Journal Issue: Volume: 32, No. 2, August 2010
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Volume
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Issue Date
2010
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Profile of unaccompanied, unconscious patients in the emergency department
(Institute of Medicine, 2010) Singh, D P; Acharya, R P; Singh, S
Abstract
Introduction: The burden of unknown and unconscious patient is a common challenge to provide medical care in the emergency department of the hospitals. As the social security systems like insurance does not exist and poverty is rampant, it will continue in the future too. In this context this study is an attempt to analyze the morbidity & mortality as well as the types of illness, causes of unconsciousness and the source of unconsciousness in these patients without any identity.
Methods: A retrospective analysis of the unaccompanied, unconscious patients attending the emergency department of Bir hospital during the Nepali year 2066 Bikram Sambat (14 April 2009 to 13 April 2010) was carried out. Results: Two-thirds of these patients were brought to hospital by the police. The next category (20%) were brought by unknown person and left without any information.
Conclusions: Use of the type of substance and their nature remains unclear and there is a need to develop a trend to identify these substances so that specific treatment and hence preventive measures can be implemented effectively.
Keywords: Destitute, unconscious, unknown substance
Role of tiotropium in chronic obstructive pulmonarydisease exacerbation
(Institute of Medicine, 2010) Pant, P; Yadav, B; Khan, G M; Koju, R; Gurung, R; Pokharel, B; Bedi, T R S; Adkhari, R K
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) remains a major public health problem. Many patients suffering from chronic obstructive lungs diseases are of poor economic status, mostly illiterate, therefore has a direct bearing on patient compliance. Tiotropium is a new anticholinergic therapy for chronic obstructive pulmonary disease that differs from ipratropium by its functional relative selectively for musarinic receptor subtypes and which allows single dosing a day. This study presents a cost-effectiveness, efficacy, and side-effects of Ipratropium bromide and Tiotropium in COPD.
Methods: Prospective study was conducted In Kathmandu University Teaching Hospital, between the year 2008 and 2009 in terms of cost-effectiveness, efficacy, and side-effects of Tiotropium and Ipratropium amongst COPD patients.
Results: Tiotropium and Ipratropium were prescribed in total of 57 patients (30 in ipratropium bromide and 27 in tiotropium bromide) for the management of COPD among outpatients. There were no significant differences in age, height, weight and baseline lung function parameters (FEV1 and PEF) between the two drugs i.e. ipratropium bromide and tiotropium bromide. Significant improvement in lung function parameters were found in each respective group of drugs after bronchodilator therapy. Tiotropium results in significant reduction of Chronic Obstructive Pulmonary disease exacerbations and significant improvement in quality of life, lung function, and dyspnoea compared to ipratropium. The additional cost to achieve these favorable outcomes was cheaper than Ipratropium bromide. (Nepalese Rs. 7.03 per day for tiotropium as compared to Rs. 9.06 for Ipratropium)
Conclusions: Tiotropium results in significant reduction of chronic obstructive pulmonary disease exacerbations and significant improvement in quality of life, lung function and dyspnoea compared to Ipratropium.
Keywords: Chronic obstructive pulmonary disease, ipratropium, tiotropium
Cardiac workload of dressers in underground manual coal mines
(Institute of Medicine, 2010) Saha, R; Samanta, A; Dey, NC; Dey, NC
Abstract
Introduction: Occupational disorders invite absenteeism amongst the miners. Though rapid technological advancement has happened, yet assessment of cardiac workload was largely ignored in underground coal mines in India.
Methods: Physiological stress was evaluated in terms of working heart rate, net cardiac cost and relative cardiac cost. Heart rate was measured during their course of work by heart rate monitor at the coal face. Recovery heart rates and environmental heat load were also assessed.
Results: Heart rate was found to be 117 and 122 beats/min respectively in first and second spell. NCC (49.7 and 54.8 beats /min) and RCC (47% and 52%) exhibit significant variations between spells, whereas rate of recovery had been very poor amongst the workers who regularly exceeded recommended levels of cardiac strain indices. The nature of work depicted it as a heavy job although recovery trend categorizes it heavier than that. ET and WBGT were above the recommended limits as per the guidelines of WHO and ACGIH.
Conclusions: High physiological demand of the job with towering heat stress was found to hinder the recovery process and may cause deleterious impacts on the workers. Ergonomic interventions were highly felt towards job organization and up gradation of environmental conditions.
Keywords: Coalmines, dressers, workload
Management of adhesive intestinal obstruction
(Institute of Medicine, 2010) Niyaf, A; Bhandari, R S; Singh, K P
Abstract
Introduction: Adhesive intestinal obstruction is an inevitable complication of abdominal surgeries. It has high morbidity with associated poor quality of life and predisposition to repeated hospitalization. Commonest cause of bowel obstruction in developed countries is postoperative adhesions with extrinsic compression of the intestine. Most of them can be managed conservatively.
Methods: A retrospective study of 30 patients admitted with the diagnosis of post operative adhesive partial bowel obstruction was conducted by analyzing their medical records. Demographic data, clinical presentation including duration, previous surgical procedures, treatments received for the condition and successful conservative approach versus requirement of operative intervention were assessed. Results: The median age was 31 yrs, most in their third decade of life. Male predominance was noted. Pelvic surgeries and gynecological surgeries (26%) were found to be the most common cause of adhesive bowel obstruction followed by appendectomy (16%). More than two third of the patients (76.7%) developed symptoms within two years of the initial surgery. Successful conservative treatment was noted in 22 patients (73.3%) and discharged on fourth day of admission. Eight patients (26.6%) underwent surgery. They all underwent adhesiolysis and had good outcome.
Conclusions: The time-honored practice of expectant management of adhesive partial bowel obstruction has equally good outcome, as compared to various interventions practiced.
Keywords: Adhesive bowel obstruction, conservative management