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Journal of Karnali Academy of Health Sciences
Number of Followers: 1  Open Access journalISSN (Print) 2616-0064 - ISSN (Online) 2676-1327 Published by Karnali Academy of Health Sciences  [1 journal]
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- Errors in Complete Denture Fabrication during Pre-clinical Learning by
Dental Students in Chitwan
Authors: Srijana Mishra Sapkota, Anisha Pandey, Smriti Narayan Thakur, Bibek Khanal
Abstract: Introduction: The success of a competency-based dental curriculum would greatly depend on students acquiring the necessary basic skills in order to practice dentistry safely and with greater confidence. The difficulty that students experience in the transition from pre-clinical to clinical work is an accepted reality of dental education. Practice in simulations laboratory allows students to develop the manual dexterity and technical skills needed for dentistry prior to their exposure to the more challenging patient care environment. Materials and methods: Seventy Ideal Complete Dentures fabricated by undergraduate dental students were evaluated on basis of parameters like porosities in master cast, adaptation and porosities in record bases, occlusion rim, mounting, axial inclination of anterior and posterior teeth, horizontal & vertical glass plate relationship, occlusion, carving. The data collected were analysed for frequency and percentage of occurrence. Results: The most common error made by preclinical students was lateral glass plate relationship (51.4% in our study) followed by fabrication of occlusion rim (48.5%). The least common error was in porosities of master cast about 10%. Conclusion: There is high possibility of incorporating error during complete denture fabrication by undergraduate dental students. The study focuses the need to explore the most effective manner in which students learn and elucidates the mechanism of how students can bridge the gap between theory and practice.
PubDate: 2022-03-02
Issue No: Vol. 4, No. 3 (2022)
- Women's Autonomy and Maternal Health Care Utilization in a Community
of Dang District, Nepal
Authors: Sharmila Sharma, Ankit Acharya, Ankit Acharya, Renuka Devi Prdhananga, Sarswoti Gautam Bhattarai
Abstract: Introduction: Maternal health services utilization during pregnancy, childbirth, and postnatal period is vital for both mother and child. Women’s autonomy is one of the determinants of maternal health care utilization. The objective of the study was to find out women’s autonomy and its effect on maternal health care utilization. Methods: Descriptive cross-sectional study design was carried out among 166 women having a child under one year using simple random sampling via lottery method from ward number 1 and 2 of Ghorahi, Dang, Nepal. Semi-structured interview schedule from 2nd July to 28th July 2017 was used to collect data, which were analyzed using descriptive and inferential statistics. Multivariate logistic regression was used to find association between women’s Autonomy and maternal health care utilization. Results: The study findings revealed that less than half (47%) of women had a higher level of Autonomy. The majority of respondents, 77.7% and 76.5%, had utilized ANC and delivery care services respectively, whereas only one-third (32.5%) had utilized postnatal care adequately. The overall maternal health care utilization was only 25.9%. Women who had a higher autonomy level were two times more probable (OR=2.870, 95% CI: 1.169-7.048) for utilizing maternal health care service than who had lower level of autonomy. Other factors which affected maternal health care utilization were the age of women (OR=4.747, 95%CI: 1.416-15.919) and the educational level of women (OR=3.157, 95% CI: 1.196-8.328). Conclusions: Both autonomy and maternal health care utilization were low. Women’s autonomy was one of the determinants for maternal health service utilization.
PubDate: 2022-02-28
Issue No: Vol. 4, No. 3 (2022)
- Study of Correlation of Serum Cholinesterase Level with Peradeniya
Organophosphorus Poisoning Scale in Organophosphorus Poisoning
Authors: Dhiraj Gurung
Abstract: Background- Organophosphorus compound poisoning is a common problem in Nepal. In rural areas, cholinesterase levels are not readily available and other clinical severity scores would be useful. Peradeniya Organophosphorus Poisoning (POP) scale is a clinical severity score that has shown promise as a prognostication tool. Method- This was a single-center, prospective study conducted in Nepal medical college between August 2012 to August 2014. A total of 62 cases of organophosphorus poisoning was included on the basis of the history of organophosphate compound ingestion. Spearman correlation method was used to find the correlation between serum cholinesterase severity and POP scale severity. Result- The majority of the patients were between the ages of 15 to 45 and female. The most consistent clinical finding was miosis followed by altered sensorium. The most common organophosphate compound ingested was methyl parathion. No significant correlation was seen between serum cholinesterase severity and POP scale severity. Conclusion- POP scale severity does not correlate with cholinesterase level severity. Multi-center trial with a larger sample size is needed due to inconsistent results amongst similar studies
PubDate: 2022-02-28
Issue No: Vol. 4, No. 3 (2022)
- Knowledge and Practice of Screening Methods Regarding Breast Carcinoma
Among Reproductive-Aged Women
Authors: Mamta Chhetri, Muniraj Chhetri, Amrita Poudel, Amrita Poudel, Subash Koirala, Moni Subedi, Sumnima Shrestha
Abstract: Background: Breast cancer is a major public health problem in developing countries. Breast cancer is the second most common malignancy among Nepalese women. This study aimed to assess the level of knowledge and practice of screening methods of breast carcinoma among reproductive-aged women in Bharatpur Metropolitan city ward no 5. Methods: A Community-based cross-sectional study was conducted from September 17, 2021, to October 16, 2021, using face-to-face interviews in Bharatpur Metropolitan city ward no. 5. A total of 155 reproductive-aged women (15-49 years) were considered as a sample. We used Pearson's Chi-square test and binary logistic regression analysis to assess the factors influencing the knowledge and practice of screening methods of breast carcinoma among reproductive-aged women in Bharatpur Metropolitan City, ward no.5, Chitwan. Results: Among 155 reproductive-aged women, 58.7% had a satisfactory level of knowledge and 41.3% had an unsatisfactory level. 34.2% of respondents knew about screening methods. Respondents acquainted with screening methods were 34.2%. Among them, 60.3% knew about Breast Self Examination (BSE), 52.8% knew about the clinical breast examination (CBE) and 39.6% knew about mammography. The level of knowledge of breast carcinoma was significantly associated with occupation [other than agriculture; Crude odds ratio (COR=2.19; CI=1.10-4.33)], educational status [literate (COR=4.38; CI=1.47-13.10)], marital status [other than married (COR=4.67; CI=1.30-16.68)], monthly income [>40,000 Rs (COR=3.71; CI=1.43-9.62)]. Conclusions: More than half of respondents had a satisfactory level of knowledge regarding breast cancer, despite that only a few participants had practiced screening methods. Increasing the literacy rate, improving socioeconomic status would increase knowledge and practice of screening methods regarding breast carcinoma. It is needed to provide comprehensive, updated information and supportive interventions which could aim to increase knowledge and practice of screening methods for breast cancer.
PubDate: 2022-02-28
Issue No: Vol. 4, No. 3 (2022)
- Attitude of Nepalese Nursing Students toward Online Learning
Authors: Nirsuba Gurung, Bipula Gaire, Govind Prasad Dhungana
Abstract: Introduction: Technology has influenced almost every aspect of life, and education is no exception. Digitization in education has made it more convenient and flexible. Likewise in present situation caused by COVID-19 pandemic, online education is an option to continue teaching-learning activities. Many nursing colleges of Nepal have started online classes. This study aims to assess the attitude of nursing students of Nepal towards online learning; as learner’s attitude is one of the critical factors for meeting the learning objectives. Methodology: A quantitative web-based cross-sectional study was conducted among 423 Nepalese nursing students. Data collection was done online through a structured, self-administered, pre-tested questionnaire consisting of socio- demographic and academic questions and 5-point Likert scale to assess the attitude of the students. Data were analyzed in SPSS 16 using descriptive and inferential statistics. Result: Total 423 students were enrolled in the study. The mean age of the students was 22.22 years. One-third of the students were from Kathmandu University-affiliated colleges and half of them were studying B. Sc. Nursing. Sixty nine percent of them owned both mobile and laptop whereas 1/3rd of them had weak Wi-Fi connections. Fifty two percent had positive attitude towards online learning, which was significantly associated with age (c2=8.37, p-value 0.039), university affiliation (c2=5.23, p-value 0.022), course of study (c2=14.03, p-value 0.001), and strength of internet connection (c2=25.97, p-value<0.001). Conclusion: Only half of the students were having a positive attitude towards online learning, which is not sufficient for effective results. It is recommended that training should be provided to teachers to run online classes effectively and the university/institute should conduct online seminars and workshops to boost students’ skills regarding online learning. Lastly, government should emphasize and work for making the internet accessible for everyone, everywhere.
PubDate: 2022-02-28
Issue No: Vol. 4, No. 3 (2022)
- Profile of Ectopic Pregnancy in Karnali Province Hospital, Surkhet Nepal
Authors: Keshar Bahadur Dhakal, Damber Khadka, Sulochana Dhakal Rai, Saroj Bhandari, Astha Dhakal
Abstract: Background: Ectopic pregnancy (EP) is one of the major causes of preventable maternal death in first trimester of pregnancy. The incidence of EP varies between 1 – 2 % worldwide. The main objective of this study is to explore the incidence, predisposing factors, clinical presentations and approaches for management of EP in Karnali Province Hospital (KPH), Nepal. Methods: This is a retrospective study carried out in KPH between 14 April 2013 to 13 April 2018. Data were extracted from patients’ admission files, discharge registers and operation theatre (OT) notes. Data were then analysed by SPSS version 26. Percentage, frequency and interquartile range (IQR) were calculated and displayed in the tables and figures. Ethical approval was granted from hospital authority prior to the study. Results: The incidence of ectopic pregnancy is found to be 0.33% in our study. The median age of the patient was 28 years and the median gestational age for ectopic was 8 weeks. Majority of patients were from Surkhet (70%) and Brahmin/Chhetri ethnicity (52.6%). Most cases were multigravida (80.7%). In this study, most of patients presented with abdominal pain (96.4%), amenorrhoea (96.4%) and vaginal bleeding (87.7%). The main predisposing factors of EP were history of previous abortion (35.10%) and pelvic inflammatory diseases (PID) (21.10%). Most of patients (87.7%) had undergone surgery for the treatment of EP. Conclusion: In our study, the incidence of ectopic pregnancy is comparatively very low (0.33%). EP is found most common in multigravida and up to 10 weeks gestation of pregnancy. Previous abortion and PID were the most common predisposing factors. The main clinical presentations of EP were abdominal pain, amenorrhoea and vaginal bleeding. Laparotomy was the main mode of treatment for EP in KPH.
PubDate: 2022-02-28
Issue No: Vol. 4, No. 3 (2022)
- Comparison between Proximal femoral nail and Proximal femoral nail
antirotationin Peritrochanteric fracture of femur
Authors: Tufan Singh Kathayat , Poojan K. Rokaya, Mangal Rawal, Subash Gurung, Deepak Dutta, Srikrishna Giri
Abstract: Introduction: With increasing life expectancy of people, the incidence of peritrochanteric fractures has increased significantly. In the management of unstable peritrochanteric fractures intramedullary devices have proven advantage over extra-medullary ones. Proximal femoral nail antirotation (PFNA) is believed to be better in term of stability, rotational stability and lower cut out rate than proximal femoral nail (PFN), but is still controversial. This study was undertaken to compare the duration of surgery, intraoperative blood loss and duration of C arm fluoroscopy exposure, position of implant, varus collapse and screw cutout, and functional outcome via Harris Hip Score (HHS) between the intramedullary devices. Method: This was a prospective observational study conducted in patients with diagnosis peritrochanteric fractures treated either with PFN and PFNA in National Trauma Center and Civil Services Hospital from 1st May 2018 to 30th November 2019. Out of 48 patients, 24 in each group were included who met the inclusion criteria. Both the groups were followed at 1 month, 3 month and 6 month and were compared in term demographic variables, postoperative complication, and functional outcome via HHS. Result: PFNA has better outcome than PFN in term of mean operative time (48.33±17.2 vs 74.16±21.9 minutes), mean blood loss (80.41±32.19 vs 138.75±45.90 millilitre) and duration of fluoroscopy exposure (48.33±17.29 vs 74.16±21.95 second) respectively. The postoperative varus collapse and screw cut out were higher in PFN than PFNA. The HHS at 6 month follow up of PFNA group had better result than PFN with P < 0.001 (86.12±5.16 vs 75.16±10.11 respectively). Conclusion: PFNA is better in reducing operative time, blood loss and duration of fluoroscopy exposure. Post-operative complication is comparable but the functional outcome at 6 month follow up of PFNA is better than PFN.
PubDate: 2022-02-28
Issue No: Vol. 4, No. 3 (2022)
- Prevalence and Outcome of Preterm Admissions: A Retrospective Study at the
Tertiary Care Center in Rural Nepal
Authors: Sandeep Shrestha, Namrata Sindan, Nirajana Kayastha, Kamal Prasad Thani, Khushbu Jha, Nirmala Pahadi, Annie Shrestha
Abstract: Background: Preterm births is one of the leading cause of perinatal mortality and morbidity. It causes long-term medical and financial burdens for affected children, their families, and the health care system of country. The objective of the study was to identify prevalence and outcome of preterm admissions attending a tertiary care centre in rural Nepal, Jumla. Methods: This retrospective study was carried out on 52 preterm births admitted at the Neonatal Intensive Care Unit (NICU) and Special Newborn Care Unit (SNCU) of the Karnali Academy of Health Sciences (KAHS), Jumla from Magh 2076 to Poush 2077. This study was carried out from March 2021 to July 2021 for 5 months. Results: Preterm admissions constituted 19.4% of all admissions i.e 52 out of 268 cases at the NICU of KAHS. The mean birth weight and mean gestational age were 1730 ± 378 grams and 33.3 ± 2.13 weeks. Sepsis (34.62 %) was the most common cause for hospital admission followed by perinatal asphyxia (15.39%) and neonatal jaundice (13.47%). The most common risk factor of preterm delivery was PROM (28.8%) followed by hypertensive disorders of pregnancy (15.3%) and teenage pregancy (11.5%) in our study. Mortality was observed in 10 (19.2% ) cases. Conclusion: : Prematurity is still one of the main cause for admissions in intensive care unit. Identification of at risk pregnancy, early detection and treatment of medical diseases, improving pregnant womens' health care quality may decrease the rate of preterm birth.
PubDate: 2022-02-28
Issue No: Vol. 4, No. 3 (2022)
- A Morphometric Study of Lumbar Spine in Nepalese Adult Population
attending a Diagnostic Center
Authors: Rajive Raj Shahi, Dosti Regmi, Lee Budhathoki, Anish Pokharel, Mani Raj Sapkota
Abstract: Background: Magnetic Resonance Imaging (MRI) is the modality of choice for the evaluation of the lumbar spine for the cause of backache and radiculopathy. The central spinal canal and neural foramen stenosis cause nerve root entrapment and radiculopathy and most of the spinal surgeries in adult patients are related to spinal stenosis. The development of a nomogram of the various morphological parameters of the central spinal canal, lateral recess, and neural foramina in the lumbar spine MRI is essential to determine the degree of acquired stenosis as well as a plan of intervention and instrumentation in surgeries. Methods: A retrospective descriptive study of the lumbar spine MRI of 107 Nepalese population (59 male and 48 female) between 18 to 50 years with no central spinal canal or neural foramen narrowing and no history of congenital anomaly, trauma, or surgery were done for six months between 01 September 2020, and 28 February 2021. Thecal sac diameters, lateral recess depth/angle, and neural foramen dimensions were measured and tabulated. Calculation of the mean and standard deviation was done in Statistical Package for Social Sciences (SPSS) version 16. Results: Nomogram of the thecal sac diameters, lateral recess depth/angle, and neural foramen dimensions were prepared for lumbar vertebra in a sample population. The mean lumbar anterior-posterior diameter and Transverse diameter of thecal sac in the study population were 11.38±1.27mm and 16.75±2.4mm respectively with no significant difference was found by gender (p>0.05). Conclusions: Thecal sac diameters, lateral recess depth, and neural foramen anterior-posterior diameters show a gradual decrease in L1-L2 to L5-S1 level. A spinal morphometric nomogram of the Nepalese population is necessary for assessment of the canal and foraminal compromise as well as surgical approach, technique, instrumentation, and implant development.
PubDate: 2022-02-28
Issue No: Vol. 4, No. 3 (2022)
- Maternal Obesity as a Risk Factor for Cesarean Section: A Case-control
Study
Authors: Merina Khadka Chhetri, Pramila Dewan, Sharmila Shrestha
Abstract: Background: The rate of obesity is rising in Nepal and it has increased rapidly among women of reproductive age group over the last decade. Similarly, the rate of caesarean section has also shown an increasing trend in the country over the same period. The objective of this study was to identify maternal obesity as a risk factor for caesarean section in Kathmandu valley. Methods: An analytical case-control design was used to conduct the study. A total of 300 participants, 150 caesarean section deliveries as cases and 150 vaginal deliveries as age-matched controls were selected using purposive sampling technique. Data were collected through interview schedule using a semi-structured questionnaire and medical records review in Paropakar Maternity and Women's Hospital postnatal ward. The Pearson's chi-square test and odds ratio were used to test the association. Results: The study findings revealed a mean body mass index of 24.32±3.96 among the caesarean section delivery group and 21.94±3.34 among the vaginal delivery group (P< 0.001). Obesity was found in 44.67% of the caesarean section delivery group and 18.67% in the vaginal delivery group. There was a significant association between maternal obesity and caesarean section delivery with adjusted OR 4.14, 95% CI: 2.34-7.20 (P <0.001). Conclusions: Maternal obesity seems to be a significant risk factor for caesarean section delivery. Health care providers should promote pre-conceptional dietary counselling, regular physical activity and a healthy lifestyle at all levels of health centres. Identification of obesity in the first antenatal visit must be encouraged and offered advice about ideal weight maintenance.
PubDate: 2022-02-28
Issue No: Vol. 4, No. 3 (2022)
- Authorship Associated Misconduct-A Rising Problem in Nepalese Medical
Academia
Authors: Rajib Chaulagain, Kapil Amgain
Abstract: A medical practitioner or researcher’s contribution is judged not only on the basis of number of patients treated or the years of practice, but also, through publications. It is through your publications, your work is validated and the lifelong techniques is disseminated to your juniors, fellows, residents and even to your colleagues. Publishing also is a source for academic development and enrich yourself to critically review others work too. In addition, your publication provides research gap for future researchers to conduct additional studies. In many countries and even in Nepal, publication is also a basis of promotion in academics. So, research, scientific writing and publishing is a part of medical and dental academia.1 The happiest moment for any medical practitioners and researchers is getting your work published in prestigious journals around the world. To come to this stage of publication, the scientific work has to undergo series of rigorous process. Conceiving any study, searching the gap, discussing with peers, writing the proposal for ethical clearance are the initial stages. After obtaining the ethical clearance the proposal undergoes several months of data collection, experimentation and analysis. The last part is scientific writing and sending the manuscript for publication. Any research should also maintain academic integrity and research ethics.2 Any studies with significant findings, done by maintaining the biomedical ethics, written in an organized way have more chances for acceptance for publication.2 However, in the line of publication, the issues of scientific misconduct are also rising.
PubDate: 2022-02-28
Issue No: Vol. 4, No. 3 (2022)
- Case Report Idiopathic Intracranial Hypertension (IIH) Post COVID-19
Infection: Case Report
Authors: Pradeep Bastola, Sunil Koirala, Polina Dahal
Abstract: Pseudotumor cerebri or benign intracranial hypertension (BIH) or idiopathic intracranial hypertension (IIH) is a clinical condition that includes headache, papilledema, increased blood pressure, and clear cerebrospinal fluid. Multiple causes have been described for this condition, including venous sinus thrombosis, the toxicity of some substances such as vitamin A, tetracyclines and oral contraceptives, and sepsis besides patients related factors like obesity and middle-aged females. We report here a case of pseudotumor cerebri in a 28 years lady presenting to the Department of Ophthalmology, Chitwan Medical College (CMC), Nepal with a history of COVID-19 infection two months earlier. To our knowledge, this is the first report of post-COVID-19 associated isolated benign intracranial hypertension (BIH) from Nepal.
PubDate: 2022-02-28
Issue No: Vol. 4, No. 3 (2022)
- Disaster Nursing Competencies among Nurses Working in Tertiary Level
Teaching Hospital in Kathmandu, Nepal
Authors: Hricha Neupane, Parikshit Chapagain
Abstract: Background: Nepal is one of the most multi hazard prone countries in the world. The first responders and the largest health workforce of any country are nurses. Therefore, it is essential to determine the competencies of nurses, as one of the baseline for disaster preparedness. This study explores nurses’ current roles and responsibilities in disaster management, core competencies that need to be implemented and barriers to developing core competencies. Methods: A descriptive cross-sectional design was conducted among 234 nurses working in Tribhuvan University Teaching Hospital which was chosen randomly. Stratified proportionate sampling was then done to calculate samples from each wards which was then followed by random sampling of the participants. Data was analyzed using descriptive statistics (mean, frequency and SD). Results: The mean score for nurses’ current roles and responsibility in disaster management was very low for all items of the questionnaire. Nurses identified their role in participation in identifying education and training needs of the nurses as the maximum. However, nurses’ opinion to develop the core competencies is high for all items. All the barriers studied were identified as barriers for developing disaster competencies. The highest barrier was found the lack of training in workplace. Conclusions: It is noteworthy that nurses’ opinion of their roles and responsibility in disaster management is very low despite of their high opinion towards developing core competencies. It may be due to the barriers perceived at workplace. Key words: competencies, disaster, nursing, barriers
PubDate: 2021-12-28
Issue No: Vol. 4, No. 3 (2021)
- Knowledge and Perception of COVID-19 among School Adolescents of Lalitpur
Authors: Susan Maharjan, Amrita Shrestha, Vivechana Shakya, Manju Nepal, Seema Thapa, Indu Sah
Abstract: Background: The world health organization declared coronavirus outbreak on 30th January 2020 and being pandemic on March 2020. It has been affecting 213 countries and territories around the world. A poor understanding of the disease among general people including school adolescents may delay seeking treatment and increase its spread. Adolescents can improve knowledge of the family members once they are well informed about disease and its prevention. Therefore, the study was conducted to identify the knowledge and perception of COVID-19 among school adolescents of Lalitpur. Methods: A cross-sectional descriptive study was carried among 305 adolescent students of purposively selected four schools. Non probability total enumerative sampling technique was used to select the sample. A self- developed self-administered structured google form questionnaire was used as instrument for data collection. Statistical Package for the Social Science (SPSS) version 16 was used for data analysis. Data analysis and interpretation was done by using descriptive statistics (frequency and percentage) and inferential statistics (Chi-square test). Results: Regarding the level of knowledge of COVID-19, 65.2 % had good knowledge, 29.2% had moderate knowledge and 5.6% had poor knowledge. Most of the students (87.2 %) had favorable perception, only 8.2% had unfavorable perception. There was significant association between age and level of knowledge (p=0.048) but no significant association with other variables. Conclusions: Nearly two third students had good knowledge and the majority of students had favorable perception toward COVID-19. However, students had lower than expected knowledge for their age; therefore awareness program is required for the school adolescent regarding COVID- 19.
PubDate: 2021-12-28
Issue No: Vol. 4, No. 3 (2021)
- Prevalence of Protein-Energy Malnutrition among Under-five Dalit Children
in Selected VDCs of Morang District
Authors: Rashmi Gachhadar, Tara Shah, Birendra Yadav, Sharmila Shrestha
Abstract: Background: The degree and distribution of malnutrition depends on several factors; political and economic situation, education, environment, food pattern, cultural believes, etc. Dalits are the people who are religiously, culturally, socially and economically oppressed, excluded and treated as untouchables; and they belong to different geographical region, language, culture and castes. Therefore, their children are more prone to poor health and various kinds of diseases including malnutrition. So, the present study aimed to assess the prevalence of Protein Energy Malnutrition (PEM) among under-five dalit children and the factors associated with it. Methods: Descriptive cross-sectional study was conducted among 238 under-five dalit children in four selected VDCs of Morang District using cluster sampling technique. Data were collected using interview schedule and anthropometric measurements. Data analysis was done using statistical Package for social sciences (SPSS) version 11.5. Results: Out of 238 children, one-fourth of them belong to age group 12-23 months and more than half (52.9%) were male. The prevalence of PEM was assessed in terms of underweight, stunting and wasting and was found to be 16.8%, 11.3% and 14.7% respectively. Underweight was found to be statistically significant with father’s educational level and antenatal care visit of the mother. Stunting was found to be statistically significant with mother’s occupation and wasting was found to be significant with age of the child, type of family, weaning and distance of the health facility. Conclusion: Prevalence of Protein-energy malnutrition was found to be higher in those children with nuclear family, illiterate parents, poor antenatal care, delayed weaning practices and availability of health facility.
PubDate: 2021-12-28
Issue No: Vol. 4, No. 3 (2021)
- Relationship Between Child Marriage with Reproductive Health and Cervical
Neoplasia in Karnali, Nepal
Authors: Niresh Thapa, Muna Maharjan, Girishma Shrestha, Narayani Maharjan
Abstract: Background: Child marriage (marital age less than 18 years) is recognized as a violation of human rights. However, it remains a deep-rooted social problem in Nepal. We aimed to find out the relationship between child marriage and reproductive health and cervical neoplasia. Methods: A cross-sectional study was conducted from March 2016 to January 2017 in the Jumla district of Karnali province, Nepal. Apparently healthy, married women ages 20–65 were invited to participate in a cervical screening awareness program followed by an interview and examination. Interviews to obtain sociodemographic and reproductive health information were followed by cervical cancer screening by cytology and visual tests. Results: Out of 2190 eligible participants, 1450 (66%) reported child marriage. Illiteracy, smoking, multiparity, number of living children, and abortion rates were all significantly higher among the women who had a marital age of less than 18. Reports of abnormal cytology, visual inspection with acetic acid, and Lugol's iodine were not significantly different among the two groups of women who married before or after the age of 18. Conclusions: Child marriage is highly prevalent in Jumla, Karnali of Nepal and is associated with poor reproductive health outcomes, but is not significantly associated with an increase in cervical neoplasia as judged by visual inspection or cytology. It is highly recommended that child marriage in Nepal be prevented by improving awareness of the risks of child marriage, education, socioeconomic status, and strict implementation of the existing marriage age law.
PubDate: 2021-12-28
Issue No: Vol. 4, No. 3 (2021)
- A Study of Electrocardiographic Changes in patients with Newly Diagnosed
Primary Hypothyroidism: A Cross-Sectional Study
Authors: Prabin Khatri, Suman Sapkota, Sumit Gami, Ashutosh Upadhaya, Mohammad Alam, Shristi Maharjan, Shriya Upadhyaya, Himal Panth, Sameer Maskey, Aryan Neupane
Abstract: Background: The thyroid hormones have an important role in the cardiovascular system; even minimal change in its level can cause significant alteration in the cardiac activity which can cause considerable electrocardiographic changes. We conducted this study to assess the electrocardiographic (ECG) changes in patients who were newly diagnosed with primary hypothyroidism. Methods: This study is a descriptive cross-sectional study conducted among 71 newly diagnosed subclinical and overt primary hypothyroidism patients visiting the out-patient department (OPD) of Universal College of Medical Sciences, Nepal from December 2018 to June 2020 after taking ethical clearance from the institutional review committee (UCMS/IRC/212/18). ECG was obtained for each patient at the time of diagnosis of primary hypothyroidism. The data were analyzed with SPSS Version 16. Results: The most common ECG changes were sinus bradycardia seen in 32.4%, followed by T wave inversion in 21.1%, low voltage QRS complex in 15.5%, and prolonged PR interval in 14.1%. ECG changes were seen in 62% of cases of newly diagnosed primary hypothyroidism. Among all patients, subclinical hypothyroidism accounted for 7%, while overt hypothyroidism accounted for 55% of the ECG findings. Conclusion: Our study found ECG changes like sinus bradycardia, T wave inversion, low QRS voltage, and prolonged PR interval in newly diagnosed primary hypothyroidism. We suggest that every newly diagnosed hypothyroid patient should be evaluated for ECG changes.
PubDate: 2021-12-28
Issue No: Vol. 4, No. 3 (2021)
- Histopathological diagnosis of dermatological lesions: a Hospital-based
study
Authors: Santosh Upadhyaya Kafle, Sabrina Yamu
Abstract: Introduction: The skin is susceptible to a wide range of pathological conditions. The histopathological analysis is mandatory for the accurate diagnosis of many of these conditions. Sometimes, additional recommendations and ancillary techniques are required for its confirmation and further classification. The study aims to analyze the various ancillary techniques and recommendations status made during the histopathological diagnosis of dermatological lesions. Methods: This cross sectional observational study was conducted for all skin biopsies (n=129) received from January 2017 to June 2020 at Department of Pathology, Birat Medical College Teaching Hospital, Morang, Nepal. H&E stained slides of these biopsies were retrieved from the departmental archives and reviewed under light microscopy for the diagnoses made before. The prevalence of various ancillary techniques and recommendations status made during diagnosis along with its correlation between categorization of histopathological diagnoses was analyzed using SPSS version 17. Results: Among 129 skin biopsies, various recommendations and ancillary technique status were 102(79.06%) and 78(60.46%) respectively. Among which, “special stains” and “follow up biopsy after adequate medication” status was maximum with 65(50.4%) cases each. Likewise, the “more representative biopsy” in 03 (2.3%) cases, “immunofluorescence study” and “special stain and immunohistochemistry panel study” each in 01(0.8%) cases were seen among the rare ones respectively. Infectious lesions of bacterial origin in 32 (24.8%) cases, of fungal and viral origin each in 02(1.6%) cases were the most common and rare diagnosis respectively. The categorization of histopathological diagnosis revealed significant association (p≤0.001) with various recommendations and ancillary techniques status. Conclusion: The significant correlation among various ancillary techniques and recommendations status made during histopathological diagnoses of dermatological lesions reflected its importance in diagnosing dermatological lesions.
PubDate: 2021-12-28
Issue No: Vol. 4, No. 3 (2021)
- Implementing a daily CME at a rural primary care hospital in Nepal
Authors: Bikash Gauchan, Rekha Sherchan, Mangal Rawal, Biplav Shresth, Amul Singh, Mrigendra Raj Pandey, Niranjan Rijal, Mandeep Pathak
Abstract: Fostering a culture of continued learning at healthcare facilities is a global priority for healthcare systems performance, patient safety, and quality improvement. In low- and middle-income countries, continuing medical education activities are almost non-existent in rural areas. National professional academies tend to be focused almost exclusively at major teaching hospitals in urban centers. In addition to playing a central role in healthcare provision, rural district-level hospitals are formative for many young healthcare professionals who are posted there for mandatory government service. The district hospital thus represents an important opportunity to be a center for learning. Methods We conducted a retrospective case study to describe the implementation of a continuing medical education program at a district-level hospital in rural Nepal. The particular modalities of continuing medical education include didactic lectures, case presentations, and morbidity and mortality conferences, presented by physicians and mid-level providers. Results During the first twelve months of the program, 155 sessions, or 73% of scheduled sessions, were conducted as planned. Ongoing challenges to the long-term success of the program include dedicated leadership time for session preparation and presenter mentorship, and improving participatory engagement across multiple clinician cadres. Conclusions Building a robust continuing medical education program in rural district hospitals is feasible, and has great potential as a mechanism of developing a professional and sustainable cadre of healthcare workers in these settings. Greater investment in these types of programs may improve healthcare worker satisfaction and retention, thereby improving access to care in these remote areas.
PubDate: 2021-12-28
Issue No: Vol. 4, No. 3 (2021)
- Does patient counseling correspond to medication adherence in chronic
diseases' A scoping review
Authors: Rojina Basnet, Rajan Bhandari, Sabyata Gautam, Nishant Lama, Shreejana KC, Tulsi Ram Bhandari
Abstract: Objective: Quality care is essential to minimize the complication or consequences of chronic diseases. The objective of this review is to identify the role of patient counseling on medication adherence in chronic diseases. Methods: Scoping review framework, as described by Arksey and O’Malley to map out the literature. Databases were searched for published studies from 1 to 30 August 2020 which described medication adherence, factors contributing and role of patient counseling in medication adherence. Results: Total 21 primary studies, including29% were randomized controlled trials designs and 76% of studies were conducted in the hospital setting. The medication non-adherence in the chronic disease was between 12-33% in reviewed studies. Conclusion: Most of the studies identified patient counseling as a major contributing factor for drug adherence in terms of chronic diseases. Similarly, pharmacist’s communication with patient is also described as important factor for medication non-adherence in reviewed articles. Thus, efforts must broaden to improve counseling services within the health system to overcome chronic diseases through addressing drug non-adherence. Practical Implication: The findings of this review would be relevant for all health professionals, medical persons, and pharmacists to sensitize them about the importance of counseling in terms of overcoming chronic diseases.
PubDate: 2021-12-28
Issue No: Vol. 4, No. 3 (2021)
