bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unusual Presentation of Lacrimal Gland Pleomorphic Adenoma
Authors: Pokharel Shailesh Mani , Pant Ashish Raj , Badhu Badri Prasad , Lavaju Punam , Shrestha Bhuwan Govinda , Agarwal Meenu 
Published: September 2018

The pleomorphic adenoma of lacrimal gland presents as a painless, progressive, slowly growing supero-temporal swelling with variable proptosis. This tumor is usually found in adults and extremely rare in teenage. We report a case of a 15-year-old boy with pleomorphic adenoma of lacrimal gland which mimicked pseudotumor of orbit due to its presentation as an orbital inflammatory disease and the age distribution. Neuroimaging also suggested pseudotumor and oral steroid was started. But, there was no improvement on steroids and ultrasound guided Fine Needle Aspiration Cytology (FNAC) was performed which suggested Pleomorphic adenoma of the lacrimal gland. En-bloc excision of the mass through antero-lateral orbitotomy was done with satisfactory final outcome The histopathological evaluation was consistent with pleomorphic adenoma of the lacrimal gland.
Keywords: lacrimal gland pleomorphic adenoma; orbitotomy; proptosis; pseudotumor.
Association between Helicobacter Pylori and Gastric Cancer
Authors: Kafle Brindeswari , Bhandari Ramesh Singh , Lakhey Paleswan Joshi , Shrestha Pradeep , Khadka Prem , Sharma Shashi 
Published: September 2018

Introduction:A casual relation has been thought to exist between Helicobacter pylori infection and gastric cancer. The present study was carried out to find correlation between H. pylori and gastric carcinogenesis.
Methods: A case control study was performed in the department of endoscopy, Tribhuvan University Teaching Hospital, between January 2008 and February 2009. All patients having carcinoma stomach on endoscopic evaluation later confirmed by histopathological examination were included. Total 50 healthy individuals, with no positive finding in endoscopy were included in control group.
Results: Total 37 cases were analyzed. There were 23 (62.2%) males and 14 (37.8%) females. Majority were above 60 years (46%). Blood group A was commonest group found in patients with carcinoma stomach. Distal part, antrum, 20 (54%) was commonest location of tumor and Borrmann type three was commonest endoscopic type of tumor presentation. Majority of patients received triple therapy and H. pylori detection was low in those treated with triple therapy. Distal tumors were significantly associated with increased prevalence of H. pylori positivity. Total incidence of H. pylori in cases was 54% (20/37). In 15 (75%) cases, H. pylori could be detected by both ELISA and biopsy method. Incidence of H. pylori in controls was 64% (32/50). There was no statistically significant difference in H. pylori presence in cases and control.
Conclusions: Our study couldn’t establish association between H. pylori and gastric cancer. More prospective trials can help find out correlation between combination of risk factors and gastric cancer.
Keywords: helicobacter pylori; gastric cancer; risk factors.
Lignocaine and Esmolol on Stress Response to Laryngoscopy and Intubation
Authors: Rajbhandari Pradeep Kumar 
Published: September 2018

Introduction: Laryngoscopy and tracheal intubation causes significant sympathetic response resulting in hypertension and tachycardia. In individuals with systemic hypertension, coronary artery disease, cerebrovascular disease and intracranial aneurysm, the effect of this transient sympathetic response can evoke life threatening conditions like pulmonary oedema, cardiac failure and cerebrovascular haemorrhage.
Methods: Patients were randomly divided into two groups, 30 in each group. Group I received 50 mg of esmolol and group II received lignocaine 2 mg/kg. Haemodynamic parameters like pulse, systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured before induction of anaesthesia, immediately after intubation then at intervals of one minute, three minutes, five minutes, seven minutes and 10 minutes.
Results: There was no significant difference in demographic or base line vital signs between two groups (Table 1). The mean systolic blood pressure increased on laryngoscopy and tracheal intubation by 15 mmHg in the group I whereas in group II it was 17.4 mmHg. There was a significant rise in diastolic blood pressure (DBP) in both the groups, but the rise was lesser in group II than in group I.
Conclusion: Both esmolol and lignocaine were not effective in attenuating hemodynamic stress response to laryngoscopy and tracheal intubation; however esmolol was superior to lignocaine in blunting the stress response.
Keywords: esmolol; intubation; laryngoscopy; lignocaine; stress response.
Induction of Labor Using Misoprostol With or Without Mifepristone in Intrauterine Deat
Authors: Agrawal Ajay , Basnet Pritha , Thakur Achala , Rizal Pappu , Rai Rubina 
Published: September 2018

Introduction: Rapid expulsion of fetus in intrauterine fetal death is usually requested without any medical grounds for it. So an efficient, safe method for induction of labor is required. The objective of this study is to determine if pre-treatment with mifepristone followed by induction of labor with misoprostol in late intrauterine fetal death is more efficacious.
Methods: We conducted a randomized controlled trial in 100 patients in B.P.Koirala Institute of Health Sciences, Nepal from June 2011 to May 2013. Group A women received single oral dose of 200 mg mifepristone, followed by induction with vaginal misoprostol after 24 hours. Group B women were induced only with vaginal misoprostol. In each group, five doses of misoprostol was used four hourly. If first cycle was unsuccessful, after break of 12 hour, second course of misoprostol was started. The primary outcome was a measure of induction to delivery time and vaginal delivery within 24 hours. Secondary outcome was to measure need of oxytocin and complications.
Results: Maternal age, parity and period of gestation were comparable between groups. Number of misoprostol dose needed in group A was significantly less than group B. Mann Whitney U test showed, women in group A had significantly earlier onset of labor, however total induction to delivery interval was not significant. In group A, 85.7% delivered within 24 hours of first dose of misoprostol while in group B 70% delivered within 24 hours (p=0.07). More women in Group B required oxytocin.
Conclusions: Pretreatment with mifepristone before induction of labor following late intrauterine fetal death is an effective and safe regimen. It appears to shorten the duration of induction to onset of labor.
Keywords: induction of labor; intrauterine fetal death; mifepristone; misoprostol.
Normal Width of Third Ventricle In Nepalese Population: Assessment By CT Scan
Authors: Shrestha Amit , Rajbhandari Nikita , Shrestha Anand , Pun Bishika 
Published: September 2018

Introduction: Cerebral ventricular enlargement occurs as a natural aging process but also has been associated with many neurological disorders. Whether this enlargement is primary or secondary to these pathological conditions remains controversial. Objective of the study was to tabulate and create normal references values for maximum width of third ventricle in Nepalese population according to age group and gender.
Methods: MTW was determined in two hundred (112 males and 88 females) and age ranging between 1- 93 years who had normal Computed tomography scan (CT scan) of the head .The data collected was analyzed with statistical program IBM SPSS version 20.
Results: Measurements of MTW in both males and females of the normal groups revealed no significant difference. No significant difference in MTW was noticed till the age of 49 years. Significant differences were noticed between 49 - 93 years of age.
Conclusions: This study corroborated well with normal MTW values published in literatures from other parts of the world. However normal values specific to our local population becomes more relevant in interpreting CT scan of head in Nepal.
Keywords: cerebral atrophy; computed tomography scan; hydrocephalus; maximum width of third ventricle.
Maternal Factors for Low Birth Weight and Preterm Birth At Tertiary Care Hospital
Authors: Ojha Neebha 
Published: September 2018

Introduction: Low birth weight and preterm birth are the major community health problems in developing countries. They are the major determinants of perinatal survival and infant morbidity and mortality. The aim of this study was to determine the proportion and the maternal risk factors for low birth weight and preterm birth among hospital deliveries in Tribhuvan University Teaching Hospital.
Methods: A cross sectional retrospective study was carried out in the Department of Obstetrics and Gynecology of TUTH. Maternal risk factors like age, parity, ethnicity, history of previous abortion, history of previous cesarean section, antepartum hemorrhage and medical disorders were studied. Information on all births that occurred was extracted from maternity case notes and delivery registers.
Results: During the study period, there were 685 singleton live births. Among these 78(11.4%) were low birth weight and 47(6.9%) were preterm birth. The mean birth weight was 2950 ± 488 gm. The mean weight of female was statistically less compared to male babies (p=0.032). The significant risk factors for LBW were primiparity (OR 2.12; 95%CI 1.25-3.58), Indo-Aryan ethnicity (OR 1.97; 95%CI 1.12-3.45) and history of medical disorder (OR 3.08; 95%CI 1.17-8.12). As for PTB antepartum hemorrhage (OR 8.63; 95%CI 1.99-37.30) and history of medical disorder (OR 3.20; 95%CI 1.04-9.89) were significant risk factors.
Conclusions: Parity, ethnicity, and medical disorders were the main risk factors for low birth weight. Antepartum hemorrhage and medical disorders were significant risk factors for preterm birth.
Keywords: low birth weight; preterm birth; risk factors.
Examination of Relationships among Organizational Characteristics and Organizational Commitment of Nurses in Western and Eastern Region of Nepal
Authors: Joshi Archana Shrestha , Namba Mineko , Pokharela Tara 
Published: September 2018

Introduction: The objective of this study is to identify relationships between three components of organizational commitment and organizational characteristics of nurses in the western and the eastern region of Nepal.
Methods: A self-administrated questionnaire was used to collect data from 310 nurses currently working at various hospitals in the eastern and the western region of the country. The questionnaire included three sections namely 1) personal characteristics 2) organizational characteristics and 3) organizational commitments scale. Descriptive analysis and multiple regression analysis were performed to identify significance in various relationships.
Results: Out of the 240 completed questionnaires, 226 were found valid for analysis. The mean age was 27.4 years. For each depended variable affective, continuance and normative commitment, multiple regression analysis was performed with personal Characteristics and organizational characteristics as independent variables. All independent variables were found significantly related to each of the two dependent variables; affective commitment and normative commitment (R2 adjusted=0.24, p<0.01 and R2 adjusted=0.05, p<0.01 respectively). However, they were not significantly related to the continuance commitment. Both support from boss (β=0.138, p<0.05) and satisfaction with training (β=0.301, p<0.05) were found to be positive and significant with affective commitment. On the other hand, satisfaction with training (β=0.191, p<0.05) was also positive and significant with normative commitment.
Conclusions: Since both support from boss and training program were found to be positive and significant with affective commitment, hospitals must encourage supervisors to provide more assistance to the subordinate nurses. Moreover, hospitals should develop more training programs to keep nurses motivated.
Keywords: nursing management; organizational commitment; organizational characteristics; retention.
Experience with Extra Hepatic Intra Abdominal Hydatid Cyst
Authors: Talpur Altaf Ahmed , Shaikh Aijaz Ahmed , Arain Muhammad Imran , Siddiqui Akmal Jamal 
Published: September 2018

Introduction: Hydatid disease is a significant health problem with their location at Extrahepatic Intra abdominal sites is a very rare disease. Disease in these sites usually found concurrently with liver hydatid disease. Diagnosis is based blood tests & imaging studies. Surgery is the mainstay of treatment. This study will help us in determining the frequency of Extra Hepatic Intra Abdominal Hydatid Disease. Also different methods to diagnose & treat the disease will be evaluated.
Methods: It includes patients of extra hepatic intra abdominal Hydatid cyst above 13 years and underwent surgery from 2009 to 2014. Variables include age, sex, clinical findings, diagnostic investigations, operative findings, operative procedure, post operative complications.
Results: Eleven patients; 07 male & 04 female; mean age 37.54 years. Most common symptoms were mass in abdomen in 11 patients & dull pain abdomen in 09 (81.8%) patients. Examination revealed non tender mass in epigastric & umbilical region in 04 (36.3%) patients. Ultrasound Abdomen showed hydatid cyst spleen in 02 (18.1%) patients, epigastrium in 04 (36.3%) patients, beneath left crus of diaphragm in 02 (18.1%) patients & right iliac fossa & pelvis in 1 (9.09%) patient. In 02 (18.1%) patients multiple Hydatid cysts were noted. Hydatid cysts liver found in 07 (63.6%) patients. C.T scan Abdomen was performed in 09 (81.8%) patients. Surgical procedures performed include Saucerization & omental packing in liver Hydatid cysts; Splenectomy for Splenic disease & complete excision of remaining intra-abdominal Hydatid cysts. Postoperative complications noted in 05 (45.4%) patients.
Conclusions: Extra hepatic intra abdominal is an infrequent disease presents significant diagnostic & therapeutic challenge for surgeons.
Keywords: extra hepatic; hydatid disease; intra abdominal.
Childhood Mishaps and Its Cognizance among Nepalese Mothers of Parsa District for Its Prevention, Small Cross-sectional Study
Authors: Bhattarai Sabitri , Saha Archana 
Published: September 2018

Introduction: Several studies have shown that there several unintentional causes for the unwanted childhood accidents. In addition, Nepal demographic health survey via West University of England revealed at 2006 A.D, 11% death casualties of under- five aged children are due to unintentional injuries 1. This particular study is extremely useful to health care planner, provider and researcher to have grand design to be produced by government of Nepal, such that; there shall be minimal rate of casualties of deceased children due to accidents.
Methods: This study is descriptive cross sectional study carried out in Parsa district of Nepal where the respondents were mother to assess their awareness of cause of childhood accidents and its prevention. Computer software SPSS is use to scrupulous analysis of study where the chi-square test is used with 95% level of confidence (p=0.05).
Results: Poisoning 96% cases is the cause of childhood accident unintentionally, followed by 94% foreign body aspiration, 85% flame burn. Unsupervised children are more prone to injury than supervised children. Finally and foremost the crucial correlation of parents level of awareness with childhood are as follows; inadequate level of knowledge have higher percentage of accident (58%), followed by moderately adequate (32%) and adequate (10%).
Conclusions: This study though done on small scale on small part of Parsa district can play key role to the policy to have vigilantive and supervision power to see the loopholes that need to be detected and dealing in curative manner.
Keywords: accident ; childhood ; injuries ;Nepal.
A Case Of Vulvar Myiasis
Authors: Dawadi Bishwa Raj , Sherpa Mingma Temba , Shrestha Rakshya 
Published: September 2018

Myiasis is occurs in humans and vertebrate animals mostly due to dipterous flies of the genera Chrysomyia and Cochliomyia. There have been reported cases of myiasis of skin, breast, intestine, eyes and ear but very few cases of vulvar myiasis have been reported in the medical literature. We report a case of a 20 years old female with vulvar myiasis. A 20-year old unmarried girl presented to our hospital with complains of vaginal discharge and vulvar irritation for 3 days with evidence of some worms around her vulvar region. Her menstrual history revealed the use of folded cloths instead of sanitary pads during her menstruation. Moreover, she washed those clothes with water and hanged them in the clothesline outside to let them dry before reuse. Examination of the external genitalia multiple ulcers measuring 1X1 cm on the inner surface of the labia minora, heavily infested with large number of maggots. The patient was admitted for 4 days during which she was given antibiotics, analgesics and anti-inflammatory medication. Daily local asepsis of the wound with antiseptic solution (betadine) was done. We removed more than 30 larvae by the fourth day after which no more larvae were seen and she gradually recovered in the following days. It is our opinion that the cause of vulvar myiasis in our patient was her poor sanitary hygiene. Simple measures such as washing clothes thoroughly, drying and ironing of clothes are also necessary to reduce the risk of this human myiasis.

Keywords: external genitalia; female; maggots; myiasis.
The Man Behind the Royal Massacre
Authors: Sherchan Surendra , Joshi Devavrat 
Published: September 2018

Delusional disorder is a relatively uncommon psychiatric condition in which patients present with non-bizarre delusions, but with no accompanying prominent perceptual disturbances, thought disorder or significant and sustained mood symptoms. Apart from their delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not generally seem odd or bizarre to others for many years of the onset of their symptoms. Because of this, they are brought to the clinician many years after the onset of their symptoms, only when their delusional behavior becomes overt. Thus, identifying and treating delusional disorders in time is a challenging task.
Keywords: delusion; grandiose; persistent delusional disorder.
Management of Acute Lower Gastrointestinal Bleeding: Principles and Current Practice in the United Kingdom
Authors: Robins James , Shrestha Anne , Hampton James , Shrestha Badri Man 
Published: September 2018

Acute lower gastrointestinal bleeding is a common cause for hospital admission that results in significant morbidity and mortality. The major objectives of all involved in the management of ALGBI patients are to reduce mortality and the need for major surgery. A secondary objective is to prevent unnecessary hospital admission for patients presenting with bleeding that is not lifethreatening. The management of ALGBI has evolved over last decade with the changing modalities of diagnostic facilities. On review of the published literature, there is paucity of randomised control trials in relation to the diagnostic tools and management of ALGBI. The aim of this review is to summarise the principles and current methods available for the diagnosis and treatment of ALGIBand based on the available evidence and the current practice in the United Kingdom, outline an algorithm for the management of ALGIB.
Keywords: Lower gastrointestinal bleeding; aetiology; prognosis; management algorithm.
Smoking and Thromboangitis Obliterans– Are they related
Authors: Sapkota Prakash , Budhathoky Prakash , Mathew Stanley 
Published: September 2018

Introduction: In 1908 Leo Buerger first gave the world the clinical picture of this dreadful disease which he called Thromboangitis Obliterans. Virtually all investigators believe that smoking or tobacco use in some form is a requirement for the diagnosis of Thromboangitis Obliterans. We studied the demographic profile and smoking pattern of patients with Thromboangiitis Obliterans.
Methods: Retrospective study carried out in a tertiary level hospital of South India from 1st January 1997 to 31st December 2003. Patients fulfilling Shionoya’s criteria form the study group. Incidence of Thromboangitis Obliterans, relation to smoking habits, type and nature of manifestation were analyzed.
Results: A total of 105 cases were studied and found to have declining pattern of incidence from 0.9%-0.3%. All patients were males, smokers at the time admission and 76% out of them were from low socioeconomic background. Patients smoking 5-15 cigarettes per day, for 5-10 years duration constituted 45% of the study group. The most frequent reasons for being referred to hospital were ischemic ulcers (83.80%), claudication (78.0%) and rest pain (26.66%).
Conclusions: In those who present early with the disease the number of cigarettes and duration of smoking shows no direct correlation to the severity. Most patients continue to smoke inspite of counseling and awareness that the disease progresses due to smoking. Ulcer, intermittent claudication and rest pain are the three common presenting symptoms of Thromboangitis Obliterans.
Keywords: smoking; thromboangitis obliterans.
Fetal Craniotomy
Authors: Shrestha Bikash , Gupta Sandip , Chawnghlut Lomi , Khaniya Bipindra 
Published: September 2018

Nowadays, even in developing countries Cesarean section is the most common method of delivery for the breech presentation. However, in rural parts of the countries still vaginal route is the only option. Trauma to the after coming head is the common issue among the contributors of birth trauma during breech delivery. Entrapment of after coming head is an unpredictable obstetrical emergency. If the fetus is alive, options from application of obstetric forceps to giving Dührssen incisions can be kept in choice. Cesarean section is done when all the methods fail to deliver the head. But, when the fetus is not salvageable, delivery of after coming head by craniotomy can reduce unnecessary morbidity of Cesarean section. In the present report, a case with entrapment of after coming head of dead preterm fetus for 6 hrs of home delivery was described and the management of this condition was reviewed.
Keywords: after coming head; breech; craniotomy; obstetrical emergency.