Knowledge and Attitude towards Do-Not-Resuscitate Order among Nurses of a Tertiary Level Hospital

Introduction: Knowledge regarding and attitude towards end-of-life care can shape the behaviour and actions of a health professional in provision of supportive care for the comfort of the patients as well as their family members. Very little is known about nurses’ knowledge and attitude regarding do-not-resuscitate (DNR) order. Therefore, the purpose of this study was to identify the knowledge of and attitude towards DNR order and relationship between knowledge and attitude towards DNR order among the nurses of a tertiary level hospital. Methods: Descriptive correlation design was used. Convenient sampling method was used to select 70 nurses from a tertiary level hospital. Data were collected using pretested self administered structured questionnaire. Data were analysed using SPSS version 20 and analysed using descriptive and inferential statistics. Result: Among 70 respondents, almost all (95.7%) of the respondents had good level of knowledge, 2.9% had fair and 1.4% had poor level of knowledge. Most (80.0%) of the respondents had positive attitude towards DNR order and 20.0% had negative attitude. There was a positive relationship between knowledge of and attitude towards DNR order (r = 0.068) but the relationship was statistically insignificant. Conclusions: Based on the findings, the study concludes that nurses of tertiary level hospital have good knowledge and positive attitude towards DNR order. Likewise, knowledge regarding DNR order is related with the attitude towards DNR order and thus knowledge can be enhanced to improve the attitude towards DNR by regular in-service education.

A Retrospective Case-Control Study of Lipid Profiles in Carcinoma Breast in Comparison with Normal Controls

Introduction: Breast cancer is the second most common cancer in the world. One of the reasons for its increasing prevalence, especially in younger women has been attributed to lifestyle changes. All these factors also have a strong association with lipid metabolism. More evidence is coming forward to emphasise the protective effect of lifestyle modification to lower lipid levels and thus decreasing the risk of breast cancer. Methods: It is a retrospective, case control study. The patients with carcinoma breast and normal controls were taken as subjects. The data for this study includes clinical profile and lipid profile measured in early morning fasting sample of the subjects. The patients of carcinoma breast, normal control aged > 18 years were included, while patients with diabetes, thyroid disorders, on treatment for hyper-lipidaemia, dieting or anorexic, pregnant patients were excluded. Results: There was no statistically significant differences in age (p = 0.920) and BMI (p = 0.137) between study and normal control group. Total Cholesterol (TC) and Triglycerides (TG) levels were significantly elevated (p = 0.009 and 0.000 respectively) in carcinoma breast group compared to normal controls, however no significant differences (p > 0.05) observed in the levels of HDL-C, LDL-C. Conclusions: There is a significant alteration in lipid metabolism in carcinoma breast patients in comparison to normal controls.

Awareness and Practice of Junk Foods among Adolescents in Secondary Level Students

Introduction: Junk food consumption among adolescents has become a serious issue that may lead to harmful effects on health. Dietary patterns of people are shifting from homemade foods to junk foods. Therefore, this study was undertaken to assess the awareness and practice of junk foods among adolescents. Methods: A descriptive cross-sectional study was conducted among adolescents of secondary level students. A simple random sampling technique was used to select the sample and the sample size was 237. Data collection was done from April 15, 2019 to May 14, 2019. A set of semi-structured self-administered questionnaire was used for data collection. Descriptive and inferential statistics were used to analyse and interpret the findings. Results: The findings showed that more than three-fifth (67.9%) of adolescents had a moderate level of awareness about junk foods. Half (49.4%) of them consumed junk foods highly. All (100%) adolescents have consumed junk foods regularly whereas two-fifth (42.2%) replaced meals once a week with junk foods. Four-fifth (82.3%) of adolescents did not bring tiffin from home. There was no significant association between the awareness and practice of junk foods (p < 0.05). Conclusions: This study concludes that most of the adolescents possessed a moderate level of awareness of junk foods. Majority of them did not bring tiffin from their home. Around half of them consumed junk foods in their daily life. Majority of them were aware of junk foods, although they still consumed junk foods.

Impact of COVID-19 on Orthopaedic Surgery: Comparison Between Before and During COVID-19 Pandemic

Introduction: Orthopaedic surgical activity has been significantly affected by COVID-19 pandemic. The decision to perform operative interventions is based on balancing risk to benefit to the patient and health care workers. Though different guidelines have been published, there is a lack of reliable data on orthopaedic surgical activities. Our study aimed to evaluate the impact of the COVID-19 pandemic on Orthopaedic surgeries comparing with the previous year. Methods: This was an epidemiological retrospective comparative study conducted at Shree Birendra Hospital, Nepal after taking ethical approval from the Institutional Review Committee of NAIHS. Data of the first four month of orthopaedic surgeries after National lockdown (from March 24 to July 23, 2020) and the same four month period of the previous year (The year 2019) were retrieved. The demographic profiles and operations categories (trauma, elective and infections) were compared between two periods using SPSS 21. Result: Out of total of 651 patients enrolled, 169 patients operated during the pandemic compared with 482 patients before the pandemic. There was a 65% reduction in total surgical procedures, 94% reduction in elective cases and trauma cases were reduced by 29% (P < 0.05). Implant removal (107, 42.8%) constituted the highest elective cases in the year 2019. Conclusions: The orthopaedic surgical procedures were decreased in frequency during COVID-19 because of a decrease in elective cases. The total trauma patients remained more equable during pandemic despite strict lock-down. Health care facilities should consider this during post pandemic recovery.

Tubercular Mastitis in an Elderly Female: A Rare Entity

Introduction: Tuberculosis of the breast is a rare entity, especially in elderly females. Moreover, the disease is overlooked and misdiagnosed as malignancy or pyogenic abscess. Here we report a case of an elderly female who presented with a lump in her left breast which resembled malignancy. Fine needle aspiration cytology followed by histopathological examination confirmed the diagnosis of breast tuberculosis. Patient underwent excision of the lump followed by six months of anti tubercular therapy to which she responded well. Key words: breast; mastitis; tuberculosis

Factors Affecting Choice Of Health Care Facilities Among The Adults of an Urban Community

Introduction: Health service delivery systems that are safe, accessible, high quality, people-centred, and integrated are critical for moving towards universal health coverage. World Health Organisation is supporting to improve the efficiency and effectiveness of health service delivery systems to all the population not only the patients. This study aims to identify the factors affecting the choice of health care facilities among the adults of an urban community and its association with the selected socio-demographic variables. Methods: A descriptive cross-sectional study was conducted among the community residence with 120 respondents using non-probability purposive sampling technique. Data was collected using semi-structured interview schedule that was analysed by using descriptive statistical methods such as frequency, percentage, mean, standard deviation and inferential statistics such as chi-square test. Result: The findings of the study revealed that majority (60.8%) of the respondents used private health care facilities and there was significant association of the choice of health care facility with the health care services related factors whereas no significant association was found with the selected socio-demographic variables. Conclusions: Based on the study findings, it concluded that various health care services related factors like availability, affordability, acceptability and accessibility factors tends to affect the choice of health care facility

Osteochondroma of the Distal Tibia Leading to Deformity and Stress Fracture of the Fibula - A Case Report

Osteochondromas seldom arise from the interosseous border of the distal tibia and may progress to involve the distal fibula. We present the case of a 14-year-old teenager with a stress fracture of the distal fibula, secondary to an osteochondroma arising from the distal tibia. Early excision of this deforming distal tibial osteochondroma was necessary in order to avoid a progressive deformity which would affect the biomechanics of the ankle joint resulting in gait disturbances.

Oral Cancer Awareness among Dental Patients

Introduction: The incidence of oral cancer in South Asian countries, including Nepal is increasing despite the fact that all of its risk factors are modifiable. This can be attributed to lack of awareness regarding oral cancer and its risk factors among general public. This study was conducted among subjects attending Dental OPD of a tertiary hospital to assess the knowledge and attitude regarding oral cancer and also practices of risk factors associated with it. Methods: This is a questionnaire based cross-sectional study conducted from July 2020 to October 2020. Subjects attending Dental OPD of a tertiary hospital in Kathmandu were asked to fill a structured close-ended Questionnaire. Section one of the questionnaire focused on the demographic data of the subjects, second part elicited information pertaining to knowledge of oral cancer, third part focused on attitude and fourth part on practices of participants towards risk factors of oral cancer. Result: Out of 300 subjects, 65% were males. Most were in the age group 41 - 50 years and 75.6% were literate. Majority mentioned smokeless tobacco as the risk factor, followed by smoking and alcohol. Regarding signs and symptoms, most of the participants mentioned non-healing ulcer, followed by lump and pain. Most of the participants responded tongue as the most common site of oral cancer. Majority answered that oral cancer can be prevented by not chewing tobacco. Among the total, 55.3% said oral cancer is non-contagious. Only 25% had undergone oral examination in the last one year. 31.7% had habit of tobacco and / or alcohol. Conclusions: The awareness level and knowledge about risk factors and early signs of oral cancer in this cross-section of dental patients were satisfactory. Key words: awareness; oral cancer; risk factors; tobacco

Knowledge, Acceptability, Perception and Stigmas on Safe Abortion among the women of reproductive age group (15-49 years) in Bhaktapur District.

Introduction: The termination of pregnancy by the removal of a foetus or an embryo before surviving outside the uterus or before attaining its viability is called abortion. This study was conducted to study the knowledge, acceptability, perception and stigma of safe abortion among women of reproductive age group. Methods: A cross-sectional analytical study was carried out in Bhaktapur District, Nepal from July 2019 to December 2019. Women of reproductive age group were included in the study. The semi-structured questionnaires were used as a data collection tool and Likert scales were used for perception and stigma which were self-designed. For Likert scale on perception and stigma, Cronbach’s α was calculated from the pre-tested samples which was found to be acceptable i.e., 0.649 and 0.856. Interview was taken as data collection technique. Data-entry was done in Epi-Data and analysed through SPSS 16.0. Chi square test was used to measure the association between dependent and independent variables. Result: The association between “Knowledge and Perception” was found to be significant with p-value of 0.04, the association between “Knowledge and Stigma” was also noted to be significant with p-value of 0.00 and “Knowledge and Acceptability” was also found to be significant with p-value of 0.00 through the assessment of knowledge, acceptability, perception and stigma. Conclusions: The study emphasises on educating and making aware every woman on safe abortion, its legalisation and its amended law to avoid the stigma and unsafe abortion practices.

Clinical significance of Catheter-Associated Urinary Tract Infection (CAUTI) in Intensive Care Units: Three Year Experience at a Single Centre

Introduction: Catheter Acquired Urinary Tract Infection (CAUTI) is one of the most common Health Care Acquired Infections (HCAI); most of these infections are attributable to use of an indwelling urethral catheter. The aim of this study was to investigate patients with catheter-associated urinary tract infection over three years at a single hospital’s Intensive Care Unit (ICU) and to identify meaningful risk factors and causative organisms. Methods: A retrograde analysis was performed on patients with indwelling catheters in ICU of Armed Forces Medical College, Pune, India. CAUTI was defined as isolated bacterial growth of 100,000 colony-forming units or more either 48 hours after transfer to the ICU if a urinary catheter was placed before the transfer or 48 hours after insertion if the catheter was inserted in the ICU. Only the patients whose culture results were negative before ICU admission were included. Result: Among 350 samples collected in medical and surgical ICU, 38 patients (10.85%) had CAUTI. Using multivariate logistic regression analysis, the study showed that those with diabetes were 4.51 (p＜0.001) times likely to have occurrences of CAUTI than those without and also showed an increased incidence of CAUTI > 1.19 fold (p＜0.01) among patient with longer duration of an indwelling catheter. Conclusions: CAUTI is a preventable HCAI and thus the risk factors and causative organisms contributing to its development in the management of ICU patients must be considered to prevent the occurrence of UTIs in this setting.