bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Profile and Outcome of Acute Glomerulonephritis in a Tertiary Care Centre in the Eastern Nepal
Authors: Shah GS , Yadav SP
Published: July 2024

Introduction: Acute glomerulonephritis (AGN) generally presents as a constellation of findings that includes hematuria, edema, and often hypertension. The study aimed to determine the clinic-biochemical profile and outcome of acute glomerulonephritis in children at tertiary care centre in the Eastern Part of Nepal.
Methods: A prospective study was conducted on all the cases found to have acute glomerulonephritis, and sample size constituted all children between 1 month to 15 year, attending the Renal Special OPD and those hospitalized in pediatric department of BPKIHS from Feb. 2012 to Jan.2013 with acute glomerulonephritis.
Results: There were total of 94 cases of acute glomerulonephritis (AGN), which comprise 3.1% of annual pediatric admissions. 52.1% were female and male were 47.8%. Mean age of presentation was 9.2 yrs. ±3.1 SD. Aetiology of AGN was post infectious glomerulonephritis (PIGN) 84.0%, lupus nephritis 10.6%, mumps nephritis 3.1% and HSP nephritis 2.1%. ASO titer was raised in 34.0%. 47.8% had raised urea, 43.6% had raised creatinine level, >2+ proteinuria was present in 26.6% and pyuria in 34.0%. The common clinical findings at presentation were microscopic hematuria (95.7%), hypertension (86.2%), edema (85.1%), fever(63.8%), oliguria(22.3%), pain abdomen (21.3%) and others. History of sore throat and pyoderma was present in 25.5% and 19.1% respectively. Complications at presentation were hypertensive encephalopathy (9.5%), cardiac failure (9.5%) and acute kidney injury (6.3%). Of 94 cases, 92 cases (97.8%) improved and 2 cases (2.1%) expired due to acute kidney injury.
Conclusion: Acute glomerulonephritis is a significant renal problem in children and is one of the common causes of hospital admission. Early identification and comprehensive monitoring and management is required to prevent morbidity and mortality.
Common childhood symptoms and rural home-treatment practices
Authors: Onyiriuka A N , Francisca E N
Published: July 2024

Introduction: At home, mothers are usually the first to identify symptoms in their children and initiate treatment but there is paucity of information on these initial steps taken by these mothers. The objective of the study is to examine how mothers treat common childhood symptoms at home before presentation in the hospital.
Methods: A hospital-based cross-sectional study along with a structured interviewer- administered questionnaire was used for data collection from 307 consecutive mothers. Data obtained included their children’s presenting symptoms, drugs administered, dosage regimen, source of the drugs, person who prescribed the drugs and storage of drugs. The axillary temperature of all the children were measured, using a mercury thermometer with the arm held firmly to the body.
Results: Fever either alone or in association with other symptoms was the commonest (75.6%) presenting symptom. Among the 232 children reported as feverish by their mothers, 119 (51.3%) had normal body temperature (<37.50C) while the remaining 113 (48.7%) had elevated axillary temperature equal or greater than 37.50C. Analgesics, antimalarials and antibiotics were the three leading classes of drugs administered by the mothers, together accounting for 62.3% of all drugs. Antimalarials was the class of drug whose dosage regimen was most frequently incorrect, being correct in only 21.4% of cases. Mothers and patent medicine dealers accounted for 67.4% of all the prescriptions. The principal source of drugs was the patent medicine stores (62.2%). Of the 307 mothers, 64 (20.8%) administered left over drugs prescribed for a previous ailment. These drugs were stored mostly in closed cupboards and drawers (67.2% of cases) for a period of three to eight weeks (mean 5.2+0.8 weeks). The mothers had difficulty in correctly identifying fever with 51.3% of cases reported as feverish by their mothers having normal axillary temperature.
Conclusions: The present home-treatment practices by mothers regarding their children’s symptoms is greatly deficient. Intervention aimed at improving the situation should include teaching mothers how to give oral drugs correctly, treat local infections, feed and give fluids during illnesses as well as ways of recognizing signs indicating immediate return to the health facility. Training of patent medicine dealers on the basics of drug action is also essential.
Recording vital signs in the emergency room: Con we improve? Alistair Appleby
Authors: Appleby Alistair
Published: July 2024

Audit is the process of measurement of care, intervention designed to improve, and remeasurement. This paper describes the development of an audit in the Emergency department of a large urban hospital in Nepal using blood pressure and pulse recordingrates as measures of care. Two periods, a year apart, were compared. We investigated the impact of several interventions including the institution of a systematic training programme for resident doctors and the appointment of a registrar in EmergencyMedicine. The paper also examines whether more sensitive measures of care can be developed.
The study found an improvement in both parameters over the year studied but this did not reach statistical significance. We describe briefly how our audit could be refined and the potential for, and benefits of, audit in Nepal.
Evaluation of Ejection Fraction in Patients with cardiac Resynchronization Therapy by Two and Three Dimensional Echocardiography
Authors: OM Anil
Published: July 2024

Introduction: Since assessment of left ventricular ejection fraction (LVEF) is crucial for evaluation of patients with cardiac resynchronization therapy (CRT) device both for selection of potential candidates for CRT as well as assessing outcome of therapy, we compared LVEF in patients with CRT device by two dimensional and three dimensional echocardiography.
Methods: Two dimensional echocardiography (2DE) was performed first with CRT device on. LVEF obtained by modified biplane Simpson’s Rule. Then real time three dimensional echocardiography (3DE) was performed by (iE 33, PHILIPS Machine). Procedure was repeated with CRT device off.
Results: A total of 19 patients aged 54.6 ±11.2 years (Range: 32 years to 75 years) were studied. LVEF measured by 2DE and 3DE, with CRT device off, was 22±4% (17-27%) and 24 ±3% (15-27%) respectively. With CRT device on, LVEF measured by 2DE and 3DE was 26.6±4.1% (22-32%) and 31.3±5.8% (25-41%) respectively.
Conclusion: Two dimensional echocardiography underestimates LVEF as compared to three dimensional echocardiography. Cardiac resynchronization therapy (CRT) improves LVEF measured either by two or three dimensional echocardiography.
Characterization of Dietzia natronolimnaea ASO3 Isolated from Arsenic Anriched Water Sources for its Potential to Arsenic Resistance and Removal
Authors: Shakya S , Pradhan B
Published: July 2024

Introduction: Arsenic is a known toxic metalloid ubiquitous in nature and exposure can occur from natural and anthropogenic sources. In organic arsenic both arsenite and arsenate constitute the highest toxicological risk associated with arsenic in drinking water. This study presents the arsenic resistance and removal capacity of a bacterial strain indigenous to arsenic enriched water of Rautahat district, Nepal.
Methods: Identification was carried out by phenotypic and 16S rDNA sequence analysis. The optimal growth conditions regarding temperature, hydrogen ion concentration and salinity; growth kinetics in presence and absence of arsenic, determination of maximum arsenic tolerance concentration, sensitivity to antibiotics, plasmid mediated resistance as well as arsenate reduction and arsenite oxidation and finally arsenic removal potential was determined.
Results: The bacterium, Dietzia natronolimnaea ASO3 showed relatively high resistance to arsenate upto 37,460 mg/l and arsenite up to 374.6 mg/l. It showed optimal growth at 30°C in pH 8. The bacterium conferred resistance to penicillin and removed 47% of arsenite and 51% of arsenate from the medium amended with 200 mg/l arsenate and 74.92mg/l arsenite respectively.
Conclusion: The higher arsenic tolerance to both arsenate and arsenite species with potential for their removal can be explored further for arsenic mitigation and mobilization study.
Disseminated cysticercosis in a child: A Rare Presentation
Authors: Poudel DR , Lhaden T , Shrestha M
Published: July 2024

We here present a rare case of disseminated cysticercosis presented with clouding of cornea with gradual loss of vision in the right eye and multiple nodules all over the body. Opthalmologic evaluation revealed none perception of light on right eye with calcified cyst in entire intraocular lens. MRI of the brain showed starry sky pattern in brain parenchyma and multiple calcified cysts in the orbit. Serological test (ELISA) for cysticercal IgG antibodies was positive. Histopathology report on an excised biopsy from subcutaneous nodule also showed calcified cyst. She was treated initially with steroid for 3 days followed by albendazole for 2 weeks. MRI was repeated after 3 months which showed no resolution of the lesion. Later she presented with generalized seizure managed with anticonvulsant.
Molecular epidemiology of Rotavirus diarrhea among children in Nepal: Emergence of G12 and G9 strains
Authors: Sherchand JB , Tandukar S , Sherchan JB , Gurung S , Dhakwa JR , Bichha RP , Mahaseth C
Published: July 2024

Introduction: Rotavirus is the leading cause of diarrhea and dehydration among infants in both developed and developing countries. The primary objective of this study was to find the magnitude of rotavirus disease burden and genotypic variations of rotavirus.
Methodology: Questionnaires and stool samples were collected from 1003 enrolled children under 5 years of age attending tertiary care Children’s Hospital with acute watery diarrhea during January to December 2012. Rotavirus in stool samples was detected by Enzyme Immuno Assay (EIA) and strains detected from rotavirus positive samples were genotyped by Reverse-Transcription Polymerase Chain reaction (RT-PCR).
Results: Among these, 356 (35.4%) cases were positive for rotavirus by EIA, among the positive cases, 344 samples underwent genotyping by RT-PCR. Rotavirus positive cases were predominant in children who were admitted to the hospital which was 37.8% (115 out of 336). Overall G12 was the most prevalent genotype (52.3%), followed by G1 (17.7%), G2 (10.17%) and G9 (8.1%). The P types identified were P[6] (55.23%), P[8] (20%), and P[4] (12.5%).
Conclusion: The study reveals that rotavirus gastroenteritis accounted for more than one-third of all cases of acute diarrhea. Use of rotavirus vaccines may reduce of high burden of rotavirus diarrhea in children. Emergence of G12 and G9 strains proves the immediate need of vaccine in Nepal.
Medicine as a career choice: motivating factors in Nepalese medical students
Authors: Thakur Amarnath , Ashokraj Prof. Gita , Koirala Shekhar
Published: July 2024

This study was done to investigate the reasons which motivated Nepalese students to choose medicine. The majority of students chose medicine because of their interest in medicine and dedication for service to sick people. A desire for monetary gain and family pressure motivated a few students to choose the medical course. Other motivating factors included social prestige and better employment prospectus.
Risk Factors of cleft malformation in Children
Authors: Khadgi D , Shrestha S
Published: July 2024

Introduction: most children born with cleft malformation (CM) are unable to be breastfeed and require several surgical procedures and complex medical treatments. Therefore, the study was to conducted to determine the risk factors of cleft malformation (CM).
Methods: The sorry used case- control design. Children with CM attending at Morang co-operative hospital were taken as cases, and controls included age (six months) and sex match children for each case for Koshi Zonal Hospital. All cases and controls included were aged below ten years. A semi-interview schedule was used to collect information regarding exposure status.
Results: Majority (80.5% of the case and 78.6% control) children belong to less than five years of age and CM was more common in males (71.4%) than female (37.5%) with cleft lip and palate being the most common type of CM. One - forth (25.0%) after case children had positive family history of CM. Similarly, 10.7% mothers of case children had consumed alcohol during the first trimester of pregnancy. Analysis using chi-square and odds ratio identified positive family history (Odds Ratio 3.4) and maternal alcohol consumption during first trimester (Odds Ratio 4.8) to be significantly associated with CM in the offspring.
Conclusions: Study concludes that positive family history of CM and maternal alcohol consumption during the first trimester tends to be the significant risk factors of CM. Children born to the family with positive history of CM are three times more likely to develop CM and mothers who consume alcohol during first trimester are five times at greater risk of delivering offspring with CM. Burden of complex and expensive cleft treatment can be prevented by minimizing exposure to the identified risk factor.
Severe Anaemia as A Predictor of Mortality in Heart Failure Patients
Authors: Poudel CM , Poudel RR , Jha SC , Sayami A
Published: July 2024

Introduction: Anaemia at the time of diagnosis of heart failure is said to be an independent factor for mortality during the following years. In this study, the effect of severe anaemia at the time of diagnosis, in the outcome of heart failure in the form of in hospital mortality is studied.
Methods: One hundred eighty-four heart failure patients admitted in Manamohan Cardiothoraccic. Vascular and Transplant Centre between September 2011 to March 2012, age above 15 years were enrolled in the study. Baseline investigations and hemoglobin was done and the patients were followed up till discharge or in hospital mortality.
Results: Among the 184 heart failure patients 115(62.5%) had anaemia. When evaluated in a bivariate model, the odds ratio of death for patients with mild anaemia compared with patients with no anaemia was 3.90.6-22.6, p value 0.124) for moderate anaemia 4.5 (0.9-23.07, p value 0.064) and for severe anaemia 46.06 (8.6-246.05, p value 1000), respectively. On multivariate analysis severe anaemia 919 (5.6-149762.9, p value 0.009) was still found to be a significant predictor of mortality
Conclusion: Severe anaemia at the time of diagnosis of heart failure is an independent predictor of in hospital mortality
Maternal Health Seeking Behavior among Pregnant Women in Nepal
Authors: Sayami M , Bhandari S , Tamrakar J , Banjara M R
Published: July 2024

Introduction: Maternal mortality remains a global public health problem. Despite the call to improve access to maternal health care services and reduce maternal mortality, maternal health-seeking behavior in Nepal has remained poor. This study, therefore, aims to assess the awareness regarding pregnancy and health seeking behavior of pregnant women in Nepal.
Methods: House-hold Survey and health camps were conducted from 2011 to 2012 by using structured questionnaires and physical examination of reproductive age women (15 to 49 years) in selected Village Development Committees of nine districts of Nepal. Data entry and analysis was performed by using SPSS version 11.5.
Results: Among the pregnant women, 19.6% (n=235) did not go for Antenatal check (ANC). More than a half of the women having ANC visited Auxiliary Nurse Mid-wife. 15.8% (n=200) of the pregnant women did not receive tetanus toxoid (T.T) vaccine and 16.3% (n=195) did not take iron/folic acid. In comparison to younger age, the odds of having antenatal check-up was increased by two times in the women 25 to 34 years of age (p<0.001, OR=2.166). Women having formal education were more likely to go for ANC than other women were (p=0,002, OR=1.703). Involvement of pregnant women in the community organizations motivated them for ANC visit (p<0.001, OR=2.106). ANC visit had significantly increased T.T vaccination (p<0.001) and consumption of iron/folic acid (p<0.001).
Conclusion: Lack of proper knowledge regarding complications of pregnancy and delivery remains the major challenge in health seeking behaviors. Therefore, raising awareness about its importance can improve maternal and child health.
Extracorporeal Shockwave Lithotripsy Versus Ureteroscopy with Pneumatic Lithotripter in Treating Proximal Ureteric Stones
Authors: Sharma UK
Published: July 2024

Introduction: In recent years, ESWL (Extracorporeal Shockwave Lithotripsy) has proved a ate and easily reproducible method for treatment of calculi in upper urinary tract particularly above iline crest. Recently other modalities, particularly ureteroscopy with LASER lithotripsy and pneumatic lithotripsy (URS/ICPL) to treat the upper ureteric stone are very popular with less morbidities and good stones clearance. So, this study aims to compare the success rate, complications and efficiency of ESWL and URS/ICPL for the upper ureteral stones.
Methods: Patients were prospectively included the radio-opaque, solitary stones of 5 to 20 mm size without evident UTI (Urinary tract infection) located between the UPJ (Uretero- pelvic junction and S1 joint (Sacroiliac Joint) were included. Post procedural X-ray KUB was taken immediately in URS group and three weeks after ESWL group. Immediate and week after patients were assessed for complication. Disintegrations and clearance of the stones were assessed.
Results: Total of 78 patients were included in this study. Of which 46 were in ESWL and 32 were in URS/ICPL groups. Both groups had stones size and location of same size and site. In URS group majority had stone disintegration and clearance with proximal dislodgement of fragment or total stone of 21.9% Multiple sessions needed to clear the stones in ESWL group was 17.3%. DJ Stenting needed after the URS was in 75% of cases.
In ESWL group, disintegration immediately after the procedure was noted in 82.6% of cases. Auxillary services needed after the URS were ESWL, ureterolithotomy, second session URS. Majority did not have major complication in either group. In URS group 12.5% of patients had fever and UTI, treated with conventional antimicrobials. Ecchymosis at the site in ESWL were in 28 cases (p0001) Efficiency Quotient (EQ) for ESWL and URS were 31.8% and 18.2% respectively (p-0.18).
Conclusion: ESWL and URS/ICPL can be offered to patient for treatment of upper ureteric stone with minimal and acceptable complications ESWL can be done on daycare basis whereas URS/ACPL needed to be admitted in hospital.
Limburg Flap Closure for Pilonidal Sinus Disease
Authors: Ghimire B , Singh YP
Published: July 2024

Introduction: Though Pilonidal sinus disease (PSD) is a benign disease it can be debilitating at times. Though there are many techniques for treating the disease, they have prolonged recovery and risk of recurrence. Limberg flap repair is a novel technique as it is curative with minimal incidence of recurrence and the healing is better
Methods: All patients diagnosed with PSD irrespective of their age were included in the study and underwent Limberg Flap Closure under spinal anesthesia in prone position.
Results: During the study period of two years, eleven patients were operated. Most of them were young males. Admission was usually for 4 days (3 to 7 days). One patient had superficial surgical site infection which healed after 10 days one patient developed seroma which was asymptomatic and three patients had hypoesthesia on the upper portion of the flap. There was no recurrence over three years follow up
Conclusion: Limberg Flap Closure for Pilonidal Sinus Disease is a safe procedure with acceptable morbidity and less risk of recurrence.
Falcine Meningioma with Massive Calvarial Hyperostosis
Authors: Subedi K , Suwal S , Chataut D , Paudel S
Published: July 2024

Meningiomas are neoplasms of meningeal origin. Hyperostosis is a peculiar but common sign of meningioma. Though common in skull base meningiomas, massive calvarial hyperostosis is rare in the vertex, with only few reported cases. We report a rare case of massive calvarial hyperostosis due to falcine meningioma, illustrated with multimodality imaging.
Open Anderson Hynes Pyeloplasty in Ureteropelvic Junction Obstruction: An Institutional Experience
Authors: Subedi PP , Chapagain S , Thakur DK , Poudyal S , Luitel BR , Chalise PR , Sharma UK , Gyawali PR , Shrestha GK
Published: July 2024

Introduction: Ureteropelvic junction obstruction (UPJO) is one of the common causes of hydronephros is in children and adults. The cause may be congenital or acquired. The standard management of UPJO has classically been an open Anderson-Hynes (A-H) dismembered pyeloplasty. This study is an audit of A-H pyeloplasty done for patients with UPJO presenting to our institution.
Methods: A retrospective analysis was done in the Urology unit, Tribhuvan University Teaching Hospital from July 2013 to November 2014. All patients undergoing A-H pyeloplasty were included for review. Preoperative data regarding the demographics, presentation, diagnostic tools used, details of the surgery, postoperative complications, duration of hospital stay and follow up findings were reviewed. Initial follow up was scheduled at two weeks, then at three months and at one year. At 3 months, DTPA renogram was obtained to assess the function and clearance of the treated kidney.
Results: The age of the patients ranged from 5 months to 69 years. Flank pain was the most common presenting complain. Most of the patients were males and left sided obstruction was common. The most common diagnostic modality used was USG and excretory urography. CT urography was done in cases of secondary UPJO. DTPA scan was used in select cases for baseline documentation of the function of the involved kidney. The average duration of surgery was 2 hours and 30 minutes. The mean duration of hospital stay was 5 days. The most common complication was urinary tract infection.
Conclusion: Open A-Hpyeloplasty is the most common surgery done for UPJO at our institution. The outcome can be improved by attention to the principles of A-H pyeloplasty.
Nephrotic syndrome in Nepalese children: clinical profile, histopathology and outcome in a tertiary care center of Nepal.
Authors: Basnet S , Poudel DR , Khanal S , Thapa NB
Published: July 2024

Introduction: The demographic, clinical features, steroid response, histopathology and complications of all children diagnosed with nephrotic syndrome at Tribhuvan University Teaching Hospital over a 3-year period.
Methods: A retrospective study was conducted among patients who were admitted in the Pediatrics ward of Tribhuvan University Teaching Hospital with the diagnosis of Nephrotic syndrome from April 2010 to April 2013.
Results: During the study period from 2010 April to 2013 April, there were total of 80 patients admitted with the diagnosis of nephrotic syndrome. There was male preponderance with sex ratio 1.28:1. Mean age of patient at first episode was 8.51±4.33 years. Among the admitted patients, 48.8% (41) of children had single episode whereas steroid resistance was observed in 16.2% (13) of patients. Hematuria and hypertension were present in 21.2% (7) and 50% (40) of patients respectively. Renal dysfunction was present in 21.2% (17). Pneumonia was the most common complications 18.8% (15), followed by UTI 8.8%(7), spontaneous bacterial peritonitis 3.8% (3) and acute renal failure 7.5% (8). Two patients had multiple complications. Alternative therapies were used in 25% (20) of patients and cyclophosphamide was used most commonly as alternative therapy which was used in 17.4% (14). Most common histopathological diagnosis was FSGS 30.3% (10) followed by MPGN 15.5% (5), SLE nephropathy 15.5% (5) and IgA nephropathy 15.5% (5)
Conclusion:
The clinical course of childhood NS in Nepal is similar to the developed world. Differences at Presentation included older age and increased prevalence of microscopic hematuria, hypertension
Colour vision deficiency in Nepalese Medical and Nursing Students of different ethnicity
Authors: Mahotara NB , Shrestha L
Published: July 2024

Introduction: Colour vision deficiency is a common but unnoticed condition. Medical students must be aware of their congenital colour vision deficiency and its effects on their work, so that color vision deficient student may not choose the discipline such as pathology and radiology, where colour vision is very important.
Methods: This is a cross-sectional study conducted in the Department of Clinical Physiology, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu from February 2013 to January 2016. Total of 556 medical and nursing students selected by convenient sampling, underwent color vision evaluation by using Ishihara chart.
Results: Out of 302 male students, 20 (6.6%) were color vision deficient. Similarly, out of 254 female students, two (0.8%) were colour vision deficient. Among the male students, two (10%) were total colour blind, eight (40%) were suffering from deuteranomaly and 10 (50%) were suffering from deuteranopia. Colour vision deficiencies were observed more in Chhetri (9.5%), followed by Brahmin (7.1%) and Madhesi ethnicity (6.9%).
Conclusion: The prevalence of colour vision deficiency in Nepalese medical students is significant. Therefore, they should be screened for colour vision deficiency, so that the students with colour vision defect can choose appropriate discipline as their future carrier where colour vision defect may not affect their work.
Risk factors for redisplacement in pediatric distal radius fractures after closed reduction and cast immobilisation
Authors: Ghimire N , Uprety S , Lamichhane A
Published: July 2024

Introducation: Pediatric distal radius fractures are one of the most common fractures that we see in our practice. The primary modality of treatment of the displaced fractures of distal radius in children is closed reduction and immobilization in cast. Loss of alignment in cast after an acceptable reduction is common. Twenty one to fifty percent rates of redisplacement in cast after acceptable initial reduction have been reported in literature.
Methods: This prospective study included 58 fractures of distal radius and distal third shaft of radius in 57 children with radiologically open physis. Age, gender, initial displacement, associated fracture of the ulna, adequacy of reduction, cast index and gap index were evaluated as possible risk factors for redisplacement in cast.
Results: A redisplacement rate of 34.48%was found in distal radius fractures of children after acceptable initial closed reduction and immobilization in cast. Initial complete displacement, degree of initial translation in coronal and sagittal plane, degree of initial angulation in the coronal plane, associated fracture of the ulna, non anatomical initial reduction and cast index were found to be significant risk factors for redisplacement. Age, gender, initial angulation in the sagittal plane and gap index were insignificant risk factors.
Conclusion: Distal radius fractures in children have high rate of redisplacement in cast. Fractures with initial complete displacement, fractures with associated fracture of ulna and non-anatomically reduced fractures should either be treated by primary closed reduction and percutaneous pinning or must be followed very carefully in cast treatment. Cast index rather than gap index is a better predictor of loss of reduction in cast.
Evaluation of image quality in CT chest by 50% mAs reduction
Authors: Thapa N , Humagain MP , Mishra D , Shrestha SI , Ansari MA
Published: July 2024

Introduction: Conventional chest CT is usually performed in the setting between 220-280 mAs. Increase use of CT in recent times has the potential to increase radiation burden to the general population. The purpose of this study was to evaluate the image quality in CT Chest with 50% mAs reduction.
Methods: This prospective study was done in 101 patients with age above 18 years and BMI less than 25kg/m2 who were referred for CECT chest examination. A 16 slice multi detector CT scanner was used to acquire non contrast at 120 kVp and 140 mAs, a modified protocol with 50% reduction in mAsand contrast enhanced scan at standard protocol of 120 kVp and 280 mAs. The images of plain and contrast enhanced scans were evaluated by two expert radiologists and given the image quality score in 5 point scale (1-worst, 2-suboptimal, 3- adequate, 4-good, 5-excellent) to each. Im- age noise was measured in images of each patient. Patient weight, height and BMI were recorded and correlated with image quality score. Statistical analysis was done with relevant test.
Results: The overall image quality with standard protocol was significantly better (p<0.05) than modified protocol. The modified protocol had acceptable image quality score for patients with weight< 60 kg, BMI<25kg/m2. The CTDIvol was 11.15 with reduced mAs and 22.15 with standard mAs resulting in significant reduction in radiation dose of about 49%.
Conclusion: Image quality of modified protocol with 50% mAs reduction i.e.140 mAs is accept- for average built patients and not patients with large anthropometric parameters.
New onset diabetes after transplant in renal transplant recipients
Authors: Nepali R , Shah DS
Published: July 2024

Introduction: New onset diabetes after transplantation (NODAT) is a common complication of renal transplantation. Despite its prevalence and importance, the data on NODAT and its risk factors in Nepalese population are lacking and the incidence and risk factors for NODAT in Nepalese population who underwent renal transplantation at Tribhuvan University Teaching Hospital.
Methods: All the patients who underwent living donor kidney transplantation at Tribhuvan University Teaching Hospital between August, 2008 and February, 2016 were included in this study. Patients who were diagnosed with diabetes mellitus before transplantation were excluded from the study. Patients were divided into NODAT and Non-NODAT groups. Then, risk factors were compared between the two groups.
Results: A total of 350 patients who underwent living donor renal transplantation at our hospital during the study period were included. 23 patients who were diagnosed cases of Diabetes Mellitus before transplantation were excluded. In the remaining 327 cases, the incidence of NODAT was 19.57% (64 patients). Most of them (95.31%) occurred within the first 12 months’ post transplantation. The mean duration of onset of NODAT was 121.46 ± 275.58 days post transplantation. Age of the recipient greater than 45 was significantly associated with NODAT than non-NODAT patients. However, there was no statistical difference in sex between NODAT and non-NODAT patients.
Conclusion: NODAT is common complication after renal transplantation. Age of recipient > 45 years is a significant risk factor for the development of NODAT. So, we have to be more vigilant in these patients
Private production of human resources for health: geographic distribution, students intake and course fees
Authors: Sigdel R
Published: July 2024

Introduction: After 1990 change of government in Nepal, private sector's role in health care system became increasingly prominent. However, in absence of scientific evidence doldrums and conundrums characterised major debates around the perceived and projected roles of the sector. This work reflects on the findings of a research commissioned by the Ministry of Health and Population as part of the private health sector assessment. Here three aspects of the private sector's role in production of human resources for health - geographic distribution, students’ intake and course fees are reported.
Methods: A stratified random sample of 44 out of 122 private Health Science Institutes was taken for inclusion in the study. Telephone contact with the principals and administrative chiefs of the selected Institutes was followed by data collection using structured interviews based on questionnaires developed through a consultative process. Guided conversation with officials of professional councils and policy makers in the Ministry of Health and Population was conducted. Data were quantitatively analysed to calculate summary measures and distribution.
Results: A third (36.89%) of Institutes was in Kathmandu valley, with 23.77% within Kathmandu city area of the valley, exlcuding parts of Bhaktapur and Lalitpur. Next was Parsa and Chitwan (15.57%), followed by Morang (9.02%) and Kaski (7.38%). Rest of the country had less than a third of total Institutes (31.14%). More than a half (59.84%) were in central region, 17.21% in eastern region, 13.11 % in western region, 7.38 in far western region and 2.46% in mid-western region.
A dominant fraction of the Institutes fed on fees by domestic students only (79.55%), with only a fifth (20.45%) of the Institutes having domestic as well as foreign students. Among this fifth of the Institutes foreign students were enrolled only in Bachelor of Medicine and Bachelor of Surgery and Bachelor of Homeopathic Medicine and Surgery.
Tuition fees among the Institutes had two-fold gap between the lowest and the highest for the same degree programmes ranging from auxiliary to masters levels.
Conclusions: We urge the government to utilise scientific evidence coming from this work and previous local and international examples in prioritising the revision of existing policies, plans and regulations regarding private sector's role in the development of human resources for health. We also recommend further research to contest, verify or extend the knowledge coming from this work.
Streptococcus pneumoniae among children with clinical meningitis in Nepal
Authors: Sherchan JB , Tandukar S , Shrestha L , Rai GK , Sharma A , Gami FC , Rijal B , Sherchand JB , Ohara H
Published: July 2024

Introduction: Invasive bacterial disease is a significant cause of morbidity and mortality worldwide and it is a major cause of childhood deaths in Nepal. Streptococcus pneumoniae is responsible for invasive and non-invasive pneumococcal diseases worldwide, such as pneumonia, bacteremia and meningitis. The aim of the study was to isolate, identify and determine antimicrobial susceptibility pattern of Streptococcus pneumoniae along with use of rapid immunochromatographic test “Binax NOW”, to detect antigen for diagnosis of bacterial meningitis.
Methods: The study was carried out from October 2013 to September 2015 in Children’s Hospital, Teaching Hospital-Department of Child Health and Public Health Research Laboratory, Institute of Medicine, Kathmandu, Nepal. Cerebrospinal fluid sample from 339 suspected cases of meningitis from children below 15 years of age were examined for identification by Gram staining, Culture and by Binax Now test. The identification of bacteria was done following standard method recommended by American Society for Microbiology. Antibiotic sensitivity testing was done by modified Kirby- Bauer disk diffusion method.
Results: Of total 339 suspected cases, 24(7.08%) bacterial meningitis was detected by Gram staining and culture methods whereas BinaxNow method detected 28(8.26%). On the basis of age, the highest numbers of the positive cases were found in the age group between 0-23 months (9.30%) followed by age group 49-60 months (8.16%)
Conclusions: In conclusion, a significant rate of bacterial meningitis was found in this study prompting concern for national wide surveillance.
Assessment of the level of knowledge regarding safe abortion among reproductive age group women, a short cross sectional study in lekhnath, kaski
Authors: Acharya A , Bhattarai S
Published: July 2024

Introduction: Overall situation of reproductive health and the quality of life of females are not satisfactory in developing countries. Complications from unsafe abortion result in maternal deaths and abortion-related morbidities worldwide, placing high strain on limited health system resources and leading to severe physical, psychological, and financial consequences for women1.
Methods: A cross sectional descriptive study carried out in 50 reproductive age group women living in Lekhnath municipality-12 at Kaski, Nepal and sample size was determined by using non probability purposive sampling where data were taken under the consent of individual using semi structured interview schedule and were analyzed using SPSS version 11.5.
Result: Regarding the type of the abortion, 40% knew about induced abortion, 16% knew about spontaneous abortion whereas 44% knew about both induced and spontaneous abortion. Among the respondents who heard about safe abortion, only 28% gave the correct meaning about safe abortion whereas rest 72% gave incorrect meaning about the safe abortion. The respondents who heard about safe abortion, there was only 51% knows about the legal period of safe abortion for women and remaining 49% of them did not have any idea for legal time of legal abortion. In addition, 40% of respondents had high as well as fair level of knowledge about safe abortion and 20% of the respondents had low level of knowledge regarding safe abortion.
Conclusion: Reproductive rights are the rights of individuals to decide whether to reproduce and have reproductive health. The present study highlights the knowledge on reproductive age group women of Lekhnath, Kaski and knowing about safe abortion is important as it helps to enhance equity and gender equality, share the burden of preventing diseases and health complications, promote satisfying sexual lives for men and women.
Co-existence of aminoglycosides and β-lactam-resistant Escherichia coli phenotypes in a Tertiary care center of Nepal
Authors: Shrestha B , Tada T , Shrestha S , Kattel HP , Ohara H , Kirikae T , Rijal BP , Sherchand JB , Pokhrel BM
Published: July 2024

Introduction: Multidrug-resistant Escherichia coli isolates conferring simultaneous resistance to both aminoglycosides and β-lactam drugs have serious implications for clinicians worldwide. This study was designed to evaluate the co-existence of various β-lactamases in aminoglycoside- resistant Escherichia coli amongst hospitalized subjects in a tertiary care center of Kathmandu, Nepal, between December 2013 and December 2014.
Methods: Standard microbiological techniques were used for isolation and identification of the isolates. The antimicrobial susceptibility of bacterial isolates was determined following Clinical and Laboratory Standard Institute recommended Kirby-Bauer Disc Diffusion method. The defining criterion in this study for an isolate to be MDR, resistance to at least one agent in three or more than three different structural classes was taken.
Results: Among 302 MDR E. coli isolates, 174 (58.0 %) were resistance to gentamicin and 138 (46.0 %) were resistance to amikacin. Maximum aminoglycoside-resistant 9/11(82.0%) strains were isolated from body fluids followed by 7/10 (70.0%) from bile, 6/9 (67.0%) from blood and 2/3 (67.0%) from tissue. Out of 174 aminoglycosides-resistant E. coli isolates, the simultaneous occurrence of Extended-spectrum- b- lactamase (ESBL) and AmpC β–lactamaseswas noted in 13.0 % isolates and Metallo-β-lactamase (MBL) and AmpC β–lactamasesin 8.0 % isolates. None E. coli isolates were positive for all 3 types of β–lactamases in combinations. In amikacin- resistant isolates, ESBL+ AmpC observed in 12% and MBL+AmpC seen in 10% isolates.
Conclusion: Our results show a high frequency of aminoglycoside- resistance phenotypes. Strict application for appropriate use of antimicrobials in medical settings should be essential to minimize the emergence of multidrug-resistance among E. coli in hospitalized patients.
Differentiation of Crohn’s disease from intestinal Tuberculosis and Ulcerative Colitis: a single tertiary centre experience in Nepal
Authors: Hamal R , Pathak R , Kafle B , Khadga PK , Sharma S
Published: July 2024

Introduction: Differentiating intestinal luminal tuberculosis from Crohn’s disease (CD) is an important clinical challenge of considerable therapeutic significance. Likewise differentiating ulcerative colitis from Crohn’s disease with colonic or ileocolonic involvement is difficult. The aim of this study was to investigate the clinical, endoscopic, radiologic and histological features that will help to differentiate Crohn’s disease from intestinal luminal tuberculosis as well as from ulcerative colitis.
Methods: A total of 40 patients diagnosed with Crohn’s disease, Intestinal luminal TB and Ulcerative colitis who were admitted under the Gastroenterology Department TUTH from July 2017 to February 2018 were included in this retrospective study. Clinical, endoscopic, radiologic, histopathologic and microbiologic features as well as response to treatment of these patients were studied in detail.
Results: Among 40 patients, Intestinal TB was diagnosed in 52.5% patients, ulcerative colitis in 32.5% patients and Crohn’s disease in 15% patients. There was a higher incidence of fever, night sweats, lung involvement and ascites in Intestinal TB whereas diarrhea, perianal disease, hematochezia and extraintestinal were predictive for Crohn’s disease. Similarly on colonoscopy involvement of IC valve, patulous IC valve and transverse ulcers favored a diagnosis of intestinal TB in contrast to Crohn’s disease where longitudinal ulcers, aphthous ulcers, cobblestone appearance and rectal involvement were seen. Similarly the diagnosis of Ulcerative colitis was favored by rectal involvement and contiguous involvement whereas patients with Crohn’s disease had significantly more deep ulcers, cobblestoning, skip areas and ileal involvement.
Conclusions: Crohn’s disease must be differentiated from Intestinal luminal TB and Ulcerative colitis before treatment. According to our study, a combination of clinical, endoscopic, serologic, radiologic, histopathologic and microbiologic features can be utilized in order to reliably predict and distinguish Crohn’s disease from Intestinal luminal TB and from Ulcerative colitis. In complicated cases deep enteroscopy and surgery may be needed before a confident diagnosis is reached.
A retrospective analysis of parasitic diseases diagnosed by tissue biopsy: a 7- year study
Authors: Manandhar U , Karki S , Shrivastav S
Published: July 2024

Introduction: There are wide varieties of parasites that can infect humans involving various tissues and organs. Parasitic diseases are common in developing countries associated with poverty and poor sanitation. Non-endemic developed areas also show increasing trend of disease as a result of immigration. Morphological identification of parasitic structure along with inflammatory reaction in the surrounding tissue forms the mainstay of diagnosis of parasitic diseases on histopathology.
Methods: The present study was a retrospective study carried out over a period of 7 years from 2010– 2016 in the department of Pathology of TUTH, Kathmandu.
Results: 121cases (0.25%) of tissue parasites out of the total 47,220 biopsy specimen submitted for histopathological examination during the seven year period was observed. There was increasing rate of parasitic infection from 0.19 to 0.34% during 7- year period. Eight different types of parasites were detected. Hydatid cyst was the commonest (57 %) followed by Cysticercosis (35 %), Giardiasis (2%), Amoebiasis (2%) and one each of Myiasis, Fascioliasis, Tungiasis and Trichuriasis. The host tissue response to the cysticercosis and hydatid cyst showed fibrosis with inflammatory cell infiltrations composed of eosinophils, palisaded histiocytes, multinucleated giant cells. None of the cases showed well formed granulomas. All three cases of Giardiasis showed normal villi to crypt ratio with only increase in intraepithelial lymphocytes. Colonic mucosa in tichuriasis and amoebiasis showed increased eosinophils in lamina propia. Adjacent tissue in myiasis showed necrosis. Liver tissue in fascioliasis showed multiple well-formed granulomas and dense sheets of eosinophils and mononuclear cells.
Conclusion: Parasitic infections are common around the world. Histopathological analysis plays an important role in diagnosis of tissue parasitic disease. Histopathological features in response to parasitic invasion are important for differential diagnosis and often confirms the presence of parasitic infestation. The commonest parasitic infections were hydatid disease and cysticercosis. So these should be kept in the differential diagnosis of cystic lesion in both endemic and non-endemic areas. Improvement in sanitation and personal hygiene helpful in preventation of parasitic infestation.
Functional outcome of single bundle anatomical anterior cruciate ligament reconstruction using either quadruple hamstring or bone patellar tendon bone graft by medial portal technique
Authors: Thapa SS , Neupane P , Lamichhane AP , Mahara DP
Published: July 2024

Introduction: The anterior cruciate ligament (ACL) is the most frequently injured knee ligament. Abnormal knee kinematics in ACL deficient knee causes early osteoarthritis. Single bundle anatomical ACL reconstruction by medial portal technique provides better knee stability then transtibial technique. Many studies suggests that there is no difference in outcome of ACL reconstruction using hamstring or bone patellar tendon autograft. In this study we evaluated functional outcome (based on mean Lysholm score) at 6 month of single bundle ACL reconstruction by medial portal technique using bone patellar tendon bone or quadruple hamstring graft
Methods: This was a prospective longitudinal study on functional outcome (using Lysholm score) of 75 patients who underwent single bundle anatomical ACL reconstruction by medial portal technique by using either quadruple graft hamstring or bone patellar tendon bone graft in sports and arthroplasty unit in Tribhuvan University teaching hospital, Kathmandu, Nepal between March 2014 to February 2016. Mean Pre op and 6 months post op Lysholm score of two groups was compared using paired-t test to evaluate the functional outcome of the surgery.
Results: In this study overall mean pre op Lysholm score was 48.48±6.50 (36-62) and 6 months post op Lysholm knee score was91.58±3.10 (85-95), with p value 0.0000. The mean pre op and post op Lysholm score for Quadruple hamstring group was 47.7 and 91.5 respectively, while that for bone patellar tendon bone group was 54 and 91.7.
Conclusion: The functional outcome (based on mean Lysholm score) at 6 months post op of single bundle anatomical ACL reconstruction was similar irrespective of type of graft used.
Mobile teledermatology for Dermatological Care in Rural Nepal: Dermatology training of medical officers at primary health care centers
Authors: Shrestha DP , Baral S , Shahi PV , Rosdahl L
Published: July 2024

Introduction: Skin diseases are common in Nepal but dermatologists are very few, and there is no adequate training for Medical officers to diagnose and treat common skin diseases. We developed a training program based on Mobile teledermatology and evaluated its effectiveness.
Methods: Five medical officers from 3 primary health care centers of Kavre District were trained in their respective working centers. They did 12 days of mobile teledermatology sessions in which they saw minimum of 60 common skin diseases in direct supervision of a dermatologist. Medical officers were involved in all aspect of patient care from history taking, examination of skin lesions, writing down the prescription to counseling and follow up. The effectiveness of training was evaluated by, difference in skin disease knowledge before and after the training, ability to diagnose and treat common skin diseases independently at the end of the training and feedback from the trainees.
Results: Altogether 337 skin diseases were seen by 5 medical officers. There was significant difference between the skin disease knowledge before and after the training (p-value 0.009). At the end of the session they were able to diagnose independently 87% (80%-95%) of common skin diseases. All of them strongly agreed that this is the effective way of training
Conclusions: Mobile teledermatology is the feasible and effective method of dermatology training to the medical officers at primary health care centres in remote areas, while providing skin care to the villagers at the same time.