Essential Emergency Surgical Care in remote hilly districts of Karnali Province - A Cross-Sectional Survey

Background: Remote hilly areas of Karnali province has one in all the very best burdens of surgically treatable conditions within the world and therefore, the highest unmet need. The first objective of our study was to gauge the capacity of first-referral health facilities in remote districts of Karnali province to perform basic surgical procedures. The aim was to assist in planning strategies for access to life-saving and disability-preventing surgical procedures. Method: The screening Tool was Situational Analysis to Assess Emergency and Essential Surgical Care ,to spot the health facility’s capacity to perform basic surgical (including obstetrics and trauma) and anesthetic procedures by investigating four categories of data: human resources, infrastructure, equipment and interventions available. The tool interrogated the supply of eight sorts of care providers, 35 surgical interventions and 67 items of apparatus. Results: on the average, 72.83% of all admissions required either minor or major surgical interventions. Oxygen supplies, electrical power backup, running water, blood bank, hospital guidelines were inconsistent. Only 1 Hospital have trained Surgeons, Anesthesiologist and Obstetrician/Gynecologist. Only 1 hospital can perform around 97.1% of procedures. Conclusion: The capacity for essential surgery is severely limited and provided limitations in basic equipment ,human resources, infrastructure, and supplies.

Status of Anxiety among Health Care Professionals during Covid-19 Pandemic: Comparison of Two Different Mental Health Screening Tools to Detect Anxiety

Background: COVID-19 outbreak has the potential to significantly affect the mental health of health care professionals (HCPs) who stand in the frontline of this crisis. The aim of this study is to determine the prevalence of anxiety among HCPs in Karnali Academy of Health Sciences (KAHS) during the COVID-19 pandemic through the use of two commonly used screening tools: Becks Anxiety Inventory (BAI) and Hospital Anxiety and Depression Scale- Anxiety Subscale (HADS-A). Methods: Hospital based descriptive cross-sectional study conducted in KAHS during the first half of October, 2020. Convenient sampling technique among HCPs was used. A 21-item BAI and a 7-item HADS-A were used to collect the data. For each of the questions, responses were rated on a 4-point Likert scale that ranged from zero (not at all) to three (severely). Results: A total of 75 HCPs participated in the study. Over-all prevalence of anxiety was found at 38.7% by BAI tool versus 33.3% by HADS-A (mean 36% percentage). Nurses reported the highest level of anxiety that was statistically significant (p<0.05). There is no significant differences between the two tools when used for the purpose of screening anxiety disorders (p-value <0.05). Conclusion: Evidence suggests that a considerable proportion of HCPs experience some level of anxiety during this outbreak, stressing the need to establish ways to mitigate mental health risks and adjust interventions to promote HCP’s psychological well-being. Both BAI and HADS-A have an evenly comparable case detection response for screening of anxiety disorders among HCPs during COVID-19 outbreak and it can be inferred that these tools can be relied upon for screening anxiety in similar instances

Health Professional Education in Karnali: Opportunity and Challenge

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Integrated Diabetic Clinic in a Rural Hospital of Nepal

Diabetes is an important public health concern which is increasing rapidly in developing countries. It is challenging to prevent and manage diabetes in a rural setting. The Integrated Diabetic Clinic is comprehensive diabetes care under one roof. Its aim is to provide efficient accessible and affordable comprehensive care. It will make a huge difference in the management of diabetes. This clinic will play a major role in unifying different aspects of health care under one roof and offer the most comprehensive and cost-effective accessible health care to minimize mortality and morbidity associated with diabetes. Keywords: Integrated, Diabetes, Clinic, Nepal, Rural Hospital DOI: http://dx.doi.org/10.3126/jkahs.v2i1.2442

Ingestion of Bell Clappers by a Shaman in Jumla, Nepal: A Case Report

Accidental foreign body ingestion is a common problem encountered in Emergency. Deliberate FB ingestion may result due to an act of insanity or an act of daring. A shaman locally known as Dhami was brought to Emergency with the history of ingestion of bell clappers. He denied the history of psychiatric illness or substance abuse. On physical examination, there were signs of peritonitis. Laparotomy was done to remove the FBs. Post-operative period was uneventful. Apart from the surgical intervention, psychological counselling was given to him. This is a rare interesting case due to the fact that the 15 cm long FBs passing all the way through without significant injury and finally causing obstruction in ileocecal junction and perforation in the distal ileum

Anxiety and depression among patients with chronic obstructive pulmonary disease and general population in rural Nepal

Abstract Background Anxiety and depression are usually under diagnosed among the patients with Chronic Obstructive Pulmonary Disease (COPD), which has a negative impact on patient quality of life through restriction of activities, loss of independence, and decreased social functioning. The purpose of this study was to describe the levels and characteristics of anxiety and depression in patients with COPD in Nepal as compared to the general population. Methods A hospital-based observational comparative analytical study was conducted in the United Mission Hospital, Tansen and the Okhaldhunga Community Hospital, Okhaldhunga, Nepal from June 1st 2015 to April 15th 2016. A convenience sample of two groups of participants were recruited: patients with COPD (study group) and visitors to the facility (comparison group). Anxiety and depression were measured with the Beck Anxiety and Depression Inventory Scale. Results A total of 198 individuals participated in the study; 93 with COPD and 105 from the general population. The mean age of the respondents was 58.24 ± 12.04 (40-82) years. The mean scores for anxiety and depression in COPD group were 23.76± 9.51 and 27.72± 9.37 respectively, while in comparison group, the mean score for anxiety was 8.01± 6.83 and depression was 11.60 ± 8.42. Both anxiety and depression scores were statistically significant between the groups with p value <0.001. Conclusions Anxiety and depression were almost three times more common in COPD patients compared to the participants from the general population. Early assessment and multi-model treatment of anxiety and depression should be part of management in COPD

Seroprevalence of Hepatitis B Virus Surface Antigen (HBsAg) Positivity in KAHS Teaching Hospital, Jumla

Background: Hepatitis B Virus (HBV) infection is a foremost global health problem. In context to Nepal, the prevalence of HBV infection is found to be low, 0.9% (1.1% in males and 0.5% in females), though high prevalence of ≥8% is shown among the population in the mountainous region by several studies. The epidemiology of HBV infection in the population of Jumla is not well-known. This study aimed to find out the seroprevalence of HBV surface antigen (HBsAg) in patients visiting Karnali Academy of Health Sciences Teaching Hospital (KAHS-TH), Jumla, Nepal. Methods: The cross-sectional study was conducted in people visiting KAHS-TH, Jumla for testing HBsAg from 1st April 2018 to 31st March 2019. The samples collected were tested for HBsAg by using the Rapid HBsAg test kit. All positive cases were further tested by Chemiluminescence (CLIA) method for HBsAg. The data entry was done in Microsoft Excel. After transferring the data into SPSS version 16, data analysis was done. Results: In this study, 1704 individuals were screened during the study period, out of which, 53 (3.11%) were HBsAg positive.  Among the HBsAg positive cases, 22 (4.34%) were males and 31 (2.58%) were females. The highest prevalence (8.1%) was observed in the age group of 40– 45 years. But the prevalence rate is zero in 0-5 years age group and above 65 years of age. Conclusion: The HBV infection was higher in Jumla as compared to an overall prevalence of Nepal. Males were more infected than females and the middle age group were at the high-risk group of HBV infection

Clarithromycin synergizes with cisplatin to inhibit ovarian cancer growth in vitro and in vivo

Abstract Background Cisplatin-based chemotherapy is the first-line treatment for ovarian cancer. However, acquired resistance to cisplatin treatment often occurs in epithelial ovarian cancer, and effective and practical methods for overcoming this obstacle are urgently needed. The study aimed to demonstrate the synergistic effect of clarithromycin (CAM) with cisplatin to inhibit ovarian carcinoma cells growth in vitro and in vivo. Results We performed CCK-8 assay to detect apoptosis rates in response to CAM alone or in combination with cisplatin, which were further confirmed by Annexin V and PI staining methods and western blotting. Mechanistically, CAM could reduce endogenous antioxidant enzyme expression and increase the levels of reactive oxygen species (ROS) to augment the cytotoxic effect of cisplatin. Meanwhile, a tumor xenograft model in athymic BALB/c-nude mice demonstrated that CAM combined with cisplatin resulted in reduced tumor growth and weight compared with cisplatin alone. Conclusion Collectively, our results indicate that CAM works synergistically with cisplatin to inhibit ovarian cancer cell growth, which may be manipulated by a ROS-mediated mechanism that enhances cisplatin therapy, and offers a novel strategy for overcoming cisplatin therapy resistance

Prevalence and type-specific distribution of human papillomavirus infection among women in mid-western rural, Nepal- A population-based study

Abstract Background Cervical cancer is the most common cancer among women in Nepal. The prevalence of human papillomavirus (HPV) 16 and or HPV 18 among women with cervical pre-cancer and cancer is higher than the incidence of HPV in the world population. The population-based epidemiological data of HPV in the general population in most parts of the country remains unknown. The objective of this study was to assess the prevalence and type distribution of HPV infection and association of abnormal cytology with high risk HPV infection among women in mid-western rural, Nepal. Methods A population-based cross sectional study was conducted in Jumla, one of the most remote districts in Nepal. A total of 1050 cervical samples were collected from married and non- pregnant women aged 20–65 years during mobile Cervical Cancer Screening Clinics conducted from May 2016 to January 2017. The presence of HPV DNA was firstly confirmed by HPV consensus PCR using PGMY09/PGMY11 designed primers, then HPV positive samples were further genotyped by the membrane hybridization method to detect the 21 high-risk HPV (HR-HPV) and low-risk HPV types. The prevalence of HR-HPV among women with normal and abnormal cytology was calculated. Data were analyzed using SPSS software for Windows. P < 0.05 was considered statistically significant. Results A total of 998 women were eligible for this study with the mean age 32.6 ± 8.6 years, and the mean marital age was 16.7 ± 3.8 years. The overall prevalence of HPV infections was 19.7%. HR-HPV and low-risk HPV were 11.7 and 8.7% respectively. The six most common HR-HPV types were HPV16, 39, 58, 33, 51 and 18. HR-HPV infection among the women with abnormal and normal cytology was of 27.3 and 10.8% respectively. Conclusions There was a higher prevalence of HR-HPV infection among women living in Jumla than other parts of Nepal. This study provides preliminary information on overall HPV and type-specific HR-HPV prevalence, HR-HPV 16, 39, 58, 33, 51, and 18 are the most prevalent genotypes in this region. The data contribute to the epidemiological knowledge about HPV and type-specific HR-HPV genotypes prevalence in mid-Western Nepal