bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neonatal Septicaemia: A Hospital Based Study in Eastern Nepal
Authors: Khanal Dr. Basudha , Shariff M , Deb M 
Published: September 2018

Septicaemia is a major cause of neonatal morbidity and mortality. Premature rupture of membrane, premature delivery, low birth weight and hospitalisation of the neonate are some of the predisposing factors, which influence the onset of infection and its outcome. Depending on the time of onset and the causative factors, a wide variety of organisms are implicated in neonatal septicaemia. The blood culture takes a minimum of 48 hrs to arrive at a definitive diagnosis. A prompt management of such cases along with empirical antibiotic therapy remains the mainstay of management. Hence, knowledge about the organisms prevalent in a particular hospital and their antibiotic susceptibility pattern is an important prerequisite. The study was carried out at the B.P. Koirala institute of health sciences, a tertiary care hospital, in Eastern Nepal for a period of 3-years from 1998 to 2001. Blood samples from 1567 neonates with suspected septicaemia were cultured using standard microbiological technique. 540 (35%) samples were culture positive. Gram- positive bacteria (74%) were more common than Gram-negative bacteria (27%). Staph aureus (60%) was the most common bacterial isolate. Resistant to ampicillin was seen but most were susceptible to other antimicrobial including gentamicin, amikacin, cefotaxime, and ciprofloxacin. Positivity rate decreased in the 3rd year to 25% as against first two years of 41% and 47% respectively, which was, attributed to training and implementation of various measures of infection control practices. Candida spp was not observed during the period of study. It was concluded that a continuous surveillance of the causative agents and their antimicrobial susceptibility pattern is required to control the infection in the hospital neonatal unit.Key Words: Neonatal septicaemia, Organisms, Antimicrobial susceptibility pattern.
Traumatic Brain Injury: Caregivers’ Problems and Needs
Authors: Syed hassan Syed Tajjudin , Khaw WF , Rosna AR , Husna J 
Published: September 2018

Traumatic brain injury (TBI) is an increasingly major world health problem. This short review using the most pertinent articles on TBI caregiving problems and needs highlights the pressing issues. Articles focusing on both TBI-caregivers’ problems and needs are rarely found, especially for developing countries. Most TBI-caregiving is done by family members, whose altered lives portend burden and stresses which add to the overwhelming demand of caring for the TBI-survivor. Lack of information, fi nancial inadequacy, anxiety, distress, coping defi cits, poor adaptability, inadequate knowledge and skills, and a poor support system comprise the major problems. Dysfunctional communication between caregivers and care-receivers has been little researched. The major needs are focused on health and rehabilitation information, fi nancial advice and assistance, emotional and social support, and positive psychological encouragement. In time, health information needs may be met, but not emotional support. Information on TBI caregiving problems and unmet needs is critical to all relevant healthcare stakeholders.
Keywords: caregivers, rehabilitation, traumatic brain injury
Acute Ischaemic Colitis- A Case Report
Authors: Basra M , Shrestha B M 
Published: September 2018

Acute ischaemic colitis (AIC) is being increasingly recognised as an uncommon cause of abdominal pain associated with fresh bleeding per rectum. It is paramount to maintain a high index of suspicion and adopt appropriate management strategies to avoid complications and inappropriate interventions. In this paper, we describe a case of AIC and review literature pertinent to the management of this condition.
Keywords: Ischaemic colitis, acute abdomen, management.
Pulmonary Cavity due to Chronic Eosinophilic Pneumonia Associated with Arsenicosis
Authors: Sengupta A , Saha K , Jash D , Bandyopadhyay A 
Published: September 2018

In developing country like India arsenic poisoning is a major public health problem. Association of chronic eosinophilic pneumonia and chronic diarrhea with arsenicosis is rare. Also pulmonary cavity formation in chronic eosinophilic pneumonia is very uncommon. A 44-year-old male patient, resident of an arsenic affected area was admitted for evaluation of chronic diarrhoea, persistent peripheral eosinophilia along with radiologically visible cavity in right upper zone. There were dermatological manifestations of arsenicosis along with presence of noncirrhotic portal fibrosis and peripheral eosinophilia. On bronchoalveolar lavage study, eosinophil comprised 40% of total cellularity making the diagnosis of chronic eosinophilic pneumonia. After ruling out all possible causes of diarrhoea and chronic eosinophilic pneumonia, we came to conclusion that arsenic could be implicated as causative agent.
Keywords: Arsenicosis, chronic diarrhoea, chronic eosinophilic pneumonia, noncirrhotic portal fibrosis.
Antibiotic resistance pattern of bacterial isolates in neonatal care unit
Authors: Shrestha S , Adhikari N , Rai BK , Shreepaili A 
Published: September 2018

INTRODUCTION:
Bacterial infections account for a huge proportion of neonatal deaths worldwide. The problem of antibiotic resistance among common bacterial pathogens mainly the gram negative bacteria is emerging globally which is of more serious concern in developing countries like Nepal.
METHODS:
A one year retrospective hospital based study was carried out to analyze the results of neonatal blood, cerebrospinal fluid, urine, stool and surface cultures and to look into the sensitivity pattern of the commonly used antibiotics.
RESULTS:
The positive yield of blood, urine, eye swab and CSF cultures were 19.56%, 38.5%, 60% and 0.36% respectively. The most common isolates in the blood culture were coagulase negative Staphylococcus, Acinetobacter, Enterobacter and non-haemolytic Streptococcus. A significant percent of the isolates were resistant to the first line antibiotics. Among the gram negative isolates more than 30% are resistant to cefotaxime and more than 50% are resistant to gentamicin. During the one year period we had Nursery outbreaks of methicillin resistant Staphylococcus aureus and Salmonella infections. With the help of environmental cultures we were able to trace the source and intervene appropriately.
CONCLUSIONS:
Continuous surveillance for antibiotic susceptibility, rational use of antibiotics and the strategy of antibiotic cycling can provide some answers to the emerging problem of antibiotic resistance.
A Cadaveric Study of Different Angles of Scapula and Their Role in its Kinesiometrics and Muscle Morphology
Authors: Sharma Ritika , Singla Rajan Kumar , Kullar Jagdev Singh , Sharma Rajan , Sharma Tripta 
Published: September 2018

Introduction: The bipedal gait and consequential freedom of the upper limb in human beings has made the movements of the shoulder joint a subject of extensive investigations. The scapular angles provide the base and leverage to various muscles and have been correlated with the different movements of the shoulder joint.Methods: In the present study, different angles of scapula namely superior, inferior, lateral, medial, acromial and coracoid angles were measured in the North Indian population. The study was conducted on 100 scapulas (R:L = 50:50) obtained from Department of Anatomy, Government Medical College, Amritsar. For measuring the angles, centimetre scales and protractor were used.Results: The mean value of superior angle was observed to be 100.830 (R=100.320 : L=101.340) ; inferior angle was 63.620 (R=68.10 : L=59.140) ; lateral angle was 61.720 (R=65.90 : L=57.540) ; medial angle was 147.640 (R=151.320 : L=143.960) ; acromial angle was 106.470 (R=107.680 : L=105.260) and coracoid angle was 83.30 (R=84.240 : L=82.020).Conclusions: It was observed that all angles were higher in the right sided bones except superior angle. Also a wide range was seen in all the angles. _______________________________________________________________________________________Keywords: acromial; coracoid; inferior; medial; superior._______________________________________________________________________________________
Dermatological Disorders in Chronic Kidney Disease
Authors: Shah Aparna , Hada Rajani , Kayastha Bhasker Mohan Mehar 
Published: September 2018

Introduction: Dermatological conditions are common complications of Chronic Kidney Disease (CKD) affecting all most all patients. Present study aimed to evaluate the dermatological conditions and their association with age, sex and severity of CKD - without and with maintenance hemodialysis (MHD).Methods: It is a cross sectional and comparative study. Eighty-three patients with established CKD, without MHD (n=35) and with MHD (n= 48), attending nephrology unit, Bir Hospital and Shree Birendra Hospital from June 2008 to May 2009 were examined for dermatological disorders.Results: The mean age of patients were 46+15.6 years with male to female ratio of 1.8:1. Comparison of CKD without MHD and with MHD showed no statistical difference of age, sex, duration of treatment, blood urea and haemoglobin and significant difference of serum creatinine (5.3 + 3.0 mg/dl vs 9.1 + 4.5 mg/dl, p<0.001) respectively.Dermatological conditions were found in 100% CKD patients with pallor 91.5%, xerosis 75.9%, pigmentary changes 65%, pruritus 60.2%, skin infection 36.9%, vascular changes 16.8%, mucosal changes 67.4%, hair changes 59%, non -specific nail changes 81.9% and specific nail changes14.4%,.Specific (23.2% vs. 8.4%, p<0.03) and non- specific (91.4% vs 75%, p < 0.05) nail changes and hair abnormalities (74.3% vs. 47.9%, p<0.01) were significantly higher in CKD without MHD.Conclusions: Dermatological conditions are present in all CKD patients with or without MHD. A further prospective study is necessary to find out pathophysiology and beneficial effect of dialysis and transplantation in these conditions.Key words: chronic kidney disease, dermatological disorder, maintenance hemodialysis.
Use of Analgesia in an Emergency Department
Authors: Bhandari Rabin , Malla Gyanendra , Mahato Indrajit Prasad , Gupta Pramendra 
Published: September 2018

Introduction: Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment.
Methods: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics.
Results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70).
Conclusions: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain.
Keywords: analgesia; emergency; Nepal.
Gender Difference in Care of Type 2 Diabetes
Authors: Shrestha Aamod Dhoj , Kosalram Kalpana , Gopichandran Vijayaprasad 
Published: September 2018

Introduction: Biologically male and female have similar diabetes prevalence. Gender differences in the social structure bring differences in life style modifications and all other self care behaviors in type 2 diabetes. The primary purpose of this study was to assess the gender difference in care of type 2 diabetes in Western region, Nepal.
Methods: Hundred men and hundred women respondents participated in a cross-sectional study conducted in two hospitals in Pokhara, Nepal. A pre-tested questionnaire was administered to each of the respondents.
Results: Dry mouth (χ2 = 3.977, P = 0.046) and abdominal pain (χ2 = 3.840, P = 0.050) were reported as symptoms of diabetes in 51% and 31% women compared to 37% and 19% men respectively. The study revealed that women had low self-efficacy with respect to their diabetes care (35%) in comparison to men (65%). There was significant association between gender and diet practices which showed men have 0.328 (95% CI: 0.184 - 0.585) times less chances of bad dietary practices compared to women. After adjusting for age, education, occupation and self-efficacy, men were less likely to have bad dietary practices (OR= 0.513, 95% CI: 0.266, 0.992).
Conclusions: The result of this study provided evidence that there are gender differences in reporting of symptoms, mode of diagnosis and certain self-management behaviors. Therefore there is a need to design gender specific behavior change communication strategies for better management of type 2 diabetes.Keywords: diabetes care; gender; self-efficacy; self-management.
Outcome of preterm babies and associated risk factors in a hospital
Authors: Shrestha S , Dangol SS , Shrestha M , Shrestha RPB 
Published: September 2018

INTRODUCTION:
Preterm birth is a major problem associated with maximum perinatal mortality and morbidity in developed and developing countries. The aim of this study is to identify risk factors associated with preterm birth and to study morbidities and mortality.
METHODS:
A descriptive retrospective study was conducted on 164 cases of preterm babies admitted to Neonatal Intensive Care Unit from January, 2007 to December, 2009
RESULTS:
Incidence of preterm birth was 19.5%. Mean birth weight was 1670 +/- 370 grams and mean gestational age was 30.02 +/- 0.37 weeks. Common risk factor associated with preterm birth were inadequate antenatal checkup (52%), maternal age <20 years (34.7%), ante partum hemorrhage (23.4%) and pregnancy induced hypertension (13.1%). Common morbidities were clinical sepsis (66.7%), hyperbilirubinemia (58.8%), birth asphyxia (26.8%) and hyaline membrane disease (23.5%). Overall survival was 79.4% with minimum age of survival of 880 grams. The mortality rate in extremely low birth rate and very low birth rate was 80% and 39.5% respectively. The common causes of death were hyaline membrane disease (64.5%), sepsis (58.06%) and necrotizing enterocolitis (25.8%).
CONCLUSIONS:
The main risk factors for preterm delivery were inadequate antenatal check up, maternal age <20 years, antepartum hemorrhage and pregnancy induced hypertension. The most common morbidity was clinical sepsis followed by hyperbilirubinemia. Common causes of death were hyaline membrane disease and sepsis.
I-gel for Positive Pressure Ventilation
Authors: Maharjan Shyam Krishna 
Published: September 2018

Introduction: I-gel is a relatively new supra-glotitc airway device which is claimed to be superior to laryngeal mask airway. It can be used ingeneral anesthesia with spontaneous ventilation as well as with positive pressure ventilation.This study was designed to assess whether I-gel creates adequate laryngeal seal during positive pressure ventilation in patients undergoing laparoscopic surgery.
Methods: A prospective randomized study was made among the 60 patients who underwent laparoscopic cholecystectomy under general anesthesia. Airway was managed with either I-gel insertion or endotracheal intubation and positive pressure ventilation in 30 patients each. Airway pressure, end-tidal CO2 and oxygen saturation were monitored and compared between two groups. Inhaled and exhaled tidal volume, minute volume were recorded and leak volume and leak fraction was calculated and compared between two groups.
Results: Oxygenation and ventilation (oxygen saturation and end-tidal carbon dioxide pressure) was within normal limit in both groups and comparable. Leak volume in tracheal tube group was 25.33±12.41 ml and in I-gel group it was 26.43±13.19 ml. Leak fraction was 0.0487±0.023 and 0.0417±0.022 in tracheal group and I-gel group respectively. The airway pressure during C02 pneumoperitoneumwas 20.55±3.25 cm H20 in tracheal tube group and 20.21± 3.97 cm H20 in I-gel group and there was no significant leak in either group. Statistically, there was no significant difference in leak volume, leak fraction and airway pressure between the two groups.
Conclusions: I- gel may be an alternate to tracheal tube during general anesthesia with positive pressure ventilation in patients with normal airway pressure with acceptable leak, adequate oxygenation and ventilation.
Keywords: I gel; Laparoscopic cholecystectomy; positive pressure ventilation; tracheal intubation.
Uncommon Solitary Mesenteric Mass: Mesenteric Panniculitis
Authors: Shah Abhishek , Cao Dianbo , Shah Deepa , Sun Wenbin 
Published: September 2018

Mesenteric panniculitis is a rare, benign disease characterized by a chronic non-specific inflammatory process of mesenteric fat tissue with unknown etiology. Its clinical outcome ranges from complete resolution without any treatment to rapid progression culminating in death. So far, there is no established treatment available for its management. A 53-year-old female was admitted to our hospital because of intermittent abdominal pain, abdominal distension and early satiety for three months. Her abdominal CT scan revealed a solitary, well-defined, heterogeneous mass with a diameter of approximately 3.5cm x 2.8cm in the mesentery of small bowel. Exploratory laparotomy revealed yellowish-grey mass with a gritty consistency and histopathology of the resected specimen confirmed it to be mesenteric panniculitis. An increased awareness may lead to the use of a less invasive diagnostic approach and optimal management of this rare disease entity.
Keywords: Computerized Tomography (CT); Mesenteric Panniculitis (MP); treatment.
Percutaneous Coronary Intervention without onsite Cardiac Surgery Backup
Authors: Dubey Laxman , Sharma Sanjib Kumar , Bhattacharya Rabindra , Guruprasad Sogunuru , Subramanyam Gangapatnam 
Published: September 2018

Introduction: Mechanical revascularization by percutaneous coronary interventions has now become an established and preferable method of revascularization in patients with acute coronary syndromes. The aim of the study was to identify the clinical indications for percutaneous coronary interventions and in-hospital outcomes of percutaneous coronary interventions in a tertiary-level hospital without onsite cardiac surgery backup.
Methods: This was a prospective descriptive study. All consecutive patients who were admitted for percutaneous coronary interventions, including both primary as well as elective percutaneous coronary interventions, between March 2011 and December 2012 were included in the study.
Results: Total 101 percutaneous coronary interventions were performed. The mean age was 58.9 ± 12.3 years. The most frequent indication was ST-elevation myocardial infarction 72 (71.3%). Proximal artery stenting were performed in 39 (38.5%) and the non proximal artery stenting in 62 (61.5%). The outcomes were mortality 5 (4.9%), periprocedural myocardial infarction 2 (1.9%), cardiogenic shock 6 (5.9%), contrast induced nephropathy requiring dialysis in 3 (2.9%), minor complications which were managed conservatively in 13 (12.9%).
Conclusions: Percutaneous coronary intervention was feasible with acceptable complications in a tertiary-level hospital without onsite cardiac surgery backup. ST-elevation myocardial infarction was the major indication and cardiogenic shock was the major complication observed, and non proximal artery stenting was more common than the proximal artery stenting.
Keywords: indication; onsite cardiac surgery; outcomes; percutaneous coronary interventions.
Left Sided Amyand’s Hernia with Sliding Component
Authors: Pun Ashis , Khatri Roshan 
Published: September 2018

The eponym ‘Amyand hernia’ coined in recognition of Claudius Amyand, the first surgeon to successfully perform appendectomy in a hernia sac containing appendix, refers to the vermiform appendix within inguinal hernia.
Here, we present a rare case, of Amyand’s hernia in an 18 month-old boy who was brought with an inguino-scortal swelling which later on exploration was left sided Amyand’s hernia with sliding component.
Amyand’s hernia is not very often seen in the clinical practice and its pre-operative diagnosis is very difficult hence awareness of this disease condition is essential for preoperative suspicion and even diagnosis of the condition.
Keywords: Amyand’s hernia; acute appendicitis; hernial repair.
Cervical Dysgenesis with Transverse Vaginal Septum with Imperforate Hymen in an 11 year old Girl Presenting with Acute Abdomen
Authors: Gupta Pratiksha , Gupta Sangeeta , Jindal Sunita , Chopra Kanwaljeet , Sinha Manjari , Arora Anita 
Published: September 2018

This case highlights the importance of careful evaluation of girls presenting with imperforate hymen as this is accompanied by other female reproductive tract anomalies. It is of utmost importance that a correct timely diagnosis is made so that the right treatment can be chosen with the perspective of future fertility. Cervical dysgenesis associated with vaginal septum and imperforate hymen has not been reported in literature so far. Present case highlights the simple mode of management with a successful outcome.
Keywords: cervical dysgenesis; imperforate hymen; transverse vaginal septum.
Organized Subdural Hematoma with Thick Membrane in Chronic Subdural Hematoma
Authors: Shrestha P , Panta B , Shrestha P , Rajbhandari P 
Published: September 2018

Introduction: Chronic subdural hematoma (CSDH) may occasionally contain organized hematoma which can lead to recurrence and other complications after surgery. There is no exact study and data about OHTMF in Nepal so far. The main objective of this study is to study its prevalence and complications.
Methods: This is a multicentric retrospective analytical study being carried out at Norvic International Hospital and Annapurna Neurological Institute. We retrospectively analyzed one hundred cases of CSDH between early 2006 to 2010 August. We focused our study mainly on OHTMF.
Results: Of 100 cases, majority of the patients were male ranging from 4 to 85 years of age. Bilateral subdural hematoma was found in about 9% of cases. Majority of cases were treated in usual fashion with single burr hole and drain.
OHTMF was found in 3 cases (3%) for which craniotomy with radical membranectomy was performed. In 2 cases membrane formation was noticed during surgery, craniotomy with total membranectomy was performed immediately. In one case there was recurrence of CSDH within 10 days of single burr hole evacuation. Craniotomy with membranectomy was performed in 2nd surgery. There was no recurrence after membranectomy. One case developed seizure post operatively.
Conclusions: OHTMF is one of the important causes of CSDH recurrence. It has to be treated radically. Different hypthotheses have been postulated regarding thick membrane formation in CSDH. We have tried to discuss these hypotheses.
Keywords: burr hole evacuation, craniotomy, CSDH, OHTMF.