bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Distensibility and Stiffness of Ascending Aortic Aneurysm using Magnetic Resonance Imaging
Authors: Tiwari Kaushal Kishore , Bevilacqua Stefano , Aquaro Giovanni , Festa Pierluigi , Ait-Ali Lamia , Solinas Marco
Published: September 2018

Introduction: Magnetic resonance imaging emerging as a new tool for the diagnosis and evaluation of ascending aortic aneurysm. The aim of our study is to evaluate in vivo distensibility and pulse wave velocity of the aortic wall using functional magnetic resonance imaging technique.Methods: We enrolled 25 patients undergoing surgery for ascending aortic aneurysm and or aortic valve replacement for a period of 8 months. Preoperatively, all the patients underwent functional MRI study of the aorta. Aortic wall distensibility and pulse wave velocity of ascending aorta was evaluated. Results: Mean age of the patient was 66 years (66.68 ± 5.62 years) with 60% (15) male patients. More than fifty percentages of patients were smoker (52%), hypertensive (64%) and diabetic (56%). We have observed significant decrease of distensibilty in the patients with aortic diameter above 50 mm (p-0.0002). Furthermore, we have found a significant inverse correlation between aortic distensibility and pulse wave velocity (R= -0.650, R2= 0.42, p-0.0004). Similarly, we have found a significant inverse correlation between ascending aortic diameter and distensibility of the aorta (R= -0.785, R2= 0.61, p-0.00001). Statistically significant positive correlation was observed between aortic diameter and pulse wave velocity (R= 0.865, R2= 0.74, p-0.00001).Conclusions: MRI measurement of aortic diameters, distensibility, and flow wave velocity is an easy, reliable and reproducible technique. Distensibility and pulse wave velocity define the elasticity of the aorta. We have observed that elasticity of aortic wall is decreased in ascending aorta aneurysm patients. Keywords: ascending aorta aneurysm; distensibility; pulse wave velocity; MRI. | PubMed
Outcomes Bronchoscopic Evaluation in A University Hospital
Authors: Ghimire Ram Hari , Bhatta Narendra , Koirala Puru , Bista Bides , Misra Deebya Raj , Shah Bhupendra
Published: September 2018

Introduction: Study of clinical profile of the patients and diagnostic yield of the selected bronchoscopic procedures gives us important information in clinical decision making and better patient care. There are hardly very few studies regarding these entities. Therefore, we decided to study clinical characteristics and outcomes of the patients who underwent bronchoscopic evaluation in our setting. Methods: This was a cross-sectional study the consecutive patients who underwent bronchoscopy from 1st May 2013- 30th April 2015 in division of pulmonary, critical care and sleep medicine. The main procedure performed was bronchoalveolar lavage. Results: The mean age was 54.71 years with 76 (76%) males. Recurrent hemoptysis in 58 (58%) patients were the commonest indication. Total 95 (95%) patients have chest X-ray abnormalities. The commonest bronchoscopic finding was bronchiectasis 23 (23%) of patients followed by chronic bronchitis in 18 (18%) and endobronchial tuberculosis in 16 (16%). Total 10 (71%) of the 14 bronchoscopically suspected lung cancer patients have intraluminal lesions. Bronchoalveolar lavage culture for tuberculosis showed growth in 46 (46%), positive for malignancy in 7 (7%) positive Ziehl Neelson stain for tuberculosis in 6 (6%).Conclusions: Bronchoscopic evaluation of patients with pulmonary diseases gives us a lot of information that may help us in better patient care and bronchoalveolar lavage has high diagnostic yield in diagnosing pulmonary tuberculosis.Keywords: bronchoalveolar lavage;clinical profile;fiberoptic bronchoscopy. | PubMed
Late Presentation of Post Diphtheritic Myocarditis in a 15-year male
Authors: Vinod Kutty Sharada , Gupta Nitin , Sahu Harsh , Wig Naveet
Published: September 2018

A 15-year old male patient presented to us with dyspnoea for four days. He had a history of fever, pseudo-membranous tonsillitis and cervical adenopathy twenty-five days prior to the presentation. On examination and laboratory investigations, he had features suggestive of myocarditis with biventricular failure. There was no reliable history of immunisation and he had a positive history of contact. He was planned for anti-diphtheria toxin but before the anti-toxin could be initiated, the patient succumbed to refractory cardiogenic shock. This was a rare case of late onset diphtheritic myocarditis in an unimmunised adult. With the advent of universal immunisation, there has been a significant decline in the incidence but there is still some road to cover.

Keywords: Corynebacterium diptheriae; diphtheria; myocarditis.
An Overview of Menopausal Symptoms at District Hospital of Nepal.
Authors: Gupta Sandeep , Acharya Karuna , Srivastav Priyanka , Gurung Purna Kala , Gupta Nupur
Published: September 2018

Introduction: Menopause is a universal reproductive phenomenon which confirms the end of fertility of the women. The objectives of this study were to establish the age of natural menopause and to identify the prevalence of menopausal symptoms among the rural women attending district hospital of Nepal. Methods: This present study is a hospital based, observational cross-sectional study conducted in Outpatient department of Lamjung District Hospital, Lamjung, Nepal. The study was carried out from January 2014 till June 2014. Fifty four menopausal women were included in the study. A structured questionnaire was used and the data were analyzed using statistical package for social sciences. Results: There were 54 participants with menopausal symptoms included in the study. Age ranged from 45 to 60 years with mean 51.2 years. Approximately seventy percentages of women were in age group of above 50 years. About two-third of participants had menarche in at 11 to 13 years of age and 32 (59.5%) of females were married before 15 years of age. In the study total 22 different health problems were reported by menopausal women. The most common symptoms were backache, fatigue/tiredness, numbness and tingling of the extremities, mental exhaustion, depressive mood, bladder problems and sexual symptoms. Conclusions: The study suggests that rural middle-age and elderly women suffer from variety of health problems related to natural menopause. The health care workers should adopt a holistic approach towards management to improve the quality of life. Keywords: age; menopausal symptoms; women; district hospital. | PubMed
Clinico-pathological Study of Malignant Melanoma in A Tertiary Care Centre
Authors: Thapa Sushma , Ghosh Arnab , Ghartimagar Dilasma , Prasad Tillotama , Narasimhan Raghavan , Talwar OP
Published: September 2018

Introduction: Malignant melanoma, which causes three fourth of all deaths related to skin cancer, is more common in Caucasian population compared to Asian population. There is no reliable information about malignant melanoma in Nepal hence an effort has been made to assess the clinical and pathological features of melanoma patients.

Methods: This was a retrospective hospital based study done in the department of Pathology. All cases of malignant melanoma diagnosed on biopsy during a period of 13 years were retrieved, reviewed and collated.

Results: We had 35 cases with age range from 15 to 84 years with the mean of 51.4 years and M: F of 1.3:1. The predominant site was lower extremities. Most cases were less than 3 cm. Majority of histologic subtypes were nodular melanoma 29 (82.8%) followed by mucosal lentiginous melanoma 3 (8.6%), superficial spreading melanoma 2 (5.7%) and acral lentiginous melanoma 1 (2.9%). Half (50%) of the excisional biopsies were at Clark’s level IV and 75% were at high Breslow thickness.

Conclusions: The most frequent site in males and females were lower extremities and trunk respectively in contrast to Western studies where it is opposite. Nodular melanoma was the commonest histologic subtype while in other Asian studies and in Western studies majority were acral lentiginous melanoma and superficial spreading melanoma respectively.

Keywords: Breslow thickness; Clark’s level; malignant melanoma; nodular melanoma.
Menopausal Health Status of the Nepalese Women
Authors: Rajbhandari Swaraj , Subedi Raj Kumar , Dangal Ganesh , Phuyal Anjana , Vaidya Achala , Karki Aruna , Tuladhar Heera , Gurung Bandana Sharma , Joshi Lalita , Shrestha Sushila
Published: September 2018

Introduction: Menopause is an unavoidable and sometimes problematic condition in which women may suffer from a number of health problems. Knowledge of the major symptoms associated with menopause helps reduce the burden and stress associated with the condition. In this context, a study was conducted to establish baseline data regarding menopausal health problems among Nepalese women.

Methods: A descriptive cross-sectional study was conducted among 2000 women aged over 40 years to identify their knowledge, attitude and practice related to menopausal health problems. Data was collected by interviewing the women and doing physical examination. Analysis was done using descriptive statistics and SPSS software was used for data analysis.

Results: A cohort of 2073 women (ages 40-60 years) participated in the research, among them 2000 yielded complete response. The study revealed that 820 (41%) women had reached menopause. The average age of menopause was 48.7 years. Majority of the women 1183 (59.2%) in the study did not know about menopausal health problems. Abnormal bleeding 353 (17.65%), sweating 315 (15.75%), hot flushes 299 (14.95%), joint/muscle pain 285 (14.25%) were the most common menopausal symptoms known by the women. Joint pain 736 (36.8%), hot flushes 584 (29.2%), irregular bleeding 582 (29.1%) were the most common experienced symptoms of menopause and only 586 (29.3%) consulted the health workers to alleviate menopausal symptoms. Moreover, most of the women 926 (46.3%) accepted menopause as a part of life.

Conclusions: The research has tried to establish the baseline of menopausal health problems in the Nepalese women. The average age of menopause was 48.7 years. Majority did not know about menopausal health problems. Further researches with nationally representative sample are recommended to further explore the menopausal health problems of Nepalese women.Keywords: health problems; menopause; Nepal; women.
Current Management of Gastric Varices
Authors: Maruyama Hitoshi , Yokosuka O
Published: September 2018

abstract
ABCDEFG IS – The Principle of Constructive Feedback
Authors: Bhattarai Madhur Dev
Published: September 2018

abstract
Rural Health Care Workers and Local Residents Health Status in Yulong County of Yunnan Province China and Hat Yai City of Songkhla Mansion Thailand
Authors: Fanwei Qu , Yanling Jiang , Chongsuvivatwong Virasakdi , Liabsuetrakul Tippawan , Yan Li , Le Cai , Runsheng Jiang
Published: September 2018

Introduction: To compare health status between Hat Yai city of Songkhla Province in Thailand and Yulong county of Yunnan province in China about rural health care workers and local residents, analyzing of both differences, learning from the advanced experience and practice of Thailand, adjusting policy, especially for the implementation of measures to improve the lack of human resources construction of Yulong County rural health, promote the level of rural health service of Lijiang.Methods: A qualitative study consisting of focus group discussions and individual in-depth interviews were conducted in Rural Health Care Workers and Local Residents Health Status in Yulong County of Yunnan Province China and Hat Yai City of Songkhla Mansion Thailand from.  Results: Compared to 41(100%) bachelor's degree of medical staffs in Hat Yai, this accounted only 94 (42%) bachelor's degree of medical staffs in Yulong county hospital, and 31 (12%)in townships hospitals. For medical workers in Hat Yai, they have at least one time on-job training per year, but for Yulong county, only 144 (29%)of the medical personnel participated in the training per year. Health expenditures of Yulong county was mainly borne by the local government, and medical insurance coverage rate is 217,107 (99%). Insurance average awareness of Hat Yai is 4449 (66.4%), Yulong County is 62,501 (28.5%), P<0.001, there are statistically significant differences between two cities.Conclusions: Thailand has good experience in training, well-paid, motivating and retaining talent for rural health human resources; multi-pronged, mechanism innovation, establish and perfect the system of human resources for health, is the essential way to solve the problem.Keywords:  Hat Yai city; Yulong County; Rural medical staff; Variance analysis.
Conservative Treatment of Nonarticular Fractures of distal third Tibia
Authors: Pandey Bimal Kumar , Manandhar R R , Sharma S , Pradhan R L , Lakhey S , Rijal K P
Published: September 2018

Abstract
Nepalese Kidney Transplant Recipient in a Follow up Clinic: Related and Unrelated Living Donor
Authors: Dulal Ram Krishna , Karki S
Published: September 2018

A cohort retrospective study was conducted on all follow up kidney transplant recipients at Transplant Follow up Clinic from June 16, 2003 to July 15, 2008. The main objective of this study was to find out the demographic pattern of the kidney transplant recipients and type of donors. Among 452 recipients, the transplantation were done in India (449), Germany (2) and in the USA (1) with male to female ratio of 3:1. Kidney donors were unrelated 315 (69.69%), related 134 (29.43%) and some did not disclose 4 (0.88%). Most of the kidney transplantation (93.75%) were done in 45 different hospitals in India and about three quarters (71.7%) of them were operated in the private hospitals in various states of India; only 2 (4.16%) in Germany and 1 (2.08%) in USA. Newar was the largest population 142 (31.4%) and second largest group was Mangol 124 (27.4.4%) that comprised of Gurung, Rai, Magar, Tamang etc. Brahmins were the third largest population 91 (20.1%). In this study the youngest recipients was 14 years and the oldest was of 75 years. The mean age was 41 (SD 13.84). This study showed that 35 (7.7%) died, 8 (1.7%) reported rejection and underwent re-transplantation and 238 patient have lost follow up till early 2008. Kidney transplantation should be promoted as it is cheaper compared to dialysis in the long run. This study found that unrelated kidney donors have outnumbered the related donors in Nepalese kidney transplant recipients which emphasize the importance of unambiguous documentation and also a provision of lawful action against the middle-men if found involved in an illegal kidney related activities in Nepal. Organ transplantation is an important integral part of human health and should be regularize and promote lawfully to protect humans from trafficking for kidney, possible kidnapping, killing and stealing.
Scenario of Mushroom Poisoning in a Tertiary Care Hospital
Authors: Karki Prahlad , Lakshmi R , Karki P , Pradhan B , Maskey R
Published: September 2018

Abstract
Effectiveness of 0.2% Glyceryl trinitrate and 0.5% Nifedipine in the Treatment of Chronic Anal Fissure
Authors: Shrestha Suman Kumar , Thapa Prabin Bikram , Maharjan Dhiresh Kumar , Tamang Tseten Yonjan
Published: September 2018

Introduction: Anal fissure is an ischemic ulcer caused by combination of spasm of internal anal sphincter and poor blood supply to the posterior midline of anal canal. This study aimed to assess the efficacy of Glyceryl Trinitrate and Nifedipine in the treatment of chronic anal fissure.

Methods: Ninety patients with symptomatic anal fissure in Kathmandu Medical College Teaching Hospital are allocated for study in two groups of 45 each from March 2013 to April 2014. The patients are assigned alternatively to GTN group and Nifedipine group. All patients were assessed every week till 8 weeks in regards to headache, compliance, healing and recurrence. The patients who had complete healing in 8 weeks were further followed up for 6 weeks to detect recurrence.

Results: Patients in the two groups were comparable in regard to demographic data (age and sex) as well as clinical factors. Headache was main complaint of patients using GTN in high percentage (16.6%) than complained by patients using topical Nifedipine (6.9%). This factor led to poor compliance with GTN compared with Nifedipine.  Nifedipine showed better healing rate 82.5% compared with GTN 60%. Recurrence was comparable among the two groups.

Conclusions: Nifedipine ointment showed better results than GTN ointment in chronic anal fissure regarding headache, compliance, healing and recurrence in 6 weeks of follow up period after complete healing of fissure in 8 weeks.

Keywords: anal fissure; glyceryl trinitrate; nifedipine.
Acute Retropharyngeal Abscess Masquerading as Meningitis
Authors: Sakthivel Pirabu , Yogal Rijendra , Verma Hitesh , Saini Anil , Chandran Ashwin
Published: September 2018

Retropharyngeal abscess is a potentially serious deep neck space infection occurring more frequently in children than in adults. The clinical picture of RPA is highly variable with paucity of physical findings. Prompt diagnosis of RPA especially in infants is mandatory to prevent potential fatal complications including airway obstruction. The diagnosis of RPA should be based on high index of clinical suspicion with supportive imaging studies like lateral X-ray of neck and CT.

We present a case of acute retropharyngeal abscess which was initially misdiagnosed as meningitis and led to airway obstruction. This case is reported to create awareness among emergency physicians, paediatricians and otolaryngologists to have high index of suspicion in diagnosing RPA especially in infants. Keywords:  retropharyngeal abscess; meningitis; deep neck infection.
Identification of Deceased Children of Nepal Airlines Crash through Dental Age Estimation
Authors: Agrawal Nitin Kumar , Dahal Samarika , Wasti Harihar
Published: September 2018

Identification of victims in a disaster is a challenging process and requires use of both primary and secondary identifiers. Development of teeth is one of the routinely used methods of age estimation and helps in establishing deceased biological profile. Two children who lost their lives in 2014 in Nepal Airlines crash, were looked for the dental developmental status. One of the children had primary dentition, while the other had mixed dentition. This helped us in estimating age of these individuals reconciled with the chronological age provided by the relatives. This led to the identification of both the children, thus, emphasizing teeth as important means of identification in any disaster.

Keywords: dental age; dental identification; disaster victim identification; forensic dentistry; forensic odontology.
Estimation of Serum Uric Acid in Cases of Hyperuriceamia and Gout
Authors: Pokharel R K , Yadav BK , Jha B , Parajuli K
Published: September 2018

Introduction: Gout is crystal deposit arthritis and is an ancient disease. The biologic precursor to gout is hyperuricaemia. The prevalence of hyperuricaemia and gout has an increasing trend all over the world including the developing countries. The purpose of this study is to estimate serum uric acid level in hyperuricaemic and gout patients attending a medical college hospital.

Methods: A consecutive 150 hyperuricaemics and 150 gout patients attending Tribhuwan University Teaching Hospital from June to September 2005 were included in this study. The serum uric acid level was measured by the enzymatic (PAP- Uricase) method. The patients with acute gout were interviewed and relevant information was obtained.

Results: Males comprised 84 % of gout cases. Hyperuricaemia was common in both sexes. The mean age for gout was 47.49 and 56.65 years in males and females respectively. The mean age for the first gout attack was 42.1 ± 14.0 years. Family history was positive in 22 % of cases. The overall mean serum uric acid level in hyperuricaemics was 7.2 ± 0.7 mg/dL and 8.4 ± 1.1 mg/dL in acute gout (p 0.0001). The mean serum uric acid level was signifi cantly (p 0.0001) high among males both at the asymptomatic phase and at acute gout. Gout was more common in non-vegetarians (95 %) and alcoholics (65.3 %). Serum uric acid level was inversely related with the amount of daily water intake (p 0.0001).

Conclusions: Serum uric acid level is signifi cantly high among the male gouty arthritic patients. However, it is also high among asymptomatic hyperuricaemic cases of both sexes. 

Keywords: asymptomatic hyperuricaemia, gout, serum uric acid level.
Histological Pattern of Gynecological Cancers
Authors: Dhakal Hari Prasad , Pradhan M
Published: September 2018

Abstract
Hormonal Changes in Intracranial Hemorrhage
Authors: Shrestha Rajendra , Pradhan Reeka , Pradhan Mahesh , You Chao
Published: September 2018

Introduction: The purpose of this study was to investigate the changes of serum ACTH and Thyroid hormone level in the acute phase of ICH.

Methods: Sixty patients with spontaneous ICH were assessed regarding hormonal changes by measuring ACTH and Thyroid hormone level. The relationships of hormone concentrations to clinical and radiological parameters were evaluated at hospital admission (t0), 5 days (t1) and 10 days (t2). The results were statistically analyzed.

Results: ACTH, TSH, Thyroxine, and free Thyroxine were not signiﬁcantly different among the three time periods (P > 0.05), while Triiodothyronine (T3) and free Triiodothyronine (FT3) were signiﬁcantly different (P < 0.05). T3 and FT3 were not signiﬁcantly different among patients with hemorrhage of different locations (P>0.05). There were significant negative correlations between T3 and FT3 with volume of ICH (r=-0.63 and r=-0.25) and there were positive correlations between T3 and FT3 with GCS (r=0.63 and r=0.37) respectively on admission day (p <0.05).

Conclusions: Hormonal secretion patterns is associated with the severity of ICH. This is an important index to evaluate the disease severity and prognosis. Keywords: ACTH; ICH; lymphocyte ICH; Thyroid hormone.
Primary Total Hip Replacement in A Military Hospital in Kathmandu
Authors: Chand Pankaj , Rana Magar Sushil , Thapa Bishnu Babu , Shrestha Bikal
Published: September 2018

Introduction: Total hip replacement is one of the most widely performed and amongst the most successful orthopedic procedures performed worldwide. Even though it is a common orthopedic procedure in developed nations, it is performed only in selected centers in Nepal.  This study will review the functional outcome of total hip replacements carried out in Shree Birendra Hospital.

Methods: We reviewed the records of total hip replacements, which were carried out in Shree Birendra Hospital, Kathmandu. Twenty-one hips were cemented and nineteen were uncemented.  Cases were followed up in six weeks, twelve weeks, six months and every year from then on. Outcome in terms of Harris hip score of 40 osteoarthritic hips were measured pre-operatively as well as post-operatively.

Results: The mean age of the patients was 50.63 years (range 22-79 years). The commonest reason for the replacement was primary osteoarthritis of the hip. Thirty-nine patients underwent unilateral total hip replacement while in one patient both hips were replaced. The mean Harris hip score for the forty hips that were available at the latest follow-up examination at an average of five years (range two to six and a half years) after the operation was 85.2 ± 7.65 points as compared to the pre-operative mean Harris hip score of 32.38 ± 3.4.

Conclusions: Based on improved Harris hip scores, we believe that THR is a good option in patients with end stage arthritis of the hip.

Keywords: cemented; primary osteoarthritis; total hip replacement.
Family Burden in Opioid Dependence Syndrome in Tertiary Care Centre
Authors: Shyangwa Pramod M , Tripathi B M , Lal R
Published: September 2018

This is a cross-sectional, hospital based study conducted in De-Addiction centre under department of psychiatry, AIIMS, New Delhi, India. Patients and their spouses fulfilling inclusion criteria were enrolled in the study after taking informed consent. A diagnosis of Opioid Dependence Syndrome (ODS) was made based on ICD-10 criteria and the assessment of severity of ODS was determined by Addiction Severity Index (Hindi version). Subsequently the family burden, perceived by spouses was assessed using Family Burden Interview Schedule (FBIS). Most of the subjects were from urban or semi-urban areas, mostly from around the service facility. The maximum number of subjects was of age group 31-40 years with majority of having below high school level education. Both subjective and objective family burden was perceived as "severe" by subjects' spouses. The relationship between spouses' perceived burden and socio-demographic variables including duration of substance abuse were not correlated. Hence it was found that opioid dependent subjects cause considerable amount of distress to their care providers.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):113-119.
Fetal Ductus Venosus Pulsatility Index and Diameter during Second and Third Trimester of Gestation
Authors: Pokharel Pratit , Ansari Mukhtar Alam
Published: September 2018

Introduction: The ductus venosus is a small funnel shaped vessel found posterior to the fetal liver connecting the intra-abdominal umbilical vein and the inferior vena cava. It is one of the three physiological shunts in the fetus. The main objective of this study is to construct the reference table and normogram for fetal ductus venosus Pulsatility Index and diameter with gestational age.

Methods: This was a prospective cross sectional study conducted during August 2011 to July 2012 taking 294 uncomplicated pregnancies using systemic random sampling method. Three measurements were made for ductus venosus diameter and Pulsatility Index in each fetus during period of fetal quiescence.

Results: The ductus venosus diameter at <20weeks, 20-25 weeks, 25-30 weeks, >30 weeks were 1.16, 1.31, 1.62, 1.81 and Pulsatility Index at <20weeks, 20-25 weeks, 25-30 weeks, >30 weeks were 0.41, 0.44, 0.41 and 0.41 respectively.

Conclusions: The mean diameter of the ductus venosus was linear across gestational age. The Pulsatility Index shows a scattered distribution across the gestational age.

Keywords: ductus venosus diameter; gestational age; Pulsatility Index.
Correlation of Serum Cholinesterase Level, Clinical Score at Presentation and Severity of Organophosphorous Poisoning
Authors: Rehiman S , Lohani SP , Bhattarai MD
Published: September 2018

The aim of the study was to correlate between the clinical score described by PeradenyaOrganophosphorus Poisoning (POP) scale, serum cholinesterase level at presentation and severityof poisoning. Consecutive patients of organophosphorous poisoning attending Bir Hospital fromAugust 2004 to September 2005 were studied.Patients were groupedinto mild, moderate andseverepoisoning groups according to the POP scale. Fifty patients fulfilled the inclusion criteria. The severity ofpoisoningdirectlycorrelatedwithserumcholinesteraselevel(P<0.001).Thedifferences inthemeanrequirements of atropine on the first day of admission, in the total amount of atropine needed to treat and in the average duration of hospital stay were significant (P<0.05). There were 26% patients in moderate poisoning and only 4% patients in severe poisoning, but a total of 14% of the patients died, indicating that patients with even moderate degree of poisoning had also died. Both the POP scaleseverity andderangementinserumcholinesterase levels atinitialpresentationdidnot correlate withmortality, which could be due to various other co-morbidities and inadvertent stoppage of atropineinfusion particularly at night in the wards. The POP scale and serum cholinesterase at presentationappeared useful to assess the severity of poisoning, particularly in terms of higher amount ofatropine andprolongeddurationofhospital stay.Thepatients withevidence ofmoderate andseveredegrees of poisoning need close monitoring. Further studies to evaluate the factors likely to causedeaths, particularly by closely monitoring of moderate and severe organophosphorous poisoning inintensive care units, are required to clarify the correlation with mortality.Key words: organophosphorous poisoning, peradeniya organsophosphorous poisoning scale, serum cholinesterase
Gestational Age Specific Postnatal Growth Curves for Singleton Babies in Tertiary Hospital of Western Nepal
Authors: Pathak Santosh , Chaudhary Nagendra , Dhakal Prativa , Mahato Shyam Kumar , Shrestha Sandeep , Bhatia Bal Dev , Bansal Ajay Kumar , Kurmi Om Prakash , Agarwal Kailash Nath
Published: September 2018

Introduction: Measurement of birth weight (BW), crown heel length (CHL), head circumference (HC) and chest circumference used to assess the intrauterine growth of a baby vary with altitude, race, gender, socio economic status, maternal size, and maternal diseases. The study aimed to construct centile charts for BW, CHL and HC for new born at different gestational ages in western Nepal.

Methods:  This was a descriptive cross sectional study done over a period of 15 months in a tertiary care hospital of western Nepal. BW, length, HC and CC were measured within 12-24 hours of birth. Gestational age was estimated from first day of last menstrual period, maternal ultrasonology and New Ballard’s scoring system. Microsoft 2007 Excel and SPSS-16 was used for data analysis. Cole’s Lambda Mu Sigma method was used for constructing centile curves.

Results: Out of 2000 babies analysed, 1910 samples were used to construct smoothed intrauterine growth curve of BW, CHL, and HC from 33-42 weeks of gestation. 57.35% (1147) were male, mean gestational age was 38.13 ±2.44 weeks, where 21.5% were preterm and 1.7% post term. The means of BW, CHL, HC and CC were 2744.78 gm, 47.80 cm, 33.18 cm, and 30.20 cm with standard deviations of 528.29, 3.124, 1.78, and 2.35 respectively. These data vary as compared to the Kathmandu data, in case of birth weight for 10th and 90th centiles, and at 90th centile in case of length.

Conclusions: This necessitates the update in the existing growth charts and develop in different geographical regions of a country.
Updates on Pharmacological Treatment of Post-Traumatic Stress Disorder
Authors: Koirala Rishav , Søegaard Erik Ganesh Iyer , Thapa Suraj Bahadur
Published: September 2018

Post-Traumatic Stress Disorder affects a significant proportion of those who have been exposed to exceptionally threatening or catastrophic events or situations such as earthquakes, rape and civil war. The condition can often become chronic and disabling. Medical intervention can therefore be of paramount importance. There are no national guidelines for trauma disorders in Nepal and there is a lack of adequate knowledge regarding drug treatment of PTSD among doctors and other service providers. Though psychotherapy is internationally regarded as the first line treatment for PTSD, it is often not feasible in Nepal due to lack of resources and skilled health workers in this field. The use of right psycho-pharmacotherapy is therefore important to reduce the burden of disease. A wide range of pharmacotherapy has been tested in the treatment of PTSD. This article is based on a selected sample of relevant articles from PubMed, PsycINFO, national guidelines from other countries and our own clinical experience. We have tried to give a concise and practical review regarding the use of drugs, their side effects and available evidence in the treatment of PTSD. The main findings point to use of Selective Serotonin Reuptake Inhibitors as the first line pharmacotherapy, and they can have effect on the full range of symptoms in PTSD. SNRIs show similar efficacy. Adjuvant drugs like Alpha-blockers and atypical antipsychotics have shown strong evidence in treating partially remitted cases and resolving ancillary symptoms.

Keywords: Antidepressive Agents; Drug Therapy; Post-Traumatic; Psychotropic Drugs; Stress Disorder. [PubMed]
Proceeding Report of Joint Meeting of Nepalese Association for the Studies of the Liver and Nepalese Society of Gastroenterologist on “Overcoming the Challenges for HCV Elimination in Nepal by 2030”
Authors: Of the Liver Nepalese Association For the Studies , (NSG) Nepalese Society of Gastroenterologist
Published: September 2018

[PubMed]
Appropriateness of Indications of Upper Gastrointestinal Endoscopy and its Association With Positive Finding
Authors: Bohara Tanka Prasad , Laudari Uttam , Thapa Abishek , Rupakheti Shail , Joshi Mukund Raj
Published: September 2018

Introduction:  Upper Gastrointestinal Endoscopy(UGIE) is a frequently advised investigation for upper abdominal symptoms. Studies have questioned the appropriateness of indications for UGIE and have shown that inappropriate indications range from 5% to 49%. The unnecessary UGIE expose patients to the risk. The number of UGIE is rising in our region and we assume so is the number of unnecessary UGIE. With an aim to evaluate the appropriateness of the indications of UGIE and compare its association with positive findings, we conducted a cross-sectional descriptive study.

Methods: All patients undergoing diagnostic UGIE during the study period were included in the study. Appropriateness of indications for UGIE was defined as per American Society for Gastrointestinal Endoscopy(ASGE) criteria as “appropriate” and “inappropriate”. UGIE endoscopy findings were classified as “significant” and “insignificant” based on endoscopy findings. The extent of this association between the appropriateness of indications and UGIE findings was expressed as the odds ratio (OR) of finding a relevant diagnosis in patients with an ‘‘appropriate’’ indication compared with those with an ‘inappropriate’’ indication.

Results: Seventy-nine patients were included in the study. Fifty- two (65.8 %) of the indications were considered appropriate as per ASGE guidelines. Thirty-three (63.5%) of the appropriate indications has clinically significant finding as compared to seven (25.9%) of inappropriate indication with an odds ratio of 4.962 (95%CI:1.773 – 13.890, p=0.002) which is statistically significant.

Conclusions:  Appropriate indications have significantly higher rates of clinically significant findings. Use of guidelines may decrease the number of unnecessary procedures.
Efficacy of Prophylactic use of Ciprofloxacin and Metronidazole in Mild and Moderately Severe Acute Pancreatitis
Authors: Mandal Amrendra Kumar , Chaudhary Sitaram , Shrestha Barun , Paudel Mukesh Sharma , Paudel Nandu Silwal , Paudel Bidhan Nidhi , Bhattarai Bikash , Ray Sunil Kumar , Ray Neetu Mandal
Published: September 2018

Introduction: There are new concepts and developments in the diagnosis and management of acute pancreatitis. Current evidence suggests that there is no role of prophylactic antibiotics use in acute pancreatitis. However, it is still a common practice to administer prophylactic antibiotics in a country like Nepal. So, we have conducted a study in mild and moderately severe acute pancreatitis to study the efficacy of prophylactic antibiotics. Methods: A case control study was conducted among 76 patients comparing efficacy of prophylactic antibiotics versus no antibiotics in patients with mild and moderately severe acute pancreatitis. Results: The two most common etiology of acute pancreatitis in AG and NAG were alcohol 21 (55.2%) vs. 24 (63.1%) and biliary 10 (26.3%) vs. 4 (10.5%) respectively. Pancreatic necrosis was seen in five (13.1 %) in AG and four (10.5%) in NAG. Four (10.5%) developed extra pancreatic complications in AG and five (13.1%) in NAG. There was one (2.6%) death in AG and no death in NAG. Abdominal pain improvement seen in AG vs. NAG was 3.2 days vs. 2.4 days (p =0.002). The hospital stay was 7.7±2.23 days in AG and 7.5±1.85 days in NAG (p=0.65).Conclusions: The routine use of prophylactic antibiotics for mild and moderately severe acute pancreatitis is not associated with improvement in meaningful clinical outcomes.Keywords: Atlanta classification 2012; mild acute pancreatitis; moderately severe acute pancreatitis; prophylactic antibiotic. [PubMed]
Outcome of Endoscopic Variceal Band Ligation
Authors: Shrestha Barun , KC Sudhamshu , Chaudhary Sita Ram , Basnet Bhupendra Kumar , Mandal Amrendra Kumar , Silwal Poudyal Nandu
Published: September 2018

Introduction: Bleeding from esophageal varices in cirrhosis is an emergent condition with high mortality. One of the preferred modality of treating esophageal varices is EVL. We aimed to find out the outcome of EVL in controlling acute esophageal variceal bleeding, prophylactic banding to prevent future bleeding and the number of sessions required for complete eradication of varices.Methods: This descriptive observational study was carried out in Gastroenterology and Hepatology unit of Bir Hospital, NAMS from June 2016 to May 2017. Consecutive cases who presented in emergency room with acute variceal bleeding due to liver cirrhosis and cases of liver cirrhosis with large varices and red color signs on endoscopic examination were enrolled. They underwent EVL and subsequent re-endoscope at one month interval till the eradication of varices was achieved. Results: Among 83 patients, 15 (18.1%) were of Child Pugh class A, 29 (34.9%) B and 39 (47%) were of C. In 20 (24.1%) cases varices could be eradicated in one session of EVL while 57 (68.7%) required two sessions and in 6 (7.2%) cases it took three sessions. Total average EVL session required for obliteration of esophageal varices was 1.84±0.53. There was only one (1.2%) of early re-bleeding post EVL.Conclusions: EVL is an effective modality of treatment in controlling acute esophageal variceal bleeding, in preventing future variceal bleeding as well as in eradicating esophageal varices, with very few complications.Keywords: acute variceal bleeding; cirrhosis; endoscopic variceal ligation; large varices; red color sign. [PubMed]
Effect of Maternal Socio-demographic Factors and Child Feeding Practice on Wasting Among Under Five Years Children in Slum Area of Rupandehi District in Nepal
Authors: Guatam Salila , Ruchal Sita , Timalsina Binod , Acharya Dilaram , Khadka Bikram , Gautam Vikash , Singh Jitendra Kumar
Published: September 2018

Introduction: Childhood wasting although well studied elsewhere, it has not been well understood about in slum area of Nepal. This study aimed to assess effect of socio-demographic factors and child feeding practice in the determination of wasting among the children under five years of age in slum area of Nepal.Methods: A community based cross-sectional study was performed among 150 children under five years of age from the slum area of Nepal between 1st January and  28th February 2013 using simple random sampling techniques. Multivariate analyses were performed to determine factors associated with wasting controlling the potential confounders.Results: In a total of 150 under five years children, the prevalence of wasting was 56 (37.33%). The current study demonstrated that children of mothers from dalit (Adjusted Odds Ratio (OR) 11.5; 95% CI: 03.1 – 41.3), aadibasi/janajati (AOR 4.6; 95% CI: 1.2 – 17.0), illiterate mothers (AOR 3.6; 95% CI: 1.1 – 13.6), laborer mothers (AOR 2.1; 95% CI: 1.1-9.4), child age group 25-36 months (AOR 2.8; 95% CI: 1.5-5.3), multiple child birth order (AOR 10.0; 95% CI: 2.5-25.0), children who were not fed colostrums (AOR 15.0; 95% CI: 1.25-10.0)) were more likely to develop wasting compared to their counterparts.Conclusions: As incremental childhood wasting is associated with maternal socio-demographic factors and child feeding practice, health promotion strategies should focus maternal socio-demographic factors, age of children and early initiation of breast feeding for the improved child nutrition in slum area of Nepal.Keywords: socio-demographic factors; urban slum; under five children; wasting. [PubMed]
Scleral Fixation of Intraocular Lens with Ab Interno Technique
Authors: Gurung Nanda Kumari , Rijal Roshija , Thapa Bel Bhahadur , Gurung Shanti
Published: September 2018

Introduction: Implantation of scleral fixation intraocular lens for the surgical management of aphakia cases without capsular support is a safe procedure.Methods: Prospective study was carried out at Lumbini Eye Institute, Bhairahawa. A total of 32 patients underwent scleral fixation intraocular lens implantation within a period of two years from February 2014 to February 2016.Results: The age range was from 15 to 79 years; mean age was 47.56±20.16 SD. Among them 14 (43.75%) were male and 18 (56.25%) were female. The follow-up lasted for 24 months. The postoperative characteristics of the patients are listed in the tables below.Conclusions: SFIOL for the surgical management of aphakia in the absence of capsular support is a safe procedure. The long-term follow-up is needed for an accurate evaluation of outcomes.Keywords: double armed prolene suture; intraocular pressure; scleral fixation intraocular lens; scleral tunnel. [PubMed]
Regional Anaesthesia in Clavicle Surgery
Authors: Shrestha Babu Raja , Sharma Puja
Published: September 2018

In routine practice, regional anaesthesia is less commonly used for clavicular fracture compared to general anaesthesia. We report two cases of clavicle fracture for which operative treatment was done under combined superficial cervical plexus andinterscalene brachial plexus block. Inboththe cases combination of ropivacaine anddexmeditomidine was used forblock. Both the patients exhibited comfort and there was no additional analgesic demand in both the cases.Thuscombination ofinterscalene and superficial cervical plexus block can prove to be useful in patients with clavicle fracture where administration of general anaesthesia and its adverse effects could be avoided. [PubMed]
Early Detection of Precursors of Cervical Cancer with Cervical Cytology and Visual Inspection of Cervix with Acetic Acid
Authors: Dhaubhadel Pragya , Vaidya A , Choudhary P
Published: September 2018

A hospital-based, prospective study was done in 350 women of 20-50 years to compare VIA withPap smear for early detection of cervical dysplasia at Maternity Hospital, Thapathali, from May2004 to December 2004. Pap smear was taken from each woman followed by VIA. Women withpositive VIA and/or positive Pap smear were referred for colposcopy-directed cervical biopsy. Thevariables studied were age group, presenting complaint, age of marriage, parity, smoking habit andappearance of cervix.The incidence of positive VIA and Pap smear was 2.86 and 0.57 respectively. Pelvic pain was themost common presenting complaint. The majority of the women were married before 20 years ofage. All women with either positive VIA and/or Pap smear were of parity two or above. Therewas no significant association between smoking and positive VIA (P=0.699) or Pap smear (P=0.397).Approximately 36.57% of the women screened had abnormal looking cervix. There were two womenwith high grade intraepithelial lesion (HSIL) and both were VIA positive and this was statisticallysignificant (Fischer exact P=0.0007). Of the ten VIA positive women, on histopathological examinationsix showed chronic cervicitis, one acute cervicitis, one showed cervical intraepithelial neoplasia (CIN)II, one had normal finding and one was lost to follow up.VIA as a screening test for cervical neoplasia did not miss any lesion detected by Pap smear andconfirmed by cervical biopsy.Key words: cervical neoplasia, pap smear, visual inspection
Giant Ovarian Mucinous Cystadenoma Complicating Term Pregnancy
Authors: Mishra Sangeeta Kaushal , Yadav Manoj , Walavalkar Sripad J
Published: September 2018

Huge ovarian cyst are found in less than 1% of all ovarian cyst in pregnancy and are associated with poor feto-maternal outcome. A 28 years old G2P1 with history of normal vaginal delivery 3 years back was referred from local health post with complains of intermittent pain abdomen at 29 weeks. Her scan showed huge ovarian cyst of 18.9×17.6 cm with multiple thick septation. Woman was conservatively managed till term and elective surgery was planned however she presented in labour with breech presentation at 39 weeks and 4days. Emergency lower segment caesarian section along with left sided salpingo–oophorectomy was done along with delivery of 2.5 kg healthy female baby. Histopathology was suggestive of mucinous cystadenoma of ovary. Although antepartum removal of ovarian cyst has been recommended to ensure good pregnancy outcome, expectant management and timed intervention can be adopted for pregnancy with huge ovarian cysts.
Work Related Complaints among Dentists
Authors: Shrestha Bikram Prasad , Singh GK , Niraula SR
Published: September 2018

The objective of this study was to describe the occurrence of neck pain, shoulder pain and back painamong dentists and to assess the risk factors affecting them.Sixty-eight dentists from Dharan and Biratnagar were interviewed using pretested questionnairesin January 2006. Back pain was the most common complaint affecting almost 80% of the study population, followed by neck pain (58.8%) and shoulder pain (47%). The frequency of shoulder pain among female dentists was nearly double that of males (P=0.009). The mean days of neck painamong males was significantly higher as compared to females (P=0.048). The study suggests that musculoskeletal complaints are commonamongdentists,thoughtheyarenot of severenature.Thereis a scope forfurtherdecreasingtheprevalence andseverityofthesedisordersbyperformingregularspecific exercises.Key words: back pain, dentists, neck pain, shoulder pain
Efficacy of IV Iron Compared to Oral Iron for Increment of Haemoglobin Level in Anemic Chronic Kidney Disease Patients
Authors: Adhikary L , Acharya S
Published: September 2018

Introduction: Anemia is the most common finding in chronic kidney disease patients. Iron supplements are commonly prescribed for these patients with or without erythropoietin therapy by means of oral and intravenous iron. Both oral and intravenous irons have their own advantage and disadvantage, and the efficacy is also different. The objective of the study is to analyze the efficacy of oral and intravenous iron in chronic kidney disease patients on erythropoietin therapy, an erythropoiesis stimulating agents for increment of haemoglobin.

Methods: This is a prospective study comparing intravenous iron to oral iron in chronic kidney disease patients who underwent maintenance hemodialysis at different centers and visited Kathmandu Medical College Teaching Hospital from April 2010 to April 2011. Patients having a haemoglobin level of < 11 g/dl, transferrin saturation (TSAT) < 25%, ferritin < 300ng/ml and who were on erythropoietin therapy were allocated alternately into two groups to receive oral iron (iron fumarate) or IV iron (iv sucrose). Haemoglobin was measured after 30 days of therapy.

Results: A significant increase in haemoglobin levels was observed in both groups. But the mean haemoglobin increment was more in the IV iron group than in the oral iron group. Sixty percent 60% of patients in the IV iron group had an increase in the haemoglobin level of more than 1gm/dl while only 20% of the oral iron group had this increase.

Conclusions: Intravenous iron therapy is more effective in raising the hemoglobin level in hemodialysis dependent chronic kidney disease patients.

Keywords: anemia; chronic kidney disease; iron.
Supracrestal Non-Surgical Therapy in Periodontal Diseases
Authors: Goel Khushboo
Published: September 2018

Periodontal diseases are the complex disease with a dynamic relationship between biofilm and the host immunoinflammatory response. The goal of periodontal therapy is to preserve the natural dentition and increase their longevity by creation of a favorable environment around the teeth. The mainstay to achieve this is by the non-surgical periodontal therapy, followed by surgical and other recent treatment modalities. However, there seems no sure indication to choose amongst them that are clinically significant and offer long term predictability. We report here two cases that had supracrestal defects and were treated with less invasive instrumentation and repeated full mouth scaling and root planing. This avoided a surgical intervention and was more cost-effective in treating moderate to severe young chronic periodontitis patients. The decision for the type of treatment needs to be critically assessed with a better understanding of the outcome, morphology of the defects, and type of teeth involved.