Triaging Patients with Post-abortion Complications: A Prospective Study in Nepal

The first manual vacuum aspiration (MVA) services unit in Nepal was established in 1995 at the country's largest national maternity hospital in Kathmandu. This research sought to assess and evaluate the safety, acceptability, and effectiveness of MVAservices. This prospective study was conducted during 12 months in 1998, and follow-up was made at six weeks. Two groups of patients were compared: 529 patients treated in the MVA unit and 236 patients who were clinically eligible for treatment in the MVA unit but were treated instead in the main operation theatre (OT) owing to the unavailability of services in the MVA unit during the hours of their admission. The two groups differed with respect to some of their background characteristics but were similar in their clinical characteristics. The MVA group received contraceptive counselling and services and had significantly shorter stays in hospital. However, the direct cost incurred by the patients, regardless of the type of facility they used, was about the same. Follow-up at six weeks revealed that the MVA patients had significantly fewer complaints and were generally more satisfied with the services they had received than their counterparts. Slightly more than half of the women in the MVA group were using contraception at the time of follow-up compared to no women in the OT group. It is concluded that the MVA unit provided safe, effective, and efficient services to about 50% of all the patients admitted to the hospital with post-abortion complications. An additional 25% of the postabortion patients could be served if the unit were kept open 24 hours a day, saving resources and time for patients and hospital staff. As a parallel development, both MVAand main OT services would need to be more effectively integrated with outside antenatal and family-planning clinics to address the reproductive health needs of women, thereby reducing the number of patients requiring post-abortion care

Nurses Knowledge on Management of Patient Receiving Spinal Anaesthesia in a Government Hospital

Introduction: Spinal Anaesthesia (SA) is a form of regional anaesthesia involving injection of a local anaesthetic into the subarachnoid space. SA is directly related to nervous system, so its mismanagement may cause various complications hence, prevention and management of complication is a vital and complex aspect of critical nursing care. Therefore, the objective of this study was to assess the nurse’s knowledge on the management of patient receiving spinal anaesthesia. Methodology: A cross-sectional descriptive study was conducted among nurses of Koshi Zonal Hospital of Province no. 1, Biratnagar, Nepal from May to June 2017. Non-probability purposive sampling method was used where self-administered questionnaire was administered among 67 working nurses in the hospital. Results: The majority of the respondents (77.6%) belonged to 20-30 years of age group, nearly half (44.8%) of the respondents had completed PCL nursing. Only 67.2% explained the meaning of anaesthesia, and 58.2% had knowledge on physiological changes after SA. Regarding ambulation and cause of backache, 29.9% had knowledge whereas only 20.9% had knowledge about management of post spinal backache. Respondents facing problem to manage the complication after SA was 13.4%. This study also found that the overall knowledge regarding SA was adequate among 80.6% respondents. Conclusion: Nurses as the key personnel in management and prevention of complication, the obtained result was below the desired competence level among working nurses as it is the vital aspect of critical nursing care. Keywords: Knowledge, Nurses, Management, Spinal anaesthesia, Hospital DOI: http://doi.org/10.3126/jkahs.v2i2.2517

The impact of sediment flux and calibre on flood risk in the Kathmandu Valley, Nepal

AbstractThis paper investigates how variations in sediment supply, grain size distribution and climate change affect channel morphology and flood inundation in the Nakkhu River, Kathmandu, Nepal. Climate change‐induced extreme rainfall is expected to increase flood intensity and frequency, causing severe flooding in the Kathmandu basin. The upper reaches of the Nakkhu River are susceptible to landslides and have been impacted by large‐scale sand mining. We simulate potential erosion and deposition scenarios along a 14 km reach of the Nakkhu River using the landscape evolution model CAESAR‐Lisflood with a 10 m digital elevation model, field‐derived sediment grain size data, daily discharge records and flood forecast models. In a series of numerical experiments, we compare riverbed profiles, cross‐sections, flood extent and flow depths for three scenarios (1.2‐, 85‐ and 1000‐year return period floods). For each scenario, the model is first run without sediment transport and then with sediment transport for three grain size distributions (GSDs) (observed average, finer and coarser). In all cases, the inclusion of sediment led to predicted floods of a larger extent than estimated without sediment. The sediment grain size distribution was found to have a significant influence on predicted river morphology and flood inundation, especially for lower magnitude, higher probability flood events. The results emphasise the importance of including sediment transport in hydrological models when predicting flood inundation in sediment‐rich rivers such as those in and around the Himalaya.</jats:p

Unzipping flood vulnerability and functionality loss:tale of struggle for existence of riparian buildings

Floods pose significant risk to riparian buildings as evidenced during many historical events. Although structural resilience to tsunami flooding is well studied in the literature, high-velocity and debris-laden floods in steep terrains are not considered adequately so far. Historical floods in steep terrains necessitate the need for flood vulnerability analysis of buildings. To this end, we report vulnerability of riparian-reinforced concrete buildings using forensic damage interpretations and empirical/analytical vulnerability analyses. Furthermore, we propose the concept and implications of functionality loss due to flooding in residential reinforced concrete (RC) buildings using empirical data. Fragility functions using inundation depth and momentum flux are presented for RC buildings considering a recent flooding event in Nepal. The results show that flow velocity and sediment load, rather than hydrostatic load, govern the damages in riparian RC buildings. However, at larger inundation depth, hydrostatic force alone may collapse some of the RC buildings

Association of childhood trauma, and resilience, with quality of life in patients seeking treatment at a psychiatry outpatient: A cross-sectional study from Nepal

Quality of life is defined by the World Health Organization as "Individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns". It is a comprehensive measure of health outcome after trauma. Childhood maltreatment is a determinant of poor mental health and quality of life. Resilience, however, is supposed to be protective. Our aim is to examine childhood trauma and resilience in patients visiting psychiatry outpatient and investigate their relations with quality of life. A descriptive cross-sectional study was conducted with a hundred patients with trauma and visiting psychiatry outpatient. Standardized tools were applied to explore childhood trauma, resilience, quality of life and clinical diagnoses and trauma categorization. Sociodemographic and relevant clinical information were obtained with a structured proforma. Bivariate followed by multivariate logistic regressions were conducted to explore the relation between childhood trauma, resilience, and quality of life. Poor quality of life was reported in almost one third of the patients. Upper socioeconomic status, emotional neglect during childhood, current depression and low resilience were the determinants of poor quality of life in bivariate analysis. Final models revealed that emotional neglect during childhood and low resilience had independent associations with poor quality of life. Efforts should be made to minimize childhood maltreatment in general; and explore strategies to build resilience suited to the cultural context to improve quality of life

Quality of life and its association with psychiatric disorders in outpatients with trauma history in a tertiary hospital in Kathmandu, Nepal: a cross-sectional study

Background Quality of life is an important indicator of health and has multiple dimensions. It is adversely affected in patients with trauma history, and psychiatric disorders play an important role therein. Studies in trauma-affected populations focus mainly on the development of psychiatric disorders. Our study explored various aspects of quality of life in trauma patients in a clinical setting, mainly focusing on the association of psychiatric disorders on various domains of quality of life. Methods One hundred patients seeking help at the psychiatry outpatient of a tertiary hospital in Kathmandu, Nepal, and with history of trauma were interviewed using the World Health Organization Composite International Diagnostic Interview version 2.1 for trauma categorization. Post-traumatic stress disorder symptoms were assessed using the Post-Traumatic Stress Disorder Checklist-Civilian Version; while the level of anxiety and depression symptoms was assessed using the 25-item Hopkins Symptom Checklist-25. Quality of life was assessed using the World Health Organization Quality Of Life-Brief Version measure. Information on sociodemographic and trauma-related variables was collected using a semi-structured interview schedule. The associations between psychiatric disorders and quality of life domains were explored using bivariate analyses followed by multiple regressions. Results The mean scores (standard deviations) for overall quality of life and health status perception were 2.79 (.87) and 2.35 (1.11), respectively. The mean scores for the physical, psychological, social and environmental domains were 12.31 (2.96), 11.46 (2.84), 12.79 (2.89), and 13.36 (1.79), respectively. Natural disaster was the only trauma variable significantly associated with overall quality of life, but not with other domains. Anxiety, depression and post-traumatic stress disorder were all significantly associated with various quality of life domains, where anxiety had the greatest number of associations. Conclusion Quality of life, overall and across domains, was affected in various ways based on the presence of psychiatric disorders such as anxiety, depression and post-traumatic stress disorder in patients with trauma. Our findings therefore emphasize the need to address these disorders in a systematic way to improve the patients’ quality of life

Detection of biofilm formation among Pseudomonas aeruginosa isolated from burn patients

Background: Pseudomonas aeruginosa is an opportunistic bacterium that rapidly colonised on the exacerbated skin surface after the burn injury. Along with inherent resistance to many antibiotics, it is also a good biofilm producer that aggravates the condition of burns patients by slow or non-responsive to antibiotics. Therefore, immediate attention must be taken otherwise the condition of patients may become life-threatening. Hence, this cross-sectional study was conducted to know the current scenario of antimicrobial profile and biofilm properties of Pseudomonas aeruginosa isolated from burn patients in Nepal Cleft and Burn Centre, Kirtipur Hospital. Methods: Wound swab or pus samples were taken from 344 patients through the Levine technique or syringe, respectively. The standard laboratory protocol was followed for the identification of Pseudomonas aeruginosa. The antibiotic susceptibility test of isolates was performed by using the Kirby-Bauer disc diffusion method as per the CLSI 2018 guidelines. Biofilm production was accessed through the tube method and microtiter plate assay. Results: All together 60 Pseudomonas aeruginosa were isolated from a total of 275 isolates. The antibiotic susceptibility profile showed that more than 50% of isolates were non-susceptible among the tested antibiotics and shifting of antibiotic choice to piperacillin-tazobactam from traditional amikacin, ciprofloxacin and imipenem. The weak agreement of Kappa statistics indicates that biofilm procurement from the tube method and microtiter plate assay was insignificant. Approximately 25% of P. aeruginosa isolates were biofilm producers and there was no relation between biofilm production and antibiotic susceptibility patterns (χ2 = 0.587). Conclusion: Pseudomonas aeruginosa is a common isolate from burn wound infections. There is a shifting in antibiotic choice and more than half of the isolates were antibiotic resistant; however, no relation between biofilm formation and multidrug resistant profile of isolates was found

An assessment of surgical outcome with the influencing factors of horizontal strabismus surgery

Background: Influencing factors of conventional horizontal surgery for surgical outcome has not been assessed in Nepal. Aims and Objective: To assess the pre-operative factors that influences the surgical outcome of horizontal strabismus surgery. Materials and Methods: The medical records of 68 patients who underwent their first horizontal strabismus surgery at Lumbini Eye Institute from 1st January to 30th December 2015 were retrospectively reviewed. The collected clinical data included diagnosis, age group, visual acuity, binocular function, extraocular motility and pre and postoperative deviation. The success of surgery was defined by eye deviation less than 10 prism diopters (PD) at 6 weeks after operation. The influencing factors for surgical success (diagnosis, age group, visual acuity, binocular function, and angle deviations) were analyzed using chi square test and Mann-Whitney - U test, where ever appropriate. Results: Out of 113 patients who underwent strabismus surgery during the year, 68 patients were enrolled in the study. Majority of the patients (27, 39.7%) were >9 years of age and 52.9% were female. Thirty seven patients (54.4%) were esotropic whereas, 31 were exotropic. Preoperatively, angle of deviation ranged from 20 to 90 PD with binocular vision present in 57.4% cases. Overall, success was seen in 26 patients (38.2%). Pre-operative angle of deviation and binocular vision had statistical significance with surgical success (p = 0.012 and 0.026 respectively). Conclusion: Larger angle of deviation and poor binocular vision at presentation has higher failure rate for horizontal strabismus surgery