Journal of Patan Academy of Health Sciences https://www.nepjol.info/index.php/JPAHS <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 The work shall not be published elsewhere in any language without the written consent of JPAHS.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> COVID-19 is associated with a high prevalence of liver damage: a systematic review and meta-analysis https://www.nepjol.info/index.php/JPAHS/article/view/32233 <p><strong>Introduction:</strong> The Coronavirus Disease 2019 (COVID-19) outbreak is a serious threat to humans, and the impact of COVID-19 on the liver remains unexplored. At present, no meta-analysis has summarized available findings of COVID-19 patients with liver injury in depth. Thus, we aimed to scrutinize the association of the liver in COVID-19 patients and approximate the prognosis of COVID-19 patients with liver injury thoroughly.</p> <p><strong>Method: </strong>We searched different databases for qualified studies between December 2019 to May 2021. Finally, meta-analysis was carried out using fixed-effect or random-effect models based on the heterogeneity.</p> <p><strong>Result:</strong> Our Meta-analysis includes 32 studies with a total of 6,933 COVID-19 patients. The pooled prevalence of chronic liver disease (CLD) was 3.5%. Overall, the rates of severity and mortality in COVID-19 patients with underlying CLD were 4.6% and 19.2%, respectively. Additionally, the incidence of acute on chronic failure (ACLF) among COVID-19 patients with CLD was 25.1%. The prevalence of an increase in serum ALT, AST, TBil, and LDH levels was 39.5%, 28.6%, 26.5%, and 55.5%, respectively. Similarly, PT was prolonged in 8.3% of cases, and albumin was decreased in 66.8% of cases. The pooled prevalence of liver injury among COVID-19 patients was 28.2%. Strikingly, the patients with liver injury had significantly more severe disease (42.3%) and a higher incidence of mortality (18.5%) than the patients without liver injury.</p> <p><strong>Conclusion: </strong>In conclusion, more than one in five of the COVID-19 patients is at risk of developing a liver injury. Further, patients with liver injury have significantly more severe disease and a higher incidence of mortality than patients without liver injury. Thus, careful monitoring of liver function is advisable while treating COVID-19 patients.</p> Dipesh Yadav Alina Singh Akanand Singh Rajesh Kumar Yadav Bai Xue Li Liang Tingbo Copyright (c) 2022 2021-12-31 2021-12-31 8 3 38 51 10.3126/jpahs.v8i3.32233 Association of thrombocytopenia with specific organism and mortality in neonatal sepsis https://www.nepjol.info/index.php/JPAHS/article/view/42007 <p><strong>Introduction: </strong>Neonatal sepsis is one of the leading causes of mortality worldwide. Knowing the association of thrombocytopenia to the specific organism can help to choose the correct antibiotic before a culture sensitivity report becomes available. Hence, this study was planned to find out if thrombocytopenia is associated with any specific type of organism in neonatal sepsis and higher mortality.</p> <p><strong>Method: </strong>It was a retrospective observational study done at the neonatal intensive care unit at Patan Hospital. The samples were taken over three years, from April 2018 to March 2021. All culture-positive sepsis within the study period were included. The cases whose files were missing were excluded. Neonatal sepsis was defined as cases where a blood culture was positive for the organism. The data was analyzed using SPSS 16.</p> <p><strong>Result: </strong>There were 51 cases whose analysis was done. Klebsiella 25(49.02%) and Acinetobacter 11(21.57%) were the most common organisms. Fifty-nine percent of cases had thrombocytopenia among which 5(10%), 6(12%), and 19(37%) had mild, moderate, and severe thrombocytopenia, respectively. Klebsiella sepsis was significantly associated with thrombocytopenia (p-value 0.001). The sensitivity of Klebsiella to Meropenem and Colistin was 70% and 100% respectively. Mortality was not associated with thrombocytopenia.</p> <p><strong>Conclusion: </strong>In the study, thrombocytopenia was associated with Klebsiella sepsis in neonates. Hence, in thrombocytopenic patients with clinical suspicion of sepsis, proper antibiotics to cover Klebsiella should be started empirically till a blood culture report becomes available.</p> Shiva Prasad Sharma Chalise Santosh Kumar Mishra Prerana Kansakar Dilip Prasad Shah Ambika Kumari Singh Copyright (c) 2022 2021-12-31 2021-12-31 8 3 61 68 10.3126/jpahs.v8i3.42007 Pregabalin and intravenous lidocaine for management of postoperative pain and surgical stress response in elective laparotomies: A double blind randomised controlled trial https://www.nepjol.info/index.php/JPAHS/article/view/42026 <p><strong>Introduction</strong>: Postoperative pain remains a significant problem in patients undergoing abdominal surgeries, and has a profound effect on patient recovery. High-dose opioids hamper bowel motility and increase nausea and vomiting. Intravenous lidocaine has been used as part of a multimodal analgesia protocol for providing effective pain relief and attenuating surgery-associated inflammatory response. Preoperative pregabalin also has a beneficial effect in reducing pain. This study was carried out to assess the efficacy of combining these drugs in reducing pain, paralytic ileus, and stress response.</p> <p><strong>Method: </strong>Patients undergoing elective laparotomy were randomized into two groups. Group A patients received preoperative placebo and intraoperative lidocaine infusion. Group B patients received preoperative pregabalin and lidocaine. The pain was assessed using a visual analog scale at 2, 6, 18, and 24 hours postoperatively. Morphine consumption on a patient-controlled analgesia pump was also noted. Surgical stress response was assessed by measuring perioperative total leucocyte count, interleukin-6, and C-reactive protein.</p> <p><strong>Result</strong>: Postoperative pain scores at 6, 18, and 24 hours were significantly lower in Group B patients who had received pregabalin. These patients also had lower morphine consumption and earlier bowel recovery as measured by the first passage of stools. Perioperative inflammatory markers were similar in both groups.</p> <p><strong>Conclusion</strong>: Preoperative pregabalin when used with intravenous lidocaine has a synergistic effect on reducing postoperative pain and opioid consumption. This also has a beneficial effect on the return of bowel function.</p> Jigish Ruparelia Prakriti Giri Copyright (c) 2021 2021-12-31 2021-12-31 8 3 69 78 10.3126/jpahs.v8i3.42026 Head computed tomography findings in relation to red flag signs among patients presenting with non-traumatic headache in the emergency services https://www.nepjol.info/index.php/JPAHS/article/view/33804 <p><strong>Introduction</strong>: Non-traumatic headaches are a common presentation in emergency services. A non-contrast computed tomography (NCCT) scan of the head is done when there is suspicion of intracranial abnormalities. Such intracranial abnormalities are indicated by "red flag" signs. This study aimed to determine the prevalence of intracranial abnormalities in patients with non-traumatic headaches and its association with the red flag signs.</p> <p><strong>Method: </strong>A total of 106 patients presenting with a non-traumatic headache to the emergency services of TUTH from Aug 2019 to Aug 2020, who underwent head CT were included in the study. The association of head CT positivity with the presence of red flag signs was studied by bivariate analysis using the chi-square test or Fisher exact test.</p> <p><strong>Result: </strong>Among 106 patients, 46(43.4%) were male and the rest were female. The mean age of the patient was 43.69<u>+</u>17.46. All the patients who had positive findings in head CT had at least one red flag sign. Out of 16 red flag signs included in this study, 10 signs showed a significant association (p&lt;0.05) with head CT positivity. These are sudden onset of headache, age of onset &gt;50 years, significant change in pattern or severity of headache, “worst headache ever”, vomiting, neck stiffness, seizures, altered sensorium, papilledema, and focal neurological deficits.</p> <p><strong>Conclusion: </strong>Red flag signs of headache are helpful to determine whether head CT is needed or not to look for significant intracranial abnormalities in a patient presenting with non-traumatic headache in an emergency.</p> Ishu Gajurel Yagya Laxmi Shakya Ram Prasad Neupane Bikash Shrestha Sanjay Gupta Shristi Karki Copyright (c) 2021 2021-12-31 2021-12-31 8 3 79 86 10.3126/jpahs.v8i3.33804 Associated risk factors for acute urinary retention among patients presenting with benign prostatic hyperplasia at a tertiary care hospital in Nepal https://www.nepjol.info/index.php/JPAHS/article/view/30335 <p><strong>Introduction:</strong> Acute urinary retention (AUR) is an important public health issue in older male population with benign prostatic hyperplasia (BPH). Various risk factors are associated with increased incidence of AUR among patients with BPH being managed conservatively.</p> <p><strong>Method:</strong> A retrospective analysis was performed AUR with BPH among patients in Shree Birendra Hospital (SBH), Chhauni, Kathmandu, Nepal for a period of one year. Study variables included patient age, serum prostate specific antigen (PSA), prostate volume, history of AUR, smoking, diabetes mellitus, hypertension, cardiovascular disease, and other comorbid diseases. The SPSS was used for data analysis, X<sup>2</sup> test to find out the association and a p&lt;0.05 considered statistically significant. The study was approved from the ethical committee.</p> <p><strong>Result:</strong> Total 110 patients (out of 182 BPH) had AUR, an incidence of 60.9% (110 out of 182), with a mean (SD) age of 67.41±7.1 (p&lt;0.05). Patients with AUR had larger mean prostate volume. There were 38(34.54 %) patients with AUR having PSA &gt;4.5 ng/mL (p&lt;0.001). More number of patients with AUR had diabetes mellitus and smoker (p&lt;0.001). Consumption of alcohol, hypertension and cardiac disease were not significantly associated with AUR (p&gt;0.05).</p> <p><strong>Conclusion:</strong> Our study showed that increasing age, high prostate volume, high serum PSA, diabetes and smoking had increased incidence of AUR among patients with BPH.</p> Narayan Thapa Sunil Basukala Kunda Bikram Shah Bikash Bahadur Rayamajhi Dhirendra Ayer Bikram Basukala Saurav Karki Saurav Karki Sanjeeb Bhakta Bista Copyright (c) 2022 2021-12-31 2021-12-31 8 3 87 93 10.3126/jpahs.v8i3.30335 Changing pattern of renal disease in children at pediatric nephrology clinic of a tertiary teaching hospital, Nepal: 10-year review https://www.nepjol.info/index.php/JPAHS/article/view/28870 <p><strong>Introduction</strong>: Children present with different renal diseases with variations according to different geographic locations. This study aims to determine the trend of pediatric renal disease presenting.</p> <p><strong>Method:</strong> This retrospective study from pediatric nephrology clinic register during 2008 to May 2018 at Patan Hospital, Patan Academy of Health Sciences, Nepal to analyze the changing pattern of renal disease. The prevalence and characteristic of renal diseases were compared between the 1st and 2nd 5-y period, the age at presentation and gender was analyzed. Mean age at presentation was analyzed by independent t-test, a p-value &lt;0.05 was considered significant. The study was approved by the ethical committee.</p> <p><strong>Result:</strong> A total of 352 children visited the nephrology clinic, male:female ratio 1.42:1, mean age 6.25±4.5 y, the majority in 0-5 y. Congenital anomalies of the kidney and urinary tracts (CAKUT) were 39%, mostly vesicoureteral reflux. Acute glomerulonephritis and the nephrotic syndrome were seen in 32.7% and 23.6%. Children &lt;5 y of age presented with CAKUT while ≥5 y with acute glomerulonephritis. The mean age at presentation for CAKUT was 2.9±3 y and acquired diseases 8.46±3.91 y, p-value&lt;0.05; and for glomerulonephritis 9.8±2.91 y and nephrotic syndrome 6.91±4.08 y, p-value&lt;0.05.</p> <p><strong>Conclusion:</strong> There was a decrease in the number of children visiting the nephrology clinic. Children &lt;5 y presented with CAKUT while ≥5 y had acquired conditions. Children with acute glomerulonephritis were of a higher age than children with nephrotic syndrome.</p> Prerana Kansakar Md Feroz Anjum sunil Kumar Daha Anish Karn Copyright (c) 2021 2021-12-31 2021-12-31 8 3 94 100 10.3126/jpahs.v8i3.28870 Neovaginoplasty with pudendal thigh flap for repair of vaginal agenesis: A case report and review of literature https://www.nepjol.info/index.php/JPAHS/article/view/28875 <p>Surgical management of vaginal agenesis constitutes a significant technical challenge. The goal of vaginal reconstruction is to create a neovagina that is both functionally and aesthetically satisfactory using a simple and reliable technique applicable to most. Bilateral pudendal thigh flaps were used to reconstruct neovagina for a 13-y girl with congenital vaginal agenesis. She presented with cyclical abdominal pain and hematometra, had normal secondary sexual characteristics and grossly normal external genitalia with a dimpling at the site of the vaginal orifice without lower vaginal tract.</p> Kiran Kishor Nakarmi Piyush Giri Apar Lamichhane Ganesh Dangal Shankar Man Rai Copyright (c) 2021 2021-12-31 2021-12-31 8 3 112 116 10.3126/jpahs.v8i3.28875 Imaging of vein of Galen malformation in late trimester https://www.nepjol.info/index.php/JPAHS/article/view/31433 <p>Vein of Galen malformation is a rare congenital vascular malformation due to the maldevelopment of the embryonic precursor median vein of Markowski. It results in significant morbidity and mortality in a fetus and neonate. Fetal ultrasound plays an important role in prenatal screening of fetuses to rule out development anomalies. Fetal Magnetic Resonance Imaging (MRI) plays a dual role both in diagnosis and periodical follow-up with identification of prognostically important complications of vein of Galen malformation. The combination of fetal ultrasound and fetal MRI provides a definite diagnosis during pregnancy thereby providing an opportunity to plan the delivery of the fetus and subsequent postnatal treatment. We are presenting a case of a 34 y female presented at 35 w period of gestation to the ultrasound unit of our hospital.</p> Pradeep Raj Regmi Isha Amatya Copyright (c) 2021 2021-12-31 2021-12-31 8 3 117 121 10.3126/jpahs.v8i3.31433 Effect of back massage on pain perception during first stage of labor among primi mothers in a teaching hospital https://www.nepjol.info/index.php/JPAHS/article/view/31434 <p><strong>Introduction:</strong> Labor pain is experienced and endured by every childbearing woman, and pain relief measures are often neglected. Thus, this study aimed to identify the effect of back massage on pain perception during the first stage of labor among primi mothers at Patan Hospital.</p> <p><strong>Method:</strong> A quasi experimental study was conducted among 56 primi mothers (28 experimental and 28 control groups) selected purposively in the active room of the maternity ward. Mothers who met the inclusion criteria were assigned non-randomly into experimental (received usual labor care and mustard oil back massage) and control groups (received usual labor care). The Visual Analogue Scale (VAS) was used to assess labor pain before and after 15 minutes of intervention in both groups, and the data was analyzed by descriptive and inferential statistics using SPSS version 16 software.</p> <p><strong>Result:</strong> The mean score of pain perceived by mothers before intervention in the experimental group was 68.21 mm, and the control group was 69.39 mm. There was a significant difference in pain perception before and after back massage in the experimental group (p&lt;0.001). Similarly, a significant difference was found after intervention in the experimental and control groups (p&lt;0.001).</p> <p><strong>Conclusion:</strong> Back massage was effective in reducing labor pain. The findings of the study might be helpful to those planning to include labor pain relief measures in maternity wards.</p> Pratiksha Karki Copyright (c) 2021 2021-12-31 2021-12-31 8 3 122 129 10.3126/jpahs.v8i3.31434 Nursing students’ perception toward their learning environment https://www.nepjol.info/index.php/JPAHS/article/view/30422 <p><strong>Introduction</strong>: The quality of the learning environment is indicative of the effectiveness of an educational program on student learning, motivation, and learning outcomes. Students' perception of their learning environment may act as a basis for making necessary modifications for ensuring quality assurance. This study aimed to assess the perception of nursing students towards their learning environment.</p> <p><strong>Method:</strong> An analytical cross-sectional study was conducted in May 2020 among nursing students from Patan Academy of Health Sciences, Lalitpur, Nepal. Dundee Ready Education Environment Measure (DREEM) inventory was used for an online survey via Google form. Descriptive analysis was used to calculate students' learning perception; a one-way ANOVA was used to analyze the difference across four programs. The difference between first and final-year students' perceptions was tested using a t-test.</p> <p><strong>Result:</strong> Out of 289 participants, 200(69.2%) perceived their learning environment as more positive than negative. The mean score was 142.64 on the DREEM global score of 200. There was a significant difference in the perceptions in all the subscales across four nursing programs (p&lt;0.05) except in the learning subscale (p=0.24). There was a significant difference in perception between first and final-year students across five subscales (p&lt;0.05) except for social self-perception (p=0.85).</p> <p><strong>Conclusion:</strong> The study revealed that more than half of the nursing students perceived their learning environment as more positive than negative. There was a statistically significant difference in perception across all the nursing programs and between first and final-year students.</p> Priscilla Samson Khagi Maya Pun Ambika Poudel Bimala Panthee Copyright (c) 2022 2021-12-31 2021-12-31 8 3 130 140 10.3126/jpahs.v8i3.30422 The COVID-19: Challenges for editors of biomedical journals during the public crisis https://www.nepjol.info/index.php/JPAHS/article/view/36843 <p>The COVID19 pandemic has changed life, the way we work, live and interact. Scientific journal editors have experienced challenging work-life since the novel coronavirus was popularly known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for the COVID19 pandemic in early 2020.<sup>1</sup></p> <p>A public crisis like COVID-19 requires faster dissemination of scientific findings unlike the usual publishing process, the biomedical journals have taken the challenge with extra effort to shorten the submission-to-publication time to on average by 49%, at times raising the concern for the quality of ‘pandemic-publishing’.<sup>2</sup></p> <p>The review process of biomedical journals normally requires on average 3-4 months and from submission to publication 8-9 months, which may be expedited in the time of crisis as we have seen during the COVID-19 pandemic with a median of 3-13 days of publication time.<sup>3</sup></p> <p>Quarantine, restriction of movements, lockdowns, working from ‘home-office’ and sudden surge in the new submissions related to the pandemic, all posing a challenge to maintain the journal office process from submission, review to the final acceptance and publication, ‘on time’.<sup>4</sup><sup>-</sup><sup>6</sup> Additional platforms, supplement issues on the COVID19 got further expanded with the various types of manuscripts added, e.g. on online education during the pandemic, psychosocial issues and lots of perspective viewpoints as people had suddenly more time for writing during the changes in lifestyle during the pandemic, all resulting in an increased number of submission to the medical journals. More and more authors included the buzzword COVID19 in the title to ride on the fast-wagon hoping and even pressurizing the editor/journal for expedited publication to disseminate the information on time. <sup>5</sup><sup>,</sup><sup>6</sup></p> Jay Shah Copyright (c) 2021 2021-12-31 2021-12-31 8 3 1 4 10.3126/jpahs.v8i3.36843 Adverse events following immunization after COVISHIELD vaccination among Nepali population of eastern Nepal https://www.nepjol.info/index.php/JPAHS/article/view/33352 <p><strong>Introduction</strong>: Vaccines require continuous monitoring to increase their compliance, quality, and safety. We conducted this study to fulfill the research gap for the adverse events following immunization (AEFIs) after COVISHIED (ChAdOx1nCoV-19) vaccination among Nepali of eastern Nepal.</p> <p><strong>Method: </strong>A cross-sectional study was conducted from 25 Jan 2021 to Jul 2021 at Birat Medical College Teaching Hospital of Morang, Nepal. The data on COVISHIELD vaccine recipients at this center were analyzed for AEFI. Ethical clearance was obtained.</p> <p><strong>Result: </strong>Out of 167 vaccine recipients, the mean age was 28.08±7.35 y. The AEFI occurred in 122(73.1%) and 89(72.9%) who developed symptoms on the same day of vaccination. The AEFI symptoms were less common in males (OR 0.43; CI (0.19-0.96; P 0.03). In both sexes, the AEFI symptoms were reported on the same day of vaccination than the next day but it had no significant association.</p> <p><strong>Conclusion: </strong>The AEFI following COVISHIED vaccination was reported by 2/3<sup>rd</sup> recipients mostly on the same day of the vaccine and less common in males.</p> Surya Bahadur Parajuli Ayushma Shakya Sujita Pokhrel Koirala Heera KC Puru Koirala Copyright (c) 2021 2021-12-31 2021-12-31 8 3 5 13 10.3126/jpahs.v8i3.33352 Clinical profile and outcome of COVID-19 in pediatric hematology-oncology patients https://www.nepjol.info/index.php/JPAHS/article/view/30423 <p><strong>Introduction</strong>: Pediatric hematology-oncology patients are assumed to be predisposed to severe COVID-19 disease and complications, but robust data from low- and middle-income countries is lacking. This study was designed with the primary objective of finding the prevalence and outcome of COVID- 19 in children with hematological or oncological diseases. Clinical characteristics of COVID-19, outcomes in terms of need for respiratory support, intensive care, mechanical ventilation or mortality, delay in therapy, and use of COVID-19 directed therapy were analyzed.</p> <p><strong>Method:</strong> Retrospective review of all children with hematological or oncological diseases with confirmed COVID-19 managed at Patan Hospital from Jan 2020 to Sep 2021. Patients were screened according to the hospital screening protocol. The clinical characteristics and outcomes of COVID-19 along with the delay in chemotherapy or local therapy were recorded.</p> <p><strong>Result:</strong> Twelve children tested positive for SARS- CoV-2 during the study period, and one had reinfection with COVID-19, 9(75%) were oncology patients, while 3(25%) were hematology patients. Fever (83.3%) was the most common symptom, followed by cough (58.3%). Four (33.3%) children had mild infections, and 4(33.3%) had severe infections. Eight oncology patients had delays in starting or continuing chemotherapy or undergoing surgery due to COVID-19. The median duration of delay was 10.5 d (range-7-21 d). The delay in therapy in patients with COVID-19 was significant in comparison to children without COVID-19.</p> <p><strong>Conclusion:</strong> The majority of pediatric hematology-oncology patients recovered from COVID-19 without sequelae. There was a delay in providing treatment to oncology patients due to changing protocols.</p> Sucharita Tuladhar Puja Amatya Rateena Rajbhandari Anu Maharjan Anil Raj Ojha Ganesh Shah Copyright (c) 2021 2021-12-31 2021-12-31 8 3 14 22 10.3126/jpahs.v8i3.30423 COVID-19 infection in chronic myeloid leukemia patients https://www.nepjol.info/index.php/JPAHS/article/view/28841 <p><strong>Introduction:</strong> Corona virus disease 2019(COVID-19) is an infectious disease caused by newly discovered coronavirus SARS CoV-2 (Severe acute respiratory syndrome coronavirus 2). Majority of the COVID-19 infections have mild symptoms in general populations but symptoms may be more severe in immunocompromised and elderly patients and may be in CML populations also. We expected most of CML patients in elderly age group may develop severe symptoms of COVID-19 and its severity may vary in different phases of the CML and different types of TKI being used.</p> <p><strong>Method:</strong> From January 2020 to June 2021 all adult CML patients receiving treatment from Patan Hospital, identified with SARS Cov-2 infection were included in the study. Those patients who had final outcome from COVID-19 infection was taken.</p> <p><strong>Result:</strong> The prevalence of SARS CoV-2 infection in CML population in our hospital is 2.60%. The COVID-19 infection was seen more on female population and younger age group less then 60 years old. Even though the infection rate was higher in the younger age group and infection rate was lesser in CML-CP group, mortality was higher in elderly and advances age group which was statically significant. Regardless of their symptoms, stages, severity of the symptoms, different TKI being used about 92% have fully recovered from COVID-19 infection.</p> <p><strong>Conclusion:</strong> About 92% of CML patients had fully recovered from COVID-19 infection. In our study advanced stage and elderly age group were associated with more severity of the disease and higher mortality rate.</p> Mipsang Lama Bimal Pandey Keshav Raj Sigdel Rajiv Sharma Gyan Krishna Kayastha Copyright (c) 2021 2021-12-31 2021-12-31 8 3 23 29 10.3126/jpahs.v8i3.28841 Perspective of medical graduates from Patan Academy of Health Sciences on the management of COVID-19, during the initial phase of pandemic in Nepal https://www.nepjol.info/index.php/JPAHS/article/view/28874 <p><strong>Introduction</strong>: Nepal, with a poor health infrastructure and resources, when hit by the COVID-19 pandemic in 2020, the health system and the health workers were not well prepared to handle the crisis.</p> <p><strong>Method:</strong> A survey was conducted during the initial phase of the pandemic (July-October, 2020) to understand the perspective of PAHS medical graduates on the management of COVID-19. A survey questionnaire was prepared in Google Form and circulated through official group emails.</p> <p><strong>Result:</strong> A total of 80 graduates participated in the survey .Of the participants, 35(66%) reported that their health facility was only partially prepared and 8 (15.1%) reported that their site was not at all prepared to take care of COVID-19 patients. The local government and the community of their workplace were reported as supportive of the efforts of the pandemic management by 30(37.7%) and 33(41.5%) respondents respectively. The graduates working during the pandemic were involved in activities like swab collection (8), screening (30), critical care (37), patient education/counseling (41), managing non-COVID-19 patients (47), and administrative work (17). Inadequate planning of service delivery was identified as major lacking nationally while the human resources, logistics, PPE and lack of motivation were reported as the major lacking locally by the participating graduates.</p> <p><strong>Conclusion:</strong> The fresh PAHS graduates were found to be contributing at their respective workplaces fitting into both the clinical and non-clinical roles during the initial phase of the pandemic in Nepal. They reported that one or more of the components of PAHS training helped in the readiness to work in this pandemic.</p> Shrijana Shrestha Ashis Shrestha Balakrishnan M Acharya Copyright (c) 2021 2021-12-31 2021-12-31 8 3 30 37 10.3126/jpahs.v8i3.28874 A brief history and indications for cesarean section https://www.nepjol.info/index.php/JPAHS/article/view/27657 <p>Cesarean section (CS) is one of the oldest surgical operations. Originally, this surgery was performed post-mortem by cutting open the woman’s abdomen to remove a dead or alive fetus. It was therefore not intended for saving the mother in ancient times. Roman law and religious rituals shaped the procedure until the Middle Ages. At that time, the indication of CS was only post-mortem. Although CS became a medical procedure in the Renaissance, maternal mortality was extremely high, mainly due to hemorrhage and puerperal infection. The reason for performing CS was to rescue the mother and fetus from protracted labor as a last resort. Since the late 19th century, with the introduction of chloroform and the developments of surgical techniques, and the availability of blood transfusion in the early twentieth century, CS became a relatively safe procedure, further helped by the introduction of antibiotics after World War II. Then, CS was increasingly an intervention to preserve the health and safety of both mother and fetus. During the 21st century, CS has been performed even without medical indication, such as maternal choice. Advancement of obstetric practice technologically and professionally during the period as well as changing attitudes of both obstetricians and childbearing women meant indications for CS are no longer limited to medical/obstetric indications. CS is perceived as a safer mode of childbirth. Therefore, the indications of CS have been changed drastically from ancient times (rescuing a baby from dying or dead mother) to the 21st century (maternal choice/reproductive rights).</p> Sulochana Dhakal-Rai Edwin van Teijlingen Pramod R Regmi Juliet Wood Ganesh Dangal Keshar Bahadur Dhakal Copyright (c) 2021 2021-12-31 2021-12-31 8 3 101 111 10.3126/jpahs.v8i3.27657 Psychological distress during COVID-19 among pregnant women attending antenatal outpatient department at tertiary hospital https://www.nepjol.info/index.php/JPAHS/article/view/32232 <p><strong>Introduction:</strong> It is known that a pregnant person’s body is undergoing immune system changes and is not operating the same way as a non-pregnant person’s body, which threatens the emotional states of women trying to cope with the COVID-19 pandemic situation. The present study aimed to identify the psychological distress during COVID-19 among pregnant women.</p> <p><strong>Method:</strong> A cross-sectional analytical study was conducted at the antenatal outpatient department of Patan Hospital, Nepal. The non-probability purposive sampling technique was used to select 457 samples. Ethical approval was obtained. Data were collected through a face-to-face interview using the Coronavirus Anxiety Scale (5 items) and the Edinburgh Postnatal Depression Scale (10 items). Descriptive and inferential statistics were used for analyzing the data.</p> <p><strong>Result:</strong> The average age of the respondents was 27 years. Results revealed that only 5(1.1%) pregnant women had anxiety, while 23(5.0%) had possible depression due to COVID-19. None of the sociodemographic variables were significantly associated with psychological distress (anxiety and depression) among pregnant women.</p> <p><strong>Conclusion:</strong> Psychological distress was found to be minimal among pregnant women attending antenatal OPD in Patan Hospital.</p> Roshani Agrawal Khatry Nirmala Ghimmire Ratna Kumari Maharjan Niran Shrestha Copyright (c) 2021 2021-12-31 2021-12-31 8 3 52 60 10.3126/jpahs.v8i3.32232 Problem based learning case construct in undergraduate medical and nursing course: should there be difference? https://www.nepjol.info/index.php/JPAHS/article/view/37011 <p>Problem Based Learning (PBL) has been implemented in medical and nursing education programs to facilitate students’ deep learning. These two educational programs have some disciplines in common, but they have distinct educational outcomes. For these common disciplines to be congruent with the educational outcome, their respective curricula describe differences in their understanding level. Since the PBL case constructs largely determine the achievement of curricular objectives, they warrant a distinct approach while preparing a PBL case. Both the programs use clinical context for constructing PBL cases to deliver basic science content, but the focus needs to be turned towards their required clinical expertise. While PBL cases need to prioritize the diagnosis and treatment of the disease along with patient care for medical undergraduates, nursing undergraduates require focus on providing holistic nursing care, supporting and helping the patient during illness. This enables the understanding of basic science content comprehensively as applicable to their clinical practice.</p> Babu Raja Maharjan Ranjan Prasad Devbhandari Shanti Awale Khagi Maya Pun Copyright (c) 2022 2021-12-31 2021-12-31 8 3 141 143 10.3126/jpahs.v8i3.37011 Supplement to "COVID-19 is associated with a high prevalence of liver damage: a systematic review and meta-analysis" https://www.nepjol.info/index.php/JPAHS/article/view/42030 <p>Supplementary files</p> Dipesh Yadav Liang Tingbo Copyright (c) 2022 2021-12-31 2021-12-31 8 3 S1 S41 10.3126/jpahs.v8i3.42030