Journal of Nepal Health Research Council最新文献

Endoscopic retrograde cholangiopancreatography (ERCP) is a unique diagnostic and therapeutic procedure performed in high-risk patients in prone/semi-prone positions. ERCP has evolved from a simple diagnostic procedure performed under endoscopist-administered sedation to a therapeutic one involving increasingly complex techniques. The anaesthesiologist has become a vital member of the team. Complex interventional gastrointestinal endoscopy procedures are challenging due to high-risk patient profiles, non-operating room set-up, non-supine position, space restrictions, prolonged duration, and airway sharing-related issues. These procedures require deep sedation or general anaesthesia to be administered to the patient, and vigilant airway management is of utmost importance. However, there is a significant lack of literature on recommendations regarding specific anaesthesia techniques. This gap in knowledge can have implications for patient safety and procedural ease. Therefore, it is crucial to increase awareness of anaesthetic concerns for these challenging non-operating room procedures, allowing the anaesthetist to select an appropriate technique to provide safe and effective anaesthesia and optimise patient outcomes. Our objective is to delve into the various anaesthesia techniques utilised and review the unique challenges these procedures pose in remote anaesthesia settings. Keywords: Anaesthesia; anaesthesia safety in endoscopic procedures; conscious sedation; developing nations; gastrointestinal endoscopy.

Background: Curcumin, the primary bioactive compound in turmeric (Curcuma longa Linn.), has demonstrated potential benefits in managing type 2 diabetes mellitus (T2DM) and hyperglycemia. This systematic meta-review aimed to evaluate the effectiveness of turmeric in improving glycemic control, lipid profiles, and other metabolic markers in the patients with T2DM or hyperglycemia.

Methods: A comprehensive literature search was conducted across seven electronic databases to identify relevant studies published up to December 2023. Inclusion criteria focused on randomized controlled trials included in systematic reviews or meta-analyses assessing curcumin's effects on metabolic markers. Data were extracted systematically, and the methodological quality of included reviews was assessed using AMSTAR-2. Meta-analyses were performed using STATA 17 to synthesize outcomes for fasting blood glucose (FBG), glycated hemoglobin (HbA1c), lipid profiles, and other markers, employing random-effects models to account for heterogeneity.

Results: Thirteen systematic reviews and meta-analyses of 63 unique randomized controlled trials involving 3706 human participants met the inclusion criteria. The pooled analysis revealed that curcumin significantly reduced FBG (mean difference [MD] = - 6.30 mg/dL; 95% CI: - 9.33, - 3.27), HbA1c (MD = - 0.31%; 95% CI: - 0.57, - 0.05), low - density lipoprotein (LDL) cholesterol (MD = - 5.95 mg/dL; 95% CI: - 9.43, - 2.47), and triglycerides (TG) (MD =  -12.88 mg/dL; 95% CI: - 20.09, - 5.67) while increasing high-density lipoprotein (HDL) cholesterol (MD = 1.46 mg/dL; 95% CI: 0.37, 2.56). No significant effects were observed on total cholesterol, blood pressure, body mass index, blood urea nitrogen, or creatinine levels. Heterogeneity across studies was high but consistent with meta-analytical expectations for diverse populations and interventions.

Conclusions: Curcumin supplementation shows statistically significant improvements in glycemic control and lipid profiles in individuals with T2DM or hyperglycemia, supporting its potential as an adjunct therapy. However, its effects on renal markers, blood pressure, and body weight remain inconclusive. Moreover the efficacy of the crude powder of turmeric remain unexplored. Future trials should address long-term efficacy and safety to optimize the therapeutic role of curcumin and turmeric powder in diabetes management.

Background: Acute Suppurative Otitis Media(ASOM) is a very common disease of childhood caused by various bacteria and viruses. Amoxicillin is used as first line antibiotics in the community setting as well as hospital setting.

Methods: This is a hospital based prospective observational cross-sectional study. All cases of ASOM of patients under 14 years presenting to the Patan Hospital with duration of less than 6weeks were included in the study. Ear discharge was collected using sterile cotton swab using aseptic precautions and sent to the Department of Microbiology for further processing. The children were treated with amoxicillin (80mg/kg/day) with maximum dose not exceeding 3g/day and follow up was done after 1 week of antibiotic therapy for clinical responsiveness.

Results: Out of 32 cases, 13 cases showed no growth of organism in the culture sensitivity reports. Among remaining 19 cases, 9 were sensitive and 10 were resistant to amoxicillin. Coagulase negative Staphylococcus (7) was the most common organism grown in the laboratory followed by Staphylococcus aureus (4) and Klebsiella pneumoniae (4). Chloramphenicol, linezolid, clindamycin and trimethoprim-sulphamethoxazole were the most common antibiotics sensitive to the organisms grown besides amoxicillin. Out of total 32 patients, 31 were responsive to high dose amoxicillin at the end of 1 week.

Conclusions: Oral amoxicillin in high doses is effective in the treatment of ASOM in children.

Background: Sickle cell disease (SCD) is a significant public health issue in Nepal, predominantly affecting the Tharu community in the Mid-Western and Sudurpaschim province. This study was design to understand the socio-demographic characteristics and symptoms of SCD patients attending the health camp conducted by Seti Provincial Hospital in Sudurpashchim Province, Nepal.

Methods: This study was cross-sectional study conducted at Sudurpashchim Province of Nepal visiting in Seti provincial Hospital during the period of free health camp organized by Hospital. After ethical clearance, patients were enrolled based on inclusion and exclusion criteria, and their demographic, epidemiological, and clinical profiles were recorded using a structured questionnaire.

Results: Among 119 patients with SCD, the mean age was 22.58 years, with a majority (58.8%) being female. Most patients (45.37%) belonged to the upper lower socioeconomic class. The most common symptom was musculoskeletal pain, weakness, and fever (30.5%), followed by jaundice, chest pain, and vertigo (21.84%). Additionally, 15.96% experienced weakness, nausea, breathing difficulties, and fever; 12.60% reported weight loss, low hemoglobin, and chest pain; 10.08% had backache, joint pain, fever, and headache; and 9.24% experienced knee pain, fever, anemia, and vertigo.

Conclusions: SCD is seen in younger patients in Sudurpashchim Province, especially Kailali and Kanchanpur Districts with Tharu communities are more affected. Major systemic manifestations of SCD include pain crisis, hemolytic crisis, acute chest syndrome, hepatopathy and AVN of hip. The government of Nepal should implement policies focus for treatment and pain management within the current health system, to minimize, control, and prevent the high burden of SCD in the Tharu communities.

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Background: Current evidence suggests an increasing prevalence of hypertension and associated burden among the older population in Nepal. Despite being a common health problem and a strong risk factor for chronic health conditions among older adults, there is a gap in the literature regarding the prevalence of hypertension and associated factors among the older population in Nepal. Hence, this study aimed to find the prevalence and factors associated with hypertension among older adults in Nepal.

Methods: The 2022 Nepal Demographic and Health Survey data on older adults aged 65 years and above (n=725) was used in this study. Hypertension was operationalized as a binary variable, indicating its presence or absence. Multiple logistic regression analyses were conducted to test the association of lifestyle factors such as obesity, food insecurity, and sociodemographic factors with hypertension while accounting for complex survey design features.

Results: The prevalence of hypertension among older population in Nepal was 37.4%. Among the lifestyle factors, individuals with overweight [adjusted odds ratio (aOR=2.03, p=0.006)], obesity (aOR=2.71, p=0.018), and those who used non-iodized kitchen salt (aOR=3.38, p=0.016) had higher odds of having hypertension. Among sociodemographic factors, greater age, and ethnic minorities such as Dalits and Terai Janajati had higher odds of having hypertension. Moreover, older adults in the richer wealth quintile (aOR=0.42, p=0.016) had lower odds of having hypertension than those in the poorest quintile.

Conclusions: This study found a notable prevalence of hypertension among the older population in Nepal. Targeted hypertension screening programs for older adults should be prioritized. Similarly, hypertension awareness and healthcare access should be improved among lower-income and marginalized ethnic households such as Dalits, and Tarai Janajatis by enhancing the capacity of the local governments.

Background: This study aimed to assess the antimicrobial resistance rates of Acinetobacter species and Pseudomonas species isolated from clinical samples in an Antimicrobial Resistance (AMR) surveillance site in Gandaki Province, Nepal.

Methods: A retrospective analysis of data from an AMR surveillance site was extracted and analyzed, covering the time period from January 2020 to June 2024. A total of 575 Acinetobacter species and 687 Pseudomonas species were identified, with varying numbers tested for susceptibility against different antibiotics. Resistance rates were calculated for each pathogen-antibiotic combination.

Results: Resistance in Acinetobacter species was observed in 49.9% of isolates to amikacin and 42.7% to gentamicin, whereas Pseudomonas species showed resistance rates of 21.2% and 18.5%, respectively. Resistance to piperacillin-tazobactam was identified in 54.0% of Acinetobacter species and 24.6% of Pseudomonas species. Notably, 80.3% of Acinetobacter species and 62.6% of Pseudomonas species were resistant to ceftazidime, while carbapenem resistance was observed in 59.3% of Acinetobacter species and 14.8% of Pseudomonas species. Norfloxacin resistance was observed in 38.3% of Acinetobacter species and 43.5% of Pseudomonas species, whereas only 4.0% of Acinetobacter species and 11.4% of Pseudomonas species isolates were resistance to tigecycline. Resistance rates varied across sample types, with Acinetobacter species from respiratory samples and Pseudomonas species from urine samples exhibiting the highest resistance.

Conclusions: The study underscores alarming levels of antimicrobial resistance in Acinetobacter species and Pseudomonas species. Acinetobacter species demonstrated higher resistance to most antibiotics compared to Pseudomonas species. The variation in resistance patterns across sample types highlights the need of infection site and pathogen-specific antibiotic stewardship strategies.

Background: The first case of dengue in Nepal was recorded in Chitwan in 2005. Since 2006, Nepal has had annual outbreakss with previous largest outbreak in 2019 with 18,000 recorded cases, 42,504 reported cases in 2022 and 51 confirmed deaths. Dengue imposes significant economic and societal burdens on countries where the disease is endemic. The objectives of this study were to explore the perceived social impact of dengue experienced by health service providers and receiver from previous dengue outbreak.

Methods: A cross-sectional exploratory qualitative design was used to conduct the study in Kathmandu and Lalitpur Metropolitan City with the sample size of 16. Primary data were collected from two categories of respondents; Key informant interviews with health service providers and In-depth interviews with health service consumers using purposive sampling technique.

Results: The findings from the healthcare consumer's perspective showed how dengue had affected them physically, socially, and financially. Likewise, healthcare providers discussed their methods for dealing with dengue outbreaks and stressed the importance of having a well-prepared plan, protocols, and effective government responses in place.

Conclusions: The research provides insight into the need for coordinated efforts from all three tiers of government to implement preventive strategies for vector control so that its negative impact on physical health of affected people, financial and social burden could be minimized effectively. In addition, various challenges like inadequacy of human resources, logistics, increasing workload, and mental stress among health workers were highlighted.

Background: The original Mini Cog was modified to make it applicable to non-literates as well. However the reliability and validity of the modified mini cog (MMC) has not been examined. Therefore, we aimed to investigate the intra- and inter-rater reliability, criterion validity, sensitivity and specificity of the MMC.

Methods: In this methodological and repeated measures design, elderly individuals (>60 years) with no neurological diagnosis or adults (>18 years) with neurological diagnosis were recruited from a tertiary hospital and the local community using purposive and snowball sampling. One of the raters administered the MMC twice (one week apart). Another rater administered the MMC and the Rowland Universal Dementia Assessment Scale (RUDAS) once during the first assessment session.

Results: The ICC for consistency of a rater across the tests and absolute agreement between two raters ranged from 0.97-0.99. The MMC scores of two raters were not significantly different. The MMC was able to differentiate between elderly participants with no neurological diagnosis and adult participants with neurological diagnosis. A significant correlation (Coefficients: 0.52-0.68) was found between the MMC and RUDAS. The sensitivity and specificity of the MMC were 86% and 70% respectively. The cutoff score of the MMC was found ? 3.

Conclusions: We demonstrated an excellent intra- and inter-rater reliability, and adequate criterion validity, sensitivity and specificity of the MMC. The MMC was also able to discriminate various groups having varied level of cognitive dysfunction. However, further studies are warranted to get more insight into the value of this instrument.

Background: Health promoting lifestyle refers to the healthy practices that improves health. The objective of the study was to assess health promoting lifestyle and health related quality of life among hypertensive patients attending a tertiary level hospital.

Methods: Cross sectional study design was used among 255 hypertensive patients, selected purposively from those attending cardiology OPD. Data were collected by using Health Promoting Lifestyle Profile tool and Short Form-36 Health Survey tool through face to face interview. Data were analyzed by using descriptive, inferential statistics with SPSS version 16.

Results: Health promoting lifestyle among hypertensive patients was at intermediate level (median score=130) with the highest score in spiritual growth (29.48) and the lowest score in physical activity (12.33) subscale. Health related quality of life among hypertensive patients was good (median score=64.45) with the highest score in mental health (80.61) and the lowest score in role physical (49.90) subscale. Health promoting lifestyle and health related quality of life were found positively correlated (r=0.757) and statistically significant (p <0.001). This study found that increasing age, longer duration of hypertension and presence of comorbidities were associated with lower HRQOL whereas being married and being literate were associated with higher HRQOL (p<0.005). Hierarchical regression analysis revealed that being married, education level, presence of comorbidities and six subscales of health promoting lifestyle (spiritual growth, interpersonal relationship, nutrition, health responsibility, stress management and physical activity) were influencing factors of health related quality of life among hypertensive patients (p<0.005).

Conclusions: Health promoting lifestyle is an important factor that influences health related quality of life among hypertensive patients.