Introduction: The kidneys remove creatinine, which is produced at a constant rate as a result of muscle metabolism, from the blood. Like insulin, creatinine is filtered, but neither reabsorbed nor secreted by the kidneys. Thus, the creatinine clearance test, which compares a patient’s blood and urine creatinine concentrations, can also be used to calculate the GFR. Therefore, a single measurement of plasma creatinine levels provides a rough index of kidney function. Aims and Objective: To compare the creatinine clearance in 12- hour and 24- hour timed urine collection in healthy volunteer. Material and Methods: 50 Healthy volunteers are selected. 25 volunteers were male and 25 volunteers were female. Each volunteer was given 2 cans for urine collection. The first can is used for 12 hour collection study from 7am to 7 pm on day 1 and the second can for another 12 hour collection from 7 pm to 7 am on day 2. The samples were mixed well and measured the volume separately. Five ml of sample from the first can was transferred to the can 2 and again mixed well. The creatinine is measured by using modification of the jaffe reaction. Result: The person’s correlation between 12-hour and 24- hour urine samples showed a significant correlation in both males and females(r = 0.8 and 0.6 respectively, p values < 0.05) Conclusion: This is clinical acceptable and hence 12 hr urine collection can be adopted in patients who are well hydrated and it can replace 24-hr urine collection.

Introduction: Community diagnosis program is a comprehensive assessment of health status of an entire community in relation to its social, physical & biological environment. Objectives: to know the students’ feedback about the each component of Community Diagnosis Program (CDP) and to identify the knowledge and skills learnt by the students. Methodology: A total 294 students from MBBS (219), BDS (50) and B Sc Nursing (25) students were posted for the CDP in different years for various activities in the field. The students were asked to give their feedback by the help of pre tested semi-structured questionnaire given to them. The data were analyzed in terms of percentage by using SPSS. Results: Ninety four percent of the students were clear about objectives of CDP, 63% of them thought duration of CDP were adequate and household survey was given first rank (74.1%) as very useful, followed by focus group discussion (69%) and social mapping (57.1%). The knowledge and skills learnt by the student during this posting were data collection, compilation, analysis and interpretation of data, communication skills, handling of the problem, cooperation and coordination among friends, understanding of the community, health status of community, cultural and behavioral aspects of community, respect towards other culture and beliefs, interaction with the community people. Conclusion: Overall students rated CDP as a very good exposure for them in community setting. They have found it as interesting, relevant, memorable and very useful to increase their practical understanding of the community which will be very fruitful for them in future as a health professionals.

Introduction: Non-adherence to prescribed medications is a major problem worldwide in most of the diseases. It is the irregularity and discontinuation of medicine taking behavior of patients. Various studies on this subject show that adherence is about 50% for medications in chronic diseases like diabetes and much lower for lifestyle prescriptions. Objective: To elucidate the possible factors of non-adherence. Material and Methods: A cross sectional study was carried out from February 2008 to July 2009 at diabetic clinic of Department of Medicine at BPKIHS, Dharan, Nepal, a Tertiary Care Centre. Three hundred diabetic patients aged 24 years and above, taking treatment for diabetes for at least six month were included using convenient sampling. Verbal and written consent was taken. Data were entered into SPSS 14.0 and relevant statistical tools applied. Results: The prevalence of adherence was only 52% among patients. Factors that were independently associated with non-adherence were: male gender (OR =1.23 95%CI = 0.778-1.93), longer time since last visit to a health worker (OR = 0.67, 95%CI = 0.42-1.07), those who were on alternative medicine, number of medicines taken due to multiple diseases. Ten patients had diabetic retinopathy of both type: non proliferative and proliferative. Conclusions: Regular using of medicine during diabetic treatment phase was minimal. There is a need to improve it through strategies which will help patients to understand about the outcome by becoming adherent and visiting the health worker as advised. Further studies should be done to find out why patients were not complying with treatment so as to improve their adherence.

Hand washing with soap can reduce the risk of diarrhoeal diseases. Hygiene behavior and sanitation is linked to our day-to-day life which includes hand washing practice. It is one of the basic elements of health. The objective of the study was to assess the knowledge level of the disadvantaged community regarding hand washing and immunization and compare the results of pre and post health education programme. An intervention program was designed after the situation analysis from log book of Bachelor in Medicine and Bachelor in Surgery (MBBS) students. A face to face interview by trained medical students was conducted before and after intervention programme with the help of pre tested schedules. Thirty six individuals were interviewed of which 81% of the respondents had correct knowledge regarding hand washing prior to the intervention which was increased to 94% after intervention program. Thirty three percent of the people showed correct way of hand washing before demonstration which improved to 78% after intervention, a statistically significant observation. Knowledge about the consequences of poor sanitation did increase from 58% to 78%. With respect to immunization knowledge 86% of the respondents had heard about the immunization before the intervention and which increased to 92% after the intervention program. Nineteen percent correctly responded about the importance of immunization before the intervention and 28% after the intervention, which was statistically non significant improvement (P value>0.05). Knowledge regarding Period of completion of immunization had increased from 77.8% to 91.6% which was highly significant (P value=0.001). Knowledge level regarding adverse effect of not immunizing children increased by 9% with intervention. The intervention program had helped in increasing the knowledge level of the community regarding hand washing techniques and knowledge regarding immunization. Hence, we would recommend; continue to use demonstration technique to improve hand washing knowledge & practice and wide approach intensive awareness program to enhance knowledge about immunization. Key words: , , ,

Renal Failure is a condition in which the kidneys fail to remove metabolic end products from the blood & regulate the fluid, electrolyte & pH balance of extracellular fluids. The underlying causes may be renal disease, systemic disease or urinary tract disorder of non-renal origin. The present study is undertaken with the aim to study of serum lipid profile in renal failure patients attending Nobel Medical College, Biratnagar from February 2012 to February 2013. To assess serum lipid profile, albumin & C - reactive protein in renal failure patients on peritoneal & hemodialysis, it included 70 patients, 31 were males & 39 were females & their age range from 21 to 80 years. The control groups were 35, they were collected from medical staff & relatives who were free from signs & symptoms of renal disease, lipid disorders, diabetes mellitus & hypertension. 19 were males & 14 were females & their age range from 22 to 66 years. Key words: ,

Background: Tuberculosis is the major public health problem in the world; it is a major cause of illness and death worldwide especially in Asia and Africa. Objective: To identify people knowledge about tuberculosis in Sonapur VDC. Methodology: Cross sectional study design, census, structured and semi structured questionnaire were used to collect respondent knowledge about tuberculosis. Results: This descriptive study included 2008 households, 9933 population of Sonapur Village Development Committee (VDC) lies in eastern part of Nepal. Among the respondent, 64 % have heard of tuberculosis, and among them 64 % think tuberculosis is caused due to smoking. In response to the symptoms of tuberculosis, 47 % of the respondent said cough for more than two weeks and 24 % said haemoptysis. Similarly, 72 % of the respondent (n=2008) said TB is transmitted from one person to another and 75 % of the respondent who have heard of TB said TB is curable. In response to the treatment procedure, 94 % of the respondent didn’t have heard of DOTS, while 64 % said the duration of treatment is 6 months. Conclusion: The study found that the respondent has satisfactory knowledge about the cause of TB, sign and symptoms of tuberculosis. They have also satisfactory knowledge regarding transmission of tuberculosis; few of them know that it is curable. However, their knowledge about Directly Observed Treatment Short Course (DOTS) (treatment method) was very low. It is recommended that national tuberculosis control authority should design health education programme focusing on preventive methods (DOTS), duration of treatment and prevention of tuberculosis. The awareness campaign should be targeted to head of the household, women, community health care provider and should be disseminated through the media that will reach to the general public. Such awareness campaign will increase people knowledge about the disease and will help to reduce the drug resistant and improve the efficacy of DOTS programme.

Nontraumatic intracerebral hemorrhage is bleeding into the parenchyma of the brain that may extend into the ventricles and, in rare cases, the subarachnoid space. Intracerebral hemorrhage accounts for 10 to 15 percent of all cases of stroke and is associated with the highest mortality rate, with only 38 percent of affected patients surviving the first year. It is a prospective analytical study carried out at Tribhuvan Universiy Teaching Hosital between April 2012 and April 2013. A total of 100 patients were admitted to the medical ward and intensive care unit during this period. Patients were followed until they were discharged from the hospital. Spontaneous Intracerebral bleeding was found to be more common in males than women. 85 percent of patients were above the age of 50. 45 Percent of the patients had onset in the early morning between 5AM and 11AM. Patients diagnosed with hypertension but not taking antihypertensive medications or taking them irregularly were more likely to have the vascular event than those who were taking the medication regularly. Patients also had very high blood pressure at the time of presentation.46 percent of the patients had putaminal bleeding. 44 percent of patients were discharged before 10 days. Only 8 percent of patients had a stay longer than 30 days. 8 percent of the patients needed mechanical ventilation during their hospital stay .The case fatality rate was 6 percent.

Introduction: Dengue fever (DF) is a disease first termed “water poison” in a Chinese encyclopedia of disease symptoms and remedies published during the Chin Dynasty (265 to 420 A.D.) Objectives: This study aimed to find out the main clinical presentations and laboratory changes of Dengue fever (DF) and Dengue hemorrhagic fever (DHF) and also to review the various treatment modalities. Method: Retrospective study of DF and DHF cases admitted to Hospital Nacional Guido Valederes (HNGV) in Dili, from January to March 2005. WHO protocol and management guidelines were used for diagnosis and management. Results: A total of 105 IgM positive cases were studied with 79% DHF and 21% DF. The median age of the patient was 42 months. The most frequent age group affected was 1 - 5 years. The Severity of the outbreak was evidenced by the most common presentations apart from fever being melena (36%) and epistaxis (32%). Discussion: This outbreak of DF/DHF was of high severity causing significant mortality and morbidity in East Timor. The commonest age group affected was 1-5 years, which is the most vulnerable age group in developing countries. Hemorrhagic manifestations were main presentations to come to hospital rather than headache, arthralgia and rashes. We had higher than expected requirements of blood transfusion .The description of the nature and severity of presentations may be useful for clinicians working in similarly sub-optimal conditions. Key words: , ,, .

Background: Since past 30 years, methadone has been used as a substitute therapy for opiate dependence because of its many advantages. It has cross-tolerance property and significantly effects to reduce drug injecting and it related behavior as well as lower the mortality in drug users with HIV infected. Objective: The aim of this Study is to find out correlation between doses and dropout rate among Methadone Maintenance Treatment clients. Method: 112 dropout methadone clients who had enrolled in the MMTP program in Department of Psychiatry, TUTH Maharajgunj within one year period assessed their final doses before dropout from the program. Result: The mean initial and last (final or exit) dose of methadone in Dose Stable group (DSG) is 32.44±9.2 mg, in Dose Increased group (DIG) 36.25±8.6 mg and 47.50±11.2 mg, and in Dose Decreased group (DDG) 37.63±7.4 mg and 15.66±10.2 mg respectively. Conclusion: The lower the doses of methadone, the higher risk of dropout among the clients of the Methadone Maintenance program

Background and objectives: The studies on difference in short- term memory in healthy males and females of Kerala of Kerala are inadequate. Therefore the present study was undertaken to observe whether there is a difference in short-term memory of males and females of Kerala and to create awareness among the healthy male and female to improve the quality of life. Methodology: The present study was performed in forty healthy males and females of Kerala with mean age 23 +/- 5. our study we have used a free- recall task of words, numbers and pictures in six sessions. We have asked the subjects to recall the displayed words, numbers and pictures. Numbers of the correct items recalled were measured. The analysis of data is done by SPSS 20.0. Results: The results of the present study suggests that males are having more short-term memory for numbers which is statistically significant and females are having more short-term memory for words which is statistically significant and slightly more short-term memory for pictures which is not statistically significant. Conclusion: In the present study we have observed that males are having more short-term memory for numbers. Females are having more short-term memory for words and slightly more short-term memory for pictures. More study is required to study the dimorphism of the brain to understand the reason for these differences

Background: Utilization of postnatal care is very vital to reduce maternal morbidity and mortality in an underdeveloped country like ours. This service is utilized very less by the mothers in comparison to antenatal care services. Objectives: The objective of the study was to assess the availability of postnatal care among the mothers in eastern Nepal and to assess the proportion of utilization of post natal care among them with child less than 24 months of age. Methodology: A descriptive cross sectional study was conducted among 235 mothers with house to house visit using random sampling. Results: 98% of the respondents had received postnatal care services and 89.7% of them received their first postnatal care within 24 hours of delivery. It was also observed that white coat bearers were the main source of awarenss regarding the utilization of postnatal care services.

Background: Performance of newly introduced modified silicone based impression materials regarding dimensional stability and the capability of surface detail reproduction remains to be known. Objective: To compare the dimensional stability and surface detail reproduction of addition silicone and condensation silicone impression materials. Materials and methods: This is an in-vitro study, total 80 impressions were taken (40 impressions of addition silicone and 40 impressions of condensation silicone impression material) of a standard stainless steel die. Dimensional stability was evaluated at 30 minutes, 24 hours and 48 hours of impression making by the use of a travelling microscope and surface detail reproduction was evaluated at 10 minutes of impression making by the use of stereomicroscope. Data were processed and analyzed using SPSS. Significance test was done using unpaired‘t’ test and Chi square (X²) test. Results: Addition silicone and condensation silicone impression materials had no significant difference (p>0.05) in surface detail reproductions at 10 minutes and dimensional stability at 30 minutes of impression making but at 24 hours and 48 hours of impression making dimensionally stability was significantly higher (p<0.05) in addition silicone than that of condensation silicone impression materials. Conclusion: Addition silicone impression materials have better dimensional stability than condensation silicone impression materials in terms of storage and similar surface detail reproduction capacity at 10 minutes of impression making. Keywords: , ,

Laparotomy is one of the commonest procedures done in gynaecology and it is a life saving measure in many of the emergency situations and its indications can be varied. The objective of this study was to analyze its indications and the frequency of their occurrence. Material and method: The study was carried out in the department of Obstetrics and Gynaecology, Nobel Medical College from the past one year (15th August-14th August 2012).Data were analysed retrospectively using the case sheets and operative notes . Result: The commonest indication for laparotomy during that period was for ovarian tumour(59.45%) followed by ectopic pregnancy (27.02%).Regarding the age distribution in ovarian tumour (45.45%)were between the age of 15-30yrs,(34.09%)between the age of 30-45yrs and (20.45%)were in between 45-65years.The commonest presenting complaint of these women were mass per abdomen in (22.72%). Ectopic pregnancy being the second leading indication of laparotomy where none of them had conservative approach rather they had operative intervention. Majority was seen in the ampulla (50%) followed by isthmus (40%) and cornual (10%) regions and the left tube was found to be slightly more involved than the right tube. Conclusion: Majority of laparotomies done in NMCTH were for ovarian mass followed by ectopic pregnancy. Key words: , ,

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal or M-protein and skin changes) is a rare multisystem disorder associated with plasma cell dyscrasia and have a wide range of clinical features and presentations. The clinical manifestations are so varied that many of them could be present at the time of diagnosis or only one could be present and followed by appearance of others making early correct diagnosis very difficult. Here, we describe a case of POEMS syndrome that first had skin changes and later developed most of the features along with transient highly raised intracranial pressure (ICP) along with gait disturbance which are unusual clinical findings and have rarely been reported in the literature.

Witkop’s syndrome, a gentle form of ectodermal dysplasia, is a rare autosomal dominant disease manifested by defects of the nail plates of the fingers and toes, hypodontia or anodontia with normal hair and sweat gland function. Other ectodermal tissues, organs do not show any alteration. Oral manifestations may include incomplete development of both primary and permanent tooth germs. The location and form of erupted teeth could be irregular. This paper reports a rare case of Witkop tooth and nail syndrome (TNS) presenting a typical clinical features of this syndrome and discusses various dental treatment modalities available.

Tuberous Sclerosis should always be considered in the differential diagnosis of children presenting with behavioral problems and academic difficulty. Though seizures, mental retardation and adenoma sebaceum are considered as the triad for the diagnosis, they may not be present on initial evaluation. In such instances, the revised diagnostic criteria are often helpful for making a diagnosis. We report a case of a thirteen-year old girl who presented in psychiatry outpatient clinic with behavioral problems since early childhood and academic difficulty and was subsequently diagnosed with tuberous sclerosis based on clinical grounds and neuroimaging.