Journal Issue: Volume: 40, No. 2 (2018) August
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Volume
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Issue Date
2018
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Identification of Non-rotavirus associated gastroenteritis pathogens among children with diarrhea in Nepal
(Institute of Medicine, 2018) Sherchand, Jeevan B.
NA.
Audit on elective surgery waiting list in the department of ENT- Head and Neck Surgery in a tertiary care center
(Institute of Medicine, 2018) Tripathi, P; Gurung, U; Shrestha, A
Abstract
Introduction: Patients needing surgical treatment for benign conditions are listed on first come first served basis in the department of ENT- Head and Neck Surgery (ENT-HNS), Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The objective of this audit was to determine the average waiting period for elective surgery in various subspecialty units of the department and the patient turn up rate on the scheduled date.
Methods: This was a retrospective audit based on the elective surgical waiting list register of year 2073 B.S. of four subspecialties in the department; namely unit I-Otology, Unit II- Head & Neck surgery, Unit III - Pediatric ENT and Unit IV- Rhinology
Results: The overall average waiting period for elective surgery was 10.6 weeks. For GA cases it was 10.4 weeks for unit I and II, 13.2 and 8.3 weeks for unit III and IV respectively. For LA cases, waiting period in unit I and IV was 16.9 and 2.5 weeks respectively. The overall turn up rate on the scheduled contact date was 40.8% (46% for GA cases and 31% for LA cases). For unit I, it was 50% for GA cases and 26.6% for LA cases. For unit II and unit III GA cases, turn up rate was 38.4% and 43.8% respectively. In unit IV, it was 53.3% for GA cases and 66% for LA cases.
Conclusion: The patient turn up rate on contact date in general decreased with longer waiting period for elective surgery.
Key Words: Elective surgery, ENT, waiting list
Managing Chiari I Malformations; 5 Year Experience
(Institute of Medicine, 2018) Sedain, G; Pradhanang, A; Sharma, MR; Shilpakar, SK
Abstract
Introduction: Chiari I malformations present with variety of symptoms. There are four types of Chiari malformations described in literature. There are two more types of Chiari introduced later; Chiari 0 and Chiari 1.5. Routine use of MRI has led to frequent identification of the Chiari malformation. Management of Chiari malformation has evolved with time. Asymptomatic patients can be managed conservatively with regular clinical and radiological follow up. Surgical management includes decompression of foramen magnum. This creates a space so that circulation of CSF is unimpeded.We analyzed patients who underwent surgical management at our centre in last 5 years.
Methods: Retrospective analysis of all patients operated in Neurosurgery department of TUTH (Tribhuvan University Teaching Hospital) from 2012 July to 2017 July was done. Data was collected from hospital records and follow up was taken from outpatient department. Demography, associated syringomyelia, improvement in clinical symptoms and radiological improvement were analyzed. Minimum follow up of 1 year was included.
Results: A total of 37 patients were available for analysis. Male to female ratio was 15:22. Major presentation was occipital headache sensory impairment and atrophy of upper limb due to syringomyelia. Clinical and radiological improvement was seen in all patients except 1 patient who developed post operative pneumonia and succumbed. Morbidity in the form of wound infection in 2, Pseudo meningocele was present in 4 patients and CSF leak in 3 patients. Resolution of syrinx was observed in 34 patients except in 3 patients who required a syringopleural shunt in follow up.
Conclusion: Management of Chiari I malformation is relatively safe.In this era of diagnosis of more and more asymptomatic patients, clinical judgement is essential.
Keywords: Chiari I Malformation, Decompression, Syringomyelia, Syringopleural shunt
Predicting outcome of acute organophosphorus poisoning using poison severity score in patients presenting at a university hospital in Nepal
(Institute of Medicine, 2018) Shrestha, TM; Aacharya, RP; Neupane, RP
Abstract
Introduction: Poisoning is a major public health threats in the agriculture based country where people have easy access to the organophosphate (OP) pesticides and herbicides. Aim of the study is to analyze morbidity and mortality (outcome) of OP poisoning using Poison Severity Score (PSS).
Methods: The study was reviewed and approved by International Review Board on 31 August 2016. This cross-sectional study included patients aged 16 years or above who presented with ingestion of OP in emergency of Tribhuvan University Teaching hospital, Kathmandu, Nepal, from September 2016 to April 2018. Socio-demographic and clinical profile of the patients, incidence of OP compounds poisoning, and morbidity and mortality were analyzed using PSS.
Results: There were 210 OP poisoning cases. 194 (92.38%) survived. Female were 143 (68.10%) and male 67 (31.90%). The mean age was 34.81 years (16 years to 85 years). Poison Severity Score (PSS) and length of hospital stay were significantly different between OP survivors (92.38%) and dead cases (7.62%), p-value <0.0001.
Conclusions: Poison severity score was useful in recognizing high-risk patients of OP poisoning in our study.
Keywords: Glasgow Coma Scale, Organophosphorus poisoning, Poison Severity Score
Clinical and epidemiological profile of bacterial pathogens isolated from infected lesions in Kathmandu University Hospital
(Institute of Medicine, 2018) Sherchan, JB; Gurung, P; Bhusal, N; Pote, N; Tamrakar, SR; Malla, BR; Tamrakar, R
Abstract
Introduction: Treatment of thepatient with wound infected with multidrug resistantorganismis a major burden and challenge to the health care persons. This study was conducted to identify the clinical and epidemiological profile of such patients.
Methods: The study was a cross-sectional study conducted between November 2017 to June 2018 in Kathmandu University Hospital. Wound swabs, pus samples collected from patients during the study period were included. Specimen collection, culture, identification tests were done following standard guidelines and patient information was collected after informed consent.
Results: Total number of patients observed for wound infection was 2,763. 1,550(56.10%) were postoperative wound and 1213(43.90%) were non-post-operative wound. Pathogenic bacteria were detected in 252(9.12%) samples. 167(66.27%) were multidrug resistant.
Conclusion: Since, limited data is available in Nepal,determination ofclinical and epidemiological profile ofwound infection might become a useful tool to prepare guidelines for controlling and treating infected wound in healthcare centers and community.
Keywords: Clinical epidemiology profile, bacterial pathogens, drug resistant, hospital