Europasian Journal of Medical Sciences

Opportunities and Challenges for Effective Implementations of Karnali Province Health Policy

Padam Simkhada, Sharada Prasad Awasti — Sat, 21 Aug 2021 08:15:42 +0000

Diaphyseal Femur Fracture in Paediatric Age group: Outcome with fixation by Elastic Nailing System

Sat, 21 Aug 2021 07:41:45 +0000

Background: Diaphyseal femur fracture in paediatric age group account for 1.6%
of all paediatric fractures. Fracture fixation by elastic nail provides three point
fixation. This study aims to assess the outcome of diaphyseal femur fracture
in paediatric age group from 5 to 15 years treated with titanium elastic nailing
system.
Methods: Thirty six patients with diaphyseal femur fracture were treated with
titanium elastic nailing system from November 2018 to August 2020 was analyzed
prospectively. All the patients were followed up for six months for the study. Final
outcome was evaluated at six months.
Results: The mean time of fracture union was 9.12 weeks. Two patients had limb
lengthening of 6 mm and 8 mm respectively. One patient had 1 cm of shortening
and 8 degree of varus angulation and 9 patients had bursitis over nail insertion
site. According to Flynn grading 26 cases have excellent results (72.22%) and 10
cases have satisfactory results (27.78%).
Conclusion: Diaphyseal femur fracture can be treated with elastic nailing system
with early mobilization and good functional outcomes.

Relaparotomy after Cesarean Section in a Tertiary Center

Sat, 21 Aug 2021 07:36:25 +0000

Background: Relaparotomy after cesarean section is associated with
significant maternal morbidity and mortality which can be prevented with
proper precaution during the primary surgery. The objective of the study
was to determine factors associated with relaparotomy after cesarean
section.
Methods: A hospital based descriptive cross sectional study conducted
by analyzing the records of 3 years from 1st July 2017 to 30th June 2020,
among the women who underwent relaparotomy after cesarean section
at Paropakar Maternity and Women’s Hospital, Kathmandu.
Results: There were 21,270 cesarean sections among 64,475 deliveries
with the mean incidence of 32.6%. A total of 22 patients underwent
relaparotomy out of which 18 had their primary surgery performed at our
hospital i.e. 0.08% of the total caesarean section, and 4 cases were referred
from peripheries. 60% of primary surgery were done by residents and
the commonest indications of primary surgery were previous CS (36.3%)
and obstructed labor (27.2%). Primary PPH was the major indication
for laparotomy (31.8%) with mean interval from primary surgery of 4.7
hours followed by burst abdomen (22.7%) and secondary PPH (18.1%).
Hysterectomy was the commonest operative intervention done during
relaparotomy accounting for 45.4% followed by tension suture for burst
abdomen (18%). There were 2 maternal death among them which were
due to aspiration pneumonia following eclapmsia and DIC.
Conclusion: Relaparotomy has increased risk of adverse maternal outcome
but still is a lifesaving intervention. Early recognition, timely intervention
and multidisciplinary teamwork helps to decrease the complications
associated with it.

Clinico-pathological Analysis of Cervical Pap Smear in Patients Attending Gynecology OPD of a Medical College

Sat, 21 Aug 2021 07:35:35 +0000

Background: Cervical cancer ranks the most common cancer among
Nepalese women. Cervical and vaginal infections constitute the most
common gynecological problems. Through Pap smear screening, early
diagnosis, follow up and treatment, morbidity and mortality can be
reduced by 70% and 80% respectively.
Methods: This retrospective study was conducted to know the incidence
of abnormal cervical epithelial lesions and cervico-vaginal infections. It
was carried out in the Outpatient Department of Gynecology at Chitwan
Medical College from April 2018 to March 2019. The data were collected
and standard statistical analysis done using Microsoft Excel 2007.
Results: The most prevalent cervical epithelial cell abnormality was
atypical squamous cells of undetermined significance (3.43%) whereas the
least common was low grade squamous intraepithelial lesion (0.21%). The
most prevalent cervical vaginal infection was Bacterial vaginosis (12.30%)
whereas the least prevalent was Trichomoniasis (0.29%). The majority of
the women with epithelial cell abnormality were in the age group of 31-40
years whereas the lowest number in the age group less than 20 years. The
highest prevalence of cervical vaginal infection was in the reproductive
age group (31-50 years) and the lowest in the age above 51 years. Most of
the patients had multiple symptoms like vaginal discharge, genital itching,
whereas only (20.17%) visited for routine screening.
Conclusion: Atypical squamous cells of undetermined significance and
Bacterial vaginosis were the most common findings in Pap smear test
representing abnormal cytology of cervix and cervicovaginal infection
respectively.

Prevalence, Knowledge and Risk Factors for Postpartum Depression in Western Nepal - A Cross-Sectional Study

Sapana Karki, Shila Gurung — Sat, 21 Aug 2021 07:17:12 +0000

Background: Postpartum depression(PPD)can be defined as nonpsychotic
depression occurring within a year after childbirth, characterized
by low mood, unusual thoughts, feeling of guilt, unexplained anxiety,
worthlessness, and other depressive symptoms. Objective: This study
aims to assess the prevalence, knowledge and risk factors of postpartum
disorder.
Methods: A cross-sectional descriptive study was conducted among
217 postpartum mothers in the outpatient department of psychiatry
of a tertiary care hospital using the Edinburgh postnatal depression
scale(EPDS). All the patients enrolled were directly interviewed using
a structured questionnaire to identify the associated risk factors of
postpartum depression. The data collected were checked for validity and
analyzed using S.P.S. version 16.0.
Results: Out of 217 patients, five women were found to have an
EPDS(Edinburgh postnatal depression scale) score greater than 10.
The prevalence of postpartum depression was found to be 2.3%.Upon
evaluation of knowledge about postpartum depression, 90.3% of women
were found to have a poor level of knowledge and 8.8% had a good
knowledge level. The statistically significant factors associated with
postpartum depression were the lack of support from family and partners
(p<0.005).
Conclusion: There was a comparatively low prevalence of P.P.D. in Western
Nepal. Majority of the mothers (90.3%) were found not aware of P.P.D.
The present study concluded on the need for educational intervention
among the mothers regarding P.P.D. in Western Nepal.

Misconception and Effect of Menstruation (Chhaupadi) and Delivery on Women’s Health in Bajura, District Nepal

Chetraj Pandit, Anil Kumar Singh, Ayuska Parajuli, Ashok Pandey — Sat, 21 Aug 2021 00:00:00 +0000

Background: Chhaupadi is the old unscientific system in mid and far
western parts of Nepal. Reproductive age women were considered unclean
during the menstrual and delivery period. Invisible cultural taboos and
practices were prevailing in each and every household. The objective of the
study is to assess the associated factors affecting during Chhaupadi and
delivery practice with their health outcome.
Methods: The cross-sectional descriptive study was conducted amongst
175 reproductive age women in Bajura districts of Nepal, by using
multistage random sampling. Both qualitative and quantitative methods
was used. All the data were entered in Ms excel and exported into
SPSS 16.0. The necessary descriptive and inferential statistics was used
for quantitative analysis and thematic analysis was done for qualitative
analysis.
Results: More than one third (38.9%) of the participants were in the age
group 20-29 years. Almost all the participants were from Hindu religion.
The majority (91%) of participants know about the Chhaupadi system.
Almost (74%) of the participants were staying in the Chhaupadi hut during
menstruation. Similarly, (78.3%) of the respondents were mentioned, they
did not like the Chhau system and never like to continued. There is a
significant association between health effect in women and the Chhaupadi
system (p < 0.031).
Conclusion: We conclude that the larger proportion of women in Bajura
District still believes in old unscientific tales and Chhaupadi practices
which lead to the different health problems.

Incidence of Congenital Fetal Malformations in Tribhuban University Teaching Hospital, Kathmandu, Nepal: a Hospital Based Study

Sunita Bajracharya, Deepak Rajbhandari, Binay Gurung, Asma rana — Sat, 21 Aug 2021 07:39:35 +0000

Background: Birth defects are the abnormalities in structure or function
present at birth. Major abnormalities of birth defects lead to physical or
developmental disabilities which may need urgent medical or surgical
treatment and may cause death in early days of life. The objective of this
study is to find the incidence of congenital abnormalities in this institution.
Methods: This was a prospective study conducted in Institute of
Medicine, Maharajgunj Medical Campus, Tribhuwan University Teaching
Hospital from April 2014 to February 2016 . All the delivered babies in
this hospital during the study period were included. All the birth cases of
gross congenital fetal malformation were identified and carefully studied
and classified with the help of the International Classification of diseases
(ICD-10).
Results: Out of total 8300 birth in 22 months study period, congenital
fetal malformation delivered during this period was 94 (1.13%) in 7868
live birth. The maximum number of congenital fetal malformation was
seen in musculoskeletal system 24.44%. This was followed by a central
nervous system 17.02%, gastrointestinal system 12.76%, and cardiac
system 10.63%. There was equal number of congenital fetal malformation
seen in renal system and genitourinary system 7.44%, in craniofacial
system and miscellaneous 9.57%.The lowest number of congenital fetal
malformation seen in respiratory system 1.06%.
Conclusion: Fetal congenital malformation has a major role in morbidity
and mortality of neonates and children as well. The most common system
involved in our study was musculoskeletal.

Factors Related to Late Intrauterine Fetal Death in a Tertiary Referral Center: A Retrospective Study

Sandip Kuikel, Preezma Shrestha, Sunita Bajracharya, Sagar Poudel, Bijay Thapa — Sat, 21 Aug 2021 07:38:32 +0000

Background: Intrauterine fetal death is a contributor of perinatal outcome and is an
important indicator of the quality of antenatal care. Despite efforts, risk factors cannot
be identified in cases of intrauterine fetal deaths. This study aims to identify the maternal,
fetal, placental and cord related factors related to it.
Methods: It is a retrospective cross-sectional study conducted analyzing patients admitted
with intrauterine fetal deaths after 28 weeks of pregnancy at Tribhuwan University Teaching
Hospital from April 2019 to March 2020 using in hospital admission records of the patient.
It was conducted after taking ethical approval from Institutional Review Committee(IRC)
of Institute of Medicine (IOM). Data were collected from review of charts of individual
patients in MS Excel and was analyzed using SPSS.
Results: There were 5496 births and 46 intrauterine fetal deaths during the study period
giving stillbirth rate of 8 per 1000 births. It was common in the age group of 26-30 years
(34.8%), 62.2% were from inside Kathmandu valley,43.5% were just literate, 13% were
illiterate, 84.8% were housewives, 56.5% were primigravida and 69.57% of the babies were
preterm. Only four percent had previous history of intra uterine fetal deaths. Hypertensive
disorders complicating pregnancy were found in 30.5% followed by heart disease in 10.9%
of the mothers. There were no known co-morbidities in 26.1% of the patients. Out of total
46 cases, 62% were female and 38% were male. Two had Rh isoimmunization and four had
congenital malformations. Placenta previa was seen in four percent and abruptio placenta
in two percent. Twin pregnancy with diamniotic dichorionic placenta was present in four
percent. Seventeen percent of the babies had cord around the neck and two percent had
thrombosis of the umbilical cord.
Conclusion: Low level of maternal education and maternal comorbidities like hypertensive
disorders complicating pregnancy were found to be most common factors seen in cases
of intrauterine fetal deaths.

Profile and Outcome of Snake-bite Envenomation: in Far-western Province of Nepal: An Observational Hospital-based study

Sat, 21 Aug 2021 08:01:51 +0000

Background: Snakebite is a well-known medical emergency and a cause of
hospital admission with significant mortality in our country. So, this study aims
to find out the status and outcome after the envenomation of snake bites in the
Farwest Provincial hospital of Nepal.
Methods: This is a prospective observational study from 15th April 2018 to
14th April 2019. All the snake bites presented to the hospital were recorded and
observed till discharge, death, or referral. Case management was done as per the
WHO guideline 2016. Ethical permission was taken from the hospital and informed
consent was taken from each participant. The data were entered in Microsoft Excel
and analyzed using SPSS and data analysis was done with appropriate descriptive
statistical tools.
Results: A total of 362 snakebites were admitted to the emergency department
of this hospital during one year period, among them, 71% were non-poisonous,
and the remaining 29% were poisonous. There were 17 deaths out of 362
snakebites with a case fatality rate of 12 %. Among poisonous snakebites, 36%
were Krait. Major clinical features of envenoming were ptosis, nausea, vomiting,
pain abdomen, parotid tenderness, numbness, blister, and bleeding in the bitten
parts. 86% of poisonous bites were given 100ml vial of snake venom antiserum.
Few cases required additional 10 vials (100ml) and 13.5% required mechanical
ventilation support for respiratory paralysis. There was no mortality in the
Intensive Care Unit and ward.
Conclusion: Snakebite is a seasonal life-threatening emergency public health
problem in the Farwest Province of Nepal. There is high mortality of snake bites
without intervention and excellent outcomes after proper intervention at the time
were observed. Community awareness and strengthening health systems are
major activities to be done to reduce the burden of Snakebites cases.

Health Related Quality of Life of Pregnant Women attending Antenatal Clinic of a Tertiary Level Hospital in Kathmandu

Radha Paudel, Anisha Deuja — Sat, 21 Aug 2021 07:43:49 +0000

Background: Pregnancy is a normal physiological process; the major
changes at that period are related to the direct impact on health-related
quality of life. The main objective of the study was to assess the healthrelated
quality of life of pregnant women.
Methods: A descriptive cross-sectional study design was used among
106 pregnant women. A non-probability purposive sampling technique
was used. Data were collected from 23 August 2019, to 31 August 2019.
A semi-structured interview schedule was used for data collection. Data
were analyzed by using descriptive statistical methods such as frequency,
percentage, mean, standard deviation, and inferential statistics such as
Chi-square test and Fischer’s exact test was used to associate selected
socio-demographic and obstetric characteristics with the level of quality
of life. A p value less than 0.05 was used for statistical significance.
Result: The study showed that the respondent’s level of health related
quality of life was highest in the psychological domain 102 (96.2%) and
the lowest level 15 (14.2%) was found in the physical domain. There was a
significant association of physical domain in health related quality of life
with the age of pregnant women (p-0.003) while the type of family, parity,
mode of delivery, and duration of pregnancy was not associated with the
physical, psychological, and social domain at p <0.05.
Conclusion: The health related quality of life of pregnant women, in
general, was good. The physical domain was most affected than the
psychological and social domain. The level of health related quality of
life of the pregnant women in the physical domain is associated with the
age of pregnant women. Improving the quality of life of pregnant women
requires better identification of their difficulties and guides them from
midwives since early pregnancy whenever possible.

Functional Outcomes of Pediatric Both Bone Fractures Fixed with Titanium Elastic Nails: : A Hospital Based Study

Sat, 21 Aug 2021 00:00:00 +0000

Background: Successful treatment of both bone fractures depends on the
restoration of normal alignment and full recovery of range of motion that can
be achieved by either closed reduction and casting or surgical intervention.
Number of surgical treatment modalities have been mentioned for unstable
pediatric both bone fractures that includes Kirschner wire fixation, plating,
external fixation and elastic intramedullary nailing.
Methods: This was descriptive cross-sectional study performed from January
2016 to December 2019. A total of 85 diaphyseal pediatric forearm fractures
were treated surgically with titanium elastic nails(TENs) during this period.
Functional outcomes and complications were analysed 6 months after
surgery.
Results: The mean age of patients in our study was 10.67±1.88. There were
50 (64.1%) male and 28 (35.9%) female. Incidence of fracture is higher in
left side 47 (60.2%) in comparison to right side 31 (39.8%). Fifty (64.1%)
fractures were in middle third, thirteen (16.7%) fractures were in proximal
third and 15 (19.2%) in distal third of both bone forearm. There were
excellent outcomes in 91%, good outcomes in 6.4% and fair results in only
2.6% of patients.Seven different types of complications were noted including
skin irritation 8 (10.2%), cortex perforation in 2 (2.5%) and iatrogenic
fracture in 1 (1.3%) case.
Conclusions: Titanium elastic nailing is excellent treatment option for
displaced unstable pediatric both bone fractures especially in elderly
children. This is technically easy, minimally invasive procedure with
relatively faster bone healing, easy implant removal with excellent cosmesis
of skin without long ugly scar.

TIMI (Thrombolysis in Myocardial Infraction) flow grade in ST Elevation Myocardial Infarction after Primary Percutaneous Intervention

Rikesh Tamrakar, Rajib Rajbhandari, Sanjay Singh KC — Sat, 21 Aug 2021 07:33:09 +0000

Background: Timely reperfusion, preferably by primary percutaneous
intervention (PCI) has been the guiding-principle for the treatment of
patients with acute ST-elevation myocardial infarction (STEMI). TIMI
flow grade of the culprit lesion after the procedure have shown to have
significant implication in clinical outcome.
Objective: We aimed to study the relation of TIMI flow grade with the inhospital
outcome and complication among patients of STEMI.
Methods: All consecutive acute STEMI patients undergoing primary PCI
during the study period (January 2020 to June 2020) were analyzed for
correlation between TIMI flow grade and clinical outcome during the
hospital stay. Prior approval was taken from institutional review board.
The study design was retrospective observational study.
Result: 51(55%) patients had achieved the TIMI 3 flow after the primary
PCI. Number of patients achieving TIMI flow of 2,1 and 0 after the
procedure were 34(37%),6(6.5%) and 2(2%). Incidence of traditional risk
factors like dyslipidemia, diabetes, hypertension was higher in TIMI flow
<2 . TIMI flow <2 was also associated with more adverse events namely
cardiogenic shock, arrythmias, in-hospital mortality and overall major
adverse cardiovascular events.
Conclusion: Patients with dyslipidemia had poor TIMI flow grade during
primary PCI. Similarly, patients having hypertension, diabetes mellitus and
late presentation showed tendency for TIMI flow <2 . Also, the poor TIMI
flow grade after primary PCI had unfavorable the clinical outcomes like
increased complications and mortality.

Knowledge, attitude and practice of prescribing antibiotics among dental practitioners in Chitwan

Sat, 21 Aug 2021 07:16:10 +0000

Background: Antibiotic resistance in recent years has become a major
threat to public health globally. In dental practice, antibiotics and analgesics
are commonly used for infection control and management of pain. The
knowledge, attitude and practice skills of antibiotic prescription by dental
practitioners should be continuously evaluated. The aim of this study was to
assess the knowledge, attitude and practice regarding antibiotic prescription
among dental practitioners.
Methods: A descriptive cross-sectional study was carried out to determine
the knowledge, attitude and practice regarding antibiotic prescription
among dental practitioners. A self-administered questionnaire was used to
collect information which was adopted from previous studies. A briefing was
given to the participants about the nature of the study and the procedure
of completing the questionnaire was explained. After completion of the
questionnaire, data was collected, reviewed, organized and expressed as
counts/percentages and statically analyzed using SPSS version 16.
Result: The current study showed that majority of the participants had
average knowledge (52.7%) regarding antibiotic resistance but despite
of that they have been prescribing antibiotic without proper guidelines.
In this study, Amoxicillin (69.1%) followed by amoxicillin-clavulanic acid
(25.5%) combination were the most commonly prescribed drugs used for
the management of oral infections, but were prescribed based on symptoms
without taking care of guidelines.
Conclusion: Dental practitioners had knowledge of antibiotic prescription
and its resistance however they have been prescribing antibiotic without
proper guidelines. It is deemed necessary to update the knowledge and
enhance the careful use of antibiotics.

Clinicopathological, Endoscopic and Radiological Evaluation of Intestinal Tuberculosis among Nepalese Patients at a Tertiary Care Center

Tshering Wangdi Sherpa, Rahul Pathak, Anurag Jha — Sat, 21 Aug 2021 07:34:02 +0000

Background: Intestinal tuberculosis is often difficult to diagnose due to its insidious
onset and nonspecific and protean manifestations. Delay or failure of diagnosis
is associated with significant complications like perforation, abscess, fistula and
strictures. The objective of the study was to provide a descriptive analysis of clinical,
endoscopic, radiological and pathological findings in these patients.
Methods: A prospective study including 52 hospitalized patients was done between
April 2018 to 2020 at Tribhuwan University Teaching Hospital. Statistical analyses
were done by Microsoft excel version 16.
Results: Males were 63% while females were 37 %. The average age was 37 years.
84% had abdominal pain followed by abdominal distension (50%), chronic diarrhea
(51%) and cough (21%). Abnormal chest X-Ray was found in (37%) among whom
(53%) had sputum positive for tubercular Bacilli. Common CT scan findings were
thickening and heterogenous enhancement of bowel loops (79%), lymphadenopathy
(56%) and ascites (44%). Endoscopically, commonly involved sites were terminal
Ileum (95%), cecum (77%) and ascending colon (42%). Frequent finding were ulcers
(83%), patulous and deformed Ileocecal valve (33%), mucosal nodularity (38%),
hypertrophic mucosa (21%) and strictures (11%). Biopsies revealed granulomas in
(77%) specimens. (65%) of them had central caseous necrosis. Among 10 subjects
undergoing needle aspiration of lymphnodes, (70%) had central caseous necrosis.
Those with coexisting peritoneal involvement had a mean ascitic fluid adenosine
deaminase level of 73 ± 8 IU/L.
Conclusion: Intestinal tuberculosis remains a major concern in developing countries.
A composite analysis of the clinical manifestations, CT scan, endoscopic findings and
pathological examination of the biopsies aid in making a proper and timely diagnosis
so as to prevent complications and mortality.

Orthodontic Management of Skeletal Class-II Malocclusion with Horizontally Impacted Maxillary Canine: A Case Report

Sanjay Prasad Gupta, Shristi Rauniyar — Sat, 21 Aug 2021 07:31:08 +0000

Management of skeletal class II relation in growing patient require careful
evaluation of growth status, proper diagnosis and treatment plan to address
the patient’s need. Twin block is the appliance of choice among functional
appliance to correct the skeletal class II malocclusion due to its acceptability
by the patient and simplified design. Maxillary canine impaction is the
second most prevalent impaction after the third molars. Treatment of
maxillary canine impaction is usually a challenge to orthodontic approach
as the defect lies in the esthetic region of the jaw.
This case report describes the orthodontic management of a 9 years male
patient having skeletal Class II malocclusion with horizontally impacted
maxillary canine. Some modifications in the treatment mechanics are
deemed essential to address the patient’s need for achieving the optimal
esthetic and to improve the occlusion.
Twin block is beneficial for the treatment of skeletal malocclusion in
a growing patient to achieve the maximum benefit. The orientation of
impacted teeth may change from horizontal to favorable one, hence it should
be considered a viable treatment alternative. In such case, early diagnosis
and interception at the right time along with radiographic follow-ups are
necessary to achieve successful results.

Understanding Oral Oncology and its Changes in Dynamics in Nepal

Aaniya Shrestha — Sat, 21 Aug 2021 07:13:45 +0000

With the increase in smoking habits, oral cancer is turning into a threat
among smokers. It is also due to a lack of awareness among people, oral
cancer is increasing rapidly. The increased rate of illiterate people in Nepal
has been a reason for a change in dynamics. Due to a lack of awareness,
people are diagnosed late with cancer which leads to an increased
mortality rate. So, awareness is a must for the reduction of oral cancer. In
most cases, surgery is the best chance. Since people in Nepal are mostly
from middle-class families, it highly impacts their life. The article primarily
addresses the incidence of oral cancer in Nepal. It also emphasizes the
risk factors and causes of oral cancer along with its diagnosis and surgery.

Effect of Menstrual Restriction on Health, Education, and Empowerment of Women: A Review of Literature

Radha Paudel, Chitra Bahadur Budhathoki, prakash shahi — Sat, 21 Aug 2021 07:42:47 +0000

A menstrual restriction is a form of social suffering which is also identified
as a violation of the constitutional right globally. But menstrual restrictionrelated
work is still a neglected area. This paper has adopted traditional
types of reviews to conceptualize how the health, education, and
empowerment of women have been affected by the menstrual restriction.
This study suggests, the menstrual-related restriction is not only a
developing world issue but exists globally and has a high impact on a
girl’s health, education, and empowerment. Though, theresearch on
implementation and evaluation of the menstrual restriction is still needed
to establish the evidence.

Nepalese Health System Response to Fight against COVID-19 Pandemic

Sharada Prasad Awasti, Padam Simkhada, Sudip Ale magar, Edwin Van Teijlingen — Sat, 21 Aug 2021 07:59:14 +0000

The novel coronavirus or COVID-19 is a new highly infectious virus
affecting a large population across the globe. There is no specific
therapeutic drug available against COVID-19, hence the most affected
public health measures need to strictly be adhered to without delay. A
range of issues were reported to fight against COVID-19 in the current
health system of Nepal which should be addressed to strengthen the full
spectrum of the health system for its effective and sustainable response.
It is crucial to understand the current health system at the local, provincial
level and sincerely adhere the federal government policies and plan as per
the protocol for maintaining minimum infection prevention and control
measures with having preventive and safety measures to both service
providers and community people. To tackle those daily increasing number
of COVID-19 cases, it provides an opportunity for the three tires of
governments to reprioritize the health service in the national agenda for
the effective prevention and response it. Although national health policy
2019 clearly articulated the need for equitable access and quality of health
care services to all. Evidence shows that Nepal is in risk zone because of
comparably weak health system that should be aware of all three levels
of government in Nepal and strengthen and control the present threat
posed the daily increasing cases of pandemic.

Soon the Recovery will Likely be the Rule and Death will be an Exception in COVID-19

Rano Mal Piryani, Suneeld d Piryani, Ganesh Dangal, Muzaherul Huq — Sat, 21 Aug 2021 08:02:58 +0000

Since the cluster of cases of SARS-CoV-2 first reported in December
2019, the number of COVID-19 cases and deaths have rapidly been rising
but cumulative percentage of deaths has been decreasing from April
2020 globally and also in South Asian countries. Knowing the number
of reported deaths during a period of the pandemic is not enough but
knowing the number of excess deaths in a given population over the
time may carry weight which is yet to be known globally. The COVID-19
pandemic may lead to increased deaths from some other communicable
diseases such as Tuberculosis, dengue, and fewer deaths from some
causes such as road accidents. Hence, both reported mortality figures and
excess mortality figures are required to understand the death toll of the
pandemic COVID-19.
Around one third patients are asymptomatic transmitting infection and
among symptomatic, 80% has mild to moderate disease managed at
outpatients settings in home isolation; 15% develop lower respiratory
tract infection require hospitalization and recover; 3-5% need intensive
care and may need ventilator support while 0.5-1% of patients may die.
We are of the opinion that in case of COVID-19, soon the recovery will
likely be the rule and death will be an exception and our opinion is based
on the facts of better understanding of COVID-19 infection and disease
and its prevention, control and supportive treatment strategy even in
the absence efficacious vaccine for prevention and effective medicine for
cure and prophylaxis. The condition is that we have to continue to follow
non-pharmacological interventions for containment and mitigation with
true public health spirit.

COVID-19 Course of Infection and Disease

Suneel Piryani, Rano Mal Piryani, Ganesh Dangal — Sat, 21 Aug 2021 08:00:47 +0000

Dear Editor,
COVID-19 course of infection and disease. World Health organization declared COVID-19, a global pandemic
on March 11, 2020. This has had far reaching impact on lives of the people, health care systems, community and
economy of all countries worldwide. COVID-19 is a multisystem disorder primarily affecting the lungs transmitted
mainly through droplet infection. 1 The estimated range of incubation period for COVID-19 is 2-14 days from the
time of exposure, with a median incubation period of 4 to 5 day’s. 2-3
Based on the severity of illness, adults with COVID-19 are grouped into five categories, even though the criteria
in each category may overlap; asymptomatic/pre-symptomatic infection, mild illness, moderate illness, severe
illness and critical illness. 3 As per Center for Disease Control and Prevention (CDC) USA, around one third of
the patients infected with COVID-19 may remain asymptomatic but can transmit the disease while among the
symptomatic, around 80% develop mild to moderate disease, while 15% develop severe lower respiratory tract
infection, 3-5% develop critical illness and 0.5-1% of patients die. 4
Frequently cited estimate is that most people recover from ‘mild’ infections within two weeks and more serious
disease within three weeks. 3 Patients who had recovered from COVID-19, majority reported the persistence of
one or more symptoms, particularly fatigue and dyspnea. 4
Various names have been given to these post recovery presentations such as “Long Covid” or “Long Haul Covid”
“Ongoing Covid19”. It is yet to be proven whether the symptoms of all of these people are due to the same
phenomenon or any other explanation for these presentations is there.

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Voices from the Field: Combating COVID-19 Pandemic in Nepal

Sat, 21 Aug 2021 07:26:35 +0000

Given the ongoing COVID-19 crisis in Nepal, this section includes some vignettes related to combatting the crisis in Nepal. When the editor-in-chief of this journal invited me to assist, I thought it would be useful to present the experiences of the actual professionals engaged in combating the pandemic in the field. This effort resulted in the collection of seven brief articles/commentaries in this section. These include six articles prepared by six individual authors and one prepared jointly by four coauthors. The experiences shared in these articles are probably just the tip of the iceberg, and there are bound to be more heart-wrenching yet untold stories out there. But these too are no less important in our efforts to fully understanding the context, consequences, and handling of various critical situations as the pandemic has unfolded globally, and in Nepal in particular.

Sources of Key Evidences for COVID-19 Pandemic

Pathiyl Ravi Shankar, nisha jha — Sat, 21 Aug 2021 07:24:51 +0000

Coronavirus disease -19 (COVID-19) has become a global pandemic
and health emergency. Research and studies are ongoing at a rapid
pace. It is challenging to keep pace with the published and ongoing
research, especially considering the fact that many show conflicting
results. Many organizations have produced key evidence sources
focusing on scientific studies about the disease. In this article the
authors describe certain important evidence sources and highlight
their important features. In this article we have described thirteen
high-quality evidence sources which will be useful to researchers,
policy makers and others make sense of the rapidly emerging
evidence related to COVID-19. As the pandemic continues for the
second year some sources dependent on volunteers are facing
challenges in regularly updating the evidence. ....Click to read Full Text PDF