Nepalese Medical Journal 2022-01-11T00:00:00+00:00 Dr Shiva Raj KC Open Journal Systems <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> Histomorphological Pattern of Malignant Skin Tumors – A Cross-sectional Study in a Teaching Hospital 2021-12-10T08:56:09+00:00 Sushma Thapa Arnab Ghosh Dilasma Ghartimagar Sudeep Regmi Adarsh Kumar Jhunjhunwala <p><strong>Introduction</strong>: The incidence of skin cancer is increasing exponentially around the world. This study aims to analyze different malignant skin tumors concerning age pattern, gender, and site-wise distribution.</p> <p><strong>Materials and Methods: </strong>This is a descriptive cross-sectional hospital-based study carried out in the Department of Pathology, a tertiary care center for over ten years from April 2011 to March 2021. All malignant skin tumors arising from the epidermis along with melanocytic and adnexal tumors were included in the study.</p> <p><strong>Results: </strong>A total of 208 cases of skin malignancies among which 117 (56.3%) cases were males and 91 (43.8%) females with a male to female ratio of 1.3:1. Overall, the majority were seen in the sixth decade 49 (23.6%) with head and neck region 113 (54.3%) being the commonest site of involvement. Basal cell carcinoma 79 (38%) was the most frequent non-melanoma skin cancer followed by squamous cell carcinoma 75 (36.1%). A maximum number of basal cell carcinoma were observed in the sixth decade 19 (24.1%) whereas squamous cell carcinoma in the seventh decade 21 (28%) cases. Other skin cancers were malignant melanoma 31 (14.9%), verrucous carcinoma 13 (6.3%), trichilemmal carcinoma five (2.4%), sebaceous carcinoma two (1%), and one case each of eccrine carcinoma, malignant nodular hidradenoma, and malignant proliferating trichilemmal tumor.</p> <p><strong>Conclusions</strong>: Skin malignancies were seen in the sixth decade with male preponderance. Overall, the head and neck region was the commonest site of involvement. Basal cell carcinoma was the most frequent non-melanoma skin cancer followed by squamous cell carcinoma.</p> 2021-12-30T00:00:00+00:00 Copyright (c) 2021 Sushma Thapa, Arnab Ghosh, Dilasma Ghartimagar, Sudeep Regmi, Adarsh Kumar Jhunjhunwala Clinical Manifestations, Neuroimaging Findings, and Treatment of Idiopathic Intracranial Hypertension in a Nepalese Tertiary Centre 2021-10-01T01:06:12+00:00 Niraj Gautam Rajeev Ojha Sanjeev Kharel Bikram Prasad Gajurel Sanjeeta Sitaula Ragesh Karn Reema Rajbhandari Ashish Shrestha <p><strong>Introduction: </strong>Idiopathic Intracranial Hypertension is characterized by headache, visual impairment, papilledema, and increased cerebrospinal fluid opening pressure. We aim to evaluate clinical manifestations, neuroimaging findings, and treatment of Idiopathic Intracranial Hypertension in a Nepalese tertiary center.</p> <p><strong>Materials and Methods: </strong>We retrospectively included patients with the diagnosis of Idiopathic Intracranial Hypertension who were admitted to the Neurology department of Tribhuvan University Teaching Hospital from 2019 June to 2021 May and presented to the Neuro-ophthalmology outpatient clinic of the hospital for follow-up.</p> <p><strong>Results: </strong>Out of 16 Idiopathic Intracranial Hypertension patients, 12(75%) patients had either headache or ocular pain. Reduced visual acuity and progressive visual loss were found in 44% of patients. Normal CSF opening pressure was found in 19%, 44% had CSF opening pressure at a range of 20-30 cm H<sub>2</sub>0 and &gt; 30 cm H<sub>2</sub>0 in 37.5%. 15 Idiopathic Intracranial Hypertension patients (93.7%) were subtyped as Typical and 1 patient was diagnosed as Fulminant Idiopathic Intracranial Hypertension. Acetazolamide was used for treatment in 15 patients and 1 patient needed ventriculoperitoneal shunting. 56% Seven patients (44%) had some abnormal findings: partial empty sella (44%), and tortuous optic nerve (31%), flattened posterior eyeball (31%), and hypoplastic transverse sinus (19%).</p> <p><strong>Conclusions: </strong>Idiopathic Intracranial Hypertension is an uncommon diagnosis but should be suspected in patients with chronic headaches with visual impairment. In low-resource settings, proper history along with neurological and ophthalmological examinations can even detect the early features and timely referral can save the vision and disability of Idiopathic Intracranial Hypertension patients.</p> 2021-12-31T00:00:00+00:00 Copyright (c) 2021 Niraj Gautam, Rajeev Ojha, Sanjeev Kharel, Bikram Prasad Gajurel, Sanjeeta Sitaula, Ragesh Karn, Reema Rajbhandari, Ashish Shrestha Histopathological Spectrum of Non-neoplastic and Neoplastic Lesions of Urinary Bladder 2021-12-11T08:36:42+00:00 Manisha Shrestha Dipti Gautam Prakriti Shah Prateek Krishna Shrestha <p><strong>Introduction: </strong>Urinary bladder is a site of various non-neoplastic and neoplastic lesions, both of which can present with hematuria. Cystoscopy allows for direct visualization of the bladder mucosa and also obtaining tissue for histopathologic evaluation. The most common non-neoplastic and neoplastic lesion of the urinary bladder is non-specific cystitis and urothelial carcinoma respectively.</p> <p><strong>Materials and methods: </strong>This study is a 4-year retrospective study conducted in the Department of Pathology at Patan Hospital, Nepal. All cases from the urinary bladder i.e., both cystoscopic and cystectomy samples were included in the study. Hematoxylin and eosin-stained slides were re-evaluated whenever required.</p> <p><strong>Results: </strong>A total of 145 cases were included which consisted of 17 cystectomy specimens and 128 cystoscopic biopsies. There was a male predominance. The non-neoplastic and neoplastic cases consisted of 32% and 68% respectively. Chronic non-specific cystitis and high-grade infiltrating urothelial carcinoma were the most common non-neoplastic and neoplastic lesions respectively. 56.1% of cystoscopic biopsies had the presence of detrusor muscle with 21.7% showing its invasion.</p> <p><strong>Conclusions: </strong>Urinary bladder lesions have a wide spectrum ranging from non-neoplastic to neoplastic conditions. The presence of detrusor muscle in a cystoscopic biopsy, and its evaluation for invasion helps in diagnosis and further planning of patient management.</p> 2021-12-31T00:00:00+00:00 Copyright (c) 2021 Manisha Shrestha, Dipti Gautam, Prakriti Shah, Prateek Krishna Shrestha Histopathological Examination in the Categorization of fungal Rhinosinusitis - a Retrospective Study 2021-12-12T07:56:52+00:00 Sangeetha Kandasamy Megala Chandrasekar Thamilselvi Ramachadran <p><strong>Introduction: </strong>Fungal Rhinosinusitis is broadly defined as any sinonasal pathology related to the presence of fungi and is increasingly recognized worldwide. This study aimed to assess and ascertain the need for histopathological examination in the management of fungal Rhinosinusitis.</p> <p><strong>Materials and Methods: </strong>This study was performed over two years, from April 2019 to April 2021, in the Department of Pathology, Vinayaka Missions KirupanandaVariyar Medical College and Hospital, Salem. A total of 383 cases of rhinosinusitis/nasal polyps were studied. Histopathological examination and categorization were done and compared with clinical diagnosis.</p> <p><strong>Results: </strong>Only 4/18 cases of acute fungal Rhinosinusitis were correctly diagnosed(22.22%). Nineteen cases of the fungal ball were diagnosed, but none was correctly categorized. Clinical suspicion of fungal sinusitis was present in 10 cases of Rhinosinusitis, which turned out to be chronic Rhinosinusitis in histopathology. In AFRS, fungal elements were overlooked in Hematoxylin and Eosin stained slides and identified only by Grocottmethenamine silver in one-fourth of the cases.</p> <p><strong>Conclusions: </strong>Though clinical diagnosis was made in 86% of fungal rhinosinusitis cases, correct categorization was done only in one-third of cases. CT scan could diagnose 60% of cases, but none was categorized. As treatment depends on the type of fungal Rhinosinusitis, histopathological examination is the gold standard for diagnosing and treating fungal Rhinosinusitis.</p> 2021-12-31T00:00:00+00:00 Copyright (c) 2021 Sangeetha Kandasamy, Megala Chandrasekar, Thamilselvi Ramachadran Clinico-Demographic Profile of Covid-19 Patients Admitted in COVID- HDU and its Association with Conjunctivitis 2021-12-16T17:30:03+00:00 Pragya Singh Basnet Deepa Sharma Shravya Singh Karki Sauhaida Karki Hira Lal Bhandari Durga Shrestha <p><strong>Introduction: </strong>The outbreak of coronavirus diseases 2019 (Covid-19) caused by SARS-COV-2 which started in Wuhan china led to an alarming level of spread and severity. In Nepal, the first case of COVID-19 was reported on 23.1.2020 and has become a global health crisis since then. The clinical presentation and outcome of patients with COVID-19 have been variable in different countries and therefore it is important to analyze as well as document the clinical behaviors of this disease in the local population so we have reported the clinic-epidemiological profile, outcome, and its association with conjunctivitis during the second wave of this pandemic which hit Nepal badly hoping this study will be helpful to tackle the future surges of COVID-19 as well.</p> <p><strong>Materials and Methods: </strong>This was a prospective, single-center study where the data regarding epidemiology, demography, common clinical presentation as well as management and outcome of COVID-19 Patients were retracted and analyzed.</p> <p><strong>Results: </strong>A total of 238 COVID-Positive patients were admitted out of which 60% were male and 39.9% people belonged to Dang valley itself with dyspnea (67.2%) was the commonest symptoms followed by fever in 59.7% of patients. Out of these patients 9 patients presented with ocular symptom conjunctivitis.</p> <p><strong>Conclusions: </strong>Mild conjunctivitis manifesting as conjunctival congestion is common and one of the major ocular manifestations in COVID -19 positive patients.</p> 2021-12-31T00:00:00+00:00 Copyright (c) 2021 Pragya Singh Basnet, Deepa Sharma, Shravya Singh Karki, Sauhaida Karki, Hira Lal Bhandari, Durga Shrestha Spectrum and Presentation of Urinary Bladder Growth: a Single-Center Retrospective Study 2022-01-04T03:34:31+00:00 Deliya Paudel Himanshu Regmi Uspal Bajracharya Guna K Shrestha <p><strong>Introduction: </strong>Urinary bladder cancers are heterogeneous diseases consisting of a divergent group of tumors.&nbsp; Diseases of the urinary bladder, both neoplastic and nonneoplastic contribute to notable mortality and morbidity. Histopathology remains the gold standard of diagnosis. Bladder transurethral resection of the tumor is a therapeutic procedure that ensures the material necessary for histopathological diagnosis because it allows assessment of the degree of differentiation, depth of tumor invasion, parameters useful in the elaboration of diagnosis and prognosis assessment</p> <p><strong>Material and Methods: </strong>All the urinary bladder biopsies submitted in the pathology laboratory during 1 year time period were included in the study.</p> <p><strong>Results: </strong>Among the 51 total cases in the study, the male to female ratio was 4.67:1 with the age group of 22-96 years. Among the study population, 30 (52.7%)&nbsp; presented with hematuria, 10 (19.2%)&nbsp; with burning micturition, frequent urination, and lower abdominal pain. In the study, 44 (86%) showed neoplastic lesions while 7(14%) remaining were non-neoplastic lesions. Infiltrative urothelial carcinoma with low and high grades was diagnosed in&nbsp; 23% (12/51)</p> <p><strong>Conclusions: </strong>This study has revealed that neoplastic lesions are more common than non-neoplastic lesions. A great majority of neoplastic lesions are of urothelial origin. Majority of which are invasive urothelial neoplasm. All urothelial neoplasms are more common in males. Cystoscopic studies and biopsies help in the early detection of bladder neoplasms and they form the mainstay of the diagnosis and follow-up.</p> 2021-12-31T00:00:00+00:00 Copyright (c) 2021 Deliya Paudel, Himanshu Regmi, Uspal Bajracharya, Guna K Shrestha Perception and Practice of Blood Donation Among Medical Students in Southern Rajasthan, India 2021-12-28T08:45:05+00:00 Matariswa Samanta Dilip L Kumar Mehul Patel Nitesh Mangal K. A. Varghese <p><strong>Introduction</strong><strong>:</strong> Despite all efforts, there is a gap in the demand and supply of blood donation in India. Medical students play a crucial role in promoting and mobilizing blood donation among potential youth. The present study attempted to ascertain the knowledge, attitude, and practice as well as factors associated with actual blood donation among medical students at various stages of their studies.</p> <p><strong>Materials and Methods</strong><strong>: </strong>The cross-sectional study was conducted during May-June 2021using a pre-tested semi-structured questionnaire through Google form among 346 medical students representing first, second and third-year MBBS. The aggregate scores for knowledge and attitude worked out for each student and analyzed for gender effect, actual practice, a correlation between knowledge and attitude score, and factors contributing to it using z- test, correlation coefficient test, and chi-square test respectively.</p> <p><strong>Results</strong>: The blood donation by students was found significantly associated with sex, age, and phases of the MBBS curriculum (p&lt;0.05). The mean attitude score of female students (6.90) was higher compared to male students (6.60). There was a significant correlation (r=0.371) between the overall knowledge and attitude score of students towards blood donation.</p> <p><strong>Conclusions</strong>: The gender, age, and phase of study of medical students are significant factors contributing to actual blood donation. The higher attitude of female students could not be transformed into the actual practice of blood donation. Special efforts are required to enthuse medical students in general and female students in particular towards blood donation.</p> 2021-12-31T00:00:00+00:00 Copyright (c) 2021 Matariswa Samanta, Dilip L Kumar, Mehul Patel, Nitesh Mangal, KA Varghese Histopathological Study of Endometrial Changes in Hysterectomy Specimens with Cystic Lesion of Ovary 2021-12-24T09:54:10+00:00 Parvathi Pillai <p><strong>Introduction: </strong>Some of the ovarian lesions become functional and secrete hormones that bring endometrial changes like hyperplasias and polyps. This study aimed to find endometrial changes associated with different types of cystic lesions of the ovary.</p> <p><strong>Materials and Methods: </strong>A histopathological study done from 2010 -2013 on all the total abdominal hysterectomy specimens with bilateral oophorectomy having cyst size more than 3cms, with a detailed clinical history received in the Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry. A total of 112 cases were collected analyzed and statistically correlated.</p> <p><strong>Results: </strong>Out of the 112 cases of cystic lesions of the ovary 67% showed endometrium within normal limits, 33% of cystic lesions of ovary showed polyps, simple hyperplasia without atypia, complex hyperplasia without atypia. Among non-neoplastic lesions, follicular cyst produced the most endometrial changes, followed by benign surface epithelial lesions. Granulosa cell tumor was found to induce polyp as well as simple hyperplasia without atypia. Two out of three malignant lesions showed endometrial changes followed by benign lesions. The majority of the cystic lesions of the ovary encountered are non-neoplastic lesions (59%) and follicular cysts were more common (97%). Endometrial hyperplasia of both simple and complex types without atypia was found with serous cystadenoma.</p> <p><strong>Conclusions: </strong>From the current study it implicates the necessity of assessing cystic lesions of the ovary like a follicular cyst, luteal cyst, granulosa cell tumors as they can become functional leading to endometrial changes that can form a fertile ground for carcinomas.</p> 2022-01-11T00:00:00+00:00 Copyright (c) 2022 Parvathi Pillai Speech, Language and Cognitive Profile of Mild Cognitive Impairment: A single Case Study 2021-08-01T03:59:41+00:00 Biraj Bhattarai Joanna K B P Niranjana Abhishek B P <p>Heterogeneity of symptoms within and among mild cognitive impairment individuals often makes it challenging to document case reports clinically. Additionally, data on the Indian population is also limited. Therefore, our study includes a case study of a 56-year-old male with mild cognitive impairment from our Institute. A patient had symptoms of mild cognitive impairment following a stroke that occurred 23 years back (vascular in origin). Both formal and informal assessments were carried out. Formal testing was done using the Montreal Cognitive Assessment. On assessment of memory, mild deficits in working memory, episodic memory, and procedural memory were noticed. Attention span and Word-finding difficulties with reduced use of words were observed in language assessment. Problems in reasoning, problem-solving, and decision-making skills, indicating deficits in executive functioning were evident. Linguistic deficits presenting secondary to cognitive deficits in our client could have led to communication breakdowns in speech, affecting his overall quality of life.</p> 2021-12-31T00:00:00+00:00 Copyright (c) 2021 Biraj Bhattarai, Joanna K B, P Niranjana, Dr. Abhishek B P Pseudoeosinophilia with Abnormal WBC Scattergram: an Important Diagnostic Clue on Hematology Analyzer 2021-12-30T06:24:52+00:00 Swathi C Prabhu Anita Tahlan Shreya Sharma Sarabmeet S Lehl <p>Malaria is one of the most common parasitic diseases causing a significant burden on health care, especially in India. Light microscopy, the gold standard for malaria diagnosis is time-consuming especially in a setup where the caseload is high and parasite index is low. Knowledge of abnormal scattergrams by the malarial parasite is very essential to suspect malaria and screen those cases thoroughly on a peripheral smear for accurate diagnosis. A timely and accurate diagnosis is crucial to the prognosis of this disease.</p> <p>Herein, we report a case of a 40-year-old male from Punjab who presented to the emergency with fever and an altered sensorium. Analyzer showed characteristic pseudo eosinophilia with greying of neutrophil eosinophil zone with double eosinophil cluster. According to flagging rules because of eosinophilia, peripheral blood film (PBF) was made and examined, which revealed Plasmodium falciparum gametocytes.</p> 2021-12-31T00:00:00+00:00 Copyright (c) 2021 Swathi C Prabhu, Anita Tahlan, Shreya Sharma, Sarabmeet S Lehl Vaccinating Our Hemodialysis Patients for COVID-19 2022-01-06T03:49:50+00:00 Nabin Bahadur Basnet 2022-01-11T00:00:00+00:00 Copyright (c) 2021 Nabin Bahadur Basnet