Morbidity and Mortality Profile of Neonates Admitted in Neonatal Intensive Care Unit

BACKGROUND

The neonatal period faces the greatest risk of death as they are vulnerable to sepsis, birth asphyxia, hypoxic injuries etc. A substantial disparity exists in NMR between Nepal and other developed countries and among different provinces of Nepal as well. This study was conducted to describe the pattern of neonatal admission, and immediate hospital outcomes from NICU located in a remote part of Nepal.

METHODS

This prospective study was conducted in The Province Hospital, Karnali, Nepal over a period of six months (June 2021 to Dec 2021 AD). The variables used were neonatal age, sex, gestation, birth weight, maternal age, mode and place of delivery. Neonatal morbidities and final outcomes at discharge were recorded in a predesigned proforma.

RESULTS

A total of 396 neonates included, the majority were inborn 283(71%), male 241(61%), term 301(76%) and had normal birth weight 279 (70.4%). Neonatal sepsis 188(37.2%), prematurity 95(24%), and birth asphyxia 55(15.2%) were main indications for hospitalization. The majority 337(85%) improved after treatment, while 33(8.3%) died, 12 (3%) left against medical advice and 14(3.5%) cases were referred. Preterm neonates had thrice the risk of mortality than term neonates (OR =3.27). Low birth weight (< 2500 grams) had higher odds of poor outcomes (OR =3.5). Low maternal age (<20 years), prematurity, LBW, mechanical ventilation and inotrope use were predictors of poor outcomes.

CONCLUSIONS

Neonatal sepsis, prematurity and perinatal asphyxia were the most common causes of NICU admissions. Mechanical ventilation, inotropes use, extreme prematurity, low birth weight and younger age of the mother were predictors of poor outcome.

Complete form of pachydermoperiostosis with good initial response to etoricoxib: A case report

Key Clinical Message

Pachydermoperiostosis is a rare genetic disorder that closely resembles acromegaly. Diagnosis is usually based on distinct clinical and radiological features. Oral etoricoxib therapy showed a good initial response in our patient.

Abstract

Pachydermoperiostosis (PDP) is a rare genetic disorder with unclear etiopathogenesis. We report a case of a 38-year-old male who presented with classic features of PDP. Our patient showed a good initial response to etoricoxib therapy but the safety and efficacy over long-term use are yet to be determined in further studies.

Was It Pneumothorax? A Case Report of a Neonate with Congenital Pulmonary Airway Malformation from Rural Nepal

Formerly called congenital cystic adenomatoid malformation (CCAM), congenital pulmonary airway malformation (CPAM) is a rare but most common congenital lung malformation that may manifest as an asymptomatic lesion at birth or in later life. The diagnosis may be difficult and is easily confused for pneumothorax often resulting incorrect ICD insertion on an emergency basis, which causes complications and delays accurate diagnosis. We report a case of a neonate, who presented with increasing respiratory distress at birth and hyperlucency in a chest radiograph initially misdiagnosed as pneumothorax and ICD inserted, later correctly diagnosed as CPAM type I with help of a CT chest. This case report is presented to highlight that CPAM is a rare cause of respiratory distress in newborns at birth.

Whole Genome Sequence Analysis to Identify SARS-CoV-2 Variant in Nepal

Background The spread of SARS-CoV-2 has become a global public health crisis. Nepal is facing the second wave of COVID-19 pandemic but, there is still a limited data on the genomic sequence of SARS-CoV-2 variants circulating in Nepal. Objective The objective of this study is to sequence the whole genome of SARS-CoV-2 in Nepal to detect possible mutation profiles and phylogenetic lineages of circulating SARSCoV-2 variants. Method In this study, swab samples tested positive for SARS-CoV-2 were investigated. After RNA extraction, the investigation was performed through real-time PCR followed by whole genome sequencing. The consensus genome sequences were, then, analyzed with appropriate bioinformatics tools. Result Sequence analysis of two SARS-CoV-2 genomes from patient without travel history (Patient A1 and A2) were found to be of lineage B.1.1. Similarly, among other four samples from subjects returning from the United Kingdom, genomes of two samples were of lineage B.1.36, and the other two were of lineage B.1.1.7 (Alpha Variant). The mutations in the consensus genomes contained the defining mutations of the respective lineages of SARS-CoV-2. Conclusion We confirmed two genomic sequences of variant of concern VOC-202012/01 in Nepal. Our study provides the concise genomic evidence for spread of different lineages of SARS-CoV-2 - B.1.1, B.1.36 and B.1.1.7 of SARS-CoV-2 in Nepal.

Parental engagement in social entrepreneurship by participatory action research at school of Nepal

School education has immense role for the better future of a country. However, schools such as in a developing, country like Nepal face many barriers in demand creation as well as quality in classroom delivery. Students enter the school with mental stress and family problems. This restricts the educational outcome of schooling. Social entrepreneurship (SE) is an alien idea still in most schools in Nepal. By this venture, School social entrepreneurship can help the students and society to detect the skill of life which changes their life standard in future. It helps students to be regular in school, improve their health and ultimately bring change in overall educational achievement. In contrary to this, because of students poor economic condition they are neither able to have proper breakfast nor lunch which leads to sleepiness and inability to concentrate in the class room. Hence their learning outcome is poor. Following a Participatory Action Research (PAR) paradigm, the first author spent more than a year with rigorous field engagement in Janajivan Secondary school at Chitwan district of Nepal in order to understand the context and real need of SE. The school has own building and enough land where opportunity to develop entrepreneurship activities with the concept of 'supporting livelihood of parents through SE' approach. To dig out the reasons, We used informal talk, focused group discussion, observation and interview with teachers, students, community members, school management committee and parents. The study finding indicates that lack of time, teacher's fear of commercialism, impeding educational structures and sustainability were some of the challenges integrating SE in school. Experiential earning and learning based activities can be practiced in school outside the classroom. Having SE at school with parental involvement can be innovative pedagogical approach in school education of Nepal.

Key messages

Entrepreneurship linking with health education. Promote livelihood with entrepreneurship by participatory action research.

Evaluation of usefulness of a commercial agarose gel electrophoresis kit (QuickGel SP) for bovine serum protein electrophoresis

The aim of this study was to show the usefulness of a commercial agarose gel electrophoresis (AGE) kit (QuickGel SP) for separating bovine serum protein fractions in comparison with conventional cellulose acetate electrophoresis (CAE). Serum protein bands were verified using five reference reagents corresponding to albumin and α1-, β1-, β2-, and γ-globulins. AGE clearly revealed six separated fractions of albumin and α1-, α2-, β1-, β2-, and γ-globulin fractions in 100% and 77.8% in serum samples of dairy cows from the healthy (n=27) and diseased groups (n=27), respectively. The α1- and α2-globulins were not separated by CAE in 14.8% and 96.3% of the samples from the healthy and diseased groups, respectively, whereas β2- and γ-globulin were not separated by CAE in 96.3% and 100% of the samples from the healthy and diseased groups, respectively. More than 94% of the points for the α-globulin fractions (α1- and α2-globulins), the β-γ-globulin fractions (β1-, β2-, and γ-globulins), and the albumin/globulin ratio between AGE and CAE were within agreement on the Bland-Altman plots. However, the mean biases were not near zero in the albumin and β-γ-globulin fractions. These results suggest that the high-resolution commercial AGE kit can be utilized to separate bovine serum protein fractions.

Accessing research literature: A mixed-method study of academics in Higher Education Institutions in Nepal

Background:  Research in Higher Education (HE), particularly in health and medical sciences plays a crucial role, not only in enhancing knowledge and skills of students and academics, but also in helping to develop   managers and policy makers who rely on evidence-based planning and programming. This paper reports university teacher’s knowledge and practices in accessing to electronic research-based evidences in health and medical sciences in Nepal. Material and Methods: This was mixed-methods study comprising a self-administered questionnaire completed by HE teachers and informant key interviews with authorities of HE institutions. A total of 15 out of the total 40 institutions offering HE above Bachelors level on health-related subjects were included for the study. Results: The response rate was 68%; 244 out of 360 HE teachers completed self-administered questionnaire.  The respondents comprised nurses (36%), followed by doctors (23%), public health practitioners (18%), dentists (17%) and pharmacists (12%). Most of the HE teachers reported that they have computer skills and possess their own computer. Two-thirds (66%) of the HE teachers had work email and almost all (93%) have a personal email ID.  All institutions had a computer lab and/or library. Almost all teachers had internet access at work but the internet was reportedly slow. Each institution had a librarian to support to the students and staff but only a third of teachers sought their help. Many do not know what kind of support librarians can provide. Less than half of the staff had accessed electronic research materials. This proportion varied between HE institutions ranging from 13 to 83%. HINARI and PubMed were the mostly used research databases. Less than half of respondents (48%) had published research papers in peer-reviewed journals, and only 19% published a paper based on a systematic review. Female HE teachers were less likely to publish (32%) than males (68%).  More readers and professors had published (75%) than instructors/assistant lecturers (30%) and lecturers (45%).  Conclusions: Accessing electronic research literature provides an opportunity to gathering up-to-date research-based information that should be core to all health curricula.  We call upon curriculum developers and university authorities in Nepal to revise health curricula and help build electronic searching skills among staff and students. DOI: http://dx.doi.org/10.3126/nje.v4i4.11375 Nepal Journal of Epidemiology 2014; 4(4):405-14

Microarray-based gene expression profiling of peripheral blood mononuclear cells in dairy cows with experimental hypocalcemia and milk fever

Although a molecular diagnostic assay using clinically accessible tissue, such as blood, would facilitate evaluation of disease conditions in humans and animals, little information exists on microarray-based gene expression profiling of circulating leukocytes from clinically hypocalcemic cows. Therefore, peripheral blood mononuclear cells from dairy cows with experimentally induced hypocalcemia or spontaneous milk fever were subjected to oligo-microarray analysis to identify specific biomarker genes. In experimental hypocalcemia induced by a 4-h infusion of 10% disodium EDTA (n=4), 32 genes were significantly up- or downregulated compared with control treatment (4-h infusion of 11% calcium EDTA; n=4). In cows with milk fever (n=8), 98 genes were expressed differentially (either up- or downregulated) compared with healthy parturient cows (n=5). From these data, the following 5 genes were selected as being strongly related to both experimental hypocalcemia and milk fever: protein kinase (cAMP-dependent, catalytic) inhibitor β (PKIB); DNA-damage-inducible transcript 4 (DDIT4); period homolog 1 (PER1); NUAK family, SNF1-like kinase, 1 (NUAK1); and expressed sequence tag (BI537947). Another gene (neuroendocrine secretory protein 55, NESP55) was also determined to be specific for milk fever, independently of hypocalcemia. The mRNA expression of these 6 genes in milk fever cases was verified by quantitative real-time reverse-transcription PCR and was significantly different compared with their expression in healthy parturient cows. In the present study, the selected genes appeared to be candidate biomarkers of milk fever because the continuous interactions between blood cells and the entire body suggest that subtle intracellular changes occur in association with disease. However, before any genomic biomarkers are incorporated into clinical evaluation of the disease, the effect of hypocalcemia on the mRNA expression of these genes in the tissues that regulate calcium homeostasis in dairy cows should be determined.

Research Methods Coverage in Medical and Health Science Curricula in Nepal

Higher education institutions in Nepal have been offering different types of health sciences programmes over the last few decades. With the growing number of education institutions, the range of programmes has also increased. Currently, five higher education institutions – TU, KU, PU, PoU and BPKIHS are providing health sciences course at undergraduate and graduate level. TU being the leading university to offer most of health science programmes, there is observable influence in the curriculum contents and design of the remaining four institutions. However, a variation is observed in structure of curriculum within and between institutions. The curricula of Pokhara University are better designed and recent compared to other while the curricula of TU are less revised and comparatively old. Curricula in general health sciences are detailed and favourable to research methodology contents. DOI: http://dx.doi.org/10.3126/nje.v3i3.9185 Nepal Journal of Epidemiology 2013;3(3): 253-258

Involving diaspora and expatriates as human resources in the health sector in Nepal

BACKGROUND

Health professional mobility has increased in the recent years and is one of the public health concerns in the developing countries including Nepal. On the other hand, we can't ignore a positive shift of Nepali diaspora coming back to Nepal for some work related projects. The objective of this study was thus to estimate the number of Nepalese Diaspora and foreign expatriate those are coming to Nepal and explore the ways and process of their engagement in the health sector of Nepal.

METHODS

Mixed method was used. In total, 13 Key Informant Interviews were conducted at the central level along with record review from professional councils.

RESULTS

Nepalese Diasporas mainly come through Diaspora Volunteering Organizations, Non Resident Nepali Association and personal connections to the place of their origin. Nepalese Diasporas have supported as health specialists, health camps and project organizers, trainer and hospital promoters, supplier of equipment including ambulances etc. The Nepalese Diasporas are unrecorded with professional organizations such as NMC and NHPC. As such the real status and results of support from Nepalese Diaspora are not known. Overall, 5,120 foreign medical professionals have served to Nepal through NMC followed by 739 nursing professionals through NNC and 189 paramedical staff through NHPC as of 2012.

CONCLUSIONS

Systematic information on number and characteristics of the Nepalese Diaspora and their role in the health sector of Nepal is limited. The health professional bodies have some record systems but they lack uniformity and systematic process.

Health governance at local level from human resource for health perspectives: the case of Nepal

BACKGROUND

Evidence about effects of good governance in Human Resources for Health (HRH) is scant in Nepal. The study aimed to explore the situation of health governance at the local level and suggest measures to address the HRH challenges.

METHODS

Ninety health facilities from Siraha, Bardiya and Doti districts were included in the study. Focus group discussions (N=36) with different groups and key informants interviews (33 VDC Secretaries, 76 Health Facility Management Committees and 9 central level policy makers and managers) were conducted.

RESULTS

Only 49 (54%) of the health facilities have properly displayed signboard, 42 (47%) citizen charter, 36 (40%) free health services and Information on Aama program in 25 (28%) health facilities. In total 52 (58%) health facilities have not displayed names of women receiving Aama benefits. Seventy two out of 90 health facilities have not displayed social audit reports and 80 (89%) of the health facilities have not maintained complaint box. The initiative of decentralized human resource management, where implemented, has increased ownership at the local level. Staff retention has been reported well though it does not apply in case of the medical doctors. Rule of law in terms of human resource recruitment and transfer, promotion, and training were not fully implemented and were lenient in the upper level. Nepotism and power exercise was frequently reported as a hindrance in implementing the gender and social inclusion policy fully.

CONCLUSIONS

Transparency, gender and social inclusion is yet to be implemented fully at the district and health facility level.

Effects of cortisol secreted via a 12-h infusion of adrenocorticotropic hormone on mineral homeostasis and bone metabolism in ovariectomized cows

To evaluate the effects of endogenously secreted cortisol on mineral homeostasis and bone metabolism in cows, 4 ovariectomized Holstein cows were infused for 12 h with either an adrenocorticotropic hormone (ACTH) solution (0.5 mg/2 L isotonic NaCl solution per cow) or isotonic NaCl solution in a 2×2 crossover design. ACTH infusion stimulated cortisol secretion and increased plasma cortisol concentrations for 18 h (P<0.001), leading to an elevated plasma glucose concentration until 36 h (P<0.001). Plasma calcium and magnesium concentrations in ACTH-infused cows fluctuated within normal ranges, whereas hypophosphatemia was observed unequivocally. The biochemical bone resorption markers tartrate-resistant acid phosphatase 5b and hydroxyproline decreased following ACTH infusion (P<0.001 and P=0.003, respectively). Similarly, the bone formation marker, bone-specific alkaline phosphatase, decreased continuously until 72 h after the ACTH infusion (P<0.001). These results demonstrate that increased secretion of cortisol via a 12-h ACTH infusion disrupted homeostasis of inorganic phosphate and suppressed bone metabolism in ovariectomized cows without involving gonadal steroid hormones.

Effects of heavy metals (Hg2+, cd2+, Pb2+) during the embryonic development of acridid grasshoppers (Insecta, caelifera)

Heavy metals present in the soil get differently accumulated in organisms and show different rates of toxicity at different stages of the life cycle of any organism living there. To see whether such toxicants get accumulated during the embryonic development and/or change the normal developmental processes of organisms exposed to heavy metals, freshly laid eggs and egg pods of two acridids, Aiolopus thalassinus and Eyprepocnemis plorans, were tested against different concentrations of Hg2+, Cd2+, and Pb2+. At increasing Hg2+ concentration in the substrate, an increased egg mortality and reduced nymphal hatching in A. thalassinus were observed, yet no change in the normal duration for embryonic development was noticed. A higher hatching rate of E. plorans nymphs than that of A. thalassinus could possibly be due to the higher tolerance, contributed by larger egg volume and thicker foam around the egg pods of the former. Treated concentrations of Hg2+ could be of sublethal (0.121 &mgr;g Hg2+/g substrate) to lethal (0.605 &mgr;g and more Hg2+/g substrate) doses. The mortality of eggs did not always increase with increasing substrate concentration of Cd2+ and Pb2+, and the hatching rates of both grasshopper species in many cases were even higher than that in the control. Still, lower accumulation factors of Cd2+ and Pb2+ than that of Hg2+ were found coupled with not increased mortality. The tested concentrations of Cd2+ and Pb2+ in the substrates, thus, could be of subacute doses. The embryonic development was found prolonged due to Cd2+ and Pb2+. During parallel egg and egg pod treatments, higher metal concentrations were found in not developed eggs than that in fresh nymphs hatching from the same substrates. This indicated the role of foam around the egg pods as "protective filter" against the toxic substances in the soil.

Utilization of rural maternity delivery services in Nawalparasi and Kapilvastu District: A Qualitative Study

Increasing the proportion of births attended by skilled health providers is likely the key factor in reducing maternal and perinatal morbidity and mortality. Study objectives were to identify key factors influencing the utilization delivery services and stakeholders’ perceptions about these services. The study utilized focus group discussions and in-depth interviews with a diversity of community members users and nonusers , dalit women and health facility staffs to gain insights about the factors influencing use of trained attendants. Field researchers were trained to use FGD guides and interview schedules, and then gathered information on the perspectives of the women and their families and health staff. In Nawalparasi and Kapilvwastu we conducted a comparative study to compare on factors affecting the volume of delivery services.In Nawalparasi the deliveries in the pervious six months was relatively large number from hospital and PHCC whereas in Kapilvastu the delivery was in smaller number. The vast majority of women planned to have a home delivery attended by relatives and/or a Trained Birth Attendants and to reserve attendance at a health facility as a back-up plan in case of prolonged labor and complications. Ritual pollution considerations interfere with a decision to seek delivery in a facility, especially in the Western Hills. The cost recovery scheme ("incentives") deals with a major factor which inhibits use of health facilities. TBAs can encourage clients to deliver in health facilities. Staff feel that the large number of vacant positions inhibits availability of services and requires strenuous efforts on their part to cover for vacancies. Key Words: Maternity; delivery; health staff DOI: 10.3126/jcmsn.v6i3.4072Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 3 pp.29-36