Search

Background and Objectives: Overweight and Obesity is a highly prevalent global epidemic. South Asians are more vulnerable to obesity-related diseases with rising co-morbidities when compared to developed countries. It is linked with several health complications. Globally more women are found overweight or obese compared to men. So this study is planned to examine the life-style related determinants of overweight and obesity in reproductive aged females (15-49 years) in Nepal. Material and Methods: Analytical cross-sectional study was carried out among reproductive aged females (15-49 years) of Kathmandu Metropolitan city, Nepal. Stratified random as well as population proportionate sampling technique was used to determine number of respondents from each selected ward. A structured questionnaire for nutrition intake and various demographic and lifestyle factors reviewed by the panel of experts was administered for data collection. Overweight or obesity was considered as per BMI international cut-off points for adults. Results: Overweight or obesity (BMI≥25) in reproductive aged females was found to be 26%. Women who were working, married, and had family history of overweight and obesity and those who took fast foods moderately were found significantly more likely of becoming overweight or obese (p < 0.05). Moderate physical activity, daily breakfast intake, were found to be significantly less likely of becoming overweight or obese in reproductive aged women (p < 0.05). Conclusions: Moderate physical activities as well as daily breakfast consumption is more likely to reduce overweight and obesity. The findings can be used as a guideline for overweight and obesity prevention in reproductive aged women. Some larger prospective studies are needed.

Introduction Intentional pesticide poisoning is a major clinical and public health problem in agricultural communities in low and middle income countries like Nepal. Bans of highly hazardous pesticides (HHP) reduce the number of suicides. We aimed to identify these pesticides by reviewing data from major hospitals across the country and from forensic toxicology laboratories. Methods We retrospectively reviewed medical records of 10 hospitals for pesticide poisoned patients and two forensic laboratories of Nepal from April 2017 to February 2020. The poison was identified from the history, referral note, and clinical toxidrome in the hospitals and from gas chromatography analysis in the laboratories. Data on demographics, poison, and patient outcome were recorded on a data collection sheet. Simple descriptive analysis was performed. Results Among hospital cases (n = 4148), the commonest form of poisoning was self-poisoning (95.8%) while occupation poisoning was rare (0.03%). Case fatality was 5.3% (n = 62). Aluminum phosphide (n = 38/62, 61.3%) was the most commonly identified lethal pesticide for deaths. Forensic toxicology laboratories reported 2535 deaths positive for pesticides, with the compounds most commonly identified being organophosphorus (OP) insecticides (n = 1463/2535; 57.7%), phosphine gas (n = 653/2535; 25.7%; both aluminum [11.8%] and zinc [0.4%] phosphide) and organochlorine insecticides (n = 241/2535; 9.5%). The OP insecticide most commonly identified was dichlorvos (n = 273/450, 60.6%). Conclusion The data held in the routine hospital medical records were incomplete but suggested that case fatality in hospitals was relatively low. The pesticides identified as causing most deaths were dichlorvos and aluminum phosphide. Since this study was completed, dichlorvos has been banned and the most toxic formulation of aluminum phosphide removed from sale. Improving the medical record system and working with forensic toxicology laboratories will allow problematic HHPs to be identified and the effects of the bans in reducing deaths monitored.

Background: The cases of Coronavirus disease-2019 (COVID-19) has been gradually increasing in Nepal. The objective of this study was to evaluate knowledge, attitude and practice regarding COVID-19 among healthcare workers in Chitwan, one of the districts located in central Nepal. Methods: It was a descriptive, cross-sectional study, conducted among healthcare workers from differ­ent health institutions of Chitwan, over the span of two weeks from 1st April, 2020 till 14th April, 2020. Bivariate analyses of knowledge, attitude and practice scores were done with different variables using appropriate tests in SPSS IBM version 25. Results: Out of 353 responses, 166 (47%) were nurses, 102 (28.9%) were doctors, 41 (11.6%) were health assistants, 7 (2%) were community medical assistants, and the remaining 37 (10.5%) were cat­egorized as others. 290 (82.2%) healthcare workers obtained moderate to good knowledge scores, 295 (83.6%) obtained moderate to good practice scores, and 321 (90.9%) had positive attitude scores. Doctors had highest mean knowledge scores (23.70 ± 4.48, p value- 0.000) and health assistants had highest mean practice scores (15.10±3.61, p value- 0.007). Positive correlation was obtained between knowledge and practice scores (r= 0.476, p value- 0.000); and attitude and practice scores (r= 0.238, p value- 0.000). Only 20.4% healthcare workers were confident to handle the pandemic in their health­care setup. Conclusions: The majority of healthcare workers had moderate to good knowledge and practice scores and had a positive attitude toward COVID-19. There was a significant association between knowledge, attitude and practice scores obtained by healthcare workers from Nepal.

Background: The cases of Coronavirus disease-2019 (COVID-19) has been gradually increasing in Nepal. The objective of this study was to evaluate knowledge, attitude and practice regarding COVID-19 among healthcare workers in Chitwan, one of the districts located in central Nepal. Methods: It was a descriptive, cross-sectional study, conducted among healthcare workers from differ­ent health institutions of Chitwan, over the span of two weeks from 1st April, 2020 till 14th April, 2020. Bivariate analyses of knowledge, attitude and practice scores were done with different variables using appropriate tests in SPSS IBM version 25. Results: Out of 353 responses, 166 (47%) were nurses, 102 (28.9%) were doctors, 41 (11.6%) were health assistants, 7 (2%) were community medical assistants, and the remaining 37 (10.5%) were cat­egorized as others. 290 (82.2%) healthcare workers obtained moderate to good knowledge scores, 295 (83.6%) obtained moderate to good practice scores, and 321 (90.9%) had positive attitude scores. Doctors had highest mean knowledge scores (23.70 ± 4.48, p value- 0.000) and health assistants had highest mean practice scores (15.10±3.61, p value- 0.007). Positive correlation was obtained between knowledge and practice scores (r= 0.476, p value- 0.000); and attitude and practice scores (r= 0.238, p value- 0.000). Only 20.4% healthcare workers were confident to handle the pandemic in their health­care setup. Conclusions: The majority of healthcare workers had moderate to good knowledge and practice scores and had a positive attitude toward COVID-19. There was a significant association between knowledge, attitude and practice scores obtained by healthcare workers from Nepal.

IntroductionThere is limited data on clinical course and outcomes of hospitalized adults with COVID-19 in Nepal. Thus, it is imperative to characterize the features of this disease in the domestic context.MethodologyWe identified all adult patients with laboratory-confirmed COVID-19 admitted to five different hospitals in Nepal from June 15 to July 15, 2020. We collected epidemiological, socio-cultural and clinicopathologic data, and stratified the patients based on their symptom status.ResultsThe study included 220 patients with an overall median age of 31.5 (25-37) years, and 181 (82.3%) were males. 159 (72.3%) were asymptomatic, and 163 (74.1%) were imported cases. Of 217 patients with the available data, 110 (50.7%) reported their annual household income less than 2000 US dollars, and 122 (56.2%) practiced Pranayama (yogic rhythmic breathing techniques) regularly. Eight patients (3.6%) required supplemental oxygen and two patients (0.9%) died. None of the patients who practiced Pranayama regularly required supplemental oxygen. Compared to asymptomatic patients, symptomatic patients had greater proportion of females (31.1% vs. 12.6%, p=0.001), imported cases (85.2% vs. 69.8%, p=0.02), illiterates (26.8% vs. 12.1%, p=0.01), alcohol users (43.3% vs. 24.5%, p=0.01), patients feeling stigmatized by society (45.8% vs. 22.6%, p=0.001), and had higher platelet count (253× 109/L vs. 185×109/L, p=0.02).ConclusionsMost cases were imported, asymptomatic young males, with very few deaths. Pranayama practice was associated with protection against severe COVID-19, but more data is needed to substantiate this. The association of platelets count with symptom status in the Nepalese population needs further exploration.

Recurrent or persistent positivity of severe acute respiratory syndrome coronavirus-2 RNA in clinically recovered coronavirus disease patients has been reported worldwide. However, replication-competent live viruses were not recovered beyond two to three weeks from the onset of symptoms in mild to severe cases of coronavirus disease. End-stage renal disease is characterized by uremia induced immune dysfunction that increases the risk of infectious diseases including coronavirus disease. The clinical implications of recurrent or persistently positive severe acute respiratory syndrome coronavirus-2 RNA in immunocompromised patients are difficult to be generalized to findings as in immunocompetent patients. We report a case of end-stage renal disease with a recent history of recovered coronavirus disease pneumonia, who again presented with positive reverse transcriptase-polymerase chain reaction test for severe acute respiratory syndrome coronavirus-2 RNA.

Background COVID-19 is a viral respiratory disease that was recently recognized in humans. The number of COVID-19 cases has been gradually increasing in Nepal. The objective of this study was to evaluate knowledge, attitude and practice regarding COVID-19 among healthcare workers in Chitwan, one of the districts located in central Nepal. Methods It was a cross-sectional study conducted among healthcare workers from various health institutions located in Chitwan district of Nepal. A self-reported questionnaire was circulated online. Bivariate analyses were done using Spearman’s correlation coefficient, Pearson’s chi square test, and student’s t test as appropriate, whereas multivariate analyses were done using linear regression models. Results A total of 353 responses were analyzed, out of which 47% were nurses, 28.9% were doctors, 11.6% were health assistants, 2% were certified medical assistants, and the remaining 10.5% were categorized as others. The majorities were females (58.9%), were in the age group of 16–29 years (67.1%) and had work experience of less than 5 years (62%). The majority of healthcare workers obtained good to moderate knowledge and practice scores (n = 82.15%, 83.57%, respectively) and had positive attitude scores (n = 90.93%). Mean score values were 21.65 ± 4.71 out of 33 in knowledge section, 8.07 ± 1.49 out of 13 in attitude section and 13.89 ± 5.33 out of 20 in practice section. Mean knowledge and practice scores were significantly associated with job descriptions of healthcare workers (p value – 0.000, 0.007, respectively) with highest mean knowledge scores among doctors (23.70 ± 4.48) and highest mean practice scores among health assistants (15.10 ± 3.61). Higher practice scores (ß = 0.626) and infection prevention training (ß = 1.467) were significantly associated with higher knowledge scores; higher knowledge (ß = 1.366) and higher practice scores (ß = 0.110) were significantly associated with higher attitude scores; and higher knowledge scores (ß = 0.308) and higher attitude scores (ß = 0.265) were significantly associated with higher practice scores. Conclusion The majority of healthcare workers from Chitwan, Nepal, had good to moderate knowledge and practice scores and had a positive attitude toward COVID-19. There was a significant association between knowledge, attitude and practice scores regarding COVID-19 among healthcare workers.

Objectives: Acute kidney injury is one of the most common cause of hospitalization in developing countries. Causes of AKI are multifactorial. Most of AKI are community acquired. The objective of the study was to identify the clinical profile and outcome of acute kidney disease. Subject and Methodology: 30 patients from Chitwan Medical College outpatient clinic were included in the study from November 2014 to April 2015. A brief history and clinical examinations were taken from all patients along with laboratory tests for Renal function tests, urine output, metabolic parameters and hematological profile. Results: 19 males (63.3% and 11 females (36.7%) were studied. The main causes for AKI were sepsis (46.6%) followed by hepatic causes (16.6%), gastroenteritis (10%) and others (10.2%). Out of 30 patients, 19 recovered (63.3%) and were discharged and 11(36.7%) died. Most of the deaths were in injury (37.5%) and failure (42.8%) stages of RIFLE criteria. Out of 19 recovered 16(84.21%) patients did not need any renal replacement therapy whereas 3(15.8%) patients had to undergo hemodialysis. Conclusion: Early identification of kidney injury may lead to lesser renal replacement therapy and better prognosis. However late presentations of AKI have higher hospital mortality rate.

Background: A strict vegetarian diet has been associated with an increased risk of vitamin B12 deficiency. Clinical manifestations of cobalamin deficiency are hematologic and neurological symptoms. The purpose of this study was to determine the prevalence of vitamin B12 deficiency in healthy vegetarian population and to study the clinical and hematological profile of vitamin B12 deficient subjects.Methods: A community based cross-sectional observational study was conducted through preplanned camps in Kathmandu Nepal. 166 vegetarian people were investigated for serum vitamin B12 level and their hematological profile was done. They were examined for neurological manifestation of vitamin B12 deficiency.Results: The mean serum vitamin B12 level of the vegetarian in this study was 271.34 ±241.74 pg/ml (mean ± SD)., 53.6 % had serum vitamin B12 deficiency. 56.5 % of male and 47.1 % of female had vitamin B12 deficiency. The risk of vitamin B12 deficiency is more in males than females with odds ratio 1.201 (CI=95%) which is not statistically significant with p-value 0.312. There was no significant difference in vitamin B12 level in different age group.The study population had mean hemoglobin of 13.12 ± 1.72 gm/dl. Anemia was present in 34.9 % of study population. 33.9 % of male and 37.3 % of female had anemia. There was no significant difference in anemia in male and female vegetarian (p-value 0.72). 40% of patient who had vitamin B12 deficiency had anemia.A significant low hemoglobin level and higher MCV were found as level of serum vitamin B12 decreased. Only one patient had macrocytic anemia.There were few symptoms but not specific to vitamin B12 deficiency.Conclusion: The result of present study show that prevalence of vitamin B12 deficiency among healthy vegetarian was 53.6% with higher prevalence in male and elder age group.Prevalence of anemia was 34.9% in this study with elderly group and females being more affected.There was significant correlation between vitamin B12 and hemoglobin level and significant negative correlation with MCV. Although, not significant, leucocytes count, lymphocyte count and platelets were low in vitamin B12 deficient population.Few clinical features were present in vitamin B12 deficient subjects but neurological features specific to vitamin B12 deficiency were not seen.

The search for sustainable energy alternatives has been increasingly important, not only because the depletion of fossil fuels, but also due to the necessary reduction in the emission of greenhouse gases. The use of renewable energy has contributed to the mitigation of this problem, but this doesn’t always adapt to the requirements of energy demand. The energy of biomass, in particular by the combustion of vegetal biomass, is a form already in use and with broad application, from domestic heating equipment to thermoelectric power plants. An alternative energy source is the refuse derived fuels, RDF, which offer a double benefit, given they provide an energy resource and avoid the occupation of landfill space. However, the use of biomass or RDF has limitations, due to the fuel quality. As received, it presents low heating value, low adiabatic flame temperature and low density. The improvement of the properties of these fuels may be obtained by torrefaction. This is a low-temperature pyrolysis process, where the heating gradient, top temperature and process duration must be controlled. In this study, an experimental prototype was developed for torrefaction trials. During the torrefaction experiments the heating rate and maximum temperature were controlled, and were measured sample temperatures, mass decay and also the composition of the gases released. Later, the higher heating value, density and hydrophilicity of biomass and RDF samples, as received and with various stages of torrefaction, were measured, confirming the advantage of applying this thermal process in the improvement of the biomass and RDF fuel properties. info:eu-repo/semantics/publishedVersion

Chromobacterium violaceumis a facultative anaerobic, Gram-negative rod, prevalent in tropical and subtropical regions. It enters through the skin injury and is capable of causing severe systemic infections leading to septic shock and multiorgan failure. It has been reported by few authors across the world but this is probably the first case ofChromobacterium violaceumisolated from wound sepsis from Nepal. In this study, a pus sample from the infection of a prick injury in the left middle finger was collected from the patient admitted to the intensive care unit. Bacteriological investigations of the pus sample revealed the causative organism to beChromobacterium violaceum. This case study indicates thatChromobacterium violaceumcan act as a potential cause of wound sepsis that may lead to the septic shock and if not treated timely, the mortality rate can be high as was in this study. Although this organism is very rare, the infection caused requires prompt treatment to minimize the mortality rate. Therefore, we recommend the timely diagnosis and antimicrobial therapy of this infection to combat the consequences led.

Primary hypoadrenalism(Addison’s disease) refers to glucocorticoid deficiency occurring in the setting of adre­nal disease(mostly due to autoimmune adrenalitis), whereas secondary hypoadrenalism arises because of deficiency of ACTH(mostly due to pituitary disease) . A major distinction between these two is that mineralocorticoid deficiency invari­ably accompanies primary hypoadrenalism, but this does not occur in secondary hypoadrenalism because only ACTH is de­ficient; the renin-angiotensin-aldosterone axis is intact and in primary hypoadrenalism skin pigmentation is always present due to increased ACTH secretion(unless of short duration) but it is absent in secondary hypoadrenalism. Addison’s disease or primary adrenocortical failure was first described by English physician Thomas Addison, who found it in six patients with adrenal tuberculosis in 1855(1). Addisonian crisis is a potentially fatal condition associated mainly with an acute defi­ciency of the glucocorticoid cortisol and, to a lesser extent, the mineralocorticoid aldosterone. This is a rare condition with an estimated incidence in the developed world of 0.8 cases per 100,000 and prevalence of 4 to 11 cases/100,000 population. Despite optimised life-saving glucocorticoid replacement and mineralocorticoid-replacement therapy, it is life threatening if overlooked(2-3). Hypothyroidism may mask the addison’s disease so in patients with panhypopituitarism and autoim­mune polyglandular syndrome type 2 thyroxine replacement without adequate steroid replacement may precipitate acute addisonian crisis. Journal of Chitwan Medical College 2013; 3(4); 54-56 DOI: http://dx.doi.org/10.3126/jcmc.v3i4.9557

Mad honey disease is one of the rarest disease caused by consumption of leaves, flowers or its products such as honey. The toxicity is secondary to consumption of honey produced by pollen and nectars found in rhodenderon species. Mad honey is mostly found in Black Sea and south east region of Turkey. However 3 cases has been reported in the few hospitals in Kathmandu, Nepal. However until now there is not such case reports reported in Chitwan, mid central region of Nepal. Here, we report a case of 40 years old man who reported to our emergency department with complaint of dizziness, vomiting and blackout with first examination of bradycardia and hypotension in consequences of mad honey consumption.