Background and Aims: Glomerular disease is the one of the major cause of end stage kidney disease in Nepal. We have undertaken this study to know the spectrum of glomerular disease in native kidneys in patients attending department of nephrology of Nepal Medical College Teaching Hospital.

From July 1998 to July 1999, 45 cases of acute renal failure were treated at Bir Hospital, Kathmandu. Outof which 24 were male and 21 were female. Age ranged from 11 months to 84 years with mean age being 35years and 9 cases were below 10 years.Four cases with pre-renal azotaemia and twenty five cases of acute tubular necrosis (ATN) accounted for64% of all cases. These were due to gastroenteritis 10, sepsis 6, post surgical 1, trauma 1 and obstreticalcomplications 5. Multiple hornet stings were responsible for acute renal failure in 3 cases, acute urate nephropathy in 1 case and miscellaneous causes in 2 cases.Glomerulonephritis / vasculitis accounted for 17.7%, acute interstitial nephritis 4.4%, haemotytic uraemicsyndrome (HUS) 6.6%, and post renal azotaemia in 6.6% of all cases. Mean serum creatinine was 8 mg/dl,mean blood urea 190 mg/dl. Eight cases were treated only conservatively, eighteen received haemodialysis,fourteen received peritoneal dialysis, three received both and two refused for dialysis. Average duration ofhospital stay was 13.6 days. Out of the forty-five cases twenty-nine recovered normal renal function, tenexpired, two recovered partially, two progressed to chronic renal failure and two left against medical advice.Overall mortality was 22.2%.Common causes of acute renal failure in our setting were gastroenteritis (22%) and sepsis (20%). HUS wasexclusively seen in children following bacillary dysentery. Multiple hornet stings is an important cause ofacute renal failure in our country.

Introduction: Co-morbid depression impacts negatively on quality of life in Chronic Kidney Diseasepatients. It is unclear if self-reported depression rating scales can be used accurately for screening.The aim of this study was to estimate prevalence of depression in patients on hemodialysis usingPatient Health Questionnaire-9 and compare Patient Health Questionnaire-9, Max Hamilton Ratingscale and International Classification of Disease-10 for diagnosis of depression. Methods: It was descriptive cross-sectional study conducted from November 2017 till June 2018.Ethical approval was taken from Ethical Review Board, Nepal Health Research Council. Informedand written consent was taken. Patients undergoing hemodialysis at Nepal Medical College for >3 months duration were included in study. Patients on hemodialysis were asked to fill validatedNepali translated version of Patient Health Questionnaire -9. Psychiatrist administered MaxHamilton Rating scale for diagnosis and categorization of depression and confirmed depressionbased on International Classification of Disease -10. Statistical Package for Social Sciences version 20was used for statistical analysis. Results: Total of 100 patients completed study. Median age was 47.5 years. Prevalence of depressionwas 78 (78%) using Patient Health Questionnaire-9 and 65 (65%) using Max Hamilton Rating scaleand 51 (51%) using International Classification of Disease -10. Mean depression in males using PatientHealth Questionnaire -9 was 7±4.33 and in females was 11.04±5.90. The most common symptom wasfatigue among 82 (82%). Conclusions: There is a high prevalence of depression in patients with Chronic Kidney Disease onhemodialysis compared to general population.

Background. Adolescent girls in developing countries do not have proper information, and proper information is covered up by sociocultural boundaries resulting in various morbidities. This study aimed to determine level of knowledge and its associated factors regarding menstrual hygiene amongst adolescent school girls in Dang district, Nepal. Methods. Institution-based cross-sectional study was conducted between April and October 2019 among 406 adolescent girls studying in grades 8–10 between ages of 10–19 years in Dang district, Nepal. From a total of 10 local units, 5 were selected randomly. Out of the selected 5 units, 10 schools consisting of 5 government and 5 private schools were selected through disproportionate stratified random sampling. A further 406 students were then selected randomly from the 10 selected schools. Bivariate analysis was used primarily to assess the association between dependent and independent variables. Variables which were associated with bivariate analysis were entered into a multivariable logistic regression model to identify associated factors of menstrual hygiene practice. Results. The mean age and family size were 15.13 ± 1.19 and 5.58 ± 1.81, respectively. A total of 87.7% of adolescents had good knowledge regarding menstrual hygiene. Adolescents living in rural area (AOR = 0.27, CI: 0.12–0.61, p ≤ 0.001 ), private schools (AOR = 6.10, CI: 1.58–23.46, p ≤ 0.001 ), mothers who can read and write (AOR = 0.22, CI: 0.07–0.64, p ≤ 0.001 ), fathers who have up-to-grade-10 education (AOR = 5.15, CI: 1.84–14.39, p ≤ 0.001 ), and living only with mothers (AOR = 0.29, CI: 0.12–0.69, p ≤ 0.018 ) were significantly associated with level of knowledge of menstrual hygiene. Conclusions. Though the majority of respondents had a good level of knowledge regarding menstrual hygiene, there was a knowledge gap in specific areas. The level of knowledge was significantly poor among adolescents in rural areas and those living only with mothers. Thus, this study concerns the need for policy makers to focus on specific education regarding menstrual hygiene in rural areas including both parents.

ABSTRACT ABSTRACTCerebrovascular accident is a frequent cause of death and disability in most parts of the globe. The incidence of cerebrovascular diseases increases with age and the number of strokes is projected to increase as the elderly population grows. This study was undertaken to determine the type of stroke and also to relate the risks factors associated with stroke. Hundred consecutive patients presenting with stroke in the emergency department / neurology clinic were subjected to computed tomography scan of the brain. Sixty -four patients had ischemic infarct and 36 had intracranial hemorrhage which included 2 patients with subarachnoid hemorrhage and 1 with underlying cavernous angioma. Ischemic stroke was thus commoner than hemorrhagic stroke. Previous infarct or lacunes were noted in 25 % of the patients presenting with stroke. Risk factors were present in most (77 %) of the patients presenting with stroke. Among the various risk factors, the single most common was smoking seen in 38 cases, followed by hypertension in 28 cases, obesity in 8 cases and diabetes in 3 cases. Twenty-one patients had multiple combinations of the above risk factors. Among the multiple risk factors, combination of alcohol and smoking was the commonest seen in 11 cases, followed by hypertension and obesity in 8 cases and alcohol with obesity in 2 cases. Change in lifestyle and eating habits may thus help reduce the incidence of stroke.

Introduction: Dialysis nurses should have a good knowledge regarding hemodialysis treatment. The status of Nepalese dialysis nurses on this aspect is unknown. This study was done to assess the knowledge and practice on different aspects of the hemodialysis treatment. Methods: We distributed questionnaires to the participants of a conference held on September 24, 2016 in Kathmandu. We included 94 out of 116 participants who were giving care to dialysis patients. We calculated mean and standard deviation for continuous variables and frequencies and percentage for the responses and compared counseling with different parameters. Results: Response rate was >96%. Fifty-nine respondents (64%) were from age group 20-29 years. Only 39 (42%) received formal nursing training in hemodialysis. Seventy-one (78%) respondents always counseled patients regarding fluid intake. Thirty-seven (96%) trained nurses always counseled the importance of regular dialysis. Seventy-six (81.7%) respondents did counseling on vaccination against Hepatitis B. Counseling on vaccination against influenza and pneumococcus was 50%. When comparing educational status, respondents below bachelor level did more frequent counseling than level above (p=0.03). All the respondents knew the importance of hand washing and BP monitoring during hemodialysis. Ninety-one (96.7%) respondents knew how to deal with BP changes during hemodialysis. Seventy-three (77.6%) respondents were very confident on managing complications. Only 31(33%) respondents knew how to deal with patients on continuous ambulatory peritoneal dialysis. Conclusions: Dialysis nurses have knowledge on basic procedures of hemodialysis but there is a space for improvement in counseling and dealing with complications to provide quality service to hemodialysis patients. Keywords: counseling; hemodialysis; Nepal; nurse.

Fractures of the mandible occur more often than the other facial bones even though the mandible is considered to be one of the strongest and most rigid bones of the facial skeleton. 1 According to Killey and Rowe, mandibular fractures comprise between 40% and 65% of all facial fractures and angle fractures are involved in 25-33% of such fractures. 2,3 Patterns of fracture depend on multiple factors such as the size, direction, nature and surface area of the impacting force, and the biomechanical characteristics of the mandible such as bone density, mass, normal, or pathologic anatomic structures. 4,5 Huelke reported that the relationship between fracture location and the presence of a tooth-bearing area is significant. 6

Schizencephaly is an uncommon congenital cerebral malformation that involves the cerebral mantle and consists of a cleft that extends through the entire cerebral hemisphere from the lateral ventricle to cerebral cortex. The condition is present at birth and present early in life. Here we present an adult patient with schizencephaly presenting with first onset seizure. Key words: schizencephaly; lateral ventricle; seizure imaging diagnosis DOI: 10.3126/jcmsn.v6i1.3604 Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 1, 54-56