Introduction: Passage of meconium in utero is a dangerous sign for fetal outcome which influence the decision to deliver as well as the mode of delivery. Methods: This descriptive case control study was carried out in the department of Obstetrics and Gynaecology, Koshi Zonal Hospital from March 2006 to July 2006. A total of 50 women with meconium stained amniotic fluid( MSAF) were studied to identify maternal and fetal outcome and was compared with women with clear amniotic fluid. Results: Normal delivery was significantly higher (58%) in clear liquor group as compared to MSAF group (22%). Cesarean section was more common in MSAF group (66%) where as it was (38%) in the clear liquor group (p=0.005). Low Apgar scores of < 5 at one minute was seen in 48% of MSAF and 6% of clear liquor born babies (p<0.2). But at 5 minutes low Apgar score persisted in same 48% of MSAF babies whereas it was seen in 12% of clear liquor group (p<0.000). Among the babies born with MSAF 34% were referred to higher center compared to 6% in clear liquor babies (p=0.000). Four babies with thick MSAF and one baby with clear liquor had neonatal death (p=0.005). Conclusion: Mode of delivery and fetal outcome were adversely affected by the presence of thick meconium stained liquor as compared to clear liquor. Additional monitoring facilities e.g. cardiotocography (CTG) if available would reduce fetal distress and allow timely intervention in such cases.
Background: Breast problems are common among female patient attending general outpatient. Although the problem is expected to have significant morbidity, patients usually hide or present late for breast related problems in Nepal. Objective: To measure the pattern of breast diseases and its frequency and distribution in different age groups among patients attending general outpatient department at BPKIHS, Nepal. Methods: A crosssectional study was conducted in general outpatient department (GOPD) of B.P.Koirala Institute of Health Sciences (BPKIHS) during a period of six months. Women of all age groups presenting with breast problem were included. Clinical assessment, fine needle aspiration cytology (FNAC) and radiology were done. Mammography being unavailable at the hospital, ultrasonography was the preferred method of imaging. Results: Hundred cases of breast diseases were assessed. The benign breast disease (BBD) was the commonest finding (96%). Among BBD, fibroadenoma was the commonest (32%) followed by breast abscess (26%) and mastalgia (22%) including cyclic and non cyclic. The common age groups of involvement were 30-39 years for fibroadenoma, 20-29 years for breast abscess, 30-39 years for cyclic mastalgia, 40- 49 years for non cyclic mastalgia and 70-79 years for breast cancer. Conclusion: BBD is the most common breast problem in women. Among BBD, fibroadenoma was the most common. Health Renaissance, January-April 2013; Vol. 11 No.1; 33-37 DOI: http://dx.doi.org/10.3126/hren.v11i1.7599
Background: Head injury is a common presentation in emergency rooms .Management often is decided by time of trauma, clinical presentations and availability of facilities. Objective: To outline the general characteristics of head injury patients presenting to emergency. Methods: This is an observational (case series) study done in BPKIHS emergency room over a period of six months. All the acute head trauma cases presenting to the department of emergency, BPKIHS, were evaluated based on the semi closed clinical performa including major clinical indicators of intracranial trauma. Results: Among 255 head injury patients, males were more common. Fall was the commonest mode of injury resulting in 71.42% in those under ten years where as road traffic accidents was commonest in twenty to fifty yeras age group.23% reached the hospital after12 hours of injury. Loss of consciousness and vomiting were the commonest history.9.4% had consumed alcohol at presentation. Mild head injury was commonest (76.5%). 23% were discharged from emergency within 12 hours.14.9% underwent neurosurgical intervention. 187 of 255 underwent CT scan, 132 were abnormal. Contusions were commonest. For the normal CT scan the mean GCS score was 13.65 and for abnormal CT scans the mean GCS was 12.48 with SD of 2.8 and 3.4 respectively, p=0.025.
Introduction: Alvarado score is one of the scoring systems for diagnosis of appendicitis. Objective: To assess the sensitivity and specificity of clinical features used in Alvarado score. Subjects and methods: A prospective study of 171 patients with pain in the right iliac fossa presenting to emergency at BPKIHS, Dharan, Nepal was conducted. The sensitivity and specificity of clinical features and lab parameters used in Alvarado score were evaluated comparing with final diagnosis based on operative and histopathological findings. Results: The sensitivity of clinical parameter were: migrating right iliac fossa pain- 99.1%, anorexia- 45.7%, nausea/vomiting- 73.7%, right iliac fossa tenderness- 100%, fever- 24.5%, rebound tenderness in right iliac fossa- 89.8%, leucocytosis (>10,000)- 84.7% and a neutrophilic shift to the left (>75%)- 68.6%. The specificity of clinical parameters were: migrating right iliac fossa pain- 45.3%, anorexia- 86.7%, nausea/vomiting- 54.7%, right iliac fossa tenderness- 1.8%, fever- 81.1%, rebound tenderness in right iliac fossa- 64.1%, leucocytosis (>10,000)- 83.1% and a neutrophilic shift to the left (>75%)- 71.6%.Conclusion: Migrating right iliac fossa pain, right iliac fossa tenderness and rebound tenderness in right iliac fossa had a high sensitivity, leucocytosis (>10,000) had both high sensitivity and high specificity. Thus, in our set up, use of Alvarado score appears helpful for diagnosis of appendicitis Keywords: Alvarado score; sensitivity; specificityDOI: 10.3126/hren.v9i1.4355Health Renaissance, 2011: Vol.9 No.1:12-14
Objective: To see the role of methyleprednisolone succinate in the management of acute spinal cord injury. Methods: A randomized control trial was done including the patients with acute spinal cord injury. They were divided into age and gender matched two groups. Patients with presence of active infection, associated open fracture, those on long term steroid and those who did not give consent to participate in the trial were excluded. One group received methyleprednisolone succinate within 8 hours of injury and another group did not receive the drug. Both the groups were managed nonoperatively. The neurological status of the patients was assessed at presentation, once spinal shock was over, at 6 th week and 6 th month and after one year according to ASIA scoring. Frankel grading was also assessed in every follow up. Conclusion: Methylprednisolone succinct prevents secondary cord injury to a great extent and hence its administration within 8 hours of injury results in a better functional (motor and sensory) outcome.
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