Nepal Mediciti Medical Journal最新文献

{"title":"Anthropozoonotic transmission of Monkeypox: Are our canine companions at risk?","authors":"J. Robinson, Indrajit Banerjee, Alexandra Leclézio","doi":"10.3126/nmmj.v3i2.52365","DOIUrl":"https://doi.org/10.3126/nmmj.v3i2.52365","url":null,"abstract":"Monkeypox is the latest zoonotic outbreak spreading in its majority throughout the Western region of the globe. The latest statistics and reports indicate that Spain, France, Germany, Portugal and the Netherlands are the country’s worst effected with a total of 7083, 3897, 3570, 845 and 1221 cases respectively. The WHO has also reported numerous cases extending into the Balkans and Turkey. The current global Monkeypox outbreak is becoming more concerning as the total number of cases globally has surpassed 35000, and the incident rates are accelerating with a 20% growth in cases being noted on a weekly basis. This global increase in cases intern enhances exposure of the virus to a larger portion of the populous; the exposure of the virus is not only intensified in humans but also their household pets and animals.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"197 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131753933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Study on transfusion requirements and deep vein thrombosis incidence with the use of Tranexamic acid on total knee replacement","authors":"R. Rana, S. Lakhey, D. Jha, N. Chitrakar, J. Thakur, A. Poudel","doi":"10.3126/nmmj.v3i2.52361","DOIUrl":"https://doi.org/10.3126/nmmj.v3i2.52361","url":null,"abstract":"BACKGROUND Total knee replacement is often associated with significant blood loss and increased rate of blood transfusion. Tranexamic acid is a potent anti-fibrinolytic agent and its use in major surgeries has shown to decrease blood loss as well as transfusion rates. It is used intravenous, oral and topical forms as well. This study aims to find out the effectiveness of systemic Tranexamic acid in terms of decrease in transfusion rate as well incidence of deep vein thrombosis (DVT) and thromboembolism. \u0000MATERIALS AND METHODS Total number of patients were 94 of which 58 had bilateral knees replacement and 36 patient underwent unilateral knee replacement over the period of 3 years (December 2018 –December 2021). All patients were screened for general condition as well as any coagulopathy pre –op. All patients were given IV form of Tranexamic acid followed by oral form for 3 days post operatively. Tourniquet was used in all cases and low molecular weight heparin (Clexane) 40 mg subcutaneous once a day for 1-2 days followed by oral aspirin was given for 6 weeks to all patients. SCD calf pumps were used for 4 to 5 days. \u0000RESULTS We found that incidence of blood transfusion was only 6.9% in our case series which was well within the incidence reported in varied literature on the use of Tranexamic acid in knee replacement surgery. There was no clinical feature of deep vein thrombosis / pulmonary embolism (DVT/PE) in any of our patients. \u0000CONCLUSION Use of Tranexamic acid is a safe and effective method for controlling blood loss and decreasing the transfusion rate after total knee replacement surgery. Its intravenous and oral forms are readily available and cost effective. Its use is not associated with DVT or PE.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128086799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An observational study on emerging antimicrobial resistance pattern in urinary tract Infection in Nepalese children","authors":"S. Bhandari, Anna Sharma, Ankita Guragain, S. Sapkota","doi":"10.3126/nmmj.v3i2.52341","DOIUrl":"https://doi.org/10.3126/nmmj.v3i2.52341","url":null,"abstract":"AIMS Evidence-based management and local antibiotic susceptibility pattern provides evidence to guide the development of urinary tract infection (UTI) treatments protocols decreasing the economic burden significantly. We aimed to investigate the aetiology and resistance pattern of bacterial uropathogens to commonly prescribed oral antibiotics (beta lactamase and fluoroquinolones) causing UTI and to recommend the most appropriate antibiotics. \u0000MATERIALS AND METHODS This study is cross sectional, retrospective study. We evaluated causative agents and antimicrobial resistance in urine, culture positive samples collected from July 2019 to June 2021 in a single hospital in Kathmandu, Nepal. To obtain urine samples, a midstream clean-catch method used in children who were toilet trained and transurethral catheterization performed in non-toilet-trained children. Urine samples were sent to the laboratory where they were inoculated using a 4 mm calibre loop on CLED (Cysteine Lactose Electrolyte Deficient) agar plate, and incubated at 37 °C for 18–24 h. Conventional methods (colony morphology, Gram stain) were opted. Different biochemical tests – catalase test, coagulase test and inoculation in Bile Esculin Agar was done for Gram-positive organisms, while Triple Sugar Indole (TSI) agar, Sulphide indole motility (SIM) agar, Simon's citrate agar and Christensen's urea agar were used for identification of Gram-negative bacilli. Significant growth was evaluated as ≥105 colony forming units (CFU)/ml of urine. Kirby-Bauer disc diffusion method was used to perform in vitro antimicrobial susceptibility tests in Mueller-Hinton agar plates. Total 13 drugs were tested for sensitivity pattern. To analyse resistance to antibiotics for different ages, subjects were divided into four age groups: Group I, 2 months - 1 year; Group II, 1 year - 5 year; Group III, 5 year - 10 year; Group IV, 10 year - 15 year. \u0000RESULTS Among 970 samples sent, a total of 230 positive urine cultures were identified, of which 116 (50.4%) were from girls and 114 (49.6%) were from boys. The most common age group was 2 months to 1 year (49.1%). The most common causative agent was Escherichia coli (49.1%) followed by Enterococcus faecalis (14.3%) and Klebsiella pneumoniae (11.3%). The overall resistance to Nalidixic acid (66%), Ceftriaxone (54.8%) Cefotaxime (48.3%) Ciprofloxacin (47.9%) and Co-trimoxazole (46.9%) was significant. The least resistance was for Chloramphenicol, Nitrofurantoin, and Norfloxacin was 9.5 %, 31.5 %, and 38.3 % respectively. Chloramphenicol (90.5%) was the most active agent against E. coli and Klebsiella, whereas Linezolid (92.7%) and cloxacillin (64.9%) was most active against Enterococcus and Staphylococcus species. \u0000CONCLUSION Escherichia coli was the most common causative agent of urinary tract infection in children. Nalidixic acid, Ceftriaxone, Cefotaxime, Ciprofloxacin and Co-trimoxazole had the highest resistance rates against urinary tract pathogens in our centre. ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116314538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of the Presenting Glasgow Coma Scale in patients who requires ICU admission or operative intervention following traumatic brain injury with the Marshall computed tomography (CT) classification of traumatic brain injury","authors":"Sumit Joshi, P. Paudel, D. B. Shah, Prasanna Karki, G. Sharma","doi":"10.3126/nmmj.v3i1.48520","DOIUrl":"https://doi.org/10.3126/nmmj.v3i1.48520","url":null,"abstract":"BACKGROUND Glasgow coma scale (GCS) and Marshall computed tomography classification of traumatic brain injury can predict the severity of the brain injury in patients following trauma. This study aims to analyse the association between two, in patients who required ICU admission or neurosurgical intervention following trauma. \u0000METHODOLOGY Retrospective study of 64 patients who underwent ICU admission or neurosurgical intervention following traumatic brain injury from September 2017 to December 2020 in Nepal Mediciti Hospital. Majority of the mild head injury where CT scan was not performed, discharged from the emergency or did not need ICU admission or admitted in ward for observation, severe polytrauma were excluded from the study. Glasgow coma Scale was categorized into mild (13-15), moderate (9-12) and severe (<8). The Marshall CT scan Grade was dichotomized into (1-3) and (4-6). \u0000RESULTS Out 64 patients, majority were male 48 (84.4%), mean age 42.33 (SD±16.16). In admitted patients, 48.4 %( GCS< 8), 39.1% (GCS 9-12), 12.5% (GCS 13-15).The higher marshal grade (4-6) was present in 93.54 %( <8), 48% (9-12), 25% (13-15). There was significant association of the GCS with the Marshall CT scan grade (p=0.00). \u0000CONCLUSION There is significant association between the presenting GCS and Marshall CT Scan grade following TBI. The more severe patients with decreasing GCS have higher Marshall CT Scan grade in CT scan of the brain.  ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124814741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Holter Monitoring in assessing Cardiac Arrhythmias in Symptomatic Patients: A Prospective Observational Study","authors":"B. Karki, J. Ghimire, B. Nepal, A. Mahaseth, A. Sah, Swapnil Pandit, N. Pandey, P. Shah, P. Karki","doi":"10.3126/nmmj.v3i1.48523","DOIUrl":"https://doi.org/10.3126/nmmj.v3i1.48523","url":null,"abstract":"BACKGROUND The 24hr ECG Holter monitoring system is helpful in assessing cardiac arrhythmias in patients presenting with palpitation, dizziness, presyncope and syncope, which are not detected by standard office electrocardiogram. \u0000METHODS This was a single center prospective observational study conducted to assess the prevalence of cardiac arrhythmias among 78 patients consisting of 41 males and 37 females referred for 24 hr ECG Holter monitoring in BPKIHS, Dharan, Nepal, between October 2021 to December 2021. \u0000RESULTS The most common indication for 24 hr ECG Holter monitoring in these patients was unexplained palpitation. Ventricular ectopics were the most common arrhythmias detected, followed by supraventricular ectopics, most of which were benign. Among 18 patients with significant bradyarrhythmia, 3 had sinus bradycardia with significant pause, 3 had AF with significant pause, and 2 had high grade/complete AV block. \u0000CONCLUSIONS The study showed that most of the arrhythmias detected are benign and prevalence of potentially fatal ventricular and supraventricular tachyarrythmias are relatively low in our population.  ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133415130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Intestinal Perforation in a Full Term Neonate: A Case Report","authors":"D. Dhungana, R. Shrestha, R. Ghimire, S. Joshi","doi":"10.3126/nmmj.v3i1.48527","DOIUrl":"https://doi.org/10.3126/nmmj.v3i1.48527","url":null,"abstract":"Spontaneous intestinal perforation suggests a perforation of the gastrointestinal tract of no demonstrable cause. Only few such cases have been described in full term newborns. Although some authors have suggested ischemia and fetal or neonatal hypoxia as the most likely cause, the etiology and pathogenesis of this disease are still widely unknown. Here, we present a case of Spontaneous intestinal perforation in a full term neonate who was born to a mother with chronic hypertension. Radiological images revealed pneumoperitoneum on a three day old baby with feeding intolerance and abdominal distention. There was no clinical evidence of Hirschsprung’s disease, necrotizing enterocolitis, anorectal malformations or bowel obstruction. An emergency laparotomy revealed a localized perforation in distal ileum. Histopathological examination failed to reveal any etiology for the perforation. The neonate recovered rapidly following a double barrel ileostomy, with no immediate gastrointestinal complications.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130068707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-COVID-19 sino-orbital mucormycosis: a case report","authors":"M. Chaudhary, Chandani Baranwal, R. Pant, S. Chhetri, T. Kc, G. Aryal","doi":"10.3126/nmmj.v3i1.48525","DOIUrl":"https://doi.org/10.3126/nmmj.v3i1.48525","url":null,"abstract":"Mucormycosis is an invasive fungal infection caused by fungi of the order Mucorales. Mucorales fungi are ubiquitous in environment in association with decaying organic matter. Here we report the case of a 68-year old female who presented with history of ptosis of the left eye with decreased vision, facial pain and loss of sensation in the left cheek. She had history of COVID-19 infection. Magnetic resonances imaging of the brain revealed intense enhancement of left optic nerve. Bilateral spenoidal, ethmoidal and left maxillary sinus showed mucosal thickening. Histopathological and microbiological examination of the specimen confirmed the case of invasive mucormycosis. Despite treatment, patient died at 7th day of hospitalization.  ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125530899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Pharmacist Intervention on Improving Knowledge, Attitude and Practice among Hypothyroid Patients","authors":"A. Yadav, Sunita Gupta, R. Piryani","doi":"10.3126/nmmj.v3i1.48518","DOIUrl":"https://doi.org/10.3126/nmmj.v3i1.48518","url":null,"abstract":"BACKGROUND Hypothyroidism causes considerable morbidity. Lack of awareness can lead to poor disease management. This study aimed to investigate the effect of pharmacist-provided counselling in terms of knowledge, attitude, and practice outcomes in hypothyroid patients. \u0000METHODS This was a prospective interventional study conducted in a tertiary care hospital of Nepal from September 2019 to February 2020. Based on the inclusion and exclusion criteria, a total of 94 hypothyroid patients were enrolled in this study. Simple Random sampling technique was used. The study population was divided into a test group and control group. The knowledge, attitude, and practice of patients regarding hypothyroidism were assessed and recorded at baseline using questionnaire and counselling was done. After one-month follow-up patients were again assessed using same questionnaire. Data was analyzed using Statistical Package for the Social Sciences version 25. \u0000RESULTS The mean knowledge, attitude, and practice scores before intervention of the test group were 6.16±2.14, 18.90±2.29 and 4.53±1.12 respectively, and these scores were changed to 12.48±1.53, 22.04±0.92 and 6.00±0.00 respectively, after the intervention (p < 0.05). Likewise, the mean knowledge, attitude, and practice scores of the control group at baseline were 8.90 ± 3.69, 18.85 ± 2.01 and 4.71 ± 1.29 respectively, and after one-month follow-up the mean scores were changed to 7.88 ± 0.77, 11.50 ± 1.59 and 4.40 ± 0.76 respectively. \u0000CONCLUSION The pharmacist-provided counselling is useful in enhancing the knowledge, attitude, and practice of hypothyroid patients.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114667264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of clinical profile and outcome of patients with snake envenomation at Bheri Hospital Nepal","authors":"R. Mandal, Nirmal Shakya, Sanket Kumar Risal, Kuldip Goit","doi":"10.3126/nmmj.v3i1.48524","DOIUrl":"https://doi.org/10.3126/nmmj.v3i1.48524","url":null,"abstract":"BACKGROUND Snake bite is a public health problem in terai and inner terai of Nepal. It is a medical emergency leading to significant morbidity and mortality every year. This study aims to find the clinical profile and outcome of snake bite envenomation patients in Bheri Hospital Nepalgunj. \u0000METHODS This was a cross sectional, observational study from April 2021 to November 2021. Patients with history of snake bite and clinical features suggesting envenomation were enrolled in this study, their clinical data and outcome were recorded in Excel sheet and analyzed by SPSS 20. \u0000RESULTS A total of 58 cases of snake envenomation was admitted and managed, out of which 3 cases expired with case fatality of 5.17%. Krait and cobra were the common snake bites in this region. 84.48% of the snake bites occur inside houses and more than half 53.44% of the patients were bitten between 12am to 6am. The most common features of envenomation were ptosis, blurring of vision, swallowing difficulty, dysphonia, neck muscle weakness, epigastric pain and salivation. Majority of cases 96.55% was given 10 vials of Anti snake venom (ASV). Only 4 patients 6.89% needed ventilator assistance. \u0000CONCLUSION Mortality with snake bites can be minimized by strengthening the treatment centers and readily availability of ASV at such centers. Public awareness about snake bite, first aid, rapid transport to health facilities would be the key to success in reducing morbidity and mortality.  ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125921296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Demographic Profile of White-coat Hypertension in the Patients Visiting a Tertiary Care Center in Eastern Nepal","authors":"J. Ghimire, B. Karki, B. Nepal, A. Mahaseth, A. Sah, Swapnil Pandit, N. Pandey, P. Shah, P. Karki","doi":"10.3126/nmmj.v3i1.48522","DOIUrl":"https://doi.org/10.3126/nmmj.v3i1.48522","url":null,"abstract":"BACKGROUND: There is unequivocal evidence showing that at hospital environment BP levels are usually different from measures found at other settings. Therefore, ambulatory BP is expected to be more dependable, as well as allow the identification of a relevant subgroup of white-coat hypertension patient. \u0000METHODS: This was a single center descriptive cross-sectional study conducted to assess the prevalence of white-coat hypertension among 50 participants consisting of 31 males and 19 females referred for 24 hour Ambulatory BP monitoring in BPKIHS, Dharan, Nepal, between October 2021 to December 2021. \u0000RESULTS: The prevalence of white-coat hypertension was 19 (32%) among 50 participants, while 31(62%) of them had sustained hypertension. Prevalence of WCHTN and sustained hypertension in young age ≤35 years was 4 (21.1%) and 10 (32.3%) respectively, similarly middle age 36-54 years was 13(68.4%) and 16(51.6%) and elderly ≥55 years was 2(10.5%) and 5(16.1%) respectively. Most participants were of middle age group 36-54 years’ age. While of sex distribution pattern of WCHTN and sustained hypertension, male was 11(57.9%) and 20 (64.5%) respectively and female was 8(36.8%) and 15(48.4%) respectively. The association between the demographic variables age, sex and BMI and white-coat HTN was not statistically significant. \u0000CONCLUSION: The study showed that White-coat hypertension was more common in male patients and in middle age group 36-54 years, but was not statistically significant. Prevalence of white-coat hypertension was 19(38%). There was no significant association between white-coat hypertension and demographic variables.  ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116761072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}