Journal of Patan Academy of Health Sciences <p>Published by the Patan Academy of Health Sciences, Kathmandu, Nepal</p> en-US <p>© Journal of Patan Academy of Health Sciences</p><p>Submission of the manuscript means that the authors agree to assign exclusive copyright to JPAHS. All authors must sign a Copyright Transfer and Author Agreement form upon submission of the manuscript to the Journal. The work shall not be published elsewhere in any language without the written consent of JPAHS. The articles published in this journal are protected by copyright which covers translation rights and the exclusive rights to reproduce and distribute all of the articles printed in the journal.</p> (Prof. Dr. Jay Narayan Shah) (Sioux Cumming) Tue, 31 Aug 2021 00:00:00 +0000 OJS 60 Author-level metrics: Its impact on scholarly output evaluation among various publication metrics <p>Publication metrics indicate the visibility and reach of a research publication. The metrics can be at article-level, author-level, and journal-level to measure the scholarly output and its impact.&nbsp;Bibliometrics is the use of statistical methods to analyze various publications mostly used in the field of library and information science; whereas, scientometrics is the sub-field concerned with the science of metrics for the measurement and analysis of scholarly publications. Readers are not always well informed about the various publication metrics, and use them without knowing how to interpret them, their strength and limitations.</p> Jay N Shah Copyright (c) 2021 Tue, 28 Sep 2021 00:00:00 +0000 Perception of nursing students towards online learning during COVID-19 pandemic <p><strong>Introduction: </strong>During COVID-19 pandemic, many academic institutions in Nepal and the world turned to online learning. The present study aimed to explore nursing students’ perception towards online learning.&nbsp;</p> <p><strong>Method: </strong>A cross-sectional analytical study was conducted to identify the perception of nursing students towards online learning in School of Nursing and Midwifery, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal during October 2020. A total enumerative sampling technique was used to collect data. Ethical approval was taken from the Institutional Review Committee (IRC) of PAHS. Data were collected using a self-developed structured questionnaire via Google form. The collected data were entered into SPSS version 16. Descriptive statistics (frequency, percentage, mean and standard division) and Chi-square test was used to analyze the data.</p> <p><strong>Result:</strong> Out of 348 nursing students, it was found that 186(53.4%) of the nursing students had positive perception and 162(46.6%) of the students had negative perceptions towards online learning during COVID-19 pandemic. The perception was associated with the academic year, access to the internet, need for use of mobile data, and academic level.</p> <p><strong>Conclusion:</strong> The overall perception of nursing students is not satisfactory towards online learning. Academic institution should plan the online learning giving the priorities on the factors associated with negative perception so that students can learn effectively through virtual.</p> Bina Rana Khagi, Bimala Panthee, Khagi Maya Pun, Sapana Shrestha Copyright (c) 2021 Tue, 31 Aug 2021 00:00:00 +0000 Impact of COVID-19 lockdown on undergraduate nursing and medical students of a medical college in Pokhara, Nepal <p><strong>Introduction</strong>: Coronavirus disease 2019 (COVID-19) is a highly infectious disease declared a pandemic on March 11, 2020, by WHO. As a preventive measure, Nepal was put into lockdown from 24 March to 21 July, 2020 for the first wave of COVID-19 infection. Sudden lockdown prompted the widespread closure of educational institutions. This study aimed to assess the academic and social impact due to COVID-19 lockdown on undergraduate students.</p> <p><strong>Method</strong>: A web based cross sectional study was conducted among 403 undergraduate students of Manipal College of Medical Sciences (MCOMS), Pokhara Nepal using the total enumeration method after the ethical approval from Institutional Review Committee (IRC), Manipal Teaching Hospital. Data was collected through online self-administered questionnaires by using Microsoft Form. Analysis of the results was done by using descriptive and inferential statistics.</p> <p><strong>Result</strong>: High academic (55.6%) and social (53.8%) impact was seen in the students. Female (OR: 1.76; CI 1.1-2.82), Nepalese students (OR: 2.05; CI 1.19-3.51), data pack users (OR: 2.09; CI 1.16-3.78) were more likely to have a high academic impact. Foreign students (OR: 1.88; CI 1.11-3.11) and students having a daily update of COVID-19 (OR: 2.2; CI 1.03-4.66) were more likely to have a high social impact.</p> <p><strong>Conclusion</strong>: Academic impact was seen more in female and Nepalese students while the social impact was high among foreign students. Educational activities need to continue in this critical situation. Concerned authorities need to focus on the improvement of digital infrastructure and technology along with the continuation of clinical learning with safety precautions during this pandemic time for better learning among students.</p> Ganga Pokharel, Nona Shakya, Kalpana Shrestha, Nirsuba Gurung Copyright (c) 2021 Journal of Patan Academy of Health Sciences Sun, 09 May 2021 00:00:00 +0000 Breakthrough infection after Covishield COVID-19 vaccine among health care workers at Patan Academy of Health Sciences, Nepal <p><strong>Introduction:</strong> Coronavirus Disease 2019 (COVID-19) vaccines have an important role in the control and prevention of the pandemic. However, infection after vaccination, though uncommon, has been reported after partial or complete immunization. This study aims to find out vaccine breakthrough infection after the Covishield COVID-19 vaccine.</p> <p><strong>Method:</strong> This cross-sectional survey was conducted among the health care workers (HCWs) from May 2021 to July 2021 at Patan Hospital, Patan Academy of Health Sciences, Nepal who received the Covishield vaccine. The data were collected using Google form and a printed questionnaire on COVID 19 breakthrough infection ≥2w after vaccination. The rate of breakthrough infection, hospitalization, and its association with age, gender, and working departments of HCWs was analyzed using SPSS. Ethical approval was obtained.</p> <p><strong>Result:</strong> Out of 1462 HCWs approached, 880 completed the survey, among which 819 (93.1%) had a completed vaccination status. Infection after the first and before the second dose was 164 (18.7% of 880) and after two doses 131 (16%). The breakthrough infection occurred in 83 (10.1% of 819). There was no statistically significant association of breakthrough infection with age, gender, and working department of HCWs. Total 74 (8.4%) were managed by admission in hospital.</p> <p><strong>Conclusion:</strong> The findings of this study reveal a low breakthrough infection rate after Covishield vaccination among HCWs at Patan Academy of Health Sciences, Kathmandu, Nepal. Overall, COVID-19 infection rates decreased after the first and second dose of the vaccine.</p> Jay Shah, Priscilla Samson, Nabees MS Pradhan, Ashis Shrestha, Shreekrishna Maharjan, Shanta Dangol Shrestha, Sarala KC Copyright (c) 2021 Tue, 31 Aug 2021 00:00:00 +0000 Adverse events following Sinopharm (Vero Cell), the inactivated COVID-19 <p><strong>Introduction</strong>: Various types of COVID 19 vaccine are being used globally to control the current pandemic. Post-licensure surveillance of vaccine is essential to ensure the safety. This study aimed to determine Adverse Events Following Immunization (AEFIs) of China Sinopharm (Vero cell), the inactivated COVID-19 vaccine.</p> <p><strong>Method: </strong>This is a cross sectional observational study conducted at Patan hospital, Patan Academy of Health Sciences (PAHS) after the approval from IRC. Vaccine recipient between April 7 to April 13 and May 16 to May 25 were contacted through a phone call after 72 h of vaccination to record the AEFIs. Pattern and distribution of AEFIs were analyzed. Ethical approval was taken from PAHS IRC.</p> <p><strong>Result: </strong>A total of 6142 individual got the first dose of the vaccine and out of them we were able to contact 4574 through phone calls. Of the 4574, only 941 were included for the follow up phone call after the second dose of the vaccine. A total of 1336 AEFIs were reported in 868(19%) first dose vaccine recipients while 147 AFEIs were reported in 105(11.2%) second dose vaccine recipients.&nbsp; The frequently reported AEFIs were pain at injection site, lethargy, headache, muscle ache and fever. All the AEFIs were mild to moderate in severity. Most of the AEFIs started within 24 h and resolved within 72 h.</p> <p><strong>Conclusion: </strong>The Sinopharm (Vero cell) vaccine was found to have mild to moderate AEFIs in our study cohort and no case of severe AEFI was identified.</p> Sushant Aryal, Ranjan Prasad Devbhandari, Shrijana Shrestha, Ashis Shrestha, Piyush Rajbhandari, Tripti Shakya, Shreyashi Tuladhar, Sanjay Maharjan, Ritu Bashyal, Ranjan Suwal, Deepshikha Mishra, Rakesh Kumar Jha Copyright (c) 2021 Tue, 31 Aug 2021 00:00:00 +0000 Gynecologic surgery during the COVID-19 pandemic: Patan Hospital experience <p><strong>Introduction</strong>: The COVID-19 pandemic is a major challenge for health care services including safe and effective surgery. This study aims to analyze gynecological surgery delivery during COVID-19 pandemic.</p> <p><strong>Method</strong>:&nbsp; Data on gynecologic surgeries performed at Patan Hospital from 01 Jan to 31 Dec,2020 during pre-lockdown , lockdown and post-lockdown&nbsp; period of the COVID-19 pandemic were analyzed from medical record for surgical&nbsp; procedures, blood transfusion, ICU stay, length of hospital stay, mortality, COVID-19 PCR positive cases. Chi-square and Anova tests were used to compare between three periods, p value &lt;0.05 was considered statistically significant. Ethical approval was obtained.</p> <p><strong>Result:</strong> Out of 413 surgeries, 149(36.1%) were done during&nbsp; pre-lockdown, 116(28.1%) during&nbsp; lockdown&nbsp;&nbsp; and 148(35.8%) during post-lockdown period. Major surgery was 155(37.5%), minor 249(60.3%), minimally invasive 9(2.2%) and 61(14.8%) required blood transfusion. Mean hospital stay was 3.75±3.711 d, 15(3.63%) stayed in ICU following procedure and 1(0.2%) expired. Thirteen patients were suspected with COVID-19 infection 8 were PCR positive.&nbsp;</p> <p><strong>Conclusion:</strong> There was decrease in major procedures during lockdown period.</p> Anagha Pradhan Malla, Padma Gurung, Sushma Lama, Reena Shrestha Thapa Copyright (c) 2021 Tue, 31 Aug 2021 00:00:00 +0000 Ocular manifestations in patients with corona virus disease (COVID-19) <p><strong>Introduction</strong>: Corona virus disease (COVID-19) has affected many subspecialties including ophthalmology. We aimed to determine the ocular manifestations of COVID-19 patients treated in a dedicated tertiary care hospital, in Nepal.</p> <p><strong>Method</strong>: This was a descriptive cross-sectional study in hospitalized COVID-19 patients in Patan Hospital, Patan Academy of Health Sciences, Kathmandu, Nepal. Data were collected during 6 months from November 2020 to May 2021 to achieve a for a specified sample size of 90. Ophthalmological manifestations were recorded in the consenting participants. Ethical approval was obtained.</p> <p><strong>Result:</strong> One or more ocular manifestations were seen in 3.4% of admitted COVID-19 patients. Bilateral diffuse red eyes was the most common manifestation.</p> <p><strong>Conclusion: </strong>Bilateral diffuse red eye was the common ocular manifestation in admitted COVID-19 patients.</p> Ranjana Sharma, Bishnu Prasad Sharma, Keshav Raj Sigdel, Sudeep Adhikari, Sudesh Subedi, Dipsikha Aryal, Ashish Jha Copyright (c) 2021 Tue, 31 Aug 2021 00:00:00 +0000 Computer vision syndrome: a rising problem during COVID-19 period amongst students and online workers <p>Dear Editor,</p> <p>Computer vision syndrome (CVS) is defined as complex eye discomfort and vision problems associated with prolonged exposure to digital screens.<a href=""><sup>1</sup></a> Symptoms include headache, dry eyes, eye strain, blurring of vision, and ocular discomfort after prolonged exposure to light from computers.<a href=""><sup>2</sup></a><sup>,</sup><a href=""><sup>3</sup></a> Blue light filtering lenses can be used to minimize CVS.<a href=""><sup>2</sup></a> Globally, around 70 million workers are at risk for computer vision syndrome which reduces the quality of life and work productivity.<a href=""><sup>1</sup></a> In the western world, use of computers, for both vocational and non-vocational activities, is almost mandatory.<a href=""><sup>1</sup></a> In today's COVID-19 (Corona-Virus Disease - 2019) era, use of computers and other digital screen devices is surging in Nepal as well, especially for online study and work from home to control the further spread of coronavirus. Moreover, the lockdown and shutdown done for the virus control by minimizing human gathering increase the demand for virtual learning and working through the online medium.</p> Bibek Raj Parajuli, Sanjib Koirala, Abishek Bajracharya Copyright (c) 2021 Tue, 31 Aug 2021 00:00:00 +0000 Living with obstetric fistula for ten years: a delayed diagnosis and review of pertinent surgical technique <p>Obstructed labour is a common cause of vesicovaginal fistula in the developing world. Those fistulae occurring after labour and its complications is called obstetric fistula. We report a case of complex obstetric fistula in a 32 y woman who was having continuous leakage of urine since last 10 y following caesarean section for obstructed labour. A successful fistula repair was done with transvaginal approach with Latzko technique and interposition with Martius flap.</p> Atit Poudel, Ganesh Dangal Copyright (c) 2021 Journal of Patan Academy of Health Sciences Sun, 27 Jun 2021 00:00:00 +0000 Uterine carcinosarcoma: a rare cause for postmenopausal bleeding <p>Uterine carcinosarcoma is a rare aggressive tumor also known as Malignant Mixed MullerianTumor.&nbsp; Prognosis is poor with 30-40% having extrauterine involvement at the first presentation and over 10% with distant metastasis. The primary treatment is surgery, along with radio-chemotherapy. We report a case of uterine carcinosarcoma in a 65 y para four lady who presented with blood mixed discharge per vagina for one month and polypoidal mass protruding through the cervical os. Endometrial biopsy showed carcinosarcoma. She was managed with surgery. She received adjuvant chemotherapy paclitaxel and carboplatin. There was no recurrence at six months follow-ups.</p> Neebha Ojha, Eliza Shrestha, Jasma Mally, Rupam Pandey, Snigdha Rai Copyright (c) 2021 Journal of Patan Academy of Health Sciences Mon, 03 May 2021 00:00:00 +0000 Predicting third wave of COVID 19 in Nepal <p>Nepal is experiencing second wave of COVID-19 infection leading to major health impacts and crisis. Despite the development of vaccine against COVID-19 and its wider coverage, many countries have already experienced third wave. After vaccination against COVID-19 antibodies has been seen to be present till eight months in different studies, evidences beyond that is yet to come. Looking at the trends of reinfections and mathematical models for prediction of COVID-19 infection, there is high chances that Nepal will face third wave, and children will be affected more due to unavailability of vaccine for this age group. There is no fixed definite time to detect when the third wave hit. From the health crisis experience during second wave, Nepal should stress on implication of various strategic and evidence-based measures for third wave preparedness and mitigation to minimize the morbidity, post COVID-19 infection complications and mortality.</p> Rony Maharjan, Dipesh Mangal Joshi Copyright (c) 2021 Tue, 31 Aug 2021 00:00:00 +0000 The scenario of childhood blindness and its remedy in Nepal <p>Childhood blindness represents one of the most common disabling and for children. There are approximately 1.4 million blind children worldwide and two-thirds live in the developing countries like Nepal. In Nepal more than 80% of the causes of childhood blindness are preventable. The main causes of blindness are diseases related to cornea, retina, lens optic nerve, refractive errors, amblyopia and hereditary. Most of the cases of unilateral childhood blindness are due to corneal causes. To decrease the burden of blindness, awareness program about various ocular diseases, nutritional blindness, ocular trauma, refractive errors, strabismus and amblyopia should be provided to the community health workers and parents. School screening programs and free eye camps should be conducted and motivate the community for regular eye checkup and follow up. Eye services should reach to rural areas and for poor socio-economic condition. Eye health education should focus on proper nutrition of children and harmful effects of traditional eye medicines. The objective of this study was to investigate the magnitude of childhood blindness in Nepal along with their possible causes. Similarly, this study is aimed to highlight the best possible modalities for the remedy of childhood blindness in the developing countries like Nepal.</p> Sanjeev Bhattarai Copyright (c) 2021 Tue, 28 Sep 2021 00:00:00 +0000 Breakthrough infection after COVID-19 vaccination: A threat for Nepal due to SARS-CoV-2 variants circulating in 2nd wave ravaging India <p>After a year of the COVID-19 pandemic, the meta-analysis in Dec 2020 did not support its reinfections. Now it’s clear that not only reinfection following earlier exposure is a reality, but also breakthrough infections after vaccinations have been increasingly reported. A breakthrough infection means that the infection has broken through the protection provided by the vaccine. The course of the disease, strict observation for preventive measures, together with safe vaccines is necessary long-term solutions. The effectiveness of the vaccine, durability of immunity, the role of the virus variants, the incidence and severity of breakthrough infections are the challenges in real life. A breakthrough infection is the detection of SARS-CoV-2 RNA or antigen in the respiratory specimen ≥14 days after inoculation of a vaccine. A breakthrough infection of 0.04 to 13% has been reported in the literature. Nepal began vaccine rollout in late Jan 2021. Nearly 3 million population has been vaccinated by two vaccines, the Covishield (AstraZeneca, from India) and Vero Cell (Sinopharm, China). Only minor ‘Adverse Event Following Immunization’ after the initial vaccine rollout has been reported. There is a lack of reports on the breakthrough infection for these vaccines in the local population. Analysis of the data on breakthrough infection from the vaccine rollouts in Nepal is awaited.</p> Jay Narayan Shah, Priscilla Samson, Nabees Man Singh Pradhan, Shreekrishna Maharjan, Ashis Shrestha, Jenifei Shah, Jesifei Shah, Sarala KC Copyright (c) 2021 Journal of Patan Academy of Health Sciences Tue, 31 Aug 2021 00:00:00 +0000 COVID-19 impact on liver: inter-organ cross-talk in an acute inflammation <p>Since coronavirus disease 2019 (COVID-19) has been a new disease, very less is known about the disease, and guidance for the treatment are often being made on the basis of an experiences or expert opinions. Now it is known that COVID-19 is caused by a new Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus which elicit infection to the cells by binding of the spike protein to angiotensin converting enzyme 2 (ACE2). Given the high transmissibility rate of the SARS-Cov-2 virus and known to have cytokine dysregulation by inducing an immune-mediated systemic inflammation, patients with underlying liver disease might be at an increased risk of severe infection and death. Here we report different mechanisms based on the organ cross-talk and other causes that how COVID-19 patients are prone to have liver injury.</p> Dipesh Kumar Yadav, Alina Singh, Rajesh Kumar Yadav, Huang Xing, Bai Xue Li, Liang Tingbo Copyright (c) 2021 Tue, 31 Aug 2021 00:00:00 +0000 Stroke patients presenting to the emergency department of a tertiary care hospital <p><strong>Introduction</strong>: Stroke is one of the most common causes of morbidity and mortality in Nepal. It is the 3rd most common cause of death worldwide. In Nepal Non-communicable diseases in Nepal(NCDs) states that stroke accounts for 42% of all deaths and is estimated to reach about 66.3% of all deaths by 2030.</p> <p><strong>Method:</strong> A retrospective cross-sectional study of all stroke patients seen in Patan Hospital Emergency Department for a period of 1 y. Demographic data, presenting complaint, time of onset of symptoms, time presenting to the Emergency, patient’s risk factors for stroke, head CT findings (hemorrhagic or ischemic stroke) were analyzed descriptively. Ethical approval was taken.</p> <p><strong>Result:</strong> Total 170 patients (96 males i.e.56.5% and 74 females i.e. 43.5%) were analyzed. 130(76.5%) were ischemic CVA and 40 (23.5%) were hemorrhagic CVA. The most common presenting symptoms was hemiparesis and speech changes.</p> <p><strong>Conclusion:</strong> Stroke is a common disease seen in Nepal, with higher percentages of hemorrhagic stroke.</p> Suraj Rijal, Sunil Adhikari, Darlene Rose House Copyright (c) 2021 Tue, 28 Sep 2021 00:00:00 +0000 Hemodynamic changes after spinal anesthesia in children below the age of four years <p><strong>Introduction</strong>: Introduction: Spinal anesthesia has become the anesthesia of choice for most of the surgeries of the abdominal-pelvic region.&nbsp; Cited with benefits such as lesser risks of apnea, minimal cardiopulmonary alteration, and abnormalities associated with neurocognitive development, it incorporates all components of balanced anesthesia, especially in pediatric surgeries. Encouraging results on the safety, efficacy, and feasibility of spinal anesthesia has increased its utility. The objective of our study was to assess the hemodynamic change occurring in children below four years undergoing lower abdominal and pelvic surgeries following spinal anesthesia.</p> <p><strong>Method:</strong> This is a cross-sectional study conducted over 2 years and includes children undergoing surgery of the lower abdomen in Kathmandu Model Hospital. The information was data regarding patients' demography, hemodynamic status prior, during, and after the procedure of spinal anesthesia, measuring systolic blood pressure (SBP), diastolic blood pressure (SBP), mean arterial pressure (MAP), heart rate (HR), sensory and motor block characteristics (modified Bromage scale) and complications.</p> <p><strong>Result:</strong> The intraoperative and postoperative hemodynamics did not show major differences. The mean peak sensory level was T4 (C7-T10) during the block. Recovery of sensory and motor blocks was complete in all patients. Modified Bromage scale was 1 in 57(98.27%), 2 h post-surgery.&nbsp; The average duration of the block was 75 min (30-180). 1(1.72%) patient developed apnea during the surgery.</p> <p><strong>Conclusion:</strong> Spinal anesthesia in small children showed minimal variation in intraoperative and postoperative hemodynamics and is a safer mode of anesthesia with sparing of respiratory alterations seen with general anesthesia.</p> Rikal Man Shrestha, Sunita Gurung, Sujan Surya Prajapati, Biplav Pokharel, Indra Kumar Shrestha, Manoj Krishna Shrestha, Sadikshya Ghimire, Brahma Dev Jha Copyright (c) 2021 Journal of Patan Academy of Health Sciences Thu, 10 Jun 2021 00:00:00 +0000 Laparoscopic excision of congenital choledochal cyst in children and modified hepaticojejunostomy with an unequal length of the jejunal loop <p><strong>Introduction:</strong> Complete excision biliary-enteric reconstruction is necessary for a congenital choledochal cyst (CC) to prevent recurrent cholangitis, acute pancreatitis, and cholangiocarcinoma. Among various reconstructions, this study aims to evaluate the therapeutic effect of unequal length jejunal loop for the biliary reconstruction of congenital choledochal cyst.</p> <p><strong>Method: </strong>The clinical data of 56 cases of congenital choledochal cyst treated in the pediatric surgery department of Children's Hospital Affiliated to Zheng Zhou University were retrospectively analyzed. All cases were treated with choledochal cyst resection and unequal length jejunal loop biliary reconstruction, including 51 cases with laparoscopic surgery and 5 cases with traditional surgery.</p> <p><strong>Result: </strong>Choledochal cyst resection and unequal length jejunal loop biliary reconstruction were successfully completed in all cases. One case of laparoscopic operation developed biliary fistula on the 3rd day after the operation, and the biliary fistula healed after conservative treatment for 8 days. The other cases recovered smoothly without obvious complications. No contrast agent bile loop reflux was found in upper gastrointestinal angiography.</p> <p><strong>Conclusion: </strong>The modified jejunal loop biliary reconstruction has many advantages over the traditional biliary reconstruction, which is worthy of clinical application.</p> Hou Guang Jun, Geng Xian Jie, Zhou Liang, Liang Ying, Liu Ru, Li Peng Fei, Ma Chun Miao, Zhou Chong Chen Copyright (c) 2021 Journal of Patan Academy of Health Sciences Thu, 10 Jun 2021 00:00:00 +0000 Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal <p><strong>Introduction</strong>: Upper gastrointestinal bleeding is an acute emergency condition. It is an important cause for the hospital admission. This study descriptively analyses the clinical profile of upper gastrointestinal bleeding presenting to a tertiary hospital in Nepal.</p> <p><strong>Method</strong>: This is a cross-sectional study of patients presenting with upper gastrointestinal bleeding from 01 Oct 2018 to 30 Sep 2019 at Patan Hospital Emergency Department, Patan Academy of Health Sciences, Nepal. Patient’s demographics, clinical presentation, duration of illness before presenting to Emergency, vitals, and laboratory parameters were descriptively analyzed. Ethical approval was obtained.</p> <p><strong>Result:</strong> There were 121 patients, male 82(67.8%) and female 38(31.4%) aging 14 to 90 years. Fifty-three patients (43.8 %) presented with hematemesis, 38(31.4%) with melena, and 27(22.3%) with both hematemesis and melena. Variceal bleeding was the main cause of upper gastrointestinal bleeding found in 73(60.33%) followed by ulcer bleeding in 48(39.66%).</p> <p><strong>Conclusion:</strong> Variceal bleeding was the main cause of upper gastrointestinal bleeding and hematemesis was the most common clinical presentation in patients presenting to the Emergency Department.</p> Sunil Adhikari, Suraj Rijal, Darlene Rose House Copyright (c) 2021 Tue, 28 Sep 2021 00:00:00 +0000 Histopathological evaluation of kidney disease in patients with diabetes mellitus <p><strong>Introduction</strong>: Non diabetic kidney disease (NDKD), a treatable condition, is common in diabetic patients with atypical clinical presentations. Present study aimed to find out histopathological diagnosis of kidney disease in type 2 Diabetes mellitus with such presentations.</p> <p><strong>Method:</strong> This was a hospital based cross sectional study conducted in Nephrology department, Bir hospital, Nepal from Aug 2019 to January 2021. Total 29 diabetic patients with atypical presentations, rapid rise of proteinuria alone (n=5), with microscopic hematuria (n=6), with impaired renal function (n=8) and rapid rise of creatinine with (n=8) or without (n=2) microscopic hematuria were included. The baseline information was recorded and kidney biopsy was performed.</p> <p><strong>Result:</strong> The mean age of patients was 52.6±10.4 y and 22(75.9%) were male. Diabetic retinopathy (DR) was absent in 24(82.8%) patients. Presence of NDKD alone was in 6(20.7%) and superimposed on diabetic kidney disease (DKD) in 10(34.5%) with total NDKD in 16(55.2%) and isolated DKD in 13(44.8%) patients. Non diabetic kidney disease were glomerulonephritis 12(75%) with membranous nephropathy 4(25%) and IgA nephropathy 4(25%) patients. The significant difference between NDKD and isolated DKD was only the duration of diabetes &lt; 5 y in 8(61.5%) of isolated DKD and ≥5 y in 13(81.2%) patients with NDKD (p=0.018). Diabetic retinopathy was absent in 6(100%) patients with isolated NDKD, 8(80%) of class III and 5(62.5%) of class IV DKD.</p> <p><strong>Conclusion:</strong> Glomerulonephritis is the commonest NDKD in type 2 DM with atypical presentation and advance DKD (Class III &amp; IV) is present even in absence of diabetic retinopathy and short duration of diabetes.</p> Juju Raj Shrestha, Kashyap Dahal, Anil Baral, Rajani Hada Copyright (c) 2021 Tue, 28 Sep 2021 00:00:00 +0000