bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic Inflammatory Response Syndrome following Gastrointestinal Surgery
Authors: Koirala Udaya , Thapa Prabin Bikram , Joshi Mukunda Raj , Singh Deepak Raj , Sharma Sunil Kumar
Published: September 2018

Introduction: Systemic inflammatory response syndrome symptoms immediately after surgery have lately been regarded as potential warnings of impending post-operative complications and multiple organ failure. This study was conducted to find out the clinical significance of systemic inflammatory response syndrome in postoperative patients and to investigate the relationship between the duration of post-operative systemic inflammatory response syndrome and the post-operative morbidity and mortality.Methods: Total 30 patients who received different gastrointestinal surgery and fulfilled the diagnostic criteria for systemic inflammatory response syndrome between 2006 and 2008 at Kathmandu Medical College Teaching Hospital were included. Patients were analyzed for preoperative physiologic status, surgical stress parameters, and postoperative status of systemic inflammatory response syndrome, complications, and end-organ dysfunction.Results: Duration of systemic inflammatory response syndrome or positive criteria's number of systemic inflammatory response syndrome after surgery significantly correlated with surgical stress parameters (blood loss/body weight and operation time). Septic complications and prolongation of systemic inflammatory response syndrome were associated with multiple organ dysfunction syndrome and increased mortality.Conclusions: Systemic inflammatory response syndrome is a useful criterion for the recognition of postoperative complications and end-organ dysfunctions. Early recovery from systemic inflammatory response syndrome may arrest the progression of organ dysfunction, thus reducing the mortality.Keywords: gastrointestinal surgery; multiple organ dysfunction syndrome; systemic inflammatory response syndrome. [PubMed]
Unresolving Pneumonia with Pleural effusion: Pulmonary Paragonimiasis
Authors: Gaire Deepshikha , Sharma Santosh , Poudel Kumar , Pant Pankaj
Published: September 2018

Paragonimiasis is a zoonosis caused by many species of Paragonimus commonly P. westermani. Human get infected by eating raw, salted, pickled, smoked, partially cooked crustaceans (crayfish or crabs). Clinical manifestations ranges from non-specific symptoms like pain abdomen, diarrhea, urticarial rashes, fever to pleuropulmonary symptoms like cough, hemoptysis, chest pain and dyspnea. 48 yrs, female presented at TUTH emergency with fever on and off for 9 months, cough and shortness of breath for 3 months, lethargy, malaise and urticaria with history of raw crab intake one month prior to the onset of symptoms. Blood and pleural fluid analysis revealed raised total counts with eosinophilia and x-ray showed bilateral infiltration of lower lobes with pleural effusion. Diagnosis was confirmed by microscopic examination of sputum for Paragonimus. She responded well to Praziquantel. Pulmonary paragonimiasis must be considered in the differential diagnosis of unresolving pneumonia and unexplained hypereosinophilia.  [PubMed]
Ocular Morbidity among Children of Government Schools of Kathmandu Valley: A Follow-up Study
Authors: Shrestha Rajesh Kishor , Shrestha Gauri Shankar
Published: September 2018

Introduction: Ocular and vision defects are common among school going children. Vision disorders, especially refractive error are the m disability of children and the leading cause of handicapping conditions in childhood. The present study was conducted to find out ocular morbidity among students of government schools of Kathmandu valley.Methods: In the descriptive and cross-sectional study, 2412 students, comprising of 1114 (46.2%) males and 1298 (53.8%) females were enrolled in to the study from the five government schools of Kathmandu valley from 2012 to 2013. Detailed eye examination included distance visual acuity testing, anterior and posterior segment examinations, retinoscopy and refraction, cover test, near point of convergence, amplitude of accommodation and color vision test. The Chi-square test was performed to analyze the association between ocular morbidity and age and sex. P-value was considered significant at 0.05 for 95% confidence interval.Results: Majority of children was age group between 11 and 13 years (n=783, 32.5%). A male to female ratio was 0.85. Presenting and best spectacle corrected visual acuity of 6/6 was present in 2257 (93.6%) and 2380 (98.7%) respectively. Total ocular morbidity was observed in 515 (21.4%) subjects. The most common types of ocular morbidity were refractive error in 241 (10%), conjunctivitis in 104 (4.3%) and convergence insufficiency in 82 (3.4%).Conclusions: Refractive error, conjunctivitis and convergence insufficiency represent the most common ocular morbidities among students of government schools.Keywords: conjunctivitis; government school; ocular morbidity; refractive error; students. [PubMed]
Bony Hydatid Disease of Superior Pubic Ramus with Extension into Pelvis and Proximal Thigh.
Authors: Khan Javed Ahmad , Devkota P , Acharya B M , Pradhan S NM , Shrestha S
Published: September 2018

Hydatid disease is caused by the tapeworm of genus ;Echinococcus. Genus Echinococcus has different species including Echinococcus vogeli, Echinococcus granulosus and Echinococcus multilucularis. Echinococcus granulosus is the most common cause of hydatid disease in humans. This disease can take place either directly through ingestion of parasite eggs from contact with infected dogs or indirectly from the ingestion of contaminated water or food. Infestation of hydatid disease in humans most commonly occurs in the liver (55-70%), followed by the lungs (18-35%). Bone hydatidosis however is very rare,whenever it occurs; it is usually secondary to visceral involvement. We present herein a case of primary hydatid cyst involving superior pubic ramus in a 43 years male patient, which is not a common site for the occurrence of this disease. Diagnosis is usually delayed if high index of suspicion is not there. MRI is a good tool for reaching diagnoses.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):139-141.
Gestational Weight Gain and its Relation with Birth Weight of the Newborn
Authors: Thapa Meena , Paneru Rupa
Published: September 2018

Introduction: Gestational weight gain is an important predictor of the health of the newborn. It is affected by body mass index of the women. This study was conducted to find out gestational weight gain according to Institute of Medicine 2009 recommendation and relationship of newborn birth weight to body mass index and gestational weight gain of the women.

Methods: It was cross sectional, hospital based study. The women, who attended at term pregnancy for delivery and having recorded first trimester body weight, were included in the study. Their body mass index was calculated and they were stratified into 4 groups according to body mass index. The gestational weight gain was calculated by subtracting first trimester body weight from body weight at the time of admission for delivery. All the women were followed till delivery. The newborn birth weight was taken immediately after delivery.

Results: A total of 227 women were enrolled in the study. More than half of the women had normal body mass index. There were 36% overweight and obese women. Mean gestational weight gain was 10.21 kg, and mean weight of the newborn was 3.05 kg.  There were equal number of women who had adequate weight gain and less weight gain according to the recommendation. Excess weight gain was seen in 15% of women. Women of higher body mass index and women who had gain more weight during pregnancy had larger newborns.

Conclusions: Body mass index and gestational weight gain of the women were important predictors of birth weight of the newborn.
Clinicohematological Study of Pancytopenia in a Tertiary Care Hospital of Western Region of Nepal
Authors: Ghartimagar Dilasma , Ghosh Arnab , Thapa Sushma , Sapkota Deepa , Jhunjhunwala Adarsh Kumar , Narasimhan Raghavan , Talwar O P
Published: September 2018

Introduction: Pancytopenia is a relatively common hematological entity and is a manifestation of many illnesses which can be life threatening at times. The severity of pancytopenia and the underlying pathology determine the management and prognosis. This study was conducted to evaluate hematological and bone marrow findings in patients presenting with pancytopenia.

Methods: It was a prospective study carried out in Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal, during the period of January 2011 to December 2016. Clinical and hematological parameters including bone marrow aspiration and biopsy were evaluated in all patients who presented with pancytopenia.

Results: Among 138 cases studied, patient’s age ranged from 2 to 82 years with a mean age of 43.95 years, and there was male predominance. Most of the patients presented with generalized weakness, pallor, dypnoea and fever. Hypoplastic marrow was seen in 38(27.5%) cases, followed by megaloblastic anemia 26 (18.8%) cases and acute leukemia 19(13.76%) cases. Other findings included one each case of hemophagocyosis, leishmaniasis, plasmodium vivex malaria and metastatic carcinoma.

Conclusions: This study highlights that pancytopenia is a common hematological problem and the study of detailed primary hematological investigations along with bone marrow study in patients with pancytopenia will help to identify the cause for further planning and management.

Keywords: hypoplastic marrow; leukemia; megaloblastic anemia; pancytopenia.
Prevalence of Alcohol Consumption and Knowledge About Alcohol at Bhimtar, Sindhupalchowk
Authors: Manandhar Naresh , Shrestha Marina Vaidya , Joshi Sunil Kumar
Published: September 2018

Introduction: Alcohol causes several health problems, economic and social consequences across the

world. Nepal is a multicultural and multi-ethnic country with an ambivalent regarding alcohol use

according to social, religious and cultural values. Alcohol use is very common and easily available

everywhere in Nepal. Objective of study is to find the prevalence of alcohol consumption and

knowledge of alcohol among people at Bhimtar.

Methods: A cross sectional study was conducted on a total of 369 households, age above 20 years

of Bhimtar, Sindhupalchowk district on November 2016. 41 households were selected using cluster

sampling from all nine wards of Bhimtar village development committee.

Results: The prevalence of alcohol consumption was 232 (62.9%) in which 144 (77.4%) of males and

88 (48.1%) of females. There was 3.3 times more chance of consuming alcohol in male than female.

Majority 137 (37%) consumed Raksi followed by Jaand/Chhyang 115 (31.3% ) and mix 97 (26.4%).

On knowledge of alcohol consumption, 280 (75.9 %) and 288 (78.0%) of current drinker opined that

it would effects own health and on the family respectively. After drinking alcohol 118 (31.9%) felt it

relieved tiredness followed by felt better 103 (28%) and reduced stress 70 (18.9%). It affects heart and

damage liver said by 72 (19.4%) and 59 (16%) respectively. There were family conflict after drinking

alcohol replied by 132 (35.8%). They have good knowledge about the affect of alcohol on pregnant

women. Only 50 (13.5%) of respondent expressed that it can be given to pregnant women.

Conclusions: The prevalence of alcohol consumption was very high. There is markedly differed

in alcohol consumption by sex. It is affecting their health and family. Consumption of alcohol is

financial burden and makes conflict in the family, which will also make psychological affect on their

children. There is significant difference in knowledge of harm on alcohol consumption by education

status. It is essential to plan and develop a specific health education program among these at-risk

populations for prevention of alcohol consumption.

Keywords: current drinker; economic burden; ever drinker; family conflict; initiation.
Clinical Profile of Atrial Fibrillation in Tertiary Hospital in Central Nepal
Authors: Dhungel Sachin , Laudari Shankar
Published: September 2018

Introduction: Atrial fibrillation is common cardiac arrhythmia in elderly causing morbidity and mortality.

Methods: A cross-sectional study was conducted in College of Medical Sciences Teaching Hospital from August 2013 to Jul 2016. All in-patients diagnosed with atrial fibrillation were included.

Results: Two hundred five patients were studied from August 2013 to July 2016. Mean age was 63.95 ±16.5 years.  There were 105 (51.2%) male and 100(48.8%) female.  There were 154(75.1%) nonvalvular and 51 (24.9%) valvular causes for atrial fibrillation. Common presentations were SOB (41%), palpitations (27.8%), stroke (16.1%), fatigability (1.5%), abdominal pain (1.9%), chest pain (2.9%), pneumonia (1%), limb pain (0.5%) and severe bleeding (2.4%).  For  valvular causes, common lesions were disease of mitral valve (90 %) in isolation or mixed with aortic valve (23.5%). Warfarin was used in   32(62.7%) with mean INR of 2.038 ± 0.6. Seventeen (53.1% )  had INR below  2. In nonvalvular cases, types were paroxysmal (55.2%), persistant(34.4%) and permanent(10.4%). Elderly age, hypertension(30.5%), ischemic heart disease(13.6%), dilated cardiomyopathy(14.9%) , degenerative multivalvular heart disease(14.9%) , atrial septal defect(3.9%), lung cancer(2.3%), mitral valve prolapsed (0.6%), hyperthyroidism(1.9%), alcoholism (0.6%) , and  pericardial effusion(1.2%)  were common risk factors. CHADS(2) calculated 2 or more were in 98(63.6%)  patients. Warfarin was used in 39 patients(25.3%) and 103 patients(66.9%) received aspirin in CHADS(2) score 2 or more.  Mean INR in nonvalvular AF was 1.5 ±0.4.

Conclusions: Atrial fibrillation is a common arrhythmia  as a result of valvular or nonvalvular origin. Common presentations were shortness of breath, palpitations and stroke. Common risk factors were old age, hypertension and heart failure. Warfarin is underused in nonvalvular  causes in our settings.

Keywords: atrial fibrillation; valvular; nonvalvular; warfarin underuse.
Outcome of Needle Fenestration, Subacromial Steroid and Diclofenac Phonophoresis in Acute Calcific Tendinitis of Shoulder
Authors: Sanjel Chhetri Rajendra , Khatri Kishor Prashad , Khanal Jagadish , KC Milan
Published: September 2018

Introduction: Acute calcific tendinitis of shoulder is very painful and disturbing condition. There are many modalities with variable outcome to address the condition. We studied needling technique with multiple fenestration, subacromial steroid and diclofenac phonophoresis and evaluated the outcome in term of pain relief and improvement of shoulder function at a simple outpatient clinical set up without image or ultrasound guidance.

Methods: We studied 18 cases of acute calcific tendinitis presenting within one week from onset of symptoms and X-ray showing calcific deposit. All underwent needle fenestration at maximum tender site with lignocaine loaded syringe, subsequent injection of 40 mg subacromial methylprednisolone and diclofenac phonophoresis done by qualified physiotherapist for five days. Visual Analogue Scale was used to measure pain, Simple shoulder Test applied to evaluate shoulder function and size of calcific deposit was measured at maximum length.

Results: Pain subsided dramatically and there was substantial improvement of shoulder function within a week.

Conclusions: Needle fenestration and subacromial methylprednisolone along with diclofenac phonophoresis without image guidance gives excellent pain reduction and improves shoulder function which can be done at simple outpatient clinic.
Chorioangioma of Placenta
Authors: Das Rubby , Subedi Nilam , Gurung Gahana
Published: September 2018

Chorioangioma of placenta is the commonest benign tumour of the placenta. It consists of a benign angioma arising from chorionic tissue. We report a case of placental chorioangioma which was diagnosed in the post partum period in a patient with polyhydramnios who went into preterm labor and delivered a premature baby.

Keywords: chorioangioma;  placenta; polyhydramnios.
Prevalence of Hepatitis D Among Patients with Hepatitis B Viral Infection Attending a Tertiary Care Centre of Nepal
Authors: Regmi Kiran , Shrestha Jeetndra Kaji , KC Sudhamshu , Jaishi Bikash , Karki Niyanta , Khadka Dipendra , Khadka Sandip
Published: September 2018

Introduction: Worldwide there is variation in prevalence of Hepatitis D viral infection. Superinfection and co infection with hepatitis B viral infection is known to occur in 15-20 million people.

Methods: This was a descriptive cross-sectional hospital based study carried out in NAMS, Bir hospital, Kathmandu, Nepal from period of January 2017 to June 2017. Consecutive patients of chronic hepatitis B viral infection of HBsAg positive with more than two-time upper normal limit of ALT were enrolled and tested for HDV IgG.

Results: Forty patients were enrolled during study period. Mean age was 30.9±12.2 years. Males were 28 (70%) and females 12 (30%). Most of the patients were asymptomatic for HBV infection 32 (80%). HBeAg negative chronic hepatitis was most commonly present in 31 (77.5%). Family history of Hepatitis B viral infection was seen in 7 (17.5%) and sexual promiscuity in 5 (12.5%) as the mode of acquisition of hepatitis B viral infection. HBcIgM was positive in three patients with mean HBV DNA of 4.97x105±4.5x105 IU/ml in HBeAg positive group. HDV IgG was negative in all patients.

Conclusions: Coinfection and superinfection of hepatitis D virus were found to be uncommon at Bir hospital, Nepal.

Keywords: HbsAg; HDV DNA; HDV IgG; Hepatitis B; Hepatitis D.
Prehospital Events in ST- Elevation Myocardial Infarction Undergoing Primary Angioplasty
Authors: Dhungel Sachin , Malla Rabi , Ahikari Chandramani , Maskey Arun , Rajbhandari Rajib , Sharma Diwakar , KC Man Bhadhur , Rauniyar Binaya , Limbu Deepak , Gautam Milan , Adhikari Ajay , Chalise Hari
Published: September 2018

Introduction: Pre-hospital delay includes time from onset of symptoms of myocardial infarction till arrival to emergency room of the hospital. This defines time from symptom onset to first medical contact and first medical contact to emergency room. This study aims to study the prehospital events and determining factors in patients undergoing primary angioplasty.

Methods: This was a cross sectional study in Shahid Gangalal National Heart Centre for three months. Timings of chest pain, first medical contact time, transfer time to hospital and overall pre-hospital time for PCI and risk factors were analysed.

Results: There were 79 cases with 66 (83.5%) males and 13 (16.5%) females with mean age 56±11.2 years. Risk factors were 60 (75.9%), smoking, 47 (59.5%) hypertension, 25 (31.6%) diabetes, 22 (27.8%) dyslipidaemia and 16 (20.3%) heart failure. Chest pain was   maximum in 5 to 9 AM. The median prehospital delay was 300 minutes (5.0 hours) of which symptom to first medical contact was 165 minutes and first medical contact to hospital was 80 minutes. The longer median prehospital delay for hypertension, diabetes, female and age ≥50 years and the shorter for male, age less than 50 years, dyslipidemia and heart failure, though not statistically significant. Private transport was the preferred from symptom to first medical contact and ambulance for first medical contact to emergency room. Patients received in ER had aspirin 72 (91.1%), atorvastatin 54 (68.4%) and double anti-platelets 45 (57%).

Conclusions: Chest pain was common in morning and the prehospital delay can be minimized by improving time from symptom to first medical contact and first medical contact to Emergency room.

Keywords:  cicardian pattern; prehospital delay; ST myocardial infarction.
Cutaneous Metastases from Carcinoma of Gall Bladder
Authors: Mukhia Rupesh , Shrestha S , Malla K , Sharma V K
Published: September 2018

Abstract
Length of Stay of Psychiatric Admissions in a Tertiary Care Hospital
Authors: Basnet Madhur , Sapkota Nidesh , Limbu Suren , Baral Dharanidhar
Published: September 2018

Introduction: The length of stay among psychiatric in-patients is usually longer than that of others. In-patient management is costly and longer length of stay can lead to catastrophic costs. We conducted this study to explore about the length of stay of psychiatric admissions and factors affecting it.Methods: We collected the data of all the patients admitted to the psychiatric ward of B. P. Koirala Institute of Health Sciences from 1st January 2007 to 31st December 2016 from the database of the medical records section after ethical approval. The sociodemographic and clinical variables were analyzed using SPSS 20.0 version. Length of stay more than 3 weeks was considered as long stay. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with length of stay.Results: There were 3687 admissions during the study period. The average length of stay was 19.36 (±13.14) days. On logistic regression, the factors associated with shorter length of stay were: male gender (aOR= 0.79, 95%CI: 0.68-0.93), being self employed (aOR= 0.17, 95%CI: 0.12-0.22), homemakers (aOR= 0.18, 95%CI: 0.14-0.24), farmers (aOR= 0.20, 95%CI: 0.15-0.27) and students (aOR= 0.23, 95%CI:0.17-0.32). Similarly, factors associated with longer length of stay were: being from other Eastern Terai districts(aOR=1.37, 95%CI: 1.11-1.70), other Eastern Hill districts (aOR= 1.68; 95%CI: 1.29-2.20), diagnosis of schizophrenia and related disorders (aOR=4.01, 95%CI: 1.34-12.0), having medical co-morbidity (aOR= 3.47; 95%CI: 2.49-4.84) and being readmitted (aOR= 1.23, 95%CI: 1.03-1.47).Conclusions: There was significant association of length of stay with gender, age, address, occupation, diagnosis and readmission
Prevalence of Non-Communicable Diseases and its Associate Factors among Government Employees in Biratnagar, Nepal
Authors: Neupane Roshan , Bhandari Tulsi Ram
Published: September 2018

Introduction: Non-communicable diseases have along duration and slow progression. It is estimated that the attribution of NCDs in mortality has been rising gradually in Nepal. This study aimed to estimate the prevalence and factors associated with NCDs in Biratnagar, Nepal.

Methods: A cross-sectional study was conducted among government employees in Biratnagar, Nepal from August to December 2016. We used self-administrated modified WHO STEPS survey questionnaire and distributed to all government employees of Biratnagar Sub-Metropolitan. We used complete filled 323 questionnaires to analyze and draw the results.

Results: The prevalence of NCDs was found 72 (22.3%). Hence, 322 (99.6%)government employees had exposed at least one established risk factor of the NCDs. The prevalence of use of any type of tobacco products was 60 (18.5%) and consumption of alcoholic products was 187 (57.9%). More than two-thirds respondents answered that they consumed fruits once a week. Most government employees consumed vegetable regularly.The majority 193 (59.6%) respondents used motorcycle and electric rickshaw as means of transportation. Out of the total participants 60 (18.6%), 19 (5.9%), and 6 (1.9%) reported hypertension, diabetes, and cardiovascular diseases respectively.

Conclusions: Prevalence of Non-Communicable Diseases has been seen in Government Employees in Biratnagar, Nepal. Most of them had at least one associated factor related to NCD was found.
Adamantinoma of Tibial Shaft
Authors: Joshi Amit , KC B R , Basnet S B , Panth R , Shrestha R L , Chand P , Thapa B B
Published: September 2018

Abstract
Knowledge and Awareness Regarding Dental Implants among Patients Attending a Tertiary Care Center
Authors: Maharjan Anjana , Regmi Sagun , Sagtani Reshu Agrawal
Published: September 2018

Introduction: Loss of natural teeth is a debilitating and irreversible process, which leads to functional, cosmetic and psychological morbidities. Dental implant serves as one of the options of tooth replacement, which are stronger, functionally effective and more durable. However, public awareness regarding it has been found to be low in Asian countries. This study was designed to know the status of knowledge and awareness of dental implant.Methods: Seventy nine patients visiting dental department of Patan Academy of Health Sciences were included in this study through non-probability sampling. Data on knowledge and awareness regarding dental implants were collected through a survey after ethical approval from Institutional Review committee of Patan Academy of Health Sciences. Data entry was done in Epidata and analyzed with the help of Statistical Package of Social Sciences version 20.Results: Total 33 (41.8%) of study populations choose dental implant as alternative for replacing teeth, 22 (30.4%) choose fixed dental prosthesis. 36 (45.6%) and 32 (40.5%) of population stated that long treatment time and high cost respectively as the disadvantages of dental implants. Only 12 (15.2%) were aware that dental implants are anchored in jaw bone. The source of information about dental implants was dentists for 48 (60.8%) of the patients followed by friends, media and medical doctors. Conclusions: Within the limitations of this study, we conclude that awareness of patients attending tertiary care center of Kathmandu valley is low. Hence, there is a need of organizing dental education programs to create awareness about dental implants.
Clinical Outcome and Safety Profile of Patients Underwent Hair Transplantation Surgery by Follicular Unit Extraction
Authors: Bishwokarma Ghimire Rupak
Published: September 2018

Introduction: Hair transplant surgery is a minimally invasive surgery, where hair follicle is transplanted from donor area of patient’s own body to the desired area.

Methods: Patient with hair transplant surgery from a clinic were followed up for one year. The patients were asked for their complications within 2 days, 7 days, one month, 2 to 6 months and one year for assessment of results, side effects. At the end of one-year, subjective evaluation was done with patient’s satisfaction to growth as- poor growth, satisfactory and good growth.

Results: Out of 152 patients, maximum patients 74 (48.6%) were in age group 21-30, followed by 61 (40.01%) in age group 31-40, mean age was 31.79, youngest being 21 years and oldest being 70 years of age. Among the complications, swelling of forehead was in more than two- thirds of the patients 106 (69.74%), followed by temporary hair fall noted in 65 (42.76%) of patients. Clients’ remarks noted at the end on one-year revealed 86.18% as excellent results, 11.84% as satisfactory and 1.97% as poor results.

Conclusions: Hair transplant sugary by FUE is a relatively safe surgery with optimum results and minimum complications, which can be useful to patients with androgenetic alopecia.
Metformin and Troglitazone in the Treatment of Female Infertility Associated with Polycystic Ovarian Syndrome
Authors: Paudel Keshab Raj , Sangraula H , Sharma M
Published: September 2018

Abstract
Teenage Pregnancies in Nepal – The Problem Status and Socio-Legal Concerns
Authors: Nepal Samata , Atreya Alok , Kanchan Tanuj
Published: September 2018

Introduction: Teenage pregnancy is an issue that needs to be addressed for a better health of the women and the society. The present analysis is undertaken to find out the incidence of teenage mothers who have had hospital delivery and focuses upon the various reasons for teenage pregnancy with a brief discussion upon the associated medicolegal and social aspects.

Methods: A cross sectional study was carried out in a tertiary hospital in western region of Nepal. The delivery case register were reviewed for teenage pregnancies and the relevant data was captured in a data sheet and analysed.

Results: During the study period, a total of sixty-nine teenage pregnancies culminated into delivery/ childbirth. The mean age of teenage mother was 18.16±0.99 years. Majority of the teenage mothers had not completed their secondary education and were of low socioeconomic strata. Mode of delivery was caesarean section in thirty four cases, whereas vaginal delivery was conducted in thirty five cases. Live births accounted for 67 deliveries, a still birth case was of anencephalic foetus while the other one was a preterm which was spontaneously delivered at the 23rd weeks of gestation.

Conclusions: Education and awareness in the form of campaign, advertisements, road shows, television or radio programmes are suggested for a decline in the rate of teenage marriages and teenage pregnancies in Nepal in the days to come.
Professional Satisfaction among B.Sc. Nursing Graduates of an Institute
Authors: Mehta R S , Yadav R
Published: September 2018

Introduction: Professional Satisfaction is a measure of valuation judgment of whether the expectations are met from the profession or not. This study was conducted to find out the professional satisfaction among pass-out B.Sc. Nursing graduates from an institute from batches 1996 to 2004.

Methods: Descriptive cross-sectional study design was adopted using convenient and snowball sampling technique. Out of 104 graduates, 50 were included in the study. A pre-tested semistructured questionnaire was used by self administration method to collect the information.

Results: Highest satisfaction was with status 36 (75%) and lowest with working condition 27 (54%). The areas with decreasing value of satisfaction were growth and development 36 (72%), achievement and recognition 35 (70%), autonomy and challenging work 35 (69%). The majority of the respondents 27 (54%) stated that there is job security in the profession and the opportunity 26 (52%) to help others was the reason for their satisfaction but 28% said that there is no updating of knowledge and autonomy 15 (30%) in nursing profession.

Conclusions: There is no difference in professional satisfaction of the respondents living in Nepal and abroad. It is seen that though there are many problems and many areas of dissatisfaction in nursing profession the respondents were satisfied to some extent with it and the reason for brain drain among B.Sc. Nursing graduates were their personal interest.

Keywords: graduate; nursing; professional; satisfaction.
Clinicopathological Evaluationof Thyroglossal Cyst
Authors: Paudel D R
Published: September 2018

Introduction: Thyroglossal cyst is a common congenital anomaly of the thyroid gland. Though malignant transformation is rare one case was a papillary carcinoma in my series.

Methods: Retrospectively thyroglossal cyst who underwent surgery during the period of January 2004 to March 2009 were evaluated.

Results: Age incidence of the cysts in the present series varied between 4 and 41 years. 12 (63%) patients were male and 7 (37%) patients were female. The sites of the lesion were as:thyrohyoid in 13 (68%),suprasternal in 1 (5%) and suprahyoid in 5 (27%) cases. Twelve patients had painless swelling on the neck and 7 had discharging sinus.Pre-operative cytological evaluation showed non-malignancy in all cases.Postoperative histological result turned out to be papillary carcinoma in 1 female patient of 33 years old and the remaining 18 had non-malignancy. This patient with papillary carcinoma had her thyroid gland in its normal position.

Conclusions: Malignant transformation should be ruled out in all cases of thyroglossal cyst and fistula. Post-operatively specimen should be sent for histological examination.

Keywords: papillary carcinoma;thyroglossal cyst; thyroid.
Innovative Method of Using Endoscope in Postoperative Canal Wall Down Mastoid Cavity
Authors: Bista Meera , Mahato Nayan Bahadur , Regmi Deepak
Published: September 2018

Introduction: Poor access to the difficult areas in the middle ear and mastoid cavity is considered as the major reason for failure in mastoid surgery. Wide field visibility, visualization of nooks and corners by an endoscope could contribute to better clinical control of the disease in these patients that cannot be accessed by the operating microscope. 

Methods: This was a descriptive cross-sectional study, done in Kathmandu Medical College from January to June 2017. Thirty two patients were included in the study. Data collection was done by convenient sampling. Statistical analysis was done by Chi square test and Fisher Exact test, P value of <0.005 was considered statistically significant.

Results: The study revealed that exposure benefit with an endoscope in canal wall down mastoid surgery was significantly better than with a microscope (P value of 0.034). The level of complete clearance and level of difficulty in cleaning with the help of a microscope compared to endoscope did not show a significant difference with P value of 0.288 and 0.652 obtained by Fisher extract test respectively. After microscopic removal of materials from the mastoid cavity, 22 (68.8%) which is more than half of cases had remaining materials in the cavity which was removed by endoscope completely.

Conclusions: Outcome will make the ENT surgeons aware of use of endoscopy in post mastoid follow up cases to give better results and make the surgeon much more successful in his/her endeavor to eradicate the disease.
Predisposing Factors and Outcome of Malpresentations in an Institute
Authors: Maskey Smrity , Dwa Yam
Published: September 2018

Introduction: This study was done to find out the incidence of malpresentation among all deliveries with various types of Malpresentations, its mode of delivery , maternal and fetal predisposing factors with outcome.

Methods: This was a cross sectional descriptive study done at KIST Medical College and Teaching Hospital. Review cases of women admitted in labor after 22 weeks with malpresentation was done. Maternal/fetal predisposing factors were recorded.

Results: Total delivery in study period was 4009 where 101 (2.5%) were of malpresentation. Breech was the commonest malpresentation 83 (82.1%). Assisted vaginal delivery occurred in 16 (15.8%) and 953 (84.2%) caesarian section. Malpresentations was common in primigravida 62 (61.3%). Half (47.2%) cases had one/more predisposing factors, commonest being oligohydramnious 7 (6.9%). Out of 108 babies with malpresentation, 10 had perinatal deaths and 10 had NICU admissions. Congenital anomaly was found in 4 babies.

Conclusions: The most common type of malpresentation was breech common in primigravida with oligohydramnios as contributing factor.
Leptospirosis in Nepal
Authors: Kandel N , Thakur G D , Andjaparidze A
Published: September 2018

The study has demonstrated the evidence of leptospirosis infection in the country. It has also highlighted the challenges and the need of further researches on this disease, which seems to be under reported in the country.

Keywords: acute encephalitis syndrome; case definition; endemic; laboratory capacity leptospirosis.
Right atrial thrombosis associated with sagittal sinus thrombosis caused by protein C-S deficiency
Authors: Sabzi Feridoun , Faraji Reza
Published: September 2018

Right atrial thrombi may develop within the right atrium or may have peripheral venous origins that, on their way to the final destination site lodge in, right atrium. Right atrial thrombosis is classified as two type: A (mobile, thin) and B (non mobile and attached to atrial wall) that they are probably of cardiac origin due to local pathology, indwelling catheter, atrial fibrillation, stasis, rheumatological or hematological disease like protein C or S deficiency. Protein C deficiency has been reported to be a risk factor for thrombosis in multiple organs as a result of inactivation of factor of Va. We describe a case of a huge right atrial thrombus with cerebral sagittal sinus thrombosis, in a protein C-S deficient patient, in which right atrial clot was successfully removed surgically and sagittal vein treated conservatively with full recovery of his central neurologic symptom.
Amniotic Band Sequence - A Debilitating Syndrome
Authors: Uma R , Garg A , Patnaik S K
Published: September 2018

A male baby was delivered by Caesarean section at term to a 35 years second gravida lady with fibroid uterus. The mother was booked and immunized and not on any medication. Antenatal and natal periods including serial ultrasounds were normal. At birth the neonate was observed to have multiple grooves over ring & middle index finger of left hand and hypoplasia of left little finger. Both great toes were amputated. In view of asymmetrical involvement, presence of amniotic bands, no other organ involvement and sporadic nature, he was diagnosed as a case of amniotic band sequence. Congenital amputations should be distinguished from congenital hypoplasia and/or aplasia. Differentiation is important for genetic counselling and evaluation of the risk of recurrence.

Keywords: Amniotic Bands, Intrauterine Amputation, Intrauterine Constriction Rings.
Pandemic (H1N1) 2009 Cases in Nepal
Authors: Kandel N , Shrestha J M , Upadhyay B , Shrestha A K , Shakya G
Published: September 2018

We analyzed the data available in Nepal during this pandemic in order to determine the epidemiological, clinical and virological characteristics of pandemic influenza A in 2009. The test was conducted by real-time Reverse Transcription – Polymerase Chain Reaction on sample from patients with suspected influenza-like illnesses. Out of 538 cases were tested, 32 % were positive for pandemic influenza A 2009 and the infection rate was highest for cases of 11-20 years and lowest in >50 years of age.

Keywords: Influenza A ; pandemic; RT-PCR; surveillance.
Osteosarcoma in Pregnancy
Authors: Nepal Pravin , Singh G K , Singh M P , Bajracharya S , Khanal G P , Pandey S R
Published: September 2018

Osteosarcoma in pregnant women is rare. Delay in diagnosis may be due to lack of any signs or symptomsduring gestation, clinical misdiagnoses, religious attitude and refusal of the patients. Most cases soft-tissueand bone tumors during pregnancy can be managed successfully with surgery during gestation. Therapieswith fetal toxicity were more likely to be deferred to postpartum period. This case is rare and liable to bemissed, hence is reported.
Raised Serum TNF-Alpha, Blood Sugar and Uric Acid in Preeclampsia in third Trimester of Pregnancy
Authors: Gulati Rajiv
Published: September 2018

In preeclapsia, insulin resistance occurs but the exact cause is unknown. It is uncertain whether womendestined to develop preeclampsia have preexisting insulin resistance or it is acquired with the developmentof the disease. Fasting blood samples were collected from 10 normal control pregnant women and from 30cases of preeclampsia in the third trimester of pregnancy to measure circulating level of glucose, uric acidand tumor necrosis factor-alpha (TNF) concentrations. Preeclampsia was diagnosed as per standard guideline adapted from national high blood pressure education program working group. In control group (n=10)mean age was 253.71 years, mean sugar level was 86.7313.06 mg/dl, uric acid level was 3.250.59 mg/dland TNF-alpha level was 9.939.56 pg/dl. In preeclapsia group mean age was 25.563.96 years, mean sugarlevel was 93.4618.6 mg/dl, uric acid was 6.001.64 mg/dl and TNF-alpha level was 67.6661.83 pg/dl.Statistical analysis done using Kruskal Wallis's test showed significantly raised levels of TNF-alpha (p<0.001),uric acid (p<0.001) and blood sugar (p=0.201) in preeclampsia cases. In preeclampsia there was positivesignificant correlations of raised TNF-alpha with uric acid (p<0.005). Spearman's test for correlation showedpositive correlation of TNF-alpha with blood sugar (p<0.043) in cases of preeclampsia. The findings suggestthe involvement of cytokines (TNF-alpha) in preeclampsia and may have a role in gestational diabetes mellitusand insulin resistance. In the present study, there was positive association of raised level of TNF-alpha withblood sugar / and uric acid levels.Key Words: TNF-alpha, glucose, uric acid, gestational diabetes mellitus, preeclampsia.
Community Based Maternal and Child Health Care in Nepal : Self-Reported Performance of Maternal and Child Health Workers
Authors: Chettry S , Clapham S , Basnett Indira
Published: September 2018

The performance of a sample of 112 refresher trained Maternal and Child Health Workers (MCHW) wasassessed over a nine-month period, using a self-reporting questionnaire. The findings show that the MCHWsare providing obstetric services, including antenatal care, birth attendance and postnatal and newborn care,at community level and identifying complications for referral, but their productivity levels are very low,particularly in the remote hill areas, where they are most needed. In order to increase their effectiveness,greater emphasis needs to be placed on the creation of an enabling environment, both in terms of professional support and recognition at community level. This requires more technical and logistical backup and thepromotion of greater awareness amongst women and their families about the importance of midwifery careand skilled birth attendance.Key Words: Skilled attendance, enabling environment, performance.
Intraoperative stereotactic navigation for reconstruction in zygomatic-orbital trauma
Authors: Nyachhyon P , Kim P C
Published: September 2018

Reconstruction of the maxillofacial skeleton after traumatic injury is not always straightforward because of its three dimensional complex anatomy and aesthetic signifi cance. In case of zygomaticorbital injury induced by trauma resulting in enophthalmos, the patient is affected on both function and cosmesis. To prevent diplopia or conspicuous asymmetry, exact correction of the orbital symmetry is required. The aim of this case report is to demonstrate the use of an intraoperative image guided navigation system for identifi cation of adequate reconstruction of the orbital fl oor and orbital symmetry in zygomatic-orbital fracture. Navigation-guided open reduction of a zygomatic-orbital complex fractures with orbital fl oor reconstruction can be regarded as a valuable treatment option for this potentially complicated procedure. This case demonstrated the use of the non-ionizing, noncontact, navigation system in intraoperative procedure and clinical monitoring to identify the correct position and symmetry in complex orbital fl oor reconstruction.

Keywords: intraoperative navigations, orbital reconstruction, zygomatico-orbital fracture.
POISONOUS HAIR
Authors: Bohlar Eric , Shah Tilak
Published: September 2018

Abstract
Isokinetic External Rotation Strength of Shoulder: Correlation with Age and Muscle Size
Authors: Pradhan Rabindra Lal , Itoi E , Shimizu T , Wakabayashi I , Sato K
Published: September 2018

The purpose of this study was to determine the correlation between quantitative (cross sectional areas)evaluation of the posterior cuff muscles and mechanical strength in asymptomatic shoulders with specialreference to aging. The cross-sectional area of the combined infraspinatus and teres minor muscles weremeasured, in the sagittal oblique magnetic resonance images, in eighty-one patients with a mean age of44.06 years (range 19 - 74). These areas were correlated with the measured isokinetic strength in externalrotation at angular velocities of 60 deg/s and 180 deg/s using Cybex 770 NORM. The results show that therewas a gradual decrease in size of the muscles as the age of the individual increases. A strong correlation wasfound between aging and combined cross-sectional area and peak torque as well. The correlation betweencombined cross-sectional area and peak torques at both angular velocities were less strong. Further, thecorrelation between the peak torque/cross-sectional area ratio with aging was also less significant, whichmay imply that the decrease in the muscle strength was greater than the change in muscle area. Our resultssuggest that there may be other qualitative and biochemical factors that may determine the true strengthof the muscles in the aged population.Key Words: Aging, muscle, cross sectional area, strength, shoulder.
A COMPARATIVE STUDY OF ACUTE POISONING IN NEPAL AT TERTIARY AND SECONDARY LEVEL HOSPITALS
Authors: Ghimire Ram Hari , Sharma S P , Pandey K R
Published: September 2018

A study was done at Tribhuvan University Teaching Hospital (TUTH) and Bharatpur District Hospital(BDH) to find out the differences among the acute poisoning cases in those hospitals during 2000-2002. Thestudy aimed to compare the acute poisoning cases in terms of some variables. It was a comparative study ofall the acute poisoning cases admitted in the internal medicine department of TUTH and BDH during2000-2002.The numbers of acute poisoning cases were found to be more at BDH than at TUTH during the sameperiod. Though the majority of the cases were female in both the hospitals, percentages of male poisoningcases were found to be more at BDH. The 16-25 age group was the predominantly affected group at TUTH,while it was below 15 age group at BDH. Pesticide poisoning cases were the commonest poisoning cases atTUTH whereas the numbers of rodenticides poisoning cases were predominant at BDH. The use of drugs issignificantly higher at TUTH. Deaths due to poisoning in TUTH were more than at BDH during the sameperiod. The maximum number of poisoning cases occurred during the months of Bhadra- Mangsir. Owingto the higher rate of use of drugs as poison, the sale of drugs without prescriptions should be discouraged.Similarly the public should be well sensitized about the childhood poisoning.Key Words: Drugs, recovery, pesticides, rodenticides.
INTRACARDIAC ELECTROPHYSIOLOGICAL STUDY AND ABLATION IN NEPAL
Authors: KC Man Bahadur , Rajbhandari S , Sharma D , Naik A M
Published: September 2018

Cardiac electrophysiology study (EPS) is one of the most advanced, challenging and a complex branch ofinvasive cardiology. It involves placement of large sized multipolar catheters in various chambers of theheart. They are used to map and also to ablate the culprit focus of arrhythmia generation. When done byexperts, the procedure can be curative. Three electrophysiology workshops were conducted in ShahidGangalal National Heart Centre. 44 patients underwent the procedure, among which 38 had radiofrequencyablations done and 8 had electrophysiological study. Of the ablated cases all were successful except onehad recurrence of tachycardia. Overall success rate was 93% and no major complications were notedduring or after procedure.Key Words: Electrophysiology, Radiofrequency ablation.
OVARIAN CYST FORMATION: MANY YEARS AFTER HYSTERECTOMY FOR HEMORRHAGIC COMPLICATIONS IN TWIN DELIVERY
Authors: Padhye Saraswati , Karki C
Published: September 2018

After a subtotal hysterectomy for severe postpartum hemorrhage due to rupture uterus, followingcomplication at internal podalic version and breech extraction for a second twin, in a primipara; a longterm follow up and management by a wedge resection of ovary, ovariotomy, and removal of cyst was carriedout by the same surgeon in three different Hospitals, so unique in our context, is reported.Key Words: TwinDelivery, Internal Podalic Version.
MENSTRUAL DISORDERS IN ADOLESCENTS
Authors: Dangal Ganesh
Published: September 2018

The health problems of adolescents are very special. Menstrual disorders such as amenorrhea, abnormal/excessive uterine bleeding, dysmenorrhea, and premenstrual syndrome are particularly common in adolescentgirls. Although menstrual irregularities may be normal during the early postmenarchal years, pathologicalconditions require proper and prompt management. This article reviews the topic: menstrual disorders anddiscusses their etiologies, diagnosis and treatment modalities. It also reviews the normal and abnormalmenstrual cycles. The knowledge of the normal menstrual cycle is very important in managing these disordersproperly.ABSTRACTDangal GKey Words: Adolescent, amenorrhea, dysfunctional uterine bleeding, dysmenorrhea,menstrual disorder, premenstrual syndrome.
TREATING A CHILD WITH COUGH OR DIFFICULTY IN BREATHING AT DISTRICT HOSPITALS
Authors: Shrestha Shiva , Bhattarai P , Sharma M
Published: September 2018

Acute respiratory infections (ARI) are the commonest infections in children under the age of five years inNepal. An under five child will have 4-6 episodes of ARI per year in Nepal. ARI episode does not differmuch between developed and developing countries. Pneumonia is the commonest single cause that causesdeath in a child with respiratory infections in developing countries. Treating pneumonia is still confusing.This article re-visits the basic concept in the treatment of pneumonia.Key Words: Pneumonia, persistent, pneumonia, antibiotics, treatment.