Assessment of Community Based Health Insurance in Sunsari District.

Background Community Based Health Insurance (CBHI) Schemes are promising alternatives for a cost sharing health care system which hopefully leads to better utilization of health care services, reduce illness related income shocks and eventually lead to a sustainable and fully functioning universal health coverage. Objective This study focused on factors influencing the people's enrolment and hindrances for enrollment of CBHI program. Method Altogether 316 households were taken according to population proportionate sampling method.Community based cross-sectional analytical study was carried out with preformed questionnaire among members and non- member in four villages. Sample unit for enrollee were selected by using population proportionate systematic random sampling method using enrolled register and for non-enroll systematic random sampling technique was used using household list from VDC. Result For non- members 28.3% small benefit package was main reason for non membership. Provision of partial payment would be a motivating factor for 26.4% of the respondents. Non-members (30.5%) felt disparities in treatment while providing good medicines (11.9%). Financial help for the treatment was good part of the program for 43.0% of the respondents. Among 9.3% of members who would not renew reported of tedious process of taking service as the main reason. The educational status of the respondents is directly related to the enrolment in the CBHI scheme (<0.001). Conclusion The study gave some insight about factors influencing the utilization of health insurance schemes in low resourced countries. Properly implemented CBHI schemes would add on better health financing and better utilization of health care in developing countries.

Origins of electronic band gap reduction in Cr/N codoped TiO2.

Recent studies indicated that noncompensated cation-anion codoping of wide-band-gap oxide semiconductors such as anatase TiO2 significantly reduces the optical band gap and thus strongly enhances the absorption of visible light [W. Zhu et al., Phys. Rev. Lett. 103, 226401 (2009)]. We used soft x-ray spectroscopy to fully determine the location and nature of the impurity levels responsible for the extraordinarily large (∼1 eV) band gap reduction of noncompensated codoped rutile TiO2. It is shown that Cr/N codoping strongly enhances the substitutional N content, compared to single element doping. The band gap reduction is due to the formation of Cr 3d3 levels in the lower half of the gap while the conduction band minimum is comprised of localized Cr 3d and delocalized N 2p states. Band gap reduction and carrier delocalization are critical elements for efficient light-to-current conversion in oxide semiconductors. These findings thus raise the prospect of using codoped oxide semiconductors with specifically engineered electronic properties in a variety of photovoltaic and photocatalytic applications.

Using rigidly fixed autogenous tooth graft to repair bone defect: an animal model.

OBJECTIVE: This study describes a new approach to regenerate bone defect using autogenous tooth. MATERIALS AND METHODS: Freshly extracted teeth were used as autogenous grafts. Teeth were sectioned, cut into desired shape, and disinfected. The grafts were rigidly fixed to the mandibular defects in eighteen rabbits using titanium screws to achieve good stability. Every six rabbits were stochastically sacrificed at 1, 3, and 6 months after implantation, respectively. For all specimens, clinical, radiographical, and histological measurements were performed. RESULTS: The boundaries of the grafts were distinctly visible in the implanted area during the first and third month. However, the teeth grafts were fully covered by new bone by the sixth month. The radiograph demonstrated the progressive change in the bone and grafted tooth interface from radiolucency to radiopacity during different time periods. Histologically, vascularization led to a temporary fibrous integration in the graft-bone interface. The bone contact rate of 1 and 3 months was significantly lower than that of the 6 months. During this period, grafts were gradually resorbed and replaced by new bone. CONCLUSION: Rigid fixation of autogenous tooth could serve as a novel approach for the repair of bone defect.

The demographics of molar pregnancies in BPKIHS.

This is an analysis of the incidence of molar pregnancies and those of complete and partial molar pregnancies across the reproductive age range for BP Koirala Institute of Health Sciences (BPKIHS) in the period 2010-2011. Patients with molar pregnancies registered with BPKIHS from January 2008 to January 2010 were identified. The overall number of molar pregnancies registered was compared to the number of maternities (live births and still births) and total viable conceptions for this year. A retrospective study of 64 cases of molar pregnancies recorded at BPKIHS during the two year time was done. Medical records were reviewed. Incidence, clinical presentation and methods of diagnosis were studied. During the study period, there were 37 complete moles, 23 partial moles, 1 persistent gestational trophoblastic tumor, 1 choriocarcinoma, and 2 invasive moles. The incidence of molar pregnancy was 3.94 per 1000 deliveries. Median distribution was at 22 years of age, and majority (67%) presented during early second trimester. Twenty one (32.8%) women were of blood group A positive and ten (15.6%) presented with severe form of anemia. This study provides detailed data regarding the incidence of partial and complete molar pregnancies with increasing maternal age. It confirms the relation of molar pregnancy with age, and blood group. Complete mole had the highest incidence, affecting mostly younger age group, and usually in the first half of their pregnancy.

Metallic vaginal ring pessary: a rare entity.

Vaginal pessaries still have role in the management of uterovaginal prolapse especially in elderly women, unfit for surgery and as a temporary relief for women waiting for surgery. Forgotten vaginal pessaries may cause serious complications. We here by present a case wtih metallic vaginal ring pessary for 16 years without significant symptoms.

Spontaneous bacterial peritonitis (SBP) in cirrhotic ascites: a prospective study in a tertiary care hospital, Nepal.

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is one of the potentially lethal complications of cirrhosis and is defined as infected ascites in the absence of any recognizable secondary cause of infection. Objective was to study the occurrence of SBP, clinical and laboratory characteristics and the response to antibiotics. METHODS: We had prospectively evaluated 81 cirrhotic patients with ascites during one-year period. All SBP patients were treated with cefotaxime, 2gm IV, every 12h for 5days. RESULTS: Of these 81 patients, 24.67% of patients (n=20) had SBP and its variants (classical SBP n= 4, CNNA n=13 and bacterascites n=3). There were thirteen males and 7 females in the study.85% of the cases had Child;s class C cirrhosis. UGI bleeding and abdominal pain were the most common presenting symptoms of SBP. Culture positives were 35% (n=7). The most frequent organisms were Escherichia coli (n=3) and Streptococcus pneumoniae (n=2). 94% of the patients responded to therapy after 48 hours of treatment. Total resolution after 5 days of therapy was 73% and in-hospital mortality was 15% (n=3). CONCLUSION: SBP, if diagnosed early can be treated with very good success rate up to 73%. Appropriate treatment of SBP with cefotaxime can help in reducing mortality and morbidity in patients with chronic liver disease.

A sustainable approach towards rural development: dry toilets in Nepal.

Existing inadequate sewerage systems and direct disposal of household waste into water courses has tremendously increased water pollution. Dry toilets are feasible in rural and peri-urban areas to reduce the consumption of costlier water that is required for flushing. As conventional treatment technologies require high investment, and operation and maintenance costs, dry toilets are the only suitable option left for sanitation in the 21st century when working with limited financial resources. To reduce environmental degradation and overcome this problem, the dry toilet is only the realistic option in Nepal. Two reactors, one exposed to sunrays and the other without sunrays, were constructed. In the model with sunrays, it was found that in 48 days of observation faecal coliform presence depleted to 610 cells per gm from the initial value of 7 x 10(10) and volatile organic matter came down from 98.09% to 70.18%. Similarly, in the other model, the destruction of faecal coliform in 65 days was found to be 920 cells/gm while the destruction of organic matter took 75 days. Also, observing from 313 people in a cluster on the pilot project, the annually recovered value of N, P and K was found to be 1565 kg, 125 kg, 344 kg, respectively. This paper deals with the different types of dry ecological toilet, their performance and feasibility study in Nepal, with the full involvement of local people, based on complete laboratory analysis and regular monitoring. Using dry toilets will save 14 LPCD, which is equivalent to 14 MLD and the resulting demand will become only 80 MLD for the urban area of Kathmandu. The result advocates the implementation of ecological dry toilets to save valuable water wasted in flushing, as well as saving the resources needed to treat the waste.

Self-concepts of mountain children of Nepal.

The authors explored the basis of the self-concepts of young children from impoverished villages high in the mountains of Nepal by having them respond to the How I See Myself questionnaire (A. Juhasz, 1985). The participants were 101 children, 7 to 14 years old, from the Sherpa and Tamang ethnic groups. The results provide evidence for questioning the appropriateness of the content of Western self-esteem instruments for such children. The authors argue that items about satisfying basic physical needs may be most appropriate for assessing the self-esteem of such children.

The effect of height and weight adjusted dose of intrathecal hyperbaric bupivacaine for elective caesarean section.

INTRODUCTION: The study compared spinal anesthesia using intrathecal hyperbaric bupivacaine between height and weight adjusted dose and fixed dose during caesarean section. METHODS: A hundred parturients, who had given their consent and were scheduled for elective caesarean section under spinal anesthesia, were randomly assigned into two groups. We adjusted the intrathecal dose of heavy bupivacaine (0.5%) according to the height and weight of patients (Group AD) from Harten's dose chart developed from the Caucasian parturients and the fixed dose (2.2 ml) was used in Group FD patients. Keeping the observer blinded to the study groups, the onset time to sensory block up to T5, haemodynamic changes, side effects, and fetal outcome were observed. RESULTS: The median onset time of spinal block in Group FD was faster than in Group AD (6 min vs. 4 min; p = 0.01). The spinal block level extended above T3 level in a significantly (p < 0.05) larger number of patients 12 (24%) in Group FD than in one (2%) patient in Group AD. A significantly (p < 0.05) larger number of patients, 32, (64%) in Group FD had hypotension than in 15 (30%) patients in Group AD. The lowest recorded SAP (101 +/- 6 mm Hg) in Group AD was higher than in Group FD (96 +/- 6.7 mm Hg). Nausea and vomiting were more pronounced in Group FD patients. CONCLUSIONS: The bupivacaine dose was significantly reduced on its dose adjustment for the body weight and height of patients for cesearean section. This adjusted-dose use suitably restricted spinal block level for cesarean section with a distinct advantage of less hypotension and with a similar neonatal outcome as fixed compared with the dose use.

Unsafe abortion: a tragic saga of maternal suffering.

INTRODUCTION: Unsafe abortion is a significant cause of maternal morbidity and mortality in developing countries despite provision of adequate care and legalization of abortion. The aim of this study was to find out the contribution of unsafe abortion in maternal mortality and its other consequences. METHODS: A retrospective study was carried out in the Department of Obstetrics and Gynecology in BPKIHS between 2005 April to 2008 September analyzing all the unsafe abortion related admissions. RESULTS: There were 70 unsafe abortion patients. Majority of them (52.8%) were of high grade. Most of them recovered but there were total 8 maternal deaths. CONCLUSIONS: Unsafe abortion is still a significant medical and social problem even in post legalization era of this country.

Loading dose versus standard regimen of magnesium sulphate in eclampsia--a randomized trial.

Eclampsia is one of the leading causes of maternal mortality and morbidity around the world. Magnesium sulphate is used as primary agent in the treatment of seizure in eclampsia. Its dosage and frequent painful injection makes it a difficult drug for the patient. This study was carried out in one of the biggest referral centre of Nepal to study the suitability of different dosage schedule for our patient. A randomized controlled trial was carried out in the Obstetric Unit of BP Koirala Institute of Health Science (BPKIHS) over the span of 1.5 years. A total of 80 eclamptic women were randomized to receive either standard Pritchard Regimen (loading and maintenance) or Loading dose of magnesium sulphate. Both groups were evaluated for recurrence of seizures and outcomes. There were no recurrent seizures in standard regimen group. There were 2 patients with recurrent seizure in loading dose group. (p=0.184) Loading dose of magnesium sulphate is a good alternative for standard Pritchard regimen. It avoids multiple painful injections of magnesium Sulphate.

Vesicovaginal fistula at tertiary care center in eastern Nepal.

Vesicovaginal fistula is physically, socially and psychologically devastating to the women who suffer from it. The aim of this study is to create some awareness about VVF, to describe the profile of the patients, etiology, and success rate of surgery in our institute. A retrospective analysis of a total of 23 cases of vesicovaginal fistula admitted to the Department of Gynecology and Obstetrics, BPKIHS over a period of three years were included in the study. The cause of VVF in all was obstructed labor except in one, which followed abdominal hysterectomy. Twenty-three subjects underwent VVF repair, of which 14 (56.5%) had successful outcome.