Kathmandu University medical journal (KUMJ)
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Kathmandu Univ Med J (KUMJ) · Jan 2010
ReviewMulti-drug resistant tuberculosis burden and risk factors: an update.
Multi-drug resistant (MDR) tuberculosis is defined as disease caused by Mycobacterium tuberculosis with resistance to at least two anti-tubercular drugs Isoniazid and Rifampicin. Recent surveillance data have revealed that prevalence of the drug resistant tuberculosis has risen to the highest rate ever recorded in the history. Drug resistant tuberculosis generally arises through the selection of mutated strains by inadequate therapy. ⋯ Treatment outcomes among MDR-TB cases have varied widely; a recent survey of five Green Line Committee (GLC) approved sites in resource-limited countries found treatment success rates of 70%. Treatment continues to be limited in the resource poor countries where the demand is high. The ultimate strategy to control multidrug resistant tuberculosis is one that implements comprehensive approach incorporating treatment of multidrug-resistant tuberculosis based upon principles closely related to those of its general DOTS strategy for TB control: sustained political commitment; a rational case-finding strategy including accurate, timely diagnosis through quality assured culture and DST; appropriate treatment strategies that use second-line drugs under proper case management conditions; uninterrupted supply of quality-assured antituberculosis drugs; standardised recording and reporting system.
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Ertapenem is a parenteral carbapenem licensed for use in adults and children more than 3 months of age. It is active against many Gram-positive and negative bacteria, including several anaerobic organisms but has a narrower spectrum of antimicrobial activity, compared with older carbapenems. ⋯ Ertapenem has been proven to be clinically and bacteriologically efficacious in randomised controlled trials for the treatment of community acquired infections including complicated intra-abdominal infections, complicated skin and skin-structure infections, acute pelvic infections, complicated urinary tract infections, community-acquired pneumonia and for the prophylaxis of surgical-site infection following elective colorectal surgery. Ertapenem is suited for mild to moderately ill patients with community-acquired infections and for outpatient intravenous antibacterial therapy.
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Kathmandu Univ Med J (KUMJ) · Oct 2009
Spinal anaesthesia for laparoscopic cholecystectomy: a feasibility and safety study.
Regional anaesthetic techniques have benefited those patients undergoing laparoscopic surgeries that are deemed high risk to receive general anaesthesia (GA). But spinal anaesthesia (SA) has not been routinely employed as the sole technique for laparoscopic cholecystectomy (LC). ⋯ Spinal anaesthesia with Morphine-mixed hyperbaric Bupivacaine is adequate and safe for elective LC in otherwise healthy patients and minimises postoperative pain and opioid use. Success and safety of this technique, however, necessitates knowledgeable patient, gentle surgical procedure, and co-operation among patient and members of the perioperative care team.
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HIV in prisons is a serious public health concern. People in prison are at risk of contracting HIV through injecting drug use, unprotected sex and tattooing. However, most countries have largely neglected HIV prevention and care in prisons. ⋯ There is recognition in Government policy documents that prisons must be involved in efforts to stem the HIV epidemic. However, HIV prevention and care remains largely non-existent in Nepal's prisons. Efforts to obtain external funding to initiate and maintain programs such as drug dependency treatment and condom distribution are required. Attention could also be given to introducing alternatives to incarceration for less serious offenders and drug dependent offenders.
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Kathmandu Univ Med J (KUMJ) · Oct 2009
External and internal fixation for comminuted intra-articular fractures of distal radius.
Distal radius fractures are a common injury and without proper treatment leads to high functional impairment and frequent complications. ⋯ Comminuted intra-articular fractures of distal radius should be treated by open reduction and combined internal and external fixation to achieve a high rate of patient satisfaction and satisfactory functional outcome.