bluuebunny/crossref_metadata_2025 huggingface dataset:
Complication of Canal Wall Down Mastoidectomy
Authors: Thapa Narmaya , Shrivastava R
Published: September 2018

This study reviewed 299 patients who underwent canal wall down mastoidectomy between April 1997 toApril 2000 in the Department of Ear, Nose & Throat (ENT), Tribhuvan University Teaching Hospital,Maharajgunj, Kathmandu. Sixty four patients had complications of chronic suppurative otitis mediaatticoantral type and five patients did not come for follow up. Out of remaining 230 patients, modifiedradical mastoidectomy was the commonest type of mastoid surgery which was done in 202 (87.83%)patients. Two hundred twenty four (96.39%) patients had a dry cavity. Nine (3.91%) patients developedwound infection, the commonest postoperative complication seen. Although 6 (2.61%) patients developedfacial nerve paresis/paralysis, 5 (2.18%) patients had total recovery of the facial nerve function and onlyone patient had persistent facial nerve palsy. Intracranial complications were seen in 3 (1.30% ) patientsand recurrence of disease in 2 (0.87%) patients. One patient died of septicemia. Proper aseptic precautionduring and after surgery and adequate knowledge of surgical landmarks is necessary to reducecomplications of surgery.
Experience of Brachytherapy in in Cacinoma of uterine Cervix at B.P. Koirala Memorial cancer Hospital, Bharatpur, Chitwan, Nepal
Authors: Prasiko Gisupnikha , Jha A K , Dong J B , Srivastava R P
Published: September 2018

Brachytherapy is primarily a treatment of a malignant disease with the use of radioactive isotope placednear or inside the target tissue. This technique plays an important role in the treatment of cancer of uterinecervix. This is a very new technique in Nepal and the department of radiation oncology of BPKMCH is theonly place practicing brachytherapy procedure. The aim of the study was to analyze the cases that haveundergone brachytherapy in the first year of initiation of this service. Total 232 patients, out of whom twohundred patients completed treatment. Total 657 applications were held during this period. Peak age groupwas in fifth decade followed by sixth decade. Good number of procedures was performed compared to otherinstitutes abroad.Key Words: Radiotherapy, Brachytherapy, Cervix.
Revascularization Procedures for Chronic Lower Limb Ischaemia in TU Teaching Hospital
Authors: Bhomi Krishna K , Timala R B , Shrestha U K , Koirala B , Sharma G P
Published: September 2018

A retrospective review of various revascularization procedures performed for the management of chroniclower limb ischaemia in Tribhuvan University Teaching Hospital (TUTH) during the last three and halfyears was done. A total of 37 revascularization procedures were done in 30 patients. Mean age of thepatients was 53.10+15.34 (range 20-88) years. Except 3, all the patients were male. Atherosclerosispredominated as the cause of arterial occlusion. Superficial femoral artery was the commonest site of occlusionfollowed by external iliac artery. Femoropopliteal bypass was the commonest procedure done (62 per cent).Vascular prosthesis was used only in 7 patients, rest were managed using autogenous saphenous vein tobypass the occluded segment. Endarterectomy (10 per cent) and thrombectomy (8 per cent) were otherprocedures done for revascularization. There was 91% immediate limb salvage rate. Late limb salvage ratewas 88% till the time of this writing.Key Words: Revascularization, chronic leg ischaemia, bypass, graft.
EVALUATION OF OUTCOMES OF ACUTE HAEMATOGENOUS OSTEOMYELITIS IN CHILDREN FOLLOWING SURGICAL DECOMPRESSION
Authors: Lamichhane Arjun P , Sharma C M , K.C. G , Shah L L
Published: September 2018

Outcomes of the surgical decompression in 21 patients of less than 15 years of age with acute haematogenousosteomyelitis attending Tribhuvan University Teaching Hospital during the period Oct. 1998 to Sept. 2000were evaluated prospectively. Average age of the patients was 9.8 years. (range 3-14 years.) Thirteen Patientswere male and 8 were female. Majority (71%) of the cases had involvement of the bones around the kneejoint. Pus culture was positive in (71.43%)of the cases. Among 21 cases who underwent surgicaldecompression, three patients were in inflammatory stage. Staphylococcus aureus was the causative organismin all culture positive cases and was sensitive to cephalexin in 86% and Cloxacillin in 100% of the cases. Xraychanges of chronic osteomyelitis developed in the 2nd week in most cases (70%). Overall rate of conversionto chronic osteomyelitis was 47.62%. Chronic osteomyelitis developed more in patients aged >10 years ofage (P=0.0015). Also chronic osteomyelitis developed more in patients who underwent surgical decompressionafter 10 days (P=0.0634). The study concluded that early surgical decompression prevents chronicity andprognosis is better in young children.Key Words: Acute haematogenous osteomyelitis, Children, Chronic osteomyelitis, Surgical decompression.
ATTITUDES AND BELIEFS REGARDING OROFACIAL CLEFT DEFORMITIES IN NEPAL
Authors: Schwarz Richard J , Khadka S B , Sleator R
Published: September 2018

The parents of 56 cleft lip and palate patients were interviewed to determine their attitudes and beliefs aswell as community attitudes towards cleft deformity. Acceptance of the child was high among the parents(89%) but low in the community (45%). Superstitious beliefs regarding the cause of the deformity werenoted in only 36% of parents. We conclude that parents of children with cleft deformity in western Nepalhave generally good attitudes towards cleft deformity and mostly reasonable beliefs regarding causes.Key Words: Cleft lip and palate, attitudes, beliefs, acceptance.
Abdominal Tuberculosis
Authors: Gautam Mani Prasad , Karki P , Rijal S
Published: September 2018

Tuberculosis is a common disease and its incidence is in rising tendency in developed world because of AIDSand transglobal migration. Abdominal tuberculosis is more common in immunocompromised populationand manifests as infection of peritoneum, hollow or solid abdominal organs and abdominal lymphatics withmycobacterium tuberculosis organism. The peritoneum and ileo-cecal region are the most likely sites ofinfection and are involved in the majority of cases by hematogenous spread or through swallowing of infectedsputum from primary pulmonary tuberculosis. Pulmonary tuberculosis is evident in less than half of patientseither in active or latent form. Abdominal tuberculosis has a protean manifestation although the mostcommon clinical feature is the triad of abdominal pain, fever and weight loss. The diagnosis is often delayedbecause of non-specific presentation and is usually made through a combination of radiologic, microbiologic,histopathologic, endoscopic and molecular techniques. None of them provide a gold standard by themselves.However, an algorithm of these diagnostic methods leads to considerably higher precision in the diagnosisof abdominal tuberculosis which primarily necessitates a clinical awareness of this serious health problem.Abdominal tuberculosis is a serious condition and if untreated outcome is fatal. Early diagnosis and immediateinitiation of treatment along with dietary support is crucial for better outcome. Antimicrobial treatment isthe same as for pulmonary tuberculosis and management often requires combination of antituberculardrugs and surgery – for diagnosis as well as therapy.Key Words: Tuberculosis; Abdominal Tuberculosis; Extrapulmonary Tuberculosis.
INCIDENCE OF CAESAREAN WOUND INFECTION IN PATAN HOSPITAL, NEPAL
Authors: Pandit Anil , Sharma P , Yangzom K
Published: September 2018

This study aims to find the incidence and outcome of caesarean wound infection in Patan Hospital, duringMarch 2002 to January 2003. We retrospectively analyzed records of patient who developed wound infectionfollowing caesarean section. Incidence of wound infection in Patan Hospital is comparatively low 2.76%.The minor wound infections (56.66%) required conservative management as an OPD basis while majorwound infections required resuturing. The wound infection is more commonly associated with color ofliqour, PROM and frequent number of vaginal examinations and emergency surgery.Key Words: Wound Infection, Caeserean Section, Nepal.
Curved knife "Khukuri" injury in the back and anaesthesia induction in lateral position for thoracotomy
Authors: Subedi A , Tripathi M , Pathak L , Bhattarai B , Koirala R
Published: September 2018

Penetrating injury in the back with knife (Khukri) demands induction of anaesthesia and intubation in lateral position. In thoracic injury a double lumen tube placement is required to facilitate one lung ventilation during thoracotomy. In emerging situation, we could successfully execute induction of patient in right lateral position using right sided DLT for left thoracotomy. Its correct placement was confirmed by fiberoptic bronchoscopy. In conclusion right-DLT intubation can be performed without difficulty by conventional direct laryngoscopy using Macintosh blade in lateral position.

Keywords: khukuri knife, lateral position, one lung ventilation, thoracic injury.
Lactational Performance of Manipuri Women
Authors: Luwang NC , Singh TA , Devi LI
Published: September 2018

A study was conducted to measure the volume of breast milk output of 26 lactating women and to estimatethe period of its adequacy as the sole food for the infants. Child-mother pairs were selected on voluntarybasis from amongst mothers who delivered in the Regional Institute of Medical Sciences Hospital, Imphal,Manipur (India). Daily volume of breast milk output was measured by test weighing method by weighingthe infants before and after each breast feeding in 24 hours period at different stages of lactation.Daily mean volume of milk output was in the range of 500-550 ml at the 1st month, 590-600 ml at 2-3months, 520-560 ml at 4 months, 450-500 ml at 5 months, 420 ml at 6 months and 340 ml at 7 months. Periodof adequacy of breast milk for the infant was judged by estimation of the proportion of energy the child isgetting from the mother in term of its energy requirement for its weight. About 60-95% of infants receivedless than 80% of energy demand from the mother at 1-3 months of age and 60-80% received less than 60%of energy requirement after completion of 4 months of age. The present study demonstrated that mother’sbreast milk is adequate as sole for the infants upto 4-5 months of age.Key Words: Breast milk output, test weighing, adequacy of breast milk, energy demand.
Kawasaki Disease - a Case Report
Authors: Shrestha S , Adhikari N
Published: September 2018

Kawasaki disease, first described by Tomisaku Kawasaki in1967, is an acute systemic vasculitis of infancy and childhood.It is now the leading cause of acquired heart disease indeveloped countries. The most common age group affected isbetween 6 months to 5 years and the peak incidence is inchildren aged 9 to 11 months. The disease has malepreponderance with the male female ratio of 1.5:1. Thoughthe exact etiology is not known the disease is known to beassociated with unusual degree of immune activation andimmunoregulatory abnormality.
SURGICAL TREATMENT OF CARCINOMA OESOPHAGUS AT B P KOIRALA MEMORIAL CANCER HOSPITAL, BHARATPUR
Authors: Lamichhane Nirmal , Tan Z B , Neupane P R , Thakur B K , Shrestha B M , Dhakal H P
Published: September 2018

To review resectability, lymph node status and post-operative complications in cases of carcinoma ofoesophagus treated surgically at B P Koirala memorial cancer hospital (BPKMCH), we reviewed the medicalrecords of 16 surgically treated cases of carcinoma oesophagus from January 2001 to March 2002. Therewere 5 patients in stage IIa and 9 patients in stage III. Tumor was resectable in 14 out of 16 patients (87.5%).There was no perioperative mortality. Anastomotic leak was seen in one case. Out of 14 resected specimens,7 (50%) of them had lymph node metastasis. Oesophagectomy is a safe procedure if done in a well-selected group of patients. Resectability is considerably high with minimal perioperative complications.Key Words: Carcinoma oesophagus, surgical therapy, lymphnode metastasis.
GOSSYPIBOMA - A CASE REPORT
Authors: Khanna Shail , Pokhrel H , Basnet N , Chuni N
Published: September 2018

Abstract
EPIDERMOID CYST OF THE SPLEEN: REPORT OF A CASE
Authors: Bhadani Punam Prasad , Sah S P , Afaque A
Published: September 2018

Splenic epidermoid cyst is a rare entity and represents about 10% of the non-parasitic benign cysts of thespleen. We report a rare case of epidermoid cyst in a 45-year-old female who presented with pain and leftupper abdominal mass. So far, such case has not been reported from Nepal.Key Words: Epidermoid cyst, spleen, late onset, mesothelial cyst.
CAN WE MANAGE NEONATAL INFECTION IN THE COMMUNITY ?
Authors: Manandhar D S , Costello A M , Osrin D
Published: September 2018

As infant mortality rates have fallen in many developing countries, the problem of neonatal mortality hasbecome more obvious. The biggest causes of mortality in the first month of life are infection, birth asphyxia,and low birth weight. Infection is implicated in about a third of neonatal deaths in Nepal. Communitybaseddata are limited, but neonatal sepsis is likely to be the result of infection by Gram positive bacteriasuch as Staphylococci and Streptococci, and enteric Gram negatives.The appropriate management for neonatal sepsis is parenteral, hospital-based treatment with a penicillinand an aminoglycoside. However, about 90% of births in Nepal take place at home, and many infants neverreach hospital. For these infants, the next best management strategy is to give parenteral antibiotics at aprimary care facility. Before referral, it would be appropriate to give a dose of oral antibiotic such ascotrimoxazole, which is already incorporated into the acute respiratory infection programme. If referralfor parenteral treatment is not successful, we propose that community-based cadres be allowed to give a fullcourse of oral antibiotic in cases of neonatal sepsis.Community health workers should receive training and pictorial guidelines for the recognition of dangersigns for neonatal sepsis, and we recommend pilot studies to compare and evaluate oral treatment in thecommunity. For Nepal, a national policy on the community management of neonatal infection is an extremelyurgent priority.Key Words: Neonatal infection, community management, antibiotic use.
HEALTH AND HOSPITAL DEVELOPMENT IN NEPAL: PAST AND PRESENT
Authors: Marasini Babu Ram
Published: September 2018

Abstract
THREE YEARS PROSPECTIVE STUDY OF NECROTIZING ENTEROCOLITIS
Authors: Jain Neeraj , Mangal V
Published: September 2018

Necrotizing Enterocolitis (NEC) is a major cause of mortality and morbidity in the newborn period. Toknow the incidence of NEC at our Neonatal Intensive Care Unit (NICU). Over a 3 year period (Prospectivestudy) ,510 cases were studied for NEC. Incidence was 5.3%, mortality due to NEC was 22%, Asphyxia,Prematurity and enteral feeding were the common risk factor. Abdominal distention, blood in stool and airin intestinal wall were the main clinical features. Prevention and high index of suspicion are important tolimit the morbidity and mortality.Key Words: Necrotizing enterocolitis, Low birth weight.
A STUDY OF CYSTOSCOPIC BIOPSIES IN KATHMANDU VALLEY
Authors: Rauniyar S K , Agrawal A , Shah A
Published: September 2018

Fifty cystoscopic biopsies submitted for histopathological evaluation in Nidaan Clinicof Kathmandu over a period of one year were analysed to ascertain the type of bladderdiseases in Kathmandu valley. Maximum number of cases were of chronic nonspecificinflammation of urinary bladder followed by transitional cell carcinoma, tubercularcystitis, dysplasia and leiomyoma. Majority of the cases were in the age group of31–60 years and majority were men.Key Words: Urinary Bladder, Cystoscopic biopsies, Urinary Bladder lesion, Kathmandu.
ELECTIVE EXPERIENCES OF FOREIGN MEDICAL STUDENTS AT THE TEACHING HOSPITAL OF TRIBHUVAN UNIVERSITY INSTITUTE OF MEDICINE, NEPAL
Authors: Pant D S , Shahi M
Published: September 2018

This paper has attempted to document and analyze the trend and experiences of foreignmedical students enrolled in the elective programme organized by the MedicalEducation Department (MED) at the Teaching Hospital of the Tribhuvan University(TUTH), Institute of Medicine in Kathmandu. Elective documents have been analyzedfor the period between 1997-2000 and a written questionnaire survey has beenadministered to a total of 73 foreign medical students who completed elective in theyear 2000. Over a period of four years a total of 268 students had undergone electiveposting in various departments of TUTH. More than half of the students (55%) camefrom European universities. More than 60% of respondents (n=73) considered theopportunity to see variety of patients as the main strength of the elective programme.Overwhelming majority of respondents (95%) rated the learning experience as goodor excellent. The most favoured department was the Internal Medicine. The studydemonstrates the unique value of elective in enriching student learning in medicaleducation. The traditional belief that all students should have a uniform curriculumthroughout their training has been largely challenged.1The insights gained couldperhaps, inspire medical schools to seriously think about introducing elective provisionas an essential component of their undergraduate curricula.1. Medical Education Department, TU Institute of Medicine.Address for correspondence : Dr. D. S. Pant, MD, MHPED,Assistant Director & Elective Programme Coordinator,Medical Education Department, TU Institute of Medicine,P.O. Box: 1524, Kathmandu, Nepal.Email: dspant@healthnet.org.np, Home Page: www.nchped.org.npKey Words: Elective terms, overseas elective, elective experience in developingcountries, core and elective options, undergraduate medical elective.
EVALUATION OF DRUG ADVERTISEMENTS IN A MEDICAL JOURNALThough ideally the scientific information provided by pharmaceutical companies in drug advertisements should be for promotion of rational use of drugs, this objective is rarely achieved, as often the d
Authors: Rehan Harmeet Singh , Nagarani M A , Rehan M
Published: September 2018

Though ideally the scientific information provided by pharmaceutical companies indrug advertisements should be for promotion of rational use of drugs, this objective israrely achieved, as often the data is incomplete and biased. Analytical studies withthe help of standard indicators on this aspect of drug advertisements are very fewfrom developing countries. We analyzed all medical drug advertisements in elevenconsecutive issues of Journal of Nepal Medical Association published between 1993and 1996 with a special emphasis on their conformity with WHO guidelines andInternational Federation of Pharmaceutical Manufacturers Association (IFPMA) codefor drug advertisement.The 78 advertisements in the Journal of Nepal Medical Association constituted 7.7%pages of the eleven issues. Of the 38 products advertised, 30 (79%) were manufacturedoutside Nepal. Antimicrobial agents were the most frequently advertised group ofdrugs (47.4%). While generic name was not mentioned in 16.7% of the advertisements,the information on indications, adverse effects and contra-indications was lacking in37%, 88.4% and 87.1% of the advertisements respectively. Only 11.5% ofadvertisements provided information on generic name, indications, dosage, adverseeffects and contra indications. However, none of the advertisement was "complete"on the basis of the indicators of WHO guidelines and IFPMA codes.Key Words: Medical drug advertisement, drug information, WHO guidelines, IFPMA code.
PESTICIDE POISONING CASES ATTENDING FIVE MAJOR HOSPITALS OF NEPAL
Authors: Gupta S K , Joshi M P
Published: September 2018

Although some hospital-based data are available, there are no large scale or nationwidedata available on the problem of pesticide poisoning in Nepal. This study wasdone to fill up this gap to some extent and was carried out at five major hospitals ofNepal - Bir Hospital, Patan Hospital and Tribhuvan University Teaching Hospital(TUTH) in Kathmandu, Western Regional Hospital (WRH) in Pokhara, and B. P.Koirala Institute of Health Sciences (BPKIHS) in Dharan. A harmonized PesticideExposure Record (PER), which was finalized during the "WHO Regional Workshopon Pesticide Poisoning Database in SEAR Countries" held in 1999 in Delhi,1 was usedin the study. Data collection was done for a period of six months in each of the fivehospitals.Altogether there were 256 patients in the present study. There were 98 patients fromBir hospital, 48 from Patan hospital, 45 from TUTH, 36 from BPKIHS, and 29 fromWRH. Of the 256 patients, 112 were males and 144 females. The most common agegroup involved in pesticide poisoning was 15-24 years. In most of the cases patient'sarrival to hospital was within three hours after pesticide exposure. In the majority ofcases the nature of exposure was intentional and the route of exposure oral. Mostpoisonings occurred in urban set-up and at home.Organophosphorous compounds were found to be the most common pesticides involved(in >50% cases), followed by zinc phosphide and aluminium phosphide. All caseswere given first aid treatment in the Emergency Room of the study hospitals, followingwhich most of the cases (n=197) were admitted; the rest were discharged or referredto other hospitals. Systemic effects of poisoning were recorded to have been present in95% of cases. For nearly two-third (65.6%) of the cases the poisoning severity scorewas recorded in the PER as "moderate" or "severe." More than 16% of patients hadfatal outcome.Improved regulation on availability of pesticides, strict registration of vendors,modification in packaging of pesticides, adequate provision of information to thepublic, further research on pesticide poisoning (including community-based studies),creation and regular revision of national/local standard treatment guidelines (STGs),regular training of health care providers based on such STGs, better availability ofdrugs/antidotes, establishment of poison information centers, and enhanced regionallinkages are some of the measures that will help reduce the problem of pesticidepoisoning in Nepal.Key Words: Pesticide poisoning, Organophosphates, Zinc phosphide, Aluminiumphosphide, Pesticide exposure record, Hospital, Nepal.
Impact of World Trade organization (WTO) Membership on Health Laboratory Services of Nepal
Authors: Shukla P K
Published: September 2018

With induction of Nepal into the World Trade Organization (WTO) members group of countries severalsectors shall have to be brought upto the internationally accepted standards. Since Health Services havealso been included in the ‘services’ to be covered, the same shall also need attention accordingly . One of thecrucial aspects of these is Laboratory services. The author with his experience in India on this aspectelaborates various’ angles of details and emphasizes need for action.Key Words: WTO, Laboratory Accreditation, External Quality Assurance.
Evaluation of Norpalnt in Nepalese Women
Authors: Bharati U , Shrivastava V
Published: September 2018

This was a prospective study done in Marie Stope clinic, Chabhill, Kathmandu. One hundredwomen who had Norplant insertion between May 1996 to April 1997 were followed upfor a year for its side effects. The age, ethnic group, number of living children, literacy,socioeconomic status of the women who has Norplant insertion were also analyzed. Norplantwas found to be most popular in age group of 21-30 years (68%). Maximum number ofacceptors were in Chetri community (32%). It was a popular contraceptive in women whohad two or more children and those who came from low socioeconomic group and wereilliterate. Among side effects, menstrual irregularity was commonest (67%) headachewas present in 12%, weight gain and depressive symptoms each was present in 10% ofwomen. 2% had local infection at insertion site and 1% of woman had allergic reaction.Key words: Norplant, Contraceptives, Side effects.
GASTRIC ADENOCARCINOMA AND HELICOBACTER PYLORI INFECTION
Authors: Adhikari Ram Chandra , Pokharel B M , Shrestha H G
Published: September 2018

Gastric adenocarcinoma is of major importance worldwide as a cause of death frommalignant disease. It is the commonest malignant tumor in T.U. Teaching Hospital.Helicobacter pylori infection is an important risk factor for the development of gastriccancer. This prospective study was carried out to correlate H. pylori infection withgastric adenocarcinoma. This study was done from January 1999 to January 2000;included 38 cases of gastric adenocarcinomas of which 28 (73.69%) cases were tubulartype; 6 (15.79%) cases were signet-ring cell type; 2 (5.26%) cases were papillary typeand 2 (5.26%) cases were mucinous type. Gastric adenocarcinomas were more commonin male (73.68%) and after the age of 50 years. Giemsa staining revealed H. pylori in30 cases (78.95%) of adenocarcinomas; whereas H. pylori seropositivity (IgG) wasfound in 29 (76.31%) cases. H. pylori were histologically detected in 88.3% cases ofresected specimens and in 71.4% cases of endoscopic gastric biopsies. Both histologicalmethod and serological test showed positivity for H. pylori in 65.78% cases. Thus, H.pylori infection is associated with gastric carcinognesisKey Words: Gastric adenocarcinoma, Helicobacter pylori, Giemsa stain.
Tuberculosis Treatment and Private Practitioners, Kathmandu Valley
Authors: Hurtig Anna K , Pande S B , Porter J D H , Bam D S
Published: September 2018

SETTING: An urban municipality of 150,000 citizensin Kathmandu valley where approximately650 TB patients annually start treatment in thepublic sector.OBJECTIVE: To determine the caseload of TBpatients, treatment practices used in the privatesector and professional characteristics of privatepractitioners involved in TB care.DESIGN: A self-administered questionnaire wasdistributed to private practitioners in the area.RESULTS: Forty-three (73%) of 59 private practitionersreturned the questionnaire, and form thebase for the analysis. Twenty-eight (65%) wereworking also in government clinics. Thirty-nine(93%) were treating tuberculosis patients. duringthe previous month, 68 suspected cases of pulmonarytuberculosis and 78 suspected extrapulmonarycases had been seen. A total of 97 patients werestarted on anti-TB treatment, 24 (25%) of thosemanaged by surgical specialists. Twenty (51%) ofthe doctors prescribed internationally or nationallyrecommended regimens (i.e. 2 EHRZ/4HR or2 EHRZ/6HE) to new pulmonary TB patients.Thirty-three (85%) reported referral of certain categoriesof TB patients to governmental or non-governmentalfacilities. Twenty-six (79%) referredtheir patients primarily to the National TuberculosisCentre. The main reason for referral mentionedby doctors (61%) was the patient’s inability to affordtreatment in the prevate sector.CONCLUSION: There quarters of the privatepractitioners used sputum smears for diagnosis, butonly about half prescribed appropriate treatmentregimens. Extrapulmonary TB cases form a substantialpart of the case-load and approximatelyone fourth of all TB patients are being treated bysurgical specialists. The cost of TB treatment inthe private sector is too high for many patients.Informal links are already evident between thepublic and private sector but collaborative effortsneed to be increased.
A Rare case of Carcinoid Tumour Presenting as an Acute Intestinal Obstruction with Cryptorchidism
Authors: Charles Neelam R , Christian L B , Harishchandra B , Basu A , Sharma P , Krishnanand G
Published: September 2018

A 40 year old man known to have cryptorchidism, presented with acute intestinal obstruction.At laparotomy stricture of the distal ileum, distended small intestine with enlarged multiplemesenteric and pelvic nodes were found. Right hemicolectomy was done and biopsies of mesentericand pelvic lymph nodes proved the tumour to be malignant carcinoid tumour withmetastasis to lymph nodes. Biopsy of the atrophied right testis showed presence of seminalvesicles.KEY WORDS: carcinoid tumour, obstruction, small intestine, cryptorchidism
SIGNIFICANCE OF COMPLEMENT PROFILE AND COMPLEMENT RECEPTOR 1 EXPRESSION IN RBC AND KIDNEY TISSUE IN IMMUNE COMPLEX MEDIATED DISEASE
Authors: Baral Nirmal , Lamsal M , Shrivastava L M
Published: September 2018

A study was conducted to evaluate role of complement proteins and complementreceptor 1 (CR1) in pathogenesis of Systemic lupus erythematosus (SLE) and Immunecomplex (IC) mediated glomerulonephritis. C3, C4, C3d and CH100 in serum, CR1 inrenal biopsies and RBC showed these parameters to be of great diagnostic andprognostic values in Immune complex mediated diseases. Our study revealed an overalldecrease in levels of CR1, C3, C4 in IC mediated as compared to non - IC mediateddisease. Whereas C3d in case of SLE 247 ± 39 AU/L including IC mediatedGlomerulonephritis (ICGN) 208 ± 51 AU/L was found to be significantly increased(P < 0.05) than normal control 46 ± 6 AU/L. There was no appreciable increase incase of non - 1C mediated GN (61 ± 12 AU/L) CRI among SLE patients (261 ± 141/E)and IC mediated group (270 ± 107/E) was found to be significantly lower (P < 0.05)than normal control (627 ± 132/E) and non - IC GN (550 ± 86/E). C4 values amongSLE, patients were found to be 191 ± 104 mg/L as compared to control (286 ±110 mg/L). The kidney biopsy of type III and type IV lupus nephritis revealed a completeabsence of CR1 in contrast to minimal change diseases. Thus this study revealed thatabove parameters could be a valuable tool for distinguishing IC versus non-IC mediatedkidney diseases.Key Words: Complement receptor 1 (CR1) Glomerulonephritis, SLE.
AN OVERVIEW OF INTEGRATED MEDICAL AND DENTAL UNDERGRADUATE PRE-CLINICAL CURRICULA AT B. P. KOIRALA INSTITUTE OF HEALTH SCIENCES, NEPAL: A MULTIPROFESSIONAL APPROACH
Authors: Nagarani M A , Bhattacharya S , Das B P , Koirala S
Published: September 2018

Curricular innovations such as multiprofessional education (MPE) sensitise healthprofessionals towards the role of other health professionals and inculcate team spirit.This is a preliminary report on MPE in practice in the preclinical phase of dental andmedical undergraduate courses at B.P. Koirala Institute of Health Sciences, Nepal.The preclinical curriculum of the undergraduate courseis integrated, organ systembased and partially problem based. There is an emphasis on early exposure of studentsto patients and to community. The undergraduate course in medicine started in 1994and in dental surgery in 1999 based on the core curriculum developed at variousworkshops. The course duration and structure is similar in bot
Prolonged survival in a Patient with Chronic Myeloid Leukemia
Authors: Shukla Ashutosh , Kalra O P
Published: September 2018

Patients with chronic myeloid leukemia treated with intermittent busulphan therapy havean average survival rate of 2 to 4 years. The authors report here a patient who continues tosurvive beyond one decade on busulphan therapy.
Retroperitoneal Duplication Cyst
Authors: Ray Dipankar , Pun P B , Harishchandra B , Krishnanand G
Published: September 2018

abstract
LARYNGOCELE - REPORT OF A CASE
Authors: Pradhan Bibhu , Amatya R CM , Bhusal C L , Singh D , Sharma B
Published: September 2018

Abstract
A CASE OF INTERDIGITAL DERMATOFIBROSARCOMA PROTUBERANS
Authors: Bandyopadhyay S K , Nair R V , Samdurkar A
Published: September 2018

A 61 year old male reported to the surgery OPD with a slow growing tumourbetween the third and the fourth fingers of the left hand. The tumour was excisedand on histopathological examination, the diagnosis was that ofdermatofibrosarcoma protuberans.Key Words: Dermatofibrosarcoma Protuberans, Interdigital, Hand.
PROFILE OF FIRST 100 IN-PATIENTS IN DE-ADDICTION WARD T.U. TEACHING HOSPITAL, NEPAL
Authors: Ojha Saroj Prasad , Pokharel A , Koirala N R , Sharma V D , Pradhan S N , Nepal M K , Timsina C L
Published: September 2018

ABSTRACTMen and women suffering from the problems of various psychoactive substance abuse were helped to comeout of the problem by the Department of Psychiatry and Mental Health since it’s establishment in 1986.Since the De-addiction ward started functioning under the Department of Psychiatry and Mental Health,T.U. Teaching Hospital (TUTH) from February, 2000 A.D., people suffering from various drugs relatedproblems have received in-patient care. This study describes the profile of first 100 psychoactive substanceabusers admitted in this ward. The first hundred patients were admitted in a period of 5 months and 2weeks, in an average of 18 patients per month. Eighty eight males, the average age being 33.3+10.98 years.Seventy were married. The average years of education was 8.56+4.94 years. Alcohol (n=58) was the commonestinitial substance, followed by cannabis (n=19) and cigarette (n=11). Currently 60 were predominantly alcoholusers and 36 predominantly opiate users. The majority were multiple substance users: 79 used alcohol, 37used opiates, 25 used cannabis and 18 used benzodiazepines. Age at first use was 19.57+5.54 years andduration of continuous use was 5.88+4.47 years. Eleven (8 males) were HIV ELISA reactive, all of whomwere parenteral opiate abusers. Thirty-nine (35 males) had fatty changes in liver and 6 (all males) hadcirrhotic changes in liver. Those 45 persons with liver abnormality were all alcohol users.Key Words: psychoactive substance, alcohol, opiates, HIV, liver changes.
COEXISTENCE OF TUBERCULOSIS AND ADENOCARCINOMA OF THE COLON
Authors: Singh Yogendra , Sayami G , Khakurel M
Published: September 2018

ABSTRACTA 60-years-old, male patient presented with a-tender swelling in the right iliac fossa with right hip flexiondeformity suggesting of psoas abscess. Following emergency drainage of faeculant pus, the general conditionof the patient improved. The barium enema showed leaking ascending colonic ulcer and colonoscopicexamination revealed nonspecific ulcerative lesion in the ascending colon. Repeat investigations were alsonon-conclusive except there was a stricture at the ascending colon on colonoscopy. A second operationshowed that there was a huge mass of terminal ileum, cecum and ascending colon and perforation of ascendingcolonic ulcer most likely carcinoma. Right hemicolectomy was performed with uneventful postoperativeperiod. Histopathological examination revealed well differentiated adenocarcinoma limited to the musclelayer of the ascending colon and features suggestive of colonic tuberculosis at the same site. Antituberculartreatment was completed with regular follow-up and monitoring on CEA level. Patient has been doing well3 years postoperatively. Although rare, the coexistence of colonic tuberculosis with carcinoma may occur. Adefinitive diagnosis can be established only by histological examination.Key Words: Colonic tuberculosis, Adenocarcinoma, Histology.
Analysis of Indicators used in the Annual Review Reports of DHS-Nepal
Authors: Suvedi B K
Published: September 2018

The indicators mentioned in the Annual Report of Department of Health Services of Nepal has beenreviewed and analyzed. The Annual Report mentions 74 indicators used by 12 different programs under theDepartment of Health Services. Out of 26 programs, Fourteen (54%) programs do not have any indicators.Of the total 74 indicators used by 12 programs, only 28 (38%) have been used in the annual report fordetailed description. Three categories of the indicators have been classified and their use in the report hasbeen analyzed. Questions are raised regarding the "silent" programs and the "silent" indicators for their usein monitoring of performance / trend analysis of various programs. Suggestions on the better use of theindicators has been made.Key Words: indicators, health, programs, Nepal, report.
CURRENT STA TUS OF RHEUMA TIC FEVER AND RHEUMA TIC HEART DISEASE IN NEPAL
Authors: Limbu Yuba Raj , Maskey A
Published: September 2018

Rheumatic fever (RF) and rheumatic heart disease (RHD) are common inunderdeveloped, deprived and depressed areas of the world. The progression of RHDis rapid in deprived communuties. Prevalence of RF and RHD has sharply declinedin affluent and developed countries, especially after the introduction of antibiotcs.RHD is a preventable disease. RHD is a leading cause of cardiovascular deaths indeveloping countries. The prevalence of RF and RHD varies from place to place. Indeveloping countries, young productive age groups are suffering from this diseasewhile in developed countries it is becoming geriatric disease due to the betterment ofliving standards and prompt awareness upon this disease. Studies and documentationof the current ststus of RF and RHD in Nepal is the present concern.1. Shahid Gangalal National Heart Centre.Address for correspondence : Dr. Yuba Raj Limbu, CardiologyShahid Gangalal National Heart CentreP.O.Box: 11360, Kathmandu, NepalEmail: yrlimbu@yahoo.comKey Words: Rheumatic fever, Rheumatic Heart Disease.
Pupils Need To Know More About Use of Medicines and self-care
Authors: Rehan Harmeet Singh
Published: September 2018

Abstract
BACTERIOLOGY AND TREA TMENT OF CHRONIC OTITIS MEDIA
Authors: Jha Anil Kumar
Published: September 2018

Tympanocentesis was performed in 30 patients with chronic Otitis media. Pus wascultured aerobically and anaerobically. Aerobes only were isolated from 26 patients,and 9 had anaerobes. The patients were divided into two groups according to theirantimicrobial only therapy: 20 received carbenicillin and 10 clindamycin. There wasexcellent to good response to therapy in 46.67% of the patients treated Carbencillinand in 36.67% treated clindamycin here was a relieved from symptoms for up to oneyear. There were statistical differences in response to therapy in the two groups treated.Antimicrobial therapy directed against aerobic and anaerobic isolates from chronicotitis media had a high success rate in complete eradication of the infection.Key Words: Bacteriology, Chronic Otitis Media, Treatment.
AN EFFORT T O REDUCE DISABILITYIN REMOTE DISTRICTS OF NEPAL, A PERSONALEXPERIENCE
Authors: KC Govinda
Published: September 2018

With the sole objective of preventing and reducing the incidence of disability in remotedistricts of Nepal resulting from lack of proper treatment due to lack of skill andknowledge in trauma and orthopaedic in the part of treating health workers, altogether,25 workshops were conducted in 18 remote districts to educate the doctors and healthworkers working in those districts. Till date 437 different level health workersunderwent basic training in this field. Workshops were conducted in district healthoffice, and health workers from health post and sub health posts were the participants.Slides, transparencies, handouts, lectures, demonstration, splints, Plaster of Paris (POP)etc had been the backbone of the teaching.Written pre and post workshop test were taken and evaluation on practical knowledgewere conducted at the end of each workshop. Time constraints, accessibility,communication and financial aspect had been the challenges for successful conductionof the workshop.Key Words: Remote Districts, Disability, Trauma, Health Workers.
DRUG PRESCRIBING PATTERN IN DERMATOLOGY IN A TEACHING HOSPITAL IN WESTERN NEPAL
Authors: Sarkar Chayna , Das B , Sripathi H
Published: September 2018

The aim was to monitor drug prescribing for patients attending the dermatologyservices (OPD) of Manipal Teaching Hospital (MTH). 292 prescriptions of patientsattending the dermatology OPD of MTH attached to MCOMS, Nepal were collectedby a random once weekly survey between July 2000 to June 2001. This informationwas analysed in consultation with clinical collaborators and critically evaluated usingWHO guidelines. The average number of drugs prescribed was 2.42 drugs/prescription.Only 13%(91 out of 708) of the drugs were prescribed in generic names. The mostcommonly prescribed topical drugs were topical steroids and their combinations (28%)followed by topical antifungal agents (12.5%). The most commonly prescribed systemicagents were antihistamines (47.6%) followed by antimicrobials (20%) and antifungalagents (12%). Frequency of administration and site of application were specified inthe majority of the prescriptions (82%) of topically administered drugs but dose/strength of topical preparations were specified in only 11 prescriptions. The durationwas not specified for 9 of the systemically prescribed drugs and 341 of all the topicaldrugs prescribed. In two patients, 2 medium or 2 high potency topical steroids wereprescribed together with systemic steroid administration. Patients who receivedsystemic antiiungal agents (34) also got a topical one simultaneously. In this study, agreat majority of the drugs were prescribed in brand names (87 %). Drugs should beprescribed in their generic names to * avoid confusion and to minimize the costs. Inthis study, on some occasions, prescriptions may have been written imprecisely/inappropriately.Key Words: Prescribing pattern, Dermatology, Nepal.
Prevalence of Viral Hepatitis B in BPKIHS, Dharan, Nepal
Authors: Bhatta Chandra Prakash
Published: September 2018

Aim of the present study is to assess prevalence of viral hepatitis B in patients attending B. P. KoiralaInstitute of Health Science Dharan, Nepal. During a period of six months (Feb 1998 to July 1998) total 300patients' sera were tested for hepatitis B surface antigen (HbsAg), of which 15 (5%) were found to bepositive. The prevalence was higher (3.6%) in males than females (1.4%). The average age of males andfemales was 32 and 31 years respectively.
Estimation of Fetal Birth Weight Using Ultra Sonographic Parameters
Authors: Dawaka Kaveeta , Das G C
Published: September 2018

One hundred antenatal patients were studied at term pregnancy at Gauhati Medical College, Guwahati, andfetal birth weight estimation was done in utero Ultrasono-graphically. The parameters measured wereAbdominal Circumference (AC), Biparietal diameter (BPD) and Femur Length (FL), Fetal weightprediction was done with Shepards formula using AC and BPD as well as Hadlocks formula using FL andAC. The scan delivery interval was maintained at 72 hours or less. Results of both formulae were comparedwith the actual fetal birthweight taken within 15 minutes of delivery. With Shepards formula, the predictedfetal weight was within 100 gm of the actual fetal weight in 71% cases, within 150gm in 86% cases, within200 gms in 93% cases and within 250 gms in 98%. With Hadlocks formula, the predicted birthweight waswithin 100 gms of the actual fetal weight in 72% cases, within 150 gms in 83%, within 200 gms in 92%cases and within 300 gms in 98%. The mean percent error calculated as Error % = Predicted weight - actualweight divided by actual weight x 100 was 2.9% with Shepards formula and 3% with Hadlocks. These datathus support a significant correlation between ultrasonographic estimation and actual fetal birth weight.Key Words: Fetal birth weight, AC, BPD, FL
PRELIMINARY REPORT ON THE TREND OF BLOOD GROUP DISTRIBUTION AMONG NEPALESE AND INDIAN MEDICAL STUDENTS
Authors: Pramanik Tapas , Saikia T C , Bandyopadhyya M
Published: September 2018

Blood group distribution ofABO and Rh factor were studied among 322 Nepalese(male - 178; female - 144) and 100 Indians (male - 72; female - 28;) in a group ofmedical students.The percentage of different groups A, B, AB and 0 in Nepalese showed relativelymore in A & AB and less in 0 groups than Indians. The Rh (-)ve was more amongIndians (9%) than Nepalese (1.5%).This difference is likely to be due to difference of ethnic origin of Indian & Nepalese.The population of Nepal is a mixture ofTibeto-Burman, Australoid and Indo-Aryanraces.Key Words: A, B, O, Rh blood group.
Retroperitoneal Hamartoma: A Rare Entity
Authors: Sigdel G , Karki K , Koirala U , Joshi BD , Dhital SP
Published: September 2018

Retroperitoneal hamartoma in adult is an extremely rare entity. Here we report a case of 23-years-old lady who presented with alarge retroperitoneal mass and abdominal pain. The mass was surgically removed and the diagnosis of hamartoma was made on histological findings.

Keywords: hamartoma malformative tumor, retroperitoneal.
MYXOMA OF ORAL SOFT TISSUE
Authors: Ramaraj P N , Sah Shatrughan Prasad
Published: September 2018

The intraoral soft tissue myxoma or the peripheral myxoma is an extremely rare,slowly growing, benign mesenchymal tumor. Pathologically, it may be difficult todifferentiate from other tumors with myxoid stroma and is occasionally misinterpretedas malignant. We report a case of unusually massive peripheral myxoma of left alveolarridge in a 35-year-old lady.Key Words: Myxoma, peripheral, alveolar ridge.
AN APPROACH TO A CHILD (1 WEEK TO 36 MONTHS) WITH FEVER
Authors: Sharma Pushpa Raj
Published: September 2018

Nearly seventy percent of all children between the ages of one week and two-years-ofageare brought to Kanti Children’s Hospital for some type of febrile episode. And50% of these visits are for temperatures greater than or equal to 39 degrees celsius.These children may have significant bacterial infection. In 35% of these childrenthere’s no definable source for the fever on clinical examination. So the child thatdon’t have identifiable sources could be either bacteremic, meningitis or could have abone or joint infection in evolution. Simple clinical observation to differentiate a welllooking infant from a toxic infant helps to differentiate children who needs admissonor out patient follow-up.Key Words: Fever, young infant, antibiotics, management.
Chondroblastoma of the Maxilla
Authors: Geetha T V , Gupta Amlan , Agrawal R , Krishnanand B R
Published: September 2018

A 27 year old female presented with swelling in the left cheek involving the maxilla, of seven monthsduration. Histopathological examination showed a lobulated tumour composed of large polygonal cellswith distinct "chicken-wire" type of calcification around individual tumour cells. A diagnosis ofchondroblastoma was made.Key Words: Bone tumour, Chondroblastoma, Maxilla.
MICROORGANISMS IN CHRONIC OTITIS MEDIA WITH EFFUSION
Authors: Jha Anil Kumar , Singh J B , Raut S P
Published: September 2018

A total of 100 patient with otitis media effusion obtained from patients suffering fromchronic otitis media with effusions was examined for bacterial smear and culture. Inmucoid effusion 82% showed positive bacterial smear, only 35% yielded positivebacterial culture. Bacterial cultures rate was higher in serous (50%) effusion. Theisolation of common pathogens accounted for the remaining 42%. The high incidenceof microorganisms in the middle ear effusions in the present study indicates bacterialcontribution in many cases of otitis media effusion. Concerning the sterile nature ofthe middle ear fluid some investigators suggested that the effusions are transudatesand are created by a negative pressure in the tympanum due to a malfunctioningEustachian tube.2It was suggested that failure to isolate organisms may be partly dueto the antimicrobial characteristics of effusions. The purpose of this study is to showpossible role of bacteria in Middle Ear Effusions.Key Words: Otitis Media, Effusion, Microorganisms.
Plasma Cell Gingivitis: A Case Report
Authors: Lamdari N , Pradhan S
Published: September 2018

Plasma cell gingivitis is a rare benign condition of the gingiva of unknown etiology characterized by sharply demarcated erythematous and edematous gingiva often extending to the mucogingival junction. This is sometimes considered as a hypersensitive reaction. It presents clinically as a diffuse, erythematous and papillary lesion of the gingiva, which frequently bleeds with minimal trauma. The histological appearance consists of a dense infiltration of normal plasma cells separated by collagenous stroma, usually confined to free and attached gingiva. The lesion can be eliminated by identifying and avoiding the source of the allergen along with nonsurgical periodontal therapy. We report a 29-years-old female patient diagnosed clinically as plasma cell gingivitis and confirmed histologically. The patient gave history of herbal dentifrice for a period of one year. Nonsurgical periodontal therapies along with discontinuation of herbal dentifrice lead to remission of the condition within a month.

Keywords: Herbal dentifrices, non-surgical periodontal therapy, plasma cell gingivitis