bluuebunny/crossref_metadata_2025 huggingface dataset:
Ondansetron and Granisetron for Prevention of Postoperative Nausea and Vomiting following Laparoscopic Cholecystectomy
Authors: Gauchan Sabin , Thapa Chitra , Shakya Priyanka , Bhattarai Ramesh , Shakya Sajal
Published: September 2018

Introduction: Laparoscopic surgeries are known to be associated with a higher incidence of postoperative nausea and vomiting. Prophylaxis of PONV is usually achieved with a single-dose antiemetic drug administered during the surgical procedure. The aim of this study was to compare the antiemetic efficacy of two different 5-hydroxytryptamine-3 receptor antagonists, ondansetron and granisetron when given prophylactically to patients undergoing laparoscopic cholecystectomy.Methods: It was a randomized, double blind study, conducted in 90 patients. Patients were divided into two groups: Group A and Group B with 45 patients in each group. Patients in groupA were given 100microgram/kg ondansetron intravenously (IV),and patients in Group B were given 40 microgram/kg granisetron. Both the drugs were diluted in 10 ml of 0.9% NaCl and were given at the end of surgery. The standard general anesthetic technique was administered to all the patients. Episodes of nausea, retching and vomiting were assessed during the first 24 hours after anesthesia.Results: There was no statistically significant difference for demographic data and duration of surgery among the two groups (P > 0.05). Evaluated nausea and vomiting scores in the first 3hours period revealed that each of the drugs had a similar antiemetic effect (P > 0.05). Between 4–12 hours also the episodes of nausea, retching as well as vomiting were statistically insignificant in both the groups. In the last 12 hours, episodes of nausea, retching and vomiting were significantly higher in ondansetron group.Conclusions: Granisetron, when given prophylactically, resulted in a significantly lower incidence of PONV than ondansetron in the first 24 hours.Keywords: Granisetron; Laparoscopic cholecystectomy; Ondansetron; postoperative nausea vomiting.
Intravenous Thrombolysis and Risk Factors for Ischemic Stroke
Authors: Shrestha Shakti , Poudel Ramesh Sharma , Thapa Lekh Jung , Khatiwada Dipendra
Published: September 2018

Thrombolysis is one of the proven potential treatments for the management of acute ischemic stroke. Intravenous recombinant tissue-plasminogen activator (rt-PA) is the only medically approved biological thrombolysing agent for the treatment of acute ischemic stroke within 4.5h of stroke (2.2% symptomatic intracerebral haemorrhage, 12.7% mortality and 58.0% functional independence), but following the guideline and criteria provided by National Institute of Neurological Disorder and Stroke (NINDS) and SITS (Safe Implementation of Thrombolysis in Stroke) studies. Nepal needs to evidently introduce intravenous rt-PA in its clinical setting for treatment of acute ischemic stroke, which has been approved for more than a decade ago in developed countries. Several modifiable and non-modifiable risk factors can affect the outcomes of the treatment with intravenous rt-PA. Early modification of factors predicting the risk outcomes can be a beneficial tool to justify the thrombolytic treatment. This review aims to discuss the major studies on thrombolysis using rt-PA and main factors that can affect the outcomes of treatment in ischemic stroke.
A Study of Body Mass Index (BMI) of Nepalese Women attending Gynaecology Clinic
Authors: Padhye Saraswati M
Published: September 2018

Abstract
Diagnostic Dilemma of an Unusual Pelvic Mass in a Young Girl
Authors: Rajbhandari Swaraj , Shrestha B , Karki A
Published: September 2018

abstract
Efficacy of Combined Antithrombotic, Statins and Anti-Hypertensive Drugs in Acute Ischemic Stroke
Authors: Poudel Ramesh Sharma , Thapa Lekhjung , Shrestha Shakti , Khatiwada Dipendra , Upadhyay Nijan , Bhandari Tirtha Raj , Shrestha Asis
Published: September 2018

Introduction: Anti-thrombotic, statins and antihypertensive drugs are commonly used for the management of acute ischemic stroke in Nepal but there is no evidence regarding their efficacy in our context. This study aims to explore the efficacy of these combined medications (anti-thrombotic, statins and antihypertensive drugs) in acute ischemic stroke patients for the first time and to assess the risk factors present in those patients.

Methods: The study was conducted on 37 acute ischemic stroke patients admitted and treated at the Neurology Department of College of Medical Sciences-Teaching Hospital, Chitwan, Nepal and they were followed at three months (90±10 days). The initial stroke severity and functional disability were evaluated at admission and at 3 months using National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) respectively. The outcome parameters were functional independence (mRS≤2) and mortality at three months (mRS=6). Frequency distribution, Mann-Whitney U-test and χ2 test were performed for statistical analysis.

Results: Out of 37 patients, 27 (73%) were Smoker, 22 (59.5%) had hypertension and 19 (51.4%) were alcohol consumer. The stroke severity on admission was statistically significant with functional independence (P=0.003) and mortality (P=0.015) at three month. Similarly, Rankin grade on admission was statistically significant with functional independence (P=0.001) and mortality (P=0.048) at three month. At three months, 20 (69%) survived patients were independent while mortality was seen in eight (21.6%) patients.

Conclusions: The management of acute ischemic stroke with combined anti-thrombotic, statins and antihypertensive drugs seems promising and efficacious in mild to moderately severe ischemic stroke.

Keywords: antihypertensive; anti-thrombotic; efficacy ; statins; stroke.
Colonic Diverticular Disease: Current Perspectives
Authors: Tappenden J , Shrestha Badri Man
Published: September 2018

abstract
Ruptured Gall Bladder containing Stones following Blunt Trauma Abdomen: A Rare Presentation of Hemodynamic Instability
Authors: Goel Vineet , Kumar Naveen , Soni Nikhil
Published: September 2018

Gall bladder injuries are seen in 2% of patients undergoing laparotomy for blunt trauma abdomen. Isolated gall bladder injury is a rare event with associated presence of stones is even rarer. The associated visceral injuries lead to intraoperative identification in most cases. Here we present a case of 30 years old male with isolated gall bladder laceration following blunt abdominal trauma. The diagnosis of gallbladder perforation after blunt injury may be suspected in patients with signs of an acute abdomen and hypotension that is not explained by blood loss. Early suspicion and prompt exploration is imperative. Cholecystectomy is an adequate treatment for the condition.
Prevalence of Occlusal Traits in the Deciduous Dentition of Children of Kaski District, Nepal
Authors: Baral Prakash , Budhathoki Prakash , Bhuju Krishna Gopal , Koirala Bandana
Published: September 2018

Introduction: The prevalence of occlusal traits varies among various populations. Ethnic, genetic and environmental factors are the major contributors, with a role in the specific cause of malocclusion. The aim of this epidemiological study was to assess the prevalence of occlusal traits in the deciduous dentition of children of Kaski District,Nepal.

Methods: A total of 506 children (251 girls, 255 boys), aged 3-5 years, were assessed. The occlusion examination was carried out by three examiners, in the school camps,community dental care centre and general health camps, utilizing a mouih mirror and probe. Intra investigator error was calculated using kappa statistics. The data were analyzed by the statistical program SPSS version 17 using the Chi-square test.

Results: The present study studied occlusal traits of 506 children (251 girls, 255 boys), aged 3-5 years. The study result showed that bilateral mesial step seen in 40.3%,bilateral flush terminal plane in 33.5%, bilateral distal steps in 8.5%,mesial step one side and flush terminal other side in 12.7%,mesial step one side and distal step other side in 2.6%,flush terminal one side and distal step other side in 2.4%,anterior crossbite in 3%,posterior crossbite in 0.4% and non-spaced dentition in 20% children.

Conclusions: Mesial step was the most prevalent followed by straight terminal plane and the distal terminal plane showed least prevalence. There were diverse traits for malocclusion. There was no significant difference(p>0.05) in occlusal traits between male and female children. 

Keywords: crossbite; distal step; flush terminal plane; mesial step; occlusion.
Emergency Department Overcrowding in Turkey: Reasons, Facts and Solutions
Authors: Cakir Oya Durmus , Cevik Sebnem Eren , Bulut Mehtap , Guneyses Ozlem , Aydin Sule Akkose
Published: September 2018

Introduction: The purpose of this study was to determine the factors affecting the long waiting times of the patients in a university hospital.

Methods: This study included 3000 of the adults above 18 years and pediatric trauma patients under 18 years who applied to emergency department between February 2009 and April 2009. The examination period of the physician, length of stay, length of hospitalization, waiting times for hospitalization and follow up times in the emergency department were recorded. Moreover, the patients were divided into four groups according to the reasons for waiting.

Results: In our study, the time period between 4 pm-12 pm was determined as the busiest time for the applications. Average length of stay in the emergency department for 3000 patients was 146.7±160.2 minutes. The length of stay for the patients consulted was longer than the length of stay for the ones who were not consulted. Because of the fact that our hospital did not have appropriate bed capacity, 41.1% of the patients waited less than two hours, 13. 4% of the patients waited more than 8 hours. It was also found that the waiting times of the Group two patients (206,7±145,2 minutes) was longer than Group one (95,5±73,9 minutes) patients and the waiting times of Group three patients (470,7±364,7 minutes) was longer than Group one patients.

Conclusions: In conclusion, cooperation of the managers, relevant departments and a multidisciplinary approach are necessary to achieve the goals to reduce overcrowding in the emergency departments.

 Keywords: bed capacity; crowding; emergency department; length of stay.
Clinical Profile, Dyslipidemia and ACS - a Correlation
Authors: Dali Bikash
Published: September 2018

Introduction: To analyze lipid profile in patients with ACS, and to study the pattern of the involvement and complication in ACS.  Methods: Hundred and eight consecutive cases of ACS, attending the CCU of Tribhuvan University Teaching Hospital fulfilling the criteria, were taken for the present study. Patient from age 30 and older were studied. All cases were scrutinized to detail serial 12 lead EKG, serial cardiac biochemical markers, laboratory test, echocardiographic study. Design of the study was carried out in prospective, cross sectional study. Results: Hyperlipidemia was present in 61% of the patients. Only 27% of them were on statins. Most of them had high cholesterol level 68%, high Tgl level 75%, Ldl 50%, where as <40 Hdl (93%) patient were found to be low. 40% was found to have UAP. In addition patient with hypertension (76%) diabetes (65%) also had comorbidity for obesity 35%, and lipid abnormalities 75% for triglycerides, 66% for TC, 50% for LDL-C, 93% for low HDL-C, and a family history of CAD in 57%.  Conclusions: The outcome of this study showed that the majority are male, relatively younger as compared to Western population. USA and STEMI were the dominant types of ACS. Strong correlations between TC, LDL-C, and low HDL-C in patient with ACS were noted. Majority of patients had hypertension, IHD in their families and Hyperlipidemia diabetes, smoking as the major risk factors. Better control of risk factors and the awareness of preventive strategies are needed.
A Giant Urethral Calculus
Authors: Sigdel Ghanshyam , Agarwal Aman , Keshaw Belokar Wasant
Published: September 2018

Urethral calculi are rare forms of urolithiasis. Majority of the calculi are migratory from urinary bladder or upper urinary tract. Primary urethral calculi usually occur in presence of urethral stricture or diverticulum. In this article we report a case of a giant posterior urethral calculus measuring 7x3x2 cm in a 47 years old male. Patient presented with acute retention of urine which was preceded by burning micturition and dribbling of urine for one week. The calculus was pushed in to the bladder through the cystoscope and was removed by suprapubic cystolithotomy.

Keywords: giant urethral calculus; posterior urethra.
Crossed Testicular Ectopia
Authors: Pradhan Anup , Panta Om Biju , Gurung Ghanshyam , Karki Dan Bahadur
Published: September 2018

Crossed testicular ectopia also known as transverse testicular ectopia is a rare anomaly of the testis which is ectopically located in contralateral hemiscrotum with absent testis in the ipsilateral hemiscrotum. Most case are incidentally discovered intraopeartively during operation of inguinal hernia and few case reports are available which have reported preoperative diagnosis of crossed testicular ectopia. We report a case of crossed testicular ectopia in 12 year old boy who presented with right undescended testis diagnosed preoperative on Ultrasound and Magnetic Resonance Imaging as crossed testicular ectopia.

Keywords: crossed ectopia; MRI; testis; ultrasonography.
Uncommon course of the ulnar artery through the pronator teres muscle
Authors: Vymazalová Katerina , Vargová Lenka , Joukal Marek
Published: September 2018

In this paper, we describe a very rare variant in the course of the ulnar artery that we encountered in dissecting the right upper limb of a 74-year-old man. The ulnar artery arose standardly from the brachial artery in the cubital fossa. However, its ensuing course differed from the norm. The artery entered together with the ulnar vein and median nerve into the pronator canal (between the humeral and ulnar heads of the pronator teres). Further, the ulnar artery descended classically to the ulnar side of the forearm between the flexor carpi ulnaris and flexor digitorum superficialis. Knowledge of this variation in the course of the ulnar artery may have significance in clinical practice because accumulation of anatomical structures in the pronator canal could be a predisposing factor for the compression of nerve or blood vessels.

Keywords: anatomical variation; median nerve; pronator canal; pronator teres muscle; ulnar artery.
Radiation induced myxoma of superior vena cava origin presenting as a right atrial mass
Authors: Sabzi Feridoun , Faraji Reza
Published: September 2018

Myxomas are the most common benign cardiac tumors. Myxomas are more common in the left heart chamber than the right side chamber. An extracardiac origin presenting as a right atrial mass is very rare. Right-sided tumors are considerably less common than left-sided tumors, and however myxoma of great vessels origin presenting as right atrial masses are rare but radiation induced villous myxoma in superior vena cava (SVC) is exceedingly rare tumor. A case of radiation induced myxoma originating in a previously undescribed location and presenting as a right atrial mass is reported.

Keywords: myxoma; right atrial; vena cava.
A Rare Case of Multiorgan Involvement of Rosai Dorfman Disease in an Elderly Female
Authors: Waghmare Rakesh Digambar
Published: September 2018

Sinus histiocytosis with massive lymphadenopathy (SHML), Rosai-Dorfman Disease, is a rare histiocytic syndrome first described by Rosai and Dorfman, most frequently seen in children and young adults.The disease is more common in males and in individuals of African descent but rare in Asians. It is mainly characterized by painless bilateral cervical lymph node enlargement and is often associated with fever and leucocytosis. This case is being reported for its rarity in presentation in an elderly female with both generalized nodal as well as extranodal manifestations. Without the awareness about RDD, the diagnosis of RDD is unexpected especially in South East Asian Countries where certain lymphadenopathies such as tuberculosis, metastatic malignancies and lymphomas are common.

Keywords: emperipolesis; rosai-dorfman disease; sinus histiocytosis with massive lymphadenopathy.
Symptoms Analysis of Obsessive–Compulsive Disorder in Adolescents and Adults in a Teaching Hospital
Authors: Goit Bharat Kumar , Ghimire Shree Ram
Published: September 2018

Introduction: Obsessive-compulsive disorder has a broadly diverse clinical expression that reflects heterogeneity. Several studies have identified consistent symptom dimensions of obsessivecompulsive disorder. The purpose of this study was to conduct an exploratory symptoms analysis of obsessive-compulsive symptoms in adolescents and adults with obsessive-compulsive disorder.

Methods: This was a cross-sectional study conducted in the Department of Psychiatry, National Medical College. This study examined lifetime occurrence of obsessive-compulsive symptoms included in the 13 symptom categories of the Yale–Brown Obsessive Compulsive Scale. Symptoms analysis was performed on 60 patients with obsessive-compulsive disorder. Eight categories of obsessions and six categories of compulsions from Yale–Brown Obsessive Compulsive Scale were included in the analyses. SPSS software package (version 16) was used to analyze the data and shown in the table.

Results: Of 60 adolescents and adults, female and male were in the ratio of 1.2:1. Contamination was the most common occurring obsession followed by aggressive obsession. The most common occurring compulsion was checking followed by washing. Only a minority of patients (13.33%) presented predominantly with obsessions however 18.33% patients presented predominantly with compulsions. Certain obsessions and compulsions co-occur to form a cluster.

Conclusions: In adolescents and adults, obsessive-compulsive disorder is a multidimensional disorder. Symptom dimensions are predominantly congruent with those described in similar studies of adults with obsessive-compulsive disorder.

Keywords: compulsion; obsession; obsessive-compulsive disorder.
Diagnosis and Management Pattern of Lateral Epicondylitis in a Tertiary Care Center
Authors: Dhakal Sita , Acharya Trishna , Gautam Savyata , Upadhyay Nijan , Dhakal Sujan
Published: September 2018

Introduction: Lateral Epicondylitis has been found to be the second most frequently diagnosed musculoskeletal disorder. A wide range of symptomatic treatments are available such as use of anti-inflammatory analgesic drugs, steroids, physiotherapy. This study aims to know about the diagnosis, prescription pattern and current practice on management of tennis elbow in Nepal.

Methods: This is a hospital based observational study carried out at Bir Hospital, Kathmandu, Nepal. Patients diagnosed with tennis elbow were purposively selected through prospective sampling technique from Orthopedic Department. Questionnaire and patient medication files were used as tools for data collection.

Results: A total of 97 patients were found to be suffering from tennis elbow affecting mostly 41-50 years of age group and seen mostly in female (62%). Further, it was found that housewives (31%) were mostly affected. Diagnosis of tennis elbow was done commonly by clinical evaluation (61%) and X-ray (39%). Both Pharmacological and Non-Pharmacological approaches were in practice. Pharmacological treatment include NSAIDS (59% Aceclofenac, 19% Naproxen, 18% Indomethacin, 16% Diclofenac, 6% Piroxicam) and Steroids (23% methylprednisolone acetate and 21% oral prednisolone). Non-Pharmacological treatment was done by lifestyle modification (100%), 78% application of heat, 63% use of tennis elbow band, 29% exercise and 28% physiotherapy. Surgical intervention (3%) was also done when the conservative management failed.

Conclusions: There is professional risk of tennis elbow for housewives, farmers and shopkeepers in context of Nepal. Only one treatment approach is not effective in management of tennis elbow for long term effect.

Keywords: lateral epicondylitis; NSAIDs; physiotherapy; steroid; tennis elbow.
Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia
Authors: Dahal Santosh , Rijal Basista Prasad , Yogi Karbir Nath , Sherchand Jeevan Bahadur , Parajuli Keshab , Parajuli Narayan , Pokhrel Bharat Mani
Published: September 2018

Introduction: Inadequate empirical antibiotic therapy for HAP is a common phenomena and one of the indicators of the poor stewardship. This study intended to analyze the efficacy of empirical antibiotics in the light of microbiological data in HAP cases.

Methods: Suspected cases of HAP were followed for clinico-bacterial evidence, antimicrobial resistance and pre and post culture antibiotic use. The study was taken from February,2014 to July, 2014 in department of Microbiology and department of Respiratory medicine prospectively. Data was analyzed by Microsoft Office Excel 2007.

Results: Out of 758 cases investigated, 77(10 %) cases were HAP, 65(84%) of them were culture positive and 48(74 %) were late in onset. In early onset cases, isolates were Acinetobacter 10(42%), Escherichia coli 5(21%), S.aureus 4(17%), Klebsiella 1(4%) and Pseudomonas 1(4%). From the late onset cases Acinetobacter 15(28%), Klebsiella 17(32%) and Pseudomonas 13(24%) were isolated. All Acinetobacter, 78% Klebsiella and 36% Pseudomonas isolates were multi drug resistant. Empirical therapies were inadequate in 12(70%) of early onset cases and 44(92%) of late onset type. Cephalosporins were used in 7(41%) of early onset infections but found to be adequate only in 2(12%) cases. Polymyxins were avoided empirically but after cultures were used in 9(19%) cases.

Conclusions: Empirical antibiotics were vastly inadequate, more frequently so in late onset infections. Use of cephalosporins empirically in early onset infections and avoiding empirical use of polymyxin antibiotics in late onset infections contributed largely to the findings. Inadequate empirical regimen is a real time feedback for a practitioner to update his knowledge on the local microbiological trends.

Keywords: empirical therapy; hospital acquired pneumonia.
Sleeping Pattern of Medical Students Preceding Viva Examination and Their Performance
Authors: Ansari Mukhtar
Published: September 2018

Introduction: Sleep is an important determinant of keeping healthy physically and mentally. Deviation in sleep is a common problem among students during examinations. The purpose of this study is to determine students’ sleep pattern during night preceding viva examination and its correlation with performance.  

Methods: This was a cross-sectional prospective study conducted between January and February 2014 among 1st and 2nd year MBBS students of National Medical College, Birgunj, Nepal who appeared in University’s final practical examinations. Based on simple random sampling approach, each of the 280 participants was allowed to pick out five pieces of lottery papers and they were asked the five questions resembling the number in the list of questions.

Results: Among the total 280 students, 74.6% were from India and 25.4% were from Nepal, and majorities (63%) of them were males. Fifty two percent of the students either could not sleep at all or slept just for 1 to 1.5 hours while 12% slept for 5 to 6.5 hours. Two-third (66%) of the students was able enough to achieve one to two scores, and only 1.8% could succeed to get the maximum score of five. The correlation between hours of sleep preceding examination and the score achieved was positively (r=0.701) and statistically significantly correlated (p<0.001).

Conclusions: There is a trend among the medical students either not to sleep or sleep only for few hours preceding viva examination that result in poor performance in examinations.

Keywords: medical; Nepal; performance; sleep deprivation; students.
Patients’ Awareness about the Complications of Diabetes Mellitus and its Co-relation with the Glycemic Status
Authors: Kumar Agrawaal Krishna
Published: September 2018

Introduction: Diabetes is a major cause of morbidity and cardiovascular related mortality along with a major cause of preventable blindness and foot amputation. There are limited studies on diabetes awareness, attitude, and prevalence.

Methods: Thus, we designed a study to seek the patients awareness about the complications associated with diabetes. It was a prospective observational study which included 123 patients with Diabetes Mellitus.

Results: The mean age of population studied was 53 years mainly from the Rupandehi and Nawalparasi districts in Nepal attending a clinic. In the study Erectile Dysfunction was statistically significant with postprandial hyperglycemia. Lack of Awareness about a calorie specific diet plan was significantly associated with increased blood sugar fasting level >110mg/dl. A majority of patients (58%) had awareness regarding kidney damage and 51% had awareness that Diabetes causes delayed wound healing. Only 3% of the patients did a regular foot care and 9% knew what the target glycemic status is. About 36% know that there can be cardiac complications due to diabetes and 27% regarding eyes. Similarly 36% of the patients also knew that there is neuropathy due to diabetes and 18% were aware about CVA. About 54% of the patients had Fasting >110mg%.

Conclusions: The study showed that though the patients are on OADs but they lack awareness about the major complications related to diabetes mellitus.

Keywords: awareness of diabetic complications; HbA1c; patient awareness.
Methotrexate in the Treatment of Recalcitrant Nodular Vasculitis
Authors: Parajuli Sudip , Dhital Kamal Raj
Published: September 2018

We report a case of recalcitrant nodular vasculitis in a 23 years old male who was treated successfully with methotrexate. He presented to our Dermatology out Patient Department, Tribhuvan university teaching hospital with complaints of recurrent painful discharging ulcer over bilateral calf and lower legs of three years duration. The diagnosis of nodular vasculitis was made on the basis of the clinical presentation and the histopathological findings. The patient was treated with antituberculosis treatment with initial good response; however the lesions persisted later on, despite completing the course of ATT. The patient did not respond to treatment with systemic corticosteroids also. On starting methotrexate, the lesion started healing within a period of two weeks and therewas significant improvement in subsequent one month. This case report highlights the efficacy of methotrexate in the treatment of recalcitrant nodular vasculitis. 

Keywords: ATT; methotrexate; nodular vasculitis.
En bloc Pancreaticodudenectomy with Colectomy for Locally Advanced Right Sided Colon Cancer
Authors: Bhandari Ramesh Singh , Lakhey Paleswan Joshi , Mishra Parsu Ram
Published: September 2018

A 57 year old male presented to our outpatient clinic with history of on and off melena, weight loss and decreasing appetite for 10 months duration and a noticeable mass on the right upper quadrant. Abdominal examination revealed an intra-abdominal lump in right upper quadrant which was subsequently evaluated by colonoscopy, which revealed an ulcero-proliferative growth in the hepatic flexure and the biopsy from it confirmed well-differentiated adenocarcinoma. Contrast enhanced computed tomography demonstrated hepatic flexure mass with possible invasion into adjacent duodenum without features of advanced disease. After completion of necessary preoperative assessment and investigations, patient was explored with curative intent and underwent extended right hemicolectomy with en bloc pancreaticodudenectomy. Patient was discharged on 10th postoperative day and at 14 months follows up; he was doing well without any evidence of recurrence.

Keywords: colectomy; locally advanced; pancreaticoduodenectomy.
Close Versus Limited Open Method of Ender’s Nail Fixation in Paediatric Femoral Shaft Fractures
Authors: Dwivedi Rajeev , Sah Shambu , Dahal Mukund , Acharya Parimal , Gurung Sandeep
Published: September 2018

Introduction: There are various surgical options for treating fracture of femoral shaft in children. Here we compare the results of close with limited open method of Ender’s nails fixation of femoral shaft fractures in children.

Methods: We studied 60 children with femoral shaft fractures in age group 5-15 years. Ender’s nail fixation was done by close technique in 40 cases and in 20 cases by limited open technique.

Results: The mean operative time was significantly high in limited open group being 64 minutes in comparison to 50 minutes in close group. There was no significant difference between close and limited open groups with respect to time for partial weight bearing and time for full weight bearing. Fracture united sooner in close group as compared to open group. Union was achieved in all patients within a mean of 11 weeks in close group in comparison to 12.4 weeks in open group. According to the Flynn criteria in close group 34 patients had excellent results, 6 had satisfactory and none poor. In limited open group outcome was excellent in 14 patients, satisfactory in 4 patients and 2 had poor result. There was no significant difference in outcome based on Flynn criteria between two groups.

Conclusions: Though operative time is more and healing is delayed in Ender’s nail fixation by limited open technique, there is no statistical difference in final outcome as per Flynn criteria between close and limited open technique of Ender’s nail fixation of femoral shaft fractures in children. 

Keywords: children; close technique; ender’s nail; fracture shaft of femur; flynn criteria.
Bilateral Synchronous Testicular Seminoma in a Patient with Bilateral Cryptorchidism
Authors: Ghartimagar Dilasma , Ghosh Arnab , Shrestha Manish Krishna , Chettri Duk Bahadur , Shrestha Santosh , Sherchan Rishi Kumar
Published: September 2018

Cryptorchidism is a known cause of testicular tumor. The incidence of testicular tumor is 11 times more in inguinal testes and 50 times more in intra-abdominal testes. The position of the undescended testis is related to the likelihood of carcinogenesis with the intra-abdominal location having the highest risk for malignancy. Bilateral testicular tumors are rare and 80% of bilateral tumors are metachronous. Synchronous bilateral testicular tumors are rare and bilateral synchronous testicular seminoma in a patient with bilateral cryptorchidism is very rare. 

Keywords: bilateral; cryptorchidism; seminoma; synchronous; testes.
Hashimoto's Thyroiditis and Medullary Carcinoma of Thyroid
Authors: Dasgupta Senjuti , Chakrabarti Sudipta , Mandal Prakas Kumar , Das Shikha
Published: September 2018

Hashimoto’s thyroiditis has been found to be associated with lymphoma, papillary carcinoma and Hürthle cell neoplasms of thyroid. In contrast, there are only a few reports of co-existence of HT with medullary carcinoma of thyroid. An overall prevalence of medullary carcinoma of only 0.35% has been reported in HT patients. Such a rare combination is being presented here. A 33 year old female presented with history of goiter for one year. Fine needle aspiration cytology of the swelling revealed cytological features suggestive of medullary carcinoma of thyroid. Histopathological examination of total thyroidectomy specimen revealed Hashimoto’s thyroiditis along with medullary carcinoma of thyroid. Although Hashimoto’s thyroiditis can uncommonly coexist with thyroid neoplasm, its association with medullary carcinoma is extremely rare and hence being presented. 

Keywords: association, hashimoto’s thyroiditis, histopathology, medullary carcinoma of thyroid.
Fontan Failure and Thrombosis of Total Cavo-Pulmonary Connection Conduit
Authors: Panthee Nirmal , Murakami Arata , Ando Masahiko , Takaoka Tetsuhiro , Ono Minoru
Published: September 2018

The immediate postoperative period of Fontan operation is frequently complicated by hemodynamic instability, sometimes requiring fenestration of the conduit. Thrombosis of total cavo-pulmonary connection conduit warrants early intervention to prevent systemic and pulmonary embolism. We report a case of Fontan failure requiring fenestration; which was further complicated by thrombosis of total cavo-pulmonary connection conduit and managed with anticoagulants. 

Keywords: congenital heart disease; fontan procedure; thrombosis.
Intravenous Iron Sucrose Therapy in Iron Deficiency Anemia in Antenatal and Postnatal Patients
Authors: Sharma Jyotshna , Tiwari Sanjeeb
Published: September 2018

Introduction: Iron deficiency anemia is the most common nutritional deficiency in pregnancy and more common in developing countries which is aggravated due to increased demand and blood loss during delivery. Though there are different methods for treating iron deficiency anemia. Iron sucrose is being used because of its minimal side effects. This study was undertaken to evaluate the response and effect of intravenous iron sucrose given to patient in antenatal and postnatal period with moderate iron deficiency anemia.

Methods: A hospital based prospective study was conducted 1st Jan 2013-30th Dec 2014 in the department of obstetrics and gynecology Kathmandu Medical College, Teaching Hospital Kathmandu, Nepal. Antenatal and postnatal patients with hemoglobin between 5-9 gm% with diagnosed iron deficiency anemia were included in the study. The aim was to bring her hemoglobin level to 11gm%.

Results: All together 37 patients were enrolled out of which two patient were dropped due to allergic reaction and 35 patients were included in study. Iron sucrose therapy is effective in achieving target hemoglobin of 11gm/dl in 80% of patients. It showed that intravenous iron sucrose significantly (P < 0.001) increase hemoglobin level within two weeks of therapy without any major adverse effects.

Conclusions: Iron sucrose therapy is safe, effective and well tolerated for the treatment of iron deficiency anemia. Parental iron therapy was effective in increasing hemoglobin, serum ferritin and other hematological parameters in antenatal and postnatal patients with anemia. The treatment will help to reduce the risk of maternal complication during pregnancy and postpartum and its adverse effect to fetus. 

Keywords: iron deficiency anemia; intravenous iron; pregnancy.
Complete Bilateral Calcified Psoas Abscess- Rare Sequelae of Untreated Pott’s Spine
Authors: Pannu Chaitanya Dev , K Deepika , Goswami Ankur , Vijayaraghavan G
Published: September 2018

Although rare in the western world; psoas abscess is a frequent finding in Indian sub continent associated with Pott’s spine. Untreated Pott’s spine may lead to various sequelae like destruction of vertebra, kyphosis, paraplageia etc which in modern world is amenable to anti-tubercular drugs and surgical management. We report a case of untreated Pott’s spine with bilateral calcified psoas abscess with kyphosis. To the best of our knowledge no such case of complete bilateral calcified psoas abscesses has been reported earlier. We want to discuss this case with relevant literature review and its influence on treatment plan.

Keywords: aminoglycoside; antistaphylococcal; psoas.
Anaesthetic Management of Patients with Takayasu’s Arteritis for Open Cholecystectomy: a Report of Two Cases
Authors: Shrestha Gentle Sunder , Shrestha Ninadini , Shrestha Battu Kumar , Shrestha Pramesh Sunder
Published: September 2018

Takayasu’s arteritis is a well known yet rare form of large vessel vasculitis. This inflammatory disease often affects the ascending aorta and aortic arch, causing obstruction of the aorta and its major arteries. Anaesthetic management for these patients is complicated by severe hypertension, end-organ dysfunction, stenosis of major blood vessles and difficulties in monitoring blood pressure. We present two patients who underwent open cholecystectomy under neuraxial anaesthesia. We have discussed about various perioperative issues and their management.

Keywords: anaesthetic management; takayasu’s arteritis.
Forensic Application of Palatal Rugae in Dental Identification
Authors: Wazir Sartaj Singh , Arora Pallok , Srivastava Rahul , Rastogi Sameer
Published: September 2018

Introduction: The palatal rugae are anatomical folds or wrinkles located on the anterior third of the palate behind the incisive papilla on each side of the palatal raphe. The rugae patterns have been studied for various purposes mainly in the field of anthropology, comparative anatomy, genetics, prosthodontics, orthodontics and forensic odontology. This study is aimed to determine the difference in number and pattern of palatal rugae in males and females.

Methods: This is a prospective study in which maxillary impressions of 50 volunteers, 25 males and 25 females were taken and the casts prepared. The boundaries of the rugae were marked with a HB pencil and were observed with a magnifying glass following the classification used by Kapali, et al, (1997). Association between rugae number and sex and rugae shape and sex were tested using two sample unpaired t test.

Results: The study revealed significant difference in the pattern of converge rugae which were found to be higher in females than males, however, no statistical significant difference was found in the number of rugae between the two sexes.

Conclusions: The rugae pattern can be an additional method of differentiation between the males and females in conjunction with the other methods used in forensic sciences.

Keywords: forensic science; human identification; palatal rugae.
Treatment of Chronic Venous Ulcers Using New Four Layers Compressive Bandage Dressing
Authors: Tiwari Kaushal K , Shrestha Krishna G , Sah Bijay , Reddy D.Jaypal
Published: September 2018

Introduction: Lower-extremity ulcers represent the largest group of ulcers presenting to an outpatient department. It is a cumbersome, difficult to treat disease, which causes high morbidity and huge cost for the patient and healthcare system. Current standard treatment includes compression therapy. However, majority of patients need long term treatment with minimal efficacy. Aim of our study is to evaluate efficacy of four layers compressive bandages for the management of chronic venous ulcers.

Methods: In Group A, we have prospectively included 20 patients with chronic venous ulcers on lower limbs for four layers hosiery bandage using Velfour bandage. Other 15 patients, Group B, were treated with conventional wound dressing. Velfour and crepe bandage were done once weekly for three weeks.

Results: DVT was cause of chronic venous ulcer in 70% patient in group A and in 73.3% in Group B. Majority of patients were having left sided chronic venous ulcers. The mean duration of the ulcers was 15.6 vs 10.86 months (group A vs. group B). At the end of 3rd week, in 55% wounds in Group A were healed except few big and deep wounds remained. Most of these wounds also became smaller with minimal discharge. Size of wounds significantly decreased in Group A vs. Group B patients (0.7±0.81 cm vs. 1.73±0.77 cm, p<0.00031). However, cost of treatment in group A remained higher than group B.

Conclusions: Our study has shown that four layer compressive bandage using Velfour is an easy, effective, and reproducible method of treatment for the chronic venous ulcer. 

Keywords: compression bandage; treatment; venous ulcer.
Clinicopathological Pattern of Penile Cancer in a Tertiary Care Centre in Nepal
Authors: Gupta Dipesh K , Luitel Bhoj Raj , Chalise Pawan Raj , Subedi Pradeep Prasad , Chapagain Suman , Thakur Dipak Kumar , Sharma Uttam Kumar , Gyawali Prem Raj , Shrestha Guna Kumar
Published: September 2018

Introduction: Carcinoma of penis is an uncommon entity. The higher incidence in developing country may be because of poor hygiene, less common practice of circumcision and unsafe sexual practice. Timely diagnosis and intervention gives the patient a chance of cure. Data on penile cancer is sparse from Nepal so treatment of penile cancer in our centre is presented here.

Methods: This was a retrospective cross-sectional study done at Urology unit of Department of Surgery of Tribhuvan University Teaching Hospital, Nepal from November, 2007 to December, 2013. Data was retrieved from case records and those with penile carcinoma were included. Patient demographics, lesion characteristics, mode of treatment with outcome measures were noted and analyzed.

Results: Total 17 patients underwent treatment for primary penile lesion. Mean age of the patients was 51.5 years. Penile growth was the most frequent presentation with five patients coming with more than one symptom. The most common site was over glans of penis (n=13) with the mean size of 3.55 cm. Partial penectomy was offered in 16 with one patient undergoing circumcision only. Inguinal lymph node dissection was done in four patients. Squamous cell carcinoma was the histological diagnosis in 15 patients.

Conclusions: Penile carcinoma is primarily a disease of old. Growth over glans penis is the most common presentation and partial penectomy is feasible in most of the patients to allow oncological cure while preserving the organ for its native function. 

Keywords: inguinal lymph node dissection; partial penectomy; penile cancer.
Estimation of Physiological Cost Index as an Energy Expenditure Index using MacGregor’s Equation
Authors: Rana Binaya SJB , Pun Matiram
Published: September 2018

Introduction: Physical activity and energy expenditure can be quantified by measuring heart rate, oxygen uptake and respiratory quotient. The Physiological Cost Index (PCI) proposed by MacGregor is a simple and straightforward method to estimate the energy expenditure index. Here, we aim to estimate the energy expenditure among young Asian population using MacGregor’s equation. 

Methods: A total of 50 young randomly selected healthy females performed 50m, 100m and 150m walking test at their self-selected preferred speed. The physiological cost index values for 100 m walk at speeds slower and faster than the preferred speed were also obtained. The physiological cost index during exercise was calculated using MacGregor’s equation considering heart rate and speed of walking over the varying distances. 

Results: The PCI values on three different distances are consistent during self selected preferred speed. The PCI estimation on second and third tests for all three distances walked consistently reproducible. However for each distance walked, the first test the PCI was significantly higher than the second and third test values. The PCI values increased significantly when subjects walked either slower (p = 0.02) or faster (p = 0.001) than their normal preferred speed. 

Conclusion: The physiological cost index values were similar for varying distances walks. The PCI was the least at the preferred speed of walking and increased when the subjects either walked slower or faster than the preferred speed. The first estimation was higher than subsequent estimations. 

Keywords: energy expenditure index; exercise; physiological cost index. | PubMed
Extracorporeal Irradiation in Malignant Bone Tumors
Authors: Bhandari Ranjan Bhakta , Jha Anjani Kumar , Neupane Pradeep , Sigdel Arun , Chaurasia Pradumna Prasad
Published: September 2018

Extracorporeal irradiation is relatively a rare method used in the management of malignant bone tumors . It consists of en block removal of the tumor bearing bone segment, removal of the tumor from the bone, irradiation and re implantation back in the body.Keywords: extracorporeal irradiation; malignant bone tumors; osteosarcoma.
Conventional Brain MRI in Carbon Monoxide Poisoning
Authors: Khanal Ashish , Thapa Subash , Chhetri Pramod Kumar
Published: September 2018

Carbon monoxide poisoning is a common fatal condition which can have acute or chronic presentation with varying severity. It commonly involves globus pallidus and putamen but can involve other parts of brain. Conventional MRI using T1 weighted,T2 weighted and FLAIR sequences are helpful in determining the extent of damage to the brain. However, appropriate clinical and laboratory findings should supplement findings on imaging.

Keywords: brain; carbon monoxide; MRI; poisoning.
Extra and Intra-articular Synovial Chondromatosis
Authors: Chaudhary Rajesh Kumar , Banskota Bibek , Rijal Saroj , Banskota Ashok Kumar
Published: September 2018

Synovial chondromatosis is not so rare intra-articular condition secondary to synovial metaplasia, that affects the knee joint. Extra-articular synovial chondromatosis however is an extremely rare condition that usually involves the synovial sheath or bursa of the foot or hand. We present two cases of synovial chondromatosis, one intra and one extra-articular. The first case was a 25 year old lady who presented with pain, swelling and restricted range of motion of left knee and was found to have an intra-articular synovial chondromatosis which was treated successfully by joint debridement. The second case was that of a 22 year old man who presented with right knee pain and was diagnosed to have an extra-articular synovial chondromatosis of his right medial hamstring tendon sheath, excision of which resulted in complete relief of symptoms.Keywords: extra-articular, intra-articular, metaplasia, rare, synovial chondromatosis.
Rational for conducting PTSD Researchand Challenges of Recruiting and Training Volunteers to Screen and Treat PTSD among the Nepal 2015 Earthquake Survivors
Authors: Jha Arun , Shakya Suraj
Published: September 2018

Post-traumatic Stress Disorder is common psychiatric morbidity among earthquake survivors, and if untreated people suffer from it for years. Government of Nepal and NGOs provided various short-term mental health services to the victims of the 2015 earthquake in Nepal, but there was no plan or provision for long-term mental health problems. The prevalence of PTSD following natural disasters depends on various local factors requiring understanding and further investigation before identifying affordable evidence based interventions. This paper discusses the need for PTSD research among the survivors of the 2015 earthquake in Nepal, and describes the challenges and difficulties of recruiting and training PTSD volunteers. 

Keywords: earthquake; narrative exposure therapy; Nepal; prevalence; PTSD.
Clinico-Epidemiological Study on Pesticide Poisoning in a Tertiary Care Hospital in Eastern Nepal
Authors: Agrawaal Krishna Kumar , Karki Prahalad
Published: September 2018

Introduction: Pesticide poisoning is a major health problem worldwide. In Nepal the most common cause is suicidal and pesticides account for more than fifty percent of cases. The objective of the study was to look in detail regarding the pesticide poisoning cases admitted at BPKIHS; their epidemiological profile, presentation, treatment and their outcome during the hospital stay. Drug therapy included specific antidotal drugs; atropine and pralidoxime (PAM) and some nonspecificdrugs: antimicrobials and sedatives.

Methods: It was a retrospective study which included 2621 patients with poisoning of which 1661 cases were related to pesticides.

Results: The mean age at presentation was 29 years. The mean duration of hospital stay was 6.7 days. The majority of patients 81.16% showed improvement whereas 6.6% of patients died within 24 hours of admission and 3.54% after 48 hours of admission. Among all the patients 0.5% patients were given ICU care and all others were managed in the different units of medicine ward. The total amount of atropine administered varied considerably from patient to patient, according to the need. Most of the cases were under the influence of alcohol. All the patients had a psychiatry evaluation before discharge.

Conclusions: Pesticide poisoning is increasing in incidence and it is one of the preventable public health problems and includes mainly the patients’ age group 20-30 years. Due to easy availability of pesticides it is the most preferred method of suicide, the main reasons being impulsive act and increased indebtedness in the society. 

Keywords: pesticides; organophosphorous poisoning.