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2D shear wave elastography of normal thyroid gland in nepalese population
(Nepal Medical College Pvt. Ltd., 2024) Shrestha, Amit; Shrestha, Subodh; Adhikari, Parash; Khanal, Roja; Poudel, Prabhat; Pradhan, Sunil; Tuladhar, Abhushan Siddhi; Acharya, Riwaz
Abstract: Ultrasonography (USG) is modality of choice for normal, diffuse or nodular thyroid diseases. Two dimensional shear wave elastography (2D-SWE) is the latest innovation in USG techniques that allows real-time quantitative assessment of tissue stiffness using acoustic radiation force impulse (ARFI) induced by ultrafast focused US beam sequence (up to 20,000Hz) to record the propagation of the shear waves in real time and displays a map that represents the local elasticity values of tissues in real-time and in a quantitative manner without any compression of the organ. At times, there are difficulties in differentiating normal thyroid gland from diffuse thyroid disease based solely on gray scale USG for which 2D-SWE can be an adjunct. This study aims to establish 2D-SWE parameters for normal thyroid gland in Nepalese population. A cross sectional descriptive study was carried out with 2D SWE on all euthyroid patients with normal thyroid gland on B-mode USG at Department of Radiology, Nepal Medical College Teaching Hospital between December 2021 and November 2022. Tissue stiffness of normal thyroid gland was recorded and tabulated in terms of SMV units (m/s) according age and gender. Out of 100 subjects ( 52 females and 48 males) the youngest was 16 year female and oldest was 68 year female with mean age of 37.07 year (S.D = 11.58). Minimum mean velocity of 1.78 m/s was seen in 36 year old male and maximum of 3.40 m/s in 26 year old female. Mean of mean velocity was 2.36 m/s with (S.D= 0.34). Linear positive correlation was seen between shear wave velocities and age with no statistically significant difference between genders. This study had the most number of normal subjects (100) with almost equal gender distribution (52 females and 48 males) compared to previous studies in known literature. This study also analyzed correlation of shear wave velocity with age unlike other studies. Statistically significant correlation was seen between age and velocities in males only and also in mean velocities between age group 21-40 and 41-60 years (p-value= 0.037).
Measurement of anterior maxillary alveolar ridge dimension and assessment of sagittal root position by cone beam computerized tomography (CBCT)
(Nepal Medical College Pvt. Ltd., 2024) Rajkanikar, Junima; Vaidya, Samriddhi; Koju, Sushmit
Abstract: Maxillary anterior region is the implant site that may require the most rigorous pre-operative assessment as it will have a direct influence on aesthetic outcome and stability of the dental implant. In the present study, CBCT (cone beam computerized tomography) images were used to evaluate alveolar ridge dimension in the maxillary anterior region. This observational radiographic study was done at Nepal Medical College Teaching Hospital. The width of the alveolar bone was measured from the labial cortex to the palatal cortex of the maxillary anterior teeth in mm at the alveolar crest (L1), mid-root (L2), and apical root region (L3) for each tooth. Alveolar height was also measured from the alveolar crest to the floor of the nasal fossa. The Sagittal Root Position (SRP) of the maxillary anterior teeth was also assessed. Results showed that the maximum width of the alveolar bone was seen at L3 of canine and lateral incisor showed least width of alveolar bone width at L1. Maximum alveolar bone height was seen in canines. Males were seen to have increased width of the alveolar bone as compared to the females in all anterior teeth. The most frequent sagittal root position was class I which was seen in 270 (51.4%) of the total teeth examined, which was followed by class IV observed in 210 (40%) of the teeth examined. It could be concluded that for maxillary anterior region, additional regeneration therapy maybe required since class I is the most frequent SRP observed.
Functional outcome of acromioclavicular joint dislocation type III injuries treated with hook plate
(Nepal Medical College Pvt. Ltd., 2024) Adhikari, Vijayendra; Sitaula, Prasamsha; Singh, Sumi; Shrestha, Praphulla; Chalise, Pralhad Kumar; Mishra, Anil Kumar; Singh, Ramesh Prasad
Abstract: The acromioclavicular joint (AC) dislocation is a complex injury due to the disruption of ligaments and joints, leading to instability and pain. Rockwood type III injuries remain controversial, so clinical evaluation should be taken into consideration before deciding the treatment modalities. The study aimed to evaluate the functional outcome of AC joint dislocation type III injuries treated with a hook plate. A total of 30 patients with AC Joint Dislocation Type III injuries were treated with open reduction and fixation with hook plate during a period of 18 months. The functional outcome was evaluated using constant murley score, the mean score of which was 82 (58-96). There were 7 (23.33%) cases of plate impingement and the symptoms was improved after plate removal. The hook plate is a good fixation device for the treatment of AC joint dislocation -Rockwood type III injuries with minimal complications, as it is a simple procedure, with good functional outcome, without ligamentous procedure and the only drawback is second surgery for implant removal.
Evaluation of leiomyoma: a clinicopathological study in a Tertiary Care Center in Kathmandu
(Nepal Medical College Pvt. Ltd., 2024) Pathak, Rakesh; Khadka, Anu; Maharjan, Bipin; Shrestha, Monika
Abstract: Uterine leiomyoma is one of the common gynecological benign tumors. It is usually observed in female of reproductive age group and often presented with symptoms like abdominal pain, dysmenorrhea and fertility disorders. Hysterectomy and myomectomy are the procedure for management of uterine leiomyoma. The prime objective of our study was to evaluate the demographic distribution and clinicopathological changes in hysterectomy and myomectomy specimens with leiomyomas. A descriptive hospital based cross-sectional study was conducted in the Department of Pathology, Nepal Medical College Teaching Hospital (NMCTH), Nepal from May 2023 to October 2023. A total of 57 uterine leiomyoma samples received in the department of Pathology for histopathological examination were included in the study. Ethical approval for the study was obtained from Institutional Review Committee of NMCTH and informed consent was taken from each patient. The tissue biopsies were routinely processed and stained with Hematoxylin and Eosin (H and E). The observed findings were managed in MS Excel sheet and later analyzed using SPSS 17. The most common age group diagnosed with uterine leiomyoma was 41 to 50 years (64.9%). The leiomyomas were highly prevalent in women from Janajati community (47.4%). Pelvic pain, menorrhagia and bleeding disorders were the most frequent clinical manifestations. Intramural was the commonest site (77.2%) and the hyalinization was the most usual secondary changes (19.2%) found. The correlation between age distribution and site of leiomyoma, age distribution and secondary changes and site of leiomyoma and secondary changes were statistically not significant. However, detailed histopathological examination gives many information related to leiomyoma and it is necessary for the effective management.
Knowledge of periconceptional folic-acid among women of childbearing age visiting Tertiary Care Hospital in Nepal
(Nepal Medical College Pvt. Ltd., 2024) Adhikari, Kushal; Basnet, Bijay; Acharya, Suyukti; Shrestha, Astha
Abstract: The value of periconceptional folic acid supplementation in reducing the incidence of neural tube abnormalities in newborns is widely known. Yet, Nepalese women of childbearing age are mainly ignorant of it. The current study examined different sociodemographic and health factors related to women’s level of knowledge about folic acid among women visiting Obstetrics and Gynaecology outpatients at a Tertiary Care Center in Nepal. It also evaluated the awareness and relevance of knowledge regarding folic acid and its periconceptional supplementation. 400 women aged 18 and 45 who sought Obstetrics and Gynecology Outpatient Services at the Tertiary Care Facility participated in this cross-sectional study. Sociodemographic information was gathered with the help of a self-report questionnaire and processed in IBM-SPSS software at a significance threshold of 0.05. Results of the studies showed that while 47.3% had heard of it, only 34.25% had adequate knowledge of periconceptional folic acid supplementation. Also, besides age (p=.493), knowledge of folic acid was significantly associated with factors including education(p=.026), ethnicity (p=<.001), income (p=.011), employment (p=.001), marital status (p=.007), past pregnancies (p=.031) and ANC visits (p=<.001). The study demonstrates the need for more public awareness to boost folic acid knowledge, adherence, and intake and ultimately lower the prevalence of related birth abnormalities. To quantify the hidden issue, further studies on the prevalence of NTDs in Nepalese society and the contribution of folic acid to their reduction are required.
Exploring mouth opening in 3–14-year-old children in a Tertiary Care Centre of Nepal
(Nepal Medical College Pvt. Ltd., 2024) Shah, Priyanka; Khanal, Sanskriti
Abstract: Mouth opening plays a crucial role in our daily lives. Maximum mouth opening is an important parameter in the assessment of several clinical situations and its value is documented to have variations with gender, age and individual’s physical characteristics. This cross-sectional study was carried out to measure the clinical maximum mouth opening in children and its correlation with age, gender, height and weight. A total of 301 children of 3 to 14 years old were included in the study. Data was analyzed using SPSS 16. The mean maximum mouth opening seen in male was 43.17 ± 6.09 mm and in female was 42.55 ± 6.13 mm. Mouth opening differences among different gender was not significant. The mean maximum mouth opening in 3 to 5 years age group was 35.71 ± 4.88 mm, 6 to 8 years age group was 41.71 ± 4.86 mm, 9 to 11 years age group was 44.82 ± 4.61 mm, and 12 to 14 years age group was 47.73 ± 5.84 mm. There was significant difference in the mouth opening of different age groups. There was a positive significant correlation between MMO and weight (Pearson’s correlation coefficient r = 0.592; P < 0.0001) as well as between MMO and height (r = 0.616; P < 0.0001).
Household waste segregation in a ward of a Budhanilkantha municipality, Kathmandu, Nepal
(Nepal Medical College Pvt. Ltd., 2024) Shrestha, Niraj; Joshi, Sammi
Abstract: The process of urbanization, which is perceived as a sign of progress, results increased number of households and their increased consumption of goods and services. This increases the volume of daily household waste which if not properly managed, can lead to various diseases and epidemics. Segregation of household waste into biodegradable and non-biodegradable wastes can make household waste management easier as the biodegradable waste whose proportion is more than 60 % of the daily household waste, can be managed at household or local level. Similarly, a large proportion of non-biodegradable waste can be recycled. This would remove great burden faced by the distant landfill sites where urban wastes are disposed on a regular basis. A study done in a ward of Budhanilkantha Municipality, an urban municipality of Kathmandu valley, which involved 592 households showed that 65% of the total households practiced waste segregation. However, the practice of household waste segregation was not significantly associated with different levels of education status or the monthly income of the family. It was also not significantly associated with the presence of open area around the house.
Association between deviated nasal septum and function of eustachian tube among patients attending a Tertiary Care Center
(Nepal Medical College Pvt. Ltd., 2024) Shrestha, Kundan Kumar; Dhungana, Anup; Rijal, Anupama Shah; Joshi, Rupesh Raj; Shrestha, Shivani; Karki, Srijana
Abstract: Deviated nasal septum is the most common cause of severe and chronic nose blockage. The eustachian tube (ET) is a tube that connects the middle ear cavity and the nasopharynx and provides middle ear ventilation. The relationship between DNS and ETF is controversial in medical literature. This study tried to find the association between deviated nasal septum and function of eustachian tube. This prospective study was conducted in Nepal Medical College Teaching Hospital, Otorhinolarynology Department from November 2022 to October2023 after acquiring ethical clearance from Institutional Review Committee. All the patients presenting to the outpatient clinic over the age of 19 with deviated nasal septum (DNS) were included. Statistical analysis was done using SPSS. A p value of < 0.05 was considered statistically significant. Our study had 71 males (54.6%) and 59 females (45.4%) with mean age 37.2±15.9 years. Of 130 patients, 56 (43.1%) had DNS to right side while 74 (56.9%) to left. All patients had moderate DNS. Age group, gender, and laterality of DNS of the patient did not show any significant association with ETDQ7 score, tympanograms and middle ear pressures on either side. Moderate DNS did not affect ETF in a significant way.
Association between abortion and acceptance of post abortion contraception
(Nepal Medical College Pvt. Ltd., 2024) Rijal, Hima; Katuwal, Neeta
Abstract: Post-abortion contraceptive uptake is essential in reproductive health, as it helps to identify women’s contraceptive needs, reduce unintended pregnancies and prevent subsequent abortions. Integrating abortion services with family planning counselling at all levels of health facilities can enhance contraceptive acceptance. This study aimed to evaluate the acceptance of various family planning methods following different abortion services over one year period, at a family planning center, Department of Obstetrics and Gynecology Tribhuvan University Teaching Hospital. This study analyzed the women who participated in contraceptive counselling and accepted different types of contraceptives following different methods of first and second trimester abortions services. The study included women who received post-abortion contraceptive counselling and services, excluding those with termination beyond the second trimester or those seeking only postpartum contraceptive counselling or post-abortion care. It aimed to analyze the association between different methods of abortion and contraception acceptance post-abortion. Among 100 women who had spontaneous and induced abortions, 89% received post-abortion counselling and 75% accepted various types of contraception immediately after abortion. About one third of women were aged 25–29 years (30%), 99% were married, 40% were graduates and 48% were housewives. Abortion methods included medical abortion (62%), manual vacuum aspiration (MVA) (35%) and dilatation and evacuation (3%). Contraceptive acceptance rates were: short-acting reversible contraception (SARC) 60%, long-acting reversible contraception (LARC) 14%, and permanent methods 1%. Among medical abortion recipients, most chose SARC (43%) followed by LARC (4%). For those undergoing MVA, 16% chose SARC, and 9% chose LARC. Condoms were the most accepted SARC method (22%). The study demonstrated that post-abortion counseling significantly increases acceptance of various contraceptive methods, with SARC being the predominant choice, especially condoms among users.
Profile of glaucoma patients at a Tertiary Care Centre in Gokarneshwor, Kathmandu, Nepal
(Nepal Medical College Pvt. Ltd., 2024) Singh, Pranisha; Rizyal, Aparna; Karmacharya, Srijana
Abstract: Glaucoma is a progressive optic neuropathy characterized by irreversible optic nerve damage and progressive visual field loss. It is the second leading cause of global irreversible blindness. The objective of this study was to find the prevalence, clinical profile and distribution of various types of glaucoma in patients attending a tertiary care center of Kathmandu. This was a retrospective, descriptive hospital based study conducted at glaucoma clinic at tertiary care center from March 2022 to February 2024 (24 months). Patients’ demographic profile along with comprehensive eye examination findings were reviewed from the records. Data analysis was done with SPSS version 18 and chi-square test was used for analysis. P value <0.05 was considered as statistically significant. Two hundred and four patients were diagnosed with glaucoma during 2 years period. The Mean age among glaucoma patients was 55.12 ± 16.7 years. Female was common 109 (53.4%) than male 95 (46.6%). Open angle was 185 (90.7%) and close angle was 19 (9.3%) on gonioscopy. Prevalence of glaucoma seen in this study was 0.72% of total outpatients (27,970). Among the glaucoma patients, primary open angle glaucoma (POAG) was more common 84 (41.2%) followed by glaucoma suspect 46 (22.5%), normal tension glaucoma (NTG) 26 (12.7%), primary angle closure disease 19 (9.4%), ocular hypertension (OHT) 12 (5.9%), secondary glaucoma 9 (4.4%) and juvenile open angle glaucoma (JOAG) 8 (3.9%). In primary angle closure disease, primary angle closure glaucoma (PACG) was 10 (4.9%), angle closure attack 5 (2.5%) and primary angle closure suspect (PACS) 4 (2%). The most common secondary glaucoma was pigmentary glaucoma 3 (1.5%) followed by steroid induced glaucoma 2 (1%), neovascular glaucoma 2 (1%) and inflammatory glaucoma 2 (1%). The most common type of glaucoma seen in a tertiary care center of Nepal was POAG. Glaucoma was more prevalent in female patients after forty years. The prevalence of glaucoma increases with increasing age. So, the patients above the age of 40 should be screened for glaucoma for early detection and prompt treatment. Awareness of glaucoma is needed as it is one of the leading causes of blindness.
Prevalence of metabolic syndrome in peri and postmenopausal women aged 40- 65 years in a Tertiary care centre
(Nepal Medical College Pvt. Ltd., 2024) Joshi, Anshumala; Dhakal, Nishchal; Giri, Amrita
Abstract: Metabolic syndrome (MetS) is a constellation of interrelated risk factors of metabolic origin— metabolic risk factors—that appear to directly promote the development of atherosclerotic cardio-vascular disease (ASCVD). Menopausal transition with its incidental hormonal changes is considered to contribute to the development of MetS. This was a hospital based cross sectional descriptive study conducted in the Obstetrics and Gynaecology department of Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, from the 1st of September 2023 till the 29th of February 2024 after clearance from the IRC (Ref. No: 56-080/081). Convenience sampling was used among women who fulfilled the inclusion criteria. The aim of the study was to determine the prevalence of MetS among the peri and postmenopausal women and to determine which component of the diagnostic criteria of MetS was more strongly associated with MetS in our population. Women were evaluated to have MetS using both the International Diabetes Federation (IDF) and the National Cholesterol Education Program- Adult Treatment Panel III (NCEP-ATPIII criteria). The prevalence of MetS by the IDF criteria was 54% among the perimenopausal women and 61% among the postmenopausal women. Similarly, the prevalence of MetS according to NCEP-ATPIII was 53.5% among the perimenopausal and 65% among the postmenopausal women. All the MetS diagnostic markers showed a strong correlation with MetS (p<0.001). The prevalence of MetS is high in our population by both the IDF and NCEP-ATP III criteria, being higher in the postmenopausal population, though not statistically significant.
Antibiotic susceptibility pattern of pseudomonas aeruginosa and detection of virulence genes in a Tertiary care hospital, Kathmandu, Nepal
(Nepal Medical College Pvt. Ltd., 2024) Ojha, Tek Raj; Sah, Anil Kumar; Karn, Govind Lal; Parajuli, Pramila
Abstract: Pseudomonas aeruginosa is one of the most common causes of hospital-acquired infections. It threatens worldwide public health because of its intrinsic antibiotic resistance and virulence. In this context, this research aimed to determine the occurrence of P. aeruginosa in a clinical setting, examine its susceptibility to antibiotics, and detect the presence of virulence genes, viz. exoY, oprL and toxA in all isolates. It was a cross-sectional study carried out from June 2022 to December 2022. A total of 1356 clinical specimens were collected and processed in the laboratory for Gram staining, culture techniques, and biochemical tests. The Kirby-Bauer disk diffusion method was applied to examine the antibiotic susceptibility pattern and conventional PCR was used to detect the virulence genes in all confirmed P. aeruginosa isolates. 40.5% of specimens showed bacterial growth, of which only 3.02% were identified as P. aeruginosa. Among them, 61.0% were multidrug resistant and 29.2% were β-lactamase producers. Aztreonam (70.7%) was the most effective antibiotic. Among all P. aeruginosa isolates, 68.3% isolates were exoY positive, 61.0% were oprL positive and 56.1% were toxA positive. Strategic interventions are required to stop the emergence and spread of antimicrobial resistance as a result of the isolation of multidrug resistant (MDR) isolates carrying these virulence genes. This study can benefit the medical staff and the entire community in building a surveillance system and enhancing infection control procedures.
Pre-operative evaluation of risk factors for difficult laparoscopic cholecystectomy
(Nepal Medical College Pvt. Ltd., 2024) Sah, Chandrika; Pokharel, Nabin; Paudel, Prakash; Shrestha, Sunil; Alam, Shahid; Yadav, Aditya Prakash; Singh, Rahul
Abstract: Cholelithiasis or the gallstone disease is the most common biliary pathology. 10-15% population of western world is estimated to be affected by gallstone disease, of which majority remains asymptomatic (>80%) and 1-2 % of these asymptomatic patients will develop symptoms needing surgery per year. In this prospective study, 77 patients years undergoing elective Laparoscopic Cholecystectomy (LC) and meeting all inclusion criteria in Department of General Surgery, Nepal Medical College and Teaching Hospital over period of 1 year. History, detailed clinical examination and laboratory investigations were performed as per the working proforma. Operative time and conversion to open cholecystectomy were recorded. The association between clinical, laboratory and sonographic factors with difficult laparoscopy were obtained. Data analysis was done using SPSS-17 version. Out of 77 patients, 63 were females. Body mass index (BMI) above 30 representing obese population were 33.2% with p value 0.0004. Also, 41.5% patients had history of acute cholecystitis while 12.9% patients had previous history of abdominal surgery and 70.1% patients had history of recurrent abdominal pain. Total of 19.4% patients had increased leucocyte count. On ultrasonography thickened GB wall of >3 mm was seen in 42.8%, distended GB was seen in 41.5%, stone size of >1 cm was seen in 70.1% patients and multiple stones were seen in 84.4%. Similarly, duration of surgery was >90 mins in 31.1% and 7.04% patients underwent conversion to open cholecystectomy both of which were considered difficult laparoscopy. Our study reveled that clinical factors like age, BMI, history of acute cholecystitis, previous history of recurrent abdominal pain and past history of abdominal surgery had significant association in prediction of difficult LC.
Detection of mecA gene in staphylococcus aureus isolated from health care workers at a Tertiary care center in Kathmandu
(Nepal Medical College Pvt. Ltd., 2024) Rai, Junu Richhinbung; Suzuki, Takashi; Amatya, Ritu; Rai, Shiba Kumar
Abstract: Staphylococcus aureus is a frequent cause of bacterial infections ranging from minor skin infections to fatal necrotizing infections and infections are on the rise particularly the hospital-acquired infections. The infections becomes more complicated when the infection are caused by drug (methicillin) resisant S. aureus. Therefore, detection of methicillin-resistant S. aureus (MRSA) becomes important. In this study, thus, we investigated the mecA gene in 53 S. aureus isolates isolated from health care workers (n= 213). Of the total 53 S. aureus isolates tested in this study, 24 (45.3%) were positive for mecA gene (533bp). Present study showed a relatively higher rate mecA gene positivity.
Correlation of diabetes self-care adherence with glycemic measures: a cross-sectional health facility-based study in Kathmandu, Nepal
(Nepal Medical College Pvt. Ltd., 2024) Silvanus, Vinutha; Maharjan, Srijana; Jha, Anushree
Abstract: Self-care plays a key role in prevention of complications, and improvement of the quality of life of persons with diabetes (PWDs). This study has assessed adherence to self-care behavior and its correlation with glycemic measures among PWDs attending private health care facilities in Kathmandu, Nepal. A cross-sectional study was carried out using a semi-structured questionnaire. Socio-demographic information and recent fasting (FBG) and 2-hr post-prandial blood glucose (2-hr PBG) levels were recorded. Self-care inventory (SCI) 12-item version was used to assess adherence to diabetes self-care over the preceding four weeks. Self-care practice was measured in five domains: glucose monitoring; diabetes medication; diet; exercise; and preventative care. The overall adherence score was obtained by computing the average of seven items (items 1, 2, 4, 5, 6, 7, 14). Scores more than or equal to median score were considered as higher levels of self-care efficacy. Univariate linear regression analysis of the subscale scores and individual item-wise score with age, duration of diabetes (years), FBG and PPBG levels was carried out. Pearson’s coefficient (r) was reported for normally distributed variables. Among 385 PWDs, mean FBG was 146 mg/dl (±54.7), 2-hr PBG was 210 mg/dl (±82). Median score for overall adherence to diabetes self-care was 25 (IQR:21 to 29). Higher self-care efficacy was seen among 55% (n=212). Overall adherence to self-care was significantly and negatively correlated with age and glycemic measures. Self-care efficacy was mainly driven by adherence to diabetes medication. Adherence to preventative care, exercise and home monitoring of blood glucose was low. FBG was significantly and negatively correlated with glucose regulation (r=-0.16, P=0.001), diabetes medication and food regulation (r=-0.11, P=0.03), preventative care (-0.14, P=0.03) and overall adherence to treatment (-0.15, P=0.004). 2-hr PBG was significantly and negatively associated with all domains of self-care (r -0.14, P=0.04 to -0.21, P<0.0001). Elderly persons, may face difficulty with regular physical exercise, dietary recommendations and overall adherence to self-care. Continuing diabetes education is imperative to motivate PWDs and caregivers regarding importance of self-care efficacy in glycemic regulation and diabetes care.
Mobile phone support for rural health workers in Nepal through ‘celemedicine
(Nepal Medical Association, 2013) Morrison, Joanna; Shrestha, Naba Raj; Hayes, Bruce; Zimmerman, Mark
ABSTRACT Globally, there is a shortage of health workers in rural areas. Effective health systems depend on having sufficient, accessible health workers with the right skills. In countries like Nepal, highly skilled health workers often prefer to work overseas or in urban centres, and therefore, in the short term, it may be pragmatic to focus on ensuring support and skills development of mid level or paramedical health workers. Information technology has the potential to support these health workers. We describe a pilot intervention undertaken in Gulmi District, whereby all mid level health workers in the district have been provided with a free phone number to call three General Practitioner Doctors (GPs) in the District Hospital. The intervention aims to increase appropriate referral, and increase connectivity between the District centre and peripheral health facilities. We hope that our intervention will provide support to rural health workers, and, if implemented as part of a package of interventions, may increase retention. We present some initial findings from discussions with health workers and analysis of call-log data, and describe our next phase evaluation and possible scale-up. Keywords: Human resources; Mobile phone; Mhealth; Nepal; Retention; Rural.
Rotavirus, vaccine and unanswered questions: a perspective from a least developed country
(Nepal Medical Association, 2013) Pun, Sher Bahadur
ABSTRACT Two rotavirus vaccines, RotaTeq (Merck) and Rotarix (GlaxoSmithKline) have been developed to neutralize the most common rotavirus serotypes, and are now available in the global market. These vaccines are primarily aimed at reducing rotavirus gastroenteritis in children in the least developed countries, where rotavirus mortality rate is believed to be greatest. Thus, the World Health Organization (WHO) has recommended rotavirus vaccination be included in all national immunization programs, while the least developed countries have so far not come up with clear vision and long term strategy on vaccine implementation, and several questions, in addition to this, remain unanswered. Keywords: Least developed country; Rotavirus; Vaccines.
Sleep induced hypoxemia in chronic obstructive pulmonary disease
(Nepal Medical Association, 2013) Jing Zhang; Yan Wang; Jing Feng; Xin Sun
Abstract Chronic obstructive pulmonary disease is a leading cause of morbidity and mortality worldwide. Sleep-induced hypoxemia is defined as â€œan SpO2 (oxyhemoglobin saturation) during sleep of < 90% for more than five minutes with a nadir of at least 85%â€ or â€œ> 30% of total sleep time with an SpO2 of < 90%â€ in subject with a baseline awake SpO2 of â‰¥ 90%. Patients with moderate or severe COPD run a high risk of developing SIH mainly because of alveolar hypoventilation and ventilationperfusion mismatch. Compared to their non-SIH brethren, SIH COPD patients have greater degrees of pulmonary hypertension and cor pulmonale, require more frequent hospitalizations, and sustain higher mortality rates. And the necessity of treatment of isolated SIH in COPD has been debated for years. In this mini review, the definition, reasons, prevalence, clinical significance and treatment approaches of SIH in COPD are summarized. Keywords: Chronic obstructive pulmonary disease; Polysomnography; Rapid eye movement; Sleep-induced hypoxemia.
Idiopathic epiretinal membrane in young patient: a rare case presentation
(Nepal Medical Association, 2013) Thapa, Raba; Paudyal, Govinda
ABSTRACT Epiretinal membrane is avascular fibrous tissue which is adhered to the internal layers of retina in the macular area. Patient may be asymptomatic or present with blurring of vision and metamorphopsia. The idiopathic Epiretinal Membrane is more often seen in elderly but it could be present in young patients in association with other vitreo-retinal diseases and following intraocular surgery. The idiopathic Eperetinal Membrane in young patients are rare. Here we present a thirty one year healthy women presented with idiopathic Epiretinal Membrane who gained full visual recovery following the pars plana vitrectomy, membrane peeling and gas for its rarity. Keywords: Epiretinal membrane; Idiopathic; Young women.
Paratesticular leiomyosarcoma: a case report
(Nepal Medical Association, 2013) Patil, Vijaya; Verma, Ashish; Pattar, Ravindra S.; Nandar, Sanjay
ABSTRACT Paratesticularleiomyosarcomas are rare neoplasms. Radical orchidectomy and high ligation of cord followed by surveillance is the treatment of choice. Here we report a 73-year-old man who presented with a 2-year history of painless lump in the left hemiscrotum. A left radical orchiectomy with high ligation of the spermatic cord was performed. The histo-pathological and immunohistochemistry evaluation revealed a moderately differentiated leiomyosarcoma of paratesticular region. The patient is still alive with no evidence of local recurrence and distant metastasis after seven years of follow-up. Keywords: Leiomyosarcoma; Spermatic cord; Paratesticular; Surgical procedures.

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