Journal Issue: Volume: 28, No. 2, August, 2006
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2006
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
Aetiology and management of epistaxis at TU Teaching Hospital
(Institute of Medicine, 2006) Adhikari, P; Pradhananga, RB; Thapa, NM; Sinha, BK
Abstract
Background: Epistaxis is a common condition, as well as a frequent otolaryngologic emergency. Up to 60% of people experiencing one episode in their lifetime and 6% seeking medical attention.
Methods: A retrospective study of records of 93 patients admitted in the department of ENT-Head and Neck Surgery of TU Teaching Hospital for the management of epistaxis in between March 2005 and February 2006.
Results: The incidence of epistaxis was found to be in 6.0% of all the ENT patients admitted in the department in this time period. The most common cause / risk factors were hypertension followed by deviated nasal septum. In 24.7% of cases no cause could be found and was labeled as idiopathic. Regarding treatment, 9.7% treated with Chemical cautery, 34.4% anterior nasal packing, 25.8% posterior nasal packing and 2.2% required arterial ligation to control their epistaxis.
Conclusion: Our study shows that epistaxis is also a common emergency. Etiology could be found nearly 75% of cases only which could be preventable. Anterior Nasal Packing was the most common treatment. We should manage a case of epistaxis in an orderly manner.
Cross – sectional study of respiratory pathogens and their antibiotic susceptibility pattern in Tribhuvan University Teaching Hospital
(Institute of Medicine, 2006) Shrestha, U; Singh, A; Pokharel, BM
Abstract
Background: Lower respiratory tract infection (LRTI) comprises an array of diseases ranging from bronchitis to pneumonia; its asperity can sway from non-pneumonic LRTI to pneumonia or chronic obstructive pulmonary disease (COPD). The HMG/WHO review in 1994 estimated the overall acute respiratory infections in Nepal to be 2.1%.
Methods: In brief, all total 132 sputum samples of patients suspected of LRTI those visiting Tribhuvan University Teaching Hospital during March to May 2005 were investigated with the use of standard microbiological methods and the bacterial isolates were subjected for antibiotic sensitivity test.
Results: Of the total, 31.0% sputum samples showed significant positive. Among them 75.6% were gram-negative bacteria (GNB) and 24.40% gram-positive bacteria (GPB). Eight different types of bacteria were isolated. Haemophilus influenzae (19.51%), Klebsiella pnemoniae (19.51%), Pseudomonas aeruginosa(19.51%), were the most common isolates followed by Streptococcus pneumoniae (12.19%), Staphylococcus aureus (12.19%), Escherichia coli (9.75 %), Citrobacter fruendii (4.87%), Acinetobacter calcoaceticus (2.43%). Antibiotic susceptibility test showed that, more than 50% of GPB were resistant to Erythromycin, Cephalexin and Ciprofloxacin whereas majority of GNB were resistant to Ciprofloxacin, Gentamycin,Ampicillin.
Conclusion: This study needs to be conducted round the year to acquire more information regarding seasonal variation.
Keywords: LRTI, Antibiotic susceptibility pattern, Sputum, GPB, GNB
The prevalence of lower respiratory tract infection in adults visiting Tribhuvan University Teaching Hospital
(Institute of Medicine, 2006) Gauchan, Sudip P; Lekhak, B; Sherchand, JB
Abstract
Background: Respiratory conditions impose enormous burden on society. Reports indicated that the top five respiratory diseases accounted for 17.4% of all deaths and 13.3% of all Disability Adjusted Life Years (DALYs). Also, out of total acute respiratory disease, 20-24% of deaths are accounted for by Lower Respiratory Tract Infection (LRTI). In developing countries like Nepal the need for timely diagnosis of the cases and the administration of appropriate therapy based on the antibiotic susceptibility test of the causative agents is critical. However, emergence of resistant strains may occur during antibiotic therapy, which is one of the contributing factors for the increase in the frequency of LRTI in recent years in the adult population of Nepal as well.
Methods: A hospital based cross-sectional study was carried out from March 2002 to February 2003. Total 181 adults presenting with LRTI defined by a new or increasing cough, productive sputum, chest pain, fever, anorexia, haemoptysis, headaches and throat ache were enrolled with their consent. This is a prospective study which included bacteriological culture, microscopic examination and sensitivity testing of bacterial isolates invitro in Health Research laboratory following Standard Operating Procedures (SOPs).
Results: Lower Respiratory Infection was found prevalent in 75 cases (41.4%). Males (61.3%) were found more at risk to LRTI than females (38.7%). LRTI was found most prevalent in 50-59 year age groups (21.3%). Altogether 15 different types of bacteria were identified majority of which were Gram-negative bacteria (72.4%). Haemophilus influenzae was the commonest isolate at 23.0% followed by Klebsiella pneumoniae (18.3%). Among Gram- positive isolates Streptococcs pneumoniae was predominant (12.7%) followed by Staphylococcus aureus(9.3%).The in vitro antibiotic susceptibility test of the isolates showed that Chloramphenicol(100%) was the most effective antibiotic against Gram-negative bacteria followed by Amikacin (79.1%) and Ciprofloxaxin (66.7%), and the least effective was Co-trimoxazole (20.6%). Similarly, for the Gram-positive bacteria Ciprofloxacin (79.2%) was the most effective antibiotic and the least effective was Co-trimoxazole.
Conclusion: The study shows increasing number of respiratory pathogens resistant to antimicrobials in-use to treat the infection.
Keywords: LRTI, Bacteria, , Antibiotic susceptibility pattern, Respiratory pathogen
Comparison of Ziehl-Neelsen staining microscopy and immunochromatographic tuberculosis test for diagnosis of pulmonary tuberculosis
(Institute of Medicine, 2006) Rai, DR; Kshetry, NT; Bhargava, D; Pokharel, BM
Abstract
Background: Tuberculosis continues to be a great public health problem in Nepal. The evaluation of suitable diagnostic method to diagnose tuberculosis is urged.
Methods: Three consecutive early morning sputum collected from 413 patients were subjected to ZN staining and serum from 224 patients to ICT-TB test.
Results: Overall positive results of Z-N staining and ICT-TB test were 13.1% and 14.3%, respectively. In ICT-TB test, males were found more positive (14.7%) than females (13.9%)(P>0.05) but in microscopy, it was vice-versa (P>0.05). Age group 41-60 was significantly more seropositive compare to younger, however, in combination it wasn’t significant (P>0.05). Alcoholics were significantly high (25.5%)(P<0.05) and smokers were marginally high (17.3%) (P>0.05) AFB positive compared to nonalcoholics (11.5%) and non-smokers (11.6%). Students and service men were remarkably lower AFB positive compare to farmers and workers but interestingly nobody was found positive among business personnel (P>0.05).
Conclusion: Z-N staining microscopy is cheaper and equally sensitive hence it is more useful diagnostic tool than ICT-TB test for pulmonary tuberculosis.
Keywords: Pulmonary Tuberculosis, Ziehl-Neelsen staining, ICT-TB test, Nepal