Kathmandu, Nepal
Kathmandu, Nepal

Time filter

Source Type

Pangeni R.,Patan Hospital | Kc R.K.,Oxfrod University Clinical Research Unit
Journal of Nepal Health Research Council | Year: 2014

Aluminium phosphide poisoning is one of the major causes of suicidal deaths in developing countries like Nepal. It is one of the common fumigant available and is within easy access. It is primarily used for crop protection. However, it is one of the misused chemicals to commit suicide. In this case, the patient had hyperglycaemia, atrial fibrillation, severe metabolic acidosis, and shock and yet survived. The key to her survival was aggressive supportive management. Therefore, knowing all the prognostic factors along with aggressive management can be life saving in conditions when no antidotes are available.


Shrestha S.,Patan Hospital | Adhikari N.,Patan Hospital | Rai B.K.,Patan Hospital | Shreepaili A.,Patan Hospital
Journal of the Nepal Medical Association | Year: 2010

Introduction: Bacterial infections account for a huge proportion of neonatal deaths worldwide. The problem of antibiotic resistance among common bacterial pathogens mainly the gram negative bacteria is emerging globally which is of more serious concern in developing countries like Nepal. Methods: A one year retrospective hospital based study was carried out to analyze the results of neonatal blood, cerebrospinal fl uid, urine, stool and surface cultures and to look into the sensitivity pattern of the commonly used antibiotics. Results: The positive yield of blood, urine, eye swab and CSF cultures were 19.56%, 38.5%, 60% and 0.36% respectively. The most common isolates in the blood culture were coagulase negative Staphylococcus, Acinetobacter, Enterobacter and non-haemolytic Streptococcus. A significant percent of the isolates were resistant to the first line antibiotics. Among the gram negative isolates more than 30% are resistant to cefotaxime and more than 50% are resistant to gentamicin. During the one year period we had Nursery outbreaks of methicillin resistant Staphylococcus aureus and Salmonella infections. With the help of environmental cultures we were able to trace the source and intervene appropriately. Conclusions: Continuous surveillance for antibiotic susceptibility, rational use of antibiotics and the strategy of antibiotic cycling can provide some answers to the emerging problem of antibiotic resistance.


Paudyal B.,Patan Hospital
Journal of Nepal Health Research Council | Year: 2010

Antiphospholipid syndrome is an autoimmune disease that presents with recurrent arteriovenous thrombosis, repeated pregnancy loss and elevated titres of antiphospholipid antibodies in the blood. It is a common cause of acquired thrombosis and can manifest within any part of the vascular tree. Inferior Venacava thrombosis at outset, however, is not a common manifestation of systemic lupus erythematosus associated-antiphospholipid syndrome particularly in children. Here, we present a 14-year old girl who developed antiphospholipid syndrome as a presenting manifestation of systemic lupus erythematosus.


Butterworth K.,Patan Hospital
Education for health (Abingdon, England) | Year: 2011

Experts suggest that distance learning continuing medical education (CME) is only effective when there is the opportunity for two-way discussion and reflection. The value of on-line mentoring has been mainly studied in the West. We examined the benefits and practical implications of providing mentors for distance learning CME in a low technology setting. We conducted a randomized controlled trial with qualitative and quantitative analysis of the impact of mentoring on completion of CME and quality of reflective learning. Twenty-six of 64 doctors completed all four CME modules. Non-completers were interviewed by telephone. Odds ratio analysis suggested that mentored doctors were three times more likely to complete their CME; however, this did not reach statistical significance (p = 0.07, 95% CI 0.89-10.57). Being in rural practice (p = 0.05) and younger in age (p = 0.005) were significantly associated with completion of CME. Mentored doctors seemed to show a higher quality of reflection on learning. Contact between mentors and mentees was difficult. Both mentors and mentees felt that optimal use of the system was not made. Despite mentors' perceptions that they had little impact, mentored doctors did appear to be more likely to complete CME. Work is needed to increase the quality of interpersonal and educational interaction between mentors and mentees.


Stoesser N.,University of Oxford | Sheppard A.E.,University of Oxford | Shakya M.,Patan Hospital | Sthapit B.,Patan Hospital | And 7 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2014

Objectives: There are limited data on Enterobacter cloacae outbreaks and fewer describing these in association with NDM-1. With whole-genome sequencing, we tested the hypothesis that a cluster of 16 E. cloacae bacteraemia cases in a Nepali neonatal unit represented a single clonal outbreak, using a wider set of epidemiologically unrelated clinical E. cloacae isolates for comparison. Methods: Forty-three isolates were analysed, including 23 E. cloacae and 3 Citrobacter sp. isolates obtained from blood cultures from 16 neonates over a 3 month period. These were compared with two contemporaneous community-associated drug-resistant isolates from adults, a unit soap dispenser isolate and a set of historical invasive isolates (n=14) from the same geographical locality. Results: There were two clear neonatal outbreaks and one isolated case in the unit. One outbreak was associated with an NDM-1 plasmid also identified in a historical community-associated strain. The smaller, second outbreak was likely associated with a contaminated soap dispenser. The two community-acquired adult cases and three sets of historical hospital-associated neonatal isolates represented four additional genetic clusters. Conclusions: E. cloacae infections in this context represent several different transmission networks, operating at the community/hospital and host strain/plasmid levels. Wide sampling frames and high-resolution typing methods are needed to describe the complex molecular epidemiology of E. cloacae outbreaks, which is not appropriately reflected by routine susceptibility phenotypes. Soap dispensers may represent a reservoir for E. cloacae and bacterial strains and plasmids may persist in hospitals and in the community for long periods, sporadically being involved in outbreaks of disease. © The Author 2014.


Butterworth K.,Patan Hospital | Hayes B.,National Academy of Medical science | Zimmerman M.,Nick Simons Institute
Education for Health: Change in Learning and Practice | Year: 2011

Context: Experts suggest that distance learning continuing medical education (CME) is only effective when there is the opportunity for two-way discussion and reflection. The value of on-line mentoring has been mainly studied in the West. Objectives: We examined the benefits and practical implications of providing mentors for distance learning CME in a low technology setting. Methods: We conducted a randomized controlled trial with qualitative and quantitative analysis of the impact of mentoring on completion of CME and quality of reflective learning. Results: Twenty-six of 64 doctors completed all four CME modules. Non-completers were interviewed by telephone. Odds ratio analysis suggested that mentored doctors were three times more likely to complete their CME; however, this did not reach statistical significance (p=0.07, 95% CI 0.89-10.57). Being in rural practice (p=0.05) and younger in age (p=0.005) were significantly associated with completion of CME. Mentored doctors seemed to show a higher quality of reflection on learning. Contact between mentors and mentees was difficult. Both mentors and mentees felt that optimal use of the system was not made. Discussion: Despite mentors' perceptions that they had little impact, mentored doctors did appear to be more likely to complete CME. Work is needed to increase the quality of interpersonal and educational interaction between mentors and mentees. © K Butterworth, B Hayes, M Zimmerman, 2011.


Shrestha S.R.,Patan Hospital | Yadav B.K.,Patan Hospital
Journal of the Nepal Medical Association | Year: 2010

Introduction: Still birth is a common adverse outcome of pregnancy, associated with many risk factors like prematurity, infection, birth injury, eclamptic disorders. Methods: A hospital based, retrospective study was conducted at Patan Hospital in the year 2064. The number of still births and their associated risk factors were assessed. Results: There were three thousand and five hundred and eighty eight deliveries. Among all deliveries, still birth cases were counted forty seven with a rate of 14 per thousand deliveries. The major risk factors were prematurity, low birth weight, fetal distress and maternal jaundice. Conclusions: Prematurity was the commonest risk factor for still birth.


Stoesser N.,University of Oxford | Giess A.,University of Oxford | Batty E.M.,Oxford Genetics | Sheppard A.E.,University of Oxford | And 17 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2014

NDM-producing Klebsiella pneumoniae strains represent major clinical and infection control challenges, particularly in re-source- limited settings with high rates of antimicrobial resistance. Determining whether transmission occurs at a gene, plasmid, or bacterial strain level and within hospital and/or the community has implications for monitoring and controlling spread. Whole-genome sequencing (WGS) is the highest-resolution typing method available for transmission epidemiology. We sequenced carbapenem-resistant K. pneumoniae isolates from 26 individuals involved in several infection case clusters in a Nepali neonatal unit and 68 other clinical Gram-negative isolates from a similar time frame, using Illumina and PacBio technologies. Within-outbreak chromosomal and closed-plasmid structures were generated and used as data set-specific references. Three temporally separated case clusters were caused by a single NDM K. pneumoniae strain with a conserved set of four plasmids, one being a 304,526-bp plasmid carrying blaNDM-1. The plasmids contained a large number of antimicrobial/heavy metal resistance and plasmid maintenance genes, which may have explained their persistence. No obvious environmental/human reservoir was found. There was no evidence of transmission of outbreak plasmids to other Gram-negative clinical isolates, although blaNDM variants were present in other isolates in different genetic contexts. WGS can effectively define complex antimicrobial resistance epidemiology. Wider sampling frames are required to contextualize outbreaks. Infection control may be effective in terminating outbreaks caused by particular strains, even in areas with widespread resistance, although this study could not demonstrate evidence supporting specific interventions. Larger, detailed studies are needed to characterize resistance genes, vectors, and host strains involved in disease, to enable effective intervention. © 2014 Stoesser et al.


Gangol R.,Patan Hospital | Maharjan D.,Kathmandu Medical College Teaching Hospital
Journal of the Nepal Medical Association | Year: 2010

Introduction: This study evaluates if addition of information leaflet after the usual verbal counseling improves the level of understanding of patients undergoing surgery about their disease, the need for surgery and its complications. Methods: It is a prospective observational case control study in which the control group receives verbal counseling only and the study group is given an information leaflet in addition to the verbal counseling after random allocation. An interviewer (surgical resident) interviews both the group using a set questionnaire. The answers are scored and added to give total marks. Results: There were total 114 patients undergoing gall bladder surgery with 59 in the study group and 55 in the control group. The level of understanding was good or satisfactory in 18.2 % in the control group compared to 76.3 % in the study group (P<0.000). This statistically significant improvement was seen even among illiterate group when analyzed separately. Conclusions: Addition of information leaflet significantly improves the patients understanding of their disease irrespective of their education status.


PubMed | Patan Hospital
Type: Journal Article | Journal: BMJ quality improvement reports | Year: 2016

Streptococcus pneumoniae infection is associated with high morbidity and mortality in low income countries. In Nepal, there is a high lung disease burden and incidence of pneumonia due to multiple factors including indoor air pollution, dust exposure, recurrent infections, and cigarette smoking. Despite the ready availability of effective pneumococcal vaccines (PNV), vaccine coverage rates remain suboptimal globally. Quality Improvement (QI) principles could be applied to improve compliance, but it is a virtually new technology in Nepal. This QI study for Patan Hospital sought to introduce the concept of QI there, to measure the baseline pneumococcal vaccination rate of qualifying adult patients discharged from the medical wards and to assess reasons for non-vaccination. QI interventions were instituted to improve this rate, measuring the effectiveness of QI methods to produce the desired outcomes using the Model for Improvement, Plan-Do-Study-Change (PDSA) methodology. In the three week baseline assessment, 2 out of 81 (2%) eligible patients recalled ever receiving a prior pneumococcal vaccine; 68 (84%) unvaccinated patients responded that they were not asked or were unaware of the PNV. After the QI interventions, the pneumococcal vaccination rate significantly increased to 42% (23/56, p<0.001). Post-intervention, the leading reason for non-vaccination was cost (20%, 11/56). Only 5 (9%) unvaccinated patients were not asked or were unaware of the PNV, a significant change in that process outcome from baseline (p<0.001). Quality improvement measures were effective in increasing pneumococcal vaccination rates, despite the limited familiarity with QI methods at this major teaching hospital. QI techniques may be useful in this and other efforts to improve quality in resource-limited settings, without great cost.

Loading Patan Hospital collaborators
Loading Patan Hospital collaborators