bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kidney Biopsy: An Experience from Tertiary Hospital
Authors: Ghimire Madhav , Pahari Bishnu , Paudel Navaraj , Das Gayatri , Das Gopal Chandra , Sharma Sanjib Kumar 
Published: September 2018

Introduction: Kidney Biopsy is an important diagnostic tool in Nephrology. It is useful in Nephrology in terms of diagnosis, prognosis and management. There is little information on renal biopsy data from central Nepal. We describe our center`s experience in kidney biopsy in term of histological patterns, complications and outcomes.Methods: We prospectively analyzed the biopsies data of patients over a period of one and half year. All kinds of kidney disease patients were included for kidney biopsy, irrespective of their clinical syndromes and underlying diagnosis.Results: A total of 75 biopsies were analyzed. Majority of them were females; 56% (n=42). Most of the biopsies; 84% (n=63) were from younger subjects ≤ 45 years and majority of them fell in the age group 11-20 years. Most common clinical renal syndrome to undergo biopsy was Sub Nephrotic range Proteinuria in 53.3% (n=40). Among comorbid conditions, 53.3% (n=40) had Hypertension. The most common histological pattern seen was Mesangial proliferative Glomerulonephritis (MesPGN) seen in 24% (n=18). Among complications associated with the procedure, macroscopic hematuria was seen in 6.7% (n=5) cases and clinically significant perinephric hematoma causing pain was seen in 5.3% (n=4). There was no mortality associated with biopsy procedure.Conclusions: Sub Nephrotic range Proteinuria was the commonest clinical renal Syndrome observed. In terms of renal histology, Mesangial Proliferative Glomerulonephritis (MesPGN) was the commonest histological pattern observed. Kidney biopsy is a safe procedure without any significant adverse events.Keywords: Kidney biopsy, sub nephrotic range proteinuria, mesangial proliferative glomerulonephritis
Frequency of Blood Culture Isolates and their Antibiogram in a Teaching Hospital
Authors: Shrestha Subha , Amatya Ritu , Shrestha Raj Kumari , Shrestha Rajiv 
Published: September 2018

Introduction: Bloodstream infections are associated with significant patient morbidity and mortality. Antimicrobial susceptibility patterns should guide the choice of empiric antimicrobial regimens for patients with bacteremia.Methods: Blood sample received from the patient attending Nepal Medical College and Teaching Hospital from March 2013 – August, 2013 were subjected to for culture. Isolate identification and antimicrobial susceptibility testing was done by standard microbiological methodResults: Out of the total 2,766 blood samples, 13.3% showed bacterial growth. The percentage of neonatal septicemia was 13.3%. Staphylococcus aureus (28%) was the most common isolates followed by Salmonella enterica Serotype Typhi (22%), Coagulase negative Staphylococci (9.5%), Salmonella enterica Serotype Paratyphi ((7.6%) and Klebsiella pneumoniae (7.6%). 26.3% of the isolates of Staphylococcus aureus were oxacillin resistant. Most of the gram positive organisms were susceptible to amikacin and vancomycin and showed high level resistance to cefuroxime and cotrimoxazole. Out of 109 isolates of typhoid bacilli, 95.3% were resistant to nalidixic acid ,79% to ciprofloxacin and 60.5% to ofloxacin. More than 50% of the isolates of Klebsiella pneumoniae and Escherichia coli showed resistance to cephalosporins and cotrimoxazole. Acinetobacter spp showed high resistance (more than 60%) to ceftriaxone and ofloxacin. More than 20% of the isolates of Pseudomonas aeruginosa were resistant to ciprofloxacin and amikacin.Conclusions: Ongoing surveillance for antimicrobial susceptibility remains essential, and will enhance efforts to identify resistance and attempt to limit its spread.Keywords: antibiotic; bacteria; blood stream infections.
Early Development of Refl ux Esophagitis after Successful Helicobacter Pylori Eradication in Superfi cial Gastritis
Authors: Jeon H H , Jeon HH 
Published: September 2018

The relationship between gastroesophageal refl ux disease (GERD) and Helicobacter pylori (H. pylori) eradication is still debated. Recently, we had a patient of GERD who had developed it shortly after H. pylori eradication therapy. A 72-year-old man was diagnosed by endoscopy as suffering from severe superfi cial gastritis in the stomach body. A rapid urease test showed H. pylori infection. He was then started on proton pump inhibitor (PPI) based therapy for two weeks eradicating H.pylori. After completion of H. pylori eradication, he complained of a heart-burn sensation. Follow-up endoscopy showed refl ux esophagitis, of grade B according to the Los Angeles classifi cation. Since the patient had developed GERD after completion of the triple therapy, their suggests that H. pylori eradication must have triggered the development of de novo GERD after a short period of time.
Keywords: GERD, Helicobacter pylori, PPI.
Neonatal Sepsis as a Major Cause of Morbidity in a Tertiary Center in Kathmandu
Authors: Thapa Badri , Thapa Anurag , Aryal Dhan Raj , Thapa Kusum , Pun Asha , Khanal Sudhir , Mahat Kishori 
Published: September 2018

Introduction: Neonatal sepsis causes high morbidity and mortality of newborns. The study aims to study the predictors and clinical, haematological and bacteriological factors of neonatal sepsis.
Methods: A descriptive cross sectional study was conducted in a Neonatal Intensive Care Unit (NICU) of Paropakar Maternity and Women’s Hospital in Kathmandu between October and December 2011. Demographic, obstetrics, clinical and microbiological data were studied for 300 neonates.
Results: The NICU prevalence rate of sepsis was 37.12%. Early onset neonatal sepsis was common (91.39%) (P=0.000). Cesarean section (OR 1.95, 95% CI 1.15-3.31), apgar score <4 at 1 min (P=0.00) and <7 at 5 min of birth (P=0.00) predicted sepsis. Neonates with sepsis were more likely to present with hypothermia (OR 1.180, 95% CI 0.080-17.214), pustules (OR 2.188, 95% CI 0.110-43.465), dehydration (OR 3.040, 95% CI 0.170-54.361), diminished movement (OR 3.082, 95% CI 0.433-21.950) and bulging fontanels (OR 16.464, 95% CI 0.007-41495.430). Coagulase negative Staphylococcus spp. (CoNS) (21, 41.17%) was most common pathogen of neonatal sepsis. Variable antibiotic resistance patterns of isolates with emergence of meropenem resistance in Pseudomonas spp. and methicillin resistance in CoNS and S. aurues were noted. Mortality due to sepsis was highest (15, 8.06%) among total mortalities (21, 11.29%).
Conclusions: Delivery via cesarian section, apgar score <4 at 1 min, and <7 at 5 min predicted sepsis. Morbidity and mortality of neonatal sepsis was common in this setting and early maternal and neonatal interventions are required to address this issue. Keywords: morbidity; mortality; neonatal sepsis; predictors.
Left Axis Deviation in Electrocardiogram with Normal QRS Duration in Ambulatory Adults without Cardiac Symptoms: A Possible Marker of Glucose Intolerance
Authors: Paudyal Amar , Bhattarai Madhur Dev , Karki Buddha Bahadur , Bajracharya Manil R , Rajouria Alark D , Pradhan Amita 
Published: September 2018

Introduction: We are increasingly noticing isolated left axis deviation (LAD) in electrocardiogram in younger people with diabetes without obvious heart disease and association of LAD with glucose intolerance has not been explicitly raised before. We planned a study of ambulatory adults with borderline (0o to –30o) and moderate-to-marked (<–30o to –90o) LAD looking into their possible association with glucose intolerance with fasting plasma glucose (FPG) ≥100mg/dL.
Methods: We consecutively enrolled adults aged 30 or more, with electrocardiogram normal duration QRS axis between 0o to –90o, without cardiac symptoms, not on any medication, attending outdoor-clinics for health checkup.
Results: Out of 100 participants enrolled, about 90% were aged between 30 and 60 and 47% had borderline and 53% moderate-to-marked LAD. Moderate-to-marked LAD group had higher frequencies of abnormal blood pressure (BP), FPG, and lipids than borderline LAD group even after conditioning effects of age and sex (p≤0.03) and of FPG after conditioning effects of BP (p=0.02). The frequencies of glucose intolerance were 48.9% even in borderline LAD with 84.9% in moderate-to-marked LAD group. In moderate-to-marked LAD group mean values of BP, FPG, and lipid profiles were higher (p<0.001) and abnormal. In borderline LAD group though mean BP and lipid values were normal, FPG was impaired.
Conclusions: Impaired mean FPG values and high frequencies of glucose intolerance in both borderline LAD group with normal BP and moderate-to-marked LAD group with conditioning of effects of BP in relatively younger ambulatory adults without cardiac symptoms indicate possible association between LAD and glucose intolerance.
Keywords: diabetes; ecg; glucose intolerance; left axis deviation.
Effects of Educational Intervention among Reproductive Age Group Women on Safe Abortion
Authors: Silwal Kalpana , Shrestha Tumla , Dulal Ram Krishna 
Published: September 2018

Introduction: Many reproductive aged women needlessly die due to unsafe abortion even when they seek help to terminate their unwanted pregnancy. These deaths could have been prevented had they been aware that safe abortion service was available to them. The study aimed at finding out the effectiveness of the education intervention in improving knowledge among reproductive age group women regarding the safe abortion.
Methods: An experimental intervention was carried out on safe abortion education among the reproductive age group women. The impact of pre- and post- intervention was evaluated by using a set of structured questionnaire in local language. The obtained data was analyzed by using the Excel and Statistical Package for the Social Sciences, version 12.0 for windows and result was interpreted.
Results: The post intervention finding revealed a significantly higher (p= 0.001) mean on knowledge among participants about safe abortion compared to pre-observational test. The mean difference between the pre-test and post-test was 64.1% (Pre-test 11.18 ±12.88 Post-test 75.28 ±9.56). The research hypothesis was accepted with p value paired t-test at <0.001 (0.05). The result supports that the educational intervention was effective in increasing safe abortion awareness among reproductive aged group women.
Conclusion: The safe abortion educational intervention program was instrumental to improve reproductive age women’s knowledge considerably about safe abortion service.
Keywords: educational intervention; knowledge; safe abortion; women.
FNAC Diagnosis of Cutaneous Leishmaniasis
Authors: Jha Abhimanyu , Gurung Dipendra 
Published: September 2018

Cutaneous leishmaniasis is rare in Nepal although visceral leishmaniasis and post-kalazar dermal leishmansis have frequently been reported. Diagnosis is often made in skin biopsy. Fine needle aspiration cytology diagnosis of the disease is a rare event. This was a 33 year male presenting with ulcerated cutaneous nodule at anterior neck. Fine needle aspiration cytology showed granulomatous inflammation with numerous intracellular and extracellular amastigotes. Fine needle aspiration cytology diagnosis of this condition is easy and less time consuming compared to skin biopsy.
Keywords: anterior neck; cutaneous leishmaniasis; FNAC.
Primary Osteosarcoma of the Breast
Authors: Bhatta Sushama , Aryal Gopi 
Published: September 2018

Primary extra-osseous osteogenic sarcomas have been reported in many tissues of the body but their occurrence in the breast is rare. The tumor has poor prognosis with high risk of recurrence and hematogenous spread, most commonly to the lungs. We report a case of primary osteosarcoma of the breast occurring in a 58-year old woman. Histo-pathological examination revealed pleomorphic tumor cells with osteoid formation and positivity for immuno-histochemical stain vimentin.
Keywords: breast; histopathology; osteosarcoma.
Open Reduction and Internal Fixation of Supracondylar Fractures of the Humerus: Revival of the Anterior Approach
Authors: Manandhar R R , Lakhey S , Pandey B K , Pradhan R L , Sharma S , Rijal K P 
Published: September 2018

Introduction: Supracondylar fractures of the humerus occur commonly in the paediatric age group. Gartland type III fractures are treated by closed manipulation and percutaneous pinning with K-wires. Open reduction is indicated in open fractures, failed closed reductions and in a dysvascular limb. There are various approaches that can be utilized to perform an open reduction. The approach of choice must be safe, surgeon and patient friendly and should provide a good access to the fracture and the important surrounding structures. The anterior approach has been described as the most versatile approach. The aim of the study was to review the advantages and drawbacks of the anterior approach and to assess the functional outcome of fractures treated via this approach.
Methods: Twenty ve (15 male and 10 female) patients out of a hundred and twenty eight children with Gartland type III extension variety of supracondylar fractures of the humerus from underwent open reduction and internal xation with K-wires via an anterior approach January 2007 to January 2011. The results were assessed at six months using Flynn’s radiological and clinical criteria.
Results: Twenty ve patients (19.53%) out of hundred and twenty eight patients underwent open reduction and internal xation. According to Flynn’s clinical and radiological criteria, 20 (80%) were found to have excellent and 5 (20%) good results.
Conclusion: The anterior approach is safe, easy and provides direct exposure of the surrounding neurovascular structures with good to excellent results.
Keywords: anterior approach, open reduction, supracondylar fractures humerus.
A Carcinoid Tumor of The Esophagus Treated with Endoscopic Ablation Therapy
Authors: Kim Na Rae , Kim Yoon Jae , Hwang In Cheol 
Published: September 2018

Esophageal carcinoids are exceedingly rare and only a few limited cases have been reported. Because knowledge about esophageal carcinoid is based primarily on case reports, the treatment of choice has not been settled. We report here on a localized carcinoid tumor in the esophagogastric junction. As our initial biopsy was nearly equal for the excision, we only performed coagulation ablation therapy instead of a wide excision which is traditionally recommended. The patient is free of recurrence so far during 50-month follow-up. Our report suggests that esophageal carcinoids may be not particularly associated with a poor prognosis.Keywords: carcinoid tumor; esophagus; argon plasma coagulation. | PubMed
Rectosigmoid Endometriosis Causing an Acute Large Bowel Obstruction: A Report of a Case and a Review of the Literature
Authors: Gupta R K , Agrawal C S , Yadav R P , Uprety D , Sah P L 
Published: September 2018

Endometriosis is often seen in gynecology practice and is treated medically. However, intestinal involvement of endometriosis causing acute large bowel obstruction is uncommon and is dif cult to differentiate from malignancy before surgery, owing to its similar colonoscopic and radiologic ndings. We report a successfully-treated case of a 30-year-old woman in which endometrial in ltration of the large bowel caused acute obstruction, requiring emergency surgery to relieve the symptom and conrm the diagnosis. We present this unusual disease in general surgical practice and also review the literature.
Keywords: colorectal malignancy, endometriosis, intestinal obstruction
Intravenous Thrombolysis and Risk Factors for Ischemic Stroke
Authors: Shrestha Shakti , Poudel Ramesh Sharma , Thapa Lekh Jung , Khatiwada Dipendra 
Published: September 2018

Thrombolysis is one of the proven potential treatments for the management of acute ischemic stroke. Intravenous recombinant tissue-plasminogen activator (rt-PA) is the only medically approved biological thrombolysing agent for the treatment of acute ischemic stroke within 4.5h of stroke (2.2% symptomatic intracerebral haemorrhage, 12.7% mortality and 58.0% functional independence), but following the guideline and criteria provided by National Institute of Neurological Disorder and Stroke (NINDS) and SITS (Safe Implementation of Thrombolysis in Stroke) studies. Nepal needs to evidently introduce intravenous rt-PA in its clinical setting for treatment of acute ischemic stroke, which has been approved for more than a decade ago in developed countries. Several modifiable and non-modifiable risk factors can affect the outcomes of the treatment with intravenous rt-PA. Early modification of factors predicting the risk outcomes can be a beneficial tool to justify the thrombolytic treatment. This review aims to discuss the major studies on thrombolysis using rt-PA and main factors that can affect the outcomes of treatment in ischemic stroke.
Efficacy of Combined Antithrombotic, Statins and Anti-Hypertensive Drugs in Acute Ischemic Stroke
Authors: Poudel Ramesh Sharma , Thapa Lekhjung , Shrestha Shakti , Khatiwada Dipendra , Upadhyay Nijan , Bhandari Tirtha Raj , Shrestha Asis 
Published: September 2018

Introduction: Anti-thrombotic, statins and antihypertensive drugs are commonly used for the management of acute ischemic stroke in Nepal but there is no evidence regarding their efficacy in our context. This study aims to explore the efficacy of these combined medications (anti-thrombotic, statins and antihypertensive drugs) in acute ischemic stroke patients for the first time and to assess the risk factors present in those patients.
Methods: The study was conducted on 37 acute ischemic stroke patients admitted and treated at the Neurology Department of College of Medical Sciences-Teaching Hospital, Chitwan, Nepal and they were followed at three months (90±10 days). The initial stroke severity and functional disability were evaluated at admission and at 3 months using National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) respectively. The outcome parameters were functional independence (mRS≤2) and mortality at three months (mRS=6). Frequency distribution, Mann-Whitney U-test and χ2 test were performed for statistical analysis.
Results: Out of 37 patients, 27 (73%) were Smoker, 22 (59.5%) had hypertension and 19 (51.4%) were alcohol consumer. The stroke severity on admission was statistically significant with functional independence (P=0.003) and mortality (P=0.015) at three month. Similarly, Rankin grade on admission was statistically significant with functional independence (P=0.001) and mortality (P=0.048) at three month. At three months, 20 (69%) survived patients were independent while mortality was seen in eight (21.6%) patients.
Conclusions: The management of acute ischemic stroke with combined anti-thrombotic, statins and antihypertensive drugs seems promising and efficacious in mild to moderately severe ischemic stroke.
Keywords: antihypertensive; anti-thrombotic; efficacy ; statins; stroke.
Prevalence of Occlusal Traits in the Deciduous Dentition of Children of Kaski District, Nepal
Authors: Baral Prakash , Budhathoki Prakash , Bhuju Krishna Gopal , Koirala Bandana 
Published: September 2018

Introduction: The prevalence of occlusal traits varies among various populations. Ethnic, genetic and environmental factors are the major contributors, with a role in the specific cause of malocclusion. The aim of this epidemiological study was to assess the prevalence of occlusal traits in the deciduous dentition of children of Kaski District,Nepal.
Methods: A total of 506 children (251 girls, 255 boys), aged 3-5 years, were assessed. The occlusion examination was carried out by three examiners, in the school camps,community dental care centre and general health camps, utilizing a mouih mirror and probe. Intra investigator error was calculated using kappa statistics. The data were analyzed by the statistical program SPSS version 17 using the Chi-square test.
Results: The present study studied occlusal traits of 506 children (251 girls, 255 boys), aged 3-5 years. The study result showed that bilateral mesial step seen in 40.3%,bilateral flush terminal plane in 33.5%, bilateral distal steps in 8.5%,mesial step one side and flush terminal other side in 12.7%,mesial step one side and distal step other side in 2.6%,flush terminal one side and distal step other side in 2.4%,anterior crossbite in 3%,posterior crossbite in 0.4% and non-spaced dentition in 20% children.
Conclusions: Mesial step was the most prevalent followed by straight terminal plane and the distal terminal plane showed least prevalence. There were diverse traits for malocclusion. There was no significant difference(p>0.05) in occlusal traits between male and female children.
Keywords: crossbite; distal step; flush terminal plane; mesial step; occlusion.
Emergency Department Overcrowding in Turkey: Reasons, Facts and Solutions
Authors: Cakir Oya Durmus , Cevik Sebnem Eren , Bulut Mehtap , Guneyses Ozlem , Aydin Sule Akkose 
Published: September 2018

Introduction: The purpose of this study was to determine the factors affecting the long waiting times of the patients in a university hospital.
Methods: This study included 3000 of the adults above 18 years and pediatric trauma patients under 18 years who applied to emergency department between February 2009 and April 2009. The examination period of the physician, length of stay, length of hospitalization, waiting times for hospitalization and follow up times in the emergency department were recorded. Moreover, the patients were divided into four groups according to the reasons for waiting.
Results: In our study, the time period between 4 pm-12 pm was determined as the busiest time for the applications. Average length of stay in the emergency department for 3000 patients was 146.7±160.2 minutes. The length of stay for the patients consulted was longer than the length of stay for the ones who were not consulted. Because of the fact that our hospital did not have appropriate bed capacity, 41.1% of the patients waited less than two hours, 13. 4% of the patients waited more than 8 hours. It was also found that the waiting times of the Group two patients (206,7±145,2 minutes) was longer than Group one (95,5±73,9 minutes) patients and the waiting times of Group three patients (470,7±364,7 minutes) was longer than Group one patients.
Conclusions: In conclusion, cooperation of the managers, relevant departments and a multidisciplinary approach are necessary to achieve the goals to reduce overcrowding in the emergency departments.
Keywords: bed capacity; crowding; emergency department; length of stay.
Clinical Profile, Dyslipidemia and ACS - a Correlation
Authors: Dali Bikash 
Published: September 2018

Introduction: To analyze lipid profile in patients with ACS, and to study the pattern of the involvement and complication in ACS. Methods: Hundred and eight consecutive cases of ACS, attending the CCU of Tribhuvan University Teaching Hospital fulfilling the criteria, were taken for the present study. Patient from age 30 and older were studied. All cases were scrutinized to detail serial 12 lead EKG, serial cardiac biochemical markers, laboratory test, echocardiographic study. Design of the study was carried out in prospective, cross sectional study. Results: Hyperlipidemia was present in 61% of the patients. Only 27% of them were on statins. Most of them had high cholesterol level 68%, high Tgl level 75%, Ldl 50%, where as <40 Hdl (93%) patient were found to be low. 40% was found to have UAP. In addition patient with hypertension (76%) diabetes (65%) also had comorbidity for obesity 35%, and lipid abnormalities 75% for triglycerides, 66% for TC, 50% for LDL-C, 93% for low HDL-C, and a family history of CAD in 57%. Conclusions: The outcome of this study showed that the majority are male, relatively younger as compared to Western population. USA and STEMI were the dominant types of ACS. Strong correlations between TC, LDL-C, and low HDL-C in patient with ACS were noted. Majority of patients had hypertension, IHD in their families and Hyperlipidemia diabetes, smoking as the major risk factors. Better control of risk factors and the awareness of preventive strategies are needed.