bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagonstic dilemma in cases of ectopic pregnancy: a five year prospective study at Tribhuvan University Teaching Hospital
Authors: Gurung G. , Rana A.
Published: July 2024

Objective: To determine the incidence of ectopic pregnancy in Tribhuvan University Teaching Hospital (TUTH) and to find out the atypical presentations of ectopic pregnancy that had lead difficulties in diagnosing the cases of ectopic pregnancy leading to increase morbidity.
Study design: It is a prospective, descriptive study done in the Dept. of Obstetrices / Gynaecology, TUTH, during the period of Baisakh 2057 – Chaitra 2061 (April 2001-April 2005).
Results: There were total of 174 cases of ectopic pregnancy during the period of five years accounting 1.15 % of all deliveries. Majority of them were multipara (P2-3)39.5 %. Among the 174 women 48.9% carried the risk factors. The commonest risk factor being secondary subfertility (25.9%) followed by history of dilatation &curettage (D & C) (18.5%) and reversal of tubal ligation (17.6%). Not all the patients had the classic triad of ectopic pregnancy (98.9% had pain, 70.7% had amenorrhea and only 58% had bleeding). Only 20% presented with syncope (the typical symptom of ruptured ectopic pregnancy). The condition was confirmed by USG in 82%. Urinary human chorionic gonadotrophin (hCG) was present in 97.1 %. Mild anaemia (8-10gm% Hb) was present in 46.6% cases where as only 4% had severe anaemia <6gm. Among these anaemic patients 60% needed blood transfusion. Twenty five (14.3%) out of 174 cases had presented with atypical symptoms resulting difficulty in diagnosis (8 cases confused with GI disorders and 17 cases with gynecological disorders).
Conclusion: USG and urinary hCG are not confirmatory diagnostic tools in all cases of ectopic pregnancies. For that serum hCG and diagnostic laparoscopy should be included to improve in the management of ectopic pregnancy.
Disease patterns among hospitalized elderly at TUTH
Authors: Joshi S. , Sharma S.P , C. T.K.
Published: July 2024

Intrduction: A descriptive study was carried out to assess the disease patterns among the elderly patients admitted at TUTH from 2061/4/1 to 2062/3/31. Secondary data were collected from the admission record; the total admissions were 16,947. Out of the total admission 19.2 % patientsbelonged to elderly from 60 years and above, and 59 % were male. Among them, majorities were young elderly (< 75 years) while rests of others were late elderly (> 85 years).
Results: The findings revealed that majority of them were suffering from diseases related to respiratory, cardiac and digestive system, followed by cerebro vascular accident and neoplasmic diseases. Further analysis revealed that among the hospitalized elderly, 53 % were suffering from medical problems and 21 % had surgical problems; while 15 %, 5.8 %, and 5 6 % had problems related to ENT, gynecology, and ophthalmic respectively. Gender based analysis revealed that respiratory (chronic obstructive pulmonary disease, chest infections including pneumonia) and cardiac problems (ischemic heart diseases including hypertension) were the common diseases among both genders. While diseases related to digestive system among female (cholecystitis / cholelithiasis, diabetes mellitus) and malignant neoplasm among male were the third commonest diseases. As gender differences is obvious in the hospitalization rate as well as in the prevalence of some of the diseases, specific care need to be given to improve health and to prevent further complications from the existing diseases.
Conclusion: A prudent life style and exercise behaviors need to be enforced to promote healthyaging. It should be our shared responsibility to encourage the elderly to be healthy by adopting the principles of “Healthy Aging / Aging Well".
Lower segment large myoma complicating pregnancy: a case report
Authors: Sharma P. , Gurung G. , Amatya A. , Rana A.
Published: July 2024

Background: Uterine myoma is becoming a common problem during pregnancy as the age at first pregnancy is seen in the increasing age and low parity.
Case report: We have encountered a 33 years old primigravida whose cervical myoma was detected during pregnancy and was confirmed at the time of emergency caesarean at term. She was found out to have cervical myoma during the operation
Study of risk factors for human Immunodeficiency virus transmission among seropositive cases
Authors: Acharya B. , Dhungel K.U. , Easow J.M , Singh Y.L
Published: July 2024

Background:Infections with Human Immunodeficiency Virus (HIV) are being increasingly reported ever since it was shown to be the cause of Acquired Immunodeficiency Syndrome (AIDS) in 1984. Knowledge of risk group / risk factors helps in taking effective interventions to reduce the spread of HIV cases.
Methods: This study is an attempt to find out the risk groups / risk factors for HIV infection among the patients who attended the clinics of Manipal Teaching Hospital, Pokhara, Nepal.
Result: Out of 681 HIV suspected cases, 54 were found to be HIV seropositive, among them 76% were male and 24% were female (male: female ratio being 3.15:1). The age group between 30 and 39 had the highest number of HIV seropositive cases. The HIV seropositive cases were further classified into different risk groups such as Intravenous drug users (IVDUS).
Conclusion: Housewives, high-risk behavior, Nepali mercenaries, children and blood transfusion; IVDUS (33.33%) was found to be the major risk group.
An association of inguinal and pelvic hernia
Authors: Rana A. , Gurung G. , Mishra P.
Published: July 2024

Background: An association of inguinal hernia and pelvic hernia (uterovaginal prolapse) documented for the first time establishes the myth of the age old teaching that pelvic organ prolapse could be related to other weakness of the other body muscles thus indicating pursuance of traditional teachings that consists in looking for hernial orifices during examination of prolapse.
Comparison between the conventional methods and Glasgow Benefit Plot in evaluating subjective hearing results after myringoplasty
Authors: Rayamajhi P , Bhattarai H. , Sinha B.K. , Shrivastav R.P
Published: July 2024

Background: To compare the Conventional methods with Glasgow Benefit Plot in evaluating subjective hearing results after myringoplasty.
Materials and Methods: Patients above 17 years of age with the diagnosis of Chronic Suppurative Otitis Media-tubotympanic type undergoing Myringoplasty at TU Teaching Hospital from January 2004 to July 2005 were included in the study. The pre and postoperative Pure Tone Audiometry (PTA) was performed and evaluated. The postoperative subjective hearing status of the patients was recorded as improved, same or worsened. Objectively, the postoperative hearing was assessed in terms of Air Bone Gap closure, Air Conduction Threshold improvement and Glasgow Benefit Plot. The objective methods were then compared with the postoperative subjective hearing status of the patients.
Results: The association between the Air Bone gap closure and the postoperative subjective hearing status was not statistically significant. The association between the Air Conduction threshold improvement and the postoperative subjective hearing status was statistically significant. The association between the Glasgow Benefit Plot and the postoperative subjective hearing status was also statistically significant.
Conclusion: The study showed that the Air Conduction threshold improvement and the Glasgow Benefit plot are better parameters for evaluating subjective hearing results after myringoplasty than the Air Bone gap closure
Effectiveness of episiotomy in preventing third and fourth degree perineal tear
Authors: Devkota A.R. , Rana A. , Gurung G. , Amatya A.
Published: July 2024

Background: To verify effectiveness of episiotomy in preventing third and fourth degree perineal tear.
Materials and Methods: Retrospective analysis of obstetric variables in 30 women who had sustained third and fourth degree perineal tear, compared with remaining 9632 vaginal deliveries during the same period. Obstetric department of Tribhuwan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal. This study identified 9662 vaginal deliveries over 42 months period from April 2003 to October 2006 from obstetric records. Thirty cases who sustained third and fourth degree perineal tear were further analyzed.
Results: Overall rate of third and fourth degree perineal tear was 0.22% (n=21) and 0.09% (n=9), respectively. Episiotomy was given to 49.0% (n=4250) of the total vaginal delivery that occurred during that period. Among women who were given episiotomy 0.42% (n=18) had severe degree perineal tear. Among women who were not given episiotomy 0.22% (n=12) had severe degree perineal tear. Among cases who had severe degree perineal tear 76.7% (n=23) were primi, compared to 23.3% multipara. Women who had sustained third degree perineal tear had slightly smaller babies of average birth weight 3.22 kg compared to 3.31 kg in those who had fourth degree tear. Post dated delivery occurred in 46.7% (n=14) cases. 15.4% (n=4) cases were induced with prostaglandins and 46.2% (n=12) were augmented with syntocinon. Forceps was used in 3.33% (n=1) and vacuum was used in 10.0% (n=3) cases.
Conclusion: Severe degree perineal tear occurred in almost double cases who were epitomized than those who were not. Large birth weight of baby, primiparity, postdated delivery and instrumentation were related to severe degree perineal tear.
Accuracy of otoscopy, tympanic membrance mobility and tympanometry in the diagnosis of otitis media with effusion
Authors: KC S. , Guragain R.P.S , Sinha B.K.
Published: July 2024

Background: To determine the accuracy of otoscopy, pneumatic otoscopy and tympanometry inthe diagnosis of otitis media with effusion.
Materials and Methods: A total of 71 patients (121 ears) suffering from Otitis Media with Effusion (OME) diagnosed clinically were subjected to myringotomy and ventilation tube insertion (VTI). The finding of presence of fluid in middle ear after myringotomy was correlated with Tympanic Membrane (TM) color, fluid level, air bubble, TM mobility and tympanometric curve recorded preoperatively.
Results: Otoscopic findings revealed pink TM in 78.5%, prominent landmarks in 98.3%, generalized retraction 73.6%, fluid level in 14% and air bubble in 2.5% of cases. On pneumatic otoscopy, decreased or absent mobility was found in 85.1%. Tympanometry with ‘B’ curve was the most sensitive finding(98.9%), whereas pneumatic otoscopy was found to be the most specific amongst all the three tools. Combination of tympanometry with either otoscopy or pneumatic otoscopy or combination of allthree modalities was found to be highly significant .
Conclusion: Tympanometry is the most sensitive tool for the diagnosis of OME and combination of tympanometry with either otoscopy or pneumatic otoscopy is highly significant.
Branchio-Oto-Renal (BOR) Syndrome-an uncommon form of congenital deafness
Authors: Koirala K. , Guragain R.P.S , Bhusal C.L
Published: July 2024

Case report: Children with congenital deafness are common referrals to the Pediatric Otolaryngology unit of the Teaching Hospital. Branchio-Oto-Renal (BOR) Syndrome, an autosomal dominant syndromic form of deafness presents variably with the presence of auricular or preauricular pits in association with hearing loss, branchial sinuses and renal abnormalities ranging from renal hypoplasia to agenesis. Renal manifestations are least common and mostly missed. The present case report highlights a case of Branchio-Oto-Renal syndrome detected at the age of 5 years with unilateral renal agenesis and normal renal function
Use of an educational DVD to explore the problem of irrational use of medicines
Authors: Shankar P.R. , Mishra P. , De. A. , Sinha A.
Published: July 2024

Background: Orienting undergraduate students to the concept of rational prescribing is an important strategy for promoting rational use of medicines. The video ‘Tiim’ deals with street-sold medicines in Burkina Faso, a country in West Africa. The objectives of the study were to:
a) Use the video as a platform to explore medicines use problemsb) Obtain student opinion about the sessions andc) Note the association of the opinion with the respondents’ demographic characteristics.
Materials and Methods: The exercise was carried out during the practical session in Pharmacology. The students were divided into groups of 7 or 8 students each and were give a set of problems. After 45 minutes the groups presented their solutions, followed by discussion and comments from the facilitators. Student feedback was collected using a structured questionnaire. Demographic information was collected and the students were asked to indicate their agreement with a set of seven statements using a modified Likert type scale. The median total score was compared among different subgroups.
Results: Fifty-eight of the 68 third semester and 72 of the 73 fourth semester students participated. Sixty-three of the 120 students (52.5%) were male. Indians, Nepalese and Sri Lankans were the major nationalities. The median total score was 24. No significant difference in the median total score wasseen among different subgroups.
Conclusion: The students were of the opinion that the situation depicted in the video is similar to that existing in South Asia and appreciated the session. The concept of rational use of medicines was reemphasized among future primary care physicians.
Controversies in acute pancreatitis
Authors: Khakurel M.
Published: July 2024

N/A
Mortality in a second gravida following dissecting aortic aneurysm due to Takayasu’s Arteritis
Authors: Rawal S.
Published: July 2024

Takayasu’s arteritis is a vasculitis involving the aorta and its branches. This is a case of undiagnosed Takayasu’s arteritis in a 32 weeks pregnant lady, who presented to the emergency department with complaints of severe chest and epigastric pain and signs consistent with aortic aneurysm. The woman died of aortic dissection two days later.
Abortions induced by inserting wooden stick
Authors: Pant P.R. , Sharma J. , Mananandher B.I , Sharma N.R. , Shrestha R.
Published: July 2024

Background: Nepal suffers from one of the highest maternal mortality rate in the world, and the practice of unsafe abortion is responsible for more than 50% of these maternal deaths. Before legalization of abortion in2002 though it was criminal act under any circumstances thousands of abortions were done illegally in the country by expert doctors to peon by different methods. Complications of abortions depend upon gestational age, service provider, method, place of abortion. According to a nationwide survey done by CREHPA in 1997 revealed that 20% of the women prisoners against 0.3 men prisoners were there for charge of abortion or infanticide. According to Measham maternal mortality is highest in cases when the abortion is done by foreign objects in to the uterine cavity.
Prevalence of chronic suppurative otitis media in school children of Kathmandu district
Authors: Adhikari P. , Sinha B.K. , Pokharel N.R. , Kharel B. , Aryal R. , Ma J.
Published: July 2024

Background: Chronic suppurative otitis media is a major health problem throughout the world in developing countries including Nepal. This study was carried out to find the prevalence of chronic suppurative otitis media (CSOM) among school going children of Kathmandu district.Methods: This is a prospective cross sectional study among 1070 school children aged between 5 - 12 years. Students were randomly selected from four different schools of Kathmandu district. All these students were interviewed and examined otoscopically from November 2006 to January 2007. Data were analyzed statistically.Results: Results showed that 5.4% of the children had CSOM. Unilateral disease was seen in 79.3% and 96.5% had a tubotympanic disease. Around 24.1% had active disease, 65.4% used unhygienicand risky materials to clean their ears. There were 10.3% students  having CSOM who did not receive any treatment. More than half were treated by paramedics.Conclusion:The prevalence of CSOM among school children in Kathmandu district is lower as compared to rural areas of Nepal. This might be due to the improvement of health care facilities or due to increase in the use of antimicrobials in Kathmandu. Awareness for school children as well as parents through health education is in need to reduce the prevalence of CSOM.
Association of systemic diseases with sudden sensorineural hearing loss
Authors: Nepal M K , Rayamajhi P. , Thapa N. , Bhattarai H. , Shrivastav R.P
Published: July 2024

Background: To find out the association of systemic diseases with sudden sensorineural hearing loss and to observe the effect of high dose intravenous steroid in its management.
Methods: All patients admitted with sudden sensorineural hearing loss in the department of ENT & Head and Neck Surgery, T. U. Teaching hospital from January 2002 to January 2005 were studied prospectively. Association with any systemic illnesses were noted. High dose steroid intravenously was given for treatment and hearing improvement was assessed by pure tone audiometry.
Results: A total of 46 patients were enrolled in the study, 21 of whom had systemic diseases. Predominant systemic disease was diabetes mellitus which was present in 16 patients. After steroid therapy, 13 patient is hearing returned to normal, 13 had improvement in hearing, 16 had no improvement and 4 had their hearing deteriorated.
Conclusion: Approximately 45.7% of the patients with sudden sensorineural hearing loss had associated systemic diseases. Only 28.3% of the patient recovered to normal hearing though another 28.3% had improvement in hearing after the high dose steroid therapy.
Community health programmes for health promotion in rural community of Nepal
Authors: Rosyara K.P. , Malla B.
Published: July 2024

Introduction: Community-based health programme is one of oldest multidisciplinary programme which effect lives of individuals in the community. These programmes in community settings are implemented to promote reproductive health, to prevent unintended pregnancy and to promote access to reproductive and preventive health services and beside that these programmes have been working to provide immunization vaccine, sexual transmission infections, community health education, community sanitarily systems, awareness regarding safe drinking water.
Objectives: to identify the community health programmes which has been accessed in rural and peripheral residential area of Kirtipur Municipality Machhegaun, Kathmandu.
Materials and Methods: An exploratory research design was followed with the help of semistructured questionnaire and information was obtained from the pre-selected area. A household survey was done by door-to-door visit. A total of eighty females were included in the study and the respondents attitude was studied. The study was conducted during the month of May to June 2007. The questionnaire was pre tested among ten females and their responses were not included in the final analysis.
Results: Thirty seven females out of the eighty respondents were taken from nuclear family and rest forty three were from joint family. Further more in demographic variables showed most of respondents were in agriculture, which covers sixty five percentages. Other twenty five percentages were engaged in other fields, such as business, service daily wages etc. Hundred percentages of the respondents were covered by vaccines and fifty percentages females used permanent family planning and only 21.25 percentages used temporary family planning tools. But 28.75 percentages women did not use family planning tools. Majority of females got their first child between the age 20 to 39 year and rest 18.75 percentages got below 20 years and 25 percentages got above 40 years.
Conclusion: The respondents opinion was positive and, community health programmes were playing vital role in the community to promote health status of the people. The respondents felt that there was an unfair advantage of community health programmes lunched in the area and Government, non government health institute and private medical service providers were playing leading role to change people to healthy behavior.
Pyoperitoneum associated with uterovaginal prolapse in two elderly women
Authors: Pradhan N. , Rana A. , Gurung G. , Zaffar S.
Published: July 2024

Case report: Incarcerated uterovaginal prolapse due to pelvic and peritoneal abscess (pyoperitoneum) which at initial laparotomy was insufficiently dealt due to plastered peritoneum and dense pelvic adhesion, just by means of peritoneal lavage alone in one case and subtotal hysterectomy in the other and were wisely operated at a later date, removing uterus and bilateral adnexal mass at abdominal hysterectomy and bilateral salphingo-oophorectomy or removal of prolapsed cervix, that included the safety of surgical procedure is highlighted
Pattern of poisoning cases in a teaching hospital in Western Nepal
Authors: Kishore P.V. , Palaian S. , Paudel R. , Mishra D. , Ojha P. , Alam K. , Mishra P.
Published: July 2024

Introduction: Poisoning is a common problem in Nepal. Data from the Western region of Nepal are lacking. The present study analyzed the clinical profile and the management pattern of poisoning cases admitted to the Manipal Teaching Hospital (MTH).
Methods: The poisoning cases treated at Manipal Teaching Hospital from January 2003 to June 2006 were studied.
Results: A total of 98 poisoning cases (0.51% of Emergency department admissions) were treated (female 54.08 %) and age group 21-40 years (44.90 %). Nearly one third (32.65%) reached the hospital with in two hours of poison consumption. The median (interquartile range) duration of the hospital stay was 4 (2) days. The poisoning was intentional in 79.59% cases. The route of exposure was mainly oral (96.94%). Rat poison was the commonest poison (31.68%) followed by drugs (22.77%). Majority (83.67%) received symptomatic treatment. Secondary complications were observed in 28.57% and the overall fatality rate was 18.37%. Rat poison was responsible for 5 deaths. Nearly two thirds (65.31%) of the total cases received psychological counseling.
Conclusion: Similar studies covering different hospitals conducted over a long period are needed to confirm our findings.
Congenital anomalies in the rural areas of Kolar District of Karnataka
Authors: Bilodi A.K.S , Gangadhar M.R
Published: July 2024

Introduction: Congenital Anomalies are the birth defects which may be morphological, biochemical or behavior of all births that has been induced during any stages of pregnancy .
Materials and Methods: The objective of the present study is to know the various types of Anomalies the percentages of incidences of Anomalies and to compare and correlate the present study with available literatures. R.L. Jallappa Teaching Hospital of Sri Devraj Urs Medical College, Tamaka, Kolar Karnataka from15.02.2007-15.07.2007-Five Months Study.
Results: Sixty anomalies were observed in live births in the Departments of Surgery and fifteen anomalies in Radiology in the above hospital. The age group of malformations were new born to adult age group. They were seen found 73.00% in males and 27% in females. The overall percentages of incidences of Anomalies in the present study were 2.17%. This study was later compared and correlated with earlier workers and with the available literatures.
Conclusion: Ultrasound can diagnose most of the congenital anomalies
Epidural steroid for low back pain in pain management clinic
Authors: Pradhan B. , Marahatta M.N. , Amatya R.
Published: July 2024

Background: Epidural steroid injection for chronic low back pain is the most common procedure performed in the pain management clinics. This study was conducted to evaluate the efficacy of epidural steroid injection for various causes of low back pain in the patients attending pain management clinic (PMC) of this institute.
Methods: This is a prospective observational study of the patients attending in pain management clinic with the complaints of low back pain in the year 2007. All the patients who were treated with the epidural steroid injections were enrolled in the study. Data regarding the age of the patients, frequency of steroid injections, outcome of the procedure and complications if any were noted.
Results: Majority of the patients attending the PMC complained of low back pain. (Table 1) Among them 74% of the patients had prolapsed intervertebral disc. Among these, 97 patients received epidural steroid injections, among which 34 (35%) patients received single dose only whereas 38 (39%) and 25 (26%) patients received second and third dose of steroid. Among the patients who received epidural steroid, 50 (51%) had significant relief of the symptoms and signs, whereas 18 (19%) patients had moderate relief, 8 (8%) patients had no relief and follow up (FU) was lost in 22 patients (22%).
Conclusion: It is concluded that the interlaminar epidural steroid injection for lumbar radicular pain is an effective method of treatment
Antibacterial activities of locally used toothpastes against dental pathogens
Authors: Tiwari K.B , Shrestha U.T. , Acharya A. , Subedi B. , Paudyal B. , Jnawali M. , SAKYA P. , KC U. , Agrawal V.P
Published: July 2024

Background: Toothpastes need to contain various antimicrobial agents in order to reduce, control and prevent different kinds of dental diseases. Different brands have their own composition and concentration of ingredients for their efficacy. The consumers should aware about the facts associated with their health.
Methods: The bacterial pathogens were isolated and identified from various dental samples. Antibacterial activities of 11 different toothpastes available locally in markets were assessed against the isolates by standard agar well diffusion method.
Result: Monomicrobial infections were observed in all cases. The bacterial pathogens were found to be Streptococcus mutans, S. salivarius, S. sanguis, S. sobrinus and S. mitis. Of the assayed toothpastes- Colgate Total, Colgate, Anchor White and Pepsodont were found to be highly effective against the pathogens.
Conclusion: The result showed that the toothpastes containing Triclosan as a major chemical ingredient posses significant antibacterial activities.
Antibacterial activities of medicinal plants of Nepal
Authors: Pokharel K , Dhungana B.R. , Tiwari K.B , Shahi R.B. , Yadav B.K. , Sharma M. , Shrestha R.K , Shrestha D. , Paudel B.H
Published: July 2024

Background: Medicinal plants of Nepal are still remaining to be assessed for their antimicrobial properties, which may lead to discovery of broad-spectrum antimicrobial compounds.
Methods: Various parts of medicinal plants, viz. Acorus calamus, Curcuma longa, Emblica officinalis, Glycyrrhiza glabra (a non-indigenous to Nepal), Justicia adhatoda and Xanthoxylum armatum, were collected from hilly regions of Nepal. The plant parts were chopped into fine pieces, air-dried at 37°C for several hours, surface sterilized and grinded to powder. The antibacterial compounds were extracted by Soxhlet Reflux method and tested against common bacterial pathogens by agar well diffusion test.
Result: All the crude extracts were found to be effective against Salmonella typhi, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus. Among tested ones E. officinalis was found to the best antibacterial plant. Minimum inhibitory concentration (MIC) and Minimum bactericidal concentration (MBC) values of the crude extract of E. officinalis were found to be 8mg/ml and 16mg/ml respectively. Similarly, MIC value of A. calamus was 128mg/ml.
Conclusion: Being highly effective against both Gram-positive and Gram-negative common bacterial pathogens, the antibacterial compounds from the plants can be exploited to commercial values provided in vivo assessment of the compounds are studied.
Rational drug prescribing and dispensing in tertiary care teaching hospital of Western Nepal
Authors: Upadhayay D.K. , Palaian S. , Shankar P.R. , Mishra P.
Published: July 2024

Background: Previous studies have acknowledged that irrational use of medicines is a problem in Nepal. Studies from the Manipal Teaching Hospital have identified lacunae in prescribing and recommended interventions to improve the drug use pattern in the hospital. Educational and managerial interventions have been carried out to improve the use of medicines.
Objectives: The study was conducted with the objectives of analyzing the prescriptions for rational prescribing and dispensing, and to evaluate the patient’s knowledge regarding use of drugs as per the International Network for Rational Use of Drugs (INRUD)/WHO indicators.
Methods: The prescription and labeling of the dispensed drugs were checked for their accuracy and necessary details were entered in the encounter form developed as per the INRUD/WHO indicators. Patients were interviewed for their knowledge regarding dose, duration, and frequency of the drug prescribed. The filled encounter forms were analyzed for the results.
Results: The average drugs per prescription were 2.53. Only 16.38% of drugs were prescribed by generic name and 18.08% of the total drugs were fixed-dose combinations. It was found that only 37.09% and 31.06% of the drugs prescribed were from the Essential drug list of Nepal and WHO Essential drug list respectively. A very high percentage (97.92%) of the drugs was prescribed from the hospital drug list and 47.75% of the drugs were from the Nepalese National Formulary. The average cost per prescription was found to be NRs. 224.83 (USD 3.10). It was found that all of the medication envelopes were labeled with name of the drug and time of administration. All the patients knew the duration of the therapy and time of administration time of drugs.
Conclusion: The study reported an improvement in the drug use at Manipal Teaching Hospital. There was also a reduction in the prescription cost and improvement in patient knowledge regarding the medications. However, larger studies covering more patients are needed.
Ethics for medical students
Authors: Adhikari Prof. Ramesh Kant
Published: July 2024

N/A
Genotoxic effect of an organophosphorus compound (Phosphamidon) on the Bone Marrow of Albino Rats
Authors: Kunwar R.B. , Jha C.B. , Saxena A.K. , Bhattacharya S.
Published: July 2024

Introduction: The present study shows the genotoxic effect of phosphamidon on bone marrow of albino rats and this study was conducted in the cytogenetic laboratory, at B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Materials and Methods: Rats were treated by drinking water containing 35 parts per million and 50 parts per million concentration of phosphamidon(an organophosphorus compound) for 30 days. After 30 days, they were sacrificed. The femur was dissected out and the bone marrow from femur was aspirated. The bone marrow was immediately processed and then slides were prepared and then observed in 100X oil immersion microscopy for chromosomal aberrations.
Results: Different type of Chromosomal aberrations were observed in both experimental groups like gaps, accentric fragments, containing single and double minutes, fragmentation, centromeric breakage and premature condensation of chromosomes.
Conclusion: Phosphamidon has profound genotoxic effect in experimental albino rats.
Safety alerts on Rosiglitazone
Authors: Subish P. , Mohamed Izham M.I. , Mishra P. , Shaker P.R.
Published: July 2024

N/A
Intestinal Parasitosis
Authors: Shakya B. , Bhargava D. , Shrestha S. , Rijal B.P.
Published: July 2024

Introduction :Intestinal parasitosis is highly prevalent among general population and hospital patients in Nepal. The study aimed to assess the prevalence of intestinal parasitosis among patients in a hospital of Nepal.
Methods: A retrospective study was done by analyzing the findings of stool examined from April 2006 to March 2008 at Department of Microbiology of the hospital. χ 2_test was used for analytical assessment.
Results: Out of 2221 fecal samples, 20.7% were positive, the positivity being 23.9% and 15.8%, respectively in first and second year (P<0.05). Overall infection rate was nearly equal in male and female (20.2% vs. 21.2%). The infection rate was highest among patients of >60 years (25.3%) followed by those of <15 years (21.2%) and 15-59 years (20.1%) ( P>0.05). Ascaris lumbricoides (31.8%) and Entamoeba histolytica (38.0%) were the commonest helminth and protozoa, respectively. Other parasites were Hookworm (18.3%), Hymenolepis nana (2.6%), Taenia solium (2.6%), Strongyloides stercoralis (1.3%) and Giardia lamblia (5.5%).
Conclusions: Though, the prevalence of intestinal parasitosis among hospital visiting patients is declining, high detection of A. lumbricoides and E. histolytica signifies the need of public awareness regarding latrine use, water source protection from fecal contamination, proper sanitation and hygienic behavior.
Small Cell Carcinoma of Ethmoid Sinus
Authors: Adhikari P. , Bhatta R. , Pradhan B. , Thapa N. , Bhandari R. , KARKI R. , Shrestha A. , Sayami G.
Published: July 2024

Extrapulmonary small cell carcinoma is a rare entity. Here, we report a case of small cell carcinoma of  left ethmoid sinus, in a 32 years old female. She underwent left medial maxillectomy and excision of the mass via lateral rhinotomy approach with post operative chemoradiation.
Antidiabetic effect of Neopicrorrhiza scrophulariiflora on type 2 diabetic model rats
Authors: Manandhar N , Rokeya B , Ali L , Amatya S
Published: July 2024

Introduction: Neopicrorrhiza srophulariiflora (NS), which is locally known as “kutki / katuki” in Nepali is available at 3500-4800 m, east to west Himalayan region of Nepal. It is being used as indigenous antidiabetic plant in Nepal by the local people in the treatment of diabetes. The present study was carried out to evaluate the antidiabetic property of NS in streptozotocin (STZ) induced type 2 diabetic model rats.
Methods: NS dried rhizomes, collected from mountainous region of Nepal, was extracted with 80% ethanol and water by cold percolation method. The extracts were administered at a dose of 1.25gkg1 body weight for 21 consecutive days to type 2 diabetic male Long-Evans rats, bred at BIRDEM animal house. Type 2 diabetes was induced by a single intraperitoneal injection of STZ to 48 hour old pups (Long Evans) from BIRDEM Animal house. Serum glucose was estimated by GOD POP method, on 0 day and by decapitation on 21st day by tail tip method.
Results: Ethanol extract of N. srophulariiflora significantly (p<0.05) improved oral glucose tolerance in type 2 rats in comparison to control group at the end of the study period. It was also found that the water extract and ethanol extracts significantly lowered serum glucose level of type 2 diabetic rats in both prandial states (simultaneously with oral glucose load p><0.05; at 75min and 30 minutes prior to oral glucose load p><0.05; at 105min) compared to water fed control group. Administration of Glibenclamide (5 mgkg-1) also produced significant reduction (p><0.01) in serum glucose concentration in type 2 diabetic rats.
Conclusions: N. srophulariiflora is beneficial for treating Type 2 diabetes and therefore merits further exploration and researches both chemically and biologically to identify the active principle(s) and mechanism of action.
Issues Associated to Qualitative Research Paradigm
Authors: Joshi S
Published: July 2024

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Incidence of dysmenorrhoea associated with high stress scores among the undergraduate Nepalese medical students
Authors: Pramanik T. , Shrestha R. , Sherpa M.T. , Adhikari P.
Published: July 2024

Introduction: Primary dysmenorrhoea is one of the major problems associated with menstruation among the young undergraduate medical students which affect the daily routine. Among various causes, mental stress is one of the major causes of primary dysmenorrhoea. This study aims to assess the relationship between the degree of stress and incidence of dysmenorrhoea amongst the young Nepalese medical students.
Methods: Young, unmarried, non-smoker female medical undergraduate students (age: 18-20years, n = 104) having no pelvic pathology participated in this study. A baseline questionnaire was used to note the medical history on menstruation, use of contraceptive pills, active or passive smoking exposure and alcohol use. The independent and individual perception of stress was evaluated by using a stress questionnaire.
Results: Result indicated that the stress score is significantly higher (31.30 vs. 18.81) in dysmenorrhoeic women (n=50) compared to eumenorrhoeic participants (n=54).
Conclusions: The present study indicated a positive relationship between psychological stress (supported by stress scores) and dysmenorrhoea. The path of solution of this painful problem might be paved out by de-stressing the person through relaxation exercise, yoga and pranayama (the breathing exercises.)
Taste disturbances following middle ear surgery
Authors: Gurung U , Bhattarai H , Shrivastav RP
Published: July 2024

Introduction: Iatrogenic chorda tympani nerve (CTN) injury during middle ear surgery is quite common. The objective of ours study is to observe frequency & types of CTN injury during middle ear surgery and assess types of post-operative taste disturbances and their functional recovery.
Methods: Patients who underwent middle ear surgery from 1st October 2005 to 1st January 2007 in Tribhuvan University Teaching Hospital were divided into 6 groups according to intraoperative CTN manipulation as; seen but not handled, handled but not stretched, stretched but intact, cut while stretching, cut while using burr and clean cut with scissors. Subjective assessment of taste disturbance was done after 2days & 2, 4 & 6 months post-operatively and categorized as altered taste sensation/metallic taste, tongue numbness and dry mouth.
Results: Amongst 260 patients, CTN was seen but not handled in 52/260 (20%), handled but not stretched in 54/260 (20.75%), stretched but intact in 66/260 (25.38%), cut while stretching in 17/260(6.5%), cut while using burr in 29/260 (11.15%) and clean cut with scissors in 42/260 (16.15%) patients. Eleven out of 260 patients (4.2%) symptomatic amongst which 6/11 (54.5%) had altered taste sensation,4/11 (36.3%) had tongue numbness and 1/11 (9%) had dry mouth. Complete recovery occurred in 9/11 (81.8%) patients by 6 months.
Conclusion: Though iatrogenic CTN injury was common during middle ear surgery, frequency of taste disturbance was comparatively less, commonest type of CTN injury being stretched but intact. The most common post-operative taste disturbance was altered taste sensation/metallic taste. Most patients recovered completely by 6 months. Functional recovery was earlier when CTN was preserved than when sectioned.
Knowledge, attitude and application of computer by Bachelor Level Nursing students
Authors: Shahi M.
Published: July 2024

Background: Computer literacy and information literacy are critical to the future of nursing in this 21st century. The objective of the study is to identify the knowledge, attitude and application of computer by the BN 1st year nursing students.
Methods: The study populations were 108 Bachelor of Nursing 1st year nursing students of the three different institutions. The research has adapted descriptive cross-sectional design. In this research study, purposive non- probability convenient sampling technique was adopted to select the nursing institutes. A self-administered structured questionnaire, Likert scale and semi structured questionnaire were used.
Results: The majority of the respondents (44.4%) were from Central development region. The majority of the respondents(59.3%) had taken basic course on computer training. Also, Majority of the respondents 33.3% respondents had average knowledge on E-mail and Internet. Interestingly, majority (54.9%) respondents had used computer for medical information occasionally. Similarly, majority of the respondents (69.7%) strongly disagreed that ‘without computer, world would be better.’ Majority of the respondent (37%) often used Internet/E-mail and chatting in computer. Likewise, the majority of the respondents (40.7%) stated that computer is very useful in nursing education and research.
Conclusion: The findings of the study indicate that there was a deficit in students’ IT competencies should be integrated into the BN 1st year course.
Obstetric factors and pregnancy outcome in placenta previa
Authors: Ojha N
Published: July 2024

Introduction: Placenta previa is one of the major causes for maternal morbidity and mortality. The aim of this study was to analyze the obstetrical factors associated with placenta previa and to find out the maternal and perinatal outcome of these cases.
Methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology of TUTH. Hospital chart records of four years (1st January 2008 to 31st December 2011) were collected. Chart records of all women who had undergone cesarean section for placenta previa were reviewed. Relevant clinical findings were noted.
Results: During the study period, there were 82 cases of cesarean sections done for placenta previa, which is 0.55% of the total deliveries. Of the eighty two cases, charts could be obtained of the 70 patients for the analysis. 21.4% had total placenta previa. Maximum women were in age group 26-30 years. Sixty one percent of the patients were multipara. Sixteen patients had history of cesarean section and 20 cases had abortions in previous pregnancy. Malpresentation was present in more than one fifth (21.4%) of the patient. 45.7% of the babies were preterm and 27% were low birth weight babies. Seven babies had neonatal death. Almost one third (31.4%) of the patient had blood loss ≥500ml. There were four cases with blood loss ≥1000ml. Among them two had loss of more than two liters. Ten patients required blood transfusion. One patient had cesarean hysterectomy.
Conclusion: Placenta previa poses danger to both the mother and the baby. There is high maternal morbidity and adverse perinatal outcome.
Fetal transcerebellar diameter nomogram in Nepalese population
Authors: Joshi B.R
Published: July 2024

Introduction: Sonographic determination of gestational age (GA) is becoming increasingly important. Many parameters can be used for establishing GA. The transverse cerebellar diameter (TCD) is a reliable parameter for estimating it. Fetal cerebellum grows progressively along with GA and can predict GA at any trimester. This study was undertaken to construct an institution specific Transcerebellar diameter (TCD) nomogram and to compare its ability to predict gestational age with previously published nomograms.
Methods: A cross-sectional nomogram was constructed using TCD measurements of 594 singleton fetuses in Nepalese population by using linear regression model. Measurements were obtained by placing the calipers of the ultrasound machine at the outer -to- outer margins of the cerebellum. The suitability of previously established TCD nomograms for predicting gestational age was assessed in Nepalese population to determine comparability between nomograms.
Results: Gestational age and TCD 50th percentile in mm coincided well till 20th week of gestation. Between 21st to 28th weeks of gestation, there were no clinically important differences between our nomogram and previously published in terms of the predicted gestational age. However, predicted gestational age in third trimester was considerably different by using our nomogram by 1-2 weeks from 29-32 weeks and by 3-6 weeks after 33 weeks. There were differences of 4-6 mm between 29-32 weeks and of 7-11 mm after 33 weeks.
Conclusions: TCD measurements had a similar relationship with gestational age across previously published nomograms before 28 weeks. Significant differences occurred in predicting gestational age after 33 weeks.
Mammographic evaluation of palpable breast masses with pathological correlation: a tertiary care centre study in Nepal
Authors: Gurung G. , Ghimire R.K , Lohani B.
Published: July 2024

Introduction: Breast cancer is one of the major health problem for all countries. . In Nepal , breast cancer is the second most common cancer in female. Early detecting tools like mammography can able to detect location , size, morphology, and nature of breast lesions that can help to reduced mortality and morbidity from breast cancer significantly.
Methods: This prospective study was carried out at the department of Radiology, Surgery and Pathology for a period of one year. A total of 100 patients with clinically palpable breast lump were subjected to mammography and subsequently to FNA or biopsy. The mammograms were reviewed by two senior consultant radiologists and pathology by a senior pathologist.
Results: Out of 100 patients, 65% had mammographic features of benign lesion and 35% had features of malignancy. Pathology revealed 64% of lesion to be benign and 36% of lesion to be malignant. There were four false negative (6.2%) and three false positive (8.6%) cases. The sensitivity and specificity of mammography were 88.9% and 95.53% respectively. The mean age of patient with malignant lesion was 46.3 years (SD=11.5) and 34.7 years (SD=10.6) for benign lesions. Among malignant lesion 37.1% had lobulated, 14.3% had oval, 31.4% round and 17.1% had irregular shape with spiculated margin in 60% and indistinct margins in 34.3%. Among benign 7.7% showed lobulated shape, 41.5% oval and 50.8% round shape. Circumscribed margin was found in 93.9% of benign and 5.7% of malignant lesions. Punctuate and polymorphic calcification was found in malignant lesions (25.7% and 5.7%). Secondary changes were found in only in the malignant cases. Halo sign was found only in benign cases and most common in fibroadenoma (38.4%).
Conclusions: Mammography is an effective diagnostic tool for benign and malignant characteristic of palpable breast mass.
Comparison Between Hydroplasty and Intra-articular Steroid Injection in Treatment of Idiopathic Frozen Shoulder
Authors: Dhungana DP , Lamichhane AP , Mahara DP
Published: July 2024

Introduction: Idiopathic frozen shoulder is one of the common problems in orthopedic outpatient department. It is characterized by gradually progressive pain and stiffness of the shoulder followed by spontaneous recovery over the period of time.Many different modalities are available for the treatment of Idiopathic frozen shoulder, but no one is universally accepted. The purpose of this study was to compare the outcome of hydroplasty with intra-articular steroid injection.
Methods: This was a comparative hospital based study conducted between March2011 to September2012, which included 50 patients with Idiopathic Frozen shoulder. There were 25 patients in each group. The mean age of respondent was 57.36 years. Simple Random method of sampling was adopted for selecting patients for each group. Hydroplasty group was given 30ml chilled(cold) sterile normal saline with 2 ml Methylprednisolone (80 mg), 4 ml 2% Lidocain(plain) and 4 ml 0.5% Bupivacain (total volume:40ml) and steroid group was given 2ml Methylprednisolone, 4ml 2% Lidocain(pain), 4ml 0.5% Bupivacain with total volume: 10 ml. Both groups were attached for therapeutic exercises. Comparison of outcomes between two treatment groups was done using Visual Analogue Scale (VAS) for pain, Shoulder Pain and Disability Index for Shoulder function and degree of range of motion. Statistical analysis was done using SPSS 17.0
Results: There was significant improvement in level of pain, Shoulder function (Shoulder Pain and Disability Index) and range of motion in forward flexion, abduction, external rotation, and internal rotation in three month period in Hydroplasty group compared to Steroid group.
Conclusion: There was improvement in pain, range of movement and Shoulder Pain and Disability Index (SPADI) score in all patients of both group but the difference in improvement was found to be statistically significant in hydroplasty group as compared to steroid injection group. So Shoulder hydroplasty technique was found to be more effective treatment modality than intra-articular steroid injection in idiopathic frozen shoulder.