Mangled right hand: A case report.

INTRODUCTION: The mangled hand is a complex and uncommon injury of the upper extremity. It involves injury to multiple structures i.e., bone, soft tissue, and neurovascular bundles of the hand leading to loss of function and viability. These injuries are usually caused due to trauma from high-energy equipment. PRESENTATION OF CASE: A 32-year female presented with a crush injury to her right hand by a grass-cutting machine. The right hand was de-vascularised with injury to both radial and ulnar arteries. She had multiple lacerations, fractures of the distal radius and ulna, and multiple fractures of the metacarpals and phalanges. An initial revascularization procedure with a vein graft was done in the ulnar artery, joints were stabilized, and planned for reconstructive surgery at a later date. DISCUSSION: Initial evaluation includes a decision to salvage or amputate the limb. Early intervention to restore vascularity is key to salvaging a mangled hand. This should be followed by a multidisciplinary team approach. Preference is given to reconstruction procedures rather than amputation and prosthesis procedures. CONCLUSION: Early intervention, a multispecialty approach, and staged procedures are required for the successful management of a mangled hand. Eventually, physiotherapy has a key role in the restoration of function.

Abortifacient effect of metoclopramide in female albino rats.

BACKGROUND: Metoclopramide a dopamine receptor antagonist is commonly used to treat nausea and vomiting. Long term use can cause parkinsonism, galactorrhoea and gynaecomastia. As it is lipid soluble, it enters the brain, easily crosses the placental barrier and can affect the fetus. Hence, the present study is designed to assess the risk of metoclopramide in pregnant albino rats. OBJECTIVES: To study the abortifacient effect of metoclopramide in pregnant albino rats. METHODS: Eighteen pregnant rats were divided into three groups of six rats each. The abortifacient activities of metoclopramide were studied in the doses of 1 mg/kg and 3 mg/kg intramuscularly. The treatments were started on the 6th day of pregnancy and continued till the 15th day. Rats were laparotomised on 19th day of pregnancy for evaluation of abortifacient action. In both the horns of the uterus, number of implantation sites, resorption sites, dead and live fetuses were observed. RESULTS: The mean percentage of aborted fetus was 17.22 +/= 21.13 33.88 +/= 37.73 after 1mg/kg and 85.21 +/=18.93 after 3mg/kg of metoclopramide. The abortifacient effect of higher dose was significantly larger compared to both control group and low dose group, but there was no significant difference between the mean percentage of abortion in control group and the low dose group of metoclopramide. CONCLUSION: Metoclopramide at 3mg/kg intra muscular has abortifacient effects in female albino rats.

Antibiotic usage and its sensitivity pattern in the NICU.

BACKGROUND: Sepsis is a major cause of mortality and morbidity in newborns affecting both developed and developing countries accounting a quarter around one million deaths per annum. OBJECTIVE: This study was aimed to assess the prevalence of neonatal sepsis, culture isolates, pattern, antibiotic sensitivity and drug prescribing pattern. METHODS: In present prospective study, 48 neonates admitted in pediatric ward from January to March 2011 of Dhulikhel Hospital were included. The gestation age, onset of sepsis, culture isolates, antibiotic sensitivity pattern and drug prescribing pattern were studied. Environmental air sampling of NICU (Neonatal Intensive Care Unit) was done by settle plate method for microbial examination. RESULT: Among 48 neonates, 23 (47.92%) neonates were culture positive with predominant isolates of Klebsiella oxytoca 11(47.83%), Pseudomonas sp. 4(17.39%), Methicillin Resistant Staphylococcus Aureus (MRSA) 3(13.04%) and single case of Enterobacter spp. In environmental samples, K. oxytoca and Enterobacter sp. were isolated. Amikacin, Imepeneum and Ciprofloxacin were sensitive whereas Ampicillin in combination with Cloxacillin, Ampicillin, Aztreonam were resistant for Klebsiella. oxytoca. Amikacin, Ceftazidime and Imipenuem were sensitive to Enterobacter spp. The single or combinations of resistant antibiotics were found to be prescribed. CONCLUSION: The emerging antibiotic resistances among the culture isolates and coherence with environmental samples were observed. Hence, special measures are imperative for reducing environmental contamination and the rational usage of antibiotics for preventing the infection and emerging antibiotic resistance. The study recommends need of the antibiotic policy to curb the present scenario.

Pandemic (H1N1) 2009 cases in Nepal.

We analyzed the data available in Nepal during this pandemic in order to determine the epidemiological, clinical and virological characteristics of pandemic influenza A in 2009. The test was conducted by real-time Reverse Transcription--Polymerase Chain Reaction on sample from patients with suspected influenza-like illnesses. Out of 538 cases were tested, 32% were positive for pandemic influenza A 2009 and the infection rate was highest for cases of 11-20 years and lowest in >50 years of age.

Pandemic influenza A (H1N1) 2009 outbreak investigation in Nepal.

BACKGROUND: The World Health Organization, on 24 April 2009, announced a Public Health emergency of international concern caused by a new influenza virus Pandemic Influenza A 2009. The objective of this study was to analyze the basic epidemiology and distribution of Pandemic Influenza A 2009 in order to understand the course of Pandemic Influenza A 2009 in Nepal. METHODS: The analyses were based upon all confirmed and probable cases that consulted Avian Influenza Control Project and National Public Health Laboratory during 29 April 2009 to 21 September 2010. RESULTS: Out of total 739 suspected samples collected, Pandemic Influenza A 2009 was detected in 210 cases in different districts of Nepal. The majority of cases were from the urban settlement of Kathmandu valley, Chitwan and Kaski and among age group 11-30 years. The clinical attack rate for Influenza like illness (ILI) was 28.48%. There was no significant difference between the clinical presentation of ILI and confirmed cases of Pandemic Influenza A 2009. CONCLUSIONS: This study presented the investigation of outbreak that helped to inform the course of epidemic in affected population and therefore urge for public health interventions.

Epidemiological situation of Japanese encephalitis in Nepal.

A human Japanese encephalitis (JE) case is considered to have elevated temperature (over 380 C) along with altered consciousness or unconsciousness and is generally confirmed serologically by finding of specific anti-JE IgM in the cerebro spinal fluid. No specific treatment for JE is available. Only supportive treatment like meticulous nursing care, introduction of Ryle's tube if the patient is unconscious, dextrose solution if dehydration is present, manitol injection in case of raised cranial temperature and diazepam in case of convulsion. Intra venous fluids, indwelling catheter in conscious patient and corticosteroids unless indicated should be avoided. Pigs, wading birds and ducks have been incriminated as important vertebrate amplifying hosts for JE virus due to viremia in them. Man along with bovines, ovines and caprines is involved in transmission cycle as accidental hosts and plays no role in perpetuating the virus due to the lack of viremia in them. The species Cx tritaeniorhyncus is suspected to be the principal vector of JE in Nepal as the species is abundantly found in the rice-field ecosystem of the endemic areas during the transmission season and JE virus isolates have been obtained from a pool of Cx tritaeniorhyncus females. Mosquito vector become infective 14 days after acquiring the JR virus from the viremic host. The disease was first recorded in Nepal in 1978 as an epidemic in Rupandehi district of the Western Development Region (WDR) and Morang of the Eastern Region (EDR). At present the disease is endemic in 24 districts. Although JE as found endemic mainly in tropical climate areas, existence and proliferation of encephalitis causing viruses in temperate and cold climates of hills and valleys are possible. Total of 26,667 cases and 5,381 deaths have been reported with average case fatality rate of 20.2% in an aggregate since 1978. More than 50% of morbidity and 60% mortality occur in the age group below 15 years. Upsurge of cases take place after the rainy season (monsoon). Cases start to appear in the month of April - May and reach its peak during late August to early September and start to decline from October. There are four designated referral laboratories, namely National Public Health Laboratory (Teku), Vector Borne Diseases Research and Training Center (Hetauda), B.P. Koirala Institute of Medical Sciences (Dharan) and JE Laboratory (Nepalgunj), for confirmatory diagnosis of JE. For prevention of JE infection; chemical and biological control of vectors including environmental management at breeding sites are necessary. Segregate pigs from humans habitation. Wear long sleeved clothes and trousers and use repellent and bed net to avoid exposure to mosquitos. For the prevention of the disease in humans, safe and efficacious vaccines are available. Therefore immunize population at risk against JE. Immunize pigs at the surroundings against JE. 225,000 doses of live attenuated SA-14-14.2 JE vaccine were received in donation from Boran Pharmaceuticals, South Korea for the first time in Nepal. Altogether 224,000 children aged between 1 to 15 years were vaccinated in Banke, Bardiya and Kailali districts during 1999. From China also, 2,000,000 doses of inactivated vaccine were received in 2000 and a total of 481,421 children aged between 6m to 10 yrs were protected from JE during 2001/2002. Ministry of Agriculture, Department of Livestock Services has vaccinated around 200,000 pigs against JE in terai zone during February 2001.