergency Laparotomy which revealed hemoperitoneum of 2000ml and right ruptured ovarian endometrioma measuring and left ovarian cyst measuring 6x6 cm was noted. The postoperative period was uneventful. Keywords: Acute abdomen; case report; endometriosis; hemoperitoneum; ruptured endometrioma.
Radiofrequency Treatment of Genicular Nerves Using a Hybrid Technique
Authors: Diwan Sandeep , Gupta Anju , Sancheti Parag
Published: November 2024

Background: Radiofrequency ablation of genicular nerves is recommended to ameliorate the pain of osteoarthritis of the knee. However, long-term efficacy in patients with persistent pain following total knee arthroplasty remains elusive. The current study aimed to evaluate radiofrequency ablation of genicular nerves using a hybrid technique to manage severe incapacitating pain and quality of life following surgery. Methods: This prospective, observational study included patients suffering from intractable knee pain with scores > 4 on the Numeric rating scale after 6 months of total knee arthroplasty. Therapy included radiofrequency ablation of the superior medial, lateral, and inferior medial genicular nerves using a hybrid technique. The Numeric rating scale and Oxford Knee Score for quality of life were assessed before therapy and at 1-, 3- and 6 months following treatment. Results: Average pain scores reduced from 8.4 ± 1.3 (admission) to 3.3 ± 1.4 (1 month; p= <0.001) but subsequently started to increase to 4 ± 1.2 (3 months; p = 0.58), and 5.6 ± 0.9 (6 months; p= <0.001). Average Oxford Knee Score significantly improved from 14.2 ± 5.9 (admission) to 38 ± 8.6(1 month); p= <0.001, but these too subsequently reduced to 36.4 ± 7.9 (3 months); p= 1, and 22.5 ± 12.5(6 months); p= <0.001. Conclusions: Ultrasound-guided radiofrequency ablation of genicular nerves diminishes intractable pain and disability in patients with chronic knee pain following total knee arthroplasty. Treatment is safe and effective, however, the benefit declined by 6 months. A repeat block would be necessary if the pain score worsens.Keywords: Analgesia; arthroplasty; disability; genicular nerve; knee.