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Identifying and appropriately managing urinary tract infections (UTIs) among chronic kidney disease (CKD) patients are essential to reduce further disease complications and economic burden. Hence, this study aims to determine the prevalence of UTIs among CKD patients and study the antibiogram of the bacterial isolates. Four hundred eighty-two clean catch midstream urine samples were collected from CKD patients during the study period. The samples were cultured, and bacteria were isolated using standard microbiological techniques. Antibiotic susceptibility testing was performed by the Kirby–Bauer disc diffusion method following the Clinical and Laboratory Standards Institute guidelines. Of the 482 CKD patients, 15.8% were culture positive, and the majority was elderly aged group population. Most bacterial isolates were Escherichia coli 50%, followed by Pseudomonas aeruginosa 15.80%, Enterococcus species 15.80%, and Klebsiella pneumoniae 11.84%. The majority of bacteria were found to be resistant to beta-lactam antibiotics, ampicillin (94.67%), ceftriaxone (89.04%), cefotaxime (87.5%), and ceftazidime (84.0%), while polymyxin, colistin, vancomycin, meropenem, and imipenem were the most sensitive antibiotics. In our study, higher levels of antibiotic resistance were observed among urinary isolates. Therefore, our findings suggest clinicians to choose better antibiotic options to treat UTIs among CKD patients.

Background: To our knowledge, there are no reports of the Ponseti method initiated after walking age and with >10 years of follow-up. Our goal was to report the clinical findings and patient-reported outcomes for children with a previously untreated idiopathic clubfoot who were seen when they were between 1 and 5 years old, were treated with the Ponseti method, and had a minimum follow-up of 10 years.Methods: A retrospective review of medical records was supplemented by a follow-up evaluation of physical findings (alignment and range of motion) and patient-reported outcomes using the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). The initial treatment was graded as successful if a plantigrade foot was achieved without the need for an extensive soft-tissue release and/or osseous procedure.Results: We located 145 (91%) of 159 patients (220 clubfeet). The average age at treatment was 3 years (range, 1 to 5 years), and the average duration of follow-up was 11 years (range, 10 to 12 years). The initial scores according to the systems of Pirani et al. and Diméglio et al. averaged 5 and 17, respectively, and an average of 8 casts were required. Surgical treatment, most commonly a percutaneous Achilles tendon release (197 feet; 90%), was required in 96% of the feet. A plantigrade foot was achieved in 95% of the feet. Complete relapse was rare (3%), although residual deformities were common. Patient-reported outcomes were favorable.Conclusions: A plantigrade foot was achieved in 95% of the feet initially and was maintained in most of the patients, although residual deformities were common. Patient-reported outcomes were satisfactory, and longer-term follow-up with age-appropriate outcome measures will be required to evaluate function in adulthood.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernias are encountered commonly, but there is a lack of uniformity and standardization in repair techniques. There are a variety of repair methods, from open methods to laparoscopic approaches. The available laparoscopic techniques that exist for inguinal hernia repair are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. This study aims to compare the outcomes of these two laparoscopic procedures., Methods: The study was initiated after receiving ethical clearance. This single-centric retrospective study included the patients that underwent laparoscopic inguinal hernia repair from January 1, 2020, to December 31, 2023. Patient records were reviewed and assessed against the inclusion criteria of the study. Systematic random sampling was applied to select patients from the records. A structured questionnaire was prepared for the purpose of data collection. The data were refined and analyzed using the SPSS software., Results: A total of 200 patients (100 in each group) who underwent laparoscopic repair of an inguinal hernia were part of this study. The median (IQR) age of patients in the TAPP group was 50 (41.25-64.75) years, and that in the TEP group was 48.5 (39.25-64.75) years. The TAPP procedure took a median (IQR) time of 81 (77-88) min, while the TEP procedure took 69 (66-73) min to finish. The patients in the TAPP group returned to their normal activities after 15 (14-16) days of surgery, and the patients in the TEP group returned after 13 (11-14) days. The pain score at 1 week was found to be better in the TEP group. No difference was observed in complications or recurrence., Conclusion: TEP repair was found to be superior to TAPP repair in terms of procedural time, return to normal activities, and pain score at 1 week., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC.)

Introduction: Postprocedural infection has been a top priority for the perioperative team. The use of sterile gloves to counter this became popular and was routinely used, but randomized studies have shown that the benefit that was thought to be added by the use of sterile gloves is insignificant and that not all procedures require the use of sterile gloves., Methods: Prospective protocol registration was and electronic databases were searched without using any search filters. Screening was performed by independent reviewers, and data was extracted from selected studies. Heterogeneity was assessed by the I2 test, and the effect model was chosen accordingly. The odds ratio was used as an effect measure as the variables in this study were dichotomous. Forest plots and funnel plots were used to give visual feedback., Results: This meta-analysis included 14 comparative studies that involved a total of 12,625 patients. Analysis of postprocedural infection outcome showed no significant difference between the procedure performed using sterile gloves and without using sterile gloves (OR: 0.88; 95% CI: 0.71-1.10; n =12,625; I2 =0%; P -value=0.26). Sensitivity analysis and subgroup analysis for randomized studies only, surgical site infection, and patients that did not receive prophylactic antibiotics showed no variations. The use of sterile gloves did not show any extra benefit for controlling infection during wound repair, excision and suturing, cystoscopy, and urinary catheterization., Conclusion: The use of sterile gloves does not have any extra benefit for preventing infections when minor surgical procedures are performed., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation of atrial fibrillation (AF); however, the results are suboptimal for persistent AF. The left atrial posterior wall (LAPW) is thought to be a major additional area in initiation and perpetuation of persistent AF. Therefore, adjunctive ablation of the posterior wall may reduce AF recurrence in patients with persistent AF., Objective: The objective of this study was to compare outcomes of catheter ablation in patients with persistent AF using PVI alone versus a combination of PVI and LAPW isolation., Methods: Literature search was conducted in PubMed, PubMed Central, Scopus, and Embase since inception to February 2023. Screening of studies was done via Covidence software. Risk of bias assessment was done using appropriate tools. Data extraction and a narrative synthesis were carried out accordingly., Results: Ten studies were included, of which five were randomized controlled trials. PVI with LAPW ablation group had significantly lower recurrence of overall atrial tachyarrhythmia (OR 0.47, CI 0.32-0.70) and AF (OR 0.39, CI 0.23-0.69). In sensitivity analysis, freedom from atrial arrhythmias was noted to be significantly higher in the PVI with LAPW ablation group (OR 2.22, CI 1.36-3.64). However, there was no significant difference in occurrence of atrial flutter (OR 1.36, CI 0.86-2.14) or with periprocedural adverse events (OR 1.10, CI 0.60-1.99)., Conclusion: LAPW ablation, in addition to PVI, significantly improves the rates of arrhythmia freedom and reduces the recurrence of overall atrial tachyarrhythmia. There was no significant difference in atrial flutter or periprocedural adverse events., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Acute appendicitis, despite being the most common surgery, can result in increased morbidity and mortality in the case of perforated appendicitis. Identifying a perforation early can reduce the impact on the patient. Bilirubin, C-reactive protein (CRP), and white blood cell (WBC) count have been shown to indicate perforation in appendicitis., Methods: A cross-sectional analytical study was conducted to observe the association between preoperative bilirubin, CRP, and white cell count with the histological findings of either the presence or absence of perforation of the appendix. The eligibility criteria included all patients above 18 years with appendicitis who were managed surgically in the study hospital, Shree Birendra Hosptial, between 1 December 2021 to 30 May 2022. The study was conducted after the approval from the ethics committee., Results: Out of 150 patients, 112 had open surgery and 38 underwent laparoscopic appendectomy. One hundred thirty-four had non-perforated appendix and 16 cases had perforated appendix. The older age group was associated with appendiceal perforation more than the younger age group. Patients with a duration of symptoms less than 24 h and more than 72 h developed perforated appendicitis less frequently. The odds of encountering perforated appendicitis increased by 2.644 times per 0.972 rise in total bilirubin ( P = 0.004) and the odds of encountering perforated appendicitis increased by 6.474 times per 1.868 rise in conjugated bilirubin ( P = 0.003). There was no significant difference in total leucocyte count and neutrophil percentage among perforated and non-perforated groups., Conclusion: The diagnostic value of the CRP, total bilirubin, and conjugated bilirubin levels was strong and significant when used in combination rather than their individual performance in the diagnosis of perforated acute appendicitis., Competing Interests: The authors declare no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this articles., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

The decision to establish a network of researchers centers on identifying shared research goals. Ecologically specific regions, such as the USA's National Ecological Observatory Network's (NEON's) eco-climatic domains, are ideal locations by which to assemble researchers with a diverse range of expertise but focused on the same set of ecological challenges. The recently established Great Lakes User Group (GLUG) is NEON's first domain specific ensemble of researchers, whose goal is to address scientific and technical issues specific to the Great Lakes Domain 5 (D05) by using NEON data to enable advancement of ecosystem science. Here, we report on GLUG's kick off workshop, which comprised lightning talks, keynote presentations, breakout brainstorming sessions and field site visits. Together, these activities created an environment to foster and strengthen GLUG and NEON user engagement. The tangible outcomes of the workshop exceeded initial expectations and include plans for (i) two journal articles (in addition to this one), (ii) two potential funding proposals, (iii) an assignable assets request and (iv) development of classroom activities using NEON datasets. The success of this 2.5-day event was due to a combination of factors, including establishment of clear objectives, adopting engaging activities and providing opportunities for active participation and inclusive collaboration with diverse participants. Given the success of this approach we encourage others, wanting to organize similar groups of researchers, to adopt the workshop framework presented here which will strengthen existing collaborations and foster new ones, together with raising greater awareness and promotion of use of NEON datasets. Establishing domain specific user groups will help bridge the scale gap between site level data collection and addressing regional and larger ecological challenges., (© 2024. The Author(s).)

Ecrrine porocarcinoma, a rare aggressive skin tumor, develops from sweat glands located in lower limbs, followed by the head and neck, trunk, and upper limbs. The incidence represents only about 0.005% of all cutaneous malignant tumors. The most common site is the lower extremities in elderly patients. As it has a high chance of metastases and recurrence after surgery, mainstay of treatment modality is wide local excision or Mohs (micrographically oriented histographic surgery) micrographic surgery. Mohs micrographic surgery (MMS) is a more effective treatment modality for tumors located in cosmetically and functionally important areas of the head and neck. We present a 56-years-old male patient with a large fungating eccrine tumor on the left axilla with ipsilateral nodal involvement on histomorphological grounds supported with immunohistochemical studies., Competing Interests: The author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Negative Pressure Wound Therapy (NPWT) is a therapeutic technique of applying sub-atmospheric pressure to a wound to reduce inflammation, manage exudate, and promote the formation of granulation tissue. It aims to optimise the natural physiological processes of wound healing for more effective recovery, and NPWT has emerged as a promising alternative to traditional dressings., Methods: The protocol followed in the study was prospectively registered. Appropriate search terms and Boolean operators were used to search electronic databases for relevant articles. Screening of articles was performed, and data extraction was done. The effect measure was chosen according to the nature of the variable, and the effect model was chosen as per heterogeneity. Forest plot was used to give visual feedback., Results: This study included 11 randomized controlled trials (13 publications) with a total of 1310 patients (1497 inguinal wounds). The NPWT group had lesser odds of developing surgical site infection (OR: 0.40; 95 % CI: 0.29-0.54; n  = 1491; I 2  = 20 %; p -value ≤0.00001) and lesser odds of needing surgical wound revision (OR: 0.48; 95 % CI: 0.26-0.91; n  = 856; I 2  = 0 %; p-value = 0.02) as compared to the normal dressing group. No significant difference was observed in duration of hospital stay, cost of care, wound healing time, or other complications., Conclusion: NPWT application in inguinal wounds significantly reduces the surgical site infection and the need for wound revision in patients who have undergone vascular surgery., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background and Aims: Autism spectrum disorder (ASD) is a neurodevelopmental condition that impacts the brain, characterized by challenges in social communication and interaction, often accompanied by repetitive behaviors or focused interests. This study sheds light on the prevalence of ASD within the Southeast Asian region., Methods: The study protocol was registered in PROSPERO (Registration No: CRD42023413915). Appropriate search terms and Boolean operators were employed to explore electronic databases for relevant articles. Data thus extracted were prepared in Excel and analyzed in Comprehensive Meta-Analysis Software. The effect measure utilized in the study was represented by the proportion, and the choice between a fixed or random-effect model depended on the observed heterogeneity. Visual feedback was provided through the use of forest plots and funnel plots., Results: A total of 14 studies were included in the qualitative and quantitative synthesis after screening the imported studies. The prevalence of ASD was six per 1000 population (proportion: 0.006; CI: 0.002-0.017; I 2 : 99.263%). Among the ASD cases, 64.4% (proportion: 0.644; CI: 0.590-0.693; I 2 : 9.937%) were males and 35.6% (proportion: 0.356; CI: 0.307-0.410; I 2 : 9.937%) were females., Conclusion: The prevalence of ASD in Southeast Asia was estimated to be six cases per 1000 individuals, with a higher prevalence among males. This study contributes to our understanding of ASD prevalence in the region, although it is essential to note certain limitations in estimating prevalence., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Abstract: Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare disease presenting as an acute abdomen. It has a clinical presentation similar to intestinal obstruction and is often missed during diagnosis. Reduced weight leading to loss of fat pad between SMA and aorta is the main pathophysiology. Diagnosis is made through barium meal and CT scan. Conservative management remains the treatment of choice; however, surgery is opted for in refractory cases., Key Clinical Message: Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare disease presenting as an acute abdomen with clinical features similar to intestinal obstruction. This is a case of SMA syndrome in an adult male with a decrease in aortomesenteric angle, with no predisposing condition., Competing Interests: The authors have no conflict of interest to declare., (© 2024 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Introduction: Autism Spectrum Disorder is a complex neurodevelopmental condition. Early identification of symptoms is crucial for timely intervention, yet diagnosing very young children can be challenging due to the variability in symptom presentation and the influence of other developmental factors. This study aimed to find the prevalence of the emergence of early behavioural signs in Nepalese children with Autism Spectrum Disorder., Methods: A descriptive cross-sectional study was conducted at the Centre for Autism in Kathmandu, Nepal, from January 2023 to June 2023. Ethical approval was obtained, and a sample of 120 children diagnosed with Autism Spectrum Disorder was included in the study. Convenience sampling method was used. Point estimate at 95% Confidence Interval was calculated., Results: Among 120 children with Autism Spectrum Disorder, the prevalence of emergence of early behavioural signs was seen in 112 (93.33%) (88.83-97.77, 95% Confidence Interval) children., Conclusions: This study provides insights into the emergence of early behavioural signs in Nepalese children with Autism Spectrum Disorder which align with global patterns in prevalence and severity.

Large cell neuroendocrine carcinoma of the gallbladder is an extremely rare tumour with aggressive behaviour and a bad prognosis. Here, we report a case of a 65-year-old lady suspected of carcinoma of the gallbladder and underwent extended cholecystectomy. The histopathology report revealed neuroendocrine carcinoma of a large cell type of gall bladder infiltrating the liver and three periportal and pericholedochal lymph nodes. She had an uneventful perioperative period and was doing good till 6 months of follow-up. The only potentially curative treatment for large cell neuroendocrine carcinoma of the gallbladder is aggressive surgical resection, owing to its aggressive behaviour and bad prognosis., Keywords: carcinoma; case reports; cholecystectomy; gallbladder.

Introduction: The zipper device is a wound closure device that can be directly applied over the intact skin on either side of the wound edges and does not need anchoring into the skin or subcutaneous plane. The noninvasive nature of the zipper device makes it less time-consuming and less painful, but its effectiveness and related complications need to be studied., Methods: Prospective registration of the protocol followed in this study was done. Electronic databases were searched for relevant articles, and their screening was completed, followed by data extraction and analysis. The odds ratio, mean difference, or standardised mean difference were used as an effect measure per the nature of the variables. Surgical site infection, wound dehiscence, skin closure time, scar score, and patient satisfaction were compared in this study., Results: A total of 10 studies were identified, out of which eight compared zippers with sutures and two compared zippers with stapler devices. Compared to the suture, the zipper device took 4.9 min less to close the incision, and the scar scale outcome reported after one month was inferior, while other results were not significant. Staples showed a lower patient satisfaction level and no difference in complications., Conclusion: The zipper device is a less technically demanding and less time-consuming method of skin closure, with no significant difference in the complication rate compared to conventional methods. The zipper device is an effective measure to use in settings with less expertise or at health institutions after assessing the cost at the local level., Competing Interests: There are no conflicts of interest to disclose.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Trail Design: Quasi-randomized clinical trial., Methods: Participants : This study includes adult patients (≥18 years) who gave written consent for preoperative site preparation using razors or clippers. Exclusions comprised individuals <18 years, bilateral hernias, prior laparoscopic hernia repair, steroid/chemotherapy use, diagnosed chronic obstructive pulmonary disease, and incomplete medical documentation. Intervention : Patients who underwent hernia surgery during the initial week of the study underwent site preparation using a razor, while in subsequent weeks underwent site preparation using a clipper. This randomization was maintained throughout the study. Uniform site preparation was done by consistent staff. Postpreparation interviews, follow-up interviews of the patients, and unbiased evaluation of digital photographs were conducted by nonoperating surgeon panels. Outcome : Preoperative, patient response, degree of skin trauma, quality of hair removal, and association between site preparation-like parameters were compared and analyzed between two groups using Statistical Package for Social Sciences-25.  Blinding : In this study, blinding was not done and the primary investigator was aware of the two groups., Results: The total number of participants was 320. The mean age of the Razor group was 45.36 ± 14.68 years and that of Clipper was 44.42 ± 13.77 ( p  < 0.98). The incidence of surgical site infection (SSI) was 23 (14.4%) in the razor group and 8(5%) in the clipper group, ( p  = 0.01). Skin trauma was found more in the razor group as compared to the clipper group. Also, the analysis of the provided data revealed that 65% of participants who experienced sustained cuts developed SSI., Conclusion: In summary, the practice of preoperative hair removal on-site preparation using a razor is associated with the incidence of skin trauma but overall shave quality at the operative site was better in the razor group with an apparent increased risk of SSI. Based on these findings, it would be better for surgeons to decide on an operation for either razors or clippers for preoperative preparation., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Introduction: Conjunctivitis is a highly prevalent ocular disease that flares up every year. The humidity and high temperature favour the causative agents responsible for the epidemic. Acute infective conjunctivitis may be either viral or bacterial, a distinct type of condition with unique clinical features and treatment approaches. The aim of the study was to find out the prevalence of acute conjunctivitis among patients visiting the outpatient Department of Ophthalmology in a tertiary care centre., Methods: This descriptive cross-sectional study was conducted among the patients visiting the outpatient Department of Ophthalmology. Data of 30 August 2023 to 30 September 2023 was collected between 21 November 2023 to 24 November 2023. All patients presenting in the Ophthalmology Department having complete hospital record were included in the study. Patients having missing data on the medical records of the hospital were excluded. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval., Results: Among 5,507 patients, acute conjunctivitis was seen in 1240 (22.52%) (21.42-23.62, 95% Confidence Interval). The majority were male 732 (59.03%) and adults 760 (61.29%) with a mean age of 32.56±18.74 years., Conclusions: The prevalence of conjunctivitis among patients visiting the outpatient Department of Opthalmology was found to be higher than other studies done in similar settings., Keywords: conjunctivitis; disease outbreaks; enterovirus.

Background: Performing surgery is a task that demands mental stability, precision, and vigilant eyes, along with resilient physical strength, as surgeons and those who assist the surgeons have to assume a sustained, difficult posture that can go on for hours. About 23-100% of surgeons report musculoskeletal discomfort that originates from poor ergonomics., Methods: Ethical clearance for the study was obtained. This cross-sectional study, conducted in a tertiary centre among the healthcare providers working inside the operating room, spanned from 1 March 2023, to 26 June 2023. Systematic sampling was applied, and consent was obtained before data collection. A structured questionnaire was used as the study tool, and the collected data was analysed in SPSS 20., Results: A total of 98 personnel responded, among which 67.3% were males and 32.7% were females, with a median age of 36 (32-42) years. Only 6.1% of the workers had received training on ergonomics. The prevalence of work-related musculoskeletal disorders was 82.7%, and more than two-thirds of the participant's life outside of work was affected by this. More than two-thirds (69.4%) felt their work environment was not safe, and surgeons performing open surgery were at lower odds of feeling that their work environment was safe., Conclusion: There is a high prevalence of work-related musculoskeletal disorders among healthcare providers working inside the operating room, and the majority had their body position deviated from neutral most of the time during the surgery. There is a deficiency in ergonomic practices, which demands an effective intervention., Competing Interests: There are no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Bacterial biofilm is a significant virulence factor threatening patients, leading to chronic infections and economic burdens. Therefore, it is crucial to identify biofilm production, its inhibition, and reduction. In this study, we investigated biofilm production among Gram-negative isolates and assessed the inhibitory and reduction potential of ethylene diamine tetra acetic acid (EDTA) and dimethyl sulfoxide (DMSO) towards them. In addition, we studied the antimicrobial resistance pattern of the Gram-negative isolates., Methods: Bacterial isolation and identification was done using standard microbiological techniques, following the Clinical and Laboratory Standards Institute (CLSI) guideline, 28th edition. The Kirby-Bauer disk diffusion method was used to determine the antibiotic susceptibility pattern of the isolates, and β -lactamase production was tested via the combination disk method. Biofilm formation was detected through the tissue culture plate (TCP) method. Different concentrations of EDTA and DMSO were used to determine their inhibitory and reduction properties against the biofilm. Both inhibition and reduction by the various concentrations of EDTA and DMSO were analyzed using paired t -tests., Results: Among the 110 clinical isolates, 61.8% (68) were found to be multidrug resistant (MDR). 30% (33/110) of the isolates were extended-spectrum β -lactamase (ESBL) producers, 14.5% (16/110) were metallo- β -lactamase (MBL), and 8% (9/110) were Klebsiella pneumoniae carbapenemase (KPC) producers. Biofilm formation was detected in 35.4% of the isolates. Biofilm-producing organisms showed the highest resistance to antibiotics such as cephalosporins, chloramphenicol, gentamicin, and carbapenem. The inhibition and reduction of biofilm were significantly lower ( p  < 0.05) for 1 mM of EDTA and 2% of DMSO., Conclusion: Isolates forming biofilm had a higher resistance rate and β -lactamase production compared to biofilm nonproducers. EDTA and DMSO were found to be potential antibiofilm agents. Hence, EDTA and DMSO might be an effective antibiofilm agent to control biofilm-associated infections., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Ojaswee Shrestha et al.)

Background: The global threat of COVID-19 has created the need for researchers to investigate the disease's progression, especially through the use of biomarkers to inform interventions. This study aims to assess the correlations of laboratory parameters to determine the severity of COVID-19 infection., Methods: This study was conducted among 191 COVID-19 patients in Sumeru Hospital, Lalitpur, Nepal. According to their clinical outcomes, these patients were divided into severe and nonsevere groups. Inflammatory markers such as LDH, D-dimer, CRP, ferritin, complete blood cell count, liver function tests, and renal function tests were performed. Binary logistic regression analysis determined relative risk factors associated with severe COVID-19. The area under the curve (AUC) was calculated with ROC curves to assess the potential predictive value of risk factors., Results: Out of 191 patients, 38 (19.8%) subjects died due to COVID-19 complications, while 156 (81.7%) survived and were discharged from hospital. The COVID-19 severity was found in patients with older age and comorbidities such as CKD, HTN, DM, COPD, and pneumonia. Parameters such as d-dimer, CRP, LDH, SGPT, neutrophil, lymphocyte count, and LMR were significant independent risk factors for the severity of the disease. The AUC was highest for d-dimer (AUC = 0.874) with a sensitivity of 82.2% and specificity of 81.2%. Similarly, the cut-off values for other factors were age >54.5 years, D-dimer >0.91 ng/ml, CRP >82.4 mg/dl, neutrophil >78.5%, LDH >600 U/L, and SGPT >35.5 U/L, respectively., Conclusion: Endorsement of biochemical and hematological parameters with their cut-off values also aids in predicting COVID-19 severity. The biomarkers such as D-dimer, CRP levels, LDH, ALT, and neutrophil count could be used to predict disease severity. So, timely analysis of these markers might allow early prediction of disease progression., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Anit Lamichhane et al.)

Background: Open appendectomy has been the conventional choice of treatment for acute appendicitis. However, nowadays laparoscopic approach is emerging for the benefits it provides, like lesser postoperative pain and lesser duration of hospital stay, but at the cost of higher expenses and longer operative duration., Methods: A retrospective cohort study was done at Shree Birendra Hospital from January 2018 to December 2021, with a total study population of 450 participants (300 in open appendectomy and 150 in laparoscopic appendectomy). Preoperative. Intraoperative and postoperative parameters were compared and analyzed between two groups using SPSS-25., Results: The mean age was 26.72 ± 9.70 in the open appendectomy (OA) and years 23.89 ± 6.32 in the laparoscopic appendectomy (LA) group. ( p  = 0.010) There was a significant difference between the mean operative time (46.08 ± 13.10 min in OA and 56.86 ±  11.70 min in LA, p  = 0.000), length of hospital stay (1.28 ± 0.80 days in OA and 1.07 ±  0.25 days in LA, p  = 0.000), course of oral analgesics (3.55 ± 0.68 days in OA and 3.00 days in LA p  = 0.000) between OA groups and LA groups, while the total number of complications was less in the LA group however there was no statistically significant difference postoperative complications ( p  = 0.124) between the two groups in the surgical findings., Conclusion: All in all, the laparoscopic approach is a better option for uncomplicated appendicitis due to its less postoperative pain and shorter duration of hospital stay., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: The great saphenous varicose vein was managed with high ligation and stripping conventionally, but with the development of minimally invasive surgical techniques like endovascular laser ablation (EVLA), they have become popular. This systematic review and meta-analysis of randomized controlled trials aim to compare the short-term and long-term outcomes of these two modalities on headings like procedural time, technical success, recovery time, recurrences, cost-effectiveness, and complications., Materials and Methods: The protocol followed in this study was registered prospectively in the Registry of Systematic Reviews/Meta-analyses. Electronic databases were searched with appropriate search terms for relevant studies, and after their screening, data was extracted. The odds ratio was used for dichotomous data, and the mean difference or standardized mean difference was used for continuous variables., Results: This study identified 18 publications (10 randomized controlled trials) with a total of 1936 patients. There was no difference in procedural time, recovery time, recurrences at 1, 2, and 5 years, or clinical severity score. The surgery group had 4.35 times higher statistically significant odds of being technically successful at 2 years, while pooling data on bruising, hematoma, sensory disturbance, infection, and phlebitis showed that the EVLA group was less likely to develop postoperative complications., Conclusion: Technical failures were more common in the EVLA, whereas postoperative complications were more common in the surgery group. Both have comparable clinical effectiveness, and neither modality has clear superiority over the other. Parameters like cost-effectiveness must be assessed at the hospital level before choosing the right procedure for the patients., Competing Interests: The authors declare no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Informed consent-taking is a part of clinical practice that has ethical and legal aspects attached to it. This protects the autonomy of the patients by providing complete information regarding the rationale, modality, potential risks, benefits, and alternatives of the planned procedure to the patients. This enables the patients to make the right decision for themselves and their care. This study aims to find out if the informed consent-taking process has ensured the active participation of the patients or the next of kin in the decision-making., Materials and Methods: This is a prospective cross-sectional study conducted in a military healthcare institution among patients undergoing major surgical procedures from July 2022 to October 2022. Ethical clearance was obtained before the commencement of this study. A structured questionnaire was prepared, and the collected data was refined in Excel and imported into SPSS for analysis., Results: A total of 350 individuals of mean age 47.95 ± 16.057 years were part of this study. The majority of the respondents were married, literate, and family by beneficiary category. All of the respondents received and signed the consent form. About 77% of the respondents read it completely, and 95.4% of them reported that it was understandable. The majority of the patients did not know who was going to perform the surgery, the alternatives to the planned treatment, the benefits of the surgery, or the outcome of non-treatment. On the patient satisfaction scale, 16.28% of the participants agreed that they were satisfied with the informed consent-taking process., Conclusion: Deficiencies in the informed consent-taking process were the lack of dissemination of adequate information on the nature, duration, pros and cons, post-operative state, and alternative of the planned procedure. A well-structured format of the consent form that is specific to a particular procedure should be adopted, and various alternatives to it must be disseminated to the patient or the next of kin to improve the quality of the informed consent-taking process., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Basukala et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Key Clinical Message: Diaphragmatic hernia does not only occur during high velocity impact or penetrating injury, but also can occur when heavy loads impact the torso. Diaphragmatic hernia must be ruled out in a patient with polytrauma with a chest X-ray at the least., Abstract: Trauma-induced diaphragmatic hernia is a protrusion of abdominal contents through the defect in diaphragm and is an uncommon and less heard of injury. This case report conveys that diaphragmatic hernia should be ruled out in any polytrauma case presenting with shortness of breath with the chest X-ray at the least., Competing Interests: No conflict of interests., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Giant appendicoliths are rare appendicoliths with the largest diameter of more than 2 cm. It can increase the risk of complications such as perforation or abscess formation. This is a case of an uncommon definitive pathology diagnosed for a right iliac fossa calcification with a rare transoperative finding., Competing Interests: No conflict of interest., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Fahr's disease, a rare motor and neurocognitive condition, is characterized by idiopathic calcification of basal ganglia. This article presents such case of 61-year-old female, exhibiting movement, speech, and swallowing difficulties with multiple calcifications in brain in NCCT. Early and supportive management can lead to improved outcomes and prevent unnecessary interventions., Competing Interests: The authors declare that there is no conflict of interests., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Background and Aims: Alexithymia is a state in which one cannot comprehend and put their emotions or feelings into words. It is a disturbance that is common among general population as well as people with mental health disorders. Medical students are at higher risk of developing alexithymia due to the extensive nature of their course and clinical postings. The presence of alexithymia is negatively correlated with the self-efficacy of the students eventually affecting self-care and patient care in the future. The aim of this study is to find the prevalence of alexithymia among medical students in Nepal and know its associated factors., Methods: This cross-sectional study used convenient sampling for selecting responders and the TAS-20 tool for data collection. Data were analyzed by using SPSS 20. Frequency was calculated for all the variables. Prevalence with 95% confidence interval [CI] is reported and the χ 2 test is used to see the difference in alexithymia status among different categories of dichotomous independent variables., Results: Out of 386 students, 380 of them responded. The ratio of male and female was 1.8 with the mean age of 22.22 ± 1.77 years. The prevalence of alexithymia was found to be 22.89% (95% CI, 18.9-27.1). There was no statistically significant difference between the presence and absence of alexithymia among categories of sex, year of study, staying at hostel, involvement in extracurricular activities, involvement in daily exercise/yoga/outdoor sports, and smoking habit., Conclusion: The prevalence of alexithymia in our study was 22.89% with no association with known factors., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: Congenital heart diseases are recognized as public health concerns worldwide and Nepal is no exception. This study aims to study congenital heart disease in Nepal on grounds of burden, commonest type, common presentations, and associated noncardiac anomalies so that its spectrum can be known for prompt diagnosis and adoption of screening protocols., Methods: Relevant articles were searched in electronic databases using appropriate search terms and Boolean operators. Data were extracted in Excel and analyzed in Comprehensive Meta-Analysis Software. The proportion was used as an effect measure and a fixed or random-effect model was used as per the heterogeneity. Forest plots were used to give visual feedback., Results: A total of nine studies were included in the qualitative and quantitative synthesis after a rigorous screening of imported studies. The prevalence of congenital heart disease was 0.7% (Proportion: 0.007; CI: 0.001-0.035; I 2 : 99.263%). The burden of atrial septal defect was 32.1%, ventricular septal defect was 31.1%, patent ductus arteriosus was 12.6% and Tetralogy of Fallot was 7.3%. The most common presentations were respiratory tract infection (54.7%), developmental delay (49.8%), difficulty in breathing (44.5%), failure to thrive (17.1%), and cyanosis (15.9%)., Conclusions: The prevalence of congenital heart disease in Nepal was 0.7% and the frequency of male patients was higher. The atrial septal defect was the commonest on the whole, while, Tetralogy of Fallot was the commonest among cyanotic variety. Respiratory tract infection was frequently seen at presentation and the most commonly associated noncardiac anomaly was the cleft palate., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Pleomorphic adenoma is the commonest benign salivary glands tumor. Major salivary glands are mainly involved, and there is very low reported incidence of such tumor in minor salivary glands of nasal cavity. We report a case of 69-year-old woman who complaint of chronic left nasal obstruction and recurrent scanty bleeding from left nostril for last 2 months. On anterior Rhinoscopy examination, there was a pinkish non-tender mass in left nasal cavity arising from cartilaginous part of nasal septum. Intranasal endoscopic excision was done under general anesthesia and histopathological examination of excised tissue revealed pleomorphic adenoma. Patient was discharged after 3 days. There was no recurrence at sixth month of follow-up., (© The Author(s) 2023. Published by Oxford University Press.)

Post-COVID syndrome, a cluster of symptoms that develops or persists even after the recovery from COVID-19 or viral clearance, can have multi-system manifestations. This entity should be considered in patients who recently tested positive for COVID-19 after ruling out other possible obvious causes. Its management should involve a multidisciplinary approach., Competing Interests: No conflict of interests., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: Headache is the most prevalent neurological symptom which can be of a serious condition, as in brain tumor, but mostly it is a benign condition that includes primary headache such as migraine or tension-type headache (TTH). Migraine reoccurs frequently and is more severe but owing to the high prevalence of TTH, however, impaired quality of life due to TTH is greater than that of migraine at the population level. Medical students are constantly subjected to stress and in such a condition, it was necessary to find out the burden of headache among medical students. This cross-sectional study done among medical students aims to generate some data and literature which will change the outlook of stakeholders towards headache disorders among medical students., Methods: This cross-sectional study is based upon Headache Screening Questionnaire-English Version questionnaire based upon the ICHD-3 beta criteria. Medical students of Kathmandu valley were sampled by using convenient sampling and data were collected. Data were refined in Microsoft Excel and imported to SPSS 20 for analysis., Results: A total of 352 individuals were part of this study, out of which 229 (65.1%) were males and 123 (34.9%) were females with a mean age of 21.72 ±  1.601 years (mean ± SD). Prevalence of migraine and TTH was found to be 15.3% (95% confidence interval [CI]: 11.7%-19.3%) and 40.3% (95% CI: 34.9-45.2), respectively. Through multivariate binomial regression, it was observed that the odds of being diagnosed with migraine increased with age (adjusted odds ratio [AOR] = 1.266 [1.013-1.583], p  = 0.038), females had twice the odds of experiencing migraine headaches compared to males (AOR = 2.119 [1.074-4.180], p  = 0.03), and medical students who stayed at the hostel were at lesser odds of experiencing migraine headache (AOR = 2.772 [1.501-5.118], p  = 0.01)., Conclusion: Prevalence of migraine and TTH among undergraduate medical students was found to be 15.3% and 40.3%, respectively., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Introduction: Health seeking behavior is any activity undertaken by individuals who find themselves with a health-related problem with the aim of seeking an appropriate remedy. It includes decision making that is not homogenous among all as it is determined by different demographic factors. Self-medication and alternative medicine are also choices made by an individual that comes under health care seeking behavior. This study aimed to put light on the health seeking behavior of undergraduate medical students and to assess how they deal with their illnesses, including the practise of self-medication., Methods: In this web-based cross-sectional study, conducted among undergraduate medical students, a total of 210 students were selected through a systematic sampling method. The data were analyzed using SPSS version 20. Frequency was calculated for all the variables. The Mann-Whitney U or Kruskal-Wallis H test was used to see if any difference existed in the response. A significant association was declared at a p-value less than 0.05., Results: Response from 208 respondents was received and among those 88.9% of the respondents were aware of physical, mental and social aspects of health; about 40.8% of the respondents sought help only when their symptoms got worse; while 27.4% of them sought the help of alternative medicine. Around 74.2% of the respondents took medicines without a proper prescription and the commonly self-medicated drug group was NSAIDs., Conclusions: The knowledge of medical science has not satisfactorily ensured better health-seeking behavior and good practices. Also, there is high prevalence of self-medication practice among medical students., Competing Interests: No conflict of interest., (© 2022 The Authors.)

Hansen's disease, a chronic granulomatous disease, classically has cutaneous and neurological manifestations. Musculoskeletal manifestation of the disease is underappreciated. This case report conveys that musculoskeletal manifestation of the disease should not be missed, as sometimes it is the only presenting symptom, to avoid delay in correct diagnosis and treatment., Competing Interests: No conflicts of interests., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Regulatory compliance is challenging for multinational clinical trials. Conflicts between country requirements impedes research and slows the approval of medicines, leading the pharmaceutical industry to devote significant resources to this area. Many academic centers and nonprofits cannot support industry-level investment and are vulnerable to noncompliance. To address an insufficiency in public access to this information, the National Institute of Allergy and Infectious Diseases developed ClinRegs-a public access database of clinical research regulations. This report describes ClinRegs' features, maintenance, and usage. From September 2019 through August 2020, ClinRegs had 68 504 users, 60% from outside the United States, demonstrating the demand for accessible, reliable, country-specific regulatory information. Tools such as ClinRegs can help increase regulatory compliance and free up resources for research. We encourage our partner agencies and biomedical research industries to promote greater regulatory knowledge sharing and harmonization for the betterment of clinical research and improved public health., (Published by Oxford University Press for the Infectious Diseases Society of America 2021.)

One of the most common complication of Coronavirus disease 2019 (COVID-19) is acute respiratory distress syndrome requiring high flow oxygen, ventilator support, corticosteroids and other supportive therapies. Opportunistic aggressive fungal infection with Mucormycosis, although an uncommon entity otherwise, has been on rise in this pandemic especially in patients with chronic underlying illnesses. One such case of rhino-orbital Mucormycosis in a background of uncontrolled hyperglycaemia presented in the hospital and the histopathological examination of the tissues from ethmoidal sinus and frontal recess showed invasive necro-inflammatory infection by numerous Mucormycosis hyphae. Keywords: COVID-19; mucormycosis; rhino-orbital.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common causes of nosocomial infections. One of the potential risk factors for nosocomial staphylococcal infections is colonization of the anterior nares of healthcare workers (HCWs). Our study aimed to determine the rate of nasal carriage MRSA among HCWs at Manmohan Memorial Medical College and Teaching Hospital, Kathmandu., Methods: Two hundred and thirty-two nasal swabs were collected from HCWs of Manmohan Memorial Medical College and Teaching Hospital, Kathmandu, Nepal, within six months (February 2018-July 2018). Nasal swabs were cultured, and S. aureus isolates were subjected to the antimicrobial susceptibility test by the modified Kirby-Bauer disc diffusion method. MRSA and iMLSB (inducible macrolide lincosamide streptogramin B) resistance was screened using the cefoxitin disc (30  μ g) and D-test (clindamycin and erythromycin sensitivity pattern), respectively, following CLSI (Clinical and Laboratory Standard Institute) guidelines. Risk factors for MRSA colonization were determined using the chi-square test considering the p value ˂0.05 as significant., Results: A total of 34/232 (14.7%) S. aureus were isolated, out of which 12 (35.3%) were MRSA. The overall rate of nasal carriage MRSA among HCWs was 5.2% (12/232). Colonization of MRSA was higher in males (8.7%) than in females (4.3%). MRSA colonization was found to be at peak among the doctors (11.4%). HCWs of the postoperative ward were colonized highest (18.2%). All MRSA isolates were sensitive to linezolid and tetracycline. iMLSB resistance was shown by 7(20.6%) of the isolates. MRSA strains showed higher iMLSB resistance accounting for 33.3% (4/12) in comparison to methicillin-susceptible strains with 13.6% (3/22). Smoking was found to be significantly associated with MRSA colonization ( p =0.004)., Conclusion: Rate of nasal carriage MRSA is high among HCWs and hence needs special attention to prevent HCW-associated infections that may result due to nasal colonization., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2021 Nisha Giri et al.)

Introduction: Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare and severe forms of drug-induced skin reaction. Most frequently involved drugs are noted to be non-steroidal anti-inflammatory agents, antibiotics, and anticonvulsants. These have high morbidity and mortality and counts among dermatological emergencies., Case Presentation: We report an eventful case of a 22-year-old lady who suffered and recovered from carbamazepine-induced SJS/TEN overlapping during her pregnancy. Our patient had a history of epilepsy for which she was under sodium valproate. Switching to carbamazepine due to its low teratogenicity led our patient to this condition. History of prodromal symptoms and exposure to carbamazepine helped in the diagnosis. Carbamazepine abstinence and a multidisciplinary approach in symptomatic management worked very well for the patient., Clinical Discussion: Carbamazepine-induced TES/SJS manifests multisystem effects and requires a multidisciplinary approach for management. The condition itself is life-threatening and in its addition, their sequelae further threaten the life of the patients. Early intervention is the key. Genetically susceptible are thought to be the ones carrying human leukocyte antigen B*15:02 (HLA-B*15:02) allele and it is most prevalent in South-East Asian populations. Screening of this allele before using carbamazepine prevents the incidence of carbamazepine-induced SJS/TEN., Conclusion: Prodromal symptoms of carbamazepine-induced SJS/TEN constitute flu-like symptoms that should not be missed. Early intervention and multidisciplinary approach prevent secondary infections and complications. Screening for HLA-B*15:02 variant allele and close monitoring of these adverse reactions along with proper counseling to patients goes a long way in preventing the development of this life-threatening condition., Competing Interests: No conflicts of interest., (© 2021 The Authors.)