Journal Issue: Volume: 31, No. 2, August 2009
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Volume
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Issue Date
2009
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Can we use qualitative research approach in biomedical studies?
(Institute of Medicine, 2009) Joshi, S
NA.
Prediction of surgical site infection and other adverse postoperative outcomes
(Institute of Medicine, 2009) Luitel, BR; Kandel, SP; Shrestha, B; Sapkota, R; Bhandari, RS
Abstract
Background: To predict surgical site infection, hospital acquired pneumonia, wound dehiscence, and mortality based on SENIC index in Nepalese perspective in surgical patients.
Methods: A Retrospective study was conducted at Department of Surgery, Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from October 2007 to September 2008. Surgicalinfection risk factors assessed by the traditional wound-classification system (clean, cleancontaminated, contaminated, and dirty-infected wound) and by the SENIC risk index (length of intervention more than 2 hours, more than three discharge diagnoses, abdominal surgery, and contaminated or dirty infected wound) were compared by Receiver Operating Characteristic (ROC) curve.
Results: The SENIC index showed a good ability to predict SSI, Hospital Acquired pneumonia, wound dehiscence and in hospital mortality. If the index score is higher, the outcome is poorer. By using SENIC index score the area under ROC curve for SSI, pneumonia, wound dehiscence and in hospital mortality was 82.2±4.8, 90.5±2.4, 85.1 ±4.7 and 96.9±1.2 % respectively with sensitivity above 95% for all the parameters.
Conclusion: This study shows that the SENIC risk index results are reproducible, and the index can be used to predict rates of SSI and other adverse postoperative complications in developing countries as well.
Keywords: Prediction, SENIC Index, surgical site infection
Maternal mortality in hilly districts of Nepal
(Institute of Medicine, 2009) Shrestha, B
Abstract
Background: Maternal mortality is a vital indicator and exhibits great disparity between developed and developing countries. The challenging nature of measuring maternal mortality has made it necessary to perform an action-oriented means of gathering information on where, how and why deaths are occurring; what kinds of action are needed and have been taken. A maternal death review is an in-depth investigation of the causes and circumstances surrounding maternal deaths. The objectives of the present study are to describe the socio-cultural and health service factors associated with maternal deaths in rural hill districts of Nepal.
Methods: We reviewed 33 maternal deaths of women who tried to reach or reached health care services in three remote districts of Nepal, namely Baglung, Dolakha and Ramechhap. A verbal autopsy technique was applied for 33 of the cases. Individuals who had witnessed any stage during the process leading to death were interviewed. Health care staffs who participated in the provision of care to the deceased were also interviewed. All interviews were tape recorded and analyzed using a grounded theory approach. The standard WHO definition of maternal deaths was used.
Results: The socioeconomic background of the cases including caste, ethnicity, geography, direct cause of death, place of death and care givers during delivery were included to analyze each cases. The following items evolved as important: underestimation of the severity of the complication, lack of family support, lack of transportation, prolonged transportation, seeking care at more than one medical facility and delay in receiving prompt, lack of money for transportation and health service, delay in reaching an appropriate medical facility, and lack of appropriate care after reaching the hospital.
Conclusion: Women in rural hill area faces variety of problems to access to care for obstetric emergencies, hence maternal mortality is prevalent among poor women. Lack of awareness and family support on safe birth preparedness, danger signs of pregnancy, delivery and post natal period, disorganized health care with lack of referral and support for transport and health service networking prompt response to emergencies with quality care are major factors contributing to a continued high mortality rate.
Treatment of Anisometropic Amblyopia in children with refractive correction
(Institute of Medicine, 2009) Kaphle, D; Shrestha, JB; Paudel, P
Abstract
Background: The main purpose of the study is to determine the effectiveness of spectacles alone in the treatment of anisometropia in paediatric population.
Methods: A hospital based prospective study was conducted on twenty children (involving twentysix eyes) with freshly diagnosed anisometropic amblyopia of mild to moderate grade. Optimal refractive correction was provided with spectacles alone and was followed at every 3 weeks until amblyopia resolved.
Results: The mean line of improvement in visual acuity in 3 weeks was 0.85 ± 0.65 snellen lines. The mean line improvement in second follow up was 0.80 ± 0.70 lines. There was statistically significant (p=0.04) decrease in inter-ocular acuity (IOD) for anisometropia of 1 to 2.0D. The IOD improvement was associated with age (1.53 snellen lines in more than 8 years) in first follow up (p=0.001). IOD also decreased in children of more than 8 yrs.
Conclusions: As in nearly half of the participants, especially who has minimal interocular acuity difference, anisometropic amblyopia resolved to normal acuity within first three weeks, we can conclud that the early improvement of visual acuity is related to lesser amount of anisometropia, age and sex.
Keywords: Anisometropic amblyopia, amblyopia resolution, inter-ocular difference (IOD), refractive correction
Utero-vaginal prolapse in far western region of Nepal
(Institute of Medicine, 2009) Pant, PR
Abstract
Background: Utero-vaginal prolapse (UVP) is very common among Nepalese women. There are about 600,000 patients suffering from this gynaecological condition, amongst which 200, 00 require immediate correction.1 UVP is multifactorial and results in weakening of pelvic support, connective tissue and muscles as well as nerve damage.
Methods: Prospective, descriptive study, conducted in the Far-western region vaginal hysterectomy camp from 14th to 29th April2009.
Result: Of 325 women with UVP, 45.54 % were Biswakarmas, 38.08% Brahmin, 17.23% Chhetri, 5.23% Tharu and 0.92 5 from other communities. Early return to work (within 10 days of delivery) among Biswakarma and Brahmin was 95.27 % and 91.09% respectively where as smoking and chronic cough in Biswakarma and Chhetri was 92.57%, 66.22% and 78.56%, 34.4 % respectively.
Conclusion: Early return to work, smoking and chronic cough are major contributors of UVP in far western Nepal which is more prevalent in the Biswakarma community.
Keywords: Utero-vaginal prolapse, UVP, contributing factors