Journal of Nepal Health Research Council最新文献

Background: Chronic obstructive pulmonary disease is defined as a preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation attributable to airway accompanied by alveolar abnormalities elicited by significant exposure to noxious particles or gases. Stress hormone is involved in proclivity towards causation of hyperglycemia and hyponatremia in COPD.

Methods: This study is an analytical cross sectional single center study that was carried out in Tribhuvan University Teaching Hospital. Specimens were processed as per the guidelines of Standard Operating Procedure (SOP) of Biochemistry laboratory of Tribhuvan University Teaching Hospital.

Results: In this study of 138 patients with acute exacerbation of COPD, the mean age was (71.88±9.771) years with higher prevalence in the age group between 70-80 years of age. Females (65.2%) outnumbered males and 71.7% came from outside the Kathmandu valley. Hyponatremia was observed in sodium levels with 51.4% below normal with majority of patient's possessing mixed acid-base disorders (58.7%). Most of thepatients 76.5% received general care with a mean hospital stay of 8.7 days. Statistical analysis revealed significant associations between care type, geographical distribution (p=0.026) and duration of stay with care type (p=0.0001). No significant associations were found regarding gender, glucose, sodium, potassium levels and age with duration of stay.

Conclusions: Factors such as age, gender, and glycemic status did not significantly affect the type of care or duration of hospital stay, geographical location emerged as a significant determinant, with patients from outside the Kathmandu valley more likely to receive general care. Despite the prevalence of electrolyte imbalances and acid-base disorders, these biochemical factors showed no substantial impact on clinical outcomes, suggesting that other factors may play a more significant role in duration of stay.

Background: Dense breasts are associated with an increased risk of cancer and also mask lesions on mammograms. In our study, we evaluated the role of sonography as an adjunct to digital mammography in patients with dense breasts.

Methods: Sonography of 676 female patients with American College of Radiology category C or D mammographic density was done in this prospective cross-sectional analytical study in the Department of Radiology, Tribhuvan University Teaching Hospital. The final imaging diagnosis was classified as per the American College of Radiology Breast Imaging Reporting and Data System categories. Tissue diagnosis was obtained in patients with sonographic category 3 solid lesions larger than 3 cm, category 4 and 5 lesions. The data were tabulated and analyzed using Statistical Package for Social Service (SPSS) for Windows version 22.

Results: Additional sonography confirmed all BIRADS 1 mammograms as normal or benign, 95.7 % (112) of inconclusive, and 82.8% (n=135) of BIRADS 3 ones as benign. It had higher sensitivity and negative predictive value (100%) than mammography with similar accuracy. Most patients (479, 70.9%) had diagnostic indications. There were 540 (79.9%) cases in ACR BIRADS category c. A final diagnosis of benign (316, 46.7%) was most common, followed by normal (293, 43.4%) and malignant (67, 9.9%). The majority of the malignant lesions were Invasive Ductal Carcinoma (59, 88%).

Conclusions: Additional sonography confirmed mammography findings as normal, benign, or suspicious for malignancy, definitely described morphology and extent of mass, and also guided biopsy. It had higher sensitivity than mammography in dense breasts.

Background: Urban areas are occupied with dense population and green spaces are hard to find. Urban agriculture solves food security problems as well as has important positive health outcomes. The aim of this study is to determine health and wellbeing Benefits of Urban Agricultural Practice.

Methods: A cross-sectional study was conducted from December 2022 to June 2023. Random selection of three study sites from Kathmandu valley was done. The total sample size was 230 which was grouped into involved in agriculture (115) and non- Involved in agriculture (115). Those groups were recruited from different wards of Kathmandu, Lalitpur and Bhaktapur. Questionnaire regarding socio-demographic variables, SF-12 health survey, perceived stress scale, satisfaction with life scale were used. KoBo Toolbox was used for data collection.

Results: The involved in agriculture groups differed from non-involved in terms of gender, ethnicity, occupation, marital status, education and ownership of the house (p<0.05). Participants engaged in urban agriculture reported significantly lower levels of perceived stress compared to those not involved in urban agriculture. Similarly, the data shows that life satisfaction was significantly higher among the group involved in urban agriculture.

Conclusions: Urban agriculture was associated with lower perceived stress and higher life satisfaction among the study participants who were involved in urban agriculture compared to the group not involved as compared to the group of study participants not involved in urban agriculture.

Background: Traumatic deaths, resulting from spinal injuries are significant issue in Nepal. The study aims to assess the prevalence of spinal injuries amongst the traumatic death cases brought in for autopsy in Jumla and to provide their socio-demographic profile.

Methods: This is a descriptive cross-sectional study done in Karnali Academy of Health Sciences (KAHS) from 16th July 2021 to 16th July 2023 incorporating all the traumatic deaths brought for autopsy. The data was collected using a proforma which included the modality of trauma, spinal involvement, seasons associated with trauma and demographic variables of the deceased. The data was analyzed using both Microsoft excel and SPSS 23.0.

Results: A total of 55 cases were brought for autopsy following traumatic death with road traffic accident (45.45%) and fall injuries (29.1%) being the most common mode of trauma. Among all traumatic deaths, 29.1% cases presented with spinal injuries. The cervical spine (68.8%) was the most commonly affected spine followed by thoracic (12%), lumbar spine (6.3%) and two cases with multiple spinal involvement. Of all the spinal injury cases in traumatic deaths, the highest and the lowest number of cases occurred during spring and summer season respectively.

Conclusions: Traumatic deaths caused by spinal injuries after fall and road traffic accidents is a common phenomenon in Jumla. Thus, timely preventive measures associated with these deaths needs to be addressed to reduce them.

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Background: Intimate Partner Violence refers to any behavior within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship. There are very serious health consequences in the health of women due to intimate partner violence. Thus, this study tries to explore the health effects of intimate partner violence and minimization strategies associated with it.

Methods: A phenomenological study design was used in the study. Interviews were conducted among eleven study participants. Interviews were done with the survivors of violence, female community health volunteers, health personnel, local leaders, and staff of the municipality working in the Judicial Committee. Interviews were transcribed and translated and thematic analysis was done.

Results: Survivors of violence mainly faced three forms of violence (Physical, sexual, and emotional) resulting in various health effects. Complaints like headache, head injury, pain, and sores were physical health effects reported by women whereas complaints like stress and having suicidal thoughts were the mental health effects. Family taboos, poverty, unemployment, illiteracy, social norms, and tradition were found to be the factors associated with intimate partner violence while the minimization strategies included proper communication, mutual understanding among partners, and awareness about social and legal rights.

Conclusions: Effective communication and mutual understanding between husband and wife is key in reducing these health effects. In addition, in community level women empowerment is crucial for mitigating IPV.

Background: Chronic kidney disease (CKD) poses significant global health challenges, including in Nepal, where the increasing need for hemodialysis are influencing patient's daily life. This study aimed to explore lived experiences of CKD patients undergoing hemodialysis.

Methods: A qualitative, phenomenological research design was employed. In-depth interviews were conducted with 13 hemodialysis patients at Bir Hospital from December, 2023 to January, 2024. Analysis followed Colaizzi's method, ensuring data quality through established credibility and transferability measures.

Results: Four major themes emerged: (i) Journey to receive hemodialysis (ii) Financial Constraints (iii) Psychosocial support (iv) Seeking for special health services. Patients perceived hemodialysis as a hope for existence but faced financial troubles and inadequate special and psychosocial support.

Conclusions: The lived experiences of the patients reflected both hope and challenges highlighting the need for improved health services and counseling in hemodialysis wards, along with enhanced governance in the healthcare system.

Background: Social anxiety is an intense anxiety or fear of being judged, negatively evaluated, or rejected in a social situation. It often develops in early adolescence, which eventually grows up to adulthood, mostly without being diagnosed. This study assessed the prevalence and factors associated with social anxiety in secondary school adolescents.

Methods: School-based cross-sectional study design was performed among secondary school adolescents of 10 schools in Kathmandu Metropolitan, Nepal. A total of 360 samples were obtained through multi-stage random sampling using the lottery method. A self-administered questionnaire was used as a data collection tool which included the Liebowitz social anxiety scale for children and adolescents. Data entry and analysis were done by using Epi Data and Statistical Package for Social Science (SPSS) software.

Results: The prevalence of social anxiety was 39.7% which was higher in females. The study found that 33.3% of the participants were in the high-risk category. A strong association (p<.001) was seen between self-perception and social anxiety. Similarly, a significant relationship (p<.001) was found with social experience-related variables, which included: the experience of traumatic situations, and being discriminated against bullied.

Conclusions: A high prevalence of social anxiety among adolescents was seen. One-third of the participants were in the high-risk category, clearly stating that the diagnosed cases only represented the tip of the iceberg. School-based youth-friendly entertainment and engagement interventions considering their emotional and mental health, might be beneficial in dealing with it.

Background: Bacterial infection is a global threat due to antibiotic resistance. This demands the urgent need for novel antibiotics, and soil actinomycetes could be the potential candidate. The key objective of our study was to detect antibacterial compounds from selected actinomycetes species isolated from high-altitude soil samples.

Methods: Three strains Streptomyces sp. 12923, Streptomyces sp. 13102, and Nocardia sp. 13105 were subjected to fermentation using International Streptomyces Project (ISP) 2 medium. Crude extracts of each isolate were recovered by Rotary evaporator. Crude extracts were fractionated in HPLC and fractions were collected in a 96-well plate to evaluate the antibacterial activity of each of the 19 fractions against a test organism E. coli BW25113. Crude extracts of three strains were analyzed using UPLC-MS/MS for antibacterial compounds. The LC-MS/MS data were processed using Metabo Scape software and features were annotated using different libraries in the software.

Results: For Streptomyces sp. 12923, fractions of the crude extract with the lowest OD600 0.472, 0.484 showed higher antibacterial activity against E. coli BW25113T, while the inhibitory action against same test organism was shown better by fractions OD600 0.250, 0.329, and OD600 0.273, 0.326 for Streptomyces sp. 13102 and Nocardia sp. 13105, respectively. The antibacterial compounds detected included Mayamycin and Mayamycin B from Streptomyces sp. 12923, Nocardamine and Streptazone D from Streptomyces sp. 13102, and Nocardimicin B, 4-O-methylmelleolide, Spathullin B and Nannozinone B from Nocardia sp. 13105.

Conclusions: The identification of these compounds from high-altitude actinomycetes further strengthens the claim that actinomycetes are rich sources of bioactive compounds.

Background: Acinetobacter baumannii has emerged as a problematic pathogen due to its ability to become resistant to antibiotics and form biofilms. The aim of this study was to explore antibiotic resistance and biofilm formation, and examine any correlation between these in Acinetobacter baumannii isolates.

Methods: This was a cross-sectional study conducted at the 750-bed Tribhuvan University Teaching Hospital in Nepal. Identification and antibiotic sensitivity of Acinetobacter baumannii isolates were performed following American Society for Microbiology guidelines. Different β-lactamases were detected by standard phenotypic tests. The microtiter plate method was used to screen strains of their ability to form biofilms.  Results: Out of total 18,343 clinical samples processed, 4,249 (23.1%) showed bacterial growth. A. baumannii comprised of 4.7% of the total bacterial growth. Multidrug-resistant (MDR) was exhibited by 97.5% of Acinetobacter baumannii isolates. All multidrug-resistant Acinetobacter baumannii isolates were resistant to cephalosporins and carbapenems; however, they were sensitive to polymyxins. Only few isolates showed sensitivity to sulbactam-containing antibiotics (15.4-29.2%), fluoroquinolones (1.0-7.2%), aminoglycosides (2.6-5.6%), and cotrimoxazole (4.1%). Extended-spectrum-beta-lactamase (ESBL), metallo-beta-lactamase (MBL), Klebsiella pneumoniae carbapenemase (KPC) and AmpC production were found in 54.9%, 73.3%, 41.5% and 14.9% isolates, respectively. Among all tested isolates, 192 were able to produce biofilms, with 83.1% being classified as strong biofilm producers. Those strains that were resistant to gentamicin were more likely to produce biofilms (P<0.05). ESBL, MBL, KPC and AmpC were seen in 51.8%, 71.6%, 43.8% and 16.0% of strong biofilm producers respectively.

Conclusions:   Only polymyxins were effective against Acinetobacter baumannii. Carbapenemase producers were generally strong biofilm producers, and gentamicin resistant strains were more likely to produce biofilms. The findings of this study may help to understand antibiotic-resistance mechanisms and provide valuable information in the treatment of MDR Acinetobacter baumannii infections.