bluuebunny/crossref_metadata_2025 huggingface dataset:
RESEARCH-BASED DEVELOPMENT OF CONSUMER DRUG INFORMATION PAMPHLET AT TRIBHUVAN UNIVERSITY TEACHING HOSPITAL IN NEPAL
Authors: Joshi Mohan P , Johnson K W , Blum N L , Regmi B , Khakurel B
Published: September 2018

Considering the generally low priority given to educating consumers in Nepal andalso as a part of its commitment towards consumer awareness, the Drug InformationUnit of Tribhuvan University Teaching Hospital (TUTH) developed and distributed aconsumer education pamphlet on basic do's and don'ts about medicines. Themethodology of the development of this pamphlet included: (1) a questionnaire interviewof visitors (n=604) of patients admitted to TUTH to find out the existing level ofknowledge on basic facts about medicines, (2) development of a draft pamphlet, mainlybased on the findings of this baseline survey, (3) pretesting of the draft pamphlet onpatients’ visitors (n=614) at TUTH and subject experts (n=13) to get their commentsand suggestions on the text, language, drawings and presentation, and (4) revision ofthe pamphlet based on the pretest and its final printing. The present work thusrepresents a research-based approach to the development of public education material.Key Words: Rational drug use; public education; consumer awareness;drug information pamphlet; Nepal.
A STUDY ON SUPRA ORBITAL FORAMINA IN HUMAN SKULL
Authors: Bilodi Arun Kumar S. , Gupta S C , Saxena R C
Published: September 2018

In the Anatomy department of Ncpalgunj Medical College, Nepal 51 adult humanskulls were studied regarding supra orbital foramen. Various types or combination ofsupra orbital foramen, supra orbital notch, double foramina, double notch, incompleteforamen, absence of all above. Their number & percentage were calculated both onright and left side separately, compared & correlated with other studiesKey Words: Supra orbital foramen, Supra orbital notch, Supra orbital ligament,Periosteal ligament.
DIABETIC NEPHROPATHY - PATHOPHYSIOLOGY AND MANAGEMENT
Authors: Sharma Sanjib Kumar
Published: September 2018

Abstract
Small Intestinal Fibrolipoma An Uncommon Cause of Intussuception
Authors: Sah Shatrughan P , Jain B K , Rani S
Published: September 2018

abstract
IMMUNOBIOCHEMICAL AND HAEMATOLOGICAL INDEXES OF RATS BLOOD AFTER THE REMOVAL OF SPLEEN
Authors: Struchko G U , Merkulova L M , Stomenskaya I S , Zahid M , Kayastha P
Published: September 2018

Background: The spleen is not a vitally important organ, but the removal of spleencan adversely affect the patient’s health, especially that of children. Abrupt decrementin antimicrobial resistance after the splenectomy is confirmed experimentally leadingto overwhelming postsplenectomic hyposplenism. Besides there are few researches inthe pathogenesis and mechanisms of development of serious infectious complicationsafter splenectomy. So in our research we studied some indexes of immunology, generallaboratory and biochemical tests of blood in different terms after splenectomy.Methods: The immunologic, general laboratory and biochemical studies were done in3, 7, 15, 30, 45, 60 and 120 days after the splenectomy on 90 white male laboratoryrats.Findings: Splenectomy causes great changes of immunologic indexes of blood: from 7day of the experiment there’s a fall of IgG level, some increase of complement activity,the decrease of neutrophile's phagocytosis activity. In 4 months after the removal ofspleen the level of IgG and IgM is almost half, the number of circulatedimmunocomplexes is raised three fold and the neutrophile's phagocytosis activityremains low. Besides there is a heavy haemolytic anaemia in 7 days after thesplenectomy, the leukaemoid reaction of myelocyte type, the thrombohemorragicsyndrome and as a result of it - the acute renal insufficiency symptoms of whichdisappear by 120 days after the operation.Conclusion: The removal of spleen causes the development of accidental involution ofthymus and because of it causes the development of secondary immunodeficiency,thrombohaemorrhagic syndrome and severe anaemia. It needs to have more consideredapproach to the splenectomy and if it can’t be avoided - to initiate immunocorrectiontherapy at the earliest.Key Words: Splenectomy, immunodeficiency, leukaemoid reaction, renal insufficiency
Disease mongering in psychiatry: fact or fiction?
Authors: Saddichha S
Published: September 2018

Disease mongering starts at the top of recent accusations being hurled at psychiatry. It is used to refer to the attempts by pharmaceutical companies or others who have similar interests, to enlarge the market for a treatment by convincing people that they are sick and need medical intervention. This paper critically analyses the 'for' and 'against' arguments of disease mongering in psychiatric disorders, both new and old, such as Bipolar disorders, attention deficit hyperactivity disorder, Restless legs syndrome, Premenstrual dysphoric disorder, female sexual dysfunction, social phobia, metabolic syndrome and road rage disorder.

Keywords: disease mongeringpharmaceutical companies, psychiatry.
VAGINAL DELIVERY OF THE TRIPLETS
Authors: Saha Rachana , Bastola N
Published: September 2018

The spontaneous conception & delivery of triplets occurs in 1: 6889 births. Most ofthe literature recommends caesarean section for triplets for better perinatal outcomeof especially second and third baby, however, we describe vaginally delivered tripletswith good perinatal outcome.1. Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal.Address for correspondence : Dr. Rachana Saha, LecturerDepartment of Obstetrics and GynaecologyKathmandu Medical College Teaching Hospital, SinamangalP. O: 5919, Kathmandu, NepalKey Words: Triplets, Mode of delivery, Neonatal outcome.
The Psychiatry of Old Age - A Review
Authors: Mullan Eleanor
Published: September 2018

The absolute number of older adults is increasing throughout the world. Furthermore theproportion of the population which they make up is increasing. This is most evident indeveloping countries. At the same time traditional culture is giving way to urbanisationresulting in less support for the elderly. The delivery of health care to the elderly hasextensive economic, social and political implications. Additional resources will be requiredto meet this demand. This review highlights the demographic changes throughout theworld and specifically in Nepal. The psychiatric illnesses of the older adult and the specialaspects of their management are discussed. In the conclusion there are guidelines for theway forward as suggested by international health organisations.Key Words: Aged, psychiatric, dementia, psychological, Nepal, resources
Gefitinib Monotherapy in Advanced non-small-cell Lung Cancer: A Retrospective Analysis
Authors: Shrestha S , Joshi P
Published: September 2018

Introduction: There is no published data in Nepal regarding the use of gefi tinib in patients with non-small cell lung cancer (NSCLC). Therefore, a retrospective analysis was conducted to evaluate the response and toxicity profi le of Gefi tinib alone in patients with advanced NSCLC and unknown epidermal growth factor receptor (EGFR) status.

Methods: A single institutional retrospective study was conducted for the period from January 2004 to December 2006 involving patients with locally advanced or metastatic NSCLC who received gefi tinib as monotherapy Primary objective was to evaluate the objective tumor response rate.

Results: A total of 36 patients with advanced NSCLC who received gefi tinib 250 mg orally once daily as 1st, 2nd, 3rd, and 4th line treatment in 7, 14, 9, and 6 patients respectively were included in the analysis. Comparable number of patients pertaining to sex, smoking status, and tumor histology were included. The overall response rate at 3 months was 60% including 47% in males and 68% in females. After one month 38% and 6.6% patients with adenocarcinoma and squamous histology respectively responded to gefi tinib therapy. The median progression-free survival was 5.7 months. Toxicities were generally mild with diarrhea, rash and pruritus being the most commonly observed side effects.

Conclusion: In this single-center experience, gefi tinib demonstrated clinically signifi cant response in overall population and provided good palliation in pretreated patients.

Keywords: Advanced stage NSCLCs, EGFR-TKIs, Gefitinib, monotherapy, Nepal.
EFFECT OF WATER AND SALINE LOAD ON URINARY OUTPUT IN HEALTHY UNDERGRADUATE MEDICAL STUDENTS
Authors: Paudel Bishnu Hari , Kumar S
Published: September 2018

ABSTRACTWater and electrolyte balance is a vital homeostatic function. Their excretion depends on various factors –state of hydration, plasma osmolarity etc. There are rare reports on effect of hypertonic solution on urinaryoutput. Therefore, the study aimed at investigating the effect of water or saline (especially the hypertonic)load on urinary output (UO) in healthy undergraduate male medical students (17-20 years). They (n=20)were randomised into 4 equal groups: control, water, normal and hypertonic saline (1.8%). The study wasa part of undergraduate practical conducted under controlled conditions in the Physiology Department,BPKIHS. The day before the experiment, all of them were given same instructions. Next day, the experimentalgroups drank water/saline solution 12 ml/kg. Then the UO was measured ½-hourly. A non-parametric –Friedman test was used for intra- and inter-group differences in UO and specific gravity. The data arepresented as median (range). In water group the 60-min UO was significantly higher than the 30-min UO[178.5 (24-415) vs. 22.5 (21-81) ml, p<0.05]. This group also had significantly higher UO than the control at90-min [84 (20-250) vs. 19 (18-23) ml, p<0.05)]. The UO of normal-saline group was significantly higherthan that of control at 90-min [40 (22-250) vs. 19 (18-23) ml, p<0.05]. There was no significant difference inspecific gravity. The water and normal saline loads were adequate to elicit physiological response, thehypertonic solution was not strong enough to show significant physiological response suggesting need ofsaline load to be more than twice of the plasma osmolarity.Key Words: homeostasis, water-electrolyte balance, salt load, water load.
Role Of Audit In Obstetrics And Other Specialties
Authors: Sharma Sudha
Published: September 2018

abstract
Health of Household Members and Timing of Joint Household Partition in Rural Eastern Nepal
Authors: Karki Debendra
Published: September 2018

Abstract
SOCIO-PSYCHOLOGICAL STUDY AMONG INJECTABLE DRUG USERS IN KATHMANDU VALLEY
Authors: Ojha Saroj Prasad , Pokharel A , Aacharya R P , Pandey K R , Bhusal C L , Marhatta M N
Published: September 2018

On the background of ever increasing HIV transmission in our community throughvarious routes, the psychosocial factors related with intravenous drug abuse has becomenecessary to be studied. Aim of the study was to assess the Socio-psychological factorsthat influence people to use drugs, especially to use Injectable drugs. We enrolled asample of 393 Intravenous drug users, all male, in the Kathmandu Valley. Participantswere administered a semi structured proforma to assess the psychosocial issues relatedwith the drug intravenous drug abuse. Mean age of the sample was 27.76+ 4.86 years.Majority were single, unemployed, Hindu and by caste Newars, with education morethan high school (SLC or more). The first psychoactive substance use by most of themwas cannabis. The most frequently used psychoactive substance was injectionBuprenorphine (Tidigesic), which was followed by mixture of various substances(opiates, benzodiazepines, antihistamines) and Diacetyl morphine (Brown sugar).Factors associated with the start of the drugs were for enjoyment, friend’s pressureand to alleviate mental tension. Many accepted Injectable drug use contributing toproblems in mental, marital, social, economic and legal aspects of their life. Despiteknowing the harms caused by the drugs majority persist on its use. A needle exchangeprogramme has been viewed positively by many.Key words: buprenorphin, needle sharing, needle replacement, HIV transmission.
Intra-Operative Imprint Cytology and Cytologic Pattern of Overian Lesions.
Authors: Upreti Harish Chandra , Rahaman A J E , Kamal M , Baruwa A R , Chaudhary T , Khan K H
Published: September 2018

abstract
Prevalence of Deafness in School Going Children of Rajbiraj
Authors: Jha Anil Kumar
Published: September 2018

Deafness is a condition where multiple aspects of the development of the children are affected includinglinguistic, cultural and academic achievement. This study was carried out in a school located in the rural area ofRajbiraj where 1500 school going children were screened for the prevalence if deafness1 and its interrelationshipwith different preventable ear diseases like CSOM, OME, AOM and Wax. Study revealed 10% of the childrensuffering from hearing impairment due to the preventable care.2 Highest prevalent rate within the age group of5-11 years and the most common causes were found out to be due to OME. Study sends clean cut message tothe community health workers to increase awareness program to help decrease in deafness due to differentmiddle ear diseases.
PREVALENCE OF STREPTOCOCCAL PHARYNGITIS AMONG SCHOOL CHILDREN OF POKHARA VALLEY, NEPAL
Authors: Shrestha Lochana , Khattri J B , Brahmadathan K N , Nagra J S
Published: September 2018

Group A Beta Haemolytic Streptococcal (GABHS) infections and their sequelaeRheumatic fever (RF) and Glomerulonephritis (GN) have a world wide distributionand pose an important health problem. Present study intended to find out the prevalenceofGABHS pharyngitis among school children in the Pokhara Valley, Nepal. It was across sectional, observational study. During 7 months period total 750 children wereexamined from six government primary schools. 25.3% were found to have symptomsof clinical pharyngitis and the prevalence of GABHS pharyngitis was 7.2% amongthese school children. GABHS pharyngitis found more among male and in the agegroup of 3-10 years. This study was undertaken to highlight the problems of GABHSthroat infections in Nepalese school children and also to stress on the urgent need forcontrol programme for streptococcal disease complex.Key Words: Prevalence, Streptococcal pharyngitis, School children.
Aortic Stenosis Pregnancy and Labour
Authors: Garg Pavan , Vaijyanath A M , Garg P
Published: September 2018

abstract
EFFECT OF CHEMOTHERAPY ON PHILADELPHIA CHROMOSOME IN CHRONIC MYELOID LEUKEMIA (CML) PATIENTS
Authors: Jha Chandra Bhusan , Kucheria K , Chaudhary V P
Published: September 2018

Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder as a resultof neoplastic transformation of the primitive hemopoetic cells. It is well known thatthe Philadelphia chormosome (ph) is a specific abnormality found in 90% of CMLpatients. It has been reported that interferon has better effect on disease control andprognosis. Cytogenetic analysis of ph chromosome plays very important role in theprognosis and monitoring of therapy. In this present study 35 diagnosed patients ofCML were considered, which included untreated patients of various age groups (2-62yrs). The cases were refered from haematology clinic of All India Institute of MedicalSciences (AIIMS). Out of 35 patients only 13 patients were available after six monthof therapy for follow-up cytogenetic analysis. Out of 13 patient, 2 were ph negative, 8were 100% ph positive and 3 were ph positive mosaic before therapy. Of the 3 mosaicpatients, 2 remained unchanged after therapy and one patient became 100% phnegative. Though in general significant reduction in ph% by interferon therapy wasseen but minority patients showed complete cytogenetic remissionKey Words: Chronic myeloid leukemia, chemotherapy, Philadelphia chromosome.
IN UTERO DIAGNOSIS OF DUODENAL ATRESIA
Authors: Yadav Chandra Mohan , Yadav R P , Krishnanand B R
Published: September 2018

Duodenal atresia can be fatal unless promptly diagnosed and treated surgically. Death occurs in the newborn secondary to emesis, aspiration, and electrolyte imbalance. Here, we report a case of duodenal atresia diagnosed by ultrasonography at 28 weeks’ gestation.Key Words: Ultrasound, duodenum, atresia.
Carcinoma of Vagina in Utero-Vaginal Prolapse: A Rare Presentation
Authors: Acharya S , Uprety DK
Published: September 2018

Primary vaginal carcinoma in uterovaginal prolapse is a rare entity. We report a case of an 84-years-old lady, who presented with long standing vaginal ulcer in association with third degree uterovaginal prolapse. Incisional biopsy was taken from the ulcer. Histopathological examination showed a large cell keratinizing squamous cell carcinoma.

Keywords: Squamous cell carcinoma, uterovaginal prolapse, vaginal carcinoma.
Laboratory approach To a Case Of Leukemia
Authors: Sah Shatrughan P , Lakhey M , Rani S
Published: September 2018

Abstract
Ocular Tuberculosis
Authors: Badhu Badari P , Kumar S , Negi N
Published: September 2018

Ocular tuberculosis is a challenge in ophthalmic practice because it is extremely difficult to diagnose it.The term ocular tuberculosis indicates any infection by Mycobacterium tuberculosis in, on, or around theeye. It tends to affect all the structures of the eye. Clinical manifestations of ocular tuberculosis depends onthe site and severity of its infection. Diagnosis of ocular tuberculosis is entirely clinical, thoughinvestigation should be made to confirm the diagnosis. Treatment of ocular tuberculosis is the same as forthat of pulmonary tuberculosis.
NON-PHARMACOLOGICAL THERAPY OF HYPERLIPIDAEMIA
Authors: Pathak Urgra Narayan , Gurubacharya D L
Published: September 2018

Hyperlipidaemia is one of the major contributors to atherosclerosis and CoronaryHeart Disease (CHD) in our society. Numerous clinical and epidemiological studieshave shown repeatedly that an elevated blood cholesterol level is one of the majormodifiable risk factors associated with the development of CHD. In particular, thesestudies have demonstrated that low- density lipoprotein (LDL) cholesterol is theprimary lipoprotein mediating atherosclerosis. Non-pharmacological therapy especiallydietary therapy and exercise remains the first line of treatment in hyperlipidaemia,with pharmacotherapy reserved for use in patients at high risk of coronary heartdisease or patients who do not respond to non-pharmacological therapyKey Words: Hyperlipidaemia, LDL Cholesterol, HDL Cholesterol, coronary HeartDisease (CHD), Atherosclerosis, National Cholesterol Education Program (NCEP)
A clinical profile of aplastic anemia
Authors: Shukla Ashutosh , Kalra O P , Sharma A
Published: September 2018

abstract
Socio - demographic profile of psychoactive substance users in Pokhara valley
Authors: Upadhyaya K D
Published: September 2018

The socio-demographic profile of psychoactive substance users (excluding alcohol)attending neuropsychiatric out patient department of western regional hospitalPokhara during the period Feb. 1997 to Oct. 1998 was studied. All the 55 cases weremales, more than 50% started drug use before the age of 24, 80% of users were fromurban areas, buprenorphine intravenous injection was the commonest drug of abuse(41.8%) followed by cannabis (30.9%), heroin (11%). The implications of the findingswith an emphasis on future direction are discussed.
A MODEL OF EYE CARE SERVICE IN THE EASTERN REGION OF NEPAL
Authors: Singh S K , Pokharel G P
Published: September 2018

Mechi Eye Care Center was established in a rented building in Nov. 1996 with thehelp of Eye Care Himalaya, The Netherlands. In the last four and half years patientflow has increased gradually and the present facility is stretched to the limit.Provision of efficient and good quality treatment, close monitoring on attainment ofgood surgical quality and visual outcome are the main aims of this eye centre.Community involvement (such as active participation in screening camp and landdonation for new proposed eye hospital) has been exemplary. Trained Ophthalmicassistants are fully utilized thus enabling Ophthalmologists to devote their time insurgery and examination of referred patients. Preventive maintenance of instruments& equipment is a routine practice in this eye center.It is facing the problem with the space and the human resources (mainlyOphthalmologist). Eye Care Himalaya has planned to construct a new building of thehospital and train required human resources. We hope that after completion of thenew hospital building and with proper and sufficient number of trained manpower atleast one thousand patients can be examined and two hundred patients can be operatedevery day. Thus, the Hospital will be a gift to the blind people of this region to preventand cure their blindness and at the same time, it could play a significant role to eliminatethe avoidable blindness in this part of the world and contribute to the Mission - Vision2020:The Right to Sight.
What do Reviewers Look for in an Original Research Article?
Authors: Shankar P Ravi
Published: September 2018

In this article common errors committed by authors especially those, whose first language is not English, while writing an original research articleis described. Avoiding common errors and improving chances of publication has also been covered. This article may resemble instruction to the author. However, tips from reviewer’s eyes has been given.

The abstract is the section of the paper most commonly read and care should be taken while writing  this section. Keywordsare usedto retrieve articles following searches and use of words from the MeSH database is recommended.The introduction describes work already conducted in the particular area and briefly mentions how the manuscript will add to the existing knowledge.The methods section describes how the study was conducted, is written in the past tense and is often the first part of the paper to be written. The results describe what was found in the study and is usually written after the methods section.The discussion compares the study with the literature and helps to put the study findings in context. The conclusions should be based on the results of the study. The references should be written strictly according to the journal format. Language should be simple, active voice should be used and jargon avoided. Avoid directly quoting from reference articles and paraphrase these in your own words to avoid plagiarism

Keywords: Original research, publication, reviewer, scientific journals.
MANAGEMENT OF SNAKEBITE – CURRENT CONCEPT
Authors: Sharma Sanjib Kumar , Khanal B , Das B P , Koirala S
Published: September 2018

Abstract
PYRAZINAMIDE INDUCED ACUTE GOUTY ARTHRITIS
Authors: Pathak U N , Shrestha B O , Shrestha R R
Published: September 2018

A typical case of pyrazinamide induced acute gouty arthritis in a tuberculous patientwith antitubercular therapy including pyrazinamide was reported. It highlights theneed of awareness among physicians about the potentially morbid complications ofpyrazinamide. The other antitubercular drug like ethambutol may also cause increasein serum uric acid.Key Words: Gout, Pyrazinamide.
ONCOCYTOMA OF THE NASAL CAVITY
Authors: Singh A K , Agrahari K N , Baitha S , Sharma R , Reddy N S , Talwar O P
Published: September 2018

ABSTRACTOncocytoma of the nasal cavity is an extremely rare condition with only a few cases reported in the literature.A case of oncocytoma of the nasal cavity in a 12 years old Nepali boy is presented along with a brief reviewof the relevant literature.Key Words: Oncocytoma, Oxyphil adenoma, Nasal cavity.
Late Complication Due to Placenta Increta Left In Situ and Management Options
Authors: Zulfikir S , Al Bash M , Kakaria A , Gowri V , Saparamandu A , Al Kharusi L
Published: September 2018

With the rising incidence of caesarean sections, the number of cases of placenta praevia and morbidly adherent placenta is increasing. Antenatal diagnosis and management in a tertiary care centre helps to reduce maternal and neonatal morbidity and mortality. We present a patient in whom the antenatal diagnosis of morbidly adherent placenta was missed due to late booking. In spite of the conservative approach at the time of caesarean section in the secondary care hospital, the patient presented with delayed complications and a total hysterectomy was performed.

Keywords: adherent placenta, hysterectomy, methotrexate, post partum haemorrhage.
SMOKING AND OCULAR DISEASE-AN UPDATE
Authors: Sood Archana , Badhu B , Dulal S , Kumar S
Published: September 2018

MISSING
TRACE METALS IN CANCER PATIENTS AND THEIR CORRELATION WITH RENAL FUNCTION
Authors: Majhi Shankhar , Toora B D , Sen S K , Anantha K , Anantha N
Published: September 2018

ABSTRACTTwo trace elements, copper (Cu) and zinc (Zn) in serum are elevated in cancer patients since both areconstituents of super oxide dismutase (SOD) as metalloenzyme, the enzyme that scavenge free radicals andactivated oxygen species in the body. The study of 52 cancer patients comprising of 31 carcinoma stomachand 21 breast cancer showed the elevation of both of these trace elements in serum when compared to 32healthy controls and effected the kidney functions as a consequences. Serum Cu and Zn were estimated byAtomic Absorption Spectrometer (AAS), analyzed statistically by student "t" test and marked elevationwas observed in cancer patient compared to healthy controls. Serum Cu and Zn values were 98.13 ± 17.49μg/dl 99..57 ± 13.91 μg /dl respectively in 38 healthy subjects and these trace metals were 156.23 ± 31.02 μg/dl and 171.86 ± 35.15 μg/dl in 52 cancer patients showing significant elevation (P <0.001). These elevatedelements were routed through kidneys and damaged nephrons since both of them are cationic heavy metals.Nephrotoxicity of these trace metals was reflected as elevated level of blood urea and creatinine and werefound to be 27.44 ± 7.72 mg /dl and 0.83 ± 0.30 mg/dl in control groups and 64.49 ± 49 mg /dl and 1.60 ± 0.72mg/dl in cancer patients respectively, a significant elevation (P<0.001) in study group. The elevation ofthese parameters may indicate renal origin.Key Words: Serum copper, serum zinc, super oxide dismutase, carcinoma stomach, carcinoma breastand nephrotoxicity.
URINARY TRACT INFECTIONS AND PRESSURE SORES AT GREEN PASTURES SPINAL INJURY UNIT
Authors: Herm Friedbert B , Tripathi R B , Altrichter -
Published: September 2018

ABSTRACTBetween 46-59% of Spinal Cord Injury (SCI) cases develop Urinary Tract Infection (UTI) and 16-18%develop pressure sores during the first year after the trauma. In a retrospective approach, the occurrence ofUTI and pressure sores at Green Pastures Hospital’s Spinal Injury Unit was studied. Between 1997-2000out of 39 included patients 27 had suffered a thoracic-lumbar, 12 a cervical trauma. Twenty of these( 51.2% ) developed UTI and 7 ( 17.9% ) developed pressure sores during their hospitalization period. Themost commonly organism found in both complications, UTI and pressure sores, was E. coli, followed byProteus in UTI and Staph. aureus in pressure sores. Detected UTI and pressure sores among referredpatients at admission was higher than expected (71.7% and 48.7% respectively). In conclusion, adherenceto a protocol by a multidisciplinary health care team resulted in favourable outcome of patients with SCIadmitted to the rehabilitation unit. This is believed to be an indicator for the need of specialized SCI units.However, also in the studied sample at Green Pastures there was room for further improvement within the expected range.Key Words: Spinal Cord Injury, Urinary Tract Infection, Pressure Sore.
Complete ossification of stylohyoid ligament
Authors: S.Bilodi Arun Kumar , Mishra D , Sinha B N
Published: September 2018

In this particular case the whole of the stylohyoid ligament has been ossified so thatstyloid process and stylohyoid ligament are continuous piece of the bone. It is a veryrare anomaly seen in a lady aged 36 years at ENT OPD of Nepalgunj Medical CollegeTeaching Hospital, Nepalgunj, Nepal. No book or journal has described a bilateralcomplete ossification of stylohyoid ligament in man. Hence it has been reported.Key Words: Lesser cornua, epihyal bone, styloid process, stylohyoid ligament.hyoid bone. (Reicherts Cartilage)
Fungal multisinusitis with intracranial extension
Authors: Thapa N , Sinha B K , Amatya RCM , Shrivastav P , Pradhan B , Bhusal C L , Baskota K , Guragain R P
Published: September 2018

Aspergillosis is the commonest fungal infection of nose and paranasal sinuses. Itsinvasive form is rare in a healthy patient. A case of fungal multisinusitis with intracranialextension with characteristic computerized tomographic finding is reported.Key Words: Aspergillosis, intracranial extension, CT scan,external frontoethmoidectomy.
Solitary plasmacytoma of the sternum
Authors: Singh Yogendra , Sayami G , Manandhar T , Khakurel M
Published: September 2018

A 40 year old male patient with solitary plasmacytoma of the sternum diagnosed byfine needle aspiration biopsy is reported. There was no evidence of multiple myelomain this case. The patient was successfully treated with radiation therapy and adjuvantcombination chemotherapy.Key Words: Plasmacytoma, Solitary tumour, Needle biopsy, Radiotherapy
ANALGESIC UTILIZATION IN POSTOPERATIVE CARE AT A TERTIARY CARE TEACHING HOSPITAL IN NEPAL
Authors: Rauniar G P , Naga Rani M A , Das B P , Agrawal C S
Published: September 2018

ABSTRACTA retrospective analysis of analgesics used in postoperative pain in abdominal surgery was done to developbase line data. Appendectomy and cholecystectomy each formed 38.63% while hernia repair constituted22.74% of all the abdominal surgeries (422). NSAIDs were the most commonly prescribed group of analgesicsboth during the hospital stay (99.52%) and at the time of discharge (86.01%). Opioid analgesics (4.73%)was used in the immediate postoperative period mainly to supplement the NSAIDs. Diclofenac (88.86%)was the most commonly prescribed analgesic to in-patients and either diclofenac (47.63) or a fixed dosecombination of ibuprofen and paracetamol (32.46%) was the most commonly prescribed at the time ofdischarge. The administered dose of diclofenac was higher than the recommended dose. Utilization ofanalgesics during postoperative period may be rationalised by pain assessment charts and regular feedbackto the precribers.Key Words: Analgesic utilization, post operative, abdominal surgery.
ECTOPIC PREGNANCY : A MAJOR CAUSE OF MATERNAL MORTALITY?
Authors: Jha Rajshree , Singh M , Rana A , Singh A , Bastola S
Published: September 2018

ABSTRACTSeventyeight cases of ectopic pregnancy were studied retrospectively at Tribhuvan University TeachingHospital during April 1993 - December 1996. The overall incidence of etopic pregnancy was 0.86% livebirths. Grandmultipara were found to be at a low risk for ectopic pregnancy. A history of infertility andprevious pelvic surgery were positive risk factors. The most common presenting symptoms were abdominalpain (90%), history of amenorrhoea (46%), abnormal uterine bleeding (40%). On examination adenexaltenderness (72%), abdominal tenderness (68%), pallor (53%) and cervical excitation (33%) were the mostfrequent findings. Adenexal mass was noted in 22% cases and in 35 % cases the size of the uterus could notbe assessed. Ultrasonography and transvaginal sonography proved to be valuable diagnostic aids. Twomaternal deaths (2.6 %) due to ectopic pregnancy occurred in the hospital during this period.Key Words: Ectopic pregnancy, risk factors, sonography.
RETROSPECTIVE ANALYSIS OF BREAST CANCER CASES AND SURGICAL TREATMENT IN A PERIOD OF TEN YEARS
Authors: Sayami Prakash , Singh B M , Singh Y , Timila R , Shrestha U , Sayami G , Chaudhari J K
Published: September 2018

Retrospective analysis of 321 cases of breast cancer diagnosed in T. U Teaching Hospitalin a period of 10 years, from May, 1991 to April, 2000 was carried out. There were317 cases (98.8%) females and 4 cases males (1.2%). The youngest patient was 22year old female and oldest patient was 92 year old female. The most common agegroup according to frequency was in forties (34.6%) followed by in thirties (25.5 %).Mean duration of symptoms before coming to doctor was 8.3 months and mean size oftumor was 6 cm. Out of 317 females, 310(97.2%) were married and average numberof children was 3. Out of 289 cases diagnosed as malignancy with fine needle aspirationcytology (FNAC) 279 (96.5%) was also diagnosed as malignancy in biopsy and theremaining 10 cases as non malignant diseases were diagnosed as malignancy in biopsywith a false negative rate of 3.5%. The histological types of breast cancer cases wereInfiltrating Ductal Carcinoma 280 cases (87.2%), Medullary Carcinoma 11 cases(3.4%), Infiltrating Lobular Carcinoma 5 cases (1.6%), Mucinous Carcinoma 4 cases(1.2%), Sarcoma 4 cases (1.2%), Squamous Cell Carcinoma 4 cases (1.2%), PapillaryCarcinoma 3 cases (0.9%), Tubular Carcinoma 2 cases, Adenosquamous Carcinoma2 cases (0.6%), Intraductal Carcinoma 2 cases (0.6%) and Non-Hodgkins Lymphoma1 case. Out of 305 operated cases, the types of operation performed was ModifiedRadical Mastectomy in 208 cases (68 %) and palliative mastectomy in 72 cases (23.5%),only lumpectomy in 24 cases (7.9%) and others in 2 cases. Among 246 cases withavailable axillary lymph node biopsy, there was metastatic diseases in 146 cases (60%)of cases. The Breast cancer was diagnosed in advanced stages in 63% of cases. StageIIIA (24%), Stage IIIB (21.5%) and Stage IV (17.4%). Breast cancers were diagnosedin advanced stages in below 40 age group in 65 out of 90 cases (72.2 % ) comparedto137 out of 231 cases ( 59.3 % ) in above 40 age group.Key Words: Breast cancer, Advanced stage, FNAC, Surgery.
HAEMODIALYSIS IN B. P. KOIRALA INSTITUTE OF HEALTH SCIENCES, DHARAN - AN INITIAL EXPERIENCE
Authors: Sharma Sanjib Kumar , Kumar P , Chapagain A , Koirala S
Published: September 2018

Dialysis supports life, in spite of complete cessation of renal functions. Haemodialysis(HD) service became available in B. P. Koirala Institute of Health Sciences, Dharansince September 1999. Six hundred and sixty one sessions of HD in 50 patients werecarried out in one year. End stage renal disease (ESRD), acute renal failure (ARF),acute on chronic renal failure constituted 54%, 26% and 20% of the patientsrespectively. Majority of the patients (72%) were between 15 to 50 years of age. Chronicglomerulonephritis, chronic interstitial nephritis, and diabetes nephropathy were themost common causes of ESRD. Recovery following HD was 70% in ARF,whileallpatients of acute on chronic renal failure improved following few sessions of HD.Drop out rate on maintained haemodialysis (MHD) was 52%. The increasing demandof dialysis service in this region is difficult to fulfill due to restricted facilities fordialysis, lack of renal transplantation in Nepal, and economic constraint in the part ofpatients. Primary and secondary prevention of renal diseases by community education,awareness and participation needs emphasis. Key Words: Haemodialysis, End stage renal disease, Acute renal failure,Acute on chronic renal failure.
Epidemiology of Snakebite A Study from Choharwa Army Camp, Siraha, Nepal
Authors: Devkota U N , Steinmann J P , Kathayat J B
Published: September 2018

Snakebite is an occupational health hazard seen mostly among farmers, hunters andherders. In Nepal, 23 districts from terai and inner terai region have been reportingsnakebite case every year. Limited studies have been conducted so far, to understandthe epidemiology of snakebite in Nepal. This study is an attempt to highlight some ofthe aspects of snakebite epidemiology in Nepal.Siraha is one of the districts where an increase in snakebite cases has been observedevery year. Apart from government health institutions, the army camp at Choharwahas been found providing snakebite treatment for civilian population very effectively.This is a retrospective study of 279 cases of suspected snakebite that presented at thecamp for treatment in the year 2000.Incidence of snakebite was slightly higher among males (53%) than females (47%)and more frequent in 15-45 years (67%) age group. The highest incidence occurredduring the monsoon from June to October (76%), with peak in August. Majorities ofthe victims were farmers (73%) and bitten mostly by kraits (27%) on the lowerextremity (58%), especially on the leg (48%). Snakebite victims were mostly bitten indaytime (61%). Outdoor activities had more risk (57%) for snakebite. The high-riskactivities identified were grass cutting (25%) and sleeping (23%) on the ground.Tourniquets were the main first aid measure used by the victims (86%). Mostly, victimswere brought to the camp with in one hour after the bite (61%). The average durationof stay in the camp was 18-24 hours in a non-poisonous bite and 2-3 days in poisonous.
Antibiotic Susceptibility Patterns of Staphylococcus Aureus with Special Reference to Methicilin Resistance- A Preliminary Report
Authors: Pai Chitra , Kiran S
Published: September 2018

One hundred strains of Staphylococcus aureus isolated from various clinical sampleswere screened for methicillin resistance by the disc diffusion technique. Antibioticsusceptibility pattern of Methicillin sensitive S. aureus (MSSA) and Methicillin resistantS. aureus (MRSA) against a number of antibiotics like penicillin, ampicillin,gentamicin, erythromycin, tetracycline, Coamoxyclav cotrimoxazole, ciprofloxacin,cefalothin and vancomycin are compared. 20% of the strains were found to be MRSAwhile 80% were MSSA. The isolation rate of MRSA from indoor (hospital acquired)and outdoor (community acquired) was 18% and 2% respectively. Drug resistance ofMRSA was highest with penicillin (100%), followed by erythromycin (80%), ampicillinand gentamicin (65%), tetracycline (60%), cotrimoxazole (55%), cefalothin (20%),Coamoxyclav (15%) and least against ciprofloxacin (5%) and vancomycin (0%). TheMSSA were sensitive to vancomycin (100%), ciprofloxacin (100%), Coamoxyclav(96.25%), and cephalothin (82.5%) while sensitivity to tetracycline (78.75%),gentamicin (75%), erythromycin (40%), ampicillin (38.75%), cotrimoxazole (37.55)and penicillin (21.25%) was much lesser. This study emphasizes the need for constantmonitoring on the prevalence of MRSA and its microbial susceptibility pattern as thedata would help clinicians in the effective management of nosocomial infections causedby S.aureus.Key Words: Staphylococcus Aureus, Methicillin, Sensitive, Resistant, Nosocomial Infection.
HAIR- AN Syndrome
Authors: Sharma Puspha Raj , Baral V R , Adhikari R , Gami F C , Shrestha S P
Published: September 2018

Abstract
Haemolytic Crisis In a Child
Authors: Shrestha Sita Ram , Dalzell W A B
Published: September 2018

Abstract
Role of Nonviable Preserved Corneas in Keratoplasty
Authors: Panda Anita
Published: September 2018

Abstract
Epidermodysolasia Verruciforms
Authors: Sripathi H , Dalal M , Basu A
Published: September 2018

Abstract
SEROTYPING AND ANTIBIOTIC SENSITIVITY TESTING OF ENTEROBACTERIAL PATHOGENS IN DIARRHOEAL PATIENTS OF KATHMANDU
Authors: Subedi Abhignya , Shrestha C D , Adhikari R P
Published: September 2018

In a study carried out at National Public Health Laboratory, Teku, 236 samples werecollected from the diarrhoeal patients and half of them were The patients below 15years of age. Altogether 61 pathogens belonging to the family Enterobacteriaceaewere isolated. The presence of pathogens in the patterns below 5 years was highlysignificant (P<0.05%). E coli was most common (68.8%) followed by Salmonella spp.(16.4%) and Shigella spp. (14.7%). Enteropathogenic was E. coli was the most frequentisolate (71.4%) among the pathogenic E. coli. Similarly, Salmonella typhimuriumwas the commonest salmonellae and Shigella dysenteriae and Shigella flexneri werethe most commonly isolated shigellae. Most of the pathogens were sensitive toCiprofloxacin (72.1%) and least was sensitive to Ampicillin (9.8%). Only 4.9% of thepathogens were sensitive to all the antibiotics tested.
Early Experience of Day Care Surgery in Nepal
Authors: Singh DR , Joshi M R , Koirala U , Shrestha BR , Shrestha S , Gautam B
Published: September 2018

INTRODUCTION:

The day care laparoscopic cholecystectomy (DCLC) is found to be safe and effective in developed countries. However, it has not been well accepted in our part of the world probably because of lack of infrastructures,established norms and published reports. We have analyzed the safety and feasibility of the procedure in the recently established first dedicated day care surgery centre of the country.

METHODS:

All the patients with American society of anaesthesiologist (ASA) score I and II admitted for laparoscopic cholecystectomy are included. Operation are performed in the morning and closely observed till evening. Patients found to be medically fit to discharge; having a responsible person at home and who can make their own arrangements in case of problems were advised for discharge. Follow up was done by telephone call from next morning.

RESULTS:

Total 35 patients underwent laparoscopic cholecystectomy. Age range was between 16-65 years and most of them were females (88%). Only 30 patients were operated in early morning and were eligible for day care surgery. 25 (83%) Patients were advised for discharge but only 10 (33%) could make arrangement. Other 15 patients could not go home mainly due to different psychosocial reasons. Only one patient needed readmission and Complications observed were minor and relatively few.

CONCLUSIONS:

Day care laparoscopic cholecystectomy is safe and feasible in our set up. Acceptance of the procedure is expected to increase once it is regularly practiced and awareness in improved.

Keywords: day care, laparoscopic cholecystectomy, surgery, Nepal.
Angiolymphoid Hyperplasia with Eosionophilia-Scalp
Authors: Lakhey Mamta , Jain B K , Mishra A , Tandon N , Rani S
Published: September 2018

abstract
PHYSICIAN-PATIENT COMMUNICATION REGARDING PRESCRIBED MEDICATION IN AN AMBULATORY CARE SETTING IN KATHMANDU, NEPAL
Authors: Joshi Mohan P , Wachter D A , Johnson K W , Regmi B M , Tamrakar R K , Ranjit S , Lama B , Sthapit R , Dev S , Subedi R S
Published: September 2018

Physician-patient interactions often lead to prescription of medicines. Safety andcompliance in the use of these medicines are largely dependent on proper verbal aswell as written communication between prescriber and patient. However, severalpublished reports suggest that such communication is often inadequate. The presentstudy indicated suboptimal doctor-patient communication at a tertiary care hospitalin Nepal. Fifty-two (21.7%) of the 240 patients/caregivers interviewed after out-patientconsultation claimed that doctors did not provide any information on prescribedmedicines. Nearly a quarter of the 188 patients/caregivers who did report havingreceived information could not recall what they had been told, and in more than halfof these cases the lack of recall was attributed to problems in communication. Frequentuse of the English language and Latin abbreviation in prescribed dosing schedulesindicated a need for improvement in written communication as well.Key Words: prescribing information; communication; physician-patient interaction; Nepal.
PREVALENCE OF GONOCOCCAL INFECTION AMONG THE PATIENTS VISITING AT DERMATOLOGY/VENEROLOGY AND GYNAECOLOGY DEPARTMENT OF TRIBHUVAN UNIVERSITY TEACHING HOSPITAL
Authors: Panta Binita , Tuladhar N R , Sharma A P , Sharma J , Jha A K
Published: September 2018

A substantial proportion of women with gonococcal infection are asymptomatic butsymptomatic in male. Thus in developing countries, problem arises in active casedetection where laboratory facilities for testing are limited. During the study, thediagnostic validity of the hierarchial clinical algorithm as well as that of a non-hierarchial scoring system were assessed among 102 patient visiting at Dermatology/Venerology (DV) and Gynecology(Gynae) out patient department(OPD) of TribhuvanUniversity Teaching Hospital (TUTH), Kathmandu, Nepal. In the study period of 8months, May –December 1999, 9 (8.82%) were infected with N. gonorrhoea& 2(1.96%)with Gram Negative intracellular diplococci. Age group of 20-30 years were found tobe more infected followed by age groups 30-40 years & 40-50 years ( P< 0.10). Themale were found to be predominantly infected than female and married were foundto be more infected than unmarried. Among the infected people most of them hadsecondary level education and least of them had higher level education. Service holderswere found to be more infected than farmers, drivers & others. But male serviceholders & housewives were equally infected.Antimicrobial susceptibility of N. gonorrhoeashowed 100% susceptible to Ceftriaxone,followed by Ciprofloxacin (88.88%) whereas 22.22% resistant to Tetracycline, 55.55%to Cotrimoxazole and 55.55% to Penicillin. Among isolates, 33.33% were ß- lactamaseproducer. Co-micro organisms like Candida sppand Staphylococcus sppwere alsoobserved.Key Words: Gonococcal infection; Outpatient department, Antimicrobial susceptibility, Nepal.
HIV Status in United Mission Hospital Tansen, Nepal
Authors: Napit I B
Published: September 2018

Abstract
A Study of Acute Epiglottitis in Adults: is it more common in adults than children?
Authors: Thapa Narmaya , Shrivastav R P , Amatya R C M , Sinha B K , Bhattarai H , Pradhan B , Bhusal C L , Banskota D K , Guragain R P S
Published: September 2018

Abstract
Sectional Delivery In Nepal
Authors: Pradhan Sephali , Tamrakar Hira Devi
Published: September 2018

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Clinical survey of Smallpox
Authors: Pandey Mrigendra Raj , Acharya I L , Moyeed A
Published: September 2018

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Infectious Hepatitis An Intresting Case
Authors: Miller Edgar Raymond
Published: September 2018

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(III) Three Interesting Cases In Dermatology
Authors: Adiga Ram Bhadra
Published: September 2018

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Hazards Of Smoking
Authors: Editorial JNMA
Published: September 2018

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Cadaveric Blood Transfusion
Authors: Matveyev M
Published: September 2018

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"Pneumoperitoneum" An Effective Method Of Treating Pulmonary Tuberculosis In A Poor Country
Authors: Joshi Y R
Published: September 2018

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Association of Cardiovascular Risk Factors in Hypertensive Subjects with Metabolic Syndrome Defined by Three Different Definitions
Authors: Shrestha R , Jha SC , Khanal M , Gyawali P , Yadav BK , Jha B
Published: September 2018

Introduction: Different authorities have put forward their criteria to defi ne metabolic syndrome (MetS). The aim of this study was to fi nd the prevalence of MetS in hypertensive individuals by the available three different defi nitions from National Cholesterol Education Program (NCEP), International diabetes Federation (IDF) and WHO and their association with other cardiac risk factors.

Methods: After anthropometric measurements fasting blood was analyzed for glucose, lipids, high sensitivity C-reactive protein (hsCRP) and anti-oxidized LDL antibody in 150 hypertensive individuals. A ten-year coronary heart disease risk was predicted using the Framingham risk score (FRS).

Results: The prevalence of MetS was 54.7 % by NCEP, 42.0 % by IDF) and 18.7 % by WHO. As many as 63.4 % had MetS by any defi nition, while only 9.4 % fulfi lled all the criteria of the three definitions. The association of cardiac risk factors also varied according to the defi nition used. hsCRP was signifi cantly elevated in MetS compared to non-MetS. Body mass index, waist circumference and HDL-C were associated in MetS defi ned by NCEP and IDF. FRS was higher in MetS defi ned by Adult Treatment Panel and WHO defi nitions. An increase in urine albumin and a decrease in eGFR were associated with MetS individuals defi ned by WHO only.

Conclusions: There is a wide variation in the prevalence of MetS and associated cardiac risk factors according to three different defi nitions used. The different cardiac risk factors among MetS also vary with the defi nitions used. However, hsCRP and emerging risk factor are signifi cantly elevated in hypertensive individuals with MetS as defi ned by all defi nitions.

Keywords: cardiovascular risk factors, hypertension,metabolic syndrome.
"Clinical Survey Of Tuberculosis Peritonitis" [An analysis of one hundred and twenty eight cases admitted in Bir Hospital, Kathmandu.]
Authors: Pandey Mrigendra Raj , Shrestha S M
Published: September 2018

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Management Of The Cases Of Tuberculous Cervical Lymphadenitis
Authors: Sharma Anjani Kumar
Published: September 2018

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Emergency Service
Authors: Editor JNMA
Published: September 2018

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The Nepal Medical Council Act
Authors: Editorial JNMA
Published: September 2018

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Prevention Or Cure?
Authors: Editorial JNMA
Published: September 2018

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