bluuebunny/crossref_metadata_2025 huggingface dataset:
Species distribution and in vitro antifungal susceptibility patterns of Candida
Authors: Mondal S , Mondal A , Pal N , Banerjee P , Kumar S , Bhargava D
Published: July 2024

Introduction: Due to advance in medical and surgical management nosocomial fungal infection rate has been increased. Recently Candididiasis has become one of the major fungal infections among hospitalized patients. Several Candida species can give rise to same clinical presentations but their antifungal susceptibility patterns may be different. The aim of the study is species identified of Candida, isolated from different clinical samples and to carry out their in vitro antifungal susceptibility tests.
Methods: From different clinical samples several Candida species were isolated. Speciation of Candida was done by using Corn meal agar, Chrom agar and Hi-Candida identification kit. In vitro antifungal susceptibility to fluconazole, ketoconazole and amphotericin B was performed by disc diffusion method as per CLSI document M44A.
Results: From 108 samples, most common species isolated was C. albicans (42.5%), followed by C. tropicalis, C. glabrata, C. parapsilosis and C. krusei. Overall 71.87% of isolates were found to be fluconazole sensitive. Fluconazole resistant rate is seen higher in Candida krusei, Candida glabrata, and Candida tropicalis. Ketoconazole was found to be sensitive against 87% of isolates. Amphotericin B was effective against 100% of isolates, although reduced zone size to Amphotericin B was seen by 10 isolates.
Conclusion: Speciation of Candida and antifungal susceptibility testing should be done routinely to prevent therapeutic failures.
A Study of Diagnostic Yield, Efficacy and Complications of Ultrasound Guided Renal Biopsy in Different Renal Pathologies
Authors: Chataut D , Subedi K , Lohani B
Published: July 2024

Introduction: Renal biopsy is an integral part of modern nephrology practice, being indicated in renal diseases in both native and transplanted kidneys. The purpose of this study was to automated biopsy gun.
Methods: This was a prospective cross-sectional study involving 184 patients including renal transplant recipients. These patients, with new onset renal symptoms or deteriorating renal function post-transplant, underwent freehand real time ultrasound guided renal biopsy with 18 gauge automated biopsy gun. The diagnostic yield, pathological and immunohistochemistry diagnosis and complications of the procedure were analyzed.
Results: 184 patients underwent the ultrasound guided biopsy, 17 were renal transplant recipients. Male and female ratio was almost equal (51.1% and 48.9%, respectively). Most patients were in the age group of 20-40 years. Most cases presented clinically with nephrotic syndrome (38.04%), followed by an equal number of lupus nephritis and nonnephrotic range proteinuria. The average number of glomeruli in the biopsy tissue was 11.8 per specimen. The average length of biopsy tissue was 1.15 cm in native kidneys and 0.9 cm in transplant kidneys. Renal biopsy yielded a pathological diagnosis in 97.2% of cases, with adequate sample for diagnosis in 98.9% of cases. Major life threatening complication was noted in a single patient. Rest of the patients showed minor or no complications.
Conclusion: Ultrasound guided percutaneous biopsy with automated biopsy gun is modality of choice for renal biopsy since it has the greatest yield, highest efficacy and least serious complication rates.
Management and Outcome of Pre-eclampsia/Eclampsia among patient admitted in maternity ward in tertiary hospital
Authors: Gautam(Bhattarai) SK , Paudel K , Silwal K
Published: July 2024

Introduction: Pre-eclampsia /eclampsia is the second leading cause of maternal mortality in Nepal. This study was done to identify the Proportion of pre-eclampsia/eclampsia cases, its management procedures and outcome among women.
Methodology: The retrospective study was done in maternity ward of Tribhuwan University Teaching Hospital (TUTH). The Women admitted in maternity ward from April 14, 2011 to March 14, 2012 having diagnosis of pre eclampsia / eclampsia was included in the study. Sampling technique was census.
Results: Among 4175 admitted cases 4.35% were diagnosed as pre-eclampsia /eclampsia with proportion of 3.88%, 0.38%, 0.09% mild pre-eclampsia, severe pre-eclampsia and eclampsia respectively. More than half (61.5%) were primi parous, 98.4% were booked case and 74.2% came after 37 weeks gestation for admission. Only 1.6% was referred cases. Antihypertensive drug was used in 60.5% mild pre-eclampsia, all severe preeclampsia and eclampsia cases. Magnesium sulphate was used in 62.5% severe pre-eclampsia and all eclampsia cases. Only 15% pre-eclampsia /eclampsia cases were managed by using the partograph properly. Majority of (94.4%) severe pre-eclampsia and all of eclampsia cases gave child birth by cesarean section and majority of mild pre-eclampsia by vaginally. In majority of cases, there was no life threatening maternal and neonatal complications.
Conclusion: The prevalence of pre-eclampsia is very low as compared to national figure. It is concluded that pre-eclampsia/eclampsia cases were managed properly which is reflected by the positive maternal and fetal outcome.
Endometrioma: A Concern for fertility
Authors: Baral J , Acharya P , Rana A , Gurung G
Published: July 2024

Introduction: Endometriosis is a complex disease of young women in reproductive age, responsible for endometriosis-associated pelvic pain (EAPP) because of the deeply infiltrating endometriosis (DIE). There has been significant successful revolution in the diagnosis and the management both surgical and medical where medical treatment both pre and post-operatively has been documented as gain for pain relieve and fertility promotion.
Methods: Retrospective study was done for a period of 4 years, April 2009 - 2013, in Department of Gynecology and Obstetrics, TU Teaching Hospital, using Operation Register obtaining files from Medical Record Section. All the cases exposed to operative management endometrioma were noted for size, adhesions and association with other gynecological condition and the type of surgical approach used for future fertility preservation.
Results: There were 77 cases of chocolate cysts, representing 3.2% of major gynecological surgery, in age up to 30 years being 21 (27%) as compared to those above the age of 30. Adhesion were omnipresent in all cases [mild 20 (26%) and dense adhesions and 57 (74%). Irrespective of the size of chocolate cysts; 3-5 cm (27); >5-10 cm (40); 10-15 cm (9), 15-20cm (1); associated was myoma in 14 (18%). Confined to 36% infertility were total 28 [Primary infertility (14); Secondary infertility (14)]. Adhesion was dense in all cases of primary infertility and in 12/14 cases of secondary infertility, yet forward anticipation in primary (9) and cases of secondary (6) infertility cases [after deducting, 13: hysterectomy (11) and bilateral ovarian removal (2)] along with 8/9 cases in unmarried [expecting, hysterectomy (1)] but may not be rewarding in cent percent.
Conclusion: Endometrioma noted to create adhesion in one and all cases, expected to enhance on operative exposure, need coverage by favorable medication before and after semiconservative surgical approach to overcome associated adverse fertility prognosis.
The prize and the price of good nutrition
Authors: Patrick W
Published: July 2024

N/A
Pattern of Dyslipidemia in Diabetes Mellitus in Tertiary Hospital of Nepal
Authors: Gajurel R M , Pant P
Published: July 2024

Introduction: Dyslipidemia is a preventable major risk factor for coronary heart disease (CHD). Despite an increased risk of CHD in diabetes, little is known concerning awareness and adequacy of dyslipidemia treatment in this population. Patients with type I Diabetes Mellitus are at an increased risk for coronary heart disease. Hence, the study aimed to evaluate the pattern of dyslipidemia in patients with Diabetes Mellitus in tertiary care hospital.
Methods: This is a prospective, cross-sectional, descriptive study of Diabetes Mellitus admitted in Medical units of TUTH. History was taken by preformed questionnaires and patients were clinically examined. A series of baseline investigations including fasting, lipid profile was done. Patients were followed up till discharge.
Results: A total 120 diagnosed diabetes mellitus patient were enrolled in the study. Total serum cholesterol level was high in 33.3%, serum triglyceride was elevated in 18.3%, LDL cholesterol was raised in 21.7% and HDL cholesterol was low in 20%.
Majority of the study patients 69.2% were found to be in poor status of Glycemic control with HbA1c level more than 7 % and 30.8% were in good control with HbA1c level less than 7%. Among poor Glycemic control group, 84.4% had HbA1c level between 7-12% and 15.6% had HbA1c level >12%.
Conclusion: Dyslipidemia, a major risk factor for CHD, remains largely undiagnosed and undertreated in high risk populations, especially in patients with Diabetes. Increased triglycerides and decreased HDL are the commonest pattern observed in diabetics. Treatment of dyslipidemia with various modalities early in the course of disease helps to prevent macrovascular complications.
Impact of duration of Prolong Manual Bag ventilated patients in the Emergency Service
Authors: Maharjan PK , Aacharya RP , Prasad PN
Published: July 2024

Introduction: There are increasing numbers of critically ill patients who need urgent emergency intubation in Emergency Service. Due to limited number of ventilators and even lack of portable ventilators in emergency room, we need to continue prolong manual bag ventilation of those patients after emergency intubation. Therefore, the aim was to analyse the impact of duration of prolong manual bag ventilated patients in the Emergency Service, Tribhuvan University Teaching Hospital in Nepal.
Methods: This was a prospective non-interventional cross-sectional study conducted from August 2012 to July 2013 (one year). This study included those Emergency Intubation cases with written informed consent from patient's party/guardian/legal representative to enroll in this study and excluding otherwise.
Results: 172 (0.4% of 45000 emergency room patients) patients were enrolled and divided in to Group I: Manual Bag Ventilation without Mechanical Ventilation (MBV-MV)-56 (32.6%) and Group II. MBV with MV (MBV+MV) 116 (67.4%) with accounting the incidence of such critically ill rarely found cases. The age ranges from 11 to 94 years with mean 49+-19. There were 33 Alive and 139 Death (p 0.006), M:F=1.32:1, MBV duration was with median 540 min (p0.02), 22.7% had <180 minutes MBV with survival rate 28.25% (OR 1.98, p 0.162 comparing with >181 minutes), 58.2% cases were only MBV in ER with 100% mortality. 41.2% had mechanical ventilation after MBV with median 3 days, mean 5.0+-SD 4.9 days in ICUs with 71.5% crude ill-defined mortality (p 0.042, ROC0.704). The probability of survival after emergency intubation varies with duration of MIBV as 0.8 in 1hr (7.1% mortality) and 0.02 after 24hrs (92.3% mortality) with underlying causes and availability of present treatment.
Conclusion: Irrespective of underlying causes, due to prolong manual bag ventilation without mechanical ventilation; there was increase chance of mortality and even 100% mortality as ill-defined crude mortality.
Management of fracture shaft of tibia by closed interlocking intramedullay nailing non-reaming versus reaming
Authors: Kafle D
Published: July 2024

Introduction: Tibia and fibula have the highest incidence of diaphyseal fractures of long bones. Closed intramedulary nailing is the treatment of choice in stabilizing displaced diaphyseal fractures of tibia. Availability of unreamed nails has raised the issue of what effect reaming with intramedullay nailing has on the clinical outcome. The aim of the study was to compare rate of healing of fractures with two techniques of nailing, reaming versus none reaming.
Methods: Fifty acute fractures of shaft of tibia were treated with closed intramedullary interlocking nailing, out of which only 39 patients were available for follow up. Twenty one fractures were treated by reamed and eighteen by un-reamed technique. Patients were followed up till nine months after operation. Displaced closed fractures and Gustilo Type I and Type II open fracture were included in the study.
Results: The time to fracture union averaged 23.29 weeks in un-reamed and 23.33 weeks in reamed group. Thirty eight percent of un-reamed and 19% of reamed fractures united by 12 weeks .There were six (35.29%) delayed union in un-reamed and four (21.05%) delayed union in reamed but all united after dynamization. There was no nonunion. Infection occurred in four patients, three superficial (14%) in reamed group and one deep infection in un-reamed group (5%), there was one case of screw breakage in un-reamed group. There were five malunion (27.77%) in un- reamed and three (14.28%) in reamed group but functional outcome was unaffected.
Conclusion: The study has revealed that both procedures are equivalent in terms of functional outcome and un-reamed has slight advantage over reaming in terms of union and lower rate of infection.
Comparison in Total Sialic acid levels between control and cancer patients visiting Teaching hospital, as a basis for oral cancer diagnosis
Authors: Dahal S , Agrawal NK , Shrestha L
Published: July 2024

Introduction: Oral squamous cell carcinoma is the most common malignant neoplasm in the head and neck region and remains one of the major causes of worldwide deaths. Recognition and diagnosis of oral cancer at an early stage can reduce morbidity and mortality. Oral cancer screening in a large population can be done non-invasively by using sialic acid in saliva as a biological marker. The aim of this study was to estimate the total sialic acid (TSA) level in three categories of populations: normal healthy controls, tobacco users with a premalignant lesion like leukoplakia, and tobacco users who developed oral squamous cell carcinoma
(OSCC).
Methods: A total of 45 subjects were involved in the study. Saliva was collected from three groups and total sialic acid was estimated. The data obtained was analyzed statistically using ANOVA and Tukey HSD test.
Results: A comparison of total salivary sialic acid levels in three groups revealed a significant rise in the level of TSA in OSCC group when compared to control group. The difference in the mean level of TSA of precancerous group was also significant when compared to control group.
Conclusion: The present study showed a significant rise in the mean level of total salivary sialic acid from control group (51.57 mg %) to precancerous group (74.64 mg %) to OSCC group (104.30 mg %), and suggests that it can be used as a reliable tool in oral cancer screening as the technique is non-invasive and inexpensive.
Deliberations of Nursing Academics towards Distance Education
Authors: Joshi S , Shahi M
Published: July 2024

Introduction: There are different ways of upgrading knowledge and competency among the learners, distance education is believed to be a valid method for enhancing competencies.
Methods: In order to assess the practicability in terms of availability of information communication technology as well as commitments of the learners in conducting distance education, a feasibility study was conducted in three nursing institutes of Institute of Medicine, which were selected purposively. For data collection structured instrument was used for administrators and self-administer semi-structured questionnaire for nursing academicians.
Results: It was revealed that all the campus administrators were ready to take part in this new initiative and willing to collaborate during implementation of the project. Cent percent of nursing academicians were enthusiastic to take part in this project, among them 95% were interested in learning proposal writing for qualitative study. Eighty percent of them had computer along with Internet facilities at their work place, and 80% had their own computer along with internet facilities at work place, while only 50% had their own computer. However, 66% of them did not have advance knowledge in handling multi-medias and computer skills.
Conclusion: Administrators as well nursing academicians are willing to collaborate in this distance education project, and nursing academicians are enthusiastic in developing competencies in conducting qualitative research via distance education on their own leisure time without hampering in their scheduled activities.
Experiences of girls about their menarche
Authors: Bhattacharya S.
Published: July 2024

This is a study conducted among the first year nursing students, who were enrolled in the Nursing campuses at Maharajgunj, Kathmandu, and at Birgunj. The study is descriptive in nature, and 123 students took part in the study. The finding indicates that the majority of girls were unprepared for such a phenomenon as menstruation, and for most of them it was a frightening experience with very little knowledge about maintaining menstrual hygiene.The objectives of the study were to find out:• how the adolescents in Nepal perceive their first menstrual period;• if these girls had some knowledge about menstruation;• how the girls coped with the sudden changes in their physiology;• the average age of menarche in Nepali girls;• who the first person was they confided when it occurred to them;• traditional customs observed during menarche and their importance
Single visit approach for Cervical Cancer Prevention in a mobile screening clinic
Authors: Singh M , Shrestha S B , Manandhar A , Ranjit R , Pradhan R , Shah A , Verma S , Malla K
Published: July 2024

Introduction: Cervical cancer is the third most common cancer in women worldwide, but the most preventable cancer. The objectives was to determine the feasibility and acceptability of immediately treating VIA positive women with thermocoagulation in a single-visit approach (SVA) in preventing cervical cancer.
Method: This was a community-based programme organized in collaboration with Nepal Australian Cervical Cancer Foundation and Thermocoagulation unit donated by Tropical Health and Education Trust in a mobile screening camp set up in five different underserved areas in Gorkha, Nepal. Total women were 1071 aged 30-60 yearrs in 5 days in December, 2016, had come for cervical cancer screening. Women who were VIA positive had thermocoaculation for treatment.
Results: Total screened women were 1071, the rate of VIA positive was 115(10.7%). 100% percent of positive result accepted treatment. All VIA positive patients except for one woman who was suspected of having invasive cervical cancer had treatment with thermocoagulation. Of all treated women only 5(4.38%) had minor side effect.
Conclusion: For cervical cancer screening, the single-visit program was feasible and the degree of acceptability was 100% in this underserved population. Single visit programs provide an opportunity to increase the rate of immediate treatment of lesions with minimal side effect compared with delayed treatment after obtaining colposcopy guided biopsy report in later visit.
Mission of Institutional Review Board/ Ethical Review Committee
Authors: Sherchand JB
Published: July 2024

N/A
A Retrospective study of Intussusception of the bowel in adults
Authors: Bhattarai A , Poudyal S , Bhandari RS , Lakhey PJ , Singh KP
Published: July 2024

Introduction: Intussusception is the leading cause of intestinal obstruction in children. In contrast to childhood intussusception, adult intussusception accounts for only 5% of all intussusceptions with 90% having a lead point, a well-defined pathological abnormality. Adult intussusceptions pose a further challenge as they are often presented with acute, subacute or chronic non-specific symptoms. Computed tomography is the most sensitive diagnostic modality and can distinguish between intussusception with and without a lead point. Surgery is the definitive treatment of adult intussusceptions. So the aim was to evaluate adults with intussusception in and to assess its etiology, clinical features, diagnosis and management.
Methods: A retrospective review of adults aged >16 years with a diagnosis of intussusceptions between 1998- 2013 was done.
Results: There were 22 cases of adult intussusceptions. Mean age was 44 years (17-86 years). Abdominal pain, nausea, vomiting and rectal bleeding were the most common symptoms. There were 2 cases of retrograde jejunogastric intussusception, 5 cases of jejunojejunal intussusceptions, 3 cases of ileoileal intussusceptions, 11 cases of ileocolic intussuscetpions and 1 case of colocolic intussusception. In seventeen cases, the lead point for intussusception was identified out of which 13 cases had benign pathology and 4 cases had malignant pathology. In five cases cause was not found. All cases were treated surgically except one case of jejunogastric intussusception which was reduced endoscopically. Mean duration of hospital stay was 13 days (5-30 days). Postoperative period was uneventful except surgical site infection in 8 cases and 1 case developed ECF which was managed conservatively. There was one mortality because of chest infection.
Conclusion: Adult intussusception is an unusual and challenging condition having a well- defined pathological abnormality in most of the cases. Treatment usually requires resection of the involved bowel segment.
Endothelial dysfunction in patients with coronary artery disease in tertiary level teaching hospital
Authors: Poudel CM , Poudyal RR , Sayami A
Published: July 2024

Introduction: Endothelial Dysfunction is a pathological condition characterized by reduction of bioavailability of vasodilators, in particular, nitric oxide whereas endothelium-derived contracting factors are increased resulting in an impairment of endothelium- dependent vasodilation. ED can be assessed by Brachial Artery Flow Mediated Dilatation (BAFMD). The study is to determine the prevalence of endothelial dysfunction in patients with coronary artery disease.
Methods: A total of 150 adult patients above 18 years both male and female diagnosed as CAD both stable and acute were enrolled. All patients were undergone ultrasound assessment of brachial artery diameter. Brachial artery flow mediated dilatation (BAFMD) was calculated as percentage increase in diameter from the baseline and after sphygmomanometer cuff inflation. BAFMD <10% was considered abnormal, signifying ED.
Results: Overall, the prevalence of ED determined by abnormal flow mediated dilatation of brachial artery (FMD<10%) in patients with CAD was found to be 66%. The prevalence of ED in patients with acute CAD and stable CAD was found to have 62.7% and 68.7% respectively. Eight risk factors analyzed were male sex, diabetes mellitus, hypertension, smoking, family history of CAD, age, hypercholesterolemia and low high density lipoprotein (HDL). When correlating the cardiovascular risk factors with ED, diabetes mellitus (p=0.031), smoking (p=0.026), and age >45yrs in male and >55yrs in female (p=0.013) was found to be statistically significant on univariate analysis by logistic regression. When undergoing multivariate analysis, age (p= 0.012) and smoking (p= 0 .024) were significantly associated with ED.
Conclusion: Overall the prevalence of ED in patients with CAD was found to be 66%. The prevalence of ED in patients with acute CAD and stable CAD was found to have 62.7% and 68.7% respectively.
Efficacy of small incision cataract surgery in community based eye camps: a report from Sindupalchowk, Nepal
Authors: Gautam P , Dhungel P , Adhikari HB , Dhungel S
Published: July 2024

Introduction: Health camp provides service to patients, near to their home, living in remote places with inadequate health facilities, like remote places of Nepal. This study was carried to assess the visual outcomes and complications associated with cataract surgery in camp patients, operated in a camp setting at community level in Sindhupalchowk.
Methods: In a retrospective study, 23 outreach camp patients had undergone cataract surgeries with chamber intraocular lens implantation under peri-bulbaranaesthesia. Post-operative complications on day-1 were examined. Patients with any complications were managed conservatively and referred for further management to tertiary eye care centre.
Results: 23 eyes underwent cataract extraction with intra ocular lens implantation. Small incision cataract surgery (SICS) was the commonest method (91.6%) used. 69.57% were female and 30.43% were male. The commonest first post- operative day complication was mild conjunctival congestion and sub-conjunctival haemorrhage. On Day-1 of post-operative Normal to Near-normal vision (6/6-6/18) was seen in 14(60.82), Moderate low vision 6/24 to 6/36 in 5 (21.74%), Severe low vision 6/60-3/60 in 3(13.04%), and Moderate blindness <3/60 in 1(4.35%) of the operated patients.
Conclusion: High quality cataract surgery with low rate of intraoperative complications and good visual outcome can be obtained in camp patients operated in community level under skilled man power suggesting more similar surgical camps to reduce the burden of preventable blindness due to cataract.
Detection of coliform bacteria in irrigation water and on vegetable surfaces in the Kathmandu Valley of Nepal
Authors: Shrestha S , Haramoto E , Sherchan JB , Junko S
Published: July 2024

Introduction: Consumption of vegetables irrigated using polluted water is widespread in the Kathmandu Valley of Nepal. However, studies on the microbial analysis of water and vegetable samples from this region are limited. In this study, irrigation water and vegetable samples from farmers' fields in the Kathmandu Valley were examined for the presence of Escherichia coli and total coliforms.
Methods: Irrigation water (n = 8) and vegetable (n = 27) samples were collected from November to December 2015. The presence of E. coli and total coliforms in water and on vegetable surfaces was determined by the most probable number (MPN) method using Colilert reagent. In addition, information about vegetable washing and consumption was obtained through a survey to discuss changes in their microbial concentrations before selling and/or consumption.
Results: E. coli was detected in 75% (6/8) of the water samples, with concentrations ranging from 8.8 * 10 ^ 3 to 5.2×107 MPN/100 ml, whereas total coliforms were detected in all the 8 water samples, with concentrations ranging from 9.7 * 10 ^ 2 | 7.9 * 10 ^ 7 * MPN / 100 * m . E. coli was similarly detected in 7% (2/27) of the vegetable samples, with concentrations ranging from 0.4 to 10.2 MPN/cm², whereas total coliforms were detected in 59% (16/27) of the vegetable samples, with concentrations ranging from 0.4 to 448 MPN/cm². Well, river, and tap were the predominant sources of water for washing vegetables before selling and/or consumption.
Conclusions: Unlike water samples, vegetable samples contained low microbial contamination; however, the level of contaminants was expected to increase because of washing with polluted water.
Twin Mesiodens present in maxillary arch, a rare finding: A report of two cases
Authors: Agrawal AK , Agrawal NK , Dahal S
Published: July 2024

The term mesiodens refers to a supernumerary tooth that is present in the midline of the maxilla between the two central incisors. Its occurrence as multiples is termed as ‘mesiodentes’. Double mesiodentes is a rare phenomenon. The prevalence of mesiodens varies between 0.09% and 2.05% in different studies. The etiology of this dental anomaly remains unclear. There probably exists a familial disposition. This is a case report of two patients presented with two mesiodens.
Progress on Aortic Surgery in Nepal
Authors: Shrestha Uttam Krishna
Published: July 2024

N\A
Castleman's disease. Report of a case and review of literature
Authors: P Sah Shatrughan , Agrawal Chandra Shekhar , Rani Sudha
Published: July 2024

We report here a case of solitary form of Castleman's disease (hyaline-vascular type) with its unusual location in the neck. The case is being reported for its rarity.
Cognizance about menopause among women and its importance, a short descriptive study in Baluwatar
Authors: Bhattarai S
Published: July 2024

Introduction: Globally with the increasing life expectancy, there is growing population of elderly women living after experiencing menopause and thus exposed to potential long term consequences of menopause. According to literature, at least 60% of women suffer from mild symptoms, 20% suffer severe symptoms and 20% are asymptomatic¹. Literature shows variations in reported symptoms in women across regions; Asian women suffer less vasomotor and psychological symptoms than Western women². This study was conducted to determine knowledge, attitude and practice toward menopause among women in Nepal. The most implication of this finding is to help to develop menopausal care guideline and provide information to health educators to design a course on menopause.
Methods: This study was descriptive cross sectional study carried out in Kathmandu metropolitian city, Baluwatar, ward no-4, icchunadi marga, Kathmandu district of Nepal where the respondents (N-380) to assess their awareness of menopause and its importance and effects on health. In addition, the data were collected by using structured questionnaire with the use of simple Nepali language on consent of respondents. Computer software SPSS version 15 was used to scrupulous analysis of study.
Results: 96% participants knew that menopause is the developmental process and every women gets menopause. Majority of respondents (94%) knew that female would not be able to reproduce after menopause, 90% of respondents said the correct age of menopause and 74% of them were agreed regarding the need of education for family member about menopause. The lowest percentage of respondents (32%) knew that smoking may affect menopause. Majority of respondents 56% knew symptoms of irregular bleeding, 30% of respondents had headache, 28% with irritability, 24% with loss of sexual interest and only 22% of respondents knew hot flushes and night sweating. In addition, family is the most effective source of information. In this study, 64% participants had heard about menopause from their family, followed by friends 28%, and lowest sources of information were the school/college 6% and health personnel 2%. Likewise, majority of respondents 74% consulted the doctor for perimenopausal symptoms whereas minority of the respondents 2% consulted friends.
Conclusion: Under several myths and taboo relating to menopause in our country, majority of women mainly of rural and even urban areas feel dejected and dispirited and make sometime life miserable with 
lack of knowledge of menopause. With increasing life expectancy, women spend 1/3rd of life in this phase, thus knowledge and awareness is vital point in every aspect. Thus the present study seems to be of small scale study, but, may have higher impact to invoke the researcher out there to do large scale study, to create new syllabic for students of college or at higher level management policy maker to take it seriously on the health of women who is backbone of family and thus country, Nepal.
Psychosocial Correlates and Treatment Compliance in Depressive Disorder: A Hospital Based Study
Authors: Rana M
Published: July 2024

Introduction: Depressive disorder is a common mental illness seen in hospitals and mental health services in Nepal. The aim of the study was to determine the psychosocial correlates and treatment compliance in depressive disorder patients, coming to Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Methods: Psychosocial profiles of 135 depressive disorder patients diagnosed by consultant psychiatrist according to ICD-10 and meeting the study criteria, attending out-patient clinic, Department of Psychiatry and Mental Health, Teaching Hospital, were included. The study sample were randomized into three different groups; i.e. cognitive behavior therapy, pharmacotherapy or combined therapy (receiving both cognitive behavior therapy and pharmacotherapy). Psychosocial correlates, illness characteristics and treatment compliance in depressive disorder were assessed by Semi-Structured Interview Schedule, Beck Depression Inventory, Automatic Thought Questionnaire-Revised and Visual Analogue Scale, by comparing the pre and post therapy results and drop- out rates.
Results: Before therapeutic interventions, 53(39.3%) had moderate, 47(34.8%) had severe depressive and 35(25.9%) had mild depressive symptoms. Negative automatic thoughts, hopelessness, anxiety and inability coping; low socio-economic assets and education; relationship and adjustment problems and significant life events were significant psychosocial correlates of depression. Compliance was poor in the pharmacotherapy group. Total 30 (22.2%) patients had dropped-out during the study period: 15(33%) from pharmacotherapy, 11(24%) from Cognitive Behavior Therapy and 6(13%) from combined therapy group.
Conclusion: Psychosocial factors were significantly correlated with depressive disorder. Compliance to treatment and recovery was better in the combined therapy group than either therapy alone.
Assessment of anatomical variations of nose and paranasal sinuses in multidetector computed tomography
Authors: Yadav RR , Ansari MA , Humagain M , Mishra D
Published: July 2024

Introduction: Paranasal sinuses are a group of air filled spaces developed as an expansion of the nasal cavities, eroding the adjacent bone structures. Conventional radiology does not permit a detailed study of anatomical variations of nose and paranasal sinuses. Currently, MDCT scanning is the standard imaging modality in the evaluation of the paranasal sinuses and anatomical variations.
Methodology: A cross-sectional hospital based study of 128 patients referred for CT scan of PNS was conducted from October 2015 to February 2016. CT scan was done in 128 slice Siemens Somatom Definition AS+ CT scanner machine applying standard protocol set by the department of radiology and imaging, Tribhuvan University Teaching Hospital, Maharajgunj. The images were evaluated for presence of any anatomical variants in paranasal sinuses.
Results: The absolute frequency of anatomical variations are Agger Nasi cell (75.8%) and DNS (68%) along with Concha Bullosa (35.9%), Paradoxical middle turbinate (26.6%), Haller’s cell (15.7%) and Onodi cell (18.8%). In this study the most frequent type of olfactory fossa was Keros type 2 (63.3%). The typical orientation of uncinate process was found in both sides 199 (77.73%) whereas medial deviation in left side (20.3%) and right side was (18.8%) along with lateral deviation in left side was (3.9%) and right side was found in (1.6%) only.
Conclusion: Anatomical variations of nose and paranasal sinuses are best depicted on MDCT scan of PNS on coronal plane with thin slice (3.0 mm) section along with bone algorithm. Agger nasi cell is the commonest anatomical variation (75.8%) followed by DNS, Concha bullosa, Paradoxical middle turbinate, Onodi cells and Haller’s cells.
Acute coronary syndrome and cardiac biomarkers
Authors: Dali B
Published: July 2024

Introduction: Diagnosis of acute cardiac event in the early stage of its onset is of utmost important in the treatment process whereas the development of highly sensitive and specific immunoassays for myocardial proteins such as cardiac Troponin I (cTnI) had made it possible. Given the possible complexities in establishing an early and accurate diagnosis of acute coronary syndrome (ACS), it is important for the clinician to use all available information, including the history, physical exam (PE), electrocardiogram (ECG), and cardiac biomarkers to formulate both the diagnosis of Acute coronary syndrome (ACS) and the overall assessment of patient prognosis and risk. Hence, the study was carried out to assess the clinical profiles of acute coronary syndromes and compare it with cardiac biochemical markers in Acute coronary syndrome (ACS) patients.
Methods: Hundred and eight consecutive cases of acute coronary syndrome (ACS), attending the Coronary Care Unit (CCU), of Tribhuvan University Teaching Hospital fulfilling the study criteria were taken for the present study. A record of physical findings was made and cardiovascular examination was done in each case. All the cases were scrutinized to a detail serial 12 lead electrocardiogram (ECG), serial cardiac biochemical markers- Troponin I (cTnI), Lactate dehydrogenase (LDH), aspartate transaminase (Serum Glutamate Oxaloacetate Transaminase, SGOT), and Creatine Kinase Myocardial Band (CK-MB), chest x-ray and laboratory test(e.g. Lipid profile, blood sugar), and echocardiographic study.
Results: Acute coronary syndrome was found to be more common in males (51%) than in females (49%). Ages ranged from 30 to 80 years. The common clinical presentations were chest pain (79%), palpitation (74%), sweating (71%), vomiting (45%), acute pulmonary oedema (6%), cardiac arrest (.9%) and (7%) presented with syncope. CKMB were high in about (64%), whereas troponin positive cases were (60%). (89%) presented with abnormal ECG findings, STEMI was diagnosed in (33%), NSTEMI in (29%), whereas (40%) was found to have UA. Main clinical profiles were diabetes (35%), hypertension (76%), and hyperlipidemia (61%), smoking (78%), alcoholic (47%) and family history of cad (57%), overweight (25%) while obesity (36%) and abnormal WHR (69%) respectively. There was significant correlation between clinical profiles and ECG, Creatine Kinase Myocardial Band (ck_mb), troponin and types of ACS, but a slight negative correlation was detected in profiles for WHR and troponin, and fasting hyperglycemia, education, gender, diabetes, hypertension, smoking, Chest pain, heart rate, WHR, and low HDL profile with types of ACS.
Conclusion: The outcome of this study showed that the majority are male, relatively younger as compared to Western population, have smoking and hypertension followed by diabetes as the major risk factors. USA and STEMI are the dominant types of ACS and the majority of patients are likely to have hypertension, IHD and diabetes in their families. Better control of risk factors and the awareness of preventive strategies are needed.
Conservatively managed puerperal retroperitoneal haematoma
Authors: Rana A. , Singh M. , Jha R , Verma S.
Published: July 2024

Puerperal haematoma occurs in 1/300 to 1/1500 deliveries. A characteristic presentation of post-delivery collapse with signs of internal haemorrhage and clinically palpable left-sided pelvic mass causing gross hydronephrosis on ipsilateral side was confirmed as a case of retroperitoneal haematoma on ultrasound, which resolved completely on conservative management.
A Retrospective Study of Magnetic Resonance Imaging Findings in Acute Encephalitis Syndrome.
Authors: Songmen S , Panta OB , Maharjan S , Paudel S , Ansari MA , Ghimire RK
Published: July 2024

Introduction: MRI is the imaging modality of choice to investigate acute encephalitis and is recommended in all patients as soon as possible in whom diagnosis is uncertain. This study aimed to study the pattern of brain involvement in MRI in patients with acute encephalitis syndrome and to correlate the findings with clinical and laboratory data.
Methods: The study was a retrospective hospital record based review conducted at Tribhuvan University Teaching Hospital. MRI and records of patients undergoing MRI for acute encephalitis syndrome during two years duration was studied. Data analysis was done using IBM SPSS 20.0.
Results: A total of 47 MRI were studied among which 11(23.40%) were pediatric and 36(76.59%) were adult population. Edema was the commonest manifestation. Cerebral hemisphere (temporal lobe) was the commonest location involved 34(72.3%). Basal ganglia and thalamus involvement was also fairly common.
Five (26.31%) out of 19 patients had positive Japanese encephalitis, 5(26.31%) had HSV antigen positive serology and in 8(42.10%) no etiology could be found. Posterior fossa and basal ganglia involvement was the most predominant findings in Japanese encephalitis and involvement of medial temporal lobe was seen in all cases of Herpes encephalitis. Fifteen patients had good prognosis: complete recovery or minimal residual deficit, while four patients were either dead or left against medical advice.
Conclusion: Medial temporal lobe involvement was seen in all cases of Herpes encephalitis; and thalamus and basal ganglia involvement was predominant pattern in Japanese encephalitis. Posterior fossa involvement was common probably due to a non-conventional etiological agent.
Radiographic evaluation of acute scaphoid fractures
Authors: Parajuli B , Uprety S , KC G
Published: July 2024

Introduction: Scaphoid fracture is the commonest carpal bone fracture. Various radiographic views have been proposed for diagnosing it. This study was conducted to determine which radiographic view/s among five different views showed scaphoid fracture consistently.
Methods: This prospective study was carried out in Department of Orthopedics, IOM, TUTH from February 2012 to June 2013. Twenty-six patients with scaphoid fracture were included in the study who had five scaphoid views done viz. postero-anterior, ulnar deviated PA, pronation oblique, supination oblique and lateral. Each view was assessed with respect to demonstrating a fracture and the clarity of demonstration. Statistical analysis of data obtained was done using SPSS 17.0 version.
Results: This study included 26 patients, 18 to 54 years of age (27.5±9.5 years). Average duration after injury was 6.73± 8.64 days. Out of five different views, pronation oblique showed fracture in 69.2% of patients followed by ulnar deviated PA in 61.5% patients. Pronation oblique showed fracture in all patients who had demonstrated fracture in supination oblique and lateral views also. Pronation oblique and ulnar deviated PA were the only views to show fracture in 5 patients each. Fracture in middle 1/3rd of the scaphoid was present in 53.8% patients while no patients had proximal 1/3rd fracture.
Conclusion: Pronation oblique and ulnar deviated PA are the most important views among the other views of scaphoid series. Supination oblique and lateral views are the least important views to detect a scaphoid fracture.
Goldenhar syndrome with left bronchopulmonary agenesis: A rare association
Authors: Ghimire B. , Thapa B. , Shrestha U. K. , Sayami P.
Published: July 2024

An eleven years female presented with recurrent chest infection since childhood with markedlydiminished air entry on her right chest and mediastinal shift. She also had vague facial deformity withmultiple auricular appendages. Computed tomography showed collapse of the left lung and onthoracotomy, complete agenesis of the left lung was noted. Goldenhar anomaly is rare and presentswith variable degree of external anomaly. Its association with bronchopulmonary agenesis is extremelyrare with few cases reported in the world literature. Features of other congenital should be sought forin a child with facial asymmetry, external auditory appendages, malformation of the, nose, soft palate,lip and mandible etc so that appropriate treatment can be administered.
A Case of Curative Resection of Massive Small Bowel Gangrene at Gandaki Medical College Teaching Hospital, Pokhara, Nepal
Authors: Rauniya RPG , Bijukche SM , Singhal VK
Published: July 2024

Ascariasis is a helminthic infection of humans with worldwide distribution. It is estimated that more than 1.4 billion people are found infected with Ascaris lumbricordes, representing 25% of the world population. We report a case of small bowel volvulus in a 15 year old male child who presented with vague symptoms of vomiting, distension of abdomen, mild pain and constipation. It was diagnosed as a case of small bowel obstruction with the presence of a bunch of Ascaris mass lying in one of the bowel loop. Administration of albendazole therapy through nasogastric tube in initial stages helps in evacuation of worms via stool successfully. The condition of this patient did not give us space to try this regime, therefore the patient had to be submitted for emergency laparotomy, resection, anastomosis and eventually his recovery with great satisfaction. This case is unique in highlighting the efforts of surgical team for achieving success through massive surgical procedures, monitoring post operative critical course and the hospitalization period till his discharge from the surgical ward.
Health Laboratory and Future Advancement
Authors: Sherchand Jeevan B.
Published: July 2024

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Clinical outcome of patients with psychiatric illness following Electroconvulsive therapy in a teaching hospital in Kathmandu
Authors: Pant SB , Upadhyaya S , Ojha SP , Chapagai M , Tulachan P , Dhungana S
Published: July 2024

Introduction: Electroconvulsive therapy (ECT) is a safe and effective procedure used for treatment of variety of psychiatric illness. In spite of its proven efficacy ECT is underutilized due to stigma and prejudice attached to it among patients, their families and even among mental health service providers. The purpose of the study was to evaluate the clinical outcome of patients diagnosed with psychiatric illness following electroconvulsive therapy.
Methods: This is a retrospective hospital based study of patients who underwent electroconvulsive therapy at department of Psychiatry and Mental health, Tribhuvan University Teaching hospital during 1 year duration. Pre-ECT and Post-ECT BPRS and GAF were obtained and the data were analyzed subsequently.
Results: A total of 39 patients underwent Electroconvulsive therapy during the study period. There were 16 males and 23 females. Among all cases receiving ECT, mean BPRS scores at the time of admission and discharge were 74.41±9.61 and 47.31±7.27 respectively whereas mean GAF scores at the time of admission and discharge were 20.21±6.03 and 57.95±11.05 respectively. The most common diagnosis for which ECT was used was Schizophrenia 14(35.89%). All patients showed statistically significant functional and symptomatic improvement except those with organic psychosis (GAF p<0.05 and BPRS p<0.05).
Conclusions: ECT is found to be effective in the treatment of patient diagnosed with various psychiatric illnesses.
A comparative study of pregnancy outcome between teenage pregnancy and older reproductive age group in a rural University Teaching Hospital of Nepal
Authors: Aryal B , Shrestha U
Published: July 2024

Introduction: Teenage pregnancy is a common public health problem worldwide and is considered as high-risk pregnancy in terms of health of both mother and child. The objective of this study was to find the incidence and outcome of teenage pregnancy in comparison to older women who delivered in Karnali Academy of Health Sciences Teaching Hospital.
Methods: This is a hospital based cross-sectional comparative study conducted in Labor Unit of Karnali Academy of Health Sciences, Jumla over a period of one year from July 2016 to June 2017. The hospital data was retrieved and divided into two groups i.e. teenagers and older age and was compared in terms of incidence and maternal and fetal outcome of pregnancy. The data were analyzed using software package SPSS 16.
Results: This study showed that incidence of teenage pregnancy was 24.14%. Maternal and fetal complication like eclampsia / preeclampsia (7.63% vs. 0.44%), cesarean section (44.44% vs. 7.96%) preterm delivery (15.97 % vs. 1.10%), small for gestational age (29.86% vs. 3.31%) and intrauterine fetal death (9.72% vs. 0.66%) occurred more frequently in teenagers in comparison to older age. Similarly, there was increased incidence of congenital anomalies (5.55% vs. 0.44%) among the neonates born to teenage mothers.
Conclusion: Incidence of teenage pregnancy in rural and resource-limited part of the country is high, which predispose them into increased risk of maternal and fetal complications like increased incidence of eclapsia / preeclampsia, cesarean section rate, prematurity and its complications, small for gestational age, congenital anomalies and intrauterine fetal death.
Nobel discoveries from isolates of multidrug resistant Acinobacter baumannii and multidrug resistant Escherichia coli in Nepal
Authors: Sherchand JB
Published: July 2024

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