Background:Acute poisoning is a common health-care problem requiring admission in the intensive care unit (ICU) in the developing countries. The study was conducted to assess the epidemiological parameters of acute poisoning and factors affecting clinical course and outcome of the patients in ICU in the eastern part of Nepal.Methodology:This was a prospective observational study conducted at ICU of tertiary care hospital in the eastern part of Nepal for the duration of 2 years. All the acute poisoning cases admitted in the ICU were studied for epidemiological profiles, poisoning characteristics, and various clinical factors affecting the outcome of the patients.Results:Eighty-five patients with acute poisoning were included in the study. Suicidal attempt leading to acute poisoning was seen in majority of the young population. Majority of the poisoning was due to the organophosphorous compounds (43.5%). Patients with organophosphorous poisoning had a significantly longer duration of ICU stay (P = 0.020). The survival of the patients was significantly affected by age, duration of presentation to the hospital, Glasgow Coma Scale, Sequential Organ Failure Assessment score, need for mechanical ventilation, duration of ICU stay, hepatic failure, coagulopathy, and need for vasoactive drugs (P < 0.05). The independent predictors of mortality observed in the study were age, delayed presentation to the hospital, hepatic failure, and need for mechanical ventilation.Conclusion:Organophosphorous poisoning was the most common acute poisoning in young population leading to the ICU admission. Older age, delayed initiation of the resuscitative measures, need for mechanical ventilation, and hepatic failure significantly affected the mortality.
Introduction:The clavicle has dual nerve supply from the brachial plexus and cervical plexus. The interscalene brachial plexus block combined with superior cervical plexus block is frequently used for the clavicle surgery. This study was conducted to compare ineterscalene approach with the supraclavicular approach for brachial plexus block used for clavicle surgery Methodology:This was prospective comparative study conducted for two years in tertiary care hospital. Sixty patients with clavicle fracture with ASA I and II were randomly divided into two equal groups; ISBPB (interscalene approach) and SCBPB (supraclavicular approach). Both of these blocks were combined with superior cervical plexus block. Ultrasound was used to perform all the blocks. Primary outcome for the comparison was block characteristics, which included sensory and motor block onset, duration, and block satisfaction. The secondary variables used for comparison were analgesic properties and complications. Results: Supraclavicular brachial plexus had rapid onset of sensory and motor block and was statistically significant (P<0.05) as compared to interscalene approach. Similarly, SCBPB had significantly longer duration of sensory block (P=0.003). The duration of motor block was comparable between the blocks. The intraoperative pain score (VAS), requirement of rescue analgesia with in 24 hours of surgery and complications related with the procedures were comparable between the two groups. Majority of the patients were satisfied with either of the approach for brachial plexus block. Conclusion: Supraclavicular brachial plexus block combined with superior cervical plexus block provided equally effective and adequate anesthesia and analgesia for clavicle surgery with comparable complications as compared to interscalene approach.
Introduction: Stroke is life threatening & debilitating neurological disease, defined as focal neurological deficit of sudden onset lasting >24 hours & vascular in origin. Significant association between ischemic type of stroke with carotid artery disease seen, more prevalent with carotid artery stenosis. Objectives: This study was done to show association between extracranial carotid artery disease & cerebrovascular accidents (CVAs) with the help of Color Doppler Sonography (CDS). The association between carotid artery disease with associated risk factors were also assessed. Methodology: In this ethically approved prospective study, carotid CDS was done in 79 consecutive patients with diagnosis of acute ischemic stroke (AIS). The various parameters studied included peak systolic velocity (PSV) of internal carotid artery (ICA) & common carotid artery (CCA), ICA/CCA PSV ratio & plaque characteristics. The data collected was analyzed with appropriate statistical test of significance was calculated. Results: Total 79 patients with AIS included out of which 53 were males & 26 were females. The most common presenting complains were hemiparesis (30.4%) & most commonly associated risk factors included hypertension (62.02%). Right sided strokes were most common (44.3%) & middle cerebral artery was most commonly involved vascular territory. Significant stenosis (≥50%) of carotid artery was seen in 27 patients with ICA most common site (45.8%) for plaque formation. Bilateral carotid artery involvement (52.1%) with hypoechoic echotexture of atheromatous plaques (46.6%) was most responsible for significant stenosis & increased intima media thickness. Increased value of PSV & EDV was seen in the stenotic area in the proportion of stenosis with increased PSV ICA/CCA ratio of more than three indicates >60% stenosis. Conclusion: The present study showed well documented role of carotid doppler in detection of site & extent of carotid artery stenosis due to atheromatous plaques of various characteristics playing critical role in thromboembolic phenomenon responsible for development of stroke.
Introduction: Knowledge and awareness of sepsis among various health care professionals is essential for prompt diagnosis and appropriate initial resuscitation and management of patient with sepsis. Objective: To assess and compare the knowledge and awareness of sepsis among health care professionals working at Birat Medical College and Teaching Hospital. Methodology This was a questionnaire-based survey with comparative study in 200 health care professionals conducted at Birat Medical College and Teaching Hospital from July– September, 2019. Questions were designed to assess the knowledge on diagnosis, initial resuscitation and management of sepsis. The knowledge level of the participants was assessed with scoring system as good, average and poor which was finally compared between the various health care professionals. Result Out of 200, only 180 health care professionals were included for statistical analysis. While assessing the knowledge on diagnosis of sepsis, 55.6% consultant doctors, 42.8% medical officers and 21.5% nursing/paramedics answered correctly on an average. Similarly, 51.7 % consultant doctors, 33.7% medical officers and 26.6% nursing/ paramedics gave correct answers while assessing knowledge on initial resuscitation and management. The nursing/paramedics had comparatively lower knowledge level on sepsis than the doctors. Around 31.7%, 51.2% and 17% of health care professionals working in Emergency, ICU and Anesthesiology departments had good, average and poor knowledge on sepsis respectively as compared to 14.2%, 28.5% and 57.1% of participants working in other departments. Conclusion: The nursing/paramedics had lower knowledge level on sepsis as compared to the doctors while health care professionals working in Emergency,ICU and Anesthesiology departments had better knowledge on sepsis as compared to staffs working in other departments.
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