Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT/1000 PD) of penicillin (p = 0.02), aminoglycoside (p < 0.001), and cephalosporin (p = 0.04). Increases in DOT/1000 PD at post-intervention were significant for metronidazole (p < 0.001), quinolone (p = 0.01), and other antibiotics (p < 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (p < 0.001) and Pokhara Academy of Health Sciences (p = 0.02), but not at Kathmandu Model Hospital (p = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (t = 3.56; p < 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (p < 0.001), de-escalation (p < 0.001), accurate documentation (p < 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (p < 0.001) and after diagnoses (p < 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal.

Background: Burn infections are the major causes of morbidity and mortality in burn patients. The infectious agent could be both Gram positive and Gram negative bacteria. The aim of this research was to study the bacteriological profile of burn patients and anti-microbial susceptibility pattern of their wound isolates.  Methods: This cross-sectional study was conducted in Kirtipur Hospital, Nepal from January 1st to March 31st 2019. A total of 109 burn patients were included and their wound swabs were collected at the time of admission. All isolates were identified by standardized microbiological procedures. Anti-microbial susceptibility tests were performed by Kirby Bauer disc diffusion method. Results: Of 109 burn wound samples, 56 (59%) yielded culture growth and the Gram negative isolates were more common than Gram positives (77% vs. 23%). The most common organism isolated was Klebsiella spp. (25%) followed by Acinetobacter spp. (21%) and Staphylococcus aureus (18%). Most burn wound isolates were of resistant strain. Particularly, highly resistant strain of Acinetobacter spp. were isolated, most of which were sensitive to Tigecycline, Polymyxin B and Colistin only. Conclusion : Gram negative isolates were common in burn wound isolates and the antibiotic susceptibility pattern was different for different organisms. The use of antimicrobials should be judicious to further not escalate the problem of antimicrobial resistance in the healthcare settings.

Introduction: In Nepal, preference of health service for treatment is different for different people, which is affected by their level of knowledge , socio-demographic factors and so on. The objective of this study was to find the first preference of health services of the people for the treatment of their illness andfactors affecting their preference. Methods: A descriptive cross-sectional study was conducted among 260 respondents of Maneswora Ward, Sindhupalchowk district which was selected through systematic random sampling. Data collection was done after taking ethical approval. Face-to-face interview was done to collect the data through semi- structured questionnaire. Data was entered and analyzed in SPSS v16. Results: One-third (36.9%) of the respondents were found to be visiting the traditional health services and more than half (63.1%) of the respondents visited modern health services. Education (0.016), duration of stay (0.014), type of disease (<0.001), distance to the health services (<0.001), modes of transportation (<0.001), affordability (0.013), waiting time (<0.001) and availability of health care provider (<0.001) demonstrated association with utilization of health services at 95% level of confidence (p<0.05). Conclusions: Despite of modern health facilities available within walking distance, still people prefer to go to the traditional healers for almost all the health problems at first hand with firm belief that they cure it. Hence, government still lacks effective programs to attract people towards modern health services to some extent. Hence, the awareness campaign regarding the benefits of modern health services should be initiated.

Introduction: The hand is a complex organ responsible for activities of daily living, making it susceptible to injuries and accidents. Hand injuries can result in significant functional impairment and it occurs in a younger productive age group. Therefore, it is important to understand the prevalence and patterns of hand injuries. The aim of the study was to find out the prevalence of hand injuries among patients visiting the emergency department of a tertiary care centre. Methods: A descriptive cross-sectional study was in the Emergency Department of a dedicated trauma centre from 1 June 2022 to 31 August 2022. Ethical approval was obtained from the Institutional Review Board (Reference number: 148412078179). Demographic profile, pattern, and mechanism of hand Injuries of all 96 consecutive patients were assessed after taking informed consent. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 4679 patients visiting the emergency department of the trauma centre, hand injuries were seen in 96 (2.05 %) (1.64-2.46, 95% Confidence Interval). Conclusions: The prevalence of hand injuries was found to be lower than in other similar studies done in similar settings.

Surgical management of vaginal agenesis constitutes a significant technical challenge. The goal of vaginal reconstruction is to create a neovagina that is both functionally and aesthetically satisfactory using a simple and reliable technique applicable to most.  Bilateral pudendal thigh flaps were used to reconstruct neovagina for a 13-y girl with congenital vaginal agenesis. She presented with cyclical abdominal pain and hematometra, had normal secondary sexual characteristics and grossly normal external genitalia with a dimpling at the site of the vaginal orifice without lower vaginal tract.