Chaturvedi A.,AIIMS |
Journal of Anaesthesiology Clinical Pharmacology | Year: 2010
Background: Perioperative shivering is a common problem during anaesthesia. Apart from physical warming many drugs have also been used for prevention of shivering. Ketamine has been used for preventing shivering during anaesthesia in doses of 0.5 to 0.75mg kg1, but even these doses causes too much sedation and hallucination. Ondansetron (8 mg) has been recently evaluated for its perioperative antishivering effect in patients under anaethesia. Present study was conducted to evaluate the efficacy and safety of low dose Ketamine (0.25mg kg 1) and Ondansetron (4 mg) for prevention of shivering during spinal anaesthesia. Patients & Methods: Total 120 patients undergoing lower abdominal surgery under spinal anaesthesia were included. 3ml of hyperbaric bupivacaine 0.5% was used for spinal anaesthesia. After intrathecal injection, the patients were randomly divided in 3 groups of 40 each who received Ketamine 0.25mg kg 1 or Ondansetron 4mg IV or Saline. Vitals, temperature and shivering scores were recorded every 5 minutes. Side effects i.e. hypotension, nausea and vomiting, sedation and hallucinations were also recorded. Results: Fall in temperature was more significant in saline and ondansetron group (gp) than in ketamine group at all time interval. Out of 40 patients, shivering was maximum & seen in 17 patients (42.50%) in saline gp, 4 patients (10%) in ondansetron gp and in only 1 patient (2.5%) in ketamine gp. Odd ratio of ketamine, ondansetron and saline are 1, 4.33 and 28.33 respectively which means that shivering in saline gp was 28.83 times higher than ketamine gp and 6.65 times higher than in ondansetron .Shivering rate was 4.33 times higher in ondansetron gp than in ketamine gp. Hypotension was lowest in ketamine gp (10%) in comparison to ondansetron gp (22.5%) and saline gp. (20%). Mild sedation was seen in almost all (95%) patients in ketamine gp, Conclusion: Prophylactic low dose ketamine (0.25mg kg1) and Ondansetron (4mg) significantly decreased shivering in patients undergoing spinal anaesthesia without significant side effects.
Kathmandu University Medical Journal | Year: 2014
New onset diabetes mellitus after transplantation (NODAT) is a well known complication following solid organ transplantation and has been reported to occur in 4% to 25% of renal transplant recipients, 2.5% to 25% of liver transplant recipients, hepatitis C virus (HCV) infection between 40% and 60% and 2% to 53% of all solid organ transplants. This variation in the reported incidence may be because of lack of a universal agreement on the definition of NODAT, the duration of followup, and the presence of modifiable and non-modifiable risks factors. Moreover, reduced patient survival and accelerated graft loss have been reported with NODAT. In our country also there is increasing in number of kidney transplants patients and along with that there is chance of development of NODA. It is better to detect the NODATS early. So in this article I tried to presents an overview of the literature on the current diagnostic criteria for NODAT and discuss suggested risk factors for the development of NODAT, its potential pathogenic mechanisms, and its impact on post-transplant outcomes after solid organ transplantation. © 2014, Kathmandu University. All rights reserved.
Bhattarai S.,Bp Koirala Institute Of Health Science Bpkihs |
Kc S.,BPKIHS |
Pradhan P.M.S.,Patan Academy of Health science |
Rijal S.,Internal Medicine
BMC Research Notes | Year: 2014
Background: Hepatitis B is a dreadful infectious disease and a major global health problem. Health-care workers including clinical students are more vulnerable to such infections and non-sterile occupational exposures as their daily activities are closely related to patient's blood and body fluids. Methods: A descriptive cross sectional study was conducted at B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal from July till October 2012. All medical, dental and nursing students were surveyed for their Hepatitis B vaccination status and only those students in clinical rotations were surveyed for the prevalence and pattern of Needle-stick and Sharps-related Injuries (NSSIs) using a pre-tested, semi-structured, self-administered questionnaire. Descriptive and inferential statistics was used to analyze the data. Results: Majority (86.5%) of students were vaccinated against Hepatitis B of which 83.7% had completed full doses. Among non-vaccinated students, 43.2% reported the main reason for non-vaccination as lack of vaccination programs. Out of 210 respondents from clinical rotations, 90 students (42.8%) reported at least one injury. Among those injured, two students reported exposure to Human immunodeficiency virus (HIV) positive cases and four to Hepatitis B virus (HBV) positive cases. Most of the injuries (44%) occurred during Internal Medicine rotation and the most common sharp involved (56.3%) was Hypodermic needle. Most injuries (35.6%) occurred while manipulating needle into patients. Following exposure, only 11.4% took Post exposure prophylaxis and 19.54% went for a Post-exposure serology test. Conclusions: Needle-stick and Sharps-related Injuries occur frequently among health care workers including trainee students keeping them at high risk for acquiring dreadful infections like HBV, HCV and HIV. They need to be protected from unwarranted hazards by adopting routine Hepatitis B vaccination programs and by reinforcing education regarding universal precautions.
Nepal Medical College journal : NMCJ | Year: 2010
Eclampsia is one of the leading causes of maternal mortality and morbidity around the world. Magnesium sulphate is used as primary agent in the treatment of seizure in eclampsia. Its dosage and frequent painful injection makes it a difficult drug for the patient. This study was carried out in one of the biggest referral centre of Nepal to study the suitability of different dosage schedule for our patient. A randomized controlled trial was carried out in the Obstetric Unit of BP Koirala Institute of Health Science (BPKIHS) over the span of 1.5 years. A total of 80 eclamptic women were randomized to receive either standard Pritchard Regimen (loading and maintenance) or Loading dose of magnesium sulphate. Both groups were evaluated for recurrence of seizures and outcomes. There were no recurrent seizures in standard regimen group. There were 2 patients with recurrent seizure in loading dose group. (p=0.184) Loading dose of magnesium sulphate is a good alternative for standard Pritchard regimen. It avoids multiple painful injections of magnesium Sulphate.
Bajaj B.K.,PGIMER |
Chaudhary S.,BPKIHS |
Journal of Neurosciences in Rural Practice | Year: 2013
Background: The understanding and management of neurological disorders is undergoing revolutionary changes over the last three decades in the background of ever increasing advances in medical technologies, diagnostic techniques, therapeutic processes and, molecular and genetic medicine. The fruits of these advances can reach patients only if the psychosocial hurdles in their delivery are identified, acknowledged and addressed. Aim: To explore the beliefs and practices of patients with neurological disorders in a tertiary care center in the eastern Nepal. Materials and Methods: One hundred patients attending neurology/medicine outpatient for neurological disorders were interviewed about their beliefs regarding the triggering factors, causation and treatment-seeking behavior particularly from traditional healers. Result: Of the 100 patients (49 males, 51 females) recruited in the study, 51% expressed having ′no idea′ about their illness. Only 20% patients gave medically congruent explanation for their illness. Psychological factors were attributed as triggering factors by 16% of patients, of which two-thirds were females. Chance, destiny and ′jadu tona′ topped the list of triggering factors. Forty-four percent patients had sought help of traditional faith healers (′Dhami Jhakri′) before seeking medical help. Traditional faith healers were approached by patients irrespective of their educational background. Fifty-nine percent of patients who first sought traditional faith healers, believed in ′jadu-tona′. Of those interviewed, 16% were planning to go to a faith healer in near future. Conclusion: The beliefs of patients with neurological disorders frequently do not conform to current medical opinion. There is need for greater communication and education of patients by their treating physicians.