Journal of Nepal Medical Association最新文献

Introduction: Suicide is a major public health concern globally as well as in Nepal. It is important to have baseline data regarding suicide attempts to develop a prevention strategy. This study aims to describe the methodology used to develop a suicide registry and use it to collect data from patient visiting emergency or psychiatric outpatient department with suicide attempts in a tertiary care hospital.

Methods: This is a descriptive cross-sectional study conducted retrospectively after obtaining ethical approval (Reference number: drs2005211371) from institutional review committee. Total sampling was done from the database covering the period from October 1, 2017, to September 30, 2023. The database was in the form of suicide registry that was developed after reviewing the existing data of primary health care centres, private hospitals, and tertiary care centers and a series of discussions among mental health experts. Data was entered in Microsoft Excel and analysis was done.

Results: Among the 248 patients, there were 109 (43.95%) male and 139 (56.05%) female. There were 209 (84.27%) patients who attempted suicide inside home, poisoning was seen in 90 (36.29%) and 183 (73.79%) had impulsive intention. Out of total patients, 59 (23.79%) had prior communication and 84 (33.87%) had previous attempts, 109 (43.95%) patients had impulsive attempts as diagnosis and 75 (30.24%) had depression.

Conclusions: As per the suicide registry, most of the patients attempted suicide inside home and the most common method used was ingestion of poison.

Introduction: Prematurity is a significant cause of neonatal morbidity and mortality, especially in low-income and middle-income countries like Nepal. However, there is a paucity of data regarding its burden. This study aimed to determine the prevalence and outcomes of preterm neonates admitted to the neonatal intensive care unit of a tertiary care hospital.

Methods: This descriptive cross-sectional study was conducted among preterm neonates at a tertiary care hospital between July 15, 2022 to July 14, 2023 after obtaining ethical approval from the Institutional Review Committee (Reference number: F-NMC/557/078-079). Neonates with gestational age less than 37 weeks were included in the study. Total sampling method was used.

Results: Among 980 neonates admitted to intensive care unit, preterm neonates were 112 (11.43%). A total of 69 (61.61%) preterm neonates were outborn, and 65 (58.04%) were male. The median gestational age and birth weight were 32 weeks (interquartile range: 30- 34 weeks) and 1500 gm (interquartile range: 1300-1800 gm), respectively. There were 60 (53.57%) neonates with sepsis, 51 (45.54%) with neonatal jaundice and 38 (33.93%) with respiratory distress. Death occurred in 12 (10.71%) preterm neonates in the hospital.

Conclusions: The prevalence of preterm neonates was similar to other studies done in similar settings.

Introduction: Fine needle aspiration cytology is a simple, rapid, cost-effective method in diagnosis of head and neck swelling with minimal risk of complications. Head and neck swellings include a broad spectrum of diseases with different management for each. Fine needle aspiration cytology is a suitable and useful method for assessment of these swelling. This study was done with the objective to study the frequency and distribution of various head and neck lesions detected by fine needle aspiration cytology.

Methods: A descriptive cross-sectional study was conducted at the Department of Pathology in a tertiary care center from February 1 to July 31, 2023 after obtaining ethical approval from Institutional Review Committee (Reference number: IRC-PA-191/2078-79). All the patients presenting with head and neck swelling during the study period were included in this study. Total sampling was done. Fine needle aspiration was done and cytological diagnosis was made. Descriptive analysis was done where frequency and percentage were calculated.

Results: Out of 112 cases included in the study, 43 (38.40%) were of lymph nodes, 36 (32.14%) of thyroid, 22 (19.64%) of skin and soft tissue and 11 (9.82%) of salivary glands. Among the lymph nodes cases, there were 11 (25.57%) metastases. In thyroid lesions, beingn lesions were seen in 24 (66.68%).

Conclusions: This study found that lymph nodes were the most common site for head and neck swellings, frequently involving metastatic lesions.

Abstract: Pentalogy of Fallot is a rare form of congenital cyanotic heart disease with a prevalence of 3/10,000 live births characterized by an association of Tetralogy of Fallot with Atrial Septal Defect. Pentalogy of Fallot with anorectal malformation is also a rare combination. Here we describe one of the rare case reports of a full-term, 38 weeks, female baby diagnosed with pentalogy of Fallot with imperforate anus and rectovaginal fistula at a tertiary care hospital. Pentalogy of Fallot combined with an imperforate anus and rectovaginal fistula is an exceptionally rare and complex congenital condition. The co- existence of these anomalies emphasizes the need for thorough prenatal and postnatal evaluation for early detection and management.

Introduction: Premature rupture of membrane (PROM) refers to the disruption of the fetal membrane before the beginning of labor, resulting in spontaneous leakage of amniotic fluid. Cervicovaginal infection is an important risk factor of PROM and can lead to complications to mother and the child. This study aimed to delineate the bacterial patterns found in PROM so that the ideal appropriate responsive antibiotics can be chosen.

Methods: A descriptive cross-sectional was done during the period of 6 months from December of 2023 to May 2023, to characterize the microorganisms in the vaginal fluid found in antenatal women presenting with premature rupture of membraneafter obtaining ethical approval (IRC number: 20102023/02). A total of 117 antenatal women diagnosed with premature rupture of membrane were included in the study. High vaginal swabs were collected for microbial culture and sensitivity. Data were entered using Microsoft Excel 2000 (v9.0) and Statistical Package for the Social Sciences (SPSS) software version 26.0 was used for analysis.

Results: Out of 117 samples, culture growth was present in the culture of high vaginal swabs of 23 (19.66%) women. The high vaginal swab cultures from the samples collected in women presenting with PROM reported 9 different types of pathogens E. coli in 12 (52.17%), Klebsiella in 4 (17.39%) and Pseudomonas in 2 (8.70%) cultures.

Conclusions: This study reveals diverse microorganisms in premature rupture of membrane cases, with E. coli being the most common. Identifying these bacterial patterns is essential for selecting effective antibiotics, improving maternal and neonatal outcomes, and reducing morbidity and mortality by early detection and treatment of vaginal infections.

Abstract: Nepal has a health care system that is complicated by access, affordability, and availability. The geographical difficulty makes the health care reach to public more difficult. Nepal being a disasterprone country, it makes very important to strengthen the disaster preparedness up to the mark before the disaster strikes. During disaster and public health emergencies, the healthcare system quickly becomes overwhelmed or structural damage makes it non-functional, which necessitate the prior identification of Alternate Care Site by health service providers. Incorporating the identification of Alternate Care Sites into the Hospital Disaster Preparedness Plan represents a crucial transition from theoretical discussion to practical implementation for strengthening healthcare facilities. . This paper discusses the concept of Alternate Care site and its implementation in Nepal's health emergency preparedness for disaster and public health emergencies.

Abstract: Levamisole has been used as an effective immunomodulator. Levamisole has been used for nephrotic syndrome due to its immunostimulant, immunomodulating, and steroid-sparing effects. Common adverse effects of levamisole are gastrointestinal symptoms (nausea, abdominal cramps), and pyrexia. However, agranulocytosis or pancytopenia is also a rare but life-threatening complication of levamisole. This is a case report of a 5-year-old girl who had steroid-dependent nephrotic syndrome for which she was started on levamisole as per her weight, following which she had falling total leukocyte count levels on every visit. Thus, this case report emphasizes identifying this rare side effect and its management.

Introduction: IgA nephropathy is the leading cause of primary glomerulonephritis worldwide. The Oxford classification can predict IgA nephropathy prognosis through renal biopsy however its applicability to the Nepalese population remains unexplored. This study aimed to evaluate the MEST-C score and treatment response in patients with IgA nephropathy.

Methods: This descriptive cross-sectional study was conducted at a tertiary care center from November 2021 to November 2022 after obtaining ethical approval [IRC-193(6-11)t2078/079]. Total population sampling was done. Fifty-two consenting patients aged 16 or older with confirmed IgA nephropathy were included, excluding those with liver disease or expected survival of less than six months. The study assessed the MEST-C score, demographic factors, and clinical parameters. Data analysis was done using Statistical Package of Social Sciences.

Results: Among 52 patients with segmental glomerulosclerosis (S1), 11 (24.44%) achieved complete remission, 30 (66.67%) partial remission, and 5 (11.11%) progressed to end-stage renal disease. In those with tubular atrophy/interstitial fibrosis (T1), 1 (5.88%) achieved complete remission, 13 (76.47%) partial remission, and 4 (23.53%) progressed to end-stage renal disease. For glomerular crescents (C1), 9 (47.37%) achieved complete remission, 9 (47.37%) partial remission, and 1 (5.26%) progressed to end-stage renal disease. IFTA% of 0-25% had complete remission in 15 (46.88%). Among the two patients with IFTA% ≥50%, one (50%) developed end-stage renal disease and the other achieved partial remission.

Conclusions: The S1 and T1/2 components of the MEST-C score had higher rates of partial remission and progression to end-stage renal disease, while other indices showed mixed results. The risk of failing to achieve complete increased with an IFTA of more than 25%.

Introduction: Laparoscopic cholecystectomy, being minimally invasive, is widely accepted in comparison to open cholecystectomy. The major benefits are small incision, less wound pain, rapid recovery, shorter hospital stay and earlier return to activities. Although, trauma and injury are limited in laparoscopic cholecystectomy; it is not a pain free surgery. Hence, we aimed to find the prevalence of pain at wound site after laparoscopic cholecystectomy at various time intervals in post-operative period.

Methods: The descriptive cross-sectional study was conducted among 125 patients who belonged to American Society of Anesthesiologists grade I & II patients, with diagnosis of symptomatic gallstone disease from October, 2022 to September, 2023 in a tertiary care hospital after ethical approval was obtained from Institutional Review Board (Reference number: MEMG/483/IRC). Total sampling was done in this study. The post-operative pain at wound site was measured at 12, 24, 36 and 48 hours. Data were analyzed using Statistical Package of Social Sciences 21.0.

Results: At 12 hours postoperatively, 2 (1.60%) patients complained of severe pain, 120 (96%) patients reported moderate pain and 3 (2.40%) patients expressed their pain as being mild. Likewise, at 24, 36 and 48 hours postoperatively, none of the patients suffered from severe pain. At 24 hours post-operative, 105 (84%) patients reported moderate pain which gradually declined over 48 hours. At 36 and 48 hours post-operative mild pain was reported by 85 (68%) and 117 (93.60%) patients. The moderate pain was complained by 40 (32%) and 8 (6.40%) patients.

Conclusions: The majority of patients suffered from mild to moderate pain after laparoscopic cholecystectomy, the intensity of which decreased over 48 hours.