bluuebunny/crossref_metadata_2025 huggingface dataset:
Skin Diseases and Impact on Quality of Life in the Central Development Region Of Nepal: A Major Public Health Problem
Authors: Shrestha DP , Gurung D , Shrestha R , Rosdahl I
Published: July 2024

Introduction: Skin diseases are one of the most common health problems in Nepal. The objectives of this study are to determine the prevalence of skin diseases and impact on quality of life in the rural areas of central development region of Nepal.
Methods: The study was conducted in the 10 VDCs of 4 districts – Dolakha, Kavre, Makawanpur and Chitwan – of the central development region. A house-to-house survey was carried out to obtain socio-demographic data and identify individuals with skin diseases. Then a dermatologic health camp was conducted in each VDC. During the health camp, the skin diseases diagnosed were recorded and villagers with skin diseases more than 1 month duration were interviewed with skin disease disability index, to assess the impact on the quality of life.
Results: A total of 7348 inhabitants (male – 3651, female – 3787) were surveyed. Of 2586 individuals with skin disease attending the health camps, 1862 (male – 721 and female – 1141, mean age 31.4yrs, range 6 months – 90years) were included in the study. The overall prevalence of skin diseases was 25%. The most common SD categories were eczemas, pigment disorders, fungal infections, nevi and urticarial. The mean skin disease disability index score in the central development region was 13.7, indicating very large impact on the quality of life.
Conclusion: The prevalence of skin diseases and impact on quality of life is very high in the rural areas of the central development region of Nepal. It is a major public health problem. Targeted intervention at the primary health care level should help to reduce the burden.
Fracture Shaft of Femur in Children with Newly Designed Femoral Brace
Authors: Mahara D P , Lamichhane A , Acharya P , Shrestha G C
Published: July 2024

Introduction: With the initial traction and secondary hip spica conservative treatment of fracture shaft of femur in children is an established technique of management all over the world. Three-six weeks of traction followed by another 6-8weeks of immobilization in spica cast at home takes away precious school going time of the children and professional earning time of the parents in our part of the world. The situation compelled us to think and design an Orthosis that not only splints the fractured femur but also maintains the continuous traction and acceptable alignment right from the beginning and allows early mobilization thereby avoiding need of long hospital stay, immobilization on spica cast and abstinence from school.
Methods: This Orthosis has been used successfully in 9 children with fractured shaft of femur, age ranged from 3 to 9 years with average age of 5 years. Initially the patients were put on skin traction. In the meantime, measurement of body parts was taken by an orthotist for fabrication of the brace, which was made available on second week. In presence of the orthotist the brace was applied and its fitting and pressure points were properly evaluated. The patients were discharged the next day and asked to follow up at 2,4,6,9 and 12 weeks with a roentgenogram at every visit. Patients were encouraged to bear weight with the affected limb with the brace on after achieving clinical union. Brace was removed after achieving radiological union.
Results: One patient did not turn up for follow up after application of brace. So, out of the ten patients, nine were included in this study as they had follow up of at least 12 weeks. Seven cases were male and two female. The average age of the patients was 5 years (range 3 to 9 years). The follow up period ranged from 12 weeks to 3 years with average period of 9.3 months. Radiological union was seen to occur at 12th week in 7 patients and 9th week in 2 patients and the brace was discarded at that time. Fracture united in all patients without any obvious angular, rotational deformities and limb length discrepancy.
Conclusion: Preliminary findings of this study showed the use of this Orthosis in the treatment of fracture shaft of femur in children has proved to be as good as the traditional method with distinct advantages of treating at home and early mobilization with the brace on.
Laboratory parameters of β thalassemia minor patients visiting BPKIHS as diagnosed by Agarose Gel Electrophoresis
Authors: Sherchand O , KC. R , Lamsal M , Baral N
Published: July 2024

Introduction: Thalassemia is one of the most common genetic disorders worldwide. The current study aims at various laboratory parameters including agarose gel electrophoresis (AGE) pattern of patients consistent with clinical symptoms of β thalassemia minor.
Methods: A total of 78 blood samples collected from patients visiting BPKIHS, Dharan to workup for anemia and red blood cell indices. From these 78 patients, 8 samples were suspected of β thalassemia minor and were included in the study. The patients were divided in two groups,  adult above 15 years of age and children less than 15 years of age. These samples were further investigated using various laboratory indices including electrophoresis.
Results: β-thalassemia minor was detected in 8 cases with various hematological parameters  and electrophortic mobilities. The electrophoretic mobility pattern revealed that the patient had increased HbA2 and HbF band and decreased HbA1 band. Among hematological parameters, the mean hemoglobin was 8.1± 2.3gm% in >15 years age group and 3.9± 1.7 in <15 years age group, Peripheral smear revealed microcytic, hypochromic, anisopoikilocytic, target cells and solubility test for sickle cell was negative for all samples. The median unconjugated bilirubin level was 1.95 (IQR: 1.6-2.1) in <15 yrs and 2.25 (IQR: 1.7-7.7) in >15 yrs, the median reticulocyte count was 1.65 (IQR: 0.55-2.3) in <15 yrs and 1.8 (IQR: 1-5) in >15 yrs, Reticulocyte production Index was less than two, median HbF was 7.5 (IQR: 4.2-25) in <15 yrs and 8 (IQR: 1.7-18) >15 yrs , median PCV was 23.4 (IQR: 19.5-25.9) in <15 yrs and 14.6 (IQR: 12.2-16.8) in > 15 yrs. The study also revealed that the β-thalassemia was predominant among Tharus (50%) compare to other ethnicity.
Conclusion: Patients of β thalassemia minor showed decrease in hemoglobin, increased unconjugated bilirubin, abnormal peripheral smear, and abnormal hemoglobin pattern on electrophoretogram.
Clinical Manifestation of Ocular Motor Nerve Palsies in a Tertiary Eye Hospital of Kathmandu, Nepal
Authors: Sitaula S , Sharma AK , Shrestha GB , Gajurel BP , Shrestha GS
Published: July 2024

Introduction: Ocular motor nerve palsies are one of the leading causes of ocular morbidity in the neuro-ophthalmology clinic.
Objective: This study was aimed to determine the aetiology of ocular motor nerve palsies in a tertiary referral eye center of Nepal.
Methods: This hospital based cross-sectional descriptive study was carried out over a period of one and a half years. All cases of ocular motor nerve palsies were evaluated and relevant laboratory investigations and imaging studies were done.
Results: Ninety–one patients with ocular motor nerve palsies were examined, of which 53 (58%) were males and 38(42%) were females. The mean age was 39.4 years ±18.29 years. Majority of the cases (n=78, 86%) had unilateral involvement and the most common chief complaint was double vision (n=58, 63.7%). The sixth cranial nerve palsy was most commonly seen (n=49, 53.85%) followed by third nerve palsy (n=22, 24.18%). Fourth cranial nerve palsy and combined cranial nerve palsies accounted for 10.99% each (n=10). Aetiology of ocular motor nerve palsies could not be determined in 31.8% of the cases. Among the identifiable etiologies were vascular diseases (n=24, 26.3%), infections (n=14, 15.3%), trauma (n=14, 15.3%) and neoplasms (n=9, 9.8%). Imaging studies were done in 92 %(n=84) of cases. In cases of combined cranial nerve palsies, positive diagnostic findings were noted in 50% (n=5) of the cases with imaging studies.
Conclusion: The sixth cranial nerve palsy was the most common ocular motor nerve palsy in our study. The most common identifiable aetiology was vascular diseases followed by trauma. Besides ophthalmic examination, neurological evaluation and imaging plays an important role in diagnosis.
Prevalence and Associated Factors of Depression among Elderly Population Living in Geriatric Homes in Kathmandu Valley
Authors: Choulagai P S , Sharma C K , Choulagai B P
Published: July 2024

Introduction: Depression generally presents in all age group but is more common among elderly population living in geriatric homes. Despite the growth of geriatric home health services, little is known about the mental health needs of geriatric people seen in their homes.
Methods: This study is conducted in July – December 2010 to determine the prevalence and associated factors of depression among elderly population living in geriatric homes in Kathmandu Valley. A total of 78 elderly people were included in this study. Semi-structured questionnaires and in-depth interview guidelines were used to further exploring the associated factors of depression. The study participants were identified by using Geriatric Depression Scale.
Results: The prevalence of depression was 51.3% with severe depression 15.4% and mild depression 35.9%. Most of the severely depressed respondents (75%) were widow/widower; most of the mild depressed respondents (85.7%) were illiterate; three quarter (75%) of severely depressed respondents had no children; and almost all of severely depressed respondents (90.9%) had difficulty in daily living activities due to health problems.
Conclusion: Majority of respondents were found to be living with varying level of depression. Poverty, presence of physical illness and lacking social and family support contributes to depression. Majority of depressed respondents mentioned their satisfaction with the living in geriatric home.
Evaluation of image quality in chest radiographs
Authors: Chand R B , Thapa N , Paudel S , Pokharel G B , Joshi B R , Pant D K
Published: July 2024

Introduction: Conventional chest radiography is a proven and a useful procedure for imaging of the main airways, lungs, mediastinum, heart, pleura and chest wall. The basic view is Postero- Anterior (PA) of chest in upright position. The role and importance of quality of radiograph is to help the radiologists and the clinicians in the diagnosis of diseases and its management. Thus it is important to show entire anatomical structure, respiration accuracy by counting 6 anterior ribs/ 10 posterior ribs, adequate penetration to see the lower thoracic intervertebral discs through the heart and scapula out of lung fields. The study is an attempt to quantify the quality of chest  radiographs by evaluating the quality of depiction of the anatomical and physical details.
Methods: A cross sectional study was carried out from June to September, 2012 in Tribhuvan University, Teaching Hospital, Maharajgunj. Chest radiographs were collected in the scheduled examination days and evaluated by under the guidance of Radiologist. Five image criteria i.e. anatomical coverage, adequate inspiration, adequate penetration, rotation and scapula out of lung fields were categorized and descriptive statistics were calculated using SPSS version 11.5 software.
Results: A total 1101 chest radiographs were collected from the radiology department for evaluation. Among them about 52.3% chest radiographs met all image criteria but remaining 47.7% did not meet these criteria due to inadequate arrested inspiration (34.8%), inadequate penetration (24%), rotation (21.8%), scapula not out of lungs field (14.7%) and no anatomical coverage (3.8%).
Conclusions: The results identified that performing good quality chest radiograph according to Europcan guidelines is difficult. To a great extent the quality of chest radiographs depends upon skill of radiographer, equipment condition (x-ray machine, CR reader) and co-operation of patients. This is always challenging for radiographer and technologist.
Lupus Nephritis: A comprehensive review
Authors: Sigdel M R , Shah D S , Raut K B
Published: July 2024

N/A
The Incidence of Adverse Reaction to Contrast Media in Computed Tomography Scan
Authors: Chand RB , Maharjan S , Pant DK , Paudel S.
Published: July 2024

Introduction: Iodinated contrast media is the most commonly used drug in diagnostic radiology. In the United States alone, more than 50 million Computed Tomography (CT) studies are performed annually and about 50% of CT studies use intravenous iodinated contrast media. The adverse reactions to intravenous iodinated contrast media range from a mild inconvenience, such as itching associated with hives to a life-threatening emergency. The aim of the study was to determine the incidence of adverse reactions to intravenous non- ionic iodinated contrast media in contrast enhanced CT examinations.
Methods: This quantitative, exploratory-descriptive cross-sectional study was carried out in Department of Radiology and Imaging of Tribhuvan University Teaching Hospital (TUTH), Maharajgunj, Kathmandu. All the patients undergoing contrast enhanced computed tomographic examinations from 29th Jestha, 2068 to 30th Asar, 2068 (12th June 2011 and 14th July 2011) were documented for the incidence of adverse reactions. Contrast reactions were categorized as mild, moderate, or severe according to American College of Radiology Guidelines. Descriptive statistics were calculated using SPSS soft ware.
Results: A total 423 cases were undergone CT scan using non-ionic low-osmolar contrast media. Out of 423 cases, 17(4.01%) adverse reactions were type I (mild). Not a single case of type II (moderate) reaction and type III (severe) reaction was observed. Type I reactions were mainly characterized by nausea, vomiting, headache, dizziness and rashes. Intensity of all events was light, with signs and symptoms receding spontaneously.
Conclusion: Adverse reactions to intravenous administration of a non-ionic contrast media are fewer and mostly mild reactions. Thus the use of non-ionic low-osmolar contrast media is an appropriate strategy for minimizing adverse reactions.
Governing the medical research by ethical norms, a challenge !
Authors: Sherchand JB
Published: July 2024

N/A
Histopathological study of ovarian cystic lesions in Tertiary Care Hospital of Kathmandu, Nepal
Authors: Gurung P , Hirachand S , Pradhanang S
Published: July 2024

Introduction: Ovarian cysts are commonly encountered lesions. They are amongst the most frequent cause of hospitalization and surgery in gynecological practice. One cannot confidently distinguish a benign lesion from a malignant one on the basis of clinical, radiological or gross characteristics along so a histopathology examination is a must as it guides therapy. The study was undertaken to determine the morphologic spectrum of the cystic lesions of the ovary.
Methods: This is a descriptive study which was carried out at Kathmandu Medical College Teaching Hospital for a period of two years from 1st January 2011 to 31st  December 2012. A Total of 135 cases of ovarian cysts were received and processed in the Pathology Department. Hematoxylin and Eosin stained slides were examined.
Results: Among the 135 ovarian cystic lesions, 119 cases (88.15%) were unilateral and 16 cases (11.85%) were bilateral. There were 59 cases (43.7%) of benign cysts, 69 cases (51.1%) of benign tumors, 5 cases (3.7%) of malignant tumors and 2 cases (1.5%) of borderline epithelial tumors. The age of patients ranged from 13 years to 73 years with mean age of presentation of 43 years. Among the ovarian cystic lesions the incidence of mature cystic teratoma was the highest (30%). The most common non-neoplastic cyst was endometriotic cyst (39%), while the most common benign tumor was mature cystic teratoma (58%). The malignant tumor encountered in the study was serous cystadenocarcinoma. Two cases of borderline epithelial tumors (1.5%) were also observed in the study.
Conclusion: The most common cystic lesion that were encountered in the study was benign tumor followed by benign cyst. Of the benign tumors, mature cystic teratoma was the most frequently observed lesion. Among the non-neoplastic cysts, endometriotic cyst was the most frequently observed lesion.
Role of dentists in Disaster Victim Identification of Sita air crash, Nepal
Authors: Dahal S , Agrawal NK , Shrestha PK
Published: July 2024

Introduction: Sita Air Dornier 228, an early-morning flight from Tribhuvan International Airport Kathmandu to Lukla on Friday 28 September 2012 plunged into the banks of the Manohara River in Bhaktapur three minutes after takeoff, killing all 16 passengers and 3 crew members out of which seven were Britons, five were Chinese, one American and the rest, including the crew members, were Nepalese. All deceased were brought to Department of Forensic Medicine, Institute of Medicine for identification.
Methods: Autopsy was carried out systematically by Forensic Medicine experts and dental experts. Personal belongings, medical and dental findings were recorded. Ante-mortem data was collected from family members, relatives and respective embassies. Reconciliation was carried out comparing ante-mortem and post-mortem records,
Results: Of the human remains recovered, sixteen positive identifications were made by dental findings correlated with dental records and description given by family member. Two passengers were identified on medical grounds and the last one by exclusion.
Conclusion: This paper describes the crash victim identification of Sita Air Dornier 228. It highlights the importance of dental records and involvement of Forensic odontologist as a part of Disaster Victim Identification team. The authors were part of Disaster Victim Identification Team, Nepal for Sita Air Crash.
Training of professional nurses in Nepal
Authors: Thakur Laxmi
Published: July 2024

The study:• traces the evolution and growth of nursing education in Nepal;• identifies the acute shortage of nursing teachers which affect the quality of nursingeducation;• reveals the acute shortage of nursing personnel to meet the current requirements.
Ritonavir - An effective drug against HIV
Authors: Grover JK , Vats Vikrant , Rathi SS
Published: July 2024

The new HIV protease inhibitors are likely to represent a major advance in the treatment of HIV infection, particularly when used in combination with other antiretroviral agents. The addition of ritonavir to the standard drug regimen of patients with HIV infection has resulted in decreased mortality and has been shown to slow down the clinical progression of disease as compared to placebo recipients. Although the drug was well tolerated and was not associated with any serious adverse reaction, data from long-term trials is eagerly awaited to corroborate the safety of ritonavir. The problem with other anti-retroviral agents is the emergence of resistance, which is responsible for their waning efficacy. Although resistance has been seen with ritonavir, it arises as a result of multiple mutations, which produces a stepwise increment in resistance. This very complex pattern of resistance explains the absence of rapid appearance of resistant mutants with ritonavir. Moreover, the resistance between ritonavir and saquinavir is not over-lapping, and therefore the combination of these drugs is an attractive proposition especially as ritonavir improves the bioavailability of saquinavir. As such, ritonavir may become an important component of the combination regimen to treat advanced as well as less advanced HIV infection.
Frequency and Severity of Portal Hypertensive Gastropathy in Cirrhosis
Authors: Poudyal S , Sharma S , Khadga PK , Pathak R , Jha A , Shrestha R
Published: July 2024

Introduction: Portal hypertensive gastropathy (PHG) is a common endoscopic finding in patients with Cirrhosis. The pathophysiology of PHG was not clearly understood. It was thought that Portal Hypertension was an important triggering factor for the development of PHG but the other factor must be considered for its progression. It is one of the clinically important gastric mucosal lesions because it may cause acute and chronic gastrointestinal blood loss leading to anemia. The aim of our study is to determine the frequency and severity of PHG in patient with Cirrhosis.
Methods: This was a Cross-sectional observational study involving 61 consecutive Cirrhotic Patients, who attended Upper GI endoscopy were enrolled in this study as per inclusion and exclusion criteria in the Department of Gastroenterology Tribhuvan University Institute of Medicine. Child-Pugh’s score and MELD score was determined at the entry to determine the severity of liver disease. Data regarding clinical and laboratory investigations were collected. Variceal size was measured endoscopically and the severity of PHG was graded according to Mac Cormack Classification.
Results: Out of total 61 patients, the frequency of PHG was found to be 47.5% among them where 44.2% patients had mild PHG and 3.3% patients having severe PHG. There were 29.5% patients in child pugh A, 39.3% in child pugh B and 31.2% in child pugh C. During analysis insignificant relation was found between the PHG with Child pugh score (ρ=0.4) and MELD score (ρ=0.7).When PHG frequency was related to alcohol intake the relations were statistically not significant. There was no association found between portal hypertensive gastropathy with esophageal varices and gender of the patient.
Conclusion: Our data showed that the frequency and the severity of PHG are not influenced by the Gender of the patient, etiology and severity of cirrhosis or by presence of esophageal varices.
Cranial dystonia
Authors: Singh Gurmukh , Upadhyaya Kapil , Dutta Shabari , Dhakal4 Sharmila
Published: July 2024

Cranial Dystonia is characterized by three distinct components - blepharospasm and spasm of oromandibular and laryngeal musculature. We report a case of 73-year old male with features of oromandibular and laryngeal dystonia. Clinicalsymptomatology, clinical investigations including EMG studies and the progress of the case with drug and speech therapies are described.
Prevalence of Helicobacter pylori in children with recurrent abdominal pain
Authors: Wagle B , Shrestha M , Shrestha L
Published: July 2024

Introduction: Recurrent abdominal pain (RAP) in children is defined as at least three episodes of abdominal pain during three month period and severe enough to affect their activities. It is frequent diagnostic problem faced by Pediatricians. Helicobacter pylori (HP) is a pathogen of human gastric mucosa and is considered to be one of the major cause of RAP. The prevalence of HP infection increases with age. The study is to determine the prevalance of HP seropositivity, and the cause of RAP in children aged between 5-16 yrs.
Methods: It was a prospective observational study conducted in department of child health, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu. A total of 60 patients of aged between 5-16 years diagnosed with RAP were enrolled. Detailed history, physical examination and relevant laboratory investigations including USG abdomen and HP antibody Enzyme linked immunosorbent assay( ELISA) were performed.
Results: The prevalence of H Pylori seropositivity in patient with RAP was found to be 16.7%. Among the total 60 patients enrolled in this study with RAP 35 patients (58.34%) the cause was unknown.
Conclusion: In majority of patients with RAP, the cause was not found (58.3%) and the organic causes were found in 38.41% of the patients. The most common cause of organic origin was Hpylori infection (16.7%).
Prevalence of Left ventricular diastolic dysfunction in newly diagnosed and never treated essential hypertension in tertiary care Hospital of Nepal
Authors: Gajurel RM , Sayami A
Published: July 2024

Introduction: Hypertension is a global public health problem with one fourth adults worldwide estimated to have high blood pressure (BP).1 The incidence of hypertension continues to increase in all developed and developing societies as the population grows older and more obese.2 The Framingham Study and other epidemiological surveys have clearly defined HTN as an important cause of morbidity and mortality. 2-3 the aim of this study was to determine the prevalence of Left ventricular diastolic dysfunction in newly diagnosed and never treated essential hypertension.
Methods: A cross sectional study was used for those patients who were attended outpatient clinic of Man Mohan centre with diagnosis of newly diagnosed and never treated hypertension over a period of October 2011 to November 2012.
Results: A total of 130 essential hypertensive patients underwent trans-thoracic echocardiography for evaluation of left ventricular diastolic function. Among 130 consecutive cases 56(43.1%) had normal Left ventricular diastolic function in echocardiography, 22(16.9%) patients had grade I LVDD, 50(38.5%) had grade II LVDD and 2 (1.5%) patients had grade IIIa LV diastolic dysfunction.
Conclusion: LV diastolic dysfunction was found to have very common preclinical myocardial dysfunction even in new and never treated essential hypertension.
Comparison of Different Estimating Equations for Prediction of Glomerular Filtration Rate in Living Kidney Donors
Authors: Poudyal S , Pradhan M , Chapagain S , Luitel BR , Chalise PR , Sharma UK , Gyawali PR
Published: July 2024

Introduction: Assessment of renal function is a crucial step in evaluation of living kidney donors. The standard method for determining renal function is measurement of glomerular filtration rate (GFR) using I-123 iothalamate, Tc-99m Diethylene Triamine Pentaacetic Acid (DTPA) and 51Cr-Ethylene Diamine Tetraacetic Acid. As these methods are expensive and cannot be used in all clinical settings, it is common practice to estimate GFR by creatinine-based equations. The objective of this study is to compare commonly used estimating equations for the prediction of GFR in Living Kidney Donors.
Methods: In 75 healthy kidney donors, GFR estimated by Modification of Diet in Renal Disease Study equation (MDRD), Cockcroft-Gault formula(CG), Chronic Kidney Disease Epidemiology Collaboration(CKD- EPI) equation and 24 hour urinary creatinine clearance were compared to GFR measured by Tc-99m DTPA. Statistical analysis was done using Dunnett’s test and Bland-Altman plot. Similarly, accuracy, precision and bias of each equation were assessed.
Results: Mean GFR calculated by DTPA clearance, CG, MDRD, CKD-EPI equations and 24 hour urine creatinine clearance were 83.35±8.59, 78.99±17.17, 93.30±17.12, 96.34±13.36 and 137.96±43.65 ml/min/1.73m2 respectively. Applying Dunnett’s test, GFR by CG equation minimally underestimated GFR measured by DTPA (p=0.612) whereas GFR estimated by MDRD (p=0.034), CKD-EPI(p=0.03) and 24 hour urine creatinine clearance(p<0.001) were statistically significant. CG equation had the highest accuracy. Using Bland-Altman plot, the precision of CKD-EPI equation was the highest among all.
Conclusion: There is no single creatinine-based estimating equation to assess GFR with utmost accuracy and precision at the same time.
Radiographic findings in non specific low back pain
Authors: Humagain M , Paudel S , Maharjan A
Published: July 2024

Introduction: About 40% of people have low back pain (LBP) at some point in their lives. Non specific LBP where precise pathoanatomical diagnosis cannot be given comprises almost 85% of patients with isolated low back pain. Lumbosacral radiograph is preferred by most of the physicians for the initial assessment of the LBP. It is therefore crucial to evaluate patients with LBP and assess for possible relationship between low back pain and patient characteristics.
Methods: In the study, lumbosacral radiographs of 200 patients with nonspecific LBP coming to Radiology department of T.U. Teaching Hospital were reviewed between July to September 2014. The findings were classified under various categories, tabulated in the Proforma and data were analyzed using SPSS software system.
Results: Among total of 200 patients, 45% (90) were male and 55% (110) were female. The study included patients of different age ranging from 13 to 92 years with highest number in 30-3 and 40-49 age groups accounting for each 23% of total population. Lumbar spondylosis, normal radiographs and loss of lumbar lordosis were the most common three findings comprising 105 (52.5%), 55 (27.2%) and 24 (12%) of radiographs respectively. Lumber spondylosis was the most common finding after the age of 30 years with highest in the age group of 60-69 years comprising 93.8 % (15) of radiographs in that age group. Most of the radiographs of younger patients below 30 years of age were normal.
Conclusion: The study demonstrated that the occurrence of lumber spondylosis was the highest among the radiographs of patients with low back pain. The loss of lordosis and disk degeneration was also significant factors associated with low back pain.
Pulmonary Arteriovenous Malformation: A Rare Cause of Right to Left Shunt.
Authors: Panta OB , Songmen S , Ansari MA , Ghimire RK
Published: July 2024

Pulmonary arteriovenous malformations are rare anomalies where pulmonary arteries and veins communicate by passing the pulmonary capillary bed. They are mostly congenital in origin, however sometimes may be acquired. They may present as a diagnostic dilemma in plain radiography. Computed tomography angiogram has emerged as the diagnostic modality of choice not only for diagnosing the case but also for delineating the angioarchitecture that is useful in treatment planning by surgery or transcatheter embolisation. Here we present a case of a child with large pulmonary arteriovenous malformation being treated as pneumonia and finally diagnosed on computed tomography angiogram.
A Study on Clinical Profile, Risk Factors, Angiographic findings and in hospital outcomes in patient with Acute Myocardial Infraction presented in Tertiary Care Cardiac Centre of Nepal
Authors: Gajurel R M
Published: July 2024

Introduction: Cardiovascular diseases are the commonest cause of death globally account for approximately 12 million deaths annually and are the major contributor to the burden of premature mortality and morbidity1. Coronary Artery Disease (CAD) is becoming a major cause in the developing world as well. Asians have been associated with a more severe form of CAD that has its onset at a younger age group with a male predominance2.
Methods: The study was carried out for the identification of clinical profiles, risk factors and to know the severity of coronary lesions in angiography in acute myocardial infarction. We enrolled 200 consecutive patients with clinical history and typical ischemic ECG changes admitted in Man Mohan cardiothoracic vascular and transplant center through emergency department from January 2016 to December 2017. A predefined Performa was completed to every patient with a detailed clinical history, physical examinations, and investigation studies. The clinical history revealed information about age, gender, risk factors, and modes of presentation and duration of symptoms. The details of physical examination including anthropometric data, vital signs and complete systemic evaluation were recorded. The regions of infarction and rhythm disturbances were also documented by 12 lead ECG
Results: The study showed a significant male predominance with mean age being 54.5 years. The commonest presenting symptom was chest pain (90%), followed by sweating (86%) and. Breathlessness (62%) Tobacco was identified as major risk factors (62%) followed by Hypertension (42%), Diabetes (38%) and strong family history of CAD (28%), Dyslipidemia (26%) & obesity (BMI >25) is least common risk factor (19%) in this study. Patients had typical chest pain (90%) and ECG showed anterior wall changes in 51%. Angiography revealed Left anterior descending (LAD) was the most common culprit artery (41%) followed by Right Coronary Artery (RCA) in STEMI and Left Circumflex Artery (LCX) and multi vessel involvement in NSTEMI. Complications developed in 42.5% of patients, majority being different type of arrhythmias (56%) and least common is mechanical complications (3.5%). All the patients with mechanical complications died in the hospital.
Conclusion: Thus we conclude that AMI is more common in adult male, typical chest pain was the most common presenting symptoms with tobacco use being the major risk factors, anterior wall was the most common STEMI and LAD was the most common culprit artery, Multi vessel with LCX was the predominantly involved in NSTEMI in our study population.
Non-adherence to Lifestyle (Diet and Exercise) Modification Recommendations among the Type 2 Diabetes Mellitus Patients in a Tertiary Level Hospital
Authors: Pandey A
Published: July 2024

Introduction: Non-adherence to lifestyle recommendations among Type 2 Diabetes Mellitus (DM) patients is a big challenge in management of those patients and increases the risk of serious complications like stroke, heart disease, retinopathy, peripheral nerve damage and renal problems compared to the general population.
Methods: A hospital based, descriptive cross-sectional study was conducted to identify non –adherence to life style modification recommendations among 104 type 2 diabetes patients in Kathmandu. Non- probability purposive sampling technique was used. Data were collected through interview by using structured questionnaire. Data were analyzed using SPSS version 16.0.
Results: The mean age of the respondents was 53.8 years (SD±11.0 and 51% were female. The prevalence of non adherence to diet and exercise were 52.9% and 67.3% respectively. The main reasons for non-adherence to diet were lack of family support (50.0%), outside eating habit (31.8%) and poor self control (22.7%). The main reasons for non-adherence to exercise were weather (45.5%), the perception that exercise exacerbated their illness (41.3%) and busy schedule (33.3%). Non-adherence to diet was significantly associated with family support and perception that proper diet plays role in management of diabetes. Non-adherence to exercise was significantly associated with family support, regular health checkup, the perception that exercise exacerbated their illness, received written instruction.
Conclusion: Non-adherence to diet and exercise recommendations was highly prevalent among type 2 DM patients and no single reason could be attributed to non-adherence to both diet and exercise recommendations.
Assessment of Functional Status and Comorbidities among Elderly Admitted in Sub-Regional Hospital, Parsa
Authors: Shrestha KD , Gautam R
Published: July 2024

Introduction: Functional decline may be the first sign of changing health status and the prevalence of co morbidity is high among elderly affecting their functional ability and increases need of hospitalizations. The functional assessment is one of the trademarks of the geriatric assessment that measures the outcome of the treatment, determinant of end of life medical costs and helps to plan for further care needed for elderly. Numerous studies have shown an association between aging and higher risks of functional dependence as well as a high prevalence of functional disability in the older adult population. Hence, this study is to assess the functional status and comorbidities among elderly patient.
Method: A descriptive cross- sectional study was done among elderly patient admitted in different wards of the Narayani Sub-regional Hospital, Parsa. Data was collected through census method from 121 respondents by using interview schedule through interview method. Katz Index of Independence in Activities of Daily Living was used to assess the functional status of elderly. Descriptive and inferential statistics (chi square & odds ratio) were used for analysis.
Results: The study reveals more than half of the respondents (62.8%) were dependent in basic activities of daily living (BADLs). Among them, 57.9% were severely dependent followed by 42.1% moderately dependent in BADLs. Respondents were dependent in bathing (68.6%), toileting (59.5%) and transferring (43.8%). Regarding comorbidities with physical problems, each respondent has average six comorbidities with minimum two comorbidities (Mean 1.71). Among them, 8.1% respondents had chronic cough, hypertension (21.5%), diabetes (8.3%), vision problem (34.7%) and 29.8% had hearing impairment. The study also reveals that hypertension, age and BMI significantly affect the functional status of the elderly. Conclusion: More than half of the respondents were dependent in BADLs especially in bathing, toileting and transferring. Each respondent had average two comorbidities. Hypertension, age and BMI significantly affect the functional status of the elderly. Therefore, functional status and comorbidities of the elderly must be assessed in regular basis to improve the quality of life.
Injury Epidemiology after 7.8 Richter Gorkha Earthquake in Nepal: A Retrospective Study of Injuries Treated at Tribhuvan University Teaching Hospital
Authors: Thapa SS , Lamichhane A , Mahara DP
Published: July 2024

Introduction: Earthquakes are one of the most catastrophic natural disasters that occur without prewarning, Nepal experienced a massive earthquake of 7.8 Richter scale on 25th April 2015.It claimed 8,962 lives across several districts in Nepal with 22,302 injuries. After the earthquake, hospitals are confronted with large number of disaster trauma victims making it challenging for management of such mass casualty. Despite such crisis Tribhuvan University Teaching Hospital (TUTH) provided all possible services round the clock to all disaster victims brought to hospital from very first hour after the earthquake.
Methods: This is a retrospective analysis of management of the injured patients admitted in TUTH after the Gorkha earthquake. Patient’s details including demographic data, injuries sustained and treatment carried out was retrieved from medical record section of the hospital. Injury pattern were categorized broadly into orthopedics related and non-orthopedics injure. Frequency distribution of these data’s was calculated using Microsoft excel.
Results: Out of 1812 earthquake related injuries treated in hospital, 493 injured cases required admission. Their mean age was 35.84±21.84 years. Of them 153(31.6%) cases were from Kathmandu and 133 (27.0%) from Sindhupalchowk and Ramechhap.364 cases had single injury and 129 cases had multiple injuries, 81% of the injuries were orthopedic related and 19 % were non-orthopedic injury. Out of them 361(73.2%) cases required surgery, 119 (24.1%) were managed conservatively, 13(2.6%) died.
Conclusion: Earthquake is the most unpredictable catastrophic natural disaster. Limb fractures and soft tissue injuries are most common among the injury survivors. Knowing the nature and epidemiology of the injuries will help in effective management of available resources for benefit of maximum number of victims.
A rare case of pseudocyesis in a grand multiparous woman in Karnali Academy of Health Sciences: a case report
Authors: Aryal B , Shrestha U
Published: July 2024

Pseudocyesis, sometimes called phantom or false pregnancy is a rare medical condition in which women has false believe of being pregnant. She experiences many signs and symptoms of pregnancy but there is absence of fetus. The etiology of this condition could be the interplay and combination of various psychological, sociocultural and endocrine factors. A case of this rare condition is described in the case report that represents the sociocultural belief of need of specific sex (male) child in the family and believe in traditional healers in rural Nepalese society
A comparison of the quality of care provided and the rational use of drugs in rural public health facilities and private shops
Authors: Holloway K. A. , Gautam B. R.
Published: July 2024

The problem of insufficient funding undermining health care in Nepal has led togreater emphasis being placed on the private sector for service delivery. This studycompared the quality of service provided by primary health care public facilities andprivate shops (the main private primary health care alternative) in rural remote areas ofhilly E. Nepal. A cross-sectional survey was done and WHO indicators used. It wasfound that public facilities provided better access and value for money than shops.Provided adequate levels of drug availability were maintained, public primary healthcare facilities offered better quality of care than private shops, where there was oftenmisuse of drugs particularly antibiotics due to irrational self-medication or patients notbuying what they had been prescribed. However, in many public facilities (notsupported by any agency apart from HMG) drug availability was poorer than in thelarger shops, leading to a similar misuse of drugs, especially antibiotics, as occurredin shops. When considering strategies to decrease the misuse of antibiotics it may beeasier to address poor drug availability in public facilities than change patient-retailerbehaviour in shops. The poor dispensing process and large number of people notknowing how to take their drugs are two serious problems, needing urgent action, inboth the public and private sectors.
Allergic Bronchopulmonary Aspergillosis with massive hemoptysis mimicking pulmonary tuberculosis
Authors: Paudel K , Adhikari S , Pant P
Published: July 2024

Allergic bronchopulmonary aspergillosis (ABPA) is a type II hypersensitivity lung disease induced by bronchial colonization of fungus, Aspergillus fumigatus that commonly occurs in patients with asthma or cystic fibrosis. We present a case of 65year-old Brahmin man, non smoker and non atopic who presented with increasing hemoptysis, initially suspected as pulmonary tuberculosis and later diagnosed as ABPA. He was managed with oral prednisolone 0.5mg/kg/day for 14 days followed by gradual tapering over the period of 6 weeks with remarkable response.
Self esteem and Marital Adjustment among clients maintained on Methadone Maintenance Treatment Program (MMTP)
Authors: Pradhan PM , Ojha SP , Rana M , Regmi MP
Published: July 2024

Introduction: The individual loses the skills necessary to function in life and ultimately exchanges living for his or her addiction. Self esteem and marital adjustment has been seen as significant factors that impact in the individual’s substance using behavior. The aim of the research was to evaluate the Self Esteem and marital adjustment among the clients in the Methadone Maintenance Treatment Program (MMTP).
Methods: The purpose of the study was to assess the level of self esteem and marital adjustment among the clients under Methadone Maintenance Treatment Program, Tribhuvan University Teaching Hospital. Study participants comprised of 61 clients who met the inclusion criteria and gave the consent. It was descriptive and cross-sectional study design. The study was carried out to determine the association between the socio demographic variables, self esteem and marital adjustment. Rosenberg self esteem scale was used to assess the level of self esteem and marital adjustment questionnaire (MAQ) was used to assess their marital adjustment.
Results: The result show there is no significant association between level of self esteem and different socio demographic variables including age group, sex, religion, occupation, and family type of the clients. Similarly, there is no significant association between level of marital adjustment and different socio demographic variables including age group, sex, religion, occupation, and family type of the clients.
Conclusion: The study has explored the self esteem and the marital adjustment of the clients under the treatment of oral substitution therapy. Clients under Methadone Maintenance Treatment Program (MMTP) report maintained marital adjustment, sexual adjustment, emotional adjustment, social adjustment and self esteem.
The Prevalence of Overweight and Obesity in Medical and Nursing Students of Institute of Medicine, Kathmandu
Authors: Mahotra NB , Shrestha L , Pradhan S , Bajimaya M , Malla N , Aryal V , Bhat N
Published: July 2024

Introduction: Obesity has become one of the important global public health issues. It is significantly associated with the prevalence of diabetes, hypertension and coronary artery disease. Body Mass Index (BMI) assesses overweight and obesity based on statistical criteria.
Methods: A cross-sectionaldescriptive study was carried out in young male medical and female nursing students in the department of Clinical Physiology, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu from January 2019 to March 2019. Subjects were selected by convenient sampling and BMI was calculated in 116 medical and nursing students.
Results: Out of 60 male medical students, 7(11.7%) were underweight, 48 (80%) were normal weight and 5(8.3%) were overweight. Similarly, out of 56 female nursing students, 1(1.8%) was underweight, 46(82.1%) were normal weight, 7(12.5%) were overweight and 2(3.6%) were obese.
Conclusion: The prevalence of overweight and obesity is increasing worldwide in all age groups. Young Nepalese people are also affected and are at risk of developing non-communicable diseases. Adaptation of healthy life styles and healthy diets could prevent overweight and obesity.
Influence of semen quality on the success of intrauterineinsemination result in a university teaching hospital infertility center
Authors: Aryal B , Vas P , Vasan SS
Published: July 2024

Introduction: Intrauterine insemination is effective for the treatment of male factor and unexplained infertility. The objective of the study was to understand whether one or more parameters of sperm quality i.e. morphology, motility and concentration have predictive value for the pregnancy outcome of the intrauterine insemination treatment for couple with primary infertility with male factor or unknown cause in the select defined population.
Methods: This is a hospital based prospective study of 776 IUI cycles. The study population was those couples between 19-35 years of age who had been trying unsuccessfully to conceive for a minimum of one year. They were randomly distributed into two groups; partner with sperm morphology, motility and concentration below 5th percentile constituted group A and group B comprised of those with above 5th percentile and their IUI outcome was evaluated.
Results: A total of 776 IUI cycles were studied out of which 94 clinical pregnancies were obtained, for a pregnancy rate cycle of 12.1%. The study shows that sperm morphology is positively associated with IUI results with statistically significant p value (p=0.034). Likewise, a higher total motility level is positively associated with IUI results. Moreover, incidence of positive IUI results were significantly more with post processing motility with excellent progression >90% with statistically significance p value (P=0.004).
Conclusion: Combination of superovulation and intrauterine insemination is an effective means of achieving pregnancy for unexplained and male factor infertility. The probability of pregnancy increases with higher normal morphology, total motile sperms with excellent progression and sperm concentration. If semen parameters are below the 5th percentile value, IVF-ICSI would be preferred.
Unusual neurological cause of intractable hiccups: A case report
Authors: Thapa B , Sedain G , Sharma MR
Published: July 2024

Intractable hiccups is a poorly understood medical problem and the pathophysiology is highly debatable. Here we report a interesting case of 40 year male patient who presented to us with complains of difficulty in swallowing and hiccups for 3 weeks which was resistant to medication . MRI scans revealed Chiari I malformation and cervical syrinx. He underwent Suboccipital craniectomy including a C1 laminectomy following which he was relieved of intractable hiccups.