Journal of Nepal Health Research Council最新文献

Background: Several studies have investigated the relationships between female reproductive diseases and ABO blood groups. However, evidence regarding the potential association between ABO blood groups and adenomyosis remains limited. The aim of the study, thus, was to investigate the association between ABO blood groups and the risk of developing adenomyosis in Nepalese women.

Methods: A cross-sectional study was conducted at the department of obstetrics and gynecology, Tribhuvan University Teaching Hospital, Maharajgunj, from 2016 to 2017. Statistical analysis was done using Statistical Package for Social Sciences (SPSS, 29). Odd ratio with their corresponding 95% confidence intervals, and P-value were calculated and analyzed. A P-value equal or < 0.05 was considered statistically significant.  Results: A total of 249 with recorded ABO groups were included in this study. Of these, 85 cases (34%) were histologically confirmed to have adenomyosis. The most frequent ABO blood group was B (43%), while the least frequent group was AB (6%). Women with blood group B had a significantly increased risk of developing adenomyosis, with an odds ratio of 2.3 (95% CI: 1.22-4.43, P value = 0.01). Conversely, blood group A was associated with a significantly reduced risk of adenomyosis, with an odds ratio of 0.41 (95% CI: 0.19-0.89, P value= 0.03).       Conclusions: This study demonstrated that women with blood group B have a 2.3-fold higher risk of developing adenomyosis, whereas those with blood group A may have a protective effect. Multicenter studies with larger sample sizes and diverse demographics groups are needed to substantiate these findings.

Key words: Adenomyosis; ABO blood group; risk factors.

Background: Female prisoners constitute a minority of prison population and their special health care needs are often neglected. This study aims to assess the knowledge of menstruation and menstrual hygiene practices of female prisoners of Jhapa and Morang.

Methods: A cross sectional study was conducted among 140 female prisoners of Jhapa and Morang District Prison of Eastern Nepal through a pretested semi structured questionnaire and face to face interview. Logistic regression model was used to assess the factors associated with the outcome variable using an adjusted odds ratio with a 95% CI, and p-value <0.05 was considered statistically significant.

Results: The study showed that 65% of the female prisoners had adequate knowledge about menstruation. Half of the respondents (50%) had good menstrual hygiene practice. Majority of the respondents (67.9%) used sanitary pad and nearly one third (32.9%) used clothes as absorbent material during menstruation. Dysmenorrhea was the major health problem (31.9%) reported by prisoners. Respondent's knowledge on menstruation was significantly associated with educational status (AOR: 6.775, 95% CI: 2.089-21.87), marital status (AOR: 3.375, 95% CI: 1.979- 11.63) and former residence (AOR: 5.014, 95% CI: 2.196-11.44) in multivariate analysis.

Conclusions: More than one third of female prisoners had inadequate knowledge about menstruation and half menstrual hygiene practices were unsatisfactory. This demonstrates a need to design health education programme and foster advocacy to improve the knowledge and promote safe hygienic practice of female prisoners during menstruation.

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.

Background: High Blood Pressure, a prevalent condition exacerbated by population growth, disproportionately affects the elderly, with over two-thirds of individuals aged 65 and above affected. This study aimed to evaluate the prevalence and risk factors of high blood pressure among elderly residents of Chandragiri Municipality in Kathmandu.

Methodology: A cross-sectional was applied, and the respondents were selected from randomly chosen wards of Chandragiri Municipality. Elderly individuals aged over 60 years residing in the area, regardless of permanency, were included. Data analysis was conducted using SPSS software, with the Chi-square test employed to assess associations between high blood pressure and various risk factors at a significance level of 5%.

Results: The study included 418 individuals, of whom 48.8% were currently suffering from high blood pressure. The majority was male 55.5% and married 73.7%, with Chhetri 45.2% and Brahmin 40.7% being the most prevalent ethnic groups. Most respondents were illiterate 44.3% and resided in joint families 68.4%. Reported risk factors for high blood pressure included tobacco smoking 37.3%, alcohol consumption 36.1%, and non-vegetarian diets 85.9%.

Conclusion: Significant relationships were observed between blood pressure and age, sex, marital status, tobacco smoking, and alcohol consumption. Conversely, religion, ethnicity, education level, family type, BMI, diet type, and physical activity did not exhibit noteworthy associations with high blood pressure in this sample. These findings underscore the multifactorial nature of high blood pressure and its diverse risk factors.

Background: Type 1 Diabetes Mellitus is known to be associated with multiple co-morbidities. Vitamin B12 deficiency is a potential co- morbidity that might have been overlooked in these patients. The aim of this study is to evaluate the serum level of vitamin B 12 in a well-defined population of Type 1 diabetes.

Methods: The cross sectional study carried out on 40 patients with Type 1 Diabetes Mellitus visiting endocrinology unit in Kanti children's Hospital, Kathmandu, Nepal. Thirty healthy non diabetics were also selected. Serum C-peptide, vitamin B12, creatinine, blood glucose level and glycosylated hemoglobin were assessed in both groups. SPSS ver. 22 was used to analyze the data.

Results: The mean serum vitamin B12 level of the diabetic group was 206.92±82.18 pmol/L. Among the population 40.0% i.e. 16 out of 40 were found to be deficient and 37.5 % i.e. 15 out of 40 were subclinically deficient. Whereas the mean serum vitamin B12 level of the non diabetic group was 340.71±136.02pmol/L. Out of 30 only 2(6.7%) were deficient, 8 (26.75%) were found to be subclinically deficient. Significant difference was noticed in the mean serum level of vitaminB12 between these two groups.

Conclusions: This study shows the presence of low serum vitamin B12 levels in Type 1 Diabetics. The routine screening for this condition along with confirmatory test and detail clinical examination could benefit the patients with Type 1 diabetes.

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.

Background: The level of various enzymes and thyroid hormones in blood get altered during miscarriage, which can have predictive value or importance as a biomarker for the diagnosis. The aim of the present study is to validate the alteration in the level of serum enzymes and thyroid hormones in patients suffering with miscarriage in a tertiary care hospital in Nepal.

Methods: A descriptive cross-sectional study was carried out on patients suffering with miscarriage and admitted for treatment in Nobel Medical College Teaching Hospital. Demographic data were recorded in a predesigned performa. The level of various enzymes and thyroid hormones were estimated from the blood sample of patients in the department of biochemistry laboratory. Data were entered in MS excel and analyzed by statistical package for the social sciences Version version 20.0 Results: The total number of patients suffering from miscarriage and enrolled in the study was 86. The mean value of serum gamma glutamyl transferase, lactate dehydrogenase and adenosine deaminase in these patients were 22.67±8.22, 289.6±126.9 and 21.3±9.9 IU/ml respectively, which were significantly higher (p=<0.0001, 0.0004, 0.0179 respectively) when compared to healthy pregnant women. Thyroid dysfunction was noted in 15 (17.44%) patients, out of that Subclinical hypothyroidism was most common and affected 8(9.3%) individuals.

Conclusions: The mean value of serum gamma glutamyl transferase, lactate dehydrogenase and adenosine deaminase in case of miscarriage was found to be elevated significantly and thyroid dysfunction was also noted to small fraction of patients suffering from miscarriage with Subclinical hypothyroidism being the most common.

Background: The medical sector in the society and its significant role of job satisfaction will improve the health workforce performance. Presently staffs/workforce management in medical colleges became more challenges. The purpose of the study was to investigate the level of job satisfaction and associated factors in medical colleges of Nepal.

Methods: The study employed descriptive, cross-sectional study with the relevant respondents' such as doctors, nurses and administrative staffs working in different medical colleges of Nepal. The study was conducted within the affiliated college of Kathmandu University School of Medical Sciences (KUSMS). Simple random sampling method was used to select respondents. A total sample size of 108 for quantitative and 18 for qualitative was collected, using the formula from Charan and Biswas, 2013. For qualitative study, we used purposive convenience sampling strategy to enroll the health workers for key informant interview to gather data on job satisfaction, impression and experience about their job.

Results: 34.3% of the respondents, we surveyed were not satisfied with their job while 65.7% were satisfied with their current job. It has also been discovered that the delivery of high-quality health care depends on the level of job satisfaction with the healthcare organization.

Conclusions: There was a significant relationship between job satisfaction of health workforce and its' associated factors in medical college of Nepal. A focus on improving work environment through increased financial motivation and career development opportunities as well as investing in health insurance for diseases with increased resources support is recommended to improve job satisfaction.

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.