Journal of Institute of Medicine <p>Official publication of the Institute of Medicine, Maharajgunj, Kathmandu, Nepal. Full text articles available for current issue.</p> en-US Authors who publish with this journal agree to the following terms:<br /> <ol type="a"><br /><li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="" target="_new">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li><br /><li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li><br /><li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a href="" target="_new">The Effect of Open Access</a>).</li></ol> (Dr Pradeep Vaidya) (Sioux Cumming) Sat, 09 Nov 2013 11:57:47 +0000 OJS 60 Responding to the need of the Society: Nepal Ambulance Service <p>DOI: <a href=""></a></p> <p>Journal of Institute of Medicine, April, 2012; 34:1 1</p> R Gongal, P Vaidya ##submission.copyrightStatement## Sat, 09 Nov 2013 10:45:59 +0000 Cost of treating Insulin-requiring diabetes in children and adolescents <p><strong>Background:</strong> Childhood diabetes care imposes a heavy economic burden on the patient&rsquo;s family and all those involved in the provision of this care need to be aware of what factors drive cost.</p> <p><strong>Methods:</strong> Using an interviewer-administered questionnaire data was obtained from eleven respondents (parents of diabetic children) on their expenditure on items of direct cost such insulin, syringes, cotton wool, methylated spirit, transportation, consultation, and glucometer with the test strips. Data was also obtained on income of the household, ability to cope with payment for medical care and sources of money used for such payment.</p> <p><strong>Results:</strong> The estimated mean monthly direct cost of routine diabetes care was ten thousand nine hundred and fifty Naira [(N10,950+4,698); 95% Confidence Interval, CI = 8,674-13,726] with purchase of insulin accounting for 51.1% of this cost. Money spent on purchase of insulin alone represented 43.7% of the average monthly household income. Eighty percent of the parents expressed varying degrees of difficulty coping with payment of direct cost of diabetes care.</p> <p><strong>Conclusion:</strong> Insulin-requiring diabetes imposes a heavy economic burden on the family of the patient with cost of purchase of insulin contributing the highest proportion among items of direct cost.</p> <p>DOI: <a href=""></a></p> <p>Journal of Institute of Medicine, April, 2012; 34:1 2-8</p> N Onyiriuka, OO Ezomo, RC Onyiriuka ##submission.copyrightStatement## Sat, 09 Nov 2013 10:58:08 +0000 Modified Altissimi and Mancini technique for carpal tunnel decompression <p><strong>Introduction:</strong> Carpal tunnel syndrome is the commonest compressive peripheral nerve neuropathy; open carpal tunnel decompression still remains the preferred method as a day case procedure using local &nbsp;anaesthesia. The local anaesthetic is commonly administered by subcutaneous infiltration alone (the Gale technique) or by infiltration of the local anaesthetic into the carpal tunnel in addition to the subcutaneous infiltration (the Altissimi and Mancini technique). The purpose of this study was to evaluate the efficacy of the modified Altissimi and Mancini technique of local anesthesia.</p> <p><strong>Methods: </strong>Fourteen hands of twelve patients age ranged from 26 to 55 years, two patients with bilateral involvements were recruited. Most involved hand was operated first with the modified Altissimi and Mancini technique of local anaesthesia.</p> <p><strong>Results:</strong> Intra-operative pain was evaluated using visual analog score. Patients experienced no to very little intra-operative pain VAS 0- 2. Only one patient experienced tourniquet discomfort which subsided after release. There was neither any intra-operative nor during follow up, the signs of iatrogenic median nerve injury.</p> <p><strong>Conclusion:</strong> We concluded that open carpal tunnel decompression using modified Altissimi and Mancini technique under local anaesthesia and with tourniquet control is a safe, effective and acceptable novel technique.</p> <p>DOI: <a href=""></a></p> <p>Journal of Institute of Medicine, April, 2012; 34:1 9-12</p> A Sigdel, S Uprety, Govind KC ##submission.copyrightStatement## Sat, 09 Nov 2013 11:06:48 +0000 Prevalence and Antibiotic Sensitivity Pattern of Methicillin- Resistant- Staphylococcus aureus in Kathmandu Medical College -Teaching Hospital <p><strong>Introduction:</strong> Staphylococcus aureus is found to be a major source of community as well as hospital acquired infection. Staphylococcal isolates from tertiary care hospital are found to be resistant to commonly used antimicrobial agents. Methicillin resistant S. aureus (MRSA) with intrinsically developed antimicrobial resistance has been associated with an increase in morbidity and mortality of the patients in the hospital. This study was undertaken to know the antibiotic sensitivity pattern of staphylococcal isolates with special reference to Methicillin resistant S. aureus.</p> <p><strong>Methods:</strong> Clinical specimens received from July 2009 to July 2010 in Kathmandu Medical college-Teaching Hospital were processed and all S. aureus isolates were included in the study. The isolates were identified by standard laboratory procedure. The antibiotic susceptibility pattern of all staphylococcal strain was determined by modified Kirby Bauer antibiotic sensitivity method.</p> <p><strong>Results:</strong> Of 111 S .aureus isolates 29(26.12%) were identified to be MRSA. The rate of multi drug resistance was 75.86% for MRSA and 6.09% for MSSA. All the staphylococcal isolates were resistant to penicillin. However, all strains were sensitive to vancomycin.</p> <p><strong>Conclusions:</strong> This study showed a high prevalence of MRSA in tertiary care hospital of Kathmandu valley. Regular surveillance of hospital-associated infection and monitoring of antibiotic sensitivity pattern is mandatory to reduce MRSA prevalence in hospital and its spread to community as well. Present study conclusively shows that vancomycin remains the first choice of treatment for MRSA infection. To preserve its value, use of vancomycin should be limited to those cases where there are clearly needed.</p> <p>DOI: <a href=""></a></p> <p>Journal of Institute of Medicine, April, 2012; 34:1 13-17</p> S Pandey, MS Raza, CP Bhatta ##submission.copyrightStatement## Sat, 09 Nov 2013 11:19:12 +0000 Second Intervention in Obstetric Hemorrhage <p><strong>Introduction:</strong> Obstetric hemorrhage is still one of the dreaded complications that contribute to a maximum number of maternal morbidity and mortality till date. The management of obstetric hemorrhage involves early recognition, assessment and resuscitation. Though dealt with appropriate use of oxytocic agents, it may seldom require surgical techniques, including uterine tamponade, major vessel ligation, compression sutures, and even hysterectomy.</p> <p><strong>Method:</strong> Prospective study of 20 cases of laparotomy for obstetrical hemorrhage carried out at Tribhuvan University Teaching Hospital, Kathmandu, Nepal, between Jan 2003 to Nov 2011.</p> <p><strong>Results:</strong> Out of 20 cases, massive hemoperitoneum (more than a liter) was noted in 9 and associated risk factors in 10. Source of bleeding in 20 cases were from extensive hematoma (retroperitoneal and broad ligament) in 5, including a rectus sheath hematoma and with colporrhexis, oozing inverted T incision repaired in a single layer (1), placental bed (3) and 1 was from vessels in LUS. There was bleeding from uterine angle (4) and incision (1). Bleeding from tear at various sites were 3, from uterovesicle fold of peritoneum 1 and from the ruptured uterus following vacuum delivery in a case of VBAC (1). Uterine packing was done in 1, B-Lynch in 3 and 1 failed needing the uterine packing; uterine artery ligation in 2 including ovarian vessel ligation in 1, repair of ruptured uterus in 1 and subtotal hysterectomy in 5 cases. There were 3 mortalities due to DIC, pulmonary edema and ARF and rest were discharged in good health.</p> <p><strong>Conclusion:</strong> Choosing of the right technique, complete hemostasis and meticulous closure of all surgical incisions will prevent the need for laparotomy following LSCS. Vigilant monitoring of all the post operative patients will lead to early diagnosis of intraperitoneal / pervaginal bleeding and its management, thus preventing morbidity and mortality owing to late diagnosis.</p> <p>DOI: <a href=""></a></p> <p>Journal of Institute of Medicine, April, 2012; 34:1 18-24</p> S Rawal, A Rana ##submission.copyrightStatement## Sat, 09 Nov 2013 11:26:42 +0000 Midazolam as an induction agent in comparison with propofol as a safe and effective alternative <p><strong>Introduction: </strong>Propofol produce rapid and smooth induction of anesthesia, with rapid metabolism, which would allow it to be used for the maintenance of anesthesia and free from the risk of anaphylactic reactions. Midazolam a new short acting water soluble Benzodiazepine with cardio vascular effects similar to that of diazepam may be an effective alternative for induction of anesthesia.</p> <p><strong>Methods: </strong>In this randomized study, all together 48 patients undergoing various surgical procedures belonging to Orthopedic, General Surgery and Gynecological Surgeries constituted the study group. Group-I (Midazolam Group) received intra-venous Midazolam 0.15mg/Kg for induction of anesthesia and Group-II (Propofol Group) received 2mg/kg intravenous Propofol for Induction of Anesthesia. Induction time, Heart Rate, Non invasive blood Pressure is recorded at 1minute interval for 5 minutes and after that at an interval for 5 minutes for another 30 minutes. Demographic data was analyzed by Student&rsquo;s t-test.</p> <p><strong>Results: </strong>The study showed no statistical significance in hemodynamic responses with either Midazolam or Propofol as an induction agent for General Anesthesia but there was statistically difference with respect to heart rate (P=0.001).</p> <p><strong>Conclusion: </strong>Midazolam was proven effective compared to Propofol as an induction Agent.</p> <p>DOI: <a href=""></a></p> <p>Journal of Institute of Medicine, April, 2012; 34:1 25-32</p> J Singh ##submission.copyrightStatement## Sat, 09 Nov 2013 11:36:40 +0000 Knowledge about Tuberculosis in outpatients who visited College of Medical Sciences Teaching Hospital, Bharatpur, Nepal <p><strong>Background:</strong> Now a days Tuberculosis is a major public health problem in the world. Number of deaths due to tuberculosis is highest among the infectious diseases.</p> <p><strong>Methods: </strong>The cross sectional study was carried out from May 2008 to July 2008 in the different out patient departments of College of Medical Sciences Teaching Hospital. A total of 500 patients belong to age &gt; 15 years who visited various departments of College of Medical Sciences Teaching Hospital were randomly selected for the present study. Interview technique was used to collect information on a pre-designed and pre-tested questionnaire.</p> <p><strong>Results:</strong> Out of total patient&rsquo;s interview, 59% and 41% were male and female respectively. Majority of the outpatients had heard about the Tuberculosis disease. 73.3% of the respondents opinioned that T.B. can be acquired by infection.</p> <p><strong>Conclusion: </strong>The study population has satisfactory knowledge about the etiology and transmission of the disease. There was poor knowledge about proper disposal of sputum which is an important aspect in regard to transmission of disease. There is need of imparting knowledge to the people about proper disposal of sputum to reduce the spread of disease and mortality due to T.B</p> <p>DOI: <a href=""></a></p> <p>Journal of Institute of Medicine, April, 2012; 34:1 33-36</p> N Manandhar, G Krishna ##submission.copyrightStatement## Sat, 09 Nov 2013 11:44:17 +0000 Sickle cell Anemia with avascular necrosis of femur being managed as rheumatic fever <p>Sickle cell anemia is a rare hematological problem in Nepal and described only in the forms of case reports. This is a case report of a patient of sickle cell disease from Nawalparasi district of Nepal. The patient had history of recurrent joint pain including both large and small joints. He also had soft systolic murmur in cardiac auscultation for which he had received penicillin prophylaxis three years for clinically suspected rheumatic heart disease. He was later diagnosed to have Sickle cell anemia with avascular necrosis of right femoral head and functional murmur of severe anemia with no evidence of rheumatic heart disease.</p> <p>DOI: <a href=""></a></p> <p>Journal of Institute of Medicine, April, 2012; 34:1 37-39</p> KS Lamsal ##submission.copyrightStatement## Sat, 09 Nov 2013 11:49:25 +0000 An Adolescent with innumerable myomas <p>Myoma is rare in younger age group, so tends to be mistaken for adnexal tumour. A 19 year old &nbsp;adolescent who was taken for laparotomy for ovarian germ cell tumour instead was found to have &nbsp;uterus studded with innumerable myomas, which were surgically removed through tedious yet &nbsp;successful myomectomy of 40 myomas, thus deserving description.</p> <p>DOI: <a href=""></a> &nbsp;</p> <p>Journal of Institute of Medicine, April, 2012; 34:1 40-42</p> J Baral, G Gurung, S Mishra, N Rai, P Paudyal, B Shrestha, A Rana ##submission.copyrightStatement## Sat, 09 Nov 2013 11:56:10 +0000