Essential Emergency Surgical Care in Remote Hilly Districts of Karnali - A Cross-Sectional Survey

Background: Remote hilly areas of Karnali Province has one in all the very best burdens of surgically treatable conditions within the world and therefore, the highest unmet need. The first objective of our study was to gauge the capacity of first-referral health facilities in remote districts of Karnali Province to perform basic surgical procedures. The aim is to assess the status of Essential Emergency Surgical Care in remote hilly districts of Karnali region of Nepal. Method: The screening Tool was Situational Analysis to Assess Emergency and Essential Surgical Care, to spot the health facility’s capacity to perform basic surgical (including obstetrics and trauma) and anesthetic procedures by investigating four categories of data: human resources, infrastructure, equipment and interventions available. The tool interrogated the supply of eight sorts of care providers, 35 surgical interventions and 67 items of apparatus. Results: on the average, 72.83% of all admissions required either minor or major surgical interventions. Oxygen supplies, electrical power backup, running water, blood bank, hospital guidelines were inconsistent. Only 1 Hospital have trained Surgeons, Anesthesiologist and Obstetrician/Gynecologist. Only 1 hospital can perform around 97.1% of procedures. Conclusion: The capacity for essential surgery is severely limited in Karnali region of Nepal. Limitations was seen in basic equipment, human resources, infrastructure, and supplies.

Health Status of Elderly People Living in Old Aged Homes in Pokhara

Background: Health is serious matter for the elderly people especially living in old aged homes. In this context, this study has tried to explore the health status of elderly people living in old aged homes. Methods: Information were collected from fifty seven elderly people living in purposively selected three major old aged homes of Pokhara by using structured questionnaire through interview techniques. The elderly people, who were unable to speak, hear, complete the interview process, have severe psychiatric disorder, did not have verbal consent to participate were excluded from the study. Descriptive analysis was carried out for this research. Results: Majority (87.7%) of the respondents had chronic physical health problem like back pain problem as major followed by other musculoskeletal problems, gastrointestinal disease, hypertension, respiratory problem, diabetes mellitus, heart disease, eyes and ears problem. The proportion of female was higher than male regarding their chronic physical health problem. Majority went to hospital when they were sick. Half of the respondents were worried about economic insecurity followed by lack of social relation, lack of treatment during illness, fear of future, lack of recreational activities, food management of old age homes, environment of elderly official, sitting and sleeping environment of elderly home and others respectively. All the respondents prayed god to cope with these stress followed by listening to religious hymns, go to religious places, solitary living, crying alone, and take cigarettes/alcohols. Conclusions: Health status of elderly people living in old aged home was not good since most of the elderly were suffered from chronic physical health problem. Females are more vulnerable.

COVID-19 Pandemic in Yemen

COVID-19, a global pandemic, has threatened the whole world with its devastating nature. Though, initially it has affected the developed countries, the countries in low- and middle-income category also are not spared. Yemen is a country with low-income economy and has been in an ongoing civil war. The first case of COVID-19 was reported on 10th April 2020 and there have been a total of 1619 cases along with 447 total deaths as of 21st July 2020. The preventive measures such as lockdown, social distancing, and personal hygiene are practiced, however there is still lack of adequate resources for efficient healthcare facilities. No drugs and vaccines are approved to fully rely on for the treatment of COVID-19, therefore the concept of “do not take the virus and do not give the virus” with different approaches of preventive aspects through hand-washing, social distancing, wearing masks and gloves, and making people aware in mass utilizing audio-visual media are helpful. Aids from different agencies and collaborative efforts of all the stakeholders are in need for the containment of COVID-19 cases in Yemen. By strengthening and increasing healthcare set-ups and resources, preparation of management guidelines by the government and mobilizing such resources to different parts for awareness, adequate reverse transcription-polymerase chain reaction (RT-PCR) tests, contact tracing, and safe quarantine and isolation services are essential.

Clinical Profile of Enteric Fever in Children of a Tertiary Care Centre in Kathmandu, Nepal

Background: Enteric fever, commonly known as typhoid fever is a global public health problem. It is one of the common infectious diseases of humans, fever lasting for more than 7 days. It is transmitted by faecooral route and common in the areas with poor sanitation. Globally, majority of the Typhoid fever is caused by Salmonella enterica var typhi, one fifth of the infection is caused by Salmonella enterica var paratyphi. This study was conducted to describe clinical and laboratory parameters among children with enteric fever. Methods: It was a descriptive cross-sectional study conducted in the Pediatric ward and Pediatric Intensive Care Unit (PICU) of Nepal Medical College Teaching Hospital (NMCTH), Atterkhel, Kathmandu, Nepal from 2015 January to 2015 December. Inclusion criteria: clinical details and laboratory parameters of children aged 13 months to 15 years old with diagnosis of enteric fever was obtained in the proforma and descriptive statistics were calculated. Result: A total of 1,020 children with the sign and symptom suggestive of enteric fever were admitted in the inpatient department (Pediatrics) during the study period. All the enteric fever suspected children were tested for blood culture, Widal test and complete blood count, out of them 80 children were diagnosed as enteric fever. Male female ratio is 1.6:1. Fever was the most common clinical feature observed in 95% cases and other common features were loose motion (37.5%), vomiting (33.8%) and abdominal pain (27.5%). Hepato-splenomegaly is common finding of Enteric fever reported in 85.0% and 43.7%. Majority of the patients had normal leucocyte count (71.0%) and leucopenia reported in 20.0%. Conclusion: Fever and hepato-splenomegaly were the major clinical presentation of typhoid fever in our study. Other less common features were loose motion, vomiting and abdominal pain. This finding may be useful for the pediatrician and other health professionals for the early diagnosis of enteric fever.

Accuracy of Ultrasound Scanning in Diagnosing Acute Appendicitis in Patients Admitted at Vicente Sotto Memorial Medical Center

Introduction: Acute appendicitis is the most common abdominal surgical emergency. Both abdominal ultrasonography and computed tomography are common diagnostic tools in its diagnosis with each having its own advantages and disadvantages. Methods: Patients of suspected acute appendicitis were evaluated with an ultrasound to see the sensitivity, specificity, positive and negative predictive value of ultrasound for intraoperative appendicitis diagnosis. The study included 113 patients of suspected acute appendicitis presenting in the emergency during a one year duration. Sensitivity, specificity, positive predictive value and negative predictive value was calculated from their respective formulae. Results: The majority of the patients were male patients between the age group of 18 to 30. The sensitivity of ultrasound for diagnosis of acute appendicitis was 96% and specificity was 33%. The positive predictive value was 98% and the negative predictive value was 20% Conclusion: Ultrasound has good sensitivity and the low cost along with no radiation exposure makes this an acceptable screening investigative modality though due to low specificity, it would be recommended to go for a computed tomography scan if ultrasound shows negative result for appendicitis.

Depression among Chronic Kidney Diseases Patients Receiving Hemodialysis

Background: Chronic Kidney Disease (CKD) is a progressive irreversible loss of renal function over a period of months or years. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintains life. Hemodialysis is used for patients who require short term dialysis (days to weeks) and for patients with advanced CKD and End Stage renal Disease (ESRD) who require long term or permanent renal replacement therapy. Hemodialysis significantly and adversely affects the lives of patients, both physically and psychologically. Depression is the most common psychological condition among patients with ESRD. Depression in dialysis patients not only effect mortality, but increased rate of hospitalizations and dialysis withdrawal is also very common. Methods: A descriptive cross sectional research design was carried out to identify the depression level of chronic kidney disease patients receiving Hemodialysis in Western Regional Hospital, Pokhara using Beck Depression Inventory among forty six patients. Results: The study findings revealed that majority of the patients (84.8%) has various degree of depression i.e. mild (21.7%), moderate (30.8%) and severe (32.6%). Only fifteen percent of patient has no depression. There was no statistical association between the level of depression and socio-demographic variables. It can be concluded that the prevalence of depression is high among patients receiving Hemodialysis. Conclusion: The prevalence of depression is high among patients receiving Hemodialysis. It is effective to provide mental health services to the CKD patients receiving Hemodialysis which help them better psychologically adaptation to their disease and improve their quality of life.

Family Caregivers’ Satisfaction towards the Communication of Health Service Providers in Tertiary Care Hospital of Nepal

Introduction: Patient and family caregivers’ satisfaction is an essential measure of the quality of care and a determinant of health service utilization. Measuring family caregivers’ satisfaction with health service providers is important for understanding and improving the quality of care at health facilities. Therefore, the present study aimed to assess the satisfaction of family caregivers towards the communication of health service providers. Methods: A descriptive cross-sectional study was conducted by the development of a questionnaire at one of the tertiary care hospitals. Self-administered questionnaires related to demography and different dimensions on the satisfaction of caregivers towards the communication of health service provider was designed. Sixty caregivers were provided questionnaire and data was collected. Descriptive analysis, frequency, and percentage were calculated using SPSS 23 (SPSS Inc., Chicago, IL, USA) Results: The study showed that the majority of the caregivers (40%) were of the young age group (31-40 years). More than half (53%) of the caregivers were satisfied with different ways of communication about the patient's condition and treatment. In terms of communication mode, the majority of the caregivers were satisfied with related different ways of communication about the patient's condition and treatment (53.3%) followed by verbal (63.6 %) and non-verbal (50.6 %) respectively during their stay at the hospital. Conclusion: The current study found that caregivers were satisfied with the communication provided by health service providers. This suggests that the treatment provided to patients might have better outcome measures. Additionally, it may help to reduce the anxiety among caregivers regarding the patients’ condition.

Get Well Soon Card: Self Help Program to Overcome Hospital Based Financial Barrier

Background: The health care cost is increasing not only in developed countries but also in developing countries. Although the modality of treatment has made significant progresses over the years, delivery of treatment is sometimes beyond the expectation of patient as well as inaccessible financially. Citizen from developing countries like Nepal have to pay out of their own pocket for even minor health issues. We initiated a new concept to bridge this gap between treatments and necessity of funds through crowd funding scheme. Methods: This was a cross sectional prospective and observational study conducted at Annapurna Neurological Institute and Allied Sciences from July 2017 to April 2020. This study was conducted on “Get Well Soon “card which was a friendly gesture with monetary value provided by visitors to patients. This card was made available in hospital pharmacy without any hidden cost. A convenient sample survey on 100 participant including admitted patients as well as visitors in the hospital was conducted on their perception about Get well soon card before initiating this program. Results: This innovative self-help scheme has been proven to be quiet successful in a short period of time with many supporters advocating in its favor. Total number of 1012 patients have been benefited from the card which was provided to them by their visitors and relatives during their hospitalization with purchase of card worth NRs. 1144500 (~$11445) during the study period. Conclusion: Get Well Soon Card can be beneficial to those populations who are financially constrained and lack insurance for the treatment. This Cultural Revolution of crowd funding can be duplicated not only in Nepal, but also in different developing countries where out of pocket system is still prevailing.

Antibiotic Profile of Extended Spectrum Beta Lactamase Escherichia coli from Clinical Samples

Background: Extended spectrum β-lactamases have addressed the serious challenges worldwide due to the emergence of ESBL producing genes which possess a serious threat for the treatment of infections both in community and hospitals since it is found to be increasing trends of multidrug resistance. This study was focused to find out the antibiotic profile of multidrug resistant Escherichia .coli and status of ESBLs producing E.coli. Methods: This was a cross-sectional study conducted over a period of 2 years (September 2017 to April 2019) at microbiology laboratory of Nepal Mediciti Hospital. A total of 16542 samples were processed. Various clinical samples were collected from both inpatients and outpatients aseptically and without contaminating skin commensals. Standard microbiological techniques were used for isolation and identification of pathogens. Extended spectrum beta-lactamases were phenotypically confirmed by combined disc method. Results: Out of 1449 E.coli isolates, 323(22.29%) were found to be MDR E.coli. Isolation rate of ESBL producing E.coli (66.56%) were found to be high among MDR E.coli isolates. Conclusion: There was increasing prevalence of ESBL producing E.coli and was essential to monitor antibiotic susceptibility pattern and formulate antibiotic policy to prevent the spread of MDR and ESBL producers.

Gender Issue in COVID-19 Pandemic

Since the first outbreak, COVID-19 has manifested itself as a serious public health threat with severe social and economic implications. Gender is an essential component that requires special attention and action in such crisis. This review is aimed at finding the gender-related issues amid COVID-19 pandemic that need to be considered and help stimulate related stakeholders to devise effective policies and actions. Health, socio-economical and education, all domains of gender are viciously affected by this pandemic. Though men and women have the same prevalence, men with COVID-19 are more at risk of worse outcomes and death. Even though the direct impact of disease is observed significantly high in men, the secondary socio-economic impact is catastrophic in women and girls considering their status in society as they are systemically oppressed and vulnerable group of population. The pandemic will have a prolong effect on socioeconomic dynamics. Hardly achieved milestones on gender equality reached low, which will take long to bounce back. From this crisis, government and policy makers should take a lesson and formulate public health policies and measures to contain the epidemic that takes account of gender and its interactions with all areas of inequality.