Implementing an emergency medical services system in Kathmandu, Nepal: a model for "white coat diplomacy".

Wilderness medicine providers often visit foreign lands, where they come in contact with medical situations that are representative of the prevailing healthcare issues in the host countries. The standards of care for matters of acute and chronic care, public health, and crisis intervention are often below those we consider to be modern and essential. Emergency medical services (EMS) is an essential public medical service that is often found to be underdeveloped.

Admixture facilitates genetic adaptations to high altitude in Tibet.

Admixture is recognized as a widespread feature of human populations, renewing interest in the possibility that genetic exchange can facilitate adaptations to new environments. Studies of Tibetans revealed candidates for high-altitude adaptations in the EGLN1 and EPAS1 genes, associated with lower haemoglobin concentration. However, the history of these variants or that of Tibetans remains poorly understood.

Limited geographic distribution of the novel cyclovirus CyCV-VN.

A novel cyclovirus, CyCV-VN, was recently identified in cerebrospinal fluid (CSF) from patients with central nervous system (CNS) infections in central and southern Vietnam. To explore the geographic distribution of this novel virus, more than 600 CSF specimens from patients with suspected CNS infections in northern Vietnam, Cambodia, Nepal and The Netherlands were screened for the presence of CyCV-VN but all were negative. Sequence comparison and phylogenetic analysis between CyCV-VN and another novel cyclovirus recently identified in CSF from Malawian patients indicated that these represent distinct cycloviral species, albeit phylogenetically closely related.

The seroepidemiology of Haemophilus influenzae type b prior to introduction of an immunization programme in Kathmandu, Nepal.

Haemophilus influenzae type b (Hib) is now recognized as an important pathogen in Asia. To evaluate disease susceptibility, and as a marker of Hib transmission before routine immunization was introduced in Kathmandu, 71 participants aged 7 months-77 years were recruited and 15 cord blood samples were collected for analysis of anti-polyribosylribitol phosphate antibody levels by enzyme-linked immunosorbent assay. Only 20% of children under 5 years old had levels considered protective (>0.

Gatifloxacin versus ofloxacin for the treatment of uncomplicated enteric fever in Nepal: an open-label, randomized, controlled trial.

Background: Fluoroquinolones are the most commonly used group of antimicrobials for the treatment of enteric fever, but no direct comparison between two fluoroquinolones has been performed in a large randomised trial. An open-label randomized trial was conducted to investigate whether gatifloxacin is more effective than ofloxacin in the treatment of uncomplicated enteric fever caused by nalidixic acid-resistant Salmonella enterica serovars Typhi and Paratyphi A.

Methodology And Principal Findings: Adults and children clinically diagnosed with uncomplicated enteric fever were enrolled in the study to receive gatifloxacin (10 mg/kg/day) in a single dose or ofloxacin (20 mg/kg/day) in two divided doses for 7 days.

Aetiologies of central nervous system infections in adults in Kathmandu, Nepal: a prospective hospital-based study.

We conducted a prospective hospital based study from February 2009-April 2011 to identify the possible pathogens of central nervous system (CNS) infections in adults admitted to a tertiary referral hospital (Patan Hospital) in Kathmandu, Nepal. The pathogens of CNS infections were confirmed in cerebrospinal fluid (CSF) using molecular diagnostics, culture (bacteria) and serology. 87 patients were recruited for the study and the etiological diagnosis was established in 38% (n = 33).

Is routine hospital visit after day case inguinal hernia surgery in children necessary?

Background: To observe the prospects of day case inguinal hernia surgery in children without routine postoperative hospital visits. The aim was to access the advantages, acceptability and safety of this change in practice in low resource country like Nepal.

Methods: This was a cross-sectional study in a tertiary care general teaching hospital.

Clinical profile of patients with systemic lupus erythematosus.

Introduction: Clinical features of systemic lupus erythematosus vary between different parts of the World; however, this information on Nepalese systemic lupus erythematosus does not exist.

Methods: Patients with systemic lupus erythematosus fulfilling the American College of Rheumatology criteria treated in Patan Hospital were studied by means of retrospective review of their case records. The results were compared with various regional and international studies.

Eosinophilic fascitis: a rare fibrosing disorder.

Eosinophilic fasciitis is a rare systemic disease characterized by inflammatory thickening of the skin and underlying fascia, peripheral eosinophilia, elevated inflammatory markers and typical biopsy findings. Internal organ involvement is rare unlike in other fibrosing disorders. Though this is usually a benign disease, it is often difficult to diagnose and the course may also be variable.

Pattern of pediatric poisoning and accident in Patan Hospital.

Background: Kerosene, drugs, pesticides are chemicals used in home and farms. But because of parents' or caretakers' negligence, accidents and poisoning in children may take life of a child.

Objective: To study the common causes and outcome of pediatric accident and poisoning cases admitted in Patan Hospital.

Behçet's disease: an account of three cases.

Behçet's disease is a chronic relapsing inflammatory condition affecting multiple organ-systems of the body. Patient's with this disease present to different specialists with wide spectrum of clinical features of varying severity. Worldwide, this disease is clustered around certain parts of Asia, previously known as 'Silk route'.

Routine use of antibiotic prophylaxis in low-risk laparoscopic cholecystectomy is unnecessary: a randomized clinical trial.

Background: Laparoscopic cholecystectomy uses smaller incision and trocars that lessen the contamination and exposure of wound, resulting in less infection. However, the antibiotic prophylaxis is still widely practiced, like in our institute, a continuation of the era of open surgery. Recent studies reveal no advantage of routine use of antibiotic, and there is growing consensus against it.

Oxygen saturation of hemoglobin in healthy children of 2-14 years at high altitude in Nepal.

Background: Individuals residing at higher altitude may have oxygen saturation of hemoglobin different to those living at lower altitude.

Objectives: To find out the baseline value of SpO2 in healthy Nepali children (2-14 years) living permanently at high altitude using pulse oximeter and also to study the relation of SpO2 with age, sex and ethnicity.

Methods: A descriptive observational study was conducted at 4 different altitudes ranging from 2700 to 3800 m in Mustang district.

Early feeding and discontinuation of intravenous fluid after laparoscopic cholecystectomy.

Background: Common practice at most centers in the country is to continue intravenous (i.v.) fluid till morning round next day following laparoscopic cholecystectomy (LC), assess patient and gradually allow oral diet.

Sex preferences among mothers delivering at Patan Hospital.

Background: High sex ratios at birth (SRB) are seen in China, Taiwan, South Korea, parts of India and Vietnam. The imbalance is the result of son preference, accentuated by declining fertility. Prenatal sex determination and female feticides are common in many countries.

Minimally invasive plate osteosynthesis in the treatment of isolated ulnar bone fractures.

Background: Minimally invasive internal fixation is also called "biological internal fixation". This concept is used widely in the treatment of various fractures but to date, there have been no report about such application in the repair of isolated ulnar bone fractures.

Methods: Eleven patients with fracture of isolated ulnar bone (four AO type 22A11 and seven AO type 22A12), mean age 43.

Remote and rural: do mentors enhance the value of distance learning continuing medical education?

Context: Experts suggest that distance learning continuing medical education (CME) is only effective when there is the opportunity for two-way discussion and reflection. The value of on-line mentoring has been mainly studied in the West.

Objectives: We examined the benefits and practical implications of providing mentors for distance learning CME in a low technology setting.

Antibiotic resistance pattern of bacterial isolates in neonatal care unit.

Introduction: Bacterial infections account for a huge proportion of neonatal deaths worldwide. The problem of antibiotic resistance among common bacterial pathogens mainly the gram negative bacteria is emerging globally which is of more serious concern in developing countries like Nepal.

Methods: A one year retrospective hospital based study was carried out to analyze the results of neonatal blood, cerebrospinal fluid, urine, stool and surface cultures and to look into the sensitivity pattern of the commonly used antibiotics.

A diagnosis missed for several years-Wegener's granulomatosis.

Wegener's granulomatosis is a form of systemic vasculitis of small to medium sized vessels and affects upper respiratory tract, lungs and kidneys along with various organs. It causes necrotizing granulomatous inflammation of the affected parts and presents with positive antineutrophil cytoplasmic antibodies in more severe forms. Being a systemic disease with the potential to affect any organ-systems with a wide range of clinical presentations, it is associated with a risk of delay in diagnosis with resultant setback in institution of appropriate treatment.

Information leaflet as an adjunct to verbal counseling in obtaining informed consent.

Introduction: This study evaluates if addition of information leaflet after the usual verbal counseling improves the level of understanding of patients undergoing surgery about their disease, the need for surgery and its complications.

Methods: It is a prospective observational case control study in which the control group receives verbal counseling only and the study group is given an information leaflet in addition to the verbal counseling after random allocation. An interviewer (surgical resident) interviews both the group using a set questionnaire.

A five years review intra-operative cholangiogram.

Background: Intra-operative cholangiogram is often performed to detect concurrent common bile duct stones in cholecystectomy patients. Routine cholangiogram add to cost and exposes patients to unnecessary exploration of common bile duct due to frequent false positive results. Thus, there is need of better indicators for cholangiogram in order to minimize unnecessary procedure and its morbidity.

Clipless laparoscopic cholecystectomy--a prospective observational study.

In laparoscopic cholecystectomy (LC), cystic duct and artery are normally secured with titanium clips. Intracorporeal ligation is normally superior to extra corporeal knotting. Most studies report of separate and multiple ligations of cystic duct and artery, which are viewed as technically demanding and time consuming.

Clinical profile of invasive pneumococcal diseases in Patan Hospital, Nepal.

Background: Pneumococcal infection is one of the leading causes of pneumonia, meningitis and septicemia in developing countries. It accounts for one million deaths each year in children.

Objectives: The objective of this study is to see the clinical profile of invasive pneumococcal disease, antibiotics sensitivity pattern and prevalent serotypes in children admitted at Patan Hospital.

Culture proven bacterial meningitis in children: agents, clinical profile and outcome.

Background: Meningitis is a serious infection. Little is known about the bacterial agents and their antibacterial sensitivity in Nepalese children.

Objectives: To study bacteriological agents, clinical profile and immediate outcome in patients admitted to children ward of Patan Hospital with meningitis.

Risk factors associated with still births.

Introduction: Still birth is a common adverse outcome of pregnancy, associated with many risk factors like prematurity, infection, birth injury, eclamptic disorders.

Methods: A hospital based, retrospective study was conducted at Patan Hospital in the year 2064. The number of still births and their associated risk factors were assessed.