bluuebunny/crossref_metadata_2025 huggingface dataset:
Litigations following spinal neurosurgery in France: “out-of-court system,” therapeutic hazard, and welfare state
Authors: Debono Bertrand , Gerson Carole , Houselstein Thierry , Lettat-Ouatah Lynda , Bougeard Renaud , Lonjon Nicolas
Published: November 2020

OBJECTIVE

Spinal surgeries carry risks of malpractice litigation due to the random nature of their functional results, which may not meet patient expectations, and the hazards associated with these complex procedures. Claims are frequent and costly. In France, since 2002, a new law, the Patients’ Rights Law of March 4, 2002, has created an alternative, out-of-court scheme, which established a simplified, rapid, free-of-charge procedure (Commission for Conciliation and Compensation [CCI]). Moreover, this law has optimized the compensation provided to patients for therapeutic hazards by use of a national solidarity fund. The authors analyzed the consequences of this alternative route in the case of claims against private neurosurgeons in France.

METHODS

From the data bank of the insurer Mutuelle d’Assurances du Corps de Santé Français (MACSF), the main insurance company for private neurosurgeons in France, the authors retrospectively analyzed 193 files covering the period 2015–2019. These computerized files comprised the anonymized medical records of the patients, the reports of the independent experts, and the final judgments of the CCI and the entities supporting the compensation, if any.

RESULTS

During the 5-year study period (2015–2019), the insurance company recorded 494 complaints involving private neurosurgeons for spinal surgery procedures, of which 126 (25.5%) were in civil court, 123 (24.9%) were under amicable procedure, and 245 (49.6%) were in the out-of-court scheme administered by the CCI. Out of these 245 cases, only 193 were closed due to delays. The conclusions of the commission were rejection/incompetence decisions in 47.2% of the cases, therapeutic hazards in 21.2%, nosocomial infections in 17.6%, and practitioner fault in 13.5%. National solidarity compensated for 48 complaints (24.8%). The final decision of the CCI is not always consistent with the conclusions of the experts mandated by it, illustrating the difficulty in defining the concept of hazards. The authors found that the therapeutic hazards retained and compensated by the national solidarity included decompensated spondylotic myelopathies (15% of the 40 cases) and cauda equina syndromes (30%). As allowed by law, 11.5% of the patients who were not satisfied triggered a classical procedure in a court.

CONCLUSIONS

In the French out-of-court system, trial decisions resulting in rulings of proven medical malpractice are rare, but patients can start a new procedure in the classical courts. The therapeutic hazard remains a subtle definition, which may be problematic and require further discussion between experts and magistrates. In spite of the imperfections, this out-of-court system proposes a major evolution to move patients and medical providers from legal battles to reconciliations.
The ethical and legal status of neurosurgical guidelines: the neurosurgeon’s golden fleece or Achilles’ heel?
Authors: Tewarie Ishaan Ashwini , Hulsbergen Alexander F. C. , Volovici Victor , Broekman Marike L. D.
Published: November 2020

Neurosurgical guidelines are fundamental for evidence-based practice and have considerably increased both in number and content over the last decades. Yet, guidelines in neurosurgery are not without limitations, as they are overwhelmingly based on low-level evidence. Such recommendations have in the past been occasionally overturned by well-designed randomized controlled trials (RCTs), demonstrating the volatility of poorly underpinned evidence. Furthermore, even RCTs in surgery come with several limitations; most notably, interventions are often insufficiently standardized and assume a homogeneous patient population, which is not always applicable to neurosurgery. Lastly, guidelines are often outdated by the time they are published and smaller fields such as neurosurgery may lack a sufficient workforce to provide regular updates. These limitations raise the question of whether it is ethical to use low-level evidence for guideline recommendations, and if so, how strictly guidelines should be adhered to from an ethical and legal perspective. This article aims to offer a critical approach to the ethical and legal status of guidelines in neurosurgery. To this aim, the authors discuss: 1) the current state of neurosurgical guidelines and the evidence they are based on; 2) the degree of implementation of these guidelines; 3) the legal status of guidelines in medical disciplinary cases; and 4) the ethical balance between confident and critical use of guidelines. Ultimately, guidelines are neither laws that should always be followed nor purely academic efforts with little practical use. Every patient is unique, and tailored treatment defined by the surgeon will ensure optimal care; guidelines play an important role in creating a solid base that can be adhered to or deviated from, depending on the situation. From a research perspective, it is inevitable to rely on weaker evidence initially in order to generate more robust evidence later, and clinician-researchers have an ethical duty to contribute to generating and improving neurosurgical guidelines.
Medical malpractice and meningiomas: an analysis of 47 cases
Authors: Boyke Andre E. , Bader Edward R. , Naidu Ishan , Lam Sharon , Alvi Mohammed Ali , Funari Abigail , Agarwal Vijay
Published: November 2020

OBJECTIVE

Among medical practices, surgical fields, including neurosurgery, are at a high risk for medical malpractice litigation. With meningiomas contributing to 10% of the total neurosurgery litigation cases, the aim of this study was to identify demographic characteristics, reasons for litigation, and surgical complications commonly reported in these cases. This analysis serves to increase neurosurgeons’ awareness of factors associated with medical malpractice litigation.

METHODS

The online legal database Westlaw was utilized to query public litigation cases related to the medical management of meningiomas between December 1985 and May 2020. Variables extracted included the following: plaintiff and defendant demographics, litigation category, plaintiff medical complaints, and trial outcomes. The authors compared these characteristics between cases with decisions in favor of the defendant and those with decisions in favor of the plaintiff.

RESULTS

A total of 47 cases met the inclusion criteria. Failure to diagnose (68.1%) was the most common type of malpractice claim, and surgical complications (19.1%), motor weakness (33%), and financial loss (33%) were cited as the most common postoperative complaints. Individual specialties that most often required defense due to malpractice claims were radiology (21.7%) and neurosurgery (19.6%). The jury verdict was in favor of the defense in 51.1% of cases and in favor of the plaintiff in 27.7% of cases. A settlement was reached in 19.1% of cases. The mean payout for a verdict in favor of the plaintiff was $3,409,650.22, while the mean payout for settlements was $867,555.56. The greatest average payout for specialties was in neurosurgery at $3,414,400, followed by radiology at $3,192,960. Cases with a verdict in favor of the plaintiff were more likely to involve an internal medicine physician as a defendant (p = 0.007).

CONCLUSIONS

Over one-half of the cases resulted in a defendant’s verdict with failure to diagnose cited as the most common reason for litigation. Radiology and neurosurgery were the most common specialties for legal cases and also had some of the largest average payouts based on specialty. Motor weakness and financial loss were the most common plaintiff postoperative complaints. These findings may inform surgeons on active measures to take, such as increasing focus on diagnostic accuracy and reducing specific postoperative complaints, such as motor weakness, through risk management and prophylactic measures, to reduce unfavorable legal outcomes.
Determinants of brain tumor malpractice litigation outcome and indemnity payments: a 29-year nationwide analysis
Authors: Tang Oliver Y. , Hartnett Davis A. , Hays Sarah B. , Syed Sohail , Daniels Alan H.
Published: November 2020

OBJECTIVE

Medical malpractice litigation is a significant challenge in neurosurgery, with more than 25% of a neurosurgeon’s career on average spent with an open malpractice claim. While earlier research has elucidated characteristics of litigation related to brain tumor treatment, factors impacting outcome and indemnity payment amount are incompletely understood.

METHODS

The authors identified all medical malpractice cases related to brain tumors from 1988 to 2017 in VerdictSearch, a database of 200,000 cases from all 50 states. The outcome for each case was dichotomized from the perspective of the defendant physician as favorable (defendant victory) or unfavorable (plaintiff victory or settlement). Indemnity payments were recorded for cases that resulted in settlement or plaintiff victory. Univariate regression was used to assess the association between case characteristics and case outcome as well as indemnity payment amount. Subsequently, significant variables were used to generate multivariate models for each outcome. Statistical significance was maintained at p < 0.05.

RESULTS

A total of 113 cases were analyzed, resulting most commonly in defendant (physician) victory (46.9%), followed by settlement and plaintiff victory (both 26.5%). The most common specialty of the primary defendant was neurosurgery (35.4%), and the most common allegation was improper diagnosis (59.3%). Indemnity payments totaled $191,621,392, with neurosurgical defendants accounting for $109,000,314 (56.9%). The average payments for cases with a plaintiff victory ($3,333,654) and for settlements ($3,051,832) did not significantly differ (p = 0.941). The highest rates of unfavorable outcomes were observed among radiologists (63.6%) and neurosurgeons (57.5%) (p = 0.042). On multivariate regression, severe disability was associated with a lower odds of favorable case outcome (OR 0.21, p = 0.023), while older plaintiff age (> 65 years) predicted higher odds of favorable outcome (OR 5.75, p = 0.047). For 60 cases resulting in indemnity payment, higher payments were associated on univariate analysis with neurosurgeon defendants (β-coefficient = 2.33, p = 0.017), whether the plaintiff underwent surgery (β-coefficient = 2.11, p = 0.012), and the plaintiff experiencing severe disability (β-coefficient = 4.30, p = 0.005). Following multivariate regression, only medical outcome was predictive of increased indemnity payments, including moderate disability (β-coefficient = 4.98, p = 0.007), severe disability (β-coefficient = 6.96, p = 0.001), and death (β-coefficient = 3.23, p = 0.027).

CONCLUSIONS

Neurosurgeons were the most common defendants for brain tumor malpractice litigation, averaging more than $3 million per claim paid. Older plaintiff age was associated with case outcome in favor of the physician. Additionally, medical outcome was predictive of both case outcome and indemnity payment amount.
Post-traumatic Sacral Epidermoid Cyst Masquerading as Chordoma on Imaging: A Case Report
Authors: Phuyal Subash , Prabhakar Anuj , Bala Parthiban , Gaikwad Sailesh
Published: November 2020

Intradural spinal epidermoid cysts are rare, benign lesions either acquired from trauma, surgery, lumbar puncture or arise as congenital lesions, particularly associated with spinal dysraphism. Epidermoid cyst arising from the spine with expansile destruction of vertebrae has not been reported yet in the literature. We report a case of 36-years male presented with history of fall 8 years back with progressive symptoms of lower back pain, weakness of left lower limb and bladder/bowel incontinence. Computed tomography revealed large lytic expansile, midline sacral vertebral lesion with soft tissue component and multiple calcific foci. Magnetic resonance imaging demonstrated large non-enhancing heterogeneous mass showing restricted diffusion on diffusion weighted images. The patient underwent biopsy confirming the diagnosis of an epidermoid cyst. The possibility of an epidermoid tumor should be kept in the differential diagnosis in patients presenting with post-traumatic sacral mass.
Knowledge and Attitude Regarding Patients Right among Nurses in a Teaching Hospital: A Descriptive Cross-sectional Study
Authors: Gurung Tara , Neupane Srijana
Published: November 2020

Introductions: It is important to maintain trust and satisfaction among patients. The health personnel take an important role to overcome their right. The objective of this study was to find out knowledge and attitude regarding patients' rights among nurses in Teaching Hospital.

Methods: A descriptive cross sectional study was conducted among 122 nurses in different wards of Teaching Hospital. Nurses were selected by using simple random sampling technique for data collection. Ethical clearance was taken from Chitwan Medical College institutional reviewers Committee (CMC-IRC) to conduct the study. A structured, self- administered questionnaire and five-point Likert scale were used to analyze the collected data. Data was collected from 27th Ashadh to 9th Shrawan 2075.

Results: This study revealed that out of 122 respondents, 30 (24.6%) of respondents have an adequate level of knowledge whereas about half 62 (50.8%) of respondents had favorable and 60 (49.2%) had an unfavorable level of attitude regarding patients right. Sixty-one (50%) of the nurses were from the age group <22 years, 27 (77.9%) were unmarried, about 93 (76.2%) of nurses had completed Proficiency Certificate Level Nursing, 101 (82.2%) had work experience less than 24 months.

Conclusions: According to the study, it concluded that one-fourth of the respondents have an adequate level of knowledge, one-half of the respondents had a favorable attitude. Therefore, knowledge and attitude regarding patients' rights should be increase through in-service education and seminars should be organized by the administration to promote quality health care service.
Anomalous Coronary Artery Variant of Common Origin from Right Coronary Cusp: A Case Report
Authors: Ullah Aziz , Rana Ramesh , Hirachan Anish
Published: November 2020

Coronary artery anomalies are rare congenital variants of coronary artery anatomy accountingsecond most common cause of sudden cardiac death in young competitive athletes. A single ostiumcoronary artery anomalous is an extremely rare variant with an incidence of less than 0.004%. Theymay present as chest pain, arrhythmia, or sudden death. Recently, advanced imaging techniques suchas computed tomography and magnetic resonance imaging coronary angiography are becoming thealternatives investigation for diagnosis. We reported a rare case of 50 years old lady who presentedwith acute chest pain with normal electrocardiography, echocardiography, and cardiac markers.Coronary Computed tomography angiography revealed anomalous coronary artery anatomy withboth right and left coronary artery arising from the large common trunk of the right coronary cusp,left main coronary artery having trans-septal course, there was no flow-limiting coronary arterydisease. She was medically managed with a single antiplatelet, beta-blocker, and statin therapy.
Emergency Stay Duration of Patients in Emergency Department of A Tertiary Care Hospital in Nepal: A Descriptive Cross-sectional Study
Authors: Simkhada Prashant , Acharya Shradha , Lama Roshan , Dahal Sujata , Lohola Nita , Thapa Ashish
Published: November 2020

Introduction: Emergency department of a hospital is responsible for providing medical and surgical care to patients arriving at the hospital in need of immediate care. Emergency department is not staffed or equipped to provide prolonged care. Duration of stay in the Emergency department directly affects the quality of patient care. Longer length of stay is associated with Emergency department overcrowding, decline in patient care, increased mortality and decreased patients satisfaction. The main aim of this study is to find the mean stay duration of patients in the emergency department of a tertiary care hospital in Nepal.Methods: This is a descriptive cross-sectional study which was conducted in a tertiary care teaching hospital from Jan 15,2019 to Jan 30, 2019. Ethical clearance was obtained from Kathmandu Medical College- Instutional Review Committee. The calculated sample size was 587. Consecutive sampling technique was used. The data thus obtained was entered in SPSS version 20 and necessary calculations were done.

Results: The mean emergency stay duration was obtained to be 3.18 hours at 95% confidence interval (C.I  and standard deviation was 2.51 hours. Female had longer mean duration of stay (3.25 hours) compared to male (3.11 hours). The maximum length of stay was 15.3 hours. Most of the patients attending the emergency department were discharged right through the emergency department 398 ( 67.8%). Mean duration of stay was longest (5.06 hours) for the referral group.

Conclusions: The mean stay duration in Emergency Department of tertiary care hospital in Nepal is getting shorter compared to similar study done previously.
Pain and Oral Health Related Quality of LIfe among Patients Undergoing Fixed Orthodontic Treatment: A Descriptive Cross-sectional Study
Authors: Poudel Prakash , Dahal Sirjana , Thapa Vivek Bikram
Published: November 2020

Introduction: Fixed orthodontic procedures such as separator placement, archwire placement andactivations, application of orthopaedic forces, and debonding of brackets produce pain in patients.This study was conducted to assess pain and oral health-related quality of life among patientsundergoing orthodontic treatment.

Methods: This descriptive cross-sectional study was conducted among 152 orthodontic patients ofa teritary care center from January 2019 to October 2019 after receiving ethical approval from theInstitutional Review Committee (Ref. no. 2311201813). Convenience sampling method was done toselect the participants. Oral health-related quality of life using “Oral Health Impact Profile-14” andpain experienced during the first month of fixed orthodontic treatment were assessed. Data analysisfor calculation of frequency and proportion was done in Statistical Package of Social Sciences.

Results: Mean pain score of the study participants was 5.05±2.07 and their mean oral health impactwas 12.71±7.27. Most of the study participants 86 (56.58%), had experienced moderate pain due toorthodontic treatment. Out of the reported impacts, 134 (88.2%) had painful aching in mouth and 127(83.6%) had difficulty during eating. Least impact was seen in alteration of taste 35 (23%).

Conclusions: The pain intensity experienced by patients was variable. Most participants hadmoderate pain but few patients perceived no pain at all. The participants had at least one or otheroral health impacts due to fixed orthodontic treatment. Orthodontists should counsel the patientsregarding possible discomfort so that there is no discontinuation of treatment due to pain.
Sensitivity of Sinus Radiography Compared to Computed Tomogram: A Descriptive Cross-sectional Study from Western Region of Nepal
Authors: Shrestha Manish Kiran , Ghartimagar Dilasma , Ghosh Arnab , Jhunjhunwala Adarsh Kumar
Published: November 2020

Introduction: Radiography of the paranasal sinuses is commonly used diagnostic modality. However,the trustworthiness of plain radiographic findings of paranasal sinuses is debatable. The intentionof this study was to weigh the diagnostic soundness of plain radiograph of the paranasal sinuses tothat of computed tomogram scan.

Methods: This is a descriptive cross sectional study carried out in 110 participants in Departmentof Radiology of Gandaki Medical College from November 2017 to April 2018. Ethical approval isobtained from Institution review board (Ref. No.39/074/075). Sample size was calculated takingconfidence level of 95%, expected prevalence of 14% and precision of 6.5% in population of 492098 inProvince 4 of Nepal. Random sampling method was used. Data was enter in Statistical Package forthe Social Sciences version 17 software and analysed.

Results: A total of 110 participants are included in this study of which 62 (56.4%) are females and48 (43.6%) are males with an overall mean age of 34.5 years. The commonly involved sinus wasmaxillary 56 (50.9%) followed by ethmoid 33 (30%) sinus. The overall sensitivity and specificity ofdetecting sinusitis by sinus radiography is higher for maxillary sinus (89.7% and 87%) followed byethmoid (69.7% and 96.1%) and frontal (61.5% and 96.9%) sinuses.

Conclusions: Sinus radiography is more sensitive for detecting pathologies in maxillary sinuses,while it is moderate for frontal, ethmoid sinuses and least for sphenoid sinuses. Diagnostic accuracyof computed tomogram scan is more, hence should be recommended to characterize the complexpathology and anatomy of the osteomeatal complex.
Morbidity of School Children in Panauti Municipality of Kavrepalanchowk: A Descriptive Cross-sectional Study
Authors: Manandhar Naresh , Pathak Pratiksha , Lama Prasanna , Joshi Sunil Kumar
Published: November 2020

Introduction: School health has been considered as a high priority intervention in developingcountries but it has not been prioritized in Nepal. The objectives of the study are to find out theprevalence of morbidity and nutritional status in school children.

Methods: A descriptive cross-sectional study was conducted in a private school located at PanautiMunicipality of Kavrepalanchowk district for one week of November 2019. A convenient samplingtechnique was used. From a selected school, a total number of 356 students studying from Grade I toX were included in the study using. Confidence Interval at 95% was calculated along with frequencyand proportion for binary data using Statistical Package for Social Science (SPSS) software.

Results: Among 356 students, the most common three morbidities were dental caries 43 (18.1%),tonsillitis 26 (6.2 %), and headache 18 (7.1 %). Based on weight for age, 43 (23.9%) boys and 22 (12.5%)girls were underweight and 12 (6.7%) boys and 4 (2.7%) girls were overweight and 6 (2%) wereobese. Thus school health programs should give more emphasis on oral health, nutrition, personalhygiene, etc.

Conclusions: The health and nutritional status of school children in this study were found to besatisfactory compared to other studies. The present study emphasized oral health. The schoolhealth program is important in the school for the prevention of diseases like a parasitic infestation,improving personal hygiene, and nutritional status.
Management of Quadruplet Pregnancy: A Case Report
Authors: Lama Lhakpa Dolma , Das Tanya , Neupane Asmita , Lama Roshan , Pandey Rakshya , Karki Urmila
Published: November 2020

Quadruplet pregnancy is a pregnancy state where four fetuses grow simultaneously inside a mother’s womb. Four fetuses developing in a womb is a challenge not only to the mother but to the obstetrician who has to calculate every risk associated with such pregnancy. High order pregnancy is considered a high risk pregnancy due to increase in maternal, fetal and neonatal morbidity and mortality. So a multidisciplinary approach with early involvement of neonatologists and anesthesiologists for the assessment of such case is essential for a successful obstetric outcome. Here we present a case report of 27 years G3P1L1A1 at 33 weeks 2 days of gestation with quadruplet pregnancy with previous lower segment Cesarian section with history of ovulation induction, delivered successfully via cesarean section with successful outcome of all 1 female and 3 male babies.
Preparedness for Coronavirus Disease in Hospitals of Nepal: A Nationwide Survey
Authors: Shrestha Gentle Sunder , Paneru Hem Raj , Acharya Subhash Prasad , Shrestha Sanjeet Krishna , Sigdel Mahesh Raj , Tiwari Sanjeeb , Yadav Bharat Kumar , Rijal Badri , Karki Lochan , Neupane Yogesh , Thapa Narmaya , Lakhey Sanjay
Published: November 2020

Introduction: Coronavirus disease pandemic has affected large number of peopleglobally and has continued to spread. Preparedness of individual nations and the hospitals isimportant to effectively deal with the surge of cases. We aimed to obtain nation wide data fromNepal, about hospital preparedness for COVID-19.

Methods: Online questionnaire was prepared in accordance with the Center for Disease Controlrecommendations to assess preparedness of hospitals for COVID-19. The questionnaire wascirculated to the over 800 doctors across the nation, who are the life members of six medical societies.

Results: We obtained 131 completed responses from all seven provinces. Majority of respondentshad anaesthesiology as the primary specialty. Only 52 (39.7%) participants mentioned that theirhospital had policy to receive suspected or proven cases with COVID-19. Presence of isolationward was mentioned by 83 (63.4%) respondents, with only 9 (6.9%)mentioning the presenceof airborne isolation. Supply of personal protective equipment (PPE) was inadequate as per 124(94.7%) respondents. Critical care services for COVID-19 patients were possible only in hospitals of42 (32.1%)respondents. RT-polymerase chain reaction could be performed only in the hospital of 6(4.6%) respondents.

Conclusions: It is apparent that most of the hospitals are not well prepared for management ofpatients with COVID-19. Resource allocation and policy making should be aimed to enhance nationalpreparedness for the pandemic.
Negative Pressure Pulmonary Edema: A Case Report
Authors: Budhathoki Anisha , Wu Yawen
Published: November 2020

Negative pressure pulmonary edema is an uncommon complication of the extubation of theendotracheal tube. An increase in intrathoracic pressure and negative pressure of the lung causedby acute laryngeal spasm results from acute upper respiratory obstruction causing life-threateningpulmonary edema by alveolar-capillary damage is called negative pressure pulmonary edema. Wehere describe 28-years old female case the preoperative diagnosis of pelvic inflammatory diseaseundergoing exploratory laporoscopy caused negative pressure pulmonary edema while extubation.With the immediate treatment, the patient was discharged without any abnormalities.
Probable Exit Strategy Against COVID-19 of Low Resource Country like Nepal: Open Floor Discussion
Authors: Rajbhandari Bibek , Gurung Minani , Poudel Lisasha , Shrestha Archana , Karmacharya Biraj Man
Published: November 2020

Lockdown is essential for containing the spread of SARS-CoV-2. It is the best measure to maintainextreme social distancing which has been effective in controlling the infection and saving lives.But they are causing huge loss economically, disrupting social life and causing distress around theworld. Reopening too quickly or too boldly without a goal-oriented strategy could mean a secondwave of infection as fierce or even worse as the first. The fundamentals of the virus remain the same –one infected person will, without a lockdown pass it onto three others on average. The consequencesof lifting the lockdown are unforeseeable and the stakes are high. Due to the different spectrumof severity with same strain of virus and uncertainty of post lockdown era, lifting the lockdownwill be a trial and error approach. Nevertheless, at some point the lockdown has to be lifted. Thestrategic approach would be innumerable testing, investigations, strong contact tracing, isolationand follow-up. In a low-income country like Nepal, this will mean negotiating a tricky balancebetween terminating the spread of SARS-CoV-2, and allowing people to recover their livelihoodsbefore they slip into extreme poverty and anguish.
Academic Stress among High School Students in a Rural Area of Nepal: A Descriptive Cross-sectional Study
Authors: Gurung Minani , Chansatitporn Natkamol , Chamroonsawasdi Kanittha , Lapvongwatana Punyarat
Published: November 2020

Introduction: The period of adolescence undergoes many physical and mental changes.Changing emotional and physical status along with increasing social, family, and academicpressure lead to various impairments in the mental health of adolescents. Academic failureleads to the suicide rate in adolescents, predominantly high during the declaration of examresults which is significantly high in a rural area in comparison with urban. The study examinedthe prevalence of academic stress among high school students in a rural area of Rolpa, Nepal.

Methods: A descriptive cross-sectional study was conducted in 6 schools in Rolpa from July to October 2019. The sample size calculated was 521. A convenient sampling technique was used for this study.The target population was adolescents enrolled in high schools of Rolpa. Ethical approval was takenbefore data collection. The scale for assessing academic stress was used to find out the prevalence.A questionnaire was translated in local language and pre-testing was done in Nepal Police School,Sanga among 10% of the calculated sample size. Data entry was done in Statistical Package for theSocial Sciences version 18. Descriptive statistical analysis was done for prevalence calculation. 

Results: Out of a total of 521 students, the prevalence of academic stress was seen among 138 (26.5%)students at a 95% confidence interval (22.72-30.28).

Conclusions: The prevalence of academic stress in our study was high and was consistent with otherSouth Asian studies. Understanding academic stress and providing help and support to the studentswould help ease the burden for them.
Laparoscopic Management of Large Right Paratubal Cyst: A Case Report
Authors: Bhansakarya Rakina , Subedi Shanti
Published: November 2020

Paratubal cysts are generally small but there are rare cases of large paratubal cyst and this case is one of them. Here we report a case of a young female with complains of abdominal fullness since 3 months. On examination, a huge mass (25 x 25 cm) extending from symphysis pubis upto xiphisternum was noted. Ultrasongraphy showed a cystic mass of 27 x 27 cm. Intraoperatively, the cyst was paratubal. It was drained with the help of veress needle and laparoscopic cystectomy was done. A large adnexal cyst extending above umbilicus is traditionally managed by laparotomy. But with the advent of laparoscopy, even a huge cyst can be managed by laparoscopy.
Radial Head Dislocation with Ipsilateral Proximal Shaft of Radius Fracture: A Case Report
Authors: Adhikari Ayush , Acharya Subi , Bhandari Ravi
Published: November 2020

Radial head dislocations are uncommon in adults. They are commonly seen in children and aregenerally associated with proximal ulna fracture. Radial head dislocation with associated proximalradial shaft fracture is rarer than isolated radial head dislocation in adults. Due to the rarity of thiscomplex injury, in the absence of keen observation and meticulous attention, the correct diagnosismight be missed leading to unsatisfactory management and related complications. Here, a similarcase of radial head dislocation with associated proximal radial shaft fracture has been presented.
Cotrimoxazole Induced Steven Johnson Syndrome: A Case Report
Authors: Acharya Ayushma , Acharya Shreedhar Prasad , Bhattarai Tulsi
Published: November 2020

Steven Johnson syndrome and toxic epidermal necrolysis are severe and rare adverse drug reactions usually caused by drugs like antiepileptics, penicillin and allopurinol and sometimes also due to infections, malignancy or idiopathic in some cases. Here we are reporting a case of a 50 years female who came with complaint of a burning sensation on the upper half of the body with atypical flat target lesion that later coalesced involving her face, chest and bilateral upper limbs. On examination, positive nikolsky sign and tenderness with <10% body surface area involvement was noticed. The diagnosis of cotrimoxazole induced Steven Johnson syndrome was made. Patient was shifted to ICU and given supportive care along with prophylactic teicoplanin, itraconazole and dexamethasone. The mechanism of eruptions in our patient was due to cotrimoxazole. Cotrimoxazole induced Steven Johnson syndrome is rare and the supportive management with broad spectrum antibiotic and the corticosteroid was enough to beat this life-threatening condition.
Gartner’s Duct Cyst of the Vagina: A Case Report
Authors: Dixit Baburam , Regmi Mohan Chandra
Published: November 2020

Paramesonephric duct or Mullerian ducts forms female genital organs whereas mesonephric ductforms male genital organs. The remnant of the mesonephric duct or Wolffian duct in femalessometimes forms a mesonephric cyst or Gartner’s duct cyst. They are usually asymptomatic and <2cm but sometimes can be bigger. It is diagnosed with pelvic examination. It is treated with surgicalexcision of the cyst. This is a unique case in urogynecology as it confuses with pelvic organ prolapseand the mode of treatment is completely different. We report a case of 32-years old lady whopresented in urogynecology outpatient department with complain of pelvic organ prolapse. Afterexamination she was diagnosed as vaginal cyst and excision was done and confirmed as Gartnerscyst in histopathological examination.
Prevalence of Acute Kidney Injury in Patients with Liver Cirrhosis
Authors: Thapa Pukar , KC Sudhamshu , Hamal Achyut Bikram , Sharma Dilip , Khadka Sandip , Karki Niyanta , Jaishi Bikash , Tiwari Pratap Sagar , Vaidya Anshu , Karki Binod
Published: November 2020

Introduction: Acute kidney injury is a common and life-threatening event in patients with liver cirrhosis occurring in approximately 20-50% of hospitalized patients of liver cirrhosis. Pre-renal acute kidney injury, the hepatorenal syndrome type of acute kidney injury and acute tubular necrosis represent the common causes. The aim of this study was to study the profile of acute kidney injury in patients with liver cirrhosis.

Methods: Consecutive patients of liver cirrhosis admitted in Liver unit of Bir Hospital were studied to see the presence of acute kidney injury in this hospital based descriptive cross-sectional study. Clinical and laboratory parameters along with various clinical outcome were compared between different groups categorized by the severity of liver disease and renal dysfunction.

Results: Out of 302 liver cirrhosis patients, 56 (18.5%) had acute kidney injury among which 23 (46%) were found to have pre-renal acute kidney injury, 15 (30%) with hepatorenal syndrome– acute kidney injury and 12 (24%) with intrinsic renal disease. Patients with higher stages of acute kidney injury had longer duration of hospital stay and hepatorenal syndrome-acute kidney injury was seen in patients with higher grade of ascites and with hyponatremia.

Conclusions: Acute kidney injury is a common occurrence in patients with advanced liver cirrhosis with pre-renal acute kidney injury being the commonest cause. Median hospital stay is directly affected by the severity of acute kidney injury and hepatorenal syndrome–acute kidney injury was seen in patients with higher grade of ascites and hyponatremia. Early identification of patients at high risk for acute kidney injury may help to reduce mortality and contain costs.
Contextualizing Critical Care Medicine in the Face of Covid-19 Pandemic
Authors: Neupane Harish Chandra , Gauli Basanta , Adhikari Shital , Shrestha Niki
Published: November 2020

Critical Care Medicine is a specialty dealing with the comprehensive management of patientshaving, or at risk of developing, acute, life threatening organ dysfunction. The glaring need of criticalcare services and human resources for critical care have become more evident in the face of thecurrent COVID-19 Pandemic. At this juncture, when the world is facing threat to humanity with anincreasing number of deaths due to COVID 19 pandemic, the discussion about the need for ICU bedsand human resources for critical care management has re-surfaced and is being increasingly realized.In Nepal, as of 15th April, 2020, there are 194 hospitals with ICU facilities. The total ICU bed strengthis 1595 in 194 hospitals (which is approximately 6% of all hospital beds) and only around 50% of themare equipped with ventilators (840). These figures indicate that Nepal has approximately 2.8 ICUbeds per 100,000 population. As Nepal braces to contain a major COVID-19 outbreak, the hospitalcapacities of the country have already come under huge pressure. If the number of confirmed casesof COVID-19 continue to rise at the current pace, the shortage of critical care facilities will becomemore glaring than ever before.The current pandemic is a tremendous opportunity for health planners to accelerate action andensure that the country is well-equipped to contain the COVID-19 pandemic. We need to be workingtowards infrastructure and human resource strengthening and expansion in critical care, in order toefficiently contain the pandemic.
Abnormal Fetal Echocardiography in Diabetic Pregnant Women at a Tertiary Care Hospital: A Descriptive Cross-sectional Study
Authors: Sharma Jyotshna , Tiwari Sanjeeb
Published: November 2020

Introduction: The sedentary lifestyle of women and change in their food habits has a significantrole in developing diabetes in pregnancies. This leads to an increased chance of fetal cardiacabnormality born by a mother with gestational diabetes and pre-existing diabetes. The objectiveof the study is to find out the prevalence of abnormal fetal echocardiography in gestational andpre-existing diabetic pregnant women at a tertiary care hospital.

Methods: A descriptive cross-sectional study was conducted among 104 diabetic pregnantwomen in a tertiary care hospital from April 15, 2017, to April 14, 2018. Ethical approvalwas obtained from the institutional review committee. The convenient sampling method wasused. The patients who were diagnosed as gestational diabetes and diabetic before pregnancywere included in the study. Fetal echocardiography was mainly done at a gestational age of22-32 weeks depending upon the time of diagnosis of gestational diabetes and for pre-diabeticwomen, fetal echocardiography was done at 24-26 weeks of gestation. Statistical analysis wasdone using the Statistical Package of the Social Sciences version 20.

Results: Among 104 patients, 16 (15.38%) patients had abnormal fetal echocardiography.Eighty-three (79.81%) were gestational diabetics, 21 (20.19%) were pre-existing diabeticwomen. Among 83 gestational diabetes, 7 (8.4%) had abnormal echo finding and among 21pre-existing diabetics, 9 (42.8%) had abnormal echo finding.

Conclusions: There was an increased chance of fetal cardiac malformation in gestational diabeticand pre-existing diabetics diabetic especially in an uncontrolled glycemic state. And, if theywere diagnosed prenatally, clinical outcomes for both mother and fetus would have been better.
Self-medication Practices among the Peri-urban Households of Two Communities of Dharan Sub-metropolitan city of Eastern Nepal: A Descriptive Cross-sectional Study
Authors: Chapagain Kumud , Rauniyar Gajendra Prasad
Published: November 2020

Introduction: Self-medication practice is the use of medication without prescription of health care professionals. Drug resistance, drug side effects, wastage of resources, and serious health hazards including death are associated with self-medication. We conducted this study to find out the prevalence of self- medication among the peri-urban population of two randomly selected communities of Dharan, Nepal.

Methods: A descriptive cross-sectional study was conducted among people residing in two randomly selected wards of peri-urban areas of Dharan from November 2017 and April 2018 after obtaining ethical clearance (IRC/1030/017). A pretested, structured self-administered questionnaire was used for data collection. Data were collected and entered in Statistical Package for the Social Sciences version 11.5; point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.

Results: Among 426 respondents, the overall prevalence of self-medication was 312 (73.23%) at 95% Confidence Interval (67.83-78.63%). It was more common among female 158 (78.60%). Common symptoms were headache 201 (64.42%), fever 135 (43.26%), gastrointestinal 93 (29.8%) and respiratory illness 87 (27.88%). Analgesics and antipyretics 275 (88.14%) were the most common drugs self- medicated with. Seeking opinion from pharmacist 112 (35.89%) was the commonest method adopted to procure drugs and comfort 127 (40.7%) and time constraints 122 (39.1%) were the commonest reasons.

Conclusions: Prevalence of self-medication among the peri-urban population was similar to other studies. Headache and fever was the common symptoms for which self-medication were adopted. Awareness regarding potential dangers of self-medication and different drug side effects are recommended at the community level.
Study of Menopausal Symptoms using Menopause Rating Scale at a Tertiary Care Center: A Descriptive Cross-sectional Study
Authors: Pandey Asmita , Karki Chanda , Shrivastava Veena Rani , Shrestha Dipty , Gautam Pratigyan
Published: November 2020

Introduction: Menopause is the permanent cessation of menstruation for more than a year resulting from the loss of follicular activity of the ovaries. It is manifested by vasomotor, psychological, and urogenital symptoms which can be assessed by an internationally accepted scale known as Menopause Rating Scale. This study was conducted to find out the issues of perimenopausal women and proceed for management and proper counseling.

Methods: A descriptive cross-sectional study was conducted among women visiting the gynecological outpatient department of a tertiary care hospital from June 2017 to May 2018 using the Menopause Rating Scale. Ethical approval was taken from the Institutional Review Committee (reference number: 20122016). Convenient sampling was done. Statistical Package for the Social Sciences version 20.0 was used for data analysis. Point estimate at 90% confidence interval was calculated along with frequency and proportion for binary data.

Results: Out of 189 perimenopausal women interviewed, the mean age of menopause was found to be 50.2±2.1 years. The most common gynecological symptoms among the study population was abnormal uterine bleeding 66 (34.9%) followed by abnormal vaginal discharge 50 (26.5%). Among symptoms in Menopause Rating Scale, the depressive mood was found in 99 (52.4%) cases followed by joint and muscular discomfort 88 (46.6%) and bladder problems in 87 (46%). None of the women had a score on the Menopause Rating Scale more than 16 and did not require management for their problem.

Conclusions: Most of the women didn't know menopausal symptoms. However, none required intervention from gynecologists for their problems reflecting better quality of life.
Health Co-morbidities and Early Marriage in Women of a Rural Area of Nepal: A Descriptive Cross-Sectional Study
Authors: Manandhar Naresh , Joshi Sunil Kumar
Published: November 2020

Introduction: Early marriage is defined as the marriage of a young person less than 18 years. Early marriage is more prevalent in South Asia as more than half of all child marriage occurs here. Thirtyseven percent of girls in Nepal marry before age 18 years. This study was done to find out the health consequences of early marriage in women of a rural area of Nepal.

Methods: A descriptive cross-sectional study was conducted from 10th to 15th Feb 2020 February in 358 women from Panauti, Kavrepalchowk. The convenient sampling method was used. Ethical approval was taken from the Institutional Review Committee. Economic status was assessed by using Kuppuswamy’s socioeconomic scale. The collected data were analyzed using the Statistical Package for Social Science version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.

Results: The prevalence of early marriage was 187 (52.2%) (47.03 to 57.37 at 95% confidence interval). One hundred sixteen (62%) early marriage women had gynecological problems followed by depression problem 85 (45.5%) and miscarriage 32 (17.1%). The mean age of marriage was 17.2 years. The majority, i.e. 167 (89.3%) of respondents who married earlier were Hindu by religion. Early marriage was observed in 104 (55.6 %) of illiterate women.

Conclusions: The prevalence of early marriage was high. Early married women had a lower level of socio-economic status, lower level of education, which harmed the participants' health status.
Prevalence of Helicobacter Pylori in Endoscopic Gastric Biopsies of Chronic Gastritis Patients at A Tertiary Care Centre
Authors: Tiwari Archana , Rai Ramji , Dahal Prahar , Regmi Sudeep
Published: November 2020

Introduction: Presence and severity of Helicobacter pylori (H. pylori) colonization is an important factor to decide the treatment of chronic gastritis. This study aimed to find the prevalence of H. pylori colonization in chronic gastritis patients.

Methods: This descriptive,cross-sectional study was carried out at the tertiary care center in the the western region of Nepal among the dyspeptic patients undergoing endoscopic gastric biopsy from October 2018 to March 2020 after approval from the Institutional review committee. Convenience sampling was done to reach the sample size. Two hundred fifty cases were included in the study. Data were recorded in proforma and Data analysis was done in the statistical package for social sciences (SPSS 16.0). The severity of H. pylori colonization and gastritis was graded using the Updated Sydney System.

Results: All cases showed chronic gastritis on histopathology. H. pylori were seen in 150 (60%) of cases. Mild, moderate, and severe H. pylori infection was seen in 59, 78, and 13 cases respectively. Out of 59 mild H. pylori cases, 35 (59.32%) had mild chronic inflammation; out of 78 moderate H. pylori cases 51 (65.38%) had moderate chronic inflammation and among 13 severe H. pylori cases, 10 (76.92%) had severe chronic inflammation.

Conclusions: Prevalence of H. pylori colonization is high in chronic gastritis and there is a parallel increase in the severity of gastritis with an increase in the severity of H. pylori load.
Stone Clearance by Computed Tomography after Percutaneous Nephrolithotomy: A Descriptive Cross-sectional Study
Authors: Shah Chitaranjan , Basnet Robin Bahadur , Shah Arvind , Chhettri Prakash , Chapagain Anup , Shrestha Parash Mani , Shrestha Anil
Published: November 2020

Introduction: Percutaneous nephrolithotomy has the highest stone free rate among other procedures with relatively higher complication rate. Post-operative imaging after stone surgeries has not been uniform. This study was done to study about the stone clearance by computed tomography after percutaneous nephrolithotomy.

Methods: The descriptive cross-sectional study was conducted in the Department of Urology, Bir Hospital for six months duration. The patients undergoing percutaneous nephrolithotomy and those with intra-operative fluoroscopic clearance were evaluated with a low dose computed tomography after 48 hours to assess residual fragments its size and location. Patient’s demographics, stone characteristics and complications were compared between the stone free and with residual stone patients.

Results: Out of 72 percutaneous nephrolithotomy performed, 40 patients were included in the study. Low dose computed tomography kidney, ureter and bladder after 48 hours of surgery detected residual fragments in 11 (27.5%) patients. The RFs size of <4mm were found in 7 (63.63%) of cases whereas RFs of >4mm were found in 4 (36.36%). The stone size was 352.47 ± 97.47 mm2 and 254.79 ± 172.68mm2 in group with residual fragments and stone free group respectively.

Conclusions: Low dose computed tomography kidney, ureter and bladder done for assessment of stone clearance after 48 hours of percutaneous nephrolithomy detected residual in around one fourth of patients, however majority of them had residual fragments <4mm. Intra-operative fluoroscopic clearance may over estimate stone clearance after percutaneous nephrolithomy as about one third of patients still may have residual fragments of >4mm size.