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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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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
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
Burden of Care among Mothers Having Children with Down Syndrome
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Mishra, Tulashi Adhikari; Pandey, Kabita; Bhujel, Bishnu; Adhikari, Shova
Abstract Background: Down syndrome is the most common chromosomal disorder associated with mental retardation. Parents who are the primary caregivers of a child with a disability face numerous challenges in their day-to-day life. The objective of the study was to find out the burden of care among mothers having children with down syndrome. Methods: A descriptive cross-sectional study was carried out among 96 mothers having down syndrome children enrolled in the Down Syndrome Society, Nepal. Purposive Sampling technique was adopted for data collection. The Modified Caregiver Strain Index tool was used to collect data through interview. Data were collected from June 14, 2021 to August 1, 2021, which was analyzed by using descriptive and inferential statistics. Results: Findings revealed that majority of the mothers (77.1%) had high level of burden of care. Majority (89.6%) of the mothers involved in the study were always overwhelmed about their child’s conditions. More than half (55.2%) of the mothers were always financially strained in care giving, 57.3% had always done work adjustments and 60.4% of mothers always had emotional adjustments to be made. Similarly, 53.1% participants always felt that care giving was a physical strain. Burden of care was significantly associated with the age of delivery (p value= 0.008). Conclusions: The study concludes that mothers having children with down syndrome tend to have high level of burden of care and it is associated with the age at delivery. Therefore, health care providers including concerned authority are recommended to conduct different programs to support the caregivers in order to reduce their burden as well as to raise awareness program related to preventive measures of down syndrome in community. Keywords: Burden of care; down syndrome; mothers
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
Clinicopathological Profile of Dengue Infection in a Tertiary Care Centre in Nepal
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Thapa, Bibechan; Pandey, Aakriti; Gautum, Santosh; KC, Sajana; Chhetri, Prabha Devi; Pokhrel, Estory; Poudel, Sangeeta; Shankar, P Ravi
Abstract Background:Dengue is a mosquito-borne viral disease with a wide spectrum of presentations ranging from subclinical disease to severe dengue. Dengue is endemic to the Terai of Nepal. Interestingly, an increasing incidence has been reported from hilly areas like Kathmandu valley. This study explored the clinicopathological profile of dengue infection. Methods:A total of 84 serologically confirmed dengue cases from September to November 2019 at KIST Medical College were recruited in a cross-sectional study after obtaining ethical approval. Dengue was categorized as dengue without warning signs, dengue with warning signs, and severe dengue. Clinicopathological information was recorded in the proforma by reviewing patients’ records. A descriptive statistical tool and chi-square test were carried out. Results: Out of 84 patients, 76% (64) were dengue without warning signs, 21.4% (18) were dengue with warning signs and 2.4% (2) were severe dengue. About 97.6% (82) presented with fever. During the course of illness, anemia was identified in 38.1% (32), thrombocytopenia in 65.5% (55), hemoconcentration in 6% (5), and leucopenia in 82.1% (69). Similarly, elevated aspartate transaminase and alanine transaminase (ALT) was observed in 67.7% (42) and 53.2% (33) respectively. The severity of dengue on presentation to hospital was significantly associated with thrombocytopenia, leucopenia, and elevated ALT. Similarly, the severity during course of illness in hospital was significantly associated with hemoconcentration, thrombocytopenia, leucopenia, and elevated ALT. Conclusions: Most common presentation of dengue infection was fever. The most common laboratory abnormalities were leucopenia, thrombocytopenia, hemoconcentration, anemia, and elevated liver enzymes. Awareness of these clinical and laboratory parameters is important for the prompt diagnosis, severity estimation, and overall management of dengue infection. Keywords: Biochemical; dengue; hematological; Nepal; serological
Comparison of Volunteer Non-Remunerated Donors and Replacement Donors
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Gurung, Numaya; Shakya, Basu; Rai, Ganesh; Shrestha, Deependra
Abstract Background: There are mainly two types of blood donor in Nepal i.e., Voluntary Non-Remunerated Donor and Replacement Donor. The main aim of this study is to compare between Voluntary Non-Remunerated Donor and Replacement Donor. Methods: This is retrospective and cross-sectional study conducted in the blood transfusion Service, Tribhuvan University Teaching Hospital. The study was conducted on both Voluntary Non-Remunerated Donor and Replacement Donor who came to blood transfusion Service and voluntary blood donation program. All the blood donors donating in blood transfusion Service were considered as the study population. Results: Out of total 25951 donors, there were 15565(60.02%) Voluntary Non-Remunerated Donor and 10386(39.97%) Replacement Donor. On the whole, there were 21938(84.59%) male donors and 3995(15.40%) female donors. The male Replacement Donor was 14273(93.12%) followed by a male Voluntary Non-Remunerated Donor 7582(73.71%). The female Voluntary Non-Remunerated Donor was 2703(67.65 %) followed by female Replacement Donor 1292(32.34 %). Conclusions: This study concludes that the Voluntary Non-Remunerated Donor is quite low, in comparison to Replacement Donor. 100 % Voluntary Non-Remunerated Donor could not be achieved due to lack of awareness about health and voluntary type of blood donation. Keywords: Blood donation; replacement donors; voluntary non-remunerated donors
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
Computed Tomography Chest Findings in COVID-19 Patients
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Tamang, Ongden Yonjen; Paudel, Sharma; Kayastha, Prakash; Maharjan, Santosh; Adhikari, Govinda; Upadhyaya, Rudra Prasad; Dawadi, Kapil; Pradhan, Prajina; Rehman, Tanveer; Malla, Saurav Krishna
Abstract Background:COVID-19 which has caused significant morbidity and mortality around the world has been declared by the World Health Organization to be a global health emergency. Our objective was to find out the lung parenchymal patterns commonly evident in high resolution Computed Tomography in patients with COVID-19 pneumonia. Methods: A retrospective cross-sectional study was conducted at a tertiary multi-specialty hospital in Kathmandu, Nepal. With ethical clearance from the institutional review board, a total of 235 patients with positive reverse transcriptase polymerase chain reaction for COVID-19 and having respiratory symptoms were included in the study. High Resolution Computed Tomography images of chest were retrieved from picture archiving and communication systems retrospectively and studied for the findings commonly attributed to COVID-19 pneumonia. The data was then analyzed using Stata version 14 (Stata Corp, College Station, TX, USA). Descriptive statistics were presented as mean and median while chi-square test was used to assess the association between socio-demographic characteristics and CT severity indices. Results: Out of 235 patients, 174 (74.0%) were males and 61(26%) were females with a mean age of 54.8±14.5 years. The most commonly encountered pattern of pulmonary changes was bilateral involvement in 222 (94.5%) patients followed by ground-glass opacities in 218 (92.8%) patients and peripheral predominance of ground-glass opacities in 211 (89.8%) patients. Conclusions: Chest Computed Tomography abnormalities are common in COVID-19 positive patients with respiratory symptoms. These findings can guide in the assessment of the severity of the disease as well as patient management. Keywords: Computed Tomography; COVID-19; ground-glass opacities; reverse transcriptase polymerase chain reaction
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
Detection of blaoxa-23 Gene from Carbapenem-resistant Acinetobacter Baumannii
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Neupane, Laxmi; Sah, Anil Kumar; Rayamajhee, Binod; Pokhrel, Anil; Singh, Anjana
Abstract Background: Antibiotic resistance is a great concern for public health and Acinetobacter baumannii-associated infections are increasing in many parts of the world, including Nepal. However, limited data is available on the prevalence of A. baumannii harboring blaOXA-23 from Nepal. Methods: A hospital-based cross-sectional study was designed to detect the blaOXA-23 gene from carbapenem-resistant A. baumannii isolates in Nepal. A total of 380 clinical specimens were collected and processed following standard microbiological procedures. Antibiotic susceptibility test was performed as per the protocol of the Kirby-Bauer disk diffusion technique and the CLSI guidelines, while screening of carbapenemase production was assessed by the Modified Hodge Test using meropenem (10µg) disc. The presence of the blaOXA-23 gene in carbapenemase-positive A. baumannii was confirmed by PCR. Results: Among 380 specimens analyzed, 210 (55.3%) samples were positive for bacterial growth, where 33(15.7% of total growth) of the isolates were A. baumannii, and most of them were isolated from the ICU patients (20/33, 60.6%) and sputum (16/33, 48.5%). Thirty-two isolates (97%) were colistin sensitive, while only four (12.1%) isolates were sensitive to meropenem and imipenem. Twenty-three (69.7%) of A. baumannii were carbapenemase positive as revealed by the Modified Hodge Test test, and 19 of them (57.6% of total A. baumannii) harbored the blaOXA-23 gene. Conclusions: A high prevalence of the blaOXA-23 gene among carbapenem-resistant A. baumannii isolates were found. Systematic network surveillance should be established to check the spread of such isolates, especially in the intensive care units of tertiary care hospitals in Nepal. Keywords: Acinetobacter baumannii; antibiotic-resistant; blaOXA-23; carbapenemase; Nepal
Dyslipidemia and Thyroid Dysfunction Associated with Psoriasis
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Rizal, Shikha; Joshi, Bishal Raj; Jha, Sanjay Kumar; Pradhan, Manish; Regmi, Sunil
Abstract Background: Psoriasis is a T-cell mediated inflammatory skin disorder which causes considerable psychosocial disability resulting in major impact on patient’s quality of life. The dominant response of Th1 cells and the high expression of related inflammatory factors appears in both psoriasis and thyroid dysfunction. Psoriasis can lead to increased risk of incidence of cardiovascular events for which dyslipidemia is an important risk factor. This study aims to evaluate thyroid function and lipid profile and its association in patients with psoriasis. Methods: This was a prospective case-control study conducted at the Department of Biochemistry, Nobel Medical College Teaching Hospital from November 2021 to October 2022. Seventy six clinically diagnosed psoriatic patients were taken as case and eighty non-psoriatic patients coming for other skin lesions were included in the study as control. Thyroid function test (serum free T3, T4, TSH) and lipid profile (total cholesterol, low density lipoprotein, high density lipoprotein and triglyceride) were done. Results: Hypothyroidism was most common thyroid abnormalities in our study population which was 13.15% (n=10). The lipid profile parameters were significantly higher in the psoriatic patients than in the controls (p<0.001). The odds of psoriatic patient having thyroid dysfunction was 2.8 times higher compared to other non-psoriatic patients and the odds of psoriatic patient having dyslipidemia was 8.7 times higher compared to other non-psoriatic patients. Conclusions: It is thus useful to assess thyroid function test and lipid profile in patients with psoriasis considering their role in etiopathogenesis and co-morbidity of psoriasis. Keywords: Co-morbidity; dyslipidemia; thyroid dysfunction
Effect of COVID-19 Pandemic on Emergency Department Admissions and Outcome
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Tiwari, Jagannath; Paudel, Pramod; Adhikari, Sujan; Lamichhane, Sharmila; Basnet, Anjali; Subedi, Kirtipal; Bhattarai, Pratiksha; Paudel, Prajwal
Abstract Background: Emergency Department admissions have changed significantly during the COVID-19 pandemic. Understanding this variation may play a crucial role in rearranging hospital resources for better outcome. In this study, we aimed to assess the impact of COVID-19 pandemic on emergency department admission and outcome. Methods: This is a cross-sectional retrospective study conducted at Bharatpur Hospital, Nepal comparing pre- pandemic data of the 4 months (March 24 to July 21, 2019) with the initial 4 months of the pandemic (March 24 to July 21, 2020). Results: Admission in emergency ward decreased during covid period among female admission (47%vs43%), age-group(0-14)(18%vs12%), Dalit(17%vs11%) p<0.0001.Diagnosis increased during covid for acute abdomen(11%vs13%), animal and insect bite(10%vs13%), psychiatric illness(2%vs6%),poisoning and drug over dose(0.9%vs2.6%)(p<0.0001).The odds for referral(cOR 3.62,95% CI:2.70-4.84), Left against medical advice(cOR 6.03,95% CI:.06-8.94) and death(cOR 3.28,95% CI:1.64-6.68) increased during the covid respectively. Conclusions: There was decrease in rates of emergency department utilization during the Covid-19 pandemic. Admissions due to trauma, gastrointestinal, respiratory, neurological, musculoskeletal and coronary artery disease showed a decline whereas psychiatric disorders, diabetes and hypertension, animal and insect bites cases increased. Overall, mortality rate was increased. Keywords: Admission; Covid-19; emergency department
Effect of Group Psycho-Educational Interventions on Child birth fear and Child birth Self-efficacy among Primiparous women
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Bista, Archana Pandey; Shrama, Chandrakala; Shrestha, Uma; Timalsina, Punjita; Devkota, Kavita; Piya, Kalpana; Neupane, Beena
Abstract Background: Child birth related fear and low self-efficacy for child birth found common among primiparous women. Antenatal group psycho-educational interventions have been used as important strategies to address child birth fear and self-efficacy. Thus, this study aimed to find out the status of child birth fear among antenatal women and effect of group psycho-educational interventions among primiparous women. Methods:One group pretest-posttest design was adopted. Total 307 primigravida women attending antenatal outpatient department of two hospitals within Kathmandu valley were selected through purposive sampling technique. Data was collected from March to July 2020. Child birth fear was assessed by using validated tool i.e.Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and Child birth self-efficacy was assessed by using childbirth self- efficacy tool. Primigravida women with moderate level of child-birth fear, were intervened for group psycho-education based on PRIME Model by nurses who were research team members. Paired t-test was used to compare differences in mean scores on child birth fear and child birth self-efficacy before and after intervention. Results: Moderate level of child birth fear was found among 24.8% of participants. Low child-birth self-efficacy was found among 42.0% participants. The overall mean score before providing group psycho-educational interventions to experimental group on child-birth fear was 54.0±2.09 and on child birth self-efficacy was 78.0±28.64 with p<0.001 and after providing group psycho-educational interventions child-birth fear was reduced to 47.8±2.44 and child birth self-efficacy was 105.2±19.6 with p<0.001. Conclusions: Group psycho-educational interventions based on PRIME approach led by nurses have significant effects in reducing child-birth fear and increasing child-birth self-efficacy. Therefore, provision of group psycho-educational interventions along with routine antenatal service need to be considered in clinical settings in Nepalese context. Keywords: Child birth fear; child birth self-efficacy; primiparous women
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
Electro-physiological Changes in the Central Nervous System by Visual Evoked Potential in Diabetic Patients
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Malla, Neha; Mahotra, Narayan B; Shrestha, Lava; Joshi, Sajun Narayan; Gurung, Sanyukta
Abstract Background: Increasing sedentary lifestyle in today’s world has increased the prevalence of Diabetes Mellitus. Loss of vision due to diabetic retinopathy is a major public health burden. Visual evoked potential identifies the neuronal degenerative changes in chronic metabolic disorders specially Diabetes Mellitus. The study aimed at evaluating changes in visual evoked potential waves in diabetic patients. Methods: This is a cross sectional comparative study consisting of 90 participants, out of which 60 were diabetic patients and 30 were non-diabetic control group. Among diabetic patients, 30 were without retinopathy, 10 with mild non-proliferative retinopathy, 10 with moderate non-proliferative retinopathy and 10 with severe non-proliferative retinopathy. Visually evoked potential latencies and amplitudes were compared among diabetic patients and the control group and also among individuals with different grades of retinopathy. Results: Delay in P100 latency and decrease in its amplitude were statistically significant in diabetic patients. The changes in P100 latency, P100 amplitude and N75 latency were also significant in different grades of retinopathy. Conclusions: There are statistically significant changes in visually evoked potential in diabetes patients. Visual evoked potential is a useful, non-invasive investigation which can establish the central nervous system neuropathy in diabetes at an early stage of the disease. So Diabetic retinopathy can be prevented due to early detection of neuropathy by visual evoked potential test Keywords: Diabetes mellitus; diabetic retinopathy; visual evoked potential
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.
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
Genodermatoses Picture: Difficulties Faced And Way Forward in Nepal
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Parajuli, Niraj; Baskota, Rabindra; Jain, Ritu
Abstract Genodermatoses are group of genetic disorders that present with cutaneous manifestations. The exact prevalence on many of these conditions are unknown due to its rarity, need of specialized tests for diagnosis and lack of proper reporting system. Most of the patients are faced with life-long disability and associated stigma. There is a need for specialized centers for proper diagnosis of these conditions and a very elaborated yet simple reporting system in Nepal. These rare conditions should be kept in priority by the government in align with the sustainable development goals to ensure healthy-lives and promote well-being for all. A wider engagement of patient-led support groups might be useful in providing necessary information on the disease to the general population and alleviate the stigma associated with these diseases. Keywords: Epidermolysis bullosa; genodermatoses; rare diseases; Nepal
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
Guillain Barre Syndrome after vaccination against Corona Virus Disease19: Managed in limited resource setting
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Kamar, Sher Bahadur; Bhatta, Uttam Kumar; Singh, Ratna; Timilsana, Manju Paudel
Abstract A 16-year-old boy who classically featured Guillain Barre Syndrome (GBS) after Corona Virus Disease-19 vaccination was timely treated successfully in limited resource setting in far western province. After Moderna (mRNA COVID 19 Vaccine) vaccination, he rapidly developed ascending paralysis of limbs without autonomic and sensory or cranial nerve involvement. He has been treated with Intravenous Immuno-Globulin (IVIG). Over six-weeks long observation and supportive care and he was discharged with full recovery. Many GBS cases after vaccination have been reported but yet to know the association of vaccine. It is very important to address the complication for successful vaccination programme. Keywords: Complication; COVID-19; guillain barre syndrome; vaccine

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