bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic Band Ligation in Patients with Variceal Bleeding
Authors: Belbase Narayan Prasad , Jalan Aditya , Upadhya Hari Prasad , Mishra Rohit , Karki Mukesh , Kumar Sujit 
Published: May 2018

Introduction: Esophageal varices (EV) affect about 50% of patients with liver cirrhosis. Mortality rate from the initial EV bleeding can rise up to 30% in patients with advanced liver disease and large varices. Several RCTs have shown endoscopic variceal banding to be more effective than sclerotherapy for the long-term prevention of variceal bleeding.Objective: This study was conducted to see the outcome of endoscopic banding in the management of esophageal varices in Nepalese population.Methodology: This was a prospective observational study conducted in the Department of Surgical Gastroenterology, College of Medical Sciences and Teaching Hospital (COMS-TH), Bharatpur, Nepal over a period of 2 years. Patients attending the COMS emergency/surgical OPD with history of UGI bleed with features consistent with portal hypertension during this period were enrolled. The endoscopic variceal band ligation was done based on similar principles applied to Barren and ligation in the treatment of internal haemorrhoids.Results During this period of two years 50 patients were analysed. The mean age of the study subjects was 52.26+/-12.80 years and male predominance was seen (M:F=42:8). Alcoholic chronic liver disease (CLD) (74%) was the most common cause of portal hypertension. Child's B score was seen among 54%, grade III varices were seen in 36% and grade II in 32%. Acute bleeding of varices was present in nine (18%) cases. On an average 3.8 sessions were required to obliterate the varices. Control of acute bleed and variceal eradication was seen in 77.78% cases and in 96% cases respectively. Complications following banding were seen in 20% cases. Mortality was seen in two (4%) cases.Conclusions: Alcoholic cirrhosis was the most common cause of portal hypertension and endoscopic banding of oesophageal varices in Nepalese population had comparable eradications, complications and recurrences with similar other studies conducted in other parts of the world. BJHS 2018;3(1)5 : 320-324
Correlates of Depression Among Elderly Population Residing in a Community in Eastern Nepal
Authors: Sharma Khem Raj , Yadav Birendra Kumar , Battachan Meika 
Published: May 2018

Introduction: With an increase in life expectancy, demographic transition has led to sharp rise in number of elderly population. The elderly population growth rate per year has always been more than the total population growth rate, signifying the start of the ageing dynamics in Nepal. Mental health is a neglected health problem of the elderly in Nepal, with depression topping the list. This needs to be addressed in the national programs for the elderly to bring about an overall improvement in their health status.Objectives: This study was conducted with objectives to identify the prevalence of depression and factors associated with it in an urban municipality of eastern Nepal.Methodology: A community based cross-sectional study was conducted using the Geriatric Depression Scale- Short Form (GDS-SF) with 15 questions to screen for depression with a cutoff of 4/5. Door to door visit was done for data collection and face to face interviews were conducted. Pearson's Chi-square was used and Odds Ratio (OR) with confidence limits was calculated for inferential statistics. Logistic regression analysis was performed for all independent variables significantly associated in the bivariate analysis.Results: Among the 353 study subjects interviewed, depression was identified in 65.2% by GDS-SF. Regression Model showed that age more than 70 years, being in the lower class of Kuppuswamy Socioeconomic scale and elderly who were not satisfied with the respect given by their community had more odds of being depressed.Conclusion: Prevalence of depression among elderly was found to be very high in this study which was significantly associated with older age, low socio-economic status and perceived lack of respect from the community. BJHS 2018;3(1)5 : 325-330
Outcome of Paediatric Cataract Surgery at Tilganga Institute of Ophthalmology, Nepal
Authors: Gurung Rajya Laxmi , Adhikari Srijana , Shrestha Ujjowala Devi , Ruit Sanduk 
Published: May 2018

Introduction: Paediatric cataract and aphakia are still a major cause of childhood blindness in developing world due to lack of advanced technology. In developing countries like Nepal, many children still present late due to lack of awareness and financial constraints.Objectives: The objective of this study was to determine the outcome of paediatric cataract surgery in a tertiary eye care centre in Nepal.Methodology: A hospital based prospective, observational study taking 42 patients (77 eyes) aged ≦15 years diagnosed with paediatric cataract were enrolled during a period of 1 year ( Jan 2011 - Jan 2012) at Tilganga Institute of Ophthalmology, Kathmandu, Nepal. The patients underwent either: a) Lens aspiration + Primary posterior capsulotomy (PPC) + Anterior Vitrectomy; b) Lens aspiration + PPC+ Anterior Vitrectomy + Intra-ocular lens (IOL); c) Lens Aspiration + IOL. Post-operatively optical ± amblyopia correction. Statistical analysis was carried out by using STATA 9.0. The association of changes in the vision of eyes before and after surgery was analyzed by using generalization of McNemar's test (Stuart-Maxwell test). A pvalue of < 0.05 was considered for the statistical significance. Institutional Ethics Board approval was obtained from the institutional review committee (IRC) of National Academy Medical Sciences ( NAMS ).Results: Mean age of patients was 4.46 yrs ± 4.32(SD), range from (15 days -12 yrs); Male : Female: 22 (52%)/20 (48%); 35 (83%) patients had bilateral cataract and 7(17%) had unilateral cataract. Morphologically, the most common type of cataract was total cataract (27/32%). Post-operatively, a statistically significant improvement in vision was there in all the eyes ( p value : < 0.0001) . Visual axis opacification was the most common post- operative complication seen in 20(26% ) of total eyes by the end of 6 months.Conclusion: Good visual outcome in paediatric cataract surgery can be obtained in developing countries like Nepal with minimal intra and post-op complications. BJHS 2018;3(1)5 : 331-337
Echocardiographic Findings in Chronic Obstructive Pulmonary Disease Patients
Authors: Khatri Devendra , Karki Parag , Shrestha Dhan Bahadur , Khatri Rishi , Thapa Raj Kumar , Panta Chiranjibi , Budhathoki Lee 
Published: May 2018

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is parenchymal lung disease with systemic effects and hemodynamic alteration more so in pulmonary circulation. In COPD, right ventricular (RV) after load increases due to structural and mechanical changes in the pulmonary vascular bed leading to increase in pulmonary arterial pressure which also leads to alteration in structure and function of RV. In COPD, congestive cardiac failure and ventricular dysfunction may coexist and demands proper assessment and management of dual condition.Objectives: This study was aimed to study the effect of COPD in cardiac anatomical and functional parameters in COPD patients in Shree Birendra Hospital.Methodology: This study was a retrospective review of hospital data on echocardiographic findings in 86 COPD patients visiting the outpatient department (OPD) in six months from June 2016 to December 2016. Available data was entered, edited and analyzed using Statistical package for social sciences (SPSS) version 22.Results: Among 86 cases studied, 43% had dilated RA and 41% with dilated RV, 24% with dilated LA and dilated LV in 22%. Normal pulmonary artery pressure was present in 41 (48%) cases and 45(52 %) individuals were having PAH. Among valvular disorder tricuspid regurgitation was commonest (50%). Left ventricle abnormalities like dilated left ventricles, LVDD, concentric ventricular hypertrophy, LVSD were also presented in significant number of COPD patients counting 22%, 37%, 7%, 30% respectively. Among the various factors analyzed in echocardiogram; there was significant association between the PAH with right atrial dilatation, right ventricular dilatation, left atrial dilatation, LVDD, tricuspid regurgitation (p<0.05) while rest of the parameters were not statistically significant association.Conclusion: COPD in most instances associated with some form of cardiac abnormalities like PAH, LVDD, LVSD, TR, dilated cardiac chambers so echocardiographic evaluation in timely basis has pivotal role in COPD cases to detect hemodynamic and mechanical alterations. BJHS 2018;3(1)5 : 342-345
Tranexamic Acid in Patients with Green Snake Bite in Western Region of Nepal
Authors: Sapkota Subash , Acharya Ramesh Raj , Paudel Navaraj 
Published: May 2018

Introduction: Green snakes found in hilly areas of Nepal cause significant morbidity in form of local swelling and bleeding manifestations. Polyvalent antivenoms are not indicated for the treatment. Specific management protocols are not endorsed for its bite. Conventionally, vitamin K and fresh frozen plasma are used to correct deranged coagulation in green snake bite.Objectives: The objective of this study was to evaluate the effectiveness of addition of tranexamic acid to the conventional method in green snake bite in western region of Nepal.Methodology: A hospital based, prospective comparative cross-sectional study was conducted at Department Medicine Manipal Teaching Hospital, Pokhara, Nepal from April 2014 to October 2017. It included 110 patients aged 15 to 76 years of both genders with confirmed history of green snake bite. Participants were alternately randomized into two groups; conventional group, tranexamic acid group. Duration of hospital stay was considered the primary outcome measure for this study while INR levels were considered the secondary outcome measure. Data were collected in a preformed pro forma and analyzed using SPSS version 16.0. Differences were considered significant if p-value is < 0.05.Results: The age (mean: 35.41; SD=17.23) of the study population ranged from 15 -76 years. The median duration of hospital stay in conventional group was 8 days (Inter Quartile Range = 7 to 8) and in tranexamic acid group was 6 days (Inter Quartile Range: 5 to 6). Mean INR was statistically significantly different at day 5 and day 6 in favor of tranexamic acid group (p<0.001)Conclusion: Treatment with tranexamic acid reduced the median duration of hospital stay by two days. Statistically significant differences in mean International Normalized Ratio levels were seen at day 5 and 6 of hospitalization (p<0.001). BJHS 2018;3(1)5 : 346-349
Study of Protein/creatinine Ratio in Preeclampsia as an Alternative to 24 Hours Urine Protein in Manipal Teaching Hospital of Nepal
Authors: Shrestha Pravin 
Published: May 2018

Introduction: Hypertensive disorder in pregnancy complicates around 5 to 10% of all pregnancies. It is one of the leading causes of maternal and fetal morbidity and mortality. Measurement of protein excretion by 24 -hour urine protein collection is gold standard but as it is time consuming, an alternative method like random urine protein/creatinine ratio is required.Objectives: The aim of this study was to assess the diagnostic accuracy of urine protein/ creatinine ratio compared with 24-hour urine protein as an alternative method for evaluating proteinuria in preeclampsia.Methodology: Patients with preeclampsia after 20 weeks of gestation were included in the study. Random urine protein/ creatinine ratio and 24-hour urine for protein was collected and evaluated for proteinuria. Results were entered and analysis was done.Results: Fisher's exact test depicted a positive association between UPCR with 24-hour urine protein, p value being less than 0.05. The area under curve was calculated as 0.87 95% CI (0.74-1.01), which was statistically significant. At cut off point of 0.3, sensitivity was 100%, specificity 90%, positive and negative predictive value 97.2% and 100% respectively.Conclusion: Random urine protein/ creatinine ratio (>0.3) is a reliable indicator of proteinuria >300mg/day. It can be used as an alternative to 24-hour protein estimation. BJHS 2018;3(1)5 : 350-353
Correlation of Clinical Presentations with Endometrial Pathologies in Women Presenting with Abnormal Uterine Bleeding. A Prospective Descriptive Study
Authors: Basnet Pritha , Thakur Achala , Agrawal Ajay , Bhandari Sangeeta , Sitaula Sarita , Karki Smriti 
Published: May 2018

Introduction: Abnormal uterine bleeding (AUB) is one of the common presenting symptoms in women attending gynaecology outpatient department and has remained one of the most frequent indications for hysterectomy in developing countries. Endometrial sampling is used as the first diagnostic step in AUB.Objectives: To correlate the clinical presentations with endometrial pathologies in women presenting with abnormal uterine bleeding.Methodology: This was a hospital based descriptive study carried out on one hundred and nineteen women who presented with AUB and planned for endometrial biopsy. Clinical profile of the patient was recorded and the histopathology of the sampled endometrial tissue was retrieved. Correlation of abnormal uterine bleeding with histopathology report was done using appropriate statistical test.Results: The mean age of presentation of women with abnormal uterine bleeding was 46.56 yrs ± 9.525. Irregular menstrual cycle was the commonest reason seeking treatment for AUB. The commonest histopathology among women who underwent endometrial biopsy was secretory endometrium (39.5%). Other causes identified were proliferative endometrium (21.8%), mucus flakes with hemorrhage (16%), disordered proliferative endometrium (10%), pill endometrium (5%) ,endometritis (5.9%), endometrial carcinoma (1.7%),endometrial hyperplasia without atypia (1.7%).Conclusion: The nature of endometrial pathology is varied across the entire spectrum of women presenting with abnormal uterine bleeding. Knowledge of endometrial pathology helps in directing specific management and can provide better care to women presenting with abnormal uterine bleeding. BJHS 2018;3(1)5 : 354-356
Study of Optic Nerve Sheath Diameter in Normal Nepalese Adults Using Ultrasound
Authors: KC Bidur , Thapa Amit 
Published: May 2018

Introduction: Though invasive intracranial devices are gold standard to calculate intracranial pressure (ICP); these are not without any complications. Non-invasive measurement of ICP by Ultrasonography could be a safe and portable technique.Objectives: The objective of the study was to measure and compare values of optic nerve sheath diameter of both eyes in healthy Nepalese adults.Methodology: A prospective cross-sectional study of healthy adult Nepalese volunteers was performed using a 7.5 MHz linear Ultrasound probe on the closed eyelids; optic nerve sheath diameter (ONSD) was measured 3 mm behind the globe in each eye.Results: Optic nerve sheath diameter (ONSD) of both eyes was measured in 100 healthy volunteers of age ranged from 15 to 75 years with a mean of 30.21 ± 14.05 years. There were 18 (18%) male and 82 (82%) female. ONSD for right eye ranged from 3.20 to 4.90 mm with mean of 4.10 ± 0.50 mm and left eye from 3.20 to 4.80 mm with mean of 4.22 ± 0.49 mm. P value for right and left eye ONSD (P = 0.06) and male and female (P = 0.12 and 0.85 for right and left ONSD respectively) were within normal limits. ONSD has no correlation with age (P = 0.27 and 0.27 for right and left ONSD respectively).Conclusion Mean of optic nerve sheath diameter (ONSD) is 4.10mm and 4.22 mm for right and left eye respectively. There is no statistical significant difference in mean of ONSD between right and left eye. BJHS 2018;3(1)5 : 357-360
Profile of Acute Coronary Syndrome In Young People: A Hospital Based Observational Study in Western Nepal
Authors: Paudel Navaraj , Alurkar Vijay Madhab , Jha Girija Shankar , Kafle Ramchandra , Sapkota Subash , Lamsal Lekhnath 
Published: May 2018

Introduction: Acute coronary syndrome is associated with high mortality and morbidity. The incidence of acute coronary events in young is increasing.Objectives: This study aimed at evaluating the profile of acute coronary syndrome in young people in the western part of Nepal.Methodology: A retrospective study was designed. All patients admitted for acute coronary syndromes were taken and data of acute coronary syndrome involving patients aged less than 45 years from April 2015 through December 2017 were collected in a pre-structured proforma and analyzed.Results: There were 712 (489 males and 223 females with M:F=2.19:1) acute coronary syndrome patients admitted during the study period. Only 79 (12.9%) patients were patients <45 years of age. Commonest risk factor of acute coronary syndrome was smoking (69%) followed by dyslipidemia (46.8%), hypertension (45.5%) and diabetes (14%). Out of 79 patients of young acute coronary syndrome, 37 (46.8%) presented with ST elevated myocardial infarction, 16 (20.2%) with non-ST elevated myocardial infarction and 26 (32.9%) with unstable angina. Most common finding in coronary angiography was single vessel disease (35%) –left anterior descending artery being the commonest (53% of single vessel disease), double vessel disease (17.7%), non-critical coronary artery disease (16.4%), triple vessel disease (7.6%) and left main (1.2%). Myocardial bridging was seen in 1.2% and 20% had normal coronaries. Comparison of males and females in different categories of acute coronary showed that males predominate significantly in ST elevated myocardial infarction (odds ratio: 2.99; p=0.03) but there was no significant difference between the males and females presenting either with Non ST elevated myocardial infarction or unstable angina.Conclusion: Acute coronary syndrome in young people was common (12.9%) particularly males with Non ST elevated myocardial infarction. Smoking was the commonest risk factor. Public awareness regarding stoppage of cigarette smoking should be focused to prevent such events especially in the young population. BJHS 2018;3(1)5 : 361-365
Clinical and Bacteriological Profile of Early Onset Neonatal Sepsis Admitted in NICU of Tertiary Hospital in Biratnagar
Authors: Giri Arun , Sah Vijay Kumar , Poudel Bikash Sharma , Niraula Niraj , Sedai Raju 
Published: May 2018

Introduction: Neonatal sepsis is one of the major causes of neonatal morbidity and mortality especially in developing countries. The clinical signs and symptoms of neonatal sepsis are non specific and blood culture report is considered gold standard for confirmation of neonatal sepsis. Organisms and their sensitivity pattern vary from place to place. The confirmation of diagnosis and management of neonatal sepsis is challenging and time consuming.Objective: The aim of this study was to find incidence of blood culture proven sepsis in suspected early onset neonatal sepsis, find out sensitivity pattern of isolated organism and to find association of risk factors and clinical signs and symptoms with blood culture proven sepsis.Methodology: Prospective study was conducted in Nobel Medical College, Biratnagar from November 2016 to November 2017. Sample size was calculated to be 300 and blood culture was sent of each neonates admitted with suspected early onset neonatal sepsis before giving neonates with first dose of antibiotics and report of 72 hours was taken into consideration.Results: Out of 300 cases of suspected early onset neonatal sepsis 70.3% presented with lethargy, followed by other symptoms like poor feeding, respiratory distress, fever, hypothermia, feeding intolerance, abnormal body movement and abdominal distension. Low birth weight neonates, preterm neonates, prolonged duration of per vaginal leaking and low platelets count were significantly associated with blood culture proven sepsis in this study. Incidence of blood culture positive sepsis in suspected early onset neonatal sepsis was 27%. Coagulase negative Staphylococcus aureus(21%) was predominant organism isolated followed by Klebsiella Pneumonia, Pseudomonas, Escherichia coli. All of the isolated Klebsiella and Pseudomonas and 86% of Escherichia coli were found to be resistant to ampicillin. All isolated Coagulase negative Staphylococcus aureus were sensitive to vancomycin.Conclusion: Coagulase negative Staphyloccus aureus was predominant organism detected but majority of organisms were gram negative organisms. High resistance to ampicillin was found and cefotaxime was also less sensitive to isolated organism. Vancomycin was found to be sensitive to all isolated Staphylococcus aureus and coagulase negative Staphylococcus aureus. Amikacin was highly sensitive among causative organisms isolated. BJHS 2018;3(1)5 : 370-376
Outcome of Type 1 Tympanoplasty with and without the use of Topical Nasal Steroid: A Comparative Study from Eastern Nepal
Authors: Shah Rajeev Kumar , Shrestha Karuna , Sapkota Shrijana , Giri Sandarva 
Published: May 2018

Introduction: Chronic suppurative otitis media (CSOM) is the infection of the middle ear cleft. It is an important cause of preventable hearing loss.Objectives: The primary objective of this study is to compare the surgery outcome in terms of graft uptake described as intact tympanic membrane or residual perforation of tympanic membrane in patients with use of levocetirizine tablet 5 milligram only and levocetirizine tablet 5 milligram with topical fluticasone 100 microgram nasal steroid spray. This study is also aimed to determine the hearing status before and after the surgery and to find out its association with graft intake.Methodology: This prospective cross sectional study was conducted on patients diagnosed with chronic suppurative otitis media with medium to large central perforation of tympanic membrane in Birat Medical College Teaching Hospital during the period from 14 April 2015 to 13 April 2017. All the patients underwent type 1 tympanoplasty with placement of temporalis fascia under general anesthesia. After surgery, two equal groups were created with 40 patients in each group. One group received antibiotics, levocetirizine tablet and another group received antibiotics, levocetirizine tablets along with topical intranasal steroid spray from 1 post operative day till 6 wks. All the patients were followed up on the 5th day, 7th day and 42nd day. On 42nd day, status of tympanic membrane graft, post operative hearing assessment was done and compared between the two groups. Data were entered and analysed using Statistical Package For Social Sciences (SPSS) v21.Result: There were 40 patients who received levocetirizine only starting from the first post operative day and 39 patients received levocetirizine and topical nasal steroid spray. Patients with intact tympanic membrane following surgery were 88.6% and remaining had residual perforation of tympanic membrane. Of the study participants 87.3 % had improvement during post operative hearing assessment. 92.3% of the patients receiving levocetirizine and topical nasal steroid post surgery had intact tympanic membrane on otoscopic examination and there was a significant association with p value of 0.04Conclusion: Combination therapy with topical intranasal steroid spray, antihistaminics and antibiotics is beneficial compared to antibiotics and antihistaminics in type 1 tympanoplasty in terms of graft intake and improvement in hearing. BJHS 2018;3(1)5 : 377-380