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Fundal Intramural Pregnancy: An Unusual and Rare Form of Ectopic Pregnancy
(Rapti Academy of Health Sciences (RAHS), 2024) Joshi, Basant Raj; Vaidya, Sapana Amatya; Jha, Meena; Shakya, Madhu; Dahal, Bibhuti; Sharma, Prasansa
Abstract: Intramural pregnancy is a rare type of ectopic pregnancy and difficult to diagnose. A 42-year-old woman, who has no past history of uterine surgeries, nor fertility treatment, presented with a fundal abnormal mass with diagnostic dilemma with invasive mole. Laparotomy with hysterectomy was performed. Histopathology and immunohistochemistry confirmed as fundal intramural ectopic pregnancy. The postoperative course was uneventful. Keywords: Case Report, Ectopic Pregnancy, Intramural Pregnancy, Fundal Pregnancy, Intramural ectopic pregnancy, Fundal intramural ectopic pregnancy, Rare form of ectopic pregnancy
Uterine Didelphys and Spontaneous Conception: A Rare Occurence
(Rapti Academy of Health Sciences (RAHS), 2024) Adhikari, Shreeprasad; Thapa, Jwala
Abstract: Mullerian duct anomalies refer to a set of congenital structural malformations which result from abnormal development of the paramesonephric or Mullerian ducts in utero. Mullerian abnormalities are estimated to affect 0.5-5% of the general population. A didelphys uterus, commonly known as “double uterus”, is an infrequent type of Mullerian duct anomaly. This report describes a rare case of a 25 years old primigravida who had a spontaneous conception followed by successful delivery of a healthy baby via cesarean section at 37 weeks of gestation.
Myrmecia (Deep Palmoplantar Wart) on Dorsal Surface of Distal Interphalangeal Joint: A Case Report
(Rapti Academy of Health Sciences (RAHS), 2024) Sigdel, Madhu
Abstract Cutaneous warts are common skin condition mostly affecting young adults and are caused due to human papilloma virus. Deep palmoplantar warts are commonly caused by HPV-1 and present as tender nodules or papules commonly occurring on the palms and soles; as well as on the lateral aspects and tips of the fingers and toes. The aim of this case study is to report one case of 25 years old female presented in skin OPD with painful nodule on dorsal surface of distal interphalangeal joint of little finger (5th finger) of left hand. This is rare and unique site for occurrence of myrmecia and no case report of myrmecia at this site has been reported till date.
Heat Related Illness: Pathophysiology, Manifestations, Treatment and Prevention
(Rapti Academy of Health Sciences (RAHS), 2024) Mahotra, Narayan
Abstract: Hot environment and physical exertion during such hot environment such as agricultural work, sports, labor work etc. may lead to adverse health conditions in different forms and severity. These adverse health conditions due to heat is called heat related illness. In this type of illness hematological, cardiovascular, neurological, and renal dysfunctions are associated with high mortality. So, the people at risk to heat related illness need education to understand basic physiology and training about this illness so that people easily recognize the clinical manifestations of heat related illness and save their lives. The pathophysiology of severe heat related illness such as heat stroke involves failure in thermoregulatory mechanism and cardiovascular overload, resulting in dangerously increasing core body temperature and subsequent multiorgan injury. Immediate cooling remains the most effective treatment strategy. In this viewpoint, I would like to provide an overview of the current literature emphasizing the pathophysiology, clinical manifestations, treatment and prevention of heat related illnesses which might be beneficial to general people and health professionals as well.
Colposcopic Evaluation of Cervix with Swede Score and its Correlation with Histopathology
(Rapti Academy of Health Sciences (RAHS), 2024) Nayak, Neha; Vaidya, Sapna Amatya; Vaidya, Karishma Malla
Abstract: Introduction: Cervical cancer is considered to be an international health issue as there is a high incidence in many LMICs. The rate of cervical cancer in the Nepal is 16.4 per 100,000 women. Special mention should be made of its applicability in determining the presence of cervical precancerous lesions, hence the choice of colposcopy as a significant guide to cervical biopsy. This paper seeks to establish the relationship between colposcopic grading of cervix with Swede score and histological examinations of cervical punch biopsy. Methods: This cross-sectional study was carried out on 81 women attending the Department of Gynaecology of tertiary care teaching hospital Paropakar Maternity and Women’s Hospital, Kathmandu. All the women with either abnormal cervical cytology result or HPV positive status were subjected to colposcopic guided biopsy using Swede score. Histopathology was then compared to the findings seen on colposcopy. Results: 54%(n=44) had abnormal biopsy reports.58% had Swede score>=5. Swede score>= 5 had sensitivity, specificicity, NPV and PPV of 81.2%, 70.2%, 76.5% and 76% respectively.Swede score>= 8 had sensitivity, specificicity, NPV and PPV of 25.5%, 97%, 91.6% and 53.6% respectively Conclusion: Colposcopy, using Swede score>=5 as cut off is sensitive in screening of cervix and can be used as a basis for treating patients directly as a “see and treat” method. Keywords: Cervical cancer, Colposcopy, Screening, Swede score
Prevalence and Risk factors of Lower Urinary Tract Symptoms in Menopausal Women
(Rapti Academy of Health Sciences (RAHS), 2024) Jha, Anamika; Dangal, Ganesh; Poudel, Sandesh
Abstract: Introduction: Lower urinary tract symptoms is existing everywhere in the world and depending on the age, geographical location, and culture it is having great impact. They encompass different disease features which include-storage, voiding and post micturition. Numerous risk factors have been identified, and there are few published articles concerning the frequency of LUTS in menopausal women as well as their associated risk factors. Thus, this study was formulated with the intention of ascertaining the incidence and the risk indicators of LUTS in menopausal women. Methods: This was a cross-sectional study of the observational type which was carried out in the Paropakar Maternity & Women’s Hospital Thapathali, Kathmandu. Approval to carry out the study was sought and granted from the IRC. It was a hospital-based descriptive cross-sectional study conducted in gynecological outdoor patient department involving all menopausal women who presented themselves to the clinic between February 1st to April 30th 2024 using convenience sampling technique. Among the study population having LUTS, their details and possible risk factors were incorporated in this study. Results: Three hundred menopausal women were recruited in the study during the considered period of time. Mean age of menopause was 48. 3 years. Concerning LUTS, the current study established a prevalence rate of 71.7% among the respondents. The most frequently reported complaint was urgency reported by 39 % of the patients ,seconded by incontinence reported by 35. 7% of the patients and thirdly nocturia was reported by 23% of patients. In menopausal women, the factors that may increase the risk to develop LUTS were BMI, having a history of childbirth and recurrent UTI. Conclusion: LUTS was significantly high among menopausal women in Paropakar Maternity and Women’s Hospital, the most dominating symptom was urgency and the second one was incontinence. Several factors were established to be predictive of LUTS namely; BMI, giving birth and a history of recurrent UTI but there was no statistical evidence related to the type of delivery. Keywords: Lower urinary tract symptoms, menopause, women
The Impact of Body Mass Index on Semen Parameters: A cross sectional study
(Rapti Academy of Health Sciences (RAHS), 2024) Sedhain, Nesuma; Adhikari, Shree Prasad; Pradhan, Hema Kumari; Thapa, Jwala; Parajuli, Rakshya
Abstract Introduction: Infertility is an emerging health issue across the world/. Obesity is another growing health concern, which is seen associated with adverse health outcomes. Several people had investigated the effects of obesity on male infertility, with inconclusive findings. Hence the present study aimed to assess the relationship between Body Mass Index (BMI) and the various parameters of semen (volume, sperm count, vitality, motility and morphology). Methods: This was a cross-sectional study involving 272 men aged 20 – 52 years. The participants were categorized into four BMI groups as underweight, normal weight, overweight, and obese. Semen samples were analyzed. In the correlation study, Spearman’s correlation was used. Independent variables were tested on the dependent variables using Analysis of Variance (ANOVA) and Multivariate Analysis of Variance (MANOVA) to find out the effects of BMI on semen parameters while controlling effects of various covariates (age, smoking and alcohol consumption, occupation, ethnicity and education). Results: Correlation analysis showed no statistically significant correlations between BMI and semen parameters. However, comparing the BMI groups revealed statistically significant differences in semen parameter (p<0.05). The normal weight, overweight and obese groups had better semen quality than underweight. Underweight men had sperm count(16±20.78 million/ml), vitality(13.6±7.09%), progressive motility(4.33±4.93%) and morphology(1.33±0.57%). The effect of BMI on semen parameters was further confirmed by MANOVA study with Wilks’ Lambda=0.802, F=3.273, p<0.05. Conclusions: Semen quality was adversely affected in underweight groups compared to other groups. Thus emphasizing importance of keeping healthy BMI in order to have a better reproductive health. Keywords: BMI, Semen parameters, Underweight.
Effects of Early Marriage Among Married Women Residing in Buddhabhumi Municipality of Kapilvastu
(Rapti Academy of Health Sciences (RAHS), 2024) Gurung, Saraj; Bajracharya, Srishti; Khatri, Binita; Chhetri, Arzoo; Kachapati, Anuja; Chhantyal, Pushpa; Lamsal, Shyam
Abstract: Introduction: Child marriage is a public health problem. It has physical, psychological and socio-economic effects for the bride. They face worse socio-economic and health effects than their unmarried peers which leads to maternal and child morbidity and mortality. The aim of the study was to find out the effects of early marriage among married women. Methods: Cross-sectional study was conducted to find out the effects of early marriage among 119 married women. Purposive and snowball sampling was used to select samples and semi-structured interview schedule was used for data collection. Data was analyzed by descriptive and inferential statistics with Statistical Package for Social Science 16. Results: The findings revealed that 84.87% and 74.38%, 38.65% and 36.13% of the respondents faced socio-economic problems, physical health problem, psychological problems and reproductive and sexual problems as effects of early marriage respectively. Physical violence (65.34%) and school dropout (47.52 %.) were found as socio-economic effects of early marriage. Backache (56.17%) and lower abdomen pain (51.16) were main physical health problem. Anxiety (86.95%) and even suicidal thoughts (26.08%) were found. Age at first pregnancy and age at first delivery had influence on problems of the respondents. Conclusion:The study findings concluded that the socio-economic problems are main effects of early marriage Anxiety was main problem and an even suicidal thought was also found. Local and national level programs on minimizing early marriage and early childbearing might reduce health problems and violence in women’ lives.
Trend of Teenage Pregnancy and its Adverse Outcome at Rapti Academy of Health Sciences, Dang District, Lumbini Province
(Rapti Academy of Health Sciences (RAHS), 2024) Lamichhane, Bikash; Lamichhane, Basant; Darlami, Radha; Kunwar, Shishir; Bhattarai, Stuti; Gautam, Ajaya Raj; Pokhrel, Bishal
Abstract: Introduction: Teenage pregnancy is defined as a pregnancy in a girl who is 10-19 years of age. In Nepal, adolescents aged 10 to 19 comprise 6.4 million of the population. The most common maternal complications in teenage pregnancy were hypertensive disorders, preterm birth and low birth weight. Teenage pregnancy has negative effects on the health outcomes of both the mother and the newborn. So, this study was conducted to describing the trend of teenage pregnancy and its outcome at a tertiary care hospital in the Dang district. Methods: A retrospective, cross-sectional study was conducted at Rapti Academy of Health Sciences (RAHS). Ethical approval was taken from the Nepal Health Research Council (NHRC). Data was retrieved from January 2018 to December 2022 from the hospital Central Admission Register and maternity register record. The total 1097 records of teenage deliveries were taken as a whole sampling. Data entry was done in Microsoft Excel and point estimate at 95% CI was calculated along with frequency and percentage. Results: Total 1097 teenage deliveries were conducted in five years where maximum teenage deliveries were of 19 years (41.2%). Among teenage delivery, live birth delivery was 89.9%. Significant tear was found in 264 teenage deliveries (95.0%) as a maternal complication. Conclusion: The trend of teenage pregnancy was in decreasing trend over five years in RAHS, Dang. Preterm delivery, Perineal tear, and Spontaneous abortion were common complications seen in pregnancy. Further awareness and health education programs helps to reduce the teenage pregnancy
Analysis of Caesarean Sections according to Robson’s Ten Group Classification System at a Tertiary Care Hospital in Lumbini Province
(Rapti Academy of Health Sciences (RAHS), 2024) Lamichhane, Basant; Darlami, Radha; Bhattarai, Stuti
Abstract: Introduction: A Caesarean section (CS) is a common surgical operation in obstetrics. There is an alarming concern regarding rising rate of CS worldwide. This study was conducted to align with the Robson classification, an international standard for tracking and comparing CS rates within an institution. The study also identifies the CS rates within each group according to Robson’s ten-group classification system (RTGCS). Methods: This cross-sectional study, conducted over six months from October 2022 to March 2023, took place in the Department of Obstetrics and Gynecology at Rapti Academy of Health Sciences, a tertiary care center in Province 5. Descriptive analysis was performed on various variables according to the Robson’s Ten Group Classification System (RTGCS), and the Caesarean sections (CS) were subsequently categorized. Results: Out of 1780 total deliveries, 1060 (59.55%) were vaginal deliveries while 720 (40.45%) were CS. According to the Robson classification, group 1 was the predominant contributor at 34.2%, followed by group 5 at 21.1% and group 3 at 16.1% respectively. In regards to the indication of CS, cephalo-pelvic disproportion was the top most indication for CS. Conclusions: As per the study as group 1 and group 5 are the leading group of CS in the institute, measures such as following evidence based labour care guide and promoting instrumental deliveries and vaginal birth after caesarean (VBAC) could help address the increasing CS rates.
Place of Child Birth and its Associated Factors in Shitganga Municipality, Arghakhanchi district, Nepal
(Rapti Academy of Health Sciences (RAHS), 2024) Darlami, Radha; Karki, Khem Bahadur; Oli, Bishnu Prasad
Abstract: Introduction: Maternal and newborn mortality are tragic facts that occur due to complications occur during pregnancy and deliveries. Although, there are improvements in institutional birth services, still more than one-third of women in Nepal give birth at home due to various circumstances. The main objective of this study is to identify the factors associated with place of child birth. Methods: A community based cross-sectional study was conducted in Shitganga Municipality of Arghakhanchi district. Using simple random sampling, 342 women who delivered in last one year were interviewed with structured questionnaire. Ethical approval was taken from the Institutional Review Committee (IRC) of Institute of Medicine, and written informed consent was obtain from respondent. Data analysis was performed in Statistical Package for the Social Sciences (SPSS). Results: Study shows that municipality has 81.9% of institutional delivery. Among them more than 50% of institutional delivery occurs outside of municipality. Factors like age, type of family, occupation of husband, education of women and husband, parity of women, knowledge and practice of ANC services and time distance from health facility were establish significantly associated at p value <0.05 with place of child birth. Conclusions: As per the study, ANC and delivery practice of women was good. Study also conclude that joint family, formal schooling of women, husband’s occupation, experience of danger signs during delivery and time distance of 60 minutes or more have significant association with place of child birth.
Practice of Surgical Dressing among Health Care Workers at a Teaching Hospital, Chitwan
(Rapti Academy of Health Sciences (RAHS), 2024) Bhattarai, Stuti; Thulung, Bedantakala; Gautam, Ajaya Raj
Abstract: Introduction: With growing concern over antimicrobial resistance and nosocomial infections, wound dressing techniques are required to prevent infection and shorten the healing time after surgery. Implementing a surgical wound dressing checklist can prevent surgical site infections and enhance healthcare professionals’ practices related to surgical wound dressing. This study aims to identify the practice of surgical dressing among health care workers at a teaching hospital, Chitwan. Methods: A descriptive observation study was conducted at a Teaching Hospital in Chitwan. Using non-probability convenience sampling, 50 health care workers practicing surgical dressing from the Surgery, Gynaecology/Obstetrics, Neurosurgery, and Orthopaedic wards were selected as a sample. Data were collected using an observation checklist. Ethical approval was obtained from the Institutional Review Committee of Chitwan Medical College (IRC-CMC) with Ref. No. 198. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS). Results: The study revealed that only 28% of the health care workers had good practice (≥ 90% of total score without missing critical steps). There was significant association between working unit and level of practice of surgical dressing (p=0.005). Conclusions: Majority of health care workers have poor practice of surgical dressing. Hence, there is need to provide in-service training for health care workers to enhance their skills. Further, procedure manual related to dressing should be made available in all wards.
Quality of Life of Chronic Myeloid Leukemia Patients receiving Tyrosine Kinase Inhibitor (TKI): Comparison with Healthy Population
(Rapti Academy of Health Sciences (RAHS), 2024) Gautam, Ajaya Raj; Bhattarai, Stuti
Abstract: Introduction: Development of tyrosine kinase inhibitors (TKIs) has changed the therapeutic landscape of chronic myeloid leukemia (CML) patients with an improved 10 years’ survival rate approximately from 20% to 90%. So, Quality of life (QoL) is an aspect of CML disease management that is gaining prominence in recent years. In Patan Hospital also, an increased 10 years’ survival rate has been seen among CML patients receiving TKIs under Glivec International Patient Assistance Program (GIPAP). So, the aim of this study was to compare the QoL of CML patients under treatment in Patan Hospital with the apparently healthy population. Methods: This is a cross sectional comparative study done at Patan Academy of Health Sciences (PAHS) from October 2018 to September 2019. Short Form 36 (SF-36) questionnaire was used for QoL assessment. Ethical approval was obtained. Data analysis was done using epi info version 7.2.2. Results: Total of 192 participants was included in this study. (98 in each CML group and apparently healthy population). Mean age of the study population was 47.42 years with 33.67% being females. Physical QoL was significantly poor in CML patients. (p value 0.01) but no difference regarding mental QoL between two groups. Conclusions: Identification of symptom burdens of TKI therapies in routine practice is needed so as to lessen these burdens to effectively improve physical QoL in CML patients. Similarly, for improvement of mental QoL in younger patients (18-39 years’ age group), assessment of psychological impact of the disease and proper counseling in these patients is required.
Nurses’ Knowledge and Practice regarding Immediate Newborn Care in Maternity Ward of a Teaching Hospital
(Rapti Academy of Health Sciences (RAHS), 2024) Khatri, Binita; Maharjan, Ratna Kumari
Abstract: Introduction: A newborn is thought to be small, helpless, and entirely reliant on others for survival. During the first hour of life, newborns are primarily susceptible to morbidity and mortality, which can be avoided with prompt care immediately after birth. The newborn care that is provided immediately after delivery is straightforward but crucial. This aim of the study is finding out the nurses’ knowledge and practice regarding immediate newborn care. Methods: A cross-sectional research design was carried out among 32 nurses. Consecutive sampling technique was used. The self–administered questionnaire was utilized to assess knowledge and observation checklist for assessing practice on immediate newborn care. The data was edited, coded and entered into excel then exported to SPSS 16 program. Results: Findings revealed that 65.63 % nurses have average knowledge and 87.50 % nurses have average practice. Education, work experience and training were not significantly associated with the nurse’s knowledge and practice regarding immediate newborn care at 95 % confidence interval. However, there was positive correlation between knowledge and practice on immediate newborn care. Conclusion: The findings conclude that majority of the nurses have average knowledge and practice on immediate newborn care. Therefore, it is necessary to conduct continuing nursing education about immediate care to neonate for nurses in maternity ward periodically.
Knowledge and Attitude Regarding Gender Based Violence among Adolescents at Selected School of Ghorahi, Dang
(Rapti Academy of Health Sciences (RAHS), 2024) Poudel, Ambika Dhakal; Khatri, Binita; Belbase, Geeta; Dhital, Puja Sharma
Abstract: Introduction: Gender-based violence is an alarming social problem that affects people around the world, including adolescents. It comprises physical, sexual or mental impairment and threats of such acts which could happen either in public or private areas. The study finds out knowledge and attitudes regarding gender-based violence. Methods: A cross-sectional research design was used for the study. A total of 286 adolescents of 9th and 10th-grade students were selected by using a non-probability purposive sampling technique. A Self- admistered questionnaire was developed by the researchers based on a literature review. Descriptive and inferential statistics were used for data analysis. Results: Out of 286 respondents, more than half (55.6 %) had an inadequate level of knowledge regarding gender-based violence. Nearly half (49.3 %) had a favourable attitude towards gender-based violence. A minority of the respondents (20.6 %) felt at least one type of gender-based violence in their lifetime. About one-fifth (20.6 %) had unfavourable attitude There is a significant association between level of knowledge and type of family. However, there is no significant association between the level of knowledge and other socio-demographic variables. Conclusion: The study concluded that more than half respondents had a poor level of knowledge while half of the respondents had a favourable attitude towards gender-based violence. A minority of respondents had felt at least one type of gender-based violence in their lifetime.
Advancing Research Excellence: Announcing the Establishment of the Journal of Rapti Academy of Health Sciences
(Rapti Academy of Health Sciences (RAHS), 2024) Lamsal, Dinesh Kumar; Lamichhane, Basant; Bhandari, Hira Lal; Kandel, Ramesh
Abstract: It is with great pleasure that we present the first edition of the Journal of Rapti Academy of Health Sciences (JRAHS). As members of the editorial board, we are committed to advancing the research activities at Rapti Academy of Health Sciences. As Mark Twain aptly stated, “The secret of making progress is to get started,” the publication of this inaugural edition of JRAHS marks a significant step forward in the realm of research and scientific writing at RAHS. This milestone is the culmination of various progressive endeavors, including the publication of numerous souvenirs, the establishment of an Institutional Review Committee (IRC), and a series of training sessions and workshops. Today, we are delighted to present the first edition of JRAHS as a testament to our collective efforts in promoting research at RAHS. As the institution continues its steady academic growth with the commencement of undergraduate programs (MBBS, BNS, BSc Nursing Programs) and postgraduate programs (MD/MS), we believe this initiative will greatly encourage all of you to engage in and explore more scientific work and research. While we must always stay abreast of evidence-based practices, our scientific writings and research papers will serve as exemplary models of effective practices in resource-limited settings like ours. In this issue, we have included valuable articles from various disciplines, ranging from original research papers to intriguing case reports. We extend our heartfelt gratitude to all authors, reviewers, and editorial staff who have dedicated their expertise to ensuring the high quality of this journal. Thank you for your contribution and readership of JRAHS. We look forward to your feedback and contributions in future editions.
Nursing Consideration in Rhinocerebral Mucormycosis: A Case Report
(Nepal APF Hospital, 2025) Sharma, Pariksha; Rai, Hasina
Abstract: Introduction : Rhinocerebral mucormycosis is a rare but aggressive opportunistic fungal infection that predominantly affects immunocompromised individuals, particularly those with uncontrolled diabetes mellitus or undergoing immunosuppressive therapy. It demands urgent diagnosis and multidisciplinary management due to its rapid progression and high mortality rate. Case Presentation: This case report describes the clinical course of rhinocerebral mucormycosis in a patient with diabetic ketoacidosis (DKA), further complicated by post-herpetic neuralgia and lower motor neuron (LMN) facial palsy. The patient's deteriorating condition, development of secondary lesions suggesting disseminated infection, central nervous system involvement, and vascular compromise hindered the possibility of surgical debridement, ultimately resulting in respiratory failure and death. Nursing care played a pivotal role throughout, including the management of DKA using glucose-potassium-insulin (GKI) protocols, administration of Amphotericin B, detection of secondary lesions, pain management, monitoring vital parameters, and effective documentation and communication. Conclusion : The case highlights the crucial role of nurses in managing complex intensive care unit presentations, from early recognition of signs and symptoms to coordinating care, administering antifungal and supportive therapies, and providing psychosocial support to the patient and their family. Nursing competence in infection control, neurological assessment, and wound management is crucial for enhancing prognosis in high-risk cases.
Rocuronium-Induced Anaphylactic Shock during Elective Septoplasty: A Case Report Authors
(Nepal APF Hospital, 2025) Bajracharya, Nitendra Raj; Shrestha, Saurav; Dangol, Shova; Paudel, Rabi; Bishwokarma, Pushkar; Shrestha, Surendra Man
Abstract: Introduction : Perioperative anaphylaxis is a rare but potentially fatal complication during anesthesia. Among muscle relaxants, rocuronium is a leading cause of intraoperative anaphylaxis. Early recognition and prompt management are crucial to reduce morbidity and mortality. Case presentation: We report a 14-year-old female with a medical history of Hashimoto’s thyroiditis and dissociative disorder scheduled for elective septoplasty. Following induction with midazolam, fentanyl, propofol, rocuronium, and tracheal intubation, the patient developed severe hypotension, tachycardia, generalized rash, lip swelling, and increased airway pressure, suggestive of Grade III anaphylaxis suspected to be secondary to rocuronium. Immediate management with intravenous epinephrine boluses (300 mcg ×2), fluid resuscitation (2 Litres Normal Saline), hydrocortisone, ketamine, and initiation of an epinephrine infusion (0.1 mcg/kg/min) was done and surgery was postponed. The patient was transferred to the ICU for close monitoring. Epinephrine infusion was tapered off and trachea was extubated the next day, and discharged to the ward on the third day without neurological or respiratory sequelae. Conclusion: This case emphasizes on the importance of early recognition of rocuronium-induced anaphylaxis, rapid administration of epinephrine and aggressive supportive care. The incidence of such reactions remains low, but the high fatality rate necessitates preparedness during anesthesia.
Inhaled Isopropyl Alcohol and Intravenous Ondansetron for Post operative Nausea and Vomiting in Patients Undergoing Laparoscopic Surgery: A Cross-Sectional Study
(Nepal APF Hospital, 2025) Bohara, Chetan; Bhandari, Parshal; Giri, Kshitizma; Bimali, Aayush; Bajracharya, Prashanna
Abstract: Introduction: Post-operative nausea and vomiting (PONV) is frequently encountered in post operative care unit. Effective treatment is promptly warranted to decrease morbidity of patients. Female gender, nonsmoker, young age, laparoscopic gastrointestinal surgeries are major risk factors for PONV. Ondansetron is commonly used for its prevention and treatment. However, inhaled isopropyl alcohol (IPA) can also be used and recently been into practice. In this study we compared inhaled isopropyl alcohol and intravenous ondansetron for treatment of post operative nausea and vomiting after laparoscopic surgery among female patients. Methods: This study was carried out at Lumbini Medical College and Teaching Hospital and included 76 female patients, aged 18 to 60 years, classified as ASA I–II, who were scheduled for laparoscopic surgery. At time of preoperative evaluation, patients were divided into two groups i.e., Group I and Group O, each consisted 38 patients. Post surgery, patients who experienced PONV in the recovery room either received inhalation treatment with 70% isopropyl alcohol (IPA)-(Group I) or 4mg ondansetron intravenously (Group O). Nausea levels were monitored using a verbal numeric rating scale (VNRS) at regular time intervals. A treatment was considered successful if the patient’s nausea and vomiting score decreased by 50% or more Results: Among 76 patients, 29 (38.16%) developed PONV. Both groups had similar baseline characteristics and initial PONV severity with p-value > 0.05. The IPA group experienced faster symptom relief, achieving 50% reduction in symptoms in 4.69 ± 2.02 minutes compared to 7.73 ± 2.59 minutes in the ondansetron group (p = 0.001). Conclusions: Inhaling 70% isopropyl alcohol provided faster relief from postoperative nausea and vomiting.
Three Delays Model and its Determinants for Maternal Death: A Descriptive Cross- Sectional Study Authors
(Nepal APF Hospital, 2025) Joshi, Rijuta; Jaiswal, Ekta; Timalsina, Gyanu; Byanjankar, Sunita
Abstract: Background: Despite significant improvements in reducing maternal mortality in Nepal, preventable deaths persist due to gaps in timely care-seeking, access, and service delivery. The ‘Three Delays Model’ offers a framework to examine delays contributing to maternal mortality and guide targeted interventions. This study was done to analyze the types of delays and determinants contributing to these maternal deaths. Methods: A retrospective cohort study of maternal deaths was conducted Patan Hospital, Nepal, from July 2021 to July 2024. Data were extracted from hospital records and maternal mortality audit reports. The ‘Three Delays Model’ was applied to categorize barriers: delay 1-decision to seek care, delay 2-reaching care, and delay 3-receiving adequate care. Descriptive analysis was performed using Microsoft Excel. Results: This study identified 16 maternal deaths over three years, with highest mortality among primigravida women in late pregnancy and postpartum periods. Indirect causes were predominant than direct obstetric causes. Dealy in seeking health care was the predominant followed by the delay in receiving care. Discussion: The main determinants of the Delay 1 were poor health literacy, cultural norms, and institutional mistrust. Comparative evidence from Nepal and other low-resource settings highlighted overlapping delays and facility-level gaps that compounded the risk. In order to reduce preventable maternal deaths, culturally responsive health education, improved community engagement, and strengthened hospital facilities may be helpful. Conclusion: Maternal deaths in Nepal remain influenced by behavioral and systemic factors, with Delay 1 as the most prevalent underlying cause followed by Delay 3.

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