bluuebunny/crossref_metadata_2025 huggingface dataset:
Pattern of Body Mass Index and Common Health Problems in Women of Reproductive Age Group in a Private Clinic in Kathmandu
Authors: Padhye Saraswati M
Published: September 2018

Introduction: High Body Mass Index is one of the risk factors for many chronic diseases and adverse health outcomes. It is associated with an increased risk of coronary heart disease, ischemic stroke, high blood pressure and type 2 diabetes mellitus. It also have many adverse effect on reproductive health of the women like sub fertility, polycystic ovarian disease, menstrual abnormality etc. The purpose of this study is to find Basal Metabolic Rate and the diseases pattern of reproductive age woman in Nepal.

Methods: This is a descriptive study of women of reproductive age (15 to 49 years) attending a private gynaecology clinic in Kathmandu Valley from October 2016 to June 2017. Six hundred and eight women of current reproductive age group participated in this study. Women’s particulars and complaints were noted down. Detailed history was taken. Height, weight and blood pressure were recorded and general examination was done. BMI was calculated as BMI is weight in kilogram divided by height in meter square, and it was interpreted as per WHO guidelines.

Results: Out of the total 608 participants, 243 (40%) were overweight, 96 (15.8%) were obese. Regarding the common health problems, 154 (25.3%) have sub fertility and 199 (32%) had genitourinary infection. Similarly, 90 (14.8%) had menstrual problems.

Conclusions: Prevalence of overweight and obesity has risen significantly comparing to the study done decade ago in same setting. Similarly, sub fertility rate has also risen whereas the prevalence of genitourinary infections has decreased.

Keywords: BMI; genitourinary infection; Nepal-reproductive age women; sub fertility.
Clinico-radiological Observations in Meconium Aspiration Syndrome
Authors: Lama Susana , Mahato Shyam Kumar , Chaudhary Nagendra , Agrawal Nikhil , Pathak Santosh , Kurmi Om Prakash , Bhatia Baldev , Agarwal Kailash Nath
Published: September 2018

Introduction: To understand and report the prevalence of meconium aspiration syndrome and the clinico-radiological features in a tertiary care hospital of western Nepal.

Methods: An observational study carried out for a year in 2014-15 in all babies with MAS. Clinical and radiological profiles of MAS in relation to gender, gestational age, mode of delivery, birth weight, Apgar score, thickness of meconium, age at admission and the immediate outcome were studied.

Results: Out of 584 admitted newborns (male=389; female=186) during the study period, 78 (13.4%) had meconium aspiration syndrome with male: female ratio of 1.2:1. Majority of babies admitted to NICU had thick meconium [n=52 (66.7%)]. There was no statistical significant difference in various parameters such as Apgar score at 1 and 5 minutes, respiratory distress, birth asphyxia, duration of oxygen use, MAS severity and chest x-ray in those with thick MAS compared to thin. Among all newborns with MAS, 59% (n=46) had abnormal radiological findings with over two-folds in those with thick MAS (71.7%)] compared to thin (28%). Hyperinflation (47.8%), diffuse patchy infiltration (37%), consolidation (21.7%) collapse (8.7%), right lung fissure (6.5%) and pneumothorax (8.7%) were the abnormal radiological findings seen in MAS babies. The odds of having APGAR score at 1 minute at least 7 or more was twice unlikely in those having thick meconium compared to thin (P=0.02)

Conclusions: Thick meconium is relatively common with more significant abnormal radiological findings and low Apgar score.
Fingerprints as an Alternative Method to Determine ABO and Rh Blood Groups
Authors: Chaudhary Sonam , Deuja Sajana , Alam Munna , Karmacharya Poonam , Mondal Monami
Published: September 2018

Introduction: Blood grouping is conventionally done with invasive method by taking blood samples. The objective of this study is to determine blood group with uninvasive procedure by taking fingerprints of the participants and know the associations between their fingerprints and blood groups.

Methods: Seven hundred participants of both genders with no any age limitation from Manipal Teaching Hospital and Manipal College of Medical Sciences were randomly selected. The blood grouping was done by cross reacting blood sample with the antibodies. The fingerprints were taken with the help of stamp pad imprinting the finger ridges over A4 size white papers. The loop, whorl and arch patterns were studied.

Results: O+ve blood group 224 (32%) was most prevalent among 700 participants. The loop pattern was highly distributed 3708 (53%) in all blood groups except in A-ve blood group with highest distribution of whorl 20 (40%). The mean comparisons of specific fingerprint in total and also in individual fingers with different ABO and ABO-Rh blood groups showed no any statistical association with P>0.05. However, the loop distribution in individual finger was highest in right middle finger (M) of B-ve blood group 5 (10%). The whorl distribution in individual finger  was highest in right index (I), left thumb (T) and left ring (R) fingers of AB+ve blood group 20  (5.5% each). Similarly, the arch distribution was highest in right index fingers of A-ve blood group 3 (6%).

Conclusions: The mean comparison of different fingerprints with ABO and Rh blood groups showed no significant statistical association concluding fingerprints cannot be used for blood grouping.

Keywords:  arch; blood group; fingerprints; loop; whorl.
Immune System and Kidney Transplantation
Authors: Shrestha Badri Man
Published: September 2018

The immune system recognises a transplanted kidney as foreign body and mounts immune response through cellular and humoral mechanisms leading to acute or chronic rejection, which ultimately results in graft loss. Over the last five decades, there have been significant advances in the understanding of the immune responses to transplanted organs in both experimental and clinical transplant settings. Modulation of the immune response by using immunosuppressive agents has led to successful outcomes after kidney transplantation. The paper provides an overview of the general organisation and function of human immune system, immune response to kidney transplantation, and the current practice of immunosuppressive therapy in kidney transplantation in the United Kingdom.
Prevention of Shivering during Spinal Anesthesia: Comparison between Tramadol, Ketamine and Ondansetron
Authors: Lakhe Gajal , Adhikari Krishna Murari , Khatri Kiran , Maharjan Anil , Bajracharya Akriti , Khanal Himdip
Published: September 2018

Introduction: Shivering is an unpleasant experience after spinal anesthesia. We conducted this study to evaluate the efficacy of ondansetron, ketamine and tramadol for prevention of shivering.

Methods: In this prospective, randomized controlled study, 120 patients aged 18-65 years of American Society of Anesthesiologist (ASA) physical status I&II undergoing various surgical procedures were included and allocated alternately to one of the 4 groups; Normal saline (Group1), Ondansetron 4mg (Group2), Ketamine 0.25mg/kg (Group3) and Tramadol 0.5mg/kg (Group4). Incidence of shivering, effect on hemodynamics, nausea, vomiting, sedation and emergence reactions were recorded. Data was analyzed using SPSS (The Statistical Package for Social Sciences) version 20.0 software.

Results: The patients were comparable in terms of demographic variables, baseline temperature, type of surgery, median level of sensory blockade, duration of surgery and anesthesia. Shivering was present in 17 (56.7%), 5 (16.7%), 3 (10%) and 3 (10%) patients respectively in Group 1, 2, 3 and 4 which was statistically significant when compared to Group 1 (P=0.00) The odds of NS and ondansetron, NS and ketamine, NS and tramadol was 6.53, 11.76 and 11.76 respectively which showed that study drugs were effective in preventing shivering. None of the patients were sedated in Group 1 and 2. Mild to moderate sedation was present in Group 3 and 4 (P=0.00). None of the patients had drug related adverse reactions.

Conclusions: Prophylactic use of ondansetron, low doses of ketamine and tramadol is effective in preventing shivering post spinal anesthesia without untoward effects.

Keywords:  Anesthesia spinal; Ketamine; Ondansetron; Shivering; Tramadol.
Management for Doctors
Authors: Mishra Rakesh C
Published: September 2018

Abstract
Effects of Intrathecal Dexmedetomidine as an Adjuvant to Hyperbaric Bupivacaine for Spinal Anaesthesia in Adults Undergoing Elective Infra-umbilical Surgery
Authors: Gautam Binod , Niroula Sujata , Sharma Mona , Lama Sushila Moktan
Published: September 2018

Introduction: Various adjuvants to local anaesthetic are used to improve quality and duration of spinal anaesthesia. Dexmedetomidine, a novel alpha-2 adrenergic agonist, has been proposed to augment local anaesthetic effects. This study aims to investigate effects of intrathecal Dexmedetomidine on duration of analgesia and duration of sensory block during spinal anaesthesia.

Methods: In this randomized double-blind study 38 patients were allocated into each of two groups. Otherwise healthy patients (18 to 75 years) scheduled for inguinal hernia repair or vaginal hysterectomy were included. For spinal anaesthesia, Group A received 2.5 ml hyperbaric Bupivacaine 0.5%, whereas Group B received five micrograms intrathecal Dexmedetomidine in addition. Characteristics of sensory and motor blocks, duration of analgesia, analgesic requirements, and side effects were studied for 24 hours. Student’s t-test for quantitative variables and Chi- squared test for qualitative variables were used for statistical analysis.

Results: Duration of analgesia was prolonged in Group B (326 min ±91) as compared to 217 min ±98 in Group A (P value <0.05). Sensory and motor block durations were significantly prolonged in Group B. Time taken to reach significant peak sensory block level was earlier in Group B. Significant reductions in incidence of visceral pain, shivering and analgesic requirements were observed in Dexmedetomidine group, without increased need of medications for altered hemodynamic parameters.

Conclusions: Dexmedetomidineas an intrathecal adjuvant to hyperbaric Bupivacaine in spinal anaesthesia prolongs duration of analgesia and sensory block with minimal adverse effects.

Keywords: Bupivacaine; Dexmedetomidine; intrathecal adjuvant; spinal anaesthesia.
Factors Predicting Mortality of Variceal Bleeding in Liver Cirrhosis
Authors: Mandal Amrendra Kumar , Paudel Mukesh Sharma , KC Sudhamshu , Chaudhary Sitaram , Paudel Bidhan Nidhi , Poudyal Nandu Silwal , Shrestha Barun , Kanth Rajan , Kafle Paritosh
Published: September 2018

Introduction: Acute variceal bleeding in liver cirrhosis is an immediate life-threatening condition and amajor complication of portal hypertension associated with higher morbidity, mortality and hospital costs than any other causes of UGI bleeding. Therefore, early stratification and initiation of therapy based on several factors can reduce mortality associated with it. We aimed to study the predictors of mortality in acute variceal bleeding in LC.

Methods: An observational prospective study was conducted in Gastroenterology and Hepatology units of Bir Hospital, Kathmandu, Nepal from April 1, 2016 to May 30, 2017. Patients were included if they had underlying liver cirrhosis and presented upper GI bleeding which were proven to be secondary to variceal bleeding.

Results: Seventy-five patients with mean age of 52.5 years were available or the analysis. The M:F ratio was 2.1:1. There were 66 patients in mortality group and 9 in survivor group. The mean CTP and MELD score were 10.17±1.66 and 20.40±8.29 respectively. Among the predictors of the mortality studied, CTP score, MELD score, mean arterial pressure, Serum bilirubin, serum creatinine, need of FFP as well as PRP transfusion, presence of hepatorenal syndrome and hepatic encephalopathy were high in mortality group with statistical significance. On multivariate analysis, high CTP and high serum creatinine level were only significant predictors of mortality. Receiver operating curve for predicting accuracy of mortality was significant with higher MELD and higher CTP score.

Conclusions: Strong predictors of mortality in patients with cirrhosis presenting with variceal bleeding are CTP score and high serum creatinine level.
Electrocardiograph and Chest X-ray in Prediction of Left Ventricular Systolic Dysfunction
Authors: Basnet Bhupendra Kumar , Manandhar K , Shrestha R , Shrestha S , Thapa M
Published: September 2018

Abstract
Blood Pressure and its Association with Body Mass Index Among the People Attending in a Hospital
Authors: Lamsal Dinesh Kumar
Published: September 2018

Introduction: Systolic and diastolic hypertension has been increasing trend and different factors are associated such as body mass index, diabetes etc. Obesity and overweight are generally associated with high blood pressure. This study aims to identify the prevalence of blood pressure level and its association to body mass index among people attending in civil service hospital, Kathmandu.

Methods: A cross-sectional descriptive study was conducted among all 1002 study subjects aged above 20 years.Information were obtained from people coming for Master health check-up during study period. Blood pressure and weight weretaken by WHO certified tool.

Results: Half of the respondents were overweight and obese. Prevalence of systolic and diastolic hypertension was found to be 171 (17.1%) and 310 (30.9%) respectively. There is significant difference between body mass index to sex. Females are 1.5 times more likely to have high blood pressurewho have high body mass index. Age group (40-59) years are more than two times likely to have overweight, systolic and diastolic blood pressure than other age group. Systolic blood pressure is more than six times more likely to be high in 60+ age group. But it is only 2.6 times in diastolic blood pressure and in body mass index, it is reduced to 1.4 times but it was still statistically significant. Overweight people are 1.4 and 1.6 times more likely to have high systolic and diastolic BP than another category.

Conclusions: Half of the respondents were overweight and obese. Male had high overweight and obesity than female. Overweight people more likely to have high systolic and diastolic BP than others.

Keywords: Body mass index; blood pressure; civil service hospital; Nepal.
Cysticerci in Palpable Nodules Diagnosed on Fine Needle Aspiration Cytology
Authors: Lakhey Mamta , Hirachand S , Akhter J , Thapa B
Published: September 2018

Abstract
Pattern of Mobile Phone Use among Students of An Institution
Authors: Thapa Kriti , Pokharel Rita , Sigdel Rambha , Rimal Surya Prasad
Published: September 2018

Introduction: The charm of mobile phone is more among young generation and the increasing use can lead to various harmful effects and may result in dependence. The objective of the study is to evaluate the pattern of mobile phone use among medical students.

Methods: A descriptive cross sectional study was conducted on a total of 229 medical students aged between 18 and 25 years who were using mobile phones for more than 1 year by using simple random sampling technique. Students were requested to complete a pre-tested self-administered questionnaire which comprised their socio-demographic characteristics and pattern of mobile phone usage.

Results: Among the total 229 students, all of them had their own smart phones. Major purpose of using mobile was for calling, listening music, taking photos/videos and internet use. Most of the students 97 (42.4%) have owned mobile phones since 4-6 years. The median time spent by the students on the mobile phone using different features of mobile phone was 3.5 hours. Majority of the students i.e. 157 (68.5%) use mobile phones at night. The median amount of money spent on recharge per month was 500. Age of student was significantly (P <0.05) associated with calls per day. There was no significant association of pattern of mobile phone use with other selected socio-demographic variables

Conclusions: Students were found to use mobile phone excessively. The pattern of mobile phone usage among the students in this study may signal the evolution of mobile phone use from a habit to an addiction.
Prevalence and Factors Associated with Microalbuminuria among Type 2 Diabetic Patients : A Hospital Based Study
Authors: Khadka Bikram , Tiwari Mohan Lal , Timalsina Binod , Risal Prabodh , Gupta Suprita , Acharya Dilaram
Published: September 2018

Introduction: Microalbuminuria is the earliest clinical evidence of diabetic nephropathy. However, prevalence and associated factors with microalbuminuria among type 2 diabetic patients has been understudied area of research in Nepalese context. This study aimed to determine the prevalence and factors associated with microalbuminuria among type 2 diabetic patients.

Methods: This study was a hospital-based cross-sectional study. Blood samples for serum creatinine, Hemoglobin A1C, Fasting blood sugar and urine sample for microalbumin and urine creatinine were collected and analyzed using validated and standardized tools from a total of 400 Type 2 diabetic patients in Devdaha Medical College and Teaching Hospital, Rupandehi, Nepal from August 2014 to September 2017. Microalbuminuria was defined as urinary albumin-to-creatinine ratio greater than 30 and less than300 μg /mg of creatinine

Results: Of 400 type 2 diabetic patients, 186 (46.5%) had microalbuminuria. The mean values of FBS, HbA1C, serum creatinine, microalbumin, microalbumin/urine creatinine ratio were higher in microalbuminuria group. Microalbuminuria was significantly positively correlated with duration of diabetes, FBS, HbA1C, serum creatinine, microalbumin, microalbumin/ urine creatinine, systolic blood pressure and diastolic blood pressure (P< 0.01).

Conclusions: Our study demonstrated that nearly half of the type 2 diabetic patients had microalbuminuria. Our results emphasize to increase to accessibility to microalbuminuria testing for all the type 2 diabetic patients and bring them under medical supervision to reduce the unwanted complications of diabetes mellitus.
An Unusual Presentation of Alveolar Type of Rhabdomyosarcoma of Orbit
Authors: Bastola Pradeep , Adhikari R K
Published: September 2018

Abstract
Natural Orifice Transluminal Endoscopic Surgery (NOTES)-an Emerging Technique in Surgery
Authors: Shrestha BM
Published: September 2018

Natural orifice transluminal endoscopic surgery (NOTES), which utilises natural anatomical passages for gaining access to the intra-abdominal organs for surgical interventions, that result in scarless surgery, is a recent advancement in the specialty of minimally invasive surgery and has gained significant momentum, It has been postulated as a promising alternative to laparoscopic surgery in the fi eld of minimal invasive surgery. Signifi cant advantages over conventional open surgery, such as less postoperative pain, a shorter hospital stay, early return to activity, avoidance of woundrelated complications and better cosmesis have been demonstrated. This article provides an update in the development, principles, practice and future applications of NOTES.

Keywords: natural orifice, minimally invasive, scarless, endoscopic surgery.
End Stage Renal Disease and Renal Replacement Therapy - Challenges and Future Prospective in Nepal
Authors: Hada Rajani
Published: September 2018

Abstract
Perceptions of Medical Students About Bedside Teaching in a Medical School
Authors: Dhakal Ajaya Kumar , Shrestha Devendra , Bajracharya Suraj , Pradhan Amita , Karki Balman Singh , Dhakal Sanjaya
Published: September 2018

Introduction: Bedside teaching is an important and established learning tool in medical education. However there is a decline in bedside teachings over the years throughout the world including Nepal, due to advancement in medical technology, clinical skills labs and simulation techniques. This study aimed to find out the perception of Nepalese medical students towards different domains of bedside teaching.

Methods: This was a descriptive cross-sectional study. A questionnaire consisting of Likert scale, open ended and closed ended questions was developed on different aspect of bedside teaching and the filled questionnaires were included for analysis.

Results: Three hundred and six questionnaires were included. Almost all of medical students responded that bedside teaching is a useful learning modality in clinical teaching 304 (99.3%) and provides active learning in real context 291 (95%). The majority of medical students 233 (76%) were satisfied with the steps of history taking, examination followed by management discussion employed at bedside teaching. The students 223 (73%) were satisfied, how to elicit signs following demonstration of clinical exam by teachers at bedside. However majority 196 (64%) felt lack of individual opportunity at bedside. According to students, focussing more on practically oriented clinical skills with proper supervision would improve learning while hindering factors were large number of students and patient’s uncooperativeness. Good communication was considered the best method of alleviating patient discomfort at bedside teaching in this study.

Conclusions: The study concluded that medical students have positive response and learning attitudes towards different aspects of bedside teaching.
Feto-maternal Outcomes of Emergency Caesarean Section following Residential Posting at Dhading District Hospital
Authors: Kattel Pramod
Published: September 2018

Introduction: Caesarean section is a commonly performed major obstetric surgery to deliver baby under certain indications which may be maternal or fetal. If performed timely, it is helpful to save the life of mother and fetus and if not, it increases both maternal and fetal risks. Methods: A hospital based descriptive cross-sectional study was conducted at Dhading district hospital from 17th October 2016 to 17th October 2017. Total of 41 patients undergoing emergency caesarean section meeting the selection criteria were included. Results: The incidence of emergency caesarean section was 41 (5.5%). Most common indication for caesarean delivery was fetal distress in 12 (29.3%) followed by failed induction and cephalopelvic disproportion each accounting 6 (14.6%) cases. The least common causes being chorioamnionitis and cord prolapse in 1 (2.4%). Regarding perinatal outcomes, 33 (80.5%) babies delivered were of normal weight. Low Apgar score (<7) at one minute was noted in 8 (19.5%) cases. Neonatal resuscitation in the form of oxygen supplementation was required in 2 (4.9%) cases whereas bag and mask ventilation was required in 5 (12.2%) cases. Referral for neonatal intensive care unit admission was done in 6 (14.6%) cases. There were three neonatal deaths.Conclusions: Residential posting was fruitful to decrease feto-maternal morbidities and mortalities. Even to minimize the delay of treatment, government should provide adequate equipments and skilled man-power to run neonatal intensive care unit.
Air due to Glue: Spontaneous Pneumothorax in a Young Adult with Glue Sniffing
Authors: Mishra Deebya Raj , Bhatta Narendra , Bista Bidesh , Koirala Puru , Ghimire Ramhari
Published: September 2018

Solvent abuse, as inhalant specially, in the form of low cost adhesives like dendrite is common in low income countries among children and the teens. This habit is often a stepping stone to harder drugs. The neurological and neuropsychological effects of solvent abuse are well explored. But the respiratory effects are often overlooked. In this report, we present a case of a 19 year old gentleman, with regular history of sniffing of commercial “glue” compounds. This patient presented with right sided chest pain and chest x-ray showed a right sided pneumothorax. The pulmonary barotrauma, possibly due to increased intra-alveolar pressure, during the sniffing process can lead to alveolar rupture and in turn, pneumothorax. In the absence of other risk factors for Pneumothorax, the link between inhalant abuse and respiratory complications has to be explored in patients with history of such abuse.
Accuracy of Frozen Section with Histopathological Report in an Institute
Authors: Adhikari Purbesh , Upadhyaya Paricha , Karki Smriti , Agrawal Chandra Shekhar , Chhetri Shyam Thapa , Agrawal Ajay
Published: September 2018

Introduction: Frozen section helps in rapid intra-operative diagnosis. It is commonly used during surgical procedures to detect malignancy so that modifications of surgery can be decided at the time of surgery on the table. Frozen section is also performed for evaluation of surgical margins and detection of lymph node metastasis. In addition it is applied for detection of unknown pathological processes.The objective of this study was to assess the accuracy of frozen section diagnosis in comparison to gold standard histopathological diagnosis and to find concordance and discordance rate of frozen section with histopathological report.Methods: This was a cross sectional study of 41 frozen section samples done in the department of pathology of BP Koirala Institute of Health Sciences from September 2014 to August 2015. All frozen section samples with their permanent tissue samples sent for final histopathological evaluation were included in the study.Results: The overall accuracy of frozen section diagnosis was 97%. The sensitivity was 94%, specificity was 87%, positive predictive value was 90% and negative predictive value was 93%. The concordance rate was 90.2% and the discordance rate was 9.8%.Conclusions: The results of frozen section varied in different organ systems and the common cause of discrepancy in our study were the gross sampling error and the interpretational error.
Pleural fluid serum bilirubin ratio for differentiating exudative and transudative effusions
Authors: Agrawal Pawan , Shrestha Tirtha Man , Prasad Pratap Narayan , Aacharya Ramesh Prasad , Gupta Priyanka
Published: September 2018

Background:  In pleural effusion, differentiating exudative and transudative fluid is an important clinical evaluation. The objective of the study was to determine the efficacy of pleural fluid serum bilirubin ratio in differentiating exudative and transudative effusions. In resource-limited settings with no facilities to measure lactate dehydrogenase (LDH) levels, using pleural fluid bilirubin ratio may help in better clinical decision.

Methods:  It was a prospective observational study, conducted in the emergency department of Tribhuvan University Teaching Hospital. All the patients attending for emergency care with pleural effusion from 6th Jan 2015 to 5th Jan 2016 were included. The cases were divided as exudates and transudates on basis of final diagnosis. Serum and pleural fluid specimen were collected and sent for investigations. The data for various laboratory parameters especially those of lights criteria and bilirubin ratio were then analyzed and fluid nature was compared with results from parameters and final diagnoses.

Results:  Among 103 cases, 71.84% had exudate and 28.16% had transudate. The commonest cause of effusion was pneumonia 35.92%, second being tubercular 23.30% followed by malignant effusion 12.60%, congestive heart failure 11.65%, chronic kidney disease 10.67% and liver cirrhosis 5.82%. The mean bilirubin ratio for exudates exceeded that for transudates. Considering the cutoff point of 0.6, the sensitivity, specificity, positive predictive value and negative predictive value were respectively 88.00%, 93.00%, 97.00% & 75.00%.

Conclusions:   Pleural fluid serum bilirubin ratio can be utilized as a diagnostic tool for differentiating exudative and transudative effusions.

Keywords:   bilirubin ratio; exudates; light’s criteria; pleural effusion; transudates.
Acute Intradialytic Complications in End Stage Renal Disease on Maintenance Hemodialysis
Authors: Agrawal R K , Khakurel S , Hada R , Shrestha D , Baral A
Published: September 2018

Introduction: Hemodialysis is the preferred method of treatment for Nepalese patients with End Stage Renal Disease. Despite the technological advances and better understanding of physiology associated with hemodialysis, a number of complications are known to be associated with hemodialysis. This study was undertaken to study the frequency of acute intradialytic complications in patients undergoing hemodialysis.

Methods: A cross-sectional study was conducted at Nephrology unit of a tertiary care hospital from 15 June, 2007 to 15 December, 2007. A total of 28 patients were included in the study. Patients with acute renal failure and acute on chronic renal failure were excluded from the study.

Results: Total sessions of hemodialysis during the period were 1455. Hypotensive episode were 66 (4.5%) and was the commonest complication and followed by hypertensive episodes were 58 (3.8%). Other problems encountered were transfusion reactions were 23 episodes (1.5%), rigors not related to transfusions were 13 episodes (0.8%), nausea/vomiting were 20 episodes (1.4%), muscle cramps were 12 episodes (0.8%), hypoglycemia were 6 episodes 5(0.4%).

Conclusions: The frequency of intradialytic complications is low and many of them are not life threatening.

Keywords: complications; end stage renal disease; hemodialysis; hypertension; hypotension.
Awareness of Infection Control among Dental Students and Interns
Authors: Ghimire Barsha , Chandra Suresh
Published: September 2018

Introduction: Disease transmission can occur through direct contact, blood, oral fluids, or other secretions and indirect contact with contaminated instruments, operatory equipment, or objects. Prevention of cross contamination helps in reducing the infection. The level of education of the students, and their knowledge about the infection control directly relates to the patient care. The current study aims to determine the level of knowledge and infection control procedures among dental students in a clihnical practice.

Methods: This was a cross-sectional study with a self-administered questionnaire comprised of 18 open and close-ended questions related to infection control and prevention. Answers of the questions were analysed by SPSS version 20.

Results: Among the students included, 53 (36.8%) participants were intern, 31 (21.5%) from fifth year, 31 (21.5) from fourth year and 29 (20.1) were third year. Performance satisfaction shows that the students were fairly satisfied with their performance. When students were asked to rate the implementation of infection control policy in their clinical practice 1 (0.7%) were very good, 74 (51.4%) were fair, 44 (30.6%) were good are while 25 (17.4%) were poor to implement infection control policy in their practice.

Conclusions: The level of knowledge and practice of infection control measures was poor among dental students. The attitude towards infections control measures was positive, but a greater compliance was needed. Formal class and examination may help improve knowledge and clinical practices.
Spinal Anesthesia for Laparoscopic Cholecystectomy in Parkinson’s disease
Authors: Gautam Binod , Baral Bikash
Published: September 2018

Parkinson’s disease, a neurodegenerative disorder, presents with resting tremor, muscle rigidity and bradykinesia. Affecting multiple organ-systems, it’s an important cause of peri-operative morbidity. General anaesthesia may deteriorate cardio-pulmonary and neuro-cognitive functions; moreover, medications used may interact with anti-parkinsonian agents. Spinal anaesthesia is usually avoided in Parkinson’s disease. However, it offers neurologic monitoring and less surgical stress response and avoids complications of general anaesthesia. This case report aims to demonstrate application of spinal anaesthesia for laparoscopic cholecystectomy in a Parkinson’s elderly with pulmonary dysfunction and anticipated difficult airway management. Sensory blockade of third thoracic dermatome was achieved. Bupivacaine was instilled intra-peritoneally. Surgery was smooth at low intra-abdominal pressure. Regular Paracetamol provided satisfactory post-operative analgesia. Single episode of post-operative vomiting was effectively managed. Without deterioration, patient was discharged from hospital on third day. Spinal anaesthesia is a valid technique for laparoscopic cholecystectomy in needy patients with multiple peri-operative risks.
Glandular Odontogenic Cystin Maxilla : A Case Series
Authors: Ojha Bidhata , Bajracharya Dipshikha , Baral Radha , Bhattacharyya Shubrata , Roy Saurabh , Singh Sumit , Deshar Bikash
Published: September 2018

Glandular odontogenic cyst is rare phenomenon with 0.012% to 0.03. 3% frequency of all jaw cysts and worldwide prevalence of 0.17%. Diagnosis of Glandular odontogenic cyst, well known for its aggressive growth potential and high rate of recurrence, is very crucial. This report presents cases of two 50-year old individuals with Glandular odontogenic cyst presenting as a radiolucent lesion of maxilla. Final diagnosis was made on the basis of histopathological features and further confirmed by immunohistochemical analysis.
Autonomic Influence on Heart Rate for Deep Breathing and Valsalva Maneuver in Healthy Subjects
Authors: Jha Reena Kumari , Acharya Amrita , Nepal Ojashwi
Published: September 2018

Introduction: The Autonomic nervous system is responsible for regulation and integration of visceral functions. Disturbance of autonomic nervous system play crucial role in pathogenesis and clinical course of many diseases. In the present study deep breathing test and valsalva maneuver have been described to monitor parasympathetic function genderwise.

Methods: A cross-sectional study was conducted among 100 subjects, aged 18-25 years, from May to November 2017, in exercise physiology laboratory, Kathmandu University School of Medical Sciences, Chaukot, Kavre. Electrocardiograph recorded by AD instrument was used to calculate the resting heart rate and the heart rate response to deep breathing test and valsalva maneuver.

Results: Heart rate response to deep breathing test (31.69±14.79 Vs. 36.08±18.65, P=0.195) and valsalva ratio (1.59±0.39 Vs. 1.69±0.54, P=0.314) tend to be higher in female than male subjects but not significant. The resting heart rate of females was significantly higher than that of males (84.37 ± 11.08 Vs. 78.43 ± 12.06, P<0.05). Heart rate was significantly increased during and decreased after valsalva maneuver in both male and female subjects.

Conclusions: This study concludes that both deep breathing test and valsalva maneuver activates parasympathetic system inhealthy subjects. And also dominant parasympathetic activity was found in female comparison to male subjects.
Acoustic Analysis of Voice in School Teachers
Authors: Mahato Nain Bahadur , Bista Meera , Regmi Deepak , Sherpa Pema
Published: September 2018

Introduction: The term ‘voice' is the acoustic energy generated from the vocal tract that are characterized by their dependence on vocal fold vibratory pattern. Teachers as professional voice users are afflicted with dysphonia and are discouraged with their jobs and seek alternative employment. Loud speaking and voice straining may lead to vocal fatigue and vocal fold tissue damage. 

Methods: Sixty teachers from various schools, volunteered to participate in this study. Acoustic analysis Doctor Speech Tiger Electronics, USA was used to assess the voice quality of the school teachers before and after teaching practice. The data were collected and analyzed using Doctor Speech Tiger Electronics, USA. Analysis was performed in terms of perturbation (jitter and shimmer), fundamental frequency, harmonic to noise ratio and maximum phonation time.

Results: We found statistically significant difference in all the four parameters except the Jitter value. The fundamental frequency and shimmer value has significantly increased (P<0.001) and (P=0.002) respectively after teaching practice. Unlikely, there was significant decrease in harmonic to noise ratio value (P<0.001) and maximum phonation time value (P<0.01) after teaching practice.

Conclusions: Vocal abuse, overuse, or misuse in teaching practice over a long period of time can result in inadequate phonatory pattern due to vocal fold tissue damage, which ultimately results in vocal nodules or polyps. So voice evaluation is particularly important for professional voice users and for the people who are concerned about their quality of voice.
Health Problems while Working as a Volunteer or Humanitarian Aid Worker in Post-Earthquake Nepal
Authors: Bhandari Durga , Pandey Prativa
Published: September 2018

Introduction: Volunteers and humanitarian aid workers working in disaster struck areas of the world are a vulnerable group of travelers. Nepal saw an influx of these humanitarian aid workers following earthquakes in April and May 2015. 

Methods: This was a descriptive cross-sectional study conducted at CIWEC Hospital located in Kathmandu. A questionnaire was given to all volunteers and aid workers who arrived at the hospital for evaluation of health related problems and agreed to be part of the study.

Results: Ninety-five volunteers were enrolled in the study. Among these, 65 (68%) were female and 30 (32%) were male. The immunizations received before travel were Hepatitis A 82 (86%), Hepatitis B 82 (86%), Typhoid 70 (73%), Rabies 38 (40%), Japanese Encephalitis 34 (36%), Influenza within last one year 23 (24%), measles 48 (51%), Cholera 34 (36%),Tetanus within 10 years 71 (75%) and Varicella 38 (40%). Forty-four (45%) of travelers carried medication for treatment of Traveler’s Diarrhea (TD) which included Ciprofloxacin, Azithromycin, Loperamide and others like Metronidazole and Charcoal. The common illnesses encountered were gastrointestinal, skin problems , injury and musculoskeletal problems, respiratory problems, genitourinary problems, cardiovascular, psychological problems, syncope, and miscellaneous.

Conclusions: Traveler’s Diarrhea and dermatological problems were the most common health related problems. Volunteers were not properly prepared for self-treatment and pre-travel preparation was sub-optimal. Important pre travel health advice will decrease the incidence of health problems in this group.
Cervical Cancer Awareness and Practice of Pap Smear Test Among Women with Gynecological Problems
Authors: Thapa Meena
Published: September 2018

Introduction: Cervical cancer is the most common cancer in women in Nepal. Pap smear test is the most important screening test for cervical cancer, which helps in reducing mortality from it. This study is to assess the knowledge of cancer cervix and practice of Pap smear test and to analyze the impact of educational status on them.

Methods: This was a descriptive cross-sectional study, carried out among the married women who attended the Out Patient Department for gynecological problems at Kathmandu Medical College. Structured questionnaires were used to collect the data.  The questionnaire consisted of three sections which included the demographic profile in first part , second part included assessment of the knowledge of cancer cervix, and third part included evaluation of  the utilization of Pap smear test.

Results: A total of 205 married women were included in the study. Out of them, 74% were aware of cancer cervix. Only 39% of women were aware of Pap smear test. Pap smear test coverage was 16.6% in studied population. Main reason of not doing Pap smear test was lack of knowledge of the test. High educational status of the women had significant positive impact on knowledge of cancer cervix and practice of Pap smear test.

Conclusions: The knowledge of cancer cervix was good in our women, but knowledge and the practice of Pap smear test was poor. Good educational status of the women was found to influence the on knowledge of cancer cervix and uptake of Pap smear test.
Need of the Regulation for Profit Percentage Investment by Pharmaceutical Companies in New Drug Discovery Research from the Various Local Traditional Medicinal and Plant Systems
Authors: Bhattarai M D
Published: September 2018

In the modern medical systems the active pharmacological ingredients, effective against any disease is identified, purified and studied for its various effects and side-effects whereas it is not so in the traditional systems. Therefore, it is not surprising that safety concerns have often been raised about the traditional medical products. The major issue now, is to make appropriate situation with basic supports to bring all the available experts and resources together for the identification, purification, and study of efficacy and safety of the active molecules of the popular traditional medicines.

Government and public sectors in the countries with such rich traditional medicinal and plant systems have related experts, but they also have much hurdle regarding recruitment and retention of expert human resources, getting fund, purchase and maintenance of equipment, bureaucratic formalities and others. The pharmaceutical companies have basic laboratories with related infrastructure and human resources as well as interest about bringing the drug molecules. To bridge the gap, there is a need of the regulation which will make the pharmaceutical companies to invest certain percentage of their profit in the field of research to identify new drug molecules and to study their effects. It is just not an issue of discovering the active molecule but also of creating the concept and culture of research, purity and quality of drugs, safety of people, and future direction of the human society.

Keywords: drug development; investments; medicinal plants; pharmaceuticals; public-private participation;research; traditional medicine.
Lemierre's Syndrome in a Patient with Severe Lupus Nephritis
Authors: Paudyal B P
Published: September 2018

Lemierre’s syndrome is a rare septic thrombophlebitis of the internal jugular vein with frequent metastatic complications following an acute oropharyngeal infection. Immunocompromised patients are at higher risk of developing this syndrome owing to the decreased host response and increased risk of oropharyngeal sepsis. We herein report a 24-year-old woman with severe lupus nephritis on immunosuppressive therapy, who developed Lemierre’s syndrome following a pharyngeal infection despite an adequate and timely antibiotic therapy. We hereby draw an attention to the importance of accurate and timely diagnosis and appropriate management of Lemierre’s syndrome in immunocompromised patients so as to achieve a successful prognosis for this deadly infection.

Keywords: Lemierre’s syndrome, lupus nephritis, immunocompromised state
Blood Pressure in Inhabitants of High Altitude of Western Nepal
Authors: Shrestha S , Shrestha A , Shrestha S , Bhattarai D
Published: September 2018

Introduction: Studies conducted amongst the inhabitants of high altitude suggested that systolic and diastolic blood pressures are lower in the high than in low altitude population. So a study was designed to look at the blood pressure values among permanent residents of high altitudes of rural Western Nepal.

Methods: This is a descriptive cross sectional study conducted at two different altitudes (2670 and 2950 meters) of Humla District, Nepal, looking at the blood pressure values among the permanent inhabitants at these altitudes. 

Results: Total number of 137 subjects with 73 (53.3%) from 2950 meters and 64 (46.7%) from 2670 meters altitude were enrolled. Mean age of the study population was 35.29 years. Male were 57 (41.6%) and female 80 (58.4%). The difference in systolic blood pressures (118.59 and 114.66 mmHg, P=0.01) and mean arterial pressures (92.0 and 89.5 mmHg, P=0.02) at the altitudes of 2670 and 2950 meters were statistically significant whereas the difference in diastolic BP at these altitudes were not statistically significant. There was no significant correlation of BMI with blood pressure values and no difference was noted in the blood pressure values among the two different ethnic groups at the given altitudes. 

Conclusions: Lower rate of hypertension was observed among the inhabitants of high altitude of rural western Nepal. Blood pressure was found to decreases with increase in altitude among permanent inhabitants of high altitude. 

Keywords: altitude; blood pressure; high altitude inhabitants; hypertension; physiological change.
Family Planning Knowledge and Practices among Women in a District Hospital of Nepal
Authors: Gupta S , Singh A , Gupta N , Shrestha V L
Published: September 2018

Introduction: Family planning services have the potential to improve the quality of the lives of people. The study was done to assess the family planning practice and methods among the married women of reproductive age attending female clinic of district hospital of Nepal. 

Methods: This is a cross sectional descriptive study carried out from October 2011 till December 2011 at Lamjung district hospital. One hundred randomly selected married women of 15-49 years, who had at least one child were the subjects of the study. A structured questionnaire on knowledge, practice and methods of use of contraception was composed and fi lled up. 

Results: The results were encouraging with 94 (94%) of participants having knowledge about contraception. The study showed that 32 (32%) of the married women belonged to 20-24 years of age group. Among them 64 (68%) were using modern contraception methods. Injectables hormonal contraceptives were most commonly practiced by 34 (54%) women. Among not using any contraceptives, 18 (60%) of them said their husband being abroad.

Conclusions: Family planning knowledge and practice among the rural women utilizing the service was appreciable. Temporary method of contraception was most commonly practiced.

Keywords: district hospital; knowledge; practice, family planning.
Surgical Management of Cervical Spondylotic Myelopathy
Authors: Sah S , Wang L , Dahal M , Acharya P , Dwivedi R
Published: September 2018

Introduction: The surgical procedure by the anterior, posterior and combined antero-posterior approaches had applied for the treatment of cervical spondylotic myelopathy. 

Methods: During the treatment process, all patients were pre-operatively as well post-operatively graded according to Japanese Orthopaedics Association. Several surgical methods such as anterior approach, posterior approach, and combined antero-posterior approach have been addressed for CSM patients, with the choice based on the pathogenesis of the myelopathy. The main indications for surgery were evidence of myelopathy on physical examinations, a JOA score below 13 points help with spinal cord compression observed on plain X-ray, CT scan, MRI studies. 

Results: The pre-operative JOA scores were 7.60±1.23 in laminoplasty, 8.30±1.03 in diskectomy and corpectomy and 7.10±1.20 in combined antero-posterior approach patients. At the follow-up after three months the JOA scores were laminoplasty 13.30±1.30, diskectomy and corpectomy 13.55±1.15 and combined antero-posterior 13.50±1.08. The JOA recovery rate averaged, 61.08±11.25% in laminoplasty, 60.67±10.60% in diskectomy and corpectomy and 64.67±10.72% in combined anteroposterior approach. The high- signal intensity changed to normal in 18 out of 28 and no any kyphotic change and instability were found in cervical spine at the follow up. 

Conclusions: Patients with OPLL (continuous, segmental and mixed type), stenosis of cervical spinal canal, multilevel cervical spondylosis, large and high ossification of IVDP with stenosis were improved with laminoplasty. Patients with PIVD, CSM with kyphosis, post laminectomy , OPLL herniated type, unstable vertebral alignment, stenosis by osteophytes, were improved with anterior approach . Ossified or deformed OPLL, unstable vertebral with stenosis ,OPLL or OYL with cervical meandearing (swan-neck) were improved with Combined anterior and posterior approach.

Keywords: cervical spondylotic mylopathy, anterior cervical diskectomy and fusion, corpectomy.