Journal of Nepal Health Research Council最新文献

Background: Maternal satisfaction is higher in the midwife-led model than in other models of maternity care. The objective of this study was to compare maternal satisfaction with childbirth services, receiving care in the birthing center, and the labor room.

Methods: A cross-sectional descriptive comparative research design was used for the study to compare the satisfaction of 70 postnatal mothers delivered in the birthing center (midwifery-led model) with 70 postnatal mothers delivered in the labor room (obstetrician-led model) of Paropakar Maternity and Women's Hospital. The study population comprised postnatal mothers with normal deliveries, selected using non-probability purposive sampling technique. Data were collected using a pretested structured interview.

Results: The median satisfaction score of the respondents delivered in the birthing center is higher (96.88%) than in the labor room (77.66%) with a statistical significant (p-value <0.001).

Conclusions: Almost all the mothers who delivered their newborns at the birthing center were more satisfied with the childbirth services provided by midwives compared with the services provided in the labor room led by other healthcare providers. Therefore, the midwifery-led model should be expanded to improve maternal satisfaction with the childbirth service.

Background: Sexual assault is one of the most traumatic crimes which leaves a deep mental and emotional scar in the victim's life. Mostly girls are the victims of sexual assault whereas boys are also victimized but are few in number. This heinous incidence hampers the normal growth and development of a growing child making them vulnerable to psychiatric disorder, drug abuse disorder and anti-social conducts in adult. This study aims at identifying the incidence of child sexual abuse in different municipal areas of Kavrepalanchok district of Nepal Methods:This is a retrospective study in which data of sexual assault victim less than 18 years presented at emergency department of Dhulikhel Hospital, KUSMS through One-stop Crisis Management Center (OCMC) by the investigating authority was studied. The data from 2076/09/01 B.S. to 2080/12/30 B.S. was included in the study. Total of 127 cases were studied.

Results: Mandandeupur rural municipality reported highest number of child victims of sexual assault i.e., 14.17%. Out of 127 victims, 4 of them were male and rests were female. Most of the victims (74.01%) were of 12-18 years age. Most of the perpetrators (51.18%) were strangers to the victim. The cases of sexual assault with children occurred mostly in the places other than house (45.66%). More than one fourth of the victims (26.77%) sustained some type of bodily injuries.

Conclusions: Sexual assault among children is predominant among females and mostly between the teenager age group with perpetrators being stranger to the victim Psychological screening of the potential pedophiles could lead to minimizing the incidence of child sexual assault and abuse. Psychosocial counseling to the victim is must to prevent the devastating psychological effects of sexual abuse.

Background: Bile duct calculi occur in a significant proportion of patients with cholelithiasis. They are usually managed by endoscopic methods, but surgical management is needed in complicated cases. The choice of a specific surgical procedure depends on various factors, such as the extent of bile duct dilation, the location of stones, and the presence of stricture or fistula. In this study, we described the different surgical procedures and their outcomes for patients with bile duct stones that could not be cleared by endoscopic methods.

Methods: This is a retrospective cross-sectional study of patients who underwent different surgical procedures for bile duct stones. Patients treated from January 2022 to December 2024 were included in the study. Demographic and clinical data were obtained from medical records and analyzed.

Results: There were 55 patients, of whom 36 were female. Pain in the abdomen and jaundice were the most common symptoms. Laparoscopic common bile duct exploration was done in 10 (18.2%) patients. Bile duct stones along with biliary fistulas, hepatolithiasis, or liver atrophy were present in 16(29.1%) cases. Besides bile duct exploration, other procedures, including choledochoduodenostomy or hepaticojejunostomy(14.5% ), choledochoplasty (5.5%), and liver resection (12.7%), were required for the management of these patients. There was no mortality, but two (3.6%) patients had residual stones, and eight (14.5%) patients developed major complications with Clavien-Dindo grade three or more.

Conclusions: Bile duct calculi that could not be cleared by endoscopic methods require surgical intervention. CBD exploration in combination of other required procedures can be performed for the management of bile duct stones and their complications with good outcomes.

Background: Asymptomatic bacteriuria in hemodialysis patients is a common problem due to their decreased immunity and renal function which often leads to development of urinary tract infection and other complications. However, there are no adequate guidelines that recommend the routine screening and management of such patients in most of the developing countries including Nepal resulting in antibiotic misuse. This study was done to find the magnitude of asymptomatic bacteriuria among hemodialysis patients along with their antibiotic susceptibility and related risk factors.

Methods: A descriptive cross-sectional study was conducted on hemodialysis patients from July 2023 to January 2024. Midstream clean catch technique was used for urine collection. Urine specimens were processed for identification of uropathogens and their antibiotic susceptibility test by Kirby Bauer disk diffusion method following standard guidelines. Statistical analysis was done by Excel 2016 and SPSS 26, the point estimate was calculated at a 95% confidence interval.

Results: The overall prevalence of asymptomatic bacteriuria was 27%. Escherichia coli (43.47%) was the most frequent isolate. Imipenem and Amikacin were the most sensitive antibiotics among Gram negative isolates while Ceftriaxone and Nitrofurantoin were the most resistant antibiotics. Pseudomonas aeruginosa was the major multidrug resistant pathogen. Hypertension and Diabetes Mellitus were commonly associated risk factors for asymptomatic bacteriuria in hemodialysis patients.

Conclusions: This study demonstrates high prevalence of asymptomatic bacteriuria among hemodialysis patients. Routine screening of asymptomatic bacteriuria aids in early detection and management of complications along with optimization of antibiotic use.

Background: Adequate nutrition during pregnancy is crucial for maternal and fetal health. This study aims to assess the nutritional status, food insecurity, and socio-demographic factors affecting the nutritional status of pregnant women in this region.

Methods: A cross-sectional study was conducted among 903 pregnant women in Kailali district. Data were collected using structured questionnaires covering socio-demographic characteristics, food insecurity and knowledge of nutrition. Nutritional status was assessed using Mid-Upper Arm Circumference (MUAC). Statistical analysis was performed to identify associations between nutritional status and various factors.

Results: The majority of women (68.6%) had normal nutritional status (MUAC >23 cm), while 31.4% were either had severe or moderate malnutrition. Approximately 10% to 12% of participants reported food insecurity. A significant association was found between higher MUAC and factors such as sufficient nutrition knowledge, regular antenatal care visits, increased dietary intake, and a higher pre-pregnancy BMI. Ethnic disparities were also noted, with Dalit, Janjati, and Brahmin women having higher MUAC compared to Madeshi and Muslim women.

Conclusions: Nutritional deficiencies and food insecurity remain significant challenges for pregnant women in Kailali district. Strengthening nutrition education, improving food security, and promoting antenatal care can improve maternal nutrition and health outcomes.

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.

Congenital cystic adenomatoid pulmonary malformations are defined as the presence of a cystic mass of undifferentiated lung tissue; a third of the cases affect one of the lower lobes, and multilobar or bilateral affection is rare. The entity is a rare congenital malformation in the lungs, with an incidence of one in 11,000 to one in 35,000 live births. It is mainly discovered during the fetal period, although a low percentage of patients will be diagnosed postnatally. The disease has a wide spectrum of clinical manifestations, from asymptomatic to life-threatening respiratory symptoms. The diagnosis is made by imaging studies, and the treatment depends on the patient's clinical status. We reported the case of an infant with a rare congenital pulmonary airway malformation and a late diagnosis, which makes the case even rarer, who required open lobectomy as treatment. Keywords: Congenital abnormalities; cystic adenomatoid malformation of lung; lung diseases.

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.

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.