American Journal of Public Health Research

Burden of Dermatological Disorders in Remote Hilly Region of Western Nepal: A Community Health Camp-based Study

by Ajay Kumar, Prasanna Raj Shrestha, Jenny Pun, Pratichya Thapa, Merina Manandhar and Brijesh Sathian

Special Issue

Population based cross-sectional surveys depicting the magnitude of dermatological diseases among the hilly population in Nepal, where limited resources are available for skin care. The study aimed to measure prevalence of dermatological conditions and associated factors in remote hilly region of Nepal. The cross sectional study was done in September 2014 in a multispecialty medical camp held in remote hilly area of western Nepal to find out the pattern and assess the relation of various demographic factors with the type of dermatological disorders. All the cases were examined by a dermatologist in natural light and a clinical diagnosis was made. 153 cases were examined (total camp cases were 1132), camp prevalence of 13.51%. Patients were from one month of age to 90 years old with mean age of 25.69. The commonest cutaneous diseases encountered were bacterial infections(56/153). Odds ratio of infectious and non infectious disease in current smokers and non-smokers was 1.60. There was no statistically significant relation in type of dermatoses and age group (p=0.55), socioeconomic status (p=0.43), education level (p=0.74), occupation (p=0.24).

American Journal of Public Health Research. 2015, 3(5A), 203-205. DOI: 10.12691/ajphr-3-5A-43
Pub. Date: October 27, 2015

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Ultrasonography in Predicting the Cause of Scrotal Pain: A Study in Nepal

by Subash K C, Mahesh Pathak, Abhijit De and Brijesh Sathian

Special Issue

Ultrasound is an easily available, less time consuming, reproducible and safest imaging modality in evaluation of scrotum. It is important to come to an accurate diagnosis in any case of scrotal pain. Although epididymitis with or without orchitis is commonly encountered, it is necessary to rule out emergency conditions like torsion of spermatic cord not only to salvage testes with timely surgery but also to avoid negative surgeries on otherwise inflammatory conditions. This study was done in Manipal Teaching Hospital situated in western region of Nepal on 100 cases presenting with scrotal pain. It was done over a period of 2 years from September 2013 to August 2015. Various causes of scrotal pain were accurately diagnosed in all the included cases. Prevalence of various common causes of scrotal pain were depicted by this study. Epididymitis was noted in 35% cases with scrotal pain, followed by varicocele in 15 % cases and epididymo-orchitis in 12 % cases. Most patients were in 20 to 30 years age group comprising 41 % followed by 31to 40 years age group comprising 39%. Hence, scrotal USG is a valuable tool in diagnosing cause of scrotal pain more so in clinically equivocal cases.

American Journal of Public Health Research. 2015, 3(5A), 199-202. DOI: 10.12691/ajphr-3-5A-42
Pub. Date: October 27, 2015

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Traditional Healers and Evidence-Based Medicine

by Ranabir Pal, Pradip Kumar Mohanta, Gautam Sarker, Neeti Rustagi and Ayan Ghosh

Special Issue

Traditional medicine is the oldest primary care with 400 million practitioners across the globe. Many consider traditional medicine to be unsystematic and not based on science, with voluminous apprehensions. Yet, due to reasons better known to them as care-seekers daily patronize traditional healers by accepting them as ‘Friend, Philosopher and Guide’. Otherwise in absence of 'receivers of treatment' these traditional healers would not have survived over years with respect from the community. They are true professionals. Our so-called academic understanding is nothing in front of their generations old practical knowledge stored in their senior members. From the pragmatic and empiricist medicine of 5000 BC, today medicine has put off the robe of ego for the ultimate benefit of mankind amidst profiteering groups. We have to use both individual clinical expertise and the best available evidence for the benefit of mankind. From the age old concept of ‘Doctor’ as ‘healer, preacher and teacher’, we have currently reached the era of evidence based medicine- ‘What is the evidence that what you have just advised, works’. Practicing evidence based medicine will identify and apply the most efficacious interventions with ideas and concepts to think positively to maximise the chances of individuals, groups and communities to attain and sustain, long happy and fulfilled lives. The empiricist traditional healers are truly practicing 'Evidenced Based Medicine' in their own limited way. We have to pass through painstaking process to help them learn how to improve.

American Journal of Public Health Research. 2015, 3(5A), 194-198. DOI: 10.12691/ajphr-3-5A-41
Pub. Date: October 27, 2015

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Motorcycle Accident Profile in Manipal Teaching Hospital

by Ranjeet Niraj, Krishna Sapkota, Pratyenta Raj Onta, Pabin Thapa, Upendra Junj Thapa, Prakash Dware and Sushil Sharma

Special Issue

This is a prospective descriptive study conducted at Manipal Teaching Hospital (MTH), where 140 patients seen at Emergency Room and OPD with a history of motorcycle accident from May 2015 to August 2015 were studied. Results showed that a high percentage of males 121 (86.4%) were involved in motorcycle accidents. Peak age range was 31-40 years old (61) (43.5%). Most of the motorcycles were manufactured in India (118) (84.2%). Single rider type of motorcycle accounted for 32(22.8%) of cases with a average speed of 50-70 km/hr (76.4%). The driver of the motorcycle was significantly involved in 106(75.7%) of cases. Alcohol intake was found in 40(28.6%) and non-license holder was 22 (15.7%) among accident victims. Abrasions 92(65.7%) was the predominant injury sustained followed by fractures 28(20%), lacerations 15(10.7%), and hematoma 10 (7.1%) in isolation or in combination. Combination of pain relievers128(91.4%), antibiotics 95(67.8%), suturing 18(12.8%), antitetanus 107(76.4%) and fracture management 21(15%) were the mode of management for these accidents. Most patients seen were discharged 116(82.8%) with home medications, wound care and follow-up, and only 24(17.2%) were admitted for observation and specific medical and surgical management.

American Journal of Public Health Research. 2015, 3(5A), 190-193. DOI: 10.12691/ajphr-3-5A-40
Pub. Date: October 27, 2015

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A Comparative Study of Ultrasound Guided Versus Blind Surgical Removal of Foreign Bodies in Western Nepal

by Prakash Sharma, Prasanna Ghimire, Amar Gurung, Chandra Bahadur Mishra, Subita Lalchan, Subash KC, Merina Gyawali and Prabhat Kumar Tiwari

Special Issue

Ultrasound is effective in localization and removal of foreign body. This study was done to evaluate the role of ultrasonography in localization of foreign body and to compare the ultrasound guided foreign body removal with that of conventional surgical exploration without ultrasound guidance. This prospective study was conducted between September 2013 and July 2015. Patients more than 14 years of age old with clinical suspicion of retained foreign body were included in our study. Ultrasonography was done using 7.5 to 10 MHZ probe in Sonoace X6 and Logiq P3 machines. After exact localization patients were randomly selected into two groups. In the first group, removal was done using ultrasonography guidance by a radiologist using a standard technique. In the second group, removal was done by referring surgeon. Statistical analysis was done using SPSS 18. Age of the patients ranged from 15 to 85 years with the mean age of 37.7±17.7 years. M: F ratio was 2.2:1. Most common location of retained foreign body was foot. Most common type of retained foreign body was wooden piece. Sensitivity of ultrasound in detection of retained foreign body was 96.8%. There was no statistical difference between the length of foreign body as measured by ultrasonography before removal and by scale after removal. Duration required for removal of foreign body under ultrasonography guidance was significantly less. Post-operative scar was smaller in patients with ultrasound guided removal. In conclusion, ultrasound has a sensitivity of 96.8% in localization of foreign body. Ultrasonography guided removal of foreign body reduces the operation time with reduction in the post-operative scar.

American Journal of Public Health Research. 2015, 3(5A), 186-189. DOI: 10.12691/ajphr-3-5A-39
Pub. Date: October 27, 2015

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Burden of Malaria and Health Service Utilization in a Tribal Community of West Bengal State, India

by Ayan Ghosh, Deblina Sarkar, Ranabir Pal and Bijoy Mukherjee

Special Issue

There is an urgent need for updating key socio-economic-cultural indictors and scientific understanding on Malaria for suitable control strategies among tribal populations. The study was conducted to find risk correlates of Malaria among tribal groups. A community based analytical cross-sectional study was done among tribals of a district of West Bengal in eastern India by interview technique using standardized tool. The study participants were predominantly males (81.50% %), between 45-60 years (65.87%),one in ten had no formal education; more than half of them were associated with agriculture. One fourth of the participants reported their source of knowledge on Malaria from Newspaper/ Radio/ TV while one fourths became knowledgeable while suffering from Malaria. Majority recognized mosquito bite as basic issue (71.63%), bite at night (96.64%), breed in stagnant water (79.57%). Yet, only one fourth correctly responded that mosquitoes, after biting a Malaria patient, can transmit the disease;. Half of them identified common malarial symptom of fever with shivering and indoor dark resting place of mosquitoes during daytime. Malaria is caused by Plasmodium parasite was correctly known to very few (1.44%). Regarding health seeking behaviour, 40.63% preferred hospital treatment; still disease condition was deciding factor to seek formal care by 95.67%; incidentally their expectation of treatment was limited to chloroquine (84.62). Bed nets was practiced as the commonest protective method followed by draining of stagnant water. Among users using bed nets only 85(70.83%) reported using Insecticide treated nets. The present study findings could provide baseline information to design effective and sustainable Malaria control strategies suited to local conditions in the near future as unsatisfactory knowledge about Malaria among the tribals is significant risk.

American Journal of Public Health Research. 2015, 3(5A), 182-185. DOI: 10.12691/ajphr-3-5A-38
Pub. Date: October 27, 2015

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Ultrasound Evaluation of Uterine Scar in Primary Caesarean Section: A Study of Single versus Double Layer Uterine Closure

by Pravin Shrestha, Smita Shrestha and Merina Gyawali

Special Issue

Caesarean section is one of the common surgical procedures to deliver baby done worldwide in obstetric practice. The aim of the study was to determine if technique of uterine closure had an effect on scar thickness measured by Ultrasonography at 6 week safter primary cesarean delivery. The Prospective study was done in department of Obstetrics and Gynecology, Manipal Teaching Hospital, Pokhara, Nepal. Fifty patients undergoing primary caesarean section were randomly assigned to one or double layer closure of lower uterine segment. Patients were followed up by ultrasonography at 6 weeks postpartum and uterine scar was measured. The mean scar thickness measured after 6 weeks by ultrasonography in single layer closure was 15.10 mm (Standard deviation 1.31) whereas it was 15.36 mm (Standard deviation 1.38) in double layer closure of uterus. There was no statistically significant difference in scar thickness after 6 weeks post partum period in single and double layer closure of lower uterine segment.

American Journal of Public Health Research. 2015, 3(5A), 178-181. DOI: 10.12691/ajphr-3-5A-37
Pub. Date: October 27, 2015

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Pediatric Modified Radical Mastoidectomy: Open Cavity versus Periosteal-Temporofascial Flap Obliteration: An Analysis

by Vishal Sharma, Krishna Prasad Koirala and Brijesh Sathian

Special Issue

Obliteration of the mastoid cavity leaves a smaller cavity with quicker as well as better healing. Chances of developing cavity granulations or infection are also reduced. Protection of the lateral semicircular canal by soft tissue obliteration also prevents vertigo episodes on exposure to cold air. This prospective study was to compare the results of pediatric modified radical mastoidectomy (MRM) in open mastoid cavities and cavities obliterated with periosteal-temporofascial swing flap at Manipal Teaching Hospital, Pokhara; a tertiary referral centre. The cohort comprised of 40 pediatric patients who underwent MRM between January 2012 and December 2014. They were divided into group 1 where mastoid cavity was kept open and group 2 where mastoid cavity was obliterated with periosteal-temporofascial swing flap plus medicated bone dust. Results in the 2 groups were assessed by comparing the time taken for mastoid cavity to become dry, incidence of vertigo on exposure to cold air, tympanic membrane graft status, mastoid cavity status and change in the pre-operative to post-operative pure tone average after 6 months. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) version 16.0. Statistical significance was set at p<0.05. Group 1 vs. Group 2 results were as follows: Mean time taken for mastoid cavity to dry was 81.8 days vs. 30.1 days. Vertigo on exposure to cold air was present in 77.3% vs. 0%. Tympanic membrane graft status was intact in 72.7% vs. 100%. Mastoid cavity epithelialization was complete in 68.2% vs. 94.4%. Mastoid cavity granulations were present in 36.4% vs. 5.6%. Mastoid cavity healing rates were 63.6% vs. 94.4%. Residual cholesteatoma was seen in 4.5% vs. 0%. Excessive wax & keratin debris was present in 36.4% vs. 5.6%. External auditory canal opening was adequate in 86.4% vs. 94.4%. The mean post-operative pure tone average was 37.61 dB vs. 25.97 dB. Mean gain in pure tone average was 8.94 dB vs. 19.84 dB. None of the patients developed intra-cranial complications. Periosteal-temporofascial swing flap plus medicated bone dust obliteration of pediatric MRM cavity provides a dry and healed cavity in less time with better hearing when compared to an open MRM cavity.

American Journal of Public Health Research. 2015, 3(5A), 174-177. DOI: 10.12691/ajphr-3-5A-36
Pub. Date: October 27, 2015

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Value and Price of Teaching-Learning Aids in Curricular Health Trainings in India

by Pushpa Potaliya, Ranabir Pal and Surajit Ghatak

Special Issue

Background: Teaching-learning (T-L) aids are being used for long time in medical education. With the technology and electronic revolution newer medical education aids are increasingly being applied that needs evaluation. Objective: To assess the overall impact of audio-visual aids in teaching-learning of medical students in India. Methods: Literature search for data sources were done through an extensive search in indexed literature and website based educational research reports. Altogether 92 studies were identified from 300 potentially pertinent articles. A broad criterion to define both physical instruments and educational instruments has been used for searching the comments. Moreover, we have utilized personal resources and from individual collections. Results: Outcomes of use of teaching-learning aids in undergraduate medical education varied largely with conventional and innovative methods, with few studies using different parameters and learning (unspecified) aids, innovative technology, and amalgamation of them. The researchers noted that in general the learning experience was not significantly dependent on the aids used during sharing knowledge and expertise, though some of the studies showed marginal and tangential benefits while the capacity of the facilitator matters most. Conclusions: In the last place it is the man behind the machine that imparts communication in health care scenario.

American Journal of Public Health Research. 2015, 3(5A), 160-173. DOI: 10.12691/ajphr-3-5A-35
Pub. Date: October 27, 2015

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Management of Acute Pancreatitis with Search for Reliable Prognostic Indicators

by N K Hazra, O B Karki, B Sathian, Abhijit De, Samikshya Ghimire, Rajan Sharma, Rajiv Nakarmi and Aman Juneja

Special Issue

Acute pancreatitis is quite common in Nepal. It afflicts male, female, adolescent and old equally. With advent of newer diagnostic tool, medical knowledge, and health awareness the thrust is on controlling the morbidity and mortality, hence search for reliable prognostic indicators. The prospective study was taken up to find out the reliable prognostic indicators from the clinical, biochemical and radiological parameters amongst the patients of acute pancreatitis with a view to optimize treatment protocol. A Cohort of 402 cases treated at Manipal Teaching Hospital from January 2006 to September 2015 were followed up. Age, sex, clinical findings were recorded. Serum amylase, LDH, Total Leucocytes Count (TLC), complete blood count (CBC), blood sugar, serum calcium, pO2, X-ray abdomen (AXR), X-ray chest (CXR), ultra sonogram (USG), and computed tomography (CT) scans were analyzed. Treatment protocol was formulated. Patient’s age ranged from 7–89 years (mean age 48 years; males were 189(47.014%), female 213(52.985%) with M:F ratio1:1.12. Precipitating causes were alcohol 116(28.855%), gall stone 78(19.402%), idiopathic 196(48.756%), mumps 6, ascariasis 4, trauma 1, postoperative 1 (Caesarian). Clinical findings were, pain in the epigastrium radiating to back in 190(47.263), pain abdomen without radiation in 212, (52.736%) vomiting in 186(46.268%) patients. Cullen’s sign was present in one, TLC was raised in 54(13.432%), serum amylase in 378(94.029%), LDH in 70.652% of cases, AXR was noncontributory, CXR showed pleural effusion in 10.778% of cases, USG abdomen done in 389 cases showed AP lesion in 241(61.93%). computed tomography (CT) and contrast enhanced computed tomography (CECT) done in 160 cases showed AP lesion in 159 (99.375%). CECT is probably the best diagnostic tool and indicator; complications encountered were renal failure in 4, ileus in 5, pseudo pancreatic cysts in 3, splenic vein thrombosis in one. Death occurred in 4 cases, Laparotomy was done in one. Diagnostic difficulty was experienced in 4 cases. Average hospital stay was 5 days (prolonged in cases those underwent cholecystectomy). Most of the cases being of mild form could be treated conservatively. Prophylactic antibiotic with cefuroxime was found to be useful. CECT probably is the best form of diagnostic tool as well as prognostic marker.

American Journal of Public Health Research. 2015, 3(5A), 156-159. DOI: 10.12691/ajphr-3-5A-34
Pub. Date: October 27, 2015

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A Study of Erythema Toxicum Neonatorum and Its Predisposing Factors

by Sahisnuta Basnet, Brijesh Sathian and Eva Gauchan

Special Issue

Erythema toxicum neonatorum is one of the commonest skin lesions observed in neonates. Despite this lesion being common, its etiology and predisposing factors remains elusive. This study was designed to evaluate various neonatal and maternal factors which predisposes to the development of erythema toxicum neonatorum. A cross-sectional case control study was conducted in Manipal Teaching Hospital, Pokhara, Nepal, where 200 newborns with erythema toxicum neonatorum and 200 newborns as controls were sampled for neonatal and maternal variables which may predispose to erythema toxicum neonatorum. Neonatal variables studied were: gender, birth weight, gestation, mode of delivery, whether the baby was born through meconium stained amniotic fluid and if the newborn had received a bath after delivery. Maternal variables studied were: parity, maternal smoking and history of atopy in the mother. Odds ratio and 95% confidence interval (CI) were used to calculate the odds and risks of developing erythema toxicum neonatorum. Higher odds of developing ETN was observed in neonates weighing more than 2500 grams [OR= 3.58; 95% CI (1.92; 6.67)], term gestation [OR= 4.03; 95% CI (1.94; 8.39)], and those neonates born through meconium stained amniotic fluid [OR= 6.882; 95% CI (1.53; 30.91)]. A number of studies have shown a significant relationship between normal birth weight and term neonates as predisposing factors in the development of erythema toxicum neonatorum. However, what our study adds is that there was a higher risk of acquiring erythema toxicum neonatorum in babies born through meconium stained amniotic fluid.

American Journal of Public Health Research. 2015, 3(5A), 152-155. DOI: 10.12691/ajphr-3-5A-33
Pub. Date: October 27, 2015

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Computed Tomography of the Brain in Adults with First Seizure

by Subita Lalchan, Manish Kiran Shrestha, Bishnu Jwarchan, Prakash Sharma, Subash K.C., Merina Gyawali and P.K. Tiwari

Special Issue

Seizure is frequently encountered in emergency department. Whether a neuroimaging should be done in every patient after a first seizure is controversial. Some study recommend imaging of brain usually with CT scan as a part of diagnostic investigation for every adult after a first seizure, while some prefer to reserve for patients with increased risk of intracranial pathology. This study has been undertaken to evaluate the role of routine CT scan of the brain in adult patients presenting with first episode of seizure in western development region of Nepal thus helping in management. This study also highlights the common CT abnormalities in patients presenting with seizure in western region of Nepal. This study was conducted in Radiology department of Manipal Teaching Hospital from August 2014 to June 2015. Patients of age > 16 years referred to our department for CT scan of head with history of first episode of seizure were included for study. Total 445 patients were included in study. Patients with history of previous seizure, head injury, electrolyte abnormalities, alcohol/drug intoxication were excluded from study. The mean age in our series was 33.75 years. There were 57.8 % males and 42.2 % were female. Focal seizure was seen in 54.8 % of patients whereas generalized seizure was seen in 45.2 % of patients. Abnormal CT scan was found in 60.7% of patients with first episode of seizure. CT scan was abnormal in 89.3 % of patients with focal seizure. Only 25.9 % of patients with generalized seizure had abnormal CT scan. Neurocysticercosis was the commonest abnormality detected on CT scan which was found in 36.85 % of patients. NCC was the commonest abnormality detected in younger population (46.1%) while infarct was common in older patients found in 21.3% of patients.

American Journal of Public Health Research. 2015, 3(5A), 148-151. DOI: 10.12691/ajphr-3-5A-32
Pub. Date: October 27, 2015

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Clinical and Histopathological Study of Struma Ovarii: A Rare Ovarian Tumor

by Dilasma Ghartimagar, Arnab Ghosh, Manish Kiran Shrestha, Sushma Thapa, Tilottama Prasad, Raghavan Narasimhan and O P Talwar

Special Issue

Struma ovarii or monodermal teratoma is a specialized ovarian neoplasm which mainly constitutes mature thyroid tissue. It is a rare tumor which comprises 1% of all ovarian tumors and 2.7% of all dermoid tumors. Thyroid tissue can be observed in 5-15% of dermoid tumors but to designate the tumor as struma ovarii, it must comprise more than 50% of the ovarian tissue. This study was conducted in the Department of Pathology, Manipal Teaching Hospital in Pokhara, Nepal over a period of 10 years (Jan 2006 to Sep 2015). Age, clinical findings, pre-operative imaging diagnosis, size and side of the tumor, gross and microscopic findings along with type of surgery performed are included in the study. During this 10 years period, there were 7 cases of struma ovarii with age ranging from 26 to 56 years. 3 cases had tumor on the right and 3 cases had tumor on the left side while 1 case had bilateral struma ovarii. Initial presenting symptom was palpable mass, abdominal pain and vaginal bleeding. The size of the tumor ranged from 4 to 15 cm. The capsule was smooth and cut surface shows multiloculated cyst filled with greenish to pale brown gelatinous thick fluid. Microscopic examination revealed well encapsulated tumor composed entirely of thyroid follicles. Diagnoses of struma ovarii were made in all cases. The preoperative imaging may not exactly give the diagnosis. Clinically, lesser age group was more affected and left side is more commonly involved in our series, in contrary to other literature. Out of 7 cases, bilateral struma ovarii was seen in 1 patient. No malignant features were seen in any of these cases.

American Journal of Public Health Research. 2015, 3(5A), 144-147. DOI: 10.12691/ajphr-3-5A-31
Pub. Date: October 27, 2015

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Prediction of Neonatal Outcome by Umbilical Artery Velocimetry in Intrauterine Growth Restriction: A Study in Western Nepal

by Merina Gyawali, Prakash Sharma, Subita Lalchan and Prabhat Kumar Tiwari

Special Issue

The introduction of Doppler velocimetry to obstetrics offered a noninvasive and safe imaging modality of indirectly assessing the fetal and uteroplacental circulation. Obstetric Doppler ultrasound plays an important role in detecting Intra Uterine Growth Restriction (IUGR). The early diagnosis of IUGR with the help of abnormal flow patterns in umbilical, uterine and middle cerebral arteries using Doppler ultrasound may help in reducing perinatal and neonatal mortality and morbidity as well as reducing perinatal complications. This provides for timely interventions to prevent progression from IUGR to Intrauterine death (IUD).The study was carried out in 140 patients in Manipal Teaching Hospital, Pokhara for a period of twenty months from October 2013 to June 2015. All the cases presented to Radiology department for obstetric Doppler with clinical suspicion of IUGR were taken up for the study and obstetric doppler of umbilical artery was performed. Seventy two out of 140 (51.50%) had abnormal umbilical artery Doppler velocimetry. Fifty seven out of these 72 subjects (positive predictive value – 79.2%) with abnormal umbilical artery Doppler were later born with small for gestational age (SGA). The S/D ratio of umbilical artery of 3 or greater was considered abnormal in predicting IUGR and it showed sensitivity, specificity, positive predictive value, and negative predictive value of 76%, 76.9%, 79.2% and 73.5% respectively. Admission to the Neonatal Intensive Care Unit (NICU) and incidence of perinatal and neonatal mortality increased with the worsening of Doppler velocimetry. Twenty seven out of one hundred and forty neonates developed perinatal asphyxia, out of which 26 (96.3%) had abnormal umbilical artery velocimetry. NICU admissions comprised of a total of 30 neonates, out of which 27(90%) had abnormal umbilical artery Doppler velocimetry prenatally. Fifteen out of thirty didn’t survive, all of whom had abnormal umbilical artery Doppler velocimetry prenatally. There were 3 still born and all of them had abnormal umbilical artery velocimetry prenatally. The study could underline that abnormal Doppler velocimetry has a fairly good sensitivity and specificity for predicting IUGR and it is related with poor neonatal outcomes.

American Journal of Public Health Research. 2015, 3(5A), 139-143. DOI: 10.12691/ajphr-3-5A-30
Pub. Date: October 27, 2015

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Maternal and Perinatal Outcome in Multifetal Pregnancy: A Study at a Teaching Hospital

by Mahendra Raj Pandey, Bikash Jang Kshetri and Deepak Dhakal

Special Issue

Multiple pregnancies are associated with adverse maternal and neonatal outcomes as compared to singleton pregnancy. This study was conducted to determine the maternal and perinatal outcomes in multifetal pregnancy at a teaching hospital in western region of Nepal. It was a prospective observational study. It was conducted in the department of obstetrics and gynecology, Manipal Teaching Hospital, Pokhara, from January 2012 to December 2014. This study included data on all women admitted between January 2012 to December 2014 with 28 completed weeks gestation having multifetal pregnancies in labor during the above mentioned period. The data was obtained from the hospital medical record department and the birth register. It included demographic details, complications of pregnancy and maternal and neonatal outcomes. The data was expressed as frequencies, percentages, and mean. There were a total of 144 multiple pregnancies who had delivered with the overall incidence of 1.9 per 1000 births during the study period. There were 5 triplet pregnancies among these. The main maternal adverse outcomes were preterm delivery (62.58%), anemia (8.6%), pregnancy induced hypertension (5%), and antepartum hemorrhage (2.2%). The mean gestational age at delivery was 34.6 weeks for twins and 33 weeks for triplets. The commonest mode of delivery was vaginal 54% of first twin and 52% of second twins whereas 3 triplets delivered by caesarean section and two delivered vaginally. The most common neonatal complication was low birth weight. The most common cause of neonatal death was prematurity with neonatal sepsis. So it was concluded that multiple pregnancy have high maternal and neonatal complications, mainly preterm delivery that increases the risk of neonatal morbidity and mortality.

American Journal of Public Health Research. 2015, 3(5A), 135-138. DOI: 10.12691/ajphr-3-5A-29
Pub. Date: October 27, 2015

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Bridging Gaps in Revised National Tuberculosis Control Program at Bankura District, West Bengal State, India

by Tapas Kumar Roy, Gautam Sarker, Avishek Gupta, Shinjini Ghosh, Debabrata Sarbapalli and Ranabir Pal

Special Issue

Background: Tuberculosis distresses economically productive age groups and emerged as a noteworthy reason of global burden. Objectives: The study was undertaken to find the gaps at the level of patients, or health providers in implementing RNTCP and also find out the reasons therein. Methods: This study was carried out among all patients enrolled as pulmonary tuberculosis cases in DOTs register of Tuberculosis Unit (TU) of a tertiary care teaching institute in eastern India in the third quarter of the year 2011. Results: Majority of cases (56.61%) belonged to 35-54 years age group, male (75.47%), from rural areas (64.15%), literacy up to primary (47.18%). Sputum was examined in 75.47 percent cases within 2-3 weeks after onset of cough and 89.62 percent were found sputum positive. DOTs providers completed initial home visit up to 70.75 percent cases; 71.70 percent initiated treatment within seven days after diagnosis. Initial defaulter was in 28.30 percent of cases; Literacy status showed significant difference in timing of diagnosis, initiation of treatment. Significance of difference with and without BPL Card was noted in delay of diagnosis and initiation of treatment. Literacy status was significantly associated with both timing of diagnosis and initiation of treatment. Socio economic status was also found significantly associated with delay in diagnosis and initiation of treatment. First contact with unqualified local practitioner with delay in advising sputum examination in Government health facility, long distances from facility, non-availability of drugs and staffs with refusal to supply drug, inconvenient timing of clinic, fear from social stigma and fear of side effects of drugs with long duration of treatment were cited as negative issues in treatment. Conclusion: Initiation and continuation of treatment of TB is related with socio-demographic correlates that needs counselling & motivation for early intervention.

American Journal of Public Health Research. 2015, 3(5A), 130-134. DOI: 10.12691/ajphr-3-5A-28
Pub. Date: October 27, 2015

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Utilization of Safe Motherhood Services in Jhorahat PHC Area of Morang District, Nepal

by Rimu Mishra, Nitendra Chaurasia and Asis De

Special Issue

It is difficult to predict which woman will develop pregnancy-related complications, but all pregnant women should have access to high quality obstetric care throughout their pregnancies. Non-utilization of antenatal and delivery care services and poor socioeconomic conditions of the patient usually is linked with maternal complications and poor perinatal outcome. Undesired outcomes are seen in unbooked than booked patients. Maternal mortality as a health indicator reveals the wide variations between rich and poor, urban and rural areas, within communities and between countries. The objective of the study was to study utilization and factors influencing the utilization of antenatal, intranatal and postnatal health care services by mothers. Community based cross sectional study was carried out from May 2013 to April 2014 in Jhorahat PHC area of Morang District. All pregnant women who had delivered during the one year period from May 2013 to April 2014 were included in the study. Out of 379 mothers majority (82.1%) were of age between 20 to 30years. Majority belonged to middle socioeconomic status family and were multiparous. Seventy percent of mother had completed all four antenatal visits. All mothers had taken TT injections, but only 62.3% completed full two dosage of TT vaccination. Majority (67%) of mothers had institutional delivery and most of the deliveries (70%) were conducted by skilled health personnel. Only 44.6% of mothers had done three postnatal visits.

American Journal of Public Health Research. 2015, 3(5A), 123-129. DOI: 10.12691/ajphr-3-5A-27
Pub. Date: October 27, 2015

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Clinico-radiological Spectrum of Patients Presenting with Cerebral Venous Thrombosis in Western Nepal

by Prakash Sharma, Prasanna Ghimire, Elina Shrestha, Subita Lalchan, Subash KC, Merina Gyawali, Mahesh Pathak, Prabhat Kumar Tiwari and Amit Shresha

Special Issue

Cerebral venous thrombosis is a rare condition characterized by occlusion of venous channels in the brain. It includes thrombosis of dural venous sinus, cortical vein and deep cerebral vein. It is often underdiagnosed because of nonspecific signs and symptoms. Imaging plays an important role in its diagnosis. Present study was done to evaluate the clinical presentation, predisposing conditions, MR venography findings and outcome of patients with cerebral venous thrombosis in western region of Nepal. Fourteen patients who were diagnosed as cerebral venous thrombosis between August 2013 and August 2015 were included in the study. Of the 14 patients, 8 were female with female to male ratio of 1.2:1. Mean age of the patients was 36.7 ± 18.3 years. Most of the patients were in the age group 21 to 40. Headache, nausea and vomiting were the commonest presenting symptoms. Mean Glasgow Coma Scale (GCS) during presentation was 14. Infection which may be local or systemic was the most common risk factor (28.4%). Parenchymal abnormalities were seen in 85.71% of the patients. Two or more sinuses were involved in 7 patients (50%) of which transverse and superior sagittal sinus were more frequently involved. There was 14% mortality, which was higher for deep cerebral vein thrombosis. In conclusion, cerebral venous thrombosis is a rare condition with varying presentations and imaging findings.

American Journal of Public Health Research. 2015, 3(5A), 119-122. DOI: 10.12691/ajphr-3-5A-26
Pub. Date: October 27, 2015

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SIGN Nail Experience in Manipal Teaching Hospital

by Ranjeet N, Sapkota K, Onta P, Thapa P, Thapa UJ and Gupta MK

Special Issue

Fifty-two patients who underwent intramedullary nailing of long bone fractures using the SIGN nail at the Department of Orthopedics, Manipal Teaching Hospital from July 2010 to July 2014 were reviewed. Healing of the fracture, incidence of post-operative complications, implant failures, weight bearing capability were described and analyzed based on the medical records and official website of SIGN. Demographic of patients, fracture configuration, size of nail and screws used, the pre and post-operative radiographs were also reviewed. Post operatively with a mean follow-up of 6 months, 46.1% of the patients had beginning callus, 40.4% of the patients were already healed, 3.8% had infection and outcome was undetermined in 9.7%. No implant failure was noted in this study.

American Journal of Public Health Research. 2015, 3(5A), 115-118. DOI: 10.12691/ajphr-3-5A-25
Pub. Date: October 27, 2015

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Efficacy Analysis of Denture Cleansing Chemicals on Microbial Flora – An in vitro Study

by Nirjalla Malla, B. Dhanasekar and I.N. Aparna

Special Issue

It is of paramount importance to maintain denture hygiene in denture wearers. It is important to know the effectiveness of denture cleaning chemicals in the elimination of known pathogenic microorganisms and efficacy of each chemical in reduction of known microbial flora. The test group commenced by placing 20 samples of sterilized acrylic resin blocks into the (BHI) broth inoculated with Staphylococcus aureus standard strain. After incubation, 5 samples of acrylic blocks were transferred from broth to 5 different test tubes containing solution ‘A’. Similarly 5 samples to solution ‘B’ and 5 to solutions ‘C’. All the test samples present in solution ‘A’, ‘B’ and ‘C’ after 7 hours were individually used to make the primary inoculums onto the agar plate. Remaining 5 samples present in the BHI broth which would serve as the control were directly used to make the primary inoculums onto the BHI agar plate. Staphylococcus aureus colonies were counted from BHI agar plates once the desired incubation period was achieved. In case of Candida albicans, 20 samples of sterilized acrylic blocks were immersed into the BHI Broth inoculated with Candida albicans of standard strain. After incubation, similarly 5 samples of each were immersed in test tubes containing solution ‘A’, ‘B’ and solution ‘C’. After completion all the test samples were individually used to make the primary inoculums onto the Sabouraud dextrose agar plate. Remaining 5 samples which will serve as control were directly used to make the primary inoculums into the Sabouraud dextrose agar plate. The fungal colonies were counted both in treated acrylic blocks and untreated acrylic blocks using colony counter unit once the desired incubation period was achieved. All the reading obtained from both the groups were statistically analyzed and it was concluded that ‘A’ denture cleansing agent brought about a reduction in the Staphylococcus aureus as well as Candida albicans to the highest degree as compared to `B’ and `C’. However there was no significant difference in the reduction brought about by ’B’ and ’C’. Nonetheless, `B’ proved to be better than ‘C’ in bringing about a reduction in Candida colonies which also proved to be statistically significant. It is important for every dentist to inspire and educate their patient and more essentially to offer various means and methods of plaque control.

American Journal of Public Health Research. 2015, 3(5A), 109-114. DOI: 10.12691/ajphr-3-5A-24
Pub. Date: October 27, 2015

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Fetal Outcome in Isolated Oligohydraminos: A Prospective Study

by Sangeeta Devi Gurung, Junu Shrestha and Aashika Shrestha

Special Issue

Amniotic Fluid is essential for the growth and development of the growing fetus. It is maximum at around thirty seven weeks of pregnancy and then gradually decreases. Decrease in the amniotic fluid is associated with maternal obstetric complication like PIH, IUGR and increases the risk of fetal morbidity and mortality. This is a prospective study carried out in the department of obstetrics and gynecology at Manipal Teaching Hospital, Pokhara, Nepal. Sixty women with isolated oligohydraminos beyond 34 weeks of gestation were included in the study. In this study, meconium stained liquor, non reassuring heart rate and the rate of cesarean section was observed to be high in isolated oligohydraminos but however, there was no NICU admission and neonatal mortality in this study.

American Journal of Public Health Research. 2015, 3(5A), 105-108. DOI: 10.12691/ajphr-3-5A-23
Pub. Date: October 27, 2015

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Qualitative Health Research: Outlining Basics

by Neeti Rustagi and Ranabir Pal

Special Issue

Measures to mitigate disease related burden are ever more focused on modifying behavior, attitudes and practices since childhood. Qualitative health research creates a window of opportunity to obtain highly valid information, enabling experts to customize care-seekers and patient centered approaches. Understanding basics of Qualitative health research is thus essential for all clinicians and public health specialists to plan and implement effective intervention.

American Journal of Public Health Research. 2015, 3(5A), 102-104. DOI: 10.12691/ajphr-3-5A-22
Pub. Date: October 27, 2015

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Dyselectrolytemia and Leucocytosis in Traumatic Brain Injury Patients

by BalGopal Karmacharya, Sarthak Nepal, Madhav Acharya, Silpa Sharma and Pranita Neupane

Special Issue

Traumatic brain injuries are common. These constitute an important cause of morbidity and mortality in people of all age groups. Electrolyte disturbance and leucocytosis are commonly seen in patients with traumatic brain injuries. This study was done to find out the frequency of electrolyte disturbances and leucocytosis in patients with traumatic brain injuries. This was a descriptive study of all patients who were brought to the emergency room of Manipal Teaching Hospital. Demographic parameters, cause of injury, CT scan findings, severity of injury were noted in a proforma. Serum sodium and potassium level and total count was measured in blood samples taken from all patients in the emergency. There were 85 patients included in the study. Abnormal sodium level was found in 36.5% and abnormal potassium level was found in 10.6%. Similarly almost two thirds of patients had leucocytosis. Electrolyte disturbances should be measured and meticulously treated in patients with traumatic brain injuries.

American Journal of Public Health Research. 2015, 3(5A), 99-101. DOI: 10.12691/ajphr-3-5A-21
Pub. Date: October 27, 2015

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Role of Mammography Combined with Ultrasonography in Evaluation of Breast Lump

by Subita Lalchan, Madan Thapa, Prakash Sharma, Sumiran Shrestha, Subash K.C., Mahesh Pathak, Merina Gyawali and P.K. Tiwari

Special Issue

Breast cancer is one of the major health problems in the world. Specially, in developing countries like ours, it is a major problem as patients present late in hospital. Hence, early diagnosis is important to reduce morbidity and mortality due to breast cancer. Mammography and Ultrasonography are two important imaging techniques to detect breast pathology. This study has been done to evaluate the role of mammography independently and mammography combined with Ultrasonography to diagnose breast lesions. This study was a prospective study conducted in Radiology department of Manipal Teaching Hospital for a period of 18 months. Total of 91 patients of more than 30 years presenting with breast lump were included in study. Mammography was performed in all cases followed by Ultrasonography. Findings were noted according to Breast Imaging Reporting and Data System (BIRADS). FNAC was done for all lumps with or without USG guidance and correlated with imaging findings. Mean age is our study was 44 +/- 7.6 years. Maximum number of patients presenting with breast lump was in the age group of 41-50 years (52.7 %). Benign lump was seen in 74.7 % of patients and malignant lump was seen in 25.3 % of patients. Sensitivity and specificity of mammography in differentiating benign from malignant lesions were 90.9 % and 92.7 % respectively. Mammogram was inconclusive in 15.4 % of patients of age group less than 50 years. Sensitivity and specificity of mammography combined with USG increased to 95.65 % and 95.58 % respectively. Combined USG and mammography has high sensitivity and specificity in diagnosing breast lesions. Hence, these two imaging modalities should be combined for evaluating breast pathology, especially in younger patients with dense breast.

American Journal of Public Health Research. 2015, 3(5A), 95-98. DOI: 10.12691/ajphr-3-5A-20
Pub. Date: October 27, 2015

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The Influence of Diabetes Mellitus on Lenticular Thickness

by Shristi Shrestha and Khem Raj Kaini

Special Issue

The prevalence of diabetes is increasing exponentially often causing an enormous public health burden. A hospital based observational study was undertaken and 144 type I diabetic subjects with equal number of non-diabetic controls were enrolled. The mean lens thickness, duration, fasting blood sugar, post prandial blood sugar and glycated hemoglobin were assessed. The crystalline lens was thicker in the diabetic group (4.33±0.38 mm vs 4.05±0.55 mm) which was statistically significant (p<0.001). There was a significant correlation between lens thickness and age (p<0.001, r=0.651) and between lens thickness and duration of diabetes (p<0.001, r=0.468). However, HBA1c and blood sugar levels had no significant influence on lenticular thickness.

American Journal of Public Health Research. 2015, 3(5A), 91-94. DOI: 10.12691/ajphr-3-5A-19
Pub. Date: October 27, 2015

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Absence of Palmaris Longus: A Study in Eastern Nepal

by Ranjib Jha, Yogendra Gupta and Rimu Mishra

Special Issue

The Palmaris longus is one of the most variable muscles in the body which flexes the wrist and tenses the palmar fascia. It is used as a source of tendon graft. It has been seen that there is association between prevalence of Palmaris longus with race, sex and body side. The prospective study was conducted during May- June 2015 to determine the incidence of the absence of the Palmaris longus in Nepalese population in the Eastern Region using three common clinical tests among patients attending OPD of Nobel Medical College and Hospital, Biratnagar, Nepal. The overall incidence of absence was 11.8% with bilateral absence at 3.5% and unilateral absence at 8.2%. The overall difference between dominant and non-dominant and males and females was statistically significant (p < 0.05). The study findings are similar with most studies done in the Asian population. The incidence of absence of Palmaris longus was more in non dominant hand. One of the explanation in favor of above findings is that the dominant hand is more involved in manual activities and hence less likely to degenerate due to disuse as compared to the non dominant hand.

American Journal of Public Health Research. 2015, 3(5A), 88-90. DOI: 10.12691/ajphr-3-5A-18
Pub. Date: October 27, 2015

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Time Trend of the Suicide Incidence in India; a Statistical Modelling

by Brijesh Sathian, Asis De, Edwin van Teijlingen, Padam Simkhada, Indrajit Banerjee, Bedanta Roy, HS Supram, Suresh Devkota and Rajesh E

Special Issue

Background: It is estimated that over 100,000 people die by suicide in India every year. India alone contributes to more than 10% of suicides in the world. The suicide rate in India has been increasing steadily and has reached 11.2 (per 100,000 of population) in 2011 registering 78% increase over the value of 1980 (6.3). Objective: Objective of the study was to forecasts the suicide incidence of India up to 2020. Material and Methods: Theoretical statistics was used for the statistical modelling of the retrospective data of suicide incidence data of 1989-2011 years collected from National Crime Records Bureau (NCRB). Results: Using curve fitting method, Linear, Logarithmic, Inverse, Quadratic, Cubic, Compound, Power and Exponential growth models were validated. Cubic Model was the best fitted model with R2>0.90, p<0.01. Suicide incidence of India has an increasing trend. In 2020, it is estimated that the suicide incidence of India will be 109814 with CI [ 86593, 133034] for male, 76224 with CI [55151, 97297] for female and 186038 with CI [145605, 226471] for total[both male and female]. Conclusion: Suicide incidence of India has an increasing trend. India requires the involvement of all governments and other organizations to contribute to the cause of suicide awareness and prevention through activities, events, conferences and campaigns to solve this public health problem.

American Journal of Public Health Research. 2015, 3(5A), 80-87. DOI: 10.12691/ajphr-3-5A-17
Pub. Date: October 27, 2015

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Factors Influencing Infant Feeding Choices of HIV Positive Mothers in Southwestern, Nigeria

by Usman Aishat, Fawole Olufunmilayo, Dairo David and Saheed Gidado

Special Issue

Breastfeeding is a socio-culturally acceptable, universal way of feeding infant during the first year of life and a key determinant of child survival and development. Semi-structured interviewer-administered questionnaire was used in the cross-sectional survey to obtain data from 600 HIV positive mothers to assess practices regarding infant feeding choices and factors influencing these choice(s) by mothers enrolled in Prevention of Mother -to -Child Transmission (PMTCT) of HIV clinics in Oyo State, Southwestern, Nigeria. Majority of the mothers (86.0%) was married and aged 31.0 ± 5.7 years. Slightly above half (53.0%) had ≤ 2 children and more than two-third had disclosed their HIV status to their spouses. About two-third (61.0%) were traders with 75.0% earning monthly income ≤ ₦18,000.00k. Half of the mothers had ≥ 3 antenatal care visits and 85.0% had infant feeding counselling. Infant feeding choices among the mothers were Exclusive Breast Feeding (EBF) (61.0%), Exclusive Replacement Feeding (ERF) (26.0%) and Mixed Feeding (MF) (13.0%). The choice of EBF, ERF and MF were influenced by fear of stigmatisation (55.0%), disclosure of HIV status to spouse (67.0%) and neighbours’ advice (66.0%) respectively. Predictors of EBF were; monthly income [AOR = 2.6, C.I. =1.45-4.59], infant feeding counselling [AOR = 2.7, C.I. = 1.62-6.94)] and fear of stigmatisation [AOR = 7. 2, C.I. = 2.11-23.60]. Predictors of ERF were; being a civil servant [AOR = 5.7, C.I. = 2.51-16.42], desire to reduce the risk of transmission of HIV [AOR = 2.5, C.I. =1.03-11.83] and disclosure of HIV status to spouses [AOR=5.0, C.I. =3.81-23.01]. Predictors of MF were; parity < 3 [AOR = 3.4, C.I. =1.72-6.96], receiving neighbours’ advice [AOR = 4.6, C.I. = 3.72-56.21] and infant illness [AOR = 6.8, C.I. = 4.0 -35.10]. Although a high proportion of mothers practiced exclusive breastfeeding for fear of stigmatization, mixed feeding is still being practiced due to neighbours’ advice. Family members’ education on safer infant feeding practices and behavioural change programmes in the context of HIV is advocated.

American Journal of Public Health Research. 2015, 3(5A), 72-79. DOI: 10.12691/ajphr-3-5A-16
Pub. Date: October 27, 2015

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A Self Care Management Awareness Study among Diabetes Mellitus Patients in Rural Nepal

by Nitendra Chaurasia, Rimu Mishra, Huang Ling, Bijay Thapa, Ava Pokhrel, Surendra Kumar and Asis De

Special Issue

Diabetes has emerged as one of the world’s biggest health problem. Diabetes is traditionally known as a ‘‘silent disease,’’ exhibiting no symptoms until progression to target organ damage. Diabetes self-care is suboptimal across a continuum from home based activities example as healthy eating, exercise and medication adherence to use of preventive care. There is a need for assessment of patient’s knowledge regarding diabetes, its complications and self care which has a significant benefit with regard to patient’s compliance to the treatment and in decreasing complications associated with disease and its consequences. The study was conductedto know self care management of diabetes mellitus among diabetic patients from a cohort of 192 diabetic patients picked up by convenience sampling technique. Data were collected, by administering a structured validated questionnaire, during March 2014 during community diagnosis program. Out of 192 patients (aged ≥ 18 years), mean score of knowledge of self care was 5.406 ± 1.709. Among them, 61 (31.77%) had poor knowledge, 110 (57.29%) had average score and 21(10.93%) had good knowledge of diabetes mellitus. Most of diabetic patients knew that self care can decrease the complications. The most of them practiced self care (hand and foot care, physical activity, general health check up) but were irregular in day to day practices. More than two third subjects had uncontrolled blood sugar level.

American Journal of Public Health Research. 2015, 3(5A), 67-71. DOI: 10.12691/ajphr-3-5A-15
Pub. Date: October 27, 2015

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Burden of Skin Diseases in Western Nepal: A Hospital Based Study

by Binamra Basnet, Saraswoti Neupane, Shristi Shrestha and Sujan Gautam

Special Issue

There is a substantial lack of data regarding the actual burden of skin diseases in Nepal. Skin diseases often account for a significant number of hospital visits specially in the rural areas of Nepal. 20-30% of the general population is affected by skin disorders at any given time. A hospital based retrospective study reviewed the medical data over a period of one year (June 2014 to May 2015). A total number of 6009 patients presented to the Department of Dermatology which accounted for 6% of the total hospital patients. There was almost equal number of males (51%) & females (49%). Cutaneous infections and dermatitis alone was responsible for more than 50% of the cases (cutaneous infection-34% & dermatitis-20%) whereas pigmentary disorders, including melasma contributed to only 6% of the cases. The occurrence of skin disease did not have significant correlation with socioeconomic class & personal hygiene (p-value>0.05). Conclusively, we need to focus more towards controlling infectious skin diseases.

American Journal of Public Health Research. 2015, 3(5A), 64-66. DOI: 10.12691/ajphr-3-5A-14
Pub. Date: October 27, 2015

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Efficacy of Gabapentin in Neuropathic Pain: A Study at Nobel Medical College and Teaching Hospital, Nepal

by Prem K. Gupta, B.D. Paranjape, Anjali Deka, Ranjib K. Jha and Raju Poudel

Special Issue

Pain is a common symptom in many diseases. Neuropathic pain is produced by damage to or pathological changes in the peripheral or central nervous systems. Since most neuropathic pain respond poorly to NSAIDSs and opioid analgesics, newer anticonvulsant drug, ‘Gabapentin’ having neuromodulatory effect on pain perception mechanisms, has shown promising effects in alleviating such pain. To have an idea of the analgesic efficacy of gabapentin in relieving neuropathic pain, this hospital based observational prospective study was taken up for six months at Nobel Medical College and Teaching Hospital, Biratnagar in the Department of Orthopedics. 100 patients with neuropathic pain were monitored daily for the severity of pain and quality of sleep for 1 week using Visual Analog scale (VAS) and Sleep Quality Scale. The mean baseline pain score on Visual Analog Scale (VAS) for all cases on day 1 was 62.8±13.4mm while it was reduced to 34.8±11.9 mm (p<0.001) on day 7. Similarly, the mean baseline Sleep interference score on Sleep Quality Scale for all cases on day 1 was 3.04 ± 1.77 while on day 7 the score was reduced to 1.92 ± 0.39 (p<0.001). Overall, the mean pain reduction in neuropathic pain was 44.58%, and the mean reduction in sleep interference was 36.84%. The study showed that gabapentin had significant analgesic efficacy in reduction in neuropathic pain with few adverse effects like dizziness and somnolence (drowsiness).

American Journal of Public Health Research. 2015, 3(5A), 57-63. DOI: 10.12691/ajphr-3-5A-13
Pub. Date: October 27, 2015

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Acute Intestinal Obstruction in Children: Experience in a Tertiary Care Hospital

by N K Hazra, Om Bahadur Karki, Hemant Batajoo, Niraj Thapa, Doledra Rijal and Abhijit De

Special Issue

Acute Intestinal Obstruction is one of the commonest surgical emergencies in children. These cases are invariably operated upon by general surgeons as pediatric surgeons are very few in Nepal. Outcome to a great extent depends on prompt clinical diagnosis and treatment. This is prospective study of 51 cases of intestinal obstruction admitted, operated and treated at Manipal Teaching Hospital, a tertiary care hospital in the Western Region of Nepal from January 2011 to September 2015. Aim of the study was to observe the pattern of intestinal obstruction in children and the treatment outcome in the hands of general surgeons. Number of cases in the cohort was 51. Out of that 50 cases were operated upon and 1 case was managed conservatively. Age of the patients’ ranged from 1 day to15 years (median age 9 months); There were 33 males and 18 females with a ratio of 1.8:1. Causes of intestinal obstruction were Intussusceptions (33), Meckel’s diverticulum (6), obstructed /strangulated hernia(4), imperforate anus(2), Hirschprung’s disease(2), Meconium ileus (1), Ladd’s band with malrotation of mid gut (1),annular pancreas(1) and Adhesions (1) Base line investigations of CBC, BT, CT, PT and serum electrolytes were done in all the cases. Plain x-ray abdomen erect and supine, ultrasonography (USG) and computed tomography (CT) scan were done in most of the cases and. Contrast study using Diatrizoate Meglumine (Gastrografin) was done wherever necessary. There were 3 mortalities and 2 cases had postoperative complications. Average post operative Hospital stay was 6 days. Early diagnosis and surgical intervention gives favorable outcome, delay increases morbidity and mortality. All these cases were taken up by general surgeons and the results were encouraging and good.

American Journal of Public Health Research. 2015, 3(5A), 53-56. DOI: 10.12691/ajphr-3-5A-12
Pub. Date: October 27, 2015

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Meconium Aspiration Syndrome and Neonatal Outcome: A Prospective Study

by Eva Gauchan, Sahisnuta Basnet and Tejesh Malla

Special Issue

Meconium staining of amniotic fluid occurs in 10-15% deliveries and meconium aspiration syndrome occurs in 5% of those deliveries. Aspiration of meconium into the trachea results in various short and long term morbidities and variable mortality. These can be prevented by timely interventions before and after delivery. Aim of this study was to identify the neonatal factors associated with meconium aspiration syndrome and factors associated with mortality in these babies. The study included all babies admitted for meconium staining of amniotic fluid during the period of August 2013 till December 2014. Meconium aspiration syndrome was diagnosed if respiratory distress occurred immediately to within 24 hours after birth in a meconium stained baby, with radiological evidence of aspiration into the lungs and need for supplemental oxygen, after exclusion of other causes of respiratory distress. Data was analyzed by SPSS version 19 and presented as actual numbers and percentages. Associated factors were presented as Odds Ratio (OR) and 95% Confidence Interval. Chi-square test was done where applicable and a p-value <0.05 was taken as significant. Meconium aspiration syndrome was diagnosed in 50 out of 78 admitted newborns. Factors associated with meconium aspiration syndrome were respiratory distress starting immediately after birth, admission Downe score >4 and abnormal chest x-ray findings. Factors associated with mortality were small for gestational age newborns, 5 minute APGAR score <7, severe hypoxic ischemic encephalopathy, requirement for bag-mask ventilation and chest compression at birth and need for assisted ventilation. Neonatal morbidity and mortality in meconium aspiration syndrome is preventable by proper antenatal care and timely intervention after birth. Meconium-stained babies should be aggressively managed to prevent complications like perinatal asphyxia and respiratory failure which contribute to the mortality. Those babies having risk for adverse outcome should be managed with special focus on respiratory care with use of assisted ventilation and inhaled nitric oxide and extracorporeal membrane oxygenation, where available.

American Journal of Public Health Research. 2015, 3(5A), 48-52. DOI: 10.12691/ajphr-3-5A-11
Pub. Date: October 27, 2015

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Functional Endoscopic Sinus Surgery Comparisonin a Tertiary Care Hospital

by Vishal Sharma, Sarina Rajbhandari and Brijesh Sathian

Special Issue

Two of the commonest indications for FESS are chronic rhinosinusitis without polyps and chronic rhinosinusitis with ethmoid polyps. This prospective study was carried out in Manipal Teaching Hospital, Pokhara to compare the results of FESS for bilateral chronic rhinosinusitis with and without ethmoid polyps. The study comprised of a cohort of 104 patients with bilateral chronic rhinosinusitis who underwent FESS between January 2012 and December 2014. The patients were divided into group 1 (without ethmoid polyps) and group 2 (with ethmoid polyps). Results in the two groups were assessed by comparing the Lund-Kennedy nasal endoscopic grading scores and Sino Nasal Outcome Test (SNOT-22) scores. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) version 16.0. Statistical significance was set at p<0.05. The Lund-Mackay CT scan mean scores for group 1 and group 2 were 14.02 and 15.28 respectively before surgery (p = 0.11). Lund-Kennedy endoscopic score 3 months after FESS were much better in group 2 patients than in group 1(p<0.00001). After FESS, there was significant improvement in SNOT-22 scores in both groups. The SNOT-22 scores 3 months after FESS were much better in patients of group 2 than in patients of group 1(p<0.0001). The improvement in post-operative endoscopic grading and SNOT-22 scores wasmore in patients of chronic rhinosinusitis with ethmoid polyps than in patients without ethmoid polyps. There was no improvement in decreased sense of smell after FESS in most patients with ethmoid polyps.

American Journal of Public Health Research. 2015, 3(5A), 44-47. DOI: 10.12691/ajphr-3-5A-10
Pub. Date: October 27, 2015

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Oral Squamous Cell Carcinoma Pattern in Manipal Teaching Hospital, Nepal

by Ram Bhakta Adhikari, A. Karmacharya, N. Malla and M.B Gurung

Special Issue

Squamous cell Carcinoma of oral cavity is amongst the first ten commonest carcinoma in world. This article shows the squamous cell carcinoma of oral cavity reported in this hospital over a period of 3 years. This descriptive hospital based study consists of cases of oral squamous cell carcinoma of oral cavity presented at the Dentistry department of Manipal Teaching Hospital, Pokhara, Nepal from September 2012 to August 2015. All cases were clinically examined and provisionally diagnosed and histopathological examination done to confirm the diagnosis. There were 58 oral squamous cell carcinoma cases, 27 (46.6%) males and 31 (53.4%) females. The age of squamous cell carcinoma cases was above 40 years. The maximum number of squamous cell carcinomas (39.7%) affected tongue. The other common sites were buccal mucosa (13.8%) and alveolus (13.8%).Histological pattern of oral Squamous cell carcinoma shows 60.5% is well differentiated, 32.8% moderately differentiated and 6.9%is poorly differentiated oral squamous cell carcinoma. The results of this study shows females were more affected due lack of education and early access to medical attention. Tongue was the most affected site due to presence of sharp tooth edges.

American Journal of Public Health Research. 2015, 3(5A), 41-43. DOI: 10.12691/ajphr-3-5A-9
Pub. Date: October 27, 2015

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Pattern of Risk Status of Antenatal Cases in a Tertiary Care Hospital

by Asis De, Abhijit De, Aashika Shrestha, Brijesh Sathian, Arpana Sharma, Manash Debnath and Komal Thakur

Special Issue

Although pregnancy is a physiological process, it is not hassle free.Any normal pregnancy can turn anytime into a life threatening event despite all cares being taken. Maternal Mortality is still very high in many of the low resource countries compared to the developed countries. Available DATA suggests that in many countries MMR is still very high and not lowering even within a reasonably organized health care set up. In Nepal, Safe Motherhood Program was started during 1997 and some significant progress was made in health care infrastructure. But the millennium development goal (MDG 5) of 213 maternal deaths per 100,000 live births by 2015 is yet to be achieved. Present hospital based study was an attempt to identify antenatal cases with risk factors by using pre validated simple score card, to observe risk status of mothers during prenatal period and intrapartum period , link pattern of risk factors to have a base line data in Nepal. The study comprised of 2466 antenatal cases. out of them 726 were in high risk and 1740 at low risk group. both the groups received adequate antenatal care in the ANC clinic of Manipal Teaching Hospital. More risk factors were present in high risk group than low, bad obstetric history, mild anemia and poor weight gain during pregnancy were the common risk factors present. In the low risk group average risk factors per woman was 1.17 while the average was 2.56 in the high risk category. Out of 726( 29.44%) cases who were initially at high risk,529(70.91%) remained at high risk during intrapartum period whereas the remaining 197 (26.41%)were converted to low risk. Out of 1740(70.56%) initial low risk cases, 346(19.88%) developed complications later on thus subsequent risk status of 1923 (77.98%) was low and 543 (22.02%) high respectively. Prolonged labour (2.34%), Premature rupture of membrane (44.63%) and traumatic deliveries (1.52%) were more in high risk group. Interventions like induction of labour and artificial rupture of membrane were higher in high risk group. The study suggests that it is possible to identify at risk expectant mothers with a simple risk scoring system during antenatal period. Intervention in time can reduce the risk and will have an impact in reduction of maternal mortality rate.

American Journal of Public Health Research. 2015, 3(5A), 34-40. DOI: 10.12691/ajphr-3-5A-8
Pub. Date: October 27, 2015

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A Profile of Common Morbidities among Elderly Rural Indian Population

by Ayan Ghosh, Deblina Sarkar, Ranabir Pal and Bijoy Mukherjee

Special Issue

Understanding health problems among elderly and health-seeking behavior is prerequisite for proving comprehensive geriatric care to them. The study was undertaken to document the prevalence of common morbidities among elderly rural population A community based cross sectional study was conducted on the census population aged 60 years & above residing permanently in the rural field practice area of Katihar Medical College using predesigned and pretested questionnaire with clinical assessment of morbidity status assessed using criteria of primary care by WONCA International Classification Committee. Gastro intestinal was most common disorder which constituted 51.04 percent of total study population. Osteoarthritis was present in 49.65 percent of total study population. Cardiovascular problems were seen in 41.29 percent population. Total respiratory morbidity (ARI, Asthma, and COPD) was seen in 41 percent of total study population. Total neurological morbidity (Epilepsy, Hemiplegia & Parkinsonism) was found in only 2.5 percent of total study population. Non-specific Generalized weakness was found in 22.73 percent of population. Diabetes mellitus was recorded only in 9.51 percent of population. Majority of the study population were Independent according to the total scores obtained from instrument of Activities of Daily living (ADL), which is 91.18 percent of the total participant. Almost 9 percent elderly needs some assistance. The present study showed that Government health facility was the most frequent (54.06%) first place of contact for health care among elderly. Only 22.97 percent of population went to private physician. 7.88 percent visited AYUSH, 5.10 percent Quacks & 9.98 percent used self-medication. The present study identified a high prevalence of morbidities in elderly age. It also pointed out various socio-demographic, nutritional, and environmental modifiable risk factors which can be tackled by effective behavior change communication of the community supported models as practiced in the developed countries.

American Journal of Public Health Research. 2015, 3(5A), 29-33. DOI: 10.12691/ajphr-3-5A-7
Pub. Date: October 27, 2015

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Diagnostic Role of Ultrasonography in Acute Appendicitis: A Study at a Tertiary Care Hospital

by Subash K C, Abhijit De, Mahesh Pathak and Brijesh Sathian

Special Issue

Acute appendicitis is commonest cause of acute abdomen necessitating emergency abdominal surgery. Although diagnosis is still largely considered to be a clinical one, ultrasound is established as easily available, less time consuming and very accurate at timely diagnosis of acute appendicitis largely reducing complications as well as negative laparotomies. Due to development of high frequency transducers and better resolution, ultrasound is highly specific and sensitive in diagnosis of acute appendicitis. This study was done to establish the diagnostic role of ultrasound in acute appendicitis in western region of Nepal. Total number of 125 patients were included in the study from May 2013 to May 2015. Findings on ultrasound were finally compared with histopathological report of appendices removed on surgery. Those cases with alternate diagnosis were followed up and proved with other means of investigation. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of ultrasound in diagnosis of acute appendicitis in our study were found to be 95.12 %, 88.88 %, 97.5% , 80% and 82 % respectively.

American Journal of Public Health Research. 2015, 3(5A), 23-28. DOI: 10.12691/ajphr-3-5A-6
Pub. Date: October 27, 2015

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Maternal Near Missina Tertiary Care Teaching Hospital

by Junu Shrestha, Rami Shrestha, Ruhee Tuladhar, Sangeeta Gurung and Ashika Shrestha

Special Issue

Near miss maternal morbidity indicators compliment the mortality indicators in ascertaining the maternal health as well as the health care delivery status. This study was conducted with the aim to find out the maternal near miss indicators of our centre and to determine the causes and nature of the maternal near miss and deaths. All cases who met the WHO organ system dysfunction criteria based on clinical, laboratoryor management based criteria for maternal near miss were included in the study. This was a prospective observational study conducted for 24 months from September 2013 to August 2015. There were 7.7 maternal near misses per 1000 live births. The maternal mortality ratio was 76.7 per 1000 live births. Maternal near miss mortality ratio was 10 and mortality index was 9.1%. Hypertensive disorders (45%) and severe haemorrhages (30%) were the major contributors to maternal near miss. As for maternal deaths, 2 out of 4 occurred due to direct cause like hypertensive disorder and haemorrhage and the remaining 2 due to indirect causes.

American Journal of Public Health Research. 2015, 3(5A), 17-22. DOI: 10.12691/ajphr-3-5A-5
Pub. Date: October 27, 2015

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Simple Febrile Convulsion and Iron Deficiency Anemia A Co-relation in Nepalese Children

by Tejesh Malla, Kalpana K Malla, Brijesh Sathian, Prabha Chettri, Sandip Singh and Amrita Ghimire

Special Issue

Simple febrile convulsion is the most common central nervous system disease seen in children. There are hypotheses that thresh hold of neuron excitation maybe affected by iron deficiency anemia. This study was done to find out a co-relation between iron deficiency anemia and simple febrile convulsion. The prospective comparative study was conducted at Manipal Teaching Hospital, Pokhara, Nepal 162 children admitted in the pediatric ward were selected and divided into two groups, febrile convulsion (Cases) and other causes of fever with no convulsion (Control). Blood was sent for each child for complete blood count, peripheral smear blood indices and iron profile. Statistical analysis was done using SPSS version 19. A p value <0.05 was considered statistically significant. The patients and controls were 22.55 ±10.220 and 21.64±12.959 months of mean age, respectively. The peak of mean temperature on admission was in the febrile convulsion group than controls. (57/92) 61.95 % of cases and 15/70) 21.42% of controls anemic (P< 0.001). Moreover, the group with febrile convulsion had significantly lower blood indices, such as Hb, MCV, MCH, MCHC and RDW, compared to control group (P< 0.001).Iron deficiency anemia was significantly higher in cases compared to controls(p<0.001) Iron supplementation can probably increase the threshold of neuron excitation in fever and help prevent febrile convulsion in children.

American Journal of Public Health Research. 2015, 3(5A), 11-16. DOI: 10.12691/ajphr-3-5A-4
Pub. Date: October 27, 2015

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Additional Ulno-Radial Pinning for Prevention of Metaphyseal Collapse in Distal Radius Fracture: A Comparative Study

by Pratyenta Raj Onta, Pabin Thapa, Krishna Sapkota, Niraj Ranjeet and Manoj Prasad Gupta

Special Issue

Fracture distal radius is one of the common fractures encountered by an orthopedic surgeon. It accounts about 20% of cases. In 1814, Abrahim Colles first diagnosed the distal radius fracture and since then there are lots of debates in the management of the distal radius fracture. Till today the best treatment method for distal radius fracture is not known. Close reduction and plaster application is commonly done but has many complications. Close reduction and percutaneous pinning technique is widely accepted but one of the late complications of this technique is metaphyseal collapse. The study was done to check if additional ulno-radial pinning prevents metaphyseal collapse compared to simple two K wire fixation technique. There were total 30 patients in this study who had distal radius fracture. These patients were randomly divided into two groups. First group (Group A) patients were treated with simple two K wire technique and the next group (Group B) were given additional ulno-radial pin and their outcome were compared. The data was analyzed by using PASW version 16.0. Difference in radial height and ulnar variance of two groups at different time point were analyzed using independent sample T-test. p value <0.05 were considered statistically significant. In the study, the radial height was better preserved in Group B (who underwent additional ulno-radial pinning). The difference was statistically significant in 6 weeks and 3 months follow up. Additional ulno-radial pinning had better preservation of radial height compared to simple two K wire technique.

American Journal of Public Health Research. 2015, 3(5A), 6-10. DOI: 10.12691/ajphr-3-5A-3
Pub. Date: October 27, 2015

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Ocular Infestation by Leech

by Jamuna Gurung and Khem Raj Kaini

Special Issue

Background: To share our experiences with a patient of leech infestation. Case description: A 70 years male presented to outpatient department of ophthalmology, Manipal Teaching Hospital with complaints of foreign body sensation, itching and redness of left eye for the past 7 days. He gives history of washing his face in tap water which comes directly from the stream and he had symptoms after this incident. Clinical diagnosis was leech adherent to the bulbar conjunctiva near the limbus at 1 o’clock position. The leech was extracted and there was no obvious signs and symptoms except for mild subconjunctival hemorrhage. Conclusion: Ocular infestation by leech is a rare occurrence. However, this should be considered when patient give history of foreign body sensation, redness and discomfort following swimming or washing face in streams, lakes or ponds.

American Journal of Public Health Research. 2015, 3(5A), 4-5. DOI: 10.12691/ajphr-3-5A-2
Pub. Date: October 27, 2015

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Health Scenario 2015: Present Day Perspective

by Asis De

Special Issue

American Journal of Public Health Research. 2015, 3(5A), 1-3. DOI: 10.12691/ajphr-3-5A-1
Pub. Date: October 27, 2015

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Volume 3, Issue 5A