Journal of Nepal Health Research Council最新文献

Background: In pneumothorax patients requiring surgery for various indications, thoracotomy was the traditional approach until the advent of video-assisted thoracoscopic surgery. In the last decade, role of thoracoscopy in the surgical management of pneumothorax has been consolidated and established. In this study, we aim to report our experience of thoracoscopy in the surgical management of pneumothorax.

Methods: A descriptive review of prospectively maintained data on all the patients undergoing thoracoscopic bullectomy for pneumothorax was done.

Result: Over the period of 9 years, a total of 120 patients underwent thoracoscopic bullectomy. Among them, 95 entered final analysis. Most common age group was 21-40 years, with male predominance (80%); most common diagnosis was primary pneumothorax (67%), first episode (74%), and on the right (65%) side; commonest symptom was shortness of breath (84%) of a median duration of 7 days. A chest tube was placed in 96% of patients before the operation. Commonest radiological finding was multiple bullae (45%) in the apical region (71%). Majority of patients underwent surgery via 3 ports, and a single bulla in the apical region was the most common intraoperative finding. Among the postoperative complications which occurred in 17%, an air leak was present in 9%. The median intensive care stay was 23 hours, the median chest tube duration was 3 days, and the median hospital stay was 9 days.

Conclusions: Thoracoscopy can be used as a safe, feasible, and effective procedure in patients presenting with pneumothorax with minimal postoperative complications.

Background: Fluoride, a naturally occurring element found in varying concentrations in water, confers preventive effects in dental caries around a concentration of 1 ppm. The study aimed to assess the level of fluoride in drinking water sources in the Sudurpashchim Province of Nepal.

Methods: A cross-sectional study was conducted from April to July 2023 with water samples from natural, municipal, and packaged sources collected in polypropylene plastic bottles from all 9 districts of the province. Three samples from each district's two most populous municipalities (one urban and one rural municipality) were taken. Water samples from the only sub-metropolitan city in the province (Dhangadhi) were also included. Fifty-seven samples were sent to a Nepal Standard-certified lab in Kathmandu for fluoride estimation using the American Public Health Association-approved method. Data were entered in Microsoft Excel and analysed using the Statistical Package for Social Sciences v 22. A p-value less than 0.05 was taken as significant.

Results: Most of the water samples had fluoride levels below 0.1 ppm. The highest fluoride concentration was seen in a sample from a hand pump in the rural municipality of Kanchanpur (0.9 ppm). No significant differences were observed between water samples according to different water sources, geographical regions, or categories of water resources.

Conclusions: Fluoride concentration in water sources of Sudurpashchim is well below the recommended level for caries protection. Measures should be taken to ascertain people get adequate fluoride as needed.

Background: Traumatic thoracolumbar fractures are frequently encountered in blunt trauma patients. The Open pedicle screw fixation has been proven to be effective in stabilizing fractures, deformity correction, early mobilization and improving long term quality of life of patients with thoracolumbar fracture. Percutaneous pedicle screw fixation is a minimally invasive approach that minimizes the tissue injury, enhances early recovery and facilitates rehabilitation program.

Objectives: To compare the surgical outcomes of percutaneous versus open pedicle screw fixation for thoracolumbar fractures without neurological deficit. Single center, Prospective, Comparative study Methods: A total of 34 patients with thoracolumbar fractures with intact neurology were treated with either percutaneous or open pedicle screw fixation between February 1st 2023 to March 1st 2024 at the National trauma center , Kathmandu. There were 17 patients in each group. The perioperative clinical and radiological parameters were collected using a preformed pro forma. Postoperatively follow-up was conducted at post op day 1, during discharge and 3 months. The clinical and radiological outcomes of percutaneous and open pedicle screw fixation were analyzed and compared.

Results: This study included 24(70.6%) males and 10(29.4%) females. The mean age was 40.73 ±15.44 years. There was a statistically significant difference between percutaneous and open pedicle screw with regard to intraoperative blood loss, fluoroscopy time, operative duration, deambulation day and overall hospital stay (p<0.05). Overall, there was a statistically significant improvement in overall pain perception at discharge and three month follow up in both groups. The kyphosis correction in percutaneous group was similar to open pedicle screw fixation technique (mean cobbs angle correction of 4.7 degree).

Conclusions: The percutaneous approach has several advantages over the open pedicle screw fixation with regard to less intraoperative blood loss, less postoperative pain, early deambulation, no was a statistically complications and shorter hospital stay Keywords: Open pedicle screw; percutaneous pedicle screw fixation; thoracolumbar fracture.

Background: The gastro-colic trunk of Henle is a venous trunk that comprises the veins draining the stomach and colon and is an important landmark for various gastro-intestinal surgeries. Understanding the anatomy of these vessels may enhance the surgical outcome. The aim of this study is, to assess the Intraoperative variations of the Gastrocolic Trunk of Henle noted in gastrointestinal surgeries in a tertiary care center.

Methods: A descriptive cross-sectional study was conducted at Kathmandu Medical College Public Limited, a tertiary center in Nepal during the period of one year (1st January 2022, to 31st December 2022). All patients undergoing right hemicolectomy, gastrectomy, and pancreaticoduodenectomy were included in the study. Based on per-operative findings, the type of The gastro-colic trunk of Henle was noted during surgery.

Results: A total of 49 patients underwent the above-mentioned surgeries during the study period. The gastro-colic trunk was found in 45 out of the 49 patients intraoperatively (91.84%), and the variations were distinguished. The most common configuration noted was the union of the right gastro-epiploic vein, the anterior superior pancreaticoduodenal vein, and the superior right colic vein (Type I), which was noticed in 46.67% of the patients.

Conclusions: The intraoperative identification of the anatomy of The gastro-colic trunk of Henle is challenging because of its variable combinations of tributaries. Knowledge of variations in The gastro-colic trunk of Henle is important in preventing intraoperative bleeding, and during identification, the meticulousness of surgery is redefined.

Background: Coronary Artery Disease is a leading cause of death and a major disorder affecting the heart and blood vessels. The aim of this study is to estimate the prevalence of Coronary Artery Disease and its associated risk factors in Nepal.

Methods: This population-based descriptive cross-sectional survey involved 12,557 participants aged 20 years and older, selected through a multistage stratified cluster sampling method. Data on demographics and risk factors were collected via face-to-face interviews, physical examinations, and laboratory tests. The association of different variables with Coronary Artery Disease outcomes was assessed using descriptive statistics.

Results: The prevalence of definite Coronary Artery Disease among Nepalese adults aged 20 years and older was found to be 0.5% (95% CI: 0.3-0.7). Possible Coronary Artery Disease had a prevalence of 2.1% (95% CI: 1.6-3.4), and probable Coronary Artery Disease had a prevalence of 0.3% (95% CI: 0.2-0.4). Higher prevalence rates were observed among older individuals, urban residents, those with higher education levels, males, and participants with hypertension, diabetes, and elevated total cholesterol levels.

Conclusion: This study represents the first comprehensive national population-based assessment of Coronary Artery Disease in Nepal. The findings indicate a significant burden of Coronary Artery Disease and its risk factors among the adult population. Addressing the high prevalence of Coronary Artery Disease and its risk factors requires both individual and population-level interventions. Keyword: Coronary arterial disease; Nepal; prevalence.

Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world and will become the third leading cause of death worldwide by 2020. A study was carried out with an objective to study the sputum bacteriology and antibiotic sensitivity pattern of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease.

Methods: A review study was carried out for a sputum culture isolated cases of acute exacerbation of COPD in Kathmandu Model Hospital. The discharged records from Jan 1st 2018 to December 31st, 2022. were analysed for demographic data and antibiotic susceptibility patterns. Any patient records with incomplete information were excluded from this study. An antibiotic susceptibility pattern was further confirmed from the laboratory records. Data were entered and analysed using SPSS version 21.

Results: Over the period of five years from Jan 1st 2018 to December 31st, 2022. We found that total 80  of our patients with acute exacerbation of chronic obstructive pulmonary disease had a positive routine sputum culture. Pseudomonas aeruginosa (28.7%), Kleibsella pneumonia (20%), Escherchia coli (17.6%), Acinetobacter baumani complex (13.8%) were the most common bacteria isolated. Most organisms are found to be sensitive to Polymyxin B, Colistin, Tigecycline followed by Piperacillin/Tazobactam while most of them are found to be resistant to Amoxicillin, Amoxicillin/Clavulanic Acid and Cefixime.   Conclusions: Pseudomonas aeruginosa, Klebsiella pneumonia and Escherchia coli accounted for most common bacteria isolated in our study. These bacteria were found to be sensitive to polymyxin B, colistin and tigecycline. Most of them were resistant to amoxicillin, amoxicillin clavulanic acid and cefixime. Our study concluded acute exacerbation of chronic obstructive pulmonary disease is associated with bacterial isolates in sputum culture and highly sensitive to broad spectrum antibiotics   Keywords: Bacteria, COPD, exacerbation, sputum culture, antibiotics, Nepal.

Background: The global aging population is growing rapidly, and Nepal is no exception. This increase is driven by changes in socioeconomic conditions, health behaviours, and advancements in the health system. In Nepal, almost a quarter of the national population are older adults (≥45 years), whose health status is rarely elaborated. This study was carried out to assess the socioeconomic, behavioural, and health-related characteristics of older adults in Nepal.

Methods: A community-based cross-sectional study was conducted among 4,179 randomly selected older adults residing in Bagmati Province from July 2022 to June 2023, via a multi-stage sampling technique. A semi-structured questionnaire including Geriatric Depression Scale, Activity of Daily Living, and Instrumental Activity of Daily Living along with sociodemographic and health profiles were used for the data collection through face-to-face interviews. The data were described in frequency and percentage across the local levels (urban/rural) and gender. Chi-square tests were done for bivariate analyses.

Results: The mean age of the population was 61.66±11.1 years. The prevalence of multimorbidity, disability, and depression was found to be 27.6%, 23.3%, and 35.1% respectively. There was no significant difference between multimorbidity and depression across local levels, while there was a significant difference across disability status. There was a significant difference between multimorbidity and depression across genders.

Conclusions: This study provides comprehensive insights into the socioeconomic status, behavioural factors, and health status of older adults in Nepal. Study findings can inform interventions and policies at local levels to consider the unique needs of the older population in Nepal.

Background: Peripheral artery disease is an important vascular disease. There is an increased incidence of acute limb ischemia in cases of peripheral artery disease. Objective of this study was to assess the prevalence of peripheral artery disease among high-risk patients attending out patient department in Shahid Gangalal National Heart Center, Janakpurdham.

Methods: A total of 386 high risk patients for Peripheral Artery Disease were included in the study. Informed consent was taken from patients undergoing the study. Patients underwent ankle brachial index calculation to make a diagnosis of peripheral artery disease. Patients having ankle brachial index of <= 0.9 was considered to have peripheral artery disease. Patients diagnosed with peripheral artery disease further underwent doppler study.

Results: The study showed the prevalence of peripheral artery disease to be 17.4% among high-risk patients attending Shahid Gangalal National Heart Centre, Janakpurdham. The prevalence of peripheral artery disease was more in females as compared to male which was statistically significant. Most of the high-risk patients were patients with hypertension at Shahid Gangalal National Heart Centre.

Conclusions: Peripheral artery disease prevalence is significant among high-risk patients attending Shahid Gangalal National Heart Centre, Janakpurdham. High risk patients should undergo evaluation of peripheral artery disease for early detection and treatment.

Background:  The ability of Staphylococcus aureus to form biofilmsâ€"architectural complexes that cause chronic and recalcitrant infectionsâ€"along with its notorious variant, methicillin-resistant Staphylococcus aureus (MRSA), leads to multidrug-resistant (MDR) infections that are challenging to treat with antibiotics. This cross-sectional study investigated the prevalence of S. aureus infections in Kanti Children’s Hospital and characterized the antibiograms of MDR, MRSA, and biofilm-forming strains, along with their coexistence.

Methods:  S. aureus strains were isolated and identified from clinical samples and tested for antibiograms following standard microbiology guidelines. MDR strains were non-susceptible to at least one agent in three antimicrobial categories, whereas MRSA strains were cefoxitin-resistant. The microtiter plate method was used to detect biofilms. Statistical analyses were performed using SPSS version 17.0.

Results:  S. aureus was detected in 9.0% (11.4-6.6%, 95% Confidence Interval) of 543 samples, primarily from pus (79.6%, 39/49). Children aged 1 to <3 years most commonly contracted infections (30.6%, 15/49), and males (67.4%, 33/49) had twice as many infections as females (32.7%, 16/49). As high as 84.7% (83/98) of strains were penicillin-resistant, while 18.4% (27/147) were aminoglycoside-resistant. MDR accounted for 79.6% (39/49) of all S. aureus infections, while MRSA and biofilm-formers accounted for 67.6% (33/49) and 24.5% (12/49), respectively. Fluoroquinolone resistance in non-MDR-MRSA-biofilm-formers, MDR-MRSA, MDR-biofilm-formers, and MRSA-biofilm-formers was 31.3%, 46.8%, 58.3%, and 60.0%, respectively, while aminoglycoside resistance was 0%, 32.3%, 50.0%, and 45.0%, and penicillin resistance was 87.5%, 85.5%, 100.0%, and 100.0%.

Conclusions:  MDR-isolates and MRSA caused nearly four-fifths of S. aureus infections. Compared to MDR and MRSA strains, biofilm-formers triggered higher levels of antimicrobial resistance.

Background: Myopia is a growing global health concern, with prevalence surging, especially in East and Southeast Asia. The World Health Organization identifies high myopia as -5.00 diopter or less, carrying an elevated risk of irreversible blindness. In 2020, an estimated 2.6 billion people had myopia, projected to reach 4.7 billion by 2050, leading to a rise in complications like myopic maculopathy. This study, conducted in Nepal, where 47.16% of the population is myopic, aims to assess fundus and optic nerve changes in high myopia, examining associations with age, gender, axial length, and mean spherical error.

Methods: A prospective, cross sectional study was conducted by recruiting 98 high myopic eyes (defined as spherical equivalent of <-5.0 diopters (D) or axial length ≥ 26.00 mm). Colored Fundus photography was performed on viewing angle of 500 in different field of gazes following pupillary dilatation. Fundus photographs were graded by independent graders to evaluate for high myopic fundus and optic disc changes. Multinomial logistic regression was performed with axial length and mean spherical error as risk and myopic changes as dependent variable.

Results: In this study, tessellated fundus (57.1%) and peripapillary atrophy (40.8%) were the most common posterior segment changes in high myopic Nepalese subjects. High myopic features were seen in 45.9% of cases. Increase in axial length and mean spherical error was established as a risk factor for development of high myopic changes in the fundus.

Conclusions: In this study of the highly myopic Nepalese population visiting tertiary eye hospital, myopic changes such as tessellated fundus and peripapillary atrophy were frequent and were associated with axial length and mean spherical error.