bluuebunny/crossref_metadata_2025 huggingface dataset:
Iron-folic acid supplementation and its differentials among Nepalese women of reproductive age
Authors: Shrestha Ira , Paudel Puja , Joshi Milli , Bhandary Shital
Published: March 2023

Introduction: Iron-folic acid (IFA) supplementations protect mothers and their infants against perinatal and maternal mortality. Ministry of health and population advises pregnant women and lactating mother to take IFA supplements everyday for certain period. However, not all women follow this.

Methods: 2011 Nepal Demographic and Health Survey (NDHS) data was used. Dependent variable was created using women with last child born live in the last five years and taking at least 1 tablet/syrup of IFA and women not taking any tablet/syrup during the study period. Key background variables of women and their last child born during last five years were used as independent variables. Logistic regression was used to find the association between the dependent and independent variables without controlling (bi-variate) and controlling (multi-variate) for other factors during analysis.

Results: About 60% of the women took/bought IFA supplements. Although bivariate analysis showed the effects of perceived child size and type of place of residence on maternal intake of IFA, multivariate analysis did not show this effect. However, motherâ€™s age, residence at hill region, education level and wealth index showed their effect on maternal IFA supplements intake in both bivariate and multivariate analysis.

Conclusion: The mothers from Dalit, Janjati and other marginalized group, living in hill region, with no education and higher age were less likely to take IFA supplements. Therefore, such groups should be counseled to increase the use of IFA.
Regional and district level estimates of maternal mortality for Nepal: Are they different from the national estimates in 2011?
Authors: Bhandary Shital
Published: March 2023

Introduction: Nepal won Millennium Development Goal Award on Maternal Health as the Maternal Mortality declined by 50% between 1996 and 2006 and by 80% between 1990 and 2010. However, maternal mortality in Nepal are estimated from Surveys using direct and indirect techniques amid the absence of robust vital registration system. Thus, maternal mortality estimates are not available at regional and district levels.

Methods: This paper estimated the regional and district level maternal mortality ratio for 2011 using multilevel regression model coefficients proposed by UN and World Bank for the first time in Nepal. Proportion of Maternal Deaths were estimated using Gross Domestic Product, General Fertility Rate and delivery by Skilled Birth Attendants. The maternal mortality ratio for five development regions and 75 districts were then estimated using the 2011 Census Reports.

Results: The maternal mortality ratio at 2011 was estimated as 155 deaths per 100,000 live births and was consistent with the previous values estimated between 1990 and 2010. Maternal mortality at Western and Central development regions were below while Eastern, Mid-Western and Far-Western Regions were above the national estimate. Twenty-two districts had it below while 53 had it above the national estimate. Kalikot and Kaski districts had highest and lowest maternal mortality ratio in 2011.

Conclusion: Maternal mortality declined in the country because of rapid fertility decline and increased contraceptive use and decreased anemia among pregnant women and obstetrics/abortion facilities in all districts of the country after legalization of abortion. Improvement in womenâ€™s education, empowerment, wealth and living standard were also responsible for declining maternal mortality. Nepal now needs a robust vital registration system to â€œexplainâ€ the reasons of this decline and further devise and implement new plans, policies and programs to reduce it further at sub-national and local levels.
Premenstrual syndrome and dysmenorrhea status before and after practicing yoga among selected women of reproductive age group living in Kathmandu valley: a mixed method study
Authors: KC Prakash , Bhandary Shital
Published: March 2023

Introduction: Premenstrual syndrome and dysmenorrhea are most common gynecological disorders associated with reduced quality of life among women of reproductive age. This study aims to compare the premenstrual syndrome and dysmenorrhea before and after practice of yoga among women of reproductive age living in Kathmandu, Nepal. Surya Namaskar, Surya Kriya and Shambhavi Mahamudra were common yoga types practiced by participants.

 

Method: A retrospective pre-post study with concurrent mixed method design was used. Study respondents were 41 women of reproductive age. Numeric pain rating scale and Premenstrual syndrome scale were used for quantitative data collection. Interview guide was used for the qualitative data collection. Google form was used for quantitative data whereas telephone was used for an in-depth interview. R-4.2.1 software was used for the quantitative data analysis. Qualitative data was analyzed using Braun and Clarke’s 6-steps thematic analysis in RQDA 0.3.8.1 package of R software. Qualitative findings were triangulated with quantitative findings to determine convergent, divergent and expansive findings.

 

Result: All outcome variables pain intensity score (Baseline: 6.46±2.31, Endline: 3.71±2.24, p<0.0001), pain duration in hour (Baseline: 6, Endline 2.5, p<0.0001) and premenstrual syndrome score (Baseline: 104.73±33.28, Endline: 74.24±22.08, p<0.0001) were significantly different after practice of yoga as compared to before yoga practice. Qualitative findings supported the quantitative result and presented expansive finding as yoga may be beneficial for management of irregular menstrual cycles and polycystic ovarian syndrome as well.

 

Conclusion: The study suggests yoga may help in alleviating premenstrual syndrome and dysmenorrhea.
A study on serum calcium level in resistant hypertension
Authors: Dangal Binod , Shakya Yogendra Man , Narayan Pratap Prasad , Shakya Yagya Laxmi , Shrestha Tirtha Man , Anil Om Murti
Published: March 2023

Introduction: Hypertension is one of the common public health problem in the world and gradually increasing in Nepal. Serum calcium level has shown to be associated with cardiovascular disease. Disturbed calcium metabolism plays important role in pathogenesis of essential hypertension.

Methods: Four hundred people including 200 normotensives and 200 hypertensives were enrolled in the study, their blood pressure and total serum calcium were measured. Hypertensive group was divided into two: Hypertensives on Calcium channel blockers (CCBs) and hypertensive other than CCBs. Serum Calcium level was measured with calcium-O- Cresopthalein complex(OCPC) reaction. All other baseline investigations including blood sugar, renal function tests, complete blood counts, thyroid function tests were done to exclude secondary causes in hypertensive group. Statistical analysis was done using SPSS version 21. Differences between the groups were analyzed with independent â€œtâ€ test.

Results: Significant difference in serum calcium level was found in between normotensive and hypertensive. Difference in serum calcium level between hypertensive on CCBs and hypertensive other than CCBs were insignificant.

Conclusion: Significantly reduced serum calcium level is found in hypertensive individuals as compared to normotensive group. Lower level of serum calcium level affects the blood pressure. Essential Hypertension is associated with significant familial predisposition.
Self inserted foreign body in the urethra due to auroerotism
Authors: Shah Surendra , Shrestha Samir , Shah Jay N
Published: March 2023

Most foreign bodies in the bladder are self inserted via urethra for autoerotic stimulation. Most of them are ashamed to admit they had introduced it for sexual gratification and diagnosis is made only when got into complication. We are reporting a case of young girl who has inserted broom stick into the urethra because of sexual curiosity and it was migrated to urinary bladder which was removed using cystoscopy. Post operative period was uneventful
Pattern and trend of deliberate self harm at emergency department of Patan hospital, PAHS
Authors: Shrestha Sitaram
Published: March 2023

Introduction: Deliberate self-harm is a major problem in the developing world. This study aims at observing the general pattern and sociodemographic variables related to it.

Methods: Present study is a hospital based Prospective study which included all age group of patients with DSH. During study period ie from April 2010-to march 2011 AD, one hundred and six patients were seen in emergency department with history of deliberate self harm (DSH).

Results: Study showed more female patients than male. Common age for DSH falls on fifteen to twenty five. House wife and students were mostly involved in DSH. Patients mostly used organ phosphorus compounds for DSH. Majority of patients discharged or admitted in medical ward, but six patients died despite of management in emergency department.

Conclusion: DSH is a problem in our community which need to be studied more extensively.
Diagnostic thoracoscopy in undiagnosed pleural effusion: Our experience in Manmohan cardio-thoracic vascular and transplant Center
Authors: Shrestha Uttam Krishna , Thapa Bibhusal , Sayami Prakash
Published: March 2023

Introduction: Diagnosis of exudative pleural effusions can often be elusive leading to delayed or misdirected treatment. Pleural biopsy remains the gold standard in the diagnosis but blind biopsy have historically low yields while thoracoscopic biopsies give â‰¥90% results. We reviewed our experience with thoracoscopic pleural biopsy.

Methods: A retrospective observational study of patients with exudative pleural effusions which had Adenosinedeaminase (ADA) values â‰¤ 60 and â‰¥ three cytology samples negative for malignancy was conducted. These patients were subjected to thoracoscopy and pleural biopsy. The concordance of pre and post operative diagnosis and morbidity of the procedure were studied.

Results: Seventeen such patients with mean age of 39.3Â±19.8 years (11 to 70 years) and Male to Female ratio of 10:7 underwent thoracoscopic pleural biopsy between Jan 2012 â€“ Jan 2013. The average duration of effusion was 11.05 Â±2.34weeks. Seven patients had either taken or were currently on a course of antitubercular treatment at the time of pleural biopsy. The presumptive clinical diagnosis was tuberculosis in nine patients, malignancy in three and unsure in five. The final histopathology confirmed pleural tuberculosis in only two while metastatic adenocarcinoma was found in six patients and non-specific pleural inflammation in nine. Pleurodesis was done in six and decortication in five patients.

Conclusion: Thoracoscopy should be considered when the cause of pleural effusion is elusive. Judicious use of this diagnostic modality may avoid delayed or misdirected treatment in people with pleural effusions and also offer opportunity of therapeutic intervention when needed.
Drug resistance pattern of Mycobacteria isolated from smear positive cases of pulmonary tuberculosis in eastern part of Nepal
Authors: Pradhan Prasil , Poudyal Nimesh , Gurung Rajendra , Acharya Anju , Bhattacharya Shyamal Kumar
Published: March 2023

Introduction: The emergence of drug resistance in tuberculosis has become a major challenge for effective control of tuberculosis. This study was done with an aim to determine the drug resistance pattern of mycobacteria isolated from pulmonary tuberculosis.

Methods: Sputum samples were collected from patients attending B.P. Koirala Institute of Health Sciences, Dharan during 1st June 2006 to 30th May 2007. The smear positive samples were cultured on Lowenstein Jensen medium and drug sensitivity was performed by proportion method.

Results: Among 202 Mycobacterial isolates, 96 (47.52%) were sensitive to all four drugs, 50 (24.75%) were resistant to single drug and 15 (7.42%) were MDR strains. Higher rate of MDR was seen in previously treated cases (15.51%) than in new cases (4.6%).

Conclusion: This study reflects a high burden of drug resistant tuberculosis in the eastern part of Nepal.
Changing trend of antimicrobial susceptibility pattern of Salmonella species isolated at Kathmandu Medical College Teaching Hospital
Authors: Pradhan SB , Shrestha CD
Published: March 2023

Introduction: The present study was designed to analyze the antibiotic susceptibility pattern of Salmonella species and to determine the changing trend of antimicrobial susceptibility pattern of Salmonella species

Method: A total of 100 isolates of Salmonella species among all the blood culture samples in KMCTH lab from March 5th 2011 onward were taken into a study group and antibiotic sensitivity test was performed by Kirby Bauerâ€™s method.

Result: Out of 100 positive samples, 93 were found to be Salmonella typhi and 7 were Salmonella paratyphi. Salmonella typhi was found to be 100% sensitive to Ciprofloxacin, Amikacin & Erythromycin. Nalidixic acid was found to be the least sensitive (86.02%). Other frequent resistant antimicrobial were Ceftriaxone (7.52%), Cotrimoxazole (4.3%), Chloramphenicol (3.22%) and Ampicillin (1.07%).Similarly, Salmonella paratyphi was found to be 100% sensitive to Ciprofloxacin & Amikacin. In addition to this Chloramphenicol, Erythromycin and Nalidixic acid were also 100% sensitive but were resistant to Ceftriaxone (28.57%), Ampicillin (28.57%) and Cotrimoxazole (14.28%).

Conclusion: The emergence of Salmonella typhi and paratyphi resistant to Ceftriaxone is of very great concern.
Management of Femoral pseudoaneurysms in intravenous drugs users - A bubble trouble
Authors: Pradhan S , Shrestha K
Published: March 2023

Introduction: Femoral pseudoaneurysm in the intravenous drug users is a challenge to the treating surgeon. Surgical options range from ligation with excision to reconstruction using various kinds of grafts. However there is no generalized consensus on the optimal surgical treatment and the controversy persists.

Methods: Medical charts of 10 consecutive patients presenting with infected femoral pseudoaneurysm of the lower limbs in emergency department,who underwent surgery in Bir Hospital from Jan 2008 to Dec 2010 were retrospectively analyzed. The patients were divided into two groups randomly based on the surgical management they had received. First was the reconstructive group and the second group underwent simple ligation of the femoral artery and excision of the pseudoaneurysm

Results: All cases underwent emergency surgery. Extra anatomical Iliofemoral bypass was done in total of 7 cases, of which polytetrafluroethylenePTFE graft in 5 and Vein graft in 2 cases. Ligation of the femoral artery and excision of the pseudoaneurysm was done in 3 cases. In the reconstructive group 2 cases had to be operated twice for bleeding, 1 with PTFE graft and other with vein graft whereas 2 cases had late graft infection and was attributed to reinjection of drugs through the graft. All 4 cases underwent reoperation with ligation. In the second group with simple ligation and excision except for mild claudication, there were no other major complications. There was no mortality in both the groups.

Conclusion: Intravenous drug users have high tendency to reuse femoral site for reinjection and thus arterial reconstruction maybe in jeopardy of recurrent infection and reoperation. Simple ligation with debridement and excision may prove to be a better option in cases of emergency surgery followed by delayed reconstruction if needed.
Common presenting symptoms in children seeking first aid service in urban school
Authors: Sharma L , Sharma D
Published: March 2023

Introduction: School is an important place next to home where a child learns to be healthy. Children may seek first aid services in a school for various reasons, so there should be a proper health system in school where these problems are addressed.

Method: This is a descriptive observational study done at N. K Sing Memorial English Preparatory School. The study duration was 12 month from Baisakh 2067 to Chaitra 2067. Data were collected in school hours from 9 am to 4 pm everyday except on government holidays and vacation. List of presenting complaints from all systems were given and nursing staff were appointed in the dispensary who were trained to collect data. Number of visits in dispensary was recorded rather than the number of patients.

Result: Total 4082 visits were taken for the study; the average visits per day were 19.8 with SD Â± 5.3. Out of 4082 visits, 44.1% of visits were by males and 55.9% of visits were by females. The mean age was 9.7 years with SD Â± 2.2 years, 4.9% of visits were from age group less than 5 years, 52.3% of visits were from age group 5 to 10 years and 42.8% of visits were from the age group more than 10 years. The top five symptoms bringing students to dispensary were trauma (15.6%), Diarrhea and vomiting (14.7%), cough and Cold (11.3%) and Headache (10.7%). Visits were relatively more common in summer (66.1%).

Conclusion: There are various health necessities of school going children which need immediate first aid support. The strategy should be implemented to reinforce this need in school health program.
Patterns of road traffic accident at emergency department of Patan Hospital
Authors: Shrestha SR
Published: March 2023

Introduction: Road traffic injuries are a major cause of death and disability globally.1, 2 Road traffic injuries kill about 3000 people and 30000 are injured and disabled for life every day.3 Road traffic injuries are currently ranked ninth globally, and the ranking is projected to rise to third by 2020.4In fact, road traffic injuries alone ranked as the number one cause of the burden of disease among children between 5-14 years in 2000.5 .Report from WHO says fifty percent of the injuries occurred in the 15-44 years age group with the male to female ratio 3:1.6 In Nepal, as per estimates of morbidity and mortality for 1988-1999, injury contributed 9% to total mortality.7 Road traffic injures in developing counties mostly affect pedestrians, pass-engers and cyclists.8 The reasons for the high burden of road traffic injuries in developing countries are: growth in the numbers of motor vehicles; poor enforcement of traffic safety regulations; .8 This study was done to evaluate the pattern of Road traffic accident, visited in Emergency department Patan Hospital.

Methods: This is a prospective and descriptive study which was done at Patan Hospital. All casualties presented to Emergency department due to RTA were included in Study.

Results: Most common vehicle involved in Injury was Motorcycle and Microbus. Male population was most affected and most vulnerable age falls on 11-30 years of age.

Conclusion: Road traffic accidents are increasing and it mainly affects to young and adult age groups. Effective measures need to implement to minimize road traffic accidents.
Labour characteristics among the Nepalese Indo-Aryan and Tibeto-Burman ethnic groups
Authors: Thapa M , Manandhar BL , Sharma J
Published: March 2023

Introduction: The study was done to analyze the duration of active phase of first stage of labour and second stage of labour in the Indoaryan and Tibetoburman ethnic population.

Methods: A total of 200 patients, 100 from each ethnic groups, Indoaryans and Tibetoburmans, who underwent delivery at Tribhuvan University Teaching Hospital from April 2007 to April 2008 were analyzed. The active phase of first stage of labour and second stage of labour were compared in the two groups . The factors affecting the duration of labour were studied by correlating these factors with duration of labour.

Results : Duration of labour was found shorter in Tibetoburmans compared to Indoaryans (155.65 Â± 77.56 mins in Indoaryans Vs 134.70 Â± 89.182 mins in Tibetoburmans). In primigravidas, mean duration of active phase of first stage of labour was significantly shorter in Tibetoburmans (135.19 Â± 53.367 mins)compared to Indoaryans (189.41 Â± 65.830 mins) but the mean duration of second stage of labour was not significantly shorter. In multigravidas, the mean duration of active phase of first stage of labour was shorter in Indoaryans (120.51 Â± 73.663 mins) than in Tibetoburmans (134.17 Â± 116.885 mins) but was not statistically significant. But the mean duration of second stage of labour was significantly shorter in Tibetoburmans (26.85 Â± 26.534 mins) as compared to Indoaryans (33.73 Â± 11.595 mins).

Conclusion : Significantly shorter duration of labour is seen in Tibetoburmans as compared to the Indoaryans.
Oral Ketamine. Is it safe?
Authors: Joshi A , Awale P , Lee M
Published: March 2023

Introduction: Safety of use of ketamine by the oral route has not been verified.

Methods: Randomized controlled trial involving 30 patients in each group, comparing effects of oral ketamine and intravenous morphine on vital signs and oxygen saturation.

Results: Significant change in Systolic blood pressure was noted after administration of oral ketamine (p < 0.05), which normalized after 2 hours of administration of the drug but change in Diastolic blood pressure, Mean Arterial pressure and oxygen saturation was insignificant (p>0.05).

Conclusion: Use of Oral Ketamine can be considered a safe method for conscious sedation.
Efficacy and safety of intravaginal Misoprostol versus intracervical Foleyâ€™s catheter for cervical ripening
Authors: Lamgade A , Kharel S , Awale P
Published: March 2023

Introduction: The purpose was to compare the efficacy and safety of the intravaginal Misoprostol versus intracervical Foleyâ€™s catheter for cervical ripening and labor inductions.

Methods: A prospective Randomized controlled trial done among pregnant women requiring induction of labor at the United Mission Hospital, Tansen, Nepal. Primary outcome was proportion of women achieving change in cervical ripening and time required achieving it.

Results: One hundred women were randomly assigned to receive intravaginal Misoprostol (n=50) or intracervical Foleyâ€™s catheter (n=50). Catheter group showed statistically significant change in Bishop Score than Misoprostol (P <0.037). Oxytocin augmentation (16% vs 58%, P <0.001) and Caesarean delivery (20% vs 28%) were lower in misoprostol group, compared to Foleyâ€™s catheter group.

Conclusions: Intracervical Foleyâ€™s Catheter is a cheap and equally effective method with less complication for cervical ripening as compared with intravaginal Misoprostol.
Incidence of oxygen desaturation with intravenous ketamine and the effects of the basic airway management maneuvers on it
Authors: Joshi A , Lamgade A , Kharel S , McArthur L
Published: March 2023

Introduction: This study was conducted to evaluate and compare the incidence of oxygen desaturation during intravenous ketamine for short surgical procedure and the effects of basic airway management maneuvers during desaturation.

Methods: A Population based comparative study was done at two different hospitals situated in hilly regions of Nepal. Children aged between 3 months and 14 years were observed for their oxygen saturation with the help of Pulse Oxymeter during intravenous ketamine anesthesia for short surgical procedures lasting less than 15 minutes.

Results: Seventy nine patients from United Mission Hospital (UMN), Tansen and 66 patients from Okhaldhunga Community Hospital (OCH), Okhadhunga were enrolled; the incidence of desaturation was 8(10%) and 11(16.1%) in Tansen and Okhaldhunga respectively. 7(87.5%) and 8(72.7%) of the patients with desaturation from UMH and OCH respectively, were improved to >90% with chin lift only and rest needed jaw thrust.

Conclusion: The incidence of oxygen desaturation is common within first few minutes of ketamine administration. Basic airway measures like chin lift and jaw thrust is enough to improve oxygen saturation.
Awareness and prevalence of diabetic retinopathy among diabetic patients attending Dailekh District Hospital, Karnali Province, Nepal
Authors: Panta Niranjan , Joshi Om Prakash , Basnet Lila Bahadur
Published: March 2023

Introduction: Diabetic retinopathy is the leading cause of blindness worldwide in the age group 20-64 years. Awareness plays crucial role in management and prevention of this serious complication. There is a need of assessment of the awareness level and prevalence of diabetic retinopathy among diabetic patients in Nepal, especially in rural community. This study was intended with an objective to find out the awareness status and prevalence of diabetes retinopathy.

Methodology: A cross-sectional study was carried among the patients visiting a district hospital. The district was chosen by purposeful sampling. A total of 236 required sample size was met by convenience sampling technique and asked to fill out the questionnaire prepared in Nepali to assess awareness of diabetic retinopathy. Detailed ophthalmic consultation of the patients were done.  

Results: Most of the patients' knowledge about DR inferred from treating physicians and other means of awareness from media and family members. About twenty-four percent of respondents had a good awareness of DR. Awareness was better in males which was statistically significant at p-value of <0.013. All the respondents pointed to lack of visual symptoms as the biggest factor for not getting an eye examination. Twenty-seven percent of respondents who returned with ophthalmic consultation had some form of DR.

Conclusion: Overall awareness of DR was poor in this study. No one had met diabetic educators at any point of treatment which should be emphasized for the management of diabetes mellitus. Also, the role of media is equally important to spread awareness of DR.

Keywords: Diabetes Mellitus(DM), Diabetic retinopathy (DR)
Colonoscopy findings of lower gastrointestinal bleeding in a tertiary care hospital: a 5-year retrospective study
Authors: Karki Sanjit , Shrestha Roshan , Sharma Yuba Raj , Gautam Sanjeev
Published: March 2023

ABSTRACT

Introduction: Malignancy is one of the aetiologies of lower gastrointestinal bleeding (LGIB). Colonoscopy is the diagnostic modalities of choice. In this study we aim to examine the common causes and prevalence of malignancy among patients presenting with LGIB.

 

Method: This is descriptive retrospective study. We reviewed data of patients undergoing colonoscopy in Patan Hospital during January 2015 to December 2019.

 

Result: Total 502 patients were included in the study. Hemorrhoids (49.4%,246) were common findings followed by normal findings (21.8%, 109), colonic polyps (7.8 %, 39) and Colorectal malignancy (4.2%, 21). 85 % (18/21) were left sided malignancies. 7.11% (5/21) of had age less than 40 years.

 

Conclusion: Hemorrhoids were the most common cause and account nearly half of LGIB cases. Left sided colorectal malignancy can present   with LGI bleeding, and not uncommon even in patients less than 40 years.
Impact of COVID-19 pandemic in safe abortion and safe motherhood services in provincial hospital of rural Nepal: comparison of 3 waves of COVID-19
Authors: Dangal Binod , Basnet Manisha , Chase Hannah , KC Archana , Dangol Deeb Shrestha
Published: March 2023

Introduction: The COVID-19 pandemic has challenged the whole world with a major public health crisis, both directly due to the disease and indirectly in all dimensions of the health care system. This included safe abortion services and safe motherhood services but data quantifying this in a lower resource setting is lacking. This study analyzed the trends of safe abortion services, post abortion contraception opted during pandemic and safe motherhood services at a provincial hospital in rural Nepal during 25 months of COVID-19 pandemic, comparing data of three major waves.

Method: This is a retrospective observational study conducted at Pashupati Chaulagain Memorial Hospital. The data were collected from records of abortion and safe motherhood service registers. We compared the overall trends of safe abortion, family planning and safe motherhood services during first, second and third waves of COVID-19 pandemic and analyzed the sociodemographic profile of patients. Data analysis was done using SPSS 25 version.

Result: During the study period from February 2020 to February 2022, a total of 634 and 2054 clients received safe abortion services and safe motherhood services respectively. There was reductions in clients visiting for safe abortion services during lockdown periods of first and second waves, but no differences noted during the third wave. More numbers of women opted for condoms as a family planning method during lockdown period of first and second waves with less intake of Long Acting Reversible Contraceptives and permanent methods compared to non-lockdown period.

Conclusion: Utilization of safe abortion services was seriously affected in the first two waves due to COVID-19 pandemic presumably due to lockdowns, travel restrictions, home isolation, patient fear of going to hospitals, and health facilities prioritizing only COVID-19 and other emergencies. However, there was no impact in third wave for reproductive and safe motherhood services.
Preliminary considerations for electronic medical record (EMR) in the public hospitals of Gandaki province in Nepal
Authors: Gauchan Bikash , Sherchan Rekha , Tiwari Shreeram , Khadka Khim B
Published: March 2023

Electronic Medical Record (EMR) is the digital tool to keep records of valuable information on computer or computer-like equipment, regarding health systems, including patient’s records and stock management which can provide real time evidence for better patient record, clinical care and health policy making. As Nepal does not have a national EMR system, and it is a challenge to get real time data, information and evidence required for effective health policy making. With an effective national EMR system in Nepal, the health system can be improved with reliable information of patients for the continuity of clinical care.

 

There are existing scientific evidence of EMR on the lessons of implementation in Nepal, opportunities for the use of EMR in Malaysia, perspectives of health care workers on EMR after its implementation in Canada, on the development of success measuring tools and the use of questionnaires for the EMR implementation in Canada, best practices, impact of EMR on physician practice, and barriers for EMR implementation.

 

EMR can improve the quality, effectiveness, transparency and efficiency of healthcare services and its management. Gandaki province is one of seven provinces in Nepal and is exploring ways to implement EMR in all the hospitals operated under the province government. There can be step wise approach to have EMR in all of these hospitals. This can give more strategies for the national EMR system.
Difficult airway management in an emergency in Nepal
Authors: Das Sunil Kumar , Mahato Gaurav
Published: March 2023

Introduction: Health care provider often face challenges in managing airway in-patients in emergency department having respiratory compromise. Here in this review, we have discussed advances in management of difficult airway in emergency setting in Nepal.

Method: Articles available n google scholar with key word “ airway management’’,  “difficult airway” , “ emergency” , “failed intubation”, “ Nepal” were retrieved. Amongst which 14 articles were retrieved for the discussion.

Result: MMT was better for predicting difficult laryngoscopy when compared to measurement of sternomental, thyromental and inter-incisor distances and grading of mandibular protrusion. Similarly when comparing upper lip bite test to MMT, ULBT has better sensitivity and specificity. laryngoscopic view with 5 cm of head elevation had a better visualization.

Conclusion: The available evidence recommend using upper lip bite test in emergency setting with comparison to modified / mallampati classification. Different tests can be used in accordance to urgency of intervention.  Similarly, head elevation of 5 cm can be routinely practiced for better visualization during laryngoscopy.
Head position for better visualization of glottis to improve first-pass intubation: A narrative review
Authors: Shrestha Ashis
Published: March 2023

Introduction: Sniffing position has been suggested to improve the visualization of the glottis during endotracheal intubation however, there are controversies regarding the various position. Therefore, this review is conducted to evaluate the recent evidence.

 

Method: Articles available in google scholar on sniffing position and various other positions for intubation was retrieved. Out of 200 articles published from 2018 to 2022, 14 articles were retrieved for review.

 

Result: The sniffing position was found to be better than the head extension position. However, a few other studies did not give the consistent result to state sniffing position to be better. Head elevation to 5 cm was found to be consistent with aligning the external auditory meatus with the sternal notch. This improved glottis views. This result was also not consistent with all studies. The ramped position was found to be frequently used in obese patients with mixed evidence of benefit. One of the studies reported a modified ramped position in obese females and claimed to have improved laryngeal view.

 

Conclusion: There is inconsistency in evidence, however as there is no evidence of harm, it is wise to use sniffing position for intubation, ramped or modified ramped position for obese patients.
Effectiveness of intrauterine condom tamponade in atonic postpartum hemorrhage
Authors: Pradhan Binita , Shrestha Reena , Todi Sushila
Published: March 2023

Introduction: Postpartum hemorrhage(PPH) is the leading cause of maternal mortality. The intrauterine balloon tamponade is the efficient and economical means to treat atonic PPH so this study was done to evaluate the outcome of uterine balloon tamponade in atonic PPH.

 

Method: This was a retrospective study conducted at the Patan Academy of Health Sciences Lalitpur, Kathmandu from January 2017 to December 2019. It included women with postpartum haemorrhage due to uterine atony in whom medical treatment had failed. 

 

Result: The condom tamponade was successful in 94.7% women with uterine atony, who did not respond to uterotonic drugs and 5.3% required peripartum hysterectomy. Majority of women were in the 25-29 years age group. 73.3% were multigravida and 63.2% had vaginal delivery. No case of febrile morbidity and wound sepsis was noted.

 

Conclusion: The study concludes the use of condom tamponade as an effective means of controlling atonic PPH. It is safe, easily available, inexpensive, minimally invasive, does not require anesthesia, easy to use and can be performed by any level of health personnel with some training.
Abdominal tuberculosis can cause utero-cutaneous fistula following caesarean section.
Authors: R.C. Laxmi
Published: March 2023

A 30 year old lady was presented with complaints of intermittent pus like blood mixed discharge during her menstruation. This was located at the midline incision below the umbilicus, following a seven month caesarean section. Magnetic resonance imaging (MRI) showed uterocutaneous fistula. A uterocutaneous fistula is a rare complication following caesarean section. This was the first case of utero cutaneous fistula which was reported in our hospital. The following procedures were carried out; laparotomy, total abdominal hysterectomy with left salpingooophorectomy. The histopathology report showed tuberculosis. After nine months of treatment with anti-tubercular drugs the patient has recovered and has no complaints.
Effectiveness of cryotherapy in VIA positive women
Authors: Pradhan Binita , Malla Anagha Pradhan
Published: March 2023

Introduction: In this study we studied the effectiveness of Cryotherapy in cases with abnormal squamous intraepithelial lesions detected only by VIA.

Method: In our study, 64 patients in reproductive age group attending gynecology OPD, with complaints of discharge per vaginum, lower abdominal pain, and post coital bleeding were screened with VIA and positive women had cryotherapy and they were followed up by same after six months.

Result: A total of 64 VIA positive women had cryotherapy. Most of the women were of age group 31-40 years (40.6%). Majority of the women were of parity 2 or more (89.1%). The most common complaint was discharge (46.9%) followed by pelvic pain (32.8%). VIA was negative among most of the women (87.5%) after cryotherapy. The outcome of cryotherapy was not associated with age and parity rather presence of symptoms was statistically associated (p=0.034).

Conclusion: We concluded that in low resource settings, simple and safe diagnostic test VIA and therapeutic procedure cryotherapy are safe and effective method to combat the killer disease of cervical cancer.

Keywords: Cryotherapy, Visual inspection with acetic acid (VIA), cervix
MIS-C sequel to COVID-19 infection, diagnostic challenge and management. A case report
Authors: Paudeal Subash , Das Sunil Kumar
Published: March 2023

Multisystem inflammatory syndrome in children (MIS-C) is a sequel to sever acute respiratory syndrome coronavirus (SARS-CoV-2). Clinical picture of MIS-C includes multi system inflammation alongside fever and severe illness with laboratory evidence of raised inflammatory marker. MIS-C may resemble toxic shock syndrome, complete or incomplete Kawasaki disease and macrophage activation syndrome. Actual management of MIS-C is yet to be formulated, currently treatment is supportive. In addition, as MIS-C is new clinical entity we do not know about its long-term prognosis.
Way forward from the experiences of disaster preparedness and response at Patan Hospital during 2013-2020: Nepal
Authors: Shrestha Ashis , Bajracharya Sumana , Phuyal Naveen , Shrestha Bikal , Maharjan Kripa
Published: March 2023

The history of the disaster management plan at Patan Hospital goes back to 1995 A.D (2051 B.S). The plan was first written by Dr. Cleve Chevassut. This was a hospital-based disaster management plan and consisted of a hospital incident command system (HICS), triaging, patient flow, job description, and management protocol. This plan was regularly updated and tested with disaster drills. In the year 2013, the 10th revision of the disaster management plan was done. This plan was tested with a disaster drill and the template of this plan was circulated to different hospitals of Nepal.  This document consists of a part of experiences and evidence of hospital-based disaster activity that took place inside Patan hospital and activities to establish hospital-based disaster management plan in different hospitals of the country from 2013 to 2020. This document does not cover the overall preparedness response of all hospitals and that of the country.
Intraperitoneal instillation of Ropivacaine for postoperative analgesia in laparoscopic cholecystectomy
Authors: Prasai Adim , Prasai Abha
Published: March 2023

Introduction: Laparoscopic cholecystectomy is one of the most frequently performed elective surgical procedures. Post-operative pain has been reported to be seen in 35-63% of patients undergoing laparoscopic surgeries. Use of intraperitoneal Ropivacaine has been widely advocated in various minimal access abdomino-pelvic surgeries with satisfactory results. Laparoscopic cholecystectomy is a common surgical procedure in our hospital and pain is complained by the patients time and again in the postoperative period especially in the first 24 hours.

Method: A cross sectional descriptive study was conducted in Nepal Medical College and Teaching Hospital among 129 patients. Patients(male/female) aged 18-65 years who were given ropivacaine intraperitoneally during laparoscopic cholecystectomy were included for the study. The post-operative analgesic effect of ropivacaine, a long-acting local anaesthetic agent was assessed.

Result: Total number of female cases was 87 (67.4%) and male cases was 42 (32.6%). One hundred and fifteen (89.1%) patients fell in ASA I and remaining 14 (10.9%) in ASA II. Normal BMI was seen in 89 (69%) patients whereas 1 (0.8) patient was underweight and 39 (30.2) patients were overweight. VAS more than 4 was seen mostly at 8 hours. Adverse effect in postoperative period was seen in 11 patients. Among which 4 (36.3%) patients had tachycardia and PONV was seen in 7 (63.6%) patients

Conclusion: Ropivacaine as intraperitoneal instillation during laparoscopic surgery prolongs the time of post-operative duration of analgesia as assessed by VAS score and need of rescue analgesia.
Patterns of Diabetic Patients visit in Emergency Department in Tertiary Care Hospital
Authors: Bajracharya Manjita , Hada Batajoo Kabita , Shrestha Trishna , Pradhananga Sneha
Published: March 2023

Introduction: Diabetes mellitus is a global health problem with increasing incidence worldwide in an epidemic form including Nepal. This chronic disease leads to many complications, hospital admissions and premature morbidity and mortality. This study aimed to study the cause and number of emergency visits and to evaluate the rate and duration of hospitalisation among diabetic patients who visit the emergency department

Method: This was an observational cross-sectional study including 98 diabetic patients of >18 years presenting to emergency department of KIST medical college and teaching hospital between January 2020 to June 2020. The number and reason of emergency visits as well as number and duration of hospitalization was recorded in a semi structured proforma. The data entry was done in Microsoft Excel and analysis was done using the SPSS 24.

Result: While 61 cases (62.2%) of this sample utilized the emergency department (ED) services in last 12 monthsâ€™ period, 32.7% reported using ED once and 23.5% used 2-3 times and only 6% of the subjects had visited emergency more than 4 times within 12 months. Heart disease (18.1%) and infections (18.1%) were the most common reason for ED visit. There were 62 (63.3%) admissions from ED, 32.2% patients were hospitalized for 1-3 days, 50% were hospitalized for 3-7 days and 17.8% stayed for 1-2 weeksâ€™ duration in the hospital.

Conclusion: Majority of the diabetic patients had utilized ED more than once in past 12 months and the most common cause was found to be related to cardiac illness and infections. More than half of the diabetic patients visiting ED were admitted for mostly 3-7 daysâ€™ duration.
Radiation induced dermatitis following infrared radiation (IR) therapy in a diagnosed case of systemic lupus erythematosus (SLE): a case report
Authors: Sah Sunny Kumar
Published: March 2023

Infrared radiation is increasingly being used for cosmetic and wellness purposes. Repeated exposure to source of Infrared radiation results in a skin lesion described as erythema ab igne. Quackery is being committed by the so called therapist who uses IR radiation luring the patient for promising result. . Instead patients land up with life threatening complication like our case.  Here article we present to you a 39 year old female who presented with skin lesions after she underwent radiation therapy. We have included clinical findings of the case with review of the literature.
Early diagnosis of atypical rupture of scarred uterus: A case Report from Rural Nepal
Authors: Dangal Binod , Gupta Tula Krishna , Pathak Santosh , Upreti Arun , Acharya Bibek
Published: March 2023

A 28 years female from rural municipality of Dolakha was referred to our center diagnosis of G2P1 at 40 weeks of gestation in active stage of labor with previous CS. With the view of symptoms and history of previous CS, patient was shifted to Operation Theatre for delay in latent stage of labor, ruptured uterus identified at operating table and Caesarian Hysterectomy was done. Her post-operative hospital stay was uneventful. 

Spontaneous silent rupture can occur in women without any alarming symptom. Rapid recognition of potential uterine rupture and immediate laparotomy  lower the rate of perinatal death.
Chiến lược kiểm soát bệnh virus hoa lan ở Việt Nam
Authors: Nguyễn Xuân Dũng , Nguyễn Thị Thanh Thảo , Dương Hoa Xô
Published: March 2023

Hoa lan là một loại hoa quan trong nhất của ngành nông nghiệp đô thị Việt Nam. Trong 10 năm qua, diện tích trồng hoa lan đã gia tăng đáng kể và việc trồng hoa lan đã làm tăng thu nhập của người trồng hoa. Bệnh virus hoa lan là nguyên nhân gây thiệt hại nghiêm trọng đến năng suất và chất lượng hoa nhưng vẫn chưa có biện pháp chữa trị. Các biện pháp kiểm soát bệnh truyền thống gây êu tốn nhiều thời gian và chi phí, tuy nhiên vẫn không đạt được hiệu quả. Để kiểm soát tốt bệnh này, cần thiết lập các chiến lược hiệu quả thông qua việc sử dụng các kỹ thuật ên ến của công nghệ sinh học thực vật. Trong báo cáo này, chúng tôi trình bày kết quả đạt được trong chiến lược kiểm soát bệnh virus ở hoa lan, bao gồm sự phát hiện virus bằng kỹ thuật RT - PCR; vi nhân giống cây sạch virus; phục hồi cây nhiễm bệnh thông qua nuôi cấy đỉnh sinh trưởng và tạo cây kháng virus bằng công nghệ can thiệp RNA (RNAi). Bên cạnh các kết quả đạt được, các vấn đề liên quan đến nh khả thi, hiệu quả và triển vọng của việc kiểm soát virus hoa lan ở Việt Nam cũng được thảo luận.
National, linguistic and religious identity of the population in Serbia
Authors: Raduški Nada
Published: March 2023

Within the current processes of globalization and integration of modern economic trends and intensive migration trends, the focus of interest, not only experts but also the public in general, are increasingly coming preservation of national, linguistic and religious identity. In accordance with the scientific significance of the research of ethnicity, linguistic and religious identity, this paper studies language and religion as important components of national identity, their importance in defining nations and national issues, as well as changes caused by numerous political factors. Empirical research has shown that there is a match between nationality and mother tongue (ethnophony), while the occurrence of a greater or lesser deviation (alterophony) is present in the fewer and sparsely dispersed ethnic communities. Regarding religion, the population of Serbia is declared to the greatest extent by the tradition, that is, the religion of parents, which is why there is a high degree of compatibility between nationality and religion. Comparison of census data shows a significantly smaller number of atheists at the beginning of the 21st century, and the reasons for this should be sought in the revitalization of religion and the action of complex political, socio-cultural and socio-historical factors in Serbia.
Understanding, testing, and relaxing sphericity of repeated measures ANOVA with manifest and latent variables using SEM
Authors: Langenberg Benedikt , Helm Jonathan L. , Günther Thomas , Mayer Axel
Published: March 2023

This article demonstrates how to perform univariate repeated measures ANOVA (U-RM-ANOVA) as a special case of structural equation models (SEMs). In the literature, sphericity is usually defined in terms of variances of pairwise differences of within-subject conditions. This article illustrates the original definition by Huynh and Feldt (1970) in terms of (co)variances of contrasts using SEM and demonstrates how to impose, test, and relax sphericity, and how to test main/interaction effects with and without the assumption of sphericity in SEM. We perform two simulation studies. The first study compares Mauchly’s sphericity test with an SEM based test and shows that the two approaches have a very similar Type 1 error and power. The second study compares U-RM-ANOVA with SEM for different degrees of departure from sphericity and shows that U-RM-ANOVA and SEM have similar statistical properties in terms of Type 1 error, power, as well as similar bias and efficiency of effect size estimates of main and interaction effects. We furthermore show how to implement sphericity in latent variable models and provide software to perform the proposed tests and analyses.