Journal of Nepal Medical Association 2018-09-22T18:51:01+00:00 Dr. Angel Magar Open Journal Systems <p><strong>About JNMA<br></strong>Journal of Nepal Medical Association (JNMA) is an internationally peer-reviewed, MedLine/PubMed indexed,&nbsp;a general medical journal of Nepal Medical Association. JNMA is the first and oldest medical journal from Nepal since 1963 AD. JNMA is available at <a href="">PubMed</a>, <a href=";query&quot;%3A%7B&quot;filtered&quot;%3A%7B&quot;filter&quot;%3A%7B&quot;bool&quot;%3A%7B&quot;must&quot;%3A%5B%7B&quot;term&quot;%3A%7B&quot;index.issn.exact&quot;%3A&quot;1815-672X&quot;%7D%7D%2C%7B&quot;term&quot;%3A%7B&quot;_type&quot;%3A&quot;article&quot;%7D%7D%5D%7D%7D%2C&quot;query&quot;%3A%7B&quot;match_all&quot;%3A%7B%7D%7D%7D%7D%2C&quot;from&quot;%3A0%2C&quot;size&quot;%3A100%7D">DOAJ</a>, <a href=";btnG=&amp;hl=en&amp;as_sdt=0%2C5">Google Scholar,</a>&nbsp;Index Copernicus, EBSCO, EMBASE and other repositories.&nbsp;<br>JNMA abide by:<br>1. 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Committee on Publication Ethics for practising good publication ethics<br>You can also view our author guideline (printed version) from&nbsp;<a href="">HERE</a>&nbsp;[You need to have Acrobat Reader installed on your computer]<br>*Please go through&nbsp;<a href="" rel="noopener">Author Guideline Video</a>&nbsp;| <a href="" rel="noopener">Manuscript Preparation Video</a>&nbsp;for Nepalese Authors.&nbsp;</p> <p>JNMA is included and associated with</p> <p><a href=""><img src="" alt="Member of OASPA" height="75"></a>&nbsp;,<img src="" alt="Search JNMA article in DOAJ">&nbsp;,&nbsp;&nbsp;<a href=";as_epq=&amp;as_oq=&amp;as_eq=&amp;as_occt=any&amp;as_sauthors=&amp;as_publication=jnma&amp;as_ylo=&amp;as_yhi=&amp;hl=en&amp;as_sdt=0%2C5"><img src="" alt="Search JNMA article in Google Scholar" height="75"></a>,<img src="" alt="Member of OASPA" width="121" height="75">,<img src="" alt="" height="75">,</p> <h1><a href=";Full=journal%20of%20nepal%20medical%20association" target="_blank" rel="noopener">Science Citation Index</a></h1> Perceptions of Medical Students About Bedside Teaching in a Medical School 2018-09-22T18:51:01+00:00 Ajaya kumar Dhakal Devendra Shrestha Suraj Bajracharya Amita Pradhan Balman Singh Karki Sanjaya Dhakal <p><strong>Introduction:</strong> Bedside teaching is an important and established learning tool in medical education. However there is a decline in bedside teachings over the years throughout the world including Nepal, due to advancement in medical technology, clinical skills labs and simulation techniques. This study aimed to find out the perception of Nepalese medical students towards different domains of bedside teaching.</p> <p><strong>Methods:</strong> This was a descriptive cross-sectional study. A questionnaire consisting of Likert scale, open ended and closed ended questions was developed on different aspect of bedside teaching and the filled questionnaires were included for analysis.</p> <p><strong>Results</strong>: Three hundred and six questionnaires were included. Almost all of medical students responded that bedside teaching is a useful learning modality in clinical teaching 304 (99.3%) and provides active learning in real context 291 (95%). The majority of medical students 233 (76%) were satisfied with the steps of history taking, examination followed by management discussion employed at bedside teaching. The students 223 (73%) were satisfied, how to elicit signs following demonstration of clinical exam by teachers at bedside. However majority 196 (64%) felt lack of individual opportunity at bedside. According to students, focussing more on practically oriented clinical skills with proper supervision would improve learning while hindering factors were large number of students and patient’s uncooperativeness. Good communication was considered the best method of alleviating patient discomfort at bedside teaching in this study.</p> <p><strong>Conclusions:</strong> The study concluded that medical students have positive response and learning attitudes towards different aspects of bedside teaching.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Lifetime Experience of Violence in Early Adulthood Female 2018-09-22T18:50:53+00:00 Kalpana Silwal Prativa Dhakal Krishna Bahadur Raut Rajendra Kumar Chaudhary <p><strong>Introduction:</strong> Despite political commitment and a supportive legal and policy framework, violence against women remains a significant problem in Nepal. Nepal Demographic and Health Survey reported more than one in five women experience violence in lifetime. Three fourth of women who had experienced physical or sexual violence had not sought any help.&nbsp;</p> <p><strong>Methods:</strong> Descriptive cross-sectional study was carried out in an Institute in Lalitpur. Accessibility sampling was used to find out the experience of violence from their childhood to this date. The data were collected by self-administered questionnaire was distributed to the female students. Data were analyzed using SPSS. Frequency, mean, percentage and standard deviation were calculated.</p> <p><strong>Results:</strong> More than three fourth 71 (79.8%) of the female students were victim of violence and among them most 67 (75.3%) were at age of 11 to 19 years. Majority 63 (70.8%) were victimized from strangers followed by friends 11 (12.4%). Teasing 55 (61.8%) and unwanted touching 35 (39.3%) were the most common type of violence. Most 51 (57.3%) were the victim while traveling by public vehicle and walking on road 47 (52.8%). More than half (57.7%) were suffered &lt;5 times. One third 34 (38.2%) told strict punishment to the offenders followed by awareness program 32 (36%) for the prevention of violence.</p> <p><strong>Conclusions:</strong> Majority of the female students were victim of violence and offenders were young adult. Awareness program, strict rules and punishment to offenders should be implemented to prevent the violence among girls.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Innovative Method of Using Endoscope in Postoperative Canal Wall Down Mastoid Cavity 2018-09-22T18:50:55+00:00 Meera Bista Nayan Bahadur Mahato Deepak Regmi <p><strong>Introduction:</strong> Poor access to the difficult areas in the middle ear and mastoid cavity is considered as the major reason for failure in mastoid surgery. Wide field visibility, visualization of nooks and corners by an endoscope could contribute to better clinical control of the disease in these patients that cannot be accessed by the operating microscope.&nbsp;</p> <p><strong>Methods:</strong> This was a descriptive cross-sectional study, done in Kathmandu Medical College from January to June 2017. Thirty two patients were included in the study. Data collection was done by convenient sampling. Statistical analysis was done by Chi square test and Fisher Exact test, P value of &lt;0.005 was considered statistically significant.</p> <p><strong>Results:</strong> The study revealed that exposure benefit with an endoscope in canal wall down mastoid surgery was significantly better than with a microscope (P value of 0.034). The level of complete clearance and level of difficulty in cleaning with the help of a microscope compared to endoscope did not show a significant difference with P value of 0.288 and 0.652 obtained by Fisher extract test respectively. After microscopic removal of materials from the mastoid cavity, 22 (68.8%) which is more than half of cases had remaining materials in the cavity which was removed by endoscope completely.</p> <p><strong>Conclusions:</strong> Outcome will make the ENT surgeons aware of use of endoscopy in post mastoid follow up cases to give better results and make the surgeon much more successful in his/her endeavor to eradicate the disease.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Cervical Cancer Awareness and Practice of Pap Smear Test Among Women with Gynecological Problems 2018-09-22T18:50:54+00:00 Meena Thapa <p><strong>Introduction</strong><strong>:</strong> Cervical cancer is the most common cancer in women in Nepal. Pap smear test is the most important screening test for cervical cancer, which helps in reducing mortality from it. This study is to assess the knowledge of cancer cervix and practice of Pap smear test and to analyze the impact of educational status on them.</p> <p><strong>Methods</strong><strong>:</strong> This was a descriptive cross-sectional study, carried out among the married women who attended the Out Patient Department for gynecological problems at Kathmandu Medical College. Structured questionnaires were used to collect the data.&nbsp; The questionnaire consisted of three sections which included the demographic profile in first part , second part included assessment of the knowledge of cancer cervix, and third part included evaluation of&nbsp; the utilization of Pap smear test.</p> <p><strong>Results</strong><strong>:</strong> A total of 205 married women were included in the study. Out of them, 74% were aware of cancer cervix. Only 39% of women were aware of Pap smear test. Pap smear test coverage was 16.6% in studied population. Main reason of not doing Pap smear test was lack of knowledge of the test. High educational status of the women had significant positive impact on knowledge of cancer cervix and practice of Pap smear test.</p> <p><strong>Conclusions:</strong> The knowledge of cancer cervix was good in our women, but knowledge and the practice of Pap smear test was poor. Good educational status of the women was found to influence the on knowledge of cancer cervix and uptake of Pap smear test.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Acoustic Analysis of Voice in School Teachers 2018-09-22T18:50:56+00:00 Nain Bahadur Mahato Meera Bista Deepak Regmi Pema Sherpa <p><strong>Introduction:</strong> The term ‘voice' is the acoustic energy generated from the vocal tract that are characterized by their dependence on vocal fold vibratory pattern. Teachers as professional voice users are afflicted with dysphonia and are discouraged with their jobs and seek alternative employment. Loud speaking and voice straining may lead to vocal fatigue and vocal fold tissue damage.&nbsp;</p> <p><strong>Methods:</strong> Sixty teachers from various schools, volunteered to participate in this study. Acoustic analysis Doctor Speech Tiger Electronics, USA was used to assess the voice quality of the school teachers before and after teaching practice. The data were collected and analyzed using Doctor Speech Tiger Electronics, USA. Analysis was performed in terms of perturbation (jitter and shimmer), fundamental frequency, harmonic to noise ratio and maximum phonation time.</p> <p><strong>Results:</strong> We found statistically significant difference in all the four parameters except the Jitter value. The fundamental frequency and shimmer value has significantly increased (P&lt;0.001) and (P=0.002) respectively after teaching practice. Unlikely, there was significant decrease in harmonic to noise ratio value (P&lt;0.001) and maximum phonation time value (P&lt;0.01) after teaching practice.</p> <p><strong>Conclusions:</strong> Vocal abuse, overuse, or misuse in teaching practice over a long period of time can result in inadequate phonatory pattern due to vocal fold tissue damage, which ultimately results in vocal nodules or polyps. So voice evaluation is particularly important for professional voice users and for the people who are concerned about their quality of voice.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Pleural fluid serum bilirubin ratio for differentiating exudative and transudative effusions 2018-09-22T18:51:00+00:00 Pawan Agrawal Tirtha Man Shrestha Pratap Narayan Prasad Ramesh Prasad Aacharya Priyanka Gupta <p><strong>Background:</strong> &nbsp;In pleural effusion, differentiating exudative and transudative fluid is an important clinical evaluation. The objective of the study was to determine the efficacy of pleural fluid serum bilirubin ratio in differentiating exudative and transudative effusions. In resource-limited settings with no facilities to measure lactate dehydrogenase (LDH) levels, using pleural fluid bilirubin ratio may help in better clinical decision.</p> <p><strong>Methods:</strong> &nbsp;It was a prospective observational study, conducted in the emergency department of Tribhuvan University Teaching Hospital. All the patients attending for emergency care with pleural effusion from 6th Jan 2015 to 5th Jan 2016 were included. The cases were divided as exudates and transudates on basis of final diagnosis. Serum and pleural fluid specimen were collected and sent for investigations. The data for various laboratory parameters especially those of lights criteria and bilirubin ratio were then analyzed and fluid nature was compared with results from parameters and final diagnoses.</p> <p><strong>Results:</strong> &nbsp;Among 103 cases, 71.84% had exudate and 28.16% had transudate. The commonest cause of effusion was pneumonia 35.92%, second being tubercular 23.30% followed by malignant effusion 12.60%, congestive heart failure 11.65%, chronic kidney disease 10.67% and liver cirrhosis 5.82%. The mean bilirubin ratio for exudates exceeded that for transudates. Considering the cutoff point of 0.6, the sensitivity, specificity, positive predictive value and negative predictive value were respectively 88.00%, 93.00%, 97.00% &amp; 75.00%.</p> <p><strong>Conclusions:</strong> &nbsp; Pleural fluid serum bilirubin ratio can be utilized as a diagnostic tool for differentiating exudative and transudative effusions.</p> <p><strong>Keywords:</strong> &nbsp; bilirubin ratio; exudates; light’s criteria; pleural effusion; transudates.</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Knowledge of Alzheimer’s Disease Among Medical Students of a Medical College 2018-09-22T18:50:57+00:00 Rachana Sharma Subhash Chandra Sharma Sudarshan N Pardhan Pratikshya Chalise Luna Paudel <p><strong>Introduction:</strong>Dementia is a public health concern as the prevalence is increasing worldwide with significant increase being in low-middle income countries. However these countries appear to be less prepared in handling this rise in terms of diagnosis and management.</p> <p><strong>Methods: </strong>This cross-sectional study was conducted in Kathmandu medical College, from June 2017 to July 2017. Purposive sampling was done and the medical students who were in their first and final year of study were included in the study after obtaining an informed consent.</p> <p><strong>Results: </strong>Total 185 students were included in the study, 80 (43.24%) from first year and 105 (56.75%) from final year of medical study. The mean score of knowledge among the students was 17.44± 2.46; 15.32± 1.22 among first year and 19.06± 1.87 among the final year students. Majority of the students said they have heard about dementia however, only 3 (3.75%) of first year and 43 (41.9%) from final year students have either attended a class or CME on dementia</p> <p><strong>Conclusion:</strong>The knowledge about dementia was found to be average among medical students but better among final year medical students in comparison to first year. The knowledge was found to be better statistically among those who had either attended a class or CME on dementia or had exposure through different medias.</p> <p><strong>Keywords:</strong><em>alzheimer`s disease; dementia; knowledge; medical students.</em></p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Autonomic Influence on Heart Rate for Deep Breathing and Valsalva Maneuver in Healthy Subjects 2018-09-22T18:50:57+00:00 Reena Kumari Jha Amrita Acharya Ojashwi Nepal <p><strong>Introduction:</strong> The Autonomic nervous system is responsible for regulation and integration of visceral functions. Disturbance of autonomic nervous system play crucial role in pathogenesis and clinical course of many diseases. In the present study deep breathing test and valsalva maneuver have been described to monitor parasympathetic function genderwise.</p> <p><strong>Methods:</strong> A cross-sectional study was conducted among 100 subjects, aged 18-25 years, from May to November 2017, in exercise physiology laboratory, Kathmandu University School of Medical Sciences, Chaukot, Kavre. Electrocardiograph recorded by AD instrument was used to calculate the resting heart rate and the heart rate response to deep breathing test and valsalva maneuver.</p> <p><strong>Results:</strong> Heart rate response to deep breathing test (31.69±14.79 Vs. 36.08±18.65, P=0.195) and valsalva ratio (1.59±0.39 Vs. 1.69±0.54, P=0.314) tend to be higher in female than male subjects but not significant. The resting heart rate of females was significantly higher than that of males (84.37 ± 11.08 Vs. 78.43 ± 12.06, P&lt;0.05). Heart rate was significantly increased during and decreased after valsalva maneuver in both male and female subjects.</p> <p><strong>Conclusions:</strong> This study concludes that both deep breathing test and valsalva maneuver activates parasympathetic system inhealthy subjects. And also dominant parasympathetic activity was found in female comparison to male subjects.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Predisposing Factors and Outcome of Malpresentations in an Institute 2018-09-22T18:50:54+00:00 Smrity Maskey Yam Dwa <p><strong>Introduction:</strong> This study was done to find out the incidence of malpresentation among all deliveries with various types of Malpresentations, its mode of delivery , maternal and fetal predisposing factors with outcome.</p> <p><strong>Methods:</strong> This was a cross sectional descriptive study done at KIST Medical College and Teaching Hospital. Review cases of women admitted in labor after 22 weeks with malpresentation was done. Maternal/fetal predisposing factors were recorded.</p> <p><strong>Results:</strong> Total delivery in study period was 4009 where 101 (2.5%) were of malpresentation. Breech was the commonest malpresentation 83 (82.1%). Assisted vaginal delivery occurred in 16 (15.8%) and 953 (84.2%) caesarian section. Malpresentations was common in primigravida 62 (61.3%). Half (47.2%) cases had one/more predisposing factors, commonest being oligohydramnious 7 (6.9%). Out of 108 babies with malpresentation, 10 had perinatal deaths and 10 had NICU admissions. Congenital anomaly was found in 4 babies.</p> <p><strong>Conclusions:</strong> The most common type of malpresentation was breech common in primigravida with oligohydramnios as contributing factor.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Teenage Pregnancies in Nepal – The Problem Status and Socio-Legal Concerns 2018-09-22T18:50:59+00:00 Samata Nepal Alok Atreya Tanuj Kanchan <p><strong>Introduction:</strong> Teenage pregnancy is an issue that needs to be addressed for a better health of the women and the society. The present analysis is undertaken to find out the incidence of teenage mothers who have had hospital delivery and focuses upon the various reasons for teenage pregnancy with a brief discussion upon the associated medicolegal and social aspects.</p> <p><strong>Methods:</strong> A cross sectional study was carried out in a tertiary hospital in western region of Nepal. The delivery case register were reviewed for teenage pregnancies and the relevant data was captured in a data sheet and analysed.</p> <p><strong>Results:</strong> During the study period, a total of sixty-nine teenage pregnancies culminated into delivery/ childbirth. The mean age of teenage mother was 18.16±0.99 years. Majority of the teenage mothers had not completed their secondary education and were of low socioeconomic strata. Mode of delivery was caesarean section in thirty four cases, whereas vaginal delivery was conducted in thirty five cases. Live births accounted for 67 deliveries, a still birth case was of anencephalic foetus while the other one was a preterm which was spontaneously delivered at the 23rd weeks of gestation.</p> <p><strong>Conclusions:</strong> Education and awareness in the form of campaign, advertisements, road shows, television or radio programmes are suggested for a decline in the rate of teenage marriages and teenage pregnancies in Nepal in the days to come.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Molecular Confirmation of G1138A Mutation in FGFR gene in Achondroplasia 2018-09-22T18:50:58+00:00 Shyam Bahadur Khanal Mitesh Shrestha Hemanta Kumari Chaudhary Smita Shrestha Rohit Kumar Pokharel <p><strong>Introduction:</strong> Achondroplasia (ACH) is the most common form of skeletal dysplasia of genetic origin in humans which is characterized by disproportionate rhizomelic dwarfism. Heterozygous mutation in the transmembrane domain of the FGFR3 gene (4p16.3) occurs as a de novo mutation in most of the cases.</p> <p>&nbsp;<strong>Methods:</strong> DNA was isolated from seven samples, out of which, five had clinical features of Achondroplasia while one was dwarf but did not show symptoms of the disorder and one as negative control. PCR was performed for the region incorporating the hotspot region viz. 1138<sup>th</sup> nucleotide. PCR amplicon of size 164 bp was obtained from all the samples, and was sequenced.</p> <p><strong>Results:</strong> Sequence analysis showed the presence of mutation (G to A transition) in all of the five samples. The five samples that showed the clinical features of Achondroplasia had mutation in the region being analyzed while the single patient who had no clinical manifestations of the disorder despite being dwarf had no such mutation. Among the five patients studied, one patient had a family history of Achondroplasia as observed through pedigree analysis while the remaining four cases were sporadic in nature.</p> <p>&nbsp;<strong>Conclusions:</strong> This study further supports that the G1138A mutation is the one of the most common point mutation among Achondroplasia cases. Genetic diagnosis can be useful to identify the disease prenatally and differentiate other life threatening dwarfism for the safety of both mother and fetus.</p> <p>&nbsp;<strong>Keywords:</strong> <em>achondroplasia; dwarfism; fibroblast growth factor receptor 3 (FGFR3); point Mutation.</em></p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Estimation of Stature from Percutaneous Hand Length Among the Students of A Medical College 2018-09-22T18:50:56+00:00 Anup Pandey Alok Atreya <p><strong>Introduction:</strong> Anthropometry is commonly used technique for the measurement of bone and soft parts in Anatomy and other fields of science. It has practical implications mainly in the field of anatomy and forensic medicine. The present study is aimed to determine the average hand length with stature among the students of a medical college.</p> <p><strong> Methods:</strong> A cross sectional study was done among 185 students including 98 females and 87 males of Devdaha Medical College and Research Institute. Hand length and stature were measured and collected data was entered and analyzed in SPSS 21. The differences in measurements of hand bone length and stature among males and females were calculated. The regression equation for the estimation of stature from hand length was calculated.</p> <p><strong>Results:</strong> The mean hand length among the total population was 17.80±1.04 cm and stature was 160.50±6.73 cm. The mean hand length and stature were higher among males as compared to females. The range of hand length and stature among the total population is 16.00-21.20 and 146.00-176.50 respectively. The regression equation for the estimation of stature from hand length revealed statistically significant value among the males and females.</p> <p><strong>Conclusions:</strong> Our study reveals higher value of hand length and stature for males as compared to females. Also there is significant correlation between the hand length and the stature. The present values are obtained from the small population of an institute. Further studies have to be carried out to develop the regression formula for the Nepalese population with larger sample size.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Health Problems while Working as a Volunteer or Humanitarian Aid Worker in Post-Earthquake Nepal 2018-09-22T18:50:55+00:00 Durga Bhandari Prativa Pandey <p><strong>Introduction:</strong> Volunteers and humanitarian aid workers working in disaster struck areas of the world are a vulnerable group of travelers. Nepal saw an influx of these humanitarian aid workers following earthquakes in April and May 2015.&nbsp;</p> <p><strong>Methods:</strong> This was a descriptive cross-sectional study conducted at CIWEC Hospital located in Kathmandu. A questionnaire was given to all volunteers and aid workers who arrived at the hospital for evaluation of health related problems and agreed to be part of the study.</p> <p><strong>Results:</strong> Ninety-five volunteers were enrolled in the study. Among these, 65 (68%) were female and 30 (32%) were male. The immunizations received before travel were Hepatitis A 82 (86%), Hepatitis B 82 (86%), Typhoid 70 (73%), Rabies 38 (40%), Japanese Encephalitis 34 (36%), Influenza within last one year 23 (24%), measles 48 (51%), Cholera 34 (36%),Tetanus within 10 years 71 (75%) and Varicella 38 (40%). Forty-four (45%) of travelers carried medication for treatment of Traveler’s Diarrhea (TD) which included Ciprofloxacin, Azithromycin, Loperamide and others like Metronidazole and Charcoal. The common illnesses encountered were gastrointestinal, skin problems , injury and musculoskeletal problems, respiratory problems, genitourinary problems, cardiovascular, psychological problems, syncope, and miscellaneous.</p> <p><strong>Conclusions:</strong> Traveler’s Diarrhea and dermatological problems were the most common health related problems. Volunteers were not properly prepared for self-treatment and pre-travel preparation was sub-optimal. Important pre travel health advice will decrease the incidence of health problems in this group.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Surgical Site Infections due to Non-Tuberculous Mycobacteria 2018-09-22T18:50:53+00:00 Rohit Prasad Yadav Bashudev Baskota Rabin Ratna Ranjitkar Sandesh Dahal <p><strong>Introduction:</strong> Non-tuberculous Mycobacteria are increasingly recognized, nowadays as an important pathogen in delayed surgical site infection in post operative cases. We here in describe cases of surgical site infection caused by Non-tuberculous Mycobacteria, seen in two centers in Jhapa. The aim of the study was to increase awareness of this atypical mycobacterial infection, prompt diagnosis, and treatment that may ultimately provide better care to patients.</p> <p><strong>Methods:</strong> Forty four patients underwent different kinds of operations in two different private hospitals in Jhapa district of Nepal. All patients were presented with painful, draining subcutaneous nodules at the infection sites. Repeated aspiration of abscess, incision and drainage of the wound were done and specimen was sent for microbiological and histopathological examination. All patients were treated with repeated wound debridement and tab. Clarithromycin and inj. Tobramycin for 45days.</p> <p><strong>Results:</strong> Mycobacterium Chelone were isolated from the purulent drainage obtained from wounds by routine microbiological techniques. Of the forty four cases, thirty of them had acid fast bacilli stain positive, two had acid fast bacilli culture positive. All the patients except two cases were treated with injection Tobramycin and Clarithromycin for six weeks.</p> <p><strong>Conclusions:</strong> There should be high level of clinical suspicion for patients presenting with delayed post- operative wound infections for the diagnosis of non-tubercular mycobacreria as causative agents. These infections not only cause physical but also emotional distress that affects both the patients and the surgeon. Emphasis should be given on good sterilization technique to avoid such infections.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Spinal Anesthesia for Laparoscopic Cholecystectomy in Parkinson’s disease 2018-09-22T18:50:59+00:00 Binod Gautam Bikash Baral <p>Parkinson’s disease, a neurodegenerative disorder, presents with resting tremor, muscle rigidity and bradykinesia. Affecting multiple organ-systems, it’s an important cause of peri-operative morbidity. General anaesthesia may deteriorate cardio-pulmonary and neuro-cognitive functions; moreover, medications used may interact with anti-parkinsonian agents. Spinal anaesthesia is usually avoided in Parkinson’s disease. However, it offers neurologic monitoring and less surgical stress response and avoids complications of general anaesthesia. This case report aims to demonstrate application of spinal anaesthesia for laparoscopic cholecystectomy in a Parkinson’s elderly with pulmonary dysfunction and anticipated difficult airway management. Sensory blockade of third thoracic dermatome was achieved. Bupivacaine was instilled intra-peritoneally. Surgery was smooth at low intra-abdominal pressure. Regular Paracetamol provided satisfactory post-operative analgesia. Single episode of post-operative vomiting was effectively managed. Without deterioration, patient was discharged from hospital on third day. Spinal anaesthesia is a valid technique for laparoscopic cholecystectomy in needy patients with multiple peri-operative risks.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Glandular Odontogenic Cystin Maxilla : A Case Series 2018-09-22T18:50:58+00:00 Bidhata Ojha Dipshikha Bajracharya Radha Baral Shubrata Bhattacharyya Saurabh Roy Sumit Singh Bikash Deshar <p>Glandular odontogenic cyst is rare phenomenon with 0.012% to 0.03. 3% frequency of all jaw cysts and worldwide prevalence of 0.17%. Diagnosis of Glandular odontogenic cyst, well known for its aggressive growth potential and high rate of recurrence, is very crucial. This report presents cases of two 50-year old individuals with Glandular odontogenic cyst presenting as a radiolucent lesion of maxilla. Final diagnosis was made on the basis of histopathological features and further confirmed by immunohistochemical analysis.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Conjoined Twins 2018-09-22T18:51:01+00:00 Pramod Kattel <p>Reported here is a case of conjoined twins presented to ante-natal outpatient department of Paropakar Maternity and Women’s Hospital on 21<sup>st</sup> August 2015 on a 20 year “Primigravida at 27 weeks and 6 days of gestation not in labor” referred from a polyclinic following ultrasonography diagnosis for better management. After confirming the diagnosis and counseling the patients regarding mode of delivery and possible outcomes, elective caesarean section was performed and delivered male conjoined twins of Parapagus dicephalus type with poor Apgar score. No resuscitation attempted except oxygen supplementation as per wish of parents and early neonatal deaths occurred at one hour of life.</p> <p><strong>&nbsp;</strong></p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Medication Error: A Case Report of Misadventure with Methotrexate 2018-09-22T18:51:00+00:00 Anup Singh Aru Chhabra Handa <p>Methotrexate is an antimetabolite drug with antineoplastic and immunomodulatory properties, useful as an antineoplastic agent in various haematological and solid tumours. MTX toxicity can occur because of accidental ingestion/overdose by the patient or because of prescription error. The toxic effects manifest as severe mucositis or as organ damage (bone marrow depression, renal/hepatic injury). The toxicity usually results from parenteral overdose or repeated chronic drug ingestion. Acute high dose ingestion does not result in MTX toxicity because of saturable absorption kinetics. We present a case of MTX toxicity occurring as a result of prescription error resulting in repeat daily dosing of the drug, and the challenges associated with the management of the same, in a patient with multiple comorbidities. The present case emphasizes on a note of caution on the part of the prescriber and the suggestions regarding the measures which can be taken to avoid MTX toxicity.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement## Emergency Medicine Education and Research in Nepal: Challenges and Opportunities 2018-09-22T18:50:59+00:00 Anmol Purna Shrestha Roshana Shrestha Sanu Krishna Shrestha Samjhana Basnet Alok Pradhan <p>Emergency medicine (EM) is a young but prestigious medical discipline worldwide.1 However, in Nepal, it is in preliminary phase.2 EM is not only restricted to urban emergency departments but also a multifaceted discipline.3 Several EM training modules are currently practiced fragmented with different curriculum and duration.4,5 Pre-hospital emergency medical services (EMS), hospitals, trauma centres, and public health are working in silos and most of them devoid of proper emergency facility.2 This brought us to the realization of an urgent need of bringing all the stakeholders together in a symposium like this.</p> <p>The symposium was arranged into four different sessions as listed below:</p> <ol> <li>To familiarize with the history and current state of EM from Global Emergency Medicine perspective.</li> <li>To highlight the different clinical experiences and advancements in EM in Nepal.</li> <li>To emphasize the importance and possibilities in EM education and research in Nepal.</li> <li>To discuss the roadmap to develop and establish EM as a recognized medical speciality in Nepal.</li> </ol> <p>The overall objectives of the symposium were to discuss the challenges faced by current Emergency Medicine providers and identify the opportunities for the future development and recognition in Nepal.</p> <p>The most important current task for Nepal’s emergency physicians of advocating for policies, programs, and funding to support further development of the specialty was realized. Rural and urban emergency service providers from academic and non-academic institutions, governmental/non-governmental organizations and international medical institutions attended the symposium. General Practice (GP) residents, medical officers, medical students, interns and paramedics were among active participants.</p> 2018-06-30T00:00:00+00:00 ##submission.copyrightStatement##