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Background: Telemedicine use has gained momentum post the COVID-19 pandemic. Acceptance, widespread implementation and success depend on factors like understanding, knowledge and skills of the users and exploring the barriers for use of this technology and addressing them. Objective: This study aimed to assess the attitude and perception of health care professionals (HCP) towards use of Telemedicine services in Obstetrics and Gynaecology in Nepal. Materials and methods: A cross-sectional, descriptive study was carried out over six months from October 2020 to March 2021. A self-designed, pre-tested, pre-validated, web-based questionnaire was mailed to 210 healthcare professionals (HCPs) in teaching hospitals providing obstetrics and gynaecology services. Likert score was used to assess the attitude. Results: A total of 148 completed responses were received (response rate70.47%). Most respondents were females (69.6%), in age group 30-40 years (62.8%), with experience less than Ave years (68.2%). The most commonly used modality (75%) was telephonic consultations and internet messaging (viber/WhatsApp). Ten percent used multiple methods including specialized telemedicine software. The major reason for use was for primary or follow-up consultations, urgent consultations with colleagues and inter-specialty consultation. Eighty eight respondents (59.5%) had good attitude towards telemedicine (attitude score >=70%). Difficulty in making a diagnosis, need for training, fear of litigation and insufficient profits and reimbursements were perceived as few barriers. Conclusion: Most HCPs had positive attitude towards the use of telemedicine in obstetrics and gynaecology. Adequate training and clear guidelines for use are need of the hour. [ABSTRACT FROM AUTHOR]

Aim:Addressing the fertility preservation needs of breast cancer patients with receptor-positive presents considerable dilemmas and difficulties. Case description: Presenting a case of a 35-year-old unmarried female with receptor-positive breast malignancy who was referred for fertility preservation. Counseling regarding remote risk with controlled ovarian stimulation using antagonist protocol was done. Antiestrogen therapy with letrozole was added to minimize the risk with supraphysiologic estrogen levels. Five mature metaphase II (MII) oocytes were retrieved and cryopreserved for future use. Conclusion: Oocyte cryopreservation in unmarried cancer patients is an acceptable option. The addition of antiestrogen-like letrozole is advisable in estrogen receptor-positive cases. Fertility concerns of young patients should be addressed with a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the risk factors and clinico-pathological profile of patients with female genital tract malignancy. Methods: It was a prospective descriptive study of female genital tract malignancy conducted from December 2019 to December 2020 in the Department of Gynaecology, BPKIHS. Results: Out of 61 cases, cervical cancer was the most common cancer (56.0%) followed by ovarian cancer (21.0%) and gestational trophoblastic neoplasia (13.0%). The mean age of patients was 50.82±12.81 years. 38 (62.3%) were postmenopausal; 59 (96.7%) had good performance status at presentation (ECOG 1 and 2); 41 (67.2%) had early stage disease (stage I and II). 36 (59.0%) were referred outside for further treatment and majority belonged to cervical cancer (n=29;80.5%) for radiotherapy services. Eight (13.1%) patients had disease recurrence and one patient (1.6%) had death during the study duration. Among patients with cervical cancer, the mean age at marriage and at first pregnancy were 17.24±2.32 years and 19.47±2.51 years respectively. Majority of them had poor local hygiene (n=27; 79.4%). The most common presentation was post menopausal bleeding (n=29; 85.3%) and most common histology was squamous cell carcinoma (n=30; 88.3%). Conclusions: Cervical cancer is the most common female genital tract cancer followed by ovarian and gestational trophoblastic tumor. [ABSTRACT FROM AUTHOR]

Introduction: Semen analysis is an initial basic step in evaluating and diagnosing male infertility. Multiple risks factors in combination or alone are responsible for abnormal semen parameters. The present study aimed to study certain risk factors and semen parameters of infertile male., Methods: It was a descriptive cross-sectional study. We consecutively enrolled 186 male partners of infertile couple who underwent certain risk factors evaluation and semen analysis according to WHO guideline., Results: Multiple risk factors were present like Gulf country migration, smoking, chemical exposure and heat exposure in infertile male partners. Forty six percent of our patients were gulf workers. Eleven percent patients had azoospermia, 27% had abnormal sperm morphology and 23% had <25% motile spermatozoa., Conclusions: Surprisingly 46% of our patients were Gulf country workers and abnormal semen analysis is very important factor for infertility. Large prospective studies need to be carried out involving Gulf migrant workers only.

Introduction: Poor dental hygiene has been associated with various perinatal complications in studies done worldwide but few studies in Nepal have explored the knowledge of pregnant ladies regarding dental hygiene. The aim of the study was to know the knowledge and practices of pregnant women regarding oral health in a tertiary care center in Nepal., Methods: A qualitative study was carried out in Nobel Medical College and Teaching Hospital from January 15, 2018 to June 15, 2018 after approval from the Institutional Review Committee of Nobel Medical College. Convenience sampling was done. Fifty pregnant women admitted in antenatal ward were interviewed regarding their knowledge of dental care in pregnancy, the common dental problems they faced and the treatment taken. A predesigned proforma was used and results were analyzed using SPSS version 17., Results: Twenty two (44%) patients reported dental problems during pregnancy. Bleeding gums was seen in 7 (14%) and toothache in 7 (14%) were commonly reported dental problems. Forty seven (94%) patients acknowledged that routine dental care was needed for health, only 6 (12%) were aware that poor dental health could affect baby weight. Oral health not seen as priority in 24 (48%) was the main barrier to seeking dental care in pregnancy followed by costs of treatment in 18 (36%) and safety concerns in pregnancy in 8 (16%) cases., Conclusions: Though dental problems were a common occurrence in pregnancy, utilization of services was low for the same. The participants reported significant barriers to obtaining dental care including lack of knowledge about the importance of maternal oral health and the treatment costs.

Background: Necrotizing fasciitis (NF) is a serious and potentially fatal condition where there is rapid progression of inflammation of skin, subcutaneous tissue, and superficial fascia and can be mono-microbial or poly-microbial. The disease is rapidly progressive in nature and if not promptly treated leads to significant morbidity or even mortality. This study was designed to explore the various risk factors commonly present and study the outcome of the disease., Methods: This was a cross sectional study done in tertiary centre over period of one year from April 2014 to March 2015. Patient admitted with soft tissue infection were presumptively made diagnosis of NF based on clinical features and final diagnosis was made after pre-operative surgical findings., Results: Forty two (40.38%) patients had final diagnosis of NF out of 102 soft tissue infections. Twentynine (69%) of 42 patients with NF fully recovered with surgical and medical management. Eleven (26.2%) of these patients succumbed to their illness and two (4.8%) needed amputation of limb to control the infection. The most common co-morbid condition was alcoholism, followed by diabetes mellitus., Conclusions: The incidence of necrotizing fasciitis in patients admitted with soft tissue infection was 40.38%. Mortality and morbidity due to this condition was found to be high.

Background: Hyperemesis gravidarum (HG) is the most severe form of nausea and vomiting of pregnancy which can have potentially dangerous complications if untreated. Its treatment is basically supportive as the condition itself is self-limiting. The aim of our study was to evaluate maternal characteristics in patients with HG including risk factors and treatment outcome with respect to improvement in Pregnancy Unique Quantification of Emesis (PUQE) scores, number of doses of antiemetics used, weight gain during treatment and duration of intravenous fluid therapy, Methods: A cross-sectional study where all women admitted to B.P. Koirala Institute of Health Sciences with a diagnosis of HG during a period of one year were studied for different maternal characteristics. The severity of disease was quantified using Modified PUQE score and the various treatment outcomes considered., Results: The admission for hyperemesis gravidarum (n=81, including 13 readmissions) was 10.64% of total early pregnancy admissions (n = 735).The condition was more common in nulliparous patients (56%) at a mean period of gestation of 8.93 ± 2.33 wks. Most patients suffered from moderate to severe disease at presentation, mean PUQE scores being 12.29 ± 1.59. The median number of doses of intravenous antiemetics used was three (IQR 3-6), median weight gain was one kg (IQR 0-1 kg), median duration of intravenous fluid therapy was 24 hrs (IQR 24-48 hrs) and mean length of hospital stay was 3.2 ± 1.48 days., Conclusions: Hyperemesis is one of the common causes of hospitalization in early pregnancy. Treatment has favourable outcome with early recovery.