bluuebunny/crossref_metadata_2025_split huggingface dataset:
Puberty menorrhagia Requiring Inpatient Admission
Authors: Khosla AH , Devi L , Goel P , Saha PK 
Published: September 2018

INTRODUCTION:
Puberty menorrhagia is a significant health problem in adolescent age group and severe cases may require admission and blood transfusion. Aim of this study was to evaluate the causes, associated complications and management of puberty menorrhagia.
METHODS:
Hospital records of all patients of puberty menorrhagia requiring admission were analyzed for etiology, duration since menarche, duration of bleeding, investigation profile and management.
RESULTS:
There were 18 patients of puberty menorrhagia requiring hospital admission. Etiology was anovulatory bleeding in 11 patients, bleeding disorders in five which included idiopathic thrombocytopenia purpura in three and one each with Von-Willebrand disease and leukemia. Two patients had hypothyroidism as the cause. Fourteen patients presented with severe anaemia and required blood transfusion. All except one responded to oral hormonal therapy.
CONCLUSIONS:
Puberty menorrhagia can be associated with severe complications and requiring blood transfusion. Although most common cause is anovulation but bleeding disorder, other medical condition and other organic causes must be ruled out in any patient of Puberty menorrhagia.KEYWORDS: anovulation, bleeding disorder, puberty, menorrhagia, anaemia.
Diagnostic Accuracy of Computed Tomogram in the Evaluation of a Neck Mass
Authors: Shrestha M K , Ghartimagar D , Ghosh A 
Published: September 2018

Introduction: The concept of dividing extracranial head and neck into different spaces is a notion that dates back to the 1800s. Various studies have led to detailed description of the soft tissue spaces that are contained within the fascial layers. This study was carried out to determine the accuracy of computed tomogram (CT) in differentiating malignant from benign lesions in the neck, to study the spatial distribution of different types of histological groups in the neck and the prevalence of malignant versus benign diseases involving the neck.
Methods: This was a hospital-based, prospective study conducted in the department of Radiodiagnosis, Kasturba Medical college, Mangalore, from 2005-2008. A hundred consecutive patients referred for CT scan examination presenting with complaints related to involvement of neck spaces or presence of palpable neck masses were enrolled in this study. The details of all the cases regarding their radiological fi ndings and histopathology were reviewed.
Results: Of the 100 patients studied, 53 % had malignant lesions, out of which 43 % were squamous cell carcinoma and 4 % were metastatic lymph nodal involvement. Twenty percent of the lesions were of an infective origin while 23 % were benign and congenital cystic lesions.
Conclusions: CT scan as an imaging modality has the ability to evaluate the malignant and benign tumors of the neck. Considering histopathology as the gold standard, the sensitivity of CT in detecting malignant/benign lesions was 96.5 % with a specifi city of 100 %. The positive predictive value was 100 % and the negative predictive value 95.2 %.
Keywords: CT scan, neck mass, neck spaces.
Cardiovascular Autonomic Neuropathyin Chronic Kidney Diseases
Authors: Thapa L , Karki P , Sharma SK , Bajaj BK 
Published: September 2018

INTRODUCTION:
This study was conducted to explore cardiovascular autonomic neuropathy and its pattern in chronic kidney disease patients.
METHODS:
Autonomic function using five standard tests was examined in 20 diabetic patients with CKD, 20 age and sex matched diabetic patients without CKD and 20 age and sex matched controls. Analysis of difference between the autonomic function was done in the three groups using Chi-square test or Fischer's test.
RESULTS:
Total 20 (100%) diabetic CKD patients were found to have autonomic neuropathy. Of these, 2 (10%) patients had early parasympathetic damage, 8 (40%) patients had definite parasympathetic damage, and 10 (50%) patients had combined damage. Heart rate response to standing was statistically significant (p = 0.014) among diabetic CKD patients when compared with diabetic patients without CKD. Combined form of autonomicdysfunction was more frequent in advanced stages of diabetic CKD. Three (42.85%) patients in stage 3 CKD, 4 (66.66%) patients in stage 4 CKD and 5 (71.42%) patients in stage 5 CKD, had combined autonomic failure.
CONCLUSIONS:
Autonomic neuropathy is common in native Nepalese diabetic CKD patients. Heart rate response to standing is significantly abnormal in diabetic CKD patients in comparison with diabetes mellitus patient without CKD. Severity of autonomic dysfunction increases with severity of CKD..
KEYWORDS: cardiovascualr autonomic neuropathy, chronic kidney disease, diabetes mellitus.
Osteosynthesis of Intercondylar Humerus Fracture Using Bryan and Morrey Approach
Authors: Lakhey S , Sharma S , Pradhan RL , Pandey BK , Manandhar RR , Rijal KP 
Published: September 2018

INTRODUCTION:
The olecranon approach has been the gold standard for surgical approaches to fracture fixation of distal articular surface of humerus. Although it provides a good exposure, it also has disadvantages of delayed union, nonunion and implant related complications at the osteotomy site.
OBJECTIVE:
The aim of this study was to determine the functional outcome of displaced intra-articular distal humerus fracture fixation using an alternative approach: the Bryan and Morrey approach.
MATERIALS AND METHODS:
Twenty patients with twenty AO type C1 and C2 intercondylar fractures of the distal humerus had bicolumnar fixationof the distal humerus with two contoured reconstruction plates and screws on the dorsal surface or various combinations of a single reconstruction plate, screws and K-wires using a Bryan and Morrey approach. Twelve of the patients were male and eight were female. The average age of the patients was 44.8 years. Eleven patients had sustained the injury as result of fall and nine of the patients had sustained it in road traffic accidents. Right elbow was involved in fifteen patients and left in five. All patients were followed up for 12 months post operatively.
RESULTS:
All twenty fractures had united at 4 months follow-up. The mean fixed flexion deformity was 9.0º (range 0º-15º) and the mean arc of motion was 115.0 º (range 85 º- 130º). All patients had grade 4 triceps strength and stable elbows at the end of 12 months follow up. One patient had deep seated wound infection resulting in necrosis of the triceps tendon requiring a second operative procedure.
CONCLUSIONS:
Bryan and Morrey approach is a simpler, easier and better approach as compared to the other posterior approaches to the elbow joint, and therefore, can be used as the approach of choice for fixation of fractures of the distal articular surface of humerus.
KEYWORDS: fracture, Humerus, intercondylar, osteosynthesis.
Clinico-demography Profile in Obsessive Compulsive Disorders
Authors: Shakya D R 
Published: September 2018

INTRODUCTION:
Obsessive compulsive disorder (OCD) is one of the most prevalent and debilitating mental illnesses. The present study was conducted to find out the clinico-demographic profiles of Nepalese OCD patients in the local set up.
METHODS:
We used the criteria of OCD as per the ICD-10: Classification of Mental and Behavioral Disorders' as a diagnostic and 'Yale Brown Obsessive Compulsive Scale' as a rating tool. Patients diagnosed as OCD were included and related information collected with their consent.
RESULTS:
Of 60 cases, 39 (65%) were male. The most common age groups were 20-29 (43%) and 30-39 (28%). Most of the subjects were relatively better educated. About half were married. More than half presented after more than five years of onset of illness. Seventy percent had some precipitating stressors. The most common obsessions were doubt (62%) and ruminations (57%); and compulsions checking (35%) and washing (28%). Somatic (28%) and mood symptoms (22%) were other common presenting complaints. About 7% had high suicidal intents. Nearly two thirds presented when they had YBOC Score of severe ranges, mean YBOC score being in the severe range (24).
CONCLUSIONS:
Most of the OCD patients present late only when severely affected. This indicates need for public awareness program in our set up.
KEYWORDS: behavioral disorder, compulsion, mental, obsession, obsessive compulsive disorder
Abdominal Wall Endometriosis
Authors: Upadhyaya P , Karak AK , Sinha AK , Kumar B , Karki S , Agarwal CS 
Published: September 2018

Endometriosis of abdominal wall scar following operation on uterus and tubes is extremely rare. The late onset of symptoms after surgery is the usual cause of misdiagnosis. Scar endometriosis is a rare disease which is difficult to diagnose and should always be considered as a differential diagnosis of painful abdominal masses in women. The diagnosis is made only after excision and histopathology of the lesion. Preoperative differentials include hernia, lipoma, suture granuloma or abscess. Hence an awareness of the entity avoids delay in diagnosis, helps clinicians to a more tailored treatment and also avoids unnecessary referrals. We report a case of abdominal endometriosis. The definitive diagnosis of which was established by histopathological studies.
KEYWORDS: abdominal wall endometriosis, cesarean scar, cyclical symptoms.
Practices and Results of Two Years Service from a single UK Renal Transplant Center
Authors: Shrestha P C , Dominguez-Escrig J , Gowardhan B , Rix D , Talbot D 
Published: September 2018

INTRODUCTION:
End stage renal failure is a common condition requiring renal replacement therapy in the form of haemodialysis or peritoneal dialysis as a short-term measure with renal transplantation as a more definitive treatment option. The aim of this study was to evaluate the set up of arenal transplant unit in a developed country and compare its results with other centers of the world.
METHODS:
A retrospective observational study was conducted to see the results of two years activities of a well known renal transplant unit in the United Kingdom. A description of the setup of a renal transplant unit has been made and its results have been discussed.
RESULTS:
Of the total patients, who had transplants in the renal transplant unit in year 2006 and 2007, 209 were renal, 14 were simultaneous kidneypancreas and two were pancreas after kidney transplants. Our one year graft survival rate was 93%, delayed graft function was 15%, early rejection rate was 11% and mortality rate was 3% in one year follow up.
CONCLUSIONS:
To attain good results in renal transplantation surgery, a multi-disciplinary team approach is crucial. Our set up is an example where the results are comparable to published and unpublished data from other established units world-wide.
Keywords: complications, immunosuppression, renal transplant.
Trend of Complete Hydatidiform Mole
Authors: Thapa K , Shrestha M , Sharma S , Pandey S 
Published: September 2018

INTRODUCTION:
Complete Hydatidiform mole is one of the most frequent abnormal pregnancies. This review studies the trend of complete mole in Paropakar Maternity and Women's hospital and clinical ability to detect it.
METHODS:
This is a retrospective study of 504 cases of complete hydatidiform mole recorded at Paropakar maternity and women's hospital, Kathmandu, during 2058-2065 B.S. Medical records were reviewed and incidence, clinical presentation and method of diagnosis were studied.
RESULTS:
During the study period, there were 13,9117 births and 504 complete moles, 12 partial moles, 48 persistent gestational tumours, six choriocarcinoma and four invasive moles recorded in the hospital. The incidence of complete mole was one per 276 births. It was prevalent among women younger than 29 years (80%) and among the primigravidae (36.7%). More than 90% women presented in the first half of their pregnancy and vaginal bleeding was the main complaint (68.3%). Suction evacuation, dilation and evacuation followed by sharp curettage and abdominal hysterectomy were performed in 80.6%, 17.6% and 1.2% of the women respectively. Persistent mole and choriocarcinoma developed in 9.5% and 0.4% respectively.
CONCLUSIONS:
Complete mole has the highest incidence. It affects mostly younger women and presents with vaginal bleeding most of the time, usually in the first half of their pregnancy.
Keywords: complete hydatidiform mole, gestational trophoblastic disease, persistent gestational tumours.
Chronic Cough in Thymoma
Authors: Agrawal K K , Dhakal SS , Bhatta N , Pradhan B , Chaurasia RK , Rijal S , Karki P 
Published: September 2018

Cough is one of the most common symptom for which patients seek medical attention from primary care physicians and pulmonologists. Although tuberculosis and other lung infections are common throughout the developing world, they are not among the most common causes of chronic cough. We report a case of a 23 years old male who presenting to the outpatient clinic with chronic cough not responding to regular and symptomatic treatment that was diagnosed to have thymoma. After all the common causes for chronic cough have been ruled out, unusual causes should also be considered in the differential diagnosis.
KEYWORDS: Chronic cough, Thymoma, Anterior Mediastinum.
Stress, Autonomic Reactivity and Blood Pressure among Undergraduate Medical Students
Authors: Khaliq F , Gupta K , Singh P 
Published: September 2018

INTRODUCTION:
Medical training is highly stressful particularly for those who are beginning their medical education. The present study was undertaken to find out the level of stress, hypertension and its etiological factors among undergraduate medical students.
METHOD:
One hundred and seventeen undergraduate medical students between 17-21 years of age got examined for blood pressure and stress level. Twelve hypertensives selected from the above subjects and twenty normotensives underwent cold pressure test to assess autonomic reactivity to laboratory induced stress.
RESULTS:
10.25% of the subjects were found to be hypertensive and 6.83% pre hypertensive. On the stress scale 53% had mild stress, 7% showed moderate stress while none had stress as a major problem. There was no correlation between BP and stress score. On CPT, BP increased significantly in both the hypertensive and normotensive group but came back to basal levels within 5 minutes indicating normal autonomic response. Rise of BP was higher in hypertensive group. The diastolic and mean BP increased significantly on CPT in subjects having family history of hypertension. The subjects taking more of junk and oily foods had a higher systolic BP. Forty percent of normotensive subjects had more than 20 mm Hg rise in systolic BP on CPT.
CONCLUSIONS:
Adolescents must be routinely screened to detect asymptomatic hypertension. Advice on risk factor modification by appropriate lifestyle changes may prevent long term effects of hypertension on target organs.
Keywords: autonomic reactivity, blood pressure, cold pressor test, medical students, stress.
Unsafe Abortion- A Tragic Saga of Maternal Suffering
Authors: Regmi M C , Rijal P , Subedi S S , Uprety D , Budathoki B , Agrawal A 
Published: September 2018

INTRODUCTION:
Unsafe abortion is a significant cause of maternal morbidity and mortality in developing countries despite provision of adequate care and legalization of abortion. The aim of this study was to find out the contribution of unsafe abortion in maternal mortality and its other consequences.
METHODS:
A retrospective study was carried out in the Department of Obstetrics and Gynecology in BPKIHS between 2005 April to 2008 September analyzing all the unsafe abortion related admissions.
RESULTS:
There were 70 unsafe abortion patients. Majority of them (52.8%) were of high grade. Most of them recovered but there were total 8maternal deaths.
CONCLUSIONS:
Unsafe abortion is still a significant medical and social problem even in post legalization era of this country.
Keywords: abortion, legalization, maternal death, unsafe.
Comparison of Bolus Phenylephrine, Ephedrine and Mephentermine for Maintenance of Arterial Pressure during Spinal Anesth
Authors: Bhattarai B , Bhat S Y , Upadya M 
Published: September 2018

INTRODUCTION:
Hypotension is common following spinal anesthesia. Various vasopressors have been indicated to prevent it. The study compares three such agents namely phenylephrine, ephedrine and mephentermine.
METHODS:
The study included 90 patients undergoing elective and emergency cesarean section who developed hypotension following subarachnoid blockade. Parturient were randomly divided into three groups each group had 30 patients. Group P received bolus of Phenylephrine 25 microgram, where as group E received Ephedrine 5mg and Group M received Mephentermine 6mg.
RESULTS:
It was found that rise of blood pressure was significantly higher in case of phenylephrine group in first six minutes, after the bolus, there was significant reduction in the heart rate in phenylephrine group, but there was tachycardia following administration of bolus ephedrine and mephenteramine. Neonatal APGAR score were similar in all three groups.
CONCLUSIONS:
All three drugs maintained hemodynamics within 20 percent of the baseline values on intravenous administration.
Keywords: APGAR, ephedrine, hypotension, mephentermine, phenylephrine, spinal anesthesia.
10+2 Agenda for Public Health in Nepal
Authors: Gautam K C 
Published: September 2018

Public health has come a long way in Nepal, but there is still a long way to go. Over the past years some remarkable achievements have been made in millennium development goals, such as reduction of child mortality, maternal mortality and fertility. However, there still exist wide gaps in healthcoverage among different ethnic groups, geographic regions and gender. In this context, a 10+2 agenda is recommended for scaling-up essentialhealth care in Nepal. These focus on equity, tackling malnutrition, prioritizing non-communicable diseases, preventing accidents, injuries and disabilities, promoting environmental health, harnessing the power of education and communication for behavior change, strengthening healthsystems, fostering public-private partnership, capitalizing on international health partnerships, as well as institutionalizing a culture of non-violence, and consolidating genuine democracy.
KEYWORDS: 10+2 agenda, Nepal, public health
Ocular Morbidity among Orphanages
Authors: Shrestha M K , Wolf L , Shrestha U , Gurung K , Chansi B S , Dhungana P , Gurung R , Ruit S 
Published: September 2018

INTRODUCTION:
The study assesses the spectrum of ocular morbidity and predictors of morbidity in children living in orphanages in the Kathmandu Valley.
METHODS:
A descriptive, cross-sectional survey was performed at 12 orphanages over a period of three months. The survey included a questionnaire and a complete eye examination, which included measurement of refraction, ocular deviation, and a fundus exam. Prevalence of ocular morbidity was calculated. Factors associated with ocular morbidity were examined using logistic regression.
RESULTS:
A total of 660 children were included in the study (median age nine years [range 0.25-15]; 53% male). The prevalence of ocular morbiditywas 17.9% (118). Of those with ocular morbidity, 88.1% (104) had similar ocular problems bilaterally. The most common type of morbidity was refractive error, found in 70.3% (83) of those with ocular morbidity (12.6% overall).
CONCLUSIONS:
Refractive errors, which are largely correctable, are the greatest source of morbidity. In order to reduce childhood blindness, children living in orphanages are an appropriate group to target for future ocular screening in Nepal.
Keywords: children, Nepal, ocular morbidity, ocular screening, orphanage
Refractive Error, Srabismus and Amblyopia in Congenital Ptosis
Authors: Thapa R 
Published: September 2018

INTRODUCTION:
Congenital ptosis is often associated with visual impairment. The aim of the study is to find out the pattern of refractive error,strabismus and amblyopia in patients with congenital ptosis in a hospital setting.
METHODS:
This is a hospital based prospective and descriptive study conducted at Tribhuvan University, B P Koirala Lion's Centre for Ophthalmic studies in Nepal from February 2003 to July 2004. All the consecutive cases with congenital ptosis were included and cases with pseudoptosis were excluded from the study.
RESULTS:
Among the 78 cases (95 eyes) of congenital ptosis, refractive error was present in 13 cases (16.7%) with astigmatism as the commonestrefractive error (8.9%). Strabismus was found in 23 cases (26.9%) of congenital ptosis. Among the strabismus, combined exotropia with hypotropia was found in the majority of cases (16.7%). Visual impairment due to amblyopia was found in 15 cases (19.2%) of congenital ptosis with mixed strabismic and refractive etiology as the commonest one (46.7%) followed by pure strabismic (26.7%), pure refractive (20%) and stimulus deprivationamblyopia (6.7%).
CONCLUSIONS:
Patients with congenital ptosis have higher rate of amblyopia due to greater prevalence of strabismus and refractive errors although stimulus deprivation amblyopia is less common. Early ophthalmic evaluation and timely treatment of these conditions may help prevent the irreversible visual impairment in case of congenital ptosis.
Keywords: amblyopia, congenital ptosis, refractive error, strabismus.
Molluscum contagiosum involving an epidermoid cyst – a rare association and potential source of clinical misdiagnosis
Authors: Ghosh Prithwijit , Saha Kaushik 
Published: September 2018

Molluscum contagiosum (MC) is a viral infection of skin and mucous membrane commonly affecting the adolescents and young adults. Extensive lesions are usually common in immunocompromised patients. We herein report a rare case of MC in an epidermoid cyst (EC) in a 24-year-old immunocompetent male. The provisional clinical diagnosis was inflammed EC or lipoma. On histopathological examination the lesion displayed a unilocular EC in the deep dermis, the lining of which was infected by MC virus with characteristic inclusions. The overlying epidermis was absolutely normal having no attachment with the cyst.
Endoscopic Grading of Adenoid in Otitis Media with Effusion
Authors: Acharya K , Bhusal C L , Guragain R P 
Published: September 2018

INTRODUCTION:
Adenoid is thought to be one of the causes of otitis media with effusion, though it is controversial. Grading the adenoid by rigid nasal endoscope in patients with otitis media with effusion may justify adenoidectomy in otitis media with effusion in the future.
METHODS:
A prospective study was carried out at GMS Memorial Academy of ENT and head neck studies from 15th December 2005-April 2007. Study group comprised of 32 children with otitis media with effusion and control group of 28 children with clinically normal ear and nose. Rigid nasal endoscope was used for grading of adenoid in study and control group. The severity of otitis media with effusion was assessed by preoperative air-bone gap and thickness of the fluid aspirated from middle ear during ventilation tube insertion.
RESULTS:
In the study group 13 out of 32 had grade 4 adenoid hypertrophy. This grade 4 adenoid hypertrophy was found to be statistically significant in children with otitis media with effusion (P < 0.0002). In control group 15 out of 28 had grade 1 adenoid hypertrophy which was significant in the same group (P < 0.002). Air-bone gap and thickness of fluid did not correlate with the increasing grade of adenoid hypertrophy.
CONCLUSIONS:
Grade 4 adenoid hypertrophy was statistically found to be significant with otitis media with effusion but severity of hypertrophy were not reflected by hearing loss and thickness of fluid.
Keywords: adenoid hypertrophy, myringotomy , otitis media with effusion, ventilaiton tube insertion.