An audit of hepatobiliary diseases in a tertiary level intensive care unit in Nepal

Abstract

Background: Hepatobiliary diseases account for significant proportion of admission in our intensive care unit, a semi-closed, 11 bedded mixed medical-surgical unit. This study was conducted to study the profile of patients with various hepatobiliary diseases who required intensive care unit admissions with the aim of identifying the need for a hepatobiliary critical care facility. Methods: A retrospective study was designed and all consecutive patients admitted with hepatobiliary problems from January 2013 till December 2013 were enrolled in the study.Results: Out of 467 patients admitted, there were 61 (13.06%) patients with hepatobiliary diseases. Out of 61 patients, there were 24 (39.3%) patients with medical cause for hepatobiliary disease and 37 (60.7%) patients with a surgical cause. The majority of the patients 52.45% were male. The overall mortality in these patients was 37.70%. The mortality in patients with surgical cause for the hepatobiliary disease was less (27.02%). Encephalopathy was a common condition leading to ICU admission. The common medical conditions were Cirrhosis secondary to Alcoholic Liver disease and Acute Fulminant Hepatic Failure. The commonest surgical conditions were Severe Pancreatitis, Post-Whipple's surgery, postoperative sepsis after Cholecystectomy, Liver Injury secondary to Road Traffic Accidents and Severe Cholangitis. Conclusion: The number of patients presenting to our multidisciplinary unit with hepatobiliary diseases is high and this group of patients have a high mortality. Though the numbers do not suggest an immediate need for a Hepatobiliary intensive care unit, the increasing trend suggests such a facility would be the need of time in near future.

Use of antimicrobials during the COVID-19 pandemic: A qualitative study among stakeholders in Nepal

“…The use of OTC antibiotics increased during the COVID-19 pandemic for several reasons. The high empirical treatment through prescription from clinicians and OTC-based use of antibiotics echoes studies from Nepal [22][23][24][25][26], Scotland [29], Saudi Arabia [30], Peru [31], and Bangladesh [32]. Indeed, the overuse of antibiotics during the pandemic has been reported globally [11].…”

“…Previous studies from Nepal, found that around 70-98% of COVID patients were treated with antibiotics in the hospital [22][23][24]. Another study found more than half of patients admitted in intensive care unit (ICU) in a tertiary care hospital were prescribed empirical antimicrobials [25]. The use of antibiotics was widespread even when only around half of the COVID infections had bacterial co-infections, and among severe and moderate COVID patients, around 20-25% had antimicrobial resistant bacterial infections [26].…”