Exploring Biomedical, Temporal, and Embodied Perspectives on the Timing of Birth in Central Nepal

As an ANHS Senior Fellow, I began to explore the standardization of time in obstetrics and its translation into everyday practice in Nepal by analyzing the various perspectives involved in determining a woman’s ideal time of delivery and a successful pregnancy: those of laypeople, doctors, and the scholars setting the guidelines. I observed Nepali biomedical practitioners’ negotiation of multiple understandings of parturition and their strategies for overcoming the challenges of pre- and post-term births

Paradigm Shift in Gynecological Surgeries Over Eight Years in Dhulikhel Hospital.

Introduction: One of the greatest achievements in the surgical field is the paradigm shift from opensurgery to minimal invasive surgery. Hysteroscopy, laparoscopy, laparoscopy-assisted vaginal hysterectomyand total laparoscopic hysterectomy are frequently performed minimal invasive gynecological surgeries.These surgeries are being regularly performed in Dhulikhel hospital. This study aims to review thechanges in surgical approaches in the field of gynecological surgeries in this institute. Methods: This was aretrospective study of changes in surgical approaches from conventional to minimal invasive surgery in thefield of gynecological surgeries from 2010 to 2018. Demographic characteristics of patients and indicationfor various minimal invasive surgeries were compared over this time period. Results: There were significantchanges in surgical approaches from conventional open surgeries to minimally invasive approach throughthe years. There was no obvious difference in demographic characteristics of the cases and the indications forhysterectomy and endometrial sampling were comparable. Conclusion: There was definitely paradigm shiftin conventional method to minimal invasive methods for major gynecological surgeries like hysterectomy,ovarian cystectomy, salpingectomy for ectopic pregnancy and endometrial samplings

Effect of Anemia in Pregnancy and its Perinatal Outcome: A Prospective Cohort Study

Introduction: Anemia is a major risk factor for poor maternal health status. Anemia during pregnancy leads to poor birth outcomes such as fetal anemia, low birth weight, preterm birth, stillbirth, and neonatal mortality. This study aimed to assess the effect of anemia in pregnancy and its perinatal outcome. Methods: A prospective study was conducted among 370 pregnant women in Dhulikhel Hospital, Kavre from June 2017 to December 2017. Descriptive statistics were used to represent the socio-clinical characteristics. Bivariate analysis was performed to analyze the effect of anemia. Results: The study found that all the participants were anemic out of which mild anemia was observed in 352 (95.4%), moderate anemia in 17 (4.6%), and severe anemia in one (0.3%) participants respectively. Women aged 17 to 24 years and multiparous women had higher odds of having moderate anemia (Hb 7.0-8.9 g/dL). Women with moderate anemia had more odds of having neonates with less Apgar scores. Women with moderate anemia had nine times higher odds of having newborn mortality. Conclusion: Anemia during pregnancy not only affects the health status of the mother but also impacts the birth outcomes. This study highlighted the emphasis on the active participation of governmental and non-governmental organizations to prevent adverse effects of anemia during pregnancy and birth outcomes

An inexpensive device to treat postpartum hemorrhage: a preliminary proof of concept study of health provider opinion and training in Nepal

BACKGROUND: Obstetric hemorrhage remains the leading cause of maternal mortality in resource limited areas. An inexpensive pneumatic anti-shock garment was devised of bicycle tubes and tailored cloth which can be prepared from local materials in resource-limited settings. The main purposes of this study were: 1) to determine acceptability of the device by nurses and midwives and obtain suggestions for making the device more suitable for use in their particular work environments, 2) to determine whether a three hour training course provided adequate instruction in the use of this device for the application of circumferential abdominal pelvic pressure, and 3) determine production capability and cost in a resource-limited country. METHODS: Fifty-eight nurse and midwife participants took part in three sessions over eight months in Nepal. Correct device placement was assessed on non-pregnant participants using ultrasound measurement of distal aortic flow before and after device inflation, and analyzed using confidence intervals. Participants were surveyed to determine acceptability of the device, obtain suggestions for improvement, and to collect data on clinical use. RESULTS: Device placement achieved flow decreases with a mean of 39% (95% CI 25%-53%, p < 0.001) in the first session, 28% (95% CI 21%-33%, P < 0.001) after four months and 29% (95% CI 24%-34%, p < 0.001) at 8 months. All nurses and midwives thought the device would be acceptable for use in obstetric hemorrhage and that they could make, clean, and apply it. They quickly learned to apply the device, remembered how to apply it, and were willing and able to use the device clinically. Ten providers used the device, each on one patient, to treat obstetric hemorrhage after routine measures had failed; bleeding stopped promptly in all ten, two of whom were transported to the hospital. Production of devices in Kathmandu using local tailors and supplies cost approximately $40 per device, in a limited production setting. CONCLUSIONS: Preliminary data suggest that an inexpensive, easily-made device is potentially an appropriate addition to current obstetric hemorrhage treatment in resource-limited areas and that further study is warranted

Outcome of anterior cruciate ligament reconstruction using bone-patellar tendon-bone auto graft

Introductions: A rupture of the Anterior Cruciate Ligament (ACL) is the most common ligament injury resulting in instability of the knee which can cause secondary articular injury and early osteoarthritis (OA). Aim of this study was to evaluate the short term outcomes of ACL reconstruction using Bone Patellar Tendon Bone Auto Graft (BPTB) auto graft and factors that might contribute to poor results. Methods: Patients with Anterior Cruciate Ligament injury during the period of July 2013 to May 2014 were enrolled to observe the outcome of the ACL reconstruction using BPTB without arthroscopy. Lysholm Knee Scoring Scale was used to determine the clinical outcome. Outcome parameters were evaluated using Statistical Package for Social Science Version 20 (SPSS). Results: Total 30 normal or near normal function outcome of knee was reported in 29 (97%) patients after ACL reconstruction using BPTB without arthroscopy. There was no failure of grafts. Good static knee stability achieved with increased patient’s satisfaction. Lysholm Score was excellent in 27 (90%) and good in 3 (10 %) cases. Anterior knee pain persisted in 6 cases (20%). Conclusions: Excellent functional outcome with BPTB auto graft in Anterior Cruciate Ligament injury was achieved. Keywords: ACL reconstruction, bone-patellar tendon-bone auto graft, clinical outcom

Minimally Invasive-Closed Reduction and Percutaneous Pinning for Supracondylar Fractures of the Humerus in Children

Introductions: Although Closed Reduction and Percutaneous Pinning is the goldstandard of treatment for Supracondylar fractures (SC) in children, reductionis not always easy. Minimally Invasive, Closed Reduction and PercutaneousPinning (MI-CRPP) reduces the soft tissue trauma and provides easy reduction.We have reviewed the success rate of minimally invasive reduction techniqueand its outcome.Methods: We reviewed the charts of 155 children (97 male, 58 female) ageranging from 2 to 14 years with SC fractures of the humerus who were operatedwith minimally invasive closed reduction and precutaneous pinning fromNovember 2008 to June 2014 at Patan Hospital and Om Hospital. They werefollowed up for a mean of eight (4 to 24) weeks. The K-wires were removed at4 to 6 (average 4.28) weeks.Results: Male children were affected more than female with the ratio being 97to 58. Right side was affected more than left (ratio 89 to 66). Post-operatively,there were six (3.87%) ulnar nerve injury and eight (5.16%) patients came withsuperficial pin tract infection. One hundred and thirteen (72.9%) had excellent,35 (22.58%) good, five (3.23%) fair and two (1.3%) poor results at the eightweek follow-up which was improved to 144 (92.9%) excellent, seven (4.5%)good, three (1.9%) fair and one (0.65%) poor results at the 14 week follow-up.Conclusions: Closed reduction of supracondylar fractures of the humerus inchildren with minimally invasive technique prior to K-wire fixation is a relativelysimple, safe and effective method of achieving satisfactory reduction and goodfunctional outcome.Keywords: cubitus varus deformity, K wire fixation,minimally invasive closedreduction and precutaneous pinning, supracondylar fracture

Flexible intramedullary nailing for femoral diaphyseal fractures in children

Background &amp; Objectives: Although various treatment options are available for the treatment of femoral diaphyesal fractures in children, the titanium flexible nailing has gained popularity because it is safe, easy procedure with rapid recovery and high success rate. The aim of this study was to evaluate the outcome of titanium elastic nails in treating paediatric femoral diaphyesal fractures at Patan Hospital.Materials &amp; Methods: There were 35 cases which were all fixed with titanium flexible intramedullary nail under image intensifier at the Patan hospital from January 2013 and December 2015. Patients were evaluated in follow-ups to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, implant failure, range of movement of hip and knee joints, and time to unite the fracture. The final results were evaluated using criteria of titanium elastic nail (TEN) outcome score described by Flynn et al.Results: The mean age of the patients was 8.51 years. Among 35 patients (22 boys and 13 girls), there were 19 mid-shaft fractures, nine proximal third fractures and seven distal third fractures. Fracture patterns were transverse (22), oblique (10), spiral (2), and comminuted (2). The mean time for fracture union was 8.17 weeks radiologically whereas 9.83 weeks clinically. According to TEN outcome score, excellent and good results were in 28 cases (80%) and seven cases (20%) respectively.Conclusion: Flexible titanium nailing is a safe and satisfactory treatment for diaphyseal femoral fractures in children, because it provides rapid recovery, short rehabilitation and immobilization as well as very high union rate with few complications. </p