Duration of stay in emergency department and 0utcomes of admitted Patients

Introductions: Duration of stay in Emergency Department (ED) is associated with negative outcomes, from increased mortality to increased duration of length of stay as inpatient. This study evaluates the length of duration of stay in ED after admission and the outcomes.Methods: This was a cross sectional observational study conducted at Patan Hospital, a tertiary care teaching hospital of Patan Acedemy of Health Sciences, capital city of Nepal. All the patients presenting to ED and getting admitted from 21st July to 4th August 2014 were enrolled in the study. Primary outcome was in hospital mortality, length of hospital stays (days) and secondary outcome was rate of transfer of inpatient to ICU or step down for higher care.Results: There was total 178 admissions form ED during the study period. Length of hospital stay increased with the increased duration spent in ED (p=0.004). The mortality group also had increased duration of stay in ED with mean duration of 23.23 hours. Increased duration of stay in ED after admission was also directly related to increased inpatient higher care transfers and thus prolonged hospital length of stay.Conclusions: Increased duration of stay in ED after admission was associated with increased hospital stay, increased mortality and increased inpatient transfer for higher care.Keywords: boarding time in emergency department,  ICU, outcome  of hospital admission, stay in emergency, persistent trophoblastic diseaseÂ

Postpartum quality of life after normal vaginal delivery and caesarean section

Introductions: Caesarean section is rising. The best method of delivery, vaginal or caesarean, for postpartum quality of life in women is a matter of controversy both from professionals’ perspectives and from women’s experience of childbirth. This study analyses quality of life after these two methods of deliveries. Methods: This was a cross-sectional comparative study in postnatal care outpatient department at Patan hospital. Primipara women with normal delivery and elective caesarean section done in Patan Hospital were enrolled to analyse postpartum quality of life. The SF-12 questionnaire tool at 6 weeks post delivery was used to compare age, ethnicity, education, family type and employment. Data was analysed using ANOVA test for descriptive parameters. Results: There were 468 primipara, age 30-45 y, 94% in 15-30 y, 77.8% educated, 74.4% in joint family, 73.5% housewife. Normal vaginal delivery was 360 (72.6%) and 128 (27.4%) elective caesarean. Vaginal delivery group had average SF score of Physical Health Composite Score of 68.7, Mental Health Composite Score 69.5 and total SF score 67.7. While in Caesarean group it was 64.8, 64.1 and 63.4  Conclusions: Normal vaginal delivery had better quality of life resulting in both superior physical as well as mental health. Keywords: caesarean section, postpartum, quality of life, vaginal delivery  Â

Assessment of metered dose inhalation technique in patients with chronic lung disease at a tertiary health care center

Introduction: Poor inhalation technique among patients using Metered Dose Inhaler (MDI) is one of the most common causes of increased acute exacerbations and hospital visits and leads to poor health outcome. Hence, the purpose of this research is to evaluate the correctness of inhalation steps in patients using MDI visiting Patan Hospital. Method: A total of 128 patients participated in the research. The study involved collection of basic sociodemographic information and visual observation of the inhalation technique of the patients using a standard checklist. Any mistakes made during the procedure were recorded. They were also asked to say each step as they performed it so that all of the steps could be clearly observed. Result: Out of 128 participants, only 3(2.34%) of the participants were able to perform all the eight steps correctly. Holding breath for five second was the most commonly made mistake 80(62.7%) followed by failure to exhale to residual volume 74(57.7%). Majority of participants were able to perform five steps correctly 29(22.6%). There seemed to be no association of inhalation technique with age, sex and educational status of the patient. Conclusion: Majority of the patients were unable to perform the inhalation steps correctly indicating the need for regular training programs to improve the inhalation technique and improve health outcome

Nepalese legal standard of milk and common milk products and its implications

The milk and milk products are diversified and there is increasing awareness about the quality standards of products among the consumers.Therefore this study reviewed the legal standard of milk and common milk Products in Nepal and its implications using desk review and exploratory research.In Nepal, the department of food technology and quality control has developed several legal standards for the quality assurance of milk and milk products. National Dairy Development Board has established the Code of Practice for Dairy Industry 2004 which directs six criteria for the standardization of milk and milk products like Organoleptic test, Clot On Boiling (COB) test, Alcohol Test,Fat test and Solids-Not-Fat (SNF)test,  Adulteration test, phosphate test, and microbial and coliform test. The review identified the quality standards of milk products like ghee, butter, paneer, milk powders but some quality parameters for ice-creams and cheese are still missing. The research identifies the quality non-compliance rate of milk and milk products that is about 19% which is in a decreasing trend. To the effective implementation of the legal standards, maintenance of health and hygiene of livestock at the production site, lab and infrastructure support at the distribution site, and creating consumer awareness to the consumer site is imperative

Credit’s use performance and its determinants on farm household: A case of Chitwan district of Nepal

Credit has been considered to play a pivotal role in the agricultural development of Nepal. A large number of institutions are involved in the disbursement of credit to agriculture. In this backdrop, the present study has examined the performance of agricultural credit and has identified the determinants of increased use of credit at the farm household level in Nepal. The study was based on survey data consisting of 107 samples collected randomly from the Chitwan district. The study has revealed that the quantum of credit availed by the farming households is affected by several socio-demographic factors which include caste, economically active population, food sufficiency, and membership in an organization. The research revealed that if the household is Brahmin/ Chettri, the probability of borrowing loans decreased by 32% as compared to other castes. Similarly, if the household’s economically active population increased by one unit, the probability of taking a loan increased by 16%. The results also show that, if household food sufficiency increased by one month the probability of taking loans decreased by 4 % but if the household head is a member of an organization, the probability of taking a loan increased by 28%. The congenial environment to increase the involvement of the household head to an organization like cooperative and farmers group, increasing the food self-sufficiency through productivity enhancement program and creating awareness on credit utilization helps to increase credit use performance in Agriculture

Plant & Its Derivative Shows Therapeutic Activity on Neuroprotective Effect

In most cases, the death of neurons in certain parts of the brain is the defining feature of a condition that is classified as neurodegenerative. There have been studies conducted on both conventional and innovative drugs, however the results have shown that they only offer symptomatic advantages and come with a number of undesirable side effects. The finding of more potent compounds that can stop the pathophysiology of these diseases will be seen as a miracle in the present day. There is a wide variety of synthetic compounds accessible; nevertheless, these drugs may also create a broad range of additional health issues. As a consequence of this, scientists are looking to plants and other natural sources for the development of new medicines. In the practise of conventional medicine, it has been discovered that certain plants possess healing powers. The use of phytochemicals, which are produced from medicinal plants, may eventually replace the need for synthetic molecules. Numerous phytochemicals have been shown to be effective in the treatment of a wide range of diseases. This article discusses the potential therapeutic applications of plant-derived alkaloids for a number of neurodegenerative disorders (NDDs), including Alzheimer\u27s disease (AD), Huntington\u27s disease (HD), Parkinson\u27s disease (PD), epilepsy, schizophrenia, and stroke. There are many different types of alkaloids that can be found in the plant kingdom. Some of these alkaloids include isoquinoline, indole, pyrroloindole, oxindole, piperidine, pyridine, aporphine, vinca, -carboline, methylxanthene, lycopodium, and erythrine byproducts. Alkaloids have a beneficial effect on the pathophysiology of these diseases because of their ability to act as muscarinic and adenosine receptor agonists, anti-oxidants, anti-amyloid and MAO inhibitors, acetylcholinestrase and butyrylcholinesterase inhibitors, an inhibitor of synuclein aggregation, dopaminergic and nicotine agonists, and NMDA antagonists

Keraunoparalysis, a neurological manifestation after lightning strike: a case Report

Lightening strike can have wide range of physical and neuropsychiatric symptoms. Burn, extensive tissue damages, cardiac rhythm disturbances and secondary injuries are well described and observed. The patient may also go through transient neurological symptoms, which may go unseen in some cases while in some cases it may get extra attention and series of investigations. Keraunoparalysis is one of the immediate neurological complications encountered after lightning strike. This manifests as transient self-limiting symptoms. Keywords: keraunaparalysis, lightning, neurological symptom

Base Deficit as a Predictor of Mortality in Sepsis and Septic Shock.

Introduction: Sepsis is a common problem encountered in the emergency room which needs to be intervened early. It is always difficult to have the quick prognostic marker of sepsis in busy emergency. So this study was conducted to determine whether base deficit can be used as an indicator of mortality among septic patients in emergency room set up like ours. Methods: It was a hospital-based descriptive cross-sectional study done at Tribhuvan University Teaching Hospital, Kathmandu from March 2018 to December 2018.  Acute physiology and chronic health evaluation II score(APACHE II), Base deficit, Sequential Organ Failure Assessment(SOFA)score on first day of arrival in the emergency room were calculated. The association of 28-day outcome with Acute physiology and chronic Health Evaluation II score, Base deficit value and SOFA score were derived. Results: Out of 229 patients with septic shock 62 died (27%) and among 71 patients without septic shock,12 died(16.9%) .Overall mortality was 24.66 %(n= 74).The area under the ROC curve for Base deficit(0.864;95% C.I.=0.822-0.906), APACHE II( 0.782;95%C.I=0.718-0.848;,SOFA(0.689;95% C.I=0.620-0.757) were greater than 0.7 except for SOFA which signifies these test to  have fair efficacy to predict mortality. Conclusions: High base deficit value predicts mortality in patients with sepsis and septic shock. Keywords: Base Deficit; Sepsis; Septic Shock, Predictor, Mortality DOI: http://doi.org/10.3126/jkahs.v2i2.2516

Behavioural science principles for scaling-up zero tillage wheat and maize in the Eastern Terai region of Nepal

Farmers have a set of convictions and tend to do what their forefathers had practiced. By identifying their beliefs and designing appropriate ways of upscaling to convince them of new and improved practices, we can improve the adoption of zero tillage technology for maize and wheat. Small and fragmented landholdings that resulted from the cultural system of distributing land to heirs are diverse in their cropping requirements. Moreover, farmers are risk-averse and do not believe easily in new technologies. Traditional extension approaches have not been effective in upscaling these technologies. A new way of thinking based on behavioural science can provide some insights and guidelines for improving the effectiveness of technology adoption. Understanding farmers' socioeconomic circumstances and their decision-making system at the household and society level can help in designing upscaling approaches. Approaches such as capitalising on social bonding, use of established technology leaders, and use of farmers' organizations can improve adoption. Recommended strategies include encouraging a comprehensive contracting system of service provision, using active community influential local leaders in technology expansion, taking group and social identity approaches in technology extension, and capacity building programs for service providers/operators and farmers to help raise confidence and to remove perceived barriers to technology adoption. &nbsp