Bedside lung ultrasound for the diagnosis of pneumonia in children presenting to an emergency department in a resource-limited setting.

BACKGROUND: Lung ultrasound (LUS) is an effective tool for diagnosing pneumonia; however, this has not been well studied in resource-limited settings where pneumonia is the leading cause of death in children under 5 years of age. OBJECTIVE: The objective of this study was to evaluate the diagnostic accuracy of bedside LUS for diagnosis of pneumonia in children presenting to an emergency department (ED) in a resource-limited setting. METHODS: This was a prospective cross-sectional study of children presenting to an ED with respiratory complaints conducted in Nepal. We included all children under 5 years of age with cough, fever, or difficulty breathing who received a chest radiograph. A bedside LUS was performed and interpreted by the treating clinician on all children prior to chest radiograph. The criterion standard was radiographic pneumonia, diagnosed by a panel of radiologists using the Chest Radiography in Epidemiological Studies methodology. The primary outcome was sensitivity and specificity of LUS for the diagnosis of pneumonia. All LUS images were later reviewed and interpreted by a blinded expert sonographer. RESULTS: Three hundred and sixty-six children were enrolled in the study. The median age was 16.5 months (IQR 22) and 57.3% were male. Eighty-four patients (23%) were diagnosed with pneumonia by chest X-ray. Sensitivity, specificity, positive and negative likelihood ratios for clinician's LUS interpretation was 89.3% (95% CI 81-95), 86.1% (95%CI 82-90), 6.4, and 0.12 respectively. LUS demonstrated good diagnostic accuracy for pneumonia with an area under the curve of 0.88 (95% CI 0.83-0.92). Interrater agreement between clinician and expert ultrasound interpretation was excellent (k = 0.85). CONCLUSION: Bedside LUS when used by ED clinicians had good accuracy for diagnosis of pneumonia in children in a resource-limited setting.

Cholesterol Gallstone among Patients with Cholelithiasis Admitted to the Department of Surgery of a Tertiary Care Center.

Introduction: Gallstone is one of the most common pathological conditions found mostly in females. The incidence of cholesterol gallstones is developing higher nowadays which is increasing the burden of cost in society. This study aimed to find out the prevalence of cholesterol gallstones among patients with cholelithiasis admitted to the Department of Surgery of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients with cholelithiasis who presented in the Department of Surgery of tertiary care centre for cholecystectomy (laparoscopic or open) from 23 December 2022 to 22 September 2023 after obtaining ethical approval from the Institutional Review Committee. Patients who were diagnosed by use of abdominal ultrasound or CT scan were included. Those patients with gallbladder polyps, cholangitis, and gallbladder tumours were excluded from the study. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 190 patients, the prevalence of cholesterol gallstones was seen in 85 (44.74%) (37.67-51.81, 95% Confidence Interval). The female to male ratio was 6.72:1. Conclusions: The prevalence of cholesterol gallstones was found to be higher as compared to other studies done in similar settings. Keywords: cholesterol; gallbladder; gallstone; prevalence.

Factors associated with meat hygiene-practices among meat-handlers in Metropolitan City of Kathmandu, Nepal.

Meat hygiene refers to all conditions and measures necessary to ensure safety and suitability of meat at all stages of the food chain. Inadequate hygiene practices allow consumers to be exposed to pathogens causing public health problems. Inadequate facilities and hygiene practices in meat shops results in meat contamination. The study aimed to identify factors associated with meat hygiene practices among meat handlers in the Metropolitan City of Kathmandu, Nepal. A cross-sectional study was designed with a semi-structured questionnaire and observation checklist that collected information about hygiene practices from 320 consenting meat-handlers by interviewer-administered technique. Data was entered in EpiData and analyzed using IBM SPSS version 21. Descriptive statistics of frequency distribution were used to report meat hygiene-practices and other independent variables, with multivariate logistic regression to establish predictors of meat hygiene-practices at 5% level of significance. The study revealed that less than half (44.4%) of the meat handlers had satisfactory meat hygiene practices. The adjusted regression analysis showed, strong evidence (p<0.01) of association of higher education level (AOR = 2.8, 95% CI = 1.7-4.5), other occupational involvement (AOR = 2.2, 95% CI = 1.9-2.4), and being officially registered (AOR = 2.8, 95% CI = 1.2-6.8) with meat hygiene practices. However, there was fair evidence (p<0.05) of association between shorter duration of meat being processed to sale (AOR = 0.57, P = 0.042) and meat hygiene practices. In this study, the satisfactory meat hygiene practices of meat handlers was low. The educational level, registration status of shops, involvement in other jobs, and awareness on meat hygiene were identified as key factors associated with meat hygiene practices. Thus, these factors need to be considered while developing programs to improve meat hygiene practices among the meat handlers. Meat handlers should be provided with training and orientation program for improving the meat hygiene practices.

Acute Mycophenolate Mofetil Overdose Managed Conservatively.

Mycophenolate mofetil (MMF) is an immunosuppressant drug widely used in post-transplant patients and the treatment of various inflammatory conditions. It is considered a relatively safe drug with minimal adverse effects. We managed an acute overdose of 19 grams (g) of MMF with a suicidal intention in a 17-year-old female with no significant past medical history. Apart from episodes of mild headaches, she did not develop other symptoms, laboratory abnormalities, or complications.

Prospective evaluation of World Health Organization guidelines for diagnosis of pneumonia in children presenting to an emergency department in a resource-limited setting.

BACKGROUND: Clinicians in resource-limited settings commonly use the World Health Organization criteria to diagnose pneumonia in children. AIM: The aim of this study was to prospectively evaluate the diagnostic accuracy of the WHO criteria compared with chest radiograph for the diagnosis of pneumonia in children under 5 years of age presenting to an emergency department (ED) in Nepal. METHODS: A prospective cross-sectional study of children presenting to an ED with respiratory complaints in Nepal was conducted. It included all children under 5 years of age with cough or difficulty breathing who received a chest radiograph. Paediatric pneumonia was diagnosed according to WHO criteria when a child presented with a cough or difficulty breathing and met the age-related WHO-defined respiratory rate for tachypnoea. The criterion standard was radiographic pneumonia. The primary outcome was the sensitivity and specificity of the WHO criteria for diagnosis of pneumonia. RESULTS: Of 324 patients enrolled, 72 had radiographic pneumonia. The median (IQR) age was 17 (23) months. Overall, WHO criteria had a sensitivity of 71% (95% CI 59-81) and specificity of 57% (95% CI 50-63). Respiratory rate had poor diagnostic accuracy for pneumonia with an area under the curve of 0.65. CONCLUSION: The WHO criteria had poor sensitivity and specificity for the diagnosis of pneumonia in children presenting to the ED in a resource-limited setting.

Guiding Documents for Disaster Risk Reduction and Management in Health Care System of Nepal.

The incidence of disaster events has increased over the years. Nepal is vulnerable to various kinds of natural disasters especially earthquakes and floods and infectious disease outbreaks like Dengue and Covid-19 pneumonia. So, it is important to review and know our existing disaster risk reduction and management plans, rules, and regulations of our country to improve disaster risk management for resilience and enhancing disaster preparedness for effective response and to â€Å“Build Back Better: in recovery rehabilitation and reconstruction.†Nepal has sufficient guiding documents to guide disaster management. Keywords: disaster;Nepal;preparedness.

Influence of internal migration on the use of reproductive and maternal health services in Nepal: An analysis of the Nepal Demographic and Health Survey 2016.

BACKGROUND: Internal migration has been an integral part of socioeconomic transformation in a country. Migrants are a vulnerable group for access to the reproductive and maternal health services. Very little is known regarding the role of internal migration on the use of reproductive and maternal health services in Nepal. This study examines the effect of internal migration on the use of reproductive and maternal health services in Nepal. METHODS: The data for this study were extracted from the 2016 Nepal Demographic and Health Survey (2016 NDHS). The study population is women age 15-49. The sample population is different for modern contraceptive use than for Antenatal care (ANC) visits and place of delivery. The sample population for modern contraceptive use is restricted to the 8,811 (weighted) women who are currently married. The total analytic sampled population for ANC visits and place of delivery is 3,220 (weighted) women. The study used descriptive and logistic regression analysis, with three outcome measures: current use of modern contraception; at least four ANC visits; and place of delivery. RESULTS: Sixty-eight percent women were internal migrants. Forty-four percent of eligible women reported current use of modern contraception, 71% of women made at least four ANC visits, about 9% of women made 8 or more ANC visits and 58% of women delivered in a health facility. Our findings show that modern contraceptive use is significantly higher among urban non-migrant women and urban-to-urban migrants. Urban-to-urban migrant women and rural-to-urban migrant women have significantly higher odds of attending at least four ANC visits for the most recent birth compared with rural-to-rural migrant women. Women who moved between urban areas, women who moved from an urban to a rural area, women who moved from a rural area to an urban area and urban non-migrants are significantly more likely to deliver in a health facility compared with women who moved between rural areas. CONCLUSION: The differentials of use of reproductive and maternal health services by migration status may need consideration during program planning to improve women's reproductive and maternal health services in Nepal.

Efficacy of Use of Triamcinolone Ointment for Clean Intermittent Self Catheterization following Internal Urethrotomy.

INTRODUCTION: Internal urethrotomy is recommended for the treatment of urethral strictures shorter than 1.5 cm but has been associated with high recurrence rates. The aim of this study was to evaluate the efficacy of use of triamcinolone ointment for clean intermittent self catheterization in the prevention of urethral stricture recurrence after internal urethrotomy. METHODS: Total of 60 male patients undergoing internal urethrotomy were assigned into two groups and clean intermittent self catheterization was performed using either triamcinolone ointment or a water-based gel for lubrication of the catheter in this randomized clinical trial. Clean intermittent self catheterization regimen was continued for 6 months and patients were followed for 12 months. Urethrocystoscopic evaluation was done 6 and 12 months postoperatively. RESULTS: The recurrence rates were compared between the two groups. There were no significant differences in patient characteristics and etiology of the stricture between the two groups. There was a 6 (22.22%) recurrence rate in the patients of the triamcinolone group against 13 (46.42%) in those of the control group after the first internal urethrotomy (P=0.04). After second internal urethrotomy, the urethra was stabilized in 5 (83.3%) of the patients in the triamcinolone group and 8 (61.5%) those in the control group (P=0.05). We also found a significant correlation between recurrence and stricture length (P=0.02) but the time to recurrence was not statistically significant (P=0.16). CONCLUSIONS: The use of triamcinolone ointment in patients on CISC regimen after internal urethrotomy significantly decreased the stricture recurrence rate.

Treatment of bifurcation lesions using dedicated bifurcation stents versus classic bare-metal stents. Randomized, controlled trial with 12-month angiographic follow up.

BACKGROUND: The aim of this study was to compare the use of classic bare- metal stents with dedicated bifurcation bare-metal stents in patients who were not eligible for drug-eluting stents (DES) implantation. METHODS: Sixty patients with bifurcation stenosis were randomly assigned to received either a dedicated bifurcation or a bare-metal stent (n = 30) or classic bare-metal stent (n = 30) with stenting of the parent vessel and angioplasty/or provisional stenting of the side branch. Fifty-nine patients underwent 12-month clinical and angiographic follow up unless this was performed earlier due to symptoms. Dual antiplatelet treatment was administered for 1 month. Acute success as well as the long-term clinical and angiographic outcome have been assessed in both groups. RESULTS: Baseline demographic, angiographic and procedure-related characteristics were well balanced in both groups. The use of dedicated stents was associated either with reduced procedure or fluoroscopy time (34 +/- 9 minutes vs. 46 +/- 20 minutes; p = 0.004 and 9 +/- 6 minutes vs. 15 +/- 9 minutes; p = 0.003, respectively) and lesser contrast volume (168 +/- 86 milliliters vs. 199 +/- 103 ml; p = 0.02). At the 12-month follow up, no statistically significant difference was found between both groups regarding major adverse cardiovascular events (MACE) (13.7 vs. 13.3%; p = 0.9). CONCLUSIONS: In our study we failed to demonstrate the superiority of a dedicated stent versus classic a bare-metal stent for the treatment of bifurcation lesions regarding MACE in patients who were not eligible for DES implantation. However, the use of dedicated stents may be preferable due to reduced procedure and fluoroscopy time and lesser contrast volume.