bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of two-month walking exercise on bone mass density in young, thin women
Authors: Habibzadeh Nasim
Published: February 2010

Effects of two-month walking exercise on bone mass density in young, thin women

Study aim: To examine the effects of a walking programme on the bone mass density (BMD) in sedentary, thin women aimed at preventing bone losses.

Material and methods: Twenty thin (BMI<20) women aged 22.0 ± 1.5 years volunteered to participate in the study. They were randomly assigned into the exercise (n = 10) or control (n = 10) groups, those from the experimental group being submitted to a training programme lasting two months. The programme consisted of 3 walking sessions per week, 30 min each, at 50 - 75% of maximal heart rate. Anthropometric measurements, bone mass density (by DXA) at the hip and lumbar spine (L2 - L4) and oestradiol concentration in serum (by radioimmunoassay kits) in the follicular phase were made before and after the training programme. The same diet was maintained throughout the study and was monitored by 7-day recalls.

Results: The walking programme induced significant increases in BMD (by 5.2% in the hip site, p<0.001, and by 7.3% in the spine, p<0.05). Significant decreases were found in calcium concentration in both groups (by about 5%) and in phosphorus concentration in the experimental group (by about 16%). In the experimental group also the relative body fat content significantly decreased (by 7.7%).

Conclusion: Walking exercise practiced for two months reduced the risk of bone loss by significantly increasing bone density.
Comparative study in extracorporeal shock wave lithotripsy with and without the use of local anaesthetic (Lidocaine 1%) infiltration at the shock wave site
Authors: Nagendra BKC , Sharma U
Published: February 2010

Background: Extracorporeal Shock Wave Lithotripsy (ESWL) is a simple and non-invasive technique in which renal and ureteric calculi are pulverised into small fragments by shockwaves and then allowed to pass spontaneously in small fragments along with urine. Effective ESWL requires a co-operative patient who will remain immobilize on the lithotripsy table comfortably for which different anaesthetic techniques are used. Occasionally discharge of patient is delayed due to persistent sedation, nausea and vomiting. Objective: The aim is to assess the use of local anaesthetic agent (20 ml Lidocaine 1%) infiltration in 60 patients (Experiment Group) and no infiltration in 60 patients (Control Group) on patients undergoing Extracorporeal shock wave lithotripsy (ESWL) procedure. Materials and methods: is a study done in 120 patients of ASA I and ASA II patients undergoing ESWL procedure. The infiltration technique is standardized so that the local anesthetic agent was infiltrated five minutes before the procedure along the line of shockwave site in Experiment Group. Result: In this study, the age, sex, weight, time of shockwave treatment was almost similar in both groups. The mean need of Ketamine and duration of stay after procedure was significantly more in control group than experiment group. Conclusion: In this study, it is concluded that the need of Ketamine and duration of stay after procedure is significantly more in control group.Key words: ESWL; infiltration; Ketamine; Lidocaine 1%   DOI: 10.3126/kumj.v7i2.2697 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 92-96
Left ventricular hypertrophy in hypertension: Correlation between electrocardiography and echocardiography
Authors: Prakash O , Karki P , Sharma SK
Published: February 2010

Background: Hypertension is an important modifiable cardiovascular risk factor. Left ventricular hypertrophy - the marker of hypertension, has emerged as an independent risk factor that can be detected by electrocardiography (ECG) and echocardiography (ECHO). Objective: Correlation of electrocardiography and echocardiographically detected left ventricular hypertrophy in hypertensive patients. Materials and methods: Hundred patients with hypertension were studied for left ventricular hypertrophy by the help of electrocardiography and echocardiography. Left ventricular hypertrophy on ECG was assessed by the help of Sokolow- Lyon Voltage Criteria (SLV) and Romhilt - Estes Point Score (R/E). Results: Among 100 patients, 60 were males and 40 were females. Mean age for male was 54.82 ± 12.10 years and 52.95 ± 11.63 years for female. The mean systolic blood pressure for male was 150.47 ± 20 mmHg and for female 148.60 ± 16.95 mmHg; where as Diastolic blood pressure for male was 93.67 ± 11.13 mmHg and for female it was 96.05 ± 12.47 mmHg. Echocardiography detected left ventricular hypertrophy in 64% patients. Electrocardiography detected Left Ventricular Hypertrophy by R/E and SLV criteria 13% and 34% respectively. Conclusion: In developing and under developed country ECG is a useful tool for detection of LVH where the facilities of echocardiography and trained echocardiographer are still not in a common man's reach. Key words: Left ventricular hypertrophy; Hypertension   DOI: 10.3126/kumj.v7i2.2698 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 97-103
Tearfilm immunoglobulin E (IgE) level in vernal keratoconjunctivitis by ELISA
Authors: Pokharel S , Shah DN , Joshi SN , Choudhary M
Published: February 2010

Background: Vernal keratoconjunctivitis (VKC) is recurrent chronic allergic conjunctivitis occurring in the prepubertal age-group with secondary involvement of the cornea and is self-limiting in character. The disease is prevalent worldwide but it shows predominance in the areas with dry and warm climate including the South Asia. VKC represents about 3% of the serious ophthalmic disease in some parts of the world where the prevalence is rate is high.Type I hypersensitivity reaction which is IgE-dependent and type IV hypersensitivity reaction have been implicated for the pathogenesis VKC. Objective: To determine level of immunoglobulin E (IgE) in the tear film of patients with Vernal Keratoconjunctivitis (VKC) attending outpatient department of BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS). Materials and methods: Thirty-four VKC patients and thirty-four controls were included in this study. Tear samples were collected using micro- capillary glass tube method and tear IgE levels were measured using an enzyme - linked immunosorbent assay (ELISA). Results: There was high concentration of tear IgE level in VKC (95.09IU/ml) than in controls (1.63IU/ml) though the difference was not statistically significant (p=0.16). No statistically significant difference was observed in male and female gender within VKC group and when compared with control group (in male group, p=0.21 and in female group, p=0.26). There was no statistically significant difference observed in tear IgE level in different age groups within VKC group and when compared with control group (p=0.30). The result did not show any significant difference in tear IgE level with respect to the duration of the disease (p=0.23).There was no statistically significant difference in tear IgE level with different episodes of VKC (p=0.69). No statistically significant difference of IgE concentration in tear was seen among different types of VKC (p=0.53) and grades of tarsal and limbal papillae (p= 0.72). Conclusion: There was high concentration of tear IgE level observed in VKC. Key words: Vernal keratoconjunctivitis; Tearfilm; IgE level; Type I hypersensitivity reaction; Type IV hypersensitivity reaction. DOI: 10.3126/kumj.v7i2.2700 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 104-108
A retrospective study on the causes for evisceration at Tilganga Eye Centre
Authors: Limbu B , Saiju R , Ruit S
Published: February 2010

Background: Evisceration is one of destructive surgery of eye after which a patient loses his hope of restoration of sight forever. Aim and objectives: To identify the major causes of evisceration at a tertiary eye centre of Nepal. Materials and methods: This is hospital based retrospective study of patients presented at Tilganga eye centre, Kathmandu, Nepal over a period of two years (10 Nov 2004 to 10 Nov 2006). Out of 2,31,976 total OPD patients, 71 patients who had evisceration with or without implant were selected and finally, only 67 patients record were enrolled for study as data were insufficient in the remaining records to fill up the study format. Data processing and analysis done using computer SPSS 11.5. Results: A total of 67 cases, with age ranging from 1.5 years to 85 years, out of which 33 male and 34 were female. Evisceration was performed most commonly due to trauma and it's subsequent sequele in 37 cases (55.2% of total cases), who were within the age group of 30 - 59 years (p = 0.033) and predominantly male 25 cases(p = 0.001). Most of the patients presented from outside Kathmandu valley, with visual acuity of no perception of light. Conclusion: Evisceration without implant was most common surgical procedure, with trauma being the leading cause for it and most of the trauma was seen in active, potential and young male patients. So prevention of ocular injuries together with early treatment protocol is best way to decrease the rate of evisceration due to ocular trauma. To prevent ocular injuries news paper, television and health education may play an important role. Key words: Ocular trauma; destructive surgery; evisceration. DOI: 10.3126/kumj.v7i2.2702 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 115-119
Influence of duration of symptoms over perioperative outcomes during emergency laparoscopic cholecystectomy
Authors: Sharma SK , Thapa PB , Maharjan DK , Dhakal A , Baral N
Published: February 2010

Background: Laparoscopic cholecystectomy is a gold standard treatment for gall stone diseases. Early surgical intervention in acute calculus cholecystitis is feasible and duration of onset of symptoms does not influence the conversion rate. Objective: To compare the safety and feasibility between urgent and delayed laparoscopic cholecystectomy in patients with acute calculus cholecystitis. Materials and methods: This is a comparative study conducted in Department of Surgery, Kathmandu Medical College, during the period of January 2006 to January 2008. Altogether, 436 patients were analysed out of which 55 were selected as urgent laparoscopic cholecystectomy and were included in the study. Among 55 patients presented with acute calculus cholecystitis were divided into two groups. Group 1 underwent laparoscopic cholecystectomy within 72 hours of onset of pain abdomen and Group 2 after 72 hours of onset of pain abdomen. Results: Conversion rate in Group 1 was 19.44% whereas it was 263% in Group 2 (p = .693). There was no statistically significant difference in mean operating time (p = .412), total hospital stay (p = .626), bile duct injury and postoperative complications. Conclusion: Urgent laparoscopic cholecystectomy is safe and duration of onset of pain abdomen does not influence conversion rate. Key words: Urgent laparoscopic cholecystectomy; Conversion rate; acute calculus cholecystitis DOI: 10.3126/kumj.v7i2.2703 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 120-124
Biochemical nutritional indicators in children with protein energy malnutrition attending Kanti Children Hospital, Kathmandu, Nepal
Authors: Mishra SK , Bastola SP , Jha B
Published: February 2010

Background: Nutrition is the science of food and its relationship to health. Nutritional status is one of the key indicators of health Nutritional status of Nepal is not satisfactory. Especially Protein Energy Malnutrition (PEM) in Nepal is a very common problem in children under five years of age. There are number biochemical parameters which become altered during protein energy malnutrition. Objectives: The objectives of the study are to determine biochemical nutritional indicators among children suffering from PEM and to compare all biochemical parameters with well nourished children and also to determine the factors affecting PEM among children under five years. Materials and methods: The study design was cross sectional, descriptive study with control. Children between ages 6 to 59 months attending outpatient department (OPD) and wards of Kanti Children's Hospital (KCH), Maharajgunj, Kathmandu, Nepal were purposively selected. The sample size was calculated by using prevalence of malnutrition in Nepalese context and allowable error of 10 %, a total of 120 cases which include 60 PEM cases and 60 controls were selected. They were grouped into two groups based on whether they are above or below the 80% of 50th percentile of weight for height based on growth chart of National Centre of Health Statistics 3 (NCHS), USA. Results: The educational status of parents of children with PEM was found to be significantly less (p<0.05) as compared to their non-PEM counterparts. Occupations of parents whose children were in PEM group include mainly housewives and labourers. Larger proportions of children in our study were born at home and exact birth weights of children were not known. Most of the children are colostrum fed. Most of the children in our study were immunized. Almost equal proportion of children belonged to nuclear family type and joint family type. The mean serum glucose, sodium, potassium, cholesterol, haemoglobin was not significantly different in both groups while mean total protein, albumin, and calcium were significantly (p<0.05) low in PEM group when compared to well nourished children (control). There was significantly (p<0.05) higher incidence of hypoproteinemia, hypoalbuminaemia, and hypocalcaemia, in PEM group when compared to control group. Conclusion: A significant proportion of children with protein energy malnutrition had altered biochemical parameters which were related to food intake and biochemical metabolism mandatory during growth and development of children less than five years of age. There was significantly higher proportion of hypoglycaemia, hypoproteinemia, hypoalbuminaemia, anaemia, hypocholesterolemia and hypocalcaemia in children with PEM when compared to normally nourished children. Key words: PEM; Biochemical nutritional indicators; anthropometry DOI: 10.3126/kumj.v7i2.2705 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 129-134
Amyand’s hernia in infant: A rare entity
Authors: Upadhyaya VD , Kumar V , Srivastava P , Gangopadhyaya AN
Published: February 2010

The chance of vermiform appendix lying with in a hernial sac is 1% or less and is known as Amyand's hernia and it is very rare in infant and neonate. Till date, only twenty cases had been reported in English literature. We are reporting a rare case of Amyand's hernia where appendix was present in right inguinal sac of non-obstructed inguinal hernia in a seven month old male infant during operation. The appendectomy was done along with right inguinal herniotomy. In most of the reported cases, appendix was inflamed or perforated, expect in one case where appendix was not inflamed but patient presented with inguinal hernia. This case is reported because of the rarity of Amyand's hernia in infant, the appendix was not inflamed, hernia was not obstructed, and whether in such types of cases appendix should be preserved or not. Key words: Amyand's hernia; infant; appendectomy DOI: 10.3126/kumj.v7i2.2708 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 143-144
Poisoning cases attending emergency department in Dhulikhel Hospital- Kathmandu University Teaching Hospital
Authors: Marahatta SB , Singh J , Shrestha R , Koju R
Published: February 2010

Objective: The objective of the present study is to evaluate the characteristics of acute poisoning cases admitted to emergency department over a one year period. The demographic, clinical and psycho-social aspects of the patients were analysed. Materials and methods: A hospital based study was carried out in the emergency department, Kathmandu University Teaching Hospital/ Dhulikhel Hospital, Dhulikhel analysing the data of the poisoning cases attended for one year. The study was carried out amongst inpatients attending emergency with acute poisoning. Results: A total of 54 patients were admitted to the emergency department with acute poisoning. The female-to-male ratio was 1.34:1. Most poisoning occurred in the age group of above 40 years. The mean ages of female and male were 29.87 ±14.85 years and 35.54±15.02 years respectively. By occupation 40.38% of the cases were farmers. Only 35.29% of the patients were illiterate. 79.24% of the cases intentionally consume the poison. Organ phosphorus poisoning (OP) was the most common poisoning. Oral route was the commonest route of poisoning accounting 98.1%. Sixty-six percentage (66.66%) of the cases had the poison stored in their home with 27.7% bought from the market once needed. Among the cases of acute poisoning 5.55% were fatal. Conclusion: The following conclusions were reached: (1) females were at greater risk for poisoning than males, (2) self-poisoning cases constituted the majority of all poisonings, and (3) the main agents of self-poisoning were OP poisoning. Key words: poisoning; insecticides; organophosphorus DOI: 10.3126/kumj.v7i2.2711 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26,152-156
Prevalence of asymptomatic bacteriuria among elderly diabetic patients residing in Chitwan
Authors: Jha BK , Singh YI , Khanal LK , Yadab VC , Sanjana RK
Published: February 2010

Background: A retrospective study was done on Asymptomatic Bacteriuria (ASB), among elderly diabetic patients residing in Chitwan, Nepal from 1st January 2006 to 12th December 2006. Diabetic patients above 40 years of age were included in this study where as below 40 years of age group were excluded. Objective: To study the prevalence of ASB among elderly diabetic patients for the Bacteriological profile and their antibiotic susceptibility pattern. Materials and methods: Urine sample was collected from 636 diabetic patients above 40 years age attending College of Medical Sciences Teaching Hospital for regular blood sugar estimation. Culture and Antibiotic susceptibility test (AST) were performed using standard microbiological technique. ASB was determined as presence of ≥ 105 bacteria/ml in a culture of urine sample. Results: The prevalence of ASB among diabetic patients in Bharatpur was found to be 9.43% (12.07% in females and 5.08% in males). The most common bacterial isolate was Escherichia coli (41.66%). Nitrofurantoin, Cefotaxime and Chloramphenicol were the most effective drugs for the majority of isolates. Conclusion: The study shows necessity of regular urine culture to detect ASB, along with blood sugar estimation for diabetic patients to prevent them from further complications due to it. Key words: Diabetic; ASB; Common pathogen and AST DOI: 10.3126/kumj.v7i2.2712 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 157-161
My experience as an exchange student at Linköping
Authors: Shrestha S
Published: February 2010

DOI: 10.3126/kumj.v7i2.2719 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 185-187
Head and neck malignancies: Emerging concepts!
Authors: Toran KC
Published: February 2010

DOI: 10.3126/kumj.v7i3.2720 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 191
The resistant macular oedema
Authors: Malla OK
Published: February 2010

DOI: 10.3126/kumj.v7i3.2721 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 192-193
Community based medical education: Prospects and challenges
Authors: Marahatta SB
Published: February 2010

DOI: 10.3126/kumj.v7i3.2722 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 194-195
Minimally invasive open lumbar discectomy: An alternative to microlumbar discectomy
Authors: Devkota UP , Lohani S , Joshi RM
Published: February 2010

Background: Lumbar disc surgery has come a long way since its first description by Dandy in 1929. Evolving through the transdural approach and a laminectomy for the removal of a disc, it now surpasses the primal technique with essentially a minimally invasive procedure, an extradural approach without laminectomy. Objective: The objective of this study is to ascertain the effectiveness of Minimally Invasive Open Lumbar Discectomy in the treatment of lumbar disc prolapse. Materials and methods: It is a descriptive study entailing the patients with paramedian or central disc prolapse at single or two consecutive lumbosacral levels undergoing surgery at the National Institute of Neurological and Allied Sciences, Bansbari, Nepal, over a period of one and a half years. Patients who underwent either laminectomy or bilateral fenestration were excluded. Results of surgery were measured prospectively in terms of primary outcome measure (outcome at six months follow up as measured with Prolo Functional and Economic Scale) and secondary outcome measures (radicular pain relief, mobilisation, complication, and residual disc). Results: In the series of 137 consecutive patients, 120 fulfilled the criteria. 98.33 % of patients had an improvement in the radicular pain and ambulation was commenced from the first post-operative day. There were three instances of inadvertent dural tear without fascicle injury, and one instance of residual disc requiring reoperation. At 6 months, 97.5 % had good to excellent (grade 4, or 5) results reaching the premorbid states in the Prolo Functional and Economic Scale. Conclusion: The results of Minimally Invasive Open Lumbar Discectomy compare favourably with those of a microlumbar discectomy, and could therefore be an alternative to the latter in resource deprived circumstances. Key words: Disc prolapse; Minimally Invasive Open Lumbar Discectomy; Microlumbar Discectomy DOI: 10.3126/kumj.v7i3.2724 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 204-208
Relationship between T lymphocyte subsets and cortisol in systemic lupus erythematosus
Authors: Shah D , Kiran R , Wanchu A , Bhatnagar A
Published: February 2010

Background: Systemic Lupus Erythematosus (SLE) is a complex chronic immunological disease characterized by increased B cell activity and altered T cell function. Objective: To investigate relationship between T lymphocyte subsets and cortisol with the disease activity of systemic lupus erythematosus patients in North India. Materials and methods: The percentage of CD4+ and CD8+ T cells in the lymphocyte of SLE patients and healthy controls were determined by flow cytometry. Serum cortisol of SLE patients and healthy controls was determined by enzyme-linked immunosorbent assay (ELISA). Results: A significant decrease in the percentage of CD4+ T cells and increase in the percentage of CD8+ T cells were found in patients with SLE compared to the healthy controls. Decrease in the ratio of CD4+/CD8+ T cell and low level of serum cortisol were found in the patients with SLE. The ratio of CD4+/CD8+ T cell was inversely correlated with systemic lupus erythematosus disease activity index (SLEDAI) score and erythrocyte sedimentation rate (ESR). A positive correlation was observed between CD8+ T cells and SLEDAI score. Furthermore, CD8+ T cells were positively correlated with ESR in the patients with SLE. Conclusion: The results showed that low level of cortisol and high percentage of CD8+ T cells in the lymphocytes could be actively involved in the pathogenesis of SLE. Key words: CD4+/CD8+ T cell ratio; cortisol; systemic lupus erythematosus; T-cell activation DOI: 10.3126/kumj.v7i3.2726 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 213-219
Efficacy of first-line, WHO recommended generic HAART regimens in Indian children
Authors: Parakh A , Dubey AP , Kumar A , Maheshwari A , Saxena R
Published: February 2010

Background: The clinical efficacy of highly active antiretroviral therapy (HAART) in children has been well documented in the developed countries, although most of the regimens are Protease Inhibitor (PI) based which are too expensive. To circumvent this problem World Health Organization (WHO) has recommended Non- Nucleotide Reverse Transcriptase Inhibitor (NNRTI) based regimen for resource-limited countries. Aim: To assess the long-term efficacy of first line World Health Organization (WHO)-recommended generic highly active antiretroviral therapy (HAART) regimens in treatment -naïve children. Materials and methods: Observational retrospective analysis was done. Thirty patients on HAART for > 6 months were included (27 on Stavudine; three on Zidovudine with Lamivudine/ Nevirapine). No protease inhibitors were used. Results: median age was seven years (Interquartile [IQR]: 5.62-8.50) and median duration on HAART was 18 months (IQR: 6-24). No new staging events were observed after six months of initiation of HAART. The median CD4% increased from 6.0 % at baseline to 15.5% at six months, 21.7% at 12 months, 25.4% at 18 months, 24.6 % at 24 months 25.3% at 30 months and 23.7% at 36 months. There was only one case of immunological failure. Stratified analysis based on baseline CD4 % show that even patients with a baseline CD4 % of <5% achieved percentage of >25% at 18-24 months and maintained it subsequently. Significant increase in the weight and body mass index Z scores was observed but significant fall in the height Z scores were observed. This sub group of patients with poor linear height velocity would require detailed endocrine evaluation after testing for viral loads. Conclusions: Non- Nucleotide Reverse Transcriptase Inhibitor based HAART regimens are feasible and effective in long term in resource-limited setting despite initiation of treatment in advanced stages. These can be continued in NACO/WHO scale up programmes at present for children. Key words: HAART in children; India; NNRTI based HAART; resource limited settings; WHO prequalified Antiretroviral therapy DOI: 10.3126/kumj.v7i3.2727 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 220-225
A comparative study of fluorescent microscopy with Ziehl-Neelsen staining and culture for the diagnosis of pulmonary tuberculosis
Authors: Laifangbam S , Singh HL , Singh NB , Devi KM , Singh NT
Published: February 2010

Background: For developing countries with a large number of cases and financial constraints, evaluation of rapid and inexpensive diagnostic methods has great importance. The bacilli in the sputum can be detected microscopically by ZN stain and fluorochrome stain. Objectives : To study the efficacy of fluorescence microscopy in the diagnosis of pulmonary tuberculosis in comparison to Ziehl-Neelsen staining and culture of sputum samples from patients suspected of pulmonary tuberculosis. Materials and methods : 306 sputum samples collected from 102 patients suspected of pulmonary tuberculosis were processed by the Petroff's method, and subjected to Ziehl-Neelsen staining (ZN), fluorescent Auramine-O staining (AO) and culture on modified Lowenstein-Jensen media (gold standard) for detection of Mycobacterium tuberculosis. Positive smears were graded according to Forbes BA et al, and culture isolates were biochemically tested for confirmation of species. Results : Out of 102 patients, 44.1%, 71.6% and 70% were found positive by ZN, AO and culture respectively. AO was found to be superior to ZN on several aspects. The difference in their case detection rates was statistically significant (χ2 = 24.93, p < 0.001). AO was also able to detect more pauci-bacillary cases than ZN. There was more agreement between culture and fluorescence microscopy (95.1%) than with ZN microscopy (69.6%). The percentage of false negative by AO staining was only 2.78% which was in sharp contrast to that of ZN (40.27%). Conclusion: The better case detection rates of AO over ZN were comparable to those found by several studies. Since screening was done under lower power of magnification (400x), fluorescence microscopy has been found to be less time consuming as compared to ZN method (1000x) in the diagnosis of tuberculosis. The tubercle bacilli stood out as bright objects against a dark background in fluorescence microscopy which makes them easily identifiable hence causing less eye-strain. The efficacy of fluorescence microscopy proved to be much higher than conventional light microscopy and comparable to that of culture. Key words: Ziehl-Neelsen staining; Mycobacterium tuberculosis; Auramine-O DOI: 10.3126/kumj.v7i3.2728 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 226-230
Quality of care provided to newborns by nursing personnel at BP Koirala Institute of Health Sciences
Authors: Shrestha M , Singh R , Upreti D
Published: February 2010

Background: Birth is a major challenge for the newborn to negotiate successfully from intrauterine to extra uterine life. The first few hours since birth is the most crucial period in the life of an infant for further growth and development, which is largely determined by the quality of care that the newborn receives. Objective: The aim of this study is to assess the quality of care provided by nursing personnel to newborn in the labour room. Materials and methods: This study was conducted in BP Koirala Institute of Health Science. Cross sectional, non participatory observational research design was adopted for the study. Care provided by nursing personnel to 814 normal newborns was observed. Samples were chosen by non probability purposive sampling technique. Data was collected through observational method by trained nursing personnel, using 46 items pre-tested, validated and self developed observational checklist. Care provided to newborns was observed from birth to two hours and categorised as good, average and poor based on scores obtained. Data was entered and analysed using SPSS-10. Descriptive statistics- [Mean, percentage, frequencies and standard deviation] was used to describe the quality of care provided to the newborn babies. Results: Overall quality of care was good in 42.36%, average in 57.64% and none of them received poor care. Overall mean score for quality of care was 34.75/46 (75.54 %). Regarding subscales quality of care was good in majority of newborns in areas such as Preparation to receive the baby (76.1%), Initiation of breathing (100%), Maintaining thermoregulation (77.3%), Physical assessment (90.9%), and other aspects of care (95.2%). However the quality of care was poor in majority of newborns in establishment of breast feeding (58.23%) and average in prevention of infection (76.9%). Conclusion: Study findings highlight the need for focus in establishment of breast feeding and prevention of infection. Key words: Quality of care; newborns; nursing personnel; breast feeding; prevention of infection and assessment of newborn. DOI: 10.3126/kumj.v7i3.2729 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 231-237
Study on determination of errors in prescription writing: A semi-electronic perspective
Authors: Ansari M , Neupane D
Published: February 2010

Background: Prescription writing is one of the most important and basic skills that a doctor needs. Prescribing errors may have various detrimental consequences. Hence, the components of a prescription should be clearly written, free of drug related omission (incomplete prescription), commission (incorrect information) and integration errors, without nonofficial abbreviations, and fulfil the legal requirements of a prescription. Since errors of prescribing are the commonest form of avoidable medication errors, it is the most important target for improvement. Objectives: To estimate the types and prevalence of medication errors during transcription. Materials and methods: A cross sectional descriptive retrospective study was conducted at Nobel Medical Teaching Hospital, Biratnagar, Nepal during a time period from 15th November 2008 to 14th February 2009. A random sample of 268 prescriptions of patients written during a period of one year (18/06/2007 to 17/06/2008) for ten different medical out patient departments of the Hospital were reviewed and the analysis was carried out for determining the different types of errors in writing a prescription. Results: No error was found regarding the name, age, sex and address of the patients. The error in prescriptions regarding the prescriber's name, qualification, NMC registration number and signature were 85.4%, 99.6%, 99.6% and 15.7% respectively. Similarly, the symbol Rx was missing in 66.8%. Dosage form, quantity, dose, frequency and route of administration were not mentioned in 12%, 60%, 19%, 10% and 63% of the prescriptions respectively. Likewise, strength of the prescribed medicines was not stated in 40% of the cases. Conclusion: There is a need to critically address the legibility of prescription, correct spelling of drugs, authorised abbreviations and all other informations of a prescription concerned with patient, prescriber and drugs to minimise the occurrence of medication errors. Key words: Drugs; Errors; Prescription; Rational; Writing DOI: 10.3126/kumj.v7i3.2730 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 238-241
Cervical epidural anaesthesia for thyroid surgery
Authors: Khanna R , Singh DK
Published: February 2010

Background: Cervical epidural anaesthesia is a regional anaesthesia technique which has been used for upper limb surgery, upper thoracic wall surgery, carotid artery surgery and neck dissections. Anaesthesia for thyroid surgery can be complicated due to the altered functional status of the thyroid or its large size. Objective: This prospective study was designed to assess the effectiveness and safety of cervical epidural anaesthesia for thyroid surgery. Materials and methods: Cervical epidural anaesthesia was attempted in 9 patients and the results compared with 44 patients who underwent thyroid surgery under conventional general anaesthesia with endotracheal intubation. The epidural catheter was placed in the C7 - T1 vertebral interspace and 10 - 15 ml of 1% Lignocaine with adrenaline was injected. Results: The technique of cervical epidural anaesthesia was successfully used in 8 out of 9 patients in whom it was attempted All patients were maintained in a state of conscious - sedation and effective analgesia was obtained in all 8 patients. There were no significant complications especially those related to diaphragmatic function and cardiovascular stability. In contrast patients undergoing surgery under conventional general anaesthesia had complications related to endotracheal intubation, cardiac arrhythmias and hypotension Conclusion: The technique of cervical epidural anaesthesia should be considered in thyroid patients where difficult endotracheal intubation is anticipated and in those in whom alterations in thyroid functional state make them vulnerable to cardiovascular complications under conventional general anaesthesia. Key words: thyroid surgery; cervical epidural anaesthesia DOI: 10.3126/kumj.v7i3.2731 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 242-245
Heart rate variability: Response to graded head up tilt in healthy men
Authors: Sharma P , Paudel BH , Singh PN , Linmbu P
Published: February 2010

Background: Heart rate variability is actually a misnomer for R to R variability in cardiac cycle. Variation in successive cycle length is called the heart rate variability (HRV). Head-up tilt is a model of studying cardiovascular haemodynamics, which reflects in heart rate variability (HRV). Objectives: To study the effect of 10° and 70° head-up tilt on HRV. Materials and methods: The study was done in the Department of Physiology using graded head up tilt (passive orthostatism). HRV measurement was done at 10° and 70° tilt and compared with supine using standardised methods on 30 consenting healthy males (age 25.37±3.89 years). The HRV variables across postures were compared by ANOVA and Bonferroni test. Results: The heart rate increased at 70° compared to 10° and supine (70.48±8.17 Vs 70.22±8.67 and 88.51±12.84 bpm, p<0.001). The 70° tilt decreased vagal HRV indicators compared to 10° and supine: SDNN (31.13±8.12 Vs 38.07±11.29 and 38.13±10.89 ms, p<0.05), RMSSD (20.06 ±8.47 Vs 34.23±14.22 and 36.16±12.22 ms, p<0.001), NN50 count (13.03±20.58 Vs 45.07±44.44 and 55.27±44.10, p<0.01), pNN50 (3.28±6.08 Vs 14.06±15.65 and 16.65±14.23, p<0.01), HF power (197.20±143.76 Vs 218.17±155.85 and 216.87±150.98 Hz, p<0.05), HFnu unit (24.28±14.16 Vs 45.48±16.34 and 47.67±19.89, p<0.001). The 70° tilt increased LF power% (197.20±143.76 Vs 218.17±155.85 and 216.87±150.98, p<0.001). LFnu unit (75.72±14.76 Vs 54.52±16.34 and 52.32±19.89, p<0.001), LF: HF (4.96±4.08 Vs 1.53±1.138 and 1.69±1.67, p<0.001) compared to 10° and supine. Conclusion: At 70° tilt, HRV measures, reflecting vagal contribution to cardiac-cycle length, decreased with reciprocal increase in sympathetic activity compared to 10° or supine leading to increase in sympathetic predominance. A 10° tilt, which is almost equivalent to lying down with pillow, did not change HRV from supine. Key words: Cardiac cycle; cardiovascular haemodynamics; head-up-tilt; heart rate variability; sympathetic activity; parasympathetic activity DOI: 10.3126/kumj.v7i3.2733 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 252-257
Clinical outcomes of total laryngectomy for laryngeal carcinoma
Authors: Bajaj Y , Shayah A , Sethi N , Harris AT , Bhatti I , Awobem A , Loke D , Woodhead CJ
Published: February 2010

Background: Controversy exists as to the management of advanced laryngeal carcinoma. In general primary radical surgery is favoured. Objective: The aim of this study was to analyse the clinical outcome of patients having total laryngectomy for cancer of larynx. Materials and methods: This study was a retrospective case note review and questionnaires were used for evaluating voice handicap. These laryngectomies included in this study were performed by the senior author (CJW) from January 2001 till June 2007 at Leeds General Infirmary, Leeds. Some of the patients had partial or total pharyngectomy in addition to total laryngectomy. Results: In this study a total of 59 patients were included. Seventeen (28.8%) of these patients had preoperative radiotherapy and laryngectomy was performed for residual or recurrent disease. The initial TNM staging of the tumour ranged from T1N0 to T4N2C. Tracheoesophageal puncture for speech prosthesis was done in 48/59 (81.4%) patients. Post-operative complications were seen in 30.5% (18/59) patients. In this study group 9 patients (15.2%) developed pharyngocutaneous fistulas. For communication 31/51 (60.8%) patients were using speech valves. In this study 30.4% had minimal, 26.1% moderate and the rest 43.4% feeling severely handicapped with regards to voice use after total laryngectomy. Five year survival after laryngectomy in this study was 65.2%. Conclusion: Long term disease control and survival is achievable with total laryngectomy with or without postoperative radiotherapy with minimal risks in patients with advanced carcinoma of larynx. Key words: Laryngectomy; Larynx; Carcinoma DOI: 10.3126/kumj.v7i3.2734 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 258-262
Prevalence of different types of gallstone in the patients with cholelithiasis at Kathmandu Medical College, Nepal
Authors: Pradhan SB , Joshi MR , Vaidya A
Published: February 2010

Background: Gallstone disease known as cholelithiasis is the most common digestive surgical disorder and account for an important part of health care expenditure. Attempt was made to analyse the gallstone for typing depending upon the composition. Aims & objectives: The main objective of this study was to see the prevalence of different types of gallstone in Nepal and to correlate them with the clinical findings. Materials & methods: Gallstones of 80 different patients who underwent cholecystectomy for cholelithiasis were collected from 20th January 2005 to 16th May 2006 in Department of Pathology, Kathmandu Medical College Teaching Hospital. Detailed history was taken. Stones were analyzed with chemical and enzymatic methods using clinical spectrophotometer. Results & conclusion: The most commonly involved age group for cholelithiasis (32.5%) is found to be 30-39 years with a female predominance (M: F=1:3.2). Cholelithiasis was found more commonly among non-vegetarian with the vegetarian: non-vegetarian ratio 1:9. Mixed type stone was found to be the most common type of stone comprising 78.75%, followed by cholesterol stone 12.5%, Brown pigment stone 7.5% and Black pigment stone 1.25%.Key words: Gallbladder; cholelithiasis; Gallstone DOI: 10.3126/kumj.v7i3.2736 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 268-271
Multiple arterial anomalies in upper limb
Authors: Baral P , Vijayabhaskar P , Roy S , Kumar S , Ghimire S , Shrestha U
Published: February 2010

An isolated neurovascular variation is common but multiple vascular anomalies on same upper limb is a very rare case. We observed an unusual variations in right upper limb during routine dissection of a Nepali cadaver. The variations were observed in Axilla, Forearm and Palm. In axilla, first part of axillary artery did not give any branch, the second part of axillary artery gave off only two branches - (a) thoracoacromial artery and (b) a large common trunk which later gave off lateral thoracic, thoracodorsal, subscapular, posterior circumflex scapular and then continued as posterior circumfl ex humeral artery. The third part of axillary artery gave off only anterior circumflex humeral artery. In forearm, the ulnar artery runs downward superficial to flexor muscles. Here, radial artery gave off common interosseous artery. In palm radial artery did not give any contribution to superficial palmar arch which is solely formed by the continuation of ulnar artery. This type of anomalies are very rare and is not reported in Nepalese cadaver at all. These anomalies are described in detail and their clinical relevance is highlighted. Key words: Axillary artery; Brachial artery; Radial artery; Ulnar artery; Palmar arch; Variations DOI: 10.3126/kumj.v7i3.2740 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 293-297
Antiretroviral treatment programmes in Nepal: Problems and barriers
Authors: Wasti SP , Simkhada P , Van Teijlingen ER
Published: February 2010

Background: Antiretroviral (ARV) drugs have become the cornerstone of HIV (Human Immunodeficiency Virus) care and treatment. Its use has led to a marked reduction in AIDS (Acquired Immune Deficiency Syndrome) related morbidity and mortality. However, more than five years after their introduction few HIV infected people in Nepal are receiving ARVs. Objective: The main aim of this study is to identify barriers and obstacles to providing and expanding ARV programmes in Nepal. Materials and methods: A qualitative approach consisting of in-depth interviews with three groups of stakeholders: policy makers, ARV service providers and ARV recipients were carried out. The transcripts were analysed using a thematic approach. Results: The estimated number of people in need was high compared with people currently receiving ARV in Nepal. With regards to the proper distribution of the ARVs, the main problems identified in the interviews were: lack of infrastructure, lack of human resources, financial constraints, programmatic problems, weak leadership and management at national level, poor cooperation between management structures, geographical barriers, lack of awareness and low uptake of counselling and/or testing, stigmatization and discrimination felt by the health workers and the community, lack of coordination and limited access to services. Conclusion: Limited resources and administrative capacity coupled with strong underlying needs for services pose serious challenges to the government. Despite this, better use could be made of existing services and resources to help benefit more people from ARV. Key words: Service provision; Antiretroviral Treatment; HIV/AIDS; Programme Management DOI: 10.3126/kumj.v7i3.2743 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 306-314
What is the role of the centre for educational scholarship?
Authors: Evans P
Published: February 2010

The role of the Centre for Educational Scholarship is to promote scholarship, in terms of teacher education, teacher accreditation, and teacher collaboration. The strategy adopted by the University of Glasgow, Scotland, UK, is outlined, and a way of estimating effectiveness is suggested. DOI: 10.3126/kumj.v7i3.2745 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 323-324
Health manpower development in Nepal: A historical perspective
Authors: Shah M
Published: February 2010

DOI: 10.3126/kumj.v7i3.2746 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 325-327
A microstructural dry-snow metamorphism model for kinetic crystal growth
Authors: Miller D.A. , Adams E.E.
Published: February 2010

Historically, dry-snow metamorphism has been classified by the thermal environment and thermodynamic processes in a snowpack. Snow experiencing predominantly macroscopic isothermal conditions develops different microstructure than snow subjected to large temperature gradients. As such, much previous research has been categorized by and limited to specific thermal conditions. The current research expands a generalized approach for the movement of heat and mass to include a snow crystal kinetic growth model. An existing spiral defect propagation theory for kinetic growth on simple faceted geometry is utilized. Primary crystal habit as a function of temperature is incorporated. A model of heat and mass transfer through an ice and pore structure is coupled with phase-change thermodynamics during kinetic growth. A kinetic growth microstructure model is developed and integrated into heat and mass transfer representations, which are solved using finite-difference techniques. The kinetic morphology model approximates frequently observed hopper-type crystals. The snow microstructure is allowed to change at every step, resulting in a transient description of kinetic growth metamorphism. Variable kinetic growth rates are demonstrated based on temperature and on crystallographic orientation relative to a temperature gradient. Crystals preferentially aligned with the temperature gradient have significantly higher growth rates, supporting previous observations of predominant crystal habits developing under temperature gradient conditions. Grain-size dispersion increase with time is demonstrated and supported experimentally in the literature. A dominant grain growth theory based on crystallographic orientation that has been previously postulated is supported. A broad range of metamorphic geometric parameters and thermal conditions may now be simulated with a single model.
Effects of digital elevation model spatial resolution on distributed calculations of solar radiation loading on a High Arctic glacier
Authors: Arnold Neil , Rees Gareth
Published: February 2010

High-resolution airborne lidar data are used to produce digital elevation models (DEMs) of an arctic valley glacier (midre Lovénbreen, Svalbard) at resolutions of 2.5–2000 m, using three different interpolation schemes. These data are used in a distributed model of solar radiation loading for glaciers. When the mean of all lidar measurements within a DEM cell is used to calculate cell height, the differences between the finest- (2.5 m) and coarsest-resolution (2000 m) DEMs for the calculated annual whole-glacier spatial means of total potential direct-beam solar radiation, potential duration of direct-beam solar radiation, and intensity of potential direct-beam solar radiation are 20%, 56% and −23% of the 2.5 m DEM values respectively. A resolution change from 2.5 m to 200 m affects the whole-glacier spatial mean summer net solar radiative flux by an average of 5%, and the summer melt production from the glacier by an average of 3% compared with the 2.5 m DEM values, for the years 2001–03. These changes are largely driven by underestimation of shading by surrounding topography at coarser DEM resolutions. This dependency is reduced in the second and third interpolation schemes, especially at resolutions finer than 50 m, which use the maximum lidar height measurement in some or all DEM cells. These results suggest that resolutions of ∼50 m are the coarsest that should be adopted in high-resolution glacier surface energy-balance models for glaciers of similar size and in similar topographic situations to midre Lovénbreen, and that the impact of DEM resolution on calculated solar radiation receipts can be reduced by an appropriate choice of DEM interpolation scheme.