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Mahotra N, Chaudhary S, Poudyal P. Pre-eclampsia among Pregnant Women Admitted to the Department of Obstetrics and Gynaecology of a Tertiary Care Centre. JNMA J Nepal Med Assoc 2023; 61:840-843. [PMID: 38289744 PMCID: PMC10725235 DOI: 10.31729/jnma.8265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Pre-eclampsia is a pregnancy-related hypertensive disorder with maternal and neonatal complications. Many studies are done regarding the prevalence of pre-eclampsia in Nepal but ascertaining the maternal risk factors and fetal outcomes are important. The aim of this study was to find out the prevalence of pre-eclampsia among pregnant women admitted to the Department of Obstetrics and Gynaecology of a tertiary care centre. Methods A descriptive cross-sectional study was conducted among pregnant women admitted to the Department of Obstetrics and Gynaecology of a tertiary care hospital from 13 July 2023 to 29 September 2023 after obtaining ethical approval from the Institutional Review Committee. Convenience sampling method was used. Point estimate was calculated at a 95% Confidence Interval. Results Among 5065 patient, pre-eclampsia was seen in 44 (0.87%) (0.61-1.13, 95% Confidence Interval). A total of 16 (36.36%) cases of pre-eclampsia were in the age group 25-29 years and 30 (68.18%) of them were nulliparous. A total of 38 (86.36%) of the newborns of the pre-eclamptic cases had low birth weight. The APGAR score of newborns at the 1 minute after birth was 26 (59.09%) followed by the newborns who needed re-evaluation 16 (36.36%). The APGAR score recorded at 5 minutes showed maximum newborns with normal APGAR score 40 (90.90%). Conclusions The prevalence of pre-eclampsia among pregnant women was found to be lower than other studies done in similar settings. Keywords maternity; Nepal; pre-eclampsia; prevalence.
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Affiliation(s)
- Narayan Mahotra
- Department of Clinical Physiology, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
| | - Sonam Chaudhary
- Department of Clinical Physiology, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
| | - Pooja Poudyal
- Department of Gynecology and Obstetrics, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
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Doran J, Hanna R, Nyagura-Mangori T, Mahotra N, Das SK, Borok M, Musani A, Maw AM. Stakeholder perspectives on current determinants of ultrasound-guided thoracentesis in resource limited settings: a qualitative study. BMJ Open 2022; 12:e064638. [PMID: 36523247 PMCID: PMC9748956 DOI: 10.1136/bmjopen-2022-064638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Preprocedure pleural fluid localization using bedside ultrasound has been shown to reduce complications related to thoracentesis and is now considered the standard of care. However, ultrasound-guided thoracentesis (USGT) has not been broadly adopted in many low-resource settings. With increasing affordability and portability of ultrasound equipment, barriers to USGT are changing. The aim of this multisite qualitative study is to understand the current barriers to USGT in two resource-limited settings. SETTING We studied two geographically diverse settings, Harare, Zimbabwe, and Kathmandu, Nepal. PARTICIPANTS 19 multilevel stakeholders including clinical trainees, attendings, clinical educators and hospital administrators were interviewed. There were no exclusion criteria. PRIMARY OUTCOME To understand the current determinants of USGT adoption in these settings. RESULTS Three main themes emerged from these interviews: (1) stakeholders perceived multiple advantages of USGT, (2) access to equipment and training were perceived as limited and (3) while an online training approach is feasible, stakeholders expressed scepticism that this was an appropriate modality for procedural training. CONCLUSION Our data suggests that USGT implementation is desired by local stakeholders and that the development of an educational intervention, cocreated with local stakeholders, should be explored to ensure optimal contextual fit.
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Affiliation(s)
- Jennifer Doran
- Department of Medicine, University of Colorado Hospital, Aurora, Colorado, USA
| | - Reem Hanna
- Division of Hospital Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - Narayan Mahotra
- Division of Physiology, Tribhuvan University Institute of Medicine, Maharajgunj, Nepal
| | - Santa Kumar Das
- Division of Pulmonary and Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Magaret Borok
- Unit of Internal Medicine, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Ali Musani
- Division of Pulmonary and Critical Care Medicine, University of Colorado, Aurora, Colorado, USA
| | - Anna M Maw
- Division of Hospital Medicine, University of Colorado, Aurora, Colorado, USA
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Dhimal M, Bhandari D, Dhimal ML, Kafle N, Pyakurel P, Mahotra N, Akhtar S, Ismail T, Dhiman RC, Groneberg DA, Shrestha UB, Müller R. Impact of Climate Change on Health and Well-Being of People in Hindu Kush Himalayan Region: A Narrative Review. Front Physiol 2021; 12:651189. [PMID: 34421631 PMCID: PMC8378503 DOI: 10.3389/fphys.2021.651189] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/30/2021] [Indexed: 12/03/2022] Open
Abstract
Climate change and variability affect virtually everyone and every region of the world but the effects are nowhere more prominent than in mountain regions and people living therein. The Hindu Kush Himalayan (HKH) region is a vast expanse encompassing 18% of the world’s mountainous area. Sprawling over 4.3 million km2, the HKH region occupies areas of eight countries namely Nepal, Bhutan, Afghanistan, Bangladesh, China, India, Myanmar, and Pakistan. The HKH region is warming at a rate higher than the global average and precipitation has also increased significantly over the last 6 decades along with increased frequency and intensity of some extreme events. Changes in temperature and precipitation have affected and will like to affect the climate-dependent sectors such as hydrology, agriculture, biodiversity, and human health. This paper aims to document how climate change has impacted and will impact, health and well-being of the people in the HKH region and offers adaptation and mitigation measures to reduce the impacts of climate change on health and well-being of the people. In the HKH region, climate change boosts infectious diseases, non-communicable diseases (NCDs), malnutrition, and injuries. Hence, climate change adaptation and mitigation measures are needed urgently to safeguard vulnerable populations residing in the HKH region.
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Affiliation(s)
- Meghnath Dhimal
- Nepal Health Research Council, Kathmandu, Nepal.,Global Institute for Interdisciplinary Studies, Lalitpur, Nepal
| | - Dinesh Bhandari
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Mandira Lamichhane Dhimal
- Global Institute for Interdisciplinary Studies, Lalitpur, Nepal.,Policy Research Institute, Kathmandu, Nepal
| | | | - Prajjwal Pyakurel
- Department of Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Narayan Mahotra
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Saeed Akhtar
- Institute of Food Science and Nutrition, Bahauddin Zakariya University, Multan, Pakistan
| | - Tariq Ismail
- Institute of Food Science and Nutrition, Bahauddin Zakariya University, Multan, Pakistan
| | - Ramesh C Dhiman
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | | | - Ruth Müller
- Institute of Tropical Medicine, Antwerp, Belgium
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Nepal G, Yadav JK, Rehrig JH, Bhandari N, Baniya S, Ghimire R, Mahotra N. Efficacy and safety of inhaled budesonide on prevention of acute mountain sickness during emergent ascent: a meta-analysis of randomized controlled trials. BMC Emerg Med 2020; 20:38. [PMID: 32404064 PMCID: PMC7222565 DOI: 10.1186/s12873-020-00329-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 04/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background Acute Mountain Sickness (AMS) is a pathophysiologic process that occurs in non-acclimated susceptible individuals rapidly ascending to high-altitude. Barometric pressure falls at high altitude and it translates to a decreased partial pressure of alveolar oxygen (PAO2) and arterial oxygen (PaO2). A gradual staged ascent with sufficient acclimatization can prevent AMS but emergent circumstances requiring exposure to rapid atmospheric pressure changes – such as for climbers, disaster or rescue team procedures, and military operations – establishes a need for effective prophylactic medications. This systematic review and meta-analysis aim to analyze the incidence of AMS during emergent ascent of non-acclimatized individuals receiving inhaled budesonide compared to placebo. Methods This current meta-analysis was conducted according to the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We searched PubMed, Google Scholar and Embase for relevant studies. The efficacy of budesonide in reducing incidence of AMS was evaluated by calculating the pooled ORs and 95% CIs. The efficacy of budesonide in maintaining hemoglobin-oxygen saturation was evaluated by calculating standard mean difference (SMD) and 95% confidence intervals. Results We found that at high altitude, inhaled budesonide was effective in reducing the incidence of mild AMS [OR: 0.37; 95% CI, 0.14 to 0.9, p = 0.042] but was ineffective in reducing the incidence of severe AMS [OR: 0.46; 95% CI, 0.14 to 1.41, p = 0.17]. Inhaled budesonide was also effective in maintaining SpO2 (SMD: 0.47; 95% CI, 0.09 to 0.84, p = 0.014) at high altitude. However, it was not effective in maintaining or improving pulmonary function at high altitude. Systematic-review found no adverse effects of budesoide in the dose used for prophylaxis of AMS. Conclusions Our systematic review showed that prophylactic inhaled budesonide is effective in preventing mild AMS during emergency ascent but not effective in preventing severe AMS. Though statistically significant, authors recommend caution in interpretation of data and questions for further well designed randomized studies to evaluate the role of budesonide in prophylaxis of AMS during an emergent ascent.
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Affiliation(s)
- Gaurav Nepal
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal. .,Mountain Medicine Society of Nepal, Kathmandu, Nepal.
| | - Jayant Kumar Yadav
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.,Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | | | - Niroj Bhandari
- Kathmandu University School of Medical Sciences, Panauti, Nepal
| | - Santosh Baniya
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.,Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | - Rakesh Ghimire
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Narayan Mahotra
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
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Paudel R, Lee K, Singh JK, Yoo SJ, Acharya D, Kadel R, Adhikari S, Paudel M, Mahotra N. Prevalence of behavioral risk factors of cardiovascular diseases and associated socio-economic factors among pregnant women in a rural area in Southern Nepal. BMC Pregnancy Childbirth 2018; 18:484. [PMID: 30526512 PMCID: PMC6286585 DOI: 10.1186/s12884-018-2122-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) have dramatically infiltrated populations living in abject poverty in Low- and Middle-income Countries (LMICs), and poor maternal and child health outcomes have been frequently reported for those with CVD risk factors. However, few studies have explored the behavioral risk factors of CVDs among pregnant women in rural settings. This study aimed at determining the prevalence and identifying the socio-economic predictors of behavioral risk factors of CVDs among pregnant women in rural area in Southern Nepal. METHODS A Community-based cross-sectional study was conducted in 52 clusters of Dhanusha District of Nepal in a total of 426 pregnant women in their second trimester using multistage cluster sampling method. Multivariable logistic regression model was used to assess independent associations between behavioral risk factors during pregnancy and maternal socio-economic characteristics. RESULTS Of the 426 study participants, 86.9, 53.9, 21.3 and 13.3%, respectively, reported insufficient fruits and vegetables consumption, insufficient physical activity, tobacco use, and harmful alcohol drinking. Socio-economic factors significantly associated with more than one behavioral risk factors in expectant mothers with a primary level education (adjusted odds ratio (AOR) 2.78; 95% Confidence Interval (CI) (1.35-5.72)), 20-34 years age group (Adjusted Odds Ratio (AOR) 0.27; 95% CI (0.13-0.56)), and those with the highest wealth index (AOR 0.36; 95% CI (0.16-0.84)). CONCLUSION Higher prevalence of behavioral risk factors for CVDs and their socio-economic factors prevailing among pregnant women living in rural Nepal call for immediate health promotion interventions such as community awareness and appropriate antenatal counseling.
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Affiliation(s)
- Rajan Paudel
- Department of Community Medicine and Public Health, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Kwan Lee
- Department of Preventive Medicine, College of Medicine, Dongguk University, 123 Dongdae-ro, Gyeongju-si, 38066 Republic of Korea
| | - Jitendra Kumar Singh
- Department of Community Medicine and Public Health, Janaki Medical College, Tribhuvan University, Janakpur, Nepal
| | - Seok-Ju Yoo
- Department of Preventive Medicine, College of Medicine, Dongguk University, 123 Dongdae-ro, Gyeongju-si, 38066 Republic of Korea
| | - Dilaram Acharya
- Department of Preventive Medicine, College of Medicine, Dongguk University, 123 Dongdae-ro, Gyeongju-si, 38066 Republic of Korea
- Department of Community Medicine, Kathmandu University, Devdaha Medical College and Research Institute, Rupandehi, Nepal
| | - Rajendra Kadel
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Samaj Adhikari
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Mohan Paudel
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Narayan Mahotra
- Department of Physiology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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