bluuebunny/crossref_metadata_2025 huggingface dataset:
Hearing results of type III tympanoplasty with or without cartilage augmentation after Canal Wall Down mastoidectomy
Authors: Shrestha B.L. , Bhattarai H. , Bhusal C.L
Published: July 2024

Background: To assess and compare the hearing results in patients undergoing canal wall down mastoidectomy with classical type III tympanoplasty using temporalis fascia alone and with cartilage augmented type III tympanoplasty. Methods: Patients of 5 years of age or more with the diagnosis of Chronic otitis media (squamous) with conductive or mixed hearing loss, needing canal wall down mastoidectomy and with intact and mobile stapes suprastructure at surgery who underwent classical type III tympanoplasty with or without cartilage augmentation were included in the study. Pure tone audiometry (PTA) was performed and evaluated. Post- operative hearing was assessed in terms of average air bone gap (ABG) and size of ABG closure. Post-operative hearing results were compared in between classical type III and cartilage augmented type III tympanoplasty groups. Results: Postoperative PTA–ABG ranged from 15–61.2 dB in classical type III tympanoplasty while the postoperative PTA–ABG ranged from 15–47.5 dB in cartilage augmented type III tympanoplasty. When comparing average post-operative ABG and size of ABG closure between classical and cartilage augmented type III tympanoplasty, cartilage augmented group showed marginally better results but this difference was statistically not significant. Conclusions: Hearing results after type III tympanoplasty varied widely. There was no statistically significant improvement in post-operative hearing results in cartilage augmented when compared to classical type III tympanoplasty, suggesting possibility of the effects of multiple other factors.
Penetration of Radial nerve by subscapular artery
Authors: Kunwar R.B. , Basnet K.S , Dhungana S. , Thapa T.P.
Published: July 2024

The present case report is about an abnormal radial nerve which was penetrated by Subscapular artery, the largest branch of Axillary artery. The nerve was completely divided into two parts; one passing posterior and the other anterior to the subscapular artery, clasping it between them. However, on due course, both parts of the nerve united together to form single radial nerve in the lower part of Axilla.
Warthin’s tumor of Submandibular gland
Authors: Adhikari P. , Singh B.K. , Baskota D.K.
Published: July 2024

Warthin’s tumour is a benign tumour which is exceedingly rare in submandibular gland. Here, we report a case of warthin’s tumour of submandibular gland in a 64 years old female which is treated with excision of tumour along with the gland. A brief review of literature is also included.
Factors affecting male infertility
Authors: Pant P.R.
Published: July 2024

Introduction: Infertility is commonly defined as the failure of conception after at least 12 months of unprotected intercourse. 1 Accurate assessment of the prevalence of infertility has always been difficult because of the large scale population based studies. 2 Male factor is the only cause of infertility in about 20 % of infertile couples, but it may be a contributing factor in as many as 30 % to 40 % of cases.3 Factors like diabetes, bronchiectasis, high grade fever, long term medication, urinary tract infection, sexually transmitted infection, epididymitis, testicular injury, un-descended testis,mumps, orchitis, excessive alcohol, smoking, exposure to heat and certain chemicals effect in the spermatogenesis. Impotence or erectile dysfunction remains one of the important contributors in the male infertility.
Methods: This is a prospective descriptive study conducted during the health camps in Sindhupalchowk, Manang, Baitedi, Rauthat and Darchula districts of the Nepal. The objective of the study is to find out the factors contributing to male infertility. Couples who were unable to conceive after regular, unprotected coitus of at least one year were included in the study. Detail history, clinical examination and semen analysis was done.
Results: There was limited facility of investigation and treatment of infertility in the health camps.The diagnosis was based only on history, examination and semen analysis. Various factors like mumps, chemical exposure like men working in carpet factory, testicular trauma and smoking were found as contributing factor of male infertility in these districts.
Conclusions: Testicular trauma, mumps, smoking is common in all the districts. Exposure to chemicalssuch as dyes, used in carpet factories seems to be responsible for infertility in some men of Sindhupalchowk and Darchula.
Neonatal hyperbilirubinaemia and its early outcome
Authors: Nepal D. , Bastola D. , Dhakal A.K. , Mishra U. , Mahashetha C.
Published: July 2024

Introduction: Jaundice is an important cause of morbidity in the neonatal period, especially in the 1st week of life. our Objective of the study was to find out early outcome of babies admitted in Kanti Children Hospital with neonatal jaundice (NNJ) and its association with other co-morbidities.
Methods: This is a retrospective study conducted in tertiary care paediatric hospital from 1st March to1st June 2009. Altogether 73 babies were included in the study. Results: Male babies outnumbered females (72.6% vs. 27.4%). Only 2.4% babies were near-term. Low birth weight (LBW) babies constituted 19.2% of the study population. Clinical sepsis as defined by WHO criteria was observed in 86.3% of babies. Nearly 50% of the babies had serum bilirubin of 15-19.9 mg/dl. Most of the babies (94.5%) improved with 5.5% of mortality.
Conclusions: hyperbilirubinaemia is one of the most common causes of hospital admission in our nursery and it is associated with various other clinical morbidities. Phototherapy is effective in most of the time, but exchange transfusion should also be carried out when phototherapy fails. Causes of hyperbilirubinaemia should be searched extensively especially to rule out haemolysis
Acute acalculous cholecystitis and gall bladder perforation induced by Salmonella enterica serovar typhi
Authors: Khatri N.S. , Koirala S. , Aryal A. , Maskay P. , Paudel S. , Karkey A. , Baker S. , Shilpakar O , Shrestha K. , Basnet B.
Published: July 2024

Salmonella Typhi is a causative agent of enteric fever, which is an ongoing public health problem in urban areas of the Kathmandu valley in Nepal. It is estimated that approximately 5 % of people in an endemic enteric fever area may asymptomatically carry Salmonella Typhi in the gall bladder. Here we describe a rare clinical manifestation of chronic Salmonella carriage. A 40 year old male resident of Kathmandu underwent an emergency cholecystectomy for acute cholecystitis and gall bladder perforation. No stone was identified but Salmonella Typhi was cultured from the gall bladder
Tumor Board
Authors: Vaidya Prof.Pradeep
Published: July 2024

N\A
Prescribing medication in patients with impaired renal function
Authors: Bharati L , Sigdel M. , SAKYA R
Published: July 2024

Introduction: Renal failure has been emerging as a major public health problem in Nepal in recent years. Chronic renal failure affects renal drug elimination and other pharmacokinetic processes. Drug dosing errors are common in patients with renal impairment and can cause adverse effects and poor outcomes. Medications with toxic metabolites should be avoided, and alternative medications should be used if potential nephrotoxicity exist. Dosages of drugs cleared renally were adjusted according to creatinine clearance and glomerular filtration rate.
Methods:A Descriptive, cross-sectional study was conducted in TUTH. Data were collected from all the renal failure patients admitted at TUTH from 2009 February to April 2009. Parameters studied included age group, gender, duration of hospital stay, causes of renal failure, any associated comorbidity, serum creatinine (Scr) at admission and at discharge, blood urea nitrogen (BUN) and different drugs prescribed. Creatinine clearance (Clcr) in ml/min/1.73 m2 was calculated by using Cockroft-Gault equation.
Results: Majority of patient (98.1%) had raised urea level. Renal function at the time of presentation showed that 39.5 % patients had End stage renal failure and 39.5%, 19.7% and 1.3% patients had severe impairment, moderate impairment and mild impairment respectively. Average number of drugs prescribed was 5 to 6. In the list of prescribed medicine, 23% were antibiotic. Of the total antibiotic prescribed, dose adjustment was done for 27.3% and 1.5% drugs were prescribed which are supposed to be avoided in renal failure patients. Similarly in non-antibiotic group, 62.9% drug don’t required dose adjustment (they are safer in renal failure), dose adjustment was done in 22.9 %. The mortality rate of the renal failure at TUTH was found to be 15.3%. Kidney diseases, diabetes and hypertension were found to be the common causes of renal failure accounting for 29.5 %, 24.8% and 22.9% respectively.
Conclusions: Most of the patients with renal failure had end stage renal disease at presentation. Though they were prescribed multiple drugs, only few had dose adjustment done and some were even prescribed nephrotoxic drugs.
Sonographic assessment of gestational age in Nepalese population
Authors: Joshi BR , Ansari MA , Pradhan S
Published: July 2024

Introduction: Knowledge of gestational age is important for the management of pregnancy.Ultrasonography is a safe and reliable method for accessing gestational age. However, since built and stature are differ amongst various ethnic groups, nomograms based on western population may not be relevant to our community. This study is carried out to determine gestational age of Nepalese women, to compare with previously published charts and to standardize the gestational age charts for Nepalese population.
Methods: Nepalese women with a history of amenorrhea coming for ultrasound scan in the Department of Radiology and Imaging, TUTH were included in this prospective study. About 630 patients fulfilling the criteria were screened for BPD, HC, AC and FL during one year from 15thAugust 2004 to 14th June 2005. A gestational chart was made from the data and it was compared with the previously published charts.
Results: All fetal biometric parameters showed an increase with gestation. When compared with that of Hadlock’s nomogram, our values were similar at 20-21 weeks. After 21 weeks, our estimated values decreased gradually with a difference of 3-5mm in BPD, 3-24mm in HC, 1-21mm in AC and 1-4 mm in FL.Conclusions: There was earlier flattening of growth starting from 22 weeks. The nomogram of Hadlock significantly overestimated gestational age in the later part of third trimester from 34 weeks onwards. This supported the argument that there is a need to have our own nomogram.
Incidence of peri-operative cardio-respiratory complications in smokers versus non-smokers
Authors: Ranjit S , Bhattarai B
Published: July 2024

Introduction: Smoking is considered to be an independent risk factor for many diseases as well as cardio-respiratory events in patients undergoing anaesthesia and surgery. This study was aimed at finding out the incidence of peri-operative cardio-respiratory complications in cigarette smokers undergoing intermediate and major surgery under general anesthesia with endotracheal intubation and compare with that in non smokers in our hospital.
Methods: A prospective case control and single blinded study was conducted. Standard anaesthetic technique was employed to 40 current smokers who smoked 5 or more cigarettes per day for at least 5 years and 40 non smokers. Any adverse cardio respiratory adverse events like tachycardia during intubation, increased oral secretions, desaturation, bronchospasm, laryngospasm, severe coughingor pulmonary edema were recorded in each group. Chi-square test and Fischer exact test have been used to test the significance of events.
Results: Increase in heart rate during intubation was significantly higher in smokers p<0.001.Respiratory events like severe cough and bronchospasm was significantly high among smokers. This study however did not show any statistical difference in incidence of desaturation between the two groups. The amount of secretions on extubation was similar in both the groups.
Conclusions: Smoking was associated with increased risk of cardio -respiratory complications in patients undergoing general anaesthesia.
PCR based molecular detection of M. tuberculosis and comparison of its efficacy against AFB based bacteriological detection in diagnosis of Pulmonary Tuberculosis in Nepal.
Authors: Karmacharya D. , Shrestha L , Bajracharya B. , Dulal P , Shrestha S , Dixit SM
Published: July 2024

Introduction: Tuberculosis is high burden infectious disease in Nepal. Diagnosis strategy for tuberculosis includes Chest X-Ray, Ziehl-Nelson staining method and culture. Culture is considered to be a “gold standard” in TB diagnosis; however, it takes almost 3 weeks to do culture which affects rapid diagnosis of TB. This study investigates molecular based TB diagnosis and compares the result with the AFB staining.
Methods: Sputum samples from the National Tuberculosis centre (NTBC), Sano Thimi, Nepal were tested with Real Time PCR (QPCR) based assay for MTB detection at the affiliated laboratory of the Center for molecular Dynamics Nepal (CMDN), Kathmandu, Nepal.
Results: Out of 47 samples, 7 AFB positive samples yielded quantifiable QPCR positive result. However, of the 40 AFB negative samples assessed, 3 were found to contain quantifiable amount of M. tuberculosis using TB DNA detection. This amounts to 6.38% under detection using just AFB microscopy alone.
Conclusions: There is added benefits of using PCR in detection of M. tuberculosis .This method, if used in conjunction with traditional AFB will provide a more rapid, reliable and accurate diagnosis of M. tuberculosis.
Primary pericardial mesothelioma presenting as pericardial constriction
Authors: Ansari MA , Thapa R. , Pradhan S.
Published: July 2024

A 48 year-old-male presented with a six month history of shortness of breath and cough with low grade fever. Chest x-ray shows enlarged cardiac size. Echocardiogram revealed pericardial effusion. ESR was raised and blood count showed lymphocytosis. Anti-tubercular treatment was started and four months after completion of treatment there was no significant improvement. Pericardial biopsy was done which revealed findings of chronic pericarditis. Echocardiogram was repeated which revealed thickened pericardium with few foci of calcification and pericardial effusion. Diagnosis of constrictive pericarditis was made. Patient was planned for pericardiactomy. During operation fleshy vascular mass was seen arising from pericardium along with nodular pericardial thickening. Biopsy was taken and closer was done. Post operatively contrast enhanced CT scan of chest was done which revealed malignant mesothelioma. Histopathological analysis showed a primary malignant mesothelioma. Post operative period was uneventful for initial 2-3 days. Patient was taken by his party against medical advice on 3rd post-operative day. Patient did not returned to the hospital again.
Ectopic pregnancy in Nepalgunj Medical College
Authors: Sharma P. , Singh BP , Shrestha B
Published: July 2024

Background: Ectopic pregnancy is one of the major health problems. There is paucity of data regarding ectopic pregnancy from Nepal. This retrospective review was done to evaluate the incidence, commonest risk factors, site and the spectral types of ectopic pregnancy in western Nepal. Methods: This was a retrospective review of all the case of ectopic pregnancy during the period of two years. The data was collected using a format. Total number of deliveries during that period was also recorded. Finally data was analyzed using SPSS (Version 17). Results: The incidence of ectopic pregnancy was 1 in 87 deliveries. A total number of 21 cases of ectopic pregnancy were seen and managed during the study period. Mean age of the patient was 30.29 years ± 6.084 years. Pelvic inflammatory disease was the most common risk factor. Most of the patients had not used contraceptive methods. Type 3 spectral type of ectopic pregnancy was the most common type. All of our cases had tubal pregnancy. Maximum patients had ampullary implantation. Nineteen patients had ruptured ectopic pregnancy. Conclusions: Ectopic pregnancy is common in western Nepal with the incidence of 1 in 87 deliveries. Pelvic infection is the most common risk factor.
Prevalence of nosocomial lower respiratory tract infections caused by Multi- drug resistance pathologens
Authors: Shrestha S , Chaudhari R , Karmacharya S , Kattel HP , Mishra SK , Dahal RK , RK  , Bam N , Banjade N , Rijal BP , Sherchand JB , Ohara H , Koirala J. , Pokharel BM
Published: July 2024

Introduction: Nosocomial infections caused by multi-drug resistant pathogens are major threat to the hospitalized patients. Extended spectrum beta-lactamase (ESBL) and metallo-beta-lactamase (MBL) producing bacterial strains causing hospital acquired lower respiratory tract infection are increasing in numbers. Only a limited number of studies related to MBL producers have been done in Nepal. Objective: The goal of this study was to determine the etiology of nosocomial lower respiratory tract infections and to assess the current levels of antimicrobial resistance with special reference to ESBL and MBL producing bacterial strains.
Methods: A total of 100 specimens including sputum and endotracheal secretion from patients diagnosed of nosocomial lower respiratory tract infection were collected and processed according to the standard methodology. Combination disk method was done for the detection of ESBL and MBL producing isolates.
Results: Out of total 100 specimens, 87% was monomicrobial while the rest were polymicrobial. 96.5 % were gram negative while 3.5% were gram positive. All E.coli, Klebsiella spp and S. aureus were found to be MDR followed by Acinetobacter spp (97.2%) and P. aeruginosa (76.2%) About 28.6 % of E. coli, 8.33% of Klebsiella spp and 2.4 % of Pseudomonas aeruginosa were ESBL producers. Acinetobacter spp. was not found to produce ESBL during the study. MBL was present in 17.4% of the gram negative isolates.
Conclusion: We found a high prevalence of MDR strains as a cause of nosocomial LRTI including significant proportions of ESBL and MBL producers. The rate of Acinetobacter spp., including MBL producers, in our hospital setting was alarmingly high which prompts a special attention for the management of such patients as well as urgent need for implementation of infection control strategies.
Reference values for Doppler velocimetric indices from the fetal and placental ends of the umbilical artery in uncomplicated third trimester pregnancy
Authors: Paudel S , Kayastha P , Lohani B , Gurung G
Published: July 2024

Introduction: The purpose of this study was to establish new reference ranges for commonly used umbilical artery Doppler indices (Pulsatility Index, Resistance Index, and Systolic: Diastolic ratio) at standardized insonation sites in uncomplicated third trimester pregnancy.
Methods: This was a prospective cross sectional study involving 101 singleton pregnancies between 30 and 37 weeks of gestation without any known risk factors. Umbilical artery indices were obtained from fetal end and placental end of the cord. Regression equations were used to construct reference ranges and percentile fitted Normograms were obtained for all the parameters. Paired t test was used to see the difference of different parameters at two different sites of the cord.
Results: Among 101 singleton pregnancies between 30 and 37 weeks of gestation, 65 (64.35%) were primigravida and 36 (34.65%) were multigravida. Mean maternal age was 23.12years (range 16 to 35 years). Maximum number of pregnancies (18.81%) was at 34 weeks of gestation. The established Doppler indices showed a continuous reduction of all the measured indices as pregnancy increases (p<0.0001). Umbilical artery RI, PI and S: D ratio were higher in the fetal end of the cord than in the placental end (p><0.0001).
Conclusions: Umbilical artery Doppler parameters vary significantly at different locations. We have established new reference ranges for the UA at fetal end and placental end of the cord which should be useful for the surveillance of fetuses with repeated observations.>
Physiotherapy awareness among clinical doctors in Nepal
Authors: Acharya RS , Khadgi B , Shakya NR , Adhikari SP , Basnet SMS , Sharma S , Webb G. , Saleh Oraibi S
Published: July 2024

Introduction: Physiotherapy as a profession has come a long way over the years. As the treatment of injuries and illness has developed over the decades, the practice has evolved and grown from general forms of physical therapies to specialized physiotherapy services in healthcare settings. Despite the recognition and advances gained worldwide in physiotherapy, yet there is lack of research study in Nepal to evaluate the awareness of physiotherapy among clinical doctors of Nepal. Objective of this study is to investigate the awareness of physiotherapy among clinical doctors working in various hospitals of Nepal.
Methods: A cross sectional survey was conducted among the clinical doctors working in various hospitals of Nepal. A questionnaire was randomly distributed among 200 doctors. It comprised of 13 questions related to physiotherapy awareness. Data were collected and statistically analyzed.
Results: Among 115 respondents, 98.3% were aware of physiotherapy and 87.8 % of the doctors reported to have physiotherapy services in their hospital. Referral to physiotherapy was found to be 94.8 %. With respect to referrals to physiotherapy in preoperative cases, it was found that 63% of the clinical doctors agreed to refer their patients to physiotherapists. The study also found that 93% of the clinical doctors agreed to refer their patients to physiotherapy post-operatively. Referrals to ICU were agreed by 88% of the doctors involved in this study. Among the clinical doctors surveyed physiotherapy in orthopedic conditions has the maximum awareness (94.8%). The study found that a very small percent of the clinical doctors knew about physiotherapy education in Nepal (39.1%) and Nepal Physiotherapy Association (NEPTA) (33%).
Conclusions: The study concluded that the clinical doctors had a good awareness about physiotherapy profession. But awareness needs to be accelerated in terms of referrals and specialized services provided by the physiotherapists for potential benefits of the patients. Physiotherapists as a part of the health care team plays an essential role in reducing the hospital stay, quick recovery and in rehabilitation for a better quality life.
Rapid assessment of expansion of nursing, paramedical and public health education and itís implication on quality of education
Authors: Md. Talukder HK , Nazneen R. , Md. Hossian Z. , Akther N , Choudhary I J , Parvin I A
Published: July 2024

Introduction: Bangladesh is facing many challenges in health care that are similar to other developing countries. In Bangladesh standard of paramedical, nursing, pharmacy and public health education are expanding rapidly which needs to call for assessment and evaluation to be up to date in the respective fields. Study aims to assess the expansion of Nursing, Paramedical & Public health Education in Govt. & non Govt. sectors & it’s implication on quality of education.
Methods: This was a descriptive type of cross-sectional explorative study, conducted among the teachers and student of different institutes. Questionnaire was developed and a FGD was done. Then the data was analyzed.
Results: At present situation, the numbers of non govt. organizations are more than govt. organizations (127 vs. 85). SWOT analyses showed the overall strength of the institutions were the scope for further improvements and the political commitments for expansion. Weaknesses lie in the lack of adequate infrastructure, suboptimal technical and laboratory facilities and teaching staffs. Opportunities were, increasing demand and provision of jobs at home and abroad. Possible threats were loss of quality services, recognition and registration of the institutes. Regarding the overall organization of the courses, 43% of the students voted as good and 100% of the teachers showed positive opinion. Regarding the teaching-learning procedure, 41% of the teachers strongly agreed about the perfect selection of the students. 48.3% teachers agreed about the adequacy of the number of teachers. 47.8% students also agreed with the competency of the teachers. Nearly one third teachers as well as students agreed about the good physical environment of the institute. About 35% and 36% of the teachers and the students respectively agreed about the transparency of the assessment systems.
Conclusions: Present Bangladesh Govt. has implemented various initiatives regarding health sector reform. Proper funding, management, monitoring and evaluation can improve present situation and thus help in the development of better institutional output.
Giant cell tumor of patella
Authors: Paudel S , Kayastha P. , Pokharel P , Shah A , Ghimire RK , Ansari MA
Published: July 2024

Giant cell tumor of bone also known as osteoclastoma is a distinct clinical, roentgenographic and pathologic entity with specific characteristics. It is a benign but locally aggressive neoplasm of the epiphyseal or metaphyseal-epiphyseal region of long tubular bones extending to the articular surface. It usually occurs after skeletal maturation and is one of the rare bone tumors that more frequently affects women. We report here a case of giant cell tumor originating from the right patella diagnosed on fine needle aspiration cytology.
Assessment of stump invagination versus simple ligation in open appendicectomy
Authors: Khan S.
Published: July 2024

Introduction: Operation of appendix is very common abdominal surgery that is done by general surgeons. Some surgeon prefer to invaginate the appendix stump while others don’t. Aim of the study was to compare the technique of ligation and invagination of the appendix stump with simple ligation of the appendix stump during appendicectomy for acute appendicitis.
Methods: A prospective comparative study of 150 appendicectomies were done in the Department of General Surgery, Nepalgunj medical college (NGMC),Nepalgunj, Nepal from June 2001-May 2007in unit III. All patients with uncomplicated and complicated acute appendicitis who underwent open appendicectomy and had appendicular stump for ligation and invagination or simple ligation, were divided into two groups. In group-I ligation with invagination and in group-II, simple ligation of appendix stump was carried out. Patients were followed up for 3-6 months to check the development of complications.
Results: Both groups were similar with respect to age and sex. Invagination of the stump after ligation of the stump was done in 70 patients while simple ligation was done in 80 cases. The incidence of postoperative pyrexia (18.57% and 22.5%), wound infection (27.15% and 30.0%) and postoperative paralytic ileus (25.71% and 27.5%) was in group-I and group-II respectively.
Conclusions: Simple ligation of appendix stump is as safe a procedure as ligation and invagination of appendix stump during appendicectomy.
Emergence of penicillin resistant Neisseria gonorrhoeae.
Authors: Bhargava D , SAKYA B. , Mondel K.C , Rijal B.P.
Published: July 2024

Introduction: Since the beginning of the modern chemotherapeutic era, the treatment of gonorrhea has been dogged by the shifting antimicrobial susceptibility of Neisseria gonorrhoeae. Though penicillins have been recommended for treatment of gonorrhoeae, there have been reports of treatment failure with penicillins. In this study, we report the emergence of penicillin resistance N. gonorrhoeae and its antimicrobial susceptibility pattern.
Methods: Antibiotic sensitivity pattern of N. gonorrhoeae isolates from the male patients was determined by Kirby Bauer’s Disc Diffusion method. The zone size was interpreted according to the Zone size interpretative chart. β-lactamase production was detected by Paper iodometric method.
Results: A total of 30 isolates of N. gonorrhoeae were obtained from male patients with suspected acute gonococcal urethritis. Out of the 30 isolates, 18 (60.0%) were resistant to penicillin. Most of the penicillin resistant isolates were from the patients of age group 31 to 40 years (77.8%) followed by 21 to 30 years (53.3%) and 41 to 50 years (50.0%) (P>0.05). All isolates were sensitive to ceftriaxone. Similarly, 6 isolates were resistant to ciprofloxacin and 10 isolates were resistant to tetracycline. βlactamase producer isolates were 16 in number.
Conclusions: Penicillin resistant N. gonorrhoeae is on the rise in and around Birgunj. Thus, systematic surveillance of antibiotic sensitivity pattern of N. gonorrhoeae could be effective in detecting emergence of newly resistant strains before they become widespread in the community.
Endoscopic management of lower ureteric stone after ureterosigmoidostomy
Authors: KC H.B. , Chalise P.R. , Bhattarai A. , Sharma U.K. , Gyawali P. , Shrestha GK , Joshi BR
Published: July 2024

Ureterosigmoidostomy is one of the oldest technique for continent urinary diversion. Though less common nowadays, it is still a useful form of urinary diversion; simple to perform, offers good continence with minimal interference with life style. It still has a major role in conditions like ectopia vesicae and post-radical cystectomy for bladder carcinoma. We present a case of 33 years lady who underwent ureterosigmoidostomy at the age of 10 years for ectopia vesicae and later developed left pyonephrosis due to distal ureteric calculus. Left sided PCN was done and successful antegrade endoscopic removal of calculus relieved her symptoms.
Profile of unaccompanied, unconscious patients in the emergency department
Authors: Singh D.P , Acharya R.P , Singh S.
Published: July 2024

Introduction: The burden of unknown and unconscious patient is a common challenge to provide medical care in the emergency department of the hospitals. As the social security systems like insurance does not exist and poverty is rampant, it will continue in the future too. In this context this study is an attempt to analyze the morbidity & mortality as well as the types of illness, causes of unconsciousness and the source of unconsciousness in these patients without any identity.
Methods: A retrospective analysis of the unaccompanied, unconscious patients attending the emergency department of Bir hospital during the Nepali year 2066 Bikram Sambat (14 April 2009 to 13 April 2010) was carried out. Results: Two-thirds of these patients were brought to hospital by the police. The next category (20%) were brought by unknown person and left without any information.
Conclusions: Use of the type of substance and their nature remains unclear and there is a need to develop a trend to identify these substances so that specific treatment and hence preventive measures can be implemented effectively.
Role of tiotropium in chronic obstructive pulmonary disease exacerbation
Authors: Pant P , Yadav B , Koju R , Gurung R. , Pokharel B. , Bedi T.R.S. , Adhikari R.K.
Published: July 2024

Introduction: Chronic obstructive pulmonary disease (COPD) remains a major public health problem. Many patients suffering from chronic obstructive lungs diseases are of poor economic status, mostly illiterate, therefore has a direct bearing on patient compliance. Tiotropium is a new anticholinergic therapy for chronic obstructive pulmonary disease that differs from ipratropium by its functional relative selectively for musarinic receptor subtypes and which allows single dosing a day. This study presents a cost-effectiveness, efficacy, and side-effects of Ipratropium bromide and Tiotropium in COPD.
Methods: Prospective study was conducted In Kathmandu University Teaching Hospital, between the year 2008 and 2009 in terms of cost-effectiveness, efficacy, and side-effects of Tiotropium and Ipratropium amongst COPD patients.
Results: Tiotropium and Ipratropium were prescribed in total of 57 patients (30 in ipratropium bromide and 27 in tiotropium bromide) for the management of COPD among outpatients. There were no significant differences in age, height, weight and baseline lung function parameters (FEV1 and PEF) between the two drugs i.e. ipratropium bromide and tiotropium bromide. Significant improvement in lung function parameters were found in each respective group of drugs after bronchodilator therapy. Tiotropium results in significant reduction of Chronic Obstructive Pulmonary disease exacerbations and significant improvement in quality of life, lung function, and dyspnoea compared to ipratropium. The additional cost to achieve these favorable outcomes was cheaper than Ipratropium bromide. (Nepalese Rs. 7.03 per day for tiotropium as compared to Rs. 9.06 for Ipratropium)
Conclusions: Tiotropium results in significant reduction of chronic obstructive pulmonary disease exacerbations and significant improvement in quality of life, lung function and dyspnoea compared to Ipratropium.
Bilobar agenesis of thyroid gland with hypertrophied isthmus
Authors: Sharma P. , KARKI B. , Gautam Ghimire P. , Shrestha M , Ghimire A , PathaK A.
Published: July 2024

Bilobar agenesis of thyroid gland is a rare presentation of thyroid gland. Here we report an 18 years male presenting with history of midline swelling in the neck. Ultrasonography and CT neck revealed bilateral agenesis of thyroid gland with hypertrophied isthmus.
Future Emerging Issues in waterborne diseases and microbial agent
Authors: Sherchand J B
Published: July 2024

N\A
Chlorhexidine cleansing of the umbilical cord in Nepal: leading by example and saving lives
Authors: Luke C. Mullany
Published: July 2024

N/A
Australian Public Health Initiatives to control Tobacco Smoking
Authors: Gartoulla RP
Published: July 2024

Introduction: Public health is a complete mental, physical, social and spiritual wellbeing of the human population. The term 'Public' denotes the meaning of both biotic and abiotic universe; 'Health' is the comprehensiveness of life; and "Public Health' means health related to the human population. Tobacco smoking is a universal public health problem and it is first reached Australian shores when it was introduced to northern-dwelling Indigenous communities.
Methods: Literature review (documents, web pages, Google, pamphlets, posters, books, journals, legal issues, etc)
Results: In Australia and many other countries, smoking behavior is inversely related to socioeconomic status, with disadvantaged groups in the population being more likely to take up and continue smoking. The Australian Government is committed to reducing the consumption of tobacco among all Australians. To achieve this, the Government has funded targeted public awareness campaigns, made changes to legislation, including banning smoking in enclosed public places, and provided grants for innovative approaches to help reduce tobacco consumption in communities with a high smoking prevalence. The South Australian Tobacco Control Strategy 2005-2010 has been developed to further guide the direction of tobacco control initiatives in this state.
Conclusion: Regular surveillance and monitoring of various cancer control initiatives and strategies require tracking of different prevention, screening and treatment modalities, risk factor reduction, and premature mortality. In Australia, cancer is a notifiable disease and all States and Territories have established registries to collect data on cancer incidence and mortality. The Australian Bureau of Statistics and other national agencies through a variety of surveys generate information on some of the major risk factors such as tobacco smoking and excessive alcohol consumption. The government ventures to reduce smoking is effective, even though it has becoming a threat for aetiology of different diseases due to use of tobacco, low immunity and lowering the age of the users.
Modified Altissimi and Mancini technique for carpal tunnel decompression
Authors: Sigdel A , Uprety S , Govind K.C.
Published: July 2024

Introduction: Carpal tunnel syndrome is the commonest compressive peripheral nerve neuropathy; open carpal tunnel decompression still remains the preferred method as a day case procedure using local anaesthesia. The local anaesthetic is commonly administered by subcutaneous infiltration alone (the Gale technique) or by infiltration of the local anaesthetic into the carpal tunnel in addition to the subcutaneous infiltration (the Altissimi and Mancini technique). The purpose of this study was to evaluate the efficacy of the modified Altissimi and Mancini technique of local anesthesia.
Methods: Fourteen hands of twelve patients age ranged from 26 to 55 years, two patients with bilateral involvements were recruited. Most involved hand was operated first with the modified Altissimi and Mancini technique of local anaesthesia.
Results: Intra-operative pain was evaluated using visual analog score. Patients experienced no to very little intra-operative pain VAS 0- 2. Only one patient experienced tourniquet discomfort which subsided after release. There was neither any intra-operative nor during follow up, the signs of iatrogenic median nerve injury.
Conclusion: We concluded that open carpal tunnel decompression using modified Altissimi and Mancini technique under local anaesthesia and with tourniquet control is a safe, effective and acceptable novel technique.
Policy Making Challenges on Dual Burden of Environment Related Diseases
Authors: Sherchand Jeevan B.
Published: July 2024

N/A
Assessment of Quality of Life of People Living with HIV and AIDS Receiving Anti-Retroviral Therapy in Kathmandu Valley
Authors: Acharya DK
Published: July 2024

Introduction: Quality of Life (QOL) of people living with HIV and AIDS is a great concern. The impact of HIV on QOL falls under four major domains referred to as physical, psychological, social and environment domain. The objective of this study was to assess the quality of life of people living with HIV and AIDS taking antiretroviral therapy and its association with socio demographic and disease related variables.
Methods: Descriptive cross sectional study design was used. 128 randomly selected participants enrolled at Tribhuwan University Teaching Hospital (TUTH) ART center above 15 years were interviewed. QOL was evaluated using the World Health Organization Quality of Life (WHOQOL) Bref instrument. Data was entered in Epi Data and analyzed using SPSS version 16.
Results: The median scores with interquartile range (IQR) in four domains of QOL was highest in social domain i.e. 69 (56 to 75) and lowest in psychological domain i.e. 56 (50 to 69). All the domains were positively correlated with the overall QOL with Spearman’s rho ranging from .31 to .63. Strongest correlation was observed between psychological domain and overall QOL. Age, sex and marital status were significantly associated with the overall QOL whereas level of education and disease related variables i.e. CD4 counts and WHO clinical stage have no significant association with overall QOL.
Conclusion: The study concludes the need for psychological support and community based interventions for PLHIV and AIDS to enhance their QOL. Social support to women living with HIV and AIDs is also required to help them better cope with the disease.
A comparison of Success of autologous Blood Patching in Sealing of Bronchopleural Fistula of Primary and Secondary Spontaneous Onset.
Authors: Thapa B , Sapkota R , Sayami P
Published: July 2024

Introduction: Autologous Blood patching (ABP) has been used to treat Broncho pleural fistula in spontaneous pneumothorax with varying success. We evaluated the safety and efficacy of ABP when used in patients with primary (PSP) versus secondary (SSP) spontaneous pneumothorax.
Methods: All patients with spontaneous pneumothorax with no evidence of pleural infection and in whom the air leak did not subside despite 48 hours of conservative management were included. A CT scan was done to categorize if there was underlying lung disease and classify patients into primary and secondary spontaneous categories. These patients underwent blood patching in one to three episodes in 50ml aliquots. Comparisons of the demographic profile, smoking status, success rate and complications in these two groups were done.
Results: Between July 2012 and January 2014, 76 patients underwent ABP. The overall success rate of ABP was 58%. There were 29 patients who were classified as PSP and 47 with SSP. There was no difference in the sex distribution but patients with PSP were younger (P= 0.00), were more likely to present earlier (P=0.04) and had higher rates of residual pneumothorax (P= 0.05) after chest tube insertion. The success rates in the two groups were similar (P=0.76).The rate of complications was low and not different in the two types (P=0.58).
Conclusion: ABP has modest success in sealing air leak of spontaneous onset. We found the success and complication rates in the two types of spontaneous pneumothoracesto be equivalent
Does Stone Culture Predict Systemic Inflammatory Response after Percutaneous Nephrolithotomy?
Authors: Luitel BR , Chalise PR , Gyawali PR , Sharma UK , Shrestha GK , Joshi BR
Published: July 2024

Introduction: Systemic inflammatory response syndrome (SIRS) is a common and important complication after percutaneous nephrolithotomy (PNL). This study was carried out with the objective of finding out the association between stone culture and PostPNL- SIRS.
Methods: A prospective study was done in the urology unit, Tribhuvan University Teaching Hospital from July 2009 to June 2011. Preoperative midstream urine, intraoperative pelvic urine and stone fragments were sent for culture in all patients undergoing PNL. The primary outcome was SIRS on second postoperative day. Data analysis was done using Statistical Package for Social Sciences (SPSS) 17.0 version.
Results: Out of 47 patients 22 (46.8%) patients developed SIRS on second postoperative day. Stone and pelvic urine culture positivity rate was 8(17%) and 6(12.8%) respectively with P. aeruginosa E. coli and Proteus spp being the common organisms isolated, most of which were sensitive to amikacin. Positive stone culture was the significant risk factor for SIRS (P=0.018).
Conclusion: Positive stone culture is an important risk factor for SIRS after PNL. Routine stone culture is beneficial in patients undergoing PNL for the subsequent postoperative management.
Human Resources for Health (HRH) and challenges in Nepal
Authors: Sherchand JB
Published: July 2024

N/A
Comparison of Blood Culture and Single Slide Agglutination Widal Test for the Diagnosis of Enteric Fever
Authors: Shrestha D , Kalakheti U , Shrestha M , Shrestha S , Shrestha P , Acharya J
Published: July 2024

Introduction: Enteric fever is a leading cause of mortality and morbidity in the developing world. Unawareness of public concerning the sanitation & hygiene led to the high prevalence of the disease.
Methods: Blood sample of patients suspecting enteric fever attending STIDH of all age group were collected & simultaneously data on pre-disposing factors associated with systemic febrile illness were collected according to the questionnaire designated. The collected blood samples were brought immediately to the laboratory. Upon arrival, the blood samples were processed for blood culture and single slide agglutination Widal test according to the standard laboratory methods.
Results: Of the total 237 cases, 13 (5.48%) were confirmed as enteric fever by blood culture with 5 (38.46%) Salmonella enterica serovar Typhi and 8 (61.54%) Salmonella enterica serovar Paratyphi A. Out of the total cases, 7 (2.95%) were positive for blood culture as well as Widal test.
At the serum titre of 1:80, Widal test showed the sensitivity of 28.57% and specificity of 73.56% for O antigen whereas sensitivity of 71.42% and specificity of 61.36% for H antigen. PPVs for the test were quite low with 8% for O antigen, 12.82% for H antigen and 12.5% for AH antigen. NPVs were 92.75% for O antigen, 96.42% for H antigen and 95.08% for AH antigen. Most of the culture confirmed cases, 9 (69.23%) were positive in the 1st week of onset of fever and most of the widal positive cases, 49(51.57%) were positive in the 2nd week of onset of fever.
Conclusion: Single slide Widal test of titre value ≥ 1:160 was found to be useful tool for diagnosis of enteric fever but the results should be corelated with clinical findings.
Empirical use of antibiotics in Emergency Department of Tribhuvan University Teaching Hospital and Treatment Success Rate in Discharged Patients
Authors: Joshi D , Bhandari S , Upreti AR , Banjara MR , Regmi BM , Prasad PN
Published: July 2024

Introduction: Infectious diseases are the common presentation in emergency department, which require treatment within minutes. As a result, the empirical antibiotics are started prompt in emergency department before the bacteriological results are available. Therefore, the aim of this study was to explore the use of antibiotics at emergency room and to determine the success rate in discharged patients.
Methods: A descriptive, exploratory, non-interventional study was conducted during 8 weeks among the discharged patients from emergency department who received the antibiotic therapy and culture/ sensitivity test was asked. Patients were followed from emergency room and adequate information was taken from emergency records and also at the time of outpatient department visit.
Results: Out of 297 patients, only 179 patients were studied. We found that 75.1% of empirically prescribed antibiotics were oral. The most commonly administered intravenous and oral antibiotics were ceftriaxone (20.4%) and cefixime (17.0%). The most common isolate leading to emergency department visit was Escherichia coli (29 patients, 16.2%). In vitro sensitive test for gram positive and gram negative isolates, amoxicillin-clavulanate combination and ciprofloxacin were most effective and cefixime was the least effective antibiotic. The treatment success rate was found to be 147(82.1%) of the patients, as the medication prescribed at emergency room was continued by outpatient department physician.
Conclusion: Quinolones and cephalosporins groups of antibiotics are rising as the determinant antibiotics at emergency room. The rate of appropriate use of antibiotics and treatment success rate were found to be higher.
Patients’ Perception towards Post Operative Pain Management in a Tertiary Hospital
Authors: Shrestha K D
Published: July 2024

Introduction: Severity of post operative pain is one of the primary factors that determine the impact of pain on a person’s overall function and sense of wellbeing. Despite increase focus on pain management, introduction of new strategy, guideline sand educational efforts, many studies reveals inadequate post operative pain management and patients were suffering from severe to intolerable pain. In this study, patients’ perception regarding post operative pain management was assessed.
Methods: A descriptive explorative study was carried out in Tribhuvan University Teaching Hospital. The sample size was estimated based on 80% prevalence. Data were collected through purposive sampling technique from 100 respondents using American Pain Society Patient Outcome Questionnaire (APS-POQ) through interview method and reviewing the record.
Results: The study revealed that respondant's pain intensity on first post operative day was  severe to worst, the mean score was 7.0 (2.12) than intensity on second post operative day i.e moderate to severe, mean score was 4.39 (1.56). It was associated with education and waiting time for pain medicine. Pain in past 24 hours had interfered during deep breathing and coughing exercise. Sixty five percent respondents were fully satisfied in overall pain treatment. Respondents perceived on use of prescribed pain medicine and communication in terms of pre and post operative counseling of patients will be helpful for reducing post operative pain most effectively.
Conclusion: More than half of the respondents were satisfied with post operative pain management but severity was worst in first post operative day which was affected by  education status and waiting time for pain medicine.