Efficacy of intravenous Tramadol in prevention of catheter-related bladder discomfort in upper urinary tract surgery

Introductions: Catheter-related bladder discomfort (CRBD) is common in patients with urinary catheterization. Centrally acting intravenous opioid like Tramadol inhibits detrusor activity and incidence of CRBD. Present study aims to analyze efficacy of intravenous (IV) Tramadol in prevention of CRBD in patients undergoing upper urinary tract surgery. Methods: Adult patients undergoing elective open upper urinary tract surgeries at Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal, over a period of six months, requiring urinary catheterization were randomly divided into Control (C) and Tramadol (T) groups. After general anesthesia, patients in T-group received IV Tramadol 1.0 mg/kg and C-group received normal saline 30 minutes before extubation. In post-operative ward, CRBD was graded as mild, moderate or severe at 0, 1, 2 and 6 hours. Post-operative Ramsay sedation score and nausea vomiting were compared in two groups.  Results: There were total 70 patients, 35 in each of groups-T and C. Incidence of CRBD in T-group was significantly low compared to the C-group at all points of evaluation (p<0.05). Postoperative sedation score, analgesic requirement and nausea vomiting were not significantly different in two groups. Conclusions: Intravenous Tramadol administered before extubation in upper urinary tract surgery reduces the incidence of CRBD. Keywords: catheter related bladder discomfort (CRBD), detrusor activity, tramado

Does the male gender govern conversion of laparoscopic cholecystectomy?

Introductions: Laparoscopic cholecystectomy (LC) occasionally demands conversion to open cholecystectomy (OC) because of multiple risk factors. This study was conducted to find out whether male gender is a stand-alone risk factors for conversion of LC to OC. Methods: This was a comparative analysis of conversion of LC to OC in patients operated for symptomatic cholelithiasis during June 2017 to May 2018 at Bir hospital, National Academy of Medical Sciences, Kathmandu, Nepal. The patients were divided into two groups: male (group 1) and female (group 2). Study variables included gender, America Society of Anesthesiologist class, history of upper abdominal pain within six weeks prior to surgery, upper abdominal surgery, emergency department visit due to upper abdominal pain, adhesion of gallbladder to adjacent structure and body mass index. Binominal logistic regression analysis of risk factors for conversion was conducted. Odds ratio (95% CI) was calculated. The p value ≤ 0.05 was considered statistically significant. Results: Among 151 patients (male 39, female 112), 7 (4.6%, male 3 and female 4) had conversion from LC to OC. Male gender itself as an isolated risk factor had no significant association to conversion (p=0.303). There was no significant difference found for age, operating time and hospital stay. Previous emergency visit (p=0.020) and adhesion (p<0.030) were associated with conversion. Conclusions: Male gender had no significant association for conversion of LC to open. Previous emergency visit due to upper abdominal pain and adhesion of gallbladder were associated risk factors for conversion. Keywords: conversion, laparoscopic cholecystectomy, male gende

Efficacy of prophylactic intravenous ondansetron for attenuation of pain on propofol injection

Introductions: Propofol is a popular intravenous anesthetic agent. One disadvantage of propofol is pain on its injection which can be excruciating at times. Various agents and methods have been tried to attenuate this unpleasant effect. Ondansetron, primarily used as an antiemetic has also been studied to reduce it.   Methods: This randomized, prospective, double-blinded, placebo-controlled study was conducted on patients of either sex, American Society of Anesthesiologists (ASA) physical status I & II, undergoing elective surgeries requiring general anesthesia. The patients were randomly divided into ondansetron and placebo groups. Manual occlusion of venous drainage was done at mid‑arm by an assistant for 1 minute after which 25% of the calculated dose (2 mg/kg) of propofol (1% w/v in lipid base) was injected. Patients were asked by a blinded investigator to score the pain on injection of propofol on 4-point scale: 0=no pain, 1=mild pain, 2=moderate pain, 3=severe pain and compared in between two groups. The p<0.05 was considered significant. Results: There were 96 adult patients, 48 in each group of Ondansetron placebo. Pain on propofol injection was found significantly higher in the placebo group compared to the ondansetron group. (62.5% vs 35.4%). Most of the patients in the ondansetron group had mild pain only, whereas, a significant number of patients in the placebo group had higher degrees of pain on propofol injection. Conclusions: Prophylactic intravenous 4 mg ondansetron is a safe and simple method of attenuating pain on propofol injection. Keywords: general anesthesia, ondansetron, pain on propofol injectio

Primary splenic hydatidosis

Hydatid disease is becoming a public health problem in Nepal. Majority of the patients have hydatidosis of liver and lungs. Primary splenic hydatidosis is rare. The clinical presentation of primary splenic hydatidosis is similar to other cystic splenic pathologies. It presents with slow growing, dull aching left upper quadrant abdominal lump. Ultrasonography and computed tomography scans are helpful in diagnosis. We report a 36 years lady with primary splenic hydatidosis, who successfully underwent open en bloc resection of hydatid cyst along with total splenectomy. Keywords:  primary splenic hydatidosis, splenic hydatid cys

Efficacy of dexamethasone in reducing the incidence of postoperative sore throat: a double blind randomized study

Introductions: Postoperative sore throat (POST) is a commonly seen adverse event after general anesthesia with endotracheal intubation. Dexamethasone, a potent corticosteroid with anti-inflammatory action is the most popular steroid studied in this regard with positive results. Methods: This randomized, prospective, double-blinded, placebo-controlled study was conducted on one hundred and ten adult patients of either sex, undergoing elective surgeries requiring endotracheal tube intubation. After obtaining written informed consent, they were randomly divided into Control (A, n=55) and Dexamethasone (B, n=55) groups and received either an injection of Dexamethasone (Group B) 8 mg intravenously or an equivalent volume of Normal Saline (Group A) just before entering the operating theatre. All the patients received a similar anesthesia with endotracheal tube intubation and at the end of surgery, extubated and transferred to the post-anesthesia care unit. The incidence and severity of sore throat were assessed at 1, 6 and 24 hours post-extubation. Severity of sore throat were graded on a 4 point scale, p <0.05 was considered significant. Results: Incidence of POST in Dexamethasone group was found significantly low compared to the control group up to six hours (p<0.05) but was comparable at 24 hours post extubation. Severity of POST in the study group was of lower grade in compare to control group. Conclusions: Prophylactic intravenous Dexamethasone 8 mg administered to patients undergoing elective surgeries requiring endotracheal tube intubation significantly reduces the incidence and severity of POST up to six hours post-extubation. Keywords: dexamethasone, general anesthesia, post-operative sore throat (POST

Pattern of Cancer in Nepal from 2003 to 2011

Correction: On 15th January 2017, the authors Sunil Kumar Sah and Naval Kishor Yadav were added to the author list.Cancer is global burden of disease in developed and developing countries. It is one of the main causes of death. The environmental factor and life styles are major causes of cancer.This hospital based retrospective study was carried out using data retrieved from the register maintained at seven cancer centers. The most common basis of diagnosis were microscopic (histopathological and cytopathological examination). The diagnosis was also based on clinical examination, radiological examination, endoscopy, biochemical and immunological tests.Most of the cancer cases were diagnosed at BPKMCH (23908) followed by BPKIHS (9668) and BH (5959) and few cases from KCH (518) in 2003 to 2011. The total number of cancer cases were increasing from 2003 to 2011 and it become double in 2011. Out of 75 district of Nepal, more number of cancer cases was found in Kathmandu, Sunsari, Morang, Chitwan, Lalitpur, Jhapa, Kaski, Nawalparasi, Rupendehi and Kavrepalchowk in 2010. Similarly, in 2011 more number of cancer cases was found in Kathmandu, Morang, Jhapa, Sunsari, Chitwan, Lalitpur, Rupendehi, Kaski, Saptari, Bhaktapur. Lung cancer was the common cancer and similarly, other prevalent cancers were cervical, breast, stomach, ovarian and colo-rectum cancer in 2003 to 2011. The common cancers were lung, cervical, breast, stomach, ovarian and colo-rectum. The number of patients is increasing, which may be due to change in life style and lack of education

PREVALENCE OF HBV INFECTION AMONG THE HEALTHY NEPALESE MALES: A SEROLOGICAL SURVEY

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Leishmania donovani persistence and circulation causing cutaneous leishmaniasis in unusual-foci of Nepal

Abstract Cutaneous leishmaniasis cases have increased dramatically in recent years in Nepal. The study offers molecular identification of the Leishmania species using 40 patient’s aspiration biopsy samples, targeting markers kinetoplast minicircle DNA (kDNA) and internal transcribed spacer-1 (ITS1). Among molecularly diagnosed 22 cutaneous leishmaniasis cases, L. donovani complex was identified in 13 instances and L. major in 9 cases. The ITS1 PCR was positive in 12 of the positive nested- kDNA PCR cases (12/22), confirming L. donovani complex in seven of the cases and L. major in five of the cases. In addition, the study conclude that concurrent occurrence of atypical cutaneous infections caused by L. donovani parasite in 59.1% of cases and typical cutaneous infections caused by L. major parasite in 40.9% of cases. A Phylogentic analaysis showed that the detected L. donovani species present null genetic distances from seven references of L. donovani, but slight differences between ITS1 sequences and not grouped into a significant monophyletic cluster

The role of care-seeking delays in Intrauterine Fetal Deaths among ‘near-miss’ women in Herat, Afghanistan

Background: Many pregnant women in resource-poor countries seek care only after developing severe complications during childbirth at home and often reach health facilities in moribund conditions. The objectives were to (i) investigate the association between care-seeking duration and fetal survival at admission; and (ii) assess the significance of care-seeking duration in relation to other determinants. Methods: Data were analysed for 266 women who were pregnant with a singleton and admitted in life-threatening conditions to the maternity ward of Herat Regional Hospital in Afghanistan from February 2007 to January 2008. Information about the women's care-seeking durations, social and financial resources, reproductive factors, household economic status and household types were collected during interviews with the women and their husbands. Information about fetal heartbeats at admission was extracted from the women's medical records. Results: Fifty-four per cent of the women had a decision delay lasting 3 h or more; 69% had a transport delay lasting 3 h or more. Multivariable logistic regression analyses suggest that a decision delay lasting an hour or more increased the odds of fetal death by 6.6 (95% confidence interval [CI] 1.6, 26.3) compared with a delay less than 1 h. A woman's lack of financial autonomy and a distance from her natal home increased the odds of fetal death by 3.1 [95% CI 1.1, 8.4] and 2.5 [95% CI 1.0, 6.3] respectively. Conclusion: An integrated approach to improving fetal and maternal health from pre-pregnancy through childbirth (including increasing women's social and financial resources) is crucial particularly where senior family members act as gatekeepers to women's access to health care