bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic factors in endometrial cancer
Authors: Bajracharya S R , Juan F Y
Published: July 2024

Introduction: Endometrial cancer (EC) is the most common malignancy of the female genital tract. It is now the fourth most common gynecological cancer among women and the sixth worldwide cancer in Western countries. It is the most curable of the 10 most common cancers in women and the most frequent and curable of the gynecologic cancers. The incidence is increasing when life expectancy rise. This study was carried out to evaluate the prognostic factors of Endometrial Cancer.
Methods: Clinico-pathological characteristics and follow-up cases of endometrial cancer were analysed retrospectively between January 2000 to December 2007 with its prognostic factors influence were statistically analysed.
Results: During the study period total 180 patients were taken. Univariate model revealed that the menopausal status, the FIGO stage, grade, histological type, myometrial invasion, ER, PR, peritoneal cytology, lymph node metastases, adjuvant therapy, and the method of operation were related with the prognosis significantly. The multivariate analysis Cox proportion hazards regression model showed that the ER (P=0.004), PR (P=0.000), myometrial invasion (P=0.006) and lymph node metastases (P=0.049) were related with the prognosis significantly.
Conclusion: The clinico- pathological character of endometrial cancer is responsible for patient’s better survival. If the patients had early detection and treated in proper modalities, this might improve the good prognosis.
Clinico-Haematological Profile of Megaloblastic Anaemia
Authors: Hirachand S , Singh R , Gurung P , Thapa R
Published: July 2024

Introduction: Megaloblastic anaemia is one of the important causes of anaemias. It is a macrocytic anaemia resulting from abnormal maturation of hematopoietic cells due to faulty DNA synthesis. Two vitamins, cyanocobalamin (vitaminB12) and folic acid are essential for DNA biosynthesis. Deficiency of either vitamin results in abnormal nuclear maturation with normal cytoplasmic maturation, apoptosis, ineffective erythropoiesis, intramedullary haemolysis, pancytopenia and typical morphological abnormalities in blood and marrow cells.
Methods: This descriptive study was carried out for two and a half years (July 2011 to December 2013) in the department of Pathology, Star hospital, Kathmandu, Nepal. Out of 885 anaemic patients 55 diagnosed as megaloblastic anaemia were included in the study. Complete blood count, reticulocyte count, peripheral smear and bone marrow examination were performed. Serum vitamin B12 and folic acid estimation was done in 32 cases.
Results: Out of 55 cases of megaloblastic anaemia, 31 were female and 24 were male with a female to male ratio of 1.3:1. Age range was 18 to 80 years. Pallor was the predominant clinical finding in these cases. Twenty cases (36.36%) presented with only anaemia while others presented with pancytopenia or bicytopenia. Of the 55 cases of megaloblastic anaemia,32 had assays done for cobalamin and folate, of which 15 (46.88%) had cobalamin deficiency, 4 (12.5%) had folate deficiency and 13 (40.62%) had combined deficiency.
Conclusion: Megaloblastic anaemia can present with varied clinical manifestations. Strong suspicion of megaloblastic anaemia should be entertained by clinicians to improve clinical outcome. Prompt diagnosis is important as it is a completely curable condition.
Topiramate-Induced Psychosis in an Individual with alcohol Dependence: a case Report
Authors: Chapagai M , Tulachan P , Dhungana S
Published: July 2024

Introduction: Topiramate, an antiepileptic drug, has been shown to reduce alcohol craving and heavy drinking and to improve abstinence among alcohol-dependent individuals 1. We report here a case of psychosis which occurred following use of topitramate in an alcohol dependence case .Thus, this case highlights need for clinicians to become aware of this association and its subsequent severe morbidity.
Bronchiectasis in a positive HIV child: a case report
Authors: Shrestha L , Basnet S , Kanskar P
Published: July 2024

Human immunodeficiency virus (HIV) infection has a wide spectrum of pulmonary disease which usually complicates the clinical course. Non-cystic fibrosis bronchiectasis is more common in children with HIV infection than in general population. Bronchiectasis in children with HIV if not diagnosed early and managed aggressively can lead to irreversible destruction of bronchial wall and surrounded tissue leading to significant morbidity. This might decrease the benefit of the antiretroviral therapy (ARV) treatment on the long run.
Knowledge, attitude and practice of contraception among women seeking: abortion care services
Authors: Bista KDB , Pradhan N , Manandhar R
Published: July 2024

Introduction: Women coming for abortion are those in whom contraceptive use is most needed. This study was therefore done to assess the knowledge, attitude and practice of family planning measures among the women who came for safe abortion services at TU Teaching Hospital
Methods: A prospective, study done for a period of 9 months (17 April 2009 to 14 Jan 2010) in the Family Planning and Comprehensive Abortion Care Centre, Tribhuvan University Teaching Hospital among the women who came to seek abortion services. The women were interviewed before the procedure and then at follow up at 1 month and at 3 months.
Results: A total of 125 women were interviewed. Most women belonged to age between 20- 29 yrs (57%). Of them 19% were > P3. Only 3 women had not heard about family planning methods, while >50% knew all the methods. Maximum source of information was media (65.6%). Ninety five percent women approved of practicing family planning and 81% intended to use it after the abortion. 81% needed approval from husband for using a contraceptive. Eighty percent of women had used some sort of contraceptives in the past while less than 50% of husband had ever used contraceptives in the past. Fifty seven percent women came for termination of pregnancy because of completed family. Seventy nine percent of women accepted different methods of family planning while 68% were found to continue using them at 3 months follow up.
Conclusion: Long acting contraceptives were less likely to be discontinued. Husbands had an important role in giving permission and deciding the contraceptive method.
Comparison of oral misoprostol with intravenous oxytocin for induction of labour in premature rupture of membranes
Authors: Maskey S , Singh M , Rawal S
Published: July 2024

Introduction: To compare the effectiveness of oral misoprostol with intravenous oxytocin for induction of labor in premature rupture of membranes (PROM) at term.
Methods: This randomized comparative study was carried out in 100 women who were at or beyond 37 weeks of gestation with cephalic presentation, had PROM more than 12 hours with bishop’s score less than six. Out of 100 women 50 were induced with 50 μg of oral misoprostol 4 hours apart (max 6 doses) and other 50 received intravenous oxytocin infusion (max 3 pints).
Results: The parity, mean bishop’s score of two groups were comparable. Both misoprostol and oxytocin group showed similar induction to delivery interval (8.68 hrs ± 3.22hours vs. 7.61hours ± 2.84hours, P value was 0.08). Maximum number (52%) of patient’s responded to single dose of misoprostol in misoprostol group. Whereas in oxytocin group 40% of primigravidae required 10 units and 47% of multigravidae required 2.5 units of oxytocin. Majority of women in both the groups delivered vaginally but oxytocin group had slightly increased number of LSCS and one instrumental delivery. Meconium stained liquor was seen more in oxytocin group than misoprostol. Neonatal outcome was comparable in both groups.
Conclusion: Oral misoprostol was as effective as oxytocin in induction of labour in term PROM with low bishop’s score.
Osteoid-Osteoma of the Ilium Associated with Malignant Hypertension in an Adult Female
Authors: KC Bikash , Lakhey RB , Shah LL , Pokharel RK
Published: July 2024

Osteoid-osteoma, a benign bone tumor, is rare in the ilium bone. Its incidence is uncommon after third decades of life, and can represent a significant diagnostic challenge, resulting in a delay of treatment.
We present a 38 years old lady who presented with history of severe right gluteal pam, more during night, and was relieved with non-steroidal anti-inflammatory drugs. Malignant hypertension was associated co-morbid condition without any underlying cause. Plain radiograph was initially normal and her diagnosis was delayed for more than six months until computed tomography (CT) scans and magnetic resonance imaging (MRI) showed a circumscribed lesion of the right ilium suggestive of Osteiod Osteoma.
Minimally invasive flouroscopy guided curettage was done, and histopathological findings confirmed the diagnosis of osteoid-osteoma, After surgery, the pain was significantly relieved and, surprisingly, the hypertension was controlled, and she was discharged on single antihypertensive drug in maintenance dose
Per-operative Instrument Failure in Lumbar Spine Surgery
Authors: Pokharel R K , Lakhey R B , Pokharel B , Dhakal R K , Sigdel A , Lalit T , Shah LL , Kafle D
Published: July 2024

Breakage of hardware is not an uncommon complication in spine surgery practice. Pedicle screw breakage is the commonest instrument failure encountered in spine surgery, and different relatively simple, techniques have been recommended to retrieve the threaded part of it. Per-operative breakage of an instrument like pedicle seeker and jaw of disc forceps is unpredictable and removal of an unthreaded smooth implant is difficult. We experienced breakage of the pedicle seeker while putting a pedicle screw in a case of spondylolisthesis and breakage of the mobile jaw of a disc forceps in another case of prolapsed intervertebral disc. Here we present an innovative technique of removal of the broken instrument through the pedicle. Regular maintenance and replacement of al old instrument is recommended.
Health - related Quality of Life of Patients with Coronary Heart Disease Attending a Cardiac Care Centre in Kathmandu
Authors: Shrestha R , Shrestha S
Published: July 2024

Introduction: Coronary heart disease (CHD) is gradually emerging as a major public health problem in many developing countries including Nepal. Consequences of CHD are that it often results in depletion of the health related quality of life (HRQL) of patients. The aim of this study was to assess the HRQL of CHD patients.
Methods: A descriptive cross sectional design was used to assess HRQL of 254 CHD patients attending out-patient department of Shahid Gangalal National Heart Centre (SGNHC), Bansbari, Kathmandu, Nepal. Purposive sampling technique was used for data collection by face to face interview technique using the MacNew Health - related Quality of Life tool.
Results: The results of the study showed that mean ± SD for emotional domain was 3.87 ± 1.01, for physical domain was 3.81 ± 0.88 and social domain was 3.82 ± 0.88 and global score of HRQL was 3.83 ± 0.87 on 7- point likert scale. The different domains of HRQL was significantly correlated with each others. The descriptive statistics of individual domain scores according to level of HRQL was found to be greater in below average group in each domain including global HRQL score.
Conclusions: The HRQL score of CHD patients attending a cardiac centre are below average. Hence, Self-Instructional Module (SIM) on “Living well with CHD” was developed to enhanced quality of life.
A study of social and psychological problems related to puberty among high school students
Authors: Sharma Nandita
Published: July 2024

A survey was carried out among teenage students of two high-schools in Kathmandu on the problems they were facing due to changes caused by puberty and their knowledge about the normal puberty changes.Forty-five percent of the boys and seventy percent of the girls thought that a girl becomes weak as blood is lost from the girl's body during menstruation. 15% of boys and 40% of girls thought that a boy could lose all energy by having nocturnal emissions. 35% of the girls and 30% of the boys thought masturbation was harmful to health. 35% of boys and 60% of the girls felt that boys and girls should sit separately in high school. 45% of the boys and 70% of the girls felt that a girl should not be married once she starts to menstruate.Fifty percent of the students were frightened and 32.5% of them were very happy by the changes that were taking place in their bodies. 55% of the girls and 50% of the boys were apprehensive when hair started to grow around their private parts. 10% of theboys and 25% of the girls felt that it was bad for a boy to have a small penis. Only 20% of the boys and 35% of the girls had been informed about the oncoming menstruation or nocturnal emission. 70% of the girls felt that they should be informed about menstruation when they reach the age. 65% of the students were using their friends, 15% sisters and 10% mothers and teachers as their source of information. 60% of the girls and 45% of the boys liked to read magazines dealing with sex. 50% of the girls and 45% of the boys were satisfied with the information. 60% of the students felt that their curriculum should include sex education. 60% of the boys and 65% of the girls were of the opinion that prior information about the changes occuring at puberty would have made puberty easier for them.Ten percent of the boys and 5% of the girls felt that God creates a baby in the mother after marriage. 15% of the students thought that after adolescence, if a girl wears the under-clothing of a boy, she will get pregnant.
A prospective randomized study of goal oriented hemodynamic therapy in cardiac surgical patients
Authors: Shrestha KR , Pradhan B , Koirala B
Published: July 2024

Introduction: Approximately 10% of patients require prolonged care after cardiac surgery because of hemodynamic instability, organ dysfunction or multi organ failure. Increased levels of oxygen delivery and consumption in early postoperative period are associated with improved outcome and early recovery. The aim of the study was to evaluate early post- operative outcome in cardiac surgery patients with adoption of goal oriented hemodynamic therapy.
Methods: This is a prospective randomized controlled trial of 12 months period, of adult patients undergoing cardiac surgery in a tertiary level teaching hospital. In the control group, standard postoperative monitoring was done, while in the study group FloTrac TM cardiac output sensor with Vigileo monitor and central venous oxygen saturation monitoring was done to reach a set goal within 8 hrs postoperatively. Findings were analysed using SPSS software version 17.
Results: 100 patients were enrolled in the study with 50 in each group. Both groups were comparable by baseline characteristics, body surface area (BSA) and duration of surgery, cardiopulmonary bypass (CPB) and aortic cross-clamp (AoX) time. But the average age was statistically higher in study group. Yet, the ventilator time and duration of use of ionotropes were significantly less in study group. The duration of intensive care unit (ICU) and hospital stay were less in study group but did not reach statistical significance.
Conclusion: This study has shown that the use of goal oriented hemodynamic therapy in cardiac surgical patients improves immediate outcome. Mortality, ICU and hospital stay also tend to be lower.
Tender Coconut Water: An ideal fluid for parenteral substitute
Authors: Singh Rehan Harmeet , Matapurkar B.G.
Published: July 2024

In this study tender coconut water was studied for biochemical, microbiological, pharmacological properties and for its effect of infusion in dogs. The high nutritive content, sterile, pyrogen-free, non-haemolysing in dogs and humans and free from acute and sub-acute toxicity suggest its valuable therapeutic applications. Autoclaving increases the shelf life without affecting its nutritive value. Intravenous administration of tender coconut water (100 ml/kg) in dogs decreased serum Na+ and increased serum K+ & Ca2+ levels immediately after stopping infusion; it came back to baseline after 1 hour of stopping infusion. Electrocardiogram did not show any evidence of hyperkalemia as high content of magnesium in tender coconut water acts as physiological antagonist to potassium. Tender coconut water showed no effect on psychomotor behaviour and analgesic activity of animals. Repeated administration of tender coconut water did not reveal any anaphylaxis or allergic reaction. It is naturally available, cost effective, highly nourished ideal fluid for parental substitute.
Validation of European Score for Cardiac Operative Risk Evaluation in cardiac surgical patients in Nepal
Authors: Pradhan B
Published: July 2024

Introduction: European System for Cardiac Operative Risk Evaluation (EuroSCORE) is the standard tool for risk stratification of patients undergoing cardiac surgery. Before using this tool in any population, its validation needs to be assessed. This study was carried out to check validation in cardiac surgical patients in Nepalese patients.
Method: This is a prospective observational analytical cohort study in 500 patients undergoing cardiac surgery for coronary artery bypass graft (CABG), valve replacement surgeries (mitral valve, aortic valve or double valve replacements) and valve and aorta replacement surgeries (Bentall procedure). The data were entered in the Microsoft excel software and were analyzed using Chi Square test from Statistical Package for Social Sciences (SPSS Version - 17) package. Calibration power and discriminative power were calculated.
Result: The model’s validation was assessed by its calibration and discriminative power. Calibration power was assessed using Hosmer- Lemeshow test (Chi-square test). It gave P value of 0.14 indicating that the model adequately fits the data and can predict mortality. Discriminative power was assessed by calculating area under the receiver operating characteristic (ROC) curve which was 0.71 indicating satisfactory discriminative power. In low and moderate risk groups, observed and predicted (additive and logistic) mortality were satisfactory. In high risk group, observed mortality was higher than predicted mortality. Logistic EuroSCORE value was nearer to observed value.
Conclusion: EuroSCORE can be applied in Nepalese cardiac surgical patients in low and moderate risk groups satisfactorily though additive EuroSCORE is better in prediction. In high risk groups, logistic and additive EuroSCORE under predicted outcome than the observed mortality. However logistic EuroSCORE was better in this group of patients. EuroSCORE needs to be refined to apply on high risk Nepalese cardiac surgical patients.
External Ventricular Drainage Infections: Experience from a Tertiary Care Center in Nepa
Authors: Pradhanang AB , Sharma MR , Sedain G , Shilpakar SK
Published: July 2024

Introduction: External Ventricular Drainage (EVD) is one of the most commonly performed procedures in neurosurgical practice. EVD related infection is among the most dreaded complications encountered after the procedure with added morbidity and mortality.
Objectives: The primary objective of this study was to assess the incidence of EVD infections in this hospital. In addition, the researchers have made an attempt to evaluate the indication for EVD placement, influence of total drainage time on the risk of catheter infection, the most common bacterial spectra in cerebrospinal fluid (CSF) culture, their antibiotic sensitivity pattern, and the association of CSF cell count with bacterial growth.
Methods: This is a retrospective study of all patients who underwent EVD placement over a period of two years. Those patients who had bacterial growth in their initial samples were excluded from the study.
Results: Out of 62 patients, 54 met the inclusion criteria for analysis. The ventricular catheters were in place from 1 to 23 days. Overall shunt infection rate was 37%. CSF cell count was significantly associated with the occurrence of a positive CSF culture (Fisher’s Exact Test, p<0.01). The most common bacterial species isolated were Acinetobacter baumannii and Burkholderia cepacia.
Conclusion: Despite many advances in care, there is still a significantly high incidence of EVD related infections. Contrary to earlier reports, the most common bacteria grown in the study were quite different and their antibiotic sensitivity varied accordingly.
Mobile teledermatology for rural Nepal: Dermatologic care using mobile phone in a primary health care centre
Authors: Shrestha DP , Suwash B , Gurung D , Uprety A , Bhattarai S
Published: July 2024

Introduction: Skin diseases are among the five most common health problems in Nepal. We have now tested the validity of mobile teledermatology with mobile phones to find a safe and easy way of diagnosis and treatment of skin diseases for the most vulnerable people in remote areas without access to derma- tologists.
Methods: A medical officer at a primary health care centre examined the patient, obtained information of the patient and the skin disease, took photographs of the skin lesions. Then he transmitted all these data via Viber to a dermatologist in Kathmmandu, who in real time formulated diagnosis and treatment and sent it via Viber to the medical officer. Subsequently the patient was examined face to face by a blinded dermatologist at the same primary health care centre. The time taken for each modality of consultation was recorded. A third dermatologist analysed and compared the diagnoses formulated during telederma- tology and the face to face consultations.
Results: Altogether 107 skin diseases were diagnosed in 101 patients. There was an overall concordance of 88% between the diagnoses of skin diseases by mobile teledermatology and face to face consultations (Cohen k coefficient 0.85). The average face to face consultation time was 5 minutes, while it was 7 min- utes more for teleconsultation. More than 75% of the photos were of good quality.
Conclusions: Mobile teledermatology using smartphones is a reliable, useful, cost effective method to provide expertise for improving dermatologic care for the needy population in rural and remote parts of Nepal.
Cost analysis of oral antihypertensive agents available in Nepal
Authors: Shrestha B
Published: July 2024

Introduction: Hypertension is one of the major causes of morbidity, mortality hence requires lifelong treatment. There is a wide range of variation in the prices of antihypertensive drugs marketed in Nepal. Thus, a study was planned to find out variations in prices of the oral antihypertensive drugs available either singly or in combination and number of manufacturing companies for each, also to evaluate the difference in cost of different brands of same drug by calculating percentage variation of cost.
Methods: Cost of a particular drug being manufactured by different companies, in the same strength and dosage forms was obtained from "Nepalese Innovation of Drug and Disease" January 2015 and drug price list of various pharmaceuticals companies in Nepal. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in price was calculated.
Results: Percentage price variation of the commonly used drugs found was enalapril (5 mg): 5300.00% enalpril (2.5 mg): 4150.00%, amlodipine (5 mg): 962.50%, Nifedipine(20mg): 794.11%. Among the combination therapy, amlodipine + atenolol (5+ 50 mg): 418.00%, amlodipine + atenolol (5+ 25 mg) 269.31%, losartan + hydrochlorothiazide (50+ 12.5 mg): 188,46%, atenolol + chlorthalidone (100 + 25 mg): 150.00% variation.
Conclusion: There is wide variation in the prices of oral antihypertensive agents available in Nepalese market. Regulatory authorities pharma companies, physicians should maximize their efforts to reduce the cost of drug
Popliteal artery injury in and about knee injury: An experience in Manmohan Cardiothoracic vascular and transplant center
Authors: Baral RK , Shrestha K R , Sapkota R , Shrestha UK
Published: July 2024

Introduction: Knee dislocation is a common knee injury leading to neurovascular insufficiency. Penetrating injury to the popliteal fossa is also associated with neurovascularv injuries. Amputation rate is high amongst popliteal artery injury associated with bone injury. Delayed detection and late interventions are the factors contributing for limb loss in these cases. We present our experience of the popliteal artery injury from a tertiary care center over the period of 3 years.
Method: It is a retrospective analysis of prospectively collected data of cases of popliteal arterial injury over the period of three years (July 2011 till June 2014). Data were analyzed on their demographic, clinical, management and outcome parameters with SPSS 17.
Result: There were total 35 popliteal artery injuries in 34 patients associated with injuries of knee. Twenty two (65%) patients were male and rests were female. Mean age of these patients was 23±12 years, with age ranging from 15 to 76 years. Twelve patients had amputation and were identified and treated late. Most of the patients reach our center late mean time 9±5 hours and as late as 7 days.
Conclusion: High index of suspicion is required to identify the popliteal artery injury in patients with injuries in and about the knee. Early vascular surgical consultation and intervention is required to alleviate its poor outcome.
Utility of Rapid Brilliant Cresyl Blue Stain in Routine Fine Needle Aspiration Cytology
Authors: Gurung P , Hirachand S , Thapa R , Pradhanang S , Kafle N , Acharya S , Sedhain M
Published: July 2024

Introduction: Rapid on-site evaluation is commonly performed by pathologists to check for cellular adequacy of fine needle aspirate smears to reduce hospital visits of patients and to make preliminary diagnosis. For rapid evaluation, laboratories use Romanowsky stain, Hematoxylin and Eosin stain, supravital stains and ultra-fast Papanicolaou stain. The aim of the study is to evaluate fine needle aspirate smears on-site for sample adequacy using supravital stain Brilliant Cresyl Blue (BCB), to make preliminary cytological diagnosis and to compare with the routine cytological Papanicolaou stain (Pap) and Giemsa stain.
Methods: The study was carried out in the Department of Pathology, Kathmandu Medical College Teaching Hospital from 1st December, 2014 to 31st December, 2015. A total of 115 cases referred from OPD for FNAC were included in the study. FNA was performed under aseptic conditions with a 23-guage needle. Samples were collected for routine stains (Papanicolaou and Giemsa stain) and one air-dried slide was stained with Brilliant Cresyl Blue and examined immediately while patient was in waiting room.
Results: Of the 115 cases, the age of patients ranged from 15 to 83 years in which male and female ratio was 1.5:1. There were 35 (30.4%) cases of enlarged lymph nodes, 28 (24%) cases of thyroid lesions, 20 (17.3%) cases of breast lesions, 7 (6%) cases of soft tissue lesion, 3 (3%) cases of salivary gland lesions, 1 (1%) case of lung mass, 1 (1%) case of epididymal swelling and others 20 (17.3%) cases. On rapid staining with brilliant cresyl blue, case sample adequacy was 104 (90%). Repeat aspiration was done in 11 (10%) of cases .Upon rapid staining, 92 (80%) of the cases were benign, 19 (17%) cases were malignant, 4 (3%) cases were inconclusive. After observation of papanicolaou and giemsa stains, there were 94 (82%) benign cases and 21 (18%) malignant cases.
Conclusion: On-spot Brilliant Cresyl Blue staining is a good stain to check for sample adequacy and to reduce reaspirations. It is as good as the conventional stains in exhibiting cytomorphology of cells.
Non-alcoholic fatty liver disease (NAFLD) and immune response
Authors: Adhikari Khem Bahadur , Tirosh Oren
Published: July 2024

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease that affects a high proportion of world’s population. This review aims to update latest advances in epidemiology, clinical aspects, pathogenesis, mechanism, immune responses and therapies of NAFLD.
Methods: This paper was prepared with reviews of published articles and books.
Results: NAFLD, the commonest liver disorder in the world, is closely associated with metabolic syndrome, particularly obesity and insulin resistance. Sedentary lifestyle and poor dietary choices are leading to obesity, subsequently increasing risk for developing metabolic syndrome and NAFLD. NAFLD is characterized with increased lipogenesis, defective mitochondrial and peroxisomal b-oxidation and/or disability to lipid export from the liver. It can progress to cirrhosis, hepatocellular carcinoma, and liver failure. The development and progression of NAFLD are also affected by diet and genetic factors. Poor immune system cannot overcome proinflammatory cytokines and reactive oxygen species (ROS) which cause oxidative liver injury. Up regulation of perioxisome proliferator activated receptor (PPAR) and disruption of sterol regulatory element binding protein (SREBP) are important targets for pharmacological intervention accompanied with lifestyle modifications.
Conclusions: People with obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome are likely to suffer from NAFLD.
Psychiatric mobility among repatriated Nepalese foreign labor migrants-a hospital based study.
Authors: Chapagai M , Pant SB , Tulachan P , Dhungana S
Published: July 2024

Introduction: International migration for employment has burgeoned in Nepal in the recent decade, and now it is an important factor of social transformation across most societies all over the country. Various factor associated with migration and working in a foreign land can affect mental health of migrating individuals. The purpose of the study was to explore psychiatric morbidity among repatriated Nepalese foreign labor migrants who visited psychiatric services at a tertiary level hospital in Kathmandu.
Methods: Repatriated Nepalese foreign labor migrants (n=51) having symptoms of mental illness at a foreign country, visiting psychiatric services at Tribhuvan University Teaching Hospital were enrolled in the study. A self- designed semi structured proforma was devised to obtain the socio- demographic characteristics of the study population and diagnosis was made using International Classification of Disease-10- Diagnostic criteria for research (ICD-10 DCR).
Results: The age range of the repatriated population was 21-45 years. Most of the cases were males (n=46) and only five were female. Majority of the subjects were literate but only 27.45% had education level above secondary level. Greater number of respondents worked in the gulf countries (66.66%) followed by Asian countries (25.49%). The most common psychiatric morbidity among repatriated Nepalese foreign labor migrant was depressive disorders (29.41%) followed by Anxiety disorder (25.49%).
Conclusion: There is a growing need to enhance our understanding about psychiatry co morbidity among repatriated Nepalese migrant workers so as to promote mental well-being at their working foreign country. A wide range of psychiatry morbidity, predominantly depression and anxiety was found among them which if addressed timely would prevent many migrant workers from returning back prematurely.
Use of reverse sural artery flap for reconstruction of defects of distal leg, ankle and foot
Authors: Shrestha JM , Raymajhi S , Lohani I , Manandhar K , Sharma S
Published: July 2024

Introduction: Reverse sural artery flap has been used effectively to cover defects of distal leg, ankle and foot. This flap is easier and quick to harvest and is a versatile flap in terms of extensive mobility and reliable vascularity and, in many instances it has obviated the need for free tissue transfer.
Methods: This is a retrospective study of sural flaps done at the Department of Plastic Surgery and Burns in Tribhuvan University Teaching Hospital over a period of 4 years from April 2011 to March 2015. It included 21 flaps carried out in 21 patients with soft tissue defects at distal lower leg, ankle and foot.
Results: Among 21 patients, 10 were men and 11 were women with an average age of 41 years (17 – 81). Successful flap coverage was obtained in 16 cases out of 21 (76%) which included 10 cases of complete survival (48%) and 6 cases (28%) of marginal flap necrosis. Four cases (19%) had partial flap loss and one case (5%) lost flap completely.
Conclusion: we found that reverse sural artery flap has good reliability with low incidence of complications and is a versatile flap for the reconstruction of defects in distal leg, ankle and foo
MRI Pattern of Lumbosacral Degeneration in Tribhuvan University Teaching Hospital, Nepal
Authors: Ansari MA , Subedi K , Panta OB , Suwal S
Published: July 2024

Introduction: The economical and social burden of degenerative disc disease remains unclear in Nepal due to lack of systematic data. However, considering the large volumes of spinal magnetic resonance imaging (MRI) performed for low back pain and/or radiculopathy, this has become the prime problems in all spinal care facilities in Nepal. Spinal MRIs constitute approximately sixty percent of the MRI performed in the Tribhuvan University Teaching Hospital (TUTH). This study is being conducted to review the pattern of degeneration of lumbosacral spine in patients referred for MRI at TUTH.
Methods: A retrospective study was conducted at TUTH. Patients with low back pain and or radiculopathy undergoing MRI in the previous 5 months were included in the study. Patients with trauma and or conditions other than degenerative processes were excluded in the study. The findings were recorded and analyzed using SPSS.
Results: A total of 301 patients were included in the study. Age ranged from 16 to 83 years, mean age being 42 years. Highest number of patients were in the 30-40 years age group (26.2%).
Male to female ratio was 1.22. Disc bulge was the most common finding, seen in 77.7% followed by protrusion (58.5%), extrusion (3.9%) and sequestration (0.3%). Foraminal stenosis (68.4%) was the most common complication followed by central canal stenosis (51.8%) and nerve root compression (37.8%). Disc protrusion was the most significant (p<0.05) predictor of complications (nerve root compression, foraminal stenosis and central canal stenosis).
Conclusion: The study shows that degenerative disc diseases remain the cause of morbidity in the most productive years of life (30-40 years of age). Large volumes of MRIs performed for this condition represent significant economic and healthcare burden in a developing country like Nepal as well.
Intestinal Parasitic Infection among School children in Chitwan district of Nepal
Authors: Bhattachan B , Panta YB , Tiwari S , Thapa Magar D , Sherchand JB , Rai G , Rai S K
Published: July 2024

Introduction: Parasitic infection occur in children of all ages living under poor sanitation, eating unhealthy food and drinking water. Study was conducted from January to June, 2012 at Saktikhor in Chitwan district of Nepal. The aim for this study was to determine prevalence rate of intestinal parasites among children (< or =18 aged) group.
Methods: 296 stool samples were collected in dry, clean and screw capped plastic container. Stool samples were preserved with 10% formalin, transported to Shi-Gan Health Research Laboratory then samples were examined microscopically by formal-ether sedimentation technique.
Results: Overall, Positive rate was 23.3% (69/296). There was no significance difference in two genders boys 21.8% and girls 24.8%, (p=0.39). Positive rate in Tibeto-Burman was highest 23.2% followed by Indo-Aryan 22.1% and Dalit 29.6%, (p=0.80). In drinking water, parasitic infection rate in well water was found higher 29.9% than tap water 21.9%, (p=0.263). Positive rate in no drug (anti-parasitic) user was found higher 32.1% than drug user 16.0%, (p=0.002). Age groups between 0-5 years Children was 26.9% highest in positive rate followed by 6-12 years 25.15% and 13-18 years 15.2%, (p=0.35). Altogether 10 species were identified. Taenia spp was most common found 21.0% followed by Entamoeba coli (17.0%), Giardia lamblia (17.0%), Endolimax nana (13.0%), Ascaris lumbricoides (11.0%) Entamoeba histolytica/ dispar (11.0%), Trichuris trichiura (4.0%), Hymenolepsis nana (3.0%), Blastocystis hominis (3.0%), and Hookworm (1.5%).
Conclusion: Children should focus on improvement of sanitation practice, periodic administration of anti-parasitic drug and safe drinking water.
Factors Associated with Health-Related Quality of Life among Nepalese Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study
Authors: K.C Tulza
Published: July 2024

Introduction: Diabetes is a chronic disease with a considerable impact on the health status and quality of life. Studies have shown that health-related quality of life (HR-QoL) among diabetics is much lower than those reported among non-diabetics. The aim of this study was to find out factors influencing the HR-QoL among diabetic people.
Methods: A descriptive, cross-sectional study was done in Tribhuvan University Teaching Hospital, Kathmandu. A total of 108 adult diabetic clients were selected using non-probability purposive sampling and information on quality of life (QoL) collected by using World Health Organization Quality of Life Questionnaire through interview method. Descriptive and inferential statistics [independent sample t test, one way ANOVA and Post hoc analysis (LSD)] were done to describe the respondent’s QoL scores.
Results: According to scoring manual of QoL scores, higher the score better the QoL. The study revealed client of young age group had scored significantly higher score (65.9±8.9, 62.9±12.6, 69.9±11.7) in three domains i.e. physical, psychological, and social domain respectively. Educated clients with higher secondary and above level scored significantly higher score (61.7±16.5, 57.0±16.7, and 61.8±11.8) in three domains i.e. physical, psychological, and environmental domain respectively. Unmarried clients scored significantly higher score (65.7±10.8) in social domain only. Clients with duration for 6 months to one year of diagnosis of diabetes and higher economic class scored significantly higher score (61.4±10.1, 57.0±13.2, 64.5±16.2, 60.4±11.2 & 59.5±16.2, 57.9±16.2, 68.2±18.4, 56.8±13.5 &) in entire four domains respectively. Equally, clients with none of diabetes related complications scored higher (58.7±12.3, 55.5±15.0, 63.3±16.9 & 56.1±10.3) in all four domains.
Conclusion: Study concludes that factors related to lower quality of life among diabetic clients included: older age, less educated, lower economic class, longer duration of diagnosis, type of complications, and counseling on diabetes. Thus, diabetes management should not only focus mainly on clinical outcomes but also on patients’ perceived outcomes, which reflect a person’s quality of life and a better compliance with the diabetes management.
Comparison of hemodynamics and LMA insertion conditions using combination of Ketamine-Propofol, Fentanyl-Propofol or Saline- Propofol
Authors: Koirala M , Acharya SP , Pradhan B , Marhatta MN , Bhattarai AS , Parajuli BD
Published: July 2024

Introduction: Laryngeal Mask Airway (LMA) insertion requires a certain depth of anesthesia to blunt the airway reflexes. Propofol alone causes undesirable hemodynamics effects and suboptimal LMA insertion condition. So this study was designed to compare the hemodynamics and insertion conditions when Ketamine or Fentanyl was combined with Propofol for induction.
Methods: In this study, sixty ASA PSI(American Society of Anesthesiologists Physical Status) patients undergoing various surgical procedures under LMA were assigned to three groups; Group K, Group F and Group S who received 0.5 mg/kg of Ketamine, 1 μg/kg Fentanyl and Normal saline respectively before receiving Propofol 2.5 mg/kg after which LMA insertion was done. Arterial blood pressure and heart rate were measured at various intervals. LMA insertion conditions were graded under different parameters to calculate LMA insertion summation score.
Result: Significant difference in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MAP) was seen between Gr K and Gr S after successful LMA insertion and after 2mins of insertion. Significant difference in SBP was seen in between Group K and Group F (p=0.01) after successful LMA insertion. The median summed score describing the LMA insertion condition was significantly better in Ketamine [7.0 (6.0-7.5)] and Fentanyl [7.0 (6.0-7.0)] in comparison to Saline [8.5 (8.0-11.0)]
Conclusion: During LMA insertion, adding Ketamine to Propofol provides stable hemodynamics in comparison to using Propofol. Addition of either Ketamine or Fentanyl to Propofol provides equally good conditions during LMA insertion than using Propofol alone.
Accuracy of various diagnostic tests and antimicrobial sensitivity pattern of Helicobacter pylori infection in a tertiary care centre in Nepal
Authors: Kansakar P , Dongol A , Vaidya P
Published: July 2024

Introduction: Helicobacter pylori infection is the most important cause of peptic ulcer disease as well as other gastrointestinal conditions. Most widely used diagnostic tests for detection of Helicobacter pylori include rapid urease test, histopathology, culture/sensitivity and serology. The objective of this study was to determine accuracy of standard diagnostic tests and the prevailing local antibiotic susceptibility patterns.
Methods: This cross sectional study, conducted from May to October 2009 at Tribhuvan University Teaching Hospital. 3 pieces of biopsy pieces were obtained from the antral mucosa which were subsequently used for Rapid Urease Test (RUT), histopathology and culture/sensitivity. Then, 2 ml of venous blood was drawn from the antecubital vein for serological examination.
Results: H. pylori positivity status was reflected as 32%, 32% and 47% by rapid urease test, culture and histology. The seroprevalence of H. pylori was 63%. A patient was considered to be positive with respect to H. pylori infection when at least two of three tests namely rapid urease test, culture and histology gave positive results. Hence, proportion of patients with positive H. pylori infection was 36%. Only 30 from 32 culture positive cases were efficiently subcultured and further processed for antibiotic susceptibility testing. Resistance to metronidazole was found to be the highest securing 53.3% and lowest to levofloxacin (0%).
Conclusions: Detection of Helicobacter pylori infection using serology was the most effective among the diagnostic tests performed. More than half of the patients were resistant metronidazole while levofloxacin was sensitive in all the cases.
Social inclusion in health services use: early changes following fee removal in rural Nepal
Authors: Bhurtyal A , Poudyal AK , Adhikari D , Pahari DP , Bhurtyal KK , Maskey MK
Published: July 2024

Introduction: User fees for primary health services were removed by a new leadership of health ministry as part of attempt to enhance access by under served people. This study aimed to measure the changes in utilization of health services by marginalized groups of people following fee removal.
Methods: Records of 1850 health services users were selected randomly from peripheral health facilities -the district hospital, the primary healthcare centre, and four of eight health posts in Jumla district. Proportions of health services use by privileged and underprivileged ethnicities, men and women, and rich and poor people at two periods, before and after user fee removal, were calculated.
Results: After fee removal, use of health services by women, underprivileged ethnicities, and poor people increased by 2.4% (P=0.303, 95% CI 1.41 to 3.39), 6.8% (P<0.001, 95% CI 5.27 to 8.13) and 9.2% (P= 0.003, 95% CI 6.72 to 11.68) respectively in comparison to their privileged counterparts. When service utilization data were disaggregated by individual castes, 10.9% (95% CI 9.01 to 12.87) increment was observed in case of the Dalit caste.
Conclusion: Removal of user fees was followed by increased use of health services by marginalized people. Further works may be conducted to examine consistency of the results.
Pulmonary Rehabilitation in COPD-An Important Non-pharmacological Treatment
Authors: Shrestha KD
Published: July 2024

Pulmonary rehabilitation (PR) is a non-pharmacological therapy that has emerged as a standard of care for patients with chronic obstructive pulmonary disease. It is an integral part of the clinical management and health maintenance of those patients with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment. It aims to reduce symptoms, decrease disability, increase participation in physical and social activities, and improve the overall quality of life (QOL) for patients with chronic respiratory disease. Currently, the focus of treatment is appropriate bronchodilator therapy but much like bronchodilator therapy, non-pharmacological therapy provides symptomatic improvement and better quality of life. Pulmonary rehabilitation is a comprehensive, multidisciplinary, patient-centered intervention that includes patient assessment, exercise training, self-management education, and psychosocial therapy delivered by an interdisciplinary team of therapists and it last for 6-8 weeks. The benefits of pulmonary rehabilitation as a non-pharmacological treatment include decreased dyspnoea, improved health-related quality of life, fewer days of hospitalization, and decreased health-care utilization. This article aims to highlight the pulmonary rehabilitation, its indication, contraindication, benefits, component of PR and health care providers’ role in successful PR.
Rational drug use workshops for consumers in Nepal
Authors: Joshi Mohan P. , Onta Sharad , Khakurel Balkrishna
Published: July 2024

Between June 1997 and March 1999, a non-government organization called Resource Centre for Primary Health Care carried out a series of six workshops for consumers on issues related to drug use. The workshops, conducted at Kathmandu, Biratnagar, Birgunj, Gorkha, Mahendranagar and Dang, covered all the five Development Regions of Nepal and included a total of 168 participants representating school teachers, journalists, grass-root health workers, non-government organization staff, members of consumer groups, the general public, and drug retailers. The overall objective of the workshop series was to bring consumers and consumer interest groups together to discuss issues that help promote rational drug use. The specific objectives were to sensitize the target audience regarding: the problem of irrational drug use and unethical drug promotion; appropriate purchase and storage of medicines; correct use of medicines including those that require special techniques of use; responsible selfmedication; and rights & responsibilities of consumers for appropriate drug use. The methods included interactive presentations by resource persons followed by extensive floor discussions and group works. Handouts, graphic presentations, real medicine samples, posters, bulletins and pamphlets were liberally used. Results of anonymous questionnaire surveys, done at the end of each workshop, indicated thatthe workshops were perceived to be useful and interesting by the vast majority of participants.
Based on original research findings: Identification of Non-rotavirus associated gastroenteritis pathogens among children with diarrhea in Nepal
Authors: Sherchand Jeevan B.
Published: July 2024

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