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

Cause of admission and mortality in geriatric patients: a hospital based study, Nepal

Introductions: As the life expectancy of people of Nepal rises, geriatric population is also on constant rise. Prevalence of diseases in this population is not well studied in Nepal. This study is carried out to assess the disease burden in geriatric in-patients and the cause of death in Patan Hospital to inform the planning process. Methods: A retrospective prevalence survey of geriatric in-patients in Internal Medicine Department in Patan Hospital was carried out using the data base record and patient's files over a period of one year. The demographics of patients, disease entity and the cause of death were recorded in Microsoft XL and were analyzed. Results: There were 1,587 patients’ charts available for analysis (out of total 1,599 admissions, 12 were excluded because charts were not found). There were 840 (52.93%) diseases of the respiratory system followed by cardio-vascular diseases 184 (11.59%) and infectious diseases 122 (7.68%). Of the 89 deaths (5.61% of 1587), 58 (65%) were due to non-communicable diseases while 31 (35%) were due to communicable diseases. The commonest cause of death was due to diseases of respiratory system 44 (COPD 20, pneumonia 18, others 6), followed by cerebrovascular accidents in 14. Conclusions: Respiratory disease was common findings in more than half of geriatric patients admitted to Patan Hospital and was also the major cause of death. Overall, non-communicable diseases accounted for two thirds of the death. Keywords: cause of death, elderly patient, geriatric patient, non-communicable diseasesÂ

Triaging in COVID-19 at Patan Hospital, Nepal

Amid this pandemic, which has been spreading like a wildfire globally, Nepal is not an exception to it. With this, we have been hearing the news of global shortage of personal protective equipment (PPE), with growing concern over the safety of medical community and possibility of cross-contamination. Triaging is less researched and reported in COVID-19. It is as important as PPE, a gateway of safety for health care worker. If we have to manage COVID-19, ensuring triage should be among the priority strategies. Patan hospital is among the few hospitals in Nepal where triaging is practiced. Keywords: COVID-19, personal protective equipment PPE, triag

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

Patient perspectives on health in chronic illness

Introductions: Medical students need to understand patients’ perspectives about illness and its impact on their lives and family, to evolve as truly socially accountable physicians. Methods: Medical students were assigned in pairs to visit a chronically sick patient over 6 months. They completed a portfolio exploring patient attitudes towards their illness, medication, concerns and beliefs. Themes were coded, and portfolios were reviewed independently. New themes were added during the review.  Data was later compiled and discussed by the team to refine key themes and portfolios were reviewed to check for frequency. Results: Fifty-eight students interviewed twenty-nine patients with a variety of chronic conditions. Areas identified included the important role of family and community.  A major concern of 18/29 (62%) patients was the impact on the family emotionally, socially and financially of their illness. Other concerns were loneliness (5/29), uncertainty about the illness and deteriorating function.  Spiritual issues were important, together with prayer.  Some patients (7/29) viewed their illness as a punishment or curse and wanted to die. Other patients believed their illness was due to diet, physical or emotional stress, contagion or exposure to environmental factors.  Two believed the oxygen for their COPD was addictive, so restricted its use. Conclusions:  As part of providing patient-centered care in the context of Nepal it is important to explore the level of family and community support available to the patient as well as the current impact on the family. Keywords: chronic illness, non-communicable disease, perspective

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

Non-COVID and COVID emergency department healthcare workers’ perception of COVID-19 at Patan Hospital, Nepal

Introduction: Patan Hospital (PH), Patan Academy of Health Sciences (PAHS) has separated non COVID and COVID emergencies for the safety of health care workers (HCWs). This study was conducted to assess the safety perception of healthcare workers working in emergency departments during the outbreak of COVID-19. Method: A cross sectional descriptive study was conducted among HCWs in non COVID and COVID emergency departments at PH, PAHS, Nepal, in April 2020 during COVID-19 outbreak. Questionnaires containing open and closed questions were used. Ethical approval was obtained. Result: Out of 72 HCWs, 58 (80.5%) responded, 47 (81%) felt need to have separate non COVID and COVID emergencies, 27 (46.6%) answered they were not comfortable working with the partial PPE (masks, gloves), 29 (50%) felt the need of having primary and secondary triaging. Conclusion: Emergency staff expressed need of having separate non COVID and COVID emergencies, and importance of primary and secondary triage. Keyword: COVID-19, emergency, primary and secondary triag

Awareness of COVID-19 and perception of work satisfaction among healthcare workers at Patan Hospital, Nepal

Introduction: Healthcare workers (HCWs) awareness of disease outbreak, and working efficiently in a changed environment is vital to fight pandemic. How an institution responds to the crisis depends on HCWs response. This study aims to find out awareness of COVID-19 and work satisfaction of HCWs at Patan Hospital (PH), Nepal. Method: A cross-sectional questionnaires base descriptive study was conducted at PH, Patan Academy of Health Sciences, Nepal, in April 2020. The HCWs were grouped in to technical staff, doctors, and support staff. There were 20 questions each in the awareness of COVID-19 and work satisfaction domain. Ethical approval was obtained. Result: Of all the staff, 223 various level staffs responded to the questionnaire. There were 80 (35.9%) technical staff, 77 (34.5%) doctors and 66 (29.6%) support staff in the study. In the technical staff group 1106 (69.2%) responses were in favour of having good awareness and 1337 (83.5%) responses were in favour of satisfaction. In the doctors’ group 1233 (80.1%) responses were in favour of having good awareness and 1000 (65%) responses were in favour of satisfaction. In the support staff group 236 (17.7%) responses were in favour of having good awareness and 347 (26.2%) responses were in favour of satisfaction. Conclusion: Our study showed that technical staff and doctors had higher levels of perception of work satisfaction and awareness for COVID-19. Keyword: awareness, COVID-19, health care workers, perception, work satisfactio

Assessment of patients presenting in shock at emergency department in a tertiary care teaching hospital Hospital

IIntroductions: Clinical profile of patient presenting with shock is important in early recognition and intervention to improve outcome especially in resource limited setup. This study is designed with an objective to evaluate history, clinical findings, laboratory findings and provisional diagnosis of patient presenting with shock. Methods: This was cross sectional observational study conducted at Patan Hospital emergency department from September to November 2014. All consecutive patients presenting with shock were included in this study during that period of time. Patient’s demography, clinical profile, provisional diagnosis and treatment were analyzed. Results: In two month period, 40 patients presented with shock to the emergency. Out of them 21(53.3 %) were female and 17(47.7%) were male. Commonest presenting complain was fever and shortness of breath 12(31.6%) each, shortness of breath followed by diarrhea 6(13.4%) and shortness of breath 5(13.2%). The diagnosis was as follows; septic shock 17(44.7%), hypovolaemic shock 10(26.3%), cardiogenic shock 7(18.4%) and unclassified 4(10.5%). Out of 17 patients with septic shock, 12 patient had pneumonia. Mean duration of stay in emergency was 100.6 minutes, minimum 30 minutes and maximum 225 minutes. Mean fluid given in emergency was 2328.9 milliliters, minimum 1000 millilitres and maximum 5000 millilitres. Conclusions: Sepsis was an important cause of shock in the emergency department. Pneumonia was common cause of sepsis and chronic obstructive pulmonary disease was common underlying condition. Keywords: emergency, lactate, shockÂ

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