Journal Issue: Volume: 28, No. 1, April, 2006
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Volume
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Issue Date
2006
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Vaccination should be a priority approach for Japanese encephalitis prevention in Nepal
(Institute of Medicine, 2006) Joshi, AB
NA.
Pattern of poisoning cases in Bir Hospital
(Institute of Medicine, 2006) Singh, DP; Acharya, RP
Abstract
Background: Poisoning is one of the major causes of hospitalization through emergency and is a major public health problem in the country. For starting preventive measures, information on nature and extent of poisoning is required. For some years, there has been no study on poisoning at Bir hospital.
Objectives: To find out the patient profile, the common poisons and outcome of poisoning cases.
Materials and Methods: A retrospective analysis of all acute poisoning cases admitted to the emergency department of Bir Hospital from January 2005 to June 2005 was done to study the pattern of acute poisoning. Data on age, sex, time elapsed after intake, circumstances of poisoning, name of the poisonous substance, actual use, chemical type, hospitalization days, severity and outcome were collected and analyzed.
Results: The age of the patients varied from 16 to 65 years. The male female ratio was 1:1.3. More than three-fourth (76.8%) of the female patients were from 16 to 25 years age group. Similarly, 46.5% of the male patients were from 16 to 25 years age group. In more than 25 years of age, there was male
predominance in all the age group. The common insecticides used for poisoning were organophosphorus compounds mainly Methyl Parathion (Metacid) and Dichlorovos (Nuvan). Paracetamol alone or combination preparations with antihistamines were the most common analgesic used. Benzodiazepines were the most commonly used anxiolytics. Ninety-seven percent of cases
were intentional poisoning for suicidal attempt. Most of the cases (61.6%) had arrived hospital within 3 hours after exposure to the poison. The hospital stay of the admitted patients with poisoning
ranged from one to sixteen days. The mean hospital stay was 5.9 days. During the hospital stay, six (6.0%) cases were managed in Intensive Care Unit (ICU) service. In this study, only 3% cases had mortality. There were 5 cases of Aluminium Phosphide poisoning but surprisingly, none of them died from this highly toxic poison.
Conclusion: Suicide among adolescents and young adults is a common public health problem. Patients with intentional poisoning must undergo psychiatric consultation during their stay in the hospital for the treatment poisoning. This will minimize the risk of next attempt of self harm. In addition, strict rules must be followed regarding sale of psychotropic medicines and pesticides. Effective clinical management of poisoning can minimize the mortality.
Leading causes of mortality from diseases and injury in Nepal: a report from national census sample survey
(Institute of Medicine, 2006) Sharma, GK
Abstract
Background: The burden of injuries in relation to other diseases has been inadequately addressed in most of the official publications and scientific literature relating to Nepal.
Objectives: In the current constraint of poor availability of such information, National Census Sample Survey information was utilized to understand the mortality pattern of major forms of injuries in relation to all diseases.
Methods: A nationally representative sample was drawn from six districts and 52 municipalities as a part of national census sample survey. The instrument included respondent-reported deaths in the family, the cause of death, the age and sex.
Results: The national representative information on the pattern of diseases shows that there were
7,010 deaths as a result of the external causes of injuries (4,803 males and 2,207 females) in a period of one year prior to the survey in 2001. Suicides, transport related accidents and other accidents accounted for the largest proportion of injuries. Other accidents ranked sixth, suicide 9th and transport accidents 10th leading cause of death for both sexes and all diseases.
Conclusion: Injuries accounted for as many number of death as tuberculosis and many times more than malaria or HIV/AIDS in Nepal. External causes of injuries are therefore a major burden of mortality and morbidity in an impoverished country like Nepal and needs an urgent public health attention.
Sepsis: a private hospital experience in Nepal
(Institute of Medicine, 2006) Lakhey, S; Karki, B; Sakya, S; Pandey, SB
Abstract
Introduction: Sepsis, severe sepsis and septic shock are associated with high mortality. Data about patient profile and outcome of sepsis in ICU of Nepal is lacking. This study was conducted to investigate the source of infection leading to sepsis, its complications and eventual outcome.
Material and Methods: It is a prospective study carried out from August 2004 to July 2005 in the ICU of B & B Hospital. The patients admitted in the ICU with the diagnosis of sepsis in accordance to the criteria laid down by American College of chest physician and Society of Critical Care Medicine were analysed and followed up. Age, sex, source of infection, duration of stay in the ICU, Co-morbidities (Mc Cabe’s score), associated severe sepsis, septic shock, acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS), disseminated intravascular coagulation (DIC) and the eventual outcome of sepsis were taken into account. The cause of death was also studied. Infection was diagnosed on the basis of clinical, radiological and microbiological parameters.
Results: Of the 28 patients included in the study, 53.6% were male and 46.4% were female, the youngest was 15 years old and the oldest was 93 years old. More than half of the patients were more than 60 years old (53.6%)the average stay in the ICU was 6 days and the main source of infection was lung/respiratory tract (57.14%). 10.7% had sepsis, 89.3% had severe sepsis, 82% had septic shock, 42.9% had MODS, 32.1% hadARDS and 7.1% had DIC. The overall mortality was 39.3%. In elderly the mortality rate was higher (46.7%). The mortality rate was highest in patients with MODS. The mortality rate of sepsis, severe sepsis and septic shock increased progressively from 0%, 39.3% and 47.8% respectively. The mortality rate in patients with ARDS was 55.6%. The most commonly failing organ was circulatory system (82.1%). The mortality was 100% in patients with 3 or more organ failure.
Conclusion: Sepsis with its complications has high mortality in our hospital that is similar to the recent findings in Brazil, Norway and USA. Awareness of sepsis and its appropriate treatment as per Surviving Sepsis Campaign Guidelines has become mandatory to reduce its mortality.
Increase use of contact lenses for optical correction
(Institute of Medicine, 2006) Poudel, P; Khadka, J; Sakya, S; Shrestha, JK; Shah, DN
Abstract
Introduction: Contact lenses (CL) are considered as a widely accepted modality of refractive correction in the last few decades, though their history is nearly about 100 years old. Millions of people are wearing contact lenses all over the world. Every year the number of CL wearers has increased significantly. No definite statistics are available regarding the number of people wearing contact lenses in Nepal. Contact lenses are not used only for refractive correction but also for therapeutic and cosmetic use.
Methods: The main purpose of the study was to find the popularity of contact lenses irrespective to other optical correction. A hospital based retrospective study was conducted evaluating the medical records of 848 CL patients attended in CL clinic at B. P. Koirala Lions Centre for Ophthalmic Studies.
Results: In this study, the number of CL wearers was found to increase significantly every year. The number of contact lens wearers in the year 2002-2003 was 158 where as in the later years the number reached up to 326 and 364 respectively. Similarly, the numbers of RGP wearers and bandage CL wearers also increased significantly in comparison to previous years. Almost 90 percent wearers were using soft contact lens. It was found to be more popular among the age group of 21yrs to 30 yrs. The number of female wearers was predominant than the male wearers. The contact lens wear ocular complications were found to be very rare.
Conclusion: In Nepal, contact lenses are being considered as suitable alternatives for optical correction due to better cosmesis than the conventional mode of optical correction.