Journal Issue: No 2, Issue 22, APRIL-JUNE, 2008
Loading...
Volume
Number
Issue Date
2008
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Towards conflict management in health services system and a healthier Nepal
(Kathmandu University, 2008) S, Lakhey
NA
Occupational health in small scale and household industries in Nepal: A situation analysis
(Kathmandu University, 2008) Joshi, SK; Dahal, P
Abstract
Introduction: Making working conditions safe and healthy is the interest of workers, employers and the Government.
Although it seems simple and obvious, this idea has not yet gained meaningful recognition in Nepal.
Materials and methods: The study was conducted in ten small scale industries of Kathmandu valley. Altogether 545
questionnaires on socioeconomic and occupational history were filled up. Similarly, Workplace Occupational Health
Assessment was done in all ten industries. A thorough medical examination of 135 child workers was done using a
structured questionnaire to find out the health effects due to occupational hazards.
Results: Out of the total 545 workers present in the industries under study, 135 (24.8%) were child workers. Higher
proportion of child workers (97%) was illiterate compared to 3% of children with primary level education. Among the
child workers, 23 (17%) were girls. The majority of the child labourers were suffering from conditions like otitis externa,
otitis media, scabies, anaemia, upper respiratory diseases, nasal problems, abdominal pain etc.
Conclusion: The occupational health and safety practices in small scale industries in Kathmandu have been found to be
unsatisfactory. Child labour is a serious problem. Out of ten industries, six have employed child workers and the working
conditions range from bad to terrible. Health and welfare of the child workers was also not satisfactory.
Key words: Situation Analysis, Occupational Hazards, Occupational Health and Safety, Small Scale and Household
Industries, Child Labour, Kathmandu, Nepal
Elevated serum bilirubin in acute appendicitis: A new diagnostic tool
(Kathmandu University, 2008) S, Khan
Abstract
Background: Acute appendicitis (AA) is one of the most common intra abdominal affections seen in surgical department,
which can be treated easily if accurate diagnosis is made in time, otherwise delay in diagnosis and treatment can lead to
gangrene perforation and diffuse peritonitis.
Aims and objectives: Of the study was to determine the role and predictive value of elevated total serum bilirubin
(TSB) in the diagnosis of AA.
Materials and methods: All the patients admitted with clinical diagnosis of AA were tested by laboratory investigations
and ultrasonograhy of the abdomen. Preoperatively patient’s blood was also collected for serum bilirubin and other liver
enzymes estimation. Cases that underwent emergency appendicectomy from January 2004-May 2007 were included in
present study.
Results: All the patients presented within 5 hours to 7 days of onset of pain. Out of 110 patients studied, 71(64.54%)
were males and 39(35.45%) were females. Age distribution was between 6 years to 73 years with a mean of 29.5years.
Out off 110 cases, 106 cases had AA (positive cases). Among 106 positive cases, TSB was elevated in 87(82.07%) cases.
The mean of elevated TSB was 2.26mg/dL, ranged 1.2-11.5mg/dL. An interesting finding was observed that patient’s
in whom the appendix was gangrenous or perforated; elevation of TSB was found to be higher as compared to simple
suppurative AA. The specificity, sensitivity was 100%, 82.07%, respectively with predictive value of positive test 100%
and predictive value of negative test 17.3%. The liver enzymes were either normal or marginally elevated (<1time) in
most of the cases (Fig.1, 2, 3).
Conclusion: It was found in our study that elevated TSB (without severe abnormalities in the value of liver enzymes)
is good indicator of AA. The specificity and sensitivity of elevated TSB was 100% and 82.07% respectively with a
predictive value for positive test 100%. If TSB is added to already existing laboratory tests, then the diagnosis of AA in
clinically suspected cases can be made with fair degree of accuracy and unnecessary or delay in appendicectomy can be
avoided (Table 4).
Key words: Elevated Serum Bilirubin, Acute Appendicitis
Midazolam for caudal analgesia in children: Comparison with caudal bupivacaine
(Kathmandu University, 2008) Pradhan, B; Bajracharya, GR
Abstract
Background: Caudal analgesia is the most popular and commonly used regional anaesthesia technique for post operative
analgesia in children undergoing lower limb, anoperineal and abdominal surgical procedures. It is commonly applied
in all the paediatric patients undergoing the above mentioned surgery, as the goal of balanced anaesthesia is not only
limited to intraoperative period but also good analgesia in post operative period. Many drugs like morphine, Pethidine,
Neostigmine etc have been used as analgesic agent via the caudal route but not without their side effects. So Midazolam
was used as an alternative drug as it may not be associated with the side effects encountered with the other drugs.
Aims and objectives: The objective of the study was to see the analgesic efficacy of caudal administration of Midazolam
with comparison to Bupivacaine for post operative analgesia, and to observe for side effects if any.
Materials and methods: This was a single blinded prospective observational study in children of age 1 to 6 years of
ASA grade I undergoing elective hernia or hydrocoele surgery. The patients were allocated randomly into two groups
(n=25) to receive caudal injection of either 0.25% Bupivacaine 1ml/kg (group A) or Midazolam 50μg/kg with normal
saline 1ml/kg (group B). In the post operative period heart rate, blood pressure, pain score, recovery to first analgesic
time, total number of analgesics required in 24 hours and side effects if any were noted and analysed.
Results: There were no significant differences in quality of pain relief, postoperative behaviour or analgesic requirements
between the Midazolam group and the Bupivacaine group. Recovery to first analgesic time though was longer in the
Bupivacaine group (9.65 hr) than Midazolam group (7.32 hr); it was statistically not significant (P= 0.9). Any of the
side effects such as motor weakness, urinary retention, and respiratory depression were not observed in both the groups.
However in both the groups, few of the patients had post operative vomiting.
Conclusion: We conclude that caudal Midazolam in a dose of 50μg/kg provides equivalent analgesia to Bupivacaine
0.25%, when administered in a volume of 1ml/kg for children undergoing unilateral inguinal herniotomy for hernia or
high ligation of processus vaginalis for hydrocoele.
Key words: analgesia, caudal, Midazolam, Bupivacaine, paediatric
Short duration anterior nasal packing after submucosal resection of nasal septum
(Kathmandu University, 2008) Gyawali, KR; Amatya, RCM; Pokharel, M
Abstract
Objectives: To find out the shortest possible duration of nasal packing after submucosal resection (SMR) operation. To
compare the outcome of the patients who underwent SMR operation and anterior nasal pack (ANP) removed after 24
hours with those who had ANP removed after 2 hours of operation.
Materials and methods: A prospective randomized hospital based study was undertaken to compare the outcome
of early removal of nasal packs after 2 hours of operation and after 48 hours. Seventy four patients undergoing SMR
operation with ANP were divided in two groups. Group I: patients who underwent SMR and ANP removed after 24
hours to 48 hours (n= 37 patients). Group II: patients who underwent SMR and ANP removed after 2 hours (n= 37 patients).
Results: There was no significant difference between the two groups in terms of age distribution (p = 0.244), sex (p =
0.76), synaechia formation (p = 0.615) and bruise in the upper lip (p = 1.000). There were no complications following
early (2 hours) removal of ANP except synaechia, no significant post-operative bleeding occurred and no post operative
septal hematoma were noted. In addition, patients reported less post-operative discomfort when the packs were removed
early in Group II. This practice reduced the length of hospital stay and therefore reduced costs.
Conclusion: Our study shows that there is no significant difference in the post operative events and recovery between
removal of ANP after 48 hours and after 2 hours of operation. This supports that ANP removal can safely be done after
two hours of operation.
Key words: Sub mucosal resection of the nasal septum (SMR), anterior nasal packing (ANP)