Journal of General Practice and Emergency Medicine of Nepal

Study of echocardiography findings in patients with type II diabetes mellitus

2024-03-10T05:15:48+00:00

Introduction: Diabetes mellitus is an escalating public health problem globally. Cardiovascular disease is the major cause of morbidity and mortality among patients with diabetes. Diabetes mellitus is an established risk factor for congestive cardiac failure in which the diastolic function is impaired more than the systolic function.

Method: A cross-sectional study was conducted from 2018 to 2019. The sample size of the study was 60 respondents. An independent student t-test and a chi-square test were used to test the statistical significance between the two variables (with two categories) in quantitative and qualitative variables respectively. Significant results were defined as p-values less than 0.05 at 95% confidence intervals.

Result: Left ventricular diastolic dysfunction (LVDD) was found in 36 (60%) of the patients. Left ventricular systolic dysfunction (LVSD) was found in 11 (18.3%) of the patients. The correlation between LVDD and index of glycemic control i.e. HbA1c was statistically significant (P value 0.025). It was also found that prevalence of LVDD increased with the duration of diabetes (P value 0.007), also the frequency of LVSD increased with duration of diabetes (P value 0.009).

Conclusion: LVDD was more common in diabetic patients with poor glycemic control and prolonged duration of the disease. LVSD was less common in diabetic patient in comparison with LVDD, but the frequency of LVSD also increased as the duration of diabetes progressed.

Knowledge regarding diabetes and its medication among patients with diabetes mellitus visiting Okhaldhunga Community Hospital, Okhaldhunga

2024-03-10T05:15:48+00:00

Introduction: Diabetes mellitus is an emerging worldwide health problem. Nepal is a developing country where most of the people reside in rural areas. This study was done to assess the knowledge regarding diabetes and its medication among patients with diabetes mellitus visiting Okhaldhunga Community Hospital, Okhaldhunga, in the rural eastern part of Nepal.

Method: A cross-sectional study was conducted among the diabetes mellitus patients presenting to Okhaldhunga Community Hospital during the period of 5 months (January 18 to June 18, 2019). Informed and written consent was taken from the patients followed by interviews and questionnaires. Data was entered in Microsoft Excel 10 and analyzed using SPSS version 16.0.

Result: A total of 74 patients were included in the study of which 48.6% were male and 51.4% female. Most of the diabetic patients were in the age group of 50-59 years. The study shows that 98.6% had inadequate knowledge and 1.4% had moderate knowledge about diabetes mellitus. 2.8% had moderate knowledge and 97.2% had inadequate knowledge about anti-diabetic medication. A total of 32.4% of patients did not know the name of their anti-diabetic medications and 18.9% of patients did not know the time of intake of their anti-diabetic medications. A total of 75.7% of patients did not know the side effects of their anti-diabetic medications.

Conclusion: Knowledge of diabetes and its medication among diabetes patients is inadequate. Healthcare providers should focus on the necessity and importance of awareness programs, patient counseling, and education to improve knowledge on diabetes.

Exploring the perspectives of health professionals in a rural district hospital in Achham, Nepal on the role of daily continuing medical education (CME)

2024-03-10T05:15:48+00:00

Introduction: A rural district hospital in Achham district of Nepal has daily continuing medical education (CME) sessions. These sessions are attended by health professionals from different departments providing healthcare services. This study aims to explore the perspectives of health professionals in a rural district hospital in Achham of Nepal on the role of daily CME on the quality of clinical care and on their professional development in order to find the impact of daily CME.

Method: A qualitative study was conducted in a rural district hospital in Achham, Nepal. Semi-structured interviews were conducted with 10 participants who were health professionals, aged 20-60 years old and recruited through a convenience sampling method in 2020. The data were analyzed using thematic content analysis (TCA).

Result: All the participants shared the importance, strengths, and challenges of daily CME sessions and recommended to improve the CME sessions. All the participants had clear perceptions of positive impact of daily CME to refresh their knowledge, create a learning environment, improve presentation and speaking skills, learn clinical protocols, improve their professional development, share ideas to improve patient care and create a platform to share quality improvement steps. The diverse educational background of health professionals, CME curriculum, and time allocation of physicians for CME sessions remain challenges of daily CME. The participants recommended adding more topics in the CME curriculum and revise CME facilitation methods.

Conclusion: District hospitals in rural Nepal can conduct daily CME sessions to upgrade the clinical knowledge and skills of health professionals and improve clinical services. Further studies are required to establish robust evidence about the impact of daily CME sessions.

Over-the-counter sales of antimicrobials and factors associated with it among private pharmacies in ward-32 of Kathmandu Metropolitan City: a pilot study

2024-03-10T05:15:49+00:00

Introduction: Over-the-counter sales of antimicrobials are contributing to the increasing burden of anti-microbial resistance. This mixed-method study aims to assess the practice of over-the-counter sales of antimicrobials by private pharmacies and factors associated with it from the perspective of both the private pharmacy staff and the community people to produce more enriched and valid findings through triangulation of results from quantitative and qualitative studies.

Method: A cross-sectional, concurrent triangulation mixed method approach was used. Participants were selected purposively, including 30 exit interviews from 5 pharmacies and 6 qualitative interviews. Descriptive statistics and Fisher’s exact test were done for quantitative analysis. Braun and Clarke’s six steps of thematic analysis were followed for qualitative data analysis.

Result: Qualitative findings illuminated the repercussions of antibiotic misuse, stressing the imperative need for patient education, responsible prescribing, and regulatory measures. Identified factors included self-medication practices, familial influence, profit-driven pharmacies, easy access, healthcare system challenges, prescription barriers, and unregulated OTC sales. Quantitative results validated these, with 53.3% obtaining antibiotics without prescriptions. Key factors contributing to this trend included profit-motivated pharmacies (p=0.014), self-medication (p=0.014), the presence of a doctor in the pharmacy (p=0.005), and fear of losing customers (p=0.046).

Conclusion: The integrated findings underscore urgent need to address antimicrobial misuse to curtail unnecessary expenses, adverse health effects, and the looming threat of antibiotic resistance. Comprehensive interventions are crucial to mitigate unwarranted costs, health risks, and the emergence of antimicrobial resistance, emphasizing the significance of a multifaceted approach in safeguarding global public health.

Knowledge, perception and belief about HIV/AIDS among health care provider of provincial level hospital outside Kathmandu valley of Bagmati province

2024-03-10T05:15:49+00:00

Introduction: Stigmatized health care providers are the strongest hindrances in effectively responding to HIV. This study is conducted to evaluate Human immunodeficiency virus (HIV)/Acquired immunodeficiency virus (AIDS) related knowledge, perception and belief of health care providers working at Dhading hospital, Dhading, Nepal.

Method: This is a cross sectional study conducted from 1^st to 15^th December 2023 among the health professionals of Dhading hospital using a google form questionnaire which consisted of questions related to socio-demographic profile, knowledge regarding testing, transmission along with perception and belief related to HIV/AIDS.

Result: Out of 135 respondents, 101 (74.8%) responded among which 59.4% were females and 98% had education of secondary level or above. Majority (>90%) of the participants demonstrated adequate knowledge on questions related to transmission of HIV/AIDS. However, only 75.8% respondents were aware of voluntary counseling and treatment (VCT) with 73.27% still believing HIV/AIDS is a taboo in Nepal.

Conclusion: Knowledge, perception and belief of the health care provider is encouraging at Dhading Hospital. Studies like this help to identify gaps and in making appropriate intervention to eliminate stigma and discrimination prevalent among healthcare workers.

Associated factors for admission among acute exacerbation of chronic obstructive pulmonary disease patients presenting at the emergency department of a tertiary care center in Eastern Nepal: a cross-sectional study

2024-03-10T05:15:49+00:00

Introduction: The burden of COPD continues to increase over the years. COPD exacerbations require frequent hospitalizations and accelerate the decline of lung function. Hence, it is significant to understand the factors that can predict hospitalization due to acute exacerbation of COPD.

Method: A cross sectional study was conducted for a period of one year in total of 99 cases with an aim to identify factors associated with hospitalization due to acute exacerbation of COPD in patients visiting emergency department of BPKIHS, eastern Nepal. We obtained data of sociodemographic, clinical, and biochemical parameters. We analyzed their association with hospital admission with a multivariate analysis using a logistic regression model.

Result: Among 99 cases 50 were admitted and 49 were discharged. In multivariate analysis, the significant factors predictive of hospital admission in COPD exacerbations were domiciliary oxygen (OR 0.162, 95% CI 0.977-1.138), SpO₂ with O₂ (OR 0.864, 95% CI 0.146-0.864), neutrophil count (OR 1.274, 95% CI 1.045-1.554), lymphocyte count (OR 1.297, 95% CI 1.027-1.639) and serum urea level (OR 1.045, 95% CI 1.003-1.089).

Conclusion: In patients presenting to the emergency department with acute exacerbation of COPD, if the value of any one of the predicting factors (domiciliary oxygen, SpO₂ with O_2,neutrophil count, lymphocyte count and serum urea level) deteriorates by one unit, then there is 1.420 times increase in hospital admission.

Perceived stigma towards mental health illness and help-seeking behavior among bachelor level students: a mixed method study

2024-03-10T05:15:49+00:00

Introduction: Nepal struggles with stigma and discrimination against people with mental disorders. Mental illness is still viewed negatively by general people. The stigma is recognized as a significant public health issue and a major reason for the lower help-seeking behavior. This study aimed to find factors associated with students' perceived stigma towards mental health illness and help-seeking behavior in selected colleges of Lalitpur district using a mixed methods approach.

Method: A cross-sectional study was conducted among 62 bachelor-level students from two selected colleges of Lalitpur district. Six in-depth interviews were conducted for the qualitative study. A concurrent mixed-method triangulation design was used. The Chi-square test and Braun and Clarke’s six-step thematic analysis was used to explore the factors associated with perceived mental health stigma and the help-seeking behavior of students. The results of quantitative and qualitative findings were triangulated.

Result: Out of 62 participants, 53.23% participants have a high perceived stigma towards mental illness and 48.39% of the participants have good help-seeking behavior. Age, ethnicity, and faculty were significantly associated with perceived stigma. Likewise, friends or relatives with mental health issues had a significant association with help-seeking. The results of the triangulation of findings identified age and friends or relatives with mental health issues as convergent factors. Ethnicity, educational faculty, sex as divergent findings and innovative media strategies, and widespread dissemination of mental health knowledge as expansive findings.

Conclusion: The factors affecting mental health stigma and help-seeking are age, ethnicity, faculty, and friends or relatives with mental health issues.

Epidemiological profile of patients visiting private family medicine clinic in Kathmandu, Nepal

2024-03-10T05:15:49+00:00

Introduction: There are a lot of evidences supporting the important role of Family Physician/General Practitioner in the prevention of illness and death. In Nepal, Family Physicians are mostly limited to the Emergency Departments in the urban settings. The concept of Family Physician led primary care in urban setting is not known to most of the patient population. This study was conducted to know about the epidemiological profile of those patients visiting a family medicine clinic.

Method: An observational, cross-sectional, quantitative study was conducted in a Family Physician lead primary care clinic in urban Nepal. All the patients attending the clinic for consultation from July 2023 to October 2023 were included in the study. Semi-structured questionnaire was used for the data collection. Data was then entered in MS EXCEL and analysis was done using Statistical Packages for Social Sciences (SPSS) version 16.

Result: Total of 195 patients attended the clinic. The mean age of the patients was 46.01 ± 15.285 years. 52% of them were males whereas 48% were females. 12 out of 195 came for medical certificate and 183 of them came for consultation. Diabetes mellitus, Hypothyroidism and general health checkup were the top three reasons for consultation. Only six patients were from outside Kathmandu Valley. Majority of the patient population were from 31 – 40 age group.

Conclusion: Average of two to three patients attended the clinic per day. There was equal male female distribution. Majority of the patients were from bread earners age group. Family physicians can have significant effect on the preventive and promotive aspect of health care and continued care for chronic diseases.

General practice reformative agenda 2024 (protocol)

2024-03-10T05:15:49+00:00

The healthcare system undergoes frequent reforms, including various services. General practice (GP), a longstanding specialty in Nepal, now requires further changes, due to changing and growing needs of the country. To facilitate this, it's essential to identify key areas for reform supported by evidence.

To gather evidence, we've designed a qualitative study based on grounded theory. The researcher aims to engage with a large number of GPs using virtual methods. Participants will be contacted through focused group discussions, key-person interviews, polls, and debates. In the first round, key issues will be identified, and in the second round, potential solutions will be explored.

Our goal is that these findings will assist stakeholders in pinpointing gaps in policies, educational strategies, research, and the overall development of GPs. With the implementation of these findings, we anticipate a well-defined role for GPs within the national health system.

Placenta percreta management in a rural setting: a case report

2024-03-10T05:15:48+00:00

Placenta accreta spectrum, formerly known as morbidly adherent placenta, refers to the range of pathologic adherence of the placenta. Placenta accreta spectrum is a complicated pregnancy linked to significant maternal and fetal health risks. There should be high suspicion for placenta accreta spectrum in previous cesarean delivery to early diagnose and treat the condition. Placenta accreta spectrum can be classified into three groups: placenta accreta, where the villi attach to the myometrium; placenta increta, where the villi invade the myometrium; and placenta percreta, where the villi penetrate the entire thickness of the myometrium.¹^, ² We report a case of placenta percreta who underwent cesarean hysterectomy while working in a resource-limited setting of rural Nepal.

Myomectomy during caesarian section: a case report

2024-03-10T05:15:48+00:00

Leiomyomas are the most common benign tumors with an incidence of 2 to 4% of the reproductive tract in women of childbearing age. Myomectomy is the most common surgical operation performed. In a study that reviewed 10 years of experience in doing myomectomy during the cesarian section, about 0.89% had myomectomy. Although the Caesarean myomectomy rate is currently increasing, many doctors are reluctant to perform Caesarean myomectomy, due to potential associated risks, particularly the perioperative hemorrhage. It has been documented that a single CM is associated with a higher rate of bleeding when the leiomyoma diameter is more than 75 mm. We reported the case of a 26-year primigravida at 38 weeks of gestation who presented with pervaginal leaking and pain in the abdomen. We found she had a huge mass over the posterior wall of the uterus. A Caesarean myomectomy was performed. Histopathologically it was proven to be a fibroid uterus.

Oral bleeding: a case report of hemangioma of palate

2024-03-10T05:15:48+00:00

Hemangiomas are benign vascular tumors of blood vessels that represent a gray area between hamartomatous malformation and true neoplasms. In spite of being largely benign, they can become unpleasant, disfiguring and also sometimes fatal if they affect vital structures. More than half of the cases occur in head and neck; however, intraoral hemangiomas are relatively rare. They can present in a variety of ways. This is a case report of cavernous hemangioma of hard palate which presented with intra oral bleeding and ulcer, which was initially investigated as being a probable case of neoplastic lesion of the palate in a 71-year-old woman.

Venesection in hypovolemic shock

2024-03-10T05:15:49+00:00

A 20-year-old female, a referred case, from health post presented to emergency department of Manthali hospital Ramechhap, with history of loose watery stool and vomiting for 4 days. On primary survey examination - Airway; patent with no c-spine tenderness, breathing; no chest retractions, no obvious injury, oxygen saturation was 94% in room air. Pulse was 160 beats per minute, feeble; blood pressure was not recordable; cold clammy and bluish discoloration of skin was noted. Intravenous cannulation was tried but could not succeed. GCS= 15/15, bilateral pupil was round, regular and reactive, there was no focal neurological deficit. Multiple prick mark for intravenous cannulation was seen. With appropriate counselling and consent, vein-section was done. An incision of about three centimeters was given just one centimeter above left medial malleolus. A 16-gauze intravenous cannula was inserted at left long saphenous vein and fixed with prolene 2. Eight pint of warm normal saline and one pint of Haemaccel was transfused. After stabilizing her bluish limbs turned into pink; her sadness turned into happiness. She was referred to higher center and was admitted for 4 days and discharged with a diagnosis of acute gastroenteritis with prerenal acute kidney injury(resolved). Gastrointestinal losses like diarrhea and vomiting can lead into hypovolemic shock which is fatal. Fluid resuscitation is the mainstay of therapy in patients with severe hypovolemia.