bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ovarian Pregnancy- A Rare Ectopic Pregnancy
Authors: Thapa M , Rawal S , Jha R , Singh M 
Published: September 2018

Primary ovarian pregnancy is a rare entity, the incidence being 1 in 25,000 to 40,000 pregnancies. The diagnosis is difficult and still continues to challenge the clinicians. A case of ovarian pregnancy is reported here. The patient underwent laparotomy with right sided oophorectomy. Histopathological examination confirmed it to be an ovarian pregnancy.
Keywords: ectopia pregnancy, oophorectomy, ovarian pregnancy.
Deep Vein Thrombosis in Protein S Deficiency
Authors: Joshi A , Jaiswal J P 
Published: September 2018

Protein S is a vitamin K-dependent anticoagulant protein. It functions as a cofactor of activated protein C to inactivate activated factor V (FVa) and activated factor VIII (FVIIIa). Its deficiency is a rare condition and can lead to deep vein thrombosis, pulmonary embolism or stroke. It is often treated with long-term anti-coagulant therapy. Protein S deficiency may be hereditary or acquired; the latter is usually due to hepatic diseases or a vitamin K deficiency. Protein S deficiency manifests as an autosomal dominant trait; manifestations of thrombosis are observed in both heterozygous and homozygous genetic deficiencies of protein S. This case report is of DVT due to Protein S deficiency in a 53 year old male. Venous Doppler was used to diagnose DVT and free Protein S level measured by ELISA. IVC filter was placed on the third day of admission.
Keywords: antithrombotic, deep venous thrombosis, inferior venacaval filter, protein S.
Cervical Rib causing Thrombosis of Subclavian Atery
Authors: Sharma P , Rasheed I , Ansari MA , Gurung GS , Chataut SP 
Published: September 2018

We describe here an unusual case of thrombosis of left subclavian artery in a patient with cervical rib. The patient presented with features of ischaemia of left upper limb. X-ray chest revealed bilateral cervical ribs, longer on the left side. Color Doppler studies showed echogenic thrombus within the left subclavian artery. Angiography revealed complete occlusion of left subclavian artery. Embolectomy was done. She was planned for excision of rib.
KEYWORDS: cervical rib, thrombosis of subclavian artery.
Summary Of Original Papers
Authors: Author No 
Published: September 2018

Prostacyclin Administration During Cardiopulmonary Bypass In Man D.B. Longmore, J.Graeme Bennett, P.M. Hoyle, M.A. Smith, A.Gregory, T.Osivand, W.A.Jones Impaired Immune Response Of Splenectomised Patient To Polyvalent Pneumococcal Vaccine Stephen W. Hosea, Cynthia G. Burch, Eric J. Brown, Richard A.Berg, Michael M.Drank Prophylactic Cefazolin Versus Placebo In Total Hip Replacement C. Hill, F.Mazas, R.Flamant, J.Evrard Randomised Placebo-Controlled Trial Of Hepatitis B Surface vaccine In French Haemodialysis Units:II, Haemodialysis Patients Jean Crosnier, Paul Jungers, Anne Marie Courouce, Agnes Laplanche, Ellen Benhamou, Francoise Degos,Bernard Lacour, Paul Prunet, Yvannex Cerisier, Pierre Guesry
Ten PM Note of Organophosphae Poisoning- Successful outcome of a Medical Audit with complete seven steps
Authors: Bhattarai M D 
Published: September 2018

Medical audit in general consists of seven steps like choosing topic, setting criterion and standard, collecting first data, comparing data with standard, introducing change, collecting second data and reflecting. Its three basic premise are improvement of patient care by using existing knowledge, team work with ongoing educational process and change management and promotion of blame-free culture maintaining confidentiality. Audit mostly relates to a particular practice and is therefore not generalisable. An audit of residents' late evening routine notes of organophosphate poisoning patients is reported here, as the change introduced appears relevant to the situation of developing countries. Organophosphate poisoning patients should be managed in intensive care unit with close monitoring, as inadvertent stoppage or slowing of atropine infusion may occur, particularly at night, leading to reappearance of poisoning manifestations, which may cause respiratory failure and death. If they are managed in wards, residents-on-duty can check the clinical and intravenous drip status in the late evening and communicate with nurses and relatives to be particularly vigilant. In the audit done, such regular ten pm notes of organophosphate poisoning about the clinical and drip status and communication by residents were increased from 15.5% in the first to 81.7% in the second data collection (p < 0.01) after the introduction of the change. The ten pm note is being continued for about two years now. Implementation of ten pm note of organophosphate poisoning patients admitted in medical wards is feasible and appears useful to improve the quality of health care delivery and learning of residents.
Keywords: atrophine, audit, audit steps, organophosphate mortality, organophosphate poisoning.
Color Vision Defects in School Going Children
Authors: Shrestha R K , Joshi MR , Shakya S , Ghising R 
Published: September 2018

Introduction: Color Vision defect can be observed in various diseases of optic nerve and retina and also a significant number of people suffer from the inherited condition of red and green color defect.
Methods: A cross-sectional descritptive study was designed with purposive sampling of students from various schools of Kathmandu Valley. All children were subjected to color vision evaluation using Ishihara Isochromatic color plates along with other examination to rule out any other causes of color deficiency.
Results: A total of 2001 students were examined, 1050 male students and 951 females with mean age of 10.35 (±2.75) and 10.54 (±2.72) respectively. Among the total students examined, 2.1% had some form of color vision defects. Of the male population , 3.9% had color vision defects while none of the female was found with the deficiency.
Conclusions: The prelevance of color vision defect in Nepal is significant and comparable with the prelevance quoted in the studies from different countries.
Keywords:color vision; congenital red green color effect; Nepal; prevalence.
Clinical Profile of Patients with Tetralogy of Fallot admitted for Surgery at a Cardiac surgical centre
Authors: Otaigbe B E , Kumar S 
Published: September 2018

INTRODUCTION:

Tetralogy of Fallot (TOF), a conotruncal defect, has been documented to be associated with chromosome abnormalities, single gene syndrome (22q11 microdeletion), known teratogens, with the rest associations being multifactorial. This study was carried out to determine the clinical profile and associated risk factors in patients with TOF admitted for surgical repairs.
METHODS:
Case files of all patients admitted for Tetralogy of Fallot over a period of one year were retrieved from the Medical Records Department and reviewed. Data on the patients' and their family history and associated cardiac anomalies were noted.
RESULTS:
There were 54 patients, 37 males and 17 females, with a mean age of 6.8 years +/- 7.1. Sixty percent were born between July and December, 81.5% as full term and 44% as first born. Twenty-six percent were born into consanguineous marriages. Five patients had dysmorphic features. Associated cardiac anomalies included right aortic arch, pulmonary atresia, dextrocardia and left superior vena cavae.
CONCLUSION:
The associated risk factors noted in this study were male sex, birthdates between July and December, first born and increased paternal age. Other risk factors were consanguinity and specific patterns of cardiovascular diseases associated with 22q 11 deletions. This suggests a multifactorial etiology for TOF.
Keywords: associated risk factors, cardiac anomalies, demographic factors, Tetralogy of Fallot
Clinical grading of Intrahepatic Cholestasis Pregnancy
Authors: Pradhan Meena , SHAO Yong 
Published: September 2018

Intrahepatic cholestasis of pregnancy (ICP) is the pregnancy induced liver disorder causing intense itching of palm, sole or even whole body especially in the evening at late second and third trimester. This disease categorized into mild and severe ICP according to raised level of LFT including serum level of Bile acid and Cholic acid. ICP has less morbidity to mother but significant risk for fetus in uterus. The predisposing element to cause intense pruritus is because of high amount of bile acid in maternal serum. Toxic bile acids affect fetal cardiomyocytes that retained in fetus body causing sudden intrauterine fetal death. ICP is commonly found in winter months and mostly itching of body occurs in the evening after sunset. Fetus in uterus is unsafe if mother’s bile acid exceeds normal value. ICP is successfully treated with Ursodeoxycholic acid (UDCA), S-adenosyl methionine (SAME), Dexamethasone and vitamin K. Keywords: itching; bile acid; obstetric cholestasis; Ursodeoxycholic cholic acid.
Delayed Presentation of Acute Coronary Syndrome: A Challenge in its Early Management
Authors: Acharya Pramod , Adhikari RR , Bhattarai J , Shrestha NR 
Published: September 2018

INTRODUCTION:The time of presentation of acute coronary syndrome from the onset of chest pain determines the treatment modality and prognosis. Delayed presentation is associated with a poor outcome. In the present study, we tried to find out the causes of late presentation of ACS in a tertiary care center in the eastern part of Nepal.METHODS:It was a cross-sectional descriptive study that included 100 consecutive patients with ACS presenting to our institute over a period of 8 months. They were studied for their demographic profile, delay in presentation, the management done at the local centers and their final diagnosis.RESULTS:We found that patients living within Dharan City reached BPKIHS within 20 hours of the onset of chest pain while those from outside the city who came directly reached within 63 hours. Other patients reached their respective local centers (health posts, district hospitals and private clinics) within 39 hours. The commonest cause of delay was vehicular problem followed by unnecessary delay at the local centers. The work up for chest pain was inadequate in these centers. Late presentation to our institute significantly affected the optimal management.CONCLUSIONS: We found that significant number of patients with ACS from eastern Nepal presented late in our tertiary care center. In order to improve ACS outcome in this region, we advise equipping the local centers with electrocardiogram machines, improvement in ambulance services and a greater emphasis on coronary artery disease awareness programs as well as initiating preventive measures.KEY WORDS:acute coronary syndrome, chest pain, delayed presentation, electrocardiogram
The Role of Ultrasonography in Detection and Localization of Radiolucent Foreign Body in Soft Tissues of Extremities
Authors: Shrestha Dipak , Sharma UK , Mohammad R , Dhoju D 
Published: September 2018

INTRODUCTION:Retained non-radiopaque foreign body inside soft tissue can be a cause of prolonged morbidity. Detection and localization is difficult task with conventional radiography. Ultrasonography, CT and MRI are other modes of evaluation but both of CT and MRI are expensive and not easily available.METHODS:Twenty three patients were evaluated with ultrasonography (8 MHz linear probe) and X-ray for clinically suspicious non-radiopaque foreignbody in soft tissue of extremities. Clinical presentation, duration of symptoms, anatomical location and foreign bodies retrieved after surgical explorations were recorded.RESULTS:X-ray could not detect any foreign body in all 23 patients. Ultrasound findings were suggestive of foreign body in 19 patients (male: female=2:1, mean age 31.68+/-11.8 years, range 12 - 54 years) which was confirmed after surgical exploration except in one where only foreign bodygranuloma was found. 4 (21%) were not aware of prick injury. Fifteen patients had attempted removal of foreign body themselves or at medical shop or local health post. Interval between injury / symptoms appearance to hospital ranged from 4-56 days. Foot and ankle was involved in 10 (52.6%), calf in 3 (15%), dorsum of hand in 2 (10.5%), palm in 2 (10.5%), shoulder in 1 (5.2%) and knee in 1 (5.2%) case. Foreign bodies retrieved were wood in 12 (63%), thorn in 4 (21%) and bamboo twig in 2 (10.5%) patients.CONCLUSION:Plain X-ray isn't sensitive for detection of non-radiopaque foreign body in soft tissue. Ultrasonography is sensitive and specific fordetection and localization of foreign body which should be included in evaluation for clinically suspicious retained non-radiopaque foreign body in softtissue of extremities.KEYWORDS:non-radiopaque foreign body; sensitivity; specificity; ultrasonography
Laparoscopic Management of Benign Ovarian Masses
Authors: Saha Rachana , Karki Chanda 
Published: September 2018

Introduction: Laparoscopic surgery is one of the most common procedures performed for benign ovarian masses. The aim of the study was to analyze all benign ovarian masses treated laparoscopically to assess safety, feasibility and outcome.Methods: A prospective study was carried out at Kathmandu Medical College Teaching Hospital, Sinamangal, Nepal. All the patients undergoing laparoscopic surgery for benign ovarian masses from 1st January 2012 to 31st December 2012 were included in the study. The pre-operative findings, intra-operative findings, operative techniques and post-operative complications were analyzed.Results: Thirty-six patients were taken for the study. Two cases were excluded since intra-operatively they were tubo-ovarian masses. The most common tumor was dermoid cyst (n=13; 38.23%) and endometriotic cyst (n=14; 41.17%). Out of 34 cases, five cases of endometriotic cyst (14.70%) were converted to laparotomy due to severe adhesions and four cases of endometriotic cyst underwent deroofing surgery. Two cases underwent laparoscopic assisted vaginal hysterectomy with bilateral salphingo-oopherectomy. Successful cystectomies were carried out in 22 cases. None were malignant. Major complications were not noted while minor complications like port-site infection (n=3; 8.82%) and subcutaneous emphysema (n=1; 2.9%) were present.Conclusions: Laproscopic management of benign ovarian masses is safe and feasible.
Overweight and Obesity among the Adolescent School Students in Belgaum City
Authors: Gurung Tika Ram , Neginhal Vijayalaxmi Shivanand 
Published: September 2018

Introduction: The World Health Organization (WHO) defines obesity as a ‘global epidemic’. An overweight adolescent has a 70 % chance of becoming obese. Overweight and obese adolescents are at higher risk for developing long-term chronic diseases. So the present study objective is to estimate the prevalence of overweight and obesity among adolescent school studentsMethods: A sample size of 300 adolescent students was taken to do a cross-sectional study. Body weight and height were recorded and BMI was categorized based on age-and sex-specific cut-off values as per IOTF reference growth charts. Proportions of obese, overweight and underweight children were calculated and subjected to chi-square and logistic regression tests at the p < 0.05 significance level.Results: The overall prevalence of overweight and obesity in the present study were 12 % and 3.3% respectively. The highest prevalence was among those aged 15 years i.e. 36.7%. The prevalence of overweight and obesity was higher among the subject who did not practice physical activity and whose family income was more than 10,000 per month.Conclusions: Prevalence of overweight and obesity among adolescents student in Belgaum city was high which is statistically associated with less physically activity and monthly income of parent. Keywords: body mass index; life style; overweight and obesity.
Acute Coronary Syndrome in an Intensive Care Unit of a Tertiary Referral Centre in Central Nepal: The Spectrum and Coronary Risk Factors.
Authors: Gautam Mani Prasad , Sogunuru Guruprasad , Subramanyam Gangapatnam , Thapa Lekhjung , Paudel Raju , Ghimire Madhav , Samir Gautam , Ghimire Usha , Shilpakar Ramila 
Published: September 2018

Introduction: Acute coronary syndrome is the major leading cause for coronary care unit admission. Its spectrum comprises a variety of disorders including unstable angina, non ST elevation and ST elevation myocardial infarction.Methods: An observational study was designed to study the spectrum of acute coronary syndrome and associated coronary heart disease risk factors in subjects admitted in intensive care unit from August 2009 to September 2010. Details including coronary risk factors and the categories and outcomes of acute coronary syndrome were analyzed.Results: A total of 57 subjects were included in the study. The majority (63.1%) were males. The mean age was 64.54±13.8 years. Five (8.8%) patients were ≤45 years and 29 (50.88%) patients were ≥65 years. Majority of the patients were smokers (50.87%). The other major coronary heart disease risk factors were diabetes (43.85%), hypertension (36.87%), dyslipidemia (26.32%) and previous history of coronary heart disease (31.58%). Coronary heart disease figured prominently in the family history as well (26.32%). ST elevation myocardial infarction was the major category (42.11%) followed by non-ST elevation myocardial infarction and unstable angina (31.58% and 26.32% respectively). Myocardial infarction complicated with cardiogenic shock had very high mortality (83.33%). Conclusions: The ST elevation myocardial infarction was the major clinical form of acute coronary syndrome admitted in intensive care unit. Prevention should be targeted on modifiable risk factors such as the management of risk factors. In addition, the improvement in cardiology service with the establishment of CCU and cathlab might alter the mortality and morbidity in ACS management.Keywords: acute coronary syndrome; coronary risk factors; intensive care unit.
Gross corelation between waist hip ration and random blood sugar level in Thami tribe of Dolakha district in Nepal
Authors: Kharal Puspa Mani , Prasad Pratap Narayan , Acharya Ramesh Prasad 
Published: September 2018

Introduction: Diabetes is one of the major public health problems in Nepal. Very few studies on correlation between waist hip ratio and random blood sugar have been done in remote areas of Nepal particularly in minor ethnic groups like Thami. This study attempted to compare waist hip ratio and blood sugar level in Thami community of Nepal.Methods: This cross sectional study was conducted in sub-health post of Lapilang village of Dolakha district of Nepal. A total of 243 local inhabitants from Thami Tribe participated in the study. Waist hip ratio was calculated after taking measurements of waist and hip using flexible measuring tape; and, blood glucose level was measured by glucometer.Results: The mean age of the participants was 46.02 years; among participants 126(51.9%) were males and 117(48.1%) were females. Mean waist hip ratio was 0.87, mean blood sugar level was 124.5mg%.Increase in Waist hip ratio correlated significantly with increase in random blood sugar level both in males(p=0.008) and females(p=0.007).Conclusions: Increase in waist hip ratio is associated with increase in random blood sugar level. Therefore, there is a need of public awareness program to reduce waist circumference thus reducing weight of people to prevent development of diabetes mellitus in long run.Keywords: blood sugar level; diabetes; Thami community; waist hip ratio
A Ten year Clinicopathological Study of Female Genital Tuberculosis and Impact on Fertility
Authors: Mondal Santosh Kumar , Dutta TK 
Published: September 2018

INTRODUCTION:To determine the histological pattern of involvement, clinical presentation, impact on fertility in women with genital tuberculosis.METHODS:A total number of 68 cases of gynaecological tuberculosis affecting different parts of female genital tract from 56 patients were selected. The age range of the patients was 17-36 years with mean age of 25.6 years. The diagnostic procedures used included endometrial curettage and biopsy, histopathological examination, culture and Mycobacterium Tuberculosis Polymerase Chain Reaction (MTB PCR), laparoscopy, Hysterosalpingography (HSG) and Ultrasonography (USG). Most of the specimens received were biopsies of endometrial curettage for evaluation of infertility. In 7 cases, specimens of total hysterectomy with bilateral salpingo-oophorectomy were submitted with lesions involving multiple sites.RESULTS:Patients presented with infertility (65-70%), pelvic/abdominal pain (50-55%), and menstrual disturbances (20-25%). Tuberculosis involved the endometrium in 55.88%, tubes in 23.53%, ovaries in 14.71% and cervix in 5.88% of the 68 cases. The endometrium(38 cases)was in the proliferative phase in 31 cases (81.57%), secretory phase in 4 cases (10.52%) and it was atrophic in 3 cases (7.89%).Caseation was present in 9 out of 68 cases and Ziehl-Neelsen (ZN) stain revealed Acid Fast Bacilli (AFB) in tissue sections in only 4 cases . After therapy, 9 patients conceived of which 8 suffered spontaneous abortions. Only one patient had a successful pregnancy and the baby was born through caesarean section.CONCLUSIONS:Genital tuberculosis is an important cause of female infertility in developing countries like India, Nepal, Bangladesh and Pakistan. Successful uterine pregnancy is rare after treatment and chances of ectopic pregnancy are high.Keywords: Key Words:female infertility, genital tuberculosis, histology
Tuberculosis in HIV Patient
Authors: Paudel Bidhan Nidhi , Paudel Punya , Paudel Luna , Dhungana Govinda Prasad , Amatya Gyanendra Lal , Kandel Prakash 
Published: September 2018

Introduction: Strict monitoring of anti tuberculosis therapy (ATT) and antiretroviral therapy (ART) is crucial for proper management of TB/HIV co-infected patients.Methods: Between December 2006 and December 2008 a prospective observational study was conducted among 135 TB/HIV co-infected patients visiting antiretroviral therapy in Seti Zonal Hospital, Dhangadi. The diagnosed TB patients were subjected to ATT through directly observed treatment short-course (DOTS) and its response was evaluated as per WHO guidelines.Results: Among 135 studied subjects, 71.9% were males and over 88 % of the patients were in the age group 21 to 50. Of the Total TB cases 68.1% presented pulmonary TB (PTB) and 37.20% of the Extra-pulmonary Tuberculosis (EPTB) cases were lymph node TB. 75.5% of them had completed ATT, 8.2% transfer out and 12.6% were default.Conclusions: Majority of the patients presented PTB, and lymph node TB was found to be the most common EPTB. Comparatively, high efficacy of ATT was found in HIV patients visiting this resource poor setting.Key words: antiretroviral therapy; anti TB therapy; Dhangadi; lymph node T; treatment response.