bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost of treating Insulin-requiring diabetes in children and adolescents
Authors: Onyiriuka N. , Ezomo O. O. , Onyiriuka R. C.
Published: July 2024

Background: Childhood diabetes care imposes a heavy economic burden on the patient’s family and all those involved in the provision of this care need to be aware of what factors drive cost.
Methods: Using an interviewer-administered questionnaire data was obtained from eleven respondents (parents of diabetic children) on their expenditure on items of direct cost such insulin, syringes, cotton wool, methylated spirit, transportation, consultation, and glucometer with the test strips. Data was also obtained on income of the household, ability to cope with payment for medical care and sources of money used for such payment.
Results: The estimated mean monthly direct cost of routine diabetes care was ten thousand nine hundred and fifty Naira [(N10,950+4,698); 95% Confidence Interval, CI = 8,674-13,726] with purchase of insulin accounting for 51.1% of this cost. Money spent on purchase of insulin alone represented 43.7% of the average monthly household income. Eighty percent of the parents expressed varying degrees of difficulty coping with payment of direct cost of diabetes care.
Conclusion: Insulin-requiring diabetes imposes a heavy economic burden on the family of the patient with cost of purchase of insulin contributing the highest proportion among items of direct cost.
Seizure precipitated during long haul flight
Authors: Devkota A. R. , Karki A. R.
Published: July 2024

We report three diagnosed cases of epilepsy under medication that were on long haul flight from Kathmandu to different destinations in USA with different clinical outcomes during flight. The first case had brief seizure like episode during flight and was given oral benzodiazepine. The second case was put on prophylactic oral benzodiazepine to induce sleep and reduce seizure threshold and had an uneventful flight. The third case developed generalized tonic clonic seizure and was managed accordingly.
 
Key words: Epilepsy, long haul flight, seizure.
IOM Smart Health Line: Giving back
Authors: Vaidya Pradeep
Published: July 2024

N/A
Changing Trends in Peripartum Hysterectomy at Tertiary Institute in Nepal
Authors: Bista KDB
Published: July 2024

Introduction: Peripartum hysterectomy refers to hysterectomy done during or immediately after delivery for obstetrical reason. The decision of hysterectomy is not an easy one as not doing it could lead to death whereas the surgery results in permanent loss of ability to bear a child and this too in a young woman.
Methods: This was a prospective study done over a period of 16 years from 1997 to 2013 by following all cases that underwent hysterectomy for obstetric causes during or after delivery and up to 6 weeks after delivery, in Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Nepal. The various factors were analyzed and data presented in percentages, means and odds ratio was calculated as necessary. P value less than 0.05 was taken as significant.
Results: The emergency peripartum hysterectomy rate was 0.05%. Placental abnormality was the most common indication (42.6%) followed by uterine atony (35.7%) and uterine trauma (17.9%). Cesarean Hysterectomy accounted for 50% of the cases. In the last 16 years there was an increased trend of Cesarean section from 18.6% to 30.7% which coincided with an increased Cesarean Hysterectomy from 36.4% in the initial 8 years to 58.8% in the last 8 years. Placental abnormalities as an indication increased over uterine atony in the last 8 years. The most common risk factor was Cesarean section (71.4%) followed by placental abnormalities (42.8%) and previous abortion in 32.1% cases.
Conclusion: Emergency Peripartum Hysterectomy rate was 0.05%. Increasing Cesarean section rates were associated with increasing Cesarean Hysterectomy rates.
Microalbuminuria as a Marker of Preclinical Diastolic Dysfunction in Newly Diagnosed and Never-Treated Essential Hypertension
Authors: Gajurel R M , Sayami A
Published: July 2024

Introduction: Hypertension (HTN) is a global public health problem with one fourth adults worldwide estimated to have high blood pressure (BP)1 The incidence of hypertension continues to increase in all developed and developing societies as the population grows older and more obese.2 The Framingham Study and other epidemiological surveys have clearly defined HTN as an important cause of morbidity and mortality.2-4 The aim of this study was to determine the spot urine Microalbuminuria as a marker of preclinical cardiac structural and functional changes in the form of left ventricular diastolic dysfunction in newly diagnosed and never treated essential hypertensive subjects.
Methods: A cross sectional study was used for those patients who were attended outpatient clinic of MCVTC with diagnosis of newly diagnosed and never treated hypertension over a period of October 2011 to November 2012.
Results: A total of 130 essential hypertensive patients underwent for spot urine for microalbuminuria estimation and Echocardiography for evaluation of left ventricular diastolic function. Among 56 (43.1%) urine samples showed negative test [(Microalbuminuria -); ( UACR 30 mg/Gm)] and those 74 (56.9%) samples revealed positive test [(Microalbuminuria+); (UACR 30 to 300 mg/Gm)]. Patients with microalbuminuria positive was found to have more left ventricular diastolic dysfunction than those who were negative for Microalbuminuria.
Conclusion: Microalbuminuria was found to have early preclinical marker of myocardial dysfunction in the form of left ventricular diastolic dysfunction in new and never treated essential hypertension.
Hysterectomy in the Present Day for Dysfunctional Uterine Bleeding: a finding from Tertiary Care Hospital Nepal
Authors: Baral J , Gurung G , Kaudel S , Paudyal P , Chudal D , Shrestha P , Rana A
Published: July 2024

Introduction: Hysterectomy is a an operative procedure in gynecology, performed for benign or malignant indication, accomplished via abdominal or vaginal routes, technically as open or endoscopic surgery by various approaches; laparoscopic, laparoscopic assisted vagina hysterectomy or robotic surgery. This study was undertaken to analyze the indications of hysterectomies for benign condition with main focus on dysfunctional uterine bleeding (DUB).
Method: This study was conducted between 2009 April and 2014 March in the Department of Obstetrics and Gynaecology Tribhuvan University Teaching Hospital. Data were obtained from Operation Theater. Results were precisely reevaluated to find out the indication of hysterectomy done for benign etiology, routes of surgery.
Results: Fibroid, utrovaginal prolapsed (UVP), adenomyosis, endometriosis, dysfunctional uterine bleeding (DUB) and adnexal mass were the main indication in total hysterectomy (n1644) performed for benign aetiopathologies, most surgery being performed abdominally (n1126). DUB which were principally treated by hysterectomy and occupied the fifth position as an indication had the postoperative diagnosis other than DUB on histopathological examination in more than 50%. The endometrial pathologies in the operated cases showed endometrial hyperplasia in three cases and adenocarcinoma in one.
Conclusion: Presently, abdominal hysterectomy is seen as the only available surgical option for DUB, indicating a need for a change in practices favoring organ preservation.
A Retrospective Review of Elderly Patients admitted in Psychiatry Department of a Tertiary care center Over 3 Years
Authors: Dhungana S , Chapagai M , Tulachan P , Ojha SP
Published: July 2024

Introduction: Psychiatric morbidity is high in the elderly population. Despite this, literature regarding inpatient study in elderly is lacking in context to world, including Nepal. This study aimed to study the socio-demographic variables and patterns of psychiatric illnesses in elderly patients admitted in a psychiatry ward of a tertiary hospital.
Methods: This was a retrospective study of all elderly patients aged 60 years and above admitted in psychiatry ward over three years period between 2067 Baisakh to 2069 Chiatra (2010 April to 2013 April). Data were collected by reviewing in-patient admission charts from medical records. Descriptive analysis was done by using SPSS version 20; Chicago, IL; and results were expressed as percentages.
Results: There were a total of 881 patients admitted in the psychiatry ward during the study period, among which 34 were elderly aged above 60 years. Females slightly predominated in our study. Most of the geriatric sample consisted of Brahmins and all were Hindus. More than 50% of the patients were from central developmental region. The most common diagnosis made was depression followed by schizophrenia Persistent Delusional Disorder (PDD) and organic conditions. Majority of the patients had hospital stay between 2-3 weeks; and all patients were discharged home without mortality.
Conclusion: We were able to show the socio-demographic characteristics of elderly patients admitted in a psychiatry ward of a tertiary care center, which will help add insight of psychiatry issues in elderly in Nepalese context.
Ameloglyphics: a Novel appraisal of the Enamel Structure in Identification of an individual
Authors: Dahal S , Boaz K , Srikant N , Agrawal NK
Published: July 2024

Introduction: Ameloglyphics is a newly emerging field that studies the patterns of enamel rods. Amelo means enamel and glyphics means carving. It is said by some investigators that the patterns of enamel rods are unique to each individual.
Methods: The aim of the study was to estimate and categorise tooth print patterns among 30 teeth of known age and gender and to analyze the variation among carious and non-carious teeth. The tooth surface was etched and imprint was transferred to a slide using an adhesive tape. Further evaluation was done under light microscopy by using verifinger SDK software.
Results: The various patterns observed were straight, wavy, branched, looped, intersecting and radiating. The carious teeth and deciduous dentition showed predominance of wavy and straight pattern which is in accordance with their softer nature and increased susceptibility to bacterial invasion.
Radiation Hazards and Protection: are Nepalese Radiologists Up to Date?
Authors: Subedi K , Suwal S , Pant OB
Published: July 2024

Introduction: Radiation safety is a major concern in this modern era of diagnostic and therapeutic radiology. Institutions in Nepal still lack the adequate standards to maintain radiation safety. This study was conducted to assess the status of update on radiation hazards and methods of protection among radiologists in Kathmandu.
Methods: A questionnaire survey was performed during continuing medical education program at Tribhuvan University Teaching Hospital, Kathmandu before and after a lecture session on radiation hazards and protection.
Results: A total of 28 participants volunteered to answer the questionnaire. The mean pretest score was 57.8±29.7, which increased to 83.5± 16.8 after the lecture session. Twelve (42.86%) participants scored less than 50%, which increased significantly comparable to the rest (scoring more than 50%) in posttest score. Mean score was least in ionizing radiation questions.
Conclusion: The update on radiation hazards and methods of protection is inadequate among radiologists in Kathmandu. Continuing medical education programs pertinent to the topic must be regularly conducted to keep the radiologists up to date.
Outcome of in-hospital resuscitation in a tertiary level teaching hospital in Nepal
Authors: Pradhan B
Published: July 2024

Introduction: Cardiopulmonary resuscitation (CPR) is being used extensively in the hospital settings for life saving purposes. Resuscitation guidelines are reviewed and published frequently for better outcome of the patient. The objective of this study was to identify predictors of outcome of CPR and compare the outcome of PR with other centers.
Method: This is a retrospective analytical study of one year duration carried out in tertiary level teaching hospital. Data were collected and then entered in Microsoft excel software with all the variables. Statistical analysis was done using Statistical Package for Social Sciences 17 software.
Results: There was no influence of gender, age, time of call and site of call on outcome of CPR. Strong correlation was observed with primary rhythm of the patient at the time of CPR, with better outcome for ventricular fibrillation (VF) & pulseless ventricular tachycardia(VT) (survival 65%), and worse for asystole (survival 25%) and pulseless electrical activity (survival 54%).
Conclusion: In this study it was found that primary rhythm at the time of CPR is strong predictor of survival. Outcome of CPR in this centre is comparable to other centres following standard protocols for CPR.
Comparison of Subjective Global Assessment and Nutritional Risk Index on Outcome after Abdominal Surgery
Authors: Gupta DK , Sharma MR , Ghimire B , Vaidya P
Published: July 2024

Introduction: Preexisting malnutrition in surgical patients has been conclusively correlated with complications such as wound infection and myriad of other adverse outcomes during and after hospitalization. So, it is imperative to recognize and manage this status preoperatively in an effort to improve outcome. The aim of the study was to compare the Subjective Global Assessment (SGA) and Nutritional Risk Index (NRI) with outcome after abdominal surgery.
Methods: This is a prospective study conducted at the Department of Surgery, Tribhuvan University Teaching Hospital, Nepal, for the period of one year. The study included a total of fifty patients undergoing abdominal surgery. Patients were assessed with two types of nutritional assessment techniques, namely, SGA and NRI. The outcome parameters included were wound infection, and chest infection, and length of hospital stay.
Results: No complications occurred in 24 of the 50 patients; 13 patients had more than one complication. The frequency of malnutrition was found to be 74% and 80% as assessed by SGA and NRI respectively. Morbidity rate was significantly higher and length of hospital stay was also longer in malnourished patients assessed by SGA group. Wound infection rate was significantly higher and length of hospital stay was also longer in malnourished patients when assessed by SGA. The area under the receiver operating characteristics curve for SGA and NRI revealed that SGA was better for predicting overall morbidity as well as specific complications than the NRI. Three patients died during treatment period.
Conclusions: Malnutrition is a marker of poor postoperative outcome. Subjective Global Assessment is better than Nutritional Risk Index to predict postoperative complications in patients undergoing abdominal surgery.
Stress among PCL Nursing Students of TUIOM Nursing Campuses in the Kathmandu Valley
Authors: Shrestha T
Published: July 2024

Background: Stress is common among students and even more common among nursing students. They have similar stresses to other students such as examination pressure, assignment load, lack of free time, family and other personal commitments as well as challenges of clinical practice. Continuous high level of stress may influence the learning process and patient care. So this study was conducted to identify the stress among Proficiency Certificate Level (PCL) nursing students.
Methods: Descriptive cross sectional study was conducted among 287 PCL nursing students currently studying in different level in nursing campuses of the Institute of Medicine during June and July 2013. Self-administered semi structured questionnaire and rating scale was used for the data collection.
Results: The most common stress was personal-environmental stress (mean 3.17±0.67) followed by clinical stress (2.99.60.51) and academic stress (2.97.10.61). Academic and personal stresses were more common among third year (3.03.10.63 and 3.24.10.73 respectively) while Clinical stress was common among second year students (mean 3.11 10.51). Stress was least among first year students.
Conclusion: The finding shows prevalence of stress among PCL nursing students. Stress is more common among second and third year than in first year students. Issues like assignment load in clinical, gap between theory and practice, test and examination, length of class, parental expectation, and change in eating-sleeping pattern, lack of play and recreational activities are felt as common stressors. These factors should be considered by faculties, administration as well as parents to minimize PCL nursing students' stress.
Development of Skin Disease Disability Index to Assess the Dermatologic Burden in Nepal
Authors: Shrestha DP , Shrestha R , Gurung D , Lama L , Roshdal I
Published: July 2024

Introduction: Skin disease is one of the leading cause of morbidity worldwide. Most instruments measuring the impact of skin disease on quality of life are developed in the west and not applicable measuring the impact of skin disease on quality of life are developed in the west and not applicable to the  socio-cultural situation in Nepal. The aim of the study was to develop and validate a questionnaire to measure quality of life impairment due to skin disease in Nepal.
Methods: Different aspects of quality of life impairment were identified from 35 in-depth. Different aspects of quality of life impairment were identified from 35 in-depth interviews and two focus group discussions, with villagers with various skin diseases. Based interviews and two focus group discussions, with villagers with various skin diseases. Based on this information, 10 questions scoring the influence of skin diseases on quality of life – Skin on this information, 10 questions scoring the influence of skin diseases on quality of life – Skin Disease Disability Index (SDDI) – was developed. This instrument was tested and validated in Disease Disability Index (SDDI) – was developed. This instrument was tested and validated in 212 villagers with skin disease and in 100 healthy villagers.
Results: The maximum total Skin Disease Disability Index score was 36. There was a wideThe maximum total Skin Disease Disability Index score was 36. There was a wide variation in total Skin Disease Disability Index score between individuals with skin disease variation in total Skin Disease Disability Index score between individuals with skin disease (range 1-33) with a mean score of 13.2, while in controls the mean total score was 1 (p<0.001).(range 1-33) with a mean score of 13.2, while in controls the mean total score was 1 (p<0.001). Thus, the Skin Disease Disability Index clearly discriminates between these two groups. The Thus, the Skin Disease Disability Index clearly discriminates between these two groups. The difference in mean score for single questions between patients and controls was also highly significant (p<0.001).
Conclusions: The questionnaire clearly covered all aspects of quality of life related to skin disease and was, simple, robust, easy to use and well accepted by the selected population. The Skin Disease Disability Index was reliable in the overall score as well as in individual questions.
How Effective is Non-surgical Management in Pediatric Intussusception?
Authors: Pokharel R
Published: July 2024

Introduction: Intussusception is common in infants and young children. Healthy babies are prone to this problem. Severe intermittent pain, vomiting, pallor, and sweating are suspicious to this problem. Early diagnosis helps to prevent surgical intervention. Late presentation may lead to intestinal perforation and serious complications.
Methods: Diagnosed cases of intussusception within a year at TUTH were studied prospectively. Patients initially evaluated with ultra sonogram. Patients without complications and contra indications were taken to the radiology department for reduction by non-surgical method (Barium enema). Complicated and contraindicated cases managed surgically.
Results: Total 21 cases admitted within a year. Male: Female ratio was 2:1. Mean age at presentation was 20.05 months (5 - 48 months). The average symptoms duration was 36.11 (6-72) hours. Abdominal pain & cry, vomiting, and blood in stool were common presenting symptoms.
Among 21 cases, 18 underwent non-surgical procedure: two were contra indicated for it and one self reduced. In non-surgically managed group 13 had successful reduction and five failed. Failed cases were managed surgically.
In our series, two recurrences noticed. One in surgically managed group, presented after five months of surgery and managed successfully with non-surgical method. Second case was in non-surgical group, presented after three months of first reduction. This was also managed successfully by non-surgical technique.
Conclusion: Early detection and complete diagnosis of pediatric intussusception is desirable for non-surgical management. Surgical intervention is considered only in contra indications, unsuccessful, and perforation during non-surgical procedures. Ultrasonography is the diagnostic choice but operator’s variation should consider.
Evaluation of Mannheim Peritonitis Index for Predicting Outcome in Emergency Exploratory Laparotomy for acute peritonitis
Authors: Paudel P , Tiwari A , Pradhan GBN , Shrestha S , Bhattachan CL
Published: July 2024

Introduction: Exploratory laparotomy is one of the commonest emergency procedure performed by general surgeons in daily practice. Due to heterogenisity of conditions required in exploratory laparotomy, the outcome is to variable. It is often difficult to predict outcome of such patients server scoring system are available to predict outcome to patients undergoing exploratory laparotomy for acute peritonitis. The aim of this study is to evaluate the role of Mannheim Peritonitis Index (MPI) score is predicting the outcome to patience you need exploratory laparotomy for acute peritonitis.
Methods: This is our prospective analysis of 86 patients who underwent emergency exploratory laparotomy over past 2 years. The mean age of patient was 41 years and 29 (33.7%) were female. All the patients had presented to the emergency with features of peritonitis. Two patient presented with shock. Hollow viscus perforation was present in 37 patients, intestinal obstruction in 31 patients and 18 patients had various other pathologies. There were total 29 complication including 10 mortalities. The mean MPI score was 21.2 ± 8(4 – 39). There was significant correlation of MPI with mortality (p<0.05).
Conclusion: the MPI score can provide simple and objective means to predict the outcome of patients with peritonitis.
Complications of warfarin in post operative heart valve surgery
Authors: Pradhan N , Bhandari NR , Bharati L
Published: July 2024

Introduction: Thromboembolic complications and bleeding are the major complications of warfarin. The aim of the study was to focus on the complication of warfarin and monitoring post-valve surgery.
Methods: A combined retrospective and prospective study was done in post mechanical heart valve surgery patients at Manmohan Cardiothoracic Vascular and Transplant Center. The study was carried out for 4 months by interviewing patients with self-administered structured questionnaire about any complications during their follow up in OPD and monitoring for their INR values.
Results: The majority of patients studied wer male 42 and 56 were female. 55 patients underwent mitral valve replacement, 22 underwent double valve replacement and 46 underwent aortic valve replacement. There were a total of 59 cases of bleeding complications. Hemoptysis was the most common bleeding event .Pericardial bleeding was the most common major bleeding complication with 3.1%. In patients taking warfarin major bleeding complication was 10.2% and minor bleeding was 50%. Out of total INR reading 47% were out of the target INR range, with 19.5% above range and 27.5% below range.
Conclusion: Minor bleeding was the most common type of bleeding. A system for proper monitoring of warfarin can bring improvement in better dose adjustment to achieve more appropriate INR values and eventually minimizing warfarin related complications. Introducing pharmacist monitored anticoagulant clinic can reduce the work load of physicians and overcome the time barrier.
Video-Thoracoscopic Management of Empyema Thoracis in tertiary level thoracic unit
Authors: Shrestha UK , Thapa B , Baral R , Sapkota R , Sayami P
Published: July 2024

Introduction: Thoracic empyema is a common problem. Use of minimal access surgery for the treatment is comparatively new. We audited our results with VATS in thoracic empyema.
Methods: We analyzed the retrospective data from the patients who received Video-Assisted Thoracoscopic Surgery (VATS) for empyema thoracis from April 2011 to April 2013 at Manmohan Cardio-thoracic Vascular and Transplant Center (MCVTC).
Results: Of the 44 patients who underwent surgery for empyema of various stages, 37 patients underwent the procedure via VATS. The average age was 26.4 ±17.19 yrs (1-64). The male to female ratio was 2:1. The duration of symptoms before VATS intervention varied very widely (7-712 days avg: 92.7±28.8 days). The duration was 32 days on an average among patients in whom deloculation sufficed but was 111 days among those in whom decortication was required. A complete VATS procedure with satisfactory lung expansion at the end of the procedure was possible in 34 patients (100% patients who underwent deloculation and 88% of those who underwent decortications). Inadequate lung expansion forced conversion in three and subsequent collapse necessitated re-operation in one. The operative times were: VATS converted to open decortication (150 mins), completed VATS decortication (60-180 mins, avg: 125.7 mins) and VATS deloculation (45-120 mins, avg: 69 mins). Post-operative chest tube drainage was shorter in patients in whom a successful VATS procedure was completed 4.0 Vs 40 days).
Conclusion: Videothoracoscopic approach is feasible in surgical management of empyema thoracis. The results seem to be better in earlier stages.
Prevalence and recognition of depressive disorder at a primary health care centre in Pakistan
Authors: Koirala NR , MH  , Minhas FA , Mirza ZI
Published: July 2024

The aim of the study was to determine the prevalence and recognition of depressive disorder at a primary health care centre in Pakistan. A purposive sample of four hundred consecutive adult primary health care attenders was screened using GHQ-12. In the second-stage a total of 271 subjects (256 High scorers and 15 Low scorers on GHQ-12) were assessed using ICD-10, DCR as a diagnostic instrument. The prevalence rate of depression using ICD-10 DCR was 22.25%. The corresponding rate for the Primary Health Care Physician was 11.43%, suggesting that Primary Care Physicians recognised depression in almost 58.49% of the patients who fulfill the ICD-10nDCR for depressive disorder. In primary care, depression constitutes major health problem. Despite this fact, Primary Health Care Physicians do not recognise a substantial proportion of this disorder.
Outcome of primary percutaneous coronary intervention versus thrombolysis in ST segment elevation myocardial infarction in tertiary Centre
Authors: Barakoti MP , Sayami A , Paudel CM
Published: July 2024

Introduction: As myocardial infarction has become leading cause of death throughout the world, reperfusion therapy either by fibrinolysis or with primary percutaneous coronary intervention (PCI) in appropriate patients becomes necessary. The study aims to evaluate the outcome of patients with ST segment elevation myocardial infarction treated with PCI and fibrinolysis in our setting.
Methods: Retrospective analysis for risk factors, complication and in-hospital mortality was done in patients presented with acute ST segment elevation myocardial infarction to emergency department of Manmohan cardiothoracic vascular and transplant centre from April 2012 to April 2013.
Results: Total 36 patients were admitted in the study period with ST elevation myocardial infarction and candidate for reperfusion. Half of them had undergone primary PCI. Patients on PCI group were having more Anteroseptal wall involvement, diabetes mellitus, higher Killip class at admission and few patients presented later than 24 hours than in fibrinolysis group. The overall complication rate and in-hospital mortality were similar in both groups (P= 0.062, 0.572 respectively).
Conclusion: This study showed similar mortality and complication rate in primary PCI group and Fibrinolytics group in spite the fact that patients in the PCI group had higher baseline risk.
Delayed management of ruptured ectopic pregnancy: an observation of concern
Authors: Rana A , Gurung G , Singh M , Pradhan N
Published: July 2024

There were 82 cases of ruptured ectopic pregnancies during a 6-year period, (2049- 2054) April 1992-1998. Associated high risk factors were proven PID (3), infertility (10), sterilization (4), previous ectopic (6), IUCD (1). One of the cases had clomiphen citrate and the other was an OCP for cystic ovary. Atypical presentations were malaena (2) and intestinal obstruction (1). Symptoms and admission interval varied from 1 hour to more than a month in 8 cases. Surgical intervention was undertaken at an earliest in 2hours and delayed beyond 1-2 weeks in 7 cases. Surgical management was delayed beyond 6 hours (69.5%) and 12 hours (56%) respectively. This delay was mainly due to misdiagnosis (45%) as the symptoms of PID (3), DUB (1), and pelvic abscess (1) overlapped with ectopic. Improper and inadequate referral due to inexpert opinion at admission was another cause for delay.
Forty-two point six percent had significant haemoperitoneum, of which 39.4 needed blood transfusion. Two cases had tubal reconstruction and two underwent hysterectomy.We emphasize to overcome the diagnostic dilemma by adopting sensitive BhCG using monoclonal antibodies, TVS and laparoscopy whenever necessary along with active surgical team to cut short the delay in operative management of ruptured ectopic.
Extracorporeal Shock Wave Lithotripsy for urolithiasis; a single center study
Authors: Sharma UK , KC Nagendra
Published: July 2024

Introduction: The introduction of extracorporeal lithotripsy (ESWL) revolutionized the treatment of urinary stones since its invention in early 1980s.At many institutions, ESWL is the procedure of choice for proximal ureteric stones and renal stones. This paper analyzes and provides a general approach to the ESWL patients, discuss the outcomes and problems area, as well as to develop awareness among the patients necessitating stone management.
Methods: This was a prospective observational study. Total of 91 cases were included in this study. Patients from different clinics and OPD were selected for ESWL therapy. Study period were from Jan 2011 to June 2012. All the patients had undergone excretory urogram before selecting for the SWL in order to rule out distal obstruction and to assess the size of the stone and its location.
Results: More than 90 patients with renal and upper ureteric stones were subjected for ESWL over one and half year’s period (Jan 2011- Jun 2012) in an ESWL center in Kathmandu.
Conclusion: ESWL is an effective and patient friendly means to treat upper urinary and renal stones. Stone size, and location greatly affect the stone free rate, morbidity and secondary procedures following ESWL.
Seasonality of tuberculosis among suspect patients visiting National Medical College, Teaching Hospital, Birgunj, Nepal
Authors: Shidiki A , Pandit BR , Bhargava D , Mondal S , Rijal BP
Published: July 2024

Introduction: Seasonal variations of tuberculosis have been demonstrated in a number of studies with reported peaks in late winter and early spring or summer. The study was to analyze effect of seasonal variation on tuberculosis suspects across the calendar year.
Methods: The research work was conducted in National Medical College & Teaching Hospital from January to December 2012. The sputum samples were collected and processed for acid fast bacilli from suspected tuberculosis patients.
Results: Among 1403 suspected tuberculosis patients, 57.0% were male and 43.0% were females. 11.3% male and 4.0% female were present among the suspected cases of tuberculosis. The highest number of cases was in the age group 51-60.There was no any significant difference in between positive cases and age group (P=0.637). The positive cases of tuberculosis were found in 8.7% Muslim and 8.1% Hindu significant difference was not found in religion and tuberculosis (P=0.780%). The highest cases of tuberculosis was detected in June (14.9%) and to decline from august (13.2%) through December (4.4%). There was significant relation for cases and month (P=0.00001). More severe (3+) cases were found more (10.6%) in June, 2+ (4.4%) in July and 1+ (9.7%) in August which was statistically significant (P=0.00001).
Conclusion: The seasonal variability of tuberculosis case detection showing mostly a peak in numbers in early spring and summer months.
A Rare Case of Synchronous Renal Cell Carcinoma and Adrenocortical Carcinoma
Authors: Gupta DK , Chapagain S , Subedi PP , Luitel BR , Maskey P , Chalise PR , Sharma UK , Gyawali PR , Shrestha GK , Joshi BR
Published: July 2024

We report a rare case of synchronous adrenocortical carcinoma and renal cell carcinoma. A 60 year male, a known diabetic and hypertensive under treatment, while undergoing routine investigations and ultrasonography of abdomen, was incidentally detected to have adrenal as well as renal masses. On computed tomograghy scan right adrenal mass measured about 10 x 8 cm while the renal mass was 4.6 x 3.8 cm in size, Urinary vanillylmandelic acid and 24 hr urine metanephrine were within normal limits. Similarly, serum cortisol and dihydroepiandrosterone were in normal range. Patient underwent right adrenalectomy with right partial nephrectomy. Histopathological examination of adrenal mass revealed adrenocortical carcinoma while that of renal mass revealed clear cell renal cell carcinoma.
Neurological Complications in Surgical Management of Carotid Body Paragangliomas
Authors: Shrestha UK
Published: July 2024

Introduction: Carotid body tumors are rare neoplasm and must be considered in the evaluation of all lateral neck masses. Though surgical excision of carotid body tumor is a challenge to the surgeon, early surgical excision is considered. Cranial nerve injuries are common because of its proximity to the carotid body tumor.
Methods: Fifteen carotid body tumors operated on 14 patients over ten year period from July 2003 to June 2013 were retrospectively reviewed. Six (42.9%) of the patients were male and eight (57.1%) were female. The average age was 41.9 years (23 to 70 years). Physical examination, radiological evaluation, method of treatment and postoperative complications were studied. Four cases belonged to Shamblin class II and 11 to Shamblin class III. Six (40%) cases were operated with carotid shunt and four (26.7%) with clamping of carotid artery. Division of external carotid artery was required in five (33.3%) cases. Polytetrafluoroethylene  graft was used to maintain continuity of internal carotid artery in three (20%) cases and external carotid artery was transposed to internal carotid artery in one (6.7%) case.
Results: Complete resection was possible in all cases. Cranial nerve palsies were noted in five (33.3%) cases. Two of them had complete recovery whereas three (20%) had permanent palsy. No stroke and mortality occurred.
Conclusion: Carotid body tumor has higher risk of cranial nerve paresis which requires good surgical skills to ensure complete removal. Vascular excision with continuity to internal carotid artery may be required while undertaking complete carotid body tumor excision.
Retrospective study on extracranial neck schwannomas in tertiary care hospital in Nepal
Authors: Shrestha UK , Shrestha KR
Published: July 2024

Introduction: Schwannomas are relatively rare tumors arising from Schwann cells that ensheath the peripheral nerves. The study aim was to identify extracranial neck schwannomas treated in a tertiary care hospital in Nepal.
Methods: We reviewed medical records of all patients with extracranial head and neck schwannomas treated at our department from July 2004 to June 2014.
Results: Ten such patients consisted of 7 males and 3 females were identified, with a mean age of 37.8 +/- 10.7 years (range: 20 to 54 years) with solitary schwannomas. Mean size of tumor was 5 cm (range: 2-10 cm). Most of the patients (60%) presented with asymptomatic palpable mass. Of these ten, 50% had a left sided neck mass. Seven originated from vagus nerve while three from sympathetic chain. The average duration of symptoms ranged from one month to two and half years. In all cases, tumor was completely resected through cervical approach. All tumors were enucleated keeping nerve of origin intact. In all cases, the tumor was completely resected surgically. The average follow up period ranged from one month to 108 months (median: 24 months). No major postoperative complications were noted. Two patients (20%) developed Homer's syndrome and one (10%) had temporary hypoglossal nerve palsy which recovered within three months.
Conclusion: Non-vestibular extracranial head and neck schwannomas most frequently present as an innocuous longstanding unilateral neck mass. The mainstay of treatment is complete excision preserving the nerve of origin. Early recognition of Schwannomas is key to optimal treatment.
Spectrum of MRCP findings: An Initial Experience with 3.0 Tesla Magnetic Resonance Imaging System in Nepal
Authors: Gurung GS , Subedi K , Karki DB
Published: July 2024

Introduction: Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive magnetic resonance imaging (MRI) examination used in the evaluation of hepatobiliary and pancreatic tree. It is a non-invasive alternative to endoscopic retrograde cholangiopancreatography (ERCP). Here we attempted to summarize the spectrum of MRCP findings in a cohort of patients undergoing MRCP examination in a 3.0 Tesla MRI system, the first of its kind in Nepal.
Methods: The study was carried among patients undergoing MRCP in a 3.0 Tesla MRI system from November 24, 2014 to June 29, 2015. 167 patients (73 male and 94 female, age range, 1-87 years, mean age, 49.8years) were identified who underwent MRCP. MRCP was performed on a 3.0 Tesla MR scanner (Ingenia, Philips Medical System) using a sixteen-element quadrature phased array body coil over the liver. The MRCP findings were reviewed and various imaging findings were recorded. The findings were analyzed using SPSS.
Results: MRCP was normal in 44(26.2%) patients. Various findings were found in the biliary ducts, liver, gall bladder, pancreas and outside the pancreas and liver. Commonest biliary duct pathology was choledocholithiasis (25.7%). Commonest liver pathology was chronic liver disease (3%). Commonest pancreatic parenchymal pathology was acute pancreatitis (4.2%). Commonest pancreatic duct pathology was dilated pancreatic duct (5.4%). Gall bladder was seen in 37 (22%) patients, and 30 patients were status post cholecystectomy (17.9%). Extra pancreaticobiliary findings included pleural effusion, ascites, splenomegaly, juxtapapillary duodenal diverticulum etc.
Conclusion: MRCP is the choice of investigation for the non-invasive diagnosis of pancreaticobiliary disorders. In the current review, we have summarized the spectrum of MRCP findings and shared an early experience with 3.0 Tesla MRCP system in Nepal. The findings are comparable to the existing literature in the subject.
Detection of Cryptosporidium, Giardia, fecal Indicator bacteria, and total bacteria in commercial jar water in the Kathmandu Valley, Nepal
Authors: Malla B , Shrestha R Ghaju , Bhandari D , Tandukar S , Shrestha S , Yoshinaga H , Inoue D , Sei K , Nishida K , Tanaka Y , Sherchand JB , Haramoto E
Published: July 2024

Introduction: Jar water is a convenient and common source of drinking water in the Kathmandu Valley. However, studies including detailed microbial analyses of this source of potable water are lacking. In this study, jar water samples were examined for the occurrence of Cryptosporidium, Giardia, fecal indicator bacteria, and total bacteria.
Methods: Thirty different brands of jars were collected in September 2014. Escherichia coli and total coliforms were determined using a Colilert reagent. Ten of the 30 brands were selected to test for Cryptosporidium, Giardia, and total bacteria. Bacterial DNA extraction from water samples was performed using the Cica Geneus DNA Extraction Kit, followed by quantitative polymerase chain reaction (qPCR) targeting the 16S rRNA gene of bacterial DNA. Protozoan detection was accomplished by concentrating the samples using the electronegative membrane vortex method. followed by immunomagnetic separation and fluorescent staining.
Results: E. coli was detected in 10% of the samples, with a maximum concentration of 2 most probable number (MPN)/100 ml., whereas total coliforms were detected in 97% of the samples, with a maximum and mean concentration of 7.3 x 102 and 3.8 x 10 MPN/100 ml., respectively. Total coliforms concentrations in 40% of the samples ranged from 10 to 10 MPN/100 ml. Cryptosporidium and Giardia were not detected in any of the tested samples. Concentrations of total bacteria in the samples ranged from 10 to 10 cells/100 ml.
Conclusions: Ninety-seven percent of the jar water brands were unsuitable for drinking without proper treatment based on the guideline values of the National Drinking Water Quality Standards (NDWQS) of Nepal. There is no guideline value for total bacteria in NDWQS however, high concentrations can be indicative of poor control on regrowth of bacteria and recontamination or inefficient water treatment methods.
Comparison of Axillary Temperature with Oral Temperature and Determination of Optimum Placement Time of Thermometer in Adults of Teaching Hospital, Nepal
Authors: Sharma M , Gautam R , Neupane B
Published: July 2024

Introduction: Accurate temperature measurement is important to person, in whom suspicion of infection could result in investigations, administration of antibiotics, and even hospital admission. This study was done with the aim to determine the optimal dwell time of the thermometer in oral and axillary sites required to accurately reflect the stabilized core body temperature.
Method: Cross-sectional survey of 113 adult patients was done who were admitted in Manmohan Cardio- Thoracic Vascular and Transplant Center (MCTVC) in the period between 16thJuly to August2013. Ethical approval from the Institutional Review Board (IRB) of TUIOM and permission from the respective hospital authority was taken before data collection. Conventional glass mercury thermometer were checked and brought to 95 degree of Fahrenheit before each measurement of the temperature. Two thermometers were simultaneously placed in oral cavity and in the axillary skin sites. Reading of the oral temperature was done in 1 and 3 minutes, similarly, reading of axillary temperature was done in 3 and 5 minutes. Data was analyzed in SPSS 18 by using parametric and nonparametric tests.
Results: Findings revealed the mean temperature difference between 1 minute oral to 3 minute axilla was 0.92 ± 0.79 SD, and the 3 minute oral to 5 minute axilla was 0.96 ± 0.82 SD, the difference was significant (P<0.05). Further, the mean oral temperature in 1 minute was 97.75 ± 1.27 SD, and in 3 minutes was 98.69 ± 1.37 SD. Similarly, mean temperature of axilla in 3 minutes was 97.67± 1.40 SD, whereas mean in 5 minutes was 98.43 ± 1.46 SD. The mean difference was significant.
Conclusion: The effective time to measure oral temperature was three minute and it was five minutes for axillary measurement.
Effectiveness of Educational Intervention on Life Style Management among Coronary Heart Disease Patients Attending a Cardiac Care Centre in Kathmandu
Authors: Shrestha R , Shrestha S
Published: July 2024

Adopting healthy life style reduces Coronary Heart Disease (CHD) progressions which help to enhance quality of life of CHD patients. The aim of this study was to identify the effectiveness of educational intervention on "Living well with CHD".
Methods: A one group pretest-post test design was used. The study was conducted during November to December 2015. Total 100 subjects were selected for pre test, base line information were collected using convenient sampling technique. The educational intervention package of one hour teaching sessions were arranged in separate room in OPD of Sahid Gangalal National Heart Centre (SGNHC) regularly for one week period with one session per day and each participant was provided the booklet prepared in Nepali language during the education sessions. After one month of education intervention program, post test was conducted with 90 subjects using same interview questionnaire and feedback questionnaire.
Results: The result shows that the knowledge regarding life style management was significantly higher among post test group than pre test group at 0.0001 levels. The percentage of respondents with inadequate level of knowledge decreased sharply from 57% to 1% where as those with adequate knowledge increased to 99% from 43%, which was found to be statistically significant (p value=0.0001).
Conclusion: Study concludes that the education intervention programme has considerably in increased knowledge regarding life style management among CHD patients. Therefore, it is recommended that this educational intervention programme may be conducted to CHD patients in similar settings with fruitful outcome.
Clinical and Echocardiographic assessment of Patient's with Rheumatic Heart Disease
Authors: Dali B
Published: July 2024

Introduction: In developed countries rheumatic heart disease (RHD) have become uncommon health problems. On the contrary, in the developing countries like Nepal they remain the leading cause of heart disease in children and young adults augmenting morbidity and mortality. The prevalence of RHD varies considerably through the world. The global average prevalence rate of RHD was 2.2/1000 ranging between 0.1 and 12.6 according to World Health Organization (WHO).
Community based data are not available regarding the prevalence and distribution of RHD whereas recent epidemiological data are limited to school surveys and facility based reports. Because of low enrollment rates and frequent absenteeism, these studies are unlikely to reflect accurately the epidemiology of RHD in Nepal. The aims of this study were to analyze the clinical presentation pattern of the involvement of various valves and complication in established RHD. To assess the accuracy of clinical evaluation of valvular heart disease to compare it with echocardiographic evaluation.
Methods: Fifty consecutives cases of RHD, attending the outpatient department (OPD), of Tribhuvan University Teaching Hospital fulfilling the criteria, formed the material for the present study. Cases were examined in detail with record of physical findings made and cardiovascular examination done in each case. All the cases were scrutinized to detail echocardiographic study using Hitachi EUB 555, 12 lead EKG, chest x-ray and laboratory test. Design of the study was carried out in prospective, cross sectional study.
Results: The distributions of the various valvular lesions were noted singly and in combination. Females were more commonly affected 80% than males 20%. Majority of the patient studied had past history of rheumatic fever (72%). Mitral stenosis (MS) was noted in 38 (76%) clinically and 45 (90%) were diagnosed by echo. Pure MS were found in 4 cases (8%). Mitral Regurgitation (MR) was the second most common lesion clinically, in 29 (58%) and 44 (88%) by echocardiography.