Tribhuvan University Research Articles

Association of sleep quality, smartphone addiction, and depressive symptoms among undergraduate medical students in Nepal

IntroductionWhile research has examined the connections between sleep quality, smartphone addiction, and depressive symptoms in general, no studies focused on undergraduate medical students in Nepal have specifically tested the complex relationship between these factors. Therefore, this study aimed to investigate the interaction between smartphone addiction, sleep quality, and depressive symptoms among undergraduate medical students of Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.MethodsA cross-sectional study was conducted among 212 undergraduate medical students at Maharajgunj Medical Campus, Tribhuvan University, Nepal. Sleep quality, smartphone addiction, and depressive symptoms were assessed using the Pittsburgh Sleep Quality Index, Smartphone Addiction Scale Short Version, and Patient Health Questionnaire-9. Data were analyzed using IBM SPSS version 26 via the bootstrap model approach.ResultsOut of the total participants, 67.9% were male. Males showed higher scores in smartphone addiction and depressive symptoms than females (b = 5.3, Bca 95% CI:1.2, 9.1, p < 0.05). The unadjusted model indicated that the presence of smartphone addiction explained 36.5% of the indirect impact of sleep quality on depressive symptoms. However, in the adjusted model, after introducing socio-demographic, behavioral, and educational variables as covariates, this percentage decreased to 33.02%.ConclusionThis study highlights the significant role of both smartphone addiction and sleep quality in mediating the indirect effect on depressive symptoms among undergraduate medical students. Smartphone addiction emerged as a key mediator of depressive symptoms, indicating a potentially important factor in mental health. Investigating this relationship further through longitudinal studies will be crucial for developing effective preventative and therapeutic approaches.

Donors' Outcome After Living Donor Liver Transplantation in a University Teaching Hospital: A Case Series.

Background Liver transplantation is the standard treatment for end-stage liver disease. Living donor liver transplantation is more commonly performed in Asian countries as compared to the Western due to the lack of organ donation. Donor safety is the key to sustaining a liver transplant program. Thus, we aimed to evaluate the overall safety of living donors and health-related quality of life using the 12-item Short Form Health Survey (SF-12) questionnaire at our institution. Methodology We analyzed the medical records of patients who underwent donor hepatectomy at Tribhuvan University Teaching Hospital, Kathmandu, from May 31, 2019, to April 18, 2023. Demography, postoperative complications, and quality of life were analyzed. Results The mean age of the 10 live liver donors was 27.9 years. Half of them were male. One of them had a post-hepatectomy bile leak and others did not have any post-operative complications. They have good physical and mental health status after liver donation as indicated by the average physical component summary and mental component summary scores of more than 50. Conclusion The case series highlights the safety and favorable outcomes of liver donors at a low-volume liver transplant center, where stringent preoperative assessments and careful surgical techniques were employed.

Relation between sarcopenia and hepatic encephalopathy in liver cirrhosis - a study in tertiary care hospital

Introduction: Liver cirrhosis is a common medical problem associated with high morbidity and mortality. Consequences of cirrhosis leading to encephalopathy is a neuropsychiatric manifestation requiring hospital admission and poor prognosis. Similarly, sarcopenia in cirrhosis, resulting from multifactorial cause confers prognostic significance. The objective of this study is to find the relation between sarcopenia and hepatic encephalopathy. Methods: A retrospective observational study was conducted and data was taken from electronic medical records of patients admitted with hepatic encephalopathy in department of gastroenterology of Tribhuvan university Teaching hospital. A total of 96 cirrhotic patients were included during one and half year study duration. Sarcopenia was assessed using assessment tool like hand grip strength, chair stand test and CT measurement of either skeletal muscle area (SMA) or skeletal muscle index (SMI). Hepatic encephalopathy was graded according to West Haven criteria among admitted patients. Results: Among 96 patients with cirrhosis, 85 patients (88.5%) were found to have sarcopenia. Prevalence of sarcopenia was higher among female compared to male (97% vs 84%). Similarly, sarcopenia was found to be higher in patients with HE-2 and HE-3 compared to HE-1 ( 91% vs 93% vs 79% respectively). Conclusion: Sarcopenia is commonly associated with hepatic encephalopathy. Bangladesh J Medicine 2024; 35: 195-199

Leadership, Professional Development and Higher Education Institutions: A Study of Constituent Campuses of Tribhuvan University

Leadership, Professional Development and Higher Education Institutions: A Study of Constituent Campuses of Tribhuvan University

Transforming Educator Growth: Professional Development at Tribhuvan University

Professional development is an inevitable facet of our life. The study aimed to explore the teachers’ professional development at Tribhuvan University. To achieve the objective, I used explanatory sequential design under mixed-methods research. The data were collected from 30 teachers of a constituent campus of TU using a set of questionnaires as a research tool. The findings reveal that more than 55% teachers strongly agreed with the importance of academic degrees for better classroom performance. Less than half of them were satisfied with their reading, and writing position. Similarly, many teachers (93%) were not satisfied with their research position. More than 90% teachers have published general articles, but only 10% teachers published their academic books. Many teachers come to the classroom with full preparation; they talk to their colleagues about their issues and professional pursuits, support one another in taking professional actions, and insist on taking professional actions with the campus administration. Different strategies such as reading and writing, achieving a higher degree, doing action and mini-research, writing articles and books, attending workshops and seminars, networking, and self-monitoring are the key strategies for their professional development. The present study can be equally beneficial not only to university teachers but also for to the teachers who wish to develop their teaching career in one hand and writers, researchers and trainers on the other.

Association between Abortion and Acceptance of Post abortion Contraception

Post-abortion contraceptive uptake is essential in reproductive health, as it helps to identify women’s contraceptive needs, reduce unintended pregnancies and prevent subsequent abortions. Integrating abortion services with family planning counselling at all levels of health facilities can enhance contraceptive acceptance. This study aimed to evaluate the acceptance of various family planning methods following different abortion services over one year period, at a family planning center, Department of Obstetrics and Gynecology Tribhuvan University Teaching Hospital. This study analyzed the women who participated in contraceptive counselling and accepted different types of contraceptives following different methods of first and second trimester abortions services. The study included women who received post-abortion contraceptive counselling and services, excluding those with termination beyond the second trimester or those seeking only postpartum contraceptive counselling or post-abortion care. It aimed to analyze the association between different methods of abortion and contraception acceptance post-abortion. Among 100 women who had spontaneous and induced abortions, 89% received post-abortion counselling and 75% accepted various types of contraception immediately after abortion. About one third of women were aged 25–29 years (30%), 99% were married, 40% were graduates and 48% were housewives. Abortion methods included medical abortion (62%), manual vacuum aspiration (MVA) (35%) and dilatation and evacuation (3%). Contraceptive acceptance rates were: short-acting reversible contraception (SARC) 60%, long-acting reversible contraception (LARC) 14%, and permanent methods 1%. Among medical abortion recipients, most chose SARC (43%) followed by LARC (4%). For those undergoing MVA, 16% chose SARC, and 9% chose LARC. Condoms were the most accepted SARC method (22%). The study demonstrated that post-abortion counseling significantly increases acceptance of various contraceptive methods, with SARC being the predominant choice, especially condoms among users.

Self-Reported Health and Associated Factors among Nepalese Older Adults

Background: Self-reported health (SRH) is a subjective measurement tool for overall health status that integrates biological, social, mental, and functional aspects of individuals. Objectives: The purpose of this article is to assess the SRH and its correlates among community-living older adults. Methods: This study is a secondary analysis of structured interview data collected by the Central Department of Population Studies at Tribhuvan University (TU) via a cross-sectional survey of community-dwelling persons aged 60+ in the Pharping area of Kathmandu. For this study, there were 1320 valid responses. A simple and direct question was used “In general, how do you rate your general health?” Its answer was recorded on the 5-point Likert scale ranging from “Very Good to Very Bad”. Results: The mean age of the participants was 69.92 years. Of the participants, 19.2% reported poor SRH. Results show mental health problems, total number of children still alive, age of respondent, literacy status, physical health problem now, satisfaction with current living arrangements, walking efficiency, adequate income sources, marital status and currently working were correlated with SRH. However, linear regression shows that significant factors of SRH are walking efficiency (β= 0.324, 95% CI= 0.240 to 0.323), physical health problems (β = -0.258, 95% CI= -0.493 to -0.346), currently working (β: 0.197, 95% CI=0.223 to 0.373), having enough income to meet basic needs (β: 0.065, 95% CI= -0.136 to -0.021) and satisfied with living arrangements (β= 0.065, 95% CI= 0.018 to 0.116). Conclusion: Nepal is aging rapidly, and the proportion of older people will increase in the coming days. Walking efficiency, physical health, currently working and having sufficient income are important factors related to SRH. Identifying these determinants through self-rated status can support the planning of actions aimed at improving the health of the community living older adults.

Dunking Pancreaticojejunostomy With Braun's Jejunojejunostomy: Perioperative Outcomes of a Hundred Pancreaticoduodenectomies.

Background The optimal surgical technique for pancreaticojejunostomy (PJ) following pancreaticoduodenectomy (PD) is still debated. Dunking and duct-to-mucosa PJ are the most commonly adopted techniques. Incorporating Braun's jejunojejunostomy (JJ) could reducetheincidence and severity of delayed gastric emptying (DGE). This retrospective descriptive study seeks to clarify the outcomes of dunking PJ with Braun's JJ in 100 PD patients. Methodology We retrospectively reviewed 100 patients who underwent PDs in a single unit of the Department of Surgical Gastroenterology of Tribhuvan University Teaching Hospital from October 2012 to February 2023. Demographic and historical data, indications, procedure-related data, complications, and mortality data were collected and analyzed. Results The mean age was 50.96 ± 14.97 years, and 64 (64%) were males. The most common indication was ampullary carcinoma (53, 53%) followed by distal cholangiocarcinoma (18, 18%) and pancreatic ductal adenocarcinoma (7, 7%). Operative time was 5.83 ± 1.09 hours, intraoperative blood loss was 515 ± 194 mL, and the average time for PJ and Braun's JJ was 22 ± 6 and 15 ± 3 minutes, respectively. Soft pancreas was encountered in 52 (52%) patients and clinically significant postoperative pancreatic fistula (Grade B, C) was seen in 23 (23%). Postpancreatectomy hemorrhage was seen in 21 (21%) patients (Grades A: 3, B: 12, C: 6). DGE (Grade B) occurred in two (2%) patients, and bile leak was observed in 4% of patients (Grades A: 1, B: 2, C: 1). Major complications (Clavien-Dindo ≥IIIA) occurred in 24%, and 11 patients died. Conclusions The dunking technique is easily adaptable, less time-consuming, and can be performed in the pancreas of any texture or duct size but is associated with an increased incidence of post-pancreatectomy hemorrhage. Incorporation of Braun's anastomosis lowers DGE, allows early initiation of feeding, and reduces complication rates.

Factors Associated with Self-Reported Health (SRH) among Nepalese Older Men

Background: Self-reported health (SRH) is a subjective measurement tool of overall health status. It integrates with the biological, social, mental, and functional aspects of individuals. The aim of this article is to assess the SRH and its correlates among community-living older men from Nepal. Methods: This study uses the secondary data collected by the Central Department of Population Studies at Tribhuvan University (TU). This study includes community-dwelling male elderly aged 60+ in the Pharping area of Kathmandu. For this study, there were 657 valid responses. A simple and direct question was used “In general, how do you rate your general health?” Its answer was recorded on the 5-point Likert scale “Very Good to Very Bad”. Results: The mean age of the participants was 69.51 years. The majority of respondents (75.9%) live with family members. People who reported poor SRH were 17.0%. Many of them have physical health problems (73.2%) and mental health problems (57.2%). Mental health problems, age of respondents, physical health problems, satisfaction with current living arrangements, walking efficiency, adequate income sources, Insecurity feelings, Income sufficient to fulfill the basic needs, and current working were correlated with SRH. However, linear regression shows that satisfaction with walking efficiency, physical health, and working situation, were significant predictors of SRH. Conclusion: This analysis suggests that working, walking ability, physical health problems, and financial adequacy are significantly associated with self-rated health. Identifying these variables through self-rated status can support the planning of actions aimed at improving the health of the community living older adult men in Nepal.

Diagnostic and Therapeutic Value of ERCP : Experience from a Tertiary Care Center

IntroductionEndoscopic Retrograde Cholangiopancreatography (ERCP) is an advanced endoscopic technique to diagnose and manage biliopancreatic diseases. The role of ERCP is increasing since its inception with refinement of operator skill, technical advancement and better patient selection. The aim of the study is to highlight common clinical and endoscopic characteristics, outcome, adverse events and safety profile of patients undergoing the procedure in a tertiary care center. MethodA retrospective observational study was conducted on patients undergoing ERCP in department of Gastroenterology, Tribhuvan University Teaching Hospital, for management of biliopancreatic diseases from April 2023 to March 2024 after taking approval from IRC committee. Patient demographics, clinical characteristics, ERCP findings and post procedure outcome data were collected and analyzed using SPSS version 26. ResultA total of 200 patients were included with mean age 52.36 + 17.04 years and female: male ratio of 1.43. Elective procedure was done in 91% patients and 9% as urgent procedure (within 48 hours). The most common indications were choledocholithiasis (78.5%) followed by benign biliary stricture (6%). Endoscopic observation revealed that the most frequent papilla was type 1 papilla (normal variant) in 48% followed by type 3 papilla (protruding) in 30% and type 4 papilla ( creased) in 10%. Difficult cannulation was encountered in 51.5 % cases. Post ERCP pancreatitis (4.5%) and hypoxia (4.5%) were the most common procedure and anesthesia related adverse events respectively. Therapeutic interventions included sphincterotomy (88%), CBD stenting (78.5%) and precut sphincterotomy (22.5%). ConclusionERCP is a relatively safe and effective therapeutic and diagnostic procedure for management of biliopancreatic disorders with acceptable risk.

Decision Making Status regarding Antenatal Care among Women in a Tertiary Level Hospital of Kathmandu

Introduction Women’s decision making is one of the important indicators of maternal health which directly influence their utilization of antenatal care services resulting on reduction maternal morbidity and mortality. The aim of this study was to find out the decision making status regarding antenatal care among women. MethodsA cross-sectional study was conducted among 180 antenatal women of third trimester from Gynae/Obs OPD of Tribhuvan University Teaching Hospital (TUTH). Non probability purposive sampling technique was adopted. Data was collected by using semi-structure interview questionnaire Data were analyzed using descriptive statistic and inferential statistics using chi square and fisher’s exact test. ResultsMore than two-thirds research participant (68.3%) had medium level of decision making on antenatal care, whereas few respondents (16.7%) had high level of decision making. The study revealed that there was statistical association between level of decision making with women’s age (p=0.009), type of family (p=0.01), duration of marriage (p=0.002), economic status (p=0.009), education (p=0.007) and number of children (&lt; p=0.001). ConclusionsFew of the antenatal women have high level of decision-making status regarding their Antenatal care. Furthermore the lowest level of decision making observed concerning on autonomy in financial matter thus the importance of advocacy for promoting women’s decision-making status in Nepalese context is necessary.

Social Support Networks and Faculty Motivation: Insights from Tribhuvan University

Study examines the topic of “Social Support Networks and faculty Motivation." The research aims to shed light on the significant factors influencing teachers' motivation within the context of Tribhuvan University. The study employed a quantitative research design, collecting data from a sample of teaching Faculty within the university. The study utilizes regression analysis to show the impact of four variables on the motivation levels of teaching faculty. SPSS 26 was used to analyze the data. The study revealed that family support and faculty-parent collaboration have a strong positive impact on faculty motivation. On the other hand, faculty -community relations and social recognition of faculty had less significant effects. These findings emphasize the importance of family encouragement and partnerships between faculty and parents in boosting faculty motivation. The study suggests that focusing on family support networks and improving teacher-parent cooperation can be effective ways to enhance faculty motivation in Tribhuvan University. Novelty: This research provides a new perspective i.e. Social Recognition, Faculty Community Relation, Faculty Parent Relation, and Family Support by studying the factors that influence faculty motivation specifically at Tribhuvan University.

Right to Employment Protection of the Adjunct and Internal Full Time Contract Faculties in the Tribhuvan Univer

This study explores at the legal rules for recruitment part-time and full-time contract teachers at Tribhuvan University (T.U.) in Nepal. It focuses on how they are recruitment, selection, and how their rights are protected. The study uses legal documents like the T.U. Act and court cases from other countries to examine these issues. The findings show how T.U. uses part-time teachers, how it hires them, and how decisions made by the administration can affect them. The study also highlights international court cases to see what they say about following proper procedures, meeting contract obligations, and protecting the rights of teachers. Based on this, the study suggests ways to improve the situation, i.e., considering the needs of teachers, following labor laws, and having clear rules about academic freedom and job security. It also suggests making contracts clearer and giving teachers more rights, such as knowing more about their jobs and being able to bargain together as a group.

Errors and Expectations: Addressing the Challenges of Graduate Writing in Tribhuvan University, Nepal

Errors and Expectations: Addressing the Challenges of Graduate Writing in Tribhuvan University, Nepal

Initiatives to the Global Representation of Scientific Collections

Ensuring that all global scientific collections become accessible online is a challenge. The Global Biodiversity Information Facility (GBIF) maintains a Global Registry of Scientific Collections (GRSciColl) but as of May 2023, 58% of the collections included in the registry were from institutions based in Europe or North America. This shows a low representation of organizations from other regions. GBIF is addressing the bias with the help of its participant network and regional support teams. The GBIF participant network is actively encouraging institutions in its regions to register and describe their collection data through GBIF and GRSciColl. To complement this effort, the regional support teams based in Africa, Asia, Latin America and the Caribbean, and Europe are engaged in mobilizing new collections and updating existing ones (Fig. 1). In addition, a community of editors review changes proposed via a user suggestion system and keeps the entries in GRSciColl updated. The work of the regional support teams involves reviewing institutional web pages or other available online sources to update GRSciColl entries. In cases where the data are not accessible on the web, contacts from the institutions are invited to suggest changes to their GRSciColl pages. As a next step, institutions are contacted to inquire about their interest and plan for sharing open access data. If the response is positive, technical support is offered to help the institutions mobilize and publish the collection data through GBIF. The regional support teams have contacted a number of institutions and several institutions have shown interest in publishing collections on GBIF. Some organizations have already started digitizing and publishing their collection(s). With the training and technical support from the regional support teams, the following institutions have started to share data on GBIF: Instituto de Biodiversidad de Venezuela - INBIO has published data on 23,414 herbarium specimens. Natural History Museum, Tribhuvan University, Nepal has started digitizing its collections and has published eight datasets constituting 1,776 specimens. National Museum of Natural History at the Bulgarian Academy of Sciences has started digitizing 31 out of its 32 collections, of which they have published two herbarium collections represented as two datasets consisting of over 6,357 specimens. Instituto de Biodiversidad de Venezuela - INBIO has published data on 23,414 herbarium specimens. Natural History Museum, Tribhuvan University, Nepal has started digitizing its collections and has published eight datasets constituting 1,776 specimens. National Museum of Natural History at the Bulgarian Academy of Sciences has started digitizing 31 out of its 32 collections, of which they have published two herbarium collections represented as two datasets consisting of over 6,357 specimens. This presentation will highlight the data mobilization activities of the institutions, the progress of the GBIF regional support teams (Fig. 2), and the opportunities and challenges experienced in the mobilization effort.

Sarcopenia in cirrhosis of liver - comparison of different tools in diagnosis

BACKGROUND AND AIMS Sarcopenia in liver cirrhosis is a common condition associated with increased mortality and adverse clinical outcome. Early recognition and treatment is essential but challenging. Clinical detection of sarcopenia with various assessment tools gives indirect knowledge of muscle mass and strength. The aim of this study is to find the most easy and applicable assessment tool in daily clinical practice to diagnose sarcopenia. METHODS A retrospective observational study was conducted and data was taken from electronic medical records of patients admitted with cirrhosis and sarcopenia in department of gastroenterology of Tribhuvan university Teaching hospital. A total of 51 cirrhotic patients were included during one and half year study duration. Sarcopenia was assessed using assessment tool like hand grip strength, chair stand test, 400 metre walk test and CT measurement of either skeletal muscle area (SMA) or skeletal muscle index (SMI). RESULTS Among 51 patients assessed with performance based assessment tool to diagnose sarcopenia, taking CT as gold standard test, SARC-F score and chair stand test were found to have highest sensitivity and specificity of 93%, 87.5 % and 93%, 100% respectively. CONCLUSION Diagnosis of sarcopenia with simple clinic based assessment tool SARC-F score and chair stand test is very useful and comparable with more costly and resource-intensive CT scan.

Study of Hyponatremia in Acute CNS Infections in A Tertiary Center

INTRODUCTION Hyponatremia significantly contributes to morbidity and mortality in CNS infections. Accurate diagnosis and timely intervention of hyponatremia is necessary as it can exacerbate the symptoms and may cause delay in management. METHODS This cross-sectional study was done in 146 consenting adults diagnosed with acute CNS infections at Tribhuvan University Teaching Hospital (TUTH) over one year. All participants underwent clinical assessments, including cerebrospinal fluid (CSF) analysis, blood tests, and imaging. Prevalence and severity of hyponatremia was studied. Data was entered into MS Excel and subsequently transformed into IBM SPSS Software version 25 for statistical assessment. RESULTS Hyponatremia was prevalent in 34.25% of cases; of which 56% were moderate in severity. Altered mental state, fever, and headache were common clinical features. In terms of etiology, viral infections (45.8%), followed by CNS TB (30.8%) were common. CONCLUSION Our study identified that hyponatremia was prevalent in more than one third of patients having CNS infections, encephalitis being the most common clinical syndrome. In terms of etiology, viral infections constituted the majority, followed by tubercular, bacterial, fungal, and parasitic infections.

Why Should One Study Anthropology?

Unlike the other social science disciplines, anthropology has a broader scope in terms of its theory and methods. It is a holistic discipline which covers all aspects of human being. Nepal has relatively short history of anthropology as teaching discipline. However, it has more than two hundred years of research tradition in Nepal. A score of foreign and native anthropologists have been carried out the research in Nepal. Compare to other disciplines, there are relatively getting research fund from the foreign universities and development agencies. Recent data of the central department of anthropology shows that employment rate of the pass out students in master’s degree in anthropology is higher. But why the number of students enrolled in graduate and undergraduate is low. Taking this issue into consideration, this paper answers the question of low number of student enrolment in the various constituent colleges of Tribhuvan University. The Paper is based on ethnographic interviews with some graduate/ undergraduate students and faculty of Tribhuvan University. There are some reasons to be a low number of students in anthropology: Anthropology demands rigorous and continuous study on the subject matter where original texts are taught. In Nepal, people not only common people but also intellectual including professionals have little knowledge about the distinction between sociology and anthropology due to a long experience of joint department, Tribhuvan University. Importantly, there is no realization from Tribhuvan University administration and Government of Nepal why anthropology is important for the development of the nation. Paper answers these issues.

Injury Epidemiology after 7.8 Richter Gorkha Earthquake in Nepal: A Retrospective Study of Injuries Treated at Tribhuvan University Teaching Hospital

Injury Epidemiology after 7.8 Richter Gorkha Earthquake in Nepal: A Retrospective Study of Injuries Treated at Tribhuvan University Teaching Hospital

Predicting outcome of acute organophosphorus poisoning using poison severity score in patients presenting at a university hospital in Nepal

Introduction: Poisoning is a major public health threats in the agriculture based country where people have easy access to the organophosphate (OP) pesticides and herbicides. Aim of the study is to analyze morbidity and mortality (outcome) of OP poisoning using Poison Severity Score (PSS). Methods: The study was reviewed and approved by International Review Board on 31 August 2016. This cross-sectional study included patients aged 16 years or above who presented with ingestion of OP in emergency of Tribhuvan University Teaching hospital, Kathmandu, Nepal, from September 2016 to April 2018. Socio-demographic and clinical profile of the patients, incidence of OP compounds poisoning, and morbidity and mortality were analyzed using PSS. Results: There were 210 OP poisoning cases. 194 (92.38%) survived. Female were 143 (68.10%) and male 67 (31.90%). The mean age was 34.81 years (16 years to 85 years). Poison Severity Score (PSS) and length of hospital stay were significantly different between OP survivors (92.38%) and dead cases (7.62%), p-value &lt;0.0001. Conclusions: Poison severity score was useful in recognizing high-risk patients of OP poisoning in our study.