Publications

Permanent URI for this collection

https://hdl.handle.net/20.500.14572/6

Browse

Now showing 1 - 20 of 5539

A Retrospective Review of Elderly Patients admitted in Psychiatry Department of a Tertiary care center Over 3 Years
(Institute of Medicine, 2014) Dhungana, S; Chapagai, M; Tulachan, P; Ojha, SP
Abstract Introduction: Psychiatric morbidity is high in the elderly population. Despite this, literature regarding inpatient study in elderly is lacking in context to world, including Nepal. This study aimed to study the socio-demographic variables and patterns of psychiatric illnesses in elderly patients admitted in a psychiatry ward of a tertiary hospital. Methods: This was a retrospective study of all elderly patients aged 60 years and above admitted in psychiatry ward over three years period between 2067 Baisakh to 2069 Chiatra (2010 April to 2013 April). Data were collected by reviewing in-patient admission charts from medical records. Descriptive analysis was done by using SPSS version 20; Chicago, IL; and results were expressed as percentages. Results: There were a total of 881 patients admitted in the psychiatry ward during the study period, among which 34 were elderly aged above 60 years. Females slightly predominated in our study. Most of the geriatric sample consisted of Brahmins and all were Hindus. More than 50% of the patients were from central developmental region. The most common diagnosis made was depression followed by schizophrenia Persistent Delusional Disorder (PDD) and organic conditions. Majority of the patients had hospital stay between 2-3 weeks; and all patients were discharged home without mortality. Conclusion: We were able to show the socio-demographic characteristics of elderly patients admitted in a psychiatry ward of a tertiary care center, which will help add insight of psychiatry issues in elderly in Nepalese context. Keywords: elderly, psychiatric illness, inpatient study
Hysterectomy in the Present Day for Dysfunctional Uterine Bleeding: a finding from Tertiary Care Hospital Nepal
(Institute of Medicine, 2014) Baral, J; Gurung, G; Kaudel, S; Paudyal, P; Chudal, D; Shrestha, P; Rana, A
Abstract Introduction: Hysterectomy is a an operative procedure in gynecology, performed for benign or malignant indication, accomplished via abdominal or vaginal routes, technically as open or endoscopic surgery by various approaches; laparoscopic, laparoscopic assisted vagina hysterectomy or robotic surgery. This study was undertaken to analyze the indications of hysterectomies for benign condition with main focus on dysfunctional uterine bleeding (DUB). Method: This study was conducted between 2009 April and 2014 March in the Department of Obstetrics and Gynaecology Tribhuvan University Teaching Hospital. Data were obtained from Operation Theater. Results were precisely reevaluated to find out the indication of hysterectomy done for benign etiology, routes of surgery. Results: Fibroid, utrovaginal prolapsed (UVP), adenomyosis, endometriosis, dysfunctional uterine bleeding (DUB) and adnexal mass were the main indication in total hysterectomy (n1644) performed for benign aetiopathologies, most surgery being performed abdominally (n1126). DUB which were principally treated by hysterectomy and occupied the fifth position as an indication had the postoperative diagnosis other than DUB on histopathological examination in more than 50%. The endometrial pathologies in the operated cases showed endometrial hyperplasia in three cases and adenocarcinoma in one. Conclusion: Presently, abdominal hysterectomy is seen as the only available surgical option for DUB, indicating a need for a change in practices favoring organ preservation. Keywords: endometrial hyperplasia, hysterectomy, dysfunctional uterine bleeding(DUB)
Nosocomial Bacterial Infection and antimicrobial Resistant Pattern in a Tertiary care Hospital in Nepal
(Institute of Medicine, 2014) Sah, MK; Mishra, SK; Ohora, H; Kirikae, T; Sherchan, JB; Rijal, BP; Pokhrel, BM
Abstract Introduction: Nosocomial infection is a global problem with multi facet outcomes. At present, the emergence of resistance to antimicrobial agents is a global public health problem which is well pronounced in developing countries. Methods: The aim of this study was to determine the prevalence of bacteria causing nosocomial infections and their antibiotics resistant pattern among the patients admitted at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. The study was conducted during a period of March 2011 to February 2012. Nine hundred clinical specimens which included urine, sputum, endotracheal aspirates, pus & blood were subjected for bacterial culture and their antibiotics sensitivity test at the Department of Microbiology with the use of standard method as described by American Society for Microbiology (ASM). Results: Prevalence of bacteria causing nosocomial infection was 34.4% (n=310). Out of 310 specimens, urine 122 (39.30%), sputum 78(25.2%), pus 78(25.2%), endotracheal secreation 24 (7.7%) and blood 8(2.6%). Three hundred thirty three bacteria were isolated from three hundred ten specimens. The most common isolates were Escherichia coli followed by Acinetobacter species, Klebsiella pneumonia and Staphylococcus aureus. In-vitro antibiotic susceptibility tests revealed that the Gram-negatives bacilli were only sensitive to fluroquinolones, ceftrixone, cefepime carbapenem, polymyxin B and colistin sulphate while the Gram-positive cocci were sensitive to fluroquinolones, Ceftroxone, cefepime and vancomycin. Conclusion: The findings suggested the need for constant monitoring of susceptibility of specific pathogens in different populations to commonly used anti-microbial agents to cope up this alarming situation in the hospital for the management of such patients and prevent the dissemination of such strains. Keywords: noscomical infections, bacteria and antibiotics
Empirical use of antibiotics in Emergency Department of Tribhuvan University Teaching Hospital and Treatment Success Rate in Discharged Patients
(Institute of Medicine, 2014) Joshi, D; Bhandari, S; Upreti, AR; Banjara, MR; Regmi, BM; Prasad, PN
Abstract Introduction: Infectious diseases are the common presentation in emergency department, which require treatment within minutes. As a result, the empirical antibiotics are started prompt in emergency department before the bacteriological results are available. Therefore, the aim of this study was to explore the use of antibiotics at emergency room and to determine the success rate in discharged patients. Methods: A descriptive, exploratory, non-interventional study was conducted during 8 weeks among the discharged patients from emergency department who received the antibiotic therapy and culture/ sensitivity test was asked. Patients were followed from emergency room and adequate information was taken from emergency records and also at the time of outpatient department visit. Results: Out of 297 patients, only 179 patients were studied. We found that 75.1% of empirically prescribed antibiotics were oral. The most commonly administered intravenous and oral antibiotics were ceftriaxone (20.4%) and cefixime (17.0%). The most common isolate leading to emergency department visit was Escherichia coli (29 patients, 16.2%). In vitro sensitive test for gram positive and gram negative isolates, amoxicillin-clavulanate combination and ciprofloxacin were most effective and cefixime was the least effective antibiotic. The treatment success rate was found to be 147(82.1%) of the patients, as the medication prescribed at emergency room was continued by outpatient department physician. Conclusion: Quinolones and cephalosporins groups of antibiotics are rising as the determinant antibiotics at emergency room. The rate of appropriate use of antibiotics and treatment success rate were found to be higher. Keywords: antibiotics, emergency department, emperical theory
Comparison Between Hydroplasty and Intra-articular Steroid Injection in Treatment of Idiopathic Frozen Shoulder
(Institute of Medicine, 2014) Dhungana, DP; Lamichhane, AP; Mahara, DP
Abstract Introduction: Idiopathic frozen shoulder is one of the common problems in orthopedic outpatient department. It is characterized by gradually progressive pain and stiffness of the shoulder followed by spontaneous recovery over the period of time.Many different modalities are available for the treatment of Idiopathic frozen shoulder, but no one is universally accepted. The purpose of this study was to compare the outcome of hydroplasty with intra-articular steroid injection. Methods: This was a comparative hospital based study conducted between March2011 to September2012, which included 50 patients with Idiopathic Frozen shoulder. There were 25 patients in each group. The mean age of respondent was 57.36 years. Simple Random method of sampling was adopted for selecting patients for each group. Hydroplasty group was given 30ml chilled(cold) sterile normal saline with 2 ml Methylprednisolone (80 mg), 4 ml 2% Lidocain(plain) and 4 ml 0.5% Bupivacain (total volume:40ml) and steroid group was given 2ml Methylprednisolone, 4ml 2% Lidocain(pain), 4ml 0.5% Bupivacain with total volume: 10 ml. Both groups were attached for therapeutic exercises. Comparison of outcomes between two treatment groups was done using Visual Analogue Scale (VAS) for pain, Shoulder Pain and Disability Index for Shoulder function and degree of range of motion. Statistical analysis was done using SPSS 17.0 Results: There was significant improvement in level of pain, Shoulder function (Shoulder Pain and Disability Index) and range of motion in forward flexion, abduction, external rotation, and internal rotation in three month period in Hydroplasty group compared to Steroid group. Conclusion: There was improvement in pain, range of movement and Shoulder Pain and Disability Index (SPADI) score in all patients of both group but the difference in improvement was found to be statistically significant in hydroplasty group as compared to steroid injection group. So Shoulder hydroplasty technique was found to be more effective treatment modality than intra-articular steroid injection in idiopathic frozen shoulder. Keywords: frozen shoulder, hydroplasty, intracular steriod injection, shoulder pain anddisability index
Anesthetic Management of Thoracic and abdominal aortic Surgery in a Tertiary Level Teaching Hospital
(Institute of Medicine, 2014) Pradhan, B
Abstract Introduction: Aortic aneurysm surgeries are one of the most challenging surgeries from anesthetic point of view, not only because the patients have extremes of hemodynamic stresses perioperatively, but also because of the association of various co-morbidities. This demands meticulous attention & extreme caution in perioperative and postoperative management of the patients. This study focuses on various strategies adopted in our center for various organ protection perioperatively and postoperatively. Methods: This is a retrospective analytical study of the outcome of the patients undergoing thoracic and abdominal aortic aneurysm surgeries of two years duration in a tertiary level teaching hospital. Results: Total number of aortic aneurysm surgeries in two years was twenty among which 3 were thoracic and 17 were abdominal aortic aneurysm (Suprarenal – 5, Infrarenal – 12). 4 patients had renal dysfunction. Survival was 17 (85%) among which 12 (70%) were operated electively and 5 (30%) had emergency surgeries. Conclusion: Management of the patients’ in this center following evidence based guidelines perioperatively and postoperatively yielded comparable outcome of the patients to other centers with long term experiences. Keywords: abdominal, aortic aneurysm, acute kidney injury, thoracic, spinal cord ischemic
Blood Lead Levels of Primary School children in Kathmandu Municipality, Nepal
(Institute of Medicine, 2014) Sherchand, O; Mehta, K.D; Poudel, P; Deo, B; Baral, N
Abstract Introduction: Lead is a toxic metal which has contaminated our environment and created health problems around the globe. Children are vulnerable to lead as the intake per unit body weight is higher and even low levels can cause neurological damage. Nepal lacks data on sources of lead exposure and its health impacts; hence screening of blood lead is mandatory. Objectives: To determine blood lead levels, its associated risk factors and impact on health in primary school children in Kathmandu municipality, Nepal. Methods: A total of 218 school children between 6-16 years age from Kathmandu were included in the study undertaken from November 2012 to June 2013. Consents were taken from guardians and students. Questionnaire was used to acquire data followed by blood sampling. Lead was measured using atomic absorption Spectrophotometer, hemoglobin and serum calcium was measured using commercial kits. Intelligent Quotient was assessed using serum form board. Data was analyzed using SPSS version 20. Results: Overall, 63% (137) had detectable blood lead level (BLL) and 54% (117) had BLL ≥ 5 ug/dl. 55% were male and 45% female. The median BLL (IQR) was 8(0-34) and 4(0-18)b in males and females respectively. The mean hemoglobin and serum calcium was 13.7±2.4 and 8.1±1.8 respectively. On risk factors evaluation, the odds of having elevated blood lead level (EBLL) was significantly higher in children living in homes with chipping walls (p value 0.001). Children belonging to families with lower socioeconomic status (p value 0.001) and residing near traffic congested areas (p value 0.007). The median IQ was 73.5(66–91). EBLL showed significant negative correlation with IQ (p value 0.001). EBLL was identified as significant risk factor lowering IQ by 2.35 points per 10 ug/dl rise in blood. Conclusion: Children living in homes with chipping walls, having lower socioeconomic status and residing near traffic congested areas had significantly higher lead level. EBLL showed significant negative correlation with IQ. Keywords: blood lead level, elevated blood level, intelligent quotient, lead
The National Institute of Health Stroke Scale Score and Outcome in acute Ischemic Stroke
(Institute of Medicine, 2014) Gajurel, BP; Dhungana, K; Parajuli, P; Karn, R; Rajbhandari, R; Kafle, D; Oli, KK
Abstract Introduction: Stroke is a focal neurological deficit of sudden onset which lasts for more than 24 hours and has a vascular cause. Various prognostic indices derived from clinical features or patient characteristics and ancillary tests have been used to predict the prognosis of patients with acute ischemic stroke. The aim of this study was to find out the significance of the National Institute of Health Stroke Scale (NIHSS) score on admission in predicting the prognosis of patients with acute ischemic stroke. Method: This is a prospective observational study done in a tertiary care hospital with two hundred patients with acute ischemic stroke Result: Themean NIHSS score in patients with better outcome was 4.6 (± 2.2) and the mean NIHSS score in patients with poor outcome was 14.16(± 7.96). The difference was statistically significant (p=0.000). Conclusion: The baseline neurological status as measured by the National Institute of Health Stroke Scale score predicts the functional status at one month after acute ischemic stroke. Keywords: ischemic stroke, baseline NIHSS score
A comparison of Success of autologous Blood Patching in Sealing of Bronchopleural Fistula of Primary and Secondary Spontaneous Onset
(Institute of Medicine, 2014) Thapa, B; Sapkota, R; Sayami, P
Abstract Introduction: Autologous Blood patching (ABP) has been used to treat Broncho pleural fistula in spontaneous pneumothorax with varying success. We evaluated the safety and efficacy of ABP when used in patients with primary (PSP) versus secondary (SSP) spontaneous pneumothorax. Methods: All patients with spontaneous pneumothorax with no evidence of pleural infection and in whom the air leak did not subside despite 48 hours of conservative management were included. A CT scan was done to categorize if there was underlying lung disease and classify patients into primary and secondary spontaneous categories. These patients underwent blood patching in one to three episodes in 50ml aliquots. Comparisons of the demographic profile, smoking status, success rate and complications in these two groups were done. Results: Between July 2012 and January 2014, 76 patients underwent ABP. The overall success rate of ABP was 58%. There were 29 patients who were classified as PSP and 47 with SSP. There was no difference in the sex distribution but patients with PSP were younger (P= 0.00), were more likely to present earlier (P=0.04) and had higher rates of residual pneumothorax (P= 0.05) after chest tube insertion. The success rates in the two groups were similar (P=0.76).The rate of complications was low and not different in the two types (P=0.58). Conclusion: ABP has modest success in sealing air leak of spontaneous onset. We found the success and complication rates in the two types of spontaneous pneumothoracesto be equivalent. Keywords: air leak, autologus blood patching, pneumothorax
Severe Winter Diarrhea associated with Rotavirus Disease in children
(Institute of Medicine, 2014) Sherchand, Jeevan B
Abstract Rotavirus is the leading cause of severe diarrhea in children under 5 years of age and is responsible more than 600,000 deaths in children annually with millions of hospitalizations. Due to limited access to proper health care, 95 percent of rotavirus related deaths occur among children in the developing countries including Nepal1. In Asia, rotaviruses take the lives of 188,000 children, accounting for more than 40% of global rotavirus deaths2. WHO (2014) publication showed that 35% of Asian children hospitalized with acute diarrheal illness are infected with rotavirus3. Although rotavirus infection occurs throughout the year the prevalence was higher during winter season (60 to 70%) 4. In Nepal, study conducted between 2007 and 2013; rotavirus infection was 30 to 50% and more than 60% strain circulated in winter and the most prevalent strain was G12P[6] followed by G2P[4] and G1P[8] 5,6,7,8,9. Rotavirus infection is highly contagious and spreads easily from person to person through contaminated hands and objects. Rotavirus disease is difficult to treat with antibiotics or other drugs. Mild rotavirus gastroenteritis can be treated effectively in the same manner as other forms of diarrhea, by oral rehydration therapy. However, children with severe rotavirus diarrhea lead to severe dehydration and often need intravenous fluids to prevent mortality. In developing countries including Nepal, this type of emergency health care is often inaccessible or unavailable, making rotavirus prevention through vaccination very important for preventing child mortality. Vaccination is the best way to prevent severe rotavirus disease and the deadly, dehydrating diarrhea that it can cause. Improvements in water quality, hygiene, and sanitation stop bacteria and parasites that cause other forms of diarrhea but do not adequately prevent the spread of rotavirus infection. Lifesaving rotavirus vaccines should be introduced as part of a comprehensive approach in control diarrheal disease, along with other interventions including oral rehydration therapy, exclusive breastfeeding, zinc supplementation and improvements in water and sanitation. The surveillance data of Nepal on rotavirus 4, 7,8,10 provides good baseline information for policy makers in regards to rotavirus vaccine introduction. In addition, rotavirus vaccination if kept under national immunization program will not only save the lives of Nepalese children but also reduces rotavirus disease burden and economic thereby contributing to poverty reduction.
Twin Mesiodens present in maxillary arch, a rare finding: A report of two cases
(Institute of Medicine, 2015) Agrawal, AK; Agrawal, NK; Dahal, S
Abstract The term mesiodens refers to a supernumerary tooth that is present in the midline of the maxilla between the two central incisors. Its occurrence as multiples is termed as ‘mesiodentes’. Double mesiodentes is a rare phenomenon. The prevalence of mesiodens varies between 0.09% and 2.05% in different studies. The etiology of this dental anomaly remains unclear. There probably exists a familial disposition. This is a case report of two patients presented with two mesiodens. Keywords: mesiodens, mesidentes, supernumerary tooth
Laparoscopic Cholecystectomy in a Private Hospital
(Institute of Medicine, 2015) Shrestha, J; Vaidya, P; Khakurel, M
Abstract Introduction: Laparoscopic Cholecystectomy is the gold standard for benign Gall Bladder disease. Laparoscopic Cholecystectomy has rapidly gained popularity and it is one of the commonly performed operations in Nepal. The current study was carried out in the Department of General Surgery, Hospital for Advanced Medicine and Surgery (HAMS), Kathmandu, Nepal to evaluate the result of Laparoscopic Cholecystectomy in our set up. Methods: A retrospective review of medical records was conducted on all study patients. Demographic data, indication for surgery, rate of conversion to open cholecystectomy, morbidity and mortality rates were noted. The data of all patients who underwent laparoscopic cholecystectomy from April, 2012 to April, 2014 was entered in standardized proforma and analysed on SPSS 20. Results: A total of 130 Cholecystectomy over a period of 2 years, Male: Female ratio 1:1.9. Mean Age group 41-50 years. Out of all these patients 76% patients presented with symptoms while 24% were asymptomatic. Overall conversion rate was 9.2%. The average hospital stay was 2 days. There were no complications and no mortality in this period of study. Conclusion: Our finding demonstrates that there was no difference in the outcome whether the patient was given the antibiotics post-operatively or not. Even the diabetics can be treated with prophylactic doses of antibiotics. Three port technique was safe. Complications can be avoided even without selecting cases if two surgeons perform together and early decision of conversion to open cholecystectomy is made. Keywords: cholelithiasis, laparoscopic cholecstectomy, private hospital, three port technique
Popliteal artery injury in and about knee injury: An experience in Manmohan Cardiothoracic vascular and transplant center
(Institute of Medicine, 2015) Baral, RK; Shrestha, K R; Sapkota, R; Shrestha, UK
Abstract Introduction: Knee dislocation is a common knee injury leading to neurovascular insufficiency. Penetrating injury to the popliteal fossa is also associated with neurovascularv injuries. Amputation rate is high amongst popliteal artery injury associated with bone injury. Delayed detection and late interventions are the factors contributing for limb loss in these cases. We present our experience of the popliteal artery injury from a tertiary care center over the period of 3 years. Method: It is a retrospective analysis of prospectively collected data of cases of popliteal arterial injury over the period of three years (July 2011 till June 2014). Data were analyzed on their demographic, clinical, management and outcome parameters with SPSS 17. Result: There were total 35 popliteal artery injuries in 34 patients associated with injuries of knee. Twenty two (65%) patients were male and rests were female. Mean age of these patients was 23±12 years, with age ranging from 15 to 76 years. Twelve patients had amputation and were identified and treated late. Most of the patients reach our center late mean time 9±5 hours and as late as 7 days. Conclusion: High index of suspicion is required to identify the popliteal artery injury in patients with injuries in and about the knee. Early vascular surgical consultation and intervention is required to alleviate its poor outcome. Keywords: knee injury, popliteal artery injury
A Retrospective study of Intussusception of the bowel in adults
(Institute of Medicine, 2015) Bhattarai, A; Poudyal, S; Bhandari, RS; Lakhey, PJ; Singh, KP
Abstract Introduction: Intussusception is the leading cause of intestinal obstruction in children. In contrast to childhood intussusception, adult intussusception accounts for only 5% of all intussusceptions with 90% having a lead point, a well-defined pathological abnormality. Adult intussusceptions pose a further challenge as they are often presented with acute, subacute or chronic non-specific symptoms. Computed tomography is the most sensitive diagnostic modality and can distinguish between intussusception with and without a lead point. Surgery is the definitive treatment of adult intussusceptions. So the aim was to evaluate adults with intussusception in and to assess its etiology, clinical features, diagnosis and management. Methods: A retrospective review of adults aged >16 years with a diagnosis of intussusceptions between 1998- 2013 was done. Results: There were 22 cases of adult intussusceptions. Mean age was 44 years (17-86 years). Abdominal pain, nausea, vomiting and rectal bleeding were the most common symptoms. There were 2 cases of retrograde jejunogastric intussusception, 5 cases of jejunojejunal intussusceptions, 3 cases of ileoileal intussusceptions, 11 cases of ileocolic intussuscetpions and 1 case of colocolic intussusception. In seventeen cases, the lead point for intussusception was identified out of which 13 cases had benign pathology and 4 cases had malignant pathology. In five cases cause was not found. All cases were treated surgically except one case of jejunogastric intussusception which was reduced endoscopically. Mean duration of hospital stay was 13 days (5-30 days). Postoperative period was uneventful except surgical site infection in 8 cases and 1 case developed ECF which was managed conservatively. There was one mortality because of chest infection. Conclusion: Adult intussusception is an unusual and challenging condition having a well- defined pathological abnormality in most of the cases. Treatment usually requires resection of the involved bowel segment. Keywords: Adult Intussusception, Computed tomography, Surgery
Knowledge Status on Mental Health among Health Professionals of Chitwan District, Nepal
(Institute of Medicine, 2015) Gortoulla, P; Pantha, S; Pandey, R
Abstract Introduction: Mental health issues are not openly shared by people due to the negative stigma that it carries. In addition, health professionals lack adequate knowledge on mental health issues. This prevents effective management of patients with mental illness. Methods: A descriptive cross-sectional study was carried out among hundred health professionals working in government health institutions of Chitwan District in order to determine the knowledge, attitude and practices on different aspects of mental illness. Knowledge score was added for each domain and changed to categorical variable. Chi- square and fisher-exact test was done accordingly. P-value of less than 0.05 was considered as significant. Results: Age of respondents ranged from 18 to 59 years. A significant number of respondents had very little knowledge on mental health issues and its causes. Majority of them identified neurosis as types of mental illness followed by personality disorder, psychosis and substance abuse. Only a quarter had better knowledge about the treatment. Age group, being male or female, high or low income, knowledge on mental illness, knowledge on type, causes, signs and symptoms, attitudes and practices of mental illness was significantly different between four levels of health professionals namely Health Assistants (HA), Staff Nurse (SN), Community Medical Assistants (CMA) and Auxillary Nurse Midwife (ANM). Conclusions: The findings suggest that further information regarding mental illness, its sign/ symptoms, causes and treatment modalities should be provided to health workers along with actions to reduce stigma related to mental illness among them. Keywords: Chitwan district, cross sectional study, health professional, mental health
Open Anderson Hynes Pyeloplasty in Ureteropelvic Junction Obstruction: An Institutional Experience
(Institute of Medicine, 2015) Subedi, PP; Chapagain, S; Thakur, DK; Poudyal, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PR; Shrestha, GK
Abstract Introduction: Ureteropelvic junction obstruction (UPJO) is one of the common causes of hydronephros is in children and adults. The cause may be congenital or acquired. The standard management of UPJO has classically been an open Anderson-Hynes (A-H) dismembered pyeloplasty. This study is an audit of A-H pyeloplasty done for patients with UPJO presenting to our institution. Methods: A retrospective analysis was done in the Urology unit, Tribhuvan University Teaching Hospital from July 2013 to November 2014. All patients undergoing A-H pyeloplasty were included for review. Preoperative data regarding the demographics, presentation, diagnostic tools used, details of the surgery, postoperative complications, duration of hospital stay and follow up findings were reviewed. Initial follow up was scheduled at two weeks, then at three months and at one year. At 3 months, DTPA renogram was obtained to assess the function and clearance of the treated kidney. Results: The age of the patients ranged from 5 months to 69 years. Flank pain was the most common presenting complain. Most of the patients were males and left sided obstruction was common. The most common diagnostic modality used was USG and excretory urography. CT urography was done in cases of secondary UPJO. DTPA scan was used in select cases for baseline documentation of the function of the involved kidney. The average duration of surgery was 2 hours and 30 minutes. The mean duration of hospital stay was 5 days. The most common complication was urinary tract infection. Conclusion: Open A-Hpyeloplasty is the most common surgery done for UPJO at our institution. The outcome can be improved by attention to the principles of A-H pyeloplasty. Keywords: hydronephrosis, A-H pyeloplasty, ureteropelvic junction obstruction
Cryptosporidium infection among the school children of Kathmandu Valley
(Institute of Medicine, 2015) Bhandari, D; Tandukar, S; Sherchand, S; Thapa, P; Shah, PK
Abstract Introduction: Cryptosporidium, a coccidian protozoan genus has emerged as an important cause of parasitic diarrhea among children living in developing countries. The present study aimed to determine the infection of Cryptosporidium and other intestinal parasites among the school children of Kathmandu Valley. Methods: Ethical approval for this research was obtained from Institutional review board, Institute of Medicine. A total of five hundred and seven stool samples from children between the age group 3-14 years, studying in 13 different schools of Kathmandu were collected during the study period (May- November, 2014) and processed in the Public Health Research Laboratory, Institute of Medicine, Kathmandu, Nepal. A modified Acid Fast staining technique (Kinyoun’s method) was used to detect oocysts of Cryptosporidium from the formal-ether concentrated stool samples. Result: The overall, prevalence of intestinal parasites among children was found to be 22.68% (115/507) with Giardia lamblia being the most predominant parasite showing the incidence of 10.45% (53/507). Cryptosporidium oocysts were detected in 0.79% (4/507) of the students investigated with the highest occurrence during the month of July i.e., 2 followed by single positive case for each, June and September. Conclusion: The detection of Cryptosporidium oocysts and observance of diarrheal symptoms, together with the pattern of age-specific occurrence, livestock presence at home, consumption of untreated drinking water and raw vegetables/fruits consumption habit among infected children suggest that in low-income Kathmandu communities, cryptosporidiosis coupled with poor sanitary practice is a public-health issue causing potentially serious consequences. Keywords: Cryptosporidium, School Children, prevalence, Kathmandu
Comparison of Axillary Temperature with Oral Temperature and Determination of Optimum Placement Time of Thermometer in Adults of Teaching Hospital, Nepal
(Institute of Medicine, 2015) Sharma, M; Gautam, R; Neupane, B
Abstract Introduction: Accurate temperature measurement is important to person, in whom suspicion of infection could result in investigations, administration of antibiotics, and even hospital admission. This study was done with the aim to determine the optimal dwell time of the thermometer in oral and axillary sites required to accurately reflect the stabilized core body temperature. Method: Cross-sectional survey of 113 adult patients was done who were admitted in Manmohan Cardio- Thoracic Vascular and Transplant Center (MCTVC) in the period between 16thJuly to August2013. Ethical approval from the Institutional Review Board (IRB) of TUIOM and permission from the respective hospital authority was taken before data collection. Conventional glass mercury thermometer were checked and brought to 95 degree of Fahrenheit before each measurement of the temperature. Two thermometers were simultaneously placed in oral cavity and in the axillary skin sites. Reading of the oral temperature was done in 1 and 3 minutes, similarly, reading of axillary temperature was done in 3 and 5 minutes. Data was analyzed in SPSS 18 by using parametric and nonparametric tests. Results: Findings revealed the mean temperature difference between 1 minute oral to 3 minute axilla was 0.92 ± 0.79 SD, and the 3 minute oral to 5 minute axilla was 0.96 ± 0.82 SD, the difference was significant (P<0.05). Further, the mean oral temperature in 1 minute was 97.75 ± 1.27 SD, and in 3 minutes was 98.69 ± 1.37 SD. Similarly, mean temperature of axilla in 3 minutes was 97.67± 1.40 SD, whereas mean in 5 minutes was 98.43 ± 1.46 SD. The mean difference was significant. Conclusion: The effective time to measure oral temperature was three minute and it was five minutes for axillary measurement. Keywords: temperature, degree of fahrenheit, oral and axillary measurements
External Ventricular Drainage Infections: Experience from a Tertiary Care Center in Nepal
(Institute of Medicine, 2015) Pradhanang, AB; Sharma, MR; Sedain, G; Shilpakar, SK
Abstract Introduction: External Ventricular Drainage (EVD) is one of the most commonly performed procedures in neurosurgical practice. EVD related infection is among the most dreaded complications encountered after the procedure with added morbidity and mortality. Objectives: The primary objective of this study was to assess the incidence of EVD infections in this hospital. In addition, the researchers have made an attempt to evaluate the indication for EVD placement, influence of total drainage time on the risk of catheter infection, the most common bacterial spectra in cerebrospinal fluid (CSF) culture, their antibiotic sensitivity pattern, and the association of CSF cell count with bacterial growth. Methods: This is a retrospective study of all patients who underwent EVD placement over a period of two years. Those patients who had bacterial growth in their initial samples were excluded from the study. Results: Out of 62 patients, 54 met the inclusion criteria for analysis. The ventricular catheters were in place from 1 to 23 days. Overall shunt infection rate was 37%. CSF cell count was significantly associated with the occurrence of a positive CSF culture (Fisher’s Exact Test, p<0.01). The most common bacterial species isolated were Acinetobacter baumannii and Burkholderia cepacia. Conclusion: Despite many advances in care, there is still a significantly high incidence of EVD related infections. Contrary to earlier reports, the most common bacteria grown in the study were quite different and their antibiotic sensitivity varied accordingly. Keywords: External Ventriculostomy Drainage infection, hydrocephalus, antibiotics in external ventriculostomy drainage
Validation of European Score for Cardiac Operative Risk Evaluation in cardiac surgical patients in Nepal
(Institute of Medicine, 2015) Pradhan, B
Abstract Introduction: European System for Cardiac Operative Risk Evaluation (EuroSCORE) is the standard tool for risk stratification of patients undergoing cardiac surgery. Before using this tool in any population, its validation needs to be assessed. This study was carried out to check validation in cardiac surgical patients in Nepalese patients. Method: This is a prospective observational analytical cohort study in 500 patients undergoing cardiac surgery for coronary artery bypass graft (CABG), valve replacement surgeries (mitral valve, aortic valve or double valve replacements) and valve and aorta replacement surgeries (Bentall procedure). The data were entered in the Microsoft excel software and were analyzed using Chi Square test from Statistical Package for Social Sciences (SPSS Version - 17) package. Calibration power and discriminative power were calculated. Result: The model’s validation was assessed by its calibration and discriminative power. Calibration power was assessed using Hosmer- Lemeshow test (Chi-square test). It gave P value of 0.14 indicating that the model adequately fits the data and can predict mortality. Discriminative power was assessed by calculating area under the receiver operating characteristic (ROC) curve which was 0.71 indicating satisfactory discriminative power. In low and moderate risk groups, observed and predicted (additive and logistic) mortality were satisfactory. In high risk group, observed mortality was higher than predicted mortality. Logistic EuroSCORE value was nearer to observed value. Conclusion: EuroSCORE can be applied in Nepalese cardiac surgical patients in low and moderate risk groups satisfactorily though additive EuroSCORE is better in prediction. In high risk groups, logistic and additive EuroSCORE under predicted outcome than the observed mortality. However logistic EuroSCORE was better in this group of patients. EuroSCORE needs to be refined to apply on high risk Nepalese cardiac surgical patients. Keywords: additive, cardiac surgicalpatients, EuroSCORE, logistic, Nepalese

Browse

Recent Submissions