bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scar Endometriosis: Cytological Diagnosis
Authors: Dwivedi Urvashee , Shukla Saumya , Anand Nidhi , Parashar Chetan , Husain Nuzhat 
Published: September 2018

Endometriosis occurring in a surgical scar is called incisional endometriosis. It is rare and can be diagnosed on the basis of detailed history, careful clinical examination and characteristic histology. An interesting case with immunocytological (ICC) confirmation is being reported. A 28-year-old female presented with a mass over anterior abdominal wall, of 3 years duration. She had a past history of LSCS. On examination, the swelling was subcutaneous, measures 3x2cm was firm in consistency and located close to the previous incisional scar. Fine needle aspiration cytology was performed and the smears were moderately cellular and showed monolayered sheets of epithelial cells and stromal fragments. A cell block was also prepared that revealed few glands lined by tall columnar epithelium, surrounded by loose stroma. Immunohistochemistry panel comprising of CK 7 and CD 10 was performed, which were positive in glandular and stromal component respectively.
Prevalence of Malnutrition in a Rural Residential Sanskrit School in Baglung, Nepal
Authors: Amatya Bhawana , Shrestha Nitesh 
Published: September 2018

Introduction: Under-nutrition is a condition in which there is inadequate consumption, poor absorption or excessive loss of nutrients. Nepal still faces high chronic as well as acute under‐nutrition in children. The following study was conducted a Sanskrit school in rural Baglung to find the prevalence of malnutrition among the children which could reflect the nutritional status of the community.
Methods: Out of 60 students admitted to the school, only 43 were present at the time when we collected our data. Weight was measured with a standard weighing scale and standing height with a measuring tape attached to the wall. Data were filled up in proforma, entered in Microsoft Excel 2013 and were analyzed and indicators calculated with SPSS version 20 using WHO Child Growth Reference data for 5-19 years and macros.
Results: Stunting (Z score < -2) was found in 53.5 % of the study group and severe stunting (Z score < -3) was found in 25.6%. 12.5% of the 8 children under 10 years in our study had weight for age < -2 Z score which indicates underweight. No one was severely underweight. In our study, 2.3% had severe thinness (Z-score < -3), 14% had thinness (Z-score < -2). No one was overweight or obese.
Conclusions: The prevalence of malnutrition was high among the students of the rural Sanskrit school where the study was conducted.

Keywords: anthropometry; Baglung; malnutrition; Nepal; prevalence.
True Brachial Artery Aneurysm Presenting as a Non-Pulsatile Mass
Authors: Pradhananga Anup , Chao Xie 
Published: September 2018

Brachial artery aneurysms are rare disease that can be encountered. It is divided into true and false. The frequency of true aneurysm of the brachial artery is so much unusual. So, we present a case of a 59 year old male who presented to us with complaint of mass in left upper limb since many years ago. Now, there was sudden onset of progressive pain with coldness, numbness, tingling sensationand blackish discolouration of skin from 8 hours. The left upper limb was pulseless and color Doppler ultrasound showed a non-pulsatile aneurysm at the mid level of left brachial artery associated with arterial occlusion in its distal branch by thrombus. The patient was successfully revascularised by interposing a saphenous vein graft.Thus,this case suggest that the prompt diagnosis of true brachial artery aneurysm by ultrasound or color Doppler ultrasound and the proper treatment by surgical repair can save limb from dangerous sequel
Keywords: brachial artery aneurysm; color doppler ultrasound; true aneurysm; ultrasound.
Intracranial MR Venography Using L ow-Field Magnet: Normal Anatomy and Variations in Nepalese Population
Authors: Sharma U K , Sharma K 
Published: September 2018

Introduction: Magnetic resonance (MR) venography is considered a reliable imaging modality for the evaluation of intracranial venous system. The purpose of this study was to evaluate the normal venous anatomy and its variations in Nepalese population using low fi eld MR technique.
Methods: One hundred patients with normal MR imaging of brain underwent MR venographic study. MR venograms were performed in 0.35 T MR scanner using a contiguous 2D time-of–fl ight MR angiographic technique.
Results: The fl ow gaps in the transverse sinus were seen in 47% of population, of which 91% occurred in the non-dominant side. Right transverse sinus was dominant in 73% population. Flow gap was observed in bilateral transverse sinus in one case, while it was seen in the dominant right transverse sinus in 6.3% population. Inferior sagittal sinus was observed in 11% cases. Internal cerebral vein was seen in 60 cases. Occipital sinus was observed in 4% of the cases. The basal vein of Rosenthal was observed in 34% of the cases, whereas vein of Labbe seen in 8% cases. Unilateralfl ow gap in the sigmoid sinus was seen in 5 cases.
Conclusions: MR angiography done at low fi eld MR unit is a reliable tool in cerebral venous sinus assessment, particularly major dural sinuses. The fl ow gaps in transverse sinus are frequently encountered anatomic variation. Visualization of small veins like inferior sagittal sinus, basal vein of Rosenthal, vein of Labbe, internal cerebral vein was inferior in our study compared to other studies done in high fi eld MR unit.
Keywords: Dural sinus, intracranial veins, MR venography.
Assessment of Automatic Thoughts in Patients with Depressive Illness at a Tertiary Hospital in Nepal
Authors: Rana Mita , Sthapit Sabitri , Sharma Vidya Deb 
Published: September 2018

Introduction: Cognitive functions have significant influence on psycho-social and general wellbeing. The quality, content and processing of negative thoughts initiate depressive symptoms; i.e. low mood, decreased self-worth and diminished interest in pleasurable activities. The study assessed the automatic thoughts of patients having depressive illness and evaluated and compared the changes after therapy; i.e. Psychotherapy and pharmacotherapy.Methods: Diagnosed cases of depressive illness (n=135), according to ICD-10 and study criteria, attending the out-patient clinic of Department of Psychiatry and Mental Health, Tribhuvan University Teaching Hospital, were included. Beck Depression Inventory was used to screen level of depressive symptoms. Automatic thoughts were assessed by the Automatic Thought Questionnaire-Revised before initiating therapy and after completion of therapy for comparison. Depressive patients received either of the three treatment procedures after randomization of the study sample into three different treatment groups; i.e. Cognitive behavior therapy, pharmacotherapy or combined therapy receiving both cognitive behavior therapy and pharmacotherapy.Results: Among the total 135 patients, 53 (39.3%) had moderate, 47 (34.8%) had severe depressive and 35 (25.9%) had mild depressive symptoms before therapeutic interventions. Negative automatic thoughts were significantly present in depressed patients and reduced after all three interventions. Negative automatic thoughts of hopelessness, anxiety and inability coping were significantly reduced after therapy.Conclusions: Automatic negative thoughts were significantly correlated with depressive disorder. Combined therapy CBT with pharmacotherapy or CBT alone was found to be more effective in modifying automatic negative thoughts than pharmacotherapy alone, ultimately reducing depressive symptoms to a significant degree.Keywords: automatic thoughts; cognitive Behavior therapy; pharmacotherapy. [PubMed]
Colorectal Cancer in Different Age Groups in a Tertiary Hospital in Nepal
Authors: Silwal Poudyal Nandu , Chaudhary Sitaram , Basnet Bhupendra Kumar , Poudel Bidhan Nidhi , Shrestha Barun , Mandal Amrendra Kumar , Sharma Mukesh 
Published: September 2018

Introduction: Some studies have suggested that colorectal cancer at a younger age had distinct biological characteristics: different clinical presentations, more advanced stage at time of diagnosis and poorly differentiated carcinoma. The aim of the study is to analyze clinical and histopathological differences between younger (≤40 years of age) and older (>40 years of age) colorectal cancer patients.Methods: A cross-sectional analysis was conducted amongst the colorectal cancer patients who visited Bir Hospital between July 2015 and April 2017. All colonoscopically diagnosed and histopathologically proven cases of colon cancer were included. Chi-square test and independent t – test was performed to analyze the difference between clinical presentations and histopathological findings among two groups of patients and p value of <0.05 was considered as significant.Results: Thirty younger patients and thirty older patients were enrolled without any differences in gender proportion. There were no statistical differences between clinical presentation and histological grade and type in younger and older patients. The younger patients had more complaints of altered bowel habit (p <0.001) while older patients mostly presented with per rectal bleeding (p< 0.008).Conclusions: In this study, colorectal cancer at younger ages showed similar characteristics to those of older patients except altered bowel habit was more common in younger patients while per rectal bleeding was more common in older patients. Although colorectal cancer incidence increases with age, younger patients with altered bowel habits, weight loss, anemia and anorexia should also be given due medical attention and undergo evaluation promptly. Keywords: carcinoma; colon; per rectal bleeding; younger group. [PubMed]
Need of The Ministry of Health in Federal Democratic Republic of Nepal
Authors: Regmi Kiran , Upadhyay Meera , Tarin Ehsanullah , Chand Padam Bahadur , Uprety Senendra Raj , Lekhak Susheel Chandra 
Published: September 2018

The constitution of Nepal provides appointing a council of ministers both at federal and provincial levels without defining portfolios. There is a political agreement that MOH will be retained at the federal level. This article draws evidences around the world to meet health needs of Nepalese, the role of provincial ministry of health and coordinating structure at district/local level.The constitution emphasises on health and pronounced in 46 articles which provides guidance for the creation of federalized governance levels at federal, provincial and local levels. Retaining ministry of health at federal level without creating devolved structure at province and local levels in health sector will create difficulty in translating the spirit of the constitution and may not be effective in addressing health issues nationally and meeting global achievements like SDGs.It is suggested to establish an elaborate health system accordingly in Nepal to ensure constitutional mandate of health as a basic human right.Keywords:constitution; federalism; health sector,ministy of health. [PubMed]
Non-Invasive Predictors of Gastro-Oesophageal Varices
Authors: Bhattarai Subash , Dewan Khus Raj , Shrestha Gaurav , Patowary Bhanumati Saikia 
Published: September 2018

Introduction: The worldwide accepted tool for screening and monitoring gastro-oesophageal varices
in patients with liver cirrhosis is upper gastrointestinal endoscopy. Endoscopy needs clinical expertise
and has got its own procedure related complications. Repeated endoscopies may be expensive and
patients tend to develop poor compliance. This study was undertaken to establish the role of noninvasive
parameters in predicting gastro-esophageal varices.
Methods: Two hundred patients with clinical features, laboratory and sonological findings
suggestive of cirrhosis of liver and endoscopic evidence of portal hypertension were included in the
study. Blood parameters like serum albumin, international normalized ratio (INR), platelets count
and ultrasonography assessments of portal vein diameter and spleen size were compared with
presence of gastro-oesophageal varices.
Results: At cutoff point of 2.55g/dl, serum albumin had high specificity of 99% whereas platelets
count <1,44,000/mm3 had 87.9% sensitivity for presence of oesophageal varices. Sensitivities of
92.72% and 94.5% while specificities of 90% and 75% were detected for presence of oesophageal
varices when the cutoff values for portal vein diameter and spleen size were 12.25 mm and 13.9 cm
respectively.
Conclusions: Measurements of serum albumin, platelets count, portal vein diameter and spleen size
by ultrasonography can be recommended as a non-invasive predictor for gastro-oesophageal varices
in cirrhosis of liver. All these non-invasive parameters could be useful to patients with liver cirrhosis
with portal hypertension in predicting presence of varices as well as in long-term clinical monitoring
and management.
Keywords: cirrhosis of liver; endoscopy; gastro-oesophageal varices; non-invasive predictors.
Incidence and Outcome of Ventilator Associated Pneumonia in ICU of a Tertiary Care Hospital in Nepal
Authors: Mishra Deebya Raj , Shah Niharika , Shah Dibya Singh 
Published: September 2018

Introduction: Ventilator associated pneumonia is an important intensive care unit acquired infection in mechanically ventilated patients. Early and correct diagnosis of Ventilator associated pneumonia is difficult but is an urgent challenge for an optimal antibiotic treatment.
Methods: A prospective observational study was conducted in Intensive Care Unit of a tertiary care hospital in Nepal. Consecutive patients were considered during the study period, who met the criteria were included for the study. Clinical Pulmonary Infection Score was used to diagnose Ventilator associated pneumonia.
Results: Among 60 patients ventilated for more than 48 hours, 25 (41.6%) developed ventilator associated pneumonia. The incidence was 25 VAPs per 100 ventilated patients or 26 VAPs per 1000 ventilator days during the period of study. Days on ventilator and duration in ICU were higher in the VAP group. There was a trend towards increasing mortality in the VAP group (P value=0.06).
Conclusions: There exists a high rate of VAP in our Intensive Care Unit. Targeted strategies aimed at reducing Ventilator associated pneumonia should be implemented to improve patient outcome and reduce length of Intensive Care Unit stay and costs.
Keywords: clinical pulmonary infection score; incidence; ventilator associated pneumonia.
Knowledge and Practice of Hemodialysis Amongst Dialysis Nurses
Authors: Manandhar Dhiraj Narayan , Chhetri Pramod Kumar , Poudel Prakash , Baidya Samir Keshari , Agrawaal Krishna Kumar 
Published: September 2018

Introduction: Dialysis nurses should have a good knowledge regarding hemodialysis treatment. The status of Nepalese dialysis nurses on this aspect is unknown. This study was done to assess the knowledge and practice on different aspects of the hemodialysis treatment.
Methods: We distributed questionnaires to the participants of a conference held on September 24, 2016 in Kathmandu. We included 94 out of 116 participants who were giving care to dialysis patients. We calculated mean and standard deviation for continuous variables and frequencies and percentage for the responses and compared counseling with different parameters.
Results: Response rate was >96%. Fifty-nine respondents (64%) were from age group 20-29 years. Only 39 (42%) received formal nursing training in hemodialysis. Seventy-one (78%) respondents always counseled patients regarding fluid intake. Thirty-seven (96%) trained nurses always counseled the importance of regular dialysis. Seventy-six (81.7%) respondents did counseling on vaccination against Hepatitis B. Counseling on vaccination against influenza and pneumococcus was 50%. When comparing educational status, respondents below bachelor level did more frequent counseling than level above (p=0.03). All the respondents knew the importance of hand washing and BP monitoring during hemodialysis. Ninety-one (96.7%) respondents knew how to deal with BP changes during hemodialysis. Seventy-three (77.6%) respondents were very confident on managing complications. Only 31(33%) respondents knew how to deal with patients on continuous ambulatory peritoneal dialysis.
Conclusions: Dialysis nurses have knowledge on basic procedures of hemodialysis but there is a space for improvement in counseling and dealing with complications to provide quality service to hemodialysis patients.
Keywords: counseling; hemodialysis; Nepal; nurse.
Ventilator-Associated Pneumonia and Role of Nurses in Its Prevention
Authors: Osti Chadani , Wosti Deepa , Pandey Bimala , Zhao Qinghua 
Published: September 2018

Ventilator-associated pneumonia (VAP) is one of the most frequent nosocomial infections among ventilated patients in ICUs, associated with an increase in days of ICU stay, morbidity, and mortality. Its prevention is a significant concern in every hospital. Most of the interventions and prevention strategies are part of routine nursing care. Nurses have different vital roles such as care provider, manager, educator, coordinator, and evaluator in preventing VAP. Lack of knowledge of infection prevention and proper nursing care among nurses may become a barrier in adhering to evidence-based guidelines for preventing ventilator-associated pneumonia. This study will help nurses to know about VAP and its prevention in detail so that they can apply the knowledge in clinical practice. Understanding pathophysiology of VAP, its risk factors, and care bundle is vital for the proper prevention and treatment of VAP. There must be specific protocols, strategies and active surveillance in every ICU regarding the care bundle.
Keywords: Mechanical ventilation; Nosocomial infections; Nurses role; Ventilator-associated pneumonia; VAP Prevention.
Evaluation of Dental Caries Among Preschool Children in Kathmandu- Using Significant Caries Index.
Authors: Limbu Senchhema , Dikshit Parajeeta , Bhagat Tarakant 
Published: September 2018

INTRODUCTION:
Dental caries among preschool children is common but there is scarcity of updated data about its prevalence among Nepalese preschool children. This study was conducted to evaluate prevalence, Significant Caries Index, Caries pattern, Restorative care index and Disparity ratio among preschool children of Kathmandu aged 3-6 years.
METHODS:
A cross sectional study was conducted on 17 preschools of Kathmandu following WHO criteria. Data were analysed using SPSS 20 and descriptive statistics was applied.
RESULTS:
Prevalence of dental caries was 803 (55.6%) with a mean deft of 3.28±3.581 and Significant Caries Index score was 7.439. Caries pattern showed the most commonly decayed teeth were mandibular second molars followed by maxillary central incisors. The least affected teeth were mandibular lateral incisors. The restorative care index was 106 (7.32%) in the total sample size and 14 (2.86%) in the SiC and disparity ratio was 2.26.
CONCLUSIONS:
The SiC Index indicated high dental caries prevalence; severity rates and restorative care index indicated little experience of restorative treatment in preschool children of Kathmandu identifying the need for more targeted efforts to reach preschool children early to effectively address unmet oral health needs.

KEYWORDS:
caries pattern; dental caries; Kathmandu; preschool; significant caries index.
Prevalence of Oral Mucosal Lesions in a Tertiary Care Dental Hospital of Kathmandu
Authors: Bajracharya Dipshikha , Gupta Sujaya , Ojha Bidhata , Baral Radha 
Published: September 2018

Introduction: Oral mucosa can be affected by a variety of soft tissue lesions and conditions. Benign as well as malignant lesions of oral cavity are common. Squamous cell carcinoma is one of the commonest malignancies. The present retrospective study was undertaken to study the prevalence of various oral mucosal lesions in a tertiary care dental hospital of Kathmandu.
Methods: This retrospective study was carried out in the Department of Oral and Maxillofacial Pathology at Kantipur Dental College and Teaching hospital from January 2015 to January 2017. The study included biopsy specimen from the oral cavity. The parameters included in the study were age, gender, site of the lesion and histopathological diagnosis. The data collected was statistically analyzed.
Results: A total of 111 biopsy cases were included in the present study. Out of which, there was 16 (14.4%) cases of non neoplastic and 16 (14.4%) cases of benign pathology. The oral cavity lesions were commonly seen in age range between 6-74 years where males 59 (53.2%) were mostly affected. The most common site for oral lesion was buccal mucosa 23 (20.7%) and anterior gingiva 23 (20.7%). 15 (13.5%) cases of oral squamous cell carcinoma were seen as the predominant malignancy affecting in the vestibular region 8 (7.2%).
Conclusions: The present study shows benign as well as the non neoplastic lesions were more prevalent in oral mucosa with the buccal mucosa and anterior gingiva as the commonest site of occurrence.
Keywords: Benign; Malignant; Non neoplastic; Oral mucosal lesion.
Dengue- An Emerging Disease in Nepal
Authors: Pun S B 
Published: September 2018

Dengue is an acute infectious disease caused by dengue viruses and transmitted by the Aedes species of mosquito. The rapid global spread of the dengue virus into new areas has begun to attract more research attention. A series of dengue fever outbreaks in several districts of Nepal has been recently observed. The evidence of all four serotypes (DEN – 1 - 4) could be a consequence of a sudden resurgence of a more severe dengue disease in Nepal. Health care providers need to become familiar with the disease to prevent or control the possibility of future outbreaks. The clinical features, diagnosis, treatment, epidemiological patterns and challenges of dengue virus infection in Nepal will be discussed here.
Keywords: Dengue, epidemiological patterns, Nepal.
Basal Cell Carcinoma in Cases with or without Xeroderma Pigmentosum
Authors: Ghartimagar Dilasma , Ghosh Arnab , Shrestha Sushil Ram , Shrestha Sachet , Narasimhan Raghavan , Talwar O P 
Published: September 2018

Introduction: Basal cell carcinoma is the most common form of cancer in humans and comprises the vast majority of skin cancers. It predominantly affects fair-skinned individuals, and its incidence is rapidly increasing. The objective of the study is to identify the epidemiology, its topography and different histological subtypes of basal cell carcinoma in patients with or without Xeroderma Pigmentosum.
Methods: A cross-sectional descriptive study was conducted at Manipal Teaching Hospital, Pokhara from Jan 2009 to Dec 2016. Ethical approval was taken from MEMG/IRC/GA. The study included patients with a confirmed diagnosis of basal cell carcinoma irrespective of their age and sex.
Results: This study showed 77 individuals with 91 biopsies of BCC including 5 cases of Xeroderma Pigmentosum. The predominant histological subtype was nodular with 41 (53.94%) cases, followed by the 14 (18.42%) cases of pigmented and 10 (13.15%) cases baso-squamous subtype. The most frequent sites of involvement were the head and neck, with predominance in the nasal and orbital region. The mean age was 57.68 years but the basal cell carcinoma in cases of Xeroderma Pigmentosum was seen more in younger age groups. There were 43 (55.84 %) male patients and 34 (44.16 %) female patients with a male to female ratio of 1.26:1.
Conclusions: Nodular and pigmented varieties were the most frequent subtypes with nose being the commonest site of involvement. Basal cell carcinomas in cases of Xeroderma Pigmentosum were noted in younger age group with multiple lesions.
Keywords: basal cell carcinoma; recurrence; topography; xeroderma pigmentosum.