bluuebunny/crossref_metadata_2025 huggingface dataset:
Awareness and Practice of Mothers Regarding Health Promotion of Under-Five Children in Urban Slum Area of Kathmandu
Authors: Koirala S , Koirala M
Published: July 2024

Introduction: Breastfeeding is the ideal food for meeting the psychological and physiological needs during infancy and early childhood period. The health status of slum children is worst among all urban groups, due to faulty infant feeding practices, impaired utilization of nutrients due to infection, inadequate food intake and health security, poor environmental conditions and lack of proper child care practices. Therefore, this study aims to assess the awareness and practice regarding health promotion of under-five children residing in urban slum area.
Methods: House hold survey was conducted from 2013-12-30 to 2014-1-29 by using purposive sampling technique used as semi-structured interview schedule. 90 mothers having children aged less than 5yearswere selected for the study from Thapathali to Sankhamul slum areas. Obtained data was analyzed by using descriptive statistics.
Results: All mothers were aware about breast-feeding where 98.8% mothers practiced on their children.92.3% of them knew that initiation of breast milk secretion occurs soon after child birth but 81% mothers had initiated it within one hour of birth. 96.7% had idea on importance of colostrums and was fed by 97.8% mothers. 11% mothers gave prelactal feeding. 95.6% were aware of demand feeding where 97.8% practiced it. 74.4% knew the meaning of exclusive breast feeding but only 17% practiced exclusive breastfeeding till 5- 6 months, and 72% had practiced predominant feeding with breast milk.98% mothers were practicing night feeds and 92.1% had breastfed even during child’s sickness. 97.7% of the mother were aware of the complementary feeding, and 75.5% of mothers knew the appropriate time to start it but only 59% mothers had started complementary food at appropriate time of 5-6 months.97.7% of mothers were aware and practiced immunization to their children. 97.7% of babies received BCG and 95.5% received polio and DPT vaccines.
Conclusion: Study concludes that slum areas’ mothers were aware and practice regarding health promotion of under 5 was found adequate. However they had lack of proper awareness in appropriate time of starting complimentary food and use of predominant feeding with breastfeeding.
Venous Diseases of Lower Limbs: Retrospective Analysis of Duplex Ultrasound Findings
Authors: Gurung GS
Published: July 2024

Introduction: Venous pathologies of the lower limb include acute deep venous thrombosis and chronic venous insufficiency. Deep vein thrombosis can cause pulmonary embolism, which is a serious medical emergency. Deep venous thrombosis usually manifests with limb pain and swelling in high risk group whereas chronic venous insufficiencies manifests with limb swelling, telengiectasia, varicosities and skin changes including ulceration which also cause serious morbidity. The aim of this study was to ret-rospectively analyze the findings of duplex ultrasound in patients with venous disease of lower limbs.
Methods: A retrospective hospital-based study in 386 patients was carried out analyzing the records of duplex ultrasound findings at Kathmandu Imaging Center, Maitighar, Kathmandu, Nepal. Clinical information and Duplex ultrasound findings including status of deep veins, superficial veins, sapheno- femoral junction, sapheno-popliteal junctions and perforators were reviewed. Associated findings of deep vein thrombosis and venous incompetence were also noted.
Results: The patient population composed of almost equal numbers of males 200(52%) and females 186(48%). Majority 197(51%) of venous Duplex examination was normal. 129(33%) of patient had chronic venous insufficiency. Similarly, 60(15.5%) of patients had deep vein thrombosis and among these deep vein thrombosis patients, 3(5%) had chronic venous insufficiency. Mean age of patients with deep vein thrombosis was 52.4±17.5 years. Males predominantly suffered from deep vein thrombosis with male to female ratio of 1.9:1. However, chronic venous insufficiency was seen in slightly younger patients with mean age of 40.8±14.7 years and males were more frequently affected by chronic venous insufficiency with male to female ratio of 1.3:1.
Conclusion: Venous duplex study is an essential tool for evaluation of lower limb venous pathology. From the study, it can be concluded that, the commonest abnormality found in the patient were varicosity, deep vein thrombosis and chronic venous insufficiency.
Evaluation of arterial phase images with 90vp in multiphase abdominal CT scan
Authors: Chapagain KM , Humagain M , Lohani B , Shrestha SL , Thapa N
Published: July 2024

Introduction: CT scan of abdomen is usually performed in 120-140 kVp and such high ranges of kilovoltage in all phases will increases the radiation dose many fold. The purpose of the study was to qualitatively and quantitatively assess image quality with low kVp in arterial phase of examination of multiphasic abdominal CT study.
Methods: A prospective cross-sectional study was done in 206 participants of age 18 to 88 years who were undergoing multiphase CT studies of the abdomen in Neusoft 16 detector MDCT. After performing non contrast scan, arterial phase study of limited region of abdomen (diaphragm to infrarenal margins) was obtained with 90 kVp. The portovenous phase scan with standard protocol was obtained (120kVp). All other scanning parameters were kept same for two phases. Images were rated on 5 point scale (1-worst, 2-Suboptimal, 3-adequate,4-very good,5-excellent) based on visualization of boundaries, anatomical details of the organs and visualization of noise and artifact by two radiologists. Patient weight, abdominal circumference (AC), height and BMI were recorded and correlated with the image quality score. Statistical analysis was done with Wilcoxon’s signed ranks test k test and descriptive analysis.
Results: Overall the image quality of portovenous phase was significantly better (p<0.005) than low kVp arterial phase. Image quality score correlated best with abdominal circumference in standard dose technique (r=0.54) and patient weight in reduced dose technique (r=0.44). Arterial phase scanning had acceptable image quality score for patient weight of <60 kg, AC <80cm and BMI<25 kg/m2. The CTDIvol was 7.71 with reduced kVp protocol and 20.02 with standard resulting significant reduction in radiation dose of about 61%
Conclusions: The image quality of arterial phase images with 90kVp tube potential is acceptable in thin and average built patients. Hence reduction in radiation dose is possible if arterial phase scanning is done with reduced kVp except in patients with large anthropometric parameters.
Hematological parameters of Salmonella typhi and paratyphi culture positive patients from Kathmandu Valley, Nepal
Authors: Rana B SJB , Pradhan SK
Published: July 2024

Introduction: Salmonella enterica causes febrile illnesses leading to changes in hematological parameters. Developing countries like Nepal remain an endemic area for this disease. However, the changes in hematological parameters among Nepalese population have not been well documented in correlation with culture diagnosed cases.
Methods: A total of 204 individuals (102 cases and 102 controls) were included in a cross-sectional, analytical comparative study. The cases and controls were recruited from the tertiary care centers in Kathmandu. The hematological parameters from both culture diagnosed and controls were measured.
Results: Enteric fever (102 culture positive cases) caused a significant decrease in total white blood cell (p < 0.05), blood platelet count (p < 0.05), lymphocyte (p < 0.05), packed cell volume (p < 0.05), eosinophils (p < 0.05) and haemoglobin (p < 0.05) compared to healthy controls. Similarly, enteric fever led to significant increase in neutrophil and monocyte count in enteric fever patients (p < 0.05).S. typhi was isolated in 60 (59%) and S. paratyphi was isolated in 42 (41%) of the patients. Anemia was found in 24 (23.52 %).Leucopenia was found in 8 (7.84%) patients, leucocytosis in 3(2.94%), neutrophilia in 29 (28.43%), lymphocytopenia in 19 (18.62%), monocytopenia in 48 (47.05%), absolute eosinopenia in 95 (93.13%), thrombocytopenia in 24(23.52%) and thrombocytosis in 2(1.96%).
Conclusion: Enteric fever was associated with leucopenia, mild neutrophilia, lymphopenia, absolute eosinopenia and decrease in haemoglobin among culture positive patients. Salmonella enterica serotype Typhi contributed febrile burden higher 59% (60).
Mortality in Emergency Department of Nepal Medical College Teaching Hospital, a tertiary care centre in Kathmandu, Nepal
Authors: Bharati U , Shrestha S
Published: July 2024

Introduction: There are limited literatures regarding mortality studies in emergency department of different hospitals of Nepal. The objectives of this study were to review and highlight the demographic patterns of mortality and to determine the frequency and causes of accident and emergency deaths.
Methods: This was a retrospective study carried out in emergency department of Nepal Medical College Teaching Hospital, Kathmandu for a period of 3 years from April 2013 to 14th April 2016. The study variables were analyzed with descriptive statistics using software SPSS 16.
Results: A total of 35,734 cases attended the emergency department during this period with mortality rates of 0.19%, 0.21% to 0.35% on consecutive 1st, 2nd, and 3rd year of study. There were 51(56%) males and 40(44%) females. The age of the cases ranged from 1month 23days to 86years old. Highest number of mortality (30.8%) was seen in the age group of more than 70 years old. Medical causes for death was far more common than surgical causes (83.5% versus 16.5%), Cardiac arrest being the commonest (n=19, 20.9%). Maximum number of cases (n=44, 48.4%) died within 1 to 6 hours of arrival to the emergency department.
Conclusions: This study on mortality patterns highlights the causes of common mortalities in one of the emergency department of tertiary care centre in Nepal. This study will provide a basic data to develop competent manpower and good infrastructure with latest equipments in order to optimize positive outcome and to strengthen the emergency setting.
Spontaneous Dissection of Right Coronary Artery and It’s Surgical Management
Authors: Timala RB , Sharma J , Rajbhandari R , Limbu Y
Published: July 2024

Primary spontaneous coronary artery dissection (SCAD) as a cause of acute myocardial infarction is rare entity with complex pathophysiology. SCAD must be considered every time that a healthy young patient presents with an onset of acute myocardial ischemic syndrome or sudden death. Mostly it appears in young women without traditional risk factors for coronary artery disease and a significant proportion of them are diagnosed during the peripartum or early postpartum period. SCAD is frequently fatal and a great number of known cases have been diagnosed at autopsy. The quick recognition of SCAD as a cause of acute myocardial ischemia in a young patient is important to establish the best medical/surgical treatment between the different therapeutic attitudes.
Identification of Taenia from child of 6 year old
Authors: Sah R , Khadka S , Sherchand JB , Tandukar S , Bhandari D , Shrestha L , Rijal B , Pokharel BM
Published: July 2024

N/A
Clinical significance of head circumference \ abdominal circumference ratio in low risk pregnancy
Authors: Joshi BR
Published: July 2024

Introduction: The ratio of HC and AC is the best conventional sonographic criterion for detection of intrauterine growth retardation. This study was conducted to determine the relationship of the ratio with GA in Nepalese population.
Methods: This prospective longitudinal study was based on 211 low-risk pregnancies.
Results: The ratio showed a continuous descending pattern until term.
Conclusion: The HC\AC ratio is around 1 and showed a continuous descending pattern until term.
Pattern of impacted mandibular third molar angulation in patients visiting Tribhuvan University Teaching Hospital
Authors: Dahal S , KC K , Agrawal NK
Published: July 2024

Introduction: The most common tooth to get impacted is the third molar. An impacted tooth can cause complications like pericoronitis, resorption of roots of adjacent tooth and temporomandibularjoint problems.
Methods: We examined orthopantomogram radiographs of 360 patients (151 males, 209 females) with bilateral impaction. Impacted mandibular third molars were classified into mesioangular, horizontal, vertical and distoangular based on angulation.
Results: Mesioangular impaction was the commonest form of impaction for sexes combined, males and females except for mandibular right side in females. Distoangular impaction was the least observed. For right side, there was a significant association between sex and the type of impaction of mandibular third molar. However, there was no significant association for the left side.
Conclusion: Mesioangular form of impaction for mandibular third molar was the most common in our study, and distoangular form of impaction was the least observed.
Nutritional risk assessment in patient undergoing major gastrointestinal surgeries
Authors: Paudel P , Ghimire S , Rai S , Pradhan GBN , Shrestha S , Bhattachan CL
Published: July 2024

Introduction: Malnutrition is prevalent in surgical patients in the range of 20–50%, depending on the population studied and method employed to determine nutritional status. Malnutrition is associated with adverse clinical outcomes, slow healing, increase in infection and longer hospital stay. There are several methods to assess the nutritional status of surgical patients. However, none has been universally accepted and there is no consensus on the best system. The Nutritional Risk Screening score (NRS 2002) was developed based on the presupposition that the severity of malnutrition indicates increased nutritional requirements and need for nutritional support. It has received approval from the European Society for Parenteral and Enteral Nutrition for use in the hospital setting. It is easy to administer in daily clinical practice and offers satisfactory reliability and reproducibility. The aim of the present study was to identify nutritional risk in patients undergoing major gastrointestinal surgeries using NRS2002 and to determine possible associations with postoperative complications.
Methods: This is a prospective study carried out in department of surgery, Nepal Medical College and Teaching Hospital from 1st August 2016 to 30th July 2017. All the major gastrointestinal surgeries performed during this period were included. The nutritional assessment was done by BMI, Serum protein /albumin and nutritional risk screening score (NRS 2002).
Results: Sixty three patients who underwent major gastrointestinal surgery were included in this study. Sixty percent patients (n=38) were male, 68.8% had BMI within ideal range (18.5-25.9 kg/m2), 71.4% (n=45) patients underwent elective surgery and 68.2% (n=43) had malignancy. A total of 44.4%  (n=28) of the patients were classified as being “at nutritional risk” and 47.6% (n=30) had postoperative complications. The mean NRS score was significantly higher among the patients who had complications compared to those who did not have complication (3.7± 1.2 vs 3± 1, p=0.016). Low serum albumin, BMI and absolute lymphocyte count correlated with presence of nutritional risk assessed by NRS 2002 and complications.
Conclusions: NRS 2002 is simple and easy to apply in routine clinical practice for nutritional assessment. It correlates with postoperative complications. Serum albumin, BMI and absolute lymphocyte count are also simple tools for nutritional assessment of surgical patients and can be used in supplementation with NRS 2002 for better accuracy.
Assessment of nutritional status among children under five years of age in Manamaiju VDC of Kathmandu District, Nepal
Authors: Gautam N , Shrestha S
Published: July 2024

Introduction: The nutritional status among under the age of five in terms of stunting, underweight and wasting and to find the association between nutritional status with selected variables. A descriptive cross-sectional study was done to determine prevalence of stunting, underweight and wasting among under five children and factors associated with that. Descriptive, univariate indices such as stunting, Underweight and wasting determined as Height for Age, weight for age and respectively.
Methods: The study was conducted in Manamaiju VDC with 56440 populations with 3742 under 5 children. Research design was descriptive cross sectional. Total sample size was 190 tools used are semi structured and face to face interview. Data collection was within 4 week (23rd chaitra 2070 to 20th Baisakh 2071). Data was analyzed by SPSS version 13.0 for Windows and ENA for SMART. Similarly, Chi square test was applied at 5% level of significance to show the association between nutritional status and selected variables as age group of children, occupation of mother, education of mother, immunization, vitamin A capsule supplementation, deworming tablets and colostrum milk feeding.
Results: This study finding is that the nutritional statuses of children in term of stunting were 32 %, in term of underweight 26% and wasting were 22% so the wasting found to be double in reference to current scenario. Similarly, associations of the variables with nutritional status were analyzed. The study found that Vitamin A supplementation, deworming tablets and colostrum milk feeding had statistically significant effect on wasting status and feeding of colostrum milk had statistically significant effect on underweight status.
Conclusion: From this study it can be showed the prevalence of stunting, underweight and wasting among under five children in Manamaiju VDC. National average given by NDHS, 2001 except the prevalence of wasting which is almost similar. Similarly regarding the association within selected variables i.e. Age group of children, Immunization, Mother’s Education level, Vitamin A supplementation, Deworming tablets and Colostrum feeding practices have significant effect on wasting status and underweight too but not on stunting and underweight. This analysis shows further need of research to explore the more regarding the nutritional status among the under five children in this community. This study showed that 41%, 29% and 11% children were stunted, underweight and wasted.
Correlation between Estimated Glomerular Filtration Rate (eGFR) and Sonographic Findings in Patients with Chronic Kidney Disease.
Authors: Neupane NP , Lohani B
Published: July 2024

Introduction: Ultrasound can also be used as a non-invasive modality for the evaluation and grading of the chronic kidney diseases. This study aims to correlate the various sonographic parameters with the various grades of CKD based on the eGFR.
Methods: The study was a cross sectional study conducted over a period of one year. Study population was adult patients (between 20 to 60 years) with chronic renal disease not undergoing renal replacement therapy. Patients with liver disease and fatty changes in liver in ultrasound and patient with ascites were excluded from the study. Estimated glomerular filtration rate (eGFR) was calculated by using Cockcroft- Gault (CG) equation and CKD classified according to Kidney Disease Improving Global Outcomes (KDIGO) 2004. Ultrasound was performed for all patients and data were entered in a predesigned proforma. Data analysis was done using SPSS 21.0.
Results: A total of 138 patients met the inclusion criteria and were included in the study. The mean renal length in our study was 9.03cm (±0.83) on right and 9.00cm (±0.82) on the left side. The mean renal cortical thickness of right kidney was 1.037±0.20 cm and of left kidney was 1.039-±0.20 cm. Renal length and renal cortical thickness demonstrated a negative correlation with grade of CKD while renal echogenicity grading demonstrated a positive correlation with CKD grade.
Conclusions: Renal Ultrasound may be used to grade and monitor progress of chronic kidney disease.
Restriction Fragment Length Polymorphism (RFLP) typing of Mycobacterium tuberculosis isolates from Nepal
Authors: Rijal B , Ghimire P
Published: July 2024

Introduction: Many studies to characterize Mycobacterium tuberculosis by RFLP have shown that predominance of Beijing genotype in China and many neighboring countries. Nepal is just bordering in southern part of China. We have tried to differentiate Mycobacterium tuberculosis isolates of Nepal by RFLP in first time in Nepal.
Methods: A standard protocol was followed for isolation, Identification and RFLP typing of 60 strains of Mycobacterium tuberculosis of Nepal.
Results: Of the 60 isolates interpretable result was found in 31 isolates. The study detected that the Beijing family 12 (38.7%), was predominant type followed by single band 12 (25.5%). Indigenous type, not reported from other part of the world was also detected in 7 strains (22.6%).
Conclusion: Beijing type is the predominant RFLP type of Mycobacterium tuberculosis in Nepal and some other endogenous type also prevails which needs further study.
Solitary skull metastasis as initial presentation of hepatocellular carcinoma
Authors: Pradhan S , Phuyal S , Kumar A , Ghimire B , Singh Y P
Published: July 2024

Hepatocellular carcinoma (HCC) is the most common primary tumor of liver. HCC usually metastasizes to regional lymph nodes and lungs, less commonly to bone and rarely to the skull. Herein we present a case of 73 year old gentleman who presented with an occipital swelling. CT head detected mass suggestive of hemangiopericytoma with a differential of metastasis and MRI showed heterogenous signal intensity mass probably metastasis. Cytological diagnosis revealed cranial metastasis. Subsequent CECT abdomen reported a 12x11x11cm heteregenous enhancing mass suggestive of hepatocellular carcinoma. Patient was planned for craniectomy and transarterial chemoembolization to treat primary cancer but he refused further treatment inspite of extensive counseling. Primary presentation with skeletal metastases is rare in HCC and only few cases have been reported so far but it should be considered in the differential diagnosis in patients with subcutaneous scalp mass.
Co-relation between Non-specific Knee Joint Pain and Osteoarthritis
Authors: Humagain M. , Paudel S , Hengwoju S
Published: July 2024

Introduction: Osteoarthritis (OA) is a degenerative joint disease. Pain is the worst and most frequent problem in OA patients that leads to disability. The rate of knee joint pain has been found to be correlated with OA in many studies. The association of knee pain with OA differs by gender, with advancing age and nature of occupations. Knee radiograph is preferred by most of the physicians for the initial assessment of the knee joint pain. This study was carried out to see the relation between knee joint pain and OA along with age, sex and occupation.
Methods: In this prospective cross-sectional study, knee radiographs of 200 patients performed in the Radiology Department of T.U. Teaching Hospital for nonspecific knee joint pain were reviewed. Pain was considered as non specific pain when there was no history of trauma or any known disease affecting the joint and no significant abnormality related to any disease entity was found during clinical examination. The study was conducted over a period of three months between July to September 2015. The proforma was filled and then collected data were analyzed using SPSS software to show the relation between knee joint pain and OA.
Results: Among total of 200 knee x-rays, 63% (126) were female and 37% (74) were male. The highest number of population was in the age group of 50-59 year, which comprised 26% of total population and lowest population was in >80 year group comprising 0.5% of total population. Housewives were highest in number comprising 39.5% (79) followed by farmer 19% (38), physical worker 15.5% (31), people in service 12.5% (25), business 7.5% (15) and student 6% (12). Of the total population, 59% (118) had radiographic features of OA changes. Most affected people were older than 50 years and all patients older than 70 years had OA changes. No OA was seen in people younger than 20 years. Highest percentage of OA was found in housewives accounting 51.7% followed by farmers (18.6%) and business people (4.2%. No OA was found in students involved in the study.
Conclusion: The study demonstrated that the occurrence of OA is more common finding in population with non-specific knee joint pain. OA is more common in females and population of age ≥50 years. OA is most common in housewives and least in students.
Correlation Of Linear Measurements Of Spleen With Splenic Volume in Computed Tomography
Authors: Suwal S , Subedi K , Gurung G
Published: July 2024

Introduction: The purpose of this study was to assess the normal linear measurements of spleen in Nepalese adults by Computed Tomography (CT) and their correlation with splenic volume.
Methods: This was a prospective cross sectional observational study done in 264 peoples undergoing abdominal CT examination for various clinical indications not pertaining to spleen, in Department of Radiology & Imaging, Tribhuvan University Teaching Hospital (TUTH). Four linear measurements of spleen were obtained in axial plane. Craniocaudal length of the spleen was also obtained. The volume was obtained by adding cross-sectional area of spleen from 10 mm contiguous axial images and multiplying them with the slice thickness. The relationships between various linear measurements of spleen with spleenic volume were derived.
Results: The mean length of spleen along long axis was 9.3 +/- 1.3 cm, and the mean length along the craniocaudal axis was 7.6 +/- 1.5 cm. The mean width, maximum thickness, and thickness at hilum of the spleen were 9.3 +/- 1.7 cm, 5.1 +/- 1.2 and 3.2 +/- 0.6 cm respectively. The mean splenic volume was 151.20 cm3 ±  59.62 cm3. Significant positive correlations were noted between linear measurements and volume, the strongest being the width followed by the craniocaudal length.
Conclusion: Linear measurements of the spleen in CT show strong correlation with volume and hence can replace the splenic volume measurements while defining splenomegaly
Prevalence and risk factors of postpartum depression in mothers attending child immunization clinic of a Teaching Hospital in Kathmandu
Authors: Khakurel G , Chalise P , Karki PK , Mahotra NB
Published: July 2024

Introduction: Postpartum depression is a major health problem in developing countries like Nepal. The objective of this study was to determine the prevalence and risk factors of postpartum depression in Nepalese women.
Methods: This was a cross sectional study conducted in Kathmandu Medical College and Teaching Hospital during the month of January-May 2018. A total number of 162 women in 4 to 14 weeks postpartum period were included in the study. A questionnaire with sociodemographic, obstretic and psychosocial variable as well as the Edinburgh Postnatal Depression Scale was used for data collection. Chi square test was used to determine the association of postpartum depression with different variables.
Results: The prevalence of postpartum depression (defined as Edinburgh Postnatal Depression Scale ≥12) was found to be 22.2 %. There was a statistically significant association of postpartum depression with nuclear family, low family income, cesarean section delivery, history of miscarriage, pregnancy complications and exposure to domestic violence.
Conclusion: There is high prevalence of postpartum depression among women in our settings. It is important to educate the women and their family about the outcomes of postpartum depression.
Outcome of Severe Pneumonia with Adjunct Corticosteroid Therapy at a Tertiary Care Teaching Hospital in Nepal
Authors: Sthapit R , Maharjan RK , Pant P , Prasad PN
Published: July 2024

Introduction: Severe pneumonia is a major cause of Emergency Room (ER) admission and morbidity and mortality worldwide. Early identification and adequate resuscitation in the initial hours after severe pneumonia is the challenge today for a better outcome. It is not clear whether corticosteroid (CS) as adjunct therapy in severe pneumonia improves the outcome. Therefore, this study was done to assess the benefit of adjunct CS therapy in the treatment of severe community acquired pneumonia (CAP).
Methods: This was a prospective, randomized controlled trial (RCT) conducted from May 2017 to April 2018 (12 months) in the ER, Intensive Care Unit (ICU), Intensive Critical Care Unit (ICCU), and Medical Intensive Care Unit (MICU) of Tribhuvan University Teaching hospital (TUTH) in patients with severe CAP {(Pneumonia Severity Index (PSI) grade IV and V)} in two groups of patients (with and without steroid as adjunct therapy).
Results: Clinical cure at 5 days in the steroid and no steroid group was 43.2% and 54.1% respectively (P =0.696); clinical cure at 28 days in the steroid and no steroid group was 75.9% and 79.3% (P = 0.753) respectively. Treatment failure was comparable in the steroid and no steroid group (45.9 % Vs 37.8 %; P = 0.696). Overall mortality in steroid and no steroid group was 32.5% and 27.5% respectively (Chi square = 0.238, p=0.626). There was no statistically significant difference in the time to clinical stability (ttcs) between steroid and no steroid group (mean ttcs: 5.22 days Vs 5.78 days, SD: 3.106 Vs 3.671, p value: 0.521). The mean length of stay (LOS) in hospital for steroid group: 10.26 days, mean LOS for no steroid group: 11.26 days; p value: 0.438).
Conclusion: Among patients with severe pneumonia, adjunct corticosteroid therapy did not result in lower 48 hours, 5 days, and 28-days mortality. Hence, it was found that adjunct corticosteroid therapy is not beneficial in patients with severe pneumonia.
Pulled Elbow: Is X-ray Evaluation Really Required?
Authors: Uprety S , Bhandari PS
Published: July 2024

Introduction: Pulled elbow is a unique condition affecting paediatric population. The mechanism of injury is well stated by the child's patents. The condition is benign and passes uneventfully following a simple reduction manoeuvre in outpatient department. The condition is detected and treated easily by experts hands but to an unwary clinician may suspect it to be a bony injury and patient may be subjected to x-ray evaluation. The study was conducted to address the need to clinically identifying the condition and treating it without subjecting the patient to x-ray Distribution Users & Roles.
Methods: This was prospective study carried out in the department of orthopaedics and trauma surgery Tribhuvan university teaching hospital A total of 20 patients with 21 of total limb were included in the study. Age of the children ranged from 2-6 years of age. The reduction of elbow was done by hyperpronation technique and confirmed by feeling the click at radial head with improvement of symptoms.
Result: Among 21 elbows click of reduction was felt in 19. In two elbows no click of reduction was felt and these patients were subjected to x-ray evaluation. The elbow radiographs were normal and patient improved subsequently.
Conclusion: A careful history taking with good clinical examination is all that is required for diagnosis and prompt treatment of the condition. An x-ray evaluation is not necessary with proper history is taken and when reduction click is felt and the child shows improvement the child can safely be discharged.
Indications of Cesarean Section in a rural referral Hospital
Authors: Aryal B , Shrestha U
Published: July 2024

Introduction: There is a huge difference in cesarean section rate between rural (3.5%) and urban (15%) areas of Nepal. The national CS rate is around 5% whereas global CS rate is 26%. The objective of this study is to find out the delivery profile and rate and indications of CS in a rural university hospital.
Methods: This is a three -year’s retrospective cross-sectional study done from January 2016 to January 2019 (Magh 2072 to Poush 2075) at Karnali Academy of Health Sciences, Jumla. The data was retrieved from hospital birth profile records and analyzed using SPSS 20. Permission was taken from Institutional review committee (IRC) to conduct the study.
Results: Total number of delivery during this period was 1841 out of which 172 were Cesarean delivery giving a CS rate of 9.3%. The most common indication of CS were fetal distress (33.7%), previous CS (9.3%), failed induction of labor (9.3%). Non progress of Labor (8.1%) and post term pregnancy (8.1%). Majority of the CS were done as an emergency procedure.
Conclusion: The CS rate at KAHS teaching hospital was within WHO recommendation of between 5-15% and was very low in comparison to other centers situated in urban areas of the country. The indications of CS was also similar to the other national and international statistics.
Determination of complications in computed tomography guided fine needle aspiration cytology of lung mass
Authors: Joshi BR , Khadgi K , Ghimire RK
Published: July 2024

Introduction: The purpose of this study was to determine the complications of computed tomography (CT) guided fine needle aspiration cytology (FNAC) of lung mass.
Methods: This prospective study was done in 56 patients in Department of Radiology and Imaging, Tribhuvan University Teaching Hospital (TUTH). The CT guided FNAC was performed in patients having lung mass. The complications during CT guided FNAC were recorded and statistical analysis was done.
Results: Among 56 individuals 29 were males and 27 were females, age ranging from 42 to 80 years. Most of the lesions were located in upper lobe of lungs. There were no complications in 34 cases whereas 16 cases had local hemorrhage, 5 cases had pneumothorax of less than 30% and 1 case had pneumothorax of more than 30%.
Conclusion: CT guided FNAC is a safe procedure for diagnostic accuracy without significant complications.
Reproductive Parameters in Upper Mustang: A Camp Based Pilot Study
Authors: Bista KDB
Published: July 2024

Introduction: Published medical information on Upper Mustang is very scarce as no specific studies have been done due to its remoteness. This was the first multidisciplinary medical health camp, done to benefit the people of Upper Mustang who have limited access to health services and also to get some basic information on reproductive parameters of woman living there.
Methods: This was a camp based prospective study done between 3-8th October 2015, in Upper Mustang among women who attended the camps for various obstetrical and gynecological problems. A fixed questionnaire was utilized after taking proper verbal consent from patients. Results were analyzed and expressed in mean and averages.
Results: Out of total 614 patients, 180 woman who attended the Obs & Gyne clinic were studied. All 7 villages of Upper Mustang were represented. Most woman ie 36% were with parity 2-4 and 72% of the woman were illiterate. Mean age of the woman was 36.8yrs with maximum between 31-40 yrs age group. Contraceptive related problems was the most common presenting problem followed by pervaginal discharge. Depo contraceptive was the most common contraceptive, used by 50% of the population. About 83 (46.1%) woman experienced death of an infant or child under 5.
Conclusion: Illiteracy was high among the woman who attended the Gyne & Obs clinic. Infant mortality was found in almost 50% of the mothers with most not knowing specific cause. Depo injection was the most common contraceptive used by the woman.
A study on thyroid disorders in suspected cases attending Om Hospital and Research Centre during 1996-1998
Authors: Jha B. , Gurung C.K. , Singh J.B. , Subedi R.C.
Published: July 2024

Altogether 735 suspected individuals were undertaken for their thyroid function test.For this total T3, T4 and TSH were estimated by ELISA (Serozyme) technique. All thesuspected cases attended Om Hospital and Research Centre from 1996 to 1998. In agesex composition, it was observed that the patients who were advised to do thyroidfunction test were more likely to be female, the ratio being M:F=1:3. Similarly, youngerand elderly age group are found less as compared to other age group. The prevalenceof hypothyroidism, hyperthyroidism and hypothalamic disorders, T3-toxicosis and T4-toxicosis are 9.9/100, 15.1/100, 6.4/100, 8.9/100, and 4/100 respectively.The prevalence of hyperthyroidism is significantly highest followed byhyperthyroidism and T3-toxicosis among the different thyroid disorders.Hypothyroidism is found to be significantly higher in females whereas hyperthyroidismis high in males. Moreover, all types of disorders are found to be significantly differentin both the sexes. When these disorders are divided into different age groups, theprevalence of all types of these disorders was not found significantly different amongage groups. But the types are significantly different in 15-44 and 45-70 years agegroups.
Role of Ultrasonography in Early Diagnosis of Acute Osteomyelitis
Authors: Sigdel Bhim , Uprety Suresh , Bhandari Prawash Singh , Paudel Sharma
Published: July 2024

Background: Osteomyelitis is the inflammation involving bone and bone marrow caused by a pathogenic organism. Acute osteomyelitis is one of the commonest bone infection in childhood and is a significant cause of morbidity. Timely diagnosis and intervention is critical for outcome. Imaging studies play an important role in diagnosis of osteomyelitis. Various modalities, including conventional radiography, bone scintigraphy, ultrasonography, computed tomography (CT) and magnetic resonance (MR) imaging have all been used. The purpose of this study is to evaluate the diagnostic value of ultrasonography in early diagnosis of acute osteomyelitis
Methods: A prospective non-randomized analytical study in 30 children with sign and symptoms suggesting acute osteomyelitis presenting in Emergency Room(ER) and Out-patient department (OPD) of Tribhuvan University Teaching Hospital (TUTH) was carried out. Plain radiograph was done to each patient followed by Ultrasonography.
Results: Twenty four patients (80%) were finally diagnosed to have osteomyelitis. Distal femur was most commonly involved site (33.33%). Sensitivity of USG was found to be 91.6% and specificity to be 83.3%.
Conclusion: Ultrasonography was found to be highly sensitive and highly specific in early diagnosis of acute osteomyelitis in children with clinical suspicion of the disease and negative plain radiographs.
Antibiotic sensitivity pattern on cluster endophthalmitis caused by Gram negative organism
Authors: Thapa M , Gautam P , Joshi SN , Khanal S
Published: July 2024

Introduction: Endophthalmitis is a rare but devastating complication of intraocular surgery occurring in 0.07%-0.3% of total surgeries. With the introduction of Phacoemulsification through corneal incision, incidence of endophthalmitis has increased in recent days. Outcome of endophthalmitis is worse when it is caused by gram negative organisms.
Methods: Hospital based prospective study of cluster endophthalmitis following cataract surgery done on a single day. Surgeries were performed at BP Koirala Lions Centre of Ophthalmic Studies, IOM, Kathmandu, Nepal.
Results: 8 cases of acute endophthalmitis following cataract surgery were included in the series. Out of them 8, 87.5% (7) had isolates in the both anterior chamber and vitreous tap. Ali patients had infection due to e-coli. 4 cases had mixed growth of E.coli and Staph. aureus in vitreous and anterior chamber both 3 patients had growth of E.coli only in both vitreous and anterior chamber. And 1 patient had growth of E.coli in vitreous only. All the patients complaint of severe pain after few hours of surgery, Visual acuity in 6 patients was CFCF and 1 patient was hand movement (HM), 1 patient had perception of light only.  Intravitreal injection of vancomycin (1 mg/0.1ml) and Amikacin (0.4mg/0.1 ml) and Dexamethsone (0.4mg/0.1ml) was given in all cases after AC and Vitreous tap on the first day. On 2nd day all patients underwent vitrectomy and intra vitreal injection repeated in half dose. Out of 8 cases, 3 (37.5%) developed RD. 1 (12.5%) had to undergo evisceration. 1 (12.5%) patients developed cornel opacity, 3(37.7%) patients has good visual recovery visual acuity of 6/6-6/36.
Conclusion: Even after aggressive treatment acute postoperative endophthalmitis due to gram negative bacteria has a bad prognosis.
Psychiatric emergencies in a general hospital setting
Authors: Khalid Abdul , Regmi Shishir K. , Koirala Naba Raj , Nepal Mahendra K. , Pokharel Anupam
Published: July 2024

A psychiatric emergency is any disturbance in thoughts, feelings, or actions forwhich immediate therapeutic intervention is necessary. For a variety of reasons, suchas the growing incidence of violence, the increased appreciation of the role of medicaldisease in altered mental status, and the epidemic of alcohol dependence and othersubstance related disorders- the number of emergency patients is on rise. The presentwork was undertaken with the aim to study socio-demographic and diagnostic profile ofpatients for whom psychiatric evaluation was sought in the Emergency Room [ER] ofTribhuvan University Teaching Hospital, Kathmandu during a three-month period. Itwas a prospective, cross-sectional, descriptive study. Majority of the patients were ofage 11-30 years (57.7%), more than half of the patients were married (64.4%,) andpatients coming from Kathmandu valley (62.5%) outnumbered patients coming fromoutside. Only 46% of the patients attended the ER within 24 hours of onset of currentproblem. Out of the patients who received the diagnosis of Category F- Mental andBehavioural disorders of the ICD-10 (79.8%), 43.4% were suffering from the Neurotic,stress-related and somatoform disorders and 20% were suffering from Mood disorders.Out of the remaining 20.2% patients, one third each belonged to those who committedintentional self harm, who were suffering from neurological disorders, and who werefound to be suffering from systemic diseases. Emergency psychiatry is yet to drawattention of administrators and policy makers, which is reflected by the fact that onlyTUTH provides 24 hours psychiatric emergency services in the whole country.
Sonographic measurement of the size of fetal cisterna magna in low risk population of pregnant women at 16-38 weeks of gestation
Authors: Yadav B , Ghimire RK , Joshi BR
Published: July 2024

Introduction: The purpose of this study was to determine the normal size values of fetal cistern magna (CM) and to evaluate its changes in normal fetuses in low risk population of pregnant women in the second and third trimesters of pregnancy using transabdominal ultrasonography.
Methods: This was a prospective cross-sectional study involving 290 women with uncomplicated singleton gestation between 16-38 weeks. CM was visualized in 264 cases. Gestational age was calculated by measuring fetal biparietal diameter (BPD). CM was measured from the posterior aspect of the cerebellar vermis to the inner edge of occipital bone. Nomogram of the sizes of CM was prepared.
Results: CM was visualized in 91% of the fetuses. The ages of the patients ranged from 17-30 years (mean 24.29, SD 2.78). The maximum numbers of case were at 23 and 27 weeks of gestation and the minimum number of cases were at 37 weeks of gestation. The mean size of the CM was 6.32mm (SD1.09; range 3- 9 mm).
Conclusion: The size of fetal CM showed continuous increment and showed significant positive correlation with the gestational age ( r2 value of 0.48; p<0.001). The findings were consistent with the previous studies done by various authors. The percentile fitted values and nomograms will be valuable for the serial measurement of the CM for complicated pregnancies.
Pretibial Cyst after Anterior Cruciate Ligament Reconstruction with Non-bioabsorbable Interference Screw
Authors: Thapa SS , Lamichhane A , Mahara DP
Published: July 2024

Pretibial cyst formation after anterior cruciate ligament reconstruction is a rare late complication. Exact etiology is not known, but it is commonly reported with use of bioabsorbable screw for fixation. Here we report a very rare case of pretibial cyst after anterior cruciate ligament reconstruction even with use of non-bioabsorbable screw for fixation.
Knowledge, Attitude and Practice of Reproductive Aged Women regarding Emergency Contraceptives in Tertiary Hospital
Authors: Rana M , Ranjitkar UD
Published: July 2024

Background: In Nepal maternal mortality rate is very high more than one in five women die from pregnancy or pregnancy related causes. Emergency contraception is a method used to avoid pregnancy after unprotected sexual intercourse unlike the regular methods of contraception that are taken before sexual contact. Oral contraceptive pills and intrauterine contraceptive devices are mainly used as emergency contraceptives. The aim of this study was to assess knowledge, attitude and practice of emergency contraceptive among women
Methods: A descriptive cross sectional research design was carried out .Non probability purposive sampling was used to select sample which was 174 reproductive aged women attending family planning clinic of TUTH. Data was collected by interview using semi structured interview questionnaire. Data analysis was done by descriptive and inferential statistics using SPSS version 17.0.
Results: Based on findings majority 67.24% of respondent had knowledge to prevent unintended pregnancy, regarding practice only 13% used emergency contraceptive (EC) correctly within 72 hours of unsafe intercourse. 90.80% of respondents used family planning (FP) methods to reduce unwanted pregnancy. 47.13% responded correctly as EC is not a method of abortion and among all respondents 43.68% did abortion for unwanted pregnancy. Maximum 82.76% respondents had positive attitude towards EC.
Conclusion: The study findings showed majority of respondents had knowledge to prevent unintended and unwanted pregnancy; but only few percentage practice EC correctly within 72 hours of unsafe intercourse. Similarly majority of respondents had positive attitude towards EC, hence IEC prograamme should be planned to provide information regarding prevention of unintended pregnancy among reproductive aged women.
Extraintestinal Gastrointestinal Stromal Tumor arising from parietal wall: A rare entity
Authors: Jha BK , Jha P , Vaidhya P , Kansakar PBS , Manandhar S
Published: July 2024

Extraintestinal gastrointestinal stromal tumors (E-GIST) are rare types of GIST most commonly involving the mesentry, omentum and retroperitoneum. Parietal wall E-GIST are very rare. Very few cases have been reported in the literature.