Journal Issue: No 1, Issue 29, JAN-MARCH, 2010
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Volume
Number
Issue Date
2010
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Outcome of cluster endophthalmitis in western plain region of Nepal
(Kathmandu University, 2010) Bajimaya, S; Kansakar, I; Sharma, BR; Byanju, R
Abstract
Background: Post-operative endophthalmitis remains one of the most visually devastating complications of cataract
surgery. Cluster endophthalmitis is defined as five or more cases of endophthalmitis occurring on a particular day in a
single operating room in one centre. Excessive inflammation, particularly in the early post-operative phase, should be
regarded as infective endophthalmitis. Early diagnosis and immediate intervention in such case, lead to salvage of eye
as well as better visual outcome.
Objective: To find out the causative organisms and visual outcome after an outbreak of post-operative endophthalmitis
in high volume cataract surgical centre.
Materials and methods: Retrospective, interventional case series of 19 patients with acute post-operative endophthalmitis
after manual small incision cataract surgery in a single day, underwent vitreous tap and received intravitreal Vancomycin,
amikacin and Dexamethasone. Subconjunctival vancomycin was given at the end of the procedure. Vitreous samples were
stained using Grams stain, Giemsa stain and KOH mount. Samples were sent to the hospital’s microbiology laboratory
for culture and sensitivity testing. All patients received intravenous ciprofloxacin for 3 days and oral ciprofloxacin for
7 days. Topical Prednisolone acetate, Ofloxacin, Gentamycin and atropine were given to all patients. Patients were
followed up till 6 weeks.
Results: 10 eyes had vitreous tap culture negative (52.6%) where as 9 eyes (47.4%) had bacterial culture growth. The
culture reports showed 4 cases (21%) of Staphylococcus epidermidis, 3 cases (15.8%) of Staphylococcus aureus and 2
cases (10.5%) of mixed growth. 48 hours after the intervention, 15 patients improved clinically. On sixth week follow
up, 7 eyes (37%) had visual acuity better than 6/18, 7 eyes had 6/18 to 6/60 and 5 eyes had visual acuity between 1/60
to 5/60.
Conclusion: Intravitreal antibiotics and steroid, along with systemic ciprofloxacin and subconjunctival vancomycin has
good visual outcome for post operative cluster endophthalmitis.
Key words: Manual small incision cataract surgery, Cluster Endophthalmitis, Nepal
Functional outcome of operatively treated displaced intra-articular calcaneal fractures using two parallel contoured reconstruction plates
(Kathmandu University, 2010) Lakhey, S; Manandhar, RR; Pradhan, RL; Pandey, BK; Sharma, S; Rijal, KP
Abstract
Introduction: The treatment of displaced intra-articular calcaneal fracture is controversial. Conventionally, they were
treated non-operatively. However, some surgeons are now operatively treating these fractures because of continuing
dissatisfaction with the outcome of conservative treatment of these fractures and improvements that have occurred in
surgical techniques and complication rates.
Objective: The aim of this study was to determine the functional outcome of operatively treated displaced intra-articular
calcaneal fractures using two parallel contoured reconstruction plates.
Materials and methods: 12 patients with 14 displaced intra-articular calcaneal fractures involving the subtalar joint
were included in the study conducted between July 2005 and December 2008. The fracture site was exposed using
extended lateral approach. Internal fixation was done by two nearly parallel 3.5mm reconstruction plates and screws
contoured to form a gentle curve in all cases with the first plate fixed just below the articular surface. At the end of
follow up, the patients' foot function was assessed by Calcaneal Fracture Scoring System of Kerr et al. Patients were also
enquired about their satisfaction with their treatment outcome.
Results: The patients were followed up for duration of 12 to 24 months (mean 15.64 months). The outcome score as
measured by Calcaneal Fracture Scoring System ranged from 48 to 94 (mean 83.64). 11 of 12 patients (91.6 %) were
satisfied with the treatment.
Conclusion: Displaced intra-articular fractures treated by open reduction and internal fixation, using two nearly parallel,
contoured reconstruction plates through an extensile lateral approach and following the principles of treatment of intra-
articular fractures, have good functional results with high patient satisfaction rate.
Key words: displaced intra-articular calcaneal fractures, operative treatment.
Preparing tutors for problem-based learning: An experience from B. P. Koirala Institute of Health Sciences, Nepal
(Kathmandu University, 2010) Baral, N; Paudel, BH; Das, BKL; Aryal, M; Gautam, A; Lamsal. M
Abstract
Background: Problem based learning (PBL) has made major impact on curricular designing and practice in medical
education for the last forty years. Incorporation of PBL approach in medical education has been a challenge and
opportunity for both educationists on how to impart change and medical teachers on how to internalise the change.
Objectives: This paper aimed to investigate experiences, achievement and responses of medical teachers at B. P. Koirala
Institute of Health Sciences (BPKIHS), Nepal.
Materials and methods: There were 25 heterogeneous groups of teachers, majority of them were entry level. Pre- and
Post- test question were taken from various topics relevant to PBL such as learning strategy and principles of adult
learning, PBL practice at BPKIHS, tutorial session and role of a tutor, making resource session interactive, designing
PBL problems, planning educational objectives in PBL, formulation of problem for PBL. In addition to it participants’
perception on development and dissemination of PBL manual and effectiveness of workshop were also included in the
questionnaire.
Results: There was significant gain in knowledge following the workshop (p<0.001). The perception of the teacher
found quite relevant and useful for adopting new role as tutor. The respondent teachers noted that skills they learned
during the training will be applicable to their job situation. They stressed for an additional training for reinforcement and
update with new trends and tools in PBL.
Conclusion: Therefore, such trainings for faculty development would be highly beneficial to inculcate new competencies
in PBL.
Key words: BPKIHS, Faculty Development, Problem Based Learning