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  • 1
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    Online Resource
    Experience of Treating COVID-19 With Remdesivir and Convalescent Plasma in a Resource-Limited Setting: A Prospective, Observational Study
    Oxford University Press (OUP) ; 2021
    In:  Open Forum Infectious Diseases Vol. 8, No. 8 ( 2021-08-01)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 8, No. 8 ( 2021-08-01)
    Abstract: Convalescent plasma therapy (CPT) and remdesivir (REM) have been approved for investigational use to treat coronavirus disease 2019 (COVID-19) in Nepal. Methods In this prospective, multicentered study, we evaluated the safety and outcomes of treatment with CPT and/or REM in 1315 hospitalized COVID-19 patients over 18 years in 31 hospitals across Nepal. REM was administered to patients with moderate, severe, or life-threatening infection. CPT was administered to patients with severe to life-threatening infections who were at high risk for progression or clinical worsening despite REM. Clinical findings and outcomes were recorded until discharge or death. Results Patients were classified as having moderate (24.2%), severe (64%), or life-threatening (11.7%) COVID-19 infection. The majority of CPT and CPT + REM recipients had severe to life-threatening infections (CPT 98.3%; CPT + REM 92.1%) and were admitted to the intensive care unit (ICU; CPT 91.8%; CPT + REM 94.6%) compared with those who received REM alone (73.3% and 57.5%, respectively). Of 1083 patients with reported outcomes, 78.4% were discharged and 21.6% died. The discharge rate was 84% for REM (n = 910), 39% for CPT (n = 59), and 54.4% for CPT + REM (n = 114) recipients. In a logistic model comparing death vs discharge and adjusted for age, gender, steroid use, and severity, the predicted margin for discharge was higher for recipients of remdesivir alone (0.82; 95% CI, 0.79–0.84) compared with CPT (0.58; 95% CI, 0.47–0.70) and CPT + REM (0.67; 95% CI, 0.60–0.74) recipients. Adverse events of remdesivir and CPT were reported in  & lt;5% of patients. Conclusions This study demonstrates a safe rollout of CPT and REM in a resource-limited setting. Remdesivir recipients had less severe infection and better outcomes. ClinicalTrials.gov identifier. NCT04570982.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofab391
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2757767-3
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  • 2
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    Trimethoprim-sulfamethoxazole Versus Azithromycin for the Treatment of Undifferentiated Febrile Illness in Nepal: A Double-blind, Randomized, Placebo-controlled Trial
    Oxford University Press (OUP) ; 2021
    In:  Clinical Infectious Diseases Vol. 73, No. 7 ( 2021-10-05), p. e1478-e1486
    Details
    In: Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 73, No. 7 ( 2021-10-05), p. e1478-e1486
    Abstract: Azithromycin and trimethoprim-sulfamethoxazole (SXT) are widely used to treat undifferentiated febrile illness (UFI). We hypothesized that azithromycin is superior to SXT for UFI treatment, but the drugs are noninferior to each other for culture-confirmed enteric fever treatment. Methods We conducted a double-blind, randomized, placebo-controlled trial of azithromycin (20 mg/kg/day) or SXT (trimethoprim 10 mg/kg/day plus sulfamethoxazole 50 mg/kg/day) orally for 7 days for UFI treatment in Nepal. We enrolled patients & gt;2 years and & lt;65 years of age presenting to 2 Kathmandu hospitals with temperature ≥38.0°C for ≥4 days without localizing signs. The primary endpoint was fever clearance time (FCT); secondary endpoints were treatment failure and adverse events. Results From June 2016 to May 2019, we randomized 326 participants (163 in each arm); 87 (26.7%) had blood culture–confirmed enteric fever. In all participants, the median FCT was 2.7 days (95% confidence interval [CI], 2.6–3.3 days) in the SXT arm and 2.1 days (95% CI, 1.6–3.2 days) in the azithromycin arm (hazard ratio [HR] , 1.25 [95% CI, .99–1.58]; P = .059). The HR of treatment failures by 28 days betw een azithromycin and SXT was 0.62 (95% CI, .37–1.05; P = .073). Planned subgroup analysis showed that azithromycin resulted in faster FCT in those with sterile blood cultures and fewer relapses in culture-confirmed enteric fever. Nausea, vomiting, constipation, and headache were more common in the SXT arm. Conclusions Despite similar FCT and treatment failure in the 2 arms, significantly fewer complications and relapses make azithromycin a better choice for empirical treatment of UFI in Nepal. Clinical Trials Registration NCT02773407.
    Type of Medium: Online Resource
    ISSN: 1058-4838 , 1537-6591
    URL: Article
    DOI: 10.1093/cid/ciaa1489
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2002229-3
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  • 3
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    Women’s Choice of Immediate Postpartum Reversible Contraceptives Visiting a Tertiary Hospital of Nepal
    Nepal Journals Online (JOL) ; 2022
    In:  Journal of College of Medical Sciences-Nepal Vol. 18, No. 2 ( 2022-06-30), p. 134-143
    Details
    In: Journal of College of Medical Sciences-Nepal, Nepal Journals Online (JOL), Vol. 18, No. 2 ( 2022-06-30), p. 134-143
    Abstract: Introduction: Long-acting reversible contraceptives (LARC, Intrauterine contraceptives devices and Implants) stand on 1st regards to safety and effectiveness. It is an easily accessible variety for spacing birth as well as preventing unintended pregnancy soon after childbirth in Nepal due to free supply by the Government under safe motherhood program of Reproductive health policy. Despite free supply, LARC is not routinely implemented in practice among immediate post-partum lady as single approach contraceptives concern to unintended pregnancy due to unmet need. To find out the choice of LARC by antenatal and immediate postpartum women after delivery. Methods: A descriptive cross-sectional study was conducted among 200 women in antenatal clinic and obstetric ward of College of Medical Science and Teaching Hospital using non probability convince sampling technique. Ethical approval was taken form Institutional Review Committee of College of Medical Sciences and Teaching Hospital and data was analyzed using descriptive statistical tools in SPSS. Results: Twenty eight percent of antenatal and 42% of postnatal women had induced abortion for unintended pregnancy in past. All women had knowledge about modern method of contraception but only 47 percent antenatal and 58 percent postnatal women adopted contraception in past. Implant was chosen by 44% antenatal and 46% postnatal women; whereas IUCD was chosen by 45% antenatal and postnatal women as LARC. Jadelle was the choice of LARC in both group due to its convenient duration (5 years) for birth spacing and its safety profile during breastfeeding. Twenty women refuse for LARC in immediate postpartum period. Conclusions: Single approach immediate postpartum LARC in is chosen by women who had induced abortion for unintended pregnancy in past for its long action, convenience during breast feeding and reliability. Maximum antenatal women prefer IUCD compared to Implants among postnatal women. Keywords: Copper T; Immediate post-partum; Jadelle; long-acting reversible contraceptives; Puerperium; Unintended pregnancy.
    Type of Medium: Online Resource
    ISSN: 2091-0673 , 2091-0657
    URL: Article
    DOI: 10.3126/jcmsn.v18i2.46591
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2022
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  • 4
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    Correlation Between Vital Signs and Amount of Hemoperitoneum in Ruptured Ectopic Pregnancy
    Nepal Journals Online (JOL) ; 2021
    In:  Journal of College of Medical Sciences-Nepal Vol. 17, No. 3 ( 2021-09-30), p. 203-207
    Details
    In: Journal of College of Medical Sciences-Nepal, Nepal Journals Online (JOL), Vol. 17, No. 3 ( 2021-09-30), p. 203-207
    Abstract: Introduction: Ectopic pregnancy is a life threatening emergency in first trimester of pregnancy. Hemodynamic stability of the patient remains one of the crucial factors that determine the treatment modalities. The main objective of this study was to study the correlation between the vital signs and amount of hemoperitoneum in ruptured ectopic pregnancy so that early and active interventions can be done. Methods: We conducted a cross sectional study of all the pregnant women with ruptured ectopic pregnancy with hemoperitoneum who presented to the emergency department of College of Medical Sciences Teaching Hospital from time period of 1st May 2017-31st May 2020.The different vital signs present at the time of initial emergency department and preoperative period prior surgery were reviewed and used for correlation with amount of hemoperitoneum by using Pearson correlation analysis. Results: A total of 61 patients were studied. Pearson correlation between different vital signs and amount of hemoperitoneum were: heart rate(r=0.48, p 〈 0.001), systolic blood pressure(r= -0.41,p=0.001), diastolic blood pressure (r= -0.34,p=0.06), mean arterial pressure (r= -0.37,p=0.03), respiration rate (r= 0.33, p=0.08) temperature (r=0.09,p=0.94), and shock index (r=0.55,p 〈 0.001). Only 19 of 36 patients with hemoperitoneum ≥750 ml had HR≥100 beats/min and 8 patients had SBP≤90mmHg. Conclusions: None of the vital signs showed strong association with the amount of hemoperitoneum. If decision for surgical interventions were made based on hemodynamic instability, most of the patients would have been over-diagnosed and treated differently. Proper and timely diagnosis with immediate management should be done.
    Type of Medium: Online Resource
    ISSN: 2091-0673 , 2091-0657
    URL: Article
    DOI: 10.3126/jcmsn.v17i3.38305
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2021
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  • 5
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    MATERNAL AND FETAL OUTCOME IN PREGNANCY BEYOND THE EXPECTED DATE OF DELIVERY IN A TERTIARY CARE HOSPITAL OF NEPAL
    Chitwan Medical College ; 2022
    In:  Journal of Chitwan Medical College Vol. 12, No. 2 ( 2022-06-30), p. 47-50
    Details
    In: Journal of Chitwan Medical College, Chitwan Medical College, Vol. 12, No. 2 ( 2022-06-30), p. 47-50
    Abstract: Background: The risk to the mother and the fetus increase with advancing gestation age. Our study aims to study the maternal and fetal outcome in pregnancy extending beyond the expected date of delivery so that safe timings of induction and appropriate mode of delivery can be determined. Methods: We conducted a retrospec tive study of 152 patients with pregnancy beyond the expected date who presented to the department of Obstetrics and Gynecology, College of Medical Sciences Teaching Hospital from the time period of October 2019- November 2021.The primary outcome measures were obtained in terms of rate of cesarean section, postpartum hemorrhage, wound infection, admission in neonatal intensive care unit, birth asphyxia and meconium aspiration syndrome. Statistical analysis was performed using Chi-square test with P value 〈 0.05. Results: The majority of 86 (56.58%) patients were between 40-41 weeks of gestation. Maximum number of vaginal deliveries were seen between 40-41weeks (77.90%). Overall cesarean section rate was 40.13% with maximum number between 41-42 weeks (64.28%). Fetal distress with meconium-stained liquor was the most common indication (36.06%). The rate of neonatal intensive care unit admission was 16.44% with birth asphyxia (12.50%) and meconium aspiration syndrome (8.55%) as the primary cause for admission. Maternal complications like oligohydramnios, postpartum hemorrhage, wound infection, cervical tear, shoulder dystocia was seen in 16.45%, 1.97%, 1.97%, 2.63% and 1.31% respectively. Conclusions: The pregnancy beyond the expected date causes definite risk to the mother and the fetus. Therefore, strict fetal surveillance with early induction of labor prior to expected date of delivery is recommended for better fetomaternal outcomes.      
    Type of Medium: Online Resource
    ISSN: 2091-2889 , 2091-2412
    URL: Article
    DOI: 10.54530/jcmc.708
    Language: Unknown
    Publisher: Chitwan Medical College
    Publication Date: 2022
    detail.hit.zdb_id: 2895123-2
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  • 6
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    Status of Scar in Repeat Cesarean Section in a Tertiary Hospital
    Lumbini Medical College ; 2016
    In:  Journal of Lumbini Medical College Vol. 4, No. 1 ( 2016-06-30), p. 42-
    Details
    In: Journal of Lumbini Medical College, Lumbini Medical College, Vol. 4, No. 1 ( 2016-06-30), p. 42-
    Abstract: Introduction: In modern Obstetrics, with rising trends of primary Cesarean section (CS) for fetal and maternal interests, pregnancy over the scarred uterus is a challenge to all treating obstetricians. How better the cesarean scar is sutured, its exact fate in next pregnancy is still not measurable. Objective of this study was to evaluate the status of previous cesarean scar during repeat cesarean section (RCS) and calculate the maternal morbidity in those cases in a tertiary hospital.   Methods: It was a descriptive, retrospective study conducted at department of Obstetrics of Lumbini Medical College Teaching Hospital. The study was conducted from 15th July 2014 to 14th July 2015. The data were retrieved from the department of Medical Records. Women undergoing RCS were enrolled. The status of scar was evaluated in terms of intact scar, scar rupture, scar dehiscence, thin lower uterine segment, scar placenta previa, and adhesions as indicator of scar integrity.   Results: There were 534 (25.4%) CS among 2,098 deliveries during the study period. Ninety one (17.04%) of them were RCS. Elective RCS were 73.6% (n=67), and emergency RCS were 26.4% (n=24). Eighty two (90.1%) women had RCS once and 9 (9.9%) had RCS for second time. Scar was intact in 22 (91.6%), scar dehiscence in 1 (8.3%), scar with adhesions in 1 (8.3%) among  emergency RCS and intact in 53 (91.3%) and scar with adhesions in 5 (8.7%) among elective RCS. Among nine women of two RCS, three (37.5%) had thin scar, five (62.5%) had well formed scar,  seven (87.5%) had intact scar, and one (12.5%) had scar with adhesion. There was no scar dehiscence and no scar rupture in two RCS women.  Adhesions were documented twice higher in women whose primary CS was undertaken outside our hospital. Placenta previa and placenta accreta each were found in two cases.   Conclusion: Most of the scars of repeat Cesarean section were healthy with no scar rupture. We can consider trial of labor for scarred uterus with strict vigilance and in need,  CS is always at option.
    Type of Medium: Online Resource
    ISSN: 2542-2618 , 2392-4632
    URL: Article
    DOI: 10.22502/jlmc.v4i1.84
    Language: Unknown
    Publisher: Lumbini Medical College
    Publication Date: 2016
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  • 7
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    Successful Management of Quadruplet Pregnancy following Spontaneous Conception
    Lumbini Medical College ; 2016
    In:  Journal of Lumbini Medical College Vol. 4, No. 1 ( 2016-06-30), p. 46-
    Details
    In: Journal of Lumbini Medical College, Lumbini Medical College, Vol. 4, No. 1 ( 2016-06-30), p. 46-
    Abstract: Introduction: When more than two fetuses simultaneously develop in the uterus, it is called higher order multiple pregnancy. The incidence of such pregnancies ranges from 0.01% to 0.07%.   Case report: We report a case of 26-year-old G2P1L0D2 with previous history of preterm vaginal twin delivery, diagnosed to have quadruplet pregnancy. She was admitted at 28 weeks of gestation for safe confinement. At 33 weeks of gestation, emergency cesarean section was conducted with outcome of two female and two male babies with quadriamniotic and quadrichorionic placenta, without any intra and post-operative complications.   Conclusion: A multidisciplinary approach with good neonatal care facilities is warranted for a better outcome in higher order multiple pregnancies.
    Type of Medium: Online Resource
    ISSN: 2542-2618 , 2392-4632
    URL: Article
    DOI: 10.22502/jlmc.v4i1.88
    Language: Unknown
    Publisher: Lumbini Medical College
    Publication Date: 2016
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  • 8
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    Online Resource
    Study of Biodiversity of Arbuscular Mycorrhizal Fungi in Addition with Different Organic Matter in Different Seasons of Kavre District (Central Nepal)
    Nepal Journals Online (JOL) ; 1970
    In:  Scientific World Vol. 5, No. 5 ( 1970-01-01), p. 75-80
    Details
    In: Scientific World, Nepal Journals Online (JOL), Vol. 5, No. 5 ( 1970-01-01), p. 75-80
    Abstract: Different types of organic matter (dried and powdered 5 gms. leaves of Tithonia diversifolia, Eupatorium adenophorum, Lantana camara, farmers compost) and triple-superphosphate were mixed with eroded soil collected from sites with no vegetation. Eroded soil without amendments served as control. The mixture was placed in mesh bags (50 Mm mesh) that allowed fungal colonization but excluded roots. Two sets of mesh bags were buried around Bauhinia purpurea and Leucaena diversifolia that had been planted in an eroded site. The first set was buried in June 2003 and harvest in December 2003 (the monsoon period) and the second set was buried in December 2003 and harvested in June 2004 (The drier period). We found that more Arbuscular mycorrhizal (AM) fungal biomas and spores were produced during the wet season than during the dry season. The different types of organic matter had similar influence on the amount of AM biomass but the species composition was varied with the types of organic matter. In wet season nine species of AM spores and in dry season ten species of AM spores were found. In dry season Scutellospora nigra was found which was different from wet season. Key words: Arbuscular mycorrhiza; Organic matter; Wet season; Dry season. DOI: 10.3126/sw.v5i5.2660 Scientific World, Vol. 5, No. 5, July 2007 75-80
    Type of Medium: Online Resource
    ISSN: 1996-8949
    URL: Article
    DOI: 10.3126/sw.v5i5.2660
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 1970
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  • 9
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    Education Status of Husband and Wife and its Influence on Acceptance of Contraception
    Lumbini Medical College ; 2015
    In:  Journal of Lumbini Medical College Vol. 3, No. 1 ( 2015-06-30), p. 5-
    Details
    In: Journal of Lumbini Medical College, Lumbini Medical College, Vol. 3, No. 1 ( 2015-06-30), p. 5-
    Abstract: Introduction: Acceptance of family planning is influenced by a variety of interrelated factors such as age at marriage, education, economic status, religion, number of living children etc. This study is an endeavor to assess the relation between education status of husband and wife and acceptance of contraception among postpartum women at Lumbini Medical College Teaching Hospital. Methods: A prospective, observational analytical study was conducted in Obstetrics and Gynecology department of Lumbini Medical College. The information on socio-demographic data, educational status of husband and wife and willingness to accept any form of contraception within the next three months was obtained by an interview, utilizing a questionnaire. Results: There were 615 postpartum ladies accompanied by their husbands who were included in the study. Mean age of wives was 25.11 years (SD=5.36, range 17-45) and husbands was 27.89 years (SD=5.55, range 20-47). Contraceptive acceptance was shown to increase significantly with literacy status. Illiterate husbands and wives refused to accept the contraception which was statistically significant (p 〈 0.001). Conclusion: Contraceptive acceptance was significantly poor in illiterate wives and husbands whereas it was significantly higher in educated wives and husbands of all education levels. We feel the need of more education programs and education friendly socio-economic conditions which increases the acceptance of contraception thereby assisting family planning and population control.
    Type of Medium: Online Resource
    ISSN: 2542-2618 , 2392-4632
    URL: Article
    DOI: 10.22502/jlmc.v3i1.60
    Language: Unknown
    Publisher: Lumbini Medical College
    Publication Date: 2015
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  • 10
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    Comparison of Perinatal Outcome of Breech Presentation between Vaginal Delivery and Cesarean Section
    Lumbini Medical College ; 2016
    In:  Journal of Lumbini Medical College Vol. 4, No. 1 ( 2016-06-30), p. 4-
    Details
    In: Journal of Lumbini Medical College, Lumbini Medical College, Vol. 4, No. 1 ( 2016-06-30), p. 4-
    Abstract: Introduction: Many times, parturient opt for labour and vaginal breech delivery even after informing increased perinatal risks. Vaginal breech deliveries are undertaken with the reasons like avoidance of cesarean section in next pregnancy, null risk of operative and anesthetic hazards, ability to resume early all household works after vaginal birth, etc. The purpose of this study is to compare the perinatal outcome of breech deliveries in singleton breech presentation between vaginal breech delivery and cesarean section.   Methods: A retrospective study was done in Lumbini Medical College Teaching Hospital for the duration of one year (December 2014 to November 2015). Data of perinatal outcome of breech deliveries were collected from the hospital records. The records of neonatal examination were also collected. The primary outcomes included were neonatal morbidity and mortality.   Results: Out of 80 selected women with breech presentation, 42 of them had vaginal deliveries and 38 women had undergone caesarean section. The perinatal mortality was 4.8% and morbidity was 2% in vaginal breech deliveries. There was no significant difference of APGAR score in the two groups at any time. Similarly, there was no significant difference in perinatal morbidity and mortality in the two groups. Nulliparous women were more likely to deliver by Cesarean section.   Conclusion:  In places where planned vaginal delivery is a common practice and when strict criteria are met before and during labour, planned vaginal breech delivery of singleton fetus in breech presentation remains a safe option that can be offered to women.
    Type of Medium: Online Resource
    ISSN: 2542-2618 , 2392-4632
    URL: Article
    DOI: 10.22502/jlmc.v4i1.87
    Language: Unknown
    Publisher: Lumbini Medical College
    Publication Date: 2016
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