bluuebunny/crossref_metadata_2025 huggingface dataset:
Bilateral, Mirror-imaged, Postero-inferior Cerebellar Artery Aneurysms: Report of a Rare Case
Authors: Sharma G R , Jha R , Khadka N , Adhikari D R , Bista P , Sultaniya P K
Published: September 2018

A 60-year-old right-handed lady presented with the features of subarachnoid haemorrhage. The CT angiogram showed a pair of very rare bilateral, mirror-imaged distal postero-inferior cerebellar artery aneurysms. Both aneurysms were clipped via the midline posterior fossa craniectomy under general anaesthesia. The literatures is reviewed on the incidence, presentation, management and outcome of bilateral distal posterior-inferior cerebellar artery aneurysms. Keywords: bilateral mirror image, distal postero-inferior cerebellar artery aneurysms, posterior fossa craniectomy, microsurgical clipping
Approach to Chronic Hepatitis B Virus Infection
Authors: Tyagi P , Arora A
Published: September 2018

Hepatitis B virus (HBV) infection constitutes one of the major global public health problems. Not only India and Nepal, East Asia is ghting with the same. About 30 percent of the world’s population has serological evidence of current or past infection with HBV. By virtue of its different stage of presentation in different age groups of patients and the rapid mutation in the virus, the treatment of HBV requires thorough work-up and regular monitoring. Many new concepts have evolved in last decade in managing these patients, such as HBV Genotype, HBV DNA quanti cation and mutation analysis. The introduction of oral antivirals in the treatment of HBV infection has revolutionized the treatment.
Clinical Profile of Idiopathic Epistaxis in a Hospital
Authors: Bhatta R
Published: September 2018

Introduction: Epistaxis is a common otolaryngological emergency but most of the cases are idiopathic. This study was done to assess clinical profile in patients with idiopathic epistaxis. 

Methods: Patients presenting in ENT outpatient department or emergency with epistaxis and no definite cause were selected. Patients demographic data, present and past history was recorded. All patients underwent anterior rhinoscopy and rigid nasal endoscopy. 

Results: There were 142 patients with epistaxis without definite cause. Age ranged from 11 to 84 years with mean 32.8 years. Approximately two-third were male. Bleeding from right side was seen in 64 (45.0%) patients. Past history of bleeding was given by 79 (55.6%) patients and out of them 60 (75.9) % had bleeding from same side. Presentation was mostly in months of January to March. Bleeding point was seen in 65 patients. Most of them (37/65) was in Little’s area. Deviated nasal septum was seen in 102 patients. More than half of patients with unilateral bleeding were having bleeding from convex side of deviation. Blood pressure was found to be equal or more than 140/90 mm Hg in 55 (38.7%) patients at the time of presentation. Antihypertensive was required in less than half of these patients. 

Conclusion: Idiopathic epistaxis is common in male, in winter season and in right side and from nasal septum. Hypertension may be found at presentation but most of them don’t need antihypertensive.

Keywords: deviated nasal septum; epistaxis; hypertension.
Maternal Near-Miss: A Multicenter Surveillance in Kathmandu Valley
Authors: Rana Ashma , Baral Gehanath , Dangal Ganesh
Published: September 2018

Introduction: Multicenter surveillance has been carried out on maternal near-miss in the hospitals with sentinel units. Near-miss is recognized as the predictor of level of care and maternal death. Reducing maternal mortality ratio is one of the challenges to achieve Millennium Development Goal. Objective was to determine the frequency and the nature of near-miss (severe acute maternal morbidity) events and analysis of near-miss morbidities among pregnant women.Methods: Prospective surveillance was done for a year in 2012 in nine hospitals in Kathmandu valley. Cases eligible by definition recorded as a census based on WHO near-miss guideline. Similar questionnaire and dummy tables were used to present the result by non-inferential statistics. Results: Out of 157 cases identified with near-miss rate of 3.8, severe complications were PPH (40%) and preeclampsia-eclampsia (17%). Blood transfusion (65%), ICU admission (54%) and surgery (32%) were the common critical intervention. Oxytocin was the main uterotonic used both prophylactically (86%) and therapeutically (76%), and 19% arrived health facility after delivery or abortion. MgSO4 was used in all cases of eclampsia. All of the laparotomies were performed within 3 hours of arrival. Near-miss to mortality ratio was 6:1 and MMR 62.Conclusions: Study result yields similar pattern amongst developing countries and same near-miss conditions as the causes of maternal death reported by national statistics. Process indicators qualify the recommended standard of care. The near-miss event can be used as a surrogate marker of maternal death and a window for system level intervention.  Keywords: abortion, eclampsia, hemorrhage, near-miss, surveillance
Surgical Treatment of Isthmic Spondylolisthesis with Radicular Pain in Adults
Authors: Khan Javed Ahmad , Bajracharya AR
Published: September 2018

Abstract
An Interesting Case of Basal Cell Carcinoma with Raynaud’s Phenomenon Following Chronic Arsenic Exposure
Authors: Gulshan Shazia , Rahman Muhammed Jawaid , Sarkar Ranu , Ghosh Suman , Hazra Rathin
Published: September 2018

Arsenic is commonly known to be associated with squamous cell carcinoma. Among the lesser known associations is basal cell carcinoma and even rarer is its effect on blood vessels causing peripheral vascular disease. Here we present a case of a 55 yr old man with ulceroproliferative lesions on scalp and forehead along with several hyperpigmented patches on trunk and extremities. He had symptoms suggestive of Raynaud’s phenomenon that eventually led to digital gangrene. FNAC was done which was suggestive of basal cell carcinoma. On further enquiry, he was found to reside in an arsenic endemic zone and was investigated for blood arsenic level which was elevated. Punch biopsy from different lesions from body confirmed nodular basal cell carcinoma. Presently the patient has stopped drinking water from the local tubewell. On follow-up he shows improvement of Raynaud’s phenomenon and skin lesions.Keywords: basal cell carcinoma; chronic arsenic exposure; raynaud’s phenomenon. | PubMed
Prevalence of Acute Diarrhoea in Kathmandu Valley
Authors: Karki Aarati , Tiwari BR
Published: September 2018

Abstract
Frequency Dependence of Hearing Loss with Perforations
Authors: Bhusal Chop Lal , Guragain RPS , Shrivastav RP
Published: September 2018

Abstract
Role of Eosinophils in Acute Appendicitis
Authors: Shrestha Reshmi , Shrestha Anju , Tiwari Mamata , Ranabhat Sabin , Maharjan Sushna
Published: September 2018

Introduction: High negative appendectomy rate still prevails on conventional histologic examination. Increased mural eosinophilic infiltrate had been observed in acute appendicitis. Present study aimed to evaluate the role of mural eosinophils in clinically suspected acute appendicitis but histological normal appendix, as an indicator of acute inflammation, alone or in association with edema and to estimate the cut off value for high eosinophil count for the diagnosis of acute appendicitis.

Methods: A prospective cross sectional study was conducted on appendectomy specimens which were categorized into three groups of classical acute appendicitis, negative appendectomy and control. HandE and Giemsa stained section were studied for the presence of mural eosinophilic infiltrate, mast cells and edema.

Results: Of total 170 cases, group 1 comprised of 68 cases, group 2 consisted of 78 cases and group 3 consisted of 24 cases. Mean eosinophil and mast cell counts in the muscularis propria were significantly higher in CAA and NA categories when compared to control group. Positive association was found between high eosinophil count and edema in CAA and NA categories. Cut off value of ≥6/ mm2 for mural eosinophil count was not significantly different in between NA and control categories.

Conclusions: Increased mural eosinophils were significantly present in acute appendicitis and clinically suspected acute appendicitis but histological normal appendix when compared with control group. Sole presence of increased mural eosinophils might represent acute inflammation. However, cut off value for high eosinophil count could not be established to suggest acute appendicitis. 

Keywords: adenomyosis; hysterectomy; leiomyoma; tumour; uterovaginal prolapse.
Patterns of Lesions in Hysterectomy Specimens in a Tertiary Care Hospital
Authors: Vaidya Sujan , Vaidya Sapana Amatya
Published: September 2018

Introduction: Hysterectomy is one of the most common gynaecological procedures performed all over the world. The most frequent indications for hysterectomy are fibroids, abnormal uterine bleeding uterovaginal prolapse and endometriosis. The objective of this study was to present the histopathological patterns of various uterine and adnexal pathologies in the hysterectomy specimens and also to correlate its pre-operative clinical diagnosis with histopathology.

Methods: This is a two-year descriptive study of hysterectomy specimens carried out in the Department of Pathology, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. Data of all the hysterectomy specimens collected during this period was analyzed.  

Results: Out of the 533 cases, fibroid was the most common indication for hysterectomy that was seen in 229 (42.94%) cases followed by uterovaginal prolapse in 101 (18.93%) cases. Leiomyoma was the most common pathology reported in 250 (46.90%) hysterectomy specimens, followed by ovarian tumours in 95 (17.82%) cases. In 17.82% (95/533) cases, no pathology was seen. Overall, the pre-operative indications in 533 cases of hysterectomy were histopathologically verifiable in 487 (91.37%) cases.

Conclusions: Though the histopathological examination correlates well with the pre-operative clinical diagnosis, a number of lesions were also encountered as pure incidental findings. Hence, it is mandatory that every hysterectomy specimen should be subjected to histopathological examination so as to ensure better post-operative management.

Keywords: adenomyosis; hysterectomy; leiomyoma; tumour; uterovaginal prolapse.
Risk of Periodontal Disease: Is there a Correlation with the Type of Antihypertensive Medication?
Authors: Scardina G A , Messina P
Published: September 2018

Introduction: The purpose of this study was to evaluate the effects of long-term oral antihypertensive treatment using centrally acting sympatho-inhibitory drugs (clonidine) and beta-blockers (metoprolol) on capillary microcirculation in the labial and periodontal mucosa.

Methods: Sixty subjects were recruited for the study: 20 patients affected by hypertension in treatment with centrally-acting sympatho-inhibitory drugs (64.28 ± 11.78 years); 20 patients in treatment with beta-blockers (62.03 ± 9.84 years) and 20 healthy subjects (62.06 ± 6.72 years). We use the videocapillaroscopic technique to evaluate in vivo the microcirculation of the labial mucosa corresponding to the lower lip and of the periodontal mucosa corresponding to the central superior incisor.

Results: Capillaroscopy revealed a significant increase in the length, diameter, tortuousity and density (P <0.05) of capillaries in patients affected by hypertension in treatment with centrally acting sympatho-inhibitory drugs, while beta-blockers had a lower effect on the labial and periodontal microcirculation compared to the healthy population.

Conclusions: The capillaroscopic has revealed substantial modifications of the oral microcirculatory pattern in hypertensive patients in treatment with centrally-acting sympatho-inhibitory drugs than with beta-blockers.

Keywords: Hypertension, antihypertensive drug, oral videocapillaroscopy.
Diagnosis Delayed but not Denied - Sheehan’s syndrome
Authors: Thyagaraj Vijayeshree , Kumar MJ Vinod
Published: September 2018

Sheehan’s syndrome is a rare complication of postpartum hemorrhage. With advancement in obstetric care, Sheehan's syndrome has become uncommon except in developing countries. Here, we report a patient with Sheehan’s syndrome who escaped diagnosis for 22 years and presented with life threatening complications. This patient also had certain unusual features of Sheehan’s syndrome like pancytopenia and renal failure. A high index of suspicion is necessary in diagnosing such patients. 

Keywords: pancytopenia; renal failure; Sheehan syndrome.
Facilitation of free residential training inside the country – The fundamental health service responsibility of the Government and its regulatory body
Authors: Bhattarai Madhur Dev
Published: September 2018

For optimum Peripheral Health Service and implementation of various Vertical Public Health Programme Services, network of public Rural and Urban Health Centers with trained Specialists in General Practice (GP) is essential. Later such Specialist GPs will thus fulfill both comprehensive training and experience required for Health Management and Planning Service in the centre.  About 40%-50% of all Residential Trainings and Specialists are required in GP. There are further up to 100 to 150 possible specialties in which remaining doctors can be trained for Specialty Health Services. Though free Residential Training has numerous advantages, its shortage inside country is the bottleneck to provide above mentioned Health Services. Planning for health service delivery by at least trainee residents under supervision or appropriately trained specialists guides Residential Training’s regulations. Fulfillment of objective training criteria as its core focus is the concept now with the major role of Faculty as supervising residents to provide required service in the specialty and simultaneously updating themselves and their team for Evidence-Based Medicine practice. Similarly the need of Ambulatory Health Service and joint management of in-patients by specialists in hospitals has changed unit and bed divisions and requirements for Residential Training. Residents, already the licensed doctors, are thus providing required hospital service as indispensable part of its functional hierarchy for which they need to be paid. With such changing concepts and trends, there are some essential points in existing situation to facilitate free Residential Training inside country. For Government doctors, relevant amendment in their regulation is accordingly required.

Keywords: ambulatory care; general practice; health service; hospitalist; medical council; medical

education; public health; regulatory body; research; residential training.
Effect of Gender and Body Weight on Postprandial Glucose and Lipid Metabolism in Adults with Type 2 Diabetes
Authors: Diaf Mustapha , Khaled Boumediene Meghit , Habib Houari Hadj , Belbraoued Slimane
Published: September 2018

Introduction: The magnitude of the healthcare problem of type-2-diabetes increases according to its association with several risk factors for cardiovascular diseases such as obesity and dyslipidemia.

Methods: This study took place in the north-western region of Algeria. We aimed to assess the effect of body weight and gender on postprandial lipid and glucose in type-2-diabetes patients. 93 diabetic patients (age 55.65±13.81 years) were studied. Anthropometric parameters and body mass index (BMI) were measured. Fasting and postprandial (PP) glucose and lipid (total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, apo A-I and apo B) profiles were evaluated.

Results: There were a positive correlation between postprandial glucose and BMI in women (r2 = 0.041). Negative correlation with BMI was noticed for PP TG in both males (r2 = 0.011) and females (r2 = 0.021). A significant difference (p= 0.019) was observed for PP HDL-c in women (0.39 ± 0.10 g/L vs. men 0.33 ± 0.12 g/L) and also for PP apo A-I (women: 1.33 ± 0.27 g/L vs. men: 1.09 ± 0.34 g/L; p= 0.0003). According to gender and weight groups, our results indicated that female gender and overweight are associated with elevated PP HDL-c and PP apo A-I levels. However, obesity in women is related to high concentration of PP TG.

Conclusions: The present study suggests that gender difference and weight classes are important factors that contribute to determining the postprandial responses, both for glucose and lipids, in type 2 diabetic patients.

Keywords: gender difference; postprandial dyslipidemia; type 2 diabetes; weight groups.
Clinico-microbiological Profile and Visual outcome in Traumatic Endophthalmitis following Pars Plana Vitrectomy at a Tertiary Eye Care Centre of Nepal
Authors: Thapa Raba , Paudyal Govinda
Published: September 2018

Introduction: Endophthalmitis is a potentially devastating ocular complication of perforating eye injury where prompt intervention can save some vision. This study aims to explore the clinico-microbiologic profile and visual outcome following pars plana vitrectomy (PPV) in traumatic endophthalmitis.

Methods: This is a retrospective interventional case series study conducted at a tertiary eye care centre of Nepal. A total of 49 consecutive cases (49 eyes) of endophthalmitis following PEI, who underwent PPV from January 2007 to June 2010 were included in the study.  

Results: Mean age was 14.7 years (S.D. 14.27). Twenty seven patients (55%) were of age group below 10 years. Male to female ratio was 2.75:1. Mean duration of presentation was 8.9 days. Nineteen eyes (36.73%) had injuries with wooden sticks, followed by injury with metallic objects in 16 patients (32.56%). PEI involving zone I was found in 31 eyes (63.25%). The retained intraocular foreign body was found in seven patients (14.2%). The post operative vision improved in almost 24 cases (49%) with visual recovery of 20/200 and better in six cases (12.24%). The vitreous culture was positive in five cases (12.8%) with predominant streptococcus pneumonia in four cases (10.25%).  

Conclusions: Children were the mostly affected group with males outnumbering females. Wooden sticks and metallic objects were the commonest insulting agents. Despite the late presentation and predominant zone I injury, eye could be salvaged in majority with visual recovery of 20/200 and better in six cases (12.24%).Keywords: endophthalmitis; intra-ocular foreign body; perforating eye injury; vitrectomy .
Effect of Physical Exercise on some Hematological Parameters in Female Athletes in Bangladesh
Authors: Alam Tanbira , Shirin Lubna , Rahman SM Niazur , Alam Tanjeda , Habib Nasrin , Umar Badar Uddin , Banna Quazi Rubayath , Begum Rokeya
Published: September 2018

Introduction:  Long term physical training has been considered to adversely affect the performance of athletes especially the females. It may be due to the iron depletion caused by hemolysis or hemodilution results from plasma volume expansion. This study aims to assess the effect of heavy exercise on hemoglobin concentration and some other hematological parameters in female athletes.

Methods: This cross sectional study was carried out in the Department of physiology, Dhaka Medical College, Dhaka, from July 2010-June 2011. A total number of 105 females (70 athletes and 35 non athletes) between 15-25 years of age were recruited. The 35 apparently healthy female non athletes were taken as control (Group-A) and 70 female athletes comprise the study group (Group-B). According to sporting category, Group-B was further subdivided as B1:Runners and B2:Cyclists. Hemoglobin percentages (Hb %), red blood cell (RBC) concentration, packed cell volume (PCV), serum iron, serum ferritin and total iron binding capacity (TIBC) were measured in fasting state after two months training. Statistical analysis was done by using SPSS/ win.15.0 for comparison between the groups, using student’s unpaired “t” test.

Results: Mean Hb%, RBC, PCV, iron and ferritin level were significantly (P<0.001) lower in athletes than those of control group. Within the study groups, runner’s serum iron and ferritin level were lower than cyclists.  TIBC significantly (P<0.001) rose in Group-B2 in comparison to Group-A.

Conclusions: The current study showed that intense physical exercise leads to early stages of Hb%, RBC, PCV, iron and ferritin depletion which might compromise the health and performance of athletes.

Keywords: exercise; hemoglobin; packed cell volume; serum iron.
Frontalis Sling Operation using Silicone Rod Compared with Autogenous Fascia Lata for Simple Congenital Ptosis
Authors: Sthapit Purnima Rajkarnikar , Saiju Rohit , Limbu Ben
Published: September 2018

Introduction: To evaluate the cosmetic results and recurrence of unilateral frontalis sling surgery using a silicone rod compared with autogenous fascia lata in cases of simple congenital ptosis.

Methods: This is a retrospective comparative study of 59 patients who underwent a frontalis sling operation for congenital ptosis. Patients were divided into two groups according to the sling material used; an autogeneous fascia lata (fl) group (n = 24) and a silicone rod group (sl) (n = 35). Cosmetic results and recurrence rates were compared between these 2 groups. The cosmetic results of the frontalis sling operation were assessed as good, fair, or poor based on the difference between the Margin Reflex Distance of both eyelids and graded as good if the difference in two eyes was ≤1mm and poor if it was 2mm or more. Recurrence was defined as the conversion of the cosmetic result from good or fair to poor category.

Results: At postoperative day seven and 30, MRD of both the groups were good but on three months follow-up MRD of silicon rod group dropped, however it was not statistically significant .Lid contour was good in both the groups, however, lid symmetry was poor in two cases of fascia lata at three months follow-up. Repeat surgery for poor outcome was done in 8.6% of cases in silicon rod and 8.3% of fascia lata group.

Conclusions: The frontalis sling operation using either a silicone rod or autogenous fascia lata showed equally good cosmetic results and lower recurrence rate at three months follow up. 

Keywords: congenital ptosis; fascia lata; frontalis sling surgery; margin reflex distance; silicone rod.
Screening for Oral Cavity Cancer: A 1-year Experience of a Regional Hospital in Taiwan
Authors: Chi Tzu-Hang , Yuan Chien-Han , Chen Rong-Feng
Published: September 2018

Introduction: The purpose of this study was to analyze the risk factors affecting precancerous lesions, and cancer of oral cavity, and to assess efficacy of visual screening for oral mucosal lesions.

Methods: The medical records of patients older than 30 years of age with history of habitual cigarette smoking or betel quid chewing that received screening for oral mucosal lesions between January 2012 and December 2012 were retrospectively reviewed. The patients' age, gender, risk factors, screening findings, and histopathology results of biopsy were included for further analysis.

Results: A total of 1341 patients were enrolled in this study. There were 1080 males and 261 females ranging from 30 to 96 years of age, with a mean age of 53.9±13.6 years. After screening, 226 (16.9%) were found to be positive of oral lesions. Among these 226 patients, 69 (30.5%) underwent biopsy under local anesthesia, and the histopathology showed malignancy in 13 (5.8%). All of the confirmed malignant cases were squamous cell carcinoma. Among them, 12 received further staging examination and one was lost to follow-up resulting in unknown stage. The early stage oral cavity cancer (stage I and II) accounted for 84.6% (11/13).  

Conclusions: The detection rate of early stage oral cavity cancer in our study was reasonable. Therefore, visual screening for oral cavity cancer is recommended for patients with habitual cigarette smoking or betel quid chewing.

Keywords: betel quid chewing; cigarette smoking; oral cavity cancer; screening.
Effect of Dexamethasone and Pheniramine Maleate in Patients Undergoing Elective Laparoscopic Cholecystectomy
Authors: Shrestha Binod Bade , Karmacharya Mikesh , Gharti Binod Babu , Timilsina Bishowdeep , Ghimire Pradeep
Published: September 2018

Introduction: Laparoscopic cholecystectomy  is elective surgical procedure for uncomplicated gallstone disease and gallbladder polyp. The objective of this study was to assess the efficacy of Dexamethasone and Pheniramine hydrogen maleate on reducing stress response and pain after surgery in patients undergoing laparoscopic cholecystectomy.

Methods: After obtaining approval from the institutional ethics committee and written informed consent, 120 patients undergoing elective laparoscopic cholecystectomy were enrolled in the study from Sep 2103 to Aug 2014 at Department of Surgery, Manipal College of Medical Sciences, Pokhara, Nepal. Patients were randomized to receive either 8mg/2ml of Dexamethasone + 45.5/2ml Pheniramine hydrogen maleate (treatment group, n= 60) or 5 ml of normal saline (control group, n=60) 90 minutes before skin incision.

Results: There was a reduction of total bilirubin, C-reactive protein value and Visual Analogue Score (VAS) in treatment group as compared to control group (p <0.05).  

Conclusions: Use of Dexamethasone and Pheniramine hydrogen maleate prior to surgical skin incision helps to reduce both postoperative pain and acute physiological stress.

Keywords: C - reactive protein; dexamethasone; laparoscopic cholecystectomy; pheniramine hydrogen

maleate.
Construction and Validation of a Women’s Autonomy Measurement Scale with Reference to Utilization of Maternal Health Care Services in Nepal
Authors: Bhandari Tulsi Ram , Dangal Ganesh , Sharma P Shankara , Kutty V Raman
Published: September 2018

Introduction: Women’s autonomy is one of the predictors of maternal health care service utilization. This study aimed to construct and validate a scale for measuring women’s autonomy with relevance to developing countries.

Methods: We conducted a study for construction and validation of a scale in Rupandehi and further validated in Kapilvastu districts of Nepal. Initially, we administered a 24-item preliminary scale and finalized a 23-item scale using psychometric tests. After defining the construct of women’s autonomy, we pooled 194 items and selected 24 items to develop a preliminary scale. The scale development process followed different steps i.e. definition of construct, generation of items pool, pretesting, analysis of psychometric test and further validation.

Results: The new scale was strongly supported by Cronbach’s Alpha value (0.84), test-retest Pearson correlation (0.87), average content validity ratio (0.8) and overall agreement- Kappa value of the items (0.83) whereas all values were found satisfactory. From factor analysis, we selected 23 items for the final scale which show good convergent and discriminant validity. From preliminary draft, we removed one item; the remaining 23 items were loaded in five factors. All five factors had single loading items by suppressing absolute coefficient value less than 0.45 and average coefficient was more than 0.60 of each factor. Similarly, the factors and loaded items had good convergent and discriminant validity which further showed strong measurement capacity of the scale.  

Conclusions: The new scale is a reliable tool for assessing women’s autonomy in developing countries. We recommend for further use and validation of the scale for ensuring the measurement capacity.

Keywords: maternal health care; scale construction and validation; women’s autonomy measurement.
Status of Vitamin D and its Association with Stroke Risk Factors in Patients with Acute Ischemic Stroke in a Tertiary Care Hospital
Authors: Thapa Lekhjung , Pokhrel Baburam , Shrestha Asis , Pradhan Manohar , Bhandari Tirtha Raj , Shrestha Shakti , Poudel Ramesh Sharma , Poudel Raju
Published: September 2018

Introduction: Vitamin D deficiency has been associated with many neurological illnesses. The status of Vitamin D in Nepalese ischemic stroke patients is still unknown. This study aims to assess the status of vitamin D and its association with stroke risk factors in patients with acute ischemic stroke from Central Nepal.

Methods: A total of 60 patients with ischemic stroke were included in the study. Their clinical profile and Vitamin D status were assessed. Frequency distribution, Pearson χ2test and Kruskal-Wallis test were performed for statistical analysis using SPSS-IBM 20.

Results: The median (IQR) age of the patient was 65 (53.25, 70.75) years, ranging from 18-87 years. Thirty-four (56.7%) were males. Fourty-eight (80%) patients had hypertension and 34 (56.7%) were smoker. Previous stroke was present in six (10%) cases. Thirty-seven (61.6%) patients had low levels of Vitamin D out of which 26 (43.3%) had vitamin D insufficiency and 11 (18.3%) had vitamin D deficiency. Vitamin D level was significantly associated with previous history of stroke (P=0.043).

Conclusions: Vitamin D deficiency occurs in patients with ischemic stroke. Previous episodes of stroke with low vitamin D levels could be a cause of recurrent strokes. Further studies are necessary to establish the role of vitamin D in acute ischemic stroke in Nepalese population.

Keywords: deficiency; nepal; stroke; vitamin D.
Unusual Presentation of Lacrimal Gland Pleomorphic Adenoma
Authors: Pokharel Shailesh Mani , Pant Ashish Raj , Badhu Badri Prasad , Lavaju Punam , Shrestha Bhuwan Govinda , Agarwal Meenu
Published: September 2018

The pleomorphic adenoma of lacrimal gland presents as a painless, progressive, slowly growing supero-temporal swelling with variable proptosis. This tumor is usually found in adults and extremely rare in teenage. We report a case of a 15-year-old boy with pleomorphic adenoma of lacrimal gland which mimicked pseudotumor of orbit due to its presentation as an orbital inflammatory disease and the age distribution. Neuroimaging also suggested pseudotumor and oral steroid was started. But, there was no improvement on steroids and ultrasound guided Fine Needle Aspiration Cytology (FNAC) was performed which suggested Pleomorphic adenoma of the lacrimal gland. En-bloc excision of the mass through antero-lateral orbitotomy was done with satisfactory final outcome The histopathological evaluation was consistent with pleomorphic adenoma of the lacrimal gland.

Keywords: lacrimal gland pleomorphic adenoma; orbitotomy; proptosis; pseudotumor.
Association between Helicobacter Pylori and Gastric Cancer
Authors: Kafle Brindeswari , Bhandari Ramesh Singh , Lakhey Paleswan Joshi , Shrestha Pradeep , Khadka Prem , Sharma Shashi
Published: September 2018

Introduction:A casual relation has been thought to exist between Helicobacter pylori infection and gastric cancer. The present study was carried out to find correlation between H. pylori and gastric carcinogenesis.

Methods: A case control study was performed in the department of endoscopy, Tribhuvan University Teaching Hospital, between January 2008 and February 2009. All patients having carcinoma stomach on endoscopic evaluation later confirmed by histopathological examination were included. Total 50 healthy individuals, with no positive finding in endoscopy were included in control group.

Results: Total 37 cases were analyzed. There were 23 (62.2%) males and 14 (37.8%) females. Majority were above 60 years (46%). Blood group A was commonest group found in patients with carcinoma stomach. Distal part, antrum, 20 (54%) was commonest location of tumor and Borrmann type three was commonest endoscopic type of tumor presentation. Majority of patients received triple therapy and H. pylori detection was low in those treated with triple therapy. Distal tumors were significantly associated with increased prevalence of H. pylori positivity. Total incidence of H. pylori in cases was 54% (20/37). In 15 (75%) cases, H. pylori could be detected by both ELISA and biopsy method. Incidence of H. pylori in controls was 64% (32/50). There was no statistically significant difference in H. pylori presence in cases and control.

Conclusions: Our study couldn’t establish association between H. pylori and gastric cancer. More prospective trials can help find out correlation between combination of risk factors and gastric cancer. 

Keywords: helicobacter pylori; gastric cancer; risk factors.
Lignocaine and Esmolol on Stress Response to Laryngoscopy and Intubation
Authors: Rajbhandari Pradeep Kumar
Published: September 2018

Introduction: Laryngoscopy and tracheal intubation causes significant sympathetic response resulting in hypertension and tachycardia. In individuals with systemic hypertension, coronary artery disease, cerebrovascular disease and intracranial aneurysm, the effect of this transient sympathetic response can evoke life threatening conditions like pulmonary oedema, cardiac failure and cerebrovascular haemorrhage.

Methods: Patients were randomly divided into two groups, 30 in each group. Group I received 50 mg of esmolol and group II received lignocaine 2 mg/kg. Haemodynamic parameters like pulse, systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured before induction of anaesthesia, immediately after intubation then at intervals of one minute, three minutes, five minutes, seven minutes and 10 minutes.

Results: There was no significant difference in demographic or base line vital signs between two groups (Table 1). The mean systolic blood pressure increased on laryngoscopy and tracheal intubation by 15 mmHg in the group I whereas in group II it was 17.4 mmHg. There was a significant rise in diastolic blood pressure (DBP) in both the groups, but the rise was lesser in group II than in group I.

Conclusion: Both esmolol and lignocaine were not effective in attenuating hemodynamic stress response to laryngoscopy and tracheal intubation; however esmolol was superior to lignocaine in blunting the stress response. 

Keywords: esmolol; intubation; laryngoscopy; lignocaine; stress response.
Induction of Labor Using Misoprostol With or Without Mifepristone in Intrauterine Deat
Authors: Agrawal Ajay , Basnet Pritha , Thakur Achala , Rizal Pappu , Rai Rubina
Published: September 2018

Introduction: Rapid expulsion of fetus in intrauterine fetal death is usually requested without any medical grounds for it. So an efficient, safe method for induction of labor is required. The objective of this study is to determine if pre-treatment with mifepristone followed by induction of labor with misoprostol in late intrauterine fetal death is more efficacious.

Methods: We conducted a randomized controlled trial in 100 patients in B.P.Koirala Institute of Health Sciences, Nepal from June 2011 to May 2013. Group A women received single oral dose of 200 mg mifepristone, followed by induction with vaginal misoprostol after 24 hours. Group B women were induced only with vaginal misoprostol. In each group, five doses of misoprostol was used four hourly. If first cycle was unsuccessful, after break of 12 hour, second course of misoprostol was started. The primary outcome was a measure of induction to delivery time and vaginal delivery within 24 hours. Secondary outcome was to measure need of oxytocin and complications.

Results: Maternal age, parity and period of gestation were comparable between groups. Number of misoprostol dose needed in group A was significantly less than group B. Mann Whitney U test showed, women in group A had significantly earlier onset of labor, however total induction to delivery interval was not significant. In group A, 85.7% delivered within 24 hours of first dose of misoprostol while in group B 70% delivered within 24 hours (p=0.07). More women in Group B required oxytocin.

Conclusions: Pretreatment with mifepristone before induction of labor following late intrauterine fetal death is an effective and safe regimen. It appears to shorten the duration of induction to onset of labor. 

Keywords:  induction of labor; intrauterine fetal death; mifepristone; misoprostol.
Normal Width of Third Ventricle In Nepalese Population: Assessment By CT Scan
Authors: Shrestha Amit , Rajbhandari Nikita , Shrestha Anand , Pun Bishika
Published: September 2018

Introduction: Cerebral ventricular enlargement occurs as a natural aging process but also has been associated with many neurological disorders. Whether this enlargement is primary or secondary to these pathological conditions remains controversial. Objective of the study was to tabulate and create normal references values for maximum width of third ventricle in Nepalese population according to age group and gender.

Methods: MTW was determined in two hundred (112 males and 88 females) and age ranging between 1- 93 years who had normal Computed tomography scan (CT scan) of the head .The data collected was analyzed with statistical program IBM SPSS version 20.

Results: Measurements of MTW in both males and females of the normal groups revealed no significant difference. No significant difference in MTW was noticed till the age of 49 years. Significant differences were noticed between 49 - 93 years of age.

Conclusions: This study corroborated well with normal MTW values published in literatures from other parts of the world. However normal values specific to our local population becomes more relevant in interpreting CT scan of head in Nepal.

Keywords: cerebral atrophy; computed tomography scan; hydrocephalus; maximum width of third ventricle.
Outcome of Both Bone Forearm Fracture Fixation in Children by Rush Nails
Authors: Dwivedi Rajeev , Joshi Ruban , Panthi Sagar , Byanjankar Subin , Shrestha Rahul
Published: September 2018

Introduction: Forearm fractures are common upper limb injuries among children and usuallytreated non-operatively. Failure of non-operative treatment, open injuries and multiple fracturesare the indications for surgery in paediatric both bone forearm fractures. Intramedullary nailingis considered as minimally invasive procedure with excellent to fair outcomes but it is not freeof complications. We reviewed the results and evaluated the outcomes of IM fixation of forearmfractures in children by Rush nails to understand the risks and complications associated with theseprocedures.Methods: A retrospective crossectional study of all paediatric patients treated for diaphyseal forearmfractures for period of five years in a tertiary care setup. Complications were classified accordingto modified Clavien-Dindo complication classification system. Outcomes were graded dependingupon complication grade along with range of motion of forearm.Results: A total of 25 patients were included in the study. Mean time for fracture union was 10.56weeks. Outcomes were excellent in 16 (64%), good in 7 (28%), fair in 2 (8%) patients and no pooroutcome was noted. Ten minor complications were seen.Conclusion: Fixation of paediatric forearm fractures by intramedullary Rush nail is minimallyinvasive procedure and outcomes are excellent to fair with acceptable complication rates.Keywords: complication; forearm fractures; intramedullary nailing; outcome; paediatrics; Rush nail.
Maternal Factors for Low Birth Weight and Preterm Birth At Tertiary Care Hospital
Authors: Ojha Neebha
Published: September 2018

Introduction: Low birth weight and preterm birth are the major community health problems in developing countries. They are the major determinants of perinatal survival and infant morbidity and mortality.  The aim of this study was to determine the proportion and the maternal risk factors for low birth weight and preterm birth among hospital deliveries in Tribhuvan University Teaching Hospital.

Methods: A cross sectional retrospective study was carried out in the Department of Obstetrics and Gynecology of TUTH. Maternal risk factors like age, parity, ethnicity, history of previous abortion, history of previous cesarean section, antepartum hemorrhage and medical disorders were studied. Information on all births that occurred was extracted from maternity case notes and delivery registers.

Results: During the study period, there were 685 singleton live births.  Among these 78(11.4%) were low birth weight and 47(6.9%) were preterm birth. The mean birth weight was 2950 ± 488 gm. The mean weight of female was statistically less compared to male babies (p=0.032). The significant risk factors for LBW were primiparity (OR 2.12; 95%CI 1.25-3.58), Indo-Aryan ethnicity (OR 1.97; 95%CI 1.12-3.45) and history of medical disorder (OR 3.08; 95%CI 1.17-8.12). As for PTB antepartum hemorrhage (OR 8.63; 95%CI 1.99-37.30) and history of medical disorder (OR 3.20; 95%CI 1.04-9.89) were significant risk factors.

Conclusions: Parity, ethnicity, and medical disorders were the main risk factors for low birth weight. Antepartum hemorrhage and medical disorders were significant risk factors for preterm birth.

Keywords: low birth weight; preterm birth; risk factors.
Examination of Relationships among Organizational Characteristics and Organizational Commitment of Nurses in Western and Eastern Region of Nepal
Authors: Joshi Archana Shrestha , Namba Mineko , Pokharela Tara
Published: September 2018

Introduction: The objective of this study is to identify relationships between three components of organizational commitment and organizational characteristics of nurses in the western and the eastern region of Nepal.

Methods: A self-administrated questionnaire was used to collect data from 310 nurses currently working at various hospitals in the eastern and the western region of the country. The questionnaire included three sections namely 1) personal characteristics 2) organizational characteristics and 3) organizational commitments scale. Descriptive analysis and multiple regression analysis were performed to identify significance in various relationships.

Results: Out of the 240 completed questionnaires, 226 were found valid for analysis. The mean age was 27.4 years. For each depended variable affective, continuance and normative commitment, multiple regression analysis was performed with personal Characteristics and organizational characteristics as independent variables. All independent variables were found significantly related to each of the two dependent variables; affective commitment and normative commitment (R2 adjusted=0.24, p<0.01 and R2 adjusted=0.05, p<0.01 respectively). However, they were not significantly related to the continuance commitment. Both support from boss (β=0.138, p<0.05) and satisfaction with training (β=0.301, p<0.05) were found to be positive and significant with affective commitment. On the other hand, satisfaction with training (β=0.191, p<0.05) was also positive and significant with normative commitment.

Conclusions: Since both support from boss and training program were found to be positive and significant with affective commitment, hospitals must encourage supervisors to provide more assistance to the subordinate nurses. Moreover, hospitals should develop more training programs to keep nurses motivated.  

Keywords: nursing management; organizational commitment; organizational characteristics; retention.
Experience with Extra Hepatic Intra Abdominal Hydatid Cyst
Authors: Talpur Altaf Ahmed , Shaikh Aijaz Ahmed , Arain Muhammad Imran , Siddiqui Akmal Jamal
Published: September 2018

Introduction: Hydatid disease is a significant health problem with their location at Extrahepatic Intra abdominal sites is a very rare disease. Disease in these sites usually found concurrently with liver hydatid disease. Diagnosis is based blood tests & imaging studies. Surgery is the mainstay of treatment. This study will help us in determining the frequency of Extra Hepatic Intra Abdominal Hydatid Disease. Also different methods to diagnose & treat the disease will be evaluated.  

Methods: It includes patients of extra hepatic intra abdominal Hydatid cyst above 13 years and underwent surgery from 2009 to 2014. Variables include age, sex, clinical findings, diagnostic investigations, operative findings, operative procedure, post operative complications.

Results: Eleven patients; 07 male & 04 female; mean age 37.54 years. Most common symptoms were mass in abdomen in 11 patients & dull pain abdomen in 09 (81.8%) patients. Examination revealed non tender mass in epigastric & umbilical region in 04 (36.3%) patients. Ultrasound Abdomen showed hydatid cyst spleen in 02 (18.1%) patients, epigastrium in 04 (36.3%) patients, beneath left crus of diaphragm in 02 (18.1%) patients & right iliac fossa & pelvis in 1 (9.09%) patient. In 02 (18.1%) patients multiple Hydatid cysts were noted. Hydatid cysts liver found in 07 (63.6%) patients. C.T scan Abdomen was performed in 09 (81.8%) patients. Surgical procedures performed include Saucerization & omental packing in liver Hydatid cysts; Splenectomy for Splenic disease & complete excision of remaining intra-abdominal Hydatid cysts. Postoperative complications noted in 05  (45.4%) patients.

Conclusions: Extra hepatic intra abdominal is an infrequent disease presents significant diagnostic & therapeutic challenge for surgeons.

Keywords: extra hepatic; hydatid disease;  intra abdominal.
Childhood Mishaps and Its Cognizance among Nepalese Mothers of Parsa District for Its Prevention, Small Cross-sectional Study
Authors: Bhattarai Sabitri , Saha Archana
Published: September 2018

Introduction: Several studies have shown that there several unintentional causes for the unwanted childhood accidents. In addition, Nepal demographic health survey via West University of England revealed at 2006 A.D, 11% death casualties of under- five aged children are due to unintentional injuries 1. This particular study is extremely useful to health care planner, provider and researcher to have grand design to be produced by government of Nepal, such that; there shall be minimal rate of casualties of deceased children due to accidents.

Methods: This study is descriptive cross sectional study carried out in Parsa district of Nepal where the respondents were mother to assess their awareness of cause of childhood accidents and its prevention. Computer software SPSS is use to scrupulous analysis of study where the chi-square test is used with 95% level of confidence (p=0.05).

Results: Poisoning 96% cases is the cause of childhood accident unintentionally, followed by 94% foreign body aspiration, 85% flame burn. Unsupervised children are more prone to injury than supervised children. Finally and foremost the crucial correlation of parents level of awareness with childhood are as follows; inadequate level of knowledge have higher percentage of accident (58%), followed by moderately adequate (32%) and adequate (10%).

Conclusions: This study though done on small scale on small part of Parsa district can play key role to the policy to have vigilantive and supervision power to see the loopholes that need to be detected and dealing in curative manner.

Keywords: accident ; childhood ; injuries ;Nepal.
A Case Of Vulvar Myiasis
Authors: Dawadi Bishwa Raj , Sherpa Mingma Temba , Shrestha Rakshya
Published: September 2018

Myiasis is occurs in humans and vertebrate animals mostly due to dipterous flies of the genera Chrysomyia and Cochliomyia. There have been reported cases of myiasis of skin, breast, intestine, eyes and ear but very few cases of vulvar myiasis have been reported in the medical literature. We report a case of a 20 years old female with vulvar myiasis. A 20-year old unmarried girl presented to our hospital with complains of vaginal discharge and vulvar irritation for 3 days with evidence of some worms around her vulvar region. Her menstrual history revealed the use of folded cloths instead of sanitary pads during her menstruation. Moreover, she washed those clothes with water and hanged them in the clothesline outside to let them dry before reuse. Examination of the external genitalia multiple ulcers measuring 1X1 cm on the inner surface of the labia minora, heavily infested with large number of maggots. The patient was admitted for 4 days during which she was given antibiotics, analgesics and anti-inflammatory medication. Daily local asepsis of the wound with antiseptic solution (betadine) was done. We removed more than 30 larvae by the fourth day after which no more larvae were seen and she gradually recovered in the following days. It is our opinion that the cause of vulvar myiasis in our patient was her poor sanitary hygiene. Simple measures such as washing clothes thoroughly, drying and ironing of clothes are also necessary to reduce the risk of this human myiasis.

 

Keywords: external genitalia; female; maggots; myiasis.