Antenatal to Postnatal: Assessing the Continuum of Maternal Health Service Utilization in Palpa, Nepal.

Introduction: One of the most prioritized programs of Government of Nepal is maternal health. Optimum utilization of maternal health services during pregnancy, delivery and post-natal period is an effective approache to reduce the maternal morbidity and mortality that helps us achieve the sustainable development goals target. This study aimed to assess the utilization of maternal health services including antenatal, intranatal and postnatal services among women in the Palpa district of Nepal. Methods: A descriptive cross-sectional study was conducted among 168 mothers in their reproductive age using a convenient sampling method. The study included those mothers who had a delivered a child in the past two years, in Palpa district. The data collection commenced from March to September 2023. The data analysis was conducted using Statistical Package for Social Sciences software (v 21.0). Results:  A remarkable finding in the present study was 88.1% of mothers had utilized a minimum of four antenatal check-ups, as recommended by the Government of Nepal. Out of 168 mothers included in the present study 89.9% had institutional delivery while the remainder had home delivery. Post-natal check-ups following delivery was surprisingly uncommon as it was observed that only 28% mothers sought such care. Adequate utilization of maternal health services is influenced by factors such as proximity of health facilities, education level, and knowledge of maternal incentives. Conclusion: While service utilization for pregnancy and delivery in Palpa district aligns with national standard, further research is needed to identify factors contributing to underutilization of postnatal services

Drug Utilization Pattern for Conjunctivitis in a Tertiary Care Hospital

Introduction:  Assessment of drug utilization pattern of conjunctivitis is an important activity that promotes the rationale use of drugs. Thus, the aim of the study is to understand the drug use pattern for conjunctivitis in a tertiary care hospital. Methods: A cross-sectional observational study was conducted in the out-patient department of Ophthalmology of Nobel Medical College Teaching Hospital from October 2021 to September 2022. Patients diagnosed with conjunctivitis irrespective of age and gender were included in the study. A structured proforma was designed that contained the demographic profile of participants, types of conjunctivitis and different drugs used in conjunctivitis. Data were expressed in frequency and percentage. Results: A total of 385 patients were enrolled in the study. Conjunctivitis was more common in male (55.8%). Viral conjunctivitis was the most common (49.8%). A total of 745 drugs were used. Average number of drugs per prescription was 1.9.  The most commonly prescribed drugs were topical antibiotics (40.9%) followed by tear drops (27.5%). Ciprofloxacin (36.1%) was the most commonly prescribed topical antibiotic. Conclusions: Topical antibiotics were commonly used in most cases of conjunctivitis. Among topical antibiotics, ciprofloxacin was commonly prescribed

Study of Neck Circumference as a New Anthropometric Indicator for Prediction of Diabetes Mellitus

Introduction: Overweight and obesity are the risk factors for metabolic syndrome. This study aimed to show that neck circumference is a simple tool to identify the overweight and obesity as a new anthropometric index and association with type 2 diabetes. Methods: This was a cross-sectional study with a total of 246 participants, 123 of whom had diabetes mellitus, and the same numbers were non-diabetics, adjusted for weight and height in both groups. Means with standard deviation were used for neck and waist circumferences, body mass index, and blood sugar, and the Pearson correlation test was applied to identify the association. A comparison of means was done by the student ‘t\u27 test in parametric data within the two groups. Results: The mean neck circumference, body mass index of diabetes and non-diabetes participants were 38.0±3.0 cm, 28.5±2.6 and 36.6±3.2 kg/m2, 27.4±3.1 kg/m2 respectively. In diabetic patients, mean neck and waist circumference, blood sugar were higher than in nondiabetic patients and was significantly correlated with body mass index (r=0.747, p<0.001), waist circumference (r=0.635, p<0.001), systolic and diastolic blood pressure (r=0.740, p<0.001 and r=0.619, p<0.001 respectively), fasting and post prandial blood sugar (r=0.275, p=0.002 and r=0.307, p<0.001respectively) and glycated hemoglobin (r=0.220, p=0.014, n=123). In nondiabetic patients, glycated hemoglobin was negatively correlated. Conclusion: This study suggested that neck circumference is a simple, reliable, and appropriate new anthropometric tool to evaluate obesity, overweight, and the risk of metabolic disorders.&nbsp

Prevalence of Abnormal PAP Smear in Pregnancy: A Hospital-Based Study in Western Nepal

Introduction: Cervical carcinoma is the third most common malignancy worldwide. The World Health Organization in 2014 reported the crude incidence rate of cervical cancer in Nepal as 24.2 per 100,000 women per year. This study was carried out with the aim of finding out the prevalence of cervical smear abnormality in pregnancy. Methods: An observational study was conducted in the department of Obstetrics and Gynecology of a tertiary center for a period of one year from May 2021 to April 2022. All pregnant women up to 28 weeks of gestation who had National Health Insurance coming for antenatal check-ups underwent PAP smear test. The cytological results were reported based on the Bethesda classification system 2001. Results: Of 200 pregnant women enrolled in the study, the Pap smear report revealed that 32% of the study subjects had inflammatory smear showing candidiasis and bacterial vaginosis with reactive inflammatory changes. However, 66.5% of the subjects showed negative for intraepithelial lesion or malignancy and only 0.5% of subjects had signs related to carcinoma cervix in which the subject had a low-grade squamous intraepithelial lesion.  No satisfactory sample was reported in 1% of the subjects. Conclusion: Pap smear during pregnancy not only gives the opportunity to screen but also helps to create awareness

Ocular Manifestations in Patients with Extrapulmonary Tuberculosis

Introduction :  The study was done to find out the ocular manifestation in patients with extrapulmonary tuberculosis visiting a tertiary eye centre. Methods: A hospital based descriptive observational study was done among newly diagnosed extrapulmonary tuberculosis cases after approval from the institutional review board. After a detailed ocular evaluation, findings including patient demographics, presenting complaints, best corrected visual acuity, colour vision, contrast sensitivity, Goldman visual field and Optical Coherence tomography Retinal nerve fibre layer analysis of the optic nerve head were recorded in a semi-structured proforma. Data were expressed in frequency and percentage. Results: Out of 50 eyes of 25 patients included in the study, the mean age was 26.92±14.2 years (11-73 years). Sixty four percent were female. Two cases had ocular findings at the time of diagnosis. One case of tuberculous lymphadenitis had phlyctenular conjunctivitis and one case of tubercular meningitis had diplopia with right lateral rectus muscle paresis secondary to raised intracranial pressure. All the patients had best corrected visual acuity better than 6/12 at presentation. Color vision was normal in 72% cases in both eyes. Goldman visual field done at presentation were normal in both eyes in 88% cases while retinal nerve fibre layer thickness and contrast sensitivity were normal in all cases. Conclusion: The prevalence of ocular findings in patients with extrapulmonary tuberculosis was 8% in this study. Ocular examination is important in cases with extrapulmonary tuberculosis since a significant number of cases have ocular findings

Peripheral Neuropathy and Foot Care Practices Among Patients with Diabetes Mellitus Attending a Tertiary Care Hospital: A Cross-sectional Study

Introduction: Peripheral neuropathy is the most common microvascular complication of diabetes mellitus. Foot care is an important part of diabetes management. This study aimed to identify the prevalence of peripheral neuropathy and foot care practices among diabetic patients. Methods: A descriptive cross-sectional study was conducted on 178 patients diagnosed with diabetes mellitus and attending out-patient and in-patient departments of Internal Medicine at Kathmandu University Hospital, Dhulikhel. The participants were conveniently selected. Face-to-face interviews and a foot examination were used to collect data. The Michigan Neuropathy Screening Instrument and the Nottingham Assessment of Functional Foot Care were used to determine the prevalence of peripheral neuropathy and to assess foot care practices. Results: The prevalence of peripheral neuropathy was 41% among the participants, and it was associated with increasing age. The majority (75.8%) of the participants had good foot care practices. Male gender was significantly associated with good foot care practices [AOR = 5.973, 95% CI (2.037-17.515)], whereas past smokers [AOR = 0.296, 95% CI (0.111-0.791)] and not receiving diabetes education [AOR = 0.367, 95% CI (0.151-0.892)] were significantly associated with poor foot care practices. Conclusion: The prevalence of peripheral neuropathy was found to be high, and it was linked to an increased age group. The majority of the participants had good foot care practices. However, in comparison, females were found less likely to practice foot care than males

Antihypertensive Drug Use Pattern in a Tertiary Care Hospital of Western Region of Nepal: A Cross-Sectional Study

Introduction: Assessing antihypertensive drug use pattern always plays an important role to mitigate the burden of hypertension and also helps doctors to prescribe the drugs rationally. This study was conducted to assess antihypertensive drug use pattern in a tertiary care hospital. Methods: An observational cross-sectional study was conducted in the Internal Medicine department of Lumbini Medical College and Teaching Hospital from July 2021 to December 2021 for the duration of five months after ethics approval. Hypertensive patients who were prescribed one or more antihypertensive drugs irrespective of age and gender were included. Socio-demographic profiles, clinical characteristics, and antihypertensive drug use-related data were collected. A convenience sampling technique was used. Categorical variables were expressed as frequency and percentage while continuous variables were reported as mean ± standard deviation. Results: A total of 224 patients were included. The average number of antihypertensive drugs per patient was 1.7 ± 0.8. Combination drug therapy (54.5%) was commonly used. Calcium channel blockers (Amlodipine) were commonly prescribed (66.5%). Moreover, 98.7% and 41.5% patients were prescribed drugs from Essential Drug List of Nepal (Revised 2016) and in Fixed Dose Combination respectively. Use of combination drug therapy was higher among male patients (p = 0.003) and patients with stage II hypertension (p < 0.001). Conclusion: Calcium channel blockers were commonly used as monotherapy and in combination therapy as well. In approximately all of the patients, antihypertensive drugs were used from the essential drug list of Nepal which is an essential component of rational use of medicine

Burden Imposed by Diabetes Mellitus on Elderly Patients Visiting a Teaching Hospital: A Cross-sectional Study

Introduction: Diabetes Mellitus, a chronic metabolic disorder, has become an alarmingly major health issue worldwide. This study aimed to assess the burden imposed by diabetes mellitus on elderly patients visiting Lumbini Medical College and Teaching Hospital. Methods: A descriptive cross-sectional study was conducted purposively among 178 diabetic elderly patients visiting medicine out-patient department of Lumbini Medical College. The Elderly Diabetes Burden Scale was used to assess the burden imposed by diabetes. Results: The mean (SD) age of the participants was 67.38 (6.92) years, more than half (52.2%) were male, 46.6% were Janajati and 77.5% were from Palpa district. Most (84.3%) had diabetes for duration of one to 10 years, 45.6% had normal body mass index, 47.2% had good glycemic control (HbA1C <7%), and 74.2% were on oral hypo-glycemic agents. Dietary restrictions (10.32±2.97) and worry about diabetes (10.30±2.85) had imposed high burden level and burden by tablets/insulin (7.02±2.12) as lower burden amongst the six domains. Age, education and body mass index were found to be statistically significant with the treatment dissatisfaction domain (p=<0.001). Likewise, duration of diabetes (p=<0.001) was statistically significant with burden by tablets/insulin and symptom burden domain. Conclusion: Dietary restrictions and worry about diabetes were found to have dominant burden whereas, burden by tablets or insulin was the least. Duration of diabetes and body mass index were found to have association with the overall burden. Likewise, age, education and body mass index had high influence on the perceived burden due to treatment dissatisfaction

Endoscopic Transcanal Type I Cartilage Tympanoplasty for Anterior Perforation of Tympanic Membrane: A Cross-sectional Study

Introduction: Repair of anterior perforation of the tympanic membrane is difficult mainly due to inadequate exposure, minimal tympanic membrane remnant, impaired vascular supply, and delayed healing. Methods: This analytical cross-sectional study was done in a tertiary center over a period of 12 months from 25 April 2021 to 24 April 2022. There were 47 patients who underwent endoscopic transcanal type I cartilage tympanoplasty for anterior perforation. All operations were performed using an underlay technique and by transcanal approach. In all the cases, perichondrium with tragal cartilage was used as a graft for the reconstruction of the tympanic membrane.  The evaluation was done after three months post-operatively in terms of graft uptake and post-operative hearing status. Results: The overall graft uptake success rate after three months post-operatively was 89.4%. The pre-operative mean pure-tone average was 34.72 ± 6.45 dB, (range 17 dB to 43 dB). The mean postoperative pure-tone average was 22.09 dB ± 9.30 (range 10 to 41 dB). The mean difference between the preoperative pure tone average and the postoperative pure tone average was 12.63 dB ± 8.96 (p < 0.05). The mean preoperative air-bone gap average was 23.38 dB ±7.98 (range 6 to 40 dB) and the mean postoperative air-bone gap of 13.45 ± 6.89 (range 5 to 32 dB). This resulted in improvement in the air-bone gap by 9.93 dB (p < 0.05). Conclusion: Endoscopic transcanal tympanoplasty is a minimally invasive procedure, which provides complete exposure of anterior tympanic membrane perforation thus avoiding external incisions and canaloplasty

A Students’ Perception in Learning Human Anatomy Towards Dissection or Prosection

Introduction: Cadaveric dissection has been used as a traditional method of teaching and learning for many years. With time, changes in the medical curriculum have reduced the time for anatomy learning and seeking alternative methodologies moving away from traditional learning. With the introduction of new methodology and technology, the question arises whether it is still effective enough to follow the old traditional mode of teaching and learning. With ever-changing medical education, it is important to recognize students\u27 perceptive and attitudes toward learning different methods. Therefore, this study aimed to determine students’ perception towards prosection and dissection in learning anatomy. Methods: The first-year medical students were included in the study. The study was carried out after a series of lectures as per the curriculum. The students were divided into four groups. Each group dissected the cadaver followed by observation of the prosected cadaver explained by the faculty. Questionnaires were prepared related to dissection and prosection and sent to the students using google form. The students\u27 perception towards dissection and prosection was recorded. The results were tabulated and subjected to statistical analysis. The percentage of students opting for dissection and prosection was calculated. Results: The majority of students (82.5%) preferred dissection over prosection, 2.6% opted for prosection over dissection and 14.9% were still not sure which method of teaching and learning is favorable. Conclusion: The study reflected the traditional method of dissection was more favorable to students while alternative methods can also provide better insight to learning