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Journal of Nepal Health Research Council

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https://hdl.handle.net/20.500.14572/7

Journal of Nepal Health Research Council (JNHRC) an official, internationally peer reviewed, Pubmed Indxed, biomedical journal of the Nepal Health Research Council (NHRC) since 2002. It is published three monthly and publishes articles on the following category: Original Article, Review Article, Case Report, Viewpoint and Letter to the Editor and others. URL : www.jnhrc.com.np

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Factors Associated with Utilization of Postnatal Care Services
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Thapa, Suraj; Choudhary, Pradeep; Adhikari, Rita; Thapa, Kanchan
Abstract Background: Preventable causes of death accounts for 810 women per day. Care provided during the child-bearing and after the childbirth is of vital importance. Despite of the facts, many women in developing world deprive of this service. Therefore, this study aims to explore the contributing factors for Postnatal care service in urban areas of Chitwan, Nepal. Methods: A cross-sectional study was conducted among 212 mothers who delivered within last one year. Data collection was conducted through pre-tested questionnaire in Nepali language after taking ethical approval and informed consent. Descriptive and bi-variate statistics were applied in analysis. Results: Higher number of mothers (39.2%) were in 25-29 years age groups. Hindu were 89.6% and Janajati were 70.7%. Mothers (26.4%) reported to reach nearest health facilities on foot by 30 minutes or more. Nearest health facility had twenty-four hours seven days a week maternal health services for 57.5% of mothers. Antenatal visitors were 83.9% and 96.7% reported institutional delivery. About 27.8% mothers were aware about Postnatal care; 48.1% were aware about maternal complications; 98.1% mothers had at least one PNC visit; and 34.4% reported Postnatal care visit as per protocol. Lack of counseling (52.6%) was one of the main reasons for not completing Postnatal care. Age factor, husband’s education, health service-related variables, availability of essential drugs and equipment in health facilities influenced Postnatal care. Conclusions: Fewer mothers reported about complete Postnatal care service. Socio-economic factors, health service-related factors, experience of mothers on their previous childbirth also contributed to complete Postnatal care. Keywords: Health services; maternal and child health; Nepal; postnatal care
Prescribing Pattern of Antibiotics among Hospitalized Patients with Urinary Tract Infection
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Shrestha, Deepti; Sapkota, Jyotshna; Poudel, Rekha; Gurung, Rashmi Shakya; Aryal, Kiran
Abstract Background: Urinary tract infection is one of the most common bacterial infections worldwide. It has become one of the most common cause for the hospitalization and sepsis. It is generally treated with antimicrobial agents and fluids. This study was conducted to study the prescribing pattern of antibiotic among hospitalized patients with urinary tract infection. Methods: A descriptive cross-sectional study was conducted in Nepal Medical College Teaching Hospital, Attarkhel, Kathmandu from January 2022 to April 2022. Patients aged 18 years or above of both sex, admitted to various departments with the provisional diagnosis of urinary tract infection prescribed with antibiotics were included in the study. Results: Out of 146 patients admitted with a diagnosis of urinary tract infection, the most commonly prescribed antibiotics during hospital stay were cephalosporin in 102 (69.9%) patients followed by combination of penicillin and beta-lactamase inhibitors (31, 21.2%) and fluoroquinolones (15, 10.3%). Ceftriaxone (78, 53.4%) alone was the most commonly prescribed antibiotic as empirical therapy followed by combination of piperacillin and tazobactam (22, 15.1%). One hundred and forty four (78.6%) patients were prescribed antibiotics from the watch group followed by the access group (21, 11.5 %). E. coli was the most common organism isolated in 29 (76.3%) patients. Conclusions: Cephalosporin was the commonest antibiotic group prescribed in hospitalized patients among which ceftriaxone was commonly prescribed as an empirical therapy. Among AWaRe classification, antibiotics from the watch group were commonly prescribed. Keywords: Antibiotics; ceftriaxone; urinary tract infection
Awareness of Breast Self-Examination among Female Community Health Volunteers of Pokhara
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Koirala, Dipti; Silwal, Muna; Pokhrel, Sushila; Adhikari, Ramesh
Abstract Background: Breast self-examination is a simple, inexpensive and effective method of examining the breast by woman herself after 20 years of age in order to detect a breast lump in the early stage. Women should have this knowledge for early detection and treatment of breast cancer. So, the present study aimed to assess awareness of female community health volunteers regarding breast self-examination and the effect of a teaching program. Methods: One group pre-test post-test study was conducted among 145 female community health volunteers selected from eight wards of Pokhara Metropolitan using convenient sampling technique. Data was collected using a self-administered questionnaire from 27 March to 23 April 2022. Descriptive and inferential statistics were used for data analysis. Results: Before intervention, around two third of respondents (67.6%) had inadequate and only 1.4% had adequate level of awareness. But after the intervention, 68.3% had adequate level of awareness. The post-test mean awareness score (23.87 ± 4.7) was higher than pre-test mean awareness score (12.97 ± 3.93). Test of significance revealed that increment in the awareness due to a structured teaching program was highly significant (p <0 .001). This study also found that there was difference in the mean pretest awareness score according to educational level of the respondents only. Based on the mean score, the score was significantly higher among women with higher level of education (p=<.001). Conclusions: Around two thirds of female community health volunteers have inadequate level of awareness regarding breast self-examination before the intervention. Educational intervention program was found to be effective in improving their awareness. Keywords: Awareness; breast; self-examination
Investigating the Efficacy and Safety of Diacerein in the Management of Knee Osteoarthritis with reference to its conventional management
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Shrestha, Rohit; Tamrakar, Sudichhya; Koju, Pramesh; Maharjan, Sagar; Malla, Subhechhya; Shrestha, Sony Shakya
Abstract Background: Designated as a “priority disease” by World Health Organization, Osteoarthritis is the most common chronic rheumatic disease. Providing a proper treatment for Osteoarthritis is still a major public health challenge. Diacerein has been proposed as a slow acting, symptom modifying or even disease modifying drug used in Osteoarthritis having a risk-benefit ratio far better than conventionally used drugs. However, the evidence of efficacy and safety of use of Diacerein in Osteoarthritis is yet to be explored. Hence, this study attempted to investigate the efficacy and safety of Diacerein in the management of knee osteoarthritis. Methods: This is an analytical cohort study comparing Diacerein with Non-steroidal anti-inflammatory drugs for two months in the management of knee OA. Efficacy was assessed by scores of Lysholm Knee Scoring Scale, Knee injury and Osteoarthritis Outcome Score – Physical Function Short form and Western Ontario and McMaster Universities Osteoarthritis Index. Results: After two months of treatment, the post- treatment scores were significantly superior to the baseline scores in both the treatment groups (p<0.001). There were no significant differences among the post-treatment scores in two different treatment groups (p>0.05). Discoloration of urine and gastritis were the frequently reported adverse effects in Diacerein treatment group and Non-steroidal anti-inflammatory drugs treatment group respectively. Conclusions: Our findings have shown Diacerein is as effective as Non-steroidal anti-inflammatory drugs in treating knee OA patients. Diacerein was generally well tolerated, with a good safety profile. These findings indicate the need for further studies with experimental study design in larger scale. Keywords: Diacerein; Efficacy; Knee Osteoarthritis; NSAIDs; Safety
Suicidal Ideation Among Medical and Nursing Students
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Atreya, Alok; Nepal, Samata; Menezes, Ritesh G; Marhatta, Anu; Ghimire, Sristi; Shah, Palak
Abstract Background: Suicidal ideation is a major predictor of suicide attempts. The present study was conducted to compare the prevalence of suicidal ideation and its risk factors among medical and nursing students in Nepal. Methods: An online survey was carried out among a cohort of medical and nursing students of Lumbini Medical College using questions derived from General Health Questionnaire-28 and Patient Health Questionnaire-9. Results:153 medical and 148 nursing students participated in the study. Lifetime suicidal ideation was present in 20.6%(n=62) medical and 13.95%(n=42) nursing students. Suicidal ideation in the last one year was present in 48 medical and 36 nursing students. There were higher odds of suicidal ideation in medical students who had parental neglect, psychiatric disorder, physical and sexual abuse, substance abuse, and academic performance dissatisfaction (p<0.05), whereas the odds were higher in nursing students with psychiatric disorder, parental demands, alcohol consumption, and academic performance dissatisfaction but was not statistically significant. Thematic analysis of the responses for open-ended question for reasons for previous suicide plans or attempts among four medical and eight nursing students revealed relationship issues, history of adverse childhood experiences, academics-related circumstances, and other individual problems as suicide antecedents. Conclusions: Periodic motivational speeches and counselling sessions during all the semesters of professional schooling would help decrease suicidal ideation. Mental health awareness programs for medical and nursing students should be aimed at reducing mental illness-associated stigma and promoting timely professional help-seeking behavior. Keywords: Medical students; Nepal; nursing students; suicidal ideation
Assessment of Thyroid Dysfunction During Different Trimester of Pregnancy
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Prajapati, Sunita; Prajapati, Gayatri; Shrestha, Vikram; Shrestha, Sujata
Abstract Background: Thyroid dysfunction is frequently seen in pregnant women and is associated with complications like miscarriage, gestational hypertension, placental abruption, pre mature delivery and fetal growth retardation and even causes impaired neuropsychological development of fetus. This study is carried out to assess the prevalence of thyroid disorder during different trimester of pregnancy. Methods: Serum samples were collected from 124 pregnant women attending Patan Academy of Health Science for ante natal visit. Free thyroxine free triiodothyronine and thyroid stimulating hormone were performed by chemiluminescent assay. Results: Out of 124 pregnant women, euthyroidism was seen in 79% (n =98) followed by subclinical hypothyroidism (10%, n=13) and primary hypothyroidism (8%, n=10). Subclinical hyperthyroidism and primary hyperthyroidism accounts for 1% (n=1), and 2% (n=2) respectively. Although, thyroid disorder was found to be more prevalent in third trimester (38.4%, n=10) but the distribution in first and second trimester (34.6%, n= 9, 27%, n= 7 respectively) were also significant. Mean fT3 and fT4 level were found to be negatively correlated with trimester (r=-0.19, p=0.027 and r=-0.29, p=0.001 respectively) whereas positive correlation of trimester was seen with TSH (r=0.08, p=0.35). Conclusions: Hypothyroidism is more common in pregnant women visiting tertiary care hospital. Different complication can be minimized if diagnosis is done early. Keywords: Hypothyroidism; pregnant; thyroid stimulating hormone; trimester, gestational week
Day One Drain Amylase as a Predictor of Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Pradhan, Sumita; Kandel, Bishnu; Bhandari, Ramesh Singh; Lakhey, Paleswan Joshi
Abstract Background: Postoperative pancreatic fistula remains the most challenging complication following pancreaticoduodenectomy. As per the definition by the International Study Group on Pancreatic Fistula, post operative pancreatic fistula is diagnosed on or after postoperative day 3. However, several studies have demonstrated that drain fluid amylase on postoperative day 1 may be a better predictor. This study was conducted to determine the diagnostic value of day one drain amylase in predicting the development of post-operative pancreatic fistula. Methods: This was a prospective observational study of patients, who underwent pancreaticoduodenectomy between April 2016 and May 2017. Post operative pancreatic fistula was defined by the International Study Group on Pancreatic Fistula (2005) criteria. The diagnostic value of day one drain amylase was determined by doing a receiver operating curve analysis and compared with the postoperative day 3 value. Results: A total of 49 patients were included. Post operative pancreatic fistula developed in 28 patients (Grade A - 40.8%; B - 12.2%; C - 4.1%). Receiver operating curve analysis confirmed the predictive relationship of day one drain amylase with an area under the curve of 0.79 and kappa 0.5. For clinically relevant postoperative pancreatic fistula, day 3 drain amylase was the better predictor (AUC for DFA3 was 0.73 while AUC for DFA1 was 0.51). A day one drain amylase cut-off value of 350 U/L demonstrated a sensitivity of 75% and specificity of 77.8% with an accuracy of 76.2%. Conclusions: Day one drain amylase predicts postoperative pancreatic fistula in patients following pancreaticoduodenectomy but for clinically relevant postoperative pancreatic fistula, day three drain amylase is a better predictor. Keywords: Amylase; drain fluid amylase; pancreaticoduodenectomy; Pancreatic fistula
Genotype-Phenotype Profile of Beta-thalassemia
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Roma, Km; Pande, Rajan; Shrestha, Durga Laxmi
Abstract Background: Beta thalassemias are extremely heterogenous hereditary monogenic blood disorders and preventable genetic hemolytic anemia caused by >200 mutations in HBB gene. In Nepal, it is more prevalent in Tharu tribe but it seen in other communities as well. Out of more than 200 mutations of beta globin gene, approximate 20 different alleles are responsible for >80% of the mutations. Mutations vary in different geographic population and are responsible for manifestation of different phenotypes. This study was done to find common mutations of HBB gene in Nepal which were responsible for different phenotypic manifestations and to know clinical severity according to the mutations. Methods: This was a descriptive, cross sectional study conducted in the pediatric and medicine department of Nepalgunj Medical College and Bheri Zonal Hospital, Nepalgunj from January 2020 to December 2020. The genotype and phenotype profiles of thalassemia cases were reported. The data was analyzed by SPSS 20. Results: The results obtained showed that clinical presentation differed with different β-globin gene mutations present. Individuals with HBB:c.47G>A and HBB:c.20A>T/ c.79G>A mutations showed milder presentation than those with HBB:c.47G>A/-619del and HBB:c.20A>T/c.47G>A. Conclusions: Therefore, these findings can be used to predict clinical severity so that we can take appropriate measures by early genotype identification for prenatal diagnosis of beta thalassemia. Keywords: Genotype phenotype; prenatal diagnosis; thalassemia
Lung Ultrasound in Diagnosis of Interstitial Lung Disease
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Manandhar, Sagun
Abstract Background: Interstitial lung disease denotes a group of disorders which mainly affects pulmonary interstitium consisting of connective tissue fibers that support the lungs. High-resolution computed tomography is currently the main imaging modality of diagnosis, however except for few major cities in the country, availability of computed tomography scan facility is sparse in remote areas; thus relevant use of lung ultrasound in patients with suspected interstitial lung disease could be rewarding. Methods: A single center cross-sectional clinical diagnostic study was carried out at department of Radiology and Imaging, Patan Academy of Health Sciences after approval from institutional review committee. Lung ultrasound was done prior to patients undergoing high-resolution computed tomography chest. Senstivity, specificity, positive predictive value , negative predictive value , and accuracy of different echographic criteria–positive chest area score, total B lines score 5 and total B lines score 10 were calculated. Association of non-homogeneity of B lines and pleural line abnormalities with presence of interstitial lung disease, and association between B3 and B7 lines with alveolar and interstitial pattern were derived. Results: Sensitivity (97.4%) and negative predictive value (97.9%) of total B lines score 5 was the highest. Maximum specificity (70.7%), PPV (61.4%) and accuracy (77.2%) was ofpositive chest area score. Pleural line abnormalities showed highly significant association with interstitial lung disease(p=0.003). B3 and B7 lines illustrated very highly significant association with alveolar and interstitial pattern respectively (p<0.001). Conclusions: Lung ultrasound can be a valid and reliable additional imaging method in evaluation of ILD in appropriate clinical scenario. Keywords: B lines; high-resolution computed tomography; interstitial lung disease; lung ultrasound
Laparoscopic Appendectomy versus Open Appendectomy in Acute Appendicitis
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Paudyal, Sanjaya; Shah, Surendra; Giri, Niraj
Abstract Background: Appendectomy is the most common emergency surgical procedure performed. Appendectomy is performed by either open or laparoscopic methods. However, there is lack of consensus regarding the most appropriate method. This study aimed to compare the outcomes of laparoscopic and open appendectomy in the treatment of acute appendicitis. Methods: Fifty-two patients undergoing appendectomy were analyzed in this prospective comparative study, with 26 patients each in laparoscopic and open group. The outcomes were measured in terms of operative time, postoperative pain at 4, 6 and 12 hours, length of hospital stay, postoperative complications according to modified Clavien Dindo classification and cost analysis. Results: Laparoscopic group had longer time after completion of surgery till exit from operation theatre (30 min in laparoscopic and 20 min in open, p<0.01) and significantly higher cost (Nrs. 26295 for laparoscopic and Nrs. 19575 for open, p<0.01) than open appendectomy. Operative time, time from entering operation theatre till being kept in operation table, time from being kept in operation table till initiation of anesthesia, postoperative pain at 4,6 and 12 hours and postoperative complications were insignificant in both groups. Conclusions: The results suggest that laparoscopic appendectomy group had longer recovery time after operation and was costlier than open appendectomy. Thus, the decision of the operative procedure can be based on the patient’s preference. Keywords: Appendectomy; laparoscopic appendectomy; open appendectomy
Perceived Communication Barriers by Caregivers of Psychiatric Patients
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Khatri, Sushila; Samson, Priscilla
Abstract Background: Caregivers have significant role in effective treatment and recovery during hospitalization. Communication barriers in health care lead to poor treatment outcome of patients and caregiver’s dissatisfaction. The aim of study was to find out perceived communication barriers by caregivers of psychiatric patients. Methods: A cross-sectional study was conducted among 120 caregivers of psychiatric patients admitted in psychiatric ward of Patan Hospital who were selected by purposive sampling and interviewed using self-developed structured questionnaire. Data was analyzed with SPSS version 16 using descriptive statistics and Chi- square test was used to find out association between personal characteristics of caregivers and extent of perceived communication barriers. Results: Low extent of communication barrier was perceived by 29.17%, great extent by 25.83%, moderate extent by 24.17% and no barriers were perceived by 20.83% caregivers. There was association between duration of hospital stay (p= .006) and extent of perceived communication barrier. Most barriers were due to caregiver’s related factors (31.2%) and least perceived barriers were due to environment related factors (17.1%). Conclusions: More than one fourth caregiver’s perceived low extent of communication barrier, almost one fourth perceived great extent and less than one fourth perceived moderate extent. There was association between duration of hospital stay and extent of perceived communication barrier. Effective communication may help to minimize perceived barriers resulting in better treatment outcome of patients and caregiver’s satisfaction. Most perceived barriers were due to caregiver’s related factors like feeling of not being educated, not knowing what to ask with health personnel, unaware of whom to approach and so on for which it is crucial to develop awareness among health personnel while delivering healthcare services. Nurses and doctors need to be effectively trained in communication skills to minimize various perceived barriers resulting in better treatment outcome and satisfaction. Keywords: Caregivers; communication barriers; therapeutic communication
Post-operative Pancreatitis as a Predictor of Postoperative Pancreatic Fistula in Patients Following Pancreaticoduodenectomy
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Subedi, Nirajan; Ghimire, Bikal; Kansakar, Prasan B S; Bhandari, Ramesh S; Lakhey, Paleswan J; Singh, Yogendra P
Abstract Background: Postoperative pancreatic fistula remains the single most important determinant of morbidity and mortality following pancreaticoduodenectomy. A new entity was proposed by Saxon Connor “Post-Operative pancreatitis”, which is defined by raised serum amylase more than the upper limit of institutional serum amylase value on Post-Operative day 0 or 1. There has been shown to be an association between postoperative pancreatitis and postoperative pancreatic fistula. We have conducted this study to see the incidence of postoperative pancreatitis and its association with postoperative pancreatic fistula. Methods: This was a prospective observational study. All patients undergoing pancreaticoduodenectomy at a tertiary care center for one and a half years were included. A cut-off value of serum amylase 80U/L was used to make a diagnosis of postoperative pancreatitis. The patients were followed up for one month. Pancreas specific complications were defined according to the definition given by the International Study Group of Pancreatic Surgery. Results: A total of 49 pancreaticoduodenectomies were done in the given period. The incidence of postoperative pancreatitis was 31(63.3%) and postoperative pancreatic fistula was 19(38.8%). Postoperative pancreatic fistula was seen in 19(61.2%) of patients having postoperative pancreatitis (P<0.001). Post-operative pancreatitis was also significantly associated with post pancreatectomy hemorrhage, increased hospital stay, and mortality. In multivariate analysis, preoperative endoscopic biliary drainage and increased serum amylase on the first postoperative day came out to be an independent predictor of postoperative pancreatic fistula. Conclusions: Post-operative Pancreatitis was associated with an increased incidence of Post-operative pancreatic fistula and other postoperative complications like Post pancreatectomy hemorrhage and mortality. Keywords: Pancreaticoduodenectomy; postoperative pancreatitis; postoperative pancreatic fistula; post pancreatectomy haemorrhage
Outcomes Of Microincision Pars Plana Vitrectomy In Rhegmatogenous Retinal Detachment
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Subedi, Santosh; Thapa, Raba; Pradhan, Eli; Bajiyama, Sanyam; Sharma, Sanjita; Duwal, Sushma; Poudel, Manish; Poudyal, Govinda
Abstract Background: With the technological advances, microincision pars plana vitrectomy is commonly used method for primary treatment of eyes with rhegmatogenous retinal detachment. Objective of this study is to evaluate anatomical and visual outcomes of microincision pars plana vitrectomy in eyes with rhegmatogenous retinal detachment. Methods: This was a hospital based prospective observational study done in Tilganga Institute of Ophthalmology, Kathmandu, Nepal. All consecutive cases of rhegmatogenous retinal detachment who underwent primary microincision pars plana vitrectomy from October 2020 to March 2021 were included in the study. Patients were evaluated at baseline, postoperative day 1, 1 week, 6 weeks and 3 months. Outcome measures evaluated were anatomical results, visual outcomes and complications of the surgery. Results: Forty-nine eyes with rhegmatogenous retinal detachment treated with primary microincision pars plana vitrectomy with minimum follow up of at least 3 months were evaluated. Anatomical success was achieved in 91.8% of cases (45/49). Baseline mean best corrected visual acuity was logMAR 1.63±0.88 and median best corrected visual acuity was 2.00 (range 0.00 to 2.70) while at 3 months follow up mean best corrected visual acuity was logMAR 1.22±0.66 and median BCVA was 1.00 ( range 0.00 to 2.70). There was significant improvement in median BCVA ( p= 0.005). There were no cases of postoperative hypotony and endophthalmitis. Other complications were also minimal such as silicon oil in anterior chamber in 1 eye, epiretinal membrane in 3 eyes and macular hole in 2 eyes. Conclusions: Microincision pars plana vitrectomy is an effective surgical method of primary treatment for rhegmatogenous retinal detachment with good anatomical and visual outcomes with minimal complications. Keywords: PPV; RRD; visual outcome
Complications of Arterio-Venous Fistula in Patients Undergoing Haemodialysis
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Agrawaal, Krishna Kumar
Abstract Background: Vascular access is required for hemodialysis and arterio-venous fistula is the preferred access. Various guidelines have recommended monitoring and surveillance of arterio-venous fistula as the standard of care. This study looked into usefulness of clinical examination to detect complications of arterio-venous fistula. Methods: The study was conducted in the from February 2022 till September 2022 under Nephrology unit, Departement of Internal Medicine at Universal College of Medical Sciences. Ethical clearance was taken. Patients undergoing hemodialysis were enrolled in the study. After informed and written consent, clinical examination of arterio-venous fistula was done by look, listen and feel method. Data was collected as per the approved performa. Statistical analysis was done using Statistical Package for the Social Sciences software version 17. Results: Total enrolled study population was 73. Mean age of the study population was 47.45 years ± 14.60 years with a Male: Female ratio of 1.3:1. Complications were seen in a total of 33 patients with an overall rate of 45.2%. The mean duration of AVF creation was 32.68 ± 24.56 months. Most common complication of arterio-venous fistula was overall stenosis 18 (24.7%). Conclusions: There is a higher rate of complications of arterio-venous fistula. Monitoring and surveillance of arterio-venous fistula should be performed as a standard of care in every hemodialysis centre. Keywords: Arterio-venous fistula; complication; hemodialysis
Induced Abortion: A Risk Factor for Adenomyosis
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Pun, Sunita
Abstract Background: Abortion, the medical and surgical termination of a pregnancy,is becoming a more common medical procedure among women in Nepal. Adenomyosis is one of the common gynecological problems among women of reproductive age. However, little is known about the relationship between abortion and adenomyosis. Therefore, our study aims to explorerisk factor for adenomyosis in among women who havehadabortions. Methods: A comparative study was carried out among women who visited at thedepartment of Obstetrics and Gynecologyof the Tribhuvan University of Teaching Hospital, Kathmandu, between 13th April 2016 to 14th July 2017. Adenomyosis were confirmed through histological examination after hysterectomy. Data wereanalyzed by using Statistical Package for Social Sciences (SPSS software)21.0 version. Odd ratio with their 95% confidence interval and P-value were calculated and analyzed. A P-value equal or below 0.05 was considered as statistically significant. Results: Of the total 255 women, 85were confirmed adenomyosisby histological examination. Of the 85 cases, 39% (33/85) had a history of abortion, while only 25 % (44/170)women had abortion among non-adenomyosis group. Overall, women who had abortion were1.8 timesmore likely to have adenomyosis (95% CI 1.04- 3.17, P value=0.03) compared to women who had no history of abortion. Women with surgical abortions were 2.5 times more likely to develop adenomyosis (95% CI- 1.03- 6.21, P value=0.03) compared towomen with no abortion history. Conclusions: This study found that women,who had abortions,aremore likely to have been diagnosed with adenomyosis compared to women without abortions.Further studies, however, need to be carried out in order toextend findings of this study. Keywords: Abortion; adenomyosis; risk factors
Efficacy and Safety of Intralesional Immunotherapy with Tuberculin Purified Protein Derivative among Cutaneous Wart Patients
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Shrestha, Sanju Babu; Bhusal, Mohan; Jwarchan, Jayanti; Gautam, Sujan; Shrestha, Prashanna Raj
Abstract Background: Cutaneous warts are common skin problems caused by Human Papilloma Virus. Conventional therapies are mostly ablative and limited by recurrences and side effects. Immunotherapy using bacterial, fungal, and viral antigens is an emerging and safer technique to treat warts at local and distant sites. The objective of this study was to measure the efficacy and safety of intralesional immunotherapy with tuberculin purified protein derivative among cutaneous wart patients in the dermatology department of a tertiary care centre. Methods: A cross sectional, time series design, was conducted between October 2019 and September 2020 among 77 patients of cutaneous warts attending Dermatology out-patient department using convenience sampling. Percentage response was evaluated for patients treated with tuberculin purified protein derivative for eight weeks at an interval of two weeks into complete response (100% clearance), partial response (50-99% clearance), no response (0-49% clearance). Side effects were also recorded. Statistical Package for the Social Sciences version 20.0 was used for data analysis. Results: Out of 77 patients, complete response (100%) was seen in 53.2% patients, partial response (50-99%) in 14.3% and no response (0-49%) was seen in 32.5%. Side effects noted were pain and erythema (19.50%), blisters (2.60%) and flu like symptoms (1.30%). Conclusions: Intralesional PPD is an effective and safer therapeutic option for the treatment of cutaneous warts. Keywords: Immunotherapy; intralesional injections; purified protein derivative of tuberculin; warts
Clinical, Bacteriological Profile and Outcome of Neonatal Sepsis
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Siwakoti, Shraddha; Sah, Rinku; Singh, Rupa Rajbhandari; Khanal, Basudha
Abstract Background: Sepsis is a major cause of morbidity and mortality among neonates in Nepal. This study was conducted to determine the clinical-bacteriological profile, their antibiotic susceptibility patterns, and clinical outcome of culture-positive neonatal sepsis. Methods: This was a prospective study conducted at B.P Koirala Institute of Health Sciences from July 2018 to June 2019. Neonates with clinically diagnosed sepsis having blood culture positive were included in the study. Blood samples culture and antimicrobial susceptibility testing were performed with the standard microbiological method. Demographic, clinical information, and clinical outcomes were documented. Results: The incidence of culture-positive sepsis was 10.3% (183/1773) of neonatal admissions. Poor feeding 85(46%) and fever 68(37%) were the common clinical features at presentation. The incidence of early-onset sepsis and late-onset sepsis were found to be 116 (63%) and 67(37%) respectively. Staphylococcus aureus was the common pathogen in both early-onset 61(49%) and late-onset 34(41%) sepsis. The incidence of multidrug-resistant cases was 41% (75/183) with 20% (15/75) extensively drug-resistant gram-negative bacilli, 36% (20/75) multidrug-resistant gram-negative bacilli, and 44% (33/75) Methicillin-resistant Staphylococcus aureus cases. In-hospital mortality rate was 12 (7%) with a higher frequency in multidrug-resistant sepsis 92% (11/12) than non- multidrug-resistant 8% (1/12). The median hospital days were longer in multidrug-resistant cases than non- multidrug-resistant [11(9-13) verses 3(2-5)]. Conclusions: The incidence of multidrug-resistant pathogens causing neonatal sepsis is high at our hospital and are associated with more in-hospital mortality and longer hospital stay. Implementation of effective preventive strategies to combat the emergence of antimicrobial resistance is immediately needed. Keywords: Bacteriological profile; incidence; MDR; neonatal sepsis; outcome
Factors Associated with Intimate Partner Violence among Married Women
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Ghimire, Sailaja; Ghimire, Sushmita; Sagtani, Reshu Agrawal; Upadhyay, Shambhu Kumar
Abstract Background: Intimate partner violence refers to any behavior within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship. Various factors such as alcohol or substance abuse, history of violence in family, extra marital affair, educational status, socio-economic status, decision making power, and established gender role are linked with Intimate partner violence. This study aims to identify the prevalence of different forms of intimate partner violence and its associated factors among married women in Shankharapur municipality of Kathmandu District. Methods: A concurrent triangulation design was used. Quantitative data were collected from 602 married females while qualitative data was collected from 11 participants. Multivariate logistic regression was done using Stata MP13 version. Thematic analysis was done for qualitative data. Triangulation of both quantitative and qualitative findings waere done. Results: The prevalence of Intimate partner violence was found to be 22.1%. After logistic regression, it was found that women’s involvement in community groups had lower odds (AOR 0.67, 95%CI 0.6-0.7) of IPV as compared to those who were not involved in community groups. Additionally, findings from the qualitative study showed female being victims of different forms of violence. Conclusions: Still, Female are the sufferers of violence behind the closed doors and mitigation strategies should have to be adopted from different levels of government to control intimate partner violence. Keywords: Intimate partner violence; Kathmandu; mixed method; triangulation.
Prevalence of Microalbuminuria in Non-diabetic Hypertensive Patients and its Correlation with Changes in Left Ventricular and Left Atrial Characteristics
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Bhusal, Khema Raj; Devkota, Surya; Pathak, Surya; Khanal, Pratik; Khanal, Umesh; Thapalia, Poojan; Neupane, Srijana; Gyanwali, Pradip; Simkhada, Rabindra; Oli, Krishna Kumar
Abstract Background: Microalbuminuria is urinary albumin excretion in the range of 30-300 mg per 24 hours and is considered as an abnormal albumin excretion rate. Microalbuminuria is associated with epithelial dysfunction and have a high risk for target organ damage resulting in stroke, retinopathy and adverse cardiovascular events. The objective of the study was to determine the prevalence of microalbuminuria in non-diabetic hypertensive patients and its correlation with cardiovascular changes. Methods: A quantitative cross-sectional study was done in 107 participants diagnosed as non-diabetic hypertensive patients visiting to Manmohan Memorial medical college and Teaching hospital and Manmohan Cardio-thoracic Vascular and transplant Centre. The assessed parameters were basic metabolic profile, urine evaluation and Echocardiography. Results:The results showed microalbuminuria in 28 study participants and not seen in 79 participants. Similarly, microalbuminuria was observed more comparable in those with presence of left ventricular hypertrophy as compared to the absence of left ventricular hypertrophy (29.3% versus 22.8%) (p value 0.469); those with presence of left ventricular diastolic dysfunction as compared to the absence of left ventricular diastolic dysfunction (31.1% versus 19%) (p value 0.170) and those with dilated left atrium as compared to normal left atrium (26.7% versus 23.9%) (p value 0.820). In case of left ventricular ejection fraction, those with normal left ventricular ejection fraction (26.3%) had slightly higher proportion of micro-albuminuria than those with mild to moderate left ventricular systolic dysfunction (20%) (p value= 0.755) Conclusions: There was no significant difference in the level of micro-albuminuria between non-diabetics, hypertensive patients with cardio vascular changes compared to patients with no cardiovascular changes. Keywords: Hypertension; microalbuminuria; non-diabetic
Prevalence of Diabetes and Diabetic Retinopathy in Far-western Province of Nepal
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Bhatta, Subash; Pant, Nayana; Pant, Suresh Raj
Abstract Background: Although diabetes is emerging as growing public health problem, there is limited population based data about the prevalence of the disease in Nepal. Methods: This cross-sectional population-based survey, conducted in the Far-western province of Nepal from April 2020 to April 2021, used standardized RAAB + DR methodology. Diabetes was diagnosed on the basis of treatment history and random blood sugar test results of greater than 200 mg/dl. Diabetic retinopathy screening was done by ophthalmologists. All relevant data were imported into the RAAB software package (RAAB V.6) for analysis. Results: Among 4615 study population, 2.8 % (n=129) had diabetes, and 35.7% (n=46) of the diabetics were newly identified cases. Of the known diabetics, 61.4% (n=51) never had an eye examination, and only 27.7% (n=23) of cases had their eye checked for DR in the last year. Fundus examination showed 13.2 % (n=17) of the diabetic patients to have some form of diabetic retinopathy and 6.2% (n=8) had diabetic maculopathy. Only 0.8% (n=1) of the cases were categorized as sight-threatening DR but a greater number of diabetes patients had severe visual impairment or blindness (3.9%) as compared to non-diabetic patients (1.8%). Conclusions: Prevalence of diabetes and DR were relatively lower in Far-western Nepal. However poor coverage of screening examinations have left many of these cases undetected in the communities. Effective community-based diabetes and DR screening and referral programs can help to detect and treat diabetes and DR early on to prevent vision loss and other diabetic complications. Keywords: Diabetes; diabetic retinopathy; maculopathy; rural Nepal, vision Impairment

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