bluuebunny/crossref_metadata_2025 huggingface dataset:
ISCHAEMIA-REPERFUSION INJURY TO THE GUT FOLLOWING CARDIOPULMONARY RESUSCITATION
Authors: Shrestha Badri Man , Throssell D
Published: September 2018

Ischaemia-reperfusion injury (IRI) to the gut following cardiopulmonary resuscitation (CPR) gives rise tolocal effects including altered mucosal permeability and infarction of the gut, and remote consequenceswhich may culminate in multiple organ failure with a potentially fatal outcome. We describe two cases ofIRI to the gut following CPR in patients where diarrhoea and abdominal pain in the first, and haematemesis,rectal bleeding and peritonitis in the second patient were the presenting features. The relevant aspects ofpathophysiology and management are summarised.IRI to the gut, defined as tissue damage occurring as a direct consequence of revascularisation, results fromintestinal hypoperfusion due to cardiogenic, septic, or haemorrhagic shock, the use of vasoactive drugs,supra-coeliac aortic cross-clamping, construction of free intestinal grafts, or a mesenteric embolic event.We describe two cases of IRI to the gut following CPR and summarise the relevant aspects of itspathophysiology and management.Key Words: Ischaemia-reperfusion injury, gut, cardiopulmonary resuscitation.
Outcome of preterm babies and associated risk factors in a hospital
Authors: Shrestha S , Dangol SS , Shrestha M , Shrestha RPB
Published: September 2018

INTRODUCTION:

Preterm birth is a major problem associated with maximum perinatal mortality and morbidity in developed and developing countries. The aim of this study is to identify risk factors associated with preterm birth and to study morbidities and mortality.

METHODS:

A descriptive retrospective study was conducted on 164 cases of preterm babies admitted to Neonatal Intensive Care Unit from January, 2007 to December, 2009

RESULTS:

Incidence of preterm birth was 19.5%. Mean birth weight was 1670 +/- 370 grams and mean gestational age was 30.02 +/- 0.37 weeks. Common risk factor associated with preterm birth were inadequate antenatal checkup (52%), maternal age <20 years (34.7%), ante partum hemorrhage (23.4%) and pregnancy induced hypertension (13.1%). Common morbidities were clinical sepsis (66.7%), hyperbilirubinemia (58.8%), birth asphyxia (26.8%) and hyaline membrane disease (23.5%). Overall survival was 79.4% with minimum age of survival of 880 grams. The mortality rate in extremely low birth rate and very low birth rate was 80% and 39.5% respectively. The common causes of death were hyaline membrane disease (64.5%), sepsis (58.06%) and necrotizing enterocolitis (25.8%).

CONCLUSIONS:

The main risk factors for preterm delivery were inadequate antenatal check up, maternal age <20 years, antepartum hemorrhage and pregnancy induced hypertension. The most common morbidity was clinical sepsis followed by hyperbilirubinemia. Common causes of death were hyaline membrane disease and sepsis.
I-gel for Positive Pressure Ventilation
Authors: Maharjan Shyam Krishna
Published: September 2018

Introduction: I-gel is a relatively new supra-glotitc airway device which is claimed to be superior to laryngeal mask airway. It can be used ingeneral anesthesia with spontaneous ventilation as well as with positive pressure ventilation.This study was designed to assess whether I-gel creates adequate laryngeal seal during positive pressure ventilation in patients undergoing laparoscopic surgery.

Methods: A prospective randomized study was made among the 60 patients who underwent laparoscopic cholecystectomy under general anesthesia. Airway was managed with either I-gel insertion or endotracheal intubation and positive pressure ventilation in 30 patients each. Airway pressure, end-tidal CO2 and oxygen saturation were monitored and compared between two groups. Inhaled and exhaled tidal volume, minute volume were recorded and leak volume and leak fraction was calculated and compared between two groups.

Results: Oxygenation and ventilation (oxygen saturation and end-tidal carbon dioxide pressure) was within normal limit in both groups and comparable. Leak volume in tracheal tube group was 25.33±12.41 ml and in I-gel group it was 26.43±13.19 ml. Leak fraction was 0.0487±0.023 and 0.0417±0.022 in tracheal group and I-gel group respectively. The airway pressure during C02 pneumoperitoneumwas 20.55±3.25 cm H20 in tracheal tube group and 20.21± 3.97 cm H20 in I-gel group and there was no significant leak in either group. Statistically, there was no significant difference in leak volume, leak fraction and airway pressure between the two groups.

Conclusions: I- gel may be an alternate to tracheal tube during general anesthesia with positive pressure ventilation in patients with normal airway pressure with acceptable leak, adequate oxygenation and ventilation.

Keywords: I gel; Laparoscopic cholecystectomy; positive pressure ventilation; tracheal intubation.
Uncommon Solitary Mesenteric Mass: Mesenteric Panniculitis
Authors: Shah Abhishek , Cao Dianbo , Shah Deepa , Sun Wenbin
Published: September 2018

Mesenteric panniculitis is a rare, benign disease characterized by a chronic non-specific inflammatory process of mesenteric fat tissue with unknown etiology. Its clinical outcome ranges from complete resolution without any treatment to rapid progression culminating in death. So far, there is no established treatment available for its management. A 53-year-old female was admitted to our hospital because of intermittent abdominal pain, abdominal distension and early satiety for three months. Her abdominal CT scan revealed a solitary, well-defined, heterogeneous mass with a diameter of approximately 3.5cm x 2.8cm in the mesentery of small bowel. Exploratory laparotomy revealed yellowish-grey mass with a gritty consistency and histopathology of the resected specimen confirmed it to be mesenteric panniculitis. An increased awareness may lead to the use of a less invasive diagnostic approach and optimal management of this rare disease entity.

Keywords: Computerized Tomography (CT); Mesenteric Panniculitis (MP); treatment.
Percutaneous Coronary Intervention without onsite Cardiac Surgery Backup
Authors: Dubey Laxman , Sharma Sanjib Kumar , Bhattacharya Rabindra , Guruprasad Sogunuru , Subramanyam Gangapatnam
Published: September 2018

Introduction: Mechanical revascularization by percutaneous coronary interventions has now become an established and preferable method of revascularization in patients with acute coronary syndromes. The aim of the study was to identify the clinical indications for percutaneous coronary interventions and in-hospital outcomes of percutaneous coronary interventions in a tertiary-level hospital without onsite cardiac surgery backup.

Methods: This was a prospective descriptive study. All consecutive patients who were admitted  for percutaneous coronary interventions, including both primary as well as elective percutaneous coronary interventions, between March 2011 and December 2012 were included in the study.

Results: Total 101 percutaneous coronary interventions were performed. The mean age was 58.9 ± 12.3 years. The most frequent indication was ST-elevation myocardial infarction 72 (71.3%). Proximal artery stenting were performed in 39 (38.5%) and the non proximal artery stenting in 62 (61.5%). The outcomes were mortality 5 (4.9%), periprocedural myocardial infarction 2 (1.9%), cardiogenic shock 6 (5.9%), contrast induced nephropathy requiring dialysis in 3 (2.9%), minor complications which were managed conservatively in 13 (12.9%).

Conclusions: Percutaneous coronary intervention was feasible with acceptable complications in a tertiary-level hospital without onsite cardiac surgery backup. ST-elevation myocardial infarction was the major indication and cardiogenic shock was the major complication observed, and non proximal  artery stenting was more common than the proximal artery stenting.

Keywords: indication; onsite cardiac surgery; outcomes; percutaneous coronary interventions.
Left Sided Amyand’s Hernia with Sliding Component
Authors: Pun Ashis , Khatri Roshan
Published: September 2018

The eponym ‘Amyand hernia’ coined in recognition of Claudius Amyand, the first surgeon to successfully perform appendectomy in a hernia sac containing appendix, refers to the vermiform appendix within inguinal hernia.

Here, we present a rare case, of Amyand’s hernia in an 18 month-old boy who was brought with an inguino-scortal swelling which later on exploration was left sided Amyand’s hernia with sliding component.

Amyand’s hernia is not very often seen in the clinical practice and its pre-operative diagnosis is very difficult hence awareness of this disease condition is essential for preoperative suspicion and even diagnosis of the condition.

Keywords: Amyand’s hernia; acute appendicitis; hernial repair.
Cannabis Abuse and Psychiatric Morbidityz
Authors: Upadhyaya Kapil Dev
Published: September 2018

Panic disorder was seen as the most common presentation amongst the cannabis users who presented in thepsychiatric out patients of Western regional hospital for the treatment.Key Words: Panic disorder, Cannabis.
Cervical Dysgenesis with Transverse Vaginal Septum with Imperforate Hymen in an 11 year old Girl Presenting with Acute Abdomen
Authors: Gupta Pratiksha , Gupta Sangeeta , Jindal Sunita , Chopra Kanwaljeet , Sinha Manjari , Arora Anita
Published: September 2018

This case highlights the importance of careful evaluation of girls presenting with imperforate hymen as this is accompanied by other female reproductive tract anomalies. It is of utmost importance that a correct timely diagnosis is made so that the right treatment can be chosen with the perspective of future fertility. Cervical dysgenesis associated with vaginal septum and imperforate hymen has not been reported in literature so far. Present case highlights the simple mode of management with a successful outcome.

Keywords: cervical dysgenesis; imperforate hymen; transverse vaginal septum.
Ameloblastoma of the Maxilla
Authors: Kumar Avneesh , Singh A K , Shetty D , Abrahm A L , Sharma R , Reddy N S , Talwar O P
Published: September 2018

A case of recurrent maxillary ameloblastoma in a 48 year's old lady is presented along with a brief reviewof literature. The factors determining recurrence, modalities of treatment and management of recurrenceare discussed.Key Words: Ameloblastoma, Maxilla.
The Association of Medical Professionals: Need to appear free from any bias
Authors: Aacharya Ramesh Prasad
Published: September 2018

Abstract
Anomalous Origin of the Coronary Arteries: An Account of Six Cases
Authors: Dubey Laxman
Published: September 2018

Anomalous origin of coronary arteries is a rare type of congenital anomalies with a low incidence. Itis considered an incidental finding without clinical significance, however, these abnormalities maybe responsible for angina pectoris, heart failure, arrhythmias and increased risk of sudden death. Inthis paper, six cases that were diagnosed with anomalous origin of coronary arteries confirmed bycoronary angiography has been described and also briefly reviewed the literature concerning currentviews and therapy of this abnormality._______________________________________________________________________________________Keywords: anomalous origin of coronary artery; coronary angiography; incidence.
Organized Subdural Hematoma with Thick Membrane in Chronic Subdural Hematoma
Authors: Shrestha P , Panta B , Shrestha P , Rajbhandari P
Published: September 2018

Introduction: Chronic subdural hematoma (CSDH) may occasionally contain organized hematoma which can lead to recurrence and other complications after surgery. There is no exact study and data about OHTMF in Nepal so far. The main objective of this study is to study its prevalence and complications.

Methods: This is a multicentric retrospective analytical study being carried out at Norvic International Hospital and Annapurna Neurological Institute. We retrospectively analyzed one hundred cases of CSDH between early 2006 to 2010 August. We focused our study mainly on OHTMF.

Results: Of 100 cases, majority of the patients were male ranging from 4 to 85 years of age. Bilateral subdural hematoma was found in about 9% of cases. Majority of cases were treated in usual fashion with single burr hole and drain.

OHTMF was found in 3 cases (3%) for which craniotomy with radical membranectomy was performed. In 2 cases membrane formation was noticed during surgery, craniotomy with total membranectomy was performed immediately. In one case there was recurrence of CSDH within 10 days of single burr hole evacuation. Craniotomy with membranectomy was performed in 2nd surgery. There was no recurrence after membranectomy. One case developed seizure post operatively.

Conclusions: OHTMF is one of the important causes of CSDH recurrence. It has to be treated radically. Different hypthotheses have been postulated regarding thick membrane formation in CSDH. We have tried to discuss these hypotheses.

Keywords: burr hole evacuation, craniotomy, CSDH, OHTMF.
Conservative treatment in acute appendicitis
Authors: Paudel G R , Agrawal CS , Regmi R , Agrawal S
Published: September 2018

INTRODUCTION:

Acute appendicitis is one of the commonest surgical problems and appendectomy is one of the most commonly done operations in the emergency world wide. Though there have been occasional reports with conservative treatment in acute appendicitis, it is not being practiced as a routine.

METHODS:

All patients between ten to sixty years of age admitted at BPKIHS with the diagnosis of acute appendicitis over a period of one year were enrolled in the study. After taking informed consent the patients were managed conservatively. Those who did not respond to antibiotics within 24 hours were operated. Total hospital stay and complications were recorded and they were followed up at first week, sixth week and sixth month. The success rate, conversion rate, recurrence rate and morbidity and mortality pattern were assessed as the final outcome of conservative treatment of acute appendicitis.

RESULTS:

A total of 96 patients (48 males and 48 females) underwent conservative treatment. The conservative treatment was successful in 79 (82.3%) cases and failed in 11 (11.4%) cases, which included: conversion to appendectomy during conservative treatment period 4 (4.2%) cases, recurrence 7 (7.3%) cases. There was no mortality in this study.

CONCLUSION:

Acute appendicitis can be treated successfully with conservative (antibiotics) treatment with a short hospital stay. Though there is a risk of recurrence in some cases, all the complications after appendectomy can be eliminated with the conservative treatment.Keywords: acute appendicitis, appendicular lump, conservative management
Neontal Intensive Care Unit Hospitalization of Very Low Birth Weight Japanese Infants with Congenital Heart Disease.
Authors: Basnet Narayan Bahadur , Noma S , Bashnet S B , Igarashi T
Published: September 2018

The lack of study regarding the duration of neonatal intensive care unit (NICU) hospitalization of very lowbirth weight (VLBW) infants (< 1500g) with congenital heart disease (CHD) necessitated this study.Retrospective data of all infants weighing <1500 g with a gestational age (GA) < 37 weeks at birth wereobtained from the NICU of Tokyo Metropolitan Hachioji Children’s Hospital in Tokyo, from January, 1997to December, 2001. Of 1515 admissions, 189 (12.5%) weighed <1500 g at birth, with weight ranging from377 g to 1496 g (mean 1060.6 g, 283.3 SD). CHD was diagnosed in 20 (10.6%) of infants. The male to femaleratio was 1:1.5. In CHD patients, birth weight ranged from 554 g to 1473 g (mean 1029.8 g, 243.5 SD), GAranged from 24 to 36 weeks (mean 29.4, 3.5 SD) and the length of hospitalization ranged from 3 to 154 days(mean 74.6 days, 43.8 SD; median 68 days). Patent ductus arteriosus was diagnosed in all infants with GA<27 weeks. Three infants (16.7%) with CHD died in NICU. Establishment of the mean duration of NICUhospitalization in CHD infants may help to improve the planning and management of resources requiredfor NICU care and counseling of parents.Key Words: Neonatal intensive care unit (NICU) hospitalization, congenital heart disease (CHD), Japan
A mental health prevalence survey in two developing towns of western region
Authors: Upadhyaya Kapil Dev , Pol K
Published: September 2018

A prevalence survey was done to find out the conspicuous psychiatric morbidity (CPM) in two rapidlydeveloping towns of western region by using Self – Rating Questionnaire (SRQ). Out of 894 people interviewed773 were selected for analysis. The CPM point prevalence rate of 35.4 % was found. The high prevalence ofCPM was most likely due to less stable social structure in the towns in transition.
Prune -Belly Syndrome with spina Bifida and Anorectal agenesis
Authors: Joshi Bharat D , Prasad R , Singh R , Bhatta N K , Bhattarai S J
Published: September 2018

Prune Belly Syndrome is a rare birth defect with only few cases reported in our part. A newborn baby withPrune belly syndrome is presented along with review of literature.Key Words: Prune belly, abdominal muscle, urinary tract anomaly
Subcutaneous Emphysema A rare complication of tonsillectomy
Authors: Sharma Ravinder , Abhraham A L , Shetty D , Kumar A , Singh A , Reddy N S
Published: September 2018

Cervical subcutaneous emphysema results from the entry of air into the muscle planes and subcutaneousplanes. It can rarely be seen after tonsillectomy. We report this rare complication in a 20 year old femaleoperated for chronic tonsillitis with history of peritonsillar abscess in past. The case is reported for itsrarity. The pathogenesis and management of this complication is presented with the review of literature.Key Words: Tonsillectomy, Subcutaneous emphysema, Cervical.
SIGNIFICANTLY HIGH INCIDENCE OF T-1654C POLYMORPHIC VARIATION IN THE PROTEIN C GENE PROMOTER REGION IN EARLY ONSET LEGG-CALVE' PERTHES DISEASE
Authors: Pokharel Rohit Kumar , Fujii S , Shiba R , Matsuo M
Published: September 2018

Inherited thrombophilia has been suggested as a cause of micro-thrombosis resulting in femoral head necrosisin Legg-Calve' Perthes Disease (LCPD). Protein C, hepatic zymogens, acts as a thrombotic agent and regulatesthe coagulation cascade. Genotype variations in the promoter region of the protein C gene (T-1654C; A-1641G & A-1476T) have been reported to be associated with plasma protein C levels and thrombotic risk.In order to clarify any association of these polymorphic variations to LCPD, we analyzed the promoterregion of gene for protein C (from –1704 to –1198 nt) in 70 Japanese LCPD cases (8 early-onset & 62 lateonsettype) and 93 controls.Results of direct sequencing of the protein C gene promoter region showed a significantly high incidence ofT-1654C change in early-onset LCPD cases than among the late-onset LCPD and control groups. Ourresults, therefore, suggest a significant association between early onset LCPD and the T-1654C mutation inthe protein C promoter region.Key Words: Protein C gene promoter region polymorphism, micro thrombosis, early-onset LCPD.
A COMPARATIVE STUDY OF RATE OF FALL OF TOTAL SERUM BILIRUBIN IN JAUNDICED BABIES FOLLOWING CONTINUOUS AND INTERMITTENT PHOTOTHERAPY
Authors: Bhatta Bhubanesh Kumar , Shrestha P S
Published: September 2018

Jaundice is observed during the first week of life in approximately 60% of term infants and 80% of preterminfants.1 Out of the 60% only 5% term and 20% preterm actually need treatment2 like phototherapy. Theobjective of the study was to calculate rate of fall of total serum bilirubin in jaundiced babies followingcontinuous and intermittent phototherapy. A non-randomized, group matched, prospective, experimentalstudy involving two comparable populations of 91 jaundiced babies receiving intermittent (45 babies - 6hour on and 6 hour off) and continuous phototherapy (46 babies) were studied at the Tribhuvan UniversityTeaching Hospital over a period of six months. The percent fall of total serum bilirubin for each 24-hour onfirst, second, third and fourth day of phototherapy was -9.724% (SD 25.094), 4.717% (SD 17.52), 7.468%(SD 7.811) and 7.349% (SD 4.482) respectively in continuous phototherapy. The corresponding figures forintermittent phototherapy were -13.623% (SD 26.804), 1.131% (SD 19.965), 7.672% (SD 15.365) and 12.864%(SD 8.29). The differences were statistically insignificant on the first, second and third day (p=0.51, p=0.60and p=0.95 respectively). On the fourth day it was higher with the intermittent phototherapy (p=0.04). Thetotal duration of photo exposure was 64.435 hours (SD 22.251) in the continuous phototherapy group ascompared to 35.581 hours (SD 12.855) in the intermittent phototherapy group (p=0.000001). In view of theconcern, which has been raised regarding the possible long-term side effects of phototherapy, intermittentphototherapy offers an attractive therapeutic alternative by reducing the duration of light exposure toabout half without decreasing the efficacy.Key Words: Neonatal jaundice, phototherapy.
PREANAESTHETIC FASTING PRACTICE AND OUTCOME : A STUDY IN NEPALI CHILDREN
Authors: Maharjan Shyam Krishna , Bajracharya G R , Aryal S
Published: September 2018

The purpose of this study is to compare the outcome of traditionally advised pre-anesthetic fasted childrenwith those who fasted for lesser time in our setup.One hundred and Sixty two children undergoing surgery under general anaesthesia were selected randomly.They were divided into two groups. Group one was advised in a traditional way – no solid food aftermidnight and no liquid drink at least six hours before anaesthesia. Group two was given either glucosewater 2-4 hours before induction or breast milk 4 hours before induction of anaesthesia. None of the childrenwere premedicated.Anesthetic techniques were either sole intravenous anaesthesia (IVA) for minor cases or general anaesthesia(GA) and combined methods (IVA or GA with regional blocks). Patients were closely monitored for anyactive regurgitation and vomiting during the induction of anaesthesia, perioperative and postoperativeperiod. Complications were analyzed in different age groups, different fasting hours and type of anaesthesiadelivered.None of the children had any regurgitation or vomiting during induction and perioperative period. Fewchildren of both groups vomited during postoperative period when they were fully conscious.As the chances of regurgitation and vomiting with clear fluid given two hours before is comparable with thetraditional system, there is no need to put the child starved for prolonged period. This will avoid unnecessarydehydration, hypoglycemia and uncoperation in the children.Key Words: Pre-anaesthetic fasting, regurgitation, dehydration.
Eclampsia An Obstetric Disaster
Authors: Pradhan P
Published: September 2018

Eclampsia has been graded as fatal and dreadful disease even before Christ and is the important cause ofmaternal and perinatal mortality in developed and developing countries. Severe morbidity associated witheclampsia include placental abruptio, cerebral haemorrhage, cortical blindness, renal failure, disseminatedintravascular coagulopathy, pulmonary oedema, psychosis and growth retardation and preterm or both.Present management of eclampsia aims to stop the convulsions, its recurrences, control of blood pressureand correct fluid and electrolyte balance and delivery of the baby. There have been great controversiesabout the best anticonvulsants to use. The randomised trials comparing magnesium sulphate with diazepamor phenytoin showed greater efficacy of magnesium sulphate in the control and prevention of recurrence offits. Perinatal mortality is also better with magnesium sulphate. Intramuscular injection is painful andlocal abscess formation at the site of injection is possible. Control of dose is better with intravenous routetherefore preferred. Magnesium sulphate should be continued for 24 hours after the delivery or after thelast fit. Antihypertensive drug therapy is now a routine practice in the management of pre-eclampsia andeclampsia. Methyl dopa, Lobetelol, Nefedipine are well tried in pregnancy and safe in pregnancy. However,hydralazine intravenous is good for quick and smooth control of blood pressure. Termination of pregnancyhas been an important part of the management of eclampsia. Studies have shown that maternal outcomesseems better with caesarean delivery compared to vaginal delivery. The caesarean section rate is high at26.3-80.4% in different studies. Recently maternal mortality and morbidity has been greatly improvedeven in developing countries by better control of fits by magnesium sulphate and caring them in intensivecare unit.Key Words: Eclampsia, Anticonvulsants, Antihypertensives, Delivery.
HIV AIDS Related Knowledge, Attitude and Practice among High School Students in Eastern Nepal
Authors: Lakhey Shishir , Lakhey M , Bhattarai M , Niraula S R , Singh G K
Published: September 2018

Abstract
KAtex Test for the Detection of Urinary Antigens in Visceral Leishmaniasis Patients of Nepal
Authors: Sherchand JB , Shah SN , Hommel M
Published: September 2018

The rapid detection of parasitic antigens in body fluid including urine by immunological tests such asKAtex has been a valuable addition to clinical medicine. Existing method of microscopic bone-marrowexamination and immunological test for antigen –enzyme-linked immunosorbent assay (ELISA) test forvisceral leishmaniasis antigen are difficult to perform in the field, and this has limited use in rural areas ofendemic countries like Nepal. In this study we have tested 276 urine samples from visceral leishmaniasispatients from different endemic areas of Nepal. Sixty-seven patients (24.3%) were found KAtex positive.The clinical picture of these patients was compared with the KAtex test and additional laboratory findings,knowledge, attitude and behaviour were assessed. High rate of KAtex positive (97.4%) was found in bonemarrow confirmed patients with high degrees of sensitivity and specificity. Hence the study confirmed thatthe KAtex test is suitable for the confirmation of suspected cases in the field and hospital where bonemarrowfacilities are limited or where there is a lack of trained manpower as well as microscopic diagnosisis not available.ORIGINAL ARTICLE Journal of Nepal Medical Association 2003; 42: 191-195Sherchand J B*, Shah S N*, Hommel M**Key Words: Rapid diagnostic test, urinary antigen, visceral leishmaniasis, Nepal.
Distribution of Risk Factors in Patients with Acute Coronary Syndrome – a Hospital Based Study
Authors: KC Man B , Rajbhandari S , Sharma D , Malla R , Limbu YR , Rajbhandari R , Regmi SR , Maskey A
Published: September 2018

A total of 230 patients admitted in coronary care unit of Shahid Gangalal National Heart Centre in betweenNovember 2001 and October 2002 were studied. 157 (68.2%) were male, with mean age of 62.8±11.8 years.Majority of acute coronary syndrome (ACS) events were observed in males with advanced age (> 65 years).About 68% patients with ACS were smoker, the most common modifiable risk factor followed by hypertension,dyslipidaemia and diabetes. A strong trend towards development of coronary artery disease (CAD) wasfound in subjects with positive family history of CAD. Multiple risk factors (2 or more) were present in vastmajority of patients. Modifiable risk factors, with smoking at number one position are more common inacute coronary syndrome patients. Appropriate management of modifiable risk factors is advisable to reducethe incidence of coronary artery disease.Key Words: Coronary Artery Disease, Risk Factors.
Contrast-enhanced Ultrasound for Non-tumor Liver Diseases
Authors: Maruyama H , Yokosuka O
Published: September 2018

Contrast-enhanced ultrasound (CEUS) is a simple, safe and reliable technique for the clinical management of patients with various liver diseases. Although the major target of the technique may be focal hepatic lesions, it is also effective for the diagnosis of non-tumor liver diseases, such as grading hepatic fibrosis, characterization of chronic liver diseases and diagnosis of portal vein thrombosis. This review article aimed to overview the recent application of CEUS in the assessment of non-tumor liver diseases.

Keywords: Cirrhosis, contrast agent, fibrosis, idiopathic portal hypertension, microbubble, portal vein thrombosis, ultrasound.
Management Strategies for Microalbuminuria in Diabetes Mellitus – an Overview
Authors: Kishore K , Sharma A
Published: September 2018

Microalbuminuria (MA) in individuals with diabetes mellitus (DM) is associated with markedly reducedsurvival, increased risk of cardiovascular disease and is predictive of later development of an overt DiabeticKidney Disease (DKD) and progressive renal failure. Patients with type 1 DM from 5 years after diagnosisand type 2 DM from the time of diagnosis should be screened annually for MA by sensitive stick test in spotcollection or Albumin Excretion Rate (AER) in the timed collection of urine. AER. of 20-200µg/min (30-300mg/24hr) or Albumin : Creatinine ratio (ACR) >2.5 is labelled as MA. ACE Inhibitor / Angiotensin IIReceptor Blocker (ARB) therapy along with improved glycaemic control is the key to prevent or slow theprogression of DKD.Key Words: Microalbuminuria, Diabetes Mellitus, Diabetic Kidney Disease.
HYDATID CYST OF ORBIT WITH PROPTOSIS
Authors: Adhikari Ram Chandra , Sayami G , Sharma A K , Lee M C , Dali S , Shrestha H G
Published: September 2018

Hydatid cyst of orbit is a rare cause of proptosis, even in endemic regions. So far, Hydatid cyst of the orbit,has not been reported from Nepal. We report a 7-year-old boy, who presented with initially painful, laterpainless axial proptosis of the right eye without ocular movements and perception of light. As the case wasclinically diagnosed as retinoblastoma or rhabdomyosarcoma, the exenteration was carried out.The retroorbitalcyst containing gel-like fluid was histopathologically examined and the diagnosis of hydatid cyst wasconfirmed. Although rare, orbital hydatid cyst should be considered as one of the differential diagnoses ofunilateral severe proptosis.Key Words: Orbit, Hydatid cyst, Proptosis.
Local resection of gastrointestinal stromal tumor of the second part of duodenum
Authors: Kansakar R , Adhikari S
Published: September 2018

Gastrointestinal stromal tumors are relatively rare in the duodenum, representing 2-4% of Gastrointestinal stromal tumors of the gastrointestinal tract. We describe a huge Gastrointestinal stromal tumor arising from the second part of the duodenum invading the transverse colon which was removed successfully by local resection of the second part of the duodenum along with a segment of transverse colon.

Keywords: duodenum, gastrointestinal stromal tumor, segmental resection
CARCINOMA OF THE BREAST : TIME TO PRACTICE EVIDENCE BASED MEDICINE
Authors: Timilsina Digvijay S
Published: September 2018

Breast cancer is a common, dangerous and to some extent curable disease. Mortality from this disease hasjust now beginning to fall after remaining stagnant for 40 years. Screening and multimodal therapy basedon our paradigm changes are responsible for this happy trend. There is a very individualistic trend amongsurgeons to manage such cases, based on their own personal experiences. We are in a situation where samestaged disease is managed very differently and thus comparison of results and national guidelines are veryfar off. We have very few indexed publications listed on this subject from Nepal.Here an attempt is madeto review the recent publications and rationalizations from the abundance of information available.Key Words: Carcinoma, breast, screening, mammography, radiotherapy, mastectomy.
MANAGEMENT OF MAGNETIC INTRAOCULAR FOREIGN BODY
Authors: Malla O K , Sharma A K , Shrestha S
Published: September 2018

Posterior segment intraocular foreign bodies pose a problem in restoration of significant visual acuity usuallydue to delayed presentation, improper evaluation and management. However, good history taking, meticulousocular examination and proper management can result in reasonable visual acuity in cases of retainedintraocular foreign body in the posterior segment. We are presenting a case report of penetrating oculartrauma with retained intraocular foreign body in the posterior segment. Following intraocular foreignbody removal, core vitrectomy and subsequent cataract extraction, the patient had best corrected visualacuity of 6/9.Key Words: Intraocular foreign body, vitrectomy, cataract.
EFFECT OF SUBMAXIMAL EXERCISE ON SYSTOLIC AND DIASTOLIC BLOOD PRESSURE IN YOUNG SEDENTARY NORMOTENSIVE NEPALESE MEDICAL STUDENTS
Authors: Ghosh Arijit , Pramanik T
Published: September 2018

Higher exercise blood pressure represents low cardiorespiratory status of an individual and vice versa. Thechanges in systolic and diastolic blood pressure in response to rhythmic isotonic muscular exercise in sedentaryyoung normotensive Nepalese students were assessed. Normal blood pressure in standing posture in maleand female subjects are about 115 / 75 mm of Hg. and 106 / 71 mm of Hg. respectively. Just after the exercisesystolic blood pressure increases moderately in both the sexes, whereas diastolic blood pressure remainsunchanged in most of the females. Diastolic blood pressure is found to be decreased slightly in the males,just after exercise. The present study indicates the cardiorespiratory status of the Napalese medical studentsis within normal range.
Bilateral eventration of sciatic nerve
Authors: Sharma T , Singla RK , Lalit M
Published: September 2018

During routine dissection of a 60 years male cadaver, it was observed that the two divisions of sciatic nerve were separate in the gluteal region on both the sides with the tibial nerve passing below the piriformis and the common peroneal nerve piercing the piriformis muscle. The abnormal passage of the sciatic nerve (SN), the common peroneal nerve (CPN), and the tibial nerve (TN), either through the piriformis or below the superior gemellus may facilitate compression of these nerves. Knowledge of such patterns is also important for surgeons dealing with piriformis syndrome which affects 5-6% of patients referred for the treatment of back and leg pain. A high division may also account for frequent failures reported with the popliteal block.

Keywords: eventration, piriformis muscle, piriformis syndrome, sciatic nerve
SYMPTOM PROFILE AND CO-MORBID PSYCHIATRIC DISORDERS IN MENTALLY RETARDED CHILDREN AND ADOLESCENTS
Authors: Ojha S P , Pokhrel A , Nepal M K , Regmi S K , Koirala N R , Sharma S C
Published: September 2018

A retrospective study of 52 children and adolescent subjects suffering from mentalretardation who attended in the Child Guidance Clinic in the Department of PsychiatryOPD, Teaching Hospital, Katmandu, Nepal. They were brought to the OPD withvarious symptoms. It was found that the number of male patients were 35 comparedto 17 female with male female ratio of 2:1. The mean age of male patients was 9.19 +3.55 years where as the mean age of female patients was 9.91 + 9.99 years. GeneralPractitioner and Pediatrician referred majority of them. The commonest symptomwith which the patients presented to the hospital was aggressive behavior (28%) while14 patients (26.9%) presented with speech related problems. Of the 52 patients whopresented in Child Guidance Clinic, 11 patients had comorbid psychiatric problems.It was found that 4 patients had hyperkinetic disorders, 3 patients had disorders ofpsychological development, 1 patient each had post encephalitic sequel, depressivedisorder, somatization disorder and eating disorder.1. Department of Psychiatry, Institute of Medicine.2. Mental Hospital, Lagankhel.3. Clinical Psychologist, Kathmandu Medical College.Address for correspondence : Dr. Saroj Prasad Ojha, MD (Psychiatry),Department of Psychiatry, Institute of MedicineMaharajgunj, Kathmandu, Nepal.Key words: Mental retardation, Psychiatric disorder, Child Guidance Clinic
Ambiguous Phorate Granules for Sesame Seeds Linked to Accidental Organophosphate Fatal Poisoning
Authors: Khatiwada S , Tripathi M , Pokharel K , Acharya R , Subedi A
Published: September 2018

Ingestion of organophosphate compound for suicidal attempt is a major health problem in developing countries. However, unintentional ingestion by an adult is rare. An 80-year-old lady and her 30-year-old granddaughter consumed phorate (organophosphate) granules thinking it to be the seeds of sesame. After grinding the granules and mixing with pickle, they consumed the preparation with rice. The granddaughter was brought dead at emergency department and the older lady after resuscitation shifted to intensive care unit. She was extubated on 17th day and discharged on 23rd day. Pesticide formulation resembling any edible items must be withdrawn from the market at the earliest. Stringent regulation on vendors, apparent formulation or packaging and education about the hazards of these compounds can prevent this type of unintentional poisoning.

Keywords: Ambiguous, organophosphate, phorate, sesame seeds, unintentional poisoning.
Pattern of Childhood Glaucoma
Authors: Shakya S , Koirala S , Pradhan E
Published: September 2018

Glaucoma is one of the important causes of blindness in children all over the world1 .Childhood glaucoma encompasses a wide variety of conditions ranging from primarycongenital glaucoma to different acquired varieties. They may present with only ocularinvolvement or as a part of a syndrome with multiple system involvement. Thevisual prognosis of childhood glaucoma depends upon the structural involvement, stageof presentation, time of intervention and their follow up2. Though all glaucomas areknown to produce blindness, childhood glaucoma unlike the glaucoma in adults havedifferent disease process which enables the optic nerve fibers to regain their functionalintegrity once the IOP is brought down to normal.3 Thus, early diagnosis andearly treatment to achieve normal intraocular pressure can, to some extent, bringback one’s vision. Childhood glaucoma certainly needs to be addressed with muchmore emphasis than that of adult glaucoma, as it may threaten physical as well asmental growth if not tackled at proper time to retain visual stimuli.Most of the literatures on childhood glaucoma have emerged from western world 4,5,6.There has been no literature in this regard from Nepal and profile of childhood glaucomais yet to be determined. This was a retrospective study carried out by GlaucomaUnit B.P. Koirala Lions Center of Ophthalmic Studies with the main intention to seethe profile of glaucoma in Nepalese children.Out of a total of 475 cases of glaucoma seen in a period of 5 years, 27 (5.68%) werefound to be the cases of congenital glaucomas.Primary congenital glaucoma (PCG) was most frequently seen among children. Majorityof the cases of PCG presented late, after 3 years of age, with significant amountof visual loss. Most of them were brought to hospital for the complaint of watering andenlargement of eyeball.
Audit of Outpatient Psychotropic Prescribing Habits in Patan Hospital
Authors: Appleby Alistair
Published: September 2018

A Study of the rate of prescribing of psychotropic drugs in the outpatient clinics of Patanhospital which reveals surprisingly low rates of prescription (1.3%). Theauthor goes on to compare this with a proposed gold standard and to suggest reasonswhy the rate is so low.
PLACENTA PREVIA ACCRETA
Authors: Giri A , Gurung G , Pradhan N , Manandhar B , Rana A
Published: September 2018

Placenta accreta is defined as any placental implantation in which the placenta isabnormally and firmly adherent to the underlying uterine wall in part or in total. Theprobable cause is defective decidual formation as shown by its occurence in area wherethe endometrium is deficient or damaged.The commonest condition associated with it are placenta previa and previous caesareansection. A case of placenta previa accreta is described herewith in a 2nd gravida whoeventually needed emergency caesarean hysterectomy (total) due to profuse bleeding.Key Words: Placenta accreta, placenta, caesarean hysterectomy.
SNAKEBITE POISONING IN CHILDREN
Authors: Shrestha Binod M
Published: September 2018

Snakebite Poisoning is a common paediatric emergency especially during the monsoonseason in the terai and inner terai regions of Nepal. There is hardly any study conductedso far in Nepal to highlight different aspects of snakebite poisoning in children. Thisretrospective study was therefore conducted basically to find out the clinicoepidemiologicalfeatures, case fatality rate and risk factors for death in childrenadmitted in Lumbini Zonal Hospital (LZH) with features of snakebite poisoning.The study showed the highest incidence of snakebite poisoning among children agedabove 10 years. The peak incidence of poisoning was seen during July-August. Thesemonths correspond with the monsoon season in Nepal. Most of the victims had bitesby unidentified snakes (75%), mostly on the fingers & hands (nearly 50%). Nearly47% of the children had respiratory distress, and a large majority of them requiredrespiratory support therapy. Case fatality rate (CFR) was nearly 29%. The relativerisk factors for death due to snakebite poisoning were: age above 5 years, male sex,bites on the finger & hand and bites by Kraits. Mortality and morbidity due to snakebitecan be reduced by early & judicious use of anti-snake venom (ASV).Key Words: Snakebite, Poisoning, Children, Case fatality rate, Nepal
A Two year Retrospective Study of Congenital Inguinal Hernia at Western Regional Hospital
Authors: Charles Meelam R , Christian L B , Sen T , Mahapatra S , Joshi B R
Published: September 2018

In a retrospective study of 133 cases of inguinal hernia in infants and children upto the age of14 years, treated surgically at Western Regional Hospital, Pokhara, Nepalbetween April 1st 1997 and March 31st 1999, it was found that male patients out numberfemale patients in the ratio of 13.7:1 Right sided hernia was almost twice as common ascompared to left. Only 1.5% of patients (2cases) had bilateral inguinal hernia. 4patients (3%) presented with obstructive features. Routine exploration of contralateralside was not done as most surgeons do not recommend this, as only 20% develop herniaon the contralateral side.1 Only one patient had recurrent hernia.Key words: Congenital, hernia, inguinal, retrospective, incarceration.
INTRAVESICAL MIGRATION OF INTRAUTERINE CONTRACEPTIVE DEVICE
Authors: Mannan Abdul , Adhikari D B , Chughtai M N
Published: September 2018

Abstract
AN UNUSUAL SITE OF HYDATID CYST: SCROMTUM
Authors: Ghimire Pradeep
Published: September 2018

An unusual of hydatid cyst in the scrotum presenting as an acute scrotal welling isreported. The nature of the cyst and its management are discussed.ABSTRACTKey Words: Hydatid cyst, Scrotum.
Abstruse diagnosis of obturator hernia--a case series
Authors: Basnet R B , Rijal B , Sharma VK
Published: September 2018

The diagnosis of obturator hernia is one of suspicion as it is almost never seen and rarely palpated. The incidence is less than 1% of all hernias worldwide. Five cases of obturator hernias are reported where the diagnosis of obturator hernia were overlooked.

Keywords: obstruction, obturator hernia, small intestine
Cysticercosis of Breast A Rare Presentation
Authors: Geetha T V , Krishnanand B R , Pai Chitra P
Published: September 2018

Human cysticercosis is the infection caused by the larvae of pork tapeworm Taenia solium.Although it can affect any organ or tissue of the body, the most common sites are themuscles and subcutaneous tissue. In this report, we present the case of a 35 yrs old womanwho came with a history of a painless lump in the left breast. Clinically diagnosed as a caseof Fibroadenoma of the Lt. Breast' an excision biopsy was carried out. A histopathologicalstudy however revealed the presence of the typical cysticercus larva and a definitive diagnosisof 'Cysticercosis of Lt. Breast' was made. Diagnosis of cysticercosis in atypical sitesmay be difficult clinically and to a great extent depends on histologic demonstration of theparasite. Also, cysticercosis of the breast though rare, should be considered as a differentialdiagnosis for a mass in the breast.Key Words : Cysticercosis, Breast.
Attitude towards Mental illness and Psychiatry among the Medical students and Interns in a University Medical College
Authors: Risal Ajay , Sharma Pushpa Prasad , Sanjel Seshananda
Published: September 2018

Introduction: Medical students tend to have a neutral or negative attitude to Psychiatry as a discipline. This study was initiated to explore the attitude towards Mental illness and Psychiatry among the Medical students and Interns in Kathmandu University School of Medical Sciences (KUSMS).Method: A cross-sectional Questionnaire based study was conducted among the Medical students and Interns at Dhulikhel Hospital (Kathmandu University Hospital). Two self-rating scales; Attitudes towards psychiatry (ATP-30) and Attitudes to mental illness (AMI) were used to assess attitudes towards mental illness and Psychiatry among the total 159 subjects. Descriptive statistics and independent sample t-test applied using SPSS-16 for analysis.Results: Among the total 159 subjects, 56.6% were males and 27.7% were Interns. Comparison of means of each item in ATP-30 and AMI was done between Males and Females, Medical students and Interns, First semester and Ninth semester students. Most of the subjects showed neutral attitude towards all the scoring items; though there were a few significant differences in mean scores of some items in group wise comparison.                                                             Conclusions: Overall attitudes towards Mental illness and Psychiatry among the Medical students and Interns in our Medical School were positive or neutral. A further study with medical students from different institutions is needed to get a detail nationwide picture.                                  Key words: Attitude, Interns, Medical Students, Mental illness, Psychiatry.
JNMA Mystery
Authors: Sharma Sudha
Published: September 2018

Abstract
POSSIBLE OCCUPATIONAL LUNG CANCER IN NEPAL
Authors: Joshi Sunil Kumar , Moen B E , Bratveit M
Published: September 2018

ABSTRACTThe objective of this study was to describe the relationship between occupational exposures and thedevelopment of lung cancer among the patients attending Bhaktapur Cancer Care Center, Bhaktapur,Nepal. The study subjects consisted of 85 cases of lung cancer and a reference group of 40 cases of coloncancer. Demographic data and information about work history was obtained by a structured interview.Based on the occupational history, subjects were divided into exposed and non-exposed groups concerningcarcinogenic agents. Exposure prone occupations like agriculture, construction of buildings, construction ofroads and bridges, manufacturing, and transport were categorised as exposed occupations. Similarly,occupations like administrative services, business, student and housewives were categorised as non-exposed.Odd ratio (OR) and 95% confidence intervals (CI) were calculated using logistic regression. Adjustmentsfor smoking habit, life long cigarette consumption (smoking pack year), alcohol habit, education level andage were done. The crude OR for the exposed workers was 5.59 (95% CI: 2.47,12.6). After adjustment forsmoking habit alone or for smoking habit, smoking pack year, alcohol habit, education level and age, theOR was 4.8 (95% CI: 2.02,11.4) and 4.2 (95% CI: 1.4,12.0), respectively.The study shows that for the exposed workers there was an increased risk of lung cancer. The risk wassignificantly increased also after adjusting for smoking habit, smoking pack year, alcohol habit, age andeducation level.Key Words: Lung Cancer, occupation, exposure, Nepal.
REDUCING MORTALITY FROM PERFORATED PEPTIC ULCER IN NEPAL
Authors: Strugnell Neil A.
Published: September 2018

ABSTRACTA study was undertaken to compare mortality from perforated peptic ulcer before and after introduction ofpre-operative, intra-operative and post-operative measures to improve clinical care of patients affected bythis condition. Data was accrued prospectively over 6 months (24 patients) and compared with the previous6 months of historical controls (27 patients). Mortality showed a trend towards improvement. (9/27 c.f. 3/24, p=0.12 n.s., Fisher exact test). Based on these findings and changing ideas in regard to disease transmissionemerging from the recent literature, a framework for limiting mortality from perforated peptic ulcer inNepal is proposed.Key Words: Perforation, peptic ulcer, Nepal, mortality reduction, Helicobacter pylori.