Health Renaissance Research Articles

A change in name: Health Renaissance is now Journal of BPKIHS

Not available.JBPKIHS 2018;1(1):5-6

Soil Health as a Transformational Change Agent for US Grazing Lands Management

There is rapidly growing national interest in grazing lands’ soil health, which has been motivated by the current soil health renaissance in cropland agriculture. In contrast to intensively managed croplands, soil health for grazing lands, especially rangelands, is tempered by limited scientific evidence clearly illustrating positive feedbacks between soil health and grazing land resilience, or sustainability. Opportunities exist for improving soil health on grazing lands with intensively managed plant communities (e.g., pasture systems) and formerly cultivated or degraded lands. Therefore, the goal of this paper is to provide direction and recommendations for incorporating soil health into grazing management considerations on grazing lands. We argue that the current soil health renaissance should not focus on improvement of soil health on grazing lands where potential is limited but rather forward science-based management for improving grazing lands’ resilience to environmental change via 1) refocusing grazing management on fundamental ecological processes (water and nutrient cycling and energy flow) rather than maximum short-term profit or livestock production; 2) emphasizing goal-based management with adaptive decision making informed by specific objectives incorporating maintenance of soil health at a minimum and directly relevant monitoring attributes; 3) advancing holistic and integrated approaches for soil health that highlight social-ecological-economic interdependencies of these systems, with particular emphasis on human dimensions; 4) building cross-institutional partnerships on grazing lands’ soil health to enhance technical capacities of students, land managers, and natural resource professionals; and 5) creating a cross-region, living laboratory network of case studies involving producers using soil health as part of their grazing land management. Collectively, these efforts could foster transformational changes by strengthening the link between natural resources stewardship and sustainable grazing lands management through management-science partnerships in a social-ecological systems framework.

A case of abdominal tuberculosis diagnosed by fine needle aspiration cytology (FNAC) of mesenteric lymph node

Background: The modes of presentation of abdominal tuberculosis can be vague resulting in diagnostic dilemma.Objective: To report a case of abdominal tuberculosis diagnosed by FNAC of a mesenteric lymphnode.Case: A 17-year-old boy presented in General out Patient department complaining of abdominal pain, abdominal distension, and low grade fever, anorexia and weight loss for 2 months. The examination revealed pallor, low body weight, doughing of abdomen and multiple palpable painless, slightly mobile abdominal lymph nodes. The ultrasonography (USG) guided fine needle aspiration cytology (FNAC) of a mesenteric lymphnode showed caseating necrosis suggestive of tuberculosis. The erythrocytes sedimentation rate (ESR) was raised.Conclusion: The abdominal tuberculosis can present with abdominal pain and abdominal distension associated with low grade fever, anorexia and weight loss. The diagnosis of abdominal tuberculosis can be confirmed by FNAC of the lymphnodes. Health Renaissance 2015;13(3): 177-180

Diffuse parenchymal neurocysticercosis

Neurocysticercosis is the commonest parasitic manifestation of brain and the leading cause of seizure in the developing world. It is caused by the ingestion of Taenia solium eggs through contaminated food and especially pork meat. Computed tomography and magnetic resonance imaging are the modality of choice for diagnosis of neurocysticercosis. We report a case of 65 years old male presented with complaint of seizure, which was diagnosed as diffuse parenchymal neurocysticercosis on computed tomography scan of brain. Health Renaissance 2015;13(3): 177-180

Family presence in emergency: Attitude and belief among emergency health professionals in a Tertiary Care Hospital of Nepal

Background: The emergency department of B.P Koirala Institute of Health Sciences, Dharan, a 700 bedded tertiary care centre provides all medical and surgical services, with easy access to patients by their family members during most of the resuscitation procedures. Complete privacy hence is not ideally maintained. Coping with emotional stress among the family members can be a gruesome experience and reactions from them can be unpredictable. Hence, health professionals are usually exposed to various emotions of the family members of these sick patients.Methods: It is a descriptive cross sectional study among the health professionals working in the emergency department. A sample size of 80 is taken over a period of 3 months. A semi-structured questionnaire leaflet was distributed and collected by the researcher. The attitude and belief was evaluated by 12 questions on the 5 point Liker scale and cutoff value being 3. Points less than 36 were given as negative attitude towards the family presence and more being positive.Results: Out of 80samples, 75 completed with a response rate of about 94%. The majority belonged to age group 20-29 years (70.7%) age, among profession Nurses respondents were about 56%. Male and Female respondent were about equal in numbers, qualification with undergraduate level was higher (73.3%), with an experience of less than 1year being 40%. Amongst the responders there is a positive attitude with increasing age, experience and qualification.Conclusion: The health professionals had a negative attitude towards the presence of family members during the resuscitation or invasive procedures. Hence with the ethnicity and cultural aspect of family their presence is well accepted. Health Renaissance 2015;13 (3): 152-160

Convulsions in pregnancy-not always eclampsia role of neuro-imaging in diagnostic dilemma

Background: Convulsions in pregnancy is always considered and treated as Eclampsia unless otherwise proved. Eclampsia is associated with increased risk of maternal death varying from 1.8 % to 14 % in developed countries. Despite availability of Intensive care units and improved antenatal care, some women still die from Eclampsia. Cerebral complications are the major cause of death in eclampsia patients. Hypercoagulopathy of pregnancy is a high risk factor for these patients in respect to development of cerebro vascular thrombosis and ischaemic strokes. Eclampsia patients who are refractory to the routine treatment have been found to have various Central Nervous System pathological conditions amenable to the medical treatment.Objective: To study the neuro pathophysiology behind a seizure in pregnancy and to reduce the morbidity associated with it. To study the role of neuro-imaging in patients with convulsions in pregnancy not responding to treatment with magnesium sulphate (MgSo4).Methods: It was a prospective study design which included 50 antenatal mothers. All patients were admitted in the eclampsia room with history of convulsions and all of them were put on MgSo4 therapy and Antihyperertensives. The patients who were refractory to the treatment such as having recurrent convulsions despite therapy with MgSo4 were selected for neuro- imaging with Computed Tomography scan. Neuro-imaging was done using Phillips Tomoscan CT scanner where slices of 10-mm thickness were taken through the entire brain in the trans-axial plane. Abdomen shielding was done with lead shield to prevent radiation hazard in the antenatal period.The results were documented and analysed using appropriate statistical method.Results: The CT scanning report revealed: Cerebral oedema (30/50), Encephalopathy (10/50), Intra Cranial Haemorrhage (02/50) Cerebral infarction (01/50), Cortical venous sinus thrombosis (01/50), Tuberculomas (01/50), Neurocysticercosis (01/50) and Hydrocephalus (01/50). Three patients out of 50 had normal CT scan report. Conclusion: Patients with convulsions in pregnancy who were refractory to the treatment with MgSo4 and Antihypertensives have been found to have very significant and morbid CNS pathological conditions. Neuro imaging in these patients have done a pivotal role in identifying the abnormality and rectifying it with medical means which had definitely improved patients conditions and have reduced morbidity and mortality. Health Renaissance 2015;13 (3): 144-151

Reversible intraventricular conduction defect in aconite poisoning: A Case report

Aconitine and related alkaloids found in the Aconitum species are highly cardiotoxic and neurotoxic. The wild plant (especially the roots and root tubers) is extremely toxic. Severe aconite poisoning can occur after accidental ingestion of the wild plant or consumption of an herbal made from aconite roots. In traditional Chinese medicine, aconite roots are used only after processing to reduce the toxic alkaloid content. Soaking and boiling during processing will hydrolyze aconite alkaloids into less toxic and non-toxic derivatives. However, the use of a larger than recommended dose and inadequate processing increases the risk of poisoning. The aconite herb is one of the commonly-prescribed ingredients for various clinical problems. However, due to its narrow therapeutic index, toxicities are not uncommonly encountered, including life-threatening cardiac arrhythmias like ventricular arrhythmias Health Renaissance 2015; 13 (1): 108-111

Maternal and neonatal health skills of nurses working in primary health care centre of Eastern Nepal

Background: Nepal has one of the world’s highest maternal and neonatal mortality. In Nepal, 73% of delivery is take place at home without trained attendant. Delivery by trained persons is 27% which reflects the need for attention of women's health in particular reproductive health.Objective: To assess knowledge and performance skills of nurses regarding maternal and neonatal health.Methods: Descriptive analytical study was carried out on nurses working in selected primary health care center of eastern region of Nepal. Random sampling technique was used to select 10 PHC and purposive sampling technique was used to select nurses in different primary health care center. Nurses were interviewed using pre-designed questionnaire and performance skill check list. Collected data were entered in SPSS 10.5 software package and analyzed.Results: The study showed that knowledge of auxillary nurse midwife/staff nurse was satisfactory in antenatal, intra-natal and post natal care of mother while they were relatively poor in newborn resuscitation. ANM/staff nurses showed very poor skills i.e. only 16.7%, 36.7% and 7% were competent in providing antenatal, intra-natal and post natal care respectively. Unfortunately none were found to be competent in newborn resuscitation.Conclusion: Birth handling competence levels are generally low in ANM/Staff nurses working in PHCCs Health Renaissance 2015;13 (1): 30-39

Impact of educational intervention on knowledge regarding safe handling of cytotoxic drugs among the nursing personnel working in BPKIHS

Introduction: Cytotoxic drugs are toxic compounds and are known to have carcinogenic, mutagenic and/or teratogenic potential. It is also considered as hazardous drugs. With direct contact they may cause irritation to the skin, eyes, and mucous membranes, and ulceration and necrosis of tissue. Safe handling refers to the process in which health care workers adhere to evidence-based practices (EBP) set forth by national organizations that have been designed to eliminate or significantly reduce occupational exposure. The key to safe handling is to protect the health care worker throughout the three phases of contact with the hazardous drugs. These phases are drug preparation, administration and disposal.Objective: To assess the effectiveness of education in enhancing the knowledge regarding safe handling of cytotoxic drugs among nursing personnel working at BPKIHS.Methods: Fifty nurses were taken as sample from selected ward of BPKIHS. One group pretest post test design was used by using population enumeration methods.Results: The overall mean score of knowledge on safe handling cytotoxic drugs of the respondents were 35.3 in the pre-test which increased to 83.7 in the post-test after an educational intervention. The difference was significant (p<0.001).Conclusion: Thus, the study's findings highlighted that there was a significant improvement in knowledge of the staffs after educational intervention. The educational intervention was very effective to improve the knowledge of the staffs. Health Renaissance 2015;13 (1):

Measurement of compartmental pressure in a leg by Whitesides method in a Nepalese patients attending a tertiary care hospital in eastern region of Nepal

Background: Compartment syndrome can be a life or limb-threatening emergency. Early diagnosis is important for the prevention of disability. The clinical features are subjective in nature. Intra compartmental pressure measurement is a reliable objective method for early and accurate diagnosis of compartment syndrome.Objective: To measure the compartmental pressure in a leg by Whitesides method in Nepalese patient attending a tertiary care hospital in eastern region of Nepal.Methods: This is a cross-sectional study done over the period of three years on adult patients aged 16 years and above presenting to the Emergency Department of BPKIHS with unilateral closed tibial fracture. Total of 60 patients aged 16 years and above with closed fracture tibia were enrolled in the study.Results: Out of total study population, 40 were males and 20 females. The anterior compartmental pressure in the uninjured legs ranged between 3 mmHg and 20 mmHg. Patients from hilly areas had more compartmental pressure (range 8 to 20 mmHg) as compared to patients of plain land (range 3 to 15 mmHg). People of hilly areas have more girth of thigh and calf muscles. Conclusion: The compartmental pressure in the uninjured legs ranged between 3 mmHg and 20 mmHg with variations in different geographic location. Whitesides injection technique of compartmental pressure measurement can be useful in the promptly defect compartmental syndrome in emergency and outpatient set-ups. Health Renaissance 2015;13 (1):health.renaissance@bpkihs.edu

An isolated capitellum fracture of the humerus in adult: A rare case report

Introduction: Isolated capitellum fractures are rare and represent only 1% of all elbow fractures and 6% of distal humeral fractures.Case description: A 45-year-old right hand dominant female presented to us with pain and stiffness in her left elbow following a fall onto the outstretched hand that occurred 6 months prior. She had capitellum fracture with avascular changes and excision of the fractured fragment was done. Physiotherapy was initiated with outcome of nearly normal elbow function. At the time of injury, she was unable to move her elbow actively due to pain and she was misdiagnosed as soft tissue injury earlier in a local hospital.Conclusion: Possibility of rare diagnosis such as capitellum fracture should also be kept in mind while treating elbow injuries. Health Renaissance 2015; 13 (1): 112-116

Psychotic symptoms in bipolar disorder: Two years’ retrospective study

Background: Psychosis in bipolar disorder is common but still not well understood. There is paucity of literature from our country and none from this institute which serves the eastern part of Nepal.Objective: To describe the hallucinations and delusions in bipolar disorders in our place.Methods: Patients-record files of bipolar disorders with psychosis discharged in two years’ time from 2012 to 2014 were analysed. Patients with unipolar depression, recurrent depressive disorder, serious organic illness, and primary substance use disorders were excluded. Information was collected in a structured performa. Association of delusion and hallucination was observed.Results: During the study period, ninety-five patients with bipolardisorder had psychosis. Hallucination was present in 29 (30.5%) cases, and out of these 23 (79.3%) were cases of mania. In 26 (89.7%) patients, the hallucinations were mood congruent. The median duration of appearance of hallucination was 10 days and appeared early in mania. Among hallucinations, auditory verbal hallucinations were present in all 29 patients. Delusions were present in 77 (81.1%) of patients, and grandiose delusions were the most common. Grandiose delusions tended to occur even in the absence of hallucinations. Conclusion: Psychosis is common in bipolar disorder. Grandiose delusions are the most common delusion and are relatively independent of hallucination. The auditory verbal hallucinations are the most common type of hallucination. Hallucinations in mania tend to manifest earlier than in bipolar depression and mixed episode, and most of the hallucinations in bipolar disorder are mood congruent. Health Renaissance 2015;13 (1): 49-57

Dietary considerations for the sick and hospitalized patients

From a clinical perspective, knowledge of the nutritional status of a hospitalized patient is an indispensable strategy for establishing an adequate approach to the maintenance and/or recovery of nutritional status during the hospital stay. Nutritional status has an important impact on the course of underlying diseases. Malnutrition increases the rate of morbidity, length of hospital stay and certain other complications. Therefore malnutrition becomes very common among hospitalized patients which in turn lead to morbidity and increased hospital stay. Nutritional requirement of the patient vary in different disease condition and their mode of feeding depends upon the condition of the patient and the functioning organ Health Renaissance 2015;13 (1):

Pre operative use of injection diclofenac versus injection tramadol for pain management of acute appendicitis in emergency department

Background: Acute appendicitis is one of the most common causes of acute abdominal pain presenting in emergency department. Preoperative use of adequate analgesia markedly reduces pain without affecting diagnosis accuracy and furthermore no single analgesia has been used for this purpose.Objective: To determine and compare the efficacy of injection diclofenac and injection tramadol for rapid pain management of acute appendicitis in emergency department.Methods: An experimental clinical trial was done including 50 patients aged _8 years who were clinically diagnosed as acute appendicitis and had not received analgesia prior to examination by the researcher. They were randomly divided into 2 groups: 25 patients (group 1) were given injection diclofenac intramuscularly and 25 patients (group 2) were given injection tramadol intravenously. Comparative analysis was carried out regarding the decrease in pain intensity using visual analogue scale (VAS) score for pain at presentation, at half an hour and at one hour of drug administration.Results: All the patients had VAS score of _5 at presentation without significant difference in the two groups. Half an hour after drug administration, 64% of subjects still had a VAS score of _6 in the first group while only 12% in the second group (p=0.005). At one hour of drug administration, 64% of subjects had a VAS score between 4 and 7 and 36% had score between 0 and 3 in group 1. In contrast to this score, in group 2 only 16% of the subjects scored between 4 and 7 and 84% between 0 and 3 (p=0.001).Conclusion: There was rapid and marked decrease of VAS score or pain in tramadol group as compared to diclofenac group. Hence, we can recommend that injection tramadol intravenous be considered for preoperative use for pain management of acute appendicitis in emergency department. Health Renaissance 2015;13 (1):

Intellectual disability among Bhutanese refugees referred to psychiatric service of BPKIHS

Background: Intellectual disability plays a significant role, especially in the field of rehabilitation. It becomes more important when people live in refugee camp for a long duration.Objective: To assess the level of intelligence and disability; and to sort out the illnesses comorbid with mental retardation in the Bhutanese refugees in eastern Nepal.Methods: Hospital based descriptive study was done using purposive sampling. Instruments used were: vineland social maturity scale, developmental screening test, seguin form board, standard progressive matrices and colored progressive matrices.Results: Samples were 42 with 64% females. Age range was 11-20 years. Among these referred cases, 45% had speech disorder and hearing loss and 31% had neurological disorders, including seizure disorders. Sixty-six percent had mild, 9% moderate and 19% severe mental retardation.Conclusion: Majority of the intellectually disabled Bhutanese refugees had mild mental retardation, followed by severe one. Seizure was a common co-morbidity in mental retardation. Health Renaissance 2015;13 (1):

A study on malaria cases in hilly areas and Terai belt of Nepal

Introduction: Malaria is a well-known disease and it continues to be a major public health problem at the start of new millennium. The problem is persistent not only amongst the city dwellers but also amongst the rural population.Objective: To identify the magnitude of malaria cases and to compare the malaria cases between hilly area and Terai belts.Methods: This cross-sectional study was carried out in Terai belt of Morang District Nepal at Nobel Medical College & Research Center Biratnagar from March to Oct 2007 and hilly area around Lumbini Medical College Teaching Hospital & Research Center Pravas, Tansen, Palpa of Nepal between March to December 2008. Blood samples were collected from all the cases and malaria parasites were examined by Peripheral Blood Smear Examination and Rapid Card Method Screening.Results: Thirty-five cases were malaria positive from hilly area of whom 80% had Plasmodium vivax infection. Whereas in Terai belt 231 positive cases ware recorded. Out of them (62.8%) cases were affected by Plasmodium vivax infection. That most vulnerable age group was 15 years and above. Males were more affected than females.Conclusion: It was observed that in hilly areas the numbers of positive cases are less than the Terai belt. The magnitude of malaria cases are found high in July. A steady decline has been observed till September to October Health Renaissance 2015;13 (1): 4-12

Trend of home or hospital delivery and child birth among Muslim women of Biratnagar, Nepal

Background: Maternal morbidity and mortality remains one of the biggest public health challenges in Nepal. This paper explores the trend of home or hospital delivery and child birth in certain ethnic group. The illiteracy women’s low socio economic status in the society, lack of access and difficult geographical rugged terrain are major reasons for not delivering children in health institutions in Nepal.Objective: To find out the trend of hospital or home delivery among Muslim women of Biratnagar city.Methods: Cross-sectional study was conducted among 200 Muslim women of ward 7 of Biratnagar municipality. They were interviewed to assess their health seeking trend of home or hospital delivery and child birth along with factors associated with the use of health services. Information's on usages of health services, education level, family structure, and occupational status information were also collected using a pre-tested and structured questionnaire.Results: The overall institutional delivery in the study population was 24.5%. Illiteracy, low socio-economic status, and poverty in women are the major challenging features of not delivering babies in health institutions.Conclusion: Only one fourth of the women of the study population had hospital/health institutional delivery. Hospital deliveries were seen among the educated women with many antenatal visits. Therefore female education must be encouraged in this community. Health Renaissance 2015;13 (1): 68-76

A study on factors influencing use of standard precautions in the emergency department at BPKIHS, Dharan

Background: This study investigated knowledge of and practices towards standard precautions, among all health care workers working in the emergency department in BPKIHS. Objective: To find out the factors influencing use of standard precautions in the emergency department, BPKIHS Dharan.Methods: This was a prospective observational study conducted in the emergency department. Data was collected in three ways: by direct observation of work practice, a questionnaire about knowledge, attitude and skills and through focus group discussions.Results: Regarding standard precaution, majority (54.2%) had partial knowledge. Only 4.2% know the component of it. In practice 69.52% among doctors group washed hand even though once in four observations; 96% used soap. 43.80% used gloves in doctors group in four observation; sisters used gloves the entire times. 74% washed hand after gloves removal (178). 35.23% didn’t recapped needles before disposal from those who used it among doctors group. Recapping is complete in sisters’ group. 60.95%. Sisters had complete proper disposal practice.Conclusion: Knowledge and practice of SP has direct impact in health of patient and HCW. High level of occupational exposure to blood highlights the urgent need for intervention to enhance occupational safety to prevent unnecessary nosocomial transmission of BBD. Strategies for promoting injection safety are necessary if the risk of nosocomial transmission of BBV via unsafe injection practice is to be minimized. Health Renaissance 2015;13 (3): 54-64

Knowledge, attitude and practice about STD/ HIV AIDS among the health attendant staffs of a Tertiary Level hospital of Eastern Nepal

Background: Knowledge, attitudes and practices (KAP) surveys are possibly the most frequently used studies in health-seeking behaviour research. Health care workers serve as key players in the prevention and management of diseases. Their perceptions, attitudes and practices have implications for the management of diseases in both health centers and communities.Objective: To assess knowledge, attitude and practice towards STDs among health attendant staffs (health aids and health attendants) of BPKIHS.Methods: This is a descriptive cross sectional study. The study population was Health attendants and Health aids workers working in different departments of BPKIHS. Modified structured questionnaire was used for data collection. SPSS version 11.5 was used for data entry and analysis.Results: 180 Health attendants and Health aids working in different departments of BPKIHS participated in the study. 29% belonged to 30-34 age groups. 86% of study population had heard about STD/HIV/AIDS. 29% expressed that having intercourse without using condoms is known as unprotected sex. Unprotected sexual habits (40.6%), using mask, gloves while working (30%) were methods listed for prevention of transmission of STDs/HIV/AIDS.Conclusion: Majority were from 30-39 years group.86% had heard about STDs/HIV/AIDS. The commonest method to protect from STDs/HIV/AIDS were listed as avoiding multiple sex partners and use gloves and mask while working. Health Renaissance 2015;13 (3): 95-106

Role of imaging (MDCT) in ocular and orbital lesions

Background: Radiological imaging is still important to diagnose ocular and orbital abnormalities. Computed tomography is the first-line imaging modality for orbital imaging in the acute setting with magnetic resonance imaging playing an important secondary role.Objective: To assess the role of multidectector computed tomography (MDCT) in diagnosis of ocular and orbital lesions. To describe the imaging features of various orbital and ocular lesions on MDCT.Methods: A prospective cross-sectional study was conducted on 50 patients in B.P. Koirala Institute of Health Sciences, over the period of one year (from July 2013 to June 2014). All the patients with clinical suspicion of ocular and orbital lesions, referred from the ophthalmology department for CT scan were included in this study.Results: Out of 50 cases 4 were traumatic and 46 were non traumatic cases. Retinoblastoma was most common non traumatic lesion in our study. We compared MDCT diagnosis and final diagnosis which was based on histopathology/ per operative finding, FNAC, clinical response to treatment, supportive laboratory (biochemical/ microbiological) findings and supportive findings on other radiological investigations (USG and MRI). The sensitivity of MDCT in diagnosing ocular and orbit lesions was 95.65%.Conclusion: MDCT has important role in characterization and diagnosis of the lesions, surgical planning and follow up of patient with various ocular and orbital pathologies. MDCT is better for evaluation of bones and detection of calcifications and to discern the location, extent and configuration of the lesions. Therefore MDCT is an ideal radiological method for evaluation of various ocular and orbital lesions. Health Renaissance 2015;13 (3): 24-36