Journal of BP Koirala Institute of Health Sciences

Sedation in intensive care unit: use of dexmedetomidine- blessing or blight?

Sindhu Khatiwada — Sat, 31 Dec 2022 00:00:00 +0000

Not available

Editorial Board Vol.5(2)

Krishna Pokharel — Sat, 31 Dec 2022 00:00:00 +0000

No Abstract available.

Factors Associated with Postpartum Depression among Mothers Visiting a University Hospital in Western Nepal

Jyoti Priyanka, Saneep Shrestha, Sanjeev Ranjan, Alok Kumar, Pradip Chhetri — Sat, 31 Dec 2022 00:00:00 +0000

Background: Postpartum depression (PPD) is a grave problem posing various complications in mothers and their children. We aimed to assess the prevalence and predictors of PPD among women attending a university hospital in western Nepal.

Methods: This institution based cross-sectional study enrolled 218 postpartum (< 12 weeks post-delivery) mothers either admitted in the in-patient-units of Obstetrics department or visiting Immunization clinics from February to July 2020. Purposive sampling technique was used. The presence of PPD was assessed by using Nepali version of Edinburgh Post- partum Depression Scale. A face-to-face interview was conducted. Mothers with mental disorders, hearing impairment and migrants were excluded. The predictors of PPD were determined by multivariate analysis.

Results: PPD affected 39% of women. Multivariate binary logistic analysis showed that PPD was associated with nuclear family (AOR: 6.74, 95% CI: 3.00-15.12), husband consuming alcohol (AOR: 2.47, 95% CI: 1.18-5.18), and preference of boy child (AOR: 2.93, 95% CI: 1.32-6.50). However, planned pregnancy (AOR: 0.23, 95% CI: 0.11-0.47), vaginal delivery (AOR: 0.37; 95% CI: 0.17-0.81), male baby (AOR: 0.33; 95% CI: 0.16-0.68), and presence of husband throughout pregnancy (AOR: 0.31; 95% CI: 0.10-0.92) were found to be negatively associated with PPD.

Conclusion: The prevalence of PPD was common and was positively associated with nuclear family, male child preference and alcohol consuming husband and negatively associated with planned pregnancy, vaginal delivery, male baby, and presence of husband throughout pregnancy.

Knowledge and Practice of Breast Self-Examination among Female Community Health Volunteers in Dharan Sub-Metropolitan City, Province No. 1, Nepal

Kala Thapa, Gayatri Rai, Mangala Shrestha, Nirmala Pokharel — Sat, 31 Dec 2022 00:00:00 +0000

Background: Regular breast self-examination is the most cost-effective method for the early detection of breast cancer. Female community health volunteers (FCHVs) could play an important role in teaching the community about breast self-examination (BSE). We aimed to assess the knowledge and practice of breast self-examination among FCHVs.

Methods: Descriptive cross-sectional study was conducted using the census sampling method to select FCHVs from all 20 wards of Dharan sub-metropolitan city. Face-to-face interview was conducted using a semi-structured questionnaire to collect information related to the knowledge of BSE from consenting participants. The practice of BSE was assessed through direct observation of BSE by using a checklist. Descriptive and inferential statistical analysis was done using SPSS version 10.0. The level of significance was set at 0.05.

Results: A total of 95 FCHVs (out of 107) were enrolled in the survey. The mean age (SD) of the study participants was 42.45 (8.97) years; 85.3% were married and majority (64.2%) had completed secondary level of education. The majority of the FCHVs, 65 (68.4%), earned monetary income less than NPR.7000.00 per month. The majority, 82 (86.3%), of the FCHVs had adequate knowledge but only 21 (22.2%) respondents had ever practiced BSE. No significant association was found between the knowledge and practice of BSE with the selected demographic variables such as age, marital status, educational level, age at menarche, and menopause.

Conclusion: The FCHVs had adequate knowledge but poor practice regarding BSE. Training should be emphasized to improve their practice of BSE.

Pattern of Pediatric Maxillofacial Injuries at a University Hospital of Eastern Nepal

Sat, 31 Dec 2022 00:00:00 +0000

Background: Although facial injuries are far more uncommon than other injuries, they pose a great challenge. We aimed to evaluate the demographic distribution and pattern of maxillofacial injuries (MFIs) among pediatric patients in Eastern Nepal.

Methods: This cross-sectional study was conducted in the university hospital of B. P. Koirala Institute of Health Sciences, a tertiary care center in Eastern Nepal. All consecutive patients less than 15 years of age who visited the out- patient unit of the maxillofacial surgery department, or pediatric emergency service of the hospital from 1 September 2018 to 31 August 2019 and had MFIs were enrolled. Demographic characteristics of the patients, mechanism of injury, time to presentation, type of facial injury and any other associated injuries were recorded.

Results: Thirty-six patients (12 girls and 24 boys) with an age (median (IQR)) of 4 (1.7 to 8.75) years presented to the hospital with a history of pediatric MFI. The delay in hospital presentation (median (IQR)) was 3.5 (1.6 – 6.3) h. Falls at home (69.4%) and road traffic accidents (27%) were the most common causes of trauma. Isolated MFI was present in 72.2% of the patients. Isolated soft tissue injury (55.6%) was the most common type of MFIs followed by the combination of hard and soft tissue injuries (36.1%).

Conclusion: Pediatric MFIs are not uncommon. Falls at home and RTAs are the most common causes of MFIs in children below the age of five years.

Outcome of Patients with Emergency Revisits at a Tertiary Care Hospital of Eastern Nepal: an Observational Study

Sat, 31 Dec 2022 00:00:00 +0000

Background: A return visit to the emergency department by the same patient within a stipulated time frame has implications in quality of care provided as well as overcrowding. We aimed to find out the outcome and describe the characteristics of the patients presenting with revisits to emergency.

Methods: This hospital based observational study recruited all consecutive cases with revisits within 30 days to emergency department from February to August 2019 after ethical approval. Clinical presentation and outcome were noted.

Results: Out of 21,215 discharges from the emergency during the study period, 176 patients had revisits (0.829%). The mean age (SD, 95% CI) was 49.74 (18.77, 46 to 52) years with male: female ratio of 1.02. The mean number of days (SD, 95% CI) for revisit was 4.94 (4.92, 4 to 5). Deterioration in triage category was seen in 33.5%; 11.9% had an ‘improved triage category’. High acuity triage score during revisit was 38%. Common revisit diagnosis was chronic kidney disease (35.8%) and infections (30.1%). Revisit diagnostic category change was seen in 20%, with mortality of 6.25%. Patients requiring admission returned within a mean of 4 days (SD, 95% CI = 3.6, 3.3 to 4.9) compared to 6 days (5.6, 4.5 to 6.8) for non-admitted patients. Early revisits (p = 0.040), lower systolic blood pressure at index visit (p = 0.001) and revisit (p = 0.002) were associated with admissions.

Conclusion: Revisits were common in the earlier days of the initial discharge from the emergency. Chronic problems tended to revisit more.

Nutritional Status of Under Five Year Children Residing in Selected Wards of Barahachhetra Municipality, Sunsari, Nepal: a Cross-sectional Study

Rambha Sigdel, Dewa Adhikari, Angur Badhu, Tara Shah — Sat, 31 Dec 2022 00:00:00 +0000

Background: The nutrition of under five children reflects a country’s health status. We aimed to assess the nutritional status of the under five year children of selected wards of Barahachhetra municipality, Sunsari.

Methods: In this cross-sectional study, we enrolled 167 under five year children in ward no. 4 and 5 of Barahachhetra municipality. Height/ length, mid- upper arm circumference (MUAC), weight and clinical signs of malnutrition were noted. The relevant information regarding the predictors of malnutrition was obtained from parents/ caregiver.

Results: Nearly half (47.9%) of the children were in the age group 25-59 months with almost equal gender distribution. About one-tenth of children (11.3%) had MUAC less than 12.5 cm, 20.4% of children were wasted, 47.2% were stunted and more than a quarter (29.6%) were underweight. The MUAC was significantly associated with per capita income (p = 0.01). Wasting was significantly associated with the age of the children (p = 0.005) and occupation of their father (p = 0.002). Underweight was significantly associated with their age (p = 0.007), ethnicity (p = 0.03), parents’ education (mother: p = 0.02, father: p = 0.002), parents’ age (mother: p = 0.04, father: p = 0.02) and fathers’ occupation.

Conclusion: Substantial number of under five year children were malnourished. One-fourth of the children were wasted, nearly half were stunted, and more than a quarter of the children were underweight. Malnutrition (as per MUAC) and stunting were higher among younger children (6-24 months) whereas wasting and underweight were higher among older children (25-59 months).

Outcome between Laparoscopic and Open Ventral Hernia Repair: a Quasi-experimental Study

Sat, 31 Dec 2022 00:00:00 +0000

Background: The debate on the best surgical approach to ventral hernia repair continues. We compared the outcomes of laparoscopic with open ventral hernia repair in terms of post-operative pain, recovery and patients’ satisfaction on cosmesis.

Methods: This quasi-experimental study allocated 70 participants scheduled for ventral hernia repair into laparoscopic and open repair (allocation 1:1) from July 2020 to July 2021. The primary outcome included VAS for pain at 24, 48 and 72 hours after surgery. The secondary outcomes included duration of surgery and hospital stay, time to return to normal activity, patients’ satisfaction on cosmesis and recurrence rate.

Results: The age, gender distribution, and size of hernia defect were comparable between the groups (p > 0.05). Post-operative VAS scores (median, IQR) were similar at 24 hours (7, 6 - 8 vs.7, 6 - 7, p > 0.99) and 48 hours (4, 3 - 5 vs. 4, 3 - 4, p > 0.99) and lesser in laparoscopic group at 72 hours (1, 1 - 2 vs. 2, 2 - 2, p < 0.001) after surgery. The duration of surgery (mean ± SD) was longer (105.14 ± 34.88 vs. 87.49 ± 29.13 minutes, p = 0.02) while duration of hospital stay was shorter (4.80 ± 3.08 vs. 6.66 ± 2.94 days, p = 0.01) and return to normal activity was earlier (6.89 ± 2.93 vs. 15.40 ± 5.65 days, p < 0.001) in laparoscopic group.

Conclusion: Laparoscopic ventral hernia repair was associated with lesser post-operative pain at 72 hours, early post-operative recovery as well as better patients’ satisfaction on cosmesis as compared to open procedure.

Prevalence of Refractive Error among Children of Koshi Rural Municipality of Sunsari District: Door-to-Door Screening

Sanjay Yadav, Rajiv Ranjan Karn, Sudhir Kumar Thakur, Rakshya Panta Sitoula — Sat, 31 Dec 2022 00:00:00 +0000

Background: Uncorrected refractive error is the commonest cause of preventable visual impairment and disability among children. This study aimed to find out the prevalence of refractive error among children in the Koshi Rural Municipality of Sunsari district.

Methods: This cross-sectional study conducted from 1 November to 31 December 2020 involved children between the ages of 4 - 18 years from Koshi Rural Municipality. The variables recorded included gender, age, religion, school type, visual acuity, and types of refractive error. Ethical approval was taken from the rural municipality and institutional review committee of Biratnagar Eye Hospital.

Results: A total of 7830 children were screened in the door-to-door campaign. The majority (n = 5508, 72%) were Hindu and 2232 (28%) were Muslims. Only 6575 (84%) children were enrolled in school. Among them 3130 (40%) were going to government schools, 2105(26.9%) were going to private schools and 1340 (17.1%) children were going to a Madrassa (Muslim school) for education. The prevalence of refractive errors among children of Koshi Rural Municipality was 131 (1.7%) (95% CI: 1.4 - 2.0). Hypermetropia was seen in 69 (53%) children, followed by Myopia 60 (46%).

Conclusion: The prevalence of uncorrected refractive error among children of Koshi Rural Municipality was low. However, the prevalence of refractive error was high among Muslim children.

Incidence of Injuries in Bhagawanpur, Siraha District, Nepal: a Door-to-Door Survey

Samyog Uprety, Prajjwal Pyakurel, Masum Poudel, Dharanidhar Baral, Anup Ghimire — Sat, 31 Dec 2022 00:00:00 +0000

Background: Rapid industrialization, increasing traffic hazards, and the hectic pace of modern life have exposed people to a greater risk of accidental injuries. We aimed to document the incidence of injuries in the Bhagawanpur Rural Municipality of Siraha District of Nepal and their pattern and cost of treatment.

Methods: This cross-sectional study involved 12,935 participants in Bhagawanpur Rural Municipality. A door-to-door survey was conducted from June to August 2018 by face-to-face interview using a preformed semi-structured questionnaire designed for this study. The households were selected by probability proportion to size method from each ward. The variables included the number of injuries, patterns, and costs of treatment.

Results: The incidence of injury was 5.3%. The majority (36.2%) belonged to the age group of 16-30 years. The fall injury occurred in 54.2% and superficial bruises affected 70% of injury. Minor injury contributed to about 89.8% and major injury was seen among 10.2% of the study participants. More than half (56%) of the individuals spent less than NPR 1500.00 for the treatment.

Conclusion: The incidence of injury was 5.3% among people living in Bhagawanpur Rural Municipality of Siraha District. Most of them were young, and had minor injuries. Treatment costs for most of the injuries were less than NPR 1500.00.

Oral Squamous Cell Carcinoma arising from Lichenoid Contact Reaction: A Case Report

Sat, 31 Dec 2022 00:00:00 +0000

Lichenoid contact reaction is a type of delayed hypersensitivity reaction to constituents derived from dental materials. It may occasionally transform into oral squamous cell carcinoma. A 62-year-male reported with the chief complaint of a wound in the inner aspect of right cheek for 2 weeks. On initial examination, a diffuse erythematous area with interspersed non- scrapable white striae was present on the right buccal mucosa and residual alveolar ridge with respect to 47 extending till gingivobuccal aspect of 45, roughly linear in shape, approximately 3x1 cm² in size, with a rough overlying surface. Ointment triamcinolone 0.1% was prescribed for 1 week. The patient visited after 3 months. Clinical examination revealed an ulcer with peripheral induration of size approximately 2.5 mm on right buccal mucosa adjacent to 46. An incisional biopsy revealed oral squamous cell carcinoma. Long-term follow-up of patients with oral lichenoid reaction is mandatory for early detection of malignant transformation.

Extra-follicular Variant of Adenomatoid Odontogenic Tumor: A Diagnostic Enigma

Sat, 31 Dec 2022 00:00:00 +0000

Adenomatoid odontogenic tumor (AOT) is an uncommon, slow-growing, noninvasive odontogenic tumor mostly in the anterior maxilla with three well-recognized clinico-pathological variants: follicular, extra-follicular, and peripheral. Extra-follicular variant presents as a well-defined, unilocular, radiolucency in between, above, or superimposed on the roots of an erupted tooth. A 19 years female reported with the chief complaint of a loose tooth in the right front region of the upper jaw for 6 months, associated with firm swelling without pain or discharge. On orthopantomogram and cone-beam computed tomography, the lesion appeared as a single, localized, well-defined, roughly oval unilocular radiolucency with flecks of radiopacity integrating radicular and cervical third of 13. Complete surgical enucleation followed by histopathological examination revealed the lesion as AOT.

The extra-follicular AOT can cause diagnostic dilemmas and is often misdiagnosed as an odontogenic cyst.

Publication of Reflective Papers– are we Lagging Behind?

Parineeta Thapa — Sat, 31 Dec 2022 00:00:00 +0000

Not available