bluuebunny/crossref_metadata_2025 huggingface dataset:
INTRAOCULAR MALIGNANT TERATOID MEDULLOEPITHELIOMA
Authors: Adhikari Ram Chandra , Sainju R , Sayami G , Dali S , Shrestha H G , Basnet R B , Pandey J S
Published: September 2018

Malignant teratoid medulloepithelioma is an uncommon unilateral intraocular tumor,occuring typically in children. This report concerns a 4-year-old boy, who presentedwith loss of vision, pain and proptosis of the left eye and showed mass in betweeneyelids. Histopathologically, the tumor was composed of pseudostratified primitive-appearing epithelium dispersed in cords, strands, tubules & glands, which wereseparated by a cystic spaces, filled with pale eosinophilic material. Foci of glial tissue,cartilage , bone, skeletal muscle and fatty tissue were recognized. In addition, scleralextension of tumor, Homer-Wright like and Flexner-Wintersteiner like rosettes andfoci of necrosis were also present. The differentiation from retinoblastoma wasdiscussed.Key Words: Malignant medulloepithelioma, eyeball, heteroplasia.
OBSTETRIC CHOLESTASIS
Authors: Pradhan Pramila
Published: September 2018

Obstetric Cholestasis is the commonest liver disease that causes pruritis and is uniqueto pregnancy. Pruritis can be so intense as to lead insomnia.The Significance of thisdisease has been highlighted more recently due to the associated perinatal mortalityand maternal morbidity. Aetiology and pathophysiology still uncertain. There, appearsto be genetic predisposition in certain individuals resulting in an increasedsusceptibility to the high oestrogen levels found in pregnancy specially in 3rdtrimesterand resolving promptly after delivery when oestrogen level falls rapidly. Pruritis iscentral in origin and thus fails to respond to commonly used antihistamines and lotiocalamine locally. Recently ursodeoxycholic acid an exogenous bile acid is increasinglybeing used and showed improved both pruritis and liver function and favourablechanges were observed in the foetus as well. Delivery planned at 37-38 weeks ofgestation reduced perinatal mortality. Because of increased rate of adverse intrapartumevents, close monitoring is appropriate. Active management of the third stage isnecessary because of the increased risk of post partum haemorrhage.Key Words: Pruritis, pregnancy, planned delivery, perinatal mortality and maternal morbidity.
Sputum cytology in bronchogenic carcinomas
Authors: Agrawal Rahjan , Jain Y K
Published: September 2018

Sputum cytology is an important investigation in the diagnosis of lung malignancies.The study was thus aimed at evaluating the role of sputum smears in bronchogeniccarcinomas. A total of 80 cases were included in the study. The positivity rate forvarious subtypes was squamous cell carcinoma (50%), large cell carcinoma (50%),non-hodgkins lymphoma (50%), secondaries (40%), small cell carcinoma (37.5%),hodgkins lymphoma (33.33%) and adenocarcinoma (30.77%). Peripherally locatedmalignant lesions have a reduced chance of being expectorated out in the sputum.Early morning samples are the best sample for diagnosis.It was thus concluded that Sputum cytology is important as an investigation to becarried out simultaneously with other techniques in detecting occult malignancies.KEY WORDS: Sputum Cytology, Bronchogenic Carcinoma
Perinatal Mortality At Kathmandu Model Hospital
Authors: Shrestha Sita Ram , Rajbhandari S
Published: September 2018

Total number of 410 deliveries were performed at Kathmandu Model Hospital (KMH)during 33 months (April 96 -Dec 98 ). Among 410 deliveries 107 (26.09%) cases weredone by Lower Segment Caesarean Section (LSCS), 54 cases (13.37%) by forcepsdelivery, 188 (45.85%) cases normal vaginal delivery with epigiotomy and 61 (14.87%)normal vaginal delivery with or without tear.During this period, 6 twin delivery cases were observed. There were 14 cases of perinataldeaths (still birth -10 and neonatal-death - 4). Hence, perinatal mortality rateduring this peroid in this hospital was 34.15.Perinatal mortality was mostly due to severe prematurity, birth asphyxia, ante-partumhaemorrhage (APH), intrauterine growth retardation (IUGR), congenital abnormalitiesand sepsis.KEY WORDS: Neonatal death, Still birth, Perinatal mortality, Antepartum haemorrhage (APH), Sepsis.
STUDENT FEEDBACK ON THE OBJECTIVE STRUCTURED COMPONENT OF THE PRACTICALEXAMINA TION IN PHARMACOLOGY
Authors: Pathiyil Ravi Shankhar , Mishra P
Published: September 2018

The study was planned to determine the attitude of undergraduate medical studentstowards the objective structured practical examination (OSPE) in pharmacology andto investigate any influence of sex, nationality and medium of instruction at school onthese attitudes. The second year undergraduate medical students of the Manipal collegeof medical sciences, Pokhara, Nepal were asked to complete a questionnaire regardingthe spotters and communication skills component of the practical examination. Studentsconsidered OSPE a good method of practical examination. The male students agreedmore strongly that the spotters develops the ability to choose an appropriate drugwhile the female students were more in favour of OSPE over animal experimentation.The Sri Lankan students were less in favour of the introduction of stations testingskills as part of OSPE and also disagreed strongly with the point that communicationskills should be conducted in a language other than English. Based on theseobservations, changes should be made in the teaching as well as evaluationmethodologies to maximize learning.
SOME OBSERVATION ON HUMAN CLAVICLE
Authors: Bilodi Arun Kumar S. , Sinha B N , Kumaran S
Published: September 2018

The present study was done in the human clavicles that were available from departmentof Anatomy of Nepalgunj Medical College, Chasapani Nepal. Observations were madeon length of the clavicle, mid shaft circumference cornoid tubercle Curvature index ofthe clavicles were also calculated. Results were analysed and discussed.Key Words: Mid shaft circumference-conoid-tubercle-curvature index,Subclavian groove, Trapezoid ridge.
COMMUNITYBASED EDUCATION: AN EXPERIENCE FROM NEPAL
Authors: Jha N , Pokharel P K , Ghartichetteri P , Yadav B K , Paudel I S , Niraula S R , Chapagain M L
Published: September 2018

Abstract
TREATMENT OF IDIOPATHIC SCOLIOSIS BY HARRINGTON INSTRUMENTATION
Authors: Bajracharya Ashok Raj , Chhetri R S , Kharel Y R , Chalise P , Rai P , Giri S K
Published: September 2018

An adolescent idiopathic right-sided thoracolumbar scoliosis has been correctedsurgically with Harrington distraction and compression instrumentation with posteriorfusion for the first time in Nepal.Key Words: Idiopathic scoliosis, Harrington system.
POLYMERASE CHAIN REACTION DETECTION OF MYCOBACTERIUM TUBERCULOSIS FROM SPUTUM
Authors: Sohn Kun Young , Shrestha S , Khagi A , Malla S S , Pokharel B M , Khanal M P , Rijal B , Bajracharya P
Published: September 2018

ABSTRACTTuberculosis has remained to be a major public health problem in Nepal. The risk of spread of infection andemergence of drug-resistant strain has created the need for a rapid, sensitive and specific diagnostic test.In addition, clinically suspicious cases that do not give positive result in conventional laboratory test needmore sensitive test for diagnosis.In order to evaluate the possibility of incorporation of Polymerase Chain Reaction (PCR) in the diagnosis oftuberculosis, we performed a comparative study of PCR to detect Mycobacterium tuberculosis in sputumspecimens, against Ziehl-Neelsen (Z-N) stain and culture as a standard method.A total of 103 specimens were subjected to Z-N staining, culture and PCR for detecting Mycobacteriumtuberculosis. Of these, 19 were positive by Z-N stain, 26 by PCR and 25 by culture. Four stain negativespecimens showed positive result in both culture and PCR. Two specimens of stain and culture positive werePCR negative. Five specimens showed positive result only with PCR. Two culture positive specimens gavenegative results by both Z-N stain and PCR. Sensitivity, specificity, positive predictive value and negativepredictive value of PCR which were 84%, 93.5%, 80.8% and 94.9% respectively.This study showed that there is no need for PCR test for the smear positive cases. However, PCR could be apossible diagnostic tool for the confirmation of the smear negative cases that show clinical symptoms of TB.Key Words: Mycobacterium tuberculosis, Z-N stain, PCR, sensitivity, specificity.
ENDOMETRIAL STUDY OF ABNORMAL UTERINE BLEEDING IN WOMEN AT 45 YEARS AND ABOVE
Authors: Dangal Ganesh
Published: September 2018

ABSTRACTThe study is done to know the causes for the abnormal uterine bleeding in perimenopausal women atChitwan valley and to compare the histopathological findings between the pre-menopausal andpostmenopausal women. Retrospective analysis of patients who have had abnormal bleeding during a periodof one and a half years' from January 2000 to June 2001 in Department of Gynaecological Oncology of BPKoirala Memorial Cancer Hospital (BPKMCH), Chitwan, Nepal. There were total sixty women (aged 45years and above) having abnormal bleeding managed at BPKMCH. A total of sixty patients were studied.Majority (57%) of them was postmenopausal ladies presented with abnormal vaginal bleeding. The agerange was 45 to 81 years. Only 37% had pathological bleeding including malignancies and only about 17%had malignancies. Malignant diseases were found in 7.7% cases in the pre-menopausal ladies whereas itwas 23.4%, almost three times higher, in the post-menopausal ladies. Carcinoma of the cervix and of theendometrium occurred with increasing frequency with increasing age in this study. So, a thorough work-upis needed for the elderly women presenting with an abnormal vaginal bleeding especially to rule outmalignancies.Key Words: endometrial biopsy, endometrial cancer, postmenopausal bleeding.
A STUDY OF MALARIA IN RELATION TO HIV AND SYPHILIS AMONG PATIENTS VISITING BHERI ZONAL HOSPITAL
Authors: Kandel Prakriti Raj , Sherchand J B , Adhikari S
Published: September 2018

ABSTRACTThe study was conducted in patients, who were febrile with signs of anaemia, splenonregaly and the classiccycle of coldness, fever peaks and sweats from January to September 2000 in Bheri Zonal Hospital, Nepal.The study aimed to find out relationship of malaria with HIV and syphilis.Two hundred and twenty three blood samples collected were processed and observed using the methods ofELISA and RPR.Among total 223 suspected risk group cases, 6 individuals were detected as HIV positive and 12 individualshad syphilis. Co-infection with malaria & HIV was detected in 2 patients and malaria with syphilis in 8patients. Similarly 2 patients were co-infected with malaria, HIV and syphilis. A small positive correlation(p<0.5) of malaria, HIV and Syphilis was detected.Key Words: Malaria, HIV, Syphilis, ELISA, RPR, Nepal.
MAXILLARY SINUS SCHWANNOMA EXTENDING TO ORBIT
Authors: Sharma Ravinder , Singh A K , Shambhu B , Reddy N S
Published: September 2018

ABSTRACTSchwannoma occur in the head and neck region more frequently than in any other part of the body, affectingmainly the eighth cranial nerve. However schwannoma in the nasal cavity and paranasal sinuses is a rareentity with only sporadic cases appearing in the literature. We present one such rare case of maxillarysinus schwannoma extending to nasal cavity orbit and anterior skull base in a 46 year old male. The tumorwas successfully removed by midfacial degloving approach. The relevant literature on the presentation,radiology and management of schwannoma of maxillary sinus is discussed.Key Words: Schwannoma, Maxillary Sinus, Nasal Cavity.
CORONARY ARTERY DISEASE : AN EMERGING EPIDEMIC IN NEPAL
Authors: Maskey Arun , Sayami A , Pandey M R
Published: September 2018

ABSTRACTCardiovascular disease is the commonest cause of death globally and is the major contributor to the burdenof premature mortality and morbidity. Coronary artery disease ( CAD) is greatest killer of mankind. Coronaryartery disease in western industrialized countries show a declining trend. However developing countrieshave shown an alarming increase. The identification of major risk factors and effective control of themthrough population based strategies of prevention were mainly responsible for this decline.A few cases ofacute myocardial infarction were seen in Kathmandu ,Nepal in 1950 and in the sixties the incidence startedrising rapidly. In a study between 1960-1968 a total of 150 cases were reported with myocardial infarctionin Kathmandu , Nepal. Although national datas for incidence and prevalence on CAD in Nepal is notavailable, hospital based datas on admission pattern in different hospitals of Kathmandu, capital city ofNepal show 40 fold increase in incidence of acute myocardial infarction (AMI) in last 30 years. Prevalenceof coronary artery disease (CAD) estimated from these figures of AMI cases indicate that 5 % of adultpopulation in Kathmandu suffer from CAD. Hence, Coronary artery disease is emerging as epidemic in Kathmandu, Nepal.Key Words: Coronary artery disease (CAD), acute myocardial infarction (AMI), Epidemic.
A review of low birth weight
Authors: Ramachandran U
Published: September 2018

As the incidence of low birth weight babies in India and the neighbouring areas isvery high a review of the causes of LBW was done. The factors responsible have beenhighlighted, risk factors been identified and some remedial measures suggested.Key Words: LBW - low birth weight, MCH - maternal and child health.
COMMUNITY AWARENESS ABOUT LEPROSY IN A DISTRICT OF NEPAL
Authors: Agrawal Sudha , Jha N , Agarwalla A , Agrawal C S , Niroula S
Published: September 2018

ABSTRACTNepal is one of the countries with high prevalence of leprosy. In general, the prevalence of the disease isrelatively higher in the plains than in the hills. We analyzed the knowledge of leprosy in the community bya structured questionnaires study. The sources of information from where they acquired the knowledgewere also studied. This study was done in Sunsari district of Nepal on National Immunization Day program.Out of 1647 respondents, 60% were female. The majority (74%) was between 20–40 years of the age group.Agricultural workers constituted 58%. One third of the respondents were illiterates. Approximately 60%of the respondents knew the cause and symptoms of leprosy. “Leprosy is curable” was felt by 81.8%.Although 75% of the respondents knew that drugs for leprosy were available free of cost, the goal ofelimination was understood by only 51% of respondents. The younger individuals had better knowledge ofthe cause and availability of the free treatment of leprosy. The females had equal knowledge about cure, buthad less knowledge of the cause, symptoms, availability of the free treatment and elimination goal. Illiterates,laborers and unemployed had significantly less knowledge of leprosy. There was no difference seen betweendifferent levels of education in literate groups. Radio was the single most effective means of providinginformation, education and communications about leprosy. A good knowledge of leprosy inculcates a positiveattitude towards leprosy. In general this may result in better case reporting and regularity of treatment aswell as fewer deformities.Key Words: Leprosy, Community Awareness.
GYNECOLOGICAL MALIGNANCY IN BPKMCH, BHARATPUR: A RETROSPECTIVE ANALYSIS OF 321 CASES
Authors: Pradhan Manohar , Dhakal H P , Pun C B , Pradhan S , Dangal G
Published: September 2018

Gynecological Malignancy is the leading cancer in female not only in Nepal butworldwide. A retrospective study of histopathological specimens was conducted inBPKMCH Bharatpur from July 1999 to January 2001, duration of 19 months. Total321 cases of Gynecological Malignancy were diagnosed in Department of Pathologyof BPKMCH. Out of which 272(84.73%) cases of cancer of cervix; 17 cases (5.29%)of cancer of vulva; 14 cases (4.36%) of ovarian cancer, 12 cases (3.73%) of cancer ofvagina and 6 cases (1.86%) of endometrial cancer were detected. Cancer of cervixwas most common in 40-49 years age group followed by 50-59 years age group. Meanage of the patients with cancer of cervix was 50 years and 10 months; minimum of 29years and maximum of 76 years. Out of 272 cases of cancer of cervix, 266 (97.79%)were squamous cell carcinoma and rest 6 (2.20%) were adenocarcinoma. Commonesthistology in vulva and vagina was squamous cell carcinoma, whereas adenocarcinomawas commonest in endometrium and ovary. The higher incidence of gynecologicalmalignancies particularly carcinoma of cervix was observed in BPKMCH.Key Words: Cancer, Cervix, Vagina, Vulva, Ovary.
STATUS OF PUBLICATIONS IN JOURNAL OF NEPAL MEDICAL ASSOCIATION DURING 1991-2000: AN OVERVIEW - I
Authors: Paudel B H
Published: September 2018

This is a "meta-analytical" study of publications in Journal of Nepal MedicalAssociation (JNMA). The study aimed at investigating the quantitative status ofpublications in JNMA during 1991-2000, which could possibly be used as a feedbackfor improvement of journal quality. A total of 469 articles were classified according totheir headings. They were sub-grouped into yearly, two-yearly (1991-1992, 1993-1994etc), three-yearly (e.g., 1991-1993, 1994-1996 etc), and five-yearly (1991-1995, 1996-2000) basis. The proportions of articles within each sub-group across time from 1991to 2000 were compared (e.g., 1991-1992 vs. 1993-1994 etc) using Fisher exact or chi-square test. The JNMA publications during 1998-1999 were also compared with JIMA(Journal of Indian Medical Association) publications. The results showed that theoriginal articles and case reports were significantly less during mid nineties of the20th century. The editorials increased significantly whereas the articles on 'healthcare' and 'clinical pharmacology' were decreased in the 2nd half of the decade. Whenthe publications during 1998-1999 were compared with JIMA, the proportions of reviewand original articles in JNMA were significantly more. But the proportion of reviewsrelative to original articles was significantly less in JNMA as compared to JIMA. TheJNMA was specially featured with articles on medical education, and health policyand planning whereas the JIMA had more articles of interest for general practitioners.In conclusion, the JNMA publications during the period of 1991-2000 were notconsistent. The JNMA may need reconsideration of publication policy and to takemeasures to maintain constancy of its publications.Key Words: meta-analysis, quality publication, quantity of publication.
AWARENESS AND PRACTICE OF UNIVERSAL PRECAUTIONS BY HEALTH CARE WORKERS IN A TEACHING INSTITUTE
Authors: Dargan Puneet , Thakur S , Jain B K , Singh R , Deb M
Published: September 2018

Health Care Workers (HCWs) face a grave risk of acquiring infection including HumanImmunodeficiency Virus (HIV) and Hepatitis B & C during the course of their work.A questionnaire based study was conducted amongst the 154 HCWs working in ateaching hospital to study Acquired Immunodeficiency Syndrome (AIDS) awareness,and to assess the knowledge, attitude, and practice in respect of application of universalprecautions. This study has shown that definite lacunae exist regarding awarenessand practice of universal precautions. Comprehensive in service educationalprogramme for HCWs regarding the implementation of universal precautions isrecommended.
ULTRASONOGRAPHIC DETERMINATION OF FETAL SEX -A STUDY ON 630 CASES IN BANGLADESH
Authors: Hosian G. M. Monawar , Milah S R , Saha M , Begum A
Published: September 2018

Ultrasound examination of the fetal perineal area was done in third trimester ofpregnancy to determine the fetal sex. We carried out ultrasound on 621 consecutiveobstetrics patients who attended these centers for obstetric causes referred by theirphysicians. Of them 612 had singleton pregnancy and 9 had twin pregnancy. Weattempted to determine the sex of all fetuses (n=630) based on demonstration of maleand female genitalia. In 585 pregnancies, fetal genitalia were well visualized – theaccuracy rate was thus 92.9%, while the rest 7.1% (n=45) could not be determinedwhich was limited by fetal presentation, position, volume of amniotic fluid and colonicgas. Among the correctly determined cases 384 (65.6%) were male and the rest 201(34.4%) were female. About 91% of the mother desired a male child in contrast toonly 3.1% of the mother who desired a female child prior to ultrasound examination.Interesting enough mothers welcoming female child were all multigravida with previousmale child/children. It needs to mention here that no primae mother welcomed femalechild. Some other aspects of prenatal sex determination have also been discussed inthisarticle.Key Words: Ultrasound, Fetal sex, Bangladesh
Knowledge on Epidemic Dropsy among the Health Workers of Sunsari, Nepal
Authors: Jha Nilambar , Yadav B K , Pokherel P K
Published: September 2018

Epidemic dropsy is caused by consuming vegetable oil contaminated with argemonemexicana, grows as a weed along with mustard seeds and is similar to it in appearance.This has been seen commonly in this part of the world. The recent outbreak in Indiaand Nepal clearly underline the need for disseminating knowledge to health workersabout being prepared to tackle and control the outbreaks of epidemic dropsy. Thisstudy talks about the knowledge and perception about epidemic dropsy among thehealth workers in Sunsari. The knowledge about epidemic dropsy among the healthworkers was poor. Health education about epidemic dropsy, reasons for outbreak andcontrol and preventive measures were given to the health workers of Sunsari district.Key Words: Epidemic Dropsy, Out Break, Nepal Health Worker.
Changes in Serum Zinc Levels in Relation to Blood Pressure During Anaesthesia
Authors: Garg H K , Agrawal P , Haleem S
Published: September 2018

Fifty age and sex matched patients admitted for surgical operation, were divided intonormotensive (control) and hypertensive (study) groups. Systolic and diastolic bloodpressures were recorded preoperatively, 10 min after intubation, at max-increase ofBP and 24 hours postoperatively. 5 ml. venous blood samples were drawn at thesetime periods, and serum zinc was also estimated. Control Gp (normotensive) subjectrecorded fall (p < 0.001) in serum Zn 10 min after intubation (n = 18) and max. Riseof BP (n = 7), Twelve subjects in study Gp recorded a rise in serum Zn at max. Increaseof BP (p < 0.01). The pattern in normotensives points towards mobilization of zinc,while in hypertensives, homeostatic, defence mechanisms appear to resist mobilizationof serum Zn till maximum rise in BP occurs, indicating hormonal and other influenceson serum Zn levels during anaesthesia.Key Words: Serum Zinc, Systolic BP, Diastolic BP, Anaesthesia
Gamma-Shaped Bicameral Gallbladder
Authors: Yadav Chandra Mohan , Geetha T V , Krishnand B R , Charles N
Published: September 2018

Abstrct
Retinoblastoma in Late Childhood
Authors: Badhu B , Sah S P , Kumar S , Sah R P
Published: September 2018

Retinoblastoma, the commonest intra-ocular tumor of childhood, is rare after the ageof 5 years. We report a case of retinoblastoma in a 10 year-old boy, who presentedwith a fungating proptosed tender mass involving the entire left eye and the orbit. Aclinical diagnosis of retinoblastoma was made. Exenteration of the left orbit was done.Histopathology revealed well-differentiated retinoblastoma with the involvement ofoptic nerve section. CSF and bone marrow aspirates did not show any malignantcells. This paper highlights the delayed presentation of retinoblastoma in late childhoodand discusses the treatment modalities of orbital retinoblastoma.Though retinoblastoma in late childhood is uncommon, it should be considered in thedifferential diagnosis of leukocoria and a fungating proptosed mass.Key Words: Retinoblastoma, late childhood, fungating proptosed mass.
Dysfunctional Uterine Bleeding and its Management Strategy
Authors: Dangal Ganesh
Published: September 2018

Dysfunctional uterine bleeding (DUB) is a diagnosis of exclusion. An adequateexamination of the abdomen and the pelvis and uterine curettage, hysteroscopy or atleast an endometrial biopsy is essential to exclude organic disease of the uterus. Itoccurs most frequently at the extremes of menstrual life, but it can develop at anyintervening time.The objectives of treatment are to control the acute bleeding, avert future episodes,and prevent a serious long-term consequence of anovulation, endometrial cancer. Themainstay of treatment has been medical therapy although surgical intervention isrequired in some cases. If the bleeding is severe and / or recurrent or the medicaltreatment fails, re-evaluation is needed.Adolescent DUB is due to immaturity of the hypothalamus and pituitary and menstrualcycles may be anovulatory. In teenage girls organic disease is rare and DUB usuallygets resolved spontaneously. That's why they are treated expectantly and curettage isoften delayed.In the middle years of reproductive life (20-39yrs), benign organic disease is common,and curettage is usually performed to exclude complications of pregnancy and otherdisease. Conservative therapy is usually indicated, though hysterectomy may beindicated if bleeding is severe or recurrent and patient has completed her family.Perimenopausal DUB is due to the decreased number of ovarian follicles and theirincreased resistance to gonadotrophin stimulation, there is a possibility of malignancy.So, these women should always be investigated by curettage or hysteroscopy withoutdelay. Although conservative therapy may be tried as a temporizing measure,hysterectomy is often indicated.Key Words: Dysfunctional uterine bleeding, curettage, hysteroscopy, and progestogen.
Time for an Undergraduate Curriculum in General Practice for Nepal
Authors: Butterworth K , Pradhan R
Published: September 2018

Introduction: This is a qualitative study, to generate a framework for a core curriculum in General Practice in the undergraduate setting, designed specifically for Nepal.

Methods: 

A Delphi process was used to involve representatives from the GP faculty in Institute of Medicine, BP Koirala institute BPKIHS, Patan Hospital/National Academy Medical Sciences and Tansen mission hospital. The Delphi involves getting input from an identified group of experts and progressively feeding back the results from each round of enquiry so that subsequent views are influenced until a point of convergence is reached. In effect the Delphi not only analyses problems and identifies solutions, but can begin the process of commitment to change.

Results:

A prioritized list of the key outcomes for an undergraduate GP curriculum was developed and a broad list of knowledge, skills and attitudes were defined. A balance was observed between the need to train doctors who are skilled in communication, who have compassion for their patients, who are also required to be excellent rational clinicians able to respond to emergency situations. There was also the need for doctors to be competent not just in individual clinical care, but in the care of communities.

Conclusions:

General Practice, as a core component of primary care, should be an obligatory part of every undergraduate medical curriculum. This Delphi process has produced an important framework for a national undergraduate curriculum in General Practice, designed specifically for Nepal.

Keywords: curriculum; delphi technique; education medical undergraduate; family practice; needs assessment
GENERAL PRACTICE : THE CORNERSTONE OF HEALTH CARE IN THE THIRD MILLENIUM
Authors: Strasser Roger
Published: September 2018

As we move into the third millennium, it is clear that the World Health Organisation(WHO) goal of “Health for All” is yet to be achieved. Nowhere is this more evidentthan in developing countries like Nepal where the majority of people live in ruralareas, many of them caught in the poverty-ill health-low productivity downward spiral.In recent decades, most programs aimed at improving population health outcomeshave been designed and delivered with little or no involvement of medical practitionersother than specialists in specific diseases or population/public health.General practice is the medical discipline which involves the provision of continuing,comprehensive, community-based patient-centred prevention-oriented primary care.General practitioners are at the interface between: low technology/low cost and hightechnology/high cost care; medical and non-medical health and welfare services; andindividual care for illness, injury or disability and community/population healthapproaches to improving health status. This places general practice and generalpractitioners in a pivotal position to provide individuals and families with timely cost-effective care, and to provide leadership in the development and implementation ofhealth care systems which are responsive to community and societal needs.Since 1994, the WHO and WONCA, the World Organisation of Family Doctors, havebeen working together first through a landmark Invitational Conference and Reporton “Making Medical Practice and Education More Relevant to People’s Needs: TheContribution of the Family Doctor”, and more recently through a Memorandum ofAgreement and the Towards Unity for Health (TUFH) Project. TUFH promotes effortsworldwide to create unity in health service organisations particularly throughsustainable integration of medicine and public health, individual health and communityhealth related activities. Achievement of “Health for All” will require development ofbalanced, affordable and sustainable health care systems which build on the broadexpertise of general practitioners and general practice.
PNEUMOCOCCAL INFECTIONS : REPORT OF A HOSPITAL BASED STUDY
Authors: Koirala Basudha , Sharma S K , Deb M , Bhatttacharya S K
Published: September 2018

Seventy-one isolates of Streptococcus pneumoniae were obtained from various clinicalspecimens of sixty-six patients. Type of pneumococcal infections varied in differentage groups. Major brunt of the invasive pneumococcal infection was borne by infantsand children. Isolates from infected corneal ulcers were relatively resistant toantimicrobials including penicillin, as compared to those isolated from normallysterile body sites.Key Words: Pneumoccoccal infection, antimicrobial susceptibility, Eastern Nepal.
Lidocaine Used As A Diluent For Intramusculat Injection To Minimize Pain, an Experience At Patan Hospital
Authors: Yadav B K
Published: September 2018

abstract
A PROSPECTIVE STUDY OF DENTAL DISEASE PATTERN AND DRUG UTILIZATION AT THE DENTAL DEPARTMENT OF A TERTIARY CARE TEACHING HOSPITAL IN EASTERN NEPAL
Authors: Rauniyar G P , Shahanas M S , Das B P , Nagarani M A
Published: September 2018

To find out the pattern of dental diseases and drug utilization at dental out patientdepartment (OPD) of B.P. Koirala Institute of Health Sciences (BPKIHS), a tertiarycare hospital. A prospective prescription audit was conducted for a period of 10 daysin the dental OPD and the data was analyzed using WHO drug indicators. The totalnumber of prescriptions analyzed were 279. Dental caries (37%), Periodontitis (14%)and chronic gingivitis (11%) were the most common diseases with a maximum incidencebetween the age groups of 9 to 40 years. Mean number of drugs per prescription was2.79. Of the total prescriptions, 223 (79.9%) had 314 antimicrobial agents (AMA)constituting 40.3% of total drugs prescribed. The mean number of antimicrobial agentsper prescription was 1.13. The most commonly prescribed antimicrobial agents wasamoxycillin (33.1%) followed by metronidazole (24.9%), doxycycline (17.2%) andtinidazole (12.7%). Fixed dose drug combination of amoxycillin + cloxacillin (26) andampicillin + cloxacillin (10) were prescribed in 36 of the prescriptions. Povidone iodinegargle (41.2%) was the most commonly prescribed oropharyngeal preparation followedby Chlorhexidine gluconate mouthwash (32.4%). Non- steroidal anti-inflammatoryagents (20.66%), multi-vitamins (19.51%) and oropharyngeal preparations (17.45%)constituted the rest of the drugs prescribed. Diclofenac (60.86%) was the mostcommonly prescribed among NSAIDs and fixed dose drug combination of ibuprofenand paracetamol was prescribed in 19 of the prescriptions. All drugs were given byoral route (except for gentamicin in one prescription) and were prescribed underbrand names. None of the prescriptions had instructions whether the drug should betaken before or after food. The results indicate that dental caries was the most commondental disease, anti-microbial agents were prescribed to majority of the patients andconstituted a little less than half of the total drugs prescribed. Commonly used anti-microbial agent was amoxycillin which in two thirds of the cases was prescribed as anfixed dose drug combination. The high incidence of anti-microbial agent prescribingmay be modified by a feedback to the prescribers.Key words: Dental morbidity, prescribing pattern, drug utilization, dental OPD,antimicrobial agents.
Human Immunodeficiency Virus Infection In Women -An Over view
Authors: Sharma Amita
Published: September 2018

abstract
First Mass Miniature Radiography In Nepal
Authors: Das G S.L , Giri J N
Published: September 2018

NA
T-tube vs Primary Common Bile Duct Closure
Authors: Joshi M R , Singh DR
Published: September 2018

INTRODUCTION:

Closure of the common bile duct over T-tube after exploration is a widely practiced traditional method. However, its use may give rise to many complications. We do primary closure of common bile duct after exploration. Aim of the study is to see the efficacy and safety of the primary closure.

METHODS:

Study was carried out to compare the results of both the techniques from 2006 to 2009 in the cases proven to have common bile duct stone with or without the features of obstructive jaundice. Post operative hospital stay and morbidities related to both the groups were recorded and analyzed.

RESULTS:

There were total 71 cases included in the study. Thirty one in T-tube group and 40 in primary closure group. T-tube was removed in most of the cases after three weeks where as average time of drain removal in primary closure group is 5.79 +/-1.79 days. Incidence of retained stone was equal in each group. Major complication in T-tube group is biliary peritonitis in four patients at the time of T-tube removal whereas none of the patient from primary closure group suffered from such major complication.

CONCLUSIONS:

Primary closure after the common bile duct exploration is safe and it helps to avoid the morbidities related to T-tube.

Keywords: Choledocholithiasis, Primary closure, retained stone, T-tube, Ureterorenoscope.
Observation On Eight Hundred And Seventy Cases Under Spinal Anaesthesia
Authors: Singh Bhawani Bhakta
Published: September 2018

NA
Chronic Pyelonephritis : Modern Concept Regarding Its Etiology And Treatment
Authors: Bahadur Shankar
Published: September 2018

NA
Incidence OF Infectious Hepatitis at the United MIssion Hospital
Authors: Miller Edgar Raymond
Published: September 2018

NA
Plain Skiagram - An Aid To Intracranial Surgery
Authors: Gongol Dinesh Nath
Published: September 2018

NA
World Health Day 7 April- No Truce For Tuberculosis
Authors: Hitze K L
Published: September 2018

NA
(I) Two Case Records Of Retained-Broomsticks
Authors: Sharma Anjani Kumar
Published: September 2018

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(II) Role Of Thiosemicarbasone In A Case Of Leprosy Intolerant To D.D.S. Therapy
Authors: Mali Indra Bahadur
Published: September 2018

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Need of Improvement in Timing of Prophylactic Antibiotic in Elective Surgery
Authors: Shah Jay N , Maharjan SB , Piya R , Shrestha A , Shrestha K , Bashnet NB , Gurung HM
Published: September 2018

INTRODUCTION:

Infections in surgery are major concern of morbidity, mortality, and costs. Timely antibiotic prophylaxis before incision ensures optimum concentration of AP in blood and tissues to prevent surgical site infections . However, proper timing of AP remains problematic as reported by various studies, though none so far from Nepal. Aim of this prospective observational study was to assess and address the issues for improvements in timing of AP.

METHODS:

The pattern of antibiotic prophylaxis were prospectively collected in respect to time of induction, and incision time were recorded on predesigned 'AP form'. The study included all the elective major cases who received AP of intravenous Cefazoline 1 g as per our existing protocol. The emergency surgeries and obstetric cases were excluded from the study.

RESULTS:

There were 125 cases of which 89% received AP before incision (63% within 5 minutes before incision), while 11% had AP after the incision and 1% within the recommended time period of 2 hour to 30 minutes before incision.

CONCLUSIONS:

Current practice of antibiotic prophylaxis (AP) needs improvement as per standard guidelines of AP within 2 hour to 30 before incision.

Keywords: antibiotic, infection, prophylaxis, surgery.
Mitral Commisurotomy A brief survey and Case Report
Authors: Robert Berry E , Surendranath A N
Published: September 2018

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Medicine - Then & Now
Authors: Author No
Published: September 2018

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March Of Medicine
Authors: Author No
Published: September 2018

Pseudotumor cerebri and corticosteroid therapy. A.E. Walker, M.D., and J.J. Adamkiewicz, M.D. Baltimore. J.A.M.A. 188: 9 (June 1, 1964) 779.Tetracycline in the Treatment of Cholera.W.B. Greenough, M D , R S Gordon. Jr.,M.D., T.S. Rosenberg. M.D..B.T. Davies, M.D. THE LANCET 1 : 7329 (Feb. 15, 1964)355.Medical Radiations and Leukaemia : a Retrospective Survey. F.W. Gunz and H.R. Atkinson.Brit.Med.Jou. (Feb. 15,1964) 389.Radiology in Diagnosis of Coeliac Disease. W. Morrice McCrae and Elizadeth M.Sweet. Brit.Med.Jou. (July 18,1964) 163.Long-term Administration of Corn Oil in Management of Patients after Myocardial Infarction : A Four-year Study. W.C. Watson, M B., M.R.C.P., M.R.C.P. Glasg. Brit. Med. Jou. (Nov. 30,1963) 1366.Evidence for "Rebound" Hypercoagulability After Stopping Anticoagulants. L.Poller,M.D.,J.Thomson, A.I.M.L.T. THE LANCET 2:7350 (July 11, 1964) 62.Ampicillin in Treatment of Salmonella typhi Carriers. J.M.F. Whitby, L.M.S.S.A. THE LANCET 2 : 7350 (July 11, 1964) 71.Comparison of Ampicillin and Chloramphenicol in Treatment of Paratyphoid Fever. R.A. Sieet, G.Sangster, and J. McC. Murdooh. Brit.Med.Jou.(Jan.18,1961) 148.Effect of Nicotinic Acid on Abnormal Serum Lipids. O.Fitzgerald, A. Heffernan, P. Brennan, R. Mulcahy, J.J. Fennelly, and R. Mulcahy, J.J. Fennelly, and R. McFarlane-Brit.Med.Jou. (Jan. 18, 1964) 157.
Deaf - Mutism A Clinical Analysis
Authors: Maskey Narbada Lal
Published: September 2018

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A Survey of Tuberculin-Positivity In School Children
Authors: Das G S.L. , Giri J N
Published: September 2018

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Tuberculosis Survey In Bhaktapur
Authors: Miyamoto T , Shiozawa K , Iwamura N , Nomura T , Fukasu H , Funato Y , Kobayashi Y , Miura T , Joshi Y R , Shrestha P N , Pradhan I , Shrestha S B , Pradhan M L , Tandokar B B , Karki D B , Bhakia Ishwari
Published: September 2018

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Medical Research
Authors: Editor JNMA
Published: September 2018

NA
Infectious Diseases
Authors: Editor JNMA
Published: September 2018

NA
Water Supply
Authors: Editor JNMA
Published: September 2018

NA
Quotations
Authors: Author No
Published: September 2018

NA
Hydatid cyst of the liver
Authors: Avrov U
Published: September 2018

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A Vaccinated Case Of Rabies
Authors: Malla F B , Acharya I L
Published: September 2018

NA
Appendicular Fistula
Authors: Sharma A K , Rajbhandary K B
Published: September 2018

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In-vitro Activity of Three Brands of Ceftriaxone against different Clinical Isolates
Authors: Thapa B , Mahat K
Published: September 2018

INTRODUCTION:

Ceftriaxone is an extended spectrum cephalosporin that has been used for decades for combating infections caused by wide array of pathogens and prescription of antibiotic is in favor of specific brands without realizing the potency of the brand. The in-vitro activity of three brands of ceftriaxone and various antibiotics against clinical isolates is studied.

METHODS:

This comparative study was carried in Kathmandu Medical College Teaching Hospital (KMCTH), Basic Science Complex, Duwakot, Bhaktapur in 2009. Thirteen clinical isolates isolated from the specimens processed in the Microbiology Laboratory at KMCTH were used. Minimum inhibitory concentration (MIC) of three brands of ceftriaxone (A, B, and C) was determined by agar dilution and antibiotic resistance patterns were deduced by disc diffusion test.

RESULTS:

MIC for three brands of ceftriaxone ranged from < 0.25 to > 256 mg/L. The MIC for brands A and C of ceftriaxone were consistent for all isolates while for brand B, MIC was higher by at least two fold suggesting this brand had less in-vitro activity against isolates tested. All isolates were multi-drug resistant. Ceftriaxone resistant isolates (n = 6) were simultaneously resistant to various antibiotics tested. Imipenem and amino glycosides were sensitive to the isolates studied.

CONCLUSIONS:

Different brands of ceftriaxone are available in Nepal and imprudent use of less potent antibiotics should be controlled to stop the emergence and spread of multi-drug resistant pathogens and to prevent undue economic burden to the patient and the country.

Keywords: agar dilution, ceftriaxone brands, multi-drug resistant.
The D Vitamins and Dihydrotachysterol in Metabolic Diseases
Authors: Dent C E
Published: September 2018

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Fracture Union in Closed Interlocking Nail in Femoral Fracture
Authors: Sahu R L , Sikdar J
Published: September 2018

INTRODUCTION:

Fractures shaft femur is a major cause of morbidity and mortality in patients with lower extremity injuries. The objective of this study was to find out the outcome of Interlocking nail in fracture femur.

METHODS:

This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Seventy eight patients were recruited from Emergency and out patient department having closed fracture of femoral shaft. All patients were operated under general or spinal anesthesia. All patients were followed for nine months.

RESULTS:

Out of seventy eight patients, sixty nine patients underwent union in 90 to 150 days with a mean of 110.68 days. Touch down weight bearing was started on 2nd post-operative day. Complications found in four patients who had non-union, and five patients had delayed union which was treated with dynamization and bone graft. The results were excellent in 88.46% and good in 6.41% patients.

CONCLUSIONS:

We concluded that this technique is advantageous because of early mobilization (early weight bearing), less complication with good results and is economical.

Keywords: close reamed interlocking nail, dynamization, femoral shaft fractures, union
Brief Analysis Of Tuberculosis Of Vertebrae Treated In Bir Hospital
Authors: Gongol Dinesh Nath
Published: September 2018

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Antibiotic Susceptibility Patterns of Vibrio cholerae isolates
Authors: Shrestha S D , Malla S , Adhikari BR , Shakya G , Basnyat SR , Sharma S
Published: September 2018

INTRODUCTION:

Cholera is one of the most common diarrhoeal diseases in Nepal. Etiological agent of cholera is Vibrio cholerae which removes essential body fluids, salts and vital nutrients, which are necessary for life causing dehydration and malnutrition. Emerging antimicrobial resistant is common. The aim of the present study was to determine the antibiotic susceptibility pattern of cholera patients in Nepal.

METHODS:

All the laboratory works were conducted in the bacteriology section of National Public Health Laboratory, Teku from March to September 2005. During this period a total of 340 stool samples from diarrhoeal patients were collected and processed according to the standard laboratory methods. Each patient suffering from diarrhoea was directly interviewed for his or her clinical history during sample collection.

RESULTS:

A total of 340 stool samples were processed and studied from both sex including all ages of patients. Among the processed sample 53 Vibrio cholerae cases were found. All isolated Vibrio cholerae O1 were El Tor, Inaba. All isolated (100%) Vibrio cholerae O1 were sensitive to Ampicillin, Ciprofloxacin, Erythromycin and Tetracycline whereas all were resistant to Nalidixic acid and Cotrimoxazole. Only 15.1% cases were sensitive to Furazolidone whereas 84.9% were resistant.

CONCLUSION:

All V. cholerae strains isolated in this study were found resistant to Multi Drug Resistant (resistant to at least two antibiotics of different group). Ampicillin, Ciprofloxacin, Erythromycin and Tetracycline were found still more potent antibiotics against Vibrio cholerae isolated during the study.

Keywords: antibiotics, susceptibility, Vibrio cholera.
A Study of Contacts In 500 tubercular families.
Authors: Joshi Y R , Das G S.L , Maskey Narbada Lal , Giri J N , Himal P B
Published: September 2018

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Review Of 41 Cases Of Hyatid Disease
Authors: Sharma A K , Rajbhandary K B , Pradhan R , Joshi N R
Published: September 2018

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Surgical Emergencies Caused by Roundworms (Ascaris Lumbricoides)
Authors: Sharma Anjani Kumar , Rajbhandary K B , Pradhan Rajendra Prasad
Published: September 2018

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Reconstruction of a Thumb with good sensibility by neurovascular skin island transfer.
Authors: Lin Chiu , Tung-yue Yang
Published: September 2018

NA
Journal Of The Nepal Medical Association
Authors: Author No
Published: September 2018

ACCOUNT OF THE SECOND ALL NEPAL MEDICAL CONFERENCE KATHMANDU BRANCH NEWS BIRATNAGAR BRANCH NEWS BIRGUNJ BRANCH NEWS RAJBIRAJ BRANCH NEWS NEPALGUNJ LIST OF THE MEMBERS OF NEPAL MEDICAL ASSOCIATION
Cytological Screening of Cervical Lymphadenopathy in the Eastern Region of Nepal- A Preliminary Study
Authors: Thakur Amarnath , Prakash MB , Raj GA
Published: September 2018

abstract
Stopping the Rot: Fluoride in Nepal's Drinking Water- A pilot study
Authors: McDonald FN , Cox SC
Published: September 2018

Abstract
A PROFILE OF DMPA OR DEPOT-PROVERA ACCEPTORS AT A DISTRICT HOSPITAL OF NEPAL
Authors: Manohar R K , Jha N , Kannan A T
Published: September 2018

ABSTRACT
Management of Male Breast Cancer
Authors: Shrestha P C , Aryal K , Shrestha D B , Sharma V K
Published: September 2018

Abstract
Deciduosis Pritonei-Two Case Reports
Authors: Mohan Praveen , Punia R S , Mohan H , Bhardwaj S , Singh J
Published: September 2018

Abstract
Cataract Surgery in the Eye Camp and its Follow up
Authors: Singh S K , Ale J B , Ale(Adhikary) A , Paudel R P , Basnet G B , Rajbanshi M L
Published: September 2018

abstract
Cancer at Bhaktapur Cancer Care Center, Nepal: A Retrospective Analysis
Authors: Paley M D , Piya M K
Published: September 2018

abstract
Pattern of Incurable Blindness in BPKIHS
Authors: Badhu Badri Prasad , Shrestha S P
Published: September 2018

Abstract
Study on Air Bacterial Flora of Kathmandu Valley
Authors: Sharma B K , Sharma A P
Published: September 2018

Abstract
CHOLECYSTECTOMY IN BIR HOSPITAL
Authors: Gongol D N , Shrestha D M , Khekurel M K
Published: September 2018

Abstract
CARE OF NEWBORN-SPECIAL PRIORITY IN BASIC HEALTH SERVICES IN NEPAL
Authors: Acharya Suniti
Published: September 2018

Abstract