Osteoporosis and its associated factors among patients attending Manakamana Hospital, Chitwan, Nepal.

BACKGROUND: Osteoporosis is the most common skeletal disorder that weakens bones and increases their susceptibility to fractures. It is becoming an urgent and serious global epidemic. Early diagnosis and treatment are essential to reduce morbidity and mortality associated with it. This study aimed to find out the prevalence of osteoporosis among patients attending at Manakamana Hospital, Bharatpur, Chitwan, Nepal. METHODS: A cross-sectional study was adopted and 623 patients attending at orthopaedic outpatients department (OPD) of Manakamana Hospital were selected using non-probability consecutive sampling technique. Data were collected from 15th October 2021 to 15th April, 2022, by using interview schedule, chart review and Bone Mineral Density (BMD) measurement through calcaneal ultrasonography. Ethical approval was obtained from Nepal Health Research Council Ethical Review Board prior to study procedures. Obtained data were analysed using descriptive statistics. Association between the variables were measured using chi-square test. RESULTS: The mean age of the patients was 43.5 (±14.26) years. Nearly half (44%, n = 274) were middle aged adults, 59.7% were female and 56.0% were involved in agriculture and household chores. Nearly half of the patients (45.7%) were overweight/ obese, 7.9% were smokers and 13.5% had habit of alcohol use. Osteopenia or low bone density was detected in 58.9% patients and 19.4% had osteoporosis. The prevalence of osteoporosis was significantly associated with age group (p = <0.001) and educational status (p = 0.013) of the patients. CONCLUSIONS AND RECOMMENDATIONS: Osteoporosis and osteopenia are prevalent in patients attending in the hospital. Hence, awareness, early screening, and treatment are necessary for the hospital attended patients to enhance their health and, minimize the risk of osteoporosis and the consequences associated with it.

Validation of the Foot and Ankle Outcome Score for Use in Infracalcaneal Heel Pain.

There is growing interest in adopting validated and reliable patient-reported outcome measures following surgery. While the Foot and Ankle Outcome Score (FAOS) has previously been validated for use in multiple foot/ankle conditions, it has not yet been validated in patients with infracalcaneal heel pain. In this study we aimed to validate the FAOS by looking at 4 psychometric properties of the survey: construct validity, content validity, reliability, and responsiveness, using patients in our practice with a clinical diagnosis of plantar fasciitis. A total of 150 patients (mean age 49.7 ± 12.1 years [36 men and 114 women]) were included in one or more of the 4 components of this study. All FAOS subscales demonstrated adequate construct validity when compared with the physical health component of the 12-Item Short Form Health Survey (SF-12), and 2 out of 5 subscales demonstrated moderate correlation with the mental health component of SF-12 (all Spearman rho >0.3, and p values <0.05). Most FAOS subscales demonstrated content validity and were found to contain relevant questions from the patient's perspective. All 5 subscales demonstrated good test-retest reliability with intraclass correlation coefficients ≥ 0.827. Finally, 4 out of the 5 subscales (all but other symptoms) were responsive to change at a mean follow up of 12.2 months after surgery (p < .05). We conclude that the FAOS is a responsive, reliable, and valid instrument for use in infracalcaneal heel pain. We believe that due to its ease of use and broad applicability, the FAOS could be more widely adopted in foot/ankle practices as patient-centered healthcare delivery and research becomes increasingly prioritized in the US and abroad.

Comparison of Regenerative Injection Therapy and Conventional Therapy for Proximal Plantar Fasciitis.

Treatment of subacute and chronic heel pain often presents a unique challenge to the physician. Regenerative therapies, such as injectable amnion and connective tissue matrix, may represent a promising new approach in these patients, and have become increasingly popular in the United States. However, little literature exists evaluating these injections compared to conventional nonoperative means. As such, we designed a retrospective comparative study evaluating patients in our practice who received a standardized plantar fascial treatment protocol only (standard therapy), and those who received regenerative plantar fascial injections in addition to standard therapy. A total of 54 patients were followed over a 3-month observation period (91.7 ± 73.9 days), with numeric pain rating (NPR) serving as the primary outcome. Both groups saw an improvement in NPR at the end of the observation period, but patients in the regenerative therapy group demonstrated lower pain scores than those receiving standard therapy alone (mean NPR 2.1 ± 2.3 vs 4.4 ± 2.8, p = .004). Additionally, those in the standard therapy group were significantly more likely to proceed onto surgical intervention compared to the regenerative therapy group (unadjusted odds ratio 15.6, 95% CI 3.0-27.9). The use of regenerative injections for subacute and chronic plantar fasciitis showed promise in our study, and may help mitigate against the need for invasive surgical intervention.

Internet Gaming Disorder and Aggression among Students on School Closure during COVID-19 Pandemic.

BACKGROUND: The Corona Virus Disease (COVID-19) pandemic has significantly disrupted the regular school-going activities of the students, predominantly increasing internet gaming activities to endure significant stress. Excessive involvement in internet gaming brings deviant behaviour, especially aggression among the students. Hence, this study aimed to assess the internet gaming disorder and aggression among the students on school closure during COVID-19 pandemic in Chitwan, Nepal. METHODS: A web-based cross-sectional survey was conducted among 417 students from secondary and higher secondary level who studied in two private schools of Chitwan district. Sample were selected using simple random sampling technique and structured questionnaire, i.e. Internet gaming disorder scale- short form (IGDS9-SF) and Aggression questionnaire (Buss and Perry, 1992) were used to collect the data via web-based through Google Form. Obtained data were analysed using descriptive and inferential statistics. RESULTS: Out of 417 students, the mean age was 17 (±1.411) years, 278 (66.7%) were male and 150 (36.0%) were studying in twelve standard. Majority of students 405 (97.1%) were non-disordered gamers whereas only 12 (2.9%) students were disordered gamers. Students' overall aggression score was 57.79% where the verbal aggression score was higher (66.33%) followed by hostility (61.41%) and anger (56.80%). Further significant positive relationship was found between scores on online gaming disorders and aggression (r=0.239). CONCLUSIONS: Internet gaming disorder and aggression are common among the students during COVID-19 pandemic. Therefore, educational institutions and concern authorities need to organize awareness programs and effective psychosocial intervention approaches for students to enhance the knowledge regarding harmful use of internet game, IGD, to cope with stress and aggression as well as to enhance the adoptive behaviour.

A Rare Case of Staphylococcal Toxic Shock Syndrome in a Neonate.

Staphylococcus toxic shock syndrome (TSS) is not well described in neonates. The present criteria for diagnosis of TSS have not yet been validated in neonates. Here, we present a case of a 13-day-old female baby who presented with acute kidney injury (AKI). She had a pus-draining lesion on the head, and the pus grew Staphylococcus aureus. Based on the clinical criteria of fever, desquamation, hypotension, and AKI and laboratory criteria of absence of growth of any organisms in blood and cerebrospinal fluid, we diagnosed the case as TSS. She was treated with antibiotics, oxygen, and fluids, along with inotropic support and mechanical ventilation, and she recovered fully and was discharged on day 17 of admission. As there is no single test to diagnose TSS and it is uncommon in neonates, physicians should be familiar with the clinical presentation of the disease to make early diagnosis.

Pregnancy Induced Hypertension among Pregnant Women Delivering in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Pregnancy Induced Hypertension is a major health issue with limited studies conducted so far in Chitwan, Nepal regarding adverse perinatal outcomes in obstetric population. This study aimed to find prevalence of pregnancy induced hypertension among pregnant women delivering in a tertiary care hospital. METHODS: A descriptive cross-sectional study was conducted in a teaching hospital of Chitwan, Nepal during the study period of six months from 15th Jan 2019- 16th July 2019 after getting ethical approval from Chitwan Medical College-Institutional Review Committee (Reference number-2075/076042). Women were selected via convenience sampling technique. Face to face interview was conducted to collect socio-demographic and obstetric data whereas, data related to the fetomaternal outcomes were obtained from patient charts and delivery record books. Statistical Package for Social Sciences version 20 was used for data analysis. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: The prevalence of pregnancy induced hypertension was found to be 91 (6.43%) (3.83-9.03 at 95% Confidence Interval) representing 71 (78.1%), 12 (13.2%), and 8 (8.7%) as gestational hypertension, preeclampsia and eclampsia respectively. CONCLUSIONS: The burden of pregnancy induced hypertension was found quite higher as compared to other similar studies done in Nepal. Gestational hypertension was most common type.

Readiness for the Online Classes during COVID-19 Pandemic among Students of Chitwan Medical College.

Online learning has been in a rising trend across the world due to increasing technology in education. Corona Virus Disease 2019 (COVID-19) pandemic enforced all the academic institutions to start online classes for the students. But the students' readiness for the adoption of online learning remains unknown. Hence, this study aimed to assess the readiness of online classes among students. Descriptive cross-sectional web based survey was carried out among 704 students who have enrolled in various streams of Bachelor level programs in Chitwan Medical College. The finding of this study revealed that 87.1% of students from various faculties were ready for online classes during COVID pandemic and 88.8% had internet facility in their home setting. Furthermore, this study found that readiness for online classes was significantly higher among female than male students (89.7% vs.83.5%, p=0.016) and students who had internet accessibility in their residence than those who did not have it (83.8% vs.34.2%, p=<0.001) but there was no significant association between readiness for online classes with academic programs (p=0.062) and years (p=0.905). Therefore, online learning can be considered as a viable alternative method in the academic institutions for the students. Keywords: COVID-19 Pandemic; online classes; readiness; students.