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Anatomical Variations of Renal Artery in Nepalese Live Kidney Donors
(Institute of Medicine, 2015) Thakur, DK; Sedhain, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PR
Abstract Introduction: Donor nephrectomy is unique surgery to predispose the surgeon on stress as healthy donors have major surgery purely for others’ benefit. Renal vessels are known with the wide range of variations which can lead to major complications or life threatening events if unrecognized. A thorough knowledge of anatomic variations in renal artery facilitates surgeons to anticipate and manage these potential risks and prevent the complications. Here we present anatomical variations in RA in Nepalese live kidney donors. Methods: This prospective observational study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Live kidney donors over a period of 17 months (From June 2013 to October 2014) presenting for donation were evaluated for renal vasculature with 64- slice multidetector computed tomography and the findings were correlated with intraoperative findings during donor nephrectomy. Results: Sixty three donors were enrolled in the study. Male & female ratio was 1:2.1. Age ranged from 18 years to 64 years (Mean 44.58 years).Anomalous RA was seen in 25 cases (39.7%). Fifty six percentages of anomalies were seen in female and 44% in male. Majority of anomalies were on left side (22.2%). The most common anomaly was supernumerary RA seen in 16 cases (25.5%) Accessory RA was seen in 11 cases (17.5%). Prehilar bifurcation was seen in 11 cases (17.5%). Aberrant RA was seen in 5 cases (8%). Preoperative CT angiographic findings correlated with intraoperative findings in all cases (r = 1, p = 0). Polar branch was transected accidentally in two cases which were repaired at bench surgery. Conclusion: Anatomical variations of renal artery in Nepalese donors are comparable with other populations. Thorough knowledge of the variations can minimize complications and improve outcome during nephrectomy. Keywords: CT renal angiography, Donor nephrectomy, Renal artery
Acquisition of history taking, physical examination and communication skills through early clinical exposure among pre-clinical students
(Institute of Medicine, 2015) Khanal, S; Bhusal, M; Sigdel, MR; Bajracharya, SR
Abstract Introduction: Early Clinical Exposure (ECE) has been shown to be an effective method in teaching history-taking, physical examination and communication to pre-clinical students. Medical students in their preclinical years at IOM, MMC have been undergoing two year ECE course since 1978, but there is no provision of formative and summative assessment to check its effectiveness. This cross-sectional study was undertaken to fill this gap in evidence. Methods: A 17-station Objective Structured Clinical Examination was administered to 17 pre-clinical students. Of the 17 stations, seven, six and four stations were designed to test their skills in history- taking, clinical-examination and communication domains respectively. Modified borderline regression method was used to calculate the pass-marks for each station. The pass-marks of all the stations were averaged to determine the pass-marks for the entire OSCE. Results: One student passed the entire OSCE whereas four and eight students passed the history taking and communication skills domains; while none could pass the physical examination skills domain. Repeated measure one-way Analysis Of Variance (ANOVA) and post-hoc test using the Bonferroni correction showed that scores in history taking (M = 44.36, SD = 11.09) and communication skills (M= 44.40, SD = 12.12) were significantly better than in physical examination (M = 29.35, SD = 10.50), (p < 0.001 and p = 0.007, respectively). Conclusions: Despite enormous teaching hours allocated to the ECE course, pre-clinical students’ performance in an OSCE did not meet the expectation of the curriculum suggesting that the ECE course at MMC, IOM is not fulfilling its objectives. Keywords: Communication, early clinical exposure, medical history taking, physical examination, medical education
Calvarial Thickness of the Nepalese Dry Skulls
(Institute of Medicine, 2015) Baral, P; Koirala, S; Bajracharya, S; Jha, CB; Banstola, D; Shrestha, RN
Abstract Introduction: Calvarium of skull comprises frontal,parietal and occipital bone.These bones cap over the brain in cranial cavity. These bones are flat bones having outer and inner tables made up of compact bone. There is cancellous bone called as diploe in between the outer and inner table. The aim was to measure the thickness of calvaria at various points on Nepalese skull and establish Nepalese database of calvarial thickness and also to compare thickness on the right and left side for bilateral points. Methods: Around140 calvaria of dried skull were studied. Thickness of various points on the frontal, parietal and occipital bones that form calvaria were measured with spreading caliper. The inner table, diploe and outer table thickness were measured with vernier caliper. Results: The mean thickness of frontal bone is 5.6 ± 0.8 mm;out of which the outer table 1±0.2mm, the inner table 0.8±0.3mm and the diploe 3.8±0.6mm.The mean thickness of parietal bone is 4.5±0.6 mm; out of which the outer table 0.8±0.2mm, the inner table 0.6±0.2mm and the diploe 3.1±0.4mm. The mean thickness of occipital bone is 8.5±0.7 mm;out of which the outer table 2.2±0.4mm, the inner table 1±0.3mm and the diploe 5.7±0.6mm.There is significant difference in the mean thickness of the frontal, parietal and occipital bone(p<0.05). Theoverallmean thickness of the calvarium is 6.5±0.7 mm;out of which the outer table 1.5±0.3mm, the inner table 0.8±0.2mm and the diploe 4.5±0.5mm.The outer table is significantly thicker than the inner table(p<0.05). Conclusion: All these results indicate that the calvarium is not uniform in thickness and there is increased thickness towards the posterior and the outer table is thicker than the inner table. Keywords: calvarium, outer table, diploe, inner table
Epiglottal taste buds and different feeding habits of mammals
(Institute of Medicine, 2015) Shrestha, R; Ranjit, N
Abstract Introduction: Taste buds which occur on the laryngeal surface of epiglottis of mammals share many similarities with lingual taste buds, although their function is different. These taste buds mediate reflex action to close the laryngeal opening or initiate the cough reflex when food comes in contact with the posterior surface of the epiglottis. Methods: Repeated microscopic studies were carried out on 6 μm serial haematoxylin and eosin stained sections of epiglottides of buffalo, guinea pig, house rat, human, lamb and rabbit. Quantitative investigation was carried out on the taste buds on the rostral, middle and caudal regions of the epiglottides of each of these mammals. Relative frequency of occurrence value for comparative assessment of taste buds is proposed here. Results: The average number of taste buds was found higher in the herbivorous buffalo, goat and rabbit; while the number was lower in the omnivorous guinea pig, house rat and the human. The density of taste buds was found to be directly proportional to the feeding behaviour of mammals, showing their significant role in inducing reflexes for safe passage of bolus through the oesophagus and for prevention of the respiratory tract congestion. Conclusion: Since the number of taste buds was found higher in the herbivorous mammals, it was concluded that the bigger the volume of the bolus the higher is the density of epiglottal taste buds. These taste buds are adapted to protect the respiratory passage during swallowing and drinking by initiating the reflex action. Keywords: Food bolus, Herbivores, Laryngeal reflexes, Omnivores, Relative Frequency of Occurrence
Visualization of Normal Appendix in Multidetector Computed Tomography
(Institute of Medicine, 2015) Ansari, MA; Kumar, M; Subedi, K
Abstract Introduction: Acute appendicitis is one of the most common causes of acute abdominal pain. Visualization of normal appendix is important to exclude the possibility of appendicitis. With the widespread use of multidetector computed tomography (MDCT) for evaluation of acute abdomen, the normal appearance and rate of visualization of appendix has to be defined. Methods: This was a prospective cross sectional study involving 250 patients undergoing abdominal CT for various indications in Tribhuvan University Teaching Hospital between October 2012 and September 2013. One hundred twenty seven patients were female and 123 were male. Age ranged from 17 years to 73 years. CT scans of the patients were obtained with a 16 slice CT scanner with IV contrast. In all patients, there was no clinical suspicion of acute appendicitis or history of appendectomy. Appendix was searched in these patients by tracing caecum. Results: Appendix was visualized in 215 patients, 111 females and 104 males. Appendix was not visualized in 35 patients, 16 females and 19 males. In total appendix was visualized in 86% of patients (87.4% females and 84.6% males). Conclusion: MDCT is an accurate imaging modality for detection of appendix, whether normal or pathological. Visualization rate of normal appendix by CT scan is higher ranging up to 96% as shown in various studies. Thin collimation, use of contrast and multiplanar reconstruction may be the reason for increased rate of visualization of normal appendix. Keywords: aapendix, multidetector computed tomography
Triclosan Coated Suture Inhibits colonization of Bacteria Responsible for Surgical Site Infection – An in Vitro Efficacy Study
(Institute of Medicine, 2015) Shah, NP; Shah, RK
Abstract Introduction: Surgical site infection is one of the common healthcare associated infections, has significant impact on associated morbidity, mortality and exerts economic burden on the patient as well as on health care system. In addition to other measures, local inhibition of colonization of bacteria would provide clinical benefits. Antibacterial suture such as Triclosan coated suture prevents local growth of bacteria during critical initial stage of wound healing. At the end of 24 hrs of incubation at 37°C, 17-19 mm of zone of inhibition was seen for both S aureus and MRSA for Triclosan coated suture, while no zone was found around for non-coated suture. Methods: The study evaluated in vitro efficacy of antibiotic coated Triclosan suture using zone of inhibition model against commonly reported organisms in SSI (Staphylococcus aureus, Methicillin resistant Staphylococcus aureus. Results: Triclosan coated suture prevents colonization of bacteria at the surgical site, thus reduce the risk of SSI, also it would have positive financial impact such as minimizing the treatment cost and reduced hospital stay. We believe the clinical effectiveness of Triclosan coated suture in minimizing the risk of SSI would be beneficial to health care settings in Nepal. Conclusion: The use of Triclosan coated suture for wound closure would be highly beneficial in controlling the SSI, morbidity, mortality and short hospital stay. Abstract Introduction: Surgical site infection is one of the common healthcare associated infections, has significant impact on associated morbidity, mortality and exerts economic burden on the patient as well as on health care system. In addition to other measures, local inhibition of colonization of bacteria would provide clinical benefits. Antibacterial suture such as Triclosan coated suture prevents local growth of bacteria during critical initial stage of wound healing. At the end of 24 hrs of incubation at 37°C, 17-19 mm of zone of inhibition was seen for both S aureus and MRSA for Triclosan coated suture, while no zone was found around for non-coated suture. Methods: The study evaluated in vitro efficacy of antibiotic coated Triclosan suture using zone of inhibition model against commonly reported organisms in SSI (Staphylococcus aureus, Methicillin resistant Staphylococcus aureus. Results: Triclosan coated suture prevents colonization of bacteria at the surgical site, thus reduce the risk of SSI, also it would have positive financial impact such as minimizing the treatment cost and reduced hospital stay. We believe the clinical effectiveness of Triclosan coated suture in minimizing the risk of SSI would be beneficial to health care settings in Nepal. Conclusion: The use of Triclosan coated suture for wound closure would be highly beneficial in controlling the SSI, morbidity, mortality and short hospital stay. Keywords: Surgical site infection, triclosan, antibacterial coated suture, bacterial colonization
Stressful life events and coping strategies among patients with generalized anxiety disorders
(Institute of Medicine, 2015) Shrestha, R
Abstract Introduction: Anxiety disorders are the most frequently occurring mental disorders resulting in psychological and physical problems. Coping is a healthy response to stress that helps in restoration to homeostasis. The aim was to identify gender and age difference on stressful life events and coping among patients with generalized anxiety disorder. Methods: In the study, 60 subjects above 15 years of age were recruited from Psychiatric OPD of Tribhuvan University, Teaching Hospital. Subjects were assessed with Presumptive Stressful Life Events Scale and standard Coping Check List was used. Mean difference in stressful life events and coping strategy was compared by age and gender by using paired t-test. Pearson correlation coefficient was calculated for association between stressful life events and coping strategy. Results: Female experienced significantly more stressful life events (SLE) than males (2.2±2.0). No age different in SLE was observed. Passive acceptance coping strategy was significantly higher among females than males (p=0.01). Passive coping strategy and problem focused coping strategy were most frequently adopted coping strategies. Conclusion: Females with generalized anxiety disorder experienced more SLE than males. Coping strategies were most commonly associated with SLE among middle adults than young adults. Problem focused coping and passive acceptance coping were the mostly adopted coping strategy amongpatients with generalized anxiety disorder and were significantly correlated with males. Keywords: Generalized anxiety disorder, coping strategy, stressful life event
Co-existence of aminoglycosides and β-lactam-resistant Escherichia coli phenotypes in a Tertiary care center of Nepal
(Institute of Medicine, 2015) Shrestha, B; Tada, T; Shrestha, S; Katte, HPl; Ohara, H; Kirikae, T; Rijal, BP; Sherchand, JB; Pokhrel, BM
Abstract Introduction: Multidrug-resistant Escherichia coli isolates conferring simultaneous resistance to both aminoglycosides and β-lactam drugs have serious implications for clinicians worldwide. This study was designed to evaluate the co-existence of various β-lactamases in aminoglycoside- resistant Escherichia coli amongst hospitalized subjects in a tertiary care center of Kathmandu, Nepal, between December 2013 and December 2014. Methods: Standard microbiological techniques were used for isolation and identification of the isolates. The antimicrobial susceptibility of bacterial isolates was determined following Clinical and Laboratory Standard Institute recommended Kirby-Bauer Disc Diffusion method. The defining criterion in this study for an isolate to be MDR, resistance to at least one agent in three or more than three different structural classes was taken. Results: Among 302 MDR E. coli isolates, 174 (58.0 %) were resistance to gentamicin and 138 (46.0 %) were resistance to amikacin. Maximum aminoglycoside-resistant 9/11(82.0%) strains were isolated from body fluids followed by 7/10 (70.0%) from bile, 6/9 (67.0%) from blood and 2/3 (67.0%) from tissue. Out of 174 aminoglycosides-resistant E. coli isolates, the simultaneous occurrence of Extended-spectrum- b- lactamase (ESBL) and AmpC β–lactamaseswas noted in 13.0 % isolates and Metallo-β-lactamase (MBL) and AmpC β–lactamasesin 8.0 % isolates. None E. coli isolates were positive for all 3 types of β–lactamases in combinations. In amikacin- resistant isolates, ESBL+ AmpC observed in 12% and MBL+AmpC seen in 10% isolates. Conclusion: Our results show a high frequency of aminoglycoside- resistance phenotypes. Strict application for appropriate use of antimicrobials in medical settings should be essential to minimize the emergence of multidrug-resistance among E. coli in hospitalized patients. Keywords: Aminoglycoside-resistant E. coli, Amp C β–lactamases, Metallo-β-lactamase, MDR E.coli
How to Write an Editorial ?
(Institute of Medicine, 2015) Joshi, S
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Paroxysmal Nocturnal Haemoglobinuria (classic category)
(Institute of Medicine, 2016) Bhandari, P; Shrestha, A
Abstract Paroxysmal nocturnal haemoglobinuria (PNH) is a rare disease. The prevalence of clinically significant PNH (i.e. classic PNH) plus patients with relatively large clones that arises in the setting of another marrow failure syndrome is likely in the order of less than 1 case per 200,000 population. Here we present a case of classic PNH who presented with acute kidney injury (AKI) requiring haemodialysis secondary to intravascular haemolysis and haemoglobin of 3.6 gm %. Her diagnosis was suggested by positive HAMS test and confirmed by Flow Cytometry. Patient recovered from AKI after starting danazol and her haemolysis was reduced but not controlled fully. Patient is awaiting treatment with either eculizumab or allogenic bone marrow transplantation. Keywords: Paroxysmal Nocturnal Haemoglobinuria, hemolysis, oliuguria, flow cytometry, eculizumab
Neuropsychiatric presentation of Wilson's disease
(Institute of Medicine, 2016) Dhungana, S; Ojha, SP; Chapagain, M; Tulachan, P; Pant, SB
Abstract Wilson's disease is a rare autosomal inherited disorder with various manifestations. Initial manifestations could be hepatic, neurological or psychiatric and there is invariable delay coming to the correct diagnosis. Exact frequency of children and adolescents presenting with psychiatric complaint as the initial manifestation is not known. It is recommended that detailed medical evaluation be done in any child presenting with psychiatric complaints. We hereby present a case of an eight-year old girl who presented with anxiety and subsequently diagnosed to have Wilson's disease. Keywords: children, neuropsychiatric presentation, Wilson's disease
Manual Vaginal Reversion of Acute Puerperal Uterine Inversion: Learning by Doing
(Institute of Medicine, 2016) Katuwal, N; Pokharel, M; Subedi, K; Baniya, J; Sherchan, K; Rawal, S; Baral, J; Gurung, G; Rana, A
Abstract Uterine inversion is the folding of the fundus into the uterine cavity in varying degrees. Acute uterine inversion is a rare and unpredictable obstetric emergency. Here we report a case of a woman who had vaginal delivery complicated by postpartum hemorrhage. Diagnosed as acute puerperal uterine inversion; reposition was tried in the labor room which failed ensuing shock. Simultaneous fluid resuscitation and manual vaginal reversion under general anesthesia was done in Operation Theater, also needing blood transfusion, 5 units in total. Therefore, this case is described herein to illustrate the importance of early recognition and prompt reversion of inverted uterus vaginally,as delay can render replacement progressively more difficult and also increase the risk of hemorrhage.
Allergic Bronchopulmonary Aspergillosis with massive hemoptysis mimicking pulmonary tuberculosis
(Institute of Medicine, 2016) Paudel, K; Adhikari, S; Pant, P
Abstract Allergic bronchopulmonary aspergillosis (ABPA) is a type II hypersensitivity lung disease induced by bronchial colonization of fungus, Aspergillus fumigatus that commonly occurs in patients with asthma or cystic fibrosis. We present a case of 65year-old Brahmin man, non smoker and non atopic who presented with increasing hemoptysis, initially suspected as pulmonary tuberculosis and later diagnosed as ABPA. He was managed with oral prednisolone 0.5mg/kg/day for 14 days followed by gradual tapering over the period of 6 weeks with remarkable response.
Hepatitis E induced severe myositis
(Institute of Medicine, 2016) Nepali, R; Shah, DS; Sigdel, MR
Abstract Hepatitis E is one of a rare cause of viral myositis in immunocompromised patients. Presentation in immunocompetent patient is even rarer. We present a case of 26-year-old female patient who presented with viral myositis secondary to hepatitis E with rhabdomyolysis with acute kidney injury with right leg foot drop due to compartment syndrome in an immunocompetent patient. Keywords: Hepatitis E, viral myositis, Rhabdomyolysis
Co-relation between Non-specific Knee Joint Pain and Osteoarthritis
(Institute of Medicine, 2016) Humagain, M; Paudel, S; Hengwoju, S
Abstract Introduction: Osteoarthritis (OA) is a degenerative joint disease. Pain is the worst and most frequent problem in OA patients that leads to disability. The rate of knee joint pain has been found to be correlated with OA in many studies. The association of knee pain with OA differs by gender, with advancing age and nature of occupations. Knee radiograph is preferred by most of the physicians for the initial assessment of the knee joint pain. This study was carried out to see the relation between knee joint pain and OA along with age, sex and occupation. Methods: In this prospective cross-sectional study, knee radiographs of 200 patients performed in the Radiology Department of T.U. Teaching Hospital for nonspecific knee joint pain were reviewed. Pain was considered as non specific pain when there was no history of trauma or any known disease affecting the joint and no significant abnormality related to any disease entity was found during clinical examination. The study was conducted over a period of three months between July to September 2015. The proforma was filled and then collected data were analyzed using SPSS software to show the relation between knee joint pain and OA. Results: Among total of 200 knee x-rays, 63% (126) were female and 37% (74) were male. The highest number of population was in the age group of 50-59 year, which comprised 26% of total population and lowest population was in >80 year group comprising 0.5% of total population. Housewives were highest in number comprising 39.5% (79) followed by farmer 19% (38), physical worker 15.5% (31), people in service 12.5% (25), business 7.5% (15) and student 6% (12). Of the total population, 59% (118) had radiographic features of OA changes. Most affected people were older than 50 years and all patients older than 70 years had OA changes. No OA was seen in people younger than 20 years. Highest percentage of OA was found in housewives accounting 51.7% followed by farmers (18.6%) and business people (4.2%. No OA was found in students involved in the study. Conclusion: The study demonstrated that the occurrence of OA is more common finding in population with non-specific knee joint pain. OA is more common in females and population of age ≥50 years. OA is most common in housewives and least in students. Keywords: knee, pain, osteoarthritis, x-ray
Depression and its association with glycemic control in Nepalese adults with diabetes mellitus
(Institute of Medicine, 2016) Pant, SB; Ojha, SP; Chapagain, M; Tulachan, P; Dhungana, S
Abstract Introduction: Depression is reported more common among people with diabetes mellitus which if not addressed, may lead to poor diabetes outcomes. The purpose of the study was to explore depression among people with diabetes mellitus attending endocrinology outpatient department of Tribhuvan University Teaching Hospital and to find its association with glycemic control. Methods: Patients with diabetes mellitus (n=158) attending endocrinology OPD of Tribhuvan University Teaching Hospital were chosen by simple random sampling technique. A self- designed semi structured proforma was devised to obtain the socio- demographic characteristics of the study population. 'General health questionnaire -12' was applied and those with a score of three or more considered as achieving 'psychiatric caseness and among them depression was diagnosed with ICD-10 DCR criteria and HAM-D scale was used to verify it objectively. Results: Among the patients, 122(77.2%) belonged to type 2 diabetes and 36 (22.8%) belonged to type 1 diabetes. Estimate of depression was found to be 29.11% (n=46) which was almost similar in both types of diabetes. The duration of diabetes were less than 5 years in 38% of patients. Level of depression showed significant associationand a positive correlation with glycemic control. Conclusion: This study concluded that depression is common in both type 1 and type 2 diabetes patients and calls the need for screening of depression for comprehensive diabetes management. Keywords: Depression, diabete smellitus, General Health Questionnaire-12, glycemic control, HAM-D, ICD-10 DCR
Correlation between Estimated Glomerular Filtration Rate (eGFR) and Sonographic Findings in Patients with Chronic Kidney Disease
(Institute of Medicine, 2016) Neupane, NP; Lohani, B
Abstract Introduction: Ultrasound can also be used as a non-invasive modality for the evaluation and grading of the chronic kidney diseases. This study aims to correlate the various sonographic parameters with the various grades of CKD based on the eGFR. Methods: The study was a cross sectional study conducted over a period of one year. Study population was adult patients (between 20 to 60 years) with chronic renal disease not undergoing renal replacement therapy. Patients with liver disease and fatty changes in liver in ultrasound and patient with ascites were excluded from the study. Estimated glomerular filtration rate (eGFR) was calculated by using Cockcroft- Gault (CG) equation and CKD classified according to Kidney Disease Improving Global Outcomes (KDIGO) 2004. Ultrasound was performed for all patients and data were entered in a predesigned proforma. Data analysis was done using SPSS 21.0. Results: A total of 138 patients met the inclusion criteria and were included in the study. The mean renal length in our study was 9.03cm (±0.83) on right and 9.00cm (±0.82) on the left side. The mean renal cortical thickness of right kidney was 1.037±0.20 cm and of left kidney was 1.039-±0.20 cm. Renal length and renal cortical thickness demonstrated a negative correlation with grade of CKD while renal echogenicity grading demonstrated a positive correlation with CKD grade. Conclusions: Renal Ultrasound may be used to grade and monitor progress of chronic kidney disease. Keywords: Chronic Kidney Disease, Estimated Glomerular Filtration Rate (eGFR), Renal Length, Ultrasound, Renal cortical thickness
Risk factors for redisplacement in pediatric distal radius fractures after closed reduction and cast immobilisation
(Institute of Medicine, 2016) Ghimire, N; Uprety, S; Lamichhane, A
Abstract Introducation: Pediatric distal radius fractures are one of the most common fractures that we see in our practice. The primary modality of treatment of the displaced fractures of distal radius in children is closed reduction and immobilization in cast. Loss of alignment in cast after an acceptable reduction is common. Twenty one to fifty percent rates of redisplacement in cast after acceptable initial reduction have been reported in literature. Methods: This prospective study included 58 fractures of distal radius and distal third shaft of radius in 57 children with radiologically open physis. Age, gender, initial displacement, associated fracture of the ulna, adequacy of reduction, cast index and gap index were evaluated as possible risk factors for redisplacement in cast. Results: A redisplacement rate of 34.48%was found in distal radius fractures of children after acceptable initial closed reduction and immobilization in cast. Initial complete displacement, degree of initial translation in coronal and sagittal plane, degree of initial angulation in the coronal plane, associated fracture of the ulna, non anatomical initial reduction and cast index were found to be significant risk factors for redisplacement. Age, gender, initial angulation in the sagittal plane and gap index were insignificant risk factors. Conclusion: Distal radius fractures in children have high rate of redisplacement in cast. Fractures with initial complete displacement, fractures with associated fracture of ulna and non-anatomically reduced fractures should either be treated by primary closed reduction and percutaneous pinning or must be followed very carefully in cast treatment. Cast index rather than gap index is a better predictor of loss of reduction in cast. Keywords: Pediatrc, Distal radius fracture, Close reduction, Redisplacement
Educational Intervention about Awareness of Preconceptional care: on Impact Among Bachelor Students
(Institute of Medicine, 2016) Dhakal, K
Abstract Introduction: Preconception care is just as important as prenatal care to reduce adverse pregnancy outcomes such as maternal and infant mortality, preterm births, and low birth weight infants. Awareness means Possession of information about preconceptional care and its components like diet, avoidance of alcohol and smoking, use of folic acid, prevention and management of risk factor related to pregnancy. The aim of the study was to assess the awareness on preconceptional care among bachelor level students before and after educational intervention Methods: A one group pre-test post-test (pre-experimental) study on "Impact of Educational Intervention on Awareness Regarding Preconceptional care Among Bachelor Level Students" was conducted to find out the effectiveness of educational intervention on awareness regarding preconceptional care dated September 2009 to June 2010. The study adopted one group pre-test post-test (pre-experimental) design. Setting for the study was Pashupati Multiple College, Chabahil, Kathmandu. Total of 40 students from bachelor level 1st year (Arts, Major English) were taken by using purposive sampling. The self administered semistructred questionnaire was administered to measure their awareness on preconceptional care before and after educational intervention. The collected data was analyzed by using descriptive and inferential statistics such as frequency, percentage, mean, standard deviation between pre test and post test. Paired t-test was used to find out the difference in awareness at 0.05 level of significance. Statistical package for social science [SPSS] version 12 was used to manage and analyze data. The respondents were between 18 to 30 years of age groups. Out of 40 respondents 57.5% were male and 42.5 were female. Most of the respondents that is 92.5% respondents were unmarried. Results: Only 27.5% respondents knew the meaning of pre conceptional care in pre-test, after intervention it was increased by 42.5%. Half that is 50% of the respondents answered that diet containing carbohydrate, protein and fat is essential for women for the preparation of being pregnant before intervention; it was reached up to 82.5% after educational Conclusion: Over all study findings reveal that there is a significant increase in the awareness in all components of preconceptional care after educational intervention. Therefore, it is concluded that educational intervention on preconceptional care can bring significant increase in awareness of bachelor level students. Further, it is recommended that similar type of educational package should be incorporatedin college level to increase the awareness on preconceptional care among reproductive age populationintervention. Only 15% of the respondents answered folic acid reduces the risk of physical defect in growing fetus in pre-test, it was reached up to 82.5% after educational intervention in post-test. Nearly half that is 45% of the respondents knew that blood sugar should be in control in diabetes women before conception in pretest, after intervention it was increased by 65% in post test. Out of total respondents, 50% respondents obtained fair awareness score and 50% respondents obtained poor awareness score in pre test, after intervention 55% of the respondents got fair awareness score and 45% of the respondents got good awareness score in post test. The grand mean of the mean awareness on preconceptional care regarding the general concept, health promotion, risk factor assessment was 12.41 with standard deviation 4.82 in pre test. Similarly the grand mean of all above mentioned item was 19.89 with standard deviation 4.20 in post test. Research hypothesis states that there will be a significant difference on awareness on preconceptional care among bachelor level students between pre and post educational intervention was tested using paired t-test which was found significant (p<0.05) at 0.05 levels. Keywords: Preconceptional care, Awareness, Bachelor Level Students, Education Intervention, Impact
Evaluation of Hounsfield Unit in adult brain structures by CT
(Institute of Medicine, 2016) Mishra, D; Ghimire, RK; Chand, RB; Thapa, N; Panta, OB
Abstract Introduction: The purpose of study was to evaluate the Hounsfield unit (HU) values in adult brain structures by computed tomography (CT). Hounsfield units (HU) describe relative densities of structures by CT. Different pathological process causes the change in attenuation by different tissues resulting in change of HU of the tissues so we should know the normal HU values to track the changes. These HU values are correlated with different clinical condition and different slice thickness. Methods: A prospective study was done in 72 patients of age above 18 years. All CT scans were performed using 16 row multi-detector CT (Neusoft New Viz16). Two sets of images were reconstructed first one with 5 X 5 mm and second one with 3 X 3 mm slice thickness. For quantitative analysis, HU measurements were obtained by drawing elliptical/ circular region-of-interests (ROI) on various anatomical structures on both 5mm and 3mm slice images. Statistical analysis was done with t test,one way ANOVA and descriptive analysis. Results: HU values for different anatomical area were: thalamus 34.50±1.92, caudate nucleus 36.64±2.01, internal capsule 31.40±2.16, pons 32.70± 2.39, dentate nucleus 30.70±2.22, cerebellar peduncle 30.90±2.37, hemisphere 39.62±2.38, vermis36.77±2.39, lateral ventricle 9.86±2.60, putamen 36.66±1.65, globus pallidus, 36.68±1.87, juxta 28.28±2.42, periventricular 29.18±2.78, deep 27.13±2.06, cortex 34.26±2.25, subcortical 27.36±2.49, corpus callosum 28.71±1.98. There was significant difference in HU values of genu of internal capsule, caudate nucleus, periventricular white matter, dentate nucleus, cerebellar peduncle & hemisphere for the 5mm and 3mm slice thickness. Conclusion: HU of gray and white matter of brain were 34.54 ± 2.54 and 28.25 ±2.00 respectively Keywords: Attenuation, Brain, Computed Tomography, Hounsfield Unit, Slice thickness

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