Journal Issue: Volume: 45, No. 2 (2023)
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2023
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
Epidemiology and Demographic Profile of Inflammatory Bowel Disease in Nepal
(Institute of Medicine, 2023) Ranjan, Mukesh K; Pathak, Rahul
ABSTRACT
Inflammatory bowel disease (IBD) is a chronic disease of the gastrointestinal tract. Once thought to be a disease of the developed nations, the burden of IBD has been rising in Asian countries. Inflammatory bowel disease leads to severe impairment in the quality of life of the patients. There have been numerous studies across the globe which have provided new insight into different aspects of this disease. Not only IBD is being diagnosed more but patients are also becoming more aware of this debilitating condition. It is encouraging to see a few studies from Nepal in the recent past. However, the epidemiological and demographic features of IBD remain largely unknown. Through this review, we aim to gain insight into the epidemiology and demographic features of patients with IBD in Nepal.
Keywords: Crohn’s disease; epidemiology; inflammatory bowel disease; ulcerative colitis
Temporal Trends, Socio-Economic Inequalities in Obesity and Responses by Federal Government, Nepal: A Systematic Review of Observational Studies, Policies, Strategies and Plans, 2005-2019
(Institute of Medicine, 2023) Bhurtyal, Ashok; Adhikari, Dushala
ABSTRACT
Introduction: Obesity has risen to epidemic proportions in low-income countries like Nepal, where maternal and child under-nutrition has reduced steadily. However, synthesised evidence on transition to obesity remains unavailable. We assessed trends and disparities in obesity occurrence, and examined central government’s policies and programmes.
Methods: We searched PubMed and Google Scholar for articles published between January 1, 2005 and April 10, 2019, and websites of Demographic and Health Survey, Non-Communicable Diseases Risk Factor Survey, and Micronutrient Status Survey. We synthesised obesity and overweight prevalence data from the selected studies, narratively; and disaggregated latest proportions from nation-wide surveys by gender, geographical location and household wealth quintile. We charted obesity related actions from policies, strategies and plans; obtained through the websites of health ministry and government’s planning commission.
Results: Twenty studies with data from 79,082 men and women aged 15 years or more and 11,866 children under five years, were included. Obesity or overweight among men and women increased from 20.0% in 2004 to 36.1% in 2016. Obesity alone rose from 5.3% to 7.5%. National average prevalence of childhood obesity or overweight remained very low. Overweight and obesity were more common among women, inhabitants of urban areas and central provinces, and the affluent. Governmental policies, strategies and plans on nutrition were primarily designed to control under-nutrition, with implications for preventing obesity.
Conclusion:Overweight and obesity increased substantially between 2005 and 2019, disproportionately affecting socio-economic and geographical groups. Governmental nutritional strategies should consider addressing obesogenic environments.
Keywords: Malnutrition; nutrition transition; obesity; obesity prevention; overweight
Need of Specialized Courses in Advance Nursing Education in Nepal
(Institute of Medicine, 2023) Rai, Lalita; KC, Takma; Adhikari, Raj D; Acharya, Devaka; Sharma, Muna; Gautam, Roshani; KC, Tulaza; Das, Indra K; Shrestha, Shristy
ABSTRACT
Introduction: Nursing specialization and certification of skill contribute nursing professionalism that improve nursing practice in an identified specific area within the entire field of professional nursing.
Methods: A descriptive cross sectional survey was used for assessing the need of specialized courses in advanced nursing. Data was collected from January to March 2022 through an online survey among 354 nurses working in Nepal. Collected data was entered into SPSS version 16 and expressed by using descriptive statistics.
Results: The findings showed that more than half (54.5%) of the participants were age group of 20-29, 99.4% were females, 50.3% had bachelor’s degree, 60.7% worked in government and 70.3% had working experience less than 10 years. Almost all (98.8%) felt importance of specialized courses in higher education and the needs of advanced courses (72.9%) and especially in critical care (53.1%) Almost all respondents (95.2 to 90.7%) perceived these courses increase self-esteem and morale, promote quality patient care, increase confidentiality and creditability, ensure competency, validate nurses’ knowledge and expertise, advancement of professional career ladder and clinical expert and increase professional accountability. Majority of them perceived (77.4%-57.6%) that specialty courses increase access to job-related power, obtain noticeable financial benefits and perform excellence services. Almost all (91.0%) of them perceived that it is beneficial to maintain professionalism.
Conclusion: This study concluded that almost all graduate nurses felt specialty courses in masters degree for personal and professional development. Thus it is strongly recommended to initiate different specialized courses at the postgraduate level.
Keywords: Advance nursing education; need; specialized courses
Caudal Dexmedetomidine versus Fentanyl with Bupivacaine in Decreasing Post-Operative Pain in Pediatric Inguinoscrotal Surgery : A Comparative Study
(Institute of Medicine, 2023) Gyawali, Nirman P; Shrestha, Reshma; Bhattarai, Krishna P; Malla, Sadikshya Shah
ABSTRACT
Introduction: Despite various advancements in postoperative analgesia in children, about half of post-surgical children still experience pain. Opioids like fentanyl are used as an adjunct leading to a lower dose of caudal local anesthetics but have many side effects. Administration of caudal dexmedetomidine with local anesthetics was shown to prolong postoperative analgesia and sedation in children. This study was conducted to compare the effects of caudally administered fentanyl and dexmedetomidine in children undergoing inguinoscrotal surgery.
Methods: This was a comparative clinical study in which 152 patients were included. Patients were divided into two groups to receive a caudal block, each having 76 cases. Group A and Group B received single-dose caudal analgesia using fentanyl (1mcg/kg) and dexmedetomidine (1mcg/kg) with 0.25% bupivacaine(0.75ml/kg), respectively. The analgesic effect of the caudal block was evaluated using the FLACC score and sedation using the RSS score. The statistical significance was evaluated using independent t test using confidence interval of 95% (p value<0.05).
Results: The study showed no statistical significance in the demographic and operative variables between the two groups. The duration of analgesia (p value<0.001) and both the FLACC (p value=0.001) and RSS score (p value=0.004) only at 30 min postoperative values were statistically significant between the groups. The only side effect that showed statistical significance was vomiting (p value=0.03) seen in fentanyl group.
Conclusion: Dexmedetomidine can thus be used safely in children along with bupivacaine in routine inguinoscrotal surgery with additional benefits of prolonged analgesia and decreased side effects.
Keywords: Bupivacaine; fentanyl; dexmedetomidine; postoperative analgesia
Perioperative Outcomes following Surgery of Brain Tumors: Assessment and Analysis of Risk Factors
(Institute of Medicine, 2023) Kafle, Prakash; Rufus, Phelix; Paudyal, Nabin; Joshi, Narendra P; Khanal, Babita; Jonathan, Edmond; Bhandari, Binod R; Sharma, Mohan R
ABSTRACT
Introduction: Cranial neurosurgery carries significant morbidity and mortality. Hence it is imperative to combine the latest available technological equipment with surgeon’s experience to prevent or reduce perioperative complications. It is also equally important to have a preoperative general assessment of the patient with functional status in particular to predict postoperative outcomes.
Methods: This is a prospective study consisting of 122 patients selected over a period of 5 years (March 2017-March 2022). The patient database was retrieved from the medical record department, Nobel Institute of Neurosciences, Nobel Medical College Teaching Hospital, Biratnagar, Nepal and the approval of Institutional review committee was obtained. Age, gender, tumor related factors (site, extent and size), preoperative Glasgow Coma Scale (GCS) score, Karnofsky Performance Status (KPS) score and Modified Rankin scale (mRS) grade and their correlation with patient’s perioperative outcome were assessed.
Results: Significant correlation was found between preoperative KPS score, mRS grade and patient’s perioperative outcome (low KPS score <70 and high mRS grade was associated with adverse outcomes). There was no positive correlation between age, gender and tumor related factors with outcomes.
Conclusion: Low KPS score <70 and a high Modified Rankin scale score were associated with adverse perioperative outcomes in patient’s undergoing elective craniotomy for brain tumor surgery.
Keywords: Brain tumor; preoperative KPS (Karnofsky performance status score); preoperative mRS (Modified Rankin scale score)