Dorsal Onlay Substitution Urethroplasty using Buccal Mucosa and Penile Skin Grafts - Our Experience

Introduction: Urethral stricture is the term used for anteriorurethral disease, or spongiofibrosis. Current research aimed tostudy buccal mucosal graft and penile skin grafts for dorsalonlay urethroplasty.Material and methods: This was a prospective studyconducted at the department of Surgery, R.I.M.S., Ranchifrom November 2010 to October 2012 in urethral stricturecases in male adults. Detail history taking and imagingprocedures were done for all patients. Patients were dividedinto two groups. The first group underwent buccal mucosalgraft and the second group underwent penile skin graft.Result: A total of 43 patients were included in the study.We found that urethral stricture was most common in theage group of 31-40 years. On follow-up, one patient (5%) inthe BMG group and 3 patients (15%) in the PSG group hadthinning of stream/failure.Conclusion: For substitution urethroplasty, buccal mucosashould be the preferred substitute but penile skin can be usedin cases when the buccal mucosa is unavailable as in cases ofsub mucosal fibrosis.

Health seeking behavior during pregnancy and delivery in Morang District of Nepal

Background and objectives: Importance of maternal health has been recognized over the last decade, however information about the perception of illness and health care behavior of obstetric complication is lacking. So, this study was conducted to find out the prevalence of taking care during pregnancy and delivery, and to find out the association between sociodemographic characteristics and taking care during pregnancy and delivery. Material and Methods: The study is a cross-sectional study conducted among the residents of Rangeli VDC of Morang District in Eastern Nepal where 300 households were taken as subjects. Semi-structured questionnaire was used and face to face interview was conducted. Chi-square test was applied to find out the association between sociodemographic characteristics and taking care during pregnancy and delivery. Results: Almost forty percent of pregnant women have taken care during pregnancy and delivery i.e. delivery conducted in Health Care Center (HCC). Only 21.8% of women were applied antiseptics after cutting cord and sixty three percent of women have fed colostrums to their babies. All of the women with Brahmin/ Chhetri have conducted delivery in Health Care Center. The women with SLC and higher education have conducted delivery at HCC more (91.1%) than below SLC (51%) and illiterate (12.5%). The women with service have conducted delivery at HCC more than other occupational groups. Conclusion: The problem of taking care during pregnancy and delivery is common and has become a key public health concern for all. Lack of education and poor occupation of wife and husband led some of the respondents not taking care during pregnancy and delivery.

A study of prevalence of worm infestation and associated risk factors among the school children of Dharan, Eastern Region of Nepal.

Background: Worm infestation has remained major zoonotic diseases in Nepal especially among children. Objectives: To measure the prevalence of worm infestation and to identify risk factors associated with worm infestation among the school children of Dharan. Material and Methods: A cross sectional study was conducted among school children of Dharan. Stratified random sampling method was applied to choose the schools and the study subjects. The Chi-square test was used to measure the association of risk factors and worm infestation. Results: Overall prevalence of worm infestation among the school children was 11.3 percent. Taenia species was found very high (5.3%) in comparison to other worms i.e. Hookworm (2%), Ascaris lumbricoides (1.9%), Trichuris trichiura (1%), Hymenolepsis nana (0.7%) and Enterobius vermicularis (0.3%). No significant relationship was traced among the factors in the causation of worm infestation although slight indications present. Conclusions: Overall prevalence of worm infestation among the school children has remained high.

Medicine counseling services at Tertiary care Hospital in Nepal

Background and Objectives: Patient needs specific guidelines from their pharmacist in support of better compliance of their medicine used. Counseling of the patient and patient representative is important for improving the therapeutic out comes. Counseling patients can improve their understanding regarding medication, disease and life style modifications which in turn improves compliance. Material and Methods: Patients and/or patient party were counseled as per the Omnibus Budget Reconciliation Act-1990 guidelines. The data was collected as per OBRA-90 during the period of eighteen month and was analyzed using statistical software SPSS version 17. Results: Three hundred and fifty patients were counseled during the study period. Majority of the counseled patients were females [75.9%]. Mean counseling time taken by the pharmacist was 7.43 minute. Minimum time taken to counsel the patient was 6-10 minutes in 58.41% of the counseled, followed by less than 5 minutes in 19.68% and 11-15 minutes in 8.89%. About 10.47% were counseled for more than 15 minutes by the pharmacist. Greater numbers of the patients referred to the Medicine Counseling Center (MCC) were from Obstetrics and Gynecology departments and most of them were directed by doctors [50.47%]. Conclusion: This study highlights that role of doctor is important to encourage patient to attend counseling services. Counseling is the integral part that not only help patient to understand the use of their medicine but also to improve their therapeutic out comes. The effect of counseling on compliance should be studied in future.

Road traffic injuries: and emerging problem in Nepal.

Road traffic injuries kill about 3000 people and 30000 are injured and disabled for life every day. Developing countries account for 90% of global road traffic deaths. In Nepal, as per estimates of morbidity and mortality for 1988-1999, injury contributed 9% to total mortality and was the third leading cause with road traffic accidents occupying eighth position in overall ranking. Therefore, the epidemic of road traffic injuries in Nepal is still in its early stage. However, it threatens to grow exponentially unless immediate action is taken. Here, an attempt is made to review the recent publications in this field.

Knowledge about human genetics among school students of eastern Nepal.

School students from 10 to 19 years of age are adolescents. Adolescent girls are usually exposed to consequences of early marriage, pregnancy and increased responsibility. Genetic disorders are important issues to persons of the reproductive age group. History-taking and screening-tests could uncover risk factors that require diagnostic testing during pregnancy. Therefore, the present survey was conducted among 707 school students (55.6% males, 44.4% females) to find out their knowledge about human genetics. Data were collected as written responses to a close-ended questionnaire. The knowledge of students about human genetic was found to be poor. The majority of students was not aware of the prevalence of genetic disorders in the community. Many students (75%) felt that genetic laboratory facilities and counseling services are necessary in this country. More than half of the students did not know the name of a hospital where genetic laboratory services are available. The study indicates that there is a need to introduce the basics of human genetics in the school curriculum and to implement strategies for awareness programs about genetic disorders and their early detection for possible intervention.

Prevalence of adverse drug reactions with commonly prescribed drugs in different hospitals of Kathmandu valley.

OBJECTIVES: To study the prevalence of adverse drug reactions (ADRs) in five different hospitals of Kathmandu Valley. MATERIALS AND METHODS: An analytical cross sectional study was designed from May 2007 to September 2007 in which prevalence of ADR was calculated. A total of 37 cases of ADRs were taken from 4287 patients and 10% of the remaining population without ADRs i.e. 425 out of 4250 patients was selected randomly. ADRs were analyzed as per the structured questionnaires designed by Canadian adverse drug reaction monitoring program. Data thus obtained were analyzed by using SPSS and Excel 2003 software and relevant statistical tools were applied. RESULTS: Prevalence of ADR in this study was 0.86% and male to female ratio was 0.85. 54.1% were female and 45.9% were male (P = 0.65). The highest percentage of ADRs were seen in adult patients, however the difference was statistically not significant. Maximum numbers of ADRs were reported from skin, 35.13% followed by GIT, 29.72% and then from CNS, 18.91%. Anti-infectives were associated with maximum number of ADRs followed by IV urograffin. Rashes, 35.13% were the most common type of ADRs reported followed by vomiting, 13.51% and then dizziness which was 10.81%. Regarding the outcomes attributed to ADRs, one patient died due to ADR caused by dapsone and 15 cases got hospitalized due to ADRs. The incidence of ADRs in different age groups was not significant. Similarly, there was no significant association between ADRs and sex. No significant difference was seen in case of age group less than one year as compared to two or more years of age (P = 0.78). For causality of ADRs, according to Naranjo algorhythm scale, 35% of reactions were assessed to be probable, 32% as possible and 19% were definite. Similarly, for severity assessment, 54% reports were mild, 35% were moderate and 10.81% were severe. CONCLUSION: Prevalence of ADR in this study was 0.8% which is similar to other studies in other countries. All the ADRs were not toxic reactions and they were unpredictable.

Social health insurance: a knowledge-do gap in eastern Nepal.

Health care costs, and those for inpatient care in particular, pose a barrier to seeking health care, and cost be a major cause of indebtedness and impoverishment, particularly among the poor. The Ministry of Health in Nepal intends to initiate alternative financing schemes such as community and social health insurance schemes as a means to supplement the government health sector financing source. Social Health Insurance (SHI) is a mechanism for financing and purchasing / delivering health care to workers in the formal sector regulated by the government. Considering all these facts BP Koirala Institute of Health Sciences (BPKIHS) has introduced SHI scheme in 2000 as an alternative health care financing mechanism to the community people of Sunsari and Morang districts. In the beginning small area was elected as a pilot project to launch the scheme. A major objective of SHI is to reduce poverty caused by paying for health care and to prevent already vulnerable families from falling into deeper poverty when facing health problems. A total of 26 organizations with 19799 populations are at present in SHI scheme. Sixteen rural based organizations with 14,047 populations and 10 urban based organizations with 5752 people are the beneficiaries in this scheme. BPKIHS SHI Scheme is the outcome of the visionary thinking on social solidarity and as an alternative health care financing mechanism to the community. BPKIHS is mobilizing people's organizations and is offering health services through its health insurance scheme at subsidized expenses. This has helped people to avail with health facilities who otherwise would have been left vulnerable because of their penetrating health needs. There is huge gap between premium collection and expenditures. The expenditures are more and this may be due to knowledge - do gap in the program. If conditions are unsuitable, SHI can lead to higher costs of care, inefficient allocation of health care resources, inequitable provision and dissatisfied patients. It can also be more difficult to realize the potential advantages of SHI in future. The future challenges confronting the scheme are to give the continuity and sustainability of the program to its catchments areas. This might entail a shift in its program operation mechanism. People's active involvement is required, which will further provide a sense of ownership in the scheme amongst the people.

Prevalence and determinants of unmet need for family planning in a district of eastern region of Nepal.

OBJECTIVES: The unmet need for family planning is defined as the discrepancy between individual's contraceptive behaviors and their stated fertility preferences--The extent of which is very high in developing countries like Nepal. This study explores the unmet need and its determinants. METHODS: Among the teaching district of B.P. Koirala institute of Health Sciences, in the Eastern Region of Nepal, a district was selected randomly to conduct a cross-sectional study. A total of 1079 women were selected using systematic random sampling. We compared different demographic variables and sex-ration to unmet need by using means, percentage and applied chi-squared test where applicable. RESULT: The extent of unmet need is 25 percent with 9.5 percent for spacing and 15.5 percent for limiting. The mean age at marriage is 16(+/-3.2) years. A strong association of gender preferences towards male child and unmet need exist, which is highly significant. CONCLUSION: Unmet need is high despite extensive family planning program in Nepal. Mean age at marriage below legal age, low female education and gender discrimination are the factors responsible for unmet need.

Impact of family health exercise program on health knowledge and practice of a rural population of eastern Nepal.

BACKGROUND: It is important to know the impact of health education on community. This may lead to improve the programs, commitment to students and staffs by taking feedback. These activities are aimed at producing changes in the community. OBJECTIVE: To assess the impact of health education as intervention program during Family Health Exercise (FHE) about the knowledge and practice of people related to health in a village of eastern Nepal. METHODS: During FHE, health education was given by the 3rd year medical students to the head of the 30 families. The neighbour 30 families were taken as control, where no health education was given. These two groups were compared after 6 months. RESULTS: Sanitary practice (Hand washing) before meal was known to both groups. But the material used for washing hand (soap and ash) was 53% in intervention as compared to 30% in control group. People were aware about the importance of care of the mother during pregnancy and lactation, but more in intervention group. The knowledge and practice for starting semisolid food other than breast milk for infants during weaning were higher in intervention (89%) than control (31%) group. CONCLUSION: There was significant change in the knowledge and practice of woman (mainly host) who received health education. The community also benefited in terms of their health knowledge and practices. Such programs are useful for the community at large.

Knowledge, attitudes and practices (KAP) regarding the management of diarrhea by pharmacists and licensed drug sellers in eastern Nepal.

Diarrhea constitutes a major cause of morbidity and mortality in developing countries. Inappropriate drug prescribing is common in diarrhea, resulting in an increase in cost and adverse drug reactions. In Nepal, drug sellers often act as the first contact persons for the underprivileged. No information has been available regarding their knowledge, attitudes and practices (KAP) regarding diarrhea management. Using a structured questionnaire, between the 1st of January and the 31st of December 2003, 109 drug sellers in eastern Nepal were interviewed about their educational status, patient/attendant presentation at the outlet and their advice to patients/attendants. Only 2.7% of drug sellers were qualified in health education. Eighty percent of the patients/attendants sought advice from the drug sellers, only 20% presented to the outlet with prescriptions. The data reveals that about half of them were taking note of the nature of the diarrhea. Although 62 (56.8%) of them were aware of dehydration, only 2 (1.8%) of them knew all three signs of dehydration (dry tongue, non-elastic skin and sunken eyes). Sixty-six (60.5%) of them knew about oral rehydration solution (ORS), its principle and the required period of administration. About 50 to 60% of them were aware of the implications resulting from dehydration from uncontrolled diarrhea and of the importance of ORS in its management. Only 20% of the drug sellers advised ORS alone, otherwise it was dispensed along with drugs, such as antimotility agents (AMA) or metronidazole. As a result of the above findings, it is important to educate the drug sellers by conferring knowledge about the ethical aspects of drugs in the management of diarrhea.

Retained intracardiac spring: an unusual foreign body.

A rare case of a penetrating intracardiac injury due to a ball-point pen in an adult male is reported. The patient presented with a retained metal spring embedded in the interventricular septum without any cardiac defects. A small metal tip of the pen was also present in the left lung. The patient was asymptomatic and without any cardiovascular compromise. The cardiac injury was managed conservatively. At two years after the injury the patient is still asymptomatic.

A study of sensitivity and resistance of pathogenic micro organisms causing UTI in Kathmandu valley.

A retrospective study was conducted in five hospitals to observe the prevalence of organisms causing UTI and their sensitivity to antibiotics. METHODOLOGY: Altogether, data from five hundred samples of urine from five hospitals in Kathmandu was collected for this study from January 2005 to April 2005. RESULT: A total of 244 samples were found to be positive. Altogether six types of organisms were isolated as the causative factors. E. coli (49%), S. aureus, (coagulase positive) (23%), Proteus species (3.6%), Klebsiella (9.71%), Pseudomonas (0.8%) and Citrobacter (2.8%). Analysis of the samples showed that UTI was more common in females of younger age group as compared to males. The common age group for females was 21-30 years, whereas that for males was 31-40 years in all the hospitals except in hospital A, where the maximum number of females was from 31-40 years and males were between 71-80 years. The most common organism to cause UTI was found to be E. coli (49%), followed by S. aureus (23%) and Klebsiella (9.71%). All the organisms causing UTI were sensitive to nitrofurantoin and amoxycillin and ciprofloxacin was found to be least effective. Similarly, in three hospitals, B (88.2%), D (64.7%) and E (65.3%), amoxycillin was found to be most effective, amikacin and gentamycin (92.5%) was most effective in hospital C, and nitrofurantoin in hospital A (78%). The second commonest organism, i.e., S. aureus (23%) was most sensitive to cephalosporin (88.8%) of second generation, followed by nitrofurantoin (77.7%), amikacin (80.6%) and norfloxacin (65.5%). The third common organism, Klebsiella (9.71%) was most sensitive to norfloxacin (75%) and nitrofurantoin (75%). Lastly, Pseudomonas was resistant to all the antibiotics in hospital A, D and E, nil in hospital B and sensitive to amikacin (100%) in hospital C.

Medical education - changing perspectives.

Various aspects of medical education have been reviewed with special reference to medical institutions in Nepal. The newer trends in teaching methodology like audiovisual and computer aided methods are being followed in most of the institutions of Nepal. Similarly, attempts are being made to implement integrated teaching which, though not perfect, differs from institution to institution. The attempts seem to be more or less satisfactory with awareness amongst most of the teachers and planners. However, the methods of assessment of the students at every level, call for changes and improvement, in the light of modern trends. Similarly, the process of selection in medical colleges needs change. The replies to the questionnaire given to the students of two batches were very interesting and it is worthwhile to undertake such studies in other institutions as well. Valid suggestions opined by them should be implemented.

Teachers awareness and opinion about AIDS--a study from eastern Nepal.

The potential for spread of HIV in Nepal is considered large because of the presence of extensive commercial sex workers, high rate of sexually transmitted disease, low condom use and many pockets of intravenous drug users. To prevent this disease from producing any public health problem in Nepal, strategies have been formulated by Government and non-government agencies in Nepal. School teachers' views and knowledge regarding HIV/AIDS are very important so that they can impart correct acknowledge about this dreaded disease AIDS to the school children who ultimately serve as catalytic agent to spread correct acknowledge in the community in long run. Teachers' awareness about HIV/AIDS in this study was fairly good. Majority of them were aware about established routes of HIV/AIDS transmission and various ways of preventing it. Various misconceptions regarding HIV transmission and its causes are the matter of concern. To impart education to the teachers and the community, more than 60% of the teachers expressed the radio to be the most effective medium. This can be suggested to the government to deliver more simple and attractive programmes about HIV/AIDS education through radio in suitable time for the community. The special AIDS education programme, for school teachers long term objective and with the support of government, non-government and social organizations will go a long way in dissemination of health knowledge to the school children.

EPI vaccination in Nepal.

A number of surveys, small or large, have been undertaken by various agencies for coverage evaluation of immunization programs. The most commonly used design is the WHO-30 cluster sampling method. Other new methods are the Institute for Refresh Medical Statistics (IRMS) New Delhi method and the lot quality assurance sampling method. This paper describes the National Immunization Day (NID) method to evaluate the immunization coverage of the Expanded Program on Immunization (EPI) vaccines in the Sunsari district of Nepal. A total number of 3,332 respondents (69.4% females and 30.6% males) were interviewed regarding the immunization status of their children during NID. The children with complete immunization (BCG, measles and three doses of DPT and OPV) were 65.7%. The individual coverage by EPI vaccines (except OPV III and measles) was more than 80%. The result shows that there is positive relationship between immunization coverage and educational level of the respondents.

Field investigaton of an outbreak of epidemic dropsy in eastern Nepal.

About 17 cases with clinical syndrome suggestive of epidemic dropsy attended to the B P Koirala Institute of Health Sciences, Dharan, for treatment. These cases were from three villages of Saptari district in eastern Nepal. Some of the mustard oil samples were tested positive with Nitric acid test. In the wake of this, an extensive field investigation was conducted covering a wider area in these villages.