bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychological Problems Among Nursing Staff in a Hospital
Authors: Shakya D R , Lama S , Shyangwa P M 
Published: September 2018

Introduction: A high prevalence of psychological/ mental disorders has frequently been reported among nursing staff. However, there is a scarcity of data about ‘psychological, mental and behavioural problems’ among Nepalese nurses. Current study aimed to measure the prevalence of psychiatric problems among nursing staff in a tertiary care hosital.
Methods: All nursing staffs working in the hospital during one year were the subjects of this study. With the informed written consent, the responses to semi-structured proforma and the questionnaire General Health Questionnaire 28 were collected. A semi-structured proforma was used to record socio-demographic, clinical profiles and other information. The GHQ 28 was used to screen major psychiatric disorders. The GHQ 28 gives ‘psychiatric caseness’ to the subjects with score of 4 or more.
Results: Overwhelming majority of nursing staff in BPKIHS is female certificate level staff nurses. Majority were from urban and semi urban settings. Some had job and institute related stressors. Most common among the reported health complaints were low back pain and headache. Few staff revealed psychiatric diagnosis. Among the enrolled 337 subjects, ‘psychiatric caseness’ was present in 34.72%. Some departments (e.g. dialysis, eye, medical, gynecology ward) had proportionately higher ‘psychiatric caseness’ rates than other (e.g. ENT, psychiatry ward, emergency OT, CSSD).
Conclusions: A great proportion of nursing staff suffer from mental and behavioral problems.
Keywords: hospital; GHQ 28; mental illness; nursing staff; psychology.
Clinical Profile of Patients with Systemic Lupus Erythematosus
Authors: Paudyal B , Gyawalee M 
Published: September 2018

Introduction: Clinical features of Systemic lupus erythematosus vary between different parts of the World; however, this information on Nepalese Sytemic lupus erythematosus does not exist.
Methods: Patients with Systemic lupus erythematosus fulfilling the American College of Rheumatology criteria treated in Patan Hospital were studied by means of retrospective review of their case records. The results were compared with various regional and international studies.
Results: The female to male ratio was 36:1 with a mean age at diagnosis 28.67 years. Cutaneous manifestations were the most common 72 (96%) presentations followed by musculoskeletal involvement 70 (93%). Haematological and renal involvements each were present in 33 (44%) of patients. Pulmonary and neuropsychiatric involvements were present in 15 (20%) and 8 (11%) patients respectively. Antinuclear antibody and anti-double stranded deoxyribonucleic acid antibodies were positive in 70 (93%) and 66 (88%) of patients respectively. A quarter of patients had some form of co-morbid conditions. At the time of last follow up, 70 (93%), 66 (90%), and 6 (9%) of patients were taking antimalarials, steroids and immunosuppressive agentsrespectively, mostly in combinations. Eighty seven percent of patients had their disease activity under control at the time of last follow up whereas four percent still had an active disease. In another four percent died during the course of therapy and the outcome was unknown in another four percent of patients who lost to follow up.
Conclusions: Clinical characteristics and antinuclear antibody pattern of Nepalese lupus patients is more or less similar to those with patients from other countries in the region and in the World.
Keywords: clinical profile; Nepal; systemic lupus erythematosus.
Emergency Medicine Education and Research in Nepal: Challenges and Opportunities
Authors: Shrestha Anmol Purna , Shrestha Roshana , Shrestha Sanu Krishna , Basnet Samjhana , Pradhan Alok 
Published: September 2018

Emergency medicine (EM) is a young but prestigious medical discipline worldwide.1 However, in Nepal, it is in preliminary phase.2 EM is not only restricted to urban emergency departments but also a multifaceted discipline.3 Several EM training modules are currently practiced fragmented with different curriculum and duration.4,5 Pre-hospital emergency medical services (EMS), hospitals, trauma centres, and public health are working in silos and most of them devoid of proper emergency facility.2 This brought us to the realization of an urgent need of bringing all the stakeholders together in a symposium like this.
The symposium was arranged into four different sessions as listed below:

To familiarize with the history and current state of EM from Global Emergency Medicine perspective.
To highlight the different clinical experiences and advancements in EM in Nepal.
To emphasize the importance and possibilities in EM education and research in Nepal.
To discuss the roadmap to develop and establish EM as a recognized medical speciality in Nepal.

The overall objectives of the symposium were to discuss the challenges faced by current Emergency Medicine providers and identify the opportunities for the future development and recognition in Nepal.
The most important current task for Nepal’s emergency physicians of advocating for policies, programs, and funding to support further development of the specialty was realized. Rural and urban emergency service providers from academic and non-academic institutions, governmental/non-governmental organizations and international medical institutions attended the symposium. General Practice (GP) residents, medical officers, medical students, interns and paramedics were among active participants.
Calcaneal Myxoid Chondrosarcoma: A Rare Case
Authors: Joshi A , Shahi R , Singh S , Chand P , KC B R 
Published: September 2018

Skeletal myxoid chondrosarcoma is an extraordinarily rare neoplasm with a distinct histological morphology. Although it grows slowly, the clinical course was found to be worse than usual chondrosarcoma. We report a case of a Skeletal myxoid chondrosarcoma in the calcaneus of a 21-year-old female who presented to us with a feature of gradually increasing benign swelling left foot for last two years. Initial investigations were indicating towards a benign lesion for which excision of the lesion was performed. But intra operative findings were suggestive of an aggressive lesion, and to our utter surprise histopathologically it turned out to be Myxoid Chondrosarcoma. Because of its high malignant nature below knee amputation was performed as second definitive surgery. Since her clinical course and radiological pictures were suggestive of benign lesion we got carried away with a diagnosis of chondrmyxoid fibroma and excision of the lesion was attempted without attempting histopathological diagnosis by less invasive methods.
Keywords: caldaneal; chondrosarcoma; myxoid.
Molecular Confirmation of G1138A Mutation in FGFR gene in Achondroplasia
Authors: Khanal Shyam Bahadur , Shrestha Mitesh , Chaudhary Hemanta Kumari , Shrestha Smita , Pokharel Rohit Kumar 
Published: September 2018

Introduction: Achondroplasia (ACH) is the most common form of skeletal dysplasia of genetic origin in humans which is characterized by disproportionate rhizomelic dwarfism. Heterozygous mutation in the transmembrane domain of the FGFR3 gene (4p16.3) occurs as a de novo mutation in most of the cases.
Methods: DNA was isolated from seven samples, out of which, five had clinical features of Achondroplasia while one was dwarf but did not show symptoms of the disorder and one as negative control. PCR was performed for the region incorporating the hotspot region viz. 1138th nucleotide. PCR amplicon of size 164 bp was obtained from all the samples, and was sequenced.
Results: Sequence analysis showed the presence of mutation (G to A transition) in all of the five samples. The five samples that showed the clinical features of Achondroplasia had mutation in the region being analyzed while the single patient who had no clinical manifestations of the disorder despite being dwarf had no such mutation. Among the five patients studied, one patient had a family history of Achondroplasia as observed through pedigree analysis while the remaining four cases were sporadic in nature.
Conclusions: This study further supports that the G1138A mutation is the one of the most common point mutation among Achondroplasia cases. Genetic diagnosis can be useful to identify the disease prenatally and differentiate other life threatening dwarfism for the safety of both mother and fetus.
Keywords: achondroplasia; dwarfism; fibroblast growth factor receptor 3 (FGFR3); point Mutation.
Unusual Presentation of Duodenal Dieulafoy’s Lesion in a Toddler
Authors: Rao S , Shenoy R , Kamath N , Rao S 
Published: September 2018

Dieulafoy’s lesion is a rare cause of massive upper gastrointestinal haemorrhage in any age. It predominantly occurs in the proximal stomach. We report on a child who presented with massive rectal haemorrhage and a clear nasogastric aspirate due toduodenal Dieulafoy’s lesion.
Keywords: clear nasogastric aspirate; hematemesis; massive rectal haemorrhage; vascular malformation
Knowledge of Alzheimer’s Disease Among Medical Students of a Medical College
Authors: Sharma Rachana , Sharma Subhash Chandra , Pardhan Sudarshan N , Chalise Pratikshya , Paudel Luna 
Published: September 2018

Introduction:Dementia is a public health concern as the prevalence is increasing worldwide with significant increase being in low-middle income countries. However these countries appear to be less prepared in handling this rise in terms of diagnosis and management.
Methods: This cross-sectional study was conducted in Kathmandu medical College, from June 2017 to July 2017. Purposive sampling was done and the medical students who were in their first and final year of study were included in the study after obtaining an informed consent.
Results: Total 185 students were included in the study, 80 (43.24%) from first year and 105 (56.75%) from final year of medical study. The mean score of knowledge among the students was 17.44± 2.46; 15.32± 1.22 among first year and 19.06± 1.87 among the final year students. Majority of the students said they have heard about dementia however, only 3 (3.75%) of first year and 43 (41.9%) from final year students have either attended a class or CME on dementia
Conclusion:The knowledge about dementia was found to be average among medical students but better among final year medical students in comparison to first year. The knowledge was found to be better statistically among those who had either attended a class or CME on dementia or had exposure through different medias.
Keywords:alzheimer`s disease; dementia; knowledge; medical students.
Estimation of Stature from Percutaneous Hand Length Among the Students of A Medical College
Authors: Pandey Anup , Atreya Alok 
Published: September 2018

Introduction: Anthropometry is commonly used technique for the measurement of bone and soft parts in Anatomy and other fields of science. It has practical implications mainly in the field of anatomy and forensic medicine. The present study is aimed to determine the average hand length with stature among the students of a medical college.
Methods: A cross sectional study was done among 185 students including 98 females and 87 males of Devdaha Medical College and Research Institute. Hand length and stature were measured and collected data was entered and analyzed in SPSS 21. The differences in measurements of hand bone length and stature among males and females were calculated. The regression equation for the estimation of stature from hand length was calculated.
Results: The mean hand length among the total population was 17.80±1.04 cm and stature was 160.50±6.73 cm. The mean hand length and stature were higher among males as compared to females. The range of hand length and stature among the total population is 16.00-21.20 and 146.00-176.50 respectively. The regression equation for the estimation of stature from hand length revealed statistically significant value among the males and females.
Conclusions: Our study reveals higher value of hand length and stature for males as compared to females. Also there is significant correlation between the hand length and the stature. The present values are obtained from the small population of an institute. Further studies have to be carried out to develop the regression formula for the Nepalese population with larger sample size.
Distal Renal Tubular Acidosis in Adolescence with Severe Growth Retardation and Nephrocalcinosis
Authors: Sigdel M R , Kafle M P , Raut K B 
Published: September 2018

Chronic acidosis is an important, often overlooked cause of growth retardation. Here we present the case of a girl with distal renal tubular acidosis who had visited multiple hospitals before the diagnosis was made. She presented to us in adolescence with non anion gap metabolic acidosis, hypokalemia, severe growth retardation and nephrocalcinosis. In 18 months follow up with alkali therapy, she had good weight gain and growth velocity.
Keywords: growth retardation; hypokalemia; nephrocalcinosis; renal tubular acidosis.
Superficial BrachialArtery with its High Division
Authors: Sharma R , Singla R K , Sharma R , Sharma T 
Published: September 2018

The upper extremity arterial system shows a large number of variations attributed to the complex and multiple sites of their embryonic development. It is important to be aware of arterial variations in this region because upper extremity is a frequent site of injury. Moreover, brachial artery is of significance in cardiac catheterization for angioplasty, pedicle flaps, or arterial grafting. Accurate knowledge and relationships of major arterial conduits and their variational patterns is important in reparative surgery in the arm, forearm and hand. One such variation is superficial brachial artery with prevalence rate of 0.2- 25%. In this report, the brachial artery emanated normally but coursed superficial to the median nerve and about five cm above the intercondylar line, bifurcated into its terminal branches i.e. radial and ulnar artery.
Keywords: brachial artery;high division; variations.
Strengthening District Health Care System through Partnership with Academic Institutions: The Social Accountability of Medical Colleges in Nepal
Authors: Magar A , Subba K 
Published: September 2018

Approximately 25-30% of the Nepalese population live below poverty line. Majority of them reside in a geographically inaccessible place while most of the health centers are focused in the urbanized cities of Nepal. Hence, they are deprived of quality health care at that level and need urgent attention by the concerned authorities. The government has not increased its human resource for health in the last two decades, while population has doubled up but the number of doctors serving in public sectors has remained the same as it was in 1990s.
We have got 19 medical colleges at the moment. If one district is allocated to each medical colleges, it could help improve district health system at local level in Nepal. This can be accomplished by posting postgraduate resiendts in the peripheral district hospital as a part of their training and later encouraging them to serve for certain years. This could be a perfect example of government envisioned public private partnership in the country. This is a concept that has already been started in many parts of the world that can be moulded further to improve health service at peripheral part of the country. It is also the social accountability of the medical colleges for the development of the nation.
Keywords: district health care system; medical education; social accountability.
Surgical Site Infections due to Non-Tuberculous Mycobacteria
Authors: Yadav Rohit Prasad , Baskota Bashudev , Ranjitkar Rabin Ratna , Dahal Sandesh 
Published: September 2018

Introduction: Non-tuberculous Mycobacteria are increasingly recognized, nowadays as an important pathogen in delayed surgical site infection in post operative cases. We here in describe cases of surgical site infection caused by Non-tuberculous Mycobacteria, seen in two centers in Jhapa. The aim of the study was to increase awareness of this atypical mycobacterial infection, prompt diagnosis, and treatment that may ultimately provide better care to patients.
Methods: Forty four patients underwent different kinds of operations in two different private hospitals in Jhapa district of Nepal. All patients were presented with painful, draining subcutaneous nodules at the infection sites. Repeated aspiration of abscess, incision and drainage of the wound were done and specimen was sent for microbiological and histopathological examination. All patients were treated with repeated wound debridement and tab. Clarithromycin and inj. Tobramycin for 45days.
Results: Mycobacterium Chelone were isolated from the purulent drainage obtained from wounds by routine microbiological techniques. Of the forty four cases, thirty of them had acid fast bacilli stain positive, two had acid fast bacilli culture positive. All the patients except two cases were treated with injection Tobramycin and Clarithromycin for six weeks.
Conclusions: There should be high level of clinical suspicion for patients presenting with delayed post- operative wound infections for the diagnosis of non-tubercular mycobacreria as causative agents. These infections not only cause physical but also emotional distress that affects both the patients and the surgeon. Emphasis should be given on good sterilization technique to avoid such infections.
Lifetime Experience of Violence in Early Adulthood Female
Authors: Silwal Kalpana , Dhakal Prativa , Raut Krishna Bahadur , Chaudhary Rajendra Kumar 
Published: September 2018

Introduction: Despite political commitment and a supportive legal and policy framework, violence against women remains a significant problem in Nepal. Nepal Demographic and Health Survey reported more than one in five women experience violence in lifetime. Three fourth of women who had experienced physical or sexual violence had not sought any help.
Methods: Descriptive cross-sectional study was carried out in an Institute in Lalitpur. Accessibility sampling was used to find out the experience of violence from their childhood to this date. The data were collected by self-administered questionnaire was distributed to the female students. Data were analyzed using SPSS. Frequency, mean, percentage and standard deviation were calculated.
Results: More than three fourth 71 (79.8%) of the female students were victim of violence and among them most 67 (75.3%) were at age of 11 to 19 years. Majority 63 (70.8%) were victimized from strangers followed by friends 11 (12.4%). Teasing 55 (61.8%) and unwanted touching 35 (39.3%) were the most common type of violence. Most 51 (57.3%) were the victim while traveling by public vehicle and walking on road 47 (52.8%). More than half (57.7%) were suffered <5 times. One third 34 (38.2%) told strict punishment to the offenders followed by awareness program 32 (36%) for the prevention of violence.
Conclusions: Majority of the female students were victim of violence and offenders were young adult. Awareness program, strict rules and punishment to offenders should be implemented to prevent the violence among girls.
Angiographic Estimation of Culprit Vessel Disease Severity in Acute ST- Segment Elevation Myocardial Infarction after Thrombolysis
Authors: Ahmed W , Noon M J , Haq A , Mustafa B 
Published: September 2018

Introduction: To study the angiographic disease severity of the infarct vessel after thrombolysis in patients with acute ST-elevation myocardial infarction and their 90 days outcome.
Methods: We conducted a retrospective analysis of a prospectively maintained cardiology database at Shifa International Hospital from February 2011 to August 2011. A total of 57 patients who underwent thrombolysis for acute ST elevated Myocardial Infarction and subsequent coronary angiographies within 24 hours of hospitalization were studied. Angiographic disease severity in the infarct vessel was quantified as mild (<50%), moderate (50-70%), severe (70-99%) and total occlusion (100%). Secondary outcomes of recurrent ischemia/reinfarction, target lesion revascularization and death were also assessed at three months follow up.
Results: Thrombolysis was successful in 48 patients. All nine cases of failed thrombolysis underwent rescue PCI. Mean time of catheterization from thrombolysis was 16 ±4 hours. Total 56 (98.2%) patients had severe (>70%) and 1 patient had moderate (50-70%) angiographic disease of the infarct vessel. Left anterior descending artery was the infarct vessel in 32 (56%) cases and right coronary artery in 20 (35%). Total 15 (26%) patients had double vessel and 11 (19%) had triple vessel coronary artery disease. Percutaneous coronary intervention was performed in all patients using bare metal stents or drug eluting stents. At three month follow-up, only one patient had recurrent myocardial infarction due to stent thrombosis.
Conclusions: The overwhelming majority of patients presenting with ST elevation myocardial infarction have angiographic evidence of severe underlying disease in the infarct vessel despite clinically successful hrombolysis.
Keywords: acute coronary syndrome; coronary angiography; myocardial infarction; thrombolysis.
Benefits of an Electronic Medical Records System in Rural Nepal
Authors: Watkinson-Powell A , Lee A 
Published: September 2018

Introduction: Electronic medical records systems may improve the efficiency and quality of health services in developing countries. However the supporting evidence is limited as there are a number of barriers to their implementation, including lack of infrastructure, resources and skills. The objective of this study was to evaluate the introduction and assess the potential benefits of an Electronic Medical Records System in Rural at an NGO-supported health post in rural Nepal.
Methods: Original research in the form of a case report was carried out using participant observation of health clinics, semi-structured interviews with health workers and recording of time spent on clinic activities at the pilot and a control site.
Results: This evaluation found that the Electronic Medical Records System was well used and easy to learn. Health workers thought it improved continuity of care and found decision-support tools useful. Monthly report creation was faster but the system was difficult to integrate with government services, which limited the reduction in paperwork. Other problems identified included minor software issues, a lack of back-up, continuity of power supply and inadequate technical support. There was no significant impact on consultation length or time spent interacting with patients.
Conclusions: The introduction of the Electronic Medical Records System was largely successful. With adequate technical support and training, Electronic Medical Records System could provide a relatively low-cost means of improving patient care and health worker efficiency in developing countries. However they must be designed to fit their intended environment.
Keywords: computerized; electronic health records; medical records; medical records systems..
Tertiary Eye Care Centre Model for Development of Paediatric Cataract Surgery Services in Developing Countries
Authors: Shrestha U D 
Published: September 2018

It is estimated that every minute a child becomes bilaterally blind in developing nations. Paediatric cataract blindness presents an enormous problem to developing countries in terms of the human social burden, economic loss, and morbidity. The management of the paediatric cataract is lens aspiration with intra ocular lens implantation with anterior vitrectomy. The surgery should be performed by paediatric ophthalmologist in tertiary eye care centres. Facilities of general anaesthesia should be available in these centres and the operating theatres should be well-equipped with vitrectomy machine, biometry and portable keratometer. Keywords: Blindness; paediatric cataract; tertiary eye care centre.