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NepMed is a Nepal MEDLINE(Medical Literature Analysis and Retrieval System Online) by Nepal Health Research Council(NHRC). It includes bibliographic information for articles from academic biomedical journals covering medicine, dentistry, nursing, pharmacy, dentistry veterinary medicine, and allied health sciences.

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Article

Face-to-face training as an effective approach for instructing rotahaler technique in newly diagnosed cases of asthma and COPD: a pilot study

(Nepal Medical Association, 2015) Poudel, Ramesh Sharma; Shrestha, Shakti; Piryani, Rano Mal; Prajapati, Aastha; Khatiwada, Dipendra

Abstract Introduction: This study aimed to evaluate the effectiveness of face-to-face training for instructing rotahaler technique in newly diagnosed cases of asthma and chronic obstructive pulmonary disease. Methods: A hospital-based study was conducted on twenty patients who were prescribed rotahaler for the first time. Patients received face-to-face training on rotahaler technique from pharmacist using GINA guidelines. The patients rotahaler technique was assessed after two weeks of training and scored one for correct and zero for incorrect steps. Descriptive statistics was performed. Results: The mean age of the study population was 48.85Â±20.49 years. Eleven (55%) patients were females and 13 (65%) were formally uneducated. Fourteen patients (70%) were able to perform all the steps correctly giving overall median score of 8 (7-8). Conclusions: Face-to-face training seems to be effective approach for instructing rotahaler technique in asthma and COPD patients. Keywords: Asthma; COPD; Face-to-face training; Inhaler technique; Pharmacist.

Article

Spinal tuberculosis with paraplegia in pregnancy: a case report with management of spinal TB in pregnancy

(Nepal Medical Association, 2015) Kaushal, Sushruti; Dora, Santosh Kumar; Thakur, Sunil

Abstract Spinal tuberculosis leading to paraplegia is uncommon in pregnancy and is a diagnostic and therapeutic challenge. We report a case of tubercular paraplegia presenting at 35 weeks of gestation. She was managed with Anti-tubercular drugs and did not require surgical intervention. Her neurological status improved and she was allowed to go in labour. She delivered a healthy term infant by cesarean. At three months follow-up, both mother and child are doing well. Keywords: Paraplegia; Pregnancy; Spinal tuberculosis.

Article

Anaesthetic management of patients with takayasuâ€™s arteritis for open cholecystectomy: a report of two cases

(Nepal Medical Association, 2015) Shrestha, Gentle Sunder; Shrestha, Ninadini; Shrestha, Battu Kumar; Shrestha, Pramesh Sunder

Abstract Takayasuâ€™s arteritis is a well known yet rare form of large vessel vasculitis. This inflammatory disease often affects the ascending aorta and aortic arch, causing obstruction of the aorta and its major arteries. Anaesthetic management for these patients is complicated by severe hypertension, end-organ dysfunction, stenosis of major blood vessles and difficulties in monitoring blood pressure. We present two patients who underwent open cholecystectomy under neuraxial anaesthesia. We have discussed about various perioperative issues and their management. Keywords: Anaesthetic management; Takayasuâ€™s arteritis.

Article

The feeding tube- a simple yet handy aid to intubate an unanticipated difficult pediatric airway

(Nepal Medical Association, 2015) Suma Mary Thampi; Serina Ruth Salins; Divya P Jacob; Ahwad Sheetal Avinash

Abstract Pediatric intubation requires certain unique set of additional skills compared to intubating adults. The challenges of successfully intubation of a child increases as the age and size of the child decrease and are compounded when airway difficulties arise for various reasons. Often in the rural setting, such procedures may have to be carried out by health care personnel who get trained on-the-job, and in the absence of adequate technological back-up. This leads to an increased incidence of failed intubations which can have devastating complications, especially in the pediatric age group. We describe a simple technique which helped us while intubate a 40-day old infant, without any major catastrophes. Keywords: Airway management; Infant; Newborn; Intubation; Endotracheal.

Article

Rhabdomyolysis due to severe hypophosphatemia in diabetic ketoacidosis

(Nepal Medical Association, 2015) Shah, Satish Kumar; Shah, Lokraj; Bhattarai, Suraj; Giri, Megha

Abstract Rhabdomyolysis(RM) is a syndrome characterized by injury to skeletal muscle fibers with disruption and release of toxic metabolites into circulation. It is characterized by triad of muscle weakness, myalgia and dark urine and is associated with increased creatine kinase (CK) and lactate dehydrogenase (LDH). A severely malnourished 10 year old girl with severe diabetic ketoacidosis (DKA) as hemr initial presentation of type 1 diabetes mellitus developed rhabdomyolysis (CK- 12,000 U/L) with nonoliguric renal failure during her initial course of hospital stay. The possible cause of her RM was attributed to severe hypophosphatemia (minimum serum phosphate, 0.8 mg/dL). Management of DKA, phosphate supplementation and urinary alkalinization with diuresis improved her clinical course. She was discharged on Day 9 with Insulin. We recommend frequent monitoring of serum phosphate during early period of DKA, particularly in malnourished children, and its normalization in case of severe hypophosphatemia. Keywords: Diabetic ketoacidosis; Hypophosphatemia; Malnutrition; Renal failure; Rhabdomyolysis.

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