bluuebunny/crossref_metadata_2025 huggingface dataset:
Post cholecystectomy biliary gastritis and H. pylori infection
Authors: Shrestha M. L , Khakurel M. , Sayam G
Published: July 2024

Background: Post cholecystectomy abdominal pain is a significant problem in a group of patients with gall stone surgery. The pathogenesis of post cholecystectomy dyspepsia is still poorly understood and yet difficult to ascertain. H. Pylori have been associated with significant number of the cases with gastritis, gastric ulcer, duodenal ulcer and other gastro -duodenal disorders. Hence, post cholecystectomy biliary gastritis associated with H. pylori infection might be a major aetiological factor. This study aims to evaluate the association of bile reflux gastritis, the presence of H. pylori and dyspeptic symptoms in post choecystectomized patients.
Patients and Methods: This is a prospective non-randomized study carried out on 68 patients with post cholecystectomy dyspeptic symptoms during 2 years period through September 2002 to October 2004 in Tribhuvan University Teaching Hospital at the Department of Surgery.
Results: Two hundred and thirty eight patients who were having cholelithiasis and underwent cholecystectomy were prospectively studied non-randomized way. Out of 238, 68 (28.57%) patients presented with upper abdominal pain, belching water brass with or without nausea and vomiting. So only 68 cases were included in the study. Of 68 patients, dyspeptic symptoms were more common in Bile reflux positive group (BR +) and H. pylori infection was seen in 38% (14/36) when compared with Bile Reflux negative (BR-) patients 13.75% (4/32), which was statistically significant. Biliary gastritis was found on 32, more over reflux esophagitis in 3 cases, duodenal ulcer in 1 case was also found on BR (-) group. H. Pylori were positive on 18 cases detected by endoscopic biopsy by Giemsa stain, 14 in BR (+) and 4 in (BR-) group.
Conclusion: This study suggests that excessive bile reflux may be responsible for persistence of symptoms after cholecystectomy by causing gastric mucosal damage and that biliary gastritis might be a significant problem associated with H.pylori infection in our context.
Outcome of intubated post-surgical cases in intensive care unit in Tribhuvan university teaching hospital, Nepal
Authors: Sharma N.R.
Published: July 2024

A retrospective study was carried out for to evaluate the outcome in intubated post-surgical cases in Intensive Care Unit in T U Teaching hospital, Kathmandu, Nepal. A total of 303 cases were admitted in Intensive Care Unit during the fiscal year 061-062 ,from 1st Shrawan 2061 to 31stAshad 2062 (July, 2004 to July, 2005) .Among them, 177 (58.5%) were medical and non-surgical cases while 126 (41.5%) were post-surgical cases. Total mortality in the ICU was 26.2 % (p value > 0.05).Among the postsurgical cases, which includes all surgical subspecialties, the mortality was 15.9% (p value = 0.92). Surgical cases were admitted in ICU either on elective basis where ICUbed was preoccupied. Whereas other emergency surgical cases requiring ICU care were admitted in ICU in an unplanned way. A total of 37 post-surgical cases required mechanical ventilatory support. Maximum stay in ICU for a medical case was 4 months and 28 days with maximum support of mechanical ventilation was for 4 months and 21 days. In contrast, the maximum stay for the postsurgical cases in ICU as well as on mechanical ventilation was 60 days, while minimum stay was only one day. Regarding post-surgical cases on mechanical ventilation two cases (5%) left the hospital against medical advice (LAMA), while out of 35 patients on mechanical ventilation, 17 patients died, accounting for a mortality of 48.6%, and 18 cases were successfully weaned off and extubated (51.4%) and further discharged from ICU to Surgical Ward.
Study on cholesterol and triglyceride level in normal people of Kathmandu valley
Authors: Pradhan P. , Pokharel B.M. , Manandhar S.
Published: July 2024

The normal range of cholesterol and triglyceride for normal people of Nepal is being compared with the standard reference value of WHO. The project work was carried out to establish the normal rangeof cholesterol and triglycerides in the Nepali citizens of Kathmandu valley in the pathology department of Patan Hospital from 2061-2-21 to 2061-6-18 by using the standard methodology. During the study, 150 samples were taken. The average range of cholesterol for age group 20-30 was found to be 114-164 mg/dL. Similarly, the same for the age group 30-40 was 122-182 mg/dl ,for age group 40-50 was 135-223 mg/dl, for age group 50-60 was 112-195 mg/dL and for age group 60 and above was found to be 110-207 mg/dL respectively. Likewise, the average range of triglyceride level for the age group 20- 30 was found to be 60-195 mg/dL and the same for the age group 30-40 was 78-193 mg/dL, for the age group 40-50 was 99-316 mg/dL, for the age group 50-60 was 54-304 mg/dLand lastly, for the age group 60 and above was 60-292 mg/dL. The cholesterol level of the females was found to be higher than the males but the triglyceride level of males was found to be higher than females. The non- vegetarians were seemed to have high cholesterol and triglyceride level than vegetarians.
A rare presentation of post hysterectomy retroperitoneal haematoma
Authors: Rana A. , Gurung G. , Singh K.P. , Ghimire R.K
Published: July 2024

Post-hysterectomy adynamic ileus, which improved after spontaneous resolution of peri renalretroperitoneal haematoma, is reported.
Spontaneous preterm delivery and risk factors at Tribhuvan University Teaching Hospital
Authors: Manandhar B.L. , Sharma J. , Gurung C.K.
Published: July 2024

Background: Preterm delivery is one of the major health problems in both, developing and developed countries because it is associated with increased perinatal morbidity and mortality.
Methods: This was an unmatched hospital based case control study. The cases were the postpartum women, who delivered after 22 weeks and before 37 completed weeks of gestation and the controls were those postpartum women, who delivered after 37 completed weeks of gestation. The estimated sample size for preterm delivery (case) were 64 and for term delivery (control) were 128, with case to control ratio being 1:2.
Results: There total number of deliveries during the study period was 1192. Of the total deliveries, 64 spontaneous preterm deliveries and 128 term deliveries were enrolled for the study, giving the prevalence of spontaneous preterm delivery = 5.5%. The previous preterm delivery, urinary tract infections in the index pregnancy and heavy physical activity during pregnancy showed strong independent risk for preterm delivery. The adjusted odds ratio for previous preterm delivery was 13.13, 95% CI 2.48-69.8 and P-value = .003. Similarly, adjusted odds ratio for urinary tract infection was 7.6, 95% CI 1.2-47.3 and p = .028. The farmers carried highest adjusted odds ratio of 14.8, 95% CI 2.8 – 78.2 and p = .001 and the adjusted odd ratio for small- scale business- women was 8.0, 95% CI 2.18 – 29.4 and p = .002.
Conclusion: The study concluded that previous preterm delivery, urinary tract infection and heavy physical activity during pregnancy were independent risk factors for preterm delivery.
Arsenic contaminated drinking water and nutrition status of the rural communities in Bagahi village, Rautahat district, Nepal
Authors: Pradhan B.
Published: July 2024

Background: Groundwater is the main source of drinking water in the Tarai region of Nepal. Analysis of arsenic contaminated groundwater of 287 tube wells and nutrition level of the rural communities of Bagahi village, Rautahat district, Tarai region has been performed.
Methods: Altogether 538 households have access to the tube wells’ water for consumption.
Results: About 6% of the total tested tube wells are considered as risk tube wells, which have arsenic level above the Nepal Interim Standard 50 part per billion (ppb). Of the total risk population, about 9% have been identified as arsenicosis patients. About 80% risk populations have consumed inadequate nutrition in terms of calorie content. The risk of arsenic among the risk populations is high because they are in most cases under nutrition and consuming the contaminated water.
Conclusion: This indicates that the rural communities of the Bagahi locality are facing alarming situation. Immediate measures to mitigate the problem is warranted.
Splenectomy and removal of bilateral huge chocolate cyst with ovarian preservation
Authors: Gurung G. , Rana A. , Joshi P. , Pradhan P.
Published: July 2024

Case report: An unusual discovery of exceptionally large, bilateral chocolate (endometriotic) cysts of ovaries amidst dense pelvic adhesion and thick peritoneal collection due to occasional spill from the cyst in a young adolescent, encountered during spleenectomy performed for idiopathic thrombocytopenia is reported.
Procidentia incarcerated by multiple vesical calculosis: vaginal cystolithotomy for cystolithiasis
Authors: Dhakal B. , Rana A.
Published: July 2024

Incarceration of procidentia from multiple calculi in the cystocele in a post menopausal lady with long standing duration of pelvic organ prolapse treated by vaginal cystolithotomy, vaginal hysterectomy and pelvic floor repair is reported herewith
Ethical criteria for medicinal drug promotion
Authors: Shankar P.R.
Published: July 2024

N/A
Health InterNetwork Access to Research Initiative (HINARI)
Authors: Shankar P.R.
Published: July 2024

N/A
Do behavioral patterns of university students of Nepal make them vulnerable to HIV/AIDS?
Authors: Joshi D.R. , Khattri D.B. , Rosyara K.P. , Malla B.
Published: July 2024

Introduction: Nepal is confronted with the increasing incidence of HIV among young adults. The University students at their age are at increased risk of the disease, determined by their behaviors Thus, Assessment of knowledge, attitude, and beliefs of them are essential prior to implementation of prevention and control strategies.
Methods: This cross sectional study was carried out in 2006 among university students at Tribhuvan University, Kirtipur, Nepal. A total of 100 students participated from different departments. The questionnaire design included background characteristics, condom use, knowledge and opinion towards HIV/ AIDS, Sexual risk behavior and sexual relation, symptoms on STI and HIV/ AIDS, stigma and discrimination regarding HIV/AIDS.
Results: The median age of male respondents was 26 years and that of female was 23 years. Among married respondents (16.7%), female respondents were married at younger age (F=23yrs, M=24yrs). The majority of them were unemployed (78.1%). The major sources of information regarding HIV/ AIDS were television (95.8%) and radio (91.7%). Only 13.5% of respondents (F=12%, M=15.2%) knew about voluntary counseling and testing services (VCT). The age of first sexual intercourse was 22 years; same for both men and women. Among them, 65.4 % admitted using condoms during first intercourse. Family planning centre was the major condom supply source (78.1%). Use of condoms was the most common perceived method of protection against HIV/AIDS for both male (93.5%) and female (78%). Seventy- nine percentage of respondents maintained that HIV is transmitted by sharing of food, and mother to child, and HIV+ individuals looked healthy.
Conclusions: This study provides empirical evidence of stirring knowledge about HIV and sexual behavior among adults; however; needs further examination through a longitudinal study
Problems regarding emergency ultrasound in Nepal
Authors: Joshi B.R. , Pradhan S. , Ansari M.A.
Published: July 2024

Introduction: Ultrasound plays an important role in management of emergency patients. This study was performed to define the patterns of indications and to analyze the findings.
Materials and Methods: Hundred patients were analyzed for 6 months from 15th August 2003.
Results: Females were 59 percent. Thirty-nine percent were of 20-29 years age group. Eleven percent presented during 8-9 PM . Provisional diagnosis and clinical history were not mentioned in some requisition forms. Normal findings were present in 18 %. Normal pregnancy was present in 11%. Acute appendicitis was present in 9%. Two were positive for ectopic pregnancy.
Conclusion: Ultrasound should be used as complementary investigation and not instead of clinical examination
Effect of short-term use of Glucocorticoids on skeletal muscle strength and endurance
Authors: GoyaL S. , Sandhu J.S. , Shenoy S.
Published: July 2024

Background: The study was carried out to investigate the effect of short-term use of glucocorticoids on skeletal muscle strength and endurance.
Methods: Pre test and post test experimental design was made. Twenty-four healthy university students participated in the study. Eight subjects were given Prednisolone 5 mg tablets, 1 tablet, once daily for 10 days and other eight subjects were given Betamethasone 1mg tablets, one tablet, once daily for 10 days. Eight subjects were given all-purpose flour as placebo. Pre test and post test peak force, average force and fatigue index of quadriceps in extension moment was computed.
Results: Non-significant differences were found in all the above variables (p>0.05) in both Prednisolone and Betamethasone groups.
Conclusion: Short-term use of glucocorticoids has no significant effect on isometric strength and endurance in skeletal muscle
Methicillin Resistant Staphylococcus Aureus in patients visiting Western Regional Hospital, Pokhara
Authors: Rijal K.R. , Shrestha N. , Pahari N. , Shrestha B. , Paudel B. , Nepal A. , Ghimire P. , Rijal B.
Published: July 2024

Introduction: Methicillin Resistant Staphylococcus aureus (MRSA) continues to be a major cause of serious infection in hospitals and in the community worldwide. This study was performed to determine the prevalence of Methicillin resistant Staphylococcus aureus in healthy school children and patients visiting Western Regional Hospital of Pokhara.
Methods: The children from three Schools namely Janapirya Higher Secondary School, Sublime School and Ratnajyoti School and patients visiting Western Regional Hospital were selected for the study. This study was conducted by The School of Pharmaceutical and Biomedical Sciences during July to November 2007. One hundred eighty four Nasal swabs were collected from the healthy school children younger than 15 years old and one hundred clinical samples such as pus, wound swabs were collected from patients attending Western Regional Hospital. Collected nasal swabs and clinical swabs were analyzed for the growth of Staphylococcus aureus on mannitol salt agar (MSA). S. aureus was isolated and identified by mannitol fermentation, coagulase positivity and DNase positivity. Antimicrobial susceptibility test was performed on Muller-Hinton agar (MHA) medium by Modified Kirby-Bauer disc diffusion method.
Results: Out of 284 samples, 184 were nasal swabs, from healthy school children and 100 were clinical samples from patients attending Western Regional Hospital. Out of total nasal swabs (n=184), S. aureus was isolated from 30.97 % (n=57). Out of 57 isolates of Staphylococcus aureus, isolated from healthy school children 56.14 % (n=32) were MRSA. Out of 100 clinical samples isolated from hospital patients, S. aureus was isolated from 45% (n= 45).Out of 45 isolates of S. aureus, 75.55% (n=34) were MRSA. Prevalence of MRSA was statistically significant in clinical specimens in comparison with nasal swabs isolated from healthy school children (P < 0.05).
Conclusion: This study showed a high prevalence of MRSA carriage in school children and hospital patients of Pokhara valley and this may indicate the spread of MRSA in the community. Larger community based studies and regular surveillance of MRSA are needed to assist in the development of therapeutic guidelines for MRSA
Bardet Biedl Syndrome
Authors: Basnet S. , Sharma A.K.
Published: July 2024

Bardet Biedl syndrome is a rare autosomal recessive condition characterized by central obesity, retinitis pigmentosa and postaxial polydactyly.
Familial Erythrocytosis
Authors: Piryani R.M , Osti B. , Shankar P.R.
Published: July 2024

Erythrocytosis is a rare red cell disorder characterized by an elevated haematocrit (Hct) and haemoglobin (Hb) level and red blood cells (RBC) with normal white cells and platelets. Both sporadic and familial forms exist. A 49 years old gentleman presented with lightheadedness, tinnitus, dizziness and uncontrolled hypertension of 5 days duration KIST Medical College Hospital Lalitpur Nepal. His Hb was 17.0 g/dl, Hct 69%, red blood cell (RBC) count 5.8Million, white blood cell (WBC) 10500 and platelets 255000. His oxygen saturation was 98% and serum erythropoietin level was 11.3 m IU/milt (normal range 3.7-29.7m IU/ml). Hb and Hct of his elder brother was 16.5 g/dl and 54% respectively and of elder sister 14.5 g/dl and 50% respectively. Our patient was having erythrocytosis most likely familial. Family didn’t agree for genetic workup; this is the limitation of our case report.
Risk factors of stroke
Authors: Bhatt V.R. , Parajuli N. , Mainali N.R. , Sigdel S. , Aryal M. , Hamal N. , Khanal S. , Koirala S. , Giri S.
Published: July 2024

Background: Modifiable risk factors of stroke are presumably poorly controlled in Nepalese population. This hospital-based study aims to assess the prevalence and control of these risk factors in stroke patients admitted to Tribhuvan University Teaching Hospital prior to the occurrence of stroke.
Method: The study was conducted among sixty-one patients admitted in Tribhuvan University Teaching Hospital. History and clinical examination were performed to gather relevant information. Necessary tests were run to confirm the diagnosis of stroke and to identify the presence or absence of risk factors.
Result: Hypertension, physical inactivity and smoking were the most common modifiable risk factors of stroke. Risk factors that could have contributed to the occurrence of the stroke were poorly controlled in these patients. The majority of the patients cited negligence and lack of knowledge for not seeking health care and/or not complying with medical advice.
Conclusion: Risk factors for stroke among patients admitted to Tribhuvan University Teaching Hospital are poorly controlled prior to the occurrence of stroke.
Young voices in research for health 2007
Authors: Shankar Dr. P. Ravi
Published: July 2024

N/A
Intermittent claudication among smokers
Authors: Yathish T.R. , Annamallai N. , Shankar V.
Published: July 2024

Introduction: Peripheral artery disease with intermittent claudication is an important cause of morbidity and mortality. Cigarette smoking is thought to be major risk factor. Currently, up to 2% of all deaths are attributable to peripheral artery disease and its complication. The economic burden associated with peripheral artery disease is also substantial. There are still significant gaps in the current understanding of the epidemiology and burden of peripheral artery disease at the population level.
Methods: The aim of this study was to study intermittent claudication through survey by questionnaire method and to study risk factors of tobacco by evaluating the relationship between smokers and intermittent claudication using well accepted Rose intermittent claudication and smoking questionnaire method.This observational, descriptive, cross-sectional study was conducted in the teaching hospital of R.L. Jalappa Hospital of Sri Devaraj Urs medical college, Tamaka, Kolar, Karnataka, India during January 2004 to July 2004. A total of 130 adult men above the age of 30 years who visited the hospital with pain in the lower limbs constituted the materials for the present study. They were categorized into smokers and non-smokers. Each case was examined for lower limbs in detail and their finding were noted.
Results: Participants in the group with leg pain on exertion and rest were nearly 92. Among 90 smokers, 80 had the classic symptom of intermittent claudication which started in the third decade of life whereas out of 40 non-smokers, only 12 had intermittent claudication which started after the fifth decade of life.
Conclusions: Smoking not only results in early onset of intermittent claudication but also increases the risk of development of intermittent claudication by more than 80%.
IgM and IgG Antibodies in Tuberculosis
Authors: Bam N. , Karn R.
Published: July 2024

Introduction: The diagnosis of tuberculosis relies on the identification of acid-fast bacilli on unprocessed sputum smears using conventional light microscopy. Microscopy has high specificity in tuberculosis-endemic countries, but modest sensitivity which varies among laboratories (range 20% to 80%). Moreover, the sensitivity is poor for paucibacillary disease (e.g., pediatric and HIVassociated tuberculosis). Many supportive investigations including serolological tests being utilized for tuberculosis diagnosis have wide variations in sensitivity, specificity in different studies. The aim of study was to evaluate the recombinant 38 KDa antigen from M. tuberculosis – based Enzyme Immunoassays (EIA) test for its sensitivity, specificity and other statistical parameters.
Methods: This hospital based prospective cross-sectional study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, from April 28, 2009 to November 30,2009. Sera from total 90 patients, pulmonary tuberculosis, extrapulmonary tuberculosis and non-tubercular chest infection patients who did not have past TB or exposure history , 30 in each group were used for Pathozyme Myco kit evalution to determine the IgM and IgG antibodies activity against the recombinant 38 KDa antigen of Mycobacteria .
Results: In overall tuberculosis, IgM TB had sensitivity 48.3%,specificity 76.7%, positive predictive value 80.6% which was statistically significant(p=0.025) . The IgG TB had sensitivity 66.7%,specificity 83.3%,positive predictive value 88.9% which is statistically highly significant(p<0.001) to diagnose tuberculosis. Utilizing IgM and IgG both together, sensitivity decreased to 44.3%, but specificity increased to 90.0% and positive predictive value 88.5%, which  was statistically significant (p=0.006) for the diagnosis of tuberculosis.
Conclusions: IgG TB antibody has high sensitivity and specificity for tuberculosis diagnosis, but IgM antibody should also be evaluated along with IgG antibody to increase specificity.
Awareness of nurses on distance education in Nepal
Authors: Shahi M
Published: July 2024

Introduction: Distance Education Technology is one of the most effective modes of impartingeducation and training for those who cannot afford formal education. This study aims to assess theawareness regarding distance education technology among graduate level students as an alternativeapproach for continuous advance level nursing education in Nepal.
Methods: The study has adopted descriptive cross-sectional design. The populations of this studywere the graduate level nurses who were studying Bachelor of Nursing courses in three differentinstitutes of Kathmandu valley. A non-probability convenient sampling technique was used to selectthe nursing institutes. A pretested semi-structured questionnaire was developed to collect data from94 nursing students to assess their interest and desire regarding distance education. A semi-structuredquestionnaire was used to enquire regarding, personal biography of respondent; knowledge ondistance education; use of distance education for continuous education; opinion on distanceeducation as an effective mode of technology for continuous nursing education etc.
Results: Most of the respondents (81%) had heard about Distance Education Technology, but noneof them had attended any academic course through distance education. Half of the respondents hadsome knowledge regarding distance education technology; among them (29.7 %) could figure outthat it is a type of interactive study between learners and facilitators from distance/far area; 38.2%recognized as an independent study, which is often provided by recognized Open University (13.8%);which can be performed from their own home (29.7%) as a means of corresponding course (17.02 %).About (46.8%) knew that major area of instruction is via internet. Surprisingly (94.7 %) of them wereinterested to study advance nursing courses through distance education in Nepal and among them(40.4 %) would like to get higher degree via Distance Education Technology in Health ProfessionsEducation.
Conclusions: It can be inferred that majorities of graduate level nursing students are eager to upgradetheir cognitive and psychomotor competencies for professional development by means of DistanceEducation Technology. It could be an alternative means of teaching even for those nurses who arehard to reach, and serving the mankind at the remote areas.
Management of Pseudoaneurysms in IV Drug Users
Authors: Sapkota R , Sapkota S. , Thapa B. , Shrestha KR , Rajbhandari N , Shrestha UK
Published: July 2024

Introduction: Pseudoaneurysms are major vascular complications in intravenous drug abusers. They are potentially fatal, often infected and require urgent management.
Method: This is a retrospective study of the prevalent practice of their management in our center. The inpatient medical charts of the patients spanning 5 years (Sep 2006 to Aug 2011) were reviewed. Data were obtained on their demographic, clinical, management and outcome parameters.
Result: Among the thirty intravenous drug users presenting with pseudoaneurysms (excluding one who bled to death before surgery), 28 had their femoral artery involved. Most of them (90%) were infected. Nearly half of the patients (45%) were seropositive for HIV and/or HCV. All were operated, with no mortality. Ligation and debridement was the technique used almost exclusively (83%). One brachial artery wasrepaired primarily, whereas 3 femoral and 1 brachial pseudoaneurysms were managed with autologous saphenous vein bypass. Five patients had neurological complications, and 5 others had non-limb threatening claudication which got better with medical management. Mean follow up period was 11 months.
Conclusion: Ligation and debridement appears to be a simple, safe and effective procedure in infected pseudoaneurysms in IV drug users.
Midazolam as an induction agent in comparison with propofol as a safe and effective alternative
Authors: Singh J
Published: July 2024

Introduction: Propofol produce rapid and smooth induction of anesthesia, with rapidmetabolism, which would allow it to be used for the maintenance of anesthesia and free from the risk of anaphylactic reactions. Midazolam a new short acting water soluble Benzodiazepine with cardio vascular effects similar to that of diazepam may be an effective alternative for induction of anesthesia. Methods: In this randomized study, all together 48 patients undergoing various surgical procedures belonging to Orthopedic, General Surgery and Gynecological Surgeries constituted the study group. Group-I (Midazolam Group) received intra-venous Midazolam 0.15mg/Kg for induction of anesthesia and Group-II (Propofol Group) received 2mg/kg intravenous Propofol for Induction of Anesthesia. Induction time, Heart Rate, Non invasive blood Pressure is recorded at 1minute interval for 5 minutes and after that at an interval for 5 minutes for another 30 minutes. Demographic data was analyzed by Student’s t-test. Results: The study showed no statistical signiÞcance in hemodynamic responses with either Midazolam or Propofol as an induction agent for General Anesthesia but there was statistically difference with respect to heart rate (P=0.001) . Conclusion: Midazolam was proven effective compared to Propofol as an induction Agent.
Knowledge about Tuberculosis in outpatients who visited College of Medical Sciences Teaching Hospital, Bharatpur, Nepal
Authors: Manandhar N , Krishna G
Published: July 2024

Background: Now a days Tuberculosis is a major public health problem in the world. Number of deaths due to tuberculosis is highest among the infectious diseases.
Methods: The cross sectional study was carried out from May 2008 to July 2008 in the different out patient departments of College of Medical Sciences Teaching Hospital.Atotal of 500 patients belong to age > 15 years who visited various departments of College of Medical Sciences Teaching Hospital were randomly selected for the present study. Interview technique was used to collect information on a pre-designed and pre-tested questionnaire.
Results: Out of total patient’s interview, 59% and 41% were male and female respectively. Majority of the outpatients had heard about the Tuberculosis disease. 73.3% of the respondents opinioned that T.B. can be acquired by infection.
Conclusion:The study population hassatisfactory knowledge about the etiology and transmission of the disease. There was poor knowledge about proper disposal of sputum which is an important aspect in regard to transmission of disease. There is need of imparting knowledge to the people about proper disposal of sputum to reduce the spread of disease and mortality due to T.B.
Sickle cell Anemia with avascular necrosis of femur being managed as rheumatic fever
Authors: Lamsal KS
Published: July 2024

Sickle cell anemia is a rare hematological problem in Nepal and described only in the forms of case reports. This is a case report of a patient of sickle cell disease from Nawalparasi district of Nepal. The patient had history of recurrent joint pain including both large and small joints. He also had soft systolic murmur in cardiac auscultation for which he had received penicillin prophylaxis three years for clinically suspected rheumatic heart disease. He was later diagnosed to have Sickle cell anemia with avascular necrosis of right femoral head and functional murmur of severe anemia with no evidence of rheumatic heart disease
An Adolescent with innumerable myomas
Authors: Baral J , Rai N , Gurung G , Mishra S. , Rai N. , Paudyal P , Shrestha B , Rana A.
Published: July 2024

Myoma is rare in younger age group, so tends to be mistaken for adnexal tumour. A 19 year old adolescent who was taken for laparotomy for ovarian germ cell tumour instead was found to have uterus studded with innumerable myomas, which were surgically removed through tedious yet successful myomectomy of 40 myomas, thus deserving description.
Efficacy of injection of steroids for lateral epicondylitis
Authors: Maharjan R , Gurung G.
Published: July 2024

Introduction: Lateral epicondylitis (Tennis elbow) is one of the most common lesions of the arm. Corticosteroid injection has been described as one of the treatment modalities for this disorder with variable clinical benefit. The purpose of this study was to analyze the short-term and long-term effects of the local injection of methylprednisolone to treat lateral epicondylitis.
Methods: A prospective comparative study was carried out in the Department of Orthopaedics in Bir Hospital from October 2009 to February 2011. Study was undertaken in 40 patients to analyze the short-term and long-term effects of the local injection of methylprednisolone for the treatment of lateral epicondylitis. Twenty patients in each group were included in the study. Patients assigned to experimental group received a single injection of 1 percent lidocaine with forty milligrams of methylprednisolone and control group received a single injection of 1 percent lidocaine with saline solution.
Results: Corticosteroid injection gave better pain relief in a shorter time than the placebo group. Pain was significantly improved in steroid group in comparison to placebo group till third successive follow ups with maximum improvement at eighteen weeks (p=0.000). However, the groups did not differ with regards to pain at six months as determined with a clinical pain score and visual analogue scale.
Conclusions: Local injections of steroids provide rapid pain relief but only short-term benefits in the treatment of lateral epicondylitis.
Neurovascular injury in supracondylar fracture of Humerus
Authors: Shrestha K R , Sapkota R , Rajbhandari N. , Thapa B. , Shrestha U K
Published: July 2024

Introduction: Supracondylar fractures of the humerus are the commonest upper limb fractures in children, accounting for up to 70% of all pediatric elbow fractures. Supracondylar fractures of the humerus can be managed in outpatient setting but are often complicated by neurovascular injury.
Methods: Retrospective study including 187 patients who had presented with supracondylar fracture of humerus with 47 neurovascular injuries during the period of July 2007 to June 2011. Out of 142 patients with Gartland type III fracture 107 underwent immediate open reduction, exploration and internal fixation.
Results: Vascular injury is commonly associated with type II supracondylar fracture with posterior displacement. Twenty-two patients had vascular injury and all of them had satisfactory outcome after surgery.
Conclusion: A careful clinical evaluation, urgent surgical treatment and adequate fracture reduction can prevent lifelong handicap.
Incidence of Bacteremia and Septicemia in patients attending in tertiary care center, Nepal
Authors: Choudhary R , Karmacharya S , Shrestha S , Dahal RK , Mishra SK , Banjade NR , Kattel HP , Rijal BP , Sherchand JB , Pokharel B M
Published: July 2024

Introduction: Bacteremia and septicemia is life threatening condition resulting in major cause of mortality and morbidity. The aim of study was to determine the etiology of bacteremia and septicemia with antibiotic sensitivity profile of those organisms.
Methods: A prospective study was carried out among the suspected cases from both inpatient and outpatient of TUTH from October 2009 - March 2010. Blood samples were collected and processed according to standard methodology.
Results: Out of 2259 samples only 237 (10.49 %) showed bacterial growth. The most common isolates among Salmonella group was Salmonella enterica serotype typhi 71(29.95%) followed by Salmonella enterica serotype Paratyphi A 45 (18.98%). Among non Salmonella group Pseudomonas aeruginosa 34 (14.34%), Klebsiella pneumoniae 22(9.28%), Acinetobacter spp 15 (6.32%), Citrobacter spp 5 (2.10%), Escherichia coli 3 (1.26%) while Staphylococcus aureus 34 (14.3%) was most common followed by Enterococcus spp 3 (1.26%), Streptococcus spp 2 (0.84%), Coagulase Negative Staphylococcus 2 (0.84%) and Listeria spp 1 (0.42%) among Gram Positive organisms. Antibiogram revealed Cefotaxime, Ceftazidime, Azithromycin and Chloramphenicol for Salmonella group while for non Salmonella Imipenem, Meropenem and Amikacin as most effective antibiotics while Clindamycin, Ciprofloxacin and Ofloxacin for gram positive.
Conclusion: Gram negative bacteria was the predominant organism causing bacteremia and septicemia. Among them salmonella typhi and salmonella paratyphi were the leading aetiology.
Spectrum of neurological disorders admitted in Tribhuvan University Teaching Hospital Maharajgunj
Authors: Gajurel BP , Parajuli P , Nepali R , Oli K K
Published: July 2024

Introduction: Neurologic disorders are very common. Data on the type and burden of neurological cases either in the outpatient and inpatient settings in our country are not available. This research has been done to perform a descriptive analysis of the spectrum of neurological cases which were admitted over a period of one fiscal year in Tribhuvan University Teaching Hospital (TUTH), Maharajgunj, Kathmandu.
Methods: This retrospective study included all patients who were admitted with any neurological complaints over a period of one fiscal year (Shrawan 2067 B.S. to Asar 2068 B.S.)
Results: The total number of patients admitted was 1165. Out of these, 693 cases were due to neurological disorders (59.48%). The most common disorders were stroke, seizure disorder and central nervous system infections.
Conclusion: A variety of neurological disorders, from very common to very rare, were admitted.
Grafts containing human amniotic epithelial cells reduce hyperactivity in open-field and digital photo-actometer after Trimethyltin chloride lesion
Authors: Omprakash K.V , Muthusamy R. , Devanand B. , Puranik Nagaraja , Mallikarjun M.
Published: July 2024

Introduction: The aim of present study is to provide adequate numbers of cells to appropriate sites for useful cellular replacement to overcome the functional deficits caused by the Trimethyltin chloride lesion.
Methods: The effect of Transplanted Human Amniotic Epithelial (HAE) cells in hippocampus after Trimethyltin chloride lesion was tested on Open-field activity and Digital Photoactometer during different time duration. Hippocampal disorder was induced by the intra peritoneal administration of Trimethyltin chloride (TMT) (Sigma chemicals, U.S.A) at a single dose of 7.5 mg/kg body weight or two divided doses of 3.75 mg/kg body weight for two days. Human Amniotic Epithelial cells were isolated from placenta obtained from uncomplicated elective caesarian. Using standard co-ordinates Human Amniotic Epithelial cells were transplanted at four sites of hippocampus.
Results: In present study, we observed that the transplanted Human Amniotic Epithelial cells can aid in the partial recovery of hyperactivity induced by the Trimethyltin chloride lesion in Open-field activity and Digital Photoactometer.
Conclusions: The present study concludes that the Human Amniotic Epithelial cells may be used as a suitable donor tissue to alleviate various degenerative diseases in animal model before the clinical trial in humans, who are suffering from various degenerative diseases.
Incisional hernia repair
Authors: Bhattarai A. , Bhandari R.S
Published: July 2024

Introduction: Incisional hernia is a late complication of any abdominal surgery, including both laparotomy and laparoscopic. It occurs at the site of previous incision through weak scar. Hernia occurs as a result of excessive tension and inadequate healing of previous incision which is often associated with surgical site infection or severe bouts of coughing in the early post operative period or injury to the nerve supplying the abdominal wall. This study was performed with objectives to review clinical profile and management of incisional hernia in Tribhuvan University Teaching Hospital (TUTH).
Methods: A retrospective study was conducted at TUTH, over the period of 18 month from, Jan 2007 to June 2008. All patients with a history of abdominal surgery with a complaint of swelling over previous incision site were included in this study.
Results: Twenty two patients who had undergone hernia repair during the period were included. Mean age of presentation was 47 years with the range of 27 to 80 year. Among them 17 were female and five were male. Among 17 female patients, 15 had history of laparotomy through lower midline incision and two had history of minilaparotomy for tubal ligation. Eleven patients had symptoms less than five years and 11 had more than five years. For 18 cases mesh repair was done while herniorraphy was performed in 4 cases. No complications were observed during one year follow up.
Conclusions: Incisional hernia is more common in females after lower midline abdominal surgery. Mesh repair is the ideal recommended treatment except in very small incisional hernia where primary repair can be done.
Sturge-Weber syndrome presenting with intractable seizures
Authors: Roka Y.B. , Puri P.R. , Ahmed W.S. , Bista B.K.
Published: July 2024

Sturge-Weber syndrome (SWS) also known as encephalotrigeminal angiomatosis is one of the many neurocutaneous syndromes consisting of port wine stain (facial nevus flammeus), congenital glaucoma and cortical calcification with anomalous leptomeningeal venous plexus. A child with intractable seizures, facial port wine stain and occipital cortical calcification is presented in this case report
Cardiac workload of dressers in underground manual coal mines
Authors: Saha R , Samanta A , Dey NC , Dey NC
Published: July 2024

Introduction: Occupational disorders invite absenteeism amongst the miners. Though rapid technological advancement has happened, yet assessment of cardiac workload was largely ignored in underground coal mines in India.
Methods: Physiological stress was evaluated in terms of working heart rate, net cardiac cost and relative cardiac cost. Heart rate was measured during their course of work by heart rate monitor at the coal face. Recovery heart rates and environmental heat load were also assessed.
Results: Heart rate was found to be 117 and 122 beats/min respectively in first and second spell. NCC (49.7 and 54.8 beats /min) and RCC (47% and 52%) exhibit significant variations between spells, whereas rate of recovery had been very poor amongst the workers who regularly exceeded recommended levels of cardiac strain indices. The nature of work depicted it as a heavy job although recovery trend categorizes it heavier than that. ET and WBGT were above the recommended limits as per the guidelines of WHO and ACGIH.
Conclusions: High physiological demand of the job with towering heat stress was found to hinder the recovery process and may cause deleterious impacts on the workers. Ergonomic interventions were highly felt towards job organization and up gradation of environmental conditions.
Study of thyroid volume by ultrasonography in clinically euthyroid patients
Authors: Kayastha P. , Paudel S , Shrestha D.M. , Ghimire R.K , Pradhan S.
Published: July 2024

Introduction: The purpose of this study was to establish reference ranges of total thyroid volume among clinically euthyroid Nepalese population using Ultrasonography and correlate this volume with age, sex, individual’s built and geographic location.
Methods: This was a prospective cross sectional study involving 485 clinically euthyroid individuals. B - mode Ultrasonography was used to measure the total thyroid volume by combining the volume of both the lobes obtained by using formula for prolate ellipsoid. Age specific reference values for thyroid volume were obtained and Pearson correlation test was used to see the relationship with various factors.
Results: Among 485 individuals between 1 to 83 years of age, 221(45.57%) were males and 264(54.43%) were females. Maximum [354 individuals (72.99%)] were from hilly region and minimum [16 individual (3.30%)] were from Himalayan region. Mean thyroid volume was 6.629 ± 2.5025 ml. In general, thyroid volume was found to be more in older individuals than in young age group. There was no significant difference of thyroid volume between males and females. Thyroid volume best correlated with body surface area (r=0.444, p<0.0001). The volume had a positive correlation with weight (r=0.443, p><0.0001), body mass index (r=0.371, p><0.0001) and height (r=0.320, p><0.0001) of the individual.
Conclusions: This study estimated the reference range of total thyroid volume for Nepalese population. These ranges are significantly lower than the WHO/ICCIDD thyroid volume references and reference values obtained in various other countries. Total thyroid volume best correlated with Body surface area.>
Primary amoebic meningoencephalitis due to Naegleria fowleri
Authors: Angrup A. , Chandel L , Sood A. , Thakur K. , Jaryal S.C
Published: July 2024

The genus Naegleria comprises of free living ameboflagellates found in soil and fresh water. More than 30 species have been isolated but only N. fowleri has been associated with human disease. N. fowleri causes primary amoebic meningoencephalitis (PAM), an acute, often fulminant infection of CNS. Here we report a rare and first case of PAM in an immunocompetent elderly patient from this part of the country. Amoeboid and flagellate forms of N. fowleri were detected in the direct microscopic examination of CSF and confirmed by flagellation test in distilled water, demonstrating plaques /clear areas on 1.5% non nutrient agar and its survival at 42° C.
Responding to the need of the Society: Nepal Ambulance Service
Authors: Gongal R , Vaidya P.
Published: July 2024

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Is it Time to Adopt Alternate Teaching Strategy?
Authors: Joshi S
Published: July 2024

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Knowledge about HIV transmission, behavior and self- perception about risk of getting HIV among men
Authors: Oli NL , Onta SR , Dhakal S
Published: July 2024

Introduction: In spite on a lot of work done by nongovernmental organizations of men having  sex with men (MSM) with the collaboration of Nepal government there is high prevalence of  unprotected anal sex with a high incidence of sexual partner change. The purpose of this study  was to explore knowledge about Human Immunodeficiency Virus (HIV) transmission, behavior  and self-perception about risk of getting HIV among men having sex with men in Kathmandu Valley.
Methods: This is cross-sectional explorative study. Study was carried out between July 2010  and December 2010 in 97 men having sex with men in Kathmandu Valley using snow balling  sampling technique. The verbal consent was taken and the respondents were interviewed using structured questionnaire.
Results: Although overall knowledge regarding HIV/AIDS and Sexual transmitted Infections (STI) is high some misconception about way of transmission is present. Majority of respondents still practiced unsafe sexual behaviors, which included multiple sex partners, irregular use of condom, frequent and regular anal sex, sex in exchange of money. More than half of them considered that they had little risk of getting HIV/AIDS.
Conclusion: Sexual behavior of men having sex with men needs to be further addressed in order to promote safer and responsible sexual behavior.
Sinonasal Inverted Papilloma
Authors: Thapa N , Pradhan B
Published: July 2024

Introduction: Sinonasal inverted papilloma is a rare tumour comprising about 0.5-4% of total nose and paranasal sinus tumours. Though various factors have been implicated its exact cause is unknown. This longitudinal, prospective study was carried out to find out demographical profile, association of this tumour with smoking, occupation, variation with ethnic races and outcome of surgery.
Methods: This study was carried out in the department of ENT-HNS, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu from April, 2005 to March, 2011.
Result: Out of 34 patients, there were 25 male and 9 female with ratio of 2.78:1. Age of the patients ranged from 14-76 years with median age of 51.5±2.74 SE years. Disease was more common in 4th to 7th decade. It was common in farmers (20). Eighteen patients were smoker and 16 nonsmoker. The disease was more common in mongoloids than in Indo-aryans. Out of 16 patients having stage III disease, 9 were smoker and 7 nonsmoker. Eighteen patients underwent endoscopic medial maxillectomy and 15 patients underwent medial maxillectomy via lateral rhinotomy approach. One patient who had bilateral disease underwent medial maxillectomy via lateral rhinotomy on the left side and endoscopically on the right side. There was recurrence of tumour in 2 patients who underwent surgery via lateral rhinotomy approach whereas in 1 patient who underwent surgery endoscopically.
Conclusion: This study showed that sinonasal inverted papilloma was common in mongoloids than in Indo-aryans and farmers but no association with smoking. Endoscopic medial maxillectomy has less reccurence of tumour in comparison to lateral rhinotomy approach.
Re-emergence of the deadly Ebola virus disease: A Global Health Threat
Authors: Sherpa K
Published: July 2024

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