Tertiary Care Hospital In Nepal Research Articles

Comparative Study on Effectiveness and Safety of Atorvastatin with Rosuvastatin in Hyperlipidemic Patients at a Tertiary Care Hospital in Nepal

Introduction: Hyperlipidemia is one of the most contributing factors to coronary heart diseases. Statins have become standard medicine in clinical practice to reduce total cholesterol, low density lipoprotein and to increase high density lipoprotein cholesterol. This study is conducted to compare the effectiveness and safety of atorvastatin with rosuvastatin in hyperlipidemic patients. Methods: This is a prospective observational study involving 150 patients conducted in the Department of Internal Medicine of Kathmandu Medical College and Teaching Hospital from July 2019 to March 2020. Patients newly diagnosed with hyperlipidemia were enrolled. Patients that were prescribed with 10 mg of atorvastatin and 5 mg of rosuvastatin by the treating physician once daily for 6 weeks were divided into two groups. Data was recorded in the customized proforma and the SPSS package version 20 was used for analysis. Results: Patients that were prescribed with atorvastatin were put in group I and those prescribed with rosuvastatin were included in group II with 75 participants in each group. The mean age of the patients were 50.56± 10.08 years in group I and 52.45±10.20 years in group II with male to female ratio of 3:1. The mean BMI of group I was 25.36±1.74 and that of group II was 26.48±2.21 before therapy. There was a significant main effect of duration (F1,74=401.02, p<0.001) on the TG and TC levels (F1,74=1134.23, p<0.001) as well as (F1,74=614.99, p<0.001) on the LDL and HDL levels (F1,74=146.38, p<0.001). Conclusion: Rosuvastatin was significantly more effective than atorvastatin in reducing levels of TG, TC and LDL-C. Rosuvastatin also significantly increased the level of HDL.

Hearing Loss in Patients with Chronic Kidney: Our Experience in a Tertiary Care Hospital in Nepal

Introduction: Patients with chronic kidney diseasesuffer from sensorineural hearing loss as a complication.The prevalence, type and degree of hearing loss along with the associated factors like age, electrolyte imbalance, hypertension, diabetes, duration and stage of CKD were studied.
 Methodology:This was a prospective cross-sectional study conducted in the department of Otorhinolaryngology and Nephrology at Nobel Medical College & Teaching Hospital, Kanchanbari, Biratnagar, Nepal from1st August 2018 to 30th September 2019.After thorough history taking, clinical & biochemical examinations, all patients underwent Tuning fork test and Pure tone audiometry. CKD was staged according to the eGFR. Data were stored in excel spreadsheet and analysis was done using the SPSS software (version 21)
 Result: Out of 150 patients,the ratio of male to female was 1.2:1. The mean age of the patients was 44.04 ± 10.524 years. 68 (45%) patients had CKD stage V with a median duration of 24 (18 – 36) months. The prevalence of hearing loss was found to be 83 (55.3%), most of them in bilateral ear (58%). The staging of CKD had a significant association with the prevalence of hearing loss and its severity. The duration of the illness had a strong association with hearing loss.
 Conclusion: This study shows that sensorineural hearing loss prevails in the patients suffering from CKD, which increases with age, duration of CKD, presence of comorbidities like hypertension, diabetes and level of serum urea and creatinine. However, it could not establish diabetes and electrolyte as a potential risk factor for developing hearing loss from CKD.

Patterns of use of drugs in hypertension in geriatric patients in the department of medicine at tertiary care hospital of Nepal.

Introduction: In Nepal, the prevalence of hypertensive in elderly population is 41.7% aged 65 years or more. Hypertension increases with age leading to arterial stiffness and endothelial dysfunction. The prevalence of hypertension is 20% of urban populations. Blood pressure control with the use of antihypertensive drugs reduces cardiovascular complications in geriatric patients.
 Objectives: The objective of our study is to know the various patterns of drugs used in geriatrics hypertensive patient along with their co-morbidities and to know the most commonly used antihypertensive drug in geriatric patient.
 Methodology: It was a hospital based cross sectional study involving 130 patients based on non-probability sampling. The study involved the hypertensive elderly patients of age > 65 years prescribed with antihypertensive drugs. Data were collected from patients attending outpatient department of medicine . Medical and nursing records were analyzed for patient’s characteristics (e.g. age, gender), systolic and diastolic BP readings, number of drugs, monotherapy, combination therapy, co morbidities. Data were analysed by using SPSS version 20.
 Results: The total 130 geriatric patients under treatment with antihypertensive drugs were included, in which 55.38% were male and 44.62% were female. The total numbers of antihypertensive drugs prescribed were 212 either as monotherapy or as a component of a combination therapy. The average number of drugs prescribed per patient was found to be 1.66. Among these drugs 56.92% were prescribed as monotherapy,26.92% were prescribed as two drugs combination therapy,12.30% were prescribed as three drugs combination and 3.84% were prescribed as four drugs combination therapy. calcium channel blockers (amlodipine )was the most commonly prescribed antihypertensive.
 Conclusion: The study showed male patient were more predominant hypertensive compare to female. calcium channel blockers group of drugs in which amlodipine was the most commonly prescribed antihypertensive drug and more than half of the patients were in monotherapy.

Prevalence and Risk Factors of Hypertensive Retinopathy in Hypertensive Patients in a Tertiary Hospital of Gandaki Province of Nepal

Introduction: Hypertensive retinopathy is one of the major complications of hypertension. The presence of hypertensive retinopathy may be an indicator of the presence of other complications too. This study aimed to determine the prevalence and risk factors of hypertensive retinopathy in hypertensive patients in a tertiary care hospital in Nepal. Methods: This was a hospital-based cross-sectional study conducted among 95 hypertensive patients aged 30 years and above. Standard proforma was used to collect socio-demographic and clinical variables of the patients. Detailed eye examination including fundus evaluation under mydriasis was done on all patients and hypertensive retinopathy was graded according to Keith-Wagener-Barker classification. Statistical analysis was carried out using Epi-info 7. Results: The mean age of the study sample was 59.74±15.11 years. The prevalence of hypertensive retinopathy was 38.95%. Among the patients with hypertensive retinopathy, the prevalence of grade I, II, III, and IV retinopathies were 7.36%, 17.89%, 10.52%, and 3.15% respectively. There was a statistically significant association between hypertensive retinopathy and controlled blood pressure and treatment of hypertension. However, there was no statistically significant association between hypertensive retinopathy and gender, duration of hypertension, residence, family history, history of smoking, and diet. Conclusion: Uncontrolled blood pressure and untreated patients of hypertension were the significant risk factors for hypertensive retinopathy. Early diagnosis and treatment of hypertension are essential to prevent loss of vision.

Prevalence of influenza and viral co-pathogens with severe acute respiratory infection visiting at tertiary care hospital in Nepal

Background: Respiratory infections are one of the major public health problems in Nepal. Data on prevalence and seasonality of respiratory viruses are poorly characterized and hence empirical antimicrobial agents are used in Nepal. The objective of this study was to describe the prevalence and seasonality of influenza and viral co-pathogen in elderly patients with severe acute respiratory infection. Methods and materials: A descriptive cross sectional study was conducted at Central Diagnostic Laboratory and Research Center, Nepal during the year 2017/018. A total of 882 throat & nasopharyngeal swab were collected from patient with severe acute respiratory infection (SARI) according to WHO case definition. Total nucleic acid was extracted using Pure Link viral RNA/DNA mini kit (Invitrogen) and multiplex RT-PCR assays were performed. Results: Of the total 882 specimens; respiratory viruses were found in 556 (63.0%) specimens. Human metapneumovirus 130 (14.7%) was most frequently detected in SARI cases followed by rhinovirus 121 (13.7%), respiratory syncytial virus 37 (4.2%) and enterovirus 36 (4.0%) respectively. The rate of human metapneumovirus 60 (15.7%) co-infection was high than rhinovirus 51 (13.4%), respiratory syncytial virus 13 (3.4%) and enterovirus 12 (3.1%) infection in elderly patients. Co-infection of human metapneumovirus, respiratory syncytial virus, and enterovirus were detected with influenza. Respiratory viruses were detected year-round in Nepal. Incidence of human metapneumovirus virus infection was most commonly detected in summer (July–Aug) and winter (Jan–Feb) season. Conclusion: Respiratory viruses are significantly higher in elderly patient with severe acute respiratory infection. Our findings highlight the importance of real time diagnostic facility for clinical management and minimize the use of antimicrobial agents for respiratory infections in Nepal.

Knowledge, Attitude, and Practices Related to COVID-19 among Healthcare Personnel in a Tertiary Care Hospital in Nepal: A Cross-sectional Survey

Background COVID-19 is significantly affecting the healthcare system globally. As a result, healthcare workers need to be updated on the best practices for the proper management of the disease. Objective The purpose of this study was to assess the knowledge, attitude, and practices (KAP) related to COVID-19 among healthcare personnel. Method This was a cross-sectional study conducted among medical personnel at Dhulikhel Hospital Kathmandu University Hospital using a semi-structured questionnaire on KAP related to COVID-19 from May 8th to June 8th, 2020. We analyzed survey data by using descriptive statistics. Spearman rank correlation, chi-square test and binary logistic analysis were used to examine the association between sociodemographic characteristics with KAP related to COVID-19. Result Among 220 participants, the majority were nurses (60%) followed by doctors (27.7%), paramedics (10%) and technicians (2.3%). The results showed that 68.6% of healthcare personnel had a good knowledge with appropriate practices (98.5%) and negative attitude (59.3%). In the multivariate binary logistic analysis, the healthcare workers with the clinical experience level of one to five years (OR:.42, 95% CI:.19- .96) and more than 5 years (OR: .16, 95% CI: .04-.63) were significantly associated with negative attitude. The confidence score for managing COVID-19 (OR:1.16, 95% CI:1.02-1.34) was significantly associated with an optimistic attitude. Conclusion Healthcare workers are knowledgeable about COVID-19 and proactively practising to minimize the spread of infection but lack optimistic attitudes. Hence, the constantly updated educational programmes related to COVID-19 for targeted groups will contribute to improving healthcare workers' attitude and practices.

Maternal and Perinatal Outcomes of Singleton Term Breech Vaginal Delivery at a Tertiary Care Center in Nepal: A Retrospective Analysis.

Background Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of mode of delivery. After the results of Term Breech Trial, most of the countries adopted the protocol of cesarean section for term breech delivery because of which breech vaginal delivery is becoming rare. The aim of this study is to evaluate short-term maternal and perinatal outcomes of breech vaginal delivery at a tertiary care hospital in Nepal. Methods A retrospective review of case records of all women who had vaginal breech delivery from April 13, 2016, to April 12, 2018, was conducted, over a period of two years. Available demographic variables, obstetric characteristics, details of labor, postpartum complications, and perinatal complications were recorded and analyzed. Results Out of 21,768 cases of deliveries during the study period, the incidence of term breech deliveries was 528 (2.4%) among which the mode of only 84 (17.8%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency cesarean section could not be performed. Three (3.6%) women had postpartum hemorrhage, and four (4.8%) had entrapment of aftercoming head, two of them requiring Dührssen incisions. Adverse perinatal outcomes were seen in 23.8% of such deliveries with <7 APGAR score at 5 minutes in 20.2%, neonatal admission in 17.7%, and perinatal mortality in 8.3%. The perinatal mortality was significantly associated with birthweight less than 2500 grams as compared to birthweight ≥2500 grams (21.1% versus 4.6%; P=0.043). Conclusion The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities, especially when the deliveries are not well planned.

Review of Perinatal Deaths in a Tertiary Care Hospital of Nepal

Aims: Perinatal mortality is a public health problem especially in developing countries like Nepal. This study is an attempt to assert the perinatal mortality status for the year 2016/2017 A.D. of Shree Birendra Hospital, a tertiary hospital. This study becomes imperative to comprehend the various shortcomings in the maternal and child health care, so as to remedy them effectively.&#x0D; Methods: This is a hospital record-based study conducted at Shree Birendra Hospital, Kathmandu, a tertiary care facility of the Nepal Army. The record of all perinatal death from 13th April 2016 to 12th April 2017 was reviewed.&#x0D; Results: Out of 1051 total births, there were 12 perinatal deaths with perinatal mortality rate of 11.42 per thousand births. Perinatal death was more prevalent in the age group 20-25 (58.33%), multiparous female (60%), period of gestation between 35-40 weeks (58.34%), male gender of baby (66.67%) but equal number of deaths was seen in both vaginal delivery and emergency LSCS. According to the Wigglesworth pathophysiological classification to classify perinatal deaths, conditions specific to neonate (33.3%) constituted as a significant cause perinatal death followed by stillbirths or neonatal deaths with congenital anomalies (25%) and conditions associated with prematurity (25%).&#x0D; Conclusions: Neonatal sepsis contributed to the major burden of perinatal mortality. Keeping detailed medical records, screening for Group B streptococcus in the third trimester, and using clinical autopsy can further strengthen obstetric and neonatal care.&#x0D; Keywords: early neonatal mortality rate, perinatal mortality, stillbirth

Prevalence of Gastric Cancers among Patients Undergoing Upper Gastrointestinal Endoscopies in a Tertiary Care Hospital in Nepal: A Descriptive Cross-sectional Study.

Gastric cancer is a common malignancy of the upper gastrointestinal tract. Gastric cancer is a common cause of death worldwide. This research aimed to study the prevalence of gastric cancer among patients undergoing upper gastrointestinal endoscopies. A descriptive, cross-sectional study was conducted in the Department of Medicine at Manipal Teaching Hospital, Nepal, from January 2018 to June 2020. A total of 2640 subjects underwent upper gastrointestinal endoscopies over the study period. Ethical approval was taken from the institutional review committee of Manipal College of Medical Sciences (MEMG/ IRC/ 383/GA). Data were analyzed by SPSS version 20. The prevalence of gastric cancer among patients undergoing UGI endoscopies was 2.4%. The mean age of subjects was 58±12.35 years (range of 31 to 96 years) with male predominance (M:F=1.9:1). Antrum was the most common site for gastric carcinoma. The most common morphology was ulcerative growth (61.6%). Adenocarcinoma (98.4%) was the most common histology, and the majority was of intestinal subtype (56.3%). Gastric cancer is not an uncommon finding in patients undergoing UGI endoscopies. Gastric cancers were commonly seen above 50 years of age and predominant in males. Patients with gastric carcinoma usually present late with advanced disease stages and unfavorable histopathology.

Outcome of Neglected Elbow Dislocation Treated with Open Reduction at Rural Tertiary Care Hospital in Nepal.

Chronic unreduced dislocation of elbow is a rare injury. Treatment options include open reduction internal fixation with K wire, replacement arthroplasty, excisional arthroplasty, arthrodesis, and hinged external fixator. The aim of this study is to determine the outcome of open reduction internal fixation with trans-olecranon K wire for neglected elbow dislocation. This is a retrospective study done in three rural hospital of Karnali. Hospital records were reviewed from July 2015 to May 2018 to identify 11 cases who underwent open reduction internal fixation for neglected elbow dislocation. Pre and Postoperative outcome was assessed using range of motion and Mayo Elbow Performance Index. Data analysis was done using SPSS version 17. The average age of patient was 22.7 years (range 9-50 years). Non dominant hand was involved in 54.55%. The average preoperative elbow extension was 5.9 degree whereas postoperative extension was 15.9 degree. The average preoperative and postoperative elbow flexion was 24.5? and 113.6? respectively. Preoperative and postoperative Mayo elbow performance index was 18.6 and 86.3 respectively. Outcome was excellent in four patients, good in five patients and fair in two patients with one case having superficial infection. Open reduction and internal fixation with trans-olecranon k wire is an effective treatment method for neglected elbow dislocation. Postoperatively, elbow function is better with minimal complications.

Clinical Profile and Colonoscopic Findings in Patients with Ulcerative Colitis at a Tertiary Care Hospital in Nepal: a Cross Sectional Study

Background and aims: Ulcerative Colitis (UC) is an inflammator condition confined to the colon. Ulcerative colitis commonly presents with rectal bleeding, bloody diarrhea and abdominal pain. This research was undertaken to study the clinical profile and colonoscopic findings of the patient presenting with ulcerative colitis in a tertiary care center at Gandaki Province, Nepal .&#x0D; Methods: A hospital based prospective observational study was conducted from November 2017 till June 2020 in department of Medicine at Manipal teaching Hospital, Pokhara, Nepal after obtaining ethical approval from Institutional Research Committee and informed consent from patients or their relatives. Clinical profile and colonoscopic findings of patients with Ulcerative colitis were studied.&#x0D; Results: Results: Out of 274 colonoscopies, 60 patients (M:F= 3: 2) were diagnosed with UC. The mean age of subjects was 37}3.56 years. Chronic diarrhea and bloody diarrhea were the common presenting symptoms. Only proctitis (E1) was seen in 40 %, left sided colitis in 35% and pan colitis (E3) was observed in 25%. Rectal involvement and erythema was observed in all. Loss of vascularity (96.7%), erosions (93.3%), increased granularity (85%), followed by ulcers (73.3%) and spontaneous bleed on touch (50%) were the common findings in colonoscopy.&#x0D; Conclusion: Lower GI bleed is a common presenting manifestation in ulcerative colitis. Proctitis followed by left sided colitis was the common sites of involvement. Majority presented with disease of moderate severity. Most common features in UC patients were universal involvement of the rectum alongside erythema and erosions, loss of vascularity, increased granularity, followed by ulcers and spontaneous bleed on colonoscopy.

Healthcare workers' knowledge, attitude and practices during the COVID-19 pandemic response in a tertiary care hospital of Nepal.

COVID-19 is an ongoing pandemic, for which appropriate infection prevention and control measures need to be adopted. Healthcare workers' adherence to prevention and control measures is affected by their knowledge, attitudes, and practices (KAP) towards COVID-19. In this study, we assessed the KAP among healthcare workers towards the COVID-19 during the ongoing pandemic. A self-developed piloted KAP questionnaire was administered to the recruited healthcare workers involved in the COVID-19 response at the Universal College of Medical Sciences Teaching Hospital (UCMSTH), in Bhairahawa, Nepal. The knowledge questionnaire consisted of questions regarding the clinical characteristics, prevention, and management of COVID-19. Assessment on attitudes and practices towards COVID-19 included questions on behaviour and change in practices made towards COVID-19 response. Knowledge scores were calculated and compared by demographic characteristics and their attitude and practices towards COVID-19. Data were analysed using bivariate statistics. A total of 103 healthcare workers participated in the study. The mean age of the participants was 28.24±6.11 years (range: 20-56); 60.2% were females; 61.2% were unmarried; 60.2% had a medical degree, and 39.8% were the nursing staff. The mean knowledge score was 10.59±1.12 (range: 7-13), and it did not vary significantly when adjusted for demographic characteristics. The attitude was positive for 53.4% of the participants with a mean knowledge score of 10.35±1.19 and negative for 46.6% participants with a mean knowledge score of 10.88±0.98 (p = 0.02). The practice was good (≥3 score) for 81.5% participants with a mean knowledge score of 10.73±1.12 and poor for 18.5% participants with a mean knowledge score of 10.46±1.13 (p = 0.24). The attitude of the participants improved with increasing age (29.55±7.17, p = 0.02). There is comparably better knowledge regarding COVID-19 among healthcare workers. Appropriate practice correlates with better knowledge and positive attitude towards COVID-19 infection is seen with increasing age. Hence, training on protection and protective measures for having a positive attitude among healthcare workers is necessary against the fight with COVID-19 infection.

Knowledge of COVID-19 among Health Care Workers at a Tertiary Care Hospital of Nepal: A Descriptive Cross-sectional Study.

Health care workers are at higher risk of infection with the coronavirus disease as they are directly involved in the treatment of infected patients and perform aerosol-generating procedures. Proper knowledge of this disease can influence the positive attitude, good practices and enhance their safety. We aim to study the knowledge of COVID-19 among health care workers of the tertiary care hospital of Nepal. A descriptive cross-sectional study was conducted among health care workers of Shahid Gangalal National Heart Centre from May 20 to June 19, 2020. Ethical approval was taken from the Institutional Review Board (IRB No: 4-2020). Written informed consent was taken from all respondents. Correct answers were summated to reflect the mean knowledge, expressed as a percentage. Data analysis was done using Statistical Package for the Social Sciences version 21. The mean general knowledge score was 95.7%. The mean medical knowledge score was 70.5%. Only 42 (56.8%) of physicians and 103 (53.6%) of nurses had a higher level of medical knowledge regarding COVID-19. Likewise, very few lab technicians 7 (21.9%) and none of the pharmacists had a higher level of medical knowledge. The healthcare workers of this centre have adequate knowledge regarding COVID-19. However, periodic training for all workers, especially the nurses and allied workers, may help to update the knowledge and hence enhance their safety and that of their patients.

Comparison of Lipid Profile Parameters and Oxidized Low-Density Lipoprotein Between Normal and Preeclamptic Pregnancies in a Tertiary Care Hospital in Nepal [Retraction

[This retracts the article DOI: 10.2147/IJWH.S117850.].

Bacteriological Profile of Urine in Patients with Different Types of Kidney Stones in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

The association of bacteriology in the pathogenesis of urolithiasis is a known and fact. The urinary tract stones being the most common problem that brings the patient to the surgical outpatient department; it is important to know the relation between the types of stone and the organism isolated from the urine for better management of the patient. The aim of this study was to find out the urine bacteriological profile of patients with kidney stones. This is a descriptive cross-sectional study done over 18 months in a tertiary care hospital in Nepal. Ethical clearance was taken from the Institutional Review Committee (No: 03/16). Preoperative urine cultures were done routinely in all the patients who agreed to take participate in the study. The biochemical stone analysis was done. Urinary microbial floras and stone composition were noted. Data entry and analysis was done using Statistical Package for the Social Sciences version 25.0. Among 107 patients, kidney stones were more common in males and most of the patients were in their 2nd to 4th decade. Female patients 45 (42.05%) had more predilections towards the urinary tract infection. Among 15 (14.01%) positive cultures, Escherichia coli 10 (67%) was the most common organism isolated followed by Klebsiella; 4 (27%), and Pseudomonas; 1 (6%). Thus, we would like to state that Escherichia coli, though being a non-urease producing organism, is a major organism isolated in the preoperative culture of urine in a patient with kidney stones.

Prevalence, Clinical Presentation, and Outcome of Tuberculosis in Patients with Chronic Kidney Disease at a Tertiary Care Hospital in Nepal.

Background Tuberculosis (TB) is a serious public health threat in low- and middle-income countries like Nepal. Chronic kidney disease (CKD) patients are at higher risk of developing new infection as well as reactivation of TB. We aimed to determine the prevalence, clinical presentations, and outcome of TB in patients with CKD in Nepal. Methods A hospital-based cross-sectional study was performed at Tribhuvan University Teaching Hospital (TUTH), a tertiary level referral centre in Kathmandu, Nepal. We included patients older than 16 years with the diagnosis of CKD stage 3, 4, 5, and 5D (CKD 5 on maintenance dialysis); renal transplant recipients and patients living with HIV/AIDS were excluded. Tuberculosis was diagnosed based on clinical, radiological, and laboratory findings. Prior written informed consent was obtained. Approval was obtained from the Institutional Review Board of the Institute of Medicine. Data entry and statistical analysis were performed using SPSS v21. Results A total of 401 patients with CKD were included in the study (mean age, 50.92 ± 17.98 years; 64.8% male). The prevalence of TB in CKD patients was found to be 13.7% (55), out of which 49 were newly diagnosed cases. The most common clinical presentations of TB in CKD were anorexia (85.7%), fever (83.7%), weight loss (51%), and cough (49%). Thirty-eight patients (69.1%) had extrapulmonary TB (EPTB), 12 (21.8%) had pulmonary TB, 3 (5.5%) had disseminated TB, and 2 (3.6%) had miliary TB. Only 4.1% of cases were sputum smear positive. Pleural effusion (34.2%) was the most common EPTB. At 2 months of starting antitubercular therapy, 29 patients out of the 49 newly diagnosed cases of TB (59.2%) had responded to therapy. Mortality at 2 months was 28.6% (14 died amongst 49 patients). Four out of 49 patients (8.2%) did not improve, and 2 (4%) patients were lost to follow-up. Conclusion Prevalence and mortality of TB were higher in patients with CKD. Special attention must be given to these people for timely diagnosis and treatment as the presentation is different and diagnosis can be missed.

Bacteria on Medical Professionals' White Coats in a University Hospital.

The transient contamination of medical professional's attires including white coats is one of the major vehicles for the horizontal transmission of microorganisms in the hospital environment. This study was carried out to determine the degree of contamination by bacterial agents on the white coats in a tertiary care hospital in Nepal. Sterilized uniforms with fabric patches of 10 cm × 15 cm size attached to the right and left pockets were distributed to 12 nurses of six different wards of a teaching hospital at the beginning of their work shift. Worn coats were collected at the end of the shifts and the patches were subjected for total bacterial count and identification of selected bacterial pathogens, as prioritized by the World Health Organization (WHO). Fifty percent of the sampled swatches were found to be contaminated by pathogenic bacteria. The average colony growth per square inch of the patch was 524 and 857 during first and second workdays, respectively, indicating an increase of 63.6% in colony counts. The pathogens detected on patches were Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter sp. Additional bacteria identified included Bacillus sp., Micrococcus sp., and coagulase-negative staphylococci (CoNS). The nurses working in the maternity department had their white coats highly contaminated with bacteria. On the other hand, the least bacterial contamination was recorded from the nurses of the surgery ward. One S. aureus isolate from the maternity ward was resistant to methicillin. This study showed that pathogens belonging to the WHO list of critical priority and high priority have been isolated from white coats of nurses, thus posing the risk of transmission to patients. White coats must be worn, maintained, and washed properly to reduce bacterial contamination load and to prevent cross-contamination of potential superbugs. The practice of wearing white coats outside the healthcare zone should be strictly discouraged.

Socio-demographic characteristics of ischemic stroke patients in a tertiary care hospital of Nepal

Introduction: Incidence of stroke patients is increasing in low income countries like Nepal where management of these patients is challenging due to poor healthcare resources. Ischemic stroke is related to risk factors like age, male population, hypertension, diabetes mellitus, smoking and alcohol. Identification of these risk factors in the vulnerable population is important for prevention of ischemic stroke. The purpose of this study is to find out the social and demographic characteristics of patients with acute ischemic stroke treated at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, a tertiary care hospital of Nepal.&#x0D; Methods: Data was collected from all acute ischemic stroke patients presenting to the hospital over a period of one year. The age, sex, medical history of hypertension and diabetes and history of smoking and alcohol consumption were recorded. Statistical analysis of data was performed using Microsoft EXCEL 2019.&#x0D; Result: Total 310 patients were studied, out of which two-thirds were male. The highest number of patients were within the age group of 60-80 years with the mean age being 60 years. Hypertension and diabetes were present in 67.42% and 28.53% of patients respectively. 43.93% of the patients smoked while 33.87% of the patients consumed alcohol.&#x0D; Conclusion: Identification of association between risk factors like age, sex, hypertension, diabetes mellitus, smoking and alcohol consumption must be the emphasis for targeted preventive action to decrease the increasing burden of ischemic stroke among developing countries.

Blood transfusion practices in a tertiary care hospital in Nepal

Background: Blood transfusion is an integral part of patient management. Good transfusion practice guided by standard protocols is considered ideal for optimal use of resources and manpower. Cross-match requests disproportionate to the actual requirement causes overestimation of blood usage and potential wastage. This study aims to determine the crossmatch, transfusion, and utilization rates for blood using transfusion index, and cross-match to transfusion ratio in the various departments of the hospital for the evaluation of transfusion practices.&#x0D; Materials and Methods: A retrospective study was conducted using the records from the hospital blood bank for 12 months to obtain transfusion and cross-match records from various clinical units. Transfusion requests, units cross-matched, and completed transfusions were used to calculate the cross-match to transfusion ratio, and transfusion index for each department.&#x0D; Results: A total of 5156 units of blood were cross-matched for 3437 transfusion requests, out of which 3752 were transfused, giving a mean cross-match to transfusion ratio of 1.37. The non-usage of blood was 27.2% and the transfusion index stood at 1.09. The cross-match to transfusion ratio for the individual clinical units ranged from 1.75 (Surgery) to 1.14 (Medicine).&#x0D; Conclusions: The cross-match to transfusion ratio and transfusion index were within recommended ranges, showing good utilization and low blood wastage. The establishment of a blood ordering protocol via a multidisciplinary approach should be considered to further optimize blood transfusion practices.

Study of the Variation in Prices of Antidepressant Drugs Available in Nepali Market

Introduction: Depression often remains unrecognized, misdiagnosed and/or under treated. There are multiple drugs from multiple companies which are available for treatment of depression. The prices of same drug with different brands are variable which questions the afford ability of treatment to the patients and their compliance.&#x0D; Objective The study was conducted to analyze the cost variation of different brands of antidepressant drugs prescribed in a tertiary care hospital of Nepal.&#x0D; Methodology This study design was cross-sectional and method was quantitative method and conducted at department of pharmacology of a tertiary care hospital from September 2018 to January 2019 after getting approval from institutional review committee. The commonly prescribed antidepressant drugs were recorded from prescription records of department of psychiatry and their cost, cost ratio and percentage variation were calculated as per current index of medical specialties and National index of medical specialties. The data were recorded in MS excel and presented as simple descriptive statistics.&#x0D; Result The study included seven commonly prescribed antidepressants obtained from 214 prescription records. The cost of one course of citalopram 40 mg tablet was found to be higher and the cost of one course of imipramine 25 mg tablet was found to be lower. The maximum and minimum cost ratio was 2.46 and 1.08 with fluoxetine 20 mg capsule and dothiepin 50 mg tablet respectively. The maximum and minimum percentage of cost variation was with fluoxetine 20 mg capsule and dothiepin 50 mg tablet.&#x0D; Conclusion Costs of antidepressants had wider variations depending on the manufacturers and availability of different dose and brands.