An Audit of An Intensive Care Unit of A Tertiary Care Hospital

Introduction: The patients with the most severe and life threatening illnesses requiring constant monitoring and support are admitted in the intensive care unit. Tribhuvan University Teaching Hospital is the oldest and tertiary referral center hospital in the country with eleven-bedded level III mixed medical surgical ICU. This audit was performed to study the profile of critically ill patients under different headings like diagnosis at admission, primary specialty, outcome of the patients, etc. Methods: A descriptive cross-sectional study was designed and all patients admitted to the intensive care unit of our center between 13 April 2017 and 13 April 2018 (1st Baisakh 2074 to 30th Chaitra 2074) were selected for this study. Results: A total of 813 patients were admitted in TUTH ICU over a period of one year (2074 B.S.) with male patients being more common. Neurosurgical cases were most common at 199 (24.48 %), followed by respiratory cases at 149 (18.32%) and so on. The overall mortality was 246 (32.8%). The overall surgical cases were more common than medical cases with better outcomes. Conclusions: This audit presents the profile of patients admitted in a tertiary level hospital in Nepal, their indications and mortality. The most common patients being admitted were Neurosurgical patients and the mortality was significantly higher compared to ICUs in developed countries

Genetic variability, heritability and genetic advance in Lentil (Lens culinaris Medik.)

The present study was carried out to study the variation, broad-sense heritability, and genetic advance, correlation among traits for growth, yield, and its attributing traits in lentil genotypes. Sixty lentil genotypes were evaluated in augmented design in 2020 at Khajura, Banke. The results indicated that the genotypes were significantly different for days to flowering, days to maturity, 500 seed weight and grain yield kg/ha. The phenotypic coefficient of variation (PCV) was greater than the genotypic coefficient of variance (GCV) for all traits. The 500 seed weight showed the highest PCV (22%) and GCV (21%) whereas days to maturity showed the lowest PCV (5.5%) and GCV (3.2%). The highest value (90%) of heritability (broad sense) was in and lowest (3%) in pods per plant. Genetic Advance Mean 40% was the highest for seed weight but lowest at 1.2% in pods per plant. Grain yield showed a positive and significant correlation in genotypic level with days to maturity (r = 0.7**), plant height (r = 1.66*), pods per plant (r = 1.15**) and seed weight (r = 0.56*). Path analysis found that the seed weight had the most impact on grain yield followed by pod per plant. Thus, selection for yield in lentils through these characteristics would be effective in the varietal developmental program. &nbsp

Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Peer reviewe

Stroke epidemiology and outcomes of stroke patients in Nepal: a systematic review and meta-analysis

Abstract Background With an increasing burden of stroke, it is essential to minimize the incidence of stroke and improve stroke care by emphasizing areas that bring out the maximum impact. The care situation remains unclear in the absence of a national stroke care registry and a lack of structured hospital-based data monitoring. We conducted this systematic review and meta-analysis to assess the status of stroke care in Nepal and identify areas that need dedicated improvement in stroke care. Methods A systematic literature review was conducted to identify all studies on stroke epidemiology or stroke care published between 2000 and 2020 in Nepal. Data analysis was done with Statistical Package for Social Sciences (SPSS) and Comprehensive Meta-analysis (CMA-3). Results We identified 2533 studies after database searching, and 55 were included in quantitative and narrative synthesis. All analyses were done in tertiary care settings in densely populated central parts of Nepal. Ischemic stroke was more frequent (70.87%) than hemorrhagic (26.79%), and the mean age of stroke patients was 62,9 years. Mortality occurred in 16.9% (13-21.7%), thrombolysis was performed in 2.39% of patients, and no studies described thrombectomy or stroke unit care. Conclusion The provision of stroke care in Nepal needs to catch up to international standards, and our systematic review demonstrated the need to improve access to quality stroke care. Dedicated studies on establishing stroke care units, prevention, rehabilitation, and studies on lower levels of care or remote regions are required