bluuebunny/crossref_metadata_2025 huggingface dataset:
Transient Elastographic Values of Healthy Volunteers in a Tertiary Care Hospital
Authors: Basnet Bhupendra Kumar , KC Sudhamshu , Sharma Dilip , Shrestha Dinesh
Published: September 2018

Introduction:Transient elastography is a very promising non invasive procedure to determine liver stiffness for diagnosis of fibrosis in various chronic liver diseases. However, studies on normal values of liver stiffness in apparently healthy subjects are still few. We aimed to determine liver stiffness values in healthy Nepalese volunteers.Methods:Transient elastography (FibroScanR, Echosens, Paris, France) was performed to find out liver stiffness values in 45 apparently healthy volunteers after explaining study protocol. Complete medical examination with routine laboratory tests was performed. Subjects with normal liver biochemistries and normal liver ultrasonography were taken for analysis.Results:Mean liver stiffness value of study subjects was 4.24±0.70 kPa. Liver stiffness value was found higher in males than in females (4.32±0.74 vs 4.07±0.61 kPa, respectively, P=0.26) but not statistically significant. Similarly, comparison between age and liver stiffness also showed positive correlation (r=0.211) but not statistically significant (P=0.164)Conclusions: Our study showed that the mean liver stiffness value was 4.24±0.70 kPa in our population and influence of age, gender and body mass index were not significant.Keywords: chronic liver disease; FibroScanR; healthy volunteers; liver stiffness valve; transient elastography.
Asymptomatic Bacteriuria in Pregnant Women
Authors: Thakur Achala , Baral Ratna , Basnet Pritha , Rai Rubina , Agrawal Ajay , Regmi Mohan Chandra , Uprety Dhruba Kumar
Published: September 2018

Introduction: Asymptomatic bacteriuria is the significant presence of bacteria in urine of an individual without symptoms. The aim of the study is to determine the prevalence of asymptomaticbacteriuria in pregnant women.

Methods: This study was a prospective study conducted in the department of Obstetrics and Gynaecology at B. P. Koirala Institute of Health Sciences. The duration of the study was six monthsfrom January to June 2012. A total of 600 pregnant women were enrolled. All women were clinically identified to have no signs and symptoms of UTI. Clean catch midstream urine sample was collectedfrom each patient into a sterile vial. The urine samples were examined for microscopic and culture sensitivity test.

Results: Out of 600 pregnant women, 52 were positive for significant bacteriuria with a prevalence rate of 8.7%. There was a significant difference in prevalence of asymptomatic bacteriuria withrespect to trimester (p=0.005). Age did not show any significant difference in the prevalence of asymptomatic bacteriuria (p=0.807). There was not any significant difference in the prevalence ofasymptomatic bacteriuria with respect to parity (p=0.864) and booking status (p=0.397). Escherichia coli (35%), Acinetobacter species (15%), Enterococcus species (12%) and Klebsiella pneumoniae (10%)were the common isolates. Most of the isolates were sensitive either to Nitrofurantoin, Norfloxacin or Amikacin.

Conclusions: Asymptomatic bacteriuria is common in pregnancy. Urine culture sensitivity should be carried out routinely on all pregnant patients in order to prevent the dangerous complicationsassociated with it.

Keywords: asymptomatic bacteriuria in pregnancy; urine culture and sensitivity.
Fungating Primary Locally Malignant Giant Cell Tumor Of Ulna – A Case Report
Authors: Shrestha B , Kumar Pankaj , Singh G J , Singh M P
Published: September 2018

A giant cell tumor with local aggressiveness and penetration of cartilage is quite rare. We presenta case of fungating giant-cell tumor of lower end of the ulna with wrist involvement includingpenetration of cartilage and diaphysis. Involvement with all these characteristics, according to theliterature reviewed, is the fi rst case of its type. We are of the opinion that the fungation may be dueto incision and drainage and delayed presentation at tertiary care centreKey Words: Fungating giant-cell tumor, lower end of ulna, local aggressiveness, penetration of cartilage
Psychiatric Comorbidities in Patients with Deliberate Self-Harm in a Tertiary Care Center
Authors: Ghimire Subash , Devota Sagar , Budhathoki Rasmita , Sapkota Nidesh , Thakur Akhilesh
Published: September 2018

Introduction: Deliberate self-harm is one of the common psychiatric emergencies in medical practice. It has become a global health problem with rates increasing over time. This hospital based study may help in understanding the cause, methods and psychiatric comorbidities present in such patients. The aim of this study was to (i) study the relationship between major socio-demographic variables and deliberate self-harm (ii) evaluate methods and precipitating cause (iii) determine the nature and prevalence of psychiatric and personality disorders in deliberate-self harm patients.Methods: This retrospective observational study was performed on 200 cases of deliberate self-harm in a tertiary referral centre in Eastern Nepal by the data collected from the medical records of these patients. Various sociodemographic data and psychiatric comorbidities prevalent in them were analysed.Results: Majority of the suicide attempters (77%) were less than 35 years of age. The female-to-male ratio was 1.35:1. 76% of the patients had received formal education. Majority (73.5%) were married. By occupation, 38% were housewives and 25.5% were students. 72.5% of cases had consumed organophosphates/-chlorides. Interpersonal conflict (72%) was the major cause of DSH. ICD-10 psychiatric disorders were diagnosed in 37% of cases and premorbid personality problems were present in 20% of cases. The most common diagnosis was adjustment disorder (13.5%) followed by mood disorder (11%).Conclusions: Majority of DSH cases were of younger generation. Psychiatric disorders and comorbid personality problems are common in DSH patients. This has important implications for proper assessment and management.Keywords: Deliberate self-harm; Organophosphorous; Para suicide; Psychiatric co-morbidities.
Need for Improvement of Medical Records
Authors: Mishra Amit Kumar , Bhattarai Shiva , Bhurtel Partha , Bista Navindra Raj , Shrestha P , Thakali Kabir , Banthia Prasan , Pathak S R
Published: September 2018

Introduction: A medical record is a systematic documentation of a patient’s medical history and care for legal and future use. A poor quality medical record can negatively affect patient care and safety. The study aims to assess the adequacy of medical records in Bir Hospital, a central hospital.Methods:A cross-sectional study was conducted by analyzing consecutive discharge summaries of patients admitted during a 6 month period in a single unit of a tertiary care center. The discharge summary format of the hospital was taken as the standard and evaluation for adequacy of data entered was assessed. Descriptive statistics were used to analyze various statistical discrepancies. Results: Patient’s condition at discharge was missing in 86 (66.15%). Patient’s address was missing in 21 (16.1%) cases. Almost all the discharge sheets lacked mailing address. Total 96 (73.8%) had use of abbreviations diagnosis. Age and sex were missing in 1 (0.76%). Doctor’s signature was illegible in 103 (79.3%) and missing in 2 (1.5%) summaries. Doctor’s name and their level/position were missing in 118 (90.76%) and 125 (96.1%) respectively. Total 126 patients (96.9%) were not given any instructions on discharge.Conclusions: The discharge summaries analyzed were seen to be inadequate especially in documenting course during the hospital stay, condition at discharge, appropriate instructions and the treating physician’s details. These can probably be addressed by introducing electronic medical records if feasible. Otherwise, the discharge summary should be standardized and doctors should be trained to write legible, complete discharge summaries.Key Words: discharge, hospital, records, summaries
Retinal Detachment Surgery at Nepal Eye Hospital
Authors: Malla O K , Shrestha S , Shrestha S P , Byanju R N , Karki D B
Published: September 2018

Introduction:Retinal diseases are one of the important causes of blindness in Nepal. This study is done with objectives of fi nding the outcome of retinal detachment surgery. Methods:A retrospective analysis of 110 patients who underwent retinal detachment surgery over fi ve year period was conducted in Nepal.Results:Retinal re-attachment was achieved in 94.4 % and postoperative visual acuity of 6/36 to 6/6 was achieved in 52.7% (As possible risk factors, myopia was present in 34.5% ophkia in 29%, trauma in 9%, and lattice) degeneration was 5.4%. Conclusions:The study has shown a promising result for the retinal detachment surgery.Key Words: retinal break, retinal detachment, scleral buckling, vitrectomy
Pattern of Abortion Care in a Tertiary Level Maternity Hospital in Nepal
Authors: Paudel Punya , Paudel Luna , Bhochhibhoya Manisha , Vaidhya Sapana Amatya , Shah Nabina , Khatiwada Dipendra
Published: September 2018

Introduction: Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries and not to mention the cost it imparts to the health system of a country. Therefore, it is equally important to find out the prevalence and the pattern of abortion among the women who utilize the safe abortion care services and provide a framework to target various health promotion programs including safe-motherhood and reproductive health; such that the future interventions to avoid the unintended pregnancy and unsafe abortion can be implemented accordingly.Methods: A cross-sectional study was conducted in a tertiary care hospital in Kathmandu, Nepal. Social and demographic information of all the women seeking induced abortions from January 2011 to December 2012 were included and the result was analyzed.Result: Abortion contributed to about 1.68% of the total patient served in the hospital that provides both obstetrical and gynecological services. Of the total 4830 patients who underwent induced abortion in this period, the mean age was 27, 92.3% were from the Kathmandu valley and more than one-third women (35.2%) were illiterate who couldn't read and write. Majorities were more than two parity and belonged to higher caste.Conclusion: The socio-demographic profile of the abortion clients in Nepal has remained similar over the years. We need to address the accessibility and availability to the safe abortion care services along with other safe motherhood programs guaranteeing access to safe abortion and post-abortion care to all group of women and also, women education regarding contraception to avoid repeated abortions or unwanted pregnancy in the future._______________________________________________________________________________________Keywords: abortion; pattern; socio-demographic.
Prophylactic Nasogastric Decompression after Emergency Laparotomy
Authors: Sapkota Ranjan , Bhandari Ramesh Singh
Published: September 2018

Introduction: Post-operative nasogastric intubation after emergency laparotomy is a commonpractice in many centers, with the intent of hastening the return of bowel function, relievinggastrointestinal discomfort, reducing various post-operative complications and reducing hospitalstay. However, bowel rest and gastric decompression have been re-examined in the light of morerecent data. Many studies and meta-analyses over the last 50 years have challenged the routine useof nasogastric tubes after laparotomy. The objective of this study is to evaluate the need for routinenasogastric decompression after emergency laparotomy.Methods: A prospective, randomized controlled trial was conducted for 12 months (May 1, 2007 toApr 30, 2008) in the Department of Surgery, Tribhuvan University Teaching Hospital, after ethicalapproval. Patients were enrolled as per criteria (Box 1), and subsequently allocated by simplerandomization into two groups: Group 1 and Group 2. Patients undergoing emergency laparotomyfor perforation peritonitis, intestinal obstruction and abdominal trauma were randomized to twogroups – with or without nasogastric tube after surgery. Gastric upset, return of bowel function andpostoperative complications were compared.Results: Total of 115 patients met the inclusion criteria. There was no statistically significantdifference in the occurrence of gastric upset (P: 0.38), wound complications (P: 0.30), respiratorycomplications (P: 0.30) and anastomotic leak (P: 0.64) between two groups. Bowel function returnedin comparable times in both groups (correlation coefficient: 0.14; P: 0.54). Nasogastric tube had tobe reinserted in three patients in the group with nasogastric decompression postoperatively, andfour in the group without (P: 0.43). Thus, routine nasogastric decompression neither prevented thedevelopment of gastrointestinal discomfort nor precluded the need for tube replacement once it wasdiscontinued. For every patient who required post-operative nasogastric decompression, at least 14patients were spared one. Mean hospital stay was significantly more in the decompressed group(7.52 days; correlation coefficient: 0.22; P<0.05).Conclusion: This study has shown that the prophylactic nasogastric decompression followingemergency laparotomy is ineffective in achieving any of the intended goals._______________________________________________________________________________________Keywords: complications; decompression; emergency laparotomy; flatus; nasogastric tube; prophylactic._______________________________________________________________________________________
Clinico-pathological Study of Colorectal Carcinoma
Authors: Thapa Rupendra , Lakhey Mamta , Yadav Pradeep Kumar
Published: September 2018

Introduction: Colorectal carcinoma (CRC) ranks as the fourth most frequent cancer in men (afterlung, prostate and stomach cancer), and third in women (after cancers of breast and uterine cervix).Adenocarcinoma of the colon is the most common malignancy of the GI tract and is a majorcause of morbidity and mortality worldwide. It is also one of the most common cancers in Nepal.Methods: A descriptive study was conducted in a Kathmandu based Hospital. This study included50 casesof colorectal carcinoma diagnosed on colonoscopic/sigmoidoscopic biopsies over a periodof two years.Results: A total of 50 patients were studied out of these, 29 (58%) patients were male, whereas21 (42%) were female with male:female ratio of 1.3:1. Age ranged was from 20 years to 80 years.Maximum number of cases were observed between the ages of 61-70 years. The most common histological type of colorectal carcinoma was moderately differentiated adenocarcinoma and seen in 37(74%) cases. Left sided tumor constituted 40 (80%) cases of all tumorsand rectum was the predominant site with 26 (52%) cases followed by sigmoid colon with 7 (14%) cases.Conclusions: Colorectal carcinoma (CRC) is not an uncommon disease in this part of the world. The use ofsigmoidoscopy and colonoscopy along with biopsy when required should be encouraged as a screeningprogram for colorectal carcinoma in an elderly age group for the detection of CRC at an earlier stage._______________________________________________________________________________________Keywords: biopsy; colonoscopy; colorectal carcinoma; histopathology; sigmoidoscopy._______________________________________________________________________________________
Emotional and Behavioural Problems among Sheltered Homeless Children
Authors: Ojha Saroj Prasad , Chapagain Manisha , Tulachan Pratiksha , Ma Jasmin
Published: September 2018

Introduction: Homelessness in children is a serious problem in the society. Factors leading tohomelessness in Nepalese children are poverty, unemployment, multiple children, exposure toviolence, caste based social discrimination etc. Children living out of their homes have problemsin attachment, temperament, social skills, cognitive ability, and language development. Few nongovernmentalorganizations that have started to look after these children but the mental healthneed is neglected. The study attempted to investigate the emotional and behavioural problems inhomeless children in one of the shelters in Kathmandu.Methods: All the children (n=126) in the SAATHI Organization were included in the study. Theywere administered Child Behaviour Check List 6-18. Children with T-score ≥65 on externalising orinternalising dimension were further evaluated in the Child Guidance Clinic for the final diagnosisbased on DSM IV.Results: The prevalence of emotional and behavioural problem among the participants was 36(28.57%) [15 (26.31%) in boys and 21 (30.43%) in girls] based on CBCL/6-18 years and 29 (23.01%)[12 (21.05%) in boys and 17 (24.63%) in girls] based on final diagnosis. The conduct problems wasthe most common among the male children 5 (8.77%), followed by ODD 3 (5.26%), ADHD 2 (3.5%),Anxiety 2 (3.50%) whereas Anxiety is most common in female children 9 (13.04 %), followed bydepression 5 (7.24%), conduct 3 (4.34%).Conclusions: The rate of emotional and behavioral disorder in homeless children in the study issimilar to the school aged non homeless children in previous studies, which may be because of theprotection provided by the shelters. This study highlighted the need for methodologically betterstudies in the field._______________________________________________________________________________________Keywords: children; emotional and behavioural problems; homelessness; Nepal.
Situation Analysis of Patients Attending TU Teaching Hospital after Medical Abortion with Problems and Complications
Authors: Ojha Neebha , Bista Kesang D
Published: September 2018

Introduction: In Nepal medical abortion has been approved for use since 2009. There were manycases coming to Tribhuvan University Teaching Hospital coming with problems and complicationsfollowing medical abortion. Thus the objective of this study was to analyze the cases that came toTUTH following medical abortion with problems and complications.Methods: This is a prospective study conducted in the Department of Obstetrics and Gynecologyof TUTH. Study was carried from 1st August 2011 to 30th November 2012. Women who came toTUTH with any complaints following medical abortion were interviewed, examined and treatmentprovided. Relevant clinical finding were noted.Results: There were a total of 57 cases during the study. Most (66.6%) of the women were in agegroup 20-29 years age. There were 45 (79%) women who had abortion up to 9 weeks. Medical shopwas the main place where most of the women (45.6%) directly come to know about medical abortion.More than 34 (77.2%) received the service from medical shops without any supervision. Most 31(54.4%) presented with incomplete abortion. There were three cases of continuing pregnancy andfour presented with ectopic pregnancy. Eighteen (31.6%) cases needed admission. Fifty six percentof the cases were treated with manual vacuum aspiration, six cases underwent laparotomy and therewas one maternal mortality.Conclusions: There is a need for proper dissemination and implementation of guideline formanagement of these women and adequate supervision to reduce the problems and complications._______________________________________________________________________________________Keywords: complications; incomplete abortion; medical abortion; problems.
Assessment of Risk Factors against Severity of COPD in Non-Smokers
Authors: Panjwani Ashok Kumar , Ghazal Shaista , Mahat Ravi , Malik Maria , Rizvi Nadeem
Published: September 2018

Introduction: Chronic obstructive pulmonary disease in non-smokers has been an importantconcern in past decade. We studied the risk factors responsible for more severe Chronic obstructivepulmonary disease. Identifying them would help to work against progression to more severe diseaseas well as prevention.Methods: A prospective cross sectional study was done in outpatient clinic of Jinnah postgraduatemedical center from December 2010 to December 2011. All patients fulfilling the criteria for Chronicobstructive pulmonary disease were taken in study. Patients with less than five pack years smokingwith other risk factors for Chronic obstructive pulmonary disease were evaluated.Results: Out of total 90 patients, 74 (82.2%) had mild chronic obstructive pulmonary disease and 16(17.7%) had moderate to severe chronic obstructive pulmonary disease. Patients with single biomassexposure were found to have mild chronic obstructive pulmonary disease except those havingmosquito coil exposure. Patients with mosquito coil and wood smoke exposure were observed tohave moderate to severe chronic obstructive pulmonary disease (p-value 0.009).Conclusions: Wood smokewith mosquito coil smoke exposure is responsible for more severe chronicobstructive pulmonary disease._______________________________________________________________________________________Keywords: biomass; chronic obstructive pulmonary disease; non-smoker; tuberculosis.
A Rare Malignant Transformation of Benign Lacrimal Tumor
Authors: Labh Rajan Kumar , Shrestha Gulshan Bahadur
Published: September 2018

Lacrimal gland tumors are common in middle age group individuals. Proptosis is one of theircommon presentations. Sometimes the tumors may undergo malignant changes which if neglectedcan be life threatening. Here we present a case of 49 years male with gradual painless protrusion anddiminution of vision in his right eye for eight years and more since last 2 months, with restrictionof ocular motility in right lateral gaze. Expecting a benign mass, superolateral orbitotomy withexcisional biopsy was done which astonishingly revealed carcinoma ex pleomorphic adenomawith components of adenocarcinoma and squamous cell carcinoma without any lymphovascularinvasion. Proptosis and vision of the patient in right eye improved post excisional biopsy withoutany residual mass in respective follow ups._______________________________________________________________________________________Keywords: adenocarcinoma; lacrimal gland; malignant transformation; proptosis._______________________________________________________________________________________
Health Seeking Behaviour of Parents for Children with Pneumonia
Authors: Pandey K R , Jha A K , Dhungana R , Lamsal Ritesh
Published: September 2018

Introduction: Health knowledge seeking behaviour is increasing throughout the world. Our study is trying to fi nd out this attitude among parents of children with pneumonia. Methods: A retrospective study was conducted to analyse all admitted children with pneumonia at Dhulikhel Hospital from September 1, 2006 to August 31, 2007. “Duration of illness at home prior to hospital presentation” was taken as the index of health seeking behaviour of the parents. Results: The mean duration of illness prior to hospital presentation for males and females were 4.40 days and 4.16 days respectively (P>0.05). Children who had been hospitalised in the past had a mean of 4.93 days; those never hospitalised before had 4.08 days (P>0.05). Children from Bhaktapur and Kathmandu were brought to the hospital the earliest. Younger children were brought to the hospital sooner; children less than fi ve years were brought earlier, particularly infants.Conclusions: Health seeking behaviour of the parents is affected by age of the children and geographical location. However, previous hospitalisation of the child and their gender do not affect health seeking behaviour of the parents. Key Words: children, health seeking behaviour, paediatrics
Rare Location of Primary Non-Hodgkin's Lymphoma in the Rectum
Authors: Shakya Vikal Chandra , Agrawal Chandra Shekhar , Sah Pannalal , Pradhan Anju , Adhikary Shailesh
Published: September 2018

Lymphomas of the gastrointestinal tract are usually secondary. Primary rectal lymphoma is veryrare by virtue of its location. We present here a 60 years old lady diagnosed as primary rectal diffuselarge B-cell Non-Hodgkin's lymphoma managed operatively. The optimum management of thisentity is still much debated._______________________________________________________________________________________Keywords: Non-Hodgkin’s lymphoma; primary; rectum.
Idiopathic Epiretinal Membrane in Young Patient: A Rare Case Presentation
Authors: Thapa Raba , Paudyal Govinda
Published: September 2018

Epiretinal membrane is avascular fibrous tissue which is adhered to the internal layers of retina in themacular area. Patient may be asymptomatic or present with blurring of vision and metamorphopsia.The idiopathic Epiretinal Membrane is more often seen in elderly but it could be present in youngpatients in association with other vitreo-retinal diseases and following intraocular surgery. Theidiopathic Eperetinal Membrane in young patients are rare. Here we present a thirty one year healthywomen presented with idiopathic Epiretinal Membrane who gained full visual recovery followingthe pars plana vitrectomy, membrane peeling and gas for its rarity._______________________________________________________________________________________Keywords: epiretinal membrane; idiopathic; young women.
Acute Viral Hepatitis in Pediatric Age Groups
Authors: KC Sudhamshu , Sharma Dilip , Silwal Nandu , Basnet Bhupendra Kumar
Published: September 2018

Introduction: Our clinical experience showed that there has been no decrease in pediatric cases of acute viral hepatitis in Kathmandu. The objective of the study was to analyze the etiology, clinical features, laboratory parameters, sonological findings and other to determine the probable prognostic factors of Acute Viral Hepatitis in pediatric population.Methods: Consecutive patients of suspected Acute Viral Hepatitis, below the age of 15 years, attending the liver clinic between January 2006 and December2010were studied. After clinical examination they were subjected to blood tests and ultrasound examination of abdomen. The patients were divided in 3 age groups; 0–5, 5–10 and 5–15 years. Clinical features, laboratory parameters, ultrasound findings were compared in three age groups.Results: Etiology of Acute Viral Hepatitis was Hepatitis A virus 266 (85%), Hepatitis E virus in 24 (8%), Hepatitis B virus in 15 (5%). In 7(2%) patients etiology was unknown. Three patients went to acute liver failure but improved with conservative treatment. There was no statistical difference in most of the parameters studied in different age groups. Ascites was more common in 5-10 years age group. Patients with secondary bacterial infection, ultrasound evidence of prominent biliary tree and ascites were associated with increased duration of illness. Patients with history of herbal medications had prolonged cholestasis.Conclusions: Hepatitis A is most common cause of Acute Viral Hepatitis in pediatric population. Improper use of herbal medications, secondary bacterial infection and faulty dietary intake was associated with prolonged illness. Patients with prominent biliary radicals should be treated with antibiotics even with normal blood counts for earlier recovery.Keywords: Acute viral hepatitis; hepatitis A; hepatitis E; herbal medications.
Sepsis as a cause of acquired Protein C and Protein S deficiency- A case report and literature review
Authors: Kannan Arun , Lizcano Jose , Chandra Sweta , Murphy Christie
Published: September 2018

Warfarin Induced Skin Necrosis is a well-known complication in patients being started on warfarin without adequate bridging . The mechanism is thought to be due to protein C deficiency . We present a rather unusual cause of protein C deficiency due to sepsis resulting in warfarin induced skin necrosis. 43 year old lady who has been on chronic warfarin therapy secondary to anti phospholipid syndrome was admitted to the hospital for acute ischemic cerebellar stroke. Warfarin was held due to acute thrombocytopenia. She was discharged after restarting the warfarin. She presented back with septic shock due to pneumonia. She was found to have multiple necrotic areas consistent with skin necrosis. Unfortunately, patient died due to multi organ failure despite goal directed therapy. This case demonstrates the importance of recognizing the sepsis as an acquired cause of protein C deficiency.
Gingival Enlargement in Antihypertensive Medication
Authors: Pradhan Shaili , Mishra P
Published: September 2018

Introduction: Drug-induced gingival enlargement is a well documented side effect with the use of phenytoin, cyclosporine and calcium channel blockers. The prevalence of gingival enlargement induced by calcium channel blockers is uncertain. Several studies show confl icting results ranging from 20% to 83%. This study was conducted to determine the prevalence of gingival enlargement in patients taking antihypertensive medication. Methods: All consecutive patients on antihypertensive agents attending the Dental OPD were studied. The prevalence of drug induced gingival enlargement was determined. The periodontal condition of all subjects were assessed including plaque index and probing depth. Results: Total 81.2% of subjects taking antihypertensive were seen to have signifi cant enlargement. Among them 71.1% were taking calcium channel blocker, 21.5% were taking ACE Inhibitors, and 7.4% were taking β- blockers. Conclusions:Patients taking antihypertensive agents are at increased risk for gingival enlargement and infl ammation is an important cofactor for the expression of this effect.Key Words: anti-hypertensive drugs, gingival enlargement
Antenatal Diagnosis of Achondrogenesis Type II
Authors: Kodandapani Sreelakshmi , Ramkumar V
Published: September 2018

Achondrogenesis is a lethal congenital chondrodystrophy characterized by extreme micromelia, small thorax and polyhydramnios. We describe a case of achondrogenesis type II (Langer-Saldino achondrogenesis). Prenatal ultrasonography at 22-weeks gestation revealed a fetus with large head, short neck and chest, prominent abdomen and short limbs. Pregnancy was terminated. Radiologic examination of neonate revealed features of achondrogenesis type II. Routine ultrasound screening made early detection and timely management possible.Key Words: achondrogenesis, antenatal, chondrodystroph, congenital
Perforated Duodenal Ulcer in a Young Child: An Uncommon Condition
Authors: Yadav Rohit Prasad , Agrawal C S , Gupta R K , Rajbansi S , Bajracharya A , Adhikary S
Published: September 2018

Duodenal ulcer is an uncommonly diagnosed entity in children. H. pyloriinfection, blood group ‘O’ or secondary to medications like non steroidal anti-infl ammatory drugs (NSAID) and corticosteroids or physiological stress in burns, head injury and mucosal ischemia are implicated as risk factors for their causation. The diagnosis is usually overlooked because of vague and variable symptoms and remote index of suspicion accounted for their low incidence in children. Undiagnosed or mistreated perforations may carry high morbidity and mortality. We report a successfully treated 41/2 year old male child who presented with features of perforation peritonitis and was incidentally found to have a perforated duodenal ulcer. Key Words: duodenal ulcer, laparotomy, perforation
Inguinal Vasal Obstruction Following Polypropylene Mesh Repair
Authors: Thapa Prabin Bikram , Maharjan D K , Pudasaini S , Sharma S K
Published: September 2018

Inguinal vasal obstruction following hernia repair is related to either direct injury to vas or ischemic injury leading to delay stricture. Not much has been described regarding the long term impact of synthetic mesh as far as integrity of the cord structure is concerned. Here, we report a case that underwent mesh explantation for posthernioplasty inguinodynia as well as recurrence and found to have total occlusion of the lumen of vas segment adherent to the explanted mesh on microscopic examination.Key Words: inguinal hernia, polypropylene mesh, vas obstruction
Anatomical and Visual Outcome following Macular Hole Surgery at a Tertiary Eye Care Centre in Nepal
Authors: Thapa R , Paudyal G
Published: September 2018

Introduction: Macular hole (MH) leading to central vision loss is common in the elderly. This study aimed to explore the anatomical and functional outcome of MH surgery at a tertiary eye care setting in Nepal.

Methods: This retrospective, interventional case series study included patients who had undergone MH treatment with pars plana vitrectomy, membrane peeling and perfluoropropane gas (C3F8) from 2007 January to 2010 August and had completed three months of follow up. The best corrected visual acuity (BCVA) and anatomical status of MH assessed with bio-microscopy and optical coherence tomography (OCT) at six weeks, three months and at the last follow-up following surgery were recorded.

Results: A total of 36 cases with the age range of 11 - 73 years and the mean age of 53.2 years (19.3 S.D) were included in the study. The mean duration of decreased vision was 11.1 months (12.1 S.D). Idiopathic macular hole comprised of 31 cases (86.1 %) and traumatic of five cases (13.9 %). The mean follow-up period was 9.4 months. The MH closed in 27 cases (75 %) at six weeks and in 28 cases (77.8%) at three months and at the last follow-up. The vision had improved in 36 % of cases, with more than 2 lines in 27.8 %, and was stable in 27.7 % of cases during the the last follow-up. The anatomical success rate was higher in the idiopathic MH (80.65 %) than in the traumatic (60 %) and visual acuity improved in 45 % of cases in the idiopathic and 20 % in the traumatic cases.

Conclusions: The overall anatomic success rate was 78 % and improvement in visual acuity was seen in one -third of cases. The success rate was higher among idiopathic MH than in traumatic.

Keywords: Anatomical success, macular hole, perfluoropropane gas, visual acuity, vitrectomy
Clinical Profile and Outcome of Patients Presenting with Mushroom Poisoning in a Tertiary Care Center of Eastern Nepal
Authors: Chaudhary Shatdal , Chaurasia Ramesh Kumar , Patel Sushila , Agrawal Krishna Kumar , Aswani Rakesh , Jaiswal Niraj Kumar
Published: September 2018

Introduction: Accidental mushroom poisoning is constantly seen and regularly reported from all over world. Exact magnitude of problem and its clinical profile in Nepal is not well known. This study was done to evaluate clinical profile and treatment outcome of patients presenting with mushroom poisoning in the department of internal medicine, BPKIHS, Dharan.

Methods: It is a prospective observational study conducted in department of internal medicine, BPKIHS, Dharan from 1st January 2008 to 31st December 2009. Informed consent was taken. All the patients were subjected to necessary laboratory investigation. They were followed up at 1 week and 1 month after discharge.

Results: All together 60 patients were analyzed. Majority of subjects 56 (93.3%) were from rural areas. Vomiting and diarrhea were the two most common presentations seen in 56 (93.3%) subjects. The latent period for the symptoms were > 6 hours in 4 (6.7%) and < 6 hours in 56 (93.3%) subjects. Fulminant hepatic failure was seen in 6 (10%) subjects and among them 4 (66.7%) expired. After admission 3 (5%) subjects developed GI bleeding. Average duration of hospital stay was 4.6 days. In follow up recovery was complete in all subjects who survived the acute phase of poisoning.

Conclusions: Especially in patients coming during rainy season mushroom poisoning should be considered in the differential diagnosis of acute gastroenteritis. Mortality is high in subjects with FHF whereas recovery is complete in subjects who survived the acute phase. Keywords: fulminant hepatic failure; gastroenteritis; mushroom poisoning; wild mushrooms.
Risk Factors Predicting Mortality in Patients with Lung Abscess in a Public Tertiary Care Center in Karachi, Pakistan
Authors: Ghazal Shaista , Kumar Ashok , Shrestha Binav , Sajid Sana , Malik Maria , Rizvi Nadeen
Published: September 2018

Introduction: Lung abscess is a commonly encountered entity in South-East Asia but not much data regarding its outcome is available. The objective of this study was to identify the factors associated with increased mortality in patients diagnosed with lung abscess in a tertiary care center of Karachi, Pakistan.

Methods: A retrospective case analysis was performed via hospital records, on patients admitted with lung abscess between January 2009 and January 2011 at the largest state-owned tertiary care centre in Karachi, Pakistan. Out of the 41 patients hospitalized, 17 could not survive and were evaluated for clinical, radiological and microbiological factors to determine association with heightened mortality.

Results: Mortality due to lung abscess stood at 41.4% (17 of 41 cases). Adult male patients were found to have higher mortality with 13 out of 17 (43%) dead patients being male. A majority (21/41, 51.2%) of the cases belonged to the 41-60 year old age group. Highest mortality was seen in patients <20 years of age (3/4, 75%). Patients with blood sugar levels of >200 mg/dL (56%) succumb to disease. Patients with a positive history of smoking, diabetes mellitus, and alcohol intake expressed mortality rates of 44%, 56%, and 50% respectively; while 29.4% of the mortalities were positive for Pseudomonas aeruginosa on sputum culture. A significant association was found with elevated mortality and low haemoglobin levels at time of admission; mortality was 58% ( p=0.005) in patients with Hb less than or equal to 10 mg/dL.

Conclusions: The risk factors involved with heightened mortality included male gender and history of smoking, diabetes and alcohol intake. High blood sugar levels and detection of Pseudomonas aeruginosa on sputum cultures were also implicated. Anemia (Hb level less than or equal to 10mg/dl) was statistically significant predictive factor for increased mortality.

Keywords: lung abscess; mortality; risk factors.
Validation of ‘Moderately Severe Acute Pancreatitis’ in patients with Acute Pancreatitis
Authors: Lakhey Paleswan Joshi , Bhandari Ramesh Singh , Kafle Brindeshwori , Singh Keshaw Prasad , Khakurel Mahesh
Published: September 2018

Introduction: Severe acute pancreatitis, according to Atlanta classification, is a heterogeneous group of patients with different outcomes. The patients with local complications and without organ failure have better outcome. This study has been conducted to determine the proportion of moderately severe acute pancreatitis and validate this subgroup in our population of patients.Methods: A total of 172 patients with the diagnosis of acute pancreatitis were categorized into three groups according to presence or absence of local complications and organ failure as mild acute pancreatitis, moderately severe acute pancreatitis and severe acute pancreatitis and were compared in terms of need for intensive care unit care, length of ICU stay, need for intervention, length of hospital stay and mortality.Results: Fifty seven (33%) were categorized as moderately severe acute pancreatitis. Need for ICU care (19.3% vs 100%, p < 0.001), length of ICU stay (1 vs 9.8 days, p < 0.001), length of hospital stay (8.3±3.7 vs 16.6±8.1 days, p < 0.001) and mortality (0% vs 33.3%, p < 0.001) between moderately severe acute pancreatitis and severe acute pancreatitis was significantly different. Moreover, mild acute pancreatitis and moderately severe acute pancreatitis had no mortality.Conclusions: This study showed that moderately severe acute pancreatitis exists as a separate group different from mild acute pancreatitis and severe acute pancreatitis with no mortality as in mild acute pancreatitis. Keywords: moderately severe acute pancreatitis; Atlanta classification; outcome.
CT Evaluation of Pelvic and Hip Fractures
Authors: Sharma Umesh Kumar , Basnyat Anjali , Rijal Keshab , Shrestha Babu Kaji , Banskota Bibek , Banskota Ashok Kumar
Published: September 2018

Introduction: To analyze the spectrum of pelvic and hip joint injuries by computed tomography in patients attending to emergency.

Methods: CT evaluation with multiplanar and 3-D reformations of 62 patients done with pelvic and hip fractures during 18 months. The mode of injury and treatment were recorded.

Results: Forty four (70.9%) of the injuries were sustained in high speed vehicle accidents (automobile, motorcycle, autopedestrian), 14 patients (22.5%) had sustained fall injury and 4 patients (6.4%) sustained injury following slip on the ground. 31 patients underwent surgery for acetabular fractures. Associated injuries included spinal fractures (5), abdominal visceral injury (3), extremity fractures (13), chest injury (5), head injury (1), urethral injury (4), clavicle fracture (1). Forty patients (64.5%) had acetabular fractures, 25 (40.3%) patients had iliac bone fractures, 47 (75.8%) had pubic bone fracture. Sacral fracture was found in 17 (27.4%) patients. Associated femoral fracture was found in 4, hip joint dislocation was seen in 5 (2- central, 3-posterior). Sacroiliac joint diastasis was found in 13(20.9%) patients, pubic diastasis in 7 (11.2%), fracture ischium in 7(11.%) , protrusio acetabuli in 5 (8%).

Conclusions: Spiral CT with multiplanar and 3-D reformations has clinical values for precise diagnosis and treatment plan for the pelvic and hip fractures.

Keywords: pelvis; hip fractures; CT scan.
Managerial experiences on Pediatric surgical tumors in Tribhuvan University Teaching Hospital
Authors: Pokharel Rameshwar Prasad
Published: September 2018

Introduction: Pediatric tumors are least prioritized but serious problems. Multidisciplinary management improves survival. Incidences, types and follow up results on Nepalese pediatric tumors have not yet been studied. To highlight our center’s experiences on pediatric tumors management and follow up is aimed.

Methods: All pediatric surgical tumors admitted in pediatric surgery unit from 2065-2070 BS werer studied. Patients evaluated with or without chemo / radiotherapy pre or post surgery. Total of 22 cases from age four months to 13 years were studied.

Results: Tumor detection shown highest in age group below 3 years, followed by 5-10 years. Mean age was 54 months. Most common problem (22.7 %) was Saccrococcygeal teratoma (histologically matured). 13% Nephroblastoma, 9% ovarian tumor, 9% Neuroblastoma and various others each were 4.45 %. Majority underwent surgical excision of tumors. Three cases pre surgery and 5 post-surgery, received chemotherapy. Rest had only excision of tumor mass.Follow up were from three weeks to five years period. During this period, two patients expired (one due to complication of second cycle of chemotherapy and second one died with severe aspiration after second laparotomy for intestinal obstruction one year after initial Nephroblastoma excision.) One patient lost for follow up after excision of stage V Nephroblastoma and first cycle of chemotherapy.

Conclusions: Management of pediatric tumors is complicated. Thus it needs better multidisciplinary centre of excellence for satisfactory results. Management is directed according to incidence, types, standard management protocol, which is not studied yet in Nepal. Research on pediatric tumors is virgin area. Large scale studies need to conduct in detail and a center of excellence is essential to provide better services. 

Keywords: follow ups; management; Nepalese population; pediatric tumors; types.
Primary Cutaneous Angiosarcoma on the Nose in a Patient with Multiple Nonmelanoma Skin Cancers
Authors: Basak Kayhan , Basak Pinar Yuksel , Demirel Hakan , Karadayi Nimet
Published: September 2018

Cutaneous angiosarcoma is an uncommon, potentially metastatic and highly aggressive vascular tumor that may arise as de novo or be associated with previous radiotherapy. A 70-year-old female with a solitary lesion on the nose was initially diagnosed as actinic keratosis. However, when the recurring lesion at the same region within 6 months was reexcised, the histological diagnosis was definitively established as well-differentiated angiosarcoma. This case was presented in order to increase awareness of this rare malignancy in an uncommon localisation, especially in the light of pathological findings. Moreover, occurrence of cutaneous angiosarcoma within a short period following a previous excision in a patient with a history of multiple nonmelanoma skin cancers was interestingly pointed out. 

Keywords: angiosarcoma; face; nonmelanoma skin cancers.
PBL Implementation of Kathmandu University Curriculum – Is It Quo Vadis?
Authors: Dixit Hemang , Vaidya Sujan , Pradhan Binita
Published: September 2018

The history of the implementation of PBL which started in 1978 is long and there have been many ups and downs in the process of getting it to work. Of course there are many reasons for this, starting with the fact that basically it is a method of learning of medicine that is being tried out in various parts of the world. What is envisaged by KU is a hybrid form of the process to be implemented for the MBBS course that KUSMS conducts at its campus at Chaukot, Kavre and at its seven affiliated medical colleges. Various points regarding this are discussed in this article. The information provided in the MBBS curriculum of KU was analysed and comments made there on. The syllabi of IoM, BPKIHS and PAHS were also referred to, to note the existing differences. 

Keywords: BPKIHS; ICM; IIME; IoM; KU; NMC; PAHS; SDL; WFME.
Effect of Submucosal Injection of Dexamethasone on Post-operative Sequelae of Third Molar Surgery
Authors: Deo S P , Shetty P
Published: September 2018

Introduction: This study was carried out to evaluate the effects of a single pre-operative sub-mucosal injection of dexamethasone after third molar surgery to see the effects on post-operative discomfort. 

Methods: This study was a prospective, double-blind, randomized, clinical trial. The subjects were  forty patients who underwent surgical removal of the mandibular impacted third molar under local anesthesia and after being randomly assigned to receive either an 8 mg dexamethasone as submucosal injection or a normal saline injection into the lower buccal vestibule adjacent to the third molar. The maximum interincisal distance and facial contours were measured at the baseline and post-surgically on Day 2 and 7. Post-operative pain was evaluated subjectively using a visual analog scale and objectively by counting the number of analgesic tablets used. All subjects were operated upon by the same investigator to minimize the difference from inter-operator variability.  

Results: There was a signicant difference in the measurements of the degree of swelling and trismus between the two groups on the 2nd post-operative day. In contrast, there was no statistically signicant difference between the groups on the 7th post-operative day. The test group also used fewer analgesics post-operatively. 

Conclusions: Submucosal injection of dexamethasone after third molar surgery is effective in reducing postoperative swelling and trismus. It also delays the onset of post-operative pain.

Keywords: dexamethasone, submucosal injection, third molar, third molar surgery, third molar extraction
Vulvar Endometrioma: A Case Report
Authors: Turan V , Ergenoglu M , Yeniel O , Emiroglu G , Ulukus M , Zekioglu O
Published: September 2018

Endometriosis is a benign and common disorder that is characterized by ectopic endometrium outside the uterus. Extrapelvic endometriosis, like of the vulva, is rarely seen. We report a case of a 47-year-old woman referred to our clinic due to complaints of a vulvar mass and periodic swelling of the mass at the time of menstruation. During surgery, the cyst ruptured and a chocolate-colored liquid escaped onto the surgical eld. The cyst was extirpated totally. Hipstopathological examination showed ndings compatible with endometriosis. She was asked to follow-up after three weeks. The patient had no complaints and the incision eld was clear at the follow-up.

Keywords: cystic mass, endometriosis, vulva.