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Panthee N, Pradhan S, Koirala R, Pant AD, Pokhrel B, Shah SC, Timala RB. Pericardial cyst in a one-year-old boy with ventricular septal defect and patent ductus arteriosus. Egypt Heart J 2022; 74:39. [PMID: 35575838 PMCID: PMC9110594 DOI: 10.1186/s43044-022-00278-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pericardial cysts are rare, with the most common etiology being congenital. Ventricular septal defect is the most common congenital heart disease in children. However, the combination of pericardial cyst, ventricular septal defect, and patent ductus arteriosus is extremely rare. CASE PRESENTATION A one-year-old boy with ventricular septal defect and patent ductus arteriosus was planned for surgical correction. Intraoperatively, we made an additional diagnosis of a large pericardial cyst; and the cyst was excised along with ventricular septal defect closure and patent ductus arteriosus ligation. CONCLUSIONS Pericardial cysts can sometimes be missed with transthoracic echocardiography. Excision of the cyst can safely be done during concomitant cardiac surgery.
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Affiliation(s)
- Nirmal Panthee
- Department of Cardiac Surgery, Shahid Gangalal National Heart Center, Bansbari, Kathmandu, Nepal.
| | - Sidhartha Pradhan
- Department of Cardiac Surgery, Shahid Gangalal National Heart Center, Bansbari, Kathmandu, Nepal
| | - Raamesh Koirala
- Department of Cardiac Surgery, Shahid Gangalal National Heart Center, Bansbari, Kathmandu, Nepal
| | - Anil Dev Pant
- Department of Pathology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Bishow Pokhrel
- Department of Cardiac Surgery, Shahid Gangalal National Heart Center, Bansbari, Kathmandu, Nepal
| | - Subhash Chandra Shah
- Department of Pediatric Cardiology, Shahid Gangalal National Heart Center, Bansbari, Kathmandu, Nepal
| | - Rabindra Bhakta Timala
- Department of Cardiac Surgery, Shahid Gangalal National Heart Center, Bansbari, Kathmandu, Nepal
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Panthee N, Shrestha BK, Pradhan S, Koirala R, Pokhrel B, Chaurasiya A, Paudel A, Kc R. Elective re-intubation to treat complete left lung collapse following Tetralogy of Fallot repair in a very young child. Clin Case Rep 2022; 10:e05792. [PMID: 35498358 PMCID: PMC9043723 DOI: 10.1002/ccr3.5792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/04/2022] [Indexed: 11/06/2022] Open
Abstract
An 18-month-old boy weighing 6 kilograms developed complete collapse of left lung following total correction of Tetralogy of Fallot on the next day of extubation. He received extensive chest physiotherapy, along with lung recruitment maneuver by using bubble CPAP, which failed to show any improvement in lung expansion in 2 days. He was then electively intubated on 3rd postoperative day (POD3) for the purpose of suctioning tracheobronchial secretions and maintaining positive airway pressure to open up the left lung. Good results were obtained immediately after intubation, and he was extubated 9 h later. His lung showed complete aeration afterward. He was transferred out of ICU on POD5 and discharged home on POD10.
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Affiliation(s)
- Nirmal Panthee
- Department of Cardiac Surgery Shahid Gangalal National Heart Center Kathmandu Nepal
| | - Battu Kumar Shrestha
- Department of Anesthesiology Shahid Gangalal National Heart Center Kathmandu Nepal
| | - Sidhartha Pradhan
- Department of Cardiac Surgery Shahid Gangalal National Heart Center Kathmandu Nepal
| | - Raamesh Koirala
- Department of Cardiac Surgery Shahid Gangalal National Heart Center Kathmandu Nepal
| | - Bishow Pokhrel
- Department of Cardiac Surgery Shahid Gangalal National Heart Center Kathmandu Nepal
| | - Abhishek Chaurasiya
- Department of Cardiac Surgery Shahid Gangalal National Heart Center Kathmandu Nepal
| | - Amita Paudel
- Department of Cardiac Surgery Shahid Gangalal National Heart Center Kathmandu Nepal
| | - Rumi Kc
- Department of Cardiac Surgery Shahid Gangalal National Heart Center Kathmandu Nepal
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Baral P, Hann K, Pokhrel B, Koirala T, Thapa R, Bijukchhe SM, Khogali M. Annual consumption of parenteral antibiotics in a tertiary hospital of Nepal, 2017-2019: a cross-sectional study. Public Health Action 2021; 11:52-57. [PMID: 34778016 PMCID: PMC8575388 DOI: 10.5588/pha.21.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022] Open
Abstract
SETTING Patan Hospital, a tertiary care hospital in Lalitpur District, Nepal. OBJECTIVES To describe the annual parenteral antibiotic consumption in 1) defined daily dose (DDD) and DDD per 100 admissions; 2) calculate DDD per 100 admissions and proportions by pharmacological subgroup, chemical subgroup and AWaRe categories; and 3) describe patient expenditure on parenteral antibiotics as a proportion of the total patient expenditure on drugs and consumables between 2017 and 2019. DESIGN This was a cross-sectional study. RESULTS Total DDD of parenteral antibiotics increased by 23% from 39,639.7 in 2017 to 48,947.7 in 2019. DDD per 100 admissions increased by 10% from 172.1 in 2017 to 190.2 in 2019. Other beta-lactam antibacterials comprised the most frequently consumed pharmacological subgroup. The chemical substance most often consumed was ceftriaxone, with an increasing trend in the consumption of vancomycin and meropenem. Parenteral antibiotics in 'Watch' category were the most consumed over the study period, with a decreasing trend in 'Access' and increasing trend in 'Reserve' categories. CONCLUSION We aimed to understand the consumption of parenteral antibiotics at a tertiary care hospital and found that Watch antibiotics comprised the bulk of antibiotic consumption. Overconsumption of antibiotics from the 'Watch' and 'Reserve' categories can promote antimicrobial resistance; recommendations were therefore made for their rational use.
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Affiliation(s)
- P Baral
- Department of Pharmacy, Modern Technical College, Sanepa, Lalitpur, Nepal
| | - K Hann
- Sustainable Health System, Freetown, Sierra Leone
| | - B Pokhrel
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - T Koirala
- Dasharathpur Primary Health Centre, Department of Health Services, Ministry of Health and Population, Surkhet, Nepal
| | - R Thapa
- Department of Pharmacy, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - S M Bijukchhe
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - M Khogali
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
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Thapa L, Shrestha A, Pradhan M, Bhandari TR, Shrestha S, Poudel RS, Poudel R, Pokhrel B. Status of Vitamin D and its Association with Stroke Risk Factors in Patients with Acute Ischemic Stroke in a Tertiary Care Hospital. JNMA J Nepal Med Assoc 2014; 52:935-939. [PMID: 26982669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Vitamin D deficiency has been associated with many neurological illnesses. The status of Vitamin D in Nepalese ischemic stroke patients is still unknown. This study aims to assess the status of vitamin D and its association with stroke risk factors in patients with acute ischemic stroke from Central Nepal. METHODS A total of 60 patients with ischemic stroke were included in the study. Their clinical profile and Vitamin D status were assessed. Frequency distribution, Pearson χ2test and Kruskal-Wallis test were performed for statistical analysis using SPSS-IBM 20. RESULTS The median (IQR) age of the patient was 65 (53.25, 70.75) years, ranging from 18-87 years. Thirty-four (56.7%) were males. Fourty-eight (80%) patients had hypertension and 34 (56.7%) were smoker. Previous stroke was present in six (10%) cases. Thirty-seven (61.6%) patients had low levels of Vitamin D out of which 26 (43.3%) had vitamin D insufficiency and 11 (18.3%) had vitamin D deficiency. Vitamin D level was significantly associated with previous history of stroke (P=0.043). CONCLUSIONS Vitamin D deficiency occurs in patients with ischemic stroke. Previous episodes of stroke with low vitamin D levels could be a cause of recurrent strokes. Further studies are necessary to establish the role of vitamin D in acute ischemic stroke in Nepalese population.
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Affiliation(s)
- L Thapa
- National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - A Shrestha
- Khairanitar Primary Health Center, Nuwakot, Nepal
| | - M Pradhan
- College of Medical Sciences-Teaching Hospital, Chitwan, Nepal
| | | | - S Shrestha
- Shree Medical and Technical College, Chitwan, Nepal
| | - R S Poudel
- Chitwan Medical College Teaching Hospital, Chitwan, Nepal
| | - R Poudel
- Grande International Hospital, Dhapasi, Kathmandu, Nepal
| | - B Pokhrel
- Kathmandu University Medical College, Dhulikhel, Nepal
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Adhikari R, Tayal A, Chhetri PK, Pokhrel B. Acute Disseminated Encephalomyelitis Following Typhoid Fever: A Case Report. J Coll Med Sci-Nepal 2014. [DOI: 10.3126/jcmsn.v9i4.10237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The involvement of central nervous system in children with typhoid fever is common. Acute disseminated encephalomyelitis is a rare immune mediated and demyelinating disease of the central nervous system that usually affects children. We report a 7-year-old child with typhoid fever who developed acute cerebellar syndrome due to acute disseminated encephalomyelitis.Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 55-58 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10237
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Kalita A, Kamrupi IR, Pokhrel B, Dolui SK. Polymer-supported heterogeneous titanium-based Ziegler-Natta catalyst for ethylene polymerization. J Appl Polym Sci 2012. [DOI: 10.1002/app.36347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kamrupi IR, Pokhrel B, Kalita A, Boruah M, Dolui SK, Boruah R. Synthesis of macroporous polymer particles by suspension polymerization using supercritical carbon dioxide as a pressure-adjustable porogen. Adv Polym Technol 2011. [DOI: 10.1002/adv.20246] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Pokhrel B, Kalita A, Dolui SK. Synthesis, Characterization, and Study of Electrochemical Behavior of N-alkyl Substituted Polycarbazole Derivatives. INT J POLYM MATER PO 2011. [DOI: 10.1080/00914037.2011.557811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pokhrel B, Konwer S, Dutta A, Huda MK, Ghosh B, Dolui SK. Study of photovoltaic performance of host-guest system comprising photoluminescent polyurethane and rhodamine B dye. J Appl Polym Sci 2011. [DOI: 10.1002/app.34430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gurung RB, Joshi G, Gautam N, Pant P, Pokhrel B, Koju R, Bedi TR. Upper gastro-intestinal bleeding: aetiology and demographic profile based on endoscopic examination at Dhulikhel Hospital, Kathmandu University Hospital. Kathmandu Univ Med J (KUMJ) 2011; 8:208-11. [PMID: 21209537 DOI: 10.3126/kumj.v8i2.3560] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The upper gastrointestinal bleeding (UGIB) is defined as bleeding within the intraluminal gastrointestinal tract from any location between the upper oesophagus to the duodenum at the ligament of Treitz. It is one of the important medical emergencies worldwide. OBJECTIVE The objective of this study is to study the aetiology of upper gastrointestinal bleeding based on endoscopic examination findings in patients of various demographic characteristics. MATERIALS AND METHODS This is a retrospective observational study. The endoscopic record book from 2007 January to 2009 October was reviewed for all the cases who underwent oesophago-gastro-duodenoscopic examination for upper GI bleeding. The clinico-epidemiological data of all the patients was reviewed and analyzed in concert with the aetiology of bleeding. RESULTS A total of 90 patients (58 males, 32 females; mean age 45.32+ 18.47 years) of upper gastrointestinal bleeding was studied and analyzed in terms of aetiology of bleeding and demographic profile. Among the ethnic groups, Aryan 46 (51%) was the most common ethnic group to have upper GI bleeding followed by Newars 24 (27%), Mongolians 16 (18%), Dalits 3 (3%) and others 1 (1%). Out of 90 patients, 47( 52.2%) cases was less than 45 years of age, 30(33.3%) of 46 to 65 age ; and 13(14.4 %) more than 65 years of age. Gastric ulcer 23(25.6%) was the most common endoscopic finding, followed by oesophageal varices 14 (15.6%), acute erosive/haemorrhagic gastropathy 11 (12.2%), duodenal ulcer 9(10%), growth 7(7.8%), vascular lesions 3(3.3%), Mallory-Weiss tear 1(1.1%), fundal varices 1(1.1%) and, no cause was identified in 21(23.3%) cases. The peptic ulcer bleeding was the most common finding in Aryan 22(47.9%), whereas oesophageal varices and growth were more common in Newar 7(29.2%) and 3 (12.5%) respectively. CONCLUSION Peptic ulcer disease is the most common cause of upper GI bleeding which was most commonly found in Aryan population; followed by oesophageal varices and growth as second and third most common causes and were more prevalent in Newar and Mongolian people.
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Affiliation(s)
- R B Gurung
- Department of Internal Medicine, Dhulikhel Hospital Kathmandu University School of Medical Science.
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Shrestha B, Pokhrel B, Mohapatra T. Study of nosocomial isolates of Staphylococcus aureus with special reference to methicillin resistant S. aureus in a tertiary care hospital in Nepal. Nepal Med Coll J 2009; 11:123-126. [PMID: 19968154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
To find out the prevalence of Staphylococcus aureus nosocomial infection and methicillin resistant S. aureus (MRSA), clinical samples from nosocomially infected patients were processed by following standard methodology in microbiology laboratory, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Of 149 S. aureus isolates, skin infection isolates contributed a major part 72.5% making nosocomial infection by S. aureus most prevalent in skin infection followed by lower respiratory tract infection 11.41% and urinary tract infection 8.7%. Overall MRSA prevalence was 45.0%. MRSA prevalence was 42.6% in skin infection, 82.3% in lower respiratory tract infection and 30.8% in urinary tract infection. MRSA infection was found associated with lower respiratory tract infection only. Highest occurrence of nosocomial infection was observed in female surgical ward, surgical out patient department, orthopedic ward, male surgical ward and maternity ward. MRSA isolation was high from lower respiratory tract of patients admitted in intensive care unit, coronary care unit, Sub-acute intensive care unit, intermediate coronary care unit, neurology ward and post-operative ward. Whereas methicillin sensitive S. aureus (MSSA) occurrence was higher in patients admitted in orthopedic, Surgical out patient department, and female surgical ward. The occurrence of MRSA did not differ with age but MRSA was found associated with male patients and MSSA was associated with female patients. Since MRSA prevalence was high, regular surveillance of MRSA and nosocomial infections should be done and universal precautions to control nosocomial infections should be followed.
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Affiliation(s)
- B Shrestha
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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Konwer S, Pokhrel B, Dolui SK. Synthesis and characterization of polyaniline/graphite composites and study of their electrical and electrochemical properties. J Appl Polym Sci 2009. [DOI: 10.1002/app.31633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Acharya GP, Davis TM, Ho M, Harris S, Chataut C, Acharya S, Tuhladar N, Kafle KE, Pokhrel B, Nosten F, Dance DA, Smith A, Weber A, White NJ. Factors affecting the pharmacokinetics of parenteral chloramphenicol in enteric fever. J Antimicrob Chemother 1997; 40:91-8. [PMID: 9249209 DOI: 10.1093/jac/40.1.91] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Chloramphenicol pharmacokinetics were studied in 29 Nepalese adults diagnosed with uncomplicated enteric fever and randomized to receive succinate ester 30 mg/kg i.v. or i.m. Serial plasma concentrations of chloramphenicol, and iothalamate (to estimate glomerular filtration rate), antipyrine (hepatocellular function) and Indocyanine Green (liver blood flow) were measured by HPLC and kinetic parameters estimated by non-compartmental analysis. In culture-positive patients (n = 16), mean residence times (MRTs) and steady-state volumes of distribution (V(d)ss) for i.v. chloramphenicol (mean +/- S.D.; 4.9 +/- 0.9 h and 1.9 +/- 0.8 L/kg; n = 7) were less than after i.m. chloramphenicol (12.3 +/- 7.3 h and 3.7 +/- 2.5 L/kg; n = 9; P < 0.05), with a higher peak plasma concentration after i.v. (16.2 +/- 9.1 versus 7.8 +/- 3.6 mg/L; P < 0.05); plasma clearance (Cl(p)) was similar in the two groups (368 +/- 172 and 310 +/- 224 mL/kg/min after i.v. and i.m. respectively). In 17 patients examined during convalescence, MRT and Vdss were less than in acute illness regardless of route chloramphenicol administration. There were similar changes in chloramphenicol kinetic parameters in culture-negative patients. Antipyrine Cl(p) and liver blood flow correlated weakly with chloramphenicol Cl(p) in culture-positive patients (P < 0.1) and were higher in convalescence; no such associations were seen for iothalamate Cl(p). These data indicate that i.v. chloramphenicol produces peak plasma concentrations which are on average twice those after i.m. injection of the same dose, due principally to a smaller V(d)ss. Cl(p) is uninfluenced by route of administration and is determined more by hepatic metabolism than renal excretion. Intramuscular treatment may result in sub-therapeutic chloramphenicol concentrations initially, but continued regular i.v. dosing is more likely to produce levels at which bone marrow toxicity occurs.
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Affiliation(s)
- G P Acharya
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Acharya G, Butler T, Ho M, Sharma PR, Tiwari M, Adhikari RK, Khagda JB, Pokhrel B, Pathak UN. Treatment of typhoid fever: randomized trial of a three-day course of ceftriaxone versus a fourteen-day course of chloramphenicol. Am J Trop Med Hyg 1995; 52:162-5. [PMID: 7872445 DOI: 10.4269/ajtmh.1995.52.162] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
To compare the efficacy of a short course of ceftriaxone with a standard course of chloramphenicol for typhoid fever, a randomized trial was conducted in 46 patients (30 adults and 16 children) who were blood culture-positive for Salmonella typhi or S. paratyphi. Ceftriaxone was given intravenously once a day for three days to 15 adults at a dose of 2 g/day and to eight children at a dose of 50 mg/kg/day. Chloramphenicol was given orally four times a day to an equal number of patients at a dose of 60 mg/kg/day until defervescence, followed by 40 mg/kg/day for a total of 14 days. Clinical cure without complications or relapse occurred in 19 patients (83%) treated with ceftriaxone and in 20 patients (87%) treated with chloramphenicol (P > 0.05). Four patients with clinical failures in the ceftriaxone group included two with fever lasting six days or more, one with altered sensorium, and one with relapse; three patients treated with chloramphenicol developed leukopenia and thrombocytopenia and were switched to amoxicillin therapy. Bacteriologically, blood cultures of all 46 patients were sterile three days after the start of treatment, and remained so through day 15 of follow-up. These results extend previous observations on the efficacy of ceftriaxone in short courses for both adults and children with typhoid fever.
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Affiliation(s)
- G Acharya
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Abstract
Bantar, one of the dominant ethnic groups of Morang district is ethno botanically very rich. 98 species of plants belonging to 89 genera and 45 families used by Bantar as traditional medicines for human and domestic animals have been documented here. Ethno medication in most instances involves mantras alongside herbal application. Most diseases are treated by the use of more than one plant species while a single plant species is found to be used in curing more than one disease. Key words: Bantar, Ethno-medicinal plants, Morangdoi:10.3126/on.v4i1.508Our Nature Vol. 4(1) 2006 pp96-103
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