Browsing by Author "Dhakal, M"
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Publication Publication Management of Typhoid fever in the Department of Medicine at Kathmandu Medical College(Kathmandu University, 2003) Dhakal, M; Neopane, A; Subedi, N; Dhakal, R; Karki, DBAim 1. To assess the ongoing management strategy of typhoid fever in department of medicine at Kathmandu Medical College, Sinamangal, Kathmandu. 1. To suggest changes, if required for the benefit of patients and doctors Method Prospective study of clinically suspected enteric fever from 2060/01/29 to 2060/04/25. Assessment and analysis of the rationality of the diagnostic parameters that are being used in the ward for clinically suspected enteric fever in unit one of department of medicine. Treatment outcome of the patients with the commonly used antibiotics. Analysis of the sensitivity pattern of the salmonellae isolated among the study group. Result 1. Only 11 cases (37%) were actually culture proven among the 30 cases suspected to be enteric fever on clinical basis. 2. 19 cases (63 %) of the clinically suspected enteric fever were diagnosed only on the basis of single widal test (titre more than 1:320), blood culture being negative. 3. Bone marrow was subjected to culture for salmonella only in 4 Cases (13%) despite blood culture being sterile. 4. The laboratory could provide sensitivity pattern of salmonellae only in 5 cases out of 11 culture positive cases (45%). 5. Eighteen cases (60%) had to be given 3rd generation cephalosporin after not responding to 5 days course of fluoroquinolones (ciprofloxacin or ofloxacin). On the other hand all the cases in the study group subjected to 3rd generation cephalosporin (injection ceftriaxone or cefixime orally) responded well to the treatment. Conclusion 1. We shouldn’t be relying too heavily on a single titre of widal test for the diagnosis of enteric fever and should be sending blood for culture for salmonella and even bone marrow culture, if necessary. This can be concluded on the basis of lots of literature against single widal test in the diagnosis of enteric fever. 2. Widal test should be positive with clearly significant rising titre (with paired sample) or modified widal test has to be performed if one wants to give gravity to the test for the diagnosis of enteric fever. 3. Laboratory personnel’s need to be more serious in their works so as to try to see sensitivity pattern in all positive cultures, if rational use of antibiotics is really desired in view of increasing antibiotic resistance. 4. Fluoroquinolones, once thought to be super powerful antibiotic & still taken as the drug of choice almost everywhere, has been found to be resistant in most of the cases in this study. Though the sample size is too small and there are lots of limitations in this study to come to a firm conclusion, it has borne one serious question in the minds of our unit doctors: Correspondence Dr. Mahesh Dhakal Dept. of Medicine, Kathmandu Medical College, Teaching Hospital Kathmandu University Medical Journal (2003) Vol. 1, No. 3, 197-204 198 whether we are over-using fluoroquinolones for trivial infections and leading to the emergence of resistant strains of salmonellae?Publication Prevalence of Depression and Associated Factors among Cervical Cancer Patients Attending Tertiary Center in Bhaktapur, Nepal(Kathmandu University, 2024) Dhakal, M; Basel, PABSTRACT Background The depressive disorder is remarkably more common among cervical cancer patients as compared to those who have other type of cancers. Objective To estimate the prevalence of depression and associated factors among cervical cancer patients attending tertiary center in Bhaktapur, Nepal. Method A cross-sectional study was conducted among 140 women aged 35 years and above with cervical cancer who came for follow-up at Bhaktapur Cancer Hospital using Beck Depression Inventory (BDI). Chi-square test and multivariate logistic regression were performed to determine the association between depression and related variables at 95% confidence level. Result The prevalence of depression was found to be 67.9%. Age, education of participants, education of husband and alcohol consumption status of husband were found to be the associated factors of depression in women with cervical cancer. Conclusion Nearly seven in ten women with cervical cancer are found to be depressed. KEY WORDS Associated factors, Cervical cancer, Depression, Nepal, Prevalence