JNMA; journal of the Nepal Medical Association
-
JNMA J Nepal Med Assoc · Dec 2020
Case ReportsCongenital Tracheoesophageal Fistula in Very Low Birth Weight Preterm Neonate with an Oligohydramnios as a Rare Presentation: A Case Report.
Tracheoesophageal fistula is a challenging anomaly with a rare prevalence with symptoms mainly respiratory, sometimes digestive. We present a rare case of oesophageal atresia with distal Tracheoesophageal fistula in a female child whose mother presented with severe oligohydramnios on ultrasonography with intrauterine growth retardation before cesarean section. After the birth of preterm and very low birth weight neonate, we initially diagnosed as respiratory distress syndrome with a club foot. ⋯ Breastfeeding initiated and the child discharged after she started gaining weight. Early post-operation complication (anastomotic stricture) was noticed after 2 weeks; however, corrected with endoscopic balloon dilatation. Currently, the child is healthy weighing 10kgs at 18 months of age.
-
JNMA J Nepal Med Assoc · Dec 2020
Cases of Left Against Medical Advice from the Emergency Department of a Tertiary Care Hospital in Kathmandu: A Descriptive Cross-Sectional Study.
Left against medical advice is a worldwide phenomenon. Patients leaving against Left against medical advice do not provide the health professionals with legal impunity. A well-informed consent should be present with surety that they are well understood by the patient before they leave. The study was undertaken to study the prevalence of patients that leave against medical advice. ⋯ The proportion of patients who left against medical advice was more than the studies done in a similar setting.
-
JNMA J Nepal Med Assoc · Dec 2020
Out of pocket Expenditure on Health Service Delivery at a Tertiary Care Women's Hospital: A Descriptive Cross-sectional Study.
Institutional delivery in Nepal is increasing in the past decades and has been the priority program of the government of Nepal. However, due to the hidden costs related to institutional deliveries, the financial burden remains unacceptably high for poor households. The study aimed to find out the major out of pocket expenditure on health service delivery at a tertiary care hospital in Kathmandu, Nepal. ⋯ Indirect expenditures were found to be higher than direct medical expenditures. Accessibility of the birthing centers and health insurance may reduce the costs related to maternal deliveries.
-
JNMA J Nepal Med Assoc · Dec 2020
Approach to Sample Collection, Transport and Processing of Suspected or Confirmed COVID-19 Patients for Biochemistry Investigations.
During this global pandemic period of COVID-19, the health care system is the most affected area. Health care workers including clinicians, laboratory professionals, and other allied health workers pose a high threat for acquiring and transmission the disease. ⋯ Every day, the laboratory receives samples of the patient with confirmed and suspected cases of COVID-19 patients. This poses a high threat of contamination to the health professionals and thus, a proper risk assessment and standard precautions protocol must be followed to ensure safety, minimize the risk of contamination and disease transmission.
-
JNMA J Nepal Med Assoc · Dec 2020
Prevalence of Hysterectomy among Gynecological Surgeries in a Tertiary Care Hospital.
Hysterectomy is the most common gynecological procedure. Over the last decade, the minimally invasive approach has been practiced more frequently. Fibroid uterus being the most common indication for hysterectomy justifies this minimal approach, however, whenever feasible, vaginal hysterectomy can be the preferred route. The objective of this study was to find out the prevalence and indication of hysterectomy among major gynecological surgeries in a tertiary care hospital. ⋯ Hysterectomy, being the most common gynecological surgery, selection of the most appropriate route is of paramount importance. As for any other surgery, it is not without complication and hysterectomy should always be justified. With the advancement in the conservative approaches, these organ-preserving options should be explored rigorously before opting for hysterectomy.