bluuebunny/crossref_metadata_2025 huggingface dataset:
quasi-experimental study to evaluate the effectiveness of a health education program in terms of knowledge and attitudes toward the prevention of common respiratory illnesses among sanitation workers in Gurugram, Haryana
Authors: Jyoti Jyoti , Dular Sunil Kumar , Chhillar Rekha , Abonmai Khiumajuliu
Published: May 2022

Objectives: The study's goal is to conduct research on the effectiveness of a Health Teaching Programme (HTP) in preventing common respiratory illnesses among sanitation employees in a specific region in Gurugram, Haryana. Methodology: Apre-experimental research was conducted to determine the effectiveness of HTP in preventing common respiratory disorders. A quantitative research technique, also known as a quantitative research design, was applied in this study. Purposive sampling was used to choose 60 people. The attitude scale on prevention of common respiratory disorders among sanitation employees was assessed using self-structured questionnaires and a Likert scale in chosen locations of Gurugram, Haryana. Result: The difference between the mean pre-test and post-test knowledge scores of sanitation work is 4.99 and the t-value is 11.675 with the df, 59 and the p-value is 0.000, which is significant at the 0.05 level. Similar to the sanitation work, there is a difference in the mean pre-test scores and post-test attitude scores of 23.55 and t-value is 44.740 with the df, 59 and p-value is 0.000, which is significant at the 0.05 level. There is an effectiveness of a health education programme on sanitation employees' understanding of how to prevent common respiratory illnesses.
brief review on social management system
Authors: Hos Jamaluddin , Prastowo F X Ari Agung , Khairuldin Wan Mohd Khairul Firdaus Wan , Embong Abdul Hanis , Chauhan Rahul
Published: May 2022

Management has an important position in every institution because management is closely related to others in determining or setting goals. In other words, management is not only to identify, analyze or set goals carefully but also to place human resources and other resources effectively. In this case, almost all human activities, whether in offices, hospitals, banks, or in educational institutions require management activities. Management has universal principles. Management activities are always concerned with efforts to achieve certain goals that have been set effectively and efficiently. In terms of ‘effective and efficient’, "effectiveness is the foundation of success; efficiency is a minimum condition for survival after success has been achieved. Efficiency is concerned with doing things right”. Effectiveness is doing the right things. Effectiveness is the foundation for achieving success and efficiency is the minimum resource used to achieve that success. Efficiency refers to doing things well, while effectiveness is about the work done in right way.
Evaluation of factors associated with postoperative delirium in patients undergoing complex orthognathic surgery
Authors: Fatima Shereen , Hussain M. Arshad , Reddy Kommuri Kavya , Ramya Yella , Betha Sharmila Priyanka , Dashatwar Pallavi Digambar , Kumar Praveen
Published: May 2022

Purpose: Postoperative delirium (PD) is a common and severe complication, following extensive surgery and prolonged stays in intensive care units (ICU). The study aimed to estimate the frequency of and identify risk factors for PD in a unified orthognathic surgery patients. Methods: A retrospective cohort study composing of patients undergoing Maxillary and Mandibular orthognathic surgeries over 2 year. The predictor variables were identified as 146 general and periprocedural parameters. The primary outcome variable was PD (+ or -). Descriptive and bivariate statistics were performed to identify existing correlations between the predictive factors and PD and the P-value was set at 0.05. A logistic regression model (LRM) was created to adjust for possible confounding factors and reveal possible independent prognostic factors for the onset of PD. Results: 200 patients (36 with PD+, 164 without PD in patient history) undergoing Orthognathic Surgery [130 males, 70 females, mean age = 20 (range 18-40 years)] surgery were recruited. 15 variables that were statistically associated with PD were identified. In the LRM, after adjusting for age, diabetes status and preoperative TSH, Orthognathic surgery was associated with an risk for PD (Odds Ratio (OR) 6.3 (1.6-25.7, p=0.01).
Forensic point of view on proving virginity
Authors: Kotb Heba Gamal , Abo-Zeid Walaa Abd el Hady Abd el Halim
Published: May 2022

Aim: Chastity is a moral virtue, whereas virginity is a physiological state indicated, but not conclusively, by an intact hymen. Sometimes, the post-pubertal hymen can be elastic, and hence some sexually active women were found to have intact hymens. Therefore, the absence of any hymen injuries should be used to rule out the possibility that the adolescent has experienced vaginal penetration. Consequently, a false virgin may claim to be a true virgin. Objectives: The current study aims to establish medico-legal aspects concerning proving virginity among Egyptian candidates. Subjects & Methods: A comparative study of two examined groups of married females coming to private section during the first week after the wedding. One group complained of bleeding, and the other complained of severe bleeding with the first intercourse, discussing the types of hymens found, medico-legal and ethical concerns regarding virginity concepts, and their husbands' feelings and attitudes. Results: The results revealed that of 189 women examined for bleeding with the first intercourse, 82.5% of them were found to have an annular elastic hymen. Only 15.8 % of 114 cases examined for severe bleeding during the first intercourse had a deflorated hymen, and the rest had an elastic hymen.
Liking that It Hurts: The Case of the Masochist and Second-Order Desire Accounts of Pain's Unpleasantness
Authors: Mitchell Jonathan
Published: May 2022

Recent work on pain focuses on the question “what makes pains unpleasant.” Second-order desire views claim that the unpleasantness of pain consists in a second-order intrinsic desire that the pain experience itself cease or stop. This paper considers a significant objection to Second-order desire views by considering the case of the masochist. It is argued that various ways in which the Second-order desire view might try to account for the case of the masochist encounter problems. The conclusion is that until there is a convincing explanation of how Second-order desire views can handle masochistic psychology, theorists should look elsewhere for an account of pains unpleasantness.
Tempo ed età nell’ufficio ecclesiastico. Il decreto del Dicastero per i Laici, la Famiglia e la Vita ( 3 giugno 2021)
Authors: Viana Antonio
Published: May 2022

SOMMARIO: Introduzione - 1. Varietà di casi di titolarità dell’ufficio - 1.1. Casi di provvisione a vita dell’ufficio - 1.2. Casi di provvisione temporale dell’ufficio - 1.3. Uffici con limite massimo di età - 1.4. Motivi a favore della temporaneità delle nomine e della cessazione per età - 2. Novità del decreto del Dicastero per i Laici, la Famiglia e la Vita (3 giugno 2021) per quanto riguarda i limiti temporali del governo delle associazioni - 2.1 Aspetti generali della normativa - 2.2 Le motivazioni della norma - 2.3. Un profondo cambiamento nello spirito del diritto associativo ecclesiastico - 2.4. La necessaria sussidiarietà - 3. Conclusione.

Time and age in the ecclesiastical office. The Decree of the Dicastery for Laity, Family and Life (June 3rd 2021)

ABSTRACT: The article deals with the incidence of two factors in ecclesiastical offices: the passage of time and the fulfilment of certain age limits in the holder of the office. The first part of the study presents a systematic summary of the general legislation. The second part discusses the novelties and consequences of the treatment of the temporal factor of offices in the regulations published in 2021 by the Dicastery for Laity, Family and Life. The study concludes with an assessment of the norms of the Dicastery's decree with regard to the fundamental freedom of association in the Church.
THE MIDDLE SMITHIAN (EARLY TRIASSIC) AMMONOIDS OF GORNJI BRČELI (SOUTHERN MONTENEGRO)
Authors: ĐAKOVIĆ MARTIN , KRYSTYN LEOPOLD , SUDAR MILAN
Published: May 2022

A rich Early Triassic (Smithian) ammonoid fauna discovered near the village of Gornji Brčeli (southern Montenegro) is unique for the Early Triassic of the western Tethys. The Smithian there is represented by a series of several tens of meters thick brown-red to grey-green marls and clays with intercalated, mica-rich, thin dark grey sandstones, and subordinate occurence of redeposited oolitic limestone. The fossils have been collected as scree material over a few square meters but are considered as contemporaneous since no unnatural association (condensation) was detected. The ammonoid assemblage is represented by 15 species, belonging to the genera Aspenites, Cordillerites, Dieneroceras, Abrekites, Owenites, Pseudaspenites, Pseudosageceras, Truempyceras, Wyomingites, Hanielites, Galfettites, Parahedenstroemia, Lingyunites and Pseudoflemingites, and can, by the presence of Owenites zitteli Smith, be correlated with the late Middle Smithian Nyamalites angustecostatus beds of the southern Tethys, the upper Owenites koeneni beds of South China or the Owenites beds of North America. Taxonomic composition of the ammonoid assemblage shows great similiarity with those of Spiti (India), NW Guangxi (China) and Nevada (USA), but also some with those of Salt Range (Pakistan) and Timor. A markedly dominance of involute, oxycone and platycone morphologies distinguishes the Gornji Brčeli fauna from other contemporaneous faunas and points to specific palaeoecological environmental conditions. Previously, three new species were described from this locality and in the present paper one more is added (Parahedenstroemia? tatjanae). Two species hitherto considered as synonyms (Abrekites arthaberi and Owenites zitteli) are revised and treated as valid based on new material from Gornji Brčeli.
A RUPELIAN CORAL REEF FISH ASSEMBLAGE FROM THE VENETIAN SOUTHERN ALPS (BERICI HILLS, NE ITALY)
Authors: MARRAMA' GIUSEPPE , GIUSBERTI LUCA , CARNEVALE GIORGIO
Published: May 2022

Here we describe a new bony fish assemblage collected from a fossiliferous outcrop located in Perarolo, Berici Hills, Venetian southern Alps. The fossiliferous deposits pertain to the Rupelian (lower Oligocene) Castelgomberto Calcarenite and are indicative of a tropical marine shallow water setting associated with coral reefs. The assemblage is characterized by diminutive putative cryptobenthic fishes, including a single goby (family Gobiidae) and several cardinalfishes of the subfamily Pseudmiinae (family Apogonidae. Furthermore, a new apogonine of the extinct tribe †Eoapogonini, a new butteflyfish (family Chaetodontidae), and an indeterminate viviparous brotula belonging to the ophidiiform family Dinematichthyidae, are also present, and likely represented part of the epibenthic community. Some of the taxa described herein are among the first occurrences for their respective lineages in the fossil record. The Perarolo taxa document the first Oligocene coral reef fish assemblage known to date. Four taxa are described as new: †Arconiapogon deangelii gen. et sp. n., †Chaetodon (Blumchaetodon) wattsi subgen. et sp. n., †Oligopseudamia iancurtisi gen. et sp. n., and †Oniketia akihitoi gen. et sp. n.
Scleria indica, a new species of Cyperaceae from India
Authors: Verma D. , Chandra Veena
Published: May 2022

A new species Scleria indica is described from South-West India. It is characterized by its perennial habit, unisexual spikelets, oblong hypogynous disc lobes and umbonulate scrobiculate nuts.
A note on the status of Combretum Razianum (Combretaceae)
Authors: Chakrabarty T. , Diwakar P.
Published: May 2022

Combretum razianum K.G. Bhat is reduced to a subspecies of C. pilosum Roxb. ex G. Don.
Sustentabilidade E Análise de Solvência: Um estudo de empresas selecionadas de capital aberto do setor de açúcar e álcool no Brasil
Authors: Cardoso Júnior Leuter Duarte , França Clévia Israel Faria , Zapparoli Irene Domenes , Faria Nathália Caroline
Published: May 2022

O setor sucroalcooleiro no Brasil passou a ter uma representação e dinâmica diferente nos últimos anos, visto os preços no mercado nacional e internacional baixos para o açúcar e as limitações para produção de etanol e, outro fator de relevância são custos maiores de produção. Há que se considerar que esse segmento econômico leva em consideração os padrões de sustentabilidade de produção. Neste sentido a questão problema desta pesquisa é verificar qual é a condição financeira e de solvência das companhias Biosev S/A e São Martinho para os anos de 2012 a 2014? Considerando esta questão problema, o objetivo central esta em verificar a solvência destas companhias de capital aberto. Para análise de solvência utilizou-se modelos de análise discriminante: Kanitz, Matias e Elizabetsky e, para que fosse possível utilizar os modelos coletaram-se dados por meio das demonstrações contábeis e financeiras das companhias. O principal resultado é que as companhias têm baixa liquidez e são insolventes segundo os modelos de análise discriminante utilizados.
Christianity in the Modern World: A Study of Religion in a Pluralistic Society
Authors: Kuek Sherman Y.L.
Published: May 2022

The modern world finds itself pervaded by the phenomenon of pluralism, which presents itself in many different embodiments. The thesis of this book is that the plethora of religious and ideological claims present in global society necessitates that dialogue takes place among the various stakeholders in order to emerge with a set of ethics shared globally for the purpose of mutual responsibility. To that end, dialogue aims to facilitate a peaceable co-existence between monotheistic and polytheistic religions,  various  ideologies and cultures, and religious and secular spheres of society, all of which have the potential to contribute to this global conversation and endeavour. In the final analysis, pluralism is no longer to be construed as an epistemological dilemma, but rather, an agent for the preservation and sustenance of the human societal order.
Hong Kong Protestant Theologies in the 1980s and 1990s Responding to the Handover of Hong Kong to China
Authors: WONG Ho Lun Donald
Published: May 2022

By closely studying primary theological works in Hong Kong during the 1980s and 1990s, this article argues that a uniquely local Hong Kong theology emerged during that period. This local theology developed in response to an unprecedented fear and an ambiguously hybrid identity in face of the imminent transition from British colonial rule to the Communist Chinese administration. Moreover, it was stamped by three distinct marks: first, the negotiation between two competing theological visions, the “prophetic” and the “priestly” voices; second, the shadow of liberation theology and its Asian progeny; and third, the seeds of postcolonial theory, which commanded increasing influence toward the turn of the century.
Why Interfaith Dialogue is Necessary but Dangerous: Raimon Panikkar’s Cosmotheandric Vision as a Case in Point
Authors: KUEK Sherman YL
Published: May 2022

With postcolonial sensibilities, increasing globalization, and intensifying worldwide religiosity, interfaith dialogue has become more important than ever. However, this imperative for dialogue inherently presents perils that the different approaches to dialogue hope to mitigate. The exclusivist approach seeks to assuage the danger of eroding one’s faith system, while the pluralist position seeks to allay the fear of one’s faith system unjustly dominating another. The inclusive approach, in mediating between the two seeming extremes, attempts to validate the dignity of various truth claims without pandering either to extreme rejection or to pedantic assimilation. Raimon Panikkar’s cosmotheandric pluralism, being a case in point, provokes both admiration, because of its creative synthesis, and alarm, because its consequential outcome could potentially be an unrecognizable mutation of the original worldviews it seeks to represent. The inevitable result of such endeavors is the erosion of classical theological categories.
Hermeneutic of Cultural Differentiation and Accommodation: A Biblical Paradigm of Inculturation for the Indian Church
Authors: KORADA Manoja Kumar
Published: May 2022

The relationship between Christian faith and culture continues to generate discussion. This issue is perennially relevant to the Indian church as it exists in a multicultural context. How should the Indian church practice its faith in a given culture? To what extent can its faith be enculturated? This article proposes a biblical hermeneutic of cultural accommodation and differentiation as a model for the Indian church. It examines the culture/customs of the patriarchs in the book of Genesis as a test case and argues that the narrator’s hermeneutic promotes the integration of culture with faith so long as both converge under the primacy of the latter.
READINESS FOR SELF-DIRECTED LEARNING AMONG NURSING STUDENTS IN A MEDICAL COLLEGE, CHITWAN
Authors: Singh Indu , Paudel Binita
Published: May 2022

Background: Self-directed learning is a type of instructional strategy where students take charge of their learning process. Self-directed learning is learning approach where learners are responsible towards learning which helps students think critically and perform task confidently. The skills that are learned through self-directed learning remain lifelong and helps to provide patient care in effective way and uplifting the nursing profession. This study was conducted to identify the readiness for self-directed learning among nursing students in Chitwan Medical College.

Methods: A descriptive cross-sectional study design was adopted. Sample size was 107 nursing students from Bachelor in science of nursing and Bachelor in nursing science program. They were selected by using probability, stratified, simple random technique. A standardized tool (Self Directed Learning Readiness Scale) was used to collect data. Data were analyzed by using descriptive statistics and inferential statistics.

Results: More than two-third of the nursing students were ready for self-directed learning. The mean score of self control was higher than the mean score of self-management and mean score of desire. The level of the readiness for self-directed learning was significantly associated with age (p=0.036), ethnicity (0.036) and most prefer resource (p=0.010).

Conclusions: Self-directed learning helps for self control towards their learning and enable students move forward towards their career goal. So, the faculties need to focus on the selection resources for learning that help to create desire for learning and promote self-directed learning skills among nursing students.
EMERGENCY DEPARTMENT LENGTH OF STAY AND DISPOSAL OF PATIENTS IN CHITWAN MEDICAL COLLEGE, NEPAL
Authors: Lamsal Daya Ram , Raut Krishna Bahadur , Adhikari Parash
Published: May 2022

Background: Measuring patients Length of Stay (LOS) in the emergency Department (ED) is one of the assessments of quality indicators in terms of clinical, managerial and public satisfaction pro­spective. Waiting time standard is defined and its impact is analyzed in many hospitals especially in developed countries. Policy of emergency operations to reduce length of stay helps to manage overcrowding, spares time to treat critical patient and minimize preventable death. The study was done to assess length of stay and disposal of patients visiting emergency department in Chitwan Medical College.

Methods: This was a retrospective study conducted from 01/10/2018 to 30/09/2019 at Chitwan Medical college, Nepal. Patients electronic records were retrieved from medical record section of all patients visiting to emergency department. Ethical approval was obtained from ethical review committee.

Results: Medial Length of Stay (LOS) was 3.84 hours (Interquartile range 0.4 hours to 84 hours) 54.54% discharged, 40.83% admitted from ED.

Conclusion: Median Length of Stay (LOS) in the Emergency Department (ED) was 3.84 hours which is satisfactory as compared to similar studies. Majority of patients discharged after treatment from ED.
LYMPHOEPITHELIAL CYST OF THE PAROTID IN HIV NEGATIVE INDIVIDUAL: A CASE REPORT
Authors: Amatya Paras Raj , Limbu Tilak Raj , Baral Sovit Jung , Bastakoti Shankar
Published: May 2022

Benign Lymphoepithelial cyst (BLEC) of parotid gland are more common in HIV positive patients and is rare in HIV negative individuals.  We present a 16-year-old HIV negative female who presented with a painless, gradually increasing swelling in the left parotid region. Excisional biopsy was done and HPE showed benign lymphoepithelial cysts. The rarity of this lesion in a HIV negative patient is the main reason for reporting this case.
ANATOMICAL STUDY OF DORSALIS PEDIS ARTERY
Authors: Gautam Ajeevan , Sintakala Chandan
Published: May 2022

Background: The dorsalis pedis artery is the dorsal artery of the foot. The knowledge of any variation in the course and distribution of the artery is clinically important and it is used to record peripheral pulsation. The aim of this study was to study origin, course, relation and branches of the artery. The length and diameter of surgically important branch were recorded.

Methods: An observational cross-sectional study was conducted at dissection hall of anatomy department at Chitwan medical college. Thirty lower limbs from fifteen cadavers were dissected for the study. Photographs were taken at different site of dissection and on finding anomalies. Newborn specimens and Conical enlargements if present were excluded.

Results: The diameter of the artery ranged from 3.0 to 4.6mm and its length ranged between 5.6cm to 8.4cm.The length of deep plantar artery was between 5.6cm to 8.4cm. Double lateral tarsal artery was found in (24)80% of the studied specimen and (6)20% were with single lateral tarsal artery. In 90% of the specimen medial tarsal artery originated as proximal and distal branch form medial aspect of dorsalis pedis. The arcuate artery emerged directly from dorsalis pedis artery in (100%) all studied specimen. The 2nd ,3rd and 4th metatarsal artery were placed on their corresponding intermetatarsal space.

Conclusions: Awareness of anatomical variation of vasculature of foot is important for the vascular surgeons, angiographers and reconstruction surgeons. Dorsalis pedis artery is excellent for the revascularization since it is the largest artery below the ankle joint.
LEFT VENTRICLE EJECTION FRACTION ESTIMATION BY POINT OF CARE ECHOCARDIOGRAPHY IN PATIENTS ADMITTED IN INTENSIVE CARE UNIT
Authors: Rana Suraj , Shrestha Bishow Kumar , Pant Chiranjibi , Adhikari Shital , Regmi Sudhir
Published: May 2022

Background: Point of care ultrasonography (POCUS) by non-cardiologist is a safe and rapidly evolving diagnostic modality for the assessment of left ventricular ejection fraction (LVEF). This study aims to correlate the eyeball estimation of LVEF (EBEF) with modified Simpson’s method and linear measurement in M-mode parasternal long axis view (PLAX).

Methods: A descriptive cross-sectional study was conducted at Chitwan Medical College. POCUS was performed in all ICU patients on the day of admission with optimal image acquisition and LVEF was estimated by three different methods and correlation of results were analyzed. 

Results: Out of total 52 patients studied, median age was 58.38 ± 17.58 years (range: 24 – 89 years). There were 28 males (53.8%) and 24 females (46.2%) in this study. LVEF measured by eyeballing method and modified Simpson’s method had excellent correlation (Pearson’s correlation coefficient (r) = 0.956, P<0.001). However, there was only a good correlation (r= 0.882, P<0.001) between linear measurement method in M-mode view and Simpson’s method. It was found that eyeballing method underestimates EF as measured by Simpson’s method by an average of 2.33% (95% CI: 1.12 – 3.55%).Similarly, EF measurement by linear method overestimates EF as compared to results observed by Simpson’s method by an average of 6.57% (95% CI: 4.87 – 8.27%).

Conclusions: Excellent correlation was observed between EBEF and modified Simpson’s method while linear measurements in M-mode may give incorrect estimation of EF especially in patients with regional wall motion abnormality.
FETO-MATERNAL OUTCOMES FOLLOWING LABOR INDUCTION AT A TERTIARY CARE CENTER
Authors: Pandit Upendra , Sharma Basant , Joshi Rakshya , Chaudhari Julli , Singh Prekshya , Sharma Asmita
Published: May 2022

Background: Labor induction is one of the most common Obstetrics interventions worldwide. It has got significant risks and benefits. Careful selection of cases for induction improves the feto­maternal outcomes. So, the study was designed to assess the fetomaternal outcome and factors associated with mode of delivery following the induction of labor.

Methods: It was a descriptive observational study conducted in the department of Obstetrics and Gynecology from July 17, 2018, to July 16, 2019. The study comprised of 264 mothers admitted in the labor ward subjected to labor induction as clinical management of labor and delivery. Data analyzed with chi-square test and one-way analysis of variance (ANOVA) wherever appropriate.

Results: Of 2950 deliveries, the induction rate was 8.94%. Out of them, 264 mothers undergone labor induction. A caesarean was the highly associated mode of deliveries 168(63.63%) due to in­duction failure 94(55.97%) followed by fetal distress 37(22%). The mean birth weight of neonates was 3.09±0.41 kg. Apgar score in one minute and hospital stay showed a significant difference (p-value .002), in modes of deliveries. No significant association was observed in maternal and fetal complications like PPH, endometritis, and low Apgar score <7 in five minutes. The majority of neonates admitted for observation at the care unit. The neonatal mortality was two.

Conclusions: Caesarean mode of delivery highly was associated with labor induction due to in­duction failure and fetal distress. Carefully selected cases improve morbidity and fetomaternal outcomes following labor induction.
KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING FAMILY PLANNING AMONG THE REPRODUCTIVE AGE WOMEN OF KHOPASI, KAVREPALANCHOWK
Authors: Manandhar Naresh , Amatya Isha , Gautam Arundhati , Kumar Gaurav , Ahlawat Himanshu , Adhikari Nitesh , Mahaseth Pawan Kumar
Published: May 2022

Background: Uncontrolled population growth has been a problematic issue all over the world. Knowing the women’s and their husband’s knowledge and attitude towards family planning may help to intervene so that the practice can be increased. This might ensure the right of women to have child as they wish and later reduce unwanted pregnancies and abor­tions. Hence the present study is concerned with knowledge and attitude of women towards family planning.
Methods: A cross-sectional study was conducted during 10th-15thNovember 2019 among women of reproductive age of Khopasi, Kavrepalanchowk. Structured questionnaire consisting of knowl­edge, attitude and practice regarding family planning was administered to reproductive women age.
Results: All respondents heard about the family planning methods. More than 90% of respondents knew about Norplant, Pills, Depo-Provera and condoms.60.8% respondents were currently using family planning methods. It has been observed that the respondents had positive attitude towards family planning.
Conclusions: Knowledge about family planning methods was good among the reproductive age women whereas the practice and attitude seemed satisfactory. The knowledge about emergency contraceptive and abortion were poor among the reproductive age women. One of the promising findings of the study was, the majority of respondents showed a positive attitude towards contra­ceptive use. There is need to target these population for health education interventions in order to achieve the desirable practices.
CLINICAL AND SONOHYSTEROGRAPHY EVALUATION OF INFERTILE WOMEN
Authors: Pandit Upendra , Baral Lekhnath
Published: May 2022

Background: Hysterosalpingography (HSG) is an integral part of the Conventional clinical evalu­ation of infertile women. Now a day, Sonohysterography is a modern technique widely used in the clinical evaluation. The objective of this study was to identify pelvic pathology; compare the effect and findings of tubal patency test between Sonohysterosalpingography and single film HSG radiograph.

Methods: This is a prospective evaluation of infertile women who attended the infertility unit of the gynecology department from 2017 March to 2018 October. Women 220 clients were subjected to clinical including SHSG evaluation followed by a single film HSG radiograph on the single sitting. The Chi-square test, multinomial logistic regression analysis was done using IBM SPSS statistics version 20.

Results: Women had bilateral tubal patency 181(82.2%) in SHSG and conformed the same number later by HSG. SHSG showed bilateral tubal occlusion in 33 (15%) whereas HSG conformed only in 22(10%) and block was seen in 18(8.18%) only by HSG. The pathological findings were polycystic ovaries in 33 (15%), Fibroid uterus 11 (5%), ovarian cysts 5(2%), endometrial polyps in 2 cases, en­dometriotic cyst with hydrosalpinx 8(4%). Procedural side effects were no pain in 69(31.1%), mild pain 125(56.3%), Moderate pain 21(9.5%), vasovagal symptoms 7(3.1%).

Conclusions: The outcome of the Sonohysterosalpingraphy (SHSG) test for tubal patency is sig­nificantly synergized by concurrent HSG in the same sitting. The combined test is best indicated if SHSG alone is not able to demonstrate the sign of tubal patency.
PROLAPSE RELATED KNOWLEDGE AND ATTITUDE AMONG MARRIED WOMEN OF REPRODUCTIVE AGE
Authors: Khanal Gayatri , Ghimire Prakash , Shrestha Niki , Koirala Subash
Published: May 2022

Background: Uterine Prolapse (UP) is a very common morbid condition in Nepal among women during reproductive health. Awareness on uterine prolapse can prevent huge number of UP cases. Thus, this study is designed to find out the knowledge and Attitude towards uterine prolapsed among married women of reproductive age (MWRA).

Methods: A community –based cross-sectional study was conducted in Daulichaur VDC of Ba­jhang district among 313 Married women of Reproductive age (15-49). Semi structure tool was used to collect the data. Data collection was done from March 2016 to April 2016. Data was col­lected through face to face interview by using interview schedule. Descriptive (frequency and percentage), (Chi-square, Pearson correlation) analysis were used for data analysis.

Results: This study revealed that almost three fourth (70%) of respondents had low level of knowl­edge and only 17.6% had positive attitude regarding uterine prolapse. The level of knowledge was associated with age, occupation status and educational status. The level of attitude was associ­ated with age, educational status and occupational status. There was significant positive relation­ship between level of knowledge and attitude (r= 0.363, p < 0.001).

Conclusions: MWRA of the Daulichaur VDC had low level of knowledge and Positive attitude re­garding uterine prolapse. The findings of this study suggest that there is an urgent need to educate and create awareness regarding UP to promote the health status of MWRA.
CONSUMPTION OF SMOKELESS TOBACCO AND ARECA NUT AMONG ADOLESCENTS OF BHAKTAPUR, NEPAL
Authors: Joshi Ujjwal , Pradhan Megha , Dahal Sirjana , Tyagi Krishan Kumar
Published: May 2022

Background: Smokeless tobacco use is prevalent in Nepal, and various Smokeless tobacco products are widely available in the country. Areca nut chewing habit is common in Nepal especially in the Terai region adjoining India. This study was aimed to assess the Smokeless Tobacco use and betel nut chewing among adolescents of Bhaktapur and to assess their knowledge about Oral Submucous Fibrosis (OSMF).

Methods: Cross-sectional study was performed among adolescents (age group 10-18) years studying in high schools and colleges in Bhaktapur. Random sampling methods was carried out to select 400 adolescents after taking written consent for questionnaire. Descriptive statistical analysis was done using SPSS version 16.

Results: Among 400 adolescents, only 24 (6%) admitted to using smokeless tobacco and tobacco based products. One hundred sixty-two (40.5%) participants had experienced betel nut chewing where the most common form was betel nut alone. Sixty one (37.8%) of them had tried at special traditional functions. OSMF was never heard before among 392 (98%) of participants.

Conclusions: Smokeless tobacco usage was seen to be less among the participants but areca nut chewing was comparatively high. Traditional functions and predominant usage of betel nut chewing at home emphasizes the need for awareness of harmful effect of betel nut chewing in any forms to be reinforced at one’s home and community. Knowledge about OSMF was seen to be scanty in the adolescents.
OVER THE COUNTER DRUGS: AWARENESS AND PRACTICE AMONG THE ADULTS OF MUSHAHAR COMMUNITY
Authors: Mahato Sanam , Bajracharya Shanti
Published: May 2022

Background: Over-the-counter drugs are the medicines that are sold without prescription of med­ical person. Though over-the-counter drugs are believed to be relatively safe, their inappropriate use could have serious implications. The aim of the study was to assess the awareness and practice on over-the-counter drugs among the Mushahar adults of Nawalparasi district, Nepal.

Methods: A descriptive cross-sectional study was conducted among 102 respondents. Non-proba­bility purposive sampling technique was used to select the sample using semi-structured question­naire. Data was collected through face to face exit interview. Descriptive statistics and inferential statistics were used for analyzing the data.

Results: Majority (91.2%) of the respondents knew that over-the-counter drugs are the unpre­scribed drugs by medical person and majority (95.1%) of the respondents used in case of fever and 83.3% of the respondents used because of easy accessibility More than half (52.9%) of the respondents had practiced over-the-counter drugs at least once within the first six months of data collection. The most preferred over-the-counter drugs were analgesics i.e 44.4%. On analyzing, there found a strong association between awareness level on demographic variables of educa­tional status and occupation with the consumption of over-the-counter drugs as p value was <0.05.

Conclusions: Study revealed that people use over-the-counter drugs because of easily availability and the most commonly used drugs were analgesics. So, different awareness programmes to the community and timely monitoring and intervention from the government is needed to prevent the rampant of over the counter drugs.
FEMALE AUTONOMY AND FERTILITY PATTERN AMONG WOMEN WORKING IN FORMAL SECTOR IN KATHMANDU VALLEY
Authors: Singh Neeti , Pandey Srijana , Sherpa Ang Tshering , Tamrakar Nijina , Chitrakar Sunil
Published: May 2022

Background: Fertility rate is declining more among women with higher education around the world. This may be due to number of years spent for achieving higher degree, choice of work and age at marriage. With growing autonomy of urban women and late age at marriage increases high risk pregnancy and declines number of children leading to decrease in young population. So, this study was done to explore the fertility pattern and associated factors among working women at formal sectors.

Methods: An observational study was done among women working at formal sectors within Kath­mandu valley. A respondent driven sampling was used to achieve total 101 sample size. The study period was October and November 2019.

Results: Median age of the participants was 40 and median age at marriage was 26.62 years. The association between level of education and age at marriage was statistically significant. The median age of pregnancy of the participants were 27 years and 58.4% of women had only one live child. Average number of desired children was 1.69 whereas actual number of children was 1.32. The gap between desired and number of children is statistically significant. Only 35.6% reported to have used some form of contraceptive devices as the measure of family planning.

Conclusions: Fertility behavior of working women is not completely influenced by their working status except for higher age at marriage, pregnancy and desired number of children which in long term may affect in the growth of country.
CLINICAL OUTCOME OF OPERATIVE TREATMENT IN 18 CASES OF GIANT CELL TUMORS OF BONES
Authors: Pandey Suresh
Published: May 2022

Background: Giant Cell Tumor of the bone (GCTB) has got variable outcome after the different methods of surgical treatment depending upon the site and grade of lesion and extent of tumor removal. This retrospective prospective analysis of operatively treated cases of GCTB of different sites aimed to highlight the clinical outcome.

Methods: This was a prospective observational study of 18 cases of GCTB; proximal tibia (n=6), distal femur (n=5), distal radius (n=4), proximal femur (n=1), proximal fibula (n=1) and anterior arc of first rib (n=1) treated with different operative management with mean follow up of 53.61 months. Functional outcome with Musculoskeletal Tumor Society Score (MSTS), recurrence and complications were analyzed with at least 24 months of follow up.

Results: There were 10 females and 8 males with average age at presentation 27.3 years (range 15-38). Average duration of symptom was 4.72 months. 2 were cases of recurrence previously op­erated and 16 were de novo cases. Mean MSTS was 84.27% with good to excellent result in 88%. There were no non-union, graft failure, metastasis, prosthetic failure or wound infection till at least 24 months of follow up in any of the cases.

Conclusions: Extended curettage or reconstruction with auto graft in grade I and II tumor or en­doprosthesis in higher grade or recurrence of GCTB can give good to excellent functional result in majority of the cases.
REGENERATION IN PERMANENT IMMATURE NECROTIC TOOTH –A CASE REPORT
Authors: Shubham Snigdha , Nepal Manisha
Published: May 2022

Immature necrotic teeth pose a challenge to endodontist. To simplify this challenge regenerative endodontic has gained popularity these days. This approach is based on triggering stem cells and repopulate over scaffold to induce regeneration of pulp like tissue. This case report presents a case of regeneration of apical tissue with significant healing of periapical lesion.
COMPOUND ODONTOMA WITH UNUSUSAL NUMBER OF DENTICLES- A CASE REPORT
Authors: Singh Vivek , Singh Jasmeet
Published: May 2022

The term odontoma refers to hamartomatous lesions (malformations) rather than true neoplasms. They are the most common odontogenic tumour of jaws. They are slow growing in nature. Miss­ing permanent tooth or retained deciduous tooth brings the patient to the clinician usually dur­ing second decade of life. Two types of odontomas has been described: complex and compound. The compound type is more common and frequently found in the anterior maxilla. A 15-year-old male patient reported to department Oral and Maxillofacial Surgery, with missing permanent right central and lateral incisor with retained deciduous in place. Intraoral radiographs were done and multiple small denticles were seen. A total of 39 denticles of various sizes were enucleated from the lesion making this case very unusual.
EVALUATION OF TUTOR PERFORMANCE IN PROBLEM BASED LEARNING: RATING THE SKILL ON STUDENTS PERSPECTIVE
Authors: Yadav Renu , Mukhopadhyay Soumitra , Yadav Subodh Kumar
Published: May 2022

Background: The Problem based learning (PBL) was developed at McMaster University School of Medicine in Canada in the 1960s. It has become today’s most accepted method of teaching and learning activities in the field of medicine. A skilled and well-trained tutor plays major role in PBL. Present study is aimed to evaluate tutor performance on student’s perspective based on questionnaire.
Methods: This questionnaire-based study was conducted with MBBS I (n=100) and II (n=100) year students of Nobel Medical College and Teaching Hospital. Tutors performance evaluation form was prepared provided with nine question items and the responses were limited to likert scale (1=strongly disagree, 2=disagree, 3=uncertain, 4=agree and 5=strongly agree). Students were in­structed to give their opinion and total percentage score along with mean score of every question items were obtained. Then, mean score of each questions were compared between both MBBS batches.
Results: Performance of tutors in problem-based learning sessions were analyzed which were ob­tained as Likert scale score; the percentage score 4 (agree, MBBS I= 52.11 %, MBBS II=53.55 %) followed by 5 (strongly agree, MBBS I=20.77 %, MBBS II= 32.22 %). Mean score obtained for each question items were compared between MBBS I and II year which significantly vary though the majority of scores were 4 (agree) and 5(strongly agree).
Conclusions: Satisfactory tutor performance was procured on evaluating the tutor for their skill in PBL as facilitator based on student’s opinion.
SATISFACTION ON CLINICAL LEARNING ENVIRONMENT AMONG NURSING STUDENTS OF SELECTED MEDICAL COLLEGES OF CHITWAN, NEPAL
Authors: Dhakal Prativa , Thapa Taniya
Published: May 2022

Background: Clinical learning environment includes everything that surrounds students and is extremely beneficial in stimulating their critical thinking and affects their professional development via focus on clinical judgment and decision–making in the clinical setting. This study aims to assess the level of satisfaction on clinical learning environment among nursing students of selected medical colleges of Chitwan, Nepal.
Methods: Descriptive, cross sectional study design was used to assess the satisfaction on clinical learning environment among nursing students of selected medical colleges of Chitwan. Standard tool (CLES + T scale) was administered among 242 nursing students. Data was entered in IBM Statistical Package for Social Science (SPSS) version 20.0 and was further analyzed by using descriptive statistics and inferential statistics.
Results: Just more than half of the nursing students were highly satisfied (51.2%) with the clinical learning environment. The level of satisfaction among nursing students was found statistically significant with year of study and type of ward of latest clinical placement with p value
<0.05. Conclusions: Nearly half of the students are still not highly satisfied towards their clinical learning environment, therefore improvement in its quality needs proper planning, implementation and supervision that too in government hospital settings. >
Conclusions: Nearly half of the students are still not highly satisfied towards their clinical learning environment, therefore improvement in its quality needs proper planning, implementation and supervision that too in government hospital settings.
ISCHEMIA MODIFIED ALBUMIN AMONG TYPE 2 DIABETIC PATIENTS VISITING A TERTIARY CARE CENTER OF KATHMANDU
Authors: Thapa Sangita , Rayamajhi Rabindra , Gautam Surakshya , Dahal Sirjana
Published: May 2022

Background: Chronic hyperglycemia in diabetes may increase oxidative stress causing ischemia and long-term complications of diabetes. It may also alter albumin, increasing the concentration of serum ischemia modified albumin. The present study was conducted to estimate serum isch­emia modified albumin level and to assess its relationship with parameters of glycemic control in diabetic patients.
Methods: In this study, 130 type 2 diabetic patients were enrolled and blood samples were ana­lyzed for ischemia modified albumin, glycated hemoglobin, fasting and postprandial blood glu­cose. Parameters of glycemic control were estimated using routine standard methods and serum ischemia modified albumin was measured manually by spectrophotometric cobalt-albumin bind­ing assay. Participants with glycated hemoglobin level less than 7% were labeled as group 1 and participants with glycated hemoglobin value more than or equal to 7% were labeled as group 2.
Results: Group 2 participants had significantly higher mean serum ischemia modified albumin as compared to group 1 (p<0.001). There was significant positive correlation between ischemia modi­fied albumin and parameters of glycemic control; glycated hemoglobin (r=0.300, p=0.001), fasting blood glucose (r=0.239, p=0.006), postprandial blood glucose (r=0.318, p<0.001). However the relationship of ischemia modified albumin with age, body mass index and duration of diabetes were statistically insignificant.
Conclusions: The present study shows increase in serum ischemia modified albumin with increase in all three glycemic parameters. This finding suggests that ischemia modified albumin can be used as a marker of hyperglycemia induced oxidative stress in diabetes.
PRACTICE REGARDING CARE OF ENDOTRACHEAL TUBE AMONG NURSES WORKING IN TEACHING HOSPITAL, BHARATPUR
Authors: Adhikari Kanchan Mijar , Subba Hem Kumari
Published: May 2022

Background: Endotracheal intubation is a most common procedure to maintain oxygenation and ventilation among the patients who admitted to critical care unit. So, meticulous care is necessary to maintain airway patency and prevent from complications. The objective of the study was to assess the practice regarding care of endotracheal tube among nurses working at teaching hospital, Bharatpur.
Methods: A descriptive, cross- sectional study was conducted among 56 nurses working in critical care units of a teaching hospital, Chitwan. Sample was selected by using non probability, consecu­tive sampling technique. Data were collected through structured self-administered questionnaire to measure the socio-demographic and professional related information and observation checklist was used to measure the practice regarding care of endotracheal tube. Data were analyzed using descriptive and inferential statistics to find out the association between variables.
Results: Majority (89.3%) of the nurses were above 20 years old, 71.4% of them were completed Proficiency Certificate Level, 60.7% had work experience of equal and less than one year in critical care unit and all of them participated in in-service education. Among 56 nurses, 57.1% had satis­factory level of practice regarding care of endotracheal tube. Nurses had highest mean practice score (79.55%) on suctioning and lowest score (19.22%) on cuff pressure management.
Conclusions: It is concluded that nurses had marginally satisfactory level of practice regarding care of endotracheal tube. Hence, there is need to provide regular training for nurses regarding patient’s care with endotracheal tube.
PURTSCHER’S RETINOPATHY: A CASE REPORT
Authors: Chaudhary Sushma , Gupta Sharad , Yadav Reena , Kamble Vinit Kumar , Shrestha Satbodh
Published: May 2022

Purtscher’s retinopathy is a rare haemorrhagic and vaso-occlusive vasculopathy following severe head trauma associated with sudden blindness. Here we report a case of 28 years old male pre­sented to out-patient department with history of sudden and painless loss of vision in his right eye for two days. He gave history of head injury following bike accident. At the time of presentation his best corrected visual acuity was 1/60 in the right eye and 6/6 in the left eye. On examina­tion, anterior segments of both eyes were normal. On fundus examination, right eye revealed retinal whitening in the peripapillary region (Purtscher’s flecken), an intraretinal hemorrhage and signs of macular edema whereas left eye was unremarkable. Findings were suggestive of right eye purtscher’s retinopathy. Optical coherence tomography and fundus fluorescence angiography was done to support the diagnosis. Purtscher’s retinopathy should not be neglected because it is associated with different systemic disease. Its pathophysiology remains unclear and there is no definite treatment but meticulous management is urgent to prevent from severe complications.