bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dermatological manifestation of chronic kidney disease
Authors: Shrestha R , Basukala M , Shrestha D 
Published: March 2023

Introduction: Dermatological abnormalities are common in chronic kidney disease (CKD) and it can vary from xerosis, pruritus to hyperpigmentation, purpuric skin changes, nail abnormalities.
Methods: This is a cross sectional observational study. The objective is to determine the prevalence of skin diseases in chronic kidney disease.
Results: Forty-nine patients (30 males and 19 females) were examined. In this study, the commonest presenting symptom was pruritus in 29(59.2%). Pruritus followed by pain in 15(30.6%) and burning sensation in 9(18.4%). Hyperpigmentation was the most common finding in our study. It was followed by xerosis in 17(34.7%), nail changes in 16(32.7%), eczema in 11(22.4%), steroid induced side-effects like acneiform eruptions in 6 patients (4%) and cushingoid facies in 2 patients. Similarly generalized pruritus were noted in 9 cases (18.4%), tinea in 9 patient (18.4%), herpes zoster and verruca in 7 (14.3%each)patients, herpes simplex in 6 patients (12.2%), bacterial infection in 5 and purpura in 5 patients (10.2%each), followed by urticaria in 4 patients (8.2%), SLE(8.2%), DLE in 2(4.1%), erythema nodosum in 4 (8.2%), pityriasis versicolor in 3(6.1%). Nail changes was seen in 16(32%) and included leuconychia in (40%), koilonychia (24%), subungual hyperkeratosis (20%), onycholysis (10%), meesâ€™ lines (4%) and beauâ€™s lines (2%).
Conclusion: In our study hyperpigmentation was the most common finding followed by xerosis and nail changes.
Assessment of cardiovascular risk and obesity
Authors: Batajoo Kabita Hada , Shrestha Roshana , Sharma Madhusudan 
Published: March 2023

Introduction: There are numbers of epidemiological studies that shows clear correlation between obesity and cardiovascular risk factors like systemic hypertension, diabetes, dyslipidemia. The primary aim of this study was to assess the absolute cardiovascular risk (ACR) and cardiovascular risk factors in obese patient.
Methods: A descriptive cross sectional study was conducted at this hospital in a population who came for preventive health checkup package. The study was done over a period of 2 years from April 2011 to march 2013. Hypertension was defined as per JNC-7 guidelines. Lipid profile was assess following the criteria of Third report of National Cholesterol Education. Cardiovascular risk assessment was done by Farmingham risk assessment calculator 2008.
Result: Total 197 people: male 95(55.5%), female 75(44.5%) participated in this study. Out of which 101 (59.4%) had high BMI with equal prevalence among gender. There was significant relation of BMI with high cholesterol and high triglyceride with p-0.021 and p-0.004 respectively. However there was no statistically significant relation with alcohol use, smoking, hypertension and diabetes .The study also revealed that 22% of population had moderate and 18% had high ACR but correlation between ACR and BMI was not significant statistically (p=0.091). .However in routine ultrasound finding there was strong association of fattyliver with high BMI 59% in overweight and in 22% obese which was statistically significant P&lt;0.001
Conclusion: Prevalence of population with BMI above normal was high in this study though it did not show any clear relationship with ACR. However this study has formulated an important hypothesis that high cholesterol can be the only indicator that gives the clue towards cardiovascular risk.
Antibiogram of bacterial isolates from urine at Okhaldhunga Community Hospital: a rural setting in Nepal
Authors: Pal Anjila , Bom Rabin 
Published: March 2023

Introduction: Infection of urinary tract is the second most common site of infection after respiratory tract worldwide. The objective of the study is to study the prevalence of positive urine samples and antibiotic susceptibility pattern of the bacterial isolates in Eastern part of Nepal.

Method: A total of 210 Mid-Stream Urine (MSU) samples collected from both inpatient and outpatient departments of Okhaldhunga Community Hospital (OCH) were included in the study. Each urine samples were cultured and the antibiogram of isolates were determined as per CLSI guideline.

Result: The prevalence of positive culture was found to be 40.9%. Out of which, 82.5% were identified bacteria. The age group with the greatest number of bacterial isolates was 20-30 years. Altogether five different bacteria were identified. Among these, E. coli was the most predominant isolate (76.1%), followed by S. aureus (16.9%) and K. pneumoniae (4.2%). Nitrofurantoin was found to be the most effective drug for the Gram-negative bacilli with a sensitivity of 86.3% while Amoxicillin was least effective showing 87.7% resistance. For Gram positive cocci, Chloramphenicol and Cloxacillin were the most effective and Penicillin was least effective drug showing 84.6% sensitivity and 92.3% resistance respectively.

Conclusion: The prevalence of positive urine culture was 40.9%. The most effective antibiotic was Nitrofurantoin. Since the isolates showed high resistance towards Amoxicillin and Doxycycline, antibiotic susceptibility testing of the isolates should be performed time to time to monitor the resistance pattern of the bacteria.
Ureteroscopy and Lithotripsy service in Patan Hospital
Authors: Shrestha Samir , Shah Surendra , Poudyal Sanjay , Shah Jay N , Jaiswal Vijay Kumar 
Published: March 2023

Introduction: With advent of URSL (ureterorenoscopy and lithotripsy) and other minimally invasive technique viz; SWL (shock wave lithotripsy), PCNL (percutaneous nephrolithotomy), the urinary stones management has taken a giant leap to serve mankind. The aim of this study is to review a wide series of ureteral stones in which ureteroscopy combined with endoscopic lithotripsy was chosen as the first approach for the treatment of ureteral calculi and to study its diagnostic efficacy.
Methods: This is a retrospective study that was carried out in Patan Hospital from Feburary 2010 to Jan 2013. In all cases preoperatively intravenous urography, and a plain film of the urinary tract was taken before the procedure. The operations were carried out with the patient under general anesthesia. Rigid ureteroscopes and the pneumatic lithotripter were used. The fragments were extracted with forceps or baskets assisted with saline flush.
Results: We analyzed the result of URSL done in our hospital for variety of urology problem. We found age group 20-40, being the most common group to develop urinary calculus. Most of our patient had single stone of size >5mm. Upper ureter, mid ureter and distal ureter comprises of 4, 30 and 56 stone respectively. Our success rate of URS insertion is 96%(96/100) with complete stone fragmentation with expulsion of the fragments occurred in 97.8%(88/90). Our major perioperative complication were 3% without mortality.
Conclusion: URS is useful for diagnostic purpose & URSL is safe and treatment of choice for mid and lower ureteic calculus
current recommendation for isolation in COVID-19 infection: a perspective review article
Authors: Das Sunil Kumar , Yadav Manish , Sah Sunny 
Published: March 2023

Introduction: There have been multiple variants of Severe acute respiratory syndrome coronavirus 2 (SARS CoV- 2), a strain of coronavirus, that causes COVID-19, a respiratory illness responsible for the ongoing COVID-19 pandemic, since its first identified outbreak in Wuhan, China in November 2019. Since the pandemic began there have been various changes in the isolation period of the identified cases reducing from 2 to 3 weeks to the current recommendation of 5 days of isolation in symptom-free individuals in various countries. As of July 2022, only the Omicron variant has been identified as a variant of concern by the World Health Organization.

Method: Articles were searched in Google scholar, PubMed, CDC guidelines, NHS guidelines (UK), Indian guidelines (Ministry of Health and Family Welfare), Nepal guidelines (Ministry of Health and Population), and WHO guidelines.

Result: The guidelines recommend a self-isolation period of infected individuals ranging from 5 to 14 days after testing positive for the COVID-19 disease.

Conclusion: COVID-19 is here to stay and showing no signs of slowing down though overall fatality rate have been on decline owing to vaccination and increased immunity against the virus, it is ideal to shorten the duration of isolation and focus on protection against the virus all the times and not letting the guard down.
Analysis of presenting complaint and co morbidity of the mortality at Patan Hospital Emergency Department
Authors: Bajracharya S 
Published: March 2023

Introduction: Studies in mortality are important since they help to describe the quality of service in the particular department This study is aimed to know the various causes of mortality in emergency department and other associated factors.
Method: It is a retrospective study data will be collected from the charts of mortality patients in emergency department in the year 2067 BS. The relation of death in emergency department (ED) with time, duration of stay, age, sex and their primary diagnosis was observed. We will also determined. The cause of death and the underlying disease in these patients were also analyzed.
Result: Among those who died, their most common chief complain on initial presenting complain had been shortness of breath (28.3%), followed by unresponsiveness (16.7%), altered sensorium (13.3%), poisoning (13.3%) and others. The leading underlying disease were Chronic obstructive pulmonary disease (COPD) (11.7%), head injury (11.7%), pneumonia (11.7%), aluminium phosphide poisoning (10%) and acute coronary syndrome (ACS) (8.3%). There were various causes of death found among which commonest one being respiratory failure(30%),followed by raised ICP (11.7%) septic shock (11.7%), heart failure (8.3%), hypovolemic shock (8.3%).. Most of the patient died within 6 hours of hospital entry (n=43). 10 patients died within 6 to 12 hours and 7 patients died after 12 hours.
Conclusion: This study concludes that the most common cause of death in ED were COPD, aluminum poisoning, head injury, pneumonia and ACS.
An emergency department audit
Authors: Pandey B 
Published: March 2023

Introduction:Regular and well conducted clinical audit helps clinicians improve services. Clinical audit, with timely feedback to all staff, is one of the most powerful tools available to assess, and therefore to drive improvements in the quality, safety, consistency for urgent and emergency care.
Method: Data were collected over six months (1stBaisakh 2068 to 30th Asoj 2068) from medical register of department of emergency, Kathmandu medical college. Demography, emergency clinical diagnosis and management were analyzed.
Result: Total 3605 cases attended over 6 months period in emergency department of Kathmandu Medical College Teaching Hospital (KMCTH). Most cases (57%) were medical cases followed by surgical (27%), Obstetrics/Gynecology, Orthopedics, Pediatrics (3% each) and psychiatry, neurosurgery, ENT (2% each).
Conclusion: Emergency audit represents status of hospital in society. It guides Management to improve and expand faculties.
Pattern of ENT foreign bodies at Lumbini Zonal Hospital, a regional level ENT referral centre in Western Nepal
Authors: Pantha S , Sharma B 
Published: March 2023

Aim: Foreign bodies in ENT account for a significant number of visits to an ENT clinic. Our study was aimed to determine the load of foreign bodies in an ENT referral centre in western Nepal.
Methods: It is a retrospective analysis of all the patients who presented with foreign bodies in the ENT department of the Lumbini Zonal Hospital over a period of 9 months from April-December 2009. Charts and outpatient register of the ENT department were retrospectively analyzed using SPSS 14.0.
Results: Foreign bodies were predominant in the paediatric age group. Aural foreign bodies were the most common followed by nasal foreign bodies. Nonliving foreign bodies were more common than living foreign bodies.
Conclusion: ENT foreign bodies can be removed safely in the outpatient clinic without much complication except for the foreign bodies in the oesophagus which require removal under general anaesthesia.
Evaluation of seasonal variation in the incidences of bacterial infection among surgical patients
Authors: Basnet RB 
Published: March 2023

Introduction: Although a lot of attention has been paid to the prevention of nosocomial infections, surgical site infections (SSIs) continue to comprise a major proportion of all adverse events in surgical patients. So this study is designed to evaluate the common pathogens prevalent in surgical patients and find its seasonal trend.
Method: This is a prospective analytical study of all operated cases in General Surgery Unit III, Bir Hospital fromMarch 2010 to February 2011. Evaluation of bacteriological culture pattern among patients with wound infection 0 to 30 days after the operation was done.
Result: There were total of 564 elective and 292 emergency operations. Surgical site infection rate was 12.1%, 18.2%, 12.2% and 10.7% respectively in spring, summer, autumn and winter seasons. Staphylococcus and Enterococcus were the most common gram positive organisms isolated which were lower in colder seasons as compared to the other seasons while gram negative E coli, Acenatobacter, Pseudomonas and Enterobacter showed predominance in the warmer season.
Conclusion: If further validated, our findings could have important implications for future infection prevention intervention studies and for choice of empirical antimicrobial therapy among hospitalized adults.
Are your patients satisfied?
Authors: Acharya S , Shrestha A , Bajracharya S , Shrestha SR , Hayes B , Yadav BK , Butterworth K 
Published: March 2023

Introduction: Patient Satisfaction is an important element in patient care. There is an association between satisfaction level, patient adherence and success of the treatment. This study was conducted to measure patient satisfaction in the department general Outpatient Department (OPD) and Emergency.
Method: This was a cross sectional descriptive study conducted in Patan Hospital on 18th August 2011. All patients registering in emergency or OPD were interviewed. A questionnaire based on the Press Ganey Questionnaire was used. Satisfaction was assessed on the basis of response to each domain which included patientsâ€™ details and waiting time, registration process, physical comfort and nursing care, physician care and finally overall satisfaction with the emergency and outpatient department.
Result: Total 92 patients were included from emergency. Average waiting time was 11.7 minutes with range of 2 to 35 minutes. Patientsâ€™ satisfaction was 83.6% while there was no patient whose satisfaction was below average. Patients were satisfied on behavior of staff at registration (93.5%), and unsatisfied about doctor not telling side effects of medicine (33.7%). Similarly 196 patients were included from OPD. Patientâ€™s satisfaction was 84.7%. Satisfaction level was highest with behavior of staff at pharmacy (94%). In OPD also patients were unsatisfied with doctors not telling side effect of medicine (41.8%).
Conclusion: Our study highlights importance of communication with patients, specifically about medicine side effects for satisfaction of patients in outpatient and emergency departments.
Screening for diabetes in a local population of Patan, Nepal
Authors: Maharjan BR , Shakya PR , Bhandary S 
Published: March 2023

Introduction: Diabetes is increasing worldwide. Earlier detection and treatment of the diabetes slowed the complications associated with diabetes. Unfortunately, 30-50% of diabetes remains undiagnosed. This study is designed to estimate the prevalence of diabetes and diabetes risk group i.e. person with impaired fasting glucose (IFG) in the Patan.
Methods: We, therefore, carried out a community based cross-sectional study for the diabetes screening using fasting plasma glucose.
Results: The result showed 3.3% screen-detected and overall prevalence of 16% diabetes showing alarming picture of diabetes status in the study population. It showed significant correlation between waist circumference (WC) and WaistHip Ratio (WHR) with fasting plasma glucose (FPG) and mean arterial pressure (MAP).
Conclusion: It pointed out the need of health education and promotion to the patients for prevention and progression of the disease.
Use of interrupted Time Series Design in COVID-19 data of Nepal
Authors: Sharma Saraswati , Bhandary Shital , Nepal Shraddha 
Published: March 2023

Introduction: Nepal was hit hard by COVID-19 pandemic and is still struggling with its implications for individuals, societies, and health systems. We applied Interrupted Time Series (ITS) analysis to see if the government's decision to end two nationwide lockdowns had an impact on the average daily new cases of COVID-19 reported in Nepal.

Method: ITS analysis on daily new cases of COVID-19 was performed for first and second nationwide lockdown on data of Nepal from data depository for 2019 Novel Coronavirus Visual Dashboard operated by Johns Hopkins University Center for Systems Science and Engineering. Impact of ''ending nationwide lockdown'' and possible associated factors were investigated.
Result: The impact of removing first nationwide lockdown contributed to statistically significant rise of an average difference of 899 daily new cases due to community transmission of COVID-19. During second lockdown, even after imposing lockdown, cases overwhelmed existing healthcare system due to high infectivity of new Delta variant followed by a lack of adherence to public health measures and delayed decision to impose lockdown due to economic reasons. Whereas significant decline of cases was observed with an average difference of 2970 daily new cases after ending second nationwide lockdown mostly due to vaccine acceptance.

Conclusion: First lockdown was imposed early due to uncertainty about progression of disease, curative measures and unavailability of vaccines. Ending of first lockdown was done untimely due to economic reasons and festive seasons. The unusual decline in cases after ending second lockdown could be contributed to increased vaccination in the country.
Point prevalence of antimicrobial prescriptions among inpatient in a tertiary level hospital in Nepal
Authors: Karki Arjun , Shrestha Anmol Purna , Shrestha Abha , Shrestha Rajeev , Shrestha Roshana 
Published: March 2023

Introduction: Inappropriate use of antimicrobials increases resistance, morbidity, and mortality. Accurate information on the use of antibiotics is crucial to address the problem of antibiotic overuse and resistance. The aim of this study is to explore the antibiotic prescription pattern at inpatient departments of Dhulikhel Hospital.
Method: This prospective point prevalence study was conducted in five inpatient departments by making 25 visits between June 2018 and March 2019. Patient planned to be discharged on the day of visit was included in the study. The details of the patients who received at least one antimicrobial for at least one clinical treatment condition or prophylaxis during the hospital stay was recorded. The data on the antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality were recorded.
Result: Out of 179 patients, 125 patients (69.8%) were prescribed one or more antibiotics. There was noticeable variation in prevalence of antibiotic prescription across the departments, ranging from 59.5%-78.9 %. The top three prescribed antibiotics were third generation cephalosporins 63 (38%), broad spectrum penicillin 49 (29.5%), and metronidazole 19 (11.4%). The patients received antibiotic for non-bacteriological proven infection 66 (52.8%) and only 8 (6.4%) patient received antibiotic for bacteriological proven infection. Culture and sensitivity testing were sent in 45(36%) patients and urine was the most frequent specimen
Conclusion: Study concluded that there is need to further explore factors contributing to the high prevalence of antibiotic use and develop strategies for appropriate antibiotic use in the hospital.
Medication adherence and blood pressure control among hypertensive patients in Salyan Hospital
Authors: Sharma Pradeep , Shrestha Bikash 
Published: March 2023

Introduction: Hypertension is a chronic medical condition with severe consequences and it remains inadequately managed everywhere. Medication adherence is a critical parameter for achieving strict blood pressure control in patients undergoing antihypertensive therapy. Good medication adherence is also a key factor determining the success of preventive measures for cardiovascular risk reduction. So, we aimed to study the medication adherence and blood pressure control among hypertensive patients of Salyan Hospital.
Method: A cross-sectional observational study was conducted in Salyan Hospital. Total of 110 adult hypertensive patients were enrolled in the study. A structured questionnaire i.e. Morisky medication adherence questionnaire (MMAS-8) in Nepali version was used to measure adherence. In addition, WHO validated method of measuring BP, drug type used and type of therapy were also included. Data were entered and analyzed using IBM SPSS.
Result: Out of 110 respondents enrolled, less than half of the respondents 45.45% had controlled BP. More than 4/5thwere on monotherapy. BP control in monotherapy was 47.87% and in combination therapy was 45.45%. Patient with high, medium and low adherence were 40.9%, (44.54%) and 14.54% respectively. Level of adherence to antihypertensive drugs was related to BP control (p=0.0004). Most commonly used anti hypertensives were CCBs.
Conclusion: There was high prevalence of uncontrolled BP among hypertensive patients in Salyan Hospital. Similarly higher number of patients were on monotherapy. But BP control in monotherapy and combination therapy was similar. Higher number of patients were non-adherent. The relation between BP control and medication adherence was statistically significant. So the causes of poor BP control and poor adherence should be explored and addressed in each doctor-patient encounter.
Keywords: Blood Pressure, Medication adherence, Morisky medication adherence questionnaire (MMAS-8)