Health Renaissance

The world is graying: Dementia is an alarming issue

N Sapkota — 2017-08-03

Not available.

Health Renaissance 2015;13 (3): 1-6

A case of abdominal tuberculosis diagnosed by fine needle aspiration cytology (FNAC) of mesenteric lymph node

Bijendra Kumar Rai — 2017-08-07

Background: The modes of presentation of abdominal tuberculosis can be vague resulting in diagnostic dilemma.

Objective: To report a case of abdominal tuberculosis diagnosed by FNAC of a mesenteric lymphnode.

Case: A 17-year-old boy presented in General out Patient department complaining of abdominal pain, abdominal distension, and low grade fever, anorexia and weight loss for 2 months. The examination revealed pallor, low body weight, doughing of abdomen and multiple palpable painless, slightly mobile abdominal lymph nodes. The ultrasonography (USG) guided fine needle aspiration cytology (FNAC) of a mesenteric lymphnode showed caseating necrosis suggestive of tuberculosis. The erythrocytes sedimentation rate (ESR) was raised.

Conclusion: The abdominal tuberculosis can present with abdominal pain and abdominal distension associated with low grade fever, anorexia and weight loss. The diagnosis of abdominal tuberculosis can be confirmed by FNAC of the lymphnodes.

Health Renaissance 2015;13(3): 177-180

Diffuse parenchymal neurocysticercosis

Sajid Ansari — 2017-08-07

Neurocysticercosis is the commonest parasitic manifestation of brain and the leading cause of seizure in the developing world. It is caused by the ingestion of Taenia solium eggs through contaminated food and especially pork meat. Computed tomography and magnetic resonance imaging are the modality of choice for diagnosis of neurocysticercosis. We report a case of 65 years old male presented with complaint of seizure, which was diagnosed as diffuse parenchymal neurocysticercosis on computed tomography scan of brain.

Health Renaissance 2015;13(3): 177-180

Drug ampoules in rectum: Lucky co-incidental finding in emergency department of eastern Nepal

Saroj Giri — 2017-08-07

Background: Rectal foreign body is uncommon in emergency usually presenting after failure to remove the object manually or with other complications.

Case: Twenty two years male in emergency department presented with rectal leeding following a manual attempt to remove drug ampoules from rectum.

Conclusion: In an unexplained rectal bleed, foreign bodies could be a pitfall.

Health Renaissance 2015;13(3): 185-187

Hydatid cyst submandibular gland, an unusal presentation: A case report

Sriti Manandhar — 2017-08-07

This is a case report of a sixteen years old female presented in the Otolaryngology and Head & Neck Surgery with left submandibular region which did not recovered by medical treatment. She underwent excision of left submandibular gland and hispathological examination confirmed the diagnosis as hydatid cyst of left submandibular gland.

Health Renaissance 2015;13(3): 188-190

Study of risk taking behaviors and practices long route drivers in Dharan Municipality of Eastern Nepal

Samyog Uprety — 2017-08-03

Background: Due to its perception as a disease of development, road traffic accident and related injuries tend to be under recognized as a major health problem in developing countries. However, majority of the world's fatalities on the roads occur in low income and middle income countries. Since the main cause of road traffic accident is attributed to human risky behaviors, it is important to identify significant factors for risky behaviors of drivers.

Objective: To know the risk taking behavior among drivers and practices of driving.

Methods: This population based cross-sectional study. The study was conducted in Dharan, a township in Eastern Nepal. The study population includes of all long route drivers who are registered in membership of vehicle organization. Modified semi structured questionnaire was used for data collection. SPSS version 11.5 computer software was used for data entry and analysis.

Results: Majority of study population belong to 25-29 years group. Majority of the drivers had valid license (98%) and about 68.9% drivers didn’t had any formal driving training school prior starting driving vehicle Most of them drive in high speed at highways but majority ignored that they take alcohol while driving. with growing age, years of driving had correlation of accidents among drivers population

Conclusion: Study population comprises of youth drivers and most they had valid lenience. With the growing age drivers are neglecting traffic rules and sings and young driver are driving vehicles with overconfidently

Health Renaissance 2015;13 (3): 1-6

Association between level of HbA1c and lipid profile in T2DM patients attending diabetic OPD at BPKIHS

Jouslin Kishore Baranwal — 2017-08-03

Hyperglycemia, dyslipidemia and coronary artery disease relate well with each other in type 2 diabetes and it has been proposed that higher prevalence of cardiovascular disease in type 2 diabetes is due to chronic uncontrolled hyperglycemia. Our study aimed to find utility of Hba1c as indicator of dyslipidemia in patients with type 2 diabetes mellitus. We enrolled 168 T2DM patients in our study and collected venous blood samples in both plain and EDTA vials after a fast of minimum 8 hours. Biochemical analysis was done in fully automated analyzer cobas c311. HbA1c was found to have significant positive correlation with total cholesterol, LDL-C, and triglyceride and significant negative correlation with HDL-C and HDL/LDL ratio. The mean value of TC, LDL-C and TG was found to be lower in patients with good glycemic control than those with poor glycemic control. But, mean value of HDL and HDL/LDL ratios were found to be higher in patients with good glycemic control than those with poor glycemic control. These differences were significant at the level of p <0.05. Our study suggests additional use of HbA1c as indicator of dyslipidemia.

Health Renaissance 2015;13 (3): 16-23

Role of imaging (MDCT) in ocular and orbital lesions

Pratima Kumari Shah — 2017-08-03

Background: Radiological imaging is still important to diagnose ocular and orbital abnormalities. Computed tomography is the first-line imaging modality for orbital imaging in the acute setting with magnetic resonance imaging playing an important secondary role.

Objective: To assess the role of multidectector computed tomography (MDCT) in diagnosis of ocular and orbital lesions. To describe the imaging features of various orbital and ocular lesions on MDCT.

Methods: A prospective cross-sectional study was conducted on 50 patients in B.P. Koirala Institute of Health Sciences, over the period of one year (from July 2013 to June 2014). All the patients with clinical suspicion of ocular and orbital lesions, referred from the ophthalmology department for CT scan were included in this study.

Results: Out of 50 cases 4 were traumatic and 46 were non traumatic cases. Retinoblastoma was most common non traumatic lesion in our study. We compared MDCT diagnosis and final diagnosis which was based on histopathology/ per operative finding, FNAC, clinical response to treatment, supportive laboratory (biochemical/ microbiological) findings and supportive findings on other radiological investigations (USG and MRI). The sensitivity of MDCT in diagnosing ocular and orbit lesions was 95.65%.

Conclusion: MDCT has important role in characterization and diagnosis of the lesions, surgical planning and follow up of patient with various ocular and orbital pathologies. MDCT is better for evaluation of bones and detection of calcifications and to discern the location, extent and configuration of the lesions. Therefore MDCT is an ideal radiological method for evaluation of various ocular and orbital lesions.

Health Renaissance 2015;13 (3): 24-36

A study on occurrence of anemia in primigravida women attending antenatal ward of BPKIHS

Upendra Yadav — 2017-08-03

Background: Anemia is identified as a very common nutritional problem in developing countries. Prevalence of micro nutrient malnutrition in respect of iron, iodine and vitamin A is more wide spread then protein energy malnutrition. Pregnancy is a serious burden to the women with the disease for the anemia and places them at increased risk of mortality.

Objective: To determine the Hb% level of Primigravida women. To classify status of anemia on the basis of level of Hb%. To find out the association between Hb level and selected background factors. To find out the association between the Hb% level and week of gestation and nutritional pattern.

Method: A descriptive and exploring Study design was carried out on 300 primigravid women admitted in BPKIHS, Dharan antenatal ward and every alternate admitted case was selected for the study. The instrument was structured questionnaires with close ended, observation check list and observational sheet. Descriptive statistics and inferential statistics were used for data analysis.

Result: Overall occurrence of anemia was found to be 42% among the study population. Mild anemia and moderate anemia were found to be 17% and 25% respectively. Greater proportions of 13-19 yr. women were found to be anemic compares to those > 20 years of age. Greater proportions of anemic women were from the nonsedentary groups than the sedentary. Both mild and moderate anemia were more among Primigravid women with >40 gestational week.

Conclusion: Understanding the extent and severity of anemia among pregnant women is essential to the development and implementation of effective anemia control for the normal delivery and healthy baby in Nepal.

Health Renaissance 2015;13 (3):

Quality assessment of discharge summaries from an emergency department in eastern Nepal

Rajani Giri — 2017-08-03

Background: Discharge summaries are intended to transfer important clinical information from inpatient to outpatient settings and between hospital admissions. A good discharge summary helps physician to provide continuity of care which will in turn improve patient outcomes. Despite the importance of the discharge summary, there has been relatively little research in this area in Nepal. We therefore decided to review discharge summaries of patients discharged from emergency department in eastern Nepal.

Objective: To assess the completeness of discharge summaries from emergency department.

Methods: A total of 360 discharge summaries, representing 20% of discharge from the emergency department of B.P. Koirala Institute of Health Sciences, Nepal were randomly selected and evaluated. Quality of discharge for completeness was evaluated using recommendations by Joint Commission on Accreditation of Hospital for the presence or absence of the following key items: admission diagnosis, drug allergy, physical examination, significant laboratory test and results, discharge diagnosis, procedures, discharge medication (including dose and duration), follow up and attending physician signature.

Results: The proportion of discharge summaries missing particular component of vital data ranged from less than 4% (no discharge medications) to 97% (no mention of drug allergy). Information was missing on patients discharge condition (74%), hospital course (61%), discharge instruction (57%) and the discharge diagnosis in (13%). Most of the discharge summaries were partially structured representing 75%. Ease of access to the diagnosis was 78%.

Conclusions: Though most of the discharge summaries were structured and access to the diagnosis was 78%, considerable deficiencies in the completeness of discharge summaries were found.

Health Renaissance 2015;13 (3): 41-47

Randomized controlled trial comparing outcome of intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures

Pashupati Chaudhary — 2017-08-03

Background: Extra-articular fracture of proximal tibia is one of common injury.The study is randomized controlled trial in which individuals sustaining a fracture of the proximal metaphysis of the tibia will be operatively managed by one of two strategies. The first strategy involves fixation of the fracture with a reamed, interlocking intramedullary nail (Nail Group). The second treatment strategy involves percutaneous fixation of the fracture with a locking plate (Plate Group).

Objective: To compare the functional outcome of intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures in adults in terms of procedure time, time to achieve union, functional outcome, blood loss, cost of treatment, complication if any.

Methods: It is randomised controlled trial study. The patients were randomized into two groups, each of size 60: Group A (IMIL group) Group B (Locking Plate group). During procedure patients were evaluated for blood loss, procedure time or any complications. Immediate post operative complications were taken into account and post operative radiological parameters measured.

Results: A total of 120 patients (75 male and 45 female) were included in the study. Fifty five patients were less than 25 years age group followed by 30 patients between 25-40 yrs, 25 patients less than 25 age group and 10 patients more than 55 years. The average blood loss is 95 ml in IMIL group and 105 ml in locked plate group.

Conclusion: IMIL is more expensive than percutaneous locked plates IMIL came out as a shorter surgery with little blood loss however at the same time much costlier to locked plating.

Health Renaissance 2015;13 (3):

A study on factors influencing use of standard precautions in the emergency department at BPKIHS, Dharan

Bijaya Devi Aryal — 2017-08-03

Background: This study investigated knowledge of and practices towards standard precautions, among all health care workers working in the emergency department in BPKIHS. Objective: To find out the factors influencing use of standard precautions in the emergency department, BPKIHS Dharan.

Methods: This was a prospective observational study conducted in the emergency department. Data was collected in three ways: by direct observation of work practice, a questionnaire about knowledge, attitude and skills and through focus group discussions.

Results: Regarding standard precaution, majority (54.2%) had partial knowledge. Only 4.2% know the component of it. In practice 69.52% among doctors group washed hand even though once in four observations; 96% used soap. 43.80% used gloves in doctors group in four observation; sisters used gloves the entire times. 74% washed hand after gloves removal (178). 35.23% didn’t recapped needles before disposal from those who used it among doctors group. Recapping is complete in sisters’ group. 60.95%. Sisters had complete proper disposal practice.

Conclusion: Knowledge and practice of SP has direct impact in health of patient and HCW. High level of occupational exposure to blood highlights the urgent need for intervention to enhance occupational safety to prevent unnecessary nosocomial transmission of BBD. Strategies for promoting injection safety are necessary if the risk of nosocomial transmission of BBV via unsafe injection practice is to be minimized.

Health Renaissance 2015;13 (3): 54-64

A study to evaluate the pattern and types of treatment of tibial plateau fracture at BPKIHS Dharan

Raju Rijal — 2017-08-03

Background: Tibial plateau fractures occur due to a combination of axial loading and varus/valgus forces leading to articular cartilage damage, mal-alignment and secondary osteoarthritis and functional loss.

Objective: To know pattern and types of treatment of tibial plateau fractures and effect of fracture pattern on functional outcome.

Method: We conducted prospective study over a period of one year. Fifty-three patients with tibial plateau fractures were presented during that period. Eighteen patients were excluded due to significant polytrauma and major limb injuries. Four patients did not give consent for the study. Thirty-one patients meeting the criteria were enrolled in the study. Two patients were lost during follow up. Remaining patients were evaluated at the end of one year. Data were recorded and analyzed using appropriate statistical methods.

Result: Among 29 patients, 21 were male. Mean age was 35.07±11.96 years. 55.2% had RTA followed by 31 percent fall injury. 65% were treated with open reduction and internal fixation with plating followed by AK pop cast, cannulated cancellous screw and ilizarov fixation. Bone grafting was done in 3 cases. Twenty-five patients had excellent, two had good, two had fair and no patients had poor result. Three patients (10%) had complications. One had common peroneal nerve palsy, two had wound infections and no patient demonstrated early arthritic changes.

Conclusion: Tibial plateau fractures treated with different modalities at our institute has been associated with excellent and good functional outcome at the end of short term follow up.

Health Renaissance 2015;13 (3): 65-72

Application of cone-beam computed tomography (CBCT) for diagnosis and management of mandibular condyle fractures

Pradip Acharya — 2017-08-03

Background: Cone beam computed tomography (CBCT) provides precise imaging of temporomandibular joint anatomy without superimposition and distortion. CBCT is relatively a new imaging modality and used commonly in dental practice.

Objective: The aim of this study is to present detailed imaging of emporomandibular joint in case of condyle fracture using CBCT for its use in diagnosis, surgical planning and evaluation of treatment.

Method: In our study, we evaluated 3D - CBCT (three dimensional Cone beam computed tomography) examinations of 18 patients with mandibular condyle fractures. All of the fractures in our cases were overlooked on CBCT, thus providing axial, coronal and para-sagittal imaging of condylar head including 3D dimensional volumetric images of the condyle and surrounding structures.

Result: Out of 18 condylar fracture patient’s CBCT, 8 radiographs showed condylar head (intracapsular) fracture, 2 condylar neck, 8 subcondylar fracture. 13 condylar fractures were unilateral and 5 were bilateral fracture. 9 of the condylar fractures were not associated with the mandible fracture. Out of the 9 associated condylar fractures; 3 were associated with symphysis fracture, 4 associated with parasymphysis fracture, 1 associated with body fracture and remaining 1 associated with mandibular angle fracture. 6 of the condylar fracture showed no signs of displacement of the fractured part and among 12 displaced condylar fracture parts 8 medially and 4 laterally displaced recorded in CBCT. All of the patients were given treatment on the basis of CBCT diagnosis and the results obtained from it was clinical satisfactory without complaints.

Conclusion: We concluded that CBCT is the latest sophisticated technology which provides clear image of condylar head without superimposition of other structures, presented supplementary information for a more effective diagnosis and management of mandibular condyle fractures.

Health Renaissance 2015;13 (3): 73-81

Awareness of HIV/AIDS among transportation staff linked to Dharan municipality, Sunsari, Nepal

Sharmila Shrestha — 2017-08-03

Background: Transportation workers are the high risk group for HIV/AIDS infection because they travel frequently; often engage in unsafe sex to reduce their loneliness. The UN predicts 68 million more deaths over the next twenty years if efforts on prevention are not increased.

Objective: To assess the level of awareness and to find out association between awareness about HIV/AIDS and selected variables.

Method: Cross sectional, descriptive study with sample of 197 staff (driver, conductor and helper) of buses and trucks of Dharan city. Purposive sampling technique was used with pretested semi structured questionnaire.

Result: The median age of drivers was 28.5, conductor’s 28 and helper’s 21 years. Most of them (84.2%) were within the age group of 15-34 years. Majority stays (77.2%) less than a week away from home. Almost 93% had heard about HIV/AIDS. Still 55.8% & 32.5% believed HIV is transmitted by insect bite and having food together respectively. Eighty one percent believed that HIV/AIDS status of self should not be kept secret with sexual partner. More than (56.7%) had first sexual exposure at the age of 19 or below. Maximum (77.4%) had not used condom at first sexual intercourse. About 15.2% has sex with CSWs. Among them 93.3% were frequenting CSW for more than once. Forty percent had multi-partner.

Conclusion: Staff of bus & truck of Dharan showed as the awareness level increased, risk taking behavior decreased and attitude became more positive among the transportation staff.

Health Renaissance 2015;13 (3): 82-94

Knowledge, attitude and practice about STD/ HIV AIDS among the health attendant staffs of a Tertiary Level hospital of Eastern Nepal

Masum Poudel — 2017-08-03

Background: Knowledge, attitudes and practices (KAP) surveys are possibly the most frequently used studies in health-seeking behaviour research. Health care workers serve as key players in the prevention and management of diseases. Their perceptions, attitudes and practices have implications for the management of diseases in both health centers and communities.

Objective: To assess knowledge, attitude and practice towards STDs among health attendant staffs (health aids and health attendants) of BPKIHS.

Methods: This is a descriptive cross sectional study. The study population was Health attendants and Health aids workers working in different departments of BPKIHS. Modified structured questionnaire was used for data collection. SPSS version 11.5 was used for data entry and analysis.

Results: 180 Health attendants and Health aids working in different departments of BPKIHS participated in the study. 29% belonged to 30-34 age groups. 86% of study population had heard about STD/HIV/AIDS. 29% expressed that having intercourse without using condoms is known as unprotected sex. Unprotected sexual habits (40.6%), using mask, gloves while working (30%) were methods listed for prevention of transmission of STDs/HIV/AIDS.

Conclusion: Majority were from 30-39 years group.86% had heard about STDs/HIV/AIDS. The commonest method to protect from STDs/HIV/AIDS were listed as avoiding multiple sex partners and use gloves and mask while working.

Health Renaissance 2015;13 (3): 95-106

Profile of chest trauma patients at B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Suresh Prasad Sah — 2017-08-03

Background: Chest trauma is a major public health problem. It includes injury to chest wall, pleura, tracheobronchial tree, lungs, diaphragm, esophagus, heart and great vessels. It comprises 10-15% of all traumas and 25% of death due to trauma occurs because of chest injury. Chest trauma is seen with increasing frequency in urban hospitals.

Methods: A prospective study of all pati with chest injury irrespective of age, sex and mode of injury presenting to BPKIHS emergency were included in this study from 15th March 2007 to 14^th March 2008.

Results: During the study period of one year total trauma patients presented to

emergency were 1524. Out of this 122 patients were of chest injury. It comprises 8% of all trauma patients. Majority of patients belonged to the age group (21-40) years. Out of 122 patients, 57 (46.7%) patients sustained injury due to fall from height and was the commonest cause of trauma in this study followed by road traffic accident which was 38 (31.1%), 15 (12.3%) had physical assault and similar number of 6 patients (4.9%) sustained injury due to gunshot injury and stab injury. Out of 122 patients, 34 (27.9%) patients had associated injury. The most common chest injury was pneumothorax followed by isolated multiple rib fracture, hemothorax, isolated single rib fracture hemopneumothorax, flail chest, subcutaneous emphysema, lung contusion, open pneumothorax and tension pneumothorax.

Conclusion: Majority of chest trauma patients were young adults with male preponderance. Blunt trauma chest was most common chest injury. Pneumothorax was the most common chest injury. Majority of patients were managed with tube thoracostomy, analgesics and chest physiotherapy.

Health Renaissance 2015;13 (3): 107-113

Socio-cultural factors associated with morbidity and mortality: A study from Eastern Nepal

Nilambar Jha — 2017-08-03

Background: Today there has been a change in the perception of disease from germ theory to the involvement of multiple factors in the causation.

Methods: With this notion, this cross sectional study made an effort to delineate the socio-cultural factors associated with health in six teaching districts of B.P. Koirala Institute of Health Sciences in the Eastern region of Nepal among the mothers of reproductive age surveying 1985 households.

Results: This study revealed association of chronic disease and acute illness with various socio-demographic variables like religion, ethnicity, family size, number of children, respondent’s literacy and occupation. Number of jobholders in the family and poverty line were found to be associated with acute illness. Treatment of shaman healers and restrictions during pregnancy period showed association with health inequalities. Mortality in the family was associated with ethnicity, number of children, and literacy of respondent.

Conclusion: As a consequence of these associated factors, the effective utilization of the modern health facilities may not be proper which may lead to ill health consequences. Multifaceted development program from the government along with effective awareness program can help out the people to combat the evil of health life.

Health Renaissance 2015;13 (3): 114-128

Clinical profile of retinoblastoma presenting in a tertiary care hospital, eastern Nepal

Poonam Lavaju — 2017-08-03

Background: Retinoblastoma is the commonest primary intraocular malignancy of childhood. Under-standing the different modes of presentation with timely intervention are associated with prognosis.

Objective: To determine the clinical profile of retinoblastoma and its association with optic nerve infiltration by tumor.

Methods: A retrospective analysis of the clinical records and histopathological reports of patients admitted with retinoblastoma in a tertiary heath care center, eastern Nepal (June 2009 to July 2012) was carried out.

Results: A total of 27 patients (28 eyes) with retinoblastoma were studied. The mean age at presentation was 2.89 ± 0.93 years. The mean duration of symptoms to presentation was 3.35 month, ranged from 7 days to 2 years. Male to female ratio was 3:2. Thirty-three percent patients were Muslims. Twentyseven patients (96.3%) had unilateral eye involvement. The commonest mode of presentation was leukocoria in 23 eyes (85.2%) followed by redness 9 eyes (33.3%), proptosis in 5 eyes (18.5%) and phthisis bulbi in one eye (3.7%). Histopathological reports of 26 eyes confirmed the diagnosis of retinoblastoma. One patient with distant metastases was referred to oncology center. Infiltration of the optic nerve by tumor cells was seen in five eyes (18.5%); of which two cases had proptosis (p-0.166). At two years follow up, recurrence was seen in one patient with proptosis and optic nerve infiltration (p-0.136). Age at presentation was positively associated with recurrence of tumor (p-0.005).

Conclusion: Leucokoria was the most common mode of presentation of retinoblastoma. Larger sample size with longer follow up is required to come to a definite association with optic nerve infiltration by tumor.

Health Renaissance 2015;13 (3): 129-136

Randomized controlled trial comparing outcome of use of staples and nylon sutures for closure in elective orthopedic surgery

Pashupati Chaudhary — 2017-08-03

Background: Wound complications are one of the major sources of morbidity after orthopaedic procedures and can prolong the inpatient stay or lead to re-admission. The most commonly used methods for skin closure after orthopaedic surgery are metal staples or nylon sutures Both methods act to hold the skin edges together while healing occurs. Metal staples are said to be superior as they are regarded as quicker as and easier than sutures.

Objective: To compare outcome of use of staples and nylon sutures for wound closure in elective orthopedic surgery in term of infection rate,cosmetic appearance(Scar), time taken for skin closure.

Methods: It is randomised controlled trial done on patients undergoing elective orthopaedic surgery at department of Orthopaedics at BPKIHS were included in the study. During procedure patients were evaluated for time taken for suture application or any complications.

Results: A total of 60 patients (38 male and 22 female) were included in the study. Twenty two patients were between 41-55 years age group followed by fifteen patients between 25-40 yrs, twelve patients less than 25 age group and eleven patients more than 55 years. The average blood loss is 5 ml in K-wire group and 145 ml in plate group. The procedure time is 33 mins as comprared to 53 mins in plate group.

Conclusion: Metal staples are superior as they are regarded as quicker and easier than nylon sutures. But use of metal staples or clips has a greater risk of wound infection and less acceptable cosmetically than sutures. Metal staples are more expensive.

Health Renaissance 2015;13 (3): 137-143

Convulsions in pregnancy-not always eclampsia role of neuro-imaging in diagnostic dilemma

M. Vijayasree — 2017-08-07

Background: Convulsions in pregnancy is always considered and treated as Eclampsia unless otherwise proved. Eclampsia is associated with increased risk of maternal death varying from 1.8 % to 14 % in developed countries. Despite availability of Intensive care units and improved antenatal care, some women still die from Eclampsia. Cerebral complications are the major cause of death in eclampsia patients. Hypercoagulopathy of pregnancy is a high risk factor for these patients in respect to development of cerebro vascular thrombosis and ischaemic strokes. Eclampsia patients who are refractory to the routine treatment have been found to have various Central Nervous System pathological conditions amenable to the medical treatment.

Objective: To study the neuro pathophysiology behind a seizure in pregnancy and to reduce the morbidity associated with it. To study the role of neuro-imaging in patients with convulsions in pregnancy not responding to treatment with magnesium sulphate (MgSo4).

Methods: It was a prospective study design which included 50 antenatal mothers. All patients were admitted in the eclampsia room with history of convulsions and all of them were put on MgSo4 therapy and Antihyperertensives. The patients who were refractory to the treatment such as having recurrent convulsions despite therapy with MgSo4 were selected for neuro- imaging with Computed Tomography scan. Neuro-imaging was done using Phillips Tomoscan CT scanner where slices of 10-mm thickness were taken through the entire brain in the trans-axial plane. Abdomen shielding was done with lead shield to prevent radiation hazard in the antenatal period.The results were documented and analysed using appropriate statistical method.

Results: The CT scanning report revealed: Cerebral oedema (30/50), Encephalopathy (10/50), Intra Cranial Haemorrhage (02/50) Cerebral infarction (01/50), Cortical venous sinus thrombosis (01/50), Tuberculomas (01/50), Neurocysticercosis (01/50) and Hydrocephalus (01/50). Three patients out of 50 had normal CT scan report.

Conclusion: Patients with convulsions in pregnancy who were refractory to the treatment with MgSo4 and Antihypertensives have been found to have very significant and morbid CNS pathological conditions. Neuro imaging in these patients have done a pivotal role in identifying the abnormality and rectifying it with medical means which had definitely improved patients conditions and have reduced morbidity and mortality.

Health Renaissance 2015;13 (3): 144-151

Family presence in emergency: Attitude and belief among emergency health professionals in a Tertiary Care Hospital of Nepal

Sonai Chaudhuri — 2017-08-07

Background: The emergency department of B.P Koirala Institute of Health Sciences, Dharan, a 700 bedded tertiary care centre provides all medical and surgical services, with easy access to patients by their family members during most of the resuscitation procedures. Complete privacy hence is not ideally maintained. Coping with emotional stress among the family members can be a gruesome experience and reactions from them can be unpredictable. Hence, health professionals are usually exposed to various emotions of the family members of these sick patients.

Methods: It is a descriptive cross sectional study among the health professionals working in the emergency department. A sample size of 80 is taken over a period of 3 months. A semi-structured questionnaire leaflet was distributed and collected by the researcher. The attitude and belief was evaluated by 12 questions on the 5 point Liker scale and cutoff value being 3. Points less than 36 were given as negative attitude towards the family presence and more being positive.

Results: Out of 80samples, 75 completed with a response rate of about 94%. The majority belonged to age group 20-29 years (70.7%) age, among profession Nurses respondents were about 56%. Male and Female respondent were about equal in numbers, qualification with undergraduate level was higher (73.3%), with an experience of less than 1year being 40%. Amongst the responders there is a positive attitude with increasing age, experience and qualification.

Conclusion: The health professionals had a negative attitude towards the presence of family members during the resuscitation or invasive procedures. Hence with the ethnicity and cultural aspect of family their presence is well accepted.

Health Renaissance 2015;13 (3): 152-160

Indications for destructive eye surgeries at tertiary care hospital, eastern Nepal: A five years experience

Poonam Lavaju — 2017-08-07

Background: Destructive surgery is the management option offered to patients when further retention of the globe is unlikely and can affect ocular and general morbidity.

Objective: To determine the frequency and indications for destructive eye surgeries in patients attending a tertiary hospital, Eastern Nepal.

Methods: A retrospective analysis of clinical records of all the tructive eye surgeries from April 2008 to March 2013 at a tertiary hospital, Eastern Nepal was carried out. Patients' history, demographic characteristics and indications for the procedure were studied.

Results: A total of 88 eyes of 88 patients, who had undergone destructive eye surgery, were reviewed. The mean age of the patient was 22.89 ± 23.49 years, median 9.5 years, with a range of 1.5 months to 80 years. Male: Female ratio was 1:1.04. Enucleation was the most common surgery performed in 46 eyes (52.3%), followed by evisceration in 30 eyes (34.1%) and exenteration in 12 eyes (13.6%). The destructive eye surgery in our study accounted for 51% neoplasms, 17% ocular trauma, 15.9% ocular infection, 10.2% anterior staphyloma and 5.7% painful blind eye. The most common indication for destructive eye surgery was enucleation (60.8%) for retinoblastoma followed by evisceration (46.6%) for open globe injury and exentration (33.3%) for sebaceous gland carcinoma.

Conclusions: Enucleation was the most common destructive eye surgery performed. Retinoblastoma, ocular trauma and sebaceous gland carcinoma were the most common indications for destructive eye surgery.

Health Renaissance 2015;13 (3): 161-168

The effect of birth interval on fetal outcomes

Rajeeb Thapaliya — 2016-08-07

Background: Perinatal mortality includes both deaths in the first week of life and fetal deaths (stillbirths). Over 130 million babies are born every year, and more than 10 million infants die before their fifth birthday and almost 8 million before their first birthday.

Objectives: To make an effort to find out impact of birth interval on fetal outcomes like, low birth weight (weight less than 2500 grams regardless of gestational age), perinatal death (death within 28 weeks of gestation to 7 days of birth) in subsequent pregnancies.

Methods: This was a cross-sectional study conducted in BPKIHS, Dharan in 2011. Patients included were women of second gravida between age group 20 -35 years .The consecutive convenience sampling method was used to collect the data. Study population was divided into three birth interval groups of <18, 18-59,>59 months respectively and fetal outcomes (low birth weight, gestational age, early neonatal death, Apgar score) were compared.

Results: Out of included population majority (55.63%) of the women had age range of 20-25 years with the mean age of 25.30. Among the total 168 who were included 20(11.91%) were belongs to birth interval <18 months, 113(67.26%) were found in 18-59 months group and 35(20.83%) were in >59 months group.

Conclusion: There was increased risk of preterm and low birth weight and perinatal death in women with birth interval <18 months as compared to women with birth interval 18-59 months and groups >59 months.

Health Renaissance 2015;13(3): 169-176