bluuebunny/crossref_metadata_2025_split huggingface dataset:
Late Presentation of Post Diphtheritic Myocarditis in a 15-year male
Authors: Vinod Kutty Sharada , Gupta Nitin , Sahu Harsh , Wig Naveet 
Published: September 2018

A 15-year old male patient presented to us with dyspnoea for four days. He had a history of fever, pseudo-membranous tonsillitis and cervical adenopathy twenty-five days prior to the presentation. On examination and laboratory investigations, he had features suggestive of myocarditis with biventricular failure. There was no reliable history of immunisation and he had a positive history of contact. He was planned for anti-diphtheria toxin but before the anti-toxin could be initiated, the patient succumbed to refractory cardiogenic shock. This was a rare case of late onset diphtheritic myocarditis in an unimmunised adult. With the advent of universal immunisation, there has been a significant decline in the incidence but there is still some road to cover.
Keywords: Corynebacterium diptheriae; diphtheria; myocarditis.
An Overview of Menopausal Symptoms at District Hospital of Nepal.
Authors: Gupta Sandeep , Acharya Karuna , Srivastav Priyanka , Gurung Purna Kala , Gupta Nupur 
Published: September 2018

Introduction: Menopause is a universal reproductive phenomenon which confirms the end of fertility of the women. The objectives of this study were to establish the age of natural menopause and to identify the prevalence of menopausal symptoms among the rural women attending district hospital of Nepal. Methods: This present study is a hospital based, observational cross-sectional study conducted in Outpatient department of Lamjung District Hospital, Lamjung, Nepal. The study was carried out from January 2014 till June 2014. Fifty four menopausal women were included in the study. A structured questionnaire was used and the data were analyzed using statistical package for social sciences. Results: There were 54 participants with menopausal symptoms included in the study. Age ranged from 45 to 60 years with mean 51.2 years. Approximately seventy percentages of women were in age group of above 50 years. About two-third of participants had menarche in at 11 to 13 years of age and 32 (59.5%) of females were married before 15 years of age. In the study total 22 different health problems were reported by menopausal women. The most common symptoms were backache, fatigue/tiredness, numbness and tingling of the extremities, mental exhaustion, depressive mood, bladder problems and sexual symptoms. Conclusions: The study suggests that rural middle-age and elderly women suffer from variety of health problems related to natural menopause. The health care workers should adopt a holistic approach towards management to improve the quality of life. Keywords: age; menopausal symptoms; women; district hospital. | PubMed
Clinico-pathological Study of Malignant Melanoma in A Tertiary Care Centre
Authors: Thapa Sushma , Ghosh Arnab , Ghartimagar Dilasma , Prasad Tillotama , Narasimhan Raghavan , Talwar OP 
Published: September 2018

Introduction: Malignant melanoma, which causes three fourth of all deaths related to skin cancer, is more common in Caucasian population compared to Asian population. There is no reliable information about malignant melanoma in Nepal hence an effort has been made to assess the clinical and pathological features of melanoma patients.
Methods: This was a retrospective hospital based study done in the department of Pathology. All cases of malignant melanoma diagnosed on biopsy during a period of 13 years were retrieved, reviewed and collated.
Results: We had 35 cases with age range from 15 to 84 years with the mean of 51.4 years and M: F of 1.3:1. The predominant site was lower extremities. Most cases were less than 3 cm. Majority of histologic subtypes were nodular melanoma 29 (82.8%) followed by mucosal lentiginous melanoma 3 (8.6%), superficial spreading melanoma 2 (5.7%) and acral lentiginous melanoma 1 (2.9%). Half (50%) of the excisional biopsies were at Clark’s level IV and 75% were at high Breslow thickness.
Conclusions: The most frequent site in males and females were lower extremities and trunk respectively in contrast to Western studies where it is opposite. Nodular melanoma was the commonest histologic subtype while in other Asian studies and in Western studies majority were acral lentiginous melanoma and superficial spreading melanoma respectively.
Keywords: Breslow thickness; Clark’s level; malignant melanoma; nodular melanoma.
Menopausal Health Status of the Nepalese Women
Authors: Rajbhandari Swaraj , Subedi Raj Kumar , Dangal Ganesh , Phuyal Anjana , Vaidya Achala , Karki Aruna , Tuladhar Heera , Gurung Bandana Sharma , Joshi Lalita , Shrestha Sushila 
Published: September 2018

Introduction: Menopause is an unavoidable and sometimes problematic condition in which women may suffer from a number of health problems. Knowledge of the major symptoms associated with menopause helps reduce the burden and stress associated with the condition. In this context, a study was conducted to establish baseline data regarding menopausal health problems among Nepalese women.
Methods: A descriptive cross-sectional study was conducted among 2000 women aged over 40 years to identify their knowledge, attitude and practice related to menopausal health problems. Data was collected by interviewing the women and doing physical examination. Analysis was done using descriptive statistics and SPSS software was used for data analysis.
Results: A cohort of 2073 women (ages 40-60 years) participated in the research, among them 2000 yielded complete response. The study revealed that 820 (41%) women had reached menopause. The average age of menopause was 48.7 years. Majority of the women 1183 (59.2%) in the study did not know about menopausal health problems. Abnormal bleeding 353 (17.65%), sweating 315 (15.75%), hot flushes 299 (14.95%), joint/muscle pain 285 (14.25%) were the most common menopausal symptoms known by the women. Joint pain 736 (36.8%), hot flushes 584 (29.2%), irregular bleeding 582 (29.1%) were the most common experienced symptoms of menopause and only 586 (29.3%) consulted the health workers to alleviate menopausal symptoms. Moreover, most of the women 926 (46.3%) accepted menopause as a part of life.
Conclusions: The research has tried to establish the baseline of menopausal health problems in the Nepalese women. The average age of menopause was 48.7 years. Majority did not know about menopausal health problems. Further researches with nationally representative sample are recommended to further explore the menopausal health problems of Nepalese women.Keywords: health problems; menopause; Nepal; women.
Rural Health Care Workers and Local Residents Health Status in Yulong County of Yunnan Province China and Hat Yai City of Songkhla Mansion Thailand
Authors: Fanwei Qu , Yanling Jiang , Chongsuvivatwong Virasakdi , Liabsuetrakul Tippawan , Yan Li , Le Cai , Runsheng Jiang 
Published: September 2018

Introduction: To compare health status between Hat Yai city of Songkhla Province in Thailand and Yulong county of Yunnan province in China about rural health care workers and local residents, analyzing of both differences, learning from the advanced experience and practice of Thailand, adjusting policy, especially for the implementation of measures to improve the lack of human resources construction of Yulong County rural health, promote the level of rural health service of Lijiang.Methods: A qualitative study consisting of focus group discussions and individual in-depth interviews were conducted in Rural Health Care Workers and Local Residents Health Status in Yulong County of Yunnan Province China and Hat Yai City of Songkhla Mansion Thailand from. Results: Compared to 41(100%) bachelor's degree of medical staffs in Hat Yai, this accounted only 94 (42%) bachelor's degree of medical staffs in Yulong county hospital, and 31 (12%)in townships hospitals. For medical workers in Hat Yai, they have at least one time on-job training per year, but for Yulong county, only 144 (29%)of the medical personnel participated in the training per year. Health expenditures of Yulong county was mainly borne by the local government, and medical insurance coverage rate is 217,107 (99%). Insurance average awareness of Hat Yai is 4449 (66.4%), Yulong County is 62,501 (28.5%), P<0.001, there are statistically significant differences between two cities.Conclusions: Thailand has good experience in training, well-paid, motivating and retaining talent for rural health human resources; multi-pronged, mechanism innovation, establish and perfect the system of human resources for health, is the essential way to solve the problem.Keywords: Hat Yai city; Yulong County; Rural medical staff; Variance analysis.
Effectiveness of 0.2% Glyceryl trinitrate and 0.5% Nifedipine in the Treatment of Chronic Anal Fissure
Authors: Shrestha Suman Kumar , Thapa Prabin Bikram , Maharjan Dhiresh Kumar , Tamang Tseten Yonjan 
Published: September 2018

Introduction: Anal fissure is an ischemic ulcer caused by combination of spasm of internal anal sphincter and poor blood supply to the posterior midline of anal canal. This study aimed to assess the efficacy of Glyceryl Trinitrate and Nifedipine in the treatment of chronic anal fissure.
Methods: Ninety patients with symptomatic anal fissure in Kathmandu Medical College Teaching Hospital are allocated for study in two groups of 45 each from March 2013 to April 2014. The patients are assigned alternatively to GTN group and Nifedipine group. All patients were assessed every week till 8 weeks in regards to headache, compliance, healing and recurrence. The patients who had complete healing in 8 weeks were further followed up for 6 weeks to detect recurrence.
Results: Patients in the two groups were comparable in regard to demographic data (age and sex) as well as clinical factors. Headache was main complaint of patients using GTN in high percentage (16.6%) than complained by patients using topical Nifedipine (6.9%). This factor led to poor compliance with GTN compared with Nifedipine. Nifedipine showed better healing rate 82.5% compared with GTN 60%. Recurrence was comparable among the two groups.
Conclusions: Nifedipine ointment showed better results than GTN ointment in chronic anal fissure regarding headache, compliance, healing and recurrence in 6 weeks of follow up period after complete healing of fissure in 8 weeks.
Keywords: anal fissure; glyceryl trinitrate; nifedipine.
Acute Retropharyngeal Abscess Masquerading as Meningitis
Authors: Sakthivel Pirabu , Yogal Rijendra , Verma Hitesh , Saini Anil , Chandran Ashwin 
Published: September 2018

Retropharyngeal abscess is a potentially serious deep neck space infection occurring more frequently in children than in adults. The clinical picture of RPA is highly variable with paucity of physical findings. Prompt diagnosis of RPA especially in infants is mandatory to prevent potential fatal complications including airway obstruction. The diagnosis of RPA should be based on high index of clinical suspicion with supportive imaging studies like lateral X-ray of neck and CT.
We present a case of acute retropharyngeal abscess which was initially misdiagnosed as meningitis and led to airway obstruction. This case is reported to create awareness among emergency physicians, paediatricians and otolaryngologists to have high index of suspicion in diagnosing RPA especially in infants. Keywords: retropharyngeal abscess; meningitis; deep neck infection.
Identification of Deceased Children of Nepal Airlines Crash through Dental Age Estimation
Authors: Agrawal Nitin Kumar , Dahal Samarika , Wasti Harihar 
Published: September 2018

Identification of victims in a disaster is a challenging process and requires use of both primary and secondary identifiers. Development of teeth is one of the routinely used methods of age estimation and helps in establishing deceased biological profile. Two children who lost their lives in 2014 in Nepal Airlines crash, were looked for the dental developmental status. One of the children had primary dentition, while the other had mixed dentition. This helped us in estimating age of these individuals reconciled with the chronological age provided by the relatives. This led to the identification of both the children, thus, emphasizing teeth as important means of identification in any disaster.
Keywords: dental age; dental identification; disaster victim identification; forensic dentistry; forensic odontology.
Estimation of Serum Uric Acid in Cases of Hyperuriceamia and Gout
Authors: Pokharel R K , Yadav BK , Jha B , Parajuli K 
Published: September 2018

Introduction: Gout is crystal deposit arthritis and is an ancient disease. The biologic precursor to gout is hyperuricaemia. The prevalence of hyperuricaemia and gout has an increasing trend all over the world including the developing countries. The purpose of this study is to estimate serum uric acid level in hyperuricaemic and gout patients attending a medical college hospital.
Methods: A consecutive 150 hyperuricaemics and 150 gout patients attending Tribhuwan University Teaching Hospital from June to September 2005 were included in this study. The serum uric acid level was measured by the enzymatic (PAP- Uricase) method. The patients with acute gout were interviewed and relevant information was obtained.
Results: Males comprised 84 % of gout cases. Hyperuricaemia was common in both sexes. The mean age for gout was 47.49 and 56.65 years in males and females respectively. The mean age for the first gout attack was 42.1 ± 14.0 years. Family history was positive in 22 % of cases. The overall mean serum uric acid level in hyperuricaemics was 7.2 ± 0.7 mg/dL and 8.4 ± 1.1 mg/dL in acute gout (p 0.0001). The mean serum uric acid level was signifi cantly (p 0.0001) high among males both at the asymptomatic phase and at acute gout. Gout was more common in non-vegetarians (95 %) and alcoholics (65.3 %). Serum uric acid level was inversely related with the amount of daily water intake (p 0.0001).
Conclusions: Serum uric acid level is signifi cantly high among the male gouty arthritic patients. However, it is also high among asymptomatic hyperuricaemic cases of both sexes.
Keywords: asymptomatic hyperuricaemia, gout, serum uric acid level.
Hormonal Changes in Intracranial Hemorrhage
Authors: Shrestha Rajendra , Pradhan Reeka , Pradhan Mahesh , You Chao 
Published: September 2018

Introduction: The purpose of this study was to investigate the changes of serum ACTH and Thyroid hormone level in the acute phase of ICH.
Methods: Sixty patients with spontaneous ICH were assessed regarding hormonal changes by measuring ACTH and Thyroid hormone level. The relationships of hormone concentrations to clinical and radiological parameters were evaluated at hospital admission (t0), 5 days (t1) and 10 days (t2). The results were statistically analyzed.
Results: ACTH, TSH, Thyroxine, and free Thyroxine were not signiﬁcantly different among the three time periods (P > 0.05), while Triiodothyronine (T3) and free Triiodothyronine (FT3) were signiﬁcantly different (P < 0.05). T3 and FT3 were not signiﬁcantly different among patients with hemorrhage of different locations (P>0.05). There were significant negative correlations between T3 and FT3 with volume of ICH (r=-0.63 and r=-0.25) and there were positive correlations between T3 and FT3 with GCS (r=0.63 and r=0.37) respectively on admission day (p <0.05).
Conclusions: Hormonal secretion patterns is associated with the severity of ICH. This is an important index to evaluate the disease severity and prognosis. Keywords: ACTH; ICH; lymphocyte ICH; Thyroid hormone.
Primary Total Hip Replacement in A Military Hospital in Kathmandu
Authors: Chand Pankaj , Rana Magar Sushil , Thapa Bishnu Babu , Shrestha Bikal 
Published: September 2018

Introduction: Total hip replacement is one of the most widely performed and amongst the most successful orthopedic procedures performed worldwide. Even though it is a common orthopedic procedure in developed nations, it is performed only in selected centers in Nepal. This study will review the functional outcome of total hip replacements carried out in Shree Birendra Hospital.
Methods: We reviewed the records of total hip replacements, which were carried out in Shree Birendra Hospital, Kathmandu. Twenty-one hips were cemented and nineteen were uncemented. Cases were followed up in six weeks, twelve weeks, six months and every year from then on. Outcome in terms of Harris hip score of 40 osteoarthritic hips were measured pre-operatively as well as post-operatively.
Results: The mean age of the patients was 50.63 years (range 22-79 years). The commonest reason for the replacement was primary osteoarthritis of the hip. Thirty-nine patients underwent unilateral total hip replacement while in one patient both hips were replaced. The mean Harris hip score for the forty hips that were available at the latest follow-up examination at an average of five years (range two to six and a half years) after the operation was 85.2 ± 7.65 points as compared to the pre-operative mean Harris hip score of 32.38 ± 3.4.
Conclusions: Based on improved Harris hip scores, we believe that THR is a good option in patients with end stage arthritis of the hip.
Keywords: cemented; primary osteoarthritis; total hip replacement.
Fetal Ductus Venosus Pulsatility Index and Diameter during Second and Third Trimester of Gestation
Authors: Pokharel Pratit , Ansari Mukhtar Alam 
Published: September 2018

Introduction: The ductus venosus is a small funnel shaped vessel found posterior to the fetal liver connecting the intra-abdominal umbilical vein and the inferior vena cava. It is one of the three physiological shunts in the fetus. The main objective of this study is to construct the reference table and normogram for fetal ductus venosus Pulsatility Index and diameter with gestational age.
Methods: This was a prospective cross sectional study conducted during August 2011 to July 2012 taking 294 uncomplicated pregnancies using systemic random sampling method. Three measurements were made for ductus venosus diameter and Pulsatility Index in each fetus during period of fetal quiescence.
Results: The ductus venosus diameter at <20weeks, 20-25 weeks, 25-30 weeks, >30 weeks were 1.16, 1.31, 1.62, 1.81 and Pulsatility Index at <20weeks, 20-25 weeks, 25-30 weeks, >30 weeks were 0.41, 0.44, 0.41 and 0.41 respectively.
Conclusions: The mean diameter of the ductus venosus was linear across gestational age. The Pulsatility Index shows a scattered distribution across the gestational age.
Keywords: ductus venosus diameter; gestational age; Pulsatility Index.
Correlation of Serum Cholinesterase Level, Clinical Score at Presentation and Severity of Organophosphorous Poisoning
Authors: Rehiman S , Lohani SP , Bhattarai MD 
Published: September 2018

The aim of the study was to correlate between the clinical score described by PeradenyaOrganophosphorus Poisoning (POP) scale, serum cholinesterase level at presentation and severityof poisoning. Consecutive patients of organophosphorous poisoning attending Bir Hospital fromAugust 2004 to September 2005 were studied.Patients were groupedinto mild, moderate andseverepoisoning groups according to the POP scale. Fifty patients fulfilled the inclusion criteria. The severity ofpoisoningdirectlycorrelatedwithserumcholinesteraselevel(P<0.001).Thedifferences inthemeanrequirements of atropine on the first day of admission, in the total amount of atropine needed to treat and in the average duration of hospital stay were significant (P<0.05). There were 26% patients in moderate poisoning and only 4% patients in severe poisoning, but a total of 14% of the patients died, indicating that patients with even moderate degree of poisoning had also died. Both the POP scaleseverity andderangementinserumcholinesterase levels atinitialpresentationdidnot correlate withmortality, which could be due to various other co-morbidities and inadvertent stoppage of atropineinfusion particularly at night in the wards. The POP scale and serum cholinesterase at presentationappeared useful to assess the severity of poisoning, particularly in terms of higher amount ofatropine andprolongeddurationofhospital stay.Thepatients withevidence ofmoderate andseveredegrees of poisoning need close monitoring. Further studies to evaluate the factors likely to causedeaths, particularly by closely monitoring of moderate and severe organophosphorous poisoning inintensive care units, are required to clarify the correlation with mortality.Key words: organophosphorous poisoning, peradeniya organsophosphorous poisoning scale, serum cholinesterase
Gestational Age Specific Postnatal Growth Curves for Singleton Babies in Tertiary Hospital of Western Nepal
Authors: Pathak Santosh , Chaudhary Nagendra , Dhakal Prativa , Mahato Shyam Kumar , Shrestha Sandeep , Bhatia Bal Dev , Bansal Ajay Kumar , Kurmi Om Prakash , Agarwal Kailash Nath 
Published: September 2018

Introduction: Measurement of birth weight (BW), crown heel length (CHL), head circumference (HC) and chest circumference used to assess the intrauterine growth of a baby vary with altitude, race, gender, socio economic status, maternal size, and maternal diseases. The study aimed to construct centile charts for BW, CHL and HC for new born at different gestational ages in western Nepal.
Methods: This was a descriptive cross sectional study done over a period of 15 months in a tertiary care hospital of western Nepal. BW, length, HC and CC were measured within 12-24 hours of birth. Gestational age was estimated from first day of last menstrual period, maternal ultrasonology and New Ballard’s scoring system. Microsoft 2007 Excel and SPSS-16 was used for data analysis. Cole’s Lambda Mu Sigma method was used for constructing centile curves.
Results: Out of 2000 babies analysed, 1910 samples were used to construct smoothed intrauterine growth curve of BW, CHL, and HC from 33-42 weeks of gestation. 57.35% (1147) were male, mean gestational age was 38.13 ±2.44 weeks, where 21.5% were preterm and 1.7% post term. The means of BW, CHL, HC and CC were 2744.78 gm, 47.80 cm, 33.18 cm, and 30.20 cm with standard deviations of 528.29, 3.124, 1.78, and 2.35 respectively. These data vary as compared to the Kathmandu data, in case of birth weight for 10th and 90th centiles, and at 90th centile in case of length.
Conclusions: This necessitates the update in the existing growth charts and develop in different geographical regions of a country.