bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Profile of Critically Ill Patients Presenting to Emergency Department of Tertiary Level Hospital of Nepal
Authors: Shrestha Shubha K , Pradhan Bishwas , Shakya Yogendra M
Published: July 2024

Introduction: Among critically ill patients presenting to Emergency Room (ER) of Tribhuwan University Teaching Hospital (TUTH), a number of patients have to either remain in ER or have to be referred outside due to unavailability of critical care beds. Studies have shown significant association between delayed admission and mortality rates along with increased length of stay and higher cost. This study aimed to present an audit of critically ill patients presenting to ER of TUTH.
Methods: This was a prospective study conducted over a period of one month. All patients presenting to ER of TUTH were triaged and critically ill patients were shifted to Red area of the ER. All patients ≥16 years of age shifted to Red area during the study period were enrolled in our study.
Results: Out of 3718 patients presenting to ER during the study period, the number of critically ill patients ≥16 years of age was 526 i.e. 14.14% of total patients. Among them, the common diagnosis were Cerebrovascular Accidents (CVA) followed by Intoxication, Acute Exacerbation(AE) of Chronic Obstructive Pulmonary Disease(COPD), Pneumonia and Chronic Kidney Disease(CKD) respectively. Almost 20% of these patients were admitted, 31% were referred and 40% were shifted for observation. The median length of ER stay was 6 hours (Mean: 8.5 hrs; Range: 20 min to 70 hr 15 min).
Conclusion: Among critically ill patients presenting to our ER, almost 1/5th of the patients were admitted whereas more than 2/3rd were either referred or remained in our ER. This data highlights the need for solutions to provide optimal care for the acute phase management of the critically ill patients.
Diagnostic Accuracy of Peritoneoscopy to Determine the Cause of Low Serum Ascites Albumin Gradient
Authors: Parajuli Pawan , Bhandari Ramesh S , Pathak Rahul , Sharma Shashi , Khadga Prem K , Jha Anurag , Hamal Rabin , Kafle Brindeswari
Published: July 2024

Introduction: Ascites, a common entity in practice of gastroenterology is pathophysiologically divided into high SAAG and low SAAG category, to rapidly classify, formulate a workup plan and expedite the diagnosis. The cause of low SAAG ascites is often due to local peritoneal cause e.g peritoneal tuberculosis, peritoneal carcinomatosis etc, mandating the need of peritoneoscopy for definitive diagnosis. This study aims to present the peritoneoscopy and peritoneal biopsy result of patients with low SAAG ascites of uncertain etiology.
Methods: Peritoneoscopy was prospectively performed in 12 patients with low SAAG ascites of unclear etiology. Patients with low SAAG ascites and willing to give consent for peritoneoscopy were enrolled in the study. Patients underwent laparoscopic peritoneoscopy under general anesthesia and appropriate biopsies were taken during the procedure for histopathological analysis.
Results: Of the twelve patients with low SAAG enrolled in the study, 3 (25%) were male and 75% (9) were female. The success rate of the procedure was 100% and there was no procedure related complications. Specific findings were seen in all patients undergoing peritoneoscopy. Of the twelve patients, 9 (75%) patients has metastatic deposits in the peritoneum, 3 (25%) had benign etiology, 2/3rd (2) of whom had granulomatous deposits suggestive of tuberculosis and 1/3rd (1) had extensive dense adhesions and peritoneal fibrosis. Primary focus was revealed (ovary) in only 1 patient undergoing peritoneoscopy.
Conclusion: Peritoneoscopy with simultaneous biopsy is safe, efficient and accurate diagnostic method due to its high diagnostic capacity and low complication rate in selected patients who have low SAAG ascites of uncertain etiology.
Association of ABO Blood Groups with Craniofacial Morphology among Orthodontic Patients in Selected Private Clinics of Kathmandu
Authors: Gupta Sanjay P
Published: July 2024

Introduction: The craniofacial morphology and blood groups both are related to genetic components, hence it can be hypothesized that blood groups have an association with craniofacial morphology. Some studies showed the relationship whereas others could not find any relationship in different population. The aim of this study was to find out the relationship between ABO blood groups and craniofacial morphology among orthodontic patients of Kathmandu district.
Methods: In this cross sectional analytical study, 385 participants (age range from 13-45 years) were selected among the orthodontic patients who came for orthodontic treatment in private orthodontic clinics. After obtaining written consent, all the patient’s demographic information were recorded and lateral cephalograms were obtained from the patient’s record. Blood group of all the participants was recorded.
Results: Among 385 participants, 162 (42.07%) were male while 223 (57.93%) were female and the mean age was 16.31±4.38 years. Twenty cephalometric parameters depicting craniofacial morphology were digitally analyzed using lateral cephalograms. The prevalence of blood group O patients was highest (32.20%) followed by blood group B (30.64%), blood group A (29.88%) and blood group AB (7.28%). Statistical analysis with ANOVA revealed nine out of twenty cephalometric parameters were statistically significant among different blood groups (p<0.05). Tukey post hoc test was done to find out the difference among the groups.
Conclusion: The evaluation of relationship between blood group and craniofacial morphology revealed that blood groups have association with some craniofacial parameters. This suggests, there may be some genetic influence of ABO blood group on craniofacial morphology.
A Case Report of Recurrent Pyogenic Granuloma with Satellitosis
Authors: Parajuli Sudip , Das Anil K , Paudel Upama
Published: July 2024

Recurrent pyogenic granuloma with satellitosis is an uncommon condition with majority of cases resolving within one year after treatment. We report a case of recurrent pyogenic granuloma in a middle aged man who kept on relapsing at different point of time despite treatment with electrocoagulation, cryosurgery and oral methotrexate. The case highlights the unusual presentation of relatively common condition of pyogenic granuloma.
Comparison of Outcomes of Open versus Laparoscopic Living Donor Nephrectomy in Nepal
Authors: Sigdel Prem R , Gnyawal Diwas , Rai Bipendra D K , Dhital Pawan , Parajuli Purushottam , Chudal Sampanna , Dhakal Niraj , Pradhan Manish , Poudyal Sujeet , Chapagain Suman , Luitel Bhoj R , Chalise Pawan R , Sharma Uttam K , Gyawali Prem R
Published: July 2024

Introduction: Laparoscopic donor nephrectomy is the gold standard for kidney retrieval in live donors. Until recently, donor nephrectomies were performed only by open technique in Nepal. There is no information on the experience and outcomes of laparoscopic donor nephrectomy in Nepal. The study was done to compare the outcomes among donors undergoing open and laparoscopic nephrectomies, and to compare the graft related outcomes between the two groups receiving these kidneys.
Methods: In this retrospective study, 44 kidney donors from March 2019 to October 2019 were analyzed. Donors were divided into 2 groups: open donor nephrectomy (ODN) and laparoscopic donor nephrectomy (LDN). Parameters for analysis included demographic data, warm ischemia time, surgery time and length of hospital stay. Data on early graft function and complications in recipients till 30th post-operative day were compared.
Results: There were 22 donors each in the ODN and LDN groups. Baseline characteristics of the donors were comparable between two groups. Mean surgery duration (183.55±43.31 minutes vs 117.73±18.75 minutes) and first warm ischemia time (11.22±4.34 minutes vs 2.3±0.8 minutes) was significantly high in LDN. Hemoglobin drop, post-operative complications in donors, creatinine of donors at discharge, mean hospital stay, graft function at one month and complications in recipients were comparable among ODN and LDN. Pain score in 1st post-operative day was comparable between two groups, however, pain was significantly less in second post-operative day in LDN.
Conclusion: Laparoscopic donor nephrectomy is feasible in Nepal and associated with acceptable morbidity and graft function when compared to ODN.
Palliative Toilet Mastectomy for Advanced Breast Cancer in a University Hospital of Nepal
Authors: Verma Rupesh , Hirachan Suzita , Singh Yogendra P
Published: July 2024

Introduction: In Nepal, half of the breast cancer patients presented in advanced stage III (IIIA 18%, IIIB 22%), and stage IV (10%). Delayed presentations are due to lack of awareness, reluctancy and poor accessibility to health care services often leads to local complications like sloughing of fungating breast lesions, secondary infection and bleeding. The aim of this study was to analyze the advanced breast cancer (ABC) patients who underwent palliative toilet mastectomy.
Methods: Retrospective review of all patients presenting with ABC who underwent palliative toilet mastectomy in the breast unit of Tribhuvan University Teaching Hospital Kathmandu, Nepal from January 2016 to December 2018, was done. The data included were demographic profile, histopathological and immunohistochemistry report, indication of surgery, adjuvant therapy, timing of surgery, and quality of life after surgery.
Results: Total number of breast carcinoma patients was 155 within the duration of 3 years. There were 7 (4.5%) cases of breast cancer treated with palliative toilet mastectomy with mean age of 57.9±12.7 years. The mean tumor size was 4.3±1.3cm. The indications of palliative mastectomy were fungation-2 (28.5%), bleeding-2 (28.5%), ulceration-1 (14.3%), malodorous discharge with secondary infection-1 (14.3%) and hemiplegic patient with infection in 1 (14.3%). Luminal A molecular subtype was seen in 1 out of 7 patients (14.3%) with basal like subtype in 6 out of 7 patients (85.7%). Lympho-vascular invasion were seen in 4 out of 7 (57.14%). One patient underwent bilateral palliative mastectomy for progressive disease and margins were positive for tumor and remaining six patients had tumor free margins.
Conclusion: Advanced breast cancers are treated with neoadjuvant therapy prior surgery but the delayed presentation of these with fungating, ulcerative, infective and bleeding lesions make the initial palliative toilet mastectomy a useful option.
Risk Factors Among Breast Cancer Patients Being Treated in Tertiary Level Hospital of Nepal: A Case Control Study
Authors: Rana Asmita , Ghimire Anup , Sah Ram B , Pyakurel Prajjwal , Shah Nirmal P
Published: July 2024

Introduction: Breast cancer is the leading cause of cancer death among females worldwide. Its incidence is on the rise in Nepal. However, the risk factors have not been studied in context of Nepal. The aim of this study is to identify and quantify the association of various risk factors with breast cancer in Nepal.
Methods: Hospital-based age-matched case-control study was conducted among 50 cases and 150 controls visiting BP Koirala Memorial Cancer Hospital, Bharatpur, Nepal. Semi-structured questionnaire was used to collect information on demographic characters, socio-economic parameters, reproductive history, dietary and personal habits, family history, history of contraception and history of benign breast disease. Height, weight, hip circumference and waist circumference were measured.
Results: Majority of the cases (52%) belonged to the age group of 46-55 years. The significant risk factors were ethnicity of Dalit/Madhesi (AOR 8.222, 95% CI 2.377-28.441, p-value 0.001), parity of 3 to 5 (AOR 5.614, 95% CI 1.140-27.639, p-value 0.03) and previous history of benign breast disease (OR 13.614, 95% CI 3.229-57.391, p-value 0.001). Hysterectomy was found to reduce the risk of breast cancer (OR 0.122, 95% CI 0.017-0.826, p-value 0.03). Knowledge of breast self-examination was significantly higher among cases than controls (AOR 36.29, 95% CI 5.788-227.555, p-value < 0.001). Knowledge of mammography was significantly lower among cases than control (AOR=0.133, 95% CI=0.028-0.647, p-value=0.01).
Conclusion: This study showed a number of factors to be associated with the increased risk of breast cancer. It was observed that the mean age at diagnosis is a decade earlier than in Western countries. Genetic component was not significant in context of Nepal. It is hoped that the findings of this study will facilitate further exploration and evidenced-based preventive measures for Nepalese women.
Thyroid Disorders and Prolactin Hormone and Their Association with Obesity in Infertile Women in a Tertiary Hospital of Nepal
Authors: Maskey Suvana , Rijal Hima
Published: July 2024

Introduction: Thyroid dysfunction has profound effects on menstrual function and female fertility. Hypothyroidism is often associated with increased prolactin level which again worsens the problem. This study was done to evaluate the prevalence of thyroid disorders in infertile women attending infertility outpatient department (OPD) in Tribhuvan University Teaching Hospital (TUTH) and to determine the association of hypothyroidism and hyperprolactenemia with obesity which is not well studied in our population.
Methods: A hospital-based cross-sectional study was conducted in infertility OPD of TUTH reviewing women’s records who underwent infertility workup and relevant history, clinical finding and results of investigations including thyroid function test (TFT) and serum prolactin (PRL) level were documented. Descriptive and inferential statistical analyses were used to identify the prevalence and associations of predictors and outcome variables.
Results: Out of 213 participants, the majority of the participants were obese (90; 42.3%) with mean (±SD) body mass index (BMI) being 24.8 ± 4.5 kg/m2. The prevalence of thyroid disorder was 18.4% including hypothyroidism 13.6% and hyperthyroidism 4.8%. There was no significant association of BMI and hyperprolactinemia with thyroid disorder as well as of BMI with hyperprolactinemia however the thyroid stimulating hormone (TSH) had significant positive correlation with prolactin (r=0.23, p<0.001).
Conclusion: Thyroid disorders and hyperprolactinemia are commonly observed in infertile women, so they should be routinely screened during initial evaluation of infertility. As majority of the study population were obese, despite no significant association of BMI with thyroid disorder and hyperprolactinemia, the effect of weight gain on infertility cannot be overlooked.
Nebulized Magnesium Sulphate Versus Saline as an Adjuvant in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Centre of Nepal: A Randomized Control Study
Authors: Bajracharya Manjita , Acharya Ramesh P , Neupane Ram P , Sthapit Rekha , Tamrakar Apurva R
Published: July 2024

Introduction: Magnesium has been shown to have bronchodilator properties in asthma and chronic obstructive pulmonary disease (COPD). Therapeutic benefits of nebulized magnesium in asthma has been seen. The purpose of this study was to compare therapeutic benefits of nebulised magnesium sulphate as an adjuvant with normal saline in patients with COPD exacerbation.
Methods: It was a randomized single blind interventional study of 172 cases of acute exacerbation of COPD presenting (AECOPD) with a peak expiratory flow rate (PEFR) <300 L/min measured 20 min after initial management. Patients received 5 mg salbutamol mixed with 3 ml isotonic magnesium sulphate or 3 ml normal saline on three occasions at 30 min intervals via nebulizer. The primary outcome measured was PEFR at 90 min and hospital admission, noninvasive or invasive ventilation and mortality were taken as secondary outcomes.
Results: The mean PEFR were 86.3±11.9 l/min, 97.6±19.1 l/min and 99.6±15.2 l/min after nebulization with magnesium sulphate and 79.17±14.11 l/min, 90.17±18.27 l/min and 93.17±20.63 l/min at 30, 60 and 90 minutes respectively in normal saline group which were statistically significant differences. Total 91.9% were admitted in ward and 8.1% got admitted in Medical and intermediate intensive care units from magnesium group and 81.7% were admitted in ward and 18.3% required ICU admissions in saline group. Differences in ventilation and mortality were insignificant.
Conclusion: Nebulized magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD has therapeutic benefit on PEFR but no effect in terms of hospital admission, requirement of invasive or non-invasive ventilation and mortality.
Knowledge of Nurses Working in Critical Care Areas Regarding Ventilator Associated Pneumonia Prevention Bundles in a Tertiary Level Cardiac Centre
Authors: Bhandari Sandip , Sharma Medha , Shrestha Gentle S
Published: July 2024

Introduction: Prevention of ventilator associated pneumonia (VAP) is influenced by the knowledge and practices of nurses. This study was conducted to assess the knowledge of nurses working in critical care areas of a tertiary level cardiac centre regarding VAP prevention bundles.
Methods: In this descriptive study, 57 nurses working in critical care areas were included, they completed a self-administered questionnaire containing demographic information followed by 18 multiple response questions. With the respondents choosing one or more correct answers, the percentage of correct answer for each options was obtained. For each questions, the correct percentage for all the options were averaged and expressed as average knowledge percent. The significance of association was tested using chi-square and Fisher exact test, with level of significance established at 95%. Data analysis was done using SPSS version 21.
Results: With a mean age of 26.8 years, the majority of the nurses had completed Bachelor’s degree (75.4%). Though 91.3% nurses had experience of more than a year in critical care, 87.7% of them had not obtained VAP or infection control training. The mean knowledge score of VAP was 70±7.5%, and 97.4% had satisfactory knowledge. There was no association between knowledge scores on prevention of VAP and educational qualification (p=0.26) and years of experience in intensive care unit (p=0.41).
Conclusion: Almost all of the nurses working in critical care areas had satisfactory knowledge regarding VAP bundle, however, they had lower knowledge on the definition and approach to prevent VAP. This study recommends to incorporate more nurses in training related to infection and VAP prevention.
Clinicopathological Features of Gallbladder Carcinoma Managed in a Tertiary Level Hospital of Nepal
Authors: Dahal Romi , Ghimire Bikal , Kansakar Prasan BS , Lakhey Paleshwan Joshi , Bhandari Ramesh S
Published: July 2024

Introduction: Gallbladder carcinoma is a relatively rare disease in some parts of the world but is common in countries like Chile, Japan, India, and Nepal. Nepal stands as one of the five countries with the highest mortality. However, there are only a few studies published on this matter from Nepal. This study aims to study the demographic and clinicopathological features of gallbladder carcinoma managed in a tertiary level teaching hospital in Nepal.
Methods: A retrospective analysis of all the patients with the diagnosis of gall bladder carcinoma in Tribhuvan University Teaching Hospital from 2018 to 2020 was done. Patient demographics, clinical characteristics, and laboratory parameters including tumor markers were analyzed.
Results: Of the 59 patients, there were 33 (56%) females. The median age at diagnosis was 56 years. Among all, the most common presenting symptom was abdominal pain. Curative resection was done in 18 (30%) of the cases. Metastasis was present in 30% of the cases of which the liver was the most frequently involved organ. The mean carcinoembryonic antigen (CEA) level in unresectable cases was 18.65±22.53 nanograms per milliliter (ng/mL) which was higher than in resectable cases being 6.78±12.75 ng/mL. Similarly, the mean carbohydrate antigen 19-9 (CA 19-9) level in unresectable cases was 604.55±671.28 units/milliliter (U/ml), which was higher than the value in the resectable cases 89.44±273.67 U/ml.
Conclusion: In this study, gall bladder carcinoma was more common in females below 60 years with vague abdominal pain as the most frequent presenting symptom. One-third of the evaluated cases were resectable. Unresectable cases were associated with high CEA and CA 19-9 levels.
Long Term Results of Adult Tonsillectomy for Recurrent Tonsillitis at a Tertiary Referral Hospital in Nepal
Authors: KC Sarita , Dongol Suman R , Bhattarai Sriya , Mahaseth Rajeev K
Published: July 2024

Introduction: Chronic recurrent tonsillitis giving rise to frequent fever and disabling sore throat is the commonest indication for tonsillectomy in adults. The study aims to evaluate long term patients’ perceived improvement subjectively as well as parameters of sore throat, fever, and antibiotics use objectively after adult tonsillectomy.
Methods: This retrospective cross sectional study was conducted at Department of ENT Head and Neck Surgery, Shree Birendra Hospital from January to May 2021. Preoperative data consisted of medical records of 81 adults who underwent tonsillectomy for recurrent tonsillitis between August 2012 and September 2013. Postoperative data on the same objective parameters were obtained by telephone during March 2021 after 7.5-8.5 years’ interval. In addition, patients were instructed to subjectively express improvement of symptoms after tonsillectomy compared to preoperative symptoms level. Subjective improvement was measured on a scale of 0% - 100%, 0% being no improvement at all to 100% for complete cure.
Results: Out of 81 patients, 31 (38.27%) could be interviewed. Twenty-three were male and 8 were female. The age ranged from 18 to 65 and the mean age was 28.39. Of the 31 patients interviewed, the mean frequency of sore throat post tonsillectomy was reduced from 8.61 to 0.23 per year. Preoperatively, overall annual frequency of fever was 3.83, which decreased to 0.25 post tonsillectomy. Similarly, frequency of antibiotics intake was 5.27 per year, which decreased to 0.73 after tonsillectomy. The mean post tonsillectomy subjective improvement was 85.74%.
Conclusion: The adult patients with recurrent tonsillitis had significant improvement in objective symptoms after tonsillectomy. More than half of the patients had complete subjective improvement in post tonsillectomy state.
Knowledge and Practice Regarding Topical Corticosteroids Among Dispensers in Community Pharmacies of Kathmandu Valley: A Cross-Sectional Survey
Authors: Shrestha Shristi , Joshi Smita , Tamang Ram K
Published: July 2024

Introduction: Topical corticosteroids (TCS) abuse and misuse are constantly rising in an alarming proportion, the main reason for this being free availability of such drugs over the counter (OTC) and pharmacists are one of the major prescribers of TCS. The present study was thus conducted to address the gap in information regarding the knowledge and practice of using corticosteroids among dispensers in community pharmacies.
Methods: A descriptive cross-sectional survey was carried out among the dispensers in community pharmacies inside Kathmandu valley from March 2020 to March 2021. A survey was conducted with a questionnaire which included questions to assess the knowledge and practice regarding TCS among dispensers in community pharmacies. Microsoft Excel 2010 and Statistical Package for Social Science (SPSS) 16 were used for data analysis.
Results: Among 209 participants, 83.73% of the participants had education related to pharmacy. They had good knowledge about brand names, generic names, and side effects of steroids. Maximum number (40.19%) of the participants responded that while coming to buy steroid creams, the patients come without prescription but with the name or cover of medicine. Majority of participants (66.51%) responded that they encounter 1-5 patients per day with recurrence of skin problems after stopping the application of creams.
Conclusion: The dispensers at community pharmacies reported having good knowledge about TCS. However, there is a need to strengthen the knowledge regarding indications of TCs including ethical and rational use of TCs among the dispensers in community pharmacies.
Characteristics and Outcomes of COVID-19 Patients Admitted to Adult Intensive Care Unit: A Single-Center Observational Study from the Second Wave in Nepal
Authors: Pradhan Saurabh , Upreti Anup R , Upadhyaya Sarobar , Oli Manish , Shrestha Asim , Shrestha Yashaswi
Published: July 2024

Introduction: There is inadequate data of critically ill COVID-19 caused by the delta variant. So, we sought to investigate the characteristics and outcomes during the second wave in Nepal.
Methods: COVID-19 patients admitted to adult ICU of a single institution from April to August 2021 were included. Clinical, laboratory and radiological findings were collected. In-hospital mortality, length of ICU stay, duration of mechanical ventilation (MV) and complications during ICU stay were obtained.
Results: Total 136 patients were included with a mean age of 56.24 (± 15.81)years and 52.2% males. Fifty-five percent had comorbidities. Mean fraction of inspired oxygen required was 0.8 and sequential organ failure assessment score on admission was 4.09. C-reactive protein (CRP), lactate dehydrogenase and ferritin levels were elevated to 62.5mg/L, 515 U/L and 472ng/mL respectively. The computed tomography score was 20. Thirty four (25%) required MV; 70 (52%) were managed with non-invasive ventilation; 41 (30.14%) required vasopressors; 4 (2.9%) required renal replacement therapy. In- hospital mortality was 43.4%. The median length of ICU stay and duration of MV were 6 and 3.5 days respectively. Hospital acquired infection was the commonest complication. Age (OR 1.126 (95% CI 1037-1.223, p value 0.005)) and CRP on admission (OR 1.023 (95% CI 1.000-1.047, p value 0.050) were found to be predictors of mortality.
Conclusion: In this single center study from the second wave of the pandemic, majority of critically ill COVID-19 patients were elderly with co- existing illnesses. In-hospital mortality was high. Age and CRP on admission were found to be independently associated with poor outcome.
Prevalence and Patterns of Coronary Artery Anomalies in a Tertiary Cardiac Center of Nepal: A Coronary Angiographic Study
Authors: Poudel Chandra M , Shakya Smriti , Gajurel Ratna M , Shrestha Hemant , Devkota Surya , Manandhar Bhawani , Thapa Sanjeev , Khanal Rajaram , Sharma Manju , Yadav Vijay
Published: July 2024

Introduction: The prevalence of coronary artery anomalies (CAAs), though rare, is nonetheless globally found in 0.2% to 1.3% of patients undergoing coronary angiography (CAG). We aimed to investigate the prevalence and patterns of CAAs.
Methods: The data was collected retrospectively by analyzing the coronary angiographic data of 6000 consecutive adult patients undergoing coronary angiography between January 2016 to December 2020 at the Manmohan Cardiothoracic Vascular and Transplant Center.
Results: Among 6000 patients, 89 (1.4%) had CAAs, with anomalies in the right coronary artery (RCA) being the most common (73%). The presence of a dominant RCA was found in 48 (53.9%) patients. The anomalous origin of RCA arising from the left sinus of valsalva was present in 33 (37.1%) patients. The left main (LM) anomaly was present in 49 (55%) patients with absent LM in 29 (32.6%) and a short LM in 20 (22.5%) patients, respectively. The left anterior descending (LAD) artery anomalies were present in 42 (47.2%) patients - out of which 29 (32.6%) had a separate origin of LAD from the left coronary sinus and 13 (14.6%) had a dual LAD. The left circumflex artery (LCx) anomalies were evident in 32 (35.9%) patients including separate origin from left coronary sinus in 29 (32.6%) and anomalous origin from the right coronary sinus in 3 (3.4%) patients, respectively. Two patients (2.2%) had coronary artery fistulas, both arising from LAD.
Conclusion: Though rare, our study did discover the prevalence of CAAs to be1.4%.
Outcomes of Anterior Urethral Stricture Management in a Tertiary Care Hospital in Eastern Nepal
Authors: Thakur Dipak K , Agrawal Chandra S
Published: July 2024

Introduction: The standard guidelines for the management of anterior urethral strictures categorizes as transurethral procedures like dilatation and urethrotomy; and open surgical procedures like urethroplasty. This study aims to find the extent and outcome of anterior urethral strictures managed in a tertiary care hospital in eastern Nepal.
Methods: It was a hospital-based cross-sectional study. Patients were evaluated preoperatively as per institutional protocol. The procedure was done either in local or spinal or general anesthesia with nasal intubation. At the end of the procedure, a 14 Fr Silicon catheter was inserted per urethra and removed either on the next day, 2 weeks or 4 weeks post operatively depending upon the type of procedure done. Patients were asked to follow up postoperatively at 6 weeks and three months.
Results: Thirty-six cases were eligible. The mean age of the patients was 39.25±14.02 years. According to the etiology; 36.1% were iatrogenic, 30.6% traumatic, 25% were balanitis xerotica obliterans or genital lichen sclerosus (BXO/LS) associated and 8.3% were infective respectively. Similarly, 61.1% of strictures were bulbar in location, 22.2% panurethral, 11.1% penile and 5.6% meatal. The mean length of the stricture was 4.26± 4.22 cm (range 1-14 cm). Similarly, Visual internal urethrotomy (VIU) was done in 47.2%, augmentation urethroplasty in 44.4% meatoplasty in 5.6% and anastomotic urethroplasty in 2.8% respectively. Complications occurred in 11.1% of cases.
Conclusion: Visual internal urethrotomy was the commonly performed procedure for the urethral stricture. Meatal stenosis was the most common complication
Surgical Management of Post-Intubation Tracheal Injuries: A Single-Center Experience from Nepal
Authors: Sapkota Ranjan , Shrestha Bibhush , Sharma Aakriti
Published: July 2024

Introduction: Despite various improvements in technology and patient care, tracheal intubation and tracheostomy still result in significant tracheal injuries like stenosis and airway fistula. Pressure necrosis by the inflated balloon is the commonest culprit. Post-intubation tracheal stenosis is a major indication for tracheal resection and anastomosis. This study was done to find out the indications and results of surgery for post-intubation tracheal lesions.
Methods: It was a descriptive observational study of patients with post- intubation tracheal lesions managed in Manmohan Cardiothoracic Vascular and Transplant Center over a period of 20 years (2001 to 2021).
Results: Twenty-five patients were treated for post-intubation tracheal lesions. Four had isolated tracheo-esophageal fistula (TEF); eighteen had an isolated tracheal stenosis and three had both. Most had a tracheal resection and end-end anastomosis (REEA) via a cervical approach, resecting an average of 2.7 cm of tracheal length. The average size of stenotic lumen was 4.32 mm. There were no operative deaths. Two patients expired within a month of surgery: one due to fatal restenosis and the other due to sepsis. There were a few immediate and a few long-term complications. The average follow-up period was 5 years.
Conclusion: Among the various post-intubation lesions, tracheal stenosis is the commonest indications for surgery. The management is challenging but safe and feasible, with a multidisciplinary team approach.
Maternal and Perinatal Outcome in COVID-19: A Hospital based Descriptive Study
Authors: Maskey Suvana , Rijal Hima
Published: July 2024

Introduction: Since the declaration of the pandemic by World Health Organization (WHO), COVID-19 infection has affected worldwide including vulnerable pregnant women, who are at risk of increased maternal as well as neonatal morbidities and mortality. This study aimed to evaluate the prevalence of COVID-19 as well as maternal and perinatal outcomes in pregnancy with covid infection compared to pregnancy without infection.
Methods: This hospital-based descriptive study was conducted in Tribhuvan University Teaching Hospital Obstetrics Department. All pregnant women delivered after the third trimester, positive for COVID-19 during the study period, were compared with age-matched control without infection for maternal outcomes in terms of morbidities, mode of delivery, complications as well as neonatal outcomes such as birth weight, Apgar score, intrauterine fetal demise (IUFD), Neonatal Unit (NNU), Neonatal intensive care unit (NICU) admission and neonatal death. Data were analyzed using Stata 14.1.
Results: During the study period, total 59 women with COVID-19 infection (prevalence 2.23%) and 118 women without infection were included. Obstetric complications were seen significantly more in study group than control group (13.55% vs 3.38%; p-value 0.01). Cesarean section and intensive care unit admission were also significantly more in study group than control group (81.35% vs 51.7%; p-value<0.001, 22.03% vs 0.85%, p-value <0.001). Women with COVID-19 infection had significantly more hospital stay than control group (p-value 0.005). but no significant difference was observed in the neonatal outcome.
Conclusion: Pregnancy with COVID-19 infection is associated with adverse obstetric complications, lower uterine segment Cesarean section and NICU admission but not with adverse neonatal outcomes compared to women without COVID-19 infection.
Ultrasonographic Assessment of Renal Parameters in Apparently Healthy Medical Students of A University Hospital
Authors: Thapa Sushma , Khanal Ujjwal P , Paudel Sharma , Sigdel Mahesh R
Published: July 2024

Introduction: Ultrasonography is a commonly used medical imaging technique to evaluate the kidneys and has become the preferred modality for the assessment of renal pathology. However, limited data are available on the normal renal parameters in Nepalese adults. The aim of this study was to establish normal reference ranges for renal size in healthy medical students using ultrasonography.
Methods: A total of 100 healthy undergraduate medical students (64 males; 36 females) between the first and internship years (age 19-29 years) were studied. Ultrasonography was performed using a single and specific ultrasound machine with 1-7MHz transducer.
Results: The study showed the left kidney was slightly longer than the right (10.46 ± 0.68cm vs 10.13 ± 0.65cm; p=0.04), but the right kidney had a significantly larger thickness (2.80 ± 0.76cm vs 2.99 ± 0.68cm; p=0.01) and volume. A strong positive correlation was found between the renal parameters of one side with another side (Length: r=0.63,p<0.001; Breadth: r=0.42, p<0.001; Thickness: r=0.51, p<001; Volume: r=0.57, p<0.001). There were significant differences in renal length and volume based on sex, height, weight, and body mass index while other parameters were not significant. Weight was found to affect renal length more than height.
Conclusion: The left kidney was slightly longer than the right kidney. There was a strong positive correlation between the right and left kidney parameters. The study also found significant associations between renal length and height, weight, and body mass index.
Solid Pseudopapillary Neoplasm of the Pancreas: Case Series of a Rare Tumor
Authors: Shrestha Simit , Pandit Subhas , Shakya Vikal C , Neupane Sameer
Published: July 2024

Solid pseudopapillary neoplasm is an infrequent type of pancreatic tumor that primarily occurs in young females. This retrospective case series analyzed three cases of SPN at Civil Service Hospital from 2012-2022. Patient’s median age was 18 years, and one of the patients presented with painless lump and other two had abdominal pain and dullness at presentation. Pre-operative investigations like CT/MRI and fine-needle aspiration cytology confirmed SPN in all cases. All patients received resection treatment, and no adjuvant therapy was administered. During follow-ups lasting 4-7 years, none of the patients experienced recurrence, indicating that surgical resection is the mainstay of treatment with excellent prognosis.
Surgery for Solid Pseudopapillary Neoplasm: Observational Study at a Nepalese Tertiary Center
Authors: Sah Dhurba N , Bhandari Ramesh S , Kansakar Prasan BS , Ghimire Bikal , Joshi Paleswan
Published: July 2024

Introduction: Solid pseudopapillary neoplasms (SPN) are rare, relatively indolent tumors with potential malignant behavior. This study aimed to analyze the clinicopathological details, surgical management, and short- and long-term outcomes of operated cases of SPN.
Methods: This was an observational descriptive study of diagnosed SPNs confirmed histopathologically after surgical resections at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from 2006 November to 2019 January. Patient’s clinical details, surgical procedures, perioperative outcomes, and follow-up were recorded. Long-term follow-up was evaluated for a minimum of three years post-surgery.
Results: Over 13 years, a total of 15 cases with a median age of 22 years (11-52) were encountered and had female predominance (14, 93.3%). Five cases were diagnosed incidentally, while pain abdomen (5, 33.3%) was the most common presentation followed by lump (4, 26.7%). There were four tumors in the head of the pancreas, two in the uncinate process, two in the neck, four in the body, and three in the tail of the pancreas. Four cases underwent pancreaticoduodenctomy, three cases underwent enucleation, and four cases underwent central pancreatectomy. Similarly, one patient underwent spleen preserving distal pancreatectomy and three patients underwent distal pancretosplenectomy. Postoperatively, 20% developed major complications with Clavien-Dindo (grade III & above) out of which one patient had mortality. Over the median follow-up of 72 months, no recurrences were noted.
Conclusion: Solid pseudopapillary neoplasms were relatively rare. Complete surgical resection was the most commonly used surgical management, post-operative complications were minimal and survival rate was excellent.
Dimensions of Normal Coronary Arteries in a Tertiary Cardiac Center Kathmandu
Authors: Sharma Padam PD , Poudel Chandra M , Shrestha Hemant , Devkota Surya , Thapa Sanjeev , Manandhar Bhawani , Khanal Rajaram , Shakya Smriti , Thapa Shovit , Gajurel Ratna M
Published: July 2024

Introduction: Coronary artery disease is the major cause of morbidity and mortality worldwide. The knowledge of normal coronary artery dimensions is fundamental during the percutaneous coronary intervention for appropriate sizing of the coronary balloons and stents. The dimensions of the coronary arteries differs among individuals of various countries, even among the different ethnicities. So, this study wass done to find out the normal coronary artery dimensions.
Methods: This study was done in randomly selected 100 normal coronary angiograms. The diameter and the length of different segments of coronary artery were measured with the use of software as quantitative coronary angiography.
Results: Diameter of left main (LM) coronary artery was 4.06±0.68 mm. Similarly, diameters of prox-left anterior descending (LAD) artery, mid-LAD, dist-LAD, prox-left circumflex (LCx) artery and dist-LCx were 3.26±0.48 mm, 2.67±0.49 mm, 2.01±0.44 mm, 2.91±0.48 mm and 2.38±0.44 mm respectively. The diameters of prox-right coronary artery (RCA), mid-RCA and dist-RCA were 3.2±0.51 mm, 2.89±0.5 mm and 2.43±0.51 mm respectively. The lengths of LM, proximal/mid and distal LAD were 10.06±3.12 mm, 17.91±6.09 mm, 18.28±6.81 mm, 67.94±15.57 mm respectively. The lengths of proximal and distal LCX were 18.95±10.13 mm, and 52.1±17.78 mm respectively. Similarly, the lengths of proximal, mid, and distal RCA were 17.2±4.74 mm, 33.82±9.4 mm, 33.43±12.01 mm respectively. The diameter and length of ramus intermedius (RI) was 2.32±0.56 mm and 70.77±19.75 mm.
Conclusion: LM artery and p-RI had the largest and the smallest diameters respectively. LAD and RI had the longest and the shortest courses respectively.
Effect of Innovative Capabilities on Transient Competitive Advantage among Hospitals in Kenya
Authors: Amboyi Evalyne Khamasi , Kaluyu Veronica , Okello Gabrielle
Published: July 2024

This paper examined the effect of innovative capabilities on transient competitive advantages of private hospitals in Kenya. The study addresses the competitive challenges faced by private hospitals in Kenya targeting 476 private hospitals’ top managers. The findings presented in this paper were drawn from 209 hospital managers. The study employed correlational research design, with innovative capabilities as the predictor variable and transient competitive advantages as the outcome variable. The data was analyzed using descriptive statistics and structural equation modelling. The Structural Equation Modelling (SEM) analysis demonstrated a statistically significant effect of innovative capabilities on transient competitive advantages, with a beta coefficient (β) of 0.412 and a p-value of 0.028. This suggests that innovative capabilities have a positive and meaningful effect on achieving transient competitive advantages of private hospitals in Kenya. The beta coefficient of 0.412 indicates a moderate strength of this effect. The p-value of 0.028, being less than 0.05, confirms that this result is statistically significant and not due to random chance. The study concludes that private hospitals with innovative capabilities are more likely to seize transient competitive advantages compared to private hospitals with low levels of innovative capabilities. Therefore, private hospitals need to prioritize innovation as a strategic priority. The study offers recommendations for private hospitals to allocate resources for research and development activities to enhance their innovative capabilities.
Significance of competencies of project managers on the performance of projects within NGOs in Mogadishu, Somalia
Authors: Abdikani Ali A , Ouma Caren A
Published: July 2024

The main objective of the study was to evaluate the competencies of project managers on the performance of projects within Non-Governmental Organizations in Mogadishu, Somalia. Descriptive research design was used, and the target population consisted of 78 managers and 390 senior employees in the 78 NGOs in Mogadishu. The study adopted a stratified random sampling technique, and the sample size was 216 respondents chosen using Yamane’s (1967) formula. The data was collected using questionnaire, and descriptive and inferential statistics were applied in the data analysis. The study findings indicated that employees’ skills and competencies influence NGO performance and there was an information sharing within the project team employees. The NGO had a competent project manager, NGO adhered to the project management process, all members were aware of the project's nature and that there was active involvement of external stakeholders. The result indicated that the intercept between Skills and Competencies of project managers and Performance of Project becomes better by β = 0.709, p<0.01 meaning that when Skills and Competencies of project managers is improved by a single unit, the project performance also significantly improves by 70.9%. The study concluded that skills and competencies of the project managers is a must for any successful delivery of project assignment. The ingredients of soft, technical and professional skills offers an effective combination for the success of any project. The study recommends that NGOs embrace the merit-based selection of individuals for any position based on the competencies required for effective performance of their roles.
Penerapan Unsur Tindak Pidana Perdagangan Satwa Liar Yang Dilindungi Pada Tahap Penyidikan di Satreskrim Polres Solok Kota
Authors: Fahmiron  , Wansri Evi
Published: July 2024

Perdagangan satwa yang dilindungi merupakan suatu tindak pidana yang mempunyai sanksi pidana dan denda sesuai yang tertuang dalam Pasal 21 ayat (2) juncto Pasal 40 ayat (2) dan Undang-undang Nomor 5 tahun 1990 tentang tentang Konservasi Sumber Daya Alam Hayati dan Ekosistemnya.  Penerapan unsur tindak pidana perdagangan satwa liar yang dilindungi oleh penyidik Satreskrim Polres Solok Kota  adalah pada unsur subyektif yaitu unsur unsur yang terpenuhi adalah  Unsur setiap orang.  Berdasarkan keterangan dari saksi-saksi  dan tersangka serta dikuatkan dengan barang bukti yang ada, maka yang melakukan Tindak pidana tersebut adalah orang perorangan. Unsur selanjutnya memiliki dan menyimpan sisik trenggiling sebanyak lebih kurang 2 Kg, tersangka lainnya memiliki dan menyimpan kulit serta tulang beruang tanpa izin dari pejabat yang berwenang. Unsur Dilarang untuk menyimpan atau memiliki kulit, tubuh, atau bagian-bagian lain satwa yang di lindungi. Setelah melihat arti dari makna kata tersebut di atas, dalam pasal ini juga terdapat kalimat bagian kulit atau bagian tubuh satwa yang di lindungi yang harus terpenuhi unsurnya.  Kendala dalam penerapan unsur tindak pidana perdagangan satwa liar yang dilindungi oleh penyidik Satreskrim Polres Solok Kota adalah pertama yaitu kurangnya koordinasi dari aparat yang berkompetensi. Sulitnya melacak tuntas tersangka dan orang-orang yang berada dibalik kasus tersebut. Mata rantai terhadap perburuan satwa liar ini sangat tertutup dan rapi Pada dasarnya ada 3 komponen yang berperan dalam mata rantai tersebut yaitu pemburu (poacher), pedagang (trader) dan pembeli (buyer). Ketidakmampuan membuktikan keterlibatan mereka dalam kasus tersebut. Kurangnya Pengetahuan Aparat Penegak Hukum juga menjadi kendala dalam penerapan unsur tindak pidana ini. Penyebab dari ketidakmampuan aparat penegak hukum dalam mengusut tuntas kasus perburuan dan perdagangan satwa liar adalah kurangnya pengetahuan akan penanganan satwa liar yang dilindungi. Penyidik sulit melakukan identifikasi terhadap jenis satwa, akibatnya kasus yang ditangani akan membutuhkan waktu yang lama.