Care Center In Nepal Research Articles

Evaluating cognitive outcomes in adult patients with acute encephalitis syndrome: a prospective study from a tertiary care center in Nepal.

Although cognitive impairment is a known complication of acute encephalitis syndrome (AES), few studies have evaluated cognitive outcomes in patients with encephalitis. The primary objective of this study was to assess the cognitive profiles of patients diagnosed with AES, which is pivotal for improving rehabilitation strategies and prognostic measures. This study was conducted at the Tribhuvan University Teaching Hospital. Adult patients with AES who met inclusion criteria were enrolled. The Montreal Cognitive Assessment (MoCA) tool was used to assess cognitive function at admission, discharge, and 3-month follow-up. Thirty-six patients were enrolled in our study. The mean age of the participants was 43 ± 18 years. Fourteen patients (38.9%) were female, and 22 (61.1%) were male. Tuberculous (TB) meningoencephalitis was present in 14 cases (38.9%), with herpes simplex virus (HSV) encephalitis in 14 (38.9%), bacterial meningoencephalitis in 4 (11.1%), autoimmune encephalitis in 2 (5.6%), and Japanese encephalitis in 2 (5.6%). Patients with bacterial meningoencephalitis had the highest MoCA scores at admission, whereas those with HSV encephalitis had the highest scores at discharge and follow-up. Compared with the scores at admission, the scores at discharge and follow-up increased significantly in patients with TB meningoencephalitis and HSV encephalitis. The MoCA score at discharge was established as a significant predictor of cognitive function at follow-up. We found that active treatment can improve the outcomes of AES patients with cognitive impairment. Although infectious etiologies are most common in low-income countries such as Nepal, autoimmune etiologies should not be overlooked.

Moderate Hydronephrosis among Acute Ureteral Calculus on Ultrasonographic Imaging in a Tertiary Care Center in Nepal: A Descriptive Cross-sectional Study.

Ureteric calculi are lying at any point of ureter from the pelvic ureteric junction to the vesicoureteral junction. If left untreated, ureteropelvic junction obstruction can lead to hydronephrosis. With the improved availability of computed tomography and ultrasound scanning, hydronephrosis is being diagnosed more frequently. The main aim of this study is to find out the prevalence of moderate Hydronephrosis among ureteral calculus on ultrasonography imaging in a tertiary care center of Nepal. A descriptive cross-sectional study was conducted among 110 acute ureteral calculus cases at Radiodiagnosis and Imaging Department of Chitwan Medical College and Teaching Hospital, Bharatpur from 15th August 2020 to 15th May 2021. The ethical approval was taken from the Institutional Review Committee of same institution. Convenient sampling technique was used to select the participant. The collected data was entered in excel 16 and analysed in Statistical Package for Social Sciences. Point estimate at 95% Confidence Interval was done and frequency and percentage were calculated. Out of the 110 cases of acute ureteral calculus, 31 (28.2%) (19.79-36.60 at 95% Confidence Interval) has moderate hydronephrosis in the ultrasonographic imaging. The mean age of participants was 31.61±8.51 years and male to female ratio was 1.97:1. Vesicoureteric junction was the most common site for ureteric calculus 39 (35.5%). The ultrasound is an easy method to be applied, and a fast one to help and diagnose obstructive hydronephrosis. The main causes of hydronephrosis are kidney stones, followed by ureteral stones, with a moderate degree of hydronephrosis.

Management of Pain with Morphine in cancer patients in a Tertiary Care Centre of Nepal

Pain is one of the most afflicting symptoms reported by cancer patients, mainly those with metastatic disease. The prevalence of cancer has increased, with an estimated projection of 17 million new cases in 2020. This means that there will be an increase in individuals with pain caused by the disease and by treatment. Morphine has been used to relieve pain in cancer patients for centuries. WHO, created a global health policy document for management of cancer pain entitled “Cancer Pain Relive,1 in which morphine was central. In a retrospective study of 1229 patients with cancer pain, the author reported that the analgesic ladder was effective in 71%. Many patients do not get adequate pain relief. Rationale of this study was to assess cancer related pain by using visual analogue pain scale and to prescribe optimal dose of morphine through dose titration to relieve pain and to improve quality of life. An interventional hospital-based study was done in fifty-two different types of cancer patients from 1st Jan, 2020 to 31st Dec, 2020 at Department of Oncology, Nepal Medical college and Teaching Hospital (NMCTH), Kathmandu. Among them 31 were male and 21 were female with mean age 63.87 and 58.19 respectively and SD +/- 12.10 in male and 16.07 in female with p value 0.152 significant. These patients were assessed for severity of pain through visual pain analogue. Improvement in daily activities after administration of morphine according to ECOG performance scale was done. Constipation was the most common complication induced by morphine 38.5%, sedation 32.7% and nausea in 25%. By understanding the context and social meaning surrounding the use of morphine to treat cancer pain, health care professionals can begin to anticipate, acknowledge and address some of the barrier to its use, thereby enhancing the pain control.

Meropenem Resistance among Acinetobacter Positive Clinical Samples in a Tertiary Care Centre in Nepal: A Descriptive Cross-sectional Study.

Antimicrobial-resistant Acinetobacter species are implicated in a variety of infections including nosocomial bacteraemia, secondary meningitis, and urinary tract infections. Carbapenem including meropenem-resistant Acinetobacter is recognized as one of the most difficult antimicrobial resistant gram-negative bacilli to control and treat. It was classified as an urgent threat by Centers for Disease Control and Prevention in 2019 Antibiotic Resistance Threats Report. This study was carried out to determine the prevalence of meropenem resistance among acinetobacter positive clinical samples in a tertiary care centre. A descriptive cross-sectional study was carried out in microbiology department of Clinical Laboratory Services among Acinetobacter positive clinical samples of a tertiary care center in Nepal. The culture and sensitivity reports of various clinical samples from April 2018 to April 2020 which were positive for Acinetobacter species were taken from hospital records section. Convenience sampling was done. Meropenem-resistant Acinetobacter samples were studied. Ethical approval was received from Institutional Review Committee (Ref No. 076/77/40). Analysis of data was done using Statistical Package for the Social Sciences version 26. Point estimate at 95% Confidence Interval calculated with frequency. Out of 121 Acinetobacter isolates, prevalence of meropenem-resistant Acinetobacter was reported in 93 (76.9%) at 95% Confidence Interval (69.39-84.40). Among the meropenem-resistant Acinetobacter samples, most of the samples were collected from the sputum 70 (75.2%) followed by blood 8 (8.6%). High prevalence of meropenem-resistant Acinetobacter species in our hospital setting is alarming. In addition, there is emergence of resistance against even the last resort drugs which is creating a treatment crisis.

PGN-018 - Antibiogram and biofilm formation among multidrug-resistant Acinetobacter baumannii clinical isolates at a tertiary care centre in Nepal

PGN-018 - Antibiogram and biofilm formation among multidrug-resistant Acinetobacter baumannii clinical isolates at a tertiary care centre in Nepal

Cesarean Section Among all Deliveries in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.

Worldwide there is a tremendous increase in cesarean section rate over the last decades which has been a global public health issue. This study aimed to find out the prevalence of cesarean delivery in a tertiary care center of Nepal. A descriptive cross-sectional study was conducted among pregnant women at tertiary care centre from 15th September 2019 to 15th October 2020. Ethical clearance was taken from the Institutional Review Committee (Ref: CMC-IRC/077/078-200). Convenience sampling was done to reach the sample size. Basic demographic data, clinical indications and neonatal outcomes were noted. Data entry was done using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 3193 total deliveries, cesarean deliveries were 1412 (44.22%) at 95% Confidence Interval (42.49-45.94). Among caesarean deliveries 1086 (76.9%) were emergency cesarean sections. Most common indication for cesarean section was fetal distress (24.9%). Among 1437 newborns, 1428 (99.4%) were live births, 1387 (98.2%) were singleton and 801 (55.7%) were male. Nearly one third 418 (29.1%) neonates required neonatal intensive care unit admission and transient tachypnoea of newborns (44.28% in emergency and 60.46% in elective cesarean delivery) was the most common indication for admission. The prevalence of cesarean delivery was found to be higher than that recommended by the World Health Organisation. Fetal distress was the leading indication for cesarean deliveries.

Anaemia among Patients of Heart Failure in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.

Anaemia is an important comorbidity common in patients with heart failure and is associated with poor clinical status and worse outcomes. In Nepal few studies have evaluated anaemia amongst patients suffering from heart failure. We intended to find out the prevalence of anaemia in patients with heart failure in a tertiary care centre. This is a descriptive cross-sectional study conducted among patients of heart failure presenting to tertiary care hospital in eastern Nepal from April 2017 to January 2018. Ethical approval was taken from the Institutional Review Committee of a tertiary care centre (reference number: IRC/0842/016). Using the convenience sampling method, 100 patients were enrolled in the study. Blood samples from the patients were taken for haemoglobin and serum iron studies. Data was analysed using Statistical Package for Social Sciences version 11. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage. Among 100 patients with heart failure, 82 (82%) (74.47-89.53 at 95% Confidence Interval) had anaemia. Mean haemoglobin level of the study population was 10.40±2.73 g/dl. Fifty four (54%) of patients had iron deficiency status irrespective of presence or absence of anaemia. Prevalence of anaemia among patients of heart failure in our study was found to be higher than various other homologous international studies.

Clinical Spectrum and Demographic Profile of Alcoholic Liver Disease Among Females Attending Tertiary Care Center in Nepal

Introduction: Alcohol is the most common abused substance in Nepal. Women tend to present with more severe liver disease with a shorter period of excessive drinking and at a lower daily alcohol intake compared to men. Methods: Adult female patients aged 16 years and above, with a diagnosis of ALD were included for a period of 1 year. Liver disease secondary to other causes were excluded. Demographic profiles, clinical features, laboratory, endoscopic findings, Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD) of the patients were recorded. Results: A total of 144 female patients with ALD were included in the study. The mean age of the patients was 48.6 years (SD=12.7). Majority of the patients were from Hilly region (n=66, 45.8%), married (n=135, 93.8%), housewife (n=83; 57.6%), Hindu by religion (n=93; 64.6%), and Tamang (n =39; 27.1%) by caste. Most common clinical features of the patients were abdominal distension (n=117; 81.2%), bilateral lower limb swelling (n=89; 61.8%), jaundice (n=54; 37.5 %) and anorexia (n=53; 36.8%). The main reason for alcohol consumption was found to be family custom in 42.3%. Esophageal varix was present in 119 (82.6%) patients. Out of 124 patients with cirrhosis, 63 (50.8%) patients were in CTP stage C and 103 (83.1%) patients had MELD score ≥ 16. Conclusion: ALD was predominantly seen among the younger female patients. The most common clinical presentations were abdominal distension, bilateral lower limb swelling, jaundice and anorexia. Among the cirrhotic patients, most of patients were in CTP class C and had MELD score ≥ 16.

Clinical Profile of Low Vision in Children

Introduction: Visual impairment in children is more common in developing countries like Nepal. A low vision service has been found to be effective in significantly improving their overall development and quality of life. The main aim of this study was to determine the causes of low vision in pediatric population along with their refractive error distribution and visual functions. Methods: A descriptive cross sectional study was carried out in Tribhuvan University, BP Koirala Lions Center for Ophthalmic Studies. A total of 50 low vision children were under went detail low vision examination. They were selected through purposive sampling. Data was analyzed by using the descriptive and inferential statistics with SPSS version 19.0. Results: The study findings showed, most common cause of visual impairment in low vision children was refractive error (20%), followed by congenital cataract (18%) and macular dystrophy (16%). The most commonly prescribed low vision device for distance was telescope and for near was spectacle magnifier. There was average acuity improvement of five lines in distance visual acuity with low vision devices. Conclusion: The study concluded that refractive error and congenital cataract being the commonest cause of low vision in children, which reflect poor accessibility of care service among Nepalese children. Refractive error, the major cause of visual impairment could have been managed even in primary eye care center in Nepal. Children with impairment have potential visual acuity that can be improved with low vision services.

Hypertension among Young Adults with Ischemic Stroke of a Tertiary Care Centre in Nepal: A Descriptive Cross-sectional Study.

Ischemic strokes in young patients have been increasing. Younger patients with ischemic stroke tend to have a different long-term prognosis than older patients. Young patients who have residual neurological deficits following ischemic stroke affect their quality of life. This study was carried out to find out the prevalence of hypertension among patients with ischemic stroke in a tertiary care hospital. This descriptive cross-sectional study was conducted in all the patients who were admitted with young ischemic stroke in the Department of Neurology, Nobel Medical College Biratnagar from December 2019 to December 2020 after taking ethical clearance from the Institutional Review Committee (reference number: 332/2019). Convenience sampling was done and data was collected, entered in Microsoft Excel, and analysis was done using Statistical Package for the Social Science software version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of the total patients with ischemic stroke in the young adults 30 (40%) (95% Confidence Interval= 28.91-51.08) had hypertension. During follow-up at 6 months, 20 (66.7%) of the patients with hypertension had favorable outcomes with a Modified Rankin Score of 0 or 1. Death during a hospital stay or during follow-up was observed in 2 (7%) of patients with hypertension. Mean age of the patients was 40±4.87 years. Most patients were in the age range of 36-45, 24 (80%). Prevalence of hypertension among young patients with ischemic stroke was high compared to other studies.

Mean Evan's Index among Patients with Normal Computed Tomography Scan visiting Radiology Department in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.

Evan's index is useful to objectively see if ventricles size is abnormal especially in borderline cases of hydrocephalus. Studying ventricular size in CT scan is essential in every pathology of the brain. Use of objective parameters to define hydrocephalus helps us not only to diagnose a case but also follow up the case following treatment. The aim of this study was to find out the mean even index among patients visiting the department of radiology of a tertiary care hospital. A descriptive cross-sectional study was conducted at a tertiary care hospital from 1st january 2020 to 31st December 2020. Ethical clearance was obtained from the Institutional Review Committee of Upendra Devkota Memorial Neurological and Allied Sciences (reference number: 116/2021). Computed tomography scans were done for various reasons in the hospital over a one year period and reported normal by the radiologists were included in the study. Convenient sampling was done. Statistical analysis was done using Statistical Package for the Social Sciences. Point estimate at 95% Confidence Interval was calculated along with mean and standard deviation for continuous data. In this study, among the 216 cases, the mean Evan's index was found to be 0.20±0.04. The mean evan's index in our study population was lower than the normal cut-off value.

Ureteric Injuries after Hysterectomy in a Tertiary Care Center of Nepal: A Descriptive Cross-sectional Study.

Pelvic surgery is the most common cause of iatrogenic ureteral injury. The incidence of ureteric injuries varies between skilled and inexperienced surgeons. The study aims to determine the prevalence of ureteric injuries sustained during hysterectomy in a tertiary care center of Nepal. A descriptive cross-sectional study involving the women attending the gynecological outpatient department of a tertiary care center of Nepal, for various benign and malignant conditions and later on underwent hysterectomy from June 2019 to June 2020 was done after obtaining ethical clearence from the Institutional Review Committee (Reference No. 245). Convenient sampling method was used. The data were entered in Excel and analyzed using Statistical Package for Social Sciences version 17. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Altogether, 1 (0.63%) (0.55-0.71 at 95% Confidence Interval) out of 159 patients sustained the ureteric injury during hysterectomy in a tertiary care center of Nepal. The injury was seen during the exploratory laparotomy for adnexal mass. The injury was recognized intraoperatively and was repaired with double J stenting. A total of 159 patients were enrolled in the study that had undergone hysterectomy over one year for various benign and malignant conditions. Out of which 21 (13.2%) had undergone surgeries for malignant conditions and 138 (86.79%) for benign conditions. Iatrogenic ureteric is still a major cause of harm and concern in hysterectomy. Patients with ureteric injury should be evaluated and intervened at the earliest.

Position of parotid papilla and commissure of lip in relation to maxillary occlusal plane among patients visiting a tertiary care centre of Nepal

Introduction: The exact position of the Parotid papilla and commissure of the lip plays a crucial role in determining the maxillary occlusal plane which directly facilitates rehabilitating edentulous patients with a removable complete denture. Since the beginning, many authors have conducted different studies regarding its position but multiple variations in its location have been noted. Also, this type of study has not been conducted in the Nepalese population which drags the urge to determine the position of these soft-tissue landmarks in context to the Nepalese population. Objective: To determine the position of parotid papilla and commissure of lip in relation to the maxillary occlusal plane. Materials and Methods: A descriptive cross-sectional study was conducted in the 45 dentate subjects visiting Nobel medical college from November 2019 to April 2020. A vestibular impression was made, stone index fabricated and vernier caliper was used to locate position of parotid papilla & commissure of lip. All the data were collected and statistically analyzed. Results: The mean measurement of distances between maxillary occlusal plane and parotid papilla was 3.69 ± 1.19 mm and between maxillary occlusal plane and commissure of lip was 0.41 ± 0.83 mm respectively. Conclusion: This study showed that the position of the parotid papilla was superior to the position of the maxillary occlusal plane with a mean distance of 3.69mm. The commissure of lip was found to be at the level of maxillary occlusion plane in highest number of cases followed by a superior position with least at the inferior position with respect to the maxillary occlusal plane.

Assessment of Chance fracture on Computed Tomography Scan in Tertiary Trauma Care Center of Nepal.

Introduction: Chance fracture is a horizontal fracture of the vertebra extending from the posterior element to the vertebral body due to flexion-distraction injury and is potentially unstable. The aim of this study was to evaluate the demography and Computed Tomography scan findings in Chance fracture of the spine. Method: A retrospective study was conducted at the National Trauma Center, National Academy of Medical Sciences over a period of one year (December 2019 to December 2020). Demographic data, mechanism of injury, and computed tomographic findings of Chance fracture were recorded. Result: Computed tomography scans of 41 patients with Chance fracture were identified. Fall injury (76%) was the most common cause of Chance fracture followed by road traffic accidents. This fracture was most commonly seen in thoracolumbar junction TLJ (D10-L2); with L1 being the most affected vertebra (36.5%). Among posterior elements, facet distraction (84%) was the most common finding followed by lamina fracture (83%), and pedicle fracture (68%). Regarding vertebral body fracture, involvement of both superior and inferior endplates were common than isolated involvement of either one of them. CT revealed that a burst component was a common finding (68%) in Chance fracture. Conclusion: Chance fracture was commonly caused by fall injury in our context which is higher in incidence than previously reported. More than half of patients with Chance fracture also had Burst-type components that could influence surgical management. Computed tomography scans is a useful imaging modality for the assessment of Chance fracture and burst component.

Surgical Management and Early Outcome of Encephalocele

Background: There are limited studies pertaining to management of encephalocele in Nepal. So the present study seems justifiable to bridge the gap in the literature on encephalocele from Nepal on its clinical profile and early outcome. This study aims to characterize the clinical profile, management and outcome of largest series of encephalocele at tertiary care center in Nepal.
 Materials and Methods: A retrospective analysis of encephalocele, managed surgically at two tertiary care centers between 2015 and 2020, was performed.
 Results: Total of 25 cases was surgically managed in the present study. The median age of study population was 2.5 months. There were 11 male and 14 female with male to female ratio of 1:1.26. Occipital encephalocele was the most common variant. Lump in the head (n=11) was the commonest clinical presentation followed by hyperteliorism (n=10). One patient presented with cleft lip and one had CSF discharge in a case of occipital encephalocele. Bony defect was the common radiological findings. Excision and repair was the most common mode of surgery leading to good outcome. Mortality rate was 4% with morbidity of 20%.
 Conclusion: Early surgical excision and tight dural closure with repair of bony defect is the standard treatment with relatively good outcome.

Tuberculosis among Patients Admitted to the Department of Medicine of a Tertiary Care Center in Nepal: A Descriptive Cross-sectional Study.

Tuberculosis has high burden in developing countries like Nepal. This study aims to determine the prevalence of tuberculosis among patients admitted in the department of medicine of a tertiary hospital. A descriptive cross-sectional study of all the patients admitted to the tertiary care hospital from 1st January 2017 to 31st December 2019 was done. Ethical approval was obtained from Institutional Review Committee (Ref: drs2006181387). Convenience sampling method was used. A descriptive analysis of demographic, clinical and laboratory profile of patients was made using Microsoft Excel version 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Among 6829 patients admitted to the department of medicine, 209 (3.06%) (2.65-3.47 at 95% CI) patients were diagnosed with tuberculosis. Among them, 147 (70.33%) were males and the mean age was 49.77 years. Pulmonary and extra-pulmonary tuberculosis were present in 153 (73.20%) and 56 (26.79%) patients, respectively. Bacteriological confirmation was limited to 107 (70%) of pulmonary tuberculosis and 3 (5%) of extrapulmonary tuberculosis. Fever was the commonest presentation in 166 (79.42%) followed by cough in 164 (78.46%), anorexia in 108 (51.67%), weight loss 104 (49.76%), and others. The study showed that the prevalence of tuberculosis among admitted patients was higher than national prevalence.

Male genital injuriesattending a tertiary hospital inawestern region of Nepal:Atwo-year snapshot.

Male genital injuries are urological emergencies which if not promptly treated with correct therapeutic interventionmaylead to chances of loss of fertility due to infections and anatomical disruption of normalcy.This study highlights the clinical scenarios, etiology and outcome of malegenitalinjury cases that were managed at a tertiary care center in Nepal.Such injuriesare not frequently encounteredaslack of reportingbypatients means cases are rare.The present study isthefirst from Nepal which depicts a comprehensive report on male genital injuries. Methods:A retrospective analysis of discharge summarieswas carried out and the cases of male genital injuries were reviewed duringJune2020. All the treatedcasesduring thetwo-yearperiod from April 2018 to April 2020at Lumbini Medical College, Nepalwere included in the study. Results:There wereeightcases ofgenitaltrauma admitted and treated during the study period. All thepatients weremales and age ranged fromsixto 71 years with a mean age of33±21.45years. Fall injury and road traffic accidents (RTA) were observed to be the primary cause inthemajority of cases. Conclusion:Superficial injuriestothepenis and scrotum do not require surgical exploration and could be managed conservatively. However,deeperand complicated injuries, testicular preservation, the functionality of the partandcosmetic issuesaretaken into consideration which might requireamulti-disciplinary approach.Apart from themedical issues pertaining togenital injuries, there arelegal and psychological aspects of such eventstoo which should not beignored.

Septorhinoplasty among Patients who Visited the Outpatient Department of Otolaryngology-Head and Neck Surgery of a Tertiary Care Center: A Descriptive Cross-sectional Study.

The nose is the central most part of the face, so any nasal deformities may cause a high level of psychological distress on one's quality of life. Septorhinoplasty is a surgical procedure used to correct both functional as well as aesthetic problems of the nose. It enhances facial harmony and increases self-confidence. The objective of this study is to find out the prevalence of out-patients who underwent septorhinoplasty in a tertiary care centre in Nepal. A descriptive cross-sectional study among 5,760 patients who visited the outpatient department of Otolaryngology-Head and Neck Surgery of Kathmandu Medical College from April 2019 to September 2020. Ethical approval was taken from the Institutional Committee of Kathmandu Medical College. A convenient sampling technique was used. The preoperative and postoperative assessment was done with the help of a rhinoplasty outcome evaluation questionnaire. Statistical Package for the Social Sciences is used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. The prevalence of septorhinoplasty was 117 (2.03%) during the study period (95% Confidence Interval= 1.66-2.40). Among 117 patients, 67 (57.3%) were males and 50 (42.7%) were females. Among 117 patients, 85 (72.6%) patients underwent an open approach, while 32 (27.4%) patients underwent closed approach rhinoplasty for the correction of both aesthetic and functional problems. This study concludes the prevalence of septorhinoplasty is low which may be due to the COVID-19 pandemic during the study period.

Rheumatic Heart Disease among Pregnant Women with Cardiac Diseases in a Tertiary Care Center of Nepal: A Descriptive Cross-sectional Study.

Cardiac disease in pregnancy is a major cause of maternal mortality and morbidity in women, particularly in resource limited countries like Nepal. Rheumatic Heart Disease is the commonest cardiac disease complicating pregnancy. There is very limited data and evidence from Nepal regarding rheumatic heart disease complicating the pregnancy. The study aims to find out the prevalence of rheumatic heart disease among cardiac disease patients in a tertiary care hospital. A descriptive cross-sectional study was conducted among 41 women with cardiac disease who delivered babies at Chitwan Medical College from 1st January 2018 to 31st December 2019, after taking ethical approval from the Institutional Review Committee. A convenient sampling method was used. Statistical Package for the Social Sciences was used for data analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Among 41 pregnant women with cardiac disease, 32 (78%) (95% Confidence Interval = 65.32-90.68) had rheumatic heart disease. The mean age of the affected pregnant women was 24.9±4.49 years. Out of 32 patients with rheumatic heart disease, postpartum haemorrhage was the most common maternal complication 5 (15.6%) followed by hypertension 4 (9.7%). Rheumatic Heart Disease was highly common among pregnant women with cardiac disease.

Prevalence assessment of sexually transmitted infections among pregnant women visiting an antenatal care center of Nepal: Pilot of the World Health Organization's standard protocol for conducting STI prevalence surveys among pregnant women.

Sexually transmitted infections (STIs) are common during pregnancy and can result in adverse delivery and birth outcomes. The purpose of this study was to estimate the prevalence of STIs; Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (syphilis), Trichomonas vaginalis (trichomoniasis), and Human Immunodeficiency Virus (HIV) among pregnant women visiting an antenatal care center in Nepal. We adapted and piloted the WHO standard protocol for conducting a prevalence survey of STIs among pregnant women visiting antenatal care center of Dhulikhel Hospital, Nepal. Patient recruitment, data collection, and specimen testing took place between November 2019-March 2020. First catch urine sample was collected from each eligible woman. GeneXpert platform was used for CT and NG testing. Wet-mount microscopy of urine sample was used for detection of trichomoniasis. Serological test for HIV was done by rapid and enzyme-linked immunosorbent assay tests. Serological test for syphilis was done using "nonspecific non-treponemal" and "specific treponemal" antibody tests. Tests for CT, NG and trichomoniasis were done as part of the prevalence study while tests for syphilis and HIV were done as part of the routine antenatal testing. 672 women were approached to participate in the study, out of which 591 (87.9%) met the eligibility criteria and consented to participate. The overall prevalence of any STIs was 8.6% (51/591, 95% CI: 6.3-10.8); 1.5% (95% CI: 0.5-2.5) for CT and 7.1% (95% CI: 5.0-9.2) for trichomoniasis infection. None of the samples tested positive for NG, HIV or syphilis. Prevalence of any STI was not significantly different among women, age ≤ 24 years (10%, 25/229) compared to women age ≥25 years (7.1%, 26/362) (p = 0.08). The prevalence of trichomoniasis among pregnant women in this sub-urban population of Nepal was high compared to few cases of CT and no cases of NG, syphilis, and HIV. The WHO standard protocol provided a valuable framework for conducting STI surveillance that can be adapted for other countries and populations.