bluuebunny/crossref_metadata_2025_split huggingface dataset:
Demographic and Clinical Profile in Patients with Liver Cirrhosis in a Tertiary Care Hospital in Central Nepal
Authors: Bhattarai Subash , Gyawali Merina , Dewan Khus Raj , Shrestha Gaurav 
Published: September 2018

Introduction: Liver cirrhosis is an important health problem worldwide and is a common disease in Nepal. The profile of cirrhosis may vary due to different factors. This study was undertaken to see the demographic and clinical profiles of patients with cirrhosis of liver attending a tertiary care hospital in Central Nepal.
Methods: Six hundred patients with clinical features, laboratory and sonological findings suggestive of chronic liver dysfunction and endoscopic evidence of portal hypertension were included in the study. Their demographic and clinical profile, endoscopic findings, outcomes during hospitalization were studied. Ethical approval was taken from Institutional Review Committee of College of Medical Sciences. SPSS 20 was used for statistical analysis.
Results: The mean age of subjects was 54±11.84 years with 435 males (72.5%) and 165 (27.5%) females. Majority of 203 (33.8%) patients were from Mongol ethnicity followed by 127 (21.2%) Khas. Two hundred and twenty (36.6%) were farmers followed by 169 (28.2%) retired personnel. A total of 338 (56.4 %) patients were from rural areas. The commonest aetiology of cirrhosis was chronic alcohol consumption and seen in 552 (92%) patients. Abdominal distension was commonest presenting sign and observed in 561 (93.5%) patients. Ascites seen in 555 (92.5%) patients was the commonest complication followed by UGI bleed in 326(54.3%) patients. Gastro-oesophageal varices observed in 345 (57.5%) patients, was the most common endoscopic finding followed by portal gastropathy, peptic ulcer and erosive mucosal diseases. In patient mortality was noted in 92 (15.3 %) patients.
Conclusions: This study highlights the burden of cirrhosis, usually caused by chronic alcohol consumption in Central Nepal. Majority of subjects were male, middle aged, farmers, from rural areas and predominantly observed in some ethnicity like Mongols. Cirrhotic patients usually present late with varied complications and have high mortality.

Keywords: cirrhosis of liver; complications; endoscopy.
Prevalence of Organic Colonic Lesions by Colonoscopy in Patients Fulfilling ROME IV Criteria of Irritable Bowel Syndrome
Authors: Paudel Mukesh Sharma , Mandal Amrendra Kumar , Shrestha Barun , Poudyal Nandu Silwal , KC Sudhamshu , Chaudhary Sitaram , Shrestha Ramila , Goel Khushboo 
Published: September 2018

Introduction: Irritable bowel syndrome occurs as recurrent abdominal pain that is related to defecation and associated with change in frequency and/or form of stool. Few Patients with IBS may have organic lesions detectable at colonoscopy.
Methods: A cross sectional study was carried out in 140 consecutive patients of IBS fulfilling the ROME IV criteria. The study was conducted in Gastroenterology unit, Department of Medicine, Bir hospital, Kathmandu from July 2016 to September 2017. All patients underwent full colonoscopy along with biopsy from sigmoid colon and any visibly abnormal areas.
Results: The average age of patients was 37.5 years with 76 (52.8%) males. Forty-two (30%) had IBS-D, 36 (26%) had IBS-C, 31 (22%) had IBS-M and 31 (22%) had IBS-U. Dyspepsia was seen in 16 (11.4%) and fear of TB/Malignancy/IBD was seen in 27 (19.2%). Organic lesions were seen in 39 (27.85%) patients. Nonspecific colitis was seen in 10 (7.1%) followed by ileal erosions in 7 (5%), polyps in 8 (5.7%), hemorrhoids in 6 (4.2%) and diverticula in 3 (2.1%). Only one (0.71%) patient had microscopic colitis and one (0.71%) had malignant lesion seen at histopathological examination. Females with IBS-D had more organic findings than males (P=0.03, RR=4.13, 95% CI=1.21-15.71).
Conclusions: The prevalence of organic lesions in patients with IBS fulfilling ROME IV criteria is 27%. Dyspepsia is the most common comorbidity and fear of TB/malignancy/IBD is the most common reason for seeking health care. Females with IBS-D have a higher risk of detecting organic lesions by colonoscopy and histopathology examination.
Postoperative Outcome in Patients with Pulmonary Hypertension Undergoing Elective Non-Cardiac Surgery
Authors: Pathak Vikas , Suwal Kriti 
Published: September 2018

Introduction: The impact of pulmonary artery hypertension on post-operative outcome in elective, non-cardiac surgery is incompletely understood. This study was designed to evaluate the post-operative outcome of patients undergoing elective, non-cardiac surgery with and without pulmonary hypertension.
Methods: The study was conducted in an inner-city hospital in Bronx, New York. A retrospective chart review was conducted on all patients who underwent elective, non- cardiac surgery from January 2000 to December 2010 and had echocardiogram within 30 days of surgery. Patients with systolic pressure of ≥35mm of Hg as estimated by echocardiogram were enrolled. Case matched peers with normal pulmonary pressures served as controls. Post-operative outcomes were compared between the two groups.
Results: A total of 66 patients were analysed, 33 cases and 33 controls. All patients were followed up to 30-day post-surgery. Heart failure, myocardial infarction, arrhythmia, stroke, delayed extubation and deaths were measured in both the groups. There were two deaths in the control group while there were three deaths in pulmonary hypertension group (statistically not significant, P >0.05). A total of three patients in pulmonary hypertension group had adverse outcome (one had a major arrhythmia, one had delayed extubation (>24 hours) and one had stroke). Whereas two patients in control group had adverse outcome (one had delayed extubation (>24 hours) and one had major arrhythmia).
Conclusions: Pulmonary hypertension does not affect the post-operative outcome in the first 30 days for elective non-cardiac surgery.
Keywords: echocardiogram; elective surgery; non-cardiac surgery; post-operative outcome; pulmonary hypertension.
Endoscopic Sinus Surgery for Sinonasal Polyposis: Microdebrider or Conventional Instruments
Authors: Lageju Nabin , Pradhan Bibhu , Thapa Narmaya 
Published: September 2018

Introduction: Sinonasal polyposis is one of the commonest causes of nasal obstruction. Surgical management is treatment of choice. Microdebrider offers more advantage to conventional instruments. We aimed to find out outcome using microdebrider versus conventional instruments in endoscopic sinus surgery of sinonasal polyposis.
Methods: The cross sectional descriptive study carried out in patients aged 13 years and above with diagnosis of sinonasal polyposis. Total of 51 patients were operated on the right side with microdebrider and left side with conventional instruments. Postoperatively each patient assessed for nasal obstruction subjectively and by endoscopic examination to look for mucosal oedema, synechiae and recurrence at 4 weeks and 8 weeks postoperatively.
Results: The incidence of mucosal oedema in microdebrider and conventional instruments at 4 weeks and 8 weeks was statistically not significant with P value 0.089, 0.322 respectively. The incidence of synechiae in conventional group was more than microdebrider 1 (2%) versus 4 (7.8%) at 4 weeks follow up but the difference was statistically not significant (P value 0.773). There were 2 (3.9%) recurrences in microdebrider group and 3 (5.8%) recurrences in conventional group with P value 0.532.
Conclusions: Use of microdebrider offered fewer incidences of synechiae and recurrence. But we couldn’t find statistical advantage over conventional instruments.
Keywords: conventional instruments; endoscopic sinus surgery; microdebrider; sinonasal polyposis.
Significance of Non-Invasive Markers as Predictor of Esophageal Varices in Liver Cirrhosis
Authors: Khadka Dipendra , Prajapati Sushil , KC Sudhamshu , Shrestha Jeetendra Kaji , Karki Niyanta , Jaishi Bikash , Regmi Kiran , Khadka Sandip 
Published: September 2018

Introduction: Upper gastro-intestinal endoscopy remains the gold standard for screening for esophageal varices but it has its own limitations. It is an invasive, expensive and uncomfortable procedure and needs clinical expertise. Accordingly, this study was conducted to establish the role of non-invasive markers for prediction of esophageal varices in liver cirrhosis.
Methods: A hospital based descriptive cross-sectional study was carried out in Liver unit of National Academy of Medical Sciences, Bir Hospital, from October 2016 to September 2017. Complete blood count, liver function test, liver ultrasound and upper gastro-intestinal endoscopy were done for all patients to detect esophageal varices and to correlate with different non-invasive markers.
Results: Total 191 patients of liver cirrhosis were studied after exclusion. Platelet count of 92082.00±43435.83/mm3 and spleen size of 144.21±10.71 mm was found to be good predictors of presence of EV (P≤0.001). Significant association between Child-Turcotte-Pugh class and presence of varices was observed (P≤0.001). AST/ALT ratio with cutoff value of 1.415 showed sensitivity of 82.4% and specificity of 36.4%. APRI at a cutoff value of 1.3 showed a sensitivity of 83.2% and specificity of 50%.
Conclusions: Platelet count, spleen size and Child-Turcotte-Pugh class are good predictors of presence of esophageal varices in patients with liver cirrhosis. AST/ALT ratio and APRI score are not good substitutes for upper gastro-intestinal endoscopy.

Keywords: esophageal varices; liver cirrhosis; non-invasive markers; portal hypertension; upper gastro-intestinal.
Blood Component Separation Service: A New Experience in an Institution
Authors: Kafle Santosh Upadhyaya , Kattel Gaurav , Nembang Tanchona , Karki Smriti 
Published: September 2018

Introduction: Blood component separation facility began dispatching its blood component units from 21st April 2013 at the new blood component separation service complex at B.P. Koirala Institute of Health Sciences. With the supply of blood components being finite and with the added recognition of a high rate of inappropriate use of blood component services around the world, there is a need to monitor these services. Our study was conducted to identify blood component utilization pattern in institute and to know about different blood components demand for future preparedness. Methods: This retrospective study was conducted at B.P. Koirala Institue of Helath Sciences, Dharan, Nepal for blood component dispatched from 21st April, 2013- 12th February, 2014. Blood components requisitions from all clinical department were reviewed regarding the specific component requested, blood group and socio-demographic profile.Results: Among 3054 transfusion units dispatched, 1552 were males, 1498 females and 4 unspecified. Likewise, 1722 were pack cell volume, 808 platelet rich plasma, 523 fresh frozen plasma and 1 cryoprecipitate disptached respectively with majority of A positive blood group demanded from Neonatal and Paediatric Intensive Care Unit ward for Packed Cell Volume was 201 and Fresh Frozen Plasma was 300 followed by emergency ward for Platelet Rich Plasma. About 197 (6.45%) requistions forms lacked the details of requesting department, while some even reveal multiple demands.
Conclusions: Packed Cell Volume of A positive blood group being the predominant blood component requested from Neonatal Intensive Care Unit/Pediatrics Intensive Care Unit ward at the institute making most requests.
Verbal autopsy to ascertain causes of neonatal deaths in a community setting: A study from Morang, Nepal
Authors: Khanal S , GC VS , Dawson P , Houston R 
Published: September 2018

Introduction: Clinical registration of the cause of death is available for less than one-third of the global newborn deaths, but the need for good quality data on causes of death for public health planning has renewed the interest in the Verbal Autopsy (VA). We aimed to determine the cause of neonatal deaths by VA in Morang district of Nepal.
Methods: Caretakers of the deceased were interviewed using a semi-structured VA questionnaire by female community health volunteers. The cause of death was assigned by two senior pediatricians independently and disagreements in ascertaining the proximate cause of death were resolved by consensus.
Results: The proximate causes of deaths were infections (41 %), birth asphyxia (37.2 %), prematurity (11.5 %), and low birth weight related causes (6.9 %). There was no signifi cant statistical difference in deaths due to infection seen in non-institutional deliveries (43.5 %) than institutional deliveries (34.6 %). More than half of the deaths (58.5 %) occurred within the fi rst three days of life where the predominant cause of death was birth asphyxia (60.7 %).
Conclusions: Analysis of verbal autopsies demonstrates that the major causes of death still are infections and birth asphyxia. The timing of deaths suggests that neonatal interventions should be aimed at the fi rst week of life. There is no comparative advantage between institutional deliveries at below district level institutions and non-institutional deliveries to prevent neonatal infection. Thus, further study on the quality of care at institutes below the district level should be conducted. Disparities still occur in deaths, with most deaths in Morang occurring in non-institutional deliveries and in disadvantaged groups.
Keywords: neonatal deaths, Nepal, newborn, verbal autopsy.
Oral Squamous Papilloma of Edentulous Mouth Interfering with Denture Retention
Authors: Pandey Nashib , Sharma Shivalal , Shrestha Ashish , Marla Vinay 
Published: September 2018

Soft tissue overgrowths inside oral cavity can present with wide range of clinical manifestations and some of them can be even asymptomatic. Oral squamous papilloma is one of that asymptomatic lesion described in the literature with extremely low virulence and infectivity rate. Soft tissue overgrowths can sometimes interfere with denture retention. Here we report a case of squamous papilloma in a 60 years old edentulous female who presented with loss of denture retention.
Keywords: denture retention; papilloma; sialadenoma papilliferum.
Loading Dose only versus Standard Dose Magnesium Sulfate Seizure Prophylaxis in Severe Pre-eclamptic Women
Authors: Rimal Surya Prasad , Rijal Pappu , Bhatt Rabindra , Thapa Kriti 
Published: September 2018

Introduction: Magnesium sulfate is the drug of choice for prevention of seizures in the pre-eclamptic woman. There is no agreement in the published randomized trials regarding the optimal time to initiate magnesium sulfate, the dose to use (both loading and maintenance) as well as the duration of therapy. The objective of this study is to determine whether magnesium sulfate (MgSO4) prophylaxis is needed for up to 24 hours postpartum in all patients with severe pre-eclampsia for the prevention of seizure.
Methods: It is a randomized controlled trial done on 60 pregnant women with severe preeclampsia randomized into standard dose regimen and loading dose only regimen.
Results: Out of 30 cases in each group 1 (3.3%) patient in standard regimen and 2 (6.7%) patients in loading dose only developed seizure. The occurrence of seizure is not significant statistically. In both regimens there was no maternal mortality. Total of 3 patients needed MICU care and 12 patient developed maternal complications. MgSO4 toxicities were seen only in standard dose regimen that is in 17 (56.7%) of the patients. The median number of IM injections of MgSO4 received in standard dose regimen was 8±2.176. In standard dose regimen 73.3 percent baby were alive whereas in case of loading dose only regimen 93.3 percent of baby were alive after 48 hours of delivery.
Conclusions: Single dose of magnesium sulfate is equally effective as standard dose regimen in terms of seizure prophylaxis in severe pre eclamptic women, with added advantage of reduced maternal toxicity and better neonatal outcome.
Keywords: severe preeclampsia; MgSO4; magnesium sulfate; loading dose; eclampsia.
Knowledge, Awareness, and Attitude Regarding Dental Implants among Dental Interns
Authors: Sharma Arati , Shrestha Bidhan , Chaudhari Bijay Kumar , Suwal Pramita , Singh Raj Kumar 
Published: September 2018

Introduction: Implant therapy is an elective dental procedure of dental rehabilitative treatment. Objective of this study was to assess the knowledge, awareness, and attitude of dental interns of Nepal toward dental implants and to see associations of the responses with gender and geographic location of dental college.
Methods: It was conducted from June 2016 to June 2017 after taking ethical clearance and approval from the research committee. The sample included the interns who were present at the time of the survey. Data collection was done through a cross-sectional questionnaire survey, during clinical postings of the interns at all the dental colleges of Nepal, supervised and monitored by the investigators themselves; coded and entered in Microsoft Excel 2013 and statistical analysis was done by SPSS.
Results: A majority of the interns said they are moderately well informed about dental implants 141 (50.36%); main advantage of dental implants is they are conservative 164 (58.6%); most important factor for implant success is case selection 143 (51.07%); the longevity of dental implants is 10-20yrs, 162 (57.85%), 188 (67.14%) agreed that they were not provided with sufficient information and 191 (68.21%) stated that they need more information; 180 (64.3%) felt the difficulty encountered while placing implants is average and 229 (81.78%) stated that they need more hygiene care than natural teeth.
Conclusions: A majority of interns have knowledge regarding dental implants, but the percentage of those who gave unsatisfactory answers is also large. They have a positive attitude towards gaining more information through various means.
Cesarean Vs Vaginal Delivery : An Institutional Experience
Authors: Sharma Shanta , Dhakal Indra 
Published: September 2018

Introduction: According to the WHO, 15% of deliveries have precise indication for cesarean section where it is mandatory for the preservation of maternal and/or fetal health. Increasing rates of Lower Segment Caesarean Sections puts foreword various question that, whether a LSCS need to be reflected as a normal delivery in this twenty first century. There are conflicting reports regarding the safety of caesarean sections. While a significant number of cesarean delivery are performed for obstetrical indications, some are simply due to maternal request and may incur several risks for the child. Not much study has compared the complications of caesarean section with those of vaginal birth. Objective of this study is to find out and compare the common complications of cesarean section with vaginal deliveries on mothers.
Methods: A descriptive study was conducted in two selected hospitals of Rupandehi district, Nepal. Data was collected as per pretested structured proforma from 550 respondents randomly and analyzed by using SPSS, MANOVA and Chi-square test to determine associations between categorical variables.
Results: In total of 550 mothers, 408 (74.2%) had vaginal delivery and 142 (25.8%) had cesarean delivery.The common maternal complications were postpartum hemorrhage 116 (21.1%), prolonged labor 47 (8.5%) and wound infection 42 (7.6%).
Conclusions: The result of the study shows that the maternal complications were higher among LSCS compared to vaginal delivery.
Variations in the Facial Dimensions and Face Types Among the Students of A Medical College
Authors: Pandey Anup , Atreya Alok 
Published: September 2018

Introduction: Facial dimensions and the face types are the most variable factors in human community. These dimensions have practical implications for the anthropologist, forensic experts, anatomists and surgeons. The present study is aimed to determine the facial dimensions and face types among the medical and nursing students.
Methods: A cross-sectional study was done among medical and nursing students of Devdaha Medical College and Devdaha College of Science and Technology from January 2017 to February 2018. There were 155 students of which 72 were males and 83 females. Facial height and width were measured and facial index was calculated. The collected data was entered and analyzed in SPSS 21 and differences in measurements among males and females were calculated.
Results: The mean facial height among the total population was 10.83 ± 0.74 cm and facial width was 12.39 ± 0.67 cm with the mean facial index of 87.44 ± 4.82. The most prevalent was the mesoprosopic face (n= 59, 38.06%) followed by leptoprosopic (n=43, 27.74%). The least prevalent face type was hyperleptoprosopic (n= 7, 4.52%) which was observed only in male individuals.
Conclusions: The present study depicts higher values of facial height, width and facial indexfor males when compared to the females. The present finding is based upon the indices and classification obtained from developed nation. Further studies with local data would help develop indices and classification for Nepalese population.
Prevalence of Different Types of Apical Root Canal Morphology and their Treatment Recommendations in an Institute
Authors: Shrestha Sushmita , Karki Smriti , Agrawal Navin , Vikram Mannu , Singh Vimmi , Shrestha Ashish 
Published: September 2018

Introduction: Canals can be of different shapes in cross section including round canals, oval canals, long oval canals or ribbon shaped canals. Recesses of nonround canals may not be included in the round preparation created by rotary instruments and thus they remain unprepared. The aim of this study included determination of shape and taper of the apical root canal based on diameter at different levels.
Methods: This was a cross sectional study which used convenient sampling technique to determine the sample size. Seventy extracted teeth were sectioned horizontally at one, two and three millimeter from the apex using the diamond disc which was observed under trinocular research microscope for the determination of diameter of root canal under 10x magnification.
Results: The most common canal configuration was oval. The taper of the canals was 25% in mesial root and 20% in distal in bucco-lingual orientation and 14% in mesial root and 15% in distal in mesio-distal orientation.
Conclusions: The most prevalent canal configuration in this study was non round, however, most of the rotary instruments tend to prepare root canals into round shape making their use questionable. The taper of the root canals was found to be higher in our study than what most of the shaping instruments have to offer. So it would be advisable to consider this fact while selecting instruments and preparing these non-round canals as far as the Nepalese subpopulation is considered.