Europasian Journal of Medical Sciences

Stress and Coping Strategies among Parents of Preterm Infants Admitted to Three Hospitals in Nepal

Tumla Shrestha, Archana Pandey Bista, Madhusudan Subedi — Mon, 15 Jan 2024 00:00:00 +0000

Background Hospitalization in neonatal care units (NCUs) is distressing to parents. Stress and inadequate coping hinder parents’ emotional health and parenting roles. Furthermore, it may impact short- and long-term developmental, cognitive, academic, and mental health outcomes among preterm infants (PTIs). This study aimed to explore the stress and coping mechanisms adopted by parents in NCUs.
Data and Methods The descriptive phenomenological study was conducted in the NCUs of three public tertiary hospitals in Kathmandu, Nepal. In-depth interviews were conducted with 15 purposively selected parents, both mothers and fathers, of preterm and low birth weight infants admitted to the NCUs. The data were descriptively analyzed employing the Colaizzi method to elucidate the stress experiences and coping strategies of parents.
Results The exploration of parents’ experiences yielded two overarching themes, namely psychological distress and insecurity and coping with the support system. Parents’ distress was linked to PTIs’ condition, infant–parent separation, altered parenting roles, and prolonged hospitalization. Family, friends, peer parents, and NCU staff were parents’ support sources. They coped with the situation by sharing experiences with peer parents, fostering closeness with the PTIs, and actively involving in care.
Conclusion Admission of PTIs to NCUs was distressing to parents. Parents valued NCU staff’s support for coping and expected more support. The provision of free newborn care service is pivotal in alleviating financial burden. Opportunities for fostering infant–parent attachment, active care involvement, and peer-to-peer support are effective coping measures for parents. Improving parental support provision in NCUs considering this stress and coping mechanisms would enhance psychological well-being of parents.

Breast Carcinoma among Patients Undergoing Breast Diagnostic Ultrasonography in a Tertiary Care Hospital in Nepal

Mon, 15 Jan 2024 00:00:00 +0000

Background Ultrasonography (US) is an important modality for investigating breast lesions, as it lacks radiation exposure, differentiates between solid tumor and fluid-filled cysts, and is particularly-useful for young females with dense breast tissue. This study aimed to determine test characteristics (sensitivity, specificity, positive and negative predictive values, and accuracy), and the prevalence of breast cancer, among patients undergoing diagnostic breast US for clinically-detected abnormalities in a tertiary care cancer hospital in Nepal, comparing US findings with histopathology and cytopathology.
Data and Methods A cross-sectional study was conducted among a convenience sample of 418 female patients who underwent diagnostic breast US between April 15 and September 10, 2022. Data were entered and analyzed on SPSS 25.0. Prevalence of cancer was determined among US patients who were referred for tissue diagnosis on the basis of clinical or US findings. Sensitivity, specificity, positive and negative predictive values, and accuracy of US in detecting breast lesions in comparison to histopathology and cytopathology findings were calculated.
Results The study respondents’ age ranged from 13 to 75 (±11.8) years. Among 97 patients who underwent fine needle aspiration or biopsy based on US findings, 52 (12.4% of total) were diagnosed with breast carcinoma. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of US to detect breast cancer were 94%, 100%, 93.7%, 100%, and 96.9%, respectively.
Conclusion Among women with breast complaints or physical examination findings, diagnostic US revealed a high prevalence in the population investigated and demonstrated very good sensitivity, specificity, and accuracy to detect breast cancer. This study confirms the important role of ultrasound in the evaluation of breast lesions, particularly in underdeveloped countries.

Utility of Rapid On-Site Evaluation on Endobronchial Ultrasound-Guided Transbronchial Needle Aspirate of the Mediastinal and Hilar Lymph Nodes in Patients with Suspected Sarcoidosis

Vikas Pathak, Mark J. Richman, Prekchha Jha — Mon, 15 Jan 2024 16:18:58 +0000

Background Rapid on-site evaluation (ROSE) is a technique where transbronchial needle aspiration (TBNA) cytology samples are rapidly stained and screened for diagnostic material in the procedure room, during the procedure. We hypothesized the sensitivity of ROSE in patients with sarcoidosis is very low, leading to unjustified use of an expensive technique.
Data and Methods This was a retrospective study at an inner-city hospital. Medical records of all patients who underwent EBUS-TBNA of mediastinal and hilar lymph nodes with ROSE over a 3-year period were evaluated. The sensitivity, specificity, and positive and negative predictive values of ROSE in patients with sarcoidosis were calculated, with pathologic diagnosis by cell block as the “gold standard.” Patients with malignancy were used as a comparison.
Results One hundred eighty-four patients who had ROSE on EBUS-TBNA of mediastinal and hilar lymph nodes were included. Thirty were diagnosed with sarcoidosis, 95 with malignancy, and 59 with benign lymph nodes. The sensitivity of ROSE in patients with sarcoidosis was 44%, specificity and positive predictive value were 100%, and negative predictive value was only 17%.
Conclusion Given low sensitivity and negative predictive value, ROSE may not be as useful in diagnosing sarcoidosis as it is in diagnosing malignancy.

Mental Health Care Experiences in Prehospital and Community Settings: A Scoping Review

Preeti Mahato, Ursula Rolfe — Tue, 27 Jun 2023 00:00:00 +0000

Background Mental health issues are among the top ten causes of disease burden worldwide. Many people waiting for mental health treatment are being resorted to emergency or crisis services and evidence points to low levels of satisfaction with these services. The purpose of this scoping review is therefore to explore the experiences of mental health patients accessing prehospital settings, for example emergency care through ambulance use and emergency medical services, and community care.
Data and Methods To identify a knowledge gap and sources of evidence, a scoping review was conducted that examined research about the experiences of people accessing prehospital and community care. A scoping review using a systematic and comprehensive literature search of databases resulted in the inclusion of 10 articles. These articles were synthesised using thematic analysis and resulted in five different themes related to access of community and prehospital based sources.
Results The themes identified were: (i) communication; (ii) relationship with patients and family members; (iii) attitude of providers and trust established; (iv) care and support; and (iv) satisfaction. Some themes overlap and were interrelated. For example, attitudes of healthcare staff determined the type of communication with patients: either positive or negative. In turn, communication by healthcare staff also affected the relationship formed with the patients and the trust established with them. In addition, results of quantitative studies were presented separately.
Conclusion The review identified that mental health service users accessing prehospital and community-based services are seeking support because of dissatisfaction with immediacy of responses elsewhere. To meet this increased demand, paramedics need further education and support on mental health to ensure the appropriate care of these service users.
Keywords prehospital, community mental health services, mental health, paramedics

Bacterial Vaginosis: A Review of Pathophysiology, Epidemiology, Complications, Diagnosis, and Treatment

Wed, 05 Jul 2023 00:00:00 +0000

Bacterial vaginosis (BV) is the most-common cause of abnormal vaginal discharge among women of reproductive age, though many are asymptomatic. It is caused by the replacement of normal vaginal Lactobacillus with Gram-negative and anaerobic organisms. BV has assumed increasing public health importance through associations with numerous adverse outcomes in both gravid and non-gravid women. Risk factors for BV include smoking, non-White race, prior BV, current other sexually transmitted diseases (STDs), inserting items in the vagina (e.g., sex, douching), and menses. Symptomatic BV has been associated with pelvic inflammatory disease (PID), miscarriage, premature rupture of membranes, chorioamnionitis, premature labor and delivery, postpartum endometritis, and post-hysterectomy vaginal cuff cellulitis. Anaerobic Gram-negative rods common to BV have also been independently associated with endometritis or PID, even in the absence of clinical BV. BV has also been independently associated with an increased risk of acquiring STDs, including acquiring and transmitting HIV. BV is not an STD, though recent sexual intercourse and multiple sex
partners are risk factors. BV causes a malodorous, white or gray vaginal discharge and is diagnosed through Amsel’s criteria. Treatment with metronidazole or clindamycin is important for symptom relief and to prevent adverse obstetric consequences, particularly among high-risk women who have had a previous preterm delivery or have a pre-pregnancy weight <50 kg.

Initiatives to Regulate Industrially Processed Foods

Shrina Pyakurel — Wed, 05 Jul 2023 00:00:00 +0000

Trans-fatty acids, commonly referred to as trans fats, were discovered in the early 20th century with the development of hydrogenation – a chemical process that converts liquid vegetable oil into solid fats. Initially perceived as a healthier alternative to saturated fats due to their stability during cooking and longer shelf life, more recent research has linked trans fats to a number of adverse health outcomes.1
There are two types of trans fats: naturally occurring and artificial. Naturally occurring trans fats are found in small amounts in meat and dairy products from ruminant animals, such as sheep, cows, and goats, where the fats are formed in the gut of the animal. By contrast, artificial trans fats, also known as industrially produced trans fatty acids (iTFAs), are created through hydrogenation, which is the process utilized in the production of margarine and shortening.1
The consumption of trans fats leads to increased LDL (bad) cholesterol and decreased HDL (good) cholesterol levels. This unfavorable cholesterol profile can contribute to cholesterol accumulation in the arteries, elevating the risk of heart disease and stroke.2 The inclusion of trans fats as part of the daily diet increases the risk of coronary heart disease by 21% and the risk of death due to the disease by 28%.3 The consumption of trans fats also promotes inflammation, which can lead to the development of stroke, diabetes, and other chronic illnesses from excessive activation of the immune system. Moreover, consuming trans fats disrupts the normal functioning of the endothelial cells lining the inner wall of blood vessels, thereby compromising their responsiveness.4
Trans fat is present in many processed and fried foods, including snacks and fast foods.1 The amount of trans fat in a food item depends on the number of times vegetable oil is heated during preparation, with increased heating leading to more significant health consequences. Specifically in South Asian cuisine, dishes cooked in vegetable ghee and certain steamed vegetable sweets like Jerry, Lalmohan, and Gundpak have been found to contain excessive amounts of trans fats.5
According to the World Health Organization (WHO), there is no safe level of trans fat consumption; WHO recommends the intake of trans fats be limited to less than 1% of total daily energy intake.6 To provide a comprehensive strategy for eliminating iTFAs from the global food supply, the WHO introduced the REPLACE package, which contains a set of practical actions and guidelines for governments, industries, and civil society to make concerted efforts toward achieving this goal.

Introduction of Laparoscopic Tubal Sterilization in Nepal’s Family Planning Program

Sanu Maiya Dali — Wed, 05 Jul 2023 00:00:00 +0000

Dr. Badri Raj Pande’s experience1 is an example of the ‘hostile’ socio-cultural environment into which the family planning program in Nepal was first introduced – and also an illustration of how the program has continued to grow and flourish over the years. His account also reminded me of some of my own personal experiences in early days of the program.
It was in 1973 that Dr. Wheeles from Johns Hopkins University brought a set of laparoscopic instruments for tubal sterilization to Nepal. He demonstrated the use of the instruments to a few of us – obstetricians and gynecologists – at Paropakar Maternity and Women’s Hospital (commonly referred to as Prasuti Griha or Maternity Hospital) in Kathmandu, where we were working at that time. Dr. Kanti Giri led this ground breaking effort, and I was among the first group of just a few doctors who participated in the training. The successful effort resulted in eventually introducing laparoscopic female sterilization (LFS) under local anesthesia through mobile camps in communities where there were no hospitals or trained doctors to perform sterilization operations.2-6 Nepal became a ‘pioneer’ country to provide LFS as a new permanent method of controlling fertility. Over the years, female sterilization has become the most widely used contractive method in Nepal.7-9
By way of informing the potential female clients of the procedure, we – the attending doctors and nurses – would tell women that a small injection is administered in their umbilical region and a tube will be inserted to look through a ‘durbin’ (telescope) and then a knot would be tied in a safe manner to prevent pregnancy. In doing so, the term ‘operation/surgery’ was purposely avoided so the women would not be scared.
At times I used to ask women why they did not send their husbands for a vasectomy instead of them going for the procedure. Their most common response was that the husband had to work for their livelihood and that they (the women) didn’t want to take any chances, and risk something happening to the family’s source of livelihood. In those days, having multiple wives was also considered a symbol of affluence and wealth. During our ‘camp’ days in Pokhara, in which Dr. Kanti Giri and I were attending surgeons, one person brought two wives over two successive days. He showed up with yet a third wife on the third day, and both Dr. Giri and I insisted that he should get a vasectomy – to which he agreed, reluctantly.
Over the years, as the program expanded, LFS became more popular – and remains so today.9,10 While in the early years, sterilization was accepted only among women who had already given birth to at least four children, perception of the procedure has changed considerably over the years, and as of 2022, the average number of children a sterilized woman has is about two.10 As aptly noted in the “Brief Communication,”1 Nepal’s family planning program has made significant progress over the last five decades. The path to progress has certainly not been easy, but this has been one success story that freed Nepali women from having to bear a large number of children.
The government, international organizations, principally USAID and the International Planned Parenthood Federation, and, most important of all, the providers – nurses, counselors and the doctors – remain the champions of this journey. From the time I was trained in LFS until I stopped doing clinical practice in 2018, I most probably performed nearly 25,000 LFS. After my 45 years of service, I feel both personally feel thankful and professionally satisfied to have contributed to this long national journey towards improving the health and reproductive rights of women in Nepal.

Obstetric Complications in Bacterial Vaginosis Cases

Rida Nasir, Lisa Iyeke, Lindsay Jordan, Mark Richman — Mon, 15 Jan 2024 14:51:21 +0000

Not applicable for a Brief Communication