Journal Issue:
Volume: 11, No 3, Issue 43, JULY- SEPT, 2013

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Volume

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Issue Date

2013

Journal Title

Journal ISSN

1812-2027

Journal Volume

Journal Volume
Volume: 11

Articles

Publication
Community Based Medical Education – Necessity Realization and Practice
(Kathmandu University, 2013) Koju, R
NA
Publication
Study on Developmental- Behavioural Pediatrics Training Experiences of Pediatricians and Pediatric Trainees Working in Nepal
(Kathmandu University, 2013) Rimal, HS; Pokharel, A; Saha, V
ABSTRACT Background There are growing concerns about developmental, behavioural, social and emotional wellbeing of children throughout the world. A huge gap exists between the instructions provided on medical disciplines and on areas of Developmental- Behavioural Pediatrics (DBP) during pediatric training in our region. Objective This study aims to evaluate the Developmental –Behavioural pediatrics (DBP) training experiences of pediatricians and pediatric trainees during their post graduate training in pediatrics. Methods Questionnaires were sent to the pediatricians / trainees and data was analyzed using SPSS software. Result More than 56 % of respondents were satisfied in 10 out of 11 medical disciplines where as more than 56% were unsatisfied in 10 out of 11 developmental behavioural pediatrics disciplines. This Study has demonstrated that between 50-60 % of pediatricians did not see the cases of ADHD, Learning difficulty and family dysfunction for a period of three months prior to the survey which are relatively common conditions. Even in post graduate training nearly 66 % of pediatricians were unsatisfied with their instructions in DB pediatrics. Conclusion Pediatricians working in Nepal have difficulties in addressing the issues of developmental pediatrics, raising a question about the need to review the curriculum of post graduate training in Pediatrics. KEY WORDS Developmental pediatrics, evaluation, multidisciplinary team, training
Publication
Histomorphological Profile of Colonoscopic Biopsies and Pattern of Colorectal Carcinoma in Kavre District
(Kathmandu University, 2013) Rajbhandari, M; Karmacharya, A; Khanal, K; Dhakal, P; Shrestha, R
ABSTRACT Background Colonoscopy is the method to visualize the mucosa of the entire colon and terminal ileum to detect the intestinal abnormalities and obtain biopsy for definitive diagnosis. For clinical decisions in the diagnosis of various colonic lesions unambiguous interpretation of colorectal biopsies is necessary. Objectives To assess the prevalence pattern of colonic diseases and to correlate the incidence of colorectal carcinoma with age, sex, site and symptoms presented at Dhulikhel Hospital. Methods The materials consisted of 126 biopsies which were submitted to the Department of Pathology, Kathmandu University School of Medical Sciences, Dhulikhel, during the period of July 2011- July 2012 .Data collected and entered in MS-Excel and were analyzed using SPSS-16. Results Out of 126 colonoscopic biopsies 34(27%) showed chronic nonspecific inflammation, followed by carcinoma 25(19.8%), non-neoplastic polyps 21(16.7%), granulomatous inflammation 14(11.1%), neoplastic polyps 8(6.3%), ulcerative colitis 4(3.2%) Miscellaneous lesions; Acute focal colitis, Eosinophilic colitis were also observed in 19 (15.1%). A higher frequency of colonic diseases in males with a male to female ratio of 1.4:1 and age range of two years to 84 years was observed. Out of 25 patients diagnosed with colorectal carcinoma,48% (n=12) were males and 52% (n=13) were females with a mean age of 55.17 years in men and 59.46 years in females. Male and female ratio among cancer groups was 1:1.08. Total 36% (n=9) were diagnosed with cancer before the age of 50. Out of these nine cases, 6( 66.7%) were males and 3(33.3%) were females. The male and female ratio in younger and older age groups were 2:1 and 1:1.7 . 17( 68%) of the lesions were left sided and 8(32%) were right sided. Below age 50 , left to Right sided lesions in males were 2:1 and in females 1:2. However, above 50 years the ratio among proximal and distal lesions were 5:1 in males and 2.3:1 in females. A statistically significant association was seen between the growth (p=0.000) and per rectal bleeding (p= 0.006) with carcinoma. Conclusion The most prevalent lesion in colorectal biopsies was non-specific colitis followed by carcinoma colon. The incidence of colorectal carcinoma is on rise in Nepalese society. Although colorectal carcinoma is more common in older age group the incidence are also increasing among young especially among women. KEY WORDS Colonoscopy, colorectal carcinoma
Publication
Correlations Between Symptoms, Nasal Endoscopy Computed Tomography and Surgical Findings in Patients with Chronic Rhinosinusitis
(Kathmandu University, 2013) Pokharel, M; Karki, S; Shrestha, BL; Shrestha, I; Amatya, RCM
ABSTRACT Background Although Chronic rhinosinusitis (CRS) is increasing in prevalence and incidence, its diagnosis and treatment still pose a challenge. The Task Force on rhinosinusitis (TFR) advocates the use of symptom based criteria. However, many otorhinolaryngologists depend on diagnostic nasal endoscopy and computed tomography(CT) of paranasal sinuses for diagnosis of CRS. Computed tomography has been extensively relied upon in confirming the presence of CRS, in assessing severity of disease, surgical planning and management decisions. Despite its widespread use, several studies have failed to correlate findings on CT with symptom severity. Objective To determine the correlations between symptoms described at presentation, radiological findings, endoscopy and extensiveness of surgery. Methods Longitudinal, prospective, analytical study conducted from August 2011 to August 2012 among 87 patients diagnosed as CRS according to the TFR criteria. Symptom, endoscopic, radiological and surgical scoring was done by using Lund and Mackay staging system. Pearson correlation coefficients between scores for symptoms, endoscopy, sinus CT and surgery was determined. Results When overall symptom score was correlated with radiological score and endoscopy score, it was found to be statistically significant (p= <0.01). However, no significant relationship was found between Lund and Mackay symptom and surgery score. Conclusion The symptom criteria used by TFR for CRS diagnosis are not very specific for sinus disease. A detail assessment of the subjective and objective criteria (CT and endoscopy) is necessary for tailoring surgical plan but should not be relied upon for determining the extensiveness of surgical intervention. KEY WORDS Chronic rhinosinusitis, lund and mackay staging system, task force on rhinosinusitis
Publication
Medical Abortion Versus Manual Vacuum Aspiration in a Hilly District Hospital of Eastern Nepal: A Comparative Study
(Kathmandu University, 2013) Panta, OB; Bhattarai, D; Parajuli, N
ABSTRACT Backgroud Nepal government has approved medical abortion and manual vacuum aspiration for early first trimester pregnancy. Both the procedures have been approved by World Health Organization for use in early first trimester. Objectives The study aims to compare efficacy and safety of medical abortion with surgical abortion in a district hospital of rural eastern Nepal. Method An observational study conducted in district hospital, dhankuta from July 2010 to January 2011. Clients for abortion services were counseled about methods of abortion and were allowed to make decision on their own and classified as medical abortion group (N=48) (receiving 200milligram Mifepristone followed by 800 microgram misoprostol sublingually or vaginally on day two)and manual vacuum aspiration group (N=36). The two groups were compared for rate of complete abortion and other complications and contraception use after procedure. Results Rate of complete abortion was similar in both groups, 95.8% among medical abortion and 97.2% in manual vacuum aspiration. Moderate to severe expulsion bleeding was reported in 91.6% of cases after Medical Abortion but none required medical attention for hemorrhage. Condom was the most preferred contraceptive in medical abortion group and depo provera in manual vacuum aspiration group. Conclusion Medical method of abortion using mifepristone and misoprostol is equally safe and effective as manual vacuum aspiration in rural setting district hospitals of Nepal. KEY WORD Contraception, manual vacuum aspiration, medical abortion

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