Dhulikhel Hospital Research Articles

Vascular anomalies: Presentation and response to medical and surgical management, our experiences in the last 5 years

Aim: Vascular anomalies, lesions of abnormal vascular development pose a significant challenge in some of the cases for diagnosis and management. The International Society for the Study of Vascular Anomalies has classified this condition into two broad types as vasoproliferative or vascular neoplasms such as hemangioma and vascular malformation. We have analyzed all the cases with vascular anomalies that have presented in outpatient department (OPD) in the past 5 years. Materials and Methods: All patients presented to vascular OPD of Dhulikhel Hospital in the year 2013–2017, if patients are diagnosed with vascular anomalies, are included in the study. Details on age, sex, site of the lesion, and medical or operative management performed are analyzed. Results: Of the total 51 vascular anomalies cases, the mean age of the patient was 22.4 years (standard division. 8.4, range 6 months to 51 years). Female-to-male ratio was 2.4:1. Forty cases (70.48%) belonged to vascular malformation while 11 cases (21.56%) were of hemangioma. In case of vascular malformation, 18 cases were of venous malformation while 8 cases were of capillary malformation. There were a total of 14 arteriovenous malformations. The highest number of anomalies was noticed in the lower limb (39.22%) followed by the head (25.49%). Regarding treatment modality opted, in five cases, medical management with oral steroids and propranolol was advised. In 35 cases, surgical resection was done. Conclusion: Vascular anomalies are detected in fairly young patients with preponderance in the female. Treatment of vascular anomalies is complex and is based on stage, type, and location of each anomaly.

Pelvic Floor Muscle Training Program in Pregnant Nepalese Women- A Feasibility Study

Aims: Obstetric Fistula is one of the common pelvic floor dysfunctions that affects the women’s quality of life. PFMT is recommended as first line treatment for prevention and treatment of pelvic floor dysfunctions. There is lack of knowledge on the feasibility of performing a PFMT program in pregnant Nepalese women. The aim was to develop a Pelvic floor muscle training (PFMT) program and to assess the feasibility of the program by assessing attendance to antenatal follow-up visits and adherence to PFMT.
 Methods: The PFMT program included development of education material (video, leaflet, and poster) and PFMT in different positions. Pregnant women (before 16 weeks of gestation) visiting Dhulikhel Hospital were recruited consecutively. Sociodemographic factors, pregnancy history, symptoms of urinary incontinence, pelvic organ prolapse and depression questionnaires were collected at first and last visit. Number of antenatal follow-up visits, exercise diary records and motivation questions for performing PFMT were also collected.Compliers were defined as women attending four or more PFMT antenatal follow-up visits. 
 Results: Two hundred and fifty three pregnant women with mean age25 (Standard deviation, (SD) 4) years and mean gestation weeks of 10(SD 3) were included. In total, 164 (65%) participants complied with the PFMT program and 89 (35%) did not comply.Eight percent of the women reported not doing PFMT and approximately 20% women over-reported to have performed PFMT.
 Conclusions: More than half of the women completed the PFMT program. Adherence to PFMT had inconsistent results.

Clinical Profile, Radiological Resolution and Risk Factors Associated with Community Acquired Pneumonia

IntroductionPneumonia is a widespread and commonest infectious lung disease that causes inflammation which lead to reduced oxygenation. Indeed, it is the leading cause of child death in the world. The study was carried out to fine out the demographic, clinical characteristics and radiologic resolution of Pneumonia in children between 2 months to 16 years of age.Material and MethodsA prospective study done in 121 cases over 18 month period in patients admitted in pediatric department of Dhulikhel hospital. Demography, clinical profile, diagnosis, Down’s scoring at presentation, response of treatment and risk factor for fetal Community acquired pneumonia were analyzed using descriptive statics. Chest radiography was done on admission and every 2 weeks until its complete resolution occurred.ResultsA total of 121 patients with community acquired pneumonia were enrolled. The male and female ratio was 1.69:1. Among all age group it was most significantly common in children less than 1 year (p=.022).The common symptoms of Community acquired pneumonia observed in this study were cough (80%), fever (66%) and shortness of breath (38.8%). On chest roentgenogram right middle zone(47.9%) was most frequently involved. The total leukocyte count had low degree of association with pneumonia. More than half of patients (54.08%) with community acquired pneumonia had radiographic resolution at 2 weeks. The respiratory distress was significantly high (p<0.0001) in children who delayed to seek medical treatment in a health facility by three days.Anemia, lymphopenia, thrombocytopenia, sepsis and hemorrhagic pleural effusion were the clinical characteristics associated withfatal Community acquired pneumoniaConclusionClinical presentations variesin Community acquired pneumonia with different age groups. Chest radiography is still best investigation for the diagnosis of pneumonia and most of the radiological clearance occurs in 2 weeks.

The epidemiology of typhoid fever in the Dhulikhel area, Nepal: A prospective cohort study.

IntroductionTyphoid fever (TF) continues to cause considerable morbidity and mortality in Nepal, but only limited epidemiologic data is available about TF outside Kathmandu.MethodsAs part of an interventional trial, we performed a prospective cohort study of bacteremic TF patients in Dhulikhel Hospital between October 2012 and October 2014. Demographic, epidemiological, clinical, and microbiologic data were recorded.Results116 bacteremic typhoid patients were included in the study. Most were young, healthy, adults (mean age 27.9±12 years), 41.4% of whom were female. More than 70% of patients were employed in non-manual services or were university students. Salmonella Typhi accounted for 64/115 (55.7%) of all isolates, while Salmonella Paratyphi accounted for 51/115 (44.3%), of which 42 were Paratyphi A and 9 Paratyphi B. A significant proportion of TF cases occurred also during the dry season (48/116, 41.6%). The clinical presentation of Salmonella Typhi and Paratyphi infections was similar, except for a greater proportion of arthralgia in patients with Salmonella Typhi. Most Salmonella Typhi and Paratyphi isolates were resistant to nalidixic acid and susceptible to older antibiotics. One Salmonella Paratyphi isolate was resistant to ceftriaxone.ConclusionsTF remains common in the Dhulikhel area, even among those with a high level of education. Public health measures aimed at reducing the incidence of TF in the Dhulikhel area are warranted. The relative burden of TF caused by Salmonella Paratyphi is rising; a vaccine with activity against Salmonella Paratyphi is needed. Since Salmonella Paratyphi B was more prevalent in this cohort than in large cohorts of patients from Kathmandu, it is likely that there are significant regional variations in the epidemiology of TF outside Kathmandu.

Barriers and facilitators to treatment among patients with newly diagnosed hypertension in Nepal

ObjectiveHypertension is a significant and rising burden in Nepal. The disease remains undetected and inadequately managed. However, no studies have been conducted to understand the inhibiting and facilitating factors to...

Correlation of Hormonal Profile and Lipid Levels with Female Adult Acne in a Tertiary Care Center of Nepal

Acne beyond 25 years of age is frequently associated with hormonal derangement in women. Hormonal association provides the impetus for hormonal therapy as well as underpins the need for blood investigations in this population. Hence, we aim to estimate the presence of hormonal derangement and lipid alteration in female adult acne. A prospective, observational study was conducted in Dhulikhel Hospital from July 2015 to February 2016. Females older than 25 years with acne were taken in the study after informed consent. Total 100 patients were enrolled after sample size estimation. Hormonal paneland lipid profile were measured. Hormones tested were androgens, C-peptide and thyroid stimulating hormone.Data analysis was done with SPSS-23. Bivariate analysis was done by chi-square test for categorical data. In this study, majority of patients were younger than 30 years (70.5%) and perioral area most commonly involved. Hormonal alteration was seen in 37.2% patients, among which17.9% had hyperandrogenism, 15.4% had abnormal thyroid level and 10.3% had high C-peptides respectively. Lipid profile was altered in 15.4% patients. Hormonal alteration had significant association with irregular menstruation (P<0.05) but not acne severity. We observed hormonal alteration frequently in females with adult acne, which comprised of various hormonal parameters including hyperandrogenism.Hormonal alteration reflects deranged metabolic milieu and we suggest that wide hormonal panel should be done in female adult acne. Relationship of hormones with menstrual irregularity but not with acne severity, suggest that clinical symptoms should lead hormonal investigations in all grades of acne.

Correlation of Hormonal Profile and Lipid Levels with Female Adult Acne in a Tertiary Care Center of Nepal

Background: Acne beyond 25 years of age is frequently associated with hormonal derangement in women. Hormonal association provides the impetus for hormonal therapy as well as underpins the need for blood investigations in this population. Hence, we aim to estimate the presence of hormonal derangement and lipid alteration in female adult acne.Methods: A prospective, observational study was conducted in Dhulikhel Hospital from July 2015 to February 2016. Females older than 25 years with acne were taken in the study after informed consent. Total 100 patients were enrolled after sample size estimation. Hormonal paneland lipid profile were measured. Hormones tested were androgens, C-peptide and thyroid stimulating hormone.Data analysis was done with SPSS-23. Bivariate analysis was done by chi-square test for categorical data.Results: In this study, majority of patients were younger than 30 years (70.5%) and perioral area most commonly involved. Hormonal alteration was seen in 37.2% patients, among which17.9% had hyperandrogenism, 15.4% had abnormal thyroid level and 10.3% had high C-peptides respectively. Lipid profile was altered in 15.4% patients. Hormonal alteration had significant association with irregular menstruation (P&lt;0.05) but not acne severity. Conclusions: We observed hormonal alteration frequently in females with adult acne, which comprised of various hormonal parameters including hyperandrogenism.Hormonal alteration reflects deranged metabolic milieu and we suggest that wide hormonal panel should be done in female adult acne. Relationship of hormones with menstrual irregularity but not with acne severity, suggest that clinical symptoms should lead hormonal investigations in all grades of acne.Keywords: Acne; adult; hormones; lipid; thyroid.

Factors Associated with Medication Adherence among Type 2 Diabetes Mellitus Patients in Nepal

Background: Diabetes is increasing globally resulting in 1.5 million deaths in 2012. The high mortality is due to life-threatening complications of uncontrolled sugar. Medication helps to control glucose level and prevents its complications. Objective: To identify the factors associated with medication adherence among type 2 diabetes mellitus (DM) patients. Methods: A hospital based cross sectional study was conducted among 343 patients visiting Dhulikhel Hospital, Nepal for their regular Fasting Blood Sugar test from September to December 2016. Inclusion criteria were (i) type 2 DM patients (ii) under diabetes medication from at least past three months (iii) aged 18 years or above. We measured medication adherence using Nepali version of 8 item Morisky Medication Adherence Scale (MMAS-8) (© 2007 Donald E. Morisky). Adherence was categorized as high if MMAS score was equal to 8 and moderate/low if it was less than 8. We used standard questionnaire to measure socio-demographic and clinical factors. Multivariate logistic regression was applied to assess factors associated with medication adherence. Results: Proportion of high and moderate/low medication adherence among the respondents were 60.9% and 39.1% respectively. In multivariate logistic regression, high medication adherence was found to be positively associated with formal education [AOR: 2.43 (95% CI: 1.34, 4.39), p=0.003] and attendance of diabetes counseling [AOR: 1.76 (95% CI: 1.02, 3.04), p=0.04] after adjusting for age, occupation, annual household per-capita income, medicine intake duration and diabetes medicine types. Other variables in the model were not statistically significantly associated. Conclusion: Formal education and attendance of diabetes counseling were found to positively affect patients’ adherence to medicine. We encourage heath care institutions to provide counseling services to all type 2 DM patients and focus more on those who are least educated. Disclosure P. Shakya: None. B.M. Karmacharya: None. A. Shrestha: None. B.E. Kulseng: None.

Achievement of 3B goals among T2DM patients: An experience from Central Nepal

Background:Management of type 2 diabetes mellitus (T2DM) requires comprehensive control of three metabolic parameters: blood glucose, blood pressure (BP), and blood lipid commonly known as 3B. We studied the prevalence of patients reaching the 3B goals in Nepalese context. Materials and Methods:Patients aged 30 years or above who presented in Dhulikhel Hospital outpatient clinic of internal medicine department of Dhulikhel Hospital with a diagnosis of T2DM diagnosed at least for 6 months were enrolled in this cross-sectional, observational study. Patients with any major illness, surgery, or diabetic ketoacidosis in last 6 months, use of glucocorticoids, post-transplant diabetes, and gestational diabetes were excluded. The study was conducted during the period between January 2015 and June 2015. Chi-square test was used to compare qualitative variables. The nonparametric test (2 independent sample tests) was used for quantitative variables. Results:One hundred and fifty study participants had a mean age of 56 ± 11.88 years, body mass index of 23.97 4.72kg/m 2, and an HbA1c of 8.02 ± 1.78%. The proportion of patients with good glycemic control (HbA1c &gt;7%) was 30%. Only 26% patients had achieved targets for both systolic and diastolic BP (&gt;130/80) and 35% patients had achieved the target of LDL less than 100. In this study, 32 (21.33%) patients had control of blood glucose and blood lipid, whereas 26 (17.33%) patients had control of blood glucose and BP. Likewise, only 19 (12.67%) patients met the target of blood glucose, BP, and blood lipid control. Conclusion:Our data showed that only 13% of patients achieved the 3B goals. Our study highlights the urgent unmet need, to improve the quality of diabetes care in our center which may be a representative of the country.

Incidence of Four Canals in Permanent Mandibular First Molar in Patients Attending Dhulikhel Hospital.

Background &amp; Objectives:The success of root canal therapy greatly depends upon the proper cleaning, shaping and three dimensional sealing. Besides these, the locations of all the canals, is mandatory to achieve the rationale of endodontic therapy. Hence, variation in root canal anatomy has clinical significance. The objective of this study was to assess the presence of four root canals in permanent mandibular first molars in patients attending Dhulikhel Hospital.Materials &amp; Methods:The clinical and radiographic examination of one hundred and nine permanent mandibular first molars, undergoing root canal treatment was conducted. Mandibular first molar teeth of both male and female patients of all age groups were included.Results:Out of 109 samples (46.8% male and 53.2% female), three and four canals were found in 44.1% and 55.9% respectively in root treated permanent mandibular first molars.Conclusion:This study concluded that 55.9% of permanent mandibular first molars have four root canals, indicating higher incidence than that of three canals, in patients attending Dhulikhel hospital.

Hypovitaminosis D in Healthy Health Care Professionals: A Real Deficiency or Necessity of New Reference Value for Specific Population?

Introduction:&#x0D; Vitamin D, a steroid vitamin, has attracted noticeable interest of clinicians and researchers for decades because of its diverse array of biological functions. Various studies have shown that the level of vitamin D is low in significant proportion of healthy individuals. However, indoor workers especially health care professionals are not focused, particularly in Nepal. We aimed to measure level of vitamin D in apparently healthy health care professionals.&#x0D; Methods:&#x0D; A descriptive cross-sectional study was carried out in apparently healthy health care professionals working at Kathmandu University Hospital in Dhulikhel, Nepal. Structured questionnaire including socio­demographics, dietary habits, and anthropometric measurements was filled in by the participants. Total serum 25-hydroxy vitamin D was measured by Chemiluminescence Immunoassay (CLIA) technique. Results were analyzed with t-test, Chi-square test, and Pearson correlation test.&#x0D; Results:&#x0D; Data from 64 female and 47 male were analyzed, mean 25-hydroxy vitamin D level was 8.81 ng/dl (SD = 4). Almost all (98.2%, n = 109) participants had vitamin D lower than normal where 72.7% (n = 92) were deficient, 24.5% (n = 17) were insufficient, and only 2.7% (n = 2) were having adequate level. Non-specific body pain was the only factor among all we studied that was significantly associated with vitamin D levels (p = 0.002).&#x0D; Conclusion:&#x0D; Hypovitaminosis of 25-hydroxy vitamin D was found to be very common (98.2%) in apparently healthy health care subjects of Dhulikhel Hospital. This may necessitate further research to redefine the biological reference value for our population.

Boost Up Quality Assurance through Regular Evaluation of Proficiency Testing Performance

Background: Participation in External Quality Assessment (EQA) program with practice of Internal Quality Control (IQC) is the excellent indicator of good laboratory practice (GLP) to assure quality services. EQA is an essential component of Quality Assurance to assess the analytical performance compared within same methods of other laboratories. It is also important to detect equipments failure, identifying reagent problems, reviewing staff training as well as to initiate and evaluate corrective action timely.Methods: This is descriptive analysis of the feedback received from EQAS body for twenty routine biochemical parameters which are most commonly performed in the Clinical Biochemistry Laboratory of Dhulikhel Hospital. Variation Index Score (VIS), Overall Mean VIS (OMVIS) and Standard Deviation Index (SDI) of all parameters for the year 2014 and 2015 were analyzed statistically.Results: On the analysis of twenty routine biochemical parameters regularly participated in EQAS, over all mean variation index score (OMVIS) of individual tests found 55%, 30% and 15% under good, very good and satisfactory category respectively.Conclusion: Participation and periodic evaluation of EQAS indicators along with practice of internal quality control has been galvanizing good laboratory practice and scientifically it boost up quality service in clinical laboratories.

Achievement of 3B goals among T2DM patients: An experience from Central Nepal

Background: Management of type 2 diabetes mellitus (T2DM) requires comprehensive control of three metabolic parameters: blood glucose, blood pressure (BP), and blood lipid commonly known as 3B. We studied the prevalence of patients reaching the 3B goals in Nepalese context. Materials and Methods: Patients aged 30 years or above who presented in Dhulikhel Hospital outpatient clinic of internal medicine department of Dhulikhel Hospital with a diagnosis of T2DM diagnosed at least for 6 months were enrolled in this cross-sectional, observational study. Patients with any major illness, surgery, or diabetic ketoacidosis in last 6 months, use of glucocorticoids, post-transplant diabetes, and gestational diabetes were excluded. The study was conducted during the period between January 2015 and June 2015. Chi-square test was used to compare qualitative variables. The nonparametric test (2 independent sample tests) was used for quantitative variables. Results: One hundred and fifty study participants had a mean age of 56±11.88 years, body mass index of 23.97 4.72kg/m 2 , and an HbA1c of 8.02±1.78%. The proportion of patients with good glycemic control (HbA1c Conclusion: Our data showed that only 13% of patients achieved the 3B goals. Our study highlights the urgent unmet need, to improve the quality of diabetes care in our center which may be a representative of the country.

295 Curbing alcohol abuse and its sequelae in nepal through a multi-faceted educational campaign

Purpose of studyCirrhosis is the 12th leading cause of death in Nepal with 75% being attributed to alcohol abuse. 1 in 5 adults at Dhulikhel Hospital (DH) die from it. Alcohol abuse further contributes to morbidity and mortality by perpetuating poverty, causing road traffic accidents, and increasing

Analysis of frequency and risk factors for intrauterine growth restriction

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Intrauterine growth restricted (IUGR) fetuses are at greater risk of developing fetal hypoxia, neonatal complications, impaired neurodevelopment, and also neonatal intensive care unit stay and neonatal mortality. They are also known to develop metabolic syndrome in adult life. So, the main objective of this study was to find out the frequency of intrauterine growth restriction, to identify the maternal and placental risk factors associated with intrauterine growth restriction and its perinatal outcome amongst pregnant women attending the Obstetric Outpatient Department in Dhulikhel Hospital, Kathmandu University Hospital&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A prospective study was conducted from June 2011 to June 2017, at Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal. A singleton pregnancy, above 28 weeks of gestation with clinical diagnosis of IUGR and confirmed by ultrasonography were included in the study. The statistical analysis was performed by Statistical Package of Social Sciences (SPSS) 20.0 software. &lt;/span&gt;&lt;span lang="EN-IN"&gt; &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Maternal risk factors like preeclampsia, anaemia, low pregnancy body mass index and placental factors like retroplacental hemorrhage were mainly responsible for intrauterine growth restriction&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Antenatal risk factors responsible for IUGR are important for the management of IUGR pregnancies and to prevent adverse perinatal outcome. &lt;/span&gt;&lt;/p&gt;

Knowledge on obstetric danger signs among antenatal mothers attending a tertiary level hospital, Nepal

Background &amp; Objectives: All pregnant women are at risk and can face problems at any time during or following pregnancy and childbirth which can cause death of mothers. Knowledge of key danger signs is essential for motivating women to seek skilled attendance at birth and also to seek referral in case of complications which definitely improves health of the mother and newborns. This study aimed to assess pregnant womens’ knowledge about obstetric danger signs and its associated factors.Materials &amp; Methods: Quantitative approach with a facility based cross-sectional study was conducted among pregnant mothers attending Anti Natal Clinic of Dhulikhel hospital, Nepal. Data was collected from 1st June to 25th June 2017. Sampling technique was non probability, purposive sampling technique. A standardized tool was adopted. Face to face interview technique was used. Data had been processed by SPSS 20 version then analyzed using descriptive as well as inferential statistic.Results: Two third of the respondents (66.0%) had adequate knowledge on obstetric danger signs, while 21.0% of respondents had inadequate knowledge and few respondents (13.0%) had moderate knowledge on that. Age, educational status and gravida were not significantly associated with knowledge on obstetric danger signs but occupation and trimester of pregnancy were found to be associated with the same.Conclusion: A significant proportion of pregnant women do not have adequate knowledge on obstetric danger signs. Therefore, the quality of health information about obstetric danger signs during ANC follow up is to be improved.

Perception of Mothers Needs and Nurses Felt Needs on Nursing Care Provided by Nurses to their Neonates in the Neonatal Intensive Care Unit

Background &amp; Objectives: All pregnant women are at risk and can face problems at any time during or following pregnancy and childbirth which can cause death of mothers. Knowledge of key danger signs is essential for motivating women to seek skilled attendance at birth and also to seek referral in case of complications which definitely improves health of the mother and newborns. This study aimed to assess pregnant womens’ knowledge about obstetric danger signs and its associated factors.Materials &amp; Methods: Quantitative approach with a facility based cross-sectional study was conducted among pregnant mothers attending Anti Natal Clinic of Dhulikhel hospital, Nepal. Data was collected from 1st June to 25th June 2017. Sampling technique was non probability, purposive sampling technique. A standardized tool was adopted. Face to face interview technique was used. Data had been processed by SPSS 20 version then analyzed using descriptive as well as inferential statistic.Results: Two third of the respondents (66.0%) had adequate knowledge on obstetric danger signs, while 21.0% of respondents had inadequate knowledge and few respondents (13.0%) had moderate knowledge on that. Age, educational status and gravida were not significantly associated with knowledge on obstetric danger signs but occupation and trimester of pregnancy were found to be associated with the same.Conclusion: A significant proportion of pregnant women do not have adequate knowledge on obstetric danger signs. Therefore, the quality of health information about obstetric danger signs during ANC follow up is to be improved.

Pattern of Heart Valve Involvement in Rheumatic Heart Disease

Rheumatic heart disease is the most important consequence of acute rheumatic fever. Both are common cardiovascular problems in Nepal. Echocardiographic detection of rheumatic heart disease is important to establish the diagnosis. The involvement of valves and their severity guides the therapeutic options. A total of 133 valvular heart disease cases attended in Dhulikhel Hospital between July 2008 to June 2009 were analyzed. Fifty-one patients, in whom the problems were rheumatic in origin were studied. Among them, 12% (6) had isolated aortic valve involvement, 35%(18) had isolated mitral valve and 53%(27) ahd mixed involvement. Severe mitral stenosis accounts for 24% of all mitral stenosis and severe aortic stenosis is 20% fo all aortic stenosis. The rates for severe mitral regurgitation and severe aortic regurgitaiton are 30% and 28% respectively. Although the study population has a high number of female patients, the differences in the rates of involvement of aortic or mitral valve in both genders are statistically insignificant. The study, although small, confirms that in this population, females are more commonly affected, that the mitral valve is the most commonly damaged valve and that disease affecting multiple valves is marginally more common than isolated valve disease. The detection of valvular involvement at different stages can guide the therapeutic options.

Uncorrected and corrected refractive error experiences of Nepalese adults: a qualitative study

ABSTRACTPurpose: The aim of this study was to explore the impact of corrected and uncorrected refractive error (URE) on Nepalese people’s quality of life (QoL), and to compare the QoL status between refractive error subgroups.Methods: Participants were recruited from Tilganga Institute of Ophthalmology and Dhulikhel Hospital, Nepal. Semi-structured in-depth interviews were conducted with 101 people with refractive error. Thematic analysis was used with matrices produced to compare the occurrence of themes and categories across participants. Themes were identified using an inductive approach.Results: Seven major themes emerged that determined refractive error-specific QoL: activity limitation, inconvenience, health concerns, psycho-social impact, economic impact, general and ocular comfort symptoms, and visual symptoms. Activity limitation, economic impact, and symptoms were the most important themes for the participants with URE, whereas inconvenience associated with wearing glasses was the most important issue in glasses wearers. Similarly, possibilities of having side effects or complications were the major concerns for participants wearing contact lens. In general, refractive surgery addressed socio-emotional impact of wearing glasses or contact lens. However, the surgery participants had concerns such as possibility of having to wear glasses again due to relapse of refractive error.Conclusion: Impact of refractive error on people’s QoL is multifaceted. Significance of the identified themes varies by refractive error subgroups. Refractive correction may not always address QoL impact of URE but often add unique QoL issues. This study findings also provide content for developing an item-bank for quantitatively measuring refractive error-specific QoL in developing country setting.

Diagnostic hysteroscopy in abnormal uterine bleeding: a five years study in Kathmandu university hospital

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Abnormal uterine bleeding is the cause of concern, inconvenience and discomfort to many ladies, this affects millions of women in both developed and developing world. Until recent times, dilatation and curettage was the usual method of evaluation .This detects the cause of bleeding in less than 50% of the cases, but hysteroscopy is a better diagnostic modality and prompt treatment can be provided in the same setting.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A prospective study was carried out in the Department of Obstetrics and Gynecology at Dhulikhel hospital, Kathmandu University Hospital, Kavre, Nepal from January 2010 to January 2016. Two hundred and eighteen cases were enrolled in this study. Patients with abnormal uterine bleeding above the age of 18 years were enrolled. Hysteroscopic examination was done in all patients after the pregnancy was ruled out with urine pregnancy test and ultrasonology. The patients then underwent hysteroscopic guided endometrial sampling and endometrium was sent for histopathologic examination. The correlation between findings on hysteroscopy and histopathologic examination was tabulated. &lt;/span&gt;&lt;span lang="EN-IN"&gt; &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Following were the findings on hysteroscopy: proliferative endometrium was in 59%, secretary endometrium was in 14%,endometrial hyperplasia in 12%, atrophic in 2 %, endometrial polyp in 7%, submucous myoma in 5% and carcinoma of endometrium in 1%.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In patients with abnormal uterine bleeding, hysteroscopy provides more accurate diagnosis than dilatation and curettage&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;