bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pegylated interferon-alfa plus ribavirin therapies for chronic hepatitis C
Authors: Kanda T , Yokosuka O 
Published: September 2018

Until HCV NS3/4A protease inhibitors become available at the end of 2011, the combination pegylated-interferon (PEG-IFN)-alfa and ribavirin (RBV) will remain the standard treatment for chronic hepatitis C patients. In some hepatitis C virus-infected patients, PEG-IFN plus RBV treatment against HCV should continue to be used because of side effects of new drugs such as anemia. Our Japanese experiences should provide new information for the treatment of chronic hepatitis C.
Keywords: Direct-acting antiviral agents (DAA), HCV, pegylated interferon, ribavirin, standard of care (SOC ).
Values of Lymphocyte Subsets in Nepalese Healthy Adult Population
Authors: Shakya G , Dumre S P , Malla S , Sharma M , KC K P , Chhetri D B , Amatya R , Paudyal P 
Published: September 2018

Introduction: CD4 T lymphocyte is the most commonly used cellular marker in tracking Human Immunodeficiency Virus (HIV) infection progression and monitoring effect of antiretroviral therapy (ART). Due to lack of local reference values of CD4 and other T lymphocytes in Nepal, most clinical decisions are based on the reference renges of western countries.
Methods: This study was conducted at three major hospitals/laboratory of central, eastern and western Nepal during November 2008 through July 2009. Using the predefined criteria, 602 (200, 202 and 200 from central, eastern and western regions respectively) healthy adult volunteers of age range 18-60 years were recruited wiht equal representation from each age group and sex. Blood specimens were screened for HIV following standard algorithm using ELISA and two rapid test kits based on different principles. Samples with discordant test-results were excluded. HIV sero-negative specimens were further analyzed for CD4, CD8 and CD4:CD8 ratio, and absolute lymphocyte count (ALC) by FACS count (Becton Dickinson, USA) and automated cell counter (BC-3000 Plus, Shenzhen Mindray Biomedical Electronics, Germany) respectively.
Results: The average value (mean± standard deviation) of CD4, CD8, CD4/CD8 ratio and ALC of Nepalese adult population were found to be 786 ± 248, 567±230, 1.52 ± 0.59 and 2712 ± 836 respectively. All four parameters but CD8 were significantly different with sex and females had relatively higher values. However, none of these parameters reported significant difference with age except the ALC.
Conclusions: Nepalese healthy adult populations have significantly different T lymphocyte subsets compared to other countries. The present reference ranges of CD4 and other T lymphocytes may be used for any clinical purposes including classifying and monitoring disease status in HIV infected individuals, immune status evaluation, monitoring ART and accordingly making amendment in national HIV treatment guidelines in Nepal.
Keywords:Absolute lymphocyte count, CD4, CD8, human immunodeficiency virus, T lymphocytes.
Organism Isolation in Corneal Ulcer- Utility of Different Techniques
Authors: Thapa M , Sharma A K , Shah D N , KC S , Shrestha S 
Published: September 2018

Introduction: Various techniques are available for isolation of microorganism in cases of microbial keratitis including conventional methods of scraping, re-scraping inoculation in different media and corneal biopsy.
Methods: This was a cross sectional descriptive study conducted from February 2002 to July 2003. A total of 161 eyes of corneal ulcers were evaluated with scraping inoculation. Re-scraping and corneal biopsy were performed in those cases which did not grow any organism in the first scraping or which did not respond to initial treatment.
Results: Microorganisms were isolated in 116 patients (72.04%) after first scraping. S pneumoniae was seen in 50(42%), Fusarium in 21(18%) and Aspergillus in 16(14%) cases. Re-scraping was done in 22 culture negative and non improving cases of which 14 (63.63%) showed isolation of organisms. After re-scraping, Fusarium and Aspergillus were isolated in four patients each (18% each) followed by S. pneumoniae in 3 (14%), S. aureus in 2 (9%), and Penicillium in 1(5%) case.Corneal biopsy was done in 10 cases with isolation of microbial agents in 7 (70%) with Aspergillus and S. aureus in three each, and S. epidermidis in 1(10%).
Conclusions: Apart from conventional scraping, other isolation techniques should be considered in the treatment of non-responding and culture negative cases of corneal ulcers. Compared to bacteria, fungi are difficult to isolate in the first scraping and requires more frequent repeat scraping and corneal biopsy.
Keywords: Corneal biopsy, corneal scraping, corneal ulcer, microbial keratitis, organismal isolation.
A Rare Solitary Fibrous Tumour of Kidney
Authors: Pathak Tilak Bahadur , Nepal Umesh 
Published: September 2018

A solitary fibrous tumour (SFT) is an unusual spindle cell neoplasm. It frequently arises from the serosal surface of pleural cavity but has recently been described in diverse extrapleural sites. Urogenital localization is rare and only 36 cases of SFTs of the kidney have been described on published report. We report a case of a large SFT clinically and radiologically thought to be renal cell carcinoma arising in the kidney of a 30- year-old female. The radical nephrectomy was performed. The tumour was a well- circumscribed, solid mass attached to the renal pelvis without necrosis and haemorrhage. Histopathologically, a spindle cell neoplasia with alternating hypo and hypercellular areas, storiform, fascicular and hemangipericytoma- like growth pattern and less cellular dense collagen deposits were observed. Immunohistochemical studies revealed reactivity for CD34, CD99 and Bcl-2 protein.
Comparison of Acid Fast Bacilli Smear and Culture for the Diagnosis of Extra-Pulmonary Tuberculosis
Authors: Rijal Basista , Ghimire P , Tuladhar N R 
Published: September 2018

The study was conducted with the objectives to compare the Acid Fast Bacilli (AFB) staining and Culture for the diagnosis of extra-pulmonary tuberculosis and to find out the burden of extra-pulmonary tuberculosis from the different site of the body in suspected TB patients. The standard Ziehl-Neelsen Technique was done for AFB staining and culture was done in Ogawa Medium. Of the 292 extra-pulmonary samples examined by AFB smear only 2(0.7%) were positive and of the 1058 extra-pulmonary samples cultured 20 (1.9%) were positive. The isolation rate for extra-pulmonary samples was three fold higher in culture in comparison to AFB Smear. The confirmation rate of extra-pulmonary tuberculosis was approximately 1/ 8th of the pulmonary tuberculosis by conventional bacteriological diagnostic methods. Of the extra-pulmonary tuberculosis renal, endometrial or pelvic and cold abscess were common in this study. M.tuberculosis was also isolated from peritoneal fluid, pericardial fluid, Synovial fluid, lymph node and cerebro spinal fluids only by culture. In conclusion, the standard AFB culture has significant role for diagnosis of extra-pulmonary tuberculosis, even though the conventional bacteriological technique could diagnose very low number of extra-pulmonary tuberculosis. The new methods of diagnosis should be considered to confirm more extra- pulmonary tuberculosis.Key Words: Extra-pulmonary tuberculosis, AFB Smear, Culture, Diagnosis, Nepal.
Malignant Melanoma of the Parotid Gland – Primary or Metastatic ?
Authors: Singh Usha Rani , Chaturvedi KU , Bhatta S , Karki S , Kumar B 
Published: September 2018

Involvement of the parotid gland by malignant melanoma is rare. Parotid Metastasis from cutaneous melanoma is uncommon. Primary melanoma of the parotid gland is a controversial entity. A diagnosis of parotid gland malignant melanoma should herald a search for a primary skin neoplasm & this may be exceptionally difficult because of the well recognised though uncommon phenomenon of spontaneous regression of the primary melanoma. A 39 years old male presented with progressive painless enlargement of the parotid gland over the past seven months. Removal of the parotid gland was possible only on the second attempt. A detailed history revealed excision of a pigmented lesion on the contralateral cheek 20 years back. The tumour was a black heavily pigmented lesion with varied morphology. In spite of low mitotic count there was vascular embolisation. The margins were infiltrative. Patients with parotid gland melanoma have a high incidence of distant spread & significantly worse prognosis, requiring medical surgery.Key Words: Melanoma, Parotid gland.
Status and Trend of HIV/AIDS Epidemic in Nepal
Authors: Joshi Anand Ballabh , Banjara MR , Karki YB , Subedi BK , Sharma M 
Published: September 2018

The main objective of this study is to review the HIV/AIDS status and trend in Nepal. The design of the study was retrospective in nature. Review was made of published and unpublished documents during the period 1988 to 2004. Year-wise data indicates that the cases of HIV/AIDS have been increased sharply since mid 1990s. In 1992, more than double numbers of new cases were reported than the formerly reported cumulative cases. The latest cumulative HIV/AIDS cases as of May 2004 were reported as 747 cases of AIDS and 3765 cases of HIV infections. Among total HIV/AIDS cases, clients of sex workers (57.8 percent) were predominant followed by sex workers (13.9 percent) and injecting drug users (15.6 percent). Similarly, others included housewives (10.6 percent), children (1.8 percent) from vertical transmission and blood or organ recipients (0.2 percent). Male cases (73.0 percent) were found predominant than female cases (27.0 percent). HIV prevalence among risk group population was found highest in injecting drug users (38.4 percent) followed by Female Sex Workers (4.1 percent) and migrants (3.0 percent). The risk population and HIV/AIDS prevalence has been found sharply increasing after mid 1990s. The increasing trend of the disease certainly has given pressure to focus on the use of comprehensive targeted intervention programs in risk group sub-populations.Key Words: HIV/AIDS, Trend, Risk populations, Prevalence.
Topical anaesthesia of the vocal cords by nebulized lignocaine inhalation to facilitate fi breoptic nasotracheal intubation in a head-size parotid tumour patient
Authors: Koirala S , Tripathi M , Subedi A , Bhattarai B 
Published: September 2018

This case report describes a successful fi breoptic naso-tracheal intubation in a patient with difficult airway due to a nearly head-size right parotid swelling. Nasal fi breoptic intubation was performed by maintaining spontaneous breathing under propofol infusion at a dose of 25 mcg/kg/hour and topical anaesthesia of vocal cords by using oxygen (6 l/min) fl ow to nebulize 4 % lignocaine from the side port of the fi breoptic bronchoscope. The topical anaesthesia was achieved by keeping the scope in close proximity of the vocal cords and in the centre of view of the scope. This case emphasizes the possibility of fi breoptic intubation in a sedated yet spontaneously breathing patient by allowing inhalation of nebulized lignocaine during fi breoptic intubation.
Keywords: fibreoptic intubation, naso-tracheal intubation, nebulized lignocaine, spontaneous breathing, topical anaesthesia.
Goldenhar Syndrome in Association with Duane Syndrome
Authors: Shrestha U D , Adhikari S 
Published: September 2018

Goldenhar syndrome (GHS) is also known as Oculo-Auriculo-Vertebral (OAV) syndrome or Branchial arch syndrome. Duane retraction syndrome (DRS) is a congenital disorder of ocular motility characterized by limited abduction, adduction or both. It is unilateral in 80% of cases. The important and interesting part of this eight months old child is presence of GHS with DRS. She has bilateral invol-vement, which is seen in only 5-8% of GHS, as compared to high incidence of unilateral involve-ment. This child also had refractive error of + 6.00/ - 1.5 * 180. At four year of age her vision with glass was 6/9. Children with GHS and DRS should have early eye examination done to treat the problem of refractive error.
Keywords: Duane retraction syndrome; goldenhar syndrome, refractive error.
Psychiatric Morbidity Patterns in Referred Inpatients of Other Specialties
Authors: Risal Ajay , Sharma Pushpa Prasad 
Published: September 2018

Introduction: Consultation-liaison psychiatry is an upcoming field dealing with interdepartmental collaboration heading into multidisciplinary and holistic care. In general hospital setting, psychiatrists need to be involved in evaluation of patients referred from other specialties. This study analyzed the psychiatric morbidity among the inpatients referred to Psychiatry Department from different wards in a Tertiary care University Teaching Hospital.
Methods: Total 385 subjects were referred to the Department of Psychiatry from different wards during a period of one year. Each of them underwent a detailed psychiatric evaluation by a consultant psychiatrist once they were medically stable. Psychiatric diagnosis was considered as per International Classification of Disease-10 criteria.
Results: The mean age of the subjects evaluated was 37.26 (±1.86); most of them were females 216 (56.4%), married 287 (74.5%), and homemaker 159 (41.3%). Maximum 271 (70.4%) referral was from Medical ward, and most of them 292 (75.8%) were admitted in general bed. The most common medical diagnosis was self-poisoning 115 (30.6%) followed by alcoholic liver disease 49 (12.7%); while the commonest 123 (31.9%) psychiatric diagnosis was depression (including Dysthymia and Adjustment disorder). Depression remained the commonest diagnosis among those referred from medical ward 131 (34.7%); while anxiety was mostly found in the emergency referral 94 (24.5%). Significant Correlation (P <0.05) was seen between the source of referral and Psychiatric diagnosis.
Conclusions: Psychiatric consultation was sought mostly by medical ward that had maximum number of patients presenting with self-poisoning. The commonest diagnosis seen in the referred in-patients was depression and anxiety disorder.
Keywords: consultation-liaison psychiatry; in-patient referral; psychiatric morbidity.
Morphological Changes in Carotid Arteries in Stroke Cases
Authors: Thapa Guna Bahadur , Sundas Alin , Rauniyar Raj Kumar 
Published: September 2018

Introduction: Majority of stroke is due to ischemic infarction and occurs in carotid artery territory. The extra cranial parts of carotid arteries are the common sites for the atherosclerotic plaque formation. Ultrasonography is the first line of investigation for screening of the carotid artery diseases to localize and characterize the plaques. Objective was to study the morphological changes in extra cranial part of carotid arteries in cases of ischemic infarction using Ultrasonography.
Methods: It was an institution based prospective study and convenience sampling method was used. Computed Tomography proven ischemic infarct, lacunar infarction and transient ischemic infarction cases were included in the study.
Results: Fifty four cases were included in the study. Mean of Intimo-medial Complex Thickness was 0.89 mm and 0.88 mm in right and left side respectively. Sixty five percent cases had plaque in extra cranial part of carotid artery. Ninety three percent of plaque was found in and adjacent to the carotid bulb region. Ipsilateral plaque was found in 76% and 65% cases on right and left side respectively. Fifty three percent of cases had soft plaque. Majority of cases had less than 50% narrowing of the lumen diameter in term of cross-sectional area due to plaque. Thirteen (24%) cases had plaque in internal carotid artery.
Conclusions: Carotid ultrasound can be used for screening of the asymptomatic but high-risk cases and following up of the symptomatic cases to plan for necessary management as required.
Keywords: carotid artery, carotid ultrasonography, ischemic infarction, plaque.
Clinical Profile, Aetiology and Outcome of Afebrile Seizures in Children
Authors: Poudel Prakash , Parakh Prince , Mehta Kayur 
Published: September 2018

Introduction: Clinical and outcome profiles of childhood seizures can be different in resource limited settings where neurologists face lots of challenges in diagnosis and management of seizure. This study was conducted to investigate the clinical profile, causes and outcome of afebrile seizures in children in resource limited settings.
Methods: This was a prospective hospital based study. Children with afebrile seizures were followed up with exclusion of febrile and acute provoked seizures. Clinical, investigation, treatment and outcome parameters were analyzed.
Results: Study included 308 (age one month to 20 years) children. Median age at first seizure was 39 (inter quartile range 12-96) months. History of status epilepticus was present in 26.0%. Cause of seizure was known in 44.2%. Seizure was generalized in 79.2%, partial in 14.0% and unclassified in 6.8%. Common causes of seizure were – birth asphyxia (12.3%), neurocysticercosis (8.8%), sequel of nervous system infection (6.5%) and structural brain abnormalities (7.1%). Neurological examination, electroencephalography and computed tomography (CT) were abnormal in 24.4%, 70.5% and 27.9% cases respectively. Seizure control was achieved in 79.3% and by monotherapy in 85.0 % cases. Seizure control with single drug, seizure without recurrence and idiopathic seizure were associated with favourable outcome.
Conclusions: Prevention and control of birth asphyxia, neurocysticercosis and nervous system infections are needed to reduce the burden of afebrile seizures in this area. CT is a valuable diagnostic tool and response to monotherapy is good. Seizure control with single drug, seizure without recurrence and idiopathic seizure are favourable prognostic factors.
Keywords: afebrile seizure; children; clinical profile; outcome.
Pharmaco-Economic Aspects of Antibiotic Prescriptions in Clinics of Kathmandu
Authors: Jauhari Akhilesh Chandra , Pokharel A , Palikharel N , Shrestha N , Rao BS 
Published: September 2018

Antibiotics (AB) are the most widely prescribed group of drugs and their use is associated with increasingrate of AB resistance. Nearly one third of prescriptions of physicians for colds, upper respiratory tractinfections and bronchitis are of AB as documented in previous studies. Antibiotic use is associated withincreased cost of financial burden, which may be difficult to be borne by the patients in developing countrieslike Nepal.The objective was study the prescribing pattern of Antibiotic preparations in various diseases and to findout how the treatment could become more pharmaco-economic without compromising the quality of service.A cross sectional study of prescription pattern of antibiotics/drugs in which antibiotics were used fromrandomly selected 20 private clinics of four major specialties in Kathmandu valley.Total No. of prescriptions audited were 386, average number of drugs/per prescription was 2.74.Maximum antibiotics were prescribed for age group 21-40 years in gynecological, surgical and medicalproblems, in Pediatrics maximum AB were prescribed between 1-12 years.Minimum antibiotics were prescribed between 13-20 years for gynecological and Pediatric problems. Inmedical and surgical problems, minimums AB were administered between 41-60 years. Above 60 yearsalmost no AB were used.Males were prescribed more AB than females (73% for surgical, 62% for medical and 53% for Pediatricproblems)Only in 20.25% patients, AB were prescribed after proper diagnosis and sensitivity testsMaximum cost of prescription was 510 Nepali rupees (NR) for treatment of STD in Gynecology.Key Words: Antibiotics, Cost, Human Immune deficiency Virus, Kathmandu, Private Clinics, Pharmacoeconomic, Sexually Transmitted Diseases.
Patent Arterial Duct and Vascular Ring in a Premature Infant
Authors: Bhattarai Anil , Vida Vladimiro , Ricato Silvia , Salvadori Sabrina , Stellin Giovanni 
Published: September 2018

We report a case of a 750 grams premature female who was scheduled for surgical ligation of a patent arterial duct. Intra-operative findings showed a patent arterial duct in association to a retro-esophageal aortic arch creating a complete vascular ring around the trachea, which was successfully divided. A vascular ring should be ruled-out in premature infants prior to ductal ligation at bidimensional echocardiography.
Keywords: congenital heart disease; premature infant; surgery; vascular ring.
Extensive Mucosal Erosion and Sloughing of Tongue: A Hitherto Unknown Complication of Topical Clotrimazole Preparation
Authors: Dutta Mainak , Ghatak Soumya , Biswas Gautam , Sinha Ramanuj 
Published: September 2018

Clotrimazole, a broad-spectrum imidazole antimycotic, is a widely-used prescription as well as an over-the-counter drug for treatment of mucosal (oral, vulvovaginal) candidiasis and dermatophytes. An extremely safe and well-tolerated drug, its safety profile has been well-explored in researches and trials. The commonest complaints are almost always non-serious-pruritus, rashes, paraesthesia (stinging/burning sensation) and erythema on topical applications, and nausea, vomiting, unpleasant taste sensation and elevated liver enzymes on oral preparations (troches). However, mucosal ulceration on topical clotrimazole preparation has not been reported in literature before. We present here the first documentation of extensive bilateral erosions and necrosis of tongue involving the mucosa, submucosa and musculature on application of one percent weight/volume clotrimazole mouth paint in a 27-year-old immunocompetent woman who presented with oral candidiasis.
Keywords: extensive bilateral ulceration and necrosis; oral candidiasis; side effect; topical clotrimazole.
Criteria for Peer Reviewing the Original Articles Submitted to a Biomedical Journal: Intellectual Honesty is the Best Policy.
Authors: Paudel Bishnu Hari 
Published: September 2018

Peer review - a process of assessing the quality of manuscripts submitted to a journal – is an establishednorm in biomedical publications. It is viewed as an extension of scientific process. The peer-reviewed researcharticles are considered trustworthy because they are believed to be unbiased and independent. The processof reviewing is a privilege and prestige. It is highly responsible, intellectually honest, and difficult job.Being expert in certain area of biomedical science is a prerequisite for reviewers. Young peer reviewerstrained in epidemiology or statistics produce high-quality review. The International Congresses on PeerReview in Biomedical Publication have shown many unresolved issues related to preparation or handling ofmanuscripts by a journal. Therefore, it is vital to identify authentic peer reviewers to ensure qualitypublication, thus, a set of peer review criteria is proposed for peer reviewing original articles. It is useful inquantifying (scoring) the manuscript quality. The proposed scoring system yields three categories ofmanuscripts: the first category is considered acceptable for publication after minor modification by editorialboard and/or reviewers, the second – requires rewriting and resubmission, and the third – rejected. Thesecriteria are preliminary guidelines, and require timely review. They are expected to sensitise peer reviewers,editors, contributors, and readers to move towards greater honesty and responsibility while working withmanuscripts. In summary, if the criteria are used they will facilitate editorial management of manuscripts,render more justice to authors and biomedical science, and improve publication quality.Key Words: Biomedical publication, peer review, peer review criteria, scoring of manuscripts, categories of manuscripts, journal of Nepal Medical Association.