bluuebunny/crossref_metadata_2025 huggingface dataset:
Deep Vein Thrombosis in Protein S Deficiency
Authors: Joshi A , Jaiswal J P
Published: September 2018

Protein S is a vitamin K-dependent anticoagulant protein. It functions as a cofactor of activated protein C to inactivate activated factor V (FVa) and activated factor VIII (FVIIIa). Its deficiency is a rare condition and can lead to deep vein thrombosis, pulmonary embolism or stroke. It is often treated with long-term anti-coagulant therapy. Protein S deficiency may be hereditary or acquired; the latter is usually due to hepatic diseases or a vitamin K deficiency. Protein S deficiency manifests as an autosomal dominant trait; manifestations of thrombosis are observed in both heterozygous and homozygous genetic deficiencies of protein S. This case report is of DVT due to Protein S deficiency in a 53 year old male. Venous Doppler was used to diagnose DVT and free Protein S level measured by ELISA. IVC filter was placed on the third day of admission.

Keywords: antithrombotic, deep venous thrombosis, inferior venacaval filter, protein S.
Nursing Services In Nepal
Authors: Chhetri Tuka
Published: September 2018

NA
Family Planning
Authors: Jha Pitambar
Published: September 2018

NA
Cervical Rib causing Thrombosis of Subclavian Atery
Authors: Sharma P , Rasheed I , Ansari MA , Gurung GS , Chataut SP
Published: September 2018

We describe here an unusual case of thrombosis of left subclavian artery in a patient with cervical rib. The patient presented with features of ischaemia of left upper limb. X-ray chest revealed bilateral cervical ribs, longer on the left side. Color Doppler studies showed echogenic thrombus within the left subclavian artery. Angiography revealed complete occlusion of left subclavian artery. Embolectomy was done. She was planned for excision of rib.

KEYWORDS:  cervical rib, thrombosis of subclavian artery.
Nepal Medical Association Supplement
Authors: Author No
Published: September 2018

First Meeting of New Central Council
Lignocaine: Its Use In Ventricular Arrythmia (Except VF) Following Acute Myocardial Infarction
Authors: Shrestha Santosh Man
Published: September 2018

IntroductionMehod of Lignocaine AdministrationResultsVentricular Premature BeatsVentricular TachycardiaSide EffectsObjective SymptomsCase 1. Mrs. E.D. (47 yrs)Case 2. A.C. (30 yrs): Paroxysnal VT.Case 3: J.M. (55 yrs)Case 4 H.P. (63 yrs)Case 5: B.L. (39 yrs): Ac. Myocarditis.DiscussionEffects of lignocaine on CirculationLignocaine as an autiarrhythmic agentVentricular Premature BeatsVentricular tachycardiaContraindications to the use of lignocaineSide EffectsConclusion
Stevens Johnson Syndrome With Severe Mucocutaneous And Systemic Reactions In One Patient During Treatment With Secondary Line Of Drugs For Pulmonary Tuberculosis
Authors: Sakya T M
Published: September 2018

NA
Malaria Transmission In High Mountain Valleys Of West Nepal Including First Record Of Anopheles Maculatus Willmori (James) As A Third Vector Of Malaria
Authors: Pradhan J N , Shrestha S L , Vaidya R G
Published: September 2018

IntroductionDescription of the AreasMetereological ConditionsMethodsEntomological TechniquesResults and DiscussionSummaryConclusionAcknowledgementReferences
Some Neurotic Symptoms
Authors: Sharma B P
Published: September 2018

SymptomsOccupationAge distributionSelection of casesGeneral ConderationPathological investigationStudy, information and impressionTreatmentDiscussion
Smoking and Health
Authors: Clark Richard I
Published: September 2018

NA
Food For Hospital Patient
Authors: Pradhananga C L
Published: September 2018

NA
Comparative Studies On Response To 5-Day Treatment With Primaquine Of Indigenous & Imported Cases Of P.Vivax in Nepal in 1974-76
Authors: Kondrashin A V , Shakya G M
Published: September 2018

NA
Treatment Of Advanced Coronary Atherosclerosis
Authors: Barr Richard R
Published: September 2018

NA
Low Spinal Analgesia By Xylocaine
Authors: Hai-Khan A
Published: September 2018

NA
Inaugural Speech Delivered by Dr. Mahendra Prasad, Vice-Chancellor, T.U. at the Inauguration of Scientific Session of the 10th all Nepal Medical Conference in Februray 19,1981 at Kathmandu
Authors: Author No
Published: September 2018

NA
PRESIDENTIAL ADDRESS delivered on Inaugural Ceremony of Tenth All Nepal Medical Conference On 19 February 1981 by Dr. M.R. baral
Authors: Author No
Published: September 2018

United We StandDoctor-Patient RelationshipNational Health PlanNepal Medical Council ActFamily WelfareHealth EducationCareer Ladder & Post GraduationRural PostingUnemployement In Our ProfessionBranch ActivitiesOur Guests
Vital Healht And Statistics
Authors: Singh Tilak Man
Published: September 2018

NA
Noise Hazards
Authors: Rajbhandari Purushottam Raj , Bhattarai Keshab Raj
Published: September 2018

NA
Summary Of Original Papers
Authors: Author No
Published: September 2018

Prostacyclin Administration During Cardiopulmonary Bypass In Man                      D.B. Longmore, J.Graeme Bennett, P.M. Hoyle, M.A. Smith, A.Gregory, T.Osivand, W.A.Jones Impaired Immune Response Of Splenectomised Patient To Polyvalent Pneumococcal Vaccine              Stephen W. Hosea, Cynthia G. Burch, Eric J. Brown, Richard A.Berg, Michael M.Drank Prophylactic Cefazolin Versus Placebo In Total Hip Replacement             C. Hill, F.Mazas, R.Flamant, J.Evrard Randomised Placebo-Controlled Trial Of Hepatitis B Surface vaccine In French Haemodialysis Units:II, Haemodialysis Patients              Jean Crosnier, Paul Jungers, Anne Marie             Courouce, Agnes Laplanche, Ellen Benhamou, Francoise    Degos,Bernard Lacour, Paul Prunet, Yvannex Cerisier, Pierre Guesry
Laparotomy For Abdominal Injuries; Role of Clinical Assessment In The Evaluation Of An Injured Abdomen
Authors: Gongal D N , Devkota U P
Published: September 2018

NA
A Unique Spontaneous Subcapsular Bilioma: Is it an idiopathic variety?
Authors: Shrestha Ananta , Lama Thupten Kelsang
Published: September 2018

Spontaneous Subcapsular bilioma is an extrabiliary intrahepatic collection of bile in subcapsular location commonly occurring after biliary trauma or surgery. It rarely occurs in absence of any underlying biliary abnormality. We report a such a case with no known underlying biliary tract abnormality except for a solitary gall stone. We bring into discussion whether this type of bilioma can be labeled as idiopathic spontaneous variety in presence of gall stone.Keywords: bile; idiopathic; subcapsular bilioma.
Ten PM Note of Organophosphae Poisoning- Successful outcome of a Medical Audit with complete seven steps
Authors: Bhattarai M D
Published: September 2018

Medical audit in general consists of seven steps like choosing topic, setting criterion and standard, collecting first data, comparing data with standard, introducing change, collecting second data and reflecting. Its three basic premise are improvement of patient care by using existing knowledge, team work with ongoing educational process and change management and promotion of blame-free culture maintaining confidentiality. Audit mostly relates to a particular practice and is therefore not generalisable. An audit of residents' late evening routine notes of organophosphate poisoning patients is reported here, as the change introduced appears relevant to the situation of developing countries. Organophosphate poisoning patients should be managed in intensive care unit with close monitoring, as inadvertent stoppage or slowing of atropine infusion may occur, particularly at night, leading to reappearance of poisoning manifestations, which may cause respiratory failure and death. If they are managed in wards, residents-on-duty can check the clinical and intravenous drip status in the late evening and communicate with nurses and relatives to be particularly vigilant. In the audit done, such regular ten pm notes of organophosphate poisoning about the clinical and drip status and communication by residents were increased from 15.5% in the first to 81.7% in the second data collection (p < 0.01) after the introduction of the change. The ten pm note is being continued for about two years now. Implementation of ten pm note of organophosphate poisoning patients admitted in medical wards is feasible and appears useful to improve the quality of health care delivery and learning of residents.

Keywords: atrophine, audit, audit steps, organophosphate mortality, organophosphate poisoning.
The Development and experience of laparoscopic tubal sterlization in Nepal.
Authors: Sharma Pramila
Published: September 2018

NA
Role of Vasectomy in family planning program in Nepal.
Authors: Vaidya Tikaman
Published: September 2018

NA
Doctors' Wives Association
Authors: NA NA
Published: September 2018

NA
Interpretation of lesser E.C.G changes in Diabetes Mellitus
Authors: Koirala Dr.Shekhar , Wasir Dr.H.S.
Published: September 2018

NA
Manual Removal of Placenta
Authors: Prasad Vedawati , Jha R.N
Published: September 2018

NA
Use of antimalarials in south Asia
Authors: Kondrashin Dr.V.V. , Dixit Dr.K.M.A
Published: September 2018

NA
Recent Advancement in the Management of Fractures with special References to Nepalese Conditions.
Authors: Shah R.K
Published: September 2018

NA
A short review on the disease pattern in the paediatric ward of Bheri Zonal Hospital observed for five years period
Authors: Pradhan Dr.D.P , Suvedi Dr.B.K.
Published: September 2018

NA
Red Cross Blood Transfusion Activities in Nepal.
Authors: Singh Ranjan , Shrestha Surya K
Published: September 2018

NA
Effectiveness of BCG vaccination in Children in the Gorkha District
Authors: Pust Ronald E , Fonken Royce L , Brown Tjerk , Brown Kerry
Published: September 2018

NA
Incision,Curettage And Primary Sutures Versus Incision And Open Drainage Of Acute Abscesses
Authors: Shafique M , Jha Bhupendra
Published: September 2018

NA
Skin Anergy and its Significance to Predict Post operative Sepsis in Benign Prostatic Hyperplasia.
Authors: Bhatta A D
Published: September 2018

NA
N.M.A. 2042 Budget
Authors: NA NA
Published: September 2018

NA
The Top Nine Diseases in The Ward of Bheri Zonal Hospital
Authors: Suvedi Dr.B.K
Published: September 2018

NA
Epidemiology and Control of Trachoma in Nepal
Authors: Chataut Dr.B.D.
Published: September 2018

NA
Disaster Planning: Are Hospitals Prepared?
Authors: Dickinson Dr.J.G.
Published: September 2018

NA
Vaso-subcutaneous-Fistua
Authors: Shakya Babu Ratna
Published: September 2018

NA
Progress In Tuberculosis Control IN Nepal
Authors: Malla Tej S
Published: September 2018

NA
Child with a Fit
Authors: Manandhar D S
Published: September 2018

NA
Management of Chronic Suppurative Otitis Media
Authors: Prasad Rakesh , Amatya R.C.M
Published: September 2018

NA
Community Mental Health in Nepal-the first One year's Experience.
Authors: Wright C , Hickinbotham D
Published: September 2018

NA
Speciation of Human Hookworm iN Eastern Hills of Nepal
Authors: Morel A M
Published: September 2018

Na
Color Vision Defects in School Going Children
Authors: Shrestha R K , Joshi MR , Shakya S , Ghising R
Published: September 2018

Introduction: Color Vision defect can be observed in various diseases of optic nerve and retina and also a significant number of people suffer from the inherited condition of red and green color defect. 

Methods: A cross-sectional descritptive study was designed with purposive sampling of students from various schools of Kathmandu Valley. All children were subjected to color vision evaluation using Ishihara Isochromatic color plates along with other examination to rule out any other causes of color deficiency. 

Results: A total of 2001 students were examined, 1050 male students and 951 females with mean age of 10.35 (±2.75) and 10.54 (±2.72) respectively. Among the total students examined, 2.1% had some form of color vision defects. Of the male population , 3.9% had color vision defects while none of the female was found with the deficiency. 

Conclusions: The prelevance of color vision defect in Nepal is significant and comparable with the prelevance quoted in the studies from different countries.

Keywords:color vision; congenital red green color effect; Nepal; prevalence.
Clinical Profile of Patients with Tetralogy of Fallot admitted for Surgery at a Cardiac surgical centre
Authors: Otaigbe B E , Kumar S
Published: September 2018

INTRODUCTION:

Tetralogy of Fallot (TOF), a conotruncal defect, has been documented to be associated with chromosome abnormalities, single gene syndrome (22q11 microdeletion), known teratogens, with the rest associations being multifactorial. This study was carried out to determine the clinical profile and associated risk factors in patients with TOF admitted for surgical repairs.

METHODS:

Case files of all patients admitted for Tetralogy of Fallot over a period of one year were retrieved from the Medical Records Department and reviewed. Data on the patients' and their family history and associated cardiac anomalies were noted.

RESULTS:

There were 54 patients, 37 males and 17 females, with a mean age of 6.8 years +/- 7.1. Sixty percent were born between July and December, 81.5% as full term and 44% as first born. Twenty-six percent were born into consanguineous marriages. Five patients had dysmorphic features. Associated cardiac anomalies included right aortic arch, pulmonary atresia, dextrocardia and left superior vena cavae.

CONCLUSION:

The associated risk factors noted in this study were male sex, birthdates between July and December, first born and increased paternal age. Other risk factors were consanguinity and specific patterns of cardiovascular diseases associated with 22q 11 deletions. This suggests a multifactorial etiology for TOF.

Keywords: associated risk factors, cardiac anomalies, demographic factors, Tetralogy of Fallot
Typhoid Meningitis
Authors: Witherington Katherine A
Published: September 2018

NA
Chyluria
Authors: Bhatta AD
Published: September 2018

NA
Aggrement of Co-operation between Dharma Chitra Guthi and Nepal Medical Association
Authors: NA NA
Published: September 2018

NA
Thiacetazone Induced Stevens-Johnson Syndrome
Authors: Shakya GR , Kanodia SK , Siddiqui N
Published: September 2018

NA
Agreement of cooperation between dharma chitra guthi and Nepal medical association.
Authors: NA NA
Published: September 2018

NA
Journal Sub- Committee
Authors: Author No
Published: September 2018

NA
Traumatic Posterior Fossa Extradural Haematoma
Authors: Roka Yam Bahadur , Kumar P , Bista P , Sharma GR , Adhikari D
Published: September 2018

Posterior fossa extradural haematoma is known for the vague signs and symptoms and a notoriouscourse that varies from recovery to sudden death. The incidence of posterior fossa epidural hematomasamong intracranial epidural hematomas has been reported from 4% to 7%. Subsequently, PFEDHwith low GCS or the haematoma of more than 10ml were subjected to evacuation. Since the volumeof the posterior fossa is limited, patients deteriorate early with the development of obstructivehydrocephalus, which is visible in the CT scan in only thirty percent of cases.A retrospective study of 43 cases was done in this Institute from May 1999 to December 2005. Themales (98%) have a clear predominance over female patients (2%). Road traffic accidents accountedfor the majority of the cases (80%), fall for the rest (17%) and one case due to a bullhorn injury.Vomiting was the most common symptom accounting for 67% of cases followed by transient lossof consciousness in 48% and headache in 34%. On arrival to the hospital 67% presented with a GCSmore than 13, 28% with score of 9-12 and the rest 5% with GCS of less than 8. Out of the total 43 casesof PFEDH surgical evacuation was done in 33(76%) and conservative management in 10 cases (23%).A dichotomised Glasgow outcome score was used to measure the outcome. This was favorable in27 of the 33 cases operated (81%), and 7 out of the 10 conservatively managed group (70%). Overallfavorable outcome was found in 34 cases (79%) with overall mortality of the study being 7%.Key words: extradural, haematoma, posterior fossa, trauma
NMA Regulations Recapitulated
Authors: Author No
Published: September 2018

NA
Six Years Of JNMA
Authors: Author No
Published: September 2018

NA
Pattern of Malignant Neoplasm in Bhagalpur
Authors: Shafique M , Verma A P
Published: September 2018

NA
Vulval Adhesion-A sequele of Vulvo-vaginitis
Authors: Rijal Bhola , Mandal Laxman
Published: September 2018

na
Prostatic Calculi.
Authors: Jha S.B , Prakash Om
Published: September 2018

NA
Editorial Notices
Authors: Editor JNMA
Published: September 2018

NA
Safety of Primary Intraocular Lens Insertion in Unilateral Childhood Traumatic Cataract
Authors: Kumar Sandeep , Panda A , Bandu BP , Das H
Published: September 2018

This study analyzes the results of cataract surgery with primary intraocular lens implantation inunilateral childhood traumatic cataract following penetrating trauma and its long term follow up.It is a hospital based study of 114 children (age 3-10 years) with unilateral traumatic cataract whounderwent extracapsular cataract extraction/ lens aspiration with implantation of posterior chamberintraocular lens (IOL). Primary posterior capsulotomy (PPC) was performed in 57 eyes and the rest57 were without PPC (NPPC). The patients were followed up at regular intervals for a period of 3years.Postoperative inflammation and pupillary capture were two frequent complications seen duringpostoperative period. Development of posterior capsular opacification (PCO) was 1/57, 4/57 at 8thweek and 7/30 and 14/39 at 6 months, in PPC and NPPC group, respectively. Best corrected visualacuity (BCVA) ≥ 6/18 was achieved in 50% of eyes at 8th week post operatively and the same at 3years with/without membranectomy/capsulotomy was evident in 73.3% of eyes.Meticulous case selection with insersion of “in the bag IOL” and subjecting the traumatizedcataractous eyes to primary posterior capsulotomy are factors responsible for optimal outcome inunilateral traumatic cataract in children.Key words: childhood, intraocular lens, Nepal, traumatic cataract
Training in Psychiatry for Community health Workers in Nepal
Authors: Hickingbotham D , Wright C
Published: September 2018

NA
Eye health for all by the year 2000 in Nepal
Authors: Chataut BD
Published: September 2018

na
Reflection ON leaving Nepal
Authors: Hankins GW
Published: September 2018

Na
Peptic Ulcer In Indo Nepal Border
Authors: Strong T N
Published: September 2018

NA
Oesophageal Foreign Bodies in Children
Authors: Adhakari Prakash , Adhikari P , Bhusal CL , Guragain RPS
Published: September 2018

Foreign body ingestion is a common occurrence and carries significant morbidity and mortality.Failure to treat foreign bodies immediately can lead to various serious complications. This study wasdone to identify the types as well as site of foreign body ingested and its complication in children.A retrospective study of 122 cases of suspected foreign body ingestion in patients admitted in ENTand Head and Neck Surgery of TU Teaching Hospital, Kathmandu were done in between April 2004to July 2008. Ages less than 12 years were included. In all cases x-ray soft tissue neck lateral andchest x-ray posterio-anterior views were done along with other preoperative investigations. Rigidoesophagoscopy or hypopharyngoscopy were done under general anesthesia to remove foreignbodies.There were 64.7% male and 35.3% female children. Foreign bodies were common in 0-4 year agegroup. Most common foreign body were coin (64.0%) followed by meat bone (14.0%). No foreignbodies were found in 2.4% patients as they were passed in stomach. No complications were notedduring the entire period of this study.Most common foreign bodies in children are coin. Though complications with these foreign bodiesare rare, these do occur due to delay in presentation and removal. No complications were noted inour series. Eventhough children who swallow foreign bodies are asymptomatic; we must maintain ahigh index of suspicion and undergo diagnostic procedure, if there is a positive history.Key words: foreign bodies, oesophagus, rigid oesophagoscopy
Agreement Of Cooperation between Dharma chitra guthi And Nepal Medical College.
Authors: NA NA NA
Published: September 2018

NA
Enteric Fever
Authors: Pandey et al M R
Published: September 2018

NA
UNICEF Seminar, Tashkent
Authors: Dixit Hemang
Published: September 2018

NA
Meniere's Disease
Authors: Bhandari Purushottam R
Published: September 2018

NA
family Planning by Paramedicos
Authors: Author No
Published: September 2018

NA
Pill And Abortion Problems
Authors: Tenhave Ralph
Published: September 2018

NA
Book reviews
Authors: Author No
Published: September 2018

Na
NMA Supplement
Authors: Author No
Published: September 2018

NA
Journal of The Nepal Medical Association- Editorial
Authors: Shrestha S M
Published: September 2018

Regional Mobile Team For Nepal (IX)
A Study of Abdomenal Pain in Children
Authors: Shakya Kashyap Narsingh , Dangol UMS , Khadka SB
Published: September 2018

Pain abdomen is a common pediatric complaint that brings patient to the hospital in Nepal.Knowledge about its etiology and frequency helps in its evaluation and management. The presentstudy was undertaken to find out the causes and their frequency of pain abdomen in Nepalichildren. Children with pain abdomen presenting at the emergency room and pediatric outpatientdepartment of Kathmandu Medical College, Kathmandu from January, 2006 to December 2007 wereclinically evaluated and investigated to find out the causes and frequency of their pain abdomen. Theoutcomes were tabulated and analyzed for interpretation. Of 444 patients attended, 356 completedinvestigations and came for follow up. Cause of pain abdomen was apparent in 117 (32.9%) only.91.5% were medical causes, comprising predominantly of diarrheal diseases (28.3%), infantile colic(9.4%), urinary tract infection (7.7%) and acid peptic disease (6.8%). 8.5% causes were related tosurgical conditions, which needed operative management. Secondary or extra-abdominal causeswere found in 20 cases (17.1%). Pneumonia (2), functional (5), vulvovaginitis (2) and infantile colic(11) were predominant causes. Our study showed that the causes of pain abdomen in children werepredominantly medical. Gastroenteritis was the most frequent cause. Secondary causes, includingfunctional and emotional causes were infrequent. Small percentage needing surgical managementformed a diagnostic challenge.Key words: abdomen, children, gastroenteritis, pain
Experience Of Outpatient Laparoscopic Sterilization In Nepal
Authors: Giri Kanti
Published: September 2018

NA
A Case Of Round Worm In Gall Bladder With Reveiew Of The Literature
Authors: Gongal D N
Published: September 2018

NA
A Review Of Typhoid Fever Cases On The Medical Service At Patan Hospital
Authors: Witherington Katherine A
Published: September 2018

NA
Fungal Infection of Ear And Its Sensitivity Pattern
Authors: Faiswal S K
Published: September 2018

NA
"Exomphalos Major" Baby In Gandaki Zonal Hospital
Authors: Adhikari Rishi Kant
Published: September 2018

NA
Agreement of Co-operation Between Dharma Chitra Guthi and Nepal Medical Association
Authors: Chataut B D
Published: September 2018

NA
Non-Hodgkin's Lymphoma With Cutaneous Manifestation
Authors: Pokhrel G P , Shrestha H G
Published: September 2018

NA
Lung Cancer in Nepal - Histological Typing And Its Relations With Smoking
Authors: Shrestha H G
Published: September 2018

Out of 51 bronchoscopy biopsy, thirty (60%) were of lung cancer which made 5.3% of the whole malignant tumours, i.e. 562 cancers in different sites in 26 months study in the Department of Pathology, TUTH. Squamous cell carcinoma (22 cases or 73.3%) was the commonest followed by Oat cell carcinoma (5 cases or 16.7%). Lung cancer was found more in the old age group, that is 23 cases (7.7%) in over 50 yrs old, 6 cases (20%) in 40-50 yrs group and only one case (3%) in 25 yrs male. The average age for the lung cancer in this study is 58.2 yrs. Lung cancer is more common in male than in female (5:1). All nine patients with bronchogenic carcinoma in whom the history of smoking habit was taken, were heavy smoker for a long time (more than 15 yrs) & 89 (8 out of 9 pts) have Squamous cell carcinoma. In 17 cases of lung cancers 12 (70%) were founf in right lung and 5 ( 30%) in the left lung.
Vas Recanalisation
Authors: Sharma A K
Published: September 2018

NA
Heart failure with Preserved EF: A Bird Eye View
Authors: Aziz Fahad , Thazhatauveetil-Kunhahamed Luqman-Arfath , Enweluzo Chijioke , Zaeem Misbah
Published: September 2018

The concept of ‘‘diastolic’’ heart failure grew out of the observation that many patients who have the symptoms and signs of heart failure had an apparently normal left ventricular (LV) ejection fraction. Thus it was assumed that since systolic function was ‘‘pre- served’’ the problem must lie in diastole, although it is not clear by whom or when this assumption was made. Diastolic heart failure is associated with a lower annual mortality rate of approximately 8% as compared to annual mortality of 19% in heart failure with systolic dysfunction, however, morbidity rate can be substantial. Thus, diastolic heart failure is an important clinical disorder mainly seen in the elderly patients with hypertensive heart disease. Early recognition and appropriate therapy of diastolic dysfunction is advisable to prevent further progression to diastolic heart failure and death. There is no specific therapy to improve LV diastolic function directly. Medical therapy of diastolic dysfunction is often empirical and lacks clear-cut pathophysiologic concepts. Nevertheless, there is growing evidence that calcium channel blockers, beta-blockers, ACE-inhibitors and ARB as well as nitric oxide donors can be beneficial. Treatment of the underlying disease is currently the most important therapeutic approach.Keywords: diastolic heart failure; doppler echocardiography; treatment.
Clinical grading of Intrahepatic Cholestasis Pregnancy
Authors: Pradhan Meena , SHAO Yong
Published: September 2018

Intrahepatic cholestasis of pregnancy (ICP) is the pregnancy induced liver disorder causing intense itching of palm, sole or even whole body especially in the evening at late second and third trimester. This disease categorized into mild and severe ICP according to raised level of LFT including serum level of Bile acid and Cholic acid. ICP has less morbidity to mother but significant risk for fetus in uterus. The predisposing element to cause intense pruritus is because of high amount of bile acid in maternal serum. Toxic bile acids affect fetal cardiomyocytes that retained in fetus body causing sudden intrauterine fetal death. ICP is commonly found in winter months and mostly itching of body occurs in the evening after sunset. Fetus in uterus is unsafe if mother’s bile acid exceeds normal value. ICP is successfully treated with Ursodeoxycholic acid (UDCA), S-adenosyl methionine (SAME), Dexamethasone and vitamin K. Keywords: itching; bile acid; obstetric cholestasis; Ursodeoxycholic cholic acid.
Spontaneous Intracystic Hemorrhage of the Arachnoid Cyst: A Case Report and Review of Literature
Authors: Jha Rajiv , Sharma GR , Kumar P , Roka YB
Published: September 2018

Arachnoid cysts represent benign cysts that occur in the cerebrospinal axis in relation to the arachnoidmembrane and do not communicate with the ventricular system. We report a case of a years righthanded lady, who presented to the emergency department with the complaints of headache andvomiting for one week CT scan showed extraaxial cystic lesion in the left fronto-parietal region.On the fifth day of admission, patient had sudden onset of severe headache associated with loss ofconsciousness for about 3-4 minutes with neck rigidity.A CT scan of head was repeated, which showed left fronto-parietal cystic lesion with intracystic bleedand SAH. Intraoperatively, there was intradural cystic lesion containing xanthochromic fluid withnormal brain surface and there were no evidence of any vascular malformations. Marsupilizationof the cystic lesion was carried out and she improved. The literature regarding arachnoid cyst withspontaneous intracranial haemorrhage is reviewed.Key word: arachnoid cyst, haemorrhage, intracycstic
Use Of Mechanical Sutures In Pulmonary Surgery
Authors: Sharma Govind Lennard
Published: September 2018

In a ten years period, Six hundred and twenty patients under surgical treatment for different kinds of pulmonary diseases. Pulmonary tuberculosis was the indication for 395 thoracotomies and 115 patients were operated for lung cancer. Ninetyone thoracotomies were performed chronic non-specific diseases of the lung and in 19 cases indications for pulmonary resection were other diseases. In all cases various types of mechanical staplers were used for individual suturing of the culmonary vessels and bronchus. Operations performed included 207 pneumonectomies, 341 lob and bilobectomies, 49 segementectomics and 23 combined resections. Chronometry was done in seventyone thoracotomitromies with average time spent for each operation being one hour and fortyseven minutes only. Out of this time, only four minutes and thirtyfour seconds (4.2%) were spent for individual suturing of the pulmonary vessels and bronchus. During the operation insufficiency of mechanical sutures were seen in few cases and dealt with accordingly. Arterial and bronchial stump insufficiency were noted in the percent cases each, whereas venous suture insufficiency was seen only in 1.3 percent cases. Five huudred and fortysix patients (88.1%) had a benign course, whereas fortythree patients (6.9%) experienced postoperative complications. But only in sixteen cases (2.6%) could the mechanical sutures be related theoretically for those complications. There were thirtyone hospital deaths (5%). Our results show that the use of mechanical sutures is safe, considerably reduces the time for pulmonary resection and is associated with relatively very few intraoperative and postoperative complications.
Clinical Quiz
Authors: Maskey C P
Published: September 2018

NA
Association News In Brief
Authors: Author No
Published: September 2018

NA
Where There Are Not Enough Doctors
Authors: Dunn F W.M.
Published: September 2018

This paper shows how a busy general hospital Out-patient Department may be run without the need for many doctors. It describes the 'Sorter System' used in the hospitals of tthe United Mission to Nepal over the last 15 years. Advantages and possible disadvantages compared to a traditional 'doctor-only' system are discussed, in the context of the health needs of Nepal.
Cholecystectomy In Bir Hospital Nepal
Authors: Gongal D N , Bhattacharya S K , Shrestha M L , Koirala R P
Published: September 2018

SummaryMaterials and MethodsAgeSexGeographical DistributionsSymptomatologyInvestigationsOperative FindingsTypes of StonesComplicationsDuration of Stay In HospitalDiscussionConclusionAcknowledgementsReferences
Isoniazid Psychosis
Authors: Pathak U N , Rauniyar B P
Published: September 2018

NA
Solitary Rectal Ulcer Syndrome: Uncommon Cause of Rectal Bleeding in Children
Authors: KC Sudhamshu , Sharma D , Bashnet B , Mishra AK
Published: September 2018

Rectal polyp and hemorrhoids are common causes of bleeding per rectum in pediatric age group.However, there are some other causes which should be considered in differential diagnosis. We haveacquainted a case of rectal bleeding due to solitary rectal ulcer in a child of 10 year. Colonoscopicexamination was required for diagnosis as proctoscopic examination and digital rectal examinationmissed the diagnosis, probably due to poor co-operation by the patient and rare nature of the disease.Although well recognized in the adult population, the pediatric experience with this condition islimited.Key word: children, rectal bleeding, solitary rectal ulcer
A PROFILE OF WOMEN WITH ALCOHOL RELATED PROBLEMS AT BPKIHS, DHARAN
Authors: Sharma Avneet , Khandelwal S K , Kalra O P
Published: September 2018

ABSTRACT
THE ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) IN THE DIAGNOSIS OF TUBERCULOSIS LYMPHADENITIS
Authors: Bhanot U K , Raut W K , Zawar M P , Kanetkar M V , Nagwanshi C A
Published: September 2018

ABSTRACT
CHOANAL ATRESIA-RARE BUT INTERESTING CASES
Authors: Thapa Narmaya , Amatya R CM , Pradhan B , Prasad R , Sinha B K , Bhattarai H , Bhusal C L , Pradhan B , Guragain R P , Banskota D K
Published: September 2018

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CHEST ULTRASONOGRAPHY IN PLEURAL DISEASE
Authors: Afset Jan Egil
Published: September 2018

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Pediatric Femoral Hernia
Authors: Yadav Rohit Prashad , Agrawal CS , Adhikari S , Regmi R , Gupta RK , Sapkota G
Published: September 2018

Pediatric femoral hernias account for less than 1% of all groin hernias. Pediatric femoral hernias arerather uncommon more so in males, often overlooked, misdiagnosed and treated as inguinal hernia.Femoral hernia masquerading as inguinal hernia in a seven year old male is reported along withreview of relevant literature.Key Words: children, femoral, hernia, misdiagnosed
A RARE CASE OF XANTHOGRANULOMATOUS PYELONEPHRITIS
Authors: Harishchandra B , Charles N , Ray D , Yadav C M , Krishnanand B R , Geetha T V
Published: September 2018

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IMPORTED CUTANEOUS LEIHSMANIASIS IN A NEPALI CITIZEN
Authors: Joshi Arun , Shatrughan P S , Agrawalla A , Agrawal S , Jacob M
Published: September 2018

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ECHOCARDIOGRAPHY AT TU TEACHING HOSPITAL(TUTH)-ONE YEAR STUDY
Authors: Singh B K M , Sayami Arun , Acharya G P
Published: September 2018

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Cervical Spine Clearance: A Review and Understanding of the Concepts
Authors: Agrawal Amit
Published: September 2018

Cervical spine injury is relatively rare, occurring in only 2% to 3% of patients with blunt traumawho undergo imaging studies. However, timely and accurate recognition of cervical spine injuryis essential for the optimal management of patients with blunt trauma as subsequent morbidity includesprolonged immobilization. Evaluation of cervical spine injuries should begin in the emergencydepartment and involves a combination of pediatric, trauma, orthopedic, and neurosurgeons fordeﬁnitive management. Knowing which patients are at highest risk for injuries will undoubtedlyinﬂuence decisions on how aggressively to pursue a potential cervical spine injury and can be achievedby establishing a multidisciplinary team approach that provides cervical spine immobilization,assessment, and clearance. Implementation of such guidelines will decrease time for cervical spineclearance and incidence of missed injuries. In this article different aspects of cervical spine injuriesand cervical spine clearance protocols are reviewed.Key words: cervical, injury, trauma, spine, vertebrae
A RARE CASE OF PERFORATED MECKEL'S DIVERTICULUM PRESENTING WITH PERITONITIS IN A CHILD
Authors: Christian Lynden B , Charles N , Harishchandra B , Basu A , Sharma P , Mahapatra S
Published: September 2018

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Analysis of Septic Abortion During Six Year Period(April 1992-1998) in Teaching hospital, Nepal
Authors: Rana A , Gurung G , Pradhan N , Singh M
Published: September 2018

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SUPPLY AND REQUIREMENT PROJECTION OF PROFESSIONAL NURSES IN NEPAL OVER THE NEXT 5 YEARS
Authors: Thakur L
Published: September 2018

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ENTERITIS NECROTICANS IN NEPAL
Authors: Parkes Gary
Published: September 2018

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INVENTORY BASICS FOR OUR DISTRICT HEALTH SYSTEM
Authors: Somlai Ivan Gyozo , Thapa Dhruba Bahadur
Published: September 2018

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Organophosphorus Poisoning
Authors: Paudyal Buddhi Prasad
Published: September 2018

Acute poisoning by organophosphorus (OP) compounds is a major global clinical problem, withthousands of deaths occurring every year. Most of these pesticide poisoning and subsequentdeaths occur in developing countries following a deliberate self ingestion of the poison. Metacid(Methyl parathion) and Nuvan (Dichlorovos) are commonly ingested OP pesticides; Dimethoate,Profenofos, and Chlorpyrifos are other less frequently ingested compounds in Nepal. The toxicityof these OP pesticides is due to the irreversible inhibition of acetylcholinesterase (AChE) enzymeleading to accumulation of acetylcholine and subsequent over-activation of cholinergic receptorsin various parts of the body. Acutely, these patients present with cholinergic crisis; intermediatesyndrome and delayed polyneuropathy are other sequel of this form of poisoning. The diagnosisdepends on the history of exposure to these pesticides, characteristic manifestations of toxicityand improvements of the signs and symptoms after administration of atropine. The supportivetreatment of OP poisoning includes the same basic principles of management of any acutelypoisoned patient i.e., rapid initial management of airways, breathing, and circulation. Gastriclavage and activated charcoal are routinely used decontamination procedures, but their valuehas not been conclusively proven in this poisoning. Atropine is the mainstay of therapy, andcan reverse the life threatening features of this acute poisoning. However, there are no clearcut guidelines on the dose and duration of atropine therapy in OP poisoning. Cholinesterasereactivators, by regenerating AChE, can reverse both the nicotinic and muscarinic effects;however, this benefit has not been translated well in clinical trials. All these facts highlight thatthere are many unanswered questions and controversies in the management of OP poisoningand there is an urgent need for research on this aspect of this common and deadly poisoning.Key Words: poisoning, organophosphorus insecticides, decontamination, antidotes
A Profile of Kala-Azar Cases At a Village Health Post of Eastern Nepal
Authors: Manohar R K , Karna U L , Kannan A T
Published: September 2018

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Gyanecological Morbidities at Rukum: An Experience of a health Camp
Authors: Sharma S , Aryal R P , Shrestha N L
Published: September 2018

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Factors associated with treatment in TB patients at National Tuberculosis Center
Authors: Malla Pushpa
Published: September 2018

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RATIONAL USE OF ANTIBIOTICS IN HOSPITALS
Authors: Joshi Mohan P
Published: September 2018

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Haematometra Following Evacuation of Retained Product of Conception
Authors: Pradhan P
Published: September 2018

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Socio-economic and operational consideration on tuberculosis control programme
Authors: Shakya T. M.
Published: September 2018

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Delayed Presentation of Acute Coronary Syndrome: A Challenge in its Early Management
Authors: Acharya Pramod , Adhikari RR , Bhattarai J , Shrestha NR
Published: September 2018

INTRODUCTION:The time of presentation of acute coronary syndrome from the onset of chest pain determines the treatment modality and prognosis. Delayed presentation is associated with a poor outcome. In the present study, we tried to find out the causes of late presentation of ACS in a tertiary care center in the eastern part of Nepal.METHODS:It was a cross-sectional descriptive study that included 100 consecutive patients with ACS presenting to our institute over a period of 8 months. They were studied for their demographic profile, delay in presentation, the management done at the local centers and their final diagnosis.RESULTS:We found that patients living within Dharan City reached BPKIHS within 20 hours of the onset of chest pain while those from outside the city who came directly reached within 63 hours. Other patients reached their respective local centers (health posts, district hospitals and private clinics) within 39 hours. The commonest cause of delay was vehicular problem followed by unnecessary delay at the local centers. The work up for chest pain was inadequate in these centers. Late presentation to our institute significantly affected the optimal management.CONCLUSIONS: We found that significant number of patients with ACS from eastern Nepal presented late in our tertiary care center. In order to improve ACS outcome in this region, we advise equipping the local centers with electrocardiogram machines, improvement in ambulance services and a greater emphasis on coronary artery disease awareness programs as well as initiating preventive measures.KEY WORDS:acute coronary syndrome, chest pain, delayed presentation, electrocardiogram
Non-Surgical Management of Stress Incontinence
Authors: Singh M
Published: September 2018

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Sexually Transmitted Diseases: A Challenge to Reproductive Health
Authors: Manohar RK
Published: September 2018

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THE DISTRICT HEALTH SYSTEM IN NEPAL-AN ASSESSMENT-I HEALTH SERVICES ANALYSIS
Authors: Mac.Rorie R A , Poudyal D K , Shrestha P , Bellringer K C
Published: September 2018

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The Role of Ultrasonography in Detection and Localization of Radiolucent Foreign Body in Soft Tissues of Extremities
Authors: Shrestha Dipak , Sharma UK , Mohammad R , Dhoju D
Published: September 2018

INTRODUCTION:Retained non-radiopaque foreign body inside soft tissue can be a cause of prolonged morbidity. Detection and localization is difficult task with conventional radiography. Ultrasonography, CT and MRI are other modes of evaluation but both of CT and MRI are expensive and not easily available.METHODS:Twenty three patients were evaluated with ultrasonography (8 MHz linear probe) and X-ray for clinically suspicious non-radiopaque foreignbody in soft tissue of extremities. Clinical presentation, duration of symptoms, anatomical location and foreign bodies retrieved after surgical explorations were recorded.RESULTS:X-ray could not detect any foreign body in all 23 patients. Ultrasound findings were suggestive of foreign body in 19 patients (male: female=2:1, mean age 31.68+/-11.8 years, range 12 - 54 years) which was confirmed after surgical exploration except in one where only foreign bodygranuloma was found. 4 (21%) were not aware of prick injury. Fifteen patients had attempted removal of foreign body themselves or at medical shop or local health post. Interval between injury / symptoms appearance to hospital ranged from 4-56 days. Foot and ankle was involved in 10 (52.6%), calf in 3 (15%), dorsum of hand in 2 (10.5%), palm in 2 (10.5%), shoulder in 1 (5.2%) and knee in 1 (5.2%) case. Foreign bodies retrieved were wood in 12 (63%), thorn in 4 (21%) and bamboo twig in 2 (10.5%) patients.CONCLUSION:Plain X-ray isn't sensitive for detection of non-radiopaque foreign body in soft tissue. Ultrasonography is sensitive and specific fordetection and localization of foreign body which should be included in evaluation for clinically suspicious retained non-radiopaque foreign body in softtissue of extremities.KEYWORDS:non-radiopaque foreign body; sensitivity; specificity; ultrasonography
A PROPOSAL OF ACTION PLAN FOR THE NEPAL MEDICAL ASSOCIATION (NMA) IN THE WAKE OF AIDS EPIDEMIC IN THE COUNTRY
Authors: Bhattarai Madhur Dev
Published: September 2018

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THE ROLE OF INCUBATION DURING SPERM PREPARATION FOR INTRAUTERINE INSEMINATION IN THE TREATMENT OF MALE FACTOR INFERTILITY
Authors: Devkota Uma N
Published: September 2018

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OSTEOPETROSIS
Authors: Tripathi R B , Teo T C , Richard B M
Published: September 2018

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SOFT TISSUE TUMOUR AND THE STEROID HORMONE RECEPTORS
Authors: Singh Yogendra
Published: September 2018

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JNMA Mystery
Authors: Zimmerman Mark
Published: September 2018

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Cellular immunity in urologic cancer patients.
Authors: Bhatta A D
Published: September 2018

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Repair of Inguinal Hernia of Childhood as an Outpatient Procedure
Authors: MATERN H R
Published: September 2018

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The Use of Auxlliaries in Performing Medical Surgical Procedures and Sorting Patients in the O.P.D
Authors: Harding 3rd J W.R.
Published: September 2018

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Auditor's Report
Authors: Author No
Published: September 2018

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A Detailed Report Of The Receipts & Payments of Xth All Nepal Medical Conference Submitted To Nepal Medical Association By The Organising Committee Of Tenth All Nepal Medical Conference.
Authors: Author No
Published: September 2018

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NMA Announcements
Authors: Author No
Published: September 2018

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Forthcoming Events
Authors: Author No
Published: September 2018

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Results Of Testing For HbsAg On Nepalese Blood Donors By Counter-Immuno-Electrophoresis
Authors: Sharma Basu Dev , Booth Kathleen , Booth P B , Kenrick K
Published: September 2018

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Family Planning And The Medical Professiona Plea (With Special Reference To India)
Authors: Bhatla Pushpa C
Published: September 2018

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Laparoscopic Management of Benign Ovarian Masses
Authors: Saha Rachana , Karki Chanda
Published: September 2018

Introduction: Laparoscopic surgery is one of the most common procedures performed for benign ovarian masses. The aim of the study was to analyze all benign ovarian masses treated laparoscopically to assess safety, feasibility and outcome.Methods: A prospective study was carried out at Kathmandu Medical College Teaching Hospital, Sinamangal, Nepal. All the patients undergoing laparoscopic surgery for benign ovarian masses from 1st January 2012 to 31st December 2012 were included in the study. The pre-operative findings, intra-operative findings, operative techniques and post-operative complications were analyzed.Results: Thirty-six patients were taken for the study. Two cases were excluded since intra-operatively they were tubo-ovarian masses. The most common tumor was dermoid cyst (n=13; 38.23%) and endometriotic cyst (n=14; 41.17%). Out of 34 cases, five cases of endometriotic cyst (14.70%) were converted to laparotomy due to severe adhesions and four cases of endometriotic cyst underwent deroofing surgery. Two cases underwent laparoscopic assisted vaginal hysterectomy with bilateral salphingo-oopherectomy. Successful cystectomies were carried out in 22 cases. None were malignant. Major complications were not noted while minor complications like port-site infection (n=3; 8.82%) and subcutaneous emphysema (n=1; 2.9%) were present.Conclusions: Laproscopic management of benign ovarian masses is safe and feasible.
Conflict of Interest - Serious Issue on Publication Ethics for Indian Medical Journals
Authors: Das Kusal K. , Vallabha Tejaswini , Ray Jaydeb , Murthy P.S.N.
Published: September 2018

Background: There are several vested interest lies on research publication hence the editorial policy is the sole important factor to control and regulate ethical publications in medical sciences especially on ‘conflict of interest’ issue.Aim: the study was aimed to assess on awareness of ‘conflict of interest’ issue in medical research and publication among the editorial staff, peer reviewers and authors of Indian medical journals.Methods: 61 authors who have published research articles recently in Indian medical journals (2008-2012), 56 peer reviewers who reviewed the manuscripts during same period and 35 editorial board members of various Indian medical journals were assessed by questionnaire and telephone interview regarding their understanding and knowledge on ‘conflict of interest’ issue for ethical publication.Results: Only 12% of the authors knew about the ‘conflict of interest’ issue and 19% of the medical authors have just heard about it! Out of 12% of authors who knew ‘conflict of interest’ issue only 5% provided that statement to the journals. Among the peer reviewers only 30% knew about ‘conflict of interest’ of which 91.5% stated that they do not bother about this issue while reviewing the manuscripts! But interestingly 75% of the peer reviewers confessed that they had a bias on the topics written by their friends or students! Among the editorial board members of Indian medical journals only 25% have any idea on ‘conflict of interest issue’.Conclusions: Results clearly shows poor understanding of ‘conflict of interest’ like important ethical issue among Indian medical scientists or journals.Keywords: authors; conflict of Interest; editorial members; peer reviewers; Indian Medical Journals.
CHEMOTHERAPY OF TUBERCULOSIS:TRIUMPH AND TRAGEDY
Authors: Bignall J R
Published: September 2018

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