Kathmandu University Medical Journal

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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.
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.
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.
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 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.
Acid base and electrolyte disturbance in diarrhoea.
(2007-01-08) Shah, G S; Das, B K; Kumar, S; Singh, M K; Bhandari, G P
OBJECTIVE: The present study was undertaken to study the frequency of electrolyte imbalance in children with diarrhoea and the relationship between electrolyte abnormalities and mortality. MATERIALS AND METHODS: This is a retrospective, observational hospital based study. Fifty seven children admitted to paediatric ward with diarrhoea and dehydration was evaluated for electrolyte and acid base status at presentation. The variables were analyzed using chi-square and student t- test. RESULTS: Majority (70%) of patients were below 2 years of age. There were 37 (65%) males and 20(35%) females. Electrolyte disturbance was observed in 46 (80%) patients while acid base disturbance was observed in all (100%) where the estimations were done. The major electrolyte disturbances noted were hyponatremia (56%), which was either isolated (26%) or associated with hypokalemia (26%). The second common abnormality was hypokalemia (46%) which was again either isolated (14%) or associated with hyponatremia (26%). About 10% patient had hypernatremia and about 3% had hyperkalemia. Twenty one (37 %) patients had mixed electrolyte imbalance. ABG analysis was performed only in 16 patients. Arterial blood gas analysis could be performed only in 16 patients. Metabolic acidosis was present in 15 (94%) while one (6%) had metabolic alkalosis. Out of 57, five patients (8.7%) expired. All of them had electrolyte abnormalities. Out of five patients who died one had isolated hyponatremia, 2 had hyponatremia + hypokalemia, while one each had hypernatremia + hypokalemia and hypernatremia+ hyperkalemia. Statistically significant mortality was observed in patients presenting with either hyponatremia or hypokalemia as compared to the group with normal electrolytes. CONCLUSION: Hyponatremia, hypokalemia and metabolic acidosis are common electrolyte and acid-base abnormalities in children with diarrhoea and dehydration and often responsible for mortality.
Acquaintance with the actuality: community diagnosis programme of Kathmandu Medical College at Gundu village, Bhaktapur, Nepal.
(2008-01-08) Vaidya, A; Pradhan, A; Joshi, S K; Gopalakrishnan, S; Dudani, I
INTRODUCTION: In Nepal, various field programs such as community diagnosis programmes (CDP) have been initiated to make the education of doctors, nurses and dentists more community oriented and relevant and suited to the health care scenario. Community diagnosis refers to the identification and quantification of the health problems in a community and identification of their correlates for the purpose of defining those individuals or groups at risk or those in need of health care. The article presents the main activities of community diagnosis as a core component of community-based education for the medical students at Kathmandu Medical College, Kathmandu, Nepal. METHODOLOGY: A 4 weeks' Community Diagnosis Programme was conducted by MBBS II students (9th Batch) of the Kathmandu Medical College under the supervision of the Department of Community Medicine in November 2006 in the rural community of Gundu VDC (village development committee). The tools used included pre-tested questionnaires, weighing machines, measuring tapes, stethoscopes and sphygmomanometers. After the data collection and compilation, the students presented their findings in oral presentations, accompanied by a written report, including essential recommendations for improving the health status of these communities. RESULTS: The students benefited from the necessary process of integrating clinical skills and a public health approach, so as to enhance their epidemiological thinking and be of greater use to the communities where they will practice. The community also benefited by achievement of behavioral changes leading to healthier lifestyles and increased awareness of health-related matters and their role in quality of life. CONCLUSIONS: CDP is a way to practically demonstrate that the link between a medical college and society is possible. That is, a medical college can serve the community and thus society, with specific activities to improve health and the skills of students who will serve as future health professionals.
Acute haemorrhagic conjunctivitis: an epidemic in August/September 2003.
(2003-10-03) Karki, D B; Shrestha, C D; Shrestha, S
OBJECTIVE: To clinically analyze 400 cases of red eye attending Nepal Eye Hospital in August/ September 2003 and to study the aetiology of the disease on the clinical basis with available laboratory resources. MATERIALS AND METHODS: It is a prospective study of 400 cases of acute conjunctivitis visiting Nepal Eye Hospital during the epidemic of acute haemorrhagic conjunctivitis in August/September 2003. RESULT: 30.5% presented in the age group of 20-29 years. Males presented predominantly (73.3%). Maximum number of patients presented at two days of onset of symptoms. All 400 cases had red eye, 89.8% had pain, 86.3% had foreign body sensation and 87.5% had discharge. Bilateral involvement was seen in 73.5% and unilateral involvement in 26.5%, 4.3 % of the total cases had corneal involvement and 20% of the cases had associated fever and preauricular lymphadenopathy. CONCLUSION: Based on clinical presentation and the report of available laboratory results, picorna virus was found to be responsible for this epidemic of acute haemorrhagic conjunctivitis.
Acute sacrococcygeal dislocation (anterior type): a case report.
(2004-10-03) Rijal, K P; Pradhan, R L; Sharma, S; Lakhey, S; Pandey, B K
Sacrococcygeal dislocation is a rare injury. A twenty nine year old male presented to us with pain over the lowest part of spine of 5 days duration. He fell down on stairs with his buttock landing directly over the edge of the stairs. On examination, a step was felt in the continuity of sacrum and coccyx. The tip of the coccyx was not palpable. Per rectal examination revealed a small bump on running the finger along the sacrococcygeal curvature. On plain radiographs of sacro coccygeal region, lateral view revealed anterior dislocation of the coccyx over the sacrum. On antero posterior view, the injury could not be identified. Under general anaesthesia, an attempt to reduce the dislocation per rectally was tried, but failed. The patient was treated conservatively with analgesics. He refused surgery, as he was relieved of pain with analgesics.
Addressing medical student's stress.
(2007-10-08) Bam, D S; Adhikari, S
AIDS at altitude.
(2005-04-18) Pun, M
Air pollution in Nepal.
(2003-10-03) Joshi, S K
Alcohol use among physicians in a medical school in Nepal.
(2006-10-08) Kumar, S; Pokharel, B; Nagesh, S; Yadav, B K
OBJECTIVE: The objective of the study was to know about the use of alcohol among physicians and factors that were related to it. METHODS: This was a cross sectional study conducted among the physicians in a medical school of eastern Nepal. A semi structured questionnaire was used to collect information. RESULTS: There were 55 subjects in the study. Half of them were between 35-45 years age group and one fourth among them were female. There were more than 88% physicians consuming alcohol for more than 10 years. One third used to preferred whisky as their favorites drink. Use of alcohol among them was due to peer pressure and to become a social human being. Most of them drink alcohol occasionally with an average amount 30-60 ml in a sitting and usually in the evening. Most of the time, they use alcohol either in parties or at home. CONCLUSION: Alcohol use in Nepal is very much prevalent. The use of alcohol is socially accepted in many communities. Uses of alcohol by physicians have direct effect on their health as well as the health of many people because they are role model for many people. They are also in direct contact with the patients. Steps to council the physicians may reduce the consumption of alcohol.
Allergic fungal sinusitis.
(2008-04-05) Mallick, S; Sharma, V; Lavania, A; Borgohain, B
Allergic fungal sinusitis (AFS) is believed to be an allergic reaction of the sinus mucosa to environmental fungi that is finely dispersed into the air. We present a 23 year old man who presented to us with a unilateral nasal mass with foul smelling discharge and headache. Functional endoscopic sinus surgery (FESS) was performed. Microbiology and histopathological examination of the mass confirmed it to be a case of AFS.
Altered serum levels of thyroxine, triiodothyroinine and thyroid stimulating hormone in patients with depression.
(2007-07-08) Das, B K L; Baral, N; Shyangwa, P M; Toora, B D; Lamsal, M
OBJECTIVE: To assess serum level of Thyroxine (T4), Triiodothyronine(T3) and thyroid stimulating hormone(TSH) in patient with depression. METHODS: Thirty one clinically diagnosed depressed patients and equal number of healthy, age and sex matched control subjects were included in this study. Ham-D scale was used to classify the degree of depression into mild, moderate and severe grades. The biochemical parameters (T3, T4 and TSH) were estimated using commercially available kits. The data were analyzed by using (SPSS-10 software), one way ANOVA and chi2 test. RESULT: Female depressed (n=17) cases outnumber the male depressed cases. The distributions of patients in mild, moderate and severe categories were similar. The T3 and T4 level were found to be significantly raised in the moderate depression as compared to the healthy controls. ANOVA with multiple comparisons testing among the patient group showed a significant high TSH level (F>3.17) at 5% level of significance. A total of six depressive patients were found to have thyroid abnormalities. CONCLUSION: This study therefore points towards presence of thyroid dysfunction among the depressive which most often characterized as a "Lower Thyroid Syndrome". Thus inclusion of thyroid screening test among depressive patients may be helpful in proper management of cases.

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