scholarly journals Study of Poisoning Cases Admitted in ICU of Western Regional Hospital

2020 ◽  
Vol 3 (2) ◽  
pp. 294-297
Author(s):  
Surya Bahadur Hamal Thakuri ◽  
Suresh Thapa ◽  
Madan Prasad Baral ◽  
Buddhi Sagar Lamichhane
Keyword(s):  
Tertiary Care ◽  
Acute Poisoning ◽  
Regional Hospital ◽  
Medical Emergency ◽  
Close Monitoring ◽  
Standard Management ◽  
Number Of Patients ◽  
Western Regional ◽  
Set Up ◽  
One Year

Introduction: Acute poisoning, irrespective of the etiology, is a medical emergency which requires prompt diagnosis and treatment. Such cases require ICU set up for better management. Central level hospitals in Nepal have ICU facilities to manage such cases. Materials and Methods: Current study is a retrospective type hospital based study conducted in Western Regional Hospital, Pokhara. Data collected from ICU department of Hospital in a period of one year from 2073 Ashad 16 to 2074 Ashad 16. It was analyzed and presented. Results: In this study it is observed that total 90 cases admitted in ICU department of WRH in a period of one year. Female patients outnumbered the male patients. Age group of 10-20 years is predominance in present study. Most of the patients were from Kaski district as the hospital belongs to Kaski district and one of the renowned tertiary care centers in the Gandaki province. Maximum number of patients consumed the OP compound. Outcome was better as out of 90 cases 80 were discharged and only 10 were died during the course of treatment. Conclusion: Early identification of the cause and type of poisoning, close monitoring and standard management, preferably in the ICU for at least a first few days, reduces the complication and improves the survival. The commonly available insecticides and rodenticides are the most common cause of acute poisoning.

Neurodevelopmental outcome of healthy term newborn with serum bilirubin >15 mg/dl at one year

2020 ◽  
pp. 1-6
Author(s):  
P. Dubey ◽  
J. Shrivastava ◽  
B.P. Choubey ◽  
A. Agrawal ◽  
V. Thakur
Keyword(s):  
Serum Bilirubin ◽  
Tertiary Care ◽  
Neurodevelopmental Outcome ◽  
Significant Risk ◽  
Central India ◽  
Significant Risk Factor ◽  
Motor Domain ◽  
Medical Emergency ◽  
One Year ◽  
Group 1

BACKGROUND: Neonatal hyperbilirubinemia is a common medical emergency in early neonatal period. Unconjugated bilirubin is neurotoxic and can lead to lifelong neurological sequelae in survivors. OBJECTIVE: To find out the association between serum bilirubin and neurodevelopmental outcome at 1 year of age using Development Assessment Scale for Indian Infants (DASII). METHODS: A prospective cohort study was conducted in the Department of Pediatrics of a tertiary care institution of Central India between January 2018 and August 2019. Total 108 term healthy neonates, with at least one serum bilirubin value of >15 mg/dl, were included. Subjects were divided into three groups based on the serum bilirubin; group 1: (15–20 mg/dl) –85(78.7%) cases, group 2: (20–25 mg/dl) –17(15.7%), and group 3: (>25 mg/dl) –6(5.5%). Developmental assessment was done using DASII at 3, 6, 9, 12 months of age. RESULTS: Out of 108 cases, 101(93.5%) received phototherapy, and 7(6.5%) received double volume exchange transfusion. Severe delay was observed in 5(4.6%) and mild delay in 2(1.9%) cases in the motor domain of DASII at one year. Severe delay in the motor domain was associated with mean TSB of 27.940±2.89 mg/dl and mild delay with mean TSB of 22.75±1.76 mg/dl (p = 0.001). On cluster analysis, delay was observed in locomotion 1 score in 11(13%) cases (p = 0.003) and manipulation score in 6(7.1%) cases in group 1. CONCLUSION: Increased serum bilirubin was a significant risk factor for the delayed neurodevelopment in babies with neonatal jaundice. Even a moderate level of bilirubin significantly affects the developmental outcome.

scholarly journals A study of the outcome of pregnancy complicated by obstetric cholestasis

2018 ◽  
Vol 7 (3) ◽  
pp. 996
Author(s):  
Samik Medda ◽  
Sibani Sengupta ◽  
Upasana Palo
Keyword(s):  
Neonatal Outcome ◽  
Tertiary Care ◽  
Fetal Distress ◽  
Adverse Outcomes ◽  
Number Of Patients ◽  
Common Causes ◽  
Fetal Surveillance ◽  
Meconium Staining ◽  
One Year ◽  
Period Of Gestation

Background: Obstetric cholestasis is one of the most common causes of liver disease in pregnancy. Present study was carried out to study the incidence of Obstetric Cholestasis and its feto-maternal outcome in a tertiary care hospital.Methods: It is a prospective epidemiologycal study during a period of one year (2014 to 2015) over 100 pregnant ladies suffering from pruritus and detected as having Obstetric Cholestasis. They were followed up and maternal as well as fetal-neonatal outcome recorded. Appropriate statistical analysis done as applicable.Results: The incidence of Obstetric Cholestasis in our hospital was 9.9%. Majority of cases (43.0%) are diagnosed in late gestational age, mostly during 28 to 32 weeks period of gestation. Maternal morbidities are due to sleep disturbance (60/100), dyslipidemia, coagulation abnormality, PPH (10.0%) and increase chance of operative delivery (66.0%). Neonatal morbidities are mainly due to fetal distress, prematurity (22.0%), low birth weight (32/100) and meconium staining of amniotic fluid (42.0%). Maximum number of patients are delivered at 37 to 38 weeks, due to active and early intervention.Conclusions: Early diagnosis and active maternal and fetal surveillance is of utmost importance to avoid adverse outcomes.

scholarly journals A clinico pathological correlation in leprosy in a tertiary care teaching institution

2019 ◽  
Vol 5 (4) ◽  
pp. 870
Author(s):  
Ramesh A. ◽  
Sampath V. ◽  
Shvedha M.
Keyword(s):  
Clinical Diagnosis ◽  
Tertiary Care ◽  
Clinical Information ◽  
Lepromatous Leprosy ◽  
Female Ratio ◽  
Histopathological Findings ◽  
Medical College ◽  
Number Of Patients ◽  
One Year ◽  
Madras Medical College

<p class="abstract"><strong>Background:</strong> Leprosy is a chronic infectious granulomatous disease caused by <em>Mycobacterium leprae</em>. The disease primarily affects peripheral nervous system, the skin and certain other tissues. It is a spectral disease which is classified into five groups based on clinical, histopathological and bacteriological and immunological criteria as tuberculoid (TT), borderline tuberculoid (BT), mid-borderline (BB), borderline lepromatous (BL), lepromatous (LL) according to Ridley-Jopling classification. Adequate clinical information combined with histopathology and bacteriological index is helpful not only in classification of different types of leprosy, but also useful for management of cases.The objective of the study was to correlate clinical diagnosis with histopathological findings of leprosy.</p><p class="abstract"><strong>Methods:</strong> A retrospective study was conducted for one year from January to December 2018 in Leprosy clinic, Department of Dermatology, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai. The histopathological findings were compared with clinical diagnosis.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total number of cases attended leprosy clinic from January 2018 to December 2018 was 167 cases, among those 49 clinically diagnosed cases were included in the study. Out of 49 cases, maximum number of patients belonged to 30-50 years age group. Male to female ratio was 3.9: 1. Hypopigmented, hypoaesthetic patches were commonly seen. Clinically as well as histopathologically BT leprosy was common.The maximum histological correlation seen in lepromatous leprosy (100%) followed by BT (80%).</p><p class="abstract"><strong>Conclusions:</strong> The study emphasises the role of skin biopsy in confirming the clinical diagnosis of leprosy and also as a therapeutic guide.</p>

scholarly journals Clinicopathological study of breast lesions over a period of one year in a tertiary care center

2018 ◽  
Vol 6 (10) ◽  
pp. 3397
Author(s):  
Divyasree Neeli ◽  
Bhagyalakshmi Atla ◽  
Satish Kumar Seeram ◽  
Lavanya Latchupatula ◽  
Srikanth Reddy Kamireddy
Keyword(s):  
Breast Carcinoma ◽  
Care Center ◽  
Tertiary Care ◽  
Duct Cell ◽  
Histopathological Diagnosis ◽  
Breast Lesions ◽  
Adequate Treatment ◽  
Molecular Features ◽  
Number Of Patients ◽  
One Year

Background: Breast carcinoma is no longer seen as a single disease but rather a multifaceted disease comprised of distinct biological subtypes with varied natural history, presenting a diverse spectrum of clinico-pathological and molecular features with different therapeutic and prognostic implications. The present study was designed to evaluate the frequency, age, gender and histopathological features of breast carcinoma in a tertiary care hospital.Methods: The present study is a hospital based retrospective study for a period of one year from January 2015 to December 2015, conducted in the Department of Pathology, Andhra Medical College, Visakhapatnam.The clinical details were recorded as per the proforma. Tissue for H&E sections were fixed in 10% formalin and subjected to routine paraffin embedded processing and stained with Hematoxylin and Eosin.Results: Out of the total 185 cases of breast lesions, 151 cases (81.62%) were diagnosed as non-malignant and 34 cases were malignant (18.37%). Maximum number of patients, 106 cases (57.2%), were between 21 - 40 years. Out of 34 malignant breast lesions, 27 were diagnosed as Infiltrative duct cell carcinoma (79.41%), followed by medullary carcinoma 4 cases (11.76%).Conclusions: The pattern of breast lesions provides valuable information concerning clinicopathological profile of breast lesions. The clinical diagnosis of a breast lump must be correlated with histopathological diagnosis for correct and adequate treatment of patient.

scholarly journals PATTERNS OF PRESCRIPTION AND ADR MONITORING OF DRUGS IN THE MANAGEMENT OF NEUROPATHIC PAIN IN A TERTIARY CARE TEACHING HOSPITAL

2021 ◽  
pp. 55
Author(s):  
SUBHRANSU SEKHAR JENA ◽  
MONALISA JENA ◽  
NIBEDITA PATRO ◽  
SWATI MISHRA ◽  
MAITREYEE PANDA ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Neuropathic Pain ◽  
Tertiary Care ◽  
Drug Efficacy ◽  
Number Of Patients ◽  
The Central Nervous System ◽  
And Gender ◽  
Fatal Adverse Events ◽  
One Year

Objective: Neuropathic pain arises from damage or pathological changes in the peripheral or central nervous system. The pain is difficult to treat as standard treatment with conventional analgesics doesn`t typically provide effective relief of pain. Methods: It was a one-year study of utilization and analysis of prescriptions for PNDs (Painful neuropathic disorders). The parameters evaluated were demographic profile of the patient (age and gender), type and etiology of PNDs, drug data (name of the group of drugs with individual drugs, mono or polytherapy, number of drugs per prescription, formulation) and associated adverse drug reactions (ADR) with the prescribed drug. Results: Maximum number of patients of PNDs resides in the age group of 18 – 35 yrs (41.2%) & more common in females. The most common PND encountered was painful diabetic neuropathy (43.9%) followed by cervical and lumbar radiculopathy, postherpetic neuralgia. 2942 drugs were prescribed in 1020 prescriptions out of which 96.8% were oral and 3.2% were topical formulations. Most frequently prescribed group of the drug was tricyclic antidepressants (27.3%) followed by anticonvulsants (25.3%). Polypharmacy was seen 89.7% as compared to monotherapy (10.3%). Only 132 ADRs of various types were seen. The most common organ system affected was the central nervous system followed by gastro intestinal systems. The most common drugs implicated for ADRs were TCAs (24.4%), anticonvulsants (16.6%), and Pregabeline (9.8%). There were no fatal adverse events. Mild to moderate ADRs included constipation, nausea, vomiting, drowsiness, dryness of mouth. Conclusions: The choice of drug depends on etiology of neuropathic pain, drug efficacy and availability and also on ADR profile.

scholarly journals Outcomes of Snakebite Envenomation in Children

1970 ◽  
Vol 31 (3) ◽  
pp. 192-197 ◽  
Author(s):  
BM Shrestha
Keyword(s):  
Risk Factors ◽  
Case Fatality ◽  
Medical Emergency ◽  
Close Monitoring ◽  
Night Time ◽  
Systemic Complications ◽  
Standard Management ◽  
Management Protocol ◽  
Management Of Complications ◽  
Public Health Hazards

Introduction: Snakebite is a medical emergency, and is considered to be one of the major public health hazards in the Terai and inner-Terai regions of Nepal. Very few studies have been conducted so far in Nepal to highlight the epidemiology of snakebite in children. Aim: To review the pattern and characteristics of snakebites in children, focusing primarily on the outcomes, fatality and risk factors for death. Settings: An emergency department of a 136-bedded secondary care-referral hospital (Lumbini Zonal Hospital) situated at Butwal in the Western Nepal. Methodology: The study was carried out in 152 children aged < 15 years old, who got anti-snake venom (ASV) over a period of 48 months. Diagnosis of snakebite envenomation was based on clinical ground. Results: Children over 5 years of age constituted the highest number (87%) of cases. Peak incidence of poisoning (71%) was observed during the months of Asadh- Bhadra (June-September). Most of the bites (61%) were by unidentified snakes, most commonly (91%) on the extremities. Snakebite envenomation occurred more frequently (52%) during night time. 85% of children had local or systemic complications, commonest being respiratory paralysis(92/152).Case fatality rate (CFR) was 28%. Risk factors for death were: age < 5 years; bites by unidentified snakes and kraits and bites on ears & unknown sites. Conclusion: Compared with adults, children with snake envenomation have higher morbidity and mortality, which can be minimized by early diagnosis, appropriate treatment and close monitoring of children on ventilation for the timely management of complications. Emphasis should be given on developing a standard management protocol in children. Keywords: Snakebite; Envenomation; Children; Outcomes; Nepal DOI: http://dx.doi.org/10.3126/jnps.v31i3.5358 J Nep Paedtr Soc 2011;31(3):192-197  

scholarly journals Profile of Ectopic Pregnancy at Western Regional Hospital

2017 ◽  
Vol 13 (4) ◽  
pp. 397-400
Author(s):  
Rabi Prasad Regmi ◽  
Shyam Sundar Parajuly ◽  
Ananda Bahadur Shrestha ◽  
Dela Joshi Singh ◽  
Sarvesh Gyawali
Keyword(s):  
Ectopic Pregnancy ◽  
Discharge Summary ◽  
Regional Hospital ◽  
Contraceptive Device ◽  
Beta Hcg ◽  
Number Of Patients ◽  
Obstetric Emergencies ◽  
Life Threatening ◽  
Western Regional ◽  
Ectopic Pregnancies

Background & Objective: Ectopic pregnancy (EP) is one of the common life threatening obstetric emergencies which if not recognized and managed on time can be ruptured which could be a cause of death.  Unfortunately, the world wide incidence of EP is in an increasing trend. The main objective of this study is to assess the frequency, trends, blood loss and management aspects of EP at Western Regional Hospital (WRH), Pokhara.Materials & Methods: The study was carried out in the department of Obstetrics and Gynecolgy, WRH. Data were collected and analyzed from patient’s records and discharge summary during the period of 2072-1-1 to 2072-9-30 B.S, retrospectively. Total number of hospital deliveries (7250) during this period was obtained from record section. Diagnosis of EP was made by urine beta- hcg (human chorionic gonado-tropin hormone) test and pelvic ultrasonography.Results:  The incidence of ectopic pregnancy was one in every 168 deliveries. Forty three such ectopic pregnancies were diagnosed and managed during the period, the mean age was 26.34 years, the median being the age of 25-29 years (16 patients). Twenty seven patients had ruptured ectopic pregnancy. Of all the cases, the number of patients with heterotopic pregnancy and intra uterine contraceptive device (IUCD) in situ were one for each (2.3%). All cases were satisfactorily managed with no mortality, and a mean of 6.1 days of hospital stay.Conclusion: Ectopic pregnancies are common cause of hospital admission, irrespective of patient's age all of which were managed at WRH with no mortality.

scholarly journals Psychiatric Referral Pattern in a General Hospital

2018 ◽  
Vol 1 (1) ◽  
pp. 28-30
Author(s):  
Leepa Vaidya ◽  
Rajan Sharma
Keyword(s):  
General Hospital ◽  
Mentally Ill ◽  
Psychiatric Patients ◽  
Psychiatric Morbidity ◽  
Regional Hospital ◽  
Referral Pattern ◽  
Psychiatric Consultation ◽  
Psychiatric Referral ◽  
Western Regional ◽  
One Year

Background: The referral rates of psychiatric patients in Nepal are very low, considering the higher rates of psychiatric morbidity in patients who attend various departments of a general hospital. Studying the pattern of psychiatric referrals may facilitate the management of the mentally ill in a comprehensive and holistic manner. Materials and methods: The study was conducted at Western Regional Hospital (WRH) over the period of one year. The patients referred from different departments were assessed by the consultant psychiatrists. Result: A total of 816 patients were referred for psychiatric consultation out of which majority was from department of medicine and the most common reason for referral was anxiety disorder. Conclusion: Multi-disciplinary interaction is beneficial to identify the psychiatric morbidity in the patients who attend general hospital.

SETTING UP OF A HOMECARE SYSTEM FOR HIGH COST NEBULISERS IN A PAEDIATRIC CYSTIC FIBROSIS CENTRE

2016 ◽  
Vol 101 (9) ◽  
pp. e2.57-e2
Author(s):  
Veronica Chorro-Mari ◽  
Nanna Christiansen
Keyword(s):  
Cystic Fibrosis ◽  
Tertiary Care ◽  
Screening Process ◽  
Patient Registration ◽  
Number Of Patients ◽  
Royal London Hospital ◽  
Cystic Fibrosis Centre ◽  
Ward Rounds ◽  
Specialist Nurses ◽  
Set Up

AimDue to national changes to the commissioning process of high cost nebulisers (HCN) for Cystic Fibrosis (CF) patients, CF centres have to repatriate the prescribing of the HCN to the tertiary care centres.1 The following nebulisers will no longer be prescribed by primary care: Cayston® (Aztreonam); Colomycin®, Pomixin®, Clobreathe® (Colistimethate); Pulmozyme® (Dornase alfa); Tobi®, Tobi Podhaler ®, Bramitob® (Tobramycin).This abstract explains how the Royal London Hospital (RLH) Paediatric Pharmacy recruited over 100 paediatric (CF) patients smoothly within a period of 4 months and set up a homecare system to avoid patients and families having to travel large distances to obtain their medication.MethodsA number of homecare companies were evaluated initially. Parameters looked at were reports of customer satisfaction, delivery cost, turn-around time once the prescription was received and availability of same day delivery service.In order to capture existing patients we met with CF Specialist Nurses to establish the total number of patients on HCN, what nebulised treatment they were on and their respective doses. We prioritised patients that had known problems with GP prescribing and anybody newly starting on HCN.To communicate the change to parents, a letter was sent to all parents explaining the changeover to homecare delivery and tertiary prescribing. In addition a section in the parent bulletin was dedicated to the topic as well. Following this we contacted parents via phone and in clinic to request consent and explain the process.Up to 10 patients were contacted weekly (average of 7); the consent form and registration form were then faxed to the Homecare company for patient registration. In parallel to this prescriptions were requested for the patients that had been set up in the previous week, ensuring that prescribing was spread out over time to avoid having peak times for repeat prescriptions.In addition to the letter to parents GP surgeries were also informed in writing about the changes in commissioning and planned repatriation of HCN. This information was also included on discharge prescriptions for patients on any of the HCNs as part of the pharmacy screening process.A system for follow up prescriptions as repeat was set up between the team so we would not have unexpected urgent requests and we could avoid missed doses, urgent delivery charge or stress in the team. In order to manage the prescriptions and ease communication across the team a database was developed.ResultsFrom March to July 2014 (16 weeks) one hundred and four patients were successfully repatriated to tertiary care.ConclusionA planned method and agreed standard operation procedure was key to effectively capture and repatriate all patients while at the same time keeping the increase on workload for the pharmacy team to a minimum. The fact of having a strong pharmacy presence as part of the multidisciplinary team attending CF clinics and ward rounds was vital in making this work.

scholarly journals Analysis of factors responsible for intrauterine fetal death in rural pregnant women at tertiary care centre of Northern India

2017 ◽  
Vol 6 (9) ◽  
pp. 4071 ◽  
Author(s):  
Shaveta Garg ◽  
Naina Kumar
Keyword(s):  
Fetal Death ◽  
Tertiary Care ◽  
Intrauterine Fetal Death ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Northern India ◽  
Number Of Patients ◽  
Tragic Event ◽  
Abruptio Placenta ◽  
One Year

Background: Intrauterine fetal death (IUFD) is a tragic event for both the parents and obstetrician. Objectives of current study were to study the underlying etiology of Intra Uterine Fetal Death (IUFD) that can be helpful in formulating the preventive measures.Methods: This study was conducted over a period of one year from April 2016 till March 2017 at a tertiary rural care hospital. All patients with diagnosed IUFD at >24 weeks of gestation were included in the study.Results: Total eighty patients were admitted with diagnosis of intrauterine fetal death. Among these majority 58 (72.5%) were multigravida and only 22 (27.5%) were primigravida. Maximum number of patients, 61 (72.5%) were between age group of 20-30 years. Maximum number of IUFD were reported between 36-40 weeks of gestation (36.25%). Most of fetal deaths were due to preventable conditions like hypertensive disorders of pregnancy (28.75%), severe anemia (15%), abruptio placenta (11.25%), and rupture uterus (10%). Out of these patients 68 (85%) delivered vaginally and 7 patients were delivered by LSCS.Conclusions: The present study emphasizes the role of health education, regular antenatal checkups, early detection of complications and hospital delivery to reduce the overall preventable IUFD.

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