Kathmandu Medical College Research Articles

Early identification of patients at risk of acute severe pancreatitis with Systemic Inflammatory Response Syndrome score at admission

Background: Clinically, the Systemic Inflammatory Response Syndrome (SIRS) is identified by two or more symptoms including fever or hypothermia, tachycardia, tachypnea and change in blood leukocyte count. The relationship between SIRS symptoms at the time of presentation and severity of pancreatitis is yet to be determined though progression of SIRS in subsequent days has already been correlated.Objectives: To determine the severity of pancreatitis with SIRS score at the time of admission.Methodology: A retrospective cohort study of patients admitted to Department of Surgery, Kathmandu Medical College Teaching Hospital (KMCTH) with diagnosis of Acute Pancreatitis (AP) from December 2014 to January 2016 was conducted. Clinical, biochemical and imaging data were collected from the medical record section. Patients with diagnosis of acute pancreatitis as per Revised Atlanta Classification 2012 were included in the study. SIRS score at time of admission was correlated with Modified Marshall scoring system for organ dysfunction. Patients were grouped into severe and nonsevere group. Sensitivity, specificity and predictive values of SIRS score at admission for organ failure were calculated.Results: Among the 41 patients admitted with diagnosis of acute pancreatitis irrespective of cause, the sensitivity of SIRS score ≥2 at admission in predicting severe pancreatitis was 60 %, specificity was 20%, positive predictive value was 28% and negative predictive value was 20 %, with p-value of 0.52 and odds ratio of 1.6 (CI: 0.376-6.808).Conclusion: SIRS score at admission cannot be solely used in predicting acute severe pancreatitis. Patients can be stratified in resource deficit setting for timely referral to tertiary centre.

Ischemic stroke: Observations and analysis of stroke patients admitted in a tertiary hospital of Kathmandu

Background: Stroke is a disabling condition that has physical and mental impact on a patient’s life. Stroke is an important morbidity for low and middle income countries like Nepal. Hypertension, diabetes, smoking, and dyslipidemia are common risk factors in this regard and are inadequately controlled; mainly because of poor public awareness, inadequate infrastructure, lack of service and qualified manpower.Objectives: This study aims to provide insight into the epidemiology and risk factors in ischemic stroke patients.Methodology: A descriptive cross sectional study was conducted in 92 ischemic stroke patients at a tertiary care hospital Kathmandu Medical College and Teaching Hospital (KMCTH), Sinamangal, Nepal from December 2017 to June 2018. Consecutive sampling technique was used and data was collected from ischemic stroke patients above 14 years of age who were admitted in the Department of Neurology. Information regarding pre-morbid and morbid conditions, imaging findings as well as results was obtained from biochemical analysis of blood after taking consent from the patient or patient’s relative. Statistical Package for the Social Sciences Version 20 was used as a tool for statistical analysis.Results: Their mean age was 63.25 years with standard deviation of 16.45. Dyslipidemia was the most commonly found risk factor which was present in 77.2% of the subjects, followed by smoking (59.8%), presence of carotid artery atherosclerosis (59.8%), hypertension (50%), atrial fibrillation (26.1%) and diabetes mellitus(15.2%). Smoking was significant in males and heart disease was mostly seen in females.Conclusion: Dyslipidemia and smoking were the most common risk factors followed by carotid artery atherosclerosis. Patients with hypertension and dyslipidemia had higher incidence of stroke in both young and elderly group.

Awareness and practice regarding cervical cancer screening among women visiting a tertiary hospital of Kathmandu

Background: Cervical cancer is the leading female cancer in Nepal. Fortunately, it is preventable by detectingprecancerous lesions and by various screening tools for early invasive cancers. Screening can be possible if women are aware of the problem. Despite the existence of effective screening using Pap smear, the uptake of screening is poor.Objectives: The objective of this study was to assess the awareness and practice regarding cervical cancer screening among women visiting tertiary hospital.Methodology: A descriptive cross – sectional study was conducted to assess the awareness and practice regarding cervical cancer screening among women attending in gynaecological outpatient department of Kathmandu Medical College Teaching Hospital. A total of one hundred and fifty two women were selected purposively for the study. Structured questionnaire was designed and data collection was done through face to face interview technique during the period of September to November 2018. The collected data were analyzed by using Statistical Package for Social Science version 20.Results: Among 152 respondents, majority of the respondents (59.2%) were aware that multiple sexual partners is one of the risk factors of cervical cancer. 38.8% were aware that cervical cancer can be prevented by regular cervical screening. Majority of the respondents: 152 (44.7%) had given correct response regarding meaning of cervical cancer screening and 42.8% were aware of Pap smear test for cervical screening. Only 31.6% had performed cervical cancer screening at least once. Overall mean percentage knowledge was 3.08 with SD 0.96.There was weak correlation between knowledge and practice.Conclusion: This study concluded that majority of respondents had inadequate knowledge and practice regarding cervical cancer screening. Thus, cervical cancer screening health camps and awareness program should be conducted at community to national level for women, to increase the level of knowledge and practice regarding cervical cancer screening.

Morphology of Dorsal Venous Arch of Hand: A Cadaveric Study

Background: Venous network of hand is superficially placed and is easy to trace for clinical purposes. Ce-phalic vein on lateral aspect and basilic vein on medial aspect of the hand are clinically important for inva-sive and surgical procedures. Thus the study of cephalic and basilic veins at dorsal venous arch of hand was dissected to observe for length of dorsal venous arch and the diameter and thickness of cephalic and basilic veins.
 Methods: This is a cross-sectional observational study conducted in 50 hands of cadavers (36 hands of male cadavers, 14 hands of female cadavers) in Department of Anatomy, Kathmandu Medical College Teaching Hospital, Duwakot. Cadavers were performed to measure the length of dorsal venous arch, diame-ter and thickness of cephalic and basilic vein on dorsum of hands.
 Results: The mean±s.d. length of dorsal venous arch in male cadaver (19.03±2.84 cm.) was significantly greater than in female (16.51±1.36 cm.).There was no significant difference in length of dorsal venous arch on right (18.22 ±2.47 cm.) and left side (18.42±3.05 cm.) in either sex. The mean±s.d thickness of basilic vein (0.10±0.01mm) in either sex was significantly greater than that of cephalic vein (0.09±0.01mm).
 Conclusions: The length of the dorsal ve-nous arch in male cadavers was found significantly greater than in female cadavers. The diameters based on external and internal circumference of basilic veins was found to be more than diameter of cephalic veins in both male and female cadavers. The thickness of basilic vein was found to be more (0.10±0.01mm) than that of cephalic vein (0.09±0.01mm) in cadaver of both sexes.

Awareness regarding diabetes mellitus among individuals attending a hospital, Bhaktapur

Background: Diabetes mellitus is the most prevalent metabolic condition and one of the major health and socioeconomic problems worldwide. Awareness of risk factors and prevention of diabetes plays a major role for prevention of diabetes mellitus in general population.Objectives: To assess level of awareness regarding diabetes mellitus risk factors and preventive measures among individuals who attended General Practice outpatient department at Kathmandu Medical College Teaching Hospital, Duwakot, Bhaktapur.Methodology: This is a descriptive study conducted in Department of General Practice and Emergency of Kathmandu Medical College Teaching Hospital. The study included 370 patients attending General Practice outpatient department from November 2018 to April 2019. The data collected was entered in the Statistical Package for the Social Sciences software and analysed for results. Ethical clearance was taken from Institutional Review Committee of Kathmandu Medical College.Results: The study included 370 participants; the mean age was 40.83±12.21 years. More than half of the participants (56.5%) were females and 43.5% were males. The most commonly mentioned risk factor was lack of physical activity and obesity. Almost 80% participants correctly stated that physical activity could help prevent diabetes mellitus. There was no statistical significance between awareness and educational level of participants.Conclusion: This study showed that proper awareness programs need to be carried out in rural and urban communities to prevent diabetes and its complications. In this study, patient awareness about risk factors and preventive measures was not appreciable. Association of awareness with age, sex and education level was not statistically significant.

Awareness about expressed breast milk feeding among working mothers visiting a tertiary level hospital, Kathmandu

Background: Expressed breast milk can be a healthy feeding option as compared to formula for working mothers. A large number of mothers are working these days and despite their desire to breastfeed, mothers have to get back to their work because of various constraints.Objectives: The research objective was to assess the status of knowledge and attitude regarding expressed breastfeeding and to identify the barriers to expressed breastfeeding among working mothers visiting Kathmandu Medical College Teaching Hospital.Methodology: A cross-sectional study was conducted at Pediatric Outpatient Department of Kathmandu Medical College Teaching Hospital from June 2018 till December 2018. One hundred and eighty working mothers were chosen purposively and interviewed. Research instrument was a structured questionnaire containing questions about technique of pumping and storing breast milk, benefits of breastfeeding, attitude regarding expressed breastfeeding and reasons for not expressing breast milk. Mean standard deviation and Chi-square tests were used for statistical analysis.Results: Out of 180 mothers, half of the mothers had adequate knowledge regarding expressed breastfeeding while slightly more than half of them (52.2%) had negative attitude about it. Only 11.7% of the mothers shared that they had expressed breast milk ever. The most important reason for not expressing breast milk was stated to be inadequate breast milk production (30.7%) and lack of time (26.4%).Conclusion: The study concludes that about half of the working mothers have adequate knowledge and positive attitude regarding expressed breastfeeding. Moreover, very few mothers ever expressed breast milk and the main reason for not doing so was inadequate milk production.

Assessment of Malnutrition as a Risk Factor for Acute Lower Respiratory Tract Infection in Children under 5 yr Age at a Tertiary Hospital

Background: Malnutrition among young children is becoming a major public health concern in low income countries like Nepal where under nutrition remains one of the primary causes of ill health. Acute lower respiratory tract infection (ALRTI) and malnutrition in children are associated with morbidity and mortality in developing countries.Objective of this study was to assess ALRTI as a risk factor for malnutrition in children at Kathmandu Medical College Teaching Hospital.
 Methods: This was a cross-sectional study con-ducted at Kathmandu Medical College Teaching Hospital over 5 months duration (August - December 2017). Under 5 yrs children diagnosed as ALRTI were taken and healthy children from same age group attending the immunization clinic were the controls. Anthropometric measurements were measured and stunting and wasting were described according to the WHO classification of malnutrition. Data were analyzed using SPSS version 18. Statistical analyses were done in the form of frequency, mean and cross tabulation. Chi-Square test was used to assess the association of ALRTI with malnutrition. P value <0.05 was considered to be sig-nificant.
 Results: A total of 200 children were included in this study. Children with ALRTI (n = 90) and con-trols (n =110) were analyzed. Male participants were observed more in both groups (60% and 68%). Wasting and stunting were observed more in ALRTI group than in control groups.
 Conclusions: This study showed there was a relation between ALRTI and malnutrition in children. So, this study has identified malnutrition as one of the major risk factor for ALRTI in under 5 yrs children.

A clinically suspected case of thrombotic thrombocytopenic purpura managed with therapeutic plasma exchange in Kathmandu Medical College Teaching Hospital

Thrombotic thrombocytopenic purpura (TT P) is a life threatening thrombotic microangiopathy which may not present with the classic pentad of microangiopathic hemolytic anemia, fever, neurologic changes, thrombocytopenia and renal dysfunction. High level of clinical vigilance has to be rendered in suspected cases of TT P and therapeutic plasma exchange (TPE) must be started as soon as possible as this can be a lifesaving intervention. TT P is a category 1 recommendation for plasmapheresis as per the guidelines from American Society for Apheresis (ASFA). We present a case of 55 years old male who presented with abdominal pain, vomiting and fever and was clinically suspected as a case of thrombotic thrombocytopenic purpura. He received an intensive care treatment (endotracheal intubation with mechanical ventilation and renal replacement therapy) and after no improvement following fifth day of treatment, he was started on therapeutic plasma exchange (TPE). After two cycles of plasmapheresis, he had marked clinical improvement. Due to the cost unaffordability by the patient›s family, further sessions of plasma exchange therapy could not be done. The patient was later discharged and followed up in outpatient basis.

Prevalence of Community-Acquired Pyoderma in Dermatological Outpatient Department of A Tertiary Care Hospital

Pyoderma is defined as any purulent skin disease and represents infections in epidermis and dermis or hair follicles. This study aims to find out the prevalence of community-acquired pyoderma in dermatological outpatient department of a tertiary care hospital. A descriptive cross-sectional study was carried out among patients who presented at dermatology outpatient department of Kathmandu Medical College Teaching Hospital between December 2018 and March 2019 after ethical clearance from institutional review committee. Convenience sampling method was done. Data was collected and analysis was done using SPSS software, point estimate at 95% CI was calculated along with frequency and proportion for binary data. Out of 385 cases, 72 (18%) cases were of community-acquired pyoderma. Prevalence of community-acquired pyoderma is 72 (18%). Primary pyoderma was seen in 49 (12.72%) mainly folliculitis 17 (4.41%), furunculosis 16 (4.15%), impetigo 6 (1.55%), abscess 6 (1.55%) and bacterial paronychia 4 (1.03%). Staphylococcus aureus was the most common organism isolated in 42 (58.3%) cases and Staphylococcus epidermidis was isolated in 3 (4.17%) cases. Staphylococcus aureus was most sensitive to Vancomycin 42 (100%) followed by Gentamycin 40 (95.2%), Ciprofloxacin 40 (95.2%) and Ceftriaxone 40 (95.2%). Highest resistance was seen to Azithromycin in 13 (30.95%), followed by Cloxacilllin in 11 (26.19%). Males were affected predominantly in 49 (68.06%) as compared to females in 23 (31.94%). Prevalence of community-acquired pyoderma is high among patients visiting dermatological outpatient departments of a tertiary care hospital compared to other studies. Antibiotic resistance of commonly used antibiotics are increasing and thus proper culture and sensitivity reports may be required to guide our treatment.

Prevalence of Chronic Cor Pulmonale in Chronic Obstructive Pulmonary Disease Patients in a Teaching Hospital in Nepal

Introduction: Chronic obstructive pulmonary disease (COPD) is the most common cause of cor pulmonale. Cor pulmonale in COPD is associated with decreased survival, increased hospitalization and mortality. In this study we aim to find out the prevalence of chronic cor pulmonale in COPD patients which would help in prevention of right sided heart failure and improve patients’ quality of life.
 Methods: This was a cross sectional observational study done in Kathmandu Medical College Teaching Hospital, Nepal. 50 COPD patients above the age of 30 years attending the outpatient department or admitted in wards were included. All COPD patients diagnosed by pulmonary function test (PFT) were assessed for cor pulmonale by echocardiography (ECHO). The demographic data, chest X-ray, PFT, electrocardiography (ECG) and ECHO findings were recorded, entered and analyzed using SPSS software, version 17.
 Results: Most of the patients enrolled in the study were between age group of 51-60 with female preponderance. 68% of the COPD patients had chronic cor pulmonale. Out of 21 male, 76.2% and out of 29 female COPD patients, 62.06% had cor pulmonale. Cor pulmonale was present in 53.12% and 94.4% of patients who had COPD for < 10 years and ≥10 years duration respectively. Cor pulmonale was present in 76% patients with severe COPD, 75% of patients with moderate COPD, 64.2% patients with very severe COPD and none of the patients with mild COPD. Pulmonary hypertension (PH) was present in 67.64% of cor pulmonale patients.
 Conclusion: The prevalence of chronic cor pulmonale in COPD patients was 68%. It was more in male patients, highest in patients with severe COPD, and the prevalence increased with duration of COPD. PH was present in 67.64% of cor pulmonale patients.

Prevalence of Chronic Cor Pulmonale in Chronic Obstructive Pulmonary Disease Patients in a Teaching Hospital in Nepal

Introduction: Chronic obstructive pulmonary disease (COPD) is the most common cause of cor pulmonale. Cor pulmonale in COPD is associated with decreased survival, increased hospitalization and mortality. In this study we aim to find out the prevalence of chronic cor pulmonale in COPD patients which would help in prevention of right sided heart failure and improve patients’ quality of life. Methods: This was a cross sectional observational study done in Kathmandu Medical College Teaching Hospital, Nepal. 50 COPD patients above the age of 30 years attending the outpatient department or admitted in wards were included. All COPD patients diagnosed by pulmonary function test (PFT) were assessed for cor pulmonale by echocardiography (ECHO). The demographic data, chest X-ray, PFT, electrocardiography (ECG) and ECHO findings were recorded, entered and analyzed using SPSS software, version 17. Results: Most of the patients enrolled in the study were between age group of 51-60 with female preponderance. 68% of the COPD patients had chronic cor pulmonale. Out of 21 male, 76.2% and out of 29 female COPD patients, 62.06% had cor pulmonale. Cor pulmonale was present in 53.12% and 94.4% of patients who had COPD for < 10 years and ≥10 years duration respectively. Cor pulmonale was present in 76% patients with severe COPD, 75% of patients with moderate COPD, 64.2% patients with very severe COPD and none of the patients with mild COPD. Pulmonary hypertension (PH) was present in 67.64% of cor pulmonale patients. Conclusion: The prevalence of chronic cor pulmonale in COPD patients was 68%. It was more in male patients, highest in patients with severe COPD, and the prevalence increased with duration of COPD. PH was present in 67.64% of cor pulmonale patients.

Prevalence of Pseudomonas Aeruginosa and its Antibiotic Sensitivity Pattern.

Pseudomonas aeruginosa is an opportunistic pathogen which causes most of the chronic infection in humans. This study was undertaken to determine the prevalence rate of Pseudomonas aeruginosa that is isolated from various clinical specimens along with its antibiotic susceptibility pattern. This descriptive cross sectional study was conducted in Kathmandu Medical College and Teaching Hospital (KMCTH) from February to May 2018. Pseudomonas aeruginosa isolated from various clinical specimens were processed in clinical laboratory, Department of Microbiology, KMCTH. Isolation, identification and sensitivity of Pseudomonas aeruginosa to antibiotics were measured. A total of 7527 samples were been processed of which 46 isolates of Pseudomonas aeruginosa were obtained. Pseudomonas aeruginosa was isolated mainly from Pus, Wound swab, Sputum and Tracheal aspirate. Here 63.04% Pseudomonas aeruginosa isolates were resistant to Ceftazidime, 65.21% to Cefixime, 56.52% to Ceftriaxone and Cefotaxime followed by 56.52% to Piperacillin. Furthermore, the current study reveals antibiotics like Imipenem, Meropenem, Piperacillin/Tazobactam, Ciprofloxacin, Gentamicin, Amikacin and Tobramycin were found to be good choice for the treatment of infection caused by this organism. Continuous monitoring of antibiotic susceptibility pattern of Pseudomonas aeruginosa is essential and rational treatment regimens prescription by the clinicians is required to limit the spread of antimicrobial resistance.

Prevalence of Pseudomonas aeruginosa and its Antibiotic Sensitivity Pattern

Background: Pseudomonas aeruginosa is an opportunistic pathogen which causes most of the chronic infection in humans. This study was undertaken to determine the prevalence rate of Pseudomonas aeruginosa that is isolated from various clinical specimens along with its antibiotic susceptibility pattern.Methods: This descriptive cross sectional study was conducted in Kathmandu Medical College and Teaching Hospital (KMCTH) from February to May 2018. Pseudomonas aeruginosa isolated from various clinical specimens were processed in clinical laboratory, Department of Microbiology, KMCTH. Isolation, identification and sensitivity of Pseudomonas aeruginosa to antibiotics were measured.Results: A total of 7527 samples were been processed of which 46 isolates of Pseudomonas aeruginosa were obtained. Pseudomonas aeruginosa was isolated mainly from Pus, Wound swab, Sputum and Tracheal aspirate. Here 63.04% Pseudomonas aeruginosa isolates were resistant to Ceftazidime, 65.21% to Cefixime, 56.52% to Ceftriaxone and Cefotaxime followed by 56.52% to Piperacillin. Furthermore, the current study reveals antibiotics like Imipenem, Meropenem, Piperacillin/Tazobactam, Ciprofloxacin, Gentamicin, Amikacin and Tobramycin were found to be good choice for the treatment of infection caused by this organism.Conclusions: Continuous monitoring of antibiotic susceptibility pattern of Pseudomonas aeruginosa is essential and rational treatment regimens prescription by the clinicians is required to limit the spread of antimicrobial resistance.Keywords: Antibiotic resistance; clinical isolates; Pseudomonas aeruginosa.

Trend of Breastfeeding and its Impact on Morbidity in Children in a Tertiary Care Hospital in Kathmandu

Introduction: WHO advocates for exclusive breastfeeding in infants till six months of age. Exclusive breastfeeding has been estimated to reduce 70% of infection related mortality in children. This study aims to elaborate the current trend of breastfeeding and its impact on common infectious morbidities in children.
 Methods: This study was a prospective longitudinal study done at Kathmandu Medical College Teaching Hospital with a sample size of 103 infants. Detailed proforma including sociodemographic data, breastfeeding related data and morbidities were collected at one and half months of life. The patients were followed up at 6 months of age again and the same proforma was again filled up. Statistical analysis was done with SPSS 20.0 and various associations were elucidated. 
 Results: A total of 103 infants were analyzed. Males were 58 in numbers with mean birth weight of the infants being 3048±537 grams. Breast feeding was initiated within an hour in around 37%. At one and half months of age, 63% reported of exclusive breastfeeding which decreased to 23% at 6 months of age. Breastfeeding for at least 45 days decreased the incidence of Acute Respiratory Infections(ARI), Acute Otitis Media(AOM) and diarrheal diseases although statistically significant difference was found with only ARIs. 
 Conclusion: Prevalence of exclusive breastfeeding is low in the study. The study has also shown that breastfeeding significantly reduces incidence of common infectious morbidities in infants.

Outcome of Respiratory distress in Neonates with Bubble CPAP at Neonatal Intensive Care Unit of a Tertiary Hospital

Respiratory distress is one of the commonest problem seen in neonates during admission in Neonatal Intensive Care Unit. Hyaline Membrane disease, Meconium Aspiration Syndrome, septicemia, congenital pneumonia, Transient Tachypnea of Newborn are the major causes of respiratory distress in neonates. Bubble Continuous Positive Airway Pressure is a non-invasive respiratory support delivered to a spontaneously breathing newborn to maintain lung volume during expiration. The main objective of this study was to observe the outcome of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure. This was a descriptive cross-sectional study conducted at Kathmandu Medical College Teaching Hospital over six months (October 2018 - March 2019) period. All preterm, term and post term babies with respiratory distress were included. Ethical clearance was received from Institutional Review Committee of Kathmandu Medical College and statistical analysis was done with SPSS 19 version. Sixty three babies with respiratory distress were included in this study with 45 (71%) male predominance. The mean birth weight receiving Bubble Continuous Positive Airway Pressure was 2661.75±84 gms and gestational age was 36.67±3.4 wks. The Bubble Continuous Positive Airway Pressure was started at 8.05±2 hr of life and duration of Bubble Continuous Positive Airway Pressure required for settling respiratory distress was 95.71±3 hrs. Out of 63 babies, improvement of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure was 39 (61%) with confidence interval of 38% to 62% whereas 24 (39%) babies required mechanical ventilation and other modalities. This study concludes usefulness of Bubble Continuous Positive Airway Pressure in neonates with respiratory distress.

Prevalence of microalbuminuria and its association with glycemic control in type 2 diabetic patients: a cross sectional study at Kathmandu Medical College

Background: Diabetes mellitus has become one of the biggest health problems of this era. The resultant microvascular and macrovascular complications add to significant amount of morbidity and mortality. Urine microalbumin is considered as an early marker for microvascular compli­cations among diabetic patients. The aim of this study was to find out the prevalence of microalbuminuria among type 2 diabetic patients attending Kathmandu Medical College and its relation with glycemic control, age, sex, duration of diabetes. 
 Methods: A total of 208 previously diagnosed type 2 diabetic patients at­tending medical outpatient department of Kathmandu Medical College, Sinamangal were included in the study over a period of 1 year (October 2017 - September 2018). Fasting and 2-hour postprandial venous blood for blood glucose and HbA1c measurement and early morning urine sam­ple (after overnight fast) was collected for detection of microalbuminuria. Statistical analysis was done using SPSS version 23. 
 Results: The prevalence of microalbuminuria among the study population (mean age: 54.22 ± 11.76 years, mean HbA1c: 7.62 ± 1.53 %) was 42.8%. Microalbuminuria had significant correlation with HbA1c and duration of diabetes (p<0.001), but not with age, sex and type of medication. There was positive correlation between urine microalbumin and fasting and post-prandial blood glucose. 
 Conclusions: Our present study found high prevalence of microalbumin­uria among diabetic patients with poor glycemic control. It is suggested that tighter glycemic control with regular urine microalbumin testing should be integral part of diabetic management plan to prevent long term complications such as diabetic nephropathy

Practice of Breastfeeding and its Barriers among Women Working in Tertiary Level Hospitals

Breastfeeding provides ideal food for newborns and prevents recurrent infection and malnutrition in infants. In Nepal, breastfeeding is a universal practice but exclusive breastfeeding is low. As there is increased involvement of women in workforce, practice of breastfeeding may have been compromised. The main objective of the study was to examine the practice and barriers of breastfeeding among women working in tertiary level hospitals of Nepal. This was a hospital based descriptive cross-sectional study. Study participants were women working in Dhulikhel Hospital and Kathmandu Medical College and Teaching Hospital and was conducted from December 2017 to June 2018. Ethical approval was taken from institutional review committee of both institutions. Total of 208 women were included in the study and face to face interview was conducted. Data entry and analysis was done using statistical package of social sciences. Breastfeeding practice was universal and colostrum was fed by 195 (94%) women. Pre-lacteal feeding was given by 14 (7%) women and 119 (57%) initiated breastfeeding within one hour of birth. Total of 93 (45%) children were exclusively breastfed for any duration while 10 (11%) were exclusively breastfed for six months. The mean duration of breastfeeding was 14.57 months and 90 (43%) started complementary feeding before six months. Total of 97 (51%) women and 42 (47%) women stated work as barrier for not exclusively breastfeeding and early complementary feeding respectively. Exclusive breastfeeding was very low and children were breastfed for less than two years. Complementary feeding was also started earlier and work was stated as the main barrier for poor breastfeeding practice.

A Study of Surgical Cases During Earthquake Disaster in A Medical College

Anearthquakeis an intense shaking of earth's surface which is caused by movements in earth's outermost layer. The earthquake of 25th April 2015, with a magnitude of 7.8 richter scale with its major aftershock on 12th May 2015 of 7.3 richter scale claimed around 8,962 lives across several districts of Nepal with 22,302 injuries. In this study we tried to figure out various surgical cases and the surgical procedures performed in a tertiary care hospital during an earthquake disaster. This study was a descriptive cross-sectional study of hospital data on all admitted surgical cases during an earthquake disaster. A total of 238 earthquake victims brought to emergency department of Kathmandu Medical College Teaching Hospital , a tertiary care center, from 26th April 2015 to 7th Jun 2015, for the period of 42 days were included. Those brought dead and discharged after primary treatments were excluded. Data obtained were entered and analysed in Microsoft Excel 2010. Among 238 patients enrolled, 122 (51%) were male and 116 (49%) female with male to female ratio of 1.05:1. Age group (31-60 years) with an average age of 45 years were encountered most frequently 110 (46%) with the maximum number of patient burden from Sindhupalchowk district 80 (33.6%). Orthopedic surgery 185 (76%) appeared to be the most frequent followed by neurosurgery, plastic surgery, general surgery and dental surgery. In natural disaster like earthquakes, traumatic injuries are very common and thereby various surgical procedures especially ortho-plastic are the domain of treatment modalities. Disaster preparedness and combined surgical team effort needs to be focused to reduce both mortality and morbidity.

Dermatophytes in Skin, Nail and Hair among the Patients Attending Out Patient Department

Dermatophytosis are the most common types of cutaneous fungal infection seen in human and animals affecting skin, hair and nails caused by dermatophytes. The diagnosis of dermatophytes is based on the clinical observation and laboratory diagnosis by direct microscopic examination and fungal cultures. The present study is undertaken to isolate different type of dermatophytes causing fungal infection. A prospective cross-sectional study design was used in a total of 90 clinically suspected cases of dermatophytic infection attending the out patient department of Kathmandu Medical College and Teaching hospital (KMCTH). Skin scraping, hair and nail samples were collected from the patients and were processed by direct microscopy and culture using standard protocol. Dermatophytes were identified based on the microscopic arrangement of microconidia and macroconidia. Dermatophytosis was more common in the age group of 21-40 years and was more predominant among male with male to female ratio of 1.7: 1. Among the total clinically suspected cases of dermatophytosis, 53 were positive in direct microscopy and only a total of 20 were positive by culture. Most common clinical type observed in our study was Tinea corporis(25%) followed by Tinea cruris. Trichophyton rubrum(50%) was the commonest aetiological agent in majority of clinical types followed by Trychophyton mentagrophytes(35%). The study highlighted T. corporis followed by T. cruris and T. unguim as the most common clinical pattern of dermatophytosis with a male predominance and 21-40 years being the most affected age group. T. rubram was the most common aetiological agent causing dermatophytosis.

Biofilm Formation and Extended-Spectrum Beta-Lactamase Producer among Acinetobacter Species Isolated in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Acinetobacter species are short, stout, gram-negative coccobacilli, generally considered to be a relatively low-grade pathogen. However, its resistance towards multiple classes of antibiotics through an array of resistance mechanisms including its ability to form biofilm has led to its emergence as an important pathogen in hospital settings. This study was done to determine the prevalence of biofilm former and Extended-spectrum Beta-Lactamase producer among Acinetobacter species. A descriptive cross-sectional study was done in the clinical microbiology laboratory, Kathmandu Medical College from January to June 2019. Convenient sampling method was used. Ethical approval was taken from the Institutional Review Committee, Ref no. 2812201805. Preliminary identification followed by characterization of Acinetobacter species was done. Antibiotic susceptibility test was done using the Kirby-Bauer method following Clinical and Laboratory Standards Institute guidelines. Extended-spectrum Beta-Lactamase was detected by combined disc method and Biofilm detection was done using congo red agar method. Statistical Package for Social Sciences 16.0 version statistical software package was used for statistical analysis. Point estimate at 95% Confidence Interval was calculated along with frequencyand proportion for binarydata. Among 108 Acinetobacter species, 86 (79.7%) Acinetobacter calcoaceticus-A. baumannii complex was seen. Seventy-eight (72%) of the isolates were multidrug-resistant, 34 (31%) of the isolates were Extended-spectrum Beta-Lactamase producer and only 10 (9.3%) of the isolates, were biofilm producers. Multidrug-resistant Acinetobacter spp. with the ability to produce Extended-spectrum Beta-Lactamase is prevalent in our hospital settings. Strict compliance with infection control practices is necessary to curb its spread.