Background: Drugs play an important role in protecting, maintaining and restoring health. Drugs are prescribed irrationally throughout the world. Objective: To study the utilization of drugs in in-patient of four major ward of a tertiary care hospital in Nepal. Method: This was a cross-sectional descriptive study conducted in four major wards for duration of one month. Result: A total of 467 patients were prescribed a total of 2188 drugs among which 535 drugs were prescribed in surgery ward, 567 drugs in medicine ward, 220 drugs in pediatric ward and 866 drugs in obstetrics and gynecology ward. The average number of drugs per prescription was 4.68. All drugs were prescribed by brand names and generic prescribing was nil. Among all, 70.61% of drugs were from essential list of drugs.43.87% of drugs were given through injections. 34.41%, 26.05%, 11.7%, 6.35%, 6.17% and 4.84% of prescribed drugs were AMA, GIT, MSK, CNS, CVS and minerals and vitamins respectively. Four drugs per prescription were prescribed to 21.41% of the total patients (n=467). Conclusion: Polypharmacy, low rate of generic prescriptions and overuse of antibiotics still remain a problem in health care facilities in Nepal. This calls for sustained interventional strategies and periodic audit at all levels of health care to avoid the negative consequences of inappropriate prescriptions. Health Renaissance 2015;13(2): 50-65
Background: Extra-articular fracture of proximal tibia is one of common injury.The study is randomized controlled trial in which individuals sustaining a fracture of the proximal metaphysis of the tibia will be operatively managed by one of two strategies. The first strategy involves fixation of the fracture with a reamed, interlocking intramedullary nail (Nail Group). The second treatment strategy involves percutaneous fixation of the fracture with a locking plate (Plate Group).Objective: To compare the functional outcome of intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures in adults in terms of procedure time, time to achieve union, functional outcome, blood loss, cost of treatment, complication if any. Methods: It is randomised controlled trial study. The patients were randomized into two groups, each of size 60: Group A (IMIL group) Group B (Locking Plate group). During procedure patients were evaluated for blood loss, procedure time or any complications. Immediate post operative complications were taken into account and post operative radiological parameters measured.Results: A total of 120 patients (75 male and 45 female) were included in the study. Fifty five patients were less than 25 years age group followed by 30 patients between 25-40 yrs, 25 patients less than 25 age group and 10 patients more than 55 years. The average blood loss is 95 ml in IMIL group and 105 ml in locked plate group.Conclusion: IMIL is more expensive than percutaneous locked plates IMIL came out as a shorter surgery with little blood loss however at the same time much costlier to locked plating. Health Renaissance 2015;13 (3):
Introduction: Malaria is a well-known disease and it continues to be a major public health problem at the start of new millennium. The problem is persistent not only amongst the city dwellers but also amongst the rural population.Objective: To identify the magnitude of malaria cases and to compare the malaria cases between hilly area and Terai belts.Methods: This cross-sectional study was carried out in Terai belt of Morang District Nepal at Nobel Medical College & Research Center Biratnagar from March to Oct 2007 and hilly area around Lumbini Medical College Teaching Hospital & Research Center Pravas, Tansen, Palpa of Nepal between March to December 2008. Blood samples were collected from all the cases and malaria parasites were examined by Peripheral Blood Smear Examination and Rapid Card Method Screening.Results: Thirty-five cases were malaria positive from hilly area of whom 80% had Plasmodium vivax infection. Whereas in Terai belt 231 positive cases ware recorded. Out of them (62.8%) cases were affected by Plasmodium vivax infection. That most vulnerable age group was 15 years and above. Males were more affected than females.Conclusion: It was observed that in hilly areas the numbers of positive cases are less than the Terai belt. The magnitude of malaria cases are found high in July. A steady decline has been observed till September to October Health Renaissance 2015;13 (1): 4-12
Background: Today there has been a change in the perception of disease from germ theory to the involvement of multiple factors in the causation.Methods: With this notion, this cross sectional study made an effort to delineate the socio-cultural factors associated with health in six teaching districts of B.P. Koirala Institute of Health Sciences in the Eastern region of Nepal among the mothers of reproductive age surveying 1985 households.Results: This study revealed association of chronic disease and acute illness with various socio-demographic variables like religion, ethnicity, family size, number of children, respondent’s literacy and occupation. Number of jobholders in the family and poverty line were found to be associated with acute illness. Treatment of shaman healers and restrictions during pregnancy period showed association with health inequalities. Mortality in the family was associated with ethnicity, number of children, and literacy of respondent.Conclusion: As a consequence of these associated factors, the effective utilization of the modern health facilities may not be proper which may lead to ill health consequences. Multifaceted development program from the government along with effective awareness program can help out the people to combat the evil of health life. Health Renaissance 2015;13 (3): 114-128
Introduction: Isolated capitellum fractures are rare and represent only 1% of all elbow fractures and 6% of distal humeral fractures.Case description: A 45-year-old right hand dominant female presented to us with pain and stiffness in her left elbow following a fall onto the outstretched hand that occurred 6 months prior. She had capitellum fracture with avascular changes and excision of the fractured fragment was done. Physiotherapy was initiated with outcome of nearly normal elbow function. At the time of injury, she was unable to move her elbow actively due to pain and she was misdiagnosed as soft tissue injury earlier in a local hospital.Conclusion: Possibility of rare diagnosis such as capitellum fracture should also be kept in mind while treating elbow injuries. Health Renaissance 2015; 13 (1): 112-116
Background: Due to its perception as a disease of development, road traffic accident and related injuries tend to be under recognized as a major health problem in developing countries. However, majority of the world's fatalities on the roads occur in low income and middle income countries. Since the main cause of road traffic accident is attributed to human risky behaviors, it is important to identify significant factors for risky behaviors of drivers.Objective: To know the risk taking behavior among drivers and practices of driving.Methods: This population based cross-sectional study. The study was conducted in Dharan, a township in Eastern Nepal. The study population includes of all long route drivers who are registered in membership of vehicle organization. Modified semi structured questionnaire was used for data collection. SPSS version 11.5 computer software was used for data entry and analysis.Results: Majority of study population belong to 25-29 years group. Majority of the drivers had valid license (98%) and about 68.9% drivers didn’t had any formal driving training school prior starting driving vehicle Most of them drive in high speed at highways but majority ignored that they take alcohol while driving. with growing age, years of driving had correlation of accidents among drivers populationConclusion: Study population comprises of youth drivers and most they had valid lenience. With the growing age drivers are neglecting traffic rules and sings and young driver are driving vehicles with overconfidently Health Renaissance 2015;13 (3): 1-6
Background: Tibial plateau fractures occur due to a combination of axial loading and varus/valgus forces leading to articular cartilage damage, mal-alignment and secondary osteoarthritis and functional loss.Objective: To know pattern and types of treatment of tibial plateau fractures and effect of fracture pattern on functional outcome. Method: We conducted prospective study over a period of one year. Fifty-three patients with tibial plateau fractures were presented during that period. Eighteen patients were excluded due to significant polytrauma and major limb injuries. Four patients did not give consent for the study. Thirty-one patients meeting the criteria were enrolled in the study. Two patients were lost during follow up. Remaining patients were evaluated at the end of one year. Data were recorded and analyzed using appropriate statistical methods.Result: Among 29 patients, 21 were male. Mean age was 35.07±11.96 years. 55.2% had RTA followed by 31 percent fall injury. 65% were treated with open reduction and internal fixation with plating followed by AK pop cast, cannulated cancellous screw and ilizarov fixation. Bone grafting was done in 3 cases. Twenty-five patients had excellent, two had good, two had fair and no patients had poor result. Three patients (10%) had complications. One had common peroneal nerve palsy, two had wound infections and no patient demonstrated early arthritic changes.Conclusion: Tibial plateau fractures treated with different modalities at our institute has been associated with excellent and good functional outcome at the end of short term follow up.Health Renaissance 2015;13 (3): 65-72
Background: Wound complications are one of the major sources of morbidity after orthopaedic procedures and can prolong the inpatient stay or lead to re-admission. The most commonly used methods for skin closure after orthopaedic surgery are metal staples or nylon sutures Both methods act to hold the skin edges together while healing occurs. Metal staples are said to be superior as they are regarded as quicker as and easier than sutures.Objective: To compare outcome of use of staples and nylon sutures for wound closure in elective orthopedic surgery in term of infection rate,cosmetic appearance(Scar), time taken for skin closure.Methods: It is randomised controlled trial done on patients undergoing elective orthopaedic surgery at department of Orthopaedics at BPKIHS were included in the study. During procedure patients were evaluated for time taken for suture application or any complications.Results: A total of 60 patients (38 male and 22 female) were included in the study. Twenty two patients were between 41-55 years age group followed by fifteen patients between 25-40 yrs, twelve patients less than 25 age group and eleven patients more than 55 years. The average blood loss is 5 ml in K-wire group and 145 ml in plate group. The procedure time is 33 mins as comprared to 53 mins in plate group.Conclusion: Metal staples are superior as they are regarded as quicker and easier than nylon sutures. But use of metal staples or clips has a greater risk of wound infection and less acceptable cosmetically than sutures. Metal staples are more expensive. Health Renaissance 2015;13 (3): 137-143
Background: Skin incisions have usually been made using a scalpel. Electrocautery, a more recent alternative, is thought to increase the risk of infection, impair healing and decrease cosmesis. Recent studies suggest that electrocautery may offer potential advantages with respect to blood loss, incision time and postoperative pain.Objective: The aim of this study was to compare the efficacy and safety of electrocautery incisions versus conventional scalpel incisions in orthopedic surgeries using internal implants.Method: The study was conducted as a prospective one in a tertiary care center in the Department of Orthopaedics, BPKIHS, Dharan, Nepal. Patients with closed fracture of the forearm bones admitted for surgery from April 2014 to September 2014 was included in the study. Each incision was divided into two halves, proximal half to be opened by steel scalpel blades and the distal half to be opened by an electrocautery blade. Proximal half and distal half of incision were compared on operating day and on days 2, 14 and again on 6 weeks and 3 month.Result: A total of 60 patients were enrolled in the study. Forearm skin incisions using electrocautery were significantly quicker than scalpel incisions (p<0.05). Postoperative wound complication rates did not differ significantly between the Scalpel and Electrocautery groups (p>0.05).Conclusion: There is no difference in healing of two halves of skin incision made by electrocautery and scalpel in orthopedic surgeries using internal implants.Health Renaissance 2015;13(2): 43-49
Background: Provision of adequate water supply, sanitation facilities, hygiene and waste management in schools reduces the disease burden among children, staff and their families. Every child has equal right to grow in a safe and sound environment. However, levels of water supply, sanitation and hygiene are unacceptable in many schools worldwide. Method: Study included forty schools comprising twenty public and twenty private schools of Sunsari district selected by simple random sampling method. The status of school environment and sanitation were assessed by using observation and interview method using observation checklist, questionnaires and photographs. Result: Two public schools were completely devoid of sanitary facilities though toilet facility was present physically. Students couldn’t use toilet due to lack of water in one school due to theft of tube well and septic tank of the toilet was full in another school. Other remaining schools didn’t have satisfactory, clean and proper sanitary facilities. Only few schools had convenient hand washing point. Conclusion: Sanitation facilities were in neglected state evidenced by unavailability of sanitation facilities even though that was physically present and the sanitation facilities were in pitiable condition including cleanliness, water supply. All the stakeholders including school management, supervisors, parents, teachers, students should be ready to play vital role on their own. Lack of one toilet affects no. of students and people of surrounding area and raises of risk of soil transmitted diseases so this situation demands attention of authorities and other stakeholders. Health Renaissance 2015;13(2): 114-124
Background: Psychosis in bipolar disorder is common but still not well understood. There is paucity of literature from our country and none from this institute which serves the eastern part of Nepal.Objective: To describe the hallucinations and delusions in bipolar disorders in our place.Methods: Patients-record files of bipolar disorders with psychosis discharged in two years’ time from 2012 to 2014 were analysed. Patients with unipolar depression, recurrent depressive disorder, serious organic illness, and primary substance use disorders were excluded. Information was collected in a structured performa. Association of delusion and hallucination was observed.Results: During the study period, ninety-five patients with bipolardisorder had psychosis. Hallucination was present in 29 (30.5%) cases, and out of these 23 (79.3%) were cases of mania. In 26 (89.7%) patients, the hallucinations were mood congruent. The median duration of appearance of hallucination was 10 days and appeared early in mania. Among hallucinations, auditory verbal hallucinations were present in all 29 patients. Delusions were present in 77 (81.1%) of patients, and grandiose delusions were the most common. Grandiose delusions tended to occur even in the absence of hallucinations. Conclusion: Psychosis is common in bipolar disorder. Grandiose delusions are the most common delusion and are relatively independent of hallucination. The auditory verbal hallucinations are the most common type of hallucination. Hallucinations in mania tend to manifest earlier than in bipolar depression and mixed episode, and most of the hallucinations in bipolar disorder are mood congruent. Health Renaissance 2015;13 (1): 49-57
Introduction: Unstable dislocations of the bilateral glenohumeral joint with fractures of both greater tuberosities are very rare.Case presentation: A 48-year-old gentleman sustained a bilateral anterior dislocation of his glenohumeral joint with fractures of the greater tuberosities on both sides after an episode of seizure. Attitude of both shoulders were abducted and externally rotated. Radiological examination revealed the dislocations of bilateral glenohumeral joint and also the fractures of the bilateral greater tuberosities. Closed reduction and shoulder derotation immobilizer was applied. The Reduction was unstable and needed fixation of both sides greater tuberosity with cannulated cancellous screws. The shoulders were immobilized for 3 weeks and subsequent rehabilitation yielded a good outcome. Results at 6 months follow-up were satisfactory with normal range of motion and no redislocations occurring. To our knowledge, this is the first reported case of bilateral unstable glenohumeral joint dislocation associated with fractures of both greater tuberosities in a middle aged man which was unstable needing fixation of greater tuberosities fractures.Conclusion: Bilateral glenohumeral joint dislocations with bilateral fractures of the greater tuberosities may be unstable needing fixation of greater tuberosity fracture.Health Renaissance 2015;13(2): 173-177
Background: Intellectual disability plays a significant role, especially in the field of rehabilitation. It becomes more important when people live in refugee camp for a long duration.Objective: To assess the level of intelligence and disability; and to sort out the illnesses comorbid with mental retardation in the Bhutanese refugees in eastern Nepal.Methods: Hospital based descriptive study was done using purposive sampling. Instruments used were: vineland social maturity scale, developmental screening test, seguin form board, standard progressive matrices and colored progressive matrices.Results: Samples were 42 with 64% females. Age range was 11-20 years. Among these referred cases, 45% had speech disorder and hearing loss and 31% had neurological disorders, including seizure disorders. Sixty-six percent had mild, 9% moderate and 19% severe mental retardation.Conclusion: Majority of the intellectually disabled Bhutanese refugees had mild mental retardation, followed by severe one. Seizure was a common co-morbidity in mental retardation. Health Renaissance 2015;13 (1):
Background: Retinoblastoma is the commonest primary intraocular malignancy of childhood. Under-standing the different modes of presentation with timely intervention are associated with prognosis.Objective: To determine the clinical profile of retinoblastoma and its association with optic nerve infiltration by tumor. Methods: A retrospective analysis of the clinical records and histopathological reports of patients admitted with retinoblastoma in a tertiary heath care center, eastern Nepal (June 2009 to July 2012) was carried out.Results: A total of 27 patients (28 eyes) with retinoblastoma were studied. The mean age at presentation was 2.89 ± 0.93 years. The mean duration of symptoms to presentation was 3.35 month, ranged from 7 days to 2 years. Male to female ratio was 3:2. Thirty-three percent patients were Muslims. Twentyseven patients (96.3%) had unilateral eye involvement. The commonest mode of presentation was leukocoria in 23 eyes (85.2%) followed by redness 9 eyes (33.3%), proptosis in 5 eyes (18.5%) and phthisis bulbi in one eye (3.7%). Histopathological reports of 26 eyes confirmed the diagnosis of retinoblastoma. One patient with distant metastases was referred to oncology center. Infiltration of the optic nerve by tumor cells was seen in five eyes (18.5%); of which two cases had proptosis (p-0.166). At two years follow up, recurrence was seen in one patient with proptosis and optic nerve infiltration (p-0.136). Age at presentation was positively associated with recurrence of tumor (p-0.005).Conclusion: Leucokoria was the most common mode of presentation of retinoblastoma. Larger sample size with longer follow up is required to come to a definite association with optic nerve infiltration by tumor. Health Renaissance 2015;13 (3): 129-136
Background: Destructive surgery is the management option offered to patients when further retention of the globe is unlikely and can affect ocular and general morbidity.Objective: To determine the frequency and indications for destructive eye surgeries in patients attending a tertiary hospital, Eastern Nepal.Methods: A retrospective analysis of clinical records of all the tructive eye surgeries from April 2008 to March 2013 at a tertiary hospital, Eastern Nepal was carried out. Patients' history, demographic characteristics and indications for the procedure were studied.Results: A total of 88 eyes of 88 patients, who had undergone destructive eye surgery, were reviewed. The mean age of the patient was 22.89 ± 23.49 years, median 9.5 years, with a range of 1.5 months to 80 years. Male: Female ratio was 1:1.04. Enucleation was the most common surgery performed in 46 eyes (52.3%), followed by evisceration in 30 eyes (34.1%) and exenteration in 12 eyes (13.6%). The destructive eye surgery in our study accounted for 51% neoplasms, 17% ocular trauma, 15.9% ocular infection, 10.2% anterior staphyloma and 5.7% painful blind eye. The most common indication for destructive eye surgery was enucleation (60.8%) for retinoblastoma followed by evisceration (46.6%) for open globe injury and exentration (33.3%) for sebaceous gland carcinoma.Conclusions: Enucleation was the most common destructive eye surgery performed. Retinoblastoma, ocular trauma and sebaceous gland carcinoma were the most common indications for destructive eye surgery.Health Renaissance 2015;13 (3): 161-168
Aconitine and related alkaloids found in the Aconitum species are highly cardiotoxic and neurotoxic. The wild plant (especially the roots and root tubers) is extremely toxic. Severe aconite poisoning can occur after accidental ingestion of the wild plant or consumption of an herbal made from aconite roots. In traditional Chinese medicine, aconite roots are used only after processing to reduce the toxic alkaloid content. Soaking and boiling during processing will hydrolyze aconite alkaloids into less toxic and non-toxic derivatives. However, the use of a larger than recommended dose and inadequate processing increases the risk of poisoning. The aconite herb is one of the commonly-prescribed ingredients for various clinical problems. However, due to its narrow therapeutic index, toxicities are not uncommonly encountered, including life-threatening cardiac arrhythmias like ventricular arrhythmias Health Renaissance 2015; 13 (1): 108-111
Background: This retrospective review was performed to identify the incidence, causes, and details of hand injuries in patients presenting to a tertiary hospital in Eastern Nepal.Objective: To identify the incidence, causes, and details of hand injuries in patients.Method: Records of all patients who had sustained hand injuries for last 5 years were collected from the medical record section. Altogether 832 injuries of hand in 484 patients were reported in this review. These patients were reviewed for age at the time of injury, gender, location of the incident, mechanism of injury, and fracture specifies.Result: 414 (85.5%) males with mean age of 28.79 ± 12.81 and in female with 30.43 ±17.13 yrs were found. Machinery injuries (25.2%) were the most common causes of injuries followed by RTA (14.5%). Metacarpal bone fractures (34.6%) were the commonest injury of the hand. Most of the patients were treated with open reduction and fixation with K wires.Conclusion: The study reveals the aetio-epidemiological and clinical aspect of hand injuries with its alarming burden in Nepal.Health Renaissance 2015;13(2): 125-133
Background: The debate regarding optimal management of femoral shaft fractures in the pediatric population is still far from resolved. While some consensus exists in the treatment of this injury in children younger than the age of six, opinion still widely divided in children six to 11 years.Objective: The aim of study was to compare the outcome of primary hip spica versus initial traction and hip spica of fracture of shaft of femur at or below the junction of the upper and middle third in children in terms of deformity and fracture healing.Method: A RCT study was carried out in the departments of Orthopedics, B.P.Koirala Institute of Health Sciences, Dharan, Nepal from March 2004 to January 2006. Forty five patients were included in the study in which 22 patients included in early spica casting (group I) and 23 patients in traction with spica casting (group II). The functional outcomes were assessed with Pearson’ Chi-square test, Independent samples test and union was assessed radiologically.Result: There was no statistically significant difference in time of union; all of them united in 8-10 weeks follow up. No significant overall difference in terms of deformity was noted in the two groups(p value-0.306).There was significant difference in terms of hospital stay in both the groups(p value<0.05).Conclusion: The study showed that there is significant advantage in primary hip spica cast for the treatment of isolated , closed femur fractures in children ages less than 10 years and weight less than 80 pounds(45kg) which allowed us to treat these fractures without any worry of wound dehiscence, pin site infections, avascular necrosis of the femoral head.Health Renaissance 2015;13(2): 80-91
Background: Cone beam computed tomography (CBCT) provides precise imaging of temporomandibular joint anatomy without superimposition and distortion. CBCT is relatively a new imaging modality and used commonly in dental practice.Objective: The aim of this study is to present detailed imaging of emporomandibular joint in case of condyle fracture using CBCT for its use in diagnosis, surgical planning and evaluation of treatment.Method: In our study, we evaluated 3D - CBCT (three dimensional Cone beam computed tomography) examinations of 18 patients with mandibular condyle fractures. All of the fractures in our cases were overlooked on CBCT, thus providing axial, coronal and para-sagittal imaging of condylar head including 3D dimensional volumetric images of the condyle and surrounding structures.Result: Out of 18 condylar fracture patient’s CBCT, 8 radiographs showed condylar head (intracapsular) fracture, 2 condylar neck, 8 subcondylar fracture. 13 condylar fractures were unilateral and 5 were bilateral fracture. 9 of the condylar fractures were not associated with the mandible fracture. Out of the 9 associated condylar fractures; 3 were associated with symphysis fracture, 4 associated with parasymphysis fracture, 1 associated with body fracture and remaining 1 associated with mandibular angle fracture. 6 of the condylar fracture showed no signs of displacement of the fractured part and among 12 displaced condylar fracture parts 8 medially and 4 laterally displaced recorded in CBCT. All of the patients were given treatment on the basis of CBCT diagnosis and the results obtained from it was clinical satisfactory without complaints.Conclusion: We concluded that CBCT is the latest sophisticated technology which provides clear image of condylar head without superimposition of other structures, presented supplementary information for a more effective diagnosis and management of mandibular condyle fractures. Health Renaissance 2015;13 (3): 73-81
