Journal Issue: Volume: 46, No. 1 (2024)
Loading...
Volume
Number
Journal of Institute of Medicine Nepal
Issue Date
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Intranasal Corticosteroid Spray Usage in Patients with Allergic Rhinitis: Correctness in Technique and Compliance
(Institute of Medicine, Tribhuvan University, 2024) Gurung, Urmila; Khadgi, Sajish
Abstract:
Introduction
Intranasal corticosteroid spray (INCS) needs to be administered correctly and regularly for it to be effective in treating allergic rhinitis. This study aimed to assess the correctness of technique and compliance of intranasal corticosteroid spray usage in patients with allergic rhinitis.
Methods
It was a cross-sectional study conducted in the Dept of ENT-Head and Neck surgery, Tribhuvan University Teaching Hospital from April to September 2023. Patients aged 18 or more with allergic rhinitis on INCS or had been on INCS in the past three months were assessed for INCS administration technique based on EPOS 2020 checklist and their compliance asked. Factors that could hinder the correct techniques and compliance were assessed.
Results
A total of 138 patients, 71 males and 67 females, aged 18 to 55 years were included. Most of them (60/138; 43.5%) had completed secondary level education. 97.1% (134/138) had been prescribed INCS spray by ENT doctor and 89.13% (124/ 138) had received verbal instructions mostly by ENT doctor (91.1%). 7.2% (10/138) completed all the steps as per EPOS 2020 checklist whilst 25/138 (18.1%) completed five essential steps. The correctness of the INCS administration technique however did not differ with age, gender, academic qualification, prescriber or whether instructions were given or not. 119/138 (86.2%) patients reported being compliant.
Conclusion
INCS spray was scarcely administered with the correct technique although the compliance was good. This study emphasizes the need for effective patient and healthcare worker education pertaining to correct INCS technique.
Hemodynamics following Prophylactic Phenylephrine Infusion in patients undergoing Cesarean Section under Spinal Anesthesia
(Institute of Medicine, Tribhuvan University, 2024) Gauchan, Sabin; Thapa, Chitra; Acharya, Sulav; Khanal, Anupa
Abstract:
Introduction
Phenylephrine is considered the vasopressor of choice in hypotension associated with obstetric spinal anesthesia. But the dose and mode of administration that is effective yet safe in mother as well as fetus remains controversial. We studied the hemodynamics of parturients who received prophylactic infusion of phenylephrine 50µg/min following spinal anesthesia.
Methods
Patients posted for elective cesarean section received a prophylactic phenylephrine infusion of 50µg/min immediately after spinal anesthesia for 30 minutes. Parturients were also co-loaded with lactated Ringer’s solution 1 litre. Blood pressure and heart rate was monitored at an interval of 3min initially and after the delivery of baby interval was increased to 5min. Episodes of hypotension, reactive hypertension and bradycardia in mother were recorded. Neonatal APGAR score at 1 and 5min was also recorded.
Results
One hundred and forty parturients were included in the study. Twenty patients (14.28%) developed hypotension. Out of 20 patients who developed hypotension, 3 patients (15%) had a single episode, 11 patients (55%) had 2 episodes and 6 patients (30%) had 3 episodes of hypotension. Three patients (2.14%) had reactive hypertension. None of the patients had bradycardia. There was no episode of hypotension induced nausea vomiting. Mean APGAR score at 1min and 5min was 8 and 9 respectively.
Conclusion
The prevalence of hypotension with prophylactic phenylephrine infusion was low. We found minimal episodes of reactive hypertension, no episodes of bradycardia and no adverse effect on fetus. It can be regarded a safe means to minimize hypotension in obstetric spinal anesthesia.
Clinico-Radiological Presentation and Outcome of Brain Abscess in Congenital Cyanotic Heart Disease
(Institute of Medicine, Tribhuvan University, 2024) Sedain, Gopal; Bohara, Sandeep; Shrestha, Dipendra Kumar; Pradhanang, Amit Bahadur; Shilpakar, Sushil Krishna; Sharma,Mohan Raj
Abstract:
Introduction
Patients with congenital cyanotic heart disease (CCHD) are at increased risk of developing brain abscesses. Having a brain abscess is itself a risk for the patient and concomitant cyanotic heart disease makes it a double jeopardy. The management of brain abscesses depends on the size, number, stage, and location of the abscess and can be medical and surgical.
Methods
This retrospective chart review was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal of patients treated between January 2018 and December 2022. Demographic and clinical profiles, imaging studies, treatment modalities, and outcomes were analyzed.
Results
Out of 17 patients, 11 were males and six were females. The mean age of the study population was 13.41±11.08 years. The most common associated cardiac problem was Tetralogy of Fallot seen in six (35.3%) patients and the most common abscess site was the parietal lobe (38%). The most common presenting symptom was vomiting, seen in 76%. Twelve patients underwent burr hole and aspiration and 17.6% of patients underwent surgical excision of the abscess wall whereas 11.7% of the patients were managed conservatively. Positive culture was seen in 33.3%. S. aureus was the most common organism grown. There was no mortality.
Conclusion
Majority of patients were male with Tetralogy of Fallot as the most common associated congenital cardiac condition. Most of the patients were managed with Burr hole and abscess aspiration with re-aspiration in three patients. Suspicion of brain abscess should be high in patients with congenital cyanotic heart disease.
Psychological Burden Faced by Parents having Children with Thalassemia in a Teaching Hospital of Birgunj, Madhesh province
(Institute of Medicine, Tribhuvan University, 2024) Shrestha, Romina; Shah, Rubi; Bhandari, Keshav; Banstola, Ratna Shila
Abstract:
Introduction
Caring for a child suffering from thalassemia is very stressful for parents. The study was aimed to identify the psychological burden of parents having children with thalassemia.
Methods
Cross-sectional analytical study was done. The parents having children diagnosed with thalassemia and receiving service from Pediatric OPD, National Medical College were the study participants. Non-probability convenience sampling technique was used and sample size was 88. Data was collected through face-to-face interviews using a structured interview schedule. Data analysis was done in SPSS version 16. Chi-square test, fisher’s exact test and odds ratio were used to examine the association.
Results
Mean psychological burden score was 47.47 ± 10.9, and 71.6% of parents had moderate level of psychological burden. Level of psychological burden was associated with parents’ sex (p=0.03), education level (p=0.03), and income (p=0.01). Odds ratio determined that psychological burden was 2.9 times higher (95% CI = 1.1-7.6) among mothers, 3.7 times higher (95% CI = 1.4-9.9) for the parents whose income was insufficient to get their needs met. Non-literate parents were 3.6 times and parents with primary to secondary level education were 1.6 times more likely to have psychological burden. In contrast, those with higher secondary or above levels of education were less likely to perceive psychological burden (OR = 0.3, 95% CI = 0.4-1.0).
Conclusion
More than two-thirds of the parents having children with thalassemia tend to have moderate levels of psychological burden. The measures to reduce psychological burden of parents should focus more towards mothers, those parents with low education level and with less income.
Antimicrobial Sensitivity among Bacterial Isolates from Sputum Samples in a Tertiary level Hospital
(Institute of Medicine, Tribhuvan University, 2024) Kaundinnyayana, Sammodavardhana; Chaudhary, Raina; Khadka, Anjan; Bhatta, Sabita; Rayamajhi, Heleena; Sharma, Manoj
Abstract:
Introduction
Emergence of antimicrobial resistance is a huge challenge in management of pneumonia especially health care associated ones. Culture and sensitivity test of the bacteria from sputum samples is not only useful for rational treatment of respiratory bacterial infections of individual cases but also for surveillance of changing sensitivity status of prevalent organisms. The aim of this study was to find the bacterial sensitivity pattern from the sputum samples and endotracheal aspirates.
Methods
This cross-sectional study was conducted in Shree Birendra Hospital, Kathmandu, Nepal. Standard guideline was followed for sputum culture and identification of the bacterial isolates. The antimicrobial susceptibility test was conducted using the Kirby-Bauer disc diffusion technique. Every bacterial isolate's sensitivity was studies and noted.
Results
The culture positivity rate was 9.87% (99/1003). Predominant isolates were gram-negative bacteria (97.4%). Pseudomonas spp. was the most frequent isolate (31%). Among the all isolates, 48.1% of Pseudomonas spp., 81.5% of Klebsiella pneumoniae, and 60% of Escherichia coli isolates showed meropenem resistance. Imipenem and meropenem resistance was observed in 91.7% of the isolates of Acinetobacter spp. Rate of resistance to carbapenems i.e. imipenem and meropenem was higher in comparison to rate of resistance to aminoglycosides in all of the gram-negative isolates.
Conclusion
The isolates belonging to Enterobacterales and the Acinetobacter spp. have been found to have high incidence of resistance to carbapenems in comparison to other groups of antibacterial agents.