bluuebunny/crossref_metadata_2025 huggingface dataset:
A Scenario of Cervical Carcinoma in a Cancer Hospital
Authors: Jha Anjani Kumar , Jha Jyoti , Bista Rabin , Basnet B , Kandel Prakash , Lama G , Banthia Prasan , Thakali Kabir
Published: September 2018

Introduction: Cervical carcinoma is an important women’s health problem throughout the world.There are very few published data on this disease in Nepal. We wanted to study the pattern ofcervical carcinoma based on hospital data.Methods: A 10 years retrospective study of scenario of cervical carcinoma was conducted. The datahave been analyzed according to age, occurrence of other cancers, histological type, religion, riskfactors and district wise.Results: The number of cervical carcinoma showed a rising pattern over the 10 year period. Themedian age of the patients was 45 years and maximum frequency (33%) of cases were found in theage group 40 to 49 years. Squamous cell carcinoma comprised 40% of cases, Adenocarcinoma 4% and1.1% cases were of mixed variety. 92% of cases were Hindu by religion. 43% of patients were smokerin our study, 5% had positive family history. Chitwan with 7.35% had the maximum number of casesfollowed by Rupandehi with 6.40% and Nawalparasi with 5.41%.Conclusions: The cancer pattern revealed by the present study provides valuable leads to cervicalcancer epidemiology in Nepal. Routine cytological screening of the population for cervical cancer ishighly necessary for its early detection and treatment.Key Words: Cervical carcinoma, hospital based study, Nepal, pattern
POST-MORTEM REPORT OF A NEONATAL DEATH
Authors: Shree Dibya , Prasad L N
Published: September 2018

ABSTRACT
A BRIEF STUDY AND REPORT OF PARAMEDICAL PERSONNEL IN THE REPUBLIC OF THE SUDAN AND EMPIRE OF THE ETHIOPIA
Authors: Regmi D N
Published: September 2018

ABSTRACT
Nepal Medical Council
Authors: Dixit Hemang
Published: September 2018

abstract
Incidence of Cancer Analysis of 10 Year's Statistics
Authors: Gurubacharya V L , Bajracharya G M , Shrestha H G
Published: September 2018

abstract
Development of anesthetic Service in Eastern Part of Nepal
Authors: Shrestha B M
Published: September 2018

abstract
Frequency of Secretor Status Amongs Neplease Population
Authors: Singh Rajan
Published: September 2018

abstract
Epidemiological Survey of Snake Case in Dhanusha District
Authors: Joshi D D
Published: September 2018

abstract
STUDY OF HYPERTENSION IN NEPALESE AND ITS TREATMENT
Authors: Pahari S K , Satyal P K , Acharya I L
Published: September 2018

ABSTRACT
Family Planning in Nepal
Authors: Jha Pitamber
Published: September 2018

Abstract
Antibiotic Resistance in Children with Recurrent or Complicated Urinary Tract Infection
Authors: Younish Nidal S , Qual K , Al-Awaisheh T , Al-Awaisheh F , Al-Kayed D
Published: September 2018

INTRODUCTION:Urinary tract infection is certainly one of the most common childhood infections. Emerging resistance to the antibiotics is not unusual. Current hospitalization for children with urinary tract infection is reserved for severe or complicated cases. The aim of the present study was to determine the antibiotic resistance pattern among children with recurrent or complicated urinary tract infection.METHODS:A retrospective study carried out at Prince Hashem hospital, Zarqa city, eastern Jordan and involved 336 episodes of culture proved urinary tract infection obtained from 121 patients with recurrent UTI, who used prophylactic antibiotics during the period from April 1, 2004 to December 31, 2006. The isolated microorganisms and there antibiotics susceptibility were studied.RESULTS:Seventy three patients (60.3%) were found to have some forms of urinary tract anomaly, significantly more prevalent among male children P<0.001. Vesicoureteral reflux being the most common (58.9%). Renal scars were significantly more prevalent among those with complicated rather than recurrent urinary tract infection (64.3% vs. 16.6%, P<0.001). Gram negative organisms were the most frequent isolates in patients with recurrent and complicated urinary tract infection. Proteus, Pseudomonas and Candida spp. were more prevalent in patients with complicated (P<0.001), and isolates in patients with UTA were significantly more resistant to most antibiotics tested.CONCLUSIONS:Pediatric urine culture isolates are becoming increasingly resistant to commonly used antibiotics. Empirical treatment with Trimethoprim-Sulfamethoxazole (TMP-SMX) or Cephalexin as the initial drug is ineffective. Nitrofurantoin and Nalidixic acid can be considered as the first line antibiotics for prophylaxis and or treatment of patients with recurrent UTI, while Meropenam and Ciprofloxacin can be used empirically in treating patients with complicated UTI.Key words: Antibiotic resistance, Complicated, Recurrent, Urinary tract infection
Need of reorientation in the field of Tuberculosis
Authors: Das G S.L.
Published: September 2018

Abstract
Immune Status in Prostatic Benign Hypertrophy and Cancer
Authors: Bhatta A D
Published: September 2018

abstract
A Clinical Study of the Internal Compression Fixation in the Diaphyseal Fracture of Tibia
Authors: Mohindra Y , Shah R K , Gupta M C , Agrawal R P
Published: September 2018

abstract
Impression from a Nepalese Resident In Canada
Authors: Tenzzing Chundak
Published: September 2018

abstract
A Pattern of Age-related Macular Degeneration
Authors: Pokhrel Suprada , Malla O K , Pradhananga C L , Joshi S N
Published: September 2018

Introduction: Age related macular degeneration is a disorder of the macula most often clinicallyapparent affecting central vision and is one of the leading causes of blindness in the populationabove 50 years. The aim of this study is to determine clinical profi le of AMD in Nepalese presentingto a Teaching Hospital in Kathmandu.Methods: It was a hospital-based cross-sectional study. The subjects included in the study were thosepresenting to the Ophthalmology department of Kathmandu Medical College Teaching Hospitalfrom July 2007- Dec 2007.The total number of individuals included in the study were 402 and totalnumber of eyes were 804.Results: AMD was observed in 5.2% out of 402 subjects of 40 years and above age group withprevalence increasing with age. The prevalence of AMD was 0.7% within 40-50 years of age-groupindividuals increasing to 2.6% in 51-60 years, 6.5% in 61-70 years and to 19.3% among subjectsabove 71 years. This study revealed that the prevalence of AMD in females was higher with femalepreponderance in ratio of 2.5:1. 52.5 % AMD subjects in our study had visual impairment with 6/24-6/60 vision and 15% had vision <3/60-PL. Our study revealed statistically signifi cant increased riskfor AMD with aging (p=0.00). Increased risk was observed in female gender and diabetics though theOdds ratio (OR) was statistically insignifi cant (p=>0.01).Conclusions: Prevalence of AMD in Nepalese presenting to Kathmandu Medical College TeachingHospital was 5% with female preponderance in ratio of 2.5:1. Aging showed statistically signifi cantincreased risk for AMD development in this study.Key Words: Age-related macular degeneration, blindness, Nepalese, prevalence
The Role of Simulator Promis2 in Learning Laparoscopic Skill
Authors: Shrestha Suman K , Nomura T , Tajiri T , Akagi I , Aso R , Miyashita M , Yoshimura A , Shimaru T
Published: September 2018

Introduction: Laparoscopic surgery is unique and complex in nature, so the training is necessarybefore proceeding to operation room. Many computer aided simulators have been developed forthe purpose. Our objective is to assess the improvement of basic laparoscopic skills after training insimulator.Methods: The fi fth year medical students underwent training of three laparoscopic skills usingPromis2 simulator twice weekly for 4-6 weeks. The skills are laparoscopic orientation, target pointingand objects transferring. Time, path length of instruments and economy of movements were recorded.The comparisons were made for these parameters between session fi rst and the last using a Mann-Whitney U test.Results: Ten volunteers completed the exercises in less time (186.3±55.4 seconds) than the fi rstexercise (215.7±57.4 seconds) (P=0.0027). Both the right and left hand instrument path lengths werealso improved from 4425.8±1284.3 mm in the fi rst exercise to 3925.3±1313.6 mm in the last exercisein the left side (P=0.0219) and likewise from 4273.8±1859.4 mm to 3831.3±1717.4 mm in the right side(P=0.0027). Economy of the movement in the left handed instrument improved from 1114.4±453.5mm in the fi rst exercise to 966.8±411.1 mm in the last (P=0.0443) and in the right handed instrumentfrom 845±398.8 mm to 771.4±370.5 mm according to the software of Promis2 simulator (P >0.005).Conclusions: Training in Promis2 simulator improves the basic laparoscopic skills. The candidatesbecome consistently faster with shorter path lengths and had smoother instruments movements.They also became signifi cantly more consistent in their performance.Key Words: laparoscopy, promis2, simulator, training
Effect of Acute Hepatitis E Infection in Patients with Liver Cirrhosis
Authors: KC Sudhamsu , Sharma D , Basnet B K , Mishra A K
Published: September 2018

Introduction: Hepatitis E virus is a major cause of enterically transmitted hepatitis. Mortality is veryhigh if it is associated with pregnancy, especially during third trimester. This study was carried out tofi nd out the effects of acute HEV hepatitis on Chronic Liver Disease patients of different etiologies.Methods: The consecutive patients of liver cirrhosis with defi nite evidence of recent HEV infectionwere enrolled in this study. Acute hepatitis was diagnosed by presence of prodromal symptomsand anti-HEV IgM antibody in their serum. The outcomes after superinfection with HEV hepatitiswere determined by changes in Child Pugh score, recovery of liver function test, hospital stay andmortality.Results: After exclusion 25 were studied. The etiology of cirrhosis in patients was: alcohol 13,autoimmune hepatitis 3, hepatitis B 2, Budd Chiari syndrome 2, alcohol plus hepatitis B 1, hepatitis C1, cardiac cirrhosis 1, Wilson’s disease 1 and cryptogenic 1. All patients with no recent decompensationshowed signs of decompensation during admission. Seven (28%) patients died. The cause of deathwas either upper gastrointestinal bleeding or hepatorenal syndrome. Remaining patients hadprolonged hospital stay with deterioration of Child-Pugh’s score.Conclusions: Superinfection of HEV in cirrhotic patient causes rapid decompensation. The morbidityand mortality is higher compared to those non-infected patients. Development of hepatorenalsyndrome and upper GI bleeding was commonest cause of death.Key Words: acute HEV infection, Chronic liver disease, third trimester pregnancy
Overweight and Obesity among the Adolescent School Students in Belgaum City
Authors: Gurung Tika Ram , Neginhal Vijayalaxmi Shivanand
Published: September 2018

Introduction: The World Health Organization (WHO) defines obesity as a ‘global epidemic’. An overweight adolescent has a 70 % chance of becoming obese. Overweight and obese adolescents are at higher risk for developing long-term chronic diseases. So the present study objective is to estimate the prevalence of overweight and obesity among adolescent school studentsMethods: A sample size of 300 adolescent students was taken to do a cross-sectional study. Body weight and height were recorded and BMI was categorized based on age-and sex-specific cut-off values as per IOTF reference growth charts.  Proportions of obese, overweight and underweight children were calculated and subjected to chi-square and logistic regression tests at the p < 0.05 significance level.Results: The overall prevalence of overweight and obesity in the present study were 12 % and 3.3% respectively. The highest prevalence was among those aged 15 years i.e. 36.7%. The prevalence of overweight and obesity was higher among the subject who did not practice physical activity and whose family income was more than 10,000 per month.Conclusions: Prevalence of overweight and obesity among adolescents student in Belgaum city was high which is statistically associated with less physically activity and monthly income of parent. Keywords: body mass index; life style; overweight and obesity.
Antiretroviral Service to HIV Patients of low CD4 Count in Seti Zonal Hospital
Authors: Paudel Bidhan Nidhi , Chaudhary SR , Sharma S , Dhunagana GP , Paydel P
Published: September 2018

INTRODUCTION:Due to unavailability of vaccine against HIV/AIDS, there are no ways other than relying on ART. We select group of late stage HIV/AIDS with CD4<50 so that opportunistic infections and outcome of patients in this late stage of severe immunosuppression after initiation of ART can be knownMETHODS:A cross sectional study was carried out in 53 HIV patients with CD4 count <50 cells/cu mm blood undergoing ART in Seti Zonal Hospital Dhangadi between December 2006 and May 2008 with objectives to explore the treatment outcome in this late stage of immunosuppression. Only those patients with CD4 count <50 were consecutively selected and recommended for various laboratory test on the basis of which ART regimen were prescribed.RESULTS:Among 53 patients, 42 (79.2%) were males and 11 (20.8%) were females, with predominant age group of 30-40 years (49.1%). Fever (71.7%), diarrhea (56.6%), pneumonia (52.8%), weight loss (52.8%) and oral thrush (33.9%) were found to be the major clinical presentation/Opportunistic infections. 19 (35.8%) patients showed normal activity throughout the treatment period with increase in CD4 count, 10 (19%) were recovered and transferred out. Only 1 (1.8%) showed decrease in CD4 count even after taking ART. Significant relationship was established between the intake of ART and increase in CD4 level (pair t = 7.88, p<0.05).CONCLUSIONS:ART service was found to be efficient enough to increase the CD4 count significantly after 6 months of therapy but the prevalence of OIs/clinical manifestations were sufficiently higher in this group of patients with low CD4 count.Keywords: antiretroviral therapy, cell count, fever, opportunistic infections
Acute Coronary Syndrome in an Intensive Care Unit of a Tertiary Referral Centre in Central Nepal: The Spectrum and Coronary Risk Factors.
Authors: Gautam Mani Prasad , Sogunuru Guruprasad , Subramanyam Gangapatnam , Thapa Lekhjung , Paudel Raju , Ghimire Madhav , Samir Gautam , Ghimire Usha , Shilpakar Ramila
Published: September 2018

Introduction: Acute coronary syndrome is the major leading cause for coronary care unit admission. Its spectrum comprises a variety of disorders including unstable angina, non ST elevation and ST elevation myocardial infarction.Methods: An observational study was designed to study the spectrum of acute coronary syndrome and associated coronary heart disease risk factors in subjects admitted in intensive care unit from August 2009 to September 2010. Details including coronary risk factors and the categories and outcomes of acute coronary syndrome were analyzed.Results: A total of 57 subjects were included in the study. The majority (63.1%) were males. The mean age was 64.54±13.8 years.  Five (8.8%) patients were ≤45 years and 29 (50.88%) patients were ≥65 years. Majority of the patients were smokers (50.87%). The other major coronary heart disease risk factors were diabetes (43.85%), hypertension (36.87%), dyslipidemia (26.32%) and previous history of coronary heart disease (31.58%). Coronary heart disease figured prominently in the family history as well (26.32%). ST elevation myocardial infarction was the major category (42.11%) followed by non-ST elevation myocardial infarction and unstable angina (31.58% and 26.32% respectively). Myocardial infarction complicated with cardiogenic shock had very high mortality (83.33%).  Conclusions: The ST elevation myocardial infarction was the major clinical form of acute coronary syndrome admitted in intensive care unit. Prevention should be targeted on modifiable risk factors such as the management of risk factors. In addition, the improvement in cardiology service with the establishment of CCU and cathlab might alter the mortality and morbidity in ACS management.Keywords: acute coronary syndrome; coronary risk factors; intensive care unit.
Antibiotic Susceptibility Pattern of Nosocomial Isolates of Staphylococcus aureus in a Tertiary Care Hospital, Nepal
Authors: Shrestha Bidya , Pokhrel B M , Mohapatra T M
Published: September 2018

Introduction: Methicillin resistant Staphylococcus aureus (MRSA), the most common cause ofnosocomial infection has been a major cause of morbidity and mortality around the world. They arenormally resistant to most of the antibiotics used in clinical practice. This study has been carried outto fi nd out the resistance pattern among S. aureus.Methods: During November 2007 to June 2008, clinical samples from patients with nosocomialinfection were processed for culture and sensitivity following standard methodology in microbiologylaboratory, Tribhuvan University teaching hospital, Kathmandu, Nepal.Results: Among 149 Staphylococcus aureus isolates, highest resistance was observed against Penicillin(91.94%) followed by Fluoroquinolone (61.74%), Erythromycin (52.94%), Gentamicin (46.98%),Cotrimoxazole (42.95%), Tetracycline (40.94%) and others, whereas susceptibility was observedmaximum against Chloramphenicol (94.85%) followed by Rifampicin (92.61%), Tetracycline(59.06%), Cotrimoxazole (57.04%), and others. None of the isolates were resistant to Vancomycinand Teicoplanin. Of these isolates 44.96 % of the isolates were Methicillin resistant S. aureus (MRSA).Resistance to Penicillin, Fluoroquinolone, Erythromycin, Gentamicin, Co-trimoxazole and Tetracyclinewere associated signifi cantly with MRSA isolates (X2= 8.779, p<0.05, X2= 74.233, p<0.05, X2= 84.2842,p<0.05, X2= 108.2032, p<0.05, X2= 88.1512, p<0.05 and X2= 79.1876, p<0.05 respectively). Althoughmost of the Methicillin sensitive S. aureus (MSSA) isolates were susceptible to both Rifampicinand Chloramphenicol, only Rifampicin susceptibility was signifi cantly associated with them (X2=10.1299, p<0.05). Among three Biochemical tests for the detection of β lactamase detection namelychromogenic, iodometric and acidimetric test, chromogenic test method had highest sensitivity andspecifi city.Conclusions: Since MRSA comprised a greater part of S. aureus isolates and were multi-resistant,patients infected by such strains should be identifi ed and kept in isolation for hospital infectioncontrol and treated with second line of drug like vancomycin.Key Words: β lactamase, methicillin resistant Staphylococcus aureus,methicillin sensitive Staphylococcus aureus, resistance pattern
Impact of Husbands’ Participation in Antenatal Health Education Services on Maternal Health Knowledge
Authors: Mullany BC , Lakhey B , Shrestha D , Hindin MJ , Becker S
Published: September 2018

INTRODUCTION:A randomized controlled trial was designed to test the impact of involving husbands in antenatal health education on women's maternal health knowledge.METHODS:Total 442 women receiving antenatal services at a hospital in Kathmandu, Nepal were randomized into three groups: women who attended education sessions with their husbands, women who attended education sessions alone, and women who attended no education sessions (controls). At baseline and after delivery, women's maternal health knowledge and change in knowledge levels were compared between the groups.RESULTS:Compared to control group women, women educated with husbands increased their knowledge scores by an average of 0.61 points (95% CI=0.32-0.89, P<0.001), while women educated alone increased their scores by only 0.34 points (95% CI=0.04-0.65, P<0.05). Women educated with partners could identify more pregnancy complications and family planning methods than women in both other groups.CONCLUSIONS:These findings suggest that women learn and retain the most information when they are educated with their partnersKeywords:couples intervention; male involvement; maternal health; Nepal
Nicorandil Induced Perianal Ulceration
Authors: Tiernan J P , Baraza W , Chelham W , Garner J , Angel C , Shrestha B M
Published: September 2018

Nicorandil is a cardioprotective drug which is used in the prophylaxis and long-term treatment ofangina pectoris. Debilitating perianal ulcer is a rare complication of Nicorandil therapy which cancause diagnostic and management dilemmas. We describe the management of a case of Nicorandilinducedperianal ulcer and review pertinent contemporary literature.Key Words: cardioprotection, ischaemia, Nicorandil, perianal ulcer
Lysosomal Storage Disease
Authors: Khatiwada Binod , Pokharel A
Published: September 2018

We report a case of lysosomal storage disease diagnosed by lysosomal enzyme assay in a two year oldboy with a history of gradual onset of weakness of body, poor vision, fl accid neck and spasticity in allfour limbs with hyper-refl exia. On fundus examination cherry red spots were noted at macula. Onperforming lysosomal enzyme assay, beta-galactosidase level was considerably low. This indicatesthat the child is affected by lysosomal storage disease most likely GM1 gangliosidosis. The diagnosisis important because the disease is rare and it may be missed as the symptoms are similar to otherneurological conditions and the diagnosis can help with future conception.Key Words: beta-galactosidase, GM1 gangliosidosis, lysosomal storage disease
Gross corelation between waist hip ration and random blood sugar level in Thami tribe of Dolakha district in Nepal
Authors: Kharal Puspa Mani , Prasad Pratap Narayan , Acharya Ramesh Prasad
Published: September 2018

Introduction:  Diabetes is one of the major public health problems in Nepal. Very few studies on correlation between waist hip ratio and random blood sugar have been done in remote areas of Nepal particularly in minor ethnic groups like Thami. This study attempted to compare waist hip ratio and blood sugar level in Thami community of Nepal.Methods: This cross sectional study was conducted in sub-health post of Lapilang village of Dolakha district of Nepal. A total of 243 local inhabitants from Thami Tribe participated in the study. Waist hip ratio was calculated after taking measurements of waist and hip using flexible measuring tape; and, blood glucose level was measured by glucometer.Results: The mean age of the participants was 46.02 years; among participants 126(51.9%) were males and 117(48.1%) were females. Mean waist hip ratio was 0.87, mean blood sugar level was 124.5mg%.Increase in Waist hip ratio correlated significantly with increase in  random blood sugar level both in males(p=0.008) and females(p=0.007).Conclusions:  Increase in waist hip ratio is associated with increase in random blood sugar level. Therefore, there is a need of public awareness program to reduce waist circumference thus reducing weight of people to prevent development of diabetes mellitus in long run.Keywords: blood sugar level; diabetes; Thami community; waist hip ratio
Twin Pregnancy with Fetus Papyraceous
Authors: Upadhyaya Indira , Pradhan M , Sharma R
Published: September 2018

A successful pregnancy outcome with vaginal delivery of a term single live fetus in case of twinpregnancy with other twin papyraceous, (vanished in second trimester) is an uncommon fi nding.Ten percent of all perinatal deaths are related with dizygotic twins. The rate of intrauterine fetaldemise in multiple pregnancies is as high as three times of monozygotic. Most frequently used andsuggested method is follow-up of the maternal coagulation system by a series of lab test. Sonographyis a visual tool to confi rm the diagnosis. In case of monofetal death of twin pregnancies, the type ofplacenta should be analysed and then follow up and treatment modalities of these cases should bechoosen.Key Words: death, fetal, pregnancy, single, twin
Radiological Techniques in the Diagnosis of Strangulating Small Bowel Obstruction
Authors: Jha Ashwini Kumar
Published: September 2018

ABSTRACTObjective: Early detection of signs of strangulation in case of acute small bowel obstruction is critical because it mandates an operation. So, the role of different available radiological techniques used for diagnosing strangulating SBO is reviewed.Conclusion: Strangulation remains a major problem in patients with acute small bowel obstruction. Despite of having several radiological diagnostic tools, CT is the only method with established higher diagnostic sensitivity and specificity in patients with acute small bowel obstruction as well as strangulation.Keywords: obstruction; radiological techniques; small intestines; strangulation.
General or Specialist Surgeons?
Authors: Shrestha B M
Published: September 2018

General Surgery is a broad surgical specialty that focuses on diseases related to abdominal organs,skins and hernias, both in elective and emergency settings. With the prevalent trend for increasingsubspecialisation in today's surgical practice, general surgery has lost some of its former glory andscope. This has led to suffering of the image of the general surgeons (GS) in the eyes of trainees,peers, the public and even GS themselves. A comprehensive review of literature is presented toaddress the controversy surrounding the role and future of general and specialist surgeons in thecurrent perspectives.Key Words: emergency, general surgeons, specialists, surgery
Minimal Invasive Anterior Decompression in Tuberculosis of Thoracolumbar Junction of the Spine – Experience With SynFrame
Authors: Karn Navin Kumar , Rao B S , Prabhakar M M
Published: September 2018

Introduction: This study assesses the role of new retractor system SynFrame for anteriordecompression of tuberculosis of thoracolumbar junction of the spine.Methods: This study includes fi ve consecutive patients with tuberculosis of thoracolumbar junctiontreated with minimal invasive anterior decompression using a new table mounted retractor systemSynFrame (Stratec Medical, Switzerland). The thoracolumbar junction was approached by a left sidedthoracotomy. Short construct pedicle screw stabilization was done in all cases before decompression.The anterior column was reconstructed using expandable cage (n=3) and autologous tricortical graft(n=2).Results: The mean operating time was 100 minutes (range 90-120). Mean overall blood loss was 400ml. No operation had to change into an open procedure. There were neither intra nor postoperativecomplications related to minimal access in particular, nor visceral/vascular complications.Conclusions: The ring retractor system allows minimal open surgery to the spine by carryingdifferent devices as well as endoscope, providing an excellent visualization of the operating fi eld,and is safe and easy to use. The only disadvantage is its high cost.Key Words: anterior decompression, minimal invasive spine surgery, SynFrame
A Ten year Clinicopathological Study of Female Genital Tuberculosis and Impact on Fertility
Authors: Mondal Santosh Kumar , Dutta TK
Published: September 2018

INTRODUCTION:To determine the histological pattern of involvement, clinical presentation, impact on fertility in women with genital tuberculosis.METHODS:A total number of 68 cases of gynaecological tuberculosis affecting different parts of female genital tract from 56 patients were selected. The age range of the patients was 17-36 years with mean age of 25.6 years. The diagnostic procedures used included endometrial curettage and biopsy, histopathological examination, culture and Mycobacterium Tuberculosis Polymerase Chain Reaction (MTB PCR), laparoscopy, Hysterosalpingography (HSG) and Ultrasonography (USG). Most of the specimens received were biopsies of endometrial curettage for evaluation of infertility. In 7 cases, specimens of total hysterectomy with bilateral salpingo-oophorectomy were submitted with lesions involving multiple sites.RESULTS:Patients presented with infertility (65-70%), pelvic/abdominal pain (50-55%), and menstrual disturbances (20-25%). Tuberculosis involved the endometrium in 55.88%, tubes in 23.53%, ovaries in 14.71% and cervix in 5.88% of the 68 cases. The endometrium(38 cases)was in the proliferative phase in 31 cases (81.57%), secretory phase in 4 cases (10.52%) and it was atrophic in 3 cases (7.89%).Caseation was present in 9 out of 68 cases and Ziehl-Neelsen (ZN) stain revealed Acid Fast Bacilli (AFB) in tissue sections in only 4 cases . After therapy, 9 patients conceived of which 8 suffered spontaneous abortions. Only one patient had a successful pregnancy and the baby was born through caesarean section.CONCLUSIONS:Genital tuberculosis is an important cause of female infertility in developing countries like India, Nepal, Bangladesh and Pakistan. Successful uterine pregnancy is rare after treatment and chances of ectopic pregnancy are high.Keywords: Key Words:female infertility, genital tuberculosis, histology
Tuberculosis in HIV Patient
Authors: Paudel Bidhan Nidhi , Paudel Punya , Paudel Luna , Dhungana Govinda Prasad , Amatya Gyanendra Lal , Kandel Prakash
Published: September 2018

Introduction: Strict monitoring of anti tuberculosis therapy (ATT) and antiretroviral therapy (ART) is crucial for proper management of TB/HIV co-infected patients.Methods: Between December 2006 and December 2008 a prospective observational study was conducted among 135 TB/HIV co-infected patients visiting antiretroviral therapy in Seti Zonal Hospital, Dhangadi. The diagnosed TB patients were subjected to ATT through directly observed treatment short-course (DOTS) and its response was evaluated as per WHO guidelines.Results:  Among 135 studied subjects, 71.9% were males and over 88 % of the patients were in the age group 21 to 50. Of the Total TB cases 68.1% presented pulmonary TB (PTB) and 37.20% of the Extra-pulmonary Tuberculosis (EPTB) cases were lymph node TB. 75.5% of them had completed ATT, 8.2% transfer out and 12.6% were default.Conclusions: Majority of the patients presented PTB, and lymph node TB was found to be the most common EPTB. Comparatively, high efficacy of ATT was found in HIV patients visiting this resource poor setting.Key words: antiretroviral therapy; anti TB therapy; Dhangadi; lymph node T; treatment response.
Clinico-radiological Aspects of Neurocysticercosis in Pediatric Population in a Tertiary Hospital
Authors: Shrestha Bandana , Mainali Prabha , Sayami Sujan , Shrestha Om Kumar
Published: September 2018

Introduction: Neurocysticercosis (NCC) is common in developing countries including Nepal. Clinical presentations vary depending on the CT scan findings of head. Adequate information of NCC in children from Western Nepal is lacking. This study was conducted with an objective of evaluating the most common clinical and radiological picture in children suffering from NCC at a tertiary care teaching hospital in Western Nepal. Methods: Hospital records of all pediatric inpatients, admitted from 16th June 2010 to 15th December 2012, consistent with the diagnosis of Neurocysticercosis were reviewed.Results: Among the 217 patients that either presented seizure or other neurological deficit, 49 were diagnosed as Neurocysticercosis. Their age varied between 2.6 years and 14 years with the mean age of 10.6 years and the peak age of 12 years among diagnosed inpatients. It also showed slight male predominance with the ratio of male and female being 1.22:1. Sorted based on geographical distribution, the maximum of 14 (28.6%) patients were from Kaski district, closely followed by Tanahun district with 13 (26.5%). 38 (77.5%) of the presentations were seizures, partial seizures being most common. 44 (89.8%) of the lesions were single, with 20 (40.8%) predominantly residing in the parietal region, 30 (61.22%) were in transitional stage. However, number of lesions discovered from CT scan of head showed no significance in association with seizure types (p=0.84). In addition, perilesional edema and scolex within the lesion were noted in 67.34% and 18.36% of the cases respectively._______________________________________________________________________________________Keywords: clinico-radiological profile; neurocysticercosis; pediatric population._______________________________________________________________________________________
Kartagener Syndrome: A Rare Genetic Disorder
Authors: Shakya Kunjan
Published: September 2018

Kartagener Syndrome is a rare autosomal recessive disorder consisting of triad of sinusitis, bronchiectasis and situs inversus with dextrocardia. It is the subset of disorder called primary ciliary dyskinesia in which the cilia have abnormal structure and/or function resulting in multisystem diseases of various severity. Clinical manifestations include lifelong, chronic upper and lower respiratory tract diseases secondary to ineffective mucociliary clearance. Early diagnosis and management of chest infections can prevent irreversible damage to lungs and prevent potential lifelong complications. This case report is on a patient who presented with long standing history of sinusitis, bronchiectasis and on examination situs inversus with dextrocardia.Key Words:bronchiectasis, dextrocardia, kartagener syndrome, primary ciliary dyskinesia, situs inversus
Ocular Trauma in Rapti Eye Hospital, Dang 1993 (2049-2050)
Authors: Adhakiri Rishi Kanta , Pokherel Hukum , CHaudhari Lal Bahadur , Sharma Menuka , Chaudhari Birbhan , Sharma Suresh Raj , Sharma Jogi Ram , Chaudhari Ganesh , Chaudhari Hari Ram , Dangi Ambika
Published: September 2018

Abstract
Bilateral Pulmonary Hydatid Cyst One Stage Bilateral Thoractomy and Exccicion of Cyst.
Authors: Sayami Prakash , Singh Bishow Man , Sharma Govinda
Published: September 2018

abstract
Multiple Primary Carcinomata: Clinical and Genetic Management
Authors: Shrestha B M , Stephenson B M , Davies J P , Sturdy D E
Published: September 2018

abstract
Spontaneous recovery of Right Bundle Branch Block (RBBB) in Acute Anterior wall Myocardial Infraction with Bifascicular Block.
Authors: Shrestha Bala Ram , Rizyal Shekhar Babu , Paudel Ratna Raj
Published: September 2018

Abstract
The Neplease National Health Policy-1991.
Authors: Mathema Padma
Published: September 2018

abstract
Anesthetic management of a child with Down’s Syndrome having atlanto axial instability
Authors: Bhattarai Basant , Kulkarni AH , Kalingarayar S , Upadya MP
Published: September 2018

Down's syndrome is the most commonly encountered congenital anomaly in medical practice. These patients are of special concern to medical practice because of their associated problems with regard to respiratory, cardiovascular and other systemic problems. As these patients present for repeated surgeries like dental extraction, facial reconstruction and fixation of cervical spine, these patients pose challenges to the anesthesiologist because of their unique set of problems, namely atlantoaxial instability, small trachea, congenital heart disease and repeated chest infections due to lowered immunity. Their reactivity to inhalational anesthetics and atropine is variable. Here we present an interesting case report of a child with Down's syndrome who presented with atlantoaxial instability for MRI of cervical spine under general anesthesia.KeyWords:atlanto axial instability, down’s syndrome, trisomy 21
Bone Marrow Examination in Cases of Pancytopenia
Authors: Jha Abhimanyu , Sayami G , Adhikari R C , Panta A D , Jha R
Published: September 2018

This study was carried to identify the causes of pancytopenia and to fi nd out the bone marrowmorphology in cases of pancytopenia.It was a cross sectional study conducted over a period of two years in the Department of Pathology,Tribhuvan University Teaching Hospital. Bone marrow aspiration smears of patients fulfi lling thecriteria of pancytopenia were examined. The data obtained were analyzed using measures of centraltendency.One hundred and forty eight cases underwent bone marrow aspiration and it constituted 15.74% oftotal cases. Mean age was 30 years (range, 1-79 years). 42 cases were children (28.37%). Male: femaleratio was 1.5:1. The commonest cause was hypoplastic bone marrow seen in 43 cases (29%) followedby megaloblastic anemia in 35 cases (23.64%), and hematological malignancy in 32 cases (21.62%).Erythroid hyperplasia was seen in 29 cases (19.6%) and normal bone marrow was seen in 5 cases(3.38%). There was one case each of Niemann-Pick disease and metastatic neuroblastoma in childrenand chronic pure red cell aplasia and leishmaniasis in adults. Acute leukemia was the commonesthematological malignancy. In children, commonest fi nding was hypoplastic bone marrow (38.1%)while in adults megaloblastic anemia (30.18%) was commonest fi nding followed by hypoplasticanemia (25.47%).In present study bone marrow examination was able to establish diagnosis in 77% of cases. Hypoplasticmarrow was the commonest diagnosis, followed by megaloblastic anemia, and hematologicalmalignancies.Key Words: Bone marrow aspiration, hypoplastic anemia, leukemia, megaloblastic anemia,pancytopenia
National Health Policy of Nepal-Time to Revisit and Reform
Authors: Magar Angel
Published: September 2018

Abstract
A Comparison of Glomerular Filtration Rate by Creatinine Based Equations and DTPA-Renogram in Healthy Adult Kidney Donors
Authors: Chaurasia Ramesh Kumar , Agrawal Rajendra Kumar , Hada Rajani , Chaurasia Sweta Kumari , Gurung Santosh , Basnet Shakti
Published: September 2018

Introduction: Accurate determination of donor kidney function has important long-term implications for both donor health and recipient outcome. Many centers use 24 hour urinary creatinine clearance or creatinine-based GFR estimations to assess kidney function but their performance when compared with GFR measurements by isotope clearance remains inconclusive. We assessed the performance of creatinine based equations against DTPA GFR for evaluating Nepalese kidney donors.Methods: All kidney donors who had undergone both DTPA GFR estimation and 24 hour urine CrCl were included. The performance of the urine-CrCl, CG-CrCl, modified MDRD GFR against DTPA GFR was evaluated by analyzing global bias, precision (R2),Pearson correlation and accuracy percentage within 30% and 15%. The sensitivity and specificity of each predictive equation in selecting donor with GFR of ≥80 mL/min/1.73 m2 was also calculated.Results: Of 51 donors analysed, only 18 (35.29%) were male. The mean measured GFR was 102.752±16.71 mL/min/1.73 m2. Of all prediction equations, urine-CrCL has most precision (R2=0.207) with the highest pearson correlation (0.455) and highest accuracy percentage within 30% and 15%. However, predictive performance was poor for all the equations. The urine CrCl had highest sensitivity of 100% for detecting donor with measured GFR>80 mL/min/1.73 m2 with positive predictive value of 92.1%.Conclusions: The performance of all equations was disappointing and even the best performing equation urine-CrCl was suboptimal for donor selection. So considering the potential risk of living kidney donation, other more accurate methods of GFR estimation should be used._________________________________________________________Keywords: Cockcroft-Gault equation; creatinine clearance; glomerular filtration rate; modification of diet in enal disease formula; 99mTc-Diethylene-Triamine Pentaacetic Acid.
ABO and Rh Blood Groups and their Ethnic Distribution in a Teaching Hospital of Kathmandu, Nepal
Authors: Shrestha Lava , Malla Uzwali , Mahotra Narayan Bahadur
Published: September 2018

Introduction: ABO and Rh blood group systems are the most important blood grouping systems from clinical aspect. Determination of blood group is important for blood transfusion therapy, medico-legal purposes, organ transplantation, settlement of paternity disputes etc.Methods: A cross-sectional descriptive study was carried out for a period of one year from 1st January 2011 to 31st December 2011 in blood bank of Tribhuvan University Teaching Hospital. All blood samples collected for blood group determination were included in the study. Blood group was determined by slide agglutination method using commercial antisera.Results: A total of 13568 blood samples were analyzed, 5123 (37.75%) were male and 8445 (62.25%) were female. Frequencies of blood groups A, B, AB and O were found to be 4034 (29.7%), 3665 (27.0%), 1114 (8.2%) and 4755 (35.1%). Frequencies of Rh positive and Rh negative blood groups were found to be 13200 (97.3%) and 368 (2.7%). Blood group O was common in Brahmin, Chhetri, Tamang, Lama, Gurung, Sherpa, Terai Brahmin, Muslim and Yadav ethnicities; blood group A was common in Newar, Rai, Magar, Limbu and Sanyasi ethnicitites; and blood group B was common in Tharu and Marwari ethnicities.Conclusions: Blood group O was found to be the most common blood group while AB was the rarest one. It was found that blood group O is the more common in Sherpa, Brahmin and Yadav; A in Limbu, Rai and Newar; and B in Tharu and Marwari ethnicities._______________________________________________________________________________________Keywords: ABO; blood group; ethnic distribution.
A 14 Years Hospital Based Study on Clinical and Morphological Spectrum of Hydatid Disease
Authors: Ghartimagar Dilasma , Ghosh Arnab , Shrestha Manish Kiran , Talwar OP , Sathian Brijesh
Published: September 2018

Introduction: Hydatid disease is endemic in sheep and cattle-raising areas worldwide. Its prevalence is high in Nepal. The study was carried out to determine the clinical, radiological and pathological presentations of hydatid disease.Methods: This was a retrospective study of all hydatid disease cases reported in Department of Pathology, from August 1996 to July 2010. All the clinical, radiological and pathological data were collected and collated. Results: A total of 51 cases of hydatidosis were studied. Patients presented with related symptoms in 47 cases, 92.16% with CI (84.78, 99.54) and asymptomatic in four cases, 7.84% with CI (0.46, 15.22). Involvement of liver and lung was found in 35 (68.63%) cases and 10 (19.61%) cases respectively. Involvement of other organs like kidney, pelvis and broad ligament were seen in 6 of the cases. Total 29 cases, 56.86% with CI (43.2, 70.46) had solitary cyst while rest of the cases had multiloculated cyst. All cases had radiological correlation and histopathological confirmation. Conclusions: Most cases presented with organ related vague symptoms, however it should be considered as a differential diagnosis especially in asymptomatic cases and cases with unusual sites. Imaging studies is useful in preoperative diagnosis and postoperative histopathology is confirmatory. A multicentric hospital based study will help to decrease the incidence._______________________________________________________________________________________Keywords: echinoccocus; hydatid cyst; hydatidosis.
Partial Splenectomy for Epithelial (Epidermoid) Splenic Cysts: Report of Two Cases
Authors: Paudel Gun Raj , Agarwal Rajat , Pathania Om Prakash , Agrawal Chandra Shekhar
Published: September 2018

Primary splenic cyst is a relatively rare disease, and the majority of cases are classified as epithelial (epidermoid) cysts. Two cases with epithelial splenic cysts are presented. Both cases had some similar symptomatology, like fullness in the left upper abdomen and a palpable mass. Preoperative radiological diagnosis was pancreatic pseudocysts. Exploratory laparotomy and partial splenectomy was done. The post operative period was uneventful in both the cases.Because of post-splenectomy sepsis, the management has shifted to splenic preservation when feasible. Partial splenectomy is an acceptable procedure for the treatment of splenic cysts which are suitably located, because it cures the disease preserving the splenic tissue. Complete splenectomy is reserved for cases in which cyst excision cannot be done otherwise. Keywords: epithelial splenic cysts; partial splenectomy; splenic preservation.
Abdominal Lump: A Diagnostic Dilemma
Authors: Bhandari Ramesh Singh , Shrestha M , Shrestha GK , Shrestha PR , Singh KP
Published: September 2018

Abdomen is a Pandora's Box. During our routine patient evaluation we come across different types of abdominal lumps out of which some are straight forward and diagnosed after routine clinical examinations and available investigations. At times these abdominal lumps present differently from their usual presentations and create confusions despite undergoing necessary investigations. The truth is explored only after opening the Pandora's Box. We present a case of 21 years old male who presented with history of gradually increasing right sided upper abdominal lump of three years duration. He was thoroughly investigated with USG and CT scan abdomen along with other supportive investigations and was diagnosed to have Hydatid cyst of liver. Accordingly patient was prepared for surgery and it was only at the time of laparotomy that he was found to have right sided giant hydronephrosis with a nonviable renal parenchymal tissue. He underwent right sided nephrectomy and had a good postoperative recovery. So at times the abdominal lumps keep on creating diagnostic dilemmas.Key words: abdominal lump, giant hydronephrosis
Psychiatric Emergencies in a Tertiary Care Hospital
Authors: Shakya Dharma Ratna , Shyangwa P M , Shakya R
Published: September 2018

People with psychiatric problems often visit a general hospital. Many of them require emergencyservice. B P Koirala Institute of Health Sciences (BPKIHS) is one of the few health institutes in Nepalproviding comprehensive 24-hour psychiatric emergency service. This study aims to document thepattern of psychiatric emergencies in a tertiary care hospital of Eastern Nepal.All psychiatric emergencies referred from different departments in 30 random days during a sixmonthperiod were enrolled. This is a descriptive study with convenience sampling method wherethe diagnoses were made based on the‘International Classifi cation of Disease and Infi rmity’ (ICD-10).One hundred twenty-nine cases were referred in the study period. The M:F ratio was 1.3:1. Theservice users were predominantly young adults. The majority of cases were seen in the emergencydepartment and medical ward. The most common causes for the consultation were behavioralproblems (39%), altered consciousness (32%) and somatic complaints (17%). Approximately 83%received the diagnosis of Category F of the ICD-10. Mental and behavioral disorder due to substanceuse (F10-19) was the most common disorder (30%), followed by mood/affective disorders (23%)and neurotic, stress-related anxiety disorders (16%). Roughly 46% had co-morbid physical illnessesand 8% received only a physical diagnosis. About 20% had attempted suicide using different means,poisoning being the most common.Emergency psychiatric consultation for mental problems is sought by almost all departments of ageneral hospital. These consultations are most commonly sought for substance use, mood or anxietydisorders.Key Words: Behavioral problems, psychiatric emergency, psychiatric disorders, substance abuse.
Halfway up the highway: Can Nepal meet its Health Millennium Development Goals?
Authors: Vaidya Abhinav , Jha N
Published: September 2018

The Millennium Development Goals (MDGs) are international objectives on poverty reduction adopted by the world community and provide the broad context for this revolution in thinking and practice. The MDGs place a central focus on public health, in recognition of the fact that improvements in public health are vital not only in their own right but also to break the poverty trap of the world's poorest economies. Nepal has been committed to achieving the MDGs since it endorsed the Millennium Declaration. As we have at present just passed the midway through the 15 years to MDGs deadline of 2015, this article reviews the status of Nepal in achieving the MDGs, the challenges it faces and whether it can achieve the MDGs by 2015.Key words: development, goals, health, millennium, Nepal