Background Posting of doctors in remote rural areas has always been a priority for Government; however data are scarce in the country about experience of doctors of working in remote areas after medical graduation.Objective A questionnaire survey of doctors was planned to analyze their experience of working after graduation in remote rural areas in various parts of the country.Method The cross-sectional survey was done by convenience sampling method. A one-page questionnaire with one partially closed-end and five open-end type questions was distributed to the doctors who had worked in remote rural areas after graduation under various governments’ postings.Result Two-third of participants had their home in urban areas and 89.8% had stayed for 1 to 5 years. About half of the participants had difficulty in getting the posting in the remote areas of their choice. Most participants indicated provision of opportunities for Residential (postgraduate) Training as their reasons of going to remote areas as well as their suggestions to encourage young graduates to go there. Similarly most also suggested appropriate career, salary and incentives to encourage doctors to go to work in remote areas. About 85% of participants pointed out the major problem faced while posted in remote areas as difficulty in handling varied situations with no guidance or seniors available around.Conclusion The notable points indicated by the participants are centered on the opportunity for Residential Training and difficulties faced without such training. Residential Training is a priority to be considered while planning the health policy for optimum health care of people.Kathmandu University Medical Journal Vol.12(2) 2014: 121-125

Introduction: Varicose vein is a common venous condition affecting quality of life presenting as an asymptomatic condition to a feeling of heaviness, pain, pigmentation, palpable superficial veins, itchiness and ulceration. Proper management of varicose vein is of huge importance due to its high prevalence and the impact it has on patients' quality of life, productivity as well as on health-care resource burden. Various conservative and invasive interventions are available for the management of varicose veins. Here we present our experience with the invasive intervention of varicose veins during a period of six years at a tertiary care center (Dhulikhel Hospital) in Nepal. Although Radio Frequency Ablation (RFA) is recently introduced in Nepal, it has shown promising outcome. Method: This is a retrospective descriptive cross-sectional study between the years 2013 and 2018 at the Dhulikhel Hospital among patients that underwent surgical management of varicose veins. For ease in interpretation, patients who underwent surgery for both lower limbs in the same setting are considered as separate cases. Results: In a total of 533 limbs, the most common vein involved was isolated great saphenous vein in 70.4%. In terms of side affected, 157 patients (33.8%) were affected on the right side, 238 (51.3%) were affected on the left side and 69 (14.9%) patients had bilateral involvement. The most common clinical feature was prominent vein present in 94.5% limbs. This was followed by pain in 55.7%, pigmentation in 25.3%, itchiness in 14.6% and ulceration in 13.1%. Mean hospital stay was 1.1 days (S.D. 0.64, Range 0-3). In terms of complication, one case with deep vein thrombosis (0.18%) developed in the seventh postoperative period. There was skin burn in two cases (0.53% of RFA cases) and in 11 cases (2.06%) there was painful superficial thrombosed veins of which three required excision under local anesthesia (0.56%). Conclusion: There are multiple invasive interventions for varicose veins. With the availability of the facilities, RFA is the procedure of choice in feasible cases. The most common complication after surgical treatment was painful thrombosed superficial veins. DVT was a rare complication.

BACkGROUND: Fluoroscopic guidance to put pedicle screws helps to confirm the accuracy of the screw in place; however, it is always not mandatory

Background: Ultrasound has been shown to be effective in the diagnosis of musculoskeletal pathology, and its use continues to increase. Objective: To evaluate the role of ultrasound in detection of pathology of muscle and tendon, where the facility of advanced imaging modality is not available. Methods: Ultrasound evaluation of muscle and tendon was done in referred 550 patients with clinical history of localized pain or trauma. A detailed clinical history was taken before sonography. The clinical findings and provisional diagnosis were recorded. A routine ultrasound examination included imaging of the affected muscle and tendon. The findings were compared with contralateral limb. Results: Ultrasound showed ailment in 130 patients and was useful to detect lateral epicondylitis in 37 patients, tenosynovitis in 26, tear of muscle or tendon in 23, cystic lesions in 9, abscess in 17, myocysticercosis in 4, radiolucent foreign bodies in 3, muscle hernia in 2 and intramuscular hemangioma in 9 patients. Conclusion: High resolution ultrasound is a rapid and inexpensive technique.It can be used as a first line imaging modality for the musculoskeletal pathology particularly in developing countries with limited imaging facilities.