bluuebunny/crossref_metadata_2025 huggingface dataset:
Routine Measurement of Serum Amylase in Acute Abdomen
Authors: Ghimire Roshan , Thapa Anurag Singh , Karki Dimindra , Shrestha Dipendra Kumar
Published: September 2018

Introduction: Acute abdominal pain is a common condition presenting to both the emergency department and surgical admission unit. Increase in serum amylase levels are found in much gastrointestinal pathology. Serum amylase level is consistently high in acute pancreatitis though high values are not pathognomonic of pancreatitis .The aim of this study to assess the level of serum amylase in various diseases presenting with acute abdominal pain and to evaluate the role of routine measurement of serum amylase in the screening of patient with acute abdominal pain for the diagnosis of acute pancreatitis in a prospective series.

Methods: A prospective observational study was performed from 15th May 2014 – 15th Nov 2014 (6 months) at Department of Surgery of Kathmandu medical College Teaching Hospital; Kathmandu. All consecutive patients presented at emergency department and required admissions in surgical ward were included. A multivariate analysis was performed to assess the level of serum amylase in various diseases presenting with acute abdominal pain including acute pancreatitis.

Results: Overall, 318 patients were included during a period of 6 months among them 48 patients were excluded. 34 cases (12.6 %) were diagnosed of acute pancreatitis. three cases (1.1%) of non pancreatic pathology with raised serum amylase level (> 1000 U\L).

Conclusions: Routine assessment of serum amylase is helpful in excluding differential diagnosis of patient presenting with acute abdomen and this study identified serum amylase as a good screening tool if done in cases with clinical suspicion. 

Keywords: acute abdominal pain; acute pancreatitis; serum amylase.
Surgical Results of Non-small Cell Lung Cancer in Nepal
Authors: Thakur Binay , Yonghui Di , Devekota Mukti , Baral Paribartan , Poudel Bishworam
Published: September 2018

Introduction: Surgery remains the only curative modality for early stage of Non small cell lung caner (NSCLC). We reviewed overall scenario of lung cancer and surgical results in Nepal.

Methods: 1000 patients with the pathological diagnosis of lung cancer were analyzed to summarize the overall scenario of lung cancer. 157 NSCLC patients underwent pulmonary resection. cIA, IB, IIA, IIB, IIIA (N1) underwent surgery as initial modality of treatment. cIIIA (N2) patients were taken for surgery after neoadjuvant chemo/ chemoradiation.

Results: Analysis of 1000 patients showed squamous cell carcinoma in 41.3%, incurable stage (IIIB/ IV) in 66.8% and rate of curative resection in 6.7% cases. Surgery as a single modality of treatment was used in 38%. Neoadjuvant Chemo/ chemoradiation/ radiation followed by surgery and surgery followed by chemo/ chemoradiation/ radiation was done in 12% and 50%, respectively. In-hospital mortality was 2% (post pneumonectomy: 5.5%; post lobectomy: 1.5%; post sublobar resection: 0%). R0 resction was achieved in 91% cases. Median survival and 5-year overall survival were 36 months and 18%, respectively. Better survival was achieved in pI-II vs pIII/ IV, pN0-1 vs pN2 and pR0 vs pR+ (p <0.05).

Conclusions: Earlier stage (pI-II), R0 resection and pathological pNo-1 has the best five year overall survival in Nepalese patients with NSCLC as well.Keywords: lung cancer; NSCLC; pulmonary resection.
Clinical Profile of Neonates with Perinatal Asphyxia in a Tertiary Care Hospital of Central Nepal
Authors: Gupta Sweta Kumari , Sarmah Bhawani Kanta , Tiwari Damodar , Shakya Amshu , Khatiwada Dipendra
Published: September 2018

Introduction: Birth asphyxia is a serious clinical problem worldwide. It claims approximately 9 million deaths each year. It can lead to serious neurological sequaele, such as cerebral palsy, mental retardation, and epilepsy.

Methods: All babies admitted in College of Medical Sciences Teaching Hospital, Chiwan, Nepal, NICU from January 2013 to December 2013 with a diagnosis of birth asphyxia (5 min Apgar<7 or those with no spontaneous respirations after birth) were included in the study (n=125). This was a descriptive observational study. Clinical information was collected (gravida, hour at presentation, mode of delivery, sex of baby, gestational age of the baby, requirement of resuscitation). Neonates were admitted to NICU, observed for complications and managed as per hospital protocol.

Results: Among the 722 neonates admitted to NICU, 125 had perinatal asphyxia (17.3%). Babies with Hypoxic ischemic encephalopathy(HIE) Grade I had a very good outcome but HIE III was associated with a poor outcome. Outborn neonates had higher grades of perinatal asphyxia as compared to inborns (p=0.018). Term gestation, Males and Multigravida were associated with a higher rate of birth asphyxia. 22.4% neonates were delivered via caesarean section and 74.4% required bag and mask ventilation at birth.

Conclusions: Birth asphyxia was one of the commonest causes of admission NICU. Babies with HIE Grade III had a very poor prognosis. Outborn neonates with birth asphyxia had a higher mortality. Males were frequently affected than females. 

Keywords: birth asphyxia; HIE; mortality; measurement.
Cytodiagnosis of Sacral Chordoma
Authors: Shukla Saumya , Awasthi Namrata Punit , Husain Nuzhat , Anand Nidhi
Published: September 2018

We report the cytological findings of a sacro-coccygeal chordoma in a 53 year male diagnosed preoperatively by guided fine needle aspiration cytology. The smears shows characteristic Physalliphorous cells in a metachromatic background of myxoid material entrapping cords of cuboidal cells. Differential diagnosis in cytology include conventional and myxoid chondrosarcoma, myxoid liposarcoma, myxoid malignant fibrous histiocytoma, metastatic mucinous carcinoma and myxo-papillary ependymoma. The distinguishing features between these neoplasms are discussed. Preoperative diagnosis of chordoma permits optimum planned surgery.  

Keywords: chordoma; myxoid; sacral.
Splenic Infarct: A Rare Presentation in a Pediatric Patient
Authors: Bhattarai Palla , Pierr Louidson , Adeyinka Adebayo , Sadanandan Swayam
Published: September 2018

A previously healthy 16-year-old male presented with a two day history of persistent epigastric pain. His physical examination was significant for tenderness in the left hypochondriac region with a palpable spleen 2cm below the left sub-costal margin. A CT scan of the abdomen showed a splenic infarct. Heterophile and EBV VCA IgM antibody test were positive. This is a rare case of infectious mononucleosis presenting with splenic infarct in an adolescent male without comorbidities. 

Keywords: infectious mononucleosis; splenic infarct.
Socio-demographic, Epidemiological and Environmental Determinants of Acute Gastroenteritis in Western India
Authors: Rupani Mihir Prafulbhai , Trivedi Atul V , Singh Manindra Pratap , Tundia Mohnish N , Patel Kaushal N , Parikh Khushali D , Parmar Vijay B
Published: September 2018

Introduction: An outbreak of acute gastroenteritis had occurred in Rajpara village of Bhavnagar district. The objective of this study was to find out the socio-demographic, epidemiological and environmental determinants of this outbreak.Methods: A case-control study was conducted in Rajpara village among 238 cases of acute gastroenteritis and an equal number of controls in January 2015. Multiple logistic regression was used for identifying the variables independently predicting acute gastroenteritis.Results: Upper socio-economic status, occupation requiring travel outside village, source of drinking water from well of ‘new’ Rajpara village, change in taste of water, use of chlorine tablets, travel outside village in last week, another family member affected with acute gastroenteritis, using common utensil for hand washing, hand washing before eating, ate food from outside in last week, having sanitary latrine at house, waste disposal in a common dump (instead of at house), waste accumulation around house and flies inside house were significantly associated with occurrence of acute gastroenteritis. On multiple logistic regression, change in taste of water (P<0.001), waste disposal in a common dump (P=0.012), another family member been affected (P<0.001), waste accumulation around house (P<0.001), higher socio-economic status (P=0.002) and eating outside food (P=0.011) made a significant contribution to prediction.Conclusions: Socio-demographic factors (higher socio-economic status), epidemiological correlates (change in taste of water, another family member been affected with acute gastroenteritis and eating outside food) and environmental determinants (waste disposal in a common dump and waste accumulation around house) significantly determines the occurrence of cases of acute gastroenteritis. Keywords: case-control studies;diarrhea; epidemiologic determinants; gastroenteritis; social determinants of health. | PubMed
Exploring the Diagnosis and Management of Bouveret's Syndrome
Authors: Bhattarai Mukul , Bansal Pardeep , Patel Bharat , Lalos Alexander
Published: September 2018

Bouveret’s syndrome is an unusual cause of gastric outlet obstruction secondary to gallstone impaction. It is so rare that it is commonly missed in clinical practice if it is not considered in differential diagnoses of intestinal obstruction more specifically in man who does not report the history of gall stone. Furthermore, there are no definitive guidelines on approach and management of this condition. We present a seventy eight year old man who developed acute abdominal symptoms due to impaction of a gallstone in the duodenum. He did not have history of gall stone. The diagnosis was supported via CT abdomen and Endoscopy. The patient was successfully managed by exploratory laparotomy followed by anterior pylorotomy to remove the stone without cholecystectomy and fistula repair. Keywords: Bouveret’s syndrome; cholelithiasis; enterolithotomy; Gallstone ileus. | PubMed
Myomectomy Revisited: Experiences in a Teaching Hospital
Authors: Subedi Shanti , Chhetry Manisha , Lamichhane Sabina
Published: September 2018

Introduction: Uterine myomas are the most common benign tumors of the female reproductive tract with myomectomy being one of the major modalities of the treatment in our set up. The aim of this study was to share the experiences of open myomectomy from a Teaching Hospital.Methods: A observational study was conducted from a records of myomectomy cases in the department of Obstetrics and Gynaecology at Nobel Medical College teaching Hospital from June 2014- May 2016.Results: Total 38 cases of myomectomy were performed during the study period in the women most commong age group being 35-39 years, followed by 30-34. The most common presenting symptoms was abnormal uterine bleeding in 15 (39.47%) followed by mass per abdomen in 10 (26.31%). The most common location of the myoma was intramural followed by subserosal, submucus. Degeneration was also noted in majority of the cases. All the myomectomies were done with Inj Vasopressin injected paracervically except in one case where tourniquet was used. None of the patients had significant post-operative morbidity except fever in the first 24 hours.Conclusions: Abdominal myomectomy is a safe and effective procedure for uterine myomas for infertile women in the past but it should be offered to those desiring for uterine preservation irrespective of age and reproductive status. Keywords: abnormal uterine bleeding; degeneration; myomectomy. | PubMed
Muscular Hamartoma of Intestine Causing Intestinal Obstruction
Authors: Upadhyaya Paricha , Shrestha Girishma , Karki Smriti , Agarwal Meenu
Published: September 2018

Hamartomatous causes of small bowel obstructionare uncommon and of them, most are attributed to inflammatory bowel diseases and also certain medications such as NSAIDs. We describe a case of muscular hamartoma in a patient without prior chronic medical condition with brief review of literature. Keywords: Bowel; Hamartoma; Muscle; Obstruction. | PubMed
Maxillary Calcifying Epithelial Odontogenic Tumour
Authors: Acharya Souvagini , Prusty Nilamadhab , Naik Choubarga , Kumar Koushal
Published: September 2018

The calcifying epithelial odontogenic tumor is a benign, locally invasive, slow-growing neoplasm occurring as intraosseous (94%) and extraosseous (6%) variants and with a frequency of 1-2%. Extraosseous variant is diagnosed slightly earlier than the intraosseous type. The intraosseous CEOT shows a maxilla:mandible site ratio of 1:2 and are mainly located in the premolar/molar region. Histologically, the CEOT is characterized by the occurrence of sheets, nests and masses of polyhedral, eosinophilic epithelial cells which may show cellular abnormalities including giant cell formation and nuclear pleomorphism. Some cells increase in size andproducea homogeneous, eosinophilic, 'amyloid-like' substance which may become calcified and which may be liberated as the cells break down. Enucleation with amarginof macroscopically normal tissue is the recommended treatment for CEOT involving the mandible. Maxillary CEOT are treated more aggressively, as they tend to grow more rapidly and do not usually remain well confined. Keywords: calcifying epithelial odontogenictumor; Pindborgtumor;hemimandibulectomy. | PubMed
Cardiovascular Collapse during Induction of General Anesthesia
Authors: Pradhan Bishwas
Published: September 2018

abstract
Estimation of Stature from Nasal Length
Authors: Shrestha Ratindra Nath , Banstola Dinesh , Nepal Dipeshwara , Baral Prakash
Published: September 2018

Introduction: Estimation of stature for the purpose of identification has a significant forensic importance. This technique is based on a principle that bones or human body parts correlate positively with the stature. Stature can be estimated from measurements of various body parts such as arm, leg, feet, finger, facial height, nasal height etc. The aim of study was to correlate Stature of Nepalese with Nasal height and estimate Stature from Nasal height.Methods: A cross-sectional study of 214 healthy adults comprising 110 males and 104 females in the age group of 25 to 35 years were carried out. Study was carried out in central Nepal where people from various parts of Nepal are migrated. Total body height and Nasal height were recorded with stadiometer and sliding caliper respectively.Results: The mean of total body height in the male and female was 160.4 (±6.80) cm and 151.8 (±4.88) cm respectively. The mean of nasal height in the male and female was 4.6 (±0.31) cm and 4.3 (±0.29) cm respectively. This study observed that in both male and female nasal height had positive partial correlation with stature; r = 0.18 for male and 0.19 for female. Stature in nepali population could be calculated as: Stature=148.22+3.02x nasal height in male where as Stature=133.01+3.12x nasal height in female.Conclusions: Both Nepali male and female nasal height had positive partial correlation with stature; r = 0.18 for male and 0.19 for female. Stature in Nepali population could be calculated as: Stature=148.22+3.02x nasal height in male where as Stature=133.01+3.12x nasal height in female.Keywords: estimation; stature; nasal height. | PubMed
Perineal Outcome after Restrictive use of Episiotomy in Primi-gravidas
Authors: Joshi A , Acharya R
Published: September 2018

Introduction: Episiotomy is a common obstetrical practice that is believed to prevent severe lacerations. Principles of evidence based medicine raises questions on the utility of routine episiotomy.

Methods: A prospective observational study was conducted in primi gravidas coming to Tansen Mission Hospital for delivery who were not offered episiotomy sticking to the protocol of restrictive use of episiotomy and the subsequent perineal tear was evaluated in terms of its length, degree and complications. Risk factors associated with significant degrees of perineal tear was investigated.

Results: The episiotomy rate during the time of study was only 22%. Among those included in the study, 16.2% of women had intact perineum and majority of women (43.2%) had first degree of tear. Only one (1.4%) had third degree tear without any long term complications. Having a baby weighing 2.5 kg increases the mean tear length significantly (P=0.019) and increases the risk of having second or third degree of tear by almost two times (Relative Risk=1.95). No clinically significant complications were observed in any of the women after the delivery.

Conclusions: This study provides some evidence that the principle of restrictive use of episiotomy with a total episiotomy rate being around 20% can be carried out successfully even in an under¬resourced setting of our country.
Hypercalcemia due to Nasopharyngeal Carcinoma
Authors: Chaudhary Shipra , Sah Jeetendra Prasad
Published: September 2018

Hypercalcemia is one of rare metabolic disorders associated with hyperparathyroidism, malignancy and various other causes. Although common in adult malignancies, hypercalcemia is rare in pediatrics and purports poor prognosis. Nasopharyngeal carcinoma is rare with no reported hypercalcemic presentation. We present here a case of hypercalcemia in a child of nasopharyngeal carcinoma. A 10 year girl presented with backache for 1 month, epistaxis, cough, chest pain for 1 week alongwith anorexia and weight loss. Investigations revealed anemia and hypercalcemia (23mg/dl; normal range 9-11 mg/dl) with hyperphosphatemia, normal parathyroid levels. Hypercalcemic crisis was managed with saline, furosemide and bisphosphonate. Computed Tomography of paranasal sinuses revealed mass in right nasal cavity. Endoscopic biopsy disclosed undifferentiated nasopharyngeal carcinoma and the child expired. Thus, hypercalcemia, though rare, may complicate advanced tumors. NPC, being rare in children, requires high index of suspicion with careful clinicoradiological examination and timely management for better chances of survival.
Prescribing Skills of First and Second Year MBBS Students of A Teaching Hospital
Authors: Chapagain Kumud , Paranjape Bhaskar Diwakar , Lama Ganesh
Published: September 2018

Introduction: To ensure safe, effective and rational prescribing by tomorrow’s doctors it is important to assess the prescribing skills of today’s medical students. The aim of this study was to assess the prescribing skills of MBBS preclinical students of a Teaching Hospital.Methods: First and second year medical students were given different sets of common clinical scenarios and asked to write a prescription for these. The physician and drug related components were analyzed following the WHO guidelines. The data were statistically analyzed using Chi-square test for 99% and 99.99% Confidence Intervals. P values < 0.01 and < 0.0001 were considered significant respectively. Results: MBBS first year student scored 123 (82%) and 94 (62.66%) in physician and drug related component respectively. MBBS second year students scored 139 (92.66%) and 111 (73.33%) in physician and drug related components respectively. Results obtained from the element prescriber's address and telephone number, date of prescription and patient’s address on the prescription of first year and second year medical students were highly significant (p<0.0001). Conclusions: Prescribing skill of first and second year MBBS students is not satisfactory. Prescribing deficiencies were found on both the physician and drug related components which emphasizes the need of adequate prescribing knowledge in order to minimize the prescription errors and irrational prescribing. Based on this study, we suggest all the undergraduate medical students should be regularly trained and evaluated to further help minimize the prescribing errors.Keywords: prescription; prescription errors; prescribing skill. | PubMed
Antenatal Detection of Conjoined Twin
Authors: Sharma Umesh Kumar , Dangol A , Chawla CD , Shrestha D
Published: September 2018

abstract
Comparison of Fissure Healing and The Incidence of Headache Among the Patients Treated with Endo- and Perianal Application of 0.2% Glyceryl Trinitrate for Chronic Anal Fissure
Authors: Joshi Mukund Raj , Bohara Tanka Prasad , Rupakheti Shail
Published: September 2018

Introduction: Chronic anal fissure is associated with significant morbidity and reduction in quality of life mostly in young healthy adults. Glyceryl Trinitrate, a most commonly used agent for treatment, is associated with incidence of headache causing discontinuation of treatment. There is belief that endoanal application instead of perianal is associated with lower incidence of headache. This study is to compare the incidence and severity of headache in between perianal and endoanal application of GTN ointment.Methods: Thirty patients were taken in each perianal and endoanal group. They were given orientation to apply 375gm of ointment either endoanally or perianally and to record severity of headache according to visual analogue scale. This record was noted by independent observer in telephonic conversation. Patients were followed up at 6 weeks for evaluation fissure. Results: The mean age, male female ratio and features of chronicity was similar in both the group however the duration of symptoms between the group was different. Regarding outcome, Overall incidence of headache was seen in two-third of patient with severe headache in approx. 10%. Severity of headache was slightly lower in endoanal group but the difference was not significant. Healing rate was comparable. Two patient in perianal and 3 in endoanal group were lost for follow up. Conclusions: Endoanal application of GTN ointment is associated with slight decrease in intensity of headache and is comparable with perianal application for fissure healing. 

Keywords: anal fissure; endoanal; glyceryl trinitrate;headache; perianal.| PubMed
Intraventricular Taenia solium Neurocysticercosis: A Report of Three Cases
Authors: Pant B , Devleesschauwer B , Shrestha P , Shrestha I , Praet N , Dorny P
Published: September 2018

Neurocysticercosis (NCC), caused by the pork tapeworm Taenia solium, is reported to be a common condition in Nepal. So far imaging diagnosis was mainstay of the diagnosis. In this paper, we report three patients presenting with neurological symptoms due to intraventricular NCC. We have diagnosed the causative agent as T. solium on molecular basis. Further research is warranted to assess the actual health impact of T. solium in Nepal.

Keywords: Intraventricular neurocysticerosis, PCR-RELP, Taenia solium.
Role of S-100 Immunostain as An Auxiliary Diagnostic Aid in Leprosy
Authors: Dhakhwa Ramesh , Acharya Sneh , Pradhan Sailesh , Shrestha Sanju Babu , Itoh Tomoo
Published: September 2018

Introduction: Histopathologic diagnosis of leprosy is difficult when Bacillary Index (BI) is zero and neural involvement are not easily identifiable on routine Hematoxylin and Eosin stain. This study was undertaken to study the role of S-100 immunostaining in demonstrating different patterns of nerve involvement in various types of leprosy.

Methods: Thirty one skin biopsies with clinico-histopathologic diagnoses of leprosy over a period of two years were included in the study. Ten cases of non-lepromatous granulomatous dermatoses (including eight cases of lupus vulgaris and two cases of erythema nodosum) were used as controls. Tissue sections from all cases and controls were stained with Hematoxylin and Eosin (H&E) stain, Fite stain and S-100 immunostain. The H&E stained slides were used to study the histopathological features, Fite stained slides for Bacillary Index and S-100 for nerve changes.

Results: Neural changes could be demonstrated in the entire spectrum of leprosy using S-100 immunostaining. The most common pattern of nerve destruction in the tuberculoid spectrum was fragmented and infiltrated whereas lepromatous spectrum showed mostly fragmented nerve twigs. Intact nerves were not detected in any of the leprosy cases.

Conclusions:  S-100 immunostain is a useful auxiliary aid to the routine  H&E stain in the diagnosis of leprosy especially tuberculoid spectrum and intermediate leprosy. 

Keywords: bacillary index; leprosy; S-100 immunostain.
Sentinel Lymph Node Detection in Patients with Early Cervical Cancer
Authors: Acharya Bijaya Chandra , Jihong L
Published: September 2018

Abstract
Therapeutic Drug Monitoring of Antiepileptic Drugs
Authors: Shakya Geeta , Malla S , Shrestha R , Shakya K N
Published: September 2018

Commonly used conventional antiepileptic drugs for pharmacotherapy in epilepsy are phenytoin, carbamazepine and valproic acid. These drugs have complex pharmacokinetic properties leading to fluctuation in their plasma level at given same therapeutic dose. The present study was done to monitor their plasma levels. A prospective observational study was conducted at Natoinal Public Health Laboratory. After taking detail history, blood samples were taken from epileptic patients of all age groups and both gender who were on usual therapeutic dose of one or two combined antiepileptic drugs. Plasma level of these drugs were analyzed by using Fluorescence Polarization Immuno Assay (FPIA) technique. Out of total 417 testing, 81were tested for phenytoin , 241 for carbamazepine and 95 for valproic acid. Their levels were further analyzed to find therapeutic, subtherapeutic and toxic levels. Out of total 81 blood samples tested for phenytoin, 38.8% had plasma drug at therapeutic level, 38.8% at subtherapeutic level and 28.4% had toxic level. Carbamazepine was tested in 241 samples and 79.3% cases had at therapeutic drug level, 15.8% had subtherapeutic drug level and 4.9% had toxic level. Out of 95 samples tested for valproic acid, 62% had therapeutic level and 20% had subtherapeutic and 18% had toxic level of drug. Therapeutic drug monitoring of phenytoin showed wide fluctuation in its plasma level. Its toxic and subtherapeutic levels were quite high. It is suggested that the dose of phenytoin should be adjusted after regular plasma level monitoring only. Monitoring of carbamazepine and valproic acid were also helpful when their toxicity and efficacy are doubtful.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):94-97.
Construction of Multiple Choice Questions Before and After An Educational Intervention
Authors: Tenzin Karma - , Dorji Thinley , Tenzin Tashi
Published: September 2018

Introduction: Khesar Gyalpo University of Medical Sciences of Bhutan, established in 2014, has ushered in a new era in medical education in Bhutan. Multiple Choice Questions are a common means of written assessment in medical education.

Methods: This was a quasi-experimental study conducted at the Faculty of Postgraduate Medicine, KGUMSB, Thimphu in December 2016. A total of 8 MCQs were prepared by four teaching faculties from different fields who had no prior training on construction of MCQs. It was delivered to a group of 16 randomly selected intern doctors. A 2 hours long workshop on construction of MCQs was conducted. After the workshop, the same MCQs were modified according to standard guidelines on developing MCQs and were tested in the same group of intern doctors. An analysis on the performance, difficulty factor, discrimination index and distractor analysis was done on the two sets of MCQs using Microsoft Excel and SPSS 20.0.

Results: For the pre- and post-workshop questions respectively, the pass percentage was 69.8% (11) and 81.3% (13), difficulty factor was 0.51 and 0.53, discrimination index was 0.59 and 0.47, distractor effectiveness was 83.3% and 74.9%.

Conclusions: The workshop on MCQ development apparently seemed highly valuable and effective in changing the learning and performances of medical educators in the development of MCQs.

Keywords: difficulty factor; discrimination index; faculty development; medical education.
Children with First Episode of Fever with Seizure: Is Lumbar Puncture Necessary?
Authors: Batajoo Ruby Joshi , Rayamajhi A , Mahaseth C
Published: September 2018

Fever with seizure, a common presentation with which a child may present to the emergency is mainly due to febrile seizure, but it may also be due to meningitis. This study was done to find out the incidence of meningitis and to find out whether lumbar puncture is necessary in different age groups of children presenting with first episode of fever with seizure. A prospective study was conducted in the emergency department of Kanti Children's Hospital. Children who presented with first episode of fever and seizure in the age group of 6 months to 5 years were included. Meningitis was diagnosed on the basis of either cytological and biochemical criteria or if a bacterial pathogen was isolated. Of the 175 children included, 17% were diagnosed to have meningitis. Cerebrospinal fluid was positive for a bacterial pathogen in 4.5% of the cases. In the age group of 6 months to 12 months, 30% of the children had meningitis as compared to 20 % and 5% in other age groups of 12- 18 months and above 18 months respectively. All children with culture proven bacterial meningitis were in the age group of 6-12 months and had no evidence of meningeal irritation. Signs of meningeal irritation had high specificity in diagnosing meningitis. Organisms grown were Haemophilus influenza in three cases, Streptococcus pneumoniae in two cases and Staphylococcus aureus in three cases. In conclusion, incidence of meningitis was found to be high in children presenting with first episode of fever and seizure. Lumbar puncture to rule out meningitis should especially be considered in children in the younger age group even without evidence of meningeal irritation.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):109-112.
Plasmablastic Lymphoma
Authors: Bhusal Subecha , Acharya Bibek , Chapagain Sandhya
Published: September 2018

Plasmablastic lymphoma is a rare and aggressive lymphoma reported to be commonly associated with immunodeficiency state. It possesses a challenge to the clinician owing it aggressiveness and poor prognosis. No standard of care treatment is available for the disease. Here we report a case of animmnocompetant 67 year female who is unique in her presentation as she did not have any of the conventional clinical features and had a history of urothelial carcinoma three months back.  [PubMed]
Lower Genital Tract Trauma in a Tertiary Care Centre in Mid-Western Nepal
Authors: Adhikari Anil Kumar , Dutta Mahuya , Das Chittra Ranjan
Published: September 2018

Introduction: The study of lower genital tract trauma has become important in gynaecological practice. There is paucity of reports on this clinical entity from our settings. The main aim of this study is to document injuries in female lower genital tract in Mid-Western Nepal.

Methods: Sixty female patients admitted to the hospital with genital tract injuries caused by coitus or accidents were included in the study. Details of the causes of trauma clinical presentations and management were recorded.

Results: These injuries were grouped according to etiological factors. This study included 33 (55%) coital injuries and 27 (45%) non- coital injuries. Out of coital injury, 12 cases were criminal assault (rape) in age group of 4 to 18 years. Four unmarried girls had consensual sex. Non-coital injuries were due to fall from height, cattle horn injuries, straddle type of trauma, vulvar haematoma and anorectal injuries.

Conclusions: Appropriate surgical intervention can avert morbidity and mortality.

Keywords: accident; lower genital tract; Nepal; trauma.
An Experience of Optimizing A Community-Based Micro-Insurance Model to Bridge the Gap between Treatment Cost and Ability to pay at BPKIHS
Authors: Kumar Narayan , Koirala Shekhar , Varma Mamta
Published: September 2018

In the year 2001 the leaders of BPKIHS started a micro social insurance scheme; Social Health Insurance (SHI) for prospective research. It is a method of financing and managing health care using compulsory contributions from employers, employees and may be from the government.Household members from organized groups in catchment areas enrolled voluntarily. Photographed service cards were issued entitled for free IPD/OPD consultations, investigations and bed charges excluding CT scans and specialty treatment. Institute bore operation and medicine costs up to 10000 and 3500 respectively for IPD yearly. Premium was fixed after a research through focus group discussion in villages of Morang, Sunsari and Biratnagar. A flat rate premium of 15 and 50 NRS/adult/month for villagers, city dwellers and half for children was fixed. Marginalized community and handicapped paid 33% of premium, 33% by Institute and 33% by concerned VDC.As the client number increased from 2383 to 7392 in second and to 15779 in third year, Premium: Expenditure ratio moved from 225:222 to 198:391. Average cost sharing of premium to expenditure came to 226:332 showing a negative balance.This scheme completed its fourth year till this research in 2005 A.D. But it was closed due to deficit. As reinsured population occasionally concealed information by not incorporating all family members. They defaulted in subsequent year after utilizing the benefits of SHI and misused the card for uninsured ones. It may, in its optimized form, become a model to be widely adopted to bridge the gap between the cost of treatment and the ability to pay in developing countries.
Mastoid Osteoma – Is “Trauma” A Possible Etiologic Factor
Authors: Sakthivel Pirabu , Yogal Rijendra , Sikka Kapil , Thakar Alok , Rajeshwari Madhu
Published: September 2018

A 19 year old female presented with painful postaural swelling of three years duration with preceding history of trauma. Clinically and radilogically the diagnosis of mastoid osteoma was made. As patient was symptomatic the osteoma was removed and cortical mastoidectomy was done. We emphasise that symptomatic mastoid osteomas must be treated early even if they are small in size to prevent the development of giant osteomas. The case is reported for its rarity with relevant review of literature.  To the best of our knowledge, this is the first case report in which there is a definitive history of trauma preceding the development of osteoma suggesting its possible role as an inciting factor.
Prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA) in a Tertiary-Care Hospital in Eastern Nepal
Authors: Kumari Namrata , Mohapatra TM , Sigh YI
Published: September 2018

Nosocomial infection is a major problem in the world today. Methicillin-resistant Staphylococcus aureus (MRSA) strains, usually resistant to several antibiotics, shows a particular ability to spread inhospitals and is now present in most of the countries.The aim of the present study was to determine the prevalence of MRSA infections and theirantimicrobial susceptibility pattern in our hospital located in eastern Nepal.Identification of Staphylococcus aureus was confirmed by standard methods and the antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method. Interpretation criteriawere those of the national committee for clinical laboratory standards.During a period of one year, out of a total of 750 Staphylococcus aureus strains isolated from variousclinical samples, 196 (26.14%) were found to be Methicillin-resistant. Seventy percent isolates of MRSA were from inpatient departments and amongst them only 10% of the isolates were from intensive care units (ICU). More than 65% of MRSA were found to be resistant to Penicillin, Cephalosporins, Ciprofloxacin, Gentamicin Erythromycin and Tetracycline, while 47.96% of them were resistant to Amikacin. Many MRSA strains were multidrug-resistant. However, no strains were resistant toVancomycin.To reduce the prevalence of MRSA, the regular surveillance of hospital acquired infection, isolationnursing of patients who carry MRSA, monitoring of antimicrobial susceptibility pattern andformulation of a definite antibiotic policy may be helpful.Key words:eastern Nepal, resistant, tertiary-care hospital
Non-communicating Rudimentary Uterine Horn Pregnancy
Authors: Upadhyaya I
Published: September 2018

Pregnancy in a non-communicating rudimentary horn is an extremely rare form of ectopic gestation. The rudimentary horn may or may not communicate with the uterine cavity with the majority of cases being non-communicating. The patient exhibits features of acute abdomen and carries a high risk of maternal death. Even modern scans remain elusive whereas laparatomy remains the confi rmatory procedure for the diagnosis. Because of the varied muscular constitution in the thickness and distensibility of the wall of the rudimentary horn, pregnancy is accommodated for a variable period of gestation. Here, we report three cases of pregnancy in a non-communicating rudimentary horn of the uterus in different periods of gestation, their outcome and a review of the available literature.

Keywords: Mullerian anomalies, non-communicating rudimentary horn pregnancy, surgical management.
Correlation of Visual Prostate Symptom Score with International Prostate Symptom Score and Uroflowmetry Parameters in Nepalese Male Patients withLower Urinary Tract Symptoms
Authors: Bhomi Krishna Kaji , Subedi Neeraj , Panta Prem Prasad
Published: September 2018

Introduction: International prostate symptom score is a validated questionnaire used to evaluate the lower urinary tract symptoms in benign prostatic hyperplasia. Visual prostate symptom score is a new simplified symptom score with pictograms to evaluate the same. We evaluated the correlation of visual prostate symptom score with international prostate symptom score and uroflowmetry parameters in Nepalese male patients with lower urinary tract symptoms.Methods: Male patients aged ≥40 years attending the Urology clinic were enrolled in the study. They were given international prostate symptom score and visual prostate symptom score questionnaires to complete providing assistance whenever needed. Demographic data, examination findings and uroflowmetry parameters were noted. Correlation and regression analysis was used to identify correlation of the two scoring systems and uroflowmetry parameters.Results: Among the 66 patients enrolled, only 10 (15.15%) patients were able to understand English language. There was a statistically significant correlation between total visual prostate symptom score and international prostate symptom score (r= 0.822; p<0.01). The correlations between individual scores of the two scoring systems related to force of urinary stream, frequency, nocturia and quality of life were also statistically significant. There was also a statistically significant correlation of both scores with maximum flow rate and average flow rate.Conclusions: There is a statistically significant correlation of visual prostate symptom score with international prostate symptom score and uroflowmetry parameters. IPSS can be replaced with simple VPSS in evaluation of lower urinary tract symptoms in elderly male patients.Keywords: correlation; international prostate symptom score; lower urinary tract symptoms; uroflowmetry; visual prostate symptom score. [PubMed]
Giant Sialolith of Submandibular Duct
Authors: Sakthivel Pirabu , Yogal Rijendra , Singh Sanjoy , Sharma Prateek , Singh Chirom Amit
Published: September 2018

Sialolithiasis is one of the most common diseases of salivary glands and commonly involves submandibular gland and ducts. “Giant sialoliths” typically measure more than 15 mm in any dimension. Here, an unusual case of sialolith in submandibular duct is reported which progressed into a giant sialolith in six months’ time is reported. A 42-year-old man presented with complaints of recurrent pain and swelling in the right submandibular area. A large stone was palpable intraorally within the Wharton’s duct and intra-operatively, an elongated giant sialolith of 50 mm length was found which is the second largest to be published till date. [PubMed]
Acute Upper Gastrointestinal Bleeding in a Tertiary Care Centre of Nepal
Authors: Paudel Mukesh Sharma , KC Sudhamshu , Mandal Amrendra Kumar , Poudyal Nandu Silwal , Shrestha Ramila , Paudel Bidhan Nidhi , Chaudhary Sitaram
Published: September 2018

Introduction: AUGIB is characterized by hematemesis or melena or both. Peptic ulcers and variceal bleed account for majority of cases. Use of proton pump inhibitors in current era is associated with a gradual reduction in burden of peptic ulcer disease. We conducted this study to look into the cause of AUGIB in our community.Methods: We studied 100 patients in one year period who presented to us with hematemesis or melena. The study was conducted in department of Gastroenterology, Bir hospital, Kathmandu. We identified the culprit lesions by upper gastrointestinal endoscopy.Results: The average age of patients with AUGIB was 51.6 years with 59 (59%) males. Duodenal ulcers are most common 29 (29%), followed by varices 23 (23%) and gastric ulcers 14 (14%). More than one lesion was identified in 38 (38%) patients. Patients with variceal bleed were more likely to present with hematemesis alone as compared to those with ulcer bleed (p=0.005). Variceal bleed patients presented earlier to the hospital (p=0.005), had lower MAP at presentation (p=0.0002), had lower hemoglobin level (p=0.0001) and higher serum creatinine level at presentation (p=0.001). Patients with variceal bleed were more likely to have consumed alcohol 20 (86.9%) and patients with ulcer bleed were more likely to be smokers 29 (67.4%) or consume tobacco 14 (32.5%) (p=0.006).Conclusions: Ulcer related bleeding is still the most common cause of AUGIB. Many patients with AUGIB have more than one lesions identified during upper gastrointestinal endoscopy.Keywords:  bleeding; endoscopy; peptic ulcer; upper gastrointestinal;varices. [PubMed]
Analysis of the Clinicopathological Features of Hepatocellular Carcinoma in Elderly Patients
Authors: Jing-Lin Xia , Sharma D , Bing-Hui Y , Bo-heng Z , Zeng-Chen M , Zhi-Quan W , Jia F , Xin-Da Z
Published: September 2018

The peak age of onset of hepatocellular carcinoma (HCC) is continually increasing worlwide. This study aims to evaluate whether there exists any significant difference in the clinicopathological features between younger- and elderly-HCC.1082 Consecutive patients with HCC who underwent liver resection at Liver Cancer Institute, Zhongshan Hospital, Fudan University from 1995 to 1998 were studied. The patients were divided into elderly-HCC (>/=65 years of age) and younger-HCC (< 65 years of age). Important clinicopathological features of the patients and postoperative survival rates were compared between these two groups. Among 1082 patients studied, 108 were elderly-HCC and 974 were younger-HCC. The resection rate of the elderly-HCC was significantly higher than that of the younger-HCC. The 1, 3 and 5-year survival rates of the elderly-HCC were not significantly different from those of the younger-HCC. Compared with the younger-HCC, the elderly-HCC had (1) less HBsAg-positive rate; (2) more frequent anti-HCV positivity ; (3) lower proportion with AFP value >/=400mug/dl; (4) a relatively small tumor diameter; (5) higher proportion of stage I-II patients; (6) a relatively low metastasis rate. However, there were no statistically significant differences in other clinicopathological features (including gender, symptoms, tumor number, tumor venous invasion, tumor differentiation, capsular formation, type of cirrhosis) between the two groups. There is a certain extent difference in clinicopathological features between elderly and younger-HCC patients, but the postoperative survival rate is comparable between the two groups.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):132-135.
C-reactive Protein in Periodontitis and its Comparison with Body Mass Index and Smoking Behaviour
Authors: Gupta Sujaya , Pradhan Shaili , KC Sushil , Shakya Sonika , Giri Mohana
Published: September 2018

Introduction: Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. In addition to declining oral health, there is always low grade infection present in periodontitis. Studies show increased levels of systemic biomarkers in periodontal disease such as CRP, which is considered a key-marker of CVD. Research has also shown positive association between BMI and smoking with periodontitis and CRP. The objective of the study was to assess the levels of CRP in patients with and without periodontitis and their relation with BMI and smoking behaviour.Methods: Patients visiting the Dental department of Bir Hospital were invited to participate in the study. Total 31 subjects in each group: Case (periodontitis) and Control (without periodontitis) were selected using convenience sampling technique. All subjects underwent periodontal examination by a single examiner. Serum CRP samples were taken before periodontal treatment. Data analysis was done by SPSS 17 software program.Results: Increase in mean CRP levels in periodontitis (5.8595mg/L) with high statistical significance (p=0.000) in comparison to subjects without periodontitis (1.1214mg/L) was observed. BMI showed positive association with periodontitis (p=0.046) but not with CRP (0.213). Smoking behaviour showed no significant relation with either CRP (p=0.344) or periodontitis (p=0.541).Conclusions: We found highly significant association between periodontitis and CRP levels but not always with BMI and smoking. CRP, which is an established marker for CVD was significantly increased in periodontal infections. Hence, a close interaction among Physician, Periodontist and Patient to prevent adverse health situations is recommended.Keywords: body mass index; cardiovascular disease; c-reactive protein; periodontitis; smoking; systemic inflammation. [PubMed]
Approximation of Height of an Individual Using Somatometry of Human Male Skull
Authors: Acharya Jenash , Shetty B Suresh Kumar , Shrestha Rijen , Kanchan Tanuj
Published: September 2018

Introduction: Numerous population specific studies conducted on skeletal remains have aimed to standardize the identification process. Known for ethnic and sexual variations, skull bone can also assist the identification process by estimating stature of the individual. The present study focuses on estimation of stature from skull bone using uni-variate and multi-variate regression models in south Indian population.Methods: Stature and Maximum cranial length, Maximum cranial Breadth, Bi-Pterion breadth, Parietal Cord and upper facial breadth were measured in wet skulls of 113 males, autopsied at Government Hospital of Kudla, Karantaka.Results: All five measurements showed significant correlation with stature (P value<0.001). MCL showed the highest (r=0.77) and UFB the lowest (r=0.42) degree of correlation. Standard error of estimate was lowest for MCL (4.90 cm) in the derived uni-variate regressions models. In the regression model obtained from the multi-variate analysis using all five skull measurements the β-coefficients were significant (P value<0.001) and the Standard Error of Estimation of the model was observed to be 4.45 cm. Bland-Altman analysis was conducted to explore the agreement between the actual length and the estimated lengths from the multivariate regression model. The mean of difference was 0.105 with a standard deviation of 4.3 and the upper and lower limits of agreement were 8.5 and -8.3 respectively.Conclusions: The study concludes that stature can be estimated from skull measurements with reasonable accuracy, observations of multi-variate regression models being more precise than the uni-variate regression models. Data collected from South India was compared with data available for Nepalese population and validates the use of data of Indian population for extrapolation in Nepalese population.Keywords: identification; linear regression; stature; skull; South India. [PubMed]