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Impact of International Medical Graduates on the UK Healthcare System: Current Contributions and Future Challenges
(Kathmandu University, 2024) Gautam, A; Sakthivel, J; Rahman, FA
ABSTRACT The Professional And Linguistic Assessments Board (PLAB) examination and the International English Language Teaching System (IELTS) represent pivotal evaluations for International Medical Graduates (IMGs) aspiring to pursue medical vocations within the United Kingdom. The United Kingdom’s National Health Service (NHS) leans significantly upon the expertise of medically trained professionals hailing from abroad, a fact further underscored by the substantial composition of IMGs within its workforce. The prevailing aftermath of the persistent pandemic has magnified the preexisting deficit of medical practitioners in the nation, thereby compounding the existing challenges. The intersection of circumscribed temporal constraints governing language proficiency assessments and the restricted worldwide capacity for the placement of IMGs has served to exacerbate this conundrum. This dual- pronged challenge has led to a noteworthy contraction in the pool of qualified physicians eligible to practice within the UK, thus catalyzing a climate of upheaval. These circumstances carry implications not solely for the medical workforce but also reverberate on the psychological equilibrium of these professionals. The exigencies imposed by their geographical separation from their homelands, coupled with the formidable task of surmounting the hurdle of examinations within an environment fraught with adversities, have underscored the urgency for timely and strategic intervention. Given the intricacies of this situation, the relevant governing authorities bear the imperative of instituting proactive measures to alleviate the predicament faced by these aspiring medical candidates. The call for timely interventions resonates strongly, aimed at ameliorating their predicament and restoring a semblance of equilibrium to this intricate situation. KEY WORDS International english language teaching system (IELTS), International medical graduates (IMGs), National health service (NHS), Medical workforce, Pandemic, Professional and linguistic assessments board (PLAB)
Plexiform Schwannoma Clinically Masquerading as Thrombosed Vein
(Kathmandu University, 2024) Basnet, D; Makaju, R; Gautam, N; Shrestha, B; Budhathoki, A
ABSTRACT Plexiform schwannoma is a rare benign nerve sheath tumor usually located in trunk, head, neck, upper extremities and occasionally in lower extremities. It is usually less than 2 cm in size and generally affects young adults. The tumour is composed of schwann cells and exhibit a plexiform growth pattern both in gross or histologic examination and is frequently accompanied by multinodularity causing serpentine distortion. Plexiform neurofibroma commonly mimics plexiform schwannoma and it is important to differentiate between them, as recurrence and malignant potential are more common with plexiform neurofibroma. We present the case of a 14-year-old female with history of a nodular soft tissue mass over his right foot measuring 11 cm in length. A Doppler scan of the foot was suggestive of thrombosed superficial vein in right foot. The histological evaluation of the mass revealed Plexiform schwannoma. S-100 immunostaining is diffuse and strong confirming the diagnosis of Plexiform schwannoma. KEY WORDS Hematoxylin and eosin, Histopathology, Plexiform, Schwannoma
Complex Regional Pain Syndrome
(Kathmandu University, 2024) Shakya, S; Amatya, S; Thapa, S; Thapa, P; Pokharel, S
ABSTRACT Complex regional pain syndrome is chronic pain condition involving hyperalgesia and allodynia of extremities. The pathophysiology of CRPS is thought to be combination of different factors that take place at the time of initial injury. Sixty two years female presented to us with severe leg pain after intravenous cannulation during her spine surgery and associated with hyperalgesia and allodynia. On examination, there was shinny skin and nail changes on right leg and significant surface temperature difference between two legs. Patients were managed conservatively with patient education, physical therapy, pharmacological management, and psychological therapy with diagnosis of complex regional pain syndrome. Diagnosis is a clinical finding based on the Budapest diagnostic criteria. Early treatment with multidisciplinary approach to pain management is necessary to achieve complete recovery and prevent damage. Complex regional pain syndrome is life altering condition but understanding the etiological factors helps us to an early diagnosis and a better implementation of treatment. KEY WORDS Allodynia, Budapest criteria, Complex reginal pain syndrome, Hyperalgesia
Thrombolysis with Tenecteplase for Basilar Artery Occlusion in Neuro and Allied Clinic: Importance of Clinical Assessment and Drip and Ship Model in Nepal
(Kathmandu University, 2024) Thapa, L; Ghimire, MR; Bhattarai, S; Shrestha, AM; Rai, N; Paudel, R
ABSTRACT Tenecteplase, a new thrombolytic drug, is now widely recommended and used for treating acute ischemic stroke, and timely thrombolysis within 4.5 hours is crucial for better outcomes. However, due to limited stroke awareness, transportation difficulties, and inadequate access to experts and comprehensive stroke care centers, fewer than 15% of stroke patients in Nepal receive thrombolytic therapy. The “drip and ship” model, which involves starting thrombolysis at a non- comprehensive stroke care center and transferring the patient to another center for further care, can effectively overcome these obstacles, provided trained personnel are available at non-comprehensive stroke care centers. We report a case of acute ischemic stroke treated with thrombolysis within 4.5 hours of symptom onset at a non-comprehensive stroke care center, followed by transfer to another center for ongoing care, demonstrating the feasibility and potential benefits of the drip and ship model in resource-limited settings. KEY WORDS Basilar artery occlusion, Drip and ship model, Tenecteplase, Thrombolysis
Incarcerated Uterine Prolapse: A Result of Neglect
(Kathmandu University, 2024) Adhikari, A; Poudel, A; Dangal, G
ABSTRACT An 80-year-old lady was brought with the three-month history of irreducible prolapse with infected ulcer at anterior vaginal wall. She initially attempted home remedies for infection with locally available materials. On examination she was ill looking, febrile with stage IV prolapse according to pelvic organ prolapse quantification classification. She was treated initially with antiseptic wash, followed by local estrogen therapy and glycerine. Prolapse was repositioned when edema decreased and held in place with silicon ring pessary with definitive management planned for later date. KEY WORDS Incarcerated prolapse, Irreducible prolapse, Ulcer
Biomarkers of Electroconvulsive Therapy (ECT) Response in Treatment-resistant Schizophrenia (TRS)
(Kathmandu University, 2024) Sharma, P; Sharma, P
ABSTRACT Electroconvulsive therapy (ECT) is a well-established treatment option for individuals with treatment-resistant schizophrenia (TRS). However, predicting treatment response and identifying potential biomarkers to guide electroconvulsive therapy interventions in treatment-resistant schizophrenia remains a challenge. This review paper aims to explore the current literature on clinical biomarkers associated with electroconvulsive therapy in treatment-resistant schizophrenia. We discuss various potential biomarkers, including clinical, neuroimaging findings, EEG markers, and genetic markers, that have shown promise in predicting electroconvulsive therapy response and understanding the underlying mechanism of action. Additionally, we highlight the limitations and future directions for research in this field. KEY WORDS Biomarkers, Electroconvulsive therapy, Treatment-resistant schizophrenia
Molecular Investigation of Dengue Virus Serotypes in the Dengue Outbreak of 2022 in Nepal
(Kathmandu University, 2024) Katuwal, N; Shrestha, A; Ranjitkar, U; Jakibanjar, S; Madhup, SK; Tamrakar, D; Shrestha, R
ABSTRACT Background Dengue, a viral infection highly prevalent in tropical regions, exhibits local variations in risks that are influenced by a combination of climatic, socioeconomic, and environmental factors. It is caused by four distinct, yet closely related serotypes of the dengue virus. Objective To identify the different serotypes of dengue virus responsible for the 2022 outbreak in Nepal, where dengue has been prevalent since 2006 but with limited availability of molecular information on the serotypes. Method Serum samples from suspected dengue patients visiting Dhulikhel Hospital were analyzed using Dengue Rapid Test, for the presence of IgG/IgM antibodies or NS1 Ag. The positive samples were stored at -80⁰C, and 89 samples were selected for further analysis. RNA was extracted from those positive samples and RT-PCR was performed to identify the serotypes present. Result A higher percentage of sero-positivity was observed in females(52%) compared to males. Positive cases were distributed in 14 different districts, with the highest percentage(58.4%) in Kavre. RT-PCR, of 53 out of 89 serologically positive samples, by RT-PCR revealed that DENV1 was the predominant, followed by DEN3(24.5%) and DENV2(16.9%). DENV4 was not detected in any of the samples. The average Ct-value of all serotypes was 17.6, with DENV3 having the lowest Ct-value of 16.6, indicating slightly higher viremia. Conclusion Our study, although limited in its coverage of Nepal, has provided molecular information on the serotypes responsible for the 2022 dengue outbreak. The high prevalence of DENV1 was observed, while prevalence of DENV3 was accompanied by high viral load. KEY WORDS Dengue virus, Molecular, Serotypes, Nepal
Outcome of Endoscopic Myringoplasty Using Gelfoam Versus no Gelfoam in Tympanic Cavity and External Auditory Canal
(Kathmandu university, 2024) Shrestha, BL; Shrestha, A; KC, AK
ABSTRACT Background Absorbable gelatin sponge (gelfoam) is used routinely during myringoplasty as a scaffold that supports tympanic membrane grafts and ossicular chain and to promote hemostasis. However, gelfoam could cause fibrosis, adhesions, granulations, new bone formation within the middle ear cavity and could obstruct the tympanic ostium of the eustachian tube and affects inner ear function and also interferes with the healing process of neodrum and middle ear cavity. Objective To compare the outcome of endoscopic myringoplasty with and without use of gelfoam in external auditory canal and tympanic cavity. Method Fifty patients, with 25 patients in each group who underwent endoscopic myringoplasty with and without gelfoam packing in middle ear cavity and external auditory canal were enrolled in the study. The hearing outcome was assessed by comparing pre-operative ABG (Air bone gap) with post-operative air bone gap and air bone gap closure in speech frequencies (0.5kHz,1kHz, 2kHz,4kHz). The status of graft and hearing results was evaluated on 3months of follow-up in both the groups. Result Out of total 25 patients enrolled for study in both non gelfoam packing group (NGFPG) and gelfoam packing group (GFPG), 24(96%) had graft uptake in each group. The audiological gain in non gelfoam packing group was 11.15±2.4dB whereas in gelfoam packing group it was 12.45±0.81dB. The audiological gain between the two groups did not show any statistically significant (p= 0.190). However, the pre and postoperative hearing difference was statistically significant(p=0.001) in both non gelfoam packing group and gelfoam packing group. Conclusion This study concluded that non gelfoam packing group has similar graft uptake and hearing gain when compared with gelfoam packing group in endoscopic myringoplasty. Hence, myringoplasty can be performed safely without using any gelfoam in the middle ear cavity. KEY WORDS Absorbable gelatine sponge, Air-bone gap, Air-bone gap closure, Chronic otitis media, Myringoplasty
Factors Associated with Urinary Tract Infection among Children Aged Less than 5 Years Visiting Department of Pediatrics of Dhulikhel Hospital
(Kathmandu University, 2024) Siluwal, N; Bhandari, N; Prajapati, R; Timalsena, D
ABSTRACT Background Urinary tract infection (UTI) constitutes a significant cause of morbidity, especially among children under five years old. Early diagnosis and management are essential to minimize acute morbidity and prevent the long-term complications associated with urinary tract infections. Objective To identify factors associated with urinary tract infections among children under five years old. Method A quantitative cross-sectional study was conducted at Dhulikhel Hospital, Kathmandu University Hospital in Nepal, involving face-to-face interviews with 105 parents of children under 5 years with suspected or culture-positive Urinary tract infections. Data collection occurred from July 2022 to December 2022, covering both outpatient (OPD) and inpatient cases. Logistic regression was employed to identify factors associated with urinary tract infections. Result The Urinary tract infection prevalence among children under five was 27.12%, with over half (55.2%) were female. Females had a seven times higher urinary tract infection risk than males (95% CI: 1.64 - 30.18; p = 0.009). Children with congenital anomalies faced a 22.8 times higher urinary tract infection risk (95% CI: 1.70 - 286.56, p = 0.01). Diaper changes exceeding 6 hours elevated the risk by 20.09 times (95% CI: 1.14 - 353.95; p = 0.04). Escherichia coli presence in urine culture correlated with a 9.43 times higher urinary tract infection risk (95% CI: 1.34 - 66.16, P = 0.02). Conclusion Implementing preventive measures, including maintaining personal hygiene and changing diapers frequently, can significantly reduce the incidence of urinary tract infections in children, ultimately minimizing medical costs. KEY WORDS Children, Cleaning, Risk factors, Urinary tract infection
Perception of Undergraduate Dental Students Regarding Teaching Learning Methods in Oral Pathology
(Kathmandu University, 2024) Poudel, P; Adhikari, BR
ABSTRACT Background Third year is considered crucial in undergraduate dental education as this is when students start to have clinical exposure and taught about various oral pathologies. Many a times, students fail to make proper clinical and pathological correlation. It is the responsibility of teacher to impart adequate knowledge to the students regarding a disease in most effective way. Understanding the students perception is an effective way of making new roadmaps for teaching. Objective To assess undergraduate dental student’s perspectives regarding oral pathology along with the effectiveness of various teaching learning methods and assessment methods currently used by faculties of Department of Oral Pathology. Method This cross sectional study was conducted from June 2023 to July 2023 among 136 undergraduate dental students of Kathmandu University School of Medical Sciences by using the pretested questionnaire. Convenience sampling method was used. The data collected were entered into the Microsoft Excel Sheet and statistical analysis was done using Statistical Package for the Social Sciences version 20. Result A total of 136 students participated in the study. Among them, 46 (33.8) were from third year, 51 (37.5) were from fourth year and 39 (28.7) were from fifth year. Half of the students believed that oral pathology is an interesting subject. Most of students; 66 (48.5) participants strongly agreed that knowledge of oral pathology helps in clinical training. Except two students, all the participants said that integration of oral pathology teaching with clinical training will help in better understanding of diseases. More than half of the students 71 (52.2) agreed that lectures and demonstrations taken by faculties has stimulated interest in the subject. Most students 80 (58.8) believe that formative assessment serve the purpose of analyzing the cognitive skill. Sixty six (48.5) students agree that MCQs are an effective tool for analyzing cognitive skills. Conclusion The overall perception of undergraduate dental students regarding the oral pathology subject and the teaching learning method used by faculties is good. However, incorporation of case based learning, integration of oral pathology with other clinical subjects and taking regular feedback from students may be of great use in providing holistic and effective learning environment. KEY WORDS Dental, Oral pathology, Perception, Teaching learning methods, Undergraduate
Antibiotic Resistance Pattern in Intensive Care Unit of a Tertiary Care Hospital, Nepal
(Kathmandu University, 2024) Chaudhary, R; Bhatta, S; Pant, C; Pathak, P; Phuyal, N; Shrestha, L
ABSTRACT Background Intensive care unit (ICU) is the especial department of the hospital where critically ill patients are treated with the unique type of technologies to revert back to functional by body’s own mechanism. Therefore, there are lots of external intervention with chance of getting bacterial infections. Antibiotics are medicines used to prevent and treat such bacterial infections. However, due to selective broad spectrum antibiotic pressure there is great chances to develop antimicrobial resistance at any time during hospital stay in intensive care unit. Objective To find out the antibiotic resistance pattern among Gram negative bacteria in Intensive Care Unit. Method A Descriptive cross-sectional study was conducted in Department of Microbiology of Tertiary care center for 18 months On the basis of previous sample load census method was used to include 500 sample from intensive care unit during study period. Among them only Gram negative bacteria were included in the study. All the samples were processed following standard methodology. Result Out of 500 samples, growth was observed in 451 (90.2%) samples. Among all the isolates Escherichia coli (29.6%) was predominant organism. It had shown high resistance towards Ciprofloxacin (93.5%) even in urine sample Ciprofloxacin (86.9%). Conclusion Our study showed Escherichia coli as a major organism in intensive care unit. This was resistant to commonly used oral antibiotic leaving restricted option for use of higher antibiotics. Therefore, continuous surveillance of such bacterial pathogen is warranted with implementation of effective Infection Prevention and Control measures in Health Care setting with emphasis to critical care units. KEY WORDS Antibiotic resistance, Escherichia coli, Intensive care unit
Specialist Periodontal Referral Knowledge, Attitude and Practice by General Dental Practitioner in Nepal
(Kathmandu University, 2024) Rijal, AH; Humagain, M; Lamichhane, S; Ghimire, P
ABSTRACT Background To enhance the referral process, it is essential for the patient, referring practitioner, and specialist to establish effective communication and ensure they are well- informed and educated about each other’s requirements. Objective To assess the knowledge and attitude of general dental practitioners towards specialist periodontal referral. Method This cross-sectional study was carried out for 6 months from October 2022 to April 2023 using a self-administered questionnaire by general dental practitioners registered in Nepal Medical Council. Knowledge and attitude about periodontics, various diseases and referral to specialist for special treatment were analyzed. Result Total of 238 General Dental Practitioners (GDPs) participated in this web-based questionnaire survey. Majority of general dental practitioners (GDPs) reported that they always performed full-mouth and subgingival scaling (193, 81.09%), providing advice on proper brushing techniques (205, 86.13%), advising patients to stop harmful habits (212, 89.07%), and offering diet counseling (122, 51.26%) for patients displaying signs of gingival or periodontal diseases. Majority of GDPs also indicated that they occasionally consult a periodontist for specific periodontal problems, such as the presence of periodontal pockets (143, 60.084%), mobile teeth (150, 63.025%), gingival enlargement (145, 60.924%), periodontal abscess (146, 61.344%), and gingival recession (149, 62.605%). Conclusion General dental practitioners play a crucial role as the primary point of contact for patients seeking dental treatment. The periodontal health of the general population largely depends on the knowledge, attitude, and practice of GDPs. KEY WORDS General dental practitioner, Periodontal referral, Periodontist
Assessment of Symptomatic Dry Eye Disease among Postgraduate Medical Students of KIST Medical College and Teaching Hospital using an Ocular Surface Disease Index Questionnaire
(Kathmandu University, 2024) Basnet, A; Thapa, S; Ghising, K; Shah, SK; Pathak, SB; Pradhan, P
ABSTRACT Background Symptomatic dry eye disease is a growing public health challenge especially among those who are visual display unit users and other long-time near activity workers. Increased screen time, prolonged use of face mask and shortage of sleep among resident doctors increases the risk of developing dry eye disease that can affect their learning and social abilities. Data is insufficient on the prevalence of dry eye disease among postgraduate medical students in Nepal. Objective To find out the prevalence of symptomatic dry eye disease using an ocular surface disease index questionnaire among postgraduate medical students of KIST Medical College and Teaching Hospital. Method A cross-sectional study was conducted among three batches postgraduate medical students until 2023 of KIST Medical College and Teaching Hospital, Imadol, Lalitpur. A single validated symptom-based questionnaire with 12 questions was used to assess symptomatic dry eye disease. Result Total of 110 post-graduate medical students with mean age of 30.4 years, 67 males and 43 females were enrolled. Among them, 68 (61.8%) had dry eye disease. Severe dry eye was the commonest followed by mild dry eye. There was statistically significant association between dry eye disease with the increased screen time and suboptimal durations of sleep. Conclusion About half of postgraduate students faced symptomatic dry eye disease. It is advisable for residents to have optimum sleep as possible, limit screen time and establish regular break time along their exposure. KEY WORDS Ocular surface disease index questionnaire, Postgraduate medical students, Symptomatic dry eye disease
Knowledge and Attitude Regarding Human Milk Banking among Antenatal Mothers Attending Antenatal Clinic
(Kathmandu University, 2024) Dhakal, RD; Upreti, R; Nepal, S; Dahal, BD; Adhikari, P
ABSTRACT Background Breast milk is the ideal food that has essential nutrients for the normal growth and development of infants. It contains antibodies that help to protect against many common childhood illnesses. For infants who cannot receive breast milk from their own mothers, due to maternal illness, death, medication, disability, insufficient milk production, allergies, or prematurity, donated breastmilk can become the ideal option. Objective To assess the knowledge and attitude regarding human milk banking among antenatal mothers. Method A cross-sectional analytical research was conducted among 422 antenatal mothers attending the antenatal outpatient department of Bharatpur hospital from date 04 November to 04 December 2022. Systematic random sampling was used to select the study unit. A semi-structured interview schedule was adopted to collect the data. Collected data were analyzed by using Descriptive statistics as well as inferential statistics. Result Out of 422 mothers, the majority 58.8 % had poor knowledge and 55.9% had a negative attitude toward human milk banking. There was a significant association between poor knowledge and negative attitude with some socio-demographic variables such as age (AOR=2.16; 95%CI= 1.372-3.401; p=0.001), history of adverse pregnancy outcome (AOR =6.202 95% CI=1.786-21.54;p=0.004), occupation (AOR= 1.906; 95% CI = 1.246-2.915; p=0.003). Conclusion It is concluded that the majority of the respondents had poor knowledge and a negative attitude regarding human milk banking.Knowledge and awareness of human milk banking, play a major role to remove misperceptions about human milk donation and banking. Therefore, proper dissemination of information about human milk bank services, is necessary. KEY WORDS Antenatal Clinic, Antenatal mother, Human milk bank, Knowledge and attitude
Philtral Column and Nostril Shape Pattern in Nepalese Population: Comparative Study between Two Ethnic Groups of Nepal
(Kathmandu University, 2024) Chaurasia, NK; Upadhyaya, C; Mahantha, S; Upadhyaya, S; Shakya, M; Upreti, S; Bhandari, A; Baral, I
ABSTRACT Background Knowledge of the normal appearance of lip-nose complexes in a particular ethnicity or race helps to plan and modify surgical techniques for their deformity. Objective To determine the shape of the philtral column and nostril in children of two ethnic groups (Aryans and Mongoloids) of the Nepalese population and compare them to see if any variation exists. Method The present prospective study was carried out between December 2021 to January 2023 among 200 children of age 5-12 years. The children meeting our inclusion criteria were divided equally into Aryan and mongoloid groups based on the caste system in Nepal. Facial photographs were obtained in frontal and basal views. They were analyzed to determine the shape of the philtral column and nostril shape based on Mori’s classification system. Result Out of 200 children, 123 were males and 77 were females. The most common type of philtral and nostril shape in the Nepalese population was triangular and teardrop respectively. Triangular and concave type philtral shape was predominant in Aryans whereas triangular and parallel type was predominant in Mongoloids however the variation was not significant. Similarly, teardrop nostrils were most common in both ethnic groups. Conclusion The results provide a morphological pattern and variation in the philtral and nostril shape in the two major ethnic group of Nepalese population. KEY WORDS Aryans, Mongoloids, Nostril shape, Philtral shape
Is an Elective Neck Dissection Needed in Squamous Cell Carcinoma of the Maxillary Alveolus and Hard Palate?
(Kathmandu University, 2024) Bhandari, S; Michael, RC; Riju, J; Thomas, M; Irodi, A; Rani, J; Tirkey, AJ; Vidya, K; Mathew, SS; Madhavi, K
ABSTRACT Background Squamous cell carcinoma (SCC) of the maxillary alveolus and hard palate is a rare site for oral cavity carcinoma. Much controversy is there regarding the management of this site and elective neck dissection due to rarity and complex lymphatic drainage. Objective To estimate the prevalence of neck nodal metastasis in squamous cell carcinoma of maxillary alveolus and hard palate and the factors influencing the nodal metastasis. Method This retrospective cohort study includes patients diagnosed with squamous cell carcinoma of maxillary alveolus and hard palate and who underwent surgical intervention between March 2017 and March 2022. Result The study included 53 patients among them majority were men (73.6%). Prevalence of neck nodal metastasis was 36.6% and occult nodal metastasis was noted in 16%. On multivariate analysis, clinical nodal positivity increases the odds of pathological nodal positivity by 9.4 times compared to no nodal involvement (95% CI 2.07–42.57, p < 0.004). A depth of invasion (DOI) of more than 10 mm increases risk by 7.4 times for pathological nodal positivity compared to less than 10 mm invasion (95% CI 1.53– 35.27, p=0.013). Conclusion Squamous cell carcinoma of maxillary alveolus and hard palate has a high risk of nodal metastasis. Depth of invasion is an important predictor for nodal metastasis. Due to the high risk of nodal metastasis elective neck dissection would be recommended in advanced stages. Squamous cell carcinoma of maxillary alveolus and hard palate with nodal metastasis has a poor survival. KEY WORDS Hard palate, Lymph node metastasis, Neck dissections, Squamous cell carcinoma
Clinical and Endoscopic Findings in Patients Presenting with Upper Gastrointestinal Bleeding at a Tertiary Care Hospital
(Kathmandu University, 2024) Sharma, P; Sapkota, P; Pathak, S; Lamsal, A; Joshi, S; Parajuli, S; Rajak, S; Gautam, S; Tamang, A
ABSTRACT Background Upper gastrointestinal (UGI) bleeding is a severe medical condition that requires prompt evaluation and management. Understanding the clinical and endoscopic findings in patients presenting with upper gastrointestinal bleeding is essential for accurate diagnosis and effective treatment. Objective To investigate the age and sex composition, clinical presentations, and endoscopic findings of patients with upper gastrointestinal bleeding at a tertiary care hospital. Method A total of 561 patients with upper gastrointestinal bleeding were included in the study. Data on age, sex, and clinical presentation were collected for each patient. Endoscopic findings were recorded, and the relative frequency of various upper gastrointestinal lesions was analyzed. Result The age distribution of patients revealed that 40.82% were between 15 and 45 years, 32.98% were aged 46 to 65 years, and 26.20% were above 65 years. Among the patients, 73.08% were male and 26.92% were female. Hematemesis was observed in 248 cases, while melena was present in 136 cases, and both were present in 171 cases. Recent onset anemia with positive occult blood was reported in 6 patients. The most common endoscopic finding was varices (39.39%), followed by ulcers (15.51%). Mallory Weiss tear was noted in 5.53% of cases. Conclusion According to our findings, varices are the most common endoscopic finding in individuals with upper gastrointestinal bleeding rather than peptic ulcer disease. The considerable increase in varices emphasizes the critical importance of early identification and care in high-risk individuals, as well as contributing to a better understanding of upper gastrointestinal bleeding. KEY WORDS Bleeding, Endoscopy, Esophageal varices, Gastric varices, Gastrointestinal hemorrhage, Upper gastrointestinal tract
Determinants of Overnutrition among Urban Adults in Yangon, Myanmar
(Kathmandu University, 2024) Tun, SS; Sornlorm, K; Mahato, RK
ABSTRACT Background Over 1.9 billion adults who are 18 years old and older were overweight and more than 6.5 million adults were said to be obese. In 2014 National Step Survey of Myanmar stated that there were 16.9% and 5.5% of overweight and obesity in adults. Due to altering lifestyle and urbanization, it is important to detect the nutritional status and its most influencing factors among urban adults in Yangon. Objective To assess the determinants of overnutrition among urban adults in Yangon, Myanmar. Method This is a cross-sectional study with a sample of 453 adults aged 18-62 years and structured questionnaires were used. Overweight and obesity were defined according to the WHO classification for Asian adults. Multivariable logistic regression analysis was used to assess independent factors associated with overnutrition. Result A total of 453 participants were included for analysis. The prevalence of overnutrition was 49.89% (95% CI, 45.28-54.50). In multivariable analysis, being male (AOR = 3.56, 95% CI = 2.09-6.08, being married/divorced/widowed/ separated (AOR = 2.95, 95% CI = 1.82–4.77), family history of overnutrition (AOR = 6.49, 95% CI = 3.72–11.33, history of DM (AOR = 1.79, 95% CI = 1.11–2.89, consumption of starchy vegetables ≥5 days (AOR = 2.05, 95% CI = 1.27–3.30), not meeting the WHO recommended physical activity (AOR = 3.57, 95% CI = 2.24–5.70), and moderate and low perception (AOR = 2.15, 95% CI = 1.21–3.84) were associated with overnutrition. Conclusion We observed high prevalence of overnutrition in this study. Socioeconomic status, health behavior and perception were the factors behind overnutrition. These findings offer important information for establishment of appropriate public health interventions and policies to lessen the burden of overnutrition. KEY WORDS Adults, Diet, Low-income country, Overnutrition, Southeast Asia
Predictors of Stone Free Rate and Application of the Size, Topography, Obstruction, Number and Evaluation of Hounsfield Units (S.T.O.N.E) Scoring System in Predicting the Outcome in Patients Undergoing Semi-rigid Ureteroscopic Lithotripsy for Ureteric Calculi at a University Hospital of Nepal
(Kathmandu University, 2024) Shrestha, B; Koju, R; Makaju Shrestha, S; Shrestha, K; Karmacharya, RM
ABSTRACT Background Ureteric colic is common urological emergency in patients with urinary stone disease. Semi rigid ureteroscopic lithotripsy is a widely acceptable treatment modality for ureteric calculi. Objective To evaluate the predicting factors of stone free rate (SFR) and application of the Size, Topography, Obstruction, Number and Evaluation of Hounsfield units (S.T.O.N.E) scoring system in predicting success rate of ureteroscopiclithotrisy (URSL) for ureteric calculi. Method This was a prospective hospital based observational study conducted at the Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital from October 2021 to September 2022. Patients undergoing ureteroscopiclithotripsy using laser and/or pneumatic lithotripsy for ureteric calculi were included in the study. Informed consent was taken from each patient and data collection was done by filling the proforma. Result A total of 82 patients were included in the study. Mean age of patients was 35.89 ± 11.51 years. Overall stone free rate was 80.5%. Stone free rate were 96.67% and 71.15% in moderate (6-9) and high (10-13) S.T.O.N.E score groups respectively. Stone size and S.T.N.O.E score were found to be significantly high in patients with retained stone following ureteroscopiclithotrisy (p value < 0.05). Duration of surgery was significantly high in high S.T.O.N.E score group (p<0.05). However no significant correlation was found between patient characters like age, sex, Body mass index and Hounsfield units of stone with stone free rate in this study. The area under the curve of the receiver operating characteristic curve for the S.T.O.N.E score and stone size were 0.693 and 0.660 respectively in this study. Conclusion Stone size and S.T.O.N.E score can be used as predictors of success following semi- rigid ureteroscopic lithotripsy. The value of S.T.N.O.E score has good predictive value for SFR and duration of surgery. There was no significant impact of patient’s age, sex, Body mass index and Hounsfield units of stone in stone free rate following ureteroscopic lithotrisyin this study. KEY WORDS Body mass index, Lithotripsy, Receiver operating characteristic curve, Ureteroscopy
The Current State of Ambulances and Emergency Medical Services in the Hilly Region of Nepal
(Kathmandu University, 2024) Shresha, SK; Weiner, Y; Therriault, C
ABSTRACT Background Pre-hospital care in Nepal has seen marked improvement in recent years. Emergency medical services means out of hospital acute medical care and/or transportation provided to a patient with an illness or an injury. It continues to lack centralization of resources and standardization across personnel and patient transport vehicles operating in the country. Objective To describe the current state of ambulances including on-board equipment, emergency medical services and driver training among ambulances servicing a hilly region of Nepal. Method A descriptive study was conducted among 117 ambulance drivers transporting patients to the Emergency Department at Dhulikhel Hospital in Kavre, Nepal. A convenience sampling was done to collect data using the self-structured questionnaire during a one-month period from 1st to 30th November 2021. The questionnaire contained 21 items to gather information about the status of ambulance services. Data was analyzed using descriptive statistics. Result The majority of ambulances lack basic and advanced life support equipment. None of the ambulance drivers surveyed had completed formal ambulance driver training and only 35% had received some form of medical training. Most ambulances (70.1%) did not have a licensed paramedic onboard during transport. Majority of the ambulances (91%) were functioning as patient transport vehicle only and these were classified as C-grade ambulances. Conclusion Ambulances remain poorly staffed and under-resourced and ambulance drivers largely lack formal training and credentialing. Targeted interventions and investment are required to bring emergency medical services into compliance with national standards. KEY WORDS Ambulance, Emergency medical services, Pre-hospital care

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