Journal of Patan Academy of Health Sciences <p>Published by the Patan Academy of Health Sciences, Kathmandu, Nepal</p> Patan Academy of Health Sciences en-US Journal of Patan Academy of Health Sciences 2091-2749 <p>© Journal of Patan Academy of Health Sciences</p><p>Submission of the manuscript means that the authors agree to assign exclusive copyright to JPAHS. All authors must sign a Copyright Transfer and Author Agreement form upon submission of the manuscript to the Journal. The work shall not be published elsewhere in any language without the written consent of JPAHS. The articles published in this journal are protected by copyright which covers translation rights and the exclusive rights to reproduce and distribute all of the articles printed in the journal.</p> The ORCID, why we need yet another ID? Jay Narayan Shah ##submission.copyrightStatement## 2020-05-07 2020-05-07 7 1 1 3 10.3126/jpahs.v7i1.28840 Serological rapid diagnostics test kit "Wondfo" for COVID-19 in Nepal Divya RSJB Rana ##submission.copyrightStatement## 2020-05-07 2020-05-07 7 1 4 6 10.3126/jpahs.v7i1.28842 Clinical characteristics of suspected COVID-19 admitted to the isolation ward of Patan Hospital, Nepal <p><strong>Introduction</strong>: Understanding clinical characteristics of patient is important to plan human resource and logistics. Moreover, this gives understanding of pattern of disease. This study aim to find the clinical characteristics observed in patients with suspected COVID-19 admitted at Patan Hospital.</p> <p><strong>Method: </strong>This is cross sectional descriptive study conducted at Patan Hospital, Patan Academy of Health Sciences, Nepal, on April 2020. Suspected COVID-19 patient admitted from January 25 to April 20, 2020 is taken for the study. Record files were retrieved from record section and patient’s age, gender, place of residence, travel history, duration of symptom onset, symptoms on admission like fever, cough, rhinorrnoea, sore throat, myalgia and shortness of breath was recorded. Signs on admission like temperature, pulse, blood pressure, respiratory rate and oxygen saturation were also recorded. Data were descriptive analyzed. Ethical approval was obtained.</p> <p><strong>Result: </strong>Total 40 suspected COVID-19 patients got admitted from 25 January to 20 April 2020. Of these admissions 25 (62.5%) were male, median age was 30 years, median days of return from abroad was 9 days, average duration of stay at hospital was 3.8 days. There were two COVID-19 positive patients who were asymptomatic.</p> <p><strong>Conclusion:</strong> Travel history and history of travel to the community inside the country where COVID-19 has been detected is important to suspect COVID-19.</p> Ashis Shrestha Sumana Bajracharya ##submission.copyrightStatement## 2020-05-07 2020-05-07 7 1 7 12 10.3126/jpahs.v7i1.28844 Perception of understanding COVID-19 among doctors at Patan Hospital, Nepal <p><strong>Introduction</strong>: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and presents with fever, dry cough, fatigue, myalgia, and dyspnea. This study aims to is find out the understanding of COVID-19 among doctors at Patan Hospital.</p> <p>&nbsp;<strong>Method:</strong> A cross sectional was conducted among doctors at Patan Hospital, Patan Academy of Health Sciences, Nepal. The questionnaire in Google form consisted, part1 perception on COVID-19 and part2 understanding using multiple choice questions corresponding to the one to fifteen questionnaire in part1. Ethnical approval was obtained.</p> <p><strong>Result: </strong>Sixty-one doctors participated in the study, of which 65.5% were directly involved in management of COVID-19. Perception and understanding regarding transmission status in country was 65.6% and 63.95% respectively, about case definition 90.1% and 62.2%, about when to do diagnostic tests 75.4% and 90.2%.</p> <p><strong>Conclusion:</strong> There was difference in perception and understanding regarding COVID-19 among doctors, and areas to be reinforced were case definition, transmission classification, diagnostic tests.</p> Bimal Pandey Mipsang Lama Prashant Kumar Shah Piyush Rajbhandari Keshav Sigdel Niroj Hirachan ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 13 18 10.3126/jpahs.v7i1.28855 Orthopaedic services during COVID-19 lockdown at Patan Hospital, Nepal <p><strong>Introduction</strong>: The COVID-19 pandemic has paralyzed the world, including elective health care services. To prevent the spread of infection, most countries have gone into lockdown and adjustments have been made to provide urgent medical care, including Orthopaedic services. In accordance with the guidelines from worst affected countries and neighboring India, Patan Hospital followed instructions from Ministry of Health and Population to provide only urgent and semi-urgent Orthopaedic services. This study aims to audit the patient profile during lockdown so as to have a clearer picture, which will enable us to be prepared for similar epidemic in the future.</p> <p><strong>Method:</strong> All patients admitted to the Orthopaedic ward of Patan hospital from 24 March to 27 April 2020, during the lockdown, were included. Clinical profile, including cause of admission, management, hospital stay were descriptively analyzed. Ethical approval was obtained.</p> <p><strong>Result:</strong> Out of 44 admissions, there were male 27 and female 17. Trauma cases were 38, and 18 were in age group 20-26 years. Admission due to infections were four. Conservative management were done in seven while 33 were treated surgically, out of which 30 accounted for trauma. Average 6.14 days hospital stay, range 1-22 days.</p> <p><strong>&nbsp;</strong><strong>Conclusion:</strong> Trauma comprised of major bulk of patients seeking urgent Orthopaedic care. Hospital needs to be prepared with necessary measures to ensure safety of health care workers and yet provide urgent Orthopaedic services.</p> Nabees Man Singh Pradhan Balakrishnan M Acharya Pramod Devkota Bidur Gyawali Toya Raj Bhatta Prabhav M Pokhrel Abhishek Kumar Thakur Amrit Shrestha Suman K Shrestha ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 19 24 10.3126/jpahs.v7i1.28858 Willingness of emergency and medicine department doctors to work during surge of COVID-19 patients, Patan Hospital, Nepal <p><strong>Introduction</strong>: With the current COVID-19 pandemic, Patan Hospital, Patan Academy of Health Sciences (PAHS), is responding with its incident action plan which also has provision of the response in case of surge. This study aim to find out the willingness of doctors to work during the surge of COVID-19 and may help in further planning.</p> <p><strong>Method:</strong> A cross-sectional descriptive study was conducted at Patan Hospital, PAHS, Nepal in April 2020. Questionnaires were circulated to the doctors via Google form to the doctors working in the emergency and medicine department. Ethical approval was obtained. Data were analyzed descriptively.</p> <p><strong>Result:</strong> Out of total 73 participants, 59 (80.8%) knew about the surge plan of COVID-19 and 54 (73.9%) were willing to work during the surge. Their major motivation was the professional obligation 56 (76.7%), whereas 61(83.6%) fear about their family getting infected. More than 50% of the participants were ready to stay in-house and work in a sub-optimal environment with a feeling of making a significant contribution to the community.</p> <p><strong>Conclusion:</strong> When the number of cases of COVID-19 peaks and the surge plan gets activated, the majority of doctors surveyed were found willing to work even in sub optimal environments.</p> Piyush Rajbhandari Kripa Maharjan ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 25 30 10.3126/jpahs.v7i1.28859 Awareness of COVID-19 and perception of work satisfaction among healthcare workers at Patan Hospital, Nepal <p><strong>Introduction</strong>: Healthcare workers (HCWs) awareness of disease outbreak, and working efficiently in a changed environment is vital to fight pandemic. How an institution responds to the crisis depends on HCWs response. This study aims to find out awareness of COVID-19 and work satisfaction of HCWs at Patan Hospital (PH), Nepal.</p> <p><strong>Method: </strong>A cross-sectional questionnaires base descriptive study was conducted at PH, Patan Academy of Health Sciences, Nepal, in April 2020. The HCWs were grouped in to technical staff, doctors, and support staff. There were 20 questions each in the awareness of COVID-19 and work satisfaction domain. Ethical approval was obtained.</p> <p><strong>Result: </strong>Of all the staff, 223 various level staffs responded to the questionnaire. There were 80 (35.9%) technical staff, 77 (34.5%) doctors and 66 (29.6%) support staff in the study. In the technical staff group 1106 (69.2%) responses were in favour of having good awareness and 1337 (83.5%) responses were in favour of satisfaction. In the doctors’ group 1233 (80.1%) responses were in favour of having good awareness and 1000 (65%) responses were in favour of satisfaction. In the support staff group 236 (17.7%) responses were in favour of having good awareness and 347 (26.2%) responses were in favour of satisfaction.</p> <p><strong>Conclusion: </strong>Our study showed that technical staff and doctors had higher levels of perception of work satisfaction and awareness for COVID-19.</p> Samita Acharya Kripa Maharjan Deveshree Dongol Anupam Ghimire ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 31 36 10.3126/jpahs.v7i1.28860 Effectiveness of lockdown as COVID-19 intervention: official and computed cases in Nepal <p><strong>Introduction</strong>: COVID-19 was first reported on 31 December 2019 from China. It was first confirmed in Nepal on 23 January 2020. Government enforced first wave of nationwide ‘lockdown’ for one week on 24 March 2020 and fourth from 16 April for 12 days. This paper aims to compute effectiveness of lockdown on COVID-19 cases in Nepal.</p> <p><strong>Method:</strong> Doubling times were calculated using official COVID-19 records first, and then, the number of COVID-19 cases based on various doubling time scenarios staring 23 January 2020 were computed and compared with the official cases of Nepal. All the calculations were done in Microsoft Excel.</p> <p><strong>Result:</strong> Doubling time was 60-day between first and second case, 5-day between 2<sup>nd</sup> and 5<sup>th</sup>, 15-day between 5<sup>th</sup> and 12<sup>th</sup> and again 5-day between 12<sup>th</sup> to 30<sup>th</sup> cases. Doubling time increased to 15-day after the lockdown. Estimated doubling time was 28 days till March, 21 days till 12 April and 18 days till 17 April 2020 and it is expected to reach 15 days on 24 April 2020.</p> <p><strong>Conclusion:</strong> The reported COVID-19 cases doubling time was 5, 15 and 5 days in Nepal after the lockdown. The doubling time increased due to lockdown.</p> Shital Bhandary ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 37 41 10.3126/jpahs.v7i1.28861 Non-COVID and COVID emergency department healthcare workers’ perception of COVID-19 at Patan Hospital, Nepal <p><strong>Introduction</strong>: Patan Hospital (PH), Patan Academy of Health Sciences (PAHS) has separated non COVID and COVID emergencies for the safety of health care workers (HCWs). This study was conducted to assess the safety perception of healthcare workers working in emergency departments during the outbreak of COVID-19.</p> <p><strong>Method:</strong> A cross sectional descriptive study was conducted among HCWs in non COVID and COVID emergency departments at PH, PAHS, Nepal, in April 2020 during COVID-19 outbreak. Questionnaires containing open and closed questions were used. Ethical approval was obtained.</p> <p><strong>Result:</strong> Out of 72 HCWs, 58 (80.5%) responded, 47 (81%) felt need to have separate non COVID and COVID emergencies, 27 (46.6%) answered they were not comfortable working with the partial PPE (masks, gloves), 29 (50%) felt the need of having primary and secondary triaging.</p> <p><strong>Conclusion:</strong> Emergency staff expressed need of having separate non COVID and COVID emergencies, and importance of primary and secondary triage.</p> Samita Acharya Anupam Ghimire Deveshree Dongol Kripa Maharjan ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 42 47 10.3126/jpahs.v7i1.28862 Quarantine, isolation and lockdown: in context of COVID-19 <p>Quarantine and lockdown, combined with restriction to the movement of people, along with measures like universal use of masks, social distancing, tracking, testing, isolation and specialized centers to manage COVID-19 patients, have been successful in the control and spread of the virus in China and most Asian countries, unlike in Europe and America. This review is written to provide information on quarantine, isolation and lockdown in the context of COVID-19 management. The quarantine and lockdown from historical, socio-cultural, and its effect on special circumstances, for example, the internal and international migrants, daily wage workers, refugees, and the ways in which countries have managed this issue, including the measures taken by Nepal to manage the quarantine and lockdown is briefly presented in this review.</p> Jay Narayan Shah Jenifei Shah Jesifei Narayan Shah ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 48 57 10.3126/jpahs.v7i1.28863 Hypothetical model of disease course of COVID-19 patients and their exit plan <p>In view of preparing ourselves for the possible rise of Corona Virus Disease (COVID-19) cases, we have proposed a hypothetical model of disease course in COVID-19 patients admitted in Patan Hospital and the exit plan based on available evidences. This will give us a scientific basis of planning discharge of our future cases. According to it, patients are subjected to repeat Polymerase chain reaction (PCR) on day 20 of illness onset and then every 4 days till negative result. Patients with two negative PCR test repeated 24 hours apart are discharged and advised for 14 days’ home quarantine.</p> Abhishek Tiwary Bimal Pandey ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 58 61 10.3126/jpahs.v7i1.28864 Impact of COVID-19 public health measures on other respiratory illnesses <p>Since the declaration of COVID-19 pandemic by WHO on 13 March2020, over 210 countries / territories have had active cases and 1/3rd of the world’s population have been on complete lockdown or partial restriction. Main route of transmission of COVID-19 is through droplets like most communicable respiratory illnesses followed by infected surfaces. Public measures like wearing masks, social distancing, hand washing and other respiratory hygiene are being followed in unprecedented level and people are tested rapidly if they show symptoms of the disease such as fever, cough, fatigue, myalgia and dyspnea. These symptoms are similar to other respiratory diseases such as common flu, influenza, pneumonia and Tuberculosis. The preventive measures are also effective in these diseases. In Wuhan, China the lockdown lasted for 76 days and seems to follow similar course in other countries. The air pollution and travel has also decreased which will further decrease transmission of respiratory illnesses. These behavioral changes can get embedded into human cultures and play a vital role to decrease incidence of other respiratory illnesses. To measure the impact, we need to be observant and carry time series analysis of the pre and post pandemic data. With proper strategies this could be utilized as an opportunity to reduce burden of other respiratory communicable disease.</p> Abishkar Thapa Monisma Malla Sunil Kumar Thapa ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 62 65 10.3126/jpahs.v7i1.28865 Health information and intelligence management: an experience from COVID-19 at Patan Hospital, Nepal <p>Health information and intelligence are important components of health care system. Moreover they are very crucial during disaster management. Collecting right information at right time and delivering it to right target at right time is important during disaster. During COVID-19, at Patan Hospital, the information management has been done through external communication officer who is a part of hospital incident command system.</p> Ashis Shrestha ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 66 68 10.3126/jpahs.v7i1.28866 COVID-19 crisis prompting innovation in addressing personal protective equipment shortage <p>Coronavirus disease 2019 (COVID-19) has swept across the globe overwhelming health care systems and disrupting supply chain of personal protective equipment (PPE) like gloves, surgical face masks, goggles, face shields, N95 respirators and gowns. Surging demand, panic buying, hoarding, and misuse of PPE has led to substantial jump in its demand. Despite the terrible impact of COVID-19, if there’s any silver lining to this crisis, it is the rapidity at which communities are moving toward innovation in not just medicine and remote work but also in ways to mitigate the growing PPE shortages.</p> Kripa Rajak ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 69 72 10.3126/jpahs.v7i1.28867 COVID-19: ramifications in surgical practice <p>Nepal lies between two large countries (India and China) who have reported high incidence of COVID-19. It is only logical that we prepare the best with the limited medical facilities that we have. There are numerous challenges that impact the surgical department and the hospital administration in general. New guidelines are being formulated and updated frequently. The challenge to provide sufficient personal protective equipment, limited finances and need to train staffs are pertinent challenges. A change in the method of treatment and execution has exerted pressure on the surgeons with a need to keep abreast of new developments.</p> <p>We describe the numerous impacts of the COVID-19 on surgical practice, the impact on surgeons, patients, surgical residents and even the hospitals which have led to all “new normal” in surgery.</p> Harish Chandra Neupane Tseten Yonjen Tamang Siddeshwar Angadi Nikki Shrestha Ganesh Dangal ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 73 76 10.3126/jpahs.v7i1.28868 Triaging in COVID-19 at Patan Hospital, Nepal <p>Amid this pandemic, which has been spreading like a wildfire globally, Nepal is not an exception to it. With this, we have been hearing the news of global shortage of personal protective equipment (PPE), with growing concern over the safety of medical community and possibility of cross-contamination. Triaging is less researched and reported in COVID-19. It is as important as PPE, a gateway of safety for health care worker. If we have to manage COVID-19, ensuring triage should be among the priority strategies. Patan hospital is among the few hospitals in Nepal where triaging is practiced.</p> Samita Acharya Kripa Maharjan ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 77 79 10.3126/jpahs.v7i1.28871 Hospital incident command system, the pillar of COVID-19 outbreak response: An experience from Patan Hospital, Nepal <p>In times of disaster, hospital’s preparedness for disaster and response plan contributes significantly to better functioning of the hospital and reducing mortality and morbidity. Activating Hospital incident command system in a timely manner in Patan Hospital has showed how the hospital is better prepared to handle this epidemic outbreak.</p> <p>&nbsp;</p> Sunil Adhikari Suraj Rijal Paras Kumar Acharya Bishnu Prasad Sharma Imran Ansari Piyush Rajbhandari Prakash Thapa ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 80 84 10.3126/jpahs.v7i1.28872 Strategies for prevention and control of COVID-19 in Nepal <p>Coronavirus disease (COVID-19) outbreak, caused by the most recently discovered coronavirus, is currently affecting a large population across the globe. World health organization (WHO) has already declared COVID-19, a pandemic, and the world is fighting to contain the COVID-19 outbreak. Nepal has taken several preventive measures to control the coronavirus outbreak. However, some additional steps are needed to prevent community transmission of the disease. This brief communication discusses the government of Nepal actions and provides recommendations for the prevention and control of COVID-19 infection in Nepal.</p> Kiran Sapkota Ganesh Dangal Madhu Koirala Kalyan Sapkota Asmita Poudel Shalik Ram Dhital ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 85 88 10.3126/jpahs.v7i1.28879 Use of mask in COVID-19 era: absence of evidence is not evidence of absence <p>World Health Organization (WHO) in its interim guidance of 6 April 2020 advises policy makers on the use of masks for healthy people in community settings. The rationale for mask use by healthy person is prevention from COVID-19, when there is risk of exposure, like working in close contact with public, people with comorbidities, where physical distancing cannot be maintained such as travelling in buses, staying in slum areas. Furthermore, WHO says the purpose and reason for mask use should be clear– whether it is to be used for source control (used by infected persons) or prevention of COVID-19 (used by healthy persons).<sup>1</sup></p> <p>Centers for Disease Control (CDC) United States of America (USA) updated its advisory on 4 Apr 2020, and recommended everyone (except some) should wear at least a cloth face covering when they have to go out in public. It will protect other people in case you are infected.<sup>2,3</sup> This advisory of no strict demand on use of face masks could be possibly due to unavailability of disposable masks.</p> Rano Mal Piryani Suneel Piryani Jay Narayan Shah ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 89 90 10.3126/jpahs.v7i1.28880 COVID-19 Lockdown effect: surge of alcohol withdrawal cases in emergency department <p>States around the world has imposed lockdown to mitigate with COVID-19. This has caused unavailability of commodities including liquor. After lockdown, we observed increase in the number alcohol withdrawal cases in Emergency department of Patan hospital, Nepal. In contrast, during post-earthquake period in 2015 there was increase in number of alcohol intoxication cases. During pandemic time, along with managing COVID-19 cases, other alarming public health concerns should be noticed and necessary health support needs to be planned.</p> Anupam Ghimire ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 91 92 10.3126/jpahs.v7i1.28881 Infection prevention and control, pillar for safety of healthcare worker: COVID-19 experience, Patan Hospital, Nepal <p>Infection prevention and control (IPC) programs play an integral part in the safety of patients, visitors, health care workers and environment as these programs provide guidelines and standard for recognition, prevention and control of infection. With COVID-19 pandemic, Patan Hospital, Patan Academy of Health Sciences, Nepal, is amongst the few hospitals in Nepal to have undertaken the responsibility of managing COVID patients. The COVID response plan has been activated and is currently the best prepared institution to manage this pandemic.</p> Piyush Rajbhandari Deveshree Dongol ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 93 96 10.3126/jpahs.v7i1.28882 Revisit the hospital policy in the era of COVID-19 <ol> <li>Patient with recent history of dry cough, fever and breathlessness (influenza-like or severe acute respiratory illness) without alternative explanation/diagnosis needs to be managed as COVID-19 unless proved otherwise.</li> <li>Suspected COVID-19 patient having fever and recent loss of taste and smell be tested for COVID-19.</li> <li>Patient with severe acute respiratory illness of unknown aetiology be tested for COVID-19.</li> <li>Patient with bilateral consolidation on chest X-ray or ground glass appearance on chest CT or interstitial oedema on chest ultrasound (not fully explained by volume overload) be tested for COVID-19 in moderate to high risk communities/countries.</li> <li>Suspected COVID-19 patients with lymphopenia, high ESR or rise in C-reactive protein and suspected of viral fevers be tested for COVID-19.</li> <li>Screening of pregnant women for COVID-19 with rapid testing preferably with Elisa in moderate to high risk communities/countries.</li> <li>Screening with rapid testing preferably with Elisa prior to invasive interventions, including operations, in moderate to high risk communities/countries.</li> <li>Limit the exposure of hospital staff who are susceptible to develop severe complications of COVID-19.</li> <li>Hospitals provide PPE to staff depending upon exposure as per international/national/local guidelines.</li> <li>Hospitals implement infection prevention control measures meticulously in context of COVID-19.</li> </ol> Rano Mal Piryani Suneel Piryani Jay Narayan Shah ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 97 100 10.3126/jpahs.v7i1.28883 Responding to changing case definition of COVID-19: experience from Patan Academy of Health Sciences, Nepal <p>It is important to track the changing case definition to plan for the clinical response. Transmission pattern of disease have been changing in COVID-19. Countries with no reported cases have moved on to sporadic, cluster of cases and then to community transmission. The response depends on how rapidly the transmission is changing in the country.</p> Sumana Bajracharya ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 101 103 10.3126/jpahs.v7i1.28884 Life during COVID-19 outbreak: perspective of foreign medical students in Shanghai, China <p style="margin-bottom: .0001pt; text-align: justify; line-height: normal;"><span style="font-size: 10.0pt;">This is the experience of medical students during COVID-19 in Shanghai; following the outbreak of corona virus and lockdown of Wuhan, China, on 23 January 2020, one day before the Chinese new year eve.<sup>1,2</sup> Since then, the virus has been declared a global pandemic, and life around the world has come to an abrupt halt. On the other hand, things in Wuhan and China have started picking up, following lifting of the 76-Day long lockdown on 7 April.<sup>3</sup> The recovery in China, Korea, and Singapore shows promise and hope for the rest of the world, to persevere and weather out the storm. Daily cases in China is in single digit now, and most are imported cases.<sup>4</sup> Shanghai reported one imported case of COVID-19, zero locally transmitted case on Thursday 23 April, with a total of 339 locally transmitted confirmed cases, including seven deaths till date, and 1,618 imported cases in mainland China.<sup>5,6</sup> No deaths have been reported from the imported cases.<sup>6</sup></span></p> Jenifei Shah Jesifei Shah Rewina Kebede Girmay Javaria Nasir ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 104 106 10.3126/jpahs.v7i1.28885 Clinical profile of patients with post-caesarean wound infection: experience of Patan Hospital, Nepal <p><strong>Introduction</strong>: Would infection following caesarean delivery adds physical, psychological, and health burden to individual and health care system. This hospital based study aim to determine the rate of infection, the risk factors, pathogens and antibiotic sensitivity.</p> <p><strong>Method:</strong> A prospective study was carried out to analyze the wound infection in women following caesarean delivery in the Department of Obstetrics and Gynecology, Patan Hospital, Nepal, between January 2018 to December 2018. The study was approved from the institutional review committee. Clinicodemographic data during perinatal period of caesarean delivery were descriptive analyzed in relation to wound infection.</p> <p><strong>Result: </strong>Wound infection occurred in 102 (3.1%)of 3285 caesarean section (of total 7131 deliveries during the study period. The caesarean SSI rate was 3.1%, all were incisional SSI (84 superficial and 18 deep) and there were no organ-space SSI. Majority (81.3%) SSI cases were detected in emergency LSCS. Coagulase Negative Staphylococci was the most common organism isolated from wound swab. Routine postoperative antibiotics did not have a major impact in reducing wound infection rate. Multiple per vaginal examinations, prolonged rupture of membrane and staples for skin closure were more commonly associated with SSI.</p> <p><strong>Conclusion:</strong> Reduction in caesarean rate is the major key factor for decreasing the post caesarean wound infection. Protocol should be developed and strictly implemented by all the health care professionals in order to minimize and prevent the infection rate after caesarean section.</p> Ekta Jaiswal Paban Sharma Alka Singh ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 107 112 10.3126/jpahs.v7i1.28886 Fetus papyraceus: a rare case report <p>Fetus papyraceus is a rare condition of a mummified and compressed fetus occurring in multiple gestations where one fetus dies in utero and is merged between the uterine wall and the membranes of living fetus. The blood vessels of the placenta of the two fetuses anastomose with each other, a third cycle occurs, causing fetal death (fetal transfer syndrome). Ultrasonography may identify the Fetus papyraceus, but is not always promising due to anatomical location. Cautious supervision is important during pregnancy for its positive outcome. We report a case of fetus papyraceus in Department of Gynecology and Obstetrics, Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal.</p> Namita Sindan Adheesh Bhandari Snigdha Rai Devi Gurung ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 113 116 10.3126/jpahs.v7i1.28887 Neonatal admission from emergency department <p>Neonatal period is a vulnerable period of life. In Nepal, most common causes of newborn admission in the neonatal intensive care unit (NICU) are birth asphyxia, neonatal sepsis. This study explores the diseases with which 131 neonates were admitted from emergency department. Sepsis was the main cause of admission, followed by pneumonia.</p> Sitaram Shrestha ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 117 120 10.3126/jpahs.v7i1.28888 Human immunodeficiency virus, acquired immunodeficiency syndrome (HIV/AIDS): awareness and attitude among school teachers <p><strong>Introduction</strong>: Awareness and attitude regarding human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) can play a crucial role in providing health education and prevention of HIV/AIDS. This study aims to find out awareness and attitude regarding HIV/AIDS amongst secondary level school teacher.</p> <p><strong>Method: </strong>During 3-months period in 2018, secondary level school teachers in Lalitpur district in Kathmandu valley, Nepal, were randomly selected by lottery to find out their awareness and attitude regarding HIV/AIDS. A self-administered structured questionnairesand a five-points Likert attitude scale was used to collect data. Data was analysed with SPSS version 16.</p> <p><strong>Result</strong>: Among 116 school teachers included in the study, 94 (81%) had adequate level of awareness on HIV/AIDS, 115(99.1%) were aware about sexual transmission of HIV, 112 (96.6%) about not being transmitted by eating drinking from same utensils and 113 (97.4%) knew commercial sex workers as high-risk group. Overall, 106 (91.4%) had favourable attitude regarding HIV/AIDS. There was no significant correlation between awareness and attitude.</p> <p><strong>Conclusion: </strong>The HIV/AIDS awareness among secondary level school teachers was adequate, their attitude was favorable. There was no association between awareness and attitude.</p> Bhoj Kumari Katuwal ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 121 129 10.3126/jpahs.v7i1.28889 Awareness regarding menopausal symptoms and effect on daily life of postmenopausal women <p><strong>Introduction</strong>: Menopause is permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity and hormone deficiency which causes various symptoms and negative effects on life. This study aimed to find out the awareness level of menopausal symptoms and effect on daily life of postmenopausal women.</p> <p><strong>Method</strong>: A cross sectional study was conducted during April 2018 to February 2019 to find out the awareness level of menopausal symptoms and effect on daily life among postmenopausal women attending female outpatient department of Patan Hospital, Nepal. Non probability purposive sampling technique was used. Data were collected using structured interview schedule. The SPSS version 16 software was used for data analysis. The association between variables was measured by chi-square test</p> <p><strong>Result</strong>: Among 160 postmenopausal women, the overall awareness of menopausal symptoms was inadequate in 130 (81.2%), effect on daily activities in 95 (59.3%), on work efficiency in 94(58.8%) and on social activities in 69 (43.2%). Educational, marital and occupational status were significantly associated with awareness level of menopausal symptoms and the symptoms had significant effect on daily life.</p> <p><strong>Conclusion</strong>: The study revealed that more than two third of postmenopausal women had inadequate awareness of menopausal symptoms and more than half had effect on daily life. Educational, marital and occupational status were significantly associated with awareness level.</p> Mangal Maya Prajapati ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 130 136 10.3126/jpahs.v7i1.28890 Awareness, attitude and practice on contraception among the clients attending abortion service at a zonal hospital <p><strong>Introduction</strong>: Contraceptive methods are important components to reduce unwanted pregnancy, abortion, maternal and child morbidity mortality. This study aim to identify awareness, attitude and practice on contraception among women attending abortion services at Seti Zonal Hospital, Nepal.</p> <p><strong>Method: </strong>Cross-sectional enumeration sampling techniques from Safe abortion Unit of Seti Zonal Hospital, Nepal, from August to September 2018 was taken for structured face to face interview using questionnaire to find out awareness, attitude and practice on contraception among women. Ethical approval was obtained. The SPSS version 16 was used to analyze data.</p> <p><strong>Result:</strong> Out of total 94 women, 59 (73.8%) had adequate awareness, 78 (83%) had positive attitude for use of contraception, 44 (46.8%) had inadequate practice of contraception and 19 (20.2%) had adequate practice. There was a significant association between types of family and level of awareness (P&lt;0.001). There was no correlation between awareness, attitude and practice.</p> <p><strong>Conclusion: </strong>Two thirds of women attending abortion clinic were aware of and had positive attitude in regard to contraception, but less than half practiced it.</p> Mithu Saud ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 137 145 10.3126/jpahs.v7i1.28891 Knowledge and attitude on emergency contraception among adolescent students of an urban school <p><strong>Introduction</strong>: Emergency contraception (EC) is used to prevent pregnancy in the first 5 days after sexual intercourse, mainly unprotected intercourse, contraceptive failure, rape or coerced unprotected sex. This study aims to identify the knowledge and attitude on EC and associated factors among adolescent students.</p> <p><strong>Method:</strong> A cross-sectional study was conducted to find out knowledge and attitude on EC among adolescent students of both sex, grade 11 and 12 at Advanced Academy, a private school in Kumaripati, Lalitpur, Nepal, during 19 January 2018 to 13 February 2018. Non probability convenience sampling and self-administered questionnaire was used for data collection. Association of demographic variables with knowledge and attitude of EC and further correlation between knowledge and attitude were analysed. The SPSS 16 was used for data analysis.</p> <p><strong>Result:</strong> Out of 343 students, 211 (61.5%) had fair knowledge of EC, 125 (36.5%) poor and 7 (2%) good knowledge. Favourable attitude towards EC was found in 285 (83.1%) and unfavourable in 58 (16.9%). The mean age was 17.33 ± 0.98 years, 206 (60.1%) in 15-17 year age group (middle adolescence), female 143 (41.7%), and 160 (46.7%) from within Kathmandu valley. There was significant positive co-relation between knowledge and attitude and no significant association between demographic variables with knowledge and attitude.</p> <p><strong>Conclusion:</strong> Majority of adolescence students 15-21 years of age had favourable attitude but less knowledgeable in regard to emergency contraception.</p> Vivechana Shakya Nirmala Ghimire ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 146 155 10.3126/jpahs.v7i1.28892 Medical students’ perception on use of abbreviations during clinical years <p><strong>Introduction</strong>: An abbreviation is a shortened form of word or phrase commonly used in medical practice for convenience. Misinterpretation of abbreviations can lead to confusion and medical errors. Studies have shown the use of abbreviations early as the first year in medical school.</p> <p><strong>Method:</strong> A cross-sectional questionnaire-based survey among undergraduate clinical year medical students in the tertiary care center of Kathmandu Valley was performed from December 2017 to April 2018.</p> <p><strong>Result: </strong>A total of 97 participants. The prevalence of abbreviation use was 95%. Senior students correctly interpreted both standard and non-standard abbreviations. The majority of students learned to use abbreviations from the medical officer’s note.</p> <p><strong>Conclusion:</strong> Students consider abbreviations are acceptable despite having difficulties in interpretation. Hospitals or concerned departments should regulate the use of standard abbreviations.</p> Jeetendra Bhandari Ujjawal Paudel ##submission.copyrightStatement## 2020-05-08 2020-05-08 7 1 156 162 10.3126/jpahs.v7i1.28893