Journal of Manmohan Memorial Institute of Health Sciences

Tubercular Tenosynovitis of Extensor Tendons of Wrist: An Unusual Presentation

T.P. Dawadi, N. Subedi, D. Poudel, Y. Bista, P. Panthi — Wed, 01 Dec 2021 00:00:00 +0000

Background: Tubercular Tenosynovitis is a very rare disease and even rare to involve extensor tendons. The clinical picture is typical and confirmation is done by histopathology.

Case Presentation: We present a rare case of soft tissue swelling at dorsum of wrist and distal forearm since six months. On Ultrasonogram, there were multiloculated cystic collections surrounding the extensor tendons. Lab parameters showed increased ESR and Mantoux test was positive. With the provisional diagnosis of Tenosynovitis, debulking tenosynovectomy was done where melon seed bodies were seen. Histopathology confirmed granulomatous lesions with caseous necrosis and Acid Fast Bacilli stain was also positive for the biopsy tissue. He responded to our anti-tubercular drugs with full range of motion after two months of surgery and no recurrence of swelling at four year follow up.

Conclusion: Typical clinical picture, intra operative findings of melon seed bodies and rice bodies and histopathological confirmation of granulomatous lesions with caseous necrosis are pathognomonic of Tubercular Tenosynovitis. Complete debulking and antitubercular drugs cure the disease and prevents recurrence.

An Investigation into the Impact of Decentralization on the Health System of Nepal

Wed, 01 Dec 2021 00:00:00 +0000

This paper introduces our international research project ‘The impact of federalisation on Nepal's health system: a longitudinal analysis’, which is examining the effects of changing Nepal’s constitution towards a federal republic on its health system. After a short overview of recent changes in the constitution of Nepal, which in turn affects the organisation of the nation’s health system, we offer a short theoretical introduction on the decentralisation of health systems. We briefly outline the WHO (World Health Organization) Health System Building Blocks and some of the issues for policy and practice that have arisen in other countries where similar major system-wide reforms have been implemented. After this, we outline the key research questions and research methods of our study, which involves an international and interdisciplinary team of researchers from Nepal and the UK and will be conducted over a period of three years, from 2020 to 2023.

Exploring the Challenges and Opportunities for Continuing Professional Development fo Nurses: A Qualitative Study with Senior Nurse Leaders in Nepal

Wed, 01 Dec 2021 00:00:00 +0000

Background: Continuing professional development for nurses is internationally recognised as a key factor in improving quality of care, career progression, job satisfaction and professionalization. Meeting the global and national challenge of Universal Health Coverage will require a flexible and skilled workforce. Since nurses are the backbone of health care in Nepal, their professional development is a key contribution to this task.

Objective: To explore the views of senior nurses on the need and opportunities for continuing professional development in nursing in Nepal and current barriers to its development.

Methods: Purposive sampling was used to identify participants and semi-structured interviews were conducted until saturation was reached. Interviews were transcribed verbatim and analysed using thematic analysis. 19 senior nurses, female (n=17) and male (n=2) working across the sector as clinicians, teachers and managers in Nepal participated in this study.

Results: Analysis revealed several themes and subthemes, including: the conceptualisation of CPD in Nepal; provision and funding; barriers – fiscal, political and geographical challenges; and future priorities which included a discussion around basic skills versus advanced practice.

Conclusions: The study provides an overview of opportunities and challenges for equitable access to continuing professional development in Nepal. Our findings illuminate the need for nurse leaders to work with policy makers and nursing organisations to establish the priorities for continuing development in light of increasing demand and expectations of health services.

Community Pharmacy Practice during COVID-19 Pandemic in Pokhara Metropolitan City, Nepal

D.P. Khanal, S. Mishra — Wed, 01 Dec 2021 00:00:00 +0000

Background: Pharmacist being a member of health care team served as a front-liner to provide health care service in the community as it is the first place visited by most of the people to purchase medicine and receive treatment or advice for minor illness.

Objectives: The objectives of this study were to assess the community pharmacy and their practitioners experience during Covid-19 pandemic including barriers to activities, preventive measures adopted and service offered by them in Pokhara metropolitan city.

Method: A cross-sectional descriptive study was design using purposive sampling technique and data from 115 community pharmacies inside Pokhara metropolitan city (1-33 wards) were collected using both close-ended and open-ended questionnaires.

Results: Majority respondents are young having experience 2-5 years. Assistant pharmacists with Diploma in pharmacy degree were 44 % and more than half of respondents were both owner and pharmacist themselves. Major barriers during Covid-19 pandemics were: shortage of personal protective equipments, panic of the patients, and shortage of products. Only 53% followed preventive measures related to Covid-19 pandemics. This was dangerous and risk factor for infection transmission. Due to the fear of pandemic, most pharmacies are providing limited pharmaceutical service. The patient suspected with Covid-19 was referred to hospital and some patients were just given medicine as per their symptoms with the fear of getting infection.

Conclusion: Community pharmacists were not following the preventive measures sufficiently which may cause high chance of community transmission of Covid-19 in Pokhara metropolitan city.

Antioxidant and Thrombolytic Activities of Methanolic Extracts of Achyranthes aspera Linn.

B. Raut, D.P. Khanal, K. Bhandari — Wed, 01 Dec 2021 00:00:00 +0000

Background: Plants have been used since a long time for the therapeutic use and precursors of therapeutic agents. People depend upon the herbal and traditional medicine to satisfy their health care needs. Achyranthes aspera L. is a multifunctional plant used to treat various kinds of diseases. It possesses various type of activities such as antioxidant, anti-inflammatory, antimicrobial and thrombolytic activity. Study of various biological activities helps to provide evidence to the traditional knowledge. Therefore, antioxidant and thrombolytic activities of its stem-leaves were aimed to explore in the present study.

Methods: Quantitative experimental method was applied to its antioxidant and thrombolytic activities. Stem-leaves of Achyranthes aspera collected from Thankot, Kathmandu was subjected for methanolic extraction by maceration method. The extract was screened for the antioxidant activity by using DPPH radical scavenging assay as well as thrombolytic activity through the clot lysis assay in human blood.

Results: The methanolic extractive value by using maceration was found to be 6.12%. Extract showed their antioxidant and thrombolytic potentialities. The concentration of antioxidants needed to decrease the initial DPPH concentration by 50% (IC₅₀) was found to be 30.5μg/ml for its extract and it was almost 5-fold lesser than ascorbic acid, 6.62 μg/ml. Similarly, the% clot lysis was found to be 7.29 % and 15.35 % in 10 mg/ml and 25 mg/ml concentration respectively.

Conclusion: The study suggests that stem-leaves of Achyranthes asperaare the possible sources of natural radical scavenger as well as thrombolytic agents. Thus, they could be used as natural antioxidants as well antithrombosis in the beverage, functional food and pharmaceutical industries that need further wide range in vivo studies.

Standardization of Visible Kinetic Assay for the Estimation of Plasma Glucose by Glucose Oxidase and Peroxidase Method

Wed, 01 Dec 2021 00:00:00 +0000

Objective: In the clinical laboratory, glucose is the most frequently analyzed test in blood which plays a vital role in the diagnosis and management of patients suffering from diabetes mellitus and metabolic disorders. The glucose oxidase and peroxidase (GOD-POD) method is an end point reaction method for glucose estimation, which is cheap and readily available in routine laboratories with significant time consumption. However, Glucose estimation by hexokinase is available for rapid estimation that may cost comparatively higher for the routine laboratories. Thus, our study is designed to standardize rapid and convenient method of plasma glucose estimation with modification by kinetic mode based on GOD-POD reaction for the rapid and high through put analysis of glucose estimation using semi-automated or autoanalyzers.

Method: Photometric linearity of the kinetic method is compared with that of end point reaction methods. Furthermore, correlation between an endpoint and kinetic method was determined using Pearson correlation using plasma from normal and diabetic patients (n=32) visiting Manmohan Memorial Teaching Hospital, Kathmandu.

Result: Our study showed, significant positive correlation between the end point and the kinetic method (r=0.99) The linearity of modified kinetic (GOD-POD) method is up to 400 mg/dl in comparison to that of existing end point method (500 mg/dl), which covers the normoglycemic to pathological hyperglycemic range of glucose estimation in routine laboratories.

Conclusion: The significant positive correlation of our visible kinetic method with end point reaction method shows possibilities for the high through put and rapid analysis of the glucose estimation in 3 minute using semi-automated and autoanalizers.

Effects of Male International Migration on Mental Health of Wives Left Behind in Nepal

Yagya Murti Bhirtyal, Sharada Prasad Wasti — Wed, 01 Dec 2021 00:00:00 +0000

Introduction: International male migration is very common and has been increasing significantly in recent days in Nepal.The increasing pattern of male migration has greatly impacted left-behind women. The aim of the study was to assess the effects of male international migration on the mental health (depression) of wives left behind in Nepal.

Methods: A cross-sectional study was conducted with a total of 800 women (400 wives left behind and 400 wives of non-migrants) in the Chitwan district of Nepal.A systematic random sampling approach was employed for the recruitment of study respondents.Data were collected through a structured questionnaire with face-to-face interviews.Depression was measured by using a valid tool of depression screening questionnaire consisting of a 20-items scale. Data were managed in SPSS version 19 and analysed with a descriptive statistic followed bylogistic regression analysis. Ethical approval was obtained from the Nepal Health Research Council and individual written consent was obtained prior to the interview.

Findings: The prevalence of depression in left-behind wives was 79 percent whereas only a 26.3 percent prevalence rate was found in the wives of non-migrants. There was a significant difference in depression between left-behind wives and the wives of non-migrants. The left-behind wives (OR = 10.57, p < 0.001) had around 11 times greater odds of having depressive symptoms compared to the wives of non-migrants. Logistic regression shows that theCaste/ethnicity (OR 1.15), level of education (OR 2.4), own named property (OR 1.7), and having children (OR 8.39) were identified as factors influencing depression in left-behind wives. However, the age of the wives (OR 0.46), level of education (OR 1.77), and employment status (OR 1.7) were found as factors that influence the depression in the wives of non-migrants. Findings between the left-behind wives and the wives of non-migrants depict that only women’s education (OR 2.94 vs 1.77) was found to be significantly associated with depression in both groups.

Conclusions: The increasing trend of male international migration has negative effects on left-behind wives regarding health and wellbeing. There should have targeted intervention mental health screening and counselling programs forboth non-migrant and left-behind wives for early detection and treatment. Government should plan psychosocial counselling clinics and awareness-raising programmes particularlyto the higher male migration communities for early detection and treatment.

Mental Health Issues in Pregnancy and Childbirth: A Review of the Nepalese Nursing Curricula

Bibha Simkhada, Edwin van Teijlingen, Jillian Ireland, Padam Simkhada — Wed, 01 Dec 2021 00:00:00 +0000

Background: Mental health is a difficult public health topic to talk about making it hard for frontline health workers especially countries like in Nepal. General Nurses are providing maternal and mental health care due to lack of midwives and specialist mental health nurses.

Aim: This is the first study of this kind to review curricula on mental health components of pre-registration nursing training in Nepal.

Methods: We conducted a rapid review of the nursing curricula on mental health and maternity care issues in Nepal. We reviewed 10 Nursing curricula of different levels of nursing. Content analysis tool was used to extract mental health related words or concepts to analyze the nursing curriculum.

Findings: There is basic material included on both mental health and maternity care but nothing or little on the combination of the two topics. There appears to be a need for more communication skill, teaching and counseling at all levels of nursing. The nursing training need to focus on competency based and evidence based practice as successful strategies for perinatal mental health care. There is a great need for a curriculum to facilitate relevant training in Nepal.

Mental Health Risk and Associated Factors in the Aftermath of the 2015 Earthquake in Nepal: A Systematic Literature Review

R.N. Gonzalez, P. Regmi, N. Aryal, T. Akudjedu — Wed, 01 Dec 2021 00:00:00 +0000

Background: In 2015, Nepal was struck by two massive earthquakes with magnitudes over the 7.0 Richter Scale, imposing short- and long-term mental health risks. This review aims to: (a) evaluate mental health risk among the earthquake survivors; and, (b) identify factors that influence it.

Methods: The following databases: Scopus and PubMed were searched to identify studies published from 2015 to July 2020 on the mental health risk among the Nepali populations. Inclusion criteria were: (a) primary research related to mental health after the 2015 earthquakes in Nepal, (b) English language articles, (c) access to full-text literature, and (d) studies conducted on the general population of Nepal. Exclusion criteria were: (a) newspaper articles or other forms of popular media, (b) grey records and reviews or, (c) studies carried out among patients in a clinical setting. Key features and risk of bias factors were extracted from each study to obtain necessary characteristics for further analysis of results.

Results: The initial search produced 134 articles, however, a total, 14 studies fulfilled the inclusion criteria and were explored for this review. Ten of these articles were obtained from established databases, and four additional studies were obtained from other sources. Findings indicate that post-traumatic stress was mostly present among earthquake survivors with rates varying from 4.9% to 51%. Mental health risks for children and adolescent were mostly high with rates greater than 23% across studies. However, the adult prevalence rate for mental health risk was lower than that of children and adolescents, with most rates across studies lower than 20%. Socio-demographic factors (such as gender and age) and methodological heterogeneities such as variations in study design and mental health tools used to assess rates were associated factors that potentially influenced the findings.

Conclusion: Mental health risks are present among earthquake survivors in Nepal. Various factors have been identified as potential mental health risk rate influencers including sex, with females presenting as the higher at-risk group for mental health relative to males. Methodological issues such as a wide range of mental health assessment instruments employed across studies can potentially impact rates.

Vaccine Race for COVID-19 Battle

Dharma Prasad Khanal — Wed, 01 Dec 2021 00:00:00 +0000

No abstract available.