bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Giant Urethral Calculus
Authors: Sigdel Ghanshyam , Agarwal Aman , Keshaw Belokar Wasant 
Published: September 2018

Urethral calculi are rare forms of urolithiasis. Majority of the calculi are migratory from urinary bladder or upper urinary tract. Primary urethral calculi usually occur in presence of urethral stricture or diverticulum. In this article we report a case of a giant posterior urethral calculus measuring 7x3x2 cm in a 47 years old male. Patient presented with acute retention of urine which was preceded by burning micturition and dribbling of urine for one week. The calculus was pushed in to the bladder through the cystoscope and was removed by suprapubic cystolithotomy.
Keywords: giant urethral calculus; posterior urethra.
Crossed Testicular Ectopia
Authors: Pradhan Anup , Panta Om Biju , Gurung Ghanshyam , Karki Dan Bahadur 
Published: September 2018

Crossed testicular ectopia also known as transverse testicular ectopia is a rare anomaly of the testis which is ectopically located in contralateral hemiscrotum with absent testis in the ipsilateral hemiscrotum. Most case are incidentally discovered intraopeartively during operation of inguinal hernia and few case reports are available which have reported preoperative diagnosis of crossed testicular ectopia. We report a case of crossed testicular ectopia in 12 year old boy who presented with right undescended testis diagnosed preoperative on Ultrasound and Magnetic Resonance Imaging as crossed testicular ectopia.
Keywords: crossed ectopia; MRI; testis; ultrasonography.
Uncommon course of the ulnar artery through the pronator teres muscle
Authors: Vymazalová Katerina , Vargová Lenka , Joukal Marek 
Published: September 2018

In this paper, we describe a very rare variant in the course of the ulnar artery that we encountered in dissecting the right upper limb of a 74-year-old man. The ulnar artery arose standardly from the brachial artery in the cubital fossa. However, its ensuing course differed from the norm. The artery entered together with the ulnar vein and median nerve into the pronator canal (between the humeral and ulnar heads of the pronator teres). Further, the ulnar artery descended classically to the ulnar side of the forearm between the flexor carpi ulnaris and flexor digitorum superficialis. Knowledge of this variation in the course of the ulnar artery may have significance in clinical practice because accumulation of anatomical structures in the pronator canal could be a predisposing factor for the compression of nerve or blood vessels.
Keywords: anatomical variation; median nerve; pronator canal; pronator teres muscle; ulnar artery.
Radiation induced myxoma of superior vena cava origin presenting as a right atrial mass
Authors: Sabzi Feridoun , Faraji Reza 
Published: September 2018

Myxomas are the most common benign cardiac tumors. Myxomas are more common in the left heart chamber than the right side chamber. An extracardiac origin presenting as a right atrial mass is very rare. Right-sided tumors are considerably less common than left-sided tumors, and however myxoma of great vessels origin presenting as right atrial masses are rare but radiation induced villous myxoma in superior vena cava (SVC) is exceedingly rare tumor. A case of radiation induced myxoma originating in a previously undescribed location and presenting as a right atrial mass is reported.
Keywords: myxoma; right atrial; vena cava.
A Rare Case of Multiorgan Involvement of Rosai Dorfman Disease in an Elderly Female
Authors: Waghmare Rakesh Digambar 
Published: September 2018

Sinus histiocytosis with massive lymphadenopathy (SHML), Rosai-Dorfman Disease, is a rare histiocytic syndrome first described by Rosai and Dorfman, most frequently seen in children and young adults.The disease is more common in males and in individuals of African descent but rare in Asians. It is mainly characterized by painless bilateral cervical lymph node enlargement and is often associated with fever and leucocytosis. This case is being reported for its rarity in presentation in an elderly female with both generalized nodal as well as extranodal manifestations. Without the awareness about RDD, the diagnosis of RDD is unexpected especially in South East Asian Countries where certain lymphadenopathies such as tuberculosis, metastatic malignancies and lymphomas are common.
Keywords: emperipolesis; rosai-dorfman disease; sinus histiocytosis with massive lymphadenopathy.
Symptoms Analysis of Obsessive–Compulsive Disorder in Adolescents and Adults in a Teaching Hospital
Authors: Goit Bharat Kumar , Ghimire Shree Ram 
Published: September 2018

Introduction: Obsessive-compulsive disorder has a broadly diverse clinical expression that reflects heterogeneity. Several studies have identified consistent symptom dimensions of obsessivecompulsive disorder. The purpose of this study was to conduct an exploratory symptoms analysis of obsessive-compulsive symptoms in adolescents and adults with obsessive-compulsive disorder.
Methods: This was a cross-sectional study conducted in the Department of Psychiatry, National Medical College. This study examined lifetime occurrence of obsessive-compulsive symptoms included in the 13 symptom categories of the Yale–Brown Obsessive Compulsive Scale. Symptoms analysis was performed on 60 patients with obsessive-compulsive disorder. Eight categories of obsessions and six categories of compulsions from Yale–Brown Obsessive Compulsive Scale were included in the analyses. SPSS software package (version 16) was used to analyze the data and shown in the table.
Results: Of 60 adolescents and adults, female and male were in the ratio of 1.2:1. Contamination was the most common occurring obsession followed by aggressive obsession. The most common occurring compulsion was checking followed by washing. Only a minority of patients (13.33%) presented predominantly with obsessions however 18.33% patients presented predominantly with compulsions. Certain obsessions and compulsions co-occur to form a cluster.
Conclusions: In adolescents and adults, obsessive-compulsive disorder is a multidimensional disorder. Symptom dimensions are predominantly congruent with those described in similar studies of adults with obsessive-compulsive disorder.
Keywords: compulsion; obsession; obsessive-compulsive disorder.
Diagnosis and Management Pattern of Lateral Epicondylitis in a Tertiary Care Center
Authors: Dhakal Sita , Acharya Trishna , Gautam Savyata , Upadhyay Nijan , Dhakal Sujan 
Published: September 2018

Introduction: Lateral Epicondylitis has been found to be the second most frequently diagnosed musculoskeletal disorder. A wide range of symptomatic treatments are available such as use of anti-inflammatory analgesic drugs, steroids, physiotherapy. This study aims to know about the diagnosis, prescription pattern and current practice on management of tennis elbow in Nepal.
Methods: This is a hospital based observational study carried out at Bir Hospital, Kathmandu, Nepal. Patients diagnosed with tennis elbow were purposively selected through prospective sampling technique from Orthopedic Department. Questionnaire and patient medication files were used as tools for data collection.
Results: A total of 97 patients were found to be suffering from tennis elbow affecting mostly 41-50 years of age group and seen mostly in female (62%). Further, it was found that housewives (31%) were mostly affected. Diagnosis of tennis elbow was done commonly by clinical evaluation (61%) and X-ray (39%). Both Pharmacological and Non-Pharmacological approaches were in practice. Pharmacological treatment include NSAIDS (59% Aceclofenac, 19% Naproxen, 18% Indomethacin, 16% Diclofenac, 6% Piroxicam) and Steroids (23% methylprednisolone acetate and 21% oral prednisolone). Non-Pharmacological treatment was done by lifestyle modification (100%), 78% application of heat, 63% use of tennis elbow band, 29% exercise and 28% physiotherapy. Surgical intervention (3%) was also done when the conservative management failed.
Conclusions: There is professional risk of tennis elbow for housewives, farmers and shopkeepers in context of Nepal. Only one treatment approach is not effective in management of tennis elbow for long term effect.
Keywords: lateral epicondylitis; NSAIDs; physiotherapy; steroid; tennis elbow.
Inadequate Empirical Antibiotic Therapy in Hospital Acquired Pneumonia
Authors: Dahal Santosh , Rijal Basista Prasad , Yogi Karbir Nath , Sherchand Jeevan Bahadur , Parajuli Keshab , Parajuli Narayan , Pokhrel Bharat Mani 
Published: September 2018

Introduction: Inadequate empirical antibiotic therapy for HAP is a common phenomena and one of the indicators of the poor stewardship. This study intended to analyze the efficacy of empirical antibiotics in the light of microbiological data in HAP cases.
Methods: Suspected cases of HAP were followed for clinico-bacterial evidence, antimicrobial resistance and pre and post culture antibiotic use. The study was taken from February,2014 to July, 2014 in department of Microbiology and department of Respiratory medicine prospectively. Data was analyzed by Microsoft Office Excel 2007.
Results: Out of 758 cases investigated, 77(10 %) cases were HAP, 65(84%) of them were culture positive and 48(74 %) were late in onset. In early onset cases, isolates were Acinetobacter 10(42%), Escherichia coli 5(21%), S.aureus 4(17%), Klebsiella 1(4%) and Pseudomonas 1(4%). From the late onset cases Acinetobacter 15(28%), Klebsiella 17(32%) and Pseudomonas 13(24%) were isolated. All Acinetobacter, 78% Klebsiella and 36% Pseudomonas isolates were multi drug resistant. Empirical therapies were inadequate in 12(70%) of early onset cases and 44(92%) of late onset type. Cephalosporins were used in 7(41%) of early onset infections but found to be adequate only in 2(12%) cases. Polymyxins were avoided empirically but after cultures were used in 9(19%) cases.
Conclusions: Empirical antibiotics were vastly inadequate, more frequently so in late onset infections. Use of cephalosporins empirically in early onset infections and avoiding empirical use of polymyxin antibiotics in late onset infections contributed largely to the findings. Inadequate empirical regimen is a real time feedback for a practitioner to update his knowledge on the local microbiological trends.
Keywords: empirical therapy; hospital acquired pneumonia.
Sleeping Pattern of Medical Students Preceding Viva Examination and Their Performance
Authors: Ansari Mukhtar 
Published: September 2018

Introduction: Sleep is an important determinant of keeping healthy physically and mentally. Deviation in sleep is a common problem among students during examinations. The purpose of this study is to determine students’ sleep pattern during night preceding viva examination and its correlation with performance.
Methods: This was a cross-sectional prospective study conducted between January and February 2014 among 1st and 2nd year MBBS students of National Medical College, Birgunj, Nepal who appeared in University’s final practical examinations. Based on simple random sampling approach, each of the 280 participants was allowed to pick out five pieces of lottery papers and they were asked the five questions resembling the number in the list of questions.
Results: Among the total 280 students, 74.6% were from India and 25.4% were from Nepal, and majorities (63%) of them were males. Fifty two percent of the students either could not sleep at all or slept just for 1 to 1.5 hours while 12% slept for 5 to 6.5 hours. Two-third (66%) of the students was able enough to achieve one to two scores, and only 1.8% could succeed to get the maximum score of five. The correlation between hours of sleep preceding examination and the score achieved was positively (r=0.701) and statistically significantly correlated (p<0.001).
Conclusions: There is a trend among the medical students either not to sleep or sleep only for few hours preceding viva examination that result in poor performance in examinations.
Keywords: medical; Nepal; performance; sleep deprivation; students.
Patients’ Awareness about the Complications of Diabetes Mellitus and its Co-relation with the Glycemic Status
Authors: Kumar Agrawaal Krishna 
Published: September 2018

Introduction: Diabetes is a major cause of morbidity and cardiovascular related mortality along with a major cause of preventable blindness and foot amputation. There are limited studies on diabetes awareness, attitude, and prevalence.
Methods: Thus, we designed a study to seek the patients awareness about the complications associated with diabetes. It was a prospective observational study which included 123 patients with Diabetes Mellitus.
Results: The mean age of population studied was 53 years mainly from the Rupandehi and Nawalparasi districts in Nepal attending a clinic. In the study Erectile Dysfunction was statistically significant with postprandial hyperglycemia. Lack of Awareness about a calorie specific diet plan was significantly associated with increased blood sugar fasting level >110mg/dl. A majority of patients (58%) had awareness regarding kidney damage and 51% had awareness that Diabetes causes delayed wound healing. Only 3% of the patients did a regular foot care and 9% knew what the target glycemic status is. About 36% know that there can be cardiac complications due to diabetes and 27% regarding eyes. Similarly 36% of the patients also knew that there is neuropathy due to diabetes and 18% were aware about CVA. About 54% of the patients had Fasting >110mg%.
Conclusions: The study showed that though the patients are on OADs but they lack awareness about the major complications related to diabetes mellitus.
Keywords: awareness of diabetic complications; HbA1c; patient awareness.
Methotrexate in the Treatment of Recalcitrant Nodular Vasculitis
Authors: Parajuli Sudip , Dhital Kamal Raj 
Published: September 2018

We report a case of recalcitrant nodular vasculitis in a 23 years old male who was treated successfully with methotrexate. He presented to our Dermatology out Patient Department, Tribhuvan university teaching hospital with complaints of recurrent painful discharging ulcer over bilateral calf and lower legs of three years duration. The diagnosis of nodular vasculitis was made on the basis of the clinical presentation and the histopathological findings. The patient was treated with antituberculosis treatment with initial good response; however the lesions persisted later on, despite completing the course of ATT. The patient did not respond to treatment with systemic corticosteroids also. On starting methotrexate, the lesion started healing within a period of two weeks and therewas significant improvement in subsequent one month. This case report highlights the efficacy of methotrexate in the treatment of recalcitrant nodular vasculitis.
Keywords: ATT; methotrexate; nodular vasculitis.
En bloc Pancreaticodudenectomy with Colectomy for Locally Advanced Right Sided Colon Cancer
Authors: Bhandari Ramesh Singh , Lakhey Paleswan Joshi , Mishra Parsu Ram 
Published: September 2018

A 57 year old male presented to our outpatient clinic with history of on and off melena, weight loss and decreasing appetite for 10 months duration and a noticeable mass on the right upper quadrant. Abdominal examination revealed an intra-abdominal lump in right upper quadrant which was subsequently evaluated by colonoscopy, which revealed an ulcero-proliferative growth in the hepatic flexure and the biopsy from it confirmed well-differentiated adenocarcinoma. Contrast enhanced computed tomography demonstrated hepatic flexure mass with possible invasion into adjacent duodenum without features of advanced disease. After completion of necessary preoperative assessment and investigations, patient was explored with curative intent and underwent extended right hemicolectomy with en bloc pancreaticodudenectomy. Patient was discharged on 10th postoperative day and at 14 months follows up; he was doing well without any evidence of recurrence.
Keywords: colectomy; locally advanced; pancreaticoduodenectomy.
Close Versus Limited Open Method of Ender’s Nail Fixation in Paediatric Femoral Shaft Fractures
Authors: Dwivedi Rajeev , Sah Shambu , Dahal Mukund , Acharya Parimal , Gurung Sandeep 
Published: September 2018

Introduction: There are various surgical options for treating fracture of femoral shaft in children. Here we compare the results of close with limited open method of Ender’s nails fixation of femoral shaft fractures in children.
Methods: We studied 60 children with femoral shaft fractures in age group 5-15 years. Ender’s nail fixation was done by close technique in 40 cases and in 20 cases by limited open technique.
Results: The mean operative time was significantly high in limited open group being 64 minutes in comparison to 50 minutes in close group. There was no significant difference between close and limited open groups with respect to time for partial weight bearing and time for full weight bearing. Fracture united sooner in close group as compared to open group. Union was achieved in all patients within a mean of 11 weeks in close group in comparison to 12.4 weeks in open group. According to the Flynn criteria in close group 34 patients had excellent results, 6 had satisfactory and none poor. In limited open group outcome was excellent in 14 patients, satisfactory in 4 patients and 2 had poor result. There was no significant difference in outcome based on Flynn criteria between two groups.
Conclusions: Though operative time is more and healing is delayed in Ender’s nail fixation by limited open technique, there is no statistical difference in final outcome as per Flynn criteria between close and limited open technique of Ender’s nail fixation of femoral shaft fractures in children.
Keywords: children; close technique; ender’s nail; fracture shaft of femur; flynn criteria.
Bilateral Synchronous Testicular Seminoma in a Patient with Bilateral Cryptorchidism
Authors: Ghartimagar Dilasma , Ghosh Arnab , Shrestha Manish Krishna , Chettri Duk Bahadur , Shrestha Santosh , Sherchan Rishi Kumar 
Published: September 2018

Cryptorchidism is a known cause of testicular tumor. The incidence of testicular tumor is 11 times more in inguinal testes and 50 times more in intra-abdominal testes. The position of the undescended testis is related to the likelihood of carcinogenesis with the intra-abdominal location having the highest risk for malignancy. Bilateral testicular tumors are rare and 80% of bilateral tumors are metachronous. Synchronous bilateral testicular tumors are rare and bilateral synchronous testicular seminoma in a patient with bilateral cryptorchidism is very rare.
Keywords: bilateral; cryptorchidism; seminoma; synchronous; testes.
Hashimoto's Thyroiditis and Medullary Carcinoma of Thyroid
Authors: Dasgupta Senjuti , Chakrabarti Sudipta , Mandal Prakas Kumar , Das Shikha 
Published: September 2018

Hashimoto’s thyroiditis has been found to be associated with lymphoma, papillary carcinoma and Hürthle cell neoplasms of thyroid. In contrast, there are only a few reports of co-existence of HT with medullary carcinoma of thyroid. An overall prevalence of medullary carcinoma of only 0.35% has been reported in HT patients. Such a rare combination is being presented here. A 33 year old female presented with history of goiter for one year. Fine needle aspiration cytology of the swelling revealed cytological features suggestive of medullary carcinoma of thyroid. Histopathological examination of total thyroidectomy specimen revealed Hashimoto’s thyroiditis along with medullary carcinoma of thyroid. Although Hashimoto’s thyroiditis can uncommonly coexist with thyroid neoplasm, its association with medullary carcinoma is extremely rare and hence being presented.
Keywords: association, hashimoto’s thyroiditis, histopathology, medullary carcinoma of thyroid.
Fontan Failure and Thrombosis of Total Cavo-Pulmonary Connection Conduit
Authors: Panthee Nirmal , Murakami Arata , Ando Masahiko , Takaoka Tetsuhiro , Ono Minoru 
Published: September 2018

The immediate postoperative period of Fontan operation is frequently complicated by hemodynamic instability, sometimes requiring fenestration of the conduit. Thrombosis of total cavo-pulmonary connection conduit warrants early intervention to prevent systemic and pulmonary embolism. We report a case of Fontan failure requiring fenestration; which was further complicated by thrombosis of total cavo-pulmonary connection conduit and managed with anticoagulants.
Keywords: congenital heart disease; fontan procedure; thrombosis.
Intravenous Iron Sucrose Therapy in Iron Deficiency Anemia in Antenatal and Postnatal Patients
Authors: Sharma Jyotshna , Tiwari Sanjeeb 
Published: September 2018

Introduction: Iron deficiency anemia is the most common nutritional deficiency in pregnancy and more common in developing countries which is aggravated due to increased demand and blood loss during delivery. Though there are different methods for treating iron deficiency anemia. Iron sucrose is being used because of its minimal side effects. This study was undertaken to evaluate the response and effect of intravenous iron sucrose given to patient in antenatal and postnatal period with moderate iron deficiency anemia.
Methods: A hospital based prospective study was conducted 1st Jan 2013-30th Dec 2014 in the department of obstetrics and gynecology Kathmandu Medical College, Teaching Hospital Kathmandu, Nepal. Antenatal and postnatal patients with hemoglobin between 5-9 gm% with diagnosed iron deficiency anemia were included in the study. The aim was to bring her hemoglobin level to 11gm%.
Results: All together 37 patients were enrolled out of which two patient were dropped due to allergic reaction and 35 patients were included in study. Iron sucrose therapy is effective in achieving target hemoglobin of 11gm/dl in 80% of patients. It showed that intravenous iron sucrose significantly (P < 0.001) increase hemoglobin level within two weeks of therapy without any major adverse effects.
Conclusions: Iron sucrose therapy is safe, effective and well tolerated for the treatment of iron deficiency anemia. Parental iron therapy was effective in increasing hemoglobin, serum ferritin and other hematological parameters in antenatal and postnatal patients with anemia. The treatment will help to reduce the risk of maternal complication during pregnancy and postpartum and its adverse effect to fetus.
Keywords: iron deficiency anemia; intravenous iron; pregnancy.
Complete Bilateral Calcified Psoas Abscess- Rare Sequelae of Untreated Pott’s Spine
Authors: Pannu Chaitanya Dev , K Deepika , Goswami Ankur , Vijayaraghavan G 
Published: September 2018

Although rare in the western world; psoas abscess is a frequent finding in Indian sub continent associated with Pott’s spine. Untreated Pott’s spine may lead to various sequelae like destruction of vertebra, kyphosis, paraplageia etc which in modern world is amenable to anti-tubercular drugs and surgical management. We report a case of untreated Pott’s spine with bilateral calcified psoas abscess with kyphosis. To the best of our knowledge no such case of complete bilateral calcified psoas abscesses has been reported earlier. We want to discuss this case with relevant literature review and its influence on treatment plan.
Keywords: aminoglycoside; antistaphylococcal; psoas.
Anaesthetic Management of Patients with Takayasu’s Arteritis for Open Cholecystectomy: a Report of Two Cases
Authors: Shrestha Gentle Sunder , Shrestha Ninadini , Shrestha Battu Kumar , Shrestha Pramesh Sunder 
Published: September 2018

Takayasu’s arteritis is a well known yet rare form of large vessel vasculitis. This inflammatory disease often affects the ascending aorta and aortic arch, causing obstruction of the aorta and its major arteries. Anaesthetic management for these patients is complicated by severe hypertension, end-organ dysfunction, stenosis of major blood vessles and difficulties in monitoring blood pressure. We present two patients who underwent open cholecystectomy under neuraxial anaesthesia. We have discussed about various perioperative issues and their management.
Keywords: anaesthetic management; takayasu’s arteritis.