Journal of Nepal Health Research Council最新文献

Background: A bibliometric analysis was performed to map the current status and development trends in medical research in Nepal. It aims to visualize research hotspots within this field and provide effective guidance for future research directions.

Methods: A systematic search of the Scopus database was performed to identify high-cited papers (HCPs) on medical research in Nepal between January 1, 1994, and December 31, 2023. Bibliometrics techniques were applied to analyze the publication dates, countries, institutions, journals, authors, and research hotspots. Statistical analysis and visualization were carried output by MS-Excel and VOSviewer software.

Results: A total of 326 HCPs were identified that have received 100 to 10719 citations and registered 223.05 Citations Per Paper (CPP). The 47.54% and 95.40% share of the 326 HCPs have received external funding support and are involved in international collaboration, respectively. The 15892 (417 from Nepal) authors, affiliated to 12830 (177 from Nepal) organizations and published in 138 journals participated in 326 HCPs from Nepal. USA (60.45% share) and India. (51.45% share) were the most collaborative countries, while Spain (1609.15 CPP) and Mexico (1597.08 CPP) made the largest citation impact in collaboration with Nepal. C.L. Ranabhat (n=27) and B. Sathian (n=26) were the most productive authors, while D. Acharya (3652.29 and 16.5), and S. Bhattarai (2880.11 and 13.01) registered the highest citation impact (CPP and RCI). Tribhuvan University, Kathmandu (n=72) and Nepal Health Research Council, Kathmandu (n=34) were the most productive organizations, while Kathmandu University (3652.29 and 16.5) and Nepal Academy of Science and Technology, Lalitpur (2941.67 and 13.29) registered the highest citation impact (CPP and RCI). The Lancet (n=75) and British Medical Journal (n=11) were the most productive journals, while The Lancet Neurology (1749.5 CPP), and The Lancet (1371.13 CPP) registered the highest average citations impact. B. Basnyat has the most citation as first author in health and medical research.

Conclusions: The present study offers an overview of research characteristics and trends of medical research output in Nepal. It identifies main contributors, core journals, and significant subject topics. The study hopes to assist researchers and practitioners in comprehending the development and trends of medical research in Nepal and discovering potential directions for future research.

Background: Acute inflammation of the appendix or acute appendicitis is one of the most prevalent surgical emergencies seen in day-to-day practice. The delay in the diagnosis and the treatment of the condition can lead to complications and even death. Various scores have been developed over the time for aiding the diagnosis of Acute Appendicitis.

Methods: A hospital based cross-sectional study was conducted in Bharatpur hospital of Chitwan district of Nepal from December 30, 2020 to December 29, 2022 .This study identified and enrolled acute appendicitis patients that were treated in a tertiary hospital’s emergency department of Bharatpur. The data were obtained and used to calculate modified Alvarado, and Lintula scores. All the patients were categorized into two groups according to their histopathological results, i.e., positive appendectomy and negative appendectomy. The sensitivity and specificity of different scoring systems in diagnosing Acute appendicitis was investigated.

Results: Sensitivity and specificity of Modified Alvarado score were 89.2% and 80.0% respectively. Diagnostic accuracy of Modified Alvarado Score was 88.57%. Positive productive value and Negative productive values of this scoring tool were 98.3% and 36.3% respectively whereas, diagnostic accuracy of Lintula score was 75.0%.

Conclusions: It can be inferred from the study that Modified Alvarado Score is a good screening tool for diagnosing need of appendectomy.

Background: Neonatal mortality, a sensitive indicator which indicates the availability, utilization, and effectiveness of maternal and child health services in the community, are major global public health challenges. The objective of the study was to find out the maternal and neonatal factors associated with neonatal mortality in selected hospitals of Nepal.

Methods: This was a hospital based prospective follow up study conducted among babies nested for case control study design. Among 1104 babies, 368 babies with LBW and 736 babies with normal birth weight were followed up after 28 days of birth and mortality was assessed.

Results: Neonatal mortality was about 10/1000 live birth. In multivariable logistic regression analysis, father with no formal education [AOR:12.54, 95% CI:(2.61-60.13), p=0.002], multi parity [AOR:11.26, 95% CI:(1.25-100.89), p=0.030] and depressed (<7) APGAR score at 5 minutes of birth[AOR:7.44, 95% CI:(1.18-46.80), p=0.032] were significantly associated with neonatal mortality.

Conclusions: The study identified ‘father with no formal education, multi parity and low APGAR score at 5 minutes of birth’ as the major contributors to neonatal mortality. Improving parental education, and access to child health care will help to improve neonatal outcome.

Background: Caudal block is a commonly used method of postoperative pain management in children. However, single shot caudal block has shorter duration of analgesia that can be extended by addition of adjuncts like opioids, clonididine, and dexmedetomidine along with local anesthetics. Recently, dexmedetomidine has been used as an adjunct for prolonging the duration of analgesia. This study aimed to find out prevalence of the caudal block and the duration of analgesia with dexmedetomidine adjunct among children undergoing lower abdominal surgeries.

Methods: A cross-sectional, observational study was conducted among the children admitted to the tertiary care children hospital of Nepal during the period of six months. Children of age 2 to 7 years, who had undergone lower abdominal surgeries under general anesthesia were enrolled in the study. We observed the prevalence of the caudal block and duration of analgesia of caudal dexmedetomidine with ropivacaine Results: Throughout the study period, 449 children were posted for lower abdominal surgeries. Out of which 226 children (50.03%) received caudal block. Among the caudal block, 51 children (22.56%)) were administered ropivacaine with dexmedetomidine, 45 children (19.91%) received ropivacaine alone, 43 children (19.02%) were given bupivacaine alone, 46 children (20.35%) received a combination of bupivacaine and fentanyl, and 41 children (18.14%) received bupivacaine and dexmedetomidine. Dexmedetomidine with ropivacaine provides 840.35±14.97 minutes of postoperative pain relief.

Conclusions: The prevalence of the caudal block was 50.03%, and the combination of Dexmedetomidine with ropivacaine provides longer duration of postoperative analgesia.

Background: Delirium is highly prevalent in the Intensive Care Unit (ICU), and managing it in critically ill patients with severe comorbidities is challenging due to transient nature of symptoms. However its significance is underestimated, often overlooked and misdiagnosed by healthcare providers. In Nepal, limited studies has been done on delirium in medical ICUs hence this study aims to assess short-term outcome of admitted patients in delirium.

Methods: Descriptive cross-sectional observational study was conducted among 92 patients referred from medical ICU with history of disorientation and altered sensorium, assessed during consultation liaison and meeting the criteria for delirium. Data were collected using semi-structured proforma. Richmond Agitation Sedation Scale and Delirium Rating Scale-Revised 98 were used to know the pattern and severity of delirium at day 0 and seven respectively and phone follow-up was done at three months. Data were tabulated and analyzed using SPSS version 25.0.

Results: Hyperactive delirium (57.6%) was most common in medical ICU. Out of total patients, 63.2% improved, 23% became worse and 13.8% remain static with treatment. Mean length of hospital stay was 11.1 days. Hypoactive delirium was associated with longer hospital stay and increased mortality. Significant association was found between length of ICU stay and outcome in terms of mortality and response to treatment.

Conclusions: Study underscores the prevalence of hyperactive delirium as the predominant pattern in MICU settings. However, it is crucial to highlight the significance of hypoactive delirium due to its poor treatment response and prolonged ICU stays compared to other forms.

Pubic symphysis is a non-synovial joint, made up of a fibrous cartilage disc connecting the two sides of pubic rami in the midline. During pregnancy under the influence of hormones particularly relaxin, the gap increases by 2 to3mm. When the diameter is more than 10 mm, it is considered as pubic symphysis diastasis. Pregnancy and childbirth are the most common causes of pubic symphysis diastasis followed by traumatic causes. Women with post-partum symphysis diastasis present during puerperium with inability to bear weight owing to severe supra-pubic and groin pain. They have complaint of severe excruciating pain while standing up or to perform any movement involving hip abduction. For the diagnosis, proper history regarding delivery should be sought followed by physical examination and radiological imaging. Most cases can be treated with conservative management which includes- use of analgesia and anti-inflammatory medicines for the pain management and stabilization of pelvis using brace/pelvic belt. Some may benefit from physiotherapy. In extreme cases, operative fixation may be required with the involvement of orthopedic surgeon. Keywords: post-partum symphysis diastasis; pubic symphysis; rare presentation.

Background: For more than two decades abortion is legalized in Nepal, recognizing unsafe abortion as one of the leading but preventable cause of maternal morbidity and mortality. To safeguard safe abortion as women’s rights, several policies, guidelines, training manuals have been developed along with training human resources and increasing access to abortion services across Nepal. However, access to safe abortion services remains a challenge. Hence, to unravel the possible reasons behind these challenges, this study explored the knowledge, attitudes, practices and intentions of policymakers of Nepal towards abortion.

Methods: Mixed methodology was used incorporating self-administered questionnaire for quantitative data collection and semi-structured interview guidelines to interview twenty local leaders from federal and provincial level, identified through purposive sampling. The ethical approval was taken from Nepal Health Research Council prior to data collection. After transcription and translation to English, Dedoose application was used for qualitative thematic analysis while the quantitative data was analysed using SPSS version.  Results: 70% understand that international health and human rights frameworks support abortion. Also, a majority (85%) believe that policies limiting abortion access create negative attitudes toward abortion. All the participants mentioned that they possess a good knowledge of safe abortion services. Majority of the participants had good attitude, confident in advocating, and had positive intention towards safe abortion services. However, existing socio-cultural barriers, lack of awareness, legal barriers and maintaining privacy were identified challenges to seek safe abortion and related services.

Conclusions: Despite strong positive intentions, policy implementation gaps and lack of accountability have resulted in poor awareness, access, and acceptability of abortion related services. Further budget allocation, safe abortion prioritization, continuous advocacy, integration of abortion in preservice curriculum and community engagement and awareness will bridge these gaps â€" to ensure equitable access to quality services including women and girls from marginalized community and adolescents.

Background: This study aimed to evaluate perception of medical students regarding online mode of assessments and to compare the academic outcomes of various methodologies adopted for online formative assessments.

Methods: This was a descriptive cross-sectional study. This study was conducted in the department of biochemistry at the constituent medical college of Health University in India and included 150 first year medical undergraduates of either gender. The institutional ethical clearance and written informed consent was taken prior to the study from all the enrolled participants. A series of online formative assessments were designed in the form of multiple choice, short answer questions, case-based learning, and viva-voce to satisfy each learning outcome. Google platform was used for conducting online formative assessment. The participants were asked to fill questionnaire based on 5-point Likert scale to obtain information on challenges and perceptions related to OFA. Academic performance was evaluated and compared for various modes of assessments.

Results: The mean age of the participants was 19.34±0.947 years. Most of the students were from urban areas and majority (73.33%) preferred MCQs. 60.67% respondents favored conduction of e-assessments. 80.67% of students agreed that solving clinical cases in the online assessments contributed to clinical learning.

Conclusions: Formative online assessment can be used as an intervention to reshape medical education sector during times when infection controls and physical isolation measures are crucial to avoid spread of disease.

Background: Every pregnant woman supposed to have Antenatal care visits at least four times during 4th, 6th, 8th and 9th month of gestation. This contributes to the reduction in maternal mortality. The main objective of the study was to assess the utilization of antenatal care services and its associated factors in Pokhara Metropolitan.

Methods: A community based cross-sectional analytical study was conducted in Pokhara Metropolitan between 16th May 2019 to 30th June 2019 among 325 mothers using probability proportional to size sampling and face to face interview. Ethical approval was obtained from Nepal Health Research Council. Data analysis was done using SPSS version 22 and Chi-square test and binary logistic regression analysis was performed.

Results: A total of 97.2 percent mothers had at least one time visit for ANC checkup while 88.6 percent mothers received four ANC visits as per protocol. A total of 94.6 percent mothers got counseling on early detection and management of complications, 95.9 percent consumed iron and folic acid and 94.3 percent consumed de-worming tablets. Mothers health literacy mobile phone ownership (AOR=11.26, 95% CI: 9.70-13.03), husband’s attitude towards ANC (AOR=6.71, 95%CI: 1.60-28.10), awareness on pregnancy complications (AOR=4.62, 95% CI: 2.53-21.73), and which is decision making on household expenditure by self (AOR 8.57%, 95% CI: 3.64-9.48) history of abortion (AOR=5.22, 95%CI: 1.71-15.30) were the factors associated with ANC service utilization.

Conclusions: Majority of the pregnant women were found to be utilizing ANC services. Mobile phone ownership, health literacy, husband's attitude towards ANC, decision making on household expenses, awareness on pregnancy complications and history of abortion were the significant factors associated with ANC service utilization.

Background: Painful diabetic peripheral neuropathy is one of the frequent presenting complaints in diabetes and endocrine clinics. Our main objective was to compare effectiveness of three commonly prescribed drugs: amitriptyline, pregabalin and duloxetine for treatment of painful diabetic peripheral neuropathy.

Methods: This was a comparative, prospective, observational study conducted among 99 diabetic patients with painful diabetic peripheral neuropathy having numeric rating pain scale ≥ 4. Thirty-three patients in each group were consecutively prescribed amitriptyline, pregabalin and duloxetine in lower dose (10mg/75mg/20mg) for first two weeks to gradually up titrate to higher dose (25mg/150mg/30mg) as per pain response for total duration of eight weeks.

Results: At the end of eight weeks, 84.9% in amitriptyline, 78.7% in pregabalin and 60.6% in duloxetine group had adequate pain reduction in form of mild or no pain. Among total patients, 42.5% patients had severe pain at baseline that decreased to 5% by the end of our study. Out of three drugs, 45.5% patients in amitriptyline group had complete resolution of pain as compared to 24.2% in pregabalin and 18.2% in duloxetine group (p value 0.05). Drowsiness (42.4%), dizziness (21.2%) and dry mouth (21.2%) were the commonest side effects among total participants in our study.

Conclusions: Amitriptyline, pregabalin and duloxetine were all associated with adequate pain reduction among patients of painful diabetic peripheral neuropathy in our study, however, amitriptyline had more favorable findings with tolerable side effects.