Journal Issue: Volume: 47, No. 1 (2025)
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Volume
Number
Issue Date
2025
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Trends in Cesarean Delivery at a Tertiary Care Hospital
(Institute of Medicine, Tribhuvan University, 2025) Ojha, Neebha; Khaniya, Bishal; Pun, Sunita; Bhansakarya, Rakina; Ghimire, Asmita; Sharma, Ashish
Abstract:
Introduction
Cesarean delivery is on the rise globally, and many government bodies and clinicians have expressed concern about the rising rate of cesarean delivery. The study aims to assess the trend in cesarean delivery rate and the type of cesarean delivery at five-year intervals during the study period.
Methods
This descriptive cross-sectional study was conducted at TU Teaching Hospital by a chart review of cesarean delivery (CD) during the years 2014, 2019, and 2024 AD. Basic data including age, parity, ethnicity, gestational age, and multiple pregnancy was obtained. The collected data were entered and analyzed in SPSS 26.
Results
The annual CD rate was 39.0 %, 52.7%, and 56.0% among the total livebirth delivery during the years 2014, 2019, and 2024, respectively. The proportion of primary CD increased from 2014 to 2019 but remained static in 2024 (31%, 41%, and 39.4%), however for repeat CD it increased steadily. Mothers undergoing CD in the age ≥35 years increased from 106 (6.1%) in 2014 to 241 (13.5%) in 2024 (8%, 11.7%, and 16.5%). The emergency CD were three times more common than elective CD in all the years interval. The most common indications for the primary and repeat CD werea fetal distress and refused trial of labor respectively.
Conclusions
This study showed increasing trend in the cesarean delivery rate. Primary CD constituted more than the repeat CD, however the rate of increase was more in the repeat than in the primary CD. It is important to reduce primary CD if we want to decrease the overall CD rate.
Impact of Thrombus Burden in Patients with Acute Coronary Syndrome during the Hospital Stay: A Cross-Sectional Study at a Tertiary Center in Nepal
(Institute of Medicine, Tribhuvan University, 2025) Bhusal, Khem Raj; Shrestha, Hemant; Devkota, Surya; Thapa, Sanjeev; Manandhar, Bhawani; Khanal, Raja Ram; Shakya, Smriti; Thapa, Shovit; Jha, Suchit; Miya, Madeena; Sah, Sangam; Upadhayaya, Prajjwal; Gajurel, Ratna Mani
Abstract:
Introduction
Acute coronary syndrome (ACS) is the leading cardiovascular (CV) cause of mortality and necessitates prompt diagnosis and treatment. Luminal thrombus secondary to coronary plaque rupture is considered as the underlying mechanism for ACS. Intracoronary thrombus burden was a strong predictor for adverse outcomes including stent thrombosis, myocardial re-infarction, and mortality.
Methods
This study was done in consecutively taken 72 patients presenting with acute coronary syndrome. Angiographic grading of intracoronary thrombus was done according to TIMI thrombus grading. Information on Cardiovascular risk factors and comorbidities was obtained and analysis was done with respect to Thrombus Grade. Adverse cardiovascular outcomes during hospital stay, length of hospital stay and in-hospital mortality were analyzed with respect to thrombus grade.
Results
Among 72 patients studied, the mean age was 58.93 (± 14.22 years) ranging from 30 years to 91 years. Males were 36.1% while 63.9% were females. Regarding the comorbidities, 62.5% were Hypertensive, 34.7% were Diabetic, 6.9% had hypothyroidism, 2.8% had chronic kidney disease and 5.6% had chronic obstructive pulmonary diseas, 38.9% were active smokers, 15.3% were former smokers, 34.7% were alcohol consumer, 5.6% were tobacco consumer and 1.4% were substance abuser. Among the participants, 6.9% had prior history of MI and 4.2% had prior history of stroke.
High thrombus burden was associated with longer duration of hospital stay (p-value=0.026).
Conclusion
High Thrombus burden was significantly associated with longer duration of hospital stay because of being sicker due to higher cardiovascular events in high thrombus group. Cardiovascular complications were significantly higher in high thrombus burden group.
Ultrasound versus Chest X-ray for Confirmation of Central Venous Catheter Tip Position: A comparative study
(Institute of Medicine, Tribhuvan University, 2025) Mandal, Lokendra Narayan; Bhattarai, Amit Sharma; Parajuli, Bashu Dev; Acharya, Subhash Prasad; Shrestha, Anil
Abstract:
Introduction
Malposition of central venous catheter (CVC) tip is common after central vein cannulation. Chest radiography is the standard method for confirmation, but ultrasound is gaining popularity for bedside localization, placement confirmation, and complication detection.
CVC insertion is frequently performed for various medical purposes. While both chest radiography and ultrasound are used to confirm tip position, ultrasound is radiation-free and faster. Real-time ultrasound during insertion reduces attemptsto catheterisation and complications like pneumothorax. However, radiographic confirmation remains the gold standard.
This study aimed to evaluate the accuracy and speed of ultrasound compared to chest X-ray for confirming CVC tip position.
Methods
A total of 109 patients (aged 15–65 years) who underwent CVC insertion via the right internal jugular vein were enrolled. Written informed consent was obtained from patients or family members. Sonographic confirmation was done using a bubble study, while chest X-ray was used for radiographic confirmation. Sensitivity, specificity, predictive values, interrater reliability, and percent agreement between the two methods were assessed. The mean confirmation times were also compared.
Results
Ultrasound showed 91.6% sensitivity, 96.91% specificity, 78.57% positive predictive value, and 98.95% negative predictive value. Interrater reliability (k = 0.82) and percent agreement (96.3%) were high. Ultrasound confirmed placement 88.29 minutes earlier than chest X-ray.
Conclusion
Ultrasound confirmation using a saline flush method is accurate and significantly faster than chest radiography for CVC tip verification.
Elevated Risk for Obstructive Sleep Apnea in Patients presenting for Surgeries at a Tertiary Hospital in Nepal: A STOP-BANG Questionnaire Study
(Institute of Medicine, Tribhuvan University, 2025) Shrestha, Ujma; Kunwar, Prakriti
Abstract:
Introduction: Obstructive sleep apnea (OSA) can lead to significant perioperative risks like difficult airway management, prolonged hospital stays and increased incidence of morbidity and mortality. We aimed to estimate the proportion of surgical patients with elevated risk for OSA during pre-anesthesia checkup at a tertiary hospital in Nepal.
Methods: This was a cross-sectional study which was conducted among 318 surgical patients presenting for Pre-anaesthetic checkup at PAC clinic. Two validated screening tools, the STOP-BANG questionnaire and Epworth Sleepiness Scale (ESS), were used. Data on demographics, comorbidities, and OSA risk factors were collected and analyzed. STOP-BANG score ≥3 was defined as elevated risk for OSA. Those patients who complained of daytime somnolence were further assessed for its severity with ESS. Statistical analysis was done with independent sample t-test, chi-square test and logistic regression.
Results: It was found that 23.58% of the participants had elevated risk for OSA (STOP-BANG >3). The risk was significantly associated with advancing age, males, obesity, increased neck circumference, hypertension, diabetes and hyperlipidemia. A weak but significant correlation was found between ESS and STOP-BANG scores (r=0.412, p=0.045).
Conclusions: Proportion of patients with elevated risk for OSA was high in our surgical population. Undiagnosed OSA can have various perioperative complications, hence, we should routinely screen patients using questionnaires like STOP-BANG.
Clinical and Endometrial Histopathological Profile of Women with Perimenopausal and Postmenopausal Bleeding
(Institute of Medicine, Tribhuvan University, 2025) Bhardwaj, Manisha; Bista, Kesang Diki; Ojha, Neebha; Khaniya, Bishal
Abstract:
Introduction:
Abnormal uterine bleeding (AUB) in perimenopausal and postmenopausal women is common and clinically important concern, as it may indicate anything from hormonal imbalance to serious pathologies like endometrial hyperplasia or carcinoma . The objective of this study was to assess clinical and endometrial histopathological characteristics in women with perimenopausal and postmenopausal bleeding in TUTH.
Methods:
This was a descriptive study carried out in the Department of Obstetrics and Gynecology at Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu from April 2018 to April 2019. All women > 40 years with abnormal uterine bleeding attending gynecology OPD were taken. Endometrial biopsy was done and histopathological examination findings were studied.
Results:
Among 328 women, 218 were with perimenopausal bleeding and those with postmenopausal bleeding were 110. The most frequent bleeding in ladies with perimenopausal bleeding was menorrhagia in 93(42.9%) and spotting accounting 68 (71%) in postmenopausal bleeding. Out of total 328 cases, 317(96.6%) had benign endometrial findings and 11 cases (3.4%) had malignant endometrial findings. The most frequent histopathological finding in women with perimenopausal bleeding was secretary endometrium. Among postmenopausal bleeding 110 (91%) were benign and 9( 8.2%) had malignant histopathology.
Conclusion:
The most frequent bleeding pattern in perimenopausal bleeding was menorrhagia and spotting in those with postmenopausal bleeding. Malignant histopathological was found more in postmenopausal bleeding than perimenopausal bleeding.