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Primary Ovarian Pregnancy
(Institute of Medicine, 2015) Shrestha, R; Singh, A; Shrestha, S Duwal; Pradhan, B; Chettri, L Rokka; Shah, W
Abstract Abstract: Ovarian pregnancy is one of the rarest form of ectopic pregnancies. The classic symptoms of ectopic pregnancy may not be present in ovarian pregnancy. Preoperative diagnosis of ovarian pregnancy is still confusing. Delay in diagnosis may lead to increase maternal morbidity and mortality. We present here a case of ovarian pregnancy presenting with acute abdominal pain with no menstrual irregularities. Transabdominal ultrasonography failed to make the diagnosis of ovarian pregnancy. The case was successfully managed by surgery and diagnosis of ovarian pregnancywas confirmed later by histopathological report. Keywords: Histopathology, Ovarian Pregnancy, Transabdominal Ultrasound
Fixed drug eruption resulting from amoxicillin use: a case report
(Institute of Medicine, 2015) Adhikari, S; Dhital, KR; Paudel, K; Adhikari, S; Parajuli, S
Abstract Abstract: Amoxicillin is commonly administered antibiotic to treat mainly the respiratory tract infections. Fixed drug eruption is a rarely seen reaction to penicillins. Commonly observed side effects of amoxicillin include nausea, vomiting, diarrhea, allergic skin reactions (a morbilliform rash).Uncommon side effects include, reversible leucopenia, antibiotics associated colitis (pseudo- membranous and haemorrhagic collitis), black hairy tongue, superficial tooth discolouration. This is a rare case of fixed drug eruption due to amoxicillin at dorsum of hand and foot. Keywords: Amoxicillin, Side effect, Fixed drug eruption
Tubercular epidural abscess presenting as acute cauda equina syndrome
(Institute of Medicine, 2015) Lakhey, RB; Kafle, D; Pokhrel, RK
Abstract Tubercular epidural abscess without osseous and pulmonary involvement is an extremely rare scenario. Presentation of the same with cauda equina syndrome is even rarer. We present a case of tubercular epidural abscess in 31-year old male patient. He presented with acute cauda equina syndrome and was shown to have epidural abscess extending from L4-S3 vertebral level without any evidence of vertebral involvement in MRI. The patient did not have pulmonary involvement. The patient made an uneventful recovery following surgical decompression and anti-tubercular chemo- therapy. The diagnosis was confirmed by histo-pathological demonstration of tubercular granuloma in the biopsy specimen. Keywords: tuberculosis, epidural abscess, cauda equina syndrome, decompression
Tubercular epidural abscess presenting as acute cauda equina syndrome
(Institute of Medicine, 2015) Lakhey, RB; Kafle, D; Pokhrel, RK
Abstract Tubercular epidural abscess without osseous and pulmonary involvement is an extremely rare scenario. Presentation of the same with cauda equina syndrome is even rarer. We present a case of tubercular epidural abscess in 31-year old male patient. He presented with acute cauda equina syndrome and was shown to have epidural abscess extending from L4-S3 vertebral level without any evidence of vertebral involvement in MRI. The patient did not have pulmonary involvement. The patient made an uneventful recovery following surgical decompression and anti-tubercular chemo- therapy. The diagnosis was confirmed by histo-pathological demonstration of tubercular granuloma in the biopsy specimen. Keywords: tuberculosis, epidural abscess, cauda equina syndrome, decompression
Phenotypic characterization of multidrug-resistant Acinetobacter baumannii with special reference to metallo-β-lactamase production from the hospitalized patients in a tertiary care hospital in Nepal
(Institute of Medicine, 2015) Shrestha, S; Tada, T; Shrestha, B; Ohara, H; Kirikae, T; Rijal, BP; Pokhrel, BM; Sherchand, JB
Abstract Introduction: Acinetobacter baumanniiis an important cause of nosocomial infection and has been associated with a wide variety of illnesses in hospitalized patients, especially patients in the intensive care units. The emergence of carbapenem-resistant clones of A. baumannii has been the most serious problem worldwide. After the carbapenem resistant clones have emerged, leaving the hope of treatment of A. baumannii infection is by the last resort of antibiotics such as tigecycline, polymyxin-B and colistin. The purpose of this study is to determine the antibiotic resistance patterns of A. baumannil isolates, prevalence of multidrug resistance, extended spectrum beta lactamase production and metallo-beta lactamase production. Methods: This is a prospective study conducted at the department of Clinical Microbiology. Tribhuvan University Teaching Hospital, from December 2013 to September 2014. Ethical approval was taken from the Institutional Review Board of Institute of Medicine. Two hundred and forty six Acinetobacterisolates were identified by standard microbiological testing. Antimicrobial susceptibility testing was performed by Kirby Bauer method as per the CLSI guidelines. Multidrug resistance was determined. ESBL production was detected by combination disc method and confirmed by Clinical and Laboratory Standerd Institute confirmatory test. MBL production was detected by using imipenem and imipenem/EDTA disc. Result: All 122 Multidrug-resistant A. baumannii isolateswere resistant to majority of the drugs used. All the isolates were completely sensitive to polymyxin B, colistin and tigecycline only. Fifteen (12.29%) isolates of A. baumannii were extended spectrum beta-lactamase producers and 50 (40.98%) were metallo-beta-lactamase producers. Multidrug resistance was common in A. baumannii Conclusion: Multidrug resistance in A. baumannii is becoming more common ESBL and MBL production should be promptly detected and reported to control the spread of resistant phenotypes to other individuals. Keywords: Acinetobacter baumannii, ESBL, MBL, multidrug-resistance
Assessment of normal splenic volume by Computed Tomography in Nepalese population
(Institute of Medicine, 2015) Suwal, S; Subedi, K; Gurung, G
Abstract Introduction: The purpose of this study was to assess the normal splenic volume in Nepalese population by Computed Tomography and its variability with age, sex and body habitus. Methods: This was a cross sectional observational study involving 264 patients undergoing CT abdomen examination for pathologies not pertaining to spleen, in Department of Radiology, Tribhuvan University Teaching Hospital. The spleen volume was obtained by adding cross-sectional area of spleen from 10 mm contiguous CT slices in axial CT images and multiplying them with the slice thickness. The relationships between spleen volume and age, sex and body habitus were also derived. Results: The mean splenic volume was 151.20 cm3 ± 59.62 cm3, ranging from 25.95 cm3 to 331.66 cm3. Weak negative correlation of spleen volume with age (r = -0.173, p <0.01) and body habitus (r = -0.132, p <0.05) were also noted. No significant correlation of spleen volume with gender was noted. Conclusion: The finding provided defining the criteria for splenomegaly. The mean splenic size in Nepalese population is similar and/or larger compared to Asian population, and smaller compared to western population. However a larger sample size is required for corroboration of our findings. Keywords: Computed Tomography, Normal, Spleen, Volume
Psychosocial Correlates and Treatment Compliance in Depressive Disorder: A Hospital Based Study
(Institute of Medicine, 2015) Rana, M
Abstract Introduction: Depressive disorder is a common mental illness seen in hospitals and mental health services in Nepal. The aim of the study was to determine the psychosocial correlates and treatment compliance in depressive disorder patients, coming to Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Methods: Psychosocial profiles of 135 depressive disorder patients diagnosed by consultant psychiatrist according to ICD-10 and meeting the study criteria, attending out-patient clinic, Department of Psychiatry and Mental Health, Teaching Hospital, were included. The study sample were randomized into three different groups; i.e. cognitive behavior therapy, pharmacotherapy or combined therapy (receiving both cognitive behavior therapy and pharmacotherapy). Psychosocial correlates, illness characteristics and treatment compliance in depressive disorder were assessed by Semi-Structured Interview Schedule, Beck Depression Inventory, Automatic Thought Questionnaire-Revised and Visual Analogue Scale, by comparing the pre and post therapy results and drop- out rates. Results: Before therapeutic interventions, 53(39.3%) had moderate, 47(34.8%) had severe depressive and 35(25.9%) had mild depressive symptoms. Negative automatic thoughts, hopelessness, anxiety and inability coping; low socio-economic assets and education; relationship and adjustment problems and significant life events were significant psychosocial correlates of depression. Compliance was poor in the pharmacotherapy group. Total 30 (22.2%) patients had dropped-out during the study period: 15(33%) from pharmacotherapy, 11(24%) from Cognitive Behavior Therapy and 6(13%) from combined therapy group. Conclusion: Psychosocial factors were significantly correlated with depressive disorder. Compliance to treatment and recovery was better in the combined therapy group than either therapy alone. Keywords: Psychosocial correlates, Treatment compliance, CBT
Prevalence of Left ventricular diastolic dysfunction in newly diagnosed and never treated essential hypertension in tertiary care Hospital of Nepal
(Institute of Medicine, 2015) Gajurel, RM; Sayami, A
Abstract Introduction: Hypertension is a global public health problem with one fourth adults worldwide estimated to have high blood pressure (BP).1 The incidence of hypertension continues to increase in all developed and developing societies as the population grows older and more obese.2 The Framingham Study and other epidemiological surveys have clearly defined HTN as an important cause of morbidity and mortality. 2-3 the aim of this study was to determine the prevalence of Left ventricular diastolic dysfunction in newly diagnosed and never treated essential hypertension. Methods: A cross sectional study was used for those patients who were attended outpatient clinic of Man Mohan centre with diagnosis of newly diagnosed and never treated hypertension over a period of October 2011 to November 2012. Results: A total of 130 essential hypertensive patients underwent trans-thoracic echocardiography for evaluation of left ventricular diastolic function. Among 130 consecutive cases 56(43.1%) had normal Left ventricular diastolic function in echocardiography, 22(16.9%) patients had grade I LVDD, 50(38.5%) had grade II LVDD and 2 (1.5%) patients had grade IIIa LV diastolic dysfunction. Conclusion: LV diastolic dysfunction was found to have very common preclinical myocardial dysfunction even in new and never treated essential hypertension. Keywords: Hypertension, Echocardiography, Left Ventricular Diastolic Dysfunction
Prevalence of Left ventricular diastolic dysfunction in newly diagnosed and never treated essential hypertension in tertiary care Hospital of Nepal
(Institute of Medicine, 2015) Gajurel, RM; Sayami, A
Abstract Introduction: Hypertension is a global public health problem with one fourth adults worldwide estimated to have high blood pressure (BP).1 The incidence of hypertension continues to increase in all developed and developing societies as the population grows older and more obese.2 The Framingham Study and other epidemiological surveys have clearly defined HTN as an important cause of morbidity and mortality. 2-3 the aim of this study was to determine the prevalence of Left ventricular diastolic dysfunction in newly diagnosed and never treated essential hypertension. Methods: A cross sectional study was used for those patients who were attended outpatient clinic of Man Mohan centre with diagnosis of newly diagnosed and never treated hypertension over a period of October 2011 to November 2012. Results: A total of 130 essential hypertensive patients underwent trans-thoracic echocardiography for evaluation of left ventricular diastolic function. Among 130 consecutive cases 56(43.1%) had normal Left ventricular diastolic function in echocardiography, 22(16.9%) patients had grade I LVDD, 50(38.5%) had grade II LVDD and 2 (1.5%) patients had grade IIIa LV diastolic dysfunction. Conclusion: LV diastolic dysfunction was found to have very common preclinical myocardial dysfunction even in new and never treated essential hypertension. Keywords: Hypertension, Echocardiography, Left Ventricular Diastolic Dysfunction
Venous Diseases of Lower Limbs: Retrospective Analysis of Duplex Ultrasound Findings
(Institute of Medicine, 2015) Gurung, GS
Abstract Introduction: Venous pathologies of the lower limb include acute deep venous thrombosis and chronic venous insufficiency. Deep vein thrombosis can cause pulmonary embolism, which is a serious medical emergency. Deep venous thrombosis usually manifests with limb pain and swelling in high risk group whereas chronic venous insufficiencies manifests with limb swelling, telengiectasia, varicosities and skin changes including ulceration which also cause serious morbidity. The aim of this study was to ret-rospectively analyze the findings of duplex ultrasound in patients with venous disease of lower limbs. Methods: A retrospective hospital-based study in 386 patients was carried out analyzing the records of duplex ultrasound findings at Kathmandu Imaging Center, Maitighar, Kathmandu, Nepal. Clinical information and Duplex ultrasound findings including status of deep veins, superficial veins, sapheno- femoral junction, sapheno-popliteal junctions and perforators were reviewed. Associated findings of deep vein thrombosis and venous incompetence were also noted. Results: The patient population composed of almost equal numbers of males 200(52%) and females 186(48%). Majority 197(51%) of venous Duplex examination was normal. 129(33%) of patient had chronic venous insufficiency. Similarly, 60(15.5%) of patients had deep vein thrombosis and among these deep vein thrombosis patients, 3(5%) had chronic venous insufficiency. Mean age of patients with deep vein thrombosis was 52.4±17.5 years. Males predominantly suffered from deep vein thrombosis with male to female ratio of 1.9:1. However, chronic venous insufficiency was seen in slightly younger patients with mean age of 40.8±14.7 years and males were more frequently affected by chronic venous insufficiency with male to female ratio of 1.3:1. Conclusion: Venous duplex study is an essential tool for evaluation of lower limb venous pathology. From the study, it can be concluded that, the commonest abnormality found in the patient were varicosity, deep vein thrombosis and chronic venous insufficiency. Keywords: CVI, Duplex ultrasound, DVT, Varicose vein, venous disease
Evaluation of image quality in CT chest by 50% mAs reduction
(Institute of Medicine, 2015) Thapa, N; Humagain, MP; Mishra, D; Shrestha, SI; Ansari, MA
Abstract Introduction: Conventional chest CT is usually performed in the setting between 220-280 mAs. Increase use of CT in recent times has the potential to increase radiation burden to the general population. The purpose of this study was to evaluate the image quality in CT Chest with 50% mAs reduction. Methods: This prospective study was done in 101 patients with age above 18 years and BMI less than 25kg/m2 who were referred for CECT chest examination. A 16 slice multi detector CT scanner was used to acquire non contrast at 120 kVp and 140 mAs, a modified protocol with 50% reduction in mAsand contrast enhanced scan at standard protocol of 120 kVp and 280 mAs. The images of plain and contrast enhanced scans were evaluated by two expert radiologists and given the image quality score in 5 point scale (1-worst, 2-suboptimal, 3- adequate, 4-good, 5-excellent) to each. Im- age noise was measured in images of each patient. Patient weight, height and BMI were recorded and correlated with image quality score. Statistical analysis was done with relevant test. Results: The overall image quality with standard protocol was significantly better (p<0.05) than modified protocol. The modified protocol had acceptable image quality score for patients with weight< 60 kg, BMI<25kg/m2. The CTDIvol was 11.15 with reduced mAs and 22.15 with standard mAs resulting in significant reduction in radiation dose of about 49%. Conclusion: Image quality of modified protocol with 50% mAs reduction i.e.140 mAs is accept- for average built patients and not patients with large anthropometric parameters. Keywords: Computed Tomography, mAs reduction, Image quality, Noise, Radiation dose
Hematological parameters of Salmonella typhi and paratyphi culture positive patients from Kathmandu Valley, Nepal
(Institute of Medicine, 2015) Rana, B SJB; Pradhan, SK
Abstract Introduction: Salmonella enterica causes febrile illnesses leading to changes in hematological parameters. Developing countries like Nepal remain an endemic area for this disease. However, the changes in hematological parameters among Nepalese population have not been well documented in correlation with culture diagnosed cases. Methods: A total of 204 individuals (102 cases and 102 controls) were included in a cross-sectional, analytical comparative study. The cases and controls were recruited from the tertiary care centers in Kathmandu. The hematological parameters from both culture diagnosed and controls were measured. Results: Enteric fever (102 culture positive cases) caused a significant decrease in total white blood cell (p < 0.05), blood platelet count (p < 0.05), lymphocyte (p < 0.05), packed cell volume (p < 0.05), eosinophils (p < 0.05) and haemoglobin (p < 0.05) compared to healthy controls. Similarly, enteric fever led to significant increase in neutrophil and monocyte count in enteric fever patients (p < 0.05).S. typhi was isolated in 60 (59%) and S. paratyphi was isolated in 42 (41%) of the patients. Anemia was found in 24 (23.52 %).Leucopenia was found in 8 (7.84%) patients, leucocytosis in 3(2.94%), neutrophilia in 29 (28.43%), lymphocytopenia in 19 (18.62%), monocytopenia in 48 (47.05%), absolute eosinopenia in 95 (93.13%), thrombocytopenia in 24(23.52%) and thrombocytosis in 2(1.96%). Conclusion: Enteric fever was associated with leucopenia, mild neutrophilia, lymphopenia, absolute eosinopenia and decrease in haemoglobin among culture positive patients. Salmonella enterica serotype Typhi contributed febrile burden higher 59% (60). Keywords: Enteric fever, Hematological parameters, Salmonella
Streptococcus pneumoniae among children with clinical meningitis in Nepal
(Institute of Medicine, 2015) Sherchan, JB; Tandukar, S; Shrestha, L; Rai, GK; Sharma, A; Gami, FC; Rijal, B; Sherchand, JB; Ohara, H
Abstract Introduction: Invasive bacterial disease is a significant cause of morbidity and mortality worldwide and it is a major cause of childhood deaths in Nepal. Streptococcus pneumoniae is responsible for invasive and non-invasive pneumococcal diseases worldwide, such as pneumonia, bacteremia and meningitis. The aim of the study was to isolate, identify and determine antimicrobial susceptibility pattern of Streptococcus pneumoniae along with use of rapid immunochromatographic test “Binax NOW”, to detect antigen for diagnosis of bacterial meningitis. Methods: The study was carried out from October 2013 to September 2015 in Children’s Hospital, Teaching Hospital-Department of Child Health and Public Health Research Laboratory, Institute of Medicine, Kathmandu, Nepal. Cerebrospinal fluid sample from 339 suspected cases of meningitis from children below 15 years of age were examined for identification by Gram staining, Culture and by Binax Now test. The identification of bacteria was done following standard method recommended by American Society for Microbiology. Antibiotic sensitivity testing was done by modified Kirby- Bauer disk diffusion method. Results: Of total 339 suspected cases, 24(7.08%) bacterial meningitis was detected by Gram staining and culture methods whereas BinaxNow method detected 28(8.26%). On the basis of age, the highest numbers of the positive cases were found in the age group between 0-23 months (9.30%) followed by age group 49-60 months (8.16%) Conclusions: In conclusion, a significant rate of bacterial meningitis was found in this study prompting concern for national wide surveillance. Keywords: Children, Meningitis, S. pneumoniae, Nepal
Accuracy of various diagnostic tests and antimicrobial sensitivity pattern of Helicobacter pylori infection in a tertiary care centre in Nepal
(Institute of Medicine, 2015) Kansakar, P; Dongol, A; Vaidya, P
Abstract Introduction: Helicobacter pylori infection is the most important cause of peptic ulcer disease as well as other gastrointestinal conditions. Most widely used diagnostic tests for detection of Helicobacter pylori include rapid urease test, histopathology, culture/sensitivity and serology. The objective of this study was to determine accuracy of standard diagnostic tests and the prevailing local antibiotic susceptibility patterns. Methods: This cross sectional study, conducted from May to October 2009 at Tribhuvan University Teaching Hospital. 3 pieces of biopsy pieces were obtained from the antral mucosa which were subsequently used for Rapid Urease Test (RUT), histopathology and culture/sensitivity. Then, 2 ml of venous blood was drawn from the antecubital vein for serological examination. Results: H. pylori positivity status was reflected as 32%, 32% and 47% by rapid urease test, culture and histology. The seroprevalence of H. pylori was 63%. A patient was considered to be positive with respect to H. pylori infection when at least two of three tests namely rapid urease test, culture and histology gave positive results. Hence, proportion of patients with positive H. pylori infection was 36%. Only 30 from 32 culture positive cases were efficiently subcultured and further processed for antibiotic susceptibility testing. Resistance to metronidazole was found to be the highest securing 53.3% and lowest to levofloxacin (0%). Conclusions: Detection of Helicobacter pylori infection using serology was the most effective among the diagnostic tests performed. More than half of the patients were resistant metronidazole while levofloxacin was sensitive in all the cases. Keywords: Helicobacter pylori, diagnostic tests, antimicrobial susceptibility
Radiographic findings in non specific low back pain
(Institute of Medicine, 2015) Humagain, M; Paudel, S; Maharjan, A
Abstract Introduction: About 40% of people have low back pain (LBP) at some point in their lives. Non specific LBP where precise pathoanatomical diagnosis cannot be given comprises almost 85% of patients with isolated low back pain. Lumbosacral radiograph is preferred by most of the physicians for the initial assessment of the LBP. It is therefore crucial to evaluate patients with LBP and assess for possible relationship between low back pain and patient characteristics. Methods: In the study, lumbosacral radiographs of 200 patients with nonspecific LBP coming to Radiology department of T.U. Teaching Hospital were reviewed between July to September 2014. The findings were classified under various categories, tabulated in the Proforma and data were analyzed using SPSS software system. Results: Among total of 200 patients, 45% (90) were male and 55% (110) were female. The study included patients of different age ranging from 13 to 92 years with highest number in 30-3 and 40-49 age groups accounting for each 23% of total population. Lumbar spondylosis, normal radiographs and loss of lumbar lordosis were the most common three findings comprising 105 (52.5%), 55 (27.2%) and 24 (12%) of radiographs respectively. Lumber spondylosis was the most common finding after the age of 30 years with highest in the age group of 60-69 years comprising 93.8 % (15) of radiographs in that age group. Most of the radiographs of younger patients below 30 years of age were normal. Conclusion: The study demonstrated that the occurrence of lumber spondylosis was the highest among the radiographs of patients with low back pain. The loss of lordosis and disk degeneration was also significant factors associated with low back pain. Keywords: Low back pain, lumbo-sacral spine, radiograph
Attitudes towards Psychiatry and Mental Illness among medical students in a university hospital
(Institute of Medicine, 2015) Chapagai, M; Dhungana, S; Tulachan, P; Ojha, S P
Abstract Introduction: Psychiatry is viewed negatively by medical students. They tend to have negative attitudes towards psychiatry, psychiatrists, mentally ill and mental illnesses as a whole. This study was intended to assess attitudes to psychiatry and mental illness among medical students in Tribhuvan University Teaching Hospital. Methods: It was a cross- sectional study done to assess attitudes to Psychiatry and Mental illness among fourth year medical students in Tribhuvan University Teaching Hospital. Socio- demographic information was filled up and two likert scales ATP-30 (Attitudes to Psychiatry) and ATM (Attitudes to Mental Illness) were used to assess attitudes. Descriptive analysis was done and chi- square test was used to see for any statistically significant difference for the items using SPSS version 20. Results: Total sample size was forty- five and males comprised three- fourth of the respondents. The mean age of participants was 22.4 years with somewhat higher number of respondents from valley (57.8%). Brahmins (26.6%) and Hindu (88%) constituted the majority. 84.4% of the respondents belonged to nuclear family. The mean ATP-30 and ATM scores obtained were 106.78 and 66.93 respectively. Conclusions: Overall attitude to Psychiatry and mental illness among fourth year medical students Tribhuvan University Teaching Hospital was found to be positive. Studies with larger sample size with students from multiple universities and medical colleges and comparison of attitudes before and after psychiatry rotation are further needed. Keywords: Attitudes, psychiatry, medical students
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

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