Nepal

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A 14-year-old boy with Isolated Tuberculous Orchitis.
(2009-01) Gurubacharya, R L; Gurubacharya, S M
The genitourinary tract is the most common extrapulmonary site affected by tuberculosis1. The male genital organs are involved in more than 50% of patients2. The epididymis is the commonest structure to be involved, followed by the seminal vesicles, prostate, testis, and the vas deferens3. An isolated tuberculous orchitis without epididymal involvement is rare. This case report describes extra pulmonary tuberculosis with exclusively testicular presentation. The confirmatory diagnosis of which was made by FNAC of the testis. It provides a successful diagnosis, thereby preventing unnecessary orchidectomy.
64-slice CT scan in Kathmandu Medical College Teaching Hospital.
(2008-04-05) Karki, D B; Neopane, A; Regmi, S; Acharya, S
64-slice CT scan is a versatile newly introduced imaging technology, which is capable of diagnosing various diseases from head to toe. The 64-slice CT coronary angiography has a negative predictive value of 100%. Virtual images of bronchi, stomach and colon can provide definite diagnosis. Coronary artery calcification score which predicts coronary artery disease can be calculated by 64-slice CT scan.
ABCDEFG IS - the principle of constructive feedback.
(2008-02-16) Bhattarai, M
Feedback is an integral part of any learning experience. Constructive feedback is a powerful instrument and facilitates the learner's professional and personal development. "ABCDEFG IS", a mnemonic for the principles of constructive feedback, stands for Amount of the information, Benefit of the trainees, Change behaviour, Descriptive language, Environment, Focused, Group check, Interpretation check, and Sharing information. The eight important steps of feedback are: Ensure prior information, Collect data, Make appropriate meeting arrangement, Begin by encouraging self assessment by the trainee, Highlight areas where the trainee is doing well, Give feedback, Handle reaction maintaining the dignity and Plan actions. Communication and reflection also share many of the principles and steps of constructive feedback and giving regular feedback, thus, helps to improve communication and reflection. The feedback provider would be able to provide genuine feedback by following the appropriate steps and principles of constructive feedback and realize how important and rewarding its role is in teaching learning activities.
Abdominal tuberculosis--a study of 25 cases.
(2004-04-12) Sharma, Y R; Roy, P K; Hasan, M
Abdominal tuberculosis is one of the common extra pulmonary tubercular infections. Its clinical presentation is protean and it has diagnostic dilemma, as most of the investigations are non-specific and less sensitive. Therefore this study was undertaken to define the most suggestive clinical features of abdominal tuberculosis, to find out the efficacy of most commonly available investigations and also to evaluate the response of abdominal tuberculosis to conventional antitubercular therapy. Twenty five cases of either sex were studied in department of gastroenterology in BSMMU (earlier IPGMR), Dhaka from January 2001 to June 2003. All patients were clinically evaluated and were investigated by available tests. Eighteen patients were diagnosed by investigations (One by detecting AFB, 9 with caseating granuloma in biopsy specimen and 8 with suggestive radiological findings). Diagnosis of 7 patients were made from the common clinical features (fever, weight loss, altered bowel habit, abdominal pain and distension, positive non-specific findings and from response by antitubercular therapy. All patients received conventional 9 month anti-tubercular treatment with Rifampicin, Isoniazide and Pyrazinamide and were followed up clinically during and one year after completion of treatment. All patients were improved with minimum side effects of drug. Therefore, it is observed that a representative tissue biopsy (when approachable) and radiological findings are good method of diagnosis of abdominal tuberculosis. Strongly suggestive clinical features with positive non specific investigation findings are also an indication for anti tubercular treatment in all endemic countries like Nepal, Bangladesh and India. Treatment of abdominal tuberculosis is in no way different from that of other conventional anti-TB therapy.
Abdomino-scrotal hydrocele in 35 years old: a case report.
(2007-04-08) Tiwary, S K; Kumar, S; Agarwal, A; Khanna, R; Khanna, A K
Abdomino-scrotal hydrocele is a condition usually affecting children. It is unusual to find an abdomino-scrotal hydrocele in middle aged adult. Most of the patients are asymptomatic except cystic abdominal mass and discomfort occasionally. We hereby report an unusual presentation of abdomino-scrotal hydrocele at age of 35 years and presenting as large cystic abdominal mass extending into scrotum.
Abnormal course of left testicular artery in relation to an abnormal left renal vein: a case report.
(2007-01-08) Satheesha, N B
The testis is an important organ upon which the survival of the human species depends. Any compression of testicular artery may lead to loss of gametogenesis and hormone production. We found a left testicular artery entrapped between two divisions of a left renal vein in an approximately 50 year old cadaver. The left renal vein was formed by union of two veins coming from the kidney, left suprarenal vein, left testicular vein and an abnormally enlarged lumbar vein. This case may be of particular importance to surgeons who transplant kidneys, radiologists and orthopaedic surgeons dealing with the spine repairs.
Abnormal hepatic function and splenomegaly on the newly diagnosed acute leukemia patients.
(2008-03-15) Sharma Poudel, B; Karki, L
To evaluate the liver function, splenomegaly and related factors in the newly diagnosed acute leukemia patients. One hundred of fifty eight acute leukemia patients admitted in our hospital from March 2003 to April 2006 were studied. The related factors such as peripheral WBC count, bone marrow blasts, peripheral blasts, sex, age, AML, ALL affecting the liver function and splenomegaly were evaluated. Sixty two (39.24%) patients presented with splenomegaly. Twelve (7.59%) patients presented with hepatomegaly. Serum ALT was elevated in 54 (34.17%) patients. Similarly, serum AST, GGT, ALP, and Direct bilirubin were elevated in 26 (16.45%), 32 (20.25%), 20 (12.65%), and 22 (13.92%) patients, respectively. Low serum albumin was found in 40 (25.31%) patients. PT was prolonged in 62 (39.24%) patients. Statistical study shows that there is a relation between high WBC counts and elevated serum ALT (P<0.05) and high WBC counts and splenomegaly (P<0.05). Acute leukemia patients with leukocytosis are more prone to develop abnormal liver function and splenomegaly.
Abnormal spicules on the inferior aspect of anterior arch of atlas vertebra.
(2007-03-06) Das, S; Suri, R; Kapur, V
Anterior arch of the atlas vertebra is known to exhibit various developmental anomalies. Bony outgrowths, osteophytes, clefts and aplasia of the anterior and posterior arches of the atlas have received special attention by research workers. To the best of our knowledge, not many osteological studies have defined the spicules on the anterior arch of the atlas. The present study describes an abnormal atlas vertebra with 2 spicules on the inferior aspect, 2 additional facets inferior to the superior articular facets and a peculiar facet to the left of the posterior tubercle. These abnormal spicules may cause dysphagia or involve atlanto-occipital movements. Such anomalies may be misinterpreted in routine X rays as a degenerative disease. However, asymptomatic cases remain undetected throughout life. Such anomalies may be important in radiological, clinical, forensic and anthropological studies.
Abortion law of Nepal : a new achievement.
(2006-03-24)
Abortion legalized: challenges ahead.
(2007-01-08) Singh, M; Jha, R
OBJECTIVE: To see whether advocacy for abortion law and comprehensive abortion care (CAC) sites after legalization of abortion in Nepal is adequate among educated people (above school leaving certificate). METHOD: 150 participants were assigned randomly who agreed to be in the survey and were given structured questionnaires to find out their perception of abortion and CAC sites. RESULT: Majority know abortion is legalized and majority have positive attitude about legalization of abortion, however majority are not aware of abortion service in CAC sites and none knew the cost of abortion service. CONCLUSION: Proper and adequate advocacy of the new abortion law and CAC service is essential.
Absence of inferior pancreaticoduodenal artery compensated by dorsal pancreatic artery: a case report.
(2006-04-08) Deepthinath, R; Nayak, S; Vollala, V R; Bhat, S; Rao, M; Samuel, V P
Consideration of new aspects of vascular anatomy of the pancreaticoduodenal region is required for further improvement of surgical procedures. Awareness of variations in arteries supplying the duodenum and pancreas can help in minimizing the blood loss during surgery. We report the absence of inferior pancreaticoduodenal artery, which was compensated by a large dorsal pancreatic artery arising from proximal part of the splenic artery. This artery replaced inferior pancreaticoduodenal artery and formed a large loop of anastomosis with the gastroduodenal artery.
Acardiac Acephalus Twin diagnosed at delivery: A case report
(Janaki Medical College, 2016-11) Jha, R
Abnormal placental vascular anastomoses in monochorionic twins can give rise to a rare congenital anomaly known as Acardiac twin. With the advancement of antenatal care and ultrasonography many such cases are diagnosed early. However, in underdeveloped country like Nepal where early antenatal care coverage rate is low such cases may be diagnosed late. I report one such case of Acardiac acepahalus twin diagnosed during delivery.
Accessory muscles of the lower calf.
(2008-04-05) Manjunath, K Y
Two rare cases of accessory muscle of the lower calf observed in dissecting room cadavers are described here. This muscle is supposed to occur in 1% bodies and is implicated in tarsal tunnel syndrome. Occurrence of such anomalous muscles should be considered while examining cases reporting with pain associated with swelling in the region of Achilles tendon since they may mimic a soft tissue tumour.
Accidental out-of-hospital deliveries: factors influencing delay in arrival to maternity hospital.
(2005-04-18) Chaudhary, P
OBJECTIVE: To find out various factors influencing delay in arrival to Shree Panch Ratna Rajya Laxmi Maternity Hospital leading to accidental - out - of hospital delivery. METHODOLOGY: This was a hospital based cross sectional descriptive study conducted at maternity hospital, Kathmandu. Women who delivered on the way to the maternity hospital during the time period- 060/9/1 to 060/12/ 31 (4 months) were interviewed using a structured questionnaire. RESULTS: The prevalence of such deliveries was 45 out of 5703 deliveries i.e. 0.78%. Majority of women (n= 37) who had accidental - out - of hospital delivery were of parity 1-2 group (82.22%), whereas 2 of them were primigravida (4.44%) and 6 of them were of group parity 3-4 (13.33%). Economic factor was not responsible for delay for majority of women as they could arrange money immediately in emergency situation (88.88%) and majority of women had personal money saved for use in emergency (71.11%). Accessibility to the hospital was difficult for few women (21.00%) only as many women lived within the ring road of Kathmandu valley (48.88%) or outside the ring road but within municipality area of Kathmandu valley (31.11%). Only 60% of women could get transport easily during daytime only. Eight of them were late due to delay in getting transport (17.77%), whereas five patients were late due to disturbed / diverted traffic (11.11%). In three cases, transport was not available due to Nepal Bundh and delay was due to time taken to arrange ambulance (6.66%). Majority of women came for antenatal visits (84.44%) and most of them came to maternity hospital for antenatal visits (73.33%). Lack of birth preparedness and inadequate counselling during antenatal visits probably contributed towards many A-O-H (65.78%). More than half of patients were not satisfied with health staff during ANC (63.15%). Many women did not have any discussion about place of birth during ANC (73.68%) and many of them had no discussion even in the family (36.84%). Seven patients had probably precipitate labour (15.55%). 4 patients were returned back home with diagnosis of false labour pain (8.88%) and later on they delivered on the way to the hospital. SUMMARY AND CONCLUSION: Lack of birth preparedness that involves adequate counselling during ANC about symptoms and signs of onset of labour pain and prior decision about place of birth together with delay in getting transport or delay due to diverted traffic were important factors leading to A-O-H. In addition, unusually short duration of labour or dismissing the diagnosis of true onset of labour may have accounted for few cases of A-O-H.
Accuracy of 7-8-9 Rule for Endotracheal Tube Placement in Nepalese Neonates.
(2011-09) Paudel, K P; Nepal, D; Mahaseth, C
Introduction: Neonatal intubation is done for cardiopulmonary resuscitation, hypoxemia, and hypercapnia, for surfactant therapy or for airway protection. When correctly placed, endotracheal tube (ETT) tip should be at mid tracheal position which is half way between the clavicles and the carina to prevent complications of ventilation. Objective: To assess the accuracy of 7-8-9 Rule in neonates at Kanti Children’s hospital. Methodology: Prospective observational study was conducted in neonates who required oral intubations from July 2009 to December 2009 at NICU of Kanti Children’s Hospital. The initial ETT depth of insertion was determined using admission weight in the 7-8-9 Rule calculation. This depth was compared to the midtracheal depth to determine clinical accuracy of the 7-8-9 Rule. Results: Mean gestation age of the 69 infants was 36.01 weeks (26 to 42 weeks) and weight was 2411 g( 900 g to 3800 g ). 7 (10.1%) neonates weighed 1000 g or less, 19 (27.5%) weighed between 1001 to 2000 g, 31 ( 44.9%) weighed between 2001 to 3000 g, 12(17.4%) weighed between 3001 to 4000 g. The accuracy of 7-8-9 rule in clinical setting with auscultation and Chest x-ray resulted in ETT depth 0.11 cm above midtracheal position. (-1.5 to 1.5 cm). Using this rule ET tube was placed 0.11 cm above the mid tracheal position. Conclusions: The 7-8- 9 Rule appears to be an accurate clinical method for endotracheal tube placement in Nepalese neonates.
Accuracy of 7-8-9 Rule: Neonatal Endotracheal Intubation.
(2012-01) Sakhuja, P; Whyte, H; Finan, E
Accuracy of triple test score in the diagnosis of palpable breast lump.
(2008-12-17) Ghimire, B; Khan, M I; Bibhusal, T; Singh, Y; Sayami, P
Breast lump is a very sensitive issue for the patient so a reliable, non invasive and prompt diagnosis helps to lessen the associated anxiety and leads to early definitive treatment. The aim of this study was to evaluate the accuracy of Triple Test Score (TTS) as a clinical tool for the diagnosis of a palpable breast lump. This diagnostic test study was carried out in the Department of Surgery of Tribhuvan University Teaching Hospital. Of the 117 patients admitted with breast diseases from the breast clinic over thirteen months, 87 had breast lump. Fifty patients underwent Triple Test Score ( physical examination, mammography and fine needle aspiration cytology) and were categorized into benign, suspicious and malignant. This was later correlated with the histopathological findings. Nineteen patients with breast lumps interpreted by TTS as benign correlated with the histopathological findings whereas of 31 malignant lumps, 30 turned out to be malignant and one benign. This gives TTS an over all accuracy of 98% with 100% sensitivity, 95.2% specificity and positive predictive value of 96.7%. Carcinoma was seen in 29 (58%) cases in the age group of 35 to 70 years. The mean age at diagnosis of benign and malignant disease was 41.8 and 45.1 years respectively. In conclusion, TTS is an accurate and least invasive diagnostic test based on which definitive treatment can be initiated.
Accuracy of ultrasonography in evaluation of level and cause of biliary obstruction: a prospective study.
(2005-01-13) Ghimire, R; Lohani, B; Pradhan, S
AIM: To find out the accuracy of ultrasound in evaluation of level and cause of biliary obstruction. MATERIALS AND METHODS: Forty-five patients (26 to 86 years of age) with suspected biliary obstruction underwent Ultrasonography followed by Direct Cholangiograms (Percutaneous Transhepatic Cholangiography / Endoscopic Retrograde Cholangiography). The levels of biliary obstructions were grouped as hilar, suprapancreatic and intrapancreatic. Similarly the causes were grouped as malignant and benign. Diagnosis was confirmed either at surgery or histopathologically (USG-guided FNAC or ERC-biopsy). RESULTS: Ultrasonography accurately identified the level of obstruction in 89 %( hilar), 91% (suprapancreatic) and 87% ( intrapancreatic) cases. Malignancy was found in 33 patients and remaining 12 had benign diseases. USG accurately identified malignant and benign causes in 91% and 84% cases respectively. Findings were found to be statistically significant (p-value =< 0.05 at 95%confidence interval). CONCLUSION: This study showed that USG has high accuracy in identifying the level and cause of biliary obstruction. Considering cost, availability and patient friendly nature, Ultrasound should be the first imaging modality of choice in evaluation of biliary obstruction.
Accuracy of ultrasonography in the diagnosis of acute appendicitis.
(2008-01-08) Khanal, B R; Ansari, M A; Pradhan, S
AIMS AND OBJECTIVES: To assess the accuracy of ultrasonography in the diagnosis of acute appendicitis. METHODOLOGY: A prospective randomized study was carried in the Dept. of Radiology and Imaging, Tribhuvan University, Teaching Hospital, Maharajgunj, Kathmandu, Nepal. A total of 120 patients, who were clinically diagnosed as acute appendicitis were subjected to ultrasonography of the abdomen. A detailed ultrasonography was performed and the findings were recorded. Twenty one cases had alternate diagnosis. Ninety nine cases ultimately underwent laparotomy and the retrieved appendices were sent for histopathological examination. Intra-operative, histopathological and ultrasonographic diagnoses were then statistically analyzed. RESULTS: Ultrasonographic, intra-operative and histopathological findings were statistically insignificant (P0.05). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy percentage of ultrasonography in the diagnosis of acute appendicitis was 85.7%, 100%, 100%, 6.7% and 85.9% respectively. CONCLUSION: Ultrasonography has a high degree of accuracy in the diagnosis of acute appendicitis. However, the diagnosis should be considered with the diameter of appendix over 6 mm. Therefore acute appendicitis with diameter of appendix having less than 6 mm should be evaluated with other diagnostic parameters.
Achieving distal locking without an image intensifier.
(2007-12-27) Giri, S K
The tibia is commonly fractured bone frequently caused by high energy trauma leading to the complications and major disabilities. Different types of intramedullary nails have been employed by surgeons over 500 years. Today, the intramedullary interlocking tibial nailing is the leading modality of treatment because of its biomechanical advantage over the other modalities. This procedure is done in the advanced centers under the C-arm image intensifier. Yet, there is no facility of C- arm image intensifier in the operation theatre at the tertiary level public hospitals in Nepal. Most of the peripheral hospitals do not have portable X- ray facility. The purpose of this study was to study the success rate of distal locking in the intramedullary nailing of tibial shaft fractures with the aid of distal aiming device (DAD). The distal locking were done in 65 tibial shaft fractures. In this technique the distal hole was directly visualized after proper drilling. All the distal locking could be done without image intensifier. So this technique can be useful where the imaging facilities are not available and even in the advanced centers to avoid radiation hazards.

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