Oral Solid Dosage form Modification in Community Pharmacies of Kavrepalanchok and Bhaktapur Districts of Nepal

Background People may modify their oral solid dosage form of medicine to deal with problem faced during medicine administration. The modification of dosage form may adversely affect the quality, safety and efficacy of the medicine. Objective To investigate the causes and practices of oral solid dosage form modification among the consumers going to community pharmacies. Method A descriptive, cross-sectional study was conducted in five community pharmacies of Kavrepalanchok and Bhaktapur districts of Nepal. The consumers visiting these pharmacies for their oral solid dosage form of medicine were invited to participate in interview using structured questionnaire. Result Among 419 participants,13.6% of participants reported having problem of taking intact medicine. Most of them (12.4% of total participants) experienced difficulty swallowing the medicine. The swallowing difficulty is significantly associated with age and sex (p < 0.05). Around one third (36.8%) of participant with medicine administration problem modified the dosage form of medicines. One quarter of medicine dosage form modifications (25.0%) were inappropriate. Medicine dosage form modification is associated with age and number of daily medicine intake (p < 0.05). Among participants modifying dosage form of medicines, 66.7% were advised to do so mainly by family and friends; 33.3% were modifying on their own and 76.2% were unaware of possible effects of medicine dosage form modification. About 62.3% of total participants were never asked about any problems on taking medicines by doctor/pharmacists. Conclusion Difficulty swallowing medicines and medicine dosage form modification were prevalent in the Nepalese population. Medicine dosage form modifications also involved inappropriate modifications due to specialized design of such dosage forms. So, it seems important to provide proper counseling while dispensing such dosage forms.

Psychosocial Problems among the Adolescent School Students of Dhulikhel Municipality

Background Adolescence is a period when an individual experiences a variety of biological, psychological and social changes. These multiple changes during the developmental period can make the adolescents vulnerable to mental health problems. Therefore early detection of psychosocial problems and addressing the need of the adolescents are crucial for promoting their mental health. Objective To assess psychosocial problems and its associated factors among school going adolescents of Dhulikhel, Nepal. Method A descriptive cross sectional study was conducted among 513 adolescents studying in grade 8 to 12 of randomly selected schools of Dhulikhel Municipality. Data were collected by using structured questionnaire and Pediatric Symptom Checklist-Youth Report (Y-PSC). Descriptive and inferential analysis was done using Statistical Package for Social Sciences version 20. Result Out of 513 adolescent students, a total of 133(25.9%) of the adolescents were found to have psychosocial problems. There was significant association between psychosocial problems and respondents' variables like age, grade, parental education status, respondents' living status, perceived family disputes, perceived marital problems of parents, relationship problem with family, stress of failure in study, punishment faced in home and school, experienced sexual harassment and death of loved ones. Conclusion Various family related factors and stressful life events of adolescents are associated with the psychosocial problems. Hence early intervention focusing on awareness and modification of stressful life events is required.

Knowledge, Attitude, and Practices Related to COVID-19 among Healthcare Personnel in a Tertiary Care Hospital in Nepal: A Cross-sectional Survey

Background COVID-19 is significantly affecting the healthcare system globally. As a result, healthcare workers need to be updated on the best practices for the proper management of the disease. Objective The purpose of this study was to assess the knowledge, attitude, and practices (KAP) related to COVID-19 among healthcare personnel. Method This was a cross-sectional study conducted among medical personnel at Dhulikhel Hospital Kathmandu University Hospital using a semi-structured questionnaire on KAP related to COVID-19 from May 8th to June 8th, 2020. We analyzed survey data by using descriptive statistics. Spearman rank correlation, chi-square test and binary logistic analysis were used to examine the association between sociodemographic characteristics with KAP related to COVID-19. Result Among 220 participants, the majority were nurses (60%) followed by doctors (27.7%), paramedics (10%) and technicians (2.3%). The results showed that 68.6% of healthcare personnel had a good knowledge with appropriate practices (98.5%) and negative attitude (59.3%). In the multivariate binary logistic analysis, the healthcare workers with the clinical experience level of one to five years (OR:.42, 95% CI:.19- .96) and more than 5 years (OR: .16, 95% CI: .04-.63) were significantly associated with negative attitude. The confidence score for managing COVID-19 (OR:1.16, 95% CI:1.02-1.34) was significantly associated with an optimistic attitude. Conclusion Healthcare workers are knowledgeable about COVID-19 and proactively practising to minimize the spread of infection but lack optimistic attitudes. Hence, the constantly updated educational programmes related to COVID-19 for targeted groups will contribute to improving healthcare workers' attitude and practices.

Digital Subtraction Angiography a Door Opener for Neurosurgical Residents who want to Perform Neurointerventional Procedures

Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know the vascular angiography of the brain and spinal cord. The technique in performing this procedure exposes residents in accessing the major vessels, branches of the arch of aorta, selective angiography and diagnosing different vascular anomalies of brain and spine. They are also exposed to the knowledge of different diagnostic catheters, its manipulation, use of dye and radiation exposure and safety. We would like to share our experience in training and disseminating the knowledge of digital subtraction angiography to the residents.

Improving Knowledge, Skill and Confidence of Novice Medical Doctors in Trauma Management with Principles of ABCDE

Background Trauma is one of the major public health concerns clamming about five million death annually worldwide. Experience and confidence of a doctor in the management of trauma patients have big impact on the overall outcome. Objective This study aims to evaluate the outcome of a trauma course in improving the knowledge, skill and confidence of novice doctors in managing trauma victims. Method A pre/post test analytical study was carried out among novice medical doctors from Kathmandu University School of Medical Science (KUSMS) who participated in a standard two and a half day trauma course, that utilizes the principles of ABCDE, as a part of their regular training. Pre-course knowledge and skill were compared with immediate post-course scores on the same guidelines. Objective structured and subjective written feedbacks from the participants were analyzed qualitatively to identify the perceptions of candidates. Result Sixty-eight males and twenty-nine females completed the course. The average pre-test scores in knowledge and skill were 8.3(33.2%) and 19.6(78.5%) respectively. Similarly the post-test scores were 16.04(64.2%) and 22.45 (89.5%) respectively, showing statistically significant improvements (P 0.000). The mean percentage improvement in knowledge was 48.8% and that in skill was 160.9%. The feedback analysis showed majority of the participants were satisfied with the course and they perceived improved "self-confident" in handling trauma cases. Conclusion All the novice doctors should participate in a standard trauma course hence their knowledge, skill and confidence in handling a trauma can be improved.

Analysis of Health Facility Based Perinatal Verbal Autopsy of Electoral Constituency 2 of Arghakhanchi District, Nepal

BACKGROUND

Verbal autopsy is a method to diagnose possible cause of death by analyzing factors associated with death through detailed questioning. This study is a part of the operational research program in electoral constituency no. 2 (EC 2) of Arghakhanchi district by MIRA and HealthRight International.

METHODS

Two day essential newborn care training followed by one day perinatal verbal autopsy training and later one day refresher verbal autopsy training was given for health staff of EC 2 of Arghakhanchi district in two groups. Stillbirths of >22wks or > 500 gms and Early neonatal deaths (newborns died within7 days of life) were included in this study. The Nepal Government approved verbal autopsy forms were used for performing autopsies. Perinatal deaths were classified according to Wigglesworth's Classification. Causes of Perinatal deaths were analyzed. Data were analyzed in the form of frequencies and tabulation in SPSS 16 .

RESULTS

There were 41 cases of perinatal deaths (PND) were identified. Among them, 37 PNDs were from Arghakhanchi district hospital, 2 PNDs from Thada PHC, and one PND each from Subarnakhal and Pokharathok HPs. Among the 41 PNDs, 26 were stillbirths (SB) and 15 were early neonatal deaths (ENND). The perinatal mortality rate (PMR) of Arghakhanchi district hospital was 32.2 per 1,000 births and neonatal mortality rate (NMR) was 9.8 per 1,000 live births. Out of 26 stillbirths, 54% (14) were fresh SBs and 46% (12) were macerated stillbirths. The most common cause of stillbirth was obstetric complications (47%) where as birth asphyxia (53%) was the commonest cause of ENND. According to Wigglesworth's classification of perinatal deaths, Group IV (40%) was the commonest cause in the health facilities.

CONCLUSIONS

Obstetric complication was the commonest cause of stillbirth and birth asphyxia was the commonest cause of early neonatal death. This study highlighted the need for regular antenatal check-ups and proper intrapartum fetal monitoring with timely and appropriate intervention to reduce the incidence of stillbirths and intrauterine asphyxia.

Non-descent Vaginal Hysterectomy: Safety and Feasibility

Aims: To assess safety and feasibility of non-descent vaginal hysterectomy. Methods: A hospital based prospective study was conducted at the department of obstetrics and gynecology of Kathmandu Medical College Teaching Hospital from 1st January 2010 to 31st December 2011. All the patients undergoing non -descent vaginal hysterectomy for benign indication, without suspected adnexal pathology were included in the study. Vaginal hysterectomy was done in usual manner. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing, or combination of these were used to remove the uterus. Data regarding age, parity, uterine size ,estimated blood loss, length of operation, complication and hospital stay were recorded. Results: A total of 50 cases were selected for non-descent vaginal hysterectomy. Among them 43 cases successfully underwent non-descent vaginal hysterectomy. Commonest age group was (41-45 years) i.e. 40%. All patients were parous. Uterus size was <10 weeks in 27 cases and >10 weeks in 23 cases. Commonest indication was leiomyoma of uterus (63%). Mean duration of surgery was two hours. Mean blood loss was 205.26ml. Reasons for failure to perform NDVH was difficulty in opening pouch of Douglas in three cases. In rest of four cases there was difficulty in reaching the myoma and transverse diameter was too large so as to prevent descent of the uterus. The most common complication was post –operative pain in 23% of cases. Febrile morbidity was present in 4.6% of cases. Blood transfusion was required in seven cases. Average duration of hospital stay was three days. Conclusions: Vaginal hysterectomy for benign gynecological causes other than prolapse is safe and feasible. For successful outcome size of uterus, size in all dimensions and location of fibroid should be taken into consideration.Today in the era of minimally invasive surgery, non descent vaginal hysterectomy needs to be considered and seems to be a safe option. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11134   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 14-16

Gestational Trophoblastic Disease: Review of Cases Managed at B P Koirala Memorial Cancer Hospital

Aims: This study was done to analyze the clinical presentation and management outcomes of gestational trophoblastic disease managed at B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal. Methods: Descriptive study was conducted at B.P. Koirala Memorial Cancer Hospital. Case records of all gestational trophoblastic cases from January 2001 to December 2007 were analyzed regarding clinical details, investigations and treatment outcomes. Results: Forty-five cases of 16 to 50 years (mean 29.1 years) had gestational trophoblastic disease, among which 19 (43%) were of Tibeto- Burmese and 15 (33%) Indo-Aryan ethnic group. Hydatidiform mole, invasive mole and choriocarcinoma were observed in 17 (37.8%), six (13.3%) and 22 (48.8%) cases respectively. In seven cases (15.5%) molar pregnancy had occurred in primigravida, seven cases (15.5%) had previous molar pregnancy and in 16 (35.5%) cases GTD had occurred following abortion. Vaginal bleeding was the commonest presentation and 26 (57.8%) cases had anaemia. Eleven (24.5%) cases had theca luteal cyst, 17 (37.8%) had lung metastasis and 4 (8.9%) had brain metastasis. Chemotherapy was administered in 34 (75.5%) cases, among which 15 (33.3%) received single agent and 18 (40%) received multiagent chemotherapy. Hysterectomy was done in nine (20%) cases. Brain irradiation was done in a case with brain metastasis. Five (11.2%) cases with high WHO risk score left the hospital against medical advice. There were three (6.6%) mortalities. Thirty-seven (72.1%) cases were in remission and follow-up. Conclusions: Early diagnosis of disease and proper management strongly influences the outcome of GTD. Even in disseminated state GTD can be cured. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 18-21 DOI: http://dx.doi.org/10.3126/njog.v8i1.8855

Study on the Prevalence of Beta Haemolytic Streptococcus Among School Children

Introduction: Βeta haemolytic streptococcal infections have a worldwide distribution among children and it poses an important health problem globally. So, a five months study was conducted to know the prevalence of beta haemolytic streptococci (BHS) in the throat of school children. Materials and Methods: Throat swabs from 200 school children of Kirtipur were collected, transported to the laboratory and were processed for BHS following standard microbiological procedures. Group A Streptococci (GAS) were identified by beta haemolytic colonies, bacitracin sensitivity and catalase negativity test. ASO test was also performed from serum samples. Result: Altogether 18 (9%) BHS isolates were identified from 200 samples, out of which 11 (5.5%) isolates were from males and 7 (3.5%) were from females. Among the 18 BHS isolates, 10 were identified as GAS isolates. The number of GAS presented only 5% of total sample. There was no significant sex difference in colonization of GAS (p> 0.05). Majority of cases were asymptomatic. All GABHS isolates were sensitive to Penicillin. In Serological examination, i.e. Antistreptolysin O (ASO) titre, all serum samples showed less than 200 IU ASO titre. Conclusion: This result highlights the current situation of GABHS throat infection in school children of Kirtipur. DOI: http://dx.doi.org/10.3126/jnps.v33i1.7004 J Nepal Paediatr Soc. 2013;33(1):45-47

Immunophenotypic study of acute leukemia by flow cytometry at BPKMCH

Background: Immunophenotyping of acute leukemia is one of the most important clinical applications of fl ow cytometry. The aim of this study was to determine the immunophenotyping profi le of acute leukemia, by means of a fl ow cytometric method, using monoclonal antibodies all marked with a fl uorochrome, in four colour systems to assess their distribution according to type of leukemia (lymphoid B or T / myeloid). Materials and Methods: We retrospectively collected data of immunophenotyping from 52 acute leukemia patients at the department of pathology in B.P. Koirala Memorial Cancer Hospital from January 2010 to December 2011. Diagnosis was based on peripheral blood and bone marrow examination for morphology, cytochemistry and immunophenotypic studies. Results: Out of total 52 cases of acute leukemia diagnosed by fl ow cytometry over a two year period, there were 31 cases (59.6 %) of acute lymphoblastic leukemia, 20 cases (38.4 %) of acute myelogenous leukemia and one case (1.9 %) of bi-phenotypic acute leukemia. Leukemia was diagnosed among adults in 44.2 % whereas among children with age less than or equal to 15 years in 55.7 %. Thirty eight (73%) were male and 14 (27 %) were female with a male: female ratio of 2.7:1. For acute myelogenous leukemia, it was found that M0 (5.0 %), M1 (20%), M2 (60%), M3 (15%), M4 (5.0 %) were detected. CD13 and CD33 were the most useful markers in the diagnosis of acute myelogenous leukemia. The most common subtype was AML-M2. Of the 31 cases with acute lymphoblastic leukemia, 20 cases (64.5 %) were identifi ed as B-ALL and 11 cases (35.5%) as T-ALL. Aside from cytoplasmic CD3 (cCD3) and CD7 were the most sensitive antigens present in all cases of T-ALL. All cases of B-ALL showed expression of pan B-cell markers CD19 and CD22, but 15 (75 %) of 20 cases expressed CD10. Conclusion: Flow cytometric immunophenotyping was found to be especially useful in the correct identifi cation and diagnosis of acute myeloid or lymphoblastic leukemia and its subtypes. In combination with French-American-British (FAB) morphology and immunophenotyping, we were able to diagnose and classify all patients with acute leukemia in this study. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 345-350 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7856

Experiences of gynecological laparoscopic surgeries in a teaching hospital

BACKGROUND

Laparoscopic surgery has revolutionised the field of gynaecological surgery. Presently, almost all gynaecological procedures can find an alternative laparoscopic or hysterescopic approach. The aim of the study was to share the early experience of gynecological laparoscopic surgeries performed at Kathmandu Medical College Teaching Hospital.

METHODS

A study was carried out at Kathmandu Medical College Teaching Hospital from 1st January 2009 to 16th August 2012. All the patients undergoing gynecological laparoscopic surgeries were analyzed for the indication, type of procedure and its complications.

RESULTS

Overall 300 patients successfully underwent laparoscopy during the study period of which diagnostic laparoscopy was in 115. Operative laparoscopy was in 185. Sixty five cases underwent laparoscopic cystectomy. Sixty cases underwent laparoscopic assisted vaginal hysterectomy (LAVH). Salpingectomy for ectopic pregnancy was done in sixteen cases. Twelve cases contemplated for laparoscopic cystectomy underwent laparotomy. LAVH was converted to abdominal hysterectomy in four cases and laparotomy was done in two cases because of bladder injury and primary hemorrhage (from vault). Of minor complications the most common was port site infection and post-operative nausea and vomiting.

CONCLUSIONS

Laparoscopic gynecological surgery has tremendous potential in Nepal. Most of the surgeries can be carried out safely and favorable outcome has been noted in all the cases undertaken.

Soil nitrogen dynamics in a river floodplain mosaic

In their natural state, river floodplains are heterogeneous and dynamic ecosystems that may retain and remove large quantities of nitrogen from surface waters. We compared the soil nitrogen dynamics in different types of habitat patches in a restored and a channelized section of a Thur River floodplain (northeast Switzerland). Our objective was to relate the spatiotemporal variability of selected nitrogen pools (ammonium, nitrate, microbial nitrogen), nitrogen transformations (mineralization, nitrification, denitrification), and gaseous nitrogen emission (NO) to soil properties and hydrological processes. Our study showed that soil water content and carbon availability, which depend on sedimentation and inundation dynamics, were the key factors controlling nitrogen pools and processes. High nitrogen turnover rates were measured on gravel bars, characterized by both frequent inundation and high sediment deposition rates, as well as in low-lying alluvial forest patches with a fine-textured, nutrient-rich soil where anaerobic microsites probably facilitated coupled nitrification-denitrification. In contrast, soils of the embankment in the channelized section had comparatively small inorganic nitrogen pools and low transformation rates, particularly those related to nitrate production. Environmental heterogeneity, characteristic of the restored section, favors nitrogen removal by creating sites of high sedimentation and denitrification. Of concern, however, are the locally high NO efflux and the possibility that nitrate could leach from nitrification hotspots.

Cancer with pregnancy in a cancer hospital

BACKGROUND

Cancer during pregnancy is rare, occurring one in every 1,000 pregnancies. Cancer itself rarely harms the baby and some cancer treatments are safe during pregnancy. However, treatment dilemmas often occur.

METHODS

Descriptive study was conducted at B. P. Koirala memorial cancer hospital. Case records of women with cancer and pregnancy from January 2001 to February 2012 were analyzed regarding their clinical details, treatment, follow-up and feto-maternal outcome.

RESULTS

Nineteen women, of 17 to 40 years had cancer with pregnancy. Observed cancers with pregnancy were: leukemia (4), head and neck (3), ovary (3), cervix (2), rectum (2), breast (1), Non-Hodgkin's lymphoma (1), osteosarcoma (1), spinal cord (1) and vulva (1). Seven women (36%) presented in the second trimester and six women (32%) presented in the first and third trimester each. Seven (36%) women opted for termination of pregnancy for definitive treatment, five (26%) deferred treatment until delivery. Among the seven (36%) that accepted definitive treatment along with pregnancy, fetal demise occurred in three and delivery of healthy baby occurred in four. Nine babies born to mothers with cancer during pregnancy till date have normal growth and development. Total 10 (52%) of the mothers are in remission, six (32%) have died from disease.

CONCLUSIONS

Cancers during pregnancy, more common in younger women, posed treatment challenges. Definitive cancer treatment could have greater fetal risk during the first trimester but could be offered with more acceptable risk in the second and third trimesters.

Analysis of carbon and nitrogen dynamics in riparian soils: model validation and sensitivity to environmental controls

The Riparian Soil Model (RSM) of Brovelli et al. (2012) was applied to study soil nutrient turnover in a revitalized section of the Thur River, North-East Switzerland. In the present work, the model was calibrated on field experimental data, and satisfactorily reproduced soil respiration, organic matter stocks and inorganic nitrogen fluxes. Calibrated rates were in good agreement with the ranges reported in the literature. The main discrepancies between model and observations were for dissolved organic carbon. The sensitivity of the model to environmental factors was also analyzed. Soil temperature was the most influential factor at daily and seasonal scales while effects of soil moisture were weak overall. The ecosystem sensitivity to temperature changes was quantified using the Q10 index. The seasonal behavior observed was related to the influence of other forcing factors and to the different state (density and activity) of the microbial biomass pool during the year. Environmental factors influencing microbial decomposition, such as the C:N ratio and litter input rate, showed intermediate sensitivity. Since these parameters are tightly linked to the vegetation type, the analysis highlighted the effect of the aboveground ecosystem on soil functioning.

Isolation and characterization of aerobic culturable arsenic-resistant bacteria from surfacewater and groundwater of Rautahat District, Nepal

Arsenic (As) contamination of groundwater is a serious Environmental Health Management issue of drinking water sources especially in Terai region of Nepal. Many studies have reported that due to natural abundance of arsenic in the environment, various bacteria have developed different resistance mechanisms for arsenic compound. In this study, the culturable arsenic-resistant bacteria indigenous to surfacewater as well as groundwater from Rautahat District of Nepal were randomly isolated by standard plate count method on the basis of viable growth on plate count agar amended with arsenate ranging from 0, 0.5, 10, 40, 80 to 160 milligram per liter (mg/l). With respect to the morphological and biochemical tests, nine morphologically distinct potent arsenate tolerant bacteria showed relatedness with Micrococcus varians, Micrococcus roseus, Micrococcus luteus, Pseudomonas maltophilia, Pseudomonas sp., Vibrio parahaemolyticus, Bacillus cereus, Bacillus smithii 1 and Bacillus smithii 2. The isolates were capable of tolerating more than 1000 mg/l of arsenate and 749 mg/l of arsenite. Likewise, bioaccumulation capability was highest with M. roseus (85.61%) and the least with B. smithii (47.88%) indicating the potential of the organisms in arsenic resistance and most probably in bioremediation.

A new species of gravel-dwelling loach (Ostariophysi: Nemacheilidae) from the Nepalese Himalayan foothills

Turcinoemacheilus himalaya, new species, is described from the Koshi and Gandaki River basins of Nepal. The new species is distinguished from its hypothesised congener, Turcinoemacheilus kosswigi, from the Euphrates, Tigris and Karoun basins of the Middle East, by the presence of small scales on the posterior half of its body (v. absence of all scales), its shorter caudal peduncle (caudal peduncle length 12-15% standard length, L(S) v. 16-23), its shorter snout (snout length 28-36% head length, L(H) v. 40-49) and by features of its colour pattern, including the presence of small irregularly shaped dark grey markings over the lateral body surface. Turcinoemacheilus himalaya is known to date only from Nepal.

Analysis of perinatal deaths and ascertaining perinatal mortality trend in a hospital

BACKGROUND

Perinatal mortality rate is very high in developing countries including Nepal. Analyzing perinatal deaths help in identifying preventable factors thus help in reducing it. Analysis of causes of perinatal deaths over a period in a hospital will help to identify the perinatal mortality trend and preventable factors thus help in taking corrective measures to reduce the perinatal mortality rate. The aim of the study is to analyse perinatal deaths and ascertain perinatal mortality trend of Kathmandu Medical College Teaching hospital in the last 8 year period.

METHODS

Stillbirths and early neonatal deaths from 2002 to 2011 are collected from the register book of the labour room, special care baby unit and operation theatre of the hospital. Perinatal mortality rate and extended perinatal mortality rates are calculated and perinatal deaths were classified according to Wigglesworth's classification. Trend of Perinatal and Extended Perinatal mortality rates, stillbirth rates and early neonatal death rates among 5 perinatal death audits of the hospital were compared.

RESULTS

In the first perinatal death audit (Oct '02-Sept '03) perinatal mortality rate (PMR) was recorded as 30.7 per 1000 births and extended perinatal mortality rate (EPMR) as 47.9 per 1000 births, where as in the fifth perinatal death audit (Apr '10-Mar '11) PMR was recorded as 14.4 per 1000 births and EPMR as 19.6 per 1000 births. In Wigglesworth's classification, in the first perinatal death audit, most of the perinatal deaths were in group IV (41%) reflecting more asphyxial deaths however in fifth audit, group III mortality (41%) was highest indicating death of low birth weight or preterm babies. In the first audit, stillbirth rate (SBR) excluding <1 kg was 18.1 per 1000 births and early neonatal deaths (ENND) excluding <1 kg was 12.9 per 1000 live births. In the fifth audit, SBR (excluding <1 kg) and ENND rate (excluding <1 kg) were 7.1 per 1000 births and 7.2 per 1000 live births respectively reflecting declining trend of both SBR and ENND rate in the hospital.

CONCLUSIONS

Distinct declining trend in PMR, EPMR, SBR and ENND rates at KMCTH were noted. As asphyxial deaths have been reduced significantly, more intensive efforts are needed to prevent premature births with care of preterm and very low birth weight babies.

Role of laparoscopy in diagnosis and treatment of ectopic pregnancy

Laparoscopy has a great role in early and effective diagnosis and treatment of ectopic pregnancy. This study was carried out to evaluate the feasibility and role of laparoscopy in diagnosis and treatment of ectopic pregnancy. This is a prospective observational study conducted in the Department of Obstetrics and Gynaecology, Kathmandu Medical College Teaching Hospital from April 2009 to March 2011. All the women who underwent laparoscopy for ectopic pregnancy or diagnosed as ectopic pregnancy during laparoscopy done for other diagnosis were included. Data were collected by interviewing patients, operating surgeons, reviewing charts and operative notes and following up patients. There were 42 cases of ectopic pregnancy during study period, of whom 16 (38.1%) underwent laparoscopy. Preoperative diagnosis of ectopic pregnancy was confirmed clinically in 6 (37.5%) patients, who underwent laparoscopy as an operative procedure. In the remaining 6 (37.5%), laparoscopy was performed as a diagnostic procedure as clinical diagnosis was doubtful; two cases of negative laparoscopy was noted. Incidental diagnosis of ectopic pregnancy was made in another 4 (25%) patients who had undergone laparoscopy for other pre operative diagnosis. All the patients were surgically managed by laparoscopy without converting it to laparotomy. There were no intraoperative or postoperative complications except for primary port infection in few (25%). Therefore, laparoscopy has a significant role in the diagnosis of ectopic pregnancy and operative laparoscopy is a safe approach with minimal complications.

Bacteriuria and urinary retention following gynaecological surgery: comparing short vs long term catheterization

BACKGROUND

Post operative bladder drainage is important care following gynaecological surgeries. This study was done to compare the incidence of urinary retention and bacteriuria following long term versus short term catheterization.

METHODS

The patients who were admitted for gynaecological major surgeries were enrolled in this study. One group of patients had post operative indwelling catheterization for 24 hrs (short term catheterization) and another group of patients had catheterization for more than 48 hrs (long term catheterization). The urine examination and culture sensitivity was sent for all patients at the removal of catheter. The patients were followed after removal of catheter for urinary retention.

RESULTS

Total of 102 patients were studied. There were 48 patients in short term catheterization group and 54 patients in long term catheterization group. In short term catheterization group, 3 (6.2%) cases had bacteriuria and no cases of urinary retention were observed. In prolonged catheterization group, 6 cases (11.1%) had bacteriuria and 2 cases (3.7%) had urinary retention.

CONCLUSIONS

This study has concluded that short time catheterization following gynaecological surgery had fewer incidences of bacteriuria and urinary retention than long term catheterization.

Safety and Efficacy of Misoprostol and Dinoprostone as Cervical Ripening Agents

INTRODUCTION: The study compares safety and efficacy of misoprostol and dinoprostone as cervical ripening agents. METHODS: Patients with term, vertex, singleton pregnancy and Bishop score of 4 or less were randomly assigned to receive misoprostol pessary (n=35, 50 microg intravaginally) or dinoprostone gel (n=31, 0.5 mg intracervically) at 6 hourly intervals. If there were no progress in cervical dilatation or effective uterine contraction even after maximum dose, patients were taken for cesarean section. Patients who achieved Bishop's score more than 7 but the delivery was not progressing, were augmented with oxytocin drip. RESULTS: No uterine hyperstimulation was observed in both groups. However, abnormal fetal heart rate was observed in 3(8.6%) cases inmisoprostol group and 2 (6.5%) in dinoprostone group. There was no statistically significant difference in meconium passage in two groups. Apgar score less than 7 at 1 minute was seen in 6 (19.4%) and 11 (31.4%) neonates in dinoprostone and misoprostol group respectively. However Apgar score less than 7 at 5 minutes was found in only one neonate of dinoprostone treated patient. Both drugs were found to be equally effective in improving Bishops score with no significant difference in mean induction to delivery time. Cesarean section was done among 32.3% and 28.6% respectively in dinoprostone and misoprostol groups. There was significant reduction in the need for oxytocin augmentation in misoprostol (37.1%) group than in dinoprostone (67.7%) group. CONCLUSIONS: Vaginal misoprostol is an effective, safer and cheaper alternative to dinoprostone as a cervical ripening agent in underdeveloped countries. Keywords: Apgar score, Bishops score, cervical ripening, Dinoprostone, induction, Misoprostol

Safety and efficacy of misoprostol and dinoprostone as cervical ripening agents

INTRODUCTION

The study compares safety and efficacy of misoprostol and dinoprostone as cervical ripening agents.

METHODS

Patients with term, vertex, singleton pregnancy and Bishop score of 4 or less were randomly assigned to receive misoprostol pessary (n=35, 50 microg intravaginally) or dinoprostone gel (n=31, 0.5 mg intracervically) at 6 hourly intervals. If there were no progress in cervical dilatation or effective uterine contraction even after maximum dose, patients were taken for cesarean section. Patients who achieved Bishop's score more than 7 but the delivery was not progressing, were augmented with oxytocin drip.

RESULTS

No uterine hyperstimulation was observed in both groups. However, abnormal fetal heart rate was observed in 3(8.6%) cases in misoprostol group and 2 (6.5%) in dinoprostone group. There was no statistically significant difference in meconium passage in two groups. Apgar score less than 7 at 1 minute was seen in 6 (19.4%) and 11 (31.4%) neonates in dinoprostone and misoprostol group respectively. However Apgar score less than 7 at 5 minutes was found in only one neonate of dinoprostone treated patient. Both drugs were found to be equally effective in improving Bishops score with no significant difference in mean induction to delivery time. Cesarean section was done among 32.3% and 28.6% respectively in dinoprostone and misoprostol groups. There was significant reduction in the need for oxytocin augmentation in misoprostol (37.1%) group than in dinoprostone (67.7%) group.

CONCLUSIONS

Vaginal misoprostol is an effective, safer and cheaper alternative to dinoprostone as a cervical ripening agent in underdeveloped countries.

BACTERIOLOGICAL STUDY OF EAR DISCHARGE IN BIR HOSPITAL

Discharge from the ear is one of the commonest symptoms of infections of the ear.With a view to study the major strains of bacteria encountered in ear discharges, thisstudy was conducted in Microbiology Laboratory, Bir Hospital. The study wasconducted for a period of 6 months from January 2000 - July 2000. A total of 224samples of aural discharges of the outpatients were collected and analysed for bacterialgrowth. These samples were cultured with the use of standard microbiologicaltechniques and the antibiotic sensitivity pattern of the isolates was also studied invitro with the use of disc diffusion method. Among 224 patients, 50.9% were male and49.1% were female and the age of the patients varied from 6 months to 76 years.Majority of the patients with discharging ear belonged to the age group 11-20 years.Bacterial growth was found in 82.6%. The bacterial isolates were of 13 differentspecies. Staphylococcus aureus was the most frequently isolated organism (49.4%)followed by Pseudomonas aeruginosa(20.9%). Other organisms isolated wereCoagulase negative Staphylococci (CONS), Streptococcus spp., Bacillus sps., Escherichiaspp., Proteus spp., Enterobacter spp., Klebsiella spp., Acinetobacter spp., Edwardsiellaspp.The prevalence of gram positive bacterial isolates was higher than gram negativebacterial isolates. 58.0% of samples showed positive correlation with direct smeargram stain and culture results. Among the antibiotics used, Ciprofloxacin was foundto be the most effective (80.2%) for overall bacterial isolates followed by Gentamicin(68.9%). The result of antibiotic sensitivity was almost similar to gram positive aswell as gram negative isolates.Key Words: Aural discharge, Gram stain, culture, sensitivity.

Multi-centre evaluation of repeatability and reproducibility of the direct agglutination test for visceral leishmaniasis

OBJECTIVE

To evaluate the repeatability and reproducibility of the serological direct agglutination test (DAT) for visceral leishmaniasis (VL) with aqueous antigen in a multi-centre study in VL-endemic areas in Sudan, Kenya and Nepal.

METHODS

Repeatability within each centre and reproducibility between the centres' results and an external reference laboratory (Belgium) was assessed on 1596 triplicate plain blood samples collected on filter paper.

RESULTS

High kappa values (range 0.86-0.97) indicated excellent DAT repeatability within the centres. The means of the titre differences between the reference laboratory and the centres in Sudan, Kenya and Nepal (2.3, 2.4 and 1.1, respectively, all significantly different from 0) showed weak reproducibility across centres. 95% of the titre differences between the reference laboratory and the respective centres were accounted for by large intervals: 0.6-9 fold titre variation for Sudan, 0.7-8 fold for Kenya and 0.26-4 fold for Nepal.

CONCLUSION

High repeatability of DAT confirms its potential, but reproducibility problems remain an obstacle to its routine use in the field. Reproducibility was hindered by alteration of the antigen through temperature and shaking, especially in Kenya and Sudan, and by nonstandardization of the test reading. DAT handling procedures and antigen quality must be carefully standardized and monitored when introducing this test into routine practice.

Ancylostoma duodenale is responsible for hookworm infections among pregnant women in the rural plains of Nepal

Fecal specimens from 292 pregnant women (ages 15-40 yr) and 129 infants (ages 10-20 wk) were examined for helminth eggs by the Kato-Katz method and cultured for helminth larvae identification using a modified Harada Mori method. These specimens were collected from June 1995 through July 1996 in Sarlahi District in the southern rural plains of Nepal. Among pregnant women, the prevalence of helminth infection by the Kato-Katz method was 78.8%, 56.2%, and 7.9% for hookworm, Ascaris lumbricoides, and Trichuris trichiura, respectively. Using the modified Harada-Mori method, 66.1% and 2.0% of women's fecal cultures were positive for hookworm and Strongyloides stercoralis, respectively. All of the cultured hookworm larvae were identified as Ancylostoma duodenale. Among infants, 1 specimen was positive for hookworm and 1 for A. lumbricoides using the Kato-Katz method. The modified Harada Mori method detected no larvae in specimens from infants. There was 81.8% agreement between the 2 methods for the detection of hookworm infection. Ancylostoma duodenale is endemic in this study population and highly prevalent in pregnant women.

Molecular epidemiology of Vibrio cholerae O1 isolated in Nepal by southern hybridization with a cholera toxin gene probe

A cholera epidemic broke out in 1992 due to Vibrio cholerae O1 biotype El Tor in the eastern and southern belt of Nepal mainly among the Bhutanese refugees. Restriction fragment profiles (RFP) of DNA fragments of V. cholerae O1 isolates hybridized with an enzyme-labelled oligonucleotide probe for cholera toxin gene (ctx) by Southern Hybridization were compared. The probe hybridized with the 13- and 8-kb fragments of PstI-digested total DNA in all isolates observed in the epidemic. This RFP in the Nepalese strain was not observed in the strains isolated during other epidemics but was observed in the strains isolated from the exported marine products from Taiwan and Thailand.

Etiological spectrum of acute sporadic viral hepatitis amongst adults in Chandigarh

All 77 HBsAg positive and 94 of representative HBsAg negative sera derived from 253 adult patients with acute sporadic viral hepatitis during 1987 at Chandigarh were tested for serological markers of hepatitis B virus (HBV) and hepatitis A virus (HAV) infections. The HBsAg positive patients could be classified as acute hepatitis B (64%); chronic hepatitis B with exacerbation, or liver damage by other infectious or noninfectious agent/s over a chronic HBsAg carrier state (35%); and coinfection of HBV and HAV (1%). Among the HBsAg negative hepatitis group, acute hepatitis B was diagnosed in 4 per cent of patients and acute hepatitis A in another 4 per cent.