bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of radiation dose in single and split bolus multidetector computed tomography urography
Authors: Joshi BR , Jha A
Published: July 2024

Introduction: Routine multidetector computed tomography (MDCT) urography protocols include three phase scan with single bolus contrast material injection. To reduce the radiation dose a split bolus MDCT urography technique has been introduced.
Methods: Nephrographic phase in single bolus was obtained by injecting 90 ml of Ioversol (Optiray320mgI/ml) contrast at the rate of 3ml/s during the preset time of 90 second. The excretory phase was taken at the delay of 10 minutes after the contrast injection. For split bolus only two phases (unenhanced and combined) were scanned from the diaphragm to the base of the urinary bladder. The combined phase in split bolus was performed by injecting the contrast in two bolus in which 40 ml at 2ml/s was injected in the first bolus and after a delay of 9 minutes, 60 ml at a rate of 3ml/s was injected, then the scan was obtained 90 second after the second bolus. The volume CT dose index (CTDIvol) and CT dose length product (CTDLP) were assessed in CT work station.
Results: The mean effective radiation dose for single bolus MDCT urography was 40.5% more than the split bolus MDCT urography.
Conclusion: Split bolus MDCT urography protocol was significantly better in effective radiation dose reduction compared with the single bolus MDCT urography protocol.
Laparoscopic Cholecystectomy in a Private Hospital
Authors: Shrestha J , Vaidya P , Khakurel M
Published: July 2024

Introduction: Laparoscopic Cholecystectomy is the gold standard for benign Gall Bladder disease. Laparoscopic Cholecystectomy has rapidly gained popularity and it is one of the commonly performed operations in Nepal. The current study was carried out in the Department of General Surgery, Hospital for Advanced Medicine and Surgery (HAMS), Kathmandu, Nepal to evaluate the result of Laparoscopic Cholecystectomy in our set up.
Methods: A retrospective review of medical records was conducted on all study patients. Demographic data, indication for surgery, rate of conversion to open cholecystectomy, morbidity and mortality rates were noted. The data of all patients who underwent laparoscopic cholecystectomy from April, 2012 to April, 2014 was entered in standardized proforma and analysed on SPSS 20.
Results: A total of 130 Cholecystectomy over a period of 2 years, Male: Female ratio 1:1.9. Mean Age group 41-50 years. Out of all these patients 76% patients presented with symptoms while 24% were asymptomatic. Overall conversion rate was 9.2%. The average hospital stay was 2 days. There were no complications and no mortality in this period of study.
Conclusion: Our finding demonstrates that there was no difference in the outcome whether the patient was given the antibiotics post-operatively or not. Even the diabetics can be treated with prophylactic doses of antibiotics. Three port technique was safe. Complications can be avoided even without selecting cases if two surgeons perform together and early decision of conversion to open cholecystectomy is made.
Prevalence and types of corneal astigmatism in patients undergoing cataract surgery
Authors: Chaudhary M , Dahal HN
Published: July 2024

Introduction: Cataract surgery is one of the most commonly performed ophthalmic surgical procedures worldwide, with a high rate of successful and rapid anatomical and functional visual recovery. Goal of cataract surgery is to achieve a desirable induction of refractive outcome with minimal astigmatism after surgery. This brings to interest the question of influence of preoperative and surgically induced corneal astigmatism on the final postoperative unaided visual acuity. Pre-existing corneal astigmatism is an important limiting factor for optimal results of cataract surgery in a significant number of patients. It has been estimated that 15% to 29% of patients with cataract have more than 1.50 dioptres (D) of pre-existing astigmatism.
Methods: Prospective study was carried out to investigate the prevalence and pattern of pre-existing corneal astigmatism in patients undergoing cataract surgery at B.P. Koirala Lions Center for Ophthalmic Studies, T.U. Teaching Hospital for a period of 2 years. All patients underwent complete ophthalmic examination including visual acuity, refraction, slit lamp examination, applanation tonometry and dilated fundus evaluation, biometry and ultrasound B-scan examination. Corneal astigmatism was measured by Keratometer at least two times for each patient. Astigmatism was calculated from dioptric difference between vertical reading and horizontal reading. With the rule (WTR) astigmatism was considered when steep meridian was at 900 ± 300. Against the rule (ATR) astigmatism was considered when steep meridian was at 1800 ± 300.
Results: Study included 225 eyes of 185 subjects, out of which 38.7% were male eyes and 61.3% were female eyes. The mean age of the subjects was 64.45±12.89 years. Mean amount of corneal astigmatism in our study was 0.84±0.80 D. 16.9% had no significant corneal astigmatism while 65.3% had corneal astigmatism between 0.25 and 1.50 diopter and 17.8% had corneal astigmatism of 1.50D or higher. With-the-rule astigmatism (axis of correcting cylinder 180±30 degrees) was present in 44.4% eyes, 40.04% of the eyes had against-the-rule (ATR) astigmatism (correcting minus cylinder 90±30 degrees), and 12.9% of the eyes had oblique astigmatism.
Conclusion: Approximately two thirds of pre-operative cataract patients had 1D or less astigmatism. Corneal astigmatism increases with age. Hence, it is important to analyze the magnitude and pattern of pre-existing corneal astigmatism in aging population due to higher demand for improved vision and use of suitable methods for best visual results.
Nasolabial cyst: Clinical presentation and surgical outcome of 14 cases with literature review
Authors: Gurung U , Tamang N , Tripathi P
Published: July 2024

Introduction: Nasolabial cyst is a rare, developmental, non-odontogenic cyst in the nasal alar region. The study aimed to assess the clinical characteristics, intra-operative findings, complications and recurrence following sublabial excision of nasolabial cyst and review the related literature.
Methods: It was a retrospective chart review of 14 cases of nasolabial cysts who underwent excision via sublabial approach in a tertiary center from December 2014 to May 2017. The data on clinical characteristics, intra-operative findings, complications and recurrence were assessed.
Results: Fourteen patients consisted of 9 females and 5 males. The age ranged from 22 to 73 years. Alar fullness was common presentation for all while 3 patients had associated pain. Two patients noted nasal obstruction. The cyst was located on left in 8 and on right side in 6 patients. The size ranged from 1.5 x1.5 to 4 x 4 cm2. All patients had the cyst excised totally via sublabial approach. Post-operatively, 8 patients developed cheek swelling which subsided within 2 weeks. None of the patients had gingival or tooth numbness or wound gape. There was no recurrence noted in follow up ranging from 3 to 30 months.
Conclusions: Nasolabial cyst is a slow growing, unilateral cyst in the nasal alar region, common in female in the fourth and fifth decade. Sublabial excision is the standard treatment with no recurrence however it has risk of intra-operative rupture of cyst and complications like cheek swelling, bruising, facial pain, facial numbness, numbness of teeth or gingiva. Transnasal endoscopic marsupialization is a new treatment modality.
Incidence of third head of biceps brachii muscles
Authors: S.Bilodi Arun Kumar , Sanikop M.B. , Prakash Jeevan
Published: July 2024

This study shows the incidence of extra head of Biceps Brachii which was found during routine dissection by the first year students of MBBS at Sri Devraj Urs Medical College, Tamaka, Kolar, Karnataka (State), India.
Lived Experience of Mothers with Duchenne Muscular Dystrophy Children, Kathmandu
Authors: Prasai S , Uprety S
Published: July 2024

Introduction: Duchenne Muscular Dystrophy (DMD) is a genetic neuromuscular disorder with functional disability. In Nepal, eight hundred cases have been registered in Muscular Dystrophy Foundation (MDF). The Survival age of child with Duchene Muscular Dystrophy (DMD) is not more than twenty four years of life. (MDF-Nepal). The purpose of this study was to explore the lived experiences of mothers who are taking care of children with muscular dystrophy.
Methods: Using a phenomenological design, nine mothers having DMD children were selected. Data was gathered using In-depth interview method. Respondent’s verbal as well as nonverbal clues were recorded during observation. Two to three in-depth interviews were carried out with each respondent along with audio tape recording and field notes.
Results: Almost all of the respondents perceived DMD as a progressive fatal form of neuromuscular disease making the child unable to walk by 7-8 years of age. Majority of the respondents had suffered from psychosocial problems as well. The initial reaction of mothers regarding children’s diagnosis was a feeling of mixed emotion. Majority of the mothers relieved their anxiety to some extent by sharing their feelings with others, assuring themselves and accepting their reality of their child’s illness. Clusters of themes were identified: perception regarding disease, treatment modality, physical mobility of child, and coping mechanisms.
Conclusion: Mothers of DMD children are facing a huge array of problems which has decreases the quality of life of mothers. It is recommended to provide, social security, free supply of medicine, health facility and Palliative care for DMD child so that parents may face fewer problems.
Zolpidem dependence
Authors: Tulachan P , Pant SB , Chapagai M , Dhungana S , Ojha SP
Published: July 2024

Recently, Zolpidem dependence is rising in clinical practice. It was once thought to have low addictive potential due to its selective affinity to α1-GABAA receptors. However, contemporary studies have shown that Zolpidem may lack selectivity when used at high dose for extended periods of time and may show addictive potential similar to that of the benzodiazepines. We hereby report a case of Zolpidem dependence in a physician with insomnia, which was successfully detoxified with Diazepam to emphasizethe caution while prescribing it.
Information technology to provide ‘Health care’ for all
Authors: JIOM
Published: July 2024

N/A
Evaluation of clinical profile, management and outcomes of molar pregnancy
Authors: Rijal H
Published: July 2024

Introduction: Hydatidiform mole is benign form of gestational trophoblastic disease characterized by hydropic swelling of the chorionic villi and proliferation of the trophoblasts. The majority of Hydatidiform mole is cured by simple surgical intervention. The disease can re-occur. The patients are followed up with serial serum BhCG till the normal level is achieved. With raised, plaetue level of serum β-hCG values, persistant GTD is diagnosed. So the proper monitoring and follow up of gestational trophoblastic disease is a must. It reduces both the morbidity and mortality of the women. This study details the clinical profiles and outcome of molar pregnancy.
Methods: This is an observational study conducted in Department of Obstretrics and Gynaecology at Tribhuvan University Teaching Hospital from 1st May 2015 to 30th April 2017 (2 years). Patients with the provisional diagnosis of molar pregnancy during the study period were included. After all required investigations, cases were managed according to the diagnosis. And were followed up with serial serum B-hCG. Further required treatment was given according the histopathological diagnosis.
Results: Total 46 cases of gestational trophoblastic disease (GTD) were diagnosed and it accounted for 4.9 per 1000 deliveries. Majority of patients belonged to age group of 20-40 years, presented during second trimester with amenorrhoea and per vaginal bleeding. Among these patients 93% (n=43) had suction evacuation, 5 % (n=2) had total abdominal hystrectomy with bilateral salphingo oophorectomy (TAH BSO), 2 % (n=1) had suction evacuation and laparotomy with untwisting of twisted theca luteal cyst. Thirteen patients developed persistent gestational trohphoblastic tumour (PGTT) and six patients were diagnosed as gestational trophoblastic neoplasia (GTN) and managed with multiagent chemotherapy.
Conclusions: Any deviation from normal norms in pregnancy or post delivery, gestational trophoblastic disease has to be thought of. Along with proper diagnosis and management, counseling regarding follow up should also be emphasized, which not only reduces morbidity but also reduces the mortality.
Community-based revolving drug funds - The way forward ?
Authors: Holloway K. A. , Gautam B. R.
Published: July 2024

Lack of drugs due to insufficient government (HMGN) funds undermines primary health care in Nepal. In order to address this problem, a number of organizations have been operating local revolving drug funds. HMGN now plans a national drug re-supplysystem, the Community Drug Programme (CDP), based upon community-controlled revolving drug funds. This paper looks at the experience of the various drug schemes operating in Nepal with a view to finding "lessons learnt" that can be used in theplanning process for the CDP. The paper incorporates a comparative study of the various drug schemes based upon data collected at health facilities and any involved organizations. Prescribing, quality of care, access, financial data, community involvement and sustainability were looked at and discussed. It was found that there was a trade-off between sustainability and quality of care. An example of a revolving drug fund is then worked through in steps showing the various issues that must be addressed. This example shows that provided HMGN continues to supply an annual drug indent (worth the same amount) and if village development committees provide a small subsidy (within the amounts recommended for health by HMGN) then patients need only pay a nominal user fee, no more than 50% of the wholesale cost of the drugs. This is considerably less than that recommended by the CDP and is advantageous in terms of patient access. Recommendations include that (1) item user fees, not more than 50% of the cost of the drugs, are charged, (2) the cost of drugs is shared between central government (HMGN), local communities (villagedevelopment committees) and individual patients, and (3) the establishment of district drug stores under the control of district health office and the district development committee be established.
Clinical and epidemiological profile of bacterial pathogens isolated from infected lesions in Kathmandu University Hospital.
Authors: Sherchan JB , Gurung P , Bhusal N , Pote N , Tamrakar SR , Malla BR , Tamrakar R
Published: July 2024

Introduction: Treatment of the patient with wound infected with multidrug resistant organism is a major burden and challenge to the health care persons. This study was conducted to identify the clinical and epidemiological profile of such patients.
Methods: The study was a cross-sectional study conducted between November 2017 to June 2018 in Kathmandu University Hospital. Wound swabs, pus samples collected from patients during the study period were included. Specimen collection, culture, identification tests were done following standard guidelines and patient information was collected after informed consent.
Results: Total number of patients observed for wound infection was 2,763. 1,550(56.10%) were postoperative wound and 1213(43.90%) were non-post-operative wound. Pathogenic bacteria were detected in 252(9.12%) samples. 167(66.27%) were multidrug resistant.
Conclusion: Since, limited data is available in Nepal, determination of clinical and epidemiological profile of wound infection might become a useful tool to prepare guidelines for controlling and treating infected wound in healthcare centers and community.
Evaluation of image quality of pelvis antero-posterior view radiographs
Authors: Joshi BR , Bhusal D
Published: July 2024

Introduction: Pelvic radiography is a common radiographic examination. Thus it is important to depict entire anatomical structure with an acceptable image quality. This study was done for quantitative evaluation of pelvis radiographs by depiction of the anatomical and physical details.
Methods: In this cross-sectional study, about 11.5 pelvis radiographs were selected over two months period. Eight image quality criteria i.e. anatomical coverage, sharp bony detail, rotation, collimation, artifact, beam centering, SI joint visibility and gonad protection were included.
Results: Out of the 115 radiographs, only about 13 fulfilled all the image quality criteria, the rest 87 lacked either one or more of the criteria.
Conclusions: To a great extent the quality of the pelvic radiographs depends on the skill of radiographer, equipment condition Ex-ray machine CR reader) and also co-operation of patients.
Annular pancreas in a patient with malignant obstructive jaundice: A case report
Authors: Shah S , Bhandari R S
Published: July 2024

Majority of cases with annular pancreas are asymptomatic. Common presentations in symptomatic patients are abdominal pain, nausea and vomiting. Jaundice is very rare presentation of annular pancreas. We are presenting a case of 40 years male with annular pancrea. He presented with jaundice, anorexia and weight loss. Contrast enhanced computed tomography shows annular pancreas with extrahepatic as well as intrahepatic bile duct dilatation. Magnetic resonant cholangiopancreatography showed abrupt narrowing of distal common bile duct with upstream dilation of biliary duct suggestive of distal cholangiocarcinoma. This case illustrates the important of evaluation for malignant cause of obstructive jaundice in patients with annular pancreas presented with jaundice, anorexia and weight loss.
Combination treatment with carbamazepine and clonidine in a case of epilepsy with ADHD
Authors: Adhikari S , Upadhyaya S , Pant SB , Dhungana S , Tulachan P , Chapagai M , Ojha SP
Published: July 2024

In a child with epilepsy, Attention Deficit Hyperactivity Disorder (ADHD) is found to be more prevalent in comparison to general population. In western literature for the management of ADHD, stimulants like Methylphenidate and non-stimulant like Atomoxetine are considered the first line drugs. Although no any robust findings are found that support the use of such drugs in cases of epilepsy with ADHD, still they recommend using these drugs in such cases. In our scenario availability of such drugs is a major hindrance for which second line drugs like alpha agonists are the only options available to us. Here in this case report we have used Clonidine along with Carbamazepine in the management of a 12 years child presented in our centre with episodes of seizure and ADHD and had shown significant improvement with these medications.
Hepatitis E induced severe myositis
Authors: Nepali R , Shah DS , Sigdel MR
Published: July 2024

Hepatitis E is one of a rare cause of viral myositis in immunocompromised patients. Presentation in immunocompetent patient is even rarer. We present a case of 26-year-old female patient who presented with viral myositis secondary to hepatitis E with rhabdomyolysis with acute kidney injury with right leg foot drop due to compartment syndrome in an immunocompetent patient.
Keywords: Hepatitis E, viral myositis, Rhabdomyolysis
Introduction
Hepatitis E is one of a rare cause of viral myositis in immunocompromised patients. The clinical manifestations ranges from myalgias to rhabdomyolysis with myoglobinuric renal failure. Here, we present a case of viral myositis with rhabdomyolysis and acute kidney injury secondary to acute hepatitis E infection in immunocompetent patient.
Identification of Non-rotavirus associated gastroenteritis pathogens among children with diarrhea in Nepal
Authors: Sherchand Jeevan B
Published: July 2024

N/A
Manual Vaginal Reversion of Acute Puerperal Uterine Inversion: Learning by Doing.
Authors: Katuwal N , Pokharel M , Subedi K , Baniya J , Sherchan K , Rawal S , Baral J , Gurung G , Rana A
Published: July 2024

Uterine inversion is the folding of the fundus into the uterine cavity in varying degrees. Acute uterine inversion is a rare and unpredictable obstetric emergency. Here we report a case of a woman who had vaginal delivery complicated by postpartum hemorrhage. Diagnosed as acute puerperal uterine inversion; reposition was tried in the labor room which failed ensuing shock. Simultaneous fluid resuscitation and manual vaginal reversion under general anesthesia was done in Operation Theater, also needing blood transfusion, 5 units in total. Therefore, this case is described herein to illustrate the importance of early recognition and prompt reversion of inverted uterus vaginally,as delay can render replacement progressively more difficult and also increase the risk of hemorrhage.
Epidemiological study of hand injury in a tertiary care centre in Nepal
Authors: Sharma S , Shrestha JM , Rayamajhi S , Manandhar K , Lohani I
Published: July 2024

Introduction: The epidemiology and pattern of hand injury may vary from one region to the other. Due to the lack of systematic documentation, not much is known regarding the epidemiology of hand injury in Nepal. The purpose of this study was to determine the patterns of hand injury in a tertiary care centre in a developing country like Nepal.
Methods: A cross-sectional descriptive study was carried out in the Department of Plastic Surgery and Burns, Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. The study included 174 patients presenting with hand injury in the emergency room and the outpatient department.
Results: There were 129 (74.1%) males and 45 (25.9%) female patients, the mean age of all patients being 30.3 years. The top four occupations concerned with hand injuries were carpenters, students, manual labourers and factory workers. Most injuries occurred in furniture and wood workshops. Electrically powered saw belt and grinding machinery were the culprits for majority of crush/avulsion injuries whereas broken glass was the commonest cause of sharp cut injury. Tendon injury was the most common diagnosis followed by fractures and fingertip injuries. Accordingly, tendon repair followed by fixation of fractures were the commonly carried out treatment procedures.
Conclusion: Hand injuries are very common among young male furniture and wood factory workers as well as manual labourers having occupational exposure to different machines. Formulating safety protocols in the furniture and industrial settings and other machinery related workplaces would play a significant role in reducing the incidence of hand injuries.
Does stenting improve the surgical outcome of Endoscopic Dacryocystorhinostomy? A prospective randomized study
Authors: Gurung U , Rauniyar N , Pradhan B , Thapa N
Published: July 2024

Introduction: The objective of this study was to compare the surgical outcome of endoscopic dacyrocystorhinostomy with or without stenting. It was a prospective, randomized study conducted from October 2011 to September 2013. Ganesh Man Singh Memorial Academy for ENT-Head and Neck Studies ,Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
Methods: Patients aged 15 years and above of all genders with primary acquired nasolacrimal duct obstruction (PANDO) were included in the study. Forty patients were randomly allocated into two groups, 20 each in Endoscopic Dacyrocystorhinostomy with stenting (EwS) and Endoscopic Dacyrocystorhinostomy without stenting (EoS). Post-operative assessment was done at 8 weeks. In the subjective assessment using with 5-point Likert Scale of degree of epiphora, a score of 1, 2 or 3 was considered a success. Objective assessment with syringing and endoscopic evaluation of patency of rhinostome considered patent and partly patent lacrimal system on syringing and patent rhinostome as success.
Results: Both the subjective and objectivesuccess rate was 95% in EwS and 90% in EoS.However, there was no significant statistical difference between the two groups (p value =1.00).
Conclusion: The success rate of EwS was comparable to that of EoS with no added benefit in our study. In addition, EoS avoided the complications associated with stenting. So, we recommend EoS for PANDO.
Measurement of Renal Arteries Using Multi detector Computed Tomography: A Study in Tertiary Care Hospital in Nepal
Authors: Khanal UP , Ansari M , Humagain M , Dhakal S
Published: July 2024

Introduction: The purpose of this study was to determine the dimensions of the renal arteries (length and diameter), among the patients referred for Contrast Enhanced CT(CECT) of abdomen in department of Radiology and Imaging, Tribhuwan University, Teaching Hospital.
Methods: This prospective study was performed in Department of Radiology and Imaging TUTH with A total of 135 (73 male and 62 female) patients underwent CECT abdomen from June to September 2018. In this study the diameter of right and left renal arteries, the length of right and left renal arteries were determined.
Results: The mean values of right renal artery diameter were found to be (0 .5706 ± 0.09861 cm) in males and (0.5061 ± 0.08384 cm) in females respectively. The mean values of left renal arteries diameter were found to be (0.5889 ± 0.10351 cm) in males and (0.5354 ± 0.10552 cm) in females respectively. The mean values of right renal artery length were found to be (4.568751 ± 0.83128cm) in males and (4.0318 ± 0.87575cm) in females respectively. The mean values of left renal arteries length were found to be (3.5990 ± 0.79567cm) in males and (3.2002 ± 0.59207cm) in females respectively. The diameter of renal artery diameter exhibited statistically significant differences in relation to age of the patients (p<0.05) with peak values in 55- 64 years age group where the mean right and left renal arteries diameters were found to be 5.801 mm and 6.012 mm respectively.
Conclusion: This study concluded that the diameter of the renal arteries varies significantly with the age of the patients.
Short term hearing results in patients with otosclerosis after stapedotomy in a tertiary care center.
Authors: Rayamajhi P , Rauniyar N
Published: July 2024

Introduction: Stapedotomy done for otosclerosis is one of the finest middle ear surgery and needs great expertise. The present study is done to evaluate the short-term hearing results in patients with otosclerosis and treated with primary stapedotomy.
Methods: A retrospective chart review of patients after stapedotomy surgery was done from April 2011 to October 2016. Stapedotomy was performed under local anesthesia using a Teflon piston under local anesthesia. The patients were followed up after 6 weeks for the assessment of the hearing status. The hearing assessment was done using the Air Bone gap improvement and Air Bone gap closure (AB gap closure) pre and postoperatively.
Results: Total of 73 cases were retrieved from hospital database. 3 cases were excluded and analysis of only 70 cases was done. Among the total patients 85.71% of the patients had bilateral involvement of the disease. The overall mean pre-operative pure tone Air conduction average was 55.66 dB, SD 11.576 (95% CI; 52.57-59212), while the overall mean post -operative pure tone average was 17.63 dB, SD 11.958 (95% CI; 14.70-21.57). This difference was found to be statistically significant (p = 0.000). The overall mean pre-operative air bone gap was 37.65 dB and the overall mean post -operative air bone gap was 18.47dB. This difference was found to be statistically significant (p = 0.000).
Conclusion: This study confirms that stapedotomy for clinical otosclerosis is a safe and successful treatment for short-term hearing improvement. Both the AC threshold and AB gap closure showed significant improvement postoperatively.
Stress, anxiety, and depression among adolescent students of public schools in Kathmandu
Authors: Sharma P , Choulagai BP
Published: July 2024

Background: Adolescence is a period characterized by changes in emotion, perception, cognition, and judgment which may adversely affect their mental health. This study aimed to find out the prevalence and associated factors of stress, anxiety, and depression among adolescent students of Kathmandu, Nepal.
Methods: We used a descriptive cross-sectional study. The study included 411 adolescent students aged 14 to 19 years from six randomly selected public schools of Kathmandu Metropolitan City. Depression, Anxiety and Stress Scale 21(DASS-21) was administered to the students to identify the prevalence of depression, anxiety, and stress. Logistic regression analysis was performed to find out the associated factors of stress, anxiety, and depression.
Results: The prevalence of stress, anxiety, and depression was 27.5%, 56.9% and 41.6% respectively. Factors associated with stress were being female, high academic pressure, and abuse. The factor associated with anxiety was high academic pressure and factors associated with depression were being female, high academic pressure and witnessed/exposed to domestic violence.
Conclusion: Depression, anxiety, and stress are common among school adolescents. Academic pressure was a major factor of depression, anxiety, and stress. Adolescent girls were more prone to develop stress, and depression compared to adolescent boys
Side effects and efficacy of oral mifepristone plus sublingual misoprostol regimen in early medical abortion (gestation up to 63 days)
Authors: Kshetri R , Bharati L , Pandey S , Sapkota B , Pandey S
Published: July 2024

Introduction: Medical abortion with mifepristone and misoprostol has few side effects that cannot be avoided. Efficacy of medical abortion varies with the routes of administration and the doses of mifepristone and misoprostol. This study aimed to investigate the side effects and abortifacient efficacy of 200 mg oral mifepristone and 800 mcg sublingual misoprostol regimen in termination of early pregnancy.
Methods: A descriptive cross-sectional study was carried out at Marie Stopes Clinic, Gongabu, Kathmandu. Altogether 103 women with a period of gestation (POG) up to 63 days were selected by purposive sampling technique and were interviewed using two sets of the semi-structured questionnaire. Each woman received 200 mg mifepristone at the clinic. Then 800 mcg misoprostol was taken sublingually at home after 48 hours. Confirmation of abortion was done by ultrasonography. Association between efficacy and POG was calculated by using Chi-square and/or Fisher’s exact test.
Results: Side effects reported were nausea, vomiting, diarrhoea, dizziness, fever, chills/shivering, headache, lower abdominal pain, anorexia, lower back pain. The overall efficacy of the regimen was 98.1%. Rates of complete abortion were 98.8% in ≤49 days’ POG and 95.0% in >49days’ POG. The differences were not statistically significant (p-value >0.05).
Conclusion: Medical abortion done by using this regimen had few side effects, but no serious side effects or complications were reported. Efficacy of this regimen was high. This study will help to estimate the possible side effects, complications and effectiveness of the given regimen required for proper counselling to the women who opt for medical abortion.
Public demand of anti-rabies vaccination prophylaxis for contacts of two rabies victims
Authors: Yadav RS , Bhatt YP , Shrestha S
Published: July 2024

Rabies is a neglected tropical disease culminating in fatal encephalitis. Available under-estimated data of dog bites with a huge number of mortalities point rabies as a re-emerging disease of global health importance. Public awareness is of greatest importance in preventing rabies deaths. One health framework along with dog vaccination and population control measures are next elements in combatting high burden of rabies in developing nations like Nepal. Two rabies deaths from same 2.5-3 months old puppy particularly due to unawareness following which entire community demanded prophylaxis is discussed herewith. There is paucity for availability of guidelines for contact prophylaxis unlike pre and post-exposure in the country. Justifying the rationale use in public proclaiming of prophylaxis in contacts was a challenge.
Sero prevalence of Scrub Typhus among Suspected Cases in Selected Area of Nepal
Authors: Gautam R , Parajuli K , Sherchand JB
Published: July 2024

Introduction: Scrub typhus is a mite-borne acute, febrile, infectious illness that is caused by Orientia tsutsugamushi the causative organism, Orientia tsutsugamushi, is transmitted to the human beings by the bite of larval stage (chiggers) of the trombiculid mites, Leptotrombidium delience. This disease is most common in rural areas of low income countries. It is difficult to differentiate clinically from other tropical infections such as malaria, dengue, enteric fever and leptospirosis. Hence the study aim was to determine the seroprevalence of scrub typhus among the acute febrile illness patients attending in different hospitals of Chitwan district.
Methods: The study was based on patients with suspected scrub typhus cases in Chitwan district from March 2017 to August 2017. Blood samples were collected from the suspected patients of scrub typhus, having acute febrile illness. IgM antibody to Orientia tsusugamushi was detected by using Scrub Typhus Detect™ Kit, In Bios International, USA.
Results: A total of 451 samples, 112 (24.80%) were positive for IgM Antibodies. Multivariate analysis demonstrated that the following factors were significantly associated with the scrub typhus. 1. Females (odd ratio [OR] =2.088, P=<0.004, confidence interval [CI] =1.268-3.438) 2. House near grassland (odd ratio [OR] =10.380, P=<0.001, confidence interval [CI] =3.615-29.802), 3. Piling weeds in house (odd ratio [OR] =0.498, P=0.011, confidence interval [CI] =0.290-0.855), 4. Presence of mouse inside the house (odd ratio [OR] =2.157, P=0.003, confidence interval [CI] =1.290-3.608), 5. Working in the field (odd ratio [OR] =10.295, P=0.002, confidence interval [CI] =2.309-45.905). All cases enrolled have presented fever (100%) followed by headache (56.2%), nausea (55.4%), shortness of breath (40.2%), abdominal pain (14.3%), jaundice (8.9%), hypertension (8.9%), COPD (8.0%), tachypnoea (4.5%), diabetes (4.5%), eschar (2.7%) and seizure (1.8%).
Conclusion: In the study the proportion of Scrub typhus infection was 25% among acute febrile cases. Our finding also explored the burden of scrub typhus in relation to demographic trend, risk factors, clinical characteristics and findings of different laboratory parameters. Early diagnosis, appropriate treatment along with health education and vector control measures are best way to prevent and management of scrub typhus.
Effects of subvalvular apparatus preservation in mitral valve replacement among rheumatic patients: early and mid term follow up.
Authors: Timala RB , Joshi D , Aryal M , Bhandari K , Singh Y , Sharma J , Sharma J
Published: July 2024

Introduction: Annulo-papillary continuity exerts significant impact on postoperative left ventricular function after mitral valve replacement.
Methods: This is a retrospective study of patients who had undergone mitral valve replacement at one of the three units of Shahid Gangalal National Heart Center. Patients were divided into three groups, group I: total resection of subvalvular apparatus, group II: posterior mitral leaflet preservation, group III: total preservation of subvalvular apparatus. Statistical analysis was done to see the differences between three groups in regards to left ventricular dimensions in diastole, systole and ejection fraction.
Results: Total of 93 patients underwent mitral valve replacement from April 14, 2011 to April 13,2012. Among group I patients, left ventricular diastolic (LVIDd) dimension decreased significantly at 3 months follow-up: group II patients left ventricular systolic dimension (LVIDs) decreased significantly at 3 months, group III patients, both LVIDd and LVIDs decreased significantly at 3 months. At the end of 3 years, the graph showed patient with group I had increasing tendency for LVIDd, whereas patients with group III had decreasing tendency for LVIDd. Similarly patients in group I showed increasing trend for LVIDs, whereas it got stabilized after 2nd year among patients in group III. The ejection fraction was most improved among the patients with group III compared to group I or II.
Conclusion: Total subvalvular apparatus preservation during mitral valve replacement did have positive impact on left ventricular dimensions as well as function in early and midterm follow-up
Endovascular Treatment for Traumatic Thoracic Aortic Injury: A Case Report
Authors: Shrestha UK , Shrestha KR , Gurung D , Upreti MR , Adhikari A , Gurung A
Published: July 2024

As majority of blunt traumatic injury with aortic tear die, we see limited numbers of survival in the hospital. Thoracic endovascular treatment for traumatic aortic injury is rare. Endovascular treatment, where available, is the trend for traumatic aortic injury for all age group. Both morbidity and mortality are significantly decreased with endovascular intervention. Twenty nine years old male patient driving a car collided with truck and had thoracic aortic pseudoaneurysm with multiple skeletal fractures that underwent successful endovascular stent graft along with fixation of all fractured bones.
Pregnancy outcome in overweight and obese mothers at a tertiary care Hospital
Authors: Ojha N
Published: July 2024

Introduction: Maternal obesity has been associated with increased risk of adverse pregnancy outcomes. The aim of this study was to determine the impact of increased body mass index on pregnancy outcome in women delivering at Tribhuvan University Teaching Hospital.
Methods: This was a retrospective comparative study carried out in the Department of Obstetrics and Gynecology of TU Teaching Hospital. The study was carried from 1 April 2016 to 31 July 2016. Women were categorized according to booking BMI into three groups: normal (18.5-24.9kg/m²). overweight (25.0-29.9 kg/m²) and obese (≥30 kg/m²). Obstetrical and neonatal outcomes were evaluated using normal group as reference. The outcome variables were maternal hypertensive disorders, type of labor and delivery, blood loss, hospital stay, birth weight, preterm delivery and NICU admission.
Results: During the study period, there were 228 mothers of whom 114 were normal weight, 85 overweight and 29 obese. The mean age and multipara were significantly higher in over weight and obese as compared to normal weight women. The overweight and obese mothers were at an increased risk of hypertensive disorders (OR3.3, 95%CI 1.4-8.1 and OR10.8, 95%CI 3.9-30.0), cesarean section (OR 2.2 95%CI 1.2-3.8 and OR 4.2, 95%CI 1.7-10.2), post partum hemorrhage (OR 3.8 95%CI 1.0- 14.9), longer mean hospital stay and adverse neonatal outcome like macrosomia, preterm birth and NICU admission.
Conclusions: Overweight and obese mothers appear to be at an increased risk of hypertensive disorders, cesarean section, postpartum hemorrhage and neonatal problems like macrosomia, preterm birth and NICU admission in comparison to normal weight mothers
Gastric pancreatic heterotopia: A rare disense entity
Authors: Karki S , Karki D
Published: July 2024

Introduction: Heterotopic pancreas, a lesion that is rarely encountered, can be located anywhere within the gastrointestinal tract. It is commonly asymptomatic though most patients may present with pain. Its submucosal location makes preoperative diagnosis difficult. This study aims to report a small series of cases of this disease which has a very low incidence and to enumerate its clinical and endoscopic Features
Methods: From the three year archives of the histopathology department of Kathmandu Pathlab and Diagnostic Centre, all cases reported as heterotopic pancreas were collected from Jan 2013-Dec 2016. Prevalent details were extracted from the requisition forms.
Results: Out of 3,000 samples received, five cases were diagnosed as having heterotopic pancreas. The age range for the disease was 20-50 years with a male predominance. Mean diameter of the lesion was 1.6cm. The endoscopic diagnosis was heterotopic pancreas in one case whereas for others it was gastrointestinal stromal tumor (GIST). Endoscopic biopsies were non diagnostic in all cases and the diagnosis was made on local surgical resection specimen. Pain was the common presenting symptom. Microscopy showed Type I lesions in all cases with involvement of the muscularis propria in one case. Other four cases had involvement upto submucosa.
Conclusion: Though a rare entity, pancreatic heterotopias should be considered in the differential diagnosis of submucosal gastrointestinal lesion. The diagnosis of ectopic pancreas is still challenging in spite of the improvement and development in the diagnostic modalities. Symptomatic relief is provided by surgical resection and surgery is recommended particularly if diagnostic dilemma exists.
Correlation of Bacteriuria and Pyuria among the suspected cases of Urinary Tract Infection in Kathmandu University Hospital
Authors: Sherchan JB , Karkee P , Wenju S
Published: July 2024

Infection of urinary tract is one of the most important infectious diseases in the world affecting all age groups across the life span. Bacteriuria and pyuria being some of the features of urinary tract infection need to be correlated. The objective of the study is to determine correlation of bacteruria with pyuria in suspected urinary tract infection.
Methods: This study was conducted at Kathmandu University Hospital, Dhulikhel between September 2014 to March 2015. During this period, 272 urine samples were collected and analyzed by microscopic examination and semi-quantitative culture technique with standard microbiological methods.
Results: A total of 272 urine samples were processed in which 78(28.67%) were culture positive. Among culture positive samples significant bacteriuria (i.e. ≥10 CFU/ml) was detected in 65(83.3%) of the cases whereas 13(16.7%) of the culture positive samples showed low count significant bacteriuria (i.e. 10-10 CFU/ml). Out of 58 urine samples with significant pyuria, 48(82.75%) were culture positive. Among 214 urine samples without significant pyuria, 30(14.01%) urine samples were culture positive which was significant (P value<0.05).
Conclusion: The study showed that pyuria and bacteriuria had no correlation in the suspected cases of urinary tract infection. According to our findings, it is necessary to culture urine and also perform microscopic examination for the correct laboratory diagnosis of urinary tract infection
De-worming during pregnancy in Nepal: an effect on neonatal mortality
Authors: Shedain PR , Dixit Devkota M , Paudel R , Wagle RR , Karki S , Shrestha R , Sharma Y
Published: July 2024

Background: The Ministry of Health and Population, Nepal has been administering the de-worming medication (with tablet albendazole) to pregnant women aiming at reducing maternal anemia and neonatal death since 2001. The neonatal mortality has remained stagnant for the past decade. The effect of de-worming during pregnancy on neonatal mortality is not known yet.
Methods: This study is based on the database of Nepal Demographic and Health Surveys (NDHS) 2006 and 2011. This study includes the recent singleton live births within five years preceding the survey as the de-worming medication during the pregnancy was collected only in the recent live births (the last live birth) in the five years preceding the surveys. The newborn death of the pregnant women administered with de-worming medication was compared with those pregnant women who were not administered with de-worming medication during the pregnancy. An association has been established with the logistic regression model adjusting several potential confounding factors.
Results: In the pooled data, the recent singleton live births were 8,147. A total of 813 and 2,274 mothers were found to have taken de-worming medication during pregnancy in the NDHS 2006 and 2011, respectively. The use of de-worming during pregnancy increased from 20% to 56% between the surveys, but the newborn deaths in de-worming group rose from 1.2% to 1.4%. The adjusted OR of the neonatal death with the de-worming was {aOR 1.129 (95% CI 0.696-1.829), P = 0.623}.
Conclusion: The de-worming during pregnancy in Nepal was not found significantly associated with reduction on neonatal deaths, which suggests timely review of the program.
Mapping the trend of HIV/AIDS in Nepal
Authors: Subedi B.K.
Published: July 2024

Mapping of districts with reported HIV infection in Nepal has been done for the last 10 years (July, 1988–July, 1998). The pattern of geographical distribution of HIV infection over these years is described. Initially, districts of the central region of Nepal were affected and gradually the spread of HIV expanded to the Eastern and Western Part of Nepal. As of end of July 1998, a total of 66 districts out of 75 districts are affected with HIV. The data are compared with the sentinel surveillance and possible explanation for this is given.
Gastric lavage in poisoning: not to be neglected
Authors: Bhattarai M.D.
Published: July 2024

Poisoning is a common cause of admission and mortality, especially of the young people in hospitals in Nepal. Limiting ongoing absorption of toxic compounds is one of the core principles of care for poisoned patients, and gastrointestinal decontamination is the most important aspect. Common gastric decontamination techniques and their indications, problems, contraindications and selective roles in the management of poisoning are reviewed in the article. Each of the gastrointestinal decontamination techniques has its own role, problems and contraindications. The use of each of them is selective.
Gastric lavage, in particular, is indicated after any potentially life-threatening poisoning. The benefit from gastric lavage in such circumstances with overdose with any potentially lethal ingestion is quite significant. This becomes more important in view of young age of the patients involved. Further, in our set-up, poisons consumed are commonly toxic and antidotes and intensive care of poisoning may not be available. That is why the mortality rate from poisoning is high as compared with that in the developed countries. Thus, the gastric lavage appears to be more important in our set up than in the developed countries. The Management and the Departments of Medicine and Emergency of Hospitals and Poison Centres should ensure that the use of gastric lavage is not neglected in indicated cases. It would be quite effective to include the procedure of gastric lavage in the log book of postgraduate students of Internal Medicine and General Practice.
Fixed drug eruption resulting from amoxicillin use: a case report
Authors: Adhikari S , Dhital KR , Paudel K , Adhikari S , Parajuli S
Published: July 2024

Abstract: Amoxicillin is commonly administered antibiotic to treat mainly the respiratory tract infections. Fixed drug eruption is a rarely seen reaction to penicillins. Commonly observed side effects of amoxicillin include nausea, vomiting, diarrhea, allergic skin reactions (a morbilliform rash).Uncommon side effects include, reversible leucopenia, antibiotics associated colitis (pseudo- membranous and haemorrhagic collitis), black hairy tongue, superficial tooth discolouration. This is a rare case of fixed drug eruption due to amoxicillin at dorsum of hand and foot.
Clobazam in childhood epilepsy
Authors: Jain Neeraj K. , Mangal Vibha
Published: July 2024

Different studies have shown that the outcome of treatment with clobazam in all types of seizures is good. The greatest success has been achieved in complex partial seizures. It is also found suitable for maintenance treatment. Although promising findings have been made with this drug, further studies are still required, especially in pediatric population.