Subjects -> HEALTH AND SAFETY (Total: 1572 journals)
    - CIVIL DEFENSE (22 journals)
    - DRUG ABUSE AND ALCOHOLISM (86 journals)
    - HEALTH AND SAFETY (744 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (390 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (115 journals)
    - PHYSICAL FITNESS AND HYGIENE (133 journals)
    - WOMEN'S HEALTH (82 journals)

HEALTH AND SAFETY (744 journals)                  1 2 3 4 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access   (Followers: 4)
ACM Transactions on Computing for Healthcare     Hybrid Journal   (Followers: 5)
Acta Informatica Medica     Open Access   (Followers: 3)
Acta Scientiarum. Health Sciences     Open Access   (Followers: 3)
Adultspan Journal     Hybrid Journal   (Followers: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 13)
Advances in Public Health     Open Access   (Followers: 32)
Adversity and Resilience Science : Journal of Research and Practice     Hybrid Journal   (Followers: 4)
African Health Sciences     Open Access   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 7)
Afrimedic Journal     Open Access   (Followers: 3)
Ageing & Society     Hybrid Journal   (Followers: 48)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 9)
AJOB Empirical Bioethics     Hybrid Journal   (Followers: 4)
Akademika     Open Access   (Followers: 1)
American Journal of Family Therapy     Hybrid Journal   (Followers: 9)
American Journal of Health Economics     Full-text available via subscription   (Followers: 22)
American Journal of Health Education     Hybrid Journal   (Followers: 39)
American Journal of Health Promotion     Hybrid Journal   (Followers: 35)
American Journal of Health Sciences     Open Access   (Followers: 13)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 31)
American Journal of Public Health     Full-text available via subscription   (Followers: 299)
American Journal of Public Health Research     Open Access   (Followers: 31)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 9)
Annales des Sciences de la Santé     Open Access  
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 16)
Annals of Health Law     Open Access   (Followers: 6)
Applied Biosafety     Hybrid Journal   (Followers: 1)
Applied Ergonomics     Hybrid Journal   (Followers: 18)
Applied Research In Health And Social Sciences: Interface And Interaction     Open Access   (Followers: 5)
Apuntes Universitarios     Open Access   (Followers: 1)
Archive of Community Health     Open Access   (Followers: 1)
Archives of Community Medicine and Public Health     Open Access   (Followers: 3)
Archives of Medicine and Health Sciences     Open Access   (Followers: 7)
Archives of Suicide Research     Hybrid Journal   (Followers: 11)
Archivos de Prevención de Riesgos Laborales     Open Access  
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 11)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 6)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 15)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 5)
Asian Journal of Medicine and Health     Open Access   (Followers: 1)
Atención Primaria     Open Access   (Followers: 2)
Atención Primaria Práctica     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 7)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 5)
Autism & Developmental Language Impairments     Open Access   (Followers: 16)
Bijzijn     Hybrid Journal   (Followers: 1)
Bijzijn XL     Hybrid Journal  
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 7)
Biosafety and Health     Open Access   (Followers: 1)
Biosalud     Open Access   (Followers: 1)
Birat Journal of Health Sciences     Open Access  
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 7)
BMC Pregnancy and Childbirth     Open Access   (Followers: 24)
BMJ Simulation & Technology Enhanced Learning     Hybrid Journal   (Followers: 13)
Boletin Médico de Postgrado     Open Access  
Brazilian Journal of Medicine and Human Health     Open Access  
British Journal of Health Psychology     Hybrid Journal   (Followers: 53)
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 23)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos de Saúde     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 16)
Canadian Family Physician     Partially Free   (Followers: 13)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 14)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 2)
Canadian Journal of Public Health     Hybrid Journal   (Followers: 28)
Cannabis and Cannabinoid Research     Hybrid Journal   (Followers: 2)
Carta Comunitaria     Open Access  
Case Reports in Women's Health     Open Access   (Followers: 4)
Case Studies in Fire Safety     Open Access   (Followers: 27)
CASUS : Revista de Investigación y Casos en Salud     Open Access   (Followers: 1)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
CES Medicina     Open Access  
CES Salud Pública     Open Access  
Child and Adolescent Obesity     Open Access   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 12)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access   (Followers: 3)
Christian Journal for Global Health     Open Access   (Followers: 1)
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia & Salud     Open Access   (Followers: 1)
Ciencia & Trabajo     Open Access   (Followers: 2)
Ciencia e Innovación en Salud     Open Access  
Ciencia y Cuidado     Open Access   (Followers: 1)
Ciencia y Salud     Open Access   (Followers: 3)
Ciencia y Salud Virtual     Open Access  
Ciencia, Tecnología y Salud     Open Access   (Followers: 2)
Cities & Health     Hybrid Journal   (Followers: 4)
Clinical and Experimental Health Sciences     Open Access   (Followers: 1)
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
Clocks & Sleep     Open Access   (Followers: 2)
CME     Hybrid Journal   (Followers: 2)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 6)
Conflict and Health     Open Access   (Followers: 8)
Contact (CTC)     Open Access  
Contraception and Reproductive Medicine     Open Access   (Followers: 2)
Cuaderno de investigaciones: semilleros andina     Open Access   (Followers: 3)
Cuadernos de la Escuela de Salud Pública     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 11)
Current Opinion in Environmental Science & Health     Hybrid Journal   (Followers: 1)
Das österreichische Gesundheitswesen ÖKZ     Hybrid Journal   (Followers: 1)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Design for Health     Hybrid Journal  
Digital Health     Open Access   (Followers: 10)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 16)
Diversity and Equality in Health and Care     Open Access   (Followers: 9)
Diversity of Research in Health Journal     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 3)
Drogues, santé et société     Open Access   (Followers: 2)
Duazary     Open Access   (Followers: 1)
Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi / Journal of Duzce University Health Sciences Institute     Open Access  
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 29)
East African Journal of Public Health     Full-text available via subscription   (Followers: 4)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 26)
EcoHealth     Hybrid Journal   (Followers: 6)
Education for Health     Open Access   (Followers: 9)
ElectronicHealthcare     Full-text available via subscription   (Followers: 4)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 5)
Emerging Trends in Drugs, Addictions, and Health     Open Access   (Followers: 1)
Ensaios e Ciência : Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access   (Followers: 4)
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 6)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 7)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 24)
EsSEX : Revista Científica     Open Access   (Followers: 1)
Estudios sociales : Revista de alimentación contemporánea y desarrollo regional     Open Access   (Followers: 1)
Ethics & Human Research     Hybrid Journal   (Followers: 4)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 8)
Ethiopian Journal of Health Development     Open Access   (Followers: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 8)
Ethnicity & Health     Hybrid Journal   (Followers: 16)
Eurasian Journal of Health Technology Assessment     Open Access   (Followers: 1)
EUREKA : Health Sciences     Open Access   (Followers: 3)
European Journal of Health Communication     Open Access   (Followers: 2)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 6)
European Medical, Health and Pharmaceutical Journal     Open Access   (Followers: 3)
Evaluation & the Health Professions     Hybrid Journal   (Followers: 11)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
F&S Reports     Open Access   (Followers: 1)
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 10)
Family & Community Health     Hybrid Journal   (Followers: 15)
Family Medicine and Community Health     Open Access   (Followers: 10)
Family Relations     Partially Free   (Followers: 15)
FASEB BioAdvances     Open Access  
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 2)
Finnish Journal of eHealth and eWelfare : Finjehew     Open Access  
Food and Public Health     Open Access   (Followers: 19)
Food Hydrocolloids for Health     Open Access  
Food Quality and Safety     Open Access   (Followers: 2)
Frontiers in Digital Health     Open Access   (Followers: 3)
Frontiers in Neuroergonomics     Open Access   (Followers: 1)
Frontiers in Public Health     Open Access   (Followers: 9)
Frontiers of Health Services Management     Partially Free   (Followers: 9)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access   (Followers: 1)
Ganesha Journal     Open Access  
Gazi Sağlık Bilimleri Dergisi     Open Access  
Geospatial Health     Open Access   (Followers: 1)
Gestão e Desenvolvimento     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 9)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Advances in Health and Medicine     Open Access  
Global Challenges     Open Access  
Global Health : Science and Practice     Open Access   (Followers: 9)
Global Health Annual Review     Open Access   (Followers: 3)
Global Health Journal     Open Access   (Followers: 3)
Global Health Promotion     Hybrid Journal   (Followers: 19)
Global Journal of Health Science     Open Access   (Followers: 12)
Global Journal of Public Health     Open Access   (Followers: 17)
Global Medical & Health Communication     Open Access   (Followers: 2)
Global Mental Health     Open Access   (Followers: 11)
Global Reproductive Health     Open Access   (Followers: 1)
Global Security : Health, Science and Policy     Open Access   (Followers: 1)
Global Transitions     Open Access   (Followers: 1)
Global Transitions Proceedings     Open Access  
Globalization and Health     Open Access   (Followers: 9)
Hacia la Promoción de la Salud     Open Access  
Hastane Öncesi Dergisi     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 7)
HCU Journal     Open Access  
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 20)
Health & Justice     Open Access   (Followers: 6)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 17)
Health and Human Rights     Open Access   (Followers: 10)
Health and Research Journal     Open Access   (Followers: 2)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 11)

        1 2 3 4 | Last

Similar Journals
Journal Cover
Birat Journal of Health Sciences
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2542-2758 - ISSN (Online) 2542-2804
Published by Nepal Journals Online Homepage  [129 journals]
  • Nurturing Professionalism in current Health Professions Education

    • Authors: Jyotsna Rimal
      Pages: 1261 - 1262
      Abstract: NA
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37552
      Issue No: Vol. 6, No. 1 (2021)
       
  • Self-Directed Learning Readiness of the Undergraduate Nursing Students: A
           Study from Eastern Nepal

    • Authors: Namu Koirala, Shyam P Kafle
      Pages: 1263 - 1268
      Abstract: Introduction: Self-directed learning is one of the concepts of learning which is mostly used in higher education, especially in the discipline of medicine and paramedics. Objectives: The objectives of this study were to assess the self-directed learning readiness of the undergraduate nursing students and to find out its association with selected demographic variables. Methodology: A descriptive, quantitative, cross-sectional study was undertaken among undergraduate nursing students from three nursing colleges of Eastern Nepal; from January 2019 to August 2020. The nursing colleges were randomly selected; one constituent nursing college and two colleges affiliated to Purbanchal University. Census sampling method was adopted and 565 students were enrolled. Ethical clearance was taken from the Institutional Review Committee of the institute. Data was collected using a self administered, valid and standard tool: Williamson's Self Rating Scale for Self-directed Learning (SRSSDL) via online google forms, then transferred to Microsoft EXCEL. Data analysis was done using SPSS 16.0 version. Mean, median, standard deviation, range, chi-square test, Mann Whitney U test and Kruskal Wallis H test were used for data analysis. Result: Overall Self-directed Learning score was 244.83±30.15. The majority of the respondents (79.3%) had high scores of SRSSDL (221-300) and 20.7% of the respondents had moderate levels of SRSSDL (141-220). The demographic variables didn't exert any significant effect on the overall level of SRSSDL but varied only with the sub-dimensions of SRSSDL. Conclusion: This study shows that overall self-directed learning among nursing students is moderate to high and the subdimensions have significant associations with demographics and academic level.
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37553
      Issue No: Vol. 6, No. 1 (2021)
       
  • Clinical Pattern of Pediatric Dermatoses Attending a Multi-Specialty
           Hospital

    • Authors: Harendra Kumar Jha
      Pages: 1269 - 1273
      Abstract: Introduction: Pediatric dermatoses deal with skin disease in children from birth to 18 years. This age group comprises significant physiological changes, and hence the pattern of disease including skin disease is unique to them. Skin diseases are influenced by the local climatic factor and socio-economic status which differ in different geographic areas including within the country. Objective: The objective of the study was to analyze the clinical spectrum of skin disease in children from 1 day to 18 years of age and to find any seasonal influence on the disease pattern. Methodology: The study was conducted retrospectively in a multi- specialty hospital from May 2014 to April 2015. Data of children from 1 day to 18 years of age were analyzed. Demographic details like age, sex, ethnicity was noted. The month and season of the presentation were also recorded. Patient with a confirmed clinical diagnosis and adequate data was included in the study. Patients were divided into 5 age groups; neonate (0 days to 1 month), infant (1 month to 2 years), young child (2-6 years), child (6-12 years), and adolescent (12-18 years). Data were entered in Microsoft excel and analysis was done with SPSS version 22 along with the Chi-square test. Result: There were 20.65% of pediatric patients out of 3292 patients visiting skin OPD. The male to female ratio was 1.63:1. The majority of the cases (47.8%) were in the adolescent age group. Infection and infestation were the predominant diagnosis (56.02%), followed by eczema (15.88%) and urticaria (6.47%). Among infection, fungal infection was seen as the majority (26.17%).Papular urticaria and urticaria were significantly (p-value <0.05) more common in summer, while scabies was more common in the spring season (p-value <0.05). Conclusion: Infection and infestation followed by eczema/dermatitis and urticaria were the three most common groups of dermatoses. There was a seasonal influence on a few common dermatoses like scabies, urticaria and papular urticaria.
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37554
      Issue No: Vol. 6, No. 1 (2021)
       
  • Modified Limberg Flap Cover for Recurrent Sacrococcygeal Pilonidal Sinus:
           Our Experience at a Medical College In Nepal

    • Authors: Budhi Nath Adhikari, Abhishek Bhattarai, Pragya Devkota, Sushma Khatiwada
      Pages: 1274 - 1279
      Abstract: Introduction: Pilonidal sinus is an inflammatory disease seen mostly in the intergluteal region of young males. Although any treatment strategy of this condition is generally free of life-threatening complications due to its superficial nature, it is still a feared disease because of recurrence which greatly increases the morbidity. Objective: To investigate the results of wide rhomboid excision and modified Limberg transposition flap reconstruction to treat recurrent pilonidal sinus. Methodology: Well-documented records of all patients with recurrent sacrococcygeal pilonidal sinus who underwent wide excision and a modified Limberg transposition flap at our center during the past 3 years and followed up for longer than 12 months were analyzed. The modification primarily consisted of an asymmetrically rotated rhomboid excision and lateralization of the lower midline. Patient demographics, days of hospitalization, complications, patient satisfaction and recurrence rates were evaluated. Result: Most patients in the study were overweight. No relationship was detected between BMI and number of sinus openings, hospital stay, drain placement or recurrences but an association with infection was noted. The number of pilonidal sinus orifices did not have a correlation with age, number of previous surgeries, duration of hospital stay or drains placement. The mean duration of hospitalization was 7.89 ± 3.41 days and the mean duration of suction drainage was 6.33±2.87 days. Half of our patients developed complications in the postoperative period. The only patient who developed superficial wound infection stayed the most in the hospital. All patients had some complaints regarding the operation site; however, they were satisfied with the result of the operation and had no recurrence at 12 months of follow-up. Conclusion: Rhomboid excision of recurrent sacrococcygeal pilonidal sinus with modified Limberg flap closure is a promising surgical technique with advantages of a good patient satisfaction and no recurrence after a year of surgery.
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37555
      Issue No: Vol. 6, No. 1 (2021)
       
  • Astigmatic Changes in Sutureless Small Incision Cataract Surgery

    • Authors: Roshan Dev Yadav, Kabindra Bajracharya, Neelam Shrestha, Kriti Joshi, Aman Kumar Gupta
      Pages: 1280 - 1284
      Abstract: Introduction: Cataract is the main cause of bilateral blindness in Nepal. Surgery is the accepted treatment option for cataract with Small incision Cataract Surgery (SICS) and Phacoemusification being the common procedures being performed with comparable results. Corneal astigmatism has been a byproduct of cataract surgery since the first limbal incision was made with improved techniques. Self-sealing scleral pocket incisions are stable and provides early healing, faster visual restoration and more importantly superior astigmatism control. A variety of scleral incisions are being used in manual SICS, with the aim of keeping the post-operative astigmatism to a minimum. Despite having many techniques of scleral incision, there have been only few studies which compares surgical induced astigmatism (SIA) between them Objective: To determine surgical induced astigmatism following frown, chevron and straight incision forms in suture-less small incision cataract surgery(SICS). Methodology: A prospective study was done on a total of 120 patients aged 40years and above with senile cataract. The patients were randomly divided into three groups where each group received specific incision- Straight, Frown and Chevron. SICS with intraocular lens (IOL) implantation was performed. The patients were compared on 2 weeks and 6 weeks post operatively for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and keratometric reading. Surgical induced astigmatism (SIA) was calculated using the SIA calculator version 2.0. The study was analysed using SPSS version 20.0. Results: At 6 weeks UCVA of 6/18-6/6 was attained by 63.41%, 78.94% and 84.61% of patients in group straight, frown and chevron. However about 97% of patients attained BCVA of 6/18-6/6 in all three groups. Mean SIA was least in Chevron group (0.30 D ± 0.16) and was most in the straight group (1.22 D ±0.36) which was statistically significant. Conclusion: Chevron incision induces the least astigmatism compared to frown and straight incision.
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37556
      Issue No: Vol. 6, No. 1 (2021)
       
  • Anxiety and Depression among Patients with Chronic Obstructive Pulmonary
           Diseases in Pulmonology Unit of Nobel Medical College Teaching Hospital

    • Authors: Nilam Kumari Jha, Komal Kant Jha
      Pages: 1285 - 1290
      Abstract: Introduction: Anxiety and Depression is a common comorbidity in chronic obstructive pulmonary disease patients. Impaired lung function is a risk factor for depression In COPD patients, reduced recreational activities and social Isolation is a major risk factor resulting in anxiety and depression.  Objective: The objective of this study is to evaluate the prevalence of Anxiety and Depression among the COPD patients at Pulmonology unit of Nobel Medical College Teaching Hospital.  Methodology: A hospital based cross- sectional research design was used for the study. A total of 185 patients with previously diagnosed COPD. Data were collected by using a face to face interview technique in patients to evaluate anxiety and depression using Nepali version of Hospital Anxiety and Depression Scale questionnaire at Nobel Medical College Teaching Hospital, Biratnagar, Nepal from May to August 2020. Data analysis were done by descriptive and inferential statistics.  Results: A total of 185 patients participated in the study, 157 patients (84.9%) had anxiety, 107 patients (57.8%) had depression and 102 patients (55.1%) had both anxiety and depression. There was statistically significant association of anxiety and depression in COPD patients with age, religion, occupation, smoking status, duration of illness, history of previous hospitalization, number of hospitalization in previous year, type of family, domiciliary oxygen therapy.  Conclusion: The study concluded that anxiety and depression had been most prevalent in COPD patients. Therefore health personnel working in the Pulmonology unit should be aware the early assessment and treatment of anxiety and depression of chronic obstructive pulmonary diseases patients. 
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37557
      Issue No: Vol. 6, No. 1 (2021)
       
  • Endoscopic Repair of Cerebrospinal Fluid (CSF) Rhinorrhea with Multilayer
           Grafts

    • Authors: Sriti Manandhar, K R Meghanadh, N V R Reddy
      Pages: 1291 - 1297
      Abstract: Introduction: Endoscopic repair of Cerebrospinal fluid (CSF) rhinorrhea has been the most popular and the most accepted among the Otorhinolaryngologists. The advancement in the endoscopes enable surgeons to manage cerebrospinal fluid rhinorrhea adequately with good result. Objective: The aim of this study was to evaluate the outcome of endoscopic CSF rhinorrhea repair with multilayer grafts. Outcome was identified in terms of postoperative complications like infection (mainly meningitis), nasal bleeding, graft failure and CSF leak, revision surgery. Methodology: A retrospective prospective study was conducted in 21 patients who had undergone endoscopic CSF rhinorrhea repair with use of multilayer grafts in a period of January 2016 to December 2018 in Department of ENT and Head and Neck Surgery in MAA ENT HOSPITAL, HYDERABAD, INDIA. All the patients were diagnosed according to history, clinical examination, diagnostic nasal endoscopy, CSF fluid analysis and radiological investigation. The materials used for the repair of CSF rhinorrhea were surgicel, temporalis fascia, conchal chondroperichrondrium, middle turbinate free mucoperiosteum graft, thigh fat and fascia lata. The follow up period of patients range from 14-44 months. The outcome of endoscopic CSF repair with use of multilayer grafts was evaluated by electronic records regarding recurrence of CSF rhinorrhea post-surgery, hospital admission, revision surgery and digital record of rigid endoscopic findings for the status of graft uptake and CSF leak. Results: In all patients, CSF leak was successfully repaired with use of multilayer grafts in first attempt without any complication. There was female predominance with male to female ratio of 1:6.The mean age of presentation was 43.09years. All 21 patients were presented with spontaneous CSF leak with unknown cause. In 21 patients only one patient presented with bilateral cerebrospinal fluid leak. Cribri form plate was the commonest site of defect in which defect medial to middle turbinate was the commonest followed by ethmoid roof and lateral wall of sphenoid. None of the patients developed meningitis after surgery. None of the patients required lumbar drain. None of the patients presented with cerebrospinal fluid rhinorrhea postoperatively. Conclusions: Endoscopic repair of Cerebrospinal fluid rhinorrhea with the use of multilayer grafts is the safer and effective method with good outcome. 
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37558
      Issue No: Vol. 6, No. 1 (2021)
       
  • Assessment of Quality of Life and Treatment Adherence in Patients under
           Maintenance Hemodialysis: A Cross- Sectional Study

    • Authors: Dejina Thapa, Pooja Koirala, Durga Chaulagain, Tara Kafle, Deepak Belbase, Subhadra Bhagat
      Pages: 1298 - 1303
      Abstract: Introduction: Chronic Kidney Disease causes sudden changes in the daily lives of patients and creates a great impact on their quality of life. Failure of adherence in Hemodialysis can lead to increased morbidity, mortality, cost, and burden on health care system. Objectives: This study was conducted to assess the quality of life and adherence to treatment of patients undergoing Hemodialysis. Methodology: A descriptive correlational study was carried out at Nobel Medical College Teaching Hospital, Biratnagar, among 96 patients who were under HD using convenience sampling technique. The data was collected through face to face interview for the period of 5 months. Quality of life and adherence to treatment were assessed using Kidney Disease Quality of Life Questionnaire (KDQOL) and End Stage Renal Disease Adherence Questionnaire (ESRD – AQ) respectively. The data was analyzed using t test, Spearman correlation statistics. Results In this study, the overall mean score of quality of life (QOL) of patients under HD was 48.9±13.7. More than half (54.1%) of the patients had moderate adherence to treatment while 31.2% had good adherence. Domains with the highest and lowest scores on quality of life and adherence to treatment were social domain and illness impact and adherence to HD treatment and diet restriction, respectively. There was statistically significant association between total score of quality of life and duration of HD (p≤0.05). Likewise, there was statistically significant association between adherence to treatment and marital status (p≤0.05), educational status (p≤0.05), ethnicity (p≤0.05), duration of illness (p≤0.05). Poor correlation (r= 0.273) was observed between quality of life and adherence to treatment. Conclusion: On average, the kidney disease component dimension of quality of life of patients under HD is higher and the overall level of adherence to treatment was moderate. Thus proper periodic counseling on illness and its long term impact, regular follow up as well as information on adherance to dietary measures are important to improve the quality of life and treatment adherance of patients under hemodialysis. 
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37563
      Issue No: Vol. 6, No. 1 (2021)
       
  • A Comparative Study between Ketamine and Lidocaine or Decrease Propofol
           Injection Pain During Induction of Anesthesia

    • Authors: Bikash Khadka, Nil Raj Sharma
      Pages: 1304 - 1309
      Abstract: Introduction: Pain during the injection of anesthetic agents may be distressing and can reduce the acceptability of an otherwise useful agent such as propofol during daycare surgeries. Lidocaine and ketamine both are used as pre-treatment to decrease propofol induced pain. This study aims to compare the effectiveness of ketamine injection to decrease propofol-induced pain in comparison to lidocaine injection. Methodology: This is a prospective cross-sectional comparative study. Eighty-nine cases were divided into two groups where group K received ketamine 2 ml (0.2 mg/kg) whereas group L received lidocaine 2% 2ml (0.5 mg/kg) after venous occlusion with rubber tourniquet. One-fourth dose of propofol was injected 1 min after release of tourniquet and pain accessed at 0, 1, and 2 minutes of propofol injection with a verbal response and behavioral signs. Chi-square test and paired T-test were used and a p-value less than 0.05 was considered significant. Result: Regarding hemodynamic, oxygenation, and adverse effects there was no significant difference. Immediately after propofol injection, only 1 patient of the ketamine group had mild pain (2.22%) while 12 patients from the lignocaine group had mild pain (27.27%) with a p-value of 0.009. Also after 2 minutes of propofol injection, only 12 cases had mild pain i.e. 13.48% (1 from ketamine group i.e. 2.22% and 11 from lidocaine group i.e. 25%) with p-value of 0.002. Conclusion: Our study helps prove low-dose ketamine is more effective in reducing the incidence and severity of pain on injection of propofol in comparison to Lidocaine with better hemodynamic stability. 
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37564
      Issue No: Vol. 6, No. 1 (2021)
       
  • Histopathological Study of Cystoscopic Bladder Biopsies in a Tertiary Care
           Center

    • Authors: Rachana Dhakal, Hem Nath Joshi, Ramesh Makaju, Shailendra Sigdel
      Pages: 1310 - 1314
      Abstract: Introduction: Non-neoplastic urinary bladder lesions are not life threatening, but are an important source to cause clinical symptoms and signs. However, neoplasms of the bladder are a source of morbidity, mortality, and exhibit more clinical challenges. Cystoscopy provides overall information about an anatomical/pathological condition of the urinary bladder which will be helpful for patients' management. A cystoscopic biopsy is a primary diagnostic tool for diagnosing urinary bladder cancer. Objectives: The objective of the study was to find the frequency and histomorphological characteristics of urinary bladder lesions in Dhulikhel Hospital, to find the clinical presentation of urinary bladder lesions and to grade the urothelial tumors based on the World Health Organization (WHO)/ International Society of Urological Pathology (ISUP) classification 2004. Methodology: This was a retrospective, cross-sectional, observational study carried out in the Department of Pathology, Dhulikhel Hospital-Kathmandu University Hospital. Convenient sampling was done. All cystoscopy biopsies received from January 2014 to December 2018 were studied. All tissue blocks were retrieved, cut, and stained with Hematoxylin and Eosin. The stained slides were examined under a light microscope by the primary investigator. Result: A total of 70 cystoscopic biopsies were analyzed. The majority of patients 20 (28.6%) were in the age group between 60 and 69 years and males were predominant 43 (61.4%). The neoplastic lesions constituted 40 (57.1%) of all bladder lesions, among them urothelial carcinoma accounted for 38 (54.2%). Similarly, chronic cystitis 27(38.6%) was the most common non-neoplastic lesion. Conclusion: The study found that the neoplastic lesions were commonly encountered in urinary bladder lesions. Among them, lowgrade urothelial carcinoma was the most common bladder tumor. However, most of the non-neoplastic lesions were inflammatory in origin. Cystoscopy combined with histomorphological examination helps in the early detection of bladder lesions. 
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37565
      Issue No: Vol. 6, No. 1 (2021)
       
  • Study on Enterococcus Isolates from Different Clinical Samples and their
           Microbial Sensitivity Tests in a Tertiary Care Hospital, Nepal

    • Authors: Kumari Ragani Yadav, Brajesh Kumar Jha
      Pages: 1315 - 1319
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37566
      Issue No: Vol. 6, No. 1 (2021)
       
  • Preparedness for Mitigating Noncommunicable Diseases in Gaindakot
           Municipality, Nepal: Perspectives of Key informants

    • Authors: Narayan Sapkota, Damaru Prasad Paneru
      Pages: 1320 - 1324
      Abstract: Introduction: Non-communicable Diseases (NCDs) are the major public health problem that leads to high morbidity and mortality in the world including Nepal. Government of Nepal has launched the Multi-sectoral NCD Action Plan in 2014 and established NCD and Injuries Poverty Commission in 2016 for the management and control of NCDs nevertheless the implementation status and its outcomes are not identified till date at the local level. Objectives: To explore the preparedness of the local government for the prevention and control of NCDs at Gaindakot, Nawalpur, Nepal. Methodology: A qualitative study was conducted in the Gaindakot municipality; Nawalpur to document the key informant's perspectives on health system's preparedness to prevent the potential impacts of NCDs. Face to face Indepth interview was performed using open-ended questions. Interview guidelines were prepared on the basis of building blocks of health system. Information was processed basis on thematic analysis. Result: The study revealed that health section has NCD preparedness structure but need to strengthening for the better delivery of health services. The study highlights that screening services and the medicine for major NCDs like hypertension and diabetes were available at local level. Limited budget was allocated and health workforce was not trained for NCDs prevention and control. There was no reporting mechanism for NCD related data from local level. Conclusion: Basic medicine and screening services were provided from the local level to the selected NCDs such as hypertension and diabetes. There was no provision of reporting NCD related information and health workforce were not trained to respond NCDs. Local level health system strengthening is an urgent need to address the increasing burden of NCDs.  
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37567
      Issue No: Vol. 6, No. 1 (2021)
       
  • Comparative Study of Standard Four-Port, Three Port and Single Incision
           Laparoscopic Cholecystectomy Performed by a Single Surgeon in Nobel
           Medical College Teaching Hospital, Nepal

    • Authors: Ruslan Sulaimankulov, Gulmira Jolochieva
      Pages: 1325 - 1329
      Abstract: Introduction: Laparoscopic Cholecystectomy is a standard operative procedure for patients with gallbladder diseases and is the most common laparoscopic procedure performed worldwide. The aim of this study is to analyze the different methods of laparoscopic cholecystectomies done by a single surgeon at Nobel Medical College Teaching Hospital. Objectives: The objective and aim of this study are comparing 4 port classic Laparoscopic Cholecystectomy (4PLC), 3 port (3PLC) and Laparo-Endoscopic Single-Site Cholecystectomy (LESC) performed by a single surgeon and correlate worldwide experience with outcomes in our institution. Methodology: The study includes retrospective analysis of 8192 patients who underwent elective laparoscopic Cholecystectomy (LC) from October 2010 to July 2020 performed by the single surgeon. All cases divided into 3 groups depending on the type of LC (4PLC, 3PLC, LESC). The data included the type of the surgery, gender, age, operative time, conversion and complication rate and duration of hospital stay. Results: The hospital stays, operation time and conversion rate decreased from group I to group III. Female patients out numbered the male ones (M:F=1:4). The hospital stays (3.4 days), operation time (35 min), conversion (0.4%) and complications (0.7%) rate decreased from Group of 4PLC to Group of LESC (1.5 days, 13 min, 0.1% conversion, 0.4% complication respectively) which is true for almost all other similar studies. Conclusion: The advantages of LESC include a better cosmetic effect and reduced chance of infections. It has been postulated to be superior in scarless surgery with added benefits of lower pain level and reduced need for analgesics, shorter hospital stays, quicker return to work and lower financial expenses. 
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37620
      Issue No: Vol. 6, No. 1 (2021)
       
  • Growth Parameters of Exclusively Breastfed versus Non-Exclusively Fed
           Infants in the First 5 Months of Life before Introduction of Semi-Solid
           Foods

    • Authors: Eva Gauchan
      Pages: 1330 - 1335
      Abstract: Introduction: Exclusive breast-feeding has many advantages over nonexclusive feeding; better growth and lower risks of infections being most important. The aim of this study was to find the hospital prevalence of exclusive breast-feeding, find any differences in growth and morbidity patterns in babies who were exclusively breast-fed as compared to those who were not. Methodology: This was a hospital-based cross-sectional study over a period of one year which enrolled infants 1.5 months, 2.5 months, 3.5 months and 5 months of age who were on exclusive breast-feeding or non-exclusive feeding and who had not been started on semi-solid foods. Growth and morbidity patterns were recorded. Statistical analysis was done by SPSS version 25. Continuous variables were reported as median [IQR] while categorical variables were reported as absolute number (%). Mann-Whitney U test and Chi-square test were used to find the level of significance respectively. Results: The hospital prevalence of exclusive breast-feeding was found to be 62%. Weight for age was significantly higher in infants who were on exclusive breast-feeding (p=<.05) at 1.5, 2.5 and 3.5 months of age. Similarly length for age was higher in infants at 1.5 months (p=.034) of age but there after no difference was seen. Undernutrition was seen in 5.5% of non-exclusively fed infants as compared to 0.9% of exclusively breast-fed babies (p=<.001). Illnesses like pneumonia, diarrhea, ear infection and urinary tract infection were seen more in infants who were on nonexclusive feeding as opposed to infants who were exclusively breast-fed (p=<.05). Conclusions: Exclusively breast-fed babies have betier growth in terms of weight and lesser morbidities as compared to those babies who are non-exclusively fed. 
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37623
      Issue No: Vol. 6, No. 1 (2021)
       
  • Functional Outcome of Intercondylar Distal Humerus Fractures Surgically
           Treated with Open Reduction and Internal Fixation with a Principle Based
           on Orthogonal Plating Technique

    • Authors: Santosh Thapa, Ranjib Kumar Jha, Ashish Rajthala
      Pages: 1336 - 1340
      Abstract: Introduction: Owing to the complex articular structure, paucity of metaphyseal bone and thin soft tissue covering, treatment of intra-articular distal humerus fractures still pose challenge to surgeons. Although it comprises 2% of all fractures the massive complication rate to the treatment is worrisome. This study aims to evaluate the outcome of surgical treatment of these fractures by open reduction and internal fixation by dual orthogonal plates. Objectives: The objective of the study is to evaluate the functional outcome of intercondylar humerus fractures managed with open reduction and internal fixation with orthogonal dual plating technique. Methodology: Eighteen patients (19 – 68 years old) with AO/OTA type 13C fractures were evaluated after surgery for one year with MEPS and range of motion. Complications were categorized as major or minor complications. Functional comparisons were made between simple articular type C1/C2 and complex articular type C3 fractures at one year. Result: There were 2 (11.11%) type C1 fracture and 8 (44.44%) each in type C2 and C3 fractures. Eight (44.44%) patients obtained excellent, 7 (38.89%) obtained good and 3 (16.7%) obtained fair results. There was no poor outcome. Average MEPS score was 83.33 and there was no significant between the subgroups (p = 0.07). The average flexion was 118.06° and it was significantly impaired in type C3 fractures (p = 0.03). Three patients obtained full extension, and remaining patients had mean extension deficit of 12°. Average arch of motion was 108.06° with significant difference between two subgroups (p = 0.008). The mean arc of motion for supination-pronation was 154.44°. There was 5 minor and 2 major complications (total - 38.9%). Conclusion: The surgical management with open reduction and internal fixation by dual plates in orthogonal configuration for the intercondylar distal humeral AO type C fractures has good or excellent functional outcome in majority of the patients.
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37625
      Issue No: Vol. 6, No. 1 (2021)
       
  • Evaluation of Efficacy of Online Case Based Learning as a Teaching
           Learning Tool in Undergraduate Oral Pathology Course

    • Authors: Bijayata Shrestha, Sushil Subedi, Ujjwal Koirala, Ishwori Sharma Paudel, Sabita Paudel
      Pages: 1341 - 1345
      Abstract: Introduction: COVID-19 had enforced educational institutes to adopt online learning. Objectives: This study was designed to compare the learning outcome of online case and online lecture based learning in the undergraduate Oral pathology module of our institute and to compare the perception of students towards the course atiended. Methodology: The 3rd year dental students (N=25) were split into – online case based learning (A1=6, A2=6) and online lecture based learning groups (B=13) randomly. An online multiple choice questions tests were conducted before and after the interventions. An online questionnaire based survey was conducted to evaluate students' perceptions toward the course attended. The statistical analysis was done using paired t test and Mann Whitney U test. Results: Online case based learning was found to be a more effective learning method than online lecture based learning group (online case based learning post test mean rank=16, online lecture based learning post test mean rank=9.54, P=0.026). Significantly more students in the online case based learning group had positive perception towards the course atiended (online lecture based learning; mean value =2.5+/- 0.54, online case based learning; mean value =2.87+/-0.2, P=0.041). Conclusion: Online case based learning should be integrated in Oral Pathology curriculum amidst such pandemics when onsite classes are not possible.
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37627
      Issue No: Vol. 6, No. 1 (2021)
       
  • Lower Segment Cesarean Section for Guillain- Barre Syndrome - A Novel
           Anaesthetic Technique

    • Authors: Rupak Bhattarai, Sabina Lamichhane, Chitta Ranjan Das
      Pages: 1346 - 1351
      Abstract: Introduction: Guillain Barre Syndrome in pregnant ladies, undergoing cesarean section, has not yet reported in Nepal. Anaesthetic management of 15 patients with Guillain Barre Syndrome who underwent lower segment cesarean section at Nobel Medical College Teaching Hospital is reported here. Objective: The purpose of this study is to assess the benefits of Rectus sheath nerve block along with infiltration of retropubic space of Retzius in Guillain Barre syndrome patients planned for lower segment cesarean section (LSCS). Methodology: During the period from 1st August 2015 to 31st April 2020 at NMCTH, a retrospective descriptive analysis of 15 pregnant ladies with Guillain Barre Syndrome who underwent lower segment cesarean section under Rectus sheath nerve block along with Retro pubic space of Retzius, infiltration and visceral peritoneum infiltration is discussed. Result: Considering Surgeons opinion about the operating conditions like Relaxation, Straining, Coughing, Bucking, Satisfactory to good operative conditions were reported. Excellent to good satisfaction was expressed by 39.9% of patients, 60% patients reported satisfactory. Hypotension and Arrhythmias was seen in 2 patients. Diaphoresis was seen in 1 patient. Fetomaternal outcome was good. There was no mortality. Conclusion: Rectus sheath block along with infiltration of retro pubic space of Retzius block can be considered as a good alternative to general anaesthesia or neuraxial block incase where general anesthesia & neuraxial block is risky or contraindicated for lower segment cesarean section in patients with Guillain Barre Syndrome. 
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37628
      Issue No: Vol. 6, No. 1 (2021)
       
  • Multidetector Computed Tomography (MDCT) Evaluation of Traumatic Brain
           Injury in Head Trauma Patients in Tertiary Hospital of Eastern Region of
           Nepal

    • Authors: Ajay Kumar Yadav, Binit Dev, Sushil Taparia, Parvez Kumar, Rakesh Mandal, Bivek Vaidya
      Pages: 1352 - 1357
      Abstract: Introduction: Traumatic brain injury (TBI) in patients with head trauma is common cause for emergency visits to hospital affecting all age groups. It is one of important leading cause of death and disability worldwide besides leading to neurological disease burden. Noncontrast enhanced Multidetector computed tomography (MDCT) is imaging modality of choice for detection of various intracranial lesions. Objectives: This study was done to analyse various imaging findings on MDCT in traumatic head injury patients along with association of CT findings with clinical manifestation and mechanism of injury. Methodology: In this ethically approved prospective study, CT scan was done in 224 consecutive patients with head injury from November 2020 to February 2021. The various imaging findings seen in CT scan were documented in proforma. The data collected was analyzed with appropriate statistical test and statistical significance was calculated. Results: Total of 224 patients with diagnosis of head injury were included in the study. The male to female ratio was 2.86 and most common age group involved was between 20-40years (41.1%). The most common mode of injury was road traffic accidents (57.6%) and most of the patients presented with history of altered sensorium (35.7%). About 47.3% patients showed abnormal findings on CT scan with scalp lesion was most common findings (82%) followed by skull fractures (54.7%) and cerebral contusions (43.4%). Patients with history of RTA had more abnormal CT scan (62%) than fall injury and physical assault. Statistically significant association seen between CT scan findings with Glasgow Coma Scale and RTA (P<0.05). Conclusion: The present study showed well documented role of CT scan in diagnosis of TBI besides detection of spectrum of intracranial lesions in patients with head trauma. Road traffic accident is most common mode of head injury with most of the victims are young middle age active male. 
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37636
      Issue No: Vol. 6, No. 1 (2021)
       
  • Outcome of Scalpel versus Diathermy Skin Incision in Inguinal Hernia
           Surgery: A Comparative Cross Sectional Study

    • Authors: Sanjaya Kumar Yadav, Sabin Shrestha, Nisesh Sitoula, Ram Kumar Singh
      Pages: 1358 - 1362
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37637
      Issue No: Vol. 6, No. 1 (2021)
       
  • Inflammatory Bowel Disease in Maldives; A Single Center Clinical
           Experience

    • Authors: Mohan Khadka
      Pages: 1363 - 1368
      Abstract: Introduction: Inflammatory bowel disease (IBD), once considered disease of west is also increasingly diagnosed in Asia in recent years. As there are already studies about IBD in Southeast Asia like India, Srilanka, it would be more informative to study the disease in Maldives as being closer to India and Srilanka. This is probably the first study about the disease from Maldives conducted in a single tertiary hospital center. The objectives of the study were to determine the prevalence, clinical characteristics and treatment of IBD in Maldives. Methodology: A preliminary hospital-based retrospective observational study was performed in ADK multispecialty hospital, a referral tertiary center located in the capital city of Maldives. Patients visiting gastroenterology OPD, who were diagnosed as IBD either Crohn's disease (CD) or Ulcerative colitis (UC) on basis of internationally established standard practice, were recruited in the study after informed oral consents for the duration of three years from January, 2017 to December, 2020. We collected clinical data including gender, age at diagnosis, symptomatology, severity, smoking habits, family history, disease phenotype, and behavior at diagnosis from each involved patients as per clinical proforma prepared for UC and Crohn's disease in separate forms. Result: Total 41 patients of IBD with 15 CD and 26 UC were recruited during study period. The prevalence of IBD in the country was estimated to be at least 20 per 100000 persons. Ileocolonic phenotype in CD and Extended colitis in UC were more common. Clinically, majority IBD patients presented with moderate to severe form. Biologic agents were frequently used in IBD. Conclusion: The prevalence of IBD in Maldives is also more or less similar to other Asian countries where as some aspects of clinical characteristics are similar to Western countries. There needs to be nationwide epidemiological study or multi center hospital based prospective or at least cross sectional study for detail and optimal information about various aspects of IBD. 
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37638
      Issue No: Vol. 6, No. 1 (2021)
       
  • Mortality Review of Children Admitted in Pediatric Intensive Care Unit
           Over One Year in a Tertiary Care Hospital

    • Authors: Pun Narayan Shrestha, Sumit Agrawal, Kosh Raj R C, Prakash Joshi, Ajit Rayamajhi
      Pages: 1369 - 1372
      Abstract: Introduction: Childhood mortality is still high in developing countries. This can be reduced with good preventive and curative services especially with critical care. The treatment of critically ill children must be focused for better outcome. The pediatrics deaths audit and review provide feedback to health workers and to the institution. The outcome measures of critical care medicine include mortality, morbidity and disability rate. Objectives: The aim of this study is to review the causes and mode of death in children and length of PICU (pediatric intensive care unit) stay. Methodology: A retrospective study was conducted of the patients who were admitted and died within the period of 16 July 2019 to 15 July, 2020 at PICU of Kanti Children Hospital (KCH). Variables recorded were patient's demography, diagnosis, co- morbidities, complications, length of PICU stay (LOS), mode and time of death. Data were tabulated into MS Excel and analyzed using SPSS version 23. Result: Out of 718 admitted children, 99 (13.78%) died with male to female ratio of 1.8:1. The maximum death (75%) was observed in less than five year of age and most of them were from outside the Kathmandu valley. The leading causes of death were pneumonia (28%), sepsis (20%) and congenital heart diseases (21%). The common complications seen were disseminated intravascular coagulation (DIC), multi- organ dysfunction syndrome (MODS), acute kidney injury (AKI) (5.1 %) and acute respiratory distress syndrome (ARDS) (6.1%) and co- morbidities were congenital heart disease (CHD) (18.2%) and global developmental delay (GDD) (9.1%). Mechanical ventilation was needed in 80.8%. Most of the cases (86%) died despite active treatment and (75%) during off hours (4pm-9am). Conclusion: Pneumonia, sepsis and CHD were the main reason of death and most of them were from outside the valley. 
      PubDate: 2021-06-13
      DOI: 10.3126/bjhs.v6i1.37639
      Issue No: Vol. 6, No. 1 (2021)
       
  • Evaluation of the Effects of Ultra-Low Dose Naloxone on Brachial Plexus
           Block with Bupivacaine

    • Authors: Amit Sharma Bhattarai, Gentle Sunder Shrestha, Megha Koirala, Pramesh Sunder Shrestha, Moda Nath Marhatta
      Pages: 1373 - 1376
      Abstract: Introduction: Adjuvants are used in conjunction with local anaesthetics for brachial plexus block to quicken onset, prolong duration and augment the quality of anaesthesia. Objectives: The study aims to evaluate the effect of adding ultra-low dose naloxone to bupivacaine on the duration of postoperative analgesia. Methodology: A prospective, randomized, double-blind study was conducted including forty American Society of Anesthesiologists Physical Status (ASA PS) I and II patients of either sex between 15 and 65 years of age scheduled for upper limb surgery. They were randomized into two groups. Group BN received a mixture of 0.33% plain bupivacaine with ultra-low dose naloxone (100 ng) and group BS received 0.33% plain bupivacaine with saline. The procedure was standardized in both groups. The onset of sensory and motor block were assessed with pinprick sensation and muscle power respectively. Visual Analogue Score (VAS) was used to assess the pain at 1, 2, 4, 8 and 12 hours postoperatively. Result: The patients were comparable with respect to age, sex, ASA PS, baseline hemodynamic and respiratory parameters and duration of surgery. The mean duration of analgesia in group BN was significantly longer (610.7±125.4 mins) as compared to group BS (354.3±59.6 mins) (p<0.001). No complications were noted in both the groups. Conclusion: This study demonstrated that 100 ng naloxone, when used with 0.33% plain bupivacaine for supraclavicular brachial plexus block, prolongs postoperative analgesia significantly after upper limb surgeries, without any significant side effects. 
      PubDate: 2021-06-14
      DOI: 10.3126/bjhs.v6i1.37640
      Issue No: Vol. 6, No. 1 (2021)
       
  • Assessment of Common Maternal Risk Factors in Fetal Malnutrition

    • Authors: Anshu Poudel, Nisha K Bhatta, Mohan Chandra Regmi, Lokraj Shah, Rajan Paudel
      Pages: 1377 - 1382
      Abstract: Introduction: Nutritional assessment of the newborn gives the reflection of the growth process in the intrauterine period. The Clinical Assessment of Fetal Nutritional Status score (CAN score) method is only the method to assess the fetal malnutrition which includes the clinical observation for the presence of the sign of malnutrition in newborns. Since the fetal growth is related to availability of intrauterine nutrition and placental function, there may be several maternal factors associated with the fetal malnutrition. Objectives: The main objective of the study was to determine the prevalance of Fetal Malnutrition in term newborns and the role of maternal factors in the etiology of fetal malnutrition (FM) in the Neonatal and Maternity Units of B.P Koirala Institute of Health Sciences, Dharan. Methodology: This was a hospital based observational cross sectional study of consecutive, singleton, term live babies delivered between September 2019 to March 2020. Fetal malnutrition was diagnosed using Clinical Assessment of Fetal Nutritional Status score (CAN score) developed by Metcoff. The maternal history was obtained from the mother which included age, parity, socioeconomic class, pre pregnancy weight, number of antenatal care during pregnancy, history of maternal illness and drugs taken during pregnancy. Nutritional status of the mother was determined using weight, height, mid arm circumference (MAC) and the body mass index (BMI). Collected data was entered in Microsoft excel 2010 and converted it into SPSS 23 version software, for statistical analysis. Results: Of the 400 studied newborns, 73 [18%] had FM. The prevalence of teenage pregnancy, primiparity, lower maternal mid arm circumference and vegetarian diets were higher in the mothers of the babies who had suffered fetal malnutrition than the mothers of the babies without FM (p value <0.05).The adverse maternal condition like Pregnancy induced hypertension (PIH), Antepartum hemorrahge (APH), Urinary tract infection (UTI), fever during pregnancy had significant impact in the fetal malnutrition(p value <0.05). Conclusion: Improvement in the socioeconomic condition of women and good antenatal care could reduce most of the maternal factors associated with fetal malnutrition. There should be implementation of more accessible programs which address the issues of the maternal nutrition and the maternal health care in Nepal. 
      PubDate: 2021-06-14
      DOI: 10.3126/bjhs.v6i1.37641
      Issue No: Vol. 6, No. 1 (2021)
       
  • A Comparative Study of the Influence of Body Mass Index on Clinical
           Outcomes of Total Laparoscopic Hysterectomy in Birat Medical College
           Teaching Hospital, Morang, Nepal

    • Authors: Bhanubhakta Neupane, Gyanendra Man Singh Karki, Hanoon P Pokharel, Prerana Dahal, Garima Bhandari
      Pages: 1383 - 1387
      Abstract: Introduction: Although laparoscopy is a safe route of hysterectomy as it provides battier view of abdominal anatomy, facilitates meticulous hemostasis and reduces surgical morbidity, laparoscopic hysterectomy in overweight and obese women may pose an increased risk of intraoperative and postoperative complications as omental fat and limited manipulation of instruments may render operation difficult. Objectives: The aim of the study is to evaluate the impact of Body Mass Index (BMI) on the clinical outcome of total laparoscopichysterectomy. Methodology: This is a comparative cross-sectional study conducted in 190 patients who underwent total laparoscopic hysterectomy (TLH) in Department of Obstetrics and Gynecology of Birat Medical College, Teaching Hospital from July, 2019 to November 2020.Ninety five patients were enrolled in high BMI group and normal BMI group each Result: Mean BMI was 28.90±2.27 ( Kg/M2)in high BMI group and 23.54 ± 1.14 (Kg/M2)in normal BMI group. Urinary tract injury occurred in 4 (4.21%) cases in high BMI group and 2 (2.1%) cases in normal BMI group. Intraoperative and immediate postoperative complication were similar in both groups. Conclusion: Intraoperative and postoperative complications were similar in both the groups. Patients with high BMI have no increased risk of complications during total laparoscopic hysterectomy. 
      PubDate: 2021-06-14
      DOI: 10.3126/bjhs.v6i1.37642
      Issue No: Vol. 6, No. 1 (2021)
       
  • Prevalence of Hyperuricemia and its Association with Sociodemography among
           Hypertensive Patients at Birat Medical College Teaching Hospital

    • Authors: Ram Kumar Mehta, Ram L Mallick, Surya Parajuli, Rajneesh Jha
      Pages: 1388 - 1391
      Abstract: Introduction: Hypertension is the most common cardiovascular diseases. In only 5-10 % of hypertensive patients, underlying cause can be identified (secondary hypertension). Serum uric acid is thought to play a pathogenic role in development of hypertension and is also a commonly associated condition in patients with hypertension. Management of hyperuricemia will ultimately help in reducing cardiovascular morbidity and mortality. Objectives: To determine the prevalence of hyperuricemia among hypertensive patients atiending Birat Medical College Teaching Hospital and also to find association between hyperuricemia and socio-demographic variables. Methodology: This was a descriptive hospital based cross-sectional study conducted in 168 hypertensive patients at Birat Medical College Teaching Hospital, Nepal for a period of 6 months from 1 September 2020 to 28th February 2021. Sociodemographic variables were recorded and serum uric acid level was obtained based on the pre-structured questionnaires. Data were analyzed by Statistical Package for the Social Sciences version 20 (SPSS 20). Result: Prevalence of hyperuricemia was 42 (25%) among hypertensive patients with more prevalent in male 33 (30.8%) than female 9 (14.8%). Hyperuricemia was more prevalent in patients having higher BMI and patients aged more than 60 years i.e. 38 (34.5%) and 25 (41.7%) respectively. It was more prevalent among patients with hypertension for more than 15 years 10 (41.7%) and non-vegetarian 33 (25.8%). Hyperuricemia was significantly associated with those aged more than 60 years (p=0.002) and BMI >25 kg/m2 (p=0.002). Conclusion: Hyperuricemia was common associated condition among hypertensive patients. Hyperuricemia is mainly associated with male gender, non-vegetarian and patients with longer duration of hypertension. Similarly, it was strongly associated with older age and patients having higher BMI. Monitoring of serum uric acid and management of hyperuricemia might be helpful in management of hypertension and thus decreasing cardiovascular morbidity and mortality. 
      PubDate: 2021-06-14
      DOI: 10.3126/bjhs.v6i1.37643
      Issue No: Vol. 6, No. 1 (2021)
       
  • Prevalence and Pattern of Substance Use among Undergraduate Medical
           Students at Birat Medical College and Teaching Hospital

    • Authors: Rajesh Kumar Shah, Sidarth Timsinha, Sanjib Kumar Sah, Umesh Kumar Mehta, Raju Kumar Chaudhary
      Pages: 1392 - 1395
      Abstract: Introduction: Medical students encounter a constant pressure of academic and clinical activities, as well as easy access to drugs which could enable them to use different substances. Medical students who use substances can endanger others by losing sound judgment, failing to take responsibility, and causing harm to service recipients. Objective: The study was aimed to find out the prevalence and pattern of substance use among undergraduate medical students of Birat Medical College and Teaching Hospital, Nepal. Methodology: This hospital based cross sectional study was carried out from January 2021 to February 2021 at Birat Medical College and Teaching Hospital, Morang Nepal. A total of 207 subjects were included in the study, which was selected using convenience sampling. All participants were given a self-prepared semi-structured pre-tested questionnaire in order to gather information about their sociodemographic profile and pattern of substance use. Result: The overall prevalence of substance use among students of BMCTH was 59 (28.50%) (n=207). Males were significantly associated with substance use than females (P < 0.001). Prevalence of substance use were maximum among final year students 26(76.47%). The most common used substance was alcohol 49 (83.05%) followed by tobacco smoking 24 (40.67%) and cannabis 11 (18.64%).Curiosity of experience 39 (35.77%) and seeking pleasure 19 (17.43%) were the main reason of substance use among students. Conclusion: In this study students were found to be involved in some form of substance use, with many of them initiating after enrolling in medical school. Majority of students used for the sake of fun which they use as a source of entertainment to deviate their minds from the pressure of studies.
      PubDate: 2021-06-14
      DOI: 10.3126/bjhs.v6i1.37644
      Issue No: Vol. 6, No. 1 (2021)
       
  • Early Re- Laparoscopy in Suspected Bile Duct Injuries after Laparoscopic
           Cholecystectomy

    • Authors: Roshan Ghimire, Dhiresh Maharjan, Prabin Thapa
      Pages: 1396 - 1400
      Abstract: Introduction: Management of patients with suspected bile leak or bile duct injury after laparoscopic cholecystectomy is challenging. Early laparoscopy in these groups of patients will benefit in terms of diagnostic as well therapeutic purpose. Objective: This study is done to assess utility of early re-laparoscopy in suspected bile duct injury in early postoperative period following laparoscopic cholecystectomy. Methodology: It is a descriptive study of all consecutive patients who underwent diagnostic as well therapeutic re-laparoscopy when required in suspected bile duct injury in early postoperative laparoscopic cholecystectomy that is within 72 hours of presentation. Study was conducted over a period from June 2019 to December 2020 at Kathmandu medical College, Sinamangal, Kathmandu, Nepal. Relaparoscopic operative findings and therapeutic intervention done were recorded. Result: The mean age at presentation was 34.6 years and male to female ratio was 1:1.8. During the study period, eleven patients underwent re-laparoscopy out of which one had no bile leak. Six out of ten were managed definitely in the same time of re-laparoscopy. However, four patients underwent definitive biliary reconstruction as they had already undergone arteriography in CT scan. Conclusions: Early re-laparoscopy may be beneficial prior to detail radiological investigations in suspected bile leak patients. Early re-laparoscopy can be an effective diagnostic as well therapeutic tool; and also it can help in planning for definitive repair in later date. 
      PubDate: 2021-06-14
      DOI: 10.3126/bjhs.v6i1.37645
      Issue No: Vol. 6, No. 1 (2021)
       
  • Use of Wrist or Ankle as Substitute Sites for Placement of Pulse Oximeter
           in Neonatal Intensive Care

    • Authors: Sonia Dahal, Hemsagar Rimal, Kumud Pyakurel, Deep Raj Adhikari
      Pages: 1401 - 1404
      Abstract: Introduction: Pulse oximetry is widely used in Neonatal intensive care setting. Both wrist and ankle are widely used as substitute sites for probe placement in place of more commonly used sites such as palm and sole. However, little is known about the accuracy and response time of pulse oximetry when the probe is placed at wrist or ankle of neonates. Objectives: The primary objective of this study was to compare the values of SpO2 reading at wrist with palm and ankle with sole in terms of correlation and accuracy. The secondary objective was to compare the response time to get a valid SpO2 reading at wrist with palm and ankle with sole. Methodology: This was a prospective observational study conducted at Neonatal intensive care unit of Biratnagar Hospital from October 2020 to January 2021. After approval from institutional review committee, a total of 152 consecutive neonates admitted in NICU of either gender both term and preterm were enrolled for the study. Recording of SpO2, heart rate and response time was done by two pulse oximeters simultaneously. The SpO2 measurements at right palm and right wrist were recorded at 0, 30 seconds and 1 minute then simultaneous recording was done for the left palm and left wrist, right sole and ankle and left sole and ankle. Response time was also recorded for each of the readings. Results: The results of our study show good correlation using regression analysis and good agreement using Bland- Altman plots between the values of SpO2 reading of paired measurements. The response times of the paired measurements were not significantly different. There was good correlation between the SpO2 of paired measurements. The correlation for right palm and wrist was 0.927 (P-value = 0.01) and that of left palm and wrist was 0.85 (P-value = 0.01). Similarly the correlation between right sole and ankle and left sole and ankle were 0.937 (P-value = 0.01) and 0.875 (Pvalue = 0.01) respectively. The bias (average difference) and precision (standard deviation of differences) were calculated. The bias and precision of the right palm and wrist, left palm and wrist, right ankle and sole; and left ankle and sole were (-0.00289, 0.76105), (-0.17982, 0.95049), (-0.03509, 0.786342) and (-0.14474, 0.859241) respectively. Conclusion: Wrist and ankle can be used as substitute sites for pulse oximter placement in neonatal intensive care setting. 
      PubDate: 2021-06-14
      DOI: 10.3126/bjhs.v6i1.37646
      Issue No: Vol. 6, No. 1 (2021)
       
  • Post operative nausea and vomiting, its causes, and the way of its
           prevention and treatment

    • Authors: Surendra Maharjan, Zhang Bing
      Pages: 1405 - 1415
      Abstract: Postoperative nausea and vomiting is still occurring in one third of the patient undergoing surgery under general anaesthesia even after following the guidelines and using multi modal approach for its prevention. Lots of studies have been done for its prevention but very few studies are done for its treatment in Post anaesthetic care unit after the failure of prophylaxis. The purpose of this article is to know about the risk factor, incidence of nausea and vomiting after surgery, its mechanism, available medication (pharmacological and nonpharmacological), reducing risk factor, and mainly to know about the method of using the antiemetic medication in PACU after the failure of the prophylactic medication.
      PubDate: 2021-06-14
      DOI: 10.3126/bjhs.v6i1.37647
      Issue No: Vol. 6, No. 1 (2021)
       
  • Post Stroke Hydrocephalus: A Case Report

    • Authors: Mohan Karki, Yam Bahadur Roka
      Pages: 1416 - 1418
      Abstract: Hydrocephalus in case of hemorrhagic stroke with intravetricular extension is common complication, but without intraventricular extension is rare. However, we rarely find hydrocephalus following resolved hemorrhagic stroke. We present a case of communicating hydrocephalus in 65 year female who presented with left sided weakness, disoriented and loss of consciousness since few weeks. Patient was managed with ventriculoperitoneal (VP) shunt. We report this unusual case with pertinent literature. 
      PubDate: 2021-06-14
      DOI: 10.3126/bjhs.v6i1.37663
      Issue No: Vol. 6, No. 1 (2021)
       
  • Odynophagia: A Rare Presenting Symptom in Acute Myeloid Leukemia (FAB AML
           - M2)

    • Authors: Sudip Yadav, Neeta Kafle, Sulav Sapkota
      Pages: 1419 - 1421
      Abstract: Acute myeloid leukemia is more common in adults than in children population. Fatigue, bleeding and fever are the most common presentations. Petechiae, gingival swelling, lymphadenopathy and hepatosplenomegaly are common signs. Here we report a case of a 57 years post-menopausal lady with gum swelling and pain on deglutition for both liquid and solid foods. She was diagnosed with a case of AML- M2 on the basis of peripheral blood smear and bone marrow examination findings.
      PubDate: 2021-06-14
      DOI: 10.3126/bjhs.v6i1.37665
      Issue No: Vol. 6, No. 1 (2021)
       
  • Ultrasound Guided Thoracic Paravertebral Block as an Analgesic Technique
           for Tracheoesophageal Fistula repair : A Case Report

    • Authors: Rupesh Kumar Yadav, Sadichhya Shah Malla, Anupama Thapa
      Pages: 1422 - 1425
      Abstract: Ultrasound has now become an eye of anaesthesiologist and has encouraged for its pervasive use. Its considerable use in the perioperative period for various invasive purposes has added an extra caution to prevent unforeseen complications over blind blocks. The ultrasound-guided thoracic paravertebral block provides excellent perioperative analgesia following thoracic surgery. It can be given as a single shot or a continuous infusion technique placing a catheter. Here the local anesthetic agent is deposited in the paravertebral space from where the spinal nerve emerges which are devoid of coverings and are sensitive to local anesthetics. Even a single-shot block provides analgesia of 4-6 dermatomal levels. The use of local anesthetics using ultrasound not only adds safety measures to minimize procedural complications but also reduces the perioperative requirement of opioids. It also helps in the reduction of postoperative pulmonary complications and early extubation following thoracic surgery. We report a case series where single-shot ultrasound-guided unilateral paravertebral blocks were used as an analgesic technique for the repair of tracheoesophageal fistula in neonates. After delivering anesthesia and confirming the correct placement of the endotracheal tube the neonate was kept on the left lateral position to undergo right thoracotomy and repair of fistula. Scanning at T4 level with a linear probe was done to identify the transverse process, pleura, costotransverse ligament, intercostal muscle, and the paravertebral space where the local anesthetic agent was deposited under aseptic precautions. Tenting of pleura was the endpoint for the completion of the block. The extensive use of various regional anesthetic technique has significantly improved the postoperative outcome of the patients along with adequate perioperative pain management.
      PubDate: 2021-06-14
      DOI: 10.3126/bjhs.v6i1.37666
      Issue No: Vol. 6, No. 1 (2021)
       
 
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