bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age of Individuals Undergoing Cleft Lip and Cleft Palate Surgeries in Nepal
Authors: Rai Shankar Man , Nakarmi Kiran , Basnet Surendra , Shakya Pramila , Nagarkoti Krishna , Ghartimagar Mangal , Karki Bishal , Hirachan Suzita 
Published: September 2018

Introduction: Timely repair of cleft lip and palate maximises the benefits of surgery. Developing countries have large number of adults with unrepaired clefts. The impact of a cleft program can be determined by observing the trends of lower age at surgery. Public Health Concern Trust, Nepal has been providing a comprehensive nationwide cleft service since 1999. This study was conducted to see any change in the age at surgery.
Methods: A retrospective cross sectional study was conducted to analyse the data of all the individuals’ age at primary cleft surgery from July 1999 to June 2010. Mean and median age of individuals as well as the proportion of individuals operated on at the right age in different years were calculated and compared.
Results: The median age for cleft lip surgery decreased from 100 to 24 months. Similarly the median age for cleft palate surgery decreased from 70 to 28 months. Proportion of surgeries carried out in the recommended age also increased. A change in the policy of the program reaching out to more remote areas and removing the age barrier for surgery resulted in older adults receiving surgery and increased median age especially for cleft palate repairs.
Conclusions: A nationwide cleft program for a decade had a small impact on age at surgery. There are still many individuals who are missing the ideal age for surgery. The program needs to reach more remote areas. This information will be useful for governmental as well as non-governmental organizations working in the area of clefts.
Keywords: age; cleft lip; cleft palate; Nepal.
Chronic Suppurative Otitis Media Atticoantral- Type Undergone Canal Wall Down Mastoidectomy in a Peripheral Government Hospital of Nepal
Authors: Paudel Dhundi Raj 
Published: September 2018

Introduction: Chronic suppurative otitis media is a severe type of chronic ear infection which is quite common in all geographical situations of Nepal. The mainstay of treatment of this disease is surgery, preferably of canal down method. The objective of the study was to identify the common presentation(s) and the clinical and operative finding(s) in patients with chronic suppurative otitis media attico-antral type and evaluation of efficacy of canal-wall down mastoidectomy in the achievement of dry ear and change in hearing in a setting of a peripheral hospital of Nepal in terms of subjectivity. Per-operative evaluation of mastoid cavities in terms of types of pathologies and post- operative assessment of ears in terms of achieving a dryness and change in hearing ability was carried out in the ENT Department, Bharatpur Hospital , Chitwan, Nepal. Study was done from January 2005 to December 2010.
Methods: Seventy three patients with chronic suppurative otitis media atticoantral- type were evaluated preoperatively in terms of gross pathologies. Postoperatively, patients were subjectively evaluated twice in six months in reference to persistent ear discharge and change in hearing ability.
Results: By six months of surgery, 75% of the patients had no discharge. Fifty two patients did not experience any change in hearing ability. Only 16% experienced betterment in hearing while 19% had diminution in hearing.
Conclusions: Canal wall down mastoidectomies are very effective in controlling otorrhoea and complications related to chronic suppurative otitis media attico-antral type.
Keywords: Chronic suppurative otitis media attico-antral (CSOM-AA) type; CWD masoidectomy; CWU mastoidectomy; ear cavity.
Histomorphology Spectrum of Gall Bladder Pathology in Cholecystectomy Specimens with Clinical Diagnosis of Chronic Cholecystitis
Authors: Kafle Santosh Upadhyaya , Sinha Arvind Kumar , Pandey Sagar Raj 
Published: September 2018

Introduction: Chronic cholecystitis is a common disease in surgery where majority of cholecystectomy are performed. This study was carried out to see histomorphological pattern of gallbladder diseases, staining pattern with various stains and prevalence of carcinoma.
Methods: This prospective study was conducted in the department of Pathology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal from January to December 2008. A minimum of fifty random samples were included in study. Clinical details and pathological data were retrieved from case sheets and patient’s history. All specimens were fixed in 10% formalin. Three sections each from neck, body and fundus were taken. Tissues were processed in an automated tissue processor and paraffin blocks made. The tissue sections were examined under light microscope after hematoxylin-eosin, neutral mucin, sulfated mucin and sialomucin stain.
Results: Chronic cholecystitis without cholelithiasis constituted majority of 25(50.0%) cases with M: F of 1: 7.1. The gastric and intestinal metaplasias were present in 33.0 % and 8.0% of the cases respectively. The neutral, sulfated and sailomucin were positive in 35.0 %, 21.0 %, 1.0 % and 34.0 %, 21.0 %, 1.0% cases respectively in gastric and intestinal metaplasia. Both gastric and intestinal metaplasia showed significant p-value on sulfated mucin.
Conclusions: The increase risk factors for developing of chronic cholecystitis were seen in female gender (86%). The gastric and intestinal metaplasia showed positivity more with neutral followed by sulfated mucin.
Keywords: chronic cholecystitis; metaplasia; mucins.
Kikuchi- Fujimoto Disease of Mesenteric Lymph Nodes Mimicking Acute Appendicitis
Authors: Shrestha Anne , Newton Katie , Benbow Emyr , Kushwaha Rajeev 
Published: September 2018

Kikuchi-Fujimoto disease, or histiocytic necrotising lymphadenopathy of unknown aetiology, is a rare, benign and self-limiting cause of lymphadenopathy often involving the cervical nodes, and rarely presenting with mesenteric lymphadenopathy. We present a 26-year-old Caucasian male, who presented with right iliac fossa pain and low grade pyrexia, mimicking acute appendicitis. He underwent a laparatomy and an extended right hemi-colectomy for a caecal mass. Histology of the specimen showed lymph nodes with extensive areas of necrosis, with abnormal architecture suggesting Kikuchi-Fujimoto lymphadenopathy. This was further confirmed by immunohistochemistry. In this context maintenance of a high index of suspicion of this condition can avoid major surgical interventions. We describe the management of our case of Kikuchi-Fujimoto’s disease involving the mesenteric nodes and provide an up to date review of the pertinent literature on this subject.
Keywords: abdominal mass; Kikuchi- Fujimoto disease; mesenteric lymphadenopathy; necrotising lymphadenitis.
Safe Delivery Care: Policy, Practice and Gaps in Nepal
Authors: Bhandari Tulsi Ram , Dangal Ganesh 
Published: September 2018

Delivery care is regarded as safe when it is attended by a skilled birth attendant either at health facility or home. Childbirth practices differ from place to place and are determined by availability and accessibility of health services. After National Health Policy (1991), Nepal has focused on safe motherhood policies and programmes. Maternal mortality ratio decreased nearly fourfold between the years 1990 to 2011. The country is likely to achieve the Millennium Development Goal (MDG) 5. However, indicators of the MDG 5: skilled care at birth and institutional delivery rates are very far from the targets. From the initial findings of limited studies, safe delivery incentive programme has been successful for increasing the skilled care at birth and institutional delivery and reducing the maternal mortality twofold between the years 1990 to 2011. In spite of numerous efforts there is a wide difference in the utilization of skilled care at birth among the women by area of residence, ecological regions, wealth quintiles, education status, age and parity of women, caste ethnicity and so forth. This difference indicates that current policies and programmes are not enough for addressing the low utilization of safe delivery care throughout the country.
Keywords: delivery practices; gaps; Nepal; place of delivery; safe delivery care policy.
The Treatment of Visceral Leishmaniasis: Safety and Efficacy
Authors: Jha Rajesh Kumar , Sah Ajit Kumar , Shah Dev Kumar , Sah Phoolgen 
Published: September 2018

Visceral leishmaniasis is the disease of poor; however availability of only expensive treatment of this disease impinges the socioeconomic condition of those affected. If untreated, almost all cases of visceral leishmaniasis are fatal. The demonstration of the leishmania donovani bodies from the tissue aspirates or serological tests confirms the diagnosis of the disease. Pentavalent antimony, amphotericin B, paromomycin, diamine pentamidine, miltefosine, sitamaquine and some new combinations are integrated in the limited therapeutic armoury for treatment of visceral leishmaniasis. The recommended first and second line therapy in the Indian sub-continent is miltefosine and amphotericin B respectively.Pentavalent antimonial, preceding first line therapy, has been replaced by miltefosine due to former increasing failure rate and toxicity.The problem of drug resistance, some of the serious drug toxicities along with high-priced drugs extends challenges equally to pharmaceutical companies and medical practitioners.More research on adverse drug events for the existing drugs and efforts to develop safer and effective drugs to counter resistance outbreaks for the successful management of visceral leishmaniasis are needed.
Keywords: amphotericin; miltefosine; pentavalent antimony; paromomycin.
Luxation of Eye Ball Following Trauma - A Rare Case Presentation
Authors: Thapa R 
Published: September 2018

Luxation of the eye globe is a rare event but it carries a risk of threat to permanent vision loss if appropriate intervention is not initiated on time. Although a rare presentation following minor trauma, it is usually associated with other ocular conditions like shallow orbital socket, oppy eyelid syndrome, and exophthalmos. Prompt reduction results in restoration of full anatomical and visual recovery in otherwise healthy eyes. We herein report a case of luxation of the eye ball following trauma in a 15-year-old girl, who recovered completely after the surgrical correction and a review of the relevant literature.
Keywords: eye ball, luxation, trauma
Acute Dengue Infection in the Western Terai Region of Nepal
Authors: Pun R , Pant KP , Bhatta DR , Pandey BD 
Published: September 2018

Introduction: Dengue fever is an emerging mosquito borne disease in Nepal claiming substantial morbidity and mortality. The objective of the study was to fi nd out frequency of acute dengue infection in patients from the hospitals of the western Nepal.
Methods: The study was conducted between August 2007 and July 2008 in patients visiting hospitals of the western terai of Nepal with chief complains of fever. The sero-diagnosis of acute dengue infection was determined by enzyme linked immunosorbent assay among 239 patients visiting Lumbini Zonal Hospital, Butwal; Bheri Zonal Hospital, Nepalgunj; Bardiya District Hospital, Bardiya and Mahakali Zonal Hospital, Mahendranagar.
Results: The anti-dengue IgM positivity was 29.3 %. There was slight male preponderance with a male to female ratio of 1.2:1. Out of the total positive cases, the highest positive cases (75.7 %) were from the age group 15 - 50 years followed by < 15 years old (15.7 %). Out of four hospitals, the highest positive cases (54.3 %) were in Lumbini Zonal Hospital, Butwal. The age and gender were independent predictors to dengue virus infection. The highest numbers of dengue positive cases were in October (52.6 %). The association between dengue disease and the month was statistically significant.
Conclusions: The dengue positivity was estimated in acute patients from hospitals of western Nepal by enzyme immunoassay. Therefore, the serological marker can be used to diagnose acute patients of dengue during outbreaks.
Keywords: dengue, ELISA, post monsoon, sero-diagnosis
Socio-Demographic Correlates in Patients with First Episode Depression in a Tertiary Hospital
Authors: Dhungana Saraswati , Ojha Saroj Prasad , Chapagain Manisha , Tulachan Pratikchya 
Published: September 2018

Introduction: Depression is the most chronic mental illness that afflicts mankind.It is widely believed to be the disease affecting mainly female gender, economically disadvantaged group with low level of education and those residing in the urban setup.There are only few studies looking into the socio-demographic correlates of depression in the context of Nepal. Methods: We looked at 70 patients with new-onset depression who met the criteria for diagnosis of depression as per ICD-10 DCR. A self- designed semi- structured proforma was developed to obtain the socio-demographic variables and was filled in the OPD and the data were analyzed.Results: Mean age of the patients was 30.30±9.75 years and 70% of the patients were females. There were almost equal number of patients residing in and out of Kathmandu valley. Most of the patients had attained secondary level of education and were married, housewives and belonged to nuclear family. Majority were Hindus, Brahmins, and from middle class family.Conclusions: We found that patients with first episode depression were relatively young with female predominance most attaining at least secondary level of education; and most belonging to middle class nuclear families.Keywords: depression; ICD- 10 DCR; socio-demographic correlates.
Substance Use among Medical Students in Kathmandu Valley
Authors: Khanal P , Ghimire R H , Gautam B , Dhungana SK , Parajuli P , Jaiswal AK , Khanal B 
Published: September 2018

Introduction: Substance use including tobacco and alcohol is the most important cause of preventable morbidity, disability, and premature mortality. The study aims to specify the prevalence and the pattern of use of different substance.
Methods: A cross sectional study was performed amongst first year and final year students in four medical colleges in Kathmandu using self administered anonymous questionnaire.Data collectedfrom 446 students were analyzed.
Results: Prevalence of substance use was found to be 60.3% among the medical students. Alcohol (57.6%) was the substance most prevalently used followed by tobacco (27.58%) and cannabis (12.8%). Mean age of first exposure was 17.94 (Confidence interval: 17.91-17.97). There was significant difference in the useof tobacco and cannabis amongst final year students than first year students. Male and female differed significantly in use of every substance except for benzodiazepine. Medical college, college and school were place of first exposure in 17.26%, 15.92% and 13.23% of the cases respectively. Family history was associated with substance use in medical students and was statistically significant (P<0.0001).Experimentation was the major reason for the use of most of the substances.
Conclusions: Substance use is prevalent in male medical students of both first and final year. Hence steps should be initiated early in school, college and medical college to prevent substance use.
Keywords: alcohol, medical students, substance use, tobacco.
Role of Biochemical Investigation in Prediction of Biliary Etiology in Acute Pancreatitis
Authors: Bohara Tanka Prasad , Parajuli Anuj , Joshi Mukund Raj 
Published: September 2018

Introduction: Acute pancreatitis is common clinical resentation. Gall stone disease and alcohol consumption are most common etiologies. Detection of biliary etiology is important in order to provide definite management in form of cholecystectomy to prevent further attacks. Sensitivity for abdominal ultrasound to detect cholelithiasis is decreased to 67–87% in presence of acute pancreatitis. Difference in biochemical investigations of acute biliary and non-biliary pancreatitis has been proposed to increase the suspicion of biliary etiology.
Methods: Sixty patients admitted with diagnosis of acute pancreatitis from March 2012 to December 2012 were included in the study. The relation between etiology with age, sex, admission serum amylase and liver function test were evaluated.
Results: Out of 60 patients 38 (63.33%) and 22 (36.66%) had biliary and non-biliary etiology respectively. Biliary pancreatitis was more common in females (25 vs. 3). Distribution of severity was comparable between both groups. Biliary pancreatitis group had significantly higher amylase level (3466.42 vs. 1987.5, p 0.003) whereas values of liver function test were higher in biliary pancreatitis though not statistically significant.
Conclusions: A simple, rapid and accurate prediction of biliary etiology of acute pancreatitis can be provided by changes in biochemical parameters.
Keywords: Acute Pancreatitis; Biliary Pancreatitis; Serum Amylase.
Multidisciplinary Cooperation in a Simultaneous Combined Liver and Kidney Transplantation Patient of Primary Hyperoxaluria
Authors: Qingqi Ren , Weiqiang Ju , Dongping Wang , Zhiyong Guo , Maogen Chen , Xiaoshun He 
Published: September 2018

Primary hyperoxaluria type 1 is an autosomal recessive hereditary glyoxylate metabolism disorder characterized by excessive production of oxalate, caused by the deficiency of liver specific peroxisomal enzyme: alanineglyoxylate aminotransferase. For patients with end-stage renal disease, combined liver and kidney transplantation was needed. This report describes one patient, with a diagnosis of end-stage renal disease and primary hyperoxaluria 1 confirmed by PCR and direct sequencing with genomic DNA, received the simultaneous combined liver and kidney transplantation after seven months’ waiting. However, there were several complications observed post surgery, such as protracted bleeding, common bile duct anastomotic stenosis, biliary calculi and recurrence of urolithiasis. All these were well solved by relevant department, and finally a satisfactory outcome was achieved. Multidisciplinary cooperation plays an important role on the PH1 patient management, especially when multiple complications are encountered.
Keywords: primary hyperoxaluria type 1; end-stage renal disease; liver transplantation; kidney transplantation.
Strategy of Making Hand Washing a Routine Habit: Principles of 5Es and 3Rs
Authors: Kandel Nirmal , Lamichhane Jaya 
Published: September 2018

Regular hand washing habit has potential to reduce morbidity and mortality due to diseases and improves child development and reduces absenteeism of children, teachers and workforce. Improving hand washing behavior is more cost effective than improving clean water and sanitation infrastructure. There are numbers of initiatives and interventions in place, which have gained momentum with key messages of a call to action with increasing investment in schools, engaging policy makers and demonstration them with evidence. However, change in behavior as a routine habit has not reached to an optimum level and requires institutionalizing hand washing practices in schools, from schools and by schools and develop it as a curriculum. Therefore, we are purposing principles of 5Es and 3Rs – a strategy to make hand washing a routine habit. These 5E principles are: i) Embedding in a system, ii) Enabling Environment, iii) Eliminating Friction, iv) Encouraging all, and v) Establishing intervention and 3Rs are practicing them Religiously, Routinely and Repeatedly.Numbers of interventions have well demonstrated that hand hygiene educational interventionscan help maintaining good practices. Finally, if schools and community start doing today, we canobserve behavioral change practices for hand washing as a routine habit by at least 10 years after.Keywords: Hand washing, Routine Habit, Principles of 5Es and 3Rs, Educational Interventions, School. | PubMed
Finasteride and Tamsulosin Combination in Benign Prostatic Enlargement in a Tertiary Hospital
Authors: Shrestha Binod Bade , Karmacharya Mikesh 
Published: September 2018

Introduction: Due to aging of the general population, prevalence of Benign Prostatic Enlargement is increasing. Symptoms of BPE may vary between the patients. Aim of the study was to analyze and compare the usefulness of combination drugs therapy and monotherapy after a trial period of six months.
Methods: Out of 100 male patients aged 45 years and above diagnosed with BPE, 92 were included in the study. Patients were randomized using computer generated random number table. Of which, 47 patients received combination therapy with Tamsulosin plus Finasteride and 45 patients received monotherapy with Tamsulosin once daily at bed time.
Results: The baseline demographic variables were comparable in both groups. The decrease in the total American Urological Association symptom score was statistically significant in the combination group (p<0.0001) as compared to monotherapy (p=0.0715) respectively. There was a statistically significant reduction in the residual urine volume with combination therapy (p<0.0001) than in patients with monotherapy (p= 0.1271).
Conclusions: The combination therapy is effective in decreasing the irritative and obstructive symptoms in patients with BPE than monotherapy.
Keywords: AUA symptom score; benign prostatic enlargement; finasteride; post voidal residual urine;
tamsulosin.
Cytological Diagnosis of Primary Thyroid Tuberculosis
Authors: Goyal Prashant , Mittal Deepti , Ghosh Soumyesh , Agrawal Dipti , Sehgal Shelly , Singh Sompal 
Published: September 2018

Primary thyroid tuberculosis is an extremely rare disease, even in countries where other forms of tuberculosis are abundant. TT has no age bar but usually affects women in fourth and fifth decade. Hereby, we report a case of 16-years-old girl presented with complaint of progressively increasing, painful thyroid swelling. Diagnosis of TT was made on cytology and there was no evidence of involvement of any other organ by tuberculosis. Despite of its rarity, TT is usually misdiagnosed. So, a clinician should always consider this entity in the differential diagnosis of thyroid swelling. Fine needle aspiration cytology is the best diagnostic method and can result in the avoidance of unnecessary thyroid surgeries.
Keywords: cytology; granuloma; thyroid; tuberculosis.
Unilateral Pulmonary Hypoplasia in a Child
Authors: Dewan Gaurab 
Published: September 2018

Pulmonary hypoplasia is an uncommon congenital anomaly. A case reported in a six year old male child from Bangladesh who presented with chronic dry cough, episodic fever and occasional haemoptysis causing confusion with tuberculosis. X-ray suggested lung collapse. Final diagnosis reached by combined bronchoscopy, computed tomogram scan of chest and pulmonary angiogram. In a child with complete radiological lung collapse possibility of pulmonary hypoplasia should be kept in mind.
Keywords: Bangladesh; child; congenital anomalies; pulmonary hypoplasia.
Interprofessional Care and Role of Team Leaders
Authors: Kaini Bachchu Kailash 
Published: September 2018

Interprofessional care is an essential part of the health service delivery system. It helps to achieve improved care and to deliver the optimal and desired health outcomes by working together, sharing and learning skills. Health care organisation is a collective sum of many leaders and followers. Successful delivery of interprofessional care relies on the contribution of interprofessional care team leaders and health care professionals from all groups. The role of the interprofessional care team leader is vital to ensuring continuity and consistency of care and to mobilise and motivate health care professionals for the effective delivery of health services. Medical professionals usually lead interprofessional care teams. Interprofessional care leaders require various skills and competencies for the successful delivery of interprofessional care.
Keywords: interprofessional care; team leaders; roles; competencies.