Echogenic liquor at term pregnancy on ultrasonography is not always meconium

Introductions: The presence of echogenic amniotic fluid at term pregnancy on sonography is uncommon. Finding of meconium in the amniotic fluid by ultrasound is used to predict mode of delivery of fetus, fetal wellbeing and risk of intrauterine fetal demise. We aim to observe the clinical significance of echogenic liquor at term pregnancy.Methods: This was a retrospective study of 102 cases of echogenic liquor at gestation age between 36 and 41 weeks (term pregnancy) during five years 2010 to 2015. Amniotic fluid index (AFI) was calculated. Fluid was observed for presence of vernix caseosa or meconium stain during spontaneous and artificial rupture of membrane. The APGAR score of baby was taken twice at 5 and 10 minutes.Results: Among the 102 patients with echogenic amniotic fluid at term, 83 (81.4%) were vernix and 19 (18.6%) had meconium stain. Low APGAR scores were found in 5 (0.9%) and normal score in 97 (95.1%) indicating good fetal outcome. Among these cases, 89 (87.3%) had normal AFI and 13 (12.7%) had decreased liquor.Conclusions: There were no association between echogenic liquor and meconium stain, AFI or APGAR score of the baby in term pregnancy.Keywords: AFI, echogenic liquor, fetal outcome, prenatal ultrasound, term pregnancy, vernix or meconiu

stuDy oF accuracy oF commonly useDFetal Parameters For estimation oF gestational age

Estimation of the gestational age by sonographic measurements of fetal parameters is usually done by measuring mean sac diameter (MSD), Crown-rump length (CRL), biparietal diameter (BPD), head circumference (HC), femoral length (FL) and abdominal circumference (AC) depending on the trimester of pregnancy. This is a prospective study to see the correlation of different fetal param-eters in estimating the gestational age. A total of 71 normal women were taken and ultrasonogram was done to take MSD and CRL in 1st trimester and BPD, HC, FL and AC in 2 nd and 3 rd trimester. Gestational age was calculated by MSD using Rempen normogram and Hadlock normograms were used for the rest of fetal parameters. Gestational age by LMP was also calculated at the same time. Correlation of different fetal parameters in estimating gestational age in different trimesters was done by Pearson correlation. Pearson correlation showed that the CRL was the best fetal param-eter (correlation coefficient of 0.909) in the first trimester. The correlation of MSD and average gestational age by MSD and CRL was with correlation coefficients of 0.778 and 0.888 respectively. Thus the averaging of gestational age in 1st trimester decreases the accuracy in the gestational age estimation. Correlation of gestational age by BPD, HC, FL and AC and their average in 2 nd trimes-ter showed that the best correlation was by AC and the least correlation by BPD in this study. It is in contrary to other studies which could be due to chance finding or bias because of prospective study. Pearson correlation calculated in 3 rd trimester showed HC and FL were better parameters than BPD and AC. Average gestational age by simple averaging of BPD, HC, FL and AC gives more accurate estimation of gestational age in both 2nd and 3 rd trimester. Key Words: Ultrasonogram, Fetal parameters, Gestational age

Crossed Testicular Ectopia

Crossed testicular ectopia also known as transverse testicular ectopia is a rare anomaly of the testis which is ectopically located in contralateral hemiscrotum with absent testis in the ipsilateral hemiscrotum. Most case are incidentally discovered intraopeartively during operation of inguinal hernia and few case reports are available which have reported preoperative diagnosis of crossed testicular ectopia. We report a case of crossed testicular ectopia in 12 year old boy who presented with right undescended testis diagnosed preoperative on Ultrasound and Magnetic Resonance Imaging as crossed testicular ectopia. Keywords: crossed ectopia; MRI; testis; ultrasonography

Tuberculosis in Staff and Students of Patan Hospital.

BACKGROUND There is a high risk of occupational exposure to tuberculosis among healthcare workers in endemic countries. Regular screening for tuberculosis among healthcare workers is not carried out in Nepal. Infection control measures are also not routinely implemented. The aim of this study was to determine the prevalence of active tuberculosis among staff/students at Patan Hospital. METHODS Participants were given a self-administered questionnaire and invited to undergo chest radiography. Cases were scored and reviewed based on predetermined criteria, and presumptive tuberculosis cases were invited to undergo sputum smear and culture. Participants were categorized according to the extent of patient contact and asked about history of tuberculosis medication. RESULTS Among 560 participants, 76.8% had direct contact with patients. Fifty-eight (10.4%) gave history of cough >2 weeks. Based on symptom history and chest radiography, 20.0% (n=112) cases were reviewed, and 12.5% (n=14) of those reviewed had sputum tested for acid-fast bacilli. One participant had culture-positive tuberculosis. Fifty participants (8.9%) reported tuberculosis in the past, among which 42.0% (n=21) occurred after employment at Patan Hospital and 42.0% before joining Patan Hospital. Security staff, radiology technicians and ward cleaning staff had the highest proportion of cases with a history of tuberculosis.History of tuberculosis medication had no relation with age, sex, education, body mass index and smoking.The incidence rate of tuberculosis at Patan Hospital was 3.6 per 1000 person-years. CONCLUSIONS Overall incidence of tuberculosis among healthcare workers is noteworthy. However, this study suggests when symptomatic tuberculosis occurs in healthcare worker at Patan Hospital, it is diagnosed and there is not a large pool of undiagnosed tuberculosis

Accessibility and Utilization of Sexual and Reproductive Health Services among People with Disabilities in Nepal

The study aims to assess the factors determining the access and utilization of sexual and reproductive health (SRH) services among people with disabilities residing in the Kathmandu Valley of Nepal. A cross-sectional study was conducted among randomly selected 422 people with disabilities in Kathmandu Valley. Data were collected through face-to-face interviews using structured questionnaires. Bivariate and multivariate logistic regression analyses were conducted. Among a total of 422 participants, 32.7% had utilized SRH-related education, information, and counselling services. Contraceptive-related services were utilized by 47.6% of participants, pregnancy-related services by 27.7%, safe abortion-related services by 13.0%, and HIV testing and treatment services by 3.6%. Likewise, 16.8% of participants utilized STI screening, diagnosis, and management services. Males were 2.5 times more likely to utilize SRH services compared to females (AOR = 2.5, 95% CI = 1.4-4.2), whereas unmarried participants were less likely to utilize SRH services as compared to single/separated/divorced (AOR = 0.2, 95% CI = 0.0-0.5). Similarly, participants who were living with their families compared to those living alone (AOR = 3.4, 95% CI = 1.4-7.7), and participants who were unemployed compared to employed (AOR = 1.8, 95% CI = 1.0-3.5) had higher odds for utilization of SRH services. There are significant variations depending on the intersections of various characteristics affecting the utilization rate across different SRH services among people with disabilities. Contraceptive-related services were the most utilized service, whereas safe abortion, pregnancy related services, STI screening and management services and HIV testing and treatment services were less utilized services.</p

Developing and deploying a community healthcare worker-driven, digitally- enabled integrated care system for municipalities in rural Nepal

International audienceIntegrating care at the home and facility level is a critical yet neglected function of healthcare delivery systems. There are few examples in practice or in the academic literature of affordable, digitally-enabled integrated care approaches embedded within healthcare delivery systems in low- and middle-income countries. Simultaneous advances in affordable digital technologies and community healthcare workers offer an opportunity to address this challenge. We describe the development of an integrated care system involving community healthcare worker networks that utilize a home-to-facility electronic health record platform for rural municipalities in Nepal. Key aspects of our approach of relevance to a global audience include: community healthcare workers continuously engaging with populations through household visits every three months; community healthcare workers using digital tools during the routine course of clinical care; individual and population-level data generated routinely being utilized for program improvement; and being responsive to privacy, security, and human rights concerns. We discuss implementation, lessons learned, challenges, and opportunities for future directions in integrated care delivery systems

Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal.

BackgroundGlobal health academic partnerships are centered around a core tension: they often mirror or reproduce the very cross-national inequities they seek to alleviate. On the one hand, they risk worsening power dynamics that perpetuate health disparities; on the other, they form an essential response to the need for healthcare resources to reach marginalized populations across the globe.ObjectivesThis study characterizes the broader landscape of global health academic partnerships, including challenges to developing ethical, equitable, and sustainable models. It then lays out guiding principles of the specific partnership approach, and considers how lessons learned might be applied in other resource-limited settings.MethodsThe experience of a partnership between the Ministry of Health in Nepal, the non-profit healthcare provider Possible, and the Health Equity Action and Leadership Initiative at the University of California, San Francisco School of Medicine was reviewed. The quality and effectiveness of the partnership was assessed using the Tropical Health and Education Trust Principles of Partnership framework.ResultsVarious strategies can be taken by partnerships to better align the perspectives of patients and public sector providers with those of expatriate physicians. Actions can also be taken to bring greater equity to the wealth and power gaps inherent within global health academic partnerships.ConclusionsThis study provides recommendations gleaned from the analysis, with an aim towards both future refinement of the partnership and broader applications of its lessons and principles. It specifically highlights the importance of targeted engagements with academic medical centers and the need for efficient organizational work-flow practices. It considers how to both prioritize national and host institution goals, and meet the career development needs of global health clinicians

Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal

ABSTRACT Background:: Global health academic partnerships are centered around a core tension: they often mirror or reproduce the very cross-national inequities they seek to alleviate. On the one hand, they risk worsening power dynamics that perpetuate health disparities; on the other, they form an essential response to the need for healthcare resources to reach marginalized populations across the globe. Objectives:: This study characterizes the broader landscape of global health academic partnerships, including challenges to developing ethical, equitable, and sustainable models. It then lays out guiding principles of the specific partnership approach, and considers how lessons learned might be applied in other resource-limited settings. Methods:: The experience of a partnership between the Ministry of Health in Nepal, the non-profit healthcare provider Possible, and the Health Equity Action and Leadership Initiative at the University of California, San Francisco School of Medicine was reviewed. The quality and effectiveness of the partnership was assessed using the Tropical Health and Education Trust Principles of Partnership framework. Results:: Various strategies can be taken by partnerships to better align the perspectives of patients and public sector providers with those of expatriate physicians. Actions can also be taken to bring greater equity to the wealth and power gaps inherent within global health academic partnerships. Conclusions:: This study provides recommendations gleaned from the analysis, with an aim towards both future refinement of the partnership and broader applications of its lessons and principles. It specifically highlights the importance of targeted engagements with academic medical centers and the need for efficient organizational work-flow practices. It considers how to both prioritize national and host institution goals, and meet the career development needs of global health clinicians