https://hdl.handle.net/20.500.14356/1954 2026-04-01T11:13:08Z https://hdl.handle.net/20.500.14356/1996 Title: Health System through the Eyes of a Doctor from Rural Nepal Authors: Hamal, P K; Shrimal, S R; Khadka, M; Sapkota, B; Thapa, J; Pariyar, J; Magar, A Abstract: Abstract Its almost 30 years of declaration of Alma-Ata for primary healthcare policy the health system in Nepal still facing shortage of trained medical doctors and health professionals reaching remote and rural part of the country to provide quality health services. There are number of issues such as financial or non-financial incentives, professional advancements, educational opportunities and workplace environment. Healthcare delivery system in Nepal is failing to meet the healthcare need of the general public and needs discussion and revision. However, despite of so many challenges more doctors are willing to work in the remote and rural Nepal. The government has to come out with effective planning and policy regarding health system and human resource for health. In this context, an attempt has been made for a analytical perspective from a medical doctor point of view to highlight some of the pertinent local and policy related issues to improve Health System in Nepal. Keywords: doctor, health, health system, Nepal, policy Description: Viewpoint 2011-01-01T00:00:00Z https://hdl.handle.net/20.500.14356/1995 Title: Medical Practice in the Peripheral Health Centers in Nepal Authors: Sitaula, S; Magar, A Abstract: Abstract The Ministry of Health and Population has implemented a compulsory two year service contract in government health facilities for all the scholarship holders of the Ministry of Education. Doctors are now being deployed to all hospitals and primary health centers of the country. Prior to 2005 it was very difficult to send doctors to the peripheral part, and now they wish to go more remote area due to the privilege given to the National Academy of Medical Sciences Post Graduate Entrance Examination, which help them get MD/MS seat. However, there are more challenges due to weak health system and failure to implement established rule and regulation. This paper highlights the outcry of a doctor working in the remote part of the country. Description: Viewpoint 2011-01-01T00:00:00Z https://hdl.handle.net/20.500.14356/1994 Title: Late Presentations of Congenital Diaphragmatic Hernia Authors: Bhandari, B B; Basnet, R B Abstract: Abstract The occurrence of congenital diaphragmatic hernia in adults is rare and misleading even to experienced clinicians. In contrast to neonatal diaphragmatic hernias, most of the adult patients present with vague gastrointestinal and respiratory symptoms mimicking other diseases. Hence high index of suspicion is required. When a diagnosis is established, it must be promptly treated surgically in order to avoid complications such as strangulation or bowel perforation. We present two cases of diaphragmatic hernia which were being managed as pulmonary pathologies. Keywords: bochdalek hernia, morgagni hernia Description: Case Report 2011-01-01T00:00:00Z https://hdl.handle.net/20.500.14356/1993 Title: Nerve Stimulation Under Ultrasound Guidance Expedites Onset of Axillary Brachial Plexus Block Authors: Shrestha, B R Abstract: Abstract Background: Axillary block is popular technique in upper extremity surgery. Nerve stimulation is used for location of nerves to provide effective blockade. The advent of ultrasound imaging technique in regional anaesthesia has increased the accuracy of needle placement and local anaesthetic deposition around the nerve. The aim of this study is to find out if the nerve stimulation technique with ultrasound guidance has advantages over sole nerve stimulation technique. The outcome measures studied were onset of sensory and motor block, procedure time, number of skin puncture, vascular puncture and paresthesia during nerve stimulation. Methods: This is a prospective randomized comparative study conducted in KMCTH from June 2009 to March 2010 on patients of American Society of Anaesthesiologist I and II requiring upper arm surgery under axillary block. The study comprised of two groups: ultrasound with nerve stimulation group (n=35) and nerve stimulation group (n=35). 24 ml of Bupivacaine 0.5% with injection Dexamethasone 4 mg was used to block the individual four nerves with 6 ml of the local anaesthetic solution per nerve namely ulnar, radial, median and musculocutaneous. The data were recorded by blinded observer. In case of partial block or block failure, the patients were supplemented with Fentanyl or subjected to laryngeal mask placement. Results: Demographic characteristics (age, weight) in either group were similar (p>0.05). The male and female ratio (M: F) in ultrasound with nerve stimulation group was 12:16. The ratio was 18:17 in nerve stimulation group. The onset of complete sensory block was earlier and the onset of motor block was faster in ultrasound with nerve stimulation group than in sole nerve stimulation group (p=0.001). Ultrasound guidance decreased the number of skin puncture during the nerve stimulation, p= 0.02. The incidence of paresthesia was encountered during nerve location (14%), which could be minimized using ultrasound (7%). The success rate of the block was 93% with ultrasound assistance. The procedure time was not different in both techniques. The surgery duration was not significant statistically in either of the group, p=0.715. Conclusions: This study showed that the onset of sensory and motor block was faster with ultrasound assistance nerve stimulation. Complications can be decreased with the use of ultrasound in axillary block. Keywords: axillary nerves, block, motor, sensory, ultrasound. Description: Original Article 2011-01-01T00:00:00Z