bluuebunny/crossref_metadata_2025 huggingface dataset:
People's Perspective on Access to Health Care Services in a Rural District of Nepal
Authors: Paudel R , Upadhyaya T , Pahari D P
Published: September 2018

Introduction: Over the past several decades, Nepal has attempted to increase the access of health care services, however progress toward achieving high coverage of health care services in rural communities is still low. Therefore this study attempts to provide a perspective on access to basic healthcare services in government health facility.

Methods: Descriptive cross-sectional study with quantitative and qualitative methods was designed and applied to identify the access to health care services. The study population were people who were sick within three months prior to the study where basic sampling unit was household. Total sample size was 96 through the application of simple random sampling method. Bivariate analysis with 95% confidence interval was used to identify the association of variables with access to health care services.

Results: Among the total population, 28% of households in the study area received health care services at government health facility. The reasons for not accessing health care were insufficient drugs (61%), distance (22%), staff unavailability (19%), sickness (9%), money (7%), and facility hours (4%). Sex, ethnicity and distance were found significantly associated with access to health care services.

Conclusions: Less than one third of households had access to health careservices in government health facility. Addressing the important factors such as drug problems, staff unavailability, long distance to health institutions and inconvenient health facility hours may help to increase access to health care services at government health facility.

Keywords: Access, government health facility, health care services, perspective.
Diagnostic Efficacy of Electrocardiography in Determining Left Ventricular Hypertrophy in Patients with Essential Hypertension
Authors: KC Mathura , Gurbacharya DL , Vaidya B , Karki DB
Published: September 2018

A total of 37 hypertensive patients of both sexes over 18 years of age and more than four years of duration after diagnosis and only those having evidence of left ventricular hypertrophy (LVH) by echocardiography (ECHO) were enrolled to analyze the diagnostic efficacy of electrocardiography in determining left ventricular hypertrophy in patients with essential hypertension. Electrocardiograhpy (ECG) of 37 LVH diagnosed cases were analysed and 31 of them were found to have LVH on voltage criteria. Thus, the sensitivity of ECG in diagnosing LVH is 83%.Key Words: Left Ventricular Hypertrophy (LVH), Electrocardiography (ECG), Echocardiography (ECHO).
Practice of analgesia in an emergency department of eastern Nepal
Authors: Bhandari Rabin
Published: September 2018

Introduction: Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment.Method: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics. Results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70).  Conclusion: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain.Key Words: Analgesia, Emergency, Nepal
Stroke Mortality in Intensive Care Unit from Tertiary Care Neurological Center
Authors: Thapa Lekhjung , Shrestha Asis , Pokhrel Baburam , Paudel Raju , Rana Parmendra Vir Singh
Published: September 2018

Introduction: Stroke is the second most common cause of death and major cause of disability worldwide. About a quarter of stroke patients are dead within a month, about a third by 6 months, and a half by 1 year. Although the most substantial advance in stroke has been the routine management of patients in stroke care units, intensive care unit has remained the choice for stroke patients’ care in developing countries. This study explores the mortality of stroke patients in intensive care unit setting in tertiary care neurological centre in a developing country.Methods: We collected data of stroke patients admitted in our ICU from August 2009 to Aug 2010 and analyzed.Results: Total 44 (10.25%) patients were admitted for acute stroke. Age ranged from 17-93 years. Low GCS (Glasgow Coma Scale), uncontrolled hypertension and aspiration pneumonia were common indications for admission in ICU. Total 23 (52.3%) patients had hemorrhagic stroke and 21(47.7%) patients had ischemic stroke. 13 (29.54%) patients of stroke died within 7 days, 9 (69.23%) patients of hemorrhagic stroke died within 6 days, and 4 patients (30.76%) of ischemic stroke died within 7 days. 6 (13.63%) patients left hospital against medical advice. All of these patients had ischemic stroke.Conclusions: Stroke mortality in intensive care unit remains high despite of care in tertiary neurological center in resource poor settings. Stroke care unit, which would also help dissemination of knowledge of stroke management, is an option for improved outcome in developing countriesKeywords: intensive care unit; mortality; stroke; stroke care unit.
Ketamine gargling and postoperative sore throat
Authors: Shrestha S K , Bhattarai B , Singh J
Published: September 2018

INTRODUCTION:

Tracheal intubation is a foremost cause of trauma to the airway mucosa, resulting in postoperative sorethroat (POST). The aim of the study was to compare the effectiveness of ketamine gargle with placebo in preventing POST after endotracheal intubation.

METHODS:

Forty patients scheduled for elective surgery under general anaesthesia were enrolled in this randomized, control trial. Patients were randomly allocated into two groups of 20 patients each: Group C, gargling with drinking water 30 ml; Group K, gargling with ketamine 50 mg in drinking water 30 ml for 30 s, 5 min before induction of anaesthesia. POST was graded at 4, 8, and 24 hours respectively after operation on a four- point scale (0-3).

RESULTS:

POST occurred more frequently in Group C, when compared with Group K at 4, 8, and 24 hours.

CONCLUSIONS:

Ketamine gargle reduces the incidence of POST after endotracheal intubation.
PREVALENCE OF LATTICE DEGENERATION IN AXIAL MYOPIA
Authors: Subedi Sudesh
Published: September 2018

Lattice degeneration is an important predisposing factor for retinal detachment. A cross sectional study of221 patients and 405 eyes with axial myopia of 25mm (–3.oo diopters) or more, was conducted with anobjective to find out prevalence of lattice degeneration of the retina among them. Of 221 patients, 48 (21.7%)had the lattice degeneration consisting of 35 uniocular (72.9%) and 13 binocular patients (27.1%). Of 139males, 36 (25.89%) had lattice degeneration; of 82 females, 12 (14.63%) had lattice degeneration (RR=1.26;95%CI=1.03-1.55; p=0.049). Axial length was from 25mm to 35.77mm (mean=27.63mm, SD 1.98). Thegreatest prevalence of lattice degeneration.9% (16 of 73 eyes) was found in eyes with axial length of 26mmto 26.99 mm (-6.0D to –8.97.0D), and the least incidence was 8.6% (8 of 93 eyes) in eyes with axial length25mm to 25.99 mm (-3.0 D to –5.97.0 D). Over all prevalence of lattice degeneration was 15% (61 of 405eyes) of eye(s) with axial length of 25 mm (-3.0 D) or more. In the age groups below 40 years, the prevalenceof lattice degeneration was highest 85.24% (59 of 61 eyes). The lattice degeneration of retina is moreprevalent in males of age less than 40 years with moderate axial myopia.Key Words: Lattice degeneration, axial myopia, retinal detachment.
Implementing Self Sustained Quality Control Procedures in a Clinical Laboratory
Authors: Khatri Roshan , KC Sanjay , Shrestha Prabodh , Sinha J N
Published: September 2018

Introduction: Quality control is an essential component in every clinical laboratory which maintains the excellence of laboratory standards, supplementing to proper disease diagnosis, patient care and resulting in overall strengthening of health care system. Numerous quality control schemes are available, with combinations of procedures, most of which are tedious, time consuming and can be “too technical” whereas commercially available quality control materials can be expensive especially for laboratories in developing nations like Nepal. Here, we present a procedure performed at our centre with self prepared control serum and use of simple statistical tools for quality assurance.

Methods: The pooled serum was prepared as per guidelines for preparation of stabilized liquid quality control serum from human sera. Internal Quality Assessment was performed on this sample, on a daily basis which included measurement of 12 routine biochemical parameters. The results were plotted on Levey-Jennings charts and analysed with quality control rules, for a period of one month.

Results: The mean levels of biochemical analytes in self prepared control serum were within normal physiological range. This serum was evaluated every day along with patients’ samples. The results obtained were plotted on control charts and analysed using common quality control rules to identify possible systematic and random errors. Immediate mitigation measures were taken and the dispatch of erroneous reports was avoided.

Conclusions: In this study we try to highlight on a simple internal quality control procedure which can be performed by laboratories, with minimum technology, expenditure, and expertise and improve reliability and validity of the test reports.

Keywords: Levey-Jennings charts; pooled sera; quality control; Westgard Rule.
Age at Menarch: Differentials And Determinants
Authors: Aryal Tika Ram
Published: September 2018

This paper is an attempt to investigate the differentials and determinants of age at menarche according tothe characteristics of females. Simple average, univariate as well as multivariate analysis were carried out.A multivariate technique has been utilized to study the effect of various socio-economic variables on thetiming of menarche.The data for this study were taken from a sample survey of Palpa and Rupandehi Districts” conductedbetween January and June 2000. A total of 1258 (including 239 daughters and 1019 mothers) femalesprovided information on the age at menarche. For this study only 239 samples of young girls have beenanalysed.Mean age at menarche was found about 15 and 14 years for older generation (mothers) and youngergeneration (their daughters) respectively. A decreased age at menarche was found with the increased levelof socio-economic status group of girls. Age at menarche was found higher for girls belonging to nonschooling(15.7 years) as compared to the schooling girls (14.2 years). It was found that the variables ‘socioeconomicstatus’, and ‘caste/ethnicity’ were the significant determinants for the timing of menarche. Ahigher risk of getting menarche early was found for high socio-economic status and schooling girls ascompared to the low socio-economic and non-schooling, which may be due to nutrition and physical andpsychological stress during the early childhood.Key Words: Fertility, Menarche, Differentials, Determinants, Reproductive, Adolescent, Sub-fecundity, Foetal wastage.
Dementia Assessment and Management Protocol for Doctors in Nepal
Authors: Jha Arun , Sapkota Nidesh
Published: September 2018

WHO Dementia Report published in 2012 highlighted the exponential rise of dementia in the elderly population worldwide, especially in low-and middle-income countries. There may be over 135,000 people with dementia in Nepal, but there are no formal arrangements for diagnosis and treatment or any care and support for their caregivers.

WHO developed the Mental Health Gap Action Programme (mhGAP) Intervention Guide in 2010, for mental, neurological and substance use, including dementia in non-specialist health settings. This paper reviews the current dementia care provisions in Nepal and proposes a mhGAP-based dementia assessment and management protocol for Nepalese doctors in hospital/clinic settings. The protocol also outlines a post-diagnostic advice for dementia caregivers. The protocol would be discussed at various stakeholders meetings before recommending for routine clinical use.

Keywords: caregiver burden; dementia; MCI; memory clinic; mhGAP-IG; protocol.
Role of Contact with Tuberculous Patients in Cases of Tuberculous Cervical Lymphadenitis.
Authors: Baskota D K , Amatya RCM , Shrivastav RP , Sinha BK
Published: September 2018

A prospective, analytical and cross-sectional study to find out the role of contact with tuberculous patientsduring the process of development of Tuberculous Cervical Lymphadenitis was currently carried out in theDepartment of ENT- Head & Neck Surgery of Tribhuvan University Teaching Hospital Kathmandu, Nepal.Altogether 103 cases of histopathologically confirmed cases of Tuberculous Cervical Lymphadenitis of morethan six weeks of duration were included in the study during the period of one year from March, 2000 toFebruary, 2001.History of contact with tuberculous patients in the past during the development of the disease process wasfound to be positive in 19(18.4%) of the 103 cases. In rest of the 84 cases history of contact with tuberculouspatients was found to be negative (81.6%).The result of this study so far indicates that there is a minimal role of contact with tuberculous patients forthe development of tuberculous cervical lymphadenitis. Although tuberculosis is known as a chroniccommunicable disease, in our study majority cases of Tuberculous Cervical Lymphadenitis did not give anyhistory of contact with tuberculous patients in the past.Key Words: Tuberculous cervical lymphadenitis, tuberculous patients, communicable disease.
Dyke-Davidoff-Masson Syndrome
Authors: Paudel Kalyan , Venugopal Anand
Published: September 2018

Dyke-Davidoff-Masson syndrome refers to atrophy of one cerebral hemisphere (hemiatrophy) due to an insult to the brain in fetal or early childhood period. This is an uncommon condition. We present a case of a nine month- old female presented with seizure and weakness of the right upper and lower extremities and subsequently computed tomography was performed and showed hemiatrophy of the left fronto-parietal lobe with degenerative changes in the left cerebral peduncle.

Keywords: Dyke-Davidoff-Masson syndrome; hemiatrophy; hemiplegia.
Pyoderma Gangrenosum and High Titer Serum Aanti-CCP2 Antibodies
Authors: Das S K , Banerjee N , Khaskil S , Mukherjee S S
Published: September 2018

Pyoderma gangrenosum is an uncommon ulcerative cutaneous neutrophilic dermatosis. In about 50 percent of cases, it is associated with systemic diseases like inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythromatosus, hematological diseases and various malignancies. There is no specific laboratory finding or histological features pathognomonic of pyoderma gangrenosum and it is often a diagnosis of exclusion. Here, we report an elderly female without history of any systemic disorders, presenting to us with extensive, bilaterally symmetrical, deep leg ulcers along with multiple superficial ulcers involving the right groin which was diagnosed as pyoderma gangrenosum. The only positive rheumatologic marker was serum anti-cyclic cittrulinated peptide2 antibody, which was found to be strongly positive. Dramatic response to systemic corticosteroid followed by successful split skin grafting was observed in our patient.

Keywords: Anti cyclic cittrulinated peptide2, pyoderma gangrenosum, symmetric leg ulcer.
MANAGEMENT OF POST-BURN CONTRACTURES
Authors: Schwarz Richard J , Joshi K D
Published: September 2018

Abstract
Effective control of hypertension in adults with chronic kidney disease
Authors: Adhikary L , Koirala A , Gautam B , Gurung A
Published: September 2018

INTRODUCTION:

Adequate control of hypertension in Chronic Kidney Disease patients is difficult to achieve. This study was designed to analyze the adequacy of Hypertension control in adults with CKD using different classes of antihypertensive drugs.

METHODS:

A cross-sectional observational study was done that included 85 patients with CKD admitted to our Medicine Department over a period of two years (2006-2008 A.D.). Presence of CKD was defined as glomerular filtration rate <60 ml/min per 1.73 m2 for more than three months or presence of albuminuria (albumin:creatinine ratio >30ug/mg). Adequate blood pressure control was defined as systolic blood pressure less than or equals to 130 and diastolic blood pressure less than or equals to 80 mm Hg. Data and Statistical analysis was done using SPSS Version 12 for Windows.

RESULTS:

Of all the CKD patients, 51.4% required three Anti-Hypertensive drugs combination for the effective control of Hypertension, while only 21% of CKD patients with hypertension was controlled on two drugs.

CONCLUSION:

Adequate control of blood pressure in CKD patient was shown to be most effective on combination of three antihypertensive drugs. A poor control was seen on patients taking less than three antihypertensive drugs.

Keywords: antihypertensive drug; chronic kidney disease; glomerular filtration rate; hypertension.
LEADER OF THE MA TERNITYCARE: DOCTORS OR MIDWIVES
Authors: Wagle R R
Published: September 2018

Technology of delivery of health care for developing countries is not a resolved issue. Moreover, maternitycare differs from other areas of health care in many ways. Developing countries have to carefully adapt towhat has been done in developed countries. Recent debate and data on maternity health care organisationhave been in favour of midwifery-led maternity care. Midwifery-led maternity care is described as the bestand necessary part of the sufficiently and thus inevitably health producing maternity health care organisation.Key Words: Midwifery-led maternity care, maternity health care organisation, midwives, doctors.
Bull's Eye Maculopathy Following Long-Term Chloroquine Phospate Therapy
Authors: Subedi Sudesh
Published: September 2018

Abstract
Study Of Minute Ventilation Requirement For Laparoscopic Cholecystectomy
Authors: Marhatta Modh Nath
Published: September 2018

Abstract
The Parasight -F Test use in malaria Epidemic in Nepal
Authors: Das Murali Lal , Jha S N , Bhattacharya S , Koirala S
Published: September 2018

A field based trial to compare microscopy and a rapid diagnostic antigen capture detection dipstick(ParaSightTM-F) to diagnose malaria was conducted in 2 village development committees (VDCs) of Nepalduring epidemic (1996/97). 57 and 273 subjects were tested from Parasan and Guthiparsauni VDCrespectively yielding 15 (26.3%) and 152 (55.7%) positive by ParaSightTM -F who were given radical treatmenton the spot. Compared to thick blood film (TBF), the ParaSight F (PSF) test was 93.8% and 94.4% sensitivityrespectively in Parasan and Guthiparsauni for the detection of P. falciparum malaria. There were 10 falsenegative results with the PSF test from the two villages; 6 samples with <100 parasites / ? l, 1 sample with240 parasite/? l and 3 samples having only gametocytes. In this population, the PSF was found to be highlyaccurate simple and rapid suggesting that it is suitable to be used in remote areas and/or epidemic situationfor prompt treatment. However microscopy is good to prevent transmission of the parasites from gametocytecarriers.Key Words: Malaria, diagnosis, ParaSightTM - F, An. fluviatilis, epidemic, Nepal.
PSYCHIATRIC MORBIDITY IN CHILDREN WITH CHRONIC MEDICAL ILLNESS: A CROSS SECTIONAL STUDY IN KALAWATI SARAN CHILDREN’S HOSPITAL, NEW DELHI
Authors: Das Mrinmay , Rathore R , Dutta A K
Published: September 2018

Psychiatric morbidity is common in the medically ill children, although it is frequently unrecognized anduntreated. This study was conducted to determine the nature and extent of psychiatric morbidity in childrenwith chronic medical diseases. 100 children attending the different follow-up clinics at a tertiary carepediatric referral Centre were evaluated using Childhood Psychopathology Measurement Schedule (Malhotraet.el.1988). Thirty one percent children showed abnormally high levels of emotional and behavioral problemsindicative of a possible psychiatric disorder. Attendance at Pediatric OPD was associated with an increasedrisk of common type of childhood psychiatric problems with about 21% children scored abnormally high infactor III (Anxiety) & VII (Physical illness with Emotional problems) suggestive of a definitive psychologicaldisorder. The result indicates that about 1/3 rd children attending pediatric follow-up clinics with chronicmedical illness need a formal psychiatric evaluation for certain psychological disturbances. This also advocatesthe provision of a hospital based pediatric psychiatric liaison service that would help to address this needand create opportunities for pediatricians to train in child psychiatry.Key Words: Psychiatric morbidity; children; chronic medical illness.
Accidental Chemical Burns of Oral Mucosa by Herbicide
Authors: Deo S P , Shetty P
Published: September 2018

Glyphosate (GlySH) is a broad spectrum, nonselective herbicide, widely used in agriculture. This case report describes a 25-year-old man presenting with extensive chemical burns and ulceration of the oral cavity as a result of accidental exposure to GlySH. This paper aims to illustrate the typical appearance of GlySH related chemical mucosal burn and to demonstrate the severity of the corrosive effect of GlySH which need team approach to prevent unfavorable sequelae such as microstomia.

Keywords: Chemical burns, corrosive injury, glyphosate poisoning, herbicide, microstomia, oral mucosal burn.
Pharmaco-Economic Aspects and Pattern of Antibiotic Precriptions in Four Major Hospitals in Kathmandu
Authors: Jauhari A C , Pokharel A , Palikhe N , Shrestha N , Rao B S
Published: September 2018

Background: Antibiotics are extensively prescribed drugs and their use is associated with increasing rateof antibiotic resistance. Nearly one third of prescriptions of physicians for colds, upper respiratory tractinfections and bronchitis are of anticiotics as documented in previous studies. Antibiotic use is associatedwith higher cost of prescriptions, which is impracticable to low socioeconomic groups in Nepal. Besidesthis patients have little knowledge about the use of antibiotics as shown by previous study of antibiotics usedin randomly selected 20 private clinics of Kathmandu valley.13To study the prescribing pattern of Antibiotic preparations in various diseases and to find out how thetreatment could become more pharmaco-economic in government hospitals, without compromising thequality of service.The results were as under Total No. of prescriptions audited were 522, average numbers of drugs/perprescription were 2.61.Maximum antibiotics were received in age group 21-41 y in gynecological, surgical and medical problems,in Pediatrics maximum antibiotics were prescribed between 1-12 years.Minimum antibiotics were prescribed between 13-20 y for gynecological and Pediatric problems. In medicaland surgical problems, minimum antibiotics was administered between 41-60 years. Above 60 years almostno antibiotics were used.Males were prescribed more antibiotics then females (73% for surgical, 62% for medical and 53% forPediatric problems)Only in 24.5% patients, antibiotics were prescribed after proper diagnosis and sensitivity testsMaximum cost of Prescription was 638 Nepali Rupees for treatment of sexually transmitted infection inGynecology.Key Words: Antibiotics, Cost, Private Clinics, Pharmacoeconomic, Sexually Transmitted Diseases.
AMPLIFICA TION OF HVR1 REGION OF HEPA TITIS C VIRUS WITH PA TIENT SPECIFIC NESTED PCR PRIMERS
Authors: Joshi Sarala , Ball J K , Craggs J
Published: September 2018

The understanding of the function of the hyper variable region (HVR) at the NH2-terminus of the E2protein remains very limited. Comparison of published sequences of HCV has led to the identification of anumber of distinct virus types that may differ from each other by as much as 33% over the whole viralgenome allowing the virus to escape cellular and humoral immunity. This phenomenon is related to thecapacity of HCV to escape immune recognition, by frequent mutations HVR1 region. Several investigationshave observed that the antibodies present in a proportion of infected patients had significant cross reactivitywith apparently unrelated HVR1 sequences presented as synthetic peptides.To study the HVR1 cross reactivity and evolution in individuals with varying liver disease severity, nestedPCR was performed to obtain patient specific 150 bp long HVR1 genome. For this, previously amplifiedfirst round single molecule amplimers were reamplified using new patient specific sense and antisenseprimers. The patient specific sense primers did not work in the second round amplification. So, the targetDNA was amplified by three rounds of nested PCR, using patient specific primers on the third round.Key Words: HCV, patient specific HVR1, nested PCR
Fetomaternal outcome in eclampsia.
Authors: Rayamajhi Anjana Karki , Uprety D , Agrawal A , Pokhrel H
Published: September 2018

A cross-sectional hospital based study was conducted to analyze the relation of fetomaternal outcome withthe time interval between onset of fit to delivery and onset of fit to start of anticonvulsant, in eclampsiapatients, from April 2001 to October 2002 in the department of Obstetrics and Gynecology, B. P. KoiralaInstitue of Health Sciences (BPKIHS), Dharan.Of the 56 total cases, 22 (39.2%) patients reached the health facility within 3 hours of the onset of fits, and5 (8.9%) after 12 hours. Twenty-five patients (44.6%) were first managed in different health care centerswhile 31 (55.4%) came directly to BPKIHS, Dharan. Maternal complications occurred more frequently inthose with fit to delivery time interval and fit to start of anticonvulsant time interval of more than 12 hours.Diazepam was the main anticonvulsant used in other health service facilities while in BPKIHS, 32 (57.1%)patients were given magnesium sulphate and 24 (42.9%) phenytoin. There were 2 maternal deaths, whichoccurred in patients in whom the time interval between the onset of fit to delivery and the start ofanticonvulsant was more than 24 hours. Seven patients presented with intrauterine fetal deaths and therewere 2 neonatal deaths.Eclampsia is associated with poor fetomaternal outcome. The fetomaternal complications are increasedwhen the fit to delivery time interval and fit to start of anticonvulsant time interval is prolonged. Rationaluse of appropriate anticonvulsants along with safe delivery should be promoted for eclampsia patients.Key Words: Eclampsia, fetomaternal outcome.
Prescribing trends in a teaching hospital in Nepal
Authors: Ghosh Ranjib , Neogi J N , Srivastava B S , Sen P
Published: September 2018

Prescriptions of the patients at the time of admission to the college of Medical Sciences (CMS), Bharatpur,Nepal were collected for a period of 6 months to study the prescribing pattern in a teaching hospital. Theprescriptions were subjected to critical evaluation using WHO basic drug use indicators. The averagenumber of drugs per prescription was 4.34. Percentage of drugs prescribed by generic name and percentageof fixed drug combinations (FDCs) were 22.57 and 17.49 respectively. The percentage of prescriptionscontaining antimicrobials (72.05%) and injections(66.66%) were relatively more in our study. Percentageof drugs prescribed from the WHO essential drug list and the Nepal essential drug list were 41.76% and38.20% respectively. The most commonly used group of drugs were antimicrobials(32.27%) ,followed byanalgesics(11.85%) and drugs for acid-peptic-disorders(10.72%). The present drug utilization study is togive feedbacks to the prescribers, so as to create awareness about the rational use of drugs.
Inter-rater reliability of the assessment of communication skills in Pharmacology
Authors: Shankar P Ravi , Das B , Partha P , Shenoy N , Dubey A K
Published: September 2018

Effective communication skills are required for medical students and doctors. Communication skills trainingand assessment in Pharmacology is conducted in English using simulated patients. The assessment procedurehas not been tested for inter-rater reliability. To overcome this deficiency, the present study was carried outto obtain information on the agreement between two independent observers simultaneously evaluating thestudents using a standardized check list. The study was conducted on 175 second and fourth semestermedical students at the Manipal College of Medical Sciences, Pokhara, during the month of December2001. Two observers, who had agreed beforehand on the scoring criteria and the checklist to be used,simultaneously and independently evaluated the students. Kappa test was used to measure agreement. Therewas very good to moderate agreement regarding the total scores. Very good to moderate agreement was alsoseen for the parameters: drug-related factors and non-drug factors. Individual factors showed poor agreementbecause of the ‘kappa paradox’. The findings, overall, demonstrate the validity of the system of assessment.This was a preliminary study and more detailed studies are required before modifications in the system ofcommunication skills assessment can be suggested.Key Words: Communication, Educational measurement, Undergraduate medical education.
Pralidoxime in organophosphorus poisoning
Authors: Simkhada N R , Kafle KK , Prasad PN
Published: September 2018

INTRODUCTION:

Pralidoxime are enzyme reactivator that are known to reactivate the phosphorylated acetylcholinesterase by binding to the organophosphorus molecule. The use of oximes in acute organophosphorus poisoning has been a controversial subjects for over two decades. This study was conducted with the objective to find out the estimation of serum cholinesterase and use of pralidoxime in organophosphorus poisoning.

METHODS:

A prospective analysis of all organophosphorus poisoning cases presented at the Emergency Department, Tribhuvan University Teaching Hospital for seven months was done.

RESULTS:

Out of 26 cases about 60% of poisoning cases were monitored for pseudocholinesterase level. About 50% of them had pseudocholinesterase level within normal limit and 20% had less than 10% of normal value. Only 33% cases with pseudocholinesterase level less than 10% were treated with pralidoxime.

CONCLUSIONS:

The initial dose of Pralidoxime used was 1 gm followed by maintenance dose of 500mg 6 hourly, the doses prescribed were less than WHO recommended doses.

 Keywords: cholinesterase, emergency, organophosphorus,poisoning, Pralidoxime.
Students’ perceptions of the pre-clinical integrated medical curriculum in a Health University in Nepal
Authors: Rani M. A. Naga , Koirala S , Das B P , Rauniyar G P
Published: September 2018

Abstract
DIABETES AND ITS MACROVASCULAR AND MICROVASCULAR MANIFESTA TIONS AMONG MICRONESIAN POPULA TIONS
Authors: Karki Prahlad , Bhandary S , Korean M , Braind K
Published: September 2018

This is a retrospective study. Over a period of 2 years between January 2000 and December 2001, a total of416 adult diabetic subjects were admitted to various wards of Majuro hospital .The case records of thepatients of both genders aged greater than 15 years and irrespective of underlying diseases were reviewed.A definitive diagnosis was made based on clinical features and blood glucose estimations according toAmerican Diabetes Association.There were 3,731 eligible subjects of which 416 were confirmed cases of diabetes mellitus (202 men and 214women). The overall percentage of diabetes was 11.14%. Diabetes in females was slightly higher than inmales. Diabetes significantly increased with age and was highest in 50-64 years. Of all diabetes 97.35%were type 2. Gestational diabetes diagnosed first time during pregnancy was 1.20%.About 33.17% of patients presented with uncontrolled diabetes and in 0.96% ketoacidosis and non-ketotichyperosmolar state was found. The most common and frequent chronic complications were diabetic footand gangrene (27.88%), cardiovascular (10.33%) and renal (7.45%) patients. Major and minor amputationswere done in 29 and 51 patients respectively. Interestingly malignant otitis externa was found in (1.68%) ofpatients. The majority of patients (88.46%) improved after admission. The overall mortality rate was 8.89%.This study showed a trend of increasing diabetes with age in both sexes, reaching the highest rate in the fifthand sixth decades of life. Obesity, a high caloric western diet, aging populations and reduced physicalactivity may be the major precipitating factors.
CANCER PATTERN IN EASTERN REGION OF NEPAL
Authors: Lakhey Mamta , Agarwal A , Lakhey S , Sinha A K , Sah S P , Gupta S , Pandey S R
Published: September 2018

Abstract
Factors Affecting Implant Failure in Fracture of the Shaft of Femur
Authors: Lakhey S , Maheshwari J , Malhotra R
Published: September 2018

17 cases of implant failure of fracture of shaft of femur were studied. All cases were young adults less than40 years of age. 15 were males. 16 of 17 cases sustained their initial injury in road - traffic accidents. Platefailures were detected earlier than those of nails as nails kept on providing splintage to an otherwise ununitedfracture. 10 of 17 cases were treated by interlocking nailing during the resurgery. Cortico-cancellous bonegrafting was done in 9 of 17 cases as per merit of each case. Follow-up ranged from 6 months to 2 years. 15of 17 cases went on to sound union after the second operation.The wrong choice of implant, implants improperly applied and bone grafting not done as recommended(i.e. technical errors) is the major cause of implant failure. Nails with diameter more than 10 mm should beused as far as possible. Early detection and resurgery for K-nail failure should be done to prevent greateramount of shortening. Wherever plating is done, instead of attempting anatomic reduction and devascularisingthe bone, biological method of fixation should be used.Key Words: Implant Failure, Shaft of Femur, Fracture.
Continuous versus Intermittent Bolus Epidural Anaesthesia in Elderly Surgical Patients
Authors: Yin XK , Xiang ZG , Prasai A , Lamichhane N
Published: September 2018

A prospective study of 70 elderly conventionally continuously randomized patients was done to compare thehaemodynamic changes produced during continuous infusion versus intermittent bolus epidural anaesthesia.The hemodynamic parameters (Blood pressure, Heart rate) were slightly changed in continuous infusiongroup but there was no significant difference compared with baseline value (p>0.05). Whereas, In bolusgroup, the hemodynamic parameters differed significantly compared with baseline values and the patientsin group I. So conclusion of better hemodynamic stability in continuous infusion epidural anaesthesia thanthat in intermittent bolus epidural method in elderly is reached.Key Words: Epidural anaesthesia, haemodynamic, intermittent bolus, continuous infusion.
A Clinical Study of Diabetic Retinopathy
Authors: Karki KJD
Published: September 2018

A clinical study of diabetic retinopathy was conducted from March- May 2002 to diagnose a patient’sdiabetic retinopathy level and identify eyes of proliferative diabetic retinopathy and maculopathy so thatthese patients could get appropriate and timely laser photocoagulation surgery and other surgical modalitiesto reduce the risk of visual loss. This study shows that out of 248 diabetic patients examined, 45.9% patientshad retinal changes. The potential candidates for panretinal and focal laser treatment were the patientswith very severe non-proliferative diabetic retinopathy (NPDR) (3.5%), early proliferative diabeticretinopathy (PDR) or high-risk PDR (3.5%), and maculopathy (8.8%).Key Words: Diabetic retinopathy, Laser photocoagulation surgery and vitrectomy Surgery.
Ifosfamide-Induced Irreversible Encephalopathy
Authors: Zhang H , Dong J , Wang Y , Singh SK
Published: September 2018

Ifosfamide associated central nervous system toxicity has been reported in 5% to 30%of patients treatedwith ifosfamide. Death from irreversible encephalopathy has been reported rarely. A 52-year-old lady withcarcinoma of cervix was treated with concurrent chemo-Radiatherapy, and residual disease was given withnew adjuvant chemotherapy, containing regimens ifosfamide and cisplatin. Two days after the initiation ofifosfamide, the patient exhibited onset of lethal encephalopathy manifested by subacutely progressiveencephlopathy then to a vegetative state and eventually to death. Brain CT-scan showed no metastatictumor and vascular cause, blood routine examination for infection and metabolic factors was also negative;except Urea and Creatinine was increasing. Ifosfamide is known to be capable of causing acute encephalopathythat can be severe but is generally reversible. This lady showed a very atypical progressive, lethal course ofifosfamide toxicity. The possibility of this complication should be considered when kidney function is withinnormal limits.Key Words: ifosfamide, encephalopathy.
Acute Cervical Spine Injuries: Diagnosis and Management
Authors: Sharma MR
Published: September 2018

Acute cervical spine injuries (CSI) are devastating types of injuries occurring largely in the economicallyproductive population. CSI have been of major public health problems because of consumption of largeamount of both personal and public resources in addition to giving rise to long-term disability for thepatient. Over the years an effort has been made to develop ways to evaluate the cervical spine in the settingof trauma using reasonably fast and accurate methods. Similarly, refinement in the management of thesepatients has significantly improved the outcome. In this article an attempt has been made to review thepertinent literature and extract the information tailored to us regarding the diagnosis and management ofcervical spine injuries, which can be used effectively in areas where even only x-ray facility is available.Key Words: Trauma, spinal cord, cervical spine, stabilization.
RESTORATIVE PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS FOR SEVERE ULCERATIVE COLITIS IN RURAL NEPAL
Authors: Ghimire K P , Walker Kenneth
Published: September 2018

For most patients with ulcerative colitis (UC) requiring surgery, restorative proctocolectomy (RP) may bethe operation of choice. By using an ileal pouch-anal anastomosis, it offers a curative operation with no needfor a permanent ileostomy. We present a 16 year-old boy from a remote village with chronic UC whichfailed to respond satisfactorily to maximal medical therapy. We opted for elective surgery because he wasunlikely to comply with long-term medical therapy and surveillance, nor to survive if he came to emergencysurgery in our setting. RP was performed and he recovered well. His bowel habit was better than the 5 or 6motions per day that is typical following this procedure. Where the expertise is available, the operation canbe performed and any complications managed, using only the basic facilities available in most districthospitals. We present this case as an example of the “one-hit medicine” approach that is often required inour context. We suggest that RP may occasionally be indicated for UC in rural Nepal, where the alternativescarry relatively greater disadvantages.Key Words: Restorative proctocolectomy, ileal pouch-anal anastomosis,ulcerative colitis, appropriate technology.
Gastroesophageal reflux disease - management by laparoscopic fundoplicaton
Authors: Goel Amit , Manohar Ram , Tiwari B
Published: September 2018

Abstract
ANTHROPOMETRY AND BLOOD HAEMOGLOBIN STATUS OF WOMEN IN MAKWANPUR DISTRICT, NEPAL
Authors: Manandhar B , Osrin D , Shrestha B P , Shrestha J R , Manandhar D S , Costello A M
Published: September 2018

BackgroundThe nutritional situation of women in Nepal remains precarious. Low energy, protein andmicronutrient intakes contribute to high levels of stunting and anaemia throughout thelife cycle. This suboptimal nutritional status contributes to high prevalences of low birthweight and death in early infancy. As background information for an ongoing study ofperinatal health interventions in 24 Village Development Committees (VDCs) of MakwanpurDistrict, a descriptive study of nutritional status and anaemia in a sample of women wascarried out.ObjectivesTo measure weight, height, mid-upper arm circumference (MUAC) and blood haemoglobinin non-pregnant married women of reproductive age.MethodsParticipants aged between 15 and 49 years were recruited at 12 sites in five VDCs. Personaldetails were collected in each case, after which height, weight, mid-upper arm circumference(MUAC) and blood haemoglobin level were measured.ResultsResults are available for 500 women. Mean height was 149.9 cm (95% confidence intervalfor mean 149.5 – 150.4 cm); mean weight was 45.5 kg (95% CI 44.9 - 46.1 kg); mean BodyMass Index (BMI) was 20.2 kg/m2(95% CI 20.0 – 20.4 kg/m2); mean MUAC was 23.47 cm(95% CI 23.2 – 23.7 cm). Overall, 27.8% (95% CI 24.1 – 32.2%) of women showed evidenceof Chronic Energy Deficiency (CED) on the basis of BMI, and 51.5% (95% CI 47.0 –56.0%) on the basis of MUAC. There were no significant differences in BMI or MUACbetween either ethnic or age groups. 35.3% of women were anaemic (95% CI 31.1 – 39.7%),one percent severely so. There were no significant differences in prevalence between ethnicgroups, but there was some evidence of an increase in anaemia prevalence with age.ConclusionsCED and anaemia appear common in Makwanpur District. As part of a package to improvenewborn infant outcome, access to and uptake of haematinics during pregnancy should bebeneficial. Community level intervention needs to attempt to address the issue of foodintake in young girls and women before improvements in nutritional status are possibleKey Words: Anaemia, anthropometry, nutritional status, Nepal.
CLINICAL PROFILE AND SEXUAL BEHAVIORS IN PATIENTS OF SEXUALLY TRANSMITTED DISEASES IN A TEACHING HOSPITAL OF EASTERN NEPAL
Authors: Agrawal Sudha , Garg V K , Agarwalla A , Deb M
Published: September 2018

A hospital based prospective cross sectional study was under taken over one-yearperiod from April 1998 to March 1999 to study the clinical profile and sexual behaviorin sexually transmitted diseases (STDs) patients at Dermatology and Venereology OPDat BPKIHS, Dharan, Nepal. A total of 105 patients giving history suggestive of STDswere studied. These patients were also enquired for their sexual behaviors. Therewere 85 males and 20 females; and the majority (55.2%) was in the age group of 21-30 years. Most of the patients (25.7%) were students followed by housewives (17.2%).service holders (13.3%), businessmen (13.3%), unemployed (9.5%) and fanners(8.5%).. Literates were 80%. Sixty-eight percent males and 90% females were married.Majority of the males contracted infection from CSW (58.8%). Females got theinfection from husbands and friends. More than 50% of male had multiple partnerswhereas in case of females it was only 5%. Homosexual and bisexual were 3.5% and4.7% respectively in males. Unprotected sexual contact was found in 94.1% of malesand 100% of females. Syphilis (30.5%) was the commonest type of STD followed bygonorrhea (14.3%), genital warts (14.3%), chancroid (6.7%), candidiasis (6.7%),herpes genitalis (5.7%), mixed infection (4.7%), donovanosis (2.8%), andLymphogranuloma venereum (0.9%). In homosexual and bisexual, only NGU andsyphilis were seen. STDs constituted 0.97% of all new dermatology patients. In spiteof high proportion of promiscuous sexual behavior, there was only one HIV positivepatient.Key Words: Clinical profile, Sexual behavior, STD patients, Nepal.
Diagnosis of Plasmodium Falciparum Infection Using Parasight-F Test in Urine Samples
Authors: Ghimire Prakash
Published: September 2018

Abstract
SUBACUTE CUTANEOUS LUPUS ERYTHEMATOSUS WITH PSEUDO-PORPHYRIA AND VITILIGO
Authors: Sripathi H , Dahal M , Basu A
Published: September 2018

Sub acute Cutaneous Lupus Erythematosus (SCLE) is a distinct subset of LupusErythematosus. It can present as non scarring psoriasiform or annular polycycliclesions. About half the patients fulfil the criteria of the American RheumatismAssociation for systemic lupus erythematosus. In this report, we present the case of a45 years old male who came with psoriasiform depigmented plaques and papulo-vesicular lesions developed after taking some medication. Clinically diagnosed as subacute cutaneous lupus erythematosus with acral vitiligo. A histopathological studyand urine analysis however revealed presence of pseudo porphyria along with theSCLE. Although SCLE is not a rare disease, the association of it with pseudo porphyriaand vitiligo is of significance as the treatment for SCLE and pseudo porphyria isphoto protection and for the vitiligo it is photo chemotherapy.ABSTRACTKey Words: Sub acute cutaneous lupus erythematosus, pseudo porphyria,vitiligo, psoriasiform eruptions.
Evidence for HIV-2 infection in Nepal
Authors: Chander Anil , Pahwa V K
Published: September 2018

Assessment of the presence and prevalence of HIV-2 antibodies in patients attending the Universal Collegeof Medical Sciences Teaching Hospital, Bhairahawa, western Nepal was done. A total of 1534 patients serawere screened for the presence of HIV-1 and HIV-2 antibodies from March 2000 to May 2003. A total of 3(0.195%) patients were found to be sero-positive for HIV-2 antibodies. Out of the above three patients, 1(0.065%) was infected with HIV-2 only and the remaining 2 (0.13%) were infected with HIV-1 and HIV -2 both. This evidence of HIV-2 presence implicates serious outcomes as HIV-2 has not been reported fromhospital patients in Nepal.Key Words: HIV-2, sero-prevalence, hospital patients, AIDS.
Enteric fever with severe pancytopenia in a four year girl
Authors: Pathak R , Sharma A , Khanal A
Published: September 2018

Typhoid fever and paratyphoid fever (also known as enteric fever) are severe systemic illnesses caused by salmonella typhi and S. paratyphi respectively. Enteric fever is prevalent in developing countries including Nepal, where it still remains as a major health problem. There have been reports of pancytopenia with enteric fever which has been attributed to mechanisms like bone marrow suppression, infection associated hemophagocytic syndrome and disseminated intravascular coagulation. We report here a case of severe pancytopenia in enteric fever as a result of bone marrow suppression due to systemic infection.

Keywords: enteric fever, pancytopenia, bone marrow suppression
Achalasia Cardia: Experience With Trans-Thoracic Heller's Cardiomyotomy.
Authors: Koirala Ramesh Raj , Shrestha B M S , Sayami P , Sharma G P
Published: September 2018

Abstract