bluuebunny/crossref_metadata_2025 huggingface dataset:
Pelatihan Mixology kepada Siswa SMK Al-Azhar Batam
Authors: Sipayung Natal Olotua , Dailami  , Moh. Thandzir  , Rais Syafruddin Rais , Saputra Ardiansyah Saputra
Published: July 2024

Mixology is the art of creating a drink that is good in taste and appearance. In making this drink, there are several methods, they are pouring, shaking, blending, layering, and stirring.  In making this drink you also need several equipment such as a jigger, shaker, blender, long bar spoon, knife, cutting board and tong.. The drink container (glass) also influences the appearance of the drink. For mocktail drinks, the following glasses are usually used as containers, they are  highball glass, hurricane glass, pocogrande glass, and cocktail glass. The mixology training activity for AL-Azhar Vocational School students was carried out in the AL-Azhar Vocational School field, the presenter first gave an explanation, practiced how to make drinks, then gave several students the opportunity to make drinks and finally the students drank the mocktails that had been prepared by the presenter.
Pelatihan Minuman Kekinian Yang Di SMA Matreywira Batam Di Kota Batam
Authors: Rezki Alhamdi  , Steven Johnson  , Tiffany Clarissa Tan  , Bram Handoko
Published: July 2024

Saat ini banyak jenis minuman yang di sajikan untuk memenuhi kebutuhan masyarakat yang menyukai berbagai jenis minuman. Salah satu minuman yang ada yang sangat di gemari oleh usia muda adalah minuman kekinian. Minuman ini di sajikan dengan percampuran berbagai dasar minuman yang menjadikan minuman tersebut menjadi nikamt dan bercita rasa yang sangat enak. Pada tanggal 26 februari 2024 Politeknik Pariwisata Batam melaksanakan pengabdian kepada masyarakat yang dilaksanakan di salah satu SMA terkemuka di Batam. Dosen Politeknik Pariwisata Batam yang terdiri dari Manajemen Kuliner dan Manajemen Tata Hidangan melaksankaan pelatihan kepada siswa dan siswa SMA bagaimana cara membuat minuman yang menarik dan mempunyai rasa yang enak dan nikmat. Ada beberapa minuman yang disajikan yang di buat langsung oleh mahasiswa manejemen tata hidangan. Pelatihan ini di harapkan dapat membantu siswa untuk berkreasi dan berwisarausaha sesuai dengan kemampuan minat dan bakat yang dimilki oleh siswa yang ada di SMA di Batam. Tujuan PKM ini oleh dosen Politeknik Pariwsata Batam ada menerapkan serta menyebarluaskan ilmu yang di miliki yang berasal dari pengajaran serta penelitian yang dilakukan oleh dosen tersebut yang diharapkan dapan memberikan manfaat untuk masyarakat yang lebih luas. Pelaksanaan PKM ini di bantu sepenuhnya oleh Politeknik Pariwisata Batam dan SMA tempat dosen melaskasakankan pengabdian kepada masyarakat.
Sosialisasi Bahaya Narkoba dan Jenis Penanggulangannya di Kampung Tua Tiangwangkang Barelang Batam
Authors: Sianipar Baktivillo , Cahayani Kartika , Kamelia Santika  , Bram Handoko  , Apryani  , Silitonga Frangky
Published: July 2024

Narkoba (narkotika, psikotropika dan bahan-bahan zat adiktif lainnya) dapat membahayakan kehidupan manusia, jika dikonsumsi dengan cara yang tidak tepat, bahkan dapat menyebabkan kematian. Narkoba mempunyai dampak negatif yang sangat luas; baik secara fisik, psikis, ekonomi, sosial budaya hankam, dan lain sebagainya. Banyak cara digunakan agar pemakai narkoba dapat normal dan pulih kembali seperti biasanya.Sehingga kepada pemakai / pengedar dalam ketentuan hukum pidana nasional diberikan sanksi yang berat. Metode pengabdian ini adalah kajian studi kepustakaan, hasilnya adalah kasus penyalahgunaan narkoba mengalami peningkatan sangat tajam karena belum ada standarisasi sistem pencatatan dan pelaporan penyalahgunaan narkoba kemudian disosialisasikan di masyarakat Kampung Tua Tiangwangkang Barelang Batam.
The Effect of Infusing Soursop Leaves (Annona muricata L.) on Vaginal Discharge in Women of Childbearing Age: A Randomized Clinical Trial at the Lolo Community Health Center, Kerinci Regency, Jambi, Indonesia
Authors: Suganda Yohana , Gusmadewi  , Rahmatul Ulya  , Mekar Zenni Radhia
Published: July 2024

Introduction: Vaginal discharge (leukorrhea) is a common gynecological complaint among women of childbearing age. While physiological discharge is normal, pathological discharge can be indicative of underlying infections or conditions. This study aimed to investigate the efficacy of soursop leaf infusion (Annona muricata L.) as a complementary treatment for vaginal discharge in women of childbearing age.
Methods: A randomized controlled trial was conducted at the Lolo Community Health Center, Kerinci Regency, Jambi, Indonesia. Women aged 15-49 years presenting with vaginal discharge were randomly assigned to either the intervention group (soursop leaf infusion) or the control group (standard care). The intervention group received soursop leaf infusion twice daily for seven days, while the control group received standard care as per the health center's protocol. The primary outcome was the reduction in vaginal discharge symptoms (amount, color, odor, and associated discomfort) after seven days. Secondary outcomes included changes in vaginal pH and microbiological assessment.
Results: A total of 130 women participated in the study (65 in each group). After seven days, the intervention group showed a significantly greater reduction in vaginal discharge symptoms compared to the control group (p < 0.05). The amount, color, and odor of discharge improved significantly in the intervention group, along with a reduction in associated discomfort such as itching and irritation. Vaginal pH was also normalized in the intervention group, and microbiological assessment revealed a decrease in pathogenic microorganisms.
Conclusion: Soursop leaf infusion (Annona muricata L) appears to be a safe and effective complementary treatment for vaginal discharge in women of childbearing age. Its antimicrobial and anti-inflammatory properties may contribute to its beneficial effects. Further research is warranted to explore its long-term efficacy and potential use in combination with conventional therapies.
Sheldrake's New Science of Life
Authors: Hinsen Konrad
Published: July 2024

One of the books I read during my summer vacation is the recently published second edition of Rupert Sheldrake's "A New Science of Life". It is one of the most controversial books in science, having been both praised and condemned; a review of the first edition in the renowned science journal

Nature

concluded that this book should be burnt! The question that Sheldrake addresses in this book is where form comes from.
The future of Python
Authors: Hinsen Konrad
Published: July 2024

I have received a number of questions and remarks about my keynote talk at EuroSciPy 2010, ranging from questions about technical details to an inquiry about the release date of Python 4.0! Rather than writing lengthy replies to everyone, I try to address all these issues here.
Static typing and code clutter
Authors: Hinsen Konrad
Published: July 2024

Among the many characteristics that distinguish programming languages, static vs. dynamic typing is one of the most debated ones. The main advantages claimed by the advocates of static typing are that compile-time type checks make code more robust and that static typing allows a compiler to do better optimizations.
ActivePapers for Python
Authors: Hinsen Konrad
Published: July 2024

Today I have published the first release of ActivePapers for Python, available on PyPI or directly from the Mercurial repository on Bitbucket. The release coincides with the publication of my first scientific paper for which the complete code and data is in the supplementary material, available through the J. Chem. Phys. Web site or from Figshare.
Monads in Clojure
Authors: Hinsen Konrad
Published: July 2024

One of my hobby projects over the last months has been the exploration of monads. Monads are packages consisting of a data structure and associated control structures that are used as abstractions in functional programming. They were popularized by the Haskell language, where they play a central role in introducing side effects (such as I/O) in a controlled way into a language that is otherwise purely functional.
Science and free will
Authors: Hinsen Konrad
Published: July 2024

The question if living beings, in particular those of our own species, possess "free will", and how it works if it exists, has recently become fashionable again. The new idea that brought the topic back into discussion was that our sense of free will might just be an illusion.
Eclipse experiences
Authors: Hinsen Konrad
Published: July 2024

A few months ago I decided to take a closer look at Eclipse, since several people I know seemed to be quite fond of it. I had tried it earlier on my old iBook G4, but quickly abandoned it because it was much too slow. But my new MacBook Pro should be able to handle it. Last week I finally decided to retire my Eclipse installation.
Prelithiation of electrodes in lithium-ion capacitors: A review
Authors: D’Silva Aston Sam , Eldho M. P. , Lekha K. , Anushree J. , Bhat Vinayambika S. , Sagar Raghavendra
Published: July 2024

Lithium-ion capacitors (LICs) are one of the modern state-of-the-art hybrid capacitors, comprising a high potential window and imparting a higher energy density than supercapacitors (SCs). These LICs encompass elevated power density and a longer life span than lithium-ion batteries (LIBs). Preparation of high-performance electrode materials with electrochemically active microstructure and prelithiation are two efficient approaches to fabricate highly efficient LICs. But it comes across as a real dilemma of low initial Columbic efficiency if only microstructure is considered as an efficient way to enhance the performance. Nevertheless, prelithiation plays a crucial role in the manufacturing of LICs, improving the initial Coulombic efficiency and enlarging the voltage window. This paper reviews the recent lithiation approaches for lithium-ion capacitors by providing their methods and discussing their results concerning their energy and power density.
Espectros del barroco. Tenebrismo, hipérbole y fantología en la deconstrucción de Jacques Derrida
Authors: García Pérez María
Published: July 2024

El presente estudio busca establecer la relación interna entre el movimiento barroco y su actualización neobarroca con la deconstrucción de Jacques Derrida. Para ello, analizaremos, en primer lugar, el núcleo de ausencia que recorre al pensamiento derridiano en tres aspectos: ausencia de sentido, ausencia de identidad y ausencia o sustracción de alteridad. Como se verá, los tres quedarán vinculados con la idea de deus absconditus a través de la influencia de Pascal dando lugar a lo que denominaremos tenebrismo deconstructivo. En segundo lugar, recurriremos a Severo Sarduy para dar cuenta de la hiperbolización que la deconstrucción lleva a cabo de características fundamentales del barroco y el neobarroco tematizadas por el pensador cubano (sustitución, proliferación y condensación). Por último, daremos cuenta del concepto de fantología (hantologie) que Derrida trae en diversos textos y en el que se muestra una espectralidad teatral propia también del barroco y el neobarroco. Concluiremos ahondando en la hipérbole, ya mencionada, pero en términos político-morales, esto es, el neobarroco de la deconstrucción no sería otra cosa que la exigencia trágica de lo imposible necesario: la justica, toda vez que la injusticia es inevitable.
THE ROLE OF THE DUE DILIGENCE PROCEDURE IN THE DECISION MAKING FOR MERGERS AND ACQUISITIONS
Authors: Ulian Ecaterina
Published: July 2024

Despite the extensive research on mergers and acquisitions, the subject of evaluation at the pre-investment stage is in continuous evolution. In the given context, it becomes important to understand the role of the Due Diligence procedure as a valuable tool for identifying risks, assessing operational and financial efficiency or inefficiency, and other aspects that can impact the performance of the transaction. The purpose of this research is to explore the interconnection between the following three important topics: Due Diligence, risk, performance. To make the clarification of this issue, the critical analysis of the opinions of other researchers, the trend analysis of evolution, and the document analysis was applied. By examining these interconnections, the study seeks to provide a comprehensive understanding of how Due Diligence influences the success of mergers and acquisitions transactions and offers insights for companies considering mergers and acquisitions activities, helping them to navigate potential challenges and optimize their strategies.
La pedagogía hospitalaria como una inclusión social al desarrollo educativo. Una revisión sistemática
Authors: Solorzano Cámara Karen Victoria
Published: July 2024

La pedagogía hospitalaria es un campo emergente que busca garantizar el derecho a la educación de niños y adolescentes en contextos de salud adversos. El objetivo de la presente revisión sistemática fue analizar estudios empíricos sobre pedagogía hospitalaria publicados entre 2016-2024. La pedagogía hospitalaria emerge como un recurso vital para garantizar la continuidad educativa e inclusión social de niños en contextos de salud adversos. Se utilizó una metodología PRISMA, seleccionando 30 artículos de las bases de datos EBSCO (36%), WoS (28%), Scielo (28%) y Scopus (8%). La mayoría fueron en inglés (70%) y español (30%). El año con más publicaciones fue 2019 (23,33%) seguido de 2022 (20%). Los estudios muestran un progreso notable en el desarrollo de estrategias innovadoras, con enfoque en la individualización de la enseñanza y uso de tecnología educativa. La creciente conciencia sobre la inclusión social ha impulsado la mejora de políticas y programas para garantizar el derecho a la educación de todos los estudiantes. Sin embargo, es crucial abordar desafíos como la falta de recursos y capacitación adecuados para maximizar su impacto positivo en el desarrollo educativo y la inclusión social de los niños en el entorno hospitalario.
Conciencia fonológica para el desarrollo lingüístico en niños de cinco años
Authors: Aguirre Ñamot Cristina Elizabeth , Merino Salazar Teresita del Rosario
Published: July 2024

La conciencia fonológica en niños de cinco años es crucial para el aprendizaje en habilidades lingüísticas, no solo influye en la adquisición del lenguaje oral, sino que también consolida la comprensión de lectoescritura. El objetivo de la investigación es identificar el grado de conciencia fonológica y las herramientas utilizadas para mejorar su desarrollo en los niños. Para lo que se empleó una revisión sistemática con un diseño y método descriptivo. En un primer paso, se buscaron los diversos artículos de publicaciones periódicas en google scholar, bases de datos como SCIELO, SCOPUS, WEB SCIENCE para su respectivo análisis. De base de datos de diferentes fuentes encontradas, el 60% de estos artículos de revisión sistemática, se encontraron en Scielo, el 20% se encontró en Scopus, el 10% se encontró en Web of Science y un 10% se pudo encontrar en Google Académico. Concluimos que la Prueba para la evaluación del conocimiento fonológica (PECO) es la más eficaz.
Desempeño docente en educación básica regular en Perú: una revisión sistemática
Authors: Martos-Huamán Irma
Published: July 2024

El desempeño docente representa un elemento fundamental y determinante para la calidad del sistema educativo actual. Debido a esto, la presente investigación tuvo como objetivo analizar el desempeño de los docentes en educación básica regular en Perú. Para ello, se realizó una revisión sistemática utilizándose el método PRISMA, del que se seleccionaron 33 artículos publicados a partir del año 2020. En los trabajos analizados se constató que la gran mayoría de los docentes que participaron en los estudios tienen un desempeño docente moderado o regular. Además, que son muchas las variables que se relacionan como la gestión educativa, el liderazgo directivo, el clima organizacional y las competencias digitales. Se concluye con la propuesta de que se establezcan acciones de superación y planificación de estrategias de enseñanza, encausadas en el dominio de los cuatros aspectos que establece el Ministerio de Educación peruano en el Marco de Buen Desempeño Docente.
Effectiveness of Audit and Feedback in Improving the Quality of Operative Notes - A Retrospective Observational Study
Authors: Maharjan Leison , Singhal Aditya , Guragain Rajendra PS
Published: July 2024

Introduction: Surgeons must maintain detailed and accurate operative notes as it is important not only for safe patient care but also for research, audit and medicolegal purposes. But literature has shown that many operative notes are incomplete and illegible. Audit and feedback is a useful strategy to improve such practices which our department has been following. Our aim is to study its effectiveness by comparing the quality of operative notes of 2016 with that of 2014.
Methods: Total 96 operative notes, 48 each of the year 2014 and 2016 were studied under 22 parameters including 18 suggested by “Good Surgical Practice” guideline. Each operative notes was analyzed by a single observer for completeness. Parameters of the operative notes of two different years were compared and given the status of either improved, deteriorated or unchanged.
Results: Only parameters related to patient identification, date, surgeon’s full name, postoperative plan were complete in both the years. In comparison to earlier year, in 2016 improvement was seen in parameters such as postoperative diagnosis, details of tissue removed, authors details, closure details, operation time and operative difficulties/ complications and deterioration was seen in hospital number, preoperative diagnosis, procedure, full name of anesthetist, full name of scrub nurse, operative findings and signature of the surgeon.
Conclusion: Improvement in the quality of the operative notes was not adequate with audit and feedback strategy alone. Hence to increase the effectiveness, other methods such as computerized operative notes and aide-memoire should also be introduced.
Analysis of Outcomes of Critically ill Surgical Patients using SAPS II Score
Authors: Paudel Prakash , Rai Subash , Shrestha Sunil , Pradhan , Giridhar BN , Bhattachan Chitra L
Published: July 2024

Introduction: Several prognostic models have been implemented for risk assessment and mortality prediction in critically ill patients admitted in ICU. The availability of such sophisticated methods has facilitated in clinical decision making and comparison of outcomes. However, none are universally accepted as standard method to predict mortality. We have decided to use SAPS II score because of the simplicity and easy availability of its variables to analyse the outcomes of critically ill surgical patients admitted to ICU at our centre.
Methods: The study was conducted between September 2016 and August 2018 at Nepal Medical College and Teaching Hospital, Kathmandu, Nepal. We prospectively collected data on surgical patients consecutively admitted to the ICU during the study period. The variables of SAPS II score were collected from the physiological, laboratory, and patient characteristics mentioned in the ICU scoring data sheet at 24 hours. The SAPS II score and predicted mortality was calculated using computer software programme. The predictive mortality based on the score was compared with the actual outcome to derive the standardized mortality ratio (SMR).
Results: During the period of study, 64 patients met the inclusion criteria. The mean age of the patients was 54±17.9 (20-84) years and length of ICU stay was 5.3 ±3.5 (3-22) days. GI malignancy was most common pathology comprising 43.8% (n=28). The mean SAPS II score was 24.9±16.4 (3-68). There was no statistical difference in mean SAPS II score between patients with different gender, nature of disease and type of surgical intervention. The mean predicted mortality was 13.4% and the observed ICU mortality was 15.6% (n=10). The calculated mean SAPS II score and predicted mortality was higher in non survivors compared to survivors (p<0.0001). The calculated SMR for our study population was 0.85 ranging from 0.01 to 5.2. The number of patients with SMR greater than 1 was only 17 % (11/64). There was significant correlation of mortality with SMR greater than 1 (p=<0.0001).
Conclusion: The variables in SAPS II score are readily available. Neither special samples nor cumbersome procedures are required. SAPS II can be used as simple and rapid tool to predict mortality in critically ill surgical patients in our set up.
Donor Factors Affecting Short Term Graft Outcome in Live Donor Kidney Transplantation
Authors: Nepali Rabin , Shah Dibya S , Gyawali Prem R , Sharma Uttam , Chalise Pawan R
Published: July 2024

Introduction: Since the beginning of renal transplant, the objective has been to increase the patient and graft survival, both short term and long term. Data relating to donor factors affecting short term survival at 6 months in live donor kidney transplantation has been scarce. This single center study tries to examine the predictors of short term graft outcome at six months in recipients of live donor kidney transplants and explore which donor characteristics are the most useful in predicting the post-transplant graft function in Nepalese population.
Methods: All patients who underwent kidney transplantation between May 2015 to July 2016 were included in the study. The patients who expired during follow were excluded. The clinical and laboratory parameters of the donors were recorded. The recipients were followed up for six months post transplantation. The eGFR of the recipients and the occurrence of rejection were recorded at the end of six months post transplantation.
Results: A total of 82 donor-recipient pairs underwent living donor renal transplantation at our hospital during the study period. One recipient who expired during follow up was excluded. The mean age of donor was 45.20 ± 11.226 years of which 55 (67.9%) were female and 26 (32.1 %) were male. The mean eGFR of the donor calculated from Cockcroft Gault equation was 81.98 ± 18.11. The eGFR of the recipient at the end of six months post transplantation calculated form the MDRD equation was 67.76 ± 20.94. A total of 7 patients (8.6%) had rejection that were biopsy proven. Only donor eGFR was found to be significantly associated with eGFR of the recipient at six months post transplantation (p=0.034). Body mass index of the donor was significantly associated with rejection in the recipient at six months post transplantation (p=0.011).
Conclusion: Our study demonstrates that the donor eGFR and body mass index are independent and important factors affecting the short term graft outcome at six months post transplantation.
Hemodialysis Catheter-Related Infection in a Teaching Hospital of Central Nepal
Authors: Sedhain Arun , Sapkota Abja , Mahotra Narayan B
Published: July 2024

Introduction: Infection of the central venous catheter (CVC) is a major complication seen among patients undergoing hemodialysis. Identifying CVC related infection (CRI) and its risk factors and causative organisms is important for better implementation of preventive strategies.
Methods: A prospective study was conducted at Chitwan Medical College for a duration of 2 years from January 2017 to December 2018 among the patients undergoing hemodialysis via CVC. The data collected were related to patients’ demographics, site of catheter insertion, and duration, microbiological data including cultures from catheter sites, blood, and catheters’ tips and antibiotic sensitivity. Catheter related infection was divided into catheter related local infection (CRLI) and catheter related blood stream infection (CRBSI). Data was analyzed using IBM SPSS Statistics version 21.0.
Results: A total of 41 cases of CVC related infection (CRI) were documented with an incidence rate of 6.94 episodes per 1000 catheter days at risk. Out of the total CRI, 39.02% were CRLI and 60.98% were CRBSI. Fever with chills and rigor were the most common clinical presentation. Risk factors for the development of CRI were duration of catheter in situ, repeated change of CVC and the use of CVC for indications other than hemodialysis (HD). Staphylococci and Klebsiella were the most common organisms isolated in culture.
Conclusion: The rate of CRI among Nepalese patients undergoing hemodialysis is high. Prolonged duration of CVC usage, recent change of catheter and the use of the HD catheter for the purpose of institution of intravenous medication have been found as the risk factors for CRI.
Mortality in Emergency Services in a University Teaching Hospital: A Retrospective Study
Authors: Shrestha Tirtha M , Aacharya Ramesh P , Neupane Ram P , Prajapati Bigyan
Published: July 2024

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 are 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.
Anorectal Autoeroticism: A Case Report
Authors: Tulachan Pratikchya , Shrestha Kenison , Chapagai Manisha , Dhungana Saraswati , Pant Sagun B , Lama Pratik , Bhandari Ramesh S
Published: July 2024

Introduction: Anorectal autoeroticism is one kind of paraphilia where individual attains sexual pleasure through self inserting objects into ones rectum. We present here a case of 40 years old man presented in Surgery department with retention of steel glass into his rectum which he had inserted himself to achieve sexual satisfaction.
Profile and Outcome of Patients Admitted to Pediatric Intensive Care Unit at a General Referral Hospital
Authors: Sharma Arun K , Gurung Binay
Published: July 2024

Introduction: Nepal has made substantial progress in child health primarily through preventive care. There is an increasing need for critical care services across the country which is highly resource intensive. Periodic data of critical care admissions help plan the utilization of scarce resources in a low-income country like Nepal. This study aimed to analyze the epidemiologic patterns of critically ill pediatric patients admitted to the pediatric intensive care unit (PICU).
Methods: This descriptive study of all children admitted to PICU at Tribhuvan University Teaching Hospital for 18 months between October 2017 and April 2019 was conducted by a retrospective review of hospital records. Demographic data, etiologies of PICU admissions and outcomes of children admitted to the PICU were analyzed.
Results: PICU admitted 413 children during the study duration from all over the country. Children under the age of 2 years (36%) were admitted in the largest number and boys outnumbered girls (65.1%). Respiratory illnesses, neurosurgical and neurological problems, infectious disorders and airway foreign bodies were the most common etiologies for admission. The average length of ICU stay was around 4.4 days. Almost one-third of patients required circulatory and respiratory support. At the time of exit from PICU, 14.3% of patients died; 4.3% patients had opted for withdrawal of life support or decided to leave hospital against medical advice.
Conclusion: Patients with diverse etiologies were admitted to ICU from all over the country. A similar analysis from PICUs across the country can serve as the basis for development of newer intensive care facilities in the country, developing dedicated protocols for critical care and redistributing the ICUs’ available resources for optimal efficiency.
Knowledge Regarding Antibiotic Use, its Resistance and Consequences among Higher Secondary Students in Private Schools of Kathmandu Valley
Authors: Deo Satish K , Gautam Naveen , Gyawali Siddinath , Shrestha Deepti , Yadav Shikha
Published: July 2024

Introduction: The lack of awareness on the appropriate use of antibiotics, its dose and duration is one of the leading causes of global antimicrobial resistance (AMR). AMR poses a growing threat to public health, as infections from resistant strains of microbes become increasingly difficult to treat, resulting in prolonged illness and greater risk of death. Hence, this study would be an important reference for determining the scope of the problem which will be essential for formulating and monitoring an effective response to antibiotic use and its problem of resistance.
Methods: A descriptive cross-sectional study was done among higher secondary level students from selected schools in Kathmandu valley. Baseline data was collected after a tutorial session through semi-structured questionnaires which was based on past researches and verified using expert consultation. Ethical consideration was maintained throughout the study. Descriptive statistics was used to find out the KAP level including knowledge score and attitude-practice score of the selected population.
Results: Among 465 participants conducted in our research, the overall average knowledge score of the participants was found to be 73.3% while the attitude-practice score was 60.53%. It was found that 80.86% of the participants had heard the term “antibiotic resistance”. The knowledge score percentage among the students of grade 10 and 11 had no significant difference (p value= 0.592).
Conclusion: Our study concludes that if topics like antibiotics and their judicial use is well covered in school curriculum, it can produce measurable change in knowledge, attitude and practice level of the students.
Case of HER2-Enriched Multifocal Breast Cancer Associated with Pregnancy
Authors: Khanal Suman , Singh Yogendra P , Shrivastav Shreya
Published: July 2024

Pregnancy-associated breast cancer is less common and often presents in advanced stage. Management is similar to non-pregnant cases with trimester-specific considerations. In this case report, we present a case of worrisome mother with locally advanced multifocal pregnancy-associated breast cancer who was so much concerned about effects of neoadjuvant chemotherapy on fetus leading to its delayed initiation, and show why targeted therapy is still not within reach in a developing economy like Nepal. Short term data of chemotherapy though reveal relative safety, long term data are lacking. This may be a hindrance in counselling, when patients are more anxious and worrisome.
A Case Report on Deliberate Self-poisoning with Imidacloprid in a Young Female - Overview of a Newer Insecticide Poisoning
Authors: Thapaliya Sabin , Basnet Bhupendra K , Das Santa K , Thapa Rakshya
Published: July 2024

Imidacloprid is a newer insecticide of the group Neonicotinoids. It is safer to humans and hence considered a better alternative to organophosphorus compounds, especially in areas like Nepal with higher incidence of deliberate self-poisoning. There has been an increase in the number of reported cases of imidacloprid poisoning from South-East Asian countries, but none from Nepal. We report a case admitted in Intensive Care Unit with neurological manifestations, respiratory failure and development of Acute Kidney Injury following acute imidacloprid poisoning.
Use of Turmeric Against Escherichia coli and Staphylococcus aureus Isolated from Urinary Tract Infections: A Laboratory-Based Study
Authors: Pal Anjila , Mahawal Bhim S , Bom Rabin
Published: July 2024

Introduction: Urinary tract infection (UTI) is an important global health problem affecting millions of peoples annually; more common among females. Among the various bacterial etiologies for UTIs, Escherichia coli is the commonest one. Turmeric has been used since ancient times as a home remedy for various medical conditions. The aim of our study is to determine the prevalence of E. coli and Staphylococcus aureus associated UTIs, their antibiogram and antibacterial effects of aqueous extracts and discs of turmeric against these isolates.
Methods: All the urine samples were cultured and the isolates were identified as E. coli and S. aureus based on standard microbiological tests. Different turmeric extracts were prepared using ethanol, methanol and distilled water as solvents. Turmeric discs were also prepared by soaking the sterile filter paper discs in the different turmeric extracts. The isolated E. coli and S. aureus were tested for antibacterial activity against turmeric extracts and discs by using agar well diffusion and disc diffusion assays.
Results: Out of 240 urine samples, 90 showed growth with 26.67% (24) and 5.55% (5) isolates of E. coli and S. aureus respectively. Most of the isolates were isolated from females of the age group 41-60 years. No zone of inhibition was observed for any of the bacterial isolates as well as the standard ATCC strains of E. coli and S. aureus against all the turmeric extracts. Nitrofurantoin and Gentamicin were most effective antibiotics against E. coli and S. aureus respectively.
Conclusion: This study concluded that no antibacterial activity was seen for bacteria isolated from suspected cases of UTIs namely; E. coli and S. aureus against different turmeric extracts and discs.
Tamsulosin Versus Alfuzosin as Medical Expulsion Therapy for Distal Ureteric Calculi: An Analytical Study
Authors: Kumar Vijay , Bhatta Pashupati , Yadav Umesh , Singh Amit , Raya Akash
Published: July 2024

Introduction: Urolithiasis is one of the most common urological problems. About 20% of urolithiasis accounts for ureteric calculi among which 2/3rd patients present with distal ureteric calculi. Alpha blockers are commonly used for effective treatment of ureteric calculi. The aim of this study was to compare effectiveness of Tamsulosin and Alfuzosin as medical expulsion therapy.
Methods: This analytical study was carried out at National Medical College Department of Surgery, Urology Unit, Birgunj from October 2020 to March 2021. Ethical clearance (FNMC/439/075/76) was obtained from institutional review committee. Total 100 cases were included in the study who presented with distal ureteric calculi of <10 mm. The patients receiving Tamsulosin were recruited in Group T and those receiving Alfuzosin were recruited into Group A. The choice of treatment was made by the treating surgeons. Tamsulosin 0.4 mg was used for the patients in Group T and 10 mg Alfuzosin was used in Group A. Patients were followed-up weekly for 4 weeks. Stone expulsion rate, time to stone expulsion, colic episodes, emergency visit, use of analgesics and drug-related side-effects were recorded.
Results: The rate of expulsion of stone in Tamsulosin group was 64% and that in Alfuzosin group was 66%. The expulsion time in Tamsulosin group was 4.28±3.49 days and that in Alfuzosin group was 5.02±4.09 days which was statistically insignificant (p=0.33). Mean episodes of colic and use of analgesics were similar in both groups. Backache was the most common side effect in both groups.
Conclusion: Efficacy of both Alfuzosin 10 mg and Tamsulosin 0.4 mg as medical expulsion therapy is comparable to each other with minimum side effects of both the drugs.
Palatal Rugae as an Indicator of Sexual Dimorphism
Authors: Dahal Samarika , Baral Radha , Gupta Sanjay P , Dahal Sirjana , Sharma Rinu
Published: July 2024

Introduction: Palatoscopy or palate rugoscopy has been studied over the years to identify its unique characteristics to utilize for the human identification process. The unique anatomical location of the palatal rugae provides stability which along with the uniqueness of the palatal rugae pattern can contribute in human identification. Despite its simplicity and reliability, the palatal rugae is unexplored in the Nepalese population. The objective of the present study is to identify the rugae pattern and assess its sexual dimorphism.
Methods: This was a cross-sectional analytical study conducted in Tribhuvan University Dental Teaching Hospital (TUDTH). The characteristics of palatal rugae based upon number, length, shape, and unification were analyzed on 100 dental casts. The rugae patterns were marked with a black color graphite pencil under adequate illumination. The length of the rugae was measured with the help of a digital vernier caliper and brass wire. The independent sample T-test and Mann Whitney U tests were used to assess the sexual dimorphism.
Results: The predominant type of rugae according to the size in both males and females was primary rugae. According to the shape of the rugae, the predominant type of rugae was wavy followed by curved, straight, diverging, converging, and circular in both the sexes. However, no significant difference was seen in the rugae pattern in males and females.
Conclusion: Based on the findings of the present study, the use of palatal rugae for sex determination is not recommended.
Predictors of Uncontrolled Seizure in Children Presenting in Tertiary Level Hospital in Nepal: A Prospective Study
Authors: Shrestha Merina , Bajracharya Luna
Published: July 2024

Introduction: About one third of the children with seizure do not achieve complete seizure control. We aimed to find the predictive factors for uncontrolled seizure in children.
Methods: This prospective study was conducted from October 2018 to September 2020 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Children aged 12 months to 16 years with seizure and who were under regular follow up visits for at least once in past 3 months time were included and followed up for one year. Uncontrolled seizure was defined when seizure frequency was 2 or more in a year during the study period. Various factors were analyzed and when they were significantly different between the groups on bivariate analysis using the Chi square test, they were further analyzed with binary logistic regression model to find out the true predictors.
Results: Total of 110 children were enrolled. Forty children (36.4%) had their seizure onset before one year of age. About one third of patient had family history of seizure. The most common type of seizure was generalized type (60%). Of the total, 56% had uncontrolled seizure. Three true predictors of uncontrolled seizure were found. They were (i) age of onset before 12 months of age (OR 2.94; 95% C.I 1.32-6.55), (ii) abnormal findings in neuroimaging (OR 26.5; 95% C.I 8.72-80.07) and (iii) frequency of seizure (OR 40.9; 95% CI 9.05-184.9).
Conclusion: Seizure onset in infancy, abnormal neuroimaging findings and frequent seizure are predictors for uncontrolled seizure in children. Thus, we suggest that these factors be considered while managing the children with seizure.
Histopathological Spectrum of Renal Tumors in Adults in Nephrectomy Specimens in a Tertiary Care Center
Authors: Sharma Nisha , Maharjan Daisy
Published: July 2024

Introduction: Renal neoplasms are heterogeneous tumors with clinical picture, prognosis and therapeutic implications differing with the various histological subtypes. There are limited studies on adult renal tumors conducted in Nepal so far. This study aims to provide a better assessment on the histopathological spectrum of renal neoplasms in adult population.
Methods: This is a descriptive study of all the nephrectomy specimens of adults received at Department of Pathology, Tribhuvan University Teaching Hospital from January 2013 to January 2020.
Results: There were 75 males and 35 females with mean age being 51.8 years. Malignant tumors (99 cases, 90%) were more common than benign tumors (11 cases, 10%). Renal cell carcinoma (RCC) was the most common malignant tumor consisting of 91 cases (82.72%) followed by 6 cases of urothelial carcinoma (5.45%) and 2 cases of primitive neuroectodermal tumor. (PNET) (1.8%). Clear cell RCC (78 cases, 70.90%) was the commonest histological subtype of RCC followed by papillary RCC (8 cases, 7.2%) and chromophobe RCC (2 cases, 1.8%). 42.65% of the cases of clear cell RCC were of WHO/ISUP grade 2, whereas, most of the cases of papillary RCC were of low grade (Grade 1, 37.5%). Majority of Renal cell carcinomas were in stage pT1a (28 cases, 34.56%).
Conclusion: Clear cell RCC was the most common renal tumor in adults comprising the majority of cases. These tumors mostly demonstrated WHO/ ISUP Nuclear grade 2 and early stage of presentation (pT1). Papillary RCC was the second commonest RCC and mostly presented at lower nuclear grade (WHO/ISUP Nuclear grade 1). Urothelial carcinomas demonstrated higher nuclear grade and stage compared with RCC.
Self-Assessment of Non-communicable Diseases related Competencies among Interns of a Medical Institute of Nepal
Authors: Pradhan Pranil MS , Adhikari Bidur , Pant Sagun B , Ranjit Nirju , Rawal Suniti , Basnet Sudha
Published: July 2024

Introduction: One of the essential strategies to tackle rising burden of non- communicable diseases (NCD) is development of competent local human resource. Assessing the level of competencies in pre-service curriculum is the first step towards building an NCD-ready health workforce. This study aimed to assess perception of competence in delivering World Health Organization Package of Essential Non- communicable diseases (WHO-PEN) interventions among interns of Maharajgunj Medical Campus of Institute of Medicine (IOM).
Methods: A survey was conducted at Maharajgunj Medical Campus of Institute of Medicine among interns using online questionnaire. The questionnaire contained seven sections on different competencies to prevent and manage NCDs. Ethical approval was obtained from Institutional Review Committee of IOM. Descriptive analysis was done to identify the level of competencies. Statistical analysis was performed using Microsoft Excel and IBM SPSS version 20.
Results: Majority of the interns expressed low to moderate confidence in managing patients with presenting complaints of major NCDs. Most interns could perform diagnostic procedures and screening related to NCDs and mental disorders under supervision only (56.9%-68.6%), and one third felt they were unable to perform spirometry and visual inspection of cervix with acetic acid. Most interns could provide counseling on major NCD risk factors, self-care and palliative care only under supervision. Majority could not identify key NCD service performance measures and their data sources.
Conclusion: Skills of independently diagnosing and screening for NCDs, counselling on healthy lifestyle, alcohol and tobacco cessation and conduct motivational interviewing, self-care and palliative care were limited.
Temporal Trends, Socio-Economic Inequalities in Obesity and Responses by Federal Government, Nepal: A Systematic Review of Observational Studies, Policies, Strategies and Plans, 2005-2019
Authors: Bhurtyal Ashok , Adhikari Dushala
Published: July 2024

Introduction: Obesity has risen to epidemic proportions in low-income countries like Nepal, where maternal and child under-nutrition has reduced steadily. However, synthesised evidence on transition to obesity remains unavailable. We assessed trends and disparities in obesity occurrence, and examined central government’s policies and programmes.
Methods: We searched PubMed and Google Scholar for articles published between January 1, 2005 and April 10, 2019, and websites of Demographic and Health Survey, Non-Communicable Diseases Risk Factor Survey, and Micronutrient Status Survey. We synthesised obesity and overweight prevalence data from the selected studies, narratively; and disaggregated latest proportions from nation-wide surveys by gender, geographical location and household wealth quintile. We charted obesity related actions from policies, strategies and plans; obtained through the websites of health ministry and government’s planning commission.
Results: Twenty studies with data from 79,082 men and women aged 15 years or more and 11,866 children under five years, were included. Obesity or overweight among men and women increased from 20.0% in 2004 to 36.1% in 2016. Obesity alone rose from 5.3% to 7.5%. National average prevalence of childhood obesity or overweight remained very low. Overweight and obesity were more common among women, inhabitants of urban areas and central provinces, and the affluent. Governmental policies, strategies and plans on nutrition were primarily designed to control under-nutrition, with implications for preventing obesity.
Conclusion: Overweight and obesity increased substantially between 2005 and 2019, disproportionately affecting socio-economic and geographical groups. Governmental nutritional strategies should consider addressing obesogenic environments.
Caudal Dexmedetomidine versus Fentanyl with Bupivacaine in Decreasing Post-Operative Pain in Pediatric Inguinoscrotal Surgery : A Comparative Study
Authors: Gyawali Nirmal P , Shrestha Reshma , Bhattarai Krishna P , Shah Malla Sadikshya
Published: July 2024

Introduction: Despite various advancements in postoperative analgesia in children, about half of post-surgical children still experience pain. Opioids like fentanyl are used as an adjunct leading to a lower dose of caudal local anesthetics but have many side effects. Administration of caudal dexmedetomidine with local anesthetics was shown to prolong postoperative analgesia and sedation in children. This study was conducted to compare the effects of caudally administered fentanyl and dexmedetomidine in children undergoing inguinoscrotal surgery.
Methods: This was a comparative clinical study in which 152 patients were included. Patients were divided into two groups to receive a caudal block, each having 76 cases. Group A and Group B received single-dose caudal analgesia using fentanyl (1mcg/kg) and dexmedetomidine (1mcg/kg) with 0.25% bupivacaine(0.75ml/kg), respectively. The analgesic effect of the caudal block was evaluated using the FLACC score and sedation using the RSS score. The statistical significance was evaluated using independent t test using confidence interval of 95% (p value<0.05).
Results: The study showed no statistical significance in the demographic and operative variables between the two groups. The duration of analgesia (p value<0.001) and both the FLACC (p value=0.001) and RSS score (p value=0.004) only at 30 min postoperative values were statistically significant between the groups. The only side effect that showed statistical significance was vomiting (p value=0.03) seen in fentanyl group.
Conclusion: Dexmedetomidine can thus be used safely in children along with bupivacaine in routine inguinoscrotal surgery with additional benefits of prolonged analgesia and decreased side effects.