bluuebunny/crossref_metadata_2025 huggingface dataset:
The prevalence of lower respiratory tract infection in adults visiting Tribhuvan University Teaching Hospital
Authors: Gauchan Sudip P. , Lekhak B. , Sherchand J.B.
Published: July 2024

Background: Respiratory conditions impose enormous burden on society. Reports indicated that the top five respiratory diseases accounted for 17.4% of all deaths and 13.3% of all Disability Adjusted Life Years (DALYs). Also, out of total acute respiratory disease, 20-24% of deaths are accounted for by Lower Respiratory Tract Infection (LRTI). In developing countries like Nepal the need for timely diagnosis of the cases and the administration of appropriate therapy based on the antibiotic susceptibility test of the causative agents is critical. However, emergence of resistant strains may occur during antibiotic therapy, which is one of the contributing factors for the increase in the frequency of LRTI in recent years in the adult population of Nepal as well.
Methods: A hospital based cross-sectional study was carried out from March 2002 to February 2003. Total 181 adults presenting with LRTI defined by a new or increasing cough, productive sputum, chest pain, fever, anorexia, haemoptysis, headaches and throat ache were enrolled with their consent. This is a prospective study which included bacteriological culture, microscopic examination and sensitivity testing of bacterial isolates invitro in Health Research laboratory following Standard Operating Procedures (SOPs).
Results: Lower Respiratory Infection was found prevalent in 75 cases (41.4%). Males (61.3%) were found more at risk to LRTI than females (38.7%). LRTI was found most prevalent in 50-59 year age groups (21.3%). Altogether 15 different types of bacteria were identified majority of which were Gram-negative bacteria (72.4%). Haemophilus influenzae was the commonest isolate at 23.0% followed by Klebsiella pneumoniae (18.3%). Among Gram- positive isolates Streptococcs pneumoniae was predominant (12.7%) followed by Staphylococcus aureus(9.3%).The in vitro antibiotic susceptibility test of the isolates showed that Chloramphenicol(100%) was the most effective antibiotic against Gram-negative bacteria followed by Amikacin (79.1%) and Ciprofloxaxin (66.7%), and the least effective was Co-trimoxazole (20.6%). Similarly, for the Gram-positive bacteria Ciprofloxacin (79.2%) was the most effective antibiotic and the least effective was Co-trimoxazole.
Conclusion: The study shows increasing number of respiratory pathogens resistant to antimicrobials in-use to treat the infection.
In the Foothills of Medicine: A Young Doctor’s Journey from the Inner City of Chicago to the Mountains of Nepal
Authors: Shankar P.R.
Published: July 2024

N/A
HOPE in Nepalese hospitals
Authors: Vaidya P.
Published: July 2024

N/A
Audit on the quality of discharge summary in TU Teaching Hospital
Authors: Pradhananga R.B. , Guragain R. P. S
Published: July 2024

Background: To find out whether all the criteria of discharge summary outlined in modified VanWalraven et al. 1999, were met in the discharge summary. To determine the completeness of the discharge summary form printed by the hospital
Methods: Review of the records of 20 discharge summary form from each seven departments of Tribhuvan University Teaching Hospital (TUTH) betweenApril 2005 and September 2005. The notes were looked for completeness and inclusion of all criteria outlined in modified van Walraven et al 1999.
Results: According to van Walraven et al Modified Criteria Department of Gynaecology showed the best summaries in which most of the necessary informations were included where as Department of Orthopedics had the least inclusion of criteria. Department of ENT & Head and Neck Surgery tops the list for completeness of the hospital printed discharge form. Department of Orthopedics, again, was found to be at the bottom of the least.
Conclusion: Discharge summary should be filled up completely, clearly and without missing necessary informations. Regular audit should be performed to ensure that the quality of discharge summary is maintained.
Ambiguous pricing of Nepalese medicines
Authors: Shankar P.R. , Subish P. , Mishra P. , Lalit M.
Published: July 2024

Background: The National Drug Policy of Nepal aims to make the country self-reliant in drug production. Nepal follows a competitive market system where both domestic and foreign manufacturers compete. Previous studies had shown ambiguities in drug pricing. Recent studies are lacking. Hence the present study was carried out to obtain information on the price variation between Nepalese brands for different drugs.
Methods:The prices of drugs listed in the December 2005 issue of Nepal Drug Review were analysed. The following formula was used for calculation. Percentage price variation = Price of most expensive brand – Price of least expensive brand x 100 Price of least expensive brand The drugs were grouped together into various therapeuticcategories and for each category, the mean number of brands and the mean percentage price variation was calculated.
Results: A total of 79 drugs and 537 brands were analysed. Thirty-five drugs which were being manufactured by a single manufacturer were listed but were not analysed. The maximum price variation was shown by the group of anthelminthics followed by antihistamines and antiemetics. Among the individual drugs, fexofenadine and albendazole showed the maximum variation. Three of the drug groups showed more than 50% variation. However, ten individual drugs showed more than 50% variation.
Conclusion: Variations were observed in the prices of different brands of the same drug being manufactured by different Nepalese companies. Prescribers and patients should be educated about drug prices. Further studies are required.
Tramadol
Authors: Upadhyay D.K. , Palaian S. , Kishore P.V. , Paudel R. , Prabhu M. , Shankar P.R. , Mishra P
Published: July 2024

Background: Tramadol is a centrally acting synthetic opioid analgesic used orally and parenterally in pain management. The United States Food and Drug Administration (US FDA) has approved Tramadol for the management of moderate to severe pain. Tramadol has minimal sedation and respiratory depression and has less gastrointestinal effect. It produces nausea, vomiting, dizziness, headache, somnolence, vertigo, seizures, etc. Concomitant use of Tramadol with CNS depressants should be avoided because Tramadol may potentiate the respiratory and CNS depressant effects of these drugs. There is an increase risk of convulsions in patient with epilepsy or history of seizures. It is contraindicated in patient receiving warfarin because it prolongs international normalized ration (INR) and prothrombin time and extensive ecchymoses. The concomitant use of Tramadol and serotonergic agents (e.g. Mirtazipine, Selegiline, Venlafaxine etc) is contraindicated because of the risk of serotonin syndrome. It has also got significant drug abuse potential. In Nepal, Tramadol is available as 50 mg capsule and 100 mg controlled release tab. It is also available as 50 mg and 100 mg injection. The safety profile, contraindications, drug interactions and the economic parameters should be considered before prescribing Tramadol.
Primary internal fixation of fractures of both bones forearm by intramedullary nailing
Authors: Singh R.P , Sharma M.
Published: July 2024

Background: Both bone fracture of forearm is a common injury, if not treated properly causes severe functional disability to the patients.
Materials and Methods: In this study 40 patients each with diaphyseal fractures of both bones forearm treated by square nail were evaluated.
Results: Conservative treatment with poor results and prolonged cast immobilization of 2-3 months adds to socio economic burden of patients. Hence various internal fixation devices were developed to achieve good results. Unstable fractures of radius and ulna with subluxation or dislocation of superior or inferior radio-ulnar joints and open fractures with skin loss need internal fixation.
Conclusion: Intramedullary nailing is a simple method of treating forearm fractures with better results than conservative methods.
Surgical antibiotic prophylaxis in a teaching hospital in western Nepal
Authors: Shankar P.R. , Subish P , Dubey A.K. , Mishra P. , Upadhayay D.K.
Published: July 2024

Background: Inappropriate prophylaxis favours the emergence of resistant organisms. In a previous study many parameters were not explored. Hence the present study was carried out to obtain information on the common antibiotics used for surgical prophylaxis, assess the appropriateness of antibiotic use for different procedures, calculate the mean cost of antibiotics used for prophylaxis. The prospective study was carried out over a four-month period (01.04.2004 to 31.07.2004) Manipal Teaching Hospital, Pokhara, Western Nepal.
Materials and Methods: Inpatients undergoing surgery in the departments of General Surgery, Obstetrics and Gynaecology, Otorhinolaryngology and Orthopaedics. The surgeries were classified as clean, clean contaminated, contaminated and dirty. Appropriateness of prophylaxis was assessed. The percentage of patients receiving inappropriate prophylaxis was calculated.
Results: Antibiotics were used in 367 of the 371 patients who underwent surgeries. 241 surgeries (65%) were clean-contaminated, 65 (17.5%) were clean while 48 (12.9%) were contaminated. Internal fixations of fractures, circumcision, tympanoplasty, appendicectomy were common surgeries performed. Antibiotics were used for prophylaxis in 322 patients (86.8%) and for treatment in others. The fixed-dose combination of ampicillin and cloxacillin, metronidazole, gentamicin, ampicillin and cefotaxime were most commonly prescribed. The use of antibiotics was according to guidelines in 68 of the 322 patients (21.1%). The mean cost of antibiotics for prophylaxis was 11.2 US$. If a standard guideline had been followed the cost would have been reduced to 1.6 US$.
Conclusions: Problems were noted in the use of antibiotics for surgical prophylaxis. Framing of antibiotic use guidelines are required.
Pelvic and endometrial tuberculosis diagnosed during vaginal hysterectomy
Authors: Rana A. , Gurung G. , Amatya A. , Koirala B.
Published: July 2024

It is indeed unusual to be confronted with cul-de-sac nodularity and exclusive pelvic peritoneal miliary deposits at vaginal hysterectomy confounding with endometrial tuberculosis, histology suggestive of chronic granulomatous condition as an example of genital and peritoneal tuberculosis the rarely which in seen.
Consumption of rodenticides by humans
Authors: Kishore P.V. , Palaian S. , Prabhu M. , Mishra P.
Published: July 2024

Case report: Poisoning is a common problem worldwide. Among the various poisonings, rat poison accounts for a significant number of cases. The common rat poisons are anticoagulant containing (superwarfarins) and phosphide containing. In case of superwarfin poisoning, the major symptom is increased prothrombin time and the management is directed towards coagulation. In case of phosphide containing, the symptoms are non-specific and the patient should be managed symptomatically. We present three case vignettes of rat poisoning cases treated at our hospital. Since rat poisoning is a common problem, the hospitals should also develop standard treatment guidelines regarding the management of rat poisoning. One should also make the differential diagnosis of the poisoning based on the type of rat poison prior to the management.
Dexamethasone Cyclophosphamide Pulse Therapy in Dermatology
Authors: Parajuli S. , Paudel U. , Pokharel D.B.
Published: July 2024

Introduction: The objectives of this study was to: study profile of dermatological disease treated with pulse therapy in TUTH , determine the clinical time to remission of diseases, duration of remission after withdrawal of treatment and determine the side effect profile of the treatment. Materials and
Methods: Demographic profile of the patients treated with pulse therapy for various dermatological conditions, the duration of diseases prior to treatment, the clinical time to remission of diseases, duration of remission after withdrawal of treatment and side effects of treatment. Results: Pulse therapy was received by 12 patients, five patients were SLE (F: M-4:1) with mean age of onset 28.75yrs, six patients were of Pemphigus (F: M-1:1) with mean age of onset 30.6 yrs and there was one 40 yrs old female patient of scleromyxoedema. The mean duration of disease prior to treatment was 2.8 yrs in SLE and 1.4 yrs in Pemphigus. The mean duration of clinical time to remission was 4 months for SLE while only one patient of Pemphigus had received clinical remission after 6 months. Duration of remission after withdrawal of treatment could not be ascertained because none of them had completed phase III. The main side effects observed in our study were flushing and secondary infection.
Conclusion: DC pulse therapy appears to be encouraging treatment in the treatment of dermatological conditions like SLE, Pemphigus and scleromyxoedema. However study involving a large number of patient and long duration of follow up is needed before considering it as best treatment available for treatment of these conditions.
Insulin glargine
Authors: Upadhayay D.K. , Palaian S. , Prabhu M. , Shankar P.R. , Mishra P.
Published: July 2024

Abstract: Insulin glargine is a long-acting human insulin analog prepared using recombinant DNA technology. It is the first long-acting analog of human insulin to be approved for clinical use. It is administered once daily and has a smooth 24 hour time-action profile that provides effective glycemic control with minimal risk of hypoglycemia. It may be used for children who are 6 years or older. Though the risk for developing hypoglycemia is less, hypoglycemia is still the most commonly reported adverse effect, especially within the first four weeks of therapy after a switching over to insulin glargine. Intravenous administration of this drug is not recommended due to the risk of severe hypoglycemia. The patients prescribed insulin glargine should be thoroughly counseled bythe healthcare professionals regarding its safe and effective use. The vials and cartridges of insulin glargine should be stored in a refrigerator between 2 to 8 degrees C.
Sex preference in urban Nepal
Authors: Adhikari N. , Ghimire A. , Ansari I
Published: July 2024

Introduction: Altered sex ratio at birth is strong indicator of bias against unwanted sex. Sex selection is currently possible through advanced technology of pre implantation sex selection, prenatal sex diagnosis and sex selective abortions. In Nepal, though preference for sons is strong, there is no evidence of altered sex ratio at birth on country wide basis.
Methods: This retrospective study was done at Patan Hospital, Kathmandu, Nepal. All live born babies born during a period of five years (2003 to 2007) were divided into three groups-first live born babies, second live born babies and the rest grouped as third and subsequent live born babies. Their sex was recorded and results were analyzed.
Results: Over the entire study period, 114 boys were born for every 100 girls (normal being 102 to 106 boys for every 100 girls). For the first live births, the ratio was 106 boys to 100 girls. For the second live birth, it was 118 to 100. For third and successive births this ratio was 177 to 100.
Conclusion: There was a highly significant decrease in proportion of female births for third and successive births. Over the years, there is some decrease in proportion of female births in all three groups. However, it is statistically not significant that there is a practice of sex selective abortions in practice in Kathmandu.
Practice of contraceptives
Authors: Pandey S. , KARKI S. , Pradhan A.
Published: July 2024

Introduction: Over the past decades fertility rate have surprisingly been stagnated demanding further research on the ways it reduces rate to a level appropriate for healthy population. Considering the status of male in developing countries like Nepal, it is believed that men play vital role in achieving success in this sector. Therefore this study was done to find out the knowledge and practice of contraceptives among married males of Makwanpur, Nepal.
Methods: This is a cross-sectional descriptive study. Data were collected from the 387 respondents by personal interview using semi-structured questionnaire.
Results: Mean age of the respondents was 34.48 years. Most of the respondents knew at least four contraceptive methods. There is a strong relationship between knowledge and the use of contraceptives with the level of education and economic status having a direct impact. The attitude of male respondents to share responsibility for promotion of contraceptive was found to be positive.
Conclusions: Almost majority agree that the responsibility for contraception should shared by both partner, but use of contraceptive methods among men is still low. This study recommended in depth action research to promote male contraceptive methods and priority for service delivery program in Nepal.
Prenatal ultrasonographic diagnosis of urethral atresia
Authors: Thapa N.B , Dwa Y , Gurung S. , Baral R.
Published: July 2024

Urethral atresia is one of the rare congenital anomaly of urogenital tract. In this case report, uretheral atresia diagnosed antenatally by ultrasonography (USG) at 24-25 weeks of gestation is presented. USG findings were confirmed by postmortem examination of the fetus.
Appendicular perforation
Authors: Malla BR , Shrestha RKM
Published: July 2024

Introduction: Appendicitis is the most common acute abdominal condition presenting in hospital. Appendicular perforation is a major complication of appendicitis. The objective of the study is review the cases of appendicular perforation in respect of its incidence, sex preference, clinicalfeatures, investigations, treatment and postoperative wound infections
Methods: A retrospective study was conducted reviewing the records of the patients who were admitted in Dhulikhel hospital with the diagnosis of appendicular perforation from January 2009 to December 2010.
Results: A total of 332 cases of appendicular disease were admitted during the study period. Out of them, 42 patients had appendicular perforation. It constituted 12.6% of total appendicular diseases. The male to female ratio in perforation was 6.1: 1. The common age group for the perforation was 30- 50 years with mean age of 35 years. The mean duration of pain before presentation to the hospital was 4.5 days.All the cases of appendicular perforation had spread of pain from right iliac fossa to all over the abdomen, and anorexia. Vomiting was found in 83.33% of the cases. All the cases had rebound tenderness and rigidity all over the abdomen. None had free gas under diaphragm. Retrocaecal shaft perforation was found in most of the cases. Post operative wound infection was found in 14.2% of the cases.
Conclusions: Appendicular perforation is a severe complication of appendicitis. Appendicular perforation has no sex preference. It is common in elderly age group. Spread of pain from right iliacfossa to all over the abdomen, anorexia and rebound tenderness were found in all cases. Elevated total leukocytes count and shift to left were significant in case of appendicular perforation. Retrocaecal appendix is more prone to perforation.
Comparison of hearing results between the averages of three and four speech frequencies in Type 3 Tympanoplasty
Authors: Shrestha BL , Gurung U , Bhattarai H
Published: July 2024

Introduction: Hearing assessment after tympanoplasty is done by taking pure tone average. This study was performed to compare the hearing results obtained from the averages of three and four speech frequencies namely 0.5, 1,2KHz and 0.5,1,2,4 KHz in type III tympanoplasty.
Methods: This study was conducted in Tribhuwan university teaching hospital and Kathmandu university hospital, Dhulikhel from October 2006 to November 2009. The pure tone audiogram was performed by Hugson and Westlake method. The audiometry results were reported as per American Academy of Otolaryngology – Head and Neck surgery guidelines. The comparison between the averages of 3 and 4 speech frequencies that are 0.5, 1,2KHz and 0.5,1,2,4 KHz were performed with regard to bone conduction threshold(BCT), air conduction threshold(ACT),air bone gap (ABG) and air bone gap closure. Data analysis was performed using SPSS 13 software.
Results: Comparison between the averages of 3 and 4 speech frequencies between the preoperative BCT and ACT showed difference of 1.5dB and 0.8dB which were statistically significant whereas the difference in ABG was 1dB which was statistically not significant. Similarly post-operative BCT, ACT, ABG showed the difference of 0.3dB, 0.5dB and 0.2dB respectively which were also statistically not significant.
Conclusions: The difference between 3 and 4 speech frequencies averages are small and are statistically not significant but it is still worth to include 4 KHz as this is a high frequency which is likely to be affected by tympanoplsty.
Postoperative pain management with combined local infiltration and oral analgesia in herniotmy wound in children
Authors: Sharma NR , Pandit U , Sapkota PR
Published: July 2024

Introduction: Post operative pain management in children is one of the most challenging job to anaesthetic as well as to surgeon. Adequate analgesia in children is necessary to reduce parent’s distress after any surgery. This study was carried out to assess the subjective adequacy of combined approach local anaesthesia and oral analgesia after inguinal herniotomy surgery in children.
Methods: It was a prospective study done in a very remote district of Ruccum in Nepal. Adequacy of postoperative pain management was observed after wound infiltration at the local site in inguinal herniotomy cases.subsequently after surgery in 80 children. Wound infiltration at the local site was made with 0.5% bupivacaine. subsequently a combination of syrup of oral analgesic ibuprofen and paracetamol was given 4 hours after surgery when child became fully awake. Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) was used to access the adequacy of pain management.
Results: out of 80 children, pain score< 6 was observed in 95.5% children . Among behavioralscore the commonest neutral bevavior in torso was found in 75 chidren. Likewise, no cry in 73, smiling in 70%, positive in 70%, not touching in 74%, neutral behavior in 74% were observed in cry, facial, child verbal, torso, touch and legs respectively.
Conclusion: Local wound infiltration with 0.5% Bupivacaine is a simple and effective method in pain management in herniotomy cases which givessatisfaction to the children as well astheir parents
Reference values for Doppler indices of the umbilical and fetal middle cerebral arteries in uncomplicated third trimester pregnancy
Authors: Paudel S , Lohani B , Gurung G , Ansari MA , Kayastha P
Published: July 2024

Introduction: The purpose of this study was to categorize new reference ranges for measurements of commonly used umbilical artery and fetal middle cerebral artery Doppler indices (Pulsatility Index, Resistance Index, and Systolic: Diastolic ratio) in uncomplicated third trimester pregnancy.
Methods: This was a prospective cross sectional study involving 101 singleton uncomplicated pregnancies of 30 to 37 weeks of gestation. Umbilical artery indices were obtained from free floating loop and middle cerebral Doppler indices were obtained from the proximal third of the artery with flow towards the probe. Regression equations were used to categorize reference ranges and percentile fitted Normograms were obtained for all the parameters.
Results: Among 101 singleton pregnancies between 30 and 37 weeks of gestation, 65 (64.35%) were primigravida women and 36 (34.65%) were multigravida. Mean maternal age was 23.12years (range 16 to 35 years). Maximum number of pregnancies (18.81%) was at 34 weeks of gestation. The established percentiles of Doppler indices showed a continuous reduction of all the measured indices as pregnancy increases (p<0.0001).
Conclusions: Reference ranges were obtained for the middle cerebral artery and umbilical artery Doppler indices. These ranges are consistent with similar studies done by other authors.
Factors determining self-harm
Authors: Shakya YL , Acharya R , Gupta MP , Banjara MR , Prasad PN
Published: July 2024

Introduction: Self-harm forms a significant proportion of patient attending in emergency departments, typically 10-30 per 100000 people commit suicide annually. The objective of this study was to find out the factors responsible for self harm.
Methods: This is a cross-sectional study of 100 patients of self-harm coming to Emergency Department of Tribhuvan University Teaching Hospital from from 1st October 2007 to 31st March, 2008. Questionnaire about demographic information of patient along with details about cause of self-harm, and any other illnesses associated was filled. Information about duration of arrival in emergency department, place of self-harm was gathered. Patients were clinically examined and hematological and biochemical tests including liver function test and the type of poison used and its level in blood were examined.
Results: Total number of patients with self-harm was 100 (female - 71%; male- 29%). Among female,16-30 years age group to be the largest (76%). Mean duration of arrival in emergency department was3.08 hour. Metacid ingestion (29%) was found to be the most common cause for self-harm. There is no difference of self-harm for suicide and threat cause. Only 5% of patient with self-harm has psychiatry illness in the past.
Conclusions: Self harm forms a significant proportion of patient attending the Emergency department and the most common form of self-harm used was metacid ingestion. There is compelling evidence for the need to improve delivery of care for patients who inflict self-harm.
Creatinine clearance and subclinical target organ damage in primary hypertension
Authors: Das S K , Jha S C
Published: July 2024

Introduction: Despite the widely recognized dangers of uncontrolled hypertension, the disease remains inadequately treated in the majority of patients. This may be, in large part, because of the asymptomatic nature of the disease for the first 15 to 20 years, even as it progressively damages the cardiovascular system. Therefore, assessment of hypertension related subclinical target-organ damage represents a key diagnostic procedure for the risk stratification of hypertensive patients.
Methods: A prospective case control study of 40 cases (patients with CCR<60) and 40 controls (patients with CCRe”60) was conducted in Tribhuvan University Teaching Hospital (TUTH). Renal function was estimated by the Cockcroft-Gault formula. Left ventricular hypertrophy was determined by echocardiography. Retinal vascular changes were evaluated by direct ophthalmoscopy. Microalbumin in urine was measured from spot morning sample.
Results: The prevalence of LVH, microalbuminuria and retinopathy in cases and control group was 55% VS 20% (P=.001), 50% VS 20% (P=.004) and 92.5% VS 52.5% (P=.001). Patients with microalbuminuria showed prevalence of LVH, CCR<60 and retinopathy as 78.57%, 71.43% and 100% respectively. There was high prevalence of grade I and grade II retinopathy in patients with low CCR
Conclusions: Results show that a reduction in creatinine clearance and/or presence of microalbuminuria is a marker of subclinical organ damage in patients with primary hypertension and normal serum creatinine irrespective of BP load and other traditional risk factors.
Management of posterior cruciate ligament avulsion by cannulated screw Fixation
Authors: Lamichhane A , Mahara D P
Published: July 2024

Introduction: Posterior cruciate ligament (PCL) is the main posterior stabilizer of the knee. The PCL also plays a role as a central axis controlling and imparting rotational stability to the knee. The most effective management of posterior cruciate ligament (PCL) injuries remains unclear and the natural history of untreated PCL injuries is controversial. The need for surgical repair of displaced bony PCL avulsions is less controversial. Here we present repair of PCL avulsion by screw fixation.
Methods: There were total of 18 patients (Male 12 and Female 6) operated for isolated PCL avulsion from tibia during the period from 2002 to 2010. Preoperative evaluation was done clinically and radiologically ‘MRI was advised for suspected other ligaments and meniscal injuries. Patients with other ligaments and meniscal injury were not included in this series. All cases operated by simplified approach described by Burks and Schaffer. Avulsed fragment was reduced and fixed with 4 mm a cannulated screw. Evaluation of the patients were done clinically, radilologically and using functional scale of Tegner-Lysholm.
Results: Out of 18 patients, 12 patients were male and 6 patients were female. Average age of the patients was 29yrs (range 18-47 yrs). Average period of follow up was 31 months (ranging 12 - 52 m). Range of movement was found full in all patients at the last follow up. Grade 1-2 laxity was found in 8 patients but subjectively they were not aware of the laxity. Average Lysholm score was 91 (range87-97).
Conclusion: Improvised approach by burk and Schaffer is safer and easier than the classical one. Open reduction and fixation with cannulated screw is one of the excellent techniques for tibial avulsion of posterior cruciate ligament.
Prevalence of skin diseases and impact on quality of life in hilly region of Nepal
Authors: Shrestha DP , Gurung D , Rosdahl I
Published: July 2024

Introduction: Skin diseases (SDs) are one of the most common health problems in Nepal. The objectives of this study are to determine the prevalence of SDs and impact on quality of life (QoL) in a rural community in Nepal.
Methods: A house-to-house survey was conducted in a community with 3,207 inhabitants, to obtain socio-demographic data and identify individuals with SDs. Free examination and treatment was offered at 4 health camps. Individuals with long-standing SDs were interviewed using the Dermatology Life Quality Index (DLQI).
Results: Of 735 individuals attending the health camps, 645 (mean age 24.9 years, range 0.5 -90) had one or more SDs. The overall prevalence of SDs was 20.1% (males 18.1%, females 22.5% and children 28.2%). The most common SD categories were eczemas (12.2%), pigment disorders (4.1%), acne (2.7%), urticaria (2.4%) and moles and lumps (1.6%). In the Nepalese culture, the DLQI question on sexuality was too direct so only 9/10 questions were used. In the 75 patients who were interviewed, the mean DLQI score was 10.7 (range 7-19), indicating a large impact on QoL.
Conclusions: This population-based study shows that SDs were very common in a rural community in Nepal. The five most common SD categories comprise 77% of all SDs. Targeted training should enable health-care workers to prevent, accurately diagnose and manage these problems on site. An appropriate instrument to measure QoL adjusted to the socio-cultural norms of Nepal has to be developed.
Papillary carcinoma of thyroid and pregnancy
Authors: Rawal S , Gurung G.
Published: July 2024

Two cases of Papillary carcinoma of thyroid and pregnancy were managed, one with the existing disease diagnosed during pregnancy and the other with a history of near total thyroidectomy. A multidisciplinary approach in the management of both the mothers lead to an uneventful pregnancy, caesarean section with good outcome and were discharged in good health.
Anesthetic management of tracheobronchial foreign body removal
Authors: Pradhan B.
Published: July 2024

Introduction: Tracheobronchial foreign body removal, is a common emergent problem especially in pediatric population and it is associated with greatest challenge to the anesthesiologist as well as to the surgeon as the airway has to be shared by both. Various pulmonary changes associated with foreign body impaction also occurs.
Methods: This is a retrospective analysis of foreign body removal of tracheobronchial tree in Institute of Medicine, Tribhuvan University Teaching Hospital over the last three years (April 2006 – April 2009). Data regarding age, sex, presentation/signs, anesthetic technique, site and types of foreign body, intraoperative events and postoperative outcomes were collected.
Results: The age range of the patients was from 6 months to 18 years. Total cases were 49. Most of the foreign bodies were organic (60%) and the common site was in right bronchus (64%). The cases were managed either with assisted ventilation or controlled ventilation intraoperatively. Most of the cases presented with dyspnoea. Postoperatively few cases (5 cases) needed to be ventilated electively in intensive care unit, while most of the cases needed oxygen supplement for few hours postoperatively.
Conclusions: Anesthetic management of tracheobronchial foreign body is challenging for both the anesthesiologist and the surgeon. The only way for the better outcome, is excellent communication in both parts i.e. anesthesiologists and surgical team, as well as timely information and involvement of other experts like paediatrician, before the procedure
Cryptosporidium and Cyclospora infection transmission by swimming
Authors: Ghimire T.R. , Ghimire L.V , Shahu R.K , Mishra P.N
Published: July 2024

Cyclospora and Cryptosporidium are obligate, intracellular, coccidian protozoa that cause selflimited diarrhoea in immunocompetent and prolonged diarrhoea in immunocompromised patients. This is the first case of coccidia infection acquired after swimming in a swimming pool in Nepal. This study describes the chronological evidence of these coccidia infections in a Nepalese swimmer with the possible epidemiological link of the environmental contamination in swimming pools in Kathmandu. It represents an important public health issue among the urban areas of the world.
Renal transplant in Nepal: medical complications in first three months
Authors: Shrestha S , Sigdel MR , Raut KB , Kafle MP , Shah DS
Published: July 2024

Introduction: A successful renal transplant program was started in Nepal on August 8, 2008 in Tribhuvan University Teaching Hospital; and since then more than 200 live renal transplants have been done in our center.
Methods: A prospective analysis was done of 50 consecutive renal transplant recipients (performed from June 29, 2011 to May 16, 2012), with a minimum of 3 months of follow up. All recipients were on tacrolimus, mycophenolate mofetil, and steroids. The outcomes of the study were medical complications that occurred within the study period.
Results: The mean age of the recipients and donors were 36.0 ± 1.1 (range 15-59) and 48.3 ± 1.1 (range 22-65) years respectively. The fatal complications were one case each of hospital acquired pneumonia leading to sepsis, delayed graft function secondary to acute tubular necrosis, and community acquired pneumonia. The most common non-fatal infection in first month post-transplant was urinary tract infection, 24 episodes were identified in 20 recipients (40%). In 1 to 3 month post-transplant also, urinary tract infection was the most common non-fatal infection, 6 episodes occurred in 5 recipients (10%). 6 episodes of biopsy proven acute rejection occurred in 6 recipients (12%). Delayed graft function was observed in 2 patients (4%). New onset diabetes after transplant occurred in 6 patients (12%).
Conclusion: The most common medical complication in first three months post-transplant was urinary tract infection, followed by acute rejection, new onset diabetes mellitus after transplant and delayed graft function.
Association between individual factors and HIV and AIDS
Authors: Karki TB , Modi KN
Published: July 2024

Introduction: Individual personality affects the culture of the society and it also affects the risk behavior of HIV and AIDS. Level of knowledge and sexual practices of individual determine the risk of HIV transmission. HIV and AIDS is one of the most dreaded diseases of century. The epidemic is unique in its devastating impact on the social, economic and demographic underpinnings of development. This study investigated the roles of individual factors increasing the risk of HIV and AIDS in the context of Nepal.
Methods: Study was non experimental cross sectional. 404 respondents were randomly selected from the long route transport workers, brick factory workers, garment factory workers and health workers. The study was conducted from Oct 2012 to Mar 2013 (6 months) in Kathmandu valley.
Results: 94.1% respondents found aware about the unsafe sex is the means of HIV transmission. But still occupation-wise, 63.4 % of Health workers wanted HIV status to remain secret as compared with only 17.8% transport workers remained it secret. Highly educated persons felt feeling of stigma being HIV positive. 11.6% respondents reported that they had sexual relationship with non- regular sex partners. Among them 37.5% had not used condom during the sexual intercourse with non- regular sex partners
Conclusions: Safer sex practices is low than level of knowledge. Negligence behavior found high free martial sex in increasing among the youth. Most of the educated person didn't want to disclose the HIV status because of the fear of stigma and discrimination of society.
Study on hypoglycemic effect of Berberis aristata on type 2 diabetic model rats
Authors: Bharati L , Amatya S , Bhoumik A , Gharti KP , Rokeya B
Published: July 2024

Introduction: Berberis aristata is one of the herbs mentioned in all ancient scriptures of Ayurveda. It is a well-known medicinal plant in hilly areas of Nepal and its occurrence is reported from middle altitude areas. It is used traditionally for treating various disorders including diabetes mellitus.
Methods: The experiment was carried out for duration of 28 days on a total of 27 rats. The rats were divided into 4 groups – type 2 water control, type 2 glibenclamide treated, type 2 extract treated and normal treated group. Blood glucose, lipid profile and serum insulin level of all groups were compared at 0 day and 28 day. The renal function, liver function liver glycogen, MDA and GSH concentration value of all groups were compared on 28 day.
Results: The study revealed that type 2 rats treated with extract showed decrease in blood glucose level at 120 mins. The significant decrease was found in normal rat treated with extract in comparison to water control, glibenclamide and type 2 rats extract treated group when fed simultaneously with glucose on the 15 day. There was significant decrease in fasting glucose level in both type 2 and normal rat treated with extract on 28 day in comparison to 0 day.
Conclusion: Berberis aristata dry stem powder 80% ethanolic extract possesses significant hypoglycemic activity in Type 2 diabetic model rats and normal rats.
Ventilator Associated Pneumonia in Tertiary Care Hospital, Maharajgunj, Kathmandu, Nepal
Authors: Shrestha RK , Dahal RK , Mishra SK , Parajuli K , Rijal BP , Sherchand JB , Kirikae T , Ohara H , Pokhrel BM
Published: July 2024

Introduction: Ventilator Associated Pneumonia (VAP) is the most common nosocomial infection among intensive care unit (ICU) patients and lack of much information in Nepal. So, the aim of this study was to determine prevalence and bacteriological profile of VAP with special reference to multi-drug resistant (MDR), Methicillin-resistant Staphylococcus aureus(MRSA), Metallo-β-Lactamase(MBL), Extended-Spectrum β-Lactamase(ESBL)-producing bacterial strains.
Methods: A total 150 tracheal specimens were studied during June 2011 to May 2012 at Department of Microbiology, TUTH as described by American Society for Microbiology (ASM). Combination disk method was done for the detection of ESBL and MBL producing isolates.
Results: Prevalence of VAP was found to be 34%. Acinetobactereal coaccticusbaumannii complex (44%) was the commonest isolate, followed by Klebsiellapneumoniae (22%), Pseudomonas aeruginosa (16%) and Staphylococcus aureus (12%). Among MDR Gram negative bacteria (GNB), 39% were MBL and 33% were ESBL-producers. All GNB (61) were sensitive to Polymyxin B and Colistinsulphate, whereas, 48% were found resistant to Carbapenems. Prevalence of MRSA was 75%, which were all sensitive to Vancomycin.
Conclusion: High prevalence of VAP, MDR along with MRSA or ESBL or MBL producing strains was found in the study. Thus, suitable control measures must be adopted to cope up this alarming situation with genetic characterization.
Carbon dioxide laser therapy of cervical intraepithelial neoplasia
Authors: Pradhan Pramila , Andrews J.D.
Published: July 2024

We present a prospective study of cytology, colposcopy and histology reports of the first 70 women treated with CO2 laser for CIN lesions in East Surrey Hospital, Redhill (U.K) from 1st Sep 1984 to 30th July 1986.Follow-up evaluation consisted mainly of cytology sampling and colposcopy if needed. Initial follow-up was at 6 weeks after laser therapy, then 3 monthly for the first year, 6th monthly interval for the second year, and yearly thereafter for the rest of life.Out of 70, 68 patients were regularly seen at the gynaecological clinic. Two patients left the country to live aboard, and advice being given to follow the above schedule and to send us the copy of the smear reports (were reported Normal up to 2 years). Nine out of 70 patients (12.8%) demonstrated abnormal cytology indicating the presence of CIN following laser therapy. All these cases were recolposcoped and rebiopsied for accurate diagnosis. Two out of 20 patients CIN grade II recolposcoped (10%) demonstrated persistent disease following primary laser therapy. Seven out of 42 patients in CIN grade III (16.6%) demonstrated persistent disease. Over 97% of the patients were cytologically free of CIN at the end of the study.CO2 laser is an effective form of treatment of CIN leisons. Failure rate was just under 3%. We recommend that any follow-up protocol should include 3 monthly interval for the first year, then 6 monthly interval for the 2nd year and then yearly thereafter for the rest of the life.
Impact of iron and zinc supplementation on child disability screening using the Ten Questions Plus tool in rural Sarlahi District, southern Nepal
Authors: LA Wu , J Katz , Khatry SK , GL Darmstadt , SC LeClerq , JM Tielsch
Published: July 2024

Introduction: The Ten Questions tool was developed in 1984 as a low-cost tool to screen for child disability prior to referral for definitive diagnosis. Iron and zinc contribute to child growth and development, but few studies examine the relationship between supplementation and longer-term neuro-developmental outcomes.
Methods: The Ten Questions Plus tool was administered to caregivers of 1410 children between 1-9 years of age from August 2007 to March 2008 in rural Sarlahi, southern Nepal. Participants had been previously enrolled in a randomized 2x2 factorial trial of daily iron and zinc supplementation between October 2001 and January 2006.
Results: Nearly 30% of the sample screened positive for disability. The most common problems were learning disability (12.3%) and motor milestone delay (11.3%). Children supplemented with zinc were less likely to screen positive overall, and for motor and learning problems. Children supplemented with smaller doses of iron were more likely to screen positive overall, and for physical, and cognitive problems, but these differences were not statistically significant. There were no differences in children dually supplemented with iron and zinc compared with placebo.
Conclusions: The Ten Questions Plus tool can be used in this rural Nepali setting to identify children at increased risk for physical and cognitive disability who should be referred for clinical examination, diagnosis and enrollment in intervention services. We found evidence for a beneficial effect of zinc supplementation in reducing the likelihood of screening positive for disability.
Analysis of mammographic findings in a tertiary care hospital of Nepal
Authors: Humagain M , Paudel S
Published: July 2024

Introduction: Mammography is commonly the first line imaging procedure in screening of breast cancer in women. It is also commonly used as diagnostic test in the assessment or characterization of palpable breast mass along with ultrasonography. The purpose of our study was to assess the mammographic findings in women undergoing screening and diagnostic mammography.
Methods: This was a prospective cross sectional study analyzing the outcomes of 497 consecutive screen-film mammographic examinations, 369 (74.2%) diagnostic and 128 (25.8%) screening, performed in female patients from 4th July 2012 to 15th October 2012 in Tribhuvan University Teaching Hospital. Analysis was based on the final assessment report of mammogram reviewed by the experienced radiologists following Breast Imaging Reporting and Data System (BI-RADS) classification. BI-RADS score 4, 5 and 6 were considered as positive, BI-RADS score 1, 2 and 3 were considered as negative and BI-RADS score 0 was considered inconclusive requiring additional imaging.
Results: The mean age of women was 46.3 years (range 26-83 years). Among 369 cases of diagnostic mammograms 300 (81.3%) were negative, 27 (5.4%) were positive and rest 42 (8.4%) were inconclusive. Among 128 cases of screening mammograms, 117 (91.4%) were negative, 11 (8.6%) were inconclusive and none of them were positive. Among total (497) numbers of mammographic examinations, 417 (84%) were negative, 27 (5.4%) were positive and 53 (10.6%) were inconclusive. BI-RADS 1 was the most common reported finding comprising 26.8% in diagnostic and 12.1% in screening group.
Conclusion: Analysis of diagnostic mammography examinations yields different results compared with those of screening examinations, including different patient demographics; higher number of positive findings; and possibly higher cancer detection rates. Diagnostic and screening data should be segregated during record keeping and analysis of combined results should be based on known differences between diagnostic and screening outcomes.
Knowledge Status on Mental Health among Health Professionals of Chitwan District, Nepal
Authors: Gortoulla P , Pantha S , Pandey R
Published: July 2024

Introduction: Mental health issues are not openly shared by people due to the negative stigma that it carries. In addition, health professionals lack adequate knowledge on mental health issues. This prevents effective management of patients with mental illness.
Methods: A descriptive cross-sectional study was carried out among hundred health professionals working in government health institutions of Chitwan District in order to determine the knowledge, attitude and practices on different aspects of mental illness. Knowledge score was added for each domain and changed to categorical variable. Chi- square and fisher-exact test was done accordingly. P-value of less than 0.05 was considered as significant.
Results: Age of respondents ranged from 18 to 59 years. A significant number of respondents had very little knowledge on mental health issues and its causes. Majority of them identified neurosis as types of mental illness followed by personality disorder, psychosis and substance abuse. Only a quarter had better knowledge about the treatment. Age group, being male or female, high or low income, knowledge on mental illness, knowledge on type, causes, signs and symptoms, attitudes and practices of mental illness was significantly different between four levels of health professionals namely Health Assistants (HA), Staff Nurse (SN), Community Medical Assistants (CMA) and Auxillary Nurse Midwife (ANM).
Conclusions: The findings suggest that further information regarding mental illness, its sign/ symptoms, causes and treatment modalities should be provided to health workers along with actions to reduce stigma related to mental illness among them.