Journal of Nepal Health Research Council最新文献

Background: Surgical site infections (SSIs) are classified as superficial, deep and organ incisions. This study was conducted to determine the prevalence of anaerobic bacteria in SSIs in Nepal.

Methods: Total 641 patients were recruited from general surgery, orthopaedics, obstetrics and gynaecology units from October 2020 to December 2022. Surgical wound specimens from suspected SSIs were collected and processed for anaerobic culture for bacterial isolation from pus, fluids and tissues with the help of conventional and rapid methods. The odds ratio for logistic regression for categorical variables was used to determine the significance of association of host risk factors with blood parameters. The antimicrobial resistance of anaerobic bacteria was observed by agar dilution method.

Results: The overall rate of SSIs was 311 (48.52%) where only anaerobic SSIs was 61 (9.52%). The anaerobic bacterial isolates from pus 43 (70.5%), fluid 14 (22.9%), tissues 4 (6.55%) from postoperative wounds accordingly. Infection rate in elective surgery cases were higher 38 (62.3%) than in the emergency surgery cases 23 (37.2%). Comorbidities and site of infections were significantly associated (p< 0.05) with anaerobic culture positive SSIs. Predominant isolates were Bacteroides fragilis 19 (31.15%), Bacteroides thetaiotamicron 12 (19.67%), Clostridium perfringens 12 (19.67%) followed by Peptoniphilus asaccharolyticus and Peptoniphilus anaerobius 5 (8.20%) each. Clostridium sporogens, Prevotella melaninogenica, Porphyromonas gingivalis and Propionibacterium isolates were 2 (3.28%) each. Metronidazole resistance was seen the highest numbers 33 (54.09%) of the isolates.

Conclusions: Susceptibility test is essential for proper prescription of antibiotics for anaerobic bacterial infections highlighting the urgent need to revise antibiotic regimens to improve the treatment of SSIs.

Background: The occurrence and fear of adverse events during blood donation is one major deterrent for new and old donors. Mostly, adverse events are regarded as symptoms in donors and clinical monitoring of donors is not usually practiced.

Methods: The general characteristics, past donation experiences, and measurements of heart rate and blood pressures were recorded in voluntary blood donors in the settings of blood donation camps organized in communities and hospital blood banks. Adverse events were recorded as subjective experiences and clinically detected presyncope or syncope.

Results: A total of 1150 donors participated in the study (79.2% males, 73% between 21 to 40 years, 62.4% overweight or obese); 9% experienced adverse effects and 4.8% had clinical presyncope and/or syncope. Among 693 repeat donors, 2.9% had experienced adverse events in past donation. Adverse events symptoms were more common in young, females, donors with previous adverse experience, long hours without meal, and in blood camps (p values <0.05). Less sleep hours, number of past donations, and amount of blood removed did not cause significant differences in the rate of adverse events. Subjective and clinical adverse effects were not significantly correlated.

Conclusions: Rate of adverse reactions is high in Nepalese blood donors. Young, female, and fasting donors should be closely monitored, especially in blood camps outside designated centers.

Background: Bicipital groove, the narrow sulcus present between the greater and lesser tubercles of proximal humerus, is an important anatomic landmark during prosthetic replacement of humeral head. Bicipital groove variations are associated with diseases of biceps tendon causing painful shoulder. The study aims to outline the morphometry of bicipital groove and create some baseline data which may be useful in arthroplasties and interpretation of radiologic anatomy of the shoulder.

Methods: A quantitative cross-sectional observational study was conducted on 100 dry humerus bones from convenience sampling of dry bones available at the Department of Anatomy, Maharajgunj Medical Campus. The length of bone was measured with osteometric board. Side of bone was determined. The length, width and depth of bicipital groove was measured with Vernier calipers. Data was analyzed in SPSS version 17 and frequencies, descriptive statistics were calculated along with bivariate analysis using independent samples T-test and Pearson's correlation.

Results: Out of the total 100 humeri studied, the mean length was 296.7 mm (22.04 SD). Mean length, width and depth of bicipital groove were 69.6 mm (6.6 SD), 6.34 mm (1.64 SD), and 5.75 mm(1.5 SD) respectively. The length and width of bicipital groove were positively correlated with length of bone.

Conclusions: The study investigated the morphometry of bicipital groove and its relation with length of humerus. The findings will have potential implications in clinical and surgical practice including shoulder prosthesis and arthroplasty.

Background: Homocysteine (Hcy) contributes to oxidative stress and renal injury by generating reactive oxygen species and reducing heme oxygenase-1 levels. Elevated Hcy (Hhcy) may worsen outcomes after acute renal failure(ARF), promoting fibrosis and progression to chronic kidney disease (CKD). This study investigates the association between Hcy levels and ARF in patients at Tribhuvan University Teaching Hospital.

Methods: This study was an analytical cross sectional single center study that was carried out in Tribhuvan University Teaching Hospital. Specimens were processed as per the guidelines of Standard Operating Procedure (SOP) of Biochemistry laboratory of Tribhuvan University Teaching Hospital.

Results: Participants had a mean age of 54.2 years. Mean homocysteine was (13.7±10.36) µmol/L and creatinine was (148.7±18.03) µmol/L. Homocysteine levels showed no significant association with age, sex, residence, or disease type. A weak but significant positive correlation was found between homocysteine and creatinine(r = 0.186, p = 0.029). Potassium correlated moderately with creatinine (r = 0.383, p< 0.001).

Conclusions: Homocysteine levels showed no significant association with age, gender, residence, or comorbid conditions. A weak but significant correlation was observed between homocysteine and creatinine, suggesting a potential link with renal function.

Background: Unstable peritrochanteric fractures are a major challenge in orthopedic trauma, with high morbidity and mortality, especially among the elderly. Their incidence is rising in Nepal due to an aging population. The Proximal Femoral Nail (PFN) provides stable fixation for these fractures, but data on functional outcomes in resource-limited settings are limited. This prospective study evaluated Harris Hip Score outcomes in patients treated with PFN at a tertiary care center in Nepal.

Methods:  A prospective interventional study was conducted at Karnali Academy of Health Sciences from November 2021 to May 2025. Forty-seven patients with unstable AO/OTA 31-A2 and 31-A3 fractures were treated with PFN and followed for 18 months. The primary outcome was functional recovery measured using the Harris Hip Score (HHS) at scheduled intervals. Statistical analysis was performed using repeated measures ANOVA to assess changes over time and identify predictors of outcome.

Results:  The mean age of patients was 69.45 ± 11.17 years, with a male predominance (53.2%). The mean HHS improved significantly from 30.57 ± 5.10 at 1 month to 73.30 ± 25.97 at 18 months (Wilks' Lambda = 0.636, F = 7.98, p = 0.003). Age and operative time were significant predictors of functional outcome (Age: F=13.02, p=0.001; Operative time: F=11.42, p=0.002). The overall complication rate was 36.1%, with varus collapse observed in 19.1% of patients and screw cutout in 17.0%; however, the presence of these complications did not significantly impact the final functional recovery (p > 0.05).

Conclusions:  PFN fixation effectively treats unstable peritrochanteric fractures in Nepali patients, showing sustained 18-month improvement, especially for younger patients with shorter operative times, proving successful even in resource-limited settings.

Background: Proper knowledge and practice regarding insulin sharps disposal is crucial to prevent health and environmental risks. Improper handling can lead to needle-stick injuries and transmission of blood-borne infections. This study aimed to assess the patterns of insulin sharps handling, disposal practices, and related knowledge among patients with diabetes mellitus.

Methods: A single-center descriptive cross-sectional study was conducted at Nepal Medical College and Teaching Hospital, Kathmandu, from July 2023 to February 2024. Diabetic patients meeting the inclusion criteria were enrolled after obtaining informed consent. Data were collected using a structured questionnaire, including demographic details(age , sex, education) and specific information on insulin therapy(duration, method ,type of insulin use) and disposal practices (how and where) along with their knowledge on disposal. Microsoft Excel was used for statistical analysis.

Results: Among the 105 patients, 56 (53.3%) were males and 49 (46.7%) females, with the largest proportion (35.2%) aged 40-60 years. A notable 25.7% were literate without formal education. Most patients (93.3%) used insulin pens, and 54.3% self-administered injections. Improper disposal of insulin sharps was reported by 92 (87.6%) patients, commonly through household dustbins. Only 13 (12.4%) practiced proper disposal via hospital waste systems. While 42 (40.0%) patients were aware of proper disposal methods, 54 (51.4%) understood the potential consequences of unsafe disposal.

Conclusions: Knowledge and proper practices related to insulin sharps disposal remain inadequate among diabetic patients. Raising awareness about safe disposal and the consequences of improper handling is essential.

Background: Chronic obstructive pulmonary disease is a major cause of morbidity and hospitalization worldwide, and acute exacerbations further increase healthcare burden. Reliable prognostic tools are required to predict outcomes and optimize management. The CAUDA 70 score, based on simple clinical parameters, has been proposed as an accessible bedside predictor. This study aimed to evaluate its prognostic value in patients admitted with acute exacerbations of COPD.

Methods: A hospital-based, observational, cross-sectional study was conducted at Tribhuvan University Teaching Hospital, Nepal. Patients aged ?40 years with a confirmed diagnosis of COPD were enrolled. Clinical and demographic data were recorded, and patients were stratified by CAUDA 70 scores. Outcomes assessed included ventilatory support, intensive care admission, acute exacerbation and hospital length of stay.

Results: A total of 180 patients with acute exacerbations of COPD (AECOPD) were included in the study. The mean age of participants was 67.16 ± 13.38 years, with 45% males and 55% females. The mean CAUDA 70 score was 1.34 ± 0.475. Significant correlations were observed between the CAUDA 70 score and arterial pH (r = 0.399, p < 0.001), serum urea (r = 0.244, p = 0.001), and mMRC score (r = 0.176, p = 0.018). Higher CAUDA 70 scores were associated with increased need for non-invasive ventilation (NIV) (?² = 47.41, p < 0.001), ICU admission (?² = 59.4, p < 0.001), and mortality (?² = 7.3, p = 0.007). The CAUDA 70 score also predicted longer hospital stays (p < 0.001). Mortality occurred in 15% of the cohort.

Conclusions: The CAUDA 70 score effectively predicts the severity of outcomes in AECOPD patients, including NIV requirement, ICU admission, prolonged hospitalization, and mortality. Its simplicity and reliance on readily available clinical and biochemical parameters make it a valuable prognostic tool, particularly in resource-limited settings.

Background: The most dengue cases ever recorded in Nepal were reported in 2019, the greatest number to date. The incidence of dengue infections in Kathmandu is examined from an epidemiological standpoint in this paper. Since its initial introduction in 2004, dengue cases-including some significant outbreaks-have been consistently reported in Nepal. The purpose of this study was to identify and characterise the dengue virus (DENV) at the molecular level in dengue patients.

Methods:  This study had 579 patients in all. Dengue patients who visited the National Public Health Laboratory provided demographic, clinical, and laboratory data. RT-PCR analysis was performed after immunochromatographic detection assays to confirm dengue infection.

Results:  By immunochromatographic screening, 234 (40.41%) of the 579 patients tested positive for the Dengue virus. Of them, 185 (79.05%) samples tested positive for the NS1 antigen, 36 (15.38%) tested positive for IgM, and 1 (0.42%) tested positive for IgG. Remarkably, 345 samples tested negative for dengue virus, while 12 (5.12%) tested positive for both NS1 and IgM. 93 of the 185 NS1-positive samples underwent real-time PCR characterisation. We discovered that the most common serotype causing the 2019 outbreak was DENV-2, 90 (96.77%). Interestingly, co-infection with DENV 1 and DENV 3 was reported in one patient, while two samples tested negative for the Dengue virus.

Conclusions:  According to our research, the main serotype responsible for the significant epidemic in Nepal in 2019 was DENV 2. Programs for disease control will benefit from this knowledge as it helps them comprehend molecular characterisation and its evolving trend.

Background: The median nerve, normally formed by two roots from the medial and lateral cords in relation to the axillary artery, but variations in its roots and unusual communications with other nerves are common. These anatomical differences can compromise anesthesia and are vulnerable to iatrogenic injury during surgical procedures of the upper limb. This study was conducted to determine the prevalence of such anatomical variations in axillary and arm regions.

Methods: A descriptive cross sectional study was conducted on 66 upper limbs from embalmed adult human cadavers, selected using a convenience sampling method. The median nerve was observed after dissections in the axillary and arm regions for variations in formations and nerve communications. Variations were photographed, and the data were recorded and analyzed using SPSSTM version 20.

Results: The median nerve was most commonly formed in the axilla (78.78%), with one case showing a high formation at the apex. A third root was present in 7.58% of cases, and one rare case involved four roots. Communication with the musculocutaneous nerve occurred in 13.63% of limbs, including a case with two separate communicating roots. Communication with the ulnar nerve was observed in 3.03% of cases.

Conclusions: Anomalous origin, aberrant branching patterns, and unusual communications of the median nerve are possible and clinically significant. Awareness of such variations is essential for accurate diagnosis, effective anesthesia, and safe surgical interventions involving the upper limb.

Hysterectomy is the most common gynaecological surgery. Hysterectomy is done by laparoscopic approach, open abdominal approach and vaginal approach. Laparoscopic approach has gained popularity among gynaecologists as well patients for its different benefits of minor perioperative complication, reduced intraoperative blood loss, and shorter period of hospital stay. However, there may occur some complications in laparoscopic hysterectomy which includes intraoperative organ injury, intraoperative blood loss, conversion into laparotomy, postoperative fever, surgical emphysema, port site infection, severe gastritis and haemorrhage. Similarly, we encountered a case of vault haemorrhage following total laparoscopic hysterectomy in our institution on 15th postoperative day leading to massive blood loss. Secondary haemorrhage is rare but occurs more often after laparoscopic hysterectomy than after other hysterectomy approaches. Secondary haemorrhage following total laparoscopic hysterectomy is an emergency condition and early diagnosis and prompt treatment is required. Keywords: Complications; hysterectomy; secondary haemorrhage; TLH.