Nepalese Medical Journal <p>Nepalese Medical Journal is published by Health Education Agriculture Nepal (<a title="HEAD" href="" target="_blank" rel="noopener">HEAD Nepal</a>). The journal&nbsp;is an official peer-reviewed, medical journal which is published bi-annually and and doesn’t charge any fee for submission, processing, and publication. The journal receives original material of interest to the practitioners and scientists in the field of medicine related to the recent developments in Medical Sciences and all articles are Open Access.&nbsp;</p> <p>This journal doesn't charge for submission and processing your manuscript. Regarding publication fee, please go to the "About the journal" section.&nbsp;</p> <p><a href="" rel="license"><img src="" alt="Creative Commons Licence"></a><br>All articles published in the Nepalese Medical Journal are licensed under a&nbsp;<a href="" rel="license">Creative Commons Attribution 4.0 International License</a>.</p> <p>Nepalese Medical Journal is indexed on <a title="DOAJ-NMJ" href="">DOAJ&nbsp;</a><a href=";journalId=49291">Index Copernicus</a></p> Health Education Agriculture Development (HEAD) Nepal en-US Nepalese Medical Journal 2631-2093 <p>Copyright on any article published by Nepalese Medical Journal is retained by the author(s).</p><p>Authors grant Nepalese Medical Journal a license to publish the article and identify itself as the original publisher.</p><p>Authors also grant any third party the right to use the article freely as long as its integrity is maintained and its original authors, citation details and publisher are identified.</p><p><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons Licence" /></a><br />All articles published in Nepalese Medical Journal licensed under a <a href="" rel="license">Creative Commons Attribution 4.0 International License</a>.</p><p>This license permits use, distribution and reproduction in any medium, provided the original work is properly cited.</p> Covid-19 in Nepal: Governance and its Implication on Public Health Measures <p>COVID-19, the pandemic caused by SARS- CoV-2 has affected more than 220 countries including Nepal, costing millions of lives around the globe. Despite the government’s effort to contain the virus by initiating several public health measures, the exponential growth of COVID-19 cases has been noted in due course. Our review is focused on preventive health measures and the role of government in implementation, in the context of Nepal. We found that while the government did enact some policy and guidelines in response to COVID-19, the response was lacking in timely execution, coordination and monitoring, and was not in compliance with human rights principles. </p> Ang Tshering Lama sherpa Tenzing Lhamo Sherpa Copyright (c) 2021 Ang Tshering Lama sherpa, Tenzing Lhamo Sherpa 2021-06-30 2021-06-30 4 1 450 453 10.3126/nmj.v4i1.38463 Vascular Access Use Among Hemodialysis Patients and Competency of Nurses at National Kidney Centre, Nepal <p><strong>Introduction: </strong>Vascular access are a prerequisite for hemodialysis and good care by nurses is key to their longevity. A pattern of vascular access use has not been assessed previously nor the competency of nurses to identify the gaps in knowledge and skills. This study aims to describe vascular access use and nursing competency at National Kidney Centre.</p> <p><strong>Materials and Methods: </strong>A cross-sectional study was done to obtain demographic information and history of vascular access of patients. Vascular access was examined. Demographic and professional information of nurses were collected. A quiz based on KDOQI Clinical Practice Guidelines and a visual analogue scale to indicate confidence in managing vascular access were administered to the nurses.</p> <p><strong>Results: </strong>Four-hundred seventy-two patients and 70 nurses were recruited. The proportion of patients with an arteriovenous fistula, arteriovenous graft, tunneled catheter, and non-tunneled catheter at the time of initiation of hemodialysis were 24.36%, 0.64%, 1.27%, and 73.73%, respectively, and after conversion was 67.23%, 5.08%, 1.98%, and 19.77%, respectively. The cost at initiation was lower for catheters and the arteriovenous access in long run. Nurses had received vascular access training during their hemodialysis course (95.71%), but a few received further training (38.57%). They did well in sections related to preparation for permanent access and treatment of complications.</p> <p><strong>Conclusions: </strong>Most of the patients initiated hemodialysis via a non-tunneled catheter. The prevalence of arteriovenous fistula was high. Continued training of nurses was lacking. Nurses were confident in managing arteriovenous fistula and non-tunneled catheters.</p> Nabin Bahadur Basnet Jeena Shrestha Sangita Raj Ghatani Subhadra Regmi Shrijana Bhandari Rishi Kumar Kafle Copyright (c) 2020 Nabin Bahadur Basnet, Jeena Shrestha, Sangita Raj Ghatani, Subhadra Regmi, Shrijana Bhandari, Rishi Kumar Kafle 2021-06-30 2021-06-30 4 1 403 409 10.3126/nmj.v3i2.34111 Utility of Neutrophil to Lymphocyte ratio and platelet to lymphocyte ratio as early predicter of severe acute biliary pancreatitis <p><strong>Introduction:</strong> Acute severe pancreatitis is associated with increased mortality. Several scoring systems have been used to predict severe acute pancreatitis which are either time-consuming or calculated 48 hours after admission. This study was aimed to assess the utility of neutrophils to lymphocyte ratio and platelet to lymphocyte ratio as an early predictor of severe acute biliary pancreatitis.<br /><strong>Materials and Methods:</strong> This was a retrospective cohort study conducted from January 2017 to January 2020. Patients with non-biliary pancreatitis, referred after initial treatment, missed data, and acute pancreatitis with acute cholecystitis or cholangitis were excluded from the study. Data were collected from case sheets. Patients were divided into two groups according to the development of severe acute biliary pancreatitis based on the revised Atlanta Classification. Association of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with severe acute biliary pancreatitis was assessed using Mann Whitney U-test. p-value &lt; 0.05 was considered as statistically significant.<br /><strong>Results:</strong> Total 73 cases included in the study (males/females= 0.55). Sixty-six patients (90.4%) had mild/moderate acute biliary pancreatitis, and 7 (9.6%) patients had severe acute biliary pancreatitis. There was a development of complications in 7 (9.6%) patients who had severe acute biliary pancreatitis including one mortality. The mean neutrophil to lymphocyte ratio and mean platelet to lymphocyte ratio were high in the severe acute biliary pancreatitis group compared to the nonsevere acute biliary pancreatitis group, however, these differences were not statistically significant.<br /><strong>Conclusions:</strong> Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio cannot predict severe acute biliary pancreatitis.</p> Surendra Shah Sanjaya Paudyal Shanta Bir Maharjan Shailendra Shah Jay Narayan Shah Copyright (c) 2021 Surendra Shah, Sanjaya Paudyal, Shanta Bir Maharjan, Shailendra Shah, Jay Narayan Shah 2021-06-30 2021-06-30 4 1 410 413 10.3126/nmj.v4i1.37094 Colorectal Polyps: A Histopathological Study in Tertiary Care Center <p><strong>Introduction:</strong> Gastrointestinal polyps are commonly encountered in the colorectal region. They can be non-neoplastic or neoplastic. Neoplastic polyps include adenomas which are clinically important because of their premalignant nature. The study was carried out to analyze the histomorphological spectrum of polyps; in our institution with special emphasis on adenomatous polyps.<br /><strong>Material and methods:</strong> This is a retrospective study done from January 2015 to December 2019 in the Department of Pathology, Dhulikhel Hospital - Kathmandu University Hospital (DH - KUH). Relevant clinical data of the patients were obtained from the histopathological records of the patient from the pathology department and biopsies stained with Haematoxylin and Eosin were studied under the light microscope.<br /><strong>Results:</strong> A total of 168 cases of polyp were studied from 125 patients. The most common indication for colonoscopy in patients with polyp was per rectal bleeding. The age of the patient ranged from 2 to 83 years. The rectum was the commonest location. 106(63.1%) of polyps were non-neoplastic and 6(36.9%) of polyps were neoplastic. Juvenile polyp(71;42.3%) was the commonest polyp. Tubular adenoma(55;32.7%) was the commonest neoplastic polyp. The<br />maximum number of neoplastic polyps were seen in the age group of 51-60years (11;29.7%). Male predominance was seen in neoplastic as well as a non-neoplastic polyp. High grade adenoma(4;6.7%) was more commonly seen in adenomatous polyp &gt;2cm(3;75%) followed by 1-2cm(1;25%) and none in &lt;1cm.<br /><strong>Conclusions:</strong> This study gives a fair insight into the distribution of neoplastic and nonneoplastic polyp in the colorectal region. Adenomatous polyps are premalignant. </p> Dipika Basnet Ramesh Makaju Ram Bahadur Gurung Rachana Dhakal Copyright (c) 2021 Dipika Basnet, Ramesh Makaju, Ram Bahadur Gurung, Rachana Dhakal 2021-06-30 2021-06-30 4 1 414 418 10.3126/nmj.v4i1.37707 Effect of Dietary Intervention Using Low-Carbohydrate Diet to Manage Newly Diagnosed Type 2 Diabetes Mellitus in TUTH Hospital, Nepal <p><strong>Introduction:</strong> Low-carbohydrate diet is effective in improving blood glucose parameters, glycated hemoglobin A1c, weight, and waist circumference. The effectiveness of this diet is well accepted in America and the United Kingdom but in Nepal due to many preexisted misbeliefs regarding carbohydrates, we still have a carbohydrate-based diet for type 2 diabetes mellitus.<br /><strong>Material and Methods:</strong> Fifty-four newly diagnosed type 2 diabetes mellitus without any treatment were selected for solely low-carbohydrate diet intervention (&lt;130g carbohydrate) in the endocrinology unit of Tribhuvan University Teaching Hospital, Kathmandu from March to August 2019. Antidiabetic medications were not used. Individualized diet plans and repeated counseling were given and followed for 3 months. Blood glucose (fasting and postprandial),<br />glycated hemoglobin A1c, weight, and waist circumference were compared at entry and 3 months. Statistical analysis was done using SPSS version 21.<br /><strong>Results:</strong> The mean ± SD age was 44.77 ± 10.32. The mean body weight decreased by 4.52 ± 1.79 kg (p&lt;0.001), mean waist circumference decreased by 7.85±0.72 cm (p&lt;0.001), mean fasting blood glucose decreased from 10.44±3.52 mmol/L to 6.18±1.02 mmol/L (p&lt;0.001), mean postprandial blood glucose decreased from 16.76±8.26 mmol/L to 8.26±1.66 mmol/L (p&lt;0.001) and mean glycated hemoglobin A1c decreased by 2.38 ± 1.49 % (p&lt;0.001) after 3<br />months of low-carbohydrate diet intervention.<br /><strong>Conclusions:</strong> The use of a low-carbohydrate diet may effectively produce glycemic control and decrease glycated hemoglobin A1c without medication in newly diagnosed type 2 diabetes mellitus. Additionally, this diet may also help to lower weight and waist circumference in newly diagnosed type 2 diabetes mellitus.</p> Aarem Karkee Samir Singh Pradeep Krishna Shrestha Nani Shova Shakya Sadiksha Shrestha Samiksha Niroula Copyright (c) 2021 Aarem Karkee, Samir Singh 2021-06-30 2021-06-30 4 1 419 423 10.3126/nmj.v4i1.34710 An An Analysis of Causes and Avoidable Factors of Perinatal Deaths at Tertiary Care Hospital <p><strong>Introduction:</strong> Perinatal deaths are potentially preventable and reflect the quality of care provided in the prenatal period, during labor, and to a newborn. The purpose of this study was to assess the causes and avoidable factors contributing to perinatal deaths in the year 2018-19 and compare these with the previous two years at Tertiary Care Hospital.<br /><strong>Materials and Methods:</strong> This study was conducted from a retrospective analysis of all stillbirths and early neonatal deaths in the year July 2018 to July 2019. The Perinatal Mortality Rate, causes, and avoidable factors leading to perinatal deaths were analysed during this year and were compared with that of the previous two years at KIST Medical College and Teaching hospital.<br /><strong>Results:</strong> PMR was 16.09 per 1000 births in the year 2018-19. Previous two studies at this hospital in the year 2017-18 and 2016-17 showed a Perinatal Mortality Rate of 14.61 and 16.27/1000 births respectively. The commonest primary cause of perinatal deaths was intrapartum hypoxia 6 (30%), preterm delivery 5 (31.25%), and congenital anomalies<br />4 (19%) during the year 2018-19, 2017-18, and 2016-17 respectively. The most common avoidable factors identified were a maternal delay to seek health care, inadequate antenatal checkups, and inadequate antenatal counseling of danger signs by a service provider over the last three years.<br /><strong>Conclusions:</strong> Maternal delay to seek health care and lack of maternal knowledge of danger signs during pregnancy were the common avoidable factors identified. More efforts should be made to raise awareness of pregnant women during antenatal care visits regarding early healthcare-seeking behavior when needed.</p> Sunita Bhandari Yam Dwa Riya Sharma Copyright (c) 2021 Sunita Bhandari, Yam Dwa, Riya Sharma 2021-06-30 2021-06-30 4 1 424 428 10.3126/nmj.v4i1.36994 Clinico-Epidemiological Profile of Patients with COVID-19 in a Tertiary Care Centre of Mid-Western Nepal <p><strong>Introduction:</strong> With little to no research done that sheds light on the COVID-19 pandemic in the Mid-Western region of Nepal, this study attempts to educate the general populace and concerned authorities on the impact of the pandemic in the region.<br /><strong>Materials and Methods:</strong> Patients presenting at Rapti Academy of Health Sciences between 14 May 2020 to December 21, 2020, diagnosed with COVID-19 were included in the study. These patients were reviewed for age, sex, address, recent travel history, and presenting symptoms.<br /><strong>Results:</strong> A total of 3895 COVID -19 positive individuals were included in the study. The mean age of the patients was 33.6 ± 13.8 years, a majority (49.5%) of the cases were in the 20-29 years age group. 73.7% were male. 82.9% of the patients were from Dang, 86% of the cases of Dang were from urban areas, and the districts bordering India accounted for 88.5% of cases. Most of the positive patients were asymptomatic (97.1%), Amongst the symptomatic cases, the most frequent clinical manifestation was both fever and cough. 8.5% of the patients also reported travel history, of which a majority had returned from India.<br /><strong>Conclusions:</strong> The patients were mostly young males belonging to the economically active age group who were mostly affected by COVID-19 in Mid-Western Nepal. It is important to carry out age-group targeted testing to flatten the infection curve. Testing must be done irrespective of observable symptoms to overcome this public health emergency.</p> Shravya Singh Karki Pragya S Basnet Sauharda S Karki Basant Lamichhane Damodar Sharma Birendra K Acharya Sunil KC Salman Seikh Santosh Kunwar Nishtha Rajbhandari Ujjwal MS Bhandari Sagar Panthi Angelica Karki Jhankar Lamichhane Sangita Bhandary Copyright (c) 2021 Shravya Singh Karki 2021-06-30 2021-06-30 4 1 429 432 10.3126/nmj.v4i1.36511 Diet Pattern and Dyslipidemia Among Type II Diabetes Mellitus Patients Diagnosed More Tthan One Year Visiting Tribhuvan University Teaching Hospital <p><strong>Introduction: </strong>Dyslipidemia is a risk factor for coronary artery disease, a leading cause of mortality in patients with type 2 diabetes mellitus. This study aims to study the dietary pattern and dyslipidemia of type 2 diabetes mellitus patients visiting Tribhuvan University Teaching Hospital.</p> <p><strong>Materials and Methods: </strong>Quantitative study was done to find out the dietary pattern and dyslipidemia of type 2 diabetes mellitus patients visiting Tribhuvan University Teaching Hospital. Patients with type 2 diabetes mellitus diagnosed for more than one year were included in the study.</p> <p><strong>Results: </strong>The percentage of dyslipidemia in type 2 diabetes mellitus was found to be 88.5%. Dyslipidemia was found to be significantly associated (p&lt;0.05) with alcohol consumption, regular dietary management, sedentary behavior, waist-hip ratio, body mass index, glycated hemoglobin, and hypertension. Dyslipidemia was also found to be significantly associated (p&lt;0.05) with the dietary habit (vegetarian and non-vegetarian), consumption of cereals and its product, consumption of fruits, consumption of fast foods and street foods, consumption of red meat, and consumption of oilseeds.</p> <p><strong>Conclusions: </strong>This study indicates the importance of dietary awareness and lifestyle modification for the management of dyslipidemia among type 2 diabetes mellitus.</p> Samiksha Niroula Rama Subba Aarem Karkee Copyright (c) 2021 Aarem Karkee, Samiksha Niroula, Rama Subba 2021-06-30 2021-06-30 4 1 433 438 10.3126/nmj.v4i1.37495 Clinical Profile of Ocular Diseases at a Tertiary Eye Care Centre in Mid-Western Nepal <p><strong>Introduction:</strong> Nepal is a developing country where most of the population does not have access to proper health care services and on top of that eye care services do not reach the entire population. This study aimed to determine the pattern of ocular morbidity in patients attending the ophthalmic OPD of Rapti Academy of Health Sciences.</p> <p><strong>Materials and Methods:</strong> This was a prospective cross-sectional study conducted in the Department of Ophthalmology of Rapti Academy of Health Science, Dang. The study period was Poush 2077 to Chaitra 2077. All the patients visiting the OPD of the Ophthalmology department with an ocular problem were included in the study.</p> <p><strong>Results:</strong> A total of 1000 patients were examined during the study period. The patient's ages below 1 year were excluded so a total of 970 samples was selected. In which 625 (64.4%) were female and 345 (35.6%) were male. Most patients 92.9% were from Dang followed by Rolpa 4.1%, Rukum 1.4%, Pyuthan 0.9%, and Salyan 0.6%. Patients were examined from all age groups except for 1 year which was excluded. Out of the total patients, a maximum number of patients were female and the maximum number of patients were in the age group of 21- 30 years and followed by more than or equal to 60 years age group.</p> <p><strong>Conclusions:</strong> This study will help in obtaining epidemiology of Ocular disease for proper planning and management in the hospital.</p> Pragya Singh Basnet Sagun Malla Deepa Sharma Roshan Gautam Copyright (c) 2021 Pragya Singh Basnet 2021-06-30 2021-06-30 4 1 439 441 10.3126/nmj.v4i1.37847 Histopathological Pattern of Gynecological Malignancies at Tribhuvan University Teaching Hospital, Nepal: A 3 years Study <p><strong>Introduction</strong>: Gynecological malignancies include malignancies affecting the female reproductive organs ovary, cervix, body of uterus, vulva, vagina, and gestational trophoblastic neoplasia.</p> <p><strong>Materials and Methods: </strong>This is a hospital-based retrospective observational study of histopathological confirmed gynecological malignancies conducted in the department of Obstetrics and Gynecology, TUTH, Maharajgunj, Kathmandu for 3 years from April 2016 to March 2018.</p> <p><strong>Results:</strong> Among 314 cases enrolled in the study, the most common gynecological malignancy was of ovary (50.63%), followed by the cervix (30.25%), endometrium (9.23%), (4.77%) gestational trophoblastic neoplasia (3.82%), and fallopian tube (1.27%). 71% of the gynecological malignancies presented in early-stage and 29% in late-stage. The most common histopathological diagnosis of ovarian cancer was serous cystadenocarcinoma (30.18%), cervical cancer was squamous cell non-keratinizing type (46.3%), endometrial carcinoma was endometrioid adenocarcinoma (55%), vulval carcinoma was squamous cell carcinoma (86%), fallopian tube carcinoma (100%). The mean age of gynecological malignancy was 49.06 +- 10.08 years.</p> <p><strong>Conclusions: </strong>Screening of gynecological malignancy is necessary to identify the disease in early-stage to decrease maternal morbidity and mortality.</p> Bishal Khaniya Copyright (c) 2021 Bishal Khaniya 2021-06-30 2021-06-30 4 1 442 445 10.3126/nmj.v4i1.37717 Study of Correlation between Iron Deficiency Anemia and Serum Lipid Profile in a Tertiary Care Center <p><strong>Introduction:</strong> Looking at the health status of our country Nepal, iron deficiency anemia fits rightly in our socioeconomic status and dyslipidemia is the rising one along with being more highlighted these days. Some studies show an association between iron deficiency anemia and dyslipidemia but the data are controversial. Therefore, this study is aimed to find the relationship between iron deficiency anemia and serum lipid profile in the Nepalese context.<br /><strong>Materials and Methods:</strong> A cross-sectional study was conducted in KIST Medical College and Teaching Hospital from June 2019 to August 2020. 76 Iron deficiency anemia and 75 age and sex-matched healthy control were investigated for any possible changes in serum lipid profile: triglyceride, low-density lipoprotein, high-density lipoprotein, and total cholesterol.<br /><strong>Results:</strong> The mean triglyceride in case and control was 92.96 mg/dl and 99.87 mg/dl respectively. The difference between these two groups was statistically significant (p=&lt;0.001). Moreover, serum total cholesterol level in the case (138.82 mg/dl) was significantly lower than the control (146.67 mg/dl). The mean high-density lipoprotein was almost the same in anemic and non-anemic groups, p=&lt;0.001. While the mean low-density lipoprotein in the<br />iron-deficiency anemia group was significantly lower than the control group (p=&lt;0.001).<br /><strong>Conclusions:</strong> In this study, the values of the lipid profile parameters: triglyceride, low-density lipoprotein, high-density lipoprotein, and total cholesterol in cases were found to be lower than those in the controls.</p> Mahima Bataju Binita Bhattarai Apeksha Niraula Anamika Priyadarshinee Santosh Gautam Copyright (c) 2021 Mahima Bataju, Binita Bhattarai, Binita Bhattarai, Apeksha Niraula, Anamika Priyadarshinee, Santosh Gautam 2021-06-30 2021-06-30 4 1 446 449 10.3126/nmj.v4i1.38480 Unexplained Fatigue in an Otherwise Healthy Man Linked to Kikuchi-Fujimoto Disease, A Case Report <p>Kikuchi histiocytic necrotizing lymphadenitis is a benign and self-limited illness usually characterized by cervical lymphadenopathy and fever. We present a case of a 42-year male who complained of extreme fatigue for 2 weeks. On laboratory workup, he had leucopenia and thrombocytopenia with normal peripheral blood and bone marrow examination. The radiological investigation revealed multiple enlarged lymph nodes in the left axilla and left supraclavicular region. The subsequent excisional biopsy of the axillary node clinched the diagnosis of Kikuchi- Fujimoto disease. The patient was completely recovered and laboratory parameters were normal with supportive treatment. Kikuchi- Fujimoto disease should be considered in patients with unexplained fatigue with lymphadenopathy and early biopsy prevents unnecessary investigations as well as potentially harmful treatments.</p> Vivek Pant Santosh Pradhan Vijay Kumar Sharma Copyright (c) 2021 vivek pant, Santosh Pradhan, Vijay Kumar Sharma 2021-06-30 2021-06-30 4 1 454 456 10.3126/nmj.v4i1.38222 A Rare Presentation of Acquired Port Wine Stain in an Elderly Male <p>Acquired port wine stain though an uncommon entity that develops later in life, resembles congenital port wine stain morphologically and histologically. Congenital port wine stains are vascular lesions caused by progressive ectasia of blood vessels which is located in the vascular plexus of the dermis. Congenital port-wine stains may be associated with Sturge Weber syndrome causing neurological and eye abnormalities such as glaucoma. Here we report a 60-year-old male presenting with a complaint of asymptomatic reddish patches over the nose for 15 years.</p> Prasanna Kumar Jha Satyendra Kumar Singh Copyright (c) 2021 Prasanna Kumar Jha 2021-06-30 2021-06-30 4 1 457 458 10.3126/nmj.v4i1.36714 Fever of Unknown Origin - A Child With an Unusual Case of Juvenile Idiopathic Arthritis <div class="page" title="Page 1"> <div class="layoutArea"> <div class="column"> <p>Fever of unknown origin in the pediatric population is fever &gt;38.3°C (101°F) of at least seven days' duration, in which no diagnosis is apparent after initial outpatient or hospital evaluation that includes a careful history and physical examination and initial laboratory assessment. Fever of unknown origin is a diagnostic challenge, with a broad spectrum of causes classified as infectious, malignant/neoplastic, rheumatic/inflammatory, and miscellaneous disorders. A high index of suspicion should be kept for juvenile idiopathic arthritis in children presenting with unexplained fever and joint symptoms and should be appropriately managed. The case described here is of a 13-year-old female from Nepal, who presented to the Pediatric outpatient department of KIST Medical College and Teaching Hospital with a history of fever and arthralgia for three months.</p> </div> </div> </div> Purnima Gyawali Deepika Gyawali Sharda Acharya Copyright (c) 2021 Purnima Gyawali 2020-06-30 2020-06-30 4 1 459 461 10.3126/nmj.v4i1.38161