bluuebunny/crossref_metadata_2025 huggingface dataset:
Extraventricular Neurocytoma
Authors: Karki B , Tamrakar K , Kai Xu Yi , Kui Wu Yuan , Wei Zhang Wei
Published: September 2018

Extraventricular neurocytoma (EVN) is a rare neuroepithelial tumor. Its propensity to occur in cerebral hemisphere is much higher. EVN has a histological resemblance to central neurocytoma but radiologically, it is more complex. Ganglionic differentiation is more common in EVN and tends to have more of a cystic component. Calcification is frequent but hemorrhage is only an occasional finding. Although it has been reported to occur in various regions, the propensity to occur in cerebral hemisphere is much higher. Herein, we report two cases which presented as a mass in the right frontal lobe and right parietal lobe. MRI showed hypointesity on T1, hyperintesity on T2-weighted images with moderate enhancement after contast injection. In short extraventricular neurocytoma should be considered indifferential diagnosis of complex intracranial masses. 

Keywords: central neurocytoma; computed tomography; xtraventricular neurocytoma; MagneticResonance Imaging.
A Diagnostic Dilemma of Cryptogenic Organising Pneumonia
Authors: Gurung K
Published: September 2018

Cryptogenic Organising Pneumonia is a rare lung condition, which has incidence of 6-9 cases per 1000,000 people with onset at age group between 50-60. The pathogenesis of this condition remains unknown. It mimics like pneumonia but has a good outcome with steroid treatment. Early recognition is very important and treatment with steroid therapy can save lives. This case highlights the unusual cause of shortness of breath due to COP and co existing incidental severe AS where we faced a diagnostic dilemma till lung biopsy was performed.

Keywords: Cryptogenic organising pneumonia; Pneumonia.
Lambda Light Chain Myeloma with Oliguric Cast Nephropathy and Remission with Bortezomib, Doxorubicin and Dexamethasone
Authors: Hada R , Poudyal B , Sharma A , Khatri R
Published: September 2018

Cast nephropathy is one of the major causes of renal failure in patients with multiple myeloma resulting from precipitation of free light chains inside the tubules. Timely diagnosis and treatment confers a better prognosis though around 10% of patients with cast nephropathy remain dialysis dependent in spite of treatment.We report the clinical course and outcome of a patient presenting with acute kidney injury and oliguria, preceded by acute gastroenteritis and intake of Chinese medications and dialysis dependent state for eight weeks. Kidney biopsy revealed cast nephropathy with lambda light chain restriction and severe tubular injury. Serum protein electrophoresis was normal with no “M spike” but serum free light chain ratio was altered with very high lambda and normal kappa light chain levels. Bone marrow biopsy showed >85% atypical plasma cells. Haemodialysis was continued and chemotherapy with bortezomib, doxorubicin and dexamethasone was started. Kidney function gradually improved with discontinuation of dialysis after 1 month and complete remission of acute kidney injury and myeloma in 4 months of chemotherapy.  

Keywords: acute kidney injury; bortezomib; cast nephropathy; multiple myeloma.
Subcutaneous Emphysema in Pregnancy
Authors: Shrestha A , Acharya S
Published: September 2018

Spontaneous pneumomediastinum and subcutaneous emphysema are rare complications of labor, especially in the late pregnancy period, but they are usually self-limiting. Management includes avoidance of exacerbative factors and close observation with supportive treatment. A 19-year-old primi gravida at 36 weeks pregnancy presented with swelling over the right side of the face, neck and chest. Her general examination was normal. Systemic examination revealed swelling with palpatory crepitation over the right side of chest, neck and face, and other examination findings were normal. Chest X-ray revealed subcutaneous emphysema without pneumothorax. The patient left hospital against medical advice.

Keywords: Pregnancy; subcutaneous emphysema; pneumomediastinum.
Acute Renal Failure in a Tertiary Care Center in Nepal
Authors: Khakurel Sudha , Satyal P R , Agrawal R K , Chhetri P K , Hada R
Published: September 2018

From July 1998 to July 1999, 45 cases of acute renal failure were treated at Bir Hospital, Kathmandu. Outof which 24 were male and 21 were female. Age ranged from 11 months to 84 years with mean age being 35years and 9 cases were below 10 years.Four cases with pre-renal azotaemia and twenty five cases of acute tubular necrosis (ATN) accounted for64% of all cases. These were due to gastroenteritis 10, sepsis 6, post surgical 1, trauma 1 and obstreticalcomplications 5. Multiple hornet stings were responsible for acute renal failure in 3 cases, acute urate nephropathy in 1 case and miscellaneous causes in 2 cases.Glomerulonephritis / vasculitis accounted for 17.7%, acute interstitial nephritis 4.4%, haemotytic uraemicsyndrome (HUS) 6.6%, and post renal azotaemia in 6.6% of all cases. Mean serum creatinine was 8 mg/dl,mean blood urea 190 mg/dl. Eight cases were treated only conservatively, eighteen received haemodialysis,fourteen received peritoneal dialysis, three received both and two refused for dialysis. Average duration ofhospital stay was 13.6 days. Out of the forty-five cases twenty-nine recovered normal renal function, tenexpired, two recovered partially, two progressed to chronic renal failure and two left against medical advice.Overall mortality was 22.2%.Common causes of acute renal failure in our setting were gastroenteritis (22%) and sepsis (20%). HUS wasexclusively seen in children following bacillary dysentery. Multiple hornet stings is an important cause ofacute renal failure in our country.
Impact and Determinants of Gender Preference in Duhavi VDC of Eastern Nepal
Authors: Uprety S , Jha N , Poudel IS , Pokharel Pk , Poudel M , Niraula SR
Published: September 2018

Introduction: Gender equality has been a priority area of demographic research. One of the major reasons for high fertility and low acceptance of family planning is the prevalence of gender preference among couples. The objectives of this study were to identify the determinants and examine the extent of gender preference on fertility.

Methods: This is a cross-sectional study carried from June 2008 to July 2009 in Duhavi VDC of Sunsari district of Nepal. Three hundred and fi ve randomly selected ever-married women of 15 - 49 years, who had at least one child were the subjects of the study. A questionnaire covering the areas on gender and fertility preference and methods and use of contraception was given and fi lled up.

Results: The study showed that 42.6 % of the ever-married women belonged to the 25 - 29 years age group. Around 92 % of women whose last child was a male were using family planning methods whereas only 40 % of women whose last child was a female were using family planning methods. This difference was statistically signifi cant (P < 0.0001).

Conclusions: The contraception use among the women having a female child was low, showing a desire for a male child which is one of the factors in the increase of family size in our society. Due to the patrilineal society, women are discouraged in the practice of contraception. Effective intervention programs need to be planned and conducted to rectify this situation. 

Keywords: Determinants, Duhavi VDC, gender preference, impact, Nepal.
Osteoporosis - An Update
Authors: Lamichhane Arjun Prasad
Published: September 2018

Osteoporosis is a systemic disease characterized by decrease in bone mass per unit volume, compromisedbone strength, which predisposes the affected bone to fracture. This is currently one of the leading causes ofmorbidity and mortality among elderly over the world. In general, osteoporosis is a silent and progressivedisorder that is often brought to attention of the patients or physician only after a fracture. The aetiology ofosteoporosis is multifactorial and is related to two main processes: acquisition of peak bone density thatoccurs at the end of the third decade and loss of bone at menopause, going on to old age. The cardinalfeatures of osteoporosis are pain, fracture and deformity. Bone mineral density measurement is the mostreliable diagnostic tool in the early stage of osteoporosis. Management of osteoporosis involves preventionand treatment. The best treatment for osteoporosis is prevention. The risk of osteoporosis can be reduced byincreasing peak bone mass or by decreasing the bone loss. It needs to be emphasized that bone mineraldensity (BMD) peaks at about age 35 and then begins to slowly decline with significant acceleration aftermenopause. Therefore, the most logical and cost-effective preventive strategies are to encourage young womento stop smoking and avoid excessive use of alcohol. They should also be counseled to exercise regularly andconsume adequate amounts of calcium and vitamin D.Key Words: Osteoporosis, Fracture, Bone mineral density, Menopause.
Interrelationship between Diabetes and Periodontitis- A Review
Authors: Pradhan S , Goel K
Published: September 2018

Evidence for the link between periodontal disease and several systemic diseases is growing rapidly. Diabetes mellitus is a systemic disease with several major complications affecting both the quality and length of life causing morbidity and mortality. Periodontitis, one of these complications, is a chronic infection associated with substantial morbidity in the form of tooth loss and that affects the quality of life directly. The association between diabetes and inflammatory periodontal disease has been studied extensively. The relationship between these two conditions appears bidirectional. The presence of one condition tends to promote the other and the meticulous management of either may assist treatment of the other. It also provides a perfect example of a cyclical association, whereby a systemic disease predisposes the individual to oral infections, and once the oral infection is established, it exacerbates the systemic disease. This review focuses to explain the interrelationship between the two based on information in the literature and the potential common immunoregulatory connections involved, exploring the mechanisms through which periodontal infection can contribute to the low-grade general inflammation associated with diabetes. Keywords: Diabetes mellitus; inflammation; insulin resistance; periodontitis.
Tuberculin Survey in Government High School of Dharan Municipality
Authors: Kumar Narayan , Baral D D , Tamrakar S
Published: September 2018

This survey was done in 682 out of 1672 children tested with Batch of Tuberculin used for Testing (PPD RT23 with Tween 80) in Jan. 1997 with financial research grant of B.P. Koirala Institute of Health Sciences,Dharan.Dharan City is situated in Eastern Development Region (EDR) of Nepal where a high percentage of migrated population is residing with very high number of sputum positive cases. The majority of populationare from high hills & mountain region where the Annual Risk of Infection (ARI) is less. This survey was doneto know the epidemiological situation of Tuberculosis (TB) in Dharan.Tuberculin survey was done in Eastern Development Region (EDR) (1994) by National Tuberculosis Centre(NTC) / Japan International Cooperation Agency (JICA) in Saptari & Morang. The reported result ofaverage Annual Risk of Infection (ARI) is 2.49% & 2.38% respectively.The mean age of surveyed population was 14.8 yrs. The Bacilli Calmette Guerin (BCG) coverage (scar rate)was 38.3% & BCG 4 - 8 age group 83.3% was highest & it gradually decreased to 37.5% in 12 + age group.The average 23 Tween – 8 – Batch of Tuberculin used for Testing (PPD) positive is 33.6% with 10 mminduration as cutoff line. Annual Risk of Infection (ARI) based on above was 2.7% in 9 - 11 age group &1.31% in 12 + age group. This survey is suggestive of tuberculosis being highly prevalent in Dharan. Thesurvey also showed average ARI to be 2.44% in Dharan in 10 - 15 yrs age group. The finding is suggestive ofhigh ARI although the populations has migrated from hill & mountain. Previous report of average ARI inthis area was 2.5% (Morang & Saptari). The survey result suggests that high priority, effective tuberculosisprogram is necessary and intensive control program can only give impact to control of tuberculosis in Dharan.Key Words: Tuberculin survey, school children, BCG coverage, ARI, Effective tuberculosis programme.
EARLY INTERVENTION OF PARS TENSA RETRACTION POCKETS IN CHILDREN BY CARTILAGE REINFORCED TYMPANOPLASTY
Authors: KC Toran , Shrestha S , Kafle P K
Published: September 2018

Posterosuperior retraction pockets involving pars tensa of a tympanic membrane is not an uncommonproblem particularly in pediatric population. This occurs as a sequelae of chronic otitis media with effusion.The management options include “wait and watch,” medical treatment and surgery. But in patients inwhom retraction is severe and seems to be irreversible the treatment should be surgery at the earliest. Weperformed cartilage reinforced tympanoplasty in 29 ears of 28 children who had grade III and IVposterosuperior retraction pockets of the pars tensa. Their average pre-operative hearing loss was 16.6 and19.4dB for grade III and IV retraction pockets respectively with 10 and 12.4dB post operative gain. Norecurrences were noted except few minor complications. We suggest that such procedures are safe andshould be performed at the earliest rather than to keep under surveillance and medical treatment only.Key Words: Pars tensa retraction pockets, Tympanic membrane atelectasis, atelectatic ear, Tympanoplasty.
INITIAL EXPERIENCE OF RADICAL HYSTERECTOMY FOR EARLY CERVICAL CANCER AT A CANCER HOSPITAL IN NEPAL
Authors: Dangal Ganesh
Published: September 2018

The purpose of this study was to find out the clinocopathologic characteristics, post-operative findings andcomplications of patients with early (up to stage IIA) cervical carcinoma who underwent radical hysterectomy.This study concentrates on the evaluation of our early experience in radical hysterectomy for cervicalcancer in Nepal. This was a retrospective analysis of 48 patients who had radical hysterectomy with bilateralpelvic lymphadenectomy for early cervical cancer at the BP Koirala Memorial Cancer Hospital (BPKMCH)from September 1999 through September 2002. Characteristics such as chief complaint, disease stagingand duration, intraoperative and postoperative complications, histopathological findings, need for bloodtransfusion, and duration of hospital stay were considered for analysis. Patients’ age ranged from 28-67years. Age group of 40-49 had highest number of patients (58.3%). Majority (62.5%) were premenopausalwomen who presented with abnormal vaginal bleeding (73%) as the chief complaint. More than half ofthem (56%) had FIGO stage IIA disease. Thirty-three percent had intraoperative and postoperativecomplications such as urinary problems, wound infection and vessel injury/ureteric injury. All neededblood transfusion, 42% needing four pints. The average duration of hospital stay was 11 days. Forty-fourhad squamous cell carcinoma and four had adenocarcinoma. Pelvic lymph node metastasis was found in 10patients. Resected margins were adequate in 42 patients. Majority (62.5%) of the women were premenopausaland 56% of them had stage IIA disease. Although the primary treatment of early-stage cervical carcinomainvolves either surgery or radiation therapy with or without chemotherapy, surgery (radical hysterectomy)was used for lower-stage disease and smaller lesions in fit and young patients in our resource-poor set-up.Fifteen patients needed postoperative radiation. The complication rate seems to be higher in Nepal; however,it will decrease as more experience is gained.Key Words: Cervical cancer, gynecological malignancies, human papillomavirus, radical hysterectomy.
USE OF ENZYME LINKED IMMUNOSERBENT ASSAY (ELISA) FOR THE DIAGNOSIS OF CLINICALLY SUSPECTED REFERRED HUMAN CYSTIC AND ALVEOLAR HYDATIDOSIS CASES IN NEPAL
Authors: Joshi D D , Joshi H , Chand P B
Published: September 2018

The objective of the study is to diagnose suspected human cystic and alveolar hydatidosis cases in Nepal. Inthis present study diagnosis of active clinical cases of cystic and alveolar hydatidosis referred to our centreby different hospitals, nursing homes and private clinics of Kathmandu were carried out from August 1999to March 2001 by using ELISA. Among 44 samples including 31 samples from male and 13 samples fromfemale. 35 (79.54%) were found positive. Regarding the age group maximum 13 samples were collectedwithin 6-15 years age of which 12(27.3%) were found serrologically positive. Ultrasonogram (USG) andcomputerised tomography (CT scan) are the method of choice to image the hepatic and other abdominalcysts. In this study 75% of CT scan suspected cases were found positive by ELISA. Hence these imagingtechniques must be used to detect the shape, size and location of the cyst but not as confirmative. Bloodexamination results, biochemical tests and stool and urine examination have basically no relation withhydatidosis.Key Words: Cystic, alveolar hydatidosis, ELISA, genotype, strain.
CHEMICAL PLEURODESIS USING POWDERED TETRACYCLINE TABLET FOR RECURRENT PNEUMOTHORAX
Authors: Prabhu M. Mukhyaprana , Mishra P , Subish P , Malhotra A , Sharma A , Upadhyay D K
Published: September 2018

Pneumothorax, a life threatening complication in chronicobstructive pulmonary disease (COPD), requires earlyrecognition and specific management. Recurrentpneumothorax can occur due to rupture of emphysematousbullae in COPD patients. Pneumothorax is treated by insertionof chest tube under focal drainage. Recurrent pneumothoraxis treated by open thorocotomy or thorocoscopy and resectionof mechanical abrasions and insufflations of talc. Non surgicalmethods of pleurodesis include chemical pleurodesis using talcpowder (Mg3Si4O10(OH2)), tetracycline, doxycycline,minocycline, bleomycin etc 1. We report a case of successfulpleurodesis using tablet tetracycline (500Mg) in a case ofrecurrent pneumothorax in a COPD patient.
MEASURING SURGICAL OUTCOMES : NEED OF THE HOUR
Authors: Timilsina Digvijay S. , Dwaka S , Majhi P C
Published: September 2018

Abstract
Medical negligence- Meaning and Scope in India
Authors: Kumar L , Bastia BK
Published: September 2018

It is a principle recognized by our as well as by other legal systems that ignorance of the law is no excuse for violating it. The rule is also expressed in the form of a legal presumption that everyone knows the law. It is the duty of every man to know that part of it which concerns him. A doctor, in particular, is conclusively presumed to know the law, and is dealt with as if he did know it, because in general he can and ought to know it. In the matter of professional liability, the medical profession differs from other occupations for the reason that the former operates in spheres where success cannot be achieved in every case and very often success or failure depends upon factors beyond a medical man’s control. Due to the increasing awareness of the rights of a patient in present day society, a medical man has become more vulnerable to being sued by a litigation suit of any kind, civil or criminal. The basis of a medical negligence suit is still alien to the majority of the practicing doctors in our country. Hence, the present article aims at discussing the various aspects of negligence, like the meaning and types of negligence, and the concept of duty of care, degree of care, and standard. 

Keywords: degree of care, duty of care, medical negligence, standard of care.
TEAR GASES AND HEALTH
Authors: Gautam M P , Ghimire U
Published: September 2018

Use of tear gases to control civil unrest is accepted practice by government authorities worldwide, in spiteof their harmful effects in human health and its ban by different organization. The most commonly usedriot control agents used as fumigant includes pepper spray, popularly known as OC (Oleoresin Capsicum)and different types of tear gases which are o-chlorobenzylidene malononitrile, known commonly as CS,omega-chloroacetophenone, known as CN, and dibenz 1,4-oxazepine, known as CR and different types ofsolvent used to disperse these agents. These gases are responsible for not only the acute and chronic healtheffects but also for the significant economic loss. Investigations shows that CS, CN, OC, CR and methylenechloride (the solvent used to disperse these agents) are responsible for acute and chronic health effectsranging from severe flu-like symptoms, to pulmonary edema and acute respiratory distress, to chromosomeaneuploidy in germ and somatic cells, which may leads to birth defects in offspring and cancer. The onlyimmediate physical symptoms developed by a victim of these gases are the irritating and immediatelydebilitating effects of the CN or CS itself. Apparently, the immediate acute effects of the gas wear off withinten to fifteen minutes. Although the chemical agents have been used for many years, full extent of effects onhealth is far beyond our understanding. All manufacturers and the police department must disclose thematerial data safety sheets of all chemicals used in crowd control and strictly follow the guidelines fordeployment. Manufacturers should be responsible for the acute and chronic health effects of the chemicalsthey create and government should take responsibility for after care.Key Words: Tear gases, Health hazards, Nepal.
Malrotation of Intestine with Carcinoma Colon in Adult
Authors: Ray Dipankar , Chattopadhyay Gautam , Das Surajit
Published: September 2018

Malrotation of gut is a congenital anomaly and patients usually present in childhood. Occasionally it may present in adulthood. Patients are usually asymptomatic when malrotation of gut is detected during investigations or operation. Also it can cause longstanding abdominal symptoms, volvulus of gut. Rarely malrotation of gut may present with gastrointestinal neoplasm. We present a 60year old female presented with carcinoma caecum along with intestinal malrotation.
Neonatal Septicaemia: A Hospital Based Study in Eastern Nepal
Authors: Khanal Dr. Basudha , Shariff M , Deb M
Published: September 2018

Septicaemia  is  a  major  cause  of  neonatal  morbidity  and  mortality.  Premature  rupture  of  membrane, premature delivery, low birth weight and hospitalisation of the neonate are some of the predisposing factors, which influence the onset of infection and its outcome.   Depending on the time of onset and the causative factors, a wide variety of organisms are implicated in neonatal septicaemia.   The blood culture takes a minimum of 48 hrs to arrive at a definitive diagnosis. A prompt management of such cases along with empirical antibiotic therapy remains the mainstay of management. Hence, knowledge about the organisms prevalent in a particular hospital and their antibiotic susceptibility pattern is an important prerequisite. The study was carried out at the B.P. Koirala institute of health sciences, a tertiary care hospital, in Eastern Nepal for a period of 3-years from 1998 to 2001. Blood samples from 1567 neonates with suspected septicaemia were cultured using standard microbiological technique. 540 (35%) samples were culture positive. Gram- positive bacteria (74%) were more common than Gram-negative bacteria (27%). Staph aureus   (60%) was the most common bacterial isolate. Resistant to ampicillin was seen but most were susceptible to other antimicrobial  including  gentamicin,  amikacin,  cefotaxime,  and  ciprofloxacin.  Positivity  rate  decreased  in the 3rd  year to 25% as against first two years of 41% and 47% respectively, which was, attributed to training and implementation of various measures of infection control practices. Candida spp was not observed during the period of study. It was concluded that a continuous surveillance of the causative agents and their antimicrobial susceptibility pattern is required to control the infection in the hospital neonatal unit.Key Words: Neonatal septicaemia, Organisms, Antimicrobial susceptibility pattern.
Comparative Study of Management of Closed Comminuted Femoral Shaft Fractures with Closed Interlocking Intramedullary Nail and Open Reduction and Dynamic Compression Bridge Plating
Authors: Shrestha Bikram Prasad , Kumar P , Singh GK
Published: September 2018

Fracture shaft of the femur are life-threatening injuries and can cause severe permanent disability. Nowadays die interlocking nailing is regarded as the operative technique of choice for fracture shaft of femur. However, the advantages and disadvantages have rarely been compared with plate osteosynthesis. This is prospective study to compare the two methods of treatments in terms of time to union, hospital slay (including readmission), wound infection, shortening of limb, delayed union, malunion, joint stiffness and implant failure. 54 patients, age (16 to 66) years, were treated by DCP (22), and interlocking nail (24). Eight patients were lost to follow up. The study was conducted in Services Hospital, Department of Orthopaedics and Ittefaq Hospital, Lahore, Pakistan from June 1996 to Dec 1997. Written consent was taken regarding the type of surgery to be performed. Open fractures of Gustilo Grade n or in, femoral shaft fractures associated with other fractures of the same femur, fractures in immature skeleton and segmental fracture were excluded. Winquist and Hansen classification was used to classify fracture comminution. Patients were alternately allocated. In the plating group, primary bone grafting was done in all cases. Time to union in nailing group was 16.43t2.48 weeks and in plating 19.88±3.46 weeks, p-value<0.05. Mean hospital stay in nailing group was 12.8±2.75 day and plating group 21.1±2.73 days, p>0.05. There were 2 deep infections in the plating group and none in nailing group. There was no shortening of limb in die plating group but 2 patients in the nailing group had shortening of 2 cms. Delayed union occurred in 2 patients in nailing group but 5 in plating group. One patient in the nailing group had external rotation of at least 10 degrees and none in plating group. Two patients in the nailing group had knee stiffness and 6 patients in me plating group. One patient in the nailing group had a broken interlocking screw 2 patients in the plating group had bent plates. Closed interlocking intramedullary nailing as a method of treating closed communited femoral shaft fracture is better than plating in terms of rate of postoperative complication including infection.Key Words: Comminuted fractures shaft of femur, static interlocking nailing and bridge plating.
Alcohol Use among Women in a Town of Eastern Nepal
Authors: Niraula Surya Raj , Shyangwa PM , Jha N , Paudel RK , Pokharel PK
Published: September 2018

A community-based cross-sectional survey with cluster sampling method (probability proportionate to size) was carried out to estimate the prevalence of alcohol consumption among Nepalese women in Dharan town to assess the pattern of use and to identify the factors associated with this habit. A representative sample of 2340 women, aged 15 years and above was interviewed in 2002. The estimated prevalence of alcohol consumption was nearly 17%. Alcohol use is prevalent among females of hill ethnic groups. Nearly half of the divorced (formal or informal) women consumed alcohol. The women, aged 50 years and above, were at risk to become addicted to its use. Most popular drink in this area is a homemade product (Local Raksi). The alcohol users are more likely to smoke as well. More than 9% of pregnant women are found to consume alcohol during their pregnancy. Effective awareness programs are required to discourage the excessive use of alcohol among women and encourage those seeking regular health care services.Key Words: Prevalence, pattern, factors, women, alcohol, Dharan, Nepal.
Micturating Cystourethrography as a Part of Urinary Tract Infection Work Up in Children
Authors: Shrestha Shrijana , Adhikari N
Published: September 2018

Urinary tract infection (UTI) is a common infection in childhood and has the potential to cause renal damage especially in younger children (< 2 years). Almost 30- 40% cases of UTI are associated with vesicoureteral reflux (VUR). The main objective of this study was to identify the presence of VUR in children with UTI and its relative distribution according to age and sex. This is a retrospective hospital based study carried out between Jestha 059 to Poush 060 (15/6/2002–15/1/2004) at department of Paediatrics, Patan Hospital. All the cases that underwent micturating cystourethrography (MCUG) as part of UTI work up were included in the study and the information was collected from patient record files. During this period total 51 patients with UTI had MCUG. Sixty-six percent were males and 82% were below 2 years of age. VUR was found in 27.4% cases and the highest number was in the age group of 2- 5 years. UTI in young children is largely overlooked and the observed frequency of VUR in children with UTI in our study is considerable, though slightly lower than reported. Therefore the standard protocol of performing MCUG as part of UTI work up in the high-risk group should be followed.Key Words: Urinary tract infections, Vesicoureteral reflux, Children.
Study on Cyclospora Cayetanensis in Kathmandu Valley
Authors: Gupta Ranjana , Gurung R , Sherchand JB , Jha SC
Published: September 2018

Cyclospora caytanensis, a human pathogenic coccidian parasite owes its recognition as an emerging parasite, which continues to be found throughout the world. Its prevalence was investigated in Kathmandu valley, Nepal in 2003. Stool examination was performed with a total of 500 specimens from 3 Hospitals, 1 Geriatric Centre (Briddhaashram), 1 Infectious and Tropical Disease Research Center/Nepal and 8 Slum areas by direct smear technique. Out of these specimens, Cyclospora caytenensis oocysts were found in 7% of specimens with the age range from 2 months to 67 years. To identify possible sources for Cyclospora infection, water samples from 3 rivers, 134 fecael samples of animals and 43 samples of green leafy vegetables wash were collected and examined by formal-ether sedimentation and floatation technique. As a result, oocyst of Cyclospora was identified only in chicken stool sample, which could be possible reservoir host for Cyclospora infection. However, further studies are needed to shed light on possible sources of infection.Key Words: Cyclospora caytanensis, coccidian parasite, diarrhoea, faecal specimens.
Cervical Schwannoma
Authors: Karmacharya Bal Gopal , Khadka N , Joshi MR , Sharma VK
Published: September 2018

Schwannomas are solitary, slow growing benign tumors arising from the Schwann cells that form the myelin sheath around the peripheral nerves. Head and neck is the commonest site of these tumors in the body. We present a case of schwannoma in a 35 years old man who had a painless slowly growing tumor in the right side of his neck.Key Words: Schwannoma, FNAC, parapharyngeal space.
Traumatic Brain Injury: Caregivers’ Problems and Needs
Authors: Syed hassan Syed Tajjudin , Khaw WF , Rosna AR , Husna J
Published: September 2018

Traumatic brain injury (TBI) is an increasingly major world health problem. This short review using the most pertinent articles on TBI caregiving problems and needs highlights the pressing issues. Articles focusing on both TBI-caregivers’ problems and needs are rarely found, especially for developing countries. Most TBI-caregiving is done by family members, whose altered lives portend burden and stresses which add to the overwhelming demand of caring for the TBI-survivor. Lack of information, fi nancial inadequacy, anxiety, distress, coping defi cits, poor adaptability, inadequate knowledge and skills, and a poor support system comprise the major problems. Dysfunctional communication between caregivers and care-receivers has been little researched. The major needs are focused on health and rehabilitation information, fi nancial advice and assistance, emotional and social support, and positive psychological encouragement. In time, health information needs may be met, but not emotional support. Information on TBI caregiving problems and unmet needs is critical to all relevant healthcare stakeholders.

Keywords: caregivers, rehabilitation, traumatic brain injury
Acute Ischaemic Colitis- A Case Report
Authors: Basra M , Shrestha B M
Published: September 2018

Acute ischaemic colitis (AIC) is being increasingly recognised as an uncommon cause of abdominal pain associated with fresh bleeding per rectum. It is paramount to maintain a high index of suspicion and adopt appropriate management strategies to avoid complications and inappropriate interventions. In this paper, we describe a case of AIC and review literature pertinent to the management of this condition.

Keywords: Ischaemic colitis, acute abdomen, management.
Pulmonary Cavity due to Chronic Eosinophilic Pneumonia Associated with Arsenicosis
Authors: Sengupta A , Saha K , Jash D , Bandyopadhyay A
Published: September 2018

In developing country like India arsenic poisoning is a major public health problem. Association of chronic eosinophilic pneumonia and chronic diarrhea with arsenicosis is rare. Also pulmonary cavity formation in chronic eosinophilic pneumonia is very uncommon. A 44-year-old male patient, resident of an arsenic affected area was admitted for evaluation of chronic diarrhoea, persistent peripheral eosinophilia along with radiologically visible cavity in right upper zone. There were dermatological manifestations of arsenicosis along with presence of noncirrhotic portal fibrosis and peripheral eosinophilia. On bronchoalveolar lavage study, eosinophil comprised 40% of total cellularity making the diagnosis of chronic eosinophilic pneumonia. After ruling out all possible causes of diarrhoea and chronic eosinophilic pneumonia, we came to conclusion that arsenic could be implicated as causative agent.

Keywords: Arsenicosis, chronic diarrhoea, chronic eosinophilic pneumonia, noncirrhotic portal fibrosis.
Antibiotic resistance pattern of bacterial isolates in neonatal care unit
Authors: Shrestha S , Adhikari N , Rai BK , Shreepaili A
Published: September 2018

INTRODUCTION:

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

METHODS:

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

RESULTS:

The positive yield of blood, urine, eye swab and CSF cultures were 19.56%, 38.5%, 60% and 0.36% respectively. The most common isolates in the blood culture were coagulase negative Staphylococcus, Acinetobacter, Enterobacter and non-haemolytic Streptococcus. A significant percent of the isolates were resistant to the first line antibiotics. Among the gram negative isolates more than 30% are resistant to cefotaxime and more than 50% are resistant to gentamicin. During the one year period we had Nursery outbreaks of methicillin resistant Staphylococcus aureus and Salmonella infections. With the help of environmental cultures we were able to trace the source and intervene appropriately.

CONCLUSIONS:

Continuous surveillance for antibiotic susceptibility, rational use of antibiotics and the strategy of antibiotic cycling can provide some answers to the emerging problem of antibiotic resistance.
A Cadaveric Study of Different Angles of Scapula and Their Role in its Kinesiometrics and Muscle Morphology
Authors: Sharma Ritika , Singla Rajan Kumar , Kullar Jagdev Singh , Sharma Rajan , Sharma Tripta
Published: September 2018

Introduction: The bipedal gait and consequential freedom of the upper limb in human beings has made the movements of the shoulder joint a subject of extensive investigations. The scapular angles provide the base and leverage to various muscles and have been correlated with the different movements of the shoulder joint.Methods: In the present study, different angles of scapula  namely superior, inferior, lateral, medial, acromial  and coracoid angles were measured in the North Indian population. The study was conducted on 100 scapulas (R:L = 50:50) obtained from Department of Anatomy, Government Medical College, Amritsar. For measuring the angles, centimetre scales and protractor were used.Results: The mean value of superior angle was observed to be 100.830 (R=100.320 : L=101.340) ; inferior angle was 63.620 (R=68.10 : L=59.140) ; lateral angle was 61.720 (R=65.90 : L=57.540) ; medial angle was 147.640 (R=151.320 : L=143.960) ; acromial angle was 106.470 (R=107.680 : L=105.260) and coracoid angle was 83.30 (R=84.240 : L=82.020).Conclusions: It was observed that all angles were higher in the right sided bones except superior angle. Also a wide range was seen in all the angles.     _______________________________________________________________________________________Keywords: acromial; coracoid; inferior; medial; superior._______________________________________________________________________________________
Dermatological Disorders in Chronic Kidney Disease
Authors: Shah Aparna , Hada Rajani , Kayastha Bhasker Mohan Mehar
Published: September 2018

Introduction: Dermatological conditions are common complications of Chronic Kidney Disease (CKD) affecting all most all patients. Present study aimed to evaluate the dermatological conditions and their association with age, sex and severity of CKD - without and with maintenance hemodialysis (MHD).Methods: It is a cross sectional and comparative study. Eighty-three patients with established CKD, without MHD (n=35) and with MHD (n= 48), attending nephrology unit, Bir Hospital and Shree Birendra Hospital from June 2008 to May 2009 were examined for dermatological disorders.Results: The mean age of patients were 46+15.6 years with male to female ratio of 1.8:1. Comparison of CKD without MHD and with MHD showed no statistical difference of age, sex, duration of treatment, blood urea and haemoglobin and significant difference of serum creatinine (5.3 + 3.0 mg/dl vs 9.1 + 4.5 mg/dl, p<0.001) respectively.Dermatological conditions were found in 100% CKD patients with pallor 91.5%, xerosis 75.9%, pigmentary changes 65%, pruritus 60.2%, skin infection 36.9%, vascular changes 16.8%, mucosal changes 67.4%, hair changes 59%, non -specific nail changes 81.9% and specific nail changes14.4%,.Specific (23.2% vs. 8.4%, p<0.03) and non- specific (91.4% vs 75%, p < 0.05) nail changes and hair abnormalities (74.3% vs. 47.9%, p<0.01) were significantly higher in CKD without MHD.Conclusions: Dermatological conditions are present in all CKD patients with or without MHD. A further prospective study is necessary to find out pathophysiology and beneficial effect of dialysis and transplantation in these conditions.Key words: chronic kidney disease, dermatological disorder, maintenance hemodialysis.
Surgical Emergencies in Obstetrics and Gynaecology in a Tertiary Care Hospital
Authors: Pokharel Hanoon P , Dahal Prerana , Rai Rubina , Budhathoki Shyam Sundar
Published: September 2018

Introduction: The management of Obstetrics and Gynaecological Emergency is directed at the preservation of life, health, sexual function and the perpetuation of fertility. Main aim of the study was to access the burden of Surgical Emergency in Obstetrics and Gynaecology and their course of management at BPKIHS.Methods: A total of 314 women presenting at the emergency admission room of Obstetrics and Gynaecology Department of BPKIHS over two years, who required surgical intervention were included in this hospital based descriptive study. Clinical assessment and routine laboratory investigations were performed in all cases. All patients who presented with shock were resuscitated and surgery was done at earliest possible time.Results: The age of patients ranged from 15- 55 years with approximately 43% in the 25-34 years category. Ninety two percent of them were married. Among the unmarried, 64% came with problems related to unsafe abortion. About 61% of females presenting as acute surgical abdomen had ruptured ectopic pregnancy, 7.64% had twisted ovarian cyst, and 6.26% had haemoperitoneum and pyoperitoneum following vaginal hysterectomies, total abdominal hysterectomies and caesarean section. Almost half (47.8%) of the cases underwent salphingectomy.Conclusions:Women present with wide range of complaints and conditions in the admission room of Obstetrics and Gynecology department of BPKIHS. Skilled clinicians, immediate investigation facilities and experienced specialty Obstetrical and Gynaecological surgeons are the main backbone of the emergency case management and saving lives. Study indicates there is need of some prospective study to establish the causes of rising trend in Ectopic Pregnancies.Keywords: ectopic pregnancy; emergency; gynaecological; obstetrics.
HIV PREVALENCE AMONG NEPALESE MIGRANT WORKER WORKING IN NEPAL AND INDIAN CITIES
Authors: Gurubacharya Dipesh L , Gurubacharya V L
Published: September 2018

Several studies have shown an association between mobility and HIV infection. In this study, we examinedthe prevalence of HIV infection among migrant workers working in Nepal and Indian cities. A representativesample of 316 migrant men (210 internal migrants and 106 external migrants) were interviewed and testedfor HIV infection during September 2001 to June 2003. HIV prevalence among migrants within Nepal was2.3% as compared to 8.5% among migrants to India. 60% of migrants within Nepal and 85% of migrantsto India have visited female sex workers. 75% of migrants within Nepal used condom while visiting femalesex workers in comparision to only 10% of migrants to India. We also found limited access to HIV informationservice for migrant workers to India as compared to migrants within Nepal. Considering the high HIVprevalence and risky behaviours regarding HIV/AIDS among external migrants as compared to internalmigrants, comprehensive HIV prevention programme is necessary for migrant workers going to work inIndia before they migrate.Key Words: HIV / AIDS, migration, sexual behaviours, Nepal, India.
Use of Analgesia in an Emergency Department
Authors: Bhandari Rabin , Malla Gyanendra , Mahato Indrajit Prasad , Gupta Pramendra
Published: September 2018

Introduction: Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment.

Methods: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics.

Results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70).

Conclusions: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain.

Keywords: analgesia; emergency; Nepal.
Partial Seizures in Children
Authors: Jain Neeraj , Mangal V
Published: September 2018

Key Words: Partial seizures, neurocyticercosis, Tuberculoma, CT scan.Seizure disorders are the most prevalent serious neurological disease. Partial seizures are the most commonform of seizures in children. This prospective study was carried out to determine the etiology and intracraniallesions in children with partial seizures. During the period of 3 years, 172 children with partial seizures (>2attacks) were included in the study. All children had contrast CT scan of head. About 70% of children hadtheir first episode of seizure before 6 years of age. The most common type of seizures was complex partialand the most common lesion on CT scan head was ring enhancing lesion (56.07%). For diagnosis of partialseizures detail history and CT Scan of Head are essential.
INTRAARTICULAR MORPHINE FOR POST OPERATIVE KNEE ARTHROSCOPY ANALGESIA
Authors: Mahara Deepak Prakash , Lamichhane A P
Published: September 2018

Key Words: Knee arthroscopy, Morphine, Opioid receptors, Post-operative pain.The Arthroscopy has dramatically changed the orthopedic surgeon's approach to the diagnosis and treatmentof variety of joint ailments. A degree of clinical accuracy, combined with low morbidity has encouraged theuse of arthroscopy to assist in diagnosis to determine prognosis and often to provide treatment. Recentwork has described peripheral opioid receptors in skin and synovium. The later may respond to the use ofintra-articular morphine for analgesia following knee arthroscopy.Two hundred and twenty five patients who had undergone different arthroscopic procedures for the last 3and half years were prospectively evaluated. Of the total arthroscopic procedures evaluated, meniscalpathology was found in 154 patients, synovial pathology in 14 patients, Anterior CruciateLigament (ACL)and Posterior Cruciate Ligament (PCL) insufficiency in 18 patients, chondral lesions in 25 patients, tightlateral structures in 6 patients and loose bodies in 8 patients. All the patients were operated on outpatientbasis. Routine intra-articular morphine (2 mg.) was used for postoperative pain relief. Drain was not putfollowing the procedures. All the patients were seen on the 5th postoperative day. Most patients were satisfiedwith the pain relief modality and needed analgesics in few patients. Postoperative low dose intra-articularmorphine injection has been found to be good alternative to other pain management modalities.
Gender Difference in Care of Type 2 Diabetes
Authors: Shrestha Aamod Dhoj , Kosalram Kalpana , Gopichandran Vijayaprasad
Published: September 2018

Introduction: Biologically male and female have similar diabetes prevalence. Gender differences in the social structure bring differences in life style modifications and all other self care behaviors in type 2 diabetes. The primary purpose of this study was to assess the gender difference in care of type 2 diabetes in Western region, Nepal.  

Methods: Hundred men and hundred women respondents participated in a cross-sectional study conducted in two hospitals in Pokhara, Nepal. A pre-tested questionnaire was administered to each of the respondents.

Results: Dry mouth (χ2 = 3.977, P = 0.046) and abdominal pain (χ2 = 3.840, P = 0.050) were reported as symptoms of diabetes in 51% and 31% women compared to 37% and 19% men respectively. The study revealed that women had low self-efficacy with respect to their diabetes care (35%) in comparison to men (65%). There was significant association between gender and diet practices which showed men have 0.328 (95% CI: 0.184 - 0.585) times less chances of bad dietary practices compared to women. After adjusting for age, education, occupation and self-efficacy, men were less likely to have bad dietary practices (OR= 0.513, 95% CI: 0.266, 0.992).

Conclusions: The result of this study provided evidence that there are gender differences in reporting of symptoms, mode of diagnosis and certain self-management behaviors. Therefore there is a need to design gender specific behavior change communication strategies for better management of type 2 diabetes.Keywords: diabetes care; gender; self-efficacy; self-management.