Study of Prescription Pattern and Factors Associated with Clinical Outcomes in Type 2 Diabetes Mellitus with Reference to Short Term Glycemic Control

Background Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Though oral hypoglycemic agents (OHAs) or/and insulin are prescribed to control the hyperglycemia, still glycemic control is not seen in most of the cases. Evaluating the treatment pattern including the glycemic control and associated factors are of utmost importance for better patient care. Objective To investigate the treatment pattern and short term glycemic control among Type 2 Diabetes Mellitus (DM2) patients and study the factors associated with it. Method Patients meeting the inclusion criteria with DM2 attending laboratory or Out-Patient Department or Emergency Department in Dhulikhel Hospital and patients who were admitted to the ward taking various OHAs and/or insulin at the time of data collection were considered. Informed consent was taken prior to the interview. The collected data was entered as well as analyzed using the SPSS (Statistical Package for Social Sciences) version 21.0 and the p-value <0.05 was considered statistically significant. Result Among the 118 patients, 50.8% of them were males. Majority (28%) of the patients belonged to the age group of 51-60 years. Out of the 118 patients, 22% had their fasting blood glucose (FBG) level under control whereas 78% had uncontrolled FBG level. Metformin was the most (28%) commonly prescribed drug. Significant association was found between gender; knowledge about disease and medication with short term glycemic control (p=0.034, p=0.004 ans p=0.039 respectively). Conclusion All the patients enrolled in this study were under various anti-diabetic medications, however, majority of them didn't have their glycemia under control. Significant association was found between FBG level and gender, knowledge about disease and knowledge about medication.

Identification of molecular species of phosphatidylcholine hydroperoxides in native and copper-oxidized triglyceride-rich lipoproteins in humans

Background

Triglyceride-rich lipoproteins are considered to be independent predictors of atherosclerotic cardiovascular disease. The molecular basis of its atherogenicity is uncertain. Here, we aim to identify molecular species of phosphatidylcholine hydroperoxides (PCOOH) in triglyceride-rich lipoproteins. For comparison, copper-oxidized triglyceride-rich lipoproteins were investigated as well.

Methods

A fasting EDTA blood sample was collected from six healthy human volunteers to isolate two major triglyceride-rich lipoproteins fractions – very low-density lipoproteins (VLDL) and intermediate-density lipoproteins (IDL) using sequential ultracentrifugation. Triglyceride-rich lipoproteins and plasma samples were studied for PCOOH by liquid chromatography (LC) coupled with Orbitrap mass spectrometry.

Results

Twelve molecular species of PCOOH in triglyceride-rich lipoproteins and/or plasma were identified using the following criteria: (1) high-resolution mass spectrometry (MS) with mass accuracy within 5 ppm, (2) retention time in LC and (3) fragmentation pattern in MS2 and MS3. PC36:4-OOH was most often detected in VLDL, IDL and plasma. The ratio of total PCOOH to phosphatidylcholine progressively increased with the duration of oxidation in both VLDL and IDL.

Conclusion

This study demonstrated the presence of 12 molecular species of PCOOH in native triglyceride-rich lipoproteins. The frequent detection of PCOOH in triglyceride-rich lipoproteins provides a molecular basis of the atherogenicity of triglyceride-rich lipoproteins. PCOOH in triglyceride-rich lipoproteins might serve as a molecular basis of the atherogenicity of triglyceride-rich lipoproteins.

Tracking the adoption of bread wheat varieties in Afghanistan using DNA fingerprinting

BACKGROUND

Wheat is the most important staple crop in Afghanistan and accounts for the main part of cereal production. However, wheat production has been unstable during the last decades and the country depends on seed imports. Wheat research in Afghanistan has emphasized releases of new, high-yielding and disease resistant varieties but rates of adoption of improved varieties are uncertain. We applied DNA fingerprinting to assess wheat varieties grown in farmers' fields in four Afghan provinces.

RESULTS

Of 560 samples collected from farmers' fields during the 2015-16 cropping season, 74% were identified as varieties released after 2000, which was more than the number reported by farmers and indicates the general prevalence of use of improved varieties, albeit unknowingly. At the same time, we found that local varieties and landraces have been replaced and were grown by 4% fewer farmers than previously reported. In 309 cases (58.5%), farmers correctly identified the variety they were growing, while in 219 cases (41.5%) farmers did not. We also established a reference library of released varieties, elite breeding lines, and Afghan landraces, which confirms the greater genetic diversity of the landraces and their potential importance as a genetic resource.

CONCLUSIONS

Our study is the first in wheat to apply DNA fingerprinting at scale for an accurate assessment of wheat varietal adoption and our findings point up the importance of DNA fingerprinting for accuracy in varietal adoption studies.

Diversity of Root Canal Morphology in Mandibular First Premolar

Background Mandibular first premolars have been reported to have complex anatomical aberration making them one of the most difficult teeth to manage endodontically. Objective To determine the root canal anatomy of mandibular first premolar in a Nepalese population using decalcification and clearing technique. Method One hundred and fifty extracted mandibular first premolars were collected from Nepalese population. Access cavities were prepared on the occlusal surface of each tooth. Teeth were decalcified by immerging in 5% nitric acid, dehydrated in ethyl alcohol and made transparent using methyl salicylate. Methylene blue dye was injected through access cavity and canal anatomy were observed and classified according to Vertucci's classification. Result The average length of mandibular first premolar was 20.43mm. One rooted teeth were 96% and two rooted were 4%. Vertucci's type I canal configuration was most prevalent (72%) followed by type V (18.6%), type III (3.3%), type II (2.6%) and type IV (2.6%). An unusual configuration was found in one tooth. Isthmus and apical deltas were found in 8.6%) and 14.6% of the cases respectively. Conclusion Type I canal configuration were the most frequently observed root canal configuration in mandibular first premolar followed by type V configuration. Such variation in root canal anatomy should be taken into consideration to ensure successful endodontic therapy of these teeth.

Prehypertension and its Risk Factors in Suburban Nepal -Findings from the Dhulikhel Heart Study

Background Prehypertension, defined as a systolic blood pressure of 120-139 mmHg or a diastolic blood pressure of 80-89 mmHg, leads to higher rates of incident hypertension, and is associated with excess morbidity and deaths from cardiovascular diseases. Objective To estimate the prevalence of and examine the factors associated with prehypertension in Dhulikhel. Method This cross-sectional study utilized data from the 752 participants of the Dhulikhel Heart Study (DHS). The data collectors interviewed the participants at their home using a tablet based structured pre-tested questionnaire and measured blood pressure using a standard digital blood pressure machine (Microlife, Switzerland). Multivariate analysis was conducted using generalized estimating equations with multivariate logistic regression (with household as cluster) adjusting for age, sex, ethnicity, marital status, income, education, alcohol consumption, smoking, physical activity, body mass index (BMI) and food consumption. Result Males had a three-fold higher odds of prehypertension than females (OR:3.17, 95% CI:1.91-5.26). The odds of prehypertension increased with being overweight (OR:2.29, 95% CI:1.42-3.70) and with being obese (OR:5.00, 95% CI:1.81-13.79) compared to normal BMI. Education reduced the odds of developing prehypertension (OR:0.51, 95% CI:0.29-0.91). Those who met the recommended level of physical activity (OR:0.61, 95% CI:0.40-0.95) also were associated with lower prehypertension prevalence. Conclusion Obese/overweight and being male increased the odds of prehypertension whereas formal education and recommended level of physical activities were associated with lower prehypertension prevalence. Primordial prevention against cardiovascular risk factors at the community level, especially targeting the young adult male, is imperative.

Triglyceride deposit cardiomyovasculopathy: a rare cardiovascular disorder

Triglyceride deposit cardiomyovasculopathy (TGCV) is a phenotype primarily reported in patients carrying genetic mutations in PNPLA2 encoding adipose triglyceride lipase (ATGL) which releases long chain fatty acid (LCFA) as a major energy source by the intracellular TG hydrolysis. These patients suffered from intractable heart failure requiring cardiac transplantation. Moreover, we identified TGCV patients without PNPLA2 mutations based on pathological and clinical studies. We provided the diagnostic criteria, in which TGCV with and without PNPLA2 mutations were designated as primary TGCV (P-TGCV) and idiopathic TGCV (I-TGCV), respectively. We hereby report clinical profiles of TGCV patients. Between 2014 and 2018, 7 P-TGCV and 18 I-TGCV Japanese patients have been registered in the International Registry. Patients with I-TGCV, of which etiologies and causes are not known yet, suffered from adult-onset severe heart disease, including heart failure and coronary artery disease, associated with a marked reduction in ATGL activity and myocardial washout rate of LCFA tracer, as similar to those with P-TGCV. The present first registry-based study showed that TGCV is an intractable, at least at the moment, and heterogeneous cardiovascular disorder.

Analysis of Factors Associated with Thyroid Dysfunction: A Hospital Based Study

Background Thyroid dysfunction (TD) is one of the major public health concerns in Nepal. This study intends to identify factors in association with thyroid dysfunction and its hospital based prevalence. Objective To determine hospital-based prevalence of thyroid dysfunction and to identify and analyze factors in association with thyroid dysfunction. Method A retroprospective cross-sectional study was conducted among patients attending Dhulikhel Hospital-Kathmandu University Hospital (DH,KUH) from January to December, 2015 with prospective part carried out from July to December 2015 in the patients visiting Dhulikhel hospital for health check-up and requested for Thyroid Function Tests (TFTs). Thyroid Function Tests of 1530 subjects were performed in the biochemistry laboratory and semi-structured questionnaire were introduced to 312 participants with convenient sampling method and their anthropometric measurements were taken. Chi-square test, Pearson's correlation and student-t test were used as a measure to analyze factors. Result Out of total 1530 subjects, 35.3% were having thyroid dysfunction with the prevalence of overt hyperthyroidism, subclinical hyperthyroidism, overt hypothyroidism and subclinical hypothyroidism to be 2.5%, 2.4%, 5.6% and 24.8% respectively. The distribution of thyroid dysfunction was preponderant among females and among older age. The prevalence of thyroid dysfunction was highest among Terai/Madhesi (40.0%) and lowest among Newars (28.5%) with higher fraction of hypothyroidism in each ethnic group. There were significant correlation between Thyroid Stimulating Hormone (TSH) with waist-hip ratio (p<0.05) and weight (kg) with free thyroxine (fT4) (p<0.05). Direct pesticide exposure (p<0.05) was significantly associated with hypothyroidism. The serum fT4 was significantly different (p<0.05) among vegetarian and non-vegetarian whereas TSH and free triiodothyronine (fT3) were not significantly different. Smoking, alcoholism, dietary food habits, diabetes and hypertension were not significantly associated with thyroid dysfunction. Conclusion Thyroid dysfunction was highly prevalent among participants with higher proportion of subclinical hypothyroidism. Besides, direct pesticide exposure found to be factor in association with hypothyroidism, this study could not find significance relation with other established risk factors.

Reasons for Summoning Ambulance Services in the Hilly Region of Nepal

Background Nepal lacks a unified and countrywide emergency medical services system as other developing countries. However, the emergence of ambulance service initiatives in the past decade shows a promising future for pre-hospital care. Nepal Ambulance Service (Est. 2011) and Dhulikhel Emergency Medical Services (Est. 2013) are the existing emergency medical services initiatives in Nepal. Objective To describe the reason for summoning ambulance services and demographics of the patients who were transported by Dhulikhel Emergency Medical Services at Dhulikhel hospital, hilly region of Nepal. Method One thousand three hundred and ninety three patient records at Dhulikhel hospital transported by Dhulikhel Emergency Medical Services during the five-year period (2013 - 2018) were included in the study. Chief complaints and demographic data were collected and categorized into overarching systemic categories. Result Among 1393 patients, majority were female (60.4%) and the most common age group was 20-29 years. The most common reason for calling ambulances was gastrointestinal problem (22.6%). Similarly, respiratory (17%), obstetric and gynecological (15.2%), trauma (12.7%) and neurological (9.6%) problems were other common reasons. The number of respiratory problem was increased during the winter season. The overall percentage of patients arriving at hospital with trauma problems was increased steadily, but it was not statistically significant. Conclusion Gastrointestinal problem was the most common reason, followed by respiratory and obstetric and gynecological problems for summoning ambulances services in the hilly regions of Nepal. The incidence of respiratory problem significantly increased during the winter season.

Vesico-vaginal fistula post Right radical nephroureterectomy with bladder cuff excision

Case: 61 years, female presented at KMH OPD with involuntary urinary leakage per vaginum for seven months following Right radical nephreureterectomy with bladder cuff excision for urinary bladder carcinoma at other centre. Dye test was positive. Cystoscopy revealed VVF defect around 2 cm (Goh’s stage 3biii) at right posterior wall of urinary bladder. Ureteric catheter was placed in left ureter and VVF repair was done. Dye test following 14 days of Foley’s catheterization was negative and patient went home dry. We present here a case of successful repair of VVF following Right radical nephreureterectomy with bladder cuff excision.  Key words: dye test, Goh’s stage, pelvic surgeries, urinary tract injuries, vesico-vaginal fistula

Profile of Obstetric and Iatrogenic Fistula Surgeries At Kathmandu Model Hospital

Aims: To find out the pattern of urogenital fistula. Methods: This was a retrospective study of 222 patients who underwent fistula surgery during the period of January 2012 to March 2018 in Kathmandu Model Hospital. The data were collected from the hospital records. The fistulae were classified according Goh system.  Patients’ demography, obstetric characteristics and surgical outcome were reviewed. The primary outcome was in terms of urinary continence. Results: Among 222 cases, majority of the patients had fistula due to obstetrical cause, contributing 58% (n=127) and 42% (n=95) had fistula after gyanaecological surgery. The age ranged from 15 to 65 years. Most of the patients had fistula of type 1a, contributing 38% (n=84) and only 0.01% (n=3) of type 3c and 4b according to Goh’s classification. Hundred (78.7%) cases of obstetric fistula patients were dry and continent after surgery, whereas 95(89.4%) cases of fistula after gynecological surgery were successfully repaired. Eighteen patients with obstetric fistula and 6 patients with fistula after gynecological surgery had failed repair. Conclusions: Our study showed obstructed and prolonged labor was the major cause of obstetric fistula, but   fistula resulting after gynecological surgery should not be overlooked. Keywords: fistula, iatrogenic, labour

A micro-pipette thermal sensing technique for measuring the thermal conductivity of non-volatile fluids

This research work demonstrates an innovative technique to measure the thermal conductivity of a small volume of non-volatile liquids. The method utilizes a micro-pipette thermal sensor (MPTS) (tip diameter < 2 μm) and is based on laser point heating thermometry and transient heat transfer. A laser beam is irradiated at the sensor tip immersed in a few microliters of the test fluid and the transient temperature change is recorded with the sensor. This temperature change is dependent on the surrounding fluid's thermal properties, such as thermal conductivity and diffusivity. The numerical solution for transient temperature profile for a point source is obtained using the finite element method in the COMSOL software. To determine the optimizing parameters such as thermal conductivity and power absorbed at the sensor tip, the multi-parameter fitting technique is used in MATLAB, which will fit the COMSOL simulation result with the experimental data. Three liquids with known thermal conductivity were tested to verify that the technique can be used to determine the thermal conductivity with high accuracy, and in addition, the thermal conductivity of growth media and serum used for culturing cancer cells is estimated. With the sensor size of 1-2 μm, we demonstrate the possibility of using this described method as the MPTS technique for measuring the thermal properties of microfluidic samples and biological fluids.

Determination of total, free and esterified short-chain fatty acid in human serum by liquid chromatography-mass spectrometry

Background

Short-chain fatty acids are primarily absorbed through the portal vein during lipid digestion, which is utilized as the energy source, as well as prevent type 2 diabetes and some cancers. However, reports on the determination of these short-chain fatty acids in human serum are limited.

Methods

Blood samples from human subjects ( n = 547, male/female = 246/301, age 58.85 ± 12.57) were collected. Saponification was applied to obtain total fatty acid. After derivatization by 2-nitrophenylhydrazine, fatty acid 4:0 and fatty acid 6:0 were measured by liquid chromatography-mass spectrometry.

Results

The developed method exhibited good linearity (R2 = 0.9996 for both). All the coefficients of variation of reproducibility and accuracy for fatty acid 4:0 and fatty acid 6:0 ranged 3.0%−6.1%, with the average recoveries of 87.8%−102.4% and 92.2%−98.2%, respectively. In all the samples, the concentration of fatty acid 4:0 (162.4 ± 76.4 μmol/L) was significantly higher than fatty acid 6:0 (2.0 ± 2.5 μmol/L, P < 0.001). Furthermore, the esterified form was predominant in both fatty acid 4:0 and fatty acid 6:0 (98.2% and 82.4% of total fatty acids, respectively). Besides, short-chain fatty acids showed no significant differences with regard to sex or age differences.

Conclusion

This developed liquid chromatography-mass spectrometry method is convenient and reliable, which might be useful for monitoring the variations of short-chain fatty acids in blood.

Deep Brain Stimulation in Parkinsons Disease in Nepal

Background Parkinsons disease is a central nervous system degenerative disorder affecting motor system and characterized by progressive tremor, rigidity, gait abnormalities. Surgical treatment of Parkinsons disease is based on the changes in the basal gangliothalamocortical circuits which is altered in Parkinsons disease. Currently pallidotomy and Deep Brain Stimulation are available modes of surgical treatment of Parkinsons disease. Objective To know efficacy of deep brain stimulation in Parkinsons Disease in Nepal. Method All patients of idiopathic Parkinsons disease who underwent Deep Brain Stimulation in Annapurna Neurological Institute and Allied sciences since 2014 were included. The standard functional coordinates for Subthalamic nucleus and Globus pallidus internus was used. We used Zamarano-Dujovny (ZD) Fisher Frame with its software. Patients' Unified Parkinsons disease rating score, Modified Hoehn and Yahr Staging and Schwab and England Activities of daily living Scale were evaluated preoperativelyv as well as postoperatively. Result Ten patients underwent Deep Brain Stimulation. The male is to female ratio was 2:1. The mean age was 55.4±8.9 years and duration of illness was 5.5±2 years. There was a significant improvement in the scores for the main motor manifestations of the disease between the preoperative off-dopa and postoperative off-dopa/on-stim conditions. There was a significant improvement in Schwab and England Activities of daily living scale scores in the off-dopa condition between the preoperative score and the postoperative M6 score. Conclusion Our result of Deep Brain Stimulation is quite promising. However, it is very expensive and requires frequent follow-up for neuromodulation.

Medication Adherence to Levothyroxine Therapy among Hypothyroid Patients and their Clinical Outcomes with Special Reference to Thyroid Function Parameters

Background Non-adherence to medication in hypothyroid patients leads to poor clinical outcome and increased health care costs. Study related to adherence to levothyroxine in hypothyroid patients is limited worldwide. Objective To determine the adherence pattern and factors affecting adherence in hypothyroid patients and compare the clinical outcomes among adherent and non-adherent patients. Method A cross-sectional study was conducted in Dhulikhel hospital, Kathmandu University hospital. Patients with hypothyroidism on levothyroxine fulfilling the inclusion criteria were enrolled in this study. After obtaining the informed consent from the patients, structured questionnaire was used to interview the patients. Statistical analysis was performed by using SPSS 23.0. P-value < 0.05 was considered as statistically significant. Result Among 113 patients enrolled in this study, 85.8% of them were females. Majority (76.10%) of them belonged to the age group of 31-40 years. More than half (51.3%) of the patients were adherent to medication. Non-adherence was significantly associated with literate people following medication (p=0.003, OR=0.305), missed appointment to follow-up (p=0.007, OR=0.346) and longer duration of medication (p=0.019, OR=4.385). However, there was no statistically significant association of clinical outcomes with reference to TSH, fT4, fT3 and patients' age, adherence to medication and concomitant use of other drugs. Conclusion More than half of the patients were adhered to the Levothyroxine therapy. Forgetfulness was the main reason for missing the dose and non-specific reasons attributed to discontinuation of medication for these patients. Good adherence was seen among illiterate people. Treatment related factor, patient-provider relationship and patient related factor were determined as the major barrier to medication adherence. Most of the non-adherent patients had uncontrolled TSH.

Radiographic Anatomy of the Neck-Shaft Angle of Femur in Nepalese People: Correlation with its Clinical Implication

Background Neck-shaft angle (NSA) is one of the prominent features in the proximal femur which is an important determinant of fracture of femoral neck. Present study evaluating the value of neck-shaft angle has relied heavily on radiographs. As knowledge of neck-shaft angle is important to orthopaedic surgeons, there is need to elucidate whether there is significant variation of this angle among the two different genders and various age groups of both right and left femora of Nepalese population. Objective To ascertain the value of neck-shaft angle in the Nepalese population by means of a radiographic study and to correlate the values with regard to right neck-shaft angle/ left neck-shaft angle side (RNSA/LNSA), gender and three different age group. Method Normal pelvic radiographs of 148 patients seen at department of orthopedic and radiology, College of Medical Sciences- Teaching Hospital (COMS-TH), Bharatpur, Chitwan from the month of February 2017 to June 2017 were divided into two different gender and three different age groups (21-40 years, 41-60 years and Above 60 years) and their neck-shaft angle of both right and left sides were recorded. Result The average of RNSA and LNSA were found to be 132.96±6.05° and 131.54±13.66° respectively for male and 134±6.57° and 132.98±6.23° respectively for female. In total the average RNSA and LNSA were 133.51±6.32° and 132.26±10.61° respectively. Similarly, the average RNSA and LNSA for three different age groups (21-40 years, 41-60 years and Above 60 years) were found to be 133.76±6.44°, 133.69±6.36° and 132.50±6.06° and the 133.35±6.29°, 132.47±5.85° and 128.84±21.98° respectively. Conclusion The average neck-shaft angle recorded here shows no significant difference in both RNSA and LNSA in males except for a small and significant difference in LNSA in female of three different age groups.

Clinical Outcome following Intra-articular Triamcinolone Injection in Osteoarthritic Knee at the Community: A Randomized Double Blind Placebo Controlled Trial

Background Knee pain is one of the common complaints patients present with in any community based health camps and Osteoarthritis of knee is a usual diagnosis. Injecting a long acting steroid is a common practice to alleviate the symptoms of osteoarthritic knee. Objective To evaluate the clinical outcome of injecting Triamcinolone acetenoid in osteoarthritis of knee in a community set up over a randomized double-blind placebo control trial. Method A prospective, randomized, double blind, placebo control trial was carried out in community after obtaining the ethical clearance from the IRC. Patients with clinically diagnosed osteoarthritis of knee were injected either Triamcinolone or Placebo after recording the baseline scores of the knee by Knee injury and Osteoarthritis Outcome Score (KOOS) - Physical Function Short form (KOOS-PS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analogue Scale (VAS). The same tools were used at two, six and at twelve weeks post injection to evaluate the functional outcome and pain. Result One hundred and seventeen patients were available for analysis among which, 55(48.7%) patients received Triamcinolone and 58(51.3%) received placebo. The baseline status of knees of two groups was comparable at the start of study. There was significant pain relief in the group receiving Triamcinolone at two and six week but not in twelve weeks. Group receiving placebo had pain relief only for first two weeks. Functional outcome was significantly improved compared to baseline in both the groups until six weeks however, in the triamcinolone group, it was significant until twelve weeks. No major complications were noted. Conclusion Intra-articular injection of Triamcinolone acetenoid is effective in symptoms control and improving functional outcome in clinically diagnosed osteoarthritis of knees in community set up during health camps.

In vitro biofilm formation by Staphylococcus aureus isolated from wounds of hospital-admitted patients and their association with antimicrobial resistance

Introduction

Staphylococcus aureus including methicillin-resistant S. aureus (MRSA) has the propensity to form biofilms, and causes significant mortality and morbidity in the patients with wounds. Our aim was to study the in vitro biofilm-forming ability of S. aureus isolated from wounds of hospitalized patients and their association with antimicrobial resistance.

Materials and methods

Forty-three clinical isolates of S. aureus were obtained from 150 pus samples using standard microbiological techniques. Biofilm formation in these isolates was detected by tissue culture plate (TCP) method and tube adherence method (TM). Antimicrobial susceptibility test was performed using the modified Kirby–Bauer disk diffusion method as per Clinical and Laboratory Standards Institute guidelines. MRSA was detected using the cefoxitin disk test.

Results

Biofilm formation was observed in 30 (69.8%) and 28 (65.1%) isolates of S. aureus via TCP method and TM, respectively. Biofilm-producing S. aureus exhibited a higher incidence of antimicrobial resistance when compared with the biofilm nonproducers (P<0.05). Importantly, 86.7% of biofilm-producing S. aureus were multidrug resistant (MDR), whereas all the biofilm nonproducers were non-MDR (P<0.05). Large proportions (43.3%) of biofilm producers were identified as MRSA; however, none of the biofilm nonproducers were found to be MRSA (P<0.05).

Conclusion

Both the in vitro methods showed that S. aureus isolated from wound infection of hospitalized patients have high degree of biofilm-forming ability. Biofilm-producing strains have very high tendency to exhibit antimicrobial resistance, multidrug resistance and methicillin resistance. Regular surveillance of biofilm formation by S. aureus and their antimicrobial resistance profile may lead to the early treatment of the wound infection.

Experience of Laparoscopic Gynecological Surgeries at Kathmandu Model Hospital

Aims: Laparoscopy has become the most common procedure in recent set-ups. It is now a major diagnostic as well as therapeutic modality for infertility, endometriosis, extrauterine pregnancy and benign ovarian tumors. The aim of the study was to share the experience of gynecological laparoscopic surgeries performed at Kathmandu Model Hospital. Methods: A descriptive study was carried out at Kathmandu Model Hospital from 1st January 2011 to 1st May 2017. All the patients who underwent gynecological laparoscopic surgeries were analyzed for the indication, type of procedure and its complications. Results: Out of 217, majority 24.4 %(n=53) patients were in age group 26-30 years. There were 51.1% (111) cases of ovarian cyst, 12.44%(27) cases of ectopic pregnancy. Eight cases were done with surgeons for cholecystectomy and ovarian cystectomy or hysterectomy. There were 15% (n=32) cases of diagnostic laparoscopy. Total laparoscopic hysterectomy was done in 16% (n=33) cases. Conversion to laparotomy was done in 3%(8) cases. There was one case of vascular injury. Most common immediate post-operative complaint was variable degree of pain, managed with parenteral and oral analgesics. Oral diet started at 4-6th hour post-operatively, and mobilization started after 24 hours. 75% (164) cases had a hospital stay of 2 days and 25%(53) cases stayed for 3 days. Conclusions: Laparoscopic surgery at our hospital has been well demonstrated in terms of reducing postoperative pain and decreasing postoperative morbidity, short hospital stay, and less postoperative recovery time. However, adequate advanced training and devices are needed to perform skillful laparoscopic surgeries. 

Outcome Analysis of Neonates following Laparotomy for Acute Abdomen: A Prospective Study

Background Low and middle-income countries (LMIC) bear the majority of the global pediatric surgical burden. Despite increasing volume of pediatric surgeries being performed in LMIC, outcomes of these surgeries in low and middle-income countries remain unknown due to lack of robust data. Objective The objective of our study was to collect data on and evaluate neonatal surgical outcomes at a tertiary level center in India. Method The surgical outcomes data of all neonates undergoing laparotomy between February 15, 2015 and October 14, 2015, at Sir Ganga Ram Hospital, New Delhi, India was collected prospectively. Descriptive statistics were used to determine the rates of various postoperative outcomes. Result A total of 37 neonatal surgeries were performed during the study period. The mean age of the neonates on the day of surgery was 7 days (range: 1-30 days). Most of the neonates (72.9%, n=27) were males. About 40% (n=15) of the neonates were preterm and 15 (40.5%) of them were small for gestational age. In our study, 10 neonates (28.6%) needed ventilation for 48 hours or less after surgery and 5 neonates (13.5%) were kept Nil per Oral (NPO) postoperatively for more than 10 days. Out of 37 neonates, 4 (10.80%) developed a surgical site infection and 8 neonates (21.6%) had postoperative sepsis. The in-hospital mortality rate among neonates undergoing laparotomy during the study period was 8.1 deaths per 100 neonates. Conclusion Co-ordination of care among pediatric surgeons, neonatologists, nursing and anesthesia team is required for optimal surgical outcome.

Improving Knowledge, Skill and Confidence of Novice Medical Doctors in Trauma Management with Principles of ABCDE

Background Trauma is one of the major public health concerns clamming about five million death annually worldwide. Experience and confidence of a doctor in the management of trauma patients have big impact on the overall outcome. Objective This study aims to evaluate the outcome of a trauma course in improving the knowledge, skill and confidence of novice doctors in managing trauma victims. Method A pre/post test analytical study was carried out among novice medical doctors from Kathmandu University School of Medical Science (KUSMS) who participated in a standard two and a half day trauma course, that utilizes the principles of ABCDE, as a part of their regular training. Pre-course knowledge and skill were compared with immediate post-course scores on the same guidelines. Objective structured and subjective written feedbacks from the participants were analyzed qualitatively to identify the perceptions of candidates. Result Sixty-eight males and twenty-nine females completed the course. The average pre-test scores in knowledge and skill were 8.3(33.2%) and 19.6(78.5%) respectively. Similarly the post-test scores were 16.04(64.2%) and 22.45 (89.5%) respectively, showing statistically significant improvements (P 0.000). The mean percentage improvement in knowledge was 48.8% and that in skill was 160.9%. The feedback analysis showed majority of the participants were satisfied with the course and they perceived improved "self-confident" in handling trauma cases. Conclusion All the novice doctors should participate in a standard trauma course hence their knowledge, skill and confidence in handling a trauma can be improved.