Western Regional Hospital Research Articles

The In-patient Physiotherapy Service at Western Regional Hospital Pokhara, Related to Health Care in Nepal

Summary This article describes a cross-sectional study of the in-patient physiotherapy service at Western Regional Hospital, Pokhara, Nepal. After presentation of dates and clinical observations, characteristics and problems are identified and analysed within the wider context of healthcare and its availability. Existing and potential strategies are discussed, and conclusions drawn for the development of the service.

Scottish News

ALTHOUGH the health services in Scotland are broadly the same as those in England and Wales, they are separately administered by the Scottish Home and Health Department. During a visit to Scotland last summer it was interesting to read of their problems in the Scottish newspapers. There were several familiar topics under discussion at the time. The Western Regional Hospital Board, which covers Glasgow, was appealing to the Government for more money to offset the declining purchasing power of the pound. Reporting on last year's accounts, the chairman of the Board's finance committee said that although more had been spent . . .

A COMPARATIVE EVALUATION OF PRESCRIBING PRACTICE OF ANTIBIOTIC PROPHYLAXIS IN HOSPITALS OF POKHARA VALLEY

The main objective of the study was to assess the prescribing practice of antibiotic prophylaxis for differentsurgeries in hospitals of Pokhara valley. A descriptive, quantitative, retrospective study was used to evaluatethe patients who have undergone surgery between 15th April 2002 – 14th April 2003. A total of 950 patientswere taken from the medical record for the study. Data about patient (age, sex), surgery (type and indication),antibiotic/s prophylaxis (dose, duration) and length of hospital stay were collected. Caesarean Section (CS)was the common surgery in Western Regional Hospital (WRH) followed by cholecystectomy, 31.1% and24.4% respectively. In Manipal Teaching Hospital (MTH), dilatation and currettage (D and C, 21.6%) wasthe most common surgery followed by hysterectomy (21%). The mean length of stay in MTH for CS surgerywas 7.97 days whereas 7.01 days for WRH. Significant difference was found in length of stay of two hospitals(p<0.05). Antibiotic prophylaxis was given preoperatively in MTH (87%) and WRH (79.5%) respectively.Antibiotic prophylaxis was given intraoperatively in 1.2% cases of MTH. In MTH, the total antibioticduration in all surgeries is higher than WRH, significant difference was found only in cholecystectomy(p<0.05). In both hospitals Ampicillin+Cloxacillin was the most commonly used regimen, 12.4% in WRHand 34% in MTH. In WRH, Ciprofloxacin/Cefotaxim was also used by 12.4%. More than 79.1% of thepatients were exposed to, at least, two antibiotics as a prophylaxis in WRH where as more than 63.0% inMTH. Penicillin was found to be mostly used in both hospitals.Key Words: Antibiotic prophylaxis, Surgery.

Alcohol Dependence Syndrome Among Older Adults Attending Psychiatry OPD of a Private Hospital in Western Region of Nepal

Background: Alcohol use disorders in elderly people are common and associated with considerable morbidity. The objective is to estimate the prevalence of alcohol dependence syndrome among elderly patients attending psychiatric outpatient department of a private hospital in Western region of Nepal. Methods: A total of 80 elderly patients aged 65 years and above who attended the psychiatry outpatient department of Fewa City Hospital and Research Centre, Pokhara, Nepal were included in the study. A semistructured Performa was used to record the sociodemographic variables and the diagnosis was made according to ICD-10 Diagnostic Criteria for Research. Results: Five percent of the samples were diagnosed with alcohol dependence syndrome. The male to female ratio was 3:1. Conclusion: Results show high rates of alcohol dependence among the elderly population attending the outpatient department of a private hospital in Western Region of Nepal. Keywords: Alcohol dependence syndrome; older adults; psychiatric OPD DOI: http://dx.doi.org/10.3126/njms.v1i1.5796 Nepal Journal of Medical Sciences. 2012; 1(1): 39-41

A Two year Retrospective Study of Congenital Inguinal Hernia at Western Regional Hospital

In a retrospective study of 133 cases of inguinal hernia in infants and children upto the age of14 years, treated surgically at Western Regional Hospital, Pokhara, Nepalbetween April 1st 1997 and March 31st 1999, it was found that male patients out numberfemale patients in the ratio of 13.7:1 Right sided hernia was almost twice as common ascompared to left. Only 1.5% of patients (2cases) had bilateral inguinal hernia. 4patients (3%) presented with obstructive features. Routine exploration of contralateralside was not done as most surgeons do not recommend this, as only 20% develop herniaon the contralateral side.1 Only one patient had recurrent hernia.Key words: Congenital, hernia, inguinal, retrospective, incarceration.

Management of Head Injury by General Surgeons in a General Hospital

Background: Head injury is one of the common causes of surgical admission in Western Regional Hospital, Pokhara, Nepal. With no neurosurgeons available, most of the cases are managed effectively with adequately trained general surgeons. The aim of the study is to study the epidemiology, incidence and pattern of head injury and their outcome in a setting of a general hospital where they were managed by general surgeons. Methods: This is a prospective analytical study of 1847 head injury patients. The study defines the patterns of head injury, their management by general surgeons and outcome in surgery ward, Western Regional Hospital, Pokhara for about five years (1999 to 2003). Results: Head injury comprised 15.5% (1847) of total admissions (11901) in surgery ward. Out of those, 80.5% (1487) were mild, 10.4% (192) moderate and 9% (168) severe head injury cases, based on Glasgow coma scale. Majority of cases (42.1%) were young adults between 21-40 years. 70% (1294) of cases were male and 30% (553) were female. 7.5% (138) cases were associated with skull fractures. Most of the cases showed good recovery. Only 2% required surgery; 3.7% were referred; 2.8% died and 0.8% left against advice. Conclusion: Most of the cases of head injury can be managed by general surgeon in a General Hospital provided basic facilities like high dependency unit, Intensive care unit and a dedicated team are available. Keywords: Glasgow Coma Scale; head injury; traumatic brain injury DOI: http://dx.doi.org/10.3126/njms.v1i1.5791 Nepal Journal of Medical Sciences. 2012; 1(1): 19-22

Socio-demographic Characteristics and Diagnostic Profile of Patients Attending Psychiatric OPD of a Private Hospital in Western Region of Nepal

Background: Mental health services in Nepal are limited and there is a scarcity of epidemiological studies in our country. The present study is done with the aim to study the socio-demographic characteristic and diagnostic profile of patients attending the psychiatric OPD. Methods: This is a retrospective study where case records of all new patients, diagnosed to be suffering from Mental and Behavioral disorders according to Chapter V (F) of ICD-10, who attended the OPD from July 2011 to December 2011, were included in the study. Results: Maximum patients fall in the younger age group and are females. The patients were found to be suffering from neurotic, stress-related and somatoform disorders (35.4%) followed by mood disorder (18.3%), schizophrenia, schizotypal and delusional disorders (17.4%) and mental and behavioral disorders due to psychoactive substance use (9.7%). Conclusion: Mental disorders comprise a wide variety of disorders and affect the most productive age group suggesting the need for early identification and prompt management. Keywords: ICD-10 DCR; psychiatric OPD; psychiatric morbidity; neurotic disorders DOI: http://dx.doi.org/10.3126/njms.v1i1.5790 Nepal Journal of Medical Sciences. 2012; 1(1): 15-18

PESTICIDE POISONING CASES ATTENDING FIVE MAJOR HOSPITALS OF NEPAL

Although some hospital-based data are available, there are no large scale or nationwidedata available on the problem of pesticide poisoning in Nepal. This study wasdone to fill up this gap to some extent and was carried out at five major hospitals ofNepal - Bir Hospital, Patan Hospital and Tribhuvan University Teaching Hospital(TUTH) in Kathmandu, Western Regional Hospital (WRH) in Pokhara, and B. P.Koirala Institute of Health Sciences (BPKIHS) in Dharan. A harmonized PesticideExposure Record (PER), which was finalized during the "WHO Regional Workshopon Pesticide Poisoning Database in SEAR Countries" held in 1999 in Delhi,1 was usedin the study. Data collection was done for a period of six months in each of the fivehospitals.Altogether there were 256 patients in the present study. There were 98 patients fromBir hospital, 48 from Patan hospital, 45 from TUTH, 36 from BPKIHS, and 29 fromWRH. Of the 256 patients, 112 were males and 144 females. The most common agegroup involved in pesticide poisoning was 15-24 years. In most of the cases patient'sarrival to hospital was within three hours after pesticide exposure. In the majority ofcases the nature of exposure was intentional and the route of exposure oral. Mostpoisonings occurred in urban set-up and at home.Organophosphorous compounds were found to be the most common pesticides involved(in >50% cases), followed by zinc phosphide and aluminium phosphide. All caseswere given first aid treatment in the Emergency Room of the study hospitals, followingwhich most of the cases (n=197) were admitted; the rest were discharged or referredto other hospitals. Systemic effects of poisoning were recorded to have been present in95% of cases. For nearly two-third (65.6%) of the cases the poisoning severity scorewas recorded in the PER as "moderate" or "severe." More than 16% of patients hadfatal outcome.Improved regulation on availability of pesticides, strict registration of vendors,modification in packaging of pesticides, adequate provision of information to thepublic, further research on pesticide poisoning (including community-based studies),creation and regular revision of national/local standard treatment guidelines (STGs),regular training of health care providers based on such STGs, better availability ofdrugs/antidotes, establishment of poison information centers, and enhanced regionallinkages are some of the measures that will help reduce the problem of pesticidepoisoning in Nepal.Key Words: Pesticide poisoning, Organophosphates, Zinc phosphide, Aluminiumphosphide, Pesticide exposure record, Hospital, Nepal.

A rare case of virilizing adult granulosa cell tumor

A twenty eight year old lady, married for two years with no issue, presented at WesternRegional Hospital Pokhara on 8th July, 1999 with a history of amenorrhea for 1½years, lump abdomen 1 year, hoarseness of voice for 1 year and signs of hirsutism forthe same duration. She was taken up for laparotomy wherein a left ovariectomy withsalpingectomy was done and a large cystic ovarian tumor was removed. Post operativeperiod was uneventful and she was advised follow up. The histopathological diagnosiswas Adult Granulosa Cell Tumor. What made this case interesting is that mostGranulosa Cell Tumors (about 3/4th) are estrogenic or feminizing, but rare examples,including a disproportionate number of large thin walled cystic tumors are androgenic.This was one of those rare virilizing tumors with classical features of infertility,amenorrhea, hoarseness of voice, clitiromegaly, and breast atrophy, but we could notestimate testosterone levels due to lack of facilities available.Key Words: Granulosa Cell Tumor, Virilizing Ovarian Tumors, Sex Cord stromal tumors.

Bacterial contamination on the surface of hospital linen chutes.

SUMMARYA survey of 13 linen chutes in eight hospitals was carried out to assess the amount of bacterial contamination on the inner walls of these chutes. It was shown that the average bacterial count in these chutes was low by general hospital standards (19·7 bacterial colonies per Rodac plate). This concentration was eight times less than the average concentration found on the floor surface at each linen disposal and collection point (153 bacterial colonies per Rodac plate).Three chutes sampled during the survey were periodically cleaned but appeared to derive only very limited benefits from the cleaning method they used.Tests carried out on three linen chutes showed that the bacterial surface contamination of a sterilized chute could normally reach a maximum concentration in a period of between 4 and 24 hr.It is concluded that so long as good engineering practices are used in the construction of linen chutes the bacterial contamination on their inner surface should not contribute to the problem of hospital cross infection. For this reason, and because of the impracticability of sterilizing linen chutes at very short intervals of time, it is considered that cleaning of chutes would serve no practical purpose.Thanks must be recorded to the authorities of all those hospitals who gave their permission for us to study their linen disposal chutes and afforded us every assistance.We should also like to thank Mr W. Carson, Leader of the Building Services Research Unit, for his help and encouragement.The work reported was a part of an investigation into the design of linen disposal chutes sponsored by the Western Regional Hospital Board, Scotland.

Experimental evacuation of the bladder by means of implanted electrodes.

Journal Article Experimental evacuation of the bladder by means of implanted electrodes Get access Shedden Alexander, Shedden Alexander Department of Surgery, Glasgow Royal Infirmary Search for other works by this author on: Oxford Academic Google Scholar David Rowan David Rowan Regional Physics Department, Western Regional Hospital Board Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 52, Issue 10, October 1965, Pages 808–812, https://doi.org/10.1002/bjs.1800521026 Published: 08 December 2005

Western Regional Hospital Board Cancer Committee

Western Regional Hospital Board Cancer Committee