Background: Safe motherhood is a priority program in Nepal, aiming to restrain maternal deaths. Meanwhile, knowledge, practices, accessibility, and service quality are considered keys to improve service utilization. This study was conducted to identify knowledge and practices of maternal health care among mothers having < 1-year-old child in the Mid-western Development Region, Nepal. Materials and Methods: A community-based cross-sectional study was conducted during January-April 2011 in rural, Mid-western Development Region, Nepal. Three Village Development Committees (VDC) from Bardiya (plain) and two VDCs from each of the Salyan and Pyuthan (hill) and Jumla (mountain) districts were selected randomly. Hence, there were 81 clusters (1VDC = 9 clusters) and 7-8 participants were selected randomly from each cluster. Data were collected by interview using structured questionnaire and Focus Group Discussion Guideline (18 FGDs), analyzed by SPSS (16.0). CD recorded qualitative data were transcribed and narrated. Percent mean and standard deviation were calculated. Results: Three quarters of the participants had correct knowledge regarding minimum numbers of antenatal visits to be done by a pregnant woman (WHO guideline). Nearly two-fifth participants knew schedule of antenatal care (ANC) visits. Almost 60% had done ≥ 4 ANC visits during last pregnancy. Majority visited Sub Health Post/Health Post/Primary Health Care Centre for ANC Checkup. About 90% had taken Iron and folic acid tablets. About 57% were home deliveries (last childbirth), 40% deliveries were assisted by relatives/husband, and only 32% did postnatal health checkup. Conclusions: There were gaps in the knowledge and practices for health care during pregnancy, childbirth and in the postpartum period. A high rate of home deliveries with the low postnatal service utilization was prevalent. Intensive awareness progam and behavioral change interventions, regular pregnancy monitoring may promote the health service utilization.

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Background: Awareness of glaucoma is low in spite of being the second leading cause of preventable blindness in the world. Aim: To study the awareness and knowledge levels of glaucoma in a tertiary eye care hospital in a tier-2 city. Materials and Methods: This is a hospital-based crosssectional study. A total of 704 patients attending ophthalmology outpatient department of Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital (SDM) Dharwad, aged 40 years and above were administered a questionnaire after a written informed consent to assess their awareness and knowledge levels of glaucoma. Subjects "having heard of glaucoma" even before they were recruited for the study were defined as "aware", and subjects having some understanding of the eye disease were defined as "knowledgeable". Results: Out of 704 subjects recruited for the study, only 34 (4.8%) subjects were aware of glaucoma and 22 (3.1%) had some knowledge of glaucoma. Determinants of glaucoma awareness were higher levels of education, diabetes, or glaucoma and family history of glaucoma. Conclusion: Awareness and knowledge of glaucoma was very low among the subjects. The findings of the study stress the need for health awareness for effective prevention of blindness due to glaucoma.

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Background: Resistance to broad-spectrum beta-lactams, mediated by extended-spectrum beta-lactamases (ESBL), AmpC beta-lactamase, and metallo-beta-lactamase (MBL) enzymes, is an increasing problem worldwide. Aim of the study: This study was undertaken to detect ESBL, AmpC beta-lactamase and metallo-beta-lactamase producing Pseudomonas aeruginosa and Acinetobacter species from the endotracheal aspirates. Materials and Methods: A prospective study was performed over a period of 15 month in a tertiary care hospital. A total of 26 clinical isolates of P.aeruginosa and 40 of Acinetobacter species were tested for the presence of ESBL, AmpC beta-lactamase, and metallo-beta-lactamase enzyme. Detection of ESBL was done by the combined disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines, and MBL was detected by imipenem-Ethylenediaminetetraacetic acid (EDTA) combined disk method. Isolates showing reduced susceptibility to cefoxitin (30 μg) disk were considered 'screen positive' for AmpC beta-lactamases and selected for detection of plasmid-mediated AmpC by the AmpC disk test. Results : 42.30% isolates of P.aeruginosa were positive for ESBL while 53.85% were MBL producers. Among 39 isolates of Acinetobacter baumannii, 43.59% were AmpC producers while 48.72% were MBL-producing strains. Conclusion: The study emphasizes the high prevalence of multidrug-resistant P.aeruginosa and A.baumannii producing beta-lactamase enzymes of diverse mechanisms. Thus, proper antibiotic policy and measures to restrict the indiscriminative use of cephalosporins and carbapenems should be taken to minimize the emergence of this multiple beta-lactamase-producing pathogens.

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Background: To assess combination of an intramedullary interlocking (IMIL) nail with limb reconstruction system (LRS) in cases of infected nonunion tibia and to show influence of nail in predicting good outcome. Materials and Methods: From 2009 to 2011, records of 20 patients (17 men and three women) aged 18 to 65 years (mean, 38.4 years) with infected nonunion of the tibia treated with the LRS over IMIL Nail technique were prospectively reviewed. According to Jain et al., patients were classified into five cases of A1, five cases of type A2, seven cases of type B1, and three cases of type B2. All cases underwent LRS and IMIL. Mean amount of target lengthening was 54.65 mm. The mean follow-up was 14 months. Results: Mean amount of tibia lengthening was 51.70 mm. Leg length equalization was achieved in 19 cases (±5). According to modified scoring by Paley et al., 12 patients had excellent results, three patients had good, four patients had fair outcome, and one patient had poor outcome. Mean distraction index was 0.97. Mean maturation index was 2.43. Mean consolidation index was 3.47. Mean healing index was 1.40. One case had proximal locking screw failure. One case developed pre mature consolidation as distraction was started at delayed period due to non-compliance. Two cases developed decreased dorsi flexion of ankle. Two cases required flap surgeries for cover of bone. One case had pin breakage, which had to be exchanged. One case developed re-infection. Conclusion: The advantages of this technique include complete eradication of infective foci, reduced risk of deformity during lengthening, decrease risk of fractures post external fixator removal and reduction of time required for external fixator use thus decreasing healing index: Number of days of external fixation required per centimetre of lengthening.

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Central giant cell granuloma is a rare benign lesion occasionally causing severe local destruction. Surgical excision is the main stay of treatment. As this lesion is unusual in clinical practice and is associated with dilemma in the treatment, we present here a case report with review of the literature concerning management.

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Adenomatoid odontogenic tumor (AOT) is a rare odontogenic tumour that is frequently misdiagnosed as odontogenic cyst. It is a tumor lined by odontogenic epithelium in a variety of histoarchitectural patterns, which are embedded in a mature connective tissue stroma. It is mostly seen in young patients with a greater predilection for females. Maxillary arch is the predilection site of occurrence, most commonly associated with an unerupted maxillary canine. It presents as a symptom-free lesion and is frequently discovered during routine radiographic examination. It is seen more frequently in female than in male patients. This rare tumor resembles other odontogenic cysts and tumors such as dentigerous cyst or ameloblastoma. The treatment for AOT is conservative and the prognosis has always been good. This article discusses the surgical management of an AOT in the maxilla in paediatric patient.

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A 60-year-old male patient came to ENT OPD with complaints of left nasal obstruction from the last 5 years and moderate quantity of epistaxis from the last 4 months. It was associated with foul smelling mucopurulent rhinorrhea. On clinical examination, a fleshy mass was seen occupying the posterior part of left nasal cavity and displacing the septum on the right side. The mass was relatively painful, soft, and bleeding on touch. The provisional diagnosis of "vascular-tumor-like" angiofibroma was suspected. Diagnostic nasal endoscopy and CT scan PNS were done which revealed a mass occupying the left nasal cavity arising from the posterior part of septum along the choanae till the anterior part of sphenoid sinus. Biopsy of the same revealed an adenoid cystic carcinoma. Adenoid cystic carcinoma is uncommon and that too of the nasal cavity. The cases of the adenoid cystic carcinoma involving the nasal cavity usually involves the lateral wall and the involvement of the posterior part of nasal septum is extremely rare. Thus the presentation of this uncommon disease is discussed here.

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Pyogenic granuloma is a benign, localized mass of exuberant granulation tissue produced in response to various stimuli. It is inflammatory hyperplasia of oral cavity commonly seen on gingival and rarely on other parts of oral cavity such as lips, tongue, palate, and buccal mucosa. It is seen predominantly in second to third decade of life in young females. Clinically manifesting as a small red erythematous exophytic lesion must be biopsied to rule out other serious conditions. This article aims to present a case of extragingival pyogenic granuloma on buccal mucosa in a 40-year-old female patient which is comparatively a rare location.

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Epidermoid cysts are slow- growing, benign tumors that result from proliferation of epidermal cells within a confined space. Epidermoid cysts of the eyelid typically present during adolescence through adulthood as a solitary, elevated, round, freely mobile subcutaneous mass with smooth overlying skin. The most common site for the sebaceous or epidermoid cysts is the meibomian glands of the upper tarsus due to retention of meibomian gland material. We report a case of a 32- year- old male who presented with chief complains of painless swelling on the right upper lid since 1 year. It was an extrameibomian site, i.e., at the lateral superior aspect of the eyelid. It is a rare site for the epidermoid cyst to grow to such an extent. The lesion was excised completely, and histopathology confirmed the diagnosis of epidermoid cyst.

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Arthritic presentation of childhood acute leukemias is well known. A subset of these children may have peripheral blast cells undetectable (aleukemic leukemia). We report classical asymmetric, fleeting type of polyarthritis involving the large weight-bearing joints along with remittent fever and normal leukocyte counts as a presenting feature of acute lymphoblastic aleukemic leukemia, deliberated as a 'paraneoplastic syndrome' of childhood.

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Aim: To study and explore the socio-demographic profile of patients with schizophrenia and depression. Materials and Methods: Consecutively, 100 schizophrenia patients and 100 depression patients attending psychiatry department were included in the study. The International Classification of Diseases and Related Health Problems (ICD) - 10 criteria were used for diagnosis and these patients were assessed by self-developed socio demographic proforma. Statistical analysis was done using SPSS, version 17 software. Chi-square tests were done for comparison of the variables between the two groups. Results: Two groups of patients with schizophrenia and depression have differed on variables like age, gender, marital status, education, occupation, duration of illness, family history of psychiatric illness, and patient income. These groups did not differ on other socio-demographic variables like, urban/rural distribution, type of family, and religion. Conclusion: The study finds significant difference in demographic variables in schizophrenia and depressive disorder.

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Background: Sinusitis with orbital complication is a potentially fatal disease that has been known since the days of Hippocrates. Primary sinus infection is the most common cause of orbital cellulitis. It is an emergency that threatens not only vision but also life from complications such as meningitis, cavernous sinus thrombosis, and brain abscess. Surgical intervention is mandatory whenever antibiotic treatment fails. There are two surgical options for the drainage, an external approach via a Lynch incision and an intranasal endoscopic procedure. Materials and Methods: Five patients with orbital cellulitis secondary to acute on chronic rhinosinusitis were included in the study from the period of 2010 - 2011. All five patients did not respond to medical management and hence underwent endoscopic sinus surgery with treatment of orbital pathology. At the end of the surgical procedure Mitomycin C in a concentration of 0.4mg/ml was applied with a cottonoid for a period of 4 minutes to prevent chance of adhesion formation. Results: In this series 3 females and 2 male patient with orbital cellulitis secondary to acute on chronic rhinosinusitis underwent endoscopic sinus surgery with treatment of orbital pathology. All 5 patients showed subjective and objective improvement within one week of endoscopic management. Conclusion: Though antibiotics have altered the course of sinusitis, its grave complications still persist in our environment. The excellent results and the absence of any major complications of endoscopic sinus surgery and drainage of abscess with application of Mitomycin C can be recommended as the preferred surgical technique.

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Aim: To evaluate the role and efficacy of laparoscopic reduction of intussusceptions in children with failed initial hydrostatic reductions. Materials and Methods: This is a retrospective study of children who underwent laparoscopy for incomplete reductions following sonoguided hydrostatic reduction.Laparoscopy guided pneumatic reduction or laparoscopic reduction was done. Results: Hydrostatic reduction was successful in 76 (73.5%) of cases. Among 26 children in Laparoscopy group 8 showed completeness of reduction. Features of necrotic bowel were seen in 4 (15%) children requiring laparotomy. Among 14 children with incomplete reduction 3 (21%) children required pneumatic reduction under laparoscopic monitoring. 11 required laparoscopic reduction. None of the incomplete group with viable bowel required conversion to open surgery. No major complications were noted in any groups. The mean hospital stay was 1.8 days in hydrostatic group 4.2 days in laparoscopic group and 6.8 days in laparotomy group. No recurrence of intussusceptions noted. Conclusions: The role of laparoscopy in intussusceptions is evolving as a safe procedure and helps in avoiding laparotomy in large number of children with incomplete reduction. Non operative reduction is the gold standard in management of intussusceptions in children. Excellent results are obtained with either saline or pneumatic reductions. However, in few cases of, incomplete reduction or doubtful complete reduction with non operative technique poses problem for further management and may need laparotomy. Laparoscopy being less invasive has distinct advantage over open laparotomy. Use of Laparoscopy in the management of Intussusceptions is described in literature. We have analyzed our results of laparoscopic management of intussusceptions in children in our center.

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The case reported here is an 18 year old male. He complained of a painless lump located on the left cheek over the anterior surface of masseter muscle for last 2 years. An early diagnosis of sebaceous cyst was made. Excision was performed and histopathological findings revealed pilomatrixoma. Pilomatrixoma is an uncommon, harmless, skin lesion derived from hair matrix cells. It is composed of an epithelial component of the most proximal portion of hair follicle. It is most often diagnosed in young children but may also affect adults. Single skin coloured or purplish lesions arise on the head and neck, but they may occur at any site. The key to diagnosis is identification of darkly stained 'basophilic cells' and 'shadow cells'. Calcium deposits are found in most of the lesions. Complete surgical excision is the treatment with rare chances of complications.

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