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Publication Publication Epilepsy in children: an epidemiological study at Kathmandu Medical College Teaching Hospital Kathmandu(2003) Shakya, KN; Shrestha, R; Baral, MRObjectives: To analyze the relative frequencies of various epileptic seizures and to study the age at onset of different seizure types in Nepalese children. Design: Prospective study. Setting: Hospital outpatient based in Kathmandu, Nepal, between November 2001 to October 2002. Participants: 50 children diagnosed as epilepsy excluding neonatal and febrile seizures. Main outcome measure: Diagnosis and classification of cases according to the International Classification of Epilepsy of the International League Against Epilepsy [ILAE] and number of patients in each category with various ages at first seizure. Result: Generalized seizures (78%) were 3.54 times commoner than partial seizures (22%). Most frequent seizure types were generalized tonic clonic (36%), tonic (16%), complex partial (14%), atonic (12%) and absence (10%). Generalized clonic, simple partial and partial with secondary generalization, each had less than 5% frequencies. In 40% cases the first seizure occurred when aged between 2-5 years. In partial seizures the peak age at onset was observed below 6 years while primary generalized seizure was more frequently seen in age group 2-10 years. Conclusion: More paediatric patients with primary generalized seizures (78%) were observed than with partial seizures (22%). In this age group, the most frequent seizure type was generalized tonic clonic (36%) with the peak frequency of age at onset of seizures in 2-5 years. Key words: Epilepsy, Frequency, Age at onset.Publication Publication Publication Publication Incidence of ophthalmoscopic fundus changes in hypertensive(Kathmandu University, 2003) KJD, KarkiA prospective, hospital based, clinical study was conducted in hypertensive patients referred to the eye OPD, KMCTH, Sinamangal during a period of three months to find out the incidence of fundus changes. A total of302 hypertensive patients were included in the study and their fundus changes were evaluated by direct ophthalmoscopy. The age of the patients ranged from 30-70 years and the duration of hypertension from 1-25years. The blood pressure was not controlled in 218 patients (72.18%). More female patients (56.22%) were hypertensive than male (43.78%). But the fundus changes were less in female patients. Caste-wise hypertension was more common in Brahmins (38.41%) and fundus changes were also comparatively more. The fundus changes were found in 192 patients (63.57%) and the most common findings were hypertensive retinopathy.GrI + GrII combined together (52.31%). The other common fundus finding was BRVO in 11 patients (3.64%).A routine ophthalmoscopic fundus examination to detect the retinal changes in hypertensive patients is recommended. Key words: Systemic hypertension, direct ophthalmoscopy, fundus changes.Publication Role of Nepal Medical Council in MBBS Curriculum(Kathmandu University, 2003) H, Dixit.The development of the Bachelor of Medicine & Bachelor of Surgery (MBBS) course in Nepal is recounted. From the stage of having a single medical college to the stage of having ten is documented. The role that the Nepal Medical Council (NMC) has played in the development of medical education in Nepal has been adequately described. Comparison of the MBBS course that the three universities are running the MBBS is done and suggestions are made for possible future directions. Keywords: Medical education, integrated system, PBLPublication Publication Publication Knowledge, attitude and practices among health care workers on needle-stick injuries(Kathmandu University, 2003) DL, Gurubacharya.; Mathura, KC; DB, KarkiObjective: This study aimed to assess the knowledge, attitude and practices among health care workers on needle stick injuries. Methods: A 15-item questionnaire was administered to seventy health care workers including nurses and paramedical staffs from different departments of Kathmandu Medical College and Teaching Hospital to measure knowledge, attitude and practices on needle stick injuries. Results: Results showed that 4% and 61% of health care workers, respectively, were unaware of the fact that hepatitis B and hepatitis C can be transmitted by needle-stick injuries. 52 subjects (74%) had a history of needle-stick injuries and only 21% reported the injuries to the hospital authority. Only 23% were in the habit of using gloves for phlebotomy procedures all the time. 79% were of the impression that needle should be recapped after use. Only 66% were aware of Universal Precaution Guidelines. 16 subjects (23%) were negative for HBsAg, Anti-HCV and Anti-HIV and 54 subjects (77%) do not know about their immune status. 42 subjects (60%) had been vaccinated against hepatitis B, while 28 subjects (40%) were not vaccinated against hepatitis B. Only 6 subjects (14%) had been tested for Anti-HBs antibody after hepatitis B vaccination. Conclusion- The survey revealed that knowledge of health care workers about the risk associated with needle-stick injuries and use of preventive measures was inadequate. A standing order procedure (SOP) should be formulated regarding needle-stick injuries in all the health institutions. It should outline precautions to be taken when dealing with blood and body fluids. It should also contain reporting of all needle-stick injuries. Health care workers should be made aware of hazards, preventive measures and post-exposure prophylaxis to needle-stick injuries. A hospital-wide hepatitis immunization programme should also be started. Keywords: needle-stick injury, universal precaution guidelinesPublication Occupational cancer in Nepal - an update(Kathmandu University, 2003) S K, JoshiThis article is a discussion of occupational cancer in Nepal. The knowledge of specific problems of occupational cancer in Nepal is very scarce. Few researches on occupational cancer have been done in Nepal. A case-control study done recently has revealed a high risk (OR 4.2 95% CI: 1.4, 12) for lung cancer among the workers, who have worked in the exposed occupations. The incidence of cancer is thought to be rising every year. In this article an attempt has been made to establish the probable occurrence of carcinogens in the middle and large scale manufacturing industries in Nepal and the approximate number of workers exposed to different hazardous substances at the work places. Keywords: Occupation, industries, carcinogens, exposure, occupational cancer, NepalPublication Painless delivery – a short experience(Kathmandu University, 2003) SK, Maharjan; CB, KarkiPurpose: To determine efficacy and safety a randomized comparison of continuous infusion versus intermittent injection of epidural bupivacaine for labor analgesia was performed in the Maternity Hospital, Thapathali Kathmandu. Methods : Twenty healthy parturient received a loading dose of 10 ml of epidural 0.1% bupivacaine with 25 mg of pethidine. They were then randomized to receive continuous infusion of 0.1% bupivacaine 10 ml/hour with the help of infusion pump or intermittent injection of 0.1% bupivacaine 10 ml hourly. For breakthrough pain 10 ml of 0.1% bupivacaine top ups given in both groups. The two groups were compared for analgesic efficacy, mode of delivery, patient assessment of analgesia, motor block and other complications. Data analyzed in Pentium III version with SPSS and statistical significance test is done with independent samples t-test. Results: The 10 patients in each group were comparable in age but not in parity. Analgesic efficacy was excellent in 10 cases and comfortable in another 10 cases [excellent / comfortable 6:4 with infusion and 4:6 with intermittent injection]. There were no statistically significant differences between groups in pain scores or duration of active first or second stage of labor. Fifteen women had spontaneous vaginal deliveries, one caesarian section (infusion group) and four instrumental deliveries (intermittent injection group). Four women in the infusion group had hypotension and motor block, but none in the intermittent injection group. APGAR scores in both groups were 7-8/10 at 1 minute and 9- 10/10 at 5 minutes. Conclusion: Both continuous infusion and intermittent injection of low dose bupivacaine are very good methods of relieving labor pain in our context. Analgesic efficacy was similar in both groups and there was no prolongation of second stage of labor. Key words : painless delivery, parturient, bupivacaine, epidural analgesia.Publication Hysterectomy: an analysis of perioperative and post operative complication(Kathmandu University, 2003) R, Saha.; M, Sharma; S, Padhye; U, Karki; S, Pandey; J, ThapaObjective : To document peri operative and post operative complication observed after hysterectomy, regardless of route on the operator. Material and methods: A hospital based prospective study was carried out in department of obstetrics and gynaecology, KMCTH Sinamangal for six months. The study was carried out in patients undergoing hysterectomy who were followed from the time of admission to the time of discharge and two weeks thereafter. And followings were noted-Indication; route of hysterectomy, intraoperative and postoperative morbidities during hospital stay and after two weeks of discharge was noted. Result: Total number of hysterectomy carried out was 50. 31(62%) were Total abdominal hysterectomy, and 19(38%) were vaginal hysterectomy. Indication for total abdominal hysterectomy were fibroid uterus 12(24%), DUB 8 (16%), CIN 4(8%), chronic cervicitis 1 (2%). II U-V prolapse with previous LSCS 1 (2%), endometriosis 1(2%). Prophylactic for Ca breast 1(2%), Postmenopausal bleeding 1(2%). All cases of vaginal hysterectomy were performed for 2nd degree U-V prolapse. Intra operative complication during surgery were two cases of haemorrhage (4%) each in both total abdominal hysterectomy and vaginal hysterectomy. There was one case of bladder injury during abdominal hysterectomy. Postoperative complication noted were febrile morbidity 1(2%) in abdominal hysterectomy. Urinary tract infection remains the single most common febrile morbidity. There was one case of secondary haemorrhage in both type of hysterectomy. One was managed conservatively and other required laprotomy. There were three(6%) cases of wound infection in abdominal hysterectomy of two which were sanguineous discharge and one was frank pus which required secondary suture.Publication Visual outcome of vitrectomy in Seasonal Hyperacute Pan Uveitis(Kathmandu University, 2003) RN, Byanju; E, Pradhan; SC, Rai; YD, SapkotaIntroduction: Seasonal Hyper Acute Panuveitis ( SHAPU) is a sight threatening condition often affecting children. Its management as yet is a challenge in ophthalmic practice. Most of the eyes even after treatment end up in pthisis bulbi. Materials and methods: A retrospective hospital based analysis of 18 patients with SHAPU managed with vitrectomy at Himalaya Eye Hospital (HEH) Pokhara over a period of two years was carried out. Results: Out of 18 patients 10 were males. Majority of them were bellow the age of 15 years. Best corrected visual acuity (BCVA) at presentation was less then 3\60 in 72% of them. BCVA was better then 6/60 in 7 (50%) out of 14 patients, who underwent vitrectomy. Conclusion: Vitrectomy is a useful procedure in management of SHAPU. Key words: Seasonal Hyper Acute Panuveitis, Visual acuity, Vitrectomy.Publication Publication Publication Clinical Profile of Neonatal Sepsis(Kathmandu university, 2003) NK, Jain; VM,Jain; S, MaheshwariIntroduction: Neonatal Sepsis is a major cause of mortality and morbidity in newborns both in developed and developing countries. Objective: This study was to analyse the symptoms and sign of Neonatal Sepsis. Materials and Methods: Retrospective hospital based study the date was collected from patient record files of two years (Jan. 2001–Dec.2002). Result: 106 Neonates with suspected sepsis were studied out of which 30 were culture positive. The most common organism was E. coli and the most common clinical presentation was the respiratory distress and letharginess. Conclusion: Infection in Neonate is an important cause of mortality & morbidity especially in low birth babies. Key Words: Neonate, Sepsis and Mortality.Publication Seroprevalence of antibodies to hepatitis C virus among injecting drug users from Kathmandu(Kathmandu University, 2003) I L, ShresthaObjective: To determine the seroprevalence of antibodies to hepatitis C virus among injecting drug users (IDU) from Kathmandu. Design: Retrospective cohort study from January 1997 to December 2002. Setting: Pathology Lab, Siddhi Polyclinic, Dillibazaar, Kathmandu. Materials and methods: Blood samples were collected from 400 injecting drug users and 400 healthy young adults. Serum samples were examined in duplicate along with negative and positive controls for the presence of antibodies to hepatitis C virus using third-generation enzyme-linked immunoassay (EIA 3.0) kit in fully automated, USA FDA approved, Bio-Rad EIA analyzer. Samples positive for anti HCV were re-examined for confirmation. Results: 342 out of 400 (85.5%) serum samples from IDU were found to be positive for anti HCV compared to 3 out of 400 (0.75%) serum samples from young adults without the history of IDU. Conclusions: 1. Injecting drug use is an important risk factor in the spread of hepatitis C virus. 2. Sharing of needles should be stopped. 3. Education and health counselling should be given to the people at risk to bring about behavioural change. Keywords: antibodies to Hepatitis C virus, seroprevalence study, EIA third generation, Injecting drug users.Publication Evaluation of undergraduate medical students: need for a change(Kathmandu University, 2003) DB KarkiNA.Publication