Correlations between Educational Struggle, Toxic Sites by School District and Demographic Variables, with Geographical Information System Projections

This correlational study associated data on children enrolled in individualized educational plans in their K-12 schools (IEP) and an algorithm-calculated score of neurotoxins at contaminated sites located in each school district. The study also mapped and projected the correlations using Geographical Information System (GIS) technology. These data were populated in ArcMap 10.5 (a GIS software) for generating maps and data to conduct geospatial analysis. A total of 1 Superfund site and 39 CERCLA sites were identified as contaminated sites for this analysis. The majority of contaminants were heavy metals such as lead, arsenic, mercury, and cadmium. The mean toxic score of all contaminated sites combined was 13.4 (SD 14.4). Correlational analysis between the IEP numbers from each school district and toxic scores from the contaminated school district sites exhibited a positive relationship (F = 23.7, p < 0.0001). Correlations were also seen among higher toxics scores, IEP numbers, and children under the age of 10 (p < 0.00052) as well as higher proportions of black students in areas with high toxics scores (p = 0.0032). Black students were also far more likely to be enrolled in an IEP (p < 0.0001). Household income and poverty percentage in contaminated areas were also correlated (p = 0.0002). Individuals without college degrees were overrepresented in high toxic score school districts (p < 0.0001). The important low socio-economic status indicator of free and reduced lunch programs also correlated with increasing toxic scores (p = 0.0012) and IEP numbers (p = 0.0416). This study emphasizes the need to account for multiple exposures to wholistically appreciate environmental factors contributing to negative health outcomes.

Pregnancy intentions and its associated factors among married women in resunga, Gulmi, Nepal

Pregnancy intention refers to a women's thinking at the time she became aware that she was pregnant. It can be categorized as intended and unintended. Identifying pregnancy intentions during prenatal periods help to employ careful monitoring of pregnancy that is at high risk for mother and children's health outcomes. Unintended pregnancy is a contributing factor for maternal and infant mortality, which is still high in Nepal. Reproductive and family planning program should incorporate pregnancy intention domains in health education and counseling with priority to design program to address and reduce unintended pregnancy. This brief research examines the pregnancy intentions and its associated factors among married women so that it could identify the intentions of pregnancy and factors influencing unintended pregnancy and could be useful to improve and maintain the health and well-being of women, family, community, and nation.

Screen time and its correlates among children aged 3–10 years during COVID-19 pandemic in Nepal: a community-based cross-sectional study

Objective

This study aims to determine the prevalence of high screen time among schoolchildren aged 3–10 years in Bhaktapur, its correlates and the parents’ strategies to reduce screen time during the COVID-19 pandemic in Nepal.

Methods and analysis

This cross-sectional descriptive study was conducted during March 2021. A total of 630 households were selected for the study from 21 randomly selected clusters in Bhaktapur, Nepal. Correlates of high screen time were determined using a logistic model. P<0.002 was taken as significant.

Results

Among all the participants, the mean (SD) age was 7.0 (2.2) years, with 50.3% male participation. Few participants had online classes (n=24, 3.8%). The prevalence of high screen time among the participants was very high (55.2%, 95% CI=51.3% to 59.1%), which is even higher in boys (61.8%, 95% CI=58.0% to 65.6%). The median screen time before the COVID-19 pandemic was 1.0 hours (mean rank=275.8) which increased to 2.2 hours (mean rank=116.6) during the pandemic (p<0.001). Participants having smartphones were about seven times (adjusted OR=6.9, 95% CI=1.5 to 31.3, p=0.013) more likely to have high screen time than those who did not have the device. Most parents used to reprimand and urge their children to play outside to limit their screen usage.

Conclusion

During the COVID-19 pandemic, about one in two schoolchildren of 3–10 years had higher screen time than before the COVID-19 pandemic. Parents’ strategies to reduce screen time were not effective. An intervention study is recommended to design and test effective strategies to reduce screen time and its negative effects on children’s health.

Menopausal Symptoms among Postmenopausal Women Visiting Outpatient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction

Menopause is defined as the complete cessation of menstruation for consecutive 12 months which occurs due to the loss of follicular activity of ovaries from the late 40s to early 50s. The menopausal symptoms are often distressing but lack of awareness leads to failure in addressing the problem. This study aimed to find out the prevalence of menopausal symptoms among postmenopausal women visiting the outpatient department of a tertiary care centre.

Methods

This descriptive cross-sectional study was done among postmenopausal women in the outpatient department of a tertiary care centre from 10 March 2021 to 10 March 2022 after taking ethical approval from the Institutional Review Committee (Reference number: MEMG/IRC/420/GA). Convenience sampling was done. Demographic data were collected using predesigned proforma and menopausal symptoms were evaluated using Rajanobritta Lakshan Mapak, the Nepali version of the menopausal rating scale. Point estimate and 95% Confidence Interval were calculated.

Results

Among 424 postmenopausal women, menopausal symptom was found in 411 (96.48%) (94.73-98.23, 95% Confidence Interval). The mean age at menopause was 49±4.70 years. The most common symptom these women presented with was somatic symptoms seen in 382 (92.94%) women.

Conclusions

The prevalence of menopausal symptoms is found to be higher than the other studies done in similar settings.

Keywords

cross-sectional study; menopause; prevalence; somatic symptoms.

Pregnancy Outcome in Early versus Late Onset Preeclampsia

Aims: To determine the pregnancy outcome of early and late onset preeclampsia. Methods:  This was a cross sectional analytical study conducted in the department of Obstetrics and Gynaecology, Manipal Teaching Hospital from July to October 2021. All cases of preeclampsia diagnosed according to International Society of Study of Hypertension in Pregnancy 2018, were included. Early and late onset preeclampsia cut-off used was 34 weeks. Preeclampsia diagnosed before 34 were classified as early onset and after 34 weeks as late onset preeclampsia. Maternal and perinatal outcomes were analyzed using Statistical Package for Social Sciences version 21. Results: The prevalence of early onset and late onset preeclampsia were 4.3% and 8.3% of all deliveries. Early to late onset preeclampsia were 1:2. Renal involvement, placental abruption, IUGR, low birth weight, low Apgar and perinatal morbidity were significantly more in early onset; pre-term labor  and use of MgSO4 and antihypertensives were also more in early onset. Conclusion: Late onset preeclampsia was more common than early onset preeclampsia but the maternal and perinatal outcome were poor for early onset as compared to late onset preeclampsia.

Oral Solid Dosage form Modification in Community Pharmacies of Kavrepalanchok and Bhaktapur Districts of Nepal

Background People may modify their oral solid dosage form of medicine to deal with problem faced during medicine administration. The modification of dosage form may adversely affect the quality, safety and efficacy of the medicine. Objective To investigate the causes and practices of oral solid dosage form modification among the consumers going to community pharmacies. Method A descriptive, cross-sectional study was conducted in five community pharmacies of Kavrepalanchok and Bhaktapur districts of Nepal. The consumers visiting these pharmacies for their oral solid dosage form of medicine were invited to participate in interview using structured questionnaire. Result Among 419 participants,13.6% of participants reported having problem of taking intact medicine. Most of them (12.4% of total participants) experienced difficulty swallowing the medicine. The swallowing difficulty is significantly associated with age and sex (p < 0.05). Around one third (36.8%) of participant with medicine administration problem modified the dosage form of medicines. One quarter of medicine dosage form modifications (25.0%) were inappropriate. Medicine dosage form modification is associated with age and number of daily medicine intake (p < 0.05). Among participants modifying dosage form of medicines, 66.7% were advised to do so mainly by family and friends; 33.3% were modifying on their own and 76.2% were unaware of possible effects of medicine dosage form modification. About 62.3% of total participants were never asked about any problems on taking medicines by doctor/pharmacists. Conclusion Difficulty swallowing medicines and medicine dosage form modification were prevalent in the Nepalese population. Medicine dosage form modifications also involved inappropriate modifications due to specialized design of such dosage forms. So, it seems important to provide proper counseling while dispensing such dosage forms.

Identifying High Risk Pregnancy and Its Effectiveness in determining Maternal and Perinatal Outcome

Introduction: Identification of high risk pregnancy can be done by using various scoring systems which is highly predictive in determining maternal and perinatal outcome. Objectives: The objectives of the study were to identify high- risk pregnancy and to compare the maternal and perinatal outcome of high-risk with low-risk pregnancies. Methodology: This study was conducted in the department of obstetrics and gynaecology, Manipal Teaching Hospital, Pokhara, from 1st August 2020 to 31st January 2021. Study included pregnant women coming for delivery after 28 weeks of gestation.  Antenatal scoring system involving various risk factors, was used to stratify women as low-risk (score 0-3), high-risk (score 4-6) and extremely high-risk group ( score ≥7). All women were followed up in intrapartum and postpartum period and complications noted. Neonates were also followed up. Maternal and perinatal outcome of three groups were compared. Results: There were 67.3% women in low-risk, 20% in high-risk and 12.7% in  extremely high-risk groups. Operative deliveries were 89.9% in extremely high- risk, 77.9% in high- risk as compared to 51% in low- risk group. Maternal complications, total amount of blood loss and duration of hospital stay was more in extremely high-risk and high-risk pregnancies. Low birth weight was more common in extremely high risk (60%) and high-risk (26%) pregnancies compared to low- risk pregnancies (15%). Neonates with low Apgar scores at 1 and 5 minutes were more in high-risk pregnancies. Thirty-two percent neonates in extremely high-risk pregnancy required neonatal intensive care admission which was significantly higher as compared to high-risk and low-risk pregnancies. Perinatal deaths were more frequent in extremely high-risk pregnancies. Conclusions: Identifying high risk pregnancy using scoring system is useful to identify women at risk of developing maternal and perinatal complications. 

Fifteen Uninterrupted Years of Maternal Mortality Findings from a Tertiary Care Centre

Introduction Maternal mortality reflects reproductive health status and availability of good health care facilities at different levels of the healthcare system at a given period, influenced by globally adopted safe motherhood policies. The leading causes of maternal death in Nepal mainly comprise of hemorrhage, eclampsia, abortion-related complications, gastroenteritis and anemia. Although a declining trend has been noted in Nepal it has yet to meet the target set by the Sustainable Development Goal (SDG) 3.1 of reducing the global MMR to less than 70 maternal deaths per 100,000 live births by 2030.  MethodsA cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Tribhuvan University Teaching Hospital (TUTH) from 1st Baisakh 2055- 30th Chaitra 2069 (15th April 1998- 14th April 2013). The study period of 15 years was divided into three parts, five years each: 2055-59 (14th April 1998-April 13th 2003) ; 2060-64 (14th April 2003- April 12th 2008) and 2065-69 (April 13th 2008 –April 12th 2013). MM was filled in Performa, discussed in morning conference and MM audit, computerized, analyzed, presented quarterly and yearly. Annual Maternal Mortality Ratio (MMR) expressed as MMR per 100,000 live births is calculated by dividing recorded (or estimated) maternal deaths by total recorded (or estimated) live births in the same period and multiplying by 100,000.  ResultsTotal MM/maternal mortality ratio (MMR) in the first, mid and last five years were 39 (270 %); 37 (212% ) and 37 (188%) respectively giving overall total MM/MMR 113 (223.5%) attributing to Direct: 55 ( 48.6%), Indirect: 44 (38.9%) and Non maternal deaths: 14 (12.3%). Predominating cause of MM in the first/mid/last five years were sepsis and infective hepatitis each (17.6%) and PPH (18.5 %). While SP/E were almost same over the years, in decreasing trend were hepatitis and puerperal sepsis but in rising trend was PPH and criminally induced abortion (10.6%). Thenumber of maternal death has not changed much, the median age in each five years is surprisingly similar, set at 25 years and the adolescents who died were not very different in every five years. It’s unfortunate that many primigravida died during this period which is a matter of concern.  ConclusionsMaternal mortality stresses the impact of timely health seeking behaviour and health providers making provision of prompt adequate services and referral to help so that all Nepalese mothers, especially the young and first-time pregnant thrive. Keywords: infective hepatitis, maternal mortality, maternal mortality ratio, PPH, sepsis.

Cervical Intraepithelial Lesions in Women with Persistent Inflammatory Smear on Pap Smear: A Descriptive Cross-sectional Study

INTRODUCTION

Persistent inflammatory smear is a benign finding on pap test but is associated with premalignant lesion of the cervix. Further evaluation is therefore necessary. This study was done to determine the prevalence of cervical intraepithelial lesions in women with persistent inflammatory smear.

METHODS

This is descriptive observational study conducted in Department of Obstetrics and Gynaecology of tertiary care centre of Nepal from 15th May 2020 to 14th May 2021 after obtaining ethical clearance from Institutional Review Board (Reference no MEMG/IRC/338/GA). Women with two consecutive pap smear reports showing inflammatory findings were enrolled. Colposcopy was performed and Modified Reid's colposcopic index was used to grade the lesions. Colposcopic guided biopsy was taken and tissue sent for histopathology for abnormal colposcopic lesions. Data analysis was done using Statistical Package for Social Sciences version 21 and frequency and percentages were used to present data. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.

RESULTS

Among 115 women, 57 (49.5%) at 95% Confidence Interval (40.37-58.63) had Cervical Intraepithelial lesions. Among them 48 (41.7%) had low grade intraepithelial lesions and 9 (7.8%) had high grade lesions on colposcopy.

CONCLUSIONS

The prevalence of cervical intraepithelial lesions in women with persistent inflammatory smear on pap was higher in our study compared to other studies.

Psychosocial Problems among the Adolescent School Students of Dhulikhel Municipality

Background Adolescence is a period when an individual experiences a variety of biological, psychological and social changes. These multiple changes during the developmental period can make the adolescents vulnerable to mental health problems. Therefore early detection of psychosocial problems and addressing the need of the adolescents are crucial for promoting their mental health. Objective To assess psychosocial problems and its associated factors among school going adolescents of Dhulikhel, Nepal. Method A descriptive cross sectional study was conducted among 513 adolescents studying in grade 8 to 12 of randomly selected schools of Dhulikhel Municipality. Data were collected by using structured questionnaire and Pediatric Symptom Checklist-Youth Report (Y-PSC). Descriptive and inferential analysis was done using Statistical Package for Social Sciences version 20. Result Out of 513 adolescent students, a total of 133(25.9%) of the adolescents were found to have psychosocial problems. There was significant association between psychosocial problems and respondents' variables like age, grade, parental education status, respondents' living status, perceived family disputes, perceived marital problems of parents, relationship problem with family, stress of failure in study, punishment faced in home and school, experienced sexual harassment and death of loved ones. Conclusion Various family related factors and stressful life events of adolescents are associated with the psychosocial problems. Hence early intervention focusing on awareness and modification of stressful life events is required.

Fetomaternal outcome of eclamptic parturient in a tertiary care center: A descriptive cross-sectional study

Background: Eclampsia is still a leading cause of maternal death second to postpartum hemorrhage in developing countries. It is also associated with poor perinatal outcome. Aims and Objective: The objective of this study was to find the incidence, maternal and perinatal outcome of patients admitted in a tertiary hospital, Pokhara with diagnosis of eclampsia. Materials and Methods: A descriptive cross sectional study was conducted in department of obstetrics and gynecology, MTH, Pokhara for duration of 1 year from 1st January 2020 to 30th December 2020. A total of 22 patients were enrolled in the study irrespective of timing of occurrence of fits, age, parity, gestational age and status of booking on admission. Results: During the study period the incidence of eclampsia at our center was 0.85% .Majority of the patients 17(77.27%) were primigravida and 16(72.68%) delivered at less than 37 weeks of gestation. Only 4 patients had her antenatal checkup done in MTH. According to timing of occurrence of fits Antepartum and postpartum eclampsia comprise 50% each with no cases of intrapartum eclampsia. Caesarean section was done in 17(77%) cases. Among the cases 10, (45.45%) patients required ICU admission and 6(27.27%) required ventilator support. HELLP, acute renal failures, PRES, PPH were causes of maternal morbidity. Three (13.63%) babieswere born stillbirth. Sixteen (72.72%) babies were born preterm and 13(59.09%) had birth weight less than 2.5kg. Six (27.27%) babies needed NICU admission. Conclusion: Eclampsia continues to be one of the prime etiological factors for maternal and perinatal morbidity and mortality in developing countries like ours. This is mostly due to the delay in seeking and reaching the care. Regular antenatal checkup, early recognition, its prevention and proper management of eclamptic cases are vital to tackle this challenge.

Patterns of Clinically Identifiable Congenital Defects in Neonates

BACKGROUND

The study is aimed at highlighting the pattern of congenital defect in a tertiary care hospital. Congenital anomalies are recognized as a growing cause of neonatal morbidity and mortality in developing countries and a major cause of distress to parents.

METHODS

This was a prospective descriptive study conducted between September 2019 and August 2020 with the objective to determine the types of congenital anomalies among live born neonates at Manipal Teaching Hospital (MTH), Pokhara and to determine their immediate outcome. Neonatal and maternal characteristics were noted.

RESULTS

Twenty four out of 2515 live births had congenital anomalies during the study period, giving an incidence rate of 9.42 congenital anomalies per 1000 live birth per year. Single system involvement was seen in 79.2 % cases, remaining 5 (20.8%) neonates had involvement of more than one system; 54.2% of these newborns were discharged, 33.3% expired, 8.3% left against medical advice and 4.2% were referred out.

CONCLUSIONS

This study highlights the importance of clinical examination of neonates to detect anomalies in our setting.

Adenosarcoma of Uterus- Rare Biphasic Malignant Tumor: A Case Report

Uterine adenosarcoma is a rare variant of mixed Mullerian tumors comprised of neoplastic glands with the benign appearance and sarcomatous stroma. The epithelium most often consists of endometrium-like cells, while the sarcomatous component usually shows low-grade homologous uterine sarcoma. These tumors present as a pelvic mass or an enlarged uterus with abnormal vaginal bleeding. Here, we present a case of 61 years old postmenopausal female patient with chief complaints of excessive vaginal bleeding and urine retention.

Knowledge, Attitude, and Practices Related to COVID-19 among Healthcare Personnel in a Tertiary Care Hospital in Nepal: A Cross-sectional Survey

Background COVID-19 is significantly affecting the healthcare system globally. As a result, healthcare workers need to be updated on the best practices for the proper management of the disease. Objective The purpose of this study was to assess the knowledge, attitude, and practices (KAP) related to COVID-19 among healthcare personnel. Method This was a cross-sectional study conducted among medical personnel at Dhulikhel Hospital Kathmandu University Hospital using a semi-structured questionnaire on KAP related to COVID-19 from May 8th to June 8th, 2020. We analyzed survey data by using descriptive statistics. Spearman rank correlation, chi-square test and binary logistic analysis were used to examine the association between sociodemographic characteristics with KAP related to COVID-19. Result Among 220 participants, the majority were nurses (60%) followed by doctors (27.7%), paramedics (10%) and technicians (2.3%). The results showed that 68.6% of healthcare personnel had a good knowledge with appropriate practices (98.5%) and negative attitude (59.3%). In the multivariate binary logistic analysis, the healthcare workers with the clinical experience level of one to five years (OR:.42, 95% CI:.19- .96) and more than 5 years (OR: .16, 95% CI: .04-.63) were significantly associated with negative attitude. The confidence score for managing COVID-19 (OR:1.16, 95% CI:1.02-1.34) was significantly associated with an optimistic attitude. Conclusion Healthcare workers are knowledgeable about COVID-19 and proactively practising to minimize the spread of infection but lack optimistic attitudes. Hence, the constantly updated educational programmes related to COVID-19 for targeted groups will contribute to improving healthcare workers' attitude and practices.

Appraisal of caesarean section incidence and indications at manipal teaching hospital, Pokhara, Nepal

Background: Worldwide lower segment caesarean section (LSCS) is the most commonly performed obstetric operation. Though it’s a lifesaving procedure it is sometime associated with both short and long term risk which can extend many years beyond current delivery and affect health of mother, fetus and future pregnancy. Aims and Objective: The study aims to examine the incidence and indication of caesarean section at Manipal teaching hospital. Materials and Methods: A retrospective descriptive study of 2140 cases was carried out at a teaching hospital in Pokhara, Nepal. Data regarding total number of vaginal delivery and caesarean section performed in 1 year duration from August 2019 to July 2020 was obtained from the operation record book and medical record section of hospital. Other information regarding age, parity, gestational period and indication of cesarean section were obtained and depicted in tabulated form. The collected secondary data has been analyzed employing frequencies and percentage. Results: During the one year study period, 2140 deliveries were made out of which 1170 (54.7%) cases underwent caesarean section. Out of those cases 78.8% of women underwent emergency LSCS. Most of the women were in the age group of 21-30 years (69.2%). In 81.2% cases caesarean was done between 38-42 weeks gestation. 52.3% of cases were multigravida, 43.8% were primigravida and only 3.1% were grand multigravida. Most common indication of caesarean were fetal distress (23.7%), previous LSCS (23%), cephalopelvic disproportion (15.6%), oligohydramnios (11%) followed by breech, preeclampsia, eclampsia and non-progress of labour. Conclusion: This study revealed that the incidence of caesarean section was high in the hospital and majority of the patients who underwent caesarean section had an emergency caesarean section. The commonest indications were fetal distress and repeat cesarean section. The issue requires further investigation to identify reasons for high CS rate and raises necessity of policy guidelines and intervention in order to prevent possible unjustified use of surgical delivery.

Digital Subtraction Angiography a Door Opener for Neurosurgical Residents who want to Perform Neurointerventional Procedures

Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know the vascular angiography of the brain and spinal cord. The technique in performing this procedure exposes residents in accessing the major vessels, branches of the arch of aorta, selective angiography and diagnosing different vascular anomalies of brain and spine. They are also exposed to the knowledge of different diagnostic catheters, its manipulation, use of dye and radiation exposure and safety. We would like to share our experience in training and disseminating the knowledge of digital subtraction angiography to the residents.

Comparison of Maternal and Perinatal Outcome in Elective and Emergency Cesarean Section in a Tertiary Care Centre

Introduction: Cesarean delivery is the birth of a fetus via laparotomy and then hysterotomy. There are increased maternal and fetal morbidities and mortalities associated with such delivery, more in emergency cesarean section. Various studies have shown increasing trend of this mode of delivery worldwide leading to an increase in its associated risks and cost to the patients. Objective: The objective of the study was to compare the maternal and perinatal outcome in elective and emergency cesarean section. Methodology: It was a prospective comparative study conducted in the department of obstetrics and gynecology, Manipal Teaching Hospital from March, 2018 to September, 2018. All the patients undergoing cesarean section either elective or emergency were enrolled in the study after their consent. After collecting data from patients, maternal and perinatal outcomes were analyzed by using SPSS software. Results: There were total 1254 deliveries in the study duration, out of which 461(36.76%) were cesarean section (cs). The incidence of emergency cs was 86.5% and elective cs was 13.5%. Majority of women (75.7%) undergoing cs had no any antenatal visit. Around 81% of cases undergoing emergency cs were unbooked whereas only 48.4% of unbooked cases underwent elective cs (P-value 0.000). The most common indication for cs in both elective and emergency category was previous cs. There was no maternal complication in elective cs group but there were 8 cases (2%) in emergency cs (P value-0.293). In emergency cs group, 7 babies had poor Apgar score whereas all babies had good Apgar score in elective group (P-value-0.057). There was increased rate of NICU admission in emergency group than in elective group (3% vs 0%, P value-0.166). Conclusion The study showed that the incidence of cesarean section was high in our centre. The maternal and fetal risks were higher in emergency cs than in elective cs, but these were not statistically significant.

Maternal and perinatal outcome of teenage pregnancy in a tertiary care centre

Aims: To evaluate the maternal and perinatal outcome in adolescent pregnancy,Method: This was a cross-sectional study conducted in Department of Obstetrics and Gynecology, Manipal Teaching Hospital, Pokhara from October 2017 to March 2018 for duration of 6 months.Results: There were total 82 cases of teenage pregnancy in the study duration with incidence of  6% among total deliveries. Majority of cases were of age 19 and were primigravida. Fifty five percent of the cases had normal vaginal delivery and cesarean section accounted for 39% of cases. The major indication for cesarean section was meconium stained liquor (52%) followed by oligohydraminos (15%) and cephalopelvic disproportion (11%). The maternal complication accounted for 59% of total cases. Among them, anaemia was highly prevalent comprising 11% of cases followed by PPROM (9.8%) and hypertensive disorders in pregnancy (8.5%). In perinatal outcome, the incidence of preterm birth was 15.9% and low birth weight was 13.4%. The rate of NICU admission was 2.4% and there was one case of still birth.Conclusion: The study showed that teenage pregnancy is at increased risk of adverse maternal and perinatal outcome. So if we lay an effort for reducing the incidence of teenage pregnancy, we can bring in positive changes in the indicators of maternal and perinatal morbidities.

Stillbirths - Determining the associated factors and causes according to relevant condition at death: an experience from Pokhara, Nepal

Background: Stillbirth contributes significantly to perinatal mortality. This study was conducted with aim to determine various factors associated with it and to define the causes of stillbirth according to relevant condition at birth.Materials and Methods :This is prospective cross-sectional study conducted in the Department of Obstetrics and Gynaecology of Manipal Teaching Hospital from July 2015 to June 2017. All cases of stillbirth occurring during antenatal or intrapartum period after 28 weeks of gestation or fetus weighing 1000 grams or more were included. Detailed demographic parameters were noted. After delivery, fetus, placenta, umbilical cord and amniotic fluid were noted in detail. Data was entered in SPSS version 16 and analysis done.Results: The stillbirth rate was 22 per 1000 births. Low educational level of women, lack of antenatal care, multiparous status, gestational age less than 34 weeks, low birth weight and male gender of fetus were found to be significantly associated with stillbirths. The cause of fetal death could be identified according to relevant condition at death in 84% of cases. Only in 16%, the cause of stillbirth was not identified. Intrauterine growth restriction was the commonest cause of stillbirth (22%), followed by congenital anomalies (15%) and hypertensive disorders of pregnancy (14%). Other causes were abruptio (7%), intrapartum asphyxia (7%) and rupture uterus (5%). Other minor causes were anemia, diabetes, cord prolapse and amniotic fluid abnormalities.Conclusion :Low level of education, lack of quality antenatal care, multiparity, low gestational age and birth weight and male sex of fetus were factors associated with stillbirth. The cause of stillbirth was identified in most of the cases and largely was due to intrauterine growth restriction.Journal of Nobel Medical CollegeVolume 6, Number 2, Issue 11, July-December 2017, 58-65

Improving Knowledge, Skill and Confidence of Novice Medical Doctors in Trauma Management with Principles of ABCDE

Background Trauma is one of the major public health concerns clamming about five million death annually worldwide. Experience and confidence of a doctor in the management of trauma patients have big impact on the overall outcome. Objective This study aims to evaluate the outcome of a trauma course in improving the knowledge, skill and confidence of novice doctors in managing trauma victims. Method A pre/post test analytical study was carried out among novice medical doctors from Kathmandu University School of Medical Science (KUSMS) who participated in a standard two and a half day trauma course, that utilizes the principles of ABCDE, as a part of their regular training. Pre-course knowledge and skill were compared with immediate post-course scores on the same guidelines. Objective structured and subjective written feedbacks from the participants were analyzed qualitatively to identify the perceptions of candidates. Result Sixty-eight males and twenty-nine females completed the course. The average pre-test scores in knowledge and skill were 8.3(33.2%) and 19.6(78.5%) respectively. Similarly the post-test scores were 16.04(64.2%) and 22.45 (89.5%) respectively, showing statistically significant improvements (P 0.000). The mean percentage improvement in knowledge was 48.8% and that in skill was 160.9%. The feedback analysis showed majority of the participants were satisfied with the course and they perceived improved "self-confident" in handling trauma cases. Conclusion All the novice doctors should participate in a standard trauma course hence their knowledge, skill and confidence in handling a trauma can be improved.

Maternal Mortality and Associated Factors in a Tertiary Care Center of Western Nepal

Introduction: Identifying the cause of maternal death is important. The aim of this study was to determine the causes of maternal deaths and the factors associated with it. Methods: This was an observational, cross-sectional, analytical study conducted at Department of Obstetrics and Gynecology, Manipal Teaching Hospital from July 2013 to June 2017. Women who died during pregnancy, delivery, or puerperium were included in the study. Demographic factors, clinical profile, cause and type of maternal deaths were noted by taking history and by inquiring with the medical personnel involved in managing patients.  Data analysis was done using SPSS version 16. Results: There were 15 maternal deaths and 9923 livebirths. The maternal mortality ratio was 151 per 100,000 live births. Mean age of mothers was 28 years (SD = 7.5). Most of them were from rural areas, had low educational status. The mean gestational age at time of death was 33 weeks (SD = 7.5). Most of deaths (73%, n = 11) occurred in the postnatal period and 60% (n = 9) were critical at presentation. Direct obstetric causes like eclampsia was the most common (26.7%, n = 4) direct obstetric cause and cardiac disease was one of the important indirect cause (13.3%, n = 2). Delay in seeking health care and delay in reaching health center was the major reason for maternal deaths. Conclusion: Maternal mortality were mostly associated with direct obstetric causes, eclampsia being the most common. Most of the deaths were associated with delay in seeking health care and reaching health care centers.

Analysis of Health Facility Based Perinatal Verbal Autopsy of Electoral Constituency 2 of Arghakhanchi District, Nepal

BACKGROUND

Verbal autopsy is a method to diagnose possible cause of death by analyzing factors associated with death through detailed questioning. This study is a part of the operational research program in electoral constituency no. 2 (EC 2) of Arghakhanchi district by MIRA and HealthRight International.

METHODS

Two day essential newborn care training followed by one day perinatal verbal autopsy training and later one day refresher verbal autopsy training was given for health staff of EC 2 of Arghakhanchi district in two groups. Stillbirths of >22wks or > 500 gms and Early neonatal deaths (newborns died within7 days of life) were included in this study. The Nepal Government approved verbal autopsy forms were used for performing autopsies. Perinatal deaths were classified according to Wigglesworth's Classification. Causes of Perinatal deaths were analyzed. Data were analyzed in the form of frequencies and tabulation in SPSS 16 .

RESULTS

There were 41 cases of perinatal deaths (PND) were identified. Among them, 37 PNDs were from Arghakhanchi district hospital, 2 PNDs from Thada PHC, and one PND each from Subarnakhal and Pokharathok HPs. Among the 41 PNDs, 26 were stillbirths (SB) and 15 were early neonatal deaths (ENND). The perinatal mortality rate (PMR) of Arghakhanchi district hospital was 32.2 per 1,000 births and neonatal mortality rate (NMR) was 9.8 per 1,000 live births. Out of 26 stillbirths, 54% (14) were fresh SBs and 46% (12) were macerated stillbirths. The most common cause of stillbirth was obstetric complications (47%) where as birth asphyxia (53%) was the commonest cause of ENND. According to Wigglesworth's classification of perinatal deaths, Group IV (40%) was the commonest cause in the health facilities.

CONCLUSIONS

Obstetric complication was the commonest cause of stillbirth and birth asphyxia was the commonest cause of early neonatal death. This study highlighted the need for regular antenatal check-ups and proper intrapartum fetal monitoring with timely and appropriate intervention to reduce the incidence of stillbirths and intrauterine asphyxia.

Non-descent Vaginal Hysterectomy: Safety and Feasibility

Aims: To assess safety and feasibility of non-descent vaginal hysterectomy. Methods: A hospital based prospective study was conducted at the department of obstetrics and gynecology of Kathmandu Medical College Teaching Hospital from 1st January 2010 to 31st December 2011. All the patients undergoing non -descent vaginal hysterectomy for benign indication, without suspected adnexal pathology were included in the study. Vaginal hysterectomy was done in usual manner. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing, or combination of these were used to remove the uterus. Data regarding age, parity, uterine size ,estimated blood loss, length of operation, complication and hospital stay were recorded. Results: A total of 50 cases were selected for non-descent vaginal hysterectomy. Among them 43 cases successfully underwent non-descent vaginal hysterectomy. Commonest age group was (41-45 years) i.e. 40%. All patients were parous. Uterus size was <10 weeks in 27 cases and >10 weeks in 23 cases. Commonest indication was leiomyoma of uterus (63%). Mean duration of surgery was two hours. Mean blood loss was 205.26ml. Reasons for failure to perform NDVH was difficulty in opening pouch of Douglas in three cases. In rest of four cases there was difficulty in reaching the myoma and transverse diameter was too large so as to prevent descent of the uterus. The most common complication was post –operative pain in 23% of cases. Febrile morbidity was present in 4.6% of cases. Blood transfusion was required in seven cases. Average duration of hospital stay was three days. Conclusions: Vaginal hysterectomy for benign gynecological causes other than prolapse is safe and feasible. For successful outcome size of uterus, size in all dimensions and location of fibroid should be taken into consideration.Today in the era of minimally invasive surgery, non descent vaginal hysterectomy needs to be considered and seems to be a safe option. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11134   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 14-16

Gestational Trophoblastic Disease: Review of Cases Managed at B P Koirala Memorial Cancer Hospital

Aims: This study was done to analyze the clinical presentation and management outcomes of gestational trophoblastic disease managed at B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal. Methods: Descriptive study was conducted at B.P. Koirala Memorial Cancer Hospital. Case records of all gestational trophoblastic cases from January 2001 to December 2007 were analyzed regarding clinical details, investigations and treatment outcomes. Results: Forty-five cases of 16 to 50 years (mean 29.1 years) had gestational trophoblastic disease, among which 19 (43%) were of Tibeto- Burmese and 15 (33%) Indo-Aryan ethnic group. Hydatidiform mole, invasive mole and choriocarcinoma were observed in 17 (37.8%), six (13.3%) and 22 (48.8%) cases respectively. In seven cases (15.5%) molar pregnancy had occurred in primigravida, seven cases (15.5%) had previous molar pregnancy and in 16 (35.5%) cases GTD had occurred following abortion. Vaginal bleeding was the commonest presentation and 26 (57.8%) cases had anaemia. Eleven (24.5%) cases had theca luteal cyst, 17 (37.8%) had lung metastasis and 4 (8.9%) had brain metastasis. Chemotherapy was administered in 34 (75.5%) cases, among which 15 (33.3%) received single agent and 18 (40%) received multiagent chemotherapy. Hysterectomy was done in nine (20%) cases. Brain irradiation was done in a case with brain metastasis. Five (11.2%) cases with high WHO risk score left the hospital against medical advice. There were three (6.6%) mortalities. Thirty-seven (72.1%) cases were in remission and follow-up. Conclusions: Early diagnosis of disease and proper management strongly influences the outcome of GTD. Even in disseminated state GTD can be cured. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 18-21 DOI: http://dx.doi.org/10.3126/njog.v8i1.8855

Study on the Prevalence of Beta Haemolytic Streptococcus Among School Children

Introduction: Βeta haemolytic streptococcal infections have a worldwide distribution among children and it poses an important health problem globally. So, a five months study was conducted to know the prevalence of beta haemolytic streptococci (BHS) in the throat of school children. Materials and Methods: Throat swabs from 200 school children of Kirtipur were collected, transported to the laboratory and were processed for BHS following standard microbiological procedures. Group A Streptococci (GAS) were identified by beta haemolytic colonies, bacitracin sensitivity and catalase negativity test. ASO test was also performed from serum samples. Result: Altogether 18 (9%) BHS isolates were identified from 200 samples, out of which 11 (5.5%) isolates were from males and 7 (3.5%) were from females. Among the 18 BHS isolates, 10 were identified as GAS isolates. The number of GAS presented only 5% of total sample. There was no significant sex difference in colonization of GAS (p> 0.05). Majority of cases were asymptomatic. All GABHS isolates were sensitive to Penicillin. In Serological examination, i.e. Antistreptolysin O (ASO) titre, all serum samples showed less than 200 IU ASO titre. Conclusion: This result highlights the current situation of GABHS throat infection in school children of Kirtipur. DOI: http://dx.doi.org/10.3126/jnps.v33i1.7004 J Nepal Paediatr Soc. 2013;33(1):45-47

Immunophenotypic study of acute leukemia by flow cytometry at BPKMCH

Background: Immunophenotyping of acute leukemia is one of the most important clinical applications of fl ow cytometry. The aim of this study was to determine the immunophenotyping profi le of acute leukemia, by means of a fl ow cytometric method, using monoclonal antibodies all marked with a fl uorochrome, in four colour systems to assess their distribution according to type of leukemia (lymphoid B or T / myeloid). Materials and Methods: We retrospectively collected data of immunophenotyping from 52 acute leukemia patients at the department of pathology in B.P. Koirala Memorial Cancer Hospital from January 2010 to December 2011. Diagnosis was based on peripheral blood and bone marrow examination for morphology, cytochemistry and immunophenotypic studies. Results: Out of total 52 cases of acute leukemia diagnosed by fl ow cytometry over a two year period, there were 31 cases (59.6 %) of acute lymphoblastic leukemia, 20 cases (38.4 %) of acute myelogenous leukemia and one case (1.9 %) of bi-phenotypic acute leukemia. Leukemia was diagnosed among adults in 44.2 % whereas among children with age less than or equal to 15 years in 55.7 %. Thirty eight (73%) were male and 14 (27 %) were female with a male: female ratio of 2.7:1. For acute myelogenous leukemia, it was found that M0 (5.0 %), M1 (20%), M2 (60%), M3 (15%), M4 (5.0 %) were detected. CD13 and CD33 were the most useful markers in the diagnosis of acute myelogenous leukemia. The most common subtype was AML-M2. Of the 31 cases with acute lymphoblastic leukemia, 20 cases (64.5 %) were identifi ed as B-ALL and 11 cases (35.5%) as T-ALL. Aside from cytoplasmic CD3 (cCD3) and CD7 were the most sensitive antigens present in all cases of T-ALL. All cases of B-ALL showed expression of pan B-cell markers CD19 and CD22, but 15 (75 %) of 20 cases expressed CD10. Conclusion: Flow cytometric immunophenotyping was found to be especially useful in the correct identifi cation and diagnosis of acute myeloid or lymphoblastic leukemia and its subtypes. In combination with French-American-British (FAB) morphology and immunophenotyping, we were able to diagnose and classify all patients with acute leukemia in this study. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 345-350 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7856

Experiences of gynecological laparoscopic surgeries in a teaching hospital

BACKGROUND

Laparoscopic surgery has revolutionised the field of gynaecological surgery. Presently, almost all gynaecological procedures can find an alternative laparoscopic or hysterescopic approach. The aim of the study was to share the early experience of gynecological laparoscopic surgeries performed at Kathmandu Medical College Teaching Hospital.

METHODS

A study was carried out at Kathmandu Medical College Teaching Hospital from 1st January 2009 to 16th August 2012. All the patients undergoing gynecological laparoscopic surgeries were analyzed for the indication, type of procedure and its complications.

RESULTS

Overall 300 patients successfully underwent laparoscopy during the study period of which diagnostic laparoscopy was in 115. Operative laparoscopy was in 185. Sixty five cases underwent laparoscopic cystectomy. Sixty cases underwent laparoscopic assisted vaginal hysterectomy (LAVH). Salpingectomy for ectopic pregnancy was done in sixteen cases. Twelve cases contemplated for laparoscopic cystectomy underwent laparotomy. LAVH was converted to abdominal hysterectomy in four cases and laparotomy was done in two cases because of bladder injury and primary hemorrhage (from vault). Of minor complications the most common was port site infection and post-operative nausea and vomiting.

CONCLUSIONS

Laparoscopic gynecological surgery has tremendous potential in Nepal. Most of the surgeries can be carried out safely and favorable outcome has been noted in all the cases undertaken.

Comparison of laparoscopy and laparotomy in the surgical management of ectopic pregnancy

OBJECTIVE

To compare the operative findings, operative procedure and complications, postoperative complications and hospital stay in patients with ectopic pregnancy managed by laparoscopy and conventional laparotomy.

STUDY DESIGN

A cross-sectional, observational study.

PLACE AND DURATION OF STUDY

Department of Obstetrics and Gynaecology, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal, from October 2009 to October 2010.

METHODOLOGY

All patients with ectopic pregnancy confirmed during surgery, were included in the study. Patients with preoperative diagnosis of ectopic pregnancy but confirmed not to be so during surgery were excluded. Data regarding the studied variables were collected by interviewing patients postoperatively, reviewing the charts and operative notes and by following-up the patients till discharge.

RESULTS

There were a total of 32 cases of ectopic pregnancy which was 4.4% of total deliveries during the study period. Twelve patients (37.5%) were managed by laparoscopy and 20 patients (62.5%) by laparotomy. All the patients who underwent laparoscopy and 40% patients who underwent laparotomy were haemodynamically stable pre-operatively. Laparoscopy was mostly performed for tubal abortion (40%) and unruptured ectopic pregnancy (25%) whereas laparotomy mostly for ruptured ectopic pregnancy (70%). Salpingectomy was the commonest procedure in both routes of surgery. One patient in the laparoscopy group and 4 patients (20%) in laparotomy group had complications with two of the latter requiring admission in intensive care unit.

CONCLUSION

Laparoscopy is feasible and safer than laparotomy in the surgical management of ectopic pregnancy.

Soil nitrogen dynamics in a river floodplain mosaic

In their natural state, river floodplains are heterogeneous and dynamic ecosystems that may retain and remove large quantities of nitrogen from surface waters. We compared the soil nitrogen dynamics in different types of habitat patches in a restored and a channelized section of a Thur River floodplain (northeast Switzerland). Our objective was to relate the spatiotemporal variability of selected nitrogen pools (ammonium, nitrate, microbial nitrogen), nitrogen transformations (mineralization, nitrification, denitrification), and gaseous nitrogen emission (NO) to soil properties and hydrological processes. Our study showed that soil water content and carbon availability, which depend on sedimentation and inundation dynamics, were the key factors controlling nitrogen pools and processes. High nitrogen turnover rates were measured on gravel bars, characterized by both frequent inundation and high sediment deposition rates, as well as in low-lying alluvial forest patches with a fine-textured, nutrient-rich soil where anaerobic microsites probably facilitated coupled nitrification-denitrification. In contrast, soils of the embankment in the channelized section had comparatively small inorganic nitrogen pools and low transformation rates, particularly those related to nitrate production. Environmental heterogeneity, characteristic of the restored section, favors nitrogen removal by creating sites of high sedimentation and denitrification. Of concern, however, are the locally high NO efflux and the possibility that nitrate could leach from nitrification hotspots.

Cancer with pregnancy in a cancer hospital

BACKGROUND

Cancer during pregnancy is rare, occurring one in every 1,000 pregnancies. Cancer itself rarely harms the baby and some cancer treatments are safe during pregnancy. However, treatment dilemmas often occur.

METHODS

Descriptive study was conducted at B. P. Koirala memorial cancer hospital. Case records of women with cancer and pregnancy from January 2001 to February 2012 were analyzed regarding their clinical details, treatment, follow-up and feto-maternal outcome.

RESULTS

Nineteen women, of 17 to 40 years had cancer with pregnancy. Observed cancers with pregnancy were: leukemia (4), head and neck (3), ovary (3), cervix (2), rectum (2), breast (1), Non-Hodgkin's lymphoma (1), osteosarcoma (1), spinal cord (1) and vulva (1). Seven women (36%) presented in the second trimester and six women (32%) presented in the first and third trimester each. Seven (36%) women opted for termination of pregnancy for definitive treatment, five (26%) deferred treatment until delivery. Among the seven (36%) that accepted definitive treatment along with pregnancy, fetal demise occurred in three and delivery of healthy baby occurred in four. Nine babies born to mothers with cancer during pregnancy till date have normal growth and development. Total 10 (52%) of the mothers are in remission, six (32%) have died from disease.

CONCLUSIONS

Cancers during pregnancy, more common in younger women, posed treatment challenges. Definitive cancer treatment could have greater fetal risk during the first trimester but could be offered with more acceptable risk in the second and third trimesters.

Analysis of carbon and nitrogen dynamics in riparian soils: model validation and sensitivity to environmental controls

The Riparian Soil Model (RSM) of Brovelli et al. (2012) was applied to study soil nutrient turnover in a revitalized section of the Thur River, North-East Switzerland. In the present work, the model was calibrated on field experimental data, and satisfactorily reproduced soil respiration, organic matter stocks and inorganic nitrogen fluxes. Calibrated rates were in good agreement with the ranges reported in the literature. The main discrepancies between model and observations were for dissolved organic carbon. The sensitivity of the model to environmental factors was also analyzed. Soil temperature was the most influential factor at daily and seasonal scales while effects of soil moisture were weak overall. The ecosystem sensitivity to temperature changes was quantified using the Q10 index. The seasonal behavior observed was related to the influence of other forcing factors and to the different state (density and activity) of the microbial biomass pool during the year. Environmental factors influencing microbial decomposition, such as the C:N ratio and litter input rate, showed intermediate sensitivity. Since these parameters are tightly linked to the vegetation type, the analysis highlighted the effect of the aboveground ecosystem on soil functioning.

Isolation and characterization of aerobic culturable arsenic-resistant bacteria from surfacewater and groundwater of Rautahat District, Nepal

Arsenic (As) contamination of groundwater is a serious Environmental Health Management issue of drinking water sources especially in Terai region of Nepal. Many studies have reported that due to natural abundance of arsenic in the environment, various bacteria have developed different resistance mechanisms for arsenic compound. In this study, the culturable arsenic-resistant bacteria indigenous to surfacewater as well as groundwater from Rautahat District of Nepal were randomly isolated by standard plate count method on the basis of viable growth on plate count agar amended with arsenate ranging from 0, 0.5, 10, 40, 80 to 160 milligram per liter (mg/l). With respect to the morphological and biochemical tests, nine morphologically distinct potent arsenate tolerant bacteria showed relatedness with Micrococcus varians, Micrococcus roseus, Micrococcus luteus, Pseudomonas maltophilia, Pseudomonas sp., Vibrio parahaemolyticus, Bacillus cereus, Bacillus smithii 1 and Bacillus smithii 2. The isolates were capable of tolerating more than 1000 mg/l of arsenate and 749 mg/l of arsenite. Likewise, bioaccumulation capability was highest with M. roseus (85.61%) and the least with B. smithii (47.88%) indicating the potential of the organisms in arsenic resistance and most probably in bioremediation.

A new species of gravel-dwelling loach (Ostariophysi: Nemacheilidae) from the Nepalese Himalayan foothills

Turcinoemacheilus himalaya, new species, is described from the Koshi and Gandaki River basins of Nepal. The new species is distinguished from its hypothesised congener, Turcinoemacheilus kosswigi, from the Euphrates, Tigris and Karoun basins of the Middle East, by the presence of small scales on the posterior half of its body (v. absence of all scales), its shorter caudal peduncle (caudal peduncle length 12-15% standard length, L(S) v. 16-23), its shorter snout (snout length 28-36% head length, L(H) v. 40-49) and by features of its colour pattern, including the presence of small irregularly shaped dark grey markings over the lateral body surface. Turcinoemacheilus himalaya is known to date only from Nepal.

Analysis of perinatal deaths and ascertaining perinatal mortality trend in a hospital

BACKGROUND

Perinatal mortality rate is very high in developing countries including Nepal. Analyzing perinatal deaths help in identifying preventable factors thus help in reducing it. Analysis of causes of perinatal deaths over a period in a hospital will help to identify the perinatal mortality trend and preventable factors thus help in taking corrective measures to reduce the perinatal mortality rate. The aim of the study is to analyse perinatal deaths and ascertain perinatal mortality trend of Kathmandu Medical College Teaching hospital in the last 8 year period.

METHODS

Stillbirths and early neonatal deaths from 2002 to 2011 are collected from the register book of the labour room, special care baby unit and operation theatre of the hospital. Perinatal mortality rate and extended perinatal mortality rates are calculated and perinatal deaths were classified according to Wigglesworth's classification. Trend of Perinatal and Extended Perinatal mortality rates, stillbirth rates and early neonatal death rates among 5 perinatal death audits of the hospital were compared.

RESULTS

In the first perinatal death audit (Oct '02-Sept '03) perinatal mortality rate (PMR) was recorded as 30.7 per 1000 births and extended perinatal mortality rate (EPMR) as 47.9 per 1000 births, where as in the fifth perinatal death audit (Apr '10-Mar '11) PMR was recorded as 14.4 per 1000 births and EPMR as 19.6 per 1000 births. In Wigglesworth's classification, in the first perinatal death audit, most of the perinatal deaths were in group IV (41%) reflecting more asphyxial deaths however in fifth audit, group III mortality (41%) was highest indicating death of low birth weight or preterm babies. In the first audit, stillbirth rate (SBR) excluding <1 kg was 18.1 per 1000 births and early neonatal deaths (ENND) excluding <1 kg was 12.9 per 1000 live births. In the fifth audit, SBR (excluding <1 kg) and ENND rate (excluding <1 kg) were 7.1 per 1000 births and 7.2 per 1000 live births respectively reflecting declining trend of both SBR and ENND rate in the hospital.

CONCLUSIONS

Distinct declining trend in PMR, EPMR, SBR and ENND rates at KMCTH were noted. As asphyxial deaths have been reduced significantly, more intensive efforts are needed to prevent premature births with care of preterm and very low birth weight babies.

Role of laparoscopy in diagnosis and treatment of ectopic pregnancy

Laparoscopy has a great role in early and effective diagnosis and treatment of ectopic pregnancy. This study was carried out to evaluate the feasibility and role of laparoscopy in diagnosis and treatment of ectopic pregnancy. This is a prospective observational study conducted in the Department of Obstetrics and Gynaecology, Kathmandu Medical College Teaching Hospital from April 2009 to March 2011. All the women who underwent laparoscopy for ectopic pregnancy or diagnosed as ectopic pregnancy during laparoscopy done for other diagnosis were included. Data were collected by interviewing patients, operating surgeons, reviewing charts and operative notes and following up patients. There were 42 cases of ectopic pregnancy during study period, of whom 16 (38.1%) underwent laparoscopy. Preoperative diagnosis of ectopic pregnancy was confirmed clinically in 6 (37.5%) patients, who underwent laparoscopy as an operative procedure. In the remaining 6 (37.5%), laparoscopy was performed as a diagnostic procedure as clinical diagnosis was doubtful; two cases of negative laparoscopy was noted. Incidental diagnosis of ectopic pregnancy was made in another 4 (25%) patients who had undergone laparoscopy for other pre operative diagnosis. All the patients were surgically managed by laparoscopy without converting it to laparotomy. There were no intraoperative or postoperative complications except for primary port infection in few (25%). Therefore, laparoscopy has a significant role in the diagnosis of ectopic pregnancy and operative laparoscopy is a safe approach with minimal complications.

Bacteriuria and urinary retention following gynaecological surgery: comparing short vs long term catheterization

BACKGROUND

Post operative bladder drainage is important care following gynaecological surgeries. This study was done to compare the incidence of urinary retention and bacteriuria following long term versus short term catheterization.

METHODS

The patients who were admitted for gynaecological major surgeries were enrolled in this study. One group of patients had post operative indwelling catheterization for 24 hrs (short term catheterization) and another group of patients had catheterization for more than 48 hrs (long term catheterization). The urine examination and culture sensitivity was sent for all patients at the removal of catheter. The patients were followed after removal of catheter for urinary retention.

RESULTS

Total of 102 patients were studied. There were 48 patients in short term catheterization group and 54 patients in long term catheterization group. In short term catheterization group, 3 (6.2%) cases had bacteriuria and no cases of urinary retention were observed. In prolonged catheterization group, 6 cases (11.1%) had bacteriuria and 2 cases (3.7%) had urinary retention.

CONCLUSIONS

This study has concluded that short time catheterization following gynaecological surgery had fewer incidences of bacteriuria and urinary retention than long term catheterization.

Safety and Efficacy of Misoprostol and Dinoprostone as Cervical Ripening Agents

INTRODUCTION: The study compares safety and efficacy of misoprostol and dinoprostone as cervical ripening agents. METHODS: Patients with term, vertex, singleton pregnancy and Bishop score of 4 or less were randomly assigned to receive misoprostol pessary (n=35, 50 microg intravaginally) or dinoprostone gel (n=31, 0.5 mg intracervically) at 6 hourly intervals. If there were no progress in cervical dilatation or effective uterine contraction even after maximum dose, patients were taken for cesarean section. Patients who achieved Bishop's score more than 7 but the delivery was not progressing, were augmented with oxytocin drip. RESULTS: No uterine hyperstimulation was observed in both groups. However, abnormal fetal heart rate was observed in 3(8.6%) cases inmisoprostol group and 2 (6.5%) in dinoprostone group. There was no statistically significant difference in meconium passage in two groups. Apgar score less than 7 at 1 minute was seen in 6 (19.4%) and 11 (31.4%) neonates in dinoprostone and misoprostol group respectively. However Apgar score less than 7 at 5 minutes was found in only one neonate of dinoprostone treated patient. Both drugs were found to be equally effective in improving Bishops score with no significant difference in mean induction to delivery time. Cesarean section was done among 32.3% and 28.6% respectively in dinoprostone and misoprostol groups. There was significant reduction in the need for oxytocin augmentation in misoprostol (37.1%) group than in dinoprostone (67.7%) group. CONCLUSIONS: Vaginal misoprostol is an effective, safer and cheaper alternative to dinoprostone as a cervical ripening agent in underdeveloped countries. Keywords: Apgar score, Bishops score, cervical ripening, Dinoprostone, induction, Misoprostol

Safety and efficacy of misoprostol and dinoprostone as cervical ripening agents

INTRODUCTION

The study compares safety and efficacy of misoprostol and dinoprostone as cervical ripening agents.

METHODS

Patients with term, vertex, singleton pregnancy and Bishop score of 4 or less were randomly assigned to receive misoprostol pessary (n=35, 50 microg intravaginally) or dinoprostone gel (n=31, 0.5 mg intracervically) at 6 hourly intervals. If there were no progress in cervical dilatation or effective uterine contraction even after maximum dose, patients were taken for cesarean section. Patients who achieved Bishop's score more than 7 but the delivery was not progressing, were augmented with oxytocin drip.

RESULTS

No uterine hyperstimulation was observed in both groups. However, abnormal fetal heart rate was observed in 3(8.6%) cases in misoprostol group and 2 (6.5%) in dinoprostone group. There was no statistically significant difference in meconium passage in two groups. Apgar score less than 7 at 1 minute was seen in 6 (19.4%) and 11 (31.4%) neonates in dinoprostone and misoprostol group respectively. However Apgar score less than 7 at 5 minutes was found in only one neonate of dinoprostone treated patient. Both drugs were found to be equally effective in improving Bishops score with no significant difference in mean induction to delivery time. Cesarean section was done among 32.3% and 28.6% respectively in dinoprostone and misoprostol groups. There was significant reduction in the need for oxytocin augmentation in misoprostol (37.1%) group than in dinoprostone (67.7%) group.

CONCLUSIONS

Vaginal misoprostol is an effective, safer and cheaper alternative to dinoprostone as a cervical ripening agent in underdeveloped countries.

BACTERIOLOGICAL STUDY OF EAR DISCHARGE IN BIR HOSPITAL

Discharge from the ear is one of the commonest symptoms of infections of the ear.With a view to study the major strains of bacteria encountered in ear discharges, thisstudy was conducted in Microbiology Laboratory, Bir Hospital. The study wasconducted for a period of 6 months from January 2000 - July 2000. A total of 224samples of aural discharges of the outpatients were collected and analysed for bacterialgrowth. These samples were cultured with the use of standard microbiologicaltechniques and the antibiotic sensitivity pattern of the isolates was also studied invitro with the use of disc diffusion method. Among 224 patients, 50.9% were male and49.1% were female and the age of the patients varied from 6 months to 76 years.Majority of the patients with discharging ear belonged to the age group 11-20 years.Bacterial growth was found in 82.6%. The bacterial isolates were of 13 differentspecies. Staphylococcus aureus was the most frequently isolated organism (49.4%)followed by Pseudomonas aeruginosa(20.9%). Other organisms isolated wereCoagulase negative Staphylococci (CONS), Streptococcus spp., Bacillus sps., Escherichiaspp., Proteus spp., Enterobacter spp., Klebsiella spp., Acinetobacter spp., Edwardsiellaspp.The prevalence of gram positive bacterial isolates was higher than gram negativebacterial isolates. 58.0% of samples showed positive correlation with direct smeargram stain and culture results. Among the antibiotics used, Ciprofloxacin was foundto be the most effective (80.2%) for overall bacterial isolates followed by Gentamicin(68.9%). The result of antibiotic sensitivity was almost similar to gram positive aswell as gram negative isolates.Key Words: Aural discharge, Gram stain, culture, sensitivity.

Multi-centre evaluation of repeatability and reproducibility of the direct agglutination test for visceral leishmaniasis

OBJECTIVE

To evaluate the repeatability and reproducibility of the serological direct agglutination test (DAT) for visceral leishmaniasis (VL) with aqueous antigen in a multi-centre study in VL-endemic areas in Sudan, Kenya and Nepal.

METHODS

Repeatability within each centre and reproducibility between the centres' results and an external reference laboratory (Belgium) was assessed on 1596 triplicate plain blood samples collected on filter paper.

RESULTS

High kappa values (range 0.86-0.97) indicated excellent DAT repeatability within the centres. The means of the titre differences between the reference laboratory and the centres in Sudan, Kenya and Nepal (2.3, 2.4 and 1.1, respectively, all significantly different from 0) showed weak reproducibility across centres. 95% of the titre differences between the reference laboratory and the respective centres were accounted for by large intervals: 0.6-9 fold titre variation for Sudan, 0.7-8 fold for Kenya and 0.26-4 fold for Nepal.

CONCLUSION

High repeatability of DAT confirms its potential, but reproducibility problems remain an obstacle to its routine use in the field. Reproducibility was hindered by alteration of the antigen through temperature and shaking, especially in Kenya and Sudan, and by nonstandardization of the test reading. DAT handling procedures and antigen quality must be carefully standardized and monitored when introducing this test into routine practice.

Ancylostoma duodenale is responsible for hookworm infections among pregnant women in the rural plains of Nepal

Fecal specimens from 292 pregnant women (ages 15-40 yr) and 129 infants (ages 10-20 wk) were examined for helminth eggs by the Kato-Katz method and cultured for helminth larvae identification using a modified Harada Mori method. These specimens were collected from June 1995 through July 1996 in Sarlahi District in the southern rural plains of Nepal. Among pregnant women, the prevalence of helminth infection by the Kato-Katz method was 78.8%, 56.2%, and 7.9% for hookworm, Ascaris lumbricoides, and Trichuris trichiura, respectively. Using the modified Harada-Mori method, 66.1% and 2.0% of women's fecal cultures were positive for hookworm and Strongyloides stercoralis, respectively. All of the cultured hookworm larvae were identified as Ancylostoma duodenale. Among infants, 1 specimen was positive for hookworm and 1 for A. lumbricoides using the Kato-Katz method. The modified Harada Mori method detected no larvae in specimens from infants. There was 81.8% agreement between the 2 methods for the detection of hookworm infection. Ancylostoma duodenale is endemic in this study population and highly prevalent in pregnant women.

Molecular epidemiology of Vibrio cholerae O1 isolated in Nepal by southern hybridization with a cholera toxin gene probe

A cholera epidemic broke out in 1992 due to Vibrio cholerae O1 biotype El Tor in the eastern and southern belt of Nepal mainly among the Bhutanese refugees. Restriction fragment profiles (RFP) of DNA fragments of V. cholerae O1 isolates hybridized with an enzyme-labelled oligonucleotide probe for cholera toxin gene (ctx) by Southern Hybridization were compared. The probe hybridized with the 13- and 8-kb fragments of PstI-digested total DNA in all isolates observed in the epidemic. This RFP in the Nepalese strain was not observed in the strains isolated during other epidemics but was observed in the strains isolated from the exported marine products from Taiwan and Thailand.

Etiological spectrum of acute sporadic viral hepatitis amongst adults in Chandigarh

All 77 HBsAg positive and 94 of representative HBsAg negative sera derived from 253 adult patients with acute sporadic viral hepatitis during 1987 at Chandigarh were tested for serological markers of hepatitis B virus (HBV) and hepatitis A virus (HAV) infections. The HBsAg positive patients could be classified as acute hepatitis B (64%); chronic hepatitis B with exacerbation, or liver damage by other infectious or noninfectious agent/s over a chronic HBsAg carrier state (35%); and coinfection of HBV and HAV (1%). Among the HBsAg negative hepatitis group, acute hepatitis B was diagnosed in 4 per cent of patients and acute hepatitis A in another 4 per cent.