bluuebunny/crossref_metadata_2025 huggingface dataset:
DEMOGRAPHIC AND CLINICAL PROFILES OF HIV POSITIVE CASES : A TWO-YEAR STUDY REPORT FROM A TERTIARY TEACHING HOSPITAL
Authors: Aich Tapas Kumar , Dhungana M , Kumar A , Pawha V K
Published: September 2018

The report on the pattern of demographic and clinical profiles of HIV positive persons in Nepal are scarce.Present study was carried out at the Universal College of Medical Sciences Teaching Hospital at Bhairahawa(UCMS-TH). Following group of patients, who attended our different OPDs for a period of two years(January 2001 to December 2002) were subjected to HIV tests: History of exposure to Commercial SexWorkers (CSW), history of travelling and working India/abroad, living single, driver/cleaner by profession,history of injection drug use (IDU), unexplained fever, diarrhoea and significant loss of weight for over amonth, all cases of Sexually Transmitted Diseases (STDs), etc. A total of 43 HIV positive cases were detectedduring the period. Mode of transmission was as follows: 6 (13.9%) patients were injection drug users (IDU),one case (2.3%) transmitted through blood transfusion (BT), one patient (2.3%) was homosexual whileheterosexual transmission was noted in 34 (79.1%) patients. Out of 23 injection drug users (IDUs) admittedduring the period, 6 cases were detected positive for HIV infection. Applying ‘Expanded WHO Case Definitionfor AIDS Surveillance’, out of total 43 cases at least 28 (65%) cases could be detected as having sufferingfrom clinical AIDS; 12 (27.7%) of them were suffering from pulmonary or extra-pulmonary tuberculosis. Asignificant percentage of these patients belonged to lower socio-economic class and many of them weremobile worker and contacted their illness while working in Indian metropolis in the past.ABSTRACTKey Words: HIV positive, Clinical AIDS, Nepal.
CT-GUIDED STEREOTACTIC BIOPSY OF INTRINSIC BRAINSTEM LESIONS
Authors: Sharma Gopal Raman , Jooma R
Published: September 2018

Although radiographic and clinical appearance may suggest the pathological diagnosis of a mass lesionlocated within vital areas of the brainstem, surgeons frequently have elected to treat patient without thebenefit of a tissue diagnosis. Such an emperic approach often leads to inappropriate therapy. We presentfive patients with intrinsic brainstem lesions who underwent CT guided stereotactic biopsy using CRWstereotactic frame. Positive diagnosis was achieved in all cases. There was no operative morbidity, however,one patient died of postoperative intratumoural haematoma.Key Words: CT Scan, Stereotactic biopsy, Brainstem lesions.
MICROBIAL QUALITY OF MILK AVAILABLE IN KATHMANDU VALLEY
Authors: Arjyal Charu , Dahal B N , Khadka B
Published: September 2018

With an objective to find microbial quality of the market milk available in Kathmandu valley, this studywas conducted in the Microbiology Laboratory, Himalayan College of Agriculture Science and Technology(HICAST). Different milk brands were collected from different outlets in the valley and analyzed formicrobial quality. The samples were cultured using the standard microbiological techniques. Almost all thesamples showed the presence of bacterial growth including coliform bacteria. The bacterial isolates were of7 different genera. E. coli was the most frequently isolated organism (92%) followed by coagulase negativeStaphylococci (CONS) (24%). Other organisms isolated were Bacillus species, Staphylococcus aureus,Streptococcus species, Salmonella species, Shigella species. The culture results were similar to directmicroscopic count results and showed that bacterial contamination in some of the samples was too numerousto be counted. Thus, it was concluded that the market milk available in Kathmandu is contaminated withvarious types of microorganisms and does not meet the required standard. The dairy industries shouldwork seriously to maintain the standards of their products.* Integrated Bioscientific Research Group (BIOINT), Kupondol, Lalitpur, Nepal.** Himalayan College of Agriculture Science and Technology (HICAST), Gatthaghar, Bhaktapur, Nepal.Address for correspondence : Charu ArjyalIntegrated Bioscientific Research Group (BIOINT), Kupondol, Lalitpur, Nepal.Email: charuarjyal@hotmail.comKey Words: Microbiology, Contamination, Milk, Quality, Coliform.
FRACTURE OF THE CORACOID PROCESS WITH FRACTURE OF SURGICAL NECK OF HUMERUS
Authors: Singh Sudhir , Gupta P K
Published: September 2018

No abstract
PRIMARY SQUAMOUS CELL CARCINOMA OF BREAST PRESENTING AS ABSCESS
Authors: Thakur Binay , Upadhya A , Lamichhane N , Pradhan M , Neupane R K
Published: September 2018

Primary squamous cell carcinoma (SCC) of breast is a very rare neoplasm. SCC of breast presenting asabscess has been reported only occasionally. Treatment guidelines are usually similar to the guidelines forordinary ductal carcinoma, though firm conclusions have yet to be established. We report a case of primarySCC of breast presenting initially as breast abscess along with review of the literature.Key Words: Breast cancer, squamous cell carcinoma, breast abscess.
Measles Outbreak among Unvaccinated Children in Bajura
Authors: Sitaula S , Awasthi GR , Thapa JB , Ramaiya A
Published: September 2018

INTRODUCTION:Measles outbreak occurs when there are three or more laboratory confirmed measles cases in a village in a period of one month. Integrated surveillance system has helped to identify the measles outbreak, to characterize its epidemiology and to timely respond it.METHODS:This is a descriptive study of measles outbreak that occurred in Bajura district in February to March 2010. The epidemiological characteristics of the outbreak are described. The outbreak was investigated from 4-8 March 2010 with necessary epidemiological information and biological specimen collection. One month follow up was done to determine the clinical outcome of the measles cases.RESULTS:A total of 36 people had measles; 97% of them were under 15 years of age and 89% had not been immunized with measles vaccine. Attack rate and vaccine efficacy was 23% and 50% amongst children less than 15 years of age and case fatality rate (CFR) was 3%. Biological samples were collected from 11 patients; all of which tested IgM positive for measles and genotype D8 was isolated.CONCLUSIONS:CFR of this outbreak is higher than the national CFR. Vaccine efficacy of 50% points towards the need for investigation of vaccine logistics and cold chain system. Moreover, this laboratory test confirmed an outbreak showing that the measles virus could be imported from an endemic region and rapidly spread through a susceptible population who were previously not immunized.
A Rare Solitary Fibrous Tumour of Kidney
Authors: Pathak Tilak Bahadur , Nepal Umesh
Published: September 2018

A solitary fibrous tumour (SFT) is an unusual spindle cell neoplasm. It frequently arises from the serosal surface of pleural cavity but has recently been described in diverse extrapleural sites. Urogenital localization is rare and only 36 cases of SFTs of the kidney have been described on published report.  We report a case of a large SFT clinically and radiologically thought to be renal cell carcinoma arising in the kidney of a 30- year-old female. The radical nephrectomy was performed. The tumour was a well- circumscribed, solid mass attached to the renal pelvis without necrosis and haemorrhage. Histopathologically, a spindle cell neoplasia with alternating hypo and hypercellular areas, storiform, fascicular and hemangipericytoma- like growth pattern and less cellular dense collagen deposits were observed. Immunohistochemical studies revealed reactivity for CD34, CD99 and Bcl-2 protein.
Comparison of Acid Fast Bacilli Smear and Culture for the Diagnosis of Extra-Pulmonary Tuberculosis
Authors: Rijal Basista , Ghimire P , Tuladhar N R
Published: September 2018

The study was conducted with the objectives to compare the Acid Fast Bacilli (AFB) staining and Culture for the diagnosis of extra-pulmonary tuberculosis and to find out the burden of extra-pulmonary tuberculosis from the different site of the body in suspected TB patients. The standard Ziehl-Neelsen Technique was done for AFB staining and culture was done in Ogawa Medium. Of the 292 extra-pulmonary samples examined by AFB smear only 2(0.7%) were positive and of the 1058 extra-pulmonary samples cultured 20 (1.9%) were positive. The isolation rate for extra-pulmonary samples was three fold higher in culture in comparison to AFB Smear. The confirmation rate of extra-pulmonary tuberculosis was approximately 1/ 8th of the pulmonary tuberculosis by conventional bacteriological diagnostic methods. Of the extra-pulmonary tuberculosis renal, endometrial or pelvic and cold abscess were common in this study. M.tuberculosis was also isolated from peritoneal fluid, pericardial fluid, Synovial fluid, lymph node and cerebro spinal fluids only by culture. In conclusion, the standard AFB culture has significant role for diagnosis of extra-pulmonary tuberculosis, even though the conventional bacteriological technique could diagnose very low number of extra-pulmonary tuberculosis. The new methods of diagnosis should be considered to confirm more extra- pulmonary  tuberculosis.Key Words: Extra-pulmonary tuberculosis, AFB Smear, Culture, Diagnosis, Nepal.
Malignant Melanoma of the Parotid Gland – Primary or Metastatic ?
Authors: Singh Usha Rani , Chaturvedi KU , Bhatta S , Karki S , Kumar B
Published: September 2018

Involvement of the parotid gland by malignant melanoma is rare. Parotid Metastasis from cutaneous melanoma is uncommon. Primary melanoma of the parotid gland is a controversial entity. A diagnosis of parotid gland malignant melanoma should herald a search for a primary skin neoplasm & this may be exceptionally difficult because of the well recognised though uncommon phenomenon of spontaneous regression of the primary melanoma. A 39 years old male presented with progressive painless enlargement of the parotid gland over the past seven months. Removal of the parotid gland was possible only on the second attempt. A detailed history revealed excision of a pigmented lesion on the contralateral cheek 20 years back. The tumour  was  a  black  heavily  pigmented  lesion  with  varied  morphology.  In spite of low mitotic count there was vascular embolisation. The margins were infiltrative. Patients with parotid gland melanoma have a high incidence of distant spread & significantly worse prognosis, requiring  medical  surgery.Key Words: Melanoma, Parotid gland.
Disseminated Tuberculosis Presenting as Tubo-Ovarian Mass
Authors: Bhadani Punam Prasad , Shah SP , Babu S
Published: September 2018

Postmenopausal tuberculosis with the involvement of myometrium is rare. A 54 years old lady who presented with painful abdominal mass and urinary retention was diagnosed as a case of dissiminated tuberculosis involving myometrium and the adenexa.Key Words: Disseminated tuberculosis, female genital tract, tubo-ovarian mass, myometrium.
Status and Trend of HIV/AIDS Epidemic in Nepal
Authors: Joshi Anand Ballabh , Banjara MR , Karki YB , Subedi BK , Sharma M
Published: September 2018

The main objective of this study is to review the HIV/AIDS status and trend in Nepal. The design of the study was retrospective in nature. Review was made of published and unpublished documents during the period 1988 to 2004. Year-wise data indicates that the cases of HIV/AIDS have been increased sharply since mid 1990s. In 1992, more than double numbers of new cases were reported than the formerly reported cumulative cases. The latest cumulative HIV/AIDS cases as of May 2004 were reported as 747 cases of AIDS and 3765 cases of HIV infections. Among total HIV/AIDS cases, clients of sex workers (57.8 percent) were predominant followed by sex workers (13.9 percent) and injecting drug users (15.6 percent). Similarly, others included housewives (10.6 percent), children (1.8 percent) from vertical transmission and blood or organ recipients (0.2 percent). Male cases (73.0 percent) were found predominant than female cases (27.0 percent). HIV prevalence among risk group population was found highest in injecting drug users (38.4 percent) followed by Female Sex Workers (4.1 percent) and migrants (3.0 percent). The risk population and HIV/AIDS prevalence has been found sharply increasing after mid 1990s. The increasing trend of the disease certainly has given pressure to focus on the use of comprehensive targeted intervention programs in risk  group  sub-populations.Key Words: HIV/AIDS, Trend, Risk populations, Prevalence.
Pediatric Cardiology and Children’s Heart Care in Nepal
Authors: Basnet Narayan Bahadur , Andrews J , Shrestha RM
Published: September 2018

Pediatric cardiology is an established sphere of modern medicine; however, Nepal presently has limited facilities and skilled practitioners dedicated to this subspecialty of pediatric medicine. The purpose of this review is to analyze present status of pediatric cardiology and children’s heart care in Nepal. Observation of the children consulted and those admitted to the cardiac unit of Kanti Children’s Hospital (KCH), as well as the review of hospital records and existing scientific literature, have revealed that majority of cardiac diseases afflicting Nepalese children originate from infections that are preventable to a great extent. Congenital heart problems are the second leading source of cardiac disease in the Nepalese pediatric population. In order to develop pediatric cardiology as a successful field in Nepal in the coming years, the major issues to address include: early diagnosis, systematizing long-term antibiotic prophylaxis to patients who require it, improving referral and patient transportation securing, funding for the long hospital stays required, expenditure, training health personnel for the tender pre and post-surgical care, and expanding and improving patient and community heart health education. Several national and international organizations could provide important assistance for controlling the preventable and treatable infections associated with pediatric cardiac disease and heart defects as well as care of children with heart problems.Key Words: Children, congenital heart disease, heart, Nepal, pediatric cardiology, rheumatic heart disease.
Topical anaesthesia of the vocal cords by nebulized lignocaine inhalation to facilitate fi breoptic nasotracheal intubation in a head-size parotid tumour patient
Authors: Koirala S , Tripathi M , Subedi A , Bhattarai B
Published: September 2018

This case report describes a successful fi breoptic naso-tracheal intubation in a patient with difficult airway due to a nearly head-size right parotid swelling. Nasal fi breoptic intubation was performed by maintaining spontaneous breathing under propofol infusion at a dose of 25 mcg/kg/hour and topical anaesthesia of vocal cords by using oxygen (6 l/min) fl ow to nebulize 4 % lignocaine from the side port of the fi breoptic bronchoscope. The topical anaesthesia was achieved by keeping the scope in close proximity of the vocal cords and in the centre of view of the scope. This case emphasizes the possibility of fi breoptic intubation in a sedated yet spontaneously breathing patient by allowing inhalation of nebulized lignocaine during fi breoptic intubation. 

Keywords: fibreoptic intubation, naso-tracheal intubation, nebulized lignocaine, spontaneous breathing, topical anaesthesia.
Community-Based Screening for Chronic Kidney Disease, Hypertension and Diabetes in Dharan
Authors: Sharma Sanjib Kumar , Dhakal Subodh , Thapa Lekhjung , Ghimire Anup , Tamrakar Rikesh , Chaudhary Satdal , Deo Rajib , Manandhar Dhiraj , Perico Norberto , Perna Annalisa , Remiuzz Giuseppe , Lamsal Madhav
Published: September 2018

Introduction: Nepal cannot afford renal replacement therapy for End Stage Renal Disease due to lack of resources. Early diagnosis of Chronic Kidney Disease and its risk factors may reduce the need of renal replacement therapy.Methods:A community-based screening on, 3218 people ≥20 years were assessed by door-to-door survey in Dharan, Nepal. Health status, lifestyle habit, physical examination and blood pressure were evaluated. Spot urine was examined for proteins and glucose by dipstick. Fasting blood glucose and serum creatinine were measured in a subset of 1000 people and the prevalence of Chronic Kidney Disease was evaluated.Results: Overweight, obesity, hypertension, diabetes and proteinuria were found in 20%, 5.0%, 38.6%, 7.5%, and 5.1% respectively. In the subset group, Chronic Kidney Disease was detected in 10.6%. Multivariate analysis indicated age (P <0.0001) and diabetes (P = 0.027) as statistically significant predictors for Chronic Kidney Disease. Total of 848 patients entered the management program of lifestyle modification and pharmacologic intervention. Glycemic and blood pressure control was achieved in 60% and 72%, respectively. Regression or stabilization of proteinuria was reported in 52% of patients. Conclusions: Burden of Chronic Kidney Disease and cardiovascular risk factors are high in Dharan. Reasonable control of blood sugar, hypertension and proteinuria was achieved in this program. Findings indicate that activation a large prevention and intervention program to tackle Chronic Kidney Disease and Cardiovascular Disease in Nepal is needed.Keywords: chronic kidney disease; community-screening; diabetes; hypertension; intervention; Nepal.
Coexistence of Cardiomyopathy and Chronic Liver Disease in Non-Moderate Drinkers
Authors: Gautam Mani Prasad , Ghimire Usha , Subramanyam Gangapatnam , Guruprasad Sogunuru
Published: September 2018

Introduction: The dose-response relationship suggests a toxic effect of alcohol on heart and liver and the possibility of a correlation between alcohol-induced liver and heart disease. The present study was aimed to look into the relationship between chronic liver and heart muscle disease among the non-moderate drinkers in our context.Methods: An observational study on non-moderate chronic drinkers was carried out. Clinical evaluation along with detail sonographic study of heart and liver was conducted.Results: Fifty-eight percent had echocardiographic features consistent with heart muscle disease, either as a dilated cardiomyopathy, categorized by the presence of echo features of impaired LV systolic function and dilated left ventricle or as a possible cardiomyopathy categorized by the presence of any of these two echo features. Similarly, 56 of the total recruits showed ultrasonographic evidence of chronic liver disease as cirrhosis or early cirrhosis. Approximately, 86% of these 56 non-moderate drinkers with chronic liver disease also had echocardiographic features of heart muscle disease and 83% of the 58 non-moderate drinkers showing echo features of heart muscle disease had ultrasonographic features of chronic liver disease.Conclusions:Our study showed a strongly positive relationship on the coexistence of chronic liver disease and cardiomyopathy among the non-moderate drinkers. Non-moderate drinkers with chronic liver disease have a high likelihood of having a concurrent clinical or sub-clinical heart muscle disease and vice versa.Keywords: alcohol; chronic liver disease; heart muscle disease; non-moderate drinking.
COMPARISION OF TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR THE DETECTION OF LEFT ATRIAL THROMBUS IN RHEUMATIC MITRAL VALVULAR DISEASE
Authors: Sharma Deewakar , Maskey A , KC B M , Rajbhandary S , Rajbhandary R , Limbu Y R , Malla R , Regmi S R , Pradhan B , Shrestha N K
Published: September 2018

Transesophageal echocardiography (TEE) was performed in 114 patients with rheumatic mitral valvulardisease and its results were compared with those of transthoracic echocardiography (TTE). Of 114 patients,LA thrombus was detected in 32 patients by TEE whereas TTE could detect LA thrombus in only 4 of them.Out of 32 cases, thrombus was located in left atrial appendage (LAA) in 20 (62%). TTE could detect LAAthrombus in only one patient. The procedure of TEE was well tolerated and there was no complication. Weconclude that TEE is superior to TTE in detection of LA cavity and LA appendage thrombus. Hence, TEEshould be a routine procedure to detect LA thrombus in patients with rheumatic mitral valvular diseaseprior to any surgical intervention.Key Words: Left atrial appendage (LAA), Transthoracic echocardiography (TTE),Transesophageal echocardiography (TEE)
Low Cost Level II Newborn Care Service: Experience Of Kathmandu Medical College Teaching Hospital
Authors: Manandhar D S , Manandhar K
Published: September 2018

Newborn infants require special care when they become sick. Majority of the newborn require only feeding,warmth and loving care by the mothers. Nearly 15-20% of newborns become sick requiring care in hospital.Most of these babies can be managed using low cost locally made equipment which makes newborn careaffordable. This is a prospective study of 201 sick newborns looked after in the Special Care Baby Unit(SCBU) of Kathmandu Medical College Teaching Hospital (KMCTH) using locally made low cost equipment.In the period of 28 months from 2nd July, 2001 to 17th Oct. 2003, 882 babies were delivered at KathmanduMedical College Teaching Hospital (KMCTH). 859 were live births. Out of 859 live births, 173 (20.1%)were admitted in the special care baby unit (SCBU). SCBU of this hospital also admitted 28 babies bornoutside the hospital. The main causes of admission in SCBU were low birth weight (37.3%), neonataljaundice (18.9%), birth asphyxia (6.9%), septicaemia (2.4%) and out of 201 babies admitted in SCBU,89% were discharged in good condition, 3.9% of the babies left against medical advice, 2 babies (one withcongenital hydronephrosis and another with congenital hypertrophic pyloric stenosis) were transferred toKanti Children Hospital for surgery and 11 babies (5.4%) expired. The main causes of neonatal deathswere extreme prematurity (70%), septicaemia (23%), birth asphyxia (15.3%) and congenital anomalies(7.6%). The perinatal mortality rate (PMR) and neonatal mortality rate (NMR) during this period were26.4/1000 births and 15.1/1000 live births respectively. In SCBU, locally made low cost equipment(Resuscitaire, Warm cot, Phototherapy and Oxygen hood designed by Prof D.S. Manandhar) are beingused in the manangement of sick babies, since the unit was started on 2nd July, 2001. Babies with birthweight as low as 1020 gms and gestation as low as 28 weeks have survived in this unit. This unit has shownthat Level II care could be provided with simple and low cost equipment and results are quite satisfactory.Good antenatal care, good care during delivery including use of partogram and care during postnatalperiod have helped to make this result good. Expansion of such facilities in district and bigger hospitals inthe country are not only affordable but also will have great impact in saving many lives. This will have amajor impact in reducing the present high IMR and NMR of the country.Key Words: Care of sick neonates, low cost locally made equipment, common neonatal problems,special care baby unit, and level II care.
Serial Haemodynamic Change In Children With Acute Empyema
Authors: Kumar Virendra , Unikrishnan G , Anand R , Rathore R , Sethy G
Published: September 2018

Empyema thoracis continues to remain a serious complication of Pneumonia in children. A number ofstudies are available on demographics, etiology and treatment of empyema but no useful information isavailable on hemodynamic changes occurring in response to acute empyema. Therefore we aimed to evaluatethe serial haemodynamic changes in children with acute empyema and their correlation with severity andout come of the disease.Serial haemodynamic changes were studied prospectively in 25 children with acute empyema before andafter the placement of chest tube and subsequently on day 1, 2, 3 and 10 of hospitalization. Twenty-five ageand sex matched children served as their controls.Their age ranged from 8 months to 12 years (mean 4.2 years). Severity of empyema was graded as mild,moderate and severe in 11, 6 and 8 children respectively. Staphylococcus aureus was the commonestorganism isolated in 11 children. At admission all the children were febrile (mean temp 39.4C) hadtachycardia (mean HR136/mt) and tachypnea (mean RR 62/mt).While CVP was high (10.2? 4cm H2O), thesystolic (102 ? 4mmHg) and mean arterial pressure(77? 3mmHg) was at lower side as compared to theircontrols.The mean changes observed after the chest tube placement were HR- 6/mt; RR - 4.44/ mt; SBP+5mmHg; DBP +2.04mmHg; MAP +3mmHg and CVP-3.1cm H2o (p <.001). Children with severe diseasehad significantly higher CVP (15 ? 3.3cmH2o), low SBP (99 ? 3mmHg) and low serum Sodium (128? 5mEq/L) and Osmolality (278 ? 9 mOsm/L) compared to those with mild or moderate disease. (p<.05 foreach factor).Seven children had features suggestive of syndrome of inappropriate ADH secretion. All thischildren belonged to severe category.It was concluded that hemodynamic compromise is a common occurrence in children with empyema. HighCVP, low SBP, low serum Na+ and Osmolality correlate best with the severity of the disease.Key Words: Empyema, Hemodynamics, Children.
Goldenhar Syndrome in Association with Duane Syndrome
Authors: Shrestha U D , Adhikari S
Published: September 2018

Goldenhar syndrome (GHS) is also known as Oculo-Auriculo-Vertebral (OAV) syndrome or Branchial arch syndrome. Duane retraction syndrome (DRS) is a congenital disorder of ocular motility characterized by limited abduction, adduction or both. It is unilateral in 80% of cases. The important and interesting part of this eight months old child is presence of GHS with DRS. She has bilateral invol-vement, which is seen in only 5-8% of GHS, as compared to high incidence of unilateral involve-ment. This child also had refractive error of + 6.00/ - 1.5 * 180. At four year of age her vision with glass was 6/9. Children with GHS and DRS should have early eye examination done to treat the problem of refractive error.

Keywords: Duane retraction syndrome; goldenhar syndrome, refractive error.
Psychiatric Morbidity Patterns in Referred Inpatients of Other Specialties
Authors: Risal Ajay , Sharma Pushpa Prasad
Published: September 2018

Introduction: Consultation-liaison psychiatry is an upcoming field dealing with interdepartmental collaboration heading into multidisciplinary and holistic care. In general hospital setting, psychiatrists need to be involved in evaluation of patients referred from other specialties. This study analyzed the psychiatric morbidity among the inpatients referred to Psychiatry Department from different wards in a Tertiary care University Teaching Hospital.

Methods: Total 385 subjects were referred to the Department of Psychiatry from different wards during a period of one year. Each of them underwent a detailed psychiatric evaluation by a consultant psychiatrist once they were medically stable. Psychiatric diagnosis was considered as per International Classification of Disease-10 criteria.

Results: The mean age of the subjects evaluated was 37.26 (±1.86); most of them were females 216 (56.4%), married 287 (74.5%), and homemaker 159 (41.3%). Maximum 271 (70.4%) referral was from Medical ward, and most of them 292 (75.8%) were admitted in general bed. The most common medical diagnosis was self-poisoning 115 (30.6%) followed by alcoholic liver disease 49 (12.7%); while the commonest 123 (31.9%) psychiatric diagnosis was depression (including Dysthymia and Adjustment disorder). Depression remained the commonest diagnosis among those referred from medical ward 131 (34.7%); while anxiety was mostly found in the emergency referral 94 (24.5%). Significant Correlation (P <0.05) was seen between the source of referral and Psychiatric diagnosis.

Conclusions: Psychiatric consultation was sought mostly by medical ward that had maximum number of patients presenting with self-poisoning. The commonest diagnosis seen in the referred in-patients was depression and anxiety disorder. 

Keywords: consultation-liaison psychiatry; in-patient referral; psychiatric morbidity.
STUDY OF BACTERIA ISOLATED FROM URINARY TRA INFECTION AND THEIR SENSITIVITY PATTERN
Authors: Karki Aarati , Tiwari B R , Pradhan S B
Published: September 2018

A retrospective study was conducted among out-patient and in-patient in Kathmandu medical collegeTeaching hospital of one month from the duration 2060-11-15 to 2060-12 -15. Mid-stream urine [MSU] of300 patient were cultured. Out of these, 75 patients’ urine were found to have significant bacterial growth.Total of five species of bacterial species isolated were viz.E.coli 37(33.3%), Proteus species 25(27.7%),Klebsiella species 15(16.6%), Staphylococcus aureus 8(8.8%) and Pseudomonas aureginosa 1(1.1%).Regarding their antibiotic sensitivity pattern, E. coli were sensitive to Nitrofurantoin 31 (83.8% ), Norfloxacin25 (67.5%), Ofloxacin 30(81.0%), Amoxycillin 16(43.2%), Nalidixic acid 15 (40.5%).proteus species weresensitive to Nitrofurantoin 15 (60.0%), Norfloxacin 15 (60.0%), Ofloxacin 12(48.0%), Amoxycillin 13(52.0%),Nalidixic acid 10 (40.0%), Ciprofloxacillin 12(48.0%). Klebsiella species were sensitive to Nitrofurantoin 9(60.0%), Norfloxacin 5 (33.3%), Oflaxin 6(40.0%), Amoxycillin 5(33.3%), Nalidixic acid 4 (26.6%),ciprofloxacillin 6(40.0%).Staphylloccus aureus were sensitive to Nitrofurantoin 8(100.0%), Norfloxacin 6(75.0%), Oflaxin 8(100.0%),Amoxycillin 7(87.5%), Nalidixic acid 6(75.0%), Ciprofloxacillin 8(100 %). And Pseudomonas aureginosawere resistant to all antibiotics which we are using in this research work.Key Words: Urine sample, Identification, Sensitivity pattern.
Effectiveness of Reproductive Health and AIDS Education among Adolescent Girls in Udupi Taluk, India.
Authors: Shrestha Lochan , Rao P
Published: September 2018

An intervention study was undertaken among adolescent girls in age group 16-19 years, studying in preuniversitycolleges, in Udupi town in Karnataka State, India, to asses the impact of health education onknowledge regarding reproductive health & AIDS. 4 pre-university colleges were randomly selected inUdupi town. There were 551 students present for the pretest and 548 in the post test. Knowledge wasassessed at the beginning of the study with the help of a questionnaire that was duly pre-tested. Based on theresults of this baseline survey, a health education programme was developed and implemented after a weekin each of the selected colleges. A second visit was made to the same colleges after one month of conductinghealth education programme for post-test The same questionnaire was administered to assess the impact ofhealth education. Significant increase in knowledge about adolescence, menarche, pregnancy, delivery,immunization and various aspects of AIDS following health education. This study has shown that there is abeneficial effect of health education on the knowledge and awareness related to reproductive health andAIDS among adolescent girls.Key Words: Reproductive Health, AIDS, Health Education.
Morphological Changes in Carotid Arteries in Stroke Cases
Authors: Thapa Guna Bahadur , Sundas Alin , Rauniyar Raj Kumar
Published: September 2018

Introduction: Majority of stroke is due to ischemic infarction and occurs in carotid artery territory. The extra cranial parts of carotid arteries are the common sites for the atherosclerotic plaque formation. Ultrasonography is the first line of investigation for screening of the carotid artery diseases to localize and characterize the plaques. Objective was to study the morphological changes in extra cranial part of carotid arteries in cases of ischemic infarction using Ultrasonography.

Methods: It was an institution based prospective study and convenience sampling method was used. Computed Tomography proven ischemic infarct, lacunar infarction and transient ischemic infarction cases were included in the study.

Results: Fifty four cases were included in the study. Mean of Intimo-medial Complex Thickness was 0.89 mm and 0.88 mm in right and left side respectively. Sixty five percent cases had plaque in extra cranial part of carotid artery. Ninety three percent of plaque was found in and adjacent to the carotid bulb region. Ipsilateral plaque was found in 76% and 65% cases on right and left side respectively. Fifty three percent of cases had soft plaque. Majority of cases had less than 50% narrowing of the lumen diameter in term of cross-sectional area due to plaque. Thirteen (24%) cases had plaque in internal carotid artery.

Conclusions: Carotid ultrasound can be used for screening of the asymptomatic but high-risk cases and following up of the symptomatic cases to plan for necessary management as required.

Keywords: carotid artery, carotid ultrasonography, ischemic infarction, plaque.
Clinical Profile, Aetiology and Outcome of Afebrile Seizures in Children
Authors: Poudel Prakash , Parakh Prince , Mehta Kayur
Published: September 2018

Introduction: Clinical and outcome profiles of childhood seizures can be different in resource limited settings where neurologists face lots of challenges in diagnosis and management of seizure. This study was conducted to investigate the clinical profile, causes and outcome of afebrile seizures in children in resource limited settings.

Methods: This was a prospective hospital based study. Children with afebrile seizures were followed up with exclusion of febrile and acute provoked seizures. Clinical, investigation, treatment and outcome parameters were analyzed.

Results: Study included 308 (age one month to 20 years) children. Median age at first seizure was 39 (inter quartile range 12-96) months. History of status epilepticus was present in 26.0%. Cause of seizure was known in 44.2%. Seizure was generalized in 79.2%, partial in 14.0% and unclassified in 6.8%. Common causes of seizure were – birth asphyxia (12.3%), neurocysticercosis (8.8%), sequel of nervous system infection (6.5%) and structural brain abnormalities (7.1%). Neurological examination, electroencephalography and computed tomography (CT) were abnormal in 24.4%, 70.5% and 27.9% cases respectively. Seizure control was achieved in 79.3% and by monotherapy in 85.0 % cases. Seizure control with single drug, seizure without recurrence and idiopathic seizure were associated with favourable outcome.

Conclusions: Prevention and control of birth asphyxia, neurocysticercosis and nervous system infections are needed to reduce the burden of afebrile seizures in this area. CT is a valuable diagnostic tool and response to monotherapy is good. Seizure control with single drug, seizure without recurrence and idiopathic seizure are favourable prognostic factors.

Keywords: afebrile seizure; children; clinical profile; outcome.
VON RECKLINGHAUSEN'S DISEASE
Authors: Khan Salamat , Chandra A , Jain N , Kumar A , Khan I U
Published: September 2018

Von Recklinghausen's disease (VRD) is a rare genetic autosomal dominant disorder that affects the ectodermaltissues (nerve and skin). The cardinal features of this disorder are spots of increase pigmentation (cafe-au-lait spot, CAL), peripheral nerve tumours (neurofibromatosis) and iris hamartoma (Lisch nodule). Clinicaldiagnosis of VRD is based on the criteria given by National Institute of Health (NIH) because the mutationanalysis is laborious. Here, we are reporting a case of a family with VRD.Key Words: VonRecklinghausen's disease (VRD), Cafe-au-lait (CAL) spot, Lisch nodule,Neurofibromatosis (NF)
Pharmaco-Economic Aspects of Antibiotic Prescriptions in Clinics of Kathmandu
Authors: Jauhari Akhilesh Chandra , Pokharel A , Palikharel N , Shrestha N , Rao BS
Published: September 2018

Antibiotics (AB) are the most widely prescribed group of drugs and their use is associated with increasingrate of AB resistance. Nearly one third of prescriptions of physicians for colds, upper respiratory tractinfections and bronchitis are of AB as documented in previous studies. Antibiotic use is associated withincreased cost of financial burden, which may be difficult to be borne by the patients in developing countrieslike Nepal.The objective was study the prescribing pattern of Antibiotic preparations in various diseases and to findout how the treatment could become more pharmaco-economic without compromising the quality of service.A cross sectional study of prescription pattern of antibiotics/drugs in which antibiotics were used fromrandomly selected 20 private clinics of four major specialties in Kathmandu valley.Total No. of prescriptions audited were 386, average number of drugs/per prescription was 2.74.Maximum antibiotics were prescribed for age group 21-40 years in gynecological, surgical and medicalproblems, in Pediatrics maximum AB were prescribed between 1-12 years.Minimum antibiotics were prescribed between 13-20 years for gynecological and Pediatric problems. Inmedical and surgical problems, minimums AB were administered between 41-60 years. Above 60 yearsalmost no AB were used.Males were prescribed more AB than females (73% for surgical, 62% for medical and 53% for Pediatricproblems)Only in 20.25% patients, AB were prescribed after proper diagnosis and sensitivity testsMaximum cost of prescription was 510 Nepali rupees (NR) for treatment of STD in Gynecology.Key Words: Antibiotics, Cost, Human Immune deficiency Virus, Kathmandu, Private Clinics, Pharmacoeconomic, Sexually Transmitted Diseases.
HYPERPLASTIC GASTRIC POLYPS PRESENTING WIT MASSIVE UPPER GASTRO-INTESTINAL BLEED
Authors: Karki Prahlad , Ansari J A , Sinha A , Rijal S
Published: September 2018

A 39 year old man presented with massive upper Gastro-intestinal (GI) Bleed of 4 days duration. There wash/o chronic epigastric pain of 6 months duration. Upper Gl Endoscopy revealed a large polypoid mass of 6cms x 5 cms in diameter on anterior wall of body. After resuscitation surgical exploration was done. Biopsyand histopathological examination revealed hyperplastic polyp. Cornual polyp of very large size (5 cm x 6cms) with presentation with massive upper gastrointestival bleeding is quite unusual. These polyp are foundin people older than 50, usual site is antrum and they usually present with occult blood loss.Key Words: Hyperplastic polyp, upper gastro-intestinal bleeding.
Clinical Manifestations in Atrial Myxoma
Authors: Shrestha U K , Koirala B , Shrestha BMS , Shrestha R , Joshi P R , Marhatta M N
Published: September 2018

In Nepal, we started regular open-heart surgery since February 1997. Primary tumors of the heart are rareand the commonest is myxoma. Left atrium is the commonest site of occurrence. There is diagnostic difficultyin this most frequent benign tumor of the heart.We present 5 cases of left atrial myxomas who presented with different clinical features. Among them 4cases were diagnosed preoperatively by transthoracic echocardiography.The youngest was 32 years whereas the oldest was 58 years (mean 49.8 years) and 4 of them were female.Among them, one presented with right unilobar pulmonary venous hypertension; another mimicking mitralstenosis with large left atrial clot; with embolization to brain with motor the third aphasia and the remainingtwo had only constitutional symptoms. All of them were discharged with successful removal of tumor andare surviving at present with no features of recurrence.There are no pathognomic features of atrial myxoma. All suspected cases must be subjected forechocardiography. With the advent of open-heart surgery, extirpation of tumors with good outcome hasbeen a regular service in our hospital.Key Words: Atrial myxoma, Transthoracic Echocardiography, Embolization, Recurrence.
Patent Arterial Duct and Vascular Ring in a Premature Infant
Authors: Bhattarai Anil , Vida Vladimiro , Ricato Silvia , Salvadori Sabrina , Stellin Giovanni
Published: September 2018

We report a case of a 750 grams premature female who was scheduled for surgical ligation of a patent arterial duct. Intra-operative findings showed a patent arterial duct in association to a retro-esophageal aortic arch creating a complete vascular ring around the trachea, which was successfully divided. A vascular ring should be ruled-out in premature infants prior to ductal ligation at bidimensional echocardiography.

Keywords: congenital heart disease; premature infant; surgery; vascular ring.
Extensive Mucosal Erosion and Sloughing of Tongue: A Hitherto Unknown Complication of Topical Clotrimazole Preparation
Authors: Dutta Mainak , Ghatak Soumya , Biswas Gautam , Sinha Ramanuj
Published: September 2018

Clotrimazole, a broad-spectrum imidazole antimycotic, is a widely-used prescription as well as an over-the-counter drug for treatment of mucosal (oral, vulvovaginal) candidiasis and dermatophytes. An extremely safe and well-tolerated drug, its safety profile has been well-explored in researches and trials. The commonest complaints are almost always non-serious-pruritus, rashes, paraesthesia (stinging/burning sensation) and erythema on topical applications, and nausea, vomiting, unpleasant taste sensation and elevated liver enzymes on oral preparations (troches). However, mucosal ulceration on topical clotrimazole preparation has not been reported in literature before. We present here the first documentation of extensive bilateral erosions and necrosis of tongue involving the mucosa, submucosa and musculature on application of one percent weight/volume clotrimazole mouth paint in a 27-year-old immunocompetent woman who presented with oral candidiasis.

Keywords: extensive bilateral ulceration and necrosis; oral candidiasis; side effect; topical clotrimazole.
ZINC FOR CHILD HEALTH IMPLICATIONS OF RESEARCH FINDINGS
Authors: Chandyo Ram Krishna , Strand T A
Published: September 2018

Malnutrition and various micronutrient deficiencies are widespread in developing countries. Although therole of vitamin A and iron in child health has been acknowledged for a long time, the importance of zinc hasnot been recognized until recently. Indeed, zinc is a micronutrient of great public health importance. Recentresearch has indicated that prevention of zinc deficiency among young children in developing countriescould have a significant impact on health as well as the economy.In the near future, the World Health Organization (WHO) will recommend oral zinc for the treatment ofacute and persistent diarrhea in young children. The WHO has also proposed to include zinc in its essentialmedicine list. Several key issues regarding zinc research and the impact of zinc on child health will bediscussed in this paper.Key Words: Zinc, young children, diarrhea, child health, developing countries and Nepal.
Squamous Cell Carcinoma Arising in Mature Cystic Teratoma
Authors: Adhakari Ram Chandra , Bashnet R B , Sayami G
Published: September 2018

Abstract
Criteria for Peer Reviewing the Original Articles Submitted to a Biomedical Journal: Intellectual Honesty is the Best Policy.
Authors: Paudel Bishnu Hari
Published: September 2018

Peer review - a process of assessing the quality of manuscripts submitted to a journal – is an establishednorm in biomedical publications. It is viewed as an extension of scientific process. The peer-reviewed researcharticles are considered trustworthy because they are believed to be unbiased and independent. The processof reviewing is a privilege and prestige. It is highly responsible, intellectually honest, and difficult job.Being expert in certain area of biomedical science is a prerequisite for reviewers. Young peer reviewerstrained in epidemiology or statistics produce high-quality review. The International Congresses on PeerReview in Biomedical Publication have shown many unresolved issues related to preparation or handling ofmanuscripts by a journal. Therefore, it is vital to identify authentic peer reviewers to ensure qualitypublication, thus, a set of peer review criteria is proposed for peer reviewing original articles. It is useful inquantifying (scoring) the manuscript quality. The proposed scoring system yields three categories ofmanuscripts: the first category is considered acceptable for publication after minor modification by editorialboard and/or reviewers, the second – requires rewriting and resubmission, and the third – rejected. Thesecriteria are preliminary guidelines, and require timely review. They are expected to sensitise peer reviewers,editors, contributors, and readers to move towards greater honesty and responsibility while working withmanuscripts. In summary, if the criteria are used they will facilitate editorial management of manuscripts,render more justice to authors and biomedical science, and improve publication quality.Key Words: Biomedical publication, peer review, peer review criteria, scoring of manuscripts, categories of manuscripts, journal of Nepal Medical Association.
END POINTS IN RESUSCITA TION OF SHOCK: UNDERST ANDING THE EVOLUTION
Authors: Timilsina D S , Majhi P C , Bawa S N
Published: September 2018

In the last two decades resuscitation strategies have gone through revolutionary changes. Ideas once heldsacred have been questioned and the very foundations on which these strategies were based shaken.Resuscitation strategies basically revolve around three questions:1. How much?2. How fast?3. When to stop?Evolutions of shocked patient management concepts show three distinct phases.• Phase 1 – Clinical parameter based.• Phase 2 – Oxygen variables based.• Phase 3 – Cellular perfusion based.Accepted criteria for endpoints of resuscitation too have undergone similar changes in paradigm and canbe grouped under similar phases.Key Words: Shock, Clinical parameter, cellular perfusion, resuscitation.
INTRAUTERINE GROWTH RESTRICTION : AN UPDATE
Authors: Chaudhary Pushpa
Published: September 2018

Intrauterine growth restriction [IUGR] is one of the leading cause of perinatal mortality and morbidity.Antenatal fetal surveillance should be focused to identify intra uterine growth restriction and intervenetimely. Screening begins with identifying pregnant women at risk of carrying growth restricted fetuses.Ultrasonic fetal biometry, amniotic fluid volume estimation and Doppler study of fetal blood flow velocityplay a valuable role in screening as well as management of IUGR. There is no promising antepartum fetaltherapy to correct IUGR. Therefore intensive fetal monitoring, which may be limited by facilities available,is suggested to time the delivery of growth restricted fetuses. Further care in a well equipped neonatal unitby dedicated team of pediatrician and nurses and appropriate follow up of these growth restricted newbornsdetermines the overall outcome.Key Words: Intrauterine growth restriction, Etiology, Screening, Diagnosis, Management.
Acute Acute Renal Failure and Hepatic Disfunction in Malaria
Authors: Sharma Sanjib Kumar , Sharma B HK , Shakya K , Khanuiya S , Shrestha N , Parajuli K , Rijal S , Karki P
Published: September 2018

The clinical presentations of severe and complicated malaria vary. The prognosis is poor when associatedwith cerebral malaria and acute renal failure. Clinical profile, biochemical parameters and outcome werestudied in 46 adult patients of malaria admitted in a tertiary care hospital between April 2002 to April2003. The age of the patients ranged from 15 to 60 years. Majority (n=30) of the patients were in age groupof 15 to 34 years. 67% of the patients were from terai belt. Mean duration of febrile illness was 10 days atthe time of presentation. 39% (n=18) patients had hepatic dysfunction and 22% (n=10) had acute renalfailure (ARF) according to WHO criteria. All patients with ARF were oligo-anuric and required dialysissupport. Four patients died of which three were patients with ARF and hepatic dysfunction. Althoughmalaria still remains a major health problem, malarial renal disease has not been formally reported previouslyfrom Nepal. Early initiation of antimalarial therapy, close observation for organ failure and early initiationof dialysis in ARF is instrumental in the recovery of the patient.Key Words: Malaria, Organ Failure.