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Anticoagulant Dependent Pseudothrombocytopenia: A Case Report
(Institute of Medicine, 2017) Aryal, B; Adhikari, S; Aryal, N; Pant, V
Abstract Pseudothrombocytopenia is a laboratory finding caused by in vitro autoaggregation of platelets (an irreversible change) resulting due to the presence of EDTA in containers. In contrast to serious and potential life-threatening causes of thrombocytopenia, EDTA-pseudothrombocytopenia (EDTA-PTCP) is solely an in vitro effect without any clinical relevance.We report a 24 year old patient from MCTVC hospitalwho presented with common flu. On blood examination there was low platelets count in EDTA anticoagulated sample but he was clinically otherwise normal and there were no symptoms of thrombocytopenia. On smear preparation, in EDTA and Trisodium citrate sample his all blood countparameters were within normal range. This case highlights the importance of slide preparation.
Combination treatment with carbamazepine and clonidine in a case of epilepsy with ADHD
(Institute of Medicine, 2017) Adhikari, S; Upadhyaya, S; Pant, SB; Dhungana, S; Tulachan, P; Chapagai, M; Ojha, SP
Abstract In a child with epilepsy, Attention Deficit Hyperactivity Disorder (ADHD) is found to be more prevalent in comparison to general population. In western literature for the management of ADHD, stimulants like Methylphenidate and non-stimulant like Atomoxetine are considered the first line drugs. Although no any robust findings are found that support the use of such drugs in cases of epilepsy with ADHD, still they recommend using these drugs in such cases. In our scenario availability of such drugs is a major hindrance for which second line drugs like alpha agonists are the only options available to us. Here in this case report we have used Clonidine along with Carbamazepine in the management of a 12 years child presented in our centre with episodes of seizure and ADHD and had shown significant improvement with these medications. Keywords: ADHD, Carbamazepine, Clonidine, Epilepsy
Epithelioid sarcoma: A rare cause of non-healing ulcer
(Institute of Medicine, 2017) Paudel, V; Das, AK
Abstract Epithelioid sarcoma, first described by Enzinger in 1970, is a rare slow-growing soft tissue malignancy, associated with a high incidence of regional recurrence and distant metastases. It is characterized by a proliferation of epithelium-like cells and the absence of a granuloma-like pattern with positivity for vimentin, cytokeratin. The recommended treatment is a wide resection with adequate margins, lymph node dissection. We report a 37-year-old male with chronic,non healing ulcer in lower leg of seven years duration who was treated conservatively leading to recurrence of the lesion with metastasis up to left inguinal region resulting lymphedema of the penis. Keywords: Epithelioidsarcoma, Soft tissue sarcoma, Vimentin, Cytokeratin
Solitary skull metastasis as initial presentation of hepatocellular carcinoma
(Institute of Medicine, 2017) Pradhan, S; Phuyal, S; Kumar, A; Ghimire, B; Singh, Y P
Abstract Hepatocellular carcinoma (HCC) is the most common primary tumor of liver. HCC usually metastasizes to regional lymph nodes and lungs, less commonly to bone and rarely to the skull. Herein we present a case of 73 year old gentleman who presented with an occipital swelling. CT head detected mass suggestive of hemangiopericytoma with a differential of metastasis and MRI showed heterogenous signal intensity mass probably metastasis. Cytological diagnosis revealed cranial metastasis. Subsequent CECT abdomen reported a 12x11x11cm heteregenous enhancing mass suggestive of hepatocellular carcinoma. Patient was planned for craniectomy and transarterial chemoembolization to treat primary cancer but he refused further treatment inspite of extensive counseling. Primary presentation with skeletal metastases is rare in HCC and only few cases have been reported so far but it should be considered in the differential diagnosis in patients with subcutaneous scalp mass. Keywords: Hepatocellular carcinoma, Skull metastasis
Annular pancreas in a patient with malignant obstructive jaundice: A case report
(Institute of Medicine, 2017) Shah, S; Bhandari, R S
Abstract Majority of cases with annular pancreas are asymptomatic. Common presentations in symptomatic patients are abdominal pain, nausea and vomiting. Jaundice is very rare presentation of annular pancreas. We are presenting a case of 40 years male with annular pancrea. He presented with jaundice, anorexia and weight loss. Contrast enhanced computed tomography shows annular pancreas with extrahepatic as well as intrahepatic bile duct dilatation. Magnetic resonant cholangiopancreatography showed abrupt narrowing of distal common bile duct with upstream dilation of biliary duct suggestive of distal cholangiocarcinoma. This case illustrates the important of evaluation for malignant cause of obstructive jaundice in patients with annular pancreas presented with jaundice, anorexia and weight loss Key words: Annular pancreas, Distal cholangiocarcinoma, Jaundice
A rare case of pseudocyesis in a grand multiparous woman in Karnali Academy of Health Sciences: a case report
(Institute of Medicine, 2017) Aryal, B; Shrestha, U
Abstract Pseudocyesis, sometimes called phantom or false pregnancy is a rare medical condition in which women has false believe of being pregnant. She experiences many signs and symptoms of pregnancy but there is absence of fetus. The etiology of this condition could be the interplay and combination of various psychological, sociocultural and endocrine factors. A case of this rare condition is described in the case report that represents the sociocultural belief of need of specific sex (male) child in the family and believe in traditional healers in rural Nepalese society. Key words: pseudocyesis, grand multipara, sociocultural belief
Atrial septal defect closure with axillary mini thoracotomy and total peripheral cannulation: a novel approach
(Institute of Medicine, 2017) Bhattarai, A; Pradhan, B
Abstract Ostium secundum atrial septal defect (ASD II) is one of the most common congenital heart defects (CHDs), occurring in 5% to 10% of children (1) and in 30% of adult patients with CHD (2,3). Surgical closure has been considered for many years the gold standard treatment for patients with an ASD II. Operative mortality is low (0% to 3%) (4–6) and long-term survival is high (25-year survival of 92%) (7). Here, we describe our initial experience with minimally invasive approach using total peripheral cannulation (TPC) and an axillary minithoracotomy (AMT) 4-5 cm long incision for surgical closure of an ASD. In our knowledge ASD closure with axillary mini-thoiracotomy is for the first time in the country.
Assessment of nutritional status among children under five years of age in Manamaiju VDC of Kathmandu District, Nepal
(Institute of Medicine, 2017) Gautam, N; Shrestha, S
Abstract Introduction: The nutritional status among under the age of five in terms of stunting, underweight and wasting and to find the association between nutritional status with selected variables. A descriptive cross-sectional study was done to determine prevalence of stunting, underweight and wasting among under five children and factors associated with that. Descriptive, univariate indices such as stunting, underweightandwasting determined as Height for Age, weight for age and respectively. Methods: The study was conducted in Manamaiju VDC with 56440 populations with 3742 under 5 children. Research design was descriptive cross sectional. Total sample size was 190 tools used are semi structured and face to face interview. Data collection was within 4 week (23rd chaitra 2070 to 20th Baisakh 2071). Data was analyzed by SPSS version 13.0 for Windows and ENA for SMART. Similarly, Chi square test was applied at 5% level of significance to show the association between nutritional status and selected variables as age group of children, occupation of mother, education of mother, immunization, vitamin A capsule supplementation, deworming tablets and colostrum milk feeding. Results: This study finding is that the nutritional statuses of children in term of stunting were 32 %, in term of underweight 26% and wasting were 22% so the wasting found to be double in reference to current scenario. Similarly, associations of the variables with nutritional status were analyzed. The study found that Vitamin A supplementation, deworming tablets and colostrum milk feeding had statistically significant effect on wasting status and feeding of colostrum milk had statistically significant effect on underweight status. Conclusion: From this study it can be showed the prevalence of stunting, underweight and wasting among under five children in Manamaiju VDC. National average given by NDHS, 2001 except the prevalence of wasting which is almost similar. Similarly regarding the association within selected variables i.e. Age group of children, Immunization, Mother’s Education level, Vitamin A supplementation, Deworming tablets and Colostrum feeding practices have significant effect on wasting status and underweight too but not on stunting and underweight. This analysis shows further need of research to explore the more regarding the nutritional status among the under five children in this community.This study showed that 41%, 29% and 11% children were stunted, underweight and wasted. Keywords: stunting, underweight and wasting, nutritional status
Surgical management of extrahepatic portal vein obstruction at University Hospital
(Institute of Medicine, 2017) Shah, S; Ghimire, B; Kansakar, P B S; Bhandari, R S; Lakhey, P J; Vaidya, P; Singh, Y P
Abstract Introduction: Extrahepatic portal vein obstruction (EHPVO) is a second most common cause of portal hypertension which causes upper gastrointestinal (GI) bleeding. Primary management of upper GI bleeding is endoscopic therapy. However, surgery is performed as a secondary management of upper GI bleeding and if patients fail to respond endoscopic management or complications of EHPVO develops. The aim of the study was to determine the perioperative outcome of surgery done for EHPVO. Methods: This is retrospective observational study of all the patients of EHPVO, who were undergone surgical management at Tribhuvan University Teaching Hospital in between April 2015 to March 2017. Data were collected from case sheets of the patients. The demographic and clinical characteristics of the patients, and perioperative and short term outcome of the surgical management of EHPVO patients were analysed. Results: Total 34 patients were included in the study including 20 males (58.8%) and 14 (41.2%) females with median age of 17 years (4 to 45 years). Most common presentation of EHPVO were fullness in upper abdomen (34/34) upper GI bleeding (29/34). Most of the patients had anemia (33/34), splenomegaly (34/34) and hypersplenism (28/34).Shunt surgery was performed in 20 patients and modified Hassab’s procedure in 14 patients. There was no post-operative severe complication except one mortality in Hassab’s procedure. The median duration of surgery was higher in shunt surgery group compared to devascularisation group (240 minutes versus 180 minutes). There were no significant differences in intraoperative blood loss, total hospital stays and recurrent upper GI bleeding in both surgery groups. Conclusions: Surgical management for EHPVO have good perioperative and short term outcome. Keywords:Esophageal varices, Hypersplenism, Portal biliopathy,Portal vein obstruction
Gene Xpert based detection of drug resistant tuberculosis among retreatment patients visiting National Tuberculosis Centre, Nepal
(Institute of Medicine, 2017) Khadka, DK; Bam, DS; Ghimire, P; Singh, A
Abstract Introduction: Tuberculosis is still one of the major public health problems in Nepal and multi drug resistant and extensively drug resistant tuberculosis (MDR /XDRTB) additionally has become serious issue. Prompt diagnosis and effective treatment of MDR/XDRTB is urgently needed. The main objective of this study was to detect MDR TB using novel molecular techniques (rpob gene mutations) in reference with drug susceptibility test (DST). Methods: A cross sectional study was carried out identifying MDRTB among retreatment patients using Gene Xpert, culture and DST on first line drugs (FLD-DST). A total of 159 sputum samples were collected from retreatment TB patients (Female 40.3%, Male 59.7%) with median age of 30 years visiting to the DR TB treatment centres of eastern and central Nepal (via private courier and directly to National TB Reference Laboratory (NRL) at NTC from April 2013 to August 2017. Results:M. tuberculosis and rifampicin resistance were detected on all 159 (100%) samples by Gene Xpert of which, 73.3%, 21.4% and 6.3% were positive, negative and contaminated respectively by culture. FLD-DST was performed on 115 cultures positives of which, 94.78% showed MDRTB, 1.74% showed mono resistance to isoniazid or rifampicin, 0.87% to streptomycin and isoniazid and 3.47% were pan susceptible. Conclusion: One hundred fifteen of 159 cases detected rifampicin resistances (RR) by Gene Xpert were culture positive and almost 95% strains were MDRTB by FLD-DST, which was found to be higher in 15-60 years group. Sputa from retreatment TB patients required to be tested by rapid diagnostics with reference to culture and DST. Key words:Gene Xpert, Culture, Drug Susceptibility Test, Multi Drug Resistant Tuberculosis, Sputa
Problems faced by clients and factors affecting post-operative recovery after open-heart surgery in selected hospitals in Kathmandu
(Institute of Medicine, 2017) Shrestha, U; Adhikary, GP
Abstract Introduction: Open-heart surgery is a stressfulcondition and people suffer from various physical, psychological, social and economic stress after open-heart surgery. These factors also affect the recovery and survival after the surgery. This is adescriptive purposive study among adult clients of two tertiary hospitals of Kathmandu with the objective of finding the problems faced by the clients and factors affecting post-operative recovery after open-heart surgery. Method: Population consisted of 50 clients who had already undergone open-heart surgery. A purposive sampling was done information collected on physical, psychological, social and economic problems using pre-tested structure questionnaire through interview method. The data was analyzed by descriptive and inferential statistics toidentify the association between research variables. Results: Fatigue and discomfort were the most frequently experienced physical complaints. The clients with less than 12 months post-operative period mainly suffered physical problems. Female clients mainly sufferedfrom psychological problems like sadness, anxiety, loss of interest and irritability. Inadequate interpersonal interaction, social and religious participation and the family support were major social tribulations that were significantly higher among female clients. Likewise, decreased follow-up frequency, family disputes and marital disharmony were chief problems due to financial constraints. Conclusion: This study concludes that clients suffer from a variety of problems associated to physical, psychological, social and economic aspects after open-heart surgery. For this reason, study strongly indicates the need for regular provision of educational sessions and proper counseling services to all clients including their families about these problems so that possible complications and the sufferings are less. Key words: open-heart surgery, client’s perception, post-operative recovery
Prescription writing skills of preclinical medical and dental students in a medical college
(Institute of Medicine, 2017) Shrestha, D; Thapa, R; Gurung, RS; Tuladhar, LR; Shrestha, L
Abstract Introduction: Prescription is a clinician’s written order to dispense drugs. Prescription writing is one of the basic competencies to be learned by medical and dental students, who are more prone to make prescription errors during the early stages of their training. Methods: It was across sectional study conducted in NMCTH, Jorpati, Kathmandu. Medical and dental students in the first and second year were included in the study. Students were given common clinical conditions to write prescriptions. Prescriptions were analyzed for physician and drug related components. Results: The total number of medical and dental students that participated in this study was 326. The percentage of different physician related components in the prescriptions of first year medical students ranged from 61.4 to 100%, from 74.1 to 100% in second year medical students, from 55 to 100% in first year dental students and from 66.7 to 100% in second year dental students. The percentage of different drug related components of prescriptions was from 73.7% to 90% in first year medical students, from 79.3 to 94.8% in second year medical students, from 57.5 to 80% in first year dental students and from 74.1 to 92.6% in second year dental students. Conclusion: Prescription writing skills of preclinical medical and dental students are lacking in its various components. Evaluation of their prescription writing skill should be done frequently to find out the deficiencies which must be corrected by better training to reduce prescription errors and to increase adherence to improve rational prescribing. Keywords: prescription skills, medical students, dental students
Assessment of Functional Status and Comorbidities among Elderly Admitted in Sub-Regional Hospital, Parsa
(Institute of Medicine, 2017) Shrestha, KD; Gautam, R
Abstract Introduction: Functional decline may be the first sign of changing health status and the prevalence of co morbidity is high among elderly affecting their functional ability and increases need of hospitalizations. The functional assessment is one of the trademarks of the geriatric assessment that measures the outcome of the treatment, determinant of end of life medical costs and helps to plan for further care needed for elderly. Numerous studies have shown an association between aging and higher risks of functional dependence as well as a high prevalence of functional disability in the older adult population. Hence, this study is to assess the functional status and comorbidities among elderly patient. Method: A descriptive cross- sectional study was done among elderly patient admitted in different wards of the Narayani Sub-regional Hospital, Parsa. Data was collected through census method from 121 respondents by using interview schedule through interview method. Katz Index of Independence in Activities of Daily Living was used to assess the functional status of elderly. Descriptive and inferential statistics (chi square & odds ratio) were used for analysis. Results: The study reveals more than half of the respondents (62.8%) were dependent in basic activities of daily living (BADLs). Among them, 57.9% were severely dependent followed by 42.1% moderately dependent in BADLs. Respondents were dependent in bathing (68.6%), toileting (59.5%) and transferring (43.8%). Regarding comorbidities with physical problems, each respondent has average six comorbidities with minimum two comorbidities (Mean 1.71). Among them, 8.1% respondents had chronic cough, hypertension (21.5%), diabetes (8.3%), vision problem (34.7%) and 29.8% had hearing impairment. The study also reveals that hypertension, age and BMI significantly affect the functional status of the elderly. Conclusion: More than half of the respondents were dependent in BADLs especially in bathing, toileting and transferring. Each respondent had average two comorbidities. Hypertension, age and BMI significantly affect the functional status of the elderly. Therefore, functional status and comorbidities of the elderly must be assessed in regular basis to improve the quality of life. Key words: Functional status, Comorbidities, Katz index of independence in ADL
Nutritional risk assessment in patient undergoing major gastrointestinal surgeries
(Institute of Medicine, 2017) Paudel, P; Ghimire, S; Rai, S; Pradhan, GBN; Shrestha, S; Bhattachan, CL
Abstract Introduction: Malnutrition is prevalent in surgical patients in the range of 20–50%, depending on the population studied and method employed to determine nutritional status. Malnutrition is associated with adverse clinical outcomes, slow healing, increase in infection and longer hospital stay. There are several methods to assess the nutritional status of surgical patients. However, none has been universally accepted and there is no consensus on the best system. The Nutritional Risk Screening score (NRS 2002) was developed based on the presupposition that the severity of malnutrition indicates increased nutritional requirements and need for nutritional support. It has received approval from the European Society for Parenteral and Enteral Nutrition for use in the hospital setting. It is easy to administer in daily clinical practice and offers satisfactory reliability and reproducibility. The aim of the present study was to identify nutritional risk in patients undergoing major gastrointestinal surgeries using NRS2002 and to determine possible associations with postoperative complications. Methods: This is a prospective study carried out in department of surgery, Nepal Medical College and Teaching Hospital from 1st August 2016 to 30th July 2017. All the major gastrointestinal surgeries performed during this period were included. The nutritional assessment was done by BMI, Serum protein /albumin and nutritional risk screening score (NRS 2002). Results: Sixty three patients who underwent major gastrointestinal surgery were included in this study. Sixty percent patients (n=38) were male, 68.8% had BMI within ideal range (18.5-25.9 kg/m2), 71.4% (n=45) patients underwent elective surgery and 68.2% (n=43) had malignancy. A total of 44.4% (n=28) of the patients were classified as being “at nutritional risk” and 47.6% (n=30) had postoperative complications. The mean NRS score was significantly higher among the patients who had complications compared to those who did not have complication (3.7± 1.2 vs 3± 1, p=0.016). Low serum albumin, BMI and absolute lymphocyte count correlated with presence of nutritional risk assessed by NRS 2002 and complications. Conclusions: NRS 2002 is simple and easy to apply in routine clinical practice for nutritional assessment. It correlates with postoperative complications. Serum albumin, BMI and absolute lymphocyte count are also simple tools for nutritional assessment of surgical patients and can be used in supplementation with NRS 2002 for better accuracy. Keywords: Albumin, Complications, Gastrointestinal surgery, Malnutrition, Nutritional risk screening
Knowledge, Attitude and Practice of Health Care Institutions and their Staff Involved in Hospital Solid Waste Management
(Institute of Medicine, 2017) Banstola, D; Banstola, R; Nepal, D; Baral, P
Abstract Introduction: Knowledge, attitude, and practice (KAP) among health care workers are first key steps in developing a successful infection control program. Without good knowledge, attitude and practice, hospital waste cannot be managed effectively. The hospital waste possesses specific problems due to presence of sharps, infectious and hazardous materials in it. The unmanaged hospital solid wastes not only affect patients, attendants, nurses and medical personnel but also have impact on general population, scavengers and sanitary personnel handling waste. On account of lack of knowledge, attitude and practice of health care institutions and their staff, hospital solid waste can be a source for transmission of infectious diseases like AIDS, Hepatitis B, Hepatitis C, Tetanus, Diarrhea, Tuberculosis, Cholera and so on. Methods: It is a descriptive cross-sectional study conducted among the waste management staff working in 14 health care institutions (HCIs) of Pokhara Sub-Metropolitan City, Kaski district, Nepal. Semi- structured, self administered questionnaire consisting of questions on knowledge, attitude and practice on hospital waste management were prepared for conducting in-depth interviews and information was recorded as provided by key respondents. Housekeeping officer, senior nurse and senior waste collector/handler of each sampled health care institutions were taken as key respondents to collect information for questionnaire survey. Results: This study assigned that 21.43% of housekeeping officers, 35.71% of senior nurses and 28.57% of senior waste collectors received training on hospital solid waste management. Out of the 14 HCIs surveyed, 100% of them were provided with face mask and utility gloves; 35.71% were provided with boots; 14.28% were provided with plastic apron and trousers; 7.14% were provided with eye protector and no single institution provided helmet, long sleeved shirt and respirator to waste handling staff. The study also examined that 35.71% of housekeeping officers, 50% of senior nurses, and 14.29% of senior waste collectors were vaccinated against Hepatitis B. On the other hand, 85.71% of housekeeping officers, 85.71% of senior nurses, and 71.43% of senior waste collectors were vaccinated against Tetanus. Conclusion: Knowledge, attitude and practice on hospital solid waste management were not given due attention by the HCIs and their staff involved in hospital waste management. The waste handlers were unaware about their health. The lack of awareness and accountability from actors in health care waste management lacked of well trained human resources were the major challenges to promote effective health care waste management system. Hospital solid waste management should be operated by well trained and well motivated personnel. Key respondents who should be one of the group of actors in each health care institution (HCI) should be related to waste management field and well trained to understand architecture, and chemistry of the problem. Key words: Attitude, knowledge, hospital staff, practice, waste management
Bacterial profile of Early versus Late onset neonatal sepsis and its antimicrobial susceptibility: A 1-year retrospective study in a tertiary level teaching hospital of Nepal
(Institute of Medicine, 2017) Gurung, B; Shrestha, LP
Abstract Introduction: Neonatal mortality accounts for 46% of all under-five deaths globally. The Neonatal Mortality Rate in Nepal (21/1,000 live births) still exceeds the global average. Infection remains one of the leading causes. South-Asian studies report different spectrum of pathogens in neonatal sepsis compared to Western literature, with concerns for emerging antimicrobial resistance. Local epidemiological data and periodic surveillance provides guidance to formulate antibiotic policy. This study was conducted to evaluate the organisms of neonatal sepsis and antimicrobial sensitivity pattern in a hospital setting. Methods: A retrospective study was conducted in Neonatal Intensive Care Unit, Tribhuvan University Teaching Hospital from April, 2016 – April, 2017. All neonates treated as neonatal sepsis were screened. Only the cases with positive blood culture were enrolled. Results: Out of 172 neonates with Probable sepsis, 36% cases were “Culture-proven sepsis”. Majority were preterm (56.45%), Low Birth Weight (59.67%) and male (64.5%). Around 30% were outborn babies which probably contributed to high (75.8%) cases of Late-onset Neonatal Sepsis (LoNS). Besides Coagulase-Negative-Staphylococcus, antimicrobial-susceptible, Gram-negative organisms dominates Early-onset Neonatal Sepsis (EoNS). There were 53.19% Multidrug resistant (MDR) organisms in LoNS– Klebsiella followed by Pseudomonas, accounting for 64.7% deaths. Excluding Methicillin Resistant Staphylococcus aureus (MRSA), all LoNS associated MDR isolates were susceptible to Colistin. Majority (90%) Non-MDR isolates in LoNS were susceptible to Amikacin and Piperacillin-Tazobactum or Meropenem combination. All MRSA isolates were susceptible to Vancomycin or Teicoplanin. Conclusion: Late onset neonatal sepsis remains the major burden. MDR isolates increase the challenge of newborn care with limited antimicrobial options and high mortality. Keywords: Antimicrobial susceptibility, Bacterial profile, Neonatal sepsis
Prenatal diagnosis of congenital anomalies and their outcome in Tribhuvan University Teaching Hospital
(Institute of Medicine, 2017) Jha, BK; Jha, P; Dahal, GR; Pokharel, RP
Abstract Introduction: Congenital anomalies represent defects in morphogenesis during early fetal life. The proportion of perinatal deaths due to congenital anomalies is increasing in developing countries like Nepal as a result of reduction of mortality due to other causes. Methods: A retrospective study was conducted in the Pediatric Surgery Unit, Department of Surgery, Tribhuvan University Teaching Hospital (TUTH). Data were collected from patients’ hospital files from 2013 to 2015 AD. Result: A total of 33 patients who had congenital anomalies either diagnosed and referred from outside or diagnosed at TUTH were included. Various types of anomalies involving different body systems were identified during the prenatal period. But surgery was performed in only seven cases. Conclusion: Due to widespread availability of ultrasound the number of patients with congenital anomalies who are being detected is on the rise. The proper management of these children in the intrauterine and neonatal period is a challenge in our context. Lack of proper policy and resources is a big hindrance to the proper management of these group of patients. Keywords: Congenital anomalies, Surgery, Nepal
Clinical significance of head circumference \ abdominal circumference ratio in low risk pregnancy
(Institute of Medicine, 2017) Joshi, BR
Abstract Introduction:The ratio of HC and AC is the best conventional sonographic criterion for detection of intrauterine growth retardation. This study was conducted to determine the relationship of the ratio with GA in Nepalese population. Methods: This prospective longitudinal study was based on 211 low-risk pregnancies. Results: The ratio showed a continuous descending pattern until term. Conclusion: The HC\AC ratio is around 1 and showed a continuous descending pattern until term. Keywords: Abdominal circumference, head circumference, HC\AC ratio, intrauterine growth retardation
Comparison of hemodynamics and LMA insertion conditions using combination of Ketamine-Propofol, Fentanyl-Propofol or Saline-Propofol
(Institute of Medicine, 2017) Koirala, M; Acharya, SP; Pradhan, B; Marhatta, MN; Bhattarai, AS; Parajuli, BD
Abstract Introduction: Laryngeal Mask Airway(LMA) insertion requires a certain depth of anaesthesia to blunt the airway reflexes. Propofol alone causes undesirable hemodynamics effects and suboptimal LMA insertion condition. So this study was designed to compare the hemodynamics and insertion conditions when Ketamine or Fentanyl was combined with Propofol for induction. Methods: In this study, sixty ASA PSI(American Society of Anesthesiologists Physical Status) patients undergoing various surgical procedures under LMA were assigned to three groups; Group K, Group F and Group S who received 0.5 mg/kg of Ketamine, 1 μg/kg Fentanyl and Normal saline respectively before receiving Propofol 2.5 mg/kg after which LMA insertion was done. Arterial blood pressure and heart rate were measured at various intervals. LMA insertion conditions were graded under different parameters to calculate LMA insertion summation score. Result: Significant difference in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MAP) was seen between Gr K and Gr S after successful LMA insertion and after 2 mins of insertion. Significant difference in SBP was seen in between Group K and Group F (p=0.01) after successful LMA insertion. The median summed score describing the LMA insertion condition was significantly better in Ketamine [7.0 (6.0-7.5)] and Fentanyl [7.0 (6.0-7.0)] in comparison to Saline [ 8.5 (8.0-11.0)] Conclusion: During LMA insertion, adding Ketamine to Propofol provides stable hemodynamics in comparison to using Propofol. Addition of either Ketamine or Fentanyl to Propofol provides equally good conditions during LMA insertion than using Propofol alone. Key words: Fentanyl, Ketamine, LMA, Propofol
Depression in survivors of female trafficking in shelter homes of Kathmandu Valley
(Institute of Medicine, 2017) Pradhan, G; Ojha, SP; Sharma, VD; Chapagain, M; Tulachan, P; Dhungana, S; Pant, SB
Abstract Introduction: Human trafficking is the recruitment and movement of individuals most often by force, coercion, or deception for the purpose of exploitation. There is very limited evidence on the health consequences of human trafficking. This study were to find out the prevalence of depression among survivors of female trafficking in the shelter homes of Kathmandu valley and also to find out severity of depression (mild, moderate and severe) among the survivors of female trafficking. Methods: A cross- sectional design was implemented. A total of 67 participants was collected from 4 different NGOs working in the field by using probability proportion to size method and from each NGOs the participants were taken using purposive sampling. The consent was taken and strict inclusion and exclusion criteria were applied during participant's selection. The semi- structured proforma was filled with adequate information. Clinical diagnosis of depression was made according to ICD-10 classification of Mental and Behavioral Disorders-Diagnostic Criteria for Research (WHO-1992) in patients and Hamilton Rating Scale for Depression (HAM-D) was used to assess the severity of depression (mild, moderate and severe). Finally, information obtained from demographic profile, clinical features, and rating scale was analyzed by using suitable statistical tools. Results: The study showed out of all 67 female human trafficking victims interviewed from 4 major shelter homes in Kathmandu valley a majority were found to be from the 16 to 20 years age group during the time of interview. Most victims were found to be trafficked at a young age, 11-15 years. A majority of them were lured with job proposals mostly by their own family members. Victims were mostly lead to India for trafficking as sex workers. Based on ICD 10 DCR 61.2% of the victims were found to be suffering from depression among which according to HDRS 16.4% had severe and 4.5% had very severe depression. Conclusion: Despite a dramatic increase in the profile of human trafficking over the past decade, the evidence on trafficked people's experiences of violence and of depression and other mental health problems is extremely limited. Depression is quite common and more information is needed on trafficked people's health needs and experiences, including evidence on interventions to mitigate the physical and psychological damage associated with this global crime.

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