Innovative methodology to guide planning of dental workforce distribution: a GIS-based study in Nepal.

OBJECTIVES: To build a predictive model based on the distribution pattern of dentists and population in selective districts of Nepal. METHOD: Cross-sectional descriptive study conducted using secondary data from the census report and available dentist data of Nepal. Population data were obtained from the most recently available census. For dentists' data, a literature search was carried out in the databases such as PubMed, Google scholar, One Search and Medline. All data were extracted from the integrated database in the Geographic Information System (GIS), and a predictive model was built. RESULTS: Overall, there was an uneven distribution of dentists in Nepal. When the distribution of dentists was compared with the population clusters, it was found that the slope of the population growth was below or equal to (≤) 20,000 for three provinces (2, 6, and 7), which means that lower numbers of dentists are available with respect to population density in these provinces. The slope was above 50,000 for province 3, and the number of dentists was almost half of the total nationwide. The number of dentists correlated with population clusters. CONCLUSION: There are substantial disparities in the distribution of dentists in Nepal. Dentists were distributed relative to higher population clusters and were unevenly distributed. The Nepal government should make necessary arrangements to address the need for the human workforce in resource-limited settings. The methods used in this study could be applied globally, as the data used are available for most countries.

Comparative Study of Common Bile Duct Diameter between Normal and Post Cholecystectomy Cases Using Trans-abdominal Ultrasonography.

Background Increase in common bile duct diameter can occur because of different causes. Post cholecystectomy status is one of the potential causes. Many studies done in the past show different results and are hence inconclusive. Objective To see if the post cholecystectomy cases would have a statistically significant change in common bile duct diameter. Method We carried out a study in 100 cases (46 post cholecystectomy cases and 54 cases with intact gall bladder, measuring their common bile duct diameters and performing an unpaired t test to see if the mean in common bile duct among these two groups of cases was statistically significant. Result One hundred cases, 46 post cholecystectomy cases and 54 cases with intact gall bladder were included in our study. An unpaired t-test was used to compare the common bile duct diameters in these two groups. Our findings showed that the difference in common bile duct diameter between the cases with intact gall bladder and those who underwent cholecystectomy was significant for both one tailed and two tailed studies (p < 0.001). Hence, it can be stated that post cholecystectomy status increases the common bile duct diameter. Conclusion An increased Common bile duct diameter in post cholecystectomy case could be because of the post cholecystectomy status itself and not due to some other obstructive cause. So careful decision is necessary before subjecting the patient to further invasive/non-invasive investigations and treatments.

Awareness and Knowledge of Glaucoma and their Associated Factors among People Visiting a Tertiary Level Hospital in Central Nepal.

Background Glaucoma is one of the major causes of irreversible blindness globally. Almost 60 million people globally are affected by glaucoma making it the second leading cause of blindness worldwide. Diagnosis of glaucoma early on is vital for timely management and prevention of blindness. However, it is challenging to diagnose it early because it is asymptomatic in the initial stage, and there is also the dearth of appropriate screening tools. Awareness, knowledge, and beliefs are believed to influence the treatment-seeking behavior of people as well as their uptake of services. Objective To assess the awareness and knowledge about glaucoma among general patients and patient attendants visiting Dhulikhel Hospital. Method We conducted a cross sectional quantitative study among general patients visiting Dhulikhel Hospital. We collected data using face-to-face interviews with semistructured questionnaires. We analyzed data in R version 4.0.3 (2020-10-10). We presented numerical variables as mean and standard deviation whereas categorical variables as frequency and percentage. We determined factors associated with awareness and knowledge of glaucoma using logistic regression analysis and estimated adjusted odds ratio (AOR) with 95% confidence interval. Result Of 379 participants, a total of 214 (56.5%) participants had heard about glaucoma. Out of the participants who heard about glaucoma, the mean knowledge score was 48.3±21.7 and 53.3% had good knowledge on glaucoma. The odds of having heard about glaucoma were two percent lower (AOR=0.98; 95%CI: 0.97-0.99; p-value 0.036) in the older participants compared to one year younger participant, 1.98 (95%CI:1.01-3.86; p-value 0.046) times higher among literates and 2.79 (95%CI: 1.76- 4.41; p-value < 0.001) times among participants with previous ocular examination. The odds of having good knowledge was 1.94 (95%CI: 1.10-3.42; p value 0.021) times among participants with previous ocular examinations. Conclusion The knowledge and awareness regarding glaucoma in a hospital-visiting population in central Nepal was low. Half of the participants were unaware of the disease glaucoma and half of the participants who heard of the glaucoma had poor knowledge on glaucoma.

Awareness and Knowledge of Glaucoma and their Associated Factors among Staffs in a Tertiary-level Hospital in Central Nepal.

Background Since glaucoma-related blindness may only be prevented with early identification and treatment, finding asymptomatic individuals in the target population is critical. It is thus important to determine the awareness and knowledge on glaucoma. Objective To determine the knowledge and awareness on glaucoma among the staff of a tertiary level hospital in central Nepal. Method This was a cross sectional study among the staffs of Dhulikhel Hospital who participated voluntarily in the study. The data was collected through the administration of semi-structured questionnaires. R version 4.0.3 (2020-10-10) was used for the data analysis. Categorical variables are presented as frequency (percentages) and the numerical ones are presented as mean (standard deviation). Adjusted odds ratio (AOR) with 95% confidence interval were estimated through logistic regression analysis for determining factors associated with awareness and knowledge of glaucoma. Result A total of 107 (89.2%) participants had heard about glaucoma of which 93 (86.9%) had good knowledge and 14(13.1%) had poor knowledge on glaucoma. The mean score of knowledge was 64.1±16.9. Only 47.7% of the participants said that glaucoma also has an asymptomatic course. We could not find an association of awareness and knowledge of glaucoma with any of the selected sociodemographic variables. Conclusion Although there was a fairly good glaucoma related awareness and knowledge among hospital staff, we found lack of understanding on some critical issues on glaucoma, mainly related to its asymptomatic nature. There is thus room for improvement in educating about glaucoma even in healthcare settings. Given the necessity of expanding glaucoma awareness in the public, hospital staff might potentially serve as messengers to the communities.

Radiographic Study of Distal Radius Parameters in Patients Visiting Tertiary Care Hospital.

Background The important morphological parameters of distal radius namely palmar tilt, radial inclination, radial height and ulnar variance are consequential in the evaluation and management of the distal radius fracture, distal radius plate design and kinesiology. Correction of these parameters in anatomical alignment is important to restore the normal biomechanics of the wrist joint. Objective To ascertain the distal radius parameters in the patients attending tertiary care hospital with regard to gender and age. Method The wrist radiographs (postero-anterior and lateral views) of 125 patients, from 16 to above 60 years of age were used to determine the four parameters of distal radius. The subjects were divided into gender and three different age groups (16-36 years, 37-57 years and > 57 years). Independent t-test and ANOVA test was used for statistical analysis with level of significance set at p ≤ 0.05. Result The mean palmar tilt was 15.69 ± 4.84° (p-value = 0.40). The mean radial inclination was 22.58 ± 2.82° (p-value = 0.88). The mean value of radial height was 10.31 ± 1.59 mm (p-value= 0.001). Positive ulnar variance were recorded in maximum of subjects (46.40%) and the least was neutral (16.80%). Conclusion The distal radius parameters of our population were similar to the Orthopedic Trauma Association standard reference value. And there was significant difference in radial height between males and females.

Teenage Pregnancy and Associated Risk Factors and Outcome in Nepal From 2000-2020: A Systematic Review and Meta-Analysis.

Background Teenage pregnancy is considered a high-risk pregnancy in terms of reproductive outcome and the subsequent financial constraint. Objective To assess the prevalence of teenage pregnancy, associated risk factors, and outcomes in the context of Nepal. Method We searched electronic databases to search relevant articles published from January 2000 till October 2020 using the keywords with appropriate Boolean operators. All the data were extracted into a standardized form designed in Excel. We conducted a statistical analysis using Comprehensive Meta-Analysis Software (CMA) version 3. Data pooled for proportion with 95% confidence interval (CI). A Forest plot was used to visualize the degree of variation between studies. Result Fourteen studies were included in the analysis after the rigorous screening of 4425 studies. Prevalence of teenage pregnancy was 13.2% (Proportion, 0.132; CI, 0.077- 0.215). Among teenage pregnancies, 11.8% were already multigravida (Proportion, 0.118; CI, 0.029-0.374). Among teen pregnancies, 18.6% were illiterate; among the literate, only 25.9% were of education above grade 10,31.9% were unaware of contraceptive methods, and only 3.2% reported using any contraception methods. 75.4% of teenage pregnancies had a vaginal delivery with or without episiotomy, 6.5% by instrumental deliveries, and 21.5% by cesarean section. Preterm delivery was 12.0%, and post-term delivery was 8.2%. Abortion was reported in 11.1% of teenage pregnancies. Major tears were reported in 52.9%, obstructed labor was in 4%, and pre-labor rupture of the membrane was in 7.0% of teenage pregnancies. The low birth weight of newborns was 19.4%. Stillbirth and neonatal deaths were 1.7% and 1.4%, respectively. Conclusion The prevalence of teenage pregnancy in Nepal was 13.2%. The majority of them did not use any form of contraceptives; and had low education. Several maternal and neonatal complications were reported among teenage pregnancies.

Mothers' Perception of Their Children's Play in Dhulikhel Hospital, Nepal.

Background Play is a cherished part of childhood that offers children holistic developmental benefits and parents the opportunity to fully engage with their children. However, modern-day children are spending significantly less time in outdoor play due to a number of factors including technological advancements, more time involved in structured activities, and a greater emphasis on early cognitive learning. Objective To assess perception of mothers on their children's play. Method This was a descriptive cross-sectional study was carried out among the 228 mothers having at least one child children who attended in Paediatric OPD of Dhulikhel hospital of Nepal from 21st June, 2018 to 16th July, 2019. Ethical approval was obtained from the Institutional Review Committee (IRC) of Kathmandu University School of Medical Sciences (KUSMS). Research instrument was developed by Barnett and was adopted for this study with permission from the author. Systematic random sampling technique was used to select mothers and face to face interview was carried out to collect information. Result Perception on play of children in the mothers was varied. Most of mothers agreed on different subscales of play with mean range 2.07-3.01 in which they were agreed on freedom play with mean score 3.01±0.40, importance of play with mean score 2.93±0.37 and nearly agreed on maternal rule with mean score 2.89±0.50, play safety with mean score 2.92±0.36, child's choice with mean score 2.96±0.49 and disagreed on imaginative play with mean score 2.42±0.59 and gender typing with mean score 2.07±0.51. Conclusion Although almost all respondents had positive attitudes towards different component of the play, they disagreed on gender typing and imaginative play which is very important for developing problem solving skill of children based on their gender. So, nursing faculties, pediatricians and nurses can use the findings to develop awareness on importance of gender typing and imaginative playamong mothers.

Respiratory Failure in a Neonate with Pierre Robin Syndrome -A Challenging Proposition.

Background Fine needle aspiration (FNA) with radiological assisted tools such as ultrasonography (USG) and computed tomography (CT) are effective in obtaining high yield aspiration of tissues located in technically difficult places such as deep-seated. It is a simple outpatient procedure with low cost as compared to surgical biopsies. Objective To study the cytomorphological features of deep-seated lesions according to the site of occurrence, and to categorize them with respect to age, sex and behavior of lesions. Method This was a descriptive cross-sectional study of 125 patients who underwent imageguided fine needle aspiration cytology of deep-seated lesions. The study was conducted in the Department of Pathology and Department of Radiodiagnosis, Dhulikhel Hospital- Kathmandu University Hospital, between January 2017 and December 2018. Under radiological guidance, aspiration was performed under negative pressure, and adequate material was obtained. Smears were stained with Giemsa and Papanicolaou stain. The prepared slides were examined under a microscope. Result Of the 125 patients who underwent USG and CT-guided fine needle aspiration cytology (FNAC), 68(54.4%) were female and 57(45.6%) were male. The age of the patients ranged from 13 to 84 years. The maximum number of patients was above 50 years. The nature of lesions was categorized as malignant 78(62.4%), followed by 23(18.4%) inflammatory and benign 1(0.8%). Conclusion Image-guided fine needle aspiration cytology is a safe diagnostic procedure, as it provides real-time visualization of tip insertion in anatomical structures. It provides high yield and a better representation of the samples.

Risk Factors of Malnutrition among under Five Children Admitted in Kanti Children's Hospital in Nepal.

Background World Health Organization (WHO) stated that malnutrition is a major global health and social problem from which many people are suffering, particularly children. Poor feeding and care practices, insufficient nutrient intake, high rate of infection and teenage pregnancy are the immediate causes of chronic malnutrition. Objective To identify the risk factors for malnutrition among under five children. Method A case control study was carried out among the mothers having under-5 years' children who were admitted in the Kanti Children's Hospital of Nepal from 1st August 2019 to 7th September 2020. Non-probability purposive sampling technique was used to select 50 children with malnutrition and 100 children without malnutrition matched on age, sex and setting. A structured interview was used to collect data from mothers of both cases and controls. Descriptive and inferential statistics were used to analyze the data. Result Present study reveals that 58% girl got marriage before 20 years. After confounders adjusted, mother's age ≥ 20 years at marriage (OR: 2.74, 95% CI: 0.98-7.63. p=0.05), and mother's age ≥ 20 years at child birth (OR: 7.74, 95% CI: 2.37-25.27. p=0.001), were significantly associated with having malnutrition among under five children. Similarly, accessibility of health facility (OR: 3.31, 95% CI: 1-10.94. p=0.05), fathers who completed master in education (OR: 0.08, 95% CI: 0.01-0.88. p=0.04), children who lived in joint family (OR: 0.25, 95% CI: 0.07-0.86. p=0.03), child < 2.5 kg at birth (OR: 0.18, 95% CI: 0.05-0.62. p=0.01), and second and third or above in order (OR: 0.09, 95% CI: 0.01-1.04. p=0.05) had significantly less chance of having malnutrition. Children's whose birth interval was 2-3 years were significantly (OR: 9.74, 95% CI: 1.16-82.23. p=0.04) associated with the occurrence of malnutrition. Children who had suffered from multiple co-morbidities in last one year were (OR: 4.55, 95% CI: 0.48-43.03. p=0.18) more chance of having malnutrition. Likewise, the mothers who feed colostrum to their child had (OR: 2.28, 95% CI: 0.52- 9.26. p=0.29) almost two-fold less chance of having malnutrition. Mothers who had done exclusive breast feeding ≥ 4 months had (OR: 40.55, 95% CI: 3.35-1.490.92. p=0.008) significantly associated with having malnutrition. Conclusion Low education status of father, living in single family, exclusive breast feeding ≥ 4 months, lack of balance diet were significant risk factors of malnutrition. Based on finding, reliable longitudinal studies, interventions and program to educate parent for prevention of malnutrition are necessary in future.

Role of Magnetic Resonance Cholangiopancreatography in the Evaluation of Obstructive Jaundice.

Background Magnetic Resonance Cholangiopancreatography is a reliable and highly sensitive imaging modality in the diagnosis of Obstructive jaundice. Objective To evaluate the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography as compared to Endoscopic Retrograde Cholangiopancreatography. Method A prospective, analytical study was conducted in the Department of Radiodiagnosis and Imaging at Dhulikhel Hospital between October 2018 and December 2020. Altogether 100 patients of all ages with obstructive jaundice undergoing Magnetic Resonance Cholangiopancreatography and Endoscopic Retrograde Cholangiopancreatography were included. The causes of obstructive jaundice as identified by Magnetic Resonance Cholangiopancreatography were compared to that of Endoscopic Retrograde Cholangiopancreatography considering Endoscopic Retrograde Cholangiopancreatography as gold standard for the diagnosis. Result Magnetic Resonance Cholangiopancreatography revealed choledocholithiasis in 60 (60%) patients, benign stricture - 14(14%), malignant stricture-11(11%), periampullary carcinoma in 8(8%) and normal study in 4(4%) patients. Endoscopic Retrograde Cholangiopancreatography showed choledocholithiasis in 59(59%) patients, strictures (benign in 13%, malignant in 10%), ascariasis in 3(3%) and normal findings in 5(5%) patients. The sensitivity, specificity, positive predictive value and negative predictive value of Magnetic Resonance Cholangiopancreatography in detecting choledocholithiasis were 96.6%, 92.3%, 95%, and 95%. The same values for benign strictures were 92.3%, 97.7%, 85.7% and 98.9%, whereas those for malignant strictures were 90.9%, 98.8%, 90.9% and 98.8%. All values were 100% for peri-ampullary carcinoma and ascariasis. Hence, Magnetic Resonance Cholangiopancreatography showed good accuracy for detecting causes of obstructive jaundice (p < 0.05) as compared to Endoscopic Retrograde Cholangiopancreatography. Conclusion Magnetic Resonance Cholangiopancreatography is an accurate, non-invasive technique in evaluation of obstructive jaundice and offers similar diagnostic value compared to Endoscopic Retrograde Cholangiopancreatography.

A Rare Case of Large Left Lateral Wall Vaginal Myoma.

Vaginal leiomyomas are rare, they are uncommon benign tumor with variable clinical presentation. They usually present as a mass per vaginum or dyspareunia or pressure symptoms on the neighbouring structures. We present a case of 47 years lady with mass per vaginum and difficulty in walking and chronic pelvic pain. Her clinical findings suggested a large mass in the left vaginal wall, the mass was approximately 12 x 10 cm in size hindering the visualization of the cervix. Her ultrasonography showed bulky uterus with mass occupying the cervix. This finding was not correlating with the clinical findings. Magnetic resonance imaging (MRI) was done and it was reported as mass lesion in pelvis separate from the cervix abutting the rectum posteriorly. Ultrasonography (USG) guided biopsy was done which was reported as Leiomyoma. She underwent vaginal myomectomy and was confirmed in histopathology as Leiomyoma. A leiomyoma is a smooth muscle tumor that arises from the muscular part of the uterus and rarely seen in the vaginal wall.

Long-term outcome of sacral nerve stimulation for faecal incontinence.

AIM: Sacral nerve stimulation (SNS) is a minimally invasive treatment for faecal incontinence (FI). We report our experience of patients who have undergone SNS for FI with a minimum of 5 years' follow-up. This is a single centre prospective observational study with the aim to assess the long-term function of SNS. METHOD: All patients implanted with SNS were identified from our prospective database. The date of implantation, first and last clinic follow-up, surgical complications and St Mark's incontinence scores were abstracted and analysed. RESULTS: From 1996 to 2014, 381 patients were considered for SNS. Of these, 256 patients met the study inclusion criteria. Median age at implantation was 52 years (range 18-81). The ratio of women to men was 205:51. Indications were urge FI (25%), passive FI (17.9%) and mixed FI (57%). The median of the incontinence score at baseline was 19/24 and this improved to 7/24 at the 6-month follow-up. Of the total cohort, 235 patients received a medium-term follow-up (median 110 months, range 12-270) with a median continence score of 10/24 which was also confirmed at the telephone long-term follow-up on 185 patients (132 months, range 60-276). CONCLUSION: This study demonstrates that SNS is an effective treatment in the long term. SNS results in an improvement of validated scores for approximately 60% of patients; however, there is a significant reduction of efficacy over time due to underlying causes.

Sexual Dimorphism of Greater Sciatic Notch among Nepalese Population by Three Dimensional CT Images of Pelvis.

Background Sex identification from the skeletal remains, is the first and the foremost step encountered by forensic experts. Hip bone being comparatively robust is resistant to damage and scores even in improperly preserved skeletons. It is also widely agreed that the greater sciatic notch (GSN) holds the greatest degree of sexual dimorphism. Objective To study the role of greater Sciatic Notch parameters in sex determination among Nepalese population by means of reconstructed Multi Slice Three-Dimensional Computed Tomography (MDCT) images. Method The CT images of individuals who underwent pelvic CT in the Department of Radiology, Dhulikhel Hospital were included in the study. Measurements of width, depth, angles and indices of greater sciatic notch were measured and calculated. Data were entered and analyzed using SPSS (Statistical Package for Social Sciences) version 25.0. Result There was a significant difference between means of all greater sciatic notch parameters (p > 0.001) between sex showing sexual dimorphism except depth (p=0.65). By using limiting point, 78.18% male and 83.64% female were correctly classified by using total width. Total angle, Posterior segment and Total width had sensitivity and specificity exceeding 80% and overall accuracy of 87% to 92% in all parameters except depth by receiver-operator characteristic curve analysis. Conclusion Application of 3D-CT virtual images in the present study helped us to easily quantify greater sciatic notch parameters. The important greater sciatic notch predictors for sex determination in Nepalese population were determined which would help forensic experts in ascertaining the sex of an unknown individual.

A Study on Variations of Branching Pattern of Hepatic Arteries with its Clinical Significance.

Background Variation of hepatic artery is very frequent and may predispose the patients to inadvertent injury to the vessels during hepato-billiary surgery. With the advancement of new diagnostic, therapeutic and operative techniques for abdomen, the sound knowledge of variations of hepatic arterial system have become increasingly important for dealing clinicians, surgeons and interventional radiologists. Objective To study the variations of hepatic artery and to evaluate the possible clinical significances. Method A total of 104 images of abdominal computed tomography scans were used for this study. The origin and branching patterns of hepatic artery were recorded. After collecting the data, statistical analysis was done. Result The present study concluded that normal branching pattern of hepatic artery was seen in 86.54% cases, whereas 13.46% cases showed different types of variations. Among them, type II and IV pattern were seen in 0.96% in each, type VI in 1.93%, type VII in 2.87% and the most common variation type IX was seen in 3.85%. There were not a single case of type III, V, VIII and X recorded in this study. Addition to these, one of the variants was common hepatic artery originating from abdominal aorta, was seen in 1.93% of cases while the other variant is unnamed artery arising from superior mesenteric artery, was seen in 0.96% of cases. Conclusion The knowledge of the branching pattern of hepatic artery might be helpful for clinicians to the better understanding of the arterial supply of the liver and may reduce the risk of complications.

Pneumonia hospitalisation and case-fatality rates in older Australians with and without risk factors for pneumococcal disease: implications for vaccine policy.

Community-acquired pneumonia (CAP) results in substantial numbers of hospitalisations and deaths in older adults. There are known lifestyle and medical risk factors for pneumococcal disease but the magnitude of the additional risk is not well quantified in Australia. We used a large population-based prospective cohort study of older adults in the state of New South Wales (45 and Up Study) linked to cause-specific hospitalisations, disease notifications and death registrations from 2006 to 2015. We estimated the age-specific incidence of CAP hospitalisation (ICD-10 J12-18), invasive pneumococcal disease (IPD) notification and presumptive non-invasive pneumococcal CAP hospitalisation (J13 + J18.1, excluding IPD), comparing those with at least one risk factor to those with no risk factors. The hospitalised case-fatality rate (CFR) included deaths in a 30-day window after hospitalisation. Among 266 951 participants followed for 1 850 000 person-years there were 8747 first hospitalisations for CAP, 157 IPD notifications and 305 non-invasive pneumococcal CAP hospitalisations. In persons 65-84 years, 54.7% had at least one identified risk factor, increasing to 57.0% in those ⩾85 years. The incidence of CAP hospitalisation in those ⩾65 years with at least one risk factor was twofold higher than in those without risk factors, 1091/100 000 (95% confidence interval (CI) 1060-1122) compared with 522/100 000 (95% CI 501-545) and IPD in equivalent groups was almost threefold higher (18.40/100 000 (95% CI 14.61-22.87) vs. 6.82/100 000 (95% CI 4.56-9.79)). The CFR increased with age but there were limited difference by risk status, except in those aged 45 to 64 years. Adults ⩾65 years with at least one risk factor have much higher rates of CAP and IPD suggesting that additional risk factor-based vaccination strategies may be cost-effective.

A Study on Variations of Branching Pattern of Renal Artery with its Clinical Significance.

Background The kidneys are supplied by a single renal artery originating from abdominal aorta. However, recent literature reports great variations in renal blood supply. Hence, it becomes mandatory for the clinicians to understand the abnormality and variations in the renal vasculature. Objective To evaluate the branching pattern of renal artery and its variations. Method The study consisted of Computed Topographic images of 206 kidneys. Numbers and branching pattern of renal artery were recorded. The data was analyzed for presence or absence, source of origin and type of accessory renal artery. Result The present study revealed that 73.79% of kidneys were supplied by a single renal artery, 25.72% by double renal artery and 0.49% by triple renal artery. The hillar branching pattern was recorded in 38.83% and early branching pattern was in 34.95%. The presence of accessory renal artery was recorded in 26.21%. They were originated from abdominal aorta in 22.81% and 3.40% from main renal artery. The prevalence of superior polar artery was found in 6.79%, hilar in 10.19% and inferior polar in 9.22%. Conclusion The knowledge of variations of renal artery becomes essential for the clinician to plan the adequate surgical procedures and to avoid any vascular complication.

Association between body mass index and laboratory-confirmed influenza in middle aged and older adults: a prospective cohort study.

BACKGROUND: Studies conducted during the 2009 influenza A (H1N1) pandemic found that obesity increases the risk of severe influenza including hospitalization and death. In this study, we examined the relationship of BMI with having laboratory-confirmed seasonal influenza and influenza-related respiratory hospitalization. METHODS: We linked a cohort of 246,494 adults aged ≥45 years with data on BMI to subsequent laboratory-confirmed influenza notifications and cause-specific hospitalizations from 2006 to 2015. Cox-proportional hazard models were used to estimate the risk of incident laboratory-confirmed influenza and influenza-related respiratory hospitalizations according to BMI, adjusting for age, sex and other covariates. RESULTS: After 1,840,408 person-years of follow-up, 1891 participants had laboratory-confirmed influenza notifications (crude rate 10.3/10,000 person-years) of whom 623 were hospitalized for a respiratory illness. Compared to those with healthy BMI (22.5 to <25.0 kg/m2), influenza incidence was respectively 27% (adjusted HR [aHR]: 1.27, 95% CI: 1.10-1.46) and 69% (aHR: 1.69, 1.24-2.29) greater among obese (BMI: 30 to <40 kg/m2) and very obese adults (40 to <50 kg/m2). The equivalent aHRs for hospitalization were 1.57 (95% CI: 1.22-2.01) and 4.81 (95% CI: 3.23-7.17). For every 5-unit BMI increase above 22.5 kg/m2, there was a 15% (aHR: 1.15, 95% CI: 1.09-1.22) increase in risk of having a diagnosis of influenza and 42% increase in hospitalization (aHR: 1.42, 95% CI: 1.30-1.60). These trends did not differ between the pandemic year (2009) and other years. CONCLUSIONS: Our results suggest that obese adults have a similar risk of hospitalization for seasonal influenza as adults with cardiovascular disease and diabetes, and should therefore  be equally prioritized for funded interventions such as targeted immunization programs.

Child maltreatment in Nepal: prevalence and associated factors.

OBJECTIVES: Child maltreatment is a global public health problem. There is limited information about this problem in low-income countries. We aimed to document the prevalence and factors associated with physical punishment of children less than 14 years of age in Nepal. STUDY DESIGN: Population-based cross-sectional study. METHODS: We conducted an in-depth analysis using data from the Nepal Multiple Indicator Cluster Survey, a nationally representative multi-stage-stratified cluster sampling survey. Data were collected from 13,000 households in 520 sample enumeration areas. We assessed prevalence of physical punishment and different child violence related acts on 5081 children aged 3-14 years for whom complete information on all acts and attitude towards violence was available. Logistic regression was used to investigate the association between physical punishment of child and factors such as household and maternal demographics. RESULTS: Our results suggested violence is common across Nepal, with data showing one in every second child is physically punished. One in every third (33%) of children were spanked, hit or slapped on the bottom, 25% were hit or slapped on the face and approximately 3% were beaten up hard. Odds of facing physical punishment were higher among children aged 3-5 years (odds ratio [OR] 2.9, 95% confidence interval [CI]: 2.0-4.3), aged 6-8 years (OR 2.8, 95% CI: 2.2-3.7), engaged in child labour activities (OR 1.4, 95% CI: 1.1-1.7), with mother that accepted wife beating by husband is justified (OR 1.2, 95% CI: 1.1-1.4), whose father is currently abroad (OR 1.5, 95% CI: 1.2-1.9) and whose father is away from home but in the same country (OR 1.60, 95% CI: 1.1-2.3). The risk was also higher among children living in households that believe physical punishment of children is necessary (OR 3.5, 95% CI: 2.9-4.3) and from lower caste/indigenous (dalit/janajati) ethnicity (OR 1.3, 95% CI: 1.1-1.7). Those less likely to experience physical punishment included female children (OR 0.7, 95% CI: 0.6-0.9) and children with an older mother (34-49 years; OR 0.5, 95% CI: 0.3-0.9). CONCLUSIONS: Our results suggest that physical punishment of children is common across Nepal with varying severity. Prevention efforts should focus on designing and promoting interventions that support parents to adapt alternative forms of parenting practices.

Perceived Health Promoting Education Needs of Middle-aged Population in Dhulikhel Municipality of Nepal.

Background Health promoting education need assessment is of utter importance while conducting health promoting education programs. However little efforts have been put on this by the policy level authorities and there are no studies to assess the perceived health promoting education needs of the middle aged population of Nepal till date. Objective The objective of this study was to assess the perceived health promoting education needs of middle-aged population in Dhulikhel municipality. Method A descriptive cross-sectional study was conducted among 300 respondents using two staged cluster and systematic technique. Face to face interview technique was used for data collection. T-test was used for comparison of dependent variables with independent variables. Result The study revealed that the mean education need score was 66.66±16.09 (in a score of minimum 25 and maximum 125). Cancer prevention was perceived as the topic of highest education need and retirement planning as the topic of least education need. There was statistically significant difference in the mean perceived education need score between male and female (p=0.048), respondents with exposure and non-exposure to health related programs on mass-media (p=0.020) and mental component summary score < 50 and mental component summary scores >=50 (p=0.048). Conclusion This study suggested that the community people have perceived moderate level of health promoting education need. Since cancer prevention was the highest rated topic followed by chronic illness prevention and dementia, it is recommended to focus on these topics while organizing any health promoting education programs in the community.

Determination of Sex from the Foramen Magnum using 3DCT: A Nepalese Study.

Background Identification is of utmost importance in any medicolegal investigation with sex determination being one of the principle indicators of identity. Sexing of bones becomes easy when the skeletal remains are complete. However, the problem arises when the bones are fragmented. Many researchers have undertaken several studies in different populations to determine the sex with reasonable accuracy using numerous measurements of the skull including those of the foramen magnum. Objective The present study was aimed to find the sexual dimorphism of the foramen magnum in the Nepalese population by analyzing the antero-posterior length, transverse diameter and area of the foramen magnum. Method The antero-posterior length and transverse diameter of the foramen magnum were measured using three-dimensional computed tomography (3DCT) images of the head in a cohort of 100 Nepalese subjects. Radinsky's and Teixeria's formulae were used to calculate the area of the foramen magnum. Discriminate function analysis was used to analyze sex differences. Result Mean values of antero-posterior length and transverse diameter of the foramen magnum in males were higher than in females. The mean of the area calculated using Radinsky's formula was smaller than that calculated by Teixeira's formula and the areas calculated were higher in males. The measurements of the foramen magnum and the areas calculated showed significant difference (p<0.001) between males and females. Discriminate function analysis for the measurements of the foramen magnum and the areas calculated showed high predictability for both the sexes. Discriminate function analysis showed a maximum predictability of 75%. Conclusion Considering the percent of predictability of sex from the various variables related to the foramen magnum in the Nepalese population, it can be concluded that its restricted applicability in forensic investigations should be constrained to cases of fragmentary skull bases.