bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pattern of Body Mass Index and Common Health Problems in Women of Reproductive Age Group in a Private Clinic in Kathmandu
Authors: Padhye Saraswati M 
Published: September 2018

Introduction: High Body Mass Index is one of the risk factors for many chronic diseases and adverse health outcomes. It is associated with an increased risk of coronary heart disease, ischemic stroke, high blood pressure and type 2 diabetes mellitus. It also have many adverse effect on reproductive health of the women like sub fertility, polycystic ovarian disease, menstrual abnormality etc. The purpose of this study is to find Basal Metabolic Rate and the diseases pattern of reproductive age woman in Nepal.
Methods: This is a descriptive study of women of reproductive age (15 to 49 years) attending a private gynaecology clinic in Kathmandu Valley from October 2016 to June 2017. Six hundred and eight women of current reproductive age group participated in this study. Women’s particulars and complaints were noted down. Detailed history was taken. Height, weight and blood pressure were recorded and general examination was done. BMI was calculated as BMI is weight in kilogram divided by height in meter square, and it was interpreted as per WHO guidelines.
Results: Out of the total 608 participants, 243 (40%) were overweight, 96 (15.8%) were obese. Regarding the common health problems, 154 (25.3%) have sub fertility and 199 (32%) had genitourinary infection. Similarly, 90 (14.8%) had menstrual problems.
Conclusions: Prevalence of overweight and obesity has risen significantly comparing to the study done decade ago in same setting. Similarly, sub fertility rate has also risen whereas the prevalence of genitourinary infections has decreased.
Keywords: BMI; genitourinary infection; Nepal-reproductive age women; sub fertility.
Clinico-radiological Observations in Meconium Aspiration Syndrome
Authors: Lama Susana , Mahato Shyam Kumar , Chaudhary Nagendra , Agrawal Nikhil , Pathak Santosh , Kurmi Om Prakash , Bhatia Baldev , Agarwal Kailash Nath 
Published: September 2018

Introduction: To understand and report the prevalence of meconium aspiration syndrome and the clinico-radiological features in a tertiary care hospital of western Nepal.
Methods: An observational study carried out for a year in 2014-15 in all babies with MAS. Clinical and radiological profiles of MAS in relation to gender, gestational age, mode of delivery, birth weight, Apgar score, thickness of meconium, age at admission and the immediate outcome were studied.
Results: Out of 584 admitted newborns (male=389; female=186) during the study period, 78 (13.4%) had meconium aspiration syndrome with male: female ratio of 1.2:1. Majority of babies admitted to NICU had thick meconium [n=52 (66.7%)]. There was no statistical significant difference in various parameters such as Apgar score at 1 and 5 minutes, respiratory distress, birth asphyxia, duration of oxygen use, MAS severity and chest x-ray in those with thick MAS compared to thin. Among all newborns with MAS, 59% (n=46) had abnormal radiological findings with over two-folds in those with thick MAS (71.7%)] compared to thin (28%). Hyperinflation (47.8%), diffuse patchy infiltration (37%), consolidation (21.7%) collapse (8.7%), right lung fissure (6.5%) and pneumothorax (8.7%) were the abnormal radiological findings seen in MAS babies. The odds of having APGAR score at 1 minute at least 7 or more was twice unlikely in those having thick meconium compared to thin (P=0.02)
Conclusions: Thick meconium is relatively common with more significant abnormal radiological findings and low Apgar score.
Fingerprints as an Alternative Method to Determine ABO and Rh Blood Groups
Authors: Chaudhary Sonam , Deuja Sajana , Alam Munna , Karmacharya Poonam , Mondal Monami 
Published: September 2018

Introduction: Blood grouping is conventionally done with invasive method by taking blood samples. The objective of this study is to determine blood group with uninvasive procedure by taking fingerprints of the participants and know the associations between their fingerprints and blood groups.
Methods: Seven hundred participants of both genders with no any age limitation from Manipal Teaching Hospital and Manipal College of Medical Sciences were randomly selected. The blood grouping was done by cross reacting blood sample with the antibodies. The fingerprints were taken with the help of stamp pad imprinting the finger ridges over A4 size white papers. The loop, whorl and arch patterns were studied.
Results: O+ve blood group 224 (32%) was most prevalent among 700 participants. The loop pattern was highly distributed 3708 (53%) in all blood groups except in A-ve blood group with highest distribution of whorl 20 (40%). The mean comparisons of specific fingerprint in total and also in individual fingers with different ABO and ABO-Rh blood groups showed no any statistical association with P>0.05. However, the loop distribution in individual finger was highest in right middle finger (M) of B-ve blood group 5 (10%). The whorl distribution in individual finger was highest in right index (I), left thumb (T) and left ring (R) fingers of AB+ve blood group 20 (5.5% each). Similarly, the arch distribution was highest in right index fingers of A-ve blood group 3 (6%).
Conclusions: The mean comparison of different fingerprints with ABO and Rh blood groups showed no significant statistical association concluding fingerprints cannot be used for blood grouping.
Keywords: arch; blood group; fingerprints; loop; whorl.
Prevention of Shivering during Spinal Anesthesia: Comparison between Tramadol, Ketamine and Ondansetron
Authors: Lakhe Gajal , Adhikari Krishna Murari , Khatri Kiran , Maharjan Anil , Bajracharya Akriti , Khanal Himdip 
Published: September 2018

Introduction: Shivering is an unpleasant experience after spinal anesthesia. We conducted this study to evaluate the efficacy of ondansetron, ketamine and tramadol for prevention of shivering.
Methods: In this prospective, randomized controlled study, 120 patients aged 18-65 years of American Society of Anesthesiologist (ASA) physical status I&II undergoing various surgical procedures were included and allocated alternately to one of the 4 groups; Normal saline (Group1), Ondansetron 4mg (Group2), Ketamine 0.25mg/kg (Group3) and Tramadol 0.5mg/kg (Group4). Incidence of shivering, effect on hemodynamics, nausea, vomiting, sedation and emergence reactions were recorded. Data was analyzed using SPSS (The Statistical Package for Social Sciences) version 20.0 software.
Results: The patients were comparable in terms of demographic variables, baseline temperature, type of surgery, median level of sensory blockade, duration of surgery and anesthesia. Shivering was present in 17 (56.7%), 5 (16.7%), 3 (10%) and 3 (10%) patients respectively in Group 1, 2, 3 and 4 which was statistically significant when compared to Group 1 (P=0.00) The odds of NS and ondansetron, NS and ketamine, NS and tramadol was 6.53, 11.76 and 11.76 respectively which showed that study drugs were effective in preventing shivering. None of the patients were sedated in Group 1 and 2. Mild to moderate sedation was present in Group 3 and 4 (P=0.00). None of the patients had drug related adverse reactions.
Conclusions: Prophylactic use of ondansetron, low doses of ketamine and tramadol is effective in preventing shivering post spinal anesthesia without untoward effects.
Keywords: Anesthesia spinal; Ketamine; Ondansetron; Shivering; Tramadol.
Effects of Intrathecal Dexmedetomidine as an Adjuvant to Hyperbaric Bupivacaine for Spinal Anaesthesia in Adults Undergoing Elective Infra-umbilical Surgery
Authors: Gautam Binod , Niroula Sujata , Sharma Mona , Lama Sushila Moktan 
Published: September 2018

Introduction: Various adjuvants to local anaesthetic are used to improve quality and duration of spinal anaesthesia. Dexmedetomidine, a novel alpha-2 adrenergic agonist, has been proposed to augment local anaesthetic effects. This study aims to investigate effects of intrathecal Dexmedetomidine on duration of analgesia and duration of sensory block during spinal anaesthesia.
Methods: In this randomized double-blind study 38 patients were allocated into each of two groups. Otherwise healthy patients (18 to 75 years) scheduled for inguinal hernia repair or vaginal hysterectomy were included. For spinal anaesthesia, Group A received 2.5 ml hyperbaric Bupivacaine 0.5%, whereas Group B received five micrograms intrathecal Dexmedetomidine in addition. Characteristics of sensory and motor blocks, duration of analgesia, analgesic requirements, and side effects were studied for 24 hours. Student’s t-test for quantitative variables and Chi- squared test for qualitative variables were used for statistical analysis.
Results: Duration of analgesia was prolonged in Group B (326 min ±91) as compared to 217 min ±98 in Group A (P value <0.05). Sensory and motor block durations were significantly prolonged in Group B. Time taken to reach significant peak sensory block level was earlier in Group B. Significant reductions in incidence of visceral pain, shivering and analgesic requirements were observed in Dexmedetomidine group, without increased need of medications for altered hemodynamic parameters.
Conclusions: Dexmedetomidineas an intrathecal adjuvant to hyperbaric Bupivacaine in spinal anaesthesia prolongs duration of analgesia and sensory block with minimal adverse effects.
Keywords: Bupivacaine; Dexmedetomidine; intrathecal adjuvant; spinal anaesthesia.
Factors Predicting Mortality of Variceal Bleeding in Liver Cirrhosis
Authors: Mandal Amrendra Kumar , Paudel Mukesh Sharma , KC Sudhamshu , Chaudhary Sitaram , Paudel Bidhan Nidhi , Poudyal Nandu Silwal , Shrestha Barun , Kanth Rajan , Kafle Paritosh 
Published: September 2018

Introduction: Acute variceal bleeding in liver cirrhosis is an immediate life-threatening condition and amajor complication of portal hypertension associated with higher morbidity, mortality and hospital costs than any other causes of UGI bleeding. Therefore, early stratification and initiation of therapy based on several factors can reduce mortality associated with it. We aimed to study the predictors of mortality in acute variceal bleeding in LC.
Methods: An observational prospective study was conducted in Gastroenterology and Hepatology units of Bir Hospital, Kathmandu, Nepal from April 1, 2016 to May 30, 2017. Patients were included if they had underlying liver cirrhosis and presented upper GI bleeding which were proven to be secondary to variceal bleeding.
Results: Seventy-five patients with mean age of 52.5 years were available or the analysis. The M:F ratio was 2.1:1. There were 66 patients in mortality group and 9 in survivor group. The mean CTP and MELD score were 10.17±1.66 and 20.40±8.29 respectively. Among the predictors of the mortality studied, CTP score, MELD score, mean arterial pressure, Serum bilirubin, serum creatinine, need of FFP as well as PRP transfusion, presence of hepatorenal syndrome and hepatic encephalopathy were high in mortality group with statistical significance. On multivariate analysis, high CTP and high serum creatinine level were only significant predictors of mortality. Receiver operating curve for predicting accuracy of mortality was significant with higher MELD and higher CTP score.
Conclusions: Strong predictors of mortality in patients with cirrhosis presenting with variceal bleeding are CTP score and high serum creatinine level.
Blood Pressure and its Association with Body Mass Index Among the People Attending in a Hospital
Authors: Lamsal Dinesh Kumar 
Published: September 2018

Introduction: Systolic and diastolic hypertension has been increasing trend and different factors are associated such as body mass index, diabetes etc. Obesity and overweight are generally associated with high blood pressure. This study aims to identify the prevalence of blood pressure level and its association to body mass index among people attending in civil service hospital, Kathmandu.
Methods: A cross-sectional descriptive study was conducted among all 1002 study subjects aged above 20 years.Information were obtained from people coming for Master health check-up during study period. Blood pressure and weight weretaken by WHO certified tool.
Results: Half of the respondents were overweight and obese. Prevalence of systolic and diastolic hypertension was found to be 171 (17.1%) and 310 (30.9%) respectively. There is significant difference between body mass index to sex. Females are 1.5 times more likely to have high blood pressurewho have high body mass index. Age group (40-59) years are more than two times likely to have overweight, systolic and diastolic blood pressure than other age group. Systolic blood pressure is more than six times more likely to be high in 60+ age group. But it is only 2.6 times in diastolic blood pressure and in body mass index, it is reduced to 1.4 times but it was still statistically significant. Overweight people are 1.4 and 1.6 times more likely to have high systolic and diastolic BP than another category.
Conclusions: Half of the respondents were overweight and obese. Male had high overweight and obesity than female. Overweight people more likely to have high systolic and diastolic BP than others.
Keywords: Body mass index; blood pressure; civil service hospital; Nepal.
Pattern of Mobile Phone Use among Students of An Institution
Authors: Thapa Kriti , Pokharel Rita , Sigdel Rambha , Rimal Surya Prasad 
Published: September 2018

Introduction: The charm of mobile phone is more among young generation and the increasing use can lead to various harmful effects and may result in dependence. The objective of the study is to evaluate the pattern of mobile phone use among medical students.
Methods: A descriptive cross sectional study was conducted on a total of 229 medical students aged between 18 and 25 years who were using mobile phones for more than 1 year by using simple random sampling technique. Students were requested to complete a pre-tested self-administered questionnaire which comprised their socio-demographic characteristics and pattern of mobile phone usage.
Results: Among the total 229 students, all of them had their own smart phones. Major purpose of using mobile was for calling, listening music, taking photos/videos and internet use. Most of the students 97 (42.4%) have owned mobile phones since 4-6 years. The median time spent by the students on the mobile phone using different features of mobile phone was 3.5 hours. Majority of the students i.e. 157 (68.5%) use mobile phones at night. The median amount of money spent on recharge per month was 500. Age of student was significantly (P <0.05) associated with calls per day. There was no significant association of pattern of mobile phone use with other selected socio-demographic variables
Conclusions: Students were found to use mobile phone excessively. The pattern of mobile phone usage among the students in this study may signal the evolution of mobile phone use from a habit to an addiction.
Prevalence and Factors Associated with Microalbuminuria among Type 2 Diabetic Patients : A Hospital Based Study
Authors: Khadka Bikram , Tiwari Mohan Lal , Timalsina Binod , Risal Prabodh , Gupta Suprita , Acharya Dilaram 
Published: September 2018

Introduction: Microalbuminuria is the earliest clinical evidence of diabetic nephropathy. However, prevalence and associated factors with microalbuminuria among type 2 diabetic patients has been understudied area of research in Nepalese context. This study aimed to determine the prevalence and factors associated with microalbuminuria among type 2 diabetic patients.
Methods: This study was a hospital-based cross-sectional study. Blood samples for serum creatinine, Hemoglobin A1C, Fasting blood sugar and urine sample for microalbumin and urine creatinine were collected and analyzed using validated and standardized tools from a total of 400 Type 2 diabetic patients in Devdaha Medical College and Teaching Hospital, Rupandehi, Nepal from August 2014 to September 2017. Microalbuminuria was defined as urinary albumin-to-creatinine ratio greater than 30 and less than300 μg /mg of creatinine
Results: Of 400 type 2 diabetic patients, 186 (46.5%) had microalbuminuria. The mean values of FBS, HbA1C, serum creatinine, microalbumin, microalbumin/urine creatinine ratio were higher in microalbuminuria group. Microalbuminuria was significantly positively correlated with duration of diabetes, FBS, HbA1C, serum creatinine, microalbumin, microalbumin/ urine creatinine, systolic blood pressure and diastolic blood pressure (P< 0.01).
Conclusions: Our study demonstrated that nearly half of the type 2 diabetic patients had microalbuminuria. Our results emphasize to increase to accessibility to microalbuminuria testing for all the type 2 diabetic patients and bring them under medical supervision to reduce the unwanted complications of diabetes mellitus.
Natural Orifice Transluminal Endoscopic Surgery (NOTES)-an Emerging Technique in Surgery
Authors: Shrestha BM 
Published: September 2018

Natural orifice transluminal endoscopic surgery (NOTES), which utilises natural anatomical passages for gaining access to the intra-abdominal organs for surgical interventions, that result in scarless surgery, is a recent advancement in the specialty of minimally invasive surgery and has gained significant momentum, It has been postulated as a promising alternative to laparoscopic surgery in the fi eld of minimal invasive surgery. Signifi cant advantages over conventional open surgery, such as less postoperative pain, a shorter hospital stay, early return to activity, avoidance of woundrelated complications and better cosmesis have been demonstrated. This article provides an update in the development, principles, practice and future applications of NOTES.
Keywords: natural orifice, minimally invasive, scarless, endoscopic surgery.
Perceptions of Medical Students About Bedside Teaching in a Medical School
Authors: Dhakal Ajaya Kumar , Shrestha Devendra , Bajracharya Suraj , Pradhan Amita , Karki Balman Singh , Dhakal Sanjaya 
Published: September 2018

Introduction: Bedside teaching is an important and established learning tool in medical education. However there is a decline in bedside teachings over the years throughout the world including Nepal, due to advancement in medical technology, clinical skills labs and simulation techniques. This study aimed to find out the perception of Nepalese medical students towards different domains of bedside teaching.
Methods: This was a descriptive cross-sectional study. A questionnaire consisting of Likert scale, open ended and closed ended questions was developed on different aspect of bedside teaching and the filled questionnaires were included for analysis.
Results: Three hundred and six questionnaires were included. Almost all of medical students responded that bedside teaching is a useful learning modality in clinical teaching 304 (99.3%) and provides active learning in real context 291 (95%). The majority of medical students 233 (76%) were satisfied with the steps of history taking, examination followed by management discussion employed at bedside teaching. The students 223 (73%) were satisfied, how to elicit signs following demonstration of clinical exam by teachers at bedside. However majority 196 (64%) felt lack of individual opportunity at bedside. According to students, focussing more on practically oriented clinical skills with proper supervision would improve learning while hindering factors were large number of students and patient’s uncooperativeness. Good communication was considered the best method of alleviating patient discomfort at bedside teaching in this study.
Conclusions: The study concluded that medical students have positive response and learning attitudes towards different aspects of bedside teaching.
Pleural fluid serum bilirubin ratio for differentiating exudative and transudative effusions
Authors: Agrawal Pawan , Shrestha Tirtha Man , Prasad Pratap Narayan , Aacharya Ramesh Prasad , Gupta Priyanka 
Published: September 2018

Background: In pleural effusion, differentiating exudative and transudative fluid is an important clinical evaluation. The objective of the study was to determine the efficacy of pleural fluid serum bilirubin ratio in differentiating exudative and transudative effusions. In resource-limited settings with no facilities to measure lactate dehydrogenase (LDH) levels, using pleural fluid bilirubin ratio may help in better clinical decision.
Methods: It was a prospective observational study, conducted in the emergency department of Tribhuvan University Teaching Hospital. All the patients attending for emergency care with pleural effusion from 6th Jan 2015 to 5th Jan 2016 were included. The cases were divided as exudates and transudates on basis of final diagnosis. Serum and pleural fluid specimen were collected and sent for investigations. The data for various laboratory parameters especially those of lights criteria and bilirubin ratio were then analyzed and fluid nature was compared with results from parameters and final diagnoses.
Results: Among 103 cases, 71.84% had exudate and 28.16% had transudate. The commonest cause of effusion was pneumonia 35.92%, second being tubercular 23.30% followed by malignant effusion 12.60%, congestive heart failure 11.65%, chronic kidney disease 10.67% and liver cirrhosis 5.82%. The mean bilirubin ratio for exudates exceeded that for transudates. Considering the cutoff point of 0.6, the sensitivity, specificity, positive predictive value and negative predictive value were respectively 88.00%, 93.00%, 97.00% & 75.00%.
Conclusions: Pleural fluid serum bilirubin ratio can be utilized as a diagnostic tool for differentiating exudative and transudative effusions.
Keywords: bilirubin ratio; exudates; light’s criteria; pleural effusion; transudates.
Acute Intradialytic Complications in End Stage Renal Disease on Maintenance Hemodialysis
Authors: Agrawal R K , Khakurel S , Hada R , Shrestha D , Baral A 
Published: September 2018

Introduction: Hemodialysis is the preferred method of treatment for Nepalese patients with End Stage Renal Disease. Despite the technological advances and better understanding of physiology associated with hemodialysis, a number of complications are known to be associated with hemodialysis. This study was undertaken to study the frequency of acute intradialytic complications in patients undergoing hemodialysis.
Methods: A cross-sectional study was conducted at Nephrology unit of a tertiary care hospital from 15 June, 2007 to 15 December, 2007. A total of 28 patients were included in the study. Patients with acute renal failure and acute on chronic renal failure were excluded from the study.
Results: Total sessions of hemodialysis during the period were 1455. Hypotensive episode were 66 (4.5%) and was the commonest complication and followed by hypertensive episodes were 58 (3.8%). Other problems encountered were transfusion reactions were 23 episodes (1.5%), rigors not related to transfusions were 13 episodes (0.8%), nausea/vomiting were 20 episodes (1.4%), muscle cramps were 12 episodes (0.8%), hypoglycemia were 6 episodes 5(0.4%).
Conclusions: The frequency of intradialytic complications is low and many of them are not life threatening.
Keywords: complications; end stage renal disease; hemodialysis; hypertension; hypotension.