bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Quality of Life in Patients of End Stage Renal Disease on Different Modalities of Treatment
Authors: Shrestha Shailendra , Ghotekar L R , Sharma S K , Shangwa P M , Karki P
Published: September 2018

This study was conducted to measure quality of life of patients with end stage renal disease ondifferent modalities of treatment.A total of 30 diagnosed cases of end stage renal disease (ESRD) attending BPKIHS were includedin the study. Group 1 included 10 patients on regular maintenance hemodialysis, group 2 included10 patients on continuous ambulatory peritoneal dialysis (CAPD) and group 3 included 10 patientson regular conservative drugs. The inclusion criteria were all diagnosed cases of ESRD based on theguidelines given by K/DOQI, 2002. A detailed history relating to the disease condition as per thedesigned proforma was taken, which included demographic data and clinical characteristics of thepatients. For assessment of quality of life, KDQOL-SF questionnaire was used. Strata 8.0 softwareprogram was used for the analysis of collected data.Physical health was found to be the most severely affected domain of the KDQOL. The mean scorefor physical health was least in group 1 (33.36 ± 16.14). Mental health was better in group 2 (54.93± 9.92) than in group 1 (39.50 ± 14.27) ( “p” value 0.01). Variables like haemoglobin, hematocrit andadequacy of dialysis have positive correlation with all the four domains of the KDQOL. There wasa statistically signifi cant correlation of physical health with mental health (p value 0.001), physicalhealth with kidney disease issues (p value 0.001) and mental health with kidney disease issues (pvalue 0.007).Our study has shown that patients of ESRD have a poor quality of life despite being in some formof dialysis and the most affected domain of the KDQOL scale is physical health. Patients on CAPDhave better quality of life than patients on maintenance haemodialysis especially in terms of mentalhealth. Variables like haemoglobin, hematocrit and adequacy of dialysis have a positive correlationwith all the four domains of the KDQOL scale i.e. optimizing these variables improves the overallquality of life.Key Words: dialysis, end stage renal disease, quality of lifeCorrespondence:
Urothelial Tumours of the Urinary Bladder: A Histopathological Study of Cystoscopic Biopsies
Authors: Vaidya Sujan , Lakhey Mamata , KC Sabira , Hirachand Suspana
Published: September 2018

Introduction: Bladder tumours constitute one of the most common urological conditions. Urothelial(transitional cell) carcinoma accounts for 90% of all primary tumours of the bladder. These tumoursare an important cause of morbidity and mortality. The objective of this study was to present thehistopathological patterns of urothelial tumours and to determine the grade and stage of thesetumours.Methods: This is a 3 year descriptive study of urothelial tumours carried out in the Departmentof Pathology, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. Data of all cystoscopicbiopsies collected during this period were analyzed.Results: Of the 83 urinary bladder tumours, 81 (97.59%) cases were urothelial (transitional cell)tumours. Transitional cell carcinoma (TCC) was the most common bladder tumour which was seenin 67 (80.72%) cases. Thirty two (47.76%) cases of TCC were low grade while 35 (52.24%) were highgrade. Forty three (64.18%) cases of TCC were superficial or in early stage (pTa and pT1) while 24(35.82%) showed muscle invasion.Conclusions: Transitional cell carcinoma was the most common bladder cancer. Most of thesetumours were high grade. A large percentage of high grade carcinomas presented with muscleinvasion. Pathological grade and muscle invasion are the most valuable prognostic predictorsof survival. The importance of including smooth muscle in the biopsy specimens needs to beemphasized._______________________________________________________________________________________Keywords: cancer; high grade; low grade; transitional tumour; urinary bladder._______________________________________________________________________________________
Mechanism Underlying the Formation of Thrombus in the Coronary Artery and Drugs Affecting this Process.
Authors: Joshi Mohan P
Published: September 2018

abstract
Ocular Morbidity among Children Attending Government and Private Schools of Kathmandu Valley
Authors: Shrestha R K , Joshi MR , Ghising R , Rizyal A
Published: September 2018

Introduction: Children from the developing world are more prone to going blind from avoidable and preventable causes. In Nepal, children in private schools are reported to have a higher ocular morbidity than those in government schools, with myopia being the major cause of the morbidity. This study was designed to evaluate ocular morbidity in students from both types of school.

Methods: This was a cross-sectional, comparative study among students from government and private schools of Kathmandu. Eye examination was carried out evaluating visual acuity, color vision, refractive status, binocular vision status, and anterior and posterior segment findings.

Results: A total of 4,228 students from government and private schools were evaluated. The prevalence of ocular morbidity was 19.56 % with refractive error (11.9 %) being the major cause of the morbidity, followed by strabismus and infective disorders. No signifi cant difference in the prevalence of ocular morbidity and refractive status was found in the students from government and private schools.

Conclusions: A signifi cant number of children of school-going age have ocular morbidity with no signifi cant difference in the prevalence in the students from government and private schools. Research exploring the effect of various risk factors in the progression of myopia would be helpful to investigate the refractive status in children from these different types of schools.

Keywords: Myopia, ocular morbidity, school Students
Nasal leiomyoma
Authors: Gurung Urmila , Gurung B , Jha A
Published: September 2018

Leiomyoma is a benign tumor showing smooth muscle differentiation. Leiomyoma in the nasal cavity is a rare entity which can present with common nasal symptoms. We report a case of 19 years old male patient with nasal leiomyoma. The patient presented with recurrent episodes of nasal obstruction and epistaxis. On nasoendoscopy, there was a single grayish polypoidal mass in the right middle meatus which bled on touch. CT-scan of nose and paranasal sinus showed homogenous opacity indistinguishable from the right middle turbinate. The mass was excised endoscopically. There is no recurrence a year after the endoscopic excision of the nasal leiomyoma. Nasal leiomyoma carries a good prognosis after complete excision.Key words: endoscopic excision, leiomyoma, nasal cavity
Study of Upper Gastrointestinal Tract Endoscopic findings in Portal Hypertension
Authors: Karki Lochan , Gorkhaly Manen Prasad , Karki Buddha Bahadur
Published: September 2018

Introduction: The gut mucosa in portal hypertension is the seat of microcirculatory changes that compromise its integrity and increase its susceptibility to damage. The mucosal changes in portal hypertension may require pharmacological, directed endoscopic or portal decompressive therapy. The objective of the study is to find out various upper gastrointestinal tract endoscopic findings in patients of portal hypertension.Methods: A prospective, cross-sectional, observational study of sixty patients of portal hypertension was conducted from June to October 2009. The esophagus, stomach and upper duodenum was visualized for any changes, especially by taking the tip of the instrument close to the mucosa.Results: Out of total, 60, 47 (78.3%) cases were cirrhotic and 13 (21.7%) cases were non-cirrhotic portal hypertension. The most frequent upper GI endoscopic finding was esophageal varices 56 (98.3%) followed by gastropathy 49 (81.6%), gastric hyperemia 19 (31.6%), duodenal hyperemia and erosive gastritis 16 (26.6% in each) and gastric varices 12 (20%). Esophageal varices were equally prevalent among cirrhotic and non cirrhotic portal hypertensive patients, 46 out of 47 (97.9%) and 13 out of 13 (100%) respectively. Gastropathy was more prevalent in cirrhotic patients with 87.2% vs. 75% in NCPF followed by 40% in EHO. However, duodenal ulcers were seen only in EHO 12.5%. Erosive gastritis was more prevalent in EHO (75%) followed by NCPF (60%), however, it was less frequent in cirrhotic portal hypertension (14.8%).Conclusions: The most common upper GI endoscopic finding in portal hypertensive patients were found to be esophageal varices followed by gastropathy, peptic ulcer disease (gastric and duodenal hyperemia, chronic gastritis, erosive gastritis, gastric ulcer and duodenal ulcer)._______________________________________________________________________________________Keywords: gastrointestinal tract; portal hypertension; varices.
Cost of Diabetes Mellitus Care among Patients attending selected Outpatient Clinics
Authors: Shrestha Niraj , Lohani Shyam Prasad , Angdembe Mirak Raj , Bhattarai Kreepa , Bhattarai Jyoti
Published: September 2018

Introduction: In developing countries diabetes mellitus affects economically productive age group; more often affecting the productive member of the family. The objective of the study was to estimate the direct and indirect cost of illness of patients with DM attending the selected outpatient clinics in Kathmandu Valley.Methods: A cross-sectional study was carried out in four outpatient clinics in Kathmandu Valley among 227 diabetic patients selected purposively. It was conducted from July to September, 2010. An adapted and pretested semi structured questionnaire was administered to diabetic patients aged 20 to 60 years with a minimum of a year of illness.Results: The mean total cost per visit by a diabetic patient to an outpatient clinic wasUS$13.3 (95% CI: 11.70-14.92). Likewise the total cost incurred in the treatment and care of DM per month was US$ 40.41 (95% CI: 36.38-44.45) and per annum was US$ 445 (95% CI: 396.11-495.61). In addition, the study results also showed that with increase in total direct cost per annum the duration of illness also increases.Conclusions: There is a high cost burden on the patient with DM visiting the selected private sector outpatient clinics._______________________________________________________________________________________Keywords: cost burden; diabetes mellitus; direct cost; indirect cost; treatment cost.
Histopathological Study of Endoscopic Biopsies
Authors: Thapa Rupendra , Lakhey Mamta , Yadav Pradeep Kumar , Kandel Prakash , Aryal Choodamani , Subba Kamana
Published: September 2018

Introduction: Diseases of upper gastrointestinal tract are responsible for a great deal of morbidity and mortality. The histopathological study of endoscopic biopsies permits exact diagnosis for further management.The aim of this study is to find out the histopathological pattern of endoscopic biopsy.Methods: A descriptive study was conducted in consecutive endoscopic gastric biopsies in a Hospital over a period of one year. The patient of all ages and both sexes who underwent gastric biopsy during the study period was included.Results: Endoscopic biopsies were studied on patients of age ranging from 20 years female to 84 years male. The histopathology revealed non-neoplastic lesions 54 (67.5%) and neoplastic lesions 26 (32.5%). Most common non-neoplastic lesion noted was mild chronic gastritis 22(27.5%) followed by chronic active gastritis 15 (18.75%) while H. pylori was present in 13 (16.25%) and absent in 2 (2.5%).Conclusions: Mild chronic gastritis was the commonest lesion noted in non-neoplastic lesions and adenocarcinoma was the commonest neoplastic lesion in the endoscopic gastric biopsies.______________________________________________________________________________________Keywords: biopsy; endoscopy; gastritis; histopathological.
Knowledge and Practice of Postnatal Mother in Newborn Care
Authors: Shrestha Tumla , Bhattarai Saraswoti Gautam , Silwal Kalpana
Published: September 2018

Introduction: Neonatal mortality has continued to increase as a percentage (>60%) of overall infant mortality. Any further reduction in infant mortality is dependent on saving more newborn lives. It is possible if their mothers are knowledgeable and provide proper newborn care. Therefore, the objective of the study was to find out knowledge and practice of the postnatal mothers about newborn care.Methods: A descriptive study was done among 100 purposively selected post natal mothers admitted in Teaching Hospital. Newborn care practice was observed among 20 mothers and comparison was done between knowledge and practice. Semi-structured interview questionnaire and observation checklist was used to collect the data. The descriptive statistics was used.Results: Respondents’ mean knowledge was on keeping newborn warm 44.2, on newborn care 47.2, on immunization 67.33, on danger signs 35.63. All (100%) respondents had have knowledge and practice to feed colostrums and exclusive breast feeding, 70 (70%) knew about early initiation of breastfeeding. Mean knowledge and practice of respondents was on measures to keep warm 8.5 and 17. Although 60 (60%) had knowledge to wash hands before breastfeeding, and after diaper care, only 10 (10%) followed it in practice. Mean practice of successful breast feeding was 37.5, 12 (60%) applied nothing kept cord dry. Conclusion: Postnatal mothers have adequate knowledge on areas like early, exclusive breast feeding, colostrums feeding, they have not much satisfactory knowledge in areas like hand washing, danger signs etc. While comparing knowledge with practice regarding newborn care, practice looks better in many areas._______________________________________________________________________________________Keywords: knowledge; newborn care; practice; postnatal mother.
Irreducible Anterior Dislocation of the Elbow without associated Fracture
Authors: Pokharel Rohit , Gyawali Gopal Prasad , Pokharel Bishnu
Published: September 2018

Anterior dislocation of the elbow joint is a rare entity and is usually associated with injuries to surrounding bony and soft tissues. Simple dislocation of the joint is managed conservatively.An eight years old girl had traumatic anterior dislocation of the elbow joint with intact distal neurovascular status. X-rays showed no associated bony injury. Close reductions failed. Per operative findings showed no intra-articular fracture and the radial head was button holed into the anterior joint capsule. Reduction was achieved openly and maintained in a posterior slab for four weeks. Active and assisted mobilization started after removal of the slab. At ten month follow-up there was almost full range of movement of the joint._______________________________________________________________________________________Keywords: anterior dislocation; elbow; open reduction.
Sensitivity and Specificity of CT and its Signs for Diagnosis of Strangulation in Patients with Acute Small Bowel Obstruction
Authors: Jha Ashwini Kumar , Tang Wen Hao , Bai Zhi Bin , Xiao Jia Quan
Published: September 2018

Introduction: To perform a meta-analysis to review the sensitivity and specificity of computed tomography and different known CT signs for the diagnosis of strangulation in patients with acute SBO.Methods: Pubmed search was performed for all reports that evaluated the use of CT and discussed different CT criteria for the diagnosis of acute SBO. Only articles published in English language between January 1978 to June 2008 were included. The bivariate random effect model was used to obtain pooled sensitivity and pooled specificity. Summary receiver operating curve was calculated using Meta-Disc. Software Openbugs 3.0.3 was used to summarize the data.Results: A total of 12 studies fulfilled the inclusion criteria. The pooled sensitivity and specificity of CT in the diagnosis of strangulation was 0.720 (95% CI 0.674 to 0.763) and 0.866 (95% CI 0.837 to 0.892) respectively. The ranges to pooled sensivity and pooled specificity of different CT signs are 0.309 - 0.623 and 0.717 - 0.991 respectively.Conclusions: This review demonstrates that the sensitivity and specificity of CT is high in preoperative diagnosis of strangulation in the setting of acute SBO which are in accordance with the published studies. Our analysis shows that “presence of mesenteric fluid” is the more sensitive, and “lack of bowel wall enhancement” is the more specific CT sign of strangulation, and also justifies need of large scale prospective studies to validate the results obtained as well as to determine a clinical protocol.
Testicular Fine Needle Aspiration in Evaluation of Male Infertility
Authors: Jha Runa , Sayami G
Published: September 2018

Fine needle aspiration cytology of superficial as well as of deep seated lesions is now well recognized in diagnosis of neoplastic as well as nonneoplastic and inflammatory lesions. Recently it has also gained popularity for its diagnostic and therapeutic role in male infertility. The purpose of this article was to review various studies published on role of testicular fine needle testicular cytology in male infertility and provide a brief information on method of testicular fine needle aspiration, interpretation of testicular fine needle aspiration cytology for evaluation of spermatogenesis, its advantages, limitations and complications as compared to testicular biopsy.Key words:cytology, fne needle aspiration, infertility, reproduction, spermatogenesis.
Reye Syndrome – A Case Report with Review of Literature .
Authors: Ghosh Arnab , Pradhan S , Swami R , KC S R , Talwar O P
Published: September 2018

Here we describe a case of Reye syndrome diagnosed at postmortem liver biopsy of a three-year oldgirl who presented with vomiting, low grade fever for three days and loss of consciousness for 18hours. Clinically, the differential diagnoses were meningitis, encephalitis and septicemia. No historyof past illness or any drug ingestion including aspirin were present. Laboratory investigationsindicated a diagnosis of Reye syndrome. The child was given supportive treatment but died aftertwo days of admission and postmortem needle-biopsy of the liver showed microvesicular steatosisconsistent with Reye syndrome.Key words: Microvesicular steatosis, mitochondrial hepatopathy, Reye syndrome, Reye-like syndrome
Unusual Cause of Unilateral Epistaxis: Nasal Leech Infestation
Authors: Ghimire Anand , Acharya A
Published: September 2018

Common causes for unilateral nasal bleeding in adults are benign or malignant tumors and deviatednasal septum. Here we present two cases of recurrent unilateral nasal bleeding due to leech infestation.Though it is not a common cause for nasal bleeding, a clinician should suspect leech infestation for arecurrent nasal bleeding specially in tropical countries like Nepal.Key words: leech infestation, nasal bleeding, unilateral
Role of Magnetic Resonance Imaging in Evaluation of Tubercular Spondylitis: Pattern of Disease in 100 Patients with Review of Literature
Authors: Khalid M , Siddiqui M A , Qaseem SMD , Mittal S , Iraqi AA , Rizvi SAA
Published: September 2018

Introduction: The purpose of this study is to evaluate the role of magnetic resonance imaging (MRI) in evaluation of tubercular spondylitis and to correlate imaging findings with clinical severity of the disease.

Methods: One hundred consecutive patients, who presented with features suggestive of spinal infections, were subjected to MRI examination. T1W and STIR images were obtained followed by T2W and post-contrast T1W images. Various imaging characteristics of spinal infections were noted and correlated with the clinical severity of the disease.

Results: Backache was the most common presenting symptom present in 86 %, while paraparesis was the most common sign seen in 62 %. The neurological status of the patients correlated well with MRI findings in the majority of the cases with an overall good correlation obtained in 96 % of cases. The majority of the vertebrae and intervertebral discs affected showed hypointensity or isointensity on T1W images and hyperintensity on T2W images. Epidural/dural disease was present in 74 % while 68 % of patients demonstrated decreased intervertebral disc height. Epidural extension and subligamentous spread was in 74 % and 90 % of patients respectively.

Conclusions: MRI plays a vital role in early and accurate diagnosis of spinal infections. It is non-invasive and clearly demonstrates soft tissue anatomy and pathology which makes it superior to X-rays and Computed Tomography (CT). Imaging findings of tubercular spondylitis were also found to have a good correlation with the clinical status of the patients. Hence, it is of much help in the evaluation and assessment of patients presenting with features of spinal infections. 

Keywords: Magnetic resonance imaging, spinal tuberculosis, tubercular spondylitis
A Study on Complication and Monitoring of Warfarin in Post-Valve Surgery
Authors: Shrestha Poonam , Koirala B , Shrestha N , Thapa P
Published: September 2018

Introduction:This study was carried out to determine the incidence of complication related to warfarin in patients with valve surgery and identify potential risk factors for complication and study its monitoring aspects.Methods:A combined retrospective and prospective observational study including a total of 185 patients who underwent mechanical valve replacement in Shahid Gangalal National Heart Centre. The study was conducted from 4 November 2006 till 1 February 2007. Results:There were a total of 141 episodes of bleeding. Among them signifi cant bleeding occurred in 15.7% patients, major bleeding was 3.2 per 100 patient-years (3.8%) and minor bleeding was 11.8 per 100 patient-years (11.9%). Epistaxis (16.8%) was the most common bleeding complication. Menorrhagia was the most common bleeding complication in females with 20.5 per 100 patient-years (27.4%). Thromboembolic complications occurred at the rate of 2.3 per 100 patient-years. Patients on warfarin were outside the INR target range 67.8% of the time, with 21% INR values above range and 46.8% INR values below range. However, dose adjustment was done only 31.8% of times when INR was outside range.Conclusions:There is high incidence of bleeding complication in patients on warfarin and hypertension is signifi cantly associated with bleeding. Diffi culty in tightly controlling INR probably is related to high incidence of bleeding. Better patient education, stricter adjustment of INR, frequent monitoring of INR at peripheral hospitals and standardization of the test at different hospitals are suggested to reduce the warfarin related complications.Key Words: bleeding complication, heart valve surgery, warfarin
Comparative Study on Effectiveness of Doxapram and Pethidine for Postanaesthetic Shivering
Authors: Shrestha Amir Babu
Published: September 2018

Introduction: Postanaesthetic shivering is a common condition after surgery which needs proper management with pharmacologic agents so as to make postoperative period comfortable to the patient and prevent from the untoward complications that can arise from it. This study was done to compare the effectiveness of Pethidine and Doxapram in the treatment of postanaesthetic shivering.Methods: Patients were randomly divided into three groups, ten in each. All received volume of 3 ml as Group I (Doxapram 1.5 mg/kg), Group II (Pethidine 0.35 mg/kg) and Group III (Normal Saline). All patients were observed for 30 minutes after reversal of muscle relaxant and occurrence of shivering within this period was observed, scored and treated. All treated patients were observed for 10 minutes after the test drug was given for control of shivering and any untoward effects.Results: Pethidine was found more effective than Doxapram in treating postanaesthetic shivering as it was effective in 80% followed by Doxapram in 60% and Normal saline in 20%. Statistically the results between Normal saline and Pethidine was signifi cant as P<0.05. As statistical significance between Doxapram and Normal Saline was p=0.16; and between Pethidine and Doxapram was p=0.62, the difference is statistically not significant.Conclusions: Pethidine was found to be more effective compared to Doxapram in treating patients with postoperative shivering.Key Words: doxapram, pethidine, postanesthetic shivering
Rotavirus, Vaccine and Unanswered Questions: A Perspective from a Least Developed Country
Authors: Pun Sher Bahadur
Published: September 2018

Two rotavirus vaccines, RotaTeq (Merck) and Rotarix (GlaxoSmithKline) have been developedto neutralize the most common rotavirus serotypes, and are now available in the global market.These vaccines are primarily aimed at reducing rotavirus gastroenteritis in children in the leastdeveloped countries, where rotavirus mortality rate is believed to be greatest. Thus, the WorldHealth Organization (WHO) has recommended rotavirus vaccination be included in all nationalimmunization programs, while the least developed countries have so far not come up with clearvision and long term strategy on vaccine implementation, and several questions, in addition to this,remain unanswered._______________________________________________________________________________________Keywords: least developed country; rotavirus; vaccines.
Mobile Phone Support for Rural Health Workers in Nepal through ‘Celemedicine’
Authors: Morrison Joanna , Shrestha Naba Raj , Hayes Bruce , Zimmerman Mark
Published: September 2018

Globally, there is a shortage of health workers in rural areas. Effective health systems depend onhaving sufficient, accessible health workers with the right skills. In countries like Nepal, highlyskilled health workers often prefer to work overseas or in urban centres, and therefore, in the shortterm, it may be pragmatic to focus on ensuring support and skills development of mid level orparamedical health workers. Information technology has the potential to support these healthworkers. We describe a pilot intervention undertaken in Gulmi District, whereby all mid levelhealth workers in the district have been provided with a free phone number to call three GeneralPractitioner Doctors (GPs) in the District Hospital. The intervention aims to increase appropriatereferral, and increase connectivity between the District centre and peripheral health facilities. Wehope that our intervention will provide support to rural health workers, and, if implemented aspart of a package of interventions, may increase retention. We present some initial findings fromdiscussions with health workers and analysis of call-log data, and describe our next phase evaluationand possible scale-up._______________________________________________________________________________________Keywords: human resources; mobile phone; mhealth; Nepal; retention; rural.
Bone Marrow Culture Vs Blood Culture in FUO
Authors: Jha Abhimanyu , Sarda R , Gupta A , Talwar O P
Published: September 2018

Introduction:Bone marrow culture is considered superior to blood culture in evaluation of FUO. The aim of this study was to compare the usefulness of these two cultures.Methods:A one year prospective cross sectional study was conducted to fi nd out the usefulness of bone marrow culture and blood culture in the diagnosis of FUO. Marrow aspirates in each case were sent for bacterial, myocbacterial and fungal culture. Simultaneously venous blood was sent forbacterial culture. The results of BMCs and BCs were compared. Results:Total 57 cases of FUO were included in the study. Male female ratio was 1.22:1. Age range was fi ve to 83 years (median 30). Duration of fever was 21 to 365 days. Bacterial growth was seen in nine cases (15.78%) of BMCs and in three cases (5.26%) of corresponding BCs. Fungal or myocbacterial growth was not seen. Salmonella typhi was the commonest organism isolated in BMCs (three cases) followed by Staphylococcus aureus (two cases), Escherichia coli, Non fermenting Gram negative bacilli, Enterococcus species and Salmonella paratyphi–A (one case each). Two cases of Salmonella typhi and one case of Salmonella paratyphi–A were isolated in BCs. Conclusions:BMCs are more useful than BCs in evaluation of patients with FUO, especially in cases of salmonella infection and are particularly important when the patient has already taken antibiotics. In immuno-competent patients presenting with FUO, BMCs for mycobacteria or fungi is unlikely to yield any growth. Key Words: blood culture, bone marrow culture, fever of unknown origin
Need of Improvement in Emergency Medical Service in Urban Cities
Authors: Gongal Rajesh , Dhungana B , Regmi S , Nakarmi M , Yadav B
Published: September 2018

Introduction: An effective Emergency Medical Service system does not exist in Nepal. For an effective EMS system to be developed the scale of the problem and the existing facilities need to be studied. Methods: Prospective observational study was carried out on 1964 patients attending Emergency Department at Patan Hospital during one month period of September 2006. The patients were specifically enquired on mode of transport used, place of origin and whether they called for an ambulance or not. Patients triage category at the time of triaging was also noted. Information on ambulance service were collected by direct interview with the service providers and the total number of patients attending Emergency Departments daily were collected from the major hospitals of the urban Lalitpur and Kathmandu. MS Excel and SPSS software were used for data entry, editing and analysis.Results: Total 9.9% patients arrived in ambulance whereas 53.6% came in a Taxi, 11.4% came in private vehicle, 13.5 % came by bus, 5.4% came by bike and the rest 6.2% came by other modes of transportation. Only 13.5% of triage category I patients took the ambulance. There were 31 service providers with 49 ambulances and 720 patients per day attend Emergency Departments in the surveyed area. Conclusions: Very less number of patients use the ambulance service for emergency services. The available ambulances are not properly equipped and do not have trained staff and as such are only a means of transportation to the hospitals of urban Lalitpur and Kathmandu.Key Words: ambulance, emergency medical service, para-medics, triage Need of Improvement in Emergency Medical Service in Urban Cities Gongal R,1Dhungana B,1Regmi S,1Nakarmi M,2Yadav B11Patan Hospital, Lalitpur, Nepal, 2Health Care Foundation, Kathmandu, NepalCorrespondence:Dr. Rajesh GongalDepartment of SurgeryPatan Hospital, Patan, Nepal.Email: rajgongal@yahoo.comORIGINAL ARTICLE J Nepal Med Assoc 2009;48(174):139-43INTRODUCTIONThe sophisticated Emergency Medical Service (EMS) is limited to developed country only. Many developing countries are now slowly developing such system although most services are localized to the urban areas.1-5 Although inadquate ambulance services are available in the capital city of Nepa
Postaxial Polydactyly
Authors: Aggrawal A N , Goyal Manoj Kumar , Gupta Rishi N
Published: September 2018

We present a case of postaxial polydactyly with well formed six digits on left hand and seven digits on right hand. Both conditions are rare and combination of these two conditions even rarer. The patient also had supernumerary sixth right toe and cleft lip. Very few cases of postaxial polydactyly are reported previously.Key Words: cleft lip, polydactyly, postaxial, supranumerary toe, syndactyly
Repaglinide induced Acute Hepatotoxicity
Authors: Jaiswal Suresh , Mehta R , Musuku M , Tran L , McNamee Jr W
Published: September 2018

Repaglinide is considered a safe drug; adverse events are mild to moderate which includes hypoglycemia, headache, nausea, vomiting, diarrhea and dyspepsia as similar to sulphonylureas. This case report describes a rare side effect of repaglinide. In rare cases, elevated liver enzymes have been noted. We report a case of acute hepatotoxicity in a 78 year old woman who developed acute hepatotoxicity while taking repaglinide.Key Words: hepatotoxicity, hypoglycemia, repaglinide,
Emergency Peripartum Hysterectomy as Postpartum Hemorrhage Treatment: Incidence, Risk factors, and Complications
Authors: Pradhan Meena , Shao Yong
Published: September 2018

Introduction: The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage.Methods: This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61) due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333) during the same study period.Results: We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i) blood loss 1000-2000 ml, crude odd ratio (OR) =18.48 (95% CI 5.1-65.7), adjusted odd ratio (AOR) = 9.1 (95% CI 2.2-37.7); (ii) blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4), AOR = 45.3 (95% CI 11.6-176.9); (iii) previous caesarean section, OR = 5.5 (95% CI 2.9-9.7), AOR = 3.7(95% CI 1.4-9.9); (iv) uterine atony, OR = 11.9 (95% CI 5.8-24.6), AOR = 7.5 (95% CI 1.8-30.2); (v) placenta previa, OR = 2.04 (95% CI 1.1-3.5), AOR = none. Conclusions: Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy.Keywords: caesarean section; hemorrhage; peripartum hysterectomy; placenta previa.
Three Patterns of Rising type 2 Diabetes Prevalence in the World: Need to Widen the Concept of Prevention in Individuals into Control in the Community
Authors: Bhattarai Madhur Dev
Published: September 2018

This paper analyses the patterns of rising type 2 diabetes prevalence in the world with their plausible reasons focusing on control measures. It shows existence of combinations of three patterns of rises, viz. gradual, rapid and accelerated, leading to prevalence of 4–9% now in Europids, 14–20% in migrant or urbanized Asian Indians, Arabs, Chinese, Africans, and Hispanics and above 30–50% in indigenous peoples of Canada, USA, Australia and Pacifi c regions. It demonstrates that though ageing, sedentary life and obesity of people explain gradual rise in Europids, effects of rapid transition in nutritional status of population and of maternal hyperglycaemia on the risk of offspring developing glucose intolerance further add to rapid and accelerated rises respectively. It recommends that current approach of primary prevention of diabetes in people, particularly with impaired glucose tolerance, advocating modest loss of excess weight and moderate-intensity exercise, be widen into concept of control in community covering rapid and accelerated rises. The control programmes essentially are vigorous educational campaign and planning to improve nutritional status of women of childbearing age in rural and poorer sectors of society and to keep weight of adults within recommended body mass index (BMI) range, like 18.5–22.9 kg/m2for Asian and other similar populations. The population-based approaches with examples, considering developing countries, are outlined. The paper emphasizes the importance of keeping prepregnancy weight optimum, preferably below the middle of recommended BMI range, to avoid even sub-clinical maternal hyperglycemia, for prevention and control of accelerated rise in any population. Key Words: diabetes, diabetes control, diabetes epidemiology, diabetes prevention, prepregnancy weight
Left Ventricular Noncompaction
Authors: Malla R , Sharma Ranjit , Rauniyar B , KC M B , Maskey A , Joshi D , Hamal S
Published: September 2018

Left Ventricular Noncompaction(LVNC) is a genetic cardiac disease of emerging importance with a distinct clinical and pathophysiological presentation. The most common clinical manifestations include heart failure,arrhythmias and embolic events, and in children it may be associatedwith facial dysmorphisms and Wolff–Parkinson–Whitesyndrome. The diagnosis of LVNC, however, is often missed, most often as a consequence of ignorance of the condition. Echocardiography is considered the reference standard for the diagnosis of LVNC. Prognosis remains poor for patients with impaired systolic left ventricular function, as treatment options are very limited. Because of the familial association of LVNC, fi rst-degree relatives should be screened by Echocardiography.Key Words: heart, left ventricle, noncompaction
Mental Health Services in New Nepal – Observations, Objections and Outlooks for the Future
Authors: Jha Arun , Adhikari S R
Published: September 2018

It has been over a decade since the government of Nepal adopted the National Mental Health Policy (NMHP) in 1997. This article analyses the current provision of fragmented mental health services in Nepal through case scenarios from Jumla innorthwest and Janakpur in southeast Nepal, criticises the proposed mental health Act, discusses the reasons why the NMHP has not been implemented and suggests future models of delivering mental health services in the wider community. Absence of a mental health section within the department of health, insuffi cient budget, chronic shortage of trained manpower, and unplanned growth of private medical institutions appear to be the issues deserving urgent attention. Setting up specialist psychiatric facilities in all developmental regions or future states, developing community mental health programmes and integration of mental health into general health care are the ways forward to meet the needs and expectations of the new federal Nepal. Key Words: community mental health, national mental health policy, Nepal, psychiatry
Maternal and Fetal Outcome in Elective versus Emergency Cesarean Section
Authors: Suwal Anupama , Shrivastava Veena R , Giri Amrita
Published: September 2018

Introduction: The complications of cesarean section are seen more commonly in emergency than in elective cases. The aim of this study was to find out the incidence of cesarean section in Nepal Medical College Teaching Hospital and to compare the maternal and fetal outcome in elective and emergency cesarean section.

Methods: A prospective study of all the cases undergoing cesarean section in Nepal Medical College Teaching Hospital was carried out during the period of six months from Asar 2069 to Mangsir 2069.

Results: The incidence of cesarean section was 254 (22.30%) out of which emergency cesarean section accounted for 167 (65.7%) and elective cesarean section for 87 (34.3%). The usual indications of emergency cesarean section were fetal distress, previous cesarean section in labour, non progress of labour and prolonged second stage of labour. The usual indications of elective cesarean section were previous cesarean section, breech, cephalopelvic disproportion and cesarean section on demand. There was found to be no significant difference in age, period of gestation, blood loss and blood transfusion in emergency vs. elective cesarean section. There was significant difference seen in the length of hospital stay, fever, urinary tract infection, wound infection and low APGAR in five minutes indicating that these were more common in emergency cesarean section. Significant difference was also seen in the incidence of postpartum haemorrhage indicating that it was seen more in elective cesarean section.

Conclusions: The incidence of cesarean section in Nepal Medical College Teaching Hospital is high and the overall complication rate is higher in emergency cesarean section than in elective cesarean section.Keywords: cesarean section; fetal and maternal outcome.
Retinoblastoma: Ten Years Experience at Kanti Children's Hospital
Authors: Sah Kailash Prasad , Saiju Rohit , Roy Pankaj , Kafle Sonali
Published: September 2018

Introduction: Retinoblastoma is a malignant tumor of the embryonic neural retina. It is the most common intraocular tumor of childhood. It is a disease of early childhood with 80% cases diagnosed before the age of 4 years. The median age at diagnosis is 2 years. Bilateral cases are diagnosed earlier (median at 12 months and unilateral median age at 24 months). The incidence of retinoblastoma is approximately 1 in 15000-18000 live births in developed countries. The aim of the research is to study the clinical pathological features, treatment and survival of children with retinoblastoma over ten years.

Methods: A retrospective hospital based study was conducted from March 1998 to February 2008. Gender, age, clinical presentation, pathology reports, treatment, follow –up and outcome were recorded at time of diagnosis.

Results: A total of 42 children with retinoblastoma (85.7 % unilateral, 14.3% bilateral), with 50% having optic nerve involvement were studied. The most common presenting signs were extraoccular (28.6%), proptosis (23.8%), leukoria (23.8%), phthisis bulbi (16.7%), and strabismus (7.1%). The age at presentation ranged from 6-120 months with mean age of 46.6 months. The male to female ratio was 1.1:1.Two-thirds presented between 2-5 yrs, followed by 12-24 months (23.8%). Majority of children had poorly differentiated retinoblastoma (62 %), followed by well differentiated (28.6%), and moderately differentiated (9.5%). CEV based protocol used to treat, and over-all 10 yrs survival was 23.8 %, death 19 %, and lost to follow-up or left against medical advice 57.2%.

Conclusions: Despite severe resource limitation, pediatric oncology unit has been successfully treating retinoblastoma with the success rate of 23.8%. 

Keywords: chemotherapy; outcome; remission; retinoblastoma.
Health Federalism: The Role of Health Care Professionals in Nepal
Authors: Dulal Ram Krishna
Published: September 2018

Nepal has entered from its unitary system into a new “Federal Democratic Republic State.” The current constitution presents basic health care services as a fundamental right.The Ministry for Health and Population has been providing resources to meet health demands, but managers are wrestling to meet these demands. Persistent disparities between rural and urban and across regions resulted inferior health outcomes e.g. life expectancy in an urban district like Bhaktapur is 71 years, whereas in the rural district of Mugu it is 44 years. The poor health and poor access to health care in the past systems prompted people to seek a different model. Ultimately, all political parties except one have agreed on federalism. The exact number of federal states that are going to be created is unknown. In federalism, all federated states have to assume certain relationships between the locality, the region, and the nation that apply not only in politics but in health care too. Managing changes in health care organization during the transitional period and after restructuring the unitary Nepal into federal states should be carefully planned. In case, if new system also fails to deliver necessary health care services, the possibility of igniting of dissatisfaction, public unrest and even disintegration cannot be ignored. In order to outline a structure and give life to a health care system under federalism, health care professionals need to engage themselves seriously.Key Words: disintegration, disparities, federalism, health care, life expectancy
Age of Individuals Undergoing Cleft Lip and Cleft Palate Surgeries in Nepal
Authors: Rai Shankar Man , Nakarmi Kiran , Basnet Surendra , Shakya Pramila , Nagarkoti Krishna , Ghartimagar Mangal , Karki Bishal , Hirachan Suzita
Published: September 2018

Introduction: Timely repair of cleft lip and palate maximises the benefits of surgery. Developing countries have large number of adults with unrepaired clefts. The impact of a cleft program can be determined by observing the trends of lower age at surgery. Public Health Concern Trust, Nepal has been providing a comprehensive nationwide cleft service since 1999. This study was conducted to see any change in the age at surgery.

Methods: A retrospective cross sectional study was conducted to analyse the data of all the individuals’ age at primary cleft surgery from July 1999 to June 2010. Mean and median age of individuals as well as the proportion of individuals operated on at the right age in different years were calculated and compared.

Results: The median age for cleft lip surgery decreased from 100 to 24 months. Similarly the median age for cleft palate surgery decreased from 70 to 28 months. Proportion of surgeries carried out in the recommended age also increased. A change in the policy of the program reaching out to more remote areas and removing the age barrier for surgery resulted in older adults receiving surgery and increased median age especially for cleft palate repairs.

Conclusions: A nationwide cleft program for a decade had a small impact on age at surgery. There are still many individuals who are missing the ideal age for surgery. The program needs to reach more remote areas. This information will be useful for governmental as well as non-governmental organizations working in the area of clefts.

Keywords: age; cleft lip; cleft palate; Nepal.
Chronic Suppurative Otitis Media Atticoantral- Type Undergone Canal Wall Down Mastoidectomy in a Peripheral Government Hospital of Nepal
Authors: Paudel Dhundi Raj
Published: September 2018

Introduction: Chronic suppurative otitis media is a severe type of chronic ear infection which is quite common in all geographical situations of Nepal. The mainstay of treatment of this disease is surgery, preferably of canal down method. The objective of the study was to identify the common presentation(s) and the clinical and operative finding(s) in patients with chronic suppurative otitis media attico-antral type and evaluation of efficacy of canal-wall down mastoidectomy in the achievement of dry ear and change in hearing in a setting of a peripheral hospital of Nepal in terms of subjectivity. Per-operative evaluation of mastoid cavities in terms of types of pathologies and post- operative assessment of ears in terms of achieving a dryness and change in hearing ability was carried out in the ENT Department, Bharatpur Hospital , Chitwan, Nepal. Study was done from January 2005 to December 2010.

Methods: Seventy three patients with chronic suppurative otitis media atticoantral- type were evaluated preoperatively in terms of gross pathologies. Postoperatively, patients were subjectively evaluated twice in six months in reference to persistent ear discharge and change in hearing ability.

Results: By six months of surgery, 75% of the patients had no discharge. Fifty two patients did not experience any change in hearing ability. Only 16% experienced betterment in hearing while 19% had diminution in hearing.

Conclusions: Canal wall down mastoidectomies are very effective in controlling otorrhoea and complications related to chronic suppurative otitis media attico-antral type. 

Keywords: Chronic suppurative otitis media attico-antral (CSOM-AA) type; CWD masoidectomy; CWU mastoidectomy; ear cavity.