Vol 20 No 04 Issue 57 Oct-Dec, 2022

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Complications of Arterio-Venous Fistula in Patients Undergoing Haemodialysis
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Agrawaal, Krishna Kumar
Abstract Background: Vascular access is required for hemodialysis and arterio-venous fistula is the preferred access. Various guidelines have recommended monitoring and surveillance of arterio-venous fistula as the standard of care. This study looked into usefulness of clinical examination to detect complications of arterio-venous fistula. Methods: The study was conducted in the from February 2022 till September 2022 under Nephrology unit, Departement of Internal Medicine at Universal College of Medical Sciences. Ethical clearance was taken. Patients undergoing hemodialysis were enrolled in the study. After informed and written consent, clinical examination of arterio-venous fistula was done by look, listen and feel method. Data was collected as per the approved performa. Statistical analysis was done using Statistical Package for the Social Sciences software version 17. Results: Total enrolled study population was 73. Mean age of the study population was 47.45 years ± 14.60 years with a Male: Female ratio of 1.3:1. Complications were seen in a total of 33 patients with an overall rate of 45.2%. The mean duration of AVF creation was 32.68 ± 24.56 months. Most common complication of arterio-venous fistula was overall stenosis 18 (24.7%). Conclusions: There is a higher rate of complications of arterio-venous fistula. Monitoring and surveillance of arterio-venous fistula should be performed as a standard of care in every hemodialysis centre. Keywords: Arterio-venous fistula; complication; hemodialysis
Ultrasound Measurement of Fetal Kidney Length in Normal Pregnancy and its Correlation with Gestational Age
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Koirla, Sapana; Adhikari, Kapil; Devkota, Karun
Abstract Background: To establish a nomogram of fetal kidney length for a normal pregnancy from 20 to 41 weeks of gestational age. Methods: A prospective cross-sectional study was carried out in the Department of radio-diagnosis and imaging BPKIHS, Dharan. 400 kidneys of 200 fetuses between the gestational age 20 to 41 weeks were scanned. Renal measurement was performed by ultrasonography. Results: Analysis was performed on data obtained from 200 normal fetuses. Size charts for right, left and mean fetal kidney length with standard deviation were presented for each weeks of gestation from 20 weeks to 41 weeks. The difference in renal length between right and left side was statistically not significant.There was significant correlation between gestational age and fetal kidney length (r=0.947, p=0.001). Conclusions: Fetal kidney length can be used as an adjunct parameter for estimation of gestation age. Keywords: Fetal kidney; gestational age; ultrasound
Assessment of Thyroid Dysfunction During Different Trimester of Pregnancy
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Prajapati, Sunita; Prajapati, Gayatri; Shrestha, Vikram; Shrestha, Sujata
Abstract Background: Thyroid dysfunction is frequently seen in pregnant women and is associated with complications like miscarriage, gestational hypertension, placental abruption, pre mature delivery and fetal growth retardation and even causes impaired neuropsychological development of fetus. This study is carried out to assess the prevalence of thyroid disorder during different trimester of pregnancy. Methods: Serum samples were collected from 124 pregnant women attending Patan Academy of Health Science for ante natal visit. Free thyroxine free triiodothyronine and thyroid stimulating hormone were performed by chemiluminescent assay. Results: Out of 124 pregnant women, euthyroidism was seen in 79% (n =98) followed by subclinical hypothyroidism (10%, n=13) and primary hypothyroidism (8%, n=10). Subclinical hyperthyroidism and primary hyperthyroidism accounts for 1% (n=1), and 2% (n=2) respectively. Although, thyroid disorder was found to be more prevalent in third trimester (38.4%, n=10) but the distribution in first and second trimester (34.6%, n= 9, 27%, n= 7 respectively) were also significant. Mean fT3 and fT4 level were found to be negatively correlated with trimester (r=-0.19, p=0.027 and r=-0.29, p=0.001 respectively) whereas positive correlation of trimester was seen with TSH (r=0.08, p=0.35). Conclusions: Hypothyroidism is more common in pregnant women visiting tertiary care hospital. Different complication can be minimized if diagnosis is done early. Keywords: Hypothyroidism; pregnant; thyroid stimulating hormone; trimester, gestational week
Factors Associated with Intimate Partner Violence among Married Women
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Ghimire, Sailaja; Ghimire, Sushmita; Sagtani, Reshu Agrawal; Upadhyay, Shambhu Kumar
Abstract Background: Intimate partner violence refers to any behavior within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship. Various factors such as alcohol or substance abuse, history of violence in family, extra marital affair, educational status, socio-economic status, decision making power, and established gender role are linked with Intimate partner violence. This study aims to identify the prevalence of different forms of intimate partner violence and its associated factors among married women in Shankharapur municipality of Kathmandu District. Methods: A concurrent triangulation design was used. Quantitative data were collected from 602 married females while qualitative data was collected from 11 participants. Multivariate logistic regression was done using Stata MP13 version. Thematic analysis was done for qualitative data. Triangulation of both quantitative and qualitative findings waere done. Results: The prevalence of Intimate partner violence was found to be 22.1%. After logistic regression, it was found that women’s involvement in community groups had lower odds (AOR 0.67, 95%CI 0.6-0.7) of IPV as compared to those who were not involved in community groups. Additionally, findings from the qualitative study showed female being victims of different forms of violence. Conclusions: Still, Female are the sufferers of violence behind the closed doors and mitigation strategies should have to be adopted from different levels of government to control intimate partner violence. Keywords: Intimate partner violence; Kathmandu; mixed method; triangulation.
Perceived Communication Barriers by Caregivers of Psychiatric Patients
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Khatri, Sushila; Samson, Priscilla
Abstract Background: Caregivers have significant role in effective treatment and recovery during hospitalization. Communication barriers in health care lead to poor treatment outcome of patients and caregiver’s dissatisfaction. The aim of study was to find out perceived communication barriers by caregivers of psychiatric patients. Methods: A cross-sectional study was conducted among 120 caregivers of psychiatric patients admitted in psychiatric ward of Patan Hospital who were selected by purposive sampling and interviewed using self-developed structured questionnaire. Data was analyzed with SPSS version 16 using descriptive statistics and Chi- square test was used to find out association between personal characteristics of caregivers and extent of perceived communication barriers. Results: Low extent of communication barrier was perceived by 29.17%, great extent by 25.83%, moderate extent by 24.17% and no barriers were perceived by 20.83% caregivers. There was association between duration of hospital stay (p= .006) and extent of perceived communication barrier. Most barriers were due to caregiver’s related factors (31.2%) and least perceived barriers were due to environment related factors (17.1%). Conclusions: More than one fourth caregiver’s perceived low extent of communication barrier, almost one fourth perceived great extent and less than one fourth perceived moderate extent. There was association between duration of hospital stay and extent of perceived communication barrier. Effective communication may help to minimize perceived barriers resulting in better treatment outcome of patients and caregiver’s satisfaction. Most perceived barriers were due to caregiver’s related factors like feeling of not being educated, not knowing what to ask with health personnel, unaware of whom to approach and so on for which it is crucial to develop awareness among health personnel while delivering healthcare services. Nurses and doctors need to be effectively trained in communication skills to minimize various perceived barriers resulting in better treatment outcome and satisfaction. Keywords: Caregivers; communication barriers; therapeutic communication
Guillain Barre Syndrome after vaccination against Corona Virus Disease19: Managed in limited resource setting
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Kamar, Sher Bahadur; Bhatta, Uttam Kumar; Singh, Ratna; Timilsana, Manju Paudel
Abstract A 16-year-old boy who classically featured Guillain Barre Syndrome (GBS) after Corona Virus Disease-19 vaccination was timely treated successfully in limited resource setting in far western province. After Moderna (mRNA COVID 19 Vaccine) vaccination, he rapidly developed ascending paralysis of limbs without autonomic and sensory or cranial nerve involvement. He has been treated with Intravenous Immuno-Globulin (IVIG). Over six-weeks long observation and supportive care and he was discharged with full recovery. Many GBS cases after vaccination have been reported but yet to know the association of vaccine. It is very important to address the complication for successful vaccination programme. Keywords: Complication; COVID-19; guillain barre syndrome; vaccine
Computed Tomography Chest Findings in COVID-19 Patients
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Tamang, Ongden Yonjen; Paudel, Sharma; Kayastha, Prakash; Maharjan, Santosh; Adhikari, Govinda; Upadhyaya, Rudra Prasad; Dawadi, Kapil; Pradhan, Prajina; Rehman, Tanveer; Malla, Saurav Krishna
Abstract Background:COVID-19 which has caused significant morbidity and mortality around the world has been declared by the World Health Organization to be a global health emergency. Our objective was to find out the lung parenchymal patterns commonly evident in high resolution Computed Tomography in patients with COVID-19 pneumonia. Methods: A retrospective cross-sectional study was conducted at a tertiary multi-specialty hospital in Kathmandu, Nepal. With ethical clearance from the institutional review board, a total of 235 patients with positive reverse transcriptase polymerase chain reaction for COVID-19 and having respiratory symptoms were included in the study. High Resolution Computed Tomography images of chest were retrieved from picture archiving and communication systems retrospectively and studied for the findings commonly attributed to COVID-19 pneumonia. The data was then analyzed using Stata version 14 (Stata Corp, College Station, TX, USA). Descriptive statistics were presented as mean and median while chi-square test was used to assess the association between socio-demographic characteristics and CT severity indices. Results: Out of 235 patients, 174 (74.0%) were males and 61(26%) were females with a mean age of 54.8±14.5 years. The most commonly encountered pattern of pulmonary changes was bilateral involvement in 222 (94.5%) patients followed by ground-glass opacities in 218 (92.8%) patients and peripheral predominance of ground-glass opacities in 211 (89.8%) patients. Conclusions: Chest Computed Tomography abnormalities are common in COVID-19 positive patients with respiratory symptoms. These findings can guide in the assessment of the severity of the disease as well as patient management. Keywords: Computed Tomography; COVID-19; ground-glass opacities; reverse transcriptase polymerase chain reaction
Post-operative Pancreatitis as a Predictor of Postoperative Pancreatic Fistula in Patients Following Pancreaticoduodenectomy
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Subedi, Nirajan; Ghimire, Bikal; Kansakar, Prasan B S; Bhandari, Ramesh S; Lakhey, Paleswan J; Singh, Yogendra P
Abstract Background: Postoperative pancreatic fistula remains the single most important determinant of morbidity and mortality following pancreaticoduodenectomy. A new entity was proposed by Saxon Connor “Post-Operative pancreatitis”, which is defined by raised serum amylase more than the upper limit of institutional serum amylase value on Post-Operative day 0 or 1. There has been shown to be an association between postoperative pancreatitis and postoperative pancreatic fistula. We have conducted this study to see the incidence of postoperative pancreatitis and its association with postoperative pancreatic fistula. Methods: This was a prospective observational study. All patients undergoing pancreaticoduodenectomy at a tertiary care center for one and a half years were included. A cut-off value of serum amylase 80U/L was used to make a diagnosis of postoperative pancreatitis. The patients were followed up for one month. Pancreas specific complications were defined according to the definition given by the International Study Group of Pancreatic Surgery. Results: A total of 49 pancreaticoduodenectomies were done in the given period. The incidence of postoperative pancreatitis was 31(63.3%) and postoperative pancreatic fistula was 19(38.8%). Postoperative pancreatic fistula was seen in 19(61.2%) of patients having postoperative pancreatitis (P<0.001). Post-operative pancreatitis was also significantly associated with post pancreatectomy hemorrhage, increased hospital stay, and mortality. In multivariate analysis, preoperative endoscopic biliary drainage and increased serum amylase on the first postoperative day came out to be an independent predictor of postoperative pancreatic fistula. Conclusions: Post-operative Pancreatitis was associated with an increased incidence of Post-operative pancreatic fistula and other postoperative complications like Post pancreatectomy hemorrhage and mortality. Keywords: Pancreaticoduodenectomy; postoperative pancreatitis; postoperative pancreatic fistula; post pancreatectomy haemorrhage
Induced Abortion: A Risk Factor for Adenomyosis
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Pun, Sunita
Abstract Background: Abortion, the medical and surgical termination of a pregnancy,is becoming a more common medical procedure among women in Nepal. Adenomyosis is one of the common gynecological problems among women of reproductive age. However, little is known about the relationship between abortion and adenomyosis. Therefore, our study aims to explorerisk factor for adenomyosis in among women who havehadabortions. Methods: A comparative study was carried out among women who visited at thedepartment of Obstetrics and Gynecologyof the Tribhuvan University of Teaching Hospital, Kathmandu, between 13th April 2016 to 14th July 2017. Adenomyosis were confirmed through histological examination after hysterectomy. Data wereanalyzed by using Statistical Package for Social Sciences (SPSS software)21.0 version. Odd ratio with their 95% confidence interval and P-value were calculated and analyzed. A P-value equal or below 0.05 was considered as statistically significant. Results: Of the total 255 women, 85were confirmed adenomyosisby histological examination. Of the 85 cases, 39% (33/85) had a history of abortion, while only 25 % (44/170)women had abortion among non-adenomyosis group. Overall, women who had abortion were1.8 timesmore likely to have adenomyosis (95% CI 1.04- 3.17, P value=0.03) compared to women who had no history of abortion. Women with surgical abortions were 2.5 times more likely to develop adenomyosis (95% CI- 1.03- 6.21, P value=0.03) compared towomen with no abortion history. Conclusions: This study found that women,who had abortions,aremore likely to have been diagnosed with adenomyosis compared to women without abortions.Further studies, however, need to be carried out in order toextend findings of this study. Keywords: Abortion; adenomyosis; risk factors
Effect of Group Psycho-Educational Interventions on Child birth fear and Child birth Self-efficacy among Primiparous women
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Bista, Archana Pandey; Shrama, Chandrakala; Shrestha, Uma; Timalsina, Punjita; Devkota, Kavita; Piya, Kalpana; Neupane, Beena
Abstract Background: Child birth related fear and low self-efficacy for child birth found common among primiparous women. Antenatal group psycho-educational interventions have been used as important strategies to address child birth fear and self-efficacy. Thus, this study aimed to find out the status of child birth fear among antenatal women and effect of group psycho-educational interventions among primiparous women. Methods:One group pretest-posttest design was adopted. Total 307 primigravida women attending antenatal outpatient department of two hospitals within Kathmandu valley were selected through purposive sampling technique. Data was collected from March to July 2020. Child birth fear was assessed by using validated tool i.e.Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and Child birth self-efficacy was assessed by using childbirth self- efficacy tool. Primigravida women with moderate level of child-birth fear, were intervened for group psycho-education based on PRIME Model by nurses who were research team members. Paired t-test was used to compare differences in mean scores on child birth fear and child birth self-efficacy before and after intervention. Results: Moderate level of child birth fear was found among 24.8% of participants. Low child-birth self-efficacy was found among 42.0% participants. The overall mean score before providing group psycho-educational interventions to experimental group on child-birth fear was 54.0±2.09 and on child birth self-efficacy was 78.0±28.64 with p<0.001 and after providing group psycho-educational interventions child-birth fear was reduced to 47.8±2.44 and child birth self-efficacy was 105.2±19.6 with p<0.001. Conclusions: Group psycho-educational interventions based on PRIME approach led by nurses have significant effects in reducing child-birth fear and increasing child-birth self-efficacy. Therefore, provision of group psycho-educational interventions along with routine antenatal service need to be considered in clinical settings in Nepalese context. Keywords: Child birth fear; child birth self-efficacy; primiparous women
Awareness of Breast Self-Examination among Female Community Health Volunteers of Pokhara
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Koirala, Dipti; Silwal, Muna; Pokhrel, Sushila; Adhikari, Ramesh
Abstract Background: Breast self-examination is a simple, inexpensive and effective method of examining the breast by woman herself after 20 years of age in order to detect a breast lump in the early stage. Women should have this knowledge for early detection and treatment of breast cancer. So, the present study aimed to assess awareness of female community health volunteers regarding breast self-examination and the effect of a teaching program. Methods: One group pre-test post-test study was conducted among 145 female community health volunteers selected from eight wards of Pokhara Metropolitan using convenient sampling technique. Data was collected using a self-administered questionnaire from 27 March to 23 April 2022. Descriptive and inferential statistics were used for data analysis. Results: Before intervention, around two third of respondents (67.6%) had inadequate and only 1.4% had adequate level of awareness. But after the intervention, 68.3% had adequate level of awareness. The post-test mean awareness score (23.87 ± 4.7) was higher than pre-test mean awareness score (12.97 ± 3.93). Test of significance revealed that increment in the awareness due to a structured teaching program was highly significant (p <0 .001). This study also found that there was difference in the mean pretest awareness score according to educational level of the respondents only. Based on the mean score, the score was significantly higher among women with higher level of education (p=<.001). Conclusions: Around two thirds of female community health volunteers have inadequate level of awareness regarding breast self-examination before the intervention. Educational intervention program was found to be effective in improving their awareness. Keywords: Awareness; breast; self-examination
Trends in Surgical Management of Esophageal Cancer
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Thakur, Binay; Devkota, Mukti; Thapa, Asha
Abstract Background: Management of esophageal cancer has changed to a combined modality approach over the past two decades due to poor outcome. Recently, multimodal treatment has become the standard practice. The aim of this study was to evaluate the changing trends in management and outcomes of esophagectomy over 15 years from a single center in Nepal. Methods: Patients with squamous cell carcinoma and adenocarcinoma of esophagus/ gastroesophageal junction who underwent surgery between 2001-2018 were analyzed. Patients were grouped into three successive 5-year periods. Results: 547 patients underwent esophagectomy during 2001-2018. There was increased trend of neoadjuvant treatment from 9-13% to 52% (p<.001) and minimally invasive surgery (MIS) from 0% to 80% (p<.001). 30-day mortality decreased from 8% to 1% (p=.01). The 5-overall survival was 24% which increased from 17% to 27% (p=.003). Conclusions: Long term outcome has improved over last 15 years with decreasing mortality which appears to be due to incorporation of MIS and neoadjuvant treatment. Keywords: Esophagectomy; esophageal cancer; multimodality therapy
Factors Associated with Utilization of Postnatal Care Services
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Thapa, Suraj; Choudhary, Pradeep; Adhikari, Rita; Thapa, Kanchan
Abstract Background: Preventable causes of death accounts for 810 women per day. Care provided during the child-bearing and after the childbirth is of vital importance. Despite of the facts, many women in developing world deprive of this service. Therefore, this study aims to explore the contributing factors for Postnatal care service in urban areas of Chitwan, Nepal. Methods: A cross-sectional study was conducted among 212 mothers who delivered within last one year. Data collection was conducted through pre-tested questionnaire in Nepali language after taking ethical approval and informed consent. Descriptive and bi-variate statistics were applied in analysis. Results: Higher number of mothers (39.2%) were in 25-29 years age groups. Hindu were 89.6% and Janajati were 70.7%. Mothers (26.4%) reported to reach nearest health facilities on foot by 30 minutes or more. Nearest health facility had twenty-four hours seven days a week maternal health services for 57.5% of mothers. Antenatal visitors were 83.9% and 96.7% reported institutional delivery. About 27.8% mothers were aware about Postnatal care; 48.1% were aware about maternal complications; 98.1% mothers had at least one PNC visit; and 34.4% reported Postnatal care visit as per protocol. Lack of counseling (52.6%) was one of the main reasons for not completing Postnatal care. Age factor, husband’s education, health service-related variables, availability of essential drugs and equipment in health facilities influenced Postnatal care. Conclusions: Fewer mothers reported about complete Postnatal care service. Socio-economic factors, health service-related factors, experience of mothers on their previous childbirth also contributed to complete Postnatal care. Keywords: Health services; maternal and child health; Nepal; postnatal care
Dyslipidemia and Thyroid Dysfunction Associated with Psoriasis
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Rizal, Shikha; Joshi, Bishal Raj; Jha, Sanjay Kumar; Pradhan, Manish; Regmi, Sunil
Abstract Background: Psoriasis is a T-cell mediated inflammatory skin disorder which causes considerable psychosocial disability resulting in major impact on patient’s quality of life. The dominant response of Th1 cells and the high expression of related inflammatory factors appears in both psoriasis and thyroid dysfunction. Psoriasis can lead to increased risk of incidence of cardiovascular events for which dyslipidemia is an important risk factor. This study aims to evaluate thyroid function and lipid profile and its association in patients with psoriasis. Methods: This was a prospective case-control study conducted at the Department of Biochemistry, Nobel Medical College Teaching Hospital from November 2021 to October 2022. Seventy six clinically diagnosed psoriatic patients were taken as case and eighty non-psoriatic patients coming for other skin lesions were included in the study as control. Thyroid function test (serum free T3, T4, TSH) and lipid profile (total cholesterol, low density lipoprotein, high density lipoprotein and triglyceride) were done. Results: Hypothyroidism was most common thyroid abnormalities in our study population which was 13.15% (n=10). The lipid profile parameters were significantly higher in the psoriatic patients than in the controls (p<0.001). The odds of psoriatic patient having thyroid dysfunction was 2.8 times higher compared to other non-psoriatic patients and the odds of psoriatic patient having dyslipidemia was 8.7 times higher compared to other non-psoriatic patients. Conclusions: It is thus useful to assess thyroid function test and lipid profile in patients with psoriasis considering their role in etiopathogenesis and co-morbidity of psoriasis. Keywords: Co-morbidity; dyslipidemia; thyroid dysfunction
Burden of Care among Mothers Having Children with Down Syndrome
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Mishra, Tulashi Adhikari; Pandey, Kabita; Bhujel, Bishnu; Adhikari, Shova
Abstract Background: Down syndrome is the most common chromosomal disorder associated with mental retardation. Parents who are the primary caregivers of a child with a disability face numerous challenges in their day-to-day life. The objective of the study was to find out the burden of care among mothers having children with down syndrome. Methods: A descriptive cross-sectional study was carried out among 96 mothers having down syndrome children enrolled in the Down Syndrome Society, Nepal. Purposive Sampling technique was adopted for data collection. The Modified Caregiver Strain Index tool was used to collect data through interview. Data were collected from June 14, 2021 to August 1, 2021, which was analyzed by using descriptive and inferential statistics. Results: Findings revealed that majority of the mothers (77.1%) had high level of burden of care. Majority (89.6%) of the mothers involved in the study were always overwhelmed about their child’s conditions. More than half (55.2%) of the mothers were always financially strained in care giving, 57.3% had always done work adjustments and 60.4% of mothers always had emotional adjustments to be made. Similarly, 53.1% participants always felt that care giving was a physical strain. Burden of care was significantly associated with the age of delivery (p value= 0.008). Conclusions: The study concludes that mothers having children with down syndrome tend to have high level of burden of care and it is associated with the age at delivery. Therefore, health care providers including concerned authority are recommended to conduct different programs to support the caregivers in order to reduce their burden as well as to raise awareness program related to preventive measures of down syndrome in community. Keywords: Burden of care; down syndrome; mothers
Prescribing Pattern of Antibiotics among Hospitalized Patients with Urinary Tract Infection
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Shrestha, Deepti; Sapkota, Jyotshna; Poudel, Rekha; Gurung, Rashmi Shakya; Aryal, Kiran
Abstract Background: Urinary tract infection is one of the most common bacterial infections worldwide. It has become one of the most common cause for the hospitalization and sepsis. It is generally treated with antimicrobial agents and fluids. This study was conducted to study the prescribing pattern of antibiotic among hospitalized patients with urinary tract infection. Methods: A descriptive cross-sectional study was conducted in Nepal Medical College Teaching Hospital, Attarkhel, Kathmandu from January 2022 to April 2022. Patients aged 18 years or above of both sex, admitted to various departments with the provisional diagnosis of urinary tract infection prescribed with antibiotics were included in the study. Results: Out of 146 patients admitted with a diagnosis of urinary tract infection, the most commonly prescribed antibiotics during hospital stay were cephalosporin in 102 (69.9%) patients followed by combination of penicillin and beta-lactamase inhibitors (31, 21.2%) and fluoroquinolones (15, 10.3%). Ceftriaxone (78, 53.4%) alone was the most commonly prescribed antibiotic as empirical therapy followed by combination of piperacillin and tazobactam (22, 15.1%). One hundred and forty four (78.6%) patients were prescribed antibiotics from the watch group followed by the access group (21, 11.5 %). E. coli was the most common organism isolated in 29 (76.3%) patients. Conclusions: Cephalosporin was the commonest antibiotic group prescribed in hospitalized patients among which ceftriaxone was commonly prescribed as an empirical therapy. Among AWaRe classification, antibiotics from the watch group were commonly prescribed. Keywords: Antibiotics; ceftriaxone; urinary tract infection
Ultrasound versus Nerve Stimulator Guided Obturator Nerve Block in Patients Undergoing Transurethral Resection of Bladder Tumor
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Baral, Bidur Kumar; Poudel, Puspa Raj; Rajbhandari, Mona; Karki, Anuj Jung; Dhakal, Gaurav Raj
Abstract Background: Urinary bladder cancer is more common in geriatric population. Transurethral resection of bladder tumor remains the mainstay of treatment. It is usually performed under subarachnoid block. However, obturator nerve is spared in subarachnoid block that can produce adductor jerk, which is associated with bladder injury, rupture, incomplete resection of tumor and hematoma. To overcome this jerk, selective obturator nerve block is commonly performed. Thus, we conducted this study to compare the efficacy of ultrasound and nerve stimulator-guided techniques for obturator nerve block. Methods: This is a prospective, comparative study conducted at a tertiary care hospital in Nepal. Sixty patients, scheduled to undergo Transurethral Resection of Bladder Tumor for lateral and posterolateral wall bladder cancer under subarachnoid block were enrolled and divided into two group having thirty patients in each groups. Group I received 15 ml of 0.25% Bupivacaine to block obturator nerve by using peripheral nerve stimulator. Group II received the same amount of Bupivacaine to block obturator nerve under ultrasound guidance. We evaluated the success of the block, ease of the procedure and complications. Results: The adductor reflex was present in 23.33% of cases with nerve stimulator guided obturator nerve block, whereas, it was16.66% in ultrasound guided technique (p=0.75). The success rate of obturator nerve block was 76.66% in nerve stimulator guided technique, whereas 83.33% in ultrasound guided technique (p= 0.21). 83.33% of obturator nerve block was found to be easy in nerve stimulator guided technique, whereas 66.66 % in ultrasound guided technique (p = 0.14). There were no major complications noted. Conclusions: The findings of this study conclude that both ultrasound and nerve stimulator guided techniques equally abolished the adductor reflexes. Both techniques are easy to perform and safe. Keywords: Bladder tumor, obturator nerve block, adductor reflex
Genodermatoses Picture: Difficulties Faced And Way Forward in Nepal
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Parajuli, Niraj; Baskota, Rabindra; Jain, Ritu
Abstract Genodermatoses are group of genetic disorders that present with cutaneous manifestations. The exact prevalence on many of these conditions are unknown due to its rarity, need of specialized tests for diagnosis and lack of proper reporting system. Most of the patients are faced with life-long disability and associated stigma. There is a need for specialized centers for proper diagnosis of these conditions and a very elaborated yet simple reporting system in Nepal. These rare conditions should be kept in priority by the government in align with the sustainable development goals to ensure healthy-lives and promote well-being for all. A wider engagement of patient-led support groups might be useful in providing necessary information on the disease to the general population and alleviate the stigma associated with these diseases. Keywords: Epidermolysis bullosa; genodermatoses; rare diseases; Nepal
Detection of blaoxa-23 Gene from Carbapenem-resistant Acinetobacter Baumannii
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Neupane, Laxmi; Sah, Anil Kumar; Rayamajhee, Binod; Pokhrel, Anil; Singh, Anjana
Abstract Background: Antibiotic resistance is a great concern for public health and Acinetobacter baumannii-associated infections are increasing in many parts of the world, including Nepal. However, limited data is available on the prevalence of A. baumannii harboring blaOXA-23 from Nepal. Methods: A hospital-based cross-sectional study was designed to detect the blaOXA-23 gene from carbapenem-resistant A. baumannii isolates in Nepal. A total of 380 clinical specimens were collected and processed following standard microbiological procedures. Antibiotic susceptibility test was performed as per the protocol of the Kirby-Bauer disk diffusion technique and the CLSI guidelines, while screening of carbapenemase production was assessed by the Modified Hodge Test using meropenem (10µg) disc. The presence of the blaOXA-23 gene in carbapenemase-positive A. baumannii was confirmed by PCR. Results: Among 380 specimens analyzed, 210 (55.3%) samples were positive for bacterial growth, where 33(15.7% of total growth) of the isolates were A. baumannii, and most of them were isolated from the ICU patients (20/33, 60.6%) and sputum (16/33, 48.5%). Thirty-two isolates (97%) were colistin sensitive, while only four (12.1%) isolates were sensitive to meropenem and imipenem. Twenty-three (69.7%) of A. baumannii were carbapenemase positive as revealed by the Modified Hodge Test test, and 19 of them (57.6% of total A. baumannii) harbored the blaOXA-23 gene. Conclusions: A high prevalence of the blaOXA-23 gene among carbapenem-resistant A. baumannii isolates were found. Systematic network surveillance should be established to check the spread of such isolates, especially in the intensive care units of tertiary care hospitals in Nepal. Keywords: Acinetobacter baumannii; antibiotic-resistant; blaOXA-23; carbapenemase; Nepal
Genotype-Phenotype Profile of Beta-thalassemia
(Government of Nepal; Nepal Health Research Council; Ramshah Path, Kathmandu, Nepal, 2022) Roma, Km; Pande, Rajan; Shrestha, Durga Laxmi
Abstract Background: Beta thalassemias are extremely heterogenous hereditary monogenic blood disorders and preventable genetic hemolytic anemia caused by >200 mutations in HBB gene. In Nepal, it is more prevalent in Tharu tribe but it seen in other communities as well. Out of more than 200 mutations of beta globin gene, approximate 20 different alleles are responsible for >80% of the mutations. Mutations vary in different geographic population and are responsible for manifestation of different phenotypes. This study was done to find common mutations of HBB gene in Nepal which were responsible for different phenotypic manifestations and to know clinical severity according to the mutations. Methods: This was a descriptive, cross sectional study conducted in the pediatric and medicine department of Nepalgunj Medical College and Bheri Zonal Hospital, Nepalgunj from January 2020 to December 2020. The genotype and phenotype profiles of thalassemia cases were reported. The data was analyzed by SPSS 20. Results: The results obtained showed that clinical presentation differed with different β-globin gene mutations present. Individuals with HBB:c.47G>A and HBB:c.20A>T/ c.79G>A mutations showed milder presentation than those with HBB:c.47G>A/-619del and HBB:c.20A>T/c.47G>A. Conclusions: Therefore, these findings can be used to predict clinical severity so that we can take appropriate measures by early genotype identification for prenatal diagnosis of beta thalassemia. Keywords: Genotype phenotype; prenatal diagnosis; thalassemia

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