Kathmandu University medical journal (KUMJ)
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Kathmandu Univ Med J (KUMJ) · Jan 2011
Incidence and risk factor for ventilator-associated pneumonia in Kathmandu University Hospital.
Ventilator associated pneumonia is a major cause of morbidity in the intensive care unit. Difficulties in identification of the risk factors, in diagnosing and in prevention, have intensified the problem. ⋯ The incidence of ventilator pneumonia is high. Patients requiring prolonged ventilation, re-intubation, more invasive lines and H2 blockers, are at high risk and need special attention towards prevention.
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Kathmandu Univ Med J (KUMJ) · Oct 2010
ReviewPrevention of hypotension following spinal anaesthesia in caesarean section--then and now.
Hypotension during spinal anaesthesia for caesarean section remains a common scenario in our clinical practice. Certain risk factors play a role in altering the incidence of hypotension. ⋯ Phenylephrine is established as a firstline vasopressor, although there are limited data from high-risk patients. Ephedrine crosses the placenta more than phenylephrine and cause possible alterations in the foetal physiology.
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The quest for greater efficiency, fairness and responsiveness to the expectation of the people that system serve have brought about three generations of health system reforms in the twentieth century. The first generation saw the founding of national health care systems and extension to middle income nations of social insurance systems in the 1940s and 1950s. By the late 1960s the rising costs of hospital based care, its usage by better off, inaccessibility by the poor and rural population of even the most basic services heralded second generation reforms promoting primary health care as a means of achieving the affordable universal coverage. ⋯ With this recognition, the third generation of reforms now underway in many countries is driven by the idea of responding more to demand, assuring access for the poor and emphasizing financing rather than just provision within the public sector. The key concern is: how to translate ethos of revitalizing in the reality. Otherwise the revitalizing concept will turn into utopian goal so like HFA by 2000 strategy.
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Kathmandu Univ Med J (KUMJ) · Apr 2010
Randomized Controlled TrialEffect of preloading on hemodynamic of the patient undergoing surgery under spinal anaesthesia.
Hypotension and bradycardia after conduction of spinal anaesthesia are common side effects because of sympathetic blockade. Efforts to prevent these complications have been attempted like preloading with crystalloids, colloids or use of vasopressors. The role of volume preloading to prevent hemodynamic changes associated with spinal anaesthesia has been recently questioned. ⋯ On the basis of findings, it is concluded that volume preloading had no effect on the incidence of hypotension and bradycardia after spinal anaesthesia.
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Kathmandu Univ Med J (KUMJ) · Apr 2010
Comparative StudyComparison of single versus multiple doses of antibiotic prophylaxis in reducing post-elective Caesarean section infectious morbidity.
Puerperal sepsis is frequently in Caesarean section. Antibiotic prophylaxis may have significant impact in reduction of infections and thus the need to study its role in sepsis prevention systematically. ⋯ A single prophylactic dose of Cefazolin plus Metronidazole given post-umbilical cord clamping gives as much protection as multiple postoperative doses of Cefazolin/Cefalexin plus Metronidazole in preventing postoperative infectious morbidity in elective caesarean section.