bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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
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.