Tertiary Care Center In Nepal Research Articles

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

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

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

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

Periodontal Health Status and its Impact on the Quality of Life among Diabetics attending Medical and Dental Out Patient Departments of a Tertiary Care Centre of Nepal

Background: Diabetics are more prone to periodontal diseases leading to poor oral function affecting their quality of life. The objective of the study was to assess the impact of periodontal health on the quality of life among diabetics using the short version of the Oral Health Impact Profile (OHIP -14). Methods: It was a descriptive cross-sectional study. Data was collected using translated and validated Nepalese version of OHIP-14 questionnaire and clinical examination for periodontal status (Community Periodontal Index and Loss of Attachment index) was done using mouth mirror and World Health Organization probe under natural light. Data was entered and analyzed using SPSS version 11.5. Mann- Whitney U test and Kruskal-Wallis tests were used to compare OHIP-14 scores between genders and periodontal status respectively. Statistical significance was established at p<0.05. Results: One hundred and forty-five subjects with confirmed diabetes participated in the study. Overall, 41% were male participants were as 59% were females. Majority of the participants had calculus with CPI score 1 (n=131, 90.3%) and another majority had loss of attachment 3-5 mm with LOA score 1 (n=55, 37.9%). There was no significant difference in mean scores between two genders (p=0.231). The OHIP scores among participants with highest CPI and LOA scores had statistically significant difference (p=0.011 and p=0.006 respectively). Conclusions: Periodontal status was poor among diabetics with significant impact on their oral health related quality of life. Glycemic control along with periodontal maintenance is required to enhance quality of life among such patients. This might be possible with comprehensive medical approach for diabetic patients.

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

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

Trans-oral Extra Tonsillar Approach of Styloidectomy for Treatment of Eagle's Syndrome among Operated Cases of the Department of Otolaryngology-Head and Neck Surgery at a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Eagle's syndrome is a poorly understood clinical entity that has variable presentations like recurrent throat pain or foreign body sensation, dysphagia, or facial pain. With a confirmed diagnosis, a surgical approach is considered appropriate for its treatment. This study aims to find out the prevalence of trans-oral extra tonsillar approach of styloidectomy among the operated cases of Department of Otolaryngology-Head and Neck Surgery at a tertiary care hospital. A descriptive cross-sectional study was conducted among 1,475 who underwent surgery at the Department of Otolaryngology-Head and Neck Surgery in a tertiary care center of Nepal between July 2018 to September 2020 after receiving the ethical clearance from the Institutional Review Committee (Reference number: 0106201802). Convenience sampling was done and data was entered in Statistical Package for the Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Among 1,475 patients enrolled in the study, 24 (1.62%) patients (95% Confidence Interval= 0.97-2.26) underwent trans-oral extra tonsillar approach of surgery for Eagle's syndrome during the study duration. The prevalence of styloidectomy among the operated cases of our study is low in comparison to other studies done in similar settings. Transoral extra tonsillar approach can be considered as a novel approach for surgical removal of the styloid process in Eagle's Syndrome.

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

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

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

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

Functional Outcome of Pediatric Monteggia Fracture Dislocation Treated Surgically in a Tertiary Care Centre of Nepal

Background Monteggia fracture dislocation may need operative management. The fracture of ulna is reduced by closed or open reduction followed by stabilization of ulna with Rush pin, K-wires or Dynamic compression plate.
 Objective To evaluate the Mayo Elbow Performance Score of patients with Monteggia fracture dislocation treated operatively.
 Method It is a retrospective study conducted at Dhulikhel Hospital, Kathmandu University Hospital. All the pediatric patients with Monteggia fracture dislocation managed operatively from January 2011- December 2019 were included in the study. The functional outcome scoring of the effected elbow using Mayo Elbow Performance Score was done in the last follow up.
 Result Forty eight surgically managed Monteggia patients had a mean age of 7.23 ± 2.9 years with male predominance. Left side was the dominant side of involvement with 29 patients. Bado type 1 was the most common type (81.3%). Most of the patient underwent closed reduction and fixation with Rush pin (n=40). All of the patient has excellent (89.6%) to good (10.4%) functional outcome.
 Conclusion Operative management of Monteggia fracture dislocation with complete ulna fracture has excellent to good outcome.

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

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

Surgical Management and Early Outcome of Encephalocele

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

Bacteriological profile of pyogenic infections at a Tertiary Care Centre of Nepal

Background: The pyogenic infections includes a wide range of abnormalities like superficial skin infections, eyes infections, wound infections, infection of burns, boils, furuncles, peritonitis and abscesses . Some of the infections are endogenous that occurs by the patient’s own normal flora. Many infections are exogenous that occur by direct and indirect airborne routes. Boils and furuncles are caused by Staphylococcus aureus. Gramnegative infections rarely occur on healthy skin except moist area of skin and axilla. Objectives: The purpose of this study was to illustrate the bacteria responsible for pyogenic infection and to determine their antibiotic susceptibility. Methods: The pyogenic bacteria were isolated from the samples collected from the Clinical Departments of Chitwan Medical College. The isolates were identified and antibiotic susceptibility test was performed by standard protocols. Results: Gram negative bacteria were frequently isolated pathogens than the gram positive bacteria. Escherichia .coli was the predominant isolate among the 138 positive samples, 49 (35.5%) of them was only the E.coli, followed by Staphylococcus aureus (15.21%), Klebsiella pneumoniae (13.04%), Acinetobacter species (11.59%), MRSA (11.59%), Pseudomonas aeruginosa (5.79%), Klebsiella oxytoca (3.62%), Enterobacter (2.17%), and Proteus mirabilis (1.44%) Gram negative bacteria were highly susceptible to Amikacin whereas most of the Gram-positive isolates were susceptible to vancomycin and linezolid. Conclusion: The knowledge of the most prevalent type of bacterial isolates and their antimicrobial susceptibility pattern is a must for the clinicians as it aids in the accurate selection of the therapeutic regimens.

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

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

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

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

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

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

COVID-19 Diagnosed by Real-Time Reverse Transcriptase-Polymerase Chain Reaction in Nasopharyngeal Specimens of Suspected Cases in a Tertiary Care Center: A Descriptive Cross-sectional Study.

The emergence of severe acute respiratory syndrome coronavirus-2 pandemic is critically challenging the whole world. The real-time reverse transcriptase-polymerase chain reaction is the most widely used confirmatory test for COVID-19 detection. This study aimed to find out the prevalence of COVID-19 infection detected by gold standard reverse transcriptase-polymerase chain reaction test in a tertiary care center of Nepal. A descriptive cross-sectional study was conducted in Karnali Academy of Health Sciences from May to August 2020 after taking ethical approval from the Institutional Review Committee of Karnali Academy of Health Sciences, Jumla. Convenient sampling was used. A total of 361 participants enrolled in this study who have done real-time reverse transcriptase-polymerase chain reaction for screening of COVID-19 infection. Also, a designated questionnaire was obtained from persons with a travel history and close contact. Statistical Package for the Social Sciences software was used for the statistical analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. The prevalence of COVID-19 was 167 (46.3%) (95% Confidence Interval= 41.16-51.44) by real-time reverse transcriptase-polymerase chain reaction test. Out of 361 samples, 339 (93.9%) were male and 22 (6%) were female. The highest frequency of the participants belongs to the age groups of 20-40 years. The findings showed a high prevalence of COVID-19 detected by reverse transcriptase-polymerase chain reaction test. Further studies are necessary to improve the precision of prevalence estimations.

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

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

Prevalence of hearing impairment in patients with diabetes mellitus at tertiary care center of Nepal

Background: Diabetes mellitus is a chronic, systemic and metabolic disorder known to affect almost every organ due to its unequivocal complications. The auditory organ is often affected but usually ignored complications of diabetes mellitus. With the rise in the prevalence of diabetes mellitus and hearing impairment in developing countries, it becomes a crucial public health issue if both of them are found to be associated. Objective: To find the prevalence of hearing impairment in diabetic patients. Materials and Methods: This was a cross-sectional study conducted at the Department of Clinical Physiology in collaboration with the Department of General Practice and Emergency Medicine and the Department of Otorhinolaryngology- Head and Neck Surgery, Tribhuvan University Teaching Hospital. After applying exclusion criteria, 55 subjects were recruited for the study. Pure Tone Audiometry, a non-invasive test was used to assess hearing threshold in this study. Audiogram findings of diabetics were then analyzed. Results: Outcomes of the tests revealed that 17 (30%) of subjects with diabetes mellitus had hearing loss, out of which 13 had mild hearing loss. A significantly positive correlation was found between age and hearing threshold at every frequency. Higher frequencies were found to be more affected. The best cut-off age for onset of hearing loss in diabetics was found to be 51.50 years. Conclusion: Current study suggests a 30% prevalence of hearing loss in diabetes mellitus. We observed hearing loss more among the elderly at higher frequencies

Temporal Delay in Neurosurgical Patients and Outcome in a Tertiary Care Center in Nepal.

Neurosurgery is a field where time from the incident to get treatment is very crucial. In low-income countries, the referral system is not well developed. In our country, a proper referral system is in the initial phase of development. We conducted a study assessing the number of visits a neurosurgery patient made before finally reaching to our center. This is a prospective observational study involving seventy patients, conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Demographic characteristics, neurological diagnosis, and numbers of other centers the patients visited and outcome at discharge and in one month was assessed. Thirty-five (50%) patients were males. Thirty-three (47.1%) patients were admitted due to head injury and 13 (18.5%) were diagnosed with subarachnoid hemorrhage. Surgery was done in 32 (45.7%) patients. Fifty-three (75.7%) patients were transferred from other hospitals. Out of 53 patients, 30 (56.6%) and 17 (32%) had visited to one and two hospitals respectively. Unavailability of the neurosurgery facility was the main reason (77.4%) for the transfer. Overall mortality was 12.9%. The trend for mortality and length of hospital stay was higher in the group who visited other centers before coming to us than those who came directly. Visiting multiple hospitals where there is no neurosurgical service available is an important reason for delay. There is a need to develop neurosurgical facilities in the different parts of the country along with establishment of an effective referral mechanism.

Culture Positive Cases of Ophthalmia Neonatorum in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.

Ophthalmia neonatorum although runs a benign course mostly, sometimes may progress to sight threatening complications. The study was conducted to find the prevalence of culture positive cases of opthalmia neonatorum. It was a descriptive cross-sectional study conducted at a tertiary care center from January to December 2019. Ethical clearance was obtained from institutional review committee of Kathmandu Medical College. Convenience sampling was done. All data were entered into excel and, then for analysis, exported to Statistal Package for Social Sciences version 21. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. The prevalence of culture positive cases of opthalmia neonaturum is 10 (55.55%) (32.61-78.49 at 95% Confidence Interval). The causative organisms were coagulase negative Staphylococcus 4 (40%), Staphylococcus aureus 3 (30%), Klebsiella 2 (20%) and Pseudomonas 1 (10%). Culture sensitivity of the isolated organisms were different according to the patient even in case of the same organism. Vancomycin 7 ( 70%) was the most sensitive antibiotic followed by Ciprofloxacin 6 (60%), Amikacin 5 (50%) and Cloxacillin 5 (50%) while Azithromycin 1 (10%), Cefixime 1 (10%) and Cotrimoxazole 1 (10%) were the least sensitive. Staphylococcus species was the most common organism isolated from neonates with ophthalmia neonatorum and vancomycin was the most sensitive antibiotic.

Advance Age Pregnancy in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Women who conceive at advance age are at risk of pregnancy complications and adverse foetal outcome. This study aims to find out the prevalence of pregnancy at advance age in a teaching hospital. A descriptive cross-sectional study was conducted between October 2019 to August 2020 at department of obstetrics and gynaecology of a tertiary care centre of Nepal, after obtaining ethical clearance from Institutional Review Committee (dated 03/09/2019 with ref no. 266) and informed consent from patient. Convenience sampling was done. All the patient who were ≥35 years and >28 weeks of gestation without any chronic illness were selected. Data and descriptive analysis were done using Statistical Package for the Social Sciences version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Women aged 35 years and above constituted 104 (5.73%) of the total deliveries of study period. Most were multigravida 72 (69.23%) and 23 (22.12%) had preterm delivery. Rate of caesarean section were higher in advance maternal age 69 (66.35%). Maternal complications such as Hypertensive disorder of pregnancy 9 (8.65%), and mal-presentation 15 (14.42%) were higher among them. Perinatal outcome in form of low birth weight 9 (8.65%) and perinatal death 5 (4.80%) were increased in those women. From this study, it can be concluded that prevalence of advanced age at pregnancy was lower than study done in developed country but it was similar to study in India and is increasing in Nepal.