Western Regional Hospital Research Articles

A study of diabetic retinopathy in diabetic foot syndrome in Western Regional Institute of India

Background: Diabetes is a rapidly growing health challenge and potential epidemic across low-and-middle-income countries like India. Diabetic retinopathy (DR) is a consequence of diabetic microangiopathy, which may cause visual deterioration due to macular edema in any stage and vitreous hemorrhage or tractional retinal detachment in the advanced proliferative retinopathy stages. Aims and Objectives: The aim was to study the retinopathy status in diabetic patients with a risk of diabetic foot syndrome (DFS) visiting a western regional hospital in India. Materials and Methods: In this cross-sectional study, all patients with diabetes mellitus (DM) with a risk of DFS, visiting a tertiary care hospital during the study period, underwent an ophthalmological evaluation for documentation of their retinopathy status. Results: One hundred and fourteen patients diagnosed to have a risk profile for DFS were included in the study. Their mean age was 61.22 years and 81.6% were males. The mean duration of DM was 12.24 years, respectively. Of the 114 patients, 72 had DR. An increased presence of retinopathy in patients with an increased risk grade of diabetic foot (DF) was found significant by the Chi‐square test. (P<0.001). Conclusion: Our study found an increased presence of DR in Western Indian cohort with DFS. The severity of retinopathy was greater in patients with higher grades of risk for DF, therefore establishment of an association between DR and DFS will help in developing an integrated management strategy for these two grave consequences of diabetes.

Knowledge, attitudes, and practices of Jamaican healthcare workers on nosocomial infection control.

The emergence of deadly infections such as methicillin-resistant Staphylococcus aureus and COVID-19 (SARS-CoV-2) highlights the need for effective infection control (IC) procedures in healthcare facilities. The aim of the study was to assess the knowledge, attitudes, and practices (KAP) of healthcare workers (HCWs) on IC procedures. A cross-sectional survey was conducted among HCWs in western Jamaica from May to August 2015. A questionnaire based on the Jamaican Health Facilities Infection and Control Policies and Procedures Manual was used to collect data on staff training in IC, and their KAP of IC. Summary statistics, ANOVA, and multiple linear regression were applied for data analyses. Among 227 participants, the mean knowledge scores were statistically higher among the younger HCWs, Physicians/Nurses, and those in clinical units. Older HCWs, non-physicians/nurses, non-clinical unit workers, HCWs at Western Regional Hospital A, and those who received ongoing IC training scored higher on attitude. The practice scores were significantly correlated with the attitude scores but not the knowledge scores. The attitude score was a significant predictor for IC practices. Six knowledge and three attitude variables were significant predictors of IC practices that the Western Regional Health Authority Officials can use to implement measures to improve IC practices among HCWs.

Drug Utilization Pattern and Potentially Inappropriate Medications among Elderly Inpatients in a Tertiary Care Hospital in Western Nepal

Introduction: Drug utilization research deals with the quality of care focusing on potentially inappropriate medication (PIM), The objectives of the study were to assess the drug utilization pattern (class of drugs used, average number of drugs per prescription per encounter, number of drug prescribed in generic name and antibiotics in prescription) and potentially inappropriate medications and their categories among elderly inpatients.
 Methods: It was a prospective observational study carried out in the medical department of Western Regional Hospital, one of the tertiary level public referral hospital in Pokhara, Nepal. One hundred and two patients of both sexes, age above 65 years and who were hospitalized in medical department were selected. The patients were followed until their discharge to obtain complete information about the drugs being used. Patient data collection form and Updated 2012 Beers Criteria were used to assess drug utilization patterns and determine PIM respectively.
 Results: Most of the patients were in the age group of 65-70 (37.25%) followed by 71-75 (27.45%) and 76-80 (18.62%). Out of 102 patients, 53 (51.97%) were male and 49 (48.03 %) were female. Antimicrobials were the most prescribed medicines (16.73%). Average number of drugs per prescription per encounters, number of drug prescribed in generic name and number of antibiotics in prescription were 7.26, 9.6% and 21% respectively. About 57% of medicines were prescribed from the national essential medicine list. Among them, 20 (3.91%) of all drugs had at least one PIM. There were 27 drugs in Beers criteria A, one drug in Beers criteria B, and no drug in Beers criteria C.
 Conclusion: Antibiotic prescription was found within the optimal values whereas values of other prescribing indicators were out of the optimal values in comparing earlier studies. PIM was observed in prescriptions that suggest irrational practice and the need for interventions.

Investigating the Relationship between Air Pollution, Meteorology, and COPD Trends in Pokhara Metropolitan City, Nepal

Abstract Spanning 464.24 km2, Pokhara Metropolitan City is Nepal’s largest city by area. With over 400 000 residents, it is also Nepal’s second most populous city. This research investigated a biometeorological system present within Pokhara Metropolitan City concerning air pollution, meteorological conditions, and health. Different aspects of this system are more or less influential in various regions of the city, and understanding these relationships can assist with future health interventions for limiting exposure to pollutants. This research was completed using datasets published in government records and scientific literature, showcasing what can be accomplished with open-source data. Key findings were a positive correlation between air pollution levels and chronic obstructive pulmonary disease (COPD) hospital admissions to Pokhara’s Western Regional Hospital and a negative correlation between meteorological measurements and hospital admissions. These findings aligned with the general body of literature on risk factors for COPD hospitalizations. Multivariate regressions yielded better predictions for hospital admissions using both mean low and high temperatures as opposed to using one temperature variable, which implied both daily low and high temperatures are related to hospital admissions. Results also revealed air pollution levels for pollutants ≤ 10 and > 2.5 μm were better predictors of hospital admissions than air pollutants sized 2.5 μm and below. Findings prompted questions about the relationships between different pollutant sizes and their correlations to COPD hospitalizations. Findings also yielded questions about health interventions and Pokhara’s built environment, which may be investigated in future research.

Outcome of intertrochanteric fracture managed with proximal femoral nail antirotation 2

Background: Intertrochanteric fracture is a common condition seen in elderly population which is managed with operative procedure in the department of orthopedics. The proximal femoral nail antirotation (PFNA) system was developed by the AO/ASIF in 2004 for this fracture that provides optimal anchoring and stability when the implant is inserted into the osteoporotic bone. The main characteristic of the implant is the use of a single blade with a large surface area and insertion of the blade compacts the cancellous bone. Aims and Objectives: The aim of the study was to study the functional outcome of intertrochanteric fracture managed with PFNA2. Materials and Methods: The prospective and observational study was conducted in patients diagnosed with intertrochanteric fracture admitted in orthopedic ward, Western Regional Hospital, Pokhara. Pre- and post-operative fracture alignment, Harris hip score (HHS), post-operative complications were taken into account. Results: Out of 55 cases taken into study, 36 (65.45%) were male and 19 (34.55%) were female. Maximum number of patients allocated in our study falls in 71–80 years group (29%) with least number in age group of 90 years or more (1.9%). Right-sided intertrochanteric fracture were 27 (49%) and left side involved were 28 (51%). Twenty-eight (51%) falls in Type II and 27 (49%) falls in Type III Boyd and Griffin intertrochanteric fractures. There was a marked improvement in fracture alignment after the operation with various parameters taken into consideration. Pre-operative HHS was 5.52±5.38 (Poor) and immediately after the procedure, it was 30.41±3.04 (Poor), 89.86±3.59 (Good) at 6 months, and 95.56±1.257 (Excellent) at 12 months. One case had blade cut out at immediate post-operative period, eight cases had surgical site infection, and five cases had GT fracture. Conclusion: This study showed that PFNA2 is an effective operative procedure in management of intertrochanteric fractures by achieving better fixation through bone impaction especially in osteoporotic bone.

Psychometric Evaluation of Turkish Version of the Cultural Competence Assessment Tool: CCA-EUnurse Project.

It is important to understand nurses' cultural competency all across the world, as globalization and international migration are increasing day by day. The evaluation of the cultural competence of nurses is necessary to provide better quality and adequate health services to individuals, and to improve patient satisfaction and health outcomes. The aim of this study is to evaluate the validity and reliability of the Turkish version of the "Cultural Competence Assessment Tool". The methodological study was performed to assess instrument adaptation and validity and reliability testing. This study was conducted in a university hospital in western region of Turkey. The study sample consisted of 410 nurses who worked in this hospital. Validity was tested using content validity index, Kendall's W test and exploratory and confirmatory factor analyses. Reliability was tested using item-total and interitem correlations, Cronbach's α coefficient of reliability and test-retest analysis. The results of this research demonstrated that the Cultural Competence Assessment Tool showed a good construct validity, internal reliability and test-retest reliability. Confirmatory factor analysis indicated that a construct with four factors showed an acceptable model fit. In conclusion, this study concluded that the Turkish version of the Cultural Competence Assessment Tool is a valid and reliable measurement tool.

Management of Ludwig's Angina at a Tertiary Care Hospital in Western Region of India

IntroductionLudwig’s angina is cellulitis of submandibular space, submental space, and sublingual space. The main causative factors include dental infections (dental caries with atypical periodontitis, pericoronitis, and dental procedures). Other predisposing conditions include poor dental hygiene, dental caries, malnutrition, diabetes mellitus, AIDS, and various other immunocompromised states. It presents as an acute onset and spreads very rapidly causing bilateral diffuse neck swelling, edema of floor of mouth, pain, fever, trismus, foul-smelling pus discharge, difficulty in swallowing, airway edema, and tongue displacement creating a compromised airway with stridor. So it requires early diagnosis and aggressive management.Material and methodsClinical data of all patients with clinical diagnosis of Ludwig’s angina managed at the Department of Otorhinolaryngology-Head and Neck Surgery, Sir Takhatsinhji (T) General Hospital and Government Medical College, Bhavnagar, India, from 2015 to 2019 were analyzed retrospectively in this study.ResultOver the review period, 30 cases were diagnosed as Ludwig’s angina, out of which 12 (40%) were males and 18 (60%) were females; male to female ratio was 1:1.5. The age of the patients ranged from six months to 64 years, with a mean age of 38.86 years. Fever, neck swelling, and neck pain were present in all patients.In 16 patients, incision and drainage were done under general anesthesia while the rest five patients required only local anesthesia. In six patients (20%), for maintenance of airway, tracheostomy was required. The most common complication was necrotizing fasciitis and death followed by septicemia. Mortality was observed in three patients (10%) in this study.ConclusionDespite improved outcomes compare to pre-antibiotic era, Ludwig's angina still remains a potentially life-threatening disease in ENT at present. Dental caries, uncontrolled diabetes mellitus, and malnutrition are commonly associated conditions. With early diagnosis, close airway observation, aggressive intravenous antibiotic treatment, and timely surgical intervention, morbidity, and mortality can be reduced.

Knowledge and Practice on Prevention and Control of Tuberculosis Among Nurses Working in a Regional Hospital, Nepal.

IntroductionTuberculosis (TB) is a highly prevalent communicable disease in Nepal. All health personnel who care for such patients are at high risk of developing tuberculosis. It is very necessary for all healthcare providers, especially nurses, who spend a lot of time with such patients, to have adequate knowledge and correct practice on the occupational safety measures to maintain health and prevent transmission of the disease. This study was carried out to assess the knowledge and practice of nurses in the prevention and control of TB infection.MethodThis study was a cross-sectional study conducted on nurses working in all wards and Outpatient Departments (OPDs) of Western Regional Hospital, Pokhara, Nepal. A complete enumeration of the respondents was performed, and data were collected consecutively, using a semi-structured self-administered questionnaire, from all nurses working in all the wards and OPDs of the hospital. The predictors of knowledge of TB infection prevention and control (TBIPC) were assessed using binary logistic regression.ResultsThe study findings showed that a majority of nurses had an inadequate level of knowledge and poor practice of prevention and control of TB. Regarding practice, none of the nurses reported the use of an N95 mask or a respirator during care of the patients with TB and all the nurses reported that they used chemical disinfectant (virex) to clean the room and the surfaces. However, none of them reported the use of fumigation or ultraviolet irradiation for disinfection. Nurses who were 40 years and older (p = 0.001, adjusted odds ratio (AOR) = 5.965, CI = 2.083–17.457) and who were currently working in the wards with isolation rooms demonstrated higher odds for knowledge on TBIPC (p = 0.010, AOR = 2.686, CI = 1.264–5.710).ConclusionsThis study showed that a majority of nurses had an inadequate level of knowledge and implemented poor safety measures for the prevention and control of tuberculosis. This increases their risk of being infected with TB infection and cross-transmission. It is recommended that the hospital plan and conduct the necessary education/training for nurses to update their knowledge, develop the organizational structure and policies, and establish a system to support and monitor the practice of health workers on the prevention and control of TB, and maintain the health and safety of nurses caring for patients with TB.

Oral Squamous Cell Cancer Scenario in a Tertiary Hospital in Western Region of Nepal

Introduction: Oral squamous cell cancer involves oral subsites namely lip, buccal mucosa, gingivobuccal sulcus, mandible, retromolar trigone, tongue, floor of the mouth, maxilla and hard palate. It has multifactorial etiologies. Alcohol, tobacco chewing, smoking, betel quid chewing, trauma and HPV viruses are implicated as the predisposing factors of oral squamous cell carcinoma. If detected early, oral cavity cancer is easily preventable and curable. Aims: To evaluate oral squamous cell cancer demographics, as well as risk factors, site, grades, and stages. Methods: This prospective cross-sectional descriptive type of study was done in patients attending dental outdoor patient department of Nepalgunj medical college from July 2018 to August 2020. 46 patients selected by enumerative sampling method in the study after they were histopathologically confirmed with oral squamous cell carcinoma by biopsy. All included patients were having primary oral cancer, single, unilateral and untreated. After data collection current oral squamous cell cancer demographics, as well as risk factors, site, grades, and stages were established. Results: Out of 46 patients ranging from 32 to 79 years 28(60.8%) were males and 18(39.1%) were females with mean age range of 55.41 ± 10.84 years. 26(56.5%) of total displayed oral squamous cell carcinoma at buccal mucosa. 25(54.3%) of total consumed gutkha and paan with betel nut plus tobacco. 30(65.2%) of total were exposed to carcinogen for a period of 21-40 years. 32(69.5%) of total had well differentiated oral squamous cancer. 32(69.5%) of total were at stage III at the time of presentation. Conclusion: Oral cancer occurred more in males, at buccal mucosa and in people above 51 years, and in those who consumed gutka and paan, betel nut plus tobacco. It was also more in people with longer history of exposure to carcinogens.

Rheumatoid Arthritis in HIV Infected Individuals: A Cross-Sectional Study

Background: HIV is a chronic viral infection documented worldwide. It infects and destroys helper T cells (CD4) leading to a number of immunological deficiencies. The main objective of this study was to examine the Rheumatoid factor (Rf) to recognize rheumatoid arthritis prevalence rates of these patients. Methods: This hospital-based cross-sectional study was carried out on 150 HIV-positive individuals visiting the ART center of Western Regional Hospital. The patients were counseled and samples were taken. Samples were processed by Mispa i2 and analyzed by SPSS. Rf was measured for all participants. Findings: Out of 150 participants, 35 (23.3%) were Rf Positive for rheumatoid arthritis. In multivariable analysis, these levels were found higher in 20-40 years age group, in females, in married, in illiterate and unknown about their transmission of HIV. The prevalence of Rheumatoid arthritis was found to be 23.3%. Similarly, the association of sex and other variables significant value was found in education, mode of transmission, and age category as 0.004, 0.00,1 and 0.001 respectively. Interpretation: The result of our research suggests the need for regular screening of Rheumatoid factor (Rf) of the patients to detect the so that it can aid to reduce mortality and pain full life of HIV infected individuals due to rheumatoid arthritis. Funding: This research was funded by the Faculty of Health Sciences, Pokhara University, Nepal as the Faculty Research Grant (2074-075). Declaration of Interest: The authors declare no conflict of interest. Ethical Approval: Ethical permission was obtained from Institutional Review Committee, Pokhara University (Ref no. 110/074/75).

Predictors of Dropout in a Cohort of People Undergoing Treatment for Borderline Personality Disorder in a Public Community Mental Health Service: A Time-to-Event Analysis

Background: Dialectical Behaviour Therapy (DBT) is an effective evidence based treatment for Borderline Personality Disorder (BPD). However, irrespective of the success of the treatment, a dropout rate of approximately 30%-40% is regarded as the norm. In this analysis we aimed to investigate whether early predictors of dropout can be identified from baseline data. Methods: Between 2014 and 2017, data was collected from 196 participants at multiple timepoints as part of a coordinated multisite study of standard DBT treatment for community based service users being treated for BPD in Ireland. Dropout was strictly defined as per the standard DBT programme four-miss rule. For this analysis data were censored at 48 weeks and risk factors for dropout were identified using a Cox proportional hazards model that adjusted for age and gender. Engagement with phone coaching in the first month was examined as a time dependant covariate. Outcomes: Of the 196 participants, 12 (6%) were censored and 9 (4%) removed leaving 187 for analysis of whom, 109 (58%) completed and 66 (32%) dropped out. Results from univariable Cox proportional hazard regressions found off-label use of anti-psychotic medication was associated with an increased risk of drop-out, while full time employment status, receipt of disability support and engagement with phone coaching in the first month were associated with a reduced risk of dropout. Entering these variables in a multivariable Cox proportional hazard regression found off-label use of anti-psychotic medication (adjusted HR 2·69, 95% CI 1·50 - 4·83; p=0·001); full time employment status (adjusted HR 0.23, 95% CI 0.07-0.77; p=0.02) and disability (adjusted HR 0.20, 95% CI 0.05-0.85; p=0.03) remained significant predictors. Interpretation: Awareness of employment status and off-label prescription of anti-psychotic medication at baseline as significant risk factors for dropout may provide clinicians with valuable insight when starting treatment and could potentially inform treatment approach. Funding Information: This work, as part of the The National DBT Project, was funded by the Irish Health Service Executive (HSE) and the National Office for Suicide Prevention (NOSP). The fund is administered via the National Suicide Research Foundation (NSRF). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: All procedures were reviewed and approved by the following research ethics committees: Clinical Research Ethics Committee of the Cork University Teaching Hospitals, Galway Clinical Research Ethics Committee, HSE Mid Western Regional Hospital Research Ethics Committee, HSE North East Area Research Ethics Committee, HSE South East Area Research Ethics Committee, Linn Dara & Beechpark Ethics Committee; Naas General Hospital Ethics Committee; Saint John of God Hospitaller Ministries Research Ethics Committee and Sligo General Hospital Research Ethics Committee.

Social Determinants of Anemia and Overweight/Obesity among Pregnant Women in Nepal

To identify the complex factors associated with anemia and overweight/obesity in pregnant Nepali women. This study was conducted with 609 pregnant women who visited the Western Regional Hospital in Pokhara, Nepal, for maternal health checkups. We assessed their nutritional status on the basis of their responses to a questionnaire (socio-economic, demographic and health information using the Nepali version of the 14-item Health Literacy Scale), hemoglobin levels and body mass index (BMI). Data were analyzed and adjusted for confounding factors by binomial logistic regression analysis; this aided in identifying factors associated with anemia and overweight/obesity. The significant factor contributing to anemia is a low BMI (p=0.005, aOR=7.930, 95% CI=1.857, 33.870), followed by maternal age in the teens (p=0.000, aOR=3.018, 95% CI=1.852, 4.919). The significant factors contributing to overweight/obesity are household income, excluding the poorest (p=0.004, aOR=2.975, 95% CI=1.404, 6.303), followed by the presence of a nuclear family (p=0.000, aOR =2.156, 95% CI=1.493, 3.112). Functional literacy (p=0.005, aOR=1.045, 95% CI=1.013, 1.077) increases the risk of overweight/obesity, but critical literacy (p=0.009, aOR=0.819, 95% CI=0.705, 0.951) is a factor that buffers its onset. The association of malnutrition with anemia and overweight/obesity has been confirmed in pregnant Nepali women, indicating the urgent need for new supports and improvements to nutrition. Nutrition education should be designed to take into consideration reproductive generation, as well as families with low health literacy.

Etiological Spectrum of Hoarseness of Voice in Western Regional Hospital, Pokhara, Nepal

Background: Hoarseness of voice is a common symptom presentation in the Department of ENT. The etiology ranges from benign to malignant causes. Video nasopharyngolaryngoscopy is an effective method of evaluation of the laryngeal pathologies. The aim of the study was to study the different etiological factors of hoarseness of voice presenting in the Department of ENT at Western Regional Hospital, Pokhara. 
 Materials and Methods: A retrospective observational longitudinal study was done in the Department of ENT, Western Regional Hospital after approval from IRC, Pokhara Academy of Health Science. A total of 275 patients presenting to the ENT Department with hoarseness of more than two weeks duration were examined with video nasopharyngolaryngoscopy (NPL) from April 2018 to March 2019. The data were electronically entered and analyzed with SPSS Version 21. 
 Results: Total number of cases were 275 among which 187 (68%) were females whereas 88 (32%) were males. Vocal cord nodules were observed in 107 patients (38.9%), features of laryngopharyngeal reflux were observed in 54 patients (19.6%) muscle tension dysphonia was seen in 49 (17.8 % ), vocal cord polyp in 6 patients (2.2%), left vocal cord palsy in 7 patients ( 2.5%), right sided vocal cord palsy in 2 patients (0.7%). The hemorrhagic polyp, leucoplakia and ventricular dysphonia were observed in 3 patients each. 
 Conclusion: Since causes of hoarseness of voice range from simple benign diseases to malignant diseases, it is mandatory to evaluate every cases of hoarseness of voice replace with of more than 2 weeks duration with history, videolaryngoscopic examination and investigations.

Study of Poisoning Cases Admitted in ICU of Western Regional Hospital

Introduction: Acute poisoning, irrespective of the etiology, is a medical emergency which requires prompt diagnosis and treatment. Such cases require ICU set up for better management. Central level hospitals in Nepal have ICU facilities to manage such cases. 
 Materials and Methods: Current study is a retrospective type hospital based study conducted in Western Regional Hospital, Pokhara. Data collected from ICU department of Hospital in a period of one year from 2073 Ashad 16 to 2074 Ashad 16. It was analyzed and presented. 
 Results: In this study it is observed that total 90 cases admitted in ICU department of WRH in a period of one year. Female patients outnumbered the male patients. Age group of 10-20 years is predominance in present study. Most of the patients were from Kaski district as the hospital belongs to Kaski district and one of the renowned tertiary care centers in the Gandaki province. Maximum number of patients consumed the OP compound. Outcome was better as out of 90 cases 80 were discharged and only 10 were died during the course of treatment. 
 Conclusion: Early identification of the cause and type of poisoning, close monitoring and standard management, preferably in the ICU for at least a first few days, reduces the complication and improves the survival. The commonly available insecticides and rodenticides are the most common cause of acute poisoning.

Incidence of Inguinal Herniotomy in Children. A Prospective Study at a Regional Hospital

Background: Inguinal hernia is one of the most common surgical conditions in children. Herniotomy is the surgery performed for a pediatric hernia and hydrocele. This study was done to know the demography and outcome of pediatric herniotomy at our center. 
 Materials and methods: A prospective study on patients who underwent herniotomy from 10th May 2016 to 9th May 2017 was conducted at the Department of Surgery, Western Regional Hospital. 
 Results: During this study 112 patients underwent herniotomy out of which 98 were boys while 14 were girls. 59(52.67%) patients had unilateral hernia, 40(35.71%) had unilateral hydrocele and 13(11.6%) had bilateral condition among which 8 had hernia and 5 had hydrocele. 69(61.6%) patients presented with a right-sided, 30(26.7%) with left-sided, and 13(11.6%) with bilateral conditions. 13 patients (11.6%) presented at the emergency with irreducible hernia. Two among the patient who underwent emergency herniotomy developed postoperative wound infection and one among the elective surgery had recurrence. 
 Conclusion: Pediatric inguinal hernias and hydroceles are often difficult to diagnose clinically. Herniotomy is often performed by junior consultants who have no specific training in pediatric surgery. Timely planning of surgery is required to minimize preoperative complications.

Adherence to Antiretroviral Therapy among Patient Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (PLHA) Patients Visiting at Anti-retroviral Therapy Center in Pokhara

The main objective of this paper is to assess the status of adherence to Anti-Retroviral Therapy (ART) among patient living with HIV AIDS (PLHA) patients receiving ART therapy. A crosssectional descriptive design was used to collect data from 326 PLHA patients. Data were collected through face to face interview among the attended in ART clinic western regional hospital, Pokhara. Participants aged 18 years and above and patient receiving ART at least for 12 months or more were included in this study. The collected data entered in Epi-data and analysis was done using SPSS. The age group of the respondents was from 18 to 70 years with the mean age of 40.29±11.84 (SD). Out of 326 respondents 55.2% were male and 59.8% were married. Forty percent of the respondents had no formal education and most of the respondents (60.4%) were unemployed. Majority (86.5%) of respondents were taking ART since more than 2 years of duration. Majority of the respondents (92.9%) had >95% adherence with ART while 7.1% respondents had non- adherence. The majority of the PLHA patients have more than ninety five percent adherences to anti-retroviral therapy. Some of them have still nonadherence to ART and the reason they claimed were forgetfulness during travelling and too long duration of treatment. It is recommended to promote awareness program related to ART therapy and importance of its adherence to their family member and community people

Age estimation based on appearance of pisiform bone in selected Nepalese children of Gandaki Province Nepal

Background: Age estimation is based on general physical examination, radiological examination of bones and dental examination. The appearance of ossification center of pisiform bone is one of the important evidence for estimating age among young children between nine to 13 years. The objective of this study is to estimate the age of appearance of pisiform among the Nepalese children.
 Materials and methods: It is a cross sectional descriptive study conducted at the department of Radiology, Pokhara Academy of Health Sciences, Western Regional Hospital on the month of July 2020. The Antero posterior view of X Rays of either hand (left or right) including the carpal bones of the patients aged seven to 15 years of 183 Nepalese children archived at the department of Radiology were taken as samples. The X rays were checked for the appearance or non appearance of Pisiform and the age of appearance analysed.
 Results: One hundred and twenty seven (69.40%) of total 183 cases were males and 56 (30.60%) were females. The minimum age of appearance of pisiform was 9 years in females and 10 years in males. All the subjects had pisiform bone appeared at the age of 13 years and above.
 Conclusion: The minimum age of appearance of Pisiform in the study subjects was 9 years in females and 10 years in males. All the cases have pisiform ossified at the age of 13 years and above.

Vacuum Deliveries: A Retrospective Study on Immediate Maternal and Neonatal Outcomes in Western Regional Hospital, Pokhara

Introduction: The overall rate of operative vaginal delivery is diminishing, but the proportion of operative vaginal deliveries conducted by vacuum is increasing. As forceps assisted delivery requires more skill and has more complications on maternal genital tract, this procedure is being less frequently practiced. By the 1970s, the vacuum extractor virtually replaced forceps for assisted deliveries in most of the countries. Vacuum assisted vaginal delivery reduces maternal as well as neonatal morbidity and mortality in prolonged second stage of labor, non reassuring fetal status and maternal conditions requiring a shortened second stage. 
 Materials and Methods: This was a record based retrospective study of 217 vacuum assisted vaginal deliveries conducted at Western Regional Hospital, Pokhara for a period of one year. Patient’s discharge charts were studied and details of indications for vacuum application, maternal genital tract status, amount of blood loss, postpartum hemorrhage (PPH), birth weight, APGAR score at 1 and 5 minute, Neonatal Intensive Care Unit (NICU) admission and neonatal death (NND) were collected. Descriptive data analysis was done using SPSS program. 
 Results: Out of the 8778 deliveries conducted during the study period, 217 (2.47%) cases were vacuum assisted vaginal deliveries. No significant adverse obstetrics outcomes were noted. Most frequent indication was fetal distress which accounted for 53.9%. Though 3rd/4th degree perineal tears were less, episiotomy rate was higher (69.1%). Regarding neonatal outcomes, mean APGAR score at 5 minute was 7.42 ± 1.11 SD and 12.4% neonates had APGAR score of less than 7 at 5 minute. 
 Conclusion: When standard criteria for vacuum application are met and standard norms are followed, there is no evidence of adverse obstetrics outcomes in vacuum assisted vaginal delivery. Prompt delivery by a skilled clinician in non reassuring fetal cardiac status reduces neonatal morbidity and mortality.

Depression among Chronic Kidney Diseases Patients Receiving Hemodialysis

Background: Chronic Kidney Disease (CKD) is a progressive irreversible loss of renal function over a period of months or years. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintains life. Hemodialysis is used for patients who require short term dialysis (days to weeks) and for patients with advanced CKD and End Stage renal Disease (ESRD) who require long term or permanent renal replacement therapy. Hemodialysis significantly and adversely affects the lives of patients, both physically and psychologically. Depression is the most common psychological condition among patients with ESRD. Depression in dialysis patients not only effect mortality, but increased rate of hospitalizations and dialysis withdrawal is also very common.
 Methods: A descriptive cross sectional research design was carried out to identify the depression level of chronic kidney disease patients receiving Hemodialysis in Western Regional Hospital, Pokhara using Beck Depression Inventory among forty six patients.
 Results: The study findings revealed that majority of the patients (84.8%) has various degree of depression i.e. mild (21.7%), moderate (30.8%) and severe (32.6%). Only fifteen percent of patient has no depression. There was no statistical association between the level of depression and socio-demographic variables. It can be concluded that the prevalence of depression is high among patients receiving Hemodialysis.
 Conclusion: The prevalence of depression is high among patients receiving Hemodialysis. It is effective to provide mental health services to the CKD patients receiving Hemodialysis which help them better psychologically adaptation to their disease and improve their quality of life.

Determinants of Unintended Pregnancy and Induced Abortion among Female Youths in Western Regional Hospital, Nepal


 
 
 
 Introduction: Youth are more susceptible to unwanted pregnancies; this may be explained by the fact that youths are facing various problems with regards to their reproductive health needs including age at marriage, contraceptive use, social, cultural and economic barriers in accessing the family planning services, their educational level as well as occupational opportunities. The study assessed the determinants of unintended pregnancies and induced abortion among female youths aged 15-25 years in Western Regional Hospital, Pokhara.
 Methods: A cross sectional hospital-based study was conducted among 125 female youths visiting Western Regional Hospital, Pokhara. Ethical approval was taken before starting data collection. The respondents were interviewed using semi structured questionnaire. All the data collected in the proformas were entered and assimilated using SPSS 21, statistical analysis software. Descriptive statistics including chi square and p-value was applied.
 Results: Among 125 female respondents, 72.8% of the respondents had unwanted pregnancy and 24% had history of abortion. Out of all the unwanted pregnancies, 86.7% had induced abortion with p-value <0.05, x2 = 67.41. The financial problems of the respondents were found to be the prime determinant ofunwanted pregnancy and induced abortion, proportion being 52.8% and 55.2% respectively, whereas to keep gap between the births (12.8%) was also associated. The association between use of contraceptive methods and unwanted pregnancy was not found to be statistically significant with the p-value of >0.05.
 Conclusions: The prevalence of unintended pregnancy and induced abortion were high and most of the induced abortion was the result of unwanted pregnancy. The economic problem of the respondents was the prime factor associated with induced abortion.