bluuebunny/crossref_metadata_2025 huggingface dataset:
El “éthos” del gobernante y el orden político: claves filosóficas para la comprensión de la virtud como capacidad a partir de “El político” de Baltasar Gracián
Authors: Palomar Torralbo Agustín
Published: July 2024

El propósito de este artículo es mostrar, en primer lugar, la centralidad del concepto de capacidad política como capacidad de gobierno en El Político de Gracián y cómo este concepto hunde sus raíces en la concepción de la virtud como dýnamis. En segundo lugar, expone de qué modo esta centralidad adquiere su verdadero sentido y alcance cuando se comprende desde la tensión que se genera en la confrontación de los dos modelos políticos que se consolidan en el Barroco: el que corresponde al de la razón de Estado y al modelo del príncipe cristiano. Finalmente, nuestro trabajo, profundizando en el concepto de virtud política en la Modernidad, pretende comprender cómo en el Renacimiento se genera la tensión que, posteriormente, lleva a Gracián a perfilar su concepto de capacidad política como capacidad de gobierno. Esta tensión puede verse paradigmáticamente en Maquiavelo y Erasmo
Mast Design Performance - Influence of the Non-Linear Elastic Behaviour of Carbon Fibres on the Accuracy of Fluid/Structure Interaction Models for Estimating Mast Bending
Authors: Keryvin Vincent , Méchin Pierre-Yves
Published: July 2024

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The masts of racing yachts are generally made of carbon fibre reinforced plastics (CFRP) and are subject to two main loads: dock tuning and the forces exerted by the sails. Both result in compression and bending of the mast. The mast design must ensure that for any given sailing configuration, the mast deflection is matched to the sail design to maximise the boat’s performance. Fluid/structure interaction models are generally employed by sail designers who use a stick model for the structural definition of the mast. The elastic properties of the CFRP plies involved in mast lamination are assumed to be constant in this latter model. However, stiffness increases under tension and decreases under compression (up to 30% at failure depending on the fibre type, standard modulus, intermediate modulus, etc) due to some reversible changes in the microstructure of the carbon fibres. As a result, the actual curvature of the mast can be very different from that calculated with the stick model, leading to a significant error in the actual shape of the sail during sailing. In this work, we use a series of three critical loading cases corresponding to those of an IMOCA mast. The influence of the elastic non-linearity of the CFRP plies on the performance of the racing yacht mast is quantified. It is concluded clearly that this elastic non-linear behaviour of carbon fibres is to be accounted for by sails designers to optimise performance. Such an influence is expected to be even more pronounced on spreader masts such as those used for America’s Cup.

Keywords

Yacht design; IMOCA mast; Carbon fibre composites; Non-linear elasticity
DEVELOPMENT CONSIDERATIONS AND OPPORTUNITIES A WINE TOURISM – THE CASE STUDY OF THE STATE ENTERPRISE QUALITY WINES INDUSTRIAL COMPLEX „MILEȘTII MICI”
Authors: Gutan Victoria , Zugravu Gheorghe Adrian
Published: July 2024

Wine tourism in the Republic of Moldova occupies an important segment in the country's tourism. Investments in wineries and the state's initiative to register the Republic of Moldova on the map of European wine tourism have led to the creation of itineraries that allow visiting numerous domains and wineries. Moldovan wine products are in demand on the EU market, which contributes to the sustainable development of both the wine sector and wine tourism. This article represents a research of the difficulties and possibilities of development of the wine tourism activity in order to discover the solutions and ways of development of the wine tourism in the Republic of Moldova. The topic is current and needs to be researched. The purpose of the present scientific investigation is to research the wine tourism activity of „Mileștii Mici” Winery, the largest underground winery in the Republic of Moldova, in order to identify development obstacles and ways to overcome them. The present study was carried out based on the following research methods: analysis, synthesis, comparison, grouping, etc. The authors' contribution consists in the presentation, calculation and analysis of the main indicators regarding the volume of tourist activity, the evaluation of the performance, competition, risk and tourist potential of the „Mileștii Mici” Winery and the development of recommendations regarding the promotion of its tourist activity.
PENERAPAN MODEL PEMBELAJARAN PROBLEM SOLVING BERBASIS SOAL HOTS PADA MATERI SPLTV DALAM MENINGKATKAN HASIL BELAJAR SISWA KELAS XF SMA NEGERI 2 ABIANSEMAL TAHUN PELAJARAN 2023/2024
Authors: I Made Surat  , I Wayan Edi Ari Suandana  , Ika Desi Budiarti
Published: July 2024

Abstrak Problem solving is the process of identifying, analyzing, and resolving a problem through systematic and creative steps to achieve the desired goal or solution. High Order Thinking Skills (HOTS) questions are educational assessments that test higher-order thinking abilities. The purpose of this research is to determine the response and whether the implementation of the problem-solving learning model can enhance students' ability to answer HOTS questions on SPLTV material. The research subjects are students of class XF at SMA Negeri 2 Abiansemal for the academic year 2023/2024. The study focuses on understanding SPLTV material with an orientation towards HOTS questions and students' responses to the problem-solving learning model. This research employs a classroom action research design, consisting of two cycles with four stages of activity processes, including (1) planning, (2) action, (3) observation, and (4) evaluation and reflection. Data collection involves assessing student test results as quantitative data and using observation techniques for qualitative data. The research findings indicate that (1) the implementation of the problem-solving learning model can improve students' ability to answer HOTS questions on SPLTV material, and (2) there is a positive response from students towards the implementation of the problem-solving learning model to enhance their ability to answer HOTS questions on SPLTV material
Perception of Nursing Students toward Academic Learning Environment in a College of Kathmandu
Authors: Koirala Manisa , Koirala Surya , Neupane Sharmila
Published: July 2024

Introduction: A supportive and systematic design of academic learning environment has been important for transfer of learning in clinical context, can lead to positive outcomes for graduates and best prepares for professional life. The objective of this study was to find out the perception of nursing students toward academic learning environment.
Methods: The descriptive, cross sectional study design was used among 172 proficiency certificate level (PCL) nursing students at Maharajgunj Nursing Campus, Kathmandu Nepal. The data were collected by using Dundee Ready Education Environment Measure (DREEM) Inventories with complete enumeration technique which was developed by Roff et al (1997). Data were analyzed using descriptive and inferential statistics.
Results: Overall mean score of academic learning environment was found 142.78 out of 200 for 50 items which was in the ranged for ‘positive’ learning environments. The total mean score for perception of learning was 34.4 out of 48; for perception of teacher 30.7 out of 44; for academic self-perception 25 out of 32; for perception of atmosphere 33.3 out of 48; for social self-perceptions 19.3 out of 28. Mean scores indicated that students’ rated all five dimensions of the educational environment in this institution as an average. The significant differences were found between overall mean score; mean score of teachers, academic self-perception & social self perception of students and different academic year.
Conclusion: The overall mean DREEM scores indicate a more positive academic learning environment. Although the overall learning environments score of this institution observe as an average, none of the items represents ‘excellent’ score or real positive academic learning environment.
Retrospective Review of Adrenalectomy in a Tertiary Center in Nepal
Authors: Dhital Pawan , Rai Bipendra DK , Pradhan Manish , Poudyal Sujeet , Chapagain Suman , Luitel Bhoj R , Chalise Pawan R , Sharma Uttam K , Gyawali Prem R
Published: July 2024

Introduction: Adrenal gland surgery is a challenging art as it encompasses diverse physiological derangements which are even life-threatening. Also, it remains a medical finesse to rightly identify the correct patient who will benefit from surgery which include strong biochemical and radiological resource. Soundly performed surgery will lead to oncologic and homeostatic correction leading to near normal course.
Methods: This is a retrospective analysis of adrenalectomy cohort over three years in a tertiary center in Nepal identifying diagnosis, perioperative management and postoperative course. The objective of this study is to review the presentation, histopathology and clinical outcomes of patients operated for adrenal mass in our center.
Results: There were 42 surgeries performed via open approach. The number of adenoma, phaeochromocytoma, carcinoma and non-functioning tumor were 13, 16, 12 and one respectively. In most of the hypertensive patients, control was achieved with minimal drug and recurrences were observed in 25% of carcinoma in postoperative follow up.
Conclusion: A large proportion of operative adrenal mass are observed clinically in our setup. The surgical outcome is satisfactory but judicious perioperative management is essential.
Outcome Analysis of Lipomeningomyelocele Repair in Children in a Tertiary Care Center in Nepal
Authors: Koirala Puspa R , Pradhanang Amit B , Sedain Gopal , Sharma Mohan R
Published: July 2024

Introduction: Lipomeningomyelocele (LMM) is a common neural tube defect especially prevalent in low-income countries. When they get appropriate care, long term result is generally good provided the patient receives good neurosurgical, paediatric and rehabilitation care. Surgery is the mainstay of treatment. Our aim was to analyze immediate and long-term results of lipomeningomyelocele repair in symptomatic patients presenting to TU Teaching Hospital, Kathmandu, Nepal.
Methods: Thirteen patients admitted to Department of Neurosurgery from January 2017 to December 2018 were evaluated. All patients underwent MRI of whole spine before surgery. Surgical procedures involved total excision of lipoma and repair in 10 patients and subtotal excision and repair in 3 patients. Division of filum terminale could be done in 8 patients. Follow up varied from 6 months to 2 years.
Results: This study included 8(61.5 %) patients of lumbosacral LMM, 3(23%) patients of sacral LMM and 2( 15.38%) patients of thoracolumbar LMM . About 2 (15.38%) were operated before 3 months of age, 2 (15.38%) were operated between 3-6 months of age, 5 (38.46%) were operated between 6-12 months of age and 4 (30.7%) were operated after 1 year. All children except one presented with lump on back since birth and four presented with urinary incontinence, one presented with bilateral club foot. Four (30.7%) patients had weakness of one or both lower limbs. Two (15.38%) patients had improvement in urinary incontinence, two unchanged and one had developed urinary incontinence postoperatively. Four children with had weakness of lower limbs; one patient improved whereas three patients did not improve postoperatively. There was no development of postoperative hydrocephalus after LMM repair. Three (23%) patients developed wound infection who responded well with regular dressings and antibiotics.
Conclusion: Lipomeningomyelocele repair can be done with satisfactory outcome with total excision of lipoma and division of filum terminale. Patients with residual lipoma and undivided filum terminale should be observed closely for the development of progressive neurological deterioration.
Ventilator-Associated Pneumonia in Neurosurgical Patients: A Tertiary Care Center Study
Authors: Shrestha Dipendra K , Rajbhandari Binod , Pradhanang Amit , Sedain Gopal , Shilpakar Sushil K , Pradhan Saurav
Published: July 2024

Introduction: Ventilator-associated pneumonia (VAP) is a well recognized complication in patients who are admitted to the Intensive Care Unit (ICU). A number of factors have been suspected or identified to increase the risk of VAP in Neurosurgical patients. Early and rapid diagnosis and initiation of the appropriate antibiotic treatment reduce mortality and decrease the development of MDR organisms. The aim of our study is to determine the incidence of VAP in the neurosurgical patients and also to assess the probable contributing neurosurgical risk factors and find out the causative bacterial pathogens and the resistant pattern of these bacteria in neurosurgical patient in ICU of our institute
Methods: A retrospective observational study of 106 neurosurgical patients who were on mechanical ventilation for more than 48 hours was done.
Results: Out of 106 patients, 35 patients fulfilled the clinical and microbiological criteria for the diagnosis of VAP. The commonest age group involved was between 15-25 years of age with male preponderance. Head injury was the commonest etiology. There was a linear correlation between the number of days in ICU and the development of VAP. The majority of the pathogen isolated were gram-negative bacteria and all were sensitive to Colistin.
Conclusion: Head injury is a significant risk factor for VAP. Prolonged mechanical ventilation is an important risk factor for VAP.
Comparison of Sevoflurane and Isoflurane for Myocardial Protection During Coronary Artery Bypass Surgery in a Tertiary Care Center in Nepal
Authors: Bastola Priska , Pradhan Bishwas , Basnet Madindra
Published: July 2024

Introduction: Myocardial protection during Coronary Artery Bypass Graft (CABG) has always been an area of concern so we aimed to evaluate the level of release of Creatine Phosphokinase (CPK-MB) and Troponin I (cTnI) at various time intervals in the first 24 hours after on pump CABG in patients receiving either Sevoflurane or Isoflurane. Furthermore clinically relevant patient outcomes were also evaluated in patients undergoing on pump coronary artery bypass grafting.
Methods: This was a prospective randomized trial in patients undergoing on pump coronary artery bypass graft surgery, which was conducted from January 2016 till June 2017. A total of 105 patients were enrolled out of whichthere were 53 in Isoflurane and 52 in Sevoflurane group who received the respective volatile anesthetic agents throughout the surgery except during bypass at 1-1.5 MAC. The primary outcome was comparison of the CPK MB and cTnI levels at 0 hr, 6 hr, 12 hr and 24 hr after surgery from baseline, whereas the secondary outcomes were duration of intensive care unit stay, usage of vasopressors and inotropes, renal dysfunction, stroke.
Results: No significant difference in CPK MB and cTnI levels at all time intervals in both the groups, the other secondary outcome parameters were comparable.
Conclusion: The study found no difference in the cardiac markers between the two anesthetics. Based on the data, Sevoflurane and Isoflurane might be used equivalently in patients undergoing coronary artery bypass graft surgery with extracorporeal circulation without any difference in their myocardial protection function.
Knowledge and Practice on Prevention of Complications of Diabetes Mellitus among Patients with Diabetes in a Tertiary Hospital
Authors: Acharya Om K , KC Takma , Shrestha Krishna D
Published: July 2024

Introduction: Diabetes is a major contributing factor for overall health status, morbidity, mortality and quality of life. Adequate knowledge and sufficient practice can prevent many possible diabetic complications. Hence, the objective of this study was to find out the knowledge and practice regarding prevention of complications of diabetes among diabetic patients.
Methods: A descriptive, cross-sectional design was carried out in Tribhuvan University Teaching Hospital Kathmandu (TUTH). A total 124 diabetic patients who came for follow-up in endocrine Outpatient Department were selected through purposive sampling technique by using pre-tested structured interview schedule during four weeks. Data was analyzed by using the descriptive and inferential statistics with the help of Statistical Package of Social Science (SPSS) version 16.
Results: The study findings showed that 24.2% respondents had adequate knowledge about complications . More than half of the respondents had sufficient practice (52.4%) regarding prevention of diabetic complications. Association between knowledge and selected variables showed that sex and education level tends to be significantly associated and regarding practice, area of residence and duration of illness were significantly associated (p<0.05). There was a statistically significant (p<0.001) and average positive relationship (r=0.605) was found between knowledge and practice.
Conclusion: The study concluded that though only few respondents had adequate knowledge, more than half of the respondents had sufficient practice regarding preventing complications. This finding suggests awareness program regarding prevention of compilcations of diabetes mellitus should be launched periodically to increase knowledge and sufficient practice on prevention of diabetic complications.
Batwing Technique in Large Volume Excision of Breast Lesions: Case Report
Authors: Khanal Suman , Singh Yogendra P , Sharma Rashmi
Published: July 2024

Oncoplastic surgical techniques are seeing widespread use for excision of large volume breast lesions. Batwing technique is one of the volume displacement techniques that can be used to manage lesions in central quadrant of the breast. Such techniques are still underused in Nepal. Here we present three cases with large volume benign breast lesions managed with simple, easy-to-learn technique of Batwing oncoplasty.
Changes in the Quality of Life of Outpatients in Methadone Maintenance Treatment Clinics in Kathmandu Valley
Authors: Sapkota Basanta , Tulachan Pratikchya , Ojha Saroj P , Chapagai Manisha , Dhungana Saraswati
Published: July 2024

Introduction: Methadone maintenance treatment (MMT) is widely accepted treatment option for the opioid dependent individuals. The evaluation of the quality of life represents the assessment of the effectiveness of the treatment program. The study aimed to explore the impact of MMT program on clients’ quality of life in the first 6 months of treatment.
Methods: A total of 63 patients were recruited from the 5 different methadone clinics of Kathmandu valley. A prospective follow-up design was used. The semi-structured pro forma was filled up. To assess quality of life, WHO Quality of Life questionnaire (WHOQOL-BREF, 26-item version) was used. The tool was used to assess the quality of life at the baseline and after 6 months of enrollment in MMT program.
Results: Following 6 months of methadone maintenance treatment of opioid dependent individuals, significant improvements (P<0.001) were observed in all measured domains of quality of life i.e. physical, psychological, environmental and social. The least improvement was noted in the social domain.
Conclusion: Methadone maintenance treatment is helpful in improving the quality of the life of the opioid dependent individuals in MMT clinics.
Role of Preoperative CEA, CA 19-9, NLR and PLR as Predictors of Adverse Prognostic Pathological Features of Gastric Carcinoma Patients in a Tertiary Centre of Nepal
Authors: Mandal Rajesh K , Bhandari Ramesh S , Lakhey Paleswan J , Singh Yogendra P , Vaidya Pradeep , Kansakar Prasan BS , Ghimire Bikal , Kandel Bishnu P
Published: July 2024

Introduction: According to GLOBOCAN 2018, gastric carcinoma is the fifth most common cancer (5.7%) and third most common cause of cancer related death (8.2%) worldwide. Delayed presentation and advanced disease at diagnosis, owing to the overlapping symptoms, can be attributed to its high mortality. Gastrectomy is one of the most commonly performed surgery at our centre. This study aims to study the role of pre-operative serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as predictors of adverse prognostic pathological features of gastric carcinoma patients who were considered for surgery at our centre.
Methods: This is a retrospective analysis of prospectively maintained database of all operated gastric carcinoma patients since June 2016 to January 2019. Various pre-operative variables including serum CEA level, serum CA 19-9 level, NLR and PLR were collected. Intra-operative surgical procedures performed and post-operative pathologic variables like tumor size, stage, grade, lymph node ratio (LNR), lymphovascular invasion (LVI) and perineural invasion (PNI) were collected.
Results: A total 60 patients were planned for surgical intervention over this duration. Mean age of the population was 56.8±12.5 years with slight male predominance (i.e. 55%). Mean CEA level was 6.17 ng/ml and CA 19-9 level was 72.1 U/ml. The mean NLR and PLR of the study population was 3.4 and 200 respectively. Fifty four patients had distal tumors and six had proximal tumors. Curative surgery was performed in 40 patients out of which 37 underwent subtotal gastrectomy and three underwent total gastrectomy. D2 gastrectomy was performed in 55% patients treated with curative intention. Advanced disease (T2 and above) was seen in 86.7% of patients. Preoperative CEA, CA 19-9, NLR, PLR were evaluated for association with pathologic features like tumor size, T stage, grade of tumor, LNR, LVI, and PNI but statistical analysis failed to show any significant association.
Conclusion: Advanced disease at presentation is common in gastric carcinoma. Preoperative clinical parameters including tumor markers CEA, CA 19-9, NLR and PLR may not be useful to diagnose the advanced disease in gastric carcinoma patients.
Comparison of Graft Uptake and Postoperative Hearing Results between Butterfly-Cartilage and Temporalis-Fascia Myringoplasty
Authors: Sah Amiya K , Rayamajhi Pabina , Bhattarai Hari
Published: July 2024

Introduction: Myringoplasty is one of the commonest surgeries done in Otology for chronic otitis media- mucosal type (COM-mucosal type). The objective of this study was to compare the graft uptake and post-operative hearing status between butterfly-cartilage and temporalis-fascia myringoplasty.
Methods: Patients of age ≥15 years with COM-mucosal type with dry, small to medium sized central perforation of pars tensa with clearly visible perforation margin were randomized into two groups of butterfly-cartilage myringoplasty and temporalis-fascia myringoplasty. Graft uptake and hearing results were assessed after six weeks and results were compared within and between the groups.
Results: Thirty-one patients in butterfly cartilage group and twenty-nine patients in temporalis fascia group were analysed. Graft uptake rate was 93.5% (29/31) in butterfly group and it was 86.2% (25/29) in temporalis fascia group with no statistically significant difference (p= 0.34) between the two groups. The mean pre and post-operative air bone gap in butterfly cartilage group were 20.65dB±8.35 dB; 12.86dB±7.39dB and that in the temporalis fascia group were 19.72±6.14dB, 13.16dB±6.26dB respectively. The difference of preoperative and postoperative hearing status, obtained within the two groups was statistically highly significant (p< 0.001). However, there was no statistically significant difference in hearing results between the two groups (p= 0.54).
Conclusion: The graft uptake rate and hearing results of butterfly-cartilage group and temporalis-fascia group were statistically significant within the group after myringoplasty but there was no statistically significant difference in between the two methods.
Effect of Preoperative Nebulized Ketamine on Incidence and Severity of Postoperative Sore Throat in Patient Undergoing General Anaesthesia with Endotracheal Intubation
Authors: Bhatta Prajjwol D , Shakya Bigen M , Bista Navindra R , Marhatta Moda N , Shrestha Ninadini
Published: July 2024

Introduction: Postoperative sore throat (POST) has a reported incidence of up to 62% following general anaesthesia. POST was rated by patients as the eighth most undesirable outcome in the postoperative period. The objective of this study was to compare the incidence and severity of postoperative sore throat after saline and ketamine nebulization in patients undergoing general anaesthesia with endotracheal intubation.
Methods: The study was prospective double blinded randomized controlled trial . One hundred patients belonging to American Society of Anesthesiologists physical status I–II undergoing surgery under general anaesthesia with endotracheal intubation were randomized into two groups; group Saline (S) received nebulization with 5 ml of normal saline and group Ketamine (K) received nebulization with 1 ml of ketamine of concentration 50 mg/ml mixed with 4 ml saline. POST was assessed at zero hour, two hour, four hour, six hour, eight hour and 24 hour.
Results: The overall incidence of POST was 28%. Twenty two (44%) patients in group S and six (12%) patients in group K had postoperative sore throat at some point of the study. The POST was significantly reduced in group K at zero hour 3(6%), two hour 3(6%), four hour 4(8%), six hour 5(10%) and eight hour 3(6%) with p value <0.05 . The severity of POST was also significantly decreased in group K at zero hour, two hour, four hour, six hour, eight hour with p value <0.05.
Conclusion: Preoperative nebulization with ketamine reduces the incidence and severity of POST after general anaesthesia with endotracheal intubation.
Variation of Arteries Forming Circle of Willis in Adult Human Cadavers
Authors: Gautam Jyoti , Adhikari Bidur , Bhandari Rosha , Shrestha Anusuya , Ranjit Nirju
Published: July 2024

Introduction: Circle of Willis is a large arterial anastomosis between internal carotid and vertebrobasilar arterial system. It is the principal collateral channel for constant blood flow to brain. Any changes in its morphology may cause vascular insufficiency of variable severity. Knowledge about its anomalies may elucidate occurrence of cerebrovascular disorders, its presentation, treatment, prognosis and prevention.
Methods: An observational study on 107 fresh cadavers was conducted at Maharajgunj Medical Campus from September 2016 to August 2017. After dissection of the scalp and removal of the vault and dura mater, the brain was obtained. Then the Circle of Willis was identified and observed for its completeness, symmetry, presence, origin and number of arteries forming it and the obtained data were documented, photographed and analyzed.
Results: Out of 107 cadavers, variations were noted among 15 (14%): out of which 10 were male and 5 female. Twelve cadavers had single variation while 3 had two variations. Accessory anterior cerebral artery was found in 7 (38.90%), fetal origin of right posterior communicating artery in 2 (11.10%), fetal origin of left posterior communicating artery in 4 (22.20%), early bifurcation of left posterior cerebral artery in 1 (5.60%), variant anterior communicating artery in 2 (11.10%), fused anterior cerebral artery in 1 (5.60%) and aneurysm in 1(5.60%) subjects were found.
Conclusion: Variations were noted among 15 cadavers (14%), 12 cadavers had single variation while 3 had two variations. The most common variation seen was accessory anterior cerebral artery found in 7 cadavers (38.90%). Most of the variations were found in midline anteriorly followed by right side.
Frequency of ABO Blood Group and its Association with Acute Coronary Syndrome in Patients Presenting in a Tertiary Care Center of Nepal
Authors: Pathak Surya R , Jha Sunil C , Gajurel Ratna M , Poudel Chandra M , Shrestha Hemant , Thapa Sanjeev , Sahi Ravi , Thapa Shovit , Koirala Paras
Published: July 2024

Introduction: Coronary artery disease is the major cause of death all over the world. There are studies suggesting association between blood group and coronary artery disease. We attempted to study the frequency of ABO blood group and its association with acute coronary syndrome (ACS) in our hospital.
Methods: This is a retrospective, cross sectional study carried out in Manmohan Cardiothoracic Vascular and Transplant Centre from March 2018 to February 2019. Patients who were admitted with diagnosis of ACS were enrolled in the study. Data were recorded and analyzed using SPSS 20. Association between blood group and ACS was analyzed using chi square test and logistic regression.
Results: Total 430 patients were admitted with diagnosis of ACS during the study period, of which 307 (71.4 %) were male and Mean age was 61.22 years (±10.75). Blood group O was the most common type of blood group observed in 207 (48%) patients. ACS was significantly higher in blood group O compared to other groups after adjusting for normal ABO blood group prevalence in general population: blood group O vs. A (OR: 3.45, 95% CI: 2.48- 4.79, p- <0.001), blood group O vs. B (OR: 5.08, 95% CI: 3.53-7.33, p- <0.001), blood group AB vs. O (OR: 0.65, 95% CI: 0.41- 1.02, p- 0.064). Individuals with blood group O and B had increased risk of having STEMI and NSTEMI whereas those with blood group A had increased risk of having unstable angina.
Conclusion: There was association between ABO blood group and coronary artery disease. Individuals with blood group O have increased incidence of ACS.
Comparison of Round Window Anatomy between Pediatric and Adult Population: A Perspective from Cochlear Implantation Surgery
Authors: Pradhananga Rabindra B , Gyawali Bigyan R , Rayamajhi Pabina
Published: July 2024

Introduction: The round window is thought to be an ideal port for inserting electrodes during cochlear implantation. Considering its complex anatomy with an individual variation, this study aims to review the anatomy of round window based on the visibility of round window niche and round window membrane via posterior tympanotomy in pediatric and adult population who underwent cochlear implantation.
Methods: This was a retrospective observational study conducted at the Department of ENT-HNS, Institute of Medicine, Kathmandu, Nepal. Surgical notes of adult (>15 years) and pediatric cases (<15years) who underwent primary cochlear implantation from January 2015 to January 2018 were assessed for different grading of round window niche and round window membrane visibility via posterior tympanotomy. Cases with revision surgery and with incomplete documentation of intra-operative findings were excluded from the study. Statistical analysis was done using SPSS software version 25. We used Chi-square and Fisher’s exact tests to analyze the statistical association.
Results: Type B round window niche (partially visible) was the most common variant seen in the pediatric group while in adults, both Type B (partially visible) and Type C (fully visible) round window niche were common. Compared to the adults, the pediatric group had good visibility of RWM. However, there was no statistical association between these observations.
Conclusion: The round window has a wide range of anatomical variations with different levels of visibility of RWN and RWM in the different age groups. Although statistically insignificant, RWM visibility seemed to be better in pediatric cases compared to adults.
Outcome of Extracranial Carotid Pseudoaneurysm Surgery: A Retrospective Study
Authors: Bhandari Nikesh , Shrestha Uttam K , Shrestha Kajan R , Gurung Dinesh
Published: July 2024

Introduction: Extracranial carotid pseudoaneurysm (ECPA) is commonly associated with blunt or penetrating trauma and can result in thromboembolic event, cranial nerves palsies, rupture and hemorrhage. Due to the limited number of large studies, safety and efficacy of surgical and interventional management of ECPA is not well characterized. Open surgery with resection of pseudoaneurysm with end-to-end anastomosis or interposition graft is currently the preferred method of management. The aim of this study is to study the demographics, etiopathogenesis, presentation and outcome after surgical intervention of ECPA at our center.
Methods: All patients who underwent surgery for carotid pseudoaneurysm form June 2012 to December 2019, at Department of Cardiothoracic and Vascular Surgery were included in this retrospective chart review study after evaluation of the hospital record book and electronic medical record. Patients who had stroke or cranial nerve injury before surgery, were excluded from this study.
Results: Fifteen patients met the inclusion criteria. Male to female ratio was 11:4. Mean age of presentation was 38.17±18.98 years. All patients presented with tender and pulsatile neck swelling. Common carotid artery involvement was more common. Three patients suffered from stroke postoperatively, and all of these patients died, however, one patient with stroke died due to reasons not related to pseudoaneurysm. Two patients suffered cranial nerve injury and ten patients had no other disabling complications.
Conclusion: ECPA is an uncommon but a serious disease and ischemic stroke after surgery is associated with high mortality.
Patterns and Causality Assessment of Adverse Drug Reactions in Inpatients of a Tertiary Care Hospital, Nepal
Authors: Mudvari Anish , Yadav Dipendra , Ghimire Rakesh , Prasad Pravin
Published: July 2024

Introduction: Adverse drug reaction (ADR) is a leading cause of morbidity and mortality around the world. Causality assessment is done to establish relation of drug exposure with undesired clinical events. This study conducted in tertiary care hospital was undertaken to evaluate the patterns of ADR and causality assessment using Naranjo causality algorithm.
Methods: Data on suspected ADR cases were collected retrospectively from Medicine and Dermatology wards of Tribhuvan University Teaching Hospital, Kathmandu from April 2018 to April 2019. Naranjo causality assessment was performed. Statistical analysis was done using SPSS version 18.
Results: Of 34 suspected ADR, occurrence of ADR was more in females (18) as compared to males (16). Skin and integumentary system was the most common organ affected (35.29%). Pyrazinamide induced hepatitis was found to be the most common suspected ADR. Causality assessment was performed and ADRs were categorized as possible 17 (50%), probable 16 (47.06%) and definite 1 (2.94%).
Conclusion: The patients are commonly admitted at the hospital due to suspected ADRs. Pyrazinamide induced hepatitis was the most common suspected ADR.
Clinical Profile of Patients Presenting with Low Back Pain to Out Patient Department of a Tertiary Level Hospital
Authors: Thapa Pradeep , Lakhey Rajesh B , Shrestha Binay L
Published: July 2024

Introduction: Low back pain is experienced by most of the people at some point of life. In our setting, there are very limited data on low back pain. This study aims to elaborate demographic and clinical profile of patients presenting to outpatient department of Orthopedics, in Tribhuvan University Teaching Hospital with complaints of low back pain.
Methods: A descriptive cross-sectional observational study was carried out in 150 patients who presented with complaints of lower back pain in outpatient department of Orthopedics of TU Teaching Hospital from May to November 2019. The demographics including age, gender, occupation, and clinical data- duration of symptoms, body mass index, VAS score and radiculopathy along with Body Mass Index of each patient were recorded in a proforma separately.
Results: Out of total 150 patients, male: female ratio was 1:1.9. The average age of patients was 42.1 years. The average height, weight and body mass index of patients were 157 cm, 61.81kg and 24.83kg/m2 respectively. The mean visual analogue score of patients was 5.41. Occupationally, predominant number of patients were housewives (41.3%). Seventy nine patients (52.7%) had low back pain alone. Seventy one patients (47.3%) had low back pain associated with radicular symptoms, out of which 74.6% had unilateral radiculopathy.
Conclusion: Low back pain is most commonly seen in fourth decade of life. More females as compared to males are affected with low back pain. The radiculopathy associated with low backache is mostly unilateral.
Single Stage Surgery for Open Lisfranc Injury: A Case Report
Authors: Lakhey Rajesh B , Bhandari Prawesh S , KC Govinda
Published: July 2024

Management of open Lisfranc injuries is challenging. The improper management of the injuries might lead to bad results like skin necrosis and arthritis of Lisfranc’s joints. A case of Myerson type A Gustilo Grade IIIB open Lisfranc injury was managed with single stage debridement and internal fixation. At three years follow-up, the result was excellent with American Orthopedic Foot and Ankle Society (AOFAS) midfoot score of 100 and the patient had rejoined his previous occupation requiring prolonged walking.
Knowledge on Self-care Management among Chronic Kidney Disease Patients Undergoing Hemodialysis in Tertiary Hospitals of Kathmandu
Authors: Dev Renu , Sah Bimala K , Onta Mandira
Published: July 2024

Introduction: Chronic kidney disease (CKD) is an alarming public health problem worldwide which often needs maintenance hemodialysis. Self-care management involves the positive efforts of patients to participate in their health care in order to optimize health. Thus this study aims to assess the knowledge on self-care management among chronic kidney disease patients undergoing hemodialysis.
Methods: A descriptive cross-sectional study was carried out at Tertiary hospitals, Kathmandu among 173 hemodialysis patients using purposive sampling technique. Data was collected through face to face interview from June to July, 2018. Self-care management constituted four components: diet and fluid intake, physical activities and exercises, care of fistula and other general management of hemodialysis. Data was analyzed with SPSS version 20 by using descriptive statistics and inferential statistics.
Results: The mean age of respondents was 45.71±14.61 years. Seventy (40.5%) were on hemodialysis for less than one year and majority (79.8%) underwent hemodialysis twice a week. The overall mean score of knowledge was 60.26±8.90. The mean score of knowledge on diet and fluid intake, physical activities and exercises, care of fistula and other general management of hemodialysis were 62.41±7.70, 47.27±20.59, 68.08±12.43 and 42.69±17.33 respectively. There were significant association between level of knowledge score and educational status and attending educational programme on hemodialysis (p=0.001 and p=0.01).
Conclusion: Only few respondents had good level of knowledge on self-care management. Thus, it is immensely needed to conduct regular educational programme focused on diet and fluid, physical activities and exercise, fistula care and general management of stress and complications.
Multiple Nocardial Brain Abscesses in a Renal Transplant Recipient: A Case Report
Authors: Nepali Rabin , Shah Dibya S , Sharma Mohan R
Published: July 2024

Nocardia is a rare but life-threatening opportunistic infection, especially in immunocompromised patients, including renal transplant recipients. It can cause intracranial abscess which has a mortality of more than 30%. So, when a renal transplant recipient presents with central nervous system involvement, nocardial brain abscess must be considered in the differential diagnosis. Here, we report a such case with multiple nocardial brain abscesses. This case highlights the importance of early diagnosis and treatment to get a good clinical outcome.
Brain MRI Findings in Severe COVID-19: Case Report of Two Cases
Authors: Regmi Pradeep R , Amatya Isha , Kayastha Prakash
Published: July 2024

Most of the imaging spectrums of COVID-19 are evolving day by day. Every other day, we get to know the imaging peculiarities in this novel disease. Apart from the chest involvement, neurological manifestations are well recognized in COVID-19 infection. The neurological manifestations are infarcts (ischemic or hemorrhagic), acute demyelination, acute necrotizing encephalomyelitis, micro-haemorrhages, acute demyelinating encephalomyelitis, leukoencephalopathy, global hypoxic injury, cranial nerve enhancement, cytotoxic lesions of the corpus callosum, olfactory bulb involvement and Guillain Barre Syndrome. Though the imaging findings in COVID-19 are non-specific and may not be diagnostic, proper correlation with the history and clinical spectrums can suggest the changes related to COVID-19. We have reported two severe COVID-19 cases that illustrate various neuroimaging manifestations.
Three Week or One Week Bladder Catheterization in Reducing Urethrocutaneous Fistula for Hypospadias Repair: A Randomized Controlled Trial
Authors: Shrestha Sandesh , Shrestha Gyaneswhor , Verma Rupesh , Koirala Dinesh P , Chapagain Suman , Dahal Geha R
Published: July 2024

Introduction: Surgical correction is the only treatment for hypospadias. Complication rate is usually high. Indwelling catheter is kept postoperatively for urinary diversion and proper healing. There is no consensus regarding the duration of catheterization. This study was conducted to compare urethrocutaneous fistula (UCF) rate between one and three weeks of catheterization.
Methods: This study was a randomized control trial, conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. All children undergoing urethroplasty for hypospadias were randomized into two groups. After surgery, urinary catheter was kept for one and three weeks in group 1 and group 2 respectively. Occurrence of UCF and other complications were noted and compared between the groups.
Results: A total of 32 patients were randomized in to 2 groups having 16 in each group. Fourteen (43.8%) developed UCF. In one week group, 8 (50%) and in three week group 6(37.5%) developed UCF. It was not statistical different (p = 0.48). Occurrence of UCF was not different in different age of children, type of hypospadias and single or staged procedure. Meatal stenosis was not different in both groups.
Conclusion: Incidence of UCF was not different in one week or three week of urinary catheterization after surgery for hypospadias.
Correlation of Sonourethrography Findings of Male Anterior Urethral Stricture with Retrograde Urethrography
Authors: Gautam Bishnu , Chataut Dinesh , Suwal Sundar , Lohani Benu
Published: July 2024

Introduction: Imaging plays significant role in diagnosing the male urethral stricture and helps the urologist in determining the treatment protocols. Retrograde urethrography (RGU) had been the standard imaging technique for anterior urethral stricture. Sonourethrography (SUG) as compared to the retrograde urethrography has the advantage of being radiation free. Aim of this study was to compare the sonourethrography findings in anterior urethral stricture with that of retrograde urethrography.
Methods: This was an observational study done in 46 patients with clinical symptoms related to lower urinary tract during the period of September 2019 to August 2020 after obtaining informed consent. Ethical clearance was received from Institutional Review Committee, Institute of Medicine. Patients were first evaluated by sonourethrography. Then, retrograde urethrography was done as per the standard protocol of the department. Data were collected in the predesignated proforma including the study variables on sonourethrography and retrograde urethrography and entered in IBM SPSS version 20. The lengths of strictures on sonourethrography and retrograde urethrography were compared.
Results: Among 46 patients 21 patients showed anterior urethral strictures on both SUG and RGU with bulbar region as the commonest location. SUG showed all the urethral strictures seen on RGU with significant positive correlation. SUG also showed spongiofibrosis in nine patients.
Conclusion: Sonourethrography, an radiation free imaging technique, showed all the strictures seen in retrograde urethrography with added benefit of detection of spongiofibrosis as well.
Fish Bone in the Glottis of a Seventeen-Month-Old Child: A Case Report
Authors: Baidya Smriti , Gyawali Bigyan R
Published: July 2024

Foreign body aspiration is one of the leading causes of accidental death in children. Young children tend to put objects in their mouths which may additionally explain the incidence of foreign body aspiration. Laryngeal impaction of a foreign body is very rare as most aspirated foreign bodies pass through the laryngeal inlet and get lodged lower down in the airway. Inhaled foreign bodies are suspected from the history of incidence witnessed by the parent or caregiver or at times from clinical symptoms of respiratory complains not responding to medical therapy. Removal of the foreign body from the airway is the modality of treatment done via rigid bronchoscopy under general anesthesia in our setting. A rare case of foreign body aspiration with glottic impaction in very young child of seventeen months has been described here.
Cardiorespiratory Fitness and its Relationship with Adiposity Indices
Authors: Ghimire Dayaram , Aryal Vibina , Majumder Anirban , Manna Sourav
Published: July 2024

Introduction: The cardiorespiratory fitness (CRF) and obesity greatly influence the cardiovascular health. Decrease in maximal oxygen consumption (VO2max) and increase in fat mass can be used as an early marker for cardiovascular disease risk. The objective of this study was to assess the CRF and observe the relationship between CRF and adiposity indices.
Methods: A cross sectional observational study was performed in 174 students (87 males and females each) of National Medical College. The subjects were assessed for different adiposity indices; BMI, body adiposity index (BAI), total body fat percentage (BF %) and waist circumference (WC). VO2max was calculated from recovery pulse rate after Queen's College Step Test. VO2max was correlated separately with each parameter of body composition using Pearson’s correlation test.
Results: The VO2max of male and female participants were 47.22 ± 9.09 and 35.67 ± 5.36 ml/kg/min respectively. The correlation of VO2max was significant with all the studied adiposity indices. WC (r= - 0.41, p< 0.001) and BF% (r= -0.38, p< 0.001) correlation with CRF was highly significant in male whereas in female correlation was highly significant with BMI (r= 0.49, p< 0.001), WC (r= -0.40, p< 0.001) and BF% (r= -0.56, p<0.001). VO2max correlated best with waist circumference in male (r= - 0.41, p< 0.001) and BF% in female (r= -0.56, p<0.001).
Conclusion: This study concludes that there is an adverse relationship between CRF and adiposity indices and females have low level of cardiorespiratory fitness.