Journal Issue: Volume: 33, No. 1, April 2011
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Volume
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Issue Date
2011
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Prescribing medication in patients with impaired renal function
(Institute of Medicine, 2011) Bharati, L; Sigdel, M; Sakya, R
Abstract
Introduction: Renal failure has been emerging as a major public health problem in Nepal in recent years. Chronic renal failure affects renal drug elimination and other pharmacokinetic processes. Drug dosing errors are common in patients with renal impairment and can cause adverse effects and poor outcomes. Medications with toxic metabolites should be avoided, and alternative medications should be used if potential nephrotoxicity exist. Dosages of drugs cleared renally were adjusted according to creatinine clearance and glomerular filtration rate.
Methods:A Descriptive, cross-sectional study was conducted in TUTH. Data were collected from all the renal failure patients admitted at TUTH from 2009 February to April 2009. Parameters studied included age group, gender, duration of hospital stay, causes of renal failure, any associated comorbidity, serum creatinine (Scr) at admission and at discharge, blood urea nitrogen (BUN) and different drugs prescribed. Creatinine clearance (Clcr) in ml/min/1.73 m2 was calculated by using Cockroft-Gault equation.
Results: Majority of patient (98.1%) had raised urea level. Renal function at the time of presentation showed that 39.5 % patients had End stage renal failure and 39.5%, 19.7% and 1.3% patients had severe impairment, moderate impairment and mild impairment respectively. Average number of drugs prescribed was 5 to 6. In the list of prescribed medicine, 23% were antibiotic. Of the total antibiotic prescribed, dose adjustment was done for 27.3% and 1.5% drugs were prescribed which are supposed to be avoided in renal failure patients. Similarly in non-antibiotic group, 62.9% drug don’t required dose adjustment (they are safer in renal failure), dose adjustment was done in 22.9 %. The mortality rate of the renal failure at TUTH was found to be 15.3%. Kidney diseases, diabetes and hypertension were found to be the common causes of renal failure accounting for 29.5 %, 24.8% and 22.9% respectively.
Conclusions: Most of the patients with renal failure had end stage renal disease at presentation. Though they were prescribed multiple drugs, only few had dose adjustment done and some were even prescribed nephrotoxic drugs.
Keywords: Acute renal failure, chronic renal failure, creatinine clearance, end stage renal diseases
Awareness of nurses on distance education in Nepal
(Institute of Medicine, 2011) Shahi, M
Abstract
Introduction: Distance Education Technology is one of the most effective modes of imparting
education and training for those who cannot afford formal education. This study aims to assess the
awareness regarding distance education technology among graduate level students as an alternative
approach for continuous advance level nursing education in Nepal.
Methods: The study has adopted descriptive cross-sectional design. The populations of this study
were the graduate level nurses who were studying Bachelor of Nursing courses in three different
institutes of Kathmandu valley. A non-probability convenient sampling technique was used to select
the nursing institutes. A pretested semi-structured questionnaire was developed to collect data from
94 nursing students to assess their interest and desire regarding distance education. A semi-structured
questionnaire was used to enquire regarding, personal biography of respondent; knowledge on
distance education; use of distance education for continuous education; opinion on distance
education as an effective mode of technology for continuous nursing education etc.
Results: Most of the respondents (81%) had heard about Distance Education Technology, but none
of them had attended any academic course through distance education. Half of the respondents had
some knowledge regarding distance education technology; among them (29.7 %) could figure out
that it is a type of interactive study between learners and facilitators from distance/far area; 38.2%
recognized as an independent study, which is often provided by recognized Open University (13.8%);
which can be performed from their own home (29.7%) as a means of corresponding course (17.02 %).
About (46.8%) knew that major area of instruction is via internet. Surprisingly (94.7 %) of them were
interested to study advance nursing courses through distance education in Nepal and among them
(40.4 %) would like to get higher degree via Distance Education Technology in Health Professions
Education.
Conclusions: It can be inferred that majorities of graduate level nursing students are eager to upgrade
their cognitive and psychomotor competencies for professional development by means of Distance
Education Technology. It could be an alternative means of teaching even for those nurses who are
hard to reach, and serving the mankind at the remote areas.
Keywords: Continuous education, distance education, nurse
Appendicular perforation
(Institute of Medicine, 2011) Malla, BR; Shrestha, RKM
Abstract
Introduction: Appendicitis is the most common acute abdominal condition presenting in hospital. Appendicular perforation is a major complication of appendicitis. The objective of the study is review the cases of appendicular perforation in respect of its incidence, sex preference, clinical
features, investigations, treatment and postoperative wound infections
Methods: A retrospective study was conducted reviewing the records of the patients who were admitted in Dhulikhel hospital with the diagnosis of appendicular perforation from January 2009 to December 2010.
Results: A total of 332 cases of appendicular disease were admitted during the study period. Out of them, 42 patients had appendicular perforation. It constituted 12.6% of total appendicular diseases. The male to female ratio in perforation was 6.1: 1. The common age group for the perforation was 30- 50 years with mean age of 35 years. The mean duration of pain before presentation to the hospital was 4.5 days.All the cases of appendicular perforation had spread of pain from right iliac fossa to all over the abdomen, and anorexia. Vomiting was found in 83.33% of the cases. All the cases had rebound tenderness and rigidity all over the abdomen. None had free gas under diaphragm. Retrocaecal shaft perforation was found in most of the cases. Post operative wound infection was found in 14.2% of the cases.
Conclusions: Appendicular perforation is a severe complication of appendicitis. Appendicular perforation has no sex preference. It is common in elderly age group. Spread of pain from right iliacfossa to all over the abdomen, anorexia and rebound tenderness were found in all cases. Elevated total leukocytes count and shift to left were significant in case of appendicular perforation. Retrocaecal appendix is more prone to perforation.
Keywords: Appendicitis, appendicular disease, appendicular perforation
Micro ESR in the evaluation of neonatal sepsis
(Institute of Medicine, 2011) Paudel, KP; Adhikari, RK
Abstract
Introduction: Neonatal sepsis is a major cause of neonatal morbidity and mortality in the developing countries like Nepal. Early diagnosis and treatment is crucial for the outcome but it is difficult in many situations especially in places with limited resources. Objective of this study is to evaluate the role of micro ESR in the diagnosis of neonatal sepsis
Methods: A prospective analytical study was done where newborns with suspected sepsis admitted for septic work up and IV antibiotics were included in the study. Micro ESR was measured with relevant septic screening investigations. The micro ESR value was compared to age specific normal values and the results were compared with various clinical presentations, laboratory findings and outcome variables.
Results: Out of 111 babies micro ESR was elevated in 63 babies and blood culture was positive in 15 cases and meningitis was present in 8 cases. Total proven cases were 16 and probable sepsis were 34. Correlation of elevated micro ESR was statistically significant with PROM >18 hours, presence of clinical symptoms, clinical and systemic signs. It had significant clinical association with blood culture and CSF findings. The sensitivity, specificity, positive and negative predictive value compared with blood culture was 100%, 47.5%, 15.6% and 20.8%, comparing with proven or no sepsis cases was 70.5%, 48.1%, 36.9% and 50% respectively.
Conclusions: Micro ESR is simple cheap and relatively sensitive, specific with good negative predictive value in the prediction of neonatal sepsis and can be useful test in settings with limited resources.
Keywords: Micro ESR, neonate, sepsis