bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Odor Score and Hunter Laboratory Color Values on Broiler Meat under Different Packaging and Frozen Storage Temperature
Authors: SIVAKUMAR P.
Published: July 2024

This study was conducted about the effect of odor score and Hunter laboratory color values in broiler meat under different packaging and frozen storage temperatures. The overall storage period odor scores of frozen samples in the 1st and 12th months were 4.00 and 3.89, showing no difference among them. The overall packaging odor score for the aerobic and vacuum-stored meat samples exhibited a significant difference (P < 0.01) among them. The overall storage temperature odor score found a significant difference (P < 0.01) among them till 1 year. The fresh broiler samples had a similar L (lightness) value of 34.92 and the overall storage period exhibited a significant variation (P < 0.01) among them and the variables such as overall packaging and temperature range had no influence among the samples. The fresh broiler meat samples had a uniform value of 5.58 and the overall mean value for the stored meat samples exhibited a significant difference (P < 0.01) and appeared to be a strong variation in the a (redness) value of the samples and after 8 months the a value showed a decreasing trend till 12 months and either aerobic or vacuum packaging had no influence. However, the overall storage temperature range (-12?C, -18?C, and -24?C) were 5.02, 4.98, and 5.09 and observed a significant difference (P < 0.01) among the samples. The overall storage period mean and overall packaging mean b value of meat samples, exhibited a significant difference (P < 0.01). Therefore, the aerobic and vacuum packaging of frozen meat samples influenced the b value till 12 months of storage. The overall storage temperature mean b value for the temperature range (-12?C, -18?C, and -24?C), noticed a significant difference (P < 0.01) among the samples. . KEYWORDS :Broiler meat, Odor score and hunter laboratory color values, Storage studies
Operations and Supply Chain Management
Authors: Sajja Dr. Guna Sekhar ,   Department of Information Technology University of the Cumberland's Williamsburg, KY, USA, Addula Mr. Santosh Reddy ,   Department of Information Technology University of the Cumberland's Williamsburg, KY, USA
Published: July 2024

Everyone from students to professors to working people has relied on Operations and Supply Chain Management. Building on its successful history, this authoritative handbook maintains its commitment to teaching students a comprehensive knowledge of supply chain and operations fundamentals in the hopes of producing outstanding leaders in the future. Students and working professionals alike will benefit from the writers’ state-of-the-art insights and best practices presented in this interesting and thorough textbook, which has been updated for the most recent edition.
Anxiety in medical students: relationship with examination
Authors: Gajurel Bikram P , Pokharel Anupam , Ojha Saroj P. , Koirala Nabaraj
Published: July 2024

High level of anxiety has been reported to impair academic performance of the students. Present study aims at measuring the level of anxiety in medical students before and after their annual examinations. Students of a single batch of MBBS programme were included in the study. Anxiety scores were rated using Zung Anxiety Rating Scale. Mean pre-examination anxiety score was 32.16±8.12, whereas postexamination scores was 27.00±6.64. The difference was statistically significant (t=2.424,p<0.05). The effects of high level of anxiety in the level of performance need to bestudied.
Cardiac resynchronization therapy in Congestive Heart Failure – a review
Authors: Jha Sunil Chandra
Published: July 2024

Congestive Heart Failure (CHF) incidence is increasing in contrast to incidence of coronary heart disease. Since 1992 cardiac pacing was introduced to treat heartfailure. Improved modes of biventricular pacing created a milestone in treatment ofCHF. Interventricular conduction delays (IVCD) are associated with adverse mechanical conditions and put CHF patients at a significant mechanical disadvantage.Apex to base contraction sequence is noted in CHF patients with IVCD. Atrialsynchronized biventricular pacing or cardiac resynchronization therapy restores the base to apex contraction sequence and is shown to improve left ventricular systolic function and resersal of left ventricular remodelling. Hence, there is a promising electrical arm of therapy for CHF patients.
Nursing in the new millenium
Authors: Shakya Nandika
Published: July 2024

This article addresses the fast changing trends in nursing education and practice in Nepal, which is the result of economic situation of the country, the changing technology and demography, and the knowledge explosion. The shifting nursing paradigm of the world also is considered here in order to run educational and health care institution effectively in the modern world. The WHO Expert Committee's advice on innovative curriculum planning and adapting teaching and learning methodology are some important facts stated here for shaping the profession according to the need of the society. The changing trends in nursing curriculum, and the strategies essential to undertake before reviewing nursing curriculum are pointed out to guide the nurse practitioners as well as the educationists
Acinetobacter spc. : A major isolates of nosocomial infection’s – clinical significance and antimicrobial susceptibility.
Authors: Ghimire G. , MAGAR J.K.G , Bhattacharya S. , Mahapatra T.M.
Published: July 2024

Acinetobacter spp. is ubiquitous, aerobic gram-negative coccobacilli that are now emerging as an important nosocomial pathogen. In our study over a period of one year (January 2002- December 2002) at BPKIHS, a tertiary care hospital, from a total no. of 1089 isolates from pus/ aspirates of ICU, Burns, Orthopedic and other post operative wards, 146 isolates (13.4%) were Acinetobacter spp. Out of 146, 23 isolates of Acinetobacter spp. were sensitive to base line drugs. Remaining 123 strains ofAcinetobacterspp. were resistant to Cefotaxime (99.2%), Ceftazidime (98.4%), Tobramicin (95.9%), Amikacin (96.7%), Netilmicin (89.43%), Ciprofloxacin (96.7%). Apart from these antibiotics none ofthe strains were sensitive to Piperacillin
Study of sella turcica with associated anomalies in the human skulls
Authors: Bilodi A. K. S.
Published: July 2024

This present study was done on 150 normal dry human skills obtained from the 1st Year M.B.B.S.students of Sri Devraj Urs Medical college, Tamaka, Kolar, Karnataka. In thirteen out of one hundredand fifty skulls showed interclinoid bar of bone with carotico clinoid foramen. In nine skulls theywere seen on both sides (69.23%) while in four skulls they were only on one side (30.76%). One skullshowed complete ossified horizontal bar of bone connecting all the three clinoid processes (7.69%)which is of rare variety that made us interested to study these skulls.
Severe cutaneous adverse reactions: an evidence based approach
Authors: Shrestha D.P. , Gurung D , Kumar A.
Published: July 2024

Background: Severe cutaneous adverse reactions (SCAR), comprising mainly Stevens-Johnsonsyndrome (SJS) and Toxic Epidermal Necrolysis (TEN), although rare, constitute a severe entity withlife-threatening consequences. The aetiology is multifactorial but drugs have been implicated in themajority of cases. Depending on the severity of the reaction, it has a wide spectrum of clinicalpresentations and there is still confusion regarding its classification. Reliable information on theincidence of drug reactions has been difficult to obtain due to lack of standardised systems for datacollection and reporting. The situation is poorer in developing countries where specificepidemiological studies have not been published, largely due to the lack of a reporting system andawareness of drug reaction patterns among medical professionals and patients alike.
Method: We have reviewed available literature regarding SJS and TEN, and the hospital admissionrecords of such patients at Tribhuvan University teaching hospital. A comparative study was done.
Results: Drugs, mainly sulfonamides and anticonvulsants have been the aetiological factors inmajority of the cases, and the presentation in the patients have ranged from mild to fatal reactions. Inthe TU teaching hospital, in almost all cases, steroids have been used in the management.
Conclusion:Though a self-limiting disorder, patients with SCAR have a multisystem involvement,and a multi-disciplinary approach is necessary for its management. The need for intensive supportivecare and the controversial role of steroids makes its management even more challenging. Thus, it isessential to develop a protocol/guidelines for the management of these disorders appropriate to ourcontext.
A human case of Hymenolepis diminuta infection in Nepal
Authors: Kunwar C.B. , Subba B. , Shrestha M. , Chapagain R.H. , Jha B. , Subedi J. , Blangero J , Williams Blangero S. , Towne B.
Published: July 2024

A case of Hymenolepis diminuta infecton in human is reported. The patient was an 18 year old Nepalese female with an array of gastrointestinal symptoms. She was successfully treated with niclosamide. This report, for the first time; of H. diminuta in Jiri area confirms the possible distribution of this species in Nepal.
Leading causes of mortality from diseases and injury in Nepal: a report from national census sample survey
Authors: Sharma G.K.
Published: July 2024

Background: The burden of injuries in relation to other diseases has been inadequately addressed in most of the official publications and scientific literature relating to Nepal.
Objectives: In the current constraint of poor availability of such information, National Census Sample Survey information was utilized to understand the mortality pattern of major forms of injuries in relation to all diseases.
Methods: A nationally representative sample was drawn from six districts and 52 municipalities as a part of national census sample survey. The instrument included respondent-reported deaths in the family, the cause of death, the age and sex.
Results: The national representative information on the pattern of diseases shows that there were7,010 deaths as a result of the external causes of injuries (4,803 males and 2,207 females) in a period of one year prior to the survey in 2001. Suicides, transport related accidents and other accidents accounted for the largest proportion of injuries. Other accidents ranked sixth, suicide 9th and transport accidents 10th leading cause of death for both sexes and all diseases.
Conclusion: Injuries accounted for as many number of death as tuberculosis and many times more than malaria or HIV/AIDS in Nepal. External causes of injuries are therefore a major burden of mortality and morbidity in an impoverished country like Nepal and needs an urgent public health attention.
Suicidal symptoms among elderly patients attending out- patient department of Tribhuvan University Teaching Hospital
Authors: Khattri J.B.K. , Nepal M K
Published: July 2024

Background: Despite the fact that suicide and its prevention continues to be a priority area for health care, suicide in the elderly remains a neglected subject receiving little interest and research attention. Suicide rates increase with age and are very high among those 65 years and older and is the major public health problem. The aim of the study is to estimate the prevalence of suicidal symptoms among geriatric patients attending outpatient departments of Tribhuvan University Teaching Hospital in Nepal.
Methods: A study group of 100 elderly patients aged 65 years and above were randomly selected from the psychiatry, medicine and general practice outpatient departments of Tribhuvan University Teaching Hospital. The symptoms of the patients were recorded carefully according to the suicidal symptoms of Hamilton Depression Rating Scale (HDRS).
Results: Sixteen percent of the samples were found to experience suicidal symptoms, out of which three percents were found to attempted suicide.
Conclusions: The results show very high rates of suicidal symptoms among the elderly population attending the outpatient departments. The early detection of suicidal feelings could lower the rates of suicide attempts among the elderly in the Nepalese population. It also calls for the need to strengthen the consultation psychiatry service for early intervention in the patients with suicide.
Fixed drug eruption due to co-trimoxazole: a case report
Authors: Dwari B.C , Bajracharya S , Gupta S. , Mishra P. , Palaian S. , Alam K. , Palaian S. , Prabhu M.
Published: July 2024

Background: Cotrimoxazole is a synergistic fixed dose combination of sulfamethoxazole and trimethoprim used in treatment of several infections including urinary, respiratory, gastrointestinal tract infections. Because of its wide spectrum and low cost it is one of the most preferred antimicrobial in Nepal. Fixed drug eruptions (FDEs) are drug rashes which tend to occur at the same site in the particular patient each time when an offending drug is administered. Co-trimoxazole is a drug commonly implicated for causing FDEs.
Case report: We report a case of FDE due to co-trimoxazole occurred in a patient for whom it was prescribed by a local practitioner without taking adequate medication history. We also carried out the causality, severity, preventability and predictability as well as the economic impact of the associated adverse drug reaction (ADR). The report suggests that before prescribing any drug, clinicians should take appropriate medication history and upon occurrence of any ADR the patient should be counseled and instructed to communicate with the clinicians wherever they attend for the next time.
Defensible record keeping
Authors: Rayamajhi P. , Guragain R.P.S
Published: July 2024

Background: This retrospective study was conducted by the department of ENT and Head & Neck Surgery, TU Teaching Hospital to evaluate the maintainance of records of the inpatients in TU Teaching Hospital. The rolling audit was performed to evaluate the implementation of the recommendations made.
Material and Methods: Total of twenty files from each of the eight departments with the inpatient wards was reviewed retrospectively on January 2004. Similarly, other twenty files from each department were studied for the rolling audit on October 2006. The notes were reviewed for completeness and inclusion of the criteria as laid down in the protocol by the Royal College of Surgeon.
Results: The admission notes were adequately filled in the department of Psychiatry. The progress notes were adequately filled in the department of Psychiatry and ENT-HNS. The investigation form filling was comparable in all the departments. The discharge summaries were complete and understandable in the department of Psychiatry followed by ENT-HNS. Significant improvement was seen in the department of Obstetrics and Gynecology during the rolling audit.
Conclusion: The rolling audit can be done every 6 month to assess the maintainance of the records and the implementation of the recommendations.
Student participants’ perception about Medical quiz at the Manipal College of Medical Sciences, Pokhara, Nepal
Authors: Shankar P.R. , Sen P.K. , Dawka S. , Barthakur R.
Published: July 2024

Background: Quiz has been used as an active learning strategy in medical schools. The Manipal College of Medical Sciences, Pokhara, Nepal admits students from Nepal, India, Sri-Lanka and other countries for the undergraduate medical course. A medical quiz program (called Mediquiz) has been organized at the medical school for the last four years. The present study was carried out to obtain information on the student perceptions towards Mediquiz and note the association, if any, of the perception with respondent characteristics.
Materials and Methods: The study was carried out during March 2006 using a semi-structured questionnaire. Demographic information was collected. Student attitudes towards Mediquiz were studied by noting their degree of agreement with a set of twelve statements. The median total scores were compared among different subgroups of respondents using appropriate non-parametric tests (p<0.05).
Results: Seventy-one of the 80 students (88.7%) participating in the quiz preliminaries completed the questionnaire. Thirty-nine respondents (54.9%) were Nepalese and 29 (40.8%) were Indians; 47 respondents (66.2%) were male. The median total score was 41 (maximum score 60) and was higher among the Nepalese. Text books, multiple choice question books, journals and the internet were used for preparation.
Conclusions: The student opinion was positive and Mediquiz was an enjoyable active learning experience. The respondents felt that there was an unfair advantage for the fourth and ninth semester students. The quiz should be conducted more frequently and improvements to make it more informative and enjoyable can be considered.
Age related study of serum lipid peroxidation and antioxidant status
Authors: Adak M. , Nazri S.
Published: July 2024

Background: Ageing is a common phenomenan throughout the globe which is characterized by an impaired ability to maintain homeostasis under the condition of physiological stress. Some parameters in serum like malondialdehyde(MDA) , â-carotene, vita-E etc. are useful marker for chronological ageing. To validate the usefulness of the above parameters as an indicators for chronological ageing in Indian subjects.
Materials and Methods: Blood samples were randomly collected from healthy 50 male and 50 female volunteers ranging in age 20-70 years who were coming for routine checkup to OPD in IGIMS, Patna. Fasting blood sample (10 ml) was collected from each individual for estimation of fasting blood sugar(FBS), malondialdehyde(MDA), Vita-E and â-carotene.
Results: Serum MDA levels of these subjects were increased and lowering trend was observed in women. However, Vita-E levels were marginally decreased with age but no significant change in FBS levels were observed. An interesting observation was seen in â–carotene levels decreases markedly after attending the age of 40 years and the lowering tendency remain 70 years of age.
Conclusion: A significant increased levels of MDA and decreased levels of â-carotene were useful marker for the study of chronological ageing in Indian subjects.
Bacteriological profile of patients with infective endocarditis
Authors: Kandel N.P. , Banyal S.R. , Koirala B. , KC M.B. , Shrestha S.
Published: July 2024

Introduction: The term infective endocarditis (IE) denotes infection of the endothelial surface of the heart and implies the physical presence of microorganisms in lesions. Although the heart valves are commonly affected the disease may also occur within the septal defects or in the mural endocarditis1 .IE is uncommon disease but it is fatal in untreated cases. This study was carried out in Shahid Gangalal National Heart Centre (SGNHC), Bansbari, Kathmandu during 30 October 2003 to 30 June 2004 among 34 patients diagnosed as definite cases of IE.
Materials and Methods: Blood culture for bacteria & antibiotic sensitivity tests were performed for each patient using standard microbiological protocol in Laboratory of SANHC. Echocardiography was done for each patient to confirm the case of IE. Questionnaires were fulfilled to get additional informations regarding the patients.
Results: We found positive blood culture in 14 (41.12%) out of 34. The frequency of isolated organisms were Viridans streptococci in 6 (42.85%) cases, Staphylococcus aureus in 3 (21.43%) cases, Pseudomonas aeruginosa in 2 (14.28%) case and Coagulase negative and Staphylococci (CONS) in 3 (24.41%) cases among positive blood culture. All Gram positive bacteria were susceptible penicillin, gentamicin, cephotaxime, ceftriaxone, vancomycin and ciprofloxacin. Only less than 50% of Gram positive bacteria were susceptible to Amoxicillin, Ampicillin, Erythromycin and Cotrimoxazole. All Gram negative bacteria were susceptible to Ciprofloxacin, Tetracycline, Cotrimoxazole and Cephotaxime. Only 50% of Gram negative bacteria were susceptible to Gentamicin. Ampicillin and Amoxicillin were found to be resistant with all Gram negative bacteria. Echocardiography records revealed vegetation in 27 (79.42%) cases of whom blood culture was positive in 12 (44.44%).
Conclusion: Blood culture and echocardiography are very useful for diagnosis and treatment of cases of IE.
A clinical review of three case vignettes
Authors: Kishore P.V. , Palaian S. , Mishra P.
Published: July 2024

Poisoning is a common problem worldwide. Among the various poisonings, rat poison accounts for a significant number of cases. The common rat poisons are anticoagulant containing (superwarfarins) and phosphide containing. In case of superwarafin poisoning, the major symptom is increased prothrombin time and the management is directed towards coagulation. In case of phosphide containing, the symptoms are non-specific and the patient should be managed symptomatically. We present three case vignettes of rat poisoning cases treated at our hospital. Since rat poisoning is a common problem, the hospitals should also develop standard treatment guidelines regarding the management of rat poisoning. One should also make the differential diagnosis of the poisoning based on the type of rat poison prior to the management.
Use of ondansetron to prevent postspinal morphine induced vomiting
Authors: Sharma N.R. , Shrestha P.
Published: July 2024

Background: The use of Ondansetron, a selective serotonin type 3 (5-hydroxytryptamine [5-HT3] antagonists has been used to prevent postspinal morphine induced vomiting in post-surgical cases. Besides this it has been widely used for the prevention of vomiting induced by chemotherapy postanaesthesia and radiotherapy.
Methods: A prospective study was carried out for the use of ondansterone to prevent morphine induced post spinal vomiting in vaginal hysterectomy cases at Gaur, Mahottari district in eastern part of Nepal from 02 - 12 - 2006 to 09- 12- 2006. A total of 100 cases were taken in the study.
Result: Among the 100 cases of postspinal morphine 15 case (15%) found to have episodes of vomiting,5% cases reported mild pruritus and 10% had complains of pain, but even a single case did not have respiratory depression.
Conclusion: Use of Ondansetron can decrease the incidence of nausea and vomiting produced by intrathecal morphine however many studies have revealed no significant difference between the placebo group.
Urine culture pattern in Norvic International Hospital
Authors: Jha R. , Sijapati K. , Pant A.D.
Published: July 2024

Background: Urinary tract infections are responsible for considerable morbidity particularly in sexually active women. The aim of this study was to study the distribution of age and sex for significant growths isolated in urine specimens, the microorganisms associated and their sensitivity pattern to antibiotics
Methods: Data on age, sex, organism isolated and sensitivity pattern was collected for all (total 103) culture positive urine samples sent between Baisakh 2064 to Bhadra 2064.
Results: Majority of patients were females and most were between 20-39 years of age. E. coli was the most common organism isolated ( 81.6%) followed by Proteus (16.5%). E coli showed sensitivity to cefotaxime, ceftriaxone and cefexime in most cases.
Conclusion: Females in sexually active age group show significant bacterial growth in urine more frequently than males . E coli are the commonest pathogen isolated.
Sickle cell anemia complicated by Hepatitis E infection in pregnancy
Authors: Amatya A. , Choudhary R. , Zeher S. , Gurung G. , Rana A.
Published: July 2024

Case report: The hemoglobinopathies are a heterogeneous group of single-gene disorders that include the structural hemoglobin variants and the thalassemias. We present a rare case of sickle cell anemia in pregnancy in a young lady who was investigated in the line of jaundice due to hemolytic anemia (suspicion of hemolytic crisis) and associated with Hepatitis E IgM positivity who eventually had a fruitful pregnancy outcome with least maternal and neonatal morbidity.
Giant retroperitoneal lipoma
Authors: Kansakar P. , Ghimire B. , Rajbhandary A. , K.C. H. , Singh Y.P. , Vaidya P.
Published: July 2024

Case report: This is a case report of a retroperitoneal lipoma.The patient was admitted with complaints of abdominal distention and early satiety. Contrast enhanced CT scan of abdomen showed a large mass of fat density arising from the retroperitoneum measuring 30 x 25 x 20cm displacing the left kidney towards the midline and anteriorly. Fat plane was maintained with surrounding structures. The patient underwent exploratory laparotomy and the lipoma was excised. The lesion measured 30 x 20 cm and weighed 5.1 kgs. Since the left kidney was displaced anteriorly and towards the midline, nephropexy was performed. Histopathology revealed benign lipoma. Post operative period was uneventful.
Pyoderma gangrenosum in childhood
Authors: Kumar A. , Gurung D. , Pokharel D.B. , Budal K.P. , Jha A. , Parajuli S.
Published: July 2024

Pyoderma gangrenosum is a rare painful, necrolytic skin ulcer with an irregular undermined border. It is a part of the spectrum of neutrophilic dermatoses. We report a case of pyoderma gangrenosum in a twelve year old boy. The findings reported in the literature are also discussed.
Immune thrombocytopenic purpuera in pregnant women
Authors: Rawal S. , Sigdel M.R , Singh M. , Baral J.
Published: July 2024

Case report: Immune Thrombocytopenic Purpuera (ITP) is the commonest autoimmune disorder occurring in pregnancy. This is a case of asymptomatic ITP diagnosed in a 21 years primigravida by doing platelet count during routine antenatal investigation at 27th week, who remained refractory to treatment with steroid and platelet transfusion, had to undergo emergency LSCS for low lying placenta, but both the intrapartum and the postpartum period remained uneventful. The baby was assumed to have neonatal alloimmune thrombocytopenia (NAIT) due to low platelet count of 10,000/ cumm and with clinical evidence of petechia on the trunk and hard palate, was later treated with platelet transfusion, intravenous immunoglobulin (IVIG) and steroids. Both the baby and the mother had an uneventful recovery following a multidisciplinary approach with the obstetrician, physician, neonatologist and the anaesthesiologist and both were discharged on steroids on the 10th post operative day.
Use of high pressure oxygen to remove nasal foreign body
Authors: Devkota A.R. , Yadav P.
Published: July 2024

Use of an innovative and simple technique of removing foreign body from nose usinghigh pressure oxygen is reported.
Acute urinary retention due to huge cervical myoma with abdomino-vaginal extensions
Authors: Rana A. , Anand B. , Gurung G. , Ojha N. , Amatya S. , Poudel S. , Sharma S. , Mandal R.
Published: July 2024

Abstract: We happened to manage a case of acute urinary retention that was relieved by drainage of 2L of urine and was sent home to attend out patient Gynecology department next day after the ultrasound diagnosis of huge myoma. This came out to be cervical myoma that filled the vagina pushing the uterus up to the level of the umbilicus. This is in reference to the general interest of everybody that any woman suffering acute urinary retention having gynecological bearing must be well evaluated before disposing them without inserting indwelling catheter.
Nutritional status of primary school children
Authors: Manandhar N. , Krishna G. , Patowary S.
Published: July 2024

Background: Malnutrition is one of the major public health problems in Nepal. The nutritional and morbidity status are indicators of the level of the quality of life of school children. Good health and adequate nutrition promote both physical growth and learning.
Methods: This study is a cross sectional study carried out during the period of August-September, 2006. The study population was the school children of Nursery to class five. One of the Government school is selected at randomly in Bharatpur.
Results: 11.38% of school children were below 80% weight for age i.e. under nutrition. According to Waterlow classification, among total school children, 89.85% were normal, 7.69% of school children were stunted and 3.38% of children were found to be wasted. Skin diseases (21.45%) were common in school children. Dental carries were found in 16.0% of school children followed by history of Worm infestation in 10.77%.
Discussion: The results of our study were quite encouraging when compared with other studies conducted in different parts of Nepal. This may be due to good water supply, better environmental conditions, good facilities for excreta disposal & health care facilities in the study area.
Conclusion: The nutritional status of primary school children in this study were found to be satisfactory when compared with other studies conducted in different parts of Nepal. The health education should be given on control and prevention of different diseases.
Effectiveness of “Teacher’s Training on Helping Students Learn” on Health Professionals
Authors: Shahi M.
Published: July 2024

Background: The main purpose of this article is to assess the effectiveness of teacher’s training workshop through comparing pretest and posttest.
Methods: A written 4-point Likert Scale questionnaires was administered to seventy six faculty teachers before and at the end of the teacher’s training. The data were collected and analyzed. A descriptive study method was used.
Results: Majority of the respondents 68(89.4%) expressed that they can confidently use audiovisual materials such as Flip Chart and Black/White Board effectively during post test while only 26(34.2%) respondents expressed they had some idea of using during pretest. The posttest result reveled highly significant effectiveness of the teacher training programmer’s performance in each item.
Conclusion: This study demonstrated overall positive effectiveness of the teacher’s training workshop.
Granulosa cell tumors
Authors: Pant P.R. , Manandhar B.L. , Shrestha S. , Amatya S , Gyawali G. , Sharma J
Published: July 2024

N/A
An unusual complication of Dermoid cyst
Authors: Sharma P. , Pandey C.P , Shrestha B. , Ranabhat S. , Thapa N. , Shrestha A.
Published: July 2024

Superinfection with abscess formation is a rare complication of mature cystic teratoma. It should be suspected whenever a patient with a documented pelvic mass develops a febrile illness following a retained placenta.
Risk factors assessment for Type-II Diabetes Mellitus
Authors: Adak M. , Nazri S.
Published: July 2024

Introduction: Diabetes mellitus is a group of metabolic abnormality often deliberating with sever complications of retinopathy, nephropathy and microangiopathy1 , which is one of the most common endocrine disorders in all populations and all age groups.
Materials and Methods: This is a retrospective study. A total of 1118 adult subjects were enrolled in the OPD in NMCTH. The case records of the patients of both genders aged range from 20-70 years. A definitive diagnosis was made based on clinical features, fasting blood sugar, post- Prandial blood sugar and lipid profiles estimation.
Results: Out of total patients, 142 were male and 71 were female Type –II diabetes patients. Male diabetes was maximum in 41-50 years age groups. Associated risk factors and co-morbid conditions were analyzed. Factors like physical activity, socio-economical status, family history, obesity have shown statistically significant association with diabetes mellitus. About 42 % have systolic BP> 140 mm of Hg and 47 % have diastolic BP> 80 mm of Hg.
Conclusion: This study showed a trend of diabetes with age in both sexes, reaching the highest in the age 41-50 years. Based on our study, we may concluded that these factors need to be addressed in prevention and control strategies in this area.
Micro-vascular complications in diabetic patient’s of type -2 diabetes mellitus
Authors: Yogi K.N.
Published: July 2024

Background: A hospital based prosopective study conducted in 11000 beded teaching hospital of a metropolitan city Islamabad, Pakistan, two group of patients having diabetes for < 5 years and > 5 years were evaluated and investigated for micro-vascular complications from January to December of 2006.
Material and Methods: A total of 100 patients were included in the study.
Result: Among them 72% patients of diabetes < 5 years and 76% patients of diabetes>5 years are overweight, most of them were having very high glycosylated haemoglobin and 48% has had neuropathy, 66% has had nephropathy and 72% has had retinopathy respectively.
Conclusion: This study once again proved that increasing age, overweight, uncontrolled blood sugar, and high level of glycosylated haemoglobin all contributes to higher rates of micro-vascular complications. Similar types of study if conducted in Nepal will be more useful for health professionals and researcher in future.
Instructions to authors
Authors: JIOM
Published: July 2024

N/A
Sonographic variations in common bile duct dimensions
Authors: Raj Joshi B.
Published: July 2024

Introduction: Biliary diseases such as cholelithiasis, cholecystitis, hepatitis, cirrhosis and pancreatitis are common in Nepal. Cholelithiasis was present in 8 percent of the emergency patients, second to acute appendicitis. Acute cholecysistitis was present in 25 percent of these patients. 1 The most common operation in a district hospital was cholecystectomy (31%]). 2 Ultrasound plays an integral part in evaluation of biliary system. The aim of the study was also to determine whether the size of the CBD increases with age.
Methods: We prospectively collected data on 100 patients aged 15 years or older who underwent abdominal sonography. The subjects had no history of biliary and pancreatic disease or operation.The CBD was measured in porta hepatis, in the distal aspect of head of pancreas and midway between these points. Linear regression was used to correlate age with the dimension.
Results: There were 30 males and 70 females in the study. The subjects ranged from 15 to 80 years.The mean diameters were as follows: 3.76mm in proximal, 4.26 mm in middle, 4.90mm in distal portionof CBD. The overall measurement was 4.23mm.
Conclusions: There was a significant correlation between CBD size and age. Correlation with age was best observed for the distal segment
Middle pancreatectomy for selected pancreatic neck tumours
Authors: Lakhey P.J , Ghimire B. , Khakurel M.
Published: July 2024

Middle pancreatectomy has been indicated for small benign lesions located in the neck or body of the pancreas. The proponents of middle pancreatectomy argue that it preserves pancreatic exocrine and endocrine function thus avoiding pancreatic exocrine insufficiency and diabetes, and preserves spleen thereby avoiding life-threatening complication of post splenectomy sepsis. However, others express concern regarding the increased risk of pancreatic fistula and oncological adequacy. Here, we report two cases with low grade cystic neoplasm involving the neck of the pancreas that underwent middle pancreatectomy with variable outcome.
Utilization of intrauterine contraceptive device in a District of West Bengal, India
Authors: Haldar A , Baur B , Bhattacharya SK , Das R , Mundle M , Saha TK
Published: July 2024

Introduction: Lack of knowledge of contraceptive methods or source of supply, cost and poor access are the barriers that exist in developing countries and present study was conducted to assess the current intrauterine contraceptive device (IUCD) utilization by eligible couple in Howrah District of West Bengal.
Methods: A community based cross sectional study using stratified multistage random sampling technique to obtain a sample size of 1600 using couple protection rate of West Bengal as 50%. So 12 villages and 4 urban wards were selected, with 125 sampled eligible couples in each village/ward to get 2000 eligible couples.
Results: Contraceptive practice by any method was 63.3% and couple protection rate by modern method was 54.3%. IUCD use rate was 3%, oral contraceptive pill (OCP) use 25.4%, ligation 18.4%, condom 7.4%, and vasectomy 0.1%. Ever use rate of IUCD (Cu-T/Loop) was 6.3%, which increased significantly with advancement of maternal age, but was not associated with maternal literacy. Lack of motivation (43.4%), misconception (24.9%), unawareness (18.7%), unwillingness (10.9%) and religious/cultural barrier (4%) were the major reasons for underutilization of IUCD.
Conclusions: IUCD acceptance is very low and different initiatives should be taken to improve it.
Vault prolapse after vaginal hysterectomy with pelvic floor repair for uterovaginal prolapse
Authors: Pant PR
Published: July 2024

Introduction: Utero-vaginal prolapse is the most common gynaecological pathology among the Neplease women. Many women in Nepal are the unable to get the treatment of this pathology due to their poor economical conditions (1,2). However since last few years many governmental and nongovernmental organizations are organizing hysterectomy camps in rural areas of Nepal to help these poor people.
Objective: To compare the incidence of vault prolapse among the women underwent vaginal hysterectomy with pelvic floor repair for different degree of utero-vaginal prolapse in hysterectomy camps.
Methods: It was Prospective comparative study, done on 1646 women in different nine districts of Nepal from June 1999 to May 2009.All the Patientssubjected to the vaginal hysterectomy for different degree of utero-vaginal prolapse were grouped in to two groups selecting the patients alternatively. In first group of the patients during anterior colporraphy bladder wassupported by interrupted bladder buttressing stitches and in second group this repair was done by applying single purse string stitch including the apex of the vagina and incidence of vault prolapse was compared in two groups after two years of the surgery in follow up camps.
Results: Out of 1646 operated patients 891 came for follow up. Among these women 567 were from group A (interrupted suture group) and325 patients were from the Group B (single purse string) group. From group A there were 22 cases and from group B 4cases of vault prolapse. In both the groups majority of the women were chronic smoker. And majority of them started heavy work after one month of prolapse surgery in both the groups.
Conclusion: Single purse string suture seems better technique for the support of the bladder or as a whole vault during the anterior colporraphy while doing the pelvic floor repair in cases of uterovaginal prolapse, especially in the camp set up.
Prevalence and types of cutaneous drug reactions in two institutes
Authors: Shrestha A , Jha A , Jha A.K. , Regmi BM , Pokharel DB , Jha AK , Jha N , Bharati L
Published: July 2024

Introduction: Adverse drug reaction is one of the growing concerns of today’s health practice. The purpose of the study was to find out the prevalence and types of cutaneous drug reactions at Tribhuvan University Teaching Hospital (TUTH) and DI Skin Hospital and Research Centre.
Methods: It was a prospective, crosssectionalstudy conducted at Department of Dermatology of TUTH and DI Skin Hospital and Research Centre from 14 th April 2010 to 14 th October 2010. All the suspected cases of cutaneous drug reaction above 14 years were included. Naranjo Algorithm was used to establish the causality and Modified Hartwig and Siegel Scale was used to access the severity of the cutaneous drug reaction. Clear purpose of the study was described and a patient consent form was produced before them while collecting the data and ethically approved from Institutional Review Board, Institute of Medicine.
Results: Prevalence of cutaneous drug reaction was found to be 0.258%. The male: female ratio was 2.1:1. The highest percentage of CDR was seen in 15-34 years age group. Antibiotics were the group of drug involved in most CDR followed by anticonvulsant. Phenytoin, ibuprofen+paracetamol combination and betamethasone were mostly associated with CDR. 51.61% of the cases were of moderate III rd level which was followed by moderate IV (b) level. 51.62% were assessed to be probable and 48.38% were possible. Out of 13 admitted cases, 6 cases were admitted for 7-9 days. Maculopapular rash was the most common clinical presentation observed followed by Steven’s Johnson Syndrome.
Conclusion: The study estimated the average rate of cutaneous drug reaction in two major hospitals of Nepal. It also determined the most common type of manifestation of the cutaneous drug reaction.
Child head entrapment in a cooking pot
Authors: Bharati U
Published: July 2024

This is a case report of a child who was brought to the Emergency department with the entrapped head in the cooking pot. The cooking pot was safely removed out of the head without any complications. This case demonstrates the age related susceptibility in the young to the possible lethal head entrapment
Second Intervention in Obstetric Hemorrhage
Authors: Rawal S , Rana A.
Published: July 2024

Introduction: Obstetric hemorrhage is still one of the dreaded complications that contribute to a maximum number of maternal morbidity and mortality till date. The management of obstetric hemorrhage involves early recognition, assessment and resuscitation. Though dealt with appropriate use of oxytocic agents, it may seldom require surgical techniques, including uterine tamponade, major vessel ligation, compression sutures, and even hysterectomy.
Method: Prospective study of 20 cases of laparotomy for obstetrical hemorrhage carried out at Tribhuvan University Teaching Hospital, Kathmandu, Nepal, between Jan 2003 to Nov 2011.
Results:Out of 20 cases,massive hemoperitoneum(more than a liter)was noted in 9 and associated risk factors in 10. Source of bleeding in 20 cases were from extensive hematoma (retroperitoneal and broad ligament) in 5, including a rectus sheath hematoma and with colporrhexis, oozing inverted T incision repaired in a single layer (1), placental bed (3) and 1 was from vessels in LUS. There was bleeding from uterine angle (4) and incision (1). Bleeding from tear at various sites were 3, from uterovesicle fold of peritoneum 1 and from the ruptured uterus following vacuum delivery in a case of VBAC (1). Uterine packing was done in 1, B-Lynch in 3 and 1 failed needing the uterine packing; uterine artery ligation in 2 including ovarian vessel ligation in 1, repair of ruptured uterus in 1 and subtotal hysterectomy in 5 cases. There were 3 mortalities due to DIC, pulmonary edema and ARF and rest were discharged in good health.
Conclusion: Choosing of the right technique, complete hemostasis and meticulous closure of all surgical incisions will prevent the need for laparotomy following LSCS. Vigilant monitoring of all the post operative patients will lead to early diagnosis of intraperitoneal / pervaginal bleeding and its management, thus preventing morbidity and mortality owing to late diagnosis.
Tear Film Evaluation in Contact Lens Wearers and Non Wearers
Authors: Shrestha G.S , Sujakhu D. , Shrestha J.B , Shrestha J.K.
Published: July 2024

Background: Dry eye symptoms are more frequent in contact lens wearers than in non wearers. Dry eye is considered relatively common in contact lens wearers than non-wearers. However, there was no any report in our clinical setting that compared and addressed the issue related to dry eye and its symptom in contact lens wearers. The present study was conducted to compare pre-ocular tear film in contact lens wearers (CLW) and contact lens non wearers (CLNW), and evaluate the relationship between clinical and subjective assessment of dry eye symptoms.
Methods: It was a comparative study conducted among 131 subjects (262 eyes) attended in the contact lens clinic at BP Koirala Lions Center for the Ophthalmic Studies. Sixty five were daily soft contact lens wearers; sixty-six were non wearers.
Tear function assessment included non- invasive tear break up time, invasive tear break up time, tear prism height and Schirmer II test. Subjective assessment of dry eye symptoms was carried out using McMonnies questionnaires.
Results: Mean age of CLNW was 23.01± 5.53 and CLW was 23.6± 4.61. Female (89 subjects) visited more than male (42 subjects) in contact lens clinic. Mean symptom score in CLW was significantly higher than CLNW (p<0.001). But, distribution of symptomatology was not significantly different in both groups. Symptomatic subjects were elder (p<0.001) and female (p<0.05) in CLNW and only elder subjects in CLW. Tear function tests were significantly lower in symptomatic subjects in CLW and CLNW; Overall tear function test scores were also lower in CLW than CLNW. Tear function tests scores were insignificantly different in male and female. Coefficient of correlation was positive and weak for all tear function tests scores.
Conclusions: Though, tear function tests scores were reduced in CLW than CLNW, dry eye symptomatology was almost similar. Subjective assessment of symptoms is as important as clinical tests.
Diagnostic efficacy of ultrasonography in acute appendicitis
Authors: Lohani B , Gurung G. , Paudel S. , Kayastha P
Published: July 2024

Introduction: Acute appendicitis is the most common acute condition of the abdomen requiring surgery in both adults 1,2 and children. 3-5 The overall frequency of appendicitis for symptomatic patients younger than 20 years is 41%; the frequency for those older than 20 years is 59%.
Methods: This was a prospective cross-sectional study involving 104 patients aged between 8 and 68 years with clinical suspicion of acute appendicitis. Patients with suspected acute appendicitis were evaluated with high frequency linear transducer using graded compression technique. Per operative findings were noted and histopathological examination were carried out in all the cases for confirmation of acute appendicitis. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of ultrasonography were calculated by using statistical method.
Results: Among 104 patients (61 males and 43 females) with clinical diagnosis of acute appendicitis, ultrasonography was positive for acute appendicitis in 79 patients (75.96%). On histopathological examination, 94 appendices (90.38%) were acutely inflamed. The sensitivity of ultrasonography for the diagnosis of acute appendicitis was 78.72% with specificity of 60%. Positive predictive value, negative predictive value and accuracy of ultrasonography were 94.87%, 23.07% and 76.92% respectively.
Conclusion: Ultrasonography is a useful method of diagnosing clinically suspected acute appendicitis especially in doubtful cases.
Post dural puncture headache
Authors: Singh J , Ranjit S , Shrestha S , Limbu T , Marhatha S.B.
Published: July 2024

Introduction: Post dural puncture headache occurs as the cerebrospinal fluid leaks out from the breach that the needle has made in the dura. The incidence of Post Dural Puncture Headache (PDPH) is a common complication after spinal anesthesia. The objective of our study is to find out incidence of PDPH in patients undergoing surgery under spinal anesthesia in Dhulikhel Hospital.
Methods: 120 patients who underwent spinal anesthesia were selected for the study. Questionnaire was used to assess the post dural puncture headache 24 hours after surgery. Headache, if present in frontal or occipital areas which increased when sitting or situational movement and relieves by lying in flat position were considered as PDPH.
Results: PDPH was observed in 25% of the patients. The incidence of PDPH is 30% and 70% in male and female respectively. It was 2.33 times more in age group 18-30- years than 31-45 years.
Conclusions: The incidence of PDPH was high in female and age group 18-30 years. The incidence of PDPH is high when the bevel is transverse to the dural fibers
Submandibular thyroid
Authors: Karki B , Sharma P. , Ghimire P.G
Published: July 2024

Submandibular thyroid is one of the rare locations of ectopic thyroid tissue. Only few cases have been reported in the literature. We report a case of 16 year old female patient presenting with ectopic submandibular thyroid tissue. Diagnosis was based on ultrasound and cytology.