B. P. Koirala Institute Of Health Sciences Research Articles

Profile of Medico-legal Cases Coming to Emergency ward of B. P. Koirala Institute of Health Sciences

Background: Medico-legal case usually presents as an emergency case in any hospital. Profiling of these cases provides with evidence on the burden of the medico-legal cases and identifying ways to better manage these cases in the emergency ward of hospitals. 
 Objective: To study the profile of medico-legal cases coming to the emergency ward of B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. 
 Material & Methods: We conducted a retrospective review of all medico-legal cases presenting in the emergency ward of BPKIHS from April 2015 to March 2016. The cases were profiled for socio-demography, injury and diagnosis from the medico-legal register at the emergency ward of BPKIHS. 
 Results: Medico-legal cases comprise almost 10% of all cases at the emergency ward of BPKIHS. A total of 3,715 cases were included in this study. Half (50.0%) of the cases fell in to the category of 25-59 years. Males were almost twice (62.7%) in number, compared to females (37.3%). The top three diagnoses among medico-legal cases are road traffic accidents (41.81%), physical assault (21.13%) and poisoning (20.08%). Other diagnoses were burns, fall injury, sexual assault, self inflicted injury, hanging, gunshot injury, stab injury, machinery injury, drug overdose, blast injury, brought dead, trauma by animal, electrical injury, snake bite and human bite. 
 Conclusions: There are significant numbers and wide varieties of medico-legal cases that present in the emergency ward of BPKIHS. Given the large number of cases presenting at BPKIHS, there is a potential for future research on medico-legal cases for academic and policy purpose.

Risk Factors for Adverse Outcome in Pregnant Women with Obstructed Labor

Aims: The aim of the study was to assess the risk factors for adverse outcomes in pregnancy with obstructed labor.Methods: It was a prospective descriptive study conducted at BP Koirala Institute of Health sciences (BPKIHS).The patients with obstructed labour were managed and followed up until delivery and six weeks postpartum from Jan to Dec 2012.Results: There were 57 (0.6%) cases of obstructed labour out of 9500 deliveries. The main cause was cephalopelvic disproportion in 36 (63.2%). The majority of the cases were from rural areas, low socioeconomic status, non salaried and illiterate. Risk for maternal mortality, peripartum hysterectomy and perinatal mortality as adverse outcomes was significantly associated with low socioeconomic status (AOR 12.5, P=0.02) and literacy status (AOR 21.9, P=0.001). If only the risk of perinatal mortality is taken as an adverse outcome, it is significantly associated with booking status (AOR 7, P=0.001), low socioeconomic status (AOR 9.62, P=0.037) and literacy of the patient (AOR 15, P=0.001). Perinatal mortality rate was 100 per 1000 live births in women with obstructed labour. The case fatality rate was 1.2%.

Serum procalcitonin in bacterial & non-bacterial meningitis in children

BackgroundBacterial meningitis is a paediatric emergency with high mortality and morbidity requiring prompt diagnosis and treatment. Clinically, it is often difficult to differentiate between bacterial and non-bacterial meningitis. Several studies have demonstrated the raised values of serum procalcitonin (PCT) in bacterial infections including meningitis but without definite cut-off guidelines. Hence, this study was done to evaluate serum PCT as a marker to differentiate bacterial and non-bacterial meningitis in children and assess its efficacy.MethodsIt was a cross-sectional study done over a period of 5 months (Aug 2016-Dec 2016) in the department of Paediatrics, B P Koirala Institute of Health Sciences (BPKIHS). Fifty children aged 3 months to 15 years with suspected meningitis were enrolled and investigated with relevant investigations like complete blood counts, and cerebrospinal fluid (CSF) analysis along with serum PCT. Patients were classified into bacterial (22) and non-bacterial meningitis (28) according to clinical & CSF findings and data analysed using SPSS software.ResultsSerum PCT levels were significantly higher in bacterial meningitis group (median = 2.04 (1.2–3.18) ng/ml) compared with non-bacterial meningitis (median = 0.35 (0.18–0.35) ng/ml); p < 0.001. The sensitivity and specificity of serum PCT in diagnosis of bacterial meningitis at cut-off level of 0.5 ng/ml were 95.45% and 84.61% respectively. Procalcitonin showed maximum area under receiver operating characteristics (ROC) curve 0.991 (0.974–1.00) (p < 0.001) compared to total leukocyte count and CSF cytochemistry.ConclusionSerum PCT has high sensitivity and specificity for early diagnosis of bacterial meningitis in children. Hence it can be a useful adjunct in differentiating bacterial and non-bacterial meningitis for prompt and better management of the children.

Evaluation of Hypothermia in Sick Neonates as Predictor of Fatality at a Tertiary Care Center of Eastern Nepal

Introduction: Hypothermia is a common and frequent problem in newborns. It has larger impact in outcome related to management of sick infants.Objective: To correlate the severity of hypothermia in sick extramural neonates with fatality and physiological derangements.Materials and Methods: This prospective observational study was carried out at Neonatology unit of Pediatric department of B. P. Koirala Institute of Health Sciences (BPKIHS) Dharan. Total 200 extramural hypothermic neonates were transferred to BPKIHS from June 2015 to June 2016. Neonates weighing more than 1000 g, with abdominal skin temperature less than 36.5°C at admission were included in the study.. Clinical features and associated features were recorded at the time of admission. Oxygen saturation was recorded by a pulse oximeter.Results: Fatality was observed to be 39.3% in mildly hypothermic babies, 51.6% in moderately hypothermic babies and 80% in severely hypothermic babies. However, the presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g were associated with more than 50% fatality even in mildly hypothermic babies. When moderate hypothermia was associated with hypoxia or shock, the fatality was 83.3% and 90.9%, respectively. Similarly, mild hypothermia with hypoglycemia was associated with 71.4% fatality.Conclusion: The presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g should be considered adverse factors in hypothermic neonates. Their presence should classify hypothermia in the next higher category of severity in WHO classification. JNGMC Vol. 14 No. 2 December 2016, page: 8-11

Induction of Labor in Post Dated Pregnancy with Intra-cervical Foley Catheter in Antenatal Ward

Introduction: Induction of labor is one of the commonest obstetric procedures done these days with the aim of normal vaginal delivery. Among the different methods, transcervical Foley catheter is one of them used with great success and less complications.Objective: This study assesses the effect of intra-cervical Foley catheter in induction of labor in post dated pregnancy.Methodology: This was a descriptive observational study. Patients admitted in antenatal ward of BP Koirala Institute of Health Sciences (BPKIHS) with period of gestation (POG) ≥ 41 weeks without any complications were taken. Patients were induced either with Foley catheter or directly with misoprostol. Patients induced with Foley catheter were included in the study. Sixteen French Gauge Foley catheter was inserted intracervically and bulb was inflated with 40- 60 ml of distilled water and observed for 24 hours. If patient didn't go into labor after 24 hours with or without Foley expulsion, patient was reassessed and prostaglandin was used for further induction. Structured Pro forma was used for data collection and collected data was analyzed using SPSS software 11.5.Results: During the study period 353 patients were induced with intracervical Foley catheter. Among them 97(27.48%) went to labor and 256 (72.52%) needed further prostaglandin. Among 97 patients who went to labor 80 had normal vaginal delivery, 16 underwent cesarean section and one patient had vacuum assisted vaginal delivery. There were nine patients who had delivered baby with meconium stained liquor. Four patients had postpartum hemorrhage and two patients had intrapartum fever. None of the patients had hyper stimulation syndrome but one patient had still birth.Conclusion: Intracervical Foley catheter is one of the options to induce the patient in postdatism for priming the cervix to increase the rate of normal vaginal delivery with less complications.BJHS 2018;3(1)5 : 338-341

Utility of Epworth Sleepiness Scale (ESS) in predicting the presence of Sleep Related Breathing Disorders (SRBD) in patients in Routine Respiratory Clinical Service

Background : Many patients attending routine respiratory clinical service in developing countries also present with complains of daytime sleepiness and sleep abnormalities. A large proportion of them might have Sleep Related Breathing Disorders (SRBD) and as such, it is underestimated. Within this background we conducted a study to explore the presence of SRBD among patients presenting with symptom complex of respiratory diseases in Routine Respiratory Clinical Service by use of Epworth Sleepiness Scale (ESS).Material and Methods: A cross-sectional study of 50 patients with respiratory symptom complex was conducted in respiratory clinical service of Division of Pulmonary, Critical Care and Sleep Medicine at B. P. Koirala Institute of Health Sciences (BPKIHS) from 2014-2015. Targeted Comprehensive Sleep History and Epworth Sleepiness Scale (ESS) were used to recognize the presence of SRBD among these patients.Results: 74% patients had ESS score ≥10. Mean ESS was 12.32 (±4.76). 72% subjects had daytime fatigue, 62% loud snoring, 58% daytime sleepiness and 46% sleep fragmentation. ESS ≥10 reflected excessive daytime sleepiness (sensitivity 86.67%; 95% CI, 69.28 – 96.24; specificity 45%, 95% CI, 23.06 – 68.47; PPV 70.27%, 95% CI, 53.02 – 84.13; NPV 69.23%, 95% CI, 38.57 – 90.91).Conclusion: Epworth Sleepiness Scale has utility in predicting SRBD in patients with respiratory symptom complex with high overall predictive accuracy. It can be used in routine clinical care to identify and predict patients having Sleep Related Breathing Disorder and refer them to clinical sleep services for further evaluation.Journal of Nobel Medical CollegeVolume 6, Number 2, Issue 11 (July-December, 2017) Page:9-13

Prevalence of co-morbid conditions in Heart failure: an experience at tertiary care hospital

Introduction: Patients with heart failure (HF) have various co-morbidities that complicate management and may adversely affect outcomes. HF guidelines provide little discussion on this topic and evidence is sparse.Material and Methods: This is a descriptive cross-sectional study on 240 consecutive patients with HF admitted from September 2016 to July 2017 at B.P. Koirala Institute of Health Sciences (BPKIHS), Nepal. All patients admitted with diagnosis of HF with reduced or preserved ejection fraction (NYHA functional class III/IV) based on Framingham Criteria and echocardiography assessments were included. Pre-defined co-morbid conditions were assessed.Results: Mean age of patients was 53.5 years and 53% were female. Most patients were in NYHA class III or IV (25% and 75% respectively) and 28.3% had ischemia as a cause of HF. Among co-morbidities, 85% of patients with HF had at least one co-morbidity. Anemia (68.3%), coronary artery disease (30.4%), hypertension (26.6%), diabetes (18.7%) and chronic kidney disease (7.5%) were the co-morbidities with the highest prevalence. Chronic obstructive pulmonary disease (3.7%), sleep apnea (2.5%), hypothyroidism (2.5%) and stroke (2.5%) were less common. Of all patients, only 15% had no co-morbidity, 40% had one co-morbidity, 22% had two co-morbidities, and 13 % had three or more co-morbidities.Conclusion: Co-morbidities are common problems and anemia is the most common in our scenario which could be of multi-factorial etiology. Careful attention to the diagnosis and management of specific co-morbidities may help to improve outcomes in patients with HF. Journal of Nobel Medical CollegeVolume 6, Number 2, Issue 11 (July-December, 2017) Page:35-41

Randomized controlled trial comparing clinical outcome and cost analysis between laparoscopic and open appendicectomy for acute appendicitis at Dharan, Sunsari, Nepal

Background: Acute appendicitis is the most common etiology of acute abdomen, generally requiring urgent surgical intervention, with a lifetime incidence between 7 and 9%. With the experience in minimal invasive surgery, laparoscopy has advantage of being both diagnostic and therapeutic. In developing country like Nepal, with limited health resources, the trend of laparoscopic appendicectomy (LA) is emerging. This study was conducted to determine difference in clinical outcome and cost analysis between laparoscopic (LA) and open appendicectomy (OA).Methods: This study was Randomized Controlled Trial conducted in the Department of Surgery, B.P. Koirala Institute of Health Sciences (BPKIHS), a tertiary care hospital in Eastern Nepal, over a period of twelve months from January 2017 to December 2017. Ethical clearance was obtained from Institutional Review Committee (IRC). The study population were adults with clinical diagnosis of acute appendicitis fulfilling inclusion and exclusion criteria.Results: In this study, 47% patients were male and 53% were female in LA and 58.8% patients were male and 41.2% were female in OA ; the mean age was 24.6 years in LA and 27.7 years in OA ; mean operation time was more in LA than in OA i.e. 70 minutes and 57 minutes respectively (p value 0.001); mean hospital stay was more for OA (3.6 days) as compared to LA (3.06 days), (p value 0.125) ; The number of analgesic injections during postoperative period in two groups was 5.52±0.99 for LA, 5.62±1.02 for OA (p value 0.626); infection rate was 1% in LA, 6% in OA; The cost of surgery was higher in case of LA (NRs 15067.04) than in OA (NRs. 12524).Conclusions: OA had statistically significant lower pain in 1st three postoperative periods, and a shorter hospital stay, early postoperative recovery but a slightly higher cost per discharge than OA.

Intermediate Syndrome Following Organophosphate Insecticide Poisoning in Emergency Department of Eastern Nepal

Acute organophosphate poisoning is the most common pesticide poisoning which can be manifested in three unique phases of toxic effects e.g. Acute Cholinergic Crisis, Intermediate Syndrome (IMS), Delayed Polyneuropathy. Looking at the previous cases reports the incidence of Intermediate Syndrome has been reported to be as high as 80%.The present study attempted to report a comparable form of incidences encountered in Emergency Department of BP Koirala Institute of Health Sciences (BPKIHS) in Eastern Nepal. Chlorpyriphos was the commonest compound associated with IMS. Early recognition with plasma acetylcholinesterase level as well as Peradeniya Organophosphorus Poisoning (POP) Scaled score might be useful tool in early diagnosis of Intermediate Syndrome.

Stenotrophomonas maltophilia causing blood stream infection in neonates and infants: a cause for concern.

Stenotrophomonas maltophilia ( S. maltophilia) is an important Gram-negative, non-fermentative, multidrug resistant (MDR) nosocomial organism. We evaluated the isolation of S. maltophilia from the seven blood culture specimens received from the Paediatric Emergency Department (PED) of BP Koirala Institute of Health Sciences (BPKIHS) over the duration of two weeks. The suspicion of a possible outbreak was raised and the hospital infection control team investigated the source and found the hand of one healthcare provider harbouring a similar organism. All six steps of hand hygiene were subsequently strictly enforced after which the same bacteria were no longer isolated. Infection control measures should be rigorously adopted for the control of such nosocomial bacteria.

Factors Affecting the Success Rate of External Dacryocystorhinostomy at B. P. Koirala Institute of Health Sciences, Dharan, Nepal

IntroductionAny disturbance to the normal ouVlow of tears through the nasolacrimal passage causes overflow known as epiphora. The clinical symptoms of epiphora range from mild dribble to the continuous ouVlow of tears. Watering of eyes caused by the nasolacrimal drainage obstruction is managed by surgery. One of the many surgeries to treat this is external dacryocystorhinostomy.ObjectiveThe objective of this study was to evaluate the success rate of external dacryocystorhinostomy as well as factors affecting it.MethodologyThis is a retrospective cross-sectional study, conducted in the Department of Ophthalmology, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan with the approval of Institutional Review Committee, BPKIHS. The medical records of patients who underwent external Dacryocystorhinostomy surgery from April 2011 to April 2016 at BPKIHS were retrospectively reviewed. Statistical analysis was performed using SPSS for windows, version 11.5 (SPSS Inc., Chicago, IL). Binary logistic regression models were used to investigate the association of the surgical outcome with various predicting variables.ResultsThe success rate of the external dacryocystorhinostomy was 78.09%. Factors studied were: age, with a range of 2-81 years; duration of symptoms with a range of 1-84 months; and gender of the patients. The intra-operative factors studied were use of silastic tube, types of flap, and osteotomy size. Among these factors, the duration of symptoms and osteotomy size had significant association with the outcome of the surgery p&lt;0.05.ConclusionOur study yielded high success rate in patients with shorter duration of watering of eyes and larger osteotomy size during surgery. Hence, a larger osteotomy size and early intervention is recommended for better surgical outcome. Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 196-200

Meningoencephalitis in intensive care unit: Do Japanese Encephalitis cases go unsuspected?

Background: Meningoencephalitis (ME) is a medical emergency. Acute infective encephalitis is usually viral. Nepal has the second highest prevalence of JE in South East Asia. About one third of the JE cases results in death. The records of the JE in the laboratory of B.P. Koirala Institute of Health Sciences (BPKIHS) showed 760 samples to have the evidence of JE infection out of 3352 tested during the period of 2001-2011 AD. The present study aimed to conduct an audit on meningoencephalitis cases admitted in the ICU of our hospital in an attempt to find its burden.Methods: Medical records of all the adult patients with the provisional diagnosis of Meningoencephalitis at BPKIHS over the period of 2009-2011 AD were examined. Laboratory findings of all the patients diagnosed with ME who were admitted to the eight bedded general intensive care unit (ICU) were also reviewed. The diagnosis was made based on the findings of medical history, clinical examination and cerebrospinal fluid analysis for biochemistry and cytology, results of anti JE IgM test performed on CSF and/or serum.Results: Altogether 127 samples of CSF were obtained from adult patients admitted in different inpatient department of BPKIHS with the clinical diagnosis of meningo encephalitis between 2009-2011 AD. Out of them, 25 (19.68%) were tested positive of JE. A total of 684 patients were admitted over the same period with different diagnoses in 8 bedded ICU of hospital. Fifteen (2.19%) were transferred to the ICU with the ME. In the ICU, 9(60%) were treated as viral encephalitis. Among them CSF of only 4 patients’ were sent for testing for JE and found positive in 2 cases. Seven (46.6%) patients expired while 4(26.6%) were taken home by the relatives against medical advice in critically ill conditions and remaining 4 (26.6%) improved and transferred to ward. Among the expired patients 5 (71.4%) had viral encephalitis.Conclusion: JE is a real problem but many cases are likely to have been gone undetected. Adoption of a more intensive approach with much liberal serology testing policy seems to be appropriate for better detecting JE cases in the setting.

Risk factors for hospital acquired bloodstream infections in neonatal intensive care unit of B.P. Koirala Institute of Health Sciences, Nepal

Introduction : With the development of advanced technologies in neonatal intensive care worldwide, survival rates of newborns, particularly low birth weight and premature babies are higher. This has led to longer duration of hospital stay predisposing these babies to hospital-acquired infections (HAIs). Hence it is one of the main cause of morbidity and mortality in the neonatal intensive care unit (NICU). Objective: To determine the risk factors for HAI in NICU of B.P. Koirala Institute of Health Sciences (BPKIHS), Nepal Method: A prospective cohort study was conducted in a seven bedded teaching and referral NICU. All neonates in NICU who did not have any sign of infection at admission and remained hospitalized for at least 48 hours were observed. HAI was diagnosed according to the CDC criteria. Risk factors for HAI were analyzed with Chi-square test and Logistic regression model. A p -value of Results: The incidence rate and density of HAI were 47% and 39.3 infections per 1000 patient-days respectively. Blood stream infection (BSI) was observed as the most common form of HAI (60.2%). Low birth weight and mechanical ventilation were found to be related to hospital acquired infection (p Conclusions : Low birth weight and mechanical ventilation were the most important risk factors for HAI in NICU of BPKIHS, Nepal Sri Lanka Journal of Child Health , 2016; 46 (1): 16-22

Laparoscopic inguinal hernia repair (total extra-peritoneal): tips and tricks

Introduction: Inguinal hernia is one of the major problems at B.P. Koirala Institute of Health Sciences (BPKIHS), a tertiary referral center. We perform Laparoscopic hernia repair as a routine procedure for groin hernias. This technique is highly demanding and complex. In our country the development of laparoscopic technique is still in a developing phase.Aims and objective: To present technical tips and trick in LIHR, which we experienced, as lead to preventing intra/post operative complication.Results: We have performed a total of 129 groin hernia repairs in 105 patients with M: F= 26:1 and mean age 41.97±20 (16-85). The mean length of hospital stay was 1.14 ± 0.35 days. Eight patients were converted to TAPP and 1 converted to open hernia repair due to operative difficulty. The complications encountered are pain (20), seroma(8) and epididymitis(2).Conclusion: In our experience LIHR (TEP) is safe method for routine management of groin hernias.

Assessment of Post Graduate Medical Students in Nepal: Is it time to introspect?

Kathmandu University Medical Journal Vol.12(4) 2014; 231-232

Clinico-epidemiological profile of molar pregnancies in a tertiary care centre of Eastern Nepal: a retrospective review of medical records.

BackgroundThe incidence of molar pregnancy has demonstrated marked geographic and ethnic differences. The reported data in Nepal is inconsistent with minimal published literature. Thus, we designed a study to determine prevalence of molar pregnancies and demonstrate clinical and epidemiological characteristics of the patients attending a tertiary care center in eastern Nepal.MethodsA retrospective review of medical records was conducted to determine the prevalence of molar pregnancies at the B.P. Koirala Institute of Health Sciences (BPKIHS) from the year 2008 to 2012. Secondary data from the medical records were analyzed. Annual and 5-year prevalence of molar pregnancy per 1000 live births was calculated. Demographic characteristics, clinical presentation, management methods and complications of molar pregnancy were studied.ResultsThe 5- year prevalence of molar pregnancy at BPKIHS is 4.17 per 1000 live births with annual prevalence ranging 3.8–4.5 per 1000 live births. More than one third of the patients were in the age group of 20–35 years and majority of them were of Hindu religion. For more than one third (41.7 %) of the patients, it was their first pregnancy while about 10 % gave a positive past history of molar pregnancy. Abnormal uterine bleeding (86.3 %) was the most frequent complaint, suction evacuation was the most common method of treatment and more than half of the patients required prolonged care after initial management.ConclusionThere is a need for studies at country level which will give us a national figure on molar pregnancies. Thus, a standardized clinic-epidemiological profile of molar pregnancy in Nepal can be created.

Lifestyle Pattern among the People Living with AIDS in Eastern Nepal

Introduction: In world more than 40 million people are living with HIV/AIDS, 2.3 million are under 15 yrs and 14000 new infections occur daily. The objectives of this study was to assess the lifestyle pattern among the people living with AIDS (PLWA) receiving anti-retroviral therapy at B. P. Koirala Institute of Health Sciences and find out the association between lifestyle pattern and the selected demographic variables. Methodology: A descriptive cross-sectional research design was used to assess lifestyle pattern of the PLWA receiving anti-retroviral therapy at the ART clinic of Tropical ward at B.P Koirala Institute of Health Sciences (BPKIHS). The PLWA receiving ART at BPKIHS for more than or equal to three months at the ART clinic who met the selection criteria constituted the sample of the study. Using purposive sampling technique total 113 PLWA were selected. The patients who themselves were physically present during the data collection period were included in the study, after their consent for the purpose. Results: It was found that most of the PLWA were of age less than 40 years, male (61.1%), residing in urban area (74.3%), married (75.2%) and Hindu (74.3%). It was found that 83.2% PLWA never do exercise, whereas 8.8% perform regularly. Most of the (91.2%) people living with AIDS reported feeling pressure and stress in daily life. About 57% PLWA only sleep less than 6 hours per day. About half (52.2%) of the PLWA never take food outside home, where as 34.5% take food outside regularly. The habit of using tobacco is present among 28.3% people living with ADIS, where the past history of using was 39.8%. Similarly only 0.9% PLWA had habit of taking alcohol at present and 63.7% in past; and 28.3% had habit of taking substances in past. The association calculated between selected demographic variables (age, sex, marital status, residence and religion) with lifestyle pattern (exercise, tobacco chewing, alcohol consumption, and food habit) found significant association between marital status and exercise (p &lt;0.001), Tobacco consumption and age (p &lt;0.001) only. Conclusion: The positive life style practices among the PLWA found high at present in comparison to past especially in relation to Tobacco, Alcohol and Substance use. Individual counseling and support is vital for improving the condition.DOI: http://dx.doi.org/10.3126/saarctb.v11i2.12436SAARC J TUBER LUNG DIS HIV/AIDS, 2014;XI(2) 29, Page: 29-33

Bilateral anatomical variation in branching pattern of external carotid artery in a male cadaver - a case report

AbstractDevelopmental anomalies in the origin and branching pattern of the external carotid artery are not common. The level of the bifurcation of the common carotid artery and also the variations in the origin/branching pattern of the external carotid artery are well known and documented. During a routine dissection of middle aged male cadaver in department of Anatomy in BP Koirala Institute of Health Sciences (BPKIHS) The clinically-relevant variations to be noted were the high origin and anomalous course of the facial artery, superior thyroid artery arising as a branch of Common Carotid artery, high origin of ascending pharyngeal artery, posterior auricular artery and direct glandular branches to the Submandibular gland. Such anatomical variations of external carotid artery are important for surgeons in surgeries of head and neck region and also for radiologists in the image interpretation of the face and neck region.

Hepatitis B vaccination status and needle-stick and sharps-related Injuries among medical school students in Nepal: a cross-sectional study.

BackgroundHepatitis B is a dreadful infectious disease and a major global health problem. Health-care workers including clinical students are more vulnerable to such infections and non-sterile occupational exposures as their daily activities are closely related to patient’s blood and body fluids.MethodsA descriptive cross sectional study was conducted at B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal from July till October 2012. All medical, dental and nursing students were surveyed for their Hepatitis B vaccination status and only those students in clinical rotations were surveyed for the prevalence and pattern of Needle-stick and Sharps-related Injuries (NSSIs) using a pre-tested, semi-structured, self-administered questionnaire. Descriptive and inferential statistics was used to analyze the data.ResultsMajority (86.5%) of students were vaccinated against Hepatitis B of which 83.7% had completed full doses. Among non-vaccinated students, 43.2% reported the main reason for non-vaccination as lack of vaccination programs. Out of 210 respondents from clinical rotations, 90 students (42.8%) reported at least one injury. Among those injured, two students reported exposure to Human immunodeficiency virus (HIV) positive cases and four to Hepatitis B virus (HBV) positive cases. Most of the injuries (44%) occurred during Internal Medicine rotation and the most common sharp involved (56.3%) was Hypodermic needle. Most injuries (35.6%) occurred while manipulating needle into patients. Following exposure, only 11.4% took Post exposure prophylaxis and 19.54% went for a Post-exposure serology test.ConclusionsNeedle-stick and Sharps-related Injuries occur frequently among health care workers including trainee students keeping them at high risk for acquiring dreadful infections like HBV, HCV and HIV. They need to be protected from unwarranted hazards by adopting routine Hepatitis B vaccination programs and by reinforcing education regarding universal precautions.

Department Of Psychiatry, BPKIHS And It’s Contribution To Mental Health Literature Of Nepal

Mental health and Psychiatry are relatively new as a medical specialty in Nepal. Psychiatry and its issues are still the matter of stigma, mystery, ignorance and negligence not only in public but also in professional and policy-maker level. It is yet to receive its due space in health policy in terms of: program, priority and resource allocation. Despite of some achievements in mental health field (service, teaching and research), they are too far from satisfaction. Along with other responsibilities in this pretext, a department of psychiatry of a teaching institute naturally bears on its shoulder a huge burden of spreading scientific information, adding to literature and destigmatizing mental health issues. The fact, data, information and awareness is a main means of changing present situation. This article intends to briefly outline the milestones, major attempts, achievements and publications in this direction, of Department of Psychiatry of B.P. Koirala Institute of Health Sciences (BPKIHS), a prominent centre for the medical education, service and research in Nepal. The basis of this review are: Journals, Abstract-books, BPKIHS Annual Reports, Thesis, other research works, Internet search, books, papers and personal communication with both concerned faculty members and students coming into the knowledge of the author. DOI: http://dx.doi.org/10.3126/jpan.v3i1.11354 J Psychiatrists’ Association of Nepal Vol .3, No.1, 2014: 48-57