Immediate Fetal Outcome in Deliveries with Meconium Stained Amniotic Fluid.

BACKGROUND: Meconium-stained amniotic fluid is considered as the bad predictor of fetal outcome having significant perinatal morbidity and mortality. This study aimed to compare immediate fetal outcomes in meconium-stained amniotic fluid and clear amniotic fluid. METHODS: Hospital-based comparative observational study was conducted from a total of 204 women admitted in labour room at a tertiary level hospital. Among them, 102 were cases with meconium-stained amniotic fluid, and 102 were comparison groups with clear amniotic fluid. Fetal outcome was compared between these two groups. RESULTS: The study findings revealed that majority (74.5%) in the study group had cesarean section as compared to 14.7% in the comparative group. More than one-fourth (26.5%) of the newborns in the study group had moderate to severe birth asphyxia, needed resuscitation (25.5%) and neonatal intensive care unit admission (25.5%) as compared to 3.9% from the comparative group. Maternal age (COR=0.34, 95%CI=0.15-0.81), color of amniotic fluid (COR=0.11; 95%CI=0.04-0.33), meconium consistency (COR=0.27; 95%CI=0.17-0.43), and mode of delivery (COR=0.36; 95%CI=0.17-0.79) were associated with birth asphyxia in bivariate analysis. Maternal age (AOR=2.66; 95%CI=1.04-6.81) and color of amniotic fluid (AOR=11.50; 95%CI=2.97-44.56) were associated with birth asphyxia in the multivariate analysis. CONCLUSIONS: Meconium-stained amniotic fluid was associated with increased frequency of cesarean section and adverse fetal outcome with birth asphyxia being the major complications compared with clear amniotic fluid. Predictors of birth asphyxia were maternal age and color of amniotic fluid.

Prevalence and factors associated with acute respiratory infection among under-five children in selected tertiary hospitals of Kathmandu Valley.

BACKGROUND: Acute respiratory infection (ARI) is responsible for about 30-50 percent of visits to health facilities and for about 20-30 percent of admissions to hospitals in Nepal for children under 5 years old. Incidence of ARI in children among under-five years of age is 344 per 1000 in Nepal. Hence, the study aims to find out the prevalence and factors associated with acute respiratory infection among under-five children. METHODS: A cross-sectional study was conducted at Nepal Medical College and Teaching Hospital and International Friendship Children's Hospital (IFCH) in Kathmandu among children of age 2-59 months attending Pediatric OPD. A total of 286 children were selected using the non-probability (convenient) sampling technique. Data were collected using pre-tested semi-structured tool through interview schedule, and descriptive and inferential statistical analyses were used. RESULTS: Out of 286 children, more than half of children (60.8%) had Acute Respiratory Infection (ARI). Nearly one-fifth of the children had severe or very severe pneumonia. Acute respiratory infection was significantly associated with religion followed by the family (p = 0.009, OR = 4.59 CI = 1.47-14.36), presence of the child in the kitchen while cooking (p = 0.001, OR = 2.03 CI = 1.17-3.51), and presence of respiratory tract infection in family (p = <0.001 OR = 2.83 CI = 1.59-5.05). CONCLUSION: The study concluded that male children are more susceptible to acute respiratory infection than female children. Parents and family members should be aware of the prevention of acute respiratory infection by addressing and minimizing the factors contributing to ARI.

Glassy cell carcinoma of cervix: an analysis for 20 cases and literatures review.

BACKGROUND: Glassy cell carcinoma (GCC) of the cervix is defined as a rare subtype of adeno-squamous cell carcinoma (ASC) with poor prognosis. We presented our clinical data of patients with cervical GCC and reviewed the outcomes in recent years. METHODS: From 2011.1 to 2019.7, 20 cases of cervical GCC diagnosed and treated in our institution were reviewed for clinicopathologic features, treatment strategies, and outcomes. RESULTS: (I) Twenty cases confirmed as cervical GCC were selected and represented 1.8% of all invasive cervical cancer diagnoses. The median age of all cervical GCC patients was 46 years (range from 33 to 69 years). The main clinical symptoms were abnormal vaginal bleeding and postcoital bleeding. The incidence of stage I, stage II, stage III was 75%, 20% and 5%. (II) Human papillomavirus (HPV) prevalence in cervical GCC was 44.4% (4/9). Of the HPV-positive tumors, HPV genotyping was variable. Tumors of 3 cases were found infected by HPV-18. Another tumor was infected by HPV-16 and HPV-31. Multiple infections were found in 1 case. (III) The disease-free survival (DFS) of early stage cervical GCC cases was 93%, and DFS of advanced stage cervical GCC cases was 67%. DFS of all cases was 85%. The median follow-up interval for surviving patients was 28 months. Three patients recurred, leading to an overall recurrence rate of 15% (3/20). One of 3 recurred cases was from multimodal treatment group who had one high risk factor (pelvic lymph node metastasis) and three intermediate risk factors lympho-vascular space involvement (LVSI), deep stromal invasion, and large tumor size (3.5 cm). Other 2 cases recurred were from radio-chemotherapy group. CONCLUSIONS: Cervical GCC is associated with high-risk type HPV infection, especially HPV 18. The prognosis of GCC was not poor as depicted in previous studies. Early-stage GCC patients should receive multimodal treatment which reduced recurrence rate and improved survival rate. With the limitation of small sample size, we speculated surgery might play a key role in curing GCC. Patients whose pathology features includes at least two intermediate high risk recurrence or one high risk factor should accept adjuvant treatment after complete surgical management.

Factors associated with job satisfaction among graduate nursing faculties in Nepal.

BACKGROUND: Job satisfaction among nursing faculty is critical to improving quality of nursing education, producing future nurses who will contribute directly to the health of patients at a local and national level. This study explores factors associated with job satisfaction among graduate nursing faculties in different universities of Nepal. METHODS: A cross-sectional study was conducted among nursing faculty with at least one year of teaching in their respective institutions. A 36-items job satisfaction questionnaire with 6-point Likert type responses was administered online. The questionnaire was pre-tested with 30 faculties pooled from multiple institutions. Link to the final survey was sent via e-mail to 327 nursing faculties working in 39 nursing colleges. Respondents were contacted by phone as a follow up to the email to politely remind them about the survey. Data analysis was carried out with SAS University Edition software. Chi-Square test and t-test were used for simple descriptive analysis. A multivariate binary logistic regression model was used to identify the significant factors associated with nursing faculties' job satisfaction. Adjusted odds ratio was calculated and significance was considered at p ≤ 0.05 with 95% confidence interval. RESULTS: The response rate was 54.4%. After retrospective cleaning of data, usable response rate was 52.3% (n = 171). The average age of the nursing faculties was 36.8 ± 7.0 years. Based on the overall job satisfaction score, 36.8% nursing faculties were satisfied with their current job. The coefficient for Cronbach's alpha was 0.895 suggesting very good reliability of the overall measure. The significant factors associated with job satisfaction were the involvement of the faculties in decision making process related to the department (OR = 4.83) and adequate access to reference materials (OR = 2.90). CONCLUSIONS: This study suggests that nursing faculties have positive attitude towards their job but are dissatisfied with the benefits offered to them and the operating condition of their institutions. Expanding the teaching learning resources, such as reference books, subscription to journals, and continuing education opportunities for nursing faculties through participation in professional meetings would be helpful in improving the quality of nursing education in Nepal.

Neutrophil-to-lymphocyte ratio as a predictor of worsening renal function in diabetic patients (3-year follow-up study).

BACKGROUND: Previous studies have demonstrated the role of inflammation in diabetic nephropathy (DN). Neutrophil to lymphocyte ratio (NLR) rather than other white cell parameters was found to be a useful inflammatory marker to predict adverse outcomes in medical and surgical conditions. Nevertheless, the value of NLR in predicting DN has not been elucidated. METHOD: An observational study included 338 diabetic patients, who were followed at our clinic between 2007 and 2009. We arranged our patients into tertiles according to their 2007 NLR. The primary outcome was continuous decrease of GFR >12 mL/min between 2007 and 2009 with the last GFR <60 mL/min. RESULT: The lowest NLR tertile had fewer patients (2.7%) with primary outcome (i.e., worsening renal function) compared with middle and highest NLR tertiles, which had more patients with primary outcomes (8.7% and 11.5%, respectively) with a significant p-value 0.0164. When other potential confounders were individually analyzed with NLR tertile, the NLR tertiles remained a significant predictor of poor GFR outcome in the presence of other variables (hemoglobin A1C, systolic blood pressure, diastolic blood pressure, age, and congestive heart failure with p-values 0.018, 0.019, 0.017, 0.033, and 0.022, respectively). CONCLUSION: NLR predicted the worsening of the renal function in diabetic patients. Further studies are needed to confirm this result.

The impact of reporting estimated glomerular filtration rate.

The 'Kidney Disease Outcomes Quality Initiative' guidelines recommend laboratory reporting of a calculated estimated glomerular filtration rate (eGFR). The United Kingdom and several states already mandate reporting eGFR for every laboratory serum creatinine (sCr) measurement. In our study, we evaluated the impact of reporting eGFR on the management of hospitalized patients. We reviewed the medical records for 2000 patients, 1000 pre- and 1000 post-reporting eGFR. We excluded patients with previous diagnosis of chronic kidney disease, acute kidney failure, and end-stage renal disease. We analyzed the subgroup of patients with eGFR <60 and sCr <1.5 mg/dL. We did not notice an increase in the number of renal consult, ordering laboratory or imaging study to evaluate chronic kidney disease. The prescription habits did not change for nephrotoxic medications (nonsteroidal anti-inflammatory drugs and aminoglycosides). We did not find any change in the percentage of patients who received hydration for a radiological contrast study or the use of N-acetylcysteine. In conclusion, reporting eGFR did not improve the renal management of hospitalized patients.

Cardiac tamponade in acute pancreatitis.

A 47-year-old man presented with severe acute pancreatitis. On hospitalisation day 8, the patient became hypotensive and developed new-onset atrial fibrillation. Echocardiography showed significant pericardial effusion with right ventricular collapse. A pericardial window was made and the effusion drained. There was rapid clinical improvement following the procedure.

A review of violent and traumatic deaths in Kathmandu, Nepal.

The objective was to study the external causes of death reported in the autopsy centre in Kathmandu, Nepal. A retrospective review of case report documentation of all violent and traumatic death autopsies was conducted in Kathmandu from mid-July 2000 to mid-July 2004. A total of 4383 autopsies were conducted by the Department of Forensic Medicine in Kathmandu. There were 1072 (25%) cases of suicide, 380 (9%) homicide, 1399 (32%) accidental, 598 (14%) deaths as a result of natural diseases and 923 (21%) undetermined causes of death. The number of males was almost twice that of females (sex ratio 2.2:1). Persons aged 15 to 44 years comprised about two-thirds of the total reported fatalities (65.4%). Suicides were mostly reported due to hanging, homicides mostly due to firearms and explosives, accidents mostly due to road traffic injuries. More than 60% of road traffic injuries resulted among pedestrians. Suicides, homicides and accidental deaths remain a poorly identified public health issue in Nepal. Medico-legal autopsy reports can serve as an important tool in understanding fatalities from violence and injuries for countries similar to Nepal. Strengthening a regular mechanism for compilation and utilization of the information, however, remains a major challenge.