Journal of BP Koirala Institute of Health Sciences

Journal of BP Koirala Institute of Health Sciences

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  • Country of publisher: nepal
  • Date added to EuroPub: 2019/Nov/09

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  • Language of fulltext: english

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  • Year open access content began: 2018
  • Does the author retain unrestricted copyright? False
  • Does the author retain publishing rights? False

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This journal has '13' articles

Blunt trauma head injuries and time to death in the cases autopsied at a tertiary care centre

Blunt trauma head injuries and time to death in the cases autopsied at a tertiary care centre

Authors: Bikash Sah
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Abstract

Background: In developing countries, accident rates in general and traumatic head injuries in particular are increasing as traffic increases besides other factors like industrialization, falls and ballistic trauma. Most injury related deaths and disabilities are preventable. Objective: To find out the relationship between the extent and severity of fatal blunt trauma injuries in head region with duration of survival (time to death), place of death, hospitalization status and intoxication status. Methods: This was a hospital based, cross sectional and analytical study done on the cases brought for postmortem examination at a mortuary of B. P. Koirala Institute of Health Sciences, Dharan, Nepal over one year period (13th April 2012 to 13th April 2013). Appropriate statistical test was used to compare the Injury Severity Score (ISS) with duration of survival, place of death, hospitalization status and intoxication status. Result: Significant difference was present between ISS of hospitalized cases and not hospitalized cases, of cases who died within half an hour (spot death) and between half hour and 6 hour (death at emergency) but there was no significant difference among other different cases who were hospitalized and between intoxicated and not intoxicated at the incident. Conclusion: This study has shown the time to death in blunt trauma head injury cases with higher ISS is less as compared to those with less ISS. The ISS is also significantly different for hospitalized and not hospitalized cases. This shows us to focus more on preventive strategies of such injuries

Keywords: Autopsies, Blunt Head injuries, Injury Severity Score
Effectiveness of education intervention programme on life support measures for the nurses working in emergency unit of BPKIHS: a pre-experimental study

Effectiveness of education intervention programme on life support measures for the nurses working in emergency unit of BPKIHS: a pre-experimental study

Authors: Upendra Yadav, Ram Sharan Mehta
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Abstract

Introduction: Lack of resuscitation skills of nurses in basic life support (BLS) and advanced life support (ALS) has been identified as a contributing factor to poor outcomes of cardiac arrest victims. Objective: To assess the effectiveness of education intervention programme to improve the knowledge and thereby the quality of Emergency service; especially in the area of Basic Life Support, Advance Life Support and Triage system. Method: Pre-experimental research design was used to conduct the study among the nurses working in Emergency unit of BP Koirala Institute of Health Sciences where CPR is very commonly performed. Using convenient sampling technique, a total of 24 nurses agreed to participate and to give consent were included in the study. The theoretical, demonstration and re-demonstration sessions were arranged, involving the trained doctors and nurses during the three hours educational programme. Post-test was carried out after education intervention programme. The 2010 BLS and ALS guidelines were used as guide for the study contents. The collected data were analyzed using SPSS-15 software. Result: It was found that there is significant increase in knowledge after education intervention in the components of life support measures (BLS/ALS) i.e. ratio of chest compression to ventilation in BLS (P= 0.001), correct sequence of CPR (p< 0.001), rate of chest compression in ALS (P= 0.001), the depth of chest compression in adult CPR (p< 0.001), and position of chest compression in CPR (P= 0.016). The participating nurses well appreciated the programme and requested to continue in future for all the nurses. Conclusion: Educational intervention programme certainly improves the knowledge of the working nurses, and thereby the quality of Emergency service; especially in the areas of Basic Life Support, Advance Life Support and Triage System.

Keywords: Nurses, Basic Life support, advanced life support, Resuscitation
Endoscopic medial maxillectomy for sinonasal inverted papilloma

Endoscopic medial maxillectomy for sinonasal inverted papilloma

Authors: Shyam Thapa, S. Karki, Shankar Shah, BP Sah
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Abstract

Background: Traditionally, medial maxillectomy was performed through lateral rhinotomy or mid facial degloving approach for inverted papilloma. Endoscopic medial maxillectomy, since reported first in 1992, has advanced tremendously and has been advocated by a number of authors for the fact that it prevents the morbidity of open approach with a similar recurrence rate. We present our experience of endoscopic medial maxillectomy for sinonasal inverted papilloma. Aims and Objective: To highlight the treatment of inverted papilloma through transnasal endoscopic approach. Methods: This study is a retrospective chart review of 18 patients out of 23 patients of which 5 were lost on follow-up with inverted papilloma who were treated during the last 2 years. Preoperative diagnosis was made on histopathological examination and Krouse staging in CT scans of paranasal sinus was used to estimate the extent of the disease. Then, surgical approach was decided. Post-operative follow up was done by performing direct nasal endoscopy. All patients were followed up for a minimum period of 1 year. Results: Among the 18 patients who underwent endoscopic medial maxillectomy, sex (male : female) ratio were 1.25: 1, age ranged from 24 yrs to 69 yrs with average being 41.7 yrs. According to Krouse staging, 2 patients were in Stage I, 9 patients in Stage II and 7 patients in Stage III. The laterality of the lesion was more on the right. The commonest site of attachment was found to be the lateral wall of nose. The average duration of hospital stay was 4 days. The commonest complication was nasal crusting and the recurrence rate was 11.11%. Conclusion: This work confirms the results described in recent literature and further supports transnasal endoscopic surgery to manage inverted papilloma.

Keywords: Inverted Papilloma, Endoscopic medial maxillectomy.
Randomized controlled trial comparing cefazolin with ceftriaxone in perioperative prophylaxis in orthopaedic surgeries

Randomized controlled trial comparing cefazolin with ceftriaxone in perioperative prophylaxis in orthopaedic surgeries

Authors: Roshan PS Kalawar, Bikram Prasad Shrestha
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Abstract

Background: Surgical site infection is one of the most dreaded complications faced by an orthopaedic surgeon. In spite of cefazolin being recommended as perioperative antibiotic, many orthopaedic surgeons continue to use ceftriaxone as perioperative antibiotic. Objective: To compare the effectiveness of cefazolin and ceftriaxone as perioperative prophylactic antibiotics in the prevention of surgical site infection in clean elective orthopaedic surgeries. Methods: We conducted a randomized controlled trial in 197 patients undergoing clean elective orthopaedic surgeries. The patients were divided into two groups. One group received intravenous prophylactic antibiotics cefazolin and gentamicin and the other group received ceftriaxone and gentamicin in standard doses for 48 hours. Both groups were followed by oral Cephadroxyl for 7 days. The patients were followed up for three months. Results: There was no significant difference in the rate of surgical site infection among the two groups. Conclusion: We conclude that there is no difference in the effectiveness of prevention of surgical site infection between cefazolin and ceftriaxone

Keywords: Cefazolin, ceftrinxone, prophylactic antibiotics, surgical site infection.
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Authors:
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Abstract

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Keywords: test
Questionnaire survey on methods of determining the relationship of the mandibular canal and third molars

Questionnaire survey on methods of determining the relationship of the mandibular canal and third molars

Authors: Apeksha Mainali
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Abstract

Background: Clinicians should assess and monitor mandibular canal (MC) to achieve an uneventful and successful final result. Two dimensional techniques like panoramic radiography, intra oral periapical radiographs are commonly used for assessment of MC, along with three dimensional techniques like cone beam computed tomography (CBCT). Objectives: To assess the radiologic modalities and assessment criteria used by clinically practicing dental surgeons when determining the proximity of MC to third molars. Method: A questionnaire based study was carried out among national and international oral maxillofacial surgeons and general dental practitioners. Data were fed to SPSS software version 21 for descriptive statistics. Result: Most of the participants (54.7%) in the study preferred combination of panoramic radiograph and CBCT for determining the relationship of mandibular canal and third molars measures. Conclusion: Initial screening can be carried out using panoramic radiograph which is a popular method in determining the relation between the third molar and mandibular canal in spite of some limitations. Cone Beam Computed Tomography is an important three-dimensional imaging technique which is a preferred method amongst most dental surgeons.

Keywords: Mandibular canal, Third molar, Imaging modality
Vaginal administration of isosorbide mononitrate for cervical ripening prior to induction of labor for postdated pregnancy: a randomized controlled trial

Vaginal administration of isosorbide mononitrate for cervical ripening prior to induction of labor for postdated pregnancy: a randomized controlled trial

Authors: Rubina Rai
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Abstract

Introduction: Induction of labor is commonly practiced intervention in modern Obstetrics. The aim of induction of labor is to initiate labor when maternal and fetal conditions necessitate delivery before the onset of spontaneous contraction with purpose to achieve safe vaginal delivery. Induction of labor is one of the most commonly practiced interventions in the Department of Obstetrics and Gynecology every day. The success of this obstetric practice is highly dependent upon the condition of the cervix which is assessed with Bishop‟s Score and it is well known that unfavorable cervix is associated with failure of induction and cesarean section. In the recent years, there has been a considerable interest in the use of nitrous oxide donors for cervical ripening and labor induction. Objective: To evaluate whether isosorbide mononitrate administered vaginally prior to induction in postdated pregnancy is effective for pre-induction cervical ripening and thus, improves the process of induction of labor. Methods: One hundred and twenty women scheduled for labor induction were recruited and assigned randomly to isosorbide mononitrate or placebo followed by misoprostol 25μg. The efficacy of the medication was evaluated by predetermined outcome variables for cervical ripening and induction of labor and delivery. Results: The groups were comparable with respect to age, gestational age and Bishop‟s score. Women receiving isosorbide with misoprostol didn‟t show any improvement in the Bishop‟s score compared to misoprostol and placebo. There was no significant difference between the two groups regarding time of delivery and onset of active stage of labor from induction. Cesarean delivery rates were similar between the two groups; however, the indications of the cesarean section were different between the two groups which were significant statistically. Neonatal outcome were similar between the two groups. Conclusion: The addition of vaginal isosorbide mononitrate to oral misoprostol for cervical ripening and labor induction did not reduce time to vaginal delivery and didn‟t help in improving pre-induction cervical score.

Keywords: Postdated pregnancy, induction of labor, isosorbide mononitrate.
Ziehl Neelsen vs. Auramine staining technique for detection of acid fast bacilli

Ziehl Neelsen vs. Auramine staining technique for detection of acid fast bacilli

Authors: Rajendra Gurung
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Abstract

Background: The culture and molecular test are the best methods for isolation and identification of Mycobacterium tuberculosis in developed countries. But, in developing countries like Nepal with a significant number of tuberculosis (TB) cases and limited resources, the diagnosis of TB relies primarily on smear microscopy for Acid fast bacilli (AFB). Objective: To compare the results of direct sputum examination for AFB stained by Ziehl Neelsen and Auramine technique. Method: Cross sectional comparative study was conducted in tuberculosis research laboratory, BPKIHS from April to June 2013. A total of 100 sputum samples were collected randomly. Four slides were smeared and labeled for each as neat ZN, neat Auramine, concentrate ZN and concentrate Auramine. Slides were processed as per WHO laboratory guidelines. Results: The findings of this study revealed that 3% positive with neat Auramine was negative for ZN stain. Similarly, 5% positive cases with Auramine concentrate were negative with ZN concentrate technique. Auramine stain was able to detect all ZN positive as positive but only 83 cases were detected as negative among 88 case of ZN negative. Both concentration techniques showed 12% of positive with significant relationship. With this; Auramine showed 100% sensitivity, 94.6% specificity, positive predictive values and negative predictive values 70.5, 100% respectively. Conclusion: Auramine stain stands efficient on comparison and can be used as an alternative to ZN stain, with added value of allowing a large number of sputum specimens to be examined in a given time as low power is used for examination.

Keywords: Identification, Mycobacterium tuberculosis, sputum examination.
Histopathological spectrum of upper gastrointestinal endoscopic biopsies

Histopathological spectrum of upper gastrointestinal endoscopic biopsies

Authors: Suspana Hirachand
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Abstract

Background: Upper gastrointestinal tract disorders are one of the most commonly encountered problems in the clinical practice. A variety of disorders can affect the upper gastrointestinal tract. Endoscopy, in combination with biopsy, plays an important role in the exact diagnosis for further management. Objectives: To determine the spectrum of histopathological lesions of upper gastrointestinal tract. Methods: A prospective study was conducted in the Department of Pathology, Kathmandu Medical College and Teaching Hospital, Nepal from January 2015 to December 2016 (2 years). Results: A total 243 endoscopic biopsies were evaluated. Out of which, 219 cases were from gastric, 15 were from esophagus and 9 were from duodenum. Among the gastric biopsies, 77 cases (35.16%) were chronic active gastritis and 27 cases (12.33%) were malignant. The most common malignancy was adenocarcinoma. Among the 15 oesophageal biopsies, 12 cases (80%) were of non-neoplastic and 3 cases (20%) were of neoplastic nature. The most common malignancy was squamous cell carcinoma. Among 9 cases of duodenum biopsies, all were non-neoplastic, of which chronic non-specific duodenitis (66.66%) was the commonest. Conclusion: Endoscopy is incomplete without histopathological examination of biopsy and so, the combinations of methods play an important role in diagnosis and management of upper gastrointestinal tract disorders.

Keywords: Endoscopic biopsy, histopathology, Non-neoplastic and neoplastic lesions of upper gastrointestinal tract.
Pentazocine induced ulcers a presentation of drug abuse

Pentazocine induced ulcers a presentation of drug abuse

Authors: Nidhi Shah
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Abstract

Pentazocine is an opioid analgesic introduced in 1967 which was purported to have no addictive potential. However, in the subsequent years, several reports have shown it to have abuse potential and cutaneous complications of pentazocine abuse have been reported.We report a case of cutaneous complications of pentazocine abuse in a 32-year-old male presenting with multiple ulcers.

Keywords:
Wernicke’s encephalopathy- a case report

Wernicke’s encephalopathy- a case report

Authors: Baikuntha Raj Adhikari
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Abstract

Wernicke‟s encephalopathy is a neuropsychiatric disorder characterized by acute onset, nystagmus and oculomotor abnormalities, and a confusional state. Chronic alcohol intake is still the most common reason. Wernicke‟s encephalopathy, if not recognized and treated, can become irreversible. Common findings in Magnetic Resonance Imaging (MRI) include: symmetric T2 Weighted Image (T2) hyperintensities in peri-aqueductal gray matter, dorsal medial thalamus and mammillary bodies. This case highlights neurological deficits, persistent memory and disorientation.

Keywords:

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