bluuebunny/crossref_metadata_2025 huggingface dataset:
Pattern of poisoning cases in Bir Hospital
Authors: Singh D.P. , Acharya R.P
Published: July 2024

Background: Poisoning is one of the major causes of hospitalization through emergency and is a major public health problem in the country. For starting preventive measures, information on nature and extent of poisoning is required. For some years, there has been no study on poisoning at Bir hospital.
Objectives: To find out the patient profile, the common poisons and outcome of poisoning cases.
Materials and Methods: A retrospective analysis of all acute poisoning cases admitted to the emergency department of Bir Hospital from January 2005 to June 2005 was done to study the pattern of acute poisoning. Data on age, sex, time elapsed after intake, circumstances of poisoning, name of the poisonous substance, actual use, chemical type, hospitalization days, severity and outcome were collected and analyzed.
Results: The age of the patients varied from 16 to 65 years. The male female ratio was 1:1.3. More than three-fourth (76.8%) of the female patients were from 16 to 25 years age group. Similarly, 46.5% of the male patients were from 16 to 25 years age group. In more than 25 years of age, there was malepredominance in all the age group. The common insecticides used for poisoning were organophosphorus compounds mainly Methyl Parathion (Metacid) and Dichlorovos (Nuvan). Paracetamol alone or combination preparations with antihistamines were the most common analgesic used. Benzodiazepines were the most commonly used anxiolytics. Ninety-seven percent of caseswere intentional poisoning for suicidal attempt. Most of the cases (61.6%) had arrived hospital within 3 hours after exposure to the poison. The hospital stay of the admitted patients with poisoningranged from one to sixteen days. The mean hospital stay was 5.9 days. During the hospital stay, six (6.0%) cases were managed in Intensive Care Unit (ICU) service. In this study, only 3% cases had mortality. There were 5 cases of Aluminium Phosphide poisoning but surprisingly, none of them died from this highly toxic poison.
Conclusion: Suicide among adolescents and young adults is a common public health problem. Patients with intentional poisoning must undergo psychiatric consultation during their stay in the hospital for the treatment poisoning. This will minimize the risk of next attempt of self harm. In addition, strict rules must be followed regarding sale of psychotropic medicines and pesticides. Effective clinical management of poisoning can minimize the mortality.
An effective short duration postoperative catheterization after vaginal hysterectomy and pelvic floor repair.
Authors: Pant P.R.
Published: July 2024

Background: The most common postoperative problem in the female bladder is atony caused by overdistention and reluctance of the patient to initiate the voluntary phase of voiding. After anterior colporraphy, spasm, edema and tenderness of the pubo-coccygeal muscles may obstruct the process of voiding. For spontaneous voiding to occur, the para sympathetic function of the bladder detrusor must be coordinated with the voluntary motor function of the abdominal wall and elevator muscles. In the past it was customary to insert an indwelling urethral catheter for 5 or more days after vaginal hysterectomy and pelvic floor repair, but infact, in uncomplicated cases 12- 24 hours post operative bladder catheterization is sufficient.
Objective: to study the urinary symptoms, like retention of urine and frequency of micturition, in patients with short duration postoperative catheterization after vaginal hysterectomy and pelvic floor repair.
Study design: This is prospective descriptive study, comprised of 257 women, who underwent vaginal hysterectomy and pelvic floor repair under spinal anaesthesia in different districts of Nepal. They were catheterized for 12 to 24 hours and after removal of catheter urinary problems were studied.
Results: Despite of different age, different degree of prolepses, different degree of cystocele and different duration of prolepses out of 257 patients only 8 patients developed urinary symptoms including retention of urine in 5 patients and frequency and burning maturation in 3 patients. They were catheterized for 12 to 24 hours. One of the patients who had retention required 5 dayscatheterization, while other 4 were re catheterized for 24 more hours. In all the cases, there was urinary tract infection.
Conclusion: Long duration postoperative catheterization 48 to 72 hours is not necessary in patients after uncomplicated vaginal hysterectomy and pelvic floor repair as practiced in many gynecological centers. Age of the patients, degree of uterine prolapse, cystocele, and duration of prolapse do not play major role in development of post catheter removal urinary symptoms. Preexisting or postoperative urinary tract infections have main role in the development of these symptoms.
Pseudo Meig's syndrome- a case report
Authors: Amatya A. , Rana A. , Gurung G.
Published: July 2024

Introduction: Pseudo-Meig isa condition where other type of tumor asa variant to ovarianfibroma associated with hydrothorax and ascites containing no malignant cells, which resolve after removal of tumor.
Case Report: This case concerns Pseudo-Meigs' in a 34year old lady with 3 months history of abdominal pain and distension due to ascites and pelvic mass along with massive right pleural effusion who underwent thoracocentesis and total abdominal hysterectomy with bilateral salphingooophorectomy and total omentectomy for ovarian malignancy histologically proven to be papillary adenocarcinoma with negative cytology of ascitic and pleural fluid, that resolved following tumour removal.
Concomitant rectal and uterovaginal prolapse in the community
Authors: Rana A. , Gurung G. , Amatya A. , Joshi A.B. , Sayami J. , Shrestha M.I. , Mishra P.
Published: July 2024

Introduction: Concurrent occurrence of rectal and uterovaginal prolapse in many women living in the community with misery should be made aware that there is possible solution to this dual debilitating condition by surgical correction which can be acquired at the same sitting to bring changes in their quality of life.
Case Report: We report here two ceses of concomitant rectal and uterovaginal prolapse.
Letter to the editor
Authors: Palaian S. , Shankar P.R.
Published: July 2024

N/A
Quality network for rational drug management
Authors: Shankar P.R. , Upadhyay D.K.
Published: July 2024

N/A
A study on prevalence of premarital sex among adolescent students.
Authors: Singh S.K. , Krishna G. , Singh C.M.
Published: July 2024

Background: This is the base line study conducted among adolescent students of District Chitwan to correlate between the knowledge of students about HIV/AIDS and prevalence of premarital sex along with some other epidemiological variables.
Methods: The present study is a cross sectional base line study conducted among adolescent students of randomly selected twelve higher secondary schools of Chitwan district in January 2005.
Results: Despite the satisfactory knowledge about HIV/AIDS, prevalence of premarital sex was quiet high (18.32%). It was more common among boys (25.8%) than girls (9.2%) and it was consistently increasing with increase in age. It was most common among Hindus adolescents (19.0%) and least among Christians. Parent’s education played very important role in reducing the practice of premarital sex as it was revealed in this study 81.76% of the adolescents had practiced safe sex and used condom and 22.32% of them properly disposed of it after use.
Conclusion: It was satisfying that most of the adolescents who practiced sex, were protected by using condom but the correct disposal was not known to majority that’s why they disposed it indiscriminately by throwing on the road or the left ground.
Vaginal and rectal misoprostol for first trimester termination of pregnancy
Authors: Pant P.R. , Sharma J. , Shrestha R.
Published: July 2024

Background: To compare the effectiveness of vaginal misoprostol with rectal misoprostol for termination of first trimester pregnancy. Prospective comparative study done on 138 women with unwanted pregnancy.
Methods: This study was conducted in Vinayak hospital Kathmandu, from April 2005 to March 2006(Baisakh 2062- Chaitra 2062) i.e. one year. Atotal of 138 women with unwanted pregnancy of 6- 12 weeks, and only those who agreed to participate were included in the study after written consent. Patients with scarred uterus following previous cesarean section, myomectomy or hysterotomy, known allergic to misoprostol, diarrhea, and fever, age below 16 and above 45 were excluded from the study. Abortion was induced with 8ooµgm of mesoprostol in alternative patients vaginally in posterior fornix (group A) and per rectally (group B)
Result: The age of the patients ranged from 16 -42 years and parity primi to sixth gravida. In group A54 patients out of 69( 78.2%) expelled products of conception after first dose of misoprostol within 24hours.15(21.7%) patients required repeat insertion of the drug .of these 8 expelled within the next 24 hours, whereas 7(10.1%) patients needed manual vacuum aspiration . In group B out of the 69 patients 59(85.5%) expelled product of conception within 24 hours of insertion of mesoprostol per rectally while the rest 10(14.4%) required re insertion of the drug. Out of these 10 cases 6 expelled within next 24 hours and four (5.8%) needed manual vacuum aspiration. Side effects of misoprostol: diarrhea, nausea, vomiting, headache and rigor were found to be more in rectal group than the vaginal.
Conclusion: For termination of first trimester pregnancy, rectal route of mesoprostol is more effective than the vaginal route , how ever the side effects like diarrhea pyrexia, headache were more in rectal group.
Genitourinary fistula affixed to uterovaginal prolapse
Authors: Rana A. , Amatya A. , Gurung G. , Bista D.K. , Joshi A.B. , Sayami J.
Published: July 2024

Case report: Obstetric genitourinary fistulas 3 [rectovaginal fistula (1), vesicovaginal fistula (2)] all as a consequences of difficult unattended labor in domiciliary settings (eventually with the imminent consecutive vaginal deliveries) congregated by uterovaginal prolapse in two cases giving dual problems of rectovaginal and vesicovaginal fistula with prolapse has been described. A difficult labor in the outset complicated with severe perineal trauma could form a basis for uterovaginal prolapse
Epidemiology of chronic liver disease mortality in community population
Authors: Turin T.C , Rumana N.
Published: July 2024

Background: Liver disease is an important cause of morbidity and mortality in the United States. Currently, up to 2% of all deaths are attributable to liver disease. The economic burden associated with liver disease is also substantial. There are still significant gaps in the current understanding of the epidemiology and burden of liver disease at the population level.
Materials and Methods: We studied chronic liver disease (CLD) and cirrhosis deaths among a community population of the state of Wisconsin for the duration of 1999-2005 to estimate the mortality and disease burden of CLD. Data information was gathered from the population based public data source; Wisconsin Interactive Statistics on Health.
Results: A total of 3024 deaths were recorded due to CLD the study period of 1999-2005. The mortality rate was 7.92 per 100,000 person-year (95%CI :7.64–8.21). Male had higher mortality compared to female. Though statistically insignificant, a trend of increase in mortality rate was observed from 1999 (4.81, 95%CI:4.17–5.44) to 2005 (6.02, 95%CI:5.33–6.21).
Conclusion: The findings were suggestive that the death due to CLD causes noteworthy burden for the population in terms of years of potential life lost. Prevention programme addressing this very problem should be accentuated.
Hospital based study on causes of low vision and patient preference for different types of low vision devices
Authors: KC B.K. , Thapa H.B. , Gurung S. , Sherchan A. , Karthikeyan A.S. , Kandel R.P
Published: July 2024

Background: In accordance with the objectives envisaged by the Vision 2020 WHO global initiative, this study was designed to reveal the causes of low vision (LV), patient preference for and acceptance of specific types of low vision devices. The study was performed between January, 2006 and December, 2006 at the Low Vision Clinic in Lumbini Eye Institute (LEI).
Materials and Methods: A descriptive clinical study of patients with low vision was performed. All patients were examined by an Ophthalmologist and an Optometrist. Un-corrected visual acuity (VA), best-corrected visual acuity (BCVA), visual loss based on anatomical sites, low vision assessment was performed and patient preference for a specific low vision device was observed and documented. Standard National Low Vision Assessment Form was used.
Results: A total of 166 new Nepali patients were included in the study out of whom 70% were male. Of these patients, lens related causes like aphakia, pseudophakia was the main cause of low vision in 35.55% patients, followed by refractive errors / amblyopia accounted for 19.23%, retinitis pigmentosa for 10.84%, whole globe abnormalities 10.25%, corneal pathology accounted for 7.24%, retinal disease (different types of maculopathies, retinal scars, retinal hemorrhages, vein occlusion, etc.) in 6.64%, and other causes (albinism, nystagmus, different syndromes, etc.) in 10.25%.
In low vision assessment, 6.02 % not needed any device (sufficient near vision enough to conduct his or her near task without any type of devices / glasses) as per the guidelines set up by National Low Vision Programme), distance glasses gave enough improvement for 19.27%, spectacle magnifier was preferred by 51.80%, other magnifiers (hand/stand/dome) was preferred by 12.65%, and monocular handheld telescope was preferred by 20.48% for distance. The above includes certain patients requiring assistance with both near and distance vision who opted for multiple LV devices (i.e., for near and distance vision separately) instead of LV devices with multiple functionality.
In non-optical Low-vision devices, 25 % preferred reading lamp, 10 % preferred reading stand, 12% preferred black felt tip pen, 6 % preferred sunglasses, 7 % preferred peaked cap, 4 % preferred typoscope, and 3 % preferred LV note book.
Conclusion: Lens related causes and refractive errors/amblyopia seem to be two of the most important causes of low vision and should not be overlooked. In addition, low vision devices with a usage similar to that of spectacles were preferred by patients for near and telescope for distance.
Acute renal failure following chorioamnionitis
Authors: Gurung G. , Rana A. , Shrestha J. , Amatya A.
Published: July 2024

Renal failure is a rare entity encountered in obstetrics commonly found as complication of septic abortion, severe PIH, APH and PPH and rarely as a result of hyperemesis gravidarum, chorio-amnionitis (1%) and idiopathic postpartum renal failure. Chorio- amnionitis is a frequent occurrence as a result of premature rupture of membrane, however acute renal failure is unusual consequence of chorio-amnionitis. We are presenting this case of renal failure as a result of chorioamnionitis because of its rarity in the obstetric practice.
Human Immuno-Deficiency Virus co-infection in suspected TB patients
Authors: Sherchand J.B. , Maharajan S. , Bam D.S. , Singh A. , Cuevas L.E.
Published: July 2024

Introduction: Tuberculosis is one of the major public health problems in Nepal and HIV has become the most potent risk factor for the progression of TB infection as HIV-positive people are more likely to develop TB when newly infected or reinfected with Mycobecterium tuberculosis. Our main aim was to determine TB/HIV co-infection cases visiting DOTS center and Research center.
Materials and Methods: The study was conducted in DOTS center of TUTH, Maharajgunj and Infectious and Tropical Disease Research and Prevention Center, Tripureshwor. We included a total of 300 patients with the respiratory tract symptoms and cough more than 3 weeks suggesting the symptom of pulmonary tuberculosis and having risk behaviour towards HIV infection. They were interviewed with a structured questionnaire during October 2006 to July 2007. All of them were screened for tuberculosis by sputum microscopy, AFB culture, radiology and HIV infection by standard ELISA method.
Results: Among 300 suspected TB patients, 79 were diagnosed as pulmonary TB positive patients and 34 as HIV seropositive. The coprevalence of TB/HIV was 4.33 percent (13/300) among total patients among which 12 males and 1 female were found to be coinfected with TB/HIV.
Conclusion: HIV co-infection in pulmonary TB positive cases was 16.46 percent (13/79), which revealed it as an alarming situation in developing countries, like Nepal. More cases were found in young adults aged range from 21-40. Males were found to be more infected than female.
Comparison of carcass and lingual examination for the diagnosis of porcine cysticercosis in Nepal
Authors: Joshi D.D. , Pandey K.R. , Doray P. , Bista P.R. , Vercruysse J.
Published: July 2024

Abstract: With the increase in pig production and consumption by smallholder, there have been problems with zoonotic parasitic diseases especially porcine cysticercosis in Nepal.
Materials and Methods: This study was conducted among 320 pigs from four different slaughter slabs of Chitwan and Kathmandu valley during June to November 2006. The objectives of this study were to determine prevalence by lingual examination, carcass examination and to identify predilection sites of T. solium cysticercosis in pigs as well as to compare the lingual examination, carcass examination.
Result: The prevalence rate of cysticercosis for lingual and carcass examination was 0.63%, 0.94% respectively. The incidence of cysticercosis was not significantly different (P>0.05) between the Chitwan and Kathmandu valley and lingual (P>0.05) and carcass examination (P>0.05). Similarly the incidence of the disease was not significantly (P>0.05) different among the slaughter slabs by lingual (P>0.05) and carcass examination (P>0.05). The common predilection sites of the cysts were skeletal muscle, diaphragm, heart, oesophagus and tongue. The sensitivity, specificity, positive and negative predictive values of Lingual examination, taking carcass examination, as gold standard was 50, 100, 100, 98.99 and 100, 82.65 respectively.
Conclusion: Among the animal factor under study breed was found significantly (P<0.05) associated with incidence of cysticercosis while the age and sex were not significant.
Surveillance of lymphatic filariasis in selected districts of Nepal
Authors: Adhikari R.K , Bhusal K.P.
Published: July 2024

Abstract: Lymphatic Filariasis has been identified by the World Health Organization as a public health problem worldwide including Nepal and targeted for elimination. The present study aimed to determine the prevalence of Lymphatic filariasis in Palpa, Tanahun, Syangja, Gorkha, Sindhupalchok, Rupendehi and Nawalparasi districts as identified by Fiariasis Elimination Programme, World Health Organization/Epidemiological Disease Control Division, Teku, Kathmandu for launching Diethyl carbamazine administration campaign and to develop the better strategies for the delivery of intervention measures in filariasis endemic areas of Nepal. Materials and Methods: A Sentinel surveillance study was carried out among 7,000 (Male-3319, Female-3681) cases and tested for microfilaraemia. The total number of Microfilaraemia positive cases was 55, and the number were 20, 5,10,4,5,7 and 4 in Sindhupalchok, Nawalparasi, Rependehi, Palpa, Tanahu, Syangja and Gorkha districts respectively. The total number of cases having symptoms and signs is 176 and the number were 138,0,28,4,1,5 and 0 in Sindhupalchok, Nawalparasi, Rependehi, Palpa, Tanahu, Syangja and Gorkha districts respectively. Result: The highest microfilariae infection rate was 2.0% in Sindhupalchowk district which is significant in number as compared to other districts and lowest 0.40% in Palpa and Gorkha districts. The highest number of symptomatic cases was found in Sindhupalchowk district 138 (13.8%). One significant finding was that 55 persons were found to be microfilaraemia positive but only 41 persons had symptoms of Lymphatic Filariasis and 14 microfilaraemia positive cases did not have symptoms and signs of filariasis. Conclusion: From these findings it is recommended that diethyl carbamazing administration campaign should be launched in Sindhupalchok, Nawalparasi, Rependehi, Palpa, Tanahu, Syangja and Gorkha districts.
Department of Information Technology in Institute of Medicine
Authors: Vaidya P.
Published: July 2024

N/A
Morbidity and mortality pattern of low birth weight babies
Authors: Basnet S. , Adhikari R.K , Shrestha P.S
Published: July 2024

Background: The Neonatal Unit, established in 1984 provides Level II care. The increase in preterm births from 25% to 42% with 21% of perinatal deaths related to immaturity and it’s consequences at birth prompted this study on low birth weight babies.
Methods: A retrospective study was done for all babies admitted from 2058 to 2061B.S.
Results: Of 1 327 babies, 29% were LBW with 62% being preterm. Increasing trends in babies < 1500gms and < 28 weeks at birth was noted. 70% were discharged, 10% referred (61% for advanced respiratory support) and 20% died. Respiratory distress and presumed sepsis were the most common reasons for admission as well as for deaths in LBW.
Conclusion: The existing Neonatal Unit facilities have become inadequate to deal with the increased number, morbidity and mortality pattern of inborn LBW babies. The unit needs to be upgraded to Level III with provision for mechanical ventilation, early use of nasal CPAP and institution of effective infection control measures to improve survival of this high risk group
Enteropathogenic microorganisms in children
Authors: Tandulkar S. , Sherchand O. , Singh A. , Sherchand J.B.
Published: July 2024

Introduction: Diarrhoeal disease is a leading cause of mortality and morbidity in the developing world. It is one of the most important causes of death in childhood and is still a considerable public health problem in developing countries especially among less than five years old.
Materials and Methods: Stool samples from children attending both ORT centre and OPD of Kanti Children’s Hospital below 10 years of age were collected and simultaneously data on predisposing factors associated with gastroenteritis along with acute diarrhoea were collected according to the questionnaire designated. The collected stool samples were brought immediately to the laboratory. Upon arrival the stool samples were processed according to the standard laboratory methods.
Result: The distribution of enteropathogens showed that rotavirus was found highest constituting 27% of the total cases. Among parasites, protozoan (12.2%) dominated over helminthes (3.0%). Among the protozoa, Entamoeba. histolytica (7.0%) was major causative agent of dysentery followed by Giardia lambia (3.8%), Cyclospora cayetanensis (1.2%), and Entamoeba coli (0.3%). Among the helminthes, Ascaris lumbricoices was the major pathogen constituting 1.3% followed by Trichuris trichiura (0.8%), Hookworm (0.5%) and Hymenolepis nana (0.3%) of the total cases. Similarly, among bacteria Shigella spp. was highest of the total cases. Shigella dysenteriae in 2.0% (12 out of total 607); followed by Shigella flexneri in 1.0% and Shigella boydii in 0.3%. In case of Vibrio cholera it constitutes about 2.0% and Salmonella spp. in 1.3% of total cases. The study shows that the prevalence of Salmonella Paratyphi A in 0.3% (2 out of 607) followed by Salmonella Paratyphi B in 0.3% and Salmonella Typhi in 0.6%.
Conclusion: It can be concluded that lots of enteropathogens were involved in children diarrhoea. Among them rotavirus were predominant followed by parasites and bacteria. Children under 2 years were more affected age groups.
Tuberous Sclerosis
Authors: Gajurel B.P. , Acharya N. , Oli K.K. , Agrawal Dr. J.P
Published: July 2024

Tuberous sclerosis is a rare genetic disorder with a variety of clinically remarkable symptoms and signs, of which seizures, mental retardation and facial angiofibromas (Vogt’s triad) are considered classical for the diagnosis. Because of the high frequency with which neoplasms are associated with it and because of the involvement of multiple organ systems, all patients with this disease should be evaluated by a multidisciplinary team. The patients should be followed up based on specific guidelines.
Utero-vaginal prolapse in far western region of Nepal
Authors: Pant P.R.
Published: July 2024

Background: Utero-vaginal prolapse (UVP) is very common among Nepalese women. There are about 600,000 patients suffering from this gynaecological condition, amongst which 200, 00 require immediate correction.1 UVP is multifactorial and results in weakening of pelvic support, connective tissue and muscles as well as nerve damage.2 Methods: Prospective, descriptive study, conducted in the Far-western region vaginal hysterectomy camp from 14th to 29th April2009. Result: Of 325 women with UVP, 45.54 % were Biswakarmas, 38.08% Brahmin, 17.23% Chhetri, 5.23% Tharu and 0.92 5 from other communities. Early return to work (within 10 days of delivery) among Biswakarma and Brahmin was 95.27 % and 91.09% respectively where as smoking and chronic cough in Biswakarma and Chhetri was 92.57%, 66.22% and 78.56%, 34.4 % respectively. Conclusion: Early return to work, smoking and chronic cough are major contributors of UVP in far western Nepal which is more prevalent in the Biswakarma community.
Attitude of junior doctors towards needle-stick injuries
Authors: Gurung B. , Gurung U.
Published: July 2024

Background: Needle-stick injury (NSI) is a known occupational hazard to health care workers. This study is done to estimate the prevalence of needle-stick injuries and evaluate the attitude of junior doctors towards it. Methods: This is a cross sectional study carried out in April 2008. Questionnaires related to NSI were distributed amongst residents, house officers and interns currently working in various departments of Tribhuvan University Teaching Hospital. Data obtained from the completed questionnaires were analyzed with simple manual analysis using frequency and percentage. Results: Hundred twenty four (83.7%) doctors had sustained NSI. Amongst those who sustained NSI, 67 (54%) doctors washed their hands with soap and water or antiseptics, 11 (8.8%) reviewed the patient’s serological status, 42(33.8%) did both of the above while 4(3.2%) did nothing. Eighteen (14.5%) doctors reported the incident to hospital authority while 106(85.4%) doctors did not. Thirty six (33.9%) doctors did not report because they did not consider it important; 50(47.1) doctors did not know what to do; 12 (11.3%) thought the hospital was not concerned regarding such injuries and 8(7.5%) did not report as the patients serology was negative. Conclusion: NSI is common amongst junior doctors. Washing hands with soap and water is what most doctors do following NSI. Non-reporting of NSI is high. Awareness of post exposure management following NSI is important to reduce the possible transmission of blood borne pathogens.
Clinical profile of patients with anemia
Authors: Lamsal K.S
Published: July 2024

Introduction: Anemia itself is not a disease but a clinical feature of some other underlying problems and leads to hypoxia and a wide range of clinical consequences. In a tertiary center like Tribhuvan University Teaching Hospital (TUTH), many patients admitted in medical wards have low hemoglobin. The objective of this study is to determine the etiology and evaluate the different components of clinical profile of the patients having anemia in medical wards of TUTH.
Methods: Patients having hemoglobin less than 10 in the medical wards of TUTH were enrolled in the study. Estimation of hemoglobin and other investigations were done in hematology lab of TUTH. Data were obtained by history taking, examination findings and investigation reports and analysis was done by statistical software SPSS 11.5v.
Results: Among the 237 patients, 138 were male and 99 were female. The commonest age group was 40-49 years. The average hemoglobin was 7.8gm%, the lowest being 2.8gm%. Peripheral blood smear showed hypochromic picture in 140, macrocytic picture in 26 and the morphology was normocytic normochromic in 71 cases. Variceal bleeding leading to anemia was seen in 52, NSAID induced GI bleeding in 22 , peptic ulcer in 18, hookworm infestation in 6, nutritional iron deficiency and anemia of chronic diseases in remaining cases. Among the 26 cases having macrocytic anemia, 11 had megaloblastic changes in bone marrow examination and 6 had vitamin B 12deficiency and 5 had folate deficiency. Among the 71 patients having normocytic normochromic blood picture, 8 had hemolytic anemia, 11 had aplastic anemia and remaining were having anemia of chronic disease mainly chronic kidney disease. Regarding treatment, 84 patients were transfused blood. Out of total 237 patients included in the study, in-hospital mortality was 28.
Conclusions: Anemia is associated with a variety of diseases. As chronic blood loss and iron deficiency are among the leading causes of anemia, hypochromic and microcytic picture was the predominant picture in peripheral blood smear. Among the patients having normocytic normochromic blood picture, majority were having chronic kidney disease which may be due to the fact that TUTH is a tertiary referral centre for chronic renal failure. In-hospital mortality due to anemia alone is lower in tertiary care centers, but the mortality in our study is due to associated co-morbid conditions like chronic renal failure and variceal upper GI bleeding.
Psychiatric manifestations of patients admitted for intentional self harm
Authors: Risal A , Sharma PP
Published: July 2024

Introduction: Psychiatric illnesses are the most common risk factors for suicide. Most cases attempting suicide (Intentional self harm, ISH) present to the hospital emergency for medical complications arising as a result of self-harm forming an important group to understand the psychosocial profile. This study was undertaken to document the various psychiatric manifestations in the patients admitted for intentional self harm (ISH) in a tertiary care hospital.
Methods: A cross-sectional study was conducted in a tertiary hospital setting. The study population included all those patients who were admitted and being managed for ISH and brought for psychiatric evaluation during the period of six months (16thApril- 15th October 2010) at Dhulikhel Hospital. Each patient underwent a detailed psychiatric evaluation by a consultant psychiatrist once they were medically stable. Psychiatric diagnoses were considered as per ICD-10 criteria.
Results: Among the total subjects (N=73) evaluated during the six months period of the study, 43.8% were in the age group of 21-40 years {mean=30.26(±14.7)}, 69.9% were females (Female to Male ratio=2.31), 80.8% were married and 28.8% belonged to the Mongolian race. There were a steadily increasing number of the patients from April to August, peaking in the month of August. Poisoning was the commonest mode of ISH (93.2 %), Organophosphorus was the most common (72%) poison used. Maximum subjects (41.1%) were found to have Depression Spectrum Disorder (Depression, Dysthymia, Adjustment Disorder) followed by Personality Disorder (26%).
Conclusions: Patients attempting ISH are brought to tertiary care hospital for associated medical complications. Organophosphorus poisoning was the commonest mode of suicide while Depression spectrum disorder was the most common psychiatric diagnosis related to suicide. Most suicide cases were seen in the summer months.
Study of anomalous babies of neural tubal defects and their mothers
Authors: Bilodi AK , Gangadhar MR , Kumari VV , Sheety HV
Published: July 2024

Introduction: Neural tube defects occur due to failure of closure of neural tube at its cephalic end .If failure takes place at cranial region, then anencephaly occurs. If failure of closure occurs from cervical region onwards caudally then spina bifida occurs. It usually involves the lumbo-sacral region. Commonly anencephaly, spinabifida, myelocele myelomeningocele occurs as neural tube defects. Environmental and genetic factors give rise to Neural tube defects.
Methods: Patients presenting to the Pediatrics department as well as from the Labor ward and antenatal ward of Obstetrics and Gynecology department in the ‘Teaching Hospital’ of ‘Sree Raja Rajeswari Medical College’, Bangalore were included in the study. It was conducted from 2007 to 2008 for a period of fifteen months. They were studied in detail with proper family history, personal history, drug history, Obstetrics history and were later examined in detail.
Results: Sixteen patients were observed out of these 5 were live births. Of them, two were males and three females. Five were still births and seven cases were born to consanguious parents. Eleven cases were first child to their parents. Mothers of three anomalous babies were diabetic, two were epileptic and the rest were normal.
Evaluation of urinary fistula after Radical hysterectomy
Authors: Jha M , Jha R. , Pant PR , Ojha N , Koirala P. , Shrestha V
Published: July 2024

Rate of lower urinary tract complications after radical hysterectomy has been reported with variable rates. It has been found that up to one half of patients will experience at least one urinary tract symptom that develops after radical hysterectomy. Various retrospective studies have examined lower urinary tract dysfunction and injuries as fistula after radical hysterectomy. Compication could be simple as a transient urinary dysfunction to severe as urinary fistula However before diagnosing severe complication of urinary fistula, we should do simple test as examination of urea and creatine level of client’s serum, fluid and urine. These simple test can help to prove that it is not a severe complication as urinary fitula. Like our case though it looked like VVF in the post operative period, however it was daignosed to be just a transient problem after doing simple test as examination of urea and creatine level of client’s serum, fluid and urine.
Impact of Elective Abortion in pregnancy with Cardiac problems
Authors: Shrestha B , Dali B , Paudel P , Jha R , Rana A , Gurung G , Baral G
Published: July 2024

Introduction: Pregnant women with heart diseases advance either to preterm/term delivery. Some of the pregnancies end in abortions, which however are spontaneous or are terminated for medical reasons.
Method: Retrospective study done in the Department of Obstetrics and Gynecology at Tribhuvan University Teaching Hospital from April 2010 to March 2011 (Baisakh 2067 to Chaitra 2067); Source of data was Operation Theater Register and Admission files.
Results: MTP were done for altogether 18 cases of heart diseasesin pregnancy. Primigravida (6) and multigravida (12) were seen in age groups 20-30 (13); 30-40 (5) at gestational weeks of 6-8 (n=10); 9-10 (n=6); 11-12 (n=1); >12 (n=1). The heart diseases were {CHD (1); rest 17 RHD: Majority being done following post valve replacement surgery 11[AVR (1); DVR (3) & MVR (7)]}. Latter mandated a tedious process of anticoagulation, switching from heparin to warfarin and vice versa demanding prolonged hospitalization (up to 12 days) as co- morbidity. Mainly because repeat MVA was needed for incomplete abortion as complication in one case, subsequent procedures were done under USG guidance.
Conclusion: It is simpler and safer to avoid pregnancy in heart diseases; especially in those women with post valve replacement surgery rather than imposing MTP, the procedure concerned are not without associated risk, beyond doubt.
Studies on anti-hypercholesterolemic activity of Indanyl tetrazoles
Authors: Adak M
Published: July 2024

Introduction: Clinically useful non-steroidal antihyperlipidemic drugs are now in the market for the treatment of patients suffering from hypercholesterolemia. Indan acids, which belong to non-steroidalaryl alkanoic acids class acids have been reported to possess varying degrees of cholesterol lowering activity. Keeping the above points in view exploration for better anti-hypercholesterolemic activity of indanyl tetrazole derivatives was undertaken.
Methods: Five-week-old male albino Charles Foster rats (120± 10 g) for normocholesterolemic and seven-week-old rats (130±10g) for hypercholesterolemic studies were used. On the 0-day and 14thday, tail vein blood was drawn from the overnight fasted animals respectively. Biochemical measurements were carried out using biochemical kits (Span, India) and an automated biochemical analyzer (Vitros-250, Johnson and Johnson Co. USA).
Results: The compound - V and VI exhibited almost same significant level of cholesterol lowering(p<0.01) activity. On closer look its reveal that the compound-VI exhibit triglyceride lowering (p<0.01) activity among the groups around 14 days of treatment on normocholesterolemic rats. Test compound-V (p<0.05) and compound-VI (p<0.001) have significant anti-hyper-cholesterolemic activity while clofibrate has no such activity on hypercholesterolemic rats.
Conclusions: Indanyl tetrazole derivatives, 5-(62 -methoxyindan-12 -yl) methyltetrazole (V) and 5-(52 , 62 -dimethoxyindan-12 -yl) methyltetrazole (VI) were more promising than their analogs in respect to their anti-hypercholesterolemic activity.
Management of stroke in emergency department in relation to blood pressure, blood sugar and use of anti-thrombotic agents
Authors: Aryal M , Niraula S. , Shahukhal R. , Mainali N.R. , Sigdel S. , Giri S. , Pandey S. , Shakya Y.L
Published: July 2024

Introduction: Since the Emergency Department (ED) of TUTH lacks uniformity in the treatment of stroke patients, it is assumed that these patients do not receive standard treatment in terms of reduction of blood pressure (BP), control of hyperglycemia and treatment with antithrombotic agents. Our hospital-based study aims to assess the mean stay of stroke patients in the ED and the level of optimal treatment they are getting.
Methods: A retrospective hospital-based study among 82 patients diagnosed as CVA in the ED (who later got admitted), was carried out using medical records. History, clinical examinations, investigations and treatment given were analysed to gather relevant information.
Results: Mean age of occurrence of stroke in the inpatients visiting ED was found to be 62.4 years. Average duration of stay in the ED before admission was 13 hours. Ischaemic stroke was almost four times more common than haemorrhagic stoke. All the patients with haemorrhagic stroke who had indication for reduction in BP received antihypertensive medications. However, 28% of the patients with ischaemic stroke, even though having indication for BP reduction, did not receive antihypertensives. Out of 11 patients who had an indication for reduction in blood sugar, only one patient (9%) received treatment with insulin. Only 52% of the patients who had ischaemic stroke received treatment with aspirin.
Conclusions: There is lack of uniformity regarding the treatment of stroke in terms of blood pressure reduction, hyperglycemia and antithrombotic treatment. A standard protocol needs to be developed in order to bring uniformity and efficiency in the treatment of stroke.
Difficulties in the diagnosis of soft tissue sarcomas
Authors: Jha R.
Published: July 2024

Introduction: Soft tissue tumors represent diagnostic challenge to general practicing pathologists because of overlap in morphologic features. The usual approach is to diagnose by presumed cell lineage. A major utility of immunohistochemistry is to identify a tumor being mesenchymal or nonmesenchymal and once mesenchymal lineage has been confirmed, histologic sub typing according to specific lineage may be achieved with help of lineage specific markers.
Methods: The objective of this study was to analyse different types of soft tissue malignancies according to their type, site and age distribution, discuss the difficulties faced during morphologic examination and review the literature for role of ancillary techniques, particularly immunohistochemistry in diagnosing soft tissue sarcomas.All soft tissue malignancies reported from Tribhuvan University Teaching Hospital in three years period from April 2008 to March 2010 were included in the study.
Results: Total 87 soft tissue malignancies were reported during study period. Most of these patients (58.6%) were male and the rest were female. These malignancies were found in all age groups. Youngest patient was newborn who was born with tongue mass and biopsy was performed on 13th day of life. However maximum numbers of tumors (41.4%) were seen in first two decades of life. Head and neck was the most common site .Rhabdomyosarcoma was the most common diagnosis. In 20 cases (23%) a definite opinion was not possible and vague terms like sarcoma, small round cell tumor, spindle cell malignancy, vascular tumor “likely” were used. Immunohistochemistry was advised in these cases.
Conclusions: Only light microscopic examination of hematoxylin and eosin stained slide not sufficient at all times because there is morphologic overlap of soft tissue sarcomas with each other and with carcinomas and melanomas. Though immunohistochemistry is not a substitute for skilled interpretation of routinely stained slides but prove helpful to reach a more definite diagnosis.
Yellowish discoloration of teeth and nails during oral iron therapy in a pregnant woman
Authors: Pai R. , Palaian S. , Prabhu S , Prabhu M. , Mishra P.
Published: July 2024

Abstract: A 27 year old pregnant woman was prescribed conventional oral iron tablets from second trimester of pregnancy. She developed gastrointestinal symptoms within 1-2 days. Following these symptoms, Iron tablets were stopped and the patient was started with iron capsule. The patient tolerated this preparation well and after 6 months she developed yellowish discoloration of the teeth and nails. Iron treatment was suspected for the discolorations and the drug was stopped. Upon stopping the therapy the discoloration vanished and teeth and nails returned to the pre treatment condition. The causality assessment and the severity assessments were carried out as per the Naranjo and Hartwig scales respectively. Since Iron treatment during pregnancy is common, this adverse drug reaction warrants monitoring.
Histopathological and molecular confirmation of Porcine Cystic Echinococcosis (CE)/Hydatidosis in Nepal
Authors: Joshi D. D. , Yamasaki H.
Published: July 2024

Introduction: Cystic echinococcosis/hydatidosis is a cyclo-anthropozoonotic disease (parasitic infestation) of herbivorous animals and human caused by larval stage of Echinococcus tapeworm, belonging to the family Taeniidae. Dogs and some wild carnivores like foxes are definitive hosts harbouring worms in their intestine while herbivorous animals and man are intermediate host. Human acts as the dead-end host of the parasite. It is known that cystic echinococcosis in humans and pigs is prevalent in Nepal.
Methods: This study was carried out in Kathmandu valley pig rearing areas. Two cysts found in the pig pancreas were examined by histopathology and molecular analysis.
Results: In the histopathological examination, the laminated layers of the cystic walls were strongly stained with PAS, and protoscoleces were observed in the cyst. In the present study, it was first confirmed that two hydatid cysts found in pigs were identified as Echinococcus granulosus sensu stricto (sheep strain, E. granulosus G1) by mitochondrial DNA analysis.
Conclusions: Molecular analysis is indispensable not only for studying Echinococcus species associated with pathogenicity and clinical manifestation, but also for molecular epidemiology.
Frequency of Bile Bacteria in Gallstone Disease
Authors: Shrestha KR , Adhikary S , Koirala R , Amatya R
Published: July 2024

Introduction: Gallstone disease is among the bread and butter surgery for most general surgeons but role of bacteria in its formation is still an enigma.
Methods: Bile was obtained during cholecystectomy from the patients admitted for uncomplicated cholecystectomy which was cultured in standard culture medium. Demographic profile and nature of stones obtained were also compared.
Results: This study involved micro biological analysis of bile obtained from 528 patients undergoing cholecystectomy without other complication for duration of one year in BP Koirala institute of health sciences, Dharan. Study showed that incidence biliary infection was 4.8% with commonest organism being E coli followed by K pneumonia. Among various types of stones pigment stone were mainly found to be associated with infection than other types of stones.
Conclusion: The study shows that though biliary infection in patients with gallstone disease is not uncommon but its exact role in the pathogenesis of gallstone disease is not elusive.
Seroprevalence of antibodies to HIV among injecting drug users in Kathmandu and HIV subtyping
Authors: Shrestha Iswar Lal
Published: July 2024

Blood samples from two hundred and twenty injecting drug users were collected for antibodies to HIV between July 1997 to June 1998.ELISA tests were performed in duplicate on all the serum samples. One hundred and five samples 105/220 (47.7%) were tested positive for antibodies to HIV. ELISA positive samples were rechecked by western blot and confirmed to have HIV-1. Bands of gp160, gp120, gp40, p24, p31, p55 of HIV-1 were present in positive samples.Results of HIV subtyping showed subtype C, similar to the one prevalent in the Indian subcontinent.Among one hundred and five positive cases, ninety-nine were male and six were female, M:F ratio 16.5:1. The youngest age of HIV positive case was 13 years old and the oldest was 45 years of age. The majority (70) was between the age of 20-29 years of age. The most common drug used was "Tidigesic" (bupronorphine) (90/105), followed by brown sugar (10/105), nitrazepam (4/105), and "Fortwin" (1/105). Ninety-four HIV positive persons gave the history of sharing needles among more than two persons. Frequency of drugs used varied from two times a day to maximum six. HIV positive cases were detected from 18 districts of Nepal. The majority (38/105) of the HIV positive cases were residents of Kathmandu.
Escitalopram Induced Priapism
Authors: Tulachan P , Chapagain M , Ojha SP , Dhungana S
Published: July 2024

Priapism, a rare but potentially dangerous condition has been linked with numerous psychotropic agents. Trazodone is already well known for this side effect, followed by antipsychotics. In last two decades there have been few individual reports of SSRI induced priapism. Escitalopram a relatively new selective serotonin reuptake inhibitor (SSRI) becoming widely administered. We report here on the first instance to our knowledge, a case of priapism which occurred following use of Escitalopram. Thus, this case highlights need for clinicians to become aware of this association and its subsequent severe morbidity.