Medical Journal of Eastern Nepal

Cardiovascular Risk Factors are Linked to Venous Thromboebolism: A systematic review and meta-analysis of case-control studies

Umesh Yadav — 2022-12-31

Background Cardiovascular risk factors are associated with venous thromboembolism (VTE) has received increased attention in the past few years. At present, it is not clear whether the each cardiovascular risk factor is risk factor for venous thromboembolism. Features of cardiovascular risk factor have shown to be been individually associated with VTE. However, whether each of the factors additively increases the risk of VTE is uncertain. We performed a meta-analysis to assess the association between some major cardiovascular risk components and VTE.

Methods Online Pub Med and Embase database were searched for case-control studies evaluating cardiovascular risk factors and incident Venous Thromboembolism in adults. Independent observers extracted data regarding annualized VTE incidence from studies meeting predetermined criteria, (Blood pressure: ≥ 140/90 mmHg. Dyslipidemia: triglycerides (TG): ≥ 1.695 mmol/L and high-density lipoprotein cholesterol (HDL-C) ≤ 0.9 mmol/L in male, ≤ 1.0 mmol/L in female, waist circumference ≥90cm for men, ≥80cm for women or body mass index > 30 kg/m². Data were analyzed weighted, random-effects meta-analysis.

Results Thirty two case-control studies with a total of 30929 patients met the inclusion criteria. Odds ratios or weighted means and 95% confidence intervals (CIs) were then calculated and pooled using a random-effects model. Statistical heterogeneity was evaluated through the use of X2 and I2 statistics. Compared with controls, the OR for VTE was 2.24 for obesity (95% CI, 1.83 to 2.75), 1.56 for hypertension (95% CI, 1.26 to 1.92) and 1.55 for diabetes mellitus (95% CI, 1.25 to 1.92). Weighted mean high-density lipoprotein cholesterol (HDL) levels were significantly lower in VTE patients with cardiovascular risk factor compared to controls with inverse correlation with risk of VTE, whereas no difference was observed for total cholesterol levels.

Conclusion Cardiovascular risk factors are significantly associated with higher risk of VTE, which may imply that it may contribute to the multi factorial pathogenesis of VTE. Nevertheless, this report could not determine whether the combination of all three components is associated with a higher risk than each of the components in isolation.

Utilization of Maternal Health Care Services and Home or Hospital Delivery of Child Birth Among Women of Deupurkot VDC of Parbat District in Nepal

Babu Ram Pokhrel — 2022-12-31

Background Nepal has made significant improvement in meeting the maternal and child health care services also progress newborn, infant and under mortality over the past two decades. The stark disparities on utilization of health services due to women with lower education, low wealth quintile household, disadvantage cast/ethnic groups and women in remote areas. The utilization of available maternal health care services from public and private service is remarkable to reduce maternal morbidity and mortality in Nepal.

Methods The community base descriptive cross sectional study was conducted in 509 households through door to door home visit in Deupurkot VDC covering all first to nine wards. The information was obtained using pretested questionnaire of Pokhara University by Bachelor level students of Public Health. The data was entered into Microsoft excel and analyzed. The data was collected from 19th November to 18th December 2014.

Results The nuclear family size was (74.3%). Majority (80%) of the household have their pakka house, (95.7%) household used sanitary latrine and (86.7%) household heads were literate. The major occupation was agriculture (52.55%). The age of marriage before 18 yrs was (25.30%). Majority of women (81%) women used Injection Depo-Provera and less used device was Norplant/Implant user was (3.7%) World Health Organization (WHO) recommended almost (41%) had antenatal care (ANC) visit. Majority (96.70%) had gone for ANC visit and (67%) of them give birth their children at health institution. More than half (51.60%) women had knowledge of postnatal care (PNC) but (32.60%) used this service either in Health post, primary health care center (PHCC) or Hospital.

Conclusion The antenatal care (ANC) visit were high in conclusion is high even up to WHO recommendation mark. There is a gap between knowledge of postnatal care (PNC) and its utilization, we need to improve this NPC visit gap utilizing available health services.

Knowledge Regarding Needle Stick Injury among Nurses in Tertiary Care Hospital Jhapa Nepal

Ganga Adhikari — 2022-12-31

Background Needle Stick Injury (NSI) is the wound or cut caused by the needles that unintentionally tear/puncture the skin that may result in exposure to contaminated blood and the body fluids. Nursing workers are on high risk of exposure of blood borne germs i.e. HIV, HBV and HCV. According to WHO study, the annual estimated proportions of health- care workers (HCW) exposed to blood-borne pathogens globally were 2.6% for HCV, 5.9% for HBV, and 0.5% for HIV, corresponding to about 16,000 HCV infections and 66,000 HBV infections in HCW worldwide.

Methods The quantitative research for approach was adopted for this study and descriptive survey research design was selected for this study. A study to assess knowledge regarding needle stick injury among nurses in tertiary care Hospital, Jhapa Nepal was conducted among the nurses from 13 th March 2022 to 20 th March 2022. Hundred nurses were selected by using convenient sampling. SPSS Version 20 was used for data analysis.

Results The collected data was analyzed by using descriptive and inferential statistics. This study result showed that 73% had average knowledge, 7% had good knowledge and 20% had poor knowledge respectively. Chi–square value revealed that there was significant association between knowledge with demographic variables of educational qualification and working experiences, where p value was less than 0.05 (p<0.05).

Conclusion This study concluded that the majority of nurses having average knowledge. They need to improve their knowledge.

Comparative Study on Laparoscopic Hernia Repair: Totally Extra Peritoneal Repair (TEP) and Transabdominal Preperitoneal (TAPP) at a Tertiary Care Centre

Bashu Dev Baskota — 2022-12-31

Background Minimal invasive surgery (MIS) procedures in the early 90's as laparoscopic transabdominal preperitoneal repair (TAPP) and totally extra peritoneal repair (TEP), have gained popularity worldwide over open hernia mesh repair with low recurrences, complications and early return to work and activities. This retrospective study aims to compare the two laparoscopic procedures regarding various parameters like duration of surgery, postoperative complications and duration of hospital stay in various ages and different sexes as described in the methodology.

Methods This is a retrospective study for over 2 years which included patients with unilateral inguinal hernia both direct and indirect using either (TAAP) or (TEP) technique.

Results Among sixty patients with an inguinal hernia, 30 patients had undergone (TAPP) and 30 had undergone (TEP). The duration of surgery for (TAPP) was observed 111.03±13.71 minutes which was significantly higher than that of (TEP) (92.80±8.24 minutes) at P<0.001. The pain score at 6 hours for (TEP) was 6.97±1.01 in comparison to 8±0.00 for (TAPP) (P<0.001). The pain score at 24 hours for (TAPP) was 5.18±1.00 in contrast to 4.27±0.70 for (TEP) (P<0.001).

Conclusion Both (TAPP) and (TEP) are feasible surgical options to treat an inguinal hernia. (TAPP) had significantly longer operating time and more early post-operative pain as compared to (TEP). However, there was no significant difference in hospital stay, post-operative complications in both the group.

Cardiopulmonary Fitness among Nursing Students of Mid-Western Nepal: A Descriptive Cross-Sectional Study

Dilli Bahadur Pun — 2022-12-31

Background Cardiopulmonary fitness in terms of maximum aerobic capacity (VO₂ max) reflects the total physical fitness of a person. Nursing students, who are the future health care workers and a role model, are more likely to encourage their patients to adopt healthy habits. However, there is a gap of evidence about nursing student’s physical fitness. Thus, this study aimed to assess the cardiopulmonary fitness in terms of VO₂ max among the nursing students of Nepalgunj Nursing campus, Banke, Nepal.

Methods A cross sectional study was conducted to assess the cardiopulmonary fitness among the nursing students enrolled in Nepalgunj Nursing Campus using a non-probability purposive sampling technique. Queen’s College Step test was conducted along with anthropometric measurements. Descriptive analysis, and chi square test was done using SPSS v20. Ethical approval was taken from the Institutional Review Committee, Institute of Medicine, Tribhuvan University (Ref-99(6-11) 077/078).

Results Total 189 female nursing students participated whose mean age was 21.06±3.41 years. Thirty-six (19%) were overweight and 11 (5.8%) were obese. Out of total, 56 (29.6%) had a high-risk waist hip ratio. Almost half (42.9%) of the respondents had superior level of VO₂ max with mean VO₂ max value of 43.605±10.686. There was a significant association between VO₂ max and BMI (X² =18.856, p=0.016).

Conclusion There is superior level of cardiopulmonary fitness among the young nursing adults. Since BMI is associated with VO₂ max, one should be aware of maintaining a normal BMI.

Problems Associated with the Use of Enteric Coated Tablets, Extended Release Tablets and the Storage of Paediatric Antibiotics at Devdaha Municipality in Nepal

Sanjeev Guragain — 2022-12-31

Background Enteric coated tablets and extended release tablets are such kinds of tablets that should not be taken in crushed form. Pharmacists may advise to break or crush such tablets to manage the dose form that may lead therapeutic failure and increase the side effects of it. Further, they may not advise patients for the storage of paediatric antibiotics at 2-8° C. The first objective of our study is to find the knowledge among pharmacists about dispensing enteric coated and extended release tablets. The second objective is to explore the knowledge and practice of pharmacists about the storage of paediatric antibiotics after its reconstitution.

Methods This study was community based cross-sectional descriptive study which was carried out in 11 pharmacies of Devdaha Municipality from September 2021 to March 2022. The questionnaire was self-administered and interviewed by the investigator. The collected data were entered in excel and expressed in frequencies.

Results Almost all (10) pharmacists did not have knowledge regarding the storage of antibiotic in refrigerator (at 2-8° C) after reconstitution. Very few (4/11) pharmacists have knowledge about not consuming enteric coated tablets and extended release tablets in the crushed form. All pharmacists (11/11) have knowledge that psychiatric drugs must not be sold as OTC (Over The Counter) drugs.

Conclusion There is lack of knowledge among pharmacists about the importance of storage of paediatric antibiotics after reconstitution. Further there is lack of knowledge and practice about the proper dispensing of enteric coated and extended release tablets to the patients. However, the positive aspect is that they have knowledge of not selling antibiotics and psychiatric drugs as OTC drugs.

Titanium Elastic Nailing (TEN) for Pediatric Long Bone Fractures: A Retrospective Institutional Experience

Jay Raj Sharma — 2022-12-31

Background Titanium Elastic Nail (TEN) is used for fixation of diaphyseal fractures of paediatric long bone, where the medullary canal is thin or flexibility of the implant is a chief concern. These are used for biologically and minimally invasive fracture treatment that delivers accurate reduction and stabilization in appropriate paediatric age group

Methods A hospital based 18 months (from December 2020 to July 2022), retrospective study was conducted at Devdaha Medical College and Research Institute, Rupandehi, Nepal with the patients of paediatric long bone fractures who were operated with an elastic titanium intramedullary nail for diaphyseal fractures. Records of the surgical procedure and the follow-up outcomes were all recorded and the data was collected and tabulated in excel sheet for statistical analysis. The total number of patients in the study were 25 wherein, 20 were male and 5 were female.

Results Children ranging from age 4 to 15 years of age were included with mean age of 9.44 years. Average hospital stay was 4 days having standard deviation of 1.68. Statistical analysis yielded z value of 2.97 and p-value of 0.003 which was significant. Most of the patients reported injury in the left side 17(68%) than right side 8(32%). Majority of the injury was sustained in forearm 18(72%) followed by femur 4(16%) and tibia 3(12%). Fall on the ground 14(56%) was commonest mode of injury followed by road traffic accident (RTA) 5(20%), fall from tree 3(12%), fall from bicycle 2(8%) and sports injury 1(4%) respectively. The average time to fracture union was 9.84 ± 2.93 weeks. Only 4 patients had complication, in which 2 had superficial surgical site infection and no
patient had Limb Length Discrepancy or non-union.

Conclusion TENS for diaphyseal fracture is not only a safe, minimally invasive technique with shorter operating time but also helps in preservation of accurate bone alignment and encourages quicker bone healing.

Knowledge, Attitude and Practice of Adverse Drug Reactions (ADRS) Reporting in Nursing Staffs of Tertiary Care Hospital

Ram Chandra Shah — 2022-12-31

Background Adverse Drug Reactions (ADRs) are adverse consequences of drug therapy and are a major cause of morbidity and mortality. Approximately 2.9-5.6% of all hospital admissions are due to ADRs and up to 35% of hospitalized patients experience ADRs during their hospital stay. Therefore, the study assesses nurses’ knowledge, attitudes and practices (KAP) for monitoring and reporting spontaneous adverse drug reactions (ADRs).

Methods In this observational study, 155 professional nurses with Proficiency Certificate Level (PCL), Bachelor Nurses and Masters working in various hospitals and academic institutes in Janakpur Municipality were selected to complete 19 pre-validated questionnaires on knowledge, attitudes and practice of ADR monitoring and reporting’ response. The data were converted by a predetermined scoring method and subjected to statistical analysis.

Results Most participants from PCL Nursing (52.25%), participants from Bachelor Nursing (35.48%) and the fewest participants from Master Nursing (12.25%) were between 26 and 35 years old. Regarding ADRs knowledge, the majority of the Master Nurses (86.18%) answered the question correctly. ADR that reported regularly, most certificate nurses disagreed (33.3%) and more certificate nurses were neutral (38.2%) and some certificate nurses were agreed (28.3%). Most master nurses (63.1%) had patients with ADRs, but bachelor nurses (52.7%) and certificate nurses (64.2%) had not experienced any patients with ADRs in the past year. Master nurses (78.9%) were aware of the response to ADRs reporting and monitoring, but most certificate nurses (83.9%) and bachelor nurses (65.5%) were unaware of the ADRs reporting and monitoring response.

Conclusion We conclude that KAP of ADRs in nurses is not sufficient especially in certificate and bachelor nurses. But master level nurses responded well. This is due to their knowledge, attitude and practices on ADRs reporting and monitoring.

A Prospective Study of Foreign Bodies in Aero-Digestive Tract at a Tertiary Care Center in Eastern Nepal

Bajrang Prasad Sah — 2022-12-31

Background Aero-digestive tract foreign body (FB) is a common emergency dealt by the otolaryngologists. Airways FB have been a major cause of morbidity and mortality. Management of FB depends on the site of impaction and types of it. The study aimed to find out the incidence, types and complications of FB encountered in aerodigestive tract.

Methods A hospital-based prospective study was conducted among the patients with aero digestive FB presented and managed at the department of ENT and HNS from August 2015 to July 2017. A self-designed proforma was used to collect the relevant data. A descriptive analysis was made of the frequency distribution of qualitative variables. The findings were presented as tables and graphs.

Results A total of 276 patients were treated for FB in aero-digestive tract and 158 (57.25%) patients were male. 90 (32.6%) cases of FB occurred in age group of 1-10 years. Ninety six cases of foreign body (34.78%) were chicken bone followed by other bone (20.65%) and coin (18.12%). All cases of coin were seen in children <13 years old and disc Battery in children <10 years old. Out of 276 cases of foreign bodies, 254 (92.03%) were in upper digestive tract and 22 (7.97%) in airways. About 140 (50.72%) were in cricopharynx, 103 (37.32%) in esophagus and 11 (3.99%) in other sites in intestine.Complications were seen in 10 (3.62%) cases and retropharyngeal abscess was the most common (60%).

Conclusion Cricopharynx was the most common site of FB lodgment in the digestive tract. Right main bronchus was the commonest site of lodgment of inhaled FB. Seeds, nuts, whistles, small toys were commonly seen obstructing the airway in children. They need to be trained not to keep these things in the mouth.

Rare Case Report of Mature Mesenteric Teratoma in a 35-Year-Old Female

Man Mohan Bir Shrestha — 2022-12-31

Teratomas are germ cell tumors that usually occur in the gonads, and present in early age group. Mesenteric teratoma is rare. Patients with mesenteric teratoma may remain asymptomatic or may present with compressive symptoms. Teratomas contain derivatives of all three germ layers, hence may contain diverse tissues. Computed tomography (CT) scan is ideal to establish the diagnosis of mesenteric teratoma, and reveal fluid, fat, calcifications, fat-fluid level. This is a case of 35-year-old female, who presented with upper abdominal pain for 2 months. She underwent Computed Tomography (CT) scan which revealed large well circumscribed mass in left upper abdomen, containing fluid, fat, and globular calcifications. Size of the lesion was: craniocaudal dimension= 12 centimeter, transverse diameter = 10 centimeter, anteroposterior diameter = 10 centimeter. Patient was managed by complete surgical resection. Histopathological examination confirmed the diagnosis of mature teratoma of mesentery.

Case Report and Review: An Unusual Case of Fetal Traumatic Brain Injury

Ashraya Kadariya — 2022-12-31

We herein report an unusual case of maternal road traffic accident with blunt trauma to the abdomen at 34 weeks of gestation followed by delivery of severely encephalopathic baby and also a brief review of similar previous reports.The baby had near normal transition, then progressively developed severe encephalopathy and multiple organ dysfunction attributed mainly to the intrauterine traumatic injury. The baby had multiple intra and extra axial bleeds,cerebral edema and diffuse axonal injury, as revealed by the CT scan. The baby was managed conservatively with various neuroprotective strategies similar to management in older children and thus cerebral edema/ hematomas subsided. The baby required ventilatory support, prolonged assisted ventilation/oxygen and the metabolic derangements were managed accordingly. The baby was discharged on oral Levetiracetam, multivitamins and nasogastric tube feeds. Baby was followed up sequentially till day 74 and on physical examination had poor head growth and increased muscle tone of the extremities. Neuroimaging revealed diffuse multicystic leukoencephalomalacia, hydrocephalus ex vacuo with cortical thinning.

Intrauterine fetal brain injury is an uncommon incidence which causes mortality and significant morbidity in the child. Neuroimaging of the fetus after trauma to the mother can lead to early diagnosis and anticipation. Early vigorous neuroprotective measures and management may prevent mortality and reduce further brain insult in theseneonates. There is paucity of information on management of such cases thus they should be reported in detail forstudy and future references.

Refractive Power Prescription in Children with Strabismus

Sanjeev Bhattarai — 2022-12-31

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