bluuebunny/crossref_metadata_2025 huggingface dataset:
Litigation risks despite guideline adherence for acute spinal cord injury: time is spine
Authors: Rafter Daniel , Vasdev Ranveer , Hurrelbrink Duncan , Gormley Mark , Chettupally Tabitha , Shen Francis X. , Samadani Uzma
Published: November 2020

OBJECTIVE

Current guidelines do not specify timing for management of acute spinal cord injury (aSCI) due to lack of high-quality evidence supporting specific intervals for intervention. Randomized prospective trials may be unethical. Nonetheless, physicians have been sued for delays in diagnosis and intervention.

METHODS

The authors reviewed both the medical literature supporting the guidelines and the legal cases reported in the Westlaw and Lexis Advance databases from 1972 to 2018 resulting in awards or settlements, to identify whether surgeons are vulnerable to litigation despite the existence of guidelines not mandating specific timing of care.

RESULTS

Timing of intervention was related to claims in 59 (36%) of 163 cases involving SCI. All 22 trauma cases identified cited timing of intervention, sometimes related to delayed diagnosis, as a reason for the lawsuit. The mean award of 10 cases in which the plaintiffs’ awards were disclosed was $4,294,384. In the majority of cases, award amounts were not disclosed.

CONCLUSIONS

Because conduct of a prospective, randomized trial to investigate surgical timing of intervention for aSCI may not be achievable, evidence-based guidelines will be unlikely to mandate specific timing. Nonetheless, surgeons who unreasonably delay intervention for aSCI may be at risk for litigation due to treatment delay. This is increasingly likely in an environment where “complete” SCI is difficult to verify. SCI may at some point be recognized as a surgical emergency, as brain injury generally is, despite a lack of prospective randomized trials supporting this implementation, challenging the feasibility of the US trauma infrastructure to provide care for these patients.
Thanatophoric Skeletal Dysplasia: A Case Report
Authors: Anjum Firoz , Daha Sunil Kumar , Sah Ganesh
Published: November 2020

Thanatophoric skeletal dysplasia is the most lethal, rare, sporadic birth defect due to de novo mutation in the fibroblast growth factor receptor-3. Clinically this is characterized by shortening of the limbs (micromelia), small conical thorax, flat vertebral bodies and macrocephaly at birth. We encountered a similar case with ultrasonographic findings suggestive of Thanatophoric skeletal dysplasia which resulted into death of the baby within an hour of birth. Almost all cases of this condition have been reported to have died interuterinally or few days after birth.
Malposition of Central Venous Catheter Inserted under Ultrasound Guidance in Intensive Care Unit: A Case Series
Authors: Keyal Niraj Kumar , Thapa Sumal , Adhikari Pooja , Yadav Sanjeeb
Published: November 2020

Malposition of central venous catheter tip inserted into the subclavian and internal jugular vein is a rare unavoidable complication that can be decreased if inserted under ultrasound guidance. We report case series of three patients, two of subclavian and another of internal jugular inserted central venous catheter, in which the catheter malpositioned into ipsilateral internal jugular and subclavian vein respectively but had no effect on patient management. From this, we want to emphasize that the effect of malposition of central venous catheter tip depends upon the indication for which central venous catheter was inserted; it can be detected bedside by ultrasound and flush test.
Study of Missing Clinical Details in Computed Tomography Radiology Request Forms: A Descriptive Cross-sectional Study
Authors: Badu Muna
Published: November 2020

Introduction: Detailed clinical history through a properly filled requisition form can help a radiologist in making a diagnosis. The objective of this study was to observe the missing clinical details of Computed Tomography requisition forms at radiology department in tertiary care hospital.

Methods: This descriptive cross-sectional study was done in 196 Computed Tomography requisition forms in the department of radiology from September 2019 to October 2019. Ethical clearance from the Institutional Review Committee – Reference No. 120720194 was obtained. An informed consent from the participants was taken prior to the procedure. Convenient sampling was done. The data obtained were computed and analyzed using Statistical Package for Social Sciences to tabulate the results. The results were displayed in frequency and proportion of binary data.

Results: All the request forms had name filled, however date was filled in 183 (93.4%), age was filled in 195 (99.5%), sex was filled in 193 (98.5%) and address was only in 30 (15.3%) of the forms. Clinical history and provisional diagnosis were written in 179 (91.3%) forms. Signature was found in more than half of forms 135 (68.9%) whereas the department referring the patient was filled in 92 (46.9%) of forms and the name of doctor referring the patient was not filled mostly. The handwriting was clear in 191 (97.4%) of cases and standard words were used. Use of non-standard abbreviation was found in only 2 (1%) forms.

Conclusions: Clinical details were filled in most of the requisition forms however other parameters were still incompletely and inadequately filled.
Caregiver Burden among Caregivers of patient undergoing Hemodialysis in Tertiary Care Center : A Descriptive Cross-sectional Study
Authors: Chhetri Srijana Khatri , Baral Rojina
Published: November 2020

Introduction: Chronic kidney disease affects almost all aspects of life of the patients and caregivers. Dialysis is a common treatment modality for Chronic Renal Failure. The caregivers of patients undergoing hemodialysis bear the emotional and psychological stress of having a chronically ill patient. The physical and psychological distress, limitations in personal and social activities, loss of freedom, financial limitations directly or indirectly affect the level of burden among caregivers. This study aims to study the level of burden among caregivers of patient undergoing hemodialysis.

Methods: A descriptive cross-sectional study among 123 caregivers giving care to hemodialysis patients for at least 3 months at Teaching Hospitals, Chitwan was carried out using simple random sampling technique.  Level of burden was evaluated using the burden questionnaire (Zarit Burden Interview).

Results: The study revealed that 60 (48.78%) had mild to moderate, 53 (43.08%) had moderate to severe. The median scores for burden among the caregivers was (39.30±11.68) with 44.65%.

Conclusions: Coping Strategies, social support, support interventions has greater impact on caregivers in achieving their roles in caring the patients and increases the capability to cope effectively with the patient’s condition.
Tooth Shade and Skin Colour: A Descriptive Cross-Sectional Study
Authors: Pradhan Dilesh , Shrestha Lajana , Lohani Junu
Published: November 2020

Introduction: Selection of proper tooth shade is one of the most significant factors influencing patients’ aesthetic perception and improved prosthesis acceptance. Guidelines in the dental literature suggest age, sex, colour of skin, hair and eye for selecting tooth shade when past records cannot be obtained. The objective of the study was to observe the most common tooth shade in relation to the skin colour and the prevalence of the same in relation to age and sex.

Methods: A descriptive cross-sectional study was carried out at Kathmandu Medical College from June to August 2019. Vitapan Classical Shade guide was used to select the shade of upper right central incisorin 338 participants. Revlon Foundation Makeup Shade guide was used to determine colour of skin. Participants were examined without facial makeup. Skin colour and teeth shade were examined in daylight at about sametime of the day.  Data obtained were computed and analysed using Microsoft Excel 2016 software.

Results: Prevalence of tooth shade with high value (lighter shade) was seen in all fair (121, 35.8%), medium (63, 18.6%) and dark skin tones (23, 6.8%). Most common teeth shade in fair individuals was B1 (47, 37.9%), in medium also B1 (25, 7.4%) and dark was B2 (9, 2.7%). Age range of 10 to 35 years had tooth shade with higher value (159, 47.04%).

Conclusions: Hence, teeth shade with high value (lighter shade) was prevalent in skin tone of all types in current study. Skin tone was not related to teeth shade selection, teeth became darker with age and females had lighter teeth shade (high value).
Outcome of Cuffed Tunneled Dialysis Catheters for Hemodialysis Patients at a Tertiary Care Hospital: A Descriptive Cross-sectional Study
Authors: Shrestha Kajan Raj , Gurung Dinesh , Krishna Shrestha Uttam
Published: November 2020

Introduction: Arteriovenous fistula is the most common vascular access for patients requiringhemodialysis, but it is not always possible or practical hence cuffed tunneled dialysis cathetercomes into play. The aim of the study was to determine the outcome of cuffed tunneled dialysiscatheter used for hemodialysis at a teaching hospital.

Methods: A descriptive cross-sectional study was conducted between January 2014 and December2019 on 103 chronic dialysis patients with end-stage renal disease presenting to a tertiary carehospital. Ethical approval was received from the institutional review board (2/(6-11) E2/076/77).Whole sampling was done. Data entry and analysis were done in Microsoft Excel 10.

Results: The study included 103 patients with 117 cuffed tunneled dialysis catheters placed forhemodialysis. On assessing the outcome of the catheters, the primary and secondary patencyrates of the catheters were 5.85±4.87 and 1.21±3.77 months. Thirty-one (30.1%) patients requiredone intervention, and 11 (10.68%) catheters required 3 or more interventions to maintain patency.Eighteen (17.48%) patients presented with catheter dysfunction while in 11 (10.68%) cases, thecatheter was kinked or malpositioned at the notch. In one patient, procedure was abandoned dueto severe bleeding and in 2 (1.94%) patients dialysis catheters could not be negotiated into the rightatrium and left in brachiocephalic junction.

Conclusions: Cuffed tunneled dialysis catheter is effective for maintenance hemodialysis in patientswith the end-stage renal disease if used with proper care during dialysis even in our setup. Theresults and outcomes of the procedure are at par with standards.
Intradural Disc Herniation in the Lumbar Spine: A Case Report
Authors: Rathod Tushar , Panchal Sameer , Marathe Nandan , Agrahari Yogendra , Sathe Ashwin
Published: November 2020

Intradural disc herniation is a rare presentation of a common pathology, comprising around 0.28-0.3% of all disc herniations. It occurs when disc material related to an intervertebral disc penetratesthe spinal dura and lies in an intradural extramedullary location. A 60 years old male patientpresented with complaints of low back pain and right lower limb radiculopathy of 2 weeks duration.Neurological examination revealed the weakness of extensor hallucis longus and ankle dorsiflexionwith diminished sensation corresponding to fourth and fifth lumbar (L4-L5) dermatome on the rightside. Magnetic resonance imaging showed a large sequestered fragment with intradural extensionsand posterior longitudinal ligament tear. Intradural nerve root showed significant displacementwith severe central canal and right lateral recess stenosis. Discectomy was performed along with theremoval of the intradural extension. The postoperative course was uneventful.
Panniculitis as an Initial Presentation of Dermatomyositis: A Case Report
Authors: Bisht Anjal , Parajuli Niraj , Vaidya Monasha , Tiwari Sumida
Published: November 2020

Dermatomyositis is an idiopathic muscle disease characterized by proximal muscle weakness, raised muscle enzymes, characteristic changes in electromyography and typical skin rash and biopsy findings. Dermatological features like Gottron’s sign and papules are considered as pathognomonic for dermatomyositis. Panniculitis is one of the rare findings in DM. Here, we report a case of DM in 37 years old female who presented with only panniculitis and the diagnosis was delayed by more than a year.
Severe Cardiac Dysautonomia and Sudden Death in a Patient Presenting with Anginal Symptoms in Absence of Cardiovascular and Other Diseases: A Case Report
Authors: Khadka Rita , Narang Rajiv , Jaryal Ashok Kumar , Patel Chetan , Deepak Kishore Kumar
Published: November 2020

Angina is a type of chest pain, experienced by patients with ischemic heart diseases. Cardiac autonomicmodulation as assessed by heart rate variability and baroreflex sensitivity is found reduced inischemic heart disease patients. Marked reduction in heart rate variability and baroreflex sensitivityin ischemic heart disease patients is found associated with sudden cardiac death. We report a caseof a 35-year-old man who presented with angina for the last few months. Thorough investigationsshowed no evidence of any cardiac or other systemic diseases. However, his cardiovascularautonomic modulation (as assessed by heart rate variability) and spontaneous baroreflex sensitivitywere markedly reduced. The patient had sudden death within 6 months of follow-up. Reportedly,no other specific abnormalities were found before death. This case report suggests that patientspresenting with typical chest pain as angina may have severe dysautonomia and risk of suddendeath even in the absence of cardiovascular or any other known end-organ diseases.
Calcifying Epithelial Odontogenic Tumor: A Case Report
Authors: Baral Radha , Bajracharya Dipshikha , Ojha Bidhata , Karn Gaurav
Published: November 2020

Calcifying epithelial odontogenic tumor is a rare benign odontogenic tumor which accounts for approximately 1% of the entire odontogenic tumor. It was firstly described by Pindborg, and thus, is also referred to as the “Pindborg tumor”. Histologically, Pindborg tumor consists of three distinct histological compo­nents: sheets of polyhedral epithelial cells, amyloid like deposits, and calcifications. This case report describes a case of Calcifying epithelial odontogenic tumor in 26 years old female patient presented with the swelling in right posterior region of mandible. Taking into account of the aggressive nature of the lesion segmental resection of the mandible followed by reconstruction was planned for treatment. This case report highlights the importance of appropriate clinical, radiographical and histological correlation for the correct diagnosis and treatment of Pindborg tumor.
Isolated Lower Motor Neuron Facial Nerve Palsy in a Patient of Varicella: A Case Report
Authors: Choudhary Sanjiv , Srivastava Ankita , Narula Soumya
Published: November 2020

Varicella or chickenpox is usually regarded as a self-limiting disease, but occasionally it may leadto irreversible neurological complications. Isolated lower motor neuron facial nerve palsy is a rarecomplication of varicella, with very few cases reported from the Indian subcontinent. We report onesuch case, where the patient developed facial palsy after healing of cutaneous lesions and recoveredcompletely with oral corticosteroids.
Histopathologic Profile of Salivary Gland Tumors among Specimens from a Tertiary Care Hospital: A Descriptive Cross-sectional Study
Authors: Ghartimagar Dilasma , Ghosh Arnab , Shrestha Manish Kiran , Thapa Sushma , Talwar Om Prakash
Published: November 2020

Introduction: Salivary gland tumors are rare, comprising about 3% of all head and neck neoplasms. About 80% of the tumors are in parotids, 10% in submandibular glands and the remainders are distributed in sublingual and minor salivary glands. This study was conducted to evaluate the relative frequencies, types, site of distribution and the histopathological features of salivary gland tumors.

Methods: A descriptive cross-sectional study was conducted in the Department of Pathology, Manipal College of Medical Sciences, Pokhara from January 2011 to December 2019. Ethical approval was taken from the institutional review committee of Manipal College of Medical Sciences (Ref: 314). Convenient sampling was done among specimen. Data were entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 21.

Results: Among the 130 specimens, the patients’ age ranged from 6 to 78 years with a mean age of 37.26 years for benign tumors and 48.45 years for malignant tumors. There was female predominance with a male to female ratio of 1:1.36. There were 98 cases of benign tumors, commonest being pleomorphic adenoma with 82 (83.67%) cases which was noticed more frequently in fourth decade of life. Among the 32 malignant tumors, mucoepidermoid carcinoma was the commonest tumor 20 (62.5%), followed by adenoid cystic carcinoma 7 (23.33%).

Conclusions: Benign salivary gland tumors were more common than malignant tumors and the most common site of location was the parotid for both the benign and malignant tumors. Female outnumbered the male population in benign tumors whereas males were slightly more than females in malignant tumors. This study corroborated well with other previously published studies.
Perceived Stress and Stressors among Medical and Dental Students of Bhairhawa, Nepal: A Descriptive Cross-sectional Study
Authors: Bali Harleen , Rai Vaibhav , Khanduri Nitin , Tripathi Rupam , Adhikari Khushbu , Sapkota Binam
Published: November 2020

Introduction: Medical school is recognized as a stressful environment that may have a negativeeffect on a student’s academic performance, health, and psychosocial well-being. This could furtherimpact future health professionals’ attitudes and compromise patients’ care. This study aims to findout various sources of stress for medical and dental students to help prevent many future healthproblems in a student’s life.

Methods: It was a cross-sectional study done in Universal College of Medical Sciences, Bhairhawa,Nepal, among undergraduate final year bachelor of medicine and bachelor of surgery and third andfourth year (phase I and phase II) dental students, using a questionnaire with Likert’s scale. Dataobtained was tabulated and analyzed using analysis of variance.

Results: Results showed that stress during exam 210 (92.9%) and preparation phase 200 (88.5%) stoodout as the maximum stressors for our study group. The least stress-causing element was recorded asterms with seniors 45 (19.9%), adjustment with roommates 52 (23.01%), and competing with peers69 (30.53%). Length of course 187 (82.74%), understanding the course 173 (76.55%), reading severaltextbooks 171 (75.66%), and work overload 165 (73.01%) amounted to significant stressors.

Conclusions: Stress has a detrimental effect both on health as well as academic performance. Thestressors at the campus should be identified and proper coping assistance should be provided toindividual students. Systemic efforts are needed to address their concerns and make mental healthcare easily accessible to them. Counseling and awareness are recommended.
Study of Arteriovenous Fistula Cases in a Tertiary Care Hospital: A Descriptive Cross-sectional Study
Authors: Karmacharya Robin Man , Vaidya Satish , Singh Amit Kumar , Dahal Sushil , Dhakal Prasesh , Bhandari Niroj , Bade Sohail , Shrestha Prabha , Thapa Pratima
Published: November 2020

Introduction: Arteriovenous fistulas are a preferred choice for hemodialysis access in chronickidney disease patients. There is increased adoption of arteriovenous fistula creation in Nepal.Our objective is to study various arteriovenous fistulas that have been created in our center.

Methods: This is a descriptive cross-sectional study conducted in a tertiary care hospital includingall cases of arteriovenous fistula creation from January 2018 to December 2019. We obtained theethical clearance from the institutional review committee of Kathmandu University School ofMedical sciences. Convenient sampling method was used. Detailed vascular mapping and colordoppler ultrasonography was done in the bilateral upper limb as preoperative preparation and tochoose a site for arteriovenous fistula creation. Data were entered into the Statistical Package for theSocial Sciences version 20 for analysis.

Results: Among 50 patients, the most common location was brachiobasilic 20 (40%) patients followedby brachiocephalic 18 (36%), radiocephalic 11 (22%), and arteriovenous graft between the brachialartery and axillary vein 1 (2%). The mean duration of hospital stay was 1.44 days. Three (6%) patientsrequired re-intervention, all within 24 hours. Two (4%) patients had a failure of arteriovenous fistularequiring the creation of a new arteriovenous fistula.

Conclusions: Brachiobasilic was the most common location for arteriovenous fistula creation.Reintervention was not common.
Transcatheter Embolization of Ruptured Uterine Artery Pseudoaneurysm: A Case Report
Authors: Singh Sristi , Shrestha Lochan , Manandhar Sagun , Roy Pooja
Published: November 2020

A 30-years-old post-cesarean lady presented with a secondary post-partum hemorrhage for aweek, complicated by anemia, which required blood transfusion. Despite conservative medicalmanagement, the bleeding persisted and ultrasonography demonstrated a ruptured left uterineartery pseudoaneurysm. Computed Tomography angiogram was performed for confirmation andplanning for embolization. Transcatheter directed uterine artery pseudoaneurysm embolizationwas performed. Her bleeding was controlled with an uneventful post-procedure period and wasdischarged after two days. This case report summarizes the procedure of transcatheter embolizationof uterine artery pseudoaneurysm in a tertiary care hospital in Nepal.
Prevalence of Smoking among Medical Students in a Tertiary Care Teaching Hospital
Authors: Shrestha Neharika , Shrestha Nikhil , Bhusal Suzit , Neupane Asmita , Pandey Rakshya , Lohala Nita , Bhandari Arpan Pratik , Yadav Mandeep Kumar , Vaidya Abhinav
Published: November 2020

Introduction: Tobacco smoking is one of the most important preventable risk factors for noncommunicable diseases. It has been seen that medical students have a higher frequency of smokingcompared to the general population. This study aims to determine the prevalence of smoking amongthird-year medical students in a tertiary care teaching hospital in Nepal.

Methods: This descriptive cross-sectional study was conducted among the hospital’s third-yearundergraduate medical students over a four-month period (October 2019 to January 2020). Ethicalclearance was received from the Institutional Review Committee of Kathmandu Medical Collegeand Teaching Hospital. The whole sampling technique was used to collect data. The Global HealthProfessional Students Survey questionnaire was used to collect data. Data analysis was done in thestatistical package for social sciences.

Results: The prevalence of current smoking among selected medical students of Kathmandu MedicalCollege and Teaching Hospital is 34 (30.1%), majority male 26 (23%). Fifty-six (49.4%) of them hadever smoked cigarettes in their life, and 27 (23.9%) had their first cigarette in late adolescence. Thenumber of students who used other forms of tobacco was comparatively lower i.e. 6 (5.3%). Manyof the students 53 (46.9%) were exposed to second-hand smoke both at home and in public, while 18(15.9) exposed only at public places, and 6 (5.3%) only at home.

Conclusions: Our study has concluded that there is a notable prevalence of smoking among theparticipants. This points to the need for specific training sessions in their clinical years about smokingcessation for themselves and regarding counseling for patients.
Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome Rare Obstructive Uterovaginal Anomaly: A Case Report
Authors: Basnet Tulasa , Pradhan Tarun , Yadav Punita , Sah Manoj Kumar , Yadav Jyotsna , Rai Yashaswi , Thapa Rashmi
Published: November 2020

Obstructed Hemivagina and Ipsilateral Renal Anomaly syndrome is a rare obstructive uterovaginal anomaly involving both mesonephric and paramesonephric ducts. It usually presents after menarche with non-specific symptoms like pelvic pain, dysmenorrhea, or paravaginal mass and examination findings of paravaginal or pelvic mass. Because of non-specific symptoms and signs, the diagnosis is usually overlooked, which leads to complications like endometriosis, tubo-ovarian abscess compromising patient’s fertility, and quality of life. Therefore, in presence of these nonspecific clinical features along with imaging findings of uterine didelphys and unilateral renal agenesis, this syndrome should be considered in the diagnosis. We present a case of a 17-year-old lady with Obstructed Hemivagina and Ipsilateral Renal Anomaly syndrome, diagnosed by finding of paravaginal mass on examination and uterine didelphys with ipsilateral renal agenesis in USG and managed successfully by resection of vaginal septum.
Prevalence of Cervical Cancer among Cervical Biopsies in a Tertiary Care Center
Authors: Parajuli Ganesh , Dawadi Pravakar , Khadka Sabina
Published: November 2020

Introduction: Cervical cancer is one of the most common cancer among the female population inNepal. The incidence and mortality rate due to cervical cancer is higher in developing countrieslike Nepal due to a lack of proper screening and early diagnosis. This study aims to find out theprevalence of cervical cancer among cervical biopsies in a tertiary care center.

Methods: A descriptive cross-sectional study was conducted among the hospital records of cervicalbiopsies from the department of pathology of Shree Birendra Hospital from 1st May 2018 to 30thApril 2019. Ethical approval was taken from the Institutional Review Committee in February 2020.This study was conducted among 146 cervical biopsies by using convenience sampling method.Point estimate at 95% Confidence Interval was calculated along with frequency and proportion forbinary data. Data were analyzed using excel 2016 software.

Results: The prevalence of cervical cancer among 146 cases included in our study is found to be6 (4.11%) at 95% Confidence Interval (0.90-7.32). Among those cases of cervical cancer, 4 (66.67%)were squamous cell carcinoma, 1 (16.67%) was adenocarcinoma, and 1 (16.67%) was of other type.Maximum cases of cervical cancer were prevalent among higher age groups.

Conclusions: Cervical cancer-related morbidity and mortality are different in different parts ofthe world. It’s burden is primarily seen in developing countries where there is a lack of effectivescreening programs.
Rupture of Non-communicating Rudimentary Horn Pregnancy at 15 Weeks with Previous Normal Pregnancies: A Case Report
Authors: Rajbhandary Sanyukta , Das Anamika , Rai Mausam , Sah Archana Kumari
Published: November 2020

Rudimentary horn is a mullerian anomaly that is a variant of unicornuate uterus. Rudimentary horn pregnancies are rare and associated with increased maternal morbidity and mortality. Diagnosis of rudimentary horn pregnancy and its rupture in a woman with previous vaginal delivery is challenging. Although ultrasonography is an important diagnostic tool, it has low sensitivity in making diagnosis of ruptured rudimentary horn pregnancy. Therefore, clinicians should have high index of suspicion in such cases. We report a case of G3P2L2 at 15 weeks period of gestation referred to our centre as a case of intrauterine pregnancy with acute abdomen. She underwent emergency laparotomy and was found to have ruptured rudimentary horn intraoperatively. Excision of the ruptured rudimentary horn and ipsilateral salpingectomy was done and the patient had an uneventful postoperative recovery.
A Five Years Old Child with Failure To Thrive and Vomiting Presenting as a Diagnostic Dilemma: A Case Report
Authors: Lamichhane Anita , Sharma Rupesh , Rajkarnikar Ramana , Awale Rubee , Shrestha Prapti , Oli Nava Chandra
Published: November 2020

Vomiting with failure to thrive in older children is a diagnostic challenge due to the diversity in the diagnosis. We report a case of a five-years-old girl with failure to thrive, history of recurrent vomiting and intermittent colicky pain abdomen since 45 days of life. Intestinal malrotation with Ladd’s band was diagnosed based on clinical acumen, high- resolution computed tomography, barium follow through and intraoperative findings. Exploratory laparotomy with Ladd’s procedure was performed under general anesthesia which showed malrotation at the duodenojejunal junction with a short route of mesentery with floating caecum with Ladd’s band. Failure to thrive with malrotation of the gut in the older age group is rare in itself. As there are very few cases reported in this age group, so we undertook to report this case to increase the awareness of knowledge concerning the diagnosis and timely management to prevent the comorbidity of this condition.
Anesthetic Management of a Patient with Wolff-Parkinson-White Syndrome for Laparoscopic Cholecystectomy: A Case Report
Authors: KC Kiran Kumar , Hyoju Sundar , Raya Pawan Kumar
Published: November 2020

Wolff-Parkinson-White syndrome, an electrophysiological disorder of heart caused by preexcitation of an abnormal accessory pathway,can either be asymptomatic or may present with palpitation or exertional dyspnea. We report a case of an asymptomatic 45-year-old male with incidental finding of Wolff-Parkinson-White syndrome posted for laparoscopic cholecystectomy under general anesthesia. The anesthetic management of these patients is challenging as they are prone to develop life-threatening tachyarrhythmia. Taking all the necessary precautions to prevent tachyarrhythmia, balanced anesthesia, rigorous monitoring and preparedness with necessary drugs and equipment to treat any complications is the cornerstone for positiveoutcome.
Sacrococcygeal Teratoma: A Case Report
Authors: Shrestha Hari Kishor , Shrestha Roshan Gongal
Published: November 2020

Sacrococcygeal teratoma is rare and happens in 1:35,000 to 40,000 live births. It is more common in girls than boys with the reported ratio of 3:1 to 4:1. We herein report an unusual case of a huge sacrococcygeal teratoma, which was more than half of the size and weight of the baby which was terminated at 24 weeks of gestation.
Prevalence of Laryngomalacia among Young Children Presenting with Stridor in a Tertiary Care Hospital
Authors: Pokharel Apar
Published: November 2020

Introduction: Laryngomalacia is one of the most common causes of stridor in young children. It can be a serious concern to both parents and caregivers. The main objective of this study is to find the prevalence of laryngomalacia among young children presenting with stridor in a tertiary care hospital in central Nepal.

Methods: A descriptive cross-sectional study was carried out form 1st December 2017 to 1st May 2020 in children less than two years of age in a tertiary care hospital. Ethical approval was taken from the Institutional Review Committee of the hospital (reference number: 2020/23). Convenient sampling was done. Detailed demography, clinical examination, and video laryngoscopy findings were evaluated to find the prevalence of laryngomalacia among all children with stridor. Data were analyzed by using Statistical Package for the Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.

Results: Out of 430 participants who presented with stridor, the laryngomalacia was found in 234 (66%) (58.7-74.07) cases at a 95% confidence interval. The male: female ratio was 1.7:1. Most children, 192 (67.6%), presented with a milder form of laryngomalacia. The most common type was a mixed type of laryngomalacia in 159 (56%). Sleep-disordered breathing was seen in 113 (39.79%) of children diagnosed with laryngomalacia.

Conclusions: Our study concluded that laryngomalacia was the most common cause of stridor in children less than two years of age. However, in most cases, the problem is not serious and a regular follow-up with weight monitoring is warranted.
Functional Outcome Estimation of Calcaneum Fractures Treated by Open Reduction and Internal Fixation with Plate and Screws in A Tertiary Centre: A Descriptive Cross-sectional Study
Authors: Dwivedi Rajeev , Khatri Mandir , KC Arjun
Published: November 2020

Introduction: Calcaneum fractures constitute about 60% of all tarsal bone fractures. Intra-articularfractures account for 70% of all calcaneal fractures. There are controversies regarding the operativetreatment of calcaneum fractures. Therefore this study aimed to estimate the functional outcomes ofcalcaneum fractures treated by open reduction and internal fixation with plate and screws.

Methods: This descriptive, cross-sectional study was carried out at the tertiary care center in thewestern region of Nepal among the patients with displaced intra-articular calcaneum fractures fromFebruary 2017 to July 2020 after approval from the Institutional review committee. Convenientsampling was done to reach the sample size. Fifteen cases were included in the study. Data wererecorded in proforma and Data analysis was done in the statistical package for social sciences. TheAmerican Orthopedic Foot and Ankle Society Hindfoot score was used to assess the final outcome.

Results: According to the American Orthopedic Foot and Ankle Society hindfoot scores, there werefive excellent (33.33%), seven good (46.66%), two fair (13.33%) and one poor (6.66 %) results.

Conclusions: In displaced intra-articular calcaneum fractures, open reduction and internal fixationwith plates and screws result in a good number of satisfactory outcomes with very few unsatisfactoryresults. Hence it can be a better option of treatment in displaced intra-articular calcaneum fractures.
Psychological Effects of COVID-19 and Its Measures in Nepalese Medical Students
Authors: Bhandari Anima , Bhatta Nisha
Published: November 2020

Having to listen to the devastating daily news brought by COVID-19 since the first case was reported on 23rd January 2020 in Nepal, it has pushed the country into various crises. The issue of psychological health has been overlooked during this crisis.COVID-19 has sabotaged the psychological health of general people and more importantly medical students. It has disrupted the academics and clinical rotations of medical education. The prospect of being the future health care personnel without adequate training has destroyed the confidence and aspiration andin addition, joining the frontline against this type of deadly virus with little preparedness has instilled fear and uncertainty among them. So, concerning the context, this article focuses on the psychological effects faced by medical students and some ways to overcome this issue.
Prevalence of Thyroid Dysfunction Among Depression Patients in a Tertiary Care Centre
Authors: Kafle Bikram , Khadka Bikram , Tiwari Mohan Lal
Published: November 2020

Introduction: Patients with thyroid disorders are more prone to develop depressive symptoms and conversely depression may be accompanied by various subtle thyroid abnormalities. The aim of the study was to estimate the prevalence of thyroid dysfunction in depression.

Methods: This is a descriptive cross-sectional study conducted at Devdaha Medical College and Research Institute employing a simple random sampling technique during the period of August 2019-January 2020. The research was approved by the Ethical Committee of the Institutional Review Board of Devdaha Medical College and Research Institute. The protocol approval number is 009/019. Data analysis was done in Statistical Package for the Social Sciences (Version 23). Results were presented as frequencies and percentages where required.

Results: Among 263 patients with depression, 69 (26.2%) had abnormal thyroid status with most common being subclinical hypothyroidism 32 (12.2%), 13 (4.9%) overt hypothyroidism and 7 (2.7%) overt hyperthyroidism.

Conclusions: The prevalence of thyroid dysfunction is high among patients with depression. We recommend to conduct routine thyroid function tests for all the patients with depression.
Excessive Daytime Sleepiness among First to Fourth Year Undergraduate Students of a Medical College in Nepal: A Descriptive Cross-sectional Study
Authors: Roka Kumar , Khadka Sabina , Dahal Sanju , Yadav Meenakshi , Thapa Puja , KC Rubina
Published: November 2020

Introduction: Excessive Daytime Sleepiness is a significant health problem among medical students worldwide which can impair their cognitive and academic performances. Our study aims to determine the prevalence of Excessive Daytime Sleepiness among the first to fourth year undergraduate students of the Nepalese Army Institute of Health Sciences-College of Medicine.

Methods: Following the ethical approval from the Institutional Review Committee with registration no. 317, a descriptive cross-sectional study was conducted among the first to fourth year medical students of the Nepalese Army Institute of Health Sciences-College of Medicine from 4" to 10" August 2020. Two hundred and thirty-two students were selected for the study using the stratified random sampling technique. Epworth Sleepiness Scale was used to obtain data on daytime sleepiness among the study participants. The data were entered into Google spreadsheets and later analyzed. Point estimate at 95% Confidence Interval was calculated along with the frequency and proportion for binary data.

Results: The prevalence of Excessive Daytime Sleepiness among the first to fourth year undergraduate students of the Nepalese Army Institute of Health Sciences-College of Medicine is found to be 67 (31.02%) at 95% Confidence Interval (24.85-37.19). It was found to be highly prevalent among the fourth year undergraduate medical students 20 (35.09%) and least prevalent among the first year students 13 (26.00%). Excessive Daytime Sleepiness was found to be slightly higher among females 23 (34.85%) than males 44 (29.33%).

Conclusions: Excessive Daytime Sleepinessis highly prevalent among medical students in our study as suggested by various international studies.
Ciało ludzkie i jego udział w szczęściu nieba – koncepcja Pseudo-Dionizego Areopagity wobec poglądów neoplatoników pogańskich
Authors: Stępień Tomasz
Published: November 2020

In seventh chapter of his On the Ecclesiastical Hierarchy Pseudo Dionysius the Areopagite treats on the ceremony of burial. While explaining the rites he makes a few remarks on the Christian understanding of the body and its fate af­ter death, and how it is inconsistent with some pagan views on the matter. He discusses several opposite statements of the complete disintegration of the body, metempsychosis and seeing the life of the body after death exactly like the life on earth (On the Ecclesiastical Hierarchy VII 3, 1). This polemic is pointed against Neoplatonic philosophers who held such opin­ions, and to understand the difference between pagan and Christian view on the matter, the second part of the article considers the Neoplatonic view of the life after death. At Neoplatonic schools there were a different opinions of whether the embodiment is good or rather damaging to the intellectual soul. Philosophers like Plotinus and Porphyry explained descend of the soul as being evil, while Iamblichus and Damaskios thought otherwise. However there were points in which Neoplatonics were completely in agreement. All of them admitted that the happiness of the soul after death is possible only without the material body, and that the soul can reincarnate. Analysis of Neoplatonic view shows that the negative approach to the body is not the feature that could be ascribed to all Late Greek philosophers. Pseudo-Dionysius sees the problem in the Christian perspective. The soul at the moment of death does not loose completely the connection with the body and thus death does not mean the dissolution of the substance. However the new body that will be given to believers after resurrection will not be exactly the same with the earthly one.
La prefazione di san Girolamo alla continuazione della "Cronaca" di Eusebio di Cesarea
Authors: Degórski Bazyli
Published: November 2020

Zanim Euzebiusz z Cezarei napisał swoje najsławniejsze dzieło Historia Kościelna (Ἐκκλησιαστική ἱστορία), zredagował Kronikę, to znaczy: dzieło historyczne, które streszcza dzieje świata. Grecki oryginał tego dzieła zaginął, ale mamy całe jego tłumaczenie w języku armeńskim i częściowe jego tłumaczenie po łacinie, którego dokonał właśnie św. Hieronim. Po przedstawieniu w pierwszej części syntezy historii wschodniej i greckiej, w drugiej części dzieła Euzebiusz prezentuje tablice, które przedstawiają historię ludzkości od Abrahama (2016 prz. Chr.) do roku 303 po Chr., i właśnie ta druga część Kroniki Euzebiusza została przetłumaczona przez św. Hieronima. To tłumaczenie św. Hieronim uzupełnił dochodząc do roku 378 po Chr. Hieronim przeczytał Kronikę Euzebiusza i przetłumaczył ją mniej więcej w roku 380. Zrobił to podczas swojego pobytu w Konstantynopolu. Pomimo wielu błędów i nieścisłości, które św. Hieronim przejął z tekstu greckiego dzieła Euzebiusza, ale także pomimo błędów popełnionych przez samego św. Hieronima, to historyczne dzieło jest użyteczne także i dzisiaj. W przeszłości natomiast zostało ono wykorzystane przez starożytnych historiografów, którzy je dalej kontynuowali. Dla przykładu byli to: Prosper z Akwitanii, Kasjodor, czy też Wiktor z Tunnuny.
Chrystianizacja prawa po „edykcie mediolańskim”
Authors: Żurek Antoni
Published: November 2020

The Constantine breakthrough was the beginning of changes in the whole Roman Empire state system. In Roman Law that process meant the introduction of Christian elements into legislation. The process of Roman Law Christianiza­tion was started by the Emperor Constantine the Great and was proceeded by his successors. The scope of those changes is difficult to determine. It is even more difficult to determine those changes mechanism of introduction. It is sure that Church was not the initiator of them. Even priests not always had been satisfied with those changes. Simplifying, those changes could be reduced to three areas: law and rules regarding the Christian cult; respecting the Christian spirit laws, and, finally, to, so called, privileges which were bestowed to the Catholic Church. It seems to be that this process did not open the way to introduction of confes­sional state but strengthened its tolerant – in religious case – character. This article is a systematization attempt of these issues, especially in the face of the numerous appearing allegations.
The missing turning point. Apologetic roots of the Nicene creed
Authors: Misiarczyk Leszek
Published: November 2020

W tekstach apologetów greckich II w. jest wyraźnie powiedziane, że Logos został zrodzony z Ojca, a Justyn i Tacjan na opisanie tego procesu używają zazwyczaj greckiego czasownika gennao (rodzić), nigdy zaś ktizo (stwarzać). Justyn Męczennik jest pierwszym autorem chrześcijańskim, który użył zwrotów „zrodzony z woli Ojca”, „według woli Ojca”, „z Ojca, Jego wolą i mocą”. W Dialogu z Żydem Tryfonem 128, 4 pośrednio potwierdza on, że Syn został zrodzony z substancji Ojca i używa po raz pierwszy w tekstach chrześcijańskich terminu “substancja Ojca” (oÙs…a), aby opisać naturę Boga. Precyzuje również, że to zrodzenie Syna z Ojca dokonało się nie przez odcięcie albo całkowite odd­zielenie się, ale przez uczestnictwo, podobnie jak nowy ogień zapala się od star­ego nie umniejszając jego natury. Ten Syn zrodzony z Ojca jest według Justyna numerycznie odrębny od Niego i różni się od Niego nie tylko imieniem, ale rzec­zywistym nowym istnieniem choć nadal uczestniczy w tej samej niepodzielnej substancji. Tak więc przynajmniej w tych dwóch punktach: Syn „został zrodzony z Ojca” i “został zrodzony z substancji Ojca” Credo Nicejskie nie jest żadnym teologicznym punktem zwrotnym, a potwierdza jedynie teologiczne idee wypra­cowane już przez Justyna i Tacjana w II wieku.
Profesor Albertyna Szczudłowska-Dembska (9 XII 1934 - 17 IX 2013)
Authors: Kopp Edyta , Stawiszyński Wojciech
Published: November 2020

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Studi Fenomenologi Budaya Perencanaan Keuangan Keluarga Musllim di Sidoarjo dan Surabaya
Authors: Fauzia Ika Yunia
Published: November 2020

Abstrac:This paper is interested in exploring the phenomenon of planning and management of the Muslim family finances in Sidoarjo and Surabaya. The Muslim families that this paper focuses on are those with high religious commitment judged from their regular attendance to religious rituals and gatherings such as Majlis Taklim and the likes. The towns of Sidoarjo and Surabaya are being chosen to obtain specific findings on the one hand, and to have a better picture of the culture of wealth management among the urban Muslims on the other. The study is qualitative in its methods, and phenomenological in its analysis. Data were extracted from 20 informants, 7 of whom are categorised as lower income, 8 are middle income, and 5 are upper income laborers. One of the findings that this paper comes about is the fact that better understanding to the teachings of religion obtained from religious gatherings does not necessarily make a family better in its financial planning and management. On the other hand, with some exceptions, many informants among the lower classes are capable of managing their household and running their finances well making them better off to prepare their future needs.Â Keywords: Planning, management, Muslim household, familyÂ Abstrak:Fenomena perencanaan dan pengelolaan keuangan rumah tangga keluarga Muslim selalu menarik untuk dibahas, terlebih keluarga dengan intensitas yang tinggi untuk mempelajari agama Islam melalui Majlis Taklim dan kajian-kajian agama lainnya. Penelitian ini membatasi lokasi hanya di Surabaya dan Sidoarjo saja, untuk mendapatkan temuan yang spesifik. Penelitian dilakukan dengan metode kualitatatif, dengan alat analisis fenomenologi. Data digali dari 20 informan, dengan spesifikasi 7 informan dari kategori pendapatan kelas bawah, 8 informan dari kategori pendapatan kelas menengah dan 5 informan dari kategori pendapatan kelas atas. Dari beberapa informan tersebut dihasilkan satu temuan, bahwa semakin tinggi pemahaman keagamaan yang didapatkan dari kajian-kajian agama tidak serta merta menjadikan sebuah keluarga cerdas dalam merencanakan dan mengelola keuangan rumah tangga mereka. Walaupun ada beberapa pengecualian, yaitu terdapat informan di kalangan bawah yang mampu memanaj keuangan rumah tangga mereka dengan baik sehingga mereka bisa mempersiapkan kebutuhan masa depan dengan bijak.Kata Kunci: Perencanaan, pengelolaan, rumah tangga Muslim, keluarga
FOÇA’DA İKİNCİ KONUTLARIN SOSYO-KÜLTÜREL VE EKONOMİK ETKİLERİ ÜZERİNE YEREL HALKIN ALGI VE TUTUMLARI
Authors: OĞAN Okan , YASAK Üzeyir
Published: November 2020

İkinci konutlar, bulunduğu mekânın sosyo-kültürel ve ekonomik yapıları üzerinde çeşitli olumlu etkilere sahiptir. İkinci konutların kent ekonomisi üzerindeki olumlu etkilerinin dışında pahalılaşma, alım gücünün düşmesi, arazi ve konut değerlerinin artması gibi olumsuz etkileri de olabilmektedir. İkinci konutların sosyo-kültürel etkileri çoğunlukla sentez bir kültürün doğması şeklinde meydana gelebileceği gibi iki toplum arasında sosyo-kültürel çatışmaya da neden olabilmektedir. Bu araştırmada, ikinci konutların sosyo-ekonomik etkilerine yönelik Foça’da yaşayan yerel halkın algı ve değerlendirmelerini belirlemek amaçlanmaktadır. Araştırma örneklemi, Foça’da yaşayan yerel halk arasından rastlantısal olarak belirlenmiştir. Araştırma, nicel araştırma yöntemi ekseninde gerçekleştirilmiş olup veriler oluşturulan soru kağıtları vasıtasıyla temin edilmiştir. Toplanan veriler IBM SPSS Statistic programı vasıtasıyla analiz edilmiştir. Araştırmada sırasıyla betimsel analizler, keşfedici faktör analizi, güvenirlik ve normallik testleri, T testi ve ANOVA testi uygulanmıştır. Araştırma bulgularına göre Foça’da yaşayan yerel halkın, ikinci konutların ekonomik katkılarıyla ilgili pozitif algıya sahip olduğu görülmesine rağmen sosyo-kültürel açıdan yerel halkın bakış açısının olumsuz yönde olduğu saptanmıştır. Yapılan fark testlerine göre yerel halkın cinsiyetlerine göre ikinci konut algılarının benzer olduğu görülmüştür. Ayrıca katılımcıların yaş, eğitim düzeyi, gelir seviyesi, meslek grubu değişkenlerine göre ikinci konut algılarının farklılaştığı tespit edilmiştir.