bluuebunny/crossref_metadata_2025 huggingface dataset:
Single Stage Management of Concomitant Cholelithiasis and Choledocholithiasis
Authors: Joshi Mukund Raj , Bohara Tanka Prasad , Rupakheti Shail , Singh Deepak Raj
Published: September 2018

Introduction: Concomitant cholelithiasis and choledocholithiasis are commonly managed in two stage procedure, endoscopic management of common bile duct stone followed by laparoscopic cholecystectomy in different time and setting. We perform these two procedures in same sitting in operating room set up. We evaluated the procedure in terms of outcome, feasibility and complications.

Methods: Prospective cross-sectional study carried out since April 2013 to August 2016 in all patients who had undergone single stage endoscopic and laparoscopic management of concomitant cholelithiasis and choledocholithiasis. Patient’s demography, procedural time for different procedure and procedure in total and post-operative complications were recorded and analyzed with suitable statistical methods.

Results: Out of 50 cases enrolled, 2 patients were converted to open. Out of 48 patients, 3 needed re-attempt for completion. Majority were female 36 (72%), mean age was 39.48years. Mean common bile duct diameter and mean stone size was 11.43±2.63 cm and 7.99±2.01cm, respectively. Mean of total procedural time was 90.93± 33.68 minutes. In most of the cases, laparoscopic cholecystectomy performed first followed by endoscopic method (66.7%). Total procedural time was less in the patients who underwent laparoscopy first in comparison to endoscopy first. Clinically significant complications like cholangitis, pancreatitis and duodenal perforation occurred in 7 patients. Out of 4 patients who developed pancreatitis, one had severe acute pancreatitis requiring prolonged hospitalization.

Conclusion: Single stage management of common bile duct and gall bladder stone by laparoscopic and endoscopic method is feasible in our setup with acceptable results. Endoscopic treatment of common bile duct stone if performed first, is associated with longer procedural time.

Keywords: choledocholithiasis; cholelithiasis; endoscopic retrograde cholangiopancreatography; laparoscopic cholecystectomy.
Scar Endometriosis: Cytological Diagnosis
Authors: Dwivedi Urvashee , Shukla Saumya , Anand Nidhi , Parashar Chetan , Husain Nuzhat
Published: September 2018

Endometriosis occurring in a surgical scar is called incisional endometriosis. It is rare and can be diagnosed on the basis of detailed history, careful clinical examination and characteristic histology. An interesting case with immunocytological (ICC) confirmation is being reported. A 28-year-old female presented with a mass over anterior abdominal wall, of 3 years duration.  She had a past history of LSCS. On examination, the swelling was subcutaneous, measures 3x2cm was firm in consistency and located close to the previous incisional scar. Fine needle aspiration cytology was performed and the smears were moderately cellular and showed monolayered sheets of epithelial cells and stromal fragments. A cell block was also prepared that revealed few glands lined by tall columnar epithelium, surrounded by loose stroma. Immunohistochemistry panel comprising of CK 7 and CD 10 was performed, which were positive in glandular and stromal component respectively.
Prevalence of Malnutrition in a Rural Residential Sanskrit School in Baglung, Nepal
Authors: Amatya Bhawana , Shrestha Nitesh
Published: September 2018

Introduction: Under-nutrition is a condition in which there is inadequate consumption, poor absorption or excessive loss of nutrients. Nepal still faces high chronic as well as acute under‐nutrition in children. The following study was conducted a Sanskrit school in rural Baglung to find the prevalence of malnutrition among the children which could reflect the nutritional status of the community.

Methods: Out of 60 students admitted to the school, only 43 were present at the time when we collected our data. Weight was measured with a standard weighing scale and standing height with a measuring tape attached to the wall. Data were filled up in proforma, entered in Microsoft Excel 2013 and were analyzed and indicators calculated with SPSS version 20 using WHO Child Growth Reference data for 5-19 years and macros.

Results: Stunting (Z score < -2) was found in 53.5 % of the study group and severe stunting (Z score < -3) was found in 25.6%. 12.5% of the 8 children under 10 years in our study had weight for age < -2 Z score which indicates underweight. No one was severely underweight. In our study, 2.3% had severe thinness (Z-score < -3), 14% had thinness (Z-score < -2). No one was overweight or obese.

Conclusions: The prevalence of malnutrition was high among the students of the rural Sanskrit school where the study was conducted.

 

Keywords: anthropometry; Baglung; malnutrition; Nepal; prevalence.
True Brachial Artery Aneurysm Presenting as a Non-Pulsatile Mass
Authors: Pradhananga Anup , Chao Xie
Published: September 2018

Brachial artery aneurysms are rare disease that can be encountered.  It is divided into true and false. The frequency of true aneurysm of the brachial artery is so much unusual. So, we present a case of a 59 year old male who presented to us with complaint of mass in left upper limb since many years ago. Now, there was sudden onset of progressive pain with coldness, numbness, tingling sensationand blackish discolouration of skin from 8 hours. The left upper limb was pulseless and color Doppler ultrasound showed a non-pulsatile aneurysm at the mid level of left brachial artery associated with arterial occlusion in its distal branch by thrombus. The patient was successfully revascularised by interposing a saphenous vein graft.Thus,this case suggest that the prompt diagnosis of true brachial artery aneurysm by ultrasound or color Doppler ultrasound and the proper treatment by surgical repair can save limb from dangerous sequel

Keywords: brachial artery aneurysm; color doppler ultrasound; true aneurysm; ultrasound.
Intracranial MR Venography Using L ow-Field Magnet: Normal Anatomy and Variations in Nepalese Population
Authors: Sharma U K , Sharma K
Published: September 2018

Introduction: Magnetic resonance (MR) venography is considered a reliable imaging modality for the evaluation of intracranial venous system. The purpose of this study was to evaluate the normal venous anatomy and its variations in Nepalese population using low fi eld MR technique. 

Methods: One hundred patients with normal MR imaging of brain underwent MR venographic study. MR venograms were performed in 0.35 T MR scanner using a contiguous 2D time-of–fl ight MR angiographic technique. 

Results: The fl ow gaps in the transverse sinus were seen in 47% of population, of which 91% occurred in the non-dominant side. Right transverse sinus was dominant in 73% population. Flow gap was observed in bilateral transverse sinus in one case, while it was seen in the dominant right transverse sinus in 6.3% population. Inferior sagittal sinus was observed in 11% cases. Internal cerebral vein was seen in 60 cases. Occipital sinus was observed in 4% of the cases. The basal vein of Rosenthal was observed in 34% of the cases, whereas vein of Labbe seen in 8% cases. Unilateralfl ow gap in the sigmoid sinus was seen in 5 cases. 

Conclusions: MR angiography done at low fi eld MR unit is a reliable tool in cerebral venous sinus assessment, particularly major dural sinuses. The fl ow gaps in transverse sinus are frequently encountered anatomic variation. Visualization of small veins like inferior sagittal sinus, basal vein of Rosenthal, vein of Labbe, internal cerebral vein was inferior in our study compared to other studies done in high fi eld MR unit. 

Keywords: Dural sinus, intracranial veins, MR venography.
Magnesium sulphate: A Life Saving Drug
Authors: Thapa Kusum , Jha R
Published: September 2018

Fever with seizure, a common presentation with which a child may present to the emergency is mainly due to febrile seizure, but it may also be due to meningitis. This study was done to find out the incidence of meningitis and to find out whether lumbar puncture is necessary in different age groups of children presenting with first episode of fever with seizure. A prospective study was conducted in the emergency department of Kanti Children's Hospital. Children who presented with first episode of fever and seizure in the age group of 6 months to 5 years were included. Meningitis was diagnosed on the basis of either cytological and biochemical criteria or if a bacterial pathogen was isolated. Of the 175 children included, 17% were diagnosed to have meningitis. Cerebrospinal fluid was positive for a bacterial pathogen in 4.5% of the cases. In the age group of 6 months to 12 months, 30% of the children had meningitis as compared to 20 % and 5% in other age groups of 12- 18 months and above 18 months respectively. All children with culture proven bacterial meningitis were in the age group of 6-12 months and had no evidence of meningeal irritation. Signs of meningeal irritation had high specificity in diagnosing meningitis. Organisms grown were Haemophilus influenza in three cases, Streptococcus pneumoniae in two cases and Staphylococcus aureus in three cases. In conclusion, incidence of meningitis was found to be high in children presenting with first episode of fever and seizure. Lumbar puncture to rule out meningitis should especially be considered in children in the younger age group even without evidence of meningeal irritation.
Vesicovaginal Fistula at Tertiary Care Center in Eastern Nepal
Authors: Uprety Dhruba Kumar , Budhathoki B , Subedi S , Regmi Mohan Chandra
Published: September 2018

Vesicovaginal fistula is physically, socially and psychologically devastating to the women who suffer from it. The aim of this study is to create some awareness about VVF, to describe the profile of the patients, etiology, and success rate of surgery in our institute. A retrospective analysis of a total of 23 cases of vesicovaginal fistula admitted to the Department of Gynecology and Obstetrics, BPKIHS over a period of three years were included in the study. The cause of VVF in all was obstructed labor except in one, which followed abdominal hysterectomy. Twenty-three subjects underwent VVF repair, of which 14 (56.5%) had successful outcome.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):120-122.
Computed Tomography Guided Percutaneous Transthoracic Fine Needle Aspiration Cytology in Chest Masses
Authors: Basnet Shiva B , Thapa G B , Shahi R , Shrestha M , Panthi R
Published: September 2018

A retrospective, hospital based discriptive study was done to know the pathological spectrum of thoracic lesions and to correlate the radiological findings with cytological findings obtained from computed tomography guided percutaneous transthoracic fine needle aspiration of chest mass. The clinical, radiological and cytological data of 100 patients were studied who underwent CT guided FNAC from May, 2004 to May, 2007. Diagnostic accuracy of FNAC is 82%. Cytological examination showed that 51 cases were malignant and 31 cases were benign. Provisional diagnosis based on radiological findings were 50 and 32 cases of malignant and benign lesions respectively. Sensitivity and specificity, positive and negative predictive value of radiological findings in this study was 88%, 84%, 90% and 81% respectively. Post procedure complication were (a) pneumothorax in two cases and both the cases had to be hospitalized for active management (b) minimal perilesional hemorrhage and hemoptysis in three cases and (c) chest pain in six cases. CT guided FNAC is a simple and safe procedure with high diagnostic accuracy in the evaluation of focal chest lesions. Pneumothorax, perilesional hemorrhage, hemoptysis and chest pain are the usually encountered complications. Very few cases of complication require active managementJNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):123-127.
Patterns of Injury and Mortality in Pediatric Patients Attending Emergency Department in a Tertiary Care Center in Eastern Nepal
Authors: Gupta Pramendra Prasad , Malla Gyanendra Bahadur , Bhandari Rabin , Shah Kalawar Rosan Prasad , Mandal Madan
Published: September 2018

Introduction: Trauma is a major and increasing global health concern in the recent world is now the leading cause of death among people less than 18 years old. Methods: This is a retrospective cross sectional study done in Emergency Department of B.P.Koirala Institute of Health Sciences. Patients aged less than 16 years were included with history of Trauma from January 1st 2013 to 31st December 2013.The details of patient were taken from computerized medical records of the hospital. The data Demographic data, Pattern of injury, Mode of injury, Diagnosis and outcomes were tabulated in Microsoft excel. Results: Total 3958 pediatrics patient were enrolled in this study. Male: Female=3.6:1,Mean age 9.6±3.2 years, fall injury & RTAs common modes and fractures of limbs, soft tissue injuries and cut injuries were common patterns. Conclusions: Injury is a serious problem for children in Low Income countries like Nepal.
The Efficacy and Safety of Low Dose Epidural Butorphanol on Postoperative Analgesia following Cesarean Delivery
Authors: Pokharel Krishna , Rahman T R , Singh S N , Bhattarai B , Basnet N , Khaniya S
Published: September 2018

Butorphanol is considered an effective and safe analgesic after cesarean delivery but is associatedwith profound dose-dependent sedation. Somnolence may cause hindrance in early mother-babyinteraction. This study was designed to assess the analgesic efficacy and to monitor side-effects of low doses (0.5 mg and 0.75 mg) of epidural butorphanol with bupivacaine compared to bupivacainealone in parturients following cesarean delivery. One hundred and twenty parturients (AmericanSociety of Anesthesiologists physical status 1 and 2) undergoing cesarean delivery were allocatedinto three groups: group 1 received epidural 0.125% bupivacaine while group 2 and 3 received an additional 0.5 mg and 0.75 mg butorphanol respectively. A combined spinal, epidural techniquewas used. Spinal anaesthesia was used for surgery. The epidural route was used for postoperativeanalgesia with the study drug. Onset, duration and quality of analgesia, lowest visual analoguescales (VAS) score, and side effects were noted. The onset and duration of analgesia in group 2(4.1±2.6 min and 202.4±62.8 min) and group 3 (4.0±2.5 min and 192.3±69.1 min) were significantly different (P<0.01) from group 1 (6.6±2.7min and145.7±89.6 min). The quality of analgesia in terms of time to first independent movement and satisfactory VAS were statistically better (P<0.01) in group 2 (3.9±0.3 hour and 8.1±0.1 mm) and group 3 (3.8±0.4 hour and 8.1±0.9 mm) than in group 1 (5.2±0.4hour and 6.3±1.3 mm). The incidence of sedation was 5% in all the three groups. A lower dose of epidural butorphanol with bupivacaine produces a significantly earlier onset, longer duration and better quality of analgesia than bupivacaine does.Key words: analgesia, epidural, postcesarean, spinal
Assessment of Automatic Thoughts in Patients with Depressive Illness at a Tertiary Hospital in Nepal
Authors: Rana Mita , Sthapit Sabitri , Sharma Vidya Deb
Published: September 2018

Introduction: Cognitive functions have significant influence on psycho-social and general wellbeing. The quality, content and processing of negative thoughts initiate depressive symptoms; i.e. low mood, decreased self-worth and diminished interest in pleasurable activities. The study assessed the automatic thoughts of patients having depressive illness and evaluated and compared the changes after therapy; i.e. Psychotherapy and pharmacotherapy.Methods: Diagnosed cases of depressive illness (n=135),  according to ICD-10 and study criteria, attending the out-patient clinic of Department of Psychiatry and Mental Health, Tribhuvan University Teaching Hospital, were included. Beck Depression Inventory was used to screen level of depressive symptoms. Automatic thoughts were assessed by the Automatic Thought Questionnaire-Revised before initiating therapy and after completion of therapy for comparison.  Depressive patients received either of the three treatment procedures after randomization of the study sample into three different treatment groups; i.e. Cognitive behavior therapy, pharmacotherapy or combined therapy receiving both cognitive behavior therapy and pharmacotherapy.Results: Among the total 135 patients, 53 (39.3%) had moderate, 47 (34.8%) had severe depressive and 35 (25.9%) had mild depressive symptoms before therapeutic interventions. Negative automatic thoughts were significantly present in depressed patients and reduced after all three interventions. Negative automatic thoughts of hopelessness, anxiety and inability coping were significantly reduced after therapy.Conclusions: Automatic negative thoughts were significantly correlated with depressive disorder. Combined therapy CBT with pharmacotherapy or CBT alone was found to be more effective in modifying automatic negative thoughts than pharmacotherapy alone, ultimately reducing depressive symptoms to a significant degree.Keywords: automatic thoughts; cognitive Behavior therapy; pharmacotherapy. [PubMed]
Depression during Pregnancy in a Tertiary Care Center of Eastern Nepal
Authors: Shakya Rabi , Sitaula S , Shyangwa P M
Published: September 2018

This is a cross sectional study, conducted in 45 pregnant women coming for antenatal check ups in the eastern regional hospitals in Nepal. Hamilton -Depression Scale (HAM-d) was applied after initial psychiatry work up to all women who were selected for the interview. Analysis revealed about half of the pregnant women having some form of depression. Life events (e.g. chronic illness in the family, marital disharmony, economic crisis to sustain the family) were found to be important risk factors (P<0.05). Antenatal depression is a more common than generally thought.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):128-131.
Colorectal Cancer in Different Age Groups in a Tertiary Hospital in Nepal
Authors: Silwal Poudyal Nandu , Chaudhary Sitaram , Basnet Bhupendra Kumar , Poudel Bidhan Nidhi , Shrestha Barun , Mandal Amrendra Kumar , Sharma Mukesh
Published: September 2018

Introduction: Some studies have suggested that colorectal cancer at a younger age had distinct biological characteristics: different clinical presentations, more advanced stage at time of diagnosis and poorly differentiated carcinoma. The aim of the study is to analyze clinical and histopathological differences between younger (≤40 years of age) and older (>40 years of age) colorectal cancer patients.Methods: A cross-sectional analysis was conducted amongst the colorectal cancer patients who visited Bir Hospital between July 2015 and April 2017. All colonoscopically diagnosed and histopathologically proven cases of colon cancer were included. Chi-square test and independent t – test was performed to analyze the difference between clinical presentations and histopathological findings among two groups of patients and p value of <0.05 was considered as significant.Results: Thirty younger patients and thirty older patients were enrolled without any differences in gender proportion. There were no statistical differences between clinical presentation and histological grade and type in younger and older patients. The younger patients had more complaints of altered bowel habit (p <0.001) while older patients mostly presented with per rectal bleeding (p< 0.008).Conclusions: In this study, colorectal cancer at younger ages showed similar characteristics to those of older patients except altered bowel habit was more common in younger patients while per rectal bleeding was more common in older patients. Although colorectal cancer incidence increases with age, younger patients with altered bowel habits, weight loss, anemia and anorexia should also be given due medical attention and undergo evaluation promptly.  Keywords: carcinoma; colon; per rectal bleeding; younger group. [PubMed]
Mammographic Diagnosis of Breast Carcinoma: An Institutional Experience
Authors: Sidharth Dr , Thapa B , Singh Y , Sayami P , Khanal U
Published: September 2018

Mammogram is a common diagnostic modality for breast carcinoma. Diagnostic mammogramis available at only few centers in Nepal. The aim of this study was to determine the accuracy ofdiagnostic mammogram in Nepalese women suffering from breast carcinoma. A retrospectiveanalysisofthebreast carcinomawas carriedoutintheDepartmentof Surgery,TribhuwanUniversityTeaching Hospital from October 1995 to October 2007. Out of 556 patients with histologically proven breast carcinoma, 378 patients (68%) had undergone mammography. Breast carcinoma was identified on mammography in 328 (87%) cases while 50 cases (13%) were reported as normal or benign lesions. Diagnostic mammogram had a sensitivity of 86.8%, a specificity of 98.6% with a positive predictive value of 68.8% and a negative predictive value of 99.5%. In mammographically missed breast carcinoma, 34% were less than 40 years of age (P<0.05), 60% were premenopausal (P<0.05) and 88% patients presented with a painless lump. The study shows that the diagnostic accuracy of the mammogram is very high. However, there is a chance of missing the breast carcinoma in youngand premenopausal women.Key words: breast carcinoma, diagnostic mammogram, premenopausal women
Outcome of Supracondylar Fractures of the Humerus in Children Treated by Closed Reduction and Percutaneous Pinning
Authors: Devkota Pramod , Khan JA , Acharya BM , Pradhan NMS , Mainali LP , Singh M , Shrestha SK , Rajbhandari AP
Published: September 2018

Supracondylar fractures of humerus in children are common injuries. Displaced fractures areinherently unstable. Conservative treatment results in malunion. Open reduction and internalfixation (ORIF) is more invasive and recovery is prolonged. From September 2004 to September 2005, 102displacedsupracondylarfractures of humerus, agedbetween one andhalf yearto 13 years, weretreated using close reduction and percutaneous Kirschner (K) wire fixation under c-arm fluoroscopy. Seventy nine patients were treated by cross K-wires and in twenty three cases lateral two K-wireswereput.Above elbow plaster ofparis back slab was appliedinall cases for atleastfour weeks.Backslab,K-wireswere removedafterfourweeks andelbowrangeofmotionexercisewas started.Resultswere analyzed using Flynn’s criteria. All patients were followed up to 14th week postoperatively. Incross K-wire group(N=79) 70.8% had excellent, 22.7% good, 3.8% fair and 2.5% had poor results at eight weeks follow up which was improved to 91.1% excellent, 6.3 good, 1.2% fair and 1.26% poor results at 14 weeks follow up. In lateral K-wire group (N=23) 70% had excellent, 21.7% good, 4.3% fair and 4.3% had poor result at eighth week which was improved to 91.3% excellent, 4.3% good, 4.3% fair and no poor result at 14th week follow up. Eight patients got superficial pin tract infection and seven patients sustained ulnar nerve injury post operatively.We recommend this procedure fordisplacedsupracondylarfractures inchildrenas itis safeandcost effectiveprocedurewithacceptablecomplication rates.Key words: closed reduction, humerus, percutaneous pinning, supracondylar fracture
Intraluminal Meigration of Gossypiboma without Intestinal Obstruction for Fourteen years
Authors: Kansakar Romeo , Thapa P , Adhikari S
Published: September 2018

A 55 years lady presented with dull aching right upper abdominal pain with intermittent episodes of diarrhea following cholecystectomy which she underwent fourteen years back. Ultrasound and computed tomography findings were suggestive of foreign body in right subhepatic space. Exploratory laparotomy revealed circumvented loop of ileum with intra luminal mass sized 5x10 cm, resection anastomosis of the segment of ileum was performed. When opened it contained a surgical sponge with no external communication but an internal fistulous tract was present between the proximal and distal loops beyond the mass. Though intraluminal migration of retained surgical sponge has often been reported, complete intraluminal migration without features of obstruction or external opening is rarely seen.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):136-138.
Two-hit Hypothesis and Multiple Organ Dysfunction Syndrome
Authors: Butt I , Shrestha Badri Man
Published: September 2018

A severe insult in the form of infection or trauma primes the host immune system so that a subsequent,relatively trivial insult produces a markedly exaggerated host immune response, which can leadto multiple organ dysfunction syndrome (MODS) and death. This forms the basis of the “two-hithypothesis” (THH), which is being increasingly recognised as an important cause of morbidity andmortality following severe injury and sepsis, particularly in intensive care settings. Appreciation ofthe impact ofrepeatedinsults andpathophysiology of MODS is vital in the prevention of this seriouscomplication. We describe a case which illustrates the concept of THH and MODS and present areview of literature on this subject.Key words: laparotomy, multiple organ dysfunction, sepsis, two-hit hypothesis
Need of The Ministry of Health in Federal Democratic Republic of Nepal
Authors: Regmi Kiran , Upadhyay Meera , Tarin Ehsanullah , Chand Padam Bahadur , Uprety Senendra Raj , Lekhak Susheel Chandra
Published: September 2018

The constitution of Nepal provides appointing a council of ministers both at federal and provincial levels without defining portfolios. There is a political agreement that MOH will be retained at the federal level. This article draws evidences around the world to meet health needs of Nepalese, the role of provincial ministry of health and coordinating structure at district/local level.The constitution emphasises on health and pronounced in 46 articles which provides guidance for the creation of federalized governance levels at federal, provincial and local levels. Retaining ministry of health at federal level without creating devolved structure at province and local levels in health sector will create difficulty in translating the spirit of the constitution and may not be effective in addressing health issues nationally and meeting global achievements like SDGs.It is suggested to establish an elaborate health system accordingly in Nepal to ensure constitutional mandate of health as a basic human right.Keywords:constitution; federalism; health sector,ministy of health. [PubMed]
Erosive Oral Lichen Planus and its Management: A Case Series
Authors: Sharma Shivalal Cs , Saimbi CS , Koirala B
Published: September 2018

Lichen planus (LP), although a dermatosis, is more common in the oral mucous membrane thanin the skin. Lesions of oral LP are classically found on the buccal mucosa and gingiva. Among thevarious types, the reticularlesions are asymptomatic and require no treatment, but pain and severediscomfort accompany the erosive or ulcerative lesions. Malignant transformation to squamouscell carcinoma developing in areas of erosive oral LP (EOLP) being a possibility, it is important forclinicians to maintain a high index of suspicion for all intraoral lichenoid lesions. Therefore, periodicfollow-up of all patients with EOLP is recommended.In view ofthe above,this paper highlights themanagement of four cases of EOLP with topical corticosteroid and CO2laser surgery.Key words: carbon dioxide laser, corticosteroid, lichen planus
A Cluster Survey for Determination of Regular Vaccination Coverage among Children
Authors: Shah Harishchandra
Published: September 2018

One of the objectives of the Expanded Program of Immunization (EPI) is to achieve and sustainvaccination coverage to >90%. The coverage is not uniform within the districts, some of the areas showing more than 100% while others are far behind. The objective of the survey was to determine the coverage of immunization among children 12-23 months of age inRautahat District of Nepal.A cross-sectional method was applied with the 30-cluster sampling method followed by taking asample of 210 children. The structured questionnaire requesting information about socio-economiccharacteristics, vaccination, history of vaccination, doses of vaccines, and vaccination records wereused for collecting data.The coverage responses according to history from mothers for BCG, DPTHb-3, Polio3 and Measlesimmunizations were 96.7%, 90.0%, 97.6% and 78.1% respectively. By analyzing the records of the sampled Village Development Committees (VDCs), the coverage for the same vaccines was 88.1%, 78.1%, 79.0, 73.8% respectively. The drop-out of BCG versus measles was also very high. The District Health Office (DHO) reports were remarkably higher than the coverage of immunizations obtained by the survey, showing additional number of the target children.Key words: coverage; cluster survey; immunization; vaccination
Non-Invasive Predictors of Gastro-Oesophageal Varices
Authors: Bhattarai Subash , Dewan Khus Raj , Shrestha Gaurav , Patowary Bhanumati Saikia
Published: September 2018

Introduction: The worldwide accepted tool for screening and monitoring gastro-oesophageal varices

in patients with liver cirrhosis is upper gastrointestinal endoscopy. Endoscopy needs clinical expertise

and has got its own procedure related complications. Repeated endoscopies may be expensive and

patients tend to develop poor compliance. This study was undertaken to establish the role of noninvasive

parameters in predicting gastro-esophageal varices.

Methods: Two hundred patients with clinical features, laboratory and sonological findings

suggestive of cirrhosis of liver and endoscopic evidence of portal hypertension were included in the

study. Blood parameters like serum albumin, international normalized ratio (INR), platelets count

and ultrasonography assessments of portal vein diameter and spleen size were compared with

presence of gastro-oesophageal varices.

Results: At cutoff point of 2.55g/dl, serum albumin had high specificity of 99% whereas platelets

count <1,44,000/mm3 had 87.9% sensitivity for presence of oesophageal varices. Sensitivities of

92.72% and 94.5% while specificities of 90% and 75% were detected for presence of oesophageal

varices when the cutoff values for portal vein diameter and spleen size were 12.25 mm and 13.9 cm

respectively.

Conclusions: Measurements of serum albumin, platelets count, portal vein diameter and spleen size

by ultrasonography can be recommended as a non-invasive predictor for gastro-oesophageal varices

in cirrhosis of liver. All these non-invasive parameters could be useful to patients with liver cirrhosis

with portal hypertension in predicting presence of varices as well as in long-term clinical monitoring

and management.

Keywords: cirrhosis of liver; endoscopy; gastro-oesophageal varices; non-invasive predictors.
Incidence and Outcome of Ventilator Associated Pneumonia in ICU of a Tertiary Care Hospital in Nepal
Authors: Mishra Deebya Raj , Shah Niharika , Shah Dibya Singh
Published: September 2018

Introduction: Ventilator associated pneumonia is an important intensive care unit acquired infection in mechanically ventilated patients. Early and correct diagnosis of Ventilator associated pneumonia is difficult but is an urgent challenge for an optimal antibiotic treatment.

Methods: A prospective observational study was conducted in Intensive Care Unit of a tertiary care hospital in Nepal. Consecutive patients were considered during the study period, who met the criteria were included for the study. Clinical Pulmonary Infection Score was used to diagnose Ventilator associated pneumonia.

Results: Among 60 patients ventilated for more than 48 hours, 25 (41.6%) developed ventilator associated pneumonia. The incidence was 25 VAPs per 100 ventilated patients or 26 VAPs per 1000 ventilator days during the period of study. Days on ventilator and duration in ICU were higher in the VAP group. There was a trend towards increasing mortality in the VAP group (P value=0.06).

Conclusions: There exists a high rate of VAP in our Intensive Care Unit. Targeted strategies aimed at reducing Ventilator associated pneumonia should be implemented to improve patient outcome and reduce length of Intensive Care Unit stay and costs.

Keywords: clinical pulmonary infection score; incidence; ventilator associated pneumonia.
Unusual Presentation of Multiple Myeloma
Authors: Lee Sang Yeoup , Choi Eun Jeong , Lim Hyun Ju
Published: September 2018

Malignancy is an independent risk factor of venous thromboembolism, although it is difficult to determine whether occult cancer is the cause of unprovoked VTE. About 25% of patients with VTE remain idiopathic. Here, the authors report the case of a 63-year-old woman with a history of unprovoked VTE some 10 months previously who presented with recurrent cough and dyspnea of 6 months’ duration and was finally diagnosed to have multiple myeloma.
Anaesthetic Management of Tracheal Agenesis
Authors: Bhattarai Balkrishna , Pratap A , Yadav R , Pokharel K
Published: September 2018

Tracheal agenesis is a rare but uniformly fatal congenital condition that obstetricians, neonatologists or anaesthesiologists may encounter as an unexpected emergency. Ventilation with bag and mask or through an endotracheal tube placed in the oesophagus may be the only options left for immediate survival and evaluation. Ventilation and maintenance of adequate oxygenation can be difficult during surgical interventions. We report a case of neonate in which ventilation and anaesthesia were maintained through an endotracheal tube in the oesophagus and frequent episodes of drop in oxygen saturation were observed during surgery. Anaesthetic management, airway and other issues are discussed.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):142-144.
Knowledge and Practice of Hemodialysis Amongst Dialysis Nurses
Authors: Manandhar Dhiraj Narayan , Chhetri Pramod Kumar , Poudel Prakash , Baidya Samir Keshari , Agrawaal Krishna Kumar
Published: September 2018

Introduction: Dialysis nurses should have a good knowledge regarding hemodialysis treatment. The status of Nepalese dialysis nurses on this aspect is unknown. This study was done to assess the knowledge and practice on different aspects of the hemodialysis treatment.

Methods: We distributed questionnaires to the participants of a conference held on September 24, 2016 in Kathmandu. We included 94 out of 116 participants who were giving care to dialysis patients. We calculated mean and standard deviation for continuous variables and frequencies and percentage for the responses and compared counseling with different parameters.

Results: Response rate was >96%. Fifty-nine respondents (64%) were from age group 20-29 years. Only 39 (42%) received formal nursing training in hemodialysis. Seventy-one (78%) respondents always counseled patients regarding fluid intake. Thirty-seven (96%) trained nurses always counseled the importance of regular dialysis. Seventy-six (81.7%) respondents did counseling on vaccination against Hepatitis B. Counseling on vaccination against influenza and pneumococcus was 50%. When comparing educational status, respondents below bachelor level did more frequent counseling than level above (p=0.03). All the respondents knew the importance of hand washing and BP monitoring during hemodialysis. Ninety-one (96.7%) respondents knew how to deal with BP changes during hemodialysis. Seventy-three (77.6%) respondents were very confident on managing complications. Only 31(33%) respondents knew how to deal with patients on continuous ambulatory peritoneal dialysis.

Conclusions: Dialysis nurses have knowledge on basic procedures of hemodialysis but there is a space for improvement in counseling and dealing with complications to provide quality service to hemodialysis patients.

Keywords: counseling; hemodialysis; Nepal; nurse.
Intracranial Ricocheting of Bullet from Anterior Clinoid Process
Authors: Agrawal Amit , Pratap A , Rauniar RK , Kumar A , Nepal U
Published: September 2018

Gunshot wounds to the head are usually mortal injuries. We present a unique case of intracranial ricocheting of bullet without neurological deficits. Patient was treated conservatively with antibiotics for one week and prophylactic anticonvulsants for six weeks. Patient is doing well at six months follow up. Repeat X-ray skull showed that bullet was lying in the occipital region. It is recommended that deep seated bullets should be left behind as any attempt to remove that bullet may increase the morbidity and mortality. However close follow up of these patients is very important as these patients may come back with brain abscess.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):145-146.
Pseudocyesis
Authors: Upadhyay Sarita
Published: September 2018

Pseudocyesis - a clinical syndrome seen in non-psychotic woman, known since the time of Hippocrates. Pseudocyesis has a psychological basis in which a woman's wish for pregnancy is essential to their identity and self-esteem. Normally, pseudocyesis is seen in women who desperately want to become pregnant, especially those with longstanding infertility. Basically, the treatment of Pseudocyesis is to help these patients recognize the illness and to educate and counsel them. Here is the case of pseudocyesis in which there is no history of long standing infertility. This case is rare and liable to be missed.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):147-150.
Ventilator-Associated Pneumonia and Role of Nurses in Its Prevention
Authors: Osti Chadani , Wosti Deepa , Pandey Bimala , Zhao Qinghua
Published: September 2018

Ventilator-associated pneumonia (VAP) is one of the most frequent nosocomial infections among ventilated patients in ICUs, associated with an increase in days of ICU stay, morbidity, and mortality. Its prevention is a significant concern in every hospital. Most of the interventions and prevention strategies are part of routine nursing care. Nurses have different vital roles such as care provider, manager, educator, coordinator, and evaluator in preventing VAP. Lack of knowledge of infection prevention and proper nursing care among nurses may become a barrier in adhering to evidence-based guidelines for preventing ventilator-associated pneumonia. This study will help nurses to know about VAP and its prevention in detail so that they can apply the knowledge in clinical practice. Understanding pathophysiology of VAP, its risk factors, and care bundle is vital for the proper prevention and treatment of VAP. There must be specific protocols, strategies and active surveillance in every ICU regarding the care bundle.

Keywords:  Mechanical ventilation; Nosocomial infections; Nurses role; Ventilator-associated pneumonia; VAP Prevention.
Evaluation of Dental Caries Among Preschool Children in Kathmandu- Using Significant Caries Index.
Authors: Limbu Senchhema , Dikshit Parajeeta , Bhagat Tarakant
Published: September 2018

INTRODUCTION:

Dental caries among preschool children is common but there is scarcity of updated data about its prevalence among Nepalese preschool children. This study was conducted to evaluate prevalence, Significant Caries Index, Caries pattern, Restorative care index and Disparity ratio among preschool children of Kathmandu aged 3-6 years.

METHODS:

A cross sectional study was conducted on 17 preschools of Kathmandu following WHO criteria. Data were analysed using SPSS 20 and descriptive statistics was applied.

RESULTS:

Prevalence of dental caries was 803 (55.6%) with a mean deft of 3.28±3.581 and Significant Caries Index score was 7.439. Caries pattern showed the most commonly decayed teeth were mandibular second molars followed by maxillary central incisors. The least affected teeth were mandibular lateral incisors. The restorative care index was 106 (7.32%) in the total sample size and 14 (2.86%) in the SiC and disparity ratio was 2.26.

CONCLUSIONS:

The SiC Index indicated high dental caries prevalence; severity rates and restorative care index indicated little experience of restorative treatment in preschool children of Kathmandu identifying the need for more targeted efforts to reach preschool children early to effectively address unmet oral health needs.

KEYWORDS:

caries pattern; dental caries; Kathmandu; preschool; significant caries index.
Prevalence of Oral Mucosal Lesions in a Tertiary Care Dental Hospital of Kathmandu
Authors: Bajracharya Dipshikha , Gupta Sujaya , Ojha Bidhata , Baral Radha
Published: September 2018

Introduction: Oral mucosa can be affected by a variety of soft tissue lesions and conditions. Benign as well as malignant lesions of oral cavity are common. Squamous cell carcinoma is one of the commonest malignancies. The present retrospective study was undertaken to study the prevalence of various oral mucosal lesions in a tertiary care dental hospital of Kathmandu.

Methods: This retrospective study was carried out in the Department of Oral and Maxillofacial Pathology at Kantipur Dental College and Teaching hospital from January 2015 to January 2017. The study included biopsy specimen from the oral cavity. The parameters included in the study were age, gender, site of the lesion and histopathological diagnosis. The data collected was statistically analyzed.

Results: A total of 111 biopsy cases were included in the present study. Out of which, there was 16 (14.4%) cases of non neoplastic and 16 (14.4%) cases of benign pathology. The oral cavity lesions were commonly seen in age range between 6-74 years where males 59 (53.2%) were mostly affected. The most common site for oral lesion was buccal mucosa 23 (20.7%) and anterior gingiva 23 (20.7%). 15 (13.5%) cases of oral squamous cell carcinoma were seen as the predominant malignancy affecting in the vestibular region 8 (7.2%).

Conclusions: The present study shows benign as well as the non neoplastic lesions were more prevalent in oral mucosa with the buccal mucosa and anterior gingiva as the commonest site of occurrence.

Keywords: Benign; Malignant; Non neoplastic; Oral mucosal lesion.
Radiotherapy for Benign Diseases
Authors: Jha Anjani Kumar , Prasiko G , Mod H , Chaurasia P P , Shrivastava R
Published: September 2018

Radiotherapy mainly involves treatment of patients with malignant tumors. Even with recognition of the risks of late skin injury, carcinogenesis, leukemogenesis, and genetic damage from all ionizing radiation; radiation therapy also continues to be accepted treatment for benign diseases. Before initiation, the quality of irradiation, total dose, overall time, underlying organs at risk, and shielding factors should be considered. Children should be treated with ionizing radiation only in very exceptional cases and after weighing the pros and cons of the therapy. Direct irradiation of skin areas overlying organs that are particularly prone to late effects (e.g. thyroid, eye, gonads, bone marrow and breast) should be avoided. Radiation protection techniques should be used in all instances. The depth of penetration of the x-ray beam should be chosen according to the depth of the pathologic process. Choice of beam energy usually depends on the depth of the target volume; every effort is made to spare normal underlying tissue in superficial lesions. There are a number of other benign conditions that can be treated with radiotherapy; we present a brief overview of some of the commonly encountered conditions.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):151-155.
Dengue- An Emerging Disease in Nepal
Authors: Pun S B
Published: September 2018

Dengue is an acute infectious disease caused by dengue viruses and transmitted by the Aedes species of mosquito. The rapid global spread of the dengue virus into new areas has begun to attract more research attention. A series of dengue fever outbreaks in several districts of Nepal has been recently observed. The evidence of all four serotypes (DEN – 1 - 4) could be a consequence of a sudden resurgence of a more severe dengue disease in Nepal. Health care providers need to become familiar with the disease to prevent or control the possibility of future outbreaks. The clinical features, diagnosis, treatment, epidemiological patterns and challenges of dengue virus infection in Nepal will be discussed here.

Keywords: Dengue, epidemiological patterns, Nepal.
Contrast-Enhanced Ultrasonography: A Recent Application for the Diagnosis and Treatment of Hepatocellular Carcinoma
Authors: Maruyama Hitoshi , Yoshikawa M , Yokosuka O
Published: September 2018

Hepatocellular carcinoma has a decisive influence on the prognosis of cirrhotic patients, and the use of imaging modalities is essential for the screening, diagnosis and treatment of hepatocellular carcinoma. Ultrasound plays a major role among them, because it provides real-time and non-invasive observation by a simple and easy technique. In addition, ultrasound-guided needle puncture methods are frequently required for the diagnosis and/or treatment process of hepatocellular carcinoma. The development of digital technology has led to the detectability of blood flow by color Doppler ultrasound, and the sensitivity for tumor vascularity has shown remarkable improvement with the introduction of microbubble contrast agents. Moreover, near real-time three-dimensional ultrasound images are now available. These advancements in the ultrasound field have led to rapid progress in hepatocellular carcinoma management, and continuing advances are expected. This article reviews the current application of contrast-enhanced ultrasound for hepatocellular carcinoma in clinical practice.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):156-166.
Basal Cell Carcinoma in Cases with or without Xeroderma Pigmentosum
Authors: Ghartimagar Dilasma , Ghosh Arnab , Shrestha Sushil Ram , Shrestha Sachet , Narasimhan Raghavan , Talwar O P
Published: September 2018

Introduction: Basal cell carcinoma is the most common form of cancer in humans and comprises the vast majority of skin cancers. It predominantly affects fair-skinned individuals, and its incidence is rapidly increasing. The objective of the study is to identify the epidemiology, its topography and different histological subtypes of basal cell carcinoma in patients with or without Xeroderma Pigmentosum.

Methods: A cross-sectional descriptive study was conducted at Manipal Teaching Hospital, Pokhara from Jan 2009 to Dec 2016. Ethical approval was taken from MEMG/IRC/GA. The study included patients with a confirmed diagnosis of basal cell carcinoma irrespective of their age and sex.

Results: This study showed 77 individuals with 91 biopsies of BCC including 5 cases of Xeroderma Pigmentosum. The predominant histological subtype was nodular with 41 (53.94%) cases, followed by the 14 (18.42%) cases of pigmented and 10 (13.15%) cases baso-squamous subtype. The most frequent sites of involvement were the head and neck, with predominance in the nasal and orbital region. The mean age was 57.68 years but the basal cell carcinoma in cases of Xeroderma Pigmentosum was seen more in younger age groups. There were 43 (55.84 %) male patients and 34 (44.16 %) female patients with a male to female ratio of 1.26:1.

Conclusions: Nodular and pigmented varieties were the most frequent subtypes with nose being the commonest site of involvement. Basal cell carcinomas in cases of Xeroderma Pigmentosum were noted in younger age group with multiple lesions.

Keywords:   basal cell carcinoma; recurrence; topography; xeroderma pigmentosum.