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Abstract Background In healthcare facilities, an efficient triage system is critical to optimize patient care. The main objective of this study was to explore the triage processes and practices in three different tiers of healthcare facilities in the Kathmandu Valley, Nepal. Methods A mixed-methods approach in this study comprised observations and interviews in ten healthcare settings across primary care centers (PHC; n = 6), secondary care centers (SHC; n = 3), and tertiary care hospital (n = 1). Data were collected from June to November 2023. Semi-structured interviews were conducted among patients (n = 30) including survey questionnaires among 144 healthcare workers (HCWs) focused on triage. The qualitative data were analyzed using Interpretative Phenomenological Analysis and quantitative data were analyzed to explore the median score on the consistent practice of triage based on the Likert scale. Results PHCs had designated space for triage with less equipped emergency services and outpatient departments (OPDs) and received severely ill patients rarely. Although prioritizing critical patients and prompt care was part of the services, there was a lack of triage protocols with more than half of the HCWs (56.3%; 36/64) from the tertiary hospital reporting the availability of triage guidelines compared to SHCs (28.1%; 9/32) and PHCs (6.3%; 3/48). The majority of HCWs from the tertiary level recognized triage's effectiveness in reducing time lag, and prioritizing patients. Tertiary level had the consistent use of triage (94%; 60/64) compared to only around two-thirds in SHCs (66%; 19/29) and PHCs (62%; 28/45). Patients often attended PHC services for routine check-ups and were motivated by health insurance, affordability, free medicines, referral cards, and proximity. In the SHC, there was a well-equipped emergency department (ED) with specific guidelines, but its use was infrequent. Patients were unaware of the triage process and its utility. In all settings, while most HCWs had a basic knowledge of triage, some were not confident due to limited exposure to the triage process and training. Many HCWs reported the need for triage-related training and its’ consistent implementation. Conclusions Consistent utilization of triage protocols, coupled with improved infrastructure, resource allocation, and training for healthcare workers is critical for the optimization of triage processes in healthcare settings in the Kathmandu Valley, Nepal.

Abstract Background Improving screening and triage practices is essential for early severity assessments at the first point of contact and ensuring timely attention by healthcare workers (HCWs). The main objective of this study was to explore the triage process among febrile patients and HCWs in the emergency department (ED) of a tertiary care hospital in a resource-constrained setting. Methods This qualitative study was conducted from March to May 2023 at the ED of Tribhuvan University Teaching Hospital (TUTH), Nepal. The study included in-depth interviews with febrile patients (n = 15) and HCWs (n = 15). Additionally, direct observation notes (n = 20) were collected to document the triage process and patients’ experiences in the ED. Data underwent thematic analysis using the Interpretative Phenomenological Analysis (IPA) approach. Results The ED of TUTH offered comprehensive triage services with clear delineation for the severity of febrile patients in line with the World Health Organization (WHO) guidelines. Nonetheless, challenges and constraints were identified. In the ED, evenings were generally the busiest period, and the triage process was not thorough during night shifts. Perception of triage was limited among patients and variable among HCWs. Digitalizing recordings of patient information including payment was deemed necessary for effective management of patients’ waiting times at the triage station. High patient throughput added pressure on HCWs and had a potential influence on the delivery of services. Availability of medical equipment and space were also identified as challenges, with patients sometimes compelled to share beds. There were constraints related to waste disposal, hygiene, cleanliness, and the availability and maintenance of washrooms. Febrile patients experienced delays in receiving timely consultations and laboratory investigation reports, which affected their rapid diagnosis and discharge; nonetheless, patients were satisfied with the overall healthcare services received in the ED. Conclusions Improving current triage management requires resource organization, including optimizing the waiting time of patients through a digitalized system. Urgent priorities involve upgrading visitor facilities, patient consultations, laboratory investigations, hygiene, and sanitation. HCWs’ recommendations to resource the ED with more equipment, space, and beds and a dedicated triage officer to ensure 24-hour service, together with training and incentives, warrant further attention.

Objectives: Recent studies after the outbreak of coronavirus disease 2019 have shown an association of the ABO blood group to the susceptibility of severe acute respiratory syndrome coronavirus 2 infection. Anti-A and anti-B antibodies, carbohydrate clustering, interleukin-6 levels and host transmembrane protease serine subtype 2 were suggested to cause the variable susceptibility of severe acute respiratory syndrome coronavirus 2 infection to the ABO blood groups. This study aims to find the association of the ABO blood group with severe acute respiratory syndrome coronavirus 2 infection susceptibility in Nepal. Methods: Population-based matched case–control study was conducted from October 2021 to February 2022 in Rupandehi district of Nepal. A total of 1091 reverse transcription-polymerase chain reaction confirmed coronavirus disease 2019 cases and 2182 controls were included in the study by convenient sampling method. Results: A statistically significant association of severe acute respiratory syndrome coronavirus 2 infection was observed for the blood group AB between cases and controls (11.5% vs 8.5%; odds ratio = 1.4, 95% confidence interval = 1.10–1.78). However, there was no association of severe acute respiratory syndrome coronavirus 2 infection for blood group A (26.7% vs 28.23%; odds ratio = 0.93, 95% confidence interval = 0.79–1.09), B (26.9% vs 29.84%; odds ratio = 0.86, 95% confidence interval = 0.73–1.02) and O (34.9% vs 33.41%; odds ratio = 1.07, 95% confidence interval = 0.92–1.25). Conclusion: This study reported slightly more susceptibility to severe acute respiratory syndrome coronavirus 2 infection among individuals with blood group AB.

Introduction: Cardiovascular autonomic functions are affected by the negative influences of stress which bring about alterations in heart rate variability (HRV). Yoga based relaxation techniques like Yoga Nidra have been found to relieve stress as shown by improved HRV. This study was conducted to assess the immediate effects of a yoga based guided relaxation technique, Yoga Nidra on HRV parameters in young and healthy volunteers. Methods: This was an interventional study conducted in the Department of Clinical Physiology, Institute of Medicine, Maharajgunj. Fifty two male medical students were divided into supine rest group (n=26) and Yoga Nidra group (n=26). HRV indices were recorded before and after supine rest and Yoga Nidra. Intra-group and inter-group comparisons of the HRV parameters were done before and after the interventions. Results: In comparison to the supine rest, Yoga Nidra produced significant increase in values of HF (1460.72 Vs 3272.99; p=0.03) and HFnu (50.32 Vs 62.68; p=0.004); and significant reduction in the values of LFnu (49.68 Vs 37.32; p=0.004) and LF:HF ratio (0.99 Vs 0.59; p=0.004), which suggested that the parasympathetic modulating response of Yoga Nidra was better than that of supine rest. Conclusion: Yoga Nidra, a yoga based relaxation technique brings better relaxation response than supine rest as indicated by the significantly improved HRV indices.

Introduction: Spirometry is the physiological test that measures how an individual breathes air volumes as a function of time. Smoking produces an increase in epithelial damage, cellular inflammatory infiltrates, muscles and fibrosis in respiratory airways and is responsible for acute respiratory various illnesses. Early identification of reduction in lung function of smokers by spirometry can be very important in order to encourage them to stop smoking. Methods: This study included a total of 106 individuals, 51 were smokers and 55 were non-smokers. The participants performed spirometry in the sitting position by open circuit method. Parameters of spirometry FVC, FEV1, FEV1/FVC and PEFR were recorded in the form of a percentage of predicted. Results: The mean FVC in smokers and non-smokers was 99.98±9.88% and 102.97±8.03% respectively (p=0.092). The mean FEV1 in smokers and non-smokers was 99.65±9.61% and 104.58±10.03% respectively (p=0.011). The mean FEV1/FVC ratio in smokers and non-smokers was 103.25±4.60% and 105.57±5.10% respectively (p=0.016). The mean PEFR in smokers and non-smokers was 102.11±8.40% and 106.01±10.62% respectively (p=0.038). The mean FVC in smokers was less than in non-smokers (99.98±9.88% and 102.97±8.03%, p=0.092). FEV1, (99.65±9.61% vs 104.58±10.03%, p=0.011) FEV1/FVC ratio (103.25±4.60% vs 105.57±5.10%, p=0.016) and PEFR (102.11±8.40% vs 106.01±10.62%, p=0.038) were significantly lesser in smokers than non-smokers. Conclusion: The spirometry parameters of pulmonary function were poorer in the smoker group. Spirometry can be useful in detecting a reduction in pulmonary function before the appearance of any symptoms or before pulmonary functions become significantly abnormal. Keywords: COPD, FEV1, FVC, PEFR, pulmonary function test, smoking, spirometry DOI: https://doi.org/10.3126/jkahs.v2i3.26661

Introduction: Carpet factory produces various types of dusts and workers occupationally get exposed to them continuously. It has adverse health effects and most notably to the pulmonary functions. Nepal is one of the carpet exporter developing countries and still does have many factories within Kathmandu valley. However, the health hazards especially the status of pulmonary function of carpet factory workers from Nepal has not been studied. Methods: A cross-sectional comparative study was designed to recruit carpet factory workers and healthy controls to assess their pulmonary functions. A total of 118 subjects (59 males and 59 females) were recruited (60 carpet factory workers and 58 controls). Pulmonary function tests were carried out using Medical International Research Spirolab II portable spirometer. Results: The carpet factory workers had signi cantly less FEV1 (90.37 ±16.6 % vs. 103.89±9.79%, p

Introduction: Carpet factory produces various types of dusts and workers occupationally get exposed to them continuously. It has adverse health effects and most notably to the pulmonary functions. Nepal is one of the carpet exporter developing countries and still does have many factories within Kathmandu valley. However, the health hazards especially the status of pulmonary function of carpet factory workers from Nepal has not been studied. Methods: A cross-sectional comparative study was designed to recruit carpet factory workers and healthy controls to assess their pulmonary functions. A total of 118 subjects (59 males and 59 females) were recruited (60 carpet factory workers and 58 controls). Pulmonary function tests were carried out using Medical International Research Spirolab II portable spirometer. Results: The carpet factory workers had significantly less FEV1 (90.37 ±16.6 % vs. 103.89±9.79%, p

Introduction: Due to regular exercises, athletes tend to have an increase in pulmonary capacity when compared to non-exercising individuals. Intensity and severity of sports engaged in by the athletes probably determines the extent of strengthening of the inspiratory muscles with a resultant increase in the pulmonary functions.1, 2 So, this study has been carried out to establish a relationship between the type of sports and pulmonary functions in Nepalese athletes. Methods: This study has adopted a cross sectional observational comparative research design. Spirometry was conducted in 84 different national level athletes [25.71 (± 4.55) years]. The athletes were from five different sport groups. Out of them, there were 16 weight lifters, 41 footballers, 10 swimmers, 8 marathon runners and 9 sprinters. Among them weight lifters, marathoners and sprinters were selected from the National sports council, Tripureshower, Kathmandu and footballers and swimmers were from the Nepal army club, Kathmandu, Nepal. The spirometry was done in sitting position using MIR SPIROLAB II spirometer based on American Thoracic Society (ATS) recommendations. Pulmonary function was assessed based on Forced Expiratory Volume in first second (FEV1), Forced Vital Capacity (FVC) and Peak Expiratory Flow Rate (PEFR) expressed as percent predicted for the age, sex, height, weight and race. Results: When comparing the mean values of FVC, FEV1 and PEFR among the five different sport groups, as expected, athletes who have more strenuous respiratory muscles exercise had significantly superior pulmonary function parameters. For example weight lifters and swimmers had 111.84 and 109.56 percentage of predicted values on FVC (P=0.008) respectively. But marathoners, footballers and sprinters had 105.83, 99.25 and 98.34 percentage of predicted values respectively. Similarly, weight lifters, swimmers, marathoners, footballers and sprinters had 110.63, 110.15 and 110.28, 102.52 and 99.23 percentages of predicted values on FEV1 (p=0.090) respectively. Swimmers, marathoners, footballers, weight lifters and sprinters had 106.03 and 107.34, 104.37, 102.08 and 86.58 percentage of predicted values on PEFR (p=0.027) respectively. Conclusion: Athletes who have most strenuous respiratory muscle exercise like swimming and weight lifting have better pulmonary function tests (PFTs) compared to other athletes like sprinters who have less strenuous muscle exercise. Journal of Nobel Medical College Vol. 2, No.1 Issue 3 Nov.-April 2013 Page 18-21 DOI: http://dx.doi.org/10.3126/jonmc.v2i1.7667

Introduction: ABO and Rh blood group systems are the most important blood grouping systems from clinical aspect. Determination of blood group is important for blood transfusion therapy, medico-legal purposes, organ transplantation, settlement of paternity disputes etc. Methods: A cross-sectional descriptive study was carried out for a period of one year from 1st January 2011 to 31st December 2011 in blood bank of Tribhuvan University Teaching Hospital. All blood samples collected for blood group determination were included in the study. Blood group was determined by slide agglutination method using commercial antisera. Results: A total of 13568 blood samples were analyzed, 5123 (37.75%) were male and 8445 (62.25%) were female. Frequencies of blood groups A, B, AB and O were found to be 4034 (29.7%), 3665 (27.0%), 1114 (8.2%) and 4755 (35.1%). Frequencies of Rh positive and Rh negative blood groups were found to be 13200 (97.3%) and 368 (2.7%). Blood group O was common in Brahmin, Chhetri, Tamang, Lama, Gurung, Sherpa, Terai Brahmin, Muslim and Yadav ethnicities; blood group A was common in Newar, Rai, Magar, Limbu and Sanyasi ethnicitites; and blood group B was common in Tharu and Marwari ethnicities. Conclusions: Blood group O was found to be the most common blood group while AB was the rarest one. It was found that blood group O is the more common in Sherpa, Brahmin and Yadav; A in Limbu, Rai and Newar; and B in Tharu and Marwari ethnicities. _______________________________________________________________________________________ Keywords: ABO; blood group; ethnic distribution.