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The Effect of Improved Cook-stove on the Incidence of Childhood Pneumonia in Jumla
(Nepal Health Research Council, 2003) Aryal, S
Fever among COVID-19 Patients in a Tertiary Care Hospital of Western Nepal: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Khatri, Prabin; Neupane, Aryan; Banjade, Ashish; Chhetri, Ashmita; Sharma, Dipesh; Chhetri, Pradip; Thapa, Pramila; Khadka, Nasatya; Karki, Saugat; Neupane, Srijana
Abstract: Introduction: COVID-19 has a wide spectrum of clinical presentation ranging from asymptomatic infection to acute respiratory distress syndrome and multi organ dysfunction. Data regarding this is scarce in our setting. This study aims to study the prevalence of fever in confirmed COVID-19 cases in a tertiary care hospital of western Nepal. Methods: We conducted a descriptive cross-sectional study among patients admitted to COVID-19 wards and intensive care units of a tertiary care hospital. We enrolled patients from August 2020 to January 2021 and the study proposal was approved by the Institutional Review Committee (reference number: 069/20). Convenience sampling method was used. Data entry and descriptive analysis were done in Statistical Package for the Social Sciences version 16.0. Point estimate at 95% Confidence Interval was calculated along with frequency and descriptive statistics. Results: Among 206 cases of COVID-19, the most common symptom was fever 136 (66.1%) (95% Confidence Interval= 58.14.63-74.05). Sixty-seven (49.3%) of those with fever required intensive care units admission whereas 27 (19.9%) of patients with fever had mortality. Most common comorbidities in the patient having fever is Diabetes mellitus 41 (66.1%) followed by hypertension 20 (62.5%). Conclusions: Fever was the most common presenting complaint with high prevalence as compared to similar studies done in similar settings. We stress the importance of considering the presence of COVID-19 even in the absence of fever as many patients presented without fever.
Back Pain among COVID-19 Positive Health Care Workers in a Tertiary Care Hospital in Nepal: A Descriptive Cross-sectional Study Authors
(Nepal Medical Association, 2021) Shrestha, Shriraj; Bajracharya, Ayush; Dahal, Saurav; Bhandari, Parash; Maharjan, Basanta; Bajracharya, Suraj
Abstract: Introduction: The world has been threatened with the emergence of the Novel Corona Virus straining the health care system and creating a global pandemic. This is not the first pandemic, and it certainly will not be the last to affect humanity. As the medical community is exposed to these highly contagious new diseases with arrays of symptoms like fever, cough, shortness of breath, anosmia, insomnia, and myalgia. Back pain can also be considered as one of the symptoms of COVID-19 infection. Therefore, this study aimed to find out the prevalence of back pain among the Health care workers who were tested positive for COVID-19 by the end of their isolation period. Methods: This descriptive cross-sectional study was done from April 2021 to June 2021 in KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal, after receiving ethical approval from the Institutional Review Committee (Registration number: 2077/078/57). Convenience sampling was done. Data collection and entry were done in Microsoft excel, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 156 COVID-19 positive patients, the prevalence of back pain was seen among 64 (41%) patients (95% Confidence Interval= 42.23-57.75). Among them 21 (32.8%) were males and 43 (67.2%) were females. Likewise, the minimum age was 20 years and the maximum was 68 years with a mean of 33.5±10.28. Conclusions: This study demonstrated that a high proportion of healthcare workers were suffering from back pain and the findings are similar to the data from other international studies.
Dementia in 50 Years and Older Patients from the Psychiatry Out Patient Department of a Tertiary Care Center: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Belbase, Mohan; Adhikari, Jyoti
Abstract: Introduction: Dementia is a chronic and progressive syndrome due to disease of brain. Alzhemeir's disease is the most common cause of dementia. There are very few studies regarding prevalence of dementia in Nepal. The objective of this study is to find the prevalence of dementia in 50 years and older patients from the psychiatry out patient department of a tertiary care center. Methods: A descriptive cross-sectional study was done in patients attending to psychiatry outpatient department over one year from May 2020 to April 2021. Ethical approval was taken from the Institutional Review Committee (Reference number: 745/077-078). The data were assessed using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 1332 patients, 52 (3.9%) (95% Confidence Interval=2.86-4.93) patients had dementia in which 30 (57.7%) are male while 22 (42.3%) are female. Mean age of study population is 70.12±11.21 with age range of 50 years to 88 years. We found 29 (55.8%) moderate, 18 (34.6%) severe and 5 (9.6%) mild type of dementia. We had 34 (65.3%) Alzheimer's followed by 16 (30.8%) vascular and 2 (3.9%) others types of dementia. Conclusions: This study concludes that the prevalence of dementia in 50 years and older patients is similar in comparison to other studies done in similar settings.
Lumbosacral Transitional Vertebrae amongst the Individuals Undergoing Magnetic Resonance Imaging of the Whole Spine in a Tertiary Care Hospital: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Karki, Subindra; Paudel, Ramchandra; Phuyal, Arun; Bhandari, Anupam
Abstract: Introduction: Lumbosacral transitional vertebrae is a common congenital anomalous condition of the spine. Recent advances in magnetic resonance imaging have made it possible to acquire images of the whole spine. This study aimed to find out the prevalence of lumbosacral transitional vertebrae amongst the individuals undergoing magnetic resonance imaging of the whole spine in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted in 750 patients of all age groups who underwent magnetic resonance imaging of the whole spine in the Department of Radiodiagnosis and Imaging, Kathmandu University School of Medical Sciences from 7th November, 2019 to 6th November, 2020. Convenience sampling technique was used. Ethical approval was taken from the Institutional Review Committee (Reference number 207/19). Data was analysed using Statistical Package for Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage. Results: Lumbosacral transitional vertebra was seen in 98 (13.10%) (95% Confidence Interval= 10.61-15.51) of the total 750 individuals. Out of the 98 patients who had lumbosacral transitional vertebra, 31 (4.10%) had lumbarization of S1 vertebra and 67 (8.94%) had sacralization of L5 vertebra. Conclusions: Prevalence of lumbosacral transitional vertebrae amongst the individuals undergoing magnetic resonance imaging of the whole spine in our hospital was similar to other study done in similar settings. Lumbosacral transitional vertebrae are a common congenital anomalous condition of the spine that is identified incidentally. Enumeration of vertebrae from the first cervical vertebra using whole spine magnetic resonance imaging can confirm the presence of the lumbosacral transitional vertebrae with much accuracy.
Non-neoplastic Lesions of Gallbladder Among Cholecystectomy Specimens of a Tertiary Care Center: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Ghartimagar, Dilasma; Shrestha, Manish Kiran; Jhunjhunwala, Adarsh; Ghosh, Arnab; Thapa, Sushma; Regmi, Sudeep; Talwar, Om Praksah
Abstract: Introduction: Gallbladder diseases are prevalent worldwide and present with a diverse histopathological spectrum. Mucosal irritation and chronic inflammation is considered as an important etiological factor for the mechanical or functional dysfunction of emptying of the gallbladder. This study aims to find the prevalence of non-neoplastic lesions of gallbladder among cholecystectomy specimens of a tertiary care center. Methods: A descriptive cross-sectional study was conducted in the Department of Pathology, of a tertiary care center from January 2005 to December 2020. Ethical approval was taken from the Institutional Review Committee. All the patients who had undergone cholecystectomy procedures which showed non-neoplastic lesions were enrolled in the study. Convenient sampling was done. Statistical Package for Social Sciences version 21 and Microsoft Excel were used for data analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 4914 cholecystectomy specimens, 4852 (98.73%) (95% Confidence Interval= 98.42- 99.04) were non-neoplastic lesions. There were 1252 (25.8%) males and 3600 (74.2%) females with a male to female ratio of 1:2.87. Age ranged from 2 to 89 years with a mean age of 45±14.48 years. Gallbladder lesions were observed maximum in age group 41-50 years with 1200 (24.7%) cases. Among the non-neoplastic lesions, cholecystitis without any specific finding was the most common finding with 3028 (62.4%) cases followed by cholelithiasis with 1478 (30.5%) cases. Conclusions: The prevalence of non-neoplastic lesions of gallbladder is similar to other studies done in similar setings. Female predominance was noted in non-neoplastic lesions.
Supporting Healthcare Workers during COVID-19 Pandemic and beyond
(Nepal Medical Association, 2021) Shrestha, Badri Man
NA
Clinical Anesthesia, South Asian Edition: A Book Review
(Nepal Medical Association, 2021) Hamal, Pawan Kumar
Abstract: Local practices, contextual issues and the therapeutic challenges of South Asian perspectives are generally overlooked in standard Clinical Anesthesia textbooks with more relevance to western scenarios. The South Asian Editors of this book, have made a tremendous painstaking effort to consider these issues and present the content as per the need of the local scenarios in an evidence-based manner.
Tobacco and its Relationship with Oral Health
(Nepal Medical Association, 2021) Bhandari, Anima; Bhatta, Nisha
Abstract: Tobacco and its various forms cause major oral health problems. Tobacco either in smoked or smokeless forms is prevalent in Nepal and counts as a risk factor for the causation of various red and white lesions, premalignant lesions, oral cancers, gingival and periodontal diseases. Tobacco in conjunction with other risk factors adds a potential threat to oral diseases and its timely control is a cure to those threats. This article focuses on tobacco and its forms affecting oral health and also focuses on its prevention and control from the ground to the National level.
Pediatric Radiology in Era of COVID-19, International Consensus and What Lies Beyond Pneumonia: A Review
(Nepal Medical Association, 2021) Regmi, Pradeep Raj; Amatya, Isha; Paudel, Sharma; Kayastha, Prakash
Abstract: Diagnostic radiology plays a crucial role in children. The pediatric population has been less studied than the adult population since the initial period of the COVID-19 pandemic to date. Realizing the potential utility of structured reporting, different guidelines and international consensus statements regarding COVID-19 in the pediatric population have been released in recent times. Different clinical and radiological manifestations in children have been evolving in this period of uncertainty and are different from the adult population in certain aspects. Apart from the involvement of lungs, a multisystemic inflammatory syndrome in children or pediatric multi systemic inflammatory syndrome is unique in children. Therefore, awareness of the recent consensus, structural uniform reporting and multi-organ involving patterns in COVID-19 can guide radiologists for a better understanding of this complex novel disease leading to early diagnosis and timely treatment of affected children.
Recurrent Dermatofibrosarcoma Protuberance: A Case Report
(Nepal Medical Association, 2021) Shah, Shiv Raj; Regmee, Sujan; Maharjan, Dhiresh Kumar; Thapa, Prabin Bikram
Abstract: Dermatofibrosarcoma protuberance represents less than 0.1% of all tumors, treatment of which requires wide local excision (≥5cm) but recurrence is not rare. Here we present a 32-year male presented with a swelling of 15 x 6cm over the left lumbar region for which he underwent excision three years ago, the histopathological examination of the swelling, showed a malignant mesenchymal tumor and Immunohistochemistry features were suggestive of Dermatofibrosarcoma protuberance. After three years of interval, he again presented with complaints of swelling in the previously operated site for nine months and underwent excision of the mass with Split Thickness Skin Graft. Although the tumor was confined to the skin and subcutaneous tissue in the present case, the patient didn’t undergo any adjuvant radiotherapy to avoid a possible relapse that would infiltrate deeper structures for the first time. Being a recurrent tumor, long-term follow-up is strongly recommended.
Adenolipoma of the Breast: A Case Report Authors
(Nepal Medical Association, 2021) Karki, Samriddhi; Shrestha, Agya; Shrestha, Bipin
Abstract: Adenolipoma of the breast is a rare tumor classified as a hamartomatous lesion. It is a well-circumscribed lesion composed of adipocytes and other breast tissues. The characteristic feature is a well-circumscribed mass containing radiolucent fat admixed with dense fibrous connective tissue surrounded by a thin radiopaque pseudo capsule. Microscopically, there is a mixture of ducts and lobules with adipose tissue. Ductal hyperplasia, adenosis, calcification, and apocrine metaplasia may occur within the hamartoma. These are rarely associated with malignancies and excision is considered curative. If these lesions are not detected clinically or radiologically, these remain unrecognized. Awareness of this poorly recognized benign entity would help avoid an incorrect diagnosis and unnecessary intervention. Here we present a case of a 35-year-old female diagnosed histologically as adenolipoma of the breast.
Laryngeal Schwannoma, Alarming Mass of Airway: A Case Report
(Nepal Medical Association, 2021) Sanjel, Anup; Shah, Shankar Prasad; Chhetri, Shyam Thapa; Mishra, Sudip; Rajak, Ashik; Banjade, Prakash
Abstract: Laryngeal schwannomas are rare tumors of neural sheath origin. They normally present as a slow-growing, encapsulated, submucosal mass commonly in the supraglottic region. We describe a 13-year-old boy presenting with a 4-month history of progressive worsening dysphagia. Fiber optic laryngoscopy and computed tomography revealed a polypoidal mass in the laryngeal surface of epiglottis abutting left the aryepiglottic fold, base of the tongue and hypopharyngeal wall. Direct laryngoscopic evaluation and microdebrider assisted debulking was performed with tracheostomy. Schwannoma was confirmed by histopathological study. In a regular follow-up after two months, 70 degree endoscopic evaluation revealed similar mass in the left aryepiglottic fold obscuring the vocal cord. Definite complete excision of the tumor was planned and endoscopic excision of the mass was performed with removal of ipsilateral aryepiglottic fold, arytenoid and false vocal cord with retracheotomy. Rapid occurrence of mass after debulking and biopsy was demonstrated in this case. Though rare, neurogenic tumors of the larynx are life-threatening and need complete removal.
Vitamin B12 Deficiency Resembling Acute Leukemia: A Case Report
(Nepal Medical Association, 2021) Sharma, Nisha; kunwar, Saru; Shrestha, Anil Kumar
Abstract: Vitamin B12 deficiency in children can cause megaloblastic anemia, poor growth, and increased chances of infections. It is an important reversible cause of bone marrow suppression which at the time of presentation can mimic hematological malignancy. Therefore, it should be considered as a differential diagnosis in cases suspected of acute leukemia. We report a case of 14 months old child who had atypical presentation of vitamin B12 deficiency. He had chronic fever, decreased feeding and increased paleness for one year. Pancytopenia with severe anemia was present along with 19% reactive/atypical cells in peripheral blood smear suggesting acute leukemia. However, bone marrow aspiration and biopsy showed features of megaloblastic anemia. Vitamin B12 level measured was very low and treatment with cyanocobalamin caused drastic improvement in the child’s condition.
Recurrent Herpes Zoster in an Immunocompetent Male: A Case Report Authors
(Nepal Medical Association, 2021) Parajuli, Niraj; Shrestha, Rushma; Lama, Laila; Karki, Anupama
Abstract: Herpes zoster is an infection caused by reactivation of varicella-zoster virus presenting as multiple grouped vesicular eruptions in a dermatomal pattern with associated pain. Recurrent herpes zoster is an uncommon event in an immunocompetent host. Here, we report a case of a young male presenting with herpes zoster over the T9 and T10 dermatome with the previous scarring of herpes zoster over the T6 dermatome over the right upper trunk. The patient improved on treatment with oral acyclovir and analgesics. In any patient with recurrenrt hepes zoster, work-up should be done to rule out immunosuppresion.
Actinomycosis of Gallbladder in Cholecystectomy Specimen: A Case Report Authors
(Nepal Medical Association, 2021) Shrestha, Brijesh; Regmi, Manisha; Adhikari, Prabesh
Abstract: Actinomyces are a part of the normal flora of the cervicofacial region, gastrointestinal tract, and urogenital tract, but can cause infections when the normal mucosal barrier is lost. Herein, we report a rare case of actinomycosis of the gallbladder in a 60-years-old-female. The patient presented with right hypochondrium pain since three months; ultrasonography showed cholelithiasis with thick oedematous wall. An open cholecystectomy was carried out. Histological examination revealed an inflamed gallbladder with colonies of radiating filamentous structures having numerous sulphur granules which on gram staining showed filamentous gram-positive rods. The diagnosis of Actinomycosis of gallbladder was made. After cholecystectomy, prolonged antimicrobial therapy is recommended for patient with actinomycosis to prevent recurrence and even mortality.
Futile Sexual Homicide in Nepal: A Case Report Authors
(Nepal Medical Association, 2021) Atreya, Alok; Pandit, Shiva; Nepal, Samata; Bajracharya, Jun; Shrestha, Deepak
Abstract: Although cases of sexual offenses are not uncommon in children, they present to the Emergency Department seeking treatment for a medical cause. Sometimes the history of abuse is missed by the treating clinicians who are only focused upon the presenting complaint and not upon the underlying cause. Furthermore, the lack of reporting of sexual abuse in medical literatures makes them a rarity in the Nepalese scenario. We present an uncommon case of a child where the perpetrator who tried to silence her during the sexual intercourse made a futile attempt to kill her cutting her throat with a sickle.
Mesothelioma with Nonbacterial Thrombotic Endocarditis: A Case Report Authors
(Nepal Medical Association, 2021) Verma, Avatar; Bhatta, Narendra; Mishra, Deebya Raj; Acharya, Achyut Bhakta; Shahi, Rejina; LImbu, Sion Hangma; Katuwal, Srijan; Lama, Urmila
Abstract: Non-bacterial thrombotic endocarditis is a rare condition characterized by noninfectious vegetation on cardiac valves which are often associated with malignancy. It often presents with features of embolism rather than cardiac failure. These are usually seen in autoimmune conditions, disseminated intravascular coagulation, malignancy of gut and lung but has also been reported in other malignancies as well. This entity is rare but one must have a clinical suspicion of the disease especially in a patient suffering from malignancy presenting with the embolic phenomenon. In this report, we are presenting a case of non-bacterial thrombotic endocarditis in an inpatient with pleural mesothelioma, a rare malignant neoplasm arising from pleura in a 35 years old mason, and a rare association as well.
Macrophage Activation Syndrome secondary to Systemic Juvenile Idiopathic Arthritis: A Case Report
(Nepal Medical Association, 2021) Kafle, Rishikesh; Bhatta, Anwesh; Gami, Sumit; Sapkota, Abhin; Sharma, Dipesh; Yadav, Arabindra; Chikanbanjar, Vijaya Kumar
Abstract: Macrophage activation syndrome is a rare but a life threatening condition commonly associated with Systemic Juvenile Idiopathic Arthritis. Its clinical presentation includes fever, hepatosplenomegaly, hypertriglyceridemia, hypofibrinogenemia, hyperferritinemia and impaired liver enzymes. The symptoms are alarming yet non-specific and often lead to a delayed diagnosis. A 12 year male presented with a history of intermittent fever and was started on antibiotics but failed to respond after several days of hospital stay. After a series of investigations to rule out multiple diagnoses he was diagnosed as a case of Macrophage Activation Syndrome secondary to Systemic onset Juvenile Arthritis and was treated with steroids.
Demography of Total Joint Replacement Surgeries Performed in a Tertiary Care Hospital: A Cross-sectional Survey Authors
(Nepal Medical Association, 2021) Thapa, Shrawan Kumar; Kandel, Manoj; Panta, Sunil; Adhikari, Bishwa Raj
Abstract: Introduction: Total joint replacement of hip and knee is considered as one of the most successful orthopedic surgeries in the twenty-first century because of the only solution to end-stage arthritis of these joints. The real burden of the problem is yet to be established in developing countries like Nepal. This study aims to describe the demographic findings of the joint replacement surgeries among total lower limb surgeries in a tertiary care hospital. Methods: This cross-sectional survey was conducted using the hospital records of 73 total joint replacement surgeries of the lower limb in the Department of Orthopedics of a tertiary care hospital from November 2016 to November 2020. Ethical approval was taken from the Institutional Review Committee (reference number: 077/78-011). Convenience sampling was done. Data analysis was done using the Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: There were 73 total joint replacement of hips and knees. Of which, 32 (43.84%) total hip replacements were done in which one (3.13%) patient had a simultaneous bilateral hip replacement in single-stage and the other one (3.13%) had two-stage bilateral hip replacement. Forty one (56.16%) total knee replacements were done in which 18 (24.65%) had a simultaneous bilateral knee replacement and five (6.85%) had a unilateral knee replacement. Conclusions: Total joint replacements of the hip were more common among the lower limb surgeries.

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