Journal of the Institute of Medicine最新文献

{"title":"Anorectal Autoeroticism: A Case Report","authors":"P. Tulachan, Kenison Shrestha, M. Chapagai, S. Dhungana, S. Pant, P. Lama, R. Bhandari","doi":"10.3126/jiom.v41i2.26555","DOIUrl":"https://doi.org/10.3126/jiom.v41i2.26555","url":null,"abstract":"Introduction Anorectal autoeroticism is one kind of paraphilia where individual attains sexual pleasure through self inserting objects into ones rectum. We present here a case of 40 years old man presented in Surgery department with retention of steel glass into his rectum which he had inserted himself to achieve sexual satisfaction.","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"41 1","pages":"62-64"},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/jiom.v41i2.26555","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43055477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Batwing Technique in Large Volume Excision of Breast Lesions: Case Report","authors":"S. Khanal, Y. Singh, Rashmi Sharma","doi":"10.3126/jiom.v41i2.26562","DOIUrl":"https://doi.org/10.3126/jiom.v41i2.26562","url":null,"abstract":"Oncoplastic surgical techniques are seeing widespread use for excision of large volume breast lesions. Batwing technique is one of the volume displacement techniques that can be used to manage lesions in central quadrant of the breast. Such techniques are still underused in Nepal. Here we present three cases with large volume benign breast lesions managed with simple, easy-to-learn technique of Batwing oncoplasty.","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"41 1","pages":"70-72"},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/jiom.v41i2.26562","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69288359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Gall Stone Diseases in Patients Presenting to General Practice Out Patient Department in a Tertiary Care Center in Nepal","authors":"R. Neupane, T. Shrestha, S. Raut, R. Aacharya","doi":"10.3126/jiom.v41i2.26545","DOIUrl":"https://doi.org/10.3126/jiom.v41i2.26545","url":null,"abstract":"Introduction Gallstone disease (GSD) is a major public health problem that is associated with a number of risk factors. This study aims to analyze the risk factors of GSD in patients visiting General Practice Outpatient Department of Tribhuvan Universtiy Teaching Hospital. Methods A case-control study of 174 participants comprising 85 cases with GSD and 89 controls without GSD, as confirmed by ultrasonography of abdomen was conducted as hospital based in outpatient department of General practice, Tribhuvan University Teaching Hospital, Kathmandu from 1st February 2018 to 31st January, 2019. The participants were asked questions regarding putative risk factors for development of GSD and underwent physical and ultrasonographic examination. Risk factors included were age, sex, BMI, occupation, co-morbidities e.g. diabetes mellitus, hemolytic diseases, family history of GSD, smoking status, alcohol consumption, parity if applicable and dietary history. Data analysis was done by univariate method. Results The mean age of the case group was 47.82 years whereas mean age for the control was 46.51 years (p=0.355). 22% of cases were male and 78% were female where as in control group 29% were male (p=0.3030). Majority of the participants in both group were housewife by occupation and Hindu by religion. Mean BMI of the cases and control were 24.05 kg/m2 and 21.13kg/m2 respectively. BMI was found significant for the gall stone diseases ( p=<0.001). Similarly, Diabetes mellitus was found significant for GSD (p=0.001). 98% cases and 61% in control group were Non-vegetarians with significant p value of 0.021. Smoking (p=0.005), Nonvegetarian diet (p=0.021), family history of gall stone disease (p<0.001) and parity (p<0.001) were also found significant for the gall stone disease. Conclusion High BMI, non-vegetarian diet, family history of gall stone disease, diabetes mellitus, smoking and increased parity were associated with gall stone diseases.","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"41 1","pages":"26-29"},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/jiom.v41i2.26545","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47084687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome Analysis of Lipomeningomyelocele Repair in Children in a Tertiary Care Center in Nepal","authors":"Puspa Koirala, A. Pradhanang, G. Sedain, M. Sharma","doi":"10.3126/jiom.v41i2.26546","DOIUrl":"https://doi.org/10.3126/jiom.v41i2.26546","url":null,"abstract":"Introduction Lipomeningomyelocele (LMM) is a common neural tube defect especially prevalent in low income countries. When they get appropriate care, long term result is generally good provided the patient receives good neurosurgical, paediatric and rehabilitation care. Surgery is the mainstay of treatment. Our aim was to analyze immediate and long-term results of lipomeningomyelocele repair in symptomatic patients presenting to TU Teaching Hospital, Kathmandu, Nepal. Methods Thirteen patients admitted to Department of Neurosurgery from January 2017 to December 2018 were evaluated. All patients underwent MRI of whole spine before surgery. Surgical procedures involved total excision of lipoma and repair in 10 patients and subtotal excision and repair in 3 patients. Division of filum terminale could be done in 8 patients. Follow up varied from 6 months to 2 years. Results This study included 8(61.5 %) patients of lumbosacral LMM, 3(23%) patients of sacral LMM and 2( 15.38%) patients of thoracolumbar LMM . About 2 (15.38%) were operated before 3 months of age, 2 (15.38%) were operated between 3-6 months of age, 5 (38.46%) were operated between 6-12 months of age and 4 (30.7%) were operated after 1 year. All children except one presented with lump on back since birth and four presented with urinary incontinence, one presented with bilateral club foot. Four (30.7%) patients had weakness of one or both lower limbs. Two (15.38%) patients had improvement in urinary incontinence, two unchanged and one had developed urinary incontinence postoperatively. Four children with had weakness of lower limbs; one patient improved whereas three patients did not improve postoperatively. There was no development of postoperative hydrocephalus after LMM repair. Three (23%) patients developed wound infection who responded well with regular dressings and antibiotics. Conclusion Lipomeningomyelocele repair can be done with satisfactory outcome with total excision of lipoma and division of filum terminale. Patients with residual lipoma and undivided filum terminale should be observed closely for the development of progressive neurological deterioration.","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"41 1","pages":"30-34"},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/jiom.v41i2.26546","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45645682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Peritoneoscopy to Determine the Cause of Low Serum Ascites Albumin Gradient","authors":"P. Parajuli, R. Bhandari, R. Pathak, Shashi S. Sharma, P. Khadga, A. Jha, R. Hamal, B. Kafle","doi":"10.3126/jiom.v41i2.26547","DOIUrl":"https://doi.org/10.3126/jiom.v41i2.26547","url":null,"abstract":"Introduction Ascites, a common entity in practice of gastroenterology is pathophysiologically divided into high SAAG and low SAAG category, to rapidly classify, formulate a workup plan and expedite the diagnosis. The cause of low SAAG ascites is often due to local peritoneal cause e.g peritoneal tuberculosis, peritoneal carcinomatosis etc, mandating the need of peritoneoscopy for definitive diagnosis. This study aims to present the peritoneoscopy and peritoneal biopsy result of patients with low SAAG ascites of uncertain etiology. Methods Peritoneoscopy was prospectively performed in 12 patients with low SAAG ascites of unclear etiology. Patients with low SAAG ascites and willing to give consent for peritoneoscopy were enrolled in the study. Patients underwent laparoscopic peritoneoscopy under general anesthesia and appropriate biopsies were taken during the procedure for histopathological analysis. Results Of the twelve patients with low SAAG enrolled in the study, 3 (25%) were male and 75% (9) were female. The success rate of the procedure was 100% and there was no procedure related complications. Specific findings were seen in all patients undergoing peritoneoscopy. Of the twelve patients, 9 (75%) patients has metastatic deposits in the peritoneum, 3 (25%) had benign etiology, 2/3rd (2) of whom had granulomatous deposits suggestive of tuberculosis and 1/3rd (1) had extensive dense adhesions and peritoneal fibrosis. Primary focus was revealed (ovary) in only 1 patient undergoing peritoneoscopy. Conclusion Peritoneoscopy with simultaneous biopsy is safe, efficient and accurate diagnostic method due to its high diagnostic capacity and low complication rate in selected patients who have low SAAG ascites of uncertain etiology.","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"41 1","pages":"35-39"},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/jiom.v41i2.26547","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48646021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elderly Great Grand Multipara with Gestational Hypertension and Anemia Managed in a Rural Tertiary Hospital: A Case Report","authors":"U. Shrestha","doi":"10.3126/jiom.v41i2.26561","DOIUrl":"https://doi.org/10.3126/jiom.v41i2.26561","url":null,"abstract":"IntroductionParity more than five is grand multiparity and more than 10 is great grand multiparity. Women with high birthorder are at increased risk for adverse obstetric outcomes. The risk is even higher for great grand multiparouswomen than grand multiparous women. Grand and Great grand multiparity predispose for adverse maternaland perinatal outcomes such as malpresentation, labor dystocia, caesarean delivery, postpartum hemorrhage,maternal anemia, congenital malformations and perinatal mortality. Grand and Great grand multiparty is alsoindependent risk factor for labor dystocia and perinatal mortality. However, most of the adverse outcomesthat have been associated with grand multiparity may actually be confounded by advanced age, less antenatalcare and low socioeconomic level. Although pregnancy hypertension is more commonly seen among youngprimigravidas, hypertension is equally common in elderly women. This is a unique case of elderly great grandmultiparous women with moderate anemia who developed gestational hypertension and underwent emergencycesarean section resulting into normal maternal and fetal outcome.KeywordsElderly, gestational hypertension, great grand multiparity, pregnancy outcome","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"41 1","pages":"67-69"},"PeriodicalIF":0.0,"publicationDate":"2019-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/jiom.v41i2.26561","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44276155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Vitamin D Level in Chronic Obstructive Pulmonary Disease and its Relation with Severity: A Single Centre Study","authors":"P. Pant, S. Thapa, S. Das, N. Bam","doi":"10.3126/jiom.v41i2.26552","DOIUrl":"https://doi.org/10.3126/jiom.v41i2.26552","url":null,"abstract":"IntroductionChronic obstructive pulmonary disease (COPD) is a public health problem of epidemic proportion. Several studieshave shown low serum vitamin D levels in patients with COPD. The aim of this study was to compare serumvitamin D level in patients with Global Initiative for Chronic Obstructive Lung Diseases (GOLD) COPD stage II, IIIand IV with controls and correlate serum vitamin D level with severity of COPD.MethodsA cross sectional study was conducted from June 2014 to November 2015 at Tribhuvan University TeachingHospital (TUTH). A total of 154 subjects were enrolled for study that consisted of 77 cases of COPD and 77controls for comparison. Participants were taken from medical wards and outpatient department. COPD stagingwas done as per GOLD guidelines and stage II, III and IV were labeled as advanced COPD cases. Both descriptiveand inferential statistics were performed in SPSS version 20.ResultsStage II, III and IV COPD were 30%, 36% and 34% respectively. Mean serum vitamin D level was 15.16±7.19 ng/mlin COPD cases and 33.99±12.37 ng/ml in healthy controls showing statistically significant relation of low serumvitamin D in patients with advanced COPD (p <0.0001). Serum vitamin D was found to be in decreasing trendwith increasing severity of COPD.ConclusionPatients with advanced COPD (GOLD stage II, III and IV) had low serum vitamin D levels compared to normalpopulation and serum vitamin D level correlated with GOLD severity in Nepalese patients with COPD.KeywordsChronic obstructive pulmonary disease; global initiative for chronic obstructive lung diseases; vitamin D","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"41 1","pages":"56-58"},"PeriodicalIF":0.0,"publicationDate":"2019-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/jiom.v41i2.26552","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41912465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional Assessment of Patients with Liver Cirrhosis by Nutrition Screening Tool and Anthropometry at a Tertiary Care Center","authors":"T. Sherpa, R. Pathak, P. Khadga, Sashi Sharma, R. Hamal, A. Jha","doi":"10.3126/jiom.v41i2.26543","DOIUrl":"https://doi.org/10.3126/jiom.v41i2.26543","url":null,"abstract":"IntroductionMalnutrition is one of the most common complications of liver cirrhosis. Yet, little attention is paid in evaluatingnutrition in this group of patients. This study aims to assess malnutrition among cirrhotic patients using a nutritionscreening tool and anthropometry.MethodsThis was a prospective, observational study of admitted patients with liver cirrhosis. In the study duration of 3months, 50 patients met the inclusion criteria and were included. Nutritional assessment was performed usingthe Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), BMI and standard anthropometry including TSF,MUAC and MAMC.ResultsThe mean age was 51.56 ± 11.50 with a Male to Female ratio of 3:2. Chronic alcohol consumption (72%) wasthe most common etiology while management of tense ascites (40%) was the most common reason for hospitaladmission. 58% had Child Pugh Class C cirrhosis while the remaining 42% were Class B. The average MELD Nascore was 19.64 ± 6. Significant differences in anthropometric measurements including BMI, MUAC, TSF andMAMC were found between Child B and C cirrhosis. Similarly, those patients who had low, moderate and highrisk of malnutrition by the RFH-NPT had significant differences in anthropometric measurements between them.ConclusionA significant number of patients had moderate to severe risk of malnutrition that correlated well withanthropometric measurements. The degree of malnutrition is parallel with the severity of liver disease amongthese patients. Both the RFH-NPT and anthropometry are relatively easy to perform and effective. Hence, theycan be used as a practical means for identifying malnutrition among cirrhotic patients in routine clinical practice.KeywordsAnthropometry, liver cirrhosis, malnutrition","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"41 1","pages":"21-25"},"PeriodicalIF":0.0,"publicationDate":"2019-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/jiom.v41i2.26543","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43981634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor Factors Affecting Short Term Graft Outcome in Live Donor Kidney Transplantation","authors":"R. Nepali, D. Shah, P. Gyawali, S. Uk, Chalise Pr","doi":"10.3126/jiom.v41i2.26539","DOIUrl":"https://doi.org/10.3126/jiom.v41i2.26539","url":null,"abstract":"IntroductionSince the beginning of renal transplant, the objective has been to increase the patient and graft survival, bothshort term and long term. Data relating to donor factors affecting short term survival at 6 months in live donorkidney transplantation has been scarce. This single center study tries to examine the predictors of short termgraft outcome at six months in recipients of live donor kidney transplants and explore which donor characteristicsare the most useful in predicting the post-transplant graft function in Nepalese population.MethodsAll patients who underwent kidney transplantation between May 2015 to July 2016 were included in the study.The patients who expired during follow were excluded. The clinical and laboratory parameters of the donors wererecorded. The recipients were followed up for six months post transplantation. The eGFR of the recipients and theoccurrence of rejection were recorded at the end of six months post transplantation.ResultsA total of 82 donor-recipient pairs underwent living donor renal transplantation at our hospital during the studyperiod. One recipient who expired during follow up was excluded. The mean age of donor was 45.20 ± 11.226years of which 55 (67.9%) were female and 26 (32.1 %) were male. The mean eGFR of the donor calculatedfrom Cockcroft Gault equation was 81.98 ± 18.11. The eGFR of the recipient at the end of six months posttransplantation calculated form the MDRD equation was 67.76 ± 20.94. A total of 7 patients (8.6%) had rejectionthat were biopsy proven. Only donor eGFR was found to be significantly associated with eGFR of the recipientat six months post transplantation (p=0.034). Body mass index of the donor was significantly associated withrejection in the recipient at six months post transplantation (p=0.011).ConclusionOur study demonstrates that the donor eGFR and body mass index are independent and important factorsaffecting the short term graft outcome at six months post transplantation.KeywordsBody mass index, donor eGFR, graft outcome, renal transplantation","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"41 1","pages":"4-7"},"PeriodicalIF":0.0,"publicationDate":"2019-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/jiom.v41i2.26539","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43849471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomedical Editing in Nepal: A Challenging Task","authors":"Yogendra Pratap Singh","doi":"10.3126/jiom.v41i2.26565","DOIUrl":"https://doi.org/10.3126/jiom.v41i2.26565","url":null,"abstract":"Not available. \u0000 ","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/jiom.v41i2.26565","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43850708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}