bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Molecular Subtypes of Breast Cancer in a University Hospital of Nepal
Authors: Hirachan Suzita , Singh Yogendra P 
Published: June 2021

Introduction Breast cancer is the second most common malignancy in Nepalese women. It represents a group of heterogenous disease with diverse biologic, clinical and molecular characteristics requiring personalized treatment. Based on Immunohistochemical markers, breast cancer is classified into distinct molecular subtypes. The aim of the study was to analyze the incidence of molecular subtypes of all breast cancer patients treated at University Hospital of Nepal in the period over 3 years.
MethodsA retrospective observational study was carried out in Breast Unit of Tribhuvan University Teaching Hospital, Kathmandu. Electronic medical records of all breast cancer patients treated between January 2017 to December 2019 were retrieved from the hospital database. Patient’s characteristic, histological features and molecular subtypes were collected and analyzed.
ResultsA total of 156 surgically treated breast carcinoma patients were studied. The median age of study population was 55 years (range 28–82years). Among these, 69 (44%) were of ≤45 years and 87 (56%) were over 45 years. The mean tumor size was 29 mm (range 50-140 mm). The most common histology was invasive ductal carcinoma (93.5%). Luminal type A was positive in 68 (43%) patients while luminal type B was present in 12 (7.6%) patients. Triple negative subtype was observed in 50 (32%) patients while HER2 rich subtype was seen in 25(16%). Incidence of Triple negative subtype was highest in patients less than 45 years (42%). Luminal A subtype was correlated with low tumor grade and less positive lymph nodes metastasis.
ConclusionThe most common molecular subtype of breast cancer in Nepal is Luminal A having favorable features. The incidence of triple negative breast cancer is higher in Nepal, having an aggressive and clinically distinct subtype and is important for personalized treatment plan.
Efficacy of Integrated Intervention Program on Mental Health of Cancer Patients
Authors: Chand Bibin , Sharma Madhavi , Thagunna Narendra S 
Published: June 2021

Introduction Copious researchers have made notable findings on the mental health of cancer patients and effect of various discrete therapies, but still there exist a significant paucity on integrated therapeutic interventions over their mental health. The objectives of this study were to find the prevalence of mental health morbidity and the efficacy of an integrated intervention program comprised of Aaron Beck’s Cognitive Behavior Therapy (CBT), Jacobson Progressive Muscle Relaxation Therapy (JPMRT) and self- imagery training on the mental health of cancer patients.
MethodsIn this cross-sectional study, data was collected from 20 patients diagnosed with cancer aged between 40-55 years from an outpatient department of Cancer Institute, India. General Health Questionnaire by Goldberg & Hiller, 1979 (GHQ-28) was administrated to assess the mental health in four domains viz: somatic complaints, anxiety and insomnia, social dysfunction and severe depression. Integrated intervention program was conducted for four days per week for one month. Data was analyzed statistically by using normal probability curve (NPC) and paired t-test.
ResultsAn overall prevalence of negative mental health and significant positive effect by the integrated intervention on the mental health among cancer patients have been statistically corroborated in this pre-post research.
ConclusionIntegrated intervention program is efficacious in improving mental health in cancer patients.
Outcome of Elastic Stable Intramedullary Nail in Length Unstable Diaphyseal Femur Fractures in Children: A Case Series
Authors: Bhandari Prawesh S , Uprety Suresh 
Published: June 2021

Introduction Elastic stable intramedullary nailing (ESIN) has been a common method of treatment of diaphyseal femur fracture in children. Though they are used in length stable fracture with favourable results, their use is debated in case of length unstable variants. The objective of the study was to evaluate outcome of these nails in length unstable diaphyseal femur fracture in children.
MethodsWe retrospectively reviewed seven fractures in seven children treated with ESIN for functional outcome.
ResultsTotal of seven patients with seven unstable femur fractures were studied. There was male predominance with 71.4%. The fracture united at a mean duration of 12 wks. The overall Flynn scoring showed 71.4 % excellent and 28.6 % satisfactory result.
ConclusionElastic stable intramedullary nailing can be safely used in length unstable variant of femur fracture in children.
Profile and Antibiotic Susceptibility Pattern of Bacterial Isolates from Mobile Phones of Healthcare Workers in a Tertiary Care Centre of Nepal
Authors: Sapkota Jyotshna , Jha Beena , Mishra Bhavesh , Shrestha Deepti , Barakoti Achut , Sharma Manisha 
Published: June 2021

Introduction Nosocomial infection is a serious problem worldwide. Healthcare workers mobile phones may act as vehicle for nosocomial infections. Mobile phones are rarely cleaned and healthcare workers frequently use them thorough out their time in hospitals. The objective of this study is to determine the rate of contamination of mobile phones, prevalent microorganisms and their antibiotic sensitivity pattern.
MethodsThe descriptive cross-sectional study was carried out in Clinical Microbiology laboratory from July 2019 to September 2019 after ethical approval. Samples were collected aseptically by rolling sterile swabs over the exposed surfaces of the mobile phones and inoculated on the agar plates and incubated aerobically. After incubation, plates were examined for growth. Bacteria were identified by standard microbiological procedure and antibiotic sensitivity test of isolated pathogens was done using Muller Hinton Agar by Kirby-Bauer method. Statistical analysis was done by Excel 2018.
ResultsOf the 198 mobile phones sample cultures, 112 (56.6%) samples showed 7 different types of bacteria. Mixed growth was observed in 3 mobile phones and total of 115 bacterial isolates were identified. Staphylococcus species (74.7%) were predominant organism followed by Acinetobacter spp, Klebsiella pneumoniae, E. coli, Citrobacter and Pseudomonas aeruginosa. Total 37.5% of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus (MRSA).
ConclusionMobile phones may have potential pathogenic microorganisms on their surface and can act as vector in spread of infectious agents in hospital settings. It is recommended to disinfect mobile phones regularly and to implement hand washing practices and regulations around the use of mobile phones in hospital settings.
Clinical Profile of Patients Undergoing Temporary Transvenous Pacing in a Tertiary Cardiac Care Centre in Nepal
Authors: Sharma Manju , Jha Sunil C , Sayami Arun , Gajurel Ratna M , Poudel Chandra M , Khanal Rajaram , Pathak Surya R , Thapa Shovit , Adhikari Suman , Yadav Vijay 
Published: June 2021

Introduction Temporary transvenous pacemaker insertion is an emergency lifesaving procedure for patients with hemodynamically unstable and life-threatening bradyarrythmias. The aim of this study was to analyze demographics, indications, route of insertion and complications in patients undergoing temporary transvenous pacemaker implantation.
MethodsThis was a retrospective observational study conducted at a tertiary-care center in Nepal. The hospital records of patients who had undergone temporary transvenous pacemaker implantation between July 2015 and June 2019 were reviewed.
ResultsA total of 343 patients with mean age of 65.52±16.09 years received temporary transvenous pacing. Out of these 205 (59.8%) were males. Greater proportion of patients were between the age group of 70-80 years (n=76, 22.2%). Hypertension (n=97, 28.3%) was the most common comorbidity noted. The most common indication for temporary pacing was symptomatic complete heart block 165 (59.6%). Total of 288 (84%) patients received permanent pacemakers while 55(16%) had reversible cause so TPI was removed. Right Femoral vein was the most common (99%) venous access site. Among the 343 patients, complications were observed in 29 (8.4%) of cases during and after the temporary transvenous pacemaker insertion. The overall mortality stood low at 2% (n=7).
ConclusionTemporary transvenous pacemaker insertion is required in elderly population presenting with bradyarrythmias and occasionally in acute myocardial infarction presenting with bradyarrythmias as complication. Temporary pacemaker insertion was overall a safe procedure with infrequent serious complications; however, strategies to avoid and alleviate such complications (RV perforation) should be sought and implemented.
Management of Postpancreatectomy Hemorrhage Following Pancreaticoduodenectomy at a Tertiary Care Center in Nepal
Authors: Subedi Nirajan , Kandel Bishnu , Ghimire Bikal , Kansakar Prasan BS , Bhandari Ramesh S , Joshi Lakhey Paleswan 
Published: June 2021

Introduction Postpancreatectomy hemorrhage (PPH) is an important complication which significantly increases morbidity and mortality following pancreaticoduodenectomy (PD). This study aims to find the incidence, classification, management, and mortality associated with PPH following PD. This study also describes the changes in management and outcomes between the period of 2004-2014 and 2015-2019 in our institute as in the later time period there was use of CT angiography and interventional radiology (IR) to identify and control the bleeding site.
MethodsThis is a retrospective study in which medical records of patients having PPH following PD between 2004-2019 were analyzed. The grading and classification were done according to the International Study Group of Pancreatic Surgery (ISGPS). Management and outcomes were analyzed using standard descriptive statistics.
ResultsA total of 43 patients developed PPH out of 336 PDs. Out of 43 patients, 4 (9.3%) had Grade A, 16 (37.2%) had Grade B and 23 (53.5%) had Grade C PPH. Fifteen (35%) patients were managed conservatively, seven (16.2%) with IR procedure and 21 (48.8%) were reexplored. There were 16 (37.2%) mortalities, out of different factors- intraoperative blood loss >500 ml showed the predictability for mortality (p= 0.01). On comparing two time periods it was seen that the PPH rate was almost similar but the mortality decreased from 58.8% to 23.07%.
ConclusionPPH following PD is associated with high mortality. Increased use of IR procedure and CT angiography can decrease the relaparotomy rates and eventually decrease mortality.
Head Injuries at the Emergency Department of a University Hospital
Authors: Henriksson Thérèse , Kjellberg Jacob , Shakya Yogendra , Kurlberg Göran 
Published: June 2021

Introduction Traumatic head injuries constitute a major cause of morbidity and mortality worldwide. The developing world is particularly affected due to a high prevalence of risk factors and difficulties in enforcing preventive efforts. This study was carried out at the Emergency Department (ED), Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal – where head injuries account for five per cent of all emergency visits. The aim was to describe demographics, cause of trauma, type of injury, and severity according to the Glasgow Coma Scale (GCS), as well as the outcome of emergency attendance in patients seeking medical care for traumatic head injuries. Auxiliary aims were to study correlations between age, cause of trauma and injury severity.
MethodsData from 577 cases of head injuries from June to October 2019 were collected retrospectively.
ResultsTraumatic head injuries accounted for 5.2 % of all emergency visits. The median age was 23 years. Patients were predominantly male. Superficial injuries and concussions were the most common. Most injuries were mild (94.4 %, GCS 13–15) and caused by falls (51.3 %) or road traffic accidents (19.1 %). Fall accidents and mild injuries had the lowest median age. Patients from outside Kathmandu Valley constituted 44.9 % of the cases. Only 12.1 % of the patients were admitted to the hospital.
ConclusionCommonest head injuries are mild and superficial; and are caused by falls and road traffic accidents. Most head injury patients are children.
Admission Profile and Outcome of Patients in a Level III Intensive Care Unit: A Two-Year Comparative Study
Authors: Pathak Sunil , Acharya Subhash P , Acharya Pragya , Bhattarai Binita 
Published: June 2021

Introduction An Intensive Care Unit (ICU) is an area where critically ill patients are admitted and the highest level of care is provided with close intensive monitoring and management. Clinical audit is a must to measure indicators of the quality of care in ICU and benchmarking outcome. The main aim of the study was to evaluate the profile of patients admitted to ICU and assess their outcome of two consecutive years.
MethodsA single-institutional, descriptive cross-sectional study was conducted on all adult patients admitted to the ICU of Tribhuvan University Teaching Hospital, Kathmandu, between April 2018 and April 2020 (Baisakh 2075 to Chaitra 2076).
ResultsWith an average of 1.98 admissions per day, a total of 1447 patients were admitted to TUTH ICU over the period of two years. A male preponderance was noted with a male to female ratio of 1.19:1. Most of the patients admitted were neurosurgical cases 429 (29.6%). A total of 884 (61%) were shifted out of ICU in stable condition while the overall mortality was 458 (31.6%).
ConclusionThis study shows that there is a higher severity of illness at admission as well as a comparatively high mortality rate. More number of patients were male, of age group of 15-65 years, with medical and neurosurgical conditions. This study of profile and outcome of patients admitted in ICU can serve as a quality indicator as well as evidence on which planning and policymaking can be based upon in the future.
Correlation of Body Mass Index with Handgrip Strength and Endurance of Dominant Hand in Medical Students
Authors: Shrestha Lava , Gurung Sanyukta , Bhat Neeti , Mahotra Narayan B , Bajimaya Mahesh M , Kandel Sabita , Malla Neha , Shakya Aman , Aryal Vibina , Gyawali Bigyan R , Rayamajhi Nirmala , Pradhan Sait 
Published: June 2021

Introduction Hand grip strength is used in evaluation of muscle strength and is also increasingly being used as an indicator for nutritional status. The maximum force applied voluntarily by the subject is called maximum handgrip strength, which is measured in kilograms. Muscular endurance is the ability of a muscle or muscle group to perform against a load for an extended period of time, measured in seconds. This study aims to correlate body mass index with handgrip strength and handgrip endurance in medical students.
MethodsThis is a cross sectional, observational study which included 74 undergraduate students of Maharajgunj Medical Campus by convenient sampling method. Body mass index was calculated by Quetelet’s formula. Camry digital hand dynamometer was used to measure handgrip strength in the dominant hand in kilograms. Participants were instructed to hold dynamometer with maintained pressure of 30% of maximum handgrip strength for as long as possible to determine the handgrip endurance. Statistical analyses were performed with SPSS Statistics software.
ResultsThe handgrip strength was more in males than females with a mean of 43.09±3.72 kg, while handgrip endurance was more in females with a mean of 123.60±50.65 sec. Positive correlation was seen between body mass index and handgrip strength (r=0.23 and p=0.045). Body mass index and handgrip endurance also showed positive correlation (r=0.34 and p=0.003).
ConclusionSignificant correlation of body mass index with handgrip strength and handgrip endurance was seen in medical students.
Assessment of a Scoring System to Predict Difficult Laparoscopic Cholecystectomy
Authors: Sigdel Prem R , Subedi Nirajan , Phuyal Suman , Pokharel Ashik , Ghimire Bikal , Singh Yogendra P 
Published: June 2021

Introduction Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. It would be useful to have some reliable predictive factors for conversion in LC. Our aim is to predict difficult laparoscopic cholecystectomy preoperatively by using a scoring system.
MethodsA total of 136 patients were included. The parameters considered for this study were old age, male sex, history of hospitalization, obesity, abdominal surgery scar, palpable gall bladder, gall bladder wall thickness, pericholecystic collection and impacted stone.
ResultsAmong 136 cases, 70.6% were easy, 24.3% were difficult and 5.1% were very difficult intraoperatively. The factors like age >50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness >4mm and impacted stone were found statistically significant in predicting difficult LC. The preoperative scoring is statistically and clinically a good test for predicting the difficult LC (area under the curve = 0.824) with sensitivity of the test being 82.3% and specificity 72.7%. Conversion rate was 3.67%.
ConclusionThe factors like age >50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness >4 mm and impacted stone are the preoperative predictors of difficult LC.
Relation of Neck Circumference to Central Obesity and Overweight in Patients with Type 2 Diabetes Mellitus Presenting to a Tertiary Center
Authors: Sharma Ishwor , Gupta Sanjay K , Niraula Kiran 
Published: June 2021

Introduction Overweight and obesity with their surrogate anthropometric markers like body mass index (BMI), waist circumference (WC) and waist hip ratio (WHR) have been shown to be strongly associated with Type 2 diabetes mellitus. Neck circumference (NC) though less used can be an equally effective alternative to diagnose overweight and obesity in patients with Type 2 diabetes mellitus in a resource limited setting.
MethodsPatients who had Type 2 Diabetes Mellitus for 5 years or more and above 35 years underwent simple random sampling. Weight, height, WC and NC were measured. BMI was calculated and patients were graded into overweight and obesity based on the Asian cutoffs for BMI and abdominal obesity.
ResultsAmong 100 patients enrolled in this study, 45% were men and the mean age was 53.05. Mean neck circumference was 36.55 ± 1.28 cm and 35.27 ± 1.78 cm for male and female respectively. NC was positively correlated with WC and BMI in both men and women (p ˂ 0.001). In the ROC curves, NC presented the largest area under the curve (AUC) for overweight in males (p ˂ 0.001), while NC presented a large AUC for central obesity in both genders. Furthermore, the cut off value of neck circumference for overweight was 35.6 cm in males vs 35.2 cm in females and for central obesity was 36.75 cm in males vs 34.75 cm in females.
ConclusionNeck circumference was positively associated with overweight and central obesity in patients with type 2 diabetes mellitus.
Nebulized Magnesium Sulphate Versus Saline as an Adjuvant in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Centre of Nepal: A Randomized Control Study
Authors: Bajracharya Manjita , Acharya Ramesh P , Neupane Ram P , Sthapit Rekha , Tamrakar Apurva R 
Published: June 2021

Introduction Magnesium has been shown to have bronchodilator properties in asthma and chronic obstructive pulmonary disease (COPD). Therapeutic benefits of nebulized magnesium in asthma has been seen. The purpose of this study was to compare therapeutic benefits of nebulised magnesium sulphate as an adjuvant with normal saline in patients with COPD exacerbation.
MethodsIt was a randomized single blind interventional study of 172 cases of acute exacerbation of COPD presenting (AECOPD) with a peak expiratory flow rate (PEFR) <300 L/min measured 20 min after initial management. Patients received 5 mg salbutamol mixed with 3 ml isotonic magnesium sulphate or 3 ml normal saline on three occasions at 30 min intervals via nebulizer. The primary outcome measured was PEFR at 90 min and hospital admission, noninvasive or invasive ventilation and mortality were taken as secondary outcomes.
ResultsThe mean PEFR were 86.3±11.9 l/min, 97.6±19.1 l/min and 99.6±15.2 l/min after nebulization with magnesium sulphate and 79.17±14.11 l/min, 90.17±18.27 l/min and 93.17±20.63 l/min at 30, 60 and 90 minutes respectively in normal saline group which were statistically significant differences. Total 91.9% were admitted in ward and 8.1% got admitted in Medical and intermediate intensive care units from magnesium group and 81.7% were admitted in ward and 18.3% required ICU admissions in saline group. Differences in ventilation and mortality were insignificant.
ConclusionNebulized magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD has therapeutic benefit on PEFR but no effect in terms of hospital admission, requirement of invasive or non-invasive ventilation and mortality.
Prevalence of Metabolic Syndrome among Subjects attending General Health Checkup of a Tertiary Center of Kathmandu, Nepal
Authors: Shakya Yagya L , Raut Shankar , Shrestha Tirtha M , Neupane Ram P 
Published: June 2021

Introduction Metabolic syndrome is one of the major concerns of modern health causing morbidity and mortality. The metabolic syndrome is the constellation of metabolic disorders - insulin resistance; obesity, dyslipidemia and hypertension that are interrelated which lead to higher risk of cardiovascular disease, diabetes, stroke, atherosclerosis and serious health condition. The study focused on the prevalence of all the metabolic syndrome cases that came to general health checkup (GHC) of Tribhuvan University Teaching Hospital.
MethodsThe study was a cross-sectional retrospective study of all cases that came to GHC from July 2019 to October 2019. GHC records files of all patients that came for their general health check-up were used to obtain data that included demographic details and the criteria for metabolic syndrome. Waist circumference, weight, height and blood investigations were sent as a routine examination of the general health checkup. Data analysis was done in Microsoft Excel 2019 and SPSS 20.
ResultsAmong 311 cases enrolled in our study, 99 (31.8%) met the revised National Cholesterol Education Program, Adult Treatment Panel III (NCEP ATP III) criteria for metabolic syndrome. Among those with metabolic syndrome, males were 52 (52.53%) and females were 47 (47.47%). Also, 81 (81.81%) out of 99 cases had decreased HDL (<1.03 mmol/L for males and <1.30 mmol/L for females), which was the most common component of metabolic syndrome in the study.
ConclusionMetabolic syndrome is present in almost one third of the studied apparently healthy patients coming for general health checkup and it emphasizes on awareness regarding screening for metabolic syndrome.