NepMed Repository :: Browsing by Author "Shrestha, JM"

Browsing by Author "Shrestha, JM"

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Antibiotic Usage and its Sensitivity Pattern in the NICU
(Kathmandu University, 2012) Shrestha, R; Shrestha, JM; Gurung, B
ABSTRACT Background Sepsis is a major cause of mortality and morbidity in newborns affecting both developed and developing countries accounting a quarter around one million deaths per annum. Objective This study was aimed to assess the prevalence of neonatal sepsis, culture isolates, pattern, antibiotic sensitivity and drug prescribing pattern. Methods In present prospective study, 48 neonates admitted in pediatric ward from January to March 2011 of Dhulikhel Hospital were included. The gestation age, onset of sepsis, culture isolates, antibiotic sensitivity pattern and drug prescribing pattern were studied. Environmental air sampling of NICU (Neonatal Intensive Care Unit) was done by settle plate method for microbial examination. Result Among 48 neonates, 23 (47.92%) neonates were culture positive with predominant isolates of Klebsiella oxytoca 11(47.83%), Pseudomonas spp. 4(17.39%), Methicillin Resistant Staphylococcus Aureus (MRSA) 3(13.04%) and single case of Enterobacter spp. In environmental samples, K. oxytoca and Enterobacter spp. were isolated. Amikacin, Imepeneum and Ciprofloxacin were sensitive whereas Ampicillin in combination with Cloxacillin, Ampicillin, Aztreonam were resistant for Klebsiella. oxytoca. Amikacin, Ceftazidime and Imipenuem are sensitive to Enterobacter spp. The single or combinations of resistant antibiotics were found to be prescribed. Conclusion The emerging antibiotic resistances among the culture isolates and coherence with environmental samples were observed. Hence, special measures are imperative for reducing environmental contamination and the rational usage of antibiotics for preventing the infection and emerging antibiotic resistance. The study recommends need of the antibiotic policy to curb the present scenario. KEY WORDS Antibiotic Sensitivity, Neonatal sepsis, NICU
Epidemiological study of hand injury in a tertiary care centre in Nepal
(Institute of Medicine, 2018) Sharma, S; Shrestha, JM; Rayamajhi, S; Manandhar, K; Lohani, I
Abstract Introduction: The epidemiology and pattern of hand injury may vary from one region to the other. Due to the lack of systematic documentation, not much is known regarding the epidemiology of hand injury in Nepal. The purpose of this study was to determine the patterns of hand injury in a tertiary care centre in a developing country like Nepal. Methods: A cross-sectional descriptive study was carried out in the Department of Plastic Surgery and Burns, Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. The study included 174 patients presenting with hand injury in the emergency room and the outpatient department. Results: There were 129 (74.1%) males and 45 (25.9%) female patients, the mean age of all patients being 30.3 years. The top four occupations concerned with hand injuries were carpenters, students, manual labourers and factory workers. Most injuries occurred in furniture and wood workshops. Electrically powered saw belt and grinding machinery were the culprits for majority of crush/avulsion injuries whereas broken glass was the commonest cause of sharp cut injury. Tendon injury was the most common diagnosis followed by fractures and fingertip injuries. Accordingly, tendon repair followed by fixation of fractures were the commonly carried out treatment procedures. Conclusion: Hand injuries are very common among young male furniture and wood factory workers as well as manual labourers having occupational exposure to different machines. Formulating safety protocols in the furniture and industrial settings and other machinery related workplaces would play a significant role in reducing the incidence of hand injuries. Keywords: Hand, hand injuries, occupational exposure
Role of Plastic Reconstructive Surgery in the management of earthquake victims of Nepal in Tribhuvan University Teaching Hospital
(Institute of Medicine, 2016) Shrestha, JM; Rayamajhi, S; Lohani, I
Abstract An earthquake of magnitude 7.8 richter on 25 April 2015 and its major aftershock on 12 May 2015 struck Nepal resulted inmassive destruction of Kathmandu valley and rural areas causingmore than 8800 mortalities and left more than 23000 injured. The casualties who were brought to the hospital were treated by various surgical specialties including plastic surgery. This is a cross sectional study in which the authors evaluated soft tissue injuries treated by the plastic surgery team in one month period after the earthquake. Information was gathered regarding pattern of soft tissue injuries and their treatment. There were total of 486 earthquakevictims admitted in the hospital and 532 major operations were performed. Total of 77 patients were admitted under plastic surgery and 115 operative procedures were perfonned for the 104 soft tissue injuries in these patients. Operations for soft tissue injuries accounted for 22% of the total operations performed. The most common operation was split thickness skin grafting (34%). Local and regional flaps were performed on ten cases (9%) and free flap was done in four cases (3.4%) ofinajor soft tissue defects requiring coverage of exposed bones. Complications occurred in 23 patients (29.87%) and included infection, skin necrosis, partial skin graft loss, Acute Kidney injury and sepsis. The authors conclude that the role of plastic surgeons is vital in disasters like earthquake and it helps in the appropriate and timely wound care and debridement and alsohelp to identify patients that would potentially benefit from limb salvage. Keywords: earthquake, crush injury, plastic surgery, skin grafting, pedicled flaps, free flaps
Use of reverse sural artery flap for reconstruction of defects of distal leg, ankle and foot
(Institute of Medicine, 2017) Shrestha, JM; Rayamajhi, S; Lohani, I; Manandhar, K; Sharma, S
Abstract Introduction: Reverse sural artery flap has been used effectively to cover defects of distal leg, ankle and foot. This flap is easier and quick to harvest and is a versatile flap in terms of extensive mobility and reliable vascularity and, in many instances it has obviated the need for free tissue transfer. Methods: This is a retrospective study of sural flaps done at the Department of Plastic Surgery and Burns in Tribhuvan University Teaching Hospital over a period of 4 years from April 2011 to March 2015. It included 21 flaps carried out in 21 patients with soft tissue defects at distal lower leg, ankle and foot. Results: Among 21 patients, 10 were men and 11 were women with an average age of 41 years (17 – 81). Successful flap coverage was obtained in 16 cases out of 21 (76%) which included 10 cases of complete survival (48%) and 6 cases (28%) of marginal flap necrosis. Four cases (19%) had partial flap loss and one case (5%) lost flap completely. Conclusion: we found that reverse sural artery flap has good reliability with low incidence of complications and is a versatile flap for the reconstruction of defects in distal leg, ankle and foot Key words: sural flap, distal leg, ankle, foot, flap survival, flap necrosis, skin strip

Browsing by Author "Shrestha, JM"

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