Academic Stress among Adolescents of Rural Nepal: A Community-based Cross-Sectional Study.

BACKGROUND: Adolescents are in the transition phase between childhood and adulthood. Their mental health influences many aspects in their life as they go through many physical and emotional changes. Adolescent mental health is harmed by changes in emotional and physical state, as well as increased academic pressure. This study aimed to assess academic stress and its associated factors among adolescents in rural Nepal. METHODS: A community-based cross-sectional survey was conducted among 424 adolescents residing in Karnali Province, Nepal. Academic stress was measured using Student Assessing Academic Stress. Multivariate logistic regression analysis was used to examine associated factors at the significance level of 0.05. RESULTS: Of the total students, 19.8% had moderate academic stress and 2.4% of them had high academic stress. Female students had thrice higher odds of having academic stress as compared to male students (Adjusted Odds Ratio:3.47; 95% Confidence Interval:1.91to 6.31, p-value:<0.001). Grade 10 students had higher odds of having academic stress as compared to grade 9 (Adjusted Odds Ratio:2.02; 95% Confidence Interval:1.13 to 3.61, p-value:0.017). Students of literate mothers were more likely to experience academic stress than those with illiterate mothers (Adjusted Odds Ratio:0.53; 95% Confidence Interval:0.29 to 0.96, p-value:0.036). Students with unsatisfactory academic performance had thrice higher odds of having academic stress as compared to students with satisfactory academic performance (Adjusted Odds Ratio:3.12; 95% Confidence Interval:1.46 to 6.67, p-value:<0.003). CONCLUSIONS: The findings of the study showed that high school students have academic stress, which is related to many factors at home and school. Understanding academic stress and parents and teachers providing the best support to the students could help lessen the burden.

Liver injury in COVID-19: prevalence and its associated factors in Nepal - A retrospective cross-sectional study.

Liver impairment has been reported as a common clinical manifestation in patients with Severe Acute Respiratory Syndrome Coronavirus 2 infection, with varying degrees of severity ranging from a mild elevation of liver enzymes to acute liver failure. However, the prevalence and clinical significance of liver injury in Coronavirus Disease 2019 (COVID-19) patients, particularly in low- and middle-income countries such as Nepal, remains poorly understood. To investigate the hepatic injury related to this disease and its clinical significance, the authors conducted a retrospective study that included adult patients with COVID-19 infection in security hospitals of Nepal. Methodology: The authors performed a retrospective chart review on 1007 COVID-19-positive patients who underwent a liver function test during their admission in two COVID-19 dedicated hospitals in Nepal from April 2021 to January 2022. The data were collected and entered into Microsoft Excel before being exported to SPSS version 24 for analysis. Univariate and multivariate logistic regression were used to determine factors associated with liver injury. We reported adjusted odds ratios (aOR) with 95% CI. Results: Of the total, 549 (54.5%) patients had an acute liver injury. Among 549 patients, 68.1% were mild, 27.9% were moderate, and 5.0% were severe. Out of 1007 patients, 1.4% had cholestatic liver injury. Most patients with mild, moderate, and severe liver injury had greater than or equal to 10 C-reactive proteins (CRP). In multivariate logistic regression, sex, and CRP were significantly associated with the presence of liver injury. Males had 1.78 times higher odds of having a liver injury compared to females (aOR:1.78; 95% CI: 1.37-2.30, P-value:<0.001). Similarly, patients who had CRP greater than 10 had higher odds of having liver injury compared to those who had CRP less than 10 (aOR: 1.84; 95% CI: 1.41-2.39; P-value: <0.001). Conclusions: The present study reveals that COVID-19 infection is commonly associated with mild increased liver enzymes. However, the likelihood of developing acute liver injury was found to be higher in patients with an inflammatory state indicated by CRP levels greater than 10. Furthermore, the study highlights the sex-based difference in the prevalence of liver injury, with males demonstrating a higher predisposition.

Prevalence and factors associated with depression, anxiety, and stress symptoms among home isolated COVID-19 patients in Western Nepal.

Introduction: Globally, COVID-19 pandemic has a significant impact on mental health. In Nepal, COVID-19 positive cases have to self-isolate at home in multi-generational and multi-family households. This could be strongly associated with depression, anxiety, and stress-related health outcomes. Additionally, COVID-19 related stigma and fear of transmission may intensify depression, anxiety, and stress symptoms. This study determined the prevalence of depression, anxiety, and stress symptoms and their association with presence of COVID-19 symptoms and comorbid conditions among home isolated COVID-19 positives in the Karnali province, Nepal. Methods: We conducted a cross-sectional study to assess depression, anxiety, and stress symptoms among 402 home isolated COVID-19 patients of Karnali province from January to May 2021 using "Depression, Anxiety and Stress Scale-21 (DASS-21)". We interviewed patients to collect socio-demographic, DASS-21, COVID-19 symptoms, comorbid conditions, and self-treatment. We conducted a telephonic interview using a standardized questionnaire using Kobotoolbox. We calculated the prevalence of depression, anxiety, and stress symptoms. We utilized univariate and multivariate logistic regression to determine their association with the presence of COVID-19 symptoms and comorbid conditions. In multivariate logistic regression, we adjusted sociodemographic factors (age, gender, ethnicity, marital status, monthly family income, education level), smoking status and history of self-treatment. We reported adjusted odds ratios (aOR) with 95% confidence intervals. All analyses were conducted in R (version: 4.0.3). Results: The prevalence of depression, anxiety and stress symptoms among home isolated COVID-19 patients were 8.0% (95% CI: 5.5 to 11.1), 11.2% (95% CI: 8.3 to 14.7), and 4.0% (95% CI: 2.3 to 6.4) respectively. Higher odds of depression symptoms (aOR: 2.86; 95% CI: 1.10-7.44, p = 0.03), anxiety symptoms (aOR: 3.81; 95% CI: 1.62 to 8.93; p = <0.01) and stress symptoms (aOR: 7.78; 95% CI: 1.43 to 42.28; p = 0.02) were associated significantly with presence of COVID-19 symptoms in past week. Higher odds of anxiety symptoms were associated with the presence of comorbid conditions (aOR = 2.92; 95% CI: 1.09 to 7.80; p = 0.03). Conclusion: Depression, anxiety, and stress symptoms were present in a significant proportion of home isolated COVID-19 patients in western Nepal and positively associated with the presence of COVID-19 symptoms. In this global COVID-19 pandemic, it is important to provide timely counseling to high-risk groups like those with comorbidities and COVID-19 symptoms to maintain a high level of mental health among home isolated COVID-19 patients.

Impact of yoga and physical exercise on psychological wellbeing among substance abusers: a randomized controlled trial.

OBJECTIVES: Substance use disorder is a pattern of recurrent use of illicit substances that leads to severe psychosocial imbalance and recurrent relapse. The study was to evaluate the efficacy of a yoga-based intervention as an add-on in enhancing psychological wellbeing, compared with physical exercise among substance abusers. METHODS: In this randomized controlled study, 96 male participants with substance use disorder from a residential rehabilitation treatment center, Kathmandu, Nepal, were randomly allocated into two groups namely the yoga group (n=48, mean age ± SD=25.18 ± 6.43) and the physical exercise group (n=48, mean age ± SD=25.02 ± 5.02). The participants in the yoga group attended the 90 min yoga sessions for 12 weeks (six days per week) whereas the physical exercise group attended exercise sessions for the same duration. Above mentioned interventions were in addition to standard rehabilitation treatment. The study measured the Self-Control, Anxiety, Depression, Sleep parameters, and Mindfulness at the baseline and after 12 weeks of intervention. RESULTS: A significant enhancement in self-control was observed in both the yoga (p<0.033, d=0.33) and the exercise group (p<0.038, d=0.32). Yoga group showed significant improvement in mindfulness score (p<0.017, d=0.37), whereas exercise group did not show any significant changes in mindfulness (p<0.169, d=0.21). The depression and anxiety scores reduced significantly in both yoga (p<0.044, d=0.31; p<0.025, d=0.35 resp.) and exercise (p<0.032, d=0.34. p<0.039, d=0.32. resp.) group. Furthermore, significant reduction was seen in sleep disturbance after yoga (p<0.001, d=0.52) and exercise (p<0.001, d=0.78) intervention. The sleep - somnolence score reduced significantly only in yoga group (p<0.020, d=0.36). The magnitude of improvement was higher in the yoga group than physical exercise group on self-control, mindfulness, depression, anxiety and some sleep parameters, however the between group differences could not reach to the level of significance. CONCLUSIONS: The 12 week yoga intervention did not appear to be significantly more effective than the 12 week physical exercise program on psychological wellbeing in male participants with substance use disorder. However, greater improvement in psychological wellbeing was observed within the yoga group. In future, a multi-centric study with robust design, larger sample size and longer follow-up is required to conform the present results and to find out the difference between the impacts of yoga and physical exercise on psychological wellbeing in substance abusers.

The Impact of Basic Police Training and Scale Diet on Body Composition and Aerobic Performance of Nepal Police Officers Trainees.

INTRODUCTION: Executing their daily duties, police officers are expected to perform complex, physically demanding activities, often at maximal levels of exertion. Given these criteria, training must be rigorous enough to ensure that when trainees graduate, they are competent in their response to crisis and flexible enough to sustain this for the span of their career. The present study aimed to determine the impact of scale diet and physical training (SDPT) on body composition and aerobic performance among Nepal police officer trainees. METHOD: We conducted a cross-sectional analytic study among 570 Nepal Police recruits from Nepal Police Academy of Butwal and Kathmandu. Null hypothesis was created followed by an alternative hypothesis. Alpha (1 - ?) for the above-mentioned study design were set. Parametric statistical analysis was done with criteria set for acceptance or rejection of the null hypothesis. We collected the data from the field as per Nepal police basic exercise and diet  protocol to determine the effect of physical training and scale diet on body composition and aerobic performance. We enrolled all the recruits  from March to May, 2019 who met the eligibility criteria in the study. We used Microsoft Excel 2013 for data entry and R program (version: 4.0.3) for statistical analysis.  Results:There was a significant rise in aerobic performance (4.51 ± 3.39 ml/kg/min) and remarkable reduction in body fat (-4.49 ± 2.33 %) and Body Mass Index (-0.433 ± 1.00 kg/m2) after SDPT among participants with normal BMI at the time of recruitment. Body fat was significantly reduced (-4.36 ± 2.3%) and aerobic performance was significantly increased (6.93±4.70 ml/kg/min) among overweight participants at the time of recruitment. CONCLUSIONS: The methodology adopted in the physical training of Nepal Police was effective in reducing body mass index and fat, improving the physical capacity. .   Key words: Scale Diet; Physical Training, Body Fat; Aerobic Performance; VO2max, Body Mass Index.

COVID Stress among Nepal Police Officers.

BACKGROUND: In Nepal, the stress factor is exacerbated by a large number of police officers working away from home with less family contact, a hectic work schedule in a pandemic situation, companions suffering from illness and updates on additional cases with rising mortality rates, and a lack of access to Personal Protection Equipment. The main aim of this study was to identify the prevalence of COVID stress among Nepal police officers working during pandemic. METHODS: We conducted a cross-sectional study among police officers (n=1526) working during pandemic in Province X Nepal. Semi-structured questionnaire was administered using google form. COVID Stress Scale -36 (CSS-36) was used to assess the stress in officers. Data collection was done after obtaining ethical approval. Data cleaning was done using a python script and then was exported to Ms. Excel for graph analysis. RESULTS: The highest percentage was seen in the xenophobia subscale (24.63%), followed by contamination (20.10 %) and compulsive checking (19.21%). Comparing socio-demographic variables, 18-27 aged groups including male officers and unmarried groups had experienced high COVID stress. CONCLUSIONS: Most of the officers feared from the foreigners perceiving them the main source of COVID-19. Fears about getting contaminated related to COVID-19 was also seen high. There is a need to assess psychological issues and provide social support to police officers during this pandemic situation.

Suspicious Case of a Body packer "Mule" in a Low Resource Country: A Case Report.

Body packing is the process of smuggling illicit drugs in the form of packages concealed within the gastrointestinal tract via ingestion or inserting into body orifices. These individuals are described as "body packers", "stuffers", "mules" or "swallowers" and resort to carrying drugs like heroin, cocaine and cannabis. They present to the hospital following the development of complications or brought dead due to the rupture of packets or directly from detention for further investigations. This case illustrates a suspected case detained from the airport who was found to be carrying 93 pellets of an illicit drug, heroin, weighing 900 grams, one of the highest quantity carried by any body packer in the country till date. This case further sheds light on the fact that a meticulous history, detailed clinical examination and radiographic investigations like abdominal radiograph and imaging are the keys to diagnose body packers in a resource limited setting.

Prevalence of Type 2 Diabetes among Patients Visiting Nepal Police Hospital in Kathmandu: A Descriptive Cross-sectional Study.

INTRODUCTION: The growing prevalence of diabetes mellitus (DM) is a critical threat for global health, including in Nepal, especially in Kathmandu District, where diabetic patients are increasing in hospitals catastrophically. This study tends to assess the prevalence rate of type 2 diabetes among admitted patients visiting a hospital in Kathmandu. METHODS: An electronic chart review was done to assess the prevalence of type 2 diabetes in Nepal Police hospital, Kathmandu, Nepal. Ethical approval was taken from the Nepal Health Research Council. Considering eligibility criteria, 8631 cases from 4 May 2018 to 31 August 2020 were observed. The calculated sample size was 500. However, all diabetic cases, i.e., 576, were processed and analyzed using Python and later visualized using MS Excel. RESULTS: The overall prevalence rate of type 2 diabetes was 6.67%. The prevalence rate was seen higher among males (7.5%). Similarly, a high prevalence rate was seen among 64-73 years, i.e., 15.10%. CONCLUSIONS: The findings showed a high prevalence rate of type 2 diabetes. Older age groups are at high risk. Urgent public health interventions including lifestyle modification measures are required to reduce the extra burden of type 2 diabetes.

Child Sexual Abuse among School Children of a Municipality: A Descriptive Cross-sectional Study.

INTRODUCTION: Sexual abuse remains a hidden and underreported form of violence against children and a serious public health concern. Although it results in severe mental, physical, and psychological risks with consequences such as depression, fear, and low self-esteem, it is still an unexplored and less prioritized area in Nepal. The objective of this study was to determine the prevalence of Child Sexual Abuse among school children of a municipality. METHODS: This was a descriptive cross-sectional study, conducted among 405 students, aged below 18 of Mandan-Deupur Municipality, Kavrepalanchowk from April to May 2018. Ethical clearance was taken from Nepal Health Research Council (Ref no 2506). A simple random sampling technique was used to select the schools. Collected data were then entered and analyzed using Statistical Package for Social Sciences version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage. RESULTS: In overall, 64 (15.8%) (12.4-19.7 at 95% Confidence Interval) were found to be sexually abused, where a high prevalence of Child Sexual Abuse was reported for boys 46 (73.43%). CONCLUSIONS: According to the findings of this study, child sexual abuse is seen as a significant issue in the place studied. Awareness programs on child sexual abuse should be organized targeting children along with parents and community people.

Pretilachlor poisoning: A rare case of a herbicide masquerading as organophosphate toxicity.

Acute oral intoxication of pretilachlor, a chloroacetanilide herbicide, in humans can present with similar clinical manifestations of organophosphate toxicity. Clinicians should be aware of such mimickers for proper management of the patient.

Multiple Organ Dysfunction and Acute Pancreatitis Following Wasp Stings.

Wasp stings are common in our part of the world and may cause complications ranging from mild local reactions to fatal anaphylaxis. Severe cases may present with multisystem involvement causing acute kidney injury, hepatic dysfunction, clotting abnormalities, rhabdomyolysis or even death. However, cases with acute pancreatitis as a complication of wasp sting is not usual and have been very rarely reported. We present a case of a fifty-two-year-old lady with the history of multiple wasp stings followed by multiple organ dysfunction and acute pancreatitis with complete recovery following immediate conservative measures. Keywords: Acute kidney injury; multiple organ dysfunction; pancreatitis; wasp; sting.

Safe Abortion among Underprivileged Group Married Women of Low Resource Country: A Descriptive Cross-sectional Study.

INTRODUCTION: Unsafe Abortion is one of the leading causes of maternal death. The unhygienic and dangerous practice has been encountered in various geographical areas of Nepal. Despite its legalization, many women are still being not concerned and well informed regarding safe abortion and become victims of it. The main aim of this study was to assess the knowledge and practice regarding safe abortion among married women of reproductive (14 to 49) years of an underprivileged group of low resource country, Nepal. METHODS: A descriptive cross-sectional study design was done in Rajbanshi community of Jhapa District. Data collection was done after taking ethical approval. Study population was selected conveniently. Data was collected by using a semi-structured questionnaire via face to face interviews among 420 married women of reproductive (14-49) years. All the extracted data were entered and analyzed using Statistical Package for the Social Services version 20. Descriptive analysis was doneand presented using frequency and percentage. RESULTS: Out of 420 respondents, 388 respondents (92.4%) found to have poor knowledge, regarding safe abortion. Likewise, only 44 respondents (10.05%) had practiced abortion, of which only 2 respondents (0.05%) had an unsafe abortion and 42 respondents (10%) had practiced safe abortion. CONCLUSIONS: Practices of unsafe abortion were prevalent. Respondents with poor knowledge werefound to have done abortion. In this context, it can be concluded that knowledge regarding safe abortion can be increased by educating and providing awareness to the people of society.

Prevalence of Overweight Among Adult Women of A Metropolitan.

INTRODUCTION: Globally, Overweight has reached epidemic proportions. It is an excessive accumulation of fat that may impair health. Overweight and obesity area major contributor to the global burden of non-communicable disease. The prevalence of overweight is commonly assessed by using Body Mass Index (BMI), where overweight is indicated by BMI greater or equal to 25. Overall, about 13% of the world's adult population was obese in 2016, among them women were more affected than men. Overall,female population is higher than male in Nepal and concentrating on Kaski district female population are significantly more than that of male as per population census of 2011. The objective of this study was to find out the prevalence of overweight among adult women. METHODS: This was a cross-sectional descriptive study, conducted among calculated sample size of 185 adult women of Lekhnath Metropolitian of Kaski district, over six months' period. Sampling technique was proportionate random sampling. Ethical approval was taken from Institutional Review Board (Ref no. 40/74/75). Anthropometric measurement was taken to calculate BMI. Collected data was entered in Epi data, which was then exported to SPSS version 20 for further analysis. Descriptive statistics was reported for demographic, socio-economic and various overweight related factors of the respondents as frequencies and percentage. RESULTS: Out of 185 adult women, 69 (37.3%) of them were overweight, 30 (16.2%) of them were obese, and central obesity was seen among 97 (52.4%) women at 95% C.I. CONCLUSIONS: The finding of this study shows prevalence of overweight and obesity was high. Regular Physical exercise and balanced diet should be followed to prevent overweight and noncommunicable diseases.

Patient Satisfaction in Out-patient Services at a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: Patient satisfaction is an important and commonly used valid indicator for the measurement of service quality. Patient responses to healthcare services are one of the best ways to obtain information about patient views regarding the quality of healthcare. The main aim of the study was to find out the patient's satisfaction level in the tertiary care center. METHODS: A descriptive cross-sectional study was conducted among 94 outpatients at a tertiary care center. Data were collected after obtaining ethical clearance from the institutional review committee. Patients were selected conveniently who visited any four of the major department. We collected demographic data and the patient satisfaction towards outpatient clinic experience was studied. We used the Patient Satisfaction Questionnaire-18 to assess patient satisfaction. Data were entered and analyzed in Statistical Package for the Social Sciences version 23. The mean score and the standard deviation were calculated. RESULTS: Overall satisfaction was 74.78% with a mean value of 3.7394±0.40128. The highest satisfaction score was found in regards to the interpersonal manner of health personnel (4.2872±0.61561) followed by communication (3.9628±0.40982) and the lowest was seen in accessibility and convenience (3.2394±0.81478). CONCLUSIONS: The mean score and percentage of patient satisfaction were high in the hospital. However, the accessibility and availability of medical personnel were only a matter of concern.

Amitraz Poisoning - Tale of an Unusual Pesticide Poisoning: A Case Report.

Amitraz is a formamidine group of compounds used in many parts of the world as an agricultural pesticide and an ectoparasiticide. Amitraz intoxication secondary to the oral, dermal or inhalational routes, both accidental and suicidal, has been encountered in humans leading to severe life-threatening side effects. Only very few cases of amitraz toxicity have been reported to date. This emphasizes the importance to ascertain amitraz intoxication from more commonly encountered pesticides like organophosphorus poisoning to avoid erroneous management of the patient. We report a case of a twenty-seven-year-old man who presented to the emergency room following suicidal ingestion of amitraz with the clinical manifestations of vomiting, altered sensorium, bradycardia and hypotension and complete recovery following supportive management.

Probable Exit Strategy Against COVID-19 of Low Resource Country like Nepal: Open Floor Discussion.

Lockdown is essential for containing the spread of SARS-CoV-2. It is the best measure to maintain extreme social distancing which has been effective in controlling the infection and saving lives. But they are causing huge loss economically, disrupting social life and causing distress around the world. Reopening too quickly or too boldly without a goal-oriented strategy could mean a second wave of infection as fierce or even worse as the first. The fundamentals of the virus remain the same - one infected person will, without a lockdown pass it onto three others on average. The consequences of lifting the lockdown are unforeseeable and the stakes are high. Due to the different spectrum of severity with same strain of virus and uncertainty of post lockdown era, lifting the lockdown will be a trial and error approach. Nevertheless, at some point the lockdown has to be lifted. The strategic approach would be innumerable testing, investigations, strong contact tracing, isolation and follow-up. In a low-income country like Nepal, this will mean negotiating a tricky balance between terminating the spread of SARS-CoV-2, and allowing people to recover their livelihoods before they slip into extreme poverty and anguish.

Air Medical Evacuation of Nepalese Citizen During Epidemic of COVID-19 from Wuhan to Nepal.

In December 2019, the world was disrupted by the news of a new strain of virus known as Novel Corona virus, taking lives of many in China. Wuhan, the capital of Central China's Hubei province is said to be the place where the outbreak started. The city went on a lockdown as the disease spread rapidly. After the lockdown, most countries like India and Bangladesh airlifted their citizens who were studying in Wuhan. Similarly, Nepal also has many youth studying medicine in Wuhan. Pleas for help from the students reached the government. This was a first encounter of such experience for Nepal government. With the help of Health Emergency Organizing committee, Epidemiology and Disease Control Division, Nepal Army Hospital, Nepal Police Hospital, Waste Management team, Nepal Ambulance service, Tribhuwan Airport and Royal Airlines the government of Nepal planned, organized and successfully brought back all the 175 students on 15 the February, 2019 from Wuhan, China. The aim of the present article is to share the experience, the challenges faced and recommendations for future similar cases. Keywords: evacuation; Nepal; Novel Corona virus; Wuhan.

Symptoms of COVID-19 Confirmed Cases Presenting to Emergency Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Clinical presentation of the patient with COVID-19 in an emergency department is very important. The proper assessment of the symptom allows correct intervention. So, this study is conducted specifically to find out the clinical spectrum of the patient on presentation to the emergency department. METHODS: This was a cross-sectional descriptive study. A retrospective analysis of patient records was done. There were 258 COVID-19 positive cases admission from 13th April to 13th August 2020. Out of these cases, 57 cases were excluded as they did not have respiratory symptoms but were admitted for other medical conditions. So, 201 symptomatic patients were analyzed in this study. Symptoms of all patients with the confirmed diagnosis of COVID-19 admitted from the emergency department were analyzed. Data entry was done in an excel sheet and presenting symptoms of COVID-19 positive patients were described along with their comorbid conditions. RESULTS: Two hundred and one symptomatic patients were analyzed in this study. The mean age of study population was 37.9 years (median 37) with a minimum age of 2 months and a maximum age of 83 years. There were 114 (56.7%) male and 87 (43.3%) female; 109 (54.2%) patients were from outside the and 92 (45.8%) were from inside of Kathmandu Valley. The most common presenting symptom was fever 131 (65.2%) and cardiovascular condition including hypertension was the most common comorbid condition. CONCLUSIONS: Fever was the most common symptom of the patient presenting to the COVID19 emergency of our hospital. Moreover, fever needs to be analyzed carefully in terms of its onset total duration and associated cough, and underlying comorbid condition.