Journal Issue: Volume: 27, No. 3, December, 2005
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Volume
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Issue Date
2005
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Public health action for Injury and violence prevention in Nepal
(Institute of Medicine, 2005) Sharma, GK; Adhikari, RK; Upadhaya, MP
NA.
Use of intrathecal morphine for analgesia in a surgical camp set up in Nepal
(Institute of Medicine, 2005) Shrestha, A; Pradhan, B
Abstract
Background: Pain management is often inadequately addressed, especially in a mobile surgical camp set up. We try to look at an easier and effective method, i.e. intrathecal morphine for pain relief and it’s practicability in a camp set up.
Method: 89 patients under going vaginal hysterectomy under spinal anesthesia were studied. They were randomly allocated to those receiving bupivacaine and intrathecal morphine (n=61) and another group receiving bupivacaine only (n=28). Their need for post operative analgesia and untoward effects like nausea/ vomiting, pruritis and respiratory depression were compared.
Results: Significant pain relief was seen with the added intrathecal morphine but it also caused increased incidence of vomiting. Other serious effects were not seen.
Conclusion: Intrathecal morphine is an effective method of post operative analgesia in operations under sub arachnoid block but an effective antiemetic cover is also required and vigilance to tackle any untoward effects is needed.
Comparison of core and surface cultures in recurrent tonsillitis
(Institute of Medicine, 2005) Bista, M; Sinha, BK; Amatya, RCM; Tuladhar, NR; Pokharel, BM
Abstract
This prospective study was done to find out the most common organism affecting the tonsils in recurrent tonsillitis and to compare the microorganisms found in the core and surface of such tonsils. A total of 50 patients attending ENT Out patient Department of Tribhuvan University Teaching Hospital (TUTH) from February 2000 to August 2001 were included in the study. All these patients
had undergone tonsillectomy under general anaesthesia by dissection method. Among these 39 patients had undergone tonsillectomy for recurrent tonsillitis and 11 had undergone tonsillectomy for reasons other than recurrent tonsillitis. The excised tonsils were kept in agar plates and transported to the microbiology laboratory within half an hour of surgery. The culture was taken from the surface and the core after cutting the tonsils into half by a sterile blade and with another sterile blade only core was extracted in a wedge shaped manner and was cultured in aerobic (5% sheep blood agar, Chocolate agar and McConkey’s agar and anaerobic (gas pack jar system) media for 24 - 48 hours. The most common microflora seen in recurrent tonsillitis was Streptococcus viridansfrom the surface, as well as the core. Other common micro organisms prevalent on the surface in recurrent tonsillitis were Staphylococcus aureus, and Brahmnella catarrhalis. Likewise other common micro organisms in the core in recurrent tronsillitis were Staphylococcus aureus, Klebsiella pneumonie, and Haemophillus influenzae. There was no statistical difference between the micro organisms found on the surface and the core except for Brahmnella catarrhalis which was significantly more on the surface. Anaerobes were isolated only from the core and there was no statistical difference between the micro organisms isolated from the non-infected tonsils and from recurrent tonsillitis.
Redefining postpartum hemorrhage
(Institute of Medicine, 2005) Adhikari, S; Bista, KD; Rana, A
Abstract
In the prospective study conducted in TUTH; 300 women with the active management of labour were enrolled; visual estimation of blood loss (volume criteria) was found to poorly correlate with changes in hemoglobin and hematocrit with unacceptably low sensitivity (3.4%) and specificity (93.4%) compared to the hemoglobin criteria (sensitivity 80.7% & specificity 93.9%) or the hematocrit criteria (sensitivity 89.7% & specificity 88.1%); thus suggesting redefinition of PPH in order to identify larger number of women with this problem; which may aid to bring down the morbidity and mortality associated with PPH.
Study of enteric fever and malaria incidence in southern part of Nepal
(Institute of Medicine, 2005) Rai, DR; Kshetry, NT; Tamang, MD; Pokharel, BM
Abstract
This study was done in order to present the incidence of enteric fever and malaria among patientswith febrile illness which can play significant role in nation’s disease control & prevention efforts. Conventional method of Widal test and Blood culture were done for diagnosis of enteric fever and Kirby Bauer disc diffusion method was applied to find antibiotic sensitivity pattern of the isolate.
Thin smear method was performed to detect the malarial parasites. A total of 611 cases attended at hospital complaining febrile illness and 150 people without any symptoms of fever were the subject of study. Among 611, 29.8% (182/611) were found positive with significant titre. Infection rate was found similar between sexes, however, more than 70% incidence were clustered among the age group 11-40 year. No significant difference of Hb was found among positive and negative cases, however, number of neutrophil and TLC was remarkably high among positive cases. Among 60 cases subjected to blood culture 16.7% (10/60) were proven culture positive for Salmonella spp. with predominant S. typhi. Ciprofloxacin and Ceftriaxone were found promising drugs. Seasonally mid May/April was found peak period of incidence. Among 150 people without any symptoms of fever 28 (18.7%) showed agglutination positive with low titre. As 50% of H & whole O antibody showed the titre of 1:80 & 1:40, local titre value against H & O antigen is 80 and 40, respectively. Malarial parasite detection rate was 3.6% (6/166) with ratio of P. vivax &P. falciparum 2:1. This finding provide current situation of incidence of malaria and enteric fever with antibiotic susceptibility pattern which enable the physician to tackle the cases very effectively.