Journal of Karnali Academy of Health Sciences

Knowledge and Compliance of Oral Anticoagulation Therapy at Warfarin Clinic in Kathmandu: A Cross-sectional Study

Roji Shakya — 2023-12-31

Background: Warfarin is the most widely used anticoagulant drug worldwide due to its low cost and ease of use. Adequate knowledge and compliance to oral anticoagulation therapy are essential measures that decrease morbidity and mortality among cardiac patients. This study aimed to assess the level of knowledge and compliance regarding oral anticoagulation therapy among patients with a mechanical heart valve.
Methods: A cross-sectional study was carried out among patients with mechanical heart valves on warfarin at Shahid Gangalal National Heart Centre of Kathmandu, Nepal. Participants were selected through a systematic random sampling technique, and a face-to-face interview was conducted. Knowledge was assessed using validated oral anticoagulation knowledge questionnaires composed of 20 multiple-choice questions. Compliance was assessed using 8 items Morisky Medication Adherence Scale. The descriptive and bivariate analysis were carried out using the Statistical Package for the Social Sciences version 16.
Results: A total of 222 patients were included in this study. Only 35 (15.8%) had good knowledge, and 93 (41.9%) had high compliance to oral anticoagulation therapy. The mean adherence score was 1.81 ± 0.78. Age, literacy, and educational level of the patients were statistically significant with knowledge. The compliance was significantly related only with a duration of warfarin use (p=0.003).
Conclusion: The patients had a moderate level of knowledge on warfarin therapy. However, they had good compliance with oral anticoagulation therapy. Based on the findings, education awareness program is recommended to improve the patient’s knowledge on oral anticoagulants.

Effect of Food Insecurity on Nutritional Status of Reproductive Age Women of Squatter Settlement of Pokhara Metropolitan, Kaski, Nepal

Saru Paudel — 2023-12-31

Background: Food insecurity is the situation that exists when all people, at all times, didn’t have secure access to enough amounts of safe and nutritious food that meets their dietary needs for an active and healthy life. However, the nutritional status of women can be determined by family care and household food security as they are keepers of family health. So, this study was conducted to assess the effect of food insecurity on the nutritional status of reproductive-age women and its determinants in squatter settlement.

Methods: A cross-sectional study was carried out in the squatter settlement of Pokhara Metropolitan. A multistage sampling procedure was used to get the required sample size i.e., 426. Reproductive age group women (15-49 years) were selected because of their central role in food preparation and distribution. Household Food Insecurity Access Scale was used to collect information based on a 30-day recall period.
Results: Nearly two-thirds (65%) of household food insecurity was found in the squatter settlement of Pokhara Metropolitan. While assessing the nutritional status of reproductive-age women it was found that 38.1% were overweight and 13.6% were underweight women. Factors such as age, dependent members in a family, educational status, occupational status, age during the marriage, age during the first pregnancy, parity, the number of children, and household food insecurity were associated with the BMI of respondents at a 95% confidence level. We found a strong direct effect on respondent’s education (OR=2.036, C.I: 1.321-3.136), occupation (OR=2.014, C.I: 1.295-3.132), and household food insecurity (OR=1.629, C.I: 1.088-2.439).
Conclusion: The study highlights a need for nutrition and food security programs. Improving the educational status of women will help them to get financially independent which can improve household food security and maintain the healthy weight of women in slums.

Attitude Towards Online Education During Covid-19 Pandemic Among Bachelor Level Students of Jumla

Monika Lama — 2023-12-31

Background: Health science students, since long time, have been using digital technology mainly for the research purposes only. Due to global spread of corona virus disease (COVID-19), education system has changed and adopted online education which was a solution for the continuity of teaching and learning process during COVID-19 pandemic. The main objective of this study was to assess the attitude towards online education among bachelor level health science students.
Methods: A descriptive cross-sectional study was carried out at Karnali Academy of Health Sciences, Jumla. Complete enumeration was done. Total 68 bachelor level students were taken for the study. A pretested self administered questionnaire was used for data collection. Data were entered and analyzed by using SPSS version 16. Frequency and percentage were also computed for demographics variables. Chi-square test was applied to assess the association between socio-demographic variables and attitude level.
Results: The study illustrated that, among the 68 bachelor level students, nearly two third (63.2%) students had negative attitude towards online education during COVID-19 pandemic. There was statistically significant association of attitude level with ethnicity, type of program and strength of internet connection (p≤0.05).
Conclusion: Majority of students of Karnali Academy had negative attitude towards online education; and they had faced many difficulties like internet and electricity problem etc. Administration and faculty members should take necessary measures for improving online education.

Neutrophil-to-Lymphocyte Ratio in Adult Patients with Anemia: A Hospital-Based Cross-Sectional Study

Nilu Manandhar — 2023-12-31

Background: Neutrophil-to-lymphocyte ratio, a well-defined marker of immunity, is raised in many conditions which are characterized by abnormal inflammatory and immunological responses. Anemia of chronic disease, the most prevalent type in hospitalized patients, is a dominant clinical picture in protracted stimulation of immunity. This study aimed to assess the neutrophil-to-lymphocyte ratio in adult participants with anemia and to compare of the ratio with non-anemic participants.
Methods: In a cross-sectional study conducted in the Department of Clinical Physiology of Karnali Academy of Health Sciences, Teaching Hospital, Jumla, Karnali Province, Nepal, in the months of August, 2023, data on clinico-demographic variables were retrieved from the laboratory information system of hospital records of February–March, 2023. From the hematological parameters retrieved, the status of anemia and the neutrophil-to-lymphocyte ratio were calculated.
Results: After scrutiny of the laboratory records of 1421 adult patients, with 69.7% (N=990) female, the prevalence of anemia was 12.4% (N=176) and the median neutrophil-to-lymphocyte ratio was 2.21 (IQR: 1.41–3.75). The median neutrophil-to-lymphocyte ratio was significantly greater in the anemic participants among the overall (p<0.001) participants and across the subgroups of gender (p<0.001) and age (p<0.05).
Conclusion: The neutrophil-to-lymphocyte ratio was significantly greater in the adult anemic than in the non-anemic participants. To this end, further studies assessing the association of this ratio with the various clinical aspects of anemia, such as subtypes, severity, course, prognosis and treatment responses are needed.

Correlation of Anthropometric Measurements with Hamstring Graft Size in Anterior Cruciate Ligament Reconstruction in Nepalese Population: A Prospective Observational Study

Santosh Nepal — 2023-12-31

Background: The use of autologous hamstring tendon for arthroscopic Anterior Cruciate ligament (ACL) reconstruction is very common. The size of hamstring tendons varies significantly between individuals, and graft diameter is unpredictable. Anthropometric measurements may be a simple way to estimate hamstring tendon length and diameter. This study aims to determine the correlation between anthropometric measurements of patients with length and diameter of harvested hamstring autograft during ACL reconstruction.
Methods: A prospective observational study was carried out after ethical approval. All patients who underwent arthroscopic ACL reconstruction from 1 March 2022 to 30 April 2023 in Birat Medical College Teaching Hospital were included. Fourty seven patients’ age, sex, height, weight and thigh length were recorded preoperatively. Hamstring tendons were harvested and length of the semitendinosus tendon and diameter of the quadrupled graft (doubled semitendinosus and doubled gracilis) was measured intraoperatively. We used Pearson’s correlation coefficient to observe the relationship between anthropometric measurements and graft variables.
Results: Mean length of harvested semitendinosus tendon was 27.4 ± 1.8 cm and mean quadrupled hamstring autograft diameter was 7.4 ± 0.8 mm. A significant positive correlation between graft variables (semitendinosus tendon length and quadrupled hamstring autograft diameter) and patients’ height and thigh length was found.Regression equations for predicting Semitendinosus tendon length and quadrupled hamstring autograft diameter from thigh length in males and females are also derived.
Conclusion: Height and thigh length of patients are useful parameters for predicting semitendinosus tendon length and quadrupled hamstring graft diameter before ACL reconstruction.

Severity and Clinical Outcome of COVID-19 Patients Admitted at a Provincial Infectious and Communicable Disease Hospital of Nepal: A Cross-Sectional Study

Bikash Gauchan — 2023-12-31

Background: This study provides information regarding severity and clinical outcome of people admitted with the diagnosis of COVID-19 infection during the global pandemic at a provincial infectious disease hospital in Gandaki Province in Nepal. The evidence from this study will be helpful to compare the clinical outcome of people admitted with COVID-19 during the outbreak.
Methods: Cross-sectional study was conducted from March 2023 to August 2023 after approval from NHRC (ref. no. 1448) with sample size of 1366 at the hospital. Structured questionnaire was used to collect secondary data (electronic and paper records) retrospectively from hospital records with a diagnosis of COVID-19 infection. Total enumeration technique was used with enlisting of all cases of COVID-19 to the hospital. The collected data was analyzed using SPSS version 11.5.
Results: The hospital admitted the highest number of cases between April to September 2021. Among the 1366 admitted cases, 791 (57.91%) were males and 575 (42.09%) were females, the most common age group affected was 31 to 40 years (22.99%); 1092 (79.94%) were from Kaski district. As per disease severity, 884 (64.71%) were moderate cases followed by 391 (28.62%) mild cases and 91 (6.67%) severe cases. A total of 1205 (88.21%) patients were discharged, 105(7.69%) patients were referred and 56 (4.10%) patients died of COVID -19.
Conclusions: Almost 3/4th of the admitted cases came from same district, majority had moderate disease and the hospital cure rate was almost 8/9th. As the majority of cases are from active age group (21 years to 60 years old), public health measures can be targeted to these groups including surrounding population to stop transmission and spread of COVID-19 or similar infectious diseases. The information from this study can guide for the preparation and planning of in-patient and isolation departments of similar other provincial infectious disease hospitals.

Comparative Study of Image Quality and Radiation Dose between 120kVp Filtered Back Projection and 80kVp Iterative Reconstructed Computed Tomography Images

Sweta Joshi — 2023-12-31

Background: Iterative Reconstruction techniques have been shown to produce diagnostically acceptable images at low doses to the patient. This study aimed to compare the image quality and radiation dose between 120kVp Filtered Back Projection and 80kVp Iterative Reconstructed (SAFIRE) CT images.
Methods: This cross-sectional study was performed on patients referred for CT Urography examinations for various clinical indications to the Department of Radiology and Imaging, Tribhuvan University Teaching Hospital. Data were collected for a period of four months (From August to November 2019) after approval from the Institutional Review Committee of the Institute of Medicine. Convenience sampling was employed and a total of 96 examinations were included. Among them 48 were male and 48 were female. Data were obtained from the 128-slice MDCT Siemens Somaton Definition AS+ CT scanner. Venous phase scans were obtained with Protocol A (120kVp and Filtered Back Projection) and non-contrast scans were obtained with Protocol B (80kVp and SAFIRE). The mAs (tube current-time product) was fixed at 200 for both protocols.
Results: There was a 72.5% reduction in Size Specific Dose Estimate (SSDE) in Protocol B compared to Protocol A. However, there was a 13.17% increase in noise in Protocol B compared to Protocol A. Image quality evaluation showed a 98.95% acceptability for the low dose i.e. Protocol B images.
Conclusion: CT using low kVp (80kVp) and low current (200mAs) along with an iterative reconstruction algorithm (SAFIRE) can provide diagnostically acceptable images at very low doses for examinations of the Urinary tract

Comparative Study of Ropivacaine Alone Versus Combination of Ropivacaine with Either Dexmedetomidine or Dexamethasone for Ultrasound Guided Supraclavicular Brachial Plexus Block

Kumud Pyakurel — 2024-01-06

Background: Ropivacaine is a common choice for supraclavicular brachial plexus block. Dexmedetomidine and Dexamethasone are frequently added to local anesthetics for improved effects. With limited comparative evidence, this study aimed to assess Dexmedetomidine and Dexamethasone as adjuvants to Ropivacaine in ultrasound-guided supraclavicular brachial plexus block.
Methods: This prospective double-blind study enrolled patients aged 18-60, scheduled for elective upper limb surgery below mid-humeral level. They were randomly assigned into three groups: Ropivacaine alone, Ropivacaine with Dexmedetomidine (1 mcg/kg), or Ropivacaine with Dexamethasone (8 mg). The study aimed to compare sensory and motor blockade onset and duration, postoperative analgesia duration, and adverse event occurrence among the groups.
Results: Ninety-eight patients participated in the study. All three groups showed similar characteristics in terms of age, weight, gender, ASA grade, and surgery duration. The onset and duration of sensory and motor block were comparable between the Dexamethasone and Dexmedetomidine groups. A significant difference was observed when comparing the Ropivacaine only group to either of the other two groups or when comparing all three groups. Similarly, postoperative analgesia duration was comparable between the Dexamethasone and Dexmedetomidine groups while it differed significantly when comparing all three groups or when comparing the Ropivacaine only group to either of the other groups. Ropivacaine with Dexmedetomidine group experienced notable occurrence of bradycardia.
Conclusion: Dexamethasone and Dexmedetomidine as adjuvants to 0.5% Ropivacaine for ultrasound-guided supraclavicular brachial plexus blockade have comparable effects on sensory and motor blockade onset and duration, along with postoperative analgesia duration. Dexmedetomidine, however, is linked to more bradycardia compared to Dexamethasone.

Analysis of Methanol Content in Different Varieties of Traditionally Fermented Alcohol Found in Chandannath Municipality of Jumla District, Nepal

Apurba Acharya — 2023-12-31

Background: Alcohol poisoning associated with traditionally fermented alcoholic beverages have been reported in Nepal with the constituents of these beverages not being quantified usually. In traditionally fermented alcoholic beverages, methanol, due to its cheaper cost and similar physiochemical properties with ethanol, is adulterated most commonly and readily. The objective of the present study was to quantify four different varieties of traditionally fermented alcoholic beverages available in Chandannath, Jumla for methanol level.
Methods: The present study is a cross-sectional study in which four different types of traditionally fermented alcoholic beverages were collected from Chandannath, Jumla and they were analyzed for methanol content. From Chandannath municipality, the ward number two was selected for collection of samples. Further, from this ward, four different households regularly involved in brewing local alcohol were also randomly selected. These households belonged to three different ethnic groups (Indo-Aryan, Tibeto-Burman and Newar) and these samples were chhyang (sample- 1), local raksi (sample- 2), nigar (sample- 3) and local apple cider (sample- 4). In air tight containers, the samples were sealed and transported to Zest laboratory, Bhaktapur, Nepal for quantification of methanol using Gas Chromatography.
Results: The residents in half of these four households belonged to the Tibeto-Burman ethnic groups. Methanol was detected in two samples among the four analyzed beverages. These samples, sample- 2 and sample- 4, on quantification showed the concentrations of 10.050ppm and 13.721ppm of methanol respectively.
Conclusion: Among four samples of locally brewed alcoholic beverages, methanol was detected in two samples, but at a concentration below the level that would be considered toxic. This finding emphasizes the importance of conducting larger-scale quantification of traditionally fermented alcohol to mitigate the various health risks associated with its potential toxicity, as these beverages are currently not being quantified.

Cyclopia: A Rare Congenital Anomaly

Uttara Gautam — 2023-12-31

Cyclopia is the most extreme form of holoprosencephaly. It is characterized by the failure of the embryonic prosencephalon to properly divide the orbits of the eye into two cavities which results in babies with a single or partially divided eye in a single orbit. We report a case of a 28 years old primigravida who came for medical termination at 25 weeks of gestation and delivered a 600 grams dead female fetus with cyclopia, fetal proboscis, and neurocutaneous marker. Its incompatibility with life makes early diagnosis using ultrasonography and fetal magnetic resonance imaging essential in early management and essential counseling to parents.

Amniotic Band Syndrome with CTEV and Meningocele: A Rare Case Report

Sandeep Shrestha — 2023-12-31

Amniotic band syndrome (ABS) is a group of rare congenital abnormalities caused by wrapping of parts of the foetus by fibrous amniotic bands during intrauterine life. It can be seen in infants without any known genetic mutations. Band formation most frequently affects the distal segments, including the hand. Here, we report a case of a neonate who presented with multiple congenital abnormalities and clinical features that suggest the Amniotic Band Syndrome. It was delivered by a 17-year-old female patient at 28 weeks period of gestation, who had a medical abortion.

Evaluating the Potentials of Open Source in Medical Field: Are We Ready to Embrace it?

Jay Prakash Jha — 2023-12-31

Open source software has gained significant traction in recent years, along with some concerns. Here we discuss the features open source model like greater transparency, cost-effectiveness, and customization. It also addresses the rising concerns on privacy and security issues in internet. This article highlights the benefits and limitations of open source software in medical services and health education.

Use of Smart Mobile and Web Application Kobotoolbox/ Kobocollect for Community Health Diagnosis: Sharing Experience from the Remote Area of Nepal

Umesh Raj Aryal — 2023-12-31

Community Health Diagnosis (CHD) is part of teaching-learning activities at medical and public health schools to recognize the health-related issues in the community, identify social and other problems in depth, and find solutions by shaking hands with community people. Every year, the household survey is conducted by medical, nursing, and public health students as a part of CHD. Our experiences revealed that the student faces several challenges while using paper-based data collection and management during CHD. To overcome such challenges, we used a web-based and smart mobile application called KoboToolbox/KoboCollect to conduct household surveys in CHD in remote areas of Nepal for the first time. Our experience suggests that mobile-based Applications can be used conveniently in CHD which saves time and money for students as well as for schools and can conserve the environment trees. Those students who are not familiar with smart technology need to be trained before using this app.