Journal of Nepal Health Research Council最新文献

Background: Acute physiology and chronic health evaluation -II (APACHE-II) and Sequential organ failure assessment (SOFA) is used to predict overall mortality and sepsis outcome in the intensive care unit (ICU) respectively. There are limited studies that have shown that both score can be used to predict mortality in surgical and medical patients admitted in the intensive care unit.

Methods: It was a prospective, observational study in a level three intensive care unit of National Medical College, Birgunj. This study was conducted in 542 patients admitted in the mixed intensive care unit of medical; college. Demographic data was gathered from each patient in the preformed sheet at the time of presentation to the intensive care unit. Outcome of patients was recorded in terms of mortality, discharge toward and leave against medical advice. The descriptive data are presented as the number and percentage for categorical data and mean ± standard deviation for continuous data according to their distribution Results: Five hundred forty two patients were included in this study. 340(62.7%) were males and 202(37.3%) were females. 440(81%) patients survived and went home, 65(12%) expired, 26(5%) left the hospital against medical advice (LAMA) and 11(2%) gave do not resuscitate orders (DNR). The discrimination power was similar for APACHE II and SOFA scores (AUC=0.732 versus 0.771, respectively, p>0.05). APACHE II score>8.5 and SOFA >3.5 was cut off to predict mortality.

Conclusions: SOFA and APACHE II has similar discriminating power to predict mortality in all group of patients in a mixed intensive care unit.

Background: Maternal health is an important focus for ensuring the well-being of both mothers and their babies. Maternal and fetal mortality which is a burning issue especially in third world countries can be reduced significantly with right obstetric referral. This study reviewed the primary reasons, time, distance, and pattern of obstetric cases referred to a tertiary center.

Methods: This descriptive study was conducted after taking ethical approval {Approval number 136 (6-11) E2} from the review board of Maharajgunj Medical Campus, Nepal, and data of three years from 1st August 2020- 31st September 2023 were analyzed from medical records. The study included all referral cases aged 18-45 years who were past 28 weeks of gestation till 42 days post-delivery. Women who had incomplete medical records were excluded from the study. A continuous convenience sampling method was used. The point estimate was calculated at a 95% confidence interval.

Results: Among 174 referred cases, 84 (48.28%) were from the government district-level hospitals with the predominant reason being medical disorders complicating pregnancy 136 (78.17%). The majority of cases 94 (54.02%) were referred during the intrapartum period.

Conclusions: Medical disorders complicating pregnancy were the primary cause for the referral in obstetrics cases, notably from district-level hospitals having less manpower to deal with those cases.

Background: Visceral pain occurred during cesarean delivery during spinal anesthesia can be decreased with a higher dose of bupivacaine. However, larger doses of bupivacaine increases the risk of high sensory block. We hypothesized that addition of fentanyl to bupivacaine intrathecally could intensifies the sensory block and improves the quality of intraoperative analgesia. The aim of this study is to compare incidence of visceral pain between hyperbaric bupivacaine with or without fentanyl during cesarean delivery under spinal anesthesia.

Methods: In this prospective randomized controlled trial, 72 term parturient with ASA PS II undergoing cesarean delivery under spinal anesthesia were randomly distributed into two groups. Group B received 2.2ml (11mg) of 0.5% hyperbaric bupivacaine while Group BF received 2 ml (10mg) of 0.5% hyperbaric bupivacaine and 0.2ml (10µg) of fentanyl intrathecally. Incidence of intraoperative visceral pain, maternal hemodynamics, side effects and APGAR score were compared.

Results: During exteriorization of uterus, 11% of parturient in Group BF and 44% parturient in Group B complained of intraoperative visceral pain with significant difference between two group (p=0.002). The intraoperative rescue analgesia was given in 22 % parturient in Group BF and 33% parturient in Group B (p= 0.29). Maternal vital parameters like blood pressure, heart rate, oxygen saturation and respiratory rate were comparable between two groups. APGAR score was similar in both groups.

Conclusion: Addition of intrathecal fentanyl to hyperbaric bupivacaine was effective in reducing intraoperative visceral pain during cesarean delivery with stable maternal hemodynamics and without neonatal side effects.

Crigler-Najjar Syndrome Type 2 (CNS2) is a rare autosomal recessive disorder characterized by unconjugated hyperbilirubinemia due to partial deficiency of the enzyme uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1). We present a case of a 13-month-old male admitted to Kanti Children's Hospital with persistent jaundice since birth. Diagnostic evaluation accompanied by gene sequencing confirmed CNS2 and the patient was effectively managed with orally administered phenobarbitone. CNS2 can be distinguished from other potential causes of unconjugated hyperbilirubinemia based on bilirubin concentration and the affected patient's response to phenobarbitone. Genetic counselling is essential for the recognition and prevention of severe hyperbilirubinemia which, in the absence of timely medical intervention, may lead to neurotoxicity. Keywords: Case report; crigler-Najjar syndrome; genetic counseling; phenobarbitone; unconjugated hyperbilirubinemia.

Teledermatology is a means of diagnosing and managing dermatological cases virtually using digital tools. This is an important method which has been in use in Nepal and has a lot of potential to provide quality care to the patients from the remote corners of Nepal. It has been mostly used to manage chronic dermatological conditions. Here. we report a patient, suffering from multiple painful ulcers and a steadiliyy declining quality of life, was diagnosed with pyoderma gangrenosum via mobile teledermatology. Prompt intervention based on this remote diagnosis led to successful management and significant clinical improvement. We try to put an emphasis on the mobile teledermatology that it is even useful in hard to diagnose cases and provide proper management. We also would like to highlight that this modality should be promoted and used more often to provide specialists medical services to the rural communities Nepal. Keywords: Digital dermatology; pyoderma gangrenosum; teledermatology; telemedicine.

Background: Metered dose inhaler is the most recommended and efficient therapy for management of respiratory disorders but incorrect inhaler use has critical to get significant impact of medication. The study aimed to assess the knowledge and practice on Metered dose inhaler among patients with respiratory disorders.

Methods: Cross-sectional study was conducted among 126 patients with respiratory conditions in 2021 in a teaching hospital. A structured questionnaire was used to assess knowledge on using Metered dose inhaler whereas checklist created by the WHO Guide to Good Prescribing was used to evaluate patient's practice on inhalation technique.

Results: The results showed that 74 (58.7%) of the patients were female and belonged to age group 66-80 years (mean/SD 63.35±11.803). Over half of the patients i.e., 66 (52%) had a satisfactory level of knowledge whereas, only 2 (1.6%) patients were aware on the waiting time between each puff of Metered dose inhaler. The results showed that only 3 (2.4%) patients had practiced correct technique on Metered dose inhaler.

Conclusion: Though the higher proportion of the patients had satisfactory level of knowledge on Metered dose inhaler use but critical gap was seen in essential steps for using Metered dose inhaler. Healthcare providers should consider appropriate measure to increase the knowledge and correct use of Metered dose inhaler. That ultimately improves the quality of respiratory health of patients with respiratory disorders.

Background: Little is known about attitudes and practices regarding oral health of developing countries. This study aimed to determine the self-assessment of oral health status among adults residing at Chautara, Sindhupalchowk, Nepal.

Methods: A descriptive cross-sectional study was conducted among 440 adults selected by convenience sampling method. Interview using WHO oral health questionnaire for adults 2013 was taken after receiving informed consent. Data were entered in Microsoft Excel Sheet and analysed in SPSS version 24. Mean, standard deviation, frequency and percentage were calculated.

Results: Majority had positive assessment regarding their teeth (366, 83.18%) and gums (384, 87.27%). Many (417, 94.77%) cleaned their teeth ?one times a day. Majority used toothbrush (434, 98.64%) and paste (411, 93.41%) for cleaning their teeth. Some, (184, 41.82%) visited a dentist at least once in their lifetime and the main reason was pain or trouble in teeth/gums/mouth (94, 51.09%). Very often, they faced problems chewing (31, 7.0%) and biting (27, 6.1%) foods. They mostly consumed tea with sugar (132, 30.0%) and biscuits, cakes and cream cakes (59, 13.4%) several times a day. Most of them smoked cigarettes every day (93, 21.1%), followed by tobacco chewing (67, 15.2%). In the past 30 days, 179 (40.7%) drank one or more drinks of alcohol.

Conclusions: The study findings showed that most of the adult residents of Chautara, had positive self-assessment of their oral health status. However, they faced many oral health problems which may be due to their unhealthy lifestyle suggesting need for oral health awareness programs.

Background: Hypertension is a significant public health concern in Nepal, particularly in rural areas with limited healthcare access. Adherence to antihypertensive medication is critical for adequate blood pressure control and reducing cardiovascular complications. This study aims to assess medication adherence among hypertensive patients and identify associated factors.

Methods: A descriptive cross-sectional study was conducted in Namobuddha Municipality, Nepal. A total of 2,024 individuals aged 30 years and older were screened, of which 1,008 were identified as hypertensive. After applying the eligibility criteria, 478 participants were included in the final analysis. Medication adherence was assessed using the Hill-Bone Compliance to High Blood Pressure Therapy (HBCHBPT) Scale. Data were collected through face-to-face interviews using standardized questionnaires and analyzed using STATA version 17. Multivariate linear regression was performed to determine factors influencing adherence.

Results: Among 478 participants, the mean age was 62.12 years, with 55.86% being female. Most participants (91.63%) were on a single antihypertensive medication, and 57.11% had uncontrolled hypertension. The mean medication adherence score was 34.57 ± 1.90. In multivariate analysis, higher hypertension knowledge scores were significantly associated with better medication adherence (? = 0.07, 95% CI: 0.01, 0.13, p = 0.03). Other factors, including age, gender, education, ethnicity, marital status, smoking, alcohol use, physical activity, and social support, were not significantly associated with adherence.

Conclusions: The study found that medication adherence among hypertensive patients was suboptimal, with a significant proportion having uncontrolled blood pressure. Higher hypertension knowledge was associated with better adherence, highlighting the importance of patient education. Strengthening educational interventions and counseling strategies may improve adherence and, consequently, hypertension control.

Background: Antimicrobial resistance in Escherichia coli is mostly associated with ß-lactamases and carbapenemases enzyme production resulting in treatment challenges. This study was conducted with the aim to detect and characterize antimicrobial resistance in E. coli isolates.

Methods: A cross-sectional study was conducted during 2018-2022, at National Public Health Laboratory where the clinical specimens (24636) received were processed for identification and characterization of antimicrobial resistance following conventional & advanced methods. Antibiotic susceptibility tests were performed by Modified Kirby Bauer disc diffusion and Minimum inhibitory concentrations using VITEK2 compact (Biomeriux). The isolates were tested for extended-spectrum ?-lactamases and Carbapenemase production following Clinical Laboratory Standards Institute guidelines.

Results: Bacterial growth was observed in 9% (2166/24636) of the specimens, of which 44% (959) were E. coli. Among the 959 E. coli isolates, 320 were reconfirmed with VITEK-MS (Biomeriux). Phenotypic multi-drug resistance was observed in 75% (240/320) of the isolates with 62% (197/320) extended-spectrum ?-lactamases, 12% (39/320) AmpC-ß-lactamase, 10% (31/320) serine carbapenemases and 7% (22/320) Metallo-ß-lactamase while 3% (9/320) produced three types of enzymes. The extended-spectrum-?-lactamase producing E. coli were sensitive to Tigecycline (100%), Amikacin (92%), Imipenem (87%), and Meropenem (84%). Carbapenemase producers were sensitive to Tigecycline (100%), with 61% to Amikacin. Extensive-drug resistance was observed in 2% (7/320) of the isolates, with Colistin resistance in one.

Conclusions: The findings highlight alarmingly high antimicrobial resistance in E. coli posing significant challenges in treatment. Early detection of multi-drug resistant isolates in healthcare settings is crucial to combat antimicrobial resistance.

Background: Treating neonatal sepsis in Nepal remains difficult given the high rates of antimicrobial resistance. The objective of this study is to determine the antibiotic resistance pattern of culture-proven infections in neonates admitted to a neonatal intensive care unit.

Methods: This cross-sectional prospective observational study was performed at the Neonatal Intensive Care Unit of Pokhara Academy of Health Sciences from 15th july 2022 to 15th july 2023. We included all neonates admitted with positive cultures grown from blood, cerebrospinal fluid, endotracheal tube, and pus. Demographic, clinical, and microbiologic data were collected from the medical record. We reviewed antimicrobial susceptibility testing of all isolates.

Results: There were 51 culture-positive infections among 1327 neonates admitted, among which 23 cases from blood culture, 2 cases from cerebrospinal fluid, 14 cases from endotracheal tube samples, and 12 cases from pus samples. Gram-negative infections were predominant amounting to 35 (68.6%) including Pseudomonas in 12 (23.5%), and Acinetobacter species in 9 (17.6%) cases. Gram-positive infections were seen in 14 (27.4%) in which Methicillin-Resistant Staphylococcus aureus accounted for 6 (11.8%) cases. Yeast cells other than Candida albicans accounted for two (5.4%). For all Gram-negative isolates, resistance to Third-generation cephalosporin and aminoglycosides was reported in 75.0% (12 of 16 isolates tested) and 87.0% (24/31), respectively. Fluoroquinolone resistance was seen in 61% (8/13), resistance to penicillin was 59.3% (10/19), and resistance to carbapenem was in 100.0% (7/7) cases.

Conclusions: There were high rates of antimicrobial resistance even with the reserved drugs among gram-negative pathogens. This alarms for the need for rationale prescribing of antimicrobials.