bluuebunny/crossref_metadata_2025 huggingface dataset:
Antibiogram and Plasmid profiling of clinical multidrug resistant Escherichis coli
Authors: Shrestha S , Mali NM , Tiwari KB , Adhikari N , Shrestha UT , Basnyat SR
Published: July 2024

Introduction: Multiple antibiotic resistances among common bacterial pathogens have been established as an alarming public health problem elsewhere. This study was aimed to explore prevalence of Extended-spectrum beta-lactamase (ESBL) producers among multi drug resistant (MDR) and plasmid profiling patterns of Escherichia coli isolated in Kathmandu Model hospital, Nepal over three months period.
Methods: Altogether 49 isolates were randomly selected among the reported MDR E. coli and retested for the susceptibility pattern and ESBL production by Kirby- Bauer disc diffusion test. Minimum Inhibitory Concentration of the isolates towards (fluro) quinolones was determined by agar dilution method. Plasmids from isolates were extracted by alkaline lysis method.
Results: All isolates were completely resistant to Amoxycillin but sensitive to Imipenem. A very high prevalence (44, 89.8%) of ESBL was detected. Most of the isolates were resistant to commonly uses antibiotics such as Quinolones, Tetracyclines and Cotrimoxazole. Among Quinolones, the Minimum Inhibitory Concentration (MIC) range for Nalidixic acid, Ciprofloxacin and Ofloxacin were 512->4093, 8-4096 and 1-256 µg/ml respectively. All 31 (63.3%) plasmid- harboring isolates contained a>33.5 kb sized plasmid. Among them, seven isolates possessed multiple (2 – 7) plasmids. Overall, twelve different resistance patterns were observed among the bacteria. Based on the patterns, the high molecular weight plasmid seemed to contain most of the resistance genes.
Conclusion: It is suspected that multi drug resistance and ESBL production in E. coli with resistance to Quinolones may be due to their high molecular weight plasmids. So, continuous antibiotic susceptibility test and surveillance of the plasmid and chromosome of E. coli is essential as plasmid analysis has been applied to determine the evolution and spread of antibiotic resistance among isolates.
Pregnancy Induced Hypertension and its Management
Authors: Subedi D
Published: July 2024

Pregnancy induced hypertension which occurs after 20 weeks gestation, in labour or within 48 hours of delivery. The mortality is closely associated with the severity of hypertension, being more evident in patients with eclampsia. Neonatal and infant mortality rates are consistently higher in preterm infants than in term infants. Preeclampsia and eclampsia can lead to higher frequency of induced labor, fetal growth restriction, neonatal respiratory difficulties, and increased frequency admission to neonatal intensive care unit. Early detection and prevention of maternal hypertensive disorder is important in order to avoid morbidity and mortality. Education about the warning symptoms is also important because early recognition may help women receive treatment and prevent worsening of the disease.
Prospective study of tubal defect in subfertile women of Nepal
Authors: Shrivastava Veena , Bajaj Satish
Published: July 2024

This prospective study has been done to assess the prevalence of tubal defect in subfertile women. Thirty-three women who came for consultation in Sidhartha Apollo Hospital, Kathmandu from March 1997 to October 1998, for sub-fertility were included in the study. Their age, type of infertility, previous obstetrical, medical and surgical history were reviewed. Hysterosalpingogram (HSG) was done to assess their tubal status. The results of 33 cases of HSG were analysed. Incidence of tubal patency were noted. If the tubes were blocked, the site and side and associated uterine abnormalities were also noted. Co-relation of tubal block with previous history wastried to be established. In this study the incidence of primary and secondary sub-fertility was found to be the same. Out of 33 cases, 10 were found to have tubal defect. In both the sub-fertility group, prevalence of tubal defect was the same (5 in each group). History of surgery and uterine manipulation was found in 80% of cases (8 out of 10). Normal labour and caesarean section were not found to be associated with tubal defect.
Antioxidant Properties of the Leaves of Chromolaena odorata Linn
Authors: Bhargava D , Mondal C K , Shivapuri J N , Mondal S , Kar S
Published: July 2024

Introduction: Chromolaena odorata Linn (Asteraceae) locally known as “Banmara” has the reputation of being used as a medicinal herb in Nepal. A systemic search for drug research in now considered to be a rational approach. Therefore in the present study an effort has been made to evaluate the antioxidant activity of the leaves of the above mentioned plant.
Methods: In the present research work the ethanolic and methanolic extract of leaves of the plant C. odorata Linn was assessed for free radical scavenging and antioxidant activity. In this work the ability of the extract to scavenge nitric oxide, hydroxyl radical and 1,1-diphenyl-2- picrylhydrazyl (DPPH) were used to assess its free radical scavenging potentials.
Results: The DPPH radical inhibition (%) was 59.10, 52.13 and 81.12 for ethanolic extract, methanolic extract and ascorbic acid respectively. Similarly ethanolic and methanolic extract also showed significant free radical scavenging action against nitric oxide and hydroxyl radical.
Conclusion: Against the backdrop of many known medicinal properties of this plant its ethanolic and methanolic extract of leaves reveals significant antioxidant properties.
Carcinoma of vulva occurs not only during old age: A Series of six cases
Authors: Pant P R , Sharma J , Manandhar B L , Joshi A
Published: July 2024

Squamous cell carcinoma of the vulva is predominantly a disease of postmenopausal women; it accounts for 5% of all female genital malignant neoplasms. Postoperative recovery in two among the five operated patient was late as their vulval wound underwent dehiscence. Other three patients had an uneventful post operative period. Histopathology report showed Squamous cell carcinoma in all the cases. Lymphnodes was negative for malignant cells in all the cases.
Quality of life of people living with lymphoedema: A cross sectional community based study in selected districts of Nepal
Authors: Adhikari RK , Sherchand JB , Mishra SR , Ranabhat K , Wagle RR
Published: July 2024

Introduction: Lymphatic Filariasis (LF) is the second most common cause of physical disability worldwide with 40 million people chronically disabled by the disease and about twice that number suffering from covert lymphatic changes or kidney diseases. The most common chronic manifestations of the disease are lymphoedema and hydrocele. The objective of this study is to evaluate the quality of life (QOL) of lymphoedema patients in Nepal.
Methods: We sought the help of female community health volunteers, health workers working in peripheral health centers in selected sentinel surveillance sites in listing out the names of patients with lymphoedema. The researcher obtained details of 205 cases of lymphoedema (49 cases of Elephantiasis and 156 cases of hydrocele) in three districts (Dhading 74, Kapilbastu 78, Kailali 53). A total of 205 healthy individuals were selected from the same locality (Dhading 68, Kapilbastu 66, Kailali 71) for comparison. World Health Organization Quality of Life questionnaire brief version (WHO QOL-BREF) was used for data collection.
Results: The mean age of the respondents was 45.95 years with a standard deviation of 17.96 years. In four domains, the physical domain scored highest (14.28±2.52) and the environmental domain scored lowest (12.19±1.69). Patients with lymphoedema had significantly low QOL scores in physical (p<0.001), psychological (p<0.001), social relationship (p<0.001), and environmental (p<0.001) compared to their healthy counterparts. Similarly, the overall QOL score was lower in patients with lymphoedema than in healthy control, and it was statistically significant (p<0.001).
Conclusion: This study reports significantly low QOL scores in all four domains in patient with lymphoedema denoting low quality of life compared to their healthy counterparts. It is recommended that the current Lymphatic Filariasis elimination program of Nepal should focus to initiate morbidity management program specifically to patients with lymphoedema and hydrocele.
Mixed Research Paradigm: A Parsimonious Approach!
Authors: Joshi S
Published: July 2024

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“South Asian Cocktail” – The Predominant Drug Use Pattern in Nepal and its Association with Spread of HIV
Authors: Ojha S P , Sigdel S , H-G M , Verthein U
Published: July 2024

Introduction: Central Bureau of Statistic of Nepal (2008) shows more than 46,000 illegal drugs users, out of which 61% are injecting drug users (IDU). An injecting mixture of  medicines called “South Asian Cocktail” is prevalent in Nepal. This study was carried out to find out the knowledge on drug use behaviour and health status with a focus on HIV in “cocktail” drug users.
Methods: A cross-sectional survey among opiate users in contact with the treatment system was performed. After an initial mapping of Kathmandu valley, 300 drug users, on a random basis, in contact of different treatment and counselling centres were interviewed. The research questionnaire was designed following Europ ASI and Maudsley Addiction Profile standards.
Results: Ninety one percent of the respondents were male and 9% female. 95% are injecting drug users with an average 8.7 years of drug use history. 86% are injecting different “cocktails” usually made of buprenorphine, diazepam, Phenergan (promethazine) and/or other substances (30 day prevalence). Similarly, 48% use heroin whereas only 2% take cocaine/ crack. Amongst tested for HIV (N=223) 33% are positive (25% of sample population).
Conclusion: The “South Asian Cocktail” users have a higher risk behaviour than heroin drug users which is associated with the spread of HIV. It needs to be considered which HIV prevention measures are needed related to the specific needs of cocktail users, since the available services (like needle syringe exchange) does not seem to cover their specific needs.
Health Problems of Nepalese Women Attending General Health Check up in Teaching Hospital
Authors: Shakya YL
Published: July 2024

Introduction: The purpose of a periodic General Health Checkup (GHC) is mainly to serve as preventive healthcare and alert healthcare providers to chronic diseases. If the health is timely evaluated, ongoing major complications and even sudden unexplained death can be prevented. Regular good health checkups every 1-2 year generally after 35 years of age, can detect diseases.
Methods: A cross sectional study was carried out among women attending GIC at Tribhuvan University Teaching Hospital (TUTH) for a period of 6 months (January to June 2012). From the total patients attended for general health check up during this period 144 women patients were randomly selected for the study. A Performa used for GHC in TUTH was utilized for collection of information in this study. Diagnostic test for the study were also carried out in TUTH. All the standard criteria that were required for GHC were followed in the study
Results: Among the 144 randomly selected women, 77.8% were non-vegetarian, 21.6% with alcobol drinking habits, 6.3% with smoking habit, and more than 50% aged more than 45 years. Regarding menstrual history, 44.4% were menopausal, 50.7% were menstruating and 4.9% had already undergone hysterectomy. Majority of women had obese BMI (61.1%) The radiological findings revealed that 24.3% had some lungs disease and cardiomegaly. The ECG was abnormal among 11.8% of women. The laboratory parameters of blood revealed that 23.6% were anaemic, 15.2% had raised fasting blood sugar, 3.4% had raised blood urea, and 14.5% had raised SGPT, The impressions after GIC were hypertension (27.8 tract infection (10.4%), cardiomegaly anaemia (13.9%), raised triglycerides (13.2%), urinary (9.0%), diabetes (7.6%) and fatty liver (7.6%). It was found that diabetes, hypertension, raised triglycerides, cardiomegaly had more prevalence in age group 46-60 years of age
Conclusion: Non-communicable diseases are common problems among women and these should be taken into account for general health check up of women.
Success Rate of Simple Underlay Myringoplasty in Smaller Perforation of Tympanic Membrane
Authors: Pradhananga RB
Published: July 2024

Introduction: The objective of the study was to compare the success rate of Simple Underlay Myringoplasty (SUM) in smaller perforation of tympanic membrane (TM) with that of Conventional Underlay Myringoplasty.
Methods: It was a prospective, longitudinal study on 46 patients of more than 15 years of age with Chronic Otitis Media Mucosal type with the small and medium sized perforations. The patients with average hearing loss more than 30 dB were excluded from the study. The patients were randomized into two groups: group A- who underwent SUM (26 patients) and group B-who underwent Conventional Myringoplasty (20 patients). The patients were followed up on 6th, 8th and 10th post operative week for the assessment of the status of the graft. The status was described as; intact TM, graft with residual pin point perforation and total rejection of the graft with remaining perforation.
Results: There was no statistical difference in graft status between SUM and Conventional Myringoplasty in all the three post operative follow up (p value = 0.121, 0.279 and 1.0 in 6th, 8th and 10th week of follow up respectively).
Conclusion: Simple Underlay Myringoplasty has comparable success rate (88.46%, 23/26) as Conventional Underlay Myringoplasty (90.0%, 18/20).
Critical Care in Neurosurgery in Developing Countries
Authors: Sharma MR
Published: July 2024

Neurological patients managed in specialized intensive care units have better outcomes than those managed in general intensive care units. However, such management strategies cannot be applied to Nepalese healthcare entirely. Effective management is affected by its difficult geographical location (difficulty in transporting sick patients due to the lack of motorable roads and almost nonexistent effective air transport systems) and virtual nonexistence of neurointesivists in the country. While some ‘supplies’ for the treatment of serious neurosurgical patients are readily available (e.g. central venous pressure lines, arterial lines, ventricular drainage catheter etc.) in major neurosurgical centers in Nepal, others are scarce (e.g. adequate operating room capacity, intracranial pressure monitors, Swan Ganz catheters etc.). In this review an attempt has been made to distill the pertinent literature in the field and recommend what is applicable in the third world countries like Nepal where a profound physical and human resource constrains exist. In addition, realistic proposals for improvement of the current situation are made.
Association of moderate level of anxiety in functional dyspeptic patients attending out door general practice in teaching hospital Kathmandu
Authors: Shakya YM
Published: July 2024

Introduction: Functional dyspepsia (FD) is a clinical syndrome defined by chronic or recurrent upper abdominal symptom without identifiable cause by conventional diagnostic means. Hamilton Anxiety Rating Scale (HAM-A) is used to measure the severity of anxiety symptoms with mild, moderate & severe score. Only moderate level of anxiety (HAM-A) was responsible for functional dyspepsia. As age increases, chance of anxiety induced dyspepsia was also increased. This study was conducted to determine the prevalence of moderate anxiety induced dyspepsia patients presented to General Practice OPD, TUTH among 15-39 years age.
Methods: 100 patients aged 15-39 years with relapse of dyspeptic symptom within 2 weeks after 6 weeks' treatment with proton pump inhibitor (PPI) correlated with moderate level of Hamilton Anxiety Rating Scale (HAM-A) who presented to GP OPD, TUTH were taken for study. Other causes of dyspepsia were excluded before enrolling them for the study. All of them underwent blood test for Helicobacter Pylori IgG serology, HAM-A scale of 18-24 score took as moderate anxiety which required treatment by TCA & PPI. Rest patient score of less than 18 were managed with PPI and above 24 score were referred to psychiatrist. Similarly duration of epigastric pain, sex & age of patients were also considered for analysis.
Results: Among 100 patients, 31 of them were positive for moderate anxiety (HAM-A). 27.27% male and 33.93% female had moderate level of anxiety. Though P value was not significant, there was moderate anxiety level with functional dyspepsia associated with increasing age. Duration of epigastric pain was not significantly associated with moderate anxiety.
Conclusion: Functional dyspepsia is common problem in Nepalese population, causing difficulties in their day to day life. Moderate level of anxiety (HAM-A) should be considered in management of functional dyspepsia in those with relapse of dyspepsia after discontinuation of PPL. Moderate anxiety with dyspepsia was associated with increasing age and in female gender.
Burden of Fungal Rhinosinusitis in Rhinology unit of Tribhuvan University Teaching Hospital, Kathmandu
Authors: Thapa N , Pradhan B
Published: July 2024

Introduction: This longitudinal, prospective, descriptive study was carried out to find out  frequency and types of fungal rhinosinusitis, clinicopathologic features,its association with systemic disease and outcome of treatment.
Method: Patients who underwent endoscopic sinus surgery and fulfilled any of the  following two criteria were included in the study: unilateral sinonasal polyps, CT Scan showing soft tissue density with hyperdense areas, presence of fungal mucin or mud during surgery, histopathological report showing fungal infection. Surgical specimens were sent for KOH preparation, fungal culture and histopathological analysis.
Results: Out of 284 patients of chronic rhinosinusitis, 41(14.44%) patients had fungal rhinosinusitis, allergic fungal rhinosinusitis (40) and acute fulminantinvasive fungal rhinosinusitis (1). Age ranged from 14-63 years, 26 males and 15 females. Sixteen patients had unilateral disease. The common symptoms were nasal obstruction (41), decreased smell (24) and sneezing (21). Eight patients had hypertension, bronchial asthma (5), COPD(1), pulmonary tuberculosis (1), diabetes mellitus (2) of which 1 patient hadmucormycosis. All the patients had nasal polyps, 1 patient with mucormycosis also had mucopurulent,discharge from left middle meatus and diffuse swelling of left periorbital and maxillary area. Aspergillusfumigatus was isolated in 1 patient. Histopathological examination reported fungal polyp in 5 and mucormycosis in 1 patient. There is no recurrence till date.
Conclusion: Fungal rhinosinusitis is a common pathological entity. It affects both genders common in age group of 21-60 years. It presents as bilateral as well as unilateral nasal polyps. Nasal obstruction is the most common symptom followed by decreased smell and sneezing. Seventeen patients had systemic disease. The treatment protocol used was effective.
Normolipidimic Tuberous Xanthomas
Authors: Neki NS , Singh I
Published: July 2024

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Earthquake disaster-associated health effects and the need for improved preventive measures
Authors: Sherchand JB
Published: July 2024

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Clinical observations among patients with Dengue Fever in Nepal
Authors: Neupane B , Sherchand JB , Pandey BD
Published: July 2024

Introduction: Dengue is an arthropod-borne viral illness that has become a serious public health threat in Nepal. The disease has been reported frequently during the post monsoon period in the southem lowlands of the country. Studies relating to sero-prevalence of dengue have been performed regularly in Nepal but the most frequent clinical observations among the patients with dengue fever have not been well documented. We report thrombocytopenia (74%), headache (44%) and myalgia (44%) among the febrile cases as the most frequent features of the 287 dengue cases identified by rapid immunochromatographic tests and ELISA during 2010 and 2011. These findings are potentially helpful for the clinicians to predict dengue in the early stage in those areas where dengue has been endemic, thus minimizing the significant morbidity and mortality of the disease.
Frequency and pattern of Skin Disorders in Adolescents in a School of Kathmandu
Authors: Shrestha DP , Baral S , Shrestha R , Gupta S , Bhattarai S , Shrestha S , Rosadahl I
Published: July 2024

Introduction: Skin disorders are one of the major causes of morbidity in Nepal. The objectives of this study are to determine the relative frequency and pattern of skin disorders in a cohort of adolescents 9-18 years of age.
Methods: The study was conducted in a residential school of Kathmandu. A detailed information about the study was given to the student members of a school club and they in turn, informed all the other students of the dermatologic health camp, which was conducted subsequently. All students appearing at the camp were examined by a dermatologist and information regarding age, gender, school grade and diagnosis were recorded in a pre-validated format.
Results: In the school there were a total of 950 students (627 m, 323 f). Of them 242 (116 m, 126 f) had skin disorder with a point prevalence of 25.5%. Female students had significantly higher prevalence (29%) than male (18.5%). The most common skin disorders were acne, eczemas and urticaria, and the 10 most frequent diagnoses comprised 87% of all skin conditions.
Conclusion: This study demonstrates that 1/4 of the students had one or more identifiable skin disorders. Despite the wide range of dermatoses, only a few of them accounted for a major proportion of the skin disorders. This study provides data for targeting health care programs for prevention and treatment of skin disorders in this age group.
Clinical Spectrum of Spontaneous Bacterial Peritonitis in Tertiary Care Centre
Authors: Pathak R , Harsh S , Adhikari A , Khadga PK
Published: July 2024

Introduction: Cirrhosis is a common diagnosis in the inpatient population seeking care at the gastroenterology department of the Institute Of Medicine. Spontaneous Bacterial Peritonitis (SBP) is commonly associated with decompensated liver cirrhosis and has been associated with frequent adverse outcome. This small study was designed to spectrum of disease and profile of patient having Spontaneous Bacterial Peritonitis.
Methods: The retrospective study was conducted in patient admitted in department of gastroenterology. A total of 51 patients suffering from cirrhosis with ascites was studied. All subject underwent different investigations, like abdominal paracentesis, abdominal Ultrasonography and biochemical analysis, these tests were analyzed. MELD score was calculated for all the patient.
Results: Total of 51 patients with Spontaneous Bacterial Peritonitis were enrolled. Majority Of patient had alcohol as the cause of cirrhosis, Jaundice, abdominal pain and fever along  with hepatic encephalopathy were chief presenting complaints. A mortality rate of 22% was seen in this small sample of patients.
Conclusions: SBP is a major concern in case of hepatic cirrhosis as it can cause considerable risk of adverse outcome and prolong the hospital stay. Early diagnosis and aggressive treatment should be practiced in order to eliminate the risk.
Reproductive Risk Factors in Uterovaginal Prolapse: A Case Control Study
Authors: Paudyal P , Pradhan N , Ojha N
Published: July 2024

Introduction: Uterovaginal prolapse (UVP) is a major women’s health concern throughout the world and contributes a major bulk of reproductive health morbidity in Nepal. The cause of this disorder is likely to be multifactorial. The aim of this study was to analyze the reproductive risk factors associated with UVP.
Methods: This was a hospital-based case control study, carried out in the Gynaecology Department of TUTH over one year from 1 st Baisakh 2068 to 30 th Chaitra 2068 (13th April 2011 to 12th April 2012). Cases comprised of 116 women with UVP, second degree or more and controls were women without prolapse of the same age group (± 5 years) admitted subsequently after the cases. The variables studied were; age at first childbirth, number of vaginal births, birth spacing and rest during puerperal period. P value and Odds Ratio (OR) for each risk factor were calculated. Multivariate analysis was done for those risk factors found to be significant from the univariate analysis.
Results: Age at first childbirth, number of vaginal births and rest during puerperium were found to be significant risk factors from univariate analysis. Only two risk factors i.e. age at first childbirth<20years; OR 2.24(95% CI 1.18-4.25) and rest during puerperium<15 days; OR 3.87(95% CI 1.9-7.93), were found to be significant by the multivariate analysis.
Conclusion: Preventing early marriage and childbirth at a young age along with imparting awareness about the importance of adequate rest during the puerperium could go a long way in reducing morbidity due to prolapse.
Needle Sticks Injuries among Health Care Professionals in Tertiary Hospital
Authors: Sayami M , Tamrakar J
Published: July 2024

Introduction: A needle stick injury (NSI) is a percutaneous piercing wound typically set by a needle point, but possibly also by other sharp instruments or objects commonly encountered by Health Care Professionals (HCP). This is a serious issue of occupational hazard because of the risk to transmitting blood-borne diseases like Hepatitis B Virus (HBV), the Hepatitis C Virus (HCV), and the Human Immunodeficiency Virus (HIV). Hence, the study was conducted to find out the prevalence of NSI among laboratory and nursing staff (HCP).
Methods: A descriptive cross sectional study from 400 Health Care Professionals was investigated by census sampling. A set of self administered questionnaire was used to collect data in the setting of Tribhuvan University Teaching Hospital (TUTH). The data analysis was done in SPSS program with descriptive statistics.
Results: The prevalence of needle stick injury (NSI) was 251(80%). Regarding knowledge response, 193(63%) said needles should not be recapped, 181(58.68%) said gloves should be used for injection all the times, 286 (91%) said HBV, HCV and HIV are transmitted by NSI, 154(50%) mentioned that HBV is a fast transmitting disease. Actions taken for NSI were as follows: 216(75%) washed injured site immediately, only 82(29.5%) said immediately report to authority and 150(54.50%) did nothing after NSI. The common device causing NSI was the syringe and needle 209(73.1%). 291(93.3%) said that they disposed used sharp needles in puncture proof bucket.
Conclusion: NSI is common among HCP in TUTH with 80% prevalence rate. So the health hazards of NSI should be well addressed like transmission of blood borne disease e.g. HIV, HBV and HCV. Preventive measures should be taken to minimize the health hazards to  professionals in health care settings.
A Study of the relationship of structures at Mandibular Foramen
Authors: Baral P , Bastola D , Shrestha RN
Published: July 2024

Introduction: Mandibular foramen is located on medial aspect of ramus of mandible. Inferior alveolar artery and nerve enters into the foramen and inferior alveolar vein comes out of it. Dissection studies on 16 male and 4 female cadavers suggested that inferior alveolar nerve was medial to inferior alveolar vessels and inferior alveolar artery was anterior to inferior alveolar vein. Knowledge of interrelationship of structures at mandibular foramen is important for dental surgeon or oral surgeons while giving the inferior alveolar nerve block.
Nutritional Status of Low Birth Weight Infants Using Mounla's Method
Authors: Rajbhandari D , Zhong Dan Ni , Jiao Gu Wei , Zhong Gao Yao
Published: July 2024

Introduction: Low birth weight infants remain a significant public health problem in many developing countries. Poor nutrition recognized as an important cause, which is associated with a short-term and long-term adverse consequences, carrying relatively greater risks of perinatal and neonatal morbidity and mortality.
Methods: The nutritional status was assessed prospectively on 170 LBWI in neonatology ward of Guangxi medical university, Nanning, China, from January 2007 to December 2008; with infant's birth weight, the most obvious day age of weight lost, the lowest weight percentage and the age recovering to birth weight. Mounla's method was based on the excess time expressed in percent beyond the allocated time for an infant to gain the birth weight and the excess drop in weight expressed in percent beyond the allowed drop of weight.
Results: There were61.8% male and 38.2% female with gestational age at the time of admission is 28 -37 (33.7+1.9) week; birth weight of 1180-2480 (19521316) gram. The most obvious day age of weight lost was 21-10 (3.7±1.4) days and the regain of the birth weight is 2-23 (7.8±3.8) days. The incidence of malnutrition was 52.9% based on Mounla's method.
Conclusion: Mounla's method used to assess nutritional status of LBWI provides certain reference for the clinical support in nutrition of the infants.
Focal nodular hyperplasia (FNH) of liver in children
Authors: Bhattarai A , Kansakar P , Vaidya P
Published: July 2024

Introduction: Focal nodular hyperplasia (FNH) is one of the rare benign tumors of liver and second common benign tumour after the haemangioma in adult. It is mostly seen in young middle age women.The actiology of this tumour is unknown; however congenital vascular malformation or vascular injury to the hepatocytes has been suggested as the underlying mechanism for hepatocellular hyperplasia. Its relation with OCP is still controversial2. The tumor is asymptomatic most of the time and detected during routine physical examination or incidentally during radiological investigation. Large lesion presented with abdominal mass and abdominal pain due to pressure effects over surrounding tissue. Only Symptomatic lesion needs treatment. Bleeding and torsion can occur but malignant transformantion never occur in this disease. FNH is very rare in pediatric population Here we report two case of such rare case in pediatric population. Hepatic resection was undertaken in both patients with excellent outcome.
Comparison of preoperative and postoperative corneal astigmatism after phacoemulsification through a 2.8mm clear corneal temporal incision
Authors: Joshi SN , Pant M , Rijal S , Bhattarai D
Published: July 2024

Introduction: Phacoemulsification with foldable intraocular lens implantation through clear corneal incision has become common surgical approach for cataract surgery because it produces minimal surgically induced astigmatism and provides best postoperative visual acuity. This study thus aims to compare the preoperative and postoperative corneal astigmatism and to compare the postoperative change in keratometric astigmatism between right and left eyes after temporal 2.8 mm clear corneal incision phacoemulsification cataract surgery and implantation of foldable intraocular lenses.
Methods: A prospective study included 31 patients with bilateral senile cataract who had undergone sutureless, 2.8mm clear corneal incision phacoemulsification cataract surgery with foldable intraocular lens implantation. Keratometry was recorded preoperatively and weeks postoperatively using Nidek automated keratometry. A paired sample t-test was performed to compare the preoperative and postoperative corneal astigmatism.
Results: Mean age of the population was 63.39 plus/minus 9.705 years (range: 49 to 83 years). Before surgery, mean corneal astigmatism in right and left eye was 0.92 plus/minus 0.58 * D and 0.85 plus/minus 0.61 * D respectively. After the surgery, mean astigmatism in right eye was 0.97 plus/minus 0.51 * D and in left eye was 0.97 plus/minus 0.48 * D There was no statistically significant difference in preoperative and postoperative keratometric astigmatism of both eyes. (RE: p-valve 0.427; LE: p-valve 0.188)
Conclusion: Temporal clear corneal incision is quite stable and has minimal effect to corneal astigmatism.
How to Write an Editorial?
Authors: Joshi S
Published: July 2024

N/A
Failed Back Syndrome: Evaluation with MRI
Authors: Gurung GS
Published: July 2024

Introduction: One of a major late post operative complication of discectomy is persistent pain and radiculopathy also termed as failed back syndrome. The study aims to evaluate the MRI findings of failed back syndrome.
Methods: A retrospective hospital record based study among 53 patients was carried out at multimodality- imaging center associated with a tertiary care neurological center in Kathmandu, Nepal. MRI of patients performed for persistent pain after discectomy were selected for duration of 3 years and reviewed. All MRIs were performed with and without contrast enhancement. Three radiologists reported the MRIs with mutual consensus in disputed issues. All data were entered in SPSS spreadsheet and analysis was done using SPSS version 19.
Results: The mean age of the patients was 45.9± 16.1 years. Out of the total 53 cases, the operative site was at cervical spine in 35.8% cases, in lumbar spine in 64.2% cases and none in dorsal spine. Predominant epidural fibrosis without any other cause attributed to radiculopathy in 93.5% patients. Recurrent Disc herniation was noted in 6.5% patients whereas spondylodiscitis was seem in only one (1.9%) patient at C6-C7 level. The most common level operated in lumbar spine was L5-S1 (28.3%) followed by L4-L5 (24.5%) and in cervical spine was C4-C5 and C5-C6 contributing 17% each.
Conclusion: The study concluded that the common causes of failed back syndrome were epidural fibrosis, recurrent disc herniation and rarely spondylodiscitis.
Outcome of Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients Presenting with Cardiogenic Shock
Authors: Anil OM , Sayami A , Nepal R , Jaiswal S , Bhattarai N
Published: July 2024

Introduction: Cardiogenic shock is the leading cause of death in patients hospitalized for acute myocardial infarction (MI). Cardiogenic shock can occur in both ST elevated MI (STEMI) and non-ST elevated MI (NSTEMI). In these patients primary percutaneous coronary intervention (PCI) has better outcome and decreased in-hospital mortality compared to thrombolysis, if performed in time.
Methods: This is a retrospective observational study conducted at Manmohan Cardiothoracic Vascular and Transplant Centre, Maharajgunj, Kathmandu, Nepal from September 2012 to December 2014. Patients who presented with acute myocardial infarction and cardiogenic shock and underwent primary
PCI were enrolled in this study. Records from cath lab, Coronary Care Unit (CCU) and discharge notes
were reviewed and analyzed.
Results: A total of 22 patients were enrolled in this study. The mean age of the study population was 61.5±11.5 years and 73% of the participants were male. Four patients were intubated in the emergency department, three received cardiopulmonaryresuscitation (CPR) and one patient received electrical cardio version on presentation. Triple vessel disease was the most common finding and left anterior descending (LAD) artery was the commonest culprit vessel. Procedural success was 91%. In-hospital mortality was 31.2% in the entire study population. Ventilator associated pneumonia and severe sepsis was seen in 5 out of 7 cases that died.
Conclusion: Initial outcome of primary PCI performed in patients with acute MI in cardiogenic shock at our centre is encouraging. In-hospital mortality in patients with acute MI complicated by cardiogenic is high. Primary PCI improves outcome in these patients and should be performed as an initial strategy.
Genetic variability of the human filarial parasite, Wuchereria bancrofti in Southern parts of Nepal
Authors: Adhikari RK , Sherchand JB , Hoti SL , Vishal LA , Mishra SR , Weber EJW , Khanal PR , Joshi G , Dumre SP , Adhikari R , Nazeer S , Ranabhat K , Wagle RR
Published: July 2024

Introduction: Lymphatic filariasis (LF) is a neglected tropical disease, caused by Wuchereria bancrofti parasite and pose potential risk to about 1.4 billion people in 73 countries. In Nepal, 60 out of 75 districts are endemic and nearly 90% of the population is at risk and mass drug administration (MDA) has beenin place since 2003. Yet, information about the genetic diversity of W. bancrofti is largely lacking.
Methods: The genetic variability of the parasites in two localities Kailali and Kapilbastu from south- western parts of Nepal were studied. Blood samples were collected at night and stained with Giemsa stain and positive archived slides were taken for the study. W. Bancrofti was individually picked under microscope and gDNA was isolated from the pooled (100 mf) samples. Short Tandem 29bp Repeats (STR) from the intronic region of Abundant Larval Transcript-2 (ALT-2) gene and haplotype mapping of the Internal Transcribed Spacer (ITS-1) region were studied. The phylogenetic trees were constructed and analyzed.
Results: The analyses of STR, haplotypes and the phylogenetic trees indicated the presence of at least two genetically distinct clusters among the W. Bancrofti parasite populations in two areas.
Conclusion: The study identified two genetically distinct clusters of mf in the populations. The finding of two genetic “variants” of W. bancrofti in the present study has important implications for filariasis epidemiology and control/elimination program.
Study of antifungal activity of amphotericin B-lipid formulations with five lipid carriers
Authors: Adhikari K
Published: July 2024

Introduction:Invasive pulmonary aspergillosis (IPA) is a prime cause of morbidity and mortality in
immunocompromised individuals, who is undergoing lung transplantation.Mortality among infected
patients is high. Death rate in excess of 90% has been shown in study by Richardson. Most of these
invasive mould infections are acquired through the respiratory tract.An increased incidence of invasive
fungal infection has created major challenges for medical practitioners. Amphotericin B(AmB) has been
the drug of choice for the treatment of many fungal infections, and it is still used as a gold standard
therapy against invasive fungal infection and most commonly used to treat life-threatening conditions
such as cryptococcosis, histoplasmosis, and IPA.Currently, lipid formulations are accepted as a less toxic
alternative to the traditional colloidal dispersion. Drug toxicity, the nephrotoxicity of AmB is the major
clinical problem, which could lead to treatment discontinuation. We designed five lipid formulations of
AmB, and compared the dose-response effects of all lipid formulations in-vitro against three different
fungal strains including Cryptococcus neoformans, Candida albicans and Saccharomyces cerevisiae.
Methods: Five lipid formulations amphotericin B were formulated by lyophilization process. The cylinder plate method performs the relative potency by determining the clear zone of AmB-lipid formulation in the inoculum medium as compared with a clear zone of AmB standard. Broth microdilution method can be used to measure the minimum inhibitory concentration (MIC). The MIC value is based upon predetermined end point, which may be interpreted as an absence of visible growth in a broth containing known concentration of AmB.The minimal inhibitory concentration (MIC) and minimal fungicidal concentration (MFC) were determined using Cryptococcus neoformans ATCC 90113 NS and Candida albicans ATCC 90028.
Results: All fiveformulations showed good responses against C. neoformans and Candida albicans, with the MIC and MFC values in the range between 0.16-0.32 µg/ml. The potency of these formulations was equivalent to pure AmB (100%).
Conclusions: The results indicate that the investigateded potassium cholate, potassium deoxycholate, sodium deoxycholate sulfate, sodium cholate and sodium deoxycholate may be used as a promising alternative carrier system for amphotericin B.
Assessment of normal splenic volume by Computed Tomography in Nepalese population
Authors: Suwal S , Subedi K , Gurung G
Published: July 2024

Introduction: The purpose of this study was to assess the normal splenic volume in Nepalese population by Computed Tomography and its variability with age, sex and body habitus.
Methods: This was a cross sectional observational study involving 264 patients undergoing CT abdomen examination for pathologies not pertaining to spleen, in Department of Radiology, Tribhuvan University Teaching Hospital. The spleen volume was obtained by adding cross-sectional area of spleen from 10 mm contiguous CT slices in axial CT images and multiplying them with the slice thickness. The relationships between spleen volume and age, sex and body habitus were also derived.
Results: The mean splenic volume was 151.20 cm3 ± 59.62 cm3, ranging from 25.95 cm3 to 331.66 cm3. Weak negative correlation of spleen volume with age (r = -0.173, p <0.01) and body habitus (r = -0.132, p <0.05) were also noted. No significant correlation of spleen volume with gender was noted.
Conclusion: The finding provided defining the criteria for splenomegaly. The mean splenic size in Nepalese population is similar and/or larger compared to Asian population, and smaller compared to western population. However a larger sample size is required for corroboration of our findings
Theraputic application if Poly-2-hydroxy ethyl mathacrylate contact lens in various ocular surface disorders among Nepalese population
Authors: Joshi SN , Chaudhary M , Bhattarai D , Gnyawali S , Shrestha G S , Adhikari P
Published: July 2024

Introduction: Therapeutic contact lens (TCL) is indicated to relieve pain, promote corneal wound healing, provide mechanical protection and support, maintain corneal hydration, improve vision and seal or splint cornea in various ocular surface disorders. Till date no study has been reported about use of contact lenses for these purposes in Nepalese population. is study thus aims to evaluate the outcome of TCL in ocular surface disorders in Nepalese population.
Methods: A prospective analysis of patients fitted with TCL for various ocular surface disorders was done at B.P. Koirala Lions centre for Ophthalmic Studies. All the subjects were fitted with Poly-2-hydroxy ethyl methacrylate (70% water content); information on clinical conditions were evaluated and recorded at initial and final treatment visit.
Results: Of 57 eyes fitted with TCL, corneal laceration caused by mechanical injury (22.8%) and vernal keratoconjunctivitis (21.1%) were the most common ocular surface disorders. The common indications for applying TCLs were to alleviate pain and discomfort (31.5%) and corneal thinning impending to perforation (26.3%). Subjects’ clinical conditions and symptoms were resolved partially to completely in 89.4%. Dry eye was a common cause of contact lens associated therapeutic failure.
Conclusion: Poly-2-hydroxy ethyl methacrylate contact lenses are safe and effective in alleviating symptoms and healing of various ocular surface disorders in Nepalese population.
Visual outcome in Keratoconus with spherical rigid gas permeable contact lens
Authors: Chaudhary M , Kandel H , Adhikari P
Published: July 2024

Introduction: Keratoconus is a bileteral asymetric progressive ecteria of cornea commonly associated with vernal keratoconjunctivitis and Atopic dermatitis. Rigid gas permeable (RGP) contact lens is the first choice for refractive correction in keratoconic eyes. The visual outcome in Keratoconus with spherical RGP contact lens along with the mean age of presentation, gender predominance, ethnicity, associated conditions, refractive error and corneal astigmatism was evaluated.
Methods: The records of the Keratoconus patients attending cornea and contact lens clinic for last 6 years were reviewed and analyzed using SPSS-14 software. Data on laterality, race, age, gender, refractive error, visual acuity (VA), associated conditions and contact lens parameters were obtained. A total of 22 patients with 38 keratoconic eyes were included in the study.
Results: The mean age of Keratoconus presentation was 18.11 ± 4.45 years. Sixteen cases (72.73 %) were bilateral; 6 (27.27 %) were unilateral. Mean uncorrected visual acuity (UCVA) was 0.86 ± 0.40 Log MAR. Mean spectacle visual acuity was 0.54 ± 0.38 Log MAR. Mean visual acuity with spherical RGP contact lenses was 0.08 ± 0.14 Log MAR. The difference between mean spectacle visual acuity and mean VA with spherical RGP contact lens was statistically significant (p < 0.001).
Conclusion: In all stages of Keratoconus, improvement in visual acuity with spherical RGP contact lens was highly significant.
Breastfeeding practices in an indigenous minority community group in Nepal: a cross-sectional study
Authors: Subedi N , Poudel S , Poudyal AK
Published: July 2024

Background: Promotion of breastfeeding has been identified as one of the effective evidence based interventions to improve health of infants and young children. Various factors play an important role in breastfeeding practices which are not sufficiently explored in communities like Chepang in Nepal. The objectives of the study were to identify the knowledge and practices of Chepang mothers on breastfeeding and its associated factors.
Methods: A cross sectional descriptive study was carried out in which 203 Chepang mothers with child under one year of age were randomly selected and interviewed. Quantitative method was applied for data collection. Analysis of association was done using logistic regression.
Results: Practice of mothers on breastfeeding was found better than knowledge. About one fourth (23%) of them knew the appropriate time for early initiation of breastfeeding, however, 36% had practiced it. Exclusive breastfeeding practice under 6 months was 88%, although 60% knew about the recommended duration. Literate mothers were more likely to initiate breastfeeding at appropriate time [AOR: 4.24 (95% CI: 2.20-8.19)] than illiterate.
Conclusions: Breastfeeding practices like colostrum feeding and exclusive breastfeeding were found better in Chepang communities than national average, however, early initiation of breastfeeding needs to be improved which could be improved through counseling during antenatal and postnatal visits.
Evaluation of Hounsfield Unit in adult brain structures by CT
Authors: Mishra D , Ghimire RK , Chand RB , Thapa N , Panta OB
Published: July 2024

Introduction: The purpose of study was to evaluate the Hounsfield unit (HU) values in adult brain structures by computed tomography (CT). Hounsfield units (HU) describe relative densities of structures by CT. Different pathological process causes the change in attenuation by different tissues resulting in change of HU of the tissues so we should know the normal HU values to track the changes. These HU values are correlated with different clinical condition and different slice thickness.
Methods: A prospective study was done in 72 patients of age above 18 years. All CT scans were performed using 16 row multi-detector CT (Neusoft New Viz16). Two sets of images were reconstructed first one with 5 X 5 mm and second one with 3 X 3 mm slice thickness. For quantitative analysis, HU measurements were obtained by drawing elliptical/ circular region-of-interests (ROI) on various anatomical structures on both 5mm and 3mm slice images. Statistical analysis was done with t test,one way ANOVA and descriptive analysis.
Results: HU values for different anatomical area were: thalamus 34.50±1.92, caudate nucleus 36.64±2.01, internal capsule 31.40±2.16, pons 32.70± 2.39, dentate nucleus 30.70±2.22, cerebellar peduncle 30.90±2.37, hemisphere 39.62±2.38, vermis36.77±2.39, lateral ventricle 9.86±2.60, putamen 36.66±1.65, globus pallidus, 36.68±1.87, juxta 28.28±2.42, periventricular 29.18±2.78, deep 27.13±2.06, cortex 34.26±2.25, subcortical 27.36±2.49, corpus callosum 28.71±1.98. There was significant difference in HU values of genu of internal capsule, caudate nucleus, periventricular white matter, dentate nucleus, cerebellar peduncle & hemisphere for the 5mm and 3mm slice thickness.
Conclusion: HU of gray and white matter of brain were 34.54 ± 2.54 and 28.25 ±2.00 respectively