Prevalence of acute myeloid leukemia and its associated risk factors at a tertiary care center: a retrospective cross-sectional study.

Background: Acute myeloid leukemia (AML) is a common malignant disorder of the bone marrow, accounting for 23.1% of total leukemia cases globally in 2017. This study aimed to know the prevalence of AML in a tertiary hospital center in Nepal and assess the associated etiological factors in the causation of AML. Materials and methods: A hospital-based retrospective cross-sectional study was conducted among patients with acute leukemia admitted to a tertiary care center in Kathmandu from 1 April 2021 to 30 April 2022. Three hundred and ten participants with acute leukemia were selected via a convenience sampling technique. The data were entered into Microsoft Excel 365 and then analyzed using Statistical Packages for Social Sciences version 22.0. Results: One hundred and forty five (46.7%) out of 310 acute leukemia patients had AML. Most of the cases were male (104, 71.7%) and aged 40-49 years (36, 24.8%). The most common signs and symptoms were pallor (115, 79.3%), fever (n=92, 63.4%), and lethargy/weakness (78, 53.8%). Ninety one (62.8%) patients underwent multiple cycles of chemotherapy while 51 (35.2%) had supportive care only, and 3 (2.1%) went bone marrow transplants. Conclusion: The prevalence of AML was higher as compared to AML in other studies done in a similar setting. Early diagnosis and treatment are key to a good prognosis and cure in most cases.

Dengue among Suspected Patients Admitted to Department of Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Dengue virus incidence has been increasing trends in every year due to the expansion of the vectors Aedes aegypti and Aedes albopictus. The objective of this study was to find out the prevalence of dengue among suspected patients admitted to the department of medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the medicine department from 30 September 2022 to 30 December 2022 after obtaining ethical approval from the Institutional Review Committee (Reference number: 019/2022). Demographic, clinical characteristics and laboratory profiles were collected from dengue patients by using a structured questionnaire. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 500 patients, 242 (48.40%) (40.66-56.14, 95% Confidence Interval) were found to be dengue positive. The average age of the enrolled patients was 39.13±20.64 years. Most dengue fever patients were diagnosed in the category of dengue with a warning sign of 234 (96.69%). The mean hospital stay of dengue patients was 4.05±2.03 days, 229 (94.62%) of patients stayed less than 7 days before discharge. Conclusions: The prevalence of dengue among suspected patients admitted to the department of medicine is found to be higher than in other similar studies done in similar settings. Patients with clinical symptoms and laboratory findings corroborating with dengue should undergo early diagnosis and facilitate prompt treatment in individual patients. Keywords: dengue virus; public health; tertiary care centre.

Poisoning among Patients Presenting to the Department of Emergency Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Poisoning is one of the major public health problems worldwide. The World Health Organization has estimated 0.3 million deaths a year due to various poisoning agents; pesticides being the leading one. Poisoning is one of the leading causes of emergency room visits. It has become a significant public health issue in Nepal. This study aimed to find out the prevalence of poisoning among patients presenting to the Department of Emergency Medicine of a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Department of Emergency Medicine of a tertiary care centre from 24 June 2022 to 6 July 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 11/2022). Data from 765 patients were collected from the hospital records. The patient's history and clinical examination were used to make the diagnosis of poisoning. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 765 patients visiting the emergency department, 8 (1.04%) (0.99-1.09, 95% Confidence Interval) patients were of poisoning. The most common poison used was organophosphates which was consumed by 2 (25%) patients and benzodiazepines by 2 (25%) patients. Conclusions: The prevalence of poisoning among patients presenting to the Department of Emergency Medicine was similar when compared to other studies conducted in similar settings. Although agricultural poisons were commonly used, cases of drug poisoning seems to be on the rise nowadays. Keywords: emergency department; poisoning; prevalence.

Chronic Obstructive Pulmonary Disease among Patients Visiting the Emergency Department of a Tertiary Care Centre: A Descriptive Cross- sectional Study.

Introduction: Chronic obstructive pulmonary disease is characterised by persistent airflow limitation which is usually progressive and is the primary global cause of morbidity and mortality. It is the third leading cause of Years Lived with Disability, the second most common cause of death after ischemic heart disease, and the fourth most common cause of premature death. The aim of this study was to find out the prevalence of chronic obstructive pulmonary disease among patients visiting the emergency department of a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Department of Emergency Medicine of a tertiary care centre from 4 July 2022 to 11 July 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 24). Data from 348 patients were collected from the hospital records. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 348 patients visiting the emergency department, 23 (6.60%) (6.57-6.63%, 95% Confidence Interval) had chronic obstructive pulmonary disease. The mean age of these patients was 73.50±2.76 years. Conclusions: The prevalence of chronic obstructive pulmonary disease was lower than in the previous studies done in similar settings. The study could provide a general idea of the burden of the disease. Keywords: chronic obstructive pulmonary disease; emergency departments; prevalence.

Universal Access to Essential Medicines: An Evaluation of Nepal's Free Health Care Scheme.

BACKGROUND: Access to medicine for the poor is recognized to be difficult task and one of the major challenges in achieving universal health coverage, particularly in low-and- middle income countries. In order to ensure the availability of essential medicines free of cost in public health facilities, Nepal has also commenced Free Health Care Services (FHCS). So, this study aims to evaluate availability, expiry, and stock-out duration of essential medicines at front line service providers in Nepal. METHODS: Cross-sectional survey was conducted 28 public health facilities, 7 district warehouses, and 14 private pharmacies in 7 districts of Nepal. The survey was conducted during the March and April 2014. Survey tools recommended by the WHO operational package for assessing, monitoring and evaluating country pharmaceutical situations was used with slight modification as per Nepal's situation. RESULTS: The availability of medicine was found to be 92.44% in this study. The percentage of expired medicines in district warehouse was found to be 8.40. The average stock-out duration in district warehouse was 0.324 days. CONCLUSIONS: Although the availability of essential medicines at peripheral health facilities was found to be satisfactory with lesser proportion of expired medicines, a strong monitoring and evaluation of expired and stock medicines are desirable to maintain and improve the access to essential medicines.

Blood Pressure and its Association with Body Mass Index Among the People Attending in a Hospital.

INTRODUCTION: Systolic and diastolic hypertension has been increasing trend and different factors are associated such as body mass index, diabetes etc. Obesity and overweight are generally associated with high blood pressure. This study aims to identify the prevalence of blood pressure level and its association to body mass index among people attending in civil service hospital, Kathmandu. METHODS: A cross-sectional descriptive study was conducted among all 1002 study subjects aged above 20 years. Information were obtained from people coming for Master health check-up during study period. Blood pressure and weight were taken by WHO certified tool. RESULTS: Half of the respondents were overweight and obese. Prevalence of systolic and diastolic hypertension was found to be 171 (17.1%) and 310 (30.9%) respectively. There is significant difference between body mass index to sex. Females are 1.5 times more likely to have high blood pressure who have high body mass index. Age group (40-59) years are more than two times likely to have overweight, systolic and diastolic blood pressure than other age group. Systolic blood pressure is more than six times more likely to be high in 60+ age group. But it is only 2.6 times in diastolic blood pressure and in body mass index, it is reduced to 1.4 times but it was still statistically significant. Overweight people are 1.4 and 1.6 times more likely to have high systolic and diastolic BP than another category. CONCLUSIONS: Half of the respondents were overweight and obese. Male had high overweight and obesity than female. Overweight people more likely to have high systolic and diastolic BP than others.

Gatifloxacin versus ceftriaxone for uncomplicated enteric fever in Nepal: an open-label, two-centre, randomised controlled trial.

BACKGROUND: Because treatment with third-generation cephalosporins is associated with slow clinical improvement and high relapse burden for enteric fever, whereas the fluoroquinolone gatifloxacin is associated with rapid fever clearance and low relapse burden, we postulated that gatifloxacin would be superior to the cephalosporin ceftriaxone in treating enteric fever. METHODS: We did an open-label, randomised, controlled, superiority trial at two hospitals in the Kathmandu valley, Nepal. Eligible participants were children (aged 2-13 years) and adult (aged 14-45 years) with criteria for suspected enteric fever (body temperature ≥38·0°C for ≥4 days without a focus of infection). We randomly assigned eligible patients (1:1) without stratification to 7 days of either oral gatifloxacin (10 mg/kg per day) or intravenous ceftriaxone (60 mg/kg up to 2 g per day for patients aged 2-13 years, or 2 g per day for patients aged ≥14 years). The randomisation list was computer-generated using blocks of four and six. The primary outcome was a composite of treatment failure, defined as the occurrence of at least one of the following: fever clearance time of more than 7 days after treatment initiation; the need for rescue treatment on day 8; microbiological failure (ie, blood cultures positive for Salmonella enterica serotype Typhi, or Paratyphi A, B, or C) on day 8; or relapse or disease-related complications within 28 days of treatment initiation. We did the analyses in the modified intention-to-treat population, and subpopulations with either confirmed blood-culture positivity, or blood-culture negativity. The trial was powered to detect an increase of 20% in the risk of failure. This trial was registered at ClinicalTrials.gov, number NCT01421693, and is now closed. FINDINGS: Between Sept 18, 2011, and July 14, 2014, we screened 725 patients for eligibility. On July 14, 2014, the trial was stopped early by the data safety and monitoring board because S Typhi strains with high-level resistance to ciprofloxacin and gatifloxacin had emerged. At this point, 239 were in the modified intention-to-treat population (120 assigned to gatifloxacin, 119 to ceftriaxone). 18 (15%) patients who received gatifloxacin had treatment failure, compared with 19 (16%) who received ceftriaxone (hazard ratio [HR] 1·04 [95% CI 0·55-1·98]; p=0·91). In the culture-confirmed population, 16 (26%) of 62 patients who received gatifloxacin failed treatment, compared with four (7%) of 54 who received ceftriaxone (HR 0·24 [95% CI 0·08-0·73]; p=0·01). Treatment failure was associated with the emergence of S Typhi exhibiting resistance against fluoroquinolones, requiring the trial to be stopped. By contrast, in patients with a negative blood culture, only two (3%) of 58 who received gatifloxacin failed treatment versus 15 (23%) of 65 who received ceftriaxone (HR 7·50 [95% CI 1·71-32·80]; p=0·01). A similar number of non-serious adverse events occurred in each treatment group, and no serious events were reported. INTERPRETATION: Our results suggest that fluoroquinolones should no longer be used for treatment of enteric fever in Nepal. Additionally, under our study conditions, ceftriaxone was suboptimum in a high proportion of patients with culture-negative enteric fever. Since antimicrobials, specifically fluoroquinolones, are one of the only routinely used control measures for enteric fever, the assessment of novel diagnostics, new treatment options, and use of existing vaccines and development of next-generation vaccines are now a high priority. FUNDING: Wellcome Trust and Li Ka Shing Foundation.