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Showing papers in "Journal of Nepal Medical Association in 2007"


Journal ArticleDOI
TL;DR: It is concluded that Dexamethasone with local anaesthetic prolongs postoperative analgesia significantly than Tramadol (P<0.05) when used as admixture to local anaesthesia in brachial plexus block in upper extremity surgery.
Abstract: This is a prospective, randomized, double blind study to evaluate the postoperative analgesia following supraclavicular brachial plexus block with Tramadol or Dexamethasone as an admixture to bupivacaine in upper extremity surgery. Total 60 patients of ASA I and II undergoing upper extremity surgery under brachial plexus block with Bupivacaine were randomly divided in to two groups; one group received Tramadol (2 mg/kg) and the other group received Dexamethasone (8 mg) as an admixture to Bupivacaine. The duration of postoperative analgesia was recorded in both groups using pain VAS score which was determined by maximum VAS score of 8-10 and when patient demands for additional analgesics. The mean duration of postoperative analgesia in the Dexamethasone group was 1028.00 minutes while in the tramadol group it was 453.17 minutes We concluded that Dexamethasone with local anaesthetic prolongs postoperative analgesia significantly than Tramadol (P<0.05) when used as admixture to local anaesthetic in brachial plexus block in upper extremity surgery.

77 citations


Journal ArticleDOI
Neeba Ojha1, D S Malla
TL;DR: It can be concluded that low maternal anthropometric measurements have a definite role in causing LBW babies at term.
Abstract: The objective of this study was to determine the relationship of maternal anthropometry with low birth weight at term. This study was conducted at the Maternity Hospital, Thapathali, from 6th December 2004 to 30th January 2005. It was a prospective, hospital based, comparative study, carried out in 308 women who had delivered singleton live babies at term. The study population was divided into two groups based on baby's weight. During the study period, 154 women, who had delivered term low birth weight (LBW) babies (<2500gm), were taken as cases. For each case, a comparative case (matching in age and parity) who had delivered normal birth weight (NBW) baby (2500gm) was selected and served as control. Maternal anthropometric measurements were compared between the two groups. The variables studied were post-delivery maternal weight, height, body mass index (BMI) and mid upper arm circumference (MUAC). The incidence of low birth weight during the study period was 12.76% (329 of 2577 total births). The incidence of term low birth weight was 8.15% among the 2283 term births. In mothers with low weight (<45.0kg), low birth weight babies were three times more common than in mothers with normal weight (OR 3.5 95% CI 1.82-6.77) and with low MUAC (<22.0cm), it was twice as common (OR 2.04 95% CI 1.14-3.63). In mothers with low height (<145.0cm), LBW babies were higher but could not reach significant level (OR 1.87 95% CI 0.98-3.75). Similarly, in mothers with low BMI (<18.5kg/m2), the difference was not significant (OR 1.9 95%CI 0.61-5.65). On multiple logistic regression analysis, only low maternal weight was powerful enough to remain significant (OR 2.84 95% CI 1.34-5.99). From these results, it can be concluded that low maternal anthropometric measurements have a definite role in causing LBW babies at term. Among the studied variables, maternal weight showed the strongest influence on low birth weight.

43 citations


Journal ArticleDOI
TL;DR: Alcohol is most prevalent substance of use/abuse and was common among house officers and medical students, and Cannabis use was seen exclusively among male students and opioid use was not found.
Abstract: Substance related disorders have become matters of global concern because of its negative impact on individual health, familial, social and professional life. This study aims to assess prevalence of alcohol and other substance use among students and junior doctors at teaching institute. This descriptive study conducted on medical students, following convenient sampling method. Results revealed the prevalence rates of 'ever used', 'last year used' and 'last month used' were 63.5%, 56.5% and 42.5% respectively. The most preferred substance was alcohol (90.9%) and only 32.2% females 'ever used' substance. Cannabis use was seen exclusively among male (15.0%) students and opioid use was not found. Alcohol is most prevalent substance of use/abuse and was common among house officers and medical students.

34 citations


Journal ArticleDOI
TL;DR: In this review, each factor influencing the long-term graft function in the donor and recipient pre- and post-transplantation is discussed in the context of current transplant practice and an up to date review of literature is presented.
Abstract: Despite continuing advances in immunosuppressive and supportive therapies, the success of renal transplantation is impacted by factors present in the donor and recipient pre- and post-transplantation. The pre-transplant factors influencing the long-term graft function in the donor include source, age, sex, and HLA mismatches; and in the recipient include age, duration of dialysis and sensitisation. After transplantation, a number of events may lead to progressive deterioration of renal function and graft loss, which include delayed graft function, acute rejection, viral infections, recurrent disease, drug nephrotoxicity, non-compliance and chronic allograft nephropathy. Modulation of individual factor is mandatory to preserve satisfactory renal function in long-term. In this review, each factor is discussed in the context of current transplant practice and an up to date review of literature is presented.

30 citations


Journal ArticleDOI
TL;DR: Investigation finds that incidence of spinal injuries and its devastating consequences can be reduced by appropriate preventive measures and management along with rehabilitation.
Abstract: Cervical spine injuries with neural deficits carry significant impact economically, socially and psychologically to the individual and to the society. Risk factors involved, mode of injuries, constraints of management and rehabilitation are different in developing countries. Total 149 patients of cervical spine injuries presented in B.P. Koirala Institute of Health Sciences, Dharan, Nepal were evaluated prospectively for three years. Demographic details, etiology of injury, method and time taken for transportation and treatment method and progression of recovery were recorded. Most commonly involved age group was 30-49 years (44%) with male to female ratio of 4:1. Fall related injury especially from trees was the commonest mode of injury (60%). Patients were transported to hospital without neck immobilization (81%) in a vehicle unsuitable for spinal injuries patient with average delay of two days of injury. 79% had neural deficits among which 42% are with quadriparesis, 31% are with quadriplegia. Associated extra spinal injuries were found in 9% patients. Average hospital stay was 31 days. C5 vertebra was the most commonly injured vertebra. Cervical spine injuries, which has major impact over patient and society is still not adequately addressed by medical and public health system of developing countries like Nepal. Incidence of spinal injuries and its devastating consequences can be reduced by appropriate preventive measures and management along with rehabilitation.

25 citations


Journal Article
TL;DR: The study showed the evidence of association of oxidative stress in BPH patients with Malondialdehyde, the marker of lipid peroxidation and anti-oxidants e.g. alpha-Tocopherol and Ascorbate status in plasma in B PH patients.
Abstract: Benign Prostate Hyperplasia (BPH) is a common health problem in aging male. Free radicals and Reactive Oxygen Species (ROS) are produced in overwhelming quantity with advancement of age. When in oxidative stress, these reactive species cause extensive damage to various organ in the body, may be associated with pathogenesis of BPH also. This study aimed at assessing Malondialdehyde (MDA), the marker of lipid peroxidation and anti-oxidants e.g. alpha-Tocopherol and Ascorbate status in plasma in BPH patients. Forty eight (n=48) cases of BPH and forty six (n = 46) healthy age matched controls were enrolled. Plasma MDA level showed 4.81+/-1.87 nmol/ml in cases compared to 3.69+/-1.56 nmol/ml in healthy controls (p 0.05) and Ascorbate (r =-0.51, p=0.008) was found in BPH patients. There was mild elevation of PSA in BPH patients compared with control but was not statistically significant. Thus, our study showed the evidence of association of oxidative stress in BPH patients.

25 citations


Journal Article
TL;DR: It can be concluded that Salmonella bacteraemia is more than other and chloramphenicol was the foremost drug of choice among the tested antibiotics with its sensitive rate of 98.4%.
Abstract: The presence of bacteria in blood is simply known as bacteraemia. The main aim of this study is to determine the bacteraemia in patients visiting Kathmandu Model Hospital and antibiotic susceptibility pattern of isolates with special interest on ciprofloxacin. This prospective study was carried out in microbiology laboratory, Kathmandu Model Hospital from April 2005 to June 2005. Standard procedure was followed for blood sample collection. The bacteria were isolated and identified by standard microbiological procedure. Further, antibiotic susceptibility test was determined by NCCLS recommended Kirby-Bauer disc diffusion method. Out of 532 culture requests, 123 samples showed evidential microbial growth. The number of isolate of Salmonella typhi, Salmonella paratyphi A and Escherichia coli were 78, 44 and one respectively. The antibiotic susceptibility test demonstrated that chloramphenicol was the foremost drug of choice among the tested antibiotics with its sensitive rate of 98.4%. All the isolates of Salmonella typhi were susceptible to ceftriaxone and all isolates of Salmonella paratyphi A were susceptible to chloramphenicol, cotrimoxazole and amoxycillin. Ciprofloxacin resistant serotype of Salmonella was not isolated but out of 16 isolated serovar of Typhi and 10 serovar of Paratyphi A screened with nalidixic acid, 10 serovar of Typhi and all serovar of Paratyphi A were found to be resistant. Three isolates of Salmonella typhi were found as multidrug resistant (MDR) whereas no MDR was found in Salmonella paratyphi A. From this it can be concluded that Salmonella bacteraemia is more than other. Although nalidixic acid resistant serovars were isolated, ciprofloxacin resistant serovar were not present.

24 citations


Journal ArticleDOI
TL;DR: People with poor hygiene practice and poor education were infected more than other people in this study and cholera cases were found almost throughout the year in the city though the numbers increased during the rainy season.
Abstract: This retrospective study was conducted during January to September in the year 1997. Three hundred and forty nine stool samples were collected from diarrhoea patients from different places of Kathmandu valley and examined at National Public Health Laboratory (NPHL), Teku, Kathmandu. Acute diarrhoea becomes epidemic in rainy season and is a major public health problem of the city. In this study, people with poor hygiene practice and poor education were infected more than other people. Among the 349 patients with the gastrointestinal disease, 26.0% were found to have bacterial infection. Out of which, 88 (25.1%), one (0.28%), one (0.28%), and one (0.28%) were found to be Vibrio cholerae 01, Vibrio cholerae 0139, Shigella dysenteriae and Escherichia coli respectively. Cholera cases were found almost throughout the year in the city though the numbers increased during the rainy season. It was highest during July (34.6%) followed by August (32.35%), September 32% and June (6.89%). The uncommon species of Vibrio i.e. Vibrio cholerae 0139 was also found in the study. Higher prevalence was found in urban areas (83.52%) than in rural areas (16.48%). Antimicrobial susceptibility testing of bacterial isolates showed that Ciprofloxacin (97.85%) was found to be the most effective antibiotic followed by Tetracycline (92.34%), Erythromycin (92.34%), Norfloxacin (93.34%), Cholramphenicol, Ampicillim, but Cotrimoxazole were found to be resistant to all isolated Vibrio cholerae.

22 citations


Journal ArticleDOI
TL;DR: Time delay between perforation and operation, preoperative blood urea and serum creatinine, size of per foration and amount of peritoneal fluid, presence of co-morbid conditions and need for post operative ICU support are the important predictors of outcome after emergency surgery for duodenal perforations.
Abstract: Duodenal perforation is a common abdominal catastrophe with excellent outcome if prompt resuscitation and surgical repair of perforation are done. The aim of this study was to identify factors associated with death after surgery in patients with duodenal perforation. One hundred and forty-five patients who underwent Graham's patch repair for perforated duodenal ulcer between 14 April 2002 and 31 December 2004 were studied. The mean age was 45.99 years and 61 patients (42.07 %) were referrals. There were 124 (85.52 %) males and 21 (14.48 %) females. There were 10 deaths (6.9 %). The mean time delay was 2.46 days. It was 2.37 days in survivors, 3.7 days in non-survivors. The time delay was 3.25 days for females and 3.13 days for patients referred from another hospital. The mortality was significantly associated with time delay between perforation and operation (p<0.01), presence of co-morbid conditions (P<0.04), respiratory rate (p<0.02), raised blood urea (p<0.01) and serum creatinine (p<0.001), size of perforation (p<0.005), amount of peritoneal fluid (p=0.003) and requirement of postoperative intensive care unit support (p=0.003). Time delay between perforation and operation, preoperative blood urea and serum creatinine, size of perforation and amount of peritoneal fluid, presence of co-morbid conditions and need for post operative ICU support are the important predictors of outcome after emergency surgery for duodenal perforation.

18 citations


Journal Article
R R Malla1, A Sayami
TL;DR: In hospital complications especially cardiogenic shock, complete A-V block and junctional rhythm are significantly higher in inferior wall MI when associated with RV infarction.
Abstract: This is a cross-sectional study of patients with inferior wall Myocardial Infarction (MI), who attended emergency and got admitted in ICU/CCU of TU Teaching Hospital, Maharajgunj and Bir Hospital, Kathmandu, Nepal during November 1999 to October 2000. This study was undertaken to compare the in-hospital complications and mortality of patients of inferior wall myocardial infarction with or without associated right ventricular infarction. Total 53 consecutive patients with acute inferior wall myocardial infarction were enrolled in the study. Right ventricular infarction was determined by the presence of ST elevation of more than 0.1 mv in V4R. All the patients of inferior wall myocardial infarction were divided into two groups. Group A consisted of patients of inferior wall MI with right ventricular infarction and group B consisted of patients of inferior wall MI without right ventricular infarction. In-hospital complications and mortality of group A were compared with group B. Among 20 patients of group A and 33 patients of group B, incidence of cardiogenic shock was significantly higher in patients of group A compared to group B (p=0.05). Ten patients of group A developed third degree AV Block compared to only one in group B; the incidence of which was significantly higher (p<0.001). Sinus nodal dysfunction, manifested by junctional rhythm was found in six patients of group A compared to only two patients of group B (p<0.05). Mortality was found higher in patients of group A, but it was not statistically significant. Two patients of group A expired on first day whereas only one patient of group B expired on the eighth day of admission. In hospital complications especially cardiogenic shock, complete A-V block and junctional rhythm are significantly higher in inferior wall MI when associated with RV infarction.

14 citations


Journal ArticleDOI
TL;DR: Addition of butorphanol to bupivacaine may be safe alternative to reduce motor block and decrease prolong 2nd stage for epidural labor analgesia.
Abstract: Analgesia during labor provided by two epidural drug regimens was compared in a double blind, randomized, prospective study. Group A (n = 12) received 10 ml bolus doses of 0.1% bupivacaine with butorphanol 2 mg while Group B (n = 8) received 10 ml of 0.25% plain bupivacaine. The objectives of this study was to compare, between the quality of an epidural labor analgesia using initial loading dose of 0.1% bupivacaine and 2 mg butorphanol with a initial loading dose of 0.25% bupivacaine. In Group A, incidence of motor block was 8.3% and that of prolong 2nd stage of labor was 16.7%, both were decreased in comparison with Group B, although they were not statistically significant. Hemodynamic variables were stable and no adverse neonatal and maternal outcome was observed in both groups. Addition of butorphanol to bupivacaine may be safe alternative to reduce motor block and decrease prolong 2nd stage for epidural labor analgesia.

Journal ArticleDOI
TL;DR: In this paper, the liver function, splenomegaly and related factors in newly diagnosed acute leukemia patients were evaluated and a statistical study showed that there is a relation between high WBC counts and elevated serum ALT.
Abstract: To evaluate the liver function, splenomegaly and related factors in the newly diagnosed acute leukemia patients. One hundred of fifty eight acute leukemia patients admitted in our hospital from March 2003 to April 2006 were studied. The related factors such as peripheral WBC count, bone marrow blasts, peripheral blasts, sex, age, AML, ALL affecting the liver function and splenomegaly were evaluated. Sixty two (39.24%) patients presented with splenomegaly. Twelve (7.59%) patients presented with hepatomegaly. Serum ALT was elevated in 54 (34.17%) patients. Similarly, serum AST, GGT, ALP, and Direct bilirubin were elevated in 26 (16.45%), 32 (20.25%), 20 (12.65%), and 22 (13.92%) patients, respectively. Low serum albumin was found in 40 (25.31%) patients. PT was prolonged in 62 (39.24%) patients. Statistical study shows that there is a relation between high WBC counts and elevated serum ALT (P<0.05) and high WBC counts and splenomegaly (P<0.05). Acute leukemia patients with leukocytosis are more prone to develop abnormal liver function and splenomegaly.

Journal ArticleDOI
TL;DR: Hearing loss is more marked at lower frequencies as compared to higher frequencies, irrespective any size or location of perforation of pars tensa, this study showed.
Abstract: This cross-sectional study was conducted in different sizes of pars tensa perforation in patients with chronic suppurative otitis media (CSOM) tubo-tympanic type undergoing myringoplasty. A total of 50 patients were recruited from the outpatient Department of Otorhinolaryngology - Head and Neck Surgery in TU Teaching Hospital from June 2003 to May 2004. Cases of CSOM tubo-tympanic type with dry central perforation, conductive type of hearing loss were subjected to myringoplasty. Preoperative audiometric evaluations were done. While operating under microscope diameter of perforations were measured and perforations were grouped according to the size. This study showed that the hearing loss was found to be more at lower frequencies and less as the frequencies increased. Hearing loss is more marked at lower frequencies as compared to higher frequencies, irrespective any size or location of perforation of pars tensa.

Journal Article
TL;DR: The higher prevalence rate of complications of tooth extractions in the peripheral centers should not be overlooked and well equipped and organized extraction procedure with qualified dental practitioner is strongly suggested to minimize the complications.
Abstract: This study was conducted to investigate and compare the prevalence of complications of simple tooth extractions in a tertiary centre (BP Koirala Institute of Health Sciences, Dharan) and the peripheral centers (Mechi and Koshi zonal hospitals). This is a prospective descriptive study. Tooth extractions were carried out under local anesthesia in the tertiary and the peripheral centers during one year period (March 15"th 2004 to March H"111 2005). Intraoperative and postoperative complications were recorded and analyzed. Out of 8,455 tooth extractions in 6,639 [male-2,465 (37.12%) and females - 4,174 (62.88%)] patients aged between 5yrs- 65 yrs, 7,152 extractions were done in tertiary center and 1,393 extractions were done in peripheral centers.90 complications (1.06%) were observed. 53(58.89%) complications were intraoperative and 37(41.12%) complications were postoperative. 60(0.84%) complications were observed in the tertiary center and 30 (2.3%) complications were observed in the peripheral centers and the difference was highly significant (P<0.000001). The most frequent complication in the tertiary centre was fracture of tuberosity (0.15%) and in the peripheral centers it was 'roots left' (0.77%). Prevalence of 'roots left', injury to adjacent tooth and postoperative hemorrhage was significantly high (P<0.05) in peripheral centers. The higher prevalence rate of complications of tooth extractions in the peripheral centers should not be overlooked and well equipped and organized extraction procedure with qualified dental practitioner is strongly suggested to minimize the complications.

Journal ArticleDOI
TL;DR: The study revealed that the current age of mothers, their education and socio-economic status were found to be the main determinants of breast-feeding, and the increased relative risk of terminating breast- feeding was found with increased the level of education of mothers.
Abstract: The aim of this study was to investigate the determinants of breast-feeding according to the characteristics of mother and her child. Cox proportional hazard model technique has been employed to investigate the determinants of breast-feeding. The data were utilized from a sample survey of Palpa and Rupandehi districts of rural Nepal. The study revealed that the current age of mothers, their education and socio-economic status were found to be the main determinants of breast-feeding. The current age of mother showed statistically significant relation with the duration of breast-feeding. Younger mothers are most likely to terminate breast-feeding early as compared to older counter-parts. The decreased risk of terminating breast-feeding was found with increased duration of post-partum amenorrhea, and a strong positive association was found to be statistically significant. The increased relative risk of terminating breast-feeding was found with increased the level of education of mothers, which indicates that the education is inversely related to the duration of breast-feeding. For instance, three times higher risk of terminating breast-feeding was found for educated mothers as compared to illiterate mothers. Socio-economic status of the household exhibits a statistically significant effect on the duration of breast-feeding. It is believed that this finding may help planners and policy-makers for designing proper policy and program for improving mothers and their children’s health and for reducing fertility of a country.

Journal ArticleDOI
TL;DR: A retrospective analysis of all mushroom poisoning cases admitted in Tansen Mission Hospital in the period of two months of the year 2005 was done and high mortality was probably due to late presentation and only the conservative management in all the cases.
Abstract: A retrospective analysis of all mushroom poisoning cases admitted in Tansen Mission Hospital in the period of two months of the year 2005 was done. Forty-one cases were admitted during that period, among which only 34 case records could be found for analysis. Female (58.82%) outnumbered the male and 15 (44.11%) of the cases were from pediatric age group. The poisoning was secondary to consumption of different species of Amanita variety including the most poisonous Amanita phalloides. The commonest symptoms at the time of presentation in both adults and children was gastrointestinal (diarrhea, vomiting and abdominal pain). There were 12 mortalities and they died at the median interval of 3.5 days after admission. The main cause of death was acute liver failure and acute renal failure. Relative risk of having a bad outcome was found to be higher when the mushroom was consumed with alcohol when compared with non-alcoholics. High mortality was probably due to late presentation and only the conservative management in all the cases. Increased community and medical awareness is needed to reduce the frequency, morbidity and mortality of mushroom poisoning.

Journal ArticleDOI
TL;DR: A 60 years postmenopausal female patient presented with painless mass coming out of the vagina with occasional bleeding and expired 6 months after the initial diagnosis of vaginal melanoma.
Abstract: Primary vaginal malignant melanoma is a very rare tumor with less than 300 cases reported to date. We describe a case of primary vaginal melanoma and review the literature. A 60 years postmenopausal female patient presented with painless mass coming out of the vagina with occasional bleeding for last 2-3 weeks. On vaginal examination there was a firm polypoidal growth of size 7 cm attached to the right lateral wall of vagina and coming out of the introitus. Histopathology of the mass showed features of malignant melanoma. Wide local excision was done and adjuvant therapy was given. However patient came back after three months with widespread metastasis and expired 6 months after the initial diagnosis. Vaginal melanoma is a very aggressive tumor and the overall prognosis is very poor despite the treatment modality.

Journal Article
TL;DR: The study concludes that women who practice sport of boxing on regular basis have a favorable lipid profile and a significant change in lipid profile of the boxers was observed after 6 weeks' training program.
Abstract: The present study was undertaken with an objective to frame out the lipid profile of Indian Women Boxers. Women boxing is a newly recognized game and no work has been reported on elite female boxers in India till date. The study was based on a sample of 45 women boxers (age 17 ~ 24 years) attending Senior National Women Boxing Camp at Sports Authority of India. Each subject was evaluated for Lipid Profile variables at the beginning and end of the six weeks training camp. Fasting blood samples were taken from the antecubital vein by venipuncture. Before the samples drawn the subjects were asked to take rest for ten minutes. The blood sample was analyzed by HITACHI UV-2000 spectrophotometer (Japan). Standard techniques and procedures were followed for all the estimation. Volume and intensity of different components of training was measured by observational and physiological methods. Data were subjected to statistical treatment like mean and standard deviation. Test of significance't' - test (for paired sample) was applied to asses the difference in pre & post-test. Results reveal that mean (+/-SD) Cholesterol, Triglyceride, LDL, HDL - Cholesterol and Cholesterol / HDL Cholesterol ratio was 144.7 +/- 3.6 mg%, 59.7 +/- 17.5 mg% 81.4 +/- 21.1 mg% 51.3 +/- 8.2 mg% and 2.8 +/- 0.5 respectively as found in the pre-test. Significant difference (P < 0.01) was observed in Cholesterol, LDL-Cholesterol, HDL Cholesterol level in the post-test. The study concludes that women who practice sport of boxing on regular basis have a favorable lipid profile. A significant change in lipid profile of the boxers was observed after 6 weeks' training program.

Journal ArticleDOI
TL;DR: A hospital based cross sectional study on clinical profile and etiology of cataract in pediatric age group with an emphasis on preventable factors in Nepal, finding that play related injuries were more common than household injuries.
Abstract: Cataract is one of the leading causes of blindness in children. There are very few studies from Nepal on pediatric cataract. The present study is an attempt to get information on clinical profile and etiology of cataract in pediatric age group with an emphasis on preventable factors. A hospital based cross sectional study was carried out in a tertiary referral hospital in Eastern region of Nepal. After obtaining detail history, all children upto 14 years of age with cataract underwent examination under slit lamp or the operating microscope. Cataract is broadly classified into traumatic and non-traumatic groups. TORCH test for rubella, random blood sugar, urine reducing substance, chromosomal analysis were done in children with non-traumatic cataract Out of 172 children 34 (88%) had non-traumatic and 65 (12%) traumatic cataract. The mean age was 5.63 +/- 3.59 years and 7.39 +/- 3.94 years in non-traumatic group and traumatic group respectively. 8 (9.82%) patients with non-traumatic cataract were below the age of one year. Among non-traumatic cataract, 42 (37.50%) had hereditary, 9 (8.03%) had systemic syndromes, 5 (4.46%) had cataract due to maternal infection, 3 (2.67%) had metabolic disorder. While 11 (9.82%) cataract were associated with other ocular dysmorphology, cause was not ascertained in 31 (idiopathic). 11 (9.82%) had complicated cataract. 24.1% (n=27) of children with bilateral cataract had nystagmus at the time of presentation to hospital. In traumatic group, play related injuries were more common than household injuries. A very few children were below one year of age at the time of presentation to hospital. Establishing pediatric vision screening program in the primary health posts, genetic counseling, maternal immunization, health education to school children and use of safety glasses are some important measures that could prevent cataract blindness in our children.

Journal ArticleDOI
TL;DR: Parity, age of mothers, survival status of child, breast-feeding practices and socio-economic status of mothers were found to be the main influencing factors for the timing of amenorrhea among rural Nepalese mothers.
Abstract: Post-partum amenorrhea is an important event for females' reproductive life and their health. It is the time period between the end of pregnancy and the resumption of menstruation after delivery, and it is considered to be the temporary infecundable period of women's reproductive life-span. The main aim of this article is to examine the differentials of post-partum amenorrhea by using current status reporting data according to the characteristics of the mother and her child. The data are utilized from a sample survey of Palpa and Rupandehi districts of western rural Nepal. A life-table based technique of survival analysis has been used. Important summary measures have been computed in order to see the differentials of duration of post-partum amenorrhea. The study revealed that parity of mothers, age of mothers, breast-feeding practices and survival status of the child were found to be the main differentials of the duration of post-partum amenorrhea. Amenorrhea period was found shorter for lower parity and younger mothers. Amenorrheic period was found to be increased with increased birth-interval and duration of breast-feeding practices. A strong positive association was found between the duration of post-partum amenorrhea and breast-feeding. The study also revealed that an inverse association was found between the duration of post-partum amenorrhea and socio-economic status of mothers. The survival status of the child showed a strong effect for the timing of amenorrhea. This study investigated the important differentials of amenorrhea by using current status reporting data according to the characteristics of mother and her child. The estimated values of mean, median and trimean duration of amenorrhea were compared. For instance, trimean of amenorrheic period was found to be 9.6 months while median was 8.4 months and mean was 10.4 months. This finding indicates that the trimean provided the most consistent and best estimates of the duration of amenorrhea than other averages. The trimean is the best measure if the data contain censored and open-ended class interval. Parity, age of mothers, survival status of child, breast-feeding practices and socio-economic status of mothers were found to be the main influencing factors for the timing of amenorrhea among rural Nepalese mothers. Although the coverage of the present study is limited to small areas as well as to a small sample size, it is expected that the findings may help in designing appropriate policies and programs for improving mothers' and children's health as well as for reducing the existing fertility level of a country.

Journal ArticleDOI
TL;DR: The feedback provider would be able to provide genuine feedback by following the appropriate steps and principles of constructive feedback and realize how important and rewarding its role is in teaching learning activities.
Abstract: Feedback is an integral part of any learning experience. Constructive feedback is a powerful instrument and facilitates the learner's professional and personal development. "ABCDEFG IS", a mnemonic for the principles of constructive feedback, stands for Amount of the information, Benefit of the trainees, Change behaviour, Descriptive language, Environment, Focused, Group check, Interpretation check, and Sharing information. The eight important steps of feedback are: Ensure prior information, Collect data, Make appropriate meeting arrangement, Begin by encouraging self assessment by the trainee, Highlight areas where the trainee is doing well, Give feedback, Handle reaction maintaining the dignity and Plan actions. Communication and reflection also share many of the principles and steps of constructive feedback and giving regular feedback, thus, helps to improve communication and reflection. The feedback provider would be able to provide genuine feedback by following the appropriate steps and principles of constructive feedback and realize how important and rewarding its role is in teaching learning activities.

Journal ArticleDOI
TL;DR: Most children with HSP will have classical manifestation of the disease but diagnostic confusion can occur in those with atypical or absent cutaneous features at the onset, as well as in patients with rheumatic fever.
Abstract: To study the clinical profile of Henoch Schonlein Purpura [HSP] in children. A retrospective case series of 30 consecutive children with a diagnosis of HSP, with special focus on clinical manifestations. Two cases with unusual features are described in detail. Data of 19 boys and 11 girls with a mean age of 10.55 years was reviewed. Overall skin was involved in 100%, joints in 86.7%, GIT in 80% and renal system in 30% Two-thirds had palpable purpura at presentation. The mean duration of appearance of skin lesions after preceding joint and gastrointestinal symptoms was 8.6 days and 6.6 days respectively. Abdominal pain was the most common gastrointestinal symptom. Knee and ankle involvement occurred in more than 3/4th of the patients with arthritis. Vesciculobullous lesions were seen in two patients while one patient had rheumatic fever. Most children with HSP will have classical manifestation of the disease but diagnostic confusion can occur in those with atypical or absent cutaneous features at the onset.

Journal ArticleDOI
Saraswati M Padhye1
TL;DR: This prospective study was carried out to find out the body mass index (BMI) of all the women attending a gynaecological clinic at Kathmandu Valley and found that eight percent of women were underweight and equal numbers of them were obese too.
Abstract: This prospective study was carried out to find out the body mass index (BMI) of all the women attending a gynaecological clinic at Kathmandu Valley. Total of 1450 women attended this clinic over the study period. After excluding few hundreds of women, one thousand women of reproductive age (15-49) were enrolled. Detail history was taken, general, systemic and pelvic examinations were performed and a provisional diagnosis was made on the clinical ground. In this process height and weight of each patient was measured then Body Mass Index (BMI) was calculated. Eight percent (8%) of women were underweight and equal numbers of them were obese too. Forty-four point six percent were healthy and 37.3 were overweight. Most of them were diagnosed vaginitis, urinary tract infection (UTI), pelvic inflammatory disease (PID), subfertility, menstrual disorders, and cervical conditions. In eleven percent no gynaecological abnormalities were detected (NAD). Commonly diagnosed conditions were vaginitis, UTI, PID, primary subfertility and menstrual disorders were the commonly diagnosed conditions.

Journal ArticleDOI
TL;DR: This overview will focus on the classification, pathophysiology, current management of gastric varices, and treatments in patient with portal hypertension.
Abstract: Gastric varices are a major hemodynamic feature in patients with portal hypertension. Its incidence as well as bleeding rate is lower than that of esophageal varices. However, rupture of gastric varices sometimes results in very serious consequences in the clinical course and its management is very important. Recent developments in imaging technology have made it possible to evaluate the portal hemodynamics in detail by less invasive procedure. Furthermore, advancements in medical instruments and technologies have led to the development of endoscopic ligation devices, interventional radiology techniques like transjugular intrahepatic portosystemic shunt and balloon-occluded retrograde transvenous obliteration, and skills in surgical treatments. This overview will focus on the classification, pathophysiology, current management of gastric varices, and treatments in patient with portal hypertension.

Journal ArticleDOI
TL;DR: A case of cephalothoracopagus conjoined twin was detected at 20 weeks pregnancy in a primigravida woman by antenatal ultrasound and the pregnancy was terminated after proper counseling, despite the need to save the baby, as multidisciplinary team to separate the twins was not available.
Abstract: Conjoined twin is a sporadic event with prevalence of 1 in 50000 to 1000000 birth. Incomplete division of embryonic disc results in conjoined twin. Ultrasound plays a major role for early detection and proper obstetric management. A case of cephalothoracopagus conjoined twin was detected at 20 weeks pregnancy in a primigravida woman by antenatal ultrasound. The pregnancy was terminated after proper counseling, despite the need to save the baby, as multidisciplinary team to separate the twins was not available.

Journal Article
TL;DR: Rational surgical approach in traumatic cataract provides encouraging results and long term follow up is mandatory to comment on actual outcome.
Abstract: This study analyzes the result of traumatic cataract surgery in a tertiary care hospital at eastern Nepal. It is a hospital-based study of 112 patients (age 15-62), who underwent cataract extraction for unilateral traumatic cataracts. The study was carried out to evaluate the surgical outcome of tramatic cataract. Thirty-eight eyes had associated posterior capsular defect. No serious postoperative complications were encountered. Posterior capsular opacification at the end of sixth week was evident only in two eyes. Best corrected visual acuity nof 6/18 or more at the eighth week was achieved in 61 (54%) eyes. Astigmatism of less than 3D was achieved in 82 (73%) eyes. Rational surgical approach in traumatic cataract provides encouraging results. To comment on actual outcome long term follow up is mandatory.

Journal ArticleDOI
Sudhamshu Kc1
TL;DR: This report describes a case of acute liver failure in which probably both the agents were involved and the patient recovered with antidote therapy and maximum supportive care.
Abstract: Acute liver failure is characterized by severe and sudden liver cell dysfunction leading to hepatic encephalopathy and hepatic coagulopathy in a person without history of liver disease in the past. This catastrophic illness can rapidly progress to coma and death from cerebral edema and multi organ dysfunction. It carries a high mortality rate if liver transplantation is not carried out. In West, paracetamol is the main cause of hepatotoxicity whereas in the East viral hepatitis tops the list. This report describes a case of acute liver failure in which probably both the agents were involved. The patient recovered with antidote therapy and maximum supportive care.

Journal ArticleDOI
TL;DR: Laterjet-Bristow procedure provides stability and good functional outcome in Rowe scale and long term patient satisfaction and can be the procedure of choice for surgical treatment of recurrent traumatic anterior dislocation and also as a salvage surgery for failed cases from other types of procedures.
Abstract: Shoulder dislocation is common problem in orthopaedics. Management of recurrent shoulder dislocation is painstaking with different surgical procedures having varying outcomes. Laterjet-Bristow procedure provides stability and good functional outcome in Rowe scale and long term patient satisfaction. This is an observational prospective study carried out at two different tertiary care centers at Nepal and Pakistan using the same protocol. Habitual and pathological recurrent dislocations were excluded and all the recurrent dislocation of shoulder following initial traumatic anterior dislocation was included in this study. Standard Laterjet-Bristow operation was done and followed up for average of 27 months. Functional evaluation was done using Rowe score and graded as excellent, good, fair and poor. There were 12 men and 9 women with the mean ages of 23.4 years. At 12 months, 11 patients had fair result and seven patients had good result. At two years only three had fair result, 15 had good result and three patients had excellent result. Only three patients had poor result at one year while none had poor result at two year. The mean loss of external rotation in operated shoulder at one year was 24.33 degrees which decreased to 21.2 degrees at the end of second year. There was no restriction of external rotation in three patients at both yearly follow-ups while 18 patients had restriction in the range 10-30 degrees. Laterjet-Bristow can be the procedure of choice for surgical treatment of recurrent traumatic anterior dislocation and also as a salvage surgery for failed cases from other types of procedures. The only shortcoming of this procedure was some limitation in external rotation and minor loss in muscle power of that shoulder.

Journal ArticleDOI
TL;DR: No laboratory diagnosis is specific for diagnosing sarcoidosis but histological confirmation from the lymph nodes accessible for biopsy either direct or by intervention may be more specific.
Abstract: Sarcoidosis is a multi system disorder of unknown cause most commonly affecting the young and middle age adults and frequently presents bilateral hilar lymph-adenopathy. The diagnosis of sarcoidosis is often delayed following the onset of symptoms. The reason being first, the disease is often sub clinical; second as the disease affects any system, the diagnosis of sarcoidosis may not be considered; third, the symptoms are not disease specific hence often treated as other chronic pulmonary diseases; finally economic issues or barriers to access for further workup may affect the timeliness of the diagnosis. No laboratory diagnosis is specific for diagnosing sarcoidosis but histological confirmation from the lymph nodes accessible for biopsy either direct or by intervention may be more specific.

Journal ArticleDOI
TL;DR: Retrospective hospital data analysis of all patients admitted with indirect traumatic optic neuropathy and treated with mega dose methylprednisolone therapy in the last three years was conducted, finding high dose steroids was found to be beneficial only in patients presenting early.
Abstract: To report the demography, nature of insult and ocular characteristics in patients presenting with indirect traumatic optic neuropathy and to evaluate the visual outcome with mega dose methylprednisolone therapy. Retrospective hospital data analysis of all patients admitted with indirect traumatic optic neuropathy and treated with mega dose methylprednisolone therapy in the last three years was conducted. Nine patients (M:F= 8:1) were identified with unilateral optic nerve injury. Road traffic injury was the most common cause of injury. Lid ecchymosis and swelling on the same side was the most frequent ocular abnormality noted, followed by loss of consciousness. Time of presentation varied from 3 hours to 11 days. All patients except two had visual acuity of no light perception at presentation. Following therapy there was improvement in visual acuity in two patients who presented within two days of injury. Patients present late with traumatic optic neuropathy in this hospital. Most of the patients are with no light perception. High dose steroids was found to be beneficial only in patients presenting early ( Language: en