Kathmandu University Medical Journal

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Comparison of Pap test among high and non-high risk female.
(2003-01-13) Vaidya, A
A prospective study of pap smear in 100 high risk and equal number of non high risk female among total 1022 female Gynecological patients within a period of two and half months {Beginning of Sept. to middle of Nov. 1995} in Maternity Hospital, Thapathali is presented. There were 9 cases positive for dyskaryosis among high risk and 3 cases among the comparison group. All positive cases were at the age of 35 years and above. In 9 positive cases, 5 cases were in CIN I (55.55%) while 4 were in CIN II (44.44%). Similarly out of 3 positive cases in comparison group 1 was in CIN I category (33.33%) and 2 cases were in CIN II (66.66%). Relation of positive cases with low social class revealed 80% CIN I and 50% CIN II among high risk group where as 66.6% CIN II in comparison group. Analysis of risk factor in development of various grades Dyskaryosis revealed 60% of CIN I had high parity while 50% had CIN II. There are about 40% of CIN I and 75% CIN II among child birth less than 19yrs, 60% smoker had CIN I where as 100%. Smoker had CIN II. 80% of CIN I gave history of excessive vaginal discharge where as 50% of CIN II had excessive vaginal discharge. 40% of CIN I was having injection Depo provera. Cases were also analyzed according to risk factor. Out of 9 positive cases among high-risk females 5 positive had parity more than 4 and 4 cases had less than 4. 5 positive cases were among less than 19 years of first childbirth, 4 among more than 19 years. 7 positive cases were smoker and 2 positive cases were non-smoker. 6 positive cases gave history of abnormal vaginal discharge and 3 positive cases had no abnormal vaginal discharge. Out of 9 positive cases 2 had history of injection Depo provera continuously for more than 5 years where as 7 were non users.
Neurocycticercosis--a review.
(2003-01-13) Ansari, J A; Karki, P; Dwivedi, S; Ghotekar, L H; Rauniyar, R K; Rijal, S
A case report of Wilson's disease.
(2003-01-13) Manandhar, Kusum; Manandhar, D S
Wilson's disease (hepatolenticuler degeneration), an inborn error of copper metabolism, is an autosomal recessive disorder characterized by degenerative changes in brain, liver disease and Kayser Fleisher (KF) rings in the cornea. It is due to a defect of p-type ATPase which is probably required for normal extrusion of copper from cells. In this case report, we present a seven and half year old male who presented with complaints of slurring of speech, drooling of saliva, intentional tremor and dark pigmentation over face and trunk for last 9 months. On examination KF ring was present, spleen was palpable and intentional tremor was present. Laboratory investigations confirmed the diagnosis.
Incidence of ophthalmoscopic fundus changes in hypertensive patients.
(2003-01-13) Karki, K J
A prospective, hospital based, clinical study was conducted in hypertensive patients referred to the eye OPD, KMCTH, Sinamangal during a period of three months to find out the incidence of fundus changes. A total of 302 hypertensive patients were included in the study and their fundus changes were evaluated by direct ophthalmoscopy. The age of the patients ranged from 30-70 years and the duration of hypertension from 1-25 years. The blood pressure was not controlled in 218 patients (72.18%). More female patients (56.22%) were hypertensive than male (43.78%). But the fundus changes were less in female patients. Caste-wise hypertension was more common in Brahmins (38.41%) and fundus changes were also comparatively more. The fundus changes were found in 192 patients (63.57%) and the most common findings were hypertensive retinopathy. GrI + GrII combined together (52.31%). The other common fundus finding was BRVO in 11 patients (3.64%). A routine ophthalmoscopic fundus examination to detect the retinal changes in hypertensive patients is recommended.
Role of Nepal medical council in MBBS curriculum.
(2003-01-13) Dixit, Hemang
The development of the Bachelor of Medicine and Bachelor of Surgery (MBBS) course in Nepal is recounted. From the stage of having a single medical college to the stage of having ten is documented. The role that the Nepal Medical Council (NMC) has played in the development of medical education in Nepal has been adequately described. Comparison of the MBBS course that the three universities are running the MBBS is done and suggestions are made for possible future directions.
Quo Vadis--post graduate medical education in Nepal?
(2003-01-13) Karki, D B
A typical case of pellagra.
(2003-01-13) Dhakak, M; Limbu, B; Neopane, A; Karki, D B
Study of pterion in skulls of Awadh area--in and around Lucknow.
(2003-01-13) Saxena, R C; Bilodi, A K S; Mane, S S; Kumar, A
Two hundred and three skulls of known sex (100 male and 103 female) were studied to find out the variations of Pterion. Sphenoparietal variety of Pterion was seen predominantly along with frontotemporal and stellate varieties.
Muscle relaxant in 21st century.
(2003-01-13) Shrestha, B M
A profile of menstrual disorders in a private set up.
(2003-01-13) Padhye, S; Karki, C; Padhye, S B
Menstruation and its disorders are still considered unholy and impure and are not yet recognised as significant reproductive health morbidity. Therefore a prospective study was carried out at a private clinic for a period of three months where total number of patients coming with current or past menstrual problems are 525. This number did not include pregnant women or those on any hormonal medications or having dysfunctional uterine bleeding. This study aimed to find out the incidence of Menstrual Morbidity and their mode of presentation. It has also tried to find out these women's age, parity, age of menarche and number, following discriminating traditional rituals during their 1st and regular menses, their family planning status and the districts from where they came to Kathmandu for their treatment. In this study, menstrual morbidity was found to be 43.75%. Approximately 60% of women having menstrual complaints had absolutely normal menstrual cycle; whereas 13% of them had irregular, 17% of them had prolonged and 6% had short menstrual cycle. A significant number (46%) of women although suffering from menstrual problems presented with other symptoms like vaginal discharge, pain lower abdomen, subfertility, urinary problems, abdominal lumps and for cuT check-ups. 3% of the women who presented with vague, non-specific complaints asking for a general check up had one or the other menstrual problem. Although approximately 69% of these women were from the age group of 20-39 years, 4% of them were adolescents and 27% above 40 years. It was observed that although approximately 78% of these women were primi- and multiparous ladies, 22% were unmarried and nulliparous suffering from various menstrual morbidities. More than 55% of these women had their menarche at the age of 12-14 years. It was not surprising to note that more than 90% of women had to follow the traditional unhealthy and unsociable rituals during their first menstruation. More than 75% of them had to follow the discriminating traditional rituals which consider a menstruating woman untouchable for 5 days of every month throughout their active reproductive lives. 20% of these women were using non-hormonal contraceptive methods, out of which more than 50% had undergone permanent sterilisation. It was a matter of pride to note that this clinic was providing the health care services to the adolescents and women of 13 zones and more than 52 districts of the country.
Epilepsy in children: an epidemiological study at Kathmandu Medical College Teaching Hospital Kathmandu.
(2003-01-13) Shakya, K N; Shrestha, R; Baral, M R
OBJECTIVES: To analyze the relative frequencies of various epileptic seizures and to study the age at onset of different seizure types in Nepalese children. DESIGN: Prospective study. SETTING: Hospital outpatient based in Kathmandu, Nepal, between November 2001 to October 2002. PARTICIPANTS: 50 children diagnosed as epilepsy excluding neonatal and febrile seizures. Main outcome measure: Diagnosis and classification of cases according to the International Classification of Epilepsy of the International League Against Epilepsy [ILAE] and number of patients in each category with various ages at first seizure. RESULT: Generalized seizures (78%) were 3.54 times commoner than partial seizures (22%). Most frequent seizure types were generalized tonic clonic (36%), tonic (16%), complex partial (14%), atonic (12%) and absence (10%). Generalized clonic, simple partial and partial with secondary generalization, each had less than 5% frequencies. In 40% cases the first seizure occurred when aged between 2-5 years. In partial seizures the peak age at onset was observed below 6 years while primary generalized seizure was more frequently seen in age group 2-10 years. CONCLUSION: More paediatric patients with primary generalized seizures (78%) were observed than with partial seizures (22%). In this age group, the most frequent seizure type was generalized tonic clonic (36%) with the peak frequency of age at onset of seizures in 2-5 years.
Atopic eczema.
(2003-01-13) Pokhrel, G
Inter pleural catheter technique for perioperative pain management.
(2003-01-13) Shrestha, B R; Tabadar, S; Maharjan, S; Amatya, S R
Management of pain in surgical patient is very crucial. It is more so in thoracic and upper abdominal surgery. Lots of technique and drugs have been used to control postoperative pain including thoracic epidural analgesia. We describe a case in whom Intraoperative and Postoperative pain was managed by injecting 0.5% bupivacaine 20 ml in the interpleural space through the catheter, followed by continuous infusion of 0.1% bupivacaine 10 ml/ hour for 24 hours. The whole perioperative and postoperative period was uneventful. The first series of patients in whom this technique was used was described by Murphy in 1983, (1) who used it in patients with multiple fractured ribs and in postoperative patients after gallbladder and kidney surgery. One year later, Reiestad and Kvalheim published their results of continuous intercostal nerve block for postoperative pain relief and presented their modification of the technique, which is now termed interpleural analgesia.
Malignant teratoid medulloepithelioma in eye.
(2003-01-13) Pradhan, S B; Adhikari, R C; Shrestha, B; Sayami, G; Dali, S; Shrestha, H G
Malignant teratoid medulloepithelioma is an extremely rare tumor occurring in children younger than 5 years of age, arising from ciliary body epithelium or iris but few arise from optic nerve and retina. This report concerns a 5 years old boy who presented with pain, redness and protrusion of right eye. Histopathologically, the tumor was composed of epithelial and sarcomatoid component. The pseudostratified primitive appearing epithelial cells were arranged mainly in diffuse pattern, nests cords and tubules. At places, pseudo rosette and true rosette were seen. Mitoses were frequent consisting of 7-10/ HPF. The sarcomatoid component consisting of spindle shaped cells arranged in interlacing bundle were also seen. Mitoses counted 5-7/HPF. Massive areas of necrosis and hemorrhage along with calcification, focal area of mature cartilage were present. Vascular and optic nerve invasions were seen. This case of malignant teratoid medulloepithelioma is the second case diagnosed in TU Teaching Hospital within the period of 10 years and reported because of its rarity. The differentiations from other tumors of the orbit such as small cell tumor were discussed.
An incidence of a complete separation of the lower lobe of right lung from the rest of upper part, as observed in a cadaver in the anatomy dissection hall.
(2003-01-13) Gogoe, P
Road traffic accident (RTA) as major killer: a report on medico-legal autopsies in Bharatpur hospital.
(2003-01-13) Prasad, B K; Prasad, C
Road traffic accidents are the major cause of medico-legal deaths. In present study out of 229 autopsy cases in one year, 110 deaths were due to road traffic accident (R.T.A.) which shows the magnitude of the problem in Chitwan and adjacent districts in Nepal.
Study of patients presenting with symptoms of peripheral neuropathy and thickened greater auricular nerve.
(2003-01-13) Neopane, A; Upadhyaya, B; Dungana, S; Karki, D B
OBJECTIVE: To analyze symptoms and make a clinical diagnosis of leprosy in patients presenting with symptoms of peripheral neuropathy and found to have thickened greater auricular nerve. DESIGN: Cross-sectional study. SETTING: Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu. Patients attending the medical out-patient department of this hospital were taken in the study. MATERIALS AND METHODS: 40 patients presenting with symptoms of peripheral neuropathy and are found to have thickened greater auricular nerve were included. RESULTS: Thickened greater auricular nerve and sensory symptoms showed male predominance (97.5%). Mean age of involvement was 28.65 years. The symptom most frequently complained of was chest pain (75%), followed by pins and needle sensation 67.5%, burning of the upper extremities, nape of the neck and chest 57.5%, palpitation 45%, disturbed sleep mostly said to be due to burning 35%, sweating 20%, dizziness 17.5%, shortness of breath 7.5%, and numbness of the limbs in 2.5%. None of the patients had somatic neuropathy. Autonomic neuropathy was present in 42.5 %. CONCLUSIONS: 1. In endemic areas patients with thickened peripheral nerve and sensory symptoms should be diagnosed clinically as primary neuritic leprosy. 2. In absence of objective loss of somatic sensation autonomic neuropathy may be the only early indicator of neuritis. 3. Close follow up of these patients is necessary.
Three in one block for unilateral knee arthrotomy in an old lady.
(2003-04-03) Tabadar, S; Shrestha, B R; Maharjan, S K
An old lady having septic arthritis of right knee joint underwent arthrotomy under three in one block for femoral, obturator and lateral cutaneous nerve of thigh in inguinal region, with catheter in situ. She was a case of chronic obstructive airway disease with ischaemic heart disease, so operation and postoperative pain management was planned under regional block. Anaesthesia was started by giving regional block with 0.25% bupivacaine at first and maintained with intermittent injection of 0.125% bupivacaine. The patient was pain free and comfortable though out the perioperative period.
A comparative study between nifedipine and isoxsuprine in the suppression of preterm labour.
(2003-04-03) Raymajhi, R; Pratap, K
Preterm labour and delivery remains a major cause of perinatal morbidity and mortality. Numerous drugs and interventions have been used to prevent and inhibit preterm labour but none have been found to be completely effective with the choice being further limited by troublesome side effects. This study compares in a prospective and randomised design the efficacy and safety of the calcium antagonist Nifedipine with the beta mimetic Isoxsuprine. 81.25% of patients receiving Nifedipine and 70% of those receiving Isoxsuprine achieved successful tocolysis. The mean prolongation of pregnancy with Nifedipine was 25+/-19.85 days and with Isoxsuprine it was 19.18+/-17.82 days. Maternal side effects were similar in both groups with hypotension and tachycardia being the commonest. Discontinuation rates were also similar with pulmonary oedema and severe hypotension being the reasons for foregoing tocolysis. It can be concluded that Nifedipine is a safe and effective alternative to Isoxsuprine for suppressing preterm labour.
Seroprevalence of antibodies to hepatitis C virus among injecting drug users from Kathmandu.
(2003-04-03) Shrestha, I L
OBJECTIVE: To determine the seroprevalence of antibodies to hepatitis C virus among injecting drug users (IDU) from Kathmandu. DESIGN: Retrospective cohort study from January 1997 to December 2002. SETTING: Pathology Lab, Siddhi Polyclinic, Dillibazaar, Kathmandu. MATERIALS AND METHODS: Blood samples were collected from 400 injecting drug users and 400 healthy young adults. Serum samples were examined in duplicate along with negative and positive controls for the presence of antibodies to hepatitis C virus using third-generation enzyme-linked immunoassay (EIA 3.0) kit in fully automated, USA FDA approved, Bio-Rad EIA analyzer. Samples positive for anti HCV were re-examined for confirmation. RESULTS: 342 out of 400 (85.5%) serum samples from IDU were found to be positive for anti HCV compared to 3 out of 400 (0.75%) serum samples from young adults without the history of IDU. CONCLUSIONS: 1. Injecting drug use is an important risk factor in the spread of hepatitis C virus. 2. Sharing of needles should be stopped. 3. Education and health counselling should be given to the people at risk to bring about behavioural change.

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