bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined Treatment of Alendronate and Low-Intensity Pulsed Ultrasound (LIPUS) Increases Bone Mineral Density at the Cancellous Bone Osteotomy Site in Aged Rats: A Preliminary Study.
Authors: Aonuma H , Miyakoshi N , Kasukawa Y , Kamo K , Sasaki H , Tsuchie H , Segawa T , Shimada Y 
Published: September 2018

Introduction: During fracture healing, alendronate encourages callus volume by inhibiting bone resorption, whereas low-intensity pulsed ultrasound (LIPUS) enhances bone regeneration by promoting an anabolic response.
Methods: In the present study, 9-month-old Sprague-Dawley rats, with a unilateral proximal tibial osteotomy, were treated with alendronate (daily, 1 g/kg) plus sham-LIPUS (n = 14), saline plus LIPUS (20 min/day) (n = 18), alendronate plus LIPUS (n = 16), or saline plus sham- LIPUS as a control (n = 13) for 4 weeks. The rats were then examined for changes in bone mineral density (BMD) during metaphyseal bone repair.
Results: The combined therapy signi cantly increased BMD at the osteotomy site at 4 weeks (p < 0.001) compared with the control, without affecting the contralateral, non-osteotomized tibia. Both alendronate and LIPUS alone also exerted a positive, albeit less, effect on BMD in the affected limb (p < 0.001 and p = 0.006, respectively).
Conclusions: Alendronate and LIPUS cooperate to enhance BMD during metaphyseal bone healing.
Keywords: LIPUS, bisphosphonate, bone mineral density.
Tamoxifen for Breast Cancer
Authors: Karn A , Jha A K , Shrestha S , Acharya B , Poudel S , Bhandari R B 
Published: September 2018

Breast cancer is one of the common cancers. Hormonal therapy along with surgery, chemotherapy, radiotherapy and targeted therapy are vital modalities for the management of breast cancer. Tamoxifen has been the most widely used hormonal therapy for more than two decades. In this article we review the benefits, dose, duration and timing of Tamoxifen therapy in patients with breast cancer.
Keywords: breast cancer, hormonal therapy, tamoxifen.
Risk Factors associated with Still Births
Authors: Shrestha S R , Yadav B K 
Published: September 2018

INTRODUCTION:
Still birth is a common adverse outcome of pregnancy, associated with many risk factors like prematurity, infection, birth injury, eclamptic disorders.
METHODS:
A hospital based, retrospective study was conducted at Patan Hospital in the year 2064. The number of still births and their associated risk factors were assessed.
RESULTS:
There were three thousand and five hundred and eighty eight deliveries. Among all deliveries, still birth cases were counted forty seven with a rate of 14 per thousand deliveries. The major risk factors were prematurity, low birth weight, fetal distress and maternal jaundice.
CONCLUSIONS:
Prematurity was the commonest risk factor for still birth.
Education of Adolescents on Reproductive Health- Which way to Go
Authors: Roy S 
Published: September 2018

INTRODUCTION:
The study was done to assess the educational needs of the adolescent girl students regarding their reproductive health.
METHODS:
The data were collected by administering an open-ended self-administered questionnaire to the participating students seeking their opinion on several issues related to adolescent reproductive health.
RESULTS:
The students preferred their teachers next only to doctors as health educator. Their health problems included menstrual problems, weakness, eye problems, headache and weight gain. Other problems were tension with studies, inability to concentrate, depression and irritability. Two most important areas of their concern are safe motherhood and AIDS.
CONCLUSIONS:
Need exists for reproductive health education.
Keywords: adolescent, reproductive health education, school.
Bacteriology and Antibiotic Susceptibility Pattern of Peitonsillar Abscess
Authors: Acharya A , Gurung R , Khanal B , Ghimire A 
Published: September 2018

INTRODUCTION:
Peritonsillar abscess is a common complication of acute tonsillitis. Its management consists of aspiration or surgical drainage followed by appropriate antibiotics. Appropriate antibiotic treatment depends on the common organisms associated with infection and their antibioticsensitivity pattern in local scenario.
METHODS:
Pus samples aspirated from diagnosed cases of peritonsillar abscess and submitted for culture and sensitivity in last two years were included in this study. Identification of different microorganisms was made on the basis of the microscopic findings, observation of their colony morphology and standard biochemical reactions. Susceptibility pattern to commonly used antibiotics were determined by Clinical Laboratory Standards Institute (CLSI) guidelines.
RESULTS:
Altogether 24 pus samples were included in the study. Positive culture was obtained from 18 samples. Among them one organism was isolated from 13 samples whereas from five samples multiple organisms were isolated. From six samples no organisms could be cultured. Altogether Streptococcus pyogenes was isolated from 12 samples and Staphylococcus aureus from five samples. Other isolated organisms included Haemophlilus influenzae, Pseudomonas aeruginosa, Escherichia coli and Enterococcus species. Penicillin was effective for Streptococcus pyogenes whereas Staphylococcus aureus was resistant to it. Cloxacillin was found to be effective for Staphylococcus aureus. Ciprofloxacin and Ceftazidime were found to be effective for both organisms.
CONCLUSIONS:
Streptococcus pyogenes and Staphylococcus aureus were more commonly associated with peritonsillar abscess. Streptococcus pyogenes were sensitive to penicillin but all Staphylococcus aureus were resistant to it. This fact should be considered in clinical practice for management of peritonsillar abscess.
KEYWORDS: Bacteriology, Peritonsillar abscess, Susceptibility pattern.
Ultrasound Versus the Landmark Technique: A Prospective Randomized Comparative Study of Internal Jugular Vein Cannulation in an Intensive Care Unit
Authors: Shrestha B R , Gautam B 
Published: September 2018

OBJECTIVE:
The aim of this study is to find out if an ultrasound technique has advantages over the conventional landmark technique.
METHODS:
This is a prospective randomized comparative study on 120 patients requiring central venous cannulation of the right internal jugular vein. The study comprised of two groups: ultrasound and landmark groups, each consisting of 60 patients. The outcome measures were compared between the groups.
RESULTS:
Cannulation of the internal jugular vein was successful in 58 patients in the ultrasound group and in 53 in the landmark group. The number of attempts was 1.5 (1 - 3) and 2 (1 - 3) in the ultrasound and landmark group respectively (p = 0.001). The time taken for the successful cannulation was 4.9 +/- 1.7 minutes in the ultrasound approach and 8.0 +/- 2.8 minutes in the landmark approach (p = 0.00). The internal jugular vein diameter in the supine position was 11.2 +/- 1.5 mm which increased to 15.04 +/- 1.5 mm with a 15 degrees head-down position in the USG group (p = 0.001). The first attempt success rate was 39/60 (63%) in the ultrasound group and 19/60 (32%) with the landmark technique. The seven (12%) failure cases in the landmark group were rescued by the ultrasound technique. Inadvertent carotid artery puncture occurred in 2/60 (3%) and 6/60 (10%) of patients in the ultrasound and land mark group respectively.
CONCLUSIONS:
Ultrasound improves success rate, minimizes cannulation time and complications during internal jugular vein cannulation. It can be employed as a rescue technique in cases of a failed landmark technique.
Keywords:cannulation, central, landmark, technique, ultrasound.
Prosthetic Replacement For Femoral Neck Fractures
Authors: Banskota A K 
Published: September 2018

Prosthetic replacement of the femoral head was performed in series of five selected patients at Shanta Bhawan Hospital, Kathmandu. Although prosthetic replacement surgery is common place in most parts of the globe, this was the first time we had undertaken this type of treatment at our hospital. We used fenestrated stem Austin Moore prosthesis in all our patients. Bone cement (methyl-methacrylate) is not readily available to us at the present and we have not yet used prosthesis with cement at our hospital. One of our patients expired in the immediate post operative period. The remaining four patients were rapidly rehabilitated and left hospital on their feet after an average in-hospital stay of about three weeks. Although it is too early right now to draw conclusions, we feel that given the selected patient, there are definite indications for this type of procedure even in the Nepalese socio-economic context. TABLE 1.Case Age Sex Side Associated conditions 1 63 M (R) ASHD, Diabetes mellitus. 2 63 M (R) ---- 3 65 M (R) ---- 4 72 F (R) Duodenal ulcer disease. 5 70 M (R)
Acute Pancreatitis in acute viral hepatitis
Authors: K.C. S , Khadka S , Sharma D , Chataut SP 
Published: September 2018

Introduction: The association of acute viral hepatitis and acute pancreatitis is well described. This study was conducted to find out the frequency of pancreatic involvement in acute viral hepatitis in the Nepalese population.
Methods: Consecutive patients of acute viral hepatitis presenting with severe abdominal pain between January 2005 and April 2010 were studied. Patients with history of significant alcohol consumption and gall stones were excluded. Acute viral hepatitis was diagnosed by clinical examination, liver function test, ultrasound examination and confirmed by viral serology. Pancreatitis was diagnosed by clinical presentation, biochemistry, ultrasound examination and CT scan.
Results: Severe abdominal pain was present in 38 of 382 serologically-confirmed acute viral hepatitis patients. Twenty five patients were diagnosed to have acute pancreatitis. The pancreatitis was mild in 14 and severe in 11 patients. The etiology of pancreatitis was hepatitis E virus in 18 and hepatitis A virus in 7 patients. Two patients died of complications secondary to shock. The remaining patients recovered from both pancreatitis and hepatitis on conservative treatment.
Conclusions: Acute pancreatitis occurred in 6.5 % of patients with acute viral hepatitis. Cholelithiasis and gastric ulcers are the other causes of severe abdominal pain. The majority of the patients recover with conservative management.
Keywords: acute viral hepatitis, acute pancreatitis, pain abdomen, hepatitis E, hepatitis A, endemic zone
Correlation of Severity of ST Segment Elevation with Respect to the Site of Right Coronary Artery Lesion
Authors: Simkhada Rabindra 
Published: September 2018

Introduction: Electrocardiogram a widely available tool may predict infarct related artery in acute inferior wall myocardial infarction. Severity of ST segment elevation may correlate with proximity of lesion in right coronary artery.Methods: Patient with acute ST segment elevation inferior wall myocardial infarction who underwent coronary angiogram was studied. Differences in electrocardiogram among right coronary and left circumflex groups were evaluated. Severity of ST segments elevation in relation to site of lesion in right coronary was studied.Results: The mean age of presentation was 59.52 ± 11.01 years. Total 36 (72%) were men. A total of 42 (84%) had lesion in right and 8 (16%) in left circumflex. Age, sex,diabetes,hypertension, smoking, dyslipidemia and physical activity showed no correlation with lesion in right or circumflex coronary artery. ST segment elevation in III>II (P=0.01), ST segment depression in AVL> I (P<0.01) and ST elevation in V4R (P=0.04), correlated with right coronary lesion. Sum of ST elevation in inferior leads were 10.90 ±1.30 mm for proximal, 7.38±1.19 mm for mid and 5.50± 0.53 mm for distal right coronary with significant correlation (P<0.01).Conclusions: Electrocardiogram was reliable tool to difference right and left circumflex lesion. Severity of sum of ST segment elevations in inferior leads correlated with the proximity of lesion in right coronary._______________________________________________________________________________________Keywords: acute inferior myocardial infarction; electrocardiogram; infarct related artery._______________________________________________________________________________________
Ocular Morbidity among Children Attending Government and Private Schools of Kathmandu Valley
Authors: Shrestha R K , Joshi MR , Ghising R , Rizyal A 
Published: September 2018

Introduction: Children from the developing world are more prone to going blind from avoidable and preventable causes. In Nepal, children in private schools are reported to have a higher ocular morbidity than those in government schools, with myopia being the major cause of the morbidity. This study was designed to evaluate ocular morbidity in students from both types of school.
Methods: This was a cross-sectional, comparative study among students from government and private schools of Kathmandu. Eye examination was carried out evaluating visual acuity, color vision, refractive status, binocular vision status, and anterior and posterior segment findings.
Results: A total of 4,228 students from government and private schools were evaluated. The prevalence of ocular morbidity was 19.56 % with refractive error (11.9 %) being the major cause of the morbidity, followed by strabismus and infective disorders. No signifi cant difference in the prevalence of ocular morbidity and refractive status was found in the students from government and private schools.
Conclusions: A signifi cant number of children of school-going age have ocular morbidity with no signifi cant difference in the prevalence in the students from government and private schools. Research exploring the effect of various risk factors in the progression of myopia would be helpful to investigate the refractive status in children from these different types of schools.
Keywords: Myopia, ocular morbidity, school Students
Sensitivity and Specificity of CT and its Signs for Diagnosis of Strangulation in Patients with Acute Small Bowel Obstruction
Authors: Jha Ashwini Kumar , Tang Wen Hao , Bai Zhi Bin , Xiao Jia Quan 
Published: September 2018

Introduction: To perform a meta-analysis to review the sensitivity and specificity of computed tomography and different known CT signs for the diagnosis of strangulation in patients with acute SBO.Methods: Pubmed search was performed for all reports that evaluated the use of CT and discussed different CT criteria for the diagnosis of acute SBO. Only articles published in English language between January 1978 to June 2008 were included. The bivariate random effect model was used to obtain pooled sensitivity and pooled specificity. Summary receiver operating curve was calculated using Meta-Disc. Software Openbugs 3.0.3 was used to summarize the data.Results: A total of 12 studies fulfilled the inclusion criteria. The pooled sensitivity and specificity of CT in the diagnosis of strangulation was 0.720 (95% CI 0.674 to 0.763) and 0.866 (95% CI 0.837 to 0.892) respectively. The ranges to pooled sensivity and pooled specificity of different CT signs are 0.309 - 0.623 and 0.717 - 0.991 respectively.Conclusions: This review demonstrates that the sensitivity and specificity of CT is high in preoperative diagnosis of strangulation in the setting of acute SBO which are in accordance with the published studies. Our analysis shows that “presence of mesenteric fluid” is the more sensitive, and “lack of bowel wall enhancement” is the more specific CT sign of strangulation, and also justifies need of large scale prospective studies to validate the results obtained as well as to determine a clinical protocol.
Role of Magnetic Resonance Imaging in Evaluation of Tubercular Spondylitis: Pattern of Disease in 100 Patients with Review of Literature
Authors: Khalid M , Siddiqui M A , Qaseem SMD , Mittal S , Iraqi AA , Rizvi SAA 
Published: September 2018

Introduction: The purpose of this study is to evaluate the role of magnetic resonance imaging (MRI) in evaluation of tubercular spondylitis and to correlate imaging findings with clinical severity of the disease.
Methods: One hundred consecutive patients, who presented with features suggestive of spinal infections, were subjected to MRI examination. T1W and STIR images were obtained followed by T2W and post-contrast T1W images. Various imaging characteristics of spinal infections were noted and correlated with the clinical severity of the disease.
Results: Backache was the most common presenting symptom present in 86 %, while paraparesis was the most common sign seen in 62 %. The neurological status of the patients correlated well with MRI findings in the majority of the cases with an overall good correlation obtained in 96 % of cases. The majority of the vertebrae and intervertebral discs affected showed hypointensity or isointensity on T1W images and hyperintensity on T2W images. Epidural/dural disease was present in 74 % while 68 % of patients demonstrated decreased intervertebral disc height. Epidural extension and subligamentous spread was in 74 % and 90 % of patients respectively.
Conclusions: MRI plays a vital role in early and accurate diagnosis of spinal infections. It is non-invasive and clearly demonstrates soft tissue anatomy and pathology which makes it superior to X-rays and Computed Tomography (CT). Imaging findings of tubercular spondylitis were also found to have a good correlation with the clinical status of the patients. Hence, it is of much help in the evaluation and assessment of patients presenting with features of spinal infections.
Keywords: Magnetic resonance imaging, spinal tuberculosis, tubercular spondylitis
Three Patterns of Rising type 2 Diabetes Prevalence in the World: Need to Widen the Concept of Prevention in Individuals into Control in the Community
Authors: Bhattarai Madhur Dev 
Published: September 2018

This paper analyses the patterns of rising type 2 diabetes prevalence in the world with their plausible reasons focusing on control measures. It shows existence of combinations of three patterns of rises, viz. gradual, rapid and accelerated, leading to prevalence of 4–9% now in Europids, 14–20% in migrant or urbanized Asian Indians, Arabs, Chinese, Africans, and Hispanics and above 30–50% in indigenous peoples of Canada, USA, Australia and Pacifi c regions. It demonstrates that though ageing, sedentary life and obesity of people explain gradual rise in Europids, effects of rapid transition in nutritional status of population and of maternal hyperglycaemia on the risk of offspring developing glucose intolerance further add to rapid and accelerated rises respectively. It recommends that current approach of primary prevention of diabetes in people, particularly with impaired glucose tolerance, advocating modest loss of excess weight and moderate-intensity exercise, be widen into concept of control in community covering rapid and accelerated rises. The control programmes essentially are vigorous educational campaign and planning to improve nutritional status of women of childbearing age in rural and poorer sectors of society and to keep weight of adults within recommended body mass index (BMI) range, like 18.5–22.9 kg/m2for Asian and other similar populations. The population-based approaches with examples, considering developing countries, are outlined. The paper emphasizes the importance of keeping prepregnancy weight optimum, preferably below the middle of recommended BMI range, to avoid even sub-clinical maternal hyperglycemia, for prevention and control of accelerated rise in any population. Key Words: diabetes, diabetes control, diabetes epidemiology, diabetes prevention, prepregnancy weight
Maternal and Fetal Outcome in Elective versus Emergency Cesarean Section
Authors: Suwal Anupama , Shrivastava Veena R , Giri Amrita 
Published: September 2018

Introduction: The complications of cesarean section are seen more commonly in emergency than in elective cases. The aim of this study was to find out the incidence of cesarean section in Nepal Medical College Teaching Hospital and to compare the maternal and fetal outcome in elective and emergency cesarean section.
Methods: A prospective study of all the cases undergoing cesarean section in Nepal Medical College Teaching Hospital was carried out during the period of six months from Asar 2069 to Mangsir 2069.
Results: The incidence of cesarean section was 254 (22.30%) out of which emergency cesarean section accounted for 167 (65.7%) and elective cesarean section for 87 (34.3%). The usual indications of emergency cesarean section were fetal distress, previous cesarean section in labour, non progress of labour and prolonged second stage of labour. The usual indications of elective cesarean section were previous cesarean section, breech, cephalopelvic disproportion and cesarean section on demand. There was found to be no significant difference in age, period of gestation, blood loss and blood transfusion in emergency vs. elective cesarean section. There was significant difference seen in the length of hospital stay, fever, urinary tract infection, wound infection and low APGAR in five minutes indicating that these were more common in emergency cesarean section. Significant difference was also seen in the incidence of postpartum haemorrhage indicating that it was seen more in elective cesarean section.
Conclusions: The incidence of cesarean section in Nepal Medical College Teaching Hospital is high and the overall complication rate is higher in emergency cesarean section than in elective cesarean section.Keywords: cesarean section; fetal and maternal outcome.
Retinoblastoma: Ten Years Experience at Kanti Children's Hospital
Authors: Sah Kailash Prasad , Saiju Rohit , Roy Pankaj , Kafle Sonali 
Published: September 2018

Introduction: Retinoblastoma is a malignant tumor of the embryonic neural retina. It is the most common intraocular tumor of childhood. It is a disease of early childhood with 80% cases diagnosed before the age of 4 years. The median age at diagnosis is 2 years. Bilateral cases are diagnosed earlier (median at 12 months and unilateral median age at 24 months). The incidence of retinoblastoma is approximately 1 in 15000-18000 live births in developed countries. The aim of the research is to study the clinical pathological features, treatment and survival of children with retinoblastoma over ten years.
Methods: A retrospective hospital based study was conducted from March 1998 to February 2008. Gender, age, clinical presentation, pathology reports, treatment, follow –up and outcome were recorded at time of diagnosis.
Results: A total of 42 children with retinoblastoma (85.7 % unilateral, 14.3% bilateral), with 50% having optic nerve involvement were studied. The most common presenting signs were extraoccular (28.6%), proptosis (23.8%), leukoria (23.8%), phthisis bulbi (16.7%), and strabismus (7.1%). The age at presentation ranged from 6-120 months with mean age of 46.6 months. The male to female ratio was 1.1:1.Two-thirds presented between 2-5 yrs, followed by 12-24 months (23.8%). Majority of children had poorly differentiated retinoblastoma (62 %), followed by well differentiated (28.6%), and moderately differentiated (9.5%). CEV based protocol used to treat, and over-all 10 yrs survival was 23.8 %, death 19 %, and lost to follow-up or left against medical advice 57.2%.
Conclusions: Despite severe resource limitation, pediatric oncology unit has been successfully treating retinoblastoma with the success rate of 23.8%.
Keywords: chemotherapy; outcome; remission; retinoblastoma.