Objectives: To determine the incidence of tuberculous lymphadenitis in enlarged neck nodes. Materials and methods: Continuous prospective study is carried out in the department of otorhinolaryngology head & neck surgery, Kathmandu Medical College, Kathmandu, during two years, from January 2006 to January 2008. The study included a group of 155 patients with cervical lymphadenopathy. Each patient underwent a detail clinical Ear, Nose and Throat (ENT) examination and a battery of investigations which included Fine Needle Aspiration Cytology (FNAC) of the nodes, Montoux's test, blood Erythrocyte Sedimentation Rate (ESR) and chest X-ray. Those patients with tubercular lymphadenitis were referred to Directly Observed Therapy System (DOTS) clinic for anti-tubercular therapy. Others with reactive lymphadenitis were treated with antibiotic and those with metastatic neck nodes were treated accordingly. Results: Of the 155 cases with enlarged neck nodes, 83 (54%) had tubercular lymphadenitis. Fifty two (33%) cases had reactive lymphadenitis and 17 (11%) cases were diagnosed with metastatic neck nodes. Fine needle aspiration cytology was found to be highly effective in the diagnosis of tubercular lymphadenitis with 94% accuracy. Majority of patients were otherwise healthy adults, aged between 8 - 71 years. No difference was observed between male and female in this study. Posterior triangle (PT) nodes were most commonly affected group of nodes accounting for 35 (42%) cases and preauricular region 1 (1%) case being the least commonly affected site. Fifteen (18%) cases presented with abscess formation. Only 42 (50%) cases had family history of tuberculosis but 8 (9%) patients had previous history of various forms of tuberculosis. Twelve (14%) patients had positive chest X-ray findings suggesting of concurrent pulmonary tuberculosis. All the patients were referred to DOTS clinic and were treated with category (CAT) - III anti tubercular therapy (ATT). Others with concurrent pulmonary tuberculosis were treated with CAT I regime. None of the patients required surgical treatment. Conclusion: There is high incidence of tubercular cervical lymphadenitis in patients with enlarged neck nodes in developing countries like Nepal. Involvement of cervical lymphnodes are the most commonly affected group of nodes. Therefore, it is important that otolaryngologists are aware of tuberculosis in the head and neck region. Key words: Tuberculosis, Lymph node, Fine needle aspiration cytology, Lymphadenitis    doi: 10.3126/kumj.v7i1.1766       Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 54-58

In teaching profession, distress has been linked to dissatisfaction with job and to negative affective and professional consequences. In the present study, the attempt was made to identify the level of job stress and job satisfaction among teachers in consideration with their gender differences along with age and experiences. Study comprised of randomly selected 69 school teachers from Pokhara, Nepal. Socio economic data of the subjects were collected by questionnaire. Modified TJSQ and Modified TARSO were applied to identify the Job satisfaction and Job stress of the subjects. Data from acceptable returned questionnaires were analyzed by SPSS 17. It can be concluded from the analysis that, the school teachers were partly satisfied and experiencing mild to moderate stress from their job overall. These can be the resultant of unfavorable job condition and job types for the school teachers. Key Words: School Teacher; Job Stress; Job Satisfaction DOI: http://dx.doi.org/10.3126/ijosh.v1i1.5226 International Journal of Occupational Safety and Health, Vol 1 (2011) 27-33

Purpose Cataract is the most prevalent cause of blindness in Nepal. Several epidemiologic studies have associated cataracts with use of biomass cookstoves. These studies, however, have had limitations, including potential control selection bias and limited adjustment for possible confounding. This study, in Pokhara city, in an area of Nepal where biomass cookstoves are widely used without direct venting of the smoke to the outdoors, focuses on pre-clinical measures of opacity, while avoiding selection bias and taking into account comprehensive data on potential confounding factors Methods Using a cross-sectional study design, severity of lenticular damage, judged on the LOCS III scales, was investigated in females (n=143), aged 20-65 years, without previously diagnosed cataract. Linear and logistic regression analyses were used to examine the relationships with stove type and length of use. Clinically significant cataract, used in the logistic regression models, was defined as a LOCS III score > 2. Results Using gas cookstoves as the reference group, logistic regression analysis for nuclear cataract showed the evidence of relationships with stove type: for biomass stoves, the odds ratio (OR) was 2.58 (95% confidence interval [CI]: 1.22-5.46) and, for kerosene stoves, the OR was 5.18 (95% CI: 0.88-30.38). Similar results were found for nuclear color (LOCS III score > 2), but no association was found with cortical cataracts. Supporting a relationship between biomass stoves and nuclear cataract was a trend with years of exposure to biomass cookstoves (p=0.01). Linear regression analyses did not show clear evidence of an association between lenticular damage and stove types. Biomass fuel used for heating was not associated with any form of opacity. Conclusions This study provides support for associations of biomass and kerosene cookstoves with nuclear opacity and change in nuclear color. The novel associations with kerosene cookstove use deserve further investigation.

Neglected traumatic dislocation of the hip is extremely rare in children, and the preferred treatment remains unclear. This retrospective case series includes 8 children treated by open reduction. The mean age was 7.5 years (range, 2-16 years), and the mean follow-up was 7 years and 7 months (range, 4 month-16 years). Presenting complaints included pain (5/8) and gait disturbance (8/8). Traction failed to achieve a reduction in all cases. At follow-up, 6 hips remained reduced, and 2 achieved a non concentric reduction. All patients had evidence of avascular necrosis. Two patients, in whom a non concentric reduction was achieved, developed progressive flattening and joint space narrowing. Two patients had mild pain at follow-up, and 6 patients were able to squat. Range of motion was restricted both before and after open reduction, most notably in abduction and rotation. Postoperative improvement was seen in abduction (4 cases). Leg lengths were within 2 cm in 7 of 8 cases, and only 1 patient had a discrepancy greater than 2 cm. The results according to Garrett et al were good in 3, fair in 3, and poor in 2. The mean Harris hip score was 89. Patients with a concentric reduction had an adequate functional outcome despite evidence of avascular necrosis. The prognosis remains guarded, and we expect that a subset of patients will develop premature degenerative joint disease. However, we continue to offer patients an operative reduction, which we feel is preferable to other methods. A failed open reduction does not preclude options for salvage.

Background and Objective: To determine the incidence and the types of various thyroid malignancies in multi-nodular goiter.Material and methods: This is a retrospective study, conducted in Department of ENT and Head and Neck Surgery, National Academy of Medical Sciences Bir Hospital Kathmandu and Alka Hospital Pvt. Ltd Lalitpur. The study period was 3 years from 11 January 2011 to 10 January 2014. The study population consisted of 100 patients who were diagnosed as a multinodular thyroid nodule.Result: The highest frequency was 50 (50%) in 31-40 years. Among the total cases, 28 (28%) were males and 72(72%) females. Histopathological analysis showed that benign multi-nodular goiter was present in 87 (87%) cases, and malignant thyroid lesion in 13 (13%) cases. Among malignancies, papillary carcinoma was found as the commonest malignancy 11 (84.61%) cases followed by follicular carcinoma 1 (7.69%) case and anaplastic carcinoma 1(7.69%) case.Conclusion: The risk of malignancy in multinodular goiter should not be underestimated as significant number of patients with thyroid malignancies present with multinodular goiter.JCMS Nepal 2014; 10(4):18-21