bluuebunny/crossref_metadata_2025 huggingface dataset:
Histomorphology Spectrum of Gall Bladder Pathology in Cholecystectomy Specimens with Clinical Diagnosis of Chronic Cholecystitis
Authors: Kafle Santosh Upadhyaya , Sinha Arvind Kumar , Pandey Sagar Raj
Published: September 2018

Introduction: Chronic cholecystitis is a common disease in surgery where majority of cholecystectomy are performed. This study was carried out to see histomorphological pattern of gallbladder diseases, staining pattern with various stains and prevalence of carcinoma.

Methods: This prospective study was conducted in the department of Pathology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal from January to December 2008. A minimum of fifty random samples were included in study. Clinical details and pathological data were retrieved from case sheets and patient’s history. All specimens were fixed in 10% formalin. Three sections each from neck, body and fundus were taken. Tissues were processed in an automated tissue processor and paraffin blocks made. The tissue sections were examined under light microscope after hematoxylin-eosin, neutral mucin, sulfated mucin and sialomucin stain.

Results: Chronic cholecystitis without cholelithiasis constituted majority of 25(50.0%) cases with M: F of 1: 7.1. The gastric and intestinal metaplasias were present in 33.0 % and 8.0% of the cases respectively. The neutral, sulfated and sailomucin were positive in 35.0 %, 21.0 %, 1.0 % and 34.0 %, 21.0 %, 1.0% cases respectively in gastric and intestinal metaplasia. Both gastric and intestinal metaplasia showed significant p-value on sulfated mucin.

Conclusions: The increase risk factors for developing of chronic cholecystitis were seen in female gender (86%). The gastric and intestinal metaplasia showed positivity more with neutral followed by sulfated mucin. 

Keywords: chronic cholecystitis; metaplasia; mucins.
Kikuchi- Fujimoto Disease of Mesenteric Lymph Nodes Mimicking Acute Appendicitis
Authors: Shrestha Anne , Newton Katie , Benbow Emyr , Kushwaha Rajeev
Published: September 2018

Kikuchi-Fujimoto disease, or histiocytic necrotising lymphadenopathy of unknown aetiology, is a rare, benign and self-limiting cause of lymphadenopathy often involving the cervical nodes, and rarely presenting with mesenteric lymphadenopathy. We present a 26-year-old Caucasian male, who presented with right iliac fossa pain and low grade pyrexia, mimicking acute appendicitis. He underwent a laparatomy and an extended right hemi-colectomy for a caecal mass. Histology of the specimen showed lymph nodes with extensive areas of necrosis, with abnormal architecture suggesting Kikuchi-Fujimoto lymphadenopathy. This was further confirmed by immunohistochemistry. In this context maintenance of a high index of suspicion of this condition can avoid major surgical interventions. We describe the management of our case of Kikuchi-Fujimoto’s disease involving the mesenteric nodes and provide an up to date review of the pertinent literature on this subject. 

Keywords: abdominal mass; Kikuchi- Fujimoto disease; mesenteric lymphadenopathy; necrotising lymphadenitis.
Safe Delivery Care: Policy, Practice and Gaps in Nepal
Authors: Bhandari Tulsi Ram , Dangal Ganesh
Published: September 2018

Delivery care is regarded as safe when it is attended by a skilled birth attendant either at health facility or home. Childbirth practices differ from place to place and are determined by availability and accessibility of health services. After National Health Policy (1991), Nepal has focused on safe motherhood policies and programmes. Maternal mortality ratio decreased nearly fourfold between the years 1990 to 2011. The country is likely to achieve the Millennium Development Goal (MDG) 5. However, indicators of the MDG 5: skilled care at birth and institutional delivery rates are very far from the targets. From the initial findings of limited studies, safe delivery incentive programme has been successful for increasing the skilled care at birth and institutional delivery and reducing the maternal mortality twofold between the years 1990 to 2011. In spite of numerous efforts there is a wide difference in the utilization of skilled care at birth among the women by area of residence, ecological regions, wealth quintiles, education status, age and parity of women, caste ethnicity and so forth. This difference indicates that current policies and programmes are not enough for addressing the low utilization of safe delivery care throughout the country. 

Keywords: delivery practices; gaps; Nepal; place of delivery; safe delivery care policy.
The Treatment of Visceral Leishmaniasis: Safety and Efficacy
Authors: Jha Rajesh Kumar , Sah Ajit Kumar , Shah Dev Kumar , Sah Phoolgen
Published: September 2018

Visceral leishmaniasis is the disease of poor; however availability of only expensive treatment of this disease impinges the socioeconomic condition of those affected. If untreated, almost all cases of visceral leishmaniasis are fatal. The demonstration of the leishmania donovani bodies from the tissue aspirates or serological tests confirms the diagnosis of the disease. Pentavalent antimony, amphotericin B, paromomycin, diamine pentamidine, miltefosine, sitamaquine and some new combinations are integrated in the limited therapeutic armoury for treatment of visceral leishmaniasis. The recommended first and second line therapy in the Indian sub-continent is miltefosine and amphotericin B respectively.Pentavalent antimonial, preceding first line therapy, has been replaced by miltefosine due to former increasing failure rate and toxicity.The problem of drug resistance, some of the serious drug toxicities along with high-priced drugs extends challenges equally to pharmaceutical companies and medical practitioners.More research on adverse drug events for the existing drugs and efforts to develop safer and effective drugs to counter resistance outbreaks for the successful management of visceral leishmaniasis are needed. 

Keywords: amphotericin; miltefosine; pentavalent antimony; paromomycin.
Luxation of Eye Ball Following Trauma - A Rare Case Presentation
Authors: Thapa R
Published: September 2018

Luxation of the eye globe is a rare event but it carries a risk of threat to permanent vision loss if appropriate intervention is not initiated on time. Although a rare presentation following minor trauma, it is usually associated with other ocular conditions like shallow orbital socket, oppy eyelid syndrome, and exophthalmos. Prompt reduction results in restoration of full anatomical and visual recovery in otherwise healthy eyes. We herein report a case of luxation of the eye ball following trauma in a 15-year-old girl, who recovered completely after the surgrical correction and a review of the relevant literature.

Keywords: eye ball, luxation, trauma
Acute Dengue Infection in the Western Terai Region of Nepal
Authors: Pun R , Pant KP , Bhatta DR , Pandey BD
Published: September 2018

Introduction: Dengue fever is an emerging mosquito borne disease in Nepal claiming substantial morbidity and mortality. The objective of the study was to fi nd out frequency of acute dengue infection in patients from the hospitals of the western Nepal.

Methods: The study was conducted between August 2007 and July 2008 in patients visiting hospitals of the western terai of Nepal with chief complains of fever. The sero-diagnosis of acute dengue infection was determined by enzyme linked immunosorbent assay among 239 patients visiting Lumbini Zonal Hospital, Butwal; Bheri Zonal Hospital, Nepalgunj; Bardiya District Hospital, Bardiya and Mahakali Zonal Hospital, Mahendranagar.

Results: The anti-dengue IgM positivity was 29.3 %. There was slight male preponderance with a male to female ratio of 1.2:1. Out of the total positive cases, the highest positive cases (75.7 %) were from the age group 15 - 50 years followed by < 15 years old (15.7 %). Out of four hospitals, the highest positive cases (54.3 %) were in Lumbini Zonal Hospital, Butwal. The age and gender were independent predictors to dengue virus infection. The highest numbers of dengue positive cases were in October (52.6 %). The association between dengue disease and the month was statistically significant.

Conclusions: The dengue positivity was estimated in acute patients from hospitals of western Nepal by enzyme immunoassay. Therefore, the serological marker can be used to diagnose acute patients of dengue during outbreaks. 

Keywords: dengue, ELISA, post monsoon, sero-diagnosis
Large versus Small Dose Magnesium Sulfate Infusion in Tetanus
Authors: Pokharel Krishna , Tripathi Mukesh , Bhattarai Balkrishna , Subedi Asish , Sah Birendra Prasad
Published: September 2018

Introduction: Evidence based guidelines regarding the use of magnesium sulfate in tetanus is lacking. Hence, our objective was to compare two infusion doses of magnesium sulfate to control the tetanic spasms. Methods: Data of 14 adult male patients admitted in the intensive care unit were retrieved. Twelve adult ventilated patients received magnesium infusion as an adjunct to diazepam therapy to control tetanic spasms. We retrospectively divided them into two groups for comparison. Group 1 patients (n=7) received a smaller dose (<1 g.h-1) than group 2 (n=5) (1.5 to 2 g.h-1). Results: The duration of symptoms before arrival to hospital was significantly longer in group 1 than group 2. The Ablett severity grade was II in three patients in group 1 and III in all patients of group 2. In Ablett severity grade III patients, the diazepam dose used was significantly higher in group 1 (n=4) (292±48 mg.d-1) than group 2 (n=3) (106±9 mg.d-1) as magnesium infusion dose was restricted due to hypotension in group 1. Amongst the patients who received MgSO4 for ≥10 days, the requirement of diazepam was significantly reduced in the second week (174.1±59.2 mg/d) than the first week (325.4±105.9 mg.d-1) of infusion in group 2 (n=4) but not in group 1 patients (n=4). Conclusions: The larger dose of MgSO4 infusion was titrated to control tetanic spasms as an adjunct to diazepam in select group of patients without hypotension. Uncontrolled hypotension, cardiac arrhythmia and renal failure were the factors to limit its infusion dose.Keywords: MgSO4; magnesium sulphate; tetanus.
Socio-Demographic Correlates in Patients with First Episode Depression in a Tertiary Hospital
Authors: Dhungana Saraswati , Ojha Saroj Prasad , Chapagain Manisha , Tulachan Pratikchya
Published: September 2018

Introduction: Depression is the most chronic mental illness that afflicts mankind.It is widely believed to be the disease affecting mainly female gender, economically disadvantaged group with low level of education and those residing in the urban setup.There are only few studies looking into the socio-demographic correlates of depression in the context of Nepal. Methods: We looked at 70 patients with new-onset depression who met the criteria for diagnosis of depression as per ICD-10 DCR. A self- designed semi- structured proforma was developed to obtain the socio-demographic variables and was filled in the OPD and the data were analyzed.Results: Mean age of the patients was 30.30±9.75 years and 70% of the patients were females. There were almost equal number of patients residing in and out of Kathmandu valley. Most of the patients had attained secondary level of education and were married, housewives and belonged to nuclear family. Majority were Hindus, Brahmins, and from middle class family.Conclusions: We found that patients with first episode depression were relatively young with female predominance most attaining at least secondary level of education; and most belonging to middle class nuclear families.Keywords: depression; ICD- 10 DCR; socio-demographic correlates.
Substance Use among Medical Students in Kathmandu Valley
Authors: Khanal P , Ghimire R H , Gautam B , Dhungana SK , Parajuli P , Jaiswal AK , Khanal B
Published: September 2018

Introduction: Substance use including tobacco and alcohol is the most important cause of preventable morbidity, disability, and premature mortality. The study aims to specify the prevalence and the pattern of use of different substance.

Methods: A cross sectional study was performed amongst first year and final year students in four medical colleges in Kathmandu using self administered anonymous questionnaire.Data collectedfrom 446 students were analyzed.

Results: Prevalence of substance use was found to be 60.3% among the medical students. Alcohol (57.6%) was the substance most prevalently used followed by tobacco (27.58%) and cannabis (12.8%). Mean age of first exposure was 17.94 (Confidence interval: 17.91-17.97). There was significant difference in the useof tobacco and cannabis amongst final year students than first year students. Male and female differed significantly in use of every substance except for benzodiazepine. Medical college, college and school were place of first exposure in 17.26%, 15.92% and 13.23% of the cases respectively. Family history was associated with substance use in medical students and was statistically significant (P<0.0001).Experimentation was the major reason for the use of most of the substances.

Conclusions: Substance use is prevalent in male medical students of both first and final year. Hence steps should be initiated early in school, college and medical college to prevent substance use.

Keywords: alcohol, medical students, substance use, tobacco.
Role of Biochemical Investigation in Prediction of Biliary Etiology in Acute Pancreatitis
Authors: Bohara Tanka Prasad , Parajuli Anuj , Joshi Mukund Raj
Published: September 2018

Introduction: Acute pancreatitis is common clinical resentation. Gall stone disease and alcohol consumption are most common etiologies. Detection of biliary etiology is important in order to provide definite management in form of cholecystectomy to prevent further attacks. Sensitivity for abdominal ultrasound to detect cholelithiasis is decreased to 67–87% in presence of acute pancreatitis. Difference in biochemical investigations of acute biliary and non-biliary pancreatitis has been proposed to increase the suspicion of biliary etiology.

Methods: Sixty patients admitted with diagnosis of acute pancreatitis from March 2012 to December 2012 were included in the study. The relation between etiology with age, sex, admission serum amylase and liver function test were evaluated.

Results: Out of 60 patients 38 (63.33%) and 22 (36.66%) had biliary and non-biliary etiology respectively. Biliary pancreatitis was more common in females (25 vs. 3). Distribution of severity was comparable between both groups. Biliary pancreatitis group had significantly higher amylase level (3466.42 vs. 1987.5, p 0.003) whereas values of liver function test were higher in biliary pancreatitis though not statistically significant.

Conclusions: A simple, rapid and accurate prediction of biliary etiology of acute pancreatitis can be provided by changes in biochemical parameters.

Keywords: Acute Pancreatitis; Biliary Pancreatitis; Serum Amylase.
Treatment of Recurrent Anterior Dislocations of Shoulder by Laterjet-Bristow Operation: An Experience
Authors: Bajracharya Ashok Raj , Anjum MP
Published: September 2018

abstract
Sarcoidosis - Three Clinical Vignettes with a Short Review
Authors: Kishore P V , Poudel R , Poudel B , Palaian S , Mishra P
Published: September 2018

abstract
Multidisciplinary Cooperation in a Simultaneous Combined Liver and Kidney Transplantation Patient of Primary Hyperoxaluria
Authors: Qingqi Ren , Weiqiang Ju , Dongping Wang , Zhiyong Guo , Maogen Chen , Xiaoshun He
Published: September 2018

Primary hyperoxaluria type 1 is an autosomal recessive hereditary glyoxylate metabolism disorder characterized by excessive production of oxalate, caused by the deficiency of liver specific peroxisomal enzyme: alanineglyoxylate aminotransferase. For patients with end-stage renal disease, combined liver and kidney transplantation was needed. This report describes one patient, with a diagnosis of end-stage renal disease and primary hyperoxaluria 1 confirmed by PCR and direct sequencing with genomic DNA, received the simultaneous combined liver and kidney transplantation after seven months’ waiting. However, there were several complications observed post surgery, such as protracted bleeding, common bile duct anastomotic stenosis, biliary calculi and recurrence of urolithiasis. All these were well solved by relevant department, and finally a satisfactory outcome was achieved. Multidisciplinary cooperation plays an important role on the PH1 patient management, especially when multiple complications are encountered.

Keywords: primary hyperoxaluria type 1; end-stage renal disease; liver transplantation; kidney transplantation.
Primary Malignant Melanoma of Vagina – A Case Report with Review of Literature
Authors: Ghosh Arnab , Pradhan S , Swami R , KC SR , Talwar OP
Published: September 2018

abstracten
Strategy of Making Hand Washing a Routine Habit: Principles of 5Es and 3Rs
Authors: Kandel Nirmal , Lamichhane Jaya
Published: September 2018

Regular hand washing habit has potential to reduce morbidity and mortality due to diseases and improves child development and reduces absenteeism of children, teachers and workforce. Improving hand washing behavior is more cost effective than improving clean water and sanitation infrastructure. There are numbers of initiatives and interventions in place, which have gained momentum with key messages of a call to action with increasing investment in schools, engaging policy makers and demonstration them with evidence. However, change in behavior as a routine habit has not reached to an optimum level and requires institutionalizing hand washing practices in schools, from schools and by schools and develop it as a curriculum. Therefore, we are purposing principles of 5Es and 3Rs – a strategy to make hand washing a routine habit. These 5E principles are: i) Embedding in a system, ii) Enabling Environment, iii) Eliminating Friction, iv) Encouraging all, and v) Establishing intervention and 3Rs are practicing them Religiously, Routinely and Repeatedly.Numbers of interventions have well demonstrated that hand hygiene educational interventionscan help maintaining good practices. Finally, if schools and community start doing today, we canobserve behavioral change practices for hand washing as a routine habit by at least 10 years after.Keywords: Hand washing, Routine Habit, Principles of 5Es and 3Rs, Educational Interventions, School. | PubMed
Finasteride and Tamsulosin Combination in Benign Prostatic Enlargement in a Tertiary Hospital
Authors: Shrestha Binod Bade , Karmacharya Mikesh
Published: September 2018

Introduction: Due to aging of the general population, prevalence of Benign Prostatic Enlargement is increasing. Symptoms of BPE may vary between the patients. Aim of the study was to analyze and compare the usefulness of combination drugs therapy and monotherapy after a trial period of six months.

Methods: Out of 100 male patients aged 45 years and above diagnosed with BPE, 92 were included in the study. Patients were randomized using computer generated random number table. Of which, 47 patients received combination therapy with Tamsulosin plus Finasteride and 45 patients received monotherapy with Tamsulosin once daily at bed time.

Results: The baseline demographic variables were comparable in both groups. The decrease in the total American Urological Association symptom score was statistically significant in the combination group (p<0.0001) as compared to monotherapy (p=0.0715) respectively. There was a statistically significant reduction in the residual urine volume with combination therapy (p<0.0001) than in patients with monotherapy (p= 0.1271).

Conclusions: The combination therapy is effective in decreasing the irritative and obstructive symptoms in patients with BPE than monotherapy. 

Keywords: AUA symptom score; benign prostatic enlargement; finasteride; post voidal residual urine;

tamsulosin.
Implementation and Effectiveness of Early Chest Tube Removal during an Enhanced Recovery Programme after Oesophago-gastrectomy
Authors: Bhandari Rajeev , Yong-hao You
Published: September 2018

Introduction: Oesophageal resection were notoriously complicated and produces a cohort of patients prone to postoperative complications and here we would like to focus on the implementation and effectiveness of early chest tube removal in ERAS after oesophago-gastrectomy considering the various aspect like pleural effusion and reducing the length of hospital stay which ultimately lead to reducing the economic burden on patient.Methods: An ERAS programme was devised and implemented with the support of a dedicated in-hospital task-force. The patients underwent esophago-gastrectomy were randomly divided into two groups: the ERAS group and the control group (non-ERAS). The ERAS group was treated with early removal of the chest tube after surgery, and the control group was treated with traditional way and outcomes were compared between them.Results: The length of hospital stay and the cost of hospitalization in the ERAS group were significantly lower than those in the control group（p<0.05. However, there was no statistical significant difference in the incidences of pleural effusion between the two groups（p＞0.05).Conclusions: The introduction of early chest tube removal as an ERAS programme after oesophago-gastrectomy would not increase the risk of pleural effusion and would not increase the total length of stay and cost of hospitalisation without jeopardising patient safety or clinical outcomes.
Cytological Diagnosis of Primary Thyroid Tuberculosis
Authors: Goyal Prashant , Mittal Deepti , Ghosh Soumyesh , Agrawal Dipti , Sehgal Shelly , Singh Sompal
Published: September 2018

Primary thyroid tuberculosis is an extremely rare disease, even in countries where other forms of tuberculosis are abundant. TT has no age bar but usually affects women in fourth and fifth decade. Hereby, we report a case of 16-years-old girl presented with complaint of progressively increasing, painful thyroid swelling. Diagnosis of TT was made on cytology and there was no evidence of involvement of any other organ by tuberculosis. Despite of its rarity, TT is usually misdiagnosed. So, a clinician should always consider this entity in the differential diagnosis of thyroid swelling. Fine needle aspiration cytology is the best diagnostic method and can result in the avoidance of unnecessary thyroid surgeries.

Keywords: cytology; granuloma; thyroid; tuberculosis.
Unilateral Pulmonary Hypoplasia in a Child
Authors: Dewan Gaurab
Published: September 2018

Pulmonary hypoplasia is an uncommon congenital anomaly. A case reported in a six year old male child from Bangladesh who presented with chronic dry cough, episodic fever and occasional haemoptysis causing confusion with tuberculosis. X-ray suggested lung collapse. Final diagnosis reached by combined bronchoscopy, computed tomogram scan of chest and pulmonary angiogram. In a child with complete radiological lung collapse possibility of pulmonary hypoplasia should be kept in mind.

Keywords: Bangladesh; child; congenital anomalies; pulmonary hypoplasia.
Interprofessional Care and Role of Team Leaders
Authors: Kaini Bachchu Kailash
Published: September 2018

Interprofessional care is an essential part of the health service delivery system. It helps to achieve improved care and to deliver the optimal and desired health outcomes by working together, sharing and learning skills. Health care organisation is a collective sum of many leaders and followers. Successful delivery of interprofessional care relies on the contribution of interprofessional care team leaders and health care professionals from all groups. The role of the interprofessional care team leader is vital to ensuring continuity and consistency of care and to mobilise and motivate health care professionals for the effective delivery of health services. Medical professionals usually lead interprofessional care teams. Interprofessional care leaders require various skills and competencies for the successful delivery of interprofessional care.

Keywords: interprofessional care; team leaders; roles; competencies.
Prevalence of Conventional Risk Factors in ST Segment Elevation Myocardial Infarction Patients in Shahid Gangalal National Heart Centre, Nepal
Authors: Adhikari Chandra Mani , Prajapati Dipanker , Baniya Bibek , Regmi Sudhir , Bogati Amrit , Thapaliya Suman
Published: September 2018

Introduction: Smoking, diabetes mellitus, hypertension, and dyslipidemia are labelled as conventional risk factors for coronary artery disease. Prevalence of these risk factors varies across populations. This study aimed to assess the prevalence of these conventional risk factors in patients, who were discharged from our hospital, with the diagnosis of ST elevation myocardial infarction.

Methods: Medical records of 495 ST elevation myocardial infarction patients discharged from our centre in between January 2012 to December 2012 were retrospectively reviewed to evaluate the prevalence of conventional risk factors.

Results: Clear dominance (75%) of male patients was seen. Inferior wall myocardial infarction (29.9%) was the most common diagnosis followed by anterior wall myocardial infarction (25.1%). Hypertension (65%), smoking (57.8%) and dyslipidemia (45.5%) were the most common risk factors. Diabetes (31.1%) was the least common. Prevalence of hypertension, dyslipidemia was similar among male and female. Smoking was statistically common in male (76.8%vs 49.5%),though diabetes was common in female (36.5%vs.29.3%) not statistically significant.

Conclusions: Conventional risk factors are common among ST elevation myocardial infarction patients. Early detection and treatment of these risk factors play a vital role for the prevention of coronary artery disease. Much more focus should be stressed on preventive programs throughout the country.

Keywords: coronary artery disease; diabetes; dyslipidemia; hypertension; smoking; ST elevation myocardial

infarction.
Higher Incision at Upper Part of Lower Segment Caesarean Section
Authors: Shao Yong , Pradhan Meena
Published: September 2018

Introduction: To determine if the upper part of the lower segment of the uterus is a better site for cesarean incision then the traditionally used lower end.

Methods: This is a case-control study (1:1 ratio) conducted from 1st October 2012– 30th September 2013 observed between transverse incision at the upper part of the lower segment versus traditional lower segment of the uterus. Two hundred caesarean sections were performed via a transverse uterine incision at the upper part of the lower segment and equal numbers of uterine incision was performed at traditional lower segment. To obtain less intraoperative bleeding high incision made at thicker wider muscular part at of the upper part of lower segment about 2-3 cm distances from vesico-uterine serosa.

Results: The estimated volume of blood loss in high incision 188±60.1 ml was significantly less compared to traditional incision 330.1± 86.5 ml (p<0.05). Duration of operation 30.5± 6.6 minute versus 45.3±7.2 minute and tearing the uterine incision was significantly less with the high incision versus traditional incision. Other procedural and patient benefits are noted.

Conclusions: An incision at the upper part of the lower segment reduces blood loss, enhances uterine retraction, predisposes to fewer complications, is easier to repair, precludes bladder adhesion to the suture line and reduces operation time. 

Keywords: caesarean section; higher incision technique; traditional uterine incision technique.
Hypertension in Primary Open Angle Glaucoma
Authors: Pokharel Suprada , Sherpa Dakki , Malla Om Krishna
Published: September 2018

Introduction: The impact of vascular factors in POAG is well known and controversial. Some reports have shown high blood pressure in POAG, some low systolic blood pressure and some described no difference in blood pressure between POAG and controls. However decreased ocular perfusion pressure was found in most of the studies. Our study aims to assess the role of hypertension in POAG .

Methods: It was cross-sectional case–control hospital based study carried out from 1st June 2012 to 1st June 2013. There were 40 cases and 100 controls included in the study. The role of hypertension were compared with those hypertensive patients with glaucoma (cases) and hypertensive patients without glaucoma (controls).

Results: Age above 50 years (odds ratio: 4.827 with 95% CI 1.862-12.517), male genders (odds ratio: 3.10 with 95% CI 1.356-7.146) and low diastolic perfusion pressure (odds ratio: 3.857 with 95% CI 1.362-11.224) showed strongly positive association with POAG. High systolic blood pressure (odds ratio: 1.476 95% CI 0.627-3.476), high diastolic blood pressure (odds ratio: 1.348 95% CI 0.587-3.096) and low systolic perfusion pressure (odds ratio: 1.8661 with 95% CI 0.649- 5.335) were weakly associated with glaucoma in our study.

Conclusions: Age above 50 years, male gender and low diastolic perfusion pressure were strong risk factor for the development of POAG.

Keywords: diastolic blood pressure; diastolic perfusion pressure; POAG; systolic blood pressure; systolic perfusion pressure.
Efficacy of Preemptive Gabapentin for Lower Extremity Orthopedic Surgery under Subarachnoid Block
Authors: Hamal Pawan Kumar , Shrestha Amir Babu , Shrestha Ravi Ram
Published: September 2018

Introduction: Gabapentin is one of the adjuncts when given before surgery as a multi modal analgesia regimen has shown to decrease pain scores and opioid consumption in the first 24 hour after surgery. The aim of the study is to assess total opioid consumption in first 24 hour postoperatively after giving 600 mg of preemptive oral Gabapentin in lower extremity orthopedic surgery done under subarachnoid block.

Methods: A randomized single blinded study was conducted for duration of 6 months after approval from institutional review board. A total of 52 American Society of Anesthesiology physical status grade I and II cases were included in the study of which 26 patients received oral Gabapentin two hours prior to surgery and 26 patients in the control group. They were evaluated postoperatively for total opioid consumption in first 24 hours, Visual Analogue Score after 2, 4, 6 and 24 hours at rest. 

Results: Total opioid consumption in first 24 hours was 74.13 ± 27.78 mg in Gabapentin group versus 123.53 ± 64.48 mg in Control (p = 0.001). VAS score was 1.23 ± 1.47 in Gabapentin group versus 2.12 ± 1.58 in Control group (p=0.04) at 2 hours and 2.19 ± 0.40 in Gabapentin group versus 2.77 ± 1.17 in control group (p=0.02) at 24 hours postoperatively at rest which were found to be statistically significant. Incidence of sedation was minimal and comparable in both groups. 

Conclusions: Oral Gabapentin 600mg given two hours before surgery reduces total opioid consumption in first 24 hours after surgery and also reduces Visual Analogue score for pain postoperatively at rest in 2 and 24 hours with minimum sedation.

Keywords: analgesia; gabapentin; opioid; preemptive; sedation; visual analogue score.
Pulmonary Functions are Impaired among Carpet Factory Workers: A Spirometric Evaluation
Authors: Rana Binaya SJB , Banstola Dinesh , Mahotra Narayan B , Shrestha Lava , Pun Matiram
Published: September 2018

Introduction: Carpet factory produces various types of dusts and workers occupationally get exposed to them continuously. It has adverse health effects and most notably to the pulmonary functions. Nepal is one of the carpet exporter developing countries and still does have many factories within Kathmandu valley. However, the health hazards especially the status of pulmonary function of carpet factory workers from Nepal has not been studied.Methods: A cross-sectional comparative study was designed to recruit carpet factory workers and healthy controls to assess their pulmonary functions. A total of 118 subjects (59 males and 59 females) were recruited (60 carpet factory workers and 58 controls). Pulmonary function tests were carried out using Medical International Research Spirolab II portable spirometer.Results: The carpet factory workers had significantly less FEV1 (90.37 ±16.6 % vs. 103.89±9.79%, p<0.001), FVC (87.78 ± 15.48 % vs. 102.81 ± 8.41 %, p < 0.001) and PEFR (66.19 ± 20.29 % vs. 102.81 ± 11.09 %, p < 0.001) as compared to control group. Similarly the carpet factory workers had significantly higher FEV1/FVC ratio (89.96 ± 6.42 % vs. 87.12 ± 4.58 %, p = 0.007) as compared to control.Conclusions: Carpet industry dusts exposure adversely affects pulmonary functions among its workers. The findings significant increase in the FEV1/FVC ratio and decrease in FEV1, FVC, and PEFR suggest that the effects are both restrictive and obstructive patterns of lung disease.Keywords: carpet industry; lung function; occupational health; pollution; spirometry. | PubMed
Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy
Authors: Joshi Mukund Raj , Bohara Tanka Prasad , Rupakheti Shail , Parajuli Anuj , Shrestha Dipendra Kumar , Karki Dimindra , Laudari Uttam
Published: September 2018

Introduction: Laparoscopic cholecystectomy is one of the most common operation performed. Though LC have become safer and easier at times it can be difficult. Difficult cases can result in prolonged operative time, bleeding, bile spillage, conversion to open technique and bile duct injury resulting in unplanned prolonged hospital stay, increase in estimated cost to the patients and for the surgeon it leads to increased stress during operation and time pressure to complete the operative list. . Identification of difficult cases has potential advantages for surgeons, patients and their relatives. We aim to develop and validate a scoring system to predict difficult LC preoperatively.

Methods: Prospective study. History, physical examination, abdominal ultrasound and biochemical parameters were included to develop a scoring system. Hundred patients undergoing LC were included and preoperative scores were calculated preoperatively to predict difficult LC which was compared with operative assessment.

Results: Sensitivity and specificity of the preoperative scoring for difficult case was 53.8 % and 89.2 % respectively with PPV of 63.64 % and NPV of 84.62%. Only three parameters (history of acute cholecystitis, gall bladder wall thickness and contracted gall bladder) were statistically significant to predict difficult LC individually. Area under ROC curve was 0.779 (95 % CI, 0.657-0.883).

Conclusions: Preoperative scoring system can be used to predict difficult LC. Surgeons can plan operation based on predicted difficulty. Patients and relatives can be counselled preoperatively for the possibility of difficult operation, prolonged hospital stay and increased cost in predicted difficult case.

Keywords: difficult cholecystectomy; laparoscopic cholecystectomy; symptomatic cholelithiasis.
The Role of Computed Tomography in Blunt Abdominal Trauma
Authors: Karki Om Bahadur
Published: September 2018

Introduction: Blunt injury trauma is regularly encountered in the emergency department. Diagnostic tools that help in optimum management of blunt abdominal trauma include; Focussed Assessment Sonography for Trauma scan, Diagnostic peritoneal lavage and Computed Tomography scan. The aim of this study is to determine the validity of CT scan as an accurate diagnostic tool and its role in management of patients with blunt abdominal trauma.

Methods: A prospective analysis of 80 patients of blunt abdomen trauma who were admitted in Manipal Teaching Hospital, Pokhara, Nepal within a span of 15 months was done. Demographic data, mechanism of trauma, management and outcomes were studied. Organ injuries were graded using the Organ Injury Scale guidelines.

Results: Most of the patients in our study were in the age group of 21-40 years with an M: F ratio of 2.3:1. Road traffic accident (47.5%) was the most common mechanism of injury. Spleen (27.5%) was the commonest organ injured. CT scan was superior to FAST scan and had sensitivity of 97.3% specificity 75% positive predictive value 98.6%. FAST scan had sensitivity of 78.9%, specificity 50%, positive predictive value 96% with p- value of 0.0034. 81% of patients were conservatively managed.

Conclusions: In conjunction with close clinical monitoring, CT scan is reliable in the evaluation and management of blunt abdominal trauma patients. Our study also shows CT as a superior diagnostic modality compared to FAST scan.

Keywords: blunt abdominal trauma; CT scan; FAST scan; road traffic accident.
Assessment of Color Vision Among School Children: A Comparative Study Between The Ishihara Test and The Farnsworth D-15 Test
Authors: Shrestha Rajesh Kishor , Shrestha Gauri Shankar
Published: September 2018

Introduction: Color vision is one of the important attribute of visual perception. The study was conducted at different schools of Kathmandu to compare the findings of the Ishihara Pseudoisochromatic test and the Farnsworth D-15 test.

Methods: A cross-sectional study was conducted among 2120 students of four schools of Kathmandu. Assessment included visual acuity measurement, slit lamp examination of anterior segment and fundus examination with direct ophthalmoscopy. Each student was assessed with the Ishihara pseudoisochromatic test and the Farnsworth D-15 test. The Chi-square test was performed to analyse color vision defect detected by the Ishihara test and the Farnsworth D-15 test.

Results: A total of 2120 students comprising of 1114 males (52.5%) and 1006 females (47.5%) were recruited in the study with mean age of 12.2 years (SD 2.3 years). The prevalence of color vision defect as indicated by the Ishihara was 2.6 and as indicated by the D-15 test was 2.15 in males.

Conclusions: For school color vision screening, the Ishihara color test and the Farnsworth D-15 test have equal capacity to detect congenital color vision defect and they complement each other.

Keywords: color vision; children; defect; Farnsworth D-15; Ishihara.
Prevalence of Gall Stones in Liver Cirrhosis
Authors: K.C. Sudhamshu , Sharma Dilip , Khadka Sandip , Karki Niyanta , Jaishi Bikash , Regmi Kiran , Khadka Dipendra
Published: September 2018

Introduction: Increased incidence and prevalence of gallstones in liver cirrhosis has already been reported by many studies. This study aimed to investigate the prevalence of gallstone disease in Nepali patients with liver cirrhosis and to identify risk factors for gallstone formation.

Methods: Consecutive patients of liver cirrhosis presenting to liver clinic from January, 2010 to December, 2012 were evaluated for GS by ultrasonography at their first visit. Liver cirrhosis was diagnosed on the basis of clinical features, laboratory parameters, ultrasonography, and/or histopathology.

Results: Two hundred and twenty four LC patients were studied. Male to female ratio was 2.3:1. Alcohol was the major etiological factor for LC followed by hepatitis B, alone or in conjunction with alcohol. Seventy-four patients (33%) were found to have GS. Incidence of GS was more in advance stage of cirrhosis. There was no significant correlation between formation of GS and etiology of LC, except for the HCV related liver cirrhosis, in which it was present in 39% of the patients. More the advance disease,more was the incidence as 57% of Child-C patients had GS. Portal vein diameter was also associated with GS formation. When portal vein diameter was more than 13 mm, there was more GS formation.

Conclusions: One third of the patients of LC showed GS at the presentation. Patients with HCV related cirrhosis are more prone to develop GS than other. Severity of the disease and portal vein diameter was found to be associated with GS formation.

Keywords: gallstones; liver cirrhosis; ultrasonography.
Folie a deux
Authors: Chalise Pratikshya , Subedi Sandip , Sharma Pawan
Published: September 2018

Shared psychotic disorderis a rare psychiatric disorder. It is defined when a primary psychotic person imposes his/her delusional beliefs to the other person usually in a close relationship. Occurrence of this disorder among family members and close friends has been described. However, its exact incidence and prevalence is not known. Since such case has not been reported in Nepal to best of our knowledge, we present a case of shared delusional disorder along with brief review of literature. This case report describes a case of common shared persecutory delusion in husband and wife.

Keywords: folie a deux; shared psychotic disorder.
Analysis of Health Sector Budget of Nepal
Authors: Dulal Ram Krishna , Magar Angel , Karki Shreejana Dulal , Khatiwada Dipendra , Hamal Pawan Kumar
Published: September 2018

Introduction: Primarily, health sector connects two segments - medicine and public health, where medicine deals with individual patients and public health with the population health. Budget enables both the disciplines to function effectively. The Interim Constitution of Nepal, 2007 has adapted the inspiration of federalism and declared the provision of basic health care services free of cost as a fundamental right, which needs strengthening under foreseen federalism.

Methods: An observational retrospective cohort study, aiming at examining the health sector budget allocation and outcome, was done. Authors gathered health budget figures (2001 to 2013) and facts published from authentic sources. Googling was done for further information. The keywords for search used were: fiscal federalism, health care, public health, health budget, health financing, external development partner, bilateral and multilateral partners and healthcare accessibility. The search was limited to English and Nepali-language report, articles and news published.

Results: Budget required to meet the population's need is still limited in Nepal. The health sector budget could not achieve even gainful results due to mismatch in policy and policy implementation despite of political commitment.

Conclusions: Since Nepal is transforming towards federalism, an increased complexity under federated system is foreseeable, particularly in the face of changed political scenario and its players. It should have clear goals, financing policy and strict implementation plans for budget execution, task performance and achieving results as per planning. Additionally, collection of revenue, risk pooling and purchasing of services should be better integrated between central government and federated states to horn effectiveness and efficiency. 

Keywords: health care; budget; financing; unitary system; federalism.
Charcot’s Elbow Following Syringomyelia: Revisited
Authors: CPS Suman , Pandey Vivek , Acharya Kiran V
Published: September 2018

Neuropathic arthropathy of the elbow joint is uncommon with a reported incidence of 3-8%only. The natural history, pathogenesis and management approaches are debatable with an absence of clear guidelines. We report two cases of Charcot’s elbow following syringomyelia with ulnar nerve manifestations. One patient required debulkingsynovectomy and ulnar nerve decompression while the other was managed conservatively. The article aims to enrich the limited knowledge of managing Charcot’s elbow.Keywords: charcot’s joint; elbow; syringomyelia; ulnar nerve.
Dermoid Cyst and its bizarre presentation
Authors: Pradhan Pramila , Thapa Meeta
Published: September 2018

Dermoid cysts or mature cystic teratoma are the most common type of ovarian germ cell tumor usually occurring in the reproductive age group. They are commonly unilateral and 10-12 % can be bilateral. They are commonly multicystic and contain sebaceous fluid as well as tissue of three germ cell layers e.g. ectoderm (skin, hair, brain) mesoderm (muscle, fat ,teeth ,bone, and cartilage) and endoderm (mucious and ciliated epithelium).These teratomas usually arise from the gonads but has been found anywhere in the body. Their site, size and clinical presentations are extremely variable causing confusion with medical and surgical diseases, acute emergency due to rupture and torsion , bowel and bladder injuries, and pregnancy etc. The malignant teratoma occurs at 3-4% only among ovarian carcinoma. The malignant transformation in benign cysts is a rare occurrence with 1-2% cases and squamous cell carcinoma being the commonest. This review is undertaken to study the different presentations produced by these tumors.

Keywords: bizarre; cyst; dermoid.
Clinicomycological Profile and Antifungal Sensitivity Pattern of Commonly Used Azoles in Dermatophytosis
Authors: Mathur Mahesh , Shrestha Shrujana
Published: September 2018

Introduction: Dermatophytosis is a common superficial fungal infection of the skin, hair and nails caused by Trichophyton, Microsporum and Epidermophyton dermatophytic species. Identification of causative dermatophytic species tend to vary with time and place and antifungal sensitivity is of epidemiological concern as well as significant for the treatment with precision at the current scenario of increasing antifungal resistance. To study clinicomycological profile and antifungal sensitivity pattern of commonly used azoles in dermatophytosis.

Methods: The prospective analysis of 145 clinically suspected cases of dermatophytosis was conducted from January 2014 to January 2015 at Department of Dermatology of COMS, Bharatpur, Chitwan, Nepal. Cases were evaluated and data recorded as per proforma. Samples were collected for microscopy and culture from skin, hair and nail. Antifungal sensitivity pattern was evaluated by standard disk diffusion technique.

Results: Maximum numbers of cases with dermatophytosis were observed between June to September with male to female ratio of 1.4:1. The youngest patient was 3 years and the oldest was 76 years. Tinea corporis (25.5%) was the dominant clnical type observed. Overall direct microscopy (KOH) positivity and culture positivity was 64.8% and 57.2% respectively. Predominant species of dermatophyte isolated was T. mentagrophyte (23.4%). Out of five antifungals used in our study, fluconazole and ketoconazole were found 100% resistant.

Conclusions: This study highlighted the increasing resistance of the antifungals, which is responsible for the treatment failure in dermatophye infections. 

Keywords: antifungal resistance; dermatophyte; epidemiology.
Perception of Palliative Care among Medical Students in a Teaching Hospital
Authors: Pandey Samiksha , Gaire Deepshikha , Dhakal Sheela , Jaishwal Neelam , Kharal Pushpa Mani , Vaidhya Pradeep
Published: September 2018

Introduction: Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness. Palliative care must be a part of every medical personnel’s practice. But still medical education curriculums have not included palliative care in its syllabus, sufficiently due to which most of the health professional are not aware about this specialty. The purpose of this study is to find out the perception of the medical students in palliative care in a teaching hospital.

Methods: A descriptive study was done among 270 undergraduate medical students studying in Institute of Medicine using a self structured pretested questionnaire. Data was entered in Microsoft Excel and analyzed by using SPSS 21.

Results: Of the total 270 undergraduate medical students only 152 has heard the word “palliative care”. Only 84 students know, palliative care can be provided early in the life threatening illness. Total 80 students know it doesn’t intend to postpone and hasten death. Though only 49 students didn’t know PC is not included in our curriculum, 227 are interested to learn about it if given any opportunity.

Conclusions: The perception of palliative care medicine is low in first couple of year of medical study. It is increased in clinically exposed students but is surprisingly more in fourth year than final year undergraduate medical students. However, it should be included in undergraduate medical study. 

Keywords: medical students; palliative care; perception.