KIST Medical College Research Articles

Prevalence of poor mental health among medical students in Nepal: a cross-sectional study

BackgroundPoor mental health among medical students is widely acknowledged. Studies on mental health among medical students of Nepal are lacking. Therefore, we conducted a study to determine the prevalence of mental disorders.MethodsA cross-sectional study was conducted among medical students at KIST Medical College and Teaching Hospital, Nepal from December 2016 to February 2017. Our survey instrument consisted of the Patient Health Questionnaire (PHQ) and questions about socio-demographic factors, smoking, marijuana use, suicidal ideation and thoughts of dropping out of medical school.ResultsThe prevalence rates were 29.2% (95% CI, 24.4% – 34.3%) depression, 22.4% (95% CI, 18.0% – 26.9%) medium to highly severe somatic symptoms, 4.1% (95% CI, 2.0% – 6.2%) panic syndrome, 5.8% (95% CI, 3.4% – 8.3%) other anxiety syndrome, 5% (95% CI, 2.7% – 7.3%) binge eating disorder and 1.2% (95% CI, 0.0% - 2.3%) bulimia nervosa. Sixteen students [4.7% (95% CI, 2.4% – 6.9%)] seriously considered committing suicide while in medical school. Thirty-four students [9.9% (95% CI, 6.8% – 13.1%)] considered dropping out of medical school within the past month. About 15% (95% CI, 11.1% – 18.6%) of the students reported use of marijuana during medical school.ConclusionsWe found high prevalence of poor mental health among medical students of Nepal. Future studies are required to identify the factors associated with poor mental health.

Antimicrobial resistance trend of Salmonella typhi and paratyphi from 2011-2013: A descriptive study from tertiary care hospital of Nepal

Background: Enteric fever is a major public health problem in Nepal. Trends of drug resistance help in choosing optimal empiric therapy.Objective: The objective of this study was to determine antibiotic resistance pattern of Salmonella enterica serotype typhi and Salmonella enterica serotype paratyphi isolated from blood cultures.Methodology: A descriptive study was conducted using hospital records at KIST Medical College and Teaching Hospital, Nepal. Isolates from blood cultures between January 2011 and December 2013 were included in this study. Susceptibility to various antimicrobials was determined using modified Kirby-Bauer disk diffusion method. A chi-square for trend analysis was done to evaluate change in susceptibility over three years.Results: Out of 216 isolates, 68.05% were Salmonella typhi and 31.48% were Salmonella paratyphi A. In Salmonella typhi, there was significant increase in cefotaxime resistance(X2 = 4.951, p < 0.05) and ciprofloxacin resistance (X2 = 17.506, p < 0.001) whereas there was significant decrease in ampicillin resistance (X2 = 4.830, p < 0.05). No resistance was seen against ceftriaxone in Salmonella typhi and Salmonella paratyphi A. Resistance to chloramphenicol and cotrimoxazole was low as well, in both isolates. None of the isolates tested were multidrug resistant.Conclusion: There is emergence of resistance to cefotaxime whereas resistance to ciprofloxacin has made its use as empiric therapy questionable. Full susceptibility of ceftriaxone makes it an excellent antibiotic for empiric therapy. Decrease in resistance to chloramphenicol, cotrimoxazole and ampicillin may again make these agents useful. Journal of Kathmandu Medical College Vol. 6, No. 1, 2017, page: 9-13

Knowledge, Attitude and Practice Regarding Pharmacovigilance and Consumer Pharmacovigilance among Consumers at Lalitpur District, Nepal.

Adverse drug reactions (ADRs) can be a big threat to the health of people in Nepal as a variety of medicines are consumed in the country. Involving consumers in pharmacovigilance can strengthen ADR reporting. The study aims to find out knowledge, attitude and practice regarding pharmacovigilance and consumer pharmacovigilance among consumers at Lalitpur district, Nepal Methods: It was carried out in outpatients visiting in KIST Medical College and Teaching Hospital, Lalitpur, Nepal. Participant's knowledge, attitude and practice were measured by noting their agreement with a set of 21 statements along with multiple choice and open ended questions. A total of 157 outpatients were surveyed. The knowledge scores for males (12) was better compared to the females (11), but the scores for attitude and practice were same for both groups. The maximum score for knowledge was 29, attitude was 6 and practice was 10. The overall KAP scores was 45. The total scores for knowledge, attitude and practice for males (24) were better compared to female (22) respondents. Seventy-one patients (68%) who participated in this study favoured establishing a consumer centre for obtaining information about ADRs. Knowledge scores among consumers regarding pharmacovigilance is low and require advocacy and improvement.

Role of Sepsis Screening in early diagnosis of Neonatal Sepsis

Background: Neonatal sepsis, a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first 4 weeks of life is a major cause of morbidity and mortality in newborn inborn. Early diagnosis is critical, as sepsis can progress more rapidly in neonates than in adults. An attempt was made to establish correlation between early neonatal sepsis screening & blood culture in neonates presenting with features of sepsis. The aim of this study is to assess the usefulness of sepsis screen in early diagnosis of neonatal septicemia.Materials and Methods: The study was done in Kist medical college and hospital, Nepal from October 2015 to October 2016. Statistical correlation between early indicators of sepsis screen & blood culture (considered as gold standard) was established in clinically suspicious cases of neonatal sepsis. Results: Out of 150 cases studied, 72 were culture positive. CRP (77.8%) and immature: total neutrophils ratio (73%) showed highest sensitivity. CRP (66.7%), I/T ratio (61.5%) and micro ESR (60.2%) showed highest specificity. Positive predictive value was highest for CRP (68.2%) followed by I/T ratio (63.8%) and corrected total leukocyte count (56.2%)Conclusion: Serum CRP is the most sensitive marker of sepsis. Use of peripheral smear study and CRP can be implicated effectively as a sepsis screen for early diagnosis of neonatal sepsis. The combination of parameters yielded better results than single tests and proved to be an invaluable tool for early diagnosis of neonatal sepsis.

Computed tomogram guided fine needle aspiration for lung masses: Radiologic-cytologic correlation

The primary objective was to compare the results of computed tomography (CT) finding with that of cytology. The secondary objective was to evaluate the safety of CT guided transthoracic Fine Needle Aspiration Cytolofy (FNAC) of lung lesions of various sizes and locations. From December 2014 to June 2016, under CT guidance, FNAC of lung lesion was performed on 64 cases attending KIST medical college and Kathmandu imaging diagnostic center. FNAC was performed by using spinal anesthesia needle (22G/23G). Procedures were carried out under CT guidance. Smears were prepared by materials obtained and were fixed in 95% alcohol. Dry as well as wet slides were prepared. The prepared slides were then examined under light microscope by consultant pathologist. Sixty four patients were enrolled in present study. The age of patients ranges from 24 to 87 year with mean age of 55.5 and male to female ratio of 2:1. Radiologically, out of 64 cases, 49 cases were reported as malignant and 15 cases were reported as benign lesion. However, Cytologically, 39 cases were malignant, 22 cases were benign and 3 cases were suspicious for malignancy (no definite diagnosis established). The CT scan showed Sensitivity of 97.4% to identify the malignant mass as compared to cytology findings. the Specificity, Positive and negative predictive value were calculated as 63.6%, 82.6 and 93.3% respectively. CT guided fine needle aspiration cytology (FNAC) is reliable procedure for evaluation of lung lesion. It is simple and safe procedure with high diagnostic accuracy for the diagnosis of Lung cancer. Compared to biopsy, CT guided FNAC shortens the diagnostic interval and helps in differentiating lung malignancy into different cytopathological types which aids in proper management of the malignant lesion.

Assessment of Knowledge, Attitude and Practice of Gingival Health among Patients under Active Orthodontic Treatment

Information and awareness on gingival health enhances knowledge and from such knowledge comes commitment and motivation for people to alter their lifestyles to prevent gingival and periodontal disease. Repeating the oral hygiene instructions on each visit, prophylactic programs and good oral home care are effective measures to prevent plaque accumulation and gingival enlargement for patients who are undergoing orthodontic treatment. This study is undertaken to assess knowledge, attitude and practice of gingival health among orthodontic patients. Materials and Methods: A cross-sectional study was carried out among 180 patients coming to the Department of Orthodontics at KIST Medical College and Teaching Hospital who are undergoing active orthodontic treatment. The questionnaire, was given to all selected patients to complete the answers, included questions about knowledge on gingival health, practices and attitude of patients regarding oral hygiene performance. Statistical analysis was done by SPSS version 21. Result: Knowledge on gingival health reveals that 62.2% of participants were aware of gingival disease. 59.4% of participants followed oral hygiene instructions very often and used interdental aids (dental floss: 58.2%,interdental brush:60.9%,toothpick 67.4%) irregularly. Only 27.8% in this survey followed the oral hygiene instructions very strictly. Use of interdental aids in various age group was found to be statistically significant. Conclusion: Successful plaque control clearly demands appropriate knowledge about gingival health, individuals’ practice and attitude to remove plaque with a long term commitment from the dental professional and the patient as cotherapist.

Minimum inhibitory concentration of vancomycin to methicillin resistant Staphylococcus aureus isolated from different clinical samples at a tertiary care hospital in Nepal.

BackgroundMethicillin resistant Staphylococcus aureus (MRSA) has evolved as a serious threat to public health. It has capability to cause infections not only in health care settings but also in community. Due to the multidrug resistance shown by MRSA, there are limited treatment options for the infections caused by this superbug. Vancomycin is used as the drug of choice for the treatment of infections caused by MRSA. Different studies from all around the world have documented the emergence of strains of S. aureus those are intermediate sensitive or resistant to vancomycin. And recently, there have been reports of reduced susceptibility of MRSA to vancomycin, from Nepal also. So the main purpose of this study was to determine the minimum inhibitory concentration (MIC) of vancomycin to methicillin resistant S. aureus isolated from different clinical specimens.MethodsTotal 125 strains of S. aureus isolated from different clinical samples at KIST Medical College and Teaching Hospital, Lalitpur, Nepal from Nov 2012 to June 2013, were subjected to MRSA detection by cefoxitin disc diffusion method. The minimum inhibitory concentrations of vancomycin to confirmed MRSA strains were determined by agar dilution method. Yellow colored colonies in mannitol salt agar, which were gram positive cocci, catalase positive and coagulase positive were confirmed to be S. aureus.ResultsAmong, total 125 S. aureus strains isolated; 47(37.6%) were MRSA. Minimum inhibitory concentrations of vancomycin to the strains of MRSA ranged from 0.125 μg/ml to 1 μg/ml.ConclusionFrom our findings we concluded that the rate of isolation of MRSA among all the strains of S. aureus isolated from clinical samples was very high. However, none of the MRSA strains were found to be vancomycin intermediate-sensitive or vancomycin-resistant.

Acetylsalicylic Acid and Oral Surgical Procedure

1 Prinicipal Investigator, Department of Oral and Maxillofacial Surgery, Kist Medical College and Teaching Hospital, Lalitpur, Nepal 2 Associate Professor, Dept of Oral and Maxillofacial Surgery, Kist Medical College and Teaching Hospital, Lalitpur, Nepal Abstract Introduction: Acetylsalicylic acid (ASA) therapy, an antithrombotic agents used in various medical conditions, was frequently discontinued before undertaking any oral surgical procedure. However recent researches advise against it.. Materials and Methodology: A study was carried out to review all the patients’ charts retrospectively. The sample size consisted of 122 patients who were taking low dose ASA 75 to 150 mg. Those patients on high dose of ASA, dual antiplatelet therapy and on oral anticoagulant therapy were excluded from the study. The Bleeding time and International Normalized ratio was obtained for the entire sample size. Results: The mean bleeding time was 3.144 and INR was 0.845. The range lies within the acceptable range. Out of 122 patients, only 4 patients reported with a complaint of post operative bleeding. The bleeding episodes were managed by simple haemostatic measures such as gauze pressure and suturing. Conclusion: The fear of uncontrolled postoperative bleeding need not worry a clinician in patients taking low dose 75 to 150 mg ASA. The oral surgical procedures with minimal anticipated bleeding can safely be carried out.

Profile of Macrosomic Babies at a Tertiary Level Hospital

Introduction: Macrosomia is known to be associated with adverse neonatal outcomes. The aim of this study was to estimate the incidence of macrosomia in a tertiary teaching hospital of Nepal based on local intrauterine foetal growth percentile curve according to gestational age, risk factors for morbidity and mortality and neonatal outcome of macrosomia.Materials and Methods: This was a descriptive observational study done on live term macrosomic babies delivered during the study period at KIST Medical College Teaching Hospital, Lalitpur Nepal. The maternal and neonatal records of macrosomic babies were reviewed. All the macrosomic babies were followed up till discharge. Macrosomic babies needing admission into the neonatal care unit were considered as ones with complication. Maternal and neonatal risk factors associated with neonatal complications were analysed.Results: Among total of 2922 live singleton deliveries, 342 (11.7%) babies were macrosomic. The neonatal complications associated with macrosomia were seen in 19.6%. The risk factors significantly associated with neonatal complications were mode of delivery via caesarean section, instrumental delivery and 1 min low Apgar score. Maternal diabetes leading to macrosomia however was seen in only one case. The most common neonatal complications were neonatal sepsis (11.4%), significant hyperbilirubinaemia (2%) and transient tachypnoea of newborn (1.6%).Conclusions: Neonatal sepsis was the major cause of morbidity even in the macrosomic babies. Importance of early interventions for prevention and management of macrosomic babies with neonatal sepsis needs to be emphasized.J Nepal Paediatr Soc 2015;35(2):135-140

Beta Lactamase Producing Escherichia coli, Klebsiella pneumoniae and Methicillin Resistant Staphylococcus aureus among Uropathogens

Urinary tract infection (UTI) is the leading cause of morbidity and health care expenditures in persons of all the ages. The impact of disease is high in the low-resource developing countries due to lack of awareness about the UTIs caused by extended spectrum beta lactamase producing pathogens and methicillin resistant Staphylococcus aureus. This study represents a cross-sectional analysis of UTI prevalence in patients attending at KIST Medical College Teaching Hospital, Imadole, Lalitpur. Bacterial isolates were identified using standard biochemical tests. The antimicrobial susceptibility to various drugs and confirmation of the extended spectrum ß-lactamase (ESBL) and methicillin resistant Staphylococcus aureus (MRSA) production was done following Clinical & Laboratory Standards Institute (CLSI) guidelines. During the study period, 303 (24.08% of urine submissions) UTIs were confirmed. Among these 303 strains, E. coli was the most common, representing 65.34% of the isolates, followed by S. aureus (6.93%) and other pathogens (27.72%). Prevalence of ESBL E. coli, K. pneumoniae and MRSA in the urinary isolates were found to be 38.38 %, 35 % and 47.61 % respectively. Empiric treatment for UTIs in Nepal should be reconsidered and prudent use of antibiotics, particularly Gentamycin, is highly recommended. The recent spread of ESBL-producing Enterobacteriaceae and MRSA is striking and underlines the need for further studies.Nepal Journal of Science and Technology Vol. 16, No.1 (2015) pp.105-112

A single-dose antibiotic prophylaxis to prevent surgical site infection in clean-contaminated surgery among diabetic patients

Introductions: Guidelines on antibiotics use in surgical patients recommends a single dose prophylaxis for clean-contaminated cases and therapeutic course for contaminated and dirty cases. Compliance to this guideline is poor among diabetic patients. The aim of this study was to test the efficacy of single dose antibiotic prophylaxis on the occurrence of postoperative surgical site infection (SSI) in clean-contaminated surgery in diabetic patients.Methods: Retrospective cross-sectional study was carried out at KIST Medical College and Teaching Hospital from September 2008 to August 2012 involving 144 diabetic patients who underwent major clean-contaminated surgery. Forty eight patients received one gram of ceftriaxone intravenously as prophylactic antibiotic within 30 minutes prior to incision (group 1) and 96 patients received three doses of ceftriaxone (group 2). One dose was given within 30 minutes prior to incision and other two doses were given postoperatively. All patients were followed up for 30 postoperative days on outpatient basis. The SSI rates were compared in two groups. Pus from the infected wound was tested for culture and sensitivity.Results: The SSI rates in group 1 and group 2 were of 5/48 (10.42%) and of 9/96 (9.37%) respectively. There was no significant difference in SSI rates between group 1 and group 2 (p=0.322).Conclusions: Single dose of Ceftriaxone shows the similar effect as three doses in clean-contaminated surgery in diabetic patients.

Clinical profile and outcome of neonates admitted to the Neonatal Care Unit at a teaching hospital in Lalitpur, Nepal

Background: Neonatal period is a vulnerable time in which the newborn has to adapt to a totally new environment and is susceptible to many problems, which may even be life threatening. It is found that neonatal mortality rate is decreasing in Nepal but at a slower pace than infant and child mortality. In order to improve neonatal outcome, it is crucial to identify the areas where health care can be improved.Objectives: This study was conducted to analyze the spectrum of diseases and outcomes at a level two NICU at a tertiary care teaching hospital.Methods: A descriptive observational study conducted at the neonatal care unit in the Department of Paediatrics at KIST Medical College, Lalitpur, Nepal over one year from 14th of April 2013 to 13th April 2014. Data on age at admission, gender, gestational age, birth weight, initial presenting symptoms at admission, fi nal diagnosis and outcome were collected from in patient records at the hospital record section and analyzed using SPSS 17.0.Results: A total of 279 neonates were studied. The commonest causes of admission were infection (45.9%), followed by respiratory conditions (14.7%), neonatal jaundice (12.5%), perinatal asphyxia (9.3%) and prematurity/ small for gestational age (SGA) (6.5 %). Most of the admissions (62%) were during the fi rst 24 hours of life. The majorities, 89.2%, were term gestation and 10.8% were preterm. Most of the preterm babies were late preterms with gestational ages between 35- 36 weeks (73% of preterms were late preterms). Total of four mortalities (1.4%) occurred, three of which were due to perinatal asphyxia and one was a Down’s syndrome with overwhelming sepsis.Conclusion: In this study, infections followed by respiratory conditions were the leading causes of admission. Most of the admissions occurred during the fi rst 24 hours of life. This emphasizes the fact that attentiveness during the fi rst day of life, simple measure to prevent infection and early detection and treatment may go a long way in improving neonatal outcome.Journal of Kathmandu Medical CollegeVol. 3, No. 4, 2014Page: 144-148

An educational intervention's effect on healthcare professionals' attitudes towards pharmacovigilance.

Pharmacovigilance concerns the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. Consumer pharmacovigilance is the involvement of consumers in adverse drug reaction (ADR) reporting. Assessing healthcare professionals' (HCPs) knowledge of and attitude towards pharmacovigilance and consumer pharmacovigilance is integral to strengthening adverse drug reaction reporting systems. To study knowledge of and attitude towards pharmacovigilance and consumer pharmacovigilance among HCPs from KIST Medical College, Lalitpur, Nepal, and to plan an appropriate educational intervention to address deficiencies noted. The study was conducted from February 2013 to December 2013 at KIST Medical College using a self-administered, pretested, structured questionnaire. The maximum possible scores for knowledge, attitude, and total were 100, 95, and 195, respectively. Baseline knowledge and attitude were studied. Two months after the questionnaire, an intervention that used a combination of methods about pharmacovigilance and consumer pharmacovigilance was undertaken. Knowledge and attitudes were studied immediately after the intervention. Scores before and after the intervention were compared using Wilcoxon signed-rank test. A total of 105 HCPs participated. The median (interquartile range) knowledge, attitude, and total scores before the intervention were 56 (7), 72 (9), and 127 (16), respectively. After the intervention the scores increased significantly to 72 (8), 75 (11.5), and 146 (16.5) (p<0.001), respectively. The intervention was effective in improving HCPs' knowledge of and attitude towards pharmacovigilance and consumer pharmacovigilance. More studies on this topic among HCPs at other institutions and in the community are required.

Growing Resistance to Vancomycin among Methicillin Resistant Staphylococcus Aureus Isolates from Different Clinical Samples

Methicillin resistant Staphylococcus aureus (MRSA), majorly associated with nosocomial and community infections worldwide, are emerging as resistant strains to many antibiotics narrowing down the efficacy of antimicrobial therapy. In order to investigate the changing resistant pattern of MRSA to empirical drugs, the study was carried out at KIST Medical College and Hospital, Nepal. It also aims to determine the minimum inhibitory concentration (MIC) of vancomycin among MRSA. Altogether 3500 clinical samples including 1303 blood, 1489 urine and 708 body fluids were collected and processed. Isolated S. aureus were further screened for methicillin resistance by Kirby-Bauer disk diffusion technique using cefoxitin (30µg) disk. All MRSA were subjected to in vitro determination of MIC of vancomycin by agar dilution method as recommended by CLSI guidelines. Total 287 S. aureus were isolated from the different clinical samples. Altogether 248 (86.41%) were found to be multidrug resistance (MDR) while 42 (14.63%) of the isolates were methicillin resistance with the highest prevalence in the age group of 16-30. All 42 (100%) MRSA isolates were resistant to ampicillin and penicillin followed by 41 (97.62%), 32 (76.19%), 31(73.81%), 29 (69.05%), 9 (21.43%) and seven (16.67%) to cefotaxime, gentamycin, cotrimoxazole, erythromycin, tetracycline and ciprofloxacin respectively. Although all MRSA strains were sensitive to vancomycin on disc diffusion, four isolates were intermediates in vitro determination of MIC of vancomycin. The break point for vancomycin was found to be 15mm. The increment in vancomycin MIC among MRSA is alarming. Strict control measures to prevent MRSA spread and a routine surveillance for VRSA must be incorporated in hospitals.

Medical humanities: developing into a mainstream discipline.

Medical humanities: developing into a mainstream discipline.

Designing and conducting a two day orientation program for first semester undergraduate medical students.

Designing and conducting a two day orientation program for first semester undergraduate medical students.

Dentists' perspective on preference for direct restorative materials for different tooth cavities: A study from two colleges in Kathmandu, Nepal

Background: Restoration of carious teeth is required to preserve anatomy, function and aesthetics of a tooth. Proper restoration of carious teeth is paramount for the prevention of progression of a dental caries so as to obviate the need for root canal treatment. Location, extent, type, duration and cost play the major roles for the selection of a dental filling material.Objective: This study was set to know the preference of dentists for the selection of filling materials for different tooth cavities.Methods: This was cross-sectional observational study carried out at Kantipur Dental College and KIST Medical College for a period of six months. Pre-structured questionnaires were distributed to the dentists who were in dental practice and collected questionnaires were analyzed for the results. Data were compiled, entered and analyzed using Microsoft Excel 2007 and Epi Info 2000. Yates corrected Chi square test was used wherever applicable and level of significance was set at &lt;0.05.Results: Out of 65 questionnaires distributed to the dental practitioners, 57 (87.7%) questionnaires were returned. Composite was the material of choice as the restorative material for all kinds of tooth cavities except for class V for which glass ionomer cement was the main choice (52.6%). After composite, dental amalgam was second most preferred material for posterior tooth restorations. Order of preference for filling materials for posterior restorations were: composite (52.6%), dental amalgam (47.4%), miracle mix (68.3%; P&lt;0.05) and glass ionomer cement (42.1%). Majority of practitioners (78.9%,P&lt;0.05) opined that strength and durability of restorative material is the main guiding factor for the selection of the filling material for posterior tooth restorations. Additionally, dental amalgam had higher (68%, P&lt; 0.05) patient satisfaction with respect to cost and longevity or durability and was associated with less tiring and time consuming procedure (84%; P&lt;0.05) on dentists’ view.Conclusion: Majority of dentists opined that composite is the more preferred filling material for both anterior and posterior tooth restorations. For posterior tooth cavities (mainly for class I, II and VI) after composite, the order preference for filling materials was amalgam, miracle mix and glass ionomer cement.DOI: http://dx.doi.org/10.3126/jkmc.v3i2.11230Journal of Kathmandu Medical CollegeVol. 3, No. 2, Issue 8, Apr.-Jun., 2014Page: 72-77

An unusual association of pleural effusion with acute viral hepatitis A infection

An unusual association of pleural effusion with acute viral hepatitis A infection Ajaya Kumar Dhakal Arati Shakya, Devendra Shrestha, Subhash Chandra Shah, Henish Shakya Department of Pediatrics, KIST Medical College Teaching Hospital, Imadol, Lalitpur, Nepal Abstract: Hepatitis A virus infection is a common public health problem in developing countries primarily due to poor hygiene and sanitation. The clinical features of hepatitis A virus are mostly related to the derangement of liver function with occasional extrahepatic complications. Herein, a 2.5-year-old girl presented with abdominal pain and decreased appetite for 4 days, high-colored urine for 3 days, and yellowish discoloration of the eyes for 2 days. On presentation, there was icterus along with hepatomegaly and diminished breath sounds on the right side were noted 1 day after admission. Chest X-ray revealed right sided pleural effusion; however, ultrasonography of chest and abdomen displayed bilateral pleural effusion (right more than left) and minimal ascites with thickened gall bladder wall. Immunoglobulin M anti-hepatitis-A virus serology was positive. The pleural effusion in this child resolved spontaneously in 10 days. We report this case to highlight that hepatitis A infection should be considered in the differential diagnosis of pleural effusion in a patient with features of acute hepatitis. However, other common causes of pleural effusion such as tuberculosis and parapneumonic effusions that may coexist with hepatitis, especially in developing world, need to be excluded. Keywords: hepatitis A, pleural effusion, viral hepatitis

Condom Tamponade in the Management of Massive Obstetric Hemorrhage: An Experience at a Teaching Hospital

Aims:This study evaluates the effectiveness of condom tamponade in the management of massive obstetric hemorrhage. Methods: This hospital based prospective descriptive study was done in the department of obstetrics and gynecology of KIST Medical College Teaching Hospital, Lalitpur, Nepal from January 2013 to December 2013. During the study period, patients with obstetric hemorrhage(&gt;500ml blood loss) were identified and the details of the patient and their treatment were acquired. Data analysis was done by descriptive statistics using mean, median and frequency cross tabulations. The decision for condom tamponade was made when active continuous hemorrhage persisted despite of initial conservative measures. Results: Among 39 patients of obstetric hemorrhage out of 1522 deliveries, eight were managed by condom tamponade which includes 6 postpartum hemorrhage cases, 1 incomplete abortion case and 1 antepartum case managed prophylactically in anticipation of postpartum hemorrhage. Conclusions: Despite of the small study sample, the study concludes the use of condom tamponade as an effective means of controlling massive obstetrical hemorrhage due to uterine atony (both in post partum and post abortion cases). It is safe, easily available, inexpensive, minimally invasive, does not require anesthesia, easy to use and can be performed by any level of health personnel with some training. DOI: http://dx.doi.org/10.3126/njog.v9i1.11187 NJOG 2014 Jan-Jun; 2(1):41-47

Bacteriology of urinary tract infection in pediatric patients at KIST Medical College Teaching Hospital

Background: Urinary tract infection is common in children and is an important cause of morbidity. Urinary tract infection at young age can lead to renal injury and scarring, and ultimately lead to end stage renal disease in adulthood. Objectives: The purpose of study was to identify the different species of microorganisms, along with their antimicrobial susceptibility pattern, causing urinary tract infection in paediatric patients presenting with urinary tract infection at KIST Medical College, Imadol, Lalitpur, Nepal. Methods: This retrospective study examined microbiological and antimicrobial susceptibility pattern for urine samples collected at KIST Medical College, Imadol, Lalitpur from December 2010 to November 2013. A urine sample was included in our dataset if it demonstrated pure growth of a single organism and accompanying antimicrobial susceptibility and subject demographic data were available. Results: Escherichia coli was the most common organism isolated, followed by Klebsiella species, Staphylococcus species and then by Proteus species, Enterococcus species and Citrobacter species being equal in number. Microorganisms were most susceptible to amikacin and nitrofurantoin and most resistant to ampicillin and nalidixic acid. Conclusion: Though various microorganisms are responsible for urinary tract infection in children, Escherichia coli is the most common causative agent. Antimicrobial resistance has already emerged against many antibiotics, making empiric treatment of these infections challenging. DOI: http://dx.doi.org/10.3126/jkmc.v3i1.10919Journal of Kathmandu Medical CollegeVol. 3, No. 1, Issue 7, Jan.-Mar., 2014, Page: 21-25