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NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

Friday, September 25, 2015

She had pulmonary stenosis treated in infancy.

You are reviewing a 17-year-old girl who has been transferred from the paediatric service.  She had pulmonary stenosis treated in infancy.

example of other chromosomal disorders 

 She has learning difficulties and facial dysmorphism.

Which one of the following is not in the differential diagnosis?

A. Holt–Oram syndrome
B. N oonan syndrome
C. 22q11 microdeletion syndrome
D. L oeys–Dietz syndrome
E. C ostello syndrome

Ans is A : Holt–Oram syndrome causes septal defects, AV node disease, and radial ray
abnormalities, but not pulmonary stenosis. In addition, it is not associated with learning

What is Holt-Oram syndrome?

Holt-Oram syndrome is characterized by skeletal abnormalities of the hands and arms (upper limbs) and heart problems.
People with Holt-Oram syndrome have abnormally developed bones in their upper limbs. At least one abnormality in the bones of the wrist (carpal bones) is present in affected individuals. Often, these wrist bone abnormalities can be detected only by x-ray. Individuals with Holt-Oram syndrome may have additional bone abnormalities including a missing thumb, a long thumb that looks like a finger, partial or complete absence of bones in the forearm, an underdeveloped bone of the upper arm, and abnormalities of the collar bone or shoulder blades. These skeletal abnormalities may affect one or both of the upper limbs. If both upper limbs are affected, the bone abnormalities can be the same or different on each side. In cases where the skeletal abnormalities are not the same on both sides of the body, the left side is usually more severely affected than the right side.
About 75 percent of individuals with Holt-Oram syndrome have heart (cardiac) problems, which can be life-threatening. The most common problem is a defect in the muscular wall (septum) that separates the right and left sides of the heart. A hole in the septum between the upper chambers of the heart (atria) is called an atrial septal defect (ASD), and a hole in the septum between the lower chambers of the heart (ventricles) is called a ventricular septal defect (VSD). Some people with Holt-Oram syndrome have cardiac conduction disease, which is caused by abnormalities in the electrical system that coordinates contractions of the heart chambers. Cardiac conduction disease can lead to problems such as a slower-than-normal heart rate (bradycardia) or a rapid and uncoordinated contraction of the heart muscle (fibrillation). Cardiac conduction disease can occur along with other heart defects (such as ASD or VSD) or as the only heart problem in people with Holt-Oram syndrome.
The features of Holt-Oram syndrome are similar to those of a condition called Duane-radial ray syndrome; however, these two disorders are caused by mutations in different genes.

Tuesday, September 15, 2015

Which of the following may cause biliary obstruction?

Which of the following may cause biliary obstruction?

A. Ancylostoma
B. Entrobius
C. Strongyloides
D. Clonorchis   Ans: D.

Adult flukes of Clonorchis and Opisthorchis measure 8-15 mm and adult flukes of Fasciola measure 20-40 mm in length. The presence of flukes in the bile ducts causes dilatation of the bile ducts, varying degrees of chronic inflammation followed by adenomatous hyperplasia, and bile duct wall thickening. Imaging findings of clonorchiasis and opisthorchiasis include visualization of adult flukes in the bile ducts and gallbladder, diffuse dilatation of the peripheral small intrahepatic bile ducts with no or minimal dilatation of the large bile ducts, and thickening of the bile duct wall. In biliary fascioliasis and ascariasis, adult worms are visualized in the dilated bile ducts and gallbladder.
Ans: D. 

Monday, September 14, 2015

हेल्थ टिप् : चुइगम चपाउदा दातलाई फाइदा :

हेल्थ टिप् : चुइगम चपाउदा दातलाई फाइदा :

-- खाना खाए पछि चिनी रहित चुईगम  चपाएमा तपाई को सास र मुख मा हुने रोग र दातमा किरालग्नु  बाट बच्न सक्नुहुने छ !

  • २० मिनट खान खाए पछि दैनिक रुपमा चुयिगम चपाएमा मुख बाट प्रस्सत पानी आउने र मुख सफा र जिवार्ण मुक्त हुने हालै गरेको अध्ययनले देखाएको छ !

  • चिनी रहित चुईगम  मात्रले फाइदा गर्छ तेसैले  सुगर भएको चुईगम  नचपाउनु !

  • सधै दिनमा २ पटक फ्लोराईड भएको दंतमंजन ले दात माझ्नु भएमा मुख स्वास्थ र किरा लग्नुबाट जोगिन्छ  !

Friday, September 11, 2015

A Child with Bruises of Different Ages

A Child with Bruises of Different Ages

Case presentation: The 3 - year - old male pictured here has been brought in by his parents because of altered mental status following a fall. His parents report that about an hour ago he tripped on some of his own toys and fell down the stairs at home. He did not lose consciousness but he has been “very sleepy” since. On examination, he is lethargic but arousable and obeys commands.

He also has gross deformity, point tenderness, and erythema at the middle anterior aspect of his right humerus.

In addition, he has facial contusions and back contusions as illustrated that appear to be of varying ages.

Question: Which of the following bruising patterns is least concerning for child abuse?

A. Bruising on the right knee of a 2-month-old infant

B. Multiple bruises on the knees and shins of a 3-year old female

C. A 5-year-old male with multiple bruises on his cheeks and forehead

D. A 2-year-old female with bruising along the arms that appears to have a consistent loop pattern

E. Multiple bruises along the buttocks of a 2-year-old male

Answer: BDiagnosis: Child abuse

Discussion: Much effort has been directed toward collecting and interpreting information about patterns of bruising in children in order to allay or corroborate the suspicion of child abuse, and this remains an area of active research. Any concern based on bruising alone should always be interpreted in the context of the developmental status of the child, the clinical scenario, and the explanation given by caregivers (as well as the consistency of that explanation). While each child should be evaluated in such context, a review of the recent medical literature does support the finding that some patterns of bruising are more suggestive of abuse and should therefore alert the physician to consider that possibility.

Some patterns of bruising are found more often with accidental mechanisms and may be more reassuring. For example, bruising of the shins and knees in a child old enough to ambulate independently can be expected as developmentally appropriate. Bruises over bony prominences
(e.g., the forehead) may also be less suspicious in appropriately mobile children.

In contrast, bruising in a child or infant that is not independently mobile is worthy of some suspicion, especially if the proposed mechanism is not plausible. Bruising in infants less than 6 months of age has been found to be extremely uncommon. Even as a child reaches 9 months, bruises remain relatively scarce. There are certain areas of the body where the discovery of bruises should be  considered suspicious for abuse.

These include areas away from bony prominences, and parts of the body that are heavily padded with underlying fat. Some of the concerning areas include the following: the buttocks, face (especially the philtrum and upper lip), neck, trunk, arms, and hands. Multiple bruising in clusters or with pathognomonic patterns also should be investigated. Examples of the latter might include bruises in a pediatric patient with distinctive imprints (such as from implements like an electrical cord or leather belt) or uniformity of size and shape.

When suspicious bruising is present, most experts agree that laboratory evaluation should be done to check for evidence of a bleeding disorder. Most experts recommend at least a platelet count and basic coagulation studies such as a prothrombin time and activated partial thromboplastin time. Some argue for a more extensive evaluation, and this may be especially relevant if indicated by elements of a patient’s personal clinical and family history.

Further evaluation is needed when suspicion of abuse exists. Most experts recommend a skeletal survey when this concern exists, especially in children under 2 years old, or if fractures suggestive of abuse (e.g., posterior rib fractures) are discovered.

Computed tomography (CT) of the head is also recommended – keeping in mind that traumatic brain injury may still exist in infants with a normal-appearing physical examination. Altered mental status (as in this case) is even more suggestive of central nervous system involvement. If brain injury is
identified, a formal retinal examination by an ophthalmologist is needed.

The discovery of retinal hemorrhages is also a strong indicator of abusive head injury. Evaluation of possible abdominal trauma should be considered. Some experts advocate laboratory screening testing such as liver function tests and serum amylase levels to search for signs of abdominal injury. If such screening is positive, bruising of the trunk or abdomen is found, or bilious emesis is present, one should consider an abdominal CT.

Monday, September 7, 2015

SERRATIOPEPTIDASE: Available products in Nepal :

SERRATIOPEPTIDASE: Available products in Nepal :

Serratiopeptidase (Serratia E-15 protease, also known as serralysin, serrapeptase, serratiapeptase, serratia peptidase, serratio peptidase, or serrapeptidase) is a proteolytic enzyme (protease) produced by enterobacterium Serratia sp. E-15.

This microorganism was originally isolated in the late 1960s from silkworm Bombyx mori L. (intestine),
Serratiopeptidase is present in the silkworm intestine and allows the emerging moth to dissolve its cocoon. Serratiopeptase is produced by purification from culture of Serratia E-15 bacteria.
Available products in Nepal :

APASE APEX(pulsar)
TAB 5MG 6.00
TAB 10MG 10.00

TAB 5MG 6.00
TAB 10MG 10.00

TAB 5MG 5.00
TAB 10MG 9.00

TAB 5MG 5.00
TAB 10MG 9.00

TAB 5MG 5.50
TAB 10MG 10.00

TAB 10MG 10.00

TAB 10MG 6.57

**note :the picture below is not registered in Nepal its just for sample demonstration;

Friday, September 4, 2015



Cefpodoxime is in a group of drugs called cephalosporin (SEF a low spor in) antibiotics. It works by fighting bacteria in your body, is manufactured and marketed by Asian Pharmaceuticals under name of incef in Nepal.
Cefpodoxime is used to treat many different types of infections caused by bacteria.
Cefpodoxime may also be used for other purposes not listed in this medication guide.

What are the possible side effects of cefpodoxime?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have any of these serious side effects:
  • diarrhea that is watery or bloody;
  • fever, chills, body aches, flu symptoms;
  • unusual bleeding or bruising;
  • cough, wheezing, chest tightness, trouble breathing;
  • fast or pounding heartbeats;
  • feeling like you might pass out;
  • seizure (convulsions);
  • pale or yellowed skin, dark colored urine
Indications and dosages
 Acute community-acquired pneumonia caused by Haemophilus influenzae or Streptococcus pneumoniae Adults and children ages 13 and older200 mg P.O. q 12 hours for 14 days
 Acute bacterial or chronic bronchitis Adults and children ages 13 and older200 mg P.O. q 12 hours for 10 days
 Uncomplicated gonorrhea; rectal gonococcal infection caused by Neisseria gonorrhoeae Adults: 200 mg P.O. as a single dose
 Uncomplicated urinary tract infections caused by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilisand Staphylococcussaprophyticus Adults: 100 mg P.O. q 12 hours for 7 days
 Skin and soft-tissue infections caused by Staphylococcus aureus and Streptococcus pyogenes Adults and children ages 13 and older400 mg P.O. q 12 hours for 7 to 14 days
 Acute otitis media caused by H. influenzae, S. pneumoniaeand Moraxella catarrhalis Children ages 5 months to 12 years: 5 mg/kg P.O. q 12 hours (maximum of 200 mg/dose) or 10 mg/kg q 24 hours (maximum of 400mg/dose) for 10 days
 Tonsillitis and pharyngitis caused by S. pyogenes Adults and children ages 13 and older100 mg P.O. q 12 hours for 5 to 10 days Children ages 2 months to 12 years: 5 mg/kg P.O. q 12 hours for 5 to 10 days

Tuesday, September 1, 2015



Morphine , sold under many trade names,is a pain medication of the opiate type. In Nepal its been manufactured and marketed by National Healthcare Pvt. Ltd as trade name under MORFIUM.

Its one of the best selling product from National Healthcare Nepal.

It acts directly on the central nervous system (CNS) to decrease the feeling of pain. It can be used for both acute pain and chronic pain.

 Morphine is also frequently used for pain from myocardial infarction and during labour

It can be used orally, intramuscularly (IM), subcutaneously, intravenously(IV), into the space around the spinal cord, or rectally.

 Effectivenes : Maximum effect is around 20 min when given intravenously and 60 min when given by mouth while duration of effect is between three and seven hours.

Long acting formulations also exist. 

Sources, street names :

Morphine is obtained from the seedpod extract or opium found in the poppy plant, Papaver somniferum.

Morphine is widely used in clinical pain management, especially for terminal cancer pain and post-surgery pain. In the body, morphine has several effects including reduction of pain, loss of hunger, and suppression of cough.
Some of the clinical uses of morphine include:
  • Pain relief after surgery
  • Pain relief after major trauma or injury except head injuries
  • Pain relief in advanced cancers with terminal cancer pain

Morphine legal status

Worldwide, morphine is a Schedule I drug under the Single Convention on Narcotic Drugs. In the Unites Sates, morphine is a Schedule II drug under the Controlled Substances Act and in the UK, it is a Class A drug under the Misuse of Drugs Act 1971 and a Schedule 2 controlled Drug under The Misuse of Drugs Regulations 2001. In Australia, it is classified as a Schedule 8 drug under State and Territory Poisons Acts.

Patient/Family Education

  Instruct patient to take oral preparations with food or juice if GI upset occurs.
  Tell patient not to crush or chew controlled-release tablets.
  Explain that full effectiveness of drug may not occur for 30 to 60 min after administration. Emphasize that drug is more effective if taken regularly to prevent pain rather than to treat pain after it occurs.
  If patient is to receive patient-controlled analgesia (PCA), instruct on use of PCA pump.
  Explain that physical dependency may occur with long-term therapy and that dosage will be tapered slowly before stopping to prevent withdrawal symptoms (nausea, vomiting, cramps, fever, faintness, anorexia).
  Encourage patient to turn, cough and breathe deeply every 2 h to prevent atelectasis.
  Advise patient to consult with health care provider if excessive sedation occurs or if pain relief is inadequate.
  Inform patient that drug may cause constipation. Stool softener, fiber laxative, increased fluid intake and bulk in diet may help alleviate problem.
  Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
  Instruct patient to avoid intake of alcoholic beverages and other CNS depressants.
  Advise patient that drug may cause drowsiness, dizziness or blurred vision and to use caution while driving or performing other tasks requiring mental alertness.