Journal of Nepal Health Research Council最新文献

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.

Background: Intraocular pressure measurement is one of the important and commonly performed examination in Ophthalmology. Goldmann applanation tonometer has been gold standard for measurement of Intraocular pressure. Intraocular pressure measurement is known to be affected by Central corneal thickness. It has been stated that thinner cornea leads to false low Intraocular pressure while thicker cornea leads to false high Intraocular pressure interpretations.

Methods: A total of 920 patients of forty and above years with no any anterior segment pathology like corneal diseases, corneal oedema and opacities, uveitis, ocular surgery, ocular trauma or evidence of glaucoma were included. This was cross sectional, descriptive, hospital based study. Ultrasonic pachymeter was used to measure Central corneal thickness and Goldmann applanation tonometer was used to measure Intraocular pressure. A correction factor was applied and corrected Intraocular pressure values were calculated.

Results: The mean Central corneal thickness was 538.70 ± 29.17 µm and Intraocular pressure was 14.72 ± 2.58 mmHg. The mean Central corneal thickness of the females was thinner and mean corrected Intraocular pressure was higher than male. There were statistical significant differences in the mean Central corneal thickness and corrected Intraocular pressure between genders (p= 0.029, p=0.04) respectively. There was a significance difference in mean Central corneal thickness between different age groups (p= <0.001). Corrected Intraocular pressure is negatively correlated with Central corneal thickness (r= - 0.49, p= <0.001). In this study there was a significant association between Central corneal thickness and Intraocular pressure, age, gender and refractive error.

Conclusions: A thick cornea leads to an overestimation of Intraocular pressure while thin cornea leads to an underestimation of Intraocular pressure. We recommend that Intraocular pressure measurement should be associated with a pachymetry correction to avoid inaccurate readings.

Background: Complete edentulism is terminal outcome of tooth loss which itself is multifactorial entity. The periodic comparison of demographic variables in the complete edentulous cases attending dental hospital can give an insight into the status of oral health care, awareness of dental treatment and burden of disease in the community.

Methods: This is a hospital-based study on secondary data of all the cases attending for complete denture therapy from January to December of three years viz. 2012, 2017 and 2022. Proportion of gender, age-specific distribution, geographic residence of patients is presented in percentage. The mean age of patients among three years is compared using One-way ANOVA at 95% confidence interval at level of significance at 0.05.

Results: A data of 830 patients were extracted for analysis. The demographic parameters were obtained and analysed using SPSS 11.5. In all years, male and female patients were almost equal. The number of patients has increased markedly from 2012 to 2017 but plateaued towards 2022. The mean age of patients being edentulous (65.71±10.38 years in 2012, 66.44±8.75 years in 2012 and 66.38±8.83 years in 2022) has not changed significantly (p >0.05) over ten years.

Conclusions: In ten years' time, demand of conventional complete denture has slightly increased, mean age of edentulism remained stagnant and patients from remote hill areas had to visit faraway hospitals for denture therapy. Large scale studies in community are needed to find out the disease burden and determinants of complete edentulism in Nepalese population.

Background: An important anatomical factor in injuries to the inferior alveolar nerve is the spatial relationship between the mandibular canal and the corresponding third molars. This study was designed to classify the anatomic three-dimensional relationship between mandibular third molars and the mandibular canal on cone-beam computed tomography mages.

Methods: A cross-sectional study was conducted by using CBCT images of 100 individuals visiting the Dental Outpatient Department of X hospital from Jan 2022 - Oct 2022. The images were used to classify the threedimensional relationship between the mandibular canal relative to the roots of the mandibular third molar according to Liqun Gu et al 2018 classification. In this classification, four anatomical positions were considered: buccal, lingual, apical and inter-radicular. The second factor considered was the contact and non-contact relationship between the inferior alveolar nerve canal and the mandibular nerve. The data was analyzed via SPSS version 20. Chi square test was performed to determine the contact relationship of the mandibular third molar root with the mandibular canal.

Results: Most of the mandibular canals observed via CBCT (45.0%) were located on the buccal side of the mandibular third molar followed by the apical side (26.0%), between the roots (23.0%) and very few (6.0%) on the lingual side. A significant association was found between the position of the mandibular third molar and the mandibular canal (p<0.001) when the position was lingual and interradicular.

Conclusions: The findings of this study revealed that the majority of mandibular third molars were located on the buccal side. There was a significant relationship between the position of the mandibular third molar and the mandibular canal.