Patan Hospital

Introduction Stroke remains a leading cause of death and disability worldwide, with a high burden in low-resource settings like Nepal. Timely administration of intravenous thrombolysis is critical for improving outcomes in patients with acute ischemic stroke. However, delays in receiving thrombolysis can significantly reduce its effectiveness and impact recovery. This study aimed to explore and understand the reasons contributing to delays in thrombolysis among stroke patients in emergency departments within low-resource settings through a qualitative approach. Methods A qualitative study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Eighteen participants, including ten stroke patients and eight witnesses, were interviewed using a semi-structured guide. Data were analyzed using thematic analysis to identify common themes regarding treatment delays. Results The study identified four primary reasons contributing to delays in thrombolysis treatment: (a) failure of patients and witnesses to recognize stroke symptoms early, (b) limited availability of thrombolysis services in the hospitals, (c) financial barriers to seeking care, and (d) delayed diagnosis or misdiagnosis by healthcare professionals. Conclusion This study highlights the significant barriers to thrombolysis delays in Nepal. Key interventions, such as improving public awareness of stroke symptoms, increasing access to thrombolysis services, and reducing financial barriers, are necessary to improve outcomes in stroke patients.

In response to the 2020 COVID-19 pandemic, a nongovernmental organization in Nepal piloted a maternal and newborn health helpline program in partnership with the Government of Nepal and the Nepal Society of Obstetricians and Gynaecologists. The program connected service providers in remote areas with real-time clinical support during obstetric and neonatal emergencies via telephone consultations with clinical experts. 551 primary health care facilities across 14 districts of Nepal were included in the program and connected to a roster of 33 clinical expert volunteers from district or tertiary care hospitals. To assess the results of the program, we collected both quantitative and qualitative data, including monthly health facility record reviews from July 2020 to June 2021 and semi-structured interviews with clinical experts and service providers conducted in June 2021. Of the 551 health facilities included in the program, 160 facilities (29%) reported using the helpline during the study period, with 429 teleconsultation cases recorded. We found that 21% of these cases that otherwise would have been referred to a hospital were effectively managed by telephone on-site at rural health facilities, revealing the promising potential for impact using a low-tech solution. Of the health facilities that participated in the program, the helpline was predominantly used in remote facilities where access to higher-level referral centers for emergencies was limited. Feedback from both experts and service providers revealed that the program helped to improve clinical decision-making during emergencies, build confidence and skills of service providers, and improve referral efficiency. Implementation challenges included service providers' underreporting of helpline utilization, a lack of essential drugs at primary health care facilities, unreliable phone signals, and a lack of financial incentives for clinical experts. The results and implementation experiences shared in this article provide a template for the design and implementation of similar support programs for service providers managing clinical emergencies in rural contexts.

Introduction: Spaying female rabbits may be necessary to control certain behaviors and prevent pregnancy. Since gaseous anesthesia is unavailable under field conditions, injectable anesthesia is required. The present study aimed to evaluate the efficacy of routine injectable intramuscular anesthetics, including ketamine and xylazine, during the spaying procedure in rabbits.Materials and methods: Five female short-haired rabbits, aged 20-24 months and weighing 1.5-1.7 kilograms, were presented to the Sahidul Alam Quadari teaching veterinary hospital in Chattogram, Bangladesh. Body temperature, heart rate, and respiratory rate were measured using a thermometer and a stethoscope. The spaying procedure was conducted using aseptic techniques, administering xylazine and ketamine in a single syringe of anesthesia at dosage rates of 5 mg/kg intramuscularly (IM) and 30 mg/kg IM, respectively, for the spaying procedure.Results: All vital parameters were within normal ranges. Injectable anesthetic xylazine at 5 mg/kg of body weight and ketamine at 30 mg/kg of body weight, administered IM, provided effective anesthesia during rabbit spaying without any complications on heart rate and respiration rate, as well as any complications during the surgery procedure. These doses were found to be optimal for field conditions.Conclusion: The present study indicated that successful rabbit spaying can be achieved with IM anesthesia using the recommended doses of ketamine (30 mg/kg) and xylazine (5 mg/kg).

The emergency obstetric care (EmOC) monitoring framework has been used for decades to monitor the availability and use of EmOC services in low- and middle-income countries (LMICs). EmOC monitoring is based around eight signal functions, a shortlist of key clinical interventions capable of averting deaths from the main direct causes of maternal mortality, categorised between two levels of care: basic and comprehensive, with a newborn resuscitation signal function added in 2009. The Re-Visioning Emergency Obstetric and Newborn Care (EmONC) Project (2020–2024) aimed to update the EmOC approach to reflect new knowledge in maternal and newborn health (MNH), and to expand the scope of the original EmOC monitoring framework. The project used technical workstreams and workshops to arrive at new proposals. This paper reports on the approach used to build consensus on a revised set of EmONC signal functions and levels of care. Using a three-round online Delphi approach, consensus (≥85%) was sought from a diverse panel of global MNH experts on EmONC signal functions and their placement at different levels of care, based on existing evidence-based guidelines. The process was iterative, each round building on the previous, and embedded in the wider Re-Visioning EmONC project; the output from each round involved coordination of inputs from multiple tiers of technical experts, including UN agencies, via technical expert groups, workstreams and workshops. The Delphi study recruited 113 experts in MNH from a range of geographic and economic settings, specialities and professions, including clinical, academic and programme expertise. The output from the three rounds included substantial convergence, resulting in set of 25 signal functions (11 obstetric, 13 neonatal and 1 referral) that reflect the spectrum of EmONC required for women and newborns. The revised EmONC signal functions are intended as a simple approach to allow health system managers to visualise their EmONC services, and as a means to hold health systems accountable to provide the main interventions to avert preventable maternal and newborn morbidity and mortality, and stillbirths.

Abstract Orthodontic fixtures provide a conducive niche for microbial colonization and inter-kingdom biofilm formation, exacerbating oral hygiene challenges. Conventional mouthwashes, though effective, are associated with adverse effects and potential antimicrobial resistance. Oil pulling is an Indian traditional method of oral detoxification. This study evaluates a blend of six essential oils (referred to as DKG) from Syzygium aromaticum, Mentha piperita, Eucalyptus globulus, Zanthoxylum armatum , and Ocimum sanctum , mixed with coconut and sesame carrier oils, as a potential oil-pulling formulation. Gas chromatography–mass spectrometry confirms the phytochemical composition of DKG. Antimicrobial assays demonstrate MIC₅₀ values of DKG ranging from 0.10% (v/v) to 0.45% (v/v) against Streptococcus pyogenes, Streptococcus mutans, Proteus mirabilis and Candida albicans , respectively. DKG exposure delays the exponential phase and perturbs the growth of these pathogens. The cariogenic traits of S. mutans are impaired at ≥ 1.0× MIC₅₀ DKG, showing reduced biofilm formation, decreased acid production, and lower survival under acidic stress. DKG inhibits C. albicans biofilms at ≥ 1.0× MIC₅₀, prevents yeast-to-hyphae transition, and disrupts cell wall integrity by reducing ergosterol. SEM analysis shows reduced microbial density, fragmented hyphae, and disrupted bacterial aggregation. These findings highlight plant-based DKG, an anticariogenic alternative for maintaining oral health in individuals with orthodontic fixtures.

Background:Acute massive pulmonary embolism (PE) can lead to right ventricular (RV) failure and cardiogenic shock, requiring urgent treatment. Thrombolytic therapy is the standard treatment for high-risk PE in hemodynamically unstable patients. However, in cases where thrombolytics are contraindicated or ineffective, mechanical circulatory support (MCS) serves as a rescue therapy. While veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is commonly utilized, the Impella RP represents a promising advancement in MCS, offering right ventricular support in patients with PE-induced cardiogenic shock.Objective:This narrative review evaluates the role of the Impella RP in improving hemodynamic parameters in patients with PE-induced cardiogenic shock or right ventricular failure. By reviewing available case reports and case series, we assess the effectiveness of Impella RP in improving patient outcomes.Methods:A comprehensive literature review was conducted, obtaining data from clinical studies, case reports, case series, systematic review, and hemodynamic assessments of Impella RP in massive PE. Key parameters, including blood pressure (BP), heart rate (HR), right atrial pressure (RAP), pulmonary artery pressure (PAP), cardiac index (CI), cardiac output (CO), and overall patient outcomes, were analyzed before and after device implantation.Findings:Our review identified 10 patients from case reports and case series in which the Impella RP was used as mechanical circulatory support (MCS) in high-risk PE patients. Hemodynamic parameters showed significant improvement following Impella RP implantation. Notably the survival rate was 100%, highlighting the role of Impella RP in managing massive PE with right ventricular failure.Conclusion:The use of Impella RP in hemodynamically unstable patients with high risk PE have shown positive outcome, including improved cardiac function and hemodynamic stability. These findings suggest that Impella RP could be valuable treatment options for patients with massive PE and right heart failure. However, the limited number of reported cases highlights the need for larger-scale clinical studies and randomized trials to further assess the long-term safety, efficacy, and optimal patient selection criteria for Impella RP use.

Hikikomori is a mental health condition characterized by social withdrawal, causing distress for both the affected individuals and those around them. While factors such as gender, anxiety, and depression have been linked to hikikomori, research on this condition in Indonesia remains limited. This study investigated the association between gender, depression, and anxiety with the risk of hikikomori in West Lombok, Indonesia. A cross-sectional study was conducted at Hospital X in West Lombok, Indonesia, involving 60 patients with depression attending the Mental Health Polyclinic. The respondent ages ranged from 20 to 79 years. Data on gender, depression, anxiety, and hikikomori were collected using self-rated questionnaires and analysed with the Chi-square test. The results showed that patients with moderate-severe anxiety had a fivefold increased risk of hikikomori (OR=5.00; 95% CI=1.42-17.57; p=0.009). Female patients were 2.5 times more likely to be at risk compared with male patients, while those with moderate-severe depression had a 2.83 times higher risk. However, this association was not statistically significant. The study concluded that anxiety is a significant risk factor for hikikomori, whereas the association between gender and depression requires further investigation. Understanding these relationships is crucial for developing targeted mental health interventions and improving support for individuals at risk of hikikomori in Indonesia.

Abstract This study aims to describe the efforts of classroom teachers in improving understanding of Natural science subject in MI. This type of research is field research with a qualitative approach. Data collection methods used observation, interviews, documentation. Data sources from the headmaster, class teacher, subject matter teacher, and students at MI Khoiriyah Pati. Data analysis with data reduction, display, and verification. The results showed that the teacher tried to improve the understanding of the material by providing orientation, apperception, and evaluation to students. The obstacles in improving students' understanding of science are inadequate school facilities, teacher abilities, classroom atmosphere and conditions, and student willingness. Meanwhile, efforts to overcome obstacles, namely teachers strive to use existing media/ facilities at school, attend workshops, provide motivation for students who do not understand the material, use interesting methods, strategies, approaches that are in accordance with students' understanding abilities, and conduct creative innovative learning to increase student interest in learning. The conclusion of the research is the efforts made by teachers by providing apperception, orientation, and evaluation. The obstacles faced are facilities, teacher abilities, classroom atmosphere, and student motivation. Efforts made are using existing facilities at school, attending workshops, innovating innovatively creatively in learning. The impact of the research is that student understanding has increased.

The background of this research is to determine teacher strategies in developing the quality of HOTS-based learning in Mathematics Subjects. This research aims to 1) find out and explain teachers' strategies in developing the quality of HOTS-based learning in Mathematics Subjects in Class V 2) find out the supporting factors and inhibiting factors for teachers' strategies in developing the quality of HOTS-based learning in Mathematics Subjects in Class V. Data collection with interviews, observation and documentation. This research uses a historical approach. This qualitative research data analysis uses interactive analysis, namely data reduction, data display, and drawing conclusions. The research results show: 1) The teacher's strategy in developing the quality of HOTS-based learning is implemented in three stages: the planning stage, the teacher makes a Learning Implementation Plan with high- level thinking learning indicators: cognitive level (C4, C5 and C6). In the implementation stage, the teacher gives problems to students using video and LCD. The teacher applies the Problem Based Learning model where the teacher becomes a facilitator, while students are encouraged to solve problems. Teacher assessment stage: written test, description test and performance test. 2) Supporting factors: a) professional class teachers, b) the head of the madrasah carries out academic supervision activities, c) the availability of learning media and supporting tools, and d) the existence of regular coaching meetings once a month. 3) Inhibiting factors: a) limited allocation of learning time, b) differences in parenting styles for children at home, c) differences in students' ability to understand the material.