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Undiagnosed hypothyroidism presenting as recurrent bilateral large ovarian cyst in an early adolescent girl. A rare case report
(Nepal Paediatric Society (JNPS), 2021) Agrawal, Jyoti; Agrawal, Ajay
Abstract: Hypothyroidism may manifest as large ovarian cyst formation with precocious puberty in young prepubertal girls, which frequently regress upon starting thyroxin suplemntation. We present a case report of 10 year old girl who had undergone unnecessary laparoscopic cystectomy for bilateral large ovarian cyst as the diagnosis of hypothyroidism was missed. She again had recurrence of bilateral ovarian cyst which regressed upon thyroxin supplementation.
Neonatal Adenoviral Myocarditis – A Case Report and Review of Literature
(Nepal Paediatric Society (JNPS), 2021) Roy, Amrita; Chowdhury, Labanya; Mukhopadhyay, Debadatta; Das Dutta, Alokananda
Abstract: Adenoviruses are DNA viruses that typically cause mild self-limited disease mostly involving the respiratory tract, gastrointestinal tract or conjunctiva. Typical respiratory symptoms include fever, pharyngitis, tonsillitis, cough, and sore throat but rare associations with severe disease such as myocarditis have been reported. Current treatment options are limited to usage of intravenous immunoglobulins (IVIGs) or antiviral agent Cidofovir, however usage of the latter is limited due to reports on drug induced adverse reactions. In this case report we describe an infant with severe myocarditis in whom Adenovirus was revealed to be the identifiable cause. The infant was treated with IVIG which is believed to act as an immunomodulatory agent. The infant recovered completely. Our conclusion is that patients with myocarditis caused by adenovirus are likely to benefit from early treatment with IVIGs.
Levothyroxine Overdose in a Toddler – A Case Report
(Nepal Paediatric Society (JNPS), 2021) Thiyagarajan, Radha; Arunprasath, Thasma Santhanakrishnan
Abstract: Levothyroxine tablet overdose, can happen in children, because of unique physical nature of the tablet. Although it has a benign course, systemic symptoms of overdose may manifest in few children. This cannot be predicted based on dose consumed or by thyroid function tests. Propranolol and steroid can be used for systemic autonomic symptoms. Delayed manifestation of overdose may occur, which needs follow up. In this report, we present a toddler who had levothyroxine overdose and was managed with monitoring and follow up. Her hyperactivity was managed with oral triclofos. We would also like to emphasize that serial thyroid function tests are not needed in these children.
Grebe Syndrome - Case Report With Review of Literature
(Nepal Paediatric Society (JNPS), 2021) Nagaraj, Rashmi; Kiran, HS
Abstract Grebe syndrome is a rare genetic condition characterized by short limb dwarfism. It is transmitted by autosomal mode of inheritance. There are no associated anomalies and the affected child has normal intelligence and normal life span. This syndrome has a very low incidence and needs to be differentiated from other forms of short limb dwarfism since treatment options may vary. We have described here a severely affected case of the same with review of literature.
Utilization and Effectiveness of Free Newborn Care Service Package in Inpatient Care of Sick Newborns –A Time For its Revision to Ensure Sustainability: Evidences From a Tertiary Level Public Hospital in Nepal
(Nepal Paediatric Society (JNPS), 2021) Paudel, Prajwal; Subedi, Kalpana Upadhyaya; Karmacharya, Shailendra Bir; Shrestha, Sarita; Shrestha, Anil Kumar; Subedi, Pratikshya; Sah, Sunil Kumar; Mishra, Megha; Tamrakar, Asia; Khati, Nisha; Singh, Astha; Subedi, Kirtipal; Sunny, Avinash K; Mishra, Sangeeta Kaushal
Abstract: Introduction: Free Newborn Care (FNC) service has been implemented to address the financial barriers to access sick newborn care in Nepal. This study was designed to evaluate the effectiveness of FNC package in terms of its adequacy to support a facility financially and the factors to be considered for reimbursement schemes in the FNC guideline. Methods: This is a cross sectional retrospective study where 2907 newborns who received FNC service from 2019 Mar 15 to 2021 Jan 14 over 20 months were included. Descriptive statistics using frequency and percentages were used to describe the package received. Pearson’s Chi squared test was used to determine if the various factors receiving different newborn packages were statistically significant or not. Results: Amount reimbursed by FNC package for 20 months fell short by NRs 1355541. Majority of preterm (58%), LBW (52.3%) and MAS (55.3%) received package C. Babies who received package C with single morbidity was 576 (37.3%) with two to three morbidities was 380 (48.7%) and with more than three morbidities was 301 (70.2%). Those newborns who stayed for four to seven days, majority 654 (53.4%) received package B, whereas those who stayed for eight to 14 days, 15 - 21 days and > 21 days, the majority 490 (38.4%), 66 (5.2%), 32 (2.5%) received package C respectively. There was an association between receiving package C mortality among cases (P < 0.001). Conclusions: Inpatient quality newborn care can save lives of many vulnerable newborns. FNC service has provided opportune context in care of sick newborns with promising results. However, revising the reimbursing schemes by focusing on length of stay, mortality and disease severity can better strengthen sick newborn care.
The Effectiveness of Handicrafts on Anxiety Reduction among Hospitalised Children in Paediatric Ward of Dhulikhel Hospital
(Nepal Paediatric Society (JNPS), 2021) Ranamagar, Binita; Karki, Sita
Abstract: Introduction: Disease and hospitalization can be the first crisis which a child encounters. It can cause acute anxiety to them which may sequel their uncooperative behavior to the treatment procedures. Furthermore, high level of anxiety if persisted for longer period can affect their physiological and psychological health. So, in order to deal this anxiety beforehand, handicraft has become an effective play intervention in the hospital. Hence, we conducted this study to investigate the effectiveness of handicrafts on anxiety reduction among hospitalized children. Method: This is a pre-experimental study administered to 30 admitted children in Paediatric Ward of Dhulikhel Hospital who were selected using consecutive sampling technique. Anxiety levels before and after intervening handicraft were assessed via interview using State-Trait Inventory of Cognitive and Somatic Anxiety - Child Version (STICSA-C) tool where intervention was making handicrafts with colorful paper as per children’s capacity and preference for total six times in two consecutive days at four hours interval. Results: The study showed significant difference between anxiety score before and after intervening handicraft (42.70 ± 10.60 Vs. 33.30 ± 8.70, p = < 0.001). While, anxiety level before intervening handicraft was not significantly associated with the selected demographic and clinical variables of children. Conclusions: In the study, handicraft was an effective play material in reducing anxiety among hospitalized children. But it is necessary to perform further studies that will take into account greater methodological stringency.
Relationship Between Microalbuminuria and Risk Factors for Cardiovascular Diseases Among Secondary School Student in Ilorin, Nigeria
(Nepal Paediatric Society (JNPS), 2021) Alabi, Kayode Olusegun; Kayode-Alabi, Titilayo Funmilayo; Ibrahim, Rasheed Olayinka; Issa, Hamdalat; Abdulkadir, Mohammed Baba; Ernest, Samuel Kolade; Ojuawo, Ayodele Isaac
Abstract: Introduction: Globally, cardiovascular diseases (CVDs) are the leading causes of deaths with more than half due to coronary heart disease linked with the development of atherosclerosis. Hypertension (HTN) and obesity are leading risk factors for atherosclerotic CVDs, presence of which is predicted by microalbuminuria (MA). We wanted to evaluate the relationship between microalbuminuria and risk factors for CVDs (obesity, overweight, pre-hypertension and hypertension) among secondary school students in Ilorin, North central Nigeria. Methods: We conducted a descriptive, cross-sectional study from December 2017 to March 2018 among secondary school students. We recruited 584 students, aged 10 to 18 years from 14 schools across the three Local Government Areas (LGAs) in Ilorin. We measured their blood pressure and anthropometrics following standard protocols and determined microalbuminuria in their early morning urine using Microalbumin 2-1 Combo strip and spot urinary albumin - creatinine ratio. Results: The prevalence of MA was 30.1%. MA was more common in obese and hypertensive adolescents (p < 0.001 and p < 0.01 respectively). Occurrence of MA correlated strongly with subject’s weight (r = 0.790, p = 0.004, p < 0.01); systolic blood pressure (r = 0.884, p = 0.001, p < 0.01) and body mass index (r = 0.710, p = 0.001, p < 0.01). Independent predictors of MA were obesity, adjusted odds ratio (aOR) 4.9, (95% CI 1.124, 20.913), overweight (aOR 3.6, 95% CI 1.184, 10.174), older age (aOR 1.1, 95% CI 1.007, 1.219) and presence of systolic hypertension (aOR 3.1, 95% CI 1.903, 5.042). Conclusions: This study shows a high prevalence of MA among the adolescents. CVDs risk factors predictive of MA are overweight, obesity, systolic hypertension and older age.
Profile of Nosocomial Sepsis in a Neonatal Intensive Care Unit of Tertiary Care Hospital in Eastern Part of Nepal
(Nepal Paediatric Society (JNPS), 2021) Yadav, Sunil Kumar; Niroula, Niraj; Giri, Arun
Abstract: Introduction: Nosocomial sepsis constitutes a global health problem. They lead to significant morbidity and mortality in both developed and resource-limited countries. The objective of the study was to describe the profile of nosocomial sepsis in neonatal intensive care unit (NICU). Methods: This was a prospective descriptive study conducted in a teaching and referral NICU. All neonates in NICU who did not have any sign of infection at admission and remained hospitalized for at least 48 hours were observed. Profile of nosocomial infection was analyzed with descriptive statistics. P value of < 0.05 was considered significant wherever applicable. Results: The incidence rate and density of nosocomial sepsis were 47.3% and 39.3 infections per 1000 patient-days respectively. Blood stream infection was the commonest nosocomial infection. Pseudomonas aeruginosa was the most commonly isolated agent in blood cultures of patients with nosocomial sepsis. Conclusions: This study revealed a high incidence of nosocomial sepsis. Hence, there is urgent need to adopt policies to prevent these infections.
Nutritional Status of Children (5 - 18 Years) by Using Anthropometric Indices: A Cross-Sectional Study Among the Sartang and Miji, Lesser Known Tribes of Arunachal Pradesh, India
(Nepal Paediatric Society (JNPS), 2021) Md. Ashgar; Amung, Radhe; Chakrabarty, Suman
Abstract: Introduction: In this era of globalization, planners often fail to understand the importance of community specific nutritional intervention among children due to dearth of study specifically among the lesser known communities in tribal dominated Indian state like Arunachal Pradesh. In order to find out the present condition of nutritional status in such lesser known tribal groups in the state, this present cross-sectional study was conceptualized to assess the nutritional status by using anthropometric indices in the Sartang and Miji tribal children in Arunachal Pradesh, India. Methods: A total of 452 children aged five to 18 years living in rural areas of West Kameng district of Arunachal Pradesh, India were considered for the present analysis. The international standards were used to collect height and weight data and height for age and BMI for age percentile were calculated. Results: The results revealed that the prevalence of stunting (< - 2 SD height for age) was higher among the Sartang male (34.0%) and female (46.3%) compared to Miji male (26.7%) and female (23.1%), respectively. Conversely the prevalence of overweight (percentile of BMI for age > 85) was also higher among the Sartang male (19.1%) and female (27.8%) compared to Miji children. It may be due to the alteration of traditional food habits, consumption of regular fast food and increasing less socio-economic equity and higher inequality in both the communities. Conclusions: Therefore, undernutrition as well as over nutrition are prevalent among studied children perhaps correlated with rapid change in their food habits and lifestyle in the early age.
Where is the Perforation ? Rare Complication of Endoscopic Retrograde Cholangio Pancreatography
(Kathmandu University, 2019) Singh, AK; Malla, BR; Gurung, RB
ABSTRACT Perforation is one of the most feared complications of Endoscopic Retrograde Cholangio Pancreatography (ERCP). ERCP has become important method for treating biliary-pancreatic diseases. Perforation related with Endoscopic Retrograde Cholangio Pancreatography is an infrequent, but if happens is a severe complication. Reported incidence of Edoscopic Retrograde Cholangio Pancreatography related perforation is 0.3-6%. Its mortality is as high as 37.5%. In our hospital since 2010 AD, There were 6 Perforations related to Endoscopic Retrograde Cholangio Pancreatography done in 4787 cases. This is a case of Endoscopic Retrograde Cholangio Pancreatography related perforation with no site of perforation recognized during surgical management. KEY WORDS Edoscopic Retrograde Cholangio Pancreatography, Negative Laparotomy, Perforations, Rare Complication
Graded Epidural Anaesthesia for Lower Segment Cesarean in a Parturient with Very Low Ejection Fraction
(Kathmandu University, 2019) Limbu, PM; Ghimire, A; Trikhatri, Y; Agrawal, A
ABSTRACT Dilated cardiomyopathy is characterized by left or biventricular dilatation with impaired ventricular contractility. It is associated with systolic dysfunction with decreased left ventricular ejection fraction and congestive progressive heart failure. Anaesthetic management of such condition is very challenging and requires highest level of expertise, strategy and precaution. We present such a case of dilated cardiomyopathy with a very low ejection fraction of 12% who underwent lower segment cesarean section under epidural anaesthesia with successful outcome. KEY WORDS Cesarean section, Dilated Cardiomyopathy, Epidural Anaesthesia, Very low ejection fraction
Intra-Articular Synovial Fibroma of the Knee in a Young Boy
(Kathmandu University, 2019) Vaidya, RK; Shrestha, A; Vaidya, KM
ABSTRACT Synovial fibroma, a benign fibro collagenous soft tissue tumour, arising in the knee joint is a rare entity. It is even rarer in the paediatric age group. The clinical symptoms, investigations, diagnosis, and treatment with the literature reviews are presented for this uncommon occurrence in an 11-year-old boy. KEY WORDS Arthroscopy, Intraarticular, Knee joint, Synovial fibroma
Cervical Enamel Projection – A Rare Case Report with its Management
(Kathmandu University, 2019) Devani, VR; Manohar, B
ABSTRACT A developmental anomaly like cervical enamel projection is a rare finding in the maxillary anterior region. Its ectopic presence attracts attention in literature. This type of anomaly is typically found in the furcation region of molars. The case report presented here deals with the ectopic presence of combined anomalous lesion and its management. A 18 year old male presented with pronounced bilobed cingulum extending as a cervical enamel projection on the maxillary right lateral incisor associated with pain, exudation and difficulty in mastication. Enameloplasty and regenerative procedure was performed. The possible etiology, its management and healing evaluated by CBCT are presented in this report. One year follow up showed satisfactory healing with no recurrence of abscess. KEY WORDS Cervical enamel projection, Enameloplasty, Periodontitis, Regeneration
Perception about Medicines among the General Public in the Semi-rural Areas of Nepal
(Kathmandu University, 2019) Sapkota, B; Rauniyar, D; Shankar, PR; Gupta, GK; Thapa, RK
ABSTRACT Background Patients’ perceptions and beliefs about medicine are affected by their culture, tradition, socioeconomic status, peer influence, educational level, advertisements among other factors. Objective To explore the perception about medicines among the general public in different semi-rural areas of Nepal. Method Cross-sectional study was conducted at different locations within Kathmandu valley from July 2015 to December 2016; 385 individuals were approached using simple random sampling but only 260, aged 18 years and above, who were taking medicines for their health problems, completed the interviewer-administered survey. Their perceptions about medicines were studied using a structured questionnaire based on the WHO booklet “How to investigate the use of medicines by consumers” and analysed using SPSS version 22. Association between respondents’ age, gender, education level and perception were statistically analysed using χ2 test and/or Fisher’s exact test and multivariate analysis of variance. Result Sixty-one respondents (23.5%) were in age group 56-65 years. Patients’ perceptions of medicine safety based on colour, shape, name of medicine, method of administration, compatibility, etc. was statistically different among respondents with regard to their level of education (p = 0.022). More individuals with lower education believed that expensive medicines were more effective (p < 0.001). Increased level of education made them more aware of negative consequences of reusing previous prescriptions (p=0.039). Conclusion Problems with knowledge about medicines were noted among lesser educated individuals. Based on findings, policy makers may develop educational strategies to increase awareness about medicines. KEY WORDS Belief, Education level, Medicine, Perception
Analysis of Factors Associated with Thyroid Dysfunction: A Hospital Based Study
(Kathmandu University, 2019) Risal, P; Adhikari, B; Shrestha, R; Manandhar, S; Bhatt, RD; Hada, M
ABSTRACT Background Thyroid dysfunction (TD) is one of the major public health concerns in Nepal. This study intends to identify factors in association with thyroid dysfunction and its hospital based prevalence. Objective To determine hospital-based prevalence of thyroid dysfunction and to identify and analyze factors in association with thyroid dysfunction. Method A retroprospective cross-sectional study was conducted among patients attending Dhulikhel Hospital-Kathmandu University Hospital (DH,KUH) from January to December, 2015 with prospective part carried out from July to December 2015 in the patients visiting Dhulikhel hospital for health check-up and requested for Thyroid Function Tests (TFTs). Thyroid Function Tests of 1530 subjects were performed in the biochemistry laboratory and semi-structured questionnaire were introduced to 312 participants with convenient sampling method and their anthropometric measurements were taken. Chi-square test, Pearson’s correlation and student-t test were used as a measure to analyze factors. Result Out of total 1530 subjects, 35.3% were having thyroid dysfunction with the prevalence of overt hyperthyroidism, subclinical hyperthyroidism, overt hypothyroidism and subclinical hypothyroidism to be 2.5%, 2.4%, 5.6% and 24.8% respectively. The distribution of thyroid dysfunction was preponderant among females and among older age. The prevalence of thyroid dysfunction was highest among Terai/Madhesi (40.0%) and lowest among Newars (28.5%) with higher fraction of hypothyroidism in each ethnic group. There were significant correlation between Thyroid Stimulating Hormone (TSH) with waist-hip ratio (p<0.05) and weight (kg) with free thyroxine (fT4) (p<0.05). Direct pesticide exposure (p<0.05) was significantly associated with hypothyroidism. The serum fT4 was significantly different (p<0.05) among vegetarian and non-vegetarian whereas TSH and free triiodothyronine (fT3) were not significantly different. Smoking, alcoholism, dietary food habits, diabetes and hypertension were not significantly associated with thyroid dysfunction. Conclusion Thyroid dysfunction was highly prevalent among participants with higher proportion of subclinical hypothyroidism. Besides, direct pesticide exposure found to be factor in association with hypothyroidism, this study could not find significance relation with other established risk factors. KEY WORDS Hyperthyroidism, Hypothyroidism, Thyroid dysfunction, Thyroid function test
Impact of Community Diagnosis Programme on Undergraduate Students at BP Koirala Institute of Health Sciences
(Kathmandu University, 2019) Singh, A; Subedi, K; Shrestha, A; Bhagat, T; Pyakurel, P; Agrawal, SK
ABSTRACT Background Community Diagnosis Programme (CDP) aims to demonstrate the importance of teamwork in health care to understand the comprehensive health needs of the rural people and conceive about the research. Objective To assess the impact of community diagnosis program on undergraduate students of BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. Method A cross sectional study with mixed design (quantitative and qualitative) was conducted among the undergraduate students of batch 2017 participating in community diagnosis programme of BP Koirala Institute of Health Sciences, Dharan, Nepal. Eight questions assessed the students’ perceptions regarding their abilities about community diagnosis program using six point Likert Scale and four open ended questions were used to know the students’ experience and perception of community diagnosis programme. Result Overall mean ± SD score for pre-exposure response was 30.47 ± 6.18 and for the post- exposure response was 40.49 ± 5.16. The overall mean ± SD score of the students categorized according to streams showed similar results in both pre-exposure response and post-exposure responses. Qualitative analysis revealed the themes like “Research, a reflection of community and new method of learning to medical students”; “method of developing confidence and good communication skills”, “learning to work as a team” and “exposure to rural area”; “Research an adjunct to medical profession”. Conclusion Community diagnosis programme had a positive impact on the students about basic survey process, learnt to communicate with rural people, understood the type of data and were willing to participate in similar projects in future. Qualitative analysis showed most of the students had positive experience with some negative experience of community diagnosis programme. KEY WORDS BPKIHS, Community Diagnosis Programme, Undergraduate Students
Reasons for Summoning Ambulance Services in the Hilly Region of Nepal
(Kathmandu University, 2019) Shrestha, SK; Jacobson, C; Dahal, S; Shrestha, R; Weiner, Y; Sheridan, A
ABSTRACT Background Nepal lacks a unified and countrywide emergency medical services system as other developing countries. However, the emergence of ambulance service initiatives in the past decade shows a promising future for pre-hospital care. Nepal Ambulance Service (Est. 2011) and Dhulikhel Emergency Medical Services (Est. 2013) are the existing emergency medical services initiatives in Nepal. Objective To describe the reason for summoning ambulance services and demographics of the patients who were transported by Dhulikhel Emergency Medical Services at Dhulikhel hospital, hilly region of Nepal. Method One thousand three hundred and ninety three patient records at Dhulikhel hospital transported by Dhulikhel Emergency Medical Services during the five-year period (2013 - 2018) were included in the study. Chief complaints and demographic data were collected and categorized into overarching systemic categories. Result Among 1393 patients, majority were female (60.4%) and the most common age group was 20-29 years. The most common reason for calling ambulances was gastrointestinal problem (22.6%). Similarly, respiratory (17%), obstetric and gynecological (15.2%), trauma (12.7%) and neurological (9.6%) problems were other common reasons. The number of respiratory problem was increased during the winter season. The overall percentage of patients arriving at hospital with trauma problems was increased steadily, but it was not statistically significant. Conclusion Gastrointestinal problem was the most common reason, followed by respiratory and obstetric and gynecological problems for summoning ambulances services in the hilly regions of Nepal. The incidence of respiratory problem significantly increased during the winter season. KEY WORDS Ambulance services, Dhulikhel hospital, Emergency medical services, Pre-hospital care
A Study on Variations of Branching Pattern of Renal Artery with its Clinical Significance
(Kathmandu University, 2019) Mansur, DI; Karki, S; Mehta, DK; Shrestha, A; Dhungana, A
ABSTRACT Background The kidneys are supplied by a single renal artery originating from abdominal aorta. However, recent literature reports great variations in renal blood supply. Hence, it becomes mandatory for the clinicians to understand the abnormality and variations in the renal vasculature. Objective To evaluate the branching pattern of renal artery and its variations. Method The study consisted of Computed Topographic images of 206 kidneys. Numbers and branching pattern of renal artery were recorded. The data was analyzed for presence or absence, source of origin and type of accessory renal artery. Result The present study revealed that 73.79% of kidneys were supplied by a single renal artery, 25.72% by double renal artery and 0.49% by triple renal artery. The hillar branching pattern was recorded in 38.83% and early branching pattern was in 34.95%. The presence of accessory renal artery was recorded in 26.21%. They were originated from abdominal aorta in 22.81% and 3.40% from main renal artery. The prevalence of superior polar artery was found in 6.79%, hilar in 10.19% and inferior polar in 9.22%. Conclusion The knowledge of variations of renal artery becomes essential for the clinician to plan the adequate surgical procedures and to avoid any vascular complication. KEY WORDS Abdominal aorta, Accessory renal artery, Renal artery
Operative Outcome of Bimalleolar Fractures
(Kathmandu University, 2019) Dhoju, D
ABSTRACT Background Ankle fractures are common injury occurring due to low energy trauma. Unstable ankle fractures are usually treated with operative management. Objective To find out demographic and the relationship between various clinical variables and outcome of operative treatment in ankle fractures in patient who underwent operative treatment for bimalleolar ankle fractures. Method A retrospective observational study of 32 patients who underwent operative treatment of bimalleolar ankle fracture in between January 2012 and December 2015 at Dhulikhel Hospital, Kathmandu University Hospital was performed. Skeletally mature individual of age greater than 16 years with bimalleolar ankle fractures operated within two weeks of injury were included in the study. Operating surgeon chose the type of surgery and implants required for the patient. Post operatively patients were kept in non-weight bearing for six weeks. Result The average age of the patients was 36.72 ± 19.97 years. The most common cause for the injury was twisted ankle. The mean follow up period of the patients was 20.94 ± 16.32 months. The most common fracture type was Weber B (supination external rotation injury). Most common technique for fixation for medial malleolus fracture was open reduction and modified tension band. Most of the lateral malleolus fractures were treated with open reduction and fixation with reconstruction plate. Six cases were treated with syndesmotic screws. Most of the patients had excellent AOFAS score with mean score of 90.56 ± 10.92 out of maximum 100. Average pain score was 32.81 ± 36.34 out of 40, average function score was 47.81 ± 6.05 out of 50 and average alignment score was 9.94 ± 0.35 out of 10. Conclusion The outcome of surgically treated bimalleolar ankle fractures was excellent for our patients. The fracture patterns and requirement of syndesmotic screw failed to show any significance when comparing the outcome. KEY WORDS Ankle, American Orthopedic Foot and Ankle Society Score, Bimalleolar fractures
Knowledge of Dysphagia in Stroke among Nurses Working in Tertiary Care Hospital
(Kathmandu University, 2019) Nepal, GM; Sherpa, MD
ABSTRACT Background Swallowing difficulty occurs in up to 37 to 78% of people experiencing a non-fatal stroke. About one half of dysphagic patients either die or recover spontaneously within the first 14 days of stroke onset leaving half with swallowing deficits that can significantly impair function, recovery and quality of life. It is important for the nurses to efficiently screen dysphagia post-stroke to reduce the odds of negative outcomes. Objective To assess the level of knowledge of Dysphagia among nurses working in Tertiary care hospital and to assess the associations of knowledge with educational level, years of experience and experience in caring for stroke patient with dysphagia. Method Self-Administered Questionnaire developed by Andrea Pickle Voight (2015) was used to collect data among nurses working in Dhulikhel hospital. Descriptive statistics was used to assess the knowledge on dysphagia and chi-square was used to assess the association between the variables. Result We found that nurses have moderate knowledge in dysphagia (62.39%). Knowledge level was significantly associated with experience in caring for stoke patient (p = 0.033) but not associated with educational level (p= 0.366) and years of experience (p= 0.065). Conclusion Nurses at Dhulikhel Hospital have moderate knowledge of dysphagia in stroke. Level of knowledge was significantly associated with caring for stroke patient but not with years of experience and educational level. KEY WORDS Aspiration, Dysphagia, Knowledge, Nurses, Stroke

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