Prevalence of methicillin resistant Staphylococcus aureus in school children of Pokhara.

Present study was carried out to find out the prevalence of methicillin resistant Staphylococcus aureus (MRSA) in school children of Pokhara city in western, Nepal. A total of 184 randomly selected children younger than 15 years were included in the study. Nasal swabs collected were subjected to standard bacteriological culture. S. aureus isolates were identified by mannitol fermentation, coagulase positivity and DNase positivity. Antimicrobial susceptibility test was performed on muller-hinton agar (MHA) by modified Kirby-Bauer disc diffusion method. Out of total 184 nasal swabs, S. aureus was isolated in 31.0% (n=57). Among the isolates, 35.1% (n=20) were from male children whereas 64.9% (n=37) were from female. There was no significant sex difference in colonization of S. aureus. Out of 57 isolates, 56.1% (n=32) were MRSA. MRSA isolates indicated relatively high rate of resistance to antibiotic cloxacillin (68.7%) followed by ofloxacin (40.6%), tetracycline (15.6%), erythromycin (9.4%), ciprofloxacin (6.2%) and vancomycin (3.1%).This study showed a high prevalence of MRSA carriage in school children indicating the spread of MRSA in the community.

Two faces of major lower limb amputations.

OBJECTIVES: To review the indications for major lower limb amputations in adults and children in our patient population and to compare our experience in prosthetic rehabilitation with that of other published information. MATERIAL AND METHODS: We retrospectively reviewed charts of patients who underwent amputation between 1997 to 2004 at the Orthopaedic Department of B& B Hospital (BBH), Gwarko and Hospital and Rehabilitation center for Disabled Children ( HRDC), Banepa. There were 113 patients at BBH & 89 patients at HRDC. Major amputation was defined as any amputation at or proximal to wrist and ankle. RESULTS: Major lower limb amputations constituted 73.58%(39/53) of all major amputations at BBH and 97.77% (44/45) at HRDC.Road traffic accident was found to be number one cause for major lower limb amputations (74.29%) in adult population. In children postburn contracture was the leading cause for amputation (29.54%) followed by Congenital limb conditions (22.72%), Spina bifida with trophic ulcers ( 20.45%), Tumor (13.63%), Chronic Osteomyelitis (6.81%), Trauma (4.54%) and Arthrogryposis (2.27%). Prosthetic fitting and rehabilitation is as yet far from satisfactory in the adult population but all the children who had amputation at HRDC were fitted with prosthesis. CONCLUSION: Main causes of major lower limb amputation in both population is largely preventable by instituting safety measures and conducting awareness program. There is a need for an effective prosthetic fitting center for adults.

Tibial plateau fractures: four years review at B & B Hospital.

BACKGROUND: Tibial plateau fractures involve the articular surface of the tibia resulting from a combination of axial loading with varus or valgus stress. Inadequate and inappropriate treatment may result in significant functional loss. OBJECTIVE: The purpose of this study was to determine the outcome of our treatment modalities and to compare with the results of comparable studies. METHODS: The results of treatment of 81 knees were reviewed over the period of five years (1997 to 2002). There were 62 men and 18 women, with an average age of 37 years (15 years to 75 years) at the time of initial evaluation. One patient had bilateral involvement. Fractures were classified according to Schatzker. Seven patients were treated conservatively. Sixteen patients (17 knees, one had bilateral involvement) were operated with closed reduction and percutaneous cannulated screws fixation. Thirty one patients' required open reduction and internal fixation with cannulated screws. Fifteen fractures were plated, and in eleven cases, external fixators were used. Follow up period ranged from six months to three years. RESULTS: Results were graded as excellent, good, fair and poor on the basis of functional outcome. Forty three (54%) patients (44 knees) had excellent, twenty two (26%) had good, five (6%) had fair and ten (14%) had poor results. Poor results were associated with high energy fractures, late presentation, and inadequate physiotherapy follow up. Eight patients (10%) had complications. One had common peroneal nerve palsy, six had wound infection and one patient demonstrated early arthritic changes. CONCLUSION: Tibial plateau fracture is a challenging fracture to manage. Restoration of articular congruity and early range of motion should be the primary goal. Proper and adequate preoperative planning is mandatory. Well maintained articular congruity with stable fixation helps early mobilization and better functional outcome.