bluuebunny/crossref_metadata_2025 huggingface dataset:
Complementary Feeding Practices of Nepali mothers for 6 months to 24 months children.
Authors: Chapagain Ram Hari
Published: September 2018

Introduction: Lack of knowledge and proper feeding practices contribute to higher childhood morbidity and mortality. The aim of the study wasto evaluate the mother’s knowledge and practices in terms of quantity, quality and timing of complementary feeding in infant and young child.Methods: A hospital based cross-sectional study was conducted between June, 2010 to October, 2011, at Kanti Children's Hospital, Nepal, involving 1100 mothers of children from 6 to 24 months of age who attended outpatient department of this hospital, applying systematic sampling technique using semi-structured questionnaire.Results: Eighty-seven percent of mothers had knowledge about the duration of exclusive breast feeding but only 33.0% practiced it and 21.0% breast fed their children up to 3 months. Eighty-seven percent of mothers knew when to start complementary feeding and 53.27% of mothers used the marketed weaning food. lito alone was offered by 28.27% as complementary food. Though 36.6% had proper knowledge of frequency of complementary feeding, only 33.27% were actually practicing it and 9.9% were offering more frequent thanrecommended. About half of the mothers fed their child with the food of appropriate consistency and 66.0% fed with the appropriate amount. But only 15.82% mothers fed their children with ideal frequency, sufficient amount and ideal quality.Conclusions: There was a knowledge and practice gap of duration of exclusive breast feeding and initiation and continuation of ideal complementary feeding. Rate of exclusive breast feeding was on declining trend._______________________________________________________________________________________Keywords: complementary feeding; exclusive breast feeding; infant and young child feeding; ideal feeding._______________________________________________________________________________________
Pattern of Occurrence of Leukemia at a Teaching Hospital in Eastern Region of Nepal - A Six Year Study
Authors: Kulshrestha Ritu , Sah SP
Published: September 2018

INTRODUCTION:Pattern of leukemia is known to vary widely throughout the world. The characterization of distribution patterns of different subtypes of leukemia in Nepal needs further study. We wanted to study the leukemia pattern in our institute.METHODS:A retrospective study of 196 cases of leukemia, diagnosed at BPKIHS, between January 1997 to December 2002 was done. We analyzed the pattern of leukemia at BPKIHS by morphological subtype, gender, age at diagnosis, time period of diagnosis (seasonality), and geographic distribution.RESULTS:Morphological sub typing showed that 121 cases were of acute leukemia and 75 of chronic leukemia. Chronic myeloid leukemia constituted the single largest group comprising 35.2 % of all cases, followed by acute myeloid leukemia (28.57 %) and acute lymphoid leukemia (19.9 %). Maximum numbers of cases were from the lowlands while least number of cases were from the mountain districts. Results were compared with literature from Nepal and other countries. This is the second series of leukemia from Nepal.CONCLUSIONS:The data published in this study reflects the leukemia pattern in the eastern region of Nepal. The pattern and distribution of AML, CML, ALL was similar to that in the developed western countries while the lesser frequency of CLL was similar to that in Southeast Asian regionKey Words:leukemia, pattern, eastern Nepal, seasonality.
Measuring Management Training Needs of Hospital Managers in Nepal
Authors: Chadwell I , Bhitrakoti R , Khadka R
Published: September 2018

Introduction: This is a study of hospital managers in Nepal, measuring their reported capability to undertake management tasks and explore their views about management development. 

Methods: A questionnaire was administered through hospitals. Respondents were asked to rate a series of management tasks on a scale according to how important it was, for their role and their capability to perform it. These tasks were grouped into different factors. The sample included government hospital of each district and major private or hospitals run bu non-government organizations. 

Results: A total of 31 hospitals were visited in 18 districts. Information was obtained from 103 managers from different professions. In most hospitals visited, overall management was provided by the doctors. Few had undergone some training to take on management responsibilities. All types of managers, regardless of profession or type of hospital, reported a ‘competence gap’for each factor defi ned as the difference between reported importance and capability. Non-government managers consistently rated themselves as beingmore capable than government managers, but the difference was only signifi cant when it concerned managing People. The need for a separate cadre of managers was supported by 85% of respondents but a majority of doctors (57%) felt that the best people to manage hospitals were doctors. 

Conclusions: Consistent with other studies from low income countries, there is an urgent need to provide different modalities of management developmentenabling hospital managers to improve their capabilities. There is widespread need of management training to be made available in Nepal. 

Keywords: hospital management, management competency, management training needs.
Normative Data of Corpus Callosal Morphology in a North-West Indian Population- An autopsy and MRI study
Authors: Gupta Tulika , Singh B , Kapoor K , Gupta M , Kochhar S
Published: September 2018

INTRODUCTION:Morphometric measurements of the corpus callosum (CC) are necessary to have normative values for studying sex, age and race related variations.METHODS:Morphometry of the CC was done in preserved brain specimens and in MRI scans, in adults.The measurements included parameters like length, width, height of the cc, distances between genu and fornix, genu and anterior commissure, splenium and superior colliculus, distances from the different parts of the cc to the nearest cortical surfaces.RESULTS:In the preserved brain group, the length CC was 6.98 cm (males) and 6.86 cm (females) while the corresponding values in the MRI group were 7.57 cm and 7.1 cm. The height CC was 2.15 cm (males) and 1.92 cm (females) in the preserved group, and 3.27 cm (males) and 2.59 cm (females) in the MRI group. The splenial width values were 1.12 cm (males) and 1.01 cm (female) in the preserved brains while the corresponding MRI values were 1.15 cm and 1.17 cm.CONCLUSIONS:The values of different CC parameters observed were almost similar to the values reported in the other two Indian studies. However, Indian values were found to be more than the Japanese values for length, height and most of the widths of CC. The length and width of CC were found to be less than those of Caucasian population. Generation of this data will help in comparing the CC structure of different sex and ages, to study variations from the normal and may help in surgical planning.Keywords:autopsy brains; corpus callosum; magnetic resonance imaging; morphometric data.
Maternal Death Reviews of a Tertiary Care Hospital
Authors: Upadhyaya Indira
Published: September 2018

Introduction: All pregnant women are at risk of obstetrical complications which occurs during labour and delivary that lead to maternal death. Here to report a 10 year review of maternal mortality ratio in "Paropakar Maternity and Women's Hospital (PMWH)" Thapathali  Kathmandu, Nepal.Methods: Medical records of 66 maternal deaths were reviewed to study the likely cause of each death over the study period.Results: There were a total of 66 maternal deaths. While 192487 deliveries conducted over the 10 year period. The maternal mortality ratio (MMR) was 356.64/100000 live birth. The highest MMR of 74.22/100,000 was observed in 2059 and lowest was 17.42/100,000 in 2068 B.S. Leading cause of MMR was remained hemorrhage accounting for 30.30% followed by eclampsia 24.24%. Sepsis, suspected cases of pulmonary embolism and amniotic fluid embolism each contributing 15.15%, 4.54% and 3.03% respectively. Where as anesthetic complication and  abortion constiuates 6.06 % each equally for maternal death. The death noted in older women (30+year) were 36.36%. Primipara accounted for more deaths (51.51%).Conclusions: The fall in maternal mortality rate has been observed except for year 2063 BS.  Haemorrhage is the main contributing cause behind maternal mortality.
A Comparative Study of the Peak Expiratory Flow Rate of Indian and Nepalese Young Adults in a Teaching Institute
Authors: Debray Parthasarathi , Shreevatsa B M , MG R B , Sen T K , Roy S , Saha C G
Published: September 2018

Peak expiratory fl ow rate (PEFR) measurement is the easiest and cheapest method to evaluaterespiratory functions. So, the study was carried out to evaluate PEFR of healthy Nepalese adults andcompare their values with healthy Indian counterparts to know whether Indian prediction equationsfor PEFR can be used for Nepalese adult population or not.One hundred twenty-three healthy, young, non smoker adult Indian (64: 28 Males, 36 Females) andNepalese (59: 32 Males, 27 Females) medical students of 18 to 20 years of age participated in the study.The mean PEFR of Indian (male: 490.4 liter/min, female: 386.0 liter/min) and Nepalese (male: 485.9liter/min, Female: 365.2 liter/min) young adults were found to have no signifi cant differences.As there is no signifi cant difference in the mean PEFR of Indian and Nepalese young adults, predictionequations made for Indian adults can be used to predict PEFR of Nepalese subjects. Therefore, anattempt has been made to formulate a regression equation from the combined Indian and Nepalesesubjects. A stepwise, multiple, linear, regression analysis was performed for this purpose. The analysisshowed that height is the best predictor for PEFR in the present study. The regression equation basedon height for the combined Indian and Nepalese young adults is calculated as: PEFR = 5.687 × Height(cm) – 495.787. However, a stepwise, multiple, linear, regression equation with residual analysisfor the best fi t model was performed to formulate prediction equation for PEFR and this showed achange of the earlier regression equation to PEFR = 5.930 × Height (cm) – 536.131.Keywords: Peak expiratory fl ow rate, peak fl ow meter, prediction equation, spirometry, youngadults
Retrospective Study of Norplant(R) Acceptors on districts of Nepal.
Authors: Shrestha Hari , Pandey Kalyan Raj , Lama H
Published: September 2018

abstract
An Unusual Case of Drug Induced Diabetes Mellitus.
Authors: Singh Dhurba Lal , Manadhar Kiran , Joshi Prajwal
Published: September 2018

abstract
Empyema Necessitatis Presented as Breast Abscess.
Authors: Singh B M , Sayami P , Sharma G P
Published: September 2018

abstract
Rationale of HIV Testing in Nepal.
Authors: Karki Benu Bahadur
Published: September 2018

abstract
Role of Foley’s Catheter in Removing Foreign Body of Oesophagus
Authors: Adhikari Prakash , Bhusal CL , Guragain RPS , Acharya S , Budhathoki B
Published: September 2018

Oesophageal foreign bodies are commonly removed with rigid oesophagoscopy under general anaesthesia, but spherical foreign bodies can also be removed using a foley's catheter under fluoroscopic control without anaesthesia. We present a case of successful removal of a spherical marble from the oesophagus in a four years old girl by a foley's catheter under general anaesthesiaKeywords:Keywords:Foreign body, oesophagus, foley’s catheter
Giant Placental Chorioangioma with Intrauterine Fetal Death
Authors: Dhar Hansa
Published: September 2018

Chorioangioma of the placenta is a common benign vascular tumour of the placenta consisting of blood vessels and stroma. Most of these tumours are small and have no adverse impact on the fetus. Large tumours are associated with complications affecting mother and the fetus which may cause intrauterine fetal death. Chorioangiomas probably act as peripheral shunts between arteries and veins (arteriovenous shunts) leading to progressive heart failure of the fetus. Prenatal diagnosis is achieved by ultrasonography and Doppler studies will confirm the highly vascular nature of the mass.As the tumour is associated with unfavourable effects on the mother and fetus like polyhydramnios, prematurity, toxaemia, hydrops and fetal heart failure pregnancy needs to have regular surveillance to detect and manage complications early. A case of giant placental chorioangioma in a primigravida associated with intrauterine fetal death at 30 weeks of gestation is reported._______________________________________________________________________________________Keywords: Chorioangioma, hydrops fetalis; intrauterine fetal death; placental tumors._________________________________________________________________________________
Characterization of Mycobacteria in HIV/AIDS Patients of Nepal
Authors: Dhungana Govind Prasad , Ghimire P , Sharma S , Rijal B P
Published: September 2018

Besides Mycobacterium tuberculosis, a number of other Mycobacterium species are also occasionalhuman pathogens. Tuberculosis due to Mycobacterium avium complex (MAC) and Mycobacteriumkansasii is particularly prevalent in AIDS patients as compared to the normal population. A crosssectionalstudy was carried out during January 2004 to August 2005 in 100 HIV-infected personsvisiting Tribhuvan University, Teaching Hospital, and about a dozen of HIV/AIDS care centersof Kathmandu with the objectives to characterize the different mycobacterial species in HIV/AIDSpatients. Three sputum specimens from each person were used to investigate tuberculosis by Ziehl-Neelsen staining, culture and identifi cation tests. Among the 100 HIV-infected cases, 66 (66%) weremales and 34 (34%) were females. Sixty percent of the cases were in the age group of 21-30 years.Mycobacteria were detected in 23 (23%) HIV cases of which 15 (65.2%) were in the age group of 21-30years ; 17(74%) were males and 6 (26 %) were females. Among 23 co-infected cases, 22 were culturepositive for mycobacteria. Among these, the predominant one was Mycobacterium avium complex(MAC), 9 (41%), followed by M. tuberculosis, 6 (27%), M .kansasii, 4 (18%), M. fortuitum, 2 (10%) andM. chelonae 1 (4%). Signifi cant relationship was established between smoking/alcoholism and thesubsequent development of tuberculosis (χ2=7.24, p<0.05 for smoking habit and χ2=4.39, p<0.05for alcoholisn). Fourteen (61%) co-infected cases presented with weight loss and cough whereasdiarrhea was presented only by those patients with atypical mycobacterial co-infection, which wasas high as 5 (56%) in patients with MAC co-infection. This study demonstrated the predominanceof atypical mycobacteria, mainly MAC, in HIV/AIDS cases and most of them were from sputumsmear-negative cases.Key words: Human Immunodefi ciency Virus, mycobacteria, tuberculosis
Unusual case of Bilateral Angle Closure Glaucoma
Authors: Thapa Madhu , Khanal Safal , Kumar Prajwal , Shrestha Gulsan Bahadhur , Sharma Ananda Kumar
Published: September 2018

Bilateral angle closure glaucoma is a rare ocular emergency which can be a potentially blinding condition. A case of 72 years male, who developed headache and vomiting after five days of demise of his mother followed by blurring of vision. He was taken to the general hospital where all the routine tests and CT Scan head failed to reveal the cause. After two days of admission, patient was referred for ophthalmic consultation. On ocular examination he was diagnosed as a case of bilateral angle closure glaucoma. After two hours of treatment patient was comfortable with normal intraocular pressure and reasonably good vision._______________________________________________________________________________________Keywords: Angle closure glaucoma; Intraocular pressure.
Retinopathy of Prematurity in A Tertiary Care Hospital in Eastern Nepal
Authors: Adhikari Srijana , Badhu B P , Bhatta N K , Rajbhandari R S , Kalakheti B K
Published: September 2018

World Health Organization’s Vision 2020 program has recognized Retinopathy of Prematurity(ROP) as an important cause of childhood blindness in industrialized and developing countries. Inthe last few years, it has been identifi ed in many under developed countries as well, as a result ofimproved neonatal intensive care. In Nepal, ROP screening is carried out in a few tertiary hospitalsbut there is no published data on this disease. The purpose of this study was to fi nd out the incidence,severity and risk factors of ROP among infants screened in a tertiary care hospital in the EasternRegion of Nepal.A prospective cohort study was carried out in neonates with gestational age of 34 weeks or less and,or birth weight of 1700 gm or less born over the period of one year. Dilated fundus examination ofall babies was done by indirect ophthalmoscopy between 2-4 weeks after birth and followed up tillthe retinal vascularization was complete. Classifi cation of ROP was done according to internationalclassifi cation (ICROP). Maternal and neonatal risk factors were also noted.A total of 55 babies fulfi lled the screening criteria. ROP was present in 25.45% (n=14) of the babies.Threshold disease was noted in 5.45% (n=3) of the babies screened. Low birth weight (p<0.01)and low gestational age (p<0.01) was signifi cantly associated with the incidence of ROP. Oxygensupplementation (p=<0.01) was an independent risk factor.ROP screening should be performed in all preterm low birth weight infants where there is availabilityof good neonatal intensive care units. The examination should be intensifi ed in those having riskfactors like oxygen. Further studies in the other tertiary care hospitals in Nepal would help toestablish the screening criteria for Nepalese infants.Key words: Retinopathy of prematurity, Eastern Nepal, screening
Kidney Biopsy: An Experience from Tertiary Hospital
Authors: Ghimire Madhav , Pahari Bishnu , Paudel Navaraj , Das Gayatri , Das Gopal Chandra , Sharma Sanjib Kumar
Published: September 2018

Introduction: Kidney Biopsy is an important diagnostic tool in Nephrology. It is useful in Nephrology in terms of diagnosis, prognosis and management. There is little information on renal biopsy data from central Nepal. We describe our center`s experience in kidney biopsy in term of histological patterns, complications and outcomes.Methods: We prospectively analyzed the biopsies data of patients over a period of one and half year. All kinds of kidney disease patients were included for kidney biopsy, irrespective of their clinical syndromes and underlying diagnosis.Results: A total of 75 biopsies were analyzed. Majority of them were females; 56% (n=42). Most of the biopsies; 84% (n=63) were from younger subjects ≤ 45 years and majority of them fell in the age group 11-20 years. Most common clinical renal syndrome to undergo biopsy was Sub Nephrotic range Proteinuria in 53.3% (n=40). Among comorbid conditions, 53.3% (n=40) had Hypertension. The most common histological pattern seen was Mesangial proliferative Glomerulonephritis (MesPGN) seen in 24% (n=18). Among complications associated with the procedure, macroscopic hematuria was seen in 6.7% (n=5) cases and clinically significant perinephric hematoma causing pain was seen in 5.3% (n=4). There was no mortality associated with biopsy procedure.Conclusions: Sub Nephrotic range Proteinuria was the commonest clinical renal Syndrome observed. In terms of renal histology, Mesangial Proliferative Glomerulonephritis (MesPGN) was the commonest histological pattern observed. Kidney biopsy is a safe procedure without any significant adverse events.Keywords: Kidney biopsy, sub nephrotic range proteinuria, mesangial proliferative glomerulonephritis
Pre-emptive Renal Transplantation: Optimum Treatment for End-Stage Renal Disease?
Authors: Shrestha B M
Published: September 2018

Renal transplantation (RT) prior to having dialysis or pre-emptive renal transplantation (PRT) hasbeen controversial because of the paucity of clinical evidence to clarify the benefi ts and risks of PRT.The recent emergence of evidences from major transplant centres in the United Kingdom and UnitedStates have confi rmed the survival advantages for both renal allografts and RT recipients. Hence anincreasing number of transplant centres are adopting the practice of PRT. This article discusses theadvantages and disadvantages of PRT and highlights the clinical evidences in support of PRT.Key Words: Dialysis, kidney transplantation, pre-emptive renal transplantation
The Effects of Aceclofenac and Nabumetone in Osteoarthritis
Authors: Paul Suhrita , Das N , Ghosh S
Published: September 2018

Introduction: Aceclofenac, a NSAID is widely used in the treatment of pain and infl ammation associated with osteoarthritis. Nabumetone, a recently developed preferential cyclo-oxygenase 2 inhibitor has also proved to be equally effective. The present study was undertaken to evaluate the ‘real better’ drug, amongst these with better effi cacy and gastro-intestinal tolerability as well.Methods:Four hundred and twenty-three patients of either sex, aged 40-64 years with uncomplicated osteoarthritis of knee joint were randomly allocated into three equal groups receiving aceclofenac, nabumetone or placebo. A baseline pain measurement was done with Visual Analogue Scale (VAS: 0-10 scale) and Investigator Global Assessment of Disease status (IGADS: 0-4 point scale). Code was broken at the end of two weeks or earlier to eliminate any real fatal outcome. Final evaluation of efficacy was done at the end of four weeks. The signifi cance of difference between the treatment outcomes was analyzed using one way ANOVA test. Results:During the active comparator controlled period, the most common reason for discontinuation was unacceptable adverse events. While 108 (76.6%) participants could take the full course of treatment with aceclofenac, 118 (83.7 %) of the nabumetone group completed the study. Drop outs were highest in the placebo group (33.9%) followed by the aceclofenac group (12.1%) and nabumetone group (8.5%). Discontinuation due to G.I. intolerance was least in the placebo group (2.1%) followed by the nabumetone group (5%) and aceclofenac group (7.8%). Conclusions:The preferential inhibition of cyclo-oxygenase 2 by nabumetone was postulated to afford better clinical effi cacy and gastrointestinal tolerability in osteoarthritis as compared to aceclofenac.Key Words: aceclofenac, nabumetone, osteoarthritis
Pattern of End Stage Renal Disease in a Tertiary Care Center
Authors: Khakurel Sudha , Agrawal Rajendra Kumar , Hada Rajani
Published: September 2018

Introduction: End Stage renal disease (ESRD) is a major public health problem across the world and it is rising. The incidence prevalence and causes of ESRD is not known in Nepal. With a population of 27 million people the estimated incidence of ESRD is around 2700/year if we take 100/million population at par with India and Pakistan. However majority of patients do not reach hospitals with dialysis facilities. The aim of the present study was to analyze the clinico-epidemiological profile of ESRD in the Nepalese context. Methods: A retrospective, cross sectional study was conducted on newly diagnosed ESRD patients within fi ve years in a tertiary care center. Their demographic profi le, etiology and follow up were studied.Results: The mean age of the patients was 42 years, male to female ratio being 1.7:1. Chronic glomerulonephritis (41%) was the leading cause of ESRD, followed by diabetic nephropathy (16.8%) and hypertensive nephrosclerosis (13.7%). Unexplained renal failure constituted 18% of our cases. Intermittent peritoneal dialysis (IPD) remained the initial mode of therapy due to easy accessibility. Most of the patients dropped out after having single session of IPD. Others went for repeat sessions of IPD or haemodialysis. Out of the 23.6% who went for haemodialysis only 13% could continue dialysis for more than three months and 3.8% could go to neighboring country for renal transplantation.Conclusions: CGN is the leading cause of ESRD followed by diabetic nephropathy and hypertension. It affected younger age group people. ESRD treatment is costly and unaffordable by most Nepalese people. Stress should be given to the health education and screening programme for prevention and early detection of CKD.Key Words: end stage renal disease, intermittent peritoneal dialysis, Nepal
Detection of Abnormal Cervical Cytology in Papanicolaou Smears in a Tertiary Care Center
Authors: Hirachand Suspana , Bajracharya Junu , Pradhanang Sabi , Lama Sanju
Published: September 2018

Introduction: Cancer of uterine cervix is a leading cause of mortality and morbidity among womenworldwide. In developing countries it is the most common gynaecological cancer and one of theleading causes of cancer death among women. Pap smears are commonly used as cytologicalscreening test for successful eradication of precancerous lesions, which has made it a routineprocedure worldwide.Methods: This descriptive study was conducted at Kathmandu Medical College Teaching Hospital,Kathmandu within a period of two years from January 2011 to December 2012. A total of 1369 caseswere screened.Results: In this study, cytological examination of the smears showed 944 (68.95%) inflammatorysmears, 301(21.99%) normal smears, 101(7.38%) atrophic smears, seven (0.51%) ASCUS, two (0.15%)LSIL, four (0.29%) HSIL and two (0.15%) squamous cell carcinoma. Radiation changes were seen inthree (0.22%) cases. Of all the smears studied five (0.36%) cases were inadequate. Regarding ethnicity,incidence of epithelial cell abnormalities was high in Tamang (5 cases). Eleven cases (73.33%) ofepithelial cell abnormalities were seen in patients from urban areas.Conclusions: In country like Nepal with predominant rural population, screening and awarenessprograms with co-operation of media, non-government organizations and government should beformulated for early detection of cervical cancer._______________________________________________________________________________________Keywords: Bethesda system; cervical intraepithelial lesions; pap smear___________________________________________________________________________
Gastric Cancer Perforation: Experience from a Tertiary Care Hospital
Authors: Kandel Bishnu Prasad , Singh Yogendra , Singh Keshav Prasad , Khakurel Mahesh
Published: September 2018

Introduction: Gastric cancer perforation can occurs in advanced stage of the disease and is oftenassociated with a high morbidity and mortality. Peritonitis due to perforation needs emergencylaparotomy and different surgical procedures can be performed for definitive treatment. Surgicalprocedures largely depend on the stage of the disease and general condition of the patient. Thisstudy was carried out to evaluate the outcome and role of different surgical procedures in gastriccancer perforation.Methods: Medical record of patients with gastric perforation, who were treated during ten yearsperiod, was reviewed retrospectively. Data regarding clinical presentation, surgical procedures,staging and survival of patients were obtained.Results: Features suggestive of diffuse peritonitis were evident in all cases. The majority of thepatients underwent emergency surgery except one who died during resuscitation. The majority ofpatients were in stage III and stage IV. Surgical procedure includes simple closure and omental patchin five patients, simple closure and gastrojejunostomy in nine patients, gastrectomy in six patientsand Devine’s antral exclusion in one patient. Surgical site infection was the most common (45.5%)postoperative complication. Four patients died within one month of the surgery. Three patients whounderwent gastrectomy survived for one year and one patient survived for five years.Conclusions: Although gastric cancer perforation usually occurs in advanced stage of the disease,curative resection should be considered as far as possible._______________________________________________________________________________________Keywords: gastric cancer; gastrectomy; laparotomy; perforation; peritonitis.
Desmoplastic Ameloblastoma of the Mandible
Authors: Adyanthaya Soniya , Shetty Pushparaja
Published: September 2018

The Desmoplastic Ameloblastoma exhibits important differences in anatomical distribution, histologicappearance and radiographic findings compared with the classic type of ameloblastoma. We describea case of desmoplastic variant of ameloblastoma localized in the mandibular anterior portion of thejaw, extending posteriorly in the left side. The tumor was expansile, slowly growing and painless.The radiographic finding showed diffuse, radiolucent lesion with cortical bone expansion. Surgicalexcision was performed and follow-up examination done after two years disclosed no recurrence.The purpose of this article is to assist in better understanding of this variant of odontogenic tumor._______________________________________________________________________________________Keywords: Ameloblastoma; desmoplasia; mandible; odontogenic tumor.
Paratesticular Leiomyosarcoma: A Case Report
Authors: Patil Vijaya , Verma Ashish , Pattar Ravindra S. , Nandar Sanjay
Published: September 2018

Paratesticularleiomyosarcomas are rare neoplasms. Radical orchidectomy and high ligation of cordfollowed by surveillance is the treatment of choice. Here we report a 73-year-old man who presentedwith a 2-year history of painless lump in the left hemiscrotum. A left radical orchiectomy with highligation of the spermatic cord was performed. The histo-pathological and immunohistochemistryevaluation revealed a moderately differentiated leiomyosarcoma of paratesticular region. Thepatient is still alive with no evidence of local recurrence and distant metastasis after seven years offollow-up._______________________________________________________________________________________Keywords: leiomyosarcoma; spermatic cord; paratesticular; surgical procedures.
Sleep Induced Hypoxemia in Chronic Obstructive Pulmonary Disease
Authors: Zhang Jing , Wang Yan , Feng Jing , Sun Xin
Published: September 2018

Chronic obstructive pulmonary disease is a leading cause of morbidity and mortality worldwide.Sleep-induced hypoxemia is defined as “an SpO2 (oxyhemoglobin saturation) during sleep of <90% for more than five minutes with a nadir of at least 85%” or “> 30% of total sleep time with anSpO2 of < 90%” in subject with a baseline awake SpO2 of ≥ 90%. Patients with moderate or severeCOPD run a high risk of developing SIH mainly because of alveolar hypoventilation and ventilationperfusionmismatch. Compared to their non-SIH brethren, SIH COPD patients have greater degreesof pulmonary hypertension and cor pulmonale, require more frequent hospitalizations, and sustainhigher mortality rates. And the necessity of treatment of isolated SIH in COPD has been debatedfor years. In this mini review, the definition, reasons, prevalence, clinical significance and treatmentapproaches of SIH in COPD are summarized._______________________________________________________________________________________Keywords: chronic obstructive pulmonary disease; polysomnography; rapid eye movement;sleep-induced hypoxemia.
Frequency of Blood Culture Isolates and their Antibiogram in a Teaching Hospital
Authors: Shrestha Subha , Amatya Ritu , Shrestha Raj Kumari , Shrestha Rajiv
Published: September 2018

Introduction: Bloodstream infections are associated with significant patient morbidity and mortality. Antimicrobial susceptibility patterns should guide the choice of empiric antimicrobial regimens for patients with bacteremia.Methods:  Blood sample received from the patient attending Nepal Medical College and Teaching Hospital from March 2013 – August, 2013 were subjected to for culture. Isolate identification and antimicrobial susceptibility testing was done by standard microbiological methodResults:  Out of the total 2,766 blood samples, 13.3% showed bacterial growth. The percentage of neonatal septicemia was 13.3%. Staphylococcus aureus (28%) was the most common isolates followed by Salmonella enterica Serotype Typhi (22%), Coagulase negative Staphylococci (9.5%), Salmonella enterica Serotype Paratyphi ((7.6%) and Klebsiella pneumoniae (7.6%). 26.3% of the isolates of Staphylococcus aureus were oxacillin resistant. Most of the gram positive organisms were susceptible to amikacin and vancomycin and showed high level resistance to cefuroxime and cotrimoxazole. Out of 109 isolates of typhoid bacilli, 95.3% were resistant to nalidixic acid ,79% to ciprofloxacin and 60.5% to ofloxacin. More than 50% of the isolates of Klebsiella pneumoniae and Escherichia coli showed resistance to  cephalosporins and cotrimoxazole. Acinetobacter spp showed high resistance (more than 60%) to ceftriaxone and ofloxacin. More than 20% of the isolates of Pseudomonas aeruginosa were resistant to ciprofloxacin and amikacin.Conclusions:  Ongoing surveillance for antimicrobial susceptibility remains essential, and will enhance efforts to identify resistance and attempt to limit its spread.Keywords: antibiotic; bacteria; blood stream infections.
Early Development of Refl ux Esophagitis after Successful Helicobacter Pylori Eradication in Superfi cial Gastritis
Authors: Jeon H H , Jeon HH
Published: September 2018

The relationship between gastroesophageal refl ux disease (GERD) and Helicobacter pylori (H. pylori) eradication is still debated. Recently, we had a patient of GERD who had developed it shortly after H. pylori eradication therapy. A 72-year-old man was diagnosed by endoscopy as suffering from severe superfi cial gastritis in the stomach body. A rapid urease test showed H. pylori infection. He was then started on proton pump inhibitor (PPI) based therapy for two weeks eradicating H.pylori. After completion of H. pylori eradication, he complained of a heart-burn sensation. Follow-up endoscopy showed refl ux esophagitis, of grade B according to the Los Angeles classifi cation. Since the patient had developed GERD after completion of the triple therapy, their suggests that H. pylori eradication must have triggered the development of de novo GERD after a short period of time.

Keywords: GERD, Helicobacter pylori, PPI.
Prognostic Value of Baseline High-Sensitivity C–Reactive Protein in Patients Undergoing Replacement Arthroplasty
Authors: Ghosh S , Paul Suhrita , Bhattacharjee D P , Ghosh P , Chatterjee N
Published: September 2018

Introduction:A prospective hospital based blinded study was carried out in an orthopedics department in a medical college hospital of Kolkata, West Bengal, India, with the objective of assessing the role of pre-operative high-sensitivity C-reactive protein (hsCRP) level in predicting postoperative complications in replacement arthroplasty. Methods:One hundred and twenty one study subjects were selected. The blood collected in pre-operative, perioperative and postoperative states were stored and fi nally analyzed after the data collection was over after the stipulated follow-up time of post operative Day-14. The patients were divided into two groups according to baseline hsCRP level <3mg/dl and >3mg/dl. The other preoperative parameters measured were found to be statistically comparable.Results: Among important fi ndings, operative time was signifi cantly higher in the group with hsCRP>3mg/dl, postoperative complication rate was also signifi cantly more in that group. Postoperative complication in Day-7 though quite high among both the groups (45% and 50.9%), the difference was not statistically signifi cant. Comparison of hsCRP levels at baseline, perioperative, postoperative D7 and D14 also showed no significant changes.Conclusions:We concluded that high hsCRP level(>3mg/dl), in patients with apparently no other risk factors may be at higher risk of developing complications after post operative D14 of replacement arthroplasty and operative time also signifi cantly increases with high baseline hsCRP level. Key Words: postoperative morbidity, reactive protein, replacement arthroplasty
Hearing Preservation in 2.7 cm Vestibular Schwannoma
Authors: Lohani Subash , Devkota U P
Published: September 2018

Hearing preservation is exceedingly diffi cult in vestibular schwannoma surgery, especially with increasing tumor size. We herein report a case of hearing preservation in a 2.7 cm vestibular schwannoma, where the patient maintained her pre-operative hearing threshold of 55 dB till a year after surgery. Hence, it appears that an attempt at hearing preservation is worth pursuing.Key Words: hearing preservation, tumor size, vestibular schwannoma
Subglottic Chicken Bone in a Five Months old Baby
Authors: Prakash Sanjay , Bhusal C L , Acharya K , Sinha B K
Published: September 2018

Foreign body aspiration most commonly affects young children,with respiratory symptoms such as wheeze and cough after a chokingepisode. When the foreign body is fi rst inhaled as per witnessed by the parents or caregiver there is always choking or gaging episode, followed by a coughing spell. The absence of a cough strongly rules out the possibility of foreign body having entered the air passage. Here we report a case of chicken bone inhaled as foreign body in a fi ve months old baby.Key Words: bone, chicken, subglottic
Neonatal Sepsis as a Major Cause of Morbidity in a Tertiary Center in Kathmandu
Authors: Thapa Badri , Thapa Anurag , Aryal Dhan Raj , Thapa Kusum , Pun Asha , Khanal Sudhir , Mahat Kishori
Published: September 2018

Introduction: Neonatal sepsis causes high morbidity and mortality of newborns. The study aims to study the predictors and clinical, haematological and bacteriological factors of neonatal sepsis.

Methods: A descriptive cross sectional study was conducted in a Neonatal Intensive Care Unit (NICU) of Paropakar Maternity and Women’s Hospital in Kathmandu between October and December 2011. Demographic, obstetrics, clinical and microbiological data were studied for 300 neonates.

Results: The NICU prevalence rate of sepsis was 37.12%. Early onset neonatal sepsis was common (91.39%) (P=0.000). Cesarean section (OR 1.95, 95% CI 1.15-3.31), apgar score <4 at 1 min (P=0.00) and <7 at 5 min of birth (P=0.00) predicted sepsis. Neonates with sepsis were more likely to present with hypothermia (OR 1.180, 95% CI 0.080-17.214), pustules (OR 2.188, 95% CI 0.110-43.465), dehydration (OR 3.040, 95% CI 0.170-54.361), diminished movement (OR 3.082, 95% CI 0.433-21.950) and bulging fontanels (OR 16.464, 95% CI 0.007-41495.430). Coagulase negative Staphylococcus spp. (CoNS) (21, 41.17%) was most common pathogen of neonatal sepsis. Variable antibiotic resistance patterns of isolates with emergence of meropenem resistance in Pseudomonas spp. and methicillin resistance in CoNS and S. aurues were noted. Mortality due to sepsis was highest (15, 8.06%) among total mortalities (21, 11.29%).

Conclusions: Delivery via cesarian section, apgar score <4 at 1 min, and <7 at 5 min predicted sepsis. Morbidity and mortality of neonatal sepsis was common in this setting and early maternal and neonatal interventions are required to address this issue. Keywords: morbidity; mortality; neonatal sepsis; predictors.
Left Axis Deviation in Electrocardiogram with Normal QRS Duration in Ambulatory Adults without Cardiac Symptoms: A Possible Marker of Glucose Intolerance
Authors: Paudyal Amar , Bhattarai Madhur Dev , Karki Buddha Bahadur , Bajracharya Manil R , Rajouria Alark D , Pradhan Amita
Published: September 2018

Introduction: We are increasingly noticing isolated left axis deviation (LAD) in electrocardiogram in younger people with diabetes without obvious heart disease and association of LAD with glucose intolerance has not been explicitly raised before. We planned a study of ambulatory adults with borderline (0o to –30o) and moderate-to-marked (<–30o to –90o) LAD looking into their possible association with glucose intolerance with fasting plasma glucose (FPG) ≥100mg/dL.

Methods: We consecutively enrolled adults aged 30 or more, with electrocardiogram normal duration QRS axis between 0o to –90o, without cardiac symptoms, not on any medication, attending outdoor-clinics for health checkup.

Results: Out of 100 participants enrolled, about 90% were aged between 30 and 60 and 47% had borderline and 53% moderate-to-marked LAD. Moderate-to-marked LAD group had higher frequencies of abnormal blood pressure (BP), FPG, and lipids than borderline LAD group even after conditioning effects of age and sex (p≤0.03) and of FPG after conditioning effects of BP (p=0.02). The frequencies of glucose intolerance were 48.9% even in borderline LAD with 84.9% in moderate-to-marked LAD group. In moderate-to-marked LAD group mean values of BP, FPG, and lipid profiles were higher (p<0.001) and abnormal. In borderline LAD group though mean BP and lipid values were normal, FPG was impaired.

Conclusions: Impaired mean FPG values and high frequencies of glucose intolerance in both borderline LAD group with normal BP and moderate-to-marked LAD group with conditioning of effects of BP in relatively younger ambulatory adults without cardiac symptoms indicate possible association between LAD and glucose intolerance.

Keywords: diabetes; ecg; glucose intolerance; left axis deviation.
Effects of Educational Intervention among Reproductive Age Group Women on Safe Abortion
Authors: Silwal Kalpana , Shrestha Tumla , Dulal Ram Krishna
Published: September 2018

Introduction: Many reproductive aged women needlessly die due to unsafe abortion even when they seek help to terminate their unwanted pregnancy. These deaths could have been prevented had they been aware that safe abortion service was available to them. The study aimed at finding out the effectiveness of the education intervention in improving knowledge among reproductive age group women regarding the safe abortion.

Methods: An experimental intervention was carried out on safe abortion education among the reproductive age group women. The impact of pre- and post- intervention was evaluated by using a set of structured questionnaire in local language. The obtained data was analyzed by using the Excel and Statistical Package for the Social Sciences, version 12.0 for windows and result was interpreted.

Results: The post intervention finding revealed a significantly higher (p= 0.001) mean on knowledge among participants about safe abortion compared to pre-observational test. The mean difference between the pre-test and post-test was 64.1% (Pre-test 11.18 ±12.88 Post-test 75.28 ±9.56). The research hypothesis was accepted with p value paired t-test at <0.001 (0.05). The result supports that the educational intervention was effective in increasing safe abortion awareness among reproductive aged group women.

Conclusion: The safe abortion educational intervention program was instrumental to improve reproductive age women’s knowledge considerably about safe abortion service. 

Keywords: educational intervention; knowledge; safe abortion; women.
FNAC Diagnosis of Cutaneous Leishmaniasis
Authors: Jha Abhimanyu , Gurung Dipendra
Published: September 2018

Cutaneous leishmaniasis is rare in Nepal although visceral leishmaniasis and post-kalazar dermal leishmansis have frequently been reported. Diagnosis is often made in skin biopsy. Fine needle aspiration cytology diagnosis of the disease is a rare event. This was a 33 year male presenting with ulcerated cutaneous nodule at anterior neck. Fine needle aspiration cytology showed granulomatous inflammation with numerous intracellular and extracellular amastigotes. Fine needle aspiration cytology diagnosis of this condition is easy and less time consuming compared to skin biopsy. 

Keywords: anterior neck; cutaneous leishmaniasis; FNAC.
Primary Osteosarcoma of the Breast
Authors: Bhatta Sushama , Aryal Gopi
Published: September 2018

Primary extra-osseous osteogenic sarcomas have been reported in many tissues of the body but their occurrence in the breast is rare. The tumor has poor prognosis with high risk of recurrence and hematogenous spread, most commonly to the lungs. We report a case of primary osteosarcoma of the breast occurring in a 58-year old woman. Histo-pathological examination revealed pleomorphic tumor cells with osteoid formation and positivity for immuno-histochemical stain vimentin.

Keywords: breast; histopathology; osteosarcoma.
Open Reduction and Internal Fixation of Supracondylar Fractures of the Humerus: Revival of the Anterior Approach
Authors: Manandhar R R , Lakhey S , Pandey B K , Pradhan R L , Sharma S , Rijal K P
Published: September 2018

Introduction: Supracondylar fractures of the humerus occur commonly in the paediatric age group. Gartland type III fractures are treated by closed manipulation and percutaneous pinning with K-wires. Open reduction is indicated in open fractures, failed closed reductions and in a dysvascular limb. There are various approaches that can be utilized to perform an open reduction. The approach of choice must be safe, surgeon and patient friendly and should provide a good access to the fracture and the important surrounding structures. The anterior approach has been described as the most versatile approach. The aim of the study was to review the advantages and drawbacks of the anterior approach and to assess the functional outcome of fractures treated via this approach. 

Methods: Twenty ve (15 male and 10 female) patients out of a hundred and twenty eight children with Gartland type III extension variety of supracondylar fractures of the humerus from underwent open reduction and internal xation with K-wires via an anterior approach January 2007 to January 2011. The results were assessed at six months using Flynn’s radiological and clinical criteria.

Results: Twenty ve patients (19.53%) out of hundred and twenty eight patients underwent open reduction and internal xation. According to Flynn’s clinical and radiological criteria, 20 (80%) were found to have excellent and 5 (20%) good results. 

Conclusion: The anterior approach is safe, easy and provides direct exposure of the surrounding neurovascular structures with good to excellent results. 

Keywords: anterior approach, open reduction, supracondylar fractures humerus.
A Carcinoid Tumor of The Esophagus Treated with Endoscopic Ablation Therapy
Authors: Kim Na Rae , Kim Yoon Jae , Hwang In Cheol
Published: September 2018

Esophageal carcinoids are exceedingly rare and only a few limited cases have been reported. Because knowledge about esophageal carcinoid is based primarily on case reports, the treatment of choice has not been settled. We report here on a localized carcinoid tumor in the esophagogastric junction. As our initial biopsy was nearly equal for the excision, we only performed coagulation ablation therapy instead of a wide excision which is traditionally recommended. The patient is free of recurrence so far during 50-month follow-up. Our report suggests that esophageal carcinoids may be not particularly associated with a poor prognosis.Keywords: carcinoid tumor; esophagus; argon plasma coagulation. | PubMed
Rectosigmoid Endometriosis Causing an Acute Large Bowel Obstruction: A Report of a Case and a Review of the Literature
Authors: Gupta R K , Agrawal C S , Yadav R P , Uprety D , Sah P L
Published: September 2018

Endometriosis is often seen in gynecology practice and is treated medically. However, intestinal involvement of endometriosis causing acute large bowel obstruction is uncommon and is dif cult to differentiate from malignancy before surgery, owing to its similar colonoscopic and radiologic ndings. We report a successfully-treated case of a 30-year-old woman in which endometrial in ltration of the large bowel caused acute obstruction, requiring emergency surgery to relieve the symptom and conrm the diagnosis. We present this unusual disease in general surgical practice and also review the literature.

Keywords: colorectal malignancy, endometriosis, intestinal obstruction
Comparative Study between Tramadol and Dexamethasone as an admixture to Bupivacaine in Supraclaivcular Brachial Plexus Block.
Authors: Shrestha Babu Raja , Maharjan S K , Shrestha S , Gautam Binod , Thapa C , Thapa Prabin Bikram , Joshi Mukund Raj
Published: September 2018

Abstract
Abnormal Hepatic Function and Splenomegaly on the Newly Diagnosed Acute Leukemia Patients
Authors: Sharma Poudel B , Karki L
Published: September 2018

Abstract