Tertiary Care Center In Nepal Research Articles

Awareness and practice regarding puerperal danger signs among postnatal mothers attending at rural tertiary care center of Nepal

Background: Global evidences show that all pregnancies are at risk and complications during pregnancy, childbirth, and the postnatal period are difficult to predict. Awareness regarding puerperal danger signs is essential for appropriate and timely health management so that maternal mortality and morbidity can be reduced. An objective of the study is to assess the awareness and practice regarding puerperal danger signs among postnatal mothers. Method: Descriptive cross-sectional study design was conducted among 139 postnatal mothers, who were attending at maternal and child health (MCH) clinic and postnatal ward of Karnali Academy of Health Sciences (KAHS), Jumla. Probability simple random sampling method was used. Data were collected by using semi-structured interview questionnaire. After collection of the data, coding was done. Coded data was entered into EXCEL and transformed in SPSS for analysis. Result: Out of 139 postnatal mothers, 60.4% had poor level of awareness regarding puerperal danger signs. Only 39.6% had good level of awareness regarding puerperal danger signs. Similarly, 85.6% of the respondents had poor practice on puerperal danger signs. Only 14.4% had good practice on puerperal danger signs. Conclusion: Health education & awareness program is needed to improve the mother’s knowledge and practice on puerperal danger signs.

Outcome of Patients Presenting with Peripartum Cardiomyopathy in a Tertiary Care Center of Nepal

Purpose: Peripartum cardiomyopathy is a rare life-threatening cardiomyopathy of unknown etiology with significant maternal morbidity and mortality. It causes heart failure due to left ventricular systolic dysfunction with or without left ventricular dilatation in the last month of pregnancy up to 5 months postpartum in previously healthy women. We aimed to determine short-term outcomes of peripartum cardiomyopathy clinically as well as in terms of left ventricular systolic function and to study the clinical profile and associated risk factors. Patients and methods: A prospective observational study was carried out in the Department of Cardiology of Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Kathmandu, Nepal, from July 2018 to January 2022. All the patients with peripartum cardiomyopathy who presented to the department of cardiology were enrolled in the study and re-evaluated with echocardiography at 6 months. Results: A total of 68 women met the inclusion criteria. The mean age was 28.38 ± 5.5 years (range 19 to 44 years). The most common clinical presentation was dyspnea followed by lower limb edema. Six (8.8%) patients presented during the last month of pregnancy whereas 62 (91.2%) patients presented in the postpartum period. The mean left ventricular ejection fraction on presentation was 30.01 ± 8.54. A full recovery was observed among 60.29% at 6 months. The mortality rate was 4.41%. Conclusion: Timely diagnosis and management of peripartum cardiomyopathy with standard therapy for heart failure leads to better recovery of left ventricular systolic function.

Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal

Introduction Traumatic spinal spondyloptosis, though rare, harbingers a high risk of mortality as well as permanent and disabling neurological deficits. They invariably become socially aloof and marginalized in most parts of our subcontinent owing to the lack of dedicated rehabilitation units amid their poor economic status. There is a paucity of studies pertaining to such rare epiphenomenon within our region. Materials ad Methods A retrospective study of 16 patients presenting with spinal spondyloptosis in a tertiary care center in Nepal was undertaken. The clinical records of the patients were retrieved from the hospital record section to study the demographic variables, modes of injury, American Spinal Injury Association (ASIA) grades, salient radiological characteristics, management strategies, and the resultant clinical outcomes. Result The mean age of the cohorts in our study was 40 years with an age range of 25-80 years. Most of the patients presented in ASIA ‘A’ neurological grade (75%). The cervical spine was involved in the majority (68.75%) of cases. 8 (50%) patients left against medical advice, 2 (12.5%) were managed conservatively, and 6 (37.5%) were operated. The posterior-only approach was undertaken in 4(66.67%) cases. Tracheo-oesophageal fistula occurred in 2 (33.33%) patients. And cerebrospinal fluid (CSF) leak occurred in 2 (33.33%) patients. The overall hospital mortality was 3(37.5%). Conclusion Traumatic spinal spondyloptosis on our center mostly involved cervical spine (68.75%). 75% of the patients presented with ASIA ‘A’ neurological grade. 50% of them left against medical advice. 37.5% were operated. The overall hospital mortality was 37.5%. This study emphasizes the implementation of a national spinal trauma data bank and the systematic implementation of dedicated neuro-rehabilitation units. This will thereby help improve the clinical outcome among these ‘socially aloof’ and marginalized subsets of neurosurgical patients.

Demographic and clinical profile of patients undergoing colonoscopy at a tertiary care center in Nepal: a retrospective cross-sectional study.

Colonoscopy is widely used as a tool for diagnosis, screening and treatment of various pathologies in the rectum, colon, and terminal ileum. The aim of this study is to evaluate the demographic, clinical, and histological parameters of the records of patients undergoing colonoscopy at a tertiary care hospital in Nepal. This retrospective cross-sectional study included the hospital records of all patients who underwent colonoscopy from 2015 to 2019 in a tertiary care centre in Nepal. A total of 1255 records were included in the study. The mean and standard deviation of age were 43.8 and 19 years, respectively. Among the total study population, 61.9% were males and 38.1% were females. Common indications for colonoscopy included lower gastrointestinal bleeding (27.7%), altered bowel habit (26.9%) and persistent or recurrent abdominal pain (17.3%). Only 3% of the patients who underwent colonoscopy had inadequate bowel preparation. The overall diagnostic yield of colonoscopy was 57.5%. Findings during colonoscopy included colorectal polyp (19.4%), internal haemorrhoids (8.2%) and colitis (6.5%). Having an age of 50 or more years was significantly associated with the presence of colorectal adenocarcinoma (P=0.017, χ2 test) with an odds ratio of 2.35 (95% CI: 1.14, 4.89). Furthermore, having a female sex was found to be significantly associated with the presence of colorectal adenocarcinoma (P=0.012, χ2 test) with an odds ratio of 2.43 (95% CI: 1.19, 4.97). In the authors' study, a smaller proportion of the colonoscopies was aimed at screening for colorectal carcinoma (CRC), when compared to studies in developed countries. The sex predisposition of CRC in the authors' study is in contrast to the global trend. The authors recommend conducting studies to determine the risk factors and need for CRC screening in the Nepalese population.

A Cross-sectional Study on Patients' Perspective Towards Dermatology Outpatient Services from a Tertiary Care Center in Nepal

Introduction: Patient-centered care has received greater prominence in recent years, and it is paramount to assess the patient’s satisfaction to improve the quality of healthcare services. The present study is aimed at understanding the patients’ perspectives regarding dermatology outpatient services offered at a tertiary care center to determine the areas for improvement for better patient satisfaction. Objective: This study is intended to understand the patients’ perspectives regarding a typical dermatology OPD setup and to identify the areas for improvement in a tertiary center in Nepal. Materials and Methods: The descriptive cross-sectional study was carried out using a content-validated, pre-tested, standardized, and translated questionnaire. All the patients who visited the outpatient department of Dermatology tertiary care center during the month of April 2022 and were willing to participate in the study were included. Result: A total of 157 patients participated in the survey. The majority of the participants were males (56.7%) and belonged to urban domiciles (80.9%). Nearly 42% of the subjects were seeking dermatology consultation for the first time, and 68.2% responded that the duration of consultation was sufficient. The details of symptoms, clinical results, and medication were clearly understood by 89.8%, 82.2%, and 73.9% of the subjects, respectively. Maintenance of privacy was reported by 76.4% of the participants. However, 25.5% of the subjects reported a waiting time of ≥4 hours for consultation, and 34.4% suggested the need for more manpower. Conclusion: The majority of the patients had a high degree of satisfaction. The areas of improvement include the adoption of technology-based appointment booking system, ensuring a good waiting ambience, increasing manpower, and reducing waiting time for consultations.

Socio-demographic determinants of the knowledge of Monkeypox Virus among the general public: a cross-sectional study in a Tertiary Care Center in Nepal

Background and objectiveMonkeypox virus (MPXV) is the causative agent of monkeypox’s zoonotic infection and was declared a global emergency by the World Health Organization (WHO). Studies from different countries have shown insufficient knowledge among the general public on MPXV. This study aimed to assess the knowledge of the general public of Nepal on MPXV.MethodsThree hundred people were interviewed in person in October 2022, and 282 complete responses were recorded. The questionnaire related to the knowledge of MPXV was derived from a previous study conducted among the general population of Saudi Arabia. Twenty-two questions were included that assessed the knowledge and attitude of Nepalese toward monkeypox. Statistical comparison between high and low knowledge was performed using Pearson’s Chi-square test. Logistic regression models were deployed to establish the relationship between participants’ knowledge and socio-demographic characteristics.ResultsAmong the total respondents, 53.8% demonstrated high knowledge of monkeypox. People aged 18–25 years, unmarried people, and those living in urban areas had significantly higher levels of knowledge. Most respondents believed that MPXV is not a conspiracy or bioterrorism (63.1%) and agreed that it is likely to affect people’s social and economic life as COVID-19 did (67.0%). The history of COVID-19 vaccination (aOR: 2.980; 95%CI: 1.227, 7.236) and the younger age (aOR: 2.975; 95%CI: 1.097, 8.069) were found to be significant determinants of the knowledge of the participants on monkeypox.ConclusionWe observed that most Nepalese populations had a high knowledge of monkeypox and that social media was the most valuable source of information.

Distribution of Sesamoid Bones in the Foot and Hand Radiographs; A Descriptive Cross-Sectional Study in a Tertiary Care Center in Nepal

Objective: The aim of this study was to present data about the prevalence and distribution of sesamoid bones of the hands and feet in Nepalese population by using radiographs, to determine the number of the sesamoid bones of the foot and hand, commonest site of occurrence and to correlate the findings between gender and age. Methodology: This prospective quantitative study was performed in the Department of Radiology and Imaging, TUTH. The radiographs of foot and hand were reviewed to evaluate the presence or absence of sesamoid bones and patient demographics were also noted. Data collection was done for a period of three months and random probability sampling method was used. Results: This study resulted that in foot radiographs, the most common sites of sesamoid bones was first metatarsophalangeal joint (1st MTPJ) where two sesamoid bones were found, whereas single sesamoid bone was found in other sites. The percentage of sesamoid bones in first interphalangeal joint (1st IPJ), second metatarsophalangeal joint (2nd MTPJ), third metatarsophalangeal joint (3rd MTPJ), fourth metatarsophalangeal joint (4th MTPJ) and fifth metatarsophalangeal joint (5th MTPJ) were 7.9%, 15.4%, 0 %, 0.4%, and 26.7% respectively. The number of sesamoid bones ranged from 2- 5 in single foot with frequency of occurrence of 2 bones being highest (58.3%). The percentage of sesamoid bones in foot was found to be relatively higher in female than male. In the analysis of hand radiographs, the most common sites of sesamoid bones was 1st MCPJ ( single sesamoid bone in 80.33% and a pair of sesamoid bones in 19.67% ) .The percentage of sesamoid bones in 1st IPJ, 2nd MCPJ, 3rd MCPJ, 4th MCPJ and 5th MCPJ were 37.33%, 58.67% ,5.33% , 5.33% and 59.33% respectively. The number of sesamoid bones ranged from 1 - 6 in single hand with frequency of occurrence of 3 bones being higher (32%). The percentage of sesamoid bones in hand was relatively higher in male than female. Conclusion: The distribution and frequency of sesamoid bones differ according to sites, gender and age. This study improves the knowledge on distribution of sesamoid bones of the foot and hand and also provides anatomical data that could help clinicians in diagnosis and management of various sesamoid bone disorders in patients who present with pain and discomfort in the foot and hand.

Treatment of failed bilioenteric anastomosis after bile duct injuries in a tertiary care center of Nepal

Treatment of failed bilioenteric anastomosis after bile duct injuries in a tertiary care center of Nepal

Non-pancreatic cancer tumors: case series from a Tertiary Care Center in Nepal

Non-pancreatic cancer tumors: case series from a Tertiary Care Center in Nepal

Histopathological Spectrum of Pigmented Skin Lesions in a Tertiary Care Centre of Nepal

IntroductionPigmented skin lesions are defined as altered pigmentation of the skin as well as mucous membrane which can present as flat or raised growth and can be blue, brown, black or grey in color. The main aim of the study was to see the histopathological spectrum of pigmented skin disease and compare the clinical and histopathological diagnoses. MethodsIt is observational cross-sectional study conducted in the Department of Pathology of Gandaki Medical College and Teaching hospital from January 2022 to December 2022 and 80 cases were included. ResultsAge of the patient ranged from seven to 89 years and mean ± SD was 49.55 ± 21.73 years. There were 34 (42.6%) males and 46 (57.4%) females with a female: male ratio 1.3:1. The most common site of distribution of pigmented lesions of the skin were face in 44(55%) followed by trunk in 15(18.7%), extremities in 13(16.2%), scalp in 7(8.8%) and genitalia in 1 (1.3%). Histopathological study revealed the most common lesion as melanocytic nevi 14(17%) followed by basal cell carcinoma 11(13.8%), seborrheic keratosis 6(7.6%), Keratoacanthoma 5(6.3%), verrucous epidermal nevus 4(5%) and others cases in few numbers. Clinicopathological agreement was seen in 44 (55%). Conclusions Melanocytic nevi were the most common among the pigmented skin lesion. Other causes of pigmented lesions were due to keratinocytic, vascular and reactive changes. Malignant tumors can sometimes mimic benign lesions. Therefore, histopathological examination remains the gold standard in diagnosing these conditions and provide proper guidance for further management of patients.

Demonstration of Urease Activity in Subgingival Plaque Sample of Periodontitis Patients in a Tertiary Care Center of Nepal

Demonstration of Urease Activity in Subgingival Plaque Sample of Periodontitis Patients in a Tertiary Care Center of Nepal

Spectrum of Radiological Findings in Hysterosalpingography for Female Subfertility: A Retrospective Cross-Sectional Study in a Tertiary Care Center of Nepal

Introduction: Hysterosalpingography (HSG) is a commonly used diagnostic procedure to investigate the causes of female subfertility. This study aimed to evaluate the range of findings observed in HSG examinations conducted for this purpose. Methods: A prospective cross-sectional study was conducted at the Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, from December 2022 to April 2023. The study included 196 female participants who underwent HSG and met the inclusion criteria. Results: Out of the 196 participants, 127 (64.8%) were categorized as having primary subfertility, while 69 (35.2%) had secondary subfertility. The mean age of the participants was 30.61±5.623 years, with an age range of 20 to 45 years. Among the participants, 142 (72.4%) exhibited a normal uterus, 23 (11.7%) displayed left tubal occlusion, 17 (8.7%) showed right tubal occlusion, 13 (6.6%) had other findings, and 1 (0.5%) was diagnosed with uterine fibroids. Conclusions: This study demonstrated that approximately one out of every five HSG examinations performed to evaluate subfertility revealed tubal occlusion. Consequently, the high detection rate of uterine and tubal pathologies using HSG underscores its critical role as a diagnostic tool for assessing women with subfertility.

Critical View of Safety Dissection and Rouviere's Sulcus for Safe Laparoscopic Cholecystectomy: A Descriptive Study.

Objective: To determine the importance of a critical view of safety (CVS) techniques and Rouviere's sulcus (RS) in laparoscopic cholecystectomy (LC) and its relation to biliary duct injuries (BDIs) and to determine the frequency and the type of RS. Design, Setting, and Participants: A descriptive study was carried out among 76 patients presenting to the surgery department of a tertiary care center in Nepal. The study population included all patients in the age group 16-80 years undergoing LC. Outcome Measures: The main outcome of interest was to calculate the percentage of BDIs along with the frequency and the type of RS. Results: A total of 76 patients were enrolled in the study, out of which 57(75%) were female patients with a male-to-female ratio of 1:3 and a mean age of 45.87 ± 15.33 years. Seventy-one (93.4%) patients were diagnosed with symptomatic gallstone disease. The CVS was achieved in 75 (98.7%) of the cases, whereas in 1 case, the CVS could not be achieved, and in the same patient routine LC was converted into open cholecystectomy owing to the difficult laparoscopic procedure. In 56 (73.7%) cases, RS was first visible to the operating surgeons after port installation, alignment, and adequate traction of the gallbladder; in 20 (26.3%) cases, RS was not originally apparent. Conclusion: According to the findings of this study and the literature's critical assessment of safety, this method will soon become a gold standard for dissecting gall bladder components. The technique needs to be extended further, especially for training purposes. Major difficulties can be avoided by identifying RS before cutting the cystic artery or duct during LC.

CLINICAL PROFILE OF PATIENTS WITH POISONING ADMITTED TO TERTIARY CARE CENTRE OF NEPAL

Background: Acute poisoning is one of major medical emergencies and a common cause of admission and death in hospitals in Nepal. In our country, agrochemicals including pesticides like Organophosphorus, organochlorine, zinc and aluminium phosphide are most common causative agents used for intentional or accidental poisoning. The study was aimed to assess clinical profile of patients with poisoning admitted to tertiary care centre of Nepal. Methods: This retrospective study was conducted to see clinical profile of patients diagnosed with poisoning in Chitwan Medical College Teaching Hospital for 1 year period from February, 2022 to January, 2023. Data were collected from hospital medical records and Midas software. Data analysis was performed using Statistical package for Social Sciences version 21 and data are presented as frequency and percentage. Results: A total of 150 cases of poisoning presented to our hospital during the one-year period. Among them, 42% patients were males and 58% females (1.38:1). Most of them (34%) belonged to age group of 21-30 years. Majority of the cases were suicidal (86%). Organophosphorus was the most common poison (36.66%), followed by rat poison-(12.66%). About 44% patients went on Leave Against Medical Advice, 28% on Discharge On Request, 23% patients were discharged with full recovery, whereas mortality with treatment was 5%. Conclusions: Poisoning is more prevalent in females and younger age group. The most common agent is Organophosphorus followed by rat poison. Self-poisoning with suicidal intent is the most common mode of poisoning. Mortality in this study was 5.33% which was more among Organophosphorus poisoning.

Prevalence of Helicobacter pylori infection in dyspeptic patients presenting to a tertiary care center of a developing country: a cross-sectional study

Background: Among the various causes for dyspepsia in patients presenting to the gastroenterology department, Helicobacter pylori is the most common etiological agents. Here, we explore the prevalence of Helicobacter pylori infection, particularly, in dyspeptic patients and different endoscopic findings in such patients. Methods: We conducted a simple observational study in the gastroenterology department of a tertiary care center of Nepal. The Helicobacter pylori was detected using rapid urease test and endoscopic findings were collected from gastroduodenoscopy unit. The obtained data was analyzed using Statistical Package for Social Sciences (IBM-SPSS), version 22. Results: The overall prevalence of Helicobacter pylori infection in dyspeptic patients in our center was found to be 0.329 (0.259 – 0.406) at 95% Confidence Interval (CI). There was significant association of Helicobacter pylori infection with alcohol history (12 [52.17] vs 44 [29.93], p = 0.035) and endoscopic findings of duodenal ulcer (3, 100%) followed by gastritis (29, 50.88%). Conclusions: Amidst various etiology for dyspepsia, Helicobacter pylori was still prevalent at our center. However, considering the variability of its prevalence due to factors like alcohol history, more comprehensive studies are needed to estimate actual proportion in patients presenting with dyspeptic symptoms.

Maternal and Fetal Outcome in Cases of Preeclampsia and Eclampsia in Tertiary Care Center of Nepal

INTRODUCTION Hypertensive disorders of pregnancy includes Gestational Hypertension, Preeclampsia and Eclampsia, Chronic Hypertension and Preeclampsia superimposed in Chronic Hypertension. These condition complicates around 5 to 10 percent of pregnancies and have significant contributions on maternal and fetal adverse outcome. This study was done to find out the maternal and fetal outcome in cases of Pre-eclampsia and Eclampsia. MATERIAL AND METHODS It was a hospital based cross sectional observational study done in department of Obstetrics and Gynecology of Universal College of Medical Sciences from August 2021 to June 2022. Maternal and fetal outcome in Preeclampsia and eclampsia were studied in 116 cases. RESULTS Incidence of diseases was 5.94%, preeclampsia 33(28.4%), eclampsia 23(19.8%) and severe preeclampsia 60 (57.7%). Adverse maternal outcome were HELLP (Hemolysis, Elevated liver enzyme and Low platelets counts) syndrome 15 (12.93%), Abruption placenta 7(6.03%), need of blood transfusion 20 (17.24%), Pulmonary Oedema 3(2.58%), Post-Partum Hemorrhage 3(2.58%) and one case had maternal death. Total 121 babies were born, 42(36.20%) admitted in NICU, 10(8.26%) were intra uterine fetal death (IUFD), 3 (2.48%) were neonatal death (NND), 10(8.26%) refused treatment and leave against medical advice. Common fetal morbidities were intra uterine growth restriction (IUGR) 29 (23.76%), preterm Low birth weight 22(18.18%), anomalous baby 3(2.48%) and congenital pneumonia 1 (0.83%). CONCLUSION Proper Antenatal care and screening, timely referral and prompt management favoured the outcome in positive way.

Postpartum hemorrhage: clinical features and management in a tertiary care center of Nepal

Introduction: Obstetric haemorrhage continues to account for a substantial proportion of maternal deaths in Nepal, despite implementation of different strategies. The most common type of obstetric haemorrhage is postpartum hemorrhage (PPH), mainly primary. Understanding its burden in the health care setting was the objective of this study by assessing its prevalence, associated factors and management. Method: This was a retrospective study conducted at Patan Academy of Health Sciences from Mar 2019 to Mar 2022. Demographic, obstetrical, medical factors and management of primary PPH was collected from medical record. Statistical analysis was done using Statistical Packages for Social Sciences (SPSS-20). Results were expressed using frequencies, tables and figures. Result: From a total 17,770 deliveries, primary PPH was seen in 84(0.47%). Most of them 49(58.3%) were multipara. The frequency and impact of PPH can be effectively reduced by reducing avoidable risk factors, especially those related to obstetric interventions as increased caesarean section rate which was 48(57.1%) among primary PPH. Other associated risk factors were induction of labor 32(38.1%), pre-existing medical diseases 32(38.1%), history of antepartum hemorrhage 15(17.9%), previous caesarean section 19(22.6%). Uterine atony 43(51.2%), abnormal placentation disorder 16(19%), genital trauma 9(10.71%), retained tissue 5(5.95%) were the leading causes of PPH. PPH in morbidly adherent placenta like placenta accreta spectrum was 8(9.5%) and placenta increta 1(1.2%). PPH was controlled by conservative management in 24(28.6%). Surgical intervention was required in 34(40.5%) including hysterectomy in 14(16.7%). Conclusion: PPH can be minimized by extra vigilance and planned conjoined management.

Prevalence of anemia and mortality among anemic patients with COVID-19 in a tertiary care setting in Nepal

Introduction: The COVID-19 pandemic first detected in December 2019 has claimed so many lives globally as well as in Nepal. Inflammatory changes in SARS-CoV-2 infection can lead to anemia. This study aims to find the prevalence of anemia and mortality among anemic patients in COVID patients admitted to a tertiary care centre in Nepal. Method: A descriptive cross-sectional study with data collected retrospectively between May 2021 to February 2022 on patients with proven COVID-19 admitted to Patan Hospital. Result: Among 890, anemia was prevalent in 296(33.25%) (CI 95%, 30.17-36.35) patients which was more among the female population. The mean hemoglobin was 10.68±1.62 g/dl in anemic patients. Mild anemia was present in 215(72.6%) patients followed by moderate in 64(21.6%) patients and severe in 17(5.8%) patients. The mortality in anemic patients was 43(14.5%). Conclusion: One third of COVID-19 patients admitted to Patan Hospital had anemia which was found to be similar to studies done in similar setting. One in four COVID-19 patients with anemia had died was found to be lower than other studies done in similar settings.

Clinicopathological Profile of Dengue Infection in a Tertiary Care Centre in Nepal.

Dengue is a mosquito-borne viral disease with a wide spectrum of presentations ranging from subclinical disease to severe dengue. Dengue is endemic to the Terai of Nepal. Interestingly, an increasing incidence has been reported from hilly areas like Kathmandu valley. This study explored the clinicopathological profile of dengue infection. A total of 84 serologically confirmed dengue cases from September to November 2019 at KIST Medical College were recruited in a cross-sectional study after obtaining ethical approval. Dengue was categorized as dengue without warning signs, dengue with warning signs, and severe dengue. Clinicopathological information was recorded in the proforma by reviewing patients' records. A descriptive statistical tool and chi-square test were carried out. Out of 84 patients, 76% (64) were dengue without warning signs, 21.4% (18) were dengue with warning signs and 2.4% (2) were severe dengue. About 97.6% (82) presented with fever. During the course of illness, anemia was identified in 38.1% (32), thrombocytopenia in 65.5% (55), hemoconcentration in 6% (5), and leucopenia in 82.1% (69). Similarly, elevated aspartate transaminase and alanine transaminase (ALT) was observed in 67.7% (42) and 53.2% (33) respectively. The severity of dengue on presentation to hospital was significantly associated with thrombocytopenia, leucopenia, and elevated ALT. Similarly, the severity during course of illness in hospital was significantly associated with hemoconcentration, thrombocytopenia, leucopenia, and elevated ALT. Most common presentation of dengue infection was fever. The most common laboratory abnormalities were leucopenia, thrombocytopenia, hemoconcentration, anemia, and elevated liver enzymes. Awareness of these clinical and laboratory parameters is important for the prompt diagnosis, severity estimation, and overall management of dengue infection.

Prevalence and Factors Associated with Occupational Musculoskeletal Disorders among the Nurses of a Tertiary Care Center of Nepal

Introduction: Musculoskeletal disorders (MSDs) are injuries or pain in the human musculoskeletal system which could lead to temporary or permanent impairments. The nature of nursing jobs makes nurses vulnerable to MSDs. This study aimed to assess the prevalence and potential risk factors associated with MSDs among nurses. Methods: In between March to June 2021, a cross-sectional study was conducted among 165 nurses using self-administered questionnaires. A standardized Nordic Questionnaire was used to measure MSDs. Pearson’s chi-square test and binary logistic regression at a 5% level of significance were performed to identify factors associated with upper extremities and spinal musculoskeletal disorders (UMSD) and lower extremities musculoskeletal disorders (LMSD). Variables associated with UMSD and LMSD in bivariate analysis were subjected to multiple logistic regression. Results: The prevalence of UMSD and LMSD experienced by nurses was 86.1% (95% CI: 79.4%-90.9%) and 66.1% (95% CI: 58.9%-74.3%), respectively. Among several factors, working in same position for long periods (AOR: 4.16, 95% CI: 1.2-13.4), not receiving training in injury prevention programs (AOR: 3.15, 95% CI: 1.0-9.2), not enough rest breaks during the day (AOR: 4.65, 95% CI: 1.3-15.9) and moderate to higher job stress (AOR: 3.62, 95% CI: 1.2-10.8) were found to be significantly associated with UMSD. Not having enough rest breaks during the day (AOR: 2.19, 95% CI: 1.0-4.7) was significantly associated with LMSD. Conclusion: Higher prevalence of MSDs among nurses is a serious concern that threatens individual health as well as the overall healthcare system. Sensitization and capacity enhancement programs on the issue could prevent MSDs among nurses.