bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Maternal Anemia on Neonatal Outcome
Authors: Adhikari Jyoti , Belbase Mohan , Rijal Shikha
Published: January 2022

Introduction: Anemia is one of the most prevalent nutritional deficiency problem affecting pregnant women. It is defined by World Health Organization as hemoglobin (Hb) level of less than 11 g/dl. Hemoglobin level of 9.0- 10.9 g/dl is mild, 7.0-8.9 g/dl is moderate and less than 7 g/dl is severe anemia respectively. Maternal anemia in pregnancy is commonly considered as a risk factor for poor pregnancy outcome and can result in complications that threaten the life of both mother and fetus.

Aims: To find out neonatal outcome delivered to anemic mothers.

Methods: A prospective case control study was carried out among 75 newborns delivered to pregnant women with hemoglobin below 10.9g/dL. Another 75 newborns were taken delivered at the same time, matched age and sex wise as a control group to mothers whose hemoglobin was more than 11g/dl.

Results: Out of total 75 cases 35(46.7%) mothers had mild, 32(42.6%) had moderate and 8(10.7%) had severe anemia respectively. Similarly, the risk of having preterm baby among anemia group was 4.42 times higher than that in control group (p 0.033). The risk of having low birth weight in anemia group was 3.9 times higher than that in control group (p 0.04). The mean of head circumference (HC) among the anemia group was 33.9cm +1.40 (Mean+SD) and among the control group was 34.4cm+1.24(Mean+SD) with a mean difference of 0.5cm (p 0.032). The mean of length among anemia group was 45.3cm+1.97 (Mean+ SD) and among the control group was 46.2cm+1.69 (Mean+ SD) with a mean difference of 0.9 cm (p 0.003).

Conclusion: Maternal anemia in pregnancy is associated with increased risk of adverse neonatal outcome. Efforts must be made to reduce the prevalence of anemia especially during pregnancy to reduce neonatal morbidity and mortality.
Covishield Vaccine Coverage and its adverse effects among the Staffs of Nepalgunj Medical College Banke
Authors: Yadav Binod Kumar , Choudhary Ram Chandra , Shah Gaurav Jung , Siddiqui Saharoj
Published: January 2022

Introduction: The corona virus disease-19 pandemic is an ongoing global health crisis and the greatest challenge we have been facing right now in the most peculiar ways. It has caused huge loss of lives and has severely affected the global economy and financial markets. Vaccines are a new critical tool to fight this voracious battle. They have been released in several parts of the world. Although the safety and efficacy of these vaccines have been discussed, we know very little about the post-vaccination experience outside clinical trial situations. Adequate information about the effects of the vaccine can aware the public remove misconceptions and increase vaccine acceptability.

Aims: To know the percentage of Covishield vaccine coverage and its adverse effects among the staffs of Nepalgunj Medical College.

Methods: A descriptive cross-sectional study was conducted among the vaccinated 91 out of 116 staff members of Nepalgunj Medical College (NGMC), Baijanath Rural Municipality-1, Banke.

Results: Out of 91 persons, 15.4%(14) developed headache, 20%(18) developed fever, and 8.7%(17) developed body aches. Of those who developed post-vaccination side effects 47%(16) of the persons were from age group 36-55years,17%(1) of them between age group 55-65 years, and none above 65 years developed fever. 20%(13) of total male and 35%(5) of total female developed fever within 96 hours after receiving first dose of Covishield AstraZeneca vaccine.

Conclusion: Most of the study subjects reported milder side effects which lasted for less than 5 days. No casualties were reported. Local pain and swelling at the injection site, headache and fever were the most common side effects. The side effects were more common in younger individuals and women.
Efficacy of Azoles Antifungals in Treatment of Pityriasis Versicolor
Authors: Jha Smita
Published: January 2022

Introduction: Pityriasis versicolor is superficial fungal infection. Topical drugs are often effective in treatment of limited disease while systemic drugs are more suitable in extensive cases. The systemic triazole drugs, itraconazole and fluconazole have shown promising results at different doses.

Aims: To assess the efficacy and safety of oral fluconazole combined with ketoconazole shampoo and oral itraconazole in the treatment of Pityriasis versicolor.

Methods: The study was conducted at department of Dermatology at Nepalgunj Medical College from March 2019 to February 2020. Total 100 patients of both genders with Pityriasis versicolor were randomly allocated into two groups with 50 patients in each group. Patients in Group I received oral fluconazole 300mg a week for two consecutive weeks along with ketoconazole 2% shampoo twice weekly for two weeks while those in Group II received  itraconazole 200mg daily for one week. Efficacy was assessed in terms of negative fungal hyphae. The drug is considered safe if no patients were withdrawn for clinical adverse effects or laboratory abnormalities.

Results: In this study age ranged from 18 to 50 years with mean age of 31.1 years in Group I and 31.92 years in Group II. Efficacy was seen in 78% of Group I patients as compared to 54% in Group II patients at two weeks and 94% in Group I and 90% in Group II at four weeks. No significant adverse effects were reported in any of the group.

Conclusion: Fluconazole along with ketoconazole shampoo is more effective than itraconazole in treatment of pityriasis versicolor with minimal side effects, at lesser cost.
Harmless Acute Pancreatitis Score
Authors: Bharti Shiv Vansh , Sharma Anup
Published: January 2022

Introduction: Acute Pancreatitis is a common disease in our region. It can range from mild to severe disease with high mortality rate. It is critical to identify patients who are at high risk for a severe disease course, since they require close monitoring and immediate aggressive treatment.

Aims: To compare the effectiveness of Harmless Acute Pancreatitis Score with Ranson’s scoring system in predicting the severity of Acute Pancreatitis.

Methods: A prospective cross sectional study was done among 45 patients who were admitted in surgery department over a period of one year with diagnosis of acute pancreatitis. If haematocrit was less than39% in female and less than43% in male, serum creatinine less than two miligram /deciliter and no sign of peritonitis, it was assigned as Harmless Acute Pancreatitis Score Zero. If at least one parameter was abnormal it was assigned as Harmless Acute Pancreatitis Score +. Severe pancreatitis (poor prognosis) was considered in those who required Intensive Care Unit care, who had in hospital mortality and who had hospitalization of more than five days. Patients with on admission Ranson’s score of more than three were suspected to have severe Pancreatitis.

Results: There were total 45 patients, 18 females and 27 males. Twenty four patients were assigned as Harmless Acute Pancreatitis Score zero and 21 patients were assigned as Harmless Acute Pancreatitis Score +. Harmless Acute Pancreatitis Score was able to predict correctly in 18 out of 26 patients who fulfilled the criteria of poor prognosis (p<0.001).

Conclusion: Harmless Acute Pancreatitis Score proved to be a better screening tool compared to on admission Ranson’s scoring system to predict the severity of Acute Pancreatitis, which may help predict the prognosis of the patient.
Effectiveness of Pentoxifylline Therapy for Management of Oral Submucous Fibrosis
Authors: Bajgai Dwarika Prasad , Agrawal Bela , Yadav Abadhesh
Published: January 2022

Introduction: Oral submucous fibrosis is a chronic oral disease characterized by progressive buildup of constricting collagen bands in the cheeks and adjacent structures of the mouth due to chewing of areca nut. This can severely restrict mouth opening and tongue movement causing pain and burning sensation in the mouth.

Aims: This study evaluates the efficacy of pentoxifylline in the management of oral submucous fibrosis.

Methods: A hospital-based study, conducted in the dental outpatient department of Nepalgunj Medical College from October 2019 to September 2020. Forty-nine patients who were diagnosed histopathologically with oral submucous fibrosis were included. The patients were divided into two groups. In group A, patients were given, 200 mg thrice daily for first 30 days, then dose hiked to 400 mg thrice daily for two more months. Group B patients received treatment with multi-vitamin capsules (B-complex one capsule before sleep daily) for three months. All patients were followed up for six months and were assessed for maximum inter-incisor opening, pain on opening of mouth and burning sensation.

Results: There was no statistical difference in mouth opening at baseline and first follow up. The mouth opening was significantly more in group A compared to group B from second follow up which persisted till third follow up (p <0.05). Pain and burning sensation significantly reduced in group A compared to group B from 2nd follow up which persisted till 3rd follow up (p <0.05). Few patients had nausea, dyspepsia and vomiting during treatment in group A which resolved within a few days without the need for cessation of the drug.

Conclusion: Pentoxifylline can bring about significant clinical improvements in the symptoms of oral submucous fibrosis like mouth opening, pain and burning sensation, thereby improving the quality of life of the affected individuals.
Outcome of Monteggia Fracture Dislocation in Children Treated With K Wires in Nepalgunj Medical College
Authors: Shrestha Sabin , Shrestha Dinesh Kumar
Published: January 2022

Introduction: Monteggia fracture dislocations are rare injuries (<5%) where missed treatment results into deformity and dysfunction of forearm and hand. For the better functional result early diagnosis, accurate reduction of radial head and rigid fixation of ulna and immobilization during post-operative period for ligamentous healing around radius is vital. So operative treatment has been the primary method of treatment to prevent deformity and disability in monteggia fracture dislocation.

Aims: The aim of this study was to evaluate the time taken to unite fractures, complications encountered and assess the functional outcome on the basis of K-wire fixation in monteggia fracture dislocation in children.

Methods: A cross-sectional observational study was conducted in Nepalgunj Medical College and Teaching Hospital, Kohalpur, Banke with monteggia fracture dislocation in children.

Results: Thirty-two monteggia fracture dislocation in children between six to 14 years of age were treated with intramedullary K-wires after reduction of radial head. Seven cases had open reduction, and five needed trans-capitellar K-wire supplementation. Mean union time was 8.44±1.94 weeks ranging from seven to 12 weeks. The functional outcome on the basis of Anderson’s scoring system was excellent in 25(78.1%), good in three and optimal in four cases.

Conclusion: Monteggia fracture dislocation is better treated early and early mobilization of elbow joint is needed for better functional results.
Preoperative Biometry and Uncorrected Visual Outcome Following Cataract Surgery at a Teaching Hospital at Western Part of Nepal
Authors: Thapa Bikram Bahadur , Adhikari Basu Prasad , Gurung Nanda Kumari , Verma Jitendra Kumar
Published: January 2022

Introduction: Proper preoperative biometry in cataract surgery provides expected postoperative uncorrected visual outcome. Astigmatism is one of the major problems to achieve best postoperative unaided visual acuity.
Aims: To determine the distribution of biometric parameter and unaided visual outcome in the cataract patients operated at Nepalgunj medical college, Banke, Nepal.
Methods: The patients who underwent cataract surgery between January 2019 and December 2020 at Nepalgunj medical college were studied. Patient’s demographic parameter, keratometric value, anterior chamber depth, lens thickness and axial length data, type of surgery, preoperative and post-operative visual acuity and other clinical details were collected and analyzed.
Results: This study enrolled 261 eyes of 261 patients who had undergone cataract surgery. The mean age of patients was 60.8 ± 14.62 years. The mean corneal astigmatism was 1.30±1.43 D. Corneal astigmatism was higher than 1.00 D in almost 40% of cases. With-therule astigmatism was the most common type (46.4%) of astigmatism observed in this study. The mean average keratometry was 44.83±2.05 D. The mean preoperative LogMAR VA of 1.52±0.83 improved to 0.48 ± 0.48 postoperatively without statistically significant differences between manual small incision cataract surgery and phacoemulsification technique (p=0.496).
Conclusion: The biometric data helps to improve surgical procedure and select most appropriate intraocular lens to attain maximal postoperative uncorrected visual acuity following cataract surgery. This study found superior convention incision is better for cataract surgery with equivalent visual outcome following manual small incision cataract surgery and phacoemulsification.
Conventional Dissection and Bipolar Electrocauterization Methods of Tonsillectomy: A Comparative Study
Authors: Sharma Anshu , Bhandari Shama , Paudel Dhundi Raj
Published: January 2022

Introduction: Tonsillectomy is frequently performed surgical procedure. There are several different methods with varied advantages and disadvantages. In spite of the different techniques available there is no consensus and definite evidence for best method. The most commonly performed are conventional dissection and bipolar electrocauterization methods.

Aims: The aim of the study was to compare time required for the completion of surgery, intraoperative and postoperative blood loss along with post operative pain between conventional dissection and bipolar electrocauterization methods.

Methods: This comparative study was conducted from August 2019 to March 2021 in total of 30 patients planned for tonsillectomy in department of Otorhinolaryngology, Nepalgunj Medical College Teaching Hospital.In every patient right side tonsillectomy was done with conventional dissection method and left side tonsillectomy was done with bipolar electrocauterization method.

Results: The mean age was 27.2±13.08 years. The mean duration of surgery was 16.53 ± 2.43 min and 11.10 ± 1.93 min in conventional dissection method and bipolar electrocauterization method respectively. The difference was statistically significant. Intraoperative blood loss was significantly lower in bipolar electrocauterization method with mean intraoperative blood loss of 19 ±4.62 ml in bipolar electrocauterization group and 81.83 ±36.54 ml in conventional dissection method. The pain intensity was statistically similar in both methods at all-time intervals post operatively.

Conclusion: In tonsillectomy, bipolar electrocauterization method has advantage over conventional dissection method in regards to reduced surgical time and intra operative blood loss, without any significant difference in post-operative pain intensity and post-operative hemorrhage.
Anemia among Pregnant Women at Nepalgunj Medical College
Authors: BC Durga
Published: January 2022

Introduction: Anemia in pregnancy is major health issue of developing countries responsible for adverse maternal and fetal outcome. According to World health organization pregnant women with hemoglobin level less than 11 gm/dl in first trimester and less than 10.5gm/dl in second and third trimester are considered to be anemic. Iron deficiency anemia is common during pregnancy followed by megaloblastic anemia.

Aims: To find out the prevalence of anemia during pregnancy. To correlate the maternal and fetal complications associated with anemia during pregnancy.

Methods: This is a prospective hospital based study done at department of obstetrics and gynecology Nepalgunj Medical College from July 2020 to January 2021. All pregnant women with hemoglobin level <11 gm/dl were enrolled in the study. Data were collected from antenatal clinic and biochemistry laboratory.

Results: In this study maximum participants were of age group 20-25 consisting of 38.5%. Anemia was more common in multiparous i.e. 60% as compared to primipara i.e. 40%. In this study maximum participant had vaginal delivery (57%) followed by LSCS (29%) then instrumental delivery (14%). These ladies had complications like postpartum hemorrhage (27.7%), preterm labor (16.9%), pregnancy induced hypertension (9.2%). similarly 10.8% had sepsis and 20% had no complications. About 23.1% babies delivered by anemic ladies required neonatal intensive care.  Intrauterine growth restriction was seen in 12.3%, preterm birth in 10.3% and 53.8% babies had no complications.

Conclusion: The prevalence of anemia during pregnancy is high leading to adverse maternal and fetal outcome.
Knowledge Regarding HIV/AIDS among Nepalese Army
Authors: Roy Roshan Kumar , Roy Deepak Kumar , Ghimire Sabal , Bist Aayush , Maharaj Anuranjan
Published: January 2022

Introduction: A global pandemic threat HIV/AIDS is also matter of concern of developing countries like Nepal where the first case was identified in July 1988 and later became epidemic and then concentrated epidemic among risk group for HIV. Several studies reflected HIV is associated to many factors, Literacy and Socio-economic conditions being at the highest rank. Members of Nepal army are generally with less educational background and few with higher educational status are at higher post. Thus knowledge regarding HIV/AIDS among this group need to be assessed.

Aims: The overall objective of our study was to assess knowledge regarding HIV/AIDS among Nepal army in Banke district.

Methods: A Cross-sectional descriptive study with population size of 146 Army was performed which covered the entire population of Shree Shreemehar Army Camp in Banke, starting from 18th June to 27th August, 2018. A pre-tested questionnaire containing structural, semi-structural and open ended questions were made as data collection tool. All the soldiers in Army camp were interviewed after receiving consent as an ethical clearance.

Results: All 146 Army of our study were aware about HIV/AIDS mainly via mass media (83.56%). 33 respondents still didn’t know about availability of its treatment. Misconception about its complete cure and vaccination was seen in 12 and 39 respondents respectively. 58 respondents were found knowing about the free health services by government. 141 respondents knew certain things about prevention. 28 respondents admitted of having multiple sex partners and only 24 among them used preventive measure.

Conclusion: Though all the respondents of our study had known about HIV/AIDS still they had misconception regarding its treatment and prevention. Many respondents do not even know about the free health services of government. Few of them still don’t use preventive measure.
Assessment of Functional Outcome of Bicolumnar Dual Plating for Bicondylar Fractures of Tibial Plateau
Authors: Shrestha Dinesh Kumar , KC Dipendra , Karki Prateek , Shrestha Sabin , Yogi Sushil
Published: January 2022

Introduction: Operative treatment of bicondylar fractures of tibial plateau is challenging and controversial.

Aims: The aim of this study is to reveal the functional outcome of it by using bicolumnar dual plates and screws.

Methods: This is a prospective hospital based interventional study carried out in the department of Orthopaedics of Nepalgunj Medical College Teaching Hospital. Thirty two Schatzker type V or AO (Association of Osteosynthesis) type 41 C1 & C2 fractures were treated between January 2016 and December 2019 with bicolumnar dual plating. The functional clinical outcomes were analyzed and evaluated using modified Rasmussen score.

Results: Thirty two patients were included in the study. Out of which twenty four were male and eight were female. Average age was 32.21 years, eighteen were right sided and fourteen were left sided. Duration of surgery was 106 mins (range 90-120 mins) and the average duration of hospitalization was 7.81 days (range 4-14 days). Five patients of impending compartment syndrome and three patients with common peroneal nerve palsy were managed conservatively and also were included in the study. Two patients with superficial wound infection needed minimal debridement. One patient had varus angulation of 100 at third follow up after he fell from bed but surgical intervention were not needed. All fractures united. The average time for fracture healing was 21.5 weeks (range 16-32 weeks). At the Eighteen months follow up, the average knee range of motion was 1310(range 1100-1400). The functional outcome were evaluated using modified Rasmussen scoring system, which was 27.34 (range 22-30).

Conclusion: Bicolumnar dual plating for bicondylar fractures of tibial plateau can provide excellent and stable fixation allowing early range of motion and gives excellent to good functional outcome.
Isolated perforation of fourth part of Duodenum following Blunt Abdominal Trauma
Authors: Maharjan Prabir , Bharti Shiv Vansh , Khadka Digbijay Bikram , Karki Anup , Gnyawali Arun
Published: January 2022

Introduction: Isolated duodenal injuries are rare in blunt abdominal trauma. These present a significant challenge for management because of the associated injuries and its difficult anatomical accessibility.

Case presentation: A 20years male presented to the Emergency department following a bike accident sustaining injury over face, chest and abdomen, 6hours after the incident. His vitals were unstable so he was resuscitated and admitted in Intensive Care Unit. He had generalized abdominal tenderness without rigidity. Contrast enhanced computed tomography of abdomen and pelvis was suggestive of hollow viscus perforation. He underwent exploratory laparotomy and primary repair for isolated perforation at fourth part of duodenum. He was discharged on his ninth postoperative day.

Conclusion: Rare injuries following blunt abdominal trauma should be considered and early intervention is necessary.
Simplified Technique of Conventional Cholecystectomy in a Patient with Situs Inversus Totalis: A Case Report from Nepal
Authors: Nag Suresh Kumar
Published: January 2022

Introduction: Situs inversus is a rare autosomal recessive disorder occurring in 1:5,000 to 1:20,000 indiviuals. Cholecystectomy is a standard treatment for symptomatic gallbladder stone. We report a case of cholelithiasis in patient with inversus totalis who underwent cholecystectomy.

Case presentation: A 48 years old obese female patient with dextrocardia and hypertention presented with a recurrent left upper abdominal pain for two years. Ultrasound abdomen showed gallbladder stone. Conventional cholecystectomy was done with a small left subcostal incision. The postoperative period was uneventful and the patient was discharged on 3rd post operative day.

Conclusion: Cholecystectomy is the treatment of choice in patients with a left sided gallbladder stone, like in normal gallbladder and it is safe.
Outcomes of Open Cystolithotomy and Percutaneous Cystolithotripsy in the Management of Urinary Bladder Stone
Authors: Shrestha Naresh Man
Published: January 2022

Introduction: Urinary bladder stone occupies only 5% of all urinary tract stone. Various techniques have been used for the management of bladder stone. Open Cystolithotomy is the traditional treatment but a percutaneous approach has been also in practice.
Aims: To confirm the best options between open cystolithotomy and percutaneous cystolithotripsy for the treatment of bladder stone.
Methods: It is a prospective hospital based study from May 2019 to January 2021 in Nepalgunj Medical College. Total 42 patients with inclusion criteria were divided into two groups.  Group I was allocated to 21 patients who were treated with open cystolithotomy while Group II were allocated to 21 patients who were treated with percutaneous cystolithotripsy. Two groups were compared for stone free rate, mean hospital stay, mean postoperative scar, mean operation time and rate of post-operative complications.
Results: The stone free rate in Group I was 100 % and in Group II was 90.47 %. Mean Operation time was in Group I and Group II were 40.09+ 2.48  minutes and 31.38+15.65 days,  respectively with p<0.05. Mean hospital stay was significantly low in Group II (3.71+1.87 days ) when compared to Group I (7.67+ 2.12 days) with p<0.001. Mean scar length of Group I (5.466+2.9 cm) with respect to Group II (1.04+0.09) was significantly long (p<0.01). Rate of complications were not significantly different between two groups (p>0.5).
Conclusion: For management of urinary bladder stones sized up to 4 cm, both open cystolithotomy and percutaneous cystolithotripsy are effective, with a low incidence of complications. However, comparing the surgery time, hospital stay, length of scar between two procedures, percutaneous cystolithotripsy procedure is more beneficial for treatment of urinary bladder stone.
Engaged Mathematics Learning as/for a Transformative Praxis
Authors: Lamichhane Basanta Raj , Dahal Niroj
Published: January 2022

Engaged learning in mathematics is essential to students' success and has a significant role in creating a transformative path in mathematics education. Considering this, this editorial attempts to highlight the role of behavioural, cognitive, affective and agentic aspects of engaged learning. It is impossible to bring all aspects of this complex and multidimensional construct in this short editorial; however, we try to open a new avenue by bringing the issue of engaged learning into pedagogical practices of mathematics in the context of Nepal. The discourse opens up how disengaged learning creates a mathematical Othering and its detrimental effects on mathematics education. Moreover, this discourse binds with the major features of classroom engagement, conceptualize and the impact of engaged learning on students' success. The editorial ends with a brief overview of the issue.
Exploring Project-Based Teaching for Engaging Students' Mathematical Learning
Authors: Tyata Raj Kumar , Dahal Niroj , Pant Binod Prasad , Luitel Bal Chandra
Published: January 2022

The declining interest of learners in mathematics in the learning process has resulted in poor achievement (Yeh et al., 2019). To get rid of these poor achievements, we explored project-based teaching in four topical areas (e.g., mathematical concepts of coordinate geometry, trigonometry, sequence, and series) in the school mathematics. This paper results from observing changes in engagement of learners in learning mathematics by motivating them through the project-based learning (PBL) guided by two theories – knowledge constitutive interests (Habermas, 1972), and collaborative and cooperative learning under the paradigms of interpretivism and criticalism. In this ethos, PBL is an “engaging and learner-directed approach that provides equal opportunities for students to explore their knowledge and understanding” (Thomas, 2000, p. 12). More specifically, we adopted the 'action research' method with the secondary level students (Grade IX) of one of the institutional schools in their classrooms. The information was collected by observing and recording the changes seen in consecutive seventeen days. The research landed that project-based learning is an appropriate pedagogy for engaged learning. The study revealed that the students were motivated while they got opportunities to interact in the projects. Moreover, the findings show that PBL is helpful to engage the learners through questioning, pair/group discussion, discovery learning, and concept mapping.
Teachers’ Perception and Challenges of Using ICT in Teaching Mathematics at Secondary Level
Authors: Adhikari Ganesh Prasad
Published: January 2022

The main objectives of this study were to identify the teachers’ perceptions and challenges of using ICT tools in the mathematics classroom at the secondary level in Kathmandu. The major tool of the study was a closed-ended questionnaire consisting of 19 items. The quantitative descriptive survey design was used in this study. The researcher selected 158 teachers by using simple random method from 261 government teachers who teach compulsory mathematics at grade X of Kathmandu district in Nepal. The standardized questionnaire was administered to the sample teachers. The SPSS-25 version database was used to analyze and interpret the collected data. Teachers’ perception of using ICTs in the mathematics classroom was positive with insignificant difference in terms of gender. There were some challenges: lack of knowledge, confidence, enough experience, training, interest and access to ICT tools, lack of technical support, lack of genuine ICT Software and unstable and unreliable internet connection at the schools. Due to these challenges, teachers did not use ICT in the classroom. Therefore, teachers should learn more to improve their knowledge and skills in ICT. The government should focus on management strategies and policies to reduce the challenges faced by teachers in mathematics classrooms. By these policies, they can use the ICT tools in the classroom.
Elementary Algebra on Vedic Mathematics
Authors: Parajuli Krishna  Kanta
Published: January 2022

The South Asian region has a long history of discovering new ideas, ideologies, and technologies. Since the Vedic period, the land has been known as a fertile place for innovative discoveries. The Vedic technique used by Bharati Krishna Tirthaji is unique among South Asian studies. The focus of this study was mostly on algebraic topics, which are typically taught in our school level. The study also looked at how Vedic Mathematics solves issues of elementary algebra using Vedic techniques such as Paravartya Yojayet, Sunyam Samyasamuccaye, Anurupye Sunyamanyat, Antyayoreva and Lopanasthapanabhyam. The comparison and discussion of the Vedic with the conventional techniques indicate that the Vedic Mathematics and its five unique formulas are more beneficial and realistic to those learners who are experiencing problems with elementary level algebra utilizing conventional methods.
Comparison of Two Different Doses of Dexamethasone to Control Swelling and Trismus following Mandibular Third Molar Surgery
Authors: Sakya Pranay Ratna , Shrestha Dipti , Shrestha Reena , Khadka Dhiraj Khadka , Tamrakar Ratina , Acharya Sudeep
Published: January 2022

Introduction: Third molar surgery is one of the most common procedures performed by dental surgeons in clinical practice, where postoperative sequelae like pain, trismus, and swelling are often encountered. Thus, in this study, we compared medications employed to reduce such complications.
Objective: To compare the effect of two different doses (4 and 8 mg) of dexamethasone in the control of swelling and trismus after the surgical extraction of mandibular impacted third molars.
Methods: An experimental study consisted of twenty-seven (27) healthy adult patients of both genders with bilateral impacted lower third molars, where surgical extraction was indicated, 4 mg and 8 mg of dexamethasone were given orally to the patients 1 hour before the surgical procedure at both the surgeries. The swelling was recorded by measuring the length of 3 facial planes using a measuring tape. Trismus was evaluated by measuring the maximum interincisal distance. Recording of facial swelling and maximum interincisal distance was done preoperatively and on the 1st and 2nd days postoperatively.
Results: Based on statistical analysis (Independent T-test), the results showed a difference in the measurements of the degree of swelling and trismus of the treated sample. 8 mg of dexamethasone promoted a greater reduction of symptoms than 4mg of dexamethasone though there was no statistically significant (p-value >0.05) difference between the two doses.
Conclusions: 8 milligrams of the dexamethasone had better effectiveness than 4 milligrams of the dexamethasone in reducing the degree of swelling and trismus.
Keywords: Dexamethasone; impacted third molars; swelling; trismus.
Detection of Extended Spectrum β-Lactamases (ESBL) Producing Bacteria in Sepsis Suspected Neonates
Authors: Nepal Sabita , Koirala Sushma , Thakur Subash , Bhattarai Susmita , Dhungana Suraj , Giri Sharad , Khanal Santosh
Published: January 2022

Introduction: Neonatal sepsis is a clinical syndrome that is caused when the bloodstream of an infant is invaded by bacteria in the first month after birth.
Objective: The objective of the study was to identify bacteria involved in the infection and to determine “extended-spectrum beta-lactamase” (ESBL) producing bacteria from blood samples of sepsis suspected neonates in the Neonatal Intensive Care Unit and Special Care Baby Unit.
Methods: This cross-sectional study was conducted from January to July 2019 at Microbiology laboratory of Paropakar Maternity and Women’s Hospital. A total of 380 venous blood specimens were included in the study. The blood culture was performed and organisms were identified with standard microbiological methods. The Antibiotic susceptibility test was performed using the modified Kirby Bauer disk diffusion method. Screening of the organisms was done using cefotaxime and ceftazidime antibiotic disc and confirmation of ESBL was done by combined disk test. The data were considered statistically significant if the p-value was < 0.05.
Results: Out of a total of 380 blood specimens, the prevalence of neonatal sepsis was found to be 21.05% among which 57.5% were EOS type and 42.5% were LOS type. In EOS, E. coli (72.73%) was the predominant isolate while CoNS (100%) was the predominant isolate in LOS. Of the total 80 isolates, 65% isolates were found multidrug-resistant (MDR) whereas 58.75% of isolates were found to be ESBL producers.
Conclusions: This study concludes that routine bacterial surveillance and study of their resistance patterns is an essential component of the neonatal care unit.
Keywords: Extended-spectrum β-Lactamases; neonates; neonate intensive care unit; special care baby unit; sepsis.
Improved Diagnosis of Pulmonary Tuberculosis using Bleach (Sodium hypochlorite) Concentration Technique at Tertiary Care Hospital
Authors: Thakur Saroj Kumar , Bansal Vishvesh Prakashchandra , Mishra Jyotsna , Bansal M.P. , Sapkota Iswari , Yadav Tapeshwar
Published: January 2022

Introduction: In the Revised National Tuberculosis Control Program (RNTCP), microscopic examination of sputum for acid-fast bacilli (AFB) is currently the backbone for the diagnosis of pulmonary tuberculosis. Studies have shown liquefaction and concentration of sputum by 5% sodium hypochlorite is useful in providing increased sensitivity and safety for the handling of specimens.
Objective: To assess the utility of the 5% Sodium hypochlorite concentration method in increasing the sensitivity of smear microscopy for detection of AFB for diagnosis of pulmonary tuberculosis.
Methods: The study included a total of 1000 sputum samples from 500 patients with suspected pulmonary tuberculosis. Direct smears were prepared from the sputum samples as per RNTCP guidelines. The remaining sputum was used for bleach concentration and smears prepared from the concentrated material. Both smears were stained by Ziehl-Neelsen staining and screened for acid-fast bacilli and graded according to the RNTCP guidelines.
Results: A total of 158 samples (15.8%) from 89 patients were positive by a routine direct method whereas by concentration method 236 samples (23.6%) from 143 patients were found positive diagnosing additional 54 patients. The gain in sputum smear positivity of 7.8% over the routine method is highly significant (p=0.0000, χ2= 270) with a 10.8% increase in case detection.
Conclusions: Improvement in the sensitivity of smears microscopy will be useful in case detection of tuberculosis especially in resource-poor countries. The increased positivity of microscopy by bleach method indicates that would prove useful if included in the RNTCP to improve case detection.
Keywords: Concentration; smear positivity; sodium hypochlorite; tuberculosis.
Thyroid Swellings Undergoing Thyroidectomy in a Tertiary Hospital of Nepal: A Retrospective Study of Distribution and Prevalence of Malignancy
Authors: Gupta Mudit , Mahaseth Rajeev Kumar , Khadgi Sajish , Shrestha Asmita , Bhat Neeti , Karna Alina
Published: January 2022

Introduction: Thyroid nodules brought to a hospital are checked for cancer. A post-operative histological examination is a gold standard for diagnosing thyroid lesions. Treatment is aided by a prior understanding of the disease’s underlying pattern.
Objective: A retrospective study was done to determine the prevalence and distribution of malignancy in suspicious thyroid nodules.
Methods: The study was conducted at Ganesh Man Singh Memorial Academy of ENT- Head and Neck studies from August 2017 to March 2020. All the subjects (n=183) presenting with a thyroid nodule and who had post-operative histopathological evaluation available were recruited in the study. The proportion and percentage of findings of Fine Needle Aspiration Cytology (FNAC) and histopathological evaluation were done. The distribution of histopathological observation was also analyzed in terms of age group and gender.
Results: The mean age of study participants was 40.23 ± 13.77 years (n=183). The predominance of women was notable. In about 98 (53.55%) of the patients who underwent thyroidectomy, a benign lesion was found, but the most common finding was papillary carcinoma (40.98%). In the age group below 50 years, papillary carcinoma was most common. Among people older than 50, colloid goiter was more common. Follicular and medullary carcinomas were only observed in female participants. Gender did not appear to be associated with malignancy (p=0.99). Follicular adenomas were noted to have the youngest mean age.
Conclusions: We observed a high prevalence of malignancy, particularly papillary carcinoma in clinically suspected thyroid nodules of a tertiary hospital in Nepal.
Keywords: Colloid Goiter; malignancy; papillary carcinoma; thyroid cancer; thyroid nodule.
Serum Ferritin Concentration in Corona Virus Disease 19
Authors: Singh Samir , Darnal Sujit Kumar , Chand Arun Bahadur
Published: January 2022

Introduction: Coronavirus disease 19 (COVID-19) is a complex disease responsible for the development of exacerbated inflammatory response (cytokine storm) that ultimately leads to multiorgan failure and death. Serum ferritin has been recently identified as one of the inflammatory markers responsible for the pro-inflammatory effects. Small amount of ferritin is present in plasma (15-150 ng/mL) which might increase with the severity of COVID-19. Therefore, measurement of ferritin is essential in identifying disease severity and predict disease prognosis.
Objective: This study aims to assess the ferritin level in COVID-19 patients.
Methods: A cross-sectional study was carried out on 259 COVID-19 patients visiting KIST Medical College and Teaching Hospital (KISTMCTH), Lalitpur, Nepal from November 2020 to April 2021. Serum ferritin was estimated in the automated Siemens ADVIA Centaur CP Chemiluminescence Immunoassay system. All the patients visiting KISTMCTH referred by clinician for ferritin assessment were included in this study. Data collected using the proforma tool was tabulated in SPSS 21 and statistical analysis was done by inferential statistical test.
Results: Out of total 259 COVID-19 patients, 58.7% were male and the majority of patients (82.6%) were below 70 years of age. The mean age for all participants was 52.11±16.59 years. Hyperferritinemia was seen in 218 (84.16%) COVID -19 patients. The mean value of serum ferritin was 767.1±789.86 (IQR: 12.8-4590) ng/mL and was significantly higher in males (p<0.001). Comparing the mean values of ferritin between the patients below and above 70 years, no statistical difference was observed (p=0.872).
Conclusions: In our study, serum ferritin levels were greatly increased in patients with COVID-19 infection.
Keywords: Coronavirus disease 19; cytokine storm; inflammatory marker; serum ferritin.
Spectrum of Oral Cavity Lesions and its Clinico-Histopathological Correlation
Authors: Gaire Deepshikha , Pant Anil Dev , Maharjan Daisy , Manandhar Usha
Published: January 2022

Introduction: Oral cavity lesions comprise a wide spectrum of diseases that varies from non-neoplastic to neoplastic. The clinical evaluation alone is insufficient for proper diagnosis in most cases. So, histopathological examination is the gold standard method for diagnosis and management of patients accordingly.
Objective: The present study was done to evaluate the histopathological spectrum of oral cavity lesions and compare them in relation to age, sex, site, clinical features, risk factors, and clinical diagnoses.
Methods: This prospective cross-sectional study enrolled 127 cases of oral biopsies which were received at the Department of Pathology, Tribhuvan University and Teaching Hospital, Kathmandu Nepal, from May 2018 to April 2019 for histopathological examination. Specimens were fixed in 10% formalin and subjected for tissue processing and Hematoxylin and Eosin stained sections. Data entry and analysis were done by using SPSS 24 version where frequency and percentile were calculated.
Results: Total cases were 127 with slight female predilection and the age group of 50-60 years (mean age of 44.24 years) were commonly affected. The tongue being the most common site, frequently lesions presented as swelling. Most of the lesions were non-neoplastic comprising 45% whereas malignant lesions comprised 23.6%. Smoking increased the risk of malignancy by 2 fold. The most common benign lesions were squamous papilloma & fibroepithelial polyp whereas the malignant lesion was squamous cell carcinoma. Sixty percent of clinical diagnoses didn’t show correlation.
Conclusions: Oral cavity lesions have a wide spectrum of distribution in age, sex, site, and clinical presentation. Initially, oral lesions may present with subtle symptoms which may cause underdiagnosis. Thus, histopathological diagnosis is a must to rule out malignancy.
Keywords: Clinical presentation; correlation; oral cavity; risk factors.
Comparison of Packed Cell Volume Changes after Erythropoietin Administration and Blood Transfusion in Patients with Anemia of Chronic Kidney Disease on Hemodialysis
Authors: Bajracharya Anju , Bajracharya Jayendra
Published: January 2022

Introduction: Anemia of chronic kidney disease (CKD) can be managed by regular administration of erythropoiesis stimulating agents (ESAs) and/or blood transfusion. The response to these therapies can be monitored by serial packed cell volume (PCV).
Objective: This study was done to compare the temporal changes in PCV after ESA therapy and blood transfusion in patients with recently diagnosed anemia in CKD stage 5 on hemodialysis (CKD 5 HD).
Methods: Medical records of patients undergoing hemodialysis at the National Kidney Center, Balaju, Kathmandu from July to September 2013 were examined retrospectively. The data collected were analyzed using Minitab 16.
Results: A total of 44 patients were on ESA therapy while 48 patients were on blood transfusion. The mean PCV at the start of blood transfusion was significantly lower than the mean PCV at the start of ESA therapy (p = 0.000) but at four weeks, the mean PCV in blood transfusion group was significantly greater than that in ESA therapy group (p = 0.008). At eight weeks and twelve weeks, the mean PCVs in both groups were not significantly different from each other (p = 0.949 and p = 0.747).
Conclusions: Blood transfusion increases PCV immediately and in sustained manner while with ESA therapy, the response takes a longer time to manifest. A large number of non-responders to ESA therapy may have influenced the findings of this study. It is recommended that adequate dosing of ESA and attention to comorbid conditions be followed during ESA therapy.
Keywords: Anemia; chronic renal insufficiency; blood transfusion; hematinics.
Peri-implantitis: A Classification Update
Authors: Shrestha Rejina , Bhochhibhoya Amar Bhochhibhoya
Published: January 2022

The cases of peri-implantitis are soaring rapidly in the current scenario. It is very important to have adequate knowledge about the etiology, pathogenesis, clinical features, radiological features, and treatment of peri-implantitis. In this context, the classification of the disease is of utmost importance for planning and execution of the treatment. Various classifications have been proposed over the years and with each classification, more information is being added and there is a lack of universal acceptance of a single classification. Clinical errors may be anticipated due to miscommunication and misguidance. Thus, it is important to sensitize the clinicians about different classification systems. This review attempts to compile and critically analyze existing classification systems of peri-implant diseases.
Keywords: Dental implants; diagnosis; peri-implantitis.
Metabolic Pathways and Pathological Outcomes of Aflatoxins: A Review
Authors: Dahal Aashma , Lamichhane Ashish , Karna Alina
Published: January 2022

Aflatoxin is a secondary fungal metabolite that contaminates foods, mostly staple diets like maize, peanuts, chillies, and even rice. These foods are also a major constituent of weaning food for infants in Asia and Sub-Saharan Africa. The fungal metabolite contaminates food during production, harvest, storage, and processing. The contamination is largely promoted by genotypes of crops, soil conditions, temperate regions, and insect activity. Once ingested into the body, aflatoxins get metabolized into different hydroxylated derivatives such as AFb1, AfM1, AFP1, aflatoxicol, and Aflatoxin B1. AFB1 is the most carcinogenic and potent of the known metabolites and they have been categorized as Group I carcinogenic agents by the International Agency for Research on Cancer. The toxic metabolites of aflatoxins have been found in blood samples, breast milk and also have been shown to traverse the placental route. Through various metabolic pathways aflatoxins are responsible for different types of pathological outcomes like gut enteropathy, anemia, stunting, and other immunological disorders. Moreover, socioeconomic determinants have indirectly shown to be strong predictors of aflatoxins exposure and thus its related pathological outcomes. Since we have a very limited number of researches about aflatoxins, this review altogether puts forward what is known about the toxin and its harmful metabolites.
Keywords: Aflatoxins; aflatoxinB1; carcinogens; fungal toxins.
Serum Lactate Dehydrogenase Level in Pregnancy Induced Hypertension and Fetomaternal Outcome
Authors: Prajapati Sarmila , Manandhar Bekha Laxmi , Maskey Suvana , Sharma Jyoti
Published: January 2022

Hypertensive disorders complicate 5-10% of all pregnancies and associated with potentially dangerous maternal and fetal complications. Studies have shown that pre-eclamptic patients with higher levels of lactate dehydrogenase (LDH) are at high risk of developing subsequent complications with poor maternal and fetal outcome. So with the aim to correlate serum LDH level in pregnancy induced hypertension (PIH) with fetomaternal outcome this hospital based observational descriptive study was done at Tribhuvan University Teaching Hospital (TUTH) for the duration of 1 year from 15th May, 2018 to 14th May, 2019. Women with PIH fulfilling inclusion criteria were enrolled in the study. Serum LDH level was measured and severity of PIH, maternal and perinatal outcome were studied according to the levels of LDH. Results were analyzed using SPSS 18. The incidence of hypertensive disorder in pregnancy was 4.74% in this study and total 180 cases were enrolled. The mean serum LDH level increased with increase in severity of PIH. Thirty two (17.7%) cases had maternal complications and hemolysis elevated liver enzymes and low platelet (HELLP) syndrome was most common complication. More than 2/3rd (62.5%) of cases with LDH level >800 IU/L had complications. The most common perinatal complication was intrauterine growth restriction (IUGR). The perinatal morbidity and mortality were significantly high in patients with PIH with LDH level >800 IU/l. As with the increase in serum LDH level increase in maternal and fetal complications was observed, LDH can be a useful biochemical marker that reflects the severity of PIH.