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Introduction Magnesium has been shown to have bronchodilator properties in asthma and chronic obstructive pulmonary disease (COPD). Therapeutic benefits of nebulized magnesium in asthma has been seen. The purpose of this study was to compare therapeutic benefits of nebulised magnesium sulphate as an adjuvant with normal saline in patients with COPD exacerbation. MethodsIt was a randomized single blind interventional study of 172 cases of acute exacerbation of COPD presenting (AECOPD) with a peak expiratory flow rate (PEFR)

Introduction: Emergency services are the gateway between the community and hospital that provides 24-hour access for most needy patients in critical and emergency conditions. Mortality rate varies in emergency department across the world and even in different emergency units of the same hospital. This retrospective study was done in adult emergency services of a tertiary hospital to determine mortality rate and analyze causes of death. Methods: A retrospective observational study of mortality cases to analyze mortality rate and causes of death of patients for a period of 6 months between October 2017 to March 2018 was carried out in the adult emergency services of Tribhuvan University Teaching Hospital, Kathmandu. Data required were collected from copies of death certificates. Results: During the study period, a total of 128 patients died in emergency, accounting 0.5% of total patient. Male deaths (52.3%) were slightly higher compared to female deaths (47.7%). Age group 66-75 years had the highest (24.2%) of total mortalities in the emergency. The most common immediate cause of death was sepsis/septic shock (21.9%) followed by cardiopulmonary arrest, aspiration, respiratory failure, other causes of shock and poisoning. The commonest antecedent cause of death was attributed to respiratory causes. Similarly, the most common contributory cause of death was chronic obstructive pulmonary disease. Conclusion: Older age group is prone to the mortality risk. Sepsis/septic shock was the most common immediate cause of death. Pneumonia was the most common antecedent causes of death. Chronic obstructive pulmonary disease was the commonest contributory cause.

Introduction: Sepsis is a common problem encountered in emergency room which needs to be intervened early. It is always difficult to have quick prognostic marker of sepsis in busy emergency. So this study was conducted to determine whether base deficit can be used as an indicator of mortality among septic patients in emergency room setup like ours. Methods: It was a hospital based descriptive cross sectional study done at Tribhuvan University Teaching Hospital, Kathmandu from March 2018 to December 2018. Acute physiology and chronic health Evaluation II score (APACHE II), Base deficit, Sequential Organ Failure Assessment (SOFA) score on first day of arrival in emergency room was calculated. The association of 28-day outcome with acute physiology and chronic Health Evaluation II score, Base deficit value and SOFA score were derived. Results: Out of 229 patients with septic shock 62 died (27%) and among 71 patients without septic shock, 12 died (16.9%).Overall mortality was 24.66 % (n= 74).The area under the ROC curve for Base deficit(0.864;95% C.I.=0.822-0.906), APACHE II (0.782; 95% C.I=0.718-0.848, SOFA (0.689;95% C.I=0.620-0.757) were greater than 0.7 except for SOFA which signifies these test to have fair efficacy to predict mortality. Conclusions: High base deficit value predicts mortality in patients with sepsis and septic shock. The base deficit could be used as an alternate marker to predict mortality in septic patient. We recommend for large multicenter study with randomization so that the findings can be applied to general population and of different geographical situations.

Coffee is one of the most consumed beverages worldwide. The main aim of this work is to characterize the elemental composition and determination of the elemental concentration of the green coffee beans, roasted coffee beans and filter coffee powder. We have chosen three types of coffee (green, roasted and filter) of all three coffee samples: Coffea Canephora (robusta coffee), Coffea Arabica (arabica coffee) and Peaberry coffee. Using Particle Induced X-Ray Emission Technique (PIXE), we found that in all coffee samples, the elements K and Ca are present at major concentration level. P, S, Cl and Fe are present at minor concentration level. Sc, Cr, Ti, Mn, Cu, Zn, Rb, Sr, Se and Ni are present at trace concentration levels. Inter-comparison study was made in which filter coffee samples are found to be richer in the concentrations for the many elements while roasted coffee showed lower concentrations. Changes in the chemical elements during the roasting process of green coffee beans and changes in the chemical elements during the processing of roasted coffee beans to make the filter coffee powder, were studied. The method was validated using NIST SRM standard samples.

BACKGROUND: Limited number of studies has compared metformin with other Oral Hypoglycemic agents (OHAs) for reducing BMI and few of the results are controversial. Perhaps, this is of clinical importance because the Nepalese population presents different dietary habits in comparison with the European population. The objective of this study was to study the comparative evaluation of metformin with other OHAs influence on Body Mass Index (BMI) in Nepalese patients with diagnosed type 2 Diabetes Mellitus (T2DM)). METHODS: A prospective cross sectional database of patients treated at diabetic clinic, TUTH, was analysed. Patients (N = 115) with type 2 Diabetes Mellitus and with complete BMI and HbA1c and treated with metformin and other OHAs, for at least three visits were included. Analysis of BMI and the type of oral agent was performed. Individuals were categorized as ideal weight, overweight, or obese (BMI 30 kg/m2, respectively). RESULTS: There were differences between the values of BMI at presentation, the third, the sixth and the ninth months, between the metformin-treated groups compared to other OHAs treated groups. Metformin was given to 48 patients and OHAs to other 57 patients. In the metformin group, mean BMI decreased significantly during the treatment time, from 29.93±5.7 to 28.95±5.2 (

Introduction: Urinary tract infections are commonly encountered in day to day practice of a general practitioner.The purpose of this study is to determine if there is an association between urinary tract infections (UTI) and sexually transmitted infections (STI), as both may present with similar symptoms. Methods: This was a hospital based, prospective observational study in 104 women of 18 to 49 years age group, done during a period of six months at Patan hospital. Urinalysis results and genital examination findings were recorded.STI was defined as a vaginal swab positive for Trichomonas vaginalis(TV)/Neisseria gonorrhoeae (NG)/Chlamydia trachomatis(CT).UTI was defined as urinary WBC >=6per high power film. A urine c/s >105 colonies of a single pathogen was considered urine culture positive. Results: Mean age of patients was 28.38 years. The most prevalent organism was TV (6/104, 5.8%), followed by NG(4/104,3.8%) and CT(2/104, 1.2%). 11.5% of women had STI , while 57.7% were urine culture positive. Out of those with urine culture positive, 83.3% had urinary WBC 30/hpf. The relation between pyuria and urine c/s positivity was significant ( p value 0.005). The prevalence of STI in urine c/s positive group was 13.3%, and in urine c/s negative group was 9.1% ( p value 0.553). Conclusion: There was no statistically significant difference in the prevalence of STI between urine culture positive and negative groups.

Introduction: Various socio-demographic factors are known to play decisive role in the acceptance of family planning methods. Commonly known factors include age of the women, age at marriage, age at first pregnancy, education and occupation. Methods: This is a hospital based cross sectional, observational study conducted at Okhaldhunga Community Hospital among married women of reproductive age (15-49 years) attending either general OPD clinic or family planning clinic. Data were collected through an interview using a predesigned questionnaire. Results: Age of women had statistical significance as the acceptance increased with the age. More than two-third of women using methods of family planning were married before the age of 20 years. About 43% of women had first pregnancy before the age of 20 years. There was no statistical significance between the current use of family planning methods and the education (p- value 0.6) and the various occupations (p-value 0.1). Conclusion: There is a need for particular emphasis on contraceptive needs of adolescents and to improve accessibility and availability of all family planning services.

Diabetes is one of the major public health problems in Nepal. Very few studies on correlation between waist hip ratio and random blood sugar have been done in remote areas of Nepal particularly in minor ethnic groups like Thami. This study attempted to compare waist hip ratio and blood sugar level in Thami community.This cross sectional study was conducted in sub-health post of Lapilang village of Dolakha district of Nepal. A total of 243 local inhabitants from Thami Tribe participated in the study. Waist hip ratio was calculated after taking measurements of waist and hip using flexible measuring tape; and, blood glucose level was measured by glucometer.The mean age of the participants was 46.02 years; among participants 126 (51.9%) were males and 117 (48.1%) were females. Mean waist hip ratio was 0.87, mean blood sugar level was 124.5 mg%. Increase in Waist hip ratio correlated significantly with increase in random blood sugar level both in males (p=0.008) and females (p=0.007).Increase in waist hip ratio is associated with increase in random blood sugar level. Therefore, there is a need of public awareness program to reduce waist circumference thus reducing weight of people to prevent development of diabetes mellitus in long run.

In troduction: Diabetes is one of the major public health problems in Nepal. Very few studies on correlation between waist hip ratio and random blood sugar have been done in remote areas of Nepal particularly in minor ethnic groups like Thami . This study attempted to compare waist hip ratio and blood sugar level in Thami community of Nepal. Methods: This cross sectional study was conducted in sub-health post of Lapilang village of Dolakha district of Nepal. A total of 243 local inhabitants from Thami Tribe participated in the study. Waist hip ratio was calculated after taking measurements of waist and hip using flexible measuring tape; and, blood glucose level was measured by glucometer. Results: The mean age of the participants was 46.02 years; among participants 126(51.9%) were males and 117(48.1%) were females. Mean waist hip ratio was 0.87, mean blood sugar level was 124.5mg%.Increase in Waist hip ratio correlated significantly with increase in random blood sugar level both in males(p=0.008) and females(p=0.007). Conclusions: Increase in waist hip ratio is associated with increase in random blood sugar level. Therefore, there is a need of public awareness program to reduce waist circumference thus reducing weight of people to prevent development of diabetes mellitus in long run. Keywords: blood sugar level; diabetes; Thami community; waist hip ratio

Introduction: Self-harm forms a significant proportion of patient attending in emergency departments, typically 10-30 per 100000 people commit suicide annually. The objective of this study was to find out the factors responsible for self harm. Methods: This is a cross sectional study of 100 patients of self harm coming to Emergency Department of Tribhuvan University Teaching Hospital from 1stOctober 2007 to 31stMarch, 2008. Questionnaire about demographic information of patient along with details about cause of self harm, and any other illnesses associated was filled. Information about duration of arrival in emergency department, place of self harm was gathered. Patients were clinically examined and hematological and biochemical tests including liver function test and the type of poison used and its level in blood were examined. Results: Total number of patients with self harm was 100 (female - 71%; male- 29%).Among female, 16-30 years age group to be the largest (76%). Mean duration of arrival in emergency department was 3.08 hour. Metacid ingestion (29%) was found to be the most common cause for self harm. There is no difference of self harm for suicide and threat cause. Only 5% of patient with self harm has psychiatry illness in the past. Conclusions: Self harm forms a significant proportion of patient attending the Emergency department and the most common form of self harm used was metacid ingestion. There is compelling evidence for the need to improve delivery of care for patients who inflict self harm. Key words: Cause; emergency department; self harm. DOI: http://dx.doi.org/10.3126/joim.v32i3.4954 Journal of Institute of Medicine , December, 2010; 32:3 14-17

Introduction: The burden of unknown and unconscious patient is a common challenge to provide medical care in the emergency department of the hospitals. As the social security systems like insurance does not exist and poverty is rampant, it will continue in the future too. In this context this study is an attempt to analyze the morbidity & mortality as well as the types of illness, causes of unconsciousness and the source of unconsciousness in these patients without any identity. Methods: A retrospective analysis of the unaccompanied, unconscious patients attending the emergency department of Bir hospital during the Nepali year 2066 Bikram Sambat (14 April 2009 to 13 April 2010) was carried out. Results: Two-thirds of these patients were brought to hospital by the police. The next category (20%) were brought by unknown person and left without any information. Conclusions: Use of the type of substance and their nature remains unclear and there is a need to develop a trend to identify these substances so that specific treatment and hence preventive measures can be implemented effectively. Keywords : Destitute; unconscious; unknown substance DOI: http://dx.doi.org/10.3126/joim.v32i2.4936 Journal of Institute of Medicine , August, 2010; 32:2-4