bluuebunny/crossref_metadata_2025 huggingface dataset:
MODEL TRANSPORTASI PENGIRIMAN PRODUK PERISHABLE DENGAN MULTI KENDARAAN
Authors: Kartika Winanda
Published: May 2019

Abstract : According to Graf theory, the shortest path determination is a problem of looking for a path between two vertices in a weighted graph to obtain the minimum amount of weight.The determination of the shortest path problem also called optimization problem. Several algorithms have been developed in solving this problem. Each algorithm has a different way of solving a particular problem. In this study, the development of algorithms was carried out to determine the critical path from one origin point to one destination point on a network for the delivery of perishable products that limited time window to minimize the total cost and the selection of vehicles that will be used for solving the problem.The Algorithm that developed is Dijkstra algorithm. The first stages of the algorithm development is to modify the network of the studied problem by making the network replication. The second stage is to make problem-solving steps to minimize the total cost, consists of a fixed cost, variable cost, vehicle turnover costs, deterioration cost and parking fees with modified Dijkstra algorithm because the problems can not be modeled mathematically.To test the developed algorithm, we used numerical examples with hypothetical dataKeywords: perishable product; deterioration; time window; modified Dijkstra algorithmAbstrak : Menurut teori Graf, penentuan rute terpendek merupakan suatu persoalan mencari lintasan antara dua buah simpul pada graf berbobot untuk mendapatkan jumlah bobot yang paling minimum. Permasalahan penentuan rute terpendek disebut juga masalah optimasi.Beberapa algoritma telah dikembangkan dalam pemecahan masalah ini. Setiap algoritma memiliki cara yang berbeda dalam menyelesaikan suatu permasalahan tertentu. Pada penelitian ini, dilakukan pengembangan algoritma untuk menentukan lintasan kritis dari satu titik asal ke satu titik tujuan pada suatu jaringan untuk pengiriman produk perishable dan dibatasi jendela waktu dengan meminimumkan total biaya sekaligus pemilihan jenis kendaraan yang akan digunakan untuk pemecahan masalah. Algoritma yang dikembangkan adalah Algoritma Dijkstra. Tahapan awal pengembangan algoritma adalah memodifikasi jaringan dari masalah yang diteliti dengan cara membuat replikasi jaringan. Tahapan kedua adalah membuat langkah pemecahan masalah untuk meminimumkan total biaya yaitu biaya tetap, biaya variabel, biaya pergantian kendaraan, biaya deteriorasi dan biaya tunggu dengan modifikasi Algoritma Dijkstra. Modifikasi Dijkstra dilakukan karena permasalahan yang diteliti tidak bisa dimodelkan secara matematis. Pengujian algoritma menggunakan contoh numerik dengan data hipotetik.Kata kunci: produk perishable; deteriorasi; jendela waktu; modifikasi Algoritma Dijkstra.
Development of Thinking Skills in Early Childhood
Authors: Aisyah Siti
Published: May 2019

This research aims to obtain empirical data on the effect of reading method and thinking skills toward intelligence language of early childhood. Thus the researchers wanted to investigate the causal relationship between the reading method and thinking skills with the intelligence language of children by giving treatment to the experimental group and compared it with the control group. This study used a treatment design by level 2 x 2 be In the design, each of the independent variables are classified into two sides, includes action variable that is reading methods (A) are classified into the Big Book Methods (A1) and Syllables Method (A2). Whereas moderator variables that is thinking skills (B), are classified based on high and low level into high-level thinking skills (B1) and low-level thinking skills (B2). ANOVA calculation results showed that language skills of children who followed reading activities by using the Big Book method is higher than the language skills of children who attend reading activities by using Syllables method. Thus, there is the effect of the application of the Big Book method and Syllables methods toward language skills of children.
The Effect of Communication Technology Development on the Intelligence of Children through Educational Value System Management
Authors: Rosa Ade Tutty R.
Published: May 2019

The development of IT in the digital era 4.0 currently provides a considerable and different influence on each user, including children. In general, the problems in the world of education include the quality and quantity of education related to quality and equality in obtaining access to education without any gaps and exceptions. The solution that can be developed is the optimization of the role of Information and Communication Technology (ICT) in the world of education. One of the roles of ICT in education is realized by the development of online learning (e-learning) or the direct use of ICTs for children. Many changes - changes in different new values can have a positive impact on children's growth, especially on intellectual intelligence, intelligence emotional, spiritual, and social intelligence. ICTs have a good influence on children's intellectual, emotional, spiritual and social intelligence; IT brings a bad influence on children's intellectual intelligence; IT has a pretty good influence on children's emotional intelligence; IT has a pretty good influence on children's spiritual intelligence, IT has a good influence on children's social intelligence. Importance of Parents has a role to be able to know the changes that occur during child development.
KELOMPOK 8
Authors: rangkuti Nur sakinah , marito Sila Sinta
Published: May 2019

BABIPENDAHULUANA.LatarBelakangDasar negara merupakan rambu bagi arah suatu pemerintahan agar sesuai dengan tujuan yang dicita-citakan.Cita-cita kemerdekaan Indonesia adalah mewujudkan suatu masyarakat yang adil dan makmur berdasarkan Pancasila. Dengan demikian Pancasila bukan saja sebagai Dasar Negara,tetapi sekaligus juga telah menjadi tujuan kehidupan berbangsa dan bernegara. Jika salah satu kmponen ini terpenuhi ,mka tujuan untuk mewujudkan masyarakat yang adil dan makmur berdasarkan Pancasila tidak mungkin dapat terwujud. Seperti halnya demokrasi : dari rakyat , oleh rakyat dan untuk rakyat . Pancasila adalah sebuah konsep ideologi yang secara yuridis ditetapkan sebagai dasar negara Indonesia pada tanggal 18 Agustus 1945 oleh PPKI . Pancasila sebagai pemersatu bangsa bertujuan untuk menciptakan keadilan dan toleransi ,disamping untuk mewujudkan cita-citabangsa. Khususnya dalam sila ketiga Pancasila “Persatuan Indonesia”.Pancasila merupakan jati diri dan identitas nasional yang harus dipahami, Dihayati dan diterapkan dalam bermasyarakat demi terciptanya persatuan bangsa. Maka perlunya menumbuhkan nilai nilai Pancasila sebagai pemersatu bangsa, penulis akan mengulas peranan Pancasila sebagai pemersatu bangsa. Akhir akhir ini eksistensi Pancasila mulai di grogoti oleh berbagai faktor. Dengan Begitu kita sebagai generasimu dah arus bisa memproteksi dengan nilai nilai falsafah Pancasila, karena nilai nilaiPancasila telah menjadi local wisdom bangsa sejak zaman dahulu. Pancasila hingga kini masih eksis sebagai ideologi yang mampu Mempersatukan bangsa Indonesia yang plural , meskipun banyak tantangan yang Telah menguji eksistensi Pancasila.
PASAR BERINGHARJO SEBAGAI PUSAT WISATA BELANJA DI YOGYAKARTA
Authors: Saputra Dimas Aji Galih
Published: May 2019

Batik is a cloth that has a picture a typical. The wors “Batik” is a combined of two words : “to write” and “the point” which means “the point”. Batik is identical with the city of Yogyakarta. The famous batik sales places ini Yogyakarta are Pasar Beringharjo.
KELOMPOK 5
Authors: rangkuti Nur sakinah , simbolon machmul syarif
Published: May 2019

BAB 1PENDAHULUANA.Latar BelakangMenghadapi Era Globalisi yang semakin maju ini . Pastinya bangsa dan negara Indonesia yang ingin berdiri kokoh kuat, tidak mudah terkecohkan oleh kerasnya masalah kehidupan berbangsa dan bernegara, tentunya perlu memiliki dasar negara dan ideologi negara yang kokoh dan kuat pula. Tanpa itu, bangsa dan negara akan di hadapi dengan makin maraknya budaya asing yang masuk ke dalam negara indonesia, makin banyaknya terorisme, komunisme dan fundalisme yang makin membahayakan bagi negri ini.Disamping itu makin banyaknya pengelompokan suku-suku didaerah masing-masing yang membuat persatuan di Indonesia semakin hancur.sesuai dengan sila ketiga pancasila yaitu persatuan indonesia,kita sebagai bangsa Indonesia wajib menjunjung persatuan, mengubur dalam-dalam perbedaan diantara kita sebagai warga negara dan bersama-sama membangun negara indonesia ini menjadi salah satu negara yang dikagumi di asia maupun di seluruh dunia.tidak memprioritaskan kepentingan kelompok melainkan bersama-sama bersatu membangun negara indonesia untuk jadi lebih maju di era krisis globalisasi ini.Mempelajari Pancasila lebih dalam menjadikan kita sadar sebagai bangsa Indonesia yang memiliki jati diri dan harus diwujudkan dalam pergaulan hidup sehari-hari untuk menunjukkan identitas bangsa yang lebih bermartabat dan berbudaya tinggi. Untuk itulah diharapkan dapat menjelaskan Pentingnya Pancasila sebagaiIndeologi yang membangun kesejahterahkan bangsa.Oleh sebab itu kita warga negara indonesia jangan pernah lupa untuk megaplikasikan nilai-nilai pancasila dalam kehidupan sehari-hari,berbangsa dan bernegara dan digantikan dengan budaya luar yang makin marak masuk kedalam bangsa indonesia.Melupakann nilai-nilai Pancasila sebagai dasar negara dan ideologi negara, menunjukkan sikap negatif terhadap Pancasila dalam kehidupan berbangsa dan bernegara, atau menampilkan sikap positif terhadap Pancasila dalam kehidupan bermasyarakat. Pengetahuan yang diperoleh dalam makalah ini juga dapat dijadikan bekal keterampilan menganalisis dan bersikap kritis terhadap sikap para penyelenggara negara yang menyimpang dari cita-cita dan tujuan Negara.
Tradisi Keislaman di Perguruan Tinggi
Authors: Hermawanto Asep , Ashrori Muhammad , Wekke Ismail Suardi
Published: May 2019

Eksistensi umat beragama selalu ditandai dengan adanya tradisi-tradisi keagamaan. Hal ini tidak hanya dalam lingkup besar seperti suatu negara tetapi bahkan sampai lingkup yang terkecil yaitu lapisan masyarakat pedesaan. Pembahasan berikut dalam makalah ini upaya menciptakan suasana religius secara praktis dengan melibatkan seluruh civitas akademika terutama mahasiswanya dalam pelaksanaan beberapa tradisi keislaman. Penerapan tradisi keislaman yang penulis paparkan dalam pembahasan berikut lebih spesifik terfokus pada proses perayaan Nuzulul qur’an dan peringatan Maulid Nabi Muhammad saw.
مَبَادِى علم الأحياء للمدرسة العالية تشويق الطلاب سلفيّة
Authors: Setiawan Adib Rifqi
Published: May 2019

مَبَادِى علم الأحياء للمدرسة العالية تشويق الطلاب سلفيّة
Profil Manajemen Bimbingan dan Konseling di Sekolah Menengah Atas
Authors: Febriani Rahmi Dwi , Triyono
Published: May 2019

Self-development activities are educational activities outside the subjects that help schools in shaping the character and personality of the learner. Self-development activities are facilitated and guided by counselor, teachers, or educational personnel that can be done in the form of extracurricular activities. In the implementation of guidance and counseling is never separated from careful planning and systematic. A program of guidance and counseling services in school is unlikely to be established, organized and achieved if not managed in a quality management system. Management guidance and counseling are all efforts or ways used to optimally utilize all components or resources such as personnel, funds and infrastructure facilities and information systems in the form of guidance data set to provide guidance and counseling services in order to achieve goals. The principles of guidance and counseling management services include planning, organizing, staffing, leading & controlling.
Open Forensic Science
Authors: Chin Jason , Ribeiro Gianni , Rairden Alicia
Published: May 2019

The mainstream sciences are experiencing a revolution of methodology. This revolution was inspired, in part, by the realization that a surprising number of findings in the bioscientific literature could not be replicated or reproduced by independent laboratories and were likely false discoveries. In response – as reflected in a 2018 report of the National Academy of Sciences, Engineering, and Medicine – scientific norms and practices are rapidly moving towards openness. These reforms promise many enhancements to the scientific process, notably improved efficiency and reliability of findings. Changes are also underway in the forensic sciences (although they have recently hit substantial political roadblocks). After years of legal-scientific criticism and several reports from peak scientific bodies, efforts are underway to establish the validity of several forensic practices and ensure forensic scientists perform and present their work in a scientifically valid way.In this article, the authors suggest that open science reforms are distinctively suited to addressing the problems faced by forensic science. Openness comports with legal and criminal justice values, helping ensure expert forensic evidence is more reliable and susceptible to rational evaluation by the trier of fact. In short, open forensic science allows parties in legal proceedings to understand and assess the strength of the case against them, resulting in fairer outcomes. Moreover, several emerging open science initiatives allow for speedier and more collaborative research. These, in many cases, may be readily applied to forensic science.
Pan, Lovelett, Phun, and Rickard (2019) Systematic and random interleaving for second language learning (preprint)
Authors: Pan Steven C. , Lovelett Jarrett , Phun Vicky , Rickard Timothy Charles
Published: May 2019

Repeatedly switching between a series of to-be-learned topics, also called interleaved practice (interleaving), can improve learning over traditional, one-topic-at-a-time blocked practice (blocking). We investigated whether interleaving’s benefits for foreign language learning are facilitated by random schedules, wherein training trials follow unpredictable patterns, or systematically alternating schedules, wherein trials are predictably sorted. Students learned to conjugate Spanish verbs in the preterite and imperfect tenses and then took a 48-hr. delayed verb conjugation test. A consistently random (Experiment 1) or systematically alternating schedule (Experiment 2) did not improve learning versus blocking. However, the combination of both types – systematic alternation for study trials and randomization for practice trials – enhanced learning (Experiments 3-4). Thus, neither interleaving schedule alone appears to be sufficient; for verb conjugation skills and likely other materials involving study followed by problem-solving practice, both are needed. Interleaving’s benefits are therefore impacted by the alignment between training schedule and task type.
Cause, Pattern and Outcome of Fractures Occurring in the Pediatric Population of Rural Tertiary Health Care Center of Nepal
Authors: Karki Dhan Bahadur , Rokaya P.K. , Rawal M. , Bhandari P.B. , Limbu D. , Shrestha S. , Acharya B.D. , Thapa S.D.
Published: May 2019

Introduction: Pediatric trauma is a significant burden to health care worldwide. In Karnali province, most of the cases present late. The aim of this study is to determine demographic characteristics, cause, pattern, treatment and outcome of pediatric fractures in tertiary health care center in Jumla.

Methods: This is a retrospective study done in patients younger than 16 years who presented to our hospital between January 2016 to December 2017. We analyzed demographic data, injury characteristics, fracture pattern, time of presentation, treatment modalities and outcome.

Results: There were total of 1028 patients out of which 60% were males. Mean duration of presentation to hospital was 4.8 days. Most common mechanism of injury was fall from height. 85.60 % were managed conservatively and 14.40% were managed operatively. Postoperative outcome was good in 71 % of the cases, fair in 28% and poor in 1% cases. Forearm fracture was the most common presentation, accounting for 358 cases (34.82%) followed by Supracondylar humerus fracture accounting 23.34%.

Conclusions: Pediatric fractures constitute a huge proportion of cases in our hospital. As pediatric bones unite readily, the treatment outcome is good in most of the cases even after conservative management and after delayed presentation.
Audio Visual aids in Medical teaching: Are they being over Subscribed?
Authors: Mishra S.M.
Published: May 2019

In the ancient past the teaching was quintessentially verbal. The Students had to be “Shrutidhar”(remembering by listening to the teachers). Our ancient Scriptures are a witness to this.

Since then, much water has flown under the bridge. We now live in a time where an effective communication has not only to be verbal but visual as well. The controlled trials have unequivocally shown that verbal presentations beefed-up with visual supplements make such presentations more informative, interesting and intensify cognitive learning.

For this, the cutting-edge technology and tools like PowerPoint presentations and OHPS have opened new vistas and dimensions in teaching methods. The poor black-board and chalk have been given a cold valediction.

However, wisdom always demands a re-assessment of the usefulness of the newly invented tools. Are these visual aids making the teaching more immersive and interactive? Are these aids being used in proper perspectives?

The answer will be a flat “no” if a student is asked to answer honestly. A large majority of the teachers are using this aid for their convenience not to increase the students cognitive engagement in the class. Transparencies of OHPS howsoever transparent they might be yet, they create a barrier between the students and teacher. The PowerPoint Presentations are more often too numerous and contain too much information that student can digest. A monotonous recital of these makes the students totally disinterested in the lecture. They feel that teacher is reciting from the lines taken down from the books.

I think there is still a place for black-board and the newer invaluable teaching aids should be very subtlety used and used in proper perspective.

Prof. S.M. MishraMS (Surgery), MS (Ortho), FRCSEditor In Chief
Pattern of Provoking Factors and Psychiatric Co- morbidity in Migraine Headache: A Study from Tertiary Care Hospital
Authors: Khan Tanveer Ahmed
Published: May 2019

Introduction: Headaches are the most prevalent neurological disorders and among the most frequent symptoms seen in general practice among which migraine only accounts up to 30%. Certain factors are found to play role in the triggering of migraine headache. Avoidance of such factors is part of migraine management. Psychiatric co morbidities are common in migraine. Recognizing these co morbidities could therefore result in improved patient management.

Methods: This study was done at Nepalgunj medical college hospital, Nepalgunj. Duration of study was six months i.e. from 1st July 2017 to 31st December 2017. All the new cases fulfilling diagnostic criteria of migraine headache visiting to psychiatric outpatient department were included in this study. The diagnosis of migraine was made based on criteria mentioned by the international classification of headache disorders (ICHD-II).

Result: A total of 50 patients were enrolled in this study. The mean age of participants was 28.60 ± 10.388 years. There was significant predominance of female participants. Family history of migraine was found in 20 (40%) of participants. The mean age of onset was 22.76± 7.899 years. The commonest type of migraine was migraine without aura in 2/3rd number of cases. Psychiatric co-morbidity was found in 26 (52%) subjects among which the most common co-morbidity was anxiety disorder in 16 (32%) followed by depression in 8 (16%). Presence of provoking factors was found in 38 (76%) subjects. Light, smoke, smell, noise and lack of adequate sleep were the common provoking factors.

Conclusion: Migraine predominantly affects females with common age of onset in second and third decade. Psychiatric co-morbidities are common in migraine patients. Anxiety disorder and depression are the commonest co-morbidities. The common provoking factors are light, smoke, smell, noise and lack of adequate sleep found in migraine. Avoidance of provoking factors and early detection and management of psychiatric co morbidities can result in better outcome.
Prevalence of Hypertension in Hemorrhagic Stroke at NGMCTH, Kohalpur
Authors: Shrestha Anil , Shrestha Richa
Published: May 2019

Aim: To study the prevalence of hypertension in hemorrhagic stroke in patients admitted in medical units of Nepalgunj Medical College Teaching Hospital (NGMCTH), Kohalpur.

Background : Hemorrhagic stroke has remained a serious disease despite recent advances in medical treatment. It is one of the most common emergencies encountered in clinical practice and predominantly effects elderly population leading to chronic disability and dependency. This study was designed to identify hypertension as a major cause of Intracerbral hemorrhage (ICH).

Material and methods: This is a cross sectional descriptive study conducted in the department of medicine of NGMCTH, Kohalpur between June 2017 and November 2017. A total of 51 patients were included in the study. History and clinical examinations were recorded. Plain CT scan head, ECG and chest x-ray PA view were done and the data were recorded and analysed.

Result: The age of patients ranged from 48 to 89 years with the mean age of 66.72 years. Among 51 patients, high BP at presentation along with ECG showing LVH was seen in 38 patients (74.5%) and chest x-ray PA view showing cardiomegaly was seen in 31 patients (60.8%). Most commonly involved ethinic group was Tharu (45.1%).

Conclusion: Hypertension is a major cause of ICH. So, early detection and regular treatment of hypertension with appropriate antihypertensive drugs and life style modification would prevent ICH.
Profile of Colonoscopy Findings: A single Centre Experience
Authors: Kidwai Roman , Sharma Anup
Published: May 2019

Background: About 30% of patients presenting to surgical outpatient department has lower gastrointestinal (LGI) symptoms. Colonoscopy is a low risk and at the same time investigation of choice in these patients which allows visualization of the entire colon and the terminal portion of ileum. This study was done to evaluate the role of colonoscopy.

Methods: This was an observational, hospital based study from February 2014 to March 2018, carried out at Nepalgunj Medical College and Teaching Hospital.

Results: 245 patients underwent colonoscopy, among them 62.85% were male and 37.14% were female with the M:F ratio being 1.6:1. The youngest patient undergoing colonoscopy was 21 and the eldest was 78 with the mean age being 53.6±12. The common indications were per rectal bleeding (49.38%), alteration in bowel habit (40.49%), and constipation (13.46%). In 85.71% patients entire large bowel could be visualized. In 21.22% no abnormality was detected. Haemorrhoids (27.34%) were the most common findings and then nonspecific inflammatory bowel diseases (17.55%), colorectal polyps (15.51%) and colorectal cancers (14.28%). Biopsy was done in 39.51% patients and the most common finding was nonspecific inflammatory bowel disease, 36.08% had adenocarcinomas and rest had ulcerative colitis, juvenile and hamartomatous polyps.

Conclusion: Colonoscopy is a safe and effective investigation in diagnosing as well as managing the patients with LGI symptoms.
Comparison of Vestibular Function Between Right and Left Handed Normal Population
Authors: Bhandari Sharma , Shrestha Sagun , Saxena R.K.
Published: May 2019

Objective To identify the side of vestibular dominance in right handed & left handed people.

Method A total of 50 normal subjects, aged between 15 - 45 years were included as Left handers (n = 25) and Right handers (n = 25). Handedness was confirmed by the Annett Hand Preference Questionnaire. Bithermal caloric testing was done which was recorded by Electronystagmography (ENG). Maximum Slow Phase Velocity (MSPV) was taken as the parameter of choice. Directional Preponderance (DP) and Canal Paresis (CP) were calculated in each group.

Results Out of the 25 Left handed subjects, 8 had DP towards Left whereas 7 had DP towards the Right and the remaining 10 showed no DP to any side (normal) (p<0.001). Out of the 25 Right handed subjects, 4 had DP towards Right and none had DP towards the Left, remaining 21 showed no DP to any side (normal) (p<0.001). For CP, out of 25 Left handed subjects, 2 showed CP towards the Left and 1 towards the Right, the remaining 22 showed no CP (normal) at all. Similarly out of the 25 Right handed subjects, 2 showed CP towards the Left and 1 towards the Right, the remaining 22 showed no CP (normal) at all. Out of 25 Right handers, it was found that Right handers showed Right vestibular preference whereas vestibular preference was almost equally distributed to Left and Right side in Left handers.

Conclusion On considering DP, it was found that Right handers showed Right vestibular preference whereas vestibular preference was almost equally distributed toLeft and Right side in Left handers (p<0.001).
Prevalence of Depression and Use of Antidepressant in Basic Medical Sciences Students of Nepalgunj Medical College, Chisapani, Nepal
Authors: Dhami Dabal B. , Singh Ankita , Shah Gaurav Jung
Published: May 2019

Introduction: According to WHO, depression would be the second-most prevalent condition worldwide by 2020. The prevalence of depression is increasing in medical colleges because of stressful, competitive environment, long hours of trainings and studying. It is important for medical educators or teacher to know the magnitude of depression in students and factors causing it. The present study was carried to assess the prevalence of depression, use of antidepressant and to find out their stressors among preclinical students of Nepalgunj Medical College, Chisapani, Nepal.

Aims and objective: To assess the prevalence of depression, use of antidepressant and to find out their most common stressor among preclinical students

Materials and methods: The descriptive cross sectional study was carried in preclinical students of Nepalgunj Medical College, Chisapani, Nepal, The data was collected with questionnaires which comprised of personal data (age, sex, year of study, religion and home country) and Zung Depression Inventory scale was used to rate the depression.

Results: Among 218 students, the prevalence of depression was 24.3%. Male students are highly depressed (16.5%) then female (7.8%). First year student are more depressed (26.5%) then second year (22.4%). The depression score of the preclinical medical student was 44.67± 5.68 (mean ±SD). Majority of the students (>50%) found on academic stress and 3.6% of the total students were on antidepressants

Conclusion: As the prevalence of depression is high in medical students there is need for the counselling services to the students in the medical college to control this morbidity.
Diagnostic Utility of Fine Needle Aspiration Cytology in Oral Cavity and Oropharyngeal Lesions
Authors: Acharya Subarna
Published: May 2019

Fine needle aspiration cytology is being commonly used for initial diagnoses of oral cavity and oropharyngeal lesions. The aim of this study was to assess the role of Fine Needle aspiration cytology in diagnosis of intraoral and oropharyngeal lesions and to compare with histopathological findings in those cases which underwent biopsy examination. This is a tertiary care center based retrospective study done over a period of two years. Out of total 660 fine needle aspiration cytology in two years; 133 cases were of oral and oropharyngeal region. 54 were male and 79 were of female. Frequently involved site was tongue (n=45). Predominant non neoplastic cases were of chronic inflammation (n=43) and neoplastic cases of squamous papilloma (n=15). Among neoplastic cases most common malignant cases were of squamous cell carcinoma (n=4). Sensitivity of the FNAC method was found to be 80% and specificity was identified as 100% comparing with gold standard histopathological examination. No significant complications were seen in patients undergoing these FNAs. It can be concluded that FNA is a simple and rapid diagnostic test that can be useful for preliminary assessment of oral and oropharyngeal lesion.
Incidental Findings in CT scan in Pediatric Populations with Head Injury
Authors: Ghimire Prasanna , Paudel Nabin , Koirala Dwight
Published: May 2019

Objective: To investigate the incidental findings in computed tomography scans performed for mild head injury in pediatric patients at Nepalgunj Medical College and Teaching Hospital, Kohalpur, Banke, Nepal.

Materials and methods: It is a cross sectional hospital based study performed on two hundred and eighteen patients of age < 18 years presenting with mild head injury with no known neurological problem, recent surgery, and time of scanning < 24 hrs of sustaining injury were included in the study between Dec 2016 and June 2017.

Results: Among the 218 patients, 134 were males and 84 females, age ranged from 3 months to 18 years. 196 out of 218 patients (89.9%) had incidental findings in CT scan images with greater than 2 incidental findings present in 54 patients. Sinus opacification was the most common incidental finding noted in 86 cases (43.9 %) followed by calcified granuloma in 27 cases (13.8 %). Incidental findings unrelated to trauma which required further investigation was present in 5 cases.

Conclusion: Incidental findings are being increasingly encountered in computed tomography scan performed for mild head injury in pediatric age group with sinus opacification as the most common finding. Recognition of these findings and communication with the treating physician is helpful in the overall management of such cases.
Attitudes of Undergraduate Medical Students towards the Persons with Mental Illness in a Medical College of Western Region of Nepal
Authors: Jalan Rekha
Published: May 2019

Background: The universality of harmful beliefs and subsequent negative attitude towards the persons with mental illness among medical students are the main obstacles facing the mentally ill people that further prevents them from seeking help and care for their mental health problems. Mental health education plays a significant role in changing medical students' attitude towards persons with mental illness.

Aim: The aim of this study was to assess undergraduate medical students' attitude towards persons with mental illness and to compare their attitudes before and after mental health education.

Materials and methods: A longitudinal prospective study was carried on final year MBBS students (N=68) from June, 2017 to November, 2017. Pretest- posttest design was adopted using Attitude Scale for Mental Illness (ASMI) before and after theory classes and clinical posting for mental health education.

Results: Findings of present study revealed that these students were less stigmatized (6.44+1.93). Domain of restrictiveness improved (9.44+2.94 from 10.54+3.09) and benevolence increased significantly (t=2.440; P=0.017*) after mental health education and training. Overall attitude of the study population was found to have unhealthy attitude towards persons with mental illness since the mean scores on separatism, stereotyping, restrictiveness and pessimistic prediction subscales were elevated on ASMI.

Conclusion: In conclusion, mental health education was found to be effective in changing the attitude of restrictiveness i.e., decreasing an uncertain view on the rights of people with mental illness and increasing kindness and sympathetic view to some extent among undergraduate medical students towards the persons with mental illness.
Burden of Anemia: A profile of a tertiary care hospital
Authors: Joshi Rinku , Bajracharya S. , Gurung S. , Shrestha D.B.
Published: May 2019

Introduction: Globally, anemia is the burning health problem with significant disability associated with it. Iron deficiency anemia (IDA) is the commonest cause of anemia more so in developing and underdeveloped part of world. Normocytic anemia is the common finding following microcytic hypochromic and macrocytic in peripheral blood film study. To understand more about the type of anemia among anemic patients in our setting this study was carried out.

Objectives: This study aims to see the prevalence and aetiology of anemia among Nepal army personnel and their families in a Kathmandu based tertiary level hospital.

Methods: This cross-sectional study was conducted over a six months period through June 30th to December 31st 2017 among 342 anemic patients presented to hematology clinic of Shree Birendra Hospital in Kathmandu with the help of data collection tool. Etiology of anemia was worked out. The study was conducted after approval from local IRC. Collected data were entered in SPSS version 22 and analyzed.

Result: Mean hemoglobin value was 8.45±1.61 gm/dL and the mean age of the patient was 52.04±18.32 years. Among the patients of anemia, generalized weakness was the commonest (159, 46.5%) presenting complaint followed by per vaginal bleeding and upper gastrointestinal bleeding. Moderately severe anemia was the commonest (159, 46.5%) laboratory finding. In peripheral blood film study, microcytic hypochromic picture was the commonest finding (169, 49.4%) favoring commonest cause of anemia as iron deficiency followed by anemia of chronic disease.70 % of the participants were female.

Conclusion: The study identified nonspecific complaints like generalized weakness as the predominant presenting complaints of anemia which is commonly neglected. Further, noninvasive tests like peripheral blood film are an important diagnostic tool which can guide us to the possible aetiology of anemia. This study showed iron deficiency anemia and anemia of chronic disease as important differential diagnosis of anemia in our context.

This was a small scale study conducted to access the prevalence of anemia among Nepal army personnel and their families. Hence a larger multicentric study is needed to make it more applicable.
Broken Femoral Intramedullary Locking Nails with Nonunion: A difficult combination!
Authors: DC Gopal Sagar , Gurung Sandeep
Published: May 2019

Background: The diaphyseal fracture of femur is universally treated with intramedullary interlocking nails. Non-union with properly done interlocking nail is not very common. When broken nail and non-union coexist, it becomes a real challenge. We reviewed our isolated femoral shaft fractures treated with antegrade interlocking nails that presented with broken nails, bolts and non-union. We discuss our simple technique of retrieval of broken nail units, their management and results with revision nailing.

Materials and methods: We reviewed our cases of femoral intramedullary locking nails operated from 2012 November to 2017 November and observed that, out of 197 cases; Eight cases of broken nails were managed in our center Nepalgunj medical college Nepalgunj. Patients were operated in lateral position under combined spinal epidural anaesthesia. We removed the broken nail segment with our simple yet less destructive technique and revised with bigger nails.

Results: Out of 197 cases of fracture shaft femur treated with IM nail, 8 cases were found to have broken nails. Seven cases were associated with non-union of femur. In one case, the femur united in spite of broken nail. In all the cases broken nail were removed in a similar manner and was struggle free. Exchange nailing was done in seven cases and only one case was augmented with bone graft from ipsilateral iliac crest. Union was achieved in all seven cases.

Conclusion: IMIL nail is the well-established, minimally invasive osteosynthesis for long bones fracture. Nonunion and broken implant when coexist the management becomes difficult.
Seroprevalence of Human Immunodeficiency Virus, Hepatitis B Virus and Hepatitis C Virus in Nepalgunj Medical College, Nepal
Authors: Gurung Kishor , Poudel T.P. , Shah G.J. , Mishra D.
Published: May 2019

Introduction: Human immune deficiency viruses (HIV), Hepatitis B viruses (HBV) and Hepatitis C viruses (HCV) are the three most common chronic viral pathogens known. The viruses have common routes of transmission (such as blood and blood products, sharing needles to inject drugs and sexual activities) and similar risk factors.

Aim and objective: The aim of study was to determine the seroprevalence of HIV, HBV and HCV in Kohalpur Teaching Hospital, Nepalgunj Medical College.

Materials and methods: This is a descriptive hospital based study. The study was conducted at Nepalgunj Medical College, KTH, Banke. In this study, 2865 were tested for HIV, 2849 were tested for HBV and 2950 were tested for HCV from 12-01-2017 to 06-07-2017.

Results: In case of HIV, 1781 (62.16%) were male and 1064 (37.84%) were female. The study revealed that in HIV reactive case was found to be 0.14% where 0.16% (3) were males and 0.09% (1) were females. In case of HBV, 1743 (61.18%) were males and 1106 (38.82%) were females. The prevalence of HBV reactive was found to be 1.65% where 1.2% (34) in male and 0.45% (13) in female. In case of HCV, 1200 (40.67%) were male and 1750 (59.33%) were female. The prevalence of HCV reactive was found to be 0.03% (1) which was only in female.

Conclusion: We found that the prevalence of HIV was more predominant in males 0.16% (3). The HBV was more prevalent followed by HIV and HCV and the prevalence of HBV in male was more 1.2% (34) as compared to females 0.45% (13).
Self-medication Practice Among Undergraduate Medical Students in Nepalgunj Medical College, Chisapani
Authors: Singh Ankita , Dhami Dhabal Bahadur , Singh Ritesh , Shah Gaurav Jung
Published: May 2019

Introduction: Self-medication forms an essential part of the self-care. Since medical students are being exposed to the knowledge of diseases and drugs, would assume a special significance to assess the self-medication practice among them.

Methods: This was a cross-sectional study conducted from March to April 2018 in 200 preclinical medical students of Nepalgunj Medical College (NGMC), Chisapani. A structured questionnaire was used for data collection and the students who took self-medication within last two months were included.

Result: Out of 200 students, 123 (61.5%) were found practicing self-medication. Majority of students (47.97%) were taking Non-steroidal Anti-inflammatory Drugs (NSAIDs) for fever (18.70%), headache (17.89%) and abdominal pain (13.01%). 21.14% of students were consuming paracetamol for these health ailments. 44.72% of students reported that they were practicing self-medication because of the mild nature of illness.

Conclusion: Students are widely practicing self-medication, particularly NSAIDs group of drugs. In this situation, awareness about the pros and cons of self-medication should be must in the medical students.
Substance Abuse Among Medical Students – A Survey in a Medical College in Nepal
Authors: Roy Roshan Kumar , Roy Deepak Kumar , Goit Rajeh Kumar
Published: May 2019

Introduction: Substance use among medical students could impact on the conduct, safety and efficiency of future doctors. Despite serious medico legal, ethical and political ramifications, there is paucity of published article on the subject, especially from Nepal.

Objective: We aimed to explore the patterns of substance abuse among a sample of Medical students from Nepalgunj Medical College.

Materials and Methods: A cross-sectional survey of medical students from Nepalgunj Medical College was done using a brief questionnaire schedule to identify current and lifetime use of tobacco, alcohol, cannabis and abuse of other drugs. An operational definition of substance abuse was made, 28 % of students fell within that criterion.

Results: Male substance abusers 81% exceeded female abusers 19%. Substances most commonly abused were alcohol 60%, minor tranquilizers 48%, and tobacco 35%, and only 11% abused cannabis. While most students were multidrug users, there was a low frequency of daily drug use. A general lifetime (occasional use) prevalence of substance use of 56% was found. Drugs consumed on a daily basis were alcohol 2% and tobacco 6%. The prevalence of drug use was highest among the fourth and final year students.

Conclusion: The majority of students were occasional abusers; there was no evidence of physical dependence. This study provides a snapshot of the problem of substance use among medical students of Nepal. Further research is needed to study nationwide patterns of substance use among medical students, and to identify important determinants and reinforce preventive measures. Strategies need to be developed for supporting students with a substance use problem.
Degloving Injury: Different Ways of Management
Authors: Nakarmi Kiran K. , Shrestha Sikshya Prakash
Published: May 2019

Degloving injury involves shearing of the skin from the underlying tissue due to differential gliding in response to the tangential force applied to the surface of the body leading to disruption of all the blood vessels connected to skin. The flap of degloved skin has precarious blood supply making it almost impossible for the flap to survive. We describe two cases of degloving of thigh managed differently in different settings.
Zika Virus (ZIKV): Symptoms, Diagnosis and Treatment
Authors: Jayan Archana
Published: May 2019

No Abstract Available.
Management of Cut Throat Injury: A Review of 20 Cases
Authors: Parajuli Ramesh , Limbu Tilak Raj , Bhandari Ramesh , Thapa Suman , Tulachan Bishow
Published: May 2019

INTRODUCTION: Cut throat injury is incised injury or incised resembling injury in the neck usually due to homicidal, suicidal or accidental cause. Multiple vital structures are vulnerable to get injured so it usually requires multi disciplinary approach. The objective of this study is to evaluate cut throat injury in terms of site, severity, cause, motivating factors, age and gender distribution of the victim and the surgical treatment method.

MATERIAL AND METHODS: Retrospective study was carried out by reviewing the chart, from May 2010 to April 2014. Demographics of the patients; cause and motivating factors; site, severity and the type of surgical treatment were recorded and analyzed.

RESULTS: There were a total of 20 patients, of which 14 were males and 6 were females. The most common age group affected was 20-40 years. Homicide was the commonest cause in 12 (60%) patients, followed by suicidal attempt in 6 (30%) and accidental injury in 2 (10%) patients. Interpersonal conflict and psychiatric illnesses were the most common motivating factors for the homicidal and suicidal cut throat injury respectively. Most of the patients had zone II injury. Primary repair was the most common surgical treatment method.

CONCLUSION: Young adults are more vulnerable to cut throat injury with majority having zone II injury and homicide being the most common cause. Primary repair is the most common surgical treatment method. Addressing the root cause of violence and identifying and treating the patients with psychiatric illness with suicidal tendency will probably reduce the incidence of cut throat injury in our society.
Use of laryngeal mask airway in paediatric external dacrocystorhinostomy surgery under anaesthesia: a retrospective study
Authors: Pathak Laxmi
Published: May 2019

INTRODUCTION: Many recent studies have shown the use of Laryngeal Mask Airway (LMA) in Adenotonsillectomy but not in Dacryocystorhinostomy (DCR) surgery in paediatric age group. So, this study was carried out to evaluate the safety of LMA use in Pediatric External Dacryocystorhinostomy performed under General Anaesthesia.

MATERIAL AND METHOD:This retrospective study was carried out by collecting the data of 96 children with American Society of Anesthesiologists (ASA) physical status 1 from Lumbini Eye Institute (Memorandum of Understanding with UCMS), Bhairahawa, Nepal from September 2008 to June 2014 to find out any significant cardio-respiratory complications associated with the use of LMA.

RESULTS: This study found no significant cardio-respiratory complications during insertion and after removal of LMA. Though airway obstruction and laryngospasm had occurred in few children, it was easily managed by bag and mask ventilation. Time taken to shift the patients from Operation Theatre to Post Anaesthesia Care Unit (PACU) was also less, average 13 minutes.

CONCLUSION: This study showed that LMA can safely be used in children undergoing External Dacryocystorhinostomy under general anesthesia with the use of intermittent suctioning and without any interruption in surgery.
Antioxidant enzyme activities and lipid peroxidation in patients with bipolar affective disorder
Authors: Dubey Raju Kumar , Gautam Narayan , Dhakal Niraj , Baral Nirmal , Lamsal Madhab , Shyangwa Pramod M.
Published: May 2019

INTRODUCTION: Brain is particularly vulnerable to oxidative free radicals. Oxidative stress might primarily or secondarily be involved in the pathogenesis of Bipolar Affective Disorder. Therefore this study was aimed to estimate & compare parameters of oxidative stress and antioxidant levels in patients with Bipolar Affective Disorder and healthy controls.

MATERIAL AND METHODS: A total of 32 Bipolar Affective Disorder patients and 30 healthy subjects were recruited in this study. Plasma MDA level was measured as indicator of lipid peroxidation and SOD and CAT activities were determined as a measure of antioxidant status.

RESULT: Out of total Bipolar Affective Disorder patients 21 were in mania with psychotic symptoms, 8 were in mania without psychotic symptoms and only 3 were in mixed episode. Significantly (p<0.001) elevated MDA level (nmol/ml) was found in before treatment patient group (7.11 ± 1.62) as compared to control (3.02 ± 1.30) group. Patients on follow-up also had significantly increased MDA level (nmol/ml) (5.37 ± 1.36) as compared to control group and decrease in level was significant (p<0.001) in comparison to before treatment patients. CAT and SOD activities (U/gm Hb) were significantly decreased in both before treatment (87.57 ± 28.79 & 1341 ± 167.18) and after treatment (77.12 ± 29.48 & 1305.56 ± 154.86) patients group compared to the control (155.92 ± 29.43 & 1408.14 ± 78.82) group respectively. CAT and MDA were negatively correlated in the before treatment patients group (r = -0.356, p<0.05).

 CONCLUSION: The findings suggest that there is increased oxidative stress in Bipolar Affective Disorder patients in comparison to controls.
Refractive errors in type II diabetic patients
Authors: Shrestha Shristi , Kaini Khem Raj
Published: May 2019

INTRODUCTION: The prevalence of diabetes is increasing rapidly. Refractive error in the diabetic population is considered a main cause of visual impairment. So this study was conducted to find out the pattern of refractive errors in patients with type II diabetes mellitus in Western Nepal.

MATERIAL AND METHODS: It was a hospital-based cross-sectional study. Three hundred forty eyes of one hundred seventy patients with type II diabetes underwent comprehensive eye examination including subjective and objective refraction and serum biochemistry.

RESULTS: The mean refraction was -0.132±0.88 D. Emmetropia was seen in 49.7% of the patients, hypermetropia in 22.6%, myopia in 12.6%, and astigmatism in 15% of the patients. Older age groups had more hypermetropic refractive error (p<0.05). Female gender was a risk factor for hypermetropia (p=0.042). Good glycemic control was seen in 49.7%. There was statistically significant correlation between fasting blood sugar level and spherical equivalent refraction (p<0.05, r = -0.115).

CONCLUSION: The present hospital-based study noted a refractive error in 50.3% among diabetic population in Pokhara with hypermetropia being the most common type (22.6%) than myopia (12.6%) and astigmatism (15%).