Tertiary Care Center In Nepal Research Articles

Reliability of a Tailored Tele-Medicine Model for Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) Clinical Practice in Remote Areas of Nepal: A Pilot Study from Tertiary Referral Center.

Introduction: Despite the ever-expanding scope of telemedicine, studies regarding its application in the field of otorhinolaryngology-head and neck surgery (ORL-HNS) in remote parts of the world are lacking. This pilot study aims to bridge the research gap and to assess the efficacy of our tailored telemedicine clinic model, operating in an "asynchronous" mode, in diagnosing various ORL-HNS diseases. Methods: This is a cross-sectional study conducted at a tertiary care center of Nepal. An asynchronous telemedicine portal was used with a store and share approach to telecast the pen endoscopic camera findings to the consultant in order to formulate a diagnosis and a management plan. Interobserver reliability was assessed using SPSS version 26 based on Cohen's kappa. The association between the results of the Mimi Hearing App (v. 5.0) and pure tone audiometry were performed using chi-square test. Results: The overall diagnostic agreement in our study was substantial to almost perfect with kappa values of .843, .784, .737, and .764 for rhinology, head and neck, otology, and pediatric cases. Chronic otitis media was the predominant diagnosis across all age groups. Various head and neck swellings, symptomatic deviated nasal septum and chronic rhinosinusitis with polyposis followed closely. Discussion: The future of telemedicine in otorhinolaryngology can be gauged to be effective in reducing cost and human resource use in the limited setting of Nepal with the model allowing for remote but effective communication between the concerned patients and the expert doctor in clarifying doubts and making diagnosis, early recognition of diseases and preventing or decreasing complications of those diseases.

Pattern of Mortality among Patients Admitted in Medical Wards in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study

Introduction: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. Morbidity and mortality pattern is a reflection of disease burden. Detailed assessment of these parameters tends to aid in formulating pivotal aspects of in-hospital policies, standards of care and so consequently promoting efficient work systems. The aim of this study is to identify the pattern of mortalities in medical wards in a tertiary care hospital.Methods: This retrospective descriptive cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital focusing on all patients admitted to the medical wards (General Medical, Hepatology, Nephrology, Neurology, Endocrinology, Pulmonology, Cardiology and Gastrology) between January 1 to December 31, 2023 after obtaining ethical approval from Institutional Review Committee (Reference Number: 390/2080/81). Total population sampling was done. Data were analyzed using Microsoft Excel and SPSS.Results: Among 10124 admitted patients in medical wards, mortality was reported in 732 (7.22%). The number of deaths seen in general medical ward was 389 (53.14%) and in liver ward was 85 (11.61%). Systemic cause of death due to respiratory diseases was 157 (21.5%) and liver disease was 143 (19.6%).Conclusions: The respiratory disease is responsible for a higher proportion of deaths among admitted patients. However, the deaths due to liver disease are increasing because of the rise in cirrhosis of the liver in the younger age group.

Assessment of Residual Ridge Morphology among Edentulous Patients at A Tertiary Care Center of Nepal

Background The morphology of the residual ridge is one of the predominant factors influencing denture retention, stability, support and the masticatory function in edentulous patients thereby affecting both the planning and treatment prognosis. This study was aimed to assess the different types of maxillary and mandibular residual ridge in the group of edentulous population in Chitwan, Nepal. MethodsA descriptive cross-sectional study was conducted in total of 107 completely edentulous patients within the age of 55-85 years’ in Prosthodontic department of Chitwan Medical College. The type of maxillary and mandibular residual alveolar ridge in both male and female patients were noted in a predesigned proforma according to American College of Prosthodontists (ACP) classification system. The collected data was entered into Microsoft Excel and later transferred into SPSS version 26 and analyzed for descriptive statistics.ResultsIn this study, 107 completely edentulous patients both male 63 (58.9%) and female 44 (41.1%) participated in the study. In the maxillary arch, Type B was most prevalent residual ridge type 55 (51.4%) whereas Type C in mandibular arch around 35 (32.7%). In male patients, Type B was most common 36 (57.1%) whereas Type A in female 20 (45.5%). Conclusions From this study it can be concluded that there is variation in the residual ridge. In maxillary arch, type B residual ridge was most prevalent followed by type A while in the mandibular arch type C was prevalent followed by type B.

Profile of Glaucoma Patients at a Tertiary Care Centre in Gokarneshwor, Kathmandu, Nepal

Glaucoma is a progressive optic neuropathy characterized by irreversible optic nerve damage and progressive visual field loss. It is the second leading cause of global irreversible blindness. The objective of this study was to find the prevalence, clinical profile and distribution of various types of glaucoma in patients attending a tertiary care center of Kathmandu. This was a retrospective, descriptive hospital based study conducted at glaucoma clinic at tertiary care center from March 2022 to February 2024 (24 months). Patients’ demographic profile along with comprehensive eye examination findings were reviewed from the records. Data analysis was done with SPSS version 18 and chi-square test was used for analysis. P value <0.05 was considered as statistically significant. Two hundred and four patients were diagnosed with glaucoma during 2 years period. The Mean age among glaucoma patients was 55.12 ± 16.7 years. Female was common 109 (53.4%) than male 95 (46.6%). Open angle was 185 (90.7%) and close angle was 19 (9.3%) on gonioscopy. Prevalence of glaucoma seen in this study was 0.72% of total outpatients (27,970). Among the glaucoma patients, primary open angle glaucoma (POAG) was more common 84 (41.2%) followed by glaucoma suspect 46 (22.5%), normal tension glaucoma (NTG) 26 (12.7%), primary angle closure disease 19 (9.4%), ocular hypertension (OHT) 12 (5.9%), secondary glaucoma 9 (4.4%) and juvenile open angle glaucoma (JOAG) 8 (3.9%). In primary angle closure disease, primary angle closure glaucoma (PACG) was 10 (4.9%), angle closure attack 5 (2.5%) and primary angle closure suspect (PACS) 4 (2%). The most common secondary glaucoma was pigmentary glaucoma 3 (1.5%) followed by steroid induced glaucoma 2 (1%), neovascular glaucoma 2 (1%) and inflammatory glaucoma 2 (1%). The most common type of glaucoma seen in a tertiary care center of Nepal was POAG. Glaucoma was more prevalent in female patients after forty years. The prevalence of glaucoma increases with increasing age. So, the patients above the age of 40 should be screened for glaucoma for early detection and prompt treatment. Awareness of glaucoma is needed as it is one of the leading causes of blindness.

Knowledge of Periconceptional Folic-Acid among Women of Childbearing age Visiting Tertiary Care Hospital in Nepal

The value of periconceptional folic acid supplementation in reducing the incidence of neural tube abnormalities in newborns is widely known. Yet, Nepalese women of childbearing age are mainly ignorant of it. The current study examined different sociodemographic and health factors related to women’s level of knowledge about folic acid among women visiting Obstetrics and Gynaecology outpatients at a Tertiary Care Center in Nepal. It also evaluated the awareness and relevance of knowledge regarding folic acid and its periconceptional supplementation. 400 women aged 18 and 45 who sought Obstetrics and Gynecology Outpatient Services at the Tertiary Care Facility participated in this cross-sectional study. Sociodemographic information was gathered with the help of a self-report questionnaire and processed in IBM-SPSS software at a significance threshold of 0.05. Results of the studies showed that while 47.3% had heard of it, only 34.25% had adequate knowledge of periconceptional folic acid supplementation. Also, besides age (p=.493), knowledge of folic acid was significantly associated with factors including education(p=.026), ethnicity (p=<.001), income (p=.011), employment (p=.001), marital status (p=.007), past pregnancies (p=.031) and ANC visits (p=<.001). The study demonstrates the need for more public awareness to boost folic acid knowledge, adherence, and intake and ultimately lower the prevalence of related birth abnormalities. To quantify the hidden issue, further studies on the prevalence of NTDs in Nepalese society and the contribution of folic acid to their reduction are required.

Exploring Mouth Opening in 3–14-year-Old Children in a Tertiary Care Centre of Nepal

Mouth opening plays a crucial role in our daily lives. Maximum mouth opening is an important parameter in the assessment of several clinical situations and its value is documented to have variations with gender, age and individual’s physical characteristics. This cross-sectional study was carried out to measure the clinical maximum mouth opening in children and its correlation with age, gender, height and weight. A total of 301 children of 3 to 14 years old were included in the study. Data was analyzed using SPSS 16. The mean maximum mouth opening seen in male was 43.17 ± 6.09 mm and in female was 42.55 ± 6.13 mm. Mouth opening differences among different gender was not significant. The mean maximum mouth opening in 3 to 5 years age group was 35.71 ± 4.88 mm, 6 to 8 years age group was 41.71 ± 4.86 mm, 9 to 11 years age group was 44.82 ± 4.61 mm, and 12 to 14 years age group was 47.73 ± 5.84 mm. There was significant difference in the mouth opening of different age groups. There was a positive significant correlation between MMO and weight (Pearson’s correlation coefficient r = 0.592; P < 0.0001) as well as between MMO and height (r = 0.616; P < 0.0001).

A Rare Case of Aconite Poisoning in a Tertiary Care Center in Nepal: Clinical Presentation and Management

Introduction: Aconite poisoning, caused by the toxin aconitine in the Aconitum genus (monkshood or wolfsbane), can be severe and requires supportive care as there is no specific antidote. Aconitine inhibits sodium channel inactivation, leading to dangerous cardiovascular and neurological symptoms.  Case Presentation: A 46-year-old male ingested half of a suspected aconite seed, leading to abdominal cramping, persistent vomiting, tingling sensations, and weakness. Upon admission, he exhibited hypotension, tachycardia, and bilateral mydriasis. ECG showed ventricular premature contractions. Treatment included intravenous amiodarone, magnesium sulfate, calcium gluconate, and gastric lavage with activated charcoal. He was admitted to the ICU for intensive monitoring and treatment, including ongoing amiodarone administration. After improvement, he was transferred to the general ward and later discharged.  Discussion: Aconite poisoning involves symptoms from aconitine's effect on sodium channels, including arrhythmias, hypotension, and neurological issues. Management focuses on supportive care, antiemetics, and monitoring. Advanced treatments like flecainide or amiodarone may restore normal heart rhythm, and severe cases might require a cardiac bypass or VA- ECMO.  Conclusion: This case describes a rare aconite poisoning with severe neurological, cardiovascular, and gastrointestinal symptoms after ingestion of a suspected aconite seed. The patient was treated with decontamination, intravenous amiodarone, and ICU care, leading to recovery. Despite its traditional use, aconite poisoning often results from its application without proper regulation, highlighting the need for rapid diagnosis and management.

Risk factors and severity of melasma in patients attending dermatology outpatient department of a tertiary care hospital: A cross-sectional study.

Melasma is a chronic acquired dysfunction of melanogenesis characterized by dark brown irregular macules on skin. Genetic predisposition, pregnancy, sun exposure, and hormonal therapy are common risk factors. Prevalence of melasma is variable, ranging from 5% to 46%. This study aimed to assess the severity and potential risk factors of melasma in a tertiary care setting. An analytical cross-sectional study was conducted on patients with melasma visiting dermatology department of a tertiary care center in Nepal. Nonprobability consecutive sampling was adopted. Severity of melasma was assessed using the Modified Melasma Area and Severity Index score. Data analysis was performed using the Statistical Package for the Social Sciences, version-23. Bivariate analysis was done by using Student t test/Mann-Whitney U test, or Chi-square/Fischer exact test for continuous and categorical variables, respectively. The overall median Modified Melasma Area and Severity Index score was 5.40 (3.60-6.75). Most patients (168, 88.42%) had mild melasma. The severity score was significantly higher in older age (P = .024), women having parity more than 3 (P = .014), centrofacial pattern (P = .024), and patients having dermatological comorbidities (P = .014). Severity was significantly lower in those who used cosmetics at home. Moreover, the use of digital screens was not associated with an increase in melasma severity. Most of the cases had mild melasma. Severity was significantly associated with age, parity, pattern, practice of cosmetic use, and presence of dermatological comorbidities.

The Role of Hematocrit Levels in Diagnosing the Severity of Acute Pancreatitis: A Cross-Sectional Study at a Tertiary Care Center in Nepal.

Background and objective Acute pancreatitis (AP) is a frequent cause of hospitalization for gastrointestinal issues, with a significant proportion of cases requiring intensive care. Although various scoring systems are available to predict AP severity, they often involve inconvenience and can be time-consuming and expensive. Hematocrit, a simple, cost-effective, readily available hematological test, has been used to predict AP severity. However, its effectivenesshas been inconsistentacross different studies. In light of this, we aimed to analyze the role of hematocrit levels in determining AP severity. Methods We conducted a prospective study at Patan Hospital in Lalitpur, Nepal, from June 8, 2022, to June 27, 2023. Sixty-five AP patients were evaluated to determine the prognostic value of hematocrit at admission. The severity of APwas classifiedper the Revised Atlanta Classification. Results Among the patients, 52 (80%) had mild AP (MAP), five (7.69%) had moderately severe AP (MSAP), and eight (12.31%) had severe AP (SAP). The receiver operating characteristic (ROC) curve for admission hematocrit levels yielded an area under the curve (AUC) of 0.551 (95% CI: 0.423-0.675). A hematocrit cutoff value of 42% resulted in a sensitivity of 69.23% and a specificity of 46.15% for predicting severe AP (MSAP + SAP). Conclusions Based on our findings, hematocrit at admission is not a strong predictor of the severity of AP.

Evaluation of the Sofa Score in Predicating Outcome of Sepsis Patients Admitted to a Tertiary Care Center in Nepal

Background Sepsis is a major health burden with life- threatening conditions, which leads to a high rate of mortality in patients. The Sequential Organ Failure Assessment (SOFA) score, which assesses organ dysfunction across multiple systems, has been considered a reliable indicator of the severity of critical illness. We have carried out this study to evaluate the predictive value of the SOFA score in assessing the mortality of patients with sepsis on admission.  Methods Our study was a cross-sectional, descriptive study carried out in patients with sepsis who were admitted to the medical ICU of Chitwan Medical College from December 15, 2021, to December 14, 2022. Patient sampling was done based on a non-probability convenience sampling technique.  Results In a study of 130 patients, 54.6% were male and 45.4% were female. The mean SOFA score was 7.1, with a median of 7. 38.5% (50 patients) died due to sepsis. The mean SOFA score was higher among deceased patients (9.3) than survivors (5.8). Higher SOFA scores were associated with increased mortality. 46% of patients required inotropes/Vasopressor support for shock. Patients requiring vasopressor support had a significantly higher mortality rate (53.3%) compared to those who did not need support (25.7%). 13.1% of patients required mechanical ventilatory support, and the majority of these patients (70.6%) had mortality.  Conclusion SOFA score is a valuable tool to assess organ dysfunctions and it can predict the outcome of patients admitted with sepsis.

Assess the Serum Lipid Profile in Patient with Acute Ischemic Stroke at Tertiary Care Center in Nepal

Introduction: Ischemic stroke takes place when the blood flow cessation endures for more than a few minutes leading to brain tissue infarction. After ischemic heart disease, ischemic stroke is the second most common cause of death worldwide and one of the top five diseases based on DALYs (disability-adjusted life years) in Nepal. Though dyslipidemia is a major risk factor for coronary heart disease, it has an unclear role in the pathogenesis of ischemic stroke. In a patient with a previous ischemic stroke, statins reduce the risk of ischemic stroke. So, this study analyses the plasma prevalence of total cholesterol (TC), low-density lipoprotein (LDL), High-density lipoprotein (HDL), and triglyceride (TG) in patients with acute non-cardioembolic ischemic stroke and their association with different non-modifiable risk factors (age, gender & family history) and modifiable risk factors (diabetes, hypertension, obesity, smoking & alcohol intake).  Materials and Method: This is a descriptive and analytical cross-sectional hospital-based study carried out from December 5th, 2021 to December 4th, 2022 including 80 patients admitted to Chitwan Medical College, Chitwan, with a diagnosis of acute ischemic stroke. All the patients underwent a detailed history, physical examination, and baseline investigations including fasting lipid profile along with CT- scan/MRI head. The fasting lipid profile was done within the first 24 hours of hospitalization. Data was entered in MS Excel 2013 and converted it into SPSS 26 for statistical analysis.  Result: A total of 80 patients with the diagnosis of acute ischemic stroke were enrolled. Out of them, 37 (46.25%) were female and 43 (53.75%) were male. A total number of 71 (88.75%) patients were from more than or equal to 55 years of age group and 9 (11.25%) patients were from less than 55 years of age group. The mean age ± standard deviation of male and female patients was 66.69 ±9.14 years and 68.54 ±14.96 respectively. Overall, derangement in serum lipid profile (dyslipidemia) was present in 63.75% of the patients. Among the total cases, high TC is found in 18 patients (22.5%), TG in 24 patients (30%), high LDL is found in 16 patients (20%), and low HDL is found in 23 patients (28.75%).  Conclusion: The study highlights hypertriglyceridemia as the leading dyslipidemia in ischemic stroke patients, showing gender and age variations in prevalence. It confirms dyslipidemia's role in brain vascular changes, notably in the Middle Cerebral Artery, and its link to carotid artery stenosis severity. Despite common risk factors, their direct association with dyslipidemia remains statistically insignificant, stressing the need for focused lipid management to mitigate stroke risks.

Epidemiological study of hand injury in a tertiary care centre in Nepal

Epidemiological study of hand injury in a tertiary care centre in Nepal

Clinical and epidemiological panorama of leprosy at a tertiary center across the Nepal–India border in the post-elimination era: A cross-sectional study

ackground: Leprosy, an infectious granulomatous disease caused by Mycobacterium leprae continues to pose a significant public health challenge globally. Despite efforts towards its elimination, leprosy remains a re-emerging threat, with increasing cases in Nepal and India. Understanding the clinical, epidemiological, socioeconomic, and histological profiles of leprosy across the Nepal–India border is essential for effective disease management and control. Methods: A descriptive, prospective study was conducted over three years at a tertiary care center in Nepal. The patients were selected based on predefined inclusion and exclusion criteria. Clinical, epidemiological, and socioeconomic data were collected and analyzed to evaluate the profiles of leprosy cases in the study population. Results: A total of 110 patients were included in the study, with a mean age of 33.54 years. The majority of the patients were Nepalese. The mean duration of the disease was 17.6 months, with a wide range observed. Borderline leprosy was the most common clinical presentation. Bacteriological positivity was observed in 85% of the cases, indicating active transmission of the disease within the community. A significant proportion of the patients (97%) belonged to the low to middle-class category. A reaction was seen in 14.5% of the patients. Conclusion: Despite efforts toward its elimination, leprosy remains a public health problem across borders. The high burden of leprosy cases, coupled with socioeconomic challenges and active transmission, underscores the need for continued vigilance and targeted interventions. Addressing cross-border dynamics, enhancing access to healthcare services, and implementing comprehensive control strategies are essential for effectively controlling leprosy. Key words: Leprosy, Clinical, Epidemiological, Cross-sectional study, Nepal–India border, Post-elimination era

136 Epidemiology and 5-Year Outcome of Operated Cases of Intracranial Meningioma in a Tertiary Care Centre in Nepal in the Last 10 Years

136 Epidemiology and 5-Year Outcome of Operated Cases of Intracranial Meningioma in a Tertiary Care Centre in Nepal in the Last 10 Years

Hydrocele among Patients undergoing Surgery in the Department of Surgery in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Hydrocele, an accumulation of serous fluid within the remnant of the processus vaginalis, is a common cause of painless scrotal enlargement. While prevalent, few studies have been conducted to assess the extent and risk factors of hydrocele in Nepal. This study aimed to assess the prevalence and associated factors of hydrocele among patients undergoing the surgery department at a tertiary care center in Nepal. This descriptive cross-sectional study was conducted at a tertiary care center. Data were retrospectively collected from medical records over one year (2021 July to 2022 June), including all patients undergoing surgery in the general surgery department. Ethical Approval was received from the Institutional Review Committee of the same institute (Reference number: 820/2080/81) Cases of hydrocele surgery were identified, and relevant data were extracted using a structured proforma. Descriptive analyses were performed using Microsoft Excel 2016. Out of 1812 surgeries, 95 (9.72%) were hydrocele surgeries. Of these, 94 (98.95%) were non-communicating hydroceles, 79 (83.16%) were unilateral, and 90 (94.74%) showed positive transillumination tests. The mean age of patients was 50.84 ± 17.02 years, with the highest number of cases in the 46-55 age group (20%). Postoperative complications occurred in 19 (20%) patients, with seroma and surgical site infection being the most common (31.58% each). Hydrocele surgeries comprised a significant portion (5.24%) of surgical cases at the tertiary care center, with the majority being non-communicating and unilateral types.

Role of Prophylactics Antibiotics in Clean Head and Neck Surgery in a Tertiary Care Center of Nepal: A Prospective Comparative Study.

Surgical site infections are well recognized complications of any surgical procedures. In head and neck surgeries, prophylactic antibiotics are commonly used to prevent Surgical site infections, in contaminated and clean contaminated procedures. Guidelines advised against routine antibiotics use in clean surgeries, but in our setting, non-compliance is frequent, resulting excessive antibiotics use. Objective of the study was to compare the Surgical site infections rate between prophylactics antibiotics group and no antibiotics group in clean head and neck surgery. It was a prospective comparative study conducted at a tertiary care centre of eastern Nepal. Patients were assigned to two groups, one receiving prophylactic antibiotics and another receiving no antibiotics. Out of 131 patients, 66 received prophylactic antibiotics and 65 did not. Thyroidectomy was the most common surgery. The surgical site infection rate was 6.06% in antibiotic group and 7.69% in no antibiotic group, the difference was not significant (p=0.744). The risk reduction of surgical site infection with use of antibiotics was 0.0163 and number need to treat was calculated to be 61.35 About 3% of the patients who were administered antibiotics experienced adverse drug reactions. Factors, such as gender, amount of blood loss, smoking, placement of drains had no significant impact on Surgical site infections rate. Prophylactics antibiotics does not offer substantial advantages in preventing surgical site infections and are not advised for such procedures. Moreover, their use increases the financial burden and risk of adverse drug reactions to the patients.

Comparison of tooth size and arch width of crowded and uncrowded Class I occlusion in individuals visiting a tertiary care center in Nepal

Comparison of tooth size and arch width of crowded and uncrowded Class I occlusion in individuals visiting a tertiary care center in Nepal

Clinical Outcome of Open Reduction and Internal Fixation of Mandibular Condyle Fracture: A Prospective Observational Study

Introduction: Condyle of mandible plays crucial role in functioning of jaw. Untimely and inadequate treatment leads to deformity of face along with range of complications. The purpose of this study was to assess outcomes of open reduction and internal fixation of mandibular condyle fractures in terms of mouth opening, facial nerve function and occlusion.Methods: This was a prospective observational study conducted at Chitwan Medical College. Thirty-two patients of mandibular condyle fracture were treated by open reduction and internal fixation via retromandibular approach and evaluated for mouth opening, facial nerve function, and occlusion on 2nd day, 10th day and 25th day postoperatively. All collected data were entered on SPSS version 21 and analyzed using descriptive statistical methods. The results were presented as graphs and tables.Results: Of 32 patients, 7 patients show abnormal occlusion while 25 patients show normal occlusion. A gradual improvement in mouth opening and facial nerve function was also seen on 25th day.Conclusion: Open reduction and internal fixation gives superior clinical outcomes in terms of mouth opening, facial nerve function and occlusion. It also allows good anatomical repositioning and early function.Keywords: Facial nerve function, Mouth opening, Occlusion, Open reduction internal fixation Layman summary: The mandible is largest and strongest bone of face. However, it is also most common facial bone that is fractured. Condyle of the mandible is highly prevalent site of mandibular fracture. The fracture of mandible is managed by open or closed reduction. Both of the methods have their own merits and demerits. In this study, we planned to assess the outcomes of open reduction and internal fixation of mandibular condyle fractures at a tertiary care center of Nepal. We found that ORIF has a good clinical outcome in mandibular fracture in terms of mouth opening, facial nerve function and occlusion.

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.