bluuebunny/crossref_metadata_2025 huggingface dataset:
CHANGING TRENDS OF VAGINAL INFECTION
Authors: Padhye Saraswati M.
Published: September 2018

ABSTRACTIntroductionVaginal discharge and /or infection are very distressing to all women.Vaginal infection encompasses-Vaginosis/vaginitis,Trichomonal vaginitis and Monilial or fungal infection. Vaginal discharge could be due to foreignbody such as ring pessary inserted for uterovaginal prolapse or for induction of abortion by untrained Daisin Nepal. It could be due to physiological condition, such as -during mid menstrual and pregnant state. Astudy of pattern of infection in vaginal discharge has been presented in this study.ObjectiveTo find the pattern of infection in the vaginal discharge of patients attending a private Gynae. Clinic.Material and methodThis is a prospective study done during the period, November 2001 to July 2002 with “Hanging drop method”of the discharge, collected from the vagina.One thousand patients complaining of vaginal discharge with or without itching, burning sensation, pain inthe lower abdomen and subfertility were enrolled in this study.Age, parity, husband’s occupation, family planning methods used, history of drugs intake and subfertilitywere expressed.ResultIt was found that Monilial infection 36.8%,Monilial infectin with vaginitis was found in6.4% Trichomonalinfection 0.9%,Trichomonas with vaginitis 1.3% and vaginitis to be 19.5 % .Thirtyfive percent had had noabnormality in the slide.There were 11 diabetic patients.Seventeen were having some or the other drugsduring the study period. Seventyfour patients revisited for same complaints. Out of which 41 had noabnormalities.The treatment given was, Clotrimazole 200 mg daily locally for three days for 3 courses and Fluconazole150 mg orally single dose for Monilial infection. For trichomonal infection, Metronidazole 200 mg threetimes on day was prescribed to both husband and wife. In case of Vaginitis, Doxycycline 100 mg two timesa day was advised. For pruritus,local application of Betamethasone was given.ConclusionIt was noted that every third patient attending this clinic complained of vaginal discharge but 35% had noabnormality. By this study, the trend of vaginal infection seems to be changing.More Monilial thanTrichomonal infection was found in these patients, in earlier studies the incidence of Trichomonal infectionwas getting less and Monilial infection is getting higher.Key Words: Monilial infection, Trichomonas vaginitis, Non-specific vaginitis.
KNOWLEDGE AND ATTITUDE ABOUT MENTAL ILLNESS AMONG NURSING STAFF
Authors: Shyangwa Pramod M. , Singh S , Khandelwal S K
Published: September 2018

ABSTRACTThe magnitude of mental health problem is cosiderable. However the attitude of the general public towardsmental illness and mentally ill people is largely negative. Perception and knowledge of the nursing staff onthis topic is important as they directly deal with patients and their relatives, and they are also involved indisseminating health information. A negative attitude is known hindrance to providing quality service tomentally or physically ill persons. This study, therefore, carried out among nursing staff at B. P. KoiralaInstitute of Health Sciences (BPKIHS) a tertiary care center in Nepal, aims to find out nurses’ knowledgeand attitude about mental illness.It is a cross-sectional, descriptive study with 110 respondents, who were predominantly females (97.27%)and young (mean age=25.7year). The study revealed some interesting findings as many of the participantsthought mentally ill people are ‘ insane’ (37.5%). The majority had showed their knowledge about causes ofmental illness as genetic or inherited (65.4%) and biochemical disturbances (90.0%). About three fourthwere ready to work together (71.8%) and chat with them (91.8%). Respondents expressed their faith inpsychiatrists (93.5%) but less in faith healers (3.0%). The vast majority had obtained information aboutmental illness from ‘seeing mentally ill persons’ (94.0%) followed by communication with medical personnel(84.5%). This study revealed that there was overall adequate knowledge and by and large a positive attitude.Key Words: Mental health, nurses, knowledge, attitude, Nepal.
SICKLE CELL DISEASE - CASE REPORTS
Authors: Adhikari Ram Chandra , Shrestha T B , Shrestha R B , Subedi R C , Parajuli K P , Dali S
Published: September 2018

ABSTRACTSickle cell diseases are inherited hematological diseases, prevalent in certain parts of the world. We reporttwo cases of sickle cell diseases, first being sickle cell b-thalassaemia and second homozygous sickle celldisease (SS). Our first case was 5 year old boy presenting with hemolytic anaemia & hepatosplenomegalyhaving sickle cell b-thalassaemia disease . Second case was 17 years female presenting with hemolyticanaemia & joint pain having homozygous sickle cell disease.Key Words: Homozygous sickle cell disease, sickle cell b - thalassaemia, hemoglobin electrophoresis.
Swyer Syndrome : A Case Report with Literature Review
Authors: Patnayak R , Suresh V , Jena A , Vijayalakshmi B , Reddy AP , Rukumangadha M , Sachan A
Published: September 2018

Gonadoblastomas are known to develop in dysgenetic gonads, especially so, if Y chromosome material is present. A 20-years- old girl who noticed breast development since the age of 12 years presented with primary amenorhoea, distension of lower abdomen and intermittent pain for two months. She had breakthrough bleeding with six months of estrogen replacement. Tanner breast stage was fi ve and pubic hair stage was also fi ve. Examination revealed a mass in the lower abdomen extending into hypogastrium, umbilical and lumbar regions. Her gonadotropin levels were grossly elevated. Karyotyping showed 46XY. CT scan of abdomen showed a 17X11 cm mass in the pelvis without visible gonads. Surgical excision of the mass along with bilateral salpingophorectomy was performed. Histopathology revealed the mass to be a dysgerminoma, while the right gonad lodged gonadoblastoma. She was diagnosed as a rare case of Swyer syndrome.

Keywords: Dysgerminoma, gonadoblastoma, Swyer syndrome, XY gonadal dysgenesis.
A PROFILE OF MEASLES CASES AT INFECTIOUS DISEASE HOSPITAL, JAIPUR, INDIA
Authors: Rathore Monika , RK M , Chauhan S
Published: September 2018

Measles is one of the disease which is amenable to eradication, but in India measles isstill a major cause of morbidity and significant contributor to childhood mortality. Inthe present study. Infectious disease hospital records for a period of five & half yearswere analysed. It was found that 253 measles cases were diagnosed & underwenttreatment. Out of 253, 179 ( 70.7%) were males and 74 ( 29.2%) were females. Fourtyeight (18.9%) were between 7-12 months of age. Maximum cases i.e. 166 ( 65.6%)were registered during months of March, April, May, & June. A significant proportionof cases i.e. 54 (21%) developed measles, inspite of immunization.measles still remain endemic with most casesoccuring in young children & infants.3In India,measles vaccine was first made available in 1978and has been reccommended for children aged 9-15 months. Vaccination against measlesPoliomyelitis, Diphtheria , Tetanus, Pertussis andtuberculosis is provided free to all infants in India,through the National Health Services and thecoverage rate is >85%.41. S.M.S. Medical College, Jaipur, India.2. Directorate of Medical & Health Services, Govt. of Rajasthan, Jaipur, India.Address for correspondence : Dr. Monika Rathore46, Shiv Raj Niketen ColonyVaishali Nagar, Jaipur, (Rajasthan),IndiaEmail: rathoremonika@rediffmail.comKey Words: Measles, Immunised Children, India.
Bacteriological Quality Of Groundwater in Urban Patan and Antibiotic Sensitivity Against Isolated Enteric Bacteria
Authors: Maharjan M , Sharma A P
Published: September 2018

Abstract
Pure red cell aplasia caused by Parvo B19 virus in a kidney transplant recipient
Authors: Baral A , Poudel B , Agrawal R K , Hada R , Gurung S
Published: September 2018

Parvo B19 is a single stranded DNA virus, which typically has affi nity for erythroid progenitor cells in the bone marrow and produces a severe form of anemia known as pure red cell aplasia. This condition is particularly worse in immunocompromised individuals. We herein report a young Nepali male who developed severe and persistent anaemia after kidney transplantation while being on immunosuppressive therapy. His bone marrow examination revealed morphological changes of pure red cell aplasia, caused by parvovirus B19. The IgM antibody against the virus was positive and the virus was detected by polymerase chain reaction in the blood. He was managed with intravenous immunoglobulin. He responded well to the treatment and has normal hemoglobin levels three months post treatment. To the best of our knowledge, this is the fi rst such case report from Nepal.

Keywords: Intravenous immunoglobulin, kidney transplant recipient, Parvovirus B19, pure red cell aplasia.
MAGNESIUM SULPHATE VERSUS PHENYTOIN FOR ECLAMPSIA: ONE YEAR PROSPECTIVE STUDY
Authors: Sharma Mona , Koirala R , Sharma U , Singh P , Gupta S
Published: September 2018

Aim: Eclampsia is one of the important preventable causes of maternal mortality.This study aims to review the clinical profile of eclamptic women and compare thematernal mortality, recurrence of convulsions, other morbidities including the neonataloutcome with Magnesium Sulphate versus Phenytoin used for its management.Material and Methods: Prospective study was carried out in all the eclamptic patientadmitted in Gynae ward from April 2000 - April 2001 (Baisak 2057 to Chaitra 2057).Results: There were total of 30 patients.Most of the them (53.3%) were of the 15-20years of age group and three fourth (73%) were primigravidas. More than half (56%)were unbooked and one fourth were nonimmunised and illiterate .Blood pressure hadnever been measured in 63% of the patient . In the Phenytoin Group 68.75% hadrecurrences of fits where as in the Magnesium Sulphate Group only 21.43 % hadreccurence. In the Magnesium Sulphate group, 50% delivered normally whereas 42.5%needed caesarean section in the Phenytoin group Only 6.2% delivered normally andin 37.5 % forceps had to be applied. There were 37.50% admission to NeonatalIntensive Unit (NICU) for various complications in Phenytoin group whereas therewere only 14.2% NICU admission in Magnesium Sulphate group. There were twocases of neonatal deaths out of 16 neonates in the Phenytoin group whereas only oneout of 14 cases in Magnesium Sulphate group. There was only one maternal death inthese thirty patients and it belonged to the Phenytoin group.Conclusion: As proved in many other studies this study also showed that MagnesiumSulphate was superior to Phenytoin in terms of recurrence of fits, maternal and neonataloutcome. In our country where many deaths still occur due to Eclampsia the valuablerole of magnesium Sulphate should not be ignored and health personnels should betrained for its frequently than it is practiced to-day.Key Words: Eclampsia, Preeclampsia, Magnesium Sulphate, Phenytion.
SILICONE TUBE SHUNT IN SUPRACHOROIDAL SPACE IN RECALCITRANC GLAUCOMAS
Authors: Karki K JD , Momose A
Published: September 2018

Silicone tube shunt operations to drain the aqueous from the anterior chamber to thesuprachoroidal space were performed in 12 different types of refractory glaucomas inwhich the intraocular pressure ranged from 25 mmHg to 80 mmHg (mean 45.75 mmHg)even after maximally tolerated medical treatment or after conventional glaucomasurgery. The post-silicone tube shunt intraocular pressure ranged from 7 mmHg to 34mmHg (mean 15. 83 mmHg) after a follow-up period ranging 2 months in some casesto 24 months in others. The intraocular pressure was controlled in all casespostoperatively either with the operation alone or with medical treatment or afterrepeat operation. The complications were very few except in one case in which therewas hyphema as well as vitreous hemorrhage prior to operation because of trauma forwhich pars plana vitrectomy followed by second silicone tube shunt operation wereperformed and at the end enucleation had to be done.Key Words: Artificial Drainage, Shunt Operation, Recalcitrant Glaucomas.
THE PHYSIOLOGICAL CONSEQUENCES OF BRONCHOSCOPY : A STUDY OF THE HAEMODYNAMIC CHANGES DURING BRONCHOSCOPY
Authors: Das Anjan K , Dutta S
Published: September 2018

Physiological consequences are inherent to the procedure of bronchoscopy. Sixtypatients who underwent bronchoscopy at the Medical College Hospitals, Calcutta,India, were studied to determine the changes that occur during bronchoscopy. Ofthese twenty were consecutive adult patients who underwent rigid bronchoscopy undergeneral anaesthesia (Group I). Twenty were consecutive adult patients who had flexiblebronchoscopy under local anaesthesia (Group II). Ten consecutive paediatric patientsunderwent rigid bronchoscopy with spontaneous ventilation under General Anaesthesia(Group III) and ten were operated with controlled ventilation (Group IV). Heart Rate,Blood Pressure SpO2and ECG were monitored during and upto 60 minutes after theprocedure.Heart Rate changes were minimal in Group I but maximum in Groups II and III.Procedures like suctioning & Bronchoalveolar Lavage (Bal) were associated with fallof SpO2, SpO2was best maintained in the fourth group. Three patients out of fortyadults patients had Electrocardiogram (ECG) changes. Significant Mean ArterialPressure (MAP) rise was seen in adults, but this was not significant in children. GeneralAnaesthesia failed to modify the rise of MAP observed in adults.Key Words: Bronchoscopy : Physiological consequences : SpO2, ECG changes,heart rate, Mean arterial pressure
EFFECT OF COLD INDUCED PAIN AND MENTAL TASK ON BREATH HOLDING TIME
Authors: Kumar Sanjay , Paudel B H , Dhungel S , Khadka R
Published: September 2018

The breath holding time (BHT) is under voluntary control to a considerable extentand is dependent on various factors. Pain interrupts ongoing mental processes andmental task stimulates the respiratory complex as a part of generalised central nervoussystem arousal. We hypothesised that the concurrent cold-induced pain and mentaltask may change BHT. In this study BHT with concurrent mental task (MT) or coldinducedpain (CPT) was assessed in healthy individuals (n=25). The objective was toinvestigate the effect of CPT and MT on BHT. Initially basal BHT was recorded thenthe BHT was recorded during MT and CPT. The data were analysed by Friedmantest. The results showed no significant effect of MT and CPT on BHT. However, BHTshowed an increasing trend with CPT and MT. It is concluded that cold pressor painand mental task do not have vital influence on breath holding time.Key Words: breath holding time, cold pressor test, pain, mental task.
INTESTINAL PARASITIC INFESTATION IN HEALTHY SCHOOL CHILDREN OF LALITPUR DISTRICT
Authors: Shrestha Bidya
Published: September 2018

Stool sample of 515 healthy urban and rural school children of Lalitpur district in theage group between 7-12 were collected and tested for the presence of ova and cyst ofhelminths and protozoan. A total of 81.94% of the children were found infested withparasites. Both rural and urban children exhibited similar pattern of infestation. Noassociation of the infestation with the localities is observed (X2 = 2.17). A very greatprevalence of helminths especially Ascaris lumbricoides and Trichuris trichuriacompared to protozoan was observed. Among rural and urban children, total A.lumbricoides infestation was 73.45% and 71.66% and T. trichuria infestation was27.27% and 37.91% respectively. 78.36% and 84.07% of the male, and 92.45% and73.72% of the female children from the urban and rural respectively were foundinfested with the protozoan and helminths. The infestation was not associated withparticular gender (X2 = 0.1121). The helminth parasitic infestation rate is very highcompared to protozoan parasites among the school going children, hence the parentsand the children should be made aware of the problem.Key Words: Helminths, Protozoan, Lalitpur, Children, Prevalence, Water.
Malignant Transformation of Multiple Enchondromas of the Hand
Authors: Litch James A , Bishop R A , Smith L O
Published: September 2018

abstract
Angioleiomyoma Pinna
Authors: Agrawal Ranjan , Singh P A , Misra V
Published: September 2018

abstract
SURVEILLANCE OF ANTI-TUBERCULAR DRUG RESISTANCE
Authors: GC G , Rijal Basista , Sharma A P
Published: September 2018

Tuberculosis is the leading cause of death in Nepal. Failure in early detection anddrug resistance are two most important problems in treatment and cure of thetuberculosis. The objective of the study was to assess the drug resistance pattern inMycobacterium tuberculosis isolated in Tribhuvan University teaching Hospital. Morethan 85% of isolates were sensitive to all the four drugs and 5.5% of isolates weremultidrug resistant. The drug resistant isolates were obtained more frequently frompreviously treated patients. More extensive studies should be carried out by independentorganizations to collect more representative data on drug resistance tuberculosis.Key Words: Tuberculosis, drug resistance and surveillance.
A STUDY ON CARDIOVASCULAR DISEASE PATTERN OF ADMITTED CASES IN NEWLY EMERGED NATIONAL HEART CENTRE
Authors: Limbu Yuba Raj , Maskey A , K.C. Man Bahadur , Malla R , Sharma D , Shrestha N K
Published: September 2018

Cardiovascular disease is one of the global leading causes of death . Although indeveloped countries overall cardiovascular death is declining due to long term declineof rheumatic heart disease (RHD), cerebro vascular and hypertensive heart disease,heart disease is still the leading cause of death. In developing countries prevalence ofcoronary heart disease (CHD) is in increasing trend and cardiovascular disease patternis changing. Cardiovascular disease pattern of this region is revealed in this study.Total 300 study subjects, admitted from May 2000 to April 2001, 174 (58%) male and126 (42%) female and age ranged from 5 to 83 years were analyzed retrospectively.Proportionate distribution of all admitted cases was calculated and arranged inaccording with sequence order.Rheumatic heart disease was found the commonest, which constituted 27.3%, followedby coronary heart disease (21.7%) and hypertension (20.7%) respectively. Chronicobstructive pulmonary disease (COPD) with cor pulmonale (7.7%) was fourth insequence order then respectively came diabetes mellitus (DM) coexisted with CHD orhypertension, dilated cardiomyopathy (DCM), cardiac arrhythmia without organicheart disease, congenital heart disease, infective endocarditis, rheumatic fever,pericardial effusion etc. Readmission rate within one year was 12.3% and mortalityrate was 2.7%. Conclusion: Rheumatic heart disease is the commonest heart diseasefollowed by coronary heart disease and hypertension. COPD with cor pulmonale,diabetes coexisted with CHD or hypertension, DCM and cardiac arrhythmia withoutorganic heart disease are also common heart diseases.Key Words: Cardiovascular diseases, Disease pattern.
BACTERIOLOGICAL STUDY OF EAR DISCHARGE IN BIR HOSPITAL
Authors: Arjyal Charu , Adhikari S , Shrestha J
Published: September 2018

Discharge from the ear is one of the commonest symptoms of infections of the ear.With a view to study the major strains of bacteria encountered in ear discharges, thisstudy was conducted in Microbiology Laboratory, Bir Hospital. The study wasconducted for a period of 6 months from January 2000 - July 2000. A total of 224samples of aural discharges of the outpatients were collected and analysed for bacterialgrowth. These samples were cultured with the use of standard microbiologicaltechniques and the antibiotic sensitivity pattern of the isolates was also studied invitro with the use of disc diffusion method. Among 224 patients, 50.9% were male and49.1% were female and the age of the patients varied from 6 months to 76 years.Majority of the patients with discharging ear belonged to the age group 11-20 years.Bacterial growth was found in 82.6%. The bacterial isolates were of 13 differentspecies. Staphylococcus aureus was the most frequently isolated organism (49.4%)followed by Pseudomonas aeruginosa(20.9%). Other organisms isolated wereCoagulase negative Staphylococci (CONS), Streptococcus spp., Bacillus sps., Escherichiaspp., Proteus spp., Enterobacter spp., Klebsiella spp., Acinetobacter spp., Edwardsiellaspp.The prevalence of gram positive bacterial isolates was higher than gram negativebacterial isolates. 58.0% of samples showed positive correlation with direct smeargram stain and culture results. Among the antibiotics used, Ciprofloxacin was foundto be the most effective (80.2%) for overall bacterial isolates followed by Gentamicin(68.9%). The result of antibiotic sensitivity was almost similar to gram positive aswell as gram negative isolates.Key Words: Aural discharge, Gram stain, culture, sensitivity.
CRYPTOCOCCAL MENINGITIS IN A NON-AIDS PATIENT
Authors: Khanal Basudha , Sharma S K , Deb M
Published: September 2018

Cryptococcal meningitis that occurred in a patient with no obviouspredisposing factor is reported. The necessity to identify this entity in thecases of chronic meningitis is discussed.ABSTRACTKey Words: Meningitis, Cryptococcus neoformans
Yellow oleander poisoning : a case report
Authors: Mollah Abid Hossain , Ahmed S , Haque Shamsuzzaman N , Islam A.K.M.N , Rashid A , Rahim M , Shamsuzzaman S
Published: September 2018

Abstract
Utilization Pattern Of Nonsteroidal Anti-Inflammatory Drugs(NSAIDS) in Orthopedic Practise at a tertuary Care Hospital In Eastern Nepal
Authors: Das B P , Adhakiri N , Garg M , Rauniar G P , Naga MA Rani
Published: September 2018

abstract
The prevalence of anaemia and morbidity profile among school going adolescent girls of urban Kathmandu, Nepal
Authors: Tiwari Kalapana , Seshadri S
Published: September 2018

A perusal of the literature on anaemia prevalence in Nepal from 1975 onwards highlightedtwo points: anaemia prevalence is high particularly among women and childrenand that adolescent girls as a group have not been studied much, in fact, theadolescent period is one of the critical periods for anaemia. The present studyassessed prevalence of iron deficiency anaemia and morbidity problems of adolescentgirl. The results highlighted anaemia as a public health problem in girls and its prevalencewas found to be higher in Brahmins girls as compared to Newars and Chhetries.Eighty-two percent of the girls reported health problems such as aches and pains inthe body, infectious morbidities, and weakness and breathlessness. Thus, this femalepopulation groups needs to be paid special attention for health promoting interventionprogram.Key words: Anaemia, morbidity, adolescent girls.
THE MBBS PROGRAMME IN NEPAL
Authors: Dixit Hemang , Sharma S C
Published: September 2018

This article gives a comparison of the MBBS course that is being conducted by thethree universities in Nepal. The course started by the Institute of Medicine was thepioneering effort. The concepts were taken a bit further at the time that the medicalcourse at the B.P. Koirala Institute of Health Sciences (BPKIHS) was formulated.This teaching institution became partly responsible for the delivery of health care tocertain areas of the country thus meeting the goal that the producers of healthmanpower were also involved in the delivery of health services to the community aswell. With the starting of the medical course by Kathmandu University, this journeyin the field of medical education was taken one more step forward. The involvementof private institutions also in the field of medical education meant that it was no longerjust the responsibility of the government. Tribhuvan University also gave affiliationsto private institutions in the medical field. The stage has now been extended by thestarting of a medical course based totally on Problem Based Learning at the KathmanduUniversity Medical School or KUMS.Key Words: MBBS, medical education, community oriented, system based, integrated.
How did Nepal Reduce the Maternal Mortality? A Result from Analysing the Determinants of Maternal Mortality
Authors: Karkee R
Published: September 2018

Nepal reportedly reduced the maternal mortality ratio by 48% within one decade between 1996-2005 and received the Millennium development goal award for this. However, there is debate regarding the accuracy of this figure. On the basis of framework of determinants of maternal mortality proposed by McCarthy and Maine in 1992 and successive data from Nepal demographic health survey of 1996, 2001 and 2006, a literature analysis was done to identify the important factors behind this decline. Although facility delivery and skilled birth attendants are acclaimed as best strategy of reducing maternal mortality, a proportionate increase in these factors was not found to account the maternal mortality rate reduction in Nepal. Alternatively, intermediate factors particularly women awareness, family planning and safe abortion might have played a significant role. Hence, Nepal as well as similar other developing countries should pay equal attention to such intermediate factors while concentrating on biomedical care strategy.

Keywords: Determinants, maternal mortality, Nepal, reduction.
Histomorphological spectrum of breast diseases
Authors: Singh Usha Rani , Thakur A N , Shah S P , Mishra A
Published: September 2018

All breast lumps are considered to be carcinomas until proved otherwise and are acause of concern both for the patient and surgeon. The study was undertaken to knowthe histological spectrum of breast disease at B. P. Koirala Institute of Health Sciences(BPKIHS). BPKIHS is a recently started Medical University in the easternregion of Nepal. No data regarding breast diseases in this region is available as yet.152 breast tissues sent for histopathology from Jan. 96 - Dec. 98 were studied. Peakincidence of benign lesion was in 21 to 30 years and malignant lesions in 31 to 50years. No breast lesions were seen in the first decade of life. Cancer was seen in18.42% of cases. Fibroadenoma & Fibrocystic disease were the commonest benign &infiltrating duct carcinoma the commonest malignant lesion. Specimens from 10 malebreasts were received. Gynaecomastia was the commonest lesion in the males. Infiltratingduct carcinoma was seen in a 70 years male. Some uncommon breast lesionslike Syringocystadenoma & cysticercosis were also seen. In 3.28% of cases no lesionswere seen.Key Words: Breast, Fibroadenoma, Fibrocystic disease,carcinoma, Gynaecomastia.
CATARACT SURGERY AND PROGRESSION OF DIABETIC RETINOPATHY
Authors: Subedi Sudesh
Published: September 2018

Patient with diabetes mellitus have a higher prevalence of lens opacity 1and cataractdevelopment at an earlier age than non diabetic.2Cataract in diabetes mellitus decreasesthe visual acuity, makes posterior segment evaluation and laser treatment difficult.Several studies have shown that there is progression of diabetic retinopathy after cataractsurgery. In all studies, criteria for progression of diabetic retinopathy are:a) progression of any form/type or stage of diabetic eye (DE), nonproliferative diabeticretinopathy (NPDR) or proliferative diabetic retinopathy (PDR) to any advanced,recurrent form/ type or stage of NPDR or PDR andb) development of new clinically significant macular edema (CSME) and/or worsening/recurrent of preexisting CSME defined by Early Treatment Diabetic RetinopathyStudy (ETDRS).• More severe the preexisting diabetic retinopathy (DR), much worse the DR aftercataract extraction. The progression of DR after cataract extraction is severe inIntracapsular Cataract Extraction (ICCE) than Extracapsular Cataract Extraction(ECCE) with Intraocular Lens (IOL) and Sutureless Small Incision CataractSurgery (SICS) and Phacoemulcification.• Progression of DR increases with complicated cataract surgery, like posteriorcapsular rupture (PCR), vitreous loss and prolonged surgery.• The first 6 months period is crucial as a minimum period of follow up to detectprogression of DR.• There are other several local and systemic risk factors for the progression of DR,like hypertension, renal failure, ischemic heart disease, high cholesterol andtriglyceride level, pregnancy etc.Key Words: Diabetic retinopathy, cataract surgery, risk factors
DESIGN OF A SURVEILLANCE SYSTEM FOR PREGNANCY AND ITS OUTCOMES IN RURAL NEPAL
Authors: Osrin David , Manandhar S , Shrestha A , Mesko N , Tumbahangphe K S , Shrestha D , Manandhar D S , Costello A M
Published: September 2018

IntroductionCommunity trials in low-income countries require monitoring and evaluation systems.The requirements of a community surveillance system include coherent design, training,field supervision and reporting, as well as the need for a robust and flexible database.Materials and methodsThis paper describes a surveillance system for identification of pregnancy and itsoutcomes in a rural area of Nepal. Mother Infant Research Activities (MIRA), incollaboration with the Institute of Child Health, London, are presently conducting astudy on the impact of a community-based participatory intervention to improveessential newborn care (ENC) in rural Nepal. The study is a cluster randomisedcontrolled trial involving 12 pairs of Village Development Committees (VDCs) inMakwanpur District. The surveillance system covers approximately 28 000 householdsand 28 000 married women of reproductive age. It was designed to identify pregnancy,its outcome for mother and infant, and activities such as antenatal care and problem-related health care seeking behaviour.DiscussionThe paper describes the processes of mapping and enumeration, pregnancyidentification, conduct of interviews, quality control and data management.Key Words: data quality, database, rural Nepal.
UTERINE PERFORATION AS A SEQUEL TO REPEATED CURETTAGE FOR MOLAR
Authors: Manandhar Bekha , Rana A , Pradhan N , Amatya A , Sharma R
Published: September 2018

An 18 year old girl was subjected to emergency hysterectomy and unilateral salpingo-oophorectomy for uterine perforation because of repeated dilatation and curettagefor persisting vaginal bleeding following molar evacuation.As significant proportion of molar do progress into Gestational trophoblastic Neoplasiawhich in this case was choriocarcinoma; directs our attention to the fact that properfollow up of post molar cases using at least urinary beta HCG and institutingchemotherapy whenever necessary should be advocated in order to avoid such adrastic management.Key Words: Uterine perforation, molar, Gestational Trophoblastic Neoplasia (GTN)
PHYSICIANS AND PRINCIPLE CENTERED DELIVERY OF HEALTH SERVICES
Authors: Adhikari Ramesh Kant
Published: September 2018

ABSTRACTHealth is the fundamental right of human beings and the constitution of Nepal also envisages that the statewill follow the policy of developing health of the people to improve their living standards. The nationalhealth policy and the evolution of health services in Nepal reveal that there have been attempts to reach allthe citizens with quality services. Health is defined and understood in different ways by different people.However, health of the population is determined by situation and services outside the purview of healthservices. The extent to which health services can influence health of the people is limited and there aregroups of people who advocate that the physicians be active outside the area of health services and medicalcare to promote health.Ideally the principles that guide the health services are equity, quality, relevance and cost- effectiveness,efficiency and compassion. The values of beneficence, non-malfeasance and autonomy also form thecornerstone of the health services. Review of the current health services in Nepal show that further effortsare needed for our health services to achieve those principles. The health services are yet to reach all thepopulation, there is a variation in the quality of services available at different places of the country. Thereis not much information on the cost-effectiveness of the services. A perusal of the health literature from thedeveloped countries recognize that medical harm is one of the important cause of illness but the similarstudies is lacking in our country. The issue of autonomy is still in infancy in Nepal. There is not muchevidence of efforts for quality assurance of the services available.A functional collaboration between medical education, health services and medical practitioners is expectedto achieve ideal values in the health services. There have been a number of international and nationalefforts to bring changes in medical education, medical practices and health care system to make the healthservices more equitable, relevant, and cost-effective and of high quality. The competences and attitudes thephysicians must have in order to provide principle-centered health services have been identified by a numberof studies. Similarly the ways to achieve those goals through better collaboration among the principalstakeholders as well as what physicians themselves can do with assistance from these stakeholders havebeen suggested.Key Words: medical education, medical practices, professional councils, health services,and principles of health services, equality and heath.
EPISIOTOMY : A CHALLENGING OBSTETRIC INTERVENTION
Authors: Malla D S
Published: September 2018

ABSTRACTThe professional literatures on the development of widely practiced procedure, episiotomy through theyears from the first publication in 1742 are reviewed. It reveals the change in number of publication as wellas the contributors to the development of perception about episiotomy. So it consisted expression of opinionof doctors initially then the co-workers like nurses and researchers and clients or consumers themselvestoo. It concludes that episiotomies prevent anterior perineal tear but fails to accomplish other benefitstraditionally ascribed to pelvic floor damage and relaxation including its sequel and also protection ofnewboin from intracranial haemorrhage and intrapartum asphyxia. Episiotomy substantially increasematernal blood loss during delivery and risk of anal sphincter damage with their long term morbidity.There is an urgent need to restrict the use of episiotomy in vaginal delivery.Key Words: Episiotomy, Perineal tear, anal sphincter damage.
COMMUNITY ORIENTED MEDICAL EDUCATION (COME) : EXPERIENCES AT THE INSTITUTE OF MEDICINE
Authors: Devkota Madhu Dixit , Adhikari R K , Shrestha B , Thakur A K
Published: September 2018

ABSTRACTSince its establishment, Institute of Medicine (IOM) has been pursuing Community Oriented MedicalEducation (COME) in training medical graduates in the country. The community orientation of the MBBSprogram of IOM is achieved through community based learning divided into different experiences like fieldbased community diagnosis, concurrent field with families with sick members, district hospital managementthrough posting in the district hospitals. The aim of this article is to review the organization of the COMEat IOM, identify the strengths and weaknesses of this approach and suggest measures for improvement. Areview of the educational activities related to community based learning experiences was done, and focusgroup discussions were carried out among the current and the past students. Besides these two activities,literature was searched and concerned authorities were informally interviewed to find out if there has beenany consensus regarding the effectiveness and desirability of this approach. The review revealed that theprogram at IOM has partially incorporated the concepts of COME in its teaching learning activities. Studentsand graduates of the program tend to like the program and value its contribution in their education.International bodies and educational experts in the country view this approach with great favour. There arecertain areas, particularly in orientation of the students, supervision and logistic support that needimprovement. In conclusion, COME though not formally evaluated so far, seems to have made a stronginfluence on the education of physicians in Nepal. It needs continuous support and strengthening in order toproduce doctors with social relevance in future as well.Key Words: Medical Education, Community Oriented, Evaluation, Nepal.
HOW COST EFFECTIVE IS THE TREATMENT? ARE PRESCRIBERS CONCERNED ?
Authors: Das B P , Naga Rani M A , Rauniar G P , Sangraula H
Published: September 2018

ABSTRACTCost-effective treatment should be of primary concern to prescribers in poor countries like Nepal. Thepresent study was carried out at a tertiary care hospital in Nepal to find out the perception of prices ofcommonly prescribed drugs among prescribers. The participants selected randomly were directed to writein 10 minutes on a proforma, the generic name(s) and price of the brand preparation of 18 most commonlyused drugs listed under their brand name.The price of the drug was considered correct if the price mentioned was within a range of 20% above orbelow the brand price. Results indicated that the participants were aware of the composition of majority(80%) of the drugs, but were not aware of the prices of 81.80% of the drugs. No single participant mentionedthe correct prices of all the drugs. Among the drug groups studied, the most accurate data was providedabout composition (90.43%) and price (24.47%) of non steroidal anti-inflammatory drugs (NSAIDs). Onlyin 9.22% of brand preparations of antimicrobial agents (AMA), the prices were mentioned correctly. Hence,sensitisation of physicians about cost-effective treatment is of immense importance and to facilitate this,hospital authorities could provide prescribers with regularly updated price lists of commonly prescribeddrugs and competitive prices of various brand preparations. Pharmacoeconomics may be introduced in the undergraduate curriculum which can be reinforced by continuing medical education.Key Words: Cost-effective, Pharmacoeconomics.
SQUAMOUS CELL CARCINOMA AS A LATE COMPLICATION OF CHRONIC OSTEOMYELITIS
Authors: Lakhey Shishir , Lakhey M , Shrestha B P
Published: September 2018

ABSTRACTSquamous cell carcinoma is a rare but well documented complication of chronic osteomyelitis. With theadvent of antibiotics, better health care delivery to the people and improving socioeconomic conditions, theincidence of squamous cell carcinoma arising as a late complication of acute haematogenous osteomyelitishas become increasingly less. Occasional difficulty in the differential diagnosis of a pseudoepitheliomatoushyperplasia and well differentiated squamous cell carcinoma can be troublesome. These two cases arepresented to remind the clinician of this now increasingly rare complication of chronic osteomyelitis andthe occasional diagnostic dilemma involved in its histopathological diagnosis.Key Words: Squamous Cell Carcinoma, Chronic Osteomyelitis.
VAGINAL VERSUS ABDOMINAL HYSTERECTOMY FOR BENIGN CONDITIONS
Authors: Garg Pradeep Kumar , Garg P
Published: September 2018

ABSTRACTHysterectomy is the commonest gynaecological surgery performed in women. Present study involved 43patients undergoing hysterectomy for benign condition. Out of 43 patients vaginal hysterectomy wereperformed in 26 cases and rest of the cases were performed by abdominal route. Out of 26 vaginalhysterectomy a case was converted into abdominal hysterectomy because of preoperative urinary bladderinjury. Keeping all complications in mind we suggest that selective women requiring a hysterectomy formenstrual disorders from fibroid uterus or DUB may be offered a choice for vaginal hysterectomy.Key Words: Hysterectomy, uterine leiomyoma.
A rare case of virilizing adult granulosa cell tumor
Authors: Dawaka Kaveeta , Gupta A , Joshi S , Bajpai S , Basi H S
Published: September 2018

A twenty eight year old lady, married for two years with no issue, presented at WesternRegional Hospital Pokhara on 8th July, 1999 with a history of amenorrhea for 1½years, lump abdomen 1 year, hoarseness of voice for 1 year and signs of hirsutism forthe same duration. She was taken up for laparotomy wherein a left ovariectomy withsalpingectomy was done and a large cystic ovarian tumor was removed. Post operativeperiod was uneventful and she was advised follow up. The histopathological diagnosiswas Adult Granulosa Cell Tumor. What made this case interesting is that mostGranulosa Cell Tumors (about 3/4th) are estrogenic or feminizing, but rare examples,including a disproportionate number of large thin walled cystic tumors are androgenic.This was one of those rare virilizing tumors with classical features of infertility,amenorrhea, hoarseness of voice, clitiromegaly, and breast atrophy, but we could notestimate testosterone levels due to lack of facilities available.Key Words: Granulosa Cell Tumor, Virilizing Ovarian Tumors, Sex Cord stromal tumors.
A 40 year old woman with cough, progressive dyspnea and bilateral lung opacities
Authors: Pahari Anil , Ghimire R K , Chokhani R , Chokhani G
Published: September 2018

Abstract
Orbital Hemangiopericytoma
Authors: Garbyal Rajendra Singh , Kumar M
Published: September 2018

KEY WORDS : Hemangiopericytoma, orbit, proptosis
Slap Lesions An Overview
Authors: Itoi Eiji , Pradhan R L
Published: September 2018

Abstract
HEALTH STATUS OF SCHOOL CHILDREN OF POKHARA VALLEY, NEPAL
Authors: Shrestha Lochana , Khattri J B.K.
Published: September 2018

ABSTRACTThe cross sectional study to assess the health and nutritional status of school children in the age group of4-15 years was carried out in 6 government primary schools of Pokhara valley by health team of thedepartment of Social & Preventive Medicine (SPM), Manipal College of Medical Science, Pokhara, Nepal.A total of 750 students of both sexes, 368 boys and 382 girls were examined. The prevalence of wasting andstunting in these children were low (10.3% & 15.7% respectively) with boys suffering more than girls inboth aspects. The 6-10 years old children were affected most. Pediculosis, Dental caries and Worm infestationwere three most common diseases suffered by students. The study highlighted the need for continuation ofschool health services aimed at improvement of their health & nutritional status.Key Words: School Children, Health Status, Wasting, Stunting.
FUNCTIONAL RESULTS AFTER VOCAL CORD MEDIALIZATION PROCEDURE WITH SCULPTURED SILICON BLOCK
Authors: KC Toran , Shrestha S
Published: September 2018

ABSTRACTMedialization technique has remained as a mainstay for the treatment of glottal insufficiency. This form oflaryngeal framework surgery not only improves the quality of voice but also protects the lungs from aspiration.We present six patients who underwent vocal cord medialization surgery. Of the six patients only onepatient had required revision surgery. Since these form of surgeries are performed under local anesthesiathe quality of the voice can be assessed per-operatively. This kind of surgery appears to be still new in the Nepalese context.Key Words: Isshiki Thyroplasty, Laryngoplasty, Laryngeal framework surgery,vocal cord paralysis, Voice disorders, glottal insufficiency.
Trends in hysterectomy for benign causes - A retrospective study at Kohalpur Teaching Hospital
Authors: Renjhen Prachi , Behura S , Acharya S
Published: September 2018

ABSTRACTA retrospective study of all hysterectomies was done from 1st January 2001 to 31st December 2001. Theobjective was to study the trends in age, parity, indications, type of surgery (abdominal or vaginal),conservation of ovaries, repair of pelvic floor and postoperative complications. All cases were reviewed forthe above parameters.73 hysterectomies were performed during this period, of which 57.53 % were abdominal and 42.47% werevaginal.Maximum numbers of operations (41.09%) were in the age groups of 31 to 40 years and 41-50yrs (35.61%).Ovaries were conserved in 50 %cases.Commonest indication was utero-vaginal prolapse (46.6%) followed by cervical intra-epithelial neoplasia(CIN) (28.77%), leiomyomas (20.54%) and dysfunctional uterine bleeding (DUB) (4.10%). Pelvic floorrepair accompanied almost all (97%) vaginal hysterectomies.Key Words: Hysterectomy, pelvic inflammatory disease, cervical intra epithelial neoplasia,utero-vaginal prolapse, DUB.
Paediatric Surgery at a Regional Hospital
Authors: McKevitt E C , Schwarc R , Schneidereit N
Published: September 2018

Infants and young children are at particular risk from anaesthesia and surgery. Somehave suggested that these patients only be cared for by those with specialty paediatricsurgical and anaesthetic training. In district hospitals and the developing world thisis often not possible. We have undertaken a prospective study to determine the mortalityand morbidity rate for children 0 to 5 years undergoing surgery at Western RegionalHospital (WRH) in Pokhara, Nepal. During 1999 there were 354 patients in this agegroup undergoing surgery. Surgical procedures were done in general surgery (coveringurology, plastics and neurosurgery as well), orthopaedics, ENT and ophthalmology.There were 6 deaths for a mortality rate of 1.7%. Seven patients had in hospitalcomplications and significant management problems were identified in four patients.In conclusion, although there is no dedicated paediatric surgical unit at WRH, childrenundergoing surgery at this hospital have acceptable morbidity and mortality rates.An improvement in timely presentation, diagnosis, treatment and intraoperativemonitoring may further improve these results.
Complications of Chronic Suppurative Otitis Media AA Type-3 Years Experience at TUTH
Authors: Thapa Naramaya , Shrivastava R P , Amatya RC M , Sinha B K , Bhattarai H , Pradhan B , Gurangain RP S , Bhusal C L , Banskota D K
Published: September 2018

This retrospective study was carried out in the Department of ORL and Head &Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu.Three hundred patients having atticoantral type of chronic suppurative otitis mediaunderwent emergency or routine mastoid exploration from 14 April 1997 to 12April 2000. Of the 300 patients, 64 (21.33%) had complications. Age of the patientswith complications ranged from 5-38 years. Thirty eight (59.38%) patients were malewhile 26 (40.62%) were female. Forty eight (75%) had extracranial and 15 (23.44%)had intracranial complications while 1 (2.08%) had both extra and intracranialcomplications. Cholesteatoma was present in 233 (77.66%) patients and of these 48(20.60%) had complications. Sixty seven (22.33%) patients had granulation tissue, ofthese 16 (23.88%) had complications.In cholesteatomatous cases 34 (70.83%) hadextracranial complications. Intracranial complications were present in 14(29.17%)cholesteatomatous cases. In patients with granulation tissue extracranial complicationwas present in 14 (87.50%) patients and only one patient had intracranialcomplication.Combination of extra and intracranial complications were found in 1patient with granulation tissue. When compared with types of pathology extracranialcomplications were higher in patients with granulation tissue (87.50% vs 70.83%)and intracranial complications were found more in cholesteatomatous cases (29.17%vs 6.26%). Both these findings were , however, statistically not significant. Reasonsbehind these findings may be presence of granulation tissue beneath the epitheliumof choleateatoma, and association of both types of pathology with infection andinflammatory process.Key Words: Chronic Suppurative Otitis Media, Atticoantral Type, Mastoid Exploration, Complications.
An Unusual Penetrating Foreign Body in the Neck
Authors: Cherian Tambi Abharam , Pujari K , Joshi B
Published: September 2018

A case of a penetrating injury of the neck sustained due to a flying fragment of metalis presented. The nature of the Injury and its management are discussed.Key Words: Neck Injury, Penetrating, Vascular Injury, Foreign Body.
Malignant Degeneration in a Mature Cystic Teratoma of Ovary A Case Report
Authors: Lakhey Mamata , Verma K , Khan I R , Sah S P , Rani S
Published: September 2018

Malignant transformation of benign cystic teratoma of ovary is rare and the mostcommon malignancy encountered is squamous cell carcinoma. The diagnosis is rarelymade preoperatively and the prognosis is usually poor. Here we report a case ofsquamous cell carcinoma arising in a dermoid in a 44 years old lady who presentedwith bilateral dermoid cysts. The preoperative findings, surgical approach andadjuvant therapy are discussed.Key Words: Malignant transformation, benign cystic teratoma, squamous cell carcinoma.