bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimation of Stature from Nasal Length
Authors: Shrestha Ratindra Nath , Banstola Dinesh , Nepal Dipeshwara , Baral Prakash 
Published: September 2018

Introduction: Estimation of stature for the purpose of identification has a significant forensic importance. This technique is based on a principle that bones or human body parts correlate positively with the stature. Stature can be estimated from measurements of various body parts such as arm, leg, feet, finger, facial height, nasal height etc. The aim of study was to correlate Stature of Nepalese with Nasal height and estimate Stature from Nasal height.Methods: A cross-sectional study of 214 healthy adults comprising 110 males and 104 females in the age group of 25 to 35 years were carried out. Study was carried out in central Nepal where people from various parts of Nepal are migrated. Total body height and Nasal height were recorded with stadiometer and sliding caliper respectively.Results: The mean of total body height in the male and female was 160.4 (±6.80) cm and 151.8 (±4.88) cm respectively. The mean of nasal height in the male and female was 4.6 (±0.31) cm and 4.3 (±0.29) cm respectively. This study observed that in both male and female nasal height had positive partial correlation with stature; r = 0.18 for male and 0.19 for female. Stature in nepali population could be calculated as: Stature=148.22+3.02x nasal height in male where as Stature=133.01+3.12x nasal height in female.Conclusions: Both Nepali male and female nasal height had positive partial correlation with stature; r = 0.18 for male and 0.19 for female. Stature in Nepali population could be calculated as: Stature=148.22+3.02x nasal height in male where as Stature=133.01+3.12x nasal height in female.Keywords: estimation; stature; nasal height. | PubMed
Perineal Outcome after Restrictive use of Episiotomy in Primi-gravidas
Authors: Joshi A , Acharya R 
Published: September 2018

Introduction: Episiotomy is a common obstetrical practice that is believed to prevent severe lacerations. Principles of evidence based medicine raises questions on the utility of routine episiotomy.
Methods: A prospective observational study was conducted in primi gravidas coming to Tansen Mission Hospital for delivery who were not offered episiotomy sticking to the protocol of restrictive use of episiotomy and the subsequent perineal tear was evaluated in terms of its length, degree and complications. Risk factors associated with significant degrees of perineal tear was investigated.
Results: The episiotomy rate during the time of study was only 22%. Among those included in the study, 16.2% of women had intact perineum and majority of women (43.2%) had first degree of tear. Only one (1.4%) had third degree tear without any long term complications. Having a baby weighing 2.5 kg increases the mean tear length significantly (P=0.019) and increases the risk of having second or third degree of tear by almost two times (Relative Risk=1.95). No clinically significant complications were observed in any of the women after the delivery.
Conclusions: This study provides some evidence that the principle of restrictive use of episiotomy with a total episiotomy rate being around 20% can be carried out successfully even in an under¬resourced setting of our country.
Prescribing Skills of First and Second Year MBBS Students of A Teaching Hospital
Authors: Chapagain Kumud , Paranjape Bhaskar Diwakar , Lama Ganesh 
Published: September 2018

Introduction: To ensure safe, effective and rational prescribing by tomorrow’s doctors it is important to assess the prescribing skills of today’s medical students. The aim of this study was to assess the prescribing skills of MBBS preclinical students of a Teaching Hospital.Methods: First and second year medical students were given different sets of common clinical scenarios and asked to write a prescription for these. The physician and drug related components were analyzed following the WHO guidelines. The data were statistically analyzed using Chi-square test for 99% and 99.99% Confidence Intervals. P values < 0.01 and < 0.0001 were considered significant respectively. Results: MBBS first year student scored 123 (82%) and 94 (62.66%) in physician and drug related component respectively. MBBS second year students scored 139 (92.66%) and 111 (73.33%) in physician and drug related components respectively. Results obtained from the element prescriber's address and telephone number, date of prescription and patient’s address on the prescription of first year and second year medical students were highly significant (p<0.0001). Conclusions: Prescribing skill of first and second year MBBS students is not satisfactory. Prescribing deficiencies were found on both the physician and drug related components which emphasizes the need of adequate prescribing knowledge in order to minimize the prescription errors and irrational prescribing. Based on this study, we suggest all the undergraduate medical students should be regularly trained and evaluated to further help minimize the prescribing errors.Keywords: prescription; prescription errors; prescribing skill. | PubMed
Comparison of Fissure Healing and The Incidence of Headache Among the Patients Treated with Endo- and Perianal Application of 0.2% Glyceryl Trinitrate for Chronic Anal Fissure
Authors: Joshi Mukund Raj , Bohara Tanka Prasad , Rupakheti Shail 
Published: September 2018

Introduction: Chronic anal fissure is associated with significant morbidity and reduction in quality of life mostly in young healthy adults. Glyceryl Trinitrate, a most commonly used agent for treatment, is associated with incidence of headache causing discontinuation of treatment. There is belief that endoanal application instead of perianal is associated with lower incidence of headache. This study is to compare the incidence and severity of headache in between perianal and endoanal application of GTN ointment.Methods: Thirty patients were taken in each perianal and endoanal group. They were given orientation to apply 375gm of ointment either endoanally or perianally and to record severity of headache according to visual analogue scale. This record was noted by independent observer in telephonic conversation. Patients were followed up at 6 weeks for evaluation fissure. Results: The mean age, male female ratio and features of chronicity was similar in both the group however the duration of symptoms between the group was different. Regarding outcome, Overall incidence of headache was seen in two-third of patient with severe headache in approx. 10%. Severity of headache was slightly lower in endoanal group but the difference was not significant. Healing rate was comparable. Two patient in perianal and 3 in endoanal group were lost for follow up. Conclusions: Endoanal application of GTN ointment is associated with slight decrease in intensity of headache and is comparable with perianal application for fissure healing.
Keywords: anal fissure; endoanal; glyceryl trinitrate;headache; perianal.| PubMed
Intraventricular Taenia solium Neurocysticercosis: A Report of Three Cases
Authors: Pant B , Devleesschauwer B , Shrestha P , Shrestha I , Praet N , Dorny P 
Published: September 2018

Neurocysticercosis (NCC), caused by the pork tapeworm Taenia solium, is reported to be a common condition in Nepal. So far imaging diagnosis was mainstay of the diagnosis. In this paper, we report three patients presenting with neurological symptoms due to intraventricular NCC. We have diagnosed the causative agent as T. solium on molecular basis. Further research is warranted to assess the actual health impact of T. solium in Nepal.
Keywords: Intraventricular neurocysticerosis, PCR-RELP, Taenia solium.
Role of S-100 Immunostain as An Auxiliary Diagnostic Aid in Leprosy
Authors: Dhakhwa Ramesh , Acharya Sneh , Pradhan Sailesh , Shrestha Sanju Babu , Itoh Tomoo 
Published: September 2018

Introduction: Histopathologic diagnosis of leprosy is difficult when Bacillary Index (BI) is zero and neural involvement are not easily identifiable on routine Hematoxylin and Eosin stain. This study was undertaken to study the role of S-100 immunostaining in demonstrating different patterns of nerve involvement in various types of leprosy.
Methods: Thirty one skin biopsies with clinico-histopathologic diagnoses of leprosy over a period of two years were included in the study. Ten cases of non-lepromatous granulomatous dermatoses (including eight cases of lupus vulgaris and two cases of erythema nodosum) were used as controls. Tissue sections from all cases and controls were stained with Hematoxylin and Eosin (H&E) stain, Fite stain and S-100 immunostain. The H&E stained slides were used to study the histopathological features, Fite stained slides for Bacillary Index and S-100 for nerve changes.
Results: Neural changes could be demonstrated in the entire spectrum of leprosy using S-100 immunostaining. The most common pattern of nerve destruction in the tuberculoid spectrum was fragmented and infiltrated whereas lepromatous spectrum showed mostly fragmented nerve twigs. Intact nerves were not detected in any of the leprosy cases.
Conclusions: S-100 immunostain is a useful auxiliary aid to the routine H&E stain in the diagnosis of leprosy especially tuberculoid spectrum and intermediate leprosy.
Keywords: bacillary index; leprosy; S-100 immunostain.
Construction of Multiple Choice Questions Before and After An Educational Intervention
Authors: Tenzin Karma - , Dorji Thinley , Tenzin Tashi 
Published: September 2018

Introduction: Khesar Gyalpo University of Medical Sciences of Bhutan, established in 2014, has ushered in a new era in medical education in Bhutan. Multiple Choice Questions are a common means of written assessment in medical education.
Methods: This was a quasi-experimental study conducted at the Faculty of Postgraduate Medicine, KGUMSB, Thimphu in December 2016. A total of 8 MCQs were prepared by four teaching faculties from different fields who had no prior training on construction of MCQs. It was delivered to a group of 16 randomly selected intern doctors. A 2 hours long workshop on construction of MCQs was conducted. After the workshop, the same MCQs were modified according to standard guidelines on developing MCQs and were tested in the same group of intern doctors. An analysis on the performance, difficulty factor, discrimination index and distractor analysis was done on the two sets of MCQs using Microsoft Excel and SPSS 20.0.
Results: For the pre- and post-workshop questions respectively, the pass percentage was 69.8% (11) and 81.3% (13), difficulty factor was 0.51 and 0.53, discrimination index was 0.59 and 0.47, distractor effectiveness was 83.3% and 74.9%.
Conclusions: The workshop on MCQ development apparently seemed highly valuable and effective in changing the learning and performances of medical educators in the development of MCQs.
Keywords: difficulty factor; discrimination index; faculty development; medical education.
Plasmablastic Lymphoma
Authors: Bhusal Subecha , Acharya Bibek , Chapagain Sandhya 
Published: September 2018

Plasmablastic lymphoma is a rare and aggressive lymphoma reported to be commonly associated with immunodeficiency state. It possesses a challenge to the clinician owing it aggressiveness and poor prognosis. No standard of care treatment is available for the disease. Here we report a case of animmnocompetant 67 year female who is unique in her presentation as she did not have any of the conventional clinical features and had a history of urothelial carcinoma three months back. [PubMed]
Lower Genital Tract Trauma in a Tertiary Care Centre in Mid-Western Nepal
Authors: Adhikari Anil Kumar , Dutta Mahuya , Das Chittra Ranjan 
Published: September 2018

Introduction: The study of lower genital tract trauma has become important in gynaecological practice. There is paucity of reports on this clinical entity from our settings. The main aim of this study is to document injuries in female lower genital tract in Mid-Western Nepal.
Methods: Sixty female patients admitted to the hospital with genital tract injuries caused by coitus or accidents were included in the study. Details of the causes of trauma clinical presentations and management were recorded.
Results: These injuries were grouped according to etiological factors. This study included 33 (55%) coital injuries and 27 (45%) non- coital injuries. Out of coital injury, 12 cases were criminal assault (rape) in age group of 4 to 18 years. Four unmarried girls had consensual sex. Non-coital injuries were due to fall from height, cattle horn injuries, straddle type of trauma, vulvar haematoma and anorectal injuries.
Conclusions: Appropriate surgical intervention can avert morbidity and mortality.
Keywords: accident; lower genital tract; Nepal; trauma.
Mastoid Osteoma – Is “Trauma” A Possible Etiologic Factor
Authors: Sakthivel Pirabu , Yogal Rijendra , Sikka Kapil , Thakar Alok , Rajeshwari Madhu 
Published: September 2018

A 19 year old female presented with painful postaural swelling of three years duration with preceding history of trauma. Clinically and radilogically the diagnosis of mastoid osteoma was made. As patient was symptomatic the osteoma was removed and cortical mastoidectomy was done. We emphasise that symptomatic mastoid osteomas must be treated early even if they are small in size to prevent the development of giant osteomas. The case is reported for its rarity with relevant review of literature. To the best of our knowledge, this is the first case report in which there is a definitive history of trauma preceding the development of osteoma suggesting its possible role as an inciting factor.
Non-communicating Rudimentary Uterine Horn Pregnancy
Authors: Upadhyaya I 
Published: September 2018

Pregnancy in a non-communicating rudimentary horn is an extremely rare form of ectopic gestation. The rudimentary horn may or may not communicate with the uterine cavity with the majority of cases being non-communicating. The patient exhibits features of acute abdomen and carries a high risk of maternal death. Even modern scans remain elusive whereas laparatomy remains the confi rmatory procedure for the diagnosis. Because of the varied muscular constitution in the thickness and distensibility of the wall of the rudimentary horn, pregnancy is accommodated for a variable period of gestation. Here, we report three cases of pregnancy in a non-communicating rudimentary horn of the uterus in different periods of gestation, their outcome and a review of the available literature.
Keywords: Mullerian anomalies, non-communicating rudimentary horn pregnancy, surgical management.
Correlation of Visual Prostate Symptom Score with International Prostate Symptom Score and Uroflowmetry Parameters in Nepalese Male Patients withLower Urinary Tract Symptoms
Authors: Bhomi Krishna Kaji , Subedi Neeraj , Panta Prem Prasad 
Published: September 2018

Introduction: International prostate symptom score is a validated questionnaire used to evaluate the lower urinary tract symptoms in benign prostatic hyperplasia. Visual prostate symptom score is a new simplified symptom score with pictograms to evaluate the same. We evaluated the correlation of visual prostate symptom score with international prostate symptom score and uroflowmetry parameters in Nepalese male patients with lower urinary tract symptoms.Methods: Male patients aged ≥40 years attending the Urology clinic were enrolled in the study. They were given international prostate symptom score and visual prostate symptom score questionnaires to complete providing assistance whenever needed. Demographic data, examination findings and uroflowmetry parameters were noted. Correlation and regression analysis was used to identify correlation of the two scoring systems and uroflowmetry parameters.Results: Among the 66 patients enrolled, only 10 (15.15%) patients were able to understand English language. There was a statistically significant correlation between total visual prostate symptom score and international prostate symptom score (r= 0.822; p<0.01). The correlations between individual scores of the two scoring systems related to force of urinary stream, frequency, nocturia and quality of life were also statistically significant. There was also a statistically significant correlation of both scores with maximum flow rate and average flow rate.Conclusions: There is a statistically significant correlation of visual prostate symptom score with international prostate symptom score and uroflowmetry parameters. IPSS can be replaced with simple VPSS in evaluation of lower urinary tract symptoms in elderly male patients.Keywords: correlation; international prostate symptom score; lower urinary tract symptoms; uroflowmetry; visual prostate symptom score. [PubMed]
Giant Sialolith of Submandibular Duct
Authors: Sakthivel Pirabu , Yogal Rijendra , Singh Sanjoy , Sharma Prateek , Singh Chirom Amit 
Published: September 2018

Sialolithiasis is one of the most common diseases of salivary glands and commonly involves submandibular gland and ducts. “Giant sialoliths” typically measure more than 15 mm in any dimension. Here, an unusual case of sialolith in submandibular duct is reported which progressed into a giant sialolith in six months’ time is reported. A 42-year-old man presented with complaints of recurrent pain and swelling in the right submandibular area. A large stone was palpable intraorally within the Wharton’s duct and intra-operatively, an elongated giant sialolith of 50 mm length was found which is the second largest to be published till date. [PubMed]
Acute Upper Gastrointestinal Bleeding in a Tertiary Care Centre of Nepal
Authors: Paudel Mukesh Sharma , KC Sudhamshu , Mandal Amrendra Kumar , Poudyal Nandu Silwal , Shrestha Ramila , Paudel Bidhan Nidhi , Chaudhary Sitaram 
Published: September 2018

Introduction: AUGIB is characterized by hematemesis or melena or both. Peptic ulcers and variceal bleed account for majority of cases. Use of proton pump inhibitors in current era is associated with a gradual reduction in burden of peptic ulcer disease. We conducted this study to look into the cause of AUGIB in our community.Methods: We studied 100 patients in one year period who presented to us with hematemesis or melena. The study was conducted in department of Gastroenterology, Bir hospital, Kathmandu. We identified the culprit lesions by upper gastrointestinal endoscopy.Results: The average age of patients with AUGIB was 51.6 years with 59 (59%) males. Duodenal ulcers are most common 29 (29%), followed by varices 23 (23%) and gastric ulcers 14 (14%). More than one lesion was identified in 38 (38%) patients. Patients with variceal bleed were more likely to present with hematemesis alone as compared to those with ulcer bleed (p=0.005). Variceal bleed patients presented earlier to the hospital (p=0.005), had lower MAP at presentation (p=0.0002), had lower hemoglobin level (p=0.0001) and higher serum creatinine level at presentation (p=0.001). Patients with variceal bleed were more likely to have consumed alcohol 20 (86.9%) and patients with ulcer bleed were more likely to be smokers 29 (67.4%) or consume tobacco 14 (32.5%) (p=0.006).Conclusions: Ulcer related bleeding is still the most common cause of AUGIB. Many patients with AUGIB have more than one lesions identified during upper gastrointestinal endoscopy.Keywords: bleeding; endoscopy; peptic ulcer; upper gastrointestinal;varices. [PubMed]
C-reactive Protein in Periodontitis and its Comparison with Body Mass Index and Smoking Behaviour
Authors: Gupta Sujaya , Pradhan Shaili , KC Sushil , Shakya Sonika , Giri Mohana 
Published: September 2018

Introduction: Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. In addition to declining oral health, there is always low grade infection present in periodontitis. Studies show increased levels of systemic biomarkers in periodontal disease such as CRP, which is considered a key-marker of CVD. Research has also shown positive association between BMI and smoking with periodontitis and CRP. The objective of the study was to assess the levels of CRP in patients with and without periodontitis and their relation with BMI and smoking behaviour.Methods: Patients visiting the Dental department of Bir Hospital were invited to participate in the study. Total 31 subjects in each group: Case (periodontitis) and Control (without periodontitis) were selected using convenience sampling technique. All subjects underwent periodontal examination by a single examiner. Serum CRP samples were taken before periodontal treatment. Data analysis was done by SPSS 17 software program.Results: Increase in mean CRP levels in periodontitis (5.8595mg/L) with high statistical significance (p=0.000) in comparison to subjects without periodontitis (1.1214mg/L) was observed. BMI showed positive association with periodontitis (p=0.046) but not with CRP (0.213). Smoking behaviour showed no significant relation with either CRP (p=0.344) or periodontitis (p=0.541).Conclusions: We found highly significant association between periodontitis and CRP levels but not always with BMI and smoking. CRP, which is an established marker for CVD was significantly increased in periodontal infections. Hence, a close interaction among Physician, Periodontist and Patient to prevent adverse health situations is recommended.Keywords: body mass index; cardiovascular disease; c-reactive protein; periodontitis; smoking; systemic inflammation. [PubMed]
Approximation of Height of an Individual Using Somatometry of Human Male Skull
Authors: Acharya Jenash , Shetty B Suresh Kumar , Shrestha Rijen , Kanchan Tanuj 
Published: September 2018

Introduction: Numerous population specific studies conducted on skeletal remains have aimed to standardize the identification process. Known for ethnic and sexual variations, skull bone can also assist the identification process by estimating stature of the individual. The present study focuses on estimation of stature from skull bone using uni-variate and multi-variate regression models in south Indian population.Methods: Stature and Maximum cranial length, Maximum cranial Breadth, Bi-Pterion breadth, Parietal Cord and upper facial breadth were measured in wet skulls of 113 males, autopsied at Government Hospital of Kudla, Karantaka.Results: All five measurements showed significant correlation with stature (P value<0.001). MCL showed the highest (r=0.77) and UFB the lowest (r=0.42) degree of correlation. Standard error of estimate was lowest for MCL (4.90 cm) in the derived uni-variate regressions models. In the regression model obtained from the multi-variate analysis using all five skull measurements the β-coefficients were significant (P value<0.001) and the Standard Error of Estimation of the model was observed to be 4.45 cm. Bland-Altman analysis was conducted to explore the agreement between the actual length and the estimated lengths from the multivariate regression model. The mean of difference was 0.105 with a standard deviation of 4.3 and the upper and lower limits of agreement were 8.5 and -8.3 respectively.Conclusions: The study concludes that stature can be estimated from skull measurements with reasonable accuracy, observations of multi-variate regression models being more precise than the uni-variate regression models. Data collected from South India was compared with data available for Nepalese population and validates the use of data of Indian population for extrapolation in Nepalese population.Keywords: identification; linear regression; stature; skull; South India. [PubMed]