bluuebunny/crossref_metadata_2025 huggingface dataset:
A report on two cases of persistent median arteries
Authors: S.Bilodi Arun Kumar , Nayak Sheela G. , Sarswathi G.
Published: July 2024

Commonly the superficial palmar arch is formed by the anastomosis of the ulnar artery with the superficial palmar branch of the radial artery at mid palmar level. Variations of the superficial palmar arch as reported include:a. Arch formed by the anastomosis of the Princeps Pollicis branch of the Radial artery with Ulnar artery.b. In the rare instances, the anastomosis of the Median artery with the Ulnar arteryforming complete superticial palm's arch of the Medio-Ulnar type.There have been previous reports about the bilateral occurrence of the Medio-Ulnartype and in most cases were similar in both hands of the same body. Here in the present study, we report a case, where in one hand, arch was formed by the ulnar and radialis indicis is joined by median artery that is accompanying the median nerve forming complete superficial palmar arch of Radio-medio-ulnar type, while in the other hand median artery continued to persist without participating in the formation of the arch. This dissimilarity between the two hands of the same body is very rare and hence reported. However, complete dissection of the whole body did not reveal anyother vascular abnormality.
What do mothers know about Acute Respiratory Infection: a case from eastern Nepal
Authors: Onta SR , Yengden B
Published: July 2024

A descriptive study was conducted in Eastern Nepal with an objective to assess the knowledge of mothers about acute respiratory infection (ARI). Two hundred mothers, who had currently at least a child under five, from randomly selected households were interviewed. 50.5% of the mothers correctly knew the signs and symptoms of ARI without pneumonia; 45% had mixed responses. Only 2.5% of the responding mothers reported to have knowledge about danger signs of ARI, 39.5% had wrong answers and 12% did not know about the danger signs of ARI. Regarding knowledge about home care management, 50.5% had correct responses. Both the correct and wrong responses about knowledge of ARI were more or less equally distributed across the educational level, ethnicity and age group of responding mothers. It is concluded that knowledge of mothers about ARI in general is low, particularly very low on danger signs of ARI. This might have led to delayed specific treatment of children with ARI, which could have resulted in various complications including death.
The need of a Clinical Skills Learning Centre (CSLC) at Institute of Medicine
Authors: Sharma P.R
Published: July 2024

N/A
Bacterial vaginosis in Tribhuvan University Teaching Hospital
Authors: Manandhar R. , Sharma J. , Pokharel B.M. , Shrestha B. , Pradhan N.
Published: July 2024

Five hundred women of reproductive age group were screened for bacterial vaginosis (BV) using Amsel’s criteria from January 2004 to July 2004 at gynaecological out patient department of Tribhuvan University Teaching Hospital (TUTH). Bacterial vaginosis was found in 2.5%. Among all BV positive patients, 67.3% were symptomatic and 32.7% were asymptomatic. Brahmans were significantly least infected caste. Highly educated women were also significantly least infected group. Sexual exposure has significant association with BV. Smokers and people using alcohol suffered much from bacterial vaginosis but were not statistically significant.
Multiple dysraphic anomalies with double thoracic meningocele and lumbosacral myelomeningocele, concurrent Chiari malformation Type I, diastematomyelia, lipomyelomeningocele and hydrocephalus: a case report and literature review.
Authors: Rai B.D.K. , Shilpakar S.K. , Bagan M.
Published: July 2024

N/A
Technology transfer for hearing impaired
Authors: Sinha B.K.
Published: July 2024

N/A
Cross – sectional study of respiratory pathogens and their antibiotic susceptibility pattern in Tribhuvan University Teaching Hospital
Authors: Shrestha U. , Singh A. , Pokharel B.M.
Published: July 2024

Background: Lower respiratory tract infection (LRTI) comprises an array of diseases ranging from bronchitis to pneumonia; its asperity can sway from non-pneumonic LRTI to pneumonia or chronic obstructive pulmonary disease (COPD). The HMG/WHO review in 1994 estimated the overall acute respiratory infections in Nepal to be 2.1%.
Methods: In brief, all total 132 sputum samples of patients suspected of LRTI those visiting Tribhuvan University Teaching Hospital during March to May 2005 were investigated with the use of standard microbiological methods and the bacterial isolates were subjected for antibiotic sensitivity test.
Results: Of the total, 31.0% sputum samples showed significant positive. Among them 75.6% were gram-negative bacteria (GNB) and 24.40% gram-positive bacteria (GPB). Eight different types of bacteria were isolated. Haemophilus influenzae (19.51%), Klebsiella pnemoniae (19.51%), Pseudomonas aeruginosa(19.51%), were the most common isolates followed by Streptococcus pneumoniae (12.19%), Staphylococcus aureus (12.19%), Escherichia coli (9.75 %), Citrobacter fruendii (4.87%), Acinetobacter calcoaceticus (2.43%). Antibiotic susceptibility test showed that, more than 50% of GPB were resistant to Erythromycin, Cephalexin and Ciprofloxacin whereas majority of GNB were resistant to Ciprofloxacin, Gentamycin,Ampicillin.
Conclusion: This study needs to be conducted round the year to acquire more information regarding seasonal variation.
Study of knowledge, attitude and practice of family planning in an urban area of Bharatpur
Authors: Manandhar N. , Singh S.K. , Patowary S. , Krishna G.
Published: July 2024

Background: A cross-sectional study was conducted during September-October, 2004 among 255purposively selected woman of reproductive age group (15-44 years) in Bharatpur Municipality,Chitwan district.
Material and Methods: Door to door survey was conducted and informations were collected on astructured and pre-tested proforma from 255 married women.
Result: It was found that 100% of the respondents had heard about any one or the other method offamily planning.All respondents had knowledge about Condom. The majority of them had knowledge about Oral Contraceptive Pills (92.9%), injectable (89.4%) and Intra Uterine Device (89.4%). The currently married women (45.8%) were using injectable (Depo-Provera). The OCP & IUD were being used by 18.8% each.
Conclusion: Knowledge regarding family planning method was far from satisfactory. They hadpositive attitude towards family planning.
Effectiveness of health insurance and its impact on rural health development
Authors: Rosyara K.P. , Acharya U. , Khadka P.K.
Published: July 2024

Background: Providing health insurance or health security for poor people continues to be one of the most important unresolved policy issues for the world. Most rural and informal sector workers in the world do not have any form of health insurance. And in most developing countries, the rural and informal sectors constitute the bulk of the population. Emerging and reemerging new diseases Medical service are being expensive in the recent years because of the advancement of new technologies and increasing demand for quality of care, changing life styles and poor health accessibility in the rural areas.
Methods:Anon experimental descriptive exploratory research design was followed. The population of this study consisted of all those people who were involved in the Health Insurance Scheme launched by various organizations. 105 household was taken from Kirtipur Municipality.
Results: 96.2% of total 105 respondents have getting accessibility through existing Health Insurance scheme and most of them 42.9% have got free bed at the time of admission in the hospital, 43.8% free operation charge, 74.3% have got free health check up and 4.8% have got free lab tests.
Conclusion: Health Insurance Scheme is important indicators of quality services delivered by the scheme. Patient satisfaction is an important factor for willingness to pay. Quality of service is one of the determining factors for rural people to join the Health Insurance Scheme. On the basis of the study finding, it was concluded that awareness program on Health Insurance Scheme should be conducted for the community people, is necessary for the people and premium rate of existing HIS to be lowered, coverage area of the Scheme to be increased for making effective Health Insurance Scheme.
Prophylactic leg wrapping in elective cesarean section under bupivacain spinal anesthesia
Authors: Sharma S.A. , Prasad P.N. , Marhatha M.N. , Gupta M.P.
Published: July 2024

Background: Hypotension is the most frequent and serious complication associated with spinal anesthesia in obstetrics. Over the years many interventions have been tried to prevent the hypotension. Preloading with fluid, prophylactic vasopressors and leg wrapping have been seen as effective interventions. Leg wrapping, a noninvasive and a nonpharmacologic method, has consistently been seen as an easy and effective intervention. Various studies using Esmarch bandage, graduated compression bandage and inflatable boots are found in the literature. Till now no study has been done using Elastic leukocrepe bandage, which is cheap and widely available. This study was thus carried out with the aim of finding out if wrapping with elastic leukocrepe would have a similar effect.
Methods: In a randomized controlled study, 30 patients (15 in each group) had either their legs wrapped or no wrapping prior to spinal anesthesia before cesarean section. Systolic blood pressure and rescue mephentermine use were recorded.
Result: The mean systolic blood pressure, SBP, at different time intervals was compared. The leg wrapped group had consistently higher SBP. Overall, 12 out of 15 patients in the leg wrapped group and all 15 patients in the control group experienced hypotensive episodes requiring rescue dose of mephentermine. The number of patients who had more than one hypotensive episodes during the surgery was also analyzed. 5 out of 15 cases compared to 14 out of 15 controls had more than one hypotensive episodes requiring supplemental mephentermine.
Conclusion: The findings of my study suggest that the wrapping of lower limbs with Leukocrepe elastic bandage (like other methods of wrapping) decreases the incidence of hypotensive episodes to a significant degree however it does not eliminate the incidence of hypotension in spinal anesthesia given to elective cesarean section patients.
How to investigate the use of medicines by consumers
Authors: Shankar P.R.
Published: July 2024

n/a
Dr. Jekyll and Mr. Hyde
Authors: Shankar P.R.
Published: July 2024

N/A
Organic psychiatric disorders in the older persons
Authors: Chandrasekaran P.K. , Srinivas P.
Published: July 2024

Background: A primary, retrospective study was done to determine the frequency and describe the patterns of presentation of delirium, dementia and mood disorder in the elderly.Methods: The sample was collected over 3 months and consisted of 10 patients above 60 years of age with features fitting those conditions, conventionally labeled at the time as Organic Brain Syndromes (OBS).Results: We found that OBS in hospitalized older people was common (29.41%) and the detection of these syndromes was poor, taking almost 5 days for a psychiatric referral to be made. Clinical presentations heterogeneously varied and the majority of cases were in a delirium (60%) due to various causes. Only low dosages of treatment were required to treat the symptoms, except in thosewho had a premorbid psychiatric disorder. Finally, symptom resolution was achieved (30%) only where the medical conditions causing the OBS were reversible, as is expected.Conclusion: This cost-effective study found that OBS in hospitalized older people was common, frequently diagnosed late and had a varied presentation.
Financial status of medical students in Institute of Medicine
Authors: Bhatta V.R. , Joshi A.B. , Jha A.J. , Parajuli P. , Koirala S.
Published: July 2024

Background: Underrepresentation of students from low-income families at the Institute of Medicine in Maharajgunj (IOM) has been generally assumed. This study aims to assess the financial status of medical students at IOM to test the accuracy of that assumption.
Methods: The study was conducted among 24th and 25th batch of students of IOM using pre-formed questionnaire.
Results: The majority of students studying in IOM thought they have average to strong financial status and they felt little to no financial stress.
Conclusion: Students from low income families are underrepresented in IOM.
Effect of Acute Appendicitis on routine Liver Function Tests
Authors: Khan S.
Published: July 2024

Background: Liver plays a central role in metabolism and host defense mechanism. It is the first organ to receive substances absorbed or microorganism translocated from gastro intestinal tract (GIT). The aim was to evaluate the effect of acute inflammation of appendix on routine liver function test.
Method: 50 cases with no history of hepatotoxic drug intake, non –alcoholic or alcoholic with AST (SGOT)/ALT (SGPT)<2, hepatitis B surface antigen (HBsAg) negative and no past history of jaundice with acute appendicitis were studied.
Result: Among 50 cases 49 cases were of acute appendicitis and its complications. Serum bilirubin was raised in 87.7% cases. It was mixed type in majority (84.6%) of the cases. The average level of serum bilirubin was 2.34 mg/dL. Serum Alanine Amino Transferase (ALT) was normal in 73.46% of the cases where as elevated in 26.54% of the case. Aspertate. Age and sex adjusted alkaline phosphatase (ALP) was normal in 51.2% of the cases where as it was elevated in 48.98% of the cases. Amino Transferase (AST) was normal in 61.22% cases whereas elevated in 38.77% of the cases
Conclusion: There was mixed type of hyperbilirubinemia and that was due to dysfunction rather than damage of the hepatocyte. This might be due to combined effect of depressed hepatocellular uptake of unconjugated bilirubin and excretion of the conjugated bilirubin by bacteria, their toxins or cytokines. The elevation of AST and ALP is of no diagnostic value where as elevation (≥1times) of ALT can be helpful to rule out acute inflammation of appendix at 95% level of confidence in clinically suspected cases of acute appendicitis.
Sneddon- Wilkinson Disease in association with NonHodgkin Lymphoma
Authors: Jha A. , Kumar A. , Gurung D. , Chaurasia A.K. , Das A.K. , Pokharel D.B.
Published: July 2024

Sneddon-Wilkinson disease is a rare condition with chronic recurrent course. It may be a part of paraneoplastic manifestation of underlying malignancy. The disease is diagnosed on the basis of its characteristic clinical features and histopathology. A case of Sneddon –Wilkinson disease associated with non-hodgkin lymphoma in a 54 years old lady is presented.
Usefulness of Ki-67 in the histological evaluation of neoplastic lesions of central nervous system
Authors: Shrestha P. , Shrestha I , Kurisu K.
Published: July 2024

Abstract: Ki-67 is an intranuclear protein, which is present in the proliferating cells. Since it is expressed in only dividing cells, it is an excellent indicator of tissue proliferation in neoplastic lesions. Immunohistochemistry is used to detect Ki67 in tumor tissues. Here, we present few cases where Ki-67 evaluation was very helpful in making final diagnosis. Cases- Case no. 1 was a case of intracranial mass lesion whose histological finding was confusing, pituitary tumor or astrocytoma. Ki-67 evaluation along with other factors helped in making diagnosis of pituitary adenoma. Case no. 2 was another case of intracranial mass. Ki-67 evaluation ruled out possibility of benign lesion, melanocytoma, though histologically the lesion was not clearly malignant melanoma. Case no. 3 was a case of peripheral spinal nerve tumor, a schwannoma. Its Ki-67 evaluation confirmed that it was of conventional type not cellular. Ki-67 is a marker of tissue proliferation and higher the Ki-67 expression, higher is the tumor grade and poorer is the prognosis. It also helps in concluding the diagnosis when the histological picture alone is not conclusive. Thus complete histological evaluation, including Ki-67, is necessary before making final diagnosis.
Chronic Supurative Otitis Media in relation to dehiscent of facial canal
Authors: Acharya K. , Nepal M K , Rayamajhi P. , Bhattarai H. , Shrivastav R.P. , Sharma P.
Published: July 2024

Background: To observe the pathological findings in CSOM-AA along with, frequency of dehiscence of facial canal and to correlate the type of pathologies found with dehiscence of fallopian canal.
Methods: It is the retrospective study conducted in the department of ENT-HNS at Tribhuvan University Teaching Hospital, Nepal of 2 yrs duration April 2004 to April 006. Patients undergoing mastoid surgeries for the CSOM-AA under general anesthesia were taken for the study. Pathological findings were divided into 3 groups which are granulation tissue, cholesteatoma or both. Special attention was given to identify the dehiscent of facial canal and its status was also followed up in postoperative period till 1 month.
Results: The pathological finding commonly encountered were cholesteatoma with granulation 75.2% (94), whereas cholesteatoma alone was 18.4% (23)and granulation tissue only was 6.4%(8) The total incidence of facial canal dehiscence was 22 % (28/125) in our study. Horizontal part of the fallopian canal was most common site for dehiscence 50% (14/28) followed by vertical part 35 % (10/28) then both part was involved in 15% (4/28). There is no statistical significance between any type of pathology and dehiscence of facial canal.
Conclusion: Cholesteatoma with granulation was the most common pathology found in CSOMAA. Irrespective of the pathologies in the middle ear cleft during mastoid surgeries for CSOM- AA, the facial canal was found to have dehiscence which was commonly occurring at horizontal part of the facial canal with higher incidence among cholesteatoma with granulation group.
Acute urinary retention in pyometra secondary to endocervical adenocarcinoma
Authors: Gurung G. , Ojha N. , Amatya A. , Rana A. , Tiwari V , Amatya S.
Published: July 2024

An elderly 76 years old grandmultipara (P10) post menopausal for several years, presented with acute urinary retention, believed to be a case of pelvic abscess underwent repeated attempt of sterile pus aspiration amounting to more than 1300ml. Finally at hysterectomy, acute retroversion and pelvic impaction of pyometra was found to be the main cause of urinary retention which is described in this case report with rare conjugal findings of coexistent ovarian cystadenoma. In conclusion, any cystic lesion suspected as pelvic abscess may instead be a pyometra, reasonably in an elderly post menopausal woman with high parity where cervical carcinoma stands as a predisposing factor for cervical os stenosis.
Indwelling catheter associated urinary tract infection
Authors: Poudel C.M. , Baniya G. , Pokharel B.M.
Published: July 2024

Background: The objective of the study is determined the microbiological profile and the resistance pattern of the strains causing Foley’s Catheter Associated Urinary Tract Infection.
Materials and methods: It was a prospective study conducted in catheterized patients admitted in medical ward in Tribhuvan University Teaching Hospital (TUTH). A total of 100 adult patients above 16 years in whom an indwelling Foley‘s catheter inserted for short to intermediate term purpose were taken in the study. Quantitative culture of urine sample was done at the time of catheterization and was repeated on 3rd-5th day, 7th day, 10th day, 14th day and then every weekly until catheter removal or patient develops bacteriuria or until discharge of the patient at Microbiology Department Laboratory TUTH. Three ml of urine specimen were obtained aseptically and were sent to laboratory within 1 hour of collection. Antibiotic sensitivity test was done by Disk-Diffusion Technique.
Results: The most common organism causing CAUTI was found to be E.Coli in 40% of cases, followed by Klebsiella, Enterococcus, Streptococcus faecalis, Pseudomonas, Staphylococcus aureus, Acinetobacter sp.and multiple bacteria. Ninety percent of E. coli isolates tested were found to be resistant to Amphicillin, Ciprofloxacin and Cephalexin, 86% were resistant to Cotrimoxazole, Coamoxiclav, 68% to Gentamycin, 41% to Ceftazidime, 36.4% to Amikacin, 22% to Nitrofurantoin, 9% to Piperacillin and non of them were resistant to Imepenem.
Conclusion: E. coli was the most common organism causing CAUTI. E. coli was found to be resistant to most of the antibiotics. The organism was not resistent to Imepenem.
Factors affecting place of delivery in Dhading district
Authors: Adhikari R.K. , Dahal L.H.
Published: July 2024

Background: Nepal is one of countries having highest maternal mortality ratio of 539 per 100,000 live births, with 9.9% health institutional deliveries and where 67% maternal deaths occur at home. The present study aimed to determine the factors affecting place of delivery in Dhading district for the quantification of the factors to help in planning and implementation of safe motherhood programme in Dhading district.
Material and Methods: The study was conducted in community and health institutions based cross– sectional comparative design. For this purpose all the 400 mothers of 4 village development committees of Salyantar, Dhuwakot, Tripureshwor and Darkha of Dhading district who delivered babies in the period of January 15, 2007 to January 14, 2008 were selected in the study by using female community health volunteers, Focus Group Discussion. The village development committees were selected by cluster sampling design.
Result: The study indicated that the odds of home deliveries among the illiterate mothers was 3.22 times higher compared to literate mothers (1.43-7.48 at 95% confidence limit; p= 0.002). Similarly the study has shown that the odds of home deliveries among multiparous mothers was 2.54 times higher than the primiparous mothers (1.27-5.13 at 95% confidence limit; p=0.002). Similarly the study has shown that the odds of home delivery in Tamang was 3.74 times higher than in ethnic group other than Tamang (1.37-5.19 at 95% confidence limit; p=0.004). These findings suggest that the maternal education, ethnicity, and parity have statistically significant effects to home and health institutional deliveries.
Conclusion: From these findings it is recommended that the Safer Motherhood Programme of Dhading district should give priority to the Tamang Commutity and focus needs to be given to the education to the girls and Family Planning Programme needs to be strengthened.
A comparison of 10% Ichthalmmol Glycerine pack with steroid-antibiotic pack for relieving pain in cases of Acute otitis Externa
Authors: Bhatta Rishi , Pokharel Rais , Adhikari Prakash , Neupane Yogesh
Published: July 2024

Background: Acute otitis externa, a common painful clinical condition is managed by aural packing to reduce edema and pain. Pack usually contains 10% Ichthalmmol Glycerine (IG) or commercially prepared steroid with antibiotic cream. The aim of study is to compare the clinical efficacy of 10% IG pack with steroid-antibiotic pack in relieving pain in cases of acute otitis externa. Materials and Methods: A prospective randomized clinical trial was carried out in 106 patients at Ganesh Man Singh Memorial Academy (GMSMA) of ENT and Head Neck studies, Institute of Medicine. Pain was assessed by Wong –Baker Scale in d”12years child and Numerical Rating Scale (NRS) in patients more than 12years of age on the day of presentation and subsequent visits till tragal tenderness disappeared. Results: Age ranged from 1 to 75 years (mean 20.08 years) out of which 46 (43.4%) were females and 60 (56.6%) were males. Average duration of pain at presentation was 3.9 days (range1-15days). Average number of visits in IG pack group (n=55) was 2.82 (2-4 visits) while in steroid-antibiotic group (n= 51) it was 2.38 (2-4 visits). There was statistically significant decrease in the number of visits in steroid group (p < 0.05). However, decrease in pain score in second visit as compared to first visit was not significant (p > 0.05) in both groups. Average number of visits in steroid-antibiotic group required to have reduction in Wong –Baker Scale by 50% or more was 2.0 which was statistically significant (p < 0.01) as compared to IG pack group (2.9). Similar results in NRS were not significant (p > 0.05). Conclusion: Steroid-antibiotic pack can be used for earlier relief of pain and decrease number of visits in management of acute otitis externa.
Phytoestrogens and cancer
Authors: Mathew B.C , Reji S.D , Jamal AI B.B. , Campbell I.W.
Published: July 2024

Abstact: Phytoestrogens are a group of compounds found in plants that are structurally or functionally similar to the hormone estradiol, and act as selective estrogen receptor modulators. Epidemiological studies show an inverse correlation between consumption of a high phytoestrogen-rich diet, as seen in traditional Asiatic societies, and the incidence of certain hormone- dependent cancers such, as breast and prostate cancer. Clinical studies to find a relationship between phytoestrogens, and breast and prostate cancers, have produced conflicting results. Phytoestrogens may protect against hormone-dependent cancers through their ability to lower the level of endogenous estrogens and their genotoxic metabolites, activation of estrogen receptor beta and peroxisome proliferator activated receptor gamma, inhibiting cell signaling pathways of growth factors, upregulating expression of antioxidant genes, tumor suppressor genes and immunomodulatory effects. There is little clinical evidence to suggest that phytoestrogens through their estrogenic activities will increase breast cancer risk in healthy women or worsen prognosis of breast cancer patients. Although phytoestrogens appear to hold promise as chemo preventive agents against cancer, more in-depth studies are required before definitive conclusions can be drawn.
Spontaneous omental hematoma
Authors: Bhandari R.S , Sapkota R. , Mishra P. , Singh K.P.
Published: July 2024

Spontaneous omental bleeding is a rare entity, and usually presents with various combination of sudden abdominal pain, shock, peritonitis and hemoperitoneum. A 68 year female presenting with acute abdomen and without antecedent trauma had obscure hemoperitoneum. Exploration revealed hemoperitoneum and hemorrhagic omentum with a huge clot.
Treatment of Anisometropic Amblyopia in children with refractive correction
Authors: Kaphle D. , Shrestha J.B. , Paudel P.
Published: July 2024

Background: The main purpose of the study is to determine the effectiveness of spectacles alone in the treatment of anisometropia in paediatric population. Methods: A hospital based prospective study was conducted on twenty children (involving twentysix eyes) with freshly diagnosed anisometropic amblyopia of mild to moderate grade. Optimal refractive correction was provided with spectacles alone and was followed at every 3 weeks until amblyopia resolved. Results: The mean line of improvement in visual acuity in 3 weeks was 0.85 ± 0.65 snellen lines. The mean line improvement in second follow up was 0.80 ± 0.70 lines. There was statistically significant (p=0.04) decrease in inter-ocular acuity (IOD) for anisometropia of 1 to 2.0D. The IOD improvement was associated with age (1.53 snellen lines in more than 8 years) in first follow up (p=0.001). IOD also decreased in children of more than 8 yrs. Conclusions: As in nearly half of the participants, especially who has minimal interocular acuity difference, anisometropic amblyopia resolved to normal acuity within first three weeks, we can conclud that the early improvement of visual acuity is related to lesser amount of anisometropia, age and sex.
Gall Bladder complications of Typhoid
Authors: Bhandari R.S , Luitel B.R. , Lakhey P.J , Singh K.P.
Published: July 2024

Surgical complications of typhoid fever usually involve gut but infrequently typhoid fever also involves gallbladder. Complications range from acalculous cholecystitis to perforation. We present a series of three cases which included acalculous cholecystitis, gangrenous cholecystitis and perforation of gallbladder. Investigations revealed them to be a complication of Enteric fever. Acalculous cholecystitis was managed conservatively; gangrenous cholecystitis and perforated gallbladder underwent emergency cholecystectomy. All three cases were discharged after treatment and are doing well on follow up
A brewing public health crisis: antibiotic resistance
Authors: Adhikari N.
Published: July 2024

N/A
Micro ESR in the evaluation of neonatal sepsis
Authors: Paudel KP , Adhikari RK
Published: July 2024

Introduction: Neonatal sepsis is a major cause of neonatal morbidity and mortality in the developing countries like Nepal. Early diagnosis and treatment is crucial for the outcome but it is difficult in many situations especially in places with limited resources. Objective of this study is to evaluate the role of micro ESR in the diagnosis of neonatal sepsis
Methods: A prospective analytical study was done where newborns with suspected sepsis admitted for septic work up and IV antibiotics were included in the study. Micro ESR was measured with relevant septic screening investigations. The micro ESR value was compared to age specific normal values and the results were compared with various clinical presentations, laboratory findings and outcome variables.
Results: Out of 111 babies micro ESR was elevated in 63 babies and blood culture was positive in 15 cases and meningitis was present in 8 cases. Total proven cases were 16 and probable sepsis were 34. Correlation of elevated micro ESR was statistically significant with PROM >18 hours, presence of clinical symptoms, clinical and systemic signs. It had significant clinical association with blood culture and CSF findings. The sensitivity, specificity, positive and negative predictive value compared with blood culture was 100%, 47.5%, 15.6% and 20.8%, comparing with proven or no sepsis cases was 70.5%, 48.1%, 36.9% and 50% respectively.
Conclusions: Micro ESR is simple cheap and relatively sensitive, specific with good negative predictive value in the prediction of neonatal sepsis and can be useful test in settings with limited resources.
Clinical profile and outcome of babies admitted to Neonatal Intensive Care Unit (NICU)
Authors: Gauchan E , Basnet S , Koirala DP , Rao KS
Published: July 2024

Introduction: Every year millions of babies are born and a large proportion of them are admitted to the neonatal ward for various indications. One of the Millennium Development Goals (MDG-4) is to reduce childhood mortality by two-thirds by 2015.This study was conducted to identify the general characteristics, disease spectrum and the commonest causes of morbidity and mortality in this group of babies.
Methods: Prospective observational study of all infants admitted to neonatal intensive care unit, Manipal Teaching Hospital, Pokhara during November 2010 to April 2011.
Results: 182 neonates were admitted during the period of study; 32.4% babies were inborn. 41.2 % babies were admitted directly from the emergency or outpatient department and 22.5 % were referred from district hospitals. Male: female ratio was 1.1:1. There were 67.5 % term babies and 31.3% preterm babies. 44.5% were admitted in the first 24 hours of life; commonest indications for admission were neonatal jaundice (24.7%); sepsis (21.4%) and perinatal asphyxia (19.2%). 76.9% babies were discharged after improvement, 6.5% left against medical advice and 1.62% were referred for surgical interventions and mortality was seen in 13.7%. Commonest cause for mortality was hyaline membrane disease (28%) and hypoxic ischaemic encephalopathy stage 3 (28%).
Conclusion: Neonatal period is a very vulnerable period with a high risk of morbidity and mortality; most of which are preventable with good obstetric and subsequent neonatal care. Early anticipation and prompt management is very essential to reduce neonatal mortality.
Molecular characterization of rabies virus of Nepal
Authors: Pant GR , Bhatta DR
Published: July 2024

A study was performed to identify the Rabies Virus genomes circulating in Nepal in 2009. Three brain samples, collected from carcass of buffalo, human and dog infected with Rabies were sent to Pasteur Institute, in France for molecular characterization and identification. The entire nucleoprotein genes (NG) of these samples were sequenced and analyzed phylogenically. Sample from buffalo was identified as Indian subcontinent lineage where as samples from human and dog were identified as Arctic lineage of Rabies virus.
Prevalence and Antibiotic Sensitivity Pattern of Methicillin Resistant- Staphylococcus aureus in Kathmandu Medical College –Teaching Hospital
Authors: Pandey S. , Raza M , Bhatta CP
Published: July 2024

Introduction: Staphylococcus aureus is found to be a major source of community as well as hospital acquired infection. Staphylococcal isolates from tertiary care hospital are found to be resistant to commonly used antimicrobial agents. Methicillin resistant S. aureus(MRSA)with intrinsically developed antimicrobial resistance has been associated with an increase in morbidity and mortality of the patients in the hospital. This study was undertaken to know the antibiotic sensitivity pattern of staphylococcal isolates with special reference to Methicillin resistant S. aureus.
Methods: Clinical specimens received from July 2009 to July 2010 in Kathmandu Medical college-Teaching Hospital were processed and all S. aureus isolates were included in the study. The isolates were identified by standard laboratory procedure.The antibiotic susceptibility pattern of all staphylococcal strain was determined by modified Kirby Bauer antibiotic sensitivity method.
Results: Of 111 S .aureus isolates 29(26.12%)were identifoed to be MRSA. The rate of multi drug resistance was 75.86% for MRSA and 6.09% for MSSA. All the staphylococcal isolates were resistant to penicillin. However, all strains were sensitive to vancomycin. Conclusions: This study showed a high prevalence of MRSA in tertiary care hospital of Kathmandu valley. Regular surveillance of hospital-associated infection and monitoring of antibiotic sensitivity pattern is mandatory to reduce MRSAprevalence in hospital and its spread to community as well. Present study conclusively shows that vancomycin remains the Þrst choice of treatment for MRSAinfection. To preserve its value, use of vancomycin should be limited to those cases where there are clearly needed.
MR imaging features and contrast enhancement characteristics in benign and malignant breast lesions
Authors: Hoon T.S , Ansari MA , Shuaib I.L , Ariff A.R , Khalid I , Baseer MB , Mohd. L , Tun M , Mohd.E. Aziz
Published: July 2024

Introduction: Breast cancer is the commonest female malignancy in Malaysia and other countries the world. All races are affected in Malaysia and breast cancer comprised 30.4% of all newly diagnosed cancer cases. A women in Malaysia has a 1 in 19 chances of getting breast cancer in her lifetime. The Age Standardized Rate (ASR) of female breast cancer in Malaysia is 52.8 per 100,000 people and is higher than that in Singapore, Hong Kong and Shanghai, but it is lower than that in Australia and the UK. Out of the 4,337 new cases of female breast cancer cases reported to the National Cancer Registry of Malaysia in 2002, 52.3% were for women less than 50 years old. Genetic risk factors have not been studies thoroughly in Malaysia.
Methods: We prospectively studied 55 patients with breast lumps in whom MR imaging was performed. The T1- and T2-weighted, axial STIR, fat-suppression contrast enhanced fast spin echo and two dimensional dynamic enhanced fast spoiled gradient-echo images were obtained. The tumour margins and shape, enhancement pattern and time-signal intensity curves were analysed.
Results: A total of 37 patients fulfilled the study criteria with the mean age of 43.46 ±11.99 years (age ranged 21-70). There were 23 benign and 14 malignant lesions. The MR imaging criteria suggestive of malignancy were poorly defined and spiculated margins, irregular shape, heterogeneous and rim enhancement as well as type II and III curves. On the other hand, the criteria for a benign breast lesions were well-defined margin, regular and lobulated shape, none or homogeneous enhancement and type I curve. Only the malignant lesions are characterised by skin, retroareolar, nipple and pectoralis muscle involvement.
Conclusion: MR imaging is a valuable complementary breast imaging tool to further evaluate equivocal findings on conventional x-ray mammography. A combination of lesion morphology and enhancement characteristics is useful in distinguishing benign from malignant lesions.
Wheezing Beyond Bronchial Asthma
Authors: Pant P , Sharma S , Shrestha S , Bom N. , Das S. , Yogi K.N
Published: July 2024

Churg-Strauss syndrome (CSS) is an eosinophil-associated, small vessel granulomatous vaculitis, characterized by late onset asthma, upper airways disease, eosinophilia, and clinical manifestations of systemic vasculitis. [1,11-13] Diagnosis is mainly clinical with findings of asthma, eosinophilia, rhino sinusitis and signs of vasculitis in major organs. So far to the best of our knowledge reporting of CSS has not been done in Nepal. We here present a case of ChurgStrauss syndrome, a Anti-Neutrophil Cytoplasmic Antibody(ANCA) Associated Vasculities more specifically perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) directed against myeloperoxidase (MPO) in a 25years female patient who was initially evaluated for progressive dyspnea, wheeze, cough, joint pain and fever. Regarding the inference drawn from our case report we suggest that patient presenting with the clinical features of asthma needs further evaluation to unmask previously unrecognized underlying Churg-stauss syndrome.
Rheumatic fever and rheumatic heart disease: how often we suspect infective endocarditis
Authors: Shrestha P N , Das A , Rayamajhi A. , Mahaseth C
Published: July 2024

Introduction: Rheumatic fever and rheumatic heart disease is a common problem in developing countries. Rheumatic valvular heart disease is one of the important risk factor for infective endocarditis.
Methods: Retrospective study was conducted among 56 children admitted in cardiology ward of Kanti children hospital with the diagnosis of rheumatic fever or rheumatic heart disease during May 2008 to M ay 2010.
Results: We found male to female ratio 2: 1, median age 12 (5- 14yrs) with the most affected age group of 11- 12 years. Common symptoms were fever (66%), dyspnea (68%), joint pain (50%), palpitation (30%), cough (16%) and chest pain (12%). Only 9% of patients had positive history of sore throat. Six ty percent patients were presented with features of congestive cardiac failure (CCF). A SO positive was found in 25 (44.6%) cases. The most common valvular lesion was mitral regurgitation (M R). Moderate to severe mitral regurgitation was found in 89% of cases. Tricuspid regurgitation (T R) was found in 57% of patients and aortic regurgitation (A R) in 55% of cases. Thirty-two patients (57%} had PA H in which 8 patients has severe PAH and 24 patients had mild to moderate PAH . Infective endocarditis was diagnosed in twenty patients (35.7%). Out of 20 patients 14 (70%) had vegetation in echocardiography. The mortality was 11% in this study.
Conclusion: Infective endocarditis is the major complication of rheumatic heart disease among children of Nepal and so clinical suspecian is important whenever patients with rheumatic heart disease present with fever.
Behavioural risk factors of non-communicable diseases among adolescents
Authors: Adhikari K , Adak M R
Published: July 2024

Introduction: Cardiovascular and other chronic diseases are becoming the major causes of morbidity and mortality in most of the third world countries, including Nepal. Unhealthy diet, physical inactivity and consumption of tobacco, alcohol, drugs etc. are major global determinants of non-communicable diseases and contribute to the excess death and disability among the poor in terms of mortality. This study was done to estimate the prevalence of behavioral risk factors of NCDs among adolescent.
Methods: A cross-sectional study based on WHO stepwise approach for surveillance of Non Communicable Diseases (NCDs) risk factors was conducted in Chitwan District to assess the risk factors of NCDs. Information was collected on substance abuse, dietary habits and physical activity through personal interview.
Results: A bout 50% male and 30% female respondents were currently abusing one or other forms of substance. Male (39%) and female (26%) were using tobacco products. It was found that only 14% of respondents were doing satisfactory level of physical activities.
Conclusions: Substantially high levels of the various behavioral risk factors among adolescents in Chitwan District suggest an urgent need for awareness raising programmes.
Protocols protocol and standard operating procedures
Authors: JIOM
Published: July 2024

N/A
Management of adhesive intestinal obstruction
Authors: Niyaf A. , Bhandari R.S , Singh K.P.
Published: July 2024

Introduction: Adhesive intestinal obstruction is an inevitable complication of abdominal surgeries. It has high morbidity with associated poor quality of life and predisposition to repeated hospitalization. Commonest cause of bowel obstruction in developed countries is postoperative adhesions with extrinsic compression of the intestine. Most of them can be managed conservatively.
Methods: A retrospective study of 30 patients admitted with the diagnosis of post operative adhesive partial bowel obstruction was conducted by analyzing their medical records. Demographic data, clinical presentation including duration, previous surgical procedures, treatments received for the condition and successful conservative approach versus requirement of operative intervention were assessed. Results: The median age was 31 yrs, most in their third decade of life. Male predominance was noted. Pelvic surgeries and gynecological surgeries (26%) were found to be the most common cause of adhesive bowel obstruction followed by appendectomy (16%). More than two third of the patients (76.7%) developed symptoms within two years of the initial surgery. Successful conservative treatment was noted in 22 patients (73.3%) and discharged on fourth day of admission. Eight patients (26.6%) underwent surgery. They all underwent adhesiolysis and had good outcome.
Conclusions: The time-honored practice of expectant management of adhesive partial bowel obstruction has equally good outcome, as compared to various interventions practiced
Tuberculosis is still a cause of infertility in developing countries
Authors: Pant P.R.
Published: July 2024

Introduction: Infertility is global problem. Tuberculosis salpingitis is a very rare condition in developed countries but in developing part of the world it is still a problem. One of the commonest symptoms of pelvic tuberculosis is primary infertility. Though infrequent, pelvic tuberculosis is still a cause of infertility in Nepal.
Methods: This is a prospective descriptive study conducted in the ‘Infertility clinic’, Department of Obstetrics and Gynaecology, Tribhuwan University, Teaching hospital, Kathmandu in 2423 patients from April2005-March2009. All couples were investigated with simple non invasive tests like total blood count with erythrocyte sedimentation rate (ESR), mantoux test, Adenosine diaminase (ADA), polymerase chain reaction (PCR), to invasive procedure like endometrial biopsy to rule out tuberculosis.
Result: Of the total of 2423 infertility among the 37 cases were found to have pelvic tuberculosis contributing to infertility. Of them, 19 patients of them were investigated in private centers for infertility and none of them had investigations for tuberculosis. Out of these 19 cases 5 women were treated in the line of tubal block by hydrotubation without performing investigations for tuberculosis. All of these 37 patients had suspicion of tuberculosis either in the history or investigation. After treatment six patients conceived but only two had successful pregnancy.
Conclusions: Pelvic tuberculosis is still a problem in Nepal affecting the fertility and hence should be considered in the management
Upper gastrointestinal bleeding in chronic pancreatitis
Authors: Kandel B.P , Ghimire B. , Lakhey P.J , Shrestha U.K , Khakurel M.
Published: July 2024

Pseudoaneurysm of peripancreatic vessels is a rare complication of chronic pancreatitis. Being close to the pancreas, splenic artery is the most frequently affected vessel whereas right gastroepiploic artery pseudoaneurysm is very rare. Rupture of such pseudoaneurysm is a rare cause of upper gastrointestinal (GI) bleeding. We report a patient of chronic pancreatitis with past history of pancreatic duct stenting who presented with massive upper GI bleeding and stent migration. Bleeding from pseudoaneurysm of right gastroepiploic artery was detected in angiography. Coil embolization was done but later rebleeding occurred and was managed with laparotomy and ligation of the pseudoaneurysm. Patient improved during postoperative period.
Incidence and risk factors of low birth weight babies born in Dhulikhel Hospital
Authors: Singh S. D. , Shrestha S. , Marahatta S. B.
Published: July 2024

Introduction: WHO defines low birth weight (LBW) as a birth weight less than 2500 grams. Almost a third of the newborn in South East Asia Region is a low birth weight baby. Many risk factors contributing to LBW have been recognized, which in order of importance are low maternal weight, low maternal hemoglobin, low maternal height, primi-parity, adolescent mother and poor or inadequate maternal nutrition during pregnancy. Low birth weight babies have a higher risk of morbidity and mortality than an infant of normal birth weight. The present study was carried out to explore the associated risk factors of low birth weight which will be beneficial to undertake effective measures to reduce the burden of the low birth weight.
Methods: This was a hospital based case control study conducted in Dhulikhel hospital, Kavre, Nepal from Jan 1st 2008 to 30th  May 2010. A total of 401 cases and an equal number of age matched controls were taken to assess the different risk factors of the mother for LBW babies. Ethical approval for the study was taken from KUSMS-Institutional research committee. Data analysis was done using SPSS version 10.0.
Results: Data of 401 LBW and equal number of normal birth weight babies were analyzed. The incidence of LBW in this study was 11.07%. LBW was more common in female (n=236) than in male(n=165) babies. However, this difference was statistically insignificant. Among the case and the control group, maternal hemoglobin (p<0.001), maternal height (p<0.001), maternal weight gain (p<0.0001), number of ANC visits (p<0.0001) were statistically significant. However, with regards to ethnicity, nutrition during pregnancy, parity and age of the mother the association were insignificant. Ethnical group, nutrition during pregnancy, age of mother and parity was found to be statically insignificant for LBW.
Conclusions: LBW is a common problem of the developing world, which is an important factor for perinatal mortality and morbidity. Maternal height, hemoglobin, total weight gain and ANC visit were found to be the significant risk factors contributing to LBW.