Aims: This study evaluates the effectiveness of usage of 0.2 mg intrathecal morphine as post-oper... more Aims: This study evaluates the effectiveness of usage of 0.2 mg intrathecal morphine as post-operative analgesia and its effect on activity of mother after elective cesarean section. Methods: This hospital based prospective, randomized, double-blinded and placebo controlled study was carried out at Nagarik Community Teaching Hospital, Bhaktapur between 2012 January to 2014 November after the approval was taken from the hospital authority and the written informed consent from the participating patients. Fifty women of ASA I or II physical status undergoing cesarean section under sub-arachnoid block was randomized into two groups-P group (placebo group, n = 25) and M group (Treatment group, n = 25). P Group received hyperbaric bupivacaine 2.3ml, 0.5% bupivacaine (11.5 mg) and M Group received morphine 0.2 ml (0.2 mg) plus bupivacaine 2.3ml, 0.5% (11.5 mg) intrathecally. All subjects received 8 mg ondansetron intravenously 30 minutes before surgery to prevent possible drug-induced pruritus and postoperative nausea and vomiting. 1000 mg rectal acetaminophen suppository was given at the end of the surgery. Pain, nausea and pruritus during the first 24 hours using visual analog scale were recorded by a trained nurse or attending doctor who was not involved in the study. Results: Duration of complete analgesia and the time to request for additional analgesics was longer in M Group than in P Group. Similarly, the active movement is earlier in M Group than in P Group. There were no significant differences in adverse effects between the groups. Conclusions: Addition of morphine 0.2 mg to heavy bupivacaine intrathecally reduced post-operative pain and analgesic requirements without any significant difference in adverse effects.
Aims: This study aims to determine the frequency of near-miss obstetric events and analyze its na... more Aims: This study aims to determine the frequency of near-miss obstetric events and analyze its nature such as reasons for nearmiss, organ dysfunction associated and critical management required among pregnant women managed over a 3-year period in a Tertiary Care Teaching Hospital in Nepal. Methods: This hospital based prospective, descriptive study was done from August 2011 to February 2015. Case eligibility was defined by WHO Near-Miss Guidelines. Medical records of the patients and the interview with the patient, accompanying family members and health workers from referral centres were used to generate the data which were filled in the pre-designed questionnaire. The data generated and analyzed included age and gestation weeks, parity, mode of intervention, associated organ dysfunctions, reasons for near-miss and critical intervention accompanied to manage the near-miss cases. Results were presented in mean ± SD and percentages, wherever applicable. Results: There were 4617 deliveries with 28 near-miss cases. The major factors contributing near-miss events were obstetric haemorrhage followed by hypertensive disorder. Three fourth (n=21) of cases required blood transfusion and almost all cases (n=26) required ICU management. Coagulation disorder was observed in majority of cases (n=23) followed by cardiovascular, respiratory and uterine atony. Conclusions: In this study, maternal near-miss event was mainly attributable to obstetric haemorrhage followed by hypertension and sepsis. Major organ-system disorders observed were coagulation disorder, cardiovascular, respiratory and uterine disorders. Almost all the cases were managed in ICU and majority of them required blood transfusion.
Aims:This study evaluates the effectiveness of condom tamponade in the management of massive obst... more 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(>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. Co...
Adenosine Deaminase (ADA) is used as a well established biological marker for diagnosis of tuberc... more Adenosine Deaminase (ADA) is used as a well established biological marker for diagnosis of tuberculous pleuritis. The aim of this study was to assess the sensitivity and specificity of ADA in patients with pleural effusion admitted in the medical ward.This was an cross sectional study. The information was gathered only from those patients whose pleural fluid sample was sent for ADA in clinical biochemistry laboratory of KIST Medical College and Teaching hospital. The data was acquired from the medical records of patients attending medical ward. The patients were considered as TB positive if they were clinically diagnosed so and taken as negative otherwise. Fifty six pleuritis patients were evaluated. Using the cut off value of 30 U/L, the overall sensitivity and specificity was 93.3% and 57.1% respectively. The association between ADA findings and the clinical findings were statistically significant (p <0.001). The positive predictive value (PVP) and the negative predictive value (PVN) were 82.3% and 80% respectively.ADA is an inexpensive, rapid and simple test for analysis of tuberculous pleuritis. Though, it is a sensitive test for tuberculosis, due to its low specificity, sometimes negative cases can be considered as positive.
Materials and methods: The CC, CT and TT genotypes frequency of C677T polymorphism of MTHFR gene ... more Materials and methods: The CC, CT and TT genotypes frequency of C677T polymorphism of MTHFR gene were 77, 22 and 1% in preeclamptic women and 73, 19.5 and 7.5% in controls and significantly were not different(P= 0.06). But the frequency of TT genotype was significantly higher in controls. OR = 8.5 (95% CI 1.1-71, P=.018). There was no significant difference detected in T allele distribution between preeclamptic women(12%) and controls(17%) too. Conclusion: Our results showed that there is not any correlation between the C677T polymorphism and preeclampsia, but the TT genotype of C677T polymorphism seems to be a protective factor for preeclampsia.
Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus... more Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus and post-operative nausea and vomiting
Given the important role of voltage-gated sodium (NaV) channel-modulating spider toxins in elucid... more Given the important role of voltage-gated sodium (NaV) channel-modulating spider toxins in elucidating the function, pharmacology, and mechanism of action of therapeutically relevant NaV channels, we screened the venom from Australian theraphosid species against the human pain target hNaV1.7. Using assay-guided fractionation, we isolated a 33-residue inhibitor cystine knot (ICK) peptide (Ssp1a) belonging to the NaSpTx1 family. Recombinant Ssp1a (rSsp1a) inhibited neuronal hNaV subtypes with a rank order of potency hNaV1.7 > 1.6 > 1.2 > 1.3 > 1.1. rSsp1a inhibited hNaV1.7, hNaV1.2 and hNaV1.3 without significantly altering the voltage-dependence of activation, inactivation, or delay in recovery from inactivation. However, rSsp1a demonstrated voltage-dependent inhibition at hNaV1.7 and rSsp1a-bound hNaV1.7 opened at extreme depolarizations, suggesting rSsp1a likely interacted with voltage-sensing domain II (VSD II) of hNaV1.7 to trap the channel in its resting state. Nucle...
Animal venoms are truly mortal cocktails of various toxins with the mere purpose of evolution for... more Animal venoms are truly mortal cocktails of various toxins with the mere purpose of evolution for the survival of the organism it endogenously possesses. Due to the significant and unavoidable venomous animal-human interactions, human envenomation is an important public health concern. Animal venom toxins are capable of affecting human physiology resulting in nonlethal allergy, erythema, and pain at the site of sting or bite that subsides without any medical interventions to a more serious anaphylaxis and organ injuries which require prompt and continued medical treatment. Venom toxins are capable of imparting its effect to almost all the tissues it interacts with and through various mechanisms. In this review, it is intended to limit to the nephrotoxic effects of venom toxins from few medically detrimental species, namely, hymenoptera (bees, wasps, and ants), spiders, scorpions, caterpillars, centipedes, jellyfish, and snakes. The pathophysiology of venom-induced nephrotoxicity und...
Intrathecal morphine is commonly used for post caesarean analgesia. However, their use is frequen... more Intrathecal morphine is commonly used for post caesarean analgesia. However, their use is frequently associated with the incidence of troublesome side effects such as nausea, vomiting and pruritus. Various mechanisms have been postulated for the opioid-induced pruritus, with a variety of medications with different mechanisms of actions formulated for the prevention and treatment. But, the results are inconsistent and hence the prevention and treatment of opioid-induced pruritus still remains a challenge. Ondansetron which is antiemetic, non-sedative and has no antianalgesic effect is an antagonist to 5-HT3 receptor, the receptor with which opioids interacts and imparts its effects. Ondansetron, thus, would be an attractive treatment strategy for both opioid-induced pruritus and post-operative nausea and vomiting. After the approval from institutional review committee and written consent received from the patient, 50 healthy parturients of ASA I and II physical status undergoing caesarean section under spinal anaesthesia were enrolled for the study. They were randomly categorized into placebo group (2 ml normal saline) and treatment group (2 ml of 4 mg ondansetron), each group containing 25 patients. Pruritus and post-operative nausea and vomiting scores were recorded up to 24 hours after the administration of intrathecal morphine. Statistical analysis was performed using chi-square test. The incidence, severity and necessity of treatment for pruritus in the treatment group was significantly reduced compared to the placebo group (16% vs 88%). Similarly, the risk of post-operative nausea and vomiting in the treatment group was less compared to the placebo group (8% vs 56%). Prophylactic administration of ondansetron to parturients receiving intrathecal morphine for post-operative analgesia provides a significant reduction of intrathecal morphine-induced pruritus and nausea and vomiting. CTRI/2015/01/005362 registered on 07/01/2015 in Clinical Trials Registry-India (ctri.nic.in).
Introduction: Transient hemodynamic instability is an inevitable outcome of laryngoscopy and intu... more Introduction: Transient hemodynamic instability is an inevitable outcome of laryngoscopy and intubation which can have serious effects in patients with COPD, heart disease and hypertension. Hemodynamic stability is one of the main goals of the anesthesiologist. This study was performed to compare the safety and effectiveness of lidocaine and esmolol in comparison to placebo-control group, in modifying the hemodynamic response to laryngoscopy and intubation. Methods: After approval of the study protocol by the institutional review board (IRB), written informed consent was obtained from each patient. It was a randomized placebo-controlled, doubleblinded study. 75 patients of American Society of Anesthesiologists physical status I and II, scheduled for general surgery under GA, aged between 20-60 years were randomly allocated into three groups: placebo control group (n=25), lidocaine group (n=25) and esmolol group (n=25). Placebo group received 12 ml normal saline, lidocaine group received 1.5mg/kg lidocaine (total volume 12 ml) and esmolol group received 1.4mg/kg esmolol (total volume 12ml). Results: Following laryngoscopy and intubation, the increase in systolic blood pressure, diastolic lidocaine group. response following laryngoscopy and intubation in comparison to lidocaine 1.5 mg/kg.
Hymenoptera stings are a health concern. Apidae (bees), Vespidae (hornets, yellow jackets and was... more Hymenoptera stings are a health concern. Apidae (bees), Vespidae (hornets, yellow jackets and wasps) and Formicidae (ants) are medically-important stinging insects under the order Hymenoptera. Clinical features from simple skin manifestations to severe and fatal organ injury are due to the hypersensitivity reactions and/ or the toxic effects of the venom inoculated. Here we discuss on Hymenoptera stings involving apids (honey bees) and vespids (wasps, hornets and yellow jackets) and their effect on renal function and associated morphological changes in the kidney. Despite the differences in venom composition and quantity released per sting in two insect groups, both lead to similar medical consequences, such as localised normal allergic reactions, mild to severe anaphylaxis and shock and multiple organ and tissue injury leading to multiple organ failure. Acute kidney injury (AKI) is one of the unusual complications of Hymenoptera stings and has the basis of both immune-mediated and ...
Introduction: Endoscopic rapid urease test is a simple and most widely used test to detect the pr... more Introduction: Endoscopic rapid urease test is a simple and most widely used test to detect the presence of urease in the gastric mucosa. Many studies have reported prevalence of H. pylori infection in relation to age, gender and site of ulcer. Therefore, this study was designed to determine the prevalence and significance of H. pylori in peptic ulcer disease. Methods: A retrospective review was carried out for patients with peptic ulcer disease who had undergone upper GI endoscopy in Department of Internal Medicine at Kathmandu Model Hospital. The records from January 2013 to December 2017 were analyzed. Any patient with previously diagnosed peptic ulcer, history of active bleeding, cancer and incomplete records were excluded. Peptic ulcer associated with H. pylori was diagnosed on the basis of endoscopic rapid urease test. Results: Among the 418 diagnosed case of peptic ulcer disease by upper GI endoscopy from Jan 2013 to Dec 2017, 213 tested positive for H. pylori by rapid urease...
Journal of Nepal Health Research Council, Jan 3, 2018
For diagnosis of enteric fever, the culture of the organism from different body fluids is the gol... more For diagnosis of enteric fever, the culture of the organism from different body fluids is the gold standard. After diagnosis, it is important to treat with the right antibiotic before any complications can occur. The retrospective study is designed to explore the antibiotic sensitivity trend in blood culture positive typhoid fever cases and the extent of drug resistance before treatment is administered. A retrospective study was carried out for culture isolated enteric fever patients admitted in Kathmandu Model Hospital. The discharged records from January 2012 to December 2016 were analyzed. The patients above 15 years and with culture isolated enteric fever were included in the study. One hundred fifty-nine strains of Salmonella typhi and paratyphi were isolated from Jan 2012 to Dec 2016 at Kathmandu Model Hospital. Out of 159 isolated, 125 (78.6%) were Salmonella typhi and 34 (21.4%) were paratyphi. Among them co-trimoxazole, chloramphenicol, ceftriaxone, cefotaxime, cefixime, an...
inguinal hernia repair has benefit of less postoperative pain, reduced recovery time, easier repa... more inguinal hernia repair has benefit of less postoperative pain, reduced recovery time, easier repair of a recurrent hernia, concurrent treatment of bilateral hernias, and improved cosmesis. 8,9 Recurrence rate may be lower in TAPP as compared to open technique due to preperitoneal tension free mesh placement. 10,11 This study was planned to reflect benefit of TAPP in our region. METHODS This was a prospective, quasi randomized hospital based study carried out from October 2012 to March 2014 at Dhulikhel Hospital. Written informed consent was taken from the patients willing to participate in the study. The enrolled patients were given numbers which was used to randomize the patients in two groups, namely Background: In the era of minimal invasive surgery, hernia repair has seen a paradigm shift from open to laparoscopic technique. However, superiority of laparoscopic repair over open repair is still controversial. Available literatures have shown laparoscopic technique to be better in term of post-operative pain and early return to work. Methods: In this prospective study, a total of 102 patients aged 21-78 years with inguinal hernia were recruited and enrolled into two comparative groups, namely Lichtenstein's and Transabdominal pre-peritoneal, and each group containing 51 participants. Hospital ethical committee approval and written informed consent from patients was obtained. Primarily, the duration of operation, post-operative pain and complication, and quality of life after surgery was compared between the two different approaches of hernia repair. Results: The study results demonstrated a statistically significant superiority of trans abdominal pre-peritoneal repair over Lichtenstein's hernioplasty in terms of post operative pain (2.00±0.63 vs 3.90±0.74 VAS score, P value<0.001), hospital stay (2.33±0.62 vs 2.96±0.20 days, P value <0.001) and quality of life with early return to normal work (13.39±0.60 vs 17.88±0.86 days, P value <0.001); whereas a prolonged operative time was seen in transabdominal pre-peritoneal repair (96.08±27.08 vs 42.55±5.95 mins, P value <0.001). Conclusions: This study has shown that transabdominal pre-peritoneal repair is better than Lichtenstein's in respect to post-operative pain, quality of life and post-operative complication. However, it has prolonged operative duration than conventional method.
Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society, 2016
The aqueous extract of Mangifera indica is known to possess diverse medicinal properties, which a... more The aqueous extract of Mangifera indica is known to possess diverse medicinal properties, which also includes anti-snake venom activities. However, its inhibitory potency and mechanism of action on multi-toxic snake venom phospholipases A2s are still unknown. Therefore, the objective of this study was to evaluate the modulatory effect of standard aqueous bark extract of M. indica on NN-XIb-PLA2 of Indian cobra venom. The in vitro sPLA2, in situ hemolytic and in vivo edema inhibition effect were carried out as described. Also the effect of substrate and calcium concentration was carried out. M. indica extract dose dependently inhibited the GIA sPLA2 (NN-XIb-PLA2) activity with an IC50 value of 7.6 μg/ml. M. indica extract effectively inhibited the indirect hemolytic activity up to 98% at ∼40 μg/ml concentration. Further, M. indica extract (0-50 μg/ml) inhibited the edema formed in a dose dependent manner. When examined as a function of increased substrate and calcium concentration, t...
Aims: This study evaluates the effectiveness of usage of 0.2 mg intrathecal morphine as post-oper... more Aims: This study evaluates the effectiveness of usage of 0.2 mg intrathecal morphine as post-operative analgesia and its effect on activity of mother after elective cesarean section. Methods: This hospital based prospective, randomized, double-blinded and placebo controlled study was carried out at Nagarik Community Teaching Hospital, Bhaktapur between 2012 January to 2014 November after the approval was taken from the hospital authority and the written informed consent from the participating patients. Fifty women of ASA I or II physical status undergoing cesarean section under sub-arachnoid block was randomized into two groups-P group (placebo group, n = 25) and M group (Treatment group, n = 25). P Group received hyperbaric bupivacaine 2.3ml, 0.5% bupivacaine (11.5 mg) and M Group received morphine 0.2 ml (0.2 mg) plus bupivacaine 2.3ml, 0.5% (11.5 mg) intrathecally. All subjects received 8 mg ondansetron intravenously 30 minutes before surgery to prevent possible drug-induced pruritus and postoperative nausea and vomiting. 1000 mg rectal acetaminophen suppository was given at the end of the surgery. Pain, nausea and pruritus during the first 24 hours using visual analog scale were recorded by a trained nurse or attending doctor who was not involved in the study. Results: Duration of complete analgesia and the time to request for additional analgesics was longer in M Group than in P Group. Similarly, the active movement is earlier in M Group than in P Group. There were no significant differences in adverse effects between the groups. Conclusions: Addition of morphine 0.2 mg to heavy bupivacaine intrathecally reduced post-operative pain and analgesic requirements without any significant difference in adverse effects.
Aims: This study aims to determine the frequency of near-miss obstetric events and analyze its na... more Aims: This study aims to determine the frequency of near-miss obstetric events and analyze its nature such as reasons for nearmiss, organ dysfunction associated and critical management required among pregnant women managed over a 3-year period in a Tertiary Care Teaching Hospital in Nepal. Methods: This hospital based prospective, descriptive study was done from August 2011 to February 2015. Case eligibility was defined by WHO Near-Miss Guidelines. Medical records of the patients and the interview with the patient, accompanying family members and health workers from referral centres were used to generate the data which were filled in the pre-designed questionnaire. The data generated and analyzed included age and gestation weeks, parity, mode of intervention, associated organ dysfunctions, reasons for near-miss and critical intervention accompanied to manage the near-miss cases. Results were presented in mean ± SD and percentages, wherever applicable. Results: There were 4617 deliveries with 28 near-miss cases. The major factors contributing near-miss events were obstetric haemorrhage followed by hypertensive disorder. Three fourth (n=21) of cases required blood transfusion and almost all cases (n=26) required ICU management. Coagulation disorder was observed in majority of cases (n=23) followed by cardiovascular, respiratory and uterine atony. Conclusions: In this study, maternal near-miss event was mainly attributable to obstetric haemorrhage followed by hypertension and sepsis. Major organ-system disorders observed were coagulation disorder, cardiovascular, respiratory and uterine disorders. Almost all the cases were managed in ICU and majority of them required blood transfusion.
Aims:This study evaluates the effectiveness of condom tamponade in the management of massive obst... more 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(>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. Co...
Adenosine Deaminase (ADA) is used as a well established biological marker for diagnosis of tuberc... more Adenosine Deaminase (ADA) is used as a well established biological marker for diagnosis of tuberculous pleuritis. The aim of this study was to assess the sensitivity and specificity of ADA in patients with pleural effusion admitted in the medical ward.This was an cross sectional study. The information was gathered only from those patients whose pleural fluid sample was sent for ADA in clinical biochemistry laboratory of KIST Medical College and Teaching hospital. The data was acquired from the medical records of patients attending medical ward. The patients were considered as TB positive if they were clinically diagnosed so and taken as negative otherwise. Fifty six pleuritis patients were evaluated. Using the cut off value of 30 U/L, the overall sensitivity and specificity was 93.3% and 57.1% respectively. The association between ADA findings and the clinical findings were statistically significant (p <0.001). The positive predictive value (PVP) and the negative predictive value (PVN) were 82.3% and 80% respectively.ADA is an inexpensive, rapid and simple test for analysis of tuberculous pleuritis. Though, it is a sensitive test for tuberculosis, due to its low specificity, sometimes negative cases can be considered as positive.
Materials and methods: The CC, CT and TT genotypes frequency of C677T polymorphism of MTHFR gene ... more Materials and methods: The CC, CT and TT genotypes frequency of C677T polymorphism of MTHFR gene were 77, 22 and 1% in preeclamptic women and 73, 19.5 and 7.5% in controls and significantly were not different(P= 0.06). But the frequency of TT genotype was significantly higher in controls. OR = 8.5 (95% CI 1.1-71, P=.018). There was no significant difference detected in T allele distribution between preeclamptic women(12%) and controls(17%) too. Conclusion: Our results showed that there is not any correlation between the C677T polymorphism and preeclampsia, but the TT genotype of C677T polymorphism seems to be a protective factor for preeclampsia.
Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus... more Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus and post-operative nausea and vomiting
Given the important role of voltage-gated sodium (NaV) channel-modulating spider toxins in elucid... more Given the important role of voltage-gated sodium (NaV) channel-modulating spider toxins in elucidating the function, pharmacology, and mechanism of action of therapeutically relevant NaV channels, we screened the venom from Australian theraphosid species against the human pain target hNaV1.7. Using assay-guided fractionation, we isolated a 33-residue inhibitor cystine knot (ICK) peptide (Ssp1a) belonging to the NaSpTx1 family. Recombinant Ssp1a (rSsp1a) inhibited neuronal hNaV subtypes with a rank order of potency hNaV1.7 > 1.6 > 1.2 > 1.3 > 1.1. rSsp1a inhibited hNaV1.7, hNaV1.2 and hNaV1.3 without significantly altering the voltage-dependence of activation, inactivation, or delay in recovery from inactivation. However, rSsp1a demonstrated voltage-dependent inhibition at hNaV1.7 and rSsp1a-bound hNaV1.7 opened at extreme depolarizations, suggesting rSsp1a likely interacted with voltage-sensing domain II (VSD II) of hNaV1.7 to trap the channel in its resting state. Nucle...
Animal venoms are truly mortal cocktails of various toxins with the mere purpose of evolution for... more Animal venoms are truly mortal cocktails of various toxins with the mere purpose of evolution for the survival of the organism it endogenously possesses. Due to the significant and unavoidable venomous animal-human interactions, human envenomation is an important public health concern. Animal venom toxins are capable of affecting human physiology resulting in nonlethal allergy, erythema, and pain at the site of sting or bite that subsides without any medical interventions to a more serious anaphylaxis and organ injuries which require prompt and continued medical treatment. Venom toxins are capable of imparting its effect to almost all the tissues it interacts with and through various mechanisms. In this review, it is intended to limit to the nephrotoxic effects of venom toxins from few medically detrimental species, namely, hymenoptera (bees, wasps, and ants), spiders, scorpions, caterpillars, centipedes, jellyfish, and snakes. The pathophysiology of venom-induced nephrotoxicity und...
Intrathecal morphine is commonly used for post caesarean analgesia. However, their use is frequen... more Intrathecal morphine is commonly used for post caesarean analgesia. However, their use is frequently associated with the incidence of troublesome side effects such as nausea, vomiting and pruritus. Various mechanisms have been postulated for the opioid-induced pruritus, with a variety of medications with different mechanisms of actions formulated for the prevention and treatment. But, the results are inconsistent and hence the prevention and treatment of opioid-induced pruritus still remains a challenge. Ondansetron which is antiemetic, non-sedative and has no antianalgesic effect is an antagonist to 5-HT3 receptor, the receptor with which opioids interacts and imparts its effects. Ondansetron, thus, would be an attractive treatment strategy for both opioid-induced pruritus and post-operative nausea and vomiting. After the approval from institutional review committee and written consent received from the patient, 50 healthy parturients of ASA I and II physical status undergoing caesarean section under spinal anaesthesia were enrolled for the study. They were randomly categorized into placebo group (2 ml normal saline) and treatment group (2 ml of 4 mg ondansetron), each group containing 25 patients. Pruritus and post-operative nausea and vomiting scores were recorded up to 24 hours after the administration of intrathecal morphine. Statistical analysis was performed using chi-square test. The incidence, severity and necessity of treatment for pruritus in the treatment group was significantly reduced compared to the placebo group (16% vs 88%). Similarly, the risk of post-operative nausea and vomiting in the treatment group was less compared to the placebo group (8% vs 56%). Prophylactic administration of ondansetron to parturients receiving intrathecal morphine for post-operative analgesia provides a significant reduction of intrathecal morphine-induced pruritus and nausea and vomiting. CTRI/2015/01/005362 registered on 07/01/2015 in Clinical Trials Registry-India (ctri.nic.in).
Introduction: Transient hemodynamic instability is an inevitable outcome of laryngoscopy and intu... more Introduction: Transient hemodynamic instability is an inevitable outcome of laryngoscopy and intubation which can have serious effects in patients with COPD, heart disease and hypertension. Hemodynamic stability is one of the main goals of the anesthesiologist. This study was performed to compare the safety and effectiveness of lidocaine and esmolol in comparison to placebo-control group, in modifying the hemodynamic response to laryngoscopy and intubation. Methods: After approval of the study protocol by the institutional review board (IRB), written informed consent was obtained from each patient. It was a randomized placebo-controlled, doubleblinded study. 75 patients of American Society of Anesthesiologists physical status I and II, scheduled for general surgery under GA, aged between 20-60 years were randomly allocated into three groups: placebo control group (n=25), lidocaine group (n=25) and esmolol group (n=25). Placebo group received 12 ml normal saline, lidocaine group received 1.5mg/kg lidocaine (total volume 12 ml) and esmolol group received 1.4mg/kg esmolol (total volume 12ml). Results: Following laryngoscopy and intubation, the increase in systolic blood pressure, diastolic lidocaine group. response following laryngoscopy and intubation in comparison to lidocaine 1.5 mg/kg.
Hymenoptera stings are a health concern. Apidae (bees), Vespidae (hornets, yellow jackets and was... more Hymenoptera stings are a health concern. Apidae (bees), Vespidae (hornets, yellow jackets and wasps) and Formicidae (ants) are medically-important stinging insects under the order Hymenoptera. Clinical features from simple skin manifestations to severe and fatal organ injury are due to the hypersensitivity reactions and/ or the toxic effects of the venom inoculated. Here we discuss on Hymenoptera stings involving apids (honey bees) and vespids (wasps, hornets and yellow jackets) and their effect on renal function and associated morphological changes in the kidney. Despite the differences in venom composition and quantity released per sting in two insect groups, both lead to similar medical consequences, such as localised normal allergic reactions, mild to severe anaphylaxis and shock and multiple organ and tissue injury leading to multiple organ failure. Acute kidney injury (AKI) is one of the unusual complications of Hymenoptera stings and has the basis of both immune-mediated and ...
Introduction: Endoscopic rapid urease test is a simple and most widely used test to detect the pr... more Introduction: Endoscopic rapid urease test is a simple and most widely used test to detect the presence of urease in the gastric mucosa. Many studies have reported prevalence of H. pylori infection in relation to age, gender and site of ulcer. Therefore, this study was designed to determine the prevalence and significance of H. pylori in peptic ulcer disease. Methods: A retrospective review was carried out for patients with peptic ulcer disease who had undergone upper GI endoscopy in Department of Internal Medicine at Kathmandu Model Hospital. The records from January 2013 to December 2017 were analyzed. Any patient with previously diagnosed peptic ulcer, history of active bleeding, cancer and incomplete records were excluded. Peptic ulcer associated with H. pylori was diagnosed on the basis of endoscopic rapid urease test. Results: Among the 418 diagnosed case of peptic ulcer disease by upper GI endoscopy from Jan 2013 to Dec 2017, 213 tested positive for H. pylori by rapid urease...
Journal of Nepal Health Research Council, Jan 3, 2018
For diagnosis of enteric fever, the culture of the organism from different body fluids is the gol... more For diagnosis of enteric fever, the culture of the organism from different body fluids is the gold standard. After diagnosis, it is important to treat with the right antibiotic before any complications can occur. The retrospective study is designed to explore the antibiotic sensitivity trend in blood culture positive typhoid fever cases and the extent of drug resistance before treatment is administered. A retrospective study was carried out for culture isolated enteric fever patients admitted in Kathmandu Model Hospital. The discharged records from January 2012 to December 2016 were analyzed. The patients above 15 years and with culture isolated enteric fever were included in the study. One hundred fifty-nine strains of Salmonella typhi and paratyphi were isolated from Jan 2012 to Dec 2016 at Kathmandu Model Hospital. Out of 159 isolated, 125 (78.6%) were Salmonella typhi and 34 (21.4%) were paratyphi. Among them co-trimoxazole, chloramphenicol, ceftriaxone, cefotaxime, cefixime, an...
inguinal hernia repair has benefit of less postoperative pain, reduced recovery time, easier repa... more inguinal hernia repair has benefit of less postoperative pain, reduced recovery time, easier repair of a recurrent hernia, concurrent treatment of bilateral hernias, and improved cosmesis. 8,9 Recurrence rate may be lower in TAPP as compared to open technique due to preperitoneal tension free mesh placement. 10,11 This study was planned to reflect benefit of TAPP in our region. METHODS This was a prospective, quasi randomized hospital based study carried out from October 2012 to March 2014 at Dhulikhel Hospital. Written informed consent was taken from the patients willing to participate in the study. The enrolled patients were given numbers which was used to randomize the patients in two groups, namely Background: In the era of minimal invasive surgery, hernia repair has seen a paradigm shift from open to laparoscopic technique. However, superiority of laparoscopic repair over open repair is still controversial. Available literatures have shown laparoscopic technique to be better in term of post-operative pain and early return to work. Methods: In this prospective study, a total of 102 patients aged 21-78 years with inguinal hernia were recruited and enrolled into two comparative groups, namely Lichtenstein's and Transabdominal pre-peritoneal, and each group containing 51 participants. Hospital ethical committee approval and written informed consent from patients was obtained. Primarily, the duration of operation, post-operative pain and complication, and quality of life after surgery was compared between the two different approaches of hernia repair. Results: The study results demonstrated a statistically significant superiority of trans abdominal pre-peritoneal repair over Lichtenstein's hernioplasty in terms of post operative pain (2.00±0.63 vs 3.90±0.74 VAS score, P value<0.001), hospital stay (2.33±0.62 vs 2.96±0.20 days, P value <0.001) and quality of life with early return to normal work (13.39±0.60 vs 17.88±0.86 days, P value <0.001); whereas a prolonged operative time was seen in transabdominal pre-peritoneal repair (96.08±27.08 vs 42.55±5.95 mins, P value <0.001). Conclusions: This study has shown that transabdominal pre-peritoneal repair is better than Lichtenstein's in respect to post-operative pain, quality of life and post-operative complication. However, it has prolonged operative duration than conventional method.
Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society, 2016
The aqueous extract of Mangifera indica is known to possess diverse medicinal properties, which a... more The aqueous extract of Mangifera indica is known to possess diverse medicinal properties, which also includes anti-snake venom activities. However, its inhibitory potency and mechanism of action on multi-toxic snake venom phospholipases A2s are still unknown. Therefore, the objective of this study was to evaluate the modulatory effect of standard aqueous bark extract of M. indica on NN-XIb-PLA2 of Indian cobra venom. The in vitro sPLA2, in situ hemolytic and in vivo edema inhibition effect were carried out as described. Also the effect of substrate and calcium concentration was carried out. M. indica extract dose dependently inhibited the GIA sPLA2 (NN-XIb-PLA2) activity with an IC50 value of 7.6 μg/ml. M. indica extract effectively inhibited the indirect hemolytic activity up to 98% at ∼40 μg/ml concentration. Further, M. indica extract (0-50 μg/ml) inhibited the edema formed in a dose dependent manner. When examined as a function of increased substrate and calcium concentration, t...
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Papers by Yashad Dongol