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© 2022 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd., Half of the global overweight/obese adult population have metabolic-dysfunction-associated fatty liver disease (MAFLD), with prevalence rising, even among non-obese individuals. This increase is observed globally and mostly in low- and low-middleincome countries of Africa, Asia and South America and represents a great worldwide burden on healthcare expenditures. Lifestyle changes and a healthy diet are still the cornerstone in the clinical management of these patients as approved medications are presently lacking.

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BACKGROUND Implementation of digital health technologies has grown rapidly, but many remain limited to pilot studies due to challenges, such as a lack of evidence or barriers to implementation. Overcoming these challenges requires learning from previous implementations and systematically documenting implementation processes to better understand the real-world impact of a technology and identify effective strategies for future implementation. OBJECTIVE A group of global experts, facilitated by the Geneva Digital Health Hub, developed the Guidelines and Checklist for the Reporting on Digital Health Implementations (iCHECK-DH, pronounced “I checked”) to improve the completeness of reporting on digital health implementations. METHODS A guideline development group was convened to define key considerations and criteria for reporting on digital health implementations. To ensure the practicality and effectiveness of the checklist, it was pilot-tested by applying it to several real-world digital health implementations, and adjustments were made based on the feedback received. The guiding principle for the development of iCHECK-DH was to identify the minimum set of information needed to comprehensively define a digital health implementation, to support the identification of key factors for success and failure, and to enable others to replicate it in different settings. RESULTS The result was a 20-item checklist with detailed explanations and examples in this paper. The authors anticipate that widespread adoption will standardize the quality of reporting and, indirectly, improve implementation standards and best practices. CONCLUSIONS Guidelines for reporting on digital health implementations are important to ensure the accuracy, completeness, and consistency of reported information. This allows for meaningful comparison and evaluation of results, transparency, and accountability and informs stakeholder decision-making. i-CHECK-DH facilitates standardization of the way information is collected and reported, improving systematic documentation and knowledge transfer that can lead to the development of more effective digital health interventions and better health outcomes.

Introduction: Basic life support (BLS) refers to preserving an airway and promoting breathing and circulation without the use of any tools. It saves lives if given timely. The lack of training and knowledge of BLS might lead to tragic consequences. Objective: To assess the knowledge regarding BLS among dental surgeons. Methods: A web-based cross-sectional study was conducted among dentists in Haryana, during April-May 2020 using a semi-structured proforma. It consisted of sociodemographic data and 11 close-ended items on BLS. Score 1 was given for each correct answer. A google form was prepared via docs.google.com/forms and the link was sent to the participants via social media platforms like WhatsApp and Viber. The filled questionnaires were extracted from the Google Forms and exported to Microsoft Excel 2016. Descriptive statistics like mean, frequency and percentage were calculated to present the study findings using Statistical Package for the Social Sciences (SPSS) software (version 21). Results: Out of 73 participants, 59 (80.8%) were male and 60 (82.2%) belonged to age group of 31-45 years. Forty one (56.2%) participants had completed a bachelor of dental surgery. Mean (±SD) knowledge score was 8.75±2.46. Thirty eight (52.1%) participants scored less than 50% of the maximum score. The knowledge score was high in male and aged 31-45 years and it was statistically significant (P-value

Background: Coronavirus disease (COVID-19) has been declared as a global pandemic. In the absence of vaccines or specific drugs for COVID-19, a better understanding and implementation of universal safety precautions is essential for the prevention of COVID-19 virus infection globally. People’s adherence to the universal precautions safety measures against COVID-19 is essential which is largely affected by their knowledge and belief. Objectives: To assess the public’s knowledge and belief toward the universal safety precautions during COVID-19 pandemic. Materials and Methods: A cross-sectional web-based online survey was conducted in general public in Nepal during April, 2020. A self-designed questionnaire was prepared using Google forms via docs.google.com/forms for the collection of the data. The study participants were grouped into two categories according to their level of knowledge: excellent (score 80% and above) and average (score less than 80%). Descriptive statistics mean, frequency and percentage were used to analyze the data. Results: Out of 228, majority were male (90.4%) and aged 36-45 years (36%). Mean knowledge score was 4.68±1.41. Most of them (57.9%) had average knowledge. Average of the correct responses in the knowledge and belief domain were found to be 66.9% and 71.2% respectively. Majority of the public (55.3%) believed that home-made alcohol-based hand sanitizer is equally effective to factory-made standard sanitizer against COVID-19 virus. Conclusion: Knowledge toward universal safety precautions against COVID-19 were average among the majority of the public. There was gap between knowledge and belief domain. There is an unmet need for long term educational interventions among the public regarding the preventive methods against COVID-19. Keywords: Knowledge; Belief; COVID-19; Nepal; Public; Universal safety precautions.

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Background: The emergency department (E. D.) of any hospital is an important entry point of critically ill patients. The initial management of these patients is often challenging, and for valuable lives to be saved, the infrastructure and manpower should be up-to-date. Materials and Methods: This retrospective study was carried out from previous medical record of emergency ward of B. P. Koirala Institute of Health Sciences (BPKIHS) from April 2015 to March2016. Total duration of study was one year. Data was extracted from medical records, entered in Mescal and analyzed with SPSS software. Results: The mortality rate at the BPKIHS emergency ward was 1.05%. Their ages ranged from 10-91 years with 43% of deaths among age >60 years. There was a similar proportion of death among the males and females, with almost 90% of cases in the Australian Triage Score (ATS) 1 and 2, i.e. the most severe cases. Sepsis, chronic obstructive pulmonary disease and chronic kidney disease were the common causes of death in BPKIHS emergency ward. Conclusion: Mortality was high in ATS 1 and 2, i.e. severe cases of ED. There is a need for further exploration of the cases including the morbidity profiles at BPKIHS emergency ward. More studies are needed to come to a conclusion regarding the quality of care.

Introduction Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU) acquired infection among patients receiving mechanical ventilation. Accurate clinical and microbiologic diagnosis of VAP is essential not only for selection of appropriate antimicrobials but also to prevent their misuse. As the organisms and their sensitivity pattern may differ in every ICU, the knowledge of the resident flora and their behaviour should be known for successful treatment. Methods The study was conducted to evaluate the organisms responsible for VAP and their Antibiotic Sensitivity Pattern for the study setting. A prospective, open, epidemiological clinical study was performed in a tertiary care hospital in Nepal. 100 patients admitted to ICU and Mechanically Ventilated were evaluated about VAP. Clinical Pulmonary Infection Score (CPIS) was used to diagnose VAP. Results Among 60 patients ventilated for more than 48 hours, 25 (41.6%) developed VAP. The VAP was caused predominantly by Klebsiella pneumonia in 34.5% of cases, followed by Acinetobacter calcoaceticus baumanni in 27.6%, Acinetobacter wolffi and Pseudomonas aeruginosa in 13.8% each and Escheresia coli in 10.3%. The most sensitive antibiotics were Colistin, followed by Polymyxin B and Amikacin with sensitivity rates of 67%, 60% and 58%, respectively. Conclusion Based on these results, an empiric approach to antibiotic treatment can be made tailored to the specific settings. Given the magnitude of drug resistance and its implicated financial and societal burden, there is an urgent need for broad implementation of Antibiotic Stewardship programs across all health care settings.

The World Organization of Family Doctors (WONCA) is a not-for-profit organization and was founded in 1972 by member organizations in 18 countries. WONCA now has 118 Member Organizations in 131 countries and territories with a membership of about 500,000 family doctors and more than 90 percent of the world's population. WONCA has seven regions, each of which has its own regional Council and run their own regional activities including conferences. WONCA South Asia Region is constituted by the national academies and colleges and academic member organizations of this region namely India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, and the Maldives. In the background of the ongoing COVID 19 pandemic, the office bearers, academic leaders, practitioners, and researchers of primary care from the South Asia Region have issued a solidarity statement articulating the role of primary care physicians.

Introduction: Domestic violence is certainly an important condition, and certainly carries significant health consequences. Screening is probably acceptable to most patients attending an emergency department. The objective of this study is to find out the frequency of domestic violence victims attending emergency department, to find out the factors related to domestic violence, type, and severity of injury and to identify the impact of domestic violence in the victims. Materials and Methods: This was a cross-sectional observational study done in the Department of General Practice and Emergency Medicine of BP Koirala Institute of Health Sciences from January 2014 to December 2014. Anyone presented with a physical injury intentionally caused by a relative, partner, or other household member (spouse, partner, sibling, ex-partner, child, and other wives/partner of spouse). Results: The total number of patient enrolled in this study was 423. Among which 71.9% were female and 28.1% were male. About 27% of female and 31.9% of male were in the age group of 20–30 years. Majority (42.4% females and 48% males) of the victim's family had agriculture for primary occupation. Among the study groups, 40.9% of cases were beaten by direct hit and 24.3 with weapon, 5% of cases were only reported as rape, and 23.6% as homicidal case. Conclusion: Domestic violence is particularly insidious form of gender-based violence. In the place where they should feel the greatest safety and security- the family-women often face terror form of physical, psychological, sexual, and economic abuse.

Background: Acute appendicitis is one of the most common causes of acute abdominal pain presenting in emergency department. Preoperative use of adequate analgesia markedly reduces pain without affecting diagnosis accuracy and furthermore no single analgesia has been used for this purpose.Objective: To determine and compare the efficacy of injection diclofenac and injection tramadol for rapid pain management of acute appendicitis in emergency department.Methods: An experimental clinical trial was done including 50 patients aged _8 years who were clinically diagnosed as acute appendicitis and had not received analgesia prior to examination by the researcher. They were randomly divided into 2 groups: 25 patients (group 1) were given injection diclofenac intramuscularly and 25 patients (group 2) were given injection tramadol intravenously. Comparative analysis was carried out regarding the decrease in pain intensity using visual analogue scale (VAS) score for pain at presentation, at half an hour and at one hour of drug administration.Results: All the patients had VAS score of _5 at presentation without significant difference in the two groups. Half an hour after drug administration, 64% of subjects still had a VAS score of _6 in the first group while only 12% in the second group (p=0.005). At one hour of drug administration, 64% of subjects had a VAS score between 4 and 7 and 36% had score between 0 and 3 in group 1. In contrast to this score, in group 2 only 16% of the subjects scored between 4 and 7 and 84% between 0 and 3 (p=0.001).Conclusion: There was rapid and marked decrease of VAS score or pain in tramadol group as compared to diclofenac group. Hence, we can recommend that injection tramadol intravenous be considered for preoperative use for pain management of acute appendicitis in emergency department. Health Renaissance 2015;13 (1)

Aconitine and related alkaloids found in the Aconitum species are highly cardiotoxic and neurotoxic. The wild plant (especially the roots and root tubers) is extremely toxic. Severe aconite poisoning can occur after accidental ingestion of the wild plant or consumption of an herbal made from aconite roots. In traditional Chinese medicine, aconite roots are used only after processing to reduce the toxic alkaloid content. Soaking and boiling during processing will hydrolyze aconite alkaloids into less toxic and non-toxic derivatives. However, the use of a larger than recommended dose and inadequate processing increases the risk of poisoning. The aconite herb is one of the commonly-prescribed ingredients for various clinical problems. However, due to its narrow therapeutic index, toxicities are not uncommonly encountered, including life-threatening cardiac arrhythmias like ventricular arrhythmias Health Renaissance 2015; 13 (1): 108-111

Background: Hypertension is a common disease affecting about 20% of the adult population, both in developed and developing world (WHO 2002). It is one of the serious public health problems. Timely detection, compliance with lifestyle modification and use of drugs are important for effective management of this condition. Objective: To find out the prevalence of systemic hypertension in the general outpatient department and to study the effect of drugs and lifestyle education on the blood pressure over time. Methods: This was an interventional series of cases involving diagnosis and management of patients with BP higher than 140/90 or with known hypertension. All the subjects included were given life style education to see the effect of change of life style on blood pressure over time. Results: A total of 258 subjects were screened and 145 (56%) were diagnosed as hypertensive. Of the total, 75 (29%) had a blood pressure level in pre- hypertensive range. Whereas, 42 (16.3%) had hypertension of stage 1, and 28 (11%) had hypertension of stage 2. Forty- nine patients came for first follow up, 40 patients for second and 10 patients for the third follow up. Blood pressure started to decrease with second follow up. Conclusion: This study demonstrated that the prevalence of hypertension is 56% in the general outpatient department. The lifestyle education can have positive impact on blood pressure control. Health Renaissance 2015;13 (1): 58-67

Background: This study investigated knowledge of and practices towards standard precautions, among all health care workers working in the emergency department in BPKIHS. Objective: To find out the factors influencing use of standard precautions in the emergency department, BPKIHS Dharan.Methods: This was a prospective observational study conducted in the emergency department. Data was collected in three ways: by direct observation of work practice, a questionnaire about knowledge, attitude and skills and through focus group discussions.Results: Regarding standard precaution, majority (54.2%) had partial knowledge. Only 4.2% know the component of it. In practice 69.52% among doctors group washed hand even though once in four observations; 96% used soap. 43.80% used gloves in doctors group in four observation; sisters used gloves the entire times. 74% washed hand after gloves removal (178). 35.23% didn’t recapped needles before disposal from those who used it among doctors group. Recapping is complete in sisters’ group. 60.95%. Sisters had complete proper disposal practice.Conclusion: Knowledge and practice of SP has direct impact in health of patient and HCW. High level of occupational exposure to blood highlights the urgent need for intervention to enhance occupational safety to prevent unnecessary nosocomial transmission of BBD. Strategies for promoting injection safety are necessary if the risk of nosocomial transmission of BBV via unsafe injection practice is to be minimized. Health Renaissance 2015;13 (3): 54-64

Background: Discharge summaries are intended to transfer important clinical information from inpatient to outpatient settings and between hospital admissions. A good discharge summary helps physician to provide continuity of care which will in turn improve patient outcomes. Despite the importance of the discharge summary, there has been relatively little research in this area in Nepal. We therefore decided to review discharge summaries of patients discharged from emergency department in eastern Nepal.Objective: To assess the completeness of discharge summaries from emergency department. Methods: A total of 360 discharge summaries, representing 20% of discharge from the emergency department of B.P. Koirala Institute of Health Sciences, Nepal were randomly selected and evaluated. Quality of discharge for completeness was evaluated using recommendations by Joint Commission on Accreditation of Hospital for the presence or absence of the following key items: admission diagnosis, drug allergy, physical examination, significant laboratory test and results, discharge diagnosis, procedures, discharge medication (including dose and duration), follow up and attending physician signature.Results: The proportion of discharge summaries missing particular component of vital data ranged from less than 4% (no discharge medications) to 97% (no mention of drug allergy). Information was missing on patients discharge condition (74%), hospital course (61%), discharge instruction (57%) and the discharge diagnosis in (13%). Most of the discharge summaries were partially structured representing 75%. Ease of access to the diagnosis was 78%.Conclusions: Though most of the discharge summaries were structured and access to the diagnosis was 78%, considerable deficiencies in the completeness of discharge summaries were found. Health Renaissance 2015;13 (3): 41-47

Background: The term chronic headache is commonly taken as headache lasting for more than three months. It is common in general practice with minimal research on the topic in Nepal. Objective: To sort out the common diagnoses of chronic headache and to study the clinical features and demographic profile of patients presenting with chronic headache. Method: A descriptive cross sectional study was conducted (2012 August to 2013 August) at General Practice outpatients in BP Koirala Institute of Health Sciences, a medical university in eastern Nepal. Approval and ethical clearance was taken from Research Committee and Institutional Ethical Review Board. Descriptive statistical analysis was done. Result: 168 patients constituting 1% of outpatient visits presented due to chronic headache. Mean age was 29.57 years (SD 10.53) and female to male ratio was 3.67. Mean number of days of headache was 19.46 days (SD 4.62). Numerical pain score was reported at 7.1/10 (SD 1.85). The mean duration of presentation was 22 months (SD 11). 40% reported impaired activity of more than one week. Headache was classified as chronic migraine in 20.2%, chronic tension type headache in 16.7%, and chronic daily persistent headache in 11.9%. The diagnosis did not fit into any diagnostic criteria in 51.2% cases. Conclusion: Chronic headache is common in females and young age group. Patients present late despite significant pain scores. Significant proportion is still unclassified. Health Renaissance 2015;13(2): 22-29

Background: Deliberate self-harm (DSH) is a widespread yet often hidden problem in adolescents and young adults though most DSH can be classified as “non-suicidal self-cutting”, some do go on to commit suicide. DSH present in acute settings of hospitals while limited information are found on reasons and methods for DSH in eastern Nepal. This study aimed at exploring the reasons and methods for deliberate self harm among patients presenting in acute setting of BPKIHS. Objective: To study the methods used and reasons for deliberate self harm in the patients presenting in emergency department and psychiatry outpatient clinics of BPKIHS. Method: Mix method (quantitative and qualitative) was used to conduct cross-sectional study using a pretested semi-structured questionnaire among 400 patients presenting in emergency department and out-patient clinic of Psychiatry department. In-depth interview was conducted among 12 respondents. Result: Four fifth of the patients, used poison as the method for DSH followed by hanging among less than a tenth of the patients. Majority (88%) of the patients did not have any planning before committing act of DSH. Interpersonal conflict (48%), financial reasons (20%) and broken love affairs (16%) are common events triggering DSH. Two-third of patients who presented with DSH were impulsive and almost two-fifth of them had depression. Conclusion: DSH was more common among the younger population. Advocacy to regulate the availability of pesticides for agricultural use may be needed to prevent the at risk population for accessing and using it for self harm. More community based studies to further explore the social aspects for the act of DSH and further researches is needed to design interventions to prevent the act of DSH at community level. Health Renaissance 2015;13(2): 92-104

Acute flaccid paralysis (AFP) is a common presentation to the emergency department and can present with paralysis of single to several limbs. Here is a case with AFP presented to highlight the approach to diagnosis. A 25 years male who recently returned from Malaysia presented to the emergency ward with acute onset of paralysis for two days which was progressive and was gradually involving the chest muscles as well. He had a history of loose mucoid stool since 4-5 days but there were no rashes or exanthema in the body. On complete examination, apart from diminished power in all the limbs, there were no other positive findings. He was started on expectant management and no other medications except multivitamins were prescribed. Patient was discharged home on patient party’s request and on follow-up after 14 days, patient's had improved.Health Renaissance 2015;13(2): 164-169

Proton Pump Inhibitors serve as the cornerstone of management of Upper Gastrointestinal bleeding. In Nepal, intravenous Pantoprazole is widely used. One of the rare complications of intravenous Pantoprazole is thrombocytopenia which may lead to paradoxical increase in bleeding possibility. Here, we present a 70 year old gentleman who presented with hematemesis and melena and was treated with IV Pantoprazole. The Platelet count started decreasing from the third day onwards following which the patient was switched to Rabeprazole on the fourth day. Platelet count subsequently normalized. Thus, drug induced thrombocytopenia is one of the rare complications that has to be kept in mind with the use of Pantoprazole.

Pramendra Prasad Gupta,1 Rabin Bhandari,1 Deebya Raj Mishra,2 Krishna Kumar Agrawal,3 Rupak Bhandari,1 Sunil Jirel,1 Gyanendra Malla1 1Department of General Practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; 2Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; 3Department of Internal Medicine, Nepal Medical College and Teaching Hospital, Kathmandu, Nepal Background: Drug-induced hypersensitivity reaction is of great clinical significance in therapeutics. The objective of this reporting of two cases is to show that anaphylaxis reaction can occur with pantoprazole. Case summaries: A 38-year-old female reported to the emergency ward in a critical condition, with a history of periorbital edema, edema of the skin, pruritus, nausea, vomiting, and difficulty breathing 20 minutes after ingestion of a pantoprazole 40 mg tablet. A 32-year-old female reported to the emergency ward in a critical condition, with complaints of rashes all over the body, itching on the whole body, and swollen lips and eyes after ingestion of a pantoprazole 40 mg tablet. Conclusion: It is necessary for all health care providers to know that pantoprazole can cause anaphylaxis, which is a life-threatening reaction, and to be cautious while prescribing it. Keywords: anaphylactic reactions, pantoprazole, proton pump inhibitors

Background: Perinatal mortality includes both deaths in the first week of life and fetal deaths (stillbirths). Over 130 million babies are born every year, and more than 10 million infants die before their fifth birthday and almost 8 million before their first birthday.Objectives: To make an effort to find out impact of birth interval on fetal outcomes like, low birth weight (weight less than 2500 grams regardless of gestational age), perinatal death (death within 28 weeks of gestation to 7 days of birth) in subsequent pregnancies.Methods: This was a cross-sectional study conducted in BPKIHS, Dharan in 2011. Patients included were women of second gravida between age group 20 -35 years .The consecutive convenience sampling method was used to collect the data. Study population was divided into three birth interval groups of 59 months respectively and fetal outcomes (low birth weight, gestational age, early neonatal death, Apgar score) were compared.Results: Out of included population majority (55.63%) of the women had age range of 20-25 years with the mean age of 25.30. Among the total 168 who were included 20(11.91%) were belongs to birth interval 59 months group.Conclusion: There was increased risk of preterm and low birth weight and perinatal death in women with birth interval 59 months. Health Renaissance 2015;13(3): 169-176

Telemedicine is a process which involve medical experts to exchange valid information for diagnosis, clinical management, treatment and counseling for both healthcare workers and patients remotely in rural setting from urban healthcare center. Providing quality healthcare services in Nepal is challenging due to many reasons such as difficult geographic terrain, limited availability of funding and many other issues.The study design was a cross sectional and will adopt an interpretative case study approach which supports the researcher to develop a deep insight in to study phenomenon and outcomes. Study was conducted at in two rural-telemedicine programme implementation sites, namely Patle, Fikkal Bazaar and one central consultation site BPKIHS Dharan.A total of 315 patients were undergone teleconsultation process during the study period. The total patients consulted after teleconsultation program in each of center were 1386 (Phikal) and 508 (Patle). Among them 205 (Phikal) and 110 (Patle) were called on the teleconsultation day. Among the patients who were seen via teleconsultation, 36 (2.6 %) from Phikal and 22 (4.3%) from Patle were referred to BPKIHS. The total number of referred patient from those center to other center were 327(Phikal) and 208 (Patle) among those referred 205 (Phikal) and 110 (Patle) came during teleconsultation Process.Telemedicine can be used as a critical component in the solution of the healthcare crisis. Telemedicine will be the best as a substitute to improve the access to healthcare, to provide the healthcare cost-effectively. The current paradigm of care can be taken by telemedicine due to which improved health outcomes can be achieved in cost effective Ways.

Background: The global pandemic COVID-19 has created havoc. Various myths prevail among public that hamper them from adopting evidence based preventive measures to minimize the spread of COVID-19 and to seek timely health advice. The aim of the study was to find out the public’s view on myths related to COVID-19 in educated Nepalese population.Methods: A cross-sectional web-based online survey was conducted in educated public in Nepal during May, 2020. A self-designed questionnaire consisting of sociodemographic variables and 21 myths was prepared using Google forms via docs.google.com/forms. The responses were recorded on a 3-point scale (agree, disagree, do not know). The Google form link was sent to the study participants via the social media platforms like Facebook, WhatsApp and Viber. Descriptive statistics mean, frequency and percentage were used to analyze the data using SPSS version 22. Results: Out of 270, 33.7%, 33.3% and 37% participants agreed that eating lemon, turmeric and garlic prevents us from COVID-19 respectively. Thirty seven percent participants believed that spraying bleach or disinfectant into our body will protect us against COVID-19. The overall view of participants toward the myths related to COVID-19 was ‘agree’ (17.3%), ‘disagree’ (59.2%) and ‘don’t know’ (23.5%).Conclusions: Myths regarding COVID-19 prevailed among majority of the participants in this study. There is an urgent need to educate the public regarding various preventive approaches for COVID-19 issues. Media and government agencies have a vital role in creating awareness to adopt evidence-based facts.

Background: Mosquito borne diseases are major health problems in rural areas even after implementation of national Vector Borne Disease Control Programme in Nepal. The information on mosquito borne diseases related knowledge, practices and behavior of the people of rural and peri-urban areas of Nepal living in endemic areas are essential to develop behavioral change communication messages and for producing policy to prevent and control mosquito borne disease in the country. Objective: To assess knowledge, practices and behavior of the people living in rural and peri-urban areas regarding mosquito borne diseases. Methods: A cross-sectional study of 413 households was conducted from 10th March - 10th April, 2013 in Inaruwa municipality and Duhabi village of Sunsari District. Pre-tested semi-structured questionnaire were administered by face to face interview for data collection. Results: Ninety four percent responded, malaria was caused by mosquito but only 21% responded as dengue and Japanese encephalitis was caused by mosquito. Malaria and filariasis were considered fatal disease by 40%; however 20% had no idea about Japanese encephalitis and dengue. More than 70% respondent had perception that mosquito bites at night only. Although use of bed-net was found to be higher; only 2% had knowledge on insecticide impregnated bed-nets. 31% of respondents didn’t take medication during anti-filarial campaign supplied by government mainly due to side effects. It was observed that 61% respondents were unaware about the routine JE vaccination by Nepal government. Conclusion: Health education must be taken into account for communities in endemic areas to create awareness regarding prevention from mosquito borne diseases. Health Renaissance 2014;12(2): pp: 92-98

Health Renaissance 2015;13(2): 1-6

Foreign body ingestion is a common occurrence in children and in specific high-risk groups. It is usually diagnosed based on a history of ingestion given by the patient or an observer. However, children and mentally retarded adults may be unable to give an accurate history, and a high index of suspicion must be maintained in these groups. We report a rare case of foreign body stone in an mentally retarded adult which presented with drooling and impaired feeds, thence enabling for high index for suspicion. Health Renaissance 2014;12(2): pp: 140-142

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Primary healthcare is considered an essential feature of health systems to secure population health and contain costs of healthcare while universal health coverage forms a key to secure access to care. This paper is based on a workshop at the 2016 World Organization of Family Doctors (WONCA) South Asia regional conference, where the health systems of Bangladesh, India, Nepal, Pakistan and Sri Lanka were presented in relation to their provision of primary healthcare. The five countries have in recent years improved the health of their populations, but currently face the challenges of non-communicable diseases and ageing populations. Primary healthcare should be a core component in restructuring health systems. However, there is a lack of understanding among policymakers of the unique contribution of primary healthcare to the health of populations. This results in insufficient investment in facilities and low priority of specialty training in the community setting. Regional collaboration could strengthen the advocacy for primary healthcare to policymakers and other stakeholders. Priorities were investment in community-based health facilities, and access to healthcare through professionals specialty-trained in the primary healthcare setting. This development fits the strategy of the WHO South East Asian Region to use community-based healthcare in achieving universal health coverage for the Asian populations.

Dapsone (4, 4’-diaminophenylsulfone), a sulfonamide derivative, was introduced in 1943 as an effective chemotherapeutic agent for leprosy and still is an important drug for the treatment of this disease. Because of its use in various conditions, its toxicity is commonly seen in adults but rare in children. Rapid clinical assessment, measurement of methemoglobin and institution of methylene blue where indicated decreases the morbidity and mortality of dapsone poisoning. We report a case of 2 year old female with accidental ingestion of 20 tablets (20gm) of dapsone.DOI: http://dx.doi.org/10.3126/hren.v12i1.11988Health Renaissance 2014;12(1):52-54

Background: Poisoning is common in Nepal. The objective of the study was to describe the profile of poisoning cases presenting to the emergency of a medical university in eastern Nepal. The specific focus was on to describe the presentation, demographics, delay to care and describe the triage parameters at presentation. Methods: An observational study was done. The secondary data from case files of all poisoning patients starting February 2012 to March 2013 were analyzed after retrieving them from Hospital record. Results: Poisoning constituted 3.89% of total emergency visits. Mean age was 24 years with female: male 1.32. Median time delay to presentation from the incident was 4 hours. Mortality rate was 5.1%, intubation rate 6.3%. Agricultural products ingestion (763/1399) was the commonest modality. The triage vitals were noted as median 110 mm of Hg (Q25, Q75 100, 120) for systolic blood pressure, median 87 mm of Hg (Q25, Q75 73, 93) for mean arterial pressure and median 97 (Q25, Q75 94, 98) for SPO2 by pulse oximetry. The level of consciousness was noted as alert (87.6%), response to verbal stimuli (3.7%), response to pain stimuli (7.1) and unconscious (1.6%). Comparison between mortality and no mortality groups showed significant difference for mean arterial pressure (n 1399, p

Background Penetrating orbital injuries pose a serious threat to vision, ocular motility, and in some cases, life. The setting and causes of eye injury are diverse, but previous studies have demonstrated that the risk and type of injury is often correlated with age, gender, and race. Pediatric ocular injury is often accidental and may be preventable. A focused history and prompt ocular examination are essential to immediate management. Case presentation This article describes a case of protruding foreign body-related penetrating orbit injury with a retained foreign body in a 4-year-old male from a town in the eastern part of Nepal. The child presented to the emergency with foreign body in situ without receiving any pre emergency care without any medical attendance. The patient was managed with non-operative removal of foreign body in the emergency. The case discussion will review the initial presentation, examination, resultant management decisions, and final outcome. Conclusion Foreign body presentations may be diverse and non-operative management may be considered in selected cases. Resource availability and conditions at presentations may also influence the management decisions. This case presentation has described such a scenario in developing country like Nepal and is expected to be interest across various medical specialties.

Introduction:Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment. Methods: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics. results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70). Conclusions: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain. _______________________________________________________________________________________ Keywords: analgesia; emergency; Nepal. _____________________________________________________________________________________