bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case Report Cholera Outbreak in Gaidataar: A Lesson for Further Strengthening the Task Force for Epidemic Management in Nepal
Authors: Yadav Sachin
Published: September 2018

Cholera is an acute enteric infection caused by the ingestion of bacterium Vibrio cholerae1. Cholera is transmitted through contaminated food and water. Prevention and preparedness of cholera require a coordinated multi-disciplinary approach. The extremely short incubation period enhances the potentially explosive pattern of outbreaks. Cholera can lead to severe dehydration and death if left untreated. The laboratory testing is required for antimicrobial sensitivity testing and for confirming the end of an outbreak. Provision of safe drinking water, proper sanitation, and food safety are critical for preventing occurrence of cholera. Health education aims at communities adopting preventive behavior for averting contamination. Specific training for all the staffs about proper case management including avoidance of noso-comial infection (like face masks, gloves, antiseptic solution, hand scrubs). Sufficient pre-positioned medical supplies for case management (diarrhoeal disease kits, iv fluids, antibiotics, safety measures). Improved access to water, effective sanitation, proper waste management and vector control. Improved communication and public information. Oral Rehydration Salts can treat 80% of cholera1. Appropriate antibiotics can reduce the duration of purging. With a well and properly managed team of health experts with all essential medicines and a good rapid response team, any outbreak can be prevented, controlled and managed.

Keywords: cholera; epidemic; ORS; rapid response team; shanchol; task force.
Nerve Conduction and Heart Rate variability in Patients with Hypothyroidism at a Tertiary Care Centre in Eastern Nepal
Authors: Gupta Shital , Khadka Rita , Thakur Dilip , Maskey Robin , Mehta K D , Paudel Bishnu Hari
Published: September 2018

Introduction: Thyroid hormone effects on many organs including central and peripheral nervous systems. However, these hormones do not affect all systems/organs to a similar extent. Thus, we conducted this study to explore the effect of thyroid hormones on somatic nervous system assessed by Nerve conduction study and cardiac autonomic activity assessed by heart rate variability.

Methods: The study included newly diagnosed hypothyroid patients and healthy controls. In all subjects NCS were performed in median, ulnar, tibial and sural nerves using Nihonkohden machine Cardiac autonomic control was assessed using Short-term Heart Rate Variability and parameters were analyzed by Time Domain and Frequency Domain methods.

Results: Both the groups were comparable in term of age, Body Mass Index, Pulse Rate, Systolic Blood Pressure and Diastolic Blood Pressure. Sensory parameters of NCS showed significant decrease in left median nerve SNAP amplitude (38.24±10.23 Vs 31.59±14.06, P=0.048) and nerve conduction velocity of bilateral median nerve in hypothyroid patients. In motor parameters of NCS, onset latencies of bilateral median nerves and right ulnar nerve were significantly increased in hypothyroid patients.  All Time Domain measures of HRV and Frequency Domain measures; LF Power, HF Power and Total Power were significantly decreased (P<0.05) in hypothyroid patients. These HRV parameters are indicators of parasympathetic activity.

Conclusions: In newly diagnosed hypothyroid patients, especially median nerve functions (both sensory and motor) and parasympathetic activity were decreased.  It reflects that in hypothyroidism both autonomic nervous system and other somatic nerves are not affected in a similar extent.

Keywords:  hypothyroidism; heart rate variability; nerve conduction study.
Limited Open Reduction and Percutaneous Plate Osteosynthesis - Alternative Option to Minimally Invasive Plate Osteosynthesis in Management of Distal Tibia Fractures
Authors: Sah Shambhu , KC Bikash , Dangi Sailoj Jung , Rai Rem Kumar , Yadav Roshan
Published: September 2018

Introduction: The management of distal tibia fracture is challenging because of the limited soft tissue coverage and poor vascularity around the bone in that area. Minimally invasive percutaneous plate osteosynthesis is a novel technique in this regard but needs fluoroscopy. In unavailability of fluoroscopy or its technical malfunction, limited open reduction percutaneous plate osteosynthesis becomes useful. The aim of this study is to compare the outcomes of distal tibia fractures treated by LORPPO and MIPPO techniques in terms of duration of hospital stay, full weight bearing, union time and complications.

Methods: Twenty-two cases of closed distal tibia fractures without articular involvement or comminution operated at Koshi Zonal Hospital, Nepal from March 2014 to May 2016 were included in this study. Total 11cases of which were treated by MIPPO whereas other 11 cases were treated by LORPPO. MIPPO technique was done only when the fluoroscopy was available.

Results: In MIPPO, the average age of the patients were 43.72 (range 23-65) years, hospital stay mean duration 8.45 (range 6-12) days, full weight-bearing walking was started in 11.27 (range 9-15) weeks and average radiological union time was 21.25 (range 18-28) weeks. In LORPPO, the mean age was 46.36 (range 25-70)years, hospital stay mean 11.81 (range 10-15) days, full weight bearing walking mean 10.63 (range 9-15) weeks and average radiological union time was 23.0 (range 19-27) weeks.

Conclusions: The outcomes are comparatively similar for both the techniques. LORPPO could be an alternative to MIPPO in the management of distal tibia fractures.

Keywords:  distal tibia fracture; limited open reduction; percutaneous plate osteosynthesis.
Human Papilloma Virus Vaccination: Should it be Mandatory?
Authors: Prasai Siru
Published: September 2018

Cervical cancer is the second most common malignancy and a leading killer among women worldwide. Seventy percent of these cervical cancers are known to be caused by Human Papilloma Virus, which is transmitted primarily by sexual contact. The use of Human Papilloma Virus prophylactic vaccine among young adolescents, who have not been previously exposed to the infection, as primary prevention holds most promise for the prevention of this cervical cancer. Each year 80% of the 274,000 deaths caused by cervical cancer occur in developing nations like Nepal. Largest promise of this vaccine is in such countries where screening program is difficult to implement and maintain. However this also raises concerns and debates about the enduring effectiveness and the long term side effects of the vaccine, which are yet unknown. Garnering public trust and public acceptance is key to the success of any public health intervention. More research on the long term safety and efficacy on Human Papilloma Virus vaccine and dissemination of these findings is recommended to increase the acceptance of the program before making it a state mandate.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):167-171.
Operative Management of late Presented Displaced Lateral Condyle Fracture of Humerus in Children
Authors: Sanjel Chhetri Rajendra , Dhakal Indra , Gnawali Gopal
Published: September 2018

Introduction: Management of late presented displaced fracture of lateral condyle of humerus in children is controversial, many recommend conservative management due to fear of complications like avascular necrosis but recently many are advocating for operative management with good results hence we studied the outcome of operative management in late presented displaced lateral condyle fracture of humerus in children.

Methods: We studied 22 children aged between 4 to 11 years, presenting 3 to 16 weeks from injury. All underwent open reduction and internal fixation with Kirschner wires with or without additional screw and followed up for average 18.05 months. Elbow range of motion, angular or local deformity, premature fusion of physis, avascular necrosis and fracture union were noted and analyzed using modified Aggarwal et al criteria.

Results: We had 9 (40.91%) excellent, 5 (22.73%) good, 5 (22.73%) fair, 3 (13.63%) poor result. Overall satisfactory results were seen in 19 (86.37%); 3 (13.63%) had poor result , one due to AVN, two due to premature fusion of physis and visible local deformity. All poor result were seen among delay of operation 6 weeks or later. There was significant improvement of elbow range of motion and all fracture united.

Conclusions: Outcome of operation without bone grafting on lateral condyle fracture of humerus in children who presents late up to 5 weeks are excellent; whereas outcome of delayed operation up to 16 weeks also gives good functional recovery and union.
Effects of Bilateral Nasal Packing on Oxygen Saturation and Blood Pressure
Authors: Bista Meera
Published: September 2018

Introduction: Nasal packing is one of the most common rhinological procedures in ENT practice exerting local in nose and systemic effects. Systemic effects may be due to poor sleep quality, respiratory difficulty, decreased oxygen saturation, circulatory problems and toxic shock syndrome which can threaten the life of a person.The study was done to investigate the effect on bilateral nasal packing on blood oxygen saturation and blood pressure changes.

Methods: A cross-sectional prospective study was undertaken in Kathmandu Medical College from January 2017 to June 2017. The ethical approval was taken from institutional review committee of KMC and verbal consent was taken from each patient. Thirty patients were included in the study by simple randomized sampling. The association between nasal packing and oxygen saturation and blood pressure was done using ANNOVA and Fisher Exact test. P value of <0.005 was considered statistically significant. SPSS version 20 for windows OS was used for analysis.

Results: Blood oxygen saturation on four different days was compared using ANNOVA and paired sample tests. It showed a significant dip on the day of bilateral nasal packing compared to other readings (P value <0.001). Likewise, systolic and diastolic blood pressures showed a significant rise on the day of bilateral nasal packing compared to readings on other days (P value <0.001).

Conclusions: Bilateral nasal packing can lead to significant rise in systolic and diastolic blood pressure and a dip in blood oxygen saturation. Thus care has to be taken while performing bilateral nasal packing in normal patients but much more in high risk patients.

Keywords:  blood pressure; nasal obstruction; nasal packing; oxygen saturation; pulse oximetry.
Demographic and Clinical Profile in Patients with Liver Cirrhosis in a Tertiary Care Hospital in Central Nepal
Authors: Bhattarai Subash , Gyawali Merina , Dewan Khus Raj , Shrestha Gaurav
Published: September 2018

Introduction: Liver cirrhosis is an important health problem worldwide and is a common disease in Nepal. The profile of cirrhosis may vary due to different factors. This study was undertaken to see the demographic and clinical profiles of patients with cirrhosis of liver attending a tertiary care hospital in Central Nepal.
Methods: Six hundred patients with clinical features, laboratory and sonological findings suggestive of chronic liver dysfunction and endoscopic evidence of portal hypertension were included in the study. Their demographic and clinical profile, endoscopic findings, outcomes during hospitalization were studied. Ethical approval was taken from Institutional Review Committee of College of Medical Sciences. SPSS 20 was used for statistical analysis.
Results: The mean age of subjects was 54±11.84 years with 435 males (72.5%) and 165 (27.5%) females. Majority of 203 (33.8%) patients were from Mongol ethnicity followed by 127 (21.2%) Khas. Two hundred and twenty (36.6%) were farmers followed by 169 (28.2%) retired personnel. A total of 338 (56.4 %) patients were from rural areas. The commonest aetiology of cirrhosis was chronic alcohol consumption and seen in 552 (92%) patients. Abdominal distension was commonest presenting sign and observed in 561 (93.5%) patients. Ascites seen in 555 (92.5%) patients was the commonest complication followed by UGI bleed in 326(54.3%) patients. Gastro-oesophageal varices observed in 345 (57.5%) patients, was the most common endoscopic finding followed by portal gastropathy, peptic ulcer and erosive mucosal diseases. In patient mortality was noted in 92 (15.3 %) patients.
Conclusions: This study highlights the burden of cirrhosis, usually caused by chronic alcohol consumption in Central Nepal. Majority of subjects were male, middle aged, farmers, from rural areas and predominantly observed in some ethnicity like Mongols. Cirrhotic patients usually present late with varied complications and have high mortality.
 
Keywords: cirrhosis of liver; complications; endoscopy.
Prevalence of Organic Colonic Lesions by Colonoscopy in Patients Fulfilling ROME IV Criteria of Irritable Bowel Syndrome
Authors: Paudel Mukesh Sharma , Mandal Amrendra Kumar , Shrestha Barun , Poudyal Nandu Silwal , KC Sudhamshu , Chaudhary Sitaram , Shrestha Ramila , Goel Khushboo
Published: September 2018

Introduction: Irritable bowel syndrome occurs as recurrent abdominal pain that is related to defecation and associated with change in frequency and/or form of stool. Few Patients with IBS may have organic lesions detectable at colonoscopy.

Methods: A cross sectional study was carried out in 140 consecutive patients of IBS fulfilling the ROME IV criteria. The study was conducted in Gastroenterology unit, Department of Medicine, Bir hospital, Kathmandu from July 2016 to September 2017. All patients underwent full colonoscopy along with biopsy from sigmoid colon and any visibly abnormal areas.

Results: The average age of patients was 37.5 years with 76 (52.8%) males. Forty-two (30%) had IBS-D, 36 (26%) had IBS-C, 31 (22%) had IBS-M and 31 (22%) had IBS-U. Dyspepsia was seen in 16 (11.4%) and fear of TB/Malignancy/IBD was seen in 27 (19.2%). Organic lesions were seen in 39 (27.85%) patients. Nonspecific colitis was seen in 10 (7.1%) followed by ileal erosions in 7 (5%), polyps in 8 (5.7%), hemorrhoids in 6 (4.2%) and diverticula in 3 (2.1%). Only one (0.71%) patient had microscopic colitis and one (0.71%) had malignant lesion seen at histopathological examination. Females with IBS-D had more organic findings than males (P=0.03, RR=4.13, 95% CI=1.21-15.71).

Conclusions: The prevalence of organic lesions in patients with IBS fulfilling ROME IV criteria is 27%. Dyspepsia is the most common comorbidity and fear of TB/malignancy/IBD is the most common reason for seeking health care. Females with IBS-D have a higher risk of detecting organic lesions by colonoscopy and histopathology examination.
Postoperative Outcome in Patients with Pulmonary Hypertension Undergoing Elective Non-Cardiac Surgery
Authors: Pathak Vikas , Suwal Kriti
Published: September 2018

Introduction: The impact of pulmonary artery hypertension on post-operative outcome in elective, non-cardiac surgery is incompletely understood. This study was designed to evaluate the post-operative outcome of patients undergoing elective, non-cardiac surgery with and without pulmonary hypertension.

Methods: The study was conducted in an inner-city hospital in Bronx, New York. A retrospective chart review was conducted on all patients who underwent elective, non- cardiac surgery from January 2000 to December 2010 and had echocardiogram within 30 days of surgery. Patients with systolic pressure of ≥35mm of Hg as estimated by echocardiogram were enrolled. Case matched peers with normal pulmonary pressures served as controls. Post-operative outcomes were compared between the two groups.

Results: A total of 66 patients were analysed, 33 cases and 33 controls. All patients were followed up to 30-day post-surgery. Heart failure, myocardial infarction, arrhythmia, stroke, delayed extubation and deaths were measured in both the groups. There were two deaths in the control group while there were three deaths in pulmonary hypertension group (statistically not significant, P >0.05). A total of three patients in pulmonary hypertension group had adverse outcome (one had a major arrhythmia, one had delayed extubation (>24 hours) and one had stroke). Whereas two patients in control group had adverse outcome (one had delayed extubation (>24 hours) and one had major arrhythmia).

Conclusions: Pulmonary hypertension does not affect the post-operative outcome in the first 30 days for elective non-cardiac surgery.

Keywords: echocardiogram; elective surgery; non-cardiac surgery; post-operative outcome; pulmonary hypertension.
Endoscopic Sinus Surgery for Sinonasal Polyposis: Microdebrider or Conventional Instruments
Authors: Lageju Nabin , Pradhan Bibhu , Thapa Narmaya
Published: September 2018

Introduction: Sinonasal polyposis is one of the commonest causes of nasal obstruction. Surgical management is treatment of choice. Microdebrider offers more advantage to conventional instruments. We aimed to find out outcome using microdebrider versus conventional instruments in endoscopic sinus surgery of sinonasal polyposis.

Methods: The cross sectional descriptive study carried out in patients aged 13 years and above with diagnosis of sinonasal polyposis. Total of 51 patients were operated on the right side with microdebrider and left side with conventional instruments. Postoperatively each patient assessed for nasal obstruction subjectively and by endoscopic examination to look for mucosal oedema, synechiae and recurrence at 4 weeks and 8 weeks postoperatively.

Results: The incidence of mucosal oedema in microdebrider and conventional instruments at 4 weeks and 8 weeks was statistically not significant with P value 0.089, 0.322 respectively. The incidence of synechiae in conventional group was more than microdebrider 1 (2%) versus 4 (7.8%) at 4 weeks follow up but the difference was statistically not significant (P value 0.773). There were 2 (3.9%) recurrences in microdebrider group and 3 (5.8%) recurrences in conventional group with P value 0.532.

Conclusions: Use of microdebrider offered fewer incidences of synechiae and recurrence. But we couldn’t find statistical advantage over conventional instruments.

Keywords:  conventional instruments; endoscopic sinus surgery; microdebrider; sinonasal polyposis.
Significance of Non-Invasive Markers as Predictor of Esophageal Varices in Liver Cirrhosis
Authors: Khadka Dipendra , Prajapati Sushil , KC Sudhamshu , Shrestha Jeetendra Kaji , Karki Niyanta , Jaishi Bikash , Regmi Kiran , Khadka Sandip
Published: September 2018

Introduction: Upper gastro-intestinal endoscopy remains the gold standard for screening for esophageal varices but it has its own limitations. It is an invasive, expensive and uncomfortable procedure and needs clinical expertise. Accordingly, this study was conducted to establish the role of non-invasive markers for prediction of esophageal varices in liver cirrhosis.

Methods: A hospital based descriptive cross-sectional study was carried out in Liver unit of National Academy of Medical Sciences, Bir Hospital, from October 2016 to September 2017. Complete blood count, liver function test, liver ultrasound and upper gastro-intestinal endoscopy were done for all patients to detect esophageal varices and to correlate with different non-invasive markers.

Results: Total 191 patients of liver cirrhosis were studied after exclusion. Platelet count of 92082.00±43435.83/mm3 and spleen size of 144.21±10.71 mm was found to be good predictors of presence of EV (P≤0.001). Significant association between Child-Turcotte-Pugh class and presence of varices was observed (P≤0.001). AST/ALT ratio with cutoff value of 1.415 showed sensitivity of 82.4% and specificity of 36.4%. APRI at a cutoff value of 1.3 showed a sensitivity of 83.2% and specificity of 50%.

Conclusions: Platelet count, spleen size and Child-Turcotte-Pugh class are good predictors of presence of esophageal varices in patients with liver cirrhosis. AST/ALT ratio and APRI score are not good substitutes for upper gastro-intestinal endoscopy.

 

Keywords:  esophageal varices; liver cirrhosis; non-invasive markers; portal hypertension; upper gastro-intestinal.
Blood Component Separation Service: A New Experience in an Institution
Authors: Kafle Santosh Upadhyaya , Kattel Gaurav , Nembang Tanchona , Karki Smriti
Published: September 2018

Introduction: Blood component separation facility began dispatching its blood component units from 21st April 2013 at the new blood component separation service complex at B.P. Koirala Institute of Health Sciences. With the supply of blood components being finite and with the added recognition of a high rate of inappropriate use of blood component services around the world, there is a need to monitor these services. Our study was conducted to identify blood component utilization pattern in institute and to know about different blood components demand for future preparedness. Methods: This retrospective study was conducted at B.P. Koirala Institue of Helath Sciences, Dharan, Nepal for blood component dispatched from 21st April, 2013- 12th February, 2014. Blood components requisitions from all clinical department were reviewed regarding the specific component requested, blood group and socio-demographic profile.Results: Among 3054 transfusion units dispatched, 1552 were males, 1498 females and 4 unspecified. Likewise, 1722 were pack cell volume, 808 platelet rich plasma, 523 fresh frozen plasma and 1 cryoprecipitate disptached respectively with majority of A positive blood group demanded from Neonatal and Paediatric Intensive Care Unit ward for Packed Cell Volume was 201 and Fresh Frozen Plasma was 300 followed by emergency ward for Platelet Rich Plasma. About 197 (6.45%) requistions forms lacked the details of requesting department, while some even reveal multiple demands.

Conclusions: Packed Cell Volume of A positive blood group being the predominant blood component requested from Neonatal Intensive Care Unit/Pediatrics Intensive Care Unit ward at the institute making most requests.
Verbal autopsy to ascertain causes of neonatal deaths in a community setting: A study from Morang, Nepal
Authors: Khanal S , GC VS , Dawson P , Houston R
Published: September 2018

Introduction: Clinical registration of the cause of death is available for less than one-third of the global newborn deaths, but the need for good quality data on causes of death for public health planning has renewed the interest in the Verbal Autopsy (VA). We aimed to determine the cause of neonatal deaths by VA in Morang district of Nepal.

Methods: Caretakers of the deceased were interviewed using a semi-structured VA questionnaire by female community health volunteers. The cause of death was assigned by two senior pediatricians independently and disagreements in ascertaining the proximate cause of death were resolved by consensus.

Results: The proximate causes of deaths were infections (41 %), birth asphyxia (37.2 %), prematurity (11.5 %), and low birth weight related causes (6.9 %). There was no signifi cant statistical difference in deaths due to infection seen in non-institutional deliveries (43.5 %) than institutional deliveries (34.6 %). More than half of the deaths (58.5 %) occurred within the fi rst three days of life where the predominant cause of death was birth asphyxia (60.7 %).

Conclusions: Analysis of verbal autopsies demonstrates that the major causes of death still are infections and birth asphyxia. The timing of deaths suggests that neonatal interventions should be aimed at the fi rst week of life. There is no comparative advantage between institutional deliveries at below district level institutions and non-institutional deliveries to prevent neonatal infection. Thus, further study on the quality of care at institutes below the district level should be conducted. Disparities still occur in deaths, with most deaths in Morang occurring in non-institutional deliveries and in disadvantaged groups.

Keywords: neonatal deaths, Nepal, newborn, verbal autopsy.
Oral Squamous Papilloma of Edentulous Mouth Interfering with Denture Retention
Authors: Pandey Nashib , Sharma Shivalal , Shrestha Ashish , Marla Vinay
Published: September 2018

Soft tissue overgrowths inside oral cavity can present with wide range of clinical manifestations and some of them can be even asymptomatic. Oral squamous papilloma is one of that asymptomatic lesion described in the literature with extremely low virulence and infectivity rate. Soft tissue overgrowths can sometimes interfere with denture retention. Here we report a case of squamous papilloma in a 60 years old edentulous female who presented with loss of denture retention.

Keywords: denture retention; papilloma; sialadenoma papilliferum.
Lymph Node Biopsies: A Hospital Based Retrospective Study
Authors: Shrestha Monahar Lal , Shrestha A K , Chalise P R
Published: September 2018

Abstract
Loading Dose only versus Standard Dose Magnesium Sulfate Seizure Prophylaxis in Severe Pre-eclamptic Women
Authors: Rimal Surya Prasad , Rijal Pappu , Bhatt Rabindra , Thapa Kriti
Published: September 2018

Introduction: Magnesium sulfate is the drug of choice for prevention of seizures in the pre-eclamptic woman. There is no agreement in the published randomized trials regarding the optimal time to initiate magnesium sulfate, the dose to use (both loading and maintenance) as well as the duration of therapy. The objective of this study is to determine whether magnesium sulfate (MgSO4) prophylaxis is needed for up to 24 hours postpartum in all patients with severe pre-eclampsia for the prevention of seizure.

Methods: It is a randomized controlled trial done on 60 pregnant women with severe preeclampsia randomized into standard dose regimen and loading dose only regimen.

Results: Out of 30 cases in each group 1 (3.3%) patient in standard regimen and 2 (6.7%) patients in loading dose only developed seizure. The occurrence of seizure is not significant statistically. In both regimens there was no maternal mortality. Total of 3 patients needed MICU care and 12 patient developed maternal complications. MgSO4 toxicities were seen only in standard dose regimen that is in 17 (56.7%) of the patients. The median number of IM injections of MgSO4 received in standard dose regimen was 8±2.176. In standard dose regimen 73.3 percent baby were alive whereas in case of loading dose only regimen 93.3 percent of baby were alive after 48 hours of delivery.

Conclusions: Single dose of magnesium sulfate is equally effective as standard dose regimen in terms of seizure prophylaxis in severe pre eclamptic women, with added advantage of reduced maternal toxicity and better neonatal outcome.

Keywords:  severe preeclampsia; MgSO4; magnesium sulfate; loading dose; eclampsia.
Knowledge, Awareness, and Attitude Regarding Dental Implants among Dental Interns
Authors: Sharma Arati , Shrestha Bidhan , Chaudhari Bijay Kumar , Suwal Pramita , Singh Raj Kumar
Published: September 2018

Introduction: Implant therapy is an elective dental procedure of dental rehabilitative treatment. Objective of this study was to assess the knowledge, awareness, and attitude of dental interns of Nepal toward dental implants and to see associations of the responses with gender and geographic location of dental college.

Methods: It was conducted from June 2016 to June 2017 after taking ethical clearance and approval from the research committee. The sample included the interns who were present at the time of the survey. Data collection was done through a cross-sectional questionnaire survey, during clinical postings of the interns at all the dental colleges of Nepal, supervised and monitored by the investigators themselves; coded and entered in Microsoft Excel 2013 and statistical analysis was done by SPSS.

Results: A majority of the interns said they are moderately well informed about dental implants 141 (50.36%); main advantage of dental implants is they are conservative 164 (58.6%); most important factor for implant success is case selection 143 (51.07%); the longevity of dental implants is 10-20yrs, 162 (57.85%), 188 (67.14%) agreed that they were not provided with sufficient information and 191 (68.21%) stated that they need more information; 180 (64.3%) felt the difficulty encountered while placing implants is average and 229 (81.78%) stated that they need more hygiene care than natural teeth. 

Conclusions: A majority of interns have knowledge regarding dental implants, but the percentage of those who gave unsatisfactory answers is also large. They have a positive attitude towards gaining more information through various means.
Prevalence of Internet Addiction and Associated Psychological Co-morbidities among College Students in Bhutan
Authors: Tenzin Karma , Dorji Thinley , Gurung Mongal S , Pelzom Dorji , Tamang Sandip , Pradhan Umesh , Dorji Gampo
Published: September 2018

Introduction: Globally 3.5 billion people have access to internet and most of them are young adults and adolescents. In South Asia, Bhutan has the highest proportion of population with internet access at 37% in 2016. Many studies in Asia have reported significantly high level of internet addiction among college going students. In this light, this study was designed to estimate the prevalence of internet addiction and other co-morbidities. Methods: This cross sectional study included 823 first year and final year students aged 18-24 from six colleges in Bhutan. A self-administered questionnaire consisting of three parts was utilized for data collection. The data was entered and validated in Epidata and analyzed using STATA/IC 14. Results: The prevalence of moderate and severe internet addiction was 282 (34.3%) and 10 (1%) respectively. Positive correlations between internet addiction and psychological well-being (r= 0.331 95% CI: 0.269, 0.390), between Internet Addiction score and years of internet usage (r=0.104 95% CI: 0.036, 0.171), age and years of using internet (r= 0.8 95% CI: 0.012, 0.148) were observed. The commonest mode of internet use was martphone 714 (86.8%). The use of computer laboratory (aPR 0.80, 95%CI: 0.66, 0.96) and internet use for news and educational purposes (aPR 0.76, 95%CI: 0.64, 0.9) showed protective effects. Conclusions: The prevalence of internet addiction is high among the college going students in Bhutan. This warrants timely interventions to address the problems of internet addiction.
Hydatid Cyst of Radial Bone
Authors: Mandal Santosh Kumar , Gupta S G
Published: September 2018

Abstract
Cesarean Vs Vaginal Delivery : An Institutional Experience
Authors: Sharma Shanta , Dhakal Indra
Published: September 2018

Introduction: According to the WHO, 15% of deliveries have precise indication for cesarean section where it is mandatory for the preservation of maternal and/or fetal health. Increasing rates of Lower Segment Caesarean Sections puts foreword various question that, whether a LSCS need to be reflected as a normal delivery in this twenty first century. There are conflicting reports regarding the safety of caesarean sections. While a significant number of cesarean delivery are performed for obstetrical indications, some are simply due to maternal request and may incur several risks for the child. Not much study has compared the complications of caesarean section with those of vaginal birth. Objective of this study is to find out and compare the common complications of cesarean section with vaginal deliveries on mothers.

Methods: A descriptive study was conducted in two selected hospitals of Rupandehi district, Nepal. Data was collected as per pretested structured proforma from 550 respondents randomly and analyzed by using SPSS, MANOVA and Chi-square test to determine associations between categorical variables.

Results: In total of 550 mothers, 408 (74.2%) had vaginal delivery and 142 (25.8%) had cesarean delivery.The common maternal complications were postpartum hemorrhage 116 (21.1%), prolonged labor 47 (8.5%) and wound infection 42 (7.6%).

Conclusions: The result of the study shows that the maternal complications were higher among LSCS compared to vaginal delivery.
Variations in the Facial Dimensions and Face Types Among the Students of A Medical College
Authors: Pandey Anup , Atreya Alok
Published: September 2018

Introduction: Facial dimensions and the face types are the most variable factors in human community. These dimensions have practical implications for the anthropologist, forensic experts, anatomists and surgeons. The present study is aimed to determine the facial dimensions and face types among the medical and nursing students.

Methods: A cross-sectional study was done among medical and nursing students of Devdaha Medical College and Devdaha College of Science and Technology from January 2017 to February 2018. There were 155 students of which 72 were males and 83 females. Facial height and width were measured and facial index was calculated. The collected data was entered and analyzed in SPSS 21 and differences in measurements among males and females were calculated.

Results: The mean facial height among the total population was 10.83 ± 0.74 cm and facial width was 12.39 ± 0.67 cm with the mean facial index of 87.44 ± 4.82. The most prevalent was the mesoprosopic face (n= 59, 38.06%) followed by leptoprosopic (n=43, 27.74%). The least prevalent face type was hyperleptoprosopic (n= 7, 4.52%) which was observed only in male individuals.

Conclusions: The present study depicts higher values of facial height, width and facial indexfor males when compared to the females. The present finding is based upon the indices and classification obtained from developed nation. Further studies with local data would help develop indices and classification for Nepalese population.
Congenital Anomaly of Left Renal Vein
Authors: Bhattarai Chacchu , Poudel P P , Baral P
Published: September 2018

Abstract
Perforation Peritonitis at High Altitude
Authors: Amatya Bhawana , Lakhey Paleswan Joshi , Pandey Prativa
Published: September 2018

Trekkers going to high altitude can suffer from several ailments both during and after their treks. Gastro-intestinal symptoms including nausea, vomiting, and abdominal pain are common in high altitude areas of Nepal due to acute mountain sickness or due to a gastro-intestinal illness. Occasionally, complications of common conditions manifest at high altitude and delay in diagnosis could be catastrophic for the patient presenting with these symptoms. We present two rare cases of duodenal and gastric perforations in trekkers who were evacuated from the Everest trekking region. Both of them had to undergo emergency laparotomy and repair of the perforation using modified Graham’s patch in the first case and distal gastrectomy that included the perforated site, followed by two-layer end-to-side gastrojejunostomy and two-layer side-to-side jejunostomy in the second case. Perforation peritonitis at high-altitude, though rare, can be life threatening. Timely evacuation from high altitude, proper diagnosis and prompt treatment are essential
Task Shifting and Innovative Medical Education - Moving Outside the Box to Serve Rural Nepal
Authors: Zimmerman Mark
Published: September 2018

Abstract
Periodontal Health Status and Pregnancy Outcomes: A Survey in Medical Doctors
Authors: Gupta Sujaya , Shrestha Barsha , Gupta Neha , Tuladhar Anik , KC Sushil , Dhami Bhageshwar
Published: September 2018

Introduction: Periodontal disease and caries are the most common causes of tooth loss worldwide. Studies have demonstrated strong association between periodontitis and adverse pregnancy outcomes. Medical doctors, who are the primary healthcare providers, seldom advise women to seek dental care during pregnancy. This study was undertaken to explore the knowledge, attitudes and behaviours of medical doctors towards oral health and to identify the barriers of prenatal periodontal healthcare in their practices and its possible implications on pregnancy outcomes.Methods: Total 377 doctors filled the questionnaire. The data collected through personal contacts, social networking, emails, online forms and networking at conferences were analysed using Statistical Package for the Social Sciences 20 software program and presented in tables, charts and diagrams.Results: Out of 263 (69.8%) male and 114 (30.2%) female doctors enrolled in the study, only 52 (13.8%) had received education or training on oral care during pregnancy. Among them 299 (79.3%) agreed that there is possible link between health of teeth-gums and pregnancy. Approximately 105 (27.9%) encountered patients with oral/periodontal problem every week but only 108 (28.6%) “always” advised their patient for regular dental check-ups. Similarly, 358 (95%) agreed that there is need for universal guidelines however, 133 (35.3%) thought there was insufficient time to advice patients on oral health during check-ups.Conclusions: An adequate referral system to oral healthcare providers and biannual check-ups is recommended for both general patient as well as pregnant women for preventing adverse situations related to oral and specifically periodontal diseases.
Relationship of Body Mass Index with Dental Caries among Children Attending Pediatric Dental Department in an Institute
Authors: Dikshit Parajeeta , Limbu Senchhema , Bhattarai Rosina
Published: September 2018

Introduction: Oral health, the mirror of general well being, is altered by many mediators like infection, chronic inflammation, and genetic predisposition. The present dietary pattern among children is contributing to childhood overweight as well as increasing the risk for developing dental caries. The food habits contributing to dental caries as well as obesity are similar. Undernutrition has also shown to be associated with the dental caries. The study was conducted to investigate the relationship of body mass index to dental caries.Methods: A cross sectional clinical study was conducted on 7 to 12 year old children, studying in public schools, visiting the Department of Pediatric Dentistry for a routine dental check up. The study evaluated the nutritional status by calculating the body mass index using the formula BMI= Weight (kg)/Height2 (m2). Then their Body Mass Index and correlated with the Dental caries status using WHO criteria for decayed, missing and filled teeth index. Data analysis was done by SPSS 20 software program.Results: Total of 251 children between 7 to 12 years were evaluated. The mean age of the participants was 9.12 years. No statistically significant result was found on comparing the nutritional status to dental caries (P=0.43). A statistically significant difference though was found on comparing dental caries status among gender (P=0.021) as well different age groups (P=0.031).Conclusions: The study showed the presence of more normal and underweight children but there was no statistically significant association between body mass index and decayed, missing and filled teeth index.
Conjoined Twins
Authors: Kattel Pramod
Published: September 2018

Reported here is a case of conjoined twins presented to ante-natal outpatient department of Paropakar Maternity and Women’s Hospital on 21st August 2015 on a 20 year “Primigravida at 27 weeks and 6 days of gestation not in labor” referred from a polyclinic following ultrasonography diagnosis for better management. After confirming the diagnosis and counseling the patients regarding mode of delivery and possible outcomes, elective caesarean section was performed and delivered male conjoined twins of Parapagus dicephalus type with poor Apgar score. No resuscitation attempted except oxygen supplementation as per wish of parents and early neonatal deaths occurred at one hour of life.
Prevalence of Different Types of Apical Root Canal Morphology and their Treatment Recommendations in an Institute
Authors: Shrestha Sushmita , Karki Smriti , Agrawal Navin , Vikram Mannu , Singh Vimmi , Shrestha Ashish
Published: September 2018

Introduction: Canals can be of different shapes in cross section including round canals, oval canals, long oval canals or ribbon shaped canals. Recesses of nonround canals may not be included in the round preparation created by rotary instruments and thus they remain unprepared. The aim of this study included determination of shape and taper of the apical root canal based on diameter at different levels.

Methods: This was a cross sectional study which used convenient sampling technique to determine the sample size. Seventy extracted teeth were sectioned horizontally at one, two and three millimeter from the apex using the diamond disc which was observed under trinocular research microscope for the determination of diameter of root canal under 10x magnification.

Results: The most common canal configuration was oval. The taper of the canals was 25% in mesial root and 20% in distal in bucco-lingual orientation and 14% in mesial root and 15% in distal in mesio-distal orientation.

Conclusions: The most prevalent canal configuration in this study was non round, however, most of the rotary instruments tend to prepare root canals into round shape making their use questionable. The taper of the root canals was found to be higher in our study than what most of the shaping instruments have to offer. So it would be advisable to consider this fact while selecting instruments and preparing these non-round canals as far as the Nepalese subpopulation is considered.
Myths and Misconceptions about Abortion Among Marginalized Underserved Community
Authors: Thapa Kusum , Karki Yagya , Bista K P
Published: September 2018

Abstract
Medication Error: A Case Report of Misadventure with Methotrexate
Authors: Singh Anup , Handa Aru Chhabra
Published: September 2018

Methotrexate is an antimetabolite drug with antineoplastic and immunomodulatory properties, useful as an antineoplastic agent in various haematological and solid tumours. MTX toxicity can occur because of accidental ingestion/overdose by the patient or because of prescription error. The toxic effects manifest as severe mucositis or as organ damage (bone marrow depression, renal/hepatic injury). The toxicity usually results from parenteral overdose or repeated chronic drug ingestion. Acute high dose ingestion does not result in MTX toxicity because of saturable absorption kinetics. We present a case of MTX toxicity occurring as a result of prescription error resulting in repeat daily dosing of the drug, and the challenges associated with the management of the same, in a patient with multiple comorbidities. The present case emphasizes on a note of caution on the part of the prescriber and the suggestions regarding the measures which can be taken to avoid MTX toxicity.
Psychological Problems Among Nursing Staff in a Hospital
Authors: Shakya D R , Lama S , Shyangwa P M
Published: September 2018

Introduction: A high prevalence of psychological/ mental disorders has frequently been reported among nursing staff. However, there is a scarcity of data about ‘psychological, mental and behavioural problems’ among Nepalese nurses. Current study aimed to measure the prevalence of psychiatric problems among nursing staff in a tertiary care hosital.

Methods: All nursing staffs working in the hospital during one year were the subjects of this study. With the informed written consent, the responses to semi-structured proforma and the questionnaire General Health Questionnaire 28 were collected. A semi-structured proforma was used to record socio-demographic, clinical profiles and other information. The GHQ 28 was used to screen major psychiatric disorders. The GHQ 28 gives ‘psychiatric caseness’ to the subjects with score of 4 or more.

Results: Overwhelming majority of nursing staff in BPKIHS is female certificate level staff nurses. Majority were from urban and semi urban settings. Some had job and institute related stressors. Most common among the reported health complaints were low back pain and headache. Few staff revealed psychiatric diagnosis. Among the enrolled 337 subjects, ‘psychiatric caseness’ was present in 34.72%. Some departments (e.g. dialysis, eye, medical, gynecology ward) had proportionately higher ‘psychiatric caseness’ rates than other (e.g. ENT, psychiatry ward, emergency OT, CSSD).

Conclusions: A great proportion of nursing staff suffer from mental and behavioral problems.

Keywords: hospital; GHQ 28; mental illness; nursing staff; psychology.
Clinical Profile of Patients with Systemic Lupus Erythematosus
Authors: Paudyal B , Gyawalee M
Published: September 2018

Introduction: Clinical features of Systemic lupus erythematosus vary between different parts of the World; however, this information on Nepalese Sytemic lupus erythematosus does not exist.

Methods: Patients with Systemic lupus erythematosus fulfilling the American College of Rheumatology criteria treated in Patan Hospital were studied by means of retrospective review of their case records. The results were compared with various regional and international studies.

Results: The female to male ratio was 36:1 with a mean age at diagnosis 28.67 years. Cutaneous manifestations were the most common 72 (96%) presentations followed by musculoskeletal involvement 70 (93%). Haematological and renal involvements each were present in 33 (44%) of patients. Pulmonary and neuropsychiatric involvements were present in 15 (20%) and 8 (11%) patients respectively. Antinuclear antibody and anti-double stranded deoxyribonucleic acid antibodies were positive in 70 (93%) and 66 (88%) of patients respectively. A quarter of patients had some form of co-morbid conditions. At the time of last follow up, 70 (93%), 66 (90%), and 6 (9%) of patients were taking antimalarials, steroids and immunosuppressive agentsrespectively, mostly in combinations. Eighty seven percent of patients had their disease activity under control at the time of last follow up whereas four percent still had an active disease. In another four percent died during the course of therapy and the outcome was unknown in another four percent of patients who lost to follow up.

Conclusions: Clinical characteristics and antinuclear antibody pattern of Nepalese lupus patients is more or less similar to those with patients from other countries in the region and in the World.

Keywords: clinical profile; Nepal; systemic lupus erythematosus.
Emergency Medicine Education and Research in Nepal: Challenges and Opportunities
Authors: Shrestha Anmol Purna , Shrestha Roshana , Shrestha Sanu Krishna , Basnet Samjhana , Pradhan Alok
Published: September 2018

Emergency medicine (EM) is a young but prestigious medical discipline worldwide.1 However, in Nepal, it is in preliminary phase.2 EM is not only restricted to urban emergency departments but also a multifaceted discipline.3 Several EM training modules are currently practiced fragmented with different curriculum and duration.4,5 Pre-hospital emergency medical services (EMS), hospitals, trauma centres, and public health are working in silos and most of them devoid of proper emergency facility.2 This brought us to the realization of an urgent need of bringing all the stakeholders together in a symposium like this.

The symposium was arranged into four different sessions as listed below:

To familiarize with the history and current state of EM from Global Emergency Medicine perspective.

To highlight the different clinical experiences and advancements in EM in Nepal.

To emphasize the importance and possibilities in EM education and research in Nepal.

To discuss the roadmap to develop and establish EM as a recognized medical speciality in Nepal.

The overall objectives of the symposium were to discuss the challenges faced by current Emergency Medicine providers and identify the opportunities for the future development and recognition in Nepal.

The most important current task for Nepal’s emergency physicians of advocating for policies, programs, and funding to support further development of the specialty was realized. Rural and urban emergency service providers from academic and non-academic institutions, governmental/non-governmental organizations and international medical institutions attended the symposium. General Practice (GP) residents, medical officers, medical students, interns and paramedics were among active participants.