Journal Issue: Volume: 34, No. 1 (2012) April
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Volume
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Issue Date
2012
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Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
Responding to the need of the Society: Nepal Ambulance Service
(Institute of Medicine, 2012) Gongal, R; Vaidya, P
NA.
Cost of treating Insulin-requiring diabetes in children and adolescents
(Institute of Medicine, 2012) Onyiriuka, N.; Ezomo, O. O.; Onyiriuka, R. C.
Abstract
Background: Childhood diabetes care imposes a heavy economic burden on the patient’s family and all those involved in the provision of this care need to be aware of what factors drive cost.
Methods: Using an interviewer-administered questionnaire data was obtained from eleven respondents (parents of diabetic children) on their expenditure on items of direct cost such insulin, syringes, cotton wool, methylated spirit, transportation, consultation, and glucometer with the test strips. Data was also obtained on income of the household, ability to cope with payment for medical care and sources of money used for such payment.
Results: The estimated mean monthly direct cost of routine diabetes care was ten thousand nine hundred and fifty Naira [(N10,950+4,698); 95% Confidence Interval, CI = 8,674-13,726] with purchase of insulin accounting for 51.1% of this cost. Money spent on purchase of insulin alone represented 43.7% of the average monthly household income. Eighty percent of the parents expressed varying degrees of difficulty coping with payment of direct cost of diabetes care.
Conclusion: Insulin-requiring diabetes imposes a heavy economic burden on the family of the patient with cost of purchase of insulin contributing the highest proportion among items of direct cost.
Keywords: Diabetes mellitus, insulin, children, adolescents, direct cost, financial cost, Nigeria
Modified Altissimi and Mancini technique for carpal tunnel decompression
(Institute of Medicine, 2012) Sigdel, A; Uprety, S; K.C., Govind
Abstract
Introduction: Carpal tunnel syndrome is the commonest compressive peripheral nerve neuropathy; open carpal tunnel decompression still remains the preferred method as a day case procedure using local anaesthesia. The local anaesthetic is commonly administered by subcutaneous infiltration alone (the Gale technique) or by infiltration of the local anaesthetic into the carpal tunnel in addition to the subcutaneous infiltration (the Altissimi and Mancini technique). The purpose of this study was to evaluate the efficacy of the modified Altissimi and Mancini technique of local anesthesia.
Methods: Fourteen hands of twelve patients age ranged from 26 to 55 years, two patients with bilateral involvements were recruited. Most involved hand was operated first with the modified Altissimi and Mancini technique of local anaesthesia.
Results: Intra-operative pain was evaluated using visual analog score. Patients experienced no to very little intra-operative pain VAS 0- 2. Only one patient experienced tourniquet discomfort which subsided after release. There was neither any intra-operative nor during follow up, the signs of iatrogenic median nerve injury.
Conclusion: We concluded that open carpal tunnel decompression using modified Altissimi and Mancini technique under local anaesthesia and with tourniquet control is a safe, effective and acceptable novel technique.
Prevalence and Antibiotic Sensitivity Pattern of Methicillin Resistant- Staphylococcus aureus in Kathmandu Medical College –Teaching Hospital
(Institute of Medicine, 2012) Pandey, S; Raza, M; Bhatta, CP
Abstract
Introduction: Staphylococcus aureus is found to be a major source of community as well as hospital acquired infection. Staphylococcal isolates from tertiary care hospital are found to be resistant to commonly used antimicrobial agents. Methicillin resistant S. aureus(MRSA)with intrinsically developed antimicrobial resistance has been associated with an increase in morbidity and mortality of the patients in the hospital. This study was undertaken to know the antibiotic sensitivity pattern of staphylococcal isolates with special reference to Methicillin resistant S. aureus.
Methods: Clinical specimens received from July 2009 to July 2010 in Kathmandu Medical college-Teaching Hospital were processed and all S. aureus isolates were included in the study. The isolates were identified by standard laboratory procedure.The antibiotic susceptibility pattern of all staphylococcal strain was determined by modified Kirby Bauer antibiotic sensitivity method.
Results: Of 111 S .aureus isolates 29(26.12%)were identifoed to be MRSA. The rate of multi drug resistance was 75.86% for MRSA and 6.09% for MSSA. All the staphylococcal isolates were resistant to penicillin. However, all strains were sensitive to vancomycin. Conclusions: This study showed a high prevalence of MRSA in tertiary care hospital of Kathmandu valley. Regular surveillance of hospital-associated infection and monitoring of antibiotic sensitivity pattern is mandatory to reduce MRSAprevalence in hospital and its spread to community as well. Present study conclusively shows that vancomycin remains the Þrst choice of treatment for MRSAinfection. To preserve its value, use of vancomycin should be limited to those cases where there are clearly needed.
Keywords: MRSA, MSSA, Antibiotic Sensitivity, Vancomycin, Staphylococcus aureus
Second Intervention in Obstetric Hemorrhage
(Institute of Medicine, 2012) Rawal, S; Rana, A
Abstract
Introduction: Obstetric hemorrhage is still one of the dreaded complications that contribute to a maximum number of maternal morbidity and mortality till date. The management of obstetric hemorrhage involves early recognition, assessment and resuscitation. Though dealt with appropriate use of oxytocic agents, it may seldom require surgical techniques, including uterine tamponade, major vessel ligation, compression sutures, and even hysterectomy.
Method: Prospective study of 20 cases of laparotomy for obstetrical hemorrhage carried out at Tribhuvan University Teaching Hospital, Kathmandu, Nepal, between Jan 2003 to Nov 2011.
Results:Out of 20 cases,massive hemoperitoneum(more than a liter)was noted in 9 and associated risk factors in 10. Source of bleeding in 20 cases were from extensive hematoma (retroperitoneal and broad ligament) in 5, including a rectus sheath hematoma and with colporrhexis, oozing inverted T incision repaired in a single layer (1), placental bed (3) and 1 was from vessels in LUS. There was bleeding from uterine angle (4) and incision (1). Bleeding from tear at various sites were 3, from uterovesicle fold of peritoneum 1 and from the ruptured uterus following vacuum delivery in a case of VBAC (1). Uterine packing was done in 1, B-Lynch in 3 and 1 failed needing the uterine packing; uterine artery ligation in 2 including ovarian vessel ligation in 1, repair of ruptured uterus in 1 and subtotal hysterectomy in 5 cases. There were 3 mortalities due to DIC, pulmonary edema and ARF and rest were discharged in good health.
Conclusion: Choosing of the right technique, complete hemostasis and meticulous closure of all surgical incisions will prevent the need for laparotomy following LSCS. Vigilant monitoring of all the post operative patients will lead to early diagnosis of intraperitoneal / pervaginal bleeding and its management, thus preventing morbidity and mortality owing to late diagnosis.
Keywords: relaparotomy, hemoperitoneum, Intraperitoneal bleeding