Progress and prospects of C4 trait engineering in plants.

Incorporating C4 photosynthetic traits into C3 crops is a rational approach for sustaining future demands for crop productivity. Using classical plant breeding, engineering this complex trait is unlikely to achieve its target. Therefore, it is critical and timely to implement novel biotechnological crop improvement strategies to accomplish this goal. However, a fundamental understanding of C3 , C4 , and C3 -C4 intermediate metabolism is crucial for the targeted use of biotechnological tools. This review assesses recent progress towards engineering C4 photosynthetic traits in C3 crops. We also discuss lessons learned from successes and failures of recent genetic engineering attempts in C3 crops, highlighting the pros and cons of using rice as a model plant for short-, medium- and long-term goals of genetic engineering. This review provides an integrated approach towards engineering improved photosynthetic efficiency in C3 crops for sustaining food, fibre and fuel production around the globe.

Comparison of Outcomes of Conventional Septoplasty Versus Endoscopic Septoplasty using Freer's Incision in Symptomatic Deviated Nasal Septum.

Background Septoplasty techniques have evolved over the years with endoscopic septoplasty gaining popularity in the recent times. Objective To compare the outcomes of conventional septoplasty with endoscopic septoplasty using Freer's incision in symptomatic deviated nasal septum. Method It was a prospective, randomized and comparative study done at Department of ENTHead and Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from July 2018 to August 2019. A total of 70 patients with symptomatic deviated nasal septum were allocated randomly into two groups. Group A underwent conventional septoplasty whilst Group B underwent endoscopic septoplasty using Freer's incision. Sino-nasal outcome test (SNOT-10) score was recorded pre-operatively and post -operatively between four to six weeks of surgery. Paired and independent 't' test for mean was used as a statistical tool. Result Out of 70 patients, 57(81.43%) were males and 13(18.57%) females. The age group mostly affected was in the third and fourth decades with total 47 patients (67.14%). In the conventional group, the pre-op mean SNOT-10 score was 11.46 (SD±3.6) while post-op mean SNOT-10 score was 2.60 (SD±1.9), the difference being statistically significant (p value 0.00001). Similarly, in the endoscopic group, pre-op mean SNOT10 score was 12.06 (SD±4.88) and post-op mean SNOT- 10 score was 3.37 (SD±2.71) with the difference being statistically significant (p value 0.00001). Comparison of post-operative mean SNOT-10 score between two techniques was not statistically significant (p value 0.17). Conclusion Both conventional and endoscopic septoplasty techniques using Freer's incision were equally effective in improving symptoms due to deviated nasal septum.

Clinico-epidemiological Profile of Extra Hepatic Portal Vein Obstruction: A Tertiary Care Hospital Based Retrospective Study.

Background Extra hepatic portal vein obstruction (EHPVO) is a common cause of portal hypertension in the developing countries (up to 30% of all variceal bleeders) and is second to cirrhosis in the West (up to 5-10%). Our understanding of the disease is poor compared with other illnesses. Objective To undertake a retrospective study of the clinicoepidemiological profile of Extra hepatic portal vein obstruction in a tertiary care hospital in eastern Nepal. Method All consecutive adult patients whose features were consistent with the diagnosis of extra hepatic portal vein obstruction from June 2014 to June 2016 were retrospectively analyzed to explore the various clinico-epidemiological parameters. Result A total of 58 patients were enrolled in the study with a median age of 24 years (20.5- 40). Portal vein thrombosis was the most common cause of extrahepatic portal vein obstruction. Hematemesis followed by melena were the most common presenting symptoms. All patients had splenomegaly on examination. None of the patients had clinical, biochemical or radiological evidence of chronic liver disease. Conclusion The diagnosis of extra hepatic portal venous obstruction and differentiation from cirrhosis can be easily made by characteristic clinical features, normal liver function tests and doppler ultrasound. Portal vein thrombosis (PVT) is the predominant cause of extra hepatic portal vein obstruction in Nepali patients, as seen at this tertiary care hospital in Nepal.

Comparison of outcomes of triamcinolone versus normal saline soaked polyvinyl alcohol pack following bilateral endoscopic sinus surgery.

BACKGROUND: Steroids have been proven to be beneficial in improving post-operative outcomes following sinus surgery. The ideal mode of delivery is to increase local concentration in the sinuses with minimal systemic side effects. In this study, we used triamcinolone soaked polyvinyl alcohol packs immediately following sinus surgery, and assessed the effects on post-operative outcomes. METHODOLOGY: This was a prospective, interventional, and comparative study. Following endoscopic sinus surgery, a polyvinyl alcohol pack was placed in both nasal cavities and 4 ml triamcinolone was infiltrated in one side and 4 ml of normal saline was infiltrated in the other. The pack was removed on the second post-operative day and nasal cavities and paranasal sinuses were evaluated using a flexible endoscope in the third post-operative week using Lund-Kennedy and Peri-operative sinus endoscopic scores. RESULTS: There was a reduction in the average Lund-Kennedy score and Peri-operative sinus endoscopy score in the treatment site compared to the control site which was statistically significant. There was a greater reduction in crusting, oedema and scarring in the treatment site compared to the control site. However, only the reduction in oedema was statistically significant. CONCLUSIONS: Triamcinolone soaked polyvinyl alcohol pack following endoscopic sinus surgery improves post-operative outcomes.

Therapeutic Drug Monitoring of Antiepileptic Drugs at a Tertiary Care Hospital of Eastern Nepal.

Background Therapeutic drug monitoring (TDM) is the process of measuring drug level in body fluids. It is done to maintain plasma concentration of the drug under therapy within a specific target range for maximum therapeutic efficacy without unnecessary exposure to adverse effects. Objective This study aims to evaluate necessity of therapeutic drug monitoring in Phenytoin, Carbamazepine and Lamotrigine therapy among epileptic patients. Method A prospective, cross-sectional study was conducted for a period of one year at BP Koirala Institute of Health Sciences, Dharan, Nepal. After taking detailed history, blood samples were collected from epileptic patients on monotherapy with the selected drugs. Plasma levels of these drugs were analyzed using High Performance Liquid Chromatography technique (HPLC). Out of total 42 selected patients, 21 were tested for phenytoin, 17 for carbamazepine and four for lamotrigine. The result was categorized into therapeutic, sub-therapeutic and above-therapeutic groups based on reference range. Result Out of total 21 samples tested for phenytoin, 15(71.4%) had plasma drug level within therapeutic range, 5(23.8%) had within subtherapeutic range and 1(4.8%) had above therapeutic range. Analysis of carbamazepine plasma level showed 14(82.3%) at therapeutic level, 1(5.9%) at sub-therapeutic level and 2(11.8%) at above-therapeutic level. Lamotrigine testing in four samples showed 2(50% in) both within therapeutic range and above-therapeutic range. Conclusion Therapeutic drug monitoring of phenytoin, carbamazepine and lamotrigine showed variation in plasma level irrespective of the therapeutic dose. It is suggested that dose adjustment of antiepileptic drugs should be done after establishing 'individual therapeutic range' following regular plasma monitoring.

Improving Knowledge, Skill and Confidence of Novice Medical Doctors in Trauma Management with Principles of ABCDE.

Background Trauma is one of the major public health concerns clamming about five million death annually worldwide. Experience and confidence of a doctor in the management of trauma patients have big impact on the overall outcome. Objective This study aims to evaluate the outcome of a trauma course in improving the knowledge, skill and confidence of novice doctors in managing trauma victims. Method A pre/post test analytical study was carried out among novice medical doctors from Kathmandu University School of Medical Science (KUSMS) who participated in a standard two and a half day trauma course, that utilizes the principles of ABCDE, as a part of their regular training. Pre-course knowledge and skill were compared with immediate post-course scores on the same guidelines. Objective structured and subjective written feedbacks from the participants were analyzed qualitatively to identify the perceptions of candidates. Result Sixty-eight males and twenty-nine females completed the course. The average pre-test scores in knowledge and skill were 8.3(33.2%) and 19.6(78.5%) respectively. Similarly the post-test scores were 16.04(64.2%) and 22.45 (89.5%) respectively, showing statistically significant improvements (P 0.000). The mean percentage improvement in knowledge was 48.8% and that in skill was 160.9%. The feedback analysis showed majority of the participants were satisfied with the course and they perceived improved "self-confident" in handling trauma cases. Conclusion All the novice doctors should participate in a standard trauma course hence their knowledge, skill and confidence in handling a trauma can be improved.

Epidemiological Study of Tobacco Smoking Behaviour amongst Residents of the Hill Region of Nepal.

Background Tobacco use is still a serious public health problem in the world and represents a major cause of morbidity and mortality in most parts of the world. Objective To measure the prevalence of tobacco use and to identify the factors associated with tobacco use among the residents of Dhankuta Municipality. Method The cross-sectional study was conducted among the residents of the Dhankuta Municipality where 205 households were taken as subjects. Pretested semistructured questionnaire was used for data collection and face to face interview was conducted. Univariate and multivariate logistic regression was used to see the association between various factors and tobacco use and identify the predictor variables. Result Overall prevalence of tobacco consumption in Dhankuta Municipality was found to be 57.1%. Prevalence of tobacco consumption among the male was significantly higher (67%) than female (47.1%) (p<0.05). Most of the respondents (56.4%) started consuming tobacco due to peer pressure and for recreation (24.8%). The multivariate logistic regression showed that the people with illiterate have higher chances of consuming tobacco than above School Leaving Certificate (OR 38.395, 95% CI=3.209- 459.417). The respondents below poverty line (<1.25 US$) was consuming tobacco more than above poverty line (> 1.25 US $) (OR 6.814, 95% CI= 1.255-36.986). Conclusion The aims of this study was to measure the prevalence of tobacco use and to identify the factors associated with tobacco use among the residents of the Dhankuta Municipality. We conclude that the prevalence rate of tobacco consumption in the Dhankuta Municipality was found to be moderately high. Factors like male in gender, Brahmin/Chhetri in ethnicity, lack of education, poor occupation like farmer and housewife, poor economic status were associated with tobacco use.

Ultrasound Guided Femoral Nerve Block to Provide Analgesia for Positioning Patients with Femur Fracture Before Subarachnoid Block: Comparison with Intravenous Fentanyl.

Background Positioning patients with fractured femur for subarachnoid block is painful. Intravenous analgesics or peripheral nerve block like femoral nerve block or fascia iliaca compartment block are some of the available techniques to reduce pain. We compared the efficacy of femoral nerve block and intravenous fentanyl in providing effective analgesia before positioning for subarachnoid block. Objective This study was designed to compare between ultrasound guided femoral nerve block with lignocaine and intravenous fentanyl in providing effective analgesia before positioning patient with femur fracture in sitting position for subarachnoid block. Method Forty patients undergoing surgery for femur fracture were randomized to either femoral nerve block (FNB) or intravenous fentanyl (IVF) group. Group FNB (n=20) received 20 ml of 2% lignocaine around femoral nerve under ultrasound guidance. IVF group (n=20) received 2 mc/kg of fentanyl intravenously. Pain score on effected limb was assessed after five minutes. If VAS was ≤ 4, the patient was positioned in sitting for subarachnoid block. On failure to achieve this with the above treatment, intravenous fentanyl 0.5 mc/kg was administered and repeated as necessary before positioning. VAS during positioning was documented and compared between the two groups. Similarly, secondary outcomes of the intervention: quality of patient position, rescue analgesia and duration of the procedure were also compared. Data were subjected to Mann Whitney U-test and chi-square test. Level of significance was set at 0.05. Result FNB group had significantly less VAS scores (median) than IVF group :2 vs 3; p=0.037) during positioning for spinal anaesthesia. Procedure time (median) for spinal anaesthesia was also significantly less in FNB than in IVA group (10 vs 12 min; p=0.033) Conclusion Ultrasound guided femoral nerve block was more effective than intravenous fentanyl for reducing pain in patients with proximal femur fracture before spinal anaesthesia.

Child-Turcotte-Pugh versus model for end stage liver disease score for predicting survival in hospitalized patients with decompensated cirrhosis.

BACKGROUND: Short term and medium term survival predictive value of the Child-Turcotte-Pugh (CTP) and Model for End Stage Liver Disease (MELD) score has been established but their usefulness in predicting survival of hospitalized patients with decompensated cirrhosis is lacking. We compared the survival predictive value of these scoring systems in hospitalized patients of decompensated cirrhosis and other associated factors. METHODS: A prospective, observational study in 216 consecutive cases of decompensated cirrhosis admitted in medical ward, were enrolled if the inclusion criteria were fulfilled. All cases were investigated and treated as per standard guidelines and clinician's judgment. CTP and MELD score were calculated for each case at the time of admission and followed throughout the hospital stay till discharge/death. The accuracy of the different score systems for predicting survival was evaluated through the area under ROC curve. RESULTS: CTP and MELD score were higher (12.44 ± 1.07, 31.91 ± 4.92) in expired cases than who improved and discharged (11.32 ± 1.28, 23.97 ± 5.36) respectively with significant p-value (<0.001). Area under ROC curve for serum creatinine, MELD score, blood urea and CTP score for predicting hospital survival were 0.887, 0.864, 0.836 and 0.738 respectively. CONCLUSIONS: MELD score is superior to CTP score in predicting survival at the time of discharge in hospitalized patients with decompensated cirrhosis. Renal failure in patients with decompensated cirrhosis carries poor prognosis and has a good outcome prognostic value, even superior to MELD/CTP scoring.

Chondrosarcoma of posterior nasal septum.

Chondrosarcoma is a rare non-epithelial tumor comprising of 10-20% of primary bone tumor. The nasal septum is a rare site for its occurrence. We present one such case of chondrosarcoma of the nasal septum who was treated with endoscopic removal followed by post operative radiotherapy and discuss the relevant clinical presentation, diagnosis and treatment and review the literature also.

Isolation and characterization of aerobic culturable arsenic-resistant bacteria from surfacewater and groundwater of Rautahat District, Nepal.

Arsenic (As) contamination of groundwater is a serious Environmental Health Management issue of drinking water sources especially in Terai region of Nepal. Many studies have reported that due to natural abundance of arsenic in the environment, various bacteria have developed different resistance mechanisms for arsenic compound. In this study, the culturable arsenic-resistant bacteria indigenous to surfacewater as well as groundwater from Rautahat District of Nepal were randomly isolated by standard plate count method on the basis of viable growth on plate count agar amended with arsenate ranging from 0, 0.5, 10, 40, 80 to 160 milligram per liter (mg/l). With respect to the morphological and biochemical tests, nine morphologically distinct potent arsenate tolerant bacteria showed relatedness with Micrococcus varians, Micrococcus roseus, Micrococcus luteus, Pseudomonas maltophilia, Pseudomonas sp., Vibrio parahaemolyticus, Bacillus cereus, Bacillus smithii 1 and Bacillus smithii 2. The isolates were capable of tolerating more than 1000 mg/l of arsenate and 749 mg/l of arsenite. Likewise, bioaccumulation capability was highest with M. roseus (85.61%) and the least with B. smithii (47.88%) indicating the potential of the organisms in arsenic resistance and most probably in bioremediation.

The study of prevalence of Helicobacter pylori in patients with acne rosacea.

BACKGROUND: Acne rosacea is an inflammatory disease affecting the central part of the face characterized by erythema, papules, papulo pustules and telangiectasias of unknown etiology. More recently numerous studies have described an association with Helicobacter pylori (Hp) and the extra gastric symptoms of cutaneous origin. OBJECTIVES: To establish the prevalence of Helicobacter pylori (Hp) infection in the stomach in patients with rosacea based on standard Hp serological test. METHODS: All patients with the clinical staging of 2, 3 and 4 rosacea attending the Dermatology Out Patient Department from May 2009-April 2010 were included in the study. Quantitative serological test using the SERION ELISA classic Helicobacter pylori IgG was done. RESULT: A total of 26 patients were enrolled in the study with the age ranging from 26-82 years. There were 14 males and 12 females and the male: female ratio was 1.6:1. Three (11.53%) patients presented with Grade IV rosacea, a severe clinical presentation and symptoms suggestive of acid peptic diseases were found in 14/26 (53.8%) patients. A positive serology to H. pylori was found in 17/26 (65.4%) of patients. A statistically significant correlation was found when association of H. pylori positivity in patients of rosacea compared with the seropositivity in controls. However correlation in the seropositivity was not found amongst the patients having gastritis and rosacea. CONCLUSION: There still proves to find a correlation of Hp infection with patients with rosacea but it can still be hypothesised as a cutaneous manifestation of an internal peptic ulcer disease.

Risk factors for stunting among children: a community based case control study in Nepal.

BACKGROUND: Stunting, a chronic condition, is an underlying cause of child morbidity and mortality in Nepal. This study intends to identify the factors causing stunting among children that will help to prioritize the strategies at the district level. OBJECTIVE: The objective of the study was to identify the risk factors for stunting among children of age between 6 to 59 months. METHODS: The study was based on community-based case control design in the mid-west, Surkhet Nepal from August to September 2010. The cases were stunted children and controls were the children without stunting. Data was collected by interviewing those children's mothers and measured length/height of 118 children as cases and 236 children as controls. Logistic regression analysis was performed to identify the best model of factors leading to stunting. Odds ratio and 95% confidence interval were used as a measure of association. RESULTS: Socio-economic risk factors for stunting comprised mothers without earning (OR=3.11, 95% CI 1.26-7.65), food deficit families (OR=4.26, 95% CI 1.73-10.45) and care taker of the children other than mother (OR=3.02, 95% CI 1.19-7.70). Environmental risk factors for stunting consisted of kitchen without ventilation and children exposed to pesticide. Inappropriate exclusive breast feeding (OR=6.90, 95% CI 2.81-16.97), complementary feeding less than four times a day (OR=3.60, 95% CI 1.32-9.95) and dietary diversity below WHO standard (OR=4.06, 95% CI 1.70-9.67) were factors of stunted children. Diarrhea was found significantly associated with stunting (OR=7.46, 95% CI 2.98-18.65). CONCLUSIONS: Stunting was found to be as a result of multiple factors such as socio-economic, environmental and inappropriate feeding practices.

Postoperative complications of septal quilting and BIPP packing following septoplasty.

BACKGROUND: Septoplasty is one of the most common surgeries in otorhinolaryngology. After septal surgery nasal packing is usually done to prevent complications like haemorrhage, septal haematoma. However it is associated with many postoperative complications such as pain, hypoxia, dryness in throat, headache, epiphora, vestibular stenosis, crusting, synaechiae, secondary infection etc. In order to prevent these complications quilting has been developed. No study has been done in our country to compare the postoperative complications after septoplasty. METHODS: This study was carried out to compare postoperative crusting, oedema, synaechia and infection in patients who underwent septal quilting and BIPP packing following septoplasty from August 2008 to July 2011 in the Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal. RESULTS: There were 44 patients in quilting and 41 patients in BIPP packing group. Out of 44 patients of quilting group, crusting occurred in 3 patients, oedema in 4 patients, synechia in 1 patient and infection in 3 patients. Out of 41 patients of BIPP packing group, 9 patients had crusting, oedema was present in 7 patients, 6 patients had synaechia and 5 patients had infection. Crusting and synaechia was found to be statistically significant while oedema and infection was not significant between two groups. CONCLUSIONS: Complications like excessive crusting, oedema, synaechia and infection can be minimized by quilting suture following septoplasty.

Spinal anesthesia for cesarean section: comparison of 5.0% lignocaine and 0.5% bupivacaine.

Objective of the study was to compare the effect of the drugs, intraoperative hemodynamic variables (heart rate, blood pressure) and associated complications (hypotension, nausea, shivering etc) between the bupivacaine and lignocaine group, when administered intrathecally in patients undergoing caesarean section. This is a randomized prospective study where the haemodynamic changes and the complications following sub arachnoid block either with 5.0% lignocaine or with 0.5% bupivacaine in 52 patients undergoing caeserian section were compared. The patients were randomly divided in two groups, group X (lignocaine group, n=26) or group B (bupivacaine group, n=26), either to receive 5.0% lignocaine 75 mg or 0.5% bupivacaine 12.5 mg. Intraoperatively heart rate, blood pressure (systolic (SBP), diastolic (DBP) and mean (MAP)), oxygen saturation were monitored. Any rescue drugs e.g. mephentermine, crystalloid 200 ml bolus, pethidine, diazepam etc given were noted with the dose and time. Urine output and total amount of fluid given was noted at the end of the surgery. Oxytocin 10 U in infusion was given after the baby was delivered in all the cases. Intraoperative blood pressures, total amount of fluid given, rescue vasopressor (mephentermine) given were compared in both the groups. Groups were also compared with respect to the patients' age, height of sensory block, motor block, duration of surgery, Apgar score and weight of the baby and duration of postoperative analgesia. It was concluded that the drugs were similar with respect to their sensory and motor effects, intraoperative hemodynamic changes like hypotension and bradycardia, and other complications like shivering and can be used interchangeably as spinal anesthetic agent for caesarean section deliveries.

Chronic cough in thymoma.

Cough is one of the most common symptom for which patients seek medical attention from primary care physicians and pulmonologists. Although tuberculosis and other lung infections are common throughout the developing world, they are not among the most common causes of chronic cough. We report a case of a 23 years old male who presenting to the outpatient clinic with chronic cough not responding to regular and symptomatic treatment that was diagnosed to have thymoma. After all the common causes for chronic cough have been ruled out, unusual causes should also be considered in the differential diagnosis.

Multiple drug resistance in bacterial isolates from liquid wastes generated in central hospitals of Nepal.

BACKGROUND: Healthcare liquid wastes are the reservoirs of harmful infectious agents such as the pathogens and multiple drug resistant microorganisms. Potential infectious risks include the spread of infectious diseases and microbial resistance from health-care establishments into the environment and thereby posing risks of getting infections and antibiotic resistance in the communities. OBJECTIVES: The objectives of this study were to assess the bacterial load of healthcare liquid waste generated in central hospitals and to explore the antimicrobial resistance pattern of these bacterial isolates. MATERIALS AND METHODS: A descriptive study was carried out in 10 conveniently selected central hospitals of Nepal during the period of May to December 2008. Effluent specimens from each hospital were subjected to total viable count studies by spread plate method in nutrient agar plate and incubated for 24 hours at 37 °C using standard laboratory protocol. Similarly, all the specimens were cultured in Mac Conkey Agar media supplemented with 30 µg/ml of Chloramphenicol and 20 µg/ml of Gentamycin for the enumeration of multiple drug resistant (MDR) bacteria, which were further subjected to in-vitro antibiotic susceptibility test by modified Kirby Bauer disc diffusion technique for resistance patterns. RESULTS: Total viable counts of hospital effluents significantly exceeded the standard heterotrophic plate count (p=0.000). Similarly, the numbers of multiple drug resistant bacteria were alarmingly high in three (more than 30% in 2 and 50% in 1) hospitals of this study. Drug resistant hospital effluent isolates showed simultaneous resistance for most of the antibiotics including Penicillin, Cephalosporin, Cotrimoxazole, Gentamycin and Quinolones. CONCLUSION: Healthcare liquid wastes were laden with MDR bacteria and seemed to pose a huge public health threat in the transfer of such resistance to the bacterial pathogens causing community acquired infections, thereby limiting our antibiotic pool.

Phenotypic characterisation and drug sensitivity testing of mycobacteria isolated from extra-pulmonary tuberculosis.

BACKGROUND: Tuberculosis (TB) is a major cause of morbidity and mortality globally, with most cases occurring in developing countries. The importance of extra pulmonary tuberculosis (EPTB) among all forms of tuberculosis has not yet been ascertained in developing countries. OBJECTIVE: To identify and perform phenotypic characterization of clinically important mycobacterium isolates from extra-pulmonary sites along with drug susceptibility testing. MATERIALS AND METHODS: A total of 513 specimens from patients of (EPTB) with varied presentation were studied. Speciation and characterization of isolates were done on the basis of growth and biochemical characteristics. Drug susceptibility testing for mycobacterium isolates was done by proportion method. RESULTS: Fifty four patients clinically suspected to have extra-pulmonary tuberculosis were culture positive for mycobacteria. On characterization 48 of the 54 isolates were identified as M. tuberculosis, 4 as M. bovis and 2 were M. avium/intracelulare. Drug susceptibility testing was done for the both M. tuberculosis as well as M. bovis. In single drug resistance, Streptomycin was highest followed by Isoniazid, Ethambutol and Refampicin. Multi drug resistance (MDR) was found in 6 isolates and it was observed only in group I cases. CONCLUSION: EPTB accounts for 10-15 percent of all cases of tuberculosis. Mycobacterium was present in 10.5 percent samples. 48 isolates out of 54 samples were found to be M. tuberculosis. The maximum numbers of M. tuberculosis were isolated from lymph node aspiration.

Health care waste management practice in a hospital.

BACKGROUND: Health-care waste is a by-product of health care. Its poor management exposes health-care workers, waste handlers and the community to infections, toxic effects and injuries including damage of the environment. It also creates opportunities for the collection of disposable medical equipment, its re-sale and potential re-use without sterilization, which causes an important burden of disease worldwide. The purpose of this study was to find out health care waste management practice in hospital. METHODS: A cross-sectional study was conducted in Narayani Sub-Regional Hospital, Birgunj from May to October 2006 using both qualitative and quantitative methods. Study population was four different departments of the hospital (Medical/Paediatric, Surgical/Ortho, Gynae/Obstetric and Emergency), Medical Superintendent, In-charges of four different departments and all sweepers. Data was collected using interview, group discussion, observation and measurement by weight and volume. RESULTS: Total health-care waste generated was 128.4 kg per day while 0.8 kg per patient per day. The composition of health care waste was found to be 96.8 kg (75.4%) general waste, 24.1 kg (8.8%) hazardous waste and 7.5 kg (5.8%) sharps per day by weight. Health staffs and sweepers were not practicing the waste segregation. Occupational health and safety was not given due attention. Majority of the sweepers were unaware of waste management and need of safety measures to protect their own health. CONCLUSIONS: Health care waste management practice in the hospital was unsatisfactory because of the lack of waste management plan and carelessness of patients, visitors and staffs. Therefore the hospital should develop the waste management plan and strictly follow the National Health Care Waste Management Guideline.

Bacteriuria and urinary retention following gynaecological surgery: comparing short vs long term catheterization.

BACKGROUND: Post operative bladder drainage is important care following gynaecological surgeries. This study was done to compare the incidence of urinary retention and bacteriuria following long term versus short term catheterization. METHODS: The patients who were admitted for gynaecological major surgeries were enrolled in this study. One group of patients had post operative indwelling catheterization for 24 hrs (short term catheterization) and another group of patients had catheterization for more than 48 hrs (long term catheterization). The urine examination and culture sensitivity was sent for all patients at the removal of catheter. The patients were followed after removal of catheter for urinary retention. RESULTS: Total of 102 patients were studied. There were 48 patients in short term catheterization group and 54 patients in long term catheterization group. In short term catheterization group, 3 (6.2%) cases had bacteriuria and no cases of urinary retention were observed. In prolonged catheterization group, 6 cases (11.1%) had bacteriuria and 2 cases (3.7%) had urinary retention. CONCLUSIONS: This study has concluded that short time catheterization following gynaecological surgery had fewer incidences of bacteriuria and urinary retention than long term catheterization.