Publications

Permanent URI for this collection

https://hdl.handle.net/20.500.14572/6

Browse

Now showing 1 - 20 of 4225

Repeat Cesarean Section among Pregnant Women in a Tertiary Center of Nepal: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Regmi, Dharma Raj; Dangal, Ganesh; Silwal, Ashmita; Shrestha, Dhan Bahadur; Oli, Prakash Raj; Budhathoki, Pravash
Abstract: Introduction: Cesarean Section is the most common obstetrics surgery done for both maternal and fetal indications. There is a rising trend of cesarean section rates which is associated with increased maternal morbidities. This study aims to find out the prevalence of repeat Cesarean Section among women with previous cesarean sections done in a tertiary centre. Methods: This was a descriptive cross-sectional study conducted in a tertiary care hospital of Nepal from August 2020 to January 2021. Pregnant women with previous Cesarean Section status without other pelvic surgery and medical comorbidities were included and data were collected regarding intraoperative findings. Ethical approval was taken from the Institutional Review Committee (Reference Number: 14). A convenience sampling technique was used. Data were analysed using Statistical Package for the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage. Results: Out of 1315 patients undergoing Cesarean Section, the prevalence of Repeat Cesarean Section was found to be 184 (13.99%) (12.11-15.86 at 95% Confidence Interval). Conclusions: The prevalence of Repeat Cesarean Cection from our study was similar to other studies done in similar settings. Repeat Cesarean Cection confers peri-operative morbidities which adversely affect postoperative recovery. Repeat Cesarean Cection continues to contribute to morbidity over subsequent pregnancies and serious maternal morbidity.
COVID-19 among Pregnant Women Delivering in a Tertiary Care Center: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Paudyal, Pooja; Katuwal, Neeta; Rawal, Suniti
Abstract: Introduction: Coronavirus Disease 2019 pandemic is raging across the world and has affected pregnant women as well. There is limited information regarding COVID-19 in pregnant women. The study aimed to find the prevalence of COVID-19 among all pregnant women who delivered during the study period in a tertiary care center. Methods: This was a descriptive cross-sectional study conducted in a tertiary care center from 16th August to 15th November 2020 after obtaining ethical clearance from the Institutional Review Committee of a tertiary care center. All the women who delivered in the hospital during the study period were enrolled and they were subjected to COVID-19 Reverse Transcriptase Polymerase Chain Reaction test. A total of 667 samples were taken using convenience sampling technique. Data were analyzed using the Statistical Package for the Social Sciences version 24 software. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 667 pregnant women, the prevalence of COVID-19 was 47 (7.05%) (5.10-8.99 at 95% Confidence Interval). Though the majority of women were asymptomatic 40 (85.1%), 5 (10.64%) developed mild disease, 1 (2.12%) each had severe and critical COVID-19 pneumonia. Conclusions: The prevalence of COVID-19 among pregnant women delivering in our center is similar to other studies done in similar settings. In our study, we found that the majority of women had been asymptomatic and were diagnosed on routine testing. Hence, it is important to test all pregnant women before delivery for Coronavirus Disease 2019 irrespective of the presence or absence of symptoms.
Antimicrobial Resistance: The Next Probable Pandemic
(Nepal Medical Association, 2022) Gautam, Ashima
Abstract: As the world still mourns the victims of the pandemic caused by Severe Acute Respiratory Syndrome Coronavirus-2, another pandemic that is expected to kill millions of people in less than a century, is already brewing. In the distant future, the global, mostly silent pandemic of antimicrobial resistance is increasingly claiming the lives of patients on hospital floors. Unfortunately, the global health community is now gradually and progressively facing the silently emerging pandemic that could endanger some of the most significant advances in modern medicine. Medical students as future physicians, have the potential to help address this problem sustainably keeping in mind that today’s medical professionals will hand over the baton to them and hope for a greater improvement in antimicrobial resistance and antibiotic usage. Thus, the next generation of doctors must be better prepared to use antimicrobials more sparingly and appropriately.
Variation in Laboratory Reports: Causes other than Laboratory Error
(Nepal Medical Association, 2022) Pradhan, Santosh; Gautam, Keyoor; Pant, Vivek
Abstract: When a sample of an individual is measured at different times at the same or different clinical laboratory, the results are always different, even the state of health of an individual is the same. This disparity in the results from clinical laboratories might confuse diagnosing, treating, and monitoring disease. Patients and healthcare professionals usually interpret these differences as laboratory errors. However, this might not always be the case, because laboratory test results are highly variable and are neither consistent nor comparable due to several reasons other than laboratory error, namely preanalytical variation, biological variation, and analytical variation.
Post-traumatic Pseudoaneurysm of the Internal Carotid Artery with Intractable Epistaxis: A Case Report Authors
(Nepal Medical Association, 2022) Phuyal, Subash; Pandey, Anisha; Bishokarma, Suresh; Lamsal, Ritesh; Sedain, Gopal
Abstract: Epistaxis is a common otorhinolaryngology emergency. There are several treatment modalities for epistaxis, but bleeding from the internal carotid artery necessitates a particular treatment technique. We report a case of a 22-years old man who presented to us recurrent episodes of epistaxis and blurry vision in the right eye for one month. The patient had undergone maxillo-facial surgery following a road traffic accident one year back. Bleeding episodes were occasionally severe with blood loss of up to 800 to 1000ml. These episodes were managed conservatively with posterior nasal packing and frequent blood transfusions. A computed tomography-angiography revealed a pseudoaneurysm arising from the cavernous segment of the right internal carotid artery which was managed successfully by embolization of the aneurysm sac with coils. Despite the rarity of internal carotid artery pseudoaneurysm in individuals with a history of trauma, doctors must be aware of the possibility. Timely identification and treatment of a pseudoaneurysm can save a person's life.
Massive Middle Cerebral Artery Ischemic Stroke Associated with Severe Acute Respiratory Distress Syndrome in H1N1 Influenza: A Case Report Authors
(Nepal Medical Association, 2022) Bhattarai, Suju; Karki, Bipin; Pokhrel, Shweta; Regmi, Sachit; Shrestha, Bibek; Shrestha, Pramesh Sunder
Abstract: Influenza has a common occurrence during its peak seasons. It usually causes disease of the respiratory tract including severe acute respiratory distress syndrome. However, it may also cause disease and complication of other organ systems. We present a rare complication of influenza in which a patient secondary to influenza developed massive middle cerebral artery ischemic stroke. The patient however survived following recovery of both severe acute respiratory distress syndrome and ischemic stroke after decompressive craniectomy and a prolonged intensive care unit stay. This case report is to highlight the importance of influenza related complications besides the pulmonary infliction which can lead to morbidity and even mortality if not managed on time.
Small Cell Lung Carcinoma with Pancoast Syndrome: A Case Report
(Nepal Medical Association, 2022) Limbu, Sion Hangma; Bhatta, Narendra; Mishra, Deebya Raj; Acharya, Achyut Bhakta; Verma, Avatar; Shahi, Rejina; Katuwal, Srijan; Singh, Sunil Kumar
Abstract: Small cell lung cancer mostly arises centrally in the large bronchi. The literature search revealed very limited cases of small cell lung cancer arising at the upper part of the pulmonary sulcus near the thoracic inlet as superior sulcus tumor and also manifesting with typical Pancoast syndrome. We report a case of a 71 years old male patient, presenting with features of Pancoast syndrome including Horner’s syndrome with completed three cycles of chemotherapy resulting in partial response which concludes that small cell lung carcinoma has to be considered despite the clinical findings like pancoast syndrome.
Bilateral Internal Carotid Arteries Occlusion: A Case Report Authors
(Nepal Medical Association, 2022) Upadhyaya, Prabhaw; Karki, Prasanna; Pokharel, Baburam; Sharma, Gopal Raman
Abstract: Bilateral internal carotid artery occlusion is a disease that is encountered rarely. We report a case of a 54 years old female smoker, who presented with acute onset right-sided limb weakness, facial deviation and slurring of speech. On computed tomography angiography occlusion of the bilateral internal carotid artery was seen and a high-flow collateral circulation was formed through the vertebrobasilar system. Computed tomography brain perfusion showed marked cerebral hypoperfusion on the left side. The patient was thrombolysed and kept on dual antiplatelet therapy. Post-medical treatment, motor power and speech significantly improved.
Duplex Collecting System with Ectopic Ureters Opening into Vagina: A Case Report Authors
(Nepal Medical Association, 2022) Singh, Suraj; Dahal, Sulochana; Kayastha, Anuj; Thapa, Bijay; Thapa, Anupama
Abstract: Continuous urinary leakage, along with normal deliberate voiding, must suggest diagnosis of ectopic ureter, specifically in girls. Combination of a duplicated collecting system with distal, infrasphincteric, vaginal insertion of ureter is an uncommon congenital anomaly and rare cause of urinary incontinence. We present a case report of a 7-year-old girl who presented to the urology department with urinary incontinence despite successful toilet training and history of recurrent urinary tract infections. Right duplex collecting system was seen on ultrasound. Magnetic resonance urography revealed a near complete right duplex collecting system with ectopic insertion of ureter into vagina, and aplastic uterus with bilateral normal ovaries suggestive of Mayer-Rokitansky-Kuster-Hauser syndrome. Surgical treatment consisted of "common sheath" reimplantation of ectopic ureters into bladder, with complete resolution of symptoms. This case suggests to us that congenital abnormalities of the genitourinary tract should be considered in case of urinary incontinence and recurrent urinary tract infections.
Angiomatoid Fibrous Histiocytoma Mimicking a Lymph Nodal Lesion: A Case Report
(Nepal Medical Association, 2022) Maharjan, Sailuja; Satyal, Bandana; Baidya, Reena; Joshi, Arbin; Baral, Pradeep
Abstract: Angiomatoid fibrous histiocytoma is an uncommon soft tissue neoplasm with potential for recurrence and rare metastasis. The majority of cases are painless, slow growing and occur in superficial extremities of young adults. Here we report a case of Angiomatoid fibrous histiocytoma in a 28-year old male patient presenting as a slowly growing painful mass in the groin region. This case is of particular interest due to its uncommon site of presentation and its misdiagnosis as lymph nodal lesion on radiology. Although it is a rare entity, it should be considered in differential diagnosis of soft tissue mass in a young patient.
Incidental Finding of Dextrocardia with Situs Inversus and Absent Left Kidney: A Case Report
(Nepal Medical Association, 2022) Karki, Sital; Khadka, Nasatya; Kashyap, Basant; Sharma, Supriya; Rijal, Samita; Basnet, Archana
Abstract: Dextrocardia is an unusual inherent positioning of the heart: during fetal life, the heart is flipped to the right side rather than the usual left side. Situs inversus is a rare congenital ailment in which the main internal organs are rearranged or reflected from their natural positions, and when both conditions are present, it is called situs inversus totalis. The majority of the people with situs inversus totalis are unaware of the situation they have because most of them are asymptomatic. It is usually discovered incidentally when they consult the doctor for an unrelated condition. We are reporting a case of a 55-year-old woman who was found to have a situs inversus totalis with an absent left kidney.
Primary Grynfeltt Lumbar Hernia: A Case Report Authors
(Nepal Medical Association, 2022) Basnet, Krity; Bhandari, Rupa; Shah, Shiv Raj; Limbu, Yugal; Ghimire, Roshan
Abstract: A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. These defects are particularly common in Petit's inferior triangle or Grynfeltt-Lesshaft superior triangle. There are very few cases of primary lumbar hernias that have been described in literature till date. As it is a rare entity, it is often misdiagnosed, leading to delay in management. We present a case of a 66-year-old male with no previous surgery who presented with a mass in left lumbar region for last ten years. The mass gradually increased in size and caused vague dragging pain. On Computed tomography, the diagnosis of Grynfeltt hernia was made. The patient underwent a laparoscopic mesh repair and had an uneventful postoperative hospital stay. Although a rare entity, there should be a high degree of suspicion of a lumbar hernia when evaluating a case of a lumbar mass. Early diagnosis by computed tomography and management with open or minimally invasive techniques can prevent complications.
Carvajal Syndrome- A Variant of Naxos Disease: A Case Report
(Nepal Medical Association, 2022) Mandal, Krishna Deo; Shrestha, Pun Narayan; Ghimire, Anjila; Joshi, Prakash; Agrawal, Sumit; Shrestha, Prapti
Abstract: Carvajal syndrome is a rare variant of Naxos disease, a recessive mutation of the desmoplakin gene characterized by presence of woolly hair, palmoplantar keratoderma and dilated cardiomyopathy, mainly left ventricular involvement. The main clinical complication is progressive heart disease which may lead to heart failure and sudden cardiac death in childhood and adolescence. Cardiomyopathy is diagnosed by Task Force Criteria. The goal of treatment is to prevent sudden cardiac death by lifestyle modification and regular clinical monitoring with pharmacotherapy. We report a nine years female who had skin and hair abnormality and was admitted with features of heart failure. She was clinically diagnosed as Carvajal syndrome, an under-recognized cardio cutaneous manifestation in children. Clinicians should be aware, if any child present with keratoderma of palm and soles with woolly hair since birth should evaluate for cardiomyopathy. Genetic tests should be done whenever available, for confirming the diagnosis and counseling.
A Baby Born with Ectopia Cordis, Omphalocele, Cleft Lips and Palate: A Case Report
(Nepal Medical Association, 2022) Shrestha, Nischal
Abstract: Ectopia cordis is a rare congenital defect with the prevalence of 5 to 8 per million live births. Here we report a rare case of preterm female live birth with ectopia cordis associated with omphalocele, cleft lip, and palate. In this case, 14+ weeks ultrasound did not show any fetal abnormalities and parents were unaware of the condition until 35+ weeks when ultrasound detected the anomaly a few days before delivery. After delivery, they didn’t give consent for further intervention which led to neonatal mortality 3 hours after birth. If the condition was diagnosed in time, an earlier intervention could have been done.
Early Oral Feeding with Vascular Resection among Patients Undergoing Pancreatoduodenectomy in a Tertiary Care Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Regmee, Sujan; Limbu, Yugal; Parajuli, Anuj; Ghimire, Roshan; Maharjan, Dhiresh Kumar; Shrestha, Suman; Thapa, Prabin Bikram
Abstract: Introduction: Pancreatoduodenectomy with vascular resection is performed in locally advanced periampullary malignancies. In our practice, early oral feeding is initiated in patients undergoing pancreatoduodenectomy. This study aims to find the prevalence of early oral feeding with vascular resection among patients undergoing pancreatoduodenectomy. Methods: This was a descriptive cross-sectional study conducted among hospital records of 152 patients who underwent pancreatoduodenectomy in the department of surgery of a tertiary care hospital from 2016 to 2020. Ethical approval was taken from the Institutional Review Committee (Reference number: 0812202102). Convenience sampling was done. Patients clinical and sociodemographic data were collected and analyzed using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean, and median. Results: Among 152 patients undergoing pancreatoduodenectomy, early oral feeding with vascular resection was done in 17 (11.18%) (6.17-16.19 at 95% Confidence Interval). Portal vein and superior mesenteric artery were resected in one (5.88%) and hepatic artery in one (5.88%) patient. Type I, III and IV reconstruction was done in nine (52.9%), five (29.41%) and one (5.88%) respectively. Clinically relevant delayed gastric emptying and postoperative pancreatic fistula were seen in two (11.7%). Complication of Clavien–Dindo Grade III or higher was seen in one (5.88%) patient. One (5.88%) mortality was noted. Conclusions: The prevalence of early oral feeding with vascular resection among patients undergoing pancreatoduodenectomy was similar to other studies done in similar settings. Early enteral feeding is well tolerated in patients undergoing pancreatoduodenectomy with vascular resection.
Perception Regarding Early Clinical Exposure among Second Year Medical Students after Educating Pregnant Women on Physiological Changes during Pregnancy: A Mixed Methods Study
(Nepal Medical Association, 2022) Shrestha, Bipin Kumar; Thapa, Bikalp; Shrestha, Rashmi; Amatya, Tara Man; Khatri, Ratna
Abstract: Introduction: The traditional teaching-learning process should reform to improve the academic performance and understanding of the students. This study aimed to determine the perceptions of second-year medical students towards early clinical exposure about their approach to educating pregnant women on the physiology of pregnancy. Methods: This was a descriptive cross-sectional study with a mixed-method design comprising both quantitative and qualitative components among second-year medical students of a medical college in Nepal from September 2019 to September 2020. After ethical approval from the Institutional Review Committee (Reference number: 207), 40 students included through the convenience sampling method. These students were subjected to early clinical exposure in the form of educating pregnant women on physiological changes during pregnancy. Data was entered and analyzed using Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 34 responses, majority of the students 29 (85.28%) (73.36-97.20 at 95% Confidence Interval) were motivated to learn the physiology of pregnancy after the activity; 15 (44.11%) strongly agreed and 14 (41.17%) agreed to this statement. Thirty-two students (94.11%) claimed that the activity improved their understanding of the physiology of pregnancy. The majority of the students expressed that this approach is pragmatic which ignited more curiosity regarding the subject matter. Conclusions: The majority of the students had satisfactory perceptions regarding their early clinical exposure which was similar to standard data and they expressed that they would like to have similar activities in the future.
Malignant Serous Effusions among Hospital In-patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Dhakhwa, Ramesh; Sapkota, Shreya; Maharjan, Anju; Pradhan, Sailesh
Abstract: Introduction: Cell block technique is an adjunct to conventional smears in the diagnosis of malignancy in effusion fluid. It aims at retrieving cellular material and concentrating cells in a small field, with preservation of cytomorphologic details. The objective of this study was to find the proportion of malignant serous effusions using cell block technique among hospital in-patients in a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted among patients visiting a tertiary care centre between 1st June 2020 to 30th November 2020. Ethical approval was taken from the Institutional Review Committee (Reference number: 305202001). Using a convenience sampling method, 96 hospital in-patients were included in the study. Serous effusions were evaluated by conventional smears and cell block sections. Data was analysed using the Statistical Package for the Social Sciences version 23. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean and standard deviation. Results: Among 96 hospital in-patients, 15 (15.62%) (8.35-22.88 at 95% Confidence Interval) were diagnosed as positive for malignancy by using cell block technique. By conventional smears, 80 (83.33%) cases turned out to be negative for malignancy, 13 (13.54%) were positive for malignancy and three (3.12%) were suspicious for malignancy. Of the three (3.12%) cases suspected for malignancy, two turned out to be positive for malignancy and one was found to be negative for malignancy on cell block technology. Conclusions: The proportion of malignant serous effusions was similar in comparison to other studies. Cell block technique could be routinely incorporated along with conventional smears for a more accurate diagnosis of malignancy on serous effusion.
Healthcare Professionals Providing Direct Care to the COVID-19 Patients: A Descriptive Cross-sectional Study Authors
(Nepal Medical Association, 2022) Acharya, Bishnu Dutta; Rawal, Mangal; Gurung, Dhiraj; Limbu, Bhanu; Baniya, Prem Laxmi; Rokya, Poojan Kumar; Panthi, Suresh
Abstract: Introduction: COVID-19 highly contagious viruses that have reached every corner of the world. Despite the heroic efforts to control the pandemic, health care professional risk for COVID-19 exposure was an important measure to identify due to lack of personal protective equipment. The objective of the study was to find out the prevalence of healthcare professionals providing direct care to the COVID-19 patient. Methods: A descriptive cross-sectional was conducted through online questionnaire from June 2020 to August 2020. Ethical approval was obtained from the Ethical Review Board of Nepal Health Research Council (Reference number: 363/2020 P). World Health Organization risk assessment protocol questionnaire was used for COVID-19 and distributed among 300 health care workers of Nepal involved in the management of COVID-19 hospitals. Convenience sampling was used. The KoBo toolbox was used for online data collection. Data analysis was done using Statistical Package for the Social Sciences version 23. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Among 300 study participants, 109 (36.33%), (30.85-41.74 at 95% Confidence Interval) of participants provide direct care to infected patients. With total respondents, 41 (37.61%) were registered nurses, medical doctors 28 (25.68%) and paramedics 36 (33.02%). Conclusions: Health care workers who provide direct care to the COVID-19 patient were similar to other studies done in similar settings. About half of the participants were exposed to COVID-19 virus from the hospital setting rather than from community setting which is similar to the study done in similar setting which might be due to lack of follow of protocols during COVID-19 patient care.
Seropositivity among Blood Samples Drawn from Suspected Dengue Cases at a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study Authors
(Nepal Medical Association, 2022) Shreewastav, Rupesh Kumar; Thakur, Manoj Kumar; Singh, Arambam Giridhari
Abstract: Introduction: The cases of dengue fever have been reported more frequently in Nepal these days. The aim of this study was to find the prevalence of seropositivity among blood samples drawn from suspected dengue cases at a tertiary care centre of Nepal. Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital from 1st June 2017 to 31st October 2018 after getting approval from the Institutional Review Committee (Reference number: 23/2016). A total of 537 suspected dengue patients were selected for the study using convenience sampling. These dengue positive sera were assayed for their reactivity with Immunoglobulin M and Immunoglobulin G present in sera and synthetic peptides of dengue virus by enzyme linked immunosorbent assay. Data was entered and analysed in Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean and standard deviation. Results: Among 537 suspected dengue cases, the seropositivity for dengue was found in 124 (23.09%) (19.52-26.65 at 95% Confidence Interval) of the serum. Conclusions: The present study revealed that dengue was more prevalent in our setting compared to similar studies. All the synthetic peptides showed reactivity with dengue-positive sera with maximum reactivity shown by RR2 peptide. In dengue-positive sera, RR2 peptide of dengue virus identified more Immunoglobulin M than Immunoglobulin G.
Depression, Anxiety and Stress among Nurses Providing Care to the COVID-19 Patients: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Bhandari, Menuka; Yadav, Upendra; Dahal, Tulasha; Karki, Anjula
Abstract: Introduction: Addressing adequately the mental health during and after COVID-19, as well as preparation for possible future outbreaks, requires an understanding of the nature and extent of mental health impacts, factors related to negative mental health outcomes and symptoms of mental illness. The aim of this study was to find the prevalence of depression, anxiety and stress among nurses providing care to the COVID-19 patients. Methods: A descriptive cross-sectional study was conducted from 10th April 2021 to 30th June 2021 among 301 nurses from three COVID-19 dedicated hospitals using self-administered questionnaires. Whole sampling technique was used. Ethical approval was obtained from the Ethical Review Board of Nepal Health Research Council (Registration number: 106/2021P). The data was analyzed using the Statistical Package for the Social Sciences version 16. Descriptive statistics like frequency, percentage, mean and standard deviation were calculated. Results: Out of 301 nurses, the prevalence of depression, anxiety and stress was 258 (85.72%), 189 (62.80%) and 151 (49.84%) respectively. Conclusions: The study has shown a higher prevalence of depression, anxiety and stress among nurses in comparison to other studies in the similar settings. A quick assessment of the mental health status and mental health requirements of nurses would be helpful in responding to and reducing psychological distress in the crisis situation. The mental health status of nurses should thus be closely monitored by the employing health institutions including managing their workload, providing emotional support and responding to their personal needs.

Browse

Recent Submissions