Journal Issue: Volume: 11, No 3, Issue 43, JULY- SEPT, 2013
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Volume
Number
Issue Date
2013
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Community Based Medical Education – Necessity Realization and Practice
(Kathmandu University, 2013) Koju, R
NA
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
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
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
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