Journal Issue: Volume: 36, No. 3 (2014) December
Loading...
Volume
Number
Issue Date
2014
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
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.
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
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
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
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