Background. This study aims at determining the factors associated with anemia among pregnant women of underprivileged ethnic groups attending antenatal care at the provincial level hospital of Province 2. Methods. A hospital-based cross-sectional study was carried out in Janakpur Provincial Hospital of Province 2, Southern Nepal. 287 pregnant women from underprivileged ethnic groups attending antenatal care were selected and interviewed. Face-to-face interviews using a structured questionnaire were undertaken. Anemia status was assessed based on hemoglobin levels determined at the hospital’s laboratory. Bivariate and multiple logistic regression analyses were used to identify the factors associated with anemia. Analyses were performed using IBM SPSS version 23 software. Results. The overall anemia prevalence in the study population was 66.9% (95% CI, 61.1–72.3). The women from most underprivileged ethnic groups (Terai Dalit, Terai Janajati, and Muslims) were twice more likely to be anemic than Madhesi women. Similarly, women having education lower than secondary level were about 3 times more likely to be anemic compared to those with secondary level or higher education. Women who had not completed four antenatal visits were twice more likely to be anemic than those completing all four visits. The odds of anemia were three times higher among pregnant women who had not taken deworming medication compared to their counterparts. Furthermore, women with inadequate dietary diversity were four times more likely to be anemic compared to women having adequate dietary diversity. Conclusions. The prevalence of anemia is a severe public health problem among pregnant women of underprivileged ethnic groups in Province 2. Being Dalit, Janajati, and Muslim, having lower education, less frequent antenatal visits, not receiving deworming medication, and having inadequate dietary diversity are found to be the significant factors. The present study highlights the need of improving the frequency of antenatal visits and coverage of deworming program in ethnic populations. Furthermore, promoting a dietary diversity at the household level would help lower the prevalence of anemia. The study findings also imply that the nutrition interventions to control anemia must target and reach pregnant women from the most-marginalized ethnic groups and those with lower education.
Introduction: Transurethral resection of the prostate requires a catheter in situ post-surgery. Early removal of catheter can reduce the length of hospital stay reducing the healthcare cost. It can also reduce the risk of infection due to prolonged catheterization. Our aim was to determine the median duration of hospital stay after early foley’s removal after transurethral resection of prostate among patients in a tertiary care hospital. Methods: A descriptive cross-sectional study was done in a tertiary care hospital from July 2019 to December 2020 and ethical clearance was obtained from the institutional review committee. Foley’s catheter were removed on the first post-operative day, who met the criteria of catheter removal. Convenience sampling was done. After foley’s removal patients were observed for spontaneous voiding. Patients with complications like hematuria, clot retention, urinary retention were recatherized. The data were expressed in mean with standard deviation, median with interquartile range and frequency and percentage as applicable using Statistical Package for the Social Sciences version 16. Results: Out of the 150 participants included in the study, the median duration of hospital stay after the early removal of foley's catheter was 3 days (interquartile range 2-4 days). A total of 20 (13.3%) patients underwent recatherization. Nine (6%) patients had to be recatheterized due to clot retention, and 11 (7.3%) were due to urinary retention. Conclusions: This study showed that the median duration of hospital stay after early removal of foley's catheter among patients undergoing transurethral resection of the prostate was similar to studies done in national/international settings.
Introduction: There is a variation in risk factors and outcome of delirium in surgical patients in different studies. This study was conducted to determine the incidence, risk factors, and outcome of delirium in the surgical semiclosed intensive care unit in a developing country. Materials and Methods: This descriptive study was done in 82 patients of age≥18 years that underwent non-neurological surgery and admitted for more than 24 hours in a level three intensive care unit of medical college from January 10, 2021 to January 9, 2022. The whole sampling method was used in our study. The Confusion Assessment Method-ICU and Richmond Agitation Sedation Scale were used to diagnose delirium and sedation, respectively, along with a checklist to assess risk factors. All data was transferred to the excel sheet and transferred to a statistical package for the social sciences-16. Chi-square test and Fisher’s exact probability test were used to detect the difference between groups in the univariate analysis, as appropriate. The risk factors were analysed using binary logistic regression. Result: Of the 82 ICU admissions 28(34.1%) developed delirium. Hyperactive delirium was the most common motor subtype 12(42.8%). The mean duration of delirium was 4.69±5.06 days. Hypertension and alcohol were identified as risk factors for delirium. Delirious patients had a longer length of stay in the ICU (10.1 ±12.7 vs 5.1 ±4.2 days) with no impact on the duration of mechanical ventilation, mortality, reintubation, and unplanned extubation. Conclusion: Early recognition of risk factors for delirium in surgical patients can decrease the mortality and morbidity of surgical patients.
Background: Acute appendicitis is one of the most common surgical emergencies in the world. The purpose of this study is to know clinical profile and outcome of surgery in patients with acute appendicitis. Materials and methods: This retrospective study was done in National Medical college and Teaching Hospital, Birgunj, Nepal from 2013 April to 2016 April. A total of 184 patients with suspected appendicitis who underwent surgery were included in the study. Patient's demographics, clinical features, white blood cell count, operative findings, histology report and outcome of surgery were recorded on patient's proforma. Results: Among 184 nd patients, 115 were males (62.5%) and 69 were females (37.5%). The majority of our patients were in the 2 decade (36.4%) followed rd by 3 decade (33.2%) with only 41.3% presenting within 24 hours of onset of symptoms. The most common symptoms were abdominal pain (100%), vomiting (68.5%), fever (37.5%) and history of migration of pain was present in 60.9%. Localized and generalized abdominal tenderness were present in 91.8% and 8.2% respectively. The most common incisions were gridiron (64.1%) and Lanz (27.2%). The negative appendicectomy rate was 9.2%. Acute appendiceal inflammation and gangrenous appendicitis was present in 69% and 4.9% respectively. The perforation rate was 16.8%. Post operative complications included surgical site infection (12.6%), complete wound dehiscence (1.1%) and chest infection (1.6%). The median length of hospital stay was 8 days. There was no mortality. Conclusion: Acute appendicitis is more commonly seen in young adults. Majority of patients present late in hospital. This delay presentation increases morbidity and treatment cost.
Introduction: Laparoscopic cholecystectomy is clean-contaminated surgery. Prophylactic antibiotics are used to reduce SSI but there is still controversy regarding use of antibiotics in postoperative period. The aim of this study is to compare the effect of single dose versus multiple doses of antibiotics in terms of wound infection. Methods: This prospective study was carried out in department of surgery of National Medical College and Teaching Hospital, Birgunj from March 2020 to March 2021. Patients with diagnosis of symptomatic cholelithiasis were divided alternatively in single dose (SD) group and multiple doses (MD) group. SD group were given injection ceftriaxone 1gm at the time of induction of anaesthesia and MD group received injection ceftriaxone 1gm at the time induction of anaesthesia and followed by continuation of same dose twice a day for 2 days. Results: A total of 249 patients were enrolled in the study. Among 249 patients, 127 patients were in the single dose (SD) group and 122 patients in (MD) group. The mean age of patient was 37.37±14.30 years with minimum age of 13 years and maximum 75 years. In single dose (SD) group, 5(3.9%) patients developed wound infection and 3(2.5%) patients in multiple (MD) group developed wound infection which was not statistically significant (p=0.437) Conclusion: Single dose antibiotic was found as effective as multiple doses of antibiotics in terms of wound infection in laparoscopic cholecystectomy.
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