bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitude of doctors working in a tertiary hospital towards Do-not-resuscitate decisions
Authors: Adhikari Sunil , Rijal Suraj 
Published: March 2023

Introduction: There has been many discussions around the world regarding various forms of end-of-life decisions and healthcare professionals might have different views towards do not resuscitate (DNR) which might have been influenced by the medical education, especially after clinical training. Hence this study is designed to explore the attitudes of doctors towards DNR decision.
Methodology: This was a descriptive cross sectional study conducted between August 2016 to November 2016 in Patan Hospital. Preformed structured questionnaires were given and the experience of events occurring around DNR decisions and problems associated with it were assessed. The attitude towards DNR was assessed using Likert scale and calculating their mean scores.
Result: Out of 106 respondents, there were total 53 interns and 53 medical officers. Almost all the doctors (96.2%) had experience in CPR and majority (88.7 %) had experience of dealing with death of a patient and had administered CPR even when there was DNR decision. The mean score of the doctorâ€™s attitude towards DNR was 3.44, most of the doctors, especially interns had conflicts with family members while taking DNR decisions.
Conclusion: This study reflects that doctors working in Patan Hospital have a positive attitude towards DNR decisions.
Analysis of dead on arrival at emergency department of Patan Hospital
Authors: Bajracharya Sumana , Shrestha Ashis 
Published: March 2023

Introduction: Prehospital care plays an important role in reducing the death on arrival from injuries and critical illnesses. This study is aimed to analyze the prevalence of the patients who were brought dead on arrival at emergency department of Patan hospital.
Method: This is a cross sectional study conducted by reviewing the record of patient who were brought dead to emergency department. The records from 15th June 2017 to 15th May 2018 were analyzed.
Result: Total 48,853 patient visited Patan Hospital emergency department in one year. Out of these patients 98 (20 out of 10,000 patients) had mortality in emergency department while 241 (49 out of 10,000) were dead on arrival to emergency department.
Conclusion: Twice the number of patients are dying on the road compare to inside emergency department.
Maternal and neonatal outcome following induction with misoprostol versus oxytocin in primigravidae at term
Authors: Maharjan Rony , Thapa Ganesh 
Published: March 2023

ABSTRACT
Introduction:The purpose of this study was to compare the outcome of vaginally administered misoprostol versus intravenously infused oxytocin for labor induction in term primigravidas.
Method:A total of 106 term primigravidas with indication for induction were assessed for eligibility to enter the study. Those meeting the inclusion criteria were assigned to two groups, women induced in TUTH as misoprostol group and WRH as oxytocin group. The misoprostol group received 50 Âµgm every 6 hours upto 2 doses.The oxytocin group received an infusion of 5 units which was gradually increased upto 60 drops/min maximum of 3 pints. The outcome of labour was compared in the two groups.
Result:Fifty-three women received oxytocin, and 53 women received misoprostol. Maternal demographics, pre induction Bishop scores, were similar between both the groups. Mean induction to delivery interval were similar in both groups (10.04 vs 10.64 , P value = 0.68). Caesarean delivery rate was higher in oxytocin (34%) compared with misoprostol (13%). There was no difference in maternal complications or neonatal outcome between the two groups.
ConclusionMisoprostol is a safe and effective drug for the induction of labour in term primigravidas. Failure is seen less with misoprostol and caesarean sections are less frequently indicated as compared to oxytocin.
A study of pattern of orthopedic injuries among patients attending an emergency department of Civil Service Hospital, Kathmandu Nepal
Authors: Pant Ramesh , Lamsal Dinesh Kumar , Thakali Kabir , K.C. Kapil Mani 
Published: March 2023

Introduction: Trauma is a common worldwide problem which has detrimental effect in the public health. It is one of the several prevailing causes of morbidity and mortality. The aim of this study is to reveal the existing nature of orthopedic injuries as seen in the emergency department and to identify potential areas of improvement for the enhancement of trauma research.
Method: This study has been conducted prospectively. All the physical trauma patients visiting the emergency department of a tertiary care hospital over the period of one year were included in study. The population of the study included patients with all kinds of orthopedic injuries. Data was entered in Statistical Package for the Social Sciences (SPSS 16) to analyze, and the result of is obtained in terms of mean (percentage), appropriate plots, and chart where appropriate. The cases with pathological fracture, patients with end stage chronic diseases, and post-operative state were excluded from the study.
Results: Total of 2823 orthopedic injury patients visited the emergency in a year, which comprised 15.46% of total emergency Patients. The gender distribution was 68.4% males and 31.6% female. Only 9.8% of the patients arrived to hospital on ambulance. 34.4% of the cases arrived within one hour of trauma incident. Fall was the most common cause of injuries(40.1%) followed by road traffic accident (34.6%).The study revealed that the most common injury was fracture (33.7%), followed by sprain & strain (26.0%), laceration (19.2%), contusion with intact skin (10.0%) and dislocation (9.1%). Commonly associated visceral injury was the head injury in 12.4% cases, followed by thoracic injuries in 10.8%, abdominal injuries in 1.7 % cases. Emergency department team alone treated and discharged 54.1% patients, whereas the remaining 45.9 % patients required specialized evaluation and treatment by other departments. Total 18.2 % patients were referred to other centers for further specialized treatment like neurosurgery, CTVS consultation, for ICU facility, for vacant admission bed, and on their wish to go to other center for further treatment.
Conclusion: Fall injury and road traffic accident were the most common cause of trauma. Younger adults in their active period of life were found to be involved more in physical trauma incident. In addition to the healthcare improvement, road safety regulations should also be strengthened and enforced, which can save more lives and reduce the severity and duration of the illness.
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.
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.