39 research outputs found
Pre-operative Hypoglycemia in Patients Presenting for Surgery: A Hospital Based Cross-sectional Study
Introduction: Peri-operative glycemic control is an important factor for post-operative recovery and is well protocoled for diabetic patients in every setup. It is not always so with non-diabetic patients. This study aimed to observe the pre-operative glucose level and prevalence of hypoglycemia in patients presenting for surgery and its association with the duration of nil per oral period (NPO), age and intravenous fluids used in the pre-operative period. Methods: A cross-sectional study was conducted in the Department of Anesthesiology in a Nepalese medical college including all the patients posted for elective surgery over a period of three months. Socio-demographic and clinical details of the participants were collected in the operating theatre. Duration of NPO period and intravenous fluid prescribed in the pre-operative fasting period were recorded. A glucose strip test was performed on all the participants. Results: Participants were found to have fasted for an unnecessarily longer duration (12.84±2.27 hours). The incidence of hypoglycemia in patients posted for elective surgery was very high (43.3%). Ringer lactate and normal saline were equally prescribed (38.4%) and dextrose-normal saline was prescribed in the rest of the participants. Gender and type of intravenous fluids were positively correlated whereas NPO period was negatively correlated in overall participants though statistically insignificant. In hypoglycemic participants, we observed that lower glucose was influenced by pre-operative fluids, age and NPO duration. Conclusion: Pre-operative use of glucose-containing fluids during NPO period is an important step to prevent hypoglycemia and related consequences
Carbon footprint of Nepalese healthcare system: A study of Dhulikhel Hospital [version 1; peer review: 2 approved, 1 approved with reservations, 1 not approved]
Background: Though direct greenhouse gas emissions cannot be observed in health care sectors, there can exist indirect emissions contributing to global climate change. This study addresses the concept of the carbon footprint and its significance in understanding the environmental impact of human activities, with a specific emphasis on the healthcare sector through gate-to-gate (GtoG) life cycle assessment. Transportation, energy consumption, and solid waste generated by hospitals are the primary sources of carbon emissions. Methods: Different standards, guidelines and parameters were used to estimate emissions from both the primary and secondary data. All steps and sub-steps involved in GtoG were accessed and analyzed within the standard ISO 14040:44 guideline. An extensive review of existing literature was carried out for the evaluation and verification of secondary data. Results: The total carbon footprint of generators, electricity consumption, transportation activities, LPG cylinders, PV systems was found to be 58,780 kg-CO2-eq/yr, 519,794 kg-CO2-eq/yr, 272,375 kg-CO2-eq/yr, 44,494 kg-CO2-eq/yr, 35,283 kg-CO2-eq/yr respectively and the emissions from non-biodegradable solid waste was found to be 489,835 kg-CO2/yr. Local air pollutants such as PM10, CO, SO2, NOX, and VOCs generated by generators and transportation were also estimated. The CH4 emissions from liquid waste were 1177.344 kg CH4/BOD yr, and those from biodegradables were 3821.6954 kg CH4/yr. Conclusions: Healthcare professionals and policymakers can take action to reduce the sector's carbon footprint by implementing best practices and encouraging sustainable behavior. This study can be taken as foundation for further exploration of indirect emissions from healthcare sectors not only in Nepal but also in south Asian scenario
Receptor-targeted, drug-loaded, functionalized graphene oxides for chemotherapy and photothermal therapy
Deployment of Open Data Kit for Information Management for Various Engineering Projects In Rural, Indonesia
AbstractĂąâŹâOpen data kit was used in an Engineering context as a data collection, storage and management tool for diverse data types from irrigation channels, weirs, saturated rice paddies and ephemeral stream catchments in the Eastern Indonesian province of Nusa Tenggara Timur. In the islands of West Timor and Flores, information was primarily used to report maintenance issues in the weir, primary, secondary, tertiary and quaternary channels. In Sumba, data was recorded for flow velocity and elevation in saturated zones and sedimentation in an ephemeral stream. Information regarding physical characteristics from groundwater wells was also collected to assess drinking water quality. Smart phone data input forms were developed progressively using Open data kit Build, according to the specific needs of each research project. It was found to be a very user-friendly and effective tool to use in the Engineering context. The features of Open data kit Build allowed us to modify the various forms in remote locations. Developing multiple choice input focused forms made data collection easier for farmers and local government workers. It virtually eliminated the need for hardcopy data, and allowed for versatility with respect to the nature of the multidisciplinary research
A Global Collaboration to Develop and Pilot Test a Mobile Application to Improve Cancer Pain Management in Nepal
INTRODUCTION: Quality palliative care, which prioritizes comfort and symptom control, can reduce global suffering from non-communicable diseases, such as cancer. To address this need, the Nepalese Association of Palliative Care (NAPCare) created pain management guidelines (PMG) to support healthcare providers in assessing and treating serious pain. The NAPCare PMG are grounded in World Health Organization best practices but adapted for the cultural and resource context of Nepal. Wider adoption of the NAPCare PMG has been limited due to distribution of the guidelines as paper booklets. METHODS: Building on a long-standing partnership between clinicians and researchers in the US and Nepal, the NAPCare PMG mobile application (âappâ) was collaboratively designed. Healthcare providers in Nepal were recruited to pilot test the app using patient case studies. Then, participants completed a Qualtrics survey to evaluate the app which included the System Usability Scale (SUS) and selected items from the Mobile App Rating Scale (MARS). Descriptive and summary statistics were calculated and compared across institutions and roles. Regression analyses to explore relationships (α = 0.05) between selected demographic variables and SUS and MARS scores were also conducted. RESULTS: Ninety eight healthcare providers (n = 98) pilot tested the NAPCare PMG app. Overall, across institutions and roles, the app received an SUS score of 76.0 (a score > 68 is considered above average) and a MARS score of 4.10 (on a scale of 1 = poor, 5 = excellent). 89.8% (n = 88) âagreedâ or âstrongly agreedâ that the app will help them better manage cancer pain. Age, years of experience, and training in palliative care were significant in predicting SUS scores (p-values, 0.0124, 0.0371, and 0.0189, respectively); institution was significant in predicting MARS scores (p = 0.0030). CONCLUSION: The NAPCare PMG mobile app was well-received, and participants rated it highly on both the SUS and MARS. Regression analyses suggest end-user variables important to consider in designing and evaluating mobile apps in lower resourced settings. Our app design and pilot testing process illustrate the benefits of cross global collaborations to build research capacity and generate knowledge within the local context
Omphalocele, Exstrophy of Cloaca, Imperforate Anus, and Spinal Defects Complex: A Case Report
 Omphalocele, exstrophy of cloaca, imperforate anus, and spinal defects complex is a rare malformation
complex that includes omphalocele, cloacal exstrophy, imperforate anus and spinal defects with the
incidence of 1 in 200,000 to 400,000 pregnancies and is even rarer in twin gestation. The etiology of
this complex is still unclear. Most cases are sporadic. Prenatal screening must be done for diagnosis
and appropriate multidisciplinary management of cases. In severe cases, termination of pregnancy is
considered. We present a 4-day first twin child with underdeveloped ambiguous genitalia delivered
via emergency lower section cesarean section at 32+3 weeks of gestation with giant liver containing
omphalocele, cloacal exstrophy, imperforate anus and meningocele with severe pulmonary artery
hypertension and non-visualization of right kidney and ureter, absence of uterus, fallopian tubes and right ovary. Separation and repair of the cecum and bladder were done. The ladd procedure was performed. Ileostomy was created and single-stage repair of the abdominal wall was done
A Late Presenting Left-Sided Congenital Diaphragmatic Hernia Repair Complicated by Postoperative Chylothorax: A Case Report
Management of chylothorax after repair of late presenting congenital diaphragmatic hernia is debatable. Conservative management in the form of close monitoring of chylous output with nutritional support appears convincing to surgery
Factors affecting utilization of mental health services from Primary Health Care (PHC) facilities of western hilly district of Nepal.
AimTo explore the factors affecting mental health service utilization from Primary Health Care facilities of Arghakhanchi district, a western hilly district of Nepal.BackgroundMental health service utilization has many facilitating and hindering factors present at different socio-ecological levels. Stigma and lack of awareness in the community have been identified as the major barriers for mental health service demand and access worldwide.MethodsA cross-sectional qualitative study was conducted in Arghakhanchi district of Nepal in July-August 2019 that collected information through face-to-face In-depth and Key Informant Interviews of three categories of participants selected judgmentally. Thirty-two purposively selected participants from the three categories were interviewed using validated interview guidelines. Thematic analysis was performed using RQDA package for EZR software. Validation of translated transcripts, member checking and inter-coder percent agreement were performed to maintain rigor in the study.ResultsMental health stigma and inadequate awareness were identified as major factors that caused barriers for mental health service utilization at community level. They also influenced different factors at other socio-ecological levels to act as barriers. Awareness in community along with accessibility and availability of comprehensive mental health services were recommended by the participants for increasing service utilization from Primary Health Care facilities.ConclusionIndividual, family and community awareness could help reduce and/or eliminate mental health stigma. Accessibility of health facilities and availability of comprehensive mental health services in Primary Health Care facilities could help increase service utilization from those facilities