Objective: To correlate the portal vein pulsatility pattern with severity of liver disease in patients with cirrhosis of liver and portal hypertension. Subjects and methods: Doppler signals from the main portal vein of 36 healthy adults and 52 cirrhotic patients with portal hypertension were studied. Severity of liver disease was graded using modified Child-Pugh classification. Pulsatility of portal flow was quantified using portal venous pulsatility index and complete spectral widening was defined as absence of window below the wave base. The Doppler findings were correlated between the study groups. Results: The mean pulsatility index value in control group was 0.37+0.10 and in cirrhotic patients was 0.17+0.03 (Child A- 0.21+0.02, Child B- 0.18+0.02, Child C- 0.14+0.03). The difference between control and cirrhosis group, as well as the difference within different Child classes were statistically significant (P<0.05). None of the patients in control group had complete spectral widening while 76.92% of cirrhotic patients had complete spectral widening (28.5% of Child A, 66.6% of Child B and 100% of Child C). The difference in distribution of complete spectral widening between control and cirrhotic group as well as within the cirrhotic group was statistically significant (P<0.05). Conclusion: Portal vein pulsatility index and spectral widening can reflect the early hemodynamic changes in cirrhotic patients. These changes become more pronounced with increasing severity of liver disease. Key words: portal vein pulsatility pattern, cirrhosis, portal hypertension

Hypertension is one of the major risk factor for an increased risk of stroke, myocardial infarction, end-stage renal disease, congestive heart failure and peripheral vascular disease. The kidney is a main target of organ damage in hypertension. Microalbuminuria is one of the earliest indications of kidney injury in patients with hypertension. Total of 50 cases and 50 controls are enrolled into the study. Their blood pressure was measured and spot urine sample was analyzed for Microalbumin. Blood pressure and Microalbumin were statically elevated in case group in comparison to control group. Key Words: Microalbumin.hypertension

Intestinal parasitosis is highly prevalent among the general population in Nepal. This study aimed to evaluate the distribution of intestinal parasites among patients attending Nobel Medical College Teaching Hospital, Biratnagar, Nepal. A total of 5,524 stool samples examined by direct smear and Formal-Ether concentration technique were reported. The overall prevalence of intestinal parasitic infection was found to be 15.17% (M=15.65% vs F=14.62%). The overall prevalence of intestinal parasitosis was found to be highest among patients aged 5-14 years (20.66%), followed by elderly people aged > 45 years (16.20%) and least among children aged < 5 years (9.09%). Among various parasites detected, the most common was Entamoeba histolytica (44.86%) followed by Giardia lamblia (33.65%), hookworm (10.50%), Ascaris lumbricoides (5.72%), Strongyloides stercoralis (4.77%), Hymenolepis nana (3.34%), Trichuris trichiura (0.95%) and Enterobius vermicularis (0.23%) respectively. Keywords: Intestinal parasites; Prevalence; Stool; Infection.

Introduction: Due to regular exercises, athletes tend to have an increase in pulmonary capacity when compared to non-exercising individuals. Intensity and severity of sports engaged in by the athletes probably determines the extent of strengthening of the inspiratory muscles with a resultant increase in the pulmonary functions.1, 2 So, this study has been carried out to establish a relationship between the type of sports and pulmonary functions in Nepalese athletes. Methods: This study has adopted a cross sectional observational comparative research design. Spirometry was conducted in 84 different national level athletes [25.71 (± 4.55) years]. The athletes were from five different sport groups. Out of them, there were 16 weight lifters, 41 footballers, 10 swimmers, 8 marathon runners and 9 sprinters. Among them weight lifters, marathoners and sprinters were selected from the National sports council, Tripureshower, Kathmandu and footballers and swimmers were from the Nepal army club, Kathmandu, Nepal. The spirometry was done in sitting position using MIR SPIROLAB II spirometer based on American Thoracic Society (ATS) recommendations. Pulmonary function was assessed based on Forced Expiratory Volume in first second (FEV1), Forced Vital Capacity (FVC) and Peak Expiratory Flow Rate (PEFR) expressed as percent predicted for the age, sex, height, weight and race. Results: When comparing the mean values of FVC, FEV1 and PEFR among the five different sport groups, as expected, athletes who have more strenuous respiratory muscles exercise had significantly superior pulmonary function parameters. For example weight lifters and swimmers had 111.84 and 109.56 percentage of predicted values on FVC (P=0.008) respectively. But marathoners, footballers and sprinters had 105.83, 99.25 and 98.34 percentage of predicted values respectively. Similarly, weight lifters, swimmers, marathoners, footballers and sprinters had 110.63, 110.15 and 110.28, 102.52 and 99.23 percentages of predicted values on FEV1 (p=0.090) respectively. Swimmers, marathoners, footballers, weight lifters and sprinters had 106.03 and 107.34, 104.37, 102.08 and 86.58 percentage of predicted values on PEFR (p=0.027) respectively. Conclusion: Athletes who have most strenuous respiratory muscle exercise like swimming and weight lifting have better pulmonary function tests (PFTs) compared to other athletes like sprinters who have less strenuous muscle exercise. Key words: athletes, FEV1, FVC, and PEFR, pulmonary function test

Abstract Objective: To evaluate the graft takes rate of the myringoplasties performed by underlay technique using temporalis fascia graft for the last one year and to assess the hearing improvement in the successfully operated cases. Methods: This prospective Study included 52 ears of 50 patients, who underwent myringoplasty. All operations were performed using an underlay technique and mostly by postaural approach. In all the cases, temporalis fascia was used for the reconstruction of TM. The data of all the patients regarding preoperative disease, perforation size and localization, surgical approach, graft material, pre- and postoperative clinical and functional (hearing evaluation by pure-tone audiogram) results were analyzed. Results: Successful closure rate of the TM perforation was 82.69% and the graft failure rate was 17.30%. In this study, lowest and highest age of patients at presentation was 12 and 42 years respectively with a mean age of 25.5 years. The success rate was better with the advancing age. The most common approach was postaural. Medium size and posterior perforations were common and the graft take rate was 80.95%, and 88.89% respectively. The mean pre and post-operative air conduction threshold in the successful cases were 38.69dB and 30.35 dB respectively with a mean audiological improvement of around 8 dB. The improvement in the hearing was achieved in only 67.44% (29 out of 43) among the successful operated myringoplasties. Conclusion: Myringoplasty is a safe and effective technique to improve the quality of life of patients. The most common approach was postaural. The graft takes rate was better with the advancing ages and with the medium size and posterior perforations. The improvement in hearing was also achieved. Keywords: Myringoplasty, Graft takes rate, Hearing improvement.

Introduction: Skull has cranial vault and base. The cranial vault is called as calvarium which roofs the cranial cavity (brain box).Cranial vault consists of frontal, parietal and occipital bones. Total thickness of calvarial bones includes outer table, diploe and inner table. Diploe is made up of spongy bone whereas outer and inner table made up of compact bone. Objective To measure the thickness of Nepalese calvarial bones i.e. Frontal, Parietal and Occipital. Methods It is a hospital base cross-sectional study. CT records of one hundred and fifty adult people were studied. Nine various points on frontal bone, seven on parietal and six on occipital were located and their thickness were measured bilaterally with help of CT scan. Results The present study showed that Mean thickness+_SD of frontal bone were 6.1+_1.8mm; parietal 4.6+_2.2 and occipital 9.5+_3.4. The study also showed that frontal bone had 2.4+_0.8 mm thick outer table; 1.4+_0.6mm inner table and 3.5+_1.3mm diploe. Similarly parietal bone had 1.9+_0.6 mm thick outer table; 1.1+_0.4mm inner table and 0.8+_0.5mm diploe. The occipital bone had 3.5+_1.5 mm thick outer table; 2.2+_0.8mm inner table and 4.3+_1.8mm diploe. Similarly this present study also calculated the mean thickness+_SD of outer table in the calvarium as 2.7+_1.3mm and that of inner table 1.5+_0.9 mm. Thus it concluded that outer table was thicker than inner table. Key words: skull, cranial vault, calvarium, diploe.

Abstract Background: Acinetobacter species is ubiquitous, aerobic gram-negative coccobacilli that are now emerging as an important nosocomial pathogen. Objectives: The present study was designed to know the prevalence of Acinetobacter in various clinical samples, their characterization and their antibiotic susceptibility pattern in B.P. Koirala Institute of Health and Sciences, Dharan. Methodology: Hundred Acinetobacter isolates obtained from different clinical specimens were taken. Identification to species level was done according to standard microbiological methods. Antimicrobial susceptibility to 10 antimicrobial agents was performed by Kirby Bauer method with special reference to Minimum inhibitory concentration to meropenem. Result : The predominant Acinetobacter isolate was Acinetobacter calcoaceticus (42%) followed by Acinetobacter baumannii (34%) , Acinetobacter lwoffii (18%) and Acinetobacter junii (6%). Resistance pattern to various drugs were Meropenem (19%), Piperacillin (96%), Piperacillintazobactum (43%) , Amikacin (51%), Ceftazidime (84%), Ceftriaxone (66%), Co-trimoxazole (58%), Gentamicin (57%), Ciprofloxacin (55%), Tetracycline (53%) . Eleven isolates of Acinetobacter were resistant to Meropenem as detected by MIC testing whereas resistant Acinetobacter by disc diffusion technique were 19 in number. Conclusion: Occurrence of Acinetobacter in our hospital as an important clinical isolate is a serious matter of concern. Moreover, its involvement in wide spectrum of diseases and development of resistance to commonly used antimicrobials has further worsened the situation. Prudent use of antimicrobials, effective surveillance of antimicrobial resistance and adherence to infection control practices, perhaps are the key factors that may prevent the development and dissemination of resistance among the local isolates. Key words: Acinetobacter, infections, resistance

Abstract Introduction: Every needy child should receive the best medical and surgical attention. In 1940, the White house Conference proposed adequate health services including medical and dental examination, immunization and early detection and treatment of diseases, vision and hearing tests, prevention and control of disease, health records and health services facilities. Objectives: To assess the health status of under five children. To know the treatment preference of the parents towards their sick children. To initiate control measures early, by allocating the health resources more efficiently and providing health awareness activities. Materials and Methods: Descriptive cross-sectional study was conducted. The entire 1-5 years age child (40children) residing in Dharan Municipality ward. No-17 at Phoklen Tapu was included. Simple random sampling technique (lottery method) was used to select the village and Census survey technique was followed to find out the 1-5 years children. The survey was conducted by investigator herself and self develop tools were used to health status of the child. Results: Most of the morbid conditions founded in the study were related to skin diseases (ring worm, boils/wound, cuts, eczema/ redness), ear infection, enlarged lymph node, Pneumonia, Diarrhoea/ vomiting, abdominal enlargement and malnutrition with different Grade. Conclusion: Majority of the parent were not having health education regarding child care. The treat their child with home remedies, by faith healer then after third time they seek sick child with health personnel. Key words: Children, Children’s’ health status,Nepal

Abstract: Background: Mental health and its related problems are growing concerns over the world. The early onset of emotional and behavioral problem in the young children is related to a variety of health and behavior problems in adolescence. It is a challenging all over the world to determine the epidemiology of childhood mental disorders. Objective: The aim of this study is to sort out the prevalence and predominance of mental illness and their onset of age and sex among the child and adolescent who attended in the child guidance clinic in TUTH. Methodology: A retrospective study of a total of 539 consecutive cases of child and adolescent attended in Child Guidance Clinic TUTH. Diagnosis was made according to the criteria of Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision. Result: The cases from the age of 0.4 year to 21 years with mean age 8.85±4.08 years. Significantly majority were boys (n=343, 63.6%) and most of from out of the Kathmandu valley (n=300, 53.2%). Significantly most case referred from ENT OPD of TUTH (n=97, 18%) and mental retardation was the commonest (n=81, 15%) followed by conversion disorder (n=77, 14.3%) and anxiety spectrum disorder (n=63, 11.7%) Conclusion: Boys are common in mental illness among child and adolescents. The common diagnoses among child and adolescent are mental retardation, conversion disorder, anxiety spectrum disorders and Autism spectrum disorder. Key words: Mental illness, Child Guidance Clinic, mental retardation, ENT OPD, TUTH

Objective: To correlate the portal vein pulsatility pattern with severity of liver disease in patients with cirrhosis of liver and portal hypertension. Subjects and methods: Doppler signals from the main portal vein of 36 healthy adults and 52 cirrhotic patients with portal hypertension were studied. Severity of liver disease was graded using modified Child-Pugh classification. Pulsatility of portal flow was quantified using portal venous pulsatility index and complete spectral widening was defined as absence of window below the wave base. The Doppler findings were correlated between the study groups. Results: The mean pulsatility index value in control group was 0.37+0.10 and in cirrhotic patients was 0.17+0.03 (Child A- 0.21+0.02, Child B- 0.18+0.02, Child C- 0.14+0.03). The difference between control and cirrhosis group, as well as the difference within different Child classes were statistically significant (P<0.05). None of the patients in control group had complete spectral widening while 76.92% of cirrhotic patients had complete spectral widening (28.5% of Child A, 66.6% of Child B and 100% of Child C). The difference in distribution of complete spectral widening between control and cirrhotic group as well as within the cirrhotic group was statistically significant (P<0.05). Conclusion: Portal vein pulsatility index and spectral widening can reflect the early hemodynamic changes in cirrhotic patients. These changes become more pronounced with increasing severity of liver disease.

Hypertension is one of the major risk factor for an increased risk of stroke, myocardial infarction, end-stage renal disease, congestive heart failure and peripheral vascular disease. The kidney is a main target of organ damage in hypertension. Microalbuminuria is one of the earliest indications of kidney injury in patients with hypertension. Total of 50 cases and 50 controls are enrolled into the study. Their blood pressure was measured and spot urine sample was analyzed for Microalbumin. Blood pressure and Microalbumin were statically elevated in case group in comparison to control group.

Intestinal parasitosis is highly prevalent among the general population in Nepal. This study aimed to evaluate the distribution of intestinal parasites among patients attending Nobel Medical College Teaching Hospital, Biratnagar, Nepal. A total of 5,524 stool samples examined by direct smear and Formal-Ether concentration technique were reported. The overall prevalence of intestinal parasitic infection was found to be 15.17% (M=15.65% vs F=14.62%). The overall prevalence of intestinal parasitosis was found to be highest among patients aged 5-14 years (20.66%), followed by elderly people aged > 45 years (16.20%) and least among children aged < 5 years (9.09%). Among various parasites detected, the most common was Entamoeba histolytica (44.86%) followed by Giardia lamblia (33.65%), hookworm (10.50%), Ascaris lumbricoides (5.72%), Strongyloides stercoralis (4.77%), Hymenolepis nana (3.34%), Trichuris trichiura (0.95%) and Enterobius vermicularis (0.23%) respectively.