Background: Poisoning is one of the leading causes of morbidity and mortality in Nepal and also a major public health problem worldwide. It needs specific epidemiological surveillance to determine the extent and pattern of poisoning of a place, and to take preventive measures. Hence this study is aimed to explore the demographic, etiological, and clinical characteristics of poisoning cases of MMTH and to assess the effect of variables such as age, sex, and agent of poisoning frequency.Methods: A retrospective, descriptive, unicentric and semi-quantitative study was conducted in a year of 2074 at Manmohan memorial teaching hospital after institution review committee approval in customised data collection form. Data from Baishakh 2070 (April 2013) to Kartik 2074 (October 2017) were reviewed. The data was entered in SPSS 16 version for analysis.Result: Among 144 patients, poisoning was common among people from the age group of 15-25 years and 26-40 years. The females were more vulnerable than male. The male to female ratio was 1:1.4. Married females (32%) and married males (31%) were more vulnerable than unmarried ones. Poisoning incidence was found more during night (40.3%) and midnight (18.80%). 81.2% of poisoning cases were found with suicidal intention. Organophosphorous poisoning was abundant with 75 cases.Conclusion: This study reveals that OP poisoning is most common for self-harm with females and young at more risk. Therefore, awareness among youths is a must.JMMIHS.2018;4(1):55-65
Background: There is increased interest on cost utilisation of psychotropic drugs in recent years. Objective of this study was to perform cost and generic prescription analysis of psychotropics in psychiatric outpatient department at tertiary care teaching hospital.Methods: This was cross sectional, observational and uni-centric study of 6 month duration which was performed at Psychiatric Outpatient Department at one of the tertiary care hospital, Karnataka India. Cost analysis of prescriptions containing at least one psychotropic drug was performed based on cost/defined daily dose method from hospital perspective. Direct drug cost of psychiatric illness per day and pattern of generic prescribing were also studied. The data was analysed & summarised as mean, frequency, percentage (%), standard deviation (SD), and chi square test( at 95% confidence level) as appropriate using Microsoft excel and Graph Pad InStat statistical software.Results: We observed 15 different types of psychotropics among 101 prescriptions that was reviewed. Most expensive psychotropic was Divalproex whereas Clonazepam was the cheapest one. Most money was spent by hospital on Sertraline (24.19%) and least on Lithium (1.92%). Most expensive therapeutic categories were antidepressants (32.39%) followed by mood stabilisers (27.06%), antipsychotics (24.77%) and sedative/hypnotics (15.76%). Among different antidepressants; Amitriptyline was cheaper option and Mirtazepine was expensive. Likewise Quetiapine was expensive and Risperidone was cheaper among antipsychotics. Zolpidem and Divalproex were expensive sedative/hypnotic and mood stabilisers respectfully. Most expensive psychiatric illness was found to be bipolar disorder (Rs 20.53±12.84). 19 out of 147 were prescribed with generic names.Conclusion: The cost burden due to psychiatric drugs is high. Expensive and cheaper psychotropic for psychiatric OPD were Divalproex and Clonazepam respectively. Expensive therapeutic category was found to be antidepressants. From hospital perspective much money was spent on Sertraline and less on Lithium respectively. Similarly high cost of illness was observed in bipolar disorder and less in dissociative disorder. Generic name prescribing is very less.JMMIHS.2018;4(1):43-54
Introduction: Pediatric injury is one of the common emergencies encountered in the emergency department. It is emerging as leading cause of death and disabilities in children. This study aims to analyze the patterns of pediatric injury based on age group, gender, mode, type, place of injury and its outcome. Methods: This is a descriptive cross sectional study conducted in Emergency Department of KIST Medical College and Teaching Hospital from 1st May 2019 to 30th July 2019. A total of 110 patients aged 15 years and below and with history of trauma were included in this study. Results: A hundred and ten pediatric patients presented to emergency with injuries. Majority of pediatric trauma cases belonged to age group 1-5 years (38.2%, n=42) and more frequent in male children (66.4%, n=73) .In both gender, male (45.5%, n=50) and female (17.3%, n=19); fall was most common mode of injury followed by accidental cut injury (7.3%,n=8) in male and road traffic accident (6.4%,n=7) in female. Most of the cases sustained soft tissue injury (32.7%, n=36) followed by cut injury (26.4%, n=29) and fracture (16.4%, n=18). Common place of injury was found to be at home (64.5%, n=71). Majority were discharged (n=100; 90.9%), Nine (8.2 %) were admitted and one expired (0.9 %) expired. Conclusion: Fall injuries are the major mode of injury encountered in both male and female children. Injuries tend to occur more at home than school. Children should be adequately supervised at home and school.
Introduction: Patients leaving against the advice of the treating team before being certified as fit is a major concern and challenge for the treating professionals as it possesses adverse medical outcomes. This study hence aimed at identifying the prevalence and major factors affecting such discharges so that advocacy can be done to help prevent it. Methods: A descriptive cross-sectional study was conducted at emergency department of a tertiary center in Lalitpur from 15th May 2019 to 15th August 2019. All the patients visiting the emergency department were included in the study and a non-probability purposive sampling method was used excluding the patients who denied giving reasons for them leaving against medical advice. Data was collected using pre-structured questionnaire and analyzed using SPSS-v21 software. Results: A hundred and fifteen patients (4.08%) left against medical advice out of 2812 patients who presented to emergency department. There were 63 male patients (54.8%), 75 patients of the total patients in the age group of 15-44 years (65.2%) and those living within a distance of 1km from the hospital (53%). The most common reason for the patients leaving against medical advice was found to be due to financial constraint (38.3%) followed by preference to other hospitals (16.5%). Conclusion: Patients leaving against medical advice possesses a small percentage of actual hospital admissions but is still a major health concern as it drastically increases the morbidity, re-admission rates and total health-care costs. Hence, understanding the general characteristics and predictors of such discharges is of utmost importance to help improve the patient outcome and reduce the health-care costs.
Background: Pressure ulcers are the serious kinds of wounds that get developed within the skin tissues. They affect larger surface areas of the body resulting severe pain in the infected body parts of the patients. Pressure wound, thus has been presented as one of the major health problem worldwide. This study was aimed to find out different aspects of pressure ulcer cases and outcomes in Sushma Koirala Memorial Hospital (SKMH). Along with this, the study was targeted to study major affected body part, role of diet in healing wounds, grades of pressure ulcers and medicines used during the management and treatment of such chronic wounds. Methods: A descriptive, unicentric, retrospective study was conducted in 2018 at Sushma Koirala Memorial Hospital. A total of 163 patient records from October 2016 to October 2018 were reviewed. The data was entered in SPSS 16 version for analysis. Results: Pressure ulcers were common among people from the age group 21-40 years. The males were more vulnerable than female. Most people stayed for 41-60 days while the most affected body part in many patients was the sacral region. Third grade sacral region pressure wound was mostly found in the admitted patients. Wounds and injuries were common cause for development of pressure ulcers. The usage of third generation cephalosporin- ceftriaxone was predominantly found during surgery as well as post-surgery. During surgery, most commonly used medications include fentanyl, paracetamol, midazolam and propofol. After surgery, analgesics like ketorolac, combination of ibuprofen and paracetamol were frequently used. For post-surgical condition, ceftriaxone, ascorbic acid, ranitidine and pantoprazole were mostly used. Patients with pressure ulcers were advised to take high protein diet. Conclusion: This study showed sacral region was most affected body part and grade 3 pressure wound were predominant in most of the admitted patients. Ceftriaxone was mostly prescribed antibiotics and combination of paracetamol and ibuprofen was mostly prescribed for analgesic effects.
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