Journal of Patan Academy of Health Sciences

Functional outcome after transperitoneal laparoscopic pyeloplasty at a tertiary care center, Nepal

Prabodh Regmi — 2023-12-31

Introduction: Pyeloplasty is the gold standard surgical treatment for Pelvic-Ureteric Junction Obstruction (PUJO). Laparoscopic pyeloplasty has gained popularity in recent years because it is less invasive, has better cosmesis, and reduces hospital stays with an equivalent success rate compared to open pyeloplasty. This study was designed to find out the success rate of laparoscopic transperitoneal pyeloplasty in cases with unilateral PUJO.

Method: This was a retrospective study, which included four years of data on patients who underwent laparoscopic pyeloplasty from 1 Jan 2019 to 31 Dec 2022 in the Department of Urology, Bir Hospital, National Academy of Medical Sciences, Nepal. Ethical approval was obtained. Microsoft Excel was used for descriptive analysis, frequency, and percentage of clinical and demographic data for age, gender, and site. Pre- and post-operative data of differential renal function (DRF) based on the radio-isotope renography and their association were compared using the χ²test. A p-value of <0.05 was considered statistically significant.

Result: Out of 25 cases, renal function improvement was observed in 18(72%), stable in 6(24%), and deteriorated in 1(4%) cases based on DRF analysis. Male to female ratio was 13:12, the mean age was 26 y (8-60 y), and the left side was 14(60%). A mean improvement of DRF of 3.1% was observed in the age group of >30 y, and a mean improvement of DRF of 4.3% was also observed in the cases with DRF ≤30%.

Conclusion: The laparoscopic pyeloplasty showed excellent functional outcomes in the majority of the cases with PUJO.

Pattern of oro-dental disease in dental clinic of a tertiary care center

Bishnu Prasad Sharma — 2023-12-31

Introduction: The oro-dental diseases are major public health problem throughout the population in Nepal and other countries of the world. It affects people throughout their lifetime. Unhealthy lifestyles, environment and oral health related behavior are the primary causes of oro-dental diseases. We aimed to study the descriptive variables related to oro-dental dental diseases amongst patients attending tertiary care center.

Method: A three-year data (April 2019 to April 2022) of patients registered for the treatment of oro-dental diseases in the record book of dental department of Patan Hospital were collected retrospectively. The collected data were entered in Microsoft Excel, and statistical analysis was carried out by using Statistical Package for the Social Science (SPSS) version 16.

Result: In the study, 15,879 patients were included; among them 8,652(54.49%) were female and 7,227(45.51%) were male. The most prevalent oro-dental disease was gingivitis/periodontitis 5,076(31.96%) followed by dental caries 5,028(31.66%), abrasion 3,525(22.2%), malocclusion 951(5.99%), impaction 585(3.68%), pulpitis 384(2.42%) and edentulous 330(2.08%). In male, majority 1,800(24.9 %) belonged to 60 years and above age group, in female, majority 1,749 (20.21 %) belonged to 20-29 y.

Conclusion: The most prevalent oro-dental diseases was gingivitis/periodontitis followed by dental caries, abrasion, malocclusion, impaction, pulpitis and edentulous. The female patients had more oro-dental problems than males.

Diabetic retinopathy in patients with newly diagnosed type 2 diabetes mellitus

Ranjana Sharma — 2023-12-31

Introduction: Diabetic retinopathy (DR) is the leading cause of visual impairment worldwide including Nepal and studies from populations have shown that up to 10% of diabetic patients have vision-threatening DR, with up to 5% requiring treatment at this initial visit. Within this context, this study aims to evaluate the presence of DR in newly diagnosed diabetic patients, presenting in the outpatient department of ophthalmology, at Patan Academy of Health Sciences.

Method: It is a retrospective cross-sectional study carried out in referred cases of newly diagnosed type 2 Diabetes Mellitus (DM) from January 2021 to December 2022. Information regarding age, gender, Body Mass Index (BMI), blood pressure (BP), Triglyceride (TG), proteinuria, and findings of fundus evaluation were extracted from the record maintained in the Department of Ophthalmology.

Result: Out of 102 patients with mean age of 49.1±13.6 y, 14(13.73%) had DR, 11(10.8%) had mild Non-proliferative Diabetic Retinopathy (NPDR) and three (2.9%) had moderate NPDR. There was female predominance 56(54.9%), 50(49%) patients were overweight or obese (BMI≥25 kg/m²), 15(14.7%) patients had proteinuria and 28(27.5%) had fasting hypertriglyceridemia and additional ocular anomaly was identified in 33(32.4%) patients.

Conclusion: Diabetic retinopathy is already present in significant proportion of newly diagnosed type 2 DM patients. Routine screening for DR at the time of diagnosis can improve ocular outcomes in newly diagnosed diabetics with targeted early treatment. Future research should evaluate this in wider population to generate guidelines for need of mandatory eye evaluation at diagnosis.

Non-communicable disease competencies in undergraduate medical (MBBS) curriculum of Patan Academy of Health Sciences, Nepal

Shrijana Shrestha — 2023-12-31

In the absence of equitable and well-established health care delivery system, the populations of lower middle income countries are more vulnerable to the impact of the non-communicable diseases (NCDs). However, adequate focus on teaching the NCD related competencies in the curriculum of medical professionals is missing in many of these countries.

The South-East Asia Regional (SEAR) NCD Network took an initiative to evaluate the NCD competencies in the pre -service curriculum of the health care providers. As part of this initiative Patan Academy of Health Sciences (PAHS), School of Medicine (SOM) conducted a competency matching exercise for the NCD related competencies in its undergraduate medical (MBBS) curriculum using the tools and format developed by SEAR NCD Network Partners. It was found that 46 out of 55 listed competencies were either fully or partially covered while 10 of the competencies were not addressed in the PAHS MBBS curriculum. Following this exercise, the working group at PAHS School of Medicine has come up with an action plan, has identified a few NCD related competencies to be certified along with the tools and timing of certification

Competency in NCD management ensures that future physicians have the necessary skills and knowledge to provide appropriate treatment and care for patients with NCDs through early detection and effective patient education which can reduce the burden of NCDs and the costs associated.

Cardiopulmonary resuscitation: knowledge among nurses in selected departments of a teaching hospital, Nepal

Rashmi Joshi — 2023-12-31

Introduction: Cardiopulmonary Resuscitation (CPR) is considered a core emergency skill in which all health care professionals must be proficient. If early basic life support CPR is instantiated, the survival rate is improved. This study aims to assess the knowledge regarding CPR among nurses.

Method: A descriptive cross-sectional study design was adopted among 150 nurses in critical care area of Patan Hospital Lalitpur Nepal, from January to April 2023. Researcher developed self-administered structured questionnaire was used for data collection. Statistical Package for Social Sciences (SPSS) version 20 was used for statistical analysis. Ethical approval was taken from the Institutional Review Committee of Patan Academy of Health Sciences.

Result: Study revealed that majority 143(95.3%) of the respondents had knowledge regarding meaning of sudden cardiac death. Same as 137(91.3%) knew the indication of CPR and most of the respondents 140(93.3%) knew the carotid pulse should be checked before starting CPR. More than half 131(87.3%) had knowledge regarding ratio of chest compression. We found more than half respondents 83(55.3%) knew the best time to switch. Nearly half of the respondents 61(40%) knew the component of high-quality CPR whereas minority of the respondents; 20(13.3%) knew the algorithm of adult cardiac arrest.

Conclusion: Majority of the respondents had knowledge regarding meaning, indication, site of pulse taking, and ratio of chest compression. Whereas more than fifty percent respondents had knowledge regarding, best time to switch, nearly half of respondents knew the components of CPR. Minority of respondents aware the algorithm of adult cardiac arrest.

Utilization of maternal health care services in a rural community of Nepal

Sushmita Sharma — 2023-12-31

Introduction: Nepal has made progress in declining maternal mortality; but not up to the target. One of the important aspects in this regard is to know about the base line maternal health care utilization among women and to develop intervention accordingly. This study aims to identify the utilization of maternal health care services among women of rural municipality of Nepal.

Method: A cross sectional analytical study with purposive sampling among 323 married women having at least one child less than five years old was conducted in Bagnaskali rural municipality of Palpa district using face to face interview technique with self-developed structured interview schedule. Descriptive statistics frequency, percentage, mean and standard deviations were used and association between descriptive variables and utilization was done using Chi square and Fisher Exact test as applicable using Statistical Package for Social Sciences (SPSS) version 16.

Result: The study showed 21.05% of respondents had completely utilized maternal health care services (four Antenatal Care (ANC) checkups, institutional delivery and three Postnatal Care (PNC) checkups), 78.94% of the respondents had partially utilized services. There was no significant difference in health care utilization between maternal age, education of both mothers and husbands, occupation, types of families and distance to nearest health facility as seen by Chi Square and Fisher Exact Test.

Conclusion: Almost all the respondents had ANC checkup and institutional delivery. More than half of the respondents had PNC checkup and the demographic variables had no association with utilization of maternal health care services.

Bullying and mental health of adolescents in Nepal

Ratna Shila Banstola — 2023-12-31

Bullying is one of the common issues among children and adolescents, bearing significant implications on mental health and wellbeing. Although there are few studies, there remains a gap in the synthesized understanding of bullying and its link to the mental health of Nepalese adolescents. Hence, this narrative review has examined the literature centering on the prevalence and impact of bullying within the context of Nepalese adolescents. Although there was limited number of relevant articles, the findings from the review revealed that bullying is a widespread experience among Nepalese adolescents and is associated with several mental health challenges such as anxiety, depression, and tendencies towards self-harm and suicidal behavior. The review sheds light on the importance of addressing bullying in order to prevent psychological consequences and foster the mental health of adolescents in Nepal.

Research and publication ethics: pillars of integrity in the scientific medical journal

Nabees Man Singh Pradhan — 2023-12-31

Research has been the foundation upon which human development has always been built. For sustainable growth, this foundation needs to be based on trustworthy knowledge, which cannot be achieved without following ethical standards at the highest possible level. Research has been conducted in various forms at different levels across all fraternities. There is no small or big research, there is only reliable or unreliable research. Research at different levels yields different levels of evidence which often builds up enough material to define a course of action, leading to the formation of guidelines or protocols.

Primary cutaneous aspergillosis presenting as a cystic lesion in the foot

Sarik Kumar Shrestha — 2023-12-31

Aspergillosis is a fungal infection, usually affecting the lungs, mostly in immunocompromised patients. Musculoskeletal or cutaneous involvement is extremely rare and when it does occur, the diagnosis and treatment is delayed. We present a case of primary cutaneous aspergillosis presenting as a cyst in the foot of a 54-year-old immunocompetent female. She presented with the complaint of painful lump over right foot at the region of the fourth webspace. Magnetic Resonance Imaging (MRI) was suggestive of infected ganglion cyst. However, histopathological examination showed granulomas with areas of caseous necrosis and silver stain showed multiple fungal hyphae with morphology suggestive of Aspergillus species.