Caesarean section is one of the most common surgeries performed in modern obstetrics. The rising trend of caesarean section in modern obstetrics is a major concern in health care system all over the world. With all the limited health care resources in a developing country like Nepal, this rising trend definitely has major implication. Rates of caesarean section countries in many countries have increased beyond the recommended level (WHO, 1985). Current available data from developed countries revealed morbidity and mortality from CS is more than in vaginal delivery for both the mother and fetus. Thus this study was conducted to evaluate the rate and indication for CS and to identify the measures to decrease its incidence if possible. Our results shows the foetal distress as the most common indication for Cesarean section in a eastern part of Nepal, which can be minimized significantly if a proper and timely investigation is carried out.

Objective: To assess the efficacy, safety and cost effectiveness of Misoprostol (Prostaglandin E1 analogue) as a single dose of 800μg in first trimester abortion Methods: A descriptive study was conducted in Nobel Medical College and Teaching Hospital from June 2010-June 2011 where 110 patients were enrolled for first trimester abortions including incomplete, missed, blighted ovum. Each woman received a single dose of 800μg of Misoprostol intravaginally and the the process of abortion was monitored to assess the outcome measures. Results: Successful abortion was seen in 102 patients (92.7%) with induction to delivery interval of < 24 hours and the remaining 8 (7.2%) of them had to undergo surgical evacuation. Side effects noted were lower abdominal pain, fever, nausea, vomiting, and diarrhoea. Mean hospital stay of the patients was 48 hours. Conclusion: Misoprostol is a safe, cost effective and efficacious drug for first trimester abortion even as a single dosage.

Allylpyrocatechol, the active component obtained from ethanol extract of leaves of Piper betle Linn at a dose of 120mg/kg body weight was shown to be an antiulcerogenic agent . Allylpyrocatechol was isolated from PBE by column chromatographic separation followed by preparative TLC and tested in rat ulcer model. Histological studies reveal that damage in the mucosal epithelium was corrected and the disrupted epithelium (as seen in ulcer) reversed with the test compound. The cellular, molecular and biochemical factors underlying the healing of gastric ulcer, such as, growth factors (EGF, EGF-R, SMAD-4) and cyclooxygenases (COX-1 and COX-2) were observed to be up-regulated in presence of APC during healing process. All the data showed statistical significance (by one way ANOVA) when compared to the experimental control value.

Dyke-Davidoff-Masson Syndrome (DDMS) is characterized by seizures, facial asymmetry, contralateral hemiplegia and mental retardation. The characteristic radiologic features are cerebral hemiatrophy with homolateral hypertrophy of the skull and sinuses. Here we report a case of a 16 years young girl who presented with seizures severe mental retardation and weakness of left upper-limb and on CT brain was diagnosed to have DDMS. Key words: DDMS, Seizure, mental retardation, Hemiatrophy, hypoplasia, cerebral hemisphere

A Prospective study of 30 cases of type III open fractures of tibia is conducted at Nepal Medical College, Kathmandu and Nobel Medical College, Biratnagar from 2009 to 2011. All cases included in the study were initially managed by wound debridement and external fixation, and followed-up regularly for 10 months for outcome. Five cases developed deep infection and 10 had superficial infection, which subsided with prolonged use of antibiotics. Union was obtained in 7 to 8 months for 28 cases. Two cases resulted in non- union which had been managed by bone grafting. Open Type III fractures of tibia are still a difficult and challenging problem for orthopedic surgeons. Almost all cases are required for twice surgery including secondary closure, skin grafting and readjustment.

Background: Inadequate sanitation has direct effect on health of individual, family, communities and nation as a whole. Objective: To assess the personal hygiene and sanitary condition of the Katahari Village Development Committee (VDC). Methods: The cross sectional study was done in Katahari VDC of Morang district. A total of 80 households were randomly selected from two wards of VDC. The data were collected by interview method using interview schedule. Data were entered in Excel sheet and analyzed on SPSS program. Results: Many respondents (61%) were unable to read and write, 33% involved in private job in various factory. Knowledge of sanitation was high (90%) but only 65% of them were using soap water for hand washing. Sixty percent had no toilet facilities. There was significant association between education and toilet facilities among community people. Land holding and type of family had no significant association with toilet facilities. Conclusion: The knowledge regarding sanitation was high among community people but very poor in practice.

Study on prevalence of psychiatric disorders in Eastern part of Nepal, is relatively understudied subject in Nepal. The present study is undertaken with the aim to study the socio-demographic characteristics and diagnostic profile of patients attending the psychiatry OPD of Nobel Medical College, that provides both outpatient and inpatient services to psychiatric patients residing in eastern part of Nepal and nearby Indian villages. It was a retrospective study where all consecutive patients attending the Psychiatry OPD from 1st May 2011 to 30th April 2012 and fulfilling the diagnostic criteria for Category F of ICD-101 were included in the study. Amongst the total number of 637 patients, cases with Epilepsy (N=44), Headache (N=53), other medical disorders (N=13) and incomplete case record (N=17) were excluded, and the final sample size was comprised of 510 cases (males=214 and females=296). Maximum numbers of patients were in the age-group 16-40 years (N=238, 47%) and were married (N=416, 79.04%). Most of the patients suffered from Neurotic stress-related and somatoform disorders (N=214, 41.96%), followed by Mood (N=168, 32.94%) and Schizophrenia, schizotypal and related disorders (N=56, 10.98%).

Allylpyrocatechol, the active component obtained from ethanol extract of leaves of Piper betle Linn at a dose of 120mg/kg body weight was shown to be an antiulcerogenic agent . Allylpyrocatechol was isolated from PBE by column chromatographic separation followed by preparative TLC and tested in rat ulcer model. Histological studies reveal that damage in the mucosal epithelium was corrected and the disrupted epithelium (as seen in ulcer) reversed with the test compound. The cellular, molecular and biochemical factors underlying the healing of gastric ulcer, such as, growth factors (EGF, EGF-R, SMAD-4) and cyclooxygenases (COX-1 and COX-2) were observed to be up-regulated in presence of APC during healing process. All the data showed statistical significance (by one way ANOVA) when compared to the experimental control value. ; , , .

Haemoglobin levels were used to estimate the incidence of anaemia in children 2-12 years old in the population of Biratnagar,Morang Dist., Nepal. who were attending Nobel Medical College & teaching hospital. Out of 5063 subjects, 634 children’s were selectively diagnosed as anaemia. Among the 2406 children’s aged 2-6 years 5.4% were diagnosed with mild anaemia,2.7% moderate anaemia and 1.7% severe anaemia (WHO definition) of 2657 children’s aged 7-12 years,10.2% were diagnosed with mild anaemia, 3.1% moderate anaemia and 1.3% severe anaemia.

Objective: To find out the proportion of intracranial abnormalities in patients with chronic headache without neurologic abnormality with the use of computed tomography (CT) and to compare the results with similar studies done previously. Materials and methods: CT images of 56 patients with chronic/recurrent headache and normal neurological findings were reviewed retrospectively. In 38 of 56 patients, both plain and contrast enhanced CT were done. Patients were divided into three groups according to the CT findings: those with no abnormality, those with minor abnormality (that did not alter patient management) and those with clinically significant abnormality. Proportion of patients in each group was found out and results were compared with previous studies with similar study design. Z test was used to evaluate whether the difference in proportions of patients in our study and previous study was statistically significant or not. Results: Of the 56 patients, 50 had normal CT (89.28 %), four had minor abnormality (7.14%) that did not alter patient management and two had significant lesions (3.57%). Contrast enhanced CT did not improve lesion detection. The minor findings detected were sub-ependymal calcifications of Tuberous sclerosis, calcified neurocysticercosis and old lacunar infarctions in external capsule. Clinically significant lesions detected were small ring enhancing lesion (neurocysticercosis or tuberculoma) and pineal cyst. Results of this study were compared with previous study with similar study design. The Z test showed that the difference in proportions in these studies was not statistically significant (p =0.0708 for minor findings and p =0.2033 for significant findings). Conclusion: The proportion of intracranial abnormalities detected by CT in this study was similar to that of previous studies. The use of intravenous contrast material administration did not improve its yield. This corroborates the evidence that the ability of CT scan in detecting significant intracranial pathology is poor in patients with chronic headache without neurologic abnormality.

Objectives: To evaluate the prevalence of mental retardation by gender and age of diagnosis at Nobel Medical College, Biratnagar. Methods: The data of all mentally retarded children recorded within a period of one year from 01st May 2011 to 30th April 2012 is analyzed retrospectively. Age, gender, IQ scores, the age of diagnosis, and their living place were evaluated. Results and conclusion: A total number 103 children attended the Psychiatric Out-patient Department of Nobel medical College and Teaching Hospital over the study period of one year. Out of all those 103 children, 67 children were with normal IQ scores, 7 with coexistence of epilepsy and other medical problems, and 3 children with incomplete case records, thus they were excluded from the study, and the subjects for further study was constituted by just 26 cases, who fulfilled the diagnostic criteria for Mental Retardation according to ICD-10. The overall prevalence of mental retardation in our study was 25% and the distribution of mental retardation amongst all those 26 cases were as follows: 2 cases (8%) were profound, 3 severe (12%), 7 (27%) were moderate and 9 (35%) mild, and 5 (19%) were borderline. Out of all those 26 mentally retarded children 11 were male (42%) and 15 (58%) were female, and of these cases, 07 were living in urban, and 19 in rural areas. Most of our cases were diagnosed between 6-10 years of age.

Thirty two years multipara with amenorrhoea of five months presented with bleeding per vagina for ten days. Clinically and radiologically she was diagnosed with intrauterine fetal demise at 20 weeks period of gestation. She was induced with prostaglandins continuously for seven days. On eighth day of admission features of uterine rupture was present. On laparotomy ruptured huge dermoid cyst with chemical peritonitis was discovered. There was no evidence of pregnancy. We are reporting this case for a rare complication of ruptured dermoid cyst and also to illustrate the importance of clinical assessment. Keywords: intrauterine fetal demise, ruptured dermoid cyst, chemical peritonitis, ultrasound

A prospective study of 20 comminuted femoral fractures, open and close, treated with interlocked intramedullary nailing. The mechanical strength of the nail and less invasive procedure has made the procedure preferable. Short Operative time and less blood loss was seen during surgical procedure. Out of 20 cases , 10 cases were taken from Nepal Medical College, Kathmandu and 10 cases from Nobel Medical College, Biratnagar, during years 2009 to 2011, which had been completed at least six months follow up. Almost all cases were relatively free from long term complication. The results were promising .All fractures healed within 6 months.

Diabetes mellitus is a group of metabolic disorder characterized by hyperglycemia resulting from defect in insulin secretion and/or insulin action. Thyroid dysfunction in diabetes mellitus patient has been frequently encountered. The clinical relationship between diabetes mellitus and thyroid function is becoming more widely recognized with hypothyroidism among diabetes mellitus patient. Total of 100 cases and 50 controls are enrolled into the study. Their fasting venous blood sample was taken and analyzed for blood sugar, T3, T4 and TSH. Blood sugar and TSH level were elevated while T3 and T4 level were statically decreased in case group in comparison to control group. Key Words:

Background: Hypertension (HTN) is a major risk factor for cardiovascular and renal diseases. The prevalence of hypertension has substantially increased during the past four decades. Information on prevalence as well as awareness regarding treatment and prevention of hypertension is scarce particularly in rural settings. The levels of awareness, treatment, and control of HTN vary between different countries and population groups. Objectives: The objective of this study was to find out the awareness of hypertensive patients about their own disease and self care. Methodology: Descriptive cross sectional study was conducted among 50 hypertensive patients who were admitted to Tribhuvan University Teaching Hospital (TUTH) and attended to medical OPD. Data was collected by using interview schedule by face to face interview method. Results: Among 50 hypertensive patients, 56% were aware about meaning of hypertension, 68% symptoms, 34% cause, 62% prognosis, and 62% complication of HTN. Likewise regarding self care, 70% were doing regular follow up, 92% using regular medication, most of them (80%) were not smoker and 84% were non alcoholic, and 74% taking low fat and low salt diet. Conclusion: Study finding reflects many of them (56%) had more than 50% of knowledge about the hypertension and more than half (54%) were giving more than 50% emphasis about their own self care.

A Prospective study of 30 cases of type III open fractures of tibia is conducted at Nepal Medical College, Kathmandu and Nobel Medical College, Biratnagar from 2009 to 2011. All cases included in the study were initially managed by wound debridement and external fixation, and followed-up regularly for 10 months for outcome. Five cases developed deep infection and 10 had superficial infection, which subsided with prolonged use of antibiotics. Union was obtained in 7to 8 months for 28 cases. Two cases resulted in non- union which had been managed by bone grafting. Open Type III fractures of tibia are still a difficult and challenging problem for orthopedic surgeons. Almost all cases are required for twice surgery including secondary closure, skin grafting and readjustment.

Microalbuminuria appears early in the natural history of kidney disease. Hypertension accelerates the progressive increase in albuminuria and decline in glomerular filtration rate, albuminuria is the most important risk for progressive kidney injury. Greater urinary albumin excretion is due to increased glomerular hydrostatic pressure and increased permselectivity of the glomerular basement membrane. Reduction in albuminuria is protective for the development of complication, Angiotensin converting enzyme inhibitor leads to larger decrease in albuminuria when compared to other antihypertensive drugs.

Haemoglobin levels were used to estimate the incidence of anaemia in children 2-12 years old in the population of Biratnagar,Morang Dist., Nepal. who were attending Nobel Medical College & teaching hospital. Out of 5063 subjects, 634 children’s were selectively diagnosed as anaemia. Among the 2406 children’s aged 2-6 years 5.4% were diagnosed with mild anaemia,2.7% moderate anaemia and 1.7% severe anaemia (WHO definition) of 2657 children’s aged 7-12 years,10.2% were diagnosed with mild anaemia, 3.1% moderate anaemia and 1.3% severe anaemia.

Background: Hypertension (HTN) is a major risk factor for cardiovascular and renal diseases. The prevalence of hypertension has substantially increased during the past four decades. Information on prevalence as well as awareness regarding treatment and prevention of hypertension is scarce particularly in rural settings. The levels of awareness, treatment, and control of HTN vary between different countries and population groups. Objectives: The objective of this study was to find out the awareness of hypertensive patients about their own disease and self care. Methodology: Descriptive cross sectional study was conducted among 50 hypertensive patients who were admitted to Tribhuvan University Teaching Hospital (TUTH) and attended to medical OPD. Data was collected by using interview schedule by face to face interview method. Results: Among 50 hypertensive patients, 56% were aware about meaning of hypertension, 68% symptoms, 34% cause, 62% prognosis, and 62% complication of HTN. Likewise regarding self care, 70% were doing regular follow up, 92% using regular medication, most of them (80%) were not smoker and 84% were non alcoholic, and 74% taking low fat and low salt diet. Conclusion: Study finding reflects many of them (56%) had more than 50% of knowledge about the hypertension and more than half (54%) were giving more than 50% emphasis about their own self care.