Journal Issue: Volume: 35, No. 3 (2013) December
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2013
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
Complications of warfarin in post operative heart valve surgery
(Institute of Medicine, 2013) Pradhan, N; Bhandari, NR; Bharati, L
Abstract
Introduction: Thromboembolic complications and bleeding are the major complications of warfarin. The aim of the study was to focus on the complication of warfarin and monitoring post-valve surgery.
Methods: A combined retrospective and prospective study was done in post mechanical heart valve surgery patients at Manmohan Cardiothoracic Vascular and Transplant Center. The study was carried out for 4 months by interviewing patients with self-administered structured questionnaire about any complications during their follow up in OPD and monitoring for their INR values.
Results: The majority of patients studied wer male 42 and 56 were female. 55 patients underwent mitral valve replacement, 22 underwent double valve replacement and 46 underwent aortic valve replacement. There were a total of 59 cases of bleeding complications. Hemoptysis was the most common bleeding event .Pericardial bleeding was the most common major bleeding complication with 3.1%. In patients taking warfarin major bleeding complication was 10.2% and minor bleeding was 50%. Out of total INR reading 47% were out of the target INR range, with 19.5% above range and 27.5% below range.
Conclusion: Minor bleeding was the most common type of bleeding. A system for proper monitoring of warfarin can bring improvement in better dose adjustment to achieve more appropriate INR values and eventually minimizing warfarin related complications. Introducing pharmacist monitored anticoagulant clinic can reduce the work load of physicians and overcome the time barrier.
Keywords: Minor bleeding, Major bleeding, INR, Thromboembolism
Video-Thoracoscopic Management of Empyema Thoracis in tertiary level thoracic unit
(Institute of Medicine, 2013) Shrestha, UK; Thapa, B; Baral, R; Sapkota, R; Sayami, P
Abstract
Introduction: Thoracic empyema is a common problem. Use of minimal access surgery for the treatment is comparatively new. We audited our results with VATS in thoracic empyema.
Methods: We analyzed the retrospective data from the patients who received Video-Assisted Thoracoscopic Surgery (VATS) for empyema thoracis from April 2011 to April 2013 at Manmohan Cardio-thoracic Vascular and Transplant Center (MCVTC).
Results: Of the 44 patients who underwent surgery for empyema of various stages, 37 patients underwent the procedure via VATS. The average age was 26.4 ±17.19 yrs (1-64). The male to female ratio was 2:1. The duration of symptoms before VATS intervention varied very widely (7-712 days avg: 92.7±28.8 days). The duration was 32 days on an average among patients in whom deloculation sufficed but was 111 days among those in whom decortication was required. A complete VATS procedure with satisfactory lung expansion at the end of the procedure was possible in 34 patients (100% patients who underwent deloculation and 88% of those who underwent decortications). Inadequate lung expansion forced conversion in three and subsequent collapse necessitated re-operation in one. The operative times were: VATS converted to open decortication (150 mins), completed VATS decortication (60-180 mins, avg: 125.7 mins) and VATS deloculation (45-120 mins, avg: 69 mins). Post-operative chest tube drainage was shorter in patients in whom a successful VATS procedure was completed 4.0 Vs 40 days).
Conclusion: Videothoracoscopic approach is feasible in surgical management of empyema thoracis. The results seem to be better in earlier stages.
Keywords: Deloculation, decortication, empyema, Video-assisted thoracoscopic Surgery (VATS)
“South Asian Cocktail” – The Predominant Drug Use Pattern in Nepal and its Association with Spread of HIV
(Institute of Medicine, 2013) Ojha, S P; Sigdel, S; H-G, M; Verthein, U
Abstract
Introduction: Central Bureau of Statistic of Nepal (2008) shows more than 46,000 illegal drugs users, out of which 61% are injecting drug users (IDU). An injecting mixture of medicines called “South Asian Cocktail” is prevalent in Nepal. This study was carried out to find out the knowledge on drug use behaviour and health status with a focus on HIV in “cocktail” drug users.
Methods: A cross-sectional survey among opiate users in contact with the treatment system was performed. After an initial mapping of Kathmandu valley, 300 drug users, on a random basis, in contact of different treatment and counselling centres were interviewed. The research questionnaire was designed following Europ ASI and Maudsley Addiction Profile standards.
Results: Ninety one percent of the respondents were male and 9% female. 95% are injecting drug users with an average 8.7 years of drug use history. 86% are injecting different “cocktails” usually made of buprenorphine, diazepam, Phenergan (promethazine) and/or other substances (30 day prevalence). Similarly, 48% use heroin whereas only 2% take cocaine/ crack. Amongst tested for HIV (N=223) 33% are positive (25% of sample population).
Conclusion: The “South Asian Cocktail” users have a higher risk behaviour than heroin drug users which is associated with the spread of HIV. It needs to be considered which HIV prevention measures are needed related to the specific needs of cocktail users, since the available services (like needle syringe exchange) does not seem to cover their specific needs.
Keywords: South Asian cocktail, Opiates, Opioid substitution treatment, HIV
Ventilator Associated Pneumonia in Tertiary Care Hospital, Maharajgunj, Kathmandu, Nepal
(Institute of Medicine, 2013) Shrestha, RK; Dahal, RK; Mishra, SK; Parajuli, K; Rijal, BP; Sherchand, JB; Kirikae, T; Ohara, H; Pokhrel, BM
Abstract
Introduction: Ventilator Associated Pneumonia (VAP) is the most common nosocomial infection among intensive care unit (ICU) patients and lack of much information in Nepal. So, the aim of this study was to determine prevalence and bacteriological profile of VAP with special reference to multi-drug resistant (MDR), Methicillin-resistant Staphylococcus aureus(MRSA), Metallo-β-Lactamase(MBL), Extended-Spectrum β-Lactamase(ESBL)-producing bacterial strains.
Methods: A total 150 tracheal specimens were studied during June 2011 to May 2012 at Department of Microbiology, TUTH as described by American Society for Microbiology (ASM). Combination disk method was done for the detection of ESBL and MBL producing isolates.
Results: Prevalence of VAP was found to be 34%. Acinetobactereal coaccticusbaumannii complex (44%) was the commonest isolate, followed by Klebsiellapneumoniae (22%), Pseudomonas aeruginosa (16%) and Staphylococcus aureus (12%). Among MDR Gram negative bacteria (GNB), 39% were MBL and 33% were ESBL-producers. All GNB (61) were sensitive to Polymyxin B and Colistinsulphate, whereas, 48% were found resistant to Carbapenems. Prevalence of MRSA was 75%, which were all sensitive to Vancomycin.
Conclusion: High prevalence of VAP, MDR along with MRSA or ESBL or MBL producing strains was found in the study. Thus, suitable control measures must be adopted to cope up this alarming situation with genetic characterization.
Keywords: VAP, ICU, MDR, MRSA, ESBL, MBL