bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of intubating conditions during rapid tracheal intubation between Rocuronium and combination of Rocuronium with Vecuronium
Authors: Piya Roshan 
Published: March 2023

Introduction: Rapid sequence induction (RSI) is usually indicated during emergency surgical procedure in the presence of full stomach and other conditions with an increased risk of aspiration. The use of succinylcholine has been the gold standard for RSI because of its rapid onset and short duration of action in spite of its adverse effects and contraindications in many conditions. Because of these side effects of succinylcholine many techniques have been attempted and published to replace succinylcholine when it is contraindicated. Aim of the study was to compare the quality of intubation conditions during tracheal intubation in 60 seconds after administration of thrice ED95 dose (0.9mg/kg) of rocuronium and combination of one & half times ED95 dose (0.45mg/kg) of rocuronium and one & half times ED95 dose (0.075mg/kg) of vecuronium.
Methods: Sixty patients scheduled for elective surgery requiring tracheal intubation, age ranges from 1865 years were chosen after informed consent. Prospective, Randomized, double blind study was conducted in the Department of Anaesthesiology, Tribhuvan University Teaching Hospital.
Results: The intubating conditions obtained with the combination groups were comparable with that of rocuronium alone. Most of the patients had excellent intubating condition and few had good intubating condition. The combination of one & half ED95 dose of rocuronium & one & half ED95 dose of vecuronium produced either excellent or good intubating condition during RSI.
Conclusion: Thus the combination of this drug with above dose can be an alternative to succinylcholine and rocuronium for RSI.
Data quality of reported age-sex structure from a community diagnosis program of a hilly region of Nepal
Authors: Bhandary S , Shakya SR , Sinha NP 
Published: March 2023

Introduction: Indicators of health are extensively based on the age-sex data and thus warrants a detailed assessment of data. The main purpose of this study is to assess and then adjust the various types of bias and error that can occur during any census or survey.
Method: This study is based on a cross-sectional de jure census of Ugrachandi Nala VDC, Kavre, Nepal, which was conducted during August 30 â€“ September 5, 2005. Digit and gender preference is analysed using Whipple Index Myers Index and, Age-Sex Accuracy Indices. The data is adjusted using Beerâ€™s Method and Hill Technique. Microsoft Excel 2003 and SPSS 11.5 programs were used for data entry and analysis respectively.
Result: The Whipple Indices revealed that the single year data as rough and Myers Index confirmed that 0 and 5 are the most preferred digits. Age-Sex Accuracy Indices disclosed the quniquennial age data as highly inaccurate. Single-year age data adjusted using Beerâ€™s Method and quinquennial age data adjusted using Hills Technique are found to be an ideal age-sex structure.
Conclusion: Although the reported age shows serious problems of digit preference and age displacement in Ugrachandi Nala VDC, its data quality is better than the Nepal and Kavre district. This study shows that bias and errors related to the reported age and gender in a census and survey can be identified and adjusted using various demographic tools. Thus, it is suggested to use adjusted age-sex structure for calculating demographic, epidemiological and other health indicators.
Prevalence of anemia among non-pregnant and pregnant women of reproductive age in Nepal
Authors: Bhandary S , Shrestha A 
Published: March 2023

Introduction: The prevalence of anaemia among pregnant women in developing countries is high. Iron deficiency is one of the major causes of nutritional anemia worldwide. In order to address the problem of anemia in Nepal, government of Nepal introduced the Iron Supplementation and Intensification Programs. The 2006 Nepal Demographic and Health Survey evaluated these programs and revealed the reduction in the prevalence of anemia among women of reproductive age. However, reduction on prevalence of anemia among the non-pregnant and pregnant women has not been studied separately so far. Thus, this study aims to explore the 2006 Nepal Demographic and Health Survey (NDHS) data to study the change in the prevalence of anemia among non-pregnant and pregnant women of reproductive age.
Methods: The data is taken from the 2006 Nepal Demographic and Health Survey (NDHS) which is a nationally representative survey of 10647 women of reproductive age or 15-49 years. Out of them 604 were pregnant at the time of the survey. Hemoglobin level is adjusted for the altitude and daily cigarettes smoking is used in this study. Using the adjusted hemoglobin level, anemia is classified into four categories i.e. severe, moderate, mild and any anemia.
Results: The prevalence of anemia among the non-pregnant reproductive age women is found to be 35.8%. The highest prevalence is observed for Far-Western terai (67.1%) followed by Mid-Western terai (59.4%), Central terai (55.5%) and Western terai (47.15%). Mean hemoglobin (Hb) level is found to be less than 12 g/dl at these regions. The prevalence of severe anemia among non-pregnant women of reproductive age at national and eco-development regions is less than 2%, moderate anemia is 5.6% and mild anemia is 29.8%. The overall prevalence of anemia among the pregnant reproductive age women is found to be 42.7%. The highest prevalence is again observed for Far-Western terai (69.2%) followed by Central terai (55.2%) and Western terai (52.1%). The mean h level is less than 11 g/dl at Central, Western, Mid-Western and Far-Western terai regions. Prevalence of severe anemia among pregnant women of Western terai and Mid-western terai is found to be more than 2%. Furthermore, Mid-western hill and Central terai also has equal or more than 1.5% prevalence of severe anemia among pregnant women of reproductive age.
Conclusion: There are some eco-development regions where anemia prevalence was found to be less in the pregnant women than the non-pregnant women and vice-versa. This warrants an immediate intervention policies and programs from the governmental and non-governmental agencies. Even though Nepal has reduced the prevalence of anemia among non-pregnant and pregnant women of reproductive age, it is required needs to further decrease the anemia prevalence in order to reduce the maternal mortality in the country and meet the target 5a of MDG Goal 5 on maternal health.
Comparison of Holmium Laser and Pneumatic Lithotripsy in treatment of ureteral stones
Authors: Bhandari BB , Basnet RB 
Published: March 2023

Introduction: To compare the effectiveness and complications of treatment of ureteric stones by holmium laser lithotripsy and pneumatic lithotripsy.
Methods: Comparison of 100 patients with ureteric stones, 50 of whom were treated with pneumatic lithotripsy and 50 with holmium laser lithotripsy was done and effectiveness and complications of the two were analysed.
Results: Both the groups were similar in respect to sex, age, stone size and location of the stones. Successful stone fragmentation occurred in 94 % on pneumatic group and in 92 % on laser group. On following the patients for a month, stone free rate was 98 % in both the groups. None of the patients had any complications relating to the procedures.
Conclusion: Although pneumatic lithotripsy has more retrograde migration of ureteric stones, the results are comparable to holmium laser. Other complications are very rare.
Analysis of pediatric patient admitted through emergency at Patan Hospital, Nepal
Authors: Acharya S , Shrestha A 
Published: March 2023

Introduction: It is very important to know the important causes of emergency visit of children and mortality. Identifying diseases which are common and severe enables planners to design proper priority setting and intervention planning.
Methods: This is a descriptive retrospective study done at Patan Hospital reviewing files of Pediatric patients admitted from Poush 2065 to Mangshir 2066 (December 2008 to December 2009).
Results: Out of 612 records selected, top five causes of hospital admission observed were Pneumonia 25.8%, Acute gastroenteritis 12.7%, Neonatal sepsis 12.3%, Febrile Seizure 12.1% and Enteric Fever 4.7%. The mean hospital stay observed was 4.93 days with SD 4.73 days. In this study mortality rate was 2.1% with major causes being Severe Sepsis 38.4% and Severe Pneumonia 30.7%.
Conclusions: In this study Pneumonia is found to be the common cause of pediatric admission and also contributes significantly in mortality.
Using a bedside ultrasound (US), an emerging technology, to confirm endotracheal tube (ETT) location in adults in emergency department
Authors: Bom Rabin , Maharjan Ramesh Kumar , Neupane Ram Prasad 
Published: March 2023

Introduction: Airway management is the most important aspect of patient treatment in emergency medicine. Prompt confirmation of Endotracheal Tube (ETT) in larynx is imperative for avoiding complications in sick patient. With quick learning graph, Point of Care Ultrasound (POCUS) has high sensitivity and specificity for detection of ETT in place.

Method: A prospective observational study was conducted at adult Emergency Department of Tribhuvan University Teaching Hospital among patients undergoing intubation for various reasons. Transtracheal POCUS was used to confirm the tube placement. Time to confirm tube by POCUS in trachea and by bilateral chest auscultation was noted.

Result: Of the 71 intubations, 68 were correctly identified to be in trachea and 3 in esophagus, resulting in sensitivity and specificity of 100% each. Transtracheal POCUS was the fastest method to determine endotracheal intubation (8.08 ± 1.69 seconds) compared to bilateral chest auscultation (22.37 ± 3.45 seconds).

Conclusion: With high sensitivity and NPV for confirmation of correct endotracheal tube intubation and early detection, transtracheal POCUS in emergency could be a useful tool for prompt localization of ETT and instant action needed before final confirmation by other means.
Loperamide in adult acute diarrhea
Authors: Shrestha A , Acharya S 
Published: March 2023

Introduction: Decrease in duration of diarrhea significantly reduces morbidity, loss of working days, hospital bed occupancy and use of hospital resources. Loperamide is an established treatment of acute diarrhea to decrease the duration and frequency of unformed stool with only rare adverse reactions.
Methods: This is a descriptive, cross sectional, parallel group, single centre study done in odd and even days of the month for treatment and control group. The study was conducted from 1st to 30th September 2010 in Patan Hospital Emergency Department.
Results: Out of 104 patients, 43 patients were included in Loperamide group and 63 patients were taken in supportive treatment group. Mean duration of diarrhea was 16.3 and 41.9 hours in supportive plus Loperamide group and supportive treatment only group respectively. Mean difference in duration of diarrhea was 25.6 hours 95% CI (23.9 to 27.3) (P<0.05). Similarly mean working day loss was 1.19 in group treated with Loperamide and 2.84 days in group not treated with Loperamide. Mean difference was 1.65 days CI 95% (1.45 to1.85) (P<0.05). Absolute risk of complication in Loperamide group was 6.6%
Conclusion: Loperamide significantly reduces duration of diarrhea and working days lost with low rate of complications in Adult with acute non infective diarrhea.
A study on effect of different inter-pregnancy intervals on perinatal outcomes
Authors: Bajracharya S 
Published: March 2023

Introduction: Both short and long inter-pregnancy intervals have been found to increase various adverse perinatal outcomes such as low birth weight, preterm delivery, and small for gestational age, still birth and neonatal death. This proposed study was endeavor to find out impact of different inter-pregnancy interval on perinatal outcome like preterm birth, low birth weight, perinatal death in second gravida women of age group 18 â€“ 35 years
Methods: This is a cross-sectional study conducted in Patan Hospital, Lalitpur in 2064 B.S. from 1st of Magh to 31st Falgun. Total 84 Patients included in the study were the women of second gravida of age group 18 â€“ 35 years. The study population was divided into three inter-pregnancy interval < 18, 18 â€“ 59 & >59 months. All the women of second gravida who fitted in the study were interviewed with the questionnaire after taking an informed consent.
Results: Among the total 84 women who were included in the study, maximum number (57.1%) of women were of IPI >59 months. In women with IPI <18 months & IPI>59 months, 33.4% & 16.7% of women had preterm delivery respectively. All women with IPI 18-59 months had termed delivery. (P value=0.007). Among women with IPI <18 months & >59 months, 50.05% & 25% woman had delivered low birth weight babies respectively. And in a group of IPI 18- 59, only 16.7% of women delivered low birth weight babies. (p value=0.272). There was only one perinatal death in the group of IPI > 59 months. In comparison of APGAR score at 5 minutes of delivery with IPI, all babies were found to have APGAR score 7 - 10.
Conclusion: There is an increased risk of preterm & low birth weight babies in women with IPI < 18 months and > 59 months compared to women with IPI 18 â€“ 59 months
correlation between arterial and venous sodium and potassium values in critically ill patients by arterial blood gas and electrolyte analyzer attending tertiary hospital of Nepal
Authors: Bhusal Pramila , Nepal Suresh Prasad 
Published: March 2023

Introduction: Electrolytes are elements and compounds that occur naturally in the body and control important physiological function. Electrolyte disorder occurs when the levels of electrolytes in the body are either too high or too low. The causes, severity, treatment, and outcomes can vastly differ depending on the implicated electrolyte imbalances. The objective of this study is to comprehend the correlation between sodium and potassium levels measured in critically ill patients attending a tertiary care hospital of Nepal.

Method: This study was a hospital based prospective observational comparative study conducted in the Department of General Practice and Emergency Medicine, Bir hospital, Kathmandu, from June 2019 to December 2019. After fulfilling inclusion and exclusion criteria a total of 95 patients were included in the study. Data were entered and analyzed in SPSS 20. The findings were presented in figures and tables. Statistical analysis was done using appropriate formula. Mean, standard deviation and correlation coefficient were calculated.

Result: The mean value of arterial sodium was 134.67mmol/L and venous sodium was 135.93mmol/L. The mean value of arterial potassium was 4.0mmol/L and venous potassium was 4.19mmol/L. The correlation coefficient obtained for sodium was 0.703 and for potassium was 0.436. There was positive correlation of arterial sodium and arterial potassium with venous sodium and venous potassium indicating agreement between the parameters.

Conclusion: Arterial sodium and arterial potassium can be used instead of venous sodium and venous potassium levels in management of critically ill patients.
Prospective study of intubation after physiological optimization in the emergency department
Authors: Das Sunil Kumar , Chhantel Narma , Shah Ashok Kumar , Tiwari Umakant , Maharjan Kripa 
Published: March 2023

Emergency departments witness all sorts of unprecedented types of patients with respiratory compromise. Airway management must be done expeditiously in dire situations. It’s a well-known fact that patients are not well optimized for intubation as soon as they land up in an emergency. There might have a myriad of comorbidities to be addressed. Amongst various, we have discussed intubation in patients with increased intracranial pressure, patients with shock, patients with acidosis, and patients with respiratory failure. To have a better understanding of the physiological status of patients, reviewed 18 articles, and retrieved a synopsis from the abstract and conclusion. Here we have discussed the physiological optimization of patients based on current recommendation.
Outcome of bipolar transurethral resection in benign enlargement of prostate: A retrospective analysis.
Authors: Shrestha Samir , Maskey Pukar , Shah Jay N 
Published: March 2023

Introduction: Lower urinary tract symptoms (LUTS) secondary to benign enlargement of prostate (BEP) is one of the common urological problem in men. Bipolar transurethral resection of prostate (B-TURP) is a standard surgical intervention for BEP. In this study we aim to analyze the perioperative outcome and complications of B-TURP for BEP.
Method: This retrospective study analyzed the perioperative outcome & complications of B-TURP in patients with BEP from August 2017 to July 2020at Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal. Data was collected from the operating room register and from inpatients files from the record section. SPSS version 16 was used to analyze the data. Study variables included age, ASA grade with known concomitant co-morbidities, prostate volume, total prostate specific antigen (TPSA), operative time, decreased hemoglobin level, postoperative bladder irrigation duration, hospital stay, transurethral resection syndrome (TURS), hyponatremia, blood transfusion, postoperative hematuria requiring intervention, postoperative acute urinary retention, urinary tract infection (UTI) and urine incontinence.
Result: A total of 72 patients underwent B-TURP. Data was analyzed on 46 patients. Those with incomplete data and those files which were unable to retrieve were not analyzed. Perioperative outcomes were: median operative time was 81.73 minutes, median hospital stay was 3.4 days, median decreased hemoglobin was 3.0 g/dl and median postoperative bladder irrigation duration was 22.50 hours. Perioperative complications were: hyponatremia in 1 (2.1%), postoperative urinary retention in 2 (4.3%), blood transfusion in 4 (8.6%), postoperative hematuria requiring intervention in 3(6.5%), urinary incontinence in 8(17.3%) & urethral stricture in 6 (13.0%). There were no TURS & mortalities.
Conclusion: Our study shows B-TURP is safe procedure with minimal morbidity for the treatment of benign enlargement of prostate.
Keywords: Benign enlargement of prostate (BEP), bipolar transurethral resection of prostate (B-TURP), lower urinary tract symptoms (LUTS)
Audit of Cesarean section by non-obstetricians in the remote part of Nepal using the Robson classification system.
Authors: Ghimire Rajan , Rai Tupesh Thulung , Dhamala Manoj , Adhikari Sugat 
Published: March 2023

Introduction: Cesarean delivery is increasing throughout the globe. It is increasing here in Nepal too. There are inequalities in cesarean deliveries in urban and rural/remote areas. Through this study, we tried to see the Cesarean delivery rate in one of the remote districts of Nepal and audited the Cesarean deliveries as per the Robson classification system.
Method: A retrospective cross-sectional study based on secondary data collection of sixteen months (Aug 2019 to Dec 2020) was designed for this purpose. We collected data from the health management and information system (HMIS) maternity registry and record files of inpatients located in District Hospital, Terhathum. We used the Robson classification system and Robson reporting table for the analysis purpose.
Result: We included 495 participants. The overall Cesarean rate was 12.9%. Robson group 1 i.e. nulliparous, single, cephalic, >37 weeks of gestation contributed most (40.63%) in cesarean delivery followed by group 5 (17.19%) i.e. multiparous, single, cephalic, >37 weeks of gestation with previous Cesarean section (CS).
Conclusion: In our study, the main contributor to CS was Robson group 1 i.e. nulliparous, single, cephalic >37 weeks of gestation followed by group 5 i.e. multiparous, single, cephalic >37 weeks of gestation with previous CS. Though the CS rate is within the WHO recommendation, we need to intervene to decrease CS in low-risk groups and strengthen hospital facilities for vaginal birth after Cesarean (VBAC).
Assessment of knowledge towards emergency contraceptives among college students in Ramechhap district of Nepal
Authors: Pokharel Yagya Raj , Pokharel Shaluja , Shrestha Bharat Kumar 
Published: March 2023

Introduction: A high rate of unintended pregnancy exists among college students as they belong to the sexually active age group. So, it is significant to know the knowledge of college students regarding emergency contraceptives.

Objectives: To assess the knowledge of students towards Emergency Contraceptives and to identify the association between male and female students towards knowledge of emergency contraceptives.

Method: An online survey in Ramechhap district among college students studying in bachelor’s and master’s level was conducted from March 15, 2022 to April 10, 2022 where total of 169 students participated. Non parametric test was used to find the result of the objectives.

Result: The study showed that 83.4% students had the knowledge of Emergency Contraceptive pills and 59.2% of students first heard about such pills in the last 5 Years. Among them 79.9% of students knew where to get Emergency Contraceptive pills, 24.2% of students know the Emergency Contraceptive pills works if there is menstrual delay. Only 56.9% of students know the time to take Emergency Contraceptives pills after unprotected sexual intercourse and 46.7% of students know that the Emergency Contraceptive pill is not used for regular contraception. Only 49.1% of students know the right number of tablets that needs to be consumed after unprotected intercourse.

Conclusion: Majority of the students are aware of the Emergency Contraceptive pills however they have limited understanding about it. In comparison to female students, male had better understanding about Emergency Contraceptives.
Management of strangulated inguinal hernia with Resection and Anastomosis in a primary health care setting during COVID -19 crisis
Authors: Sapkota Sanju 
Published: March 2023

Introduction: Longstanding reducible hernia should be intervened timely so as to prevent the risk of strangulated hernia and resection and anastomosis of gut. Strangulated hernia is a surgical emergency and only timely surgical intervention can prevent from further deterioration of patientâ€™s health condition.
Case Report
There was a case of 75 years male from rural area of Eastern Nepal at Charikot Hospital emergency department, with the complaint of severe pain and swelling over right inguinal region, associated with abdominal distension, vomiting, not passing stool for 3 days. He had history of swelling of right inguinoscrotal region for last 5 years. Intraoperative finding showed that there was indirect hernia and the content was jejunum and omentum which was gangrenous, resection and anastomosis along with bassini's repair was done.
Conclusion: Hernia should be managed as soon as the diagnosis is confirmed before emergency visit due to serious risk of obstruction and strangulation. So, we should repair any inguinal hernia on an elective basis in any age group.