bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bone and Joint Decade 2000-2010 in Neplease Perspective
Authors: Paudyal B P 
Published: September 2018

The Bone and Joint Decade is a worldwide multi-disciplinary initiative targeting the care of people with musculoskeletal disorders. It focuses on improving the quality of life of these people through advances in the understanding and treatment through education, research, and prevention strategies. Though the epidemiological data in Nepal are very scanty, worldwide statistics have shown that musculoskeletal conditions represent more than half of all chronic diseases, and are the most common cause of severe long-term pain and disability. There is acute shortage of specialist manpower that care for people with these disorders. Furthermore the teaching in musculoskeletal disorders in health institutions is very minimal. All of these problems highlight the need for expanding the teaching of musculoskeletal disorders at all levels of medical education; promotion of clinical research; improving diagnostic, treatment, and rehabilitative facilities; and implementation of preventive strategies to reduce the burden of these chronic debilitating conditions in the society.
Keywords: bone and joint decade, musculoskeletal and rheumatic diseases, Nepal.
Tzanakis Score vs Alvarado in Acute Appendicitis
Authors: Sigdel G , Lakhey PJ , Misra PR 
Published: September 2018

INTRODUCTION:
Acute appendicitis is a common surgical emergency. Accurate diagnosis and timely intervention reduces mortality and morbidity. This study compared the efficacy of Tzanakis and Alvarado score in diagnosis of acute appendicitis.
METHODS:
A prospective, non randomized study was conducted in 100 consecutive patients who had undergone emergency appendectomy from May 2008 to October 2008. Tzanakis and Alvarado scores were obtained at the time of admission. Final diagnosis of acute appendicitis was based on histological findings.
RESULTS:
The sensitivity, specificity and overall diagnostic accuracy of Tzanakis score was 91.48% and 66.66% and 90% respectively. The sensitivity, specificity and overall diagnostic accuracy of Alvarado score was 81.91% and 66.66% and 81% respectively. Negative appendectomy rate was 6%.
CONCLUSIONS:
Tzanakis score is an effective modality to establish the accurate diagnosis of acute appendicitis.
Keywords: acute appendicities, Tzanakis score, Alvarado Score.
Revisiting Appendicular Lump
Authors: Bhandari R S , Thakur DK , Singh KP 
Published: September 2018

INTRODUCTION:
Appendicular lump is a well known sequalae of acute appendicitis encountered in 2-6% of patients. Successful management of appendicular lump is controversial with different approaches. As many controversies are arising regarding management of appendicular lump. The aim of this study was to find out the outcome and evaluate possible need of changing our management strategy of appendicular lump.
METHODS:
A retrospective analysis of the patients managed with appendicular lump were done. All the patients admitted with diagnosis of appendicular lump and managed between, over two and half years, were included in the study. All age groups and both sex were included. Any patients whose diagnosis was changed after initial diagnosis of appendicular lump were excluded from the study.
RESULTS:
Total 75 patients had appendicular lump suggesting 10% incidence. Age varied between 11-83 years with nearly equal incidence in both sexes. Majority had onset of symptoms between 2 to 14 days with an average of 4 days. Average stay was 3 to 4 days. During study period, 12 (16%) came with recurrence and 13 (17%) cases came for elective appendectomy.
CONCLUSIONS:
Based on our finding, it is not sufficient to change our classical management strategy of appendicular lump and suggests a need for long term prospective study in this very common clinical condition.
KEYWORDS: appendicular lump, conservative management.
Lipid Profile in a Tertiary Care Center
Authors: Pant P , Hamal PK , Gurung D , Subedi K 
Published: September 2018

INTRODUCTION:
Lipid profile is changing with changing developmental status and lifestyle in less developed countries and coronary artery disease risk factor is rising. The aim of the study is to find the lipid pattern in Department of Medicine in tertiary care hospital.
METHODS:
An observational prospective study was conducted in 408 subjects from January 2009 to February 2010. Study subjects were selected irrespective of co-morbid condition and coronary risk factors.
RESULTS:
The mean triglycerides, cholesterol, LDL, HDL were 138.3 +/- 78.3 mg/dl, 180.2 +/- 53.7 mg/dl, 113.8 +/- 41.2 mg/dl, 40.1 +/- 10.1 mg/dl respectively. The Triglycerides (>140 mg/dl), Cholesterol (>250 mg/dl), LDL (>92 mg/dl), HDL (<45mg/dl) were 35.5%, 7.6%, 67.9%, 76% respectively.
CONCLUSIONS:
Lipid profile is becoming atherogenic with high triglyceride, high LDL and low HDL being the most common abnormality. An epidemiological study is recommended to understand the true burden of the disease in the community.
KEYWORDS: atherogenic, cholestrol, coronary artery diseases, lipid profile, triglyceride.
Markel Cell Carcinoma
Authors: Wallis S , Durham-hall A , Tondon N , Brotherstone TM , Shrestha BM 
Published: September 2018

Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine tumour of the skin with high rate of local recurrence and distant metastatic potential leading to poor outcomes. Merkel cells are normally found as innervated clusters of cells around hair follicles in the basal layer of the epidermis and are thought to function as touch receptors. Here, we describe a case of MCC in a 71-year-old female and provide an up-to-date review of the literature pertinent to the management of MCC.
KEYWORDS: merkell cell carcinoma, diagnosis, imunohistochemistry, management.
Efficacy of Endovascular Therapy for Direct Occlusion of Intracranial Aneurysms
Authors: Tamrakar K , Karki B , Duan C-Z , Li X-F , Zhang X 
Published: September 2018

Introduction: Our purpose was to evaluate the effectiveness of endovascular therapy using detachable coils and balloons for the direct occlusion of intracranial aneurysms.
Methods: We retrospectively reviewed 563 patients undergoing digital subtraction angiography from January 2007 to July 2009. Two hundred and fi fty patients with 323 embolized intracranial aneurysms were studied.
Results: Among 250 patients, 66 % were female and 34 % male, the age ranging from 19 - 83 years (mean 50.66 ± 12.92). One hundred and seventy-seven had a single aneurysm while 73 showed multiple aneurysms. Seventeen (9.6 %) had giant aneurysms. Three hundred and eleven aneurysms were treated using detachable coils, and 12 giant aneurysms were embolized by detachable balloons for the parent vessel occlusion. Of 323 aneurysms treated via the endovascular approach, total occlusion was seen in 93 % of the aneurysms, near total occlusion in 5.2 % and incomplete embolization in 1.5 %. Among patients presenting with sub-arachnoid hemorrhage, 62 improved to the Glasgow outcome score (GOS) of 5, 93 improved to GOS 4, 14 improved to GOS 3, 10 improved to GOS 2 at the time of discharge and 5 patients died. Angiographic follow-up was scheduled between 6 - 12 months post-embolization. The aneurysm recurred in 1.2 % and were re-embolized using additional coils. Statistically, Hunt and Hess Grade and GOS indicated clinical signifi cance (P < 0.05). The patients, gender, clinical presentation and aneurysmal location did not show statistical signifi cance (P > 0.05).
Conclusions: Hunt and Hess VI and V are considered as poor clinical gradings in aneurysmal SAH. However, endovascular treatment has been established as an effective method to obliterate intracranial aneurysms allowing subsequent decrease in mortality and morbidity.
Keywords: detachable coils, detachable balloons, endovascular therapy, intracranial aneurysms.
Primary Heealth Care Development: Where is Nepal after 30 years of Alma Ata Declaration??
Authors: Karkee R , Jha N 
Published: September 2018

The year 2008 has witnessed the global conversation to return to tenets of Alma-Ata and to review its 30 years of journey. We reviewed Nepal's journey on Primary Health Care development: policy formulation, structure development, progress and constraints. Though Nepal has institutionalised the PHC approach in health policy, strategy and health care delivery system, this has not been effectively translated into actions, and the results are mixed. Nepal has gained impressive achievements in selective primary health care markers: 45.43% maternal mortality and 62.34% child mortality reduction during 1990-2005. But gain in comprehensive health care markers is not impressive: 18.7% Skilled Birth Attendant (4% in poorest quintile and 45% in richest quintile), 39% having access to improved sanitation and 55.7% of females are literate as compared to males. Socio-political environment until recently was not favourable for comprehensive primary health care, allowing limited health sector decentralisation and community empowerment. Health activities were focussed more on selective health care strategy in the form of disease control, immunisation, vitamin A supplementation, oral rehydration solution use and contraceptive use. Nepal's rural hilly geography posed great challenge on logistic supply, communication and retention of health workers rendering public health centres of low quality with negative perceptions of consumers. Nepal is on the pathway to build equitable comprehensive primary health care.
Learning Pelvic Examination with Professional Patients
Authors: Shrestha S , Wijma B , Swahnberg K , Siwe K 
Published: September 2018

Performing pelvic examination is a vital skill to learn during gynecological and obstetrical training. It's a difficult maneuver to master as there is very little to see and more to feel and interpret. In addition, learning PE in usual clinical set-up has been found to induce lot of stress and anxiety among both the patients and the students. Students fear of hurting the patients and being judged inept, whereas patients feel embarrassed having to expose their most intimate body parts for learning purpose. This hampers effective learning. Learning PE on sedated women before surgery or on mannequins has been practiced as alternative learning models. But, they have been found to miss out on teaching the communication skills, which are as important as the palpation skills. However, there exists another model of learning PE--the professional patients, who are specially trained to act as patients and also guide the students on how to make a proper PE. They provide stress-free environment for the students to learn PE and at the same time, provide immediate feedback on each of their maneuvers. They form a complete learning model and help students to see patients as partner and not just a person seeking help.
Keywords: learning model, pelvic examination, stress, students.
Percutaneous Adductor Release in Nonambulant Children with Cerebral Palsy
Authors: Sahu Ramji Lal 
Published: September 2018

Introduction: Adductor spasticity at hips is the main barrier in functional activities and rehabilitation of spastic cerebral palsy patients. The aim of this study is to evaluate the results of percutaneous adductor release under general anesthesia.Methods: From July 2005 to July 2010, 64 hips in 32 patients (19 males and 13 females) were recruited from outpatient department having adductor contracture at hips in cerebral palsy children. All children were operated under general anesthesia. All children were followed for twenty-four months. The clinical results were evaluated radiologically, including measurement of CE- angle, AC-index and femoral head coverage and in terms of activity level of children. Results: Of the thirty-two children, twenty-eight showed marked and immediate improvement. None of our children was functionally worse at follow-up. The CE-angle and femoral head coverage did not change significantly. The AC-index improved significantly (p = 0.01).The results were excellent in 12.5% children, good in 50%, fair in 25% and poor in 12.5%. Conclusions: Bilateral mini-invasive adductor release can be an effective treatment for children suffering from adductor contracture refractory to nonoperative management and early adductor release can prevent subluxation and possibly the need for future bony procedure on the proximal femur and pelvis.Keywords: Adductor contracture, Percutaneous, Cerebral palsy, Minimal invasive procedure.
B-Thalassaemia: A Case Report
Authors: Shrestha H G , Hamal P , Singh B.K. Man , Nakanishi N , Sada D T 
Published: September 2018

A case report of B-thalassaemia intermedia was diagnosed in a 22 years women old Nepalese on the basis of the investigations of blood, bone marrow, haemoglobin electrophoresis and X-rays with clinical findings.
Surgical Management of Odontoid Fracture in Elderly
Authors: Nadeem Muhammad , Noon Muhammad Jawad , Daraz Khan Rana Muhammad Omar , Khan Inayatullah 
Published: September 2018

Odontoid type II fractures are associated with high mortality in the elderly. Their management can be done either conservatively or surgically, however, surgical treatment is technically demanding and relatively new.
We report a case of 75 years old man who presented to our clinical setting, following a history of fall. The CT scan and MRI showed odontoid type II fracture. With time, the neurological deficit got marked and he underwent transoral odontoidectomy and occipitocervical fixation using rods and screws via posterior approach. Patient’s neurological condition improved dramatically and on the short term follow up, he had no motor deficit. Our experience suggests that occipitocervical fixation via posterior approach is a viable option for the management of odontoid type II fracture in the geriatric population.
The effect of height and weight adjusted dose of intrathecal hyperbaric bupivacaine for elective caesarean section
Authors: Subedi A , Tripathi M , Bhattarai BK , Gupta PK , Pokharel K , Regmi MC 
Published: September 2018

Introduction: The study compared spinal anesthesia using intrathecal hyperbaric bupivacaine between height and weight adjusted dose and fi xed dose during caesarean section.
Methods: A hundred parturients, who had given their consent and were scheduled for elective caesarean section under spinal anesthesia, were randomly assigned into two groups. We adjusted the intrathecal dose of heavy bupivacaine (0.5 %) according to the height and weight of patients (Group AD) from Harten’s dose chart developed from the Caucasian parturients and the fi xed dose (2.2 ml) was used in Group FD patients. Keeping the observer blinded to the study groups, the onset time to sensory block up to T5, haemodynamic changes, side effects, and fetal outcome were observed.
Results: The median onset time of spinal block in Group FD was faster than in Group AD (6 min vs. 4 min; p = 0.01). The spinal block level extended above T3 level in a signifi cantly (p < 0.05) larger number of patients 12 (24 %) in Group FD than in one (2 %) patient in Group AD. A signifi cantly (p < 0.05) larger number of patients, 32, (64 %) in Group FD had hypotension than in 15 (30 %) patients in Group AD. The lowest recorded SAP (101 ± 6 mm Hg) in Group AD was higher than in Group FD (96 ± 6.7 mm Hg). Nausea and vomiting were more pronounced in Group FD patients.
Conclusions: The bupivacaine dose was signifi cantly reduced on its dose adjustment for the body weight and height of patients for cesearean section. This adjusted-dose use suitably restricted spinal block level for cesarean section with a distinct advantage of less hypotension and with a similar neonatal outcome as fi xed compared with the dose use.
keywords: caesarean section; low-dose hyperbaric bupivacaine; spinal anesthesia.
Prevalence of Dental Caries in 5 – 6 Years and 12 – 13 Years Age Group of School Children of Kathmandu Valley
Authors: Subedi B , Shakya P , KC U , Janawali M , Paudyal BD , Acharya A , Koirala S , Singh A 
Published: September 2018

Introduction: Dental caries is one of the most common conditions affecting the general health of children. The present study was carried out among school children of Kathmandu valley to determine the prevalence of dental caries in two age groups.
Methods: The study was conducted from December 2007 to May 2008. The age of the school children of the study was divided into two group: 5 - 6 years and 12 - 13 years. A stratifi ed cluster sampling with proportional allocation was used while grouping the subjects. The dental status examination was done with the help of trained dentists. Decayed, missed and fi lled teeth index and decayed, missed and fi lled surfaces index (dmft for primary dentition and DMFT for permanent dentition) were used as the standard tools for the determination of prevalence.
Results: A total of 638 students (325 of age group 12 - 13 years and 313 of age group 5 - 6 years) from 30 different schools of the Kathmandu valley were included in the study. The caries status was found higher in the age group of 5 - 6 years than in the 12 - 13 years and it was found to be statistically signifi cant (p < 0.001). The dmfs and caries percentage of the age group 5 - 6 years and the DMFS and caries percent of the 12 - 13 years was found to be 3.79, 69 % and 1.6, 53.23 % respectively. The dmft/dmfs value was found to be signifi cant according to the districts in the 5 - 6 years age group whereas the DMFS was found statistically signifi cant among the sexes of the 12 - 13 years age group.
Conclusions: The caries percentage was found to be above the recommended level of the World Health Organization. However, the DMFS and DMFT values were within the WHO level.
Keywords: Children, dental caries, DMF index.
Complementary Feeding Practices of Nepali mothers for 6 months to 24 months children.
Authors: Chapagain Ram Hari 
Published: September 2018

Introduction: Lack of knowledge and proper feeding practices contribute to higher childhood morbidity and mortality. The aim of the study wasto evaluate the mother’s knowledge and practices in terms of quantity, quality and timing of complementary feeding in infant and young child.Methods: A hospital based cross-sectional study was conducted between June, 2010 to October, 2011, at Kanti Children's Hospital, Nepal, involving 1100 mothers of children from 6 to 24 months of age who attended outpatient department of this hospital, applying systematic sampling technique using semi-structured questionnaire.Results: Eighty-seven percent of mothers had knowledge about the duration of exclusive breast feeding but only 33.0% practiced it and 21.0% breast fed their children up to 3 months. Eighty-seven percent of mothers knew when to start complementary feeding and 53.27% of mothers used the marketed weaning food. lito alone was offered by 28.27% as complementary food. Though 36.6% had proper knowledge of frequency of complementary feeding, only 33.27% were actually practicing it and 9.9% were offering more frequent thanrecommended. About half of the mothers fed their child with the food of appropriate consistency and 66.0% fed with the appropriate amount. But only 15.82% mothers fed their children with ideal frequency, sufficient amount and ideal quality.Conclusions: There was a knowledge and practice gap of duration of exclusive breast feeding and initiation and continuation of ideal complementary feeding. Rate of exclusive breast feeding was on declining trend._______________________________________________________________________________________Keywords: complementary feeding; exclusive breast feeding; infant and young child feeding; ideal feeding._______________________________________________________________________________________
Measuring Management Training Needs of Hospital Managers in Nepal
Authors: Chadwell I , Bhitrakoti R , Khadka R 
Published: September 2018

Introduction: This is a study of hospital managers in Nepal, measuring their reported capability to undertake management tasks and explore their views about management development.
Methods: A questionnaire was administered through hospitals. Respondents were asked to rate a series of management tasks on a scale according to how important it was, for their role and their capability to perform it. These tasks were grouped into different factors. The sample included government hospital of each district and major private or hospitals run bu non-government organizations.
Results: A total of 31 hospitals were visited in 18 districts. Information was obtained from 103 managers from different professions. In most hospitals visited, overall management was provided by the doctors. Few had undergone some training to take on management responsibilities. All types of managers, regardless of profession or type of hospital, reported a ‘competence gap’for each factor defi ned as the difference between reported importance and capability. Non-government managers consistently rated themselves as beingmore capable than government managers, but the difference was only signifi cant when it concerned managing People. The need for a separate cadre of managers was supported by 85% of respondents but a majority of doctors (57%) felt that the best people to manage hospitals were doctors.
Conclusions: Consistent with other studies from low income countries, there is an urgent need to provide different modalities of management developmentenabling hospital managers to improve their capabilities. There is widespread need of management training to be made available in Nepal.
Keywords: hospital management, management competency, management training needs.
Maternal Death Reviews of a Tertiary Care Hospital
Authors: Upadhyaya Indira 
Published: September 2018

Introduction: All pregnant women are at risk of obstetrical complications which occurs during labour and delivary that lead to maternal death. Here to report a 10 year review of maternal mortality ratio in "Paropakar Maternity and Women's Hospital (PMWH)" Thapathali Kathmandu, Nepal.Methods: Medical records of 66 maternal deaths were reviewed to study the likely cause of each death over the study period.Results: There were a total of 66 maternal deaths. While 192487 deliveries conducted over the 10 year period. The maternal mortality ratio (MMR) was 356.64/100000 live birth. The highest MMR of 74.22/100,000 was observed in 2059 and lowest was 17.42/100,000 in 2068 B.S. Leading cause of MMR was remained hemorrhage accounting for 30.30% followed by eclampsia 24.24%. Sepsis, suspected cases of pulmonary embolism and amniotic fluid embolism each contributing 15.15%, 4.54% and 3.03% respectively. Where as anesthetic complication and abortion constiuates 6.06 % each equally for maternal death. The death noted in older women (30+year) were 36.36%. Primipara accounted for more deaths (51.51%).Conclusions: The fall in maternal mortality rate has been observed except for year 2063 BS. Haemorrhage is the main contributing cause behind maternal mortality.