Journal Issue: Volume: 15, No 4, Issue 60, OCT.-DEC, 2017
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Volume
Number
Issue Date
2017
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Injuries in Nepal - A Neglected Public Health Burden and Ways Forward
(Kathmandu University, 2017) Joshi, SK; Pant, PR; Banstola, A; Bhatta, S; Mytton, J
NA
Placebo Controlled Introduction of Prophylactic Supplementation of Probiotics to Decrease the Incidence of Necrotizing Enterocolitis at Dhulikhel Hospital in Nepal
(Kathmandu University, 2017) Dongol, Singh S; Klobassa, DS; Resch, B; Urlesberger, B; Shrestha, RPB
ABSTRACT
Background
Although recent reports suggest that the use of probiotics may enhance intestinal
functions in premature infants, the mechanisms are unclear, and open questions
remain regarding the safety and its efficacy.
Objective
The objective of this study is to evaluate the efficacy of probiotics on prevention of
necrotizing enterocolitis in preterm infants in Nepal.
Method
We conducted a randomized, double blind, placebo controlled study of 72
hospitalized preterm infants. They were randomly allocated to receive probiotics
(lactobacillus rhamnosus 35) at a dose of 0.8 mg in infants >1500 gms and 0.4 mg
in infants <1500 gms in 2 ml of expressed breast milk two times daily or the same
amount of expressed breast milk as placebo (without probiotics).
Result
Seventy-two patients were studied. The probiotics group (n=37) and placebo
group (n=35) showed similar clinical characteristics. The incidence of necrotizing
enterocolitis was found less frequently in the probiotic group (6/37, 16.2%) compared
to the control group (10/35, 28.6%), this difference was not significant (p=0.16). This is
12.35% reduction in the incidence of necrotizing enterocolitis. Among the risk factors
for necrotizing enterocolitis, pregnancy risk factors and perinatal risk factors were
not significant. However neonatal risk factors were more frequent in the probiotic
group (59.3%, n=32) than in the placebo group (40.7%, n=22), the difference was
significant (p=0.02).
Conclusion
In the western world probiotics have been shown to be preventive in regard to
necrotizing enterocolitis incidence. The present randomized trial showed a trend
towards necrotizing enterocolitis minimal reduction in Nepal too. Further studies in
a larger cohort are warranted to prove this effect for preterm infants.
KEY WORDS
Necrotizing enterocolitis, Placebo, Probiotics
Effect of Sildenafil Citrate on Pulmonary Arterial Systolic Pressure and Sub-maximal Exercise Capacity in Chronic Obstructive Pulmonary Disease
(Kathmandu University, 2017) Shrestha, SK; Srivastava, B; Karki, M; Khatri, DB; Pradhan, RM
ABSTRACT
Background
Pulmonary hypertension (PH) often complicates Chronic Obstructive Pulmonary
Disease (COPD). Sildenafil reduces pulmonary arterial pressure associated with
multitude of diseases.
Objective
To evaluate the use of Sildenafil in Pulmonary Hypertension associated with COPD.
Method
This randomized control study enrolled 72 patients: 61 completed the study. Thirty-
patients with COPD received Sildenafil 25 mg thrice daily and 31 patients with
COPD received optimal medical therapy for four weeks. Symptom assessment and
dyspnoea grading was done with modified Borg scale and Modified Medical Research
Council (MMRC) grade. The functional assessment was done with WHO functional
classification. The estimation of pulmonary arterial systolic pressure and six minute
walking distance was done before and after four weeks of the administration of
therapy in both groups. Adverse reaction profiling was done for Sildenafil. The
primary outcomes were the changes in pulmonary arterial systolic pressure and six
minute walk test. The secondary outcomes were change in modified Borg scale for
dyspnoea, MMRC grading and WHO functional class.
Result
The mean decrease in pulmonary arterial systolic pressure in Sildenafil group was
significant as compared to controls (9.87+7.84 mmHg Vs 5.93+7.44 mmHg, P=0.048).
The mean increase in six minute walk distance was significantly more in cases as
compared to controls (48.13+25.79 m Vs 32.59+32.96 m,P=0.047). The changes in
modified Borg scale was not significant (1.20+1.92 to 1.55+1.23; P=0.401). There was
significant changes in MMRC grade (p=0.037). There was no significant change in
WHO functional class after four weeks (p=0.071).
Conclusion
Sildenafil marginally decreased pulmonary arterial systolic pressure and increased six
minute walk distance in COPD patients. It improved MMRC grading without affecting
modified Borg’s Scale and WHO functional class.
KEY WORDS
Chronic obstructive pulmonary disease, Pulmonary hypertension, Sildenafil, Six
minute walk distance
Efficacy of Salbutamol in Mixed Obstructive and Restrictive Pattern Spirometry
(Kathmandu University, 2017) Tuladhar, LR; Tamrakar, (Tuladhar) ET
ABSTRACT
Background
Salbutamol is a short acting β2 agonist bronchodilator most commonly used for
management of asthma and chronic obstructive pulmonary disease. Besides the
disease state, it is also used for bronchodilator reversibility in spirometry. The
spirometry reading show one of the four patterns i.e. normal, obstructive, restrictive
and combined or mixed (obstructive-restrictive).
Objective
To determine the efficacy of salbutamol in mixed obstructive and restrictive pattern
spirometry.
Method
A descriptive cross sectional study was conducted at Nepal Medical College and
Teaching Hospital (NMCTH) for a period of 9 months. A total of 70 patients who
presented with symptoms of respiratory disease in medicine outpatient department
(OPD) in which spirometry was performed were selected. Of the 70 patients, 35 with
mixed pattern spirometry were selected as cases and remaining 35 with normal
spirometry were selected as control. After taking informed consent, spirometry
parameter were measured before and after salbutamol therapy. Data was collected
from medicine department, pulmonary function test (PFT) unit. All the data were
entered in statistical package for social sciences (SPSS version 20) and Forced
expiratory volume in first second (FEV1), Forced vital capacity (FVC), FEV1/FVC and
Peak expiratory flow rate (PEFR) were analyzed.
Result
There was significant difference (p<0.05) in spirometry parameters (i.e. FEV1, FVC,
PEFR) when after salbutamol therapy was compared from before therapy. Statistical
significance was also seen in percentage change in spirometry parameter (i.e. %FEV1
change, %FVC change, % change in ratio of FEV1/FVC and %PEFR change) between
case and control groups.
Conclusion
Salbutamol is an effective bronchodilator in mixed pattern or combined obstructive-
restrictive lung disease.
KEY WORDS
Bronchodilation, mixed obstructive and restrictive lung pattern, salbutamol,
spirometry
Indications and Fetal Outcomes of Caesarean Section in Sindhu Sadabahar Hospital, Sindhupalchok
(Kathmandu University, 2017) Bhandari, BR
ABSTRACT
Background
There has been a sustained increase in the rate of caesarean section in the last few
years around the world. Caesarean section (CS) Audit which plays an important
role in the analysis of rate, indications and outcomes of caesarean section, helps to
modify the trend of caesarean delivery.
Objective
This study was done to know the indications and outcomes of caesarean section in
Sindhu Sadabahar Hospital, Khadichaur, Sindhupalchok.
Method
A hospital based descriptive study was conducted in gynaecological department of
Sindhu Sadabahar hospital, Sindhupalchok over 14 months period from 1st Baisakh
2070 to 30thAshad 2071 (14th April 2013 to 14th July 2014) among 218 women who
underwent caesarean section.
Result
The foetal distress was the leading indication of caesarean section (34%, n=74).
Non-progress of labour and prolonged second stage of labour were seen in 15.6%
(n=34) women respectively. There was 3.2% (n=7) fresh still birth and 1.8% (n=4)
early neonatal death. Total perinatal death was 5% (n=11). There were 12.1% (n=27)
low birth weight baby and 9.9% (n=22) macrosomic baby. ≤ 5/10 Appearance, Pulse,
Grimace, Activity and Respiration (APGAR) score at five minutes was seen in 35.5%
(n=79) neonates.
Conclusion
This study showed that majority of patients had an emergency cesarean section
for foetal distress, nonprogress of labour and prolonged second stage of labour.
Prevalence of caesarean section was higher than the caesarean rate (15%)
recommended by World Health Organization (WHO). Cesarean sections performed
for appropriate medical or obstetric indications are life saving for both the mother as
well as the new born.
KEY WORDS
Cesarean section, Fetal outcomes, Indication of cesarean section