Journal Issue: Volume: 55, No. 207, Jul-Sep (2017)
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2017
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JNMA Print ISSN: 0028-2715; Online ISSN: 1815-672X
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Articles
Prevalence of alcohol consumption and knowledge about alcohol at Bhimtar, Sindhupalchowk
(Nepal Medical Association, 2017) Manandhar, Naresh; Shrestha, Marina Vaidya; Joshi, Sunil Kumar
Abstract
Introduction: Alcohol causes several health problems, economic and social consequences across the world. Nepal is a multicultural and multi-ethnic country with an ambivalent regarding alcohol use according to social, religious and cultural values. Alcohol use is very common and easily available everywhere in Nepal. Objective of study is to find the prevalence of alcohol consumption and knowledge of alcohol among people at Bhimtar.
Methods: A cross sectional study was conducted on a total of 369 households, age above 20 years of Bhimtar, Sindhupalchowk district on November 2016. 41 households were selected using cluste sampling from all nine wards of Bhimtar village development committee.
Results: The prevalence of alcohol consumption was 232 (62.9%) in which 144 (77.4%) of males and 88 (48.1%) of females. There was 3.3 times more chance of consuming alcohol in male than female. Majority 137 (37%) consumed Raksi followed by Jaand/Chhyang 115 (31.3% ) and mix 97 (26.4%) On knowledge of alcohol consumption, 280 (75.9 %) and 288 (78.0%) of current drinker opined that it would effects own health and on the family respectively. After drinking alcohol 118 (31.9%) felt it relieved tiredness followed by felt better 103 (28%) and reduced stress 70 (18.9%). It affects heart and damage liver said by 72 (19.4%) and 59 (16%) respectively. There were family conflict after drinking alcohol replied by 132 (35.8%). They have good knowledge about the affect of alcohol on pregnant women. Only 50 (13.5%) of respondent expressed that it can be given to pregnant women.
Conclusions: The prevalence of alcohol consumption was very high. There is markedly differed in alcohol consumption by sex. It is affecting their health and family. Consumption of alcohol is financial burden and makes conflict in the family, which will also make psychological affect on their children. There is significant difference in knowledge of harm on alcohol consumption by education status. It is essential to plan and develop a specific health education program among these at-risk populations for prevention of alcohol consumption.
Keywords: Current drinker; Economic burden; Ever drinker; Family conflict; Initiation.
Non-invasive predictors of gastro-oesophageal varices
(Nepal Medical Association, 2017) Bhattarai, Subash; Dewan, Khus Raj; Shrestha, Gaurav; Patowary, Bhanumati Saikia
Abstract
Introduction: The worldwide accepted tool for screening and monitoring gastro-oesophageal varices in patients with liver cirrhosis is upper gastrointestinal endoscopy. Endoscopy needs clinical expertise and has got its own procedure related complications. Repeated endoscopies may be expensive and patients tend to develop poor compliance. This study was undertaken to establish the role of noninvasive parameters in predicting gastro-esophageal varices.
Methods: Two hundred patients with clinical features, laboratory and sonological finding suggestive of cirrhosis of liver and endoscopic evidence of portal hypertension were included in th study. Blood parameters like serum albumin, international normalized ratio (INR), platelets count and ultrasonography assessments of portal vein diameter and spleen size were compared with presence of gastro-oesophageal varices.
Results: At cutoff point of 2.55g/dl, serum albumin had high specificity of 99% whereas platelets count <1,44,000/mm3 had 87.9% sensitivity for presence of oesophageal varices. Sensitivities of 92.72% and 94.5% while specificities of 90% and 75% were detected for presence of oesophageal varices when the cutoff values for portal vein diameter and spleen size were 12.25 mm and 13.9 cm respectively.
Conclusions: Measurements of serum albumin, platelets count, portal vein diameter and spleen size by ultrasonography can be recommended as a non-invasive predictor for gastro-oesophageal varices in cirrhosis of liver. All these non-invasive parameters could be useful to patients with liver cirrhosis with portal hypertension in predicting presence of varices as well as in long-term clinical monitoring and management.
Keywords: Cirrhosis of liver; Endoscopy; Gastro-oesophageal varices; Non-invasive predictors.
Incidence and outcome of ventilator associated pneumonia in ICU of a tertiary care hospital in Nepal.
(Nepal Medical Association, 2017) Mishra, Deebya Raj; Shah, Niharika; Shah, Dibya Singh
Abstract
Introduction: Ventilator associated pneumonia is an important intensive care unit acquired infection in mechanically ventilated patients. Early and correct diagnosis of Ventilator associated pneumonia is difficult but is an urgent challenge for an optimal antibiotic treatment.
Methods: A prospective observational study was conducted in Intensive Care Unit of a tertiary care hospital in Nepal. Consecutive patients were considered during the study period, who met the criteria were included for the study. Clinical Pulmonary Infection Score was used to diagnose Ventilator associated pneumonia.
Results: Among 60 patients ventilated for more than 48 hours, 25 (41.6%) developed ventilator associated pneumonia. The incidence was 25 VAPs per 100 ventilated patients or 26 VAPs per 1000 ventilator days during the period of study. Days on ventilator and duration in ICU were higher in the VAP group. There was a trend towards increasing mortality in the VAP group (P value=0.06).
Conclusions: There exists a high rate of VAP in our Intensive Care Unit. Targeted strategies aimed at reducing Ventilator associated pneumonia should be implemented to improve patient outcome and reduce length of Intensive Care Unit stay and costs.
Keywords: Clinical pulmonary infection score; Incidence; Ventilator associated pneumonia.
Gestational weight gain and its relation with birth weight of the newborn
(Nepal Medical Association, 2017) Thapa, Meena; Paneru, Rupa
Abstract
Introduction: Gestational weight gain is an important predictor of the health of the newborn. It is affected by body mass index of the women. This study was conducted to find out gestational weight gain according to Institute of Medicine 2009 recommendation and relationship of newborn birth weight to body mass index and gestational weight gain of the women.
Methods: It was cross sectional, hospital based study. The women, who attended at term pregnancy for delivery and having recorded first trimester body weight, were included in the study. Their body mass index was calculated and they were stratified into 4 groups according to body mass index. The gestational weight gain was calculated by subtracting first trimester body weight from body weight at the time of admission for delivery. All the women were followed till delivery. The newborn birth weight was taken immediately after delivery.
Results: A total of 227 women were enrolled in the study. More than half of the women had normal body mass index. There were 36% overweight and obese women. Mean gestational weight gain was 10.21 kg, and mean weight of the newborn was 3.05 kg. There were equal number of women who had adequate weight gain and less weight gain according to the recommendation. Excess weight gain was seen in 15% of women. Women of higher body mass index and women who had gain more weight during pregnancy had larger newborns.
Conclusions: Body mass index and gestational weight gain of the women were important predictors of birth weight of the newborn.
Prediction of difficult airway among patients requiring endotracheal intubation in a tertiary care hospital in Eastern Nepal
(Nepal Medical Association, 2017) Khatiwada, Sindhu; Bhattarai, Balkrishna; Pokharel, Krishna; Acharya, Roshan
Abstract
Introduction: Unanticipated difficult intubation is an undesirable situation. Various bedside screening tests are routinely performed for predicting difficult airway. Although considered a surrogate indicator, difficult laryngoscopy is not the exact measure of intubation difficulty. We aimed to determine the best screening test for predicting difficult laryngoscopy and the association between difficult laryngoscopic view and difficult intubation.
Methods: This prospective, observational study involved 314, ASA I/II adult patients requiring endotracheal intubation for various routine surgical procedures. Sternomental distance < 12 cm, thyromental distance < 6.5cm, inter-incisor distance < 3.5 cm, mandibular protrusion grade 3 and modified Mallampati class III/IV were the predictors of difficult laryngoscopy. Laryngoscopic view was defined as ‘difficult’ when the Cormack and Lehane grade was III/ IV. The sensitivity, specificity, positive and negative predictive values and accuracy of these predictors were compared to find out the best predictor. Requirement of >3 attempts for insertion of the tracheal tube was defined as ‘difficult intubation’. The association between difficult laryngoscopic view and difficult intubation was determined.
Results: The sensitivity of the modified Mallampati class for predicting difficult laryngoscopy was highest (83%). Twelve (3.8%) patients had grade III laryngoscopic view and none had a grade of IV. Intubation was difficult in seven (2.2%) patients. Majority of patients (4 of 7) with difficult intubation had difficult laryngoscopic view (p<0.001).
Conclusions: Modified Mallampati test was better for predicting difficult laryngoscopy compared to other bedside screeing tests. Difficult laryngoscopy could significantly predict difficult intubation in our patients.
Keywords: Airway evaluation; Difficult intubation; Difficult laryngoscopy; Modified Mallampati class; Nepalese patients; Sensitivity.