bluuebunny/crossref_metadata_2025 huggingface dataset:
The Man Behind the Royal Massacre
Authors: Sherchan Surendra , Joshi Devavrat
Published: September 2018

Delusional disorder is a relatively uncommon psychiatric condition in which patients present with non-bizarre delusions, but with no accompanying prominent perceptual disturbances, thought disorder or significant and sustained mood symptoms. Apart from their delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not generally seem odd or bizarre to others for many years of the onset of their symptoms. Because of this, they are brought to the clinician many years after the onset of their symptoms, only when their delusional behavior becomes overt. Thus, identifying and treating delusional disorders in time is a challenging task.

Keywords: delusion; grandiose; persistent delusional disorder.
Management of Acute Lower Gastrointestinal Bleeding: Principles and Current Practice in the United Kingdom
Authors: Robins James , Shrestha Anne , Hampton James , Shrestha Badri Man
Published: September 2018

Acute lower gastrointestinal bleeding is a common cause for hospital admission that results in significant morbidity and mortality. The major objectives of all involved in the management of ALGBI patients are to reduce mortality and the need for major surgery. A secondary objective is to prevent unnecessary hospital admission for patients presenting with bleeding that is not lifethreatening. The management of ALGBI has evolved over last decade with the changing modalities of diagnostic facilities. On review of the published literature, there is paucity of randomised control trials in relation to the diagnostic tools and management of ALGBI. The aim of this review is to summarise the principles and current methods available for the diagnosis and treatment of ALGIBand based on the available evidence and the current practice in the United Kingdom, outline an algorithm for the management of ALGIB. 

Keywords: Lower gastrointestinal bleeding; aetiology; prognosis; management algorithm.
Smoking and Thromboangitis Obliterans– Are they related
Authors: Sapkota Prakash , Budhathoky Prakash , Mathew Stanley
Published: September 2018

Introduction: In 1908 Leo Buerger first gave the world the clinical picture of this dreadful disease which he called Thromboangitis Obliterans. Virtually all investigators believe that smoking or tobacco use in some form is a requirement for the diagnosis of Thromboangitis Obliterans. We studied the demographic profile and smoking pattern of patients with Thromboangiitis Obliterans.

Methods: Retrospective study carried out in a tertiary level hospital of South India from 1st January 1997 to 31st December 2003. Patients fulfilling Shionoya’s criteria form the study group. Incidence of Thromboangitis Obliterans, relation to smoking habits, type and nature of manifestation were analyzed.

Results: A total of 105 cases were studied and found to have declining pattern of incidence from 0.9%-0.3%. All patients were males, smokers at the time admission and 76% out of them were from low socioeconomic background. Patients smoking 5-15 cigarettes per day, for 5-10 years duration constituted 45% of the study group. The most frequent reasons for being referred to hospital were ischemic ulcers (83.80%), claudication (78.0%) and rest pain (26.66%).  

Conclusions: In those who present early with the disease the number of cigarettes and duration of smoking shows no direct correlation to the severity. Most patients continue to smoke inspite of counseling and awareness that the disease progresses due to smoking. Ulcer, intermittent claudication and rest pain are the three common presenting symptoms of Thromboangitis Obliterans. 

Keywords: smoking; thromboangitis obliterans.
Fetal Craniotomy
Authors: Shrestha Bikash , Gupta Sandip , Chawnghlut Lomi , Khaniya Bipindra
Published: September 2018

Nowadays, even in developing countries Cesarean section is the most common method of delivery for the breech presentation. However, in rural parts of the countries still vaginal route is the only option. Trauma to the after coming head is the common issue among the contributors of birth trauma during breech delivery. Entrapment of after coming head is an unpredictable obstetrical emergency. If the fetus is alive, options from application of obstetric forceps to giving Dührssen incisions can be kept in choice. Cesarean section is done when all the methods fail to deliver the head. But, when the fetus is not salvageable, delivery of after coming head by craniotomy can reduce unnecessary morbidity of Cesarean section. In the present report, a case with entrapment of after coming head of dead preterm fetus for 6 hrs of home delivery was described and the management of this condition was reviewed. 

Keywords: after coming head; breech; craniotomy; obstetrical emergency.
Developing an Index to Measure Health System Performance: Measurement for Districts of Nepal
Authors: Kandel Nirmal , Fric Anton , Lamichhane Jaya
Published: September 2018

Various frameworks for measuring health system performance have been proposed and discussed. The scope of using performance indicators are broad, ranging from examining national health system to individual patients at various levels of health system. Development of innovative and easy index is essential to measure multidimensionality of health systems.  

We used indicators, which also serve as proxy to the set of activities, whose primary goal is to maintain and improve health. We used eleven indicators of MDGs, which represent all dimensions of health to develop index. These indicators are computed with similar methodology that of human development index. We used published data of Nepal for computation of the index for districts of Nepal as an illustration. To validate our finding, we compared the indices of these districts with other development indices of Nepal.

An index for each district has been computed from eleven indicators. Then indices are compared with that of human development index, socio-economic and infrastructure development indices and findings has shown the similarity on distribution of districts. Categories of low and high performing districts on health system performance are also having low and high human development, socioeconomic, and infrastructure indices respectively.

This methodology of computing index from various indicators could assist policy makers and program managers to prioritize activities based on their performance. Validation of the findings with that of other development indicators show that this can be one of the tools, which can assist on assessing health system performance for policy makers, program managers and others. 

Keywords: health system performance; health system performance index; human development index; socioeconomicindex; infrastructure index.
Strengthening Free Healthcare in Rural Nepal
Authors: Basnet Bibhusan , Gauchan Bikash , Shrestha Rishav , Baruwal Ashma , Karcles Gregory , Silver Zach
Published: September 2018

Nepal, a mountainous country in South East Asia, still lags in increasing access to healthcare and reducing health inequity. Possible Non Government Organization based in Achham, Nepal, which is a sister organization of Possible International Non Government Organization based in New York, USA recognized the increasing health needs in the far western rural hilly parts of Nepal, where extreme poverty and illiteracy was creating a vulnerable picture especially in Achham. Possible (previously named Nyaya Health) started to operate Bayalpata Hospital in 2009 after completing more than one year of free health services in Sanfe-Bagar, Achham, in partnership with the Nepalese Ministry of Health and Population. It supports the idea that free health service has its own challenges but a public-private partnership can thrive while promote equity in health services.

Keywords: achham; free health care; nepal; nyaya health; possible.
Adverse Events in Children Receiving General Anaesthesia with Laryngeal Mask Airway Insertion
Authors: Khatiwada Sindhu , Bhattarai Balkrishna , Pokharel Krishna , Subedi Asish
Published: September 2018

Introduction: Perioperative adverse events are more common in children compared to adult population. Reporting an adverse event proves effective in identifying problems and helps in prevention and early management. Our objective was to identify the types, incidence, and the time of occurrence of perioperative adverse event. We also aimed to find out whether the occurrence of the types of adverse events differs in children below and above five years.

Methods: This was a prospective study in 242, ASA Physical Status I and II children aged day one to 14 years, receiving general anesthesia with laryngeal mask airway for various elective surgeries. Adverse events observed in the perioperative period were recorded.

Results: Adverse events related to respiratory system (n=26, 55%) were the most common followed by cardiovascular system (n= 14, 30%). Adverse events were observed in 24(10%) children in the operating room and in 20 (8%) children in the post anaesthesia care unit. In the operating room, majority (14 of 27, 52%) of the events occurred immediately after removal of laryngeal mask airway. Respiratory events were more common in children below five years (p=0.007), whereas cardiac events were more common in children above five years (p=0.02).

Conclusions: The commonest adverse event in children is related to respiratory system. Adverse events occur more frequently in the operating room, mostly immediately after removal of laryngeal mask airway. Respiratory events are more frequent in children below five years whereas cardiac events are more frequent in children above five years. 

Keywords: adverse events; children; laryngeal mask airway; laryngospasm; perioperative.
Targeted Therapy for Renal Cell Carcinoma: a Prospective study
Authors: Joshi Robin , Rawal Sudhir
Published: September 2018

Introduction: Our study aims to evaluate the use of targeted therapy in metastatic renal cell carcinoma.

Methods: This is a prospective study done over three years from December 2010 to December, 2013. Out of Forty seven patients of metastatic renal cell carcinoma 8(neo-adjuvant cases) were excluded and 39 were included in this study. All patients received Tyrosine kinase inhibitor, sunitinib therapy (50 mg OD, 4/2 scheme). All 39 patients underwent radical nephrectomy prior to sunitinib therapy. Patients were followed up every cycle for their clinical symptoms following sunitinib therapy and every 3 months with chest X-ray, ultra-sonography and bone scan. CT scan was done if needed. A RECIST criterion was used to evaluate the complete, partial and no tumor response.

Results: The median survival was 28.5 months (CI 9.253-47.7) and progression free survival (PFS) was 9.16 months(CI 6.08-12.23).According to RECIST, stable disease was found in 6 patients till date and a complete response in two patients. Clear cell histology was found in 30(76.9%) patients, papillary variety in 6(15.39%) patients, chromophobe type was seen in one patient and rest had mixed sarcomatoid papillary and rhabdoid clear cell variety. Twenty four patients (61.5%) had multiple metastases. Most frequent metastasis was seen in lungs in 14 patients (36%) and bone in 12 patients (31%).Metastases were also seen in draining lymph nodes, adrenals, omentum,skin, liver, and brain.

Conclusions: In our cohort, use of sunitinib showed similar outcome to previously published articles. Our study supports the use of sunitinib in metastatic renal cell carcinoma. 

Keywords: metastatic renal cell carcinoma; sunitinib; tyrosine kinase inhibitor.
Phenotypic Characterization of Multidrug-resistant Escherichia Coli with Special Reference to Extended-spectrum-beta-lactamases and Metallo-beta-lactamases in a Tertiary Care Center
Authors: Shrestha Basudha , Shrestha Shovita , Mishra Shyam Kumar , Kattel Hari Prasad , Tada Tatsuya , Ohara Hiroshi , Kirikae Teruo , Rijal Basista Prasad , Sherchand Jeevan Bahadur , Pokhrel Bharat Mani
Published: September 2018

Introduction: The increasing reports on extended-spectrum-beta-lactamase and metallo-betalactamase producing Escherichia coli have addressed a potential threat to global health since it is found to be highly resistance to most of the currently available antibiotics including carbapenems. The present study was aimed to determine the antibiogram of extended-spectrum-beta-lactamase and metallo-beta-lactamase producing MDR E. coli isolates from various clinical samples.

Methods: This was a cross-sectional study conducted over a period of seven months (December 2013 to July 2014) at bacteriology laboratory of Tribhuvan University Teaching Hospital. A total of 250 clinical specimens (urine, pus, sputum, blood, body fluid, bile, tissue and central venous pressure line tip) were processed from inpatients, with multidrug-resistant Escherichia coli infections. Standard microbiological techniques were used for isolation and identification of the isolates. The presence of extended-spectrum-beta-lactamase was detected by phenotypic confirmatory test recommended by Clinical and Laboratory Standards Institute and imipenem (IMP) /EDTA combined disc method was performed to detect metallo-beta-lactamase mediated resistance mechanism.

Results: We found high level of beta lactamase mediated resistance mechanism as part of multidrug resistance. Among 250 MDR isolates, 60% isolates were extended-spectrum-beta-lactamase producers and 17.2% isolates were metallo-beta-lactamase producers. Co-existence of extended-spectrum-betalactamase and metallo-beta-lactamase identified in 6.8% isolates.

Conclusions: Beta-lactamase mediated resistance mechanisms are accounting very high in the multidrug resistant isolates of E. coli. Therefore, early detection of beta lactamase mediated resistant strains and their current antibiotic susceptibility pattern is necessary to avoid treatment failure and prevent the spread of MDR. 

Keywords: e. coli; extended-spectrum-β-lactamase; metallo-β-lactamase; multidrug-resistance.
Markers of Autolysis in Acute ST Elevation Myocardial Infarction – A Comparative Analysis
Authors: Maharjan Prabindra , Manandhar Reezu , Xu Wei , Ma Shuting , Han Wenqi , Liu Yan , Zhou Yuan , Wu Yue , Sun Caofeng , Yuan Zuyi
Published: September 2018

Introduction: The availability of reliable noninvasive markers for infarct-related artery patency status are very limited, otherwise could allow early identification of patients with patent IRA, for whom repeat thrombolysis or rescue percutaneous coronary intervention are not necessary.

Methods: We conducted a single centered retrospective study of STEMI patients undergoing primary PCI to determine how various factors such as demographic characteristics, risk markers of coronary heart disease, clinical and blood parameters present differently in patients with higher coronary flow and patent infarct related artery from patients with total occlusion at the time of initial angiography and how they affect in outcome of the disease.

Results: MPV level (11.96 fL vs. 10.92 fL, P < 0.001), Lp (a) level (179.57 nmol/l vs 141.16 nmol/l , p < 0.001), CK-MB (290.2 vs. 190.98, P < 0.001), total cholesterol level (4.11 mmol/L vs. 3.8 mmol/L, p < 0.02) in total occlusion group were higher than in the patent IRA group. Wall motion abnormality was 77.2% for 203 patients with total occlusion group and 54.2% for 83 patients with patent IRA group (P<0.01). Mean hospital stay days were higher in total occlusion group as compared to the patent IRA group P < 0.01.

Conclusions: MVP, Lp (a), TC, and CK-MB levels and myocardial wall motion at the presentation may play the role of markers for IRA patency status that will help in early identification of patients with IRA, for whom repeat thrombolysis or rescue PCI may not be required. 

Keywords: acute coronary syndrome; infarct related artery; myocardial infarction.
Delayed Presentation of Catheter-related Subclavian Artery Pseudoaneurysm
Authors: M Kim , Kang ES , Kim HW , Kim Y , Kang MH , Chang YJ , Choe KH , Lee KM , An JY
Published: September 2018

Central venous catheterization is a common diagnostic and therapeutic procedure in modern clinical practice. Pseudoaneurysms of the subclavian artery are rare and usually occur immediately after the causative event, whether the cause was trauma or a medical procedure. Here, we report a case of a 71-year-old woman with delayed presentation of catheter-related subclavian pseudoaneurysm. The patient’s symptoms began two weeks after the initial catheterization, probably because of slow leakage of blood from the injured subclavian artery caused by incomplete compression of the puncture site and uremic coagulopathy. She was successfully treated with ultrasound-guided thrombin and angiography-guided histoacryl injection without stent insertion or surgery.

Keywords: butyl 2-cyanacrylate; pseudoaneurysm; subclavian; thrombin.
Rhabdomyolysis Due to Severe Hypophosphatemia in Diabetic Ketoacidosis
Authors: Shah Satish Kumar , Shah Lokraj , Bhattarai Suraj , Giri Megha
Published: September 2018

Rhabdomyolysis(RM) is a syndrome characterized by injury to skeletal muscle fibers with disruption and release of toxic metabolites into circulation. It is characterized by triad of muscle weakness, myalgia and dark urine and is associated with increased creatine kinase (CK) and lactate dehydrogenase (LDH). A severely malnourished 10 year old girl with severe diabetic ketoacidosis (DKA) as hemr initial presentation of type 1 diabetes mellitus developed rhabdomyolysis (CK- 12,000 U/L) with nonoliguric renal failure during her initial course of hospital stay. The possible cause of her RM was attributed to severe hypophosphatemia (minimum serum phosphate, 0.8 mg/dL). Management of DKA, phosphate supplementation and urinary alkalinization with diuresis improved her clinical course. She was discharged on Day 9 with Insulin. We recommend frequent monitoring of serum phosphate during early period of DKA, particularly in malnourished children, and its normalization in case of severe hypophosphatemia. 

Keywords: diabetic ketoacidosis; hypophosphatemia; malnutrition; renal failure; rhabdomyolysis.
Face-to-face Training as an Effective Approach for Instructing Rotahaler Technique in Newly Diagnosed Cases of Asthma and COPD: a Pilot Study
Authors: Poudel Ramesh Sharma , Shrestha Shakti , Piryani Rano Mal , Prajapati Aastha , Khatiwada Dipendra
Published: September 2018

Introduction: This study aimed to evaluate the effectiveness of face-to-face training for instructing rotahaler technique in newly diagnosed cases of asthma and chronic obstructive pulmonary disease.

Methods: A hospital-based study was conducted on twenty patients who were prescribed rotahaler for the first time. Patients received face-to-face training on rotahaler technique from pharmacist using GINA guidelines. The patients rotahaler technique was assessed after two weeks of training and scored one for correct and zero for incorrect steps. Descriptive statistics was performed.

Results: The mean age of the study population was 48.85±20.49 years. Eleven (55%) patients were females and 13 (65%) were formally uneducated. Fourteen patients (70%) were able to perform all the steps correctly giving overall median score of 8 (7-8).

Conclusions: Face-to-face training seems to be effective approach for instructing rotahaler technique in asthma and COPD patients. 

Keywords: asthma; COPD; face-to-face training; inhaler technique; pharmacist.
Intradialytic Muscle Cramp and its Association with Peripheral Arterial Disease in End Stage Renal Disease Patients on Hemodialysis
Authors: Ghimire Madhav , Sharma Sanjib Kumar , Chimoriya Romila , Das Gopal Chandra
Published: September 2018

Introduction: Muscle cramp is a common intradialytic complication observed in hemodialysis patients. Similarly Peripheral arterial disease is a common condition in the hemodialysis population. No study on intradialytic muscle cramp and its association with Peripheral arterial disease is yet reported from Nepal.

Methods: Fifty patients with a diagnosis of End Stage Renal Disease who were on hemodialysis were studied over a period of one year. Muscle cramp was defined clinically as contractions of a large muscle group and Peripheral arterial disease was diagnosed on the basis of the ankle –brachial index. Chi square (X2) test was used to determine the association between Intradialytic Muscle cramps and Peripheral Arterial Disease.

Results: A total of 50 End Stage Renal Disease patients were analyzed. The mean age of the patient was 49.81±12.63 years. The major causes of End Stage Renal Disease in the study population was Chronic Glomerulonephritis 40 % (n=20). Muscle cramps were present in 26% (n=13) cases. Peripheral arterial disease was present in 30% (n=15) of patients. However there was no statistically significant association between the presence of Intradialytic Muscle cramps and peripheral arterial disease (p value =0.18)

Conclusions: Intradialytic Muscle cramps and peripheral arterial disease were common occurrence in end stage renal disease patients on hemodialysis patients, however there was no association between the presence of intradialytic Muscle cramps and peripheral arterial disease. 

Keywords: end stage renal disease; intradialytic muscle cramps; peripheral arterial disease.
Growing Resistance to Vancomycin among Methicillin Resistant Staphylococcus Aureus Isolates from Different Clinical Samples
Authors: Pahadi Prakash Chandra , Shrestha Upendra Thapa , Adhikari Nabaraj , Shah Pradeep Kumar , Amatya Ritu
Published: September 2018

Introduction: Methicillin resistant Staphylococcus aureus (MRSA), majorly associated with nosocomial and community infections worldwide, are emerging as resistant strains to many antibiotics narrowing down the efficacy of antimicrobial therapy. In order to investigate the changing resistant pattern of MRSA to empirical drugs, the study was carried out at KIST Medical College and Hospital, Nepal. It also aims to determine the minimum inhibitory concentration of vancomycin among MRSA.

Methods: Altogether 3500 clinical samples including 1303 blood, 1489 urine and 708 body fluids were collected and processed. Isolated S. aureus were further screened for methicillin resistance by Kirby-Bauer disk diffusion technique using cefoxitin (30μg) disk. All MRSA were subjected to in vitro determination of MIC of vancomycin by agar dilution method as recommended by CLSI guidelines.

Results: Total 287 S. aureus were isolated from the different clinical samples. Altogether 248 (86.41%) were found to be multidrug resistance (MDR) while 42 (14.63%) of the isolates were methicillin resistance with the highest prevalence in the age group of 16-30. All 42 (100%) MRSA isolates were resistant to ampicillin and penicillin followed by 41 (97.62%), 32 (76.19%), 31(73.81%), 29 (69.05%), 9 (21.43%) and seven (16.67%) to cefotaxime, gentamycin, cotrimoxazole, erythromycin, tetracycline and ciprofloxacin respectively. Although all MRSA strains were sensitive to vancomycin on disc diffusion, four isolates were intermediates in vitro determination of MIC of vancomycin. The break point for vancomycin was found to be 15mm.

Conclusions: The increment in vancomycin MIC among MRSA is alarming. Strict control measures to prevent MRSA spread and a routine surveillance for VRSA must be incorporated in hospitals. 

Keywords: mdr; mrsa; mic; visa; vrsa.
Diversity of Hepatitis B genotypes in Nepal and updated Phylogenetic Tree: a Pilot Survey in 2012
Authors: Paudel Damodar , Aung Myo Nein , Sa-nguanmo Pattaratida , Suvedi Sushma , Patel Anuj , Sharma Dipendra , Poovorawan Yong
Published: September 2018

Introduction: Hepatitis B virus is a current global health problem. HBV genotypes influence the treatment and long term outcome of HBV infected patients. Moreover, HBV genotypes differ in various region of the world. Such data was reported haphazardly but yet to be comprehensive for Nepal. This study attempted to find out the diverse hepatitis B genotypes in Nepal.

Methods: A convenient serum sample of 58 HBsAg positive patients from different parts of the country mainly from Nepalgunj, Palpa and Kathmandu were screened for hepatitis B genotype. Sequencing was done and Phylogenetic tree was created.

Results: Among 58 samples, 23 were genotype D, 17were genotype A and B wereC/D recombinant. Phylogenetic trees were created by distance-matrix and neighbor-joining analyses after bootstrapping to 1000 replicates.Discussion: HBV genotypes A and D are the most common genotype in Nepal. Horizontal transmission is common in these genotypes. C/D recombinant genotype may be transmitted from Tibetan people living in Kathmandu. Prophylactic major controlling, horizontal and cross border transmission could be effective.

Conclusions: Three major genotypes of HBV in Nepal were found to be A, C and D. Despite being a low prevalence area, Nepal has a diversity of hepatitis B genotypes. 

Keywords: genotypes; HBV; nepal.
Comparison of Phacotrabeculectomy and Phacotrabeculectomy with Subconjunctival 5-Fluorouracil
Authors: Gurung Nanda Kumari , Gautam Prachand , Gurung Shanti , Bhattarai Binita
Published: September 2018

Introduction: Glaucoma is the second leading cause of blindness worldwide. Phacotrabeculectomyis a technique in which glaucoma and cataract surgery performed.

Methods: Prospective study was carried out in the department of glaucoma at Lumbini Eye Institute, Bhairahawa.100 patients who underwent phacotrabeculectomy within a period of two years. Patients were divided into two groups those who received 5FU (n=47) and no antifibrotic agent (n= 53).

Results: The age range was from 38 to 80 years; mean age of 62.97±9.14 SD. 55% were male and 45% were female.The postoperative IOP reduction in last follow- up group A was mean=13.08±1.57SD and mean=13.23±1.73SD in group B. This was statically significant with P <0.001. Bleb survival was almost similar in two groups 3.17(78.31%) in group A and 3.20 (78.93%) in group B. 85% visual acuity was improved in both groups.

Conclusions: Phacotrabeculectomy and phacotrabeculectomy with inj. 5FU, both were equally effective surgical techniques in terms of visual acuity, IOP control and bleb survival.There was no significant statistical difference vis-à-vis the success of Phacotrabeculectomy using of either these two techniques. 

Keywords: glaucoma; 5FU; intraocular pressure; phacotrabeculectomy.
Allergic BronchoPulmonary Aspergillosis in Nepal
Authors: Agarwal Neha , Shrestha Prajowl , Chokhani Ramesh
Published: September 2018

Allergic BronchoPulmonary Aspergillosis is clinically under recognized and often misdiagnosed in Nepal. A total of 15 cases of ABPA were enrolled in this case series. Cases were followed up after the 3 months of start of treatment and clinical responses were assessed. The mean age of the patients was 33.06 ± 9.2 yrs. 80% were male. 26.6% patients were empirically on antitubercular treatment at the time of presentation. 40% patients were misdiagnosed and already treated as pulmonary Tuberculosis. 10 patients were previously treated as cases of refractory asthma. Majority of patients had significant eosinophillia and raised total serum IgE. All patients required treatment with bronchodilator and systemic steroid. 80% patients underwent remission with the treatment. Pulmonary Tuberculosis and refractory bronchial asthma are common condition that leads to the misdiagnosis of this disease. 

Keywords: ABPA; bronchial asthma; central bronchiectasis; eosinophil count; serum IgE.
Visual Axis Opacification in Children Following Paediatric Cataract Surgery
Authors: Shrestha Ujjowala Devi , Shrestha Mohan Krishna
Published: September 2018

Visual axis opacification (VAO) occurs in up to 40% of pediatric patients after cataract surgery withintraocular lens implantation(IOL) even with a primary posterior capsulotomy (PPC). In both children and adult group, opacification does obscure the visual axis. However, in children after PPC, there is no capsule. Hence, the terminology VAO is used in children rather than posterior capsular opacification. This opacification is caused by a proliferation of epithelial cells on the posterior capsule or anterior vitreous face and can hinder the optical image quality needed for normal visual development. The rate of epithelial mitotic activity is higher in children compared to adult. It can be managed by Yag laser or surgical membranectomy, the latter is preferable. International and national published articles were systematically reviewed on aetio-pathogenesis, surgical techniques and equipment, type and material of IOL, and management of VAO in children operated for cataract. Author's experience was also included to write manuscript. VAO is frequent complication following cataract surgery in pediatric patients. Age of cataract patients, surgical technique and type and materials of IOL are most common influencing factor for VAO. Immediate management with advance equipment of VAO reduces the incidence for development of irreversible stimulation deprivation amblyopia. 

Keywords: pediatric cataract; pediatric cataract surgery; visual axis opacification.
Cognitive Dysfunctions in Patients with Alcohol Dependence Syndrome in a Tertiary Hospital in Kathmandu
Authors: Adhikari Sirjana , Rana Mita , Shakya Suraj , Ojha Saroj Prasad
Published: September 2018

Introduction: Alcohol dependence is a chronic disorder, accompanied by neuropsychological deficits. Patients with alcohol dependence were evaluated to identify the cognitive dysfunctions. Method: The study followed descriptive design and recruited participants (N=62) from inpatient services of the Department of Psychiatry and Mental Health by convenient sampling. Participants were evaluated with the Severity of Alcohol Dependence Questionnaire, Frontal Assessment Battery and PGI Memory Scale for the severity of alcohol dependence, executive impairments and memory dysfunctions respectively once they had completed alcohol detoxification. Results: Total duration of alcohol consumption was 13.93±8.74 years, period of dependence was 2.97±2.23 years and 56.5% had moderate level of dependence. 33.9% of the participants had executive impairments particularly in conceptualization, programming and mental flexibility. 38% of variance in executive dysfunction was explained by illness variables, where period of alcohol dependence and education were significant predictors. 54.8% had significant memory dysfunction particularly in visual retention, remote memory, verbal retention of dissimilar pairs and delayed recall. Memory dysfunction differed significantly among the age groups (F=10.22, p<0.01) and age was a significant predictor (β=.542, p<0.001). 19% variance in memory dysfunction was explained by illness variables, where duration of alcohol consumption was a significant predictor (β = .485, p<0.01). Conclusion: Findings indicate that cognitive dysfunctions are prevalent among patients with alcohol dependence. Hence, routine neuropsychological assessment is of particular importance for early detection and remediation of underlying deficits, which completes the treatment of alcohol dependence. Keywords: alcohol dependence: cognitive dysfunctions; executive functions; memory. | PubMed
Giant Left Atrium - A Rare Case of Acute Upper Gastrointestinal Bleeding
Authors: Dewan Khus Raj , Patowary Bhanumati Saikia , Bhattarai Subash
Published: September 2018

Acute upper GI bleeding is a common medical emergency with a hospital mortality of approximately10%. Non variceal UGI bleeding is the most common cause followed by oesophageal varices. Variousrare causes have been described in the literature but there are very few cases of giant left atriumleading to oesophageal erosion and causing upper GI bleeding. We are presenting a case of rheumaticvalvular heart disease with giant left atrium who presented in our department with acute upper GIbleeding. Keywords: giant left atrium;oesophgeal erosion; upper GI bleeding. | PubMed
Epidermoid Cyst of Tongue
Authors: Naik Choubarga , Prusty Nilamadhab
Published: September 2018

Epidermoid cyst occurring within the tongue is rare. A 5 year old male child was brought to OPD with a tongue mass which was gradually increasing in size. There was associated difficulty in speech and mastication as the swelling increased in size. Intraoral examination revealed moderately tender, fluctuant and enlarged tongue. A diagnosis of dermoid cyst was made and the patient was booked for surgery. Excision of the cyst was done under general anaesthesia. Post-operative histopathology was done. The histopathological findings confirm the diagnosis of an epidermoid cyst, characterized by the presence of: (I) a cyst cavity lined by stratified squamous epithelium with keratinization on the surface; and (II) connective tissue with a mild inflammation. The proposed treatment was considered successful as the case was solved and there was no recurrence. Keywords: dermoid; epidermoid cyst;tounge. | PubMed
Forensic Odontology: A Boon to Community in Medico-legal Affairs
Authors: Chidambaram Ramasamy
Published: September 2018

Forensic odontology is a sub-discipline of dental science which involves the relationship between dentistry and the law. The specialty of forensic odontology is applied in radiographic investigation, human bite marks analysis, anthropologic examination and during mass disasters. Besides the fact that radiographs require pretentious laboratory, it is still claimed to be a facile, rapid, non-invasive method of age identification in the deceased. The budding DNA technology has conquered the traditional procedures and currently being contemplated as chief investigating tool in revealing the hidden mysteries of victims and suspects, especially in hopeless circumstances. Forensic odontology has played a chief role in solving cold cases and proved to be strong evidence in the court of law. Systematic collection of dental records and preservation of the same would marshal the legal officials in identification of the deceased. To serve the forensic operation and legal authorities, dental professionals need to be familiar with the basics of forensic odontology, which would create a consciousness to preserve the dental data. The aim of this paper is to emphasize the vital applications of forensic odontology in medico-legal issues. Conjointly the recent advancements applied in forensic human identification have been updated. Keywords: bite marks; dental records; forensic identification; mass disaster; medico-legal issues. | PubMed
Clinical Evaluation of Fused/Ankylosed Hip with Severe Flexion Deformity after Conversion to Total Hip Arthroplasty
Authors: Suwal Saroj Kumar , Songming Peng , Gang Luo , Kui Huang
Published: September 2018

Introduction: Fused or Ankylosed hip is late complication of chronic inflammatory disorder with progressive changes in and around articular as well as periarticular structures with alteration in bio-force line of body which later lead to severe flexion deformity of joint. This not only results decreased movements of hip, it’s also increase pain around the hip, back and contralateral hip.Methods: Retrospectively, all patients aged 18 years or older undergoing THA between June 2006 to June 2012 were reviewed with selection criteria. The five ankylosed hips (three left and two right) with severe flexion deformities which ankylosed spontaneously were successfully converted to THA at time period of 2006 to June 2012. Range of Motion (ROM), Harris Hip Score and Flexion Deformity Angle at preoperative, postoperative and follow-up periods were used as evaluation.Results: Mean follow up is 42 months. Mean HHS increased from 21.6±4.97 to 81.8±4.02 points with one excellent, two good and two fair cases. The FDA is corrected to mean 8°±10.95 postoperatively and 4°±5.47 at final follow up from 81.6°±4.39 with two hips of 10° residual deformity. Hip ROM is improved as flexion 70° to 100°, adduction 10° to 20°, abduction 10° to 30°, internal rotation 5° to 10° and external rotation 2° to 50° from 0° activity. As complications, one hip had loose prosthesis, two had early postoperative dislocations, one had Deep Vein Thrombosis and one had femoral nerve palsy with quadriceps weakness.Conclusions: THA is an effective treatment for ankylosed hip with severe flexion deformity although complications are noted more than routine hip arthroplasties. Keywords: ankylosed hip; fused hip; severe flexion deformity; total hip arthroplasty. | PubMed
Comprehensive Diabetes and Non-Communicable Disease Educator in the Low-Resource Settings
Authors: Bhattarai Madhur Dev
Published: September 2018

The role of self-management education in diabetes and other major non-communicable diseases is clearly evident. To take care of and educate people with diabetes and other major NCD under the supervision of medical professionals and for education of other health care professionals, Comprehensive Diabetes and NCD Educators are needed in the routine service in peripheral health clinics and hospitals. The areas of training of CDNCD educator should match with the cost-effective interventions for diabetes and other major NCD that are feasible and planned for implementation in primary care in the low resource settings. Most of such interventions are part of diabetes education as required for Diabetes Self-Management Education programmes and traditional Diabetes Educator. The addition of use of inhaled steroids and bronchodilator in chronic respiratory disease and identification of presenting features of cancer, also required for many people with diabetes with various such common co-morbidities, will complete the areas of training of traditional Diabetes Educator as that of CDNCD Educator. Staff nurse and health assistants, who are as such already providing routine clinical service to all patients including with diabetes and major NCD in peripheral health clinics and hospitals, are most appropriate for CDNCD Educator training. The training of CDNCD Educator, like that of traditional Diabetes Educator, requires fulfillment of sufficient hours of practical work experience under supervision and achievement of the essential competencies entailing at least 6 month or more of intensive training schedules to be eligible to appear in its final certifying examination. Keywords: CDNCD Educator; diabetes; diabetes educator; DSME; global NCD alliance; NCD; non-communicable diseases; WHO PEN. | PubMed
Medication Practice of Patients with Dermatophytosis
Authors: Poudyal Yogesh , Joshi Shambhu Dutta
Published: September 2018

Introduction: Dermatophytosis is one of the commonest dermatoses observed in Dermatology OPD. It is caused by Fungus Dermatophyte. Its pattern and prevalence varies from region to region. As self medication practice is very common, we aim to find the prevalence of various clinical pattern of dermatophytosis and to find out the medication commonly used by the patients for this condition.Methods: This was cross sectional observational study. The case collection was done from outpatient department of Dermatology and Venereology of a Teaching Hospital from 15th March, 2013 to 14March, 2014. Demographic, Clinical and other relevant details were recorded in Proforma after history and examination. Results: The total number of cases were 594. Crural area was the most commonly involved. Tinea corporis was most common dermatophytosis followed by Tinea incognito. Risk of recurrence was highest in buttocks [odds ratio-2.404 (1.510, 3.827) and crural area [odds ratio- 2.298 (1.637,3.266). Topical steroid and topical steroid with antifungal was used by 225 (30.1%) and 226 (30.2%) respectively. Patients who consulted dermatologist were more likely to use antifungal, odds ratio- 12.060 (4.907, 29.643).Conclusions: Tinea corporis was the commonest dermatophytosis. Due to practice of topical steroid misuse T. incognito was second common. It is essential to educate the general public, pharmacist and paramedics regarding the proper use of topical steroid. Keywords: dermatophytosis; steroid; tinea. | PubMed
Study of Infertile Couples Attending a Teaching Hospital in Eastern Nepal
Authors: Subedi Shanti , Lamichhane Sabina , Chhetry Manisha
Published: September 2018

Introduction: Infertility is a global health issue and a socially destabilizing condition for couples with several stigmas including medical, social, psychological burdens and a marital disharmony. The aim was to study the incidence of infertility in couples attending outdoor of Nobel Medical College and to know the contributing factors among the infertile couples.Methods: A prospective cross-sectional study was carried out in the outpatient department of a teaching hospital July 2015-June 2016, where the incidence of infertility and the contributing factors for the same were evaluated.Results: The incidence of infertility in this study was 5.45% and it was dominated by secondary infertility. The most important cause was male factor in 37.39%. Majority of male factor abnormality was due to exposure to heat as these male work abroad in Arabian Countries.Conclusions: The study shows a dominance of secondary infertility and male factor being a major contributor. The most common semen abnormality was oligospermia. Keywords: infertility; incidence; oligospermia; semen. | PubMed
Hysteroscopy in Abnormal Uterine Bleeding vs Ultrasonography and Histopathology Report in Perimenopausal and Postmenopausal Women
Authors: Sharma Jyotshna , Tiwari Sanjeeb
Published: September 2018

Introduction: Abnormal uterine bleeding is one of the most common morbidity landing women to attend medical attention in gynecology outpatient department. This study aims to evaluate the hysteroscopy finding in diagnosis of AUB and its correlation with ultrasonography finding and histopathological reports.Methods:This was a prospective comparative study in which ultrasonography was performed in fifty patients with abnormal uterine bleeding attending OPD then hysteroscopy was performed. After removing hysteroscopy dilation and curettage was done and sample sent for histopathology. At the end reports of hysteroscopy finding were compared with sonograhic and pathological results.Results:In the study women aged from 45 to 64years with the symptoms duration of 15 days to 6months. Post menopausal women seek medical attention more early then the menstruating women. Common symptoms are menorrhagia, metrorrhagia and postmenopausal bleeding. Most common abnormality was menorrhagia (32%) followed by post menopausal bleeding 28 %. Ultrasonography showed 46% of abnormal finding in which 17 (47%)menstruating women and 6 (43%) women were postmenopausal women. Among 50 women 17 (34%) had negative finding and 43 (66%) had abnormal finding in which most common finding of hyperplastic endometrium. Hysteroscopy correctly diagnose atrophic endometrium, polyp and endometrial Ca which is also confirmed by histopathology finding.Conclusions: Hysteroscopy is reliable method for evaluating cases of AUB and it can be used as first line diagnostic method for benign lesions. Hysteroscopy guided biopsy has most accurate in diagnosing pathology. Keywords: AUB; D and ; Hysteroscopy,OPD; Ultrasonography. | PubMed
It’s Even Here! Two Rare Cases of Pyriformis Myocysticercus
Authors: Prakash Mahesh , Gupta Pankaj , Gulati Ajay , Khandelwal Niranjan
Published: September 2018

Cysticercus, the larval form of Taenia Solium, a tapeworm, can infest various tissues in the human body. Though central nervous system involvement is the most dramatic form of infestation, several other uncommon sites of has been reported in the literature. One such involvement is that of the musculature. The most easily recalled manifestation of myocysticercus is that in the orbit where the patients present with painful proptosis. However, other less common muscular sites of involvement are documented in case reports. To the best of our knowledge, there are no documented cases of pyriformis muscle infestation with cysticercus. We came across two interesting cases, where imaging established the diagnosis of isolated pyriformis cysticercosis. Follow up after one month of anti-elminthic treatment imaging revealed disappearance of the lesions. Keywords: magnetic resonance imaging,myocysticercosis; pyriformis; ultrasound. | PubMed
Safety and Efficacy of Spinal Anaesthesia in Percutaneous Nephrolithotomy
Authors: Shah Rajiv , Thapa Ajaya Singh , Lamichhane Nirmal , KC Sudeep Raj
Published: September 2018

Introduction: Renal stone is one of the common entities occurring in our population. There are different treatment modalities of stones; out of those percutaneous nephrolithotomy is one of the most popular and effective for the renal and upper tract stones. This study is based to compare the safety and efficacy of spinal anaesthesia and general anaesthesia in PCNL. Methods: In a randomized prospective study 60 patients were divided in two groups; group 1 (n=30) underwent PCNL in general anaesthesia and group 2 (n=30) underwent PCNL in spinal anaesthesia in prone position with the conventional technique. Demographic, operative data, post operative complications, patients’ satisfaction rate and follow up complications were recorded and analyzed between two groups. Results: Mean age in group 1 was 39.10±12.45years and 36.10±14.18 in group 2 (P=0.100). Mean stone size in group 1 was 3.75±1.27cm and 3.23±1.36cm in group 2 (P=0.129).Similarly the operative time was 89.10 ± 49.38 min and 62.53±35.91 min in group 1 and group 2 respectively (P=0.042). There was no significant difference between the complications regarding the anaesthesia. Post operative nausea and vomiting were significantly higher in group 1 and headache in group 2 (p=<0.001). Overall patient satisfaction rate was higher in group 2 then in group 1 (p=0.01). Hospital stay in group 1 was 5.27±1.87 days and 4.53±1.88 days in group 2 (p = 0.07). Stone success rate was similar in each group (p =0.50). Conclusions: Spinal anaesthesia is a safe and effective method in performing PCNL.

Keywords: general anaesthesia; percutaneous nephrolithotomy; spinal anaesthesia. | PubMed
Knowledge, Attitude and Practice on Hypertension among Antihypertensive Medication Users
Authors: Shrestha Shakti , Adhikari Bhojraj , Poudel Ramesh Sharma , Thapaliya Kailash , Kharal Tikaram , Bastakoti Mahanath , Bhatta Nanda Kishor
Published: September 2018

Introduction: Hypertension is growing among the population of Nepal. We aimed to determine the current knowledge, attitude and practice of hypertension among hypertensive patients taking antihypertensive medication in the community of Central Nepal.Methods: A cross-sectional study was conducted among the hypertensive patients in Bharatpur, Chitwan, Nepal from July 2015 to September 2015 using clustered sampling technique. Suitably designed and validated questionnaire of knowledge, attitude and practice on hypertension consisting of 27 questions were used to determine the KAP scores. The difference in the median KAP scores between sex, level of education and duration of hypertension were assessed using Mann-Whitney U test.Results: A total of 200 patients met the inclusion criteria and majority of them were male (60%), had received primary education (36%) and had hypertension for ≥5 years (46.5%). The blood pressure ranged from 100-180/60-110 mmHg. The median K, A and P scores were 8 (6), 5 (1) and 6 (3) respectively. K and A were statistically associated with sex both at p<0.001 and level of education (K at p<0.001 and A at p=0.016).Conclusions: The current knowledge, attitude and practice among hypertensive patients using antihypertensive medication can be improved. Keywords: attitude; hypertension; knowledge; practice. | PubMed
Ritodrine and Isoxsuprine in Managment of Preterm Labor
Authors: Yagol N S , Shakya R , Thapa P
Published: September 2018

Introduction: