bluuebunny/crossref_metadata_2025 huggingface dataset:
A Rare Case of Pulmonary Embolism: A Case Report
Authors: Shrestha Tirtha Man , Neupane Ram , Neupane Bandana , Manandhar Reeju
Published: December 2019

Pulmonary embolism in an old patient with a history of coagulation disorder, any recent major surgeries or in a chronic heart or lung diseases is widely reported. Also, a recent history of travel by air with flight distance of more than 5000km or BMI greater than 35 kg/m2 increase risk. However, we report here, a suggestive case of acute pulmonary embolism in a previously well male of 38 years, with a BMI of 25.71kg/m2 without any history of chronic illness or acute exacerbations.

The patient presented in health facility with sudden onset of radiating chest pain and some other nonspecific symptoms. Neither any other significant personal risk factors except smoking, nor any family history of heart/lung diseases were ruled out during initial assessments. On investigations, other routine examinations were normal but T-wave inversion was noticed in lead V1-4 in ECG, Troponin-I was positive and CPK-MB was slightly elevated (27 U/L). Furthermore, no any remarkable changes were noticed in Chest X-ray. Then, the patient was referred to higher center with cardiac facility with provisional diagnosis of Acute Coronary Syndrome for further evaluation and management.

Thereupon, Coronary Angiogram (CAG) was done and the report was normal but echocardiography findings were suggestive of pulmonary Embolism. D-dimer was also elevated (8279.05 ng/ml) but venous doppler study of bilateral lower limb was normal. Finally, CT-PA showed partially occluding thrombus in main pulmonary bifurcation extending into left and right pulmonary artery, its bilateral segmental branches and calcified granuloma was seen in right lobe of liver. Patient was under inj. LMWH and other supportive management during hospitalization. After an uneventful hospital stay for 12 days, general condition was improved and eventually, patient was discharged, with oral warfarin.

Keywords: chest pain; Nepal; pulmonary embolism; risk factors.
Functional And Neurological Outcomes Of Closed Reduction And Percutaneous Pinning In Pediatric Monteggia Fracture
Authors: Pradhan Govinda
Published: December 2019

Introduction: The aim of this study was to assess the neurological and functional recovery of children with Monteggia fracture following closed reduction and percutaneous pinning.

Methods: It was a descriptive observational study, patients aged from 3 to 15 years with Monteggia fractures are taken in to consideration during the period between 2074/02/01 and 2074/7/30. Participants were selected on the basis of pre-determined inclusion/exclusion criteria. A total of 33 patients were included in the study. The demographics and pre- and post-operative outcomes were recorded in semi-structured proforma. Data entry, synthesis and descriptive analysis were done using MS EXCEL and SPSS version 16.0.

Results: Total of 33 patients met the inclusion and exclusion criteria. The mean age was 8.21±3.4 years, with sex ratio (m: f) of 1.75: 1. Majority of the patients (57.58%) injured their left elbow and the most common mechanism of injury was fall while playing (36.36%). According to modified classification system for children, 60.61% had class C and 39.39% had class B Monteggia fracture. Five patients (15.15%) presented with PIN injury. All patients were treated with closed reduction and percutaneous pinning (IM RUSH nail) within 2.27±1.30 days after injury. The average duration of surgery was 62.42±23.55 minutes. The average duration of fracture healing was 5.39±1.6 weeks. Jupiter’s criteria for the evaluation of elbow function was used and at the time of cast removal, 6 (18.18%) had excellent, 10 (30.30%) had good, 13 (39.39%) had fair and 4 (12.13%) had poor functional recovery.

Conclusions: This study concludes that most of the pediatric Monteggia fractures (class B and C) can be treated with closed reduction and percutaneous intramedullary nailing using RUSH pins. This technique has very good functional and neurological outcomes with fewer complications.

Keywords: children; functional recovery; Intra-medullary nailing; jupiter’s criteria; Monteggia fractures.
Role of Ultrasonography in the Evaluation of Painful Shoulder
Authors: Sharma Sindhu , Pant Santosh , Rajbhandari Bibek
Published: December 2019

Introduction: Shoulder pain is a common problem encountered in clinical practice. It is often disabling to the patient and results in considerable morbidity and unsatisfactory outcomes if therapy is not instituted effectively or delayed. Ultrasonography is a rapid, real time and cost effective alternative to MRI and diagnostic arthroscopy. Here, we compare sonographic diagnosis with clinical diagnosis in the diagnosis of the various causes of shoulder pain.

Methods: This descriptive study was done in the radiology department of Nepalgunj Medical College Teaching Hospital, Kohalpur during a time period of 18 months. About 30 cases of shoulder pain that had been evaluated clinically by a single examiner in the orthopedics OPD were diagnosed with the help of sonography. Correlation between clinical diagnosis and USG diagnosis was done.

Results: Clinically, most of these cases were provisionally diagnosed as Frozen shoulder 9 (30%) followed by Cuff tendinopathy 8 (26.66%) and Impingement syndrome 6 (20%). However, USG of the shoulder revealed rotator cuff tendinopathy and cuff tear (n=6 each) to be the main etiology behind shoulder pain. Supraspinatus calcific tendinopathy was found in 4 individuals. Hence, it was seen that the diagnosis of the causes of shoulder pain with clinical tests alone is unsatisfactory. Out of 30 cases, clinical examination could correctly diagnose only 20% of the time (n=6). 73% of the time (n=20), USG showed a different diagnosis compared to clinical examination whereas in 4 (7%) cases a more specific diagnosis was reached.Conclusions: We conclude that USG is more specific and frequently leads to increased diagnostic accuracy when compared to clinical examination.
Vergi Afları Ve Vergilemede Adalet Algısının Vergi Uyumuna Etkisi: Bursa İli Örneği
Authors: AKBELEN Zuhal , AYDIN Zehra Berna
Published: December 2019

Gelişmiş ve gelişmekte olan ülkelerde sık sık uygulanan vergi afları gelir arttırıcı ve vergi idaresinin yükünü azaltıcı araç olarak görülmektedir. Bununla birlikte vergi aflarına sık sık başvurulması dürüst vergi mükelleflerinde cezalandırıldığı ve vergi kaçağının yaygın olduğu algısını yaratarak, vergilemede adalet algısını ve vergi uyumunu olumsuz yönde etkilemektedir. Çalışmada vergi aflarının ve vergilemede adalet algısının vergi uyumu üzerindeki etkisinin belirlenmesi amaçlanmıştır. Bu doğrultuda Bursa ilinde 754 ticari kazanç elde eden vergi mükellefine anket gerçekleştirilmiştir. Çalışmada ilk olarak mükelleflerin vergi afları ve vergi adalet algılarına ilişkin ölçeklere faktör analizi uygulanmıştır. Sonrasında elde edilen faktörlerin vergi uyumuna etkisi çoklu doğrusal regresyon analiziyle ortaya konulmuştur. Analiz sonucunda, vergi uyumunun %18,2’sini ceza adaleti, prosedürel adalet ve vergi affı değişkenlerinin açıkladığı görülmüştür. Modeli en iyi açıklayan değişkenin vergi afları olduğu belirlenmiştir. Söz konusu değişkenlerin vergi uyumunu negatif yönde etkilediği görülmüştür. Bu durumda vergi affı uygulamasına sık sık başvurulmamalıdır. Prosedürel adalet algısı açısından vergi kanunları herkese eşit uygulanmalıdır.
SWOT Analizi Tekniği ile Suriye’de Demokrasi İmkanı
Authors: CANYURT Dilek , DALAR Mehmet
Published: December 2019

Suriye krizinin çözümü ile ülkedeki kalıcı barışın tesis edilmesinde önemli bir faktör olarak görülen demokrasiyi kısaca analiz eden bu çalışma, Suriye için nasıl bir demokrasinin olabileceğini SWOT (Strengths, Weaknesses, Opportunities, Threats-Güçlü yönleri, Zayıf yönleri, Fırsatlar, Tehditler) analiz bağlamında incelemektedir. Suriye’deki toplumlar arasındaki çatışmalara yol açan faktörlere ve Suriye’deki hükümet ve muhalif unsurlarının demokrasiyle ilgili yaklaşımlarına değinen bu çalışma, Suriye’nin toprak bütünlüğü dahilinde bütün farklı etnik, dinsel ve mezhepsel unsurların barış içinde demokratik bir yapıda yaşamaları konusunda fırsat alanlarını araştırmaktadır. Çok katmanlı toplum görüntüsünü veren Suriye toplumunun sosyal yapısı ile siyasal özelliklerini dikkate alarak demokrasi yönünden Suriye’nin güçlü ve zayıf yönlerini inceleyen çalışmamız bu konuda fırsatların ve tehditlerin neler olduğunu ortaya koymaktadır.
İznik / Nikaia Koimesis Tes Theotokos Kilisesi Mozaikleri
Authors: GÜNGÖRDÜ Sedat
Published: December 2019

Bu makalenin konusunu Bursa ilinin İznik ilçesinde bulunan ve MS 8. yüzyıla tarihlenen Koimesis Tes Theotokos Kilisesi’ne ait duvar ve tavan mozaikleri oluşturmaktadır. 19. yüzyılın sonları ve 20. yüzyılın başlarında yapılan araştırmalar yapının erken dönemlerinden itibaren mozaiklerle süslenmiş olduğunu göstermektedir. Bizans ve Hristiyanlık tarihi açısından öneme sahip olan Kilisenin mozaikleri, Oskar Wulff ve Theodor Schmit tarafından yapılan çalışmalar ile belgelenerek bu alandaki araştırmalara önemli bir kaynak olmuştur.
İkonoklast Dönemler ve depremlerle birçok kez değiştirilen ya da orijinal hali ile yenilenen bu mozaikler Kilise’nin apsis yarım kubbesinde, bema kemerinde, orta nefin doğu pandantiflerinde ve narteks bölümünde yer almaktadır. Özellikle yapının ana apsis ve bema bölümlerinde bulunan mozaikler, Kilisenin ilk inşa dönemleri hakkında önemli bilgiler vermektedir.
LEADERSHIP WITHOUT HIERARCHY AND AUTHORITY: LATERAL LEADERSHIP
Authors: KOÇAK R. Dilek
Published: December 2019

Conventional leadership styles require hierarchical processes primarily characterized by the exertion of power. However, recent studies have indicated that lateral leadership, which substitutes a subordinating approach with insight, collaboration, coordination, and creativity with all stakeholders and especially with employees, can also achieve organizational goals. In this article, lateral leadership and thought system is discussed. Based on lateral thinking, it seeks contributions from all employees to make business more effective through creativity, innovation, and collaborative methods to meet the challenge of a globalized world. The basic mechanisms of lateral leadership are creating common understandings, changing power games, creating an atmosphere of trust, and eliminating hierarchical authority. In this context, the main findings of this article prepared within the framework of narrative review methodology; lateral leadership is a fairly new approach that is suited to changing working environments, leadership characteristics, organizational structures, and followers’ qualifications. This leadership style is most appropriate for group studies, ad hoc meetings, or lateral-networking structures in organizations in which conventional leadership is ineffective or dysfunctional.
Kaynak Bağımlılığı Kuramı Çerçevesinde Bağımlılık Kavramına İlişkin Bir Araştırma: Türkiye Otomotiv Sektöründe Faaliyet Gösteren Ana Firma-Tedarikçiler Arasındaki Satın Alma Süreçleri Üzerine Nitel Bir Analiz
Authors: ÖZTÜRK Oğuzhan , DİL Esra , ÖZER Meryem
Published: December 2019

Bu çalışmacının amacı, Kaynak Bağımlılığı Kuramı (KBK) çerçevesinde bağımlılık ilişkisi geliştiren örgütlerde bağımlılığın i- nasıl oluştuğu ve ii- işlediğini ortaya koymaktır. Temel nitel araştırma yönteminin benimsendiği böylesi bir araştırmada, Türkiye’de otomotiv endüstrisinde faaliyet gösteren ana/alıcı ve tedarikçi firmalara odaklanılmıştır. Veriler, bağımlılık ilişkisinin tarafları olan, 8 ana firma ve 10 tedarikçi firma yetkilisi ile yapılan tam yapılandırılmış mülakatlar sonucu elde edilmiştir. Verilerin analizi iki aşamada sunulmuştur. Araştırma sorusunun birinci kısmı olan “bağımlılık ilişkisinin nasıl oluştuğuna” yönelik verilerin analizi için başlangıç tema ve kodların belirlenmesinde KBK’nın bağımlılık çerçevesi (literatür) yönlendirici olduğu için tümdengelimsel bir yaklaşım benimsenmiştir. Araştırma sorusunun ikinci kısmı olan “bağımlılık ilişkisinin nasıl işlediğine” yönelik olarak KBK herhangi bir açıklama alanına sahip olmadığından verilerin analizinde tümevarımsal bir yaklaşım benimsenmiş ve bu aşamadaki tema ve kodlar doğrudan verilerden hareketle ortaya çıkmıştır. Bu nedenle araştırma sonuçlarının KBK literatürüne en önemli katkılarından birisi bağımlılığın tanımlanmasında yeni bir boyut olarak “bağımlılık ilişkisinin nasıl işlediğine” yönelik ortaya konan çerçevedir. Bağımlılığın oluşum koşullarına ilişkin araştırma bulguları, bağımlılık ilişkisinin tarafları arasındaki asimetrik ilişkiyi mevcut literatürle örtüşen şekilde ortaya koymaktadır. Araştırılan ana firmalar için ‘kaynağın önemi’ ve ‘alternatiflerin belirlenmesi’, tedarikçi firma içinse ‘alıcının önemi’ ve ‘ana firmanın ikame edilebilirliği’ önemlidir. Bulgulara göre, ana firmalar bu ilişkinin güçlü tarafını temsil etmektedir, ancak her iki taraf için de niteliksel unsurlar, niceliksel olanlardan önemlidir. Bağımlılığın nasıl işlediğine ilişkin bulgular ise, KBK ile stratejik yönetim alanlarında kesişen yeni çalışmaları gerekli kılacak imalar barındırmaktadır. Firmalar için pazarlık gücü bağımlılık ilişkisinde merkezi öneme sahiptir.
Uluslararası Hukukta Balinaların Korunması Ve Uluslararası Adalet Divanının Japonya- Avustralya & Yeni Zelanda Kararı
Authors: REÇBER Sercan
Published: December 2019

Uluslararası hukukta balinaların korunması konusunda en kapsamlı düzenlemeler Uluslararası Balina Avcılığının Düzenlenmesi Sözleşmesi’nde (IWCR) yer almaktadır. Bu sözleşme uyarınca balinalar bilimsel amaçlar doğrultusunda avlanabilirler. Ayrıca sözleşme hükümlerinin uygulanmasını sağlamak amacıyla kurulan Komisyonun (IWC) ticari balina avcılığını yasakladığı bir kararı bulunmaktadır. Japonya, JARPA II programı çerçevesinde Antarktika’da, Güney Okyanusu’nda sürdürmüş olduğu balina avlama faaliyetini sözleşmenin bilimsel amaçlar doğrultusunda balina avlanabileceğine ilişkin hükmüne dayandırmaktadır. Bu kapsamda yapılan bu faaliyetin sözleşmenin ilgili hükmünün ihlalini oluşturduğu gerekçesiyle Avustralya tarafından ilgili uyuşmazlığın çözümlenmesi ve söz konusu hükmün kapsamının anlaşılması amacıyla, hukuki sorun Uluslararası Adalet Divanı’nın önüne getirilmiştir. Bu dava sonucunda Uluslararası Adalet Divanı, Japonya’nın JARPA II adlı bilimsel araştırma amacıyla yürüttüğü balina avlama programının sözleşmenin “bilimsel amaçlarla balina avlanabileceğine” ilişkin hükmünü ihlal ettiği sonucuna varmıştır. Bu makalede balina avcılığına ilişkin uluslararası düzenlemelerle, Uluslararası Adalet Divanı’nın ilgili uyuşmazlığın çözümüne yönelik olarak vermiş olduğu bu karar incelenecektir. Anahtar Kelimeler:
Uluslararası Uzaktan Eğitim Örgütlerinin İletişim Ağları Ve İşbirliği Rejimleri
Authors: TOPRAK Elif , FIRAT Mehmet , KAYA GÜLEN Seçil , KOÇDAR Serpil , KOÇAK N. Gizem , AKDEMİR Erhan , DEMİRER Kazım
Published: December 2019

Ulusaşırı işbirlikleri, devletlerin dışında çok sayıda ulusal ve uluslararası aktörün aktif olarak; ortak çıkarlar, amaçlar, değerler etrafında buluşmalarına ve sinerji oluşturmalarına ortam ve olanak sunmaktadır. Bu aktörler, ulusaşırı işbirlikleri yanında hükümetler arasındaki işbirliklerine de etki etmektedir. Uzaktan eğitimin uluslararasılaşması sonucunda bu alanda aktif olan örgütler ve mesleki ağlar, eğitimde rejim oluşumu yönünde etkinliklerde bulunmaktadır. Proje UZENET kapsamında (Uluslararası Uzaktan Eğitim Örgütleri İletişim Ağlarının ve İşbirliği Rejimlerinin Karşılaştırmalı Olarak Değerlendirilmesi), uzaktan eğitim alanında çalışan uluslararası örgütlerin iletişim ağları ve işbirliği modelleri uluslararası rejim unsurlarına göre karşılaştırmalı olarak incelenmiştir. Araştırmanın temel amacı; uluslararası uzaktan eğitim örgütlerinin iletişim ağlarının ne ölçüde rejimlere dönüştüğü ve ortak hareket edilebildiğinin belirlenmesidir. Ortak çatılar altında kurumsallaşan işbirliklerinin, kendi içinde ve diğer örgütlerle geliştirdikleri ortak norm, değer ve kurallar saptanarak bu veriler ışığında alanda bir rejim oluşturma konusunda hangi aktörlerin daha belirleyici olduğu ve rejimin hangi konularda daha güçlü olduğu tartışılmaktadır. Araştırmanın kuramsal temelini, uluslararası rejim teorilerinden bilgi-bazlı/bilişsel yaklaşım oluşturmaktadır. Karşılaştırmalı durum çalışması olarak desenlenen araştırmada yirmi (20) farklı uzaktan öğretim örgütüyle çalışılmıştır. Araştırma bulgularına dayanarak bilgi ve iletişim teknolojilerindeki gelişmelerin uluslararası rejim yaklaşımlarından bilgiye dayalı olanları, özellikle “fikirlere, öğrenmeye, bilgi topluluklarına” dayalı uluslararası işbirliği anlayışını ön plana çıkardığı görülmüştür.
Anahtar Kelimeler: Uluslararası Rejim, Uzaktan Eğitim, Uluslararası Uzaktan Eğitim Örgütleri, Transnasyonel Eğitim, Epistemik Topluluklar.
PROBLEMS OF IMPLEMENTATION OF EUROPEAN PUBLIC-PRIVATE FORMS OF SUSTAINABLE ENTREPRENEURSHIP IN UKRAINE
Authors: Bystryakov Igor
Published: December 2019

The problem issues and points of inhibition of the introduction of public-private forms of sustainable management of European type in the national economy of Ukraine are determined in order to ensure the effective implementation of the relevant principles and mechanisms in the system of sustainable development of the state and its territories, in particular in the context of water, land, forest and mineral resources. The main limitations of the system, as well as the factors of deterrence and directions of the development of public-private relations in Ukraine are revealed.
SPACE MANAGEMENT OF NATURAL RESOURCE ASSETS – PREVENTION OF DEVELOPMENT OF A NATIONAL STATE PROJECT AND ITS SAFETY
Authors: Mykytenko Victoriia
Published: December 2019

The basic elements of the national security of the individual, society and the state that are to be taken into account in the development and implementation of the practice of the management of doctrines and strategies for sustainable development are revealed. The complex of potential factor determinants and motivational factors of de-evolutionary development of the national socio-economic system at the present stage of its functioning are determined. The methodological substantiation of the specificity of modern processes of state development of Ukraine on its key meta-spaces is accomplished. The formalization of the interconnection and interdependence of spatial management of natural resource assets has been made on six planes: ideological; political; spiritual-moral and politico-ideological; institutional; value-ideological; the goal is conceptual.
A Comparative Study on Community Based DOTS service and Health Institution Based DOTS service among TB Patients
Authors: Baral Subash , Adhikari Shraddha
Published: December 2019

Tuberculosis (TB) is the most problematic and highly prevalent communicable disease affecting about one-third of the world’s population and debilitating pulmonary (PTB) infection today. In spite of all these efforts by the government of Nepal, many people still die every year and transferring the disease to the healthy person. The new approach for the effective treatment of tuberculosis has been introduced i.e. Community Based Directly Observed Treatment Short Course (CB-DOTS) which provides training to community health workers to increase awareness, detection, and treatment of TB and bring services directly to the homes of those at risk for infection and those who are infected. The aim of this study was to compare availability, accessibility, compliance and satisfaction between CB-DOTS service and health institution based DOTS (HI-DOTS) service among TB patients. A cross sectional study was carried out in Kaski and Tanahun district in 2014. Census was conducted for the TB patients who are registered during 6 months in the community based DOTS with same number and same time period, that had been enrolled in DOTS from health institution were chosen. The collected data was entered in EPI-DATA and analyzed by using the software SPSS-16. In HI-DOTS the average traveling time to get TB drugs is ≤ 30 minutes for 56.8 percent respondents and in CB-DOTS majority of the respondents; 90.9 percent have to travel ≤ 30 minutes. In HI-DOTS majority; 84.1 percent were dissatisfied and only 15.9 percent were satisfied. Just opposite to this, majority (81.8%) of respondents utilizing CB-DOTS service were satisfied and only 18.2 percent were dissatisfied. There is highly significant association between the patient's satisfaction and two different DOTS services (p<0.001). CB-DOTS service approach shows its better effectiveness in availability, accessibility, compliance and patient's satisfaction aspects. CB-DOTS is a viable option and can complement and strengthen the existing HI-DOTS, especially in developing countries like Nepal where the health system is overwhelmed with increasing number of TB patients and high TB related deaths.

Key words: Community Based Directly Observed Treatment Short Course, Availability, Accessibility, Satisfaction
Distribution Factors of Candida species in Respiratory Tract of Elderly Population of Kathmandu.
Authors: Khaling Rai Mamita , Gurung Krishna , Joshi Devraj
Published: December 2019

Though normal flora of upper respiratory tract, Candida species are a significant clinical problem for a variety of immune compromised patients worldwide. Impaired salivary gland function, drugs, dentures, high carbohydrate diet, age, smoking, diabetes mellitus, Cushing’s syndrome, malignancies, and immunosuppressive conditions are the associated risk factors for the Candidiasis. The study was designed with the objectives of describing the distribution pattern of Candida species and some molds in the elderly and non elderly population randomly sampled from the three Oldage Care Centers. A total of 304 samples each of sputum and throat swabs were collected from the study objects having age 20-80 years. The specimens were cultured on Sabouraud’s Dextrose Agar (SDA). Candida isolates were identified on the basis of Gram stain, germ tube test, production of chlamydospore, sugar fermentation and assimilation test. The mold isolates were identified by cultural and microscopic characteristics. Out of total 304 samples of each sputum and throat swabs 16.45% and 5.3% samples respectively were growth positive for fungal culture. Among elderly population, 32.87% (47/143) of sputum and 9.8% (14/143) throat swabs showed culture positivity. In case of non elderly population however only 1.9% (3/161) sputum and 1.24% (2/161) throat swab samples were culture positive. In total, 56 Candida isolates (41 from sputum and 14 from throat swabs) were obtained. Significantly higher number of isolates was obtained from elderly population (38 from sputum and 12 from throat swabs) than non elderly population. Among three antimycotic drugs used, the Candida isolates were highly susceptible against Ketoconazole and resistant towards Fluconazole. Candida distribution was significantly associated with the age, respiratory tract problem and smoking habits of the study population. Elderly population having age above 50 years are in the high risk of drug resistant Candida infection.

Key Words: Candida, elderly population, sputum, throat swab, antimycotic susceptibility
Comparative Study of White and Black Sesame by Using Oxygen Glucose Deprivation on PC12 Cells
Authors: Jamarkattel-Pandit Nirmala
Published: December 2019

Sesame (Sesamum indicum L.) is one of the most important oilseed crops in the world. It is not only a source of edible oil, but also widely used in baked goods and confectionery products. Sesame seed varies considerably in color, size, and texture of the seed coat. The most commonly used are of white and black sesame, having almost same pharmacological activity and contain almost same components. However, it is reported that the components, such as Se, Zn, Fe, Mg, sesamin, and vitamin E, are different between the white and the black coat sesame. Active components of sesame seeds has been reported as protective effects against neuronal damage induced by chemical hypoxia or hydrogen peroxide but there was no sufficient biological study of white sesame and black sesame. In present study, oxygen and glucose deprivation followed by reoxygenation (OGD-R) model, an in vitro model of cerebral ischemia/reperfusion was used to investigate the effects and comparative study of white sesame and black sesame on different cell lines. This result clearly demonstrated that crude extract of white sesame is superior than crude extract of black sesame and fractions of white sesame and black sesame protected PC12 cells from hypoxia-induced stress.

Keywords: Oxygen glucose deprivation, PC12 Cells, Ischemia model, Sesamum indicum L.
Exclusive breastfeeding for the first six months followed by complementary feeding along with breastfeeding is crucial for proper growth and development of a child. This study aims to determine the factors that influence the feeding practice of mothers ha
Authors: Khatri Dipika , Shrestha Naveen
Published: December 2019

Exclusive breastfeeding for the first six months followed by complementary feeding along with breastfeeding is crucial for proper growth and development of a child. This study aims to determine the factors that influence the feeding practice of mothers having the children 6-23 months in Kaski district and to correlate the relationship between complementary feeding practices and nutritional status of children 6-23 months. A community-based cross sectional analytical study was conducted among 453 mothers having the children 6-23 months, applying cluster sampling technique and using the structured questionnaire, salter scale weighing machine, stadiometer and sakir tape were used as research tools. From all respondents 67% started complementary feeding at 6-8 months of age. The practices of minimum meal frequency, minimum dietary diversity, and minimum acceptable diet were 93.8%, 45.9% and 42.4% among mothers of 6–23 months aged children, respectively. More than half of children have worst feeding practices. Types of family, mother’s education, father’s education, mother’s occupation were significantly associated with feeding practices. In term of nutritional status, 62.26% of children were stunted, 7.3% of children were underweight and 3.4% of children were wasted. Feeding practices were significantly associated with children nutritional status based on wasting and mid upper arm circumference. Overall in Kaski district, it was found that majority of mother had poor feeding practices which contribute to the under nutrition. Nutrition messages on Infant and Young Child Feeding Practices (IYCF) should emphasis dietary diversity and frequency of feeding for all the children.

Keywords: Associated factors, Children, Feeding practices, Nutritional status
Extended Spectrem Beta Lactamases among Multi Drug Resistant Gram Negetive Bacilli Causing Urinry Tract Infection
Authors: Bhattarai Ganga Sagar , Shrestha Dipendra , , Tiwari Bishnu Raj
Published: December 2019

Extended Spectrum Beta Lactamases (ESBL), the main cause of resistance to broad spectrum β-lactams, among uropathogenic bacteria have increased over time raising a global concern in the therapeutic management of infections caused by these organisms. The study was carried out in Janamaitri Hospital, Kathmandu between December 2012 to May 2013 with an objective to determine the status of ESBL producing Gram negative bacilli isolated from the urine sample, collected from patients suspected of urinary tract infection. Gram negative bacilli isolated were tested for the presence of ESBL by combined disk and antibiotic susceptibility by Kirby Bauer disc diffusion method following Clinical and Laboratory Standard Institute guidelines. Among the total 1105 mid-stream urine samples, 256 Gram negative bacilli were isolated. By screening test using third generation cephalosporins, 156 isolates were screened as ESBL producers and 91 isolates were positive for ESBL test by combined disk method. Among the 91 (35.55%) ESBL producers, 70 (39.32%) Escherichia coli, 16 (44.44%) Klebsiella pneumoniae, and 5 (33.33%) Pseudomonas aeruginosa were found to be ESBL producers. Majority of ESBL producer showed resistance to ampicillin, co-trimoxazole, norfloxacin followed by ofloxacin. imipenem, amikacin and nitrofurantoin seemed to be the agent of choice for urinary tract infections when ESBL producers are susceptible to it. ESBL production found in these Gram negative bacilli with resultant microbial resistance to available cephalosporins and other agents may pose difficulties with the choice of therapeutic options for the treatment of severe infections.

Keywords: UTI, Extended Spectrum Beta Lactamases, Gram negative bacilli
Evaluation of Hair Growth Promoting Activity of Maharanga bicolor and Hibiscus rosa sinensis
Authors: Adhikari Kishor , Wagle Laxman , Dhakal Pramod , Dhungana Sanjaya , Baral Sujan , Jamarkattel-Pandit Nirmala
Published: December 2019

Alopecia is common and most frequently complaint dermatological disorder since the time immemorial. Various herbal and allopathic formulations are reported to have hair growth promoting activity. Minoxidil and Finasteride are only US FDA approved drugs for alopecia and hair loss. Maharanga bicolor and Hibiscus rosa sinensis are two ethnomedicinal herbs commonly used for hair growth promotion. Present study was conducted to determine hair growth promoting activity of petroleum ether extract of M. bicolor and H. rosa sinensis in Aloe vera gel. Minoxidil Sulphate and Different formulations of petroleum ether extract of M. bicolor and H. rosa sinensis was formulated in Aloe vera gel and applied to denuated area of rats for 30 days. Hair growth pattern, hair growth initiation, hair growth completion and length of hair was measured. M. bicolor (2%) formulation shows shortest hair growth initiation time on 6th day compared to 11th day in blank sample. Formulation containing 2% of each extract have shortest hair growth completion time on 19th day of sample application and showed potent hair growth pattern observed by blind investigation. The result suggests that petroleum ether extract of M. bicolor and H. rosa sinensis possess good hair growth promoting activity.

Key words: Maharanga bicolor, Hibiscus rosa sinensis, Hair growth promotion, Activity
Educational Satisfaction of Public Health Undergraduates: A cross sectional study in Nepal
Authors: Subedi Sudarshan , Kaphle Hari Prasad , Neupane Roshan , Rajbhandari Roshna
Published: December 2019

Educational satisfaction determines the quality of education system which interns affects the performance and achievement of students during study and finally future professional competencies. The objectives of this study were to identify the perceived status of satisfaction on educational conditions and teaching-learning environment and associated factors of it among the public health undergraduates. This was the descriptive cross sectional study carried out among 384 undergraduate students of public health studying in final year/semester of three universities of Nepal using self administered questionnaire. The result of the study showed that satisfactions on various components are below than average. Among the satisfied components, the major were in case of duration of course (46.1%), teaching skills of part time teacher (39.1%), curriculum and overall course of study (36.2%), research/dissertation guidance (34.6%) and teaching skills of full time teacher (33.6%). The satisfaction level was least in case of result timing/procedure (14.1%), tuition fee (23.7%), examination procedure (26.3%) and evaluation system (27.1%). Ethnicity, educational background, course duration, types of teacher, availability of books in library and availability of research papers/journals were found associated with educational satisfaction. The study concluded low educational satisfaction among public health under graduate students. It is recommended to take immediate action for improvements of different components of education system like curriculum structure & contains, teaching methodology, teaching learning materials, admission and examination procedure.

Key words: Public health; Education; undergraduate course; satisfaction; Nepal
Factors Associated with Treatment Compliance among Tuberculosis Patients Receiving Directly Observed Treatment Short Course Therapy
Authors: Sharma Sunita , Tamrakar Neeta
Published: December 2019

Tubercular infection is still a pervasive public health problem in Nepal despite the massive efforts of National Health Service stakeholders. This study was carried out to identify the factors associated with treatment compliance among Tuberculosis Patients Receiving DOTS in 11 centres of Pokhara valley. A cross-sectional descriptive study design was used to collect information from 142 Tuberculosis patients. Purposive sampling method was used and chi-square test was used at 5% level of significance. Pattern of compliance was categorized as; compliance and non-compliance. Out of 142 respondents, majority (94.37%) of respondents was compliant and minority (5.63%) was non-compliant. Among non-compliant patients, (75.0%) of respondents missed their medicine in intensive phase and the reasons for non-compliance were carelessness of patients, forgetfulness of patients, confusion of staff, side effects of medicines and agitation by political parties. The study found no significant association of treatment compliance with demographic factors, patient related factors, health service factors and social factors (p>0.05). The finding was satisfactory that the compliance of TB patients was high i.e. (94.37%) of respondents were compliant. About (6.00%) of respondents were non-compliant. The reasons for non-compliance were due to their own cause rather than health service factors. They themselves were responsible for being non-compliant. Tuberculosis, being a major public health problem; six percent non-compliance is still a serious health problem and being non-compliant; these patients can transmit tuberculosis to many other healthy people in the family and community. Therefore, tuberculosis patients should be more conscious on treatment compliance to improve their health as well as of family and community.

Key words: Compliance, non-compliance, DOTS Therapy
Sulfide ion Selective Method of Analysis of Sulfurated Hydrogen in Alkaline Smoked Cigarette Solution
Authors: Malla Komal Prasad , Neupane Bishnu Prasad , Malla Bindu , Gautam Anil , Chaudhary Dinesh
Published: December 2019

Sulfurated hydrogen commonly called hydrogen sulfide (H2 S) is a clear, colorless, extremely toxic gas that has a rotten egg smell at low concentration. The human nose can detect H2 S at concentrations below 100 parts per billion (ppb). It is found least amount in cigarette smoke that has been the subject of analysis for many analytical chemists. This gases is soluble in alkaline medium and gives free sulfide (S-2 ) ions. Sulfide ion concentration in cigarette smoke solution is found in the range of detection limit of lab made Silver- silver sulfide (Ag/Ag2 S) ion selective electrode (ISE).This project has designed to investigate the amount hydrogen sulfide as a free sulfide (S--)ion in cigarette smoke solution. Silver-silver sulfide ion selective electrode (Ag/ Ag2 S ISE) and Silver–silver chloride (Ag/AgCl) reference electrode are prepared in the lab for determination. Detail protocol of standard addition method with modified Grant’s plot is applied for estimation. Different brand of cigarette samples were collected from different area of Pokhara valley and analyzed. The average amount of H2 S per stick of cigarette smoke is found to vary from 0.0453 mg to 0.0573 mg in different brands. Among them sample no SA-5 shows 0.0453mg per stick of cigarette. This result is minimum in compare to other brands. Similarly, sample no SA- 7 have found 0.0573mg per stick which is higher in compare to other brands.

Key words: Cigarette smoke, hydrogen sulfide, ion selective electrode, standard addition method, Grant’s plot method,
Diurnal Variation of Serum 25 (OH) D3 , Calcium and Phosphorus in Type 2 Diabetes Mellitus
Authors: Shakya Rupendra , Neupane Balram , Bhandari Devi Prasad
Published: December 2019

Diurnal variation, an outgrowth of chronobiology, is the inferential statistical mapping of structures in variables; in and around us, consisting of rhythms chaos and trends. Type-2 diabetes mellitus is a metabolic disorder with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both. The diurnal time structure of serum 25(OH) D3 and calcium may relate to the prevention and chronotherapeutic efficacy and management of type 2 diabetes mellitus. To our knowledge, the diurnal variation of serum 25(OH) D3 has not yet been reported in type 2 diabetic patients. The present study was planned to evaluate the diurnal variation of serum 25(OH) D3 , calcium and phosphorus levels in type 2 diabetic patients. Ten clinically healthy volunteers and ten diagnosed patients of type 2 diabetes mellitus of similar age groups were synchronized for one month with diurnal activity from about 06:00 to about 22:00 and nocturnal rest. All subjects took their meals three times daily without any change in their usual fluid intake. Blood sample were collected into plain and sterile vials under quality control procedures from each participant at every 6 hour. Serum 25(OH) D3 , serum Ca++, serum PO4 , FBS and PPBS levels were estimated. A marked diurnal variation in serum 25(OH) D3 was recorded in healthy subjects (P=0.030). Similarly, a circadian rhythm of borderline statistical significance was also recorded for vitamin D in diabetic patients (P=0.083) and in healthy participants for serum calcium (P=0.070), phosphorus (P=0.102), and the calcium-phosphorus ratio (P=0.091) by the Two way ANOVA analysis. In addition, the amplitude and acrophase differed from healthy participants in diabetic patients for studied variables with a change of MESOR for calcium-phosphorus ratio. Mapping the broader time structure of different physiological variables investigated herein may be helpful in understanding the treatment and prevention of diabetic mellitus.

Key words: Serum 25(OH) D3 , Calcium, Phosphorous, Type 2 Diabetes mellitus
Prevalence of Intestinal Parasitic Infections among School Children of Dadeldhura District, Nepal
Authors: Tiwari Bishnu Raj , Chaudhary Ranju , Adhikari Nabaraj , Jayaswal Sailesh Kumar , Poudel Thakur Prasad , Rijal Komal Raj
Published: December 2019

Intestinal parasitic infestations are a common finding in the developing world, however, the patterns of parasitic distribution and rates are different elsewhere. The prevalence of intestinal parasitic infestation and chemical analysis of stool sample of the school children of age group 4-12 years in Dadeldhura district, far western region of Nepal. Out of 530 stool samples, 165 (31.13%) were found to be intestinal parasites positive. Among the total parasites, Hymenolepsis nana (46.56%) and Giardia lamblia (7.47%) were found in high prevalence as helmiths and protozoa respectively. Among the total stool samples 159 (30%) showed positive occult blood test. The prevalence of parasitic infection was found high in the children of age group 4-6 years (38.18%) than others though the result was not significant statistically (P>0.05). Highest prevalence of parasites was found in those not following the hygienic conditions (36.17%) than those following (18.83%). Similarly, high proportion of the parasites were found in children having gastrointestinal symptoms (49.23%) than in children without the gastrointestinal symptoms (13.70%) though the result was not significant statistically (P>0.05). The study showed the children using the water directly from the source had higher prevalence of parasites (32.13%) than those using treated water (14.28%). This study presents the high prevalence of stool parasites in school going children of Dadeldhura district.

Key words: Parasitic infection, School children, Stool samples, Dadeldhura, Nepal.
Compliance to Directly Observed Treatment Short Course (DOTS) Chemotherapy among the Patient of Pulmonary Tuberculosis in Banke District of Nepal
Authors: Bahadur Nepali Ram , Prasad Paneru Damaru
Published: December 2019

Tubercular infection is still a pervasive public health problem in Nepal despite the massive efforts of National Health Service stakeholders. High bacterial infectivity, transmissibility, increasing drug resistance and non compliance to the therapy have been adding up challenges to prevention and control of tuberculosis. This study was conducted to observe the treatment compliance pattern among new pulmonary sputum smear positive cases of tuberculosis. A cross sectional study was carried out in the year 2009. The 114 new smear positive pulmonary tuberculosis patients registered in the six selected DOTS centres of the Banke Disrtict were randomly selected. Participants were selected from each DOTS centre by probability proportionate sampling methods. Data were analyzed by SPSS (11.0 Version) and P< 0.05 was considered as significant. Overall compliance to DOTS was 86.80 percent; of these, 57.00 percent showed excellent and regular compliance followed by nearly 30 percent good compliance. And 13.20 percent participants were non complaint to DOTS therapy. Positive Family behaviors were positively associated with compliance while alcohol consumption was found to be negatively associated with compliance however; age, sex and income were found to be non significant factors for compliance. Feeling of getting cure even before the course of DOTS therapy (feeling better after 2-3 months regular treatment) and drinking habits were found to be the major causes of non compliance. Supportive family behaviors and avoidance of alcohol consumption may promote the compliance. Excellent treatment compliance in the face of many odds is highly encouraging and the pattern can be useful in treatment despite little non compliances; furthermore compliance can be enhanced by acting on these causes of non compliances.

Key words: Pulmonary, Tuberculosis, DOTS, Banke, Nepal
A Study of Typhoid Fever in Bheri Zonal Hospital and Nepalgunj Medical College Teaching Hospital, Banke, Nepal
Authors: Shah Gaurav Jung , Prasad Poudel Thakur
Published: December 2019

Typhoid fever remains an important public health issue in many developing countries and predominates in areas with poor sanitation, which aids its transmission and persistencein the human population. The prevalence of typhoid fever in different months of a year (2009/2010) and the distribution of cases of typhoid fever with respect to their age and gender among patients visiting Nepalgunj Medical College Teaching Hospital (NGMCTH) and Bheri Zonal Hospital (BZH), the two major health delivering institutions of Mid-western and Far-western regions of Nepal. During this period, 4657 and 5496 blood samples were collected in NGMCTH and BZH respectively. Of the 4657 tested in NGMCTH, agglutinins to Salmonella typhi was observed in 1092 samples (overall prevalence rate being 23.45%), that were most prevalent in months corresponding to wet season (June/ July-31%, July/August-29.65%).Similar trend was observed for BZH where of 5496 samples tested, Salmonella typhi was positive in 1814 samples with overall prevalence rate being 31.77%, cases being most prevalent in months corresponding to wet season (June/July–45.91%, July/August – 47.41%). In both hospitals, there was male predominance among cases (Male to Female Sex-ratio: 224:100 for NGMCTH and 247:100 for BZH). This male predominance was maintained in almost all age-groups. There was high proportion of cases of less than 30 years of age in both NGMCTH and BZH (77.84% and 73.98% respectively) indicating that most of the cases of typhoid fever are of younger age-group.On the average, typhoid cases aged 24.58 years ± 13.00 years for NGMCTH, while for BZH it was 25.81 years ± 13.41 years. Mean age of females was found to exceed to that of males in both NGMCTH (26.84 years ± 12.31 years against 23.58 years ± 13.16 years) and BZH (27.61 years ± 13.64years against 25.08 years ± 13.25 years).

Key words: Salmonella typhi, widal test, incidence, Nepal.
Neuroprotective Effect of Metaplexis japonica against in vitro Ischemia Model
Authors: Jamarkattel-Pandit Nirmala , Kim Hocheol
Published: December 2019

Metaplexis japonica (Apocynaceae) is a perennial herb, extensively used in traditional medicinal system for various diseases. The purpose of the study was to evaluate the protective effect of M. japonica against in vitro ischemia. In the present study, 70% ethanol extract of M. japonica was fractionated with different polarity solvents. For in vitro ischemia, oxygen-glucose deprivation followed by reoxygenation (OGD-R) in cells was used to investigate the effects of M. japonica and its fractions. For oxidative stress model, Hydrogen peroxide (H2 O2 ) induced cell death was studied in HT22 cell line. M. japonica and its fractions significantly reduced the HT22 cell damage, which was induced by 4 hrs of OGD followed by 24 hrs of reoxygenation and 24 hrs of H2 O2, respectively. The effectiveness of ethyl acetate fraction was higher than other fractions/crude extract. Our results suggest that M. japonica could be a neuroprotective agent for the treatment of stroke.

Key words: Metaplexis japonica, Stroke, Oxygen-glucose deprivation, Neuroprotection
Factors Associated with Nutritional Status of Under Five Children in Rupandehi District of Nepal
Authors: Acharya Dilaram , Gautam Salila , Prasad Kaphle Hari , Naupane Nirmala
Published: December 2019

Childhood is a time of active growth in terms of physical size, mental, emotional and psychological development. Normal growth is dependent on adequate nutrition and encompasses major transformations from birth to adulthood. Socio-economic status and behaviors of family members, environmental factors are other determinants of nutritional status of under five year children. This research was conducted to assess the factors associated with nutritional status of under five year children in Rupandehi District of Nepal. This was a community based Cross-sectional study. It was conducted in Rupandehi. Two hundred ninety two children were selected using proportionate random sampling technique. For collecting the data, selected households were visited by enumerators for two months from January to February 2008. Data were analyzed using SPSS version 12. The proportion of the participants was 51.7% male and 48.7%female. Nearly half of the children (45.9%) of the children aged 36- 59 months were under weight according to Indian Academy of Pediatrics (NCHS/WHO standard). Fifty percent of the children born to illiterate mothers were found underweight. Majority of the children (65%) were found stunted according to Waterlow’s classification. More than the half the children (57.75%) were underweight who were born by mother less than 18 years of age where as 75% were underweight born by mother aged above 35 years of age. However the association between age of the mother at the birth of the child and nutritional status is not statistically significant. More than half of the children were found underweight and Nearly 2/3rd of the children were found stunted. To get better nutritional status of children, greater emphasis should be given to under five years children with community based awareness programs to mother and care givers.

Key words: Height-for-age, weight-for-age, Malnutrition, Waterlow’s classification