Journal of Nepal Medical Association最新文献

Introduction: Posterior instrumented stabilization is a commonly done surgery in spinal tuberculosis. This study aims to evaluate the clinical, radiological, and neurological outcomes of posterior instrumented stabilization and transpedicular decompression in thoracic and lumbar spinal tuberculosis.

Methods: A descriptive cross-sectional study was conducted for one and a half years with at least six months of follow-up in a tertiary care center. The study was approved by the Institutional Review Committee (Reference number: 119 (6-11-5) 2/075-076). Total sampling was done and the study included patients over 18 years of age with spinal tuberculosis of the thoracic or lumbar regions. These patients underwent posterior instrumented stabilization and transpedicular decompression at the tertiary care center. The age, site of involvement, Visual Analog Scale score for back pain, neurological status as per Frankel Neurology grading, and local kyphotic angle in X-ray were recorded. The median, interquartile range and percentage were calculated. The data was entered in Microsoft Excel 2016 and analysis was done using Epi Info software version 7.2.

Results: Thoracic level was most commonly involved in 14 (46.68%) cases. The median back pain as assessed by the Visual Analogue Scale score improved from 8 to 2 at the 6-month follow-up. There was improvement in the neurological grading of all cases and there was no loss of correction in the local kyphotic angle till the final follow-up. The median age of cases was 48 years (interquartile range: 28-62.50).

Conclusions: Posterior instrumented stabilization and transpedicular decompression in adult patients with thoracic or lumbar spinal tuberculosis achieves improvements in clinical, radiological, and neurological outcomes.

Introduction: Anthropometry is one of the important parameters for differentiation of sex which varies significantly based on hereditary, geographical, racial, sexual, and other factors. This study was done to provide baseline foot anthropometric data for Nepali medical students to improve the accuracy of stature estimations and enhance forensic and clinical applications. The aim of the study was to calculate anthropometric measurements of foot in undergraduate medical students of a medical college.

Methods: A descriptive cross-sectional study was conducted on medical students studying at a tertiary care hospital during the period of November 6, 2022 to February 28, 2023 after obtaining ethical clearance from the Institutional Review Committee (Reference number: 06/2022). A total population sampling method was used. The present study was conducted to determine the mean foot index from the right and left foot, mean measurements of the left and right foot, and sex-related dimensions of the foot in Nepalese medical students. Data were collected and analyzed using SPSS.

Results: Out of 115 participants, the mean foot index for male and female were 38.34±2.13 and 39.33±2.22 respectively. The mean length of the right foot for males and females were 24.12±0.98 cm and 22.10±1.25 cm respectively. The mean length of the left foot for males and females was 24.20±1.06 cm and 22.07±1.24 cm respectively.

Conclusions: This study provides mean values of different measurements of the right and left foot of both sexes of the age group of 18-24 years in the students of a medical college.

Abstract: Herbicide such as 2,4-Dichlorophenoxyacetic acid is commonly used in wheat growing regions and is being ingested with suicidal intent due to easy availability and lack of regulation for buying it. Various articles suggest high fatality upon ingestion of this compound. We report a rare survival of a 24-year-old male who ingested about 45 ml of the compound and presented with symptoms similar to organophosphate poisoning. Before presenting to our hospital, the patient was misdiagnosed and an atropine challenge test and gastric lavage was done. However, after presenting to our center, detailed history was taken and the bottle containing the compound was retrieved, following which the patient was shifted to the intensive care unit where urinary alkalinization and forced diuresis was done. He started getting better and was discharged on fourth day. Detailed history taking can prevent misdiagnosis of 2,4-Dichlorophenoxyacetic acid poisoning. Early diagnosis and adequate supportive management of urinary alkalinization and forced diuresis can improve patient outcomes and reduce fatality.

Introduction: Idiopathic pulmonary fibrosis is the most prevalent form of interstitial lung disease, which presents as usual interstitial pneumonia on histopathology and imaging. It leads to significant lung scarring, damage, and fibrosis and is associated with a high degree of mortality, repeated hospital admissions, and oxygen dependence. Many complications are associated with idiopathic pulmonary fibrosis, which further increases the morbidity of patients. High-resolution computed tomography chest is the imaging modality of choice for usual interstitial pneumonia tracking its progression, evaluating treatment response, and detecting potential complications.

Methods: This descriptive cross-sectional study was approved by the Institutional Ethics Committee (Reference number: IEC-INT/2023/Study-1256). Departmental computed tomography report database from November, 2017 to June, 2018 was reviewed and scans with imaging features consistent with the 'usual interstitial pneumonia' pattern were identified. Total sampling method was used and two independent radiologists, blinded to the patient's clinical information, reviewed the high-resolution computed tomography chest scans to assess for imaging features of usual interstitial pneumonia and associated complications. Data was collected and analyzed using Microsoft Excel.

Results: There were 65 patients reported as unusual interstitial pneumonia pattern. Emphysema and pneumothorax were identified in 4 (6.15%) and 1 (1.53%) scans, respectively. Two (3.08%) scans showed features of pulmonary arterial hypertension. Ten (15.38%) scans exhibited findings consistent with co-existent or superimposed pulmonary infection. Additionally, features of lung malignancy were identified in high-resolution computed tomography scans of 5 (7.69%) patients.

Conclusions: Patients with UIP often experience severe lung scarring, and frequent complications, and require regular chest CT scans to monitor disease progression and identify potential complications.

Abstract: Mumps is a highly contagious viral infection caused by paramyxovirus. It usually presents with fever and parotid gland swelling. It may be associated with complications like aseptic meningitis, encephalitis, oophoritis, orchitis, pancreatitis. The incidence of mumps infection is increasing in Nepal. This paper aims to advocate for the introduction of vaccination against mumps in the national immunization schedule.

Introduction: Cervical cancer, the most prevalent cancer among women, is also the primary cause of cancer-related deaths in reproductive age women in Nepal. The study aims to assess the situation of cervical cancer screening services in Nepal.

Methods: This cross-sectional study used quantitative methods to understand the situation of cervical cancer screening in 572 health facilities of Nepal. The research was conducted to assess screening facilities, the allocation of separate screening rooms, the availability of screening services on a routine basis throughout the week, screening facilities that are free of charge, human resources, and the availability of treatment. It was conducted in October to December 2022.

Results: The research was carried out among 572 healthcare facilities, out of which 134 (23.42%) had provision for cervical cancer screening services. Ethical approval was obtained from the Nepal Health Research Council (NHRC) under reference number 397/2022 P. Amongst those 134, 72 (53.73%) healthcare facilities had assigned separate rooms for screening intentions. One hundred and two (76.12%) healthcare facilities provided regular screening services throughout the week, while 112 (83.58 %) had free-of-charge  screening services. Concerning trained personnel, 121 (90.30%) health facilities had personnel trained in visual inspection with Acetic acid, 9 (6.72%) had personnel trained in use of colposcopy, and 5 (3.73%) had personnel trained in use of Loop Electrosurgical Excision Procedure (LEEP). Lastly, 31 (23.13%) healthcare facilities offered treatment choices for cervical cancer.

Conclusions: Most of the health care facilities did not have provision of cervical screening. Amongst those who had the provision, personnel trained in loop electrosurgical excision procedure colposcopy.

With the rapid advancement of health delivery, there has been a renewed interest in conducting research among healthcare professionals in Nepal. However, concern is there regarding availability of funds and mechanisms of awarding.  The purpose of this scoping review is to map the available evidence regarding the evolution and current status of health research funding in Nepal and to highlight gaps and areas for future research. We searched three databases for empirical papers and several gray literature. Our search, conducted between March and April 2024 yielded 76 documents of which 30 that met the selection criteria were included in the scoping review. Almost all studies identified lack of funding as a deterrent to research. We found a paucity of research focusing on the role of researchers in funding decision-making. Our findings revealed that there are 12 national and four international organizations providing funds for research. University Grant Commission is the largest funder from Nepal whereas the Research Council of Norway is the biggest international funder. There were certain barriers and facilitators for obtaining funds identified by this scoping review.  Further efforts are needed to increase the amount and availability of funds in Nepal to enable high-quality research.

As a seismic hotspot, Nepal has endured many catastrophic earthquakes, including the 2023 Jajarkot quake. These quakes worsen the existing fragilities, resulting in difficulties in accessing healthcare, outbreaks of infectious diseases, mental health problems, and nutritional shortfalls. The article examines the complex web of health consequences, such as infectious and non-infectious diseases and malnutrition, highlighting the need for a global health lens in tackling these issues. It also reveals the long-term health effects, such as mental health disorders and increased disease susceptibility, that emerge after the quake and the importance of enhancing coordination and communication, enforcing building codes, and assisting affected communities in response to the seismic hazards. The article identifies mitigation strategies, community involvement, and international cooperation as key elements in building resilience against future quakes. It discusses the role of climate change in seismic risks and the need for research, innovation, and adaptability in global health interventions, suggesting measures such as strengthening primary healthcare, preventing avoidable health problems through education, and improving supply chains. The article calls for a holistic approach to building resilient health systems, emphasizing community engagement, prevention, and preparedness to protect the health of vulnerable groups in seismic regions.

Introduction: Timely institution of pre-hospital therapies aimed at damage control and the appropriately timed decision of transfer to higher centers for definitive neurosurgical management are crucial in determining the outcome of patients following traumatic brain injury. This study aimed to evaluate the factors determining pre-hospital care and delay in patients with traumatic brain injury.

Methods: This was a descriptive cross-sectional study conducted in a tertiary care center after obtaining ethical approval from the Institutional Review Board (approval number 392 (6-11) E2). All patients with traumatic brain injury who presented to the emergency department from 1 July, 2018 to 15 June, 2019 were enrolled. Data related to patient demographics, the primary cause of the incident, grading of traumatic brain injury on admission, pre-hospital care, and variables that cause pre-hospital delay were collected.

Results: In this study of 144 patients with traumatic brain injury, we found that 70 (48.61%) experienced transfer delays exceeding one hour. There were 71 (49.31%) patients aged 15-44 years, and 100 (69.44%) were males , with falls being the primary cause of 119 (82.64%). Most patients had mild traumatic brain injury 80 (55.56%). Out of 144, 20 (13.89%) received prehospital care, and 28 (19.44%) underwent a computed tomography scan of the head before arrival.

Conclusions: Our study highlights the challenges in pre-hospital care and delays in reaching for neurosurgical care in patients with traumatic brain injury. Falls, road accidents, and physical assaults were the leading causes.

Introduction: Proper physician-patient communication has shown to impact patients' satisfaction, and better health outcomes. On the contrary, negative impacts of poor communication have been attributed as one of the causes of increasing workplace violence. It is imperative to identify the attitude of the students towards communication skill learning. The aim of the study was to find out the attitude of undergraduate students towards communication skill learning using the communication skill attitude scale.

Methods: This cross-sectional study was carried out from October, 2022 to July 2023 among undergraduate medical and dental students. Data was collected after obtaining the ethical approval from Institutional Review Committee (IRC number 2079/80/82) using a preformed proforma and the previously validated communication skills attitude scale questionnaire. Convenience sampling was done. The demographic details, educational characteristics, opinions regarding communication learning and median of positive and negative attitude scale scores were calculated using Statistical Package for the Social Sciences (SPSS).

Results: The total median (interquartile range) positive attitudes scale (PAS) and negative attitudes scale (NAS) scores were 52.00 (48.00-87.00) and 31.00 (28.00-34.00) respectively. The first year of undergraduates had higher PAS scores 56.00 (50.00-60.00) than final year 48.50 (44.25-55.00). The students who were in favour of CS learning during the clinical years of training had a higher PAS median score, 54.00 (49.00-58.00).

Conclusions: The undergraduates had overall positive attitude towards CS learning but negative attitudes were also noted, with deterioration in the scores from first to final year of undergraduation, reiterating the importance of strengthening CS learning in the curriculum early-on in the study period.