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A National Equity Initiative to Address Noncommunicable Diseases and Injuries: Findings and Recommendation from the Nepal NCDI Poverty Commission
(Kathmandu University, 2022) Koirala, B; Adhikari, SR; Shrestha, A; Vaidya, A; Aryal, KK; Kalaunee, SP; Shrestha, A; Mishra, SR; Sharma SK; Karki, A; Maharjan, B; Singh, S; Schwarz, D; Gupta, N; Bukhman, G; Karmacharya, BM
ABSTRACT We aimed to assess the burden of NCDIs across socioeconomic groups, their economic impact, existing health service readiness and availability, current policy frameworks and national investment, and planned programmatic initiatives in Nepal through a comprehensive literature review. Secondary data from Global Burden of Disease estimates from GBD 2015 and National Living Standard Survey 2011 were used to estimate the burden of NCDI and present the relationship of NCDI burden with socioeconomic status. The Commission used these data to define priority NCDI conditions and recommend potential cost-effective, poverty-averting, and equity-promoting health system interventions. NCDIs disproportionately affect the health and well-being of poorer populations in Nepal and cause significant impoverishment. The Commission found a high diversity of NCDIs in Nepal, with approximately 60% of the morbidity and mortality caused by NCDIs without primary quantified behavioral or metabolic risk factors, and nearly half of all NCDI-related DALYs occurring in Nepalese younger than 40 years. The Commission prioritized an expanded set of twenty-five NCDI conditions and recommended introduction or scale-up of twenty-three evidence-based health sector interventions. Implementation of these interventions would avert an estimated 9680 premature deaths per annum by 2030 and would cost approximately $8.76 per capita. The Commission modelled potential financing mechanisms, including increased excise taxation on tobacco, alcohol, and sugar-sweetened beverages, which would provide significant revenue for NCDI-related expenditures. Overall, the Commission’s conclusions are expected to be a valuable contribution to equitable NCDI planning in Nepal and similar resource-constrained settings globally. KEY WORDS NCDI Poverty Commission, Noncommunicable diseases and injuries
Solving the Mystery of Giant Intrathoracic Mass
(Kathmandu University, 2022) Karmacharya, RM; Singh, A; Devbhandari, M; Napit, D; Ghimire, K; Mahat, C; Vaidya, S
ABSTRACT Intrathoracic schwannoma are highly vascular nerve sheath benign tumors arising from neural crest derived schwann cells of the intercostal nerves. Common clinical presentation is palpable mass but in our case patient presented with shortness of breath which is rare presentation in Schwannoma. Imaging studies of the patient showed the lesion in left lung, however surgical finding showed mass to arise from chest wall and it was confirmed to be schwannoma by histopathological examination. KEY WORDS Chest wall mass, Intrathoracic mass, Schwannoma
Oral and Craniofacial Anomalies of Fraser Syndrome: Prosthetic Management
(Kathmandu University, 2022) Amornvit, P; Rokaya, D; Sapkota, D; Sanohkan, S
ABSTRACT Fraser syndrome (FS, MIM 219000) is a rare autosomal disorder characterized by systemic and oro-facial malformation, usually comprising cryptophthalmos, laryngeal malformations, syndactyly, and urogenital defects. We presented a 21-year-old FS case with partial missing teeth seeking aesthetic dental treatment. Clinical examination revealed bilateral cryptophthalmos, extensive syndactyly of hands and feet broad nose with the depressed nasal bridge, and surgically corrected bilateral cleft lip. She presented class III jaw relation and reduced the vertical height of the face. Prosthetic rehabilitation of the patient was done with upper and lower overlay dentures made from acrylic resin (VIPI BLOCK TRILUX®, VIPI Industria, Pirassununga, SP, Brazil) using computer-aided design (CAD) and computer-aided manufacturing (CAM) process. At the follow-up visit, the patient presented improved aesthetics and function. Proper management and rehabilitation of FS patients are challenging, but standard guidelines for oral health management are currently lacking. This article presents a case of Fraser syndrome presenting oral and craniofacial anomalies, and prosthetic rehabilitation was done. We also provided recommendations for the optimal oral health care for the FS patients. Functional adaptation and rehabilitation have significant roles in the various functions, survival, and quality of the life of FS patients. Integrated medical- dental care is needed in such patients with support from family members, friends, and colleagues. KEY WORDS Cryptophthalmos, Fraser syndrome, Overlay denture, Syndactyly
Sellar Tuberculosis Mimicking Pituitary Adenoma
(Kathmandu University, 2022) Maharjan, S; Satyal, B; Baidya, R
ABSTRACT Tuberculosis of central nervous system accounts for only 1% of tuberculosis cases worldwide, of which pituitary is an extremely unusual site. We report a case of pituitary tuberculosis in a 29-year-old female presenting with complains of headache and diminished vision on right eye. It was misdiagnosed as pituitary adenoma on radiology. Biopsy showed epithelioid granulomas, langhans giant cells and caseous necrosis. Ziehl nelseen stain showed presence of acid fast bacilli confirming the tubercular etiology. Therefore, histology remains the mainstay for diagnosis of these lesions. Early diagnosis and prompt use of antitubercular drugs results in good outcome. KEY WORDS Pituitary adenoma, Sellar, Tuberculosis
Fahr´s Syndrome; Pseudohypoparathyroidism Type Ib Masquerading as Epileptic Seizures
(Kathmandu University, 2022) Kutilek, S; Plasilova, I; Talabova, M; Senkerikova, M; Solarova, P; Rondzikova, E; Stefackova, S
ABSTRACT Hypocalcaemia of various origin can be manifested by paresthesia, muscle cramps, muscle weakness, syncope, convulsions and even severe psychomotor retardation. Such symptoms can be initially considered as signs of epilepsy. We present a 12- year old boy with partial seizures and basal ganglia calcifications, initially diagnosed as having Fahr´s disease and epilepsy, where severe hypocalcaemia, due to genetically confirmed pseudohypoparathyroidism type Ib was the underlying cause. Excellent clinical improvement was observed after calcium and vitamin D therapy. The basal ganglia calcifications were secondary due to chronic hypocalcaemia, therefore the appropriate diagnosis was pseudohypoparathyroidism type Ib with Fahr´s syndrome, but not Fahr´s disease. In conclusion, the serum evaluation of minerals, especially calcium and phosphate, should be performed in all patients with convulsions, cramps and psychomotor retardation. This is essential in arriving at a proper diagnosis and early initiation of appropriate treatment. KEY WORDS Calcium, Convulsions, Fahr´s syndrome, Hypocalcaemia, Intracerebral calcifications, Pseudohypoparathyroidism
Managing Heart Failure with Preserved Ejection Fraction; A Short Review of Latest Evidences
(Kathmandu University, 2022) Mahaseth, A; Karki, P
ABSTRACT Heart failure with preserved ejection fraction (HFpEF) is a clinical dilemma and various clinical trials so far have failed to give a concrete evidence of reducing mortality and major adverse cardiac events (MACE) in this condition. A detailed analysis of the existing evidences and a future plan for a concrete trial design with long duration of follow up is needed to address the dilemma of Heart failure with preserved ejection fraction. The objective of this short review was to review the latest and major randomized controlled trials and study the primary outcomes. The public database of PubMed, Google Scholar and Cochrane were extensively searched for all randomized controlled trials using keywords of Heart failure with preserved ejection fraction, major adverse cardiac events, Hospitalizations; and studies were included in the review if data were reported for patients with ejection fraction > 40%, did not include congenital heart disease, and demonstrated evidence of diastolic failure on echocardiogram (ECHO), and evaluated hospitalizations, major adverse cardiac events and cardiovascular mortality. Despite the major trials reporting improved primary composite endpoints with newer drugs the results have to be interpreted cautiously since the primary outcome were mostly driven by heart failure hospitalizations and not mortality reduction. KEY WORDS Diastolic dysfunction, Heart failure, Heart failure with preserved ejection fraction, Preserved left ventricular function, SGLT2
Rickettsial Infection amongst Febrile Illness Patient in a Tertiary Care Hospital: A Retrospective Cross-sectional Study
(Kathmandu University, 2022) Gurung, RB; Sapkota, P; Bhatt, S; Tamang, A; Joshi, S; Khadka, S; Jaisy, DN; Chalise, S; Shrestha, P
ABSTRACT Background Rickettsial infection is an emerging neglected tropical disease in the Southeast Asia. In past few years Nepal is also reporting escalating prevalence of rickettsia. The under evaluation is resulting it as undiagnosed or are simply labeled as pyrexia of unknown origin. Objective To find out the prevalence of rickettsia in a hospital setting, assess the socio- demographic and other relevant clinical features of the rickettsia patients. Method This is a hospital based retrospective cross-sectional study from October 2020 to October 2021. This study reviewed the medical records of the department. Result The study included 105 eligible patients and the prevalence rate was 4.38 per 100 patients. The mean age of the participants was 42 years, and the mean hospital stay was 3 (SD ±2.06) days. More than 55% of the participants had fever for less than or equal to 5 days and 9% had Eschar present. Vomiting, headache, and myalgia were the most common symptoms and hypertension, and diabetes were the common comorbidities. Pneumonia and the acute kidney injury were the two complications of the patients as stated in the study. The severity of the thrombocytopenia deducted from admission time to discharge, and the case fatality was 4%. Conclusion The future studies shall consider on collaborative clinical and entomological research. This would help in better understanding of the etiology of supposedly unknown febrile illness and the under-investigated field of emerging rickettsia in Nepal. KEY WORDS Eschar, Febrile illness, IgM titer, Rickettsia, Thrombocytopenia
Comparison of Hearing Result and Graft Uptake Rate between Temporalis Fascia and Tragal Cartilage in Endoscopic Myringoplasty
(Kathmandu University, 2022) Shrestha, BL; Shakya, S; Pradhan, A; Dhakal, A; KC, AK; Shrestha, KS; Pokharel, M
ABSTRACT Background There are different methods to repair the perforation of the tympanic membrane. Recently cartilage has been used for the repair and results are comparable to temporalis fascia. For surgical procedure endoscope had added good assistance in middle ear surgery. Though the one hand technique the image quality and results are on par with the use of a microscope. Objective To compare the graft uptake rate and hearing results between temporalis fascia and tragal cartilage in endoscopic myringoplasty. Method This is a prospective, longitudinal study conducted among 50 patients who underwent endoscopic myringoplasty using temporalis fascia and tragal cartilage with 25 patients in each group. The hearing was assessed by comparing pre with post-operative ABG (Air bone gap) and ABG closure in speech frequencies (500Hz, 1 KHz, 2 KHz, 4 KHz). The status of graft and hearing results was evaluated on 6 months of follow up in both the groups. Result Out of total 25 patients enrolled for study in both (temporalis fascia and cartilage) groups, 23 (92%) patients in each group had graft uptaken. The audiological gain in the temporalis fascia group was 11.37±0.32 dB whereas in the tragal cartilage group it was 14.56±1.22dB. The audiological gain between the two groups did not show any statistically significant (p = 0.765). However, the pre and post-operative hearing difference was statistically significant in both temporalis fascia and tragal cartilage group. Conclusion Tragal cartilage has similar graft uptake rate and hearing gain when compared with temporalis fascia in endoscopic myringoplasty. Hence, tragal cartilage can be used for myringoplasty whenever required without any fear of deterioration in hearing. KEY WORDS Air bone gap, Endoscopic myringoplasty, Temporalis fascia, Tragal cartilage
A Point Prevalence Study of the Use of Antibiotics in Six Tertiary Care Hospitals in the Kathmandu Valley, Nepal
(Kathmandu University, 2022) Jha, N; Thapa, B; Pathak, SB; Pandey, A; Pokhrel, S; Shankar, PR; Bhandary, S; Mudvari, A; Dangal, G
ABSTRACT Background Point prevalence survey (PPS) on antibiotic use developed by the WHO has already been used in many hospitals globally. Objective To obtain information on antibiotic prescribtion using point prevalence survey methodology in six private hospitals in the Kathmandu valley. Method This descriptive cross-sectional study was completed during 20th July to 28th July 2021 using point prevalence survey methodology. The study was conducted among inpatients admitted at or before 8:00 AM on the day of survey in various wards. Data was presented as frequencies and percentages. Result Maximum number of patients were above 60 years [34 (18.7%)]. Number of male and female participants were equal [91 (50%)]. Only one antibiotic was used in 81 patients (44.5%) followed by two antibiotics in 71 (39%) patients. Duration of prophylactic antibiotic use was one day in 66 (63.7%) patients. Blood, urine, sputum, and wound swabs were the common samples for culture. Cultures were positive for 17 (24.7%) samples. The common organisms isolated were E. Coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Ceftriaxone was the most used antibiotic. Drug and therapeutics, infection control committee and pharmacovigilance activities were present in 3/6 (50%) study sites. Antimicrobial stewardship was present in 3/6 (50%) and microbiological services was present in all hospitals. Antibiotic formulary and antibiotic guideline were present in 4/6 sites and facilities to audit or review surgical antibiotic prophylaxis choice in 2/6 (33.3%) sites, facility to monitor antibiotic use in 4/6 (66.6%) and cumulative antibiotic susceptibility reports in 2/6 (33.3%) study sites. Conclusion Ceftriaxone was the most used antibiotic. E. Coli, Pseudomonas aeruginosa and Klebsiella pneumonia were the commonly isolated organisms. Not all parameters for infrastructure, policy and practice and monitoring and feedback were present at the study sites. KEY WORDS Antibiotics, Point prevalence survey, Private hospitals, Tertiary care centers
Correlation between Sonoelastographic, Doppler and Histopathological Findings in Chronic Kidney Disease Patients in Tertiary Care Centre
(Kathmandu University, 2022) Jha, SK; Lohani, B; Pant, AD; Chataut, D; Regmi, D; Bhatta, U; Gautam, N; Jha, G
ABSTRACT Background Ultrasound (USG) with Doppler examination of intrarenal vessels is the imaging modality of choice employed in patients with renal failure and is commonly performed early in the clinical course. The pulsatility index (PI) and the resistive index (RI) of downstream renal artery have been found to correlate with renal vascular resistance, filtration fraction and effective renal plasma flow in chronic renal failure. Pathological process in any tissues alters their elastic properties which can be assessed non-invasively through newer technique like elastography. Objective To correlate the findings obtained by sonoelastographic, doppler and histopathological studies in chronic kidney disease patients. Method Study was done in 146 patients referred to Department of Radiodiagnosis and Imaging, TUTH for native renal biopsy. Renal sonographic morphology (length, echogenicity, cortical thickness), Sonoelastography (Young’s modulus) and Doppler parameters (peak systolic velocity, resistive index) were assessed. The grading of estimated GFR (eGFR) was calculated based on chronic kidney disease (CKD) criteria. Result Among 146 patients, 63 (43.2%) were females and 83 (56.8%) were males. Maximum patients were in age group of 41-50 years (25.3%) followed by age group 51-60 years (24%). Mean age of patient was 42.06±14.70 for males and 39.57±12.54 females. Maximum mean Young’s modulus was seen in eGFR stage G1 with 46.57±19.51 kPa followed by in stage G3a with 36.46±10.01 kPa and observed to be statistically non-significant (p=0.172). However, statistical significance difference was noted between the resistive index and elastographic measurement of Young’s modulus (r=0.462, p=0.0001). Minimum mean cortical thickness was seen in eGFR stage G5 with 4.42±1.48 mm followed by stage G4 with 5.57±1.24 mm (p= 0.0001). Cortical thickness is decreasing as eGFR stage was increasing in our study (p=0.0001). Resistive index is increasing with decrease in renal size (r=-0.202, p=0.015). Conclusion Ultrasonography along with doppler study and elastography have limited role in diagnosing the pathology of chronic kidney disease, however, it has significant role in the disease progression. KEY WORDS Chronic kidney disease, Doppler, Elastography, Resistive index, Ultrasonography
Morphometric Analysis of Posterior Fossa and Foramen Magnum among Pediatric Age Group 6 to 16 Years
(Kathmandu University, 2022) Shrestha, B; Paudel, RC; Kashichhawa, S; Maharjan, N
ABSTRACT Background Configuration and size of the foramen magnum and posterior cranial fossa plays an important role in the pathophysiology of various disorders like Chiari malformations, basilar invagination etc. Thus, a fundamental knowledge of normal anatomy of this region is important to the clinician for diagnosis and treatment. However, we couldn’t find any anatomical study related to the concerned topic among the pediatric population aged 6 to 16 years in Nepal to the best of our knowledge. Objective To attain the baseline results (volume of bony part of posterior cranial fossa and the surface area of foramen magnum) that will help in the better diagnosis, classification, and treatment of diseases related to posterior fossa and craniovertebral junction and serve as a future reference defining an anatomic range in our region. Method This is a retrospective prospective observational study conducted from 1st February 2021 to 31st January 2022 at Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal. We used convenient sampling technique to fulfil our sample size. We considered 68 patients, who got recruited either from our emergency and OPD departments and were fulfilling our criteria of inclusion. Upon the recruitment, 68 consecutive head CT scan of pediatric patients with normal reports (without any bony or soft-tissue abnormality) were studied. Volume of the posterior fossa was calculated with the help of inbuilt “advanced work station - 3D volume calculator” program in 128 slices - SOMATOM PERSPECTIVE CT Scanner from Siemens, Germany. The area of the foramen magnum was calculated using formula πr2, where r is average radius calculated from obtained antero-posterior and transverse diameter. Result The age of the patients ranged between 6 and 16 years with the mean age of 10.56 ± 3.38 years with male to female distribution of 1: 1.125. The mean volume of the posterior fossa was 165.61 ± 8.52 mm3. The mean AP diameter, transverse diameter, and the surface area of foramen magnum were 3.31 ± 0.12 mm, 2.72 ± 0.12 mm, and 28.60 ± 0.09 mm2 respectively. Conclusion Normal ranges of volume of posterior cranial fossa and various dimensions and surface area of foramen magnum of pediatric population were determined using CT scans, which could serve as future reference in Nepal. KEY WORDS Chiari malformation, Foramen magnum, Posterior cranial fossa
A Comparative Study of Rapid SARS-Cov-2 Antigen Detection Assay against RT-PCR Assay for Diagnosis of COVID-19 in a Tertiary Hospital of Kathmandu
(Kathmandu University, 2022) Chaudhary, R; Bhatta, S; Singh, A; Pradhan, M; Moktan, B; Duwal, S; Pandit, R
ABSTRACT Background The Coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has spread worldwide since its first recorded case in the city of Wuhan, China, in December 2019. SARS-CoV-2 infection causes asymptomatic to sever pneumonia. Severe cases may develop acute respiratory disease symdrome (ARDS), with an average mortality rate of 6.9%. Real Time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) assay is the current reference standard laboratory method for the diagnosis of SARS-CoV-2 infection. However, it takes around 6-8 hours to get the result and is time consuming. Therefore, rapid and accurate tests for SARS-CoV-2 screening are essential to expedite disease prevention and control. Lateral flow immunoassay using monoclonal anti SARS-CoV-2 antibodies which target for SARS-CoV-2 antigen can be complimentary screening test if their accuracy were comparable to that of the real time reverse transcription- polymerase chain reaction (RT-PCR) assay. Objective To find the sensitivity and specificity of a rapid antigentest kit in comparison to reverse transcription-polymerase chain reaction (RT-PCR). Method A cross-sectional hospital based study was carried out at Shree Birendra Army Hospital, Kathmandu for a period of four months. Result Our finding shows sensitivity and specificity of rapid diagnostic tests (RDT) Ag kit as 60.6% and 96.4% respectively. Positive and negative predictive value was 83.7% and 89.0%. Likewise, positive and negative likelihood ratio was 17.0 and 0.4. The overall accuracy of the antigen kit was 88.1% in comparison to reverse transcription- polymerase chain reaction (RT-PCR) as the gold standard. Conclusion Our study concluded the use of rapid antigen kit is mainly useful for screening purposes. KEY WORDS RDT Ag Kit, RT-PCR, SARS-CoV-2
Utilization of Cervical Cancer Screening and Associated Factors among Women in Bhaktapur, Nepal
(Kathmandu University, 2022) Nepal, J; Poudyal, AK; Duwal, S; Gyawali, S; Basel, P
ABSTRACT Background Cervical cancer is the most common cancer among women in Nepal causing highest cancer mortality among women of reproductive age. However, it can be prevented through early and regular screening. Objective To assess utilization of cervical cancer screening, its awareness and perception among women, and associated factors. Method A cross-sectional study was conducted where 360 women of age 30-60 years were randomly selected and interviewed from five administrative wards of Bhaktapur municipality. Result Utilization of cervical cancer screening through Pap test or Visual Inspection with Acetic acid was found in 32.2% women and 47.8% were aware of cervical cancer and its screening tests. 100% of them had high level of perceived benefits and facilitators. More than 80% of them had low level of perceived barriers and susceptibility. Women of age group 51-60 years were more likely to perform the screening test (AOR=13.14) whereas unemployed women were at higher odds of performing the test (AOR=3.29). Women who were aware of cervical cancer and its screening were more likely to perform the screening (AOR=53.65). Women having low level of perceived barriers (AOR=5.83) and high level of perceived seriousness (AOR=6.67) were more likely to perform the screening. Conclusion Only one third of women had performed Pap test/VIA and those who were aware of cervical cancer and had high level of perception were more likely to perform the screening. Thus, more rigorous and tailor-made awareness programs should be developed by health program planners to increase the screening rate among younger and working women. KEY WORDS Awareness, Cervical cancer screening, Perception, Utilization
Knowledge, Attitude and Practice of Disposal of Unused, Unwanted and Expired Medicines among Healthcare Professionals
(Kathmandu University, 2022) Sarraf, DP; Rauniar, GP; Kushwaha, RP; Keshwar, S; Maharjan, R
ABSTRACT Background Unused, unwanted and expired medicines stored at home pose threats to both health systems and environments. Healthcare professionals (HCPs) should be aware of the proper disposal methods of such medicines. Objective To assess the knowledge, attitude and practice of disposal of unused, unwanted and expired medicines among healthcare professionals. Method A web-based cross-sectional descriptive study was conducted among faculties and junior residents at B.P. Koirala Institute of Health Sciences, Dharan, Nepal using a semi-structured proforma. The data were collected through Google Form. Descriptive statistics were calculated. Chi-square test and Student’s t test were used for analysis using statistical package for the social sciences at p value of 0.05. Result A total of 294 healthcare professionals with mean age 35.37± 6.630 years were participated out of which 231 (78.6%) were male and 151 (51.4%) were faculties. Mean knowledge score was higher in faculties (2.37±1.111) than the Junior residents (2.33±1.155) [F(1,293)=0.102, p=0.750]. Junior residents (140 out of 143, 97.9%) had a better attitude than faculties (141 out of 151, 93.3%) regarding the disposal of medicines [χ2 (1)=3.558, p=0.059]. Junior residents (36 out of 143, 25.1%) also had a better practice than faculties (24 out of 151, 15.8%) regarding the disposal of medicines [χ2 (1)=3.895, p=0.048]. Conclusion Majority of the Healthcare professionals had positive attitude but poor knowledge and practice regarding disposal of expired and unused medicines. There was a high practice of keeping medicines at home by healthcare professionals. The findings would be useful for planning strategies to minimize unused medicines and foster the appropriate disposal practice. KEY WORDS Attitude, Faculties, Knowledge, Medical waste disposal, Practice
Analysis between Vaccinated and Unvaccinated Hospitalized Patients Infected with SARS-CoV-2
(Kathmandu University, 2022) Basnet A; Tamang, B; Pokhrel, N; Khadka, S; Shrestha, MR; Ghimire, S; Prajapati, R; Thapa S; Duwal Shrestha, SK; Chand, AB; Amatya, I; Rai, SK
ABSTRACT Background Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) variants, which have emerged due to several mutations in spike protein, have a potential to escape immune protection provided by the first-generation vaccines, thereby resulting in breakthrough infections. Objective To identify the socio-demographic factors, clinical features, and outcomes in both vaccinated and unvaccinated hospitalized patients infected with SARS-CoV-2. Method Socio-demographic details, clinical features, and the outcomes among fully vaccinated (double for Covishield/AstraZeneca and BBIBP-CorV and single for Janssen), partially vaccinated, and unvaccinated hospitalized patients with coronavirus disease of 2019 (COVID-19) were collected and analyzed using SPSS version 17. Result Among the hospitalized COVID-19 patients (n=299), 175 (58.5%) patients received a single-dose, 82 (27.4%) double-dose, and 124 (41.5%) did not receive any dose of the COVID-19 vaccines. The risk of SARS-CoV-2 infection when compared between vaccinated and unvaccinated patients was found to be associated among professional degree holders (23.4% versus 9.7%) (p<0.05), professional workers (43.4% vs. 25.0%) (p<0.05), hospitalization to general ward (76.6% vs. 72.6%) (p<0.05), and presence of multiple symptoms (≥3) (86.8% vs. 75.0%) (p>0.05) and comorbidities (≥2) (15.5% vs. 13.7%) (p>0.05). Despite such approximate incidences, the risk of in-hospital mortality among the vaccinated patients was reduced (0.6% vs. 3.2%) (p>0.05), when compared to the unvaccinated patients. The risk of in-hospital mortality was associated with the older age and the presence of multiple comorbidities including bronchial asthma, diabetes, and hypertension. Conclusion Full or partial vaccination against the SARS-CoV-2 variants of concerns might be effective in preventing in-hospital mortality among COVID-19 patients. KEY WORDS COVID-19, Clinical features, SARS-CoV-2, Socio-demographic factors, Vaccine, Variants
Use of Magnetic Resonance Imaging in the Evaluation of Acute Cholecystitis in Emergency Setting
(Kathmandu University, 2022) Sharma, UK; Thapa, DK; Thapaliya, S; Pokhrel, A; Baskota, B; Rai, U
ABSTRACT Background Acute cholecystitis is one of the commonest surgical disease. The rapid diagnosis at its early stage is one of the crucial factor in patient care and management. Objective To evaluate the role of magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) in the diagnosis or exclusion of acute cholecystitis, coexisting choledocholithiasis, and acute pancreatitis in emergency setting. Method This study was conducted in the department of radiodiagnosis B&C teaching hospital, Birtamod, Nepal from July 2016 to November 2019. Patients, clinically diagnosed as acute cholecystitis or biliary condition with positive Murphy’s sign with or without jaundice and deranged Liver Function Test, raised Leucocyte counts were evaluated by Magnetic Resonance imaging. The sensitivity, specificity, Positive Productive Value (PPV), Negative Productive Value (NPV) were calculated for the diagnosis of acute cholecystitis. Data was entered and analysed by using SPSS version 20. Result There were 40 patients included in our study. Among them 27 (67.5%) were females and 13 (32.5%) male. The age of the patients ranged from 16 years to 79 years, mean age 49.4 years. Majority of the patients were in the age group of 40-60 years (57.5%). The overall sensitivity, specificity, Positive Productive Value and Negative Productive Value of Magnetic Resonance imaging diagnosis of acute cholecystitis were 100%, 66.6%, 94.4% and 100% respectively. Acute cholecystitis associated with gall stone disease were common and found in 72.5% cases, with sensitivity 96.5%, specificity 27.7%, Positive Productive Value 77.7% and Negative Productive Value 75.0%. Conclusion Magnetic resonance imaging (MRI)/Magnetic resonance cholangiopancreatography (MRCP) is an excellent tool for the evaluation of biliary pathology and can be used for the preoperative evaluation of acute cholecystitis at the emergency setting. KEY WORDS Acute Cholecystitis, Cholelithiasis, Magnetic resonance cholangiopancreatography
Bacterial Flora and Antibiotics Sensitivity Pattern in Chronic Rhinosinusitis Outpatient Cases in Tertiary Care Hospital
(Kathmandu University, 2022) Shrestha, D
ABSTRACT Background Chronic rhinosinusitis is a disease that afflicts a significant percentage of the population and causes considerable long-term morbidity. The initial treatment is clinical evaluation followed by starting empirical antibiotics. With the use of empirical antibiotics there is a possibility of aggravating the disease and leading to the persistence of chronic sinusitis. In order to start a protocol for rational use of antibiotics, we need to have the bacteriological profile in cases of chronic rhinosinusitis along with the sensitive group of antibiotics. Objective To determine the bacterial flora in nasal swab of patients with chronic rhinosinusitis and identify the sensitive antibiotics for the bacterial isolate. Method A prospective, cross-sectional study was conducted in ENT Head and Neck Department of tertiary care hospital. The study population was the patients with clinical diagnosis of chronic rhinosinusitis whose nasal swabs were taken during nasal endoscopy and sent for culture and sensitivity. The data were entered in Microsoft Excel and analyzed using statistical computer program Statistical Package for the Social Sciences (SPSS). The ethical approval for the study was taken from Ethical Committee of Kathmandu Medical College. Result There were 60 (87%) bacterial isolate growths out of 69 samples of which 49 (82%) were gram positive and 11 (18%) were gram negative. The most common bacteria isolated was S aureus (42%) followed by Cogaulase neagative Staphylococcus (25%). Conclusion Among gram positive isolates, amoxycillin was the most sensitive antibiotic and among gram negative isolates, ceftriaxone, levofloxacin, imipenem, meropenem and piperacillin were most sensitive antibiotics. In this study, we have determined the bacterial flora from endoscopic nasal swab of the sinuses in chronic rhinosinusitis patients and identified the sensitive antibiotics. This study would help us prescribe rational antibiotics in cases of chronic rhinosinusitis. KEY WORDS Antibiotics, Bacteria, Chronic rhinosinusitis, Sensitivity
Prevalence of Gingivitis in Second Trimester of Pregnancy
(Kathmandu University, 2022) Shrestha, R; Pradhan, S; Baral, G
ABSTRACT Background Gingivitis simply means the inflammation of gingiva. It is a reversible state but can lead to periodontitis. The final result could be the exfoliation of the tooth causing decreased masticatory function leading to a compromised quality of life. Gingivitis in the pregnant woman should be carefully assessed and treated and given special attention. There is rare documentation on the prevalence of gingivitis in pregnancy in the least developed countries. Objective To evaluate the prevalence of gingivitis in the second trimester of pregnancy and assess its relationship with age, parity, education, occupation, gravidity, oral hygiene habit and frequency of brushing. Method An observational descriptive study was conducted among 384 pregnant females in their second trimester in Kathmandu, Nepal. Demographic variables and general information including those related to oral hygiene practices and habits were collected during an interview. Plaque index and Gingival Index was recorded among the patients through full mouth examination at four sites. Result The prevalence of gingivitis in the second trimester of pregnancy was 76.3%. Statistically significant relationship was found between gingivitis and gravida and parity. A relation could not be established between gingivitis with age, education, occupation, oral hygiene habit and frequency of brushing. Conclusion The prevalence of gingivitis is found to be high in Nepalese pregnant women. Special strategies should be introduced targeting the pregnant women of least developed countries to uplift their periodontal health. KEY WORDS Gingivitis, Oral hygiene, Pregnancy
Study on Status of Serum Biochemical and Hematological Parameters in COVID-19 Positive Patients Attending a Tertiary Care Hospital
(Kathmandu University, 2022) Shreewastav, RK; Singh, GK; Jha, KK; Yadav, RK; Gharti, SB
ABSTRACT Background Coronavirus disease 2019 (COVID-19) presents clinically a variety of pathological and clinical organ dysfunctions, ranging in severity from asymptomatic to fatal. The care and monitoring of COVID-19 patients may benefit from the use of biochemical and hematological markers. Objective To observe the alteration of serum biochemical and hematological parameters in COVID-19 positive patients, attending a Tertiary Care Hospital. Method A descriptive cross-sectional study was conducted on all COVID-19 positive patients attending Nobel Medical College Teaching Hospital, Biratnagar, Nepal from 15th December 2021 to 15th February 2022. The test results of different serum biochemical and hematological parameters done for these patients were recorded in clinical laboratory services and obtained retrospectively for the analysis. The data were entered in MS excel and analyzed by SPSS version 20. Result Out of 1537 COVID-11699 declared positive patients, 712 (46.32%) were male and 825 (53.68%) female. Mean age of COVID positive patients was 40.03±20.08 years. The level of serum SGOT, SGPT, ALP and GGT was significantly elevated in 39.9%, 42.8%, 32.3% and 47.2% of COVID positive patients respectively. Blood Urea, creatinine, uric acid and sugar level were significantly elevated in 63%, 56.1%, 33.1% and 47.6% patients respectively. The serum level of LDH, D-dimer, CRP and procalcitonin (PCT) were significantly increased in 52.1%, 75.9%, 71.6% and 61.2% of patients respectively. The serum value of total cholesterol, triglyceride, HDL and LDL were significantly lowered in 52.2%, 43.8%, 70.1% and 60.3% of patients respectively. RBC concentration and level of hemoglobin was reduced in 56.6% and 53.6% of COVID positive patients respectively whereas total leukocyte count was elevated in 80.7% with increase in neutrophil in 87.9% and decrease in lymphocyte in 79.4%. Conclusion A portion of COVID-19 positive patients showed drastically altered test results for various serum biochemical and hematological markers, although many of them had normal findings. KEY WORDS Biochemical markers, COVID-19, Tertiary hospital
Intimate Partner Violence and Adverse Pregnancy Outcomes
(Kathmandu University, 2022) Koirala, S
ABSTRACT Background Intimate partner violence (IPV) is an abuse or harm that occurs in a close relationship. The World Health Organization (WHO) estimated that, globally, 35% of women living in industrialized and developed countries have experienced exposure to intimate partner violence and during pregnancy it is associated with low birth weight, preterm birth, and even death of the baby. Objective To find out proportion of intimate partner violence and adverse pregnancy outcome among postnatal mothers who recently delivered their baby. Method A cross-sectional study was conducted among 220 postnatal mothers using a structured questionnaire based on 13-item WHO Violence against women instrument in Nepali language. Face-to-face interview technique was used to collect data using consecutive sampling technique at Kathmandu Medical College teaching Hospital. The data were analyzed using SPSS version 20. Result In recent pregnancy, 32.7% of women had experienced intimate partner violence at least once, which has been categorized as physical 28.6%, psychological 30.9%, and 22.7% sexual violence. Among them, 36% had low birth weight babies, 24% had preterm, 2.8% had dead baby, and 35% reported abortion in previous pregnancy. In the binary logistic regression, intimate partner violence was significantly associated with preterm baby (OR-1.143, 95% CI- 0.386-3.384, p=0.002), low-birth weight (OR- 0.237, 95% CI- 0.093-0.602, p ≤ 0.001), and abortion (OR-0.021, 95% CI- 0.003-0.175, p ≤ 0.001). Conclusion One in three women experienced intimate partner violence during their recent pregnancy and is associated with adverse pregnancy outcomes. Programs targeting screening of intimate partner violence against women should therefore be emphasized during reproductive health services such that adverse pregnancy outcomes can be prevented. KEY WORDS Intimate partner violence, Low birth weight, Pregnancy outcomes, Preterm birth

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