Nepal Medical College Journal : NMCJ

Rectus Sternalis is a rare flat slip of muscle present parasternally in the thoracic wall. During the regular dissection of pectoral region, three slips of Sternalis muscle were observed bilaterally in an adult male cadaver. On the right side there was a single slip (RS 1) while on the left side two slips (RS2 and RS3) were present. All three slips were present anterior to the Pectoralis Major muscle of respective side and each muscle had fleshy origin and tendinous insertions. RS1 had two heads arising from the aponeurosis of External Oblique and Rectus Abdominis...

Cor triloculare biatriatum or double inlet single ventricle is a congenital heart defect in which both atria are connected to a common or dominant ventricle. The present report presents an index case and describes the embryological basis and clinical aspects of this extremely rare anomaly. A three months old infant presented with extreme respiratory distress without cyanosis and repeated chest infections. The patient was diagnosed to be a case of single ventricle with both atria opening in the common ventricular chamber...

There is a wide spread availability of highly active antiretroviral treatment but opportunistic illnesses still occur and result in an increased risk of mortality among persons with HIV/AIDS. The spectrum of illness that one observes, changes as the CD4+ cell count declines. The close relationship between clinical manifestation and CD4+ cell count has made measurement of the latter a routine part of evaluation of the progress of HIV infection in individuals: The objective of this study was to reveal the clinical spectrum and explore the different types of opportunistic infections in HIV/AIDS patients...

Low birth weight (LBW) remains an important cause of newborn morbidity and mortality. A hospital based prospective and descriptive study was conducted at Paediatric wards, Nursery, Neonatal intensive unit (NICU) and Post natal ward during period of June to October 2010 to note the clinico-epidemiological profile of Low Birth Weight (LBW) newborns. Incidence of the LBW babies in our hospital was 14.45%; more than four fifth (82.2%) baby's mothers were primigravida. Eighty two percent mothers had unbooked pregnancies...

The concept of stretching is to increase the range of motion of a joint. Theoretical evidence suggests that the in vivo properties of tendon are different between men and women. There exist gender differences in the viscoelastic properties of a tendon too. This suggests that stretching affects the properties of a muscle and because male and female tendons have different viscoelastic properties, the effect of stretching should also vary accordingly. However, no experimental study has been conducted till date to verify these theoretical constructs...

Templating x-rays of total hip and knee replacements pre-operatively are important to plan surgery. This is usually done using acetate templates of the prosthesis on hard copies of the x-ray. With the change in practice, to use digital x-rays on computer screens instead of hard copies, it is important to assess if acetate templates can be used for digital x-rays on the computer screen. This is a retrospective x-ray study of 19 hip replacements and 30 knee replacements to assess their magnification using the Patient Archiving Computerised System (PACS) software...

Both cataract and glaucoma are significant public health problems. Combined cataract operation and trabeculectomy is required for visual rehabilitation and control of intraocular pressure (IOP) thereby preventing progressive optic nerve damage, in patients with coexisting cataract and glaucoma. The aim of this study was to find out the visual rehabilitation and IOP control following combined manual small incision cataract surgery (SICS) and mitomycin-C (MMC) augmented trabeculectomy. In this study 45 consecutive eyes of 45 patients who had undergone combined procedures (manual SICS+ trabeculectomy with MMC) were reviewed between September 2011 and August 2012...

The total facial index exhibits sexual differences and different shapes of face. Facial anthropometry has its well known implications for forensic scientists, anatomists, human biologists, criminologists and physical anthropologists. Facial index is the ratio of the morphological facial height to facial width and multiplied by 100. The present study aimed to examine the facial length, facial width, facial index and to find out the facial type in students of Kathmandu University School of Medical Sciences. The present study was conducted on 300 medical, dental and human biology students of Kathmandu University School of Medical Sciences, Dhulikhel, Nepal...

Spinal cord injury is a serious problem that affects many facets of an individual's life. This was a retrospective study which included data from all patients admitted to the Spinal Injury Rehabilitation Center (SIRC), Sanga with spinal injuries over a 4 year period between January 2008 and January 2011. The overall objective of the study was to determine the epidemiology of spinal injury patients admitted at the center. Socio-demographic details, mechanism of injury, level of injury, ASIA score and length of hospital stay of the subjects were recorded and analyzed...

A prospective study was carried out to evaluate safety, in-hospital clinical end points and early outcome in a consecutive series of 212 patients with coronary artery disease (CAD) who underwent coronary angioplasty in Manmohan Cardiothoracic Vascular and Transplant Centre from October 2012 to April 2014 over a period of 18 months. All patients who underwent angioplasty during the specified period were included in the study. Majority of the patients were male (84.4%). Hypertension was found in 31%, diabetes in 29%, dyslipidemia in 23% and smoking in 19%...

Neonatal Sepsis is one of the most common reasons for admission to neonatal units in developing countries. It is also a major cause of mortality in both developed and developing countries. Identification of the common bacteria and risk factors causing such infections and their susceptibility patterns will provide necessary information for timely intervention. This study was carried out to determine the bacteriological profile and associated risk factors of neonatal sepsis in Paropakar Maternity and Women's hospital...

Cervical spinal cord injuries make up more than half of all spinal cord injuries. It affects 2-3% of all trauma patients and accounts for 8.2% of all trauma related deaths. Cervical spine surgery has been evolving in terms of surgical technique, equipment, and instrumentation. We have analyzed a series of patients with cervical spine injuries stabilized with various instrumentation techniques. The objective of the study was to evaluate the outcome of instrumentation in cervical spine injury measured on ASIA Impairment Scale...

The fetal nasal bone length (FNBL) is a recent sonographic marker included in second trimester genetic sonography which varies with race and ethnicity. The importance of measuring FNBL is in the prenatal diagnosis of Down's syndrome (DS), the most common chromosomal abnormality. Nasal bone hypoplasia or absence is one of the frequent features of DS. Different studies conducted in different parts of the world have established FNBL in different races. But, reference values for normal fetal nasal bone length are yet to be established for Nepalese population...

Surgical site infection is one of the most common complications following Lower Segment Cesarean Section, which accounts for prolonged hospital stay thereby increasing expense. Prophylactic antibiotics in cesarean section reduces surgical site infection significantly. The best protection is provided when tissue level of antibiotics are adequate before incision, without prejudice to neonatal infectious morbidity. The objective of this study was to compare the incidence of surgical site wound infection with prophylactic antibiotics given before skin incision and after cord clamping following delivery of baby...

Temocillin is relatively more stable against most β-lactamases and requires re-evaluation to include it in common clinical practice as a therapeutic alternative. At the National Reference Laboratory of Nepal, we evaluated multidrug resistance (MDR) and extended spectrum β-lactamase (ESBL) phenotypes among 292 gram-negative clinical bacterial isolates of 18 different genera during 2009/2010 by Kirby-Bauer disc diffusion method following CLSI guidelines. ESBL screen positive isolates were tested for Temocillin efficacy by disc diffusion method following British Society of Antimicrobial Chemotherapy (BSAC) guidelines and other antibiotics following Clinical and Laboratory Standards Institute (CLSI) guidelines...

Laparoscopic cholecystectomy under general anaesthesia is the present gold standard in treatment of symptomatic gall bladder disease. This study was conducted to determine the efficacy and safety of laparoscopic cholecystectomy under spinal anaesthesia which could be more cost effective. A prospective study was conducted was over a fourteen month period at a teaching hospital to evaluate efficacy, safety and cost benefit of conducting laparoscopic cholecystectomy under spinal anaesthesia(SA). Patients meeting inclusion criteria were taken up for laparoscopic cholecystectomy under spinal anaesthesia by standardized techniques...

A descriptive study on food practice among postnatal mothers in a hilly township in northeastern Nepal was carried out with 50 mothers (aged 20-39 years) of different ethnic groups (Adibasi-Janajati: 46.0%, Bahun/ Chhetri: 34.0% and Dalit 20.0%). Findings show that this township was representative of a rural area in northeastern Nepal in terms of demographic characteristics like mixed ethnic composition, high illiteracy rate (especially among women), joint family structure in majority of the households (80% of the total participants) and agriculture as the more common occupation (44% of the total participants)...

Hearing loss is the most common sensory deficit in the elderly, and is becoming a severe social and health problem. Presbycusis is the result of aging which can lead to communication problems compromising the quality of life (QoL).Since the elderly population is increasing worldwide, presbycusis is showing a similar trend. This study intended to identify the impact of hearing loss in the social life of the elderly. A total of 70 elderly patients attending Nepal Medical College Teaching Hospital who were found to have sensorineural hearing loss (SNHL) on pure tone audiometry (PTA) were recruited for this study...

Children spend around 25% of their time of 260 days in a year in school. Hence early detection of abnormalities in health enables timely corrective measures to be taken. A descriptive study related to health of primary class students was carried out from June to September 2013 in a village which lies inside Kathmandu valley. Health status and related behavior was assessed in 69 students from a public school and 125 students from a private school who belonged to class 1 to 5. The results did not show significant difference between the variables in private and public school...

High level aminoglycoside resistance is an established phenomenon in enterococci. With the increasing use of broad spectrum cephalosporins and glycopeptides, vancomycin resistant enterococci are being increasingly reported from different parts of the world. The objective of our study was to determine the prevalence of high level gentamicin resistant (HLAR) enterococci among the clinical isolates in our hospital and to find the minimum inhibitory concentration (MIC) of vancomycin against these isolates. The enterococci isolated over a year (n = 41) were subjected to HLAR screening by disc diffusion and MIC of vancomycin by agar dilution method...