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Twin Mesiodens present in maxillary arch, a rare finding: A report of two cases
(Institute of Medicine, 2015) Agrawal, AK; Agrawal, NK; Dahal, S
Abstract The term mesiodens refers to a supernumerary tooth that is present in the midline of the maxilla between the two central incisors. Its occurrence as multiples is termed as ‘mesiodentes’. Double mesiodentes is a rare phenomenon. The prevalence of mesiodens varies between 0.09% and 2.05% in different studies. The etiology of this dental anomaly remains unclear. There probably exists a familial disposition. This is a case report of two patients presented with two mesiodens. Keywords: mesiodens, mesidentes, supernumerary tooth
Laparoscopic Cholecystectomy in a Private Hospital
(Institute of Medicine, 2015) Shrestha, J; Vaidya, P; Khakurel, M
Abstract Introduction: Laparoscopic Cholecystectomy is the gold standard for benign Gall Bladder disease. Laparoscopic Cholecystectomy has rapidly gained popularity and it is one of the commonly performed operations in Nepal. The current study was carried out in the Department of General Surgery, Hospital for Advanced Medicine and Surgery (HAMS), Kathmandu, Nepal to evaluate the result of Laparoscopic Cholecystectomy in our set up. Methods: A retrospective review of medical records was conducted on all study patients. Demographic data, indication for surgery, rate of conversion to open cholecystectomy, morbidity and mortality rates were noted. The data of all patients who underwent laparoscopic cholecystectomy from April, 2012 to April, 2014 was entered in standardized proforma and analysed on SPSS 20. Results: A total of 130 Cholecystectomy over a period of 2 years, Male: Female ratio 1:1.9. Mean Age group 41-50 years. Out of all these patients 76% patients presented with symptoms while 24% were asymptomatic. Overall conversion rate was 9.2%. The average hospital stay was 2 days. There were no complications and no mortality in this period of study. Conclusion: Our finding demonstrates that there was no difference in the outcome whether the patient was given the antibiotics post-operatively or not. Even the diabetics can be treated with prophylactic doses of antibiotics. Three port technique was safe. Complications can be avoided even without selecting cases if two surgeons perform together and early decision of conversion to open cholecystectomy is made. Keywords: cholelithiasis, laparoscopic cholecstectomy, private hospital, three port technique
Popliteal artery injury in and about knee injury: An experience in Manmohan Cardiothoracic vascular and transplant center
(Institute of Medicine, 2015) Baral, RK; Shrestha, K R; Sapkota, R; Shrestha, UK
Abstract Introduction: Knee dislocation is a common knee injury leading to neurovascular insufficiency. Penetrating injury to the popliteal fossa is also associated with neurovascularv injuries. Amputation rate is high amongst popliteal artery injury associated with bone injury. Delayed detection and late interventions are the factors contributing for limb loss in these cases. We present our experience of the popliteal artery injury from a tertiary care center over the period of 3 years. Method: It is a retrospective analysis of prospectively collected data of cases of popliteal arterial injury over the period of three years (July 2011 till June 2014). Data were analyzed on their demographic, clinical, management and outcome parameters with SPSS 17. Result: There were total 35 popliteal artery injuries in 34 patients associated with injuries of knee. Twenty two (65%) patients were male and rests were female. Mean age of these patients was 23±12 years, with age ranging from 15 to 76 years. Twelve patients had amputation and were identified and treated late. Most of the patients reach our center late mean time 9±5 hours and as late as 7 days. Conclusion: High index of suspicion is required to identify the popliteal artery injury in patients with injuries in and about the knee. Early vascular surgical consultation and intervention is required to alleviate its poor outcome. Keywords: knee injury, popliteal artery injury
A Retrospective study of Intussusception of the bowel in adults
(Institute of Medicine, 2015) Bhattarai, A; Poudyal, S; Bhandari, RS; Lakhey, PJ; Singh, KP
Abstract Introduction: Intussusception is the leading cause of intestinal obstruction in children. In contrast to childhood intussusception, adult intussusception accounts for only 5% of all intussusceptions with 90% having a lead point, a well-defined pathological abnormality. Adult intussusceptions pose a further challenge as they are often presented with acute, subacute or chronic non-specific symptoms. Computed tomography is the most sensitive diagnostic modality and can distinguish between intussusception with and without a lead point. Surgery is the definitive treatment of adult intussusceptions. So the aim was to evaluate adults with intussusception in and to assess its etiology, clinical features, diagnosis and management. Methods: A retrospective review of adults aged >16 years with a diagnosis of intussusceptions between 1998- 2013 was done. Results: There were 22 cases of adult intussusceptions. Mean age was 44 years (17-86 years). Abdominal pain, nausea, vomiting and rectal bleeding were the most common symptoms. There were 2 cases of retrograde jejunogastric intussusception, 5 cases of jejunojejunal intussusceptions, 3 cases of ileoileal intussusceptions, 11 cases of ileocolic intussuscetpions and 1 case of colocolic intussusception. In seventeen cases, the lead point for intussusception was identified out of which 13 cases had benign pathology and 4 cases had malignant pathology. In five cases cause was not found. All cases were treated surgically except one case of jejunogastric intussusception which was reduced endoscopically. Mean duration of hospital stay was 13 days (5-30 days). Postoperative period was uneventful except surgical site infection in 8 cases and 1 case developed ECF which was managed conservatively. There was one mortality because of chest infection. Conclusion: Adult intussusception is an unusual and challenging condition having a well- defined pathological abnormality in most of the cases. Treatment usually requires resection of the involved bowel segment. Keywords: Adult Intussusception, Computed tomography, Surgery
Knowledge Status on Mental Health among Health Professionals of Chitwan District, Nepal
(Institute of Medicine, 2015) Gortoulla, P; Pantha, S; Pandey, R
Abstract Introduction: Mental health issues are not openly shared by people due to the negative stigma that it carries. In addition, health professionals lack adequate knowledge on mental health issues. This prevents effective management of patients with mental illness. Methods: A descriptive cross-sectional study was carried out among hundred health professionals working in government health institutions of Chitwan District in order to determine the knowledge, attitude and practices on different aspects of mental illness. Knowledge score was added for each domain and changed to categorical variable. Chi- square and fisher-exact test was done accordingly. P-value of less than 0.05 was considered as significant. Results: Age of respondents ranged from 18 to 59 years. A significant number of respondents had very little knowledge on mental health issues and its causes. Majority of them identified neurosis as types of mental illness followed by personality disorder, psychosis and substance abuse. Only a quarter had better knowledge about the treatment. Age group, being male or female, high or low income, knowledge on mental illness, knowledge on type, causes, signs and symptoms, attitudes and practices of mental illness was significantly different between four levels of health professionals namely Health Assistants (HA), Staff Nurse (SN), Community Medical Assistants (CMA) and Auxillary Nurse Midwife (ANM). Conclusions: The findings suggest that further information regarding mental illness, its sign/ symptoms, causes and treatment modalities should be provided to health workers along with actions to reduce stigma related to mental illness among them. Keywords: Chitwan district, cross sectional study, health professional, mental health
Open Anderson Hynes Pyeloplasty in Ureteropelvic Junction Obstruction: An Institutional Experience
(Institute of Medicine, 2015) Subedi, PP; Chapagain, S; Thakur, DK; Poudyal, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PR; Shrestha, GK
Abstract Introduction: Ureteropelvic junction obstruction (UPJO) is one of the common causes of hydronephros is in children and adults. The cause may be congenital or acquired. The standard management of UPJO has classically been an open Anderson-Hynes (A-H) dismembered pyeloplasty. This study is an audit of A-H pyeloplasty done for patients with UPJO presenting to our institution. Methods: A retrospective analysis was done in the Urology unit, Tribhuvan University Teaching Hospital from July 2013 to November 2014. All patients undergoing A-H pyeloplasty were included for review. Preoperative data regarding the demographics, presentation, diagnostic tools used, details of the surgery, postoperative complications, duration of hospital stay and follow up findings were reviewed. Initial follow up was scheduled at two weeks, then at three months and at one year. At 3 months, DTPA renogram was obtained to assess the function and clearance of the treated kidney. Results: The age of the patients ranged from 5 months to 69 years. Flank pain was the most common presenting complain. Most of the patients were males and left sided obstruction was common. The most common diagnostic modality used was USG and excretory urography. CT urography was done in cases of secondary UPJO. DTPA scan was used in select cases for baseline documentation of the function of the involved kidney. The average duration of surgery was 2 hours and 30 minutes. The mean duration of hospital stay was 5 days. The most common complication was urinary tract infection. Conclusion: Open A-Hpyeloplasty is the most common surgery done for UPJO at our institution. The outcome can be improved by attention to the principles of A-H pyeloplasty. Keywords: hydronephrosis, A-H pyeloplasty, ureteropelvic junction obstruction
Cryptosporidium infection among the school children of Kathmandu Valley
(Institute of Medicine, 2015) Bhandari, D; Tandukar, S; Sherchand, S; Thapa, P; Shah, PK
Abstract Introduction: Cryptosporidium, a coccidian protozoan genus has emerged as an important cause of parasitic diarrhea among children living in developing countries. The present study aimed to determine the infection of Cryptosporidium and other intestinal parasites among the school children of Kathmandu Valley. Methods: Ethical approval for this research was obtained from Institutional review board, Institute of Medicine. A total of five hundred and seven stool samples from children between the age group 3-14 years, studying in 13 different schools of Kathmandu were collected during the study period (May- November, 2014) and processed in the Public Health Research Laboratory, Institute of Medicine, Kathmandu, Nepal. A modified Acid Fast staining technique (Kinyoun’s method) was used to detect oocysts of Cryptosporidium from the formal-ether concentrated stool samples. Result: The overall, prevalence of intestinal parasites among children was found to be 22.68% (115/507) with Giardia lamblia being the most predominant parasite showing the incidence of 10.45% (53/507). Cryptosporidium oocysts were detected in 0.79% (4/507) of the students investigated with the highest occurrence during the month of July i.e., 2 followed by single positive case for each, June and September. Conclusion: The detection of Cryptosporidium oocysts and observance of diarrheal symptoms, together with the pattern of age-specific occurrence, livestock presence at home, consumption of untreated drinking water and raw vegetables/fruits consumption habit among infected children suggest that in low-income Kathmandu communities, cryptosporidiosis coupled with poor sanitary practice is a public-health issue causing potentially serious consequences. Keywords: Cryptosporidium, School Children, prevalence, Kathmandu
Comparison of Axillary Temperature with Oral Temperature and Determination of Optimum Placement Time of Thermometer in Adults of Teaching Hospital, Nepal
(Institute of Medicine, 2015) Sharma, M; Gautam, R; Neupane, B
Abstract Introduction: Accurate temperature measurement is important to person, in whom suspicion of infection could result in investigations, administration of antibiotics, and even hospital admission. This study was done with the aim to determine the optimal dwell time of the thermometer in oral and axillary sites required to accurately reflect the stabilized core body temperature. Method: Cross-sectional survey of 113 adult patients was done who were admitted in Manmohan Cardio- Thoracic Vascular and Transplant Center (MCTVC) in the period between 16thJuly to August2013. Ethical approval from the Institutional Review Board (IRB) of TUIOM and permission from the respective hospital authority was taken before data collection. Conventional glass mercury thermometer were checked and brought to 95 degree of Fahrenheit before each measurement of the temperature. Two thermometers were simultaneously placed in oral cavity and in the axillary skin sites. Reading of the oral temperature was done in 1 and 3 minutes, similarly, reading of axillary temperature was done in 3 and 5 minutes. Data was analyzed in SPSS 18 by using parametric and nonparametric tests. Results: Findings revealed the mean temperature difference between 1 minute oral to 3 minute axilla was 0.92 ± 0.79 SD, and the 3 minute oral to 5 minute axilla was 0.96 ± 0.82 SD, the difference was significant (P<0.05). Further, the mean oral temperature in 1 minute was 97.75 ± 1.27 SD, and in 3 minutes was 98.69 ± 1.37 SD. Similarly, mean temperature of axilla in 3 minutes was 97.67± 1.40 SD, whereas mean in 5 minutes was 98.43 ± 1.46 SD. The mean difference was significant. Conclusion: The effective time to measure oral temperature was three minute and it was five minutes for axillary measurement. Keywords: temperature, degree of fahrenheit, oral and axillary measurements
External Ventricular Drainage Infections: Experience from a Tertiary Care Center in Nepal
(Institute of Medicine, 2015) Pradhanang, AB; Sharma, MR; Sedain, G; Shilpakar, SK
Abstract Introduction: External Ventricular Drainage (EVD) is one of the most commonly performed procedures in neurosurgical practice. EVD related infection is among the most dreaded complications encountered after the procedure with added morbidity and mortality. Objectives: The primary objective of this study was to assess the incidence of EVD infections in this hospital. In addition, the researchers have made an attempt to evaluate the indication for EVD placement, influence of total drainage time on the risk of catheter infection, the most common bacterial spectra in cerebrospinal fluid (CSF) culture, their antibiotic sensitivity pattern, and the association of CSF cell count with bacterial growth. Methods: This is a retrospective study of all patients who underwent EVD placement over a period of two years. Those patients who had bacterial growth in their initial samples were excluded from the study. Results: Out of 62 patients, 54 met the inclusion criteria for analysis. The ventricular catheters were in place from 1 to 23 days. Overall shunt infection rate was 37%. CSF cell count was significantly associated with the occurrence of a positive CSF culture (Fisher’s Exact Test, p<0.01). The most common bacterial species isolated were Acinetobacter baumannii and Burkholderia cepacia. Conclusion: Despite many advances in care, there is still a significantly high incidence of EVD related infections. Contrary to earlier reports, the most common bacteria grown in the study were quite different and their antibiotic sensitivity varied accordingly. Keywords: External Ventriculostomy Drainage infection, hydrocephalus, antibiotics in external ventriculostomy drainage
Validation of European Score for Cardiac Operative Risk Evaluation in cardiac surgical patients in Nepal
(Institute of Medicine, 2015) Pradhan, B
Abstract Introduction: European System for Cardiac Operative Risk Evaluation (EuroSCORE) is the standard tool for risk stratification of patients undergoing cardiac surgery. Before using this tool in any population, its validation needs to be assessed. This study was carried out to check validation in cardiac surgical patients in Nepalese patients. Method: This is a prospective observational analytical cohort study in 500 patients undergoing cardiac surgery for coronary artery bypass graft (CABG), valve replacement surgeries (mitral valve, aortic valve or double valve replacements) and valve and aorta replacement surgeries (Bentall procedure). The data were entered in the Microsoft excel software and were analyzed using Chi Square test from Statistical Package for Social Sciences (SPSS Version - 17) package. Calibration power and discriminative power were calculated. Result: The model’s validation was assessed by its calibration and discriminative power. Calibration power was assessed using Hosmer- Lemeshow test (Chi-square test). It gave P value of 0.14 indicating that the model adequately fits the data and can predict mortality. Discriminative power was assessed by calculating area under the receiver operating characteristic (ROC) curve which was 0.71 indicating satisfactory discriminative power. In low and moderate risk groups, observed and predicted (additive and logistic) mortality were satisfactory. In high risk group, observed mortality was higher than predicted mortality. Logistic EuroSCORE value was nearer to observed value. Conclusion: EuroSCORE can be applied in Nepalese cardiac surgical patients in low and moderate risk groups satisfactorily though additive EuroSCORE is better in prediction. In high risk groups, logistic and additive EuroSCORE under predicted outcome than the observed mortality. However logistic EuroSCORE was better in this group of patients. EuroSCORE needs to be refined to apply on high risk Nepalese cardiac surgical patients. Keywords: additive, cardiac surgicalpatients, EuroSCORE, logistic, Nepalese
Analysis of mammographic findings in a tertiary care hospital of Nepal
(Institute of Medicine, 2015) Humagain, M; Paudel, S
Abstract Introduction: Mammography is commonly the first line imaging procedure in screening of breast cancer in women. It is also commonly used as diagnostic test in the assessment or characterization of palpable breast mass along with ultrasonography. The purpose of our study was to assess the mammographic findings in women undergoing screening and diagnostic mammography. Methods: This was a prospective cross sectional study analyzing the outcomes of 497 consecutive screen-film mammographic examinations, 369 (74.2%) diagnostic and 128 (25.8%) screening, performed in female patients from 4th July 2012 to 15th October 2012 in Tribhuvan University Teaching Hospital. Analysis was based on the final assessment report of mammogram reviewed by the experienced radiologists following Breast Imaging Reporting and Data System (BI-RADS) classification. BI-RADS score 4, 5 and 6 were considered as positive, BI-RADS score 1, 2 and 3 were considered as negative and BI-RADS score 0 was considered inconclusive requiring additional imaging. Results: The mean age of women was 46.3 years (range 26-83 years). Among 369 cases of diagnostic mammograms 300 (81.3%) were negative, 27 (5.4%) were positive and rest 42 (8.4%) were inconclusive. Among 128 cases of screening mammograms, 117 (91.4%) were negative, 11 (8.6%) were inconclusive and none of them were positive. Among total (497) numbers of mammographic examinations, 417 (84%) were negative, 27 (5.4%) were positive and 53 (10.6%) were inconclusive. BI-RADS 1 was the most common reported finding comprising 26.8% in diagnostic and 12.1% in screening group. Conclusion: Analysis of diagnostic mammography examinations yields different results compared with those of screening examinations, including different patient demographics; higher number of positive findings; and possibly higher cancer detection rates. Diagnostic and screening data should be segregated during record keeping and analysis of combined results should be based on known differences between diagnostic and screening outcomes. Keywords: BI-RAIDS, diagnosttic, mammography, screening
Deliberations of Nursing Academics towards Distance Education
(Institute of Medicine, 2015) Joshi, S; Shahi, M
Abstract Introduction: There are different ways of upgrading knowledge and competency among the learners, distance education is believed to be a valid method for enhancing competencies. Methods: In order to assess the practicability in terms of availability of information communication technology as well as commitments of the learners in conducting distance education, a feasibility study was conducted in three nursing institutes of Institute of Medicine, which were selected purposively. For data collection structured instrument was used for administrators and self-administer semi-structured questionnaire for nursing academicians. Results: It was revealed that all the campus administrators were ready to take part in this new initiative and willing to collaborate during implementation of the project. Cent percent of nursing academicians were enthusiastic to take part in this project, among them 95% were interested in learning proposal writing for qualitative study. Eighty percent of them had computer along with Internet facilities at their work place, and 80% had their own computer along with internet facilities at work place, while only 50% had their own computer. However, 66% of them did not have advance knowledge in handling multi-medias and computer skills. Conclusion: Administrators as well nursing academicians are willing to collaborate in this distance education project, and nursing academicians are enthusiastic in developing competencies in conducting qualitative research via distance education on their own leisure time without hampering in their scheduled activities. Keywords: distance education, feasibility study, qualitative research approach
Comparison in Total Sialic acid levels between control and cancer patients visiting Teaching hospital, as a basis for oral cancer diagnosis
(Institute of Medicine, 2015) Dahal, S; Agrawal, NK; Shrestha, L
Abstract Introduction: Oral squamous cell carcinoma is the most common malignant neoplasm in the head and neck region and remains one of the major causes of worldwide deaths. Recognition and diagnosis of oral cancer at an early stage can reduce morbidity and mortality. Oral cancer screening in a large population can be done non-invasively by using sialic acid in saliva as a biological marker. The aim of this study was to estimate the total sialic acid (TSA) level in three categories of populations: normal healthy controls, tobacco users with a premalignant lesion like leukoplakia, and tobacco users who developed oral squamous cell carcinoma (OSCC). Methods: A total of 45 subjects were involved in the study. Saliva was collected from three groups and total sialic acid was estimated. The data obtained was analyzed statistically using ANOVA and Tukey HSD test. Results: A comparison of total salivary sialic acid levels in three groups revealed a significant rise in the level of TSA in OSCC group when compared to control group. The difference in the mean level of TSA of precancerous group was also significant when compared to control group. Conclusion: The present study showed a significant rise in the mean level of total salivary sialic acid from control group (51.57 mg %) to precancerous group (74.64 mg %) to OSCC group (104.30 mg %), and suggests that it can be used as a reliable tool in oral cancer screening as the technique is non-invasive and inexpensive. Keywords: oral cancer, salivary markers, total salic acid
A prospective randomized study of goal oriented hemodynamic therapy in cardiac surgical patients
(Institute of Medicine, 2015) Shrestha, KR; Pradhan, B; koirala, B
Abstract Introduction: Approximately 10% of patients require prolonged care after cardiac surgery because of hemodynamic instability, organ dysfunction or multi organ failure. Increased levels of oxygen delivery and consumption in early postoperative period are associated with improved outcome and early recovery. The aim of the study was to evaluate early post- operative outcome in cardiac surgery patients with adoption of goal oriented hemodynamic therapy. Methods: This is a prospective randomized controlled trial of 12 months period, of adult patients undergoing cardiac surgery in a tertiary level teaching hospital. In the control group, standard postoperative monitoring was done, while in the study group FloTrac TM cardiac output sensor with Vigileo monitor and central venous oxygen saturation monitoring was done to reach a set goal within 8 hrs postoperatively. Findings were analysed using SPSS software version 17. Results: 100 patients were enrolled in the study with 50 in each group. Both groups were comparable by baseline characteristics, body surface area (BSA) and duration of surgery, cardiopulmonary bypass (CPB) and aortic cross-clamp (AoX) time. But the average age was statistically higher in study group. Yet, the ventilator time and duration of use of ionotropes were significantly less in study group. The duration of intensive care unit (ICU) and hospital stay were less in study group but did not reach statistical significance. Conclusion: This study has shown that the use of goal oriented hemodynamic therapy in cardiac surgical patients improves immediate outcome. Mortality, ICU and hospital stay also tend to be lower. Keywords: cardiac surgery, goal orientedhemodynamic therapy, FloTrac system, hemodynamic monitoring
Reproductive Risk Factors in Uterovaginal Prolapse: A Case Control Study
(Institute of Medicine, 2015) Paudyal, P; Pradhan, N; Ojha, N
Abstract Introduction: Uterovaginal prolapse (UVP) is a major women’s health concern throughout the world and contributes a major bulk of reproductive health morbidity in Nepal. The cause of this disorder is likely to be multifactorial. The aim of this study was to analyze the reproductive risk factors associated with UVP. Methods: This was a hospital-based case control study, carried out in the Gynaecology Department of TUTH over one year from 1 st Baisakh 2068 to 30 th Chaitra 2068 (13th April 2011 to 12th April 2012). Cases comprised of 116 women with UVP, second degree or more and controls were women without prolapse of the same age group (± 5 years) admitted subsequently after the cases. The variables studied were; age at first childbirth, number of vaginal births, birth spacing and rest during puerperal period. P value and Odds Ratio (OR) for each risk factor were calculated. Multivariate analysis was done for those risk factors found to be significant from the univariate analysis. Results: Age at first childbirth, number of vaginal births and rest during puerperium were found to be significant risk factors from univariate analysis. Only two risk factors i.e. age at first childbirth<20years; OR 2.24(95% CI 1.18-4.25) and rest during puerperium<15 days; OR 3.87(95% CI 1.9-7.93), were found to be significant by the multivariate analysis. Conclusion: Preventing early marriage and childbirth at a young age along with imparting awareness about the importance of adequate rest during the puerperium could go a long way in reducing morbidity due to prolapse. Keywords: reproductive risk factor, uterovaginal prolapse
Impact of iron and zinc supplementation on child disability screening using the Ten Questions Plus tool in rural Sarlahi District, southern Nepal
(Institute of Medicine, 2015) Wu, LA; Katz, J; Mullany, LC; Khatry, SK; Darmstadt, GL; LeClerq, SC; Tielsch, JM
Abstract Introduction: The Ten Questions tool was developed in 1984 as a low-cost tool to screen for child disability prior to referral for definitive diagnosis. Iron and zinc contribute to child growth and development, but few studies examine the relationship between supplementation and longer-term neuro-developmental outcomes. Methods: The Ten Questions Plus tool was administered to caregivers of 1410 children between 1-9 years of age from August 2007 to March 2008 in rural Sarlahi, southern Nepal. Participants had been previously enrolled in a randomized 2x2 factorial trial of daily iron and zinc supplementation between October 2001 and January 2006. Results: Nearly 30% of the sample screened positive for disability. The most common problems were learning disability (12.3%) and motor milestone delay (11.3%). Children supplemented with zinc were less likely to screen positive overall, and for motor and learning problems. Children supplemented with smaller doses of iron were more likely to screen positive overall, and for physical, and cognitive problems, but these differences were not statistically significant. There were no differences in children dually supplemented with iron and zinc compared with placebo. Conclusions: The Ten Questions Plus tool can be used in this rural Nepali setting to identify children at increased risk for physical and cognitive disability who should be referred for clinical examination, diagnosis and enrollment in intervention services. We found evidence for a beneficial effect of zinc supplementation in reducing the likelihood of screening positive for disability. Keywords: micronutrient supplement, zinc, iron, disabiity, children, Nepal, screening
Frequency and pattern of Skin Disorders in Adolescents in a School of Kathmandu
(Institute of Medicine, 2015) Shrestha, DP; Baral, S; Shrestha, R; Gupta, S; Bhattarai, S; Shrestha, S; Rosdahl, I
Abstract Introduction: Skin disorders are one of the major causes of morbidity in Nepal. The objectives of this study are to determine the relative frequency and pattern of skin disorders in a cohort of adolescents 9-18 years of age. Methods: The study was conducted in a residential school of Kathmandu. A detailed information about the study was given to the student members of a school club and they in turn, informed all the other students of the dermatologic health camp, which was conducted subsequently. All students appearing at the camp were examined by a dermatologist and information regarding age, gender, school grade and diagnosis were recorded in a pre-validated format. Results: In the school there were a total of 950 students (627 m, 323 f). Of them 242 (116 m, 126 f) had skin disorder with a point prevalence of 25.5%. Female students had significantly higher prevalence (29%) than male (18.5%). The most common skin disorders were acne, eczemas and urticaria, and the 10 most frequent diagnoses comprised 87% of all skin conditions. Conclusion: This study demonstrates that 1/4 of the students had one or more identifiable skin disorders. Despite the wide range of dermatoses, only a few of them accounted for a major proportion of the skin disorders. This study provides data for targeting health care programs for prevention and treatment of skin disorders in this age group. Keywords: skin disorrders, adolscents, frequency, patttern
Assessment of Health Systems in Relation to Interface Between Malaria Control Programs and Health System Strengthening: Comparative Study Between Nepal and Viet Nam
(Institute of Medicine, 2015) Oraha, H; Sherchan, JB; Pokhrel, BM; Hirayama, T; Huy Nam, Vu; Sherchand, JB
Abstract Introduction: Malaria control has been a major health issue with high priority in endemic countries and various efforts have been made with the support of foreign assistant partners. In order to implement efficient and sustainable control, integration of the control program into general health system or effective interactions between them is one of the important strategies. Methods: Studies were conducted in Nepal and Viet Nam. Information obtained from document reviews, interviews, and field surveys were analyzed from the viewpoint of interface between malaria control program and the health system in accordance with six building blocks of a health system, with special emphasis on good practices and challenges in the implementation of the malaria control program. Results: Among good practices, strong government commitment towards the control programs to strengthen facilities and capacity of health workers at the primary level, utilization of health volunteers, setting up mobile team and intensified education for residents were noteworthy. Key challenges mainly involved remote areas. Introduction of malaria due to population movement and the emergence of new endemic areas have become growing issues. While strengthening of the vertical health program appeared to have some impact on the general health system, particularly at the primary level, dissociation between the vertical control program and horizontal general health system still remains. Conclusion: It is crucial to implement an effective and equitable malaria control program that responds to these existing challenges and can create a sustainable health system. Addressing these issues will lead to further strengthening of the health system there and eventually lead to the effective implementation of various health programs. Keywords: malaria control, health system, Nepal, Veit Nam
Health - related Quality of Life of Patients with Coronary Heart Disease Attending a Cardiac Care Centre in Kathmandu
(Institute of Medicine, 2015) Shrestha, R; Shrestha, S
Abstract Introduction: Coronary heart disease (CHD) is gradually emerging as a major public health problem in many developing countries including Nepal. Consequences of CHD are that it often results in depletion of the health related quality of life (HRQL) of patients. The aim of this study was to assess the HRQL of CHD patients. Methods: A descriptive cross sectional design was used to assess HRQL of 254 CHD patients attending out-patient department of Shahid Gangalal National Heart Centre (SGNHC), Bansbari, Kathmandu, Nepal. Purposive sampling technique was used for data collection by face to face interview technique using the MacNew Health - related Quality of Life tool. Results: The results of the study showed that mean ± SD for emotional domain was 3.87 ± 1.01, for physical domain was 3.81 ± 0.88 and social domain was 3.82 ± 0.88 and global score of HRQL was 3.83 ± 0.87 on 7- point likert scale. The different domains of HRQL was significantly correlated with each others. The descriptive statistics of individual domain scores according to level of HRQL was found to be greater in below average group in each domain including global HRQL score. Conclusions: The HRQL score of CHD patients attending a cardiac centre are below average. Hence, Self-Instructional Module (SIM) on “Living well with CHD” was developed to enhanced quality of life. Keywords: coronary heart disease, health- related quality of life, cross sectional study, Nepal
Earthquake disaster-associated health effects and the need for improved preventive measures
(Institute of Medicine, 2015) Sherchand, JB
NA.

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