Nosocomial Citrobacter Infection in Neonatal Intensive Care Unit in a Hospital of Nepal.

Introduction: Neonatal Citrobacter infection is either acquired horizontally or vertically as a nosocomial infection. The source of nosocomial Citrobacter is either hands of medical staff or the innate objects. Objective: The aim of this study was to study nosocomial Citrobacter infection in neonates admitted in Neonatal Intensive Care Unit (NICU) and trace the source of infection. Methods: The study was conducted in NICU in a hospital in Kathmandu, Nepal during a period of January to March 2010. Specimens were collected from neonates, hands of medical staff and innate objects and were processed using a standard microbiological method. Results: The prevalence of neonatal nosocomial infection was 32.6% (29/89). Citrobacter spp. was isolated in 11 neonates admitted in NICU with the prevalence rate of 37.9% (11/29) among other pathogens. Umbilical cord infection was most common (n=8). These isolates were grouped into five antibiotypes (I, 4; II, 3; III, 2; IV, I; V, 1). All of these isolates were multi-drug resistant showing susceptibility towards quinolones. The isolate of Citrobacter spp. was also recovered from a nasal prong which was grouped with 4 other clinical strains. Conclusion: Multi-drug resistant nosocomial Citrobacter spp. was inflicting neonates in NICU and the source of this pathogen was traced to nasal prong. Nosocomial Citrobacter infection is a common problem of neonates in NICU. This will lead to increase neonatal mortality if infection prevention and control practices are not initiated.

A study of abdominal pain in children.

Pain abdomen is a common pediatric complaint that brings patient to the hospital in Nepal. Knowledge about its etiology and frequency helps in its evaluation and management. The present study was undertaken to find out the causes and their frequency of pain abdomen in Nepali children. Children with pain abdomen presenting at the emergency room and pediatric outpatient department of Kathmandu Medical College, Kathmandu from January, 2006 to December 2007 were clinically evaluated and investigated to find out the causes and frequency of their pain abdomen. The outcomes were tabulated and analyzed for interpretation. Of 444 patients attended, 356 completed investigations and came for follow up. Cause of pain abdomen was apparent in 117 (32.9%) only. 91.5% were medical causes, comprising predominantly of diarrheal diseases (28.3%), infantile colic (9.4%), urinary tract infection (7.7%) and acid peptic disease (6.8%). 8.5% causes were related to surgical conditions, which needed operative management. Secondary or extra-abdominal causes were found in 20 cases (17.1%). Pneumonia (2), functional (5), vulvovaginitis (2) and infantile colic (11) were predominant causes. Our study showed that the causes of pain abdomen in children were predominantly medical. Gastroenteritis was the most frequent cause. Secondary causes, including functional and emotional causes were infrequent. Small percentage needing surgical management formed a diagnostic challenge.

Pattern of poisoning cases in Emergency Department of Kathmandu Medical College Teaching Hospital.

OBJECTIVE: This study was conducted to determine the pattern and severity of poisoning cases in Emergency Department of Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal (KMCTH). DESIGN: Retrospective observational study. MATERIALS AND METHODS: Hospital records of all admissions to the Emergency Department of Kathmandu Medical College Teaching Hospital (KMCTH) following acute poisoning were revised and all data from February 2007 to February 2008 were analyzed retrospectively. RESULTS: This retrospective observational study was performed on 148 cases of poisoning who attended Emergency Department of KMCTH over a period of one year. The overall male to female ratio was 1.05:1. Poisoning was most common in the age group 21-30 years (40.5%). The most common causes of poisoning in adults were organophosphorous compounds and in children was kerosene oil. Oral route (79.05%) was the most common route of administration. 66.2% of cases were intentional poisoning for suicidal attempt. Students (43.9%) and service holders (18.9%) were commonly involved in poisoning. CONCLUSION: It was seen that adult between 21-30 years of age were more prone to suicidal poisoning with organophosphorous compounds and children of 1-10 years of age were more susceptible to accidental poisoning with kerosene oil.

An epidemiological study of road traffic accident cases attending emergency department of teaching hospital.

Several studies have shown that road traffic injuries are a major cause of death and disability globally, with a disproportionate number occurring in developing countries. The growth in numbers of motor vehicles is a major contributing factor in the rising toll of fatalities and injuries from road traffic crashes in poor countries. In this study, we reviewed medical records of all the victims of road traffic accidents attending the emergency department of Kathmandu Medical College Teaching Hospital within a year. A total of 757 road traffic victims were reported which accounted for 6.66% of all the cases attending the emergency. 49.93% cases belonged to 21-40 years age group. The most common victim group comprised the pedestrians (56.54%) with motorcycle (55.09%) being the most commonly involved vehicle. 44.65% accidents occurred in evening (12-6 pm). The lower limbs (in 42.0% cases) were the most common body region injured with superficial injuries (bruise/abrasion) accounting for the most common injury pattern followed by soft tissue injuries, incised/lacerated wounds and fractures and dislocations. Most accidents occurred in the April-June trimester.

A study of poisoning cases in emergency Kathmandu Medical College Teaching Hospital.

OBJECTIVE: To determine the pattern and severity of poisoning cases in emergency Kathmandu Medical College Teaching Hospital. DESIGN: Retrospective observational study. MATERIALS AND METHODS: All the poisoning cases due to various agents who attended Emergency from 1st of April 2002 to 30th of March 2003 were evaluated retrospectively. RESULTS: A total of 67 poisoning cases attended emergency Kathmandu Medical College Teaching Hospital over a period of one year. The overall female to male ratio was 1.09:1. Most poisoning occurred in the age group 21-30 for adults (38.8%) and 2-5 yrs for the children. Organophosphorous was the most common poisoning for the adults where as kerosene was common in children. Oral route was the most common route of administration which accounted 86.57%. Students (35.8%) and housewife (23.3%) were commonly involved in self poisoning. Intentional poisoning comprised 58.2% of all poisonings. CONCLUSION: Majority of the intentional poisoning occurred in the female housewife & students of younger age group but accidental poisoning was found common in children under five years mostly with kerosene ingestion.

Victims of road traffic crashes attending the emergency department of Kathmandu Medical College Teaching Hospital.

OBJECTIVE: To study the epidemiological factors and pattern of impact and injuries in victims of road traffic crashes visiting the emergency room of an urban teaching hospital in Kathmandu. DESIGN: Retrospective observational study. METHODS AND MATERIALS: Review of medical records of all the victims of road traffic crashes of one year. RESULTS AND CONCLUSION: Victims of road traffic crashes formed 6.2% of all emergency attendees of the hospital. Two thirds of the victims came between midday and midnight. The most vulnerable age group to get involved in the crashes was the 15 to 45 year group, which is also the working age group. Pedestrians constitute approximately 40.0% of the victims. Most of the injuries occurred in the lower extremities. Most impacts were seen in upper and lower extremities or in head/face region. The non fatal nature of injuries can be attributed to the low velocity at which crashes might have occurred.