BackgroundThere are many other reasons besides fracture for which a patient could potentially be admitted to orthopaedic inpatient care. The goal of this retrospective review was to analyze the spectrum of orthopaedic admissions to a tertiary level teaching hospital of Nepal. Material & MethodsThis retrospective descriptive epidemiological study was based on patients admitted for orthopaedic inpatient care at a tertiary level health care center of eastern Nepal. Registry data of 1 year was used to analyze the spectrum of orthopaedic admissions. ResultsMale admission outnumbered females with a ratio of 1.82:1. Trauma accounted to majority of Orthopaedic admissions (67.9%) and Infection lied second in order (12.4%). Upper and Lower limb fractures (with right sided dominance) contributed to highest numbers of trauma respectively. Incidence of closed to open fracture was 5.45:1. More than half of trauma and fractures involved the 10 -39 years age group with predominance in 10-19 years. Fracture incidence was higher among men than women until 59 years of age after which the gender ratio reversed. Conclusions:Leading cause for orthopaedic admission was Trauma accounting more than 2/3 of the total. Biasness in gender admission reflects true picture of male dominated society. Upper limb injury, right side and closed fractures were dominating. Sexual dimorphism was apparent in fractures which may be due to higher rates of Osteoporotic fractures in elderly females.

Subacromial-subdeltoid bursitis of a shoulder with rice bodies is relatively uncommon. The understanding of the pathogenesis of rice body formation is yet approximate only but some clinical conditions like rheumatoid arthritis, tuberculous arthritis, seronegative inflammatory arthritis, juvenile rheumatoid arthritis and osteoarthritis are related to it. We describe a case of a 44 years old female with subacromialsubdeltoid bursitis of her right shoulder with numerous rice bodies' formation as a presenting feature of rheumatoid arthritis. She underwent subacromial and subdeltoid bursectomy with the removal of rice bodies and had immediate improvement of symptoms.

Introduction: This study aimed to analyze the average length of stay of all inpatients in the department of Orthopaedics and to compare the variations in hospital stay between age, gender, traumatic and non-traumatic co-morbidities and modality of payment. Methods: This hospital based retrospective descriptive epidemiological study was based on patients discharged from a tertiary level health care center of eastern Nepal. Registry data of 1 year was used to calculate length of stay and analyze the variations. Results: Average length of stay was 10.5 days. It was 10.7 days for males and 10.1 days for females. It was 10.12 days for patients paying themselves for their treatment whereas 14.98 days for patients receiving reimbursement (third party payment). Conclusions: Average length of stay was more in elderly and patients of trauma (longest in pelvis injury). It was 1.5 times longer for patients receiving reimbursement for treatment.  Keywords: length of stay; non-traumatic co-morbidities; trauma; third party payment.

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Background: Pharmacovigilance has evolved as an important tool for dealing with Adverse Drug Reactions (ADRs) both in pre-marketing and post-marketing scenario. Underreporting of ADRs at our Adverse drug reaction Monitoring Centre (AMC) led us to conduct this study to assess Knowledge, Attitude and Practice (KAP) of the practicing clinicians at our tertiary care Pt. J.N.M. Medical College associated Dr. B.R.A.M. Hospital, Raipur, Chhattisgarh, India, towards ADRs reporting.Methods: This was a cross-sectional study using pretested questionnaires consisting of 29 questions related to KAP of the practicing clinicians at Pt. J.N.M. Medical College associated Dr. B.R.A.M.  Hospital, Raipur towards ADRs reporting. The percentage of responders for each question was calculated. All statistical analysis was performed in Microsoft Office Excel 2007.Results: Out of 135 questionnaires distributed only 100 were considered for analysis, so the overall response rate was 74.07%. We calculated the result from the 100 responders. Overall 77% responders were aware of existence of ADR monitoring system in India, while only 40% were aware of its existence at their hospital. Only 8% responders had reported ADRs to the National Pharmacovigilance Centre and 10% to the Adverse drug reaction Monitoring Centre (AMC) at their hospital. Lack of knowledge about where, how and whom to report ADRs, lack of time, inability to decide what to report (known or unknown ADRs) and unavailability of ADR reporting form were the important factors discouraging them reporting ADRs.Conclusions: Creating awareness regarding ADR reporting through CMEs among practicing clinicians and early sensitization at medical undergraduate level for medical students may improve the current ADR reporting rate.

Background: Empirically chosen antibiotics based on the local resistance pattern of uropathogens remain the principle treatment of urinary tract infections (UTI).Methods: Antibiogram of most frequent uropathogen was determined. Based on the antibiogram result, authors compared effectiveness of drugs recommended for UTI by National centre for disease control (NCDC), India, and assessed age and gender based variability in the effectiveness of these drugs.Results: 1278 urine samples were accounted, of which 405 samples showed significant growth. E. coli was the most common uropathogen (n=146, 36%) followed by enterococcus species (31%) and Klebsiella pneumoniae (10%). Using McNemar’s test authors found that nitrofurantoin (90% sensitivity) was statistically the most effective drug among drugs recommended by NCDC for uncomplicated cystitis. Furthermore, authors used Fisher’s exact test on adults and paediatrics and found that significant difference in effectiveness was observed for nitrofurantoin (p-value <0.001) and cotrimoxazole (p-value 0.034). Using logistic regression, authors found that with age, effectiveness of ciprofloxacin and cotrimoxazole deteriorate significantly (p-value 0.021 and 0.002 respectively). Additionally, authors observed that cotrimoxazole has significantly better efficacy in males compared to females (p-value 0.022).Conclusions: In accordance with present study, nitrofurantoin can be used as first line treatment for uncomplicated cystitis. Age and gender should be considered while prescribing empirical treatment for UTI. Periodic surveillance should be carried out to identify the on-going pattern of antibiogram to update the guideline for empirical therapy.

Introduction Surgical site infection (SSI) is the commonest preventable health care–associated infection among postoperative cases. Several guidelines are available for surgical antimicrobial prophylaxis (SAP) and other measures which prevent SSI. National Center for Disease Control (NCDC), India, has also provided a guideline for prevention of SSI in 2016. In this study we have compared the NCDC, India, guideline with WHO (World health organization) and American Society of Health System Pharmacists (ASHP) guidelines. The timing of antimicrobial agent administration is the only parameter which is included in all the three guidelines. As per NCDC and ASHP it should be within 60 minutes of incision while as per WHO it is within 120 minutes of incision. Material and Methods  This was a prospective observational study—104 patients undergoing surgery in general surgical ward between January 2016 and June 2017 were included in this study. The NCDC guideline was compared with WHO and ASHP guidelines. Real data comparison was done for those parameters which were included in all the three guidelines. Statistical Analysis Data were analyzed using descriptive methods and chi-square test. Results None of the patients in our study received SAP within 60 minutes of incision. In 70% cases it was administered within 2 hours of incision and in the remaining 30% it was administered after more than 2 hours. There was no significant difference in the incidence of SSI among these two groups. Conclusion NCDC SAP guideline helps in rational use of antimicrobials. Increasing the duration for SAP may be added in the NCDC guidelines. Inclusion of certain additional parameters like weight-based doses and consideration for other comorbidities will help in patient- and procedure-specific SAP. Antimicrobial stewardship should be encouraged in all the hospitals and should follow local antimicrobial resistance pattern. This will assist in therapy decision, policy making, and evidence-based treatment.

A substantial proportion of women with gonococcal infection are asymptomatic butsymptomatic in male. Thus in developing countries, problem arises in active casedetection where laboratory facilities for testing are limited. During the study, thediagnostic validity of the hierarchial clinical algorithm as well as that of a non-hierarchial scoring system were assessed among 102 patient visiting at Dermatology/Venerology (DV) and Gynecology(Gynae) out patient department(OPD) of TribhuvanUniversity Teaching Hospital (TUTH), Kathmandu, Nepal. In the study period of 8months, May –December 1999, 9 (8.82%) were infected with N. gonorrhoea& 2(1.96%)with Gram Negative intracellular diplococci. Age group of 20-30 years were found tobe more infected followed by age groups 30-40 years & 40-50 years ( P< 0.10). Themale were found to be predominantly infected than female and married were foundto be more infected than unmarried. Among the infected people most of them hadsecondary level education and least of them had higher level education. Service holderswere found to be more infected than farmers, drivers & others. But male serviceholders & housewives were equally infected.Antimicrobial susceptibility of N. gonorrhoeashowed 100% susceptible to Ceftriaxone,followed by Ciprofloxacin (88.88%) whereas 22.22% resistant to Tetracycline, 55.55%to Cotrimoxazole and 55.55% to Penicillin. Among isolates, 33.33% were ß- lactamaseproducer. Co-micro organisms like Candida sppand Staphylococcus sppwere alsoobserved.Key Words: Gonococcal infection; Outpatient department, Antimicrobial susceptibility, Nepal.