bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal diagnosis of congenital anomalies and their outcome in Tribhuvan University Teaching Hospital
Authors: Jha BK , Jha P , Dahal GR , Pokharel RP
Published: July 2024

Introduction: Congenital anomalies represent defects in morphogenesis during early fetal life. The proportion of perinatal deaths due to congenital anomalies is increasing in developing countries like Nepal as a result of reduction of mortality due to other causes.
Methods: A retrospective study was conducted in the Pediatric Surgery Unit, Department of Surgery, Tribhuvan University Teaching Hospital (TUTH). Data were collected from patients’ hospital files from 2013 to 2015 AD.
Result: A total of 33 patients who had congenital anomalies either diagnosed and referred from outside or diagnosed at TUTH were included. Various types of anomalies involving different body systems were identified during the prenatal period. But surgery was performed in only seven cases.
Conclusion: Due to widespread availability of ultrasound the number of patients with congenital anomalies who are being detected is on the rise. The proper management of these children in the intrauterine and neonatal period is a challenge in our context. Lack of proper policy and resources is a big hindrance to the proper management of these group of patients.
Audit on elective surgery waiting list in the department of ENT- Head and Neck Surgery in a tertiary care center
Authors: Tripathi P , Gurung U , Shrestha A
Published: July 2024

Introduction: Patients needing surgical treatment for benign conditions are listed on first come first served basis in the department of ENT- Head and Neck Surgery (ENT-HNS), Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The objective of this audit was to determine the average waiting period for elective surgery in various subspecialty units of the department and the patient turn up rate on the scheduled date.
Methods: This was a retrospective audit based on the elective surgical waiting list register of year 2073 B.S. of four subspecialties in the department; namely unit I-Otology, Unit II- Head & Neck surgery, Unit III - Pediatric ENT and Unit IV- Rhinology
Results: The overall average waiting period for elective surgery was 10.6 weeks. For GA cases it was 10.4 weeks for unit I and II, 13.2 and 8.3 weeks for unit III and IV respectively. For LA cases, waiting period in unit I and IV was 16.9 and 2.5 weeks respectively. The overall turn up rate on the scheduled contact date was 40.8% (46% for GA cases and 31% for LA cases). For unit I, it was 50% for GA cases and 26.6% for LA cases. For unit II and unit III GA cases, turn up rate was 38.4% and 43.8% respectively. In unit IV, it was 53.3% for GA cases and 66% for LA cases.
Conclusion: The patient turn up rate on contact date in general decreased with longer waiting period for elective surgery.
Managing Chiari I Malformations; 5 Year Experience
Authors: Sedain G , Pradhanang A , Sharma MR , Shilpakar SK
Published: July 2024

Introduction: Chiari I malformations present with variety of symptoms. There are four types of Chiari malformations described in literature. There are two more types of Chiari introduced later; Chiari 0 and Chiari 1.5. Routine use of MRI has led to frequent identification of the Chiari malformation. Management of Chiari malformation has evolved with time. Asymptomatic patients can be managed conservatively  with regular clinical and radiological follow up. Surgical management includes decompression of foramen magnum. This creates a space so that circulation of CSF is unimpeded. We analyzed patients who underwent surgical management at our centre in last 5 years.
Methods: Retrospective analysis of all patients operated in Neurosurgery department of TUTH (Tribhuvan University Teaching Hospital) from 2012 July to 2017 July was done. Data was collected from hospital records and follow up was taken from outpatient department. Demography, associated syringomyelia, improvement in clinical symptoms and radiological improvement were analyzed. Minimum follow up of 1 year was included.
Results: A total of 37 patients were available for analysis. Male to female ratio was 15:22. Major presentation was occipital headache sensory impairment and atrophy of upper limb due to syringomyelia. Clinical and radiological improvement was seen in all patients except 1 patient who developed post operative pneumonia and succumbed. Morbidity in the form of wound infection in 2, Pseudo meningocele was present in 4 patients and CSF leak in 3 patients. Resolution of syrinx was observed in 34 patients except in 3 patients who required a syringopleural shunt in follow up.
Conclusion: Management of Chiari I malformation is relatively safe. In this era of diagnosis of more and more asymptomatic patients, clinical judgement is essential.
Gene Xpert based detection of drug resistant tuberculosis among retreatment patients visiting National Tuberculosis Centre, Nepal
Authors: Khadka DK , Bam DS , Ghimire P , Singh A
Published: July 2024

Introduction: Tuberculosis is still one of the major public health problems in Nepal and multi drug resistant and extensively drug resistant tuberculosis (MDR /XDRTB) additionally has become serious issue. Prompt diagnosis and effective treatment of MDR/XDRTB is urgently needed. The main objective of this study was to detect MDR TB using novel molecular techniques (rpob gene mutations) in reference with drug susceptibility test (DST).
Methods: A cross sectional study was carried out identifying MDRTB among retreatment patients using Gene Xpert, culture and DST on first line drugs (FLD-DST). A total of 159 sputum samples were collected from retreatment TB patients (Female 40.3%, Male 59.7%) with median age of 30 years visiting to the DR TB treatment centres of eastern and central Nepal (via private courier and directly to National TB Reference Laboratory (NRL) at NTC from April 2013 to August 2017.
Results: M. tuberculosis and rifampicin resistance were detected on all 159 (100%) samples by Gene Xpert of which, 73.3%, 21.4% and 6.3% were positive, negative and contaminated respectively by culture. FLD-DST was performed on 115 cultures positives of which, 94.78% showed MDRTB, 1.74% showed mono resistance to isoniazid or rifampicin, 0.87% to streptomycin and isoniazid and 3.47% were pan susceptible.
Conclusion: One hundred fifteen of 159 cases detected rifampicin resistances (RR) by Gene Xpert were culture positive and almost 95% strains were MDRTB by FLD-DST, which was found to be higher in 15-60 years group. Sputa from retreatment TB patients required to be tested by rapid diagnostics with reference to culture and DST.
Impact of cancer on Nepalese patients and their caretakers
Authors: Dhungana A
Published: July 2024

Introduction: Cancer is today’s burning healthcare issue. Disease itself as well as side effects from treatment has massive impact on patients’ lives. Tragic disease consequences happen, further worsened by inevitable adverse reactions of treatment. This study attempts to measure the various impact of disease among Nepalese cancer patients and their caretakers.
Methods: This was a hospital based descriptive cross sectional study conducted in Bhaktapur Cancer Hospital for two months on l98 adult cancer patients and 20 caretakers. Face to face interview was done with semi structured interview schedule, 0-10 Numeric Pain Intensity Scale, Kuppuswamy’s Socioeconomic Status Scale and Beck’s Depression Inventory. Data entry and analysis was done on IBM SPSS V20.
Results: Disease was seen in advanced age group with no sex wise variations. Majority was married, literate, from rural area, of upper caste and upper lower socioeconomic status. Cancer of lung, rectum and bile duct were more frequent in male in contrary to that of breast, ovary and cervix in female. Majority suffered from various impact of disease and side effects of the treatment like pain, depression, fatigue, weight loss, diminished physical activity and financial burden. Family members were equally prone to depression.
Conclusion: Patients and their families are cosufferers in the battle against cancer. To confront the mounting impact of cancer epidemic in Nepal, cancer should be given high priority in national health programs, and population based cancer registry should be immediately established.
Radiographic evaluation of Calcaneal angles in patients presenting to tertiary care center of Nepal
Authors: Rokaya PK , Pokharel RK , Lamichhane AP
Published: July 2024

Introduction: Fractures of the calcaneus are the most common tarsal fracture and they account for approximately 2% of all fractures. Recognizing the normal limits of the calcaneal angles is important in determining the degree of deformity and quality of reduction, and can thus help to predict the morbidity after calcaneal fractures. No study about the normal ranges of the calcaneal angles in the Nepalese populations is to our knowledge till date.
Methods: Lateral plain radiographs of foot and ankle of 140 patients without a calcaneal fracture were analyzed at Department of Orthopedics TUTH, Maharajgunj, Kathmandu between February2012 to September2013. Böhler angle and Gissane angle were measured. The distribution characteristics of these angles with respect to age, gender, and side of the body were analyzed and compared with those of previous studies.
Results: The mean BA was 31.3 plus/minus 5.28 deg (range of 18-47°) and the mean GA was 108.4 plus/minus 10.59 deg (range of 85-135°) There were no significant differences for calcaneal angles with respect to side (for BA, p = 0.728 for GA, P ^ =0.091) and for sex (for BA, P = 0.555 for GA, p = 0.212 ) There were no significant differences between the age groups for calcaneal angles (for BA, p = 0.659 for GA, p = 0.912 )
Conclusion: Calcaneal parameters specific to the Nepalese population have to be taken into consideration by the orthopedic surgeons to improve the standard of calcaneal fracture treatment in Nepal. The range herein reported of ( 47 deg for BA, 35 - 135 deg for GA) may be used as reference values for the Nepalese population.
Laparoscopic management of hydatid cyst of liver
Authors: Pradhan S , Ghimire B , Kansakar P , Singh Bhandari R , Lakhey Joshi P , Singh YP , Vaidya P , Mishra P , Singh KP
Published: July 2024

Introduction: The surgical treatment of liver hydatid disease has evolved dramatically and laparoscopic treatment has shown encouraging results with the advantages of minimally invasive surgery. We conducted this study to determine the outcome of laparoscopic management of hydatid disease of the liver.
Methods: Consecutive patients with this disease reporting to our department from July 2014 to July 2015 were offered laparoscopic management. All patients received pre- and postoperative albendazole. The laparoscopic technique consisted of aspiration of the cyst fluid, sterilization, suction and drainage of the cavity, deroofing and addition of omentoplasty. Age, sex, duration of surgery, surgical morbidity, hospital stay and evidence of hydatid cyst recurrence were measured.
Results: Twenty six patients had laparoscopic treatment for hepatic hydatid cysts. Females were 18 (69.2%) and males were 8 (30.8%). Mean age of patients was 37.46 ± 15.96 years (range 17-74 years). Pain was the commonest presentation occurring in 21 (80.8%). The right lobe of the liver was most commonly involved in 20 patients (76.9%). The mean cyst size was 6.77 cm (range, 5 cm to 12 cm). Minor spillage of cyst contents occurred in 5 patients (19.23%) and major spillage occurred in 1 patient (3.8%). The mean duration of surgery was 84.81±28.93 minutes (range 50-150 minutes). Conversion was needed in 2 (7.7%). Complications included port-site infection in 2 (7.7%), bile leak in 3 (11.5%), fever in 5 (19.2%) and chest infection in 2 (7.7%) cases. Mean hospital stay is 4.58 ± 3.40 days (range 3-16). There was no mortality in the series. The average follow-up period is 7.81 ±2.57 months. There have been no recurrences to date however 1 patient was lost to follow up.
Conclusion: Laparoscopic management of hydatid cysts of the liver is a safe and effective option with advantage of minimally invasive surgery in properly selected patients.
Pattern of toxicology cases in Emergency, Tribhuvan University Teaching Hospital
Authors: Raut S , Shakya YL , Shrestha TM , Neupane RP , Maharjan RK
Published: July 2024

Background: Acute poisoning is one of the major contributors of heath problem causing morbidity and mortality in the emergency of the hospital. The study focused on the demographic and epidemiological aspects of all the poisoning cases that came to Emergency of TUTH.
Methods: The study was a cross-sectional retrospective data collection of all poisoning cases recorded in hospital from April 2016 to March 2018. Hospital records of all poisoning cases were used to extract demographic and other data such as poisonous agents used, circumstance of poisoning, route and outcome of poisoning. The data analysis was done in Microsoft Excel.
Results: The total number of cases was 641 out of which 40 cases were excluded from the study. Of 601 cases, males were 42.09% and females were 57.90%. The most common age group for both male and female was 16-26 years group and male to female ratio was 1:1.3. The most common circumstance of poisoning was deliberate self-harm which was 91.68% followed by accidental which was 4.6%. The common route of administration was ingestion at 99.91%. The mortality in the Emergency was 5.15% and total of 75.04% cases were admitted in observation after primary management in ER and discharged from the observation after improvement and psychiatric evaluation. The most common toxicology agent was pesticide at 52.57%followed by pharmaceuticals at 25.45%.
Conclusions: Pesticides are the major cause of poisoning and accounts for majority of cases of toxicology followed by pharmaceuticals. The study also concludes that the young age group is more vulnerable to poisoning, hence strong regulatory measures are required for control of easy accessibility of these substance.
Case of necrotizing fasciitis of breast in a young lactating mother
Authors: Jha P , Jha BK
Published: July 2024

Introduction: Necrotizing fasciitis is an infection of soft tissues associated with a high risk of mortality. Primary necrotizing fasciitis of breast is an extremely rare condition with very few cases reported in literature.
Case presentation: This case report describes a 19 year old Hindu female with necrotizing fasciitis of left breast. Patient was managed with intravenous antibiotics, early aggressive debridement, daily dressing followed by split thickness skin grafting.
Conclusion: Though necrotizing fasciitis of breast is a rare condition, it should be suspected in a patient with pain and swelling of breast.
Leptospirosis: An Emerging Infectious Disease in Nepal
Authors: Bhattachan B. , Bhattacharya A , Sherchan JB , Dhoubhadel BG , Sherchand JB
Published: July 2024

Introduction: The aim of this study was to determine prevalence of Leptospira spp in Japanese Encephalitis negative cases, as well as its demographic and geographical picture in Nepal.
Methods: The Nepal government along with World Health Organization (WHO) country office Nepal had approved this surveillance project, which conducted from 2007 to 2008 throughout 47 districts in Nepal. JE was confirmed from Cerebrospinal fluid (CSF) samples using ELIZA Method whereas Leptospiraspp was identified by using Latex Agglutination Test kit method in Nepal Public Health Laboratory (NPHL), Kathmandu, Nepal.
Results: Among 2690 Acute Encephalitis Surveillance, the lumber puncture (LP) was done in 2145 patients. Among those tested, JE positive was confirmed in 771 patients. LP was not done in 381 cases. Among 993 JE negative cases, positivity rate of Leptospira spp was reported 41.8% (416/993) . There was more male preponderance 63.5% (264/416) However, it was not statistically significant (p = 0.713) . In terms of age distribution, those above 15 years of age were 64.5% (268/416) while those below 15 years of age were 35.5% (148/416), (p = 0) In eco- region, the rate of infection was highest in Terai region at 53.2% (222/416) followed by Mountain region at 45.2% (188/416) and Himalayan at 1.4% (6/416), (p = 0.005) In terms of seasonal distribution, the rate of infection in autumn was at 44.2% (188/416) followed by summer at 40.1% (167/416), spring at 9.6% (40/416) and winter at 6.1% (25/416) (p = 0)
Conclusions: Nepal government cannot neglect the increasing possibility of outbreaks of Leptospira spp in different parts of the country, so this study recommends for surveillance of this infection to prevent future outbreaks in Nepal
Managing Deep Mycoses in Nepal is still a challenge: case report of actinomycetoma, a neglected tropical disease
Authors: Paudel U , Sharma R , Parajuli S
Published: July 2024

Deep mycoses are frequent diagnoses in Nepal. Most of the cases remain undiagnosed because of unavailability of specific diagnostic services in our setting. We report a case of deep mycosis, in a 60-year-old male, who presented with multiple nodules and scars on his neck and chest, and was histopathologically diagnosed as actinomycosis. The culture was negative. The patient did not respond to treatment with penicillin initially, however, on starting co-Trimoxazole , the lesions resolved in two months, thus pointing towards diagnosis of actinomycetoma. The patient remained disease free at last follow- up at two years. The case highlights importance of considering actinomycetoma as one of the differential diagnosis of such presentation and also need of developing well set reference laboratory in order to reach to a proper diagnosis.
Sonographic measurement of the atrium of fetal lateral ventricle in low risk population of pregnant women at 16-38 weeks of gestation.
Authors: Yadav B , Thapa BR , Ghimire RK , Joshi BR
Published: July 2024

The purpose of this study was to establish the size of atrium of fetal lateral ventricle and to evaluate its changes in normal fetuses in low risk population of pregnant women in the second and third trimesters of pregnancy.
Methods: This was a prospective cross-sectional study involving 290 women with uncomplicated singleton gestation between 16-38 weeks. Atrium was visualized in 264 cases. The fetal biparietal diameter (BPD) was measured first. Atrium was measured at the level of the glomus of the choroid plexus, perpendicular to the ventricular cavity, positioning the calipers inside the echoes generated by the lateral walls. Nomogram of the sizes of atrium was prepared.
Results: Atrium was visualized in 91% of the fetuses. The ages of the patients ranged from 17-30 years (mean 24.29, SD 2.78). The maximum numbers of case were at 23 and 27 weeks of gestation and the minimum number of cases were at 37 weeks of gestation. The mean size of the atrium of lateral ventricle was 6.28mm, (SD1.2; range 3.5-8.9 mm). The size of atrium showed significant positive correlation with gestational age (r2 value of 0.78; p<0.001 for atrium)
Conclusion: Atrium of lateral ventricle showed continuous increment and showed significant correlation with the gestational age. The findings were consistent with the previous studies done by various authors. The percentile fitted values and nomograms will be valuable for the serial measurement of the atrium of lateral ventricle for complicated pregnancies.
Clinical and etiological profile of optic disc edema cases in neuro- ophthalmology clinic of B.P Koirala lions centre of ophthalmic studies, IOM
Authors: Sah RK
Published: July 2024

Introduction: Optic disc edema can be a manifestation of various neurological disorders. Identification of those causes is possible in most cases using tests like visual acuity, color vision, visual field and suitable radiological imaging. Study in Nepalese population with regard to optic disc edema is scarce. Hence this study aims to act as a guideline for evaluation of such cases and help in further studies in this regard.
Methods: A descriptive, cross-sectional study was conducted in all cases of optic disc edema presenting to neuro-ophthalmology clinic of B.P. Koirala Lions Centre for Ophthalmic Studies from January 2011 to June 2012. A detailed history was obtained and proper ocular and nervous examination was done by ophthalmologist and neuro-physician. Assessment of visual acuity, color vision, contrast sensitivity and visual field along with radiological tests were done in all possible cases.
Results: Out of all the cases evaluated, 38 cases where causes of optic disc edema could be established were included in the study. The commonly affected age group was 31 to 40 years (26.3%) and most of them were males. The commonest cause observed was optic neuritis (36.8%). Others were papilledema, idiopathic intracranial hypertension, toxic optic neuropathy, non-arteritic anterior ischemic optic neuropathy (NA-AION), compressive and traumatic optic neuropathy.
Conclusion: Optic neuritis and papilledema should be considered as common differential diagnosis in patients with optic disc edema. NA-AION is a relatively uncommon disease among Nepalese population.
Antiepileptic Effects of Amlodipine in Mice
Authors: Bajracharya SR , Sathyanarayana  Rao KN
Published: July 2024

Introduction: Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures with at least two unprovoked seizures occurring >24 hours apart. It is one of the most common neurological diseases globally. Earlier studies revealed that a potent calcium channel agonist induced convulsion and calcium channel antagonists produced antiepileptic activities. Hence, this study was carried out to assess antiepileptic effects of amlodipine since it holds a good safety profile among calcium channel blockers.Methods: Inbred Swiss albino mice of both sexes weighing between 20-30 g were used. Antiepileptic effects were assessed using Maximal Electroshock Seizure (MES) test and Pentylene tetrazole (PTZ) induced seizure test. Mice were arranged into 5 groups, each containing 6 mice: Tween-80 (Negative control). Amlodipine at the doses of 1 mg/kg, 2 mg/kg. 4 mg/kg and Sod. valproate (Positive control). Comparison between the test and control was done using Mann-Whitney U test and dose-dependent effects by regression analysis. P value of less than 0.05 was taken as significant.Results: In MES Test, Amlodipine in the dose of 2 mg/kg and 4 mg/kg significantly decreased the duration of tonic hind limb extension (P<0.01) with significant dose dependent effect (r = 0.96).In PTZ test, Amlodipine in the dose of 2 and 4 mg/kg significantly increased the latent period (P<0.05) with dose dependent increase in the latent period (r² = 0.97).However, protection offered in both the seizure models are lower with amlodipine even in higher dose as compared to Sodium valproate.
Conclusion: Amlodipine is effective to control seizure in animal models of epilepsy especially in higher doses. Amlodipine can be a good add-on drug to sodium valproate rather than an alternative to it.
Attitudes towards Psychiatry and Mental Illness among medical students in a university hospital
Authors: Chapagai M , Dhungana S , Tulachan P , Ojha S P
Published: July 2024

Introduction: Psychiatry is viewed negatively by medical students. They tend to have negative attitudes towards psychiatry, psychiatrists, mentally ill and mental illnesses as a whole. This study was intended to assess attitudes to psychiatry and mental illness among medical students in Tribhuvan University Teaching Hospital.
Methods: It was a cross- sectional study done to assess attitudes to Psychiatry and Mental illness among fourth year medical students in Tribhuvan University Teaching Hospital. Socio- demographic information was filled up and two likert scales ATP-30 (Attitudes to Psychiatry) and ATM (Attitudes to Mental Illness) were used to assess attitudes. Descriptive analysis was done and chi- square test was used to see for any statistically significant difference for the items using SPSS version 20.
Results: Total sample size was forty- five and males comprised three- fourth of the respondents. The mean age of participants was 22.4 years with somewhat higher number of respondents from valley (57.8%). Brahmins (26.6%) and Hindu (88%) constituted the majority. 84.4% of the respondents belonged to nuclear family. The mean ATP-30 and ATM scores obtained were 106.78 and 66.93 respectively.
Conclusions: Overall attitude to Psychiatry and mental illness among fourth year medical students Tribhuvan University Teaching Hospital was found to be positive. Studies with larger sample size with students from multiple universities and medical colleges and comparison of attitudes before and after psychiatry rotation are further needed.
Calvarial Thickness of the Nepalese Dry Skulls
Authors: Baral P , Koirala S , Bajracharya S , Jha CB , Banstola D , Shrestha RN
Published: July 2024

Introduction: Calvarium of skull comprises frontal,parietal and occipital bone.These bones cap over the brain in cranial cavity. These bones are flat bones having outer and inner tables made up of compact bone. There is cancellous bone called as diploe in between the outer and inner table. The aim was to measure the thickness of calvaria at various points on Nepalese skull and establish Nepalese database of calvarial thickness and also to compare thickness on the right and left side for bilateral points.
Methods: Around140 calvaria of dried skull were studied. Thickness of various points on the frontal, parietal and occipital bones that form calvaria were measured with spreading caliper. The inner table, diploe and outer table thickness were measured with vernier caliper.
Results: The mean thickness of frontal bone is 5.6 ± 0.8 mm;out of which the outer table 1±0.2mm, the inner table 0.8±0.3mm and the diploe 3.8±0.6mm.The mean thickness of parietal bone is 4.5±0.6 mm; out of which the outer table 0.8±0.2mm, the inner table 0.6±0.2mm and the diploe 3.1±0.4mm. The mean thickness of occipital bone is 8.5±0.7 mm;out of which the outer table 2.2±0.4mm, the inner table 1±0.3mm and the diploe 5.7±0.6mm.There is significant difference in the mean thickness of the frontal, parietal and occipital bone(p<0.05). Theoverallmean thickness of the calvarium is 6.5±0.7 mm;out of which the outer table 1.5±0.3mm, the inner table 0.8±0.2mm and the diploe 4.5±0.5mm.The outer table is significantly thicker than the inner table(p<0.05).
Conclusion: All these results indicate that the calvarium is not uniform in thickness and there is increased thickness towards the posterior and the outer table is thicker than the inner table.
Disease Patterns among the Elderly People coming in Tribhuvan University Teaching Hospital, Kathmandu, Nepal
Authors: Shakya YL , Shrestha Bikash , Acharya R , Gupta Sanjay
Published: July 2024

Introduction: Globally, the proportion of elderly people is increasing at an unprecedented rate. Geriatric health problems are important issues even in developing countries like Nepal. The main objective of the study is to identify the disease patterns among the elderly people coming in Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal.
Methods: A cross sectional descriptive study was done among 100 patients, aged 60 years and above, in General Health Checkup clinic of Tribhuvan University Teaching Hospital in Kathmandu Written consent was maintained in the study. The obtained data through questionnaire method were managed by coding and entered and analyzed by using IBM SPSS V20.
Results: More than half (53%) of the patients were male. The mean (±SD) age was 67.35 (±16.927) years. Most of them were suffering from more than one disease. Hypertension was the commonest morbidity found in 47% of the patients. The other health problems were diabetes mellitus, dyslipidemia, coronary artery disease, hypothyroidism, cholelithiasis, cataract, chronic obstructive airway disease, benign hyperplasia of prostate and hysterectomy.
Conclusion: From the study, it can be concluded that non-communicable diseases are the major bulk of diseases in elderly population and have substantial impact on public health. Clinical settings like general health checkup clinics should focus on disease prevention and management including life style modifications, early detection and treatment, and self-management education Effective geriatric health care services need to stress ranging from family-based community care approach to convenient access to primary health care. Family caregivers and health care professionals need training and support in this field.
Papillary renal cell carcinoma – a case report
Authors: Krishnanand B.R. , Geetha T.V. , Basu Amitabha , Mukherjee A.L
Published: July 2024

Papillary renal cell carcinoma is an uncommon variant of renal cellcarcinoma. It is considered to be a less aggressive tumour. This tumour has betterprognosis than that for non-papillary renal tumours.The possibility of papillary renal cell carcinoma should be consideredeven when the tumour is small and well circumscribed.
Uterine Perforation following Induced Second trimester Abortion in an Adolescent
Authors: Rijal H , Baral J , Gurung G , Rajbhandari S.Rana A A
Published: July 2024

We report a case of a 19 year adolescent, who underwent unsafe induced abortion at 14 weeks of pregnancy followed by continuous pain and fever discovered at laparotomy to be due to uterine perforation with the findings of product of conception along with flat bone popping through a uterine rent in anterior and lower part of the uterus within the vicinity of uterovesical which was repaired with good outcome.
Neglected Medial Hoffa Fracture for 9 years -A Case Report
Authors: Thapa SS , Lamichhane A , Mahara DP
Published: July 2024

Hoffa fractures, coronal fractures of the femoral condyle, are uncommon injuries. It is often missed on initial plain radiographs. Medial Hoffa fractures are three times less common then lateral Hoffa. Here we present a case of neglected non-union of medial Hoffa fractures for 9 years, with good outcome after Open reduction and internal fixation.
Cases of Situs inversus: a report
Authors: S.Bilodi Arun Kumar , Jain Neeraj , Sinha B.N. , Jain Vibha
Published: July 2024

SITUS INVERSUS is the mirror image of normal, where there is transposition of abdominal viscera associated with dextrocardia. It is often accidentally discovered during routine physical examination and radiological examination.
In the present study, there are two cases of situs inversus. One adult male of 23 years presented with dextrocardia and situs inversus was accidentally detected during the routine physical examination. In another case, a 9-month male child also presented with situs inversus with ventricular septal defect. The above cases are found to be rare elsewhere but in Nepal it seems to be common. Hence, these cases were studied and reported.
A Meta-Analysis Comparing General Anesthesia, Deep Sedation, and Conscious Sedation for Catheter Ablation of Atrial Fibrillation
Authors: Ye Tingting , Fan Yuncao , Shao Jianzhi , Wang Qizeng , Wang Taotao
Published: July 2024

Background: The optimal anesthesia strategy during catheter ablation of atrial fibrillation (AF) remains controversial. This meta-analysis compared general anesthesia, deep sedation, and conscious sedation in terms of procedural time and complications. Methods: Literature searches were conducted in PubMed, EMBASE, and Web of Science databases. Mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- and random-effect models on the basis of the heterogeneity among studies, as assessed by I2 statistics. The random-effect model was used when the heterogeneity was high (I2 > 50%). Publication bias was evaluated through funnel plots and Egger's tests. Results: Sixteen studies were included in this study. No significant difference was observed in procedural time between the general anesthesia and conscious sedation groups (MD: –8.1479 minutes, 95% CI: from –27.6836 to 11.3878, seven studies). Deep sedation was associated with procedural time (MD: 131.8436 minutes, 95% CI: 99.6540–164.0332, eight studies). The rate of serious intraprocedural complications was 1.5% (95% CI: 1.2%–1.9%) with deep sedation (seven studies). Conscious/analog sedation had 26%–29% higher odds of perioperative complications than general anesthesia (OR: 1.2622, 95% CI: 1.0273–1.5507, nine studies). Significant heterogeneity was present across studies. Conclusions: This meta-analysis found no significant difference in procedural time between general anesthesia and conscious sedation for AF ablation. Deep sedation was associated with longer procedural time. Conscious sedation appeared to have a higher risk of perioperative complications than general anesthesia. Further randomized trials are warranted to determine the optimal anesthesia strategy.
Effects of Exercise-Based Cardiac Rehabilitation on Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis
Authors: Bao Xuedan , Hong Weiwei , Feng Liyao
Published: July 2024

Objective: This study aims to systematically analyze the impact of exercise-based cardiac rehabilitation on patients undergoing percutaneous coronary intervention (PCI). Methods: We searched for original studies on the effect of exercise-based cardiac rehabilitation on patients undergoing PCI published in domestic and foreign databases such as PubMed, Web of Science, Embase, Cochrane Library, China Knowledge Network (CNKI), and VIP until December 2023. Studies retrieved were screened, and meta-analysis was extracted. The quality of the literature was evaluated; meta-analysis was carried out by RevMan5.4 software (Cochrane Collaboration, Oxford, UK). Results: A total of 1073 sufferers undergoing PCI were included in 11 literatures. Meta-analysis displayed that cardiogenic mortality [risk ratio (RR) = 0.23, 95% confidence interval (CI) (0.08, 0.64)], coronary restenosis rate [RR = 0.59, 95% CI (0.41, 0.87)], revascularization rate [RR = 0.58, 95% CI (0.43,  0.79)], incidence of recurrent angina pectoris [RR = 0.41, 95% CI (0.27, 0.62)], and late lumen loss [RR = –0.60, 95% CI (–0.98, –0.23)] in the trial group, were lower than those in the control group (p < 0.05). No significant difference was found in the recurrence rate of myocardial infarction between the test group and the control group [RR = 0.52, 95% CI (0.22, 1.25)]. Conclusion: Exercise-based cardiac rehabilitation therapy can effectively reduce the risk of major adverse cardio-cerebrovascular events, such as cardiogenic death and coronary restenosis after PCI; it reduces the late lumen loss of the stent coronary segment and has no obvious effect on the recurrence of myocardial infarction. However, this therapy tends to reduce the recurrence rate of myocardial infarction.
The Aesthetic and Decorative Calligraphic Values of the Kaaba Kiswah
Authors: Abu-Rawis Basma
Published: July 2024

This study seeks to explore the aesthetic and decorative values of the covering the Kaaba throughout history, focusing on design analysis. The study also aims to shed light on the genius of Arabic calligraphy embodied in the covering the Kaaba, using an analytical artistic approach and vision. The study is based on the descriptive analytical approach, The study concluded that the history of interest in designing the covering the Kaaba dates back to an ancient period before Islam, where the decorations and fabrics used developed until they reached the current form, reflecting the value of beauty and art of the covering the Kaaba through its designs, emphasizing the importance of Arab-Islamic decoration and the role of art in highlighting this. The great legacy. I also concluded that the aesthetics of Arabic calligraphy on the covering of the Kaaba express aesthetic, artistic and religious values, and carry an important message for Islam, where Arabic calligraphy is applied with the highest levels of authenticity and distinction according to artistic foundations.
Sodelovanje in vztrajanje bolnikov z multiplo sklerozo pri zdravljenju z zdravili
Authors: Jožef Maj , Locatelli Igor , Brecl Jakob Gregor , Kos Mitja , Rot Uroš
Published: July 2024

Multiple sclerosis (MS) is a chronic, inflammatory, and demyelinating disease of the central nervous system that presents the second highest cause of disability among young adults in their thirties. Medication treatments are based on parenteral and novel oral disease-modifying therapies (DMTs) for their simple dosage form, increased efficacy, and safety. Medication adherence (MA) assesses the extent to which patients’ medication administration corresponds with the agreed-upon treatment recommendations from health-care providers. Medication persistence (MP) is part of the MA continuum and defined as the interval between the initiation and last dose of the applied medication immediately preceding discontinuation. Adherence measures are based on medication availability and gaps over the period it is dispensed. Medication adherence in persons with MS is complex due to disease chronicity and more demanding routes of administration. Adherence is higher in patients on oral compared to older injectable parenteral treatment. Younger age, female gender, and longer disease course are key risk factors leading to lower adherence, which declines substantially after six months of treatment. The association of disability with adherence remains unknown. The major adherence barriers in the course of treatment are adverse effects, injectophobia, and dosage frequency. Common non-adherence reasons among patients are forgetfulness, depression, and fatigue. Medication non-adherence is associated with lower health and economic outcomes. Interventions for increasing MA in persons with MS are complex and individualized. Overcoming adherence barriers in MS should be aimed at injectophobia, coping with adverse effects, and increasing beliefs towards treatment necessity.
Academic integrity of scientists: problems of implementation and responsibility in Ukraine
Authors: Kryvolapchuk Volodymyr , Pluhatar Tetiana
Published: July 2024

The article outlines the concept of academic integrity as a component of academic culture and states the academic integrity of researchers is a key aspect in determining the quality and reliability of scientific research, as well as the reputation of the scientific community. Adherence to the principles of academic integrity is the foundation for the development of scientific knowledge and innovation.
It was noted that Ukrainian legislation provides a clear framework for the regulation of academic integrity, establishing fundamental principles, requirements, and sanctions for violations. This contributes to the assurance of the quality of education and research, as well as the enhancement of trust in the outcomes of educational and research activities. A critical assessment of the list of violations of academic integrity is given. Particularly emphasized the shortcomings of the legal regulation of the definition and application of the institute “academic responsibility” as a form of ensuring “academic integrity”. The authors analyze and summarize the basic ethical principles that form the basis of academic integrity.
Conclusions. Thus, academic integrity violations, such as plagiarism, can result in serious consequences, including the revocation of academic degrees and academic titles. At the same time, maintaining academic integrity is a researcher’s moral and professional obligation, as it affects public trust in scientific results. Maintaining academic integrity is essential for the development of a scientific environment that is conducive to intellectual honesty and transparency in scientific research. Furthermore, the culture of academic integrity encourages high standards of ethics and professional behavior among scientists. Consequently, the quality and credibility of research results are contingent upon the research process being conducted in an honest and ethical manner, free from practices that are deemed unacceptable within the scientific community and that compromise academic integrity. In this regard, all the efforts of the scientific community should be aimed at preventing academic dishonesty, hindering and stopping it by creating a responsible and honest scientific environment.
Functional purpose of local self-government bodies as a subject of ensuring the law enforcement function of the state
Authors: Vorobets Arsen
Published: July 2024

The article is dedicated to the scientific substantiation of the need for the participation of local self-government bodies in the implementation of law enforcement function, the study of legal forms of implementation of law enforcement function by local self-government bodies in Ukraine, and the development of proposals for their improvement.
It has been established that the law enforcement function of local self-government is mostly forgotten in the legal literature, following the Soviet habit of attributing this function to the prerogatives of the state. In this regard, the study of the law enforcement function of local self- government is an important theoretical and practical task of modern administrative and legal science.
It has been argued that in administrative and legal science, insufficient attention has been paid to the problems of: administrative and legal mechanism of activity to ensure public order and public safety; participation of local self-government bodies in the implementation of the law enforcement function; legal forms of implementation of the law enforcement function by local self-government bodies; interaction of local self-government institutions with law enforcement bodies regarding the implementation of the law enforcement function.
It has been established that the modern system of public administration does not fully use the capabilities of local self-governments in the field of protecting public law and order and ensuring public safety. This is due to the fact that the process of establishing their legal status at the current stage of development of Ukraine remains incomplete, and the constitutional and legislative norms establishing their competence are not mutually coherent, clear and certain. As a result, the implementation of the powers of local self-government bodies enshrined in the Constitution of Ukraine in the field of law and order and ensuring public safety is quite limited.
It has been proven that at this stage of municipal development, the implementation of law enforcement function by local self-government bodies in Ukraine is carried out in four legal forms of activity: establishing, rule-making, law enforcement and control. In turn, the relevant local self-government bodies with law enforcement powers can be considered as institutional forms of implementing the law enforcement function of local self-government.
Ecological and cultural niches in the environmental education. Legal connotations
Authors: Berlingher Daniel , Maior Corneliu , Darau Aurel P. , Morostes Anca , Sasu Lavinia , Boja Nicusor
Published: July 2024

The human being is the only species in the Universe holding two existential niches: a cultural one, and an ecological one. Along the humankind development, the most often objectives were survival, fulfilling one’s needs and the quality of life. To achieve these goals, the cooperation between the two niches is mandatory, due to the humankind’s double nature, biological and spiritual. In this context, the process of environment education cannot be other that an integrated one, relying on training and self-training, and the environment community law has to enter into the EU efforts of implementing the “European Green Deal” which implies the achievement of the climate neutrality by 2050.
Estrategia de Desarrollo Performático (EDP): Una propuesta educativa empleada en las clases de trombón de la Licenciatura en Música de la Universidad Autónoma de Aguascalientes/México
Authors: de Torres Leslie Freitas
Published: July 2024

The objective of this research is to present the Performative Development Strategy (PDE) used in the trombone classes of the Bachelor of Music of the Autonomous University of Aguascalientes (UAA)/Mexico, as well as its implementation during the health emergency caused by SARS-Cov-2 and its impact on the academic performance of students of this instrument during and after the pandemic. To this, the qualitative research method was used, where the sample group was made up of the four trombone students of the bachelor's degree of the UAA, during the years of 2020 and 2021. The results of the EDP in the educational action of the analyzed group show a significant increase in their academic performance, a fact that points to the efficacy and viability of this educational strategy in the teaching of the trombone.
MODEL OF HUMAN IN PARALLELS OF ECONOMIC THOUGHT / ՄԱՐԴՈՒ ՄՈԴԵԼԸ ՏՆՏԵՍԱԳԻՏԱԿԱՆ ՄՏՔԻ ԶՈՒԳԱՀԵՌՆԵՐՈՒՄ
Authors: Sarinyan Robert , Gabrielyan Bella
Published: July 2024

In economics, the understanding of the relief of the theory of human behavior is changing. An attempt is being made to create a unified theory of human behavior with a more precise aim of refining the "concept of rationality". The idealized premise of rationality accepted in the theory of economics, as evidenced by the works of D. Kahneman, V. Smith, Tversky, R. Taylor and other economists, does not express the real processes of human behavior. By diving economics into the behavioral realm, it is shown that economic thinking needs a change, that the behavior of people in real life is in every way different from the behavior of the fictitious creatures that inhabit economic models.
The issue of the human model is especially important for countries transitioning to a market economy. This is where the modern theory of economics disappoints, and the proposed propositions do not suggest solid news and do not connect with the new structure of social delimitation of a person, especially in the initial stage of the latter, subjecting the individual's behavior to the logic of unconscious deviations.
Francis Bacon’s Ideal Social Model Through the Work “New Atlantis”: Historical Value and Contemporary Significance
Authors: Anh Pham Phuong
Published: July 2024

Francis Bacon (1561-1626) was an English empiricist philosopher who laid the groundwork for British empiricism and paved the way for modern experimental science. In his pioneering spirit of new thought and philosophy, his ideas on the ideal social model through the work "New Atlantis" in particular, and his philosophical thoughts in general, are among the invaluable theoretical legacies for the development of humanity. Clarifying Francis Bacon's perspective on the ideal social model through the study of the work "New Atlantis" and drawing historical significance, contributes significantly to the research and teaching of the history of philosophy in general and the history of Western philosophy in particular, for both lecturers and students studying political theory.
The Effect of Blended Learning with Higher Order Thinking Skills Approach on Students' Critical Thinking Skills
Authors: Murcahyanto Hary , Djalillah Sitti Rohmi , . Mohzana , Haritani Hartini , . Musifuddin , Yunitasari Dukha
Published: July 2024

The study examines how blended learning impacts student’s critical thinking skills. This type of research quantitative with the Quasy Experiment method using a time series design. The number of research samples was thirty students, who were drawn from two classes. The instruments used were essay questions, questionnaires for critical thinking variables, blended learning with the HOTS approach, and field notes. The results indicate that integrating a blended learning odel with HOTS techniques enchances student’s critical thinking skills. The findings of the ANOVA test, which produced a F value of 5.851 with a significance level of 0.036, corroborate this conclusion. The results of the proposed hypothesis are accepted because the F count is greater than the F table. Namely 5.851> 4.196. The study’s findings affirm that blended learning models combined with HOTS techniques positively affect students' critical thinking abilities.