Journal Issue: Volume: 33, No. 2, August 2011
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Volume
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Issue Date
2011
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Ectopic pregnancy in Nepalgunj Medical College
(Institute of Medicine, 2011) Sharma, P; Singh, BP; Shrestha, B
Abstract
Background: Ectopic pregnancy is one of the major health problems. There is paucity of data regarding ectopic pregnancy from Nepal. This retrospective review was done to evaluate the incidence, commonest risk factors, site and the spectral types of ectopic pregnancy in western Nepal. Methods: This was a retrospective review of all the case of ectopic pregnancy during the period of two years. The data was collected using a format. Total number of deliveries during that period was also recorded. Finally data was analyzed using SPSS (Version 17). Results: The incidence of ectopic pregnancy was 1 in 87 deliveries. A total number of 21 cases of ectopic pregnancy were seen and managed during the study period. Mean age of the patient was 30.29 years ± 6.084 years. Pelvic inflammatory disease was the most common risk factor. Most of the patients had not used contraceptive methods. Type 3 spectral type of ectopic pregnancy was the most common type. All of our cases had tubal pregnancy. Maximum patients had ampullary implantation. Nineteen patients had ruptured ectopic pregnancy. Conclusions: Ectopic pregnancy is common in western Nepal with the incidence of 1 in 87 deliveries. Pelvic infection is the most common risk factor.
Keywords: Ectopic Pregnancy, Western Nepal, Incidence
Prevalence of nosocomial lowerrespiratory tract infections caused by Multi-drug resistance pathologens
(Institute of Medicine, 2011) Shrestha, S; Chaudhari, R; Karmacharya, S; Kattel, HP; Mishra, SK; Dahal, RK; Bam, N; Banjade, N; Rijal, BP; Sherchand, JB; Ohara, H; Koirala, J; Pokhrel, BM
Abstract
Introduction: Nosocomial infections caused by multi-drug resistant pathogens are major threat to the hospitalized patients. Extended spectrum beta-lactamase (ESBL) and metallo-beta-lactamase (MBL) producing bacterial strains causing hospital acquired lower respiratory tract infection are increasing in numbers. Only a limited number of studies related to MBL producers have been done in Nepal. Objective: The goal of this study was to determine the etiology of nosocomial lower respiratory tract infections and to assess the current levels of antimicrobial resistance with special reference to ESBL and MBL producing bacterial strains.
Methods: A total of 100 specimens including sputum and endotracheal secretion from patients diagnosed of nosocomial lower respiratory tract infection were collected and processed according to the standard methodology. Combination disk method was done for the detection of ESBL and MBL producing isolates.
Results: Out of total 100 specimens, 87% was monomicrobial while the rest were polymicrobial. 96.5 % were gram negative while 3.5% were gram positive. All E.coli, Klebsiella spp and S. aureus were found to be MDR followed by Acinetobacter spp (97.2%) and P. aeruginosa (76.2%) About 28.6 % of E. coli, 8.33% of Klebsiella spp and 2.4 % of Pseudomonas aeruginosa were ESBL producers. Acinetobacter spp. was not found to produce ESBL during the study. MBL was present in 17.4% of the gram negative isolates.
Conclusion: We found a high prevalence of MDR strains as a cause of nosocomial LRTI including significant proportions of ESBL and MBL producers. The rate of Acinetobacter spp., including MBL producers, in our hospital setting was alarmingly high which prompts a special attention for the management of such patients as well as urgent need for implementation of infection control strategies.
Keywords: MDR, LRTI, ESBL, MBL, nosocomial infection
Reference values for Doppler velocimetric indices from the fetal and placental ends of the umbilical artery in uncomplicated third trimester pregnancy
(Institute of Medicine, 2011) Paudel, S; Kayastha, P; Lohani, B; Gurung, G
Abstract
Introduction: The purpose of this study was to establish new reference ranges for commonly used umbilical artery Doppler indices (Pulsatility Index, Resistance Index, and Systolic: Diastolic ratio) at standardized insonation sites in uncomplicated third trimester pregnancy.
Methods: This was a prospective cross sectional study involving 101 singleton pregnancies between 30 and 37 weeks of gestation without any known risk factors. Umbilical artery indices were obtained from fetal end and placental end of the cord. Regression equations were used to construct reference ranges and percentile fitted Normograms were obtained for all the parameters. Paired t test was used to see the difference of different parameters at two different sites of the cord.
Results: Among 101 singleton pregnancies between 30 and 37 weeks of gestation, 65 (64.35%) were primigravida and 36 (34.65%) were multigravida. Mean maternal age was 23.12years (range 16 to 35 years). Maximum number of pregnancies (18.81%) was at 34 weeks of gestation. The established Doppler indices showed a continuous reduction of all the measured indices as pregnancy increases (p<0.0001). Umbilical artery RI, PI and S: D ratio were higher in the fetal end of the cord than in the placental end (p><0.0001).
Conclusions: Umbilical artery Doppler parameters vary significantly at different locations. We have established new reference ranges for the UA at fetal end and placental end of the cord which should be useful for the surveillance of fetuses with repeated observations.
Keywords: Doppler study, fetal end of cord, placental end of cord, umbilical artery
Comparison of hearing results between the averages of three and four speech frequencies in Type 3 Tympanoplasty
(Institute of Medicine, 2011) Shrestha, BL; Gurung, U; Bhattarai, H
Abstract
Introduction: Hearing assessment after tympanoplasty is done by taking pure tone average. This study was performed to compare the hearing results obtained from the averages of three and four speech frequencies namely 0.5, 1,2KHz and 0.5,1,2,4 KHz in type III tympanoplasty.
Methods: This study was conducted in Tribhuwan university teaching hospital and Kathmandu university hospital, Dhulikhel from October 2006 to November 2009. The pure tone audiogram was performed by Hugson and Westlake method. The audiometry results were reported as per American Academy of Otolaryngology – Head and Neck surgery guidelines. The comparison between the averages of 3 and 4 speech frequencies that are 0.5, 1,2KHz and 0.5,1,2,4 KHz were performed with regard to bone conduction threshold(BCT), air conduction threshold(ACT),air bone gap (ABG) and air bone gap closure. Data analysis was performed using SPSS 13 software.
Results: Comparison between the averages of 3 and 4 speech frequencies between the preoperative BCT and ACT showed difference of 1.5dB and 0.8dB which were statistically significant whereas the difference in ABG was 1dB which was statistically not significant. Similarly post-operative BCT, ACT, ABG showed the difference of 0.3dB, 0.5dB and 0.2dB respectively which were also statistically not significant.
Conclusions: The difference between 3 and 4 speech frequencies averages are small and are statistically not significant but it is still worth to include 4 KHz as this is a high frequency which is likely to be affected by tympanoplsty.
Keywords: tympanoplasty, bone conduction threshold, air conduction threshold, air bone gap