bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge and Practice of Health Care Workers regarding Needle Stick Injuries in a Tertiary Care Center of Nepal
Authors: Singh B. , Paudel B. , KC S.
Published: February 2017

Background Needle stick injuries are common health hazards among health care workers. Considering the increasing prevalence of body fluid borne infectious diseases; knowledge regarding the common errors and universal precautions are vital for the prevention of such accidents.Objective This study aimed to assess for knowledge and practice approaches among health care workers regarding needle stick injuries.Method This is a cross sectional survey was conducted using an anonymous, self-reporting 25-item structured questionnaire at a tertiary care center of central Nepal. A total of 165 health care personnel of working experience of more than 6 months were included in the study. Questionnaire included aspects of prevalence and knowledge on needle stick injury, hepatitis B immunization status and post exposure prophylaxis for HIV.Result Prevalence of needle stick injury was found to be 703 per 1000 health care worker (70.3%) during their working tenure and majority of the injury happened among nurses (p<0.05) besides other professions. Seventy nine (47.9%) participants experienced the injury more than one time in their career and the mean number of injury was 2.06±1.16. The practice of needle recapping is still prevalent and 80% participants often use single handed technique. Vaccination against hepatitis B virus was not completed by 31% health workers. Inadequate knowledge about post exposure prophylaxis for HIV was reported by 46% participants.Conclusion High prevalence of needle stick injury with a high rate of ignorance was noted. These issues need to be addressed, through appropriate education and interventional strategies.
Study of Pre-disposing Factors of Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Antibiotic Prescribing Pattern with Reference to Antibiotic Sensitivity Test
Authors: Shrestha R. , Shrestha B. , Shakya Shrestha S. , Pant A. , Prajapati B. , Karmacharya B.M.
Published: February 2017

Background Chronic Obstructive Pulmonary Disease (COPD) affects about 329 million people worldwide, which is nearly 5% of the entire global population. In the context of Nepal, COPD accounts for 43% of the non-communicable disease burden and 2.56% of hospitalizations. Various pre-disposing factors like bacterial, viral, fungal, smoking, occupational exposures and genetic factors have been proposed to precipitate COPD and its exacerbation though, the definitive pre-disposing factors and factors related to acute exacerbation have not been determined in the context of Nepal.Objective To find out the pre-disposing factors and the related causative agents for COPD.Method A cross sectional study was conducted in a tertiary care hospital. Patients of all age group who were diagnosed as COPD and admitted in the hospital were included in this study. Patients were interviewed using structured questionnaire. The socio-demographic data including personal and medical history were recorded from those participants. In addition, sputum from those patients was sent for culture to investigate the possible responsible pathogens as well as its antibiotic sensitivity pattern.Result A total of 150 patients having Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) who have admitted from either emergency or out-patient department of the hospital were included in this study. Among the total number of patients, more than half of them were female (n=82). In addition, analysis of occupations shows that most of them were either farmer (36.0%) or housewife (30.7%). In total studied patients (n=150), most of them were using traditional firewood (83%) for cooking purpose and majority of patients (91%) were smokers. Most of the sputum samples show growth of gram-positive cocci (26.7%) and gram negative bacilli (27.5%). Considering the overall sensitivity pattern, the higher sensitivity was recorded for Co-trimoxazole and Ciprofloxacin while higher rate of resistance was noted for Penicillin group of drugs. The most widely used antibiotics were found to be Cephalosporin group of drugs (68%).Conclusion The present study revealed that the case of COPD is more in female and the commonest pre-disposing factor is found to be smoke/firewood. Cephalosporin group of drugs is the most commonly prescribed drug.
Fluoroscopy Guided Percutaneous Transpedicular Biopsy for Thoracic and Lumbar Vertebral Body Lesion: Technique and Safety in 23 Consecutive Cases
Authors: Shrestha D. , Shrestha R. , Dhoju D
Published: February 2017

Background Though some vertebral lesions have typical imaging findings, histological/ microbiological evidence are required for definitive diagnosis and management, specially for tumor and infective lesions so that wrong diagnosis and wrong treatment can be avoided. Conventionally, open biopsy methods are used. With availability of CT scan, MRI, percutaneous transpedicular vertebral biopsy has now become popular as a minimally invasive technique for biopsy of vertebral lesion.Objective To describes technique and to analyzes safety and feasibility of percutaneous transpedicular vertebral biopsy with fluoroscopy guidance for thoracic and lumbar vertebral body lesions.Method Twenty three patients who underwent percutaneous transpedicular vertebral biopsy under fluoroscopy guidance were retrospectively evaluated for demographic data, indication for biopsy, anatomical locations, histological/microbiological diagnosis, complications and final outcome of treatment. True positive, true negative, false positive and false negative cases were defined.Result There were 17 males and 6 female patients of mean age 47 (range 22-73 years). Biopsies were performed in 17 dorsal and six lumbar vertebral bodies. Adequate sample were obtained in all cases. Seventeen patients (12: tubercular pathology, 1: primary tumor, 3: metastasis, 1: osteoporotic fracture) had definitive histological/ microbiological diagnosis. Four patients had no granuloma and tumor. Two had histological features of chronic non specific inflammation. True positive cases were 17, true negative were four and false negative case were two. Overall accuracy was 92%. One patient developed small hematoma at biopsy site.Conclusion Fluoroscopy guided percutaneous transpedicular biopsy of is a safe procedure with high adequacy and accuracy and low complication rate for thoracic and lumbar vertebral body lesion.
Uterine Tachysystole with Prolonged Deceleration Following Nipple Stimulation for Labor Augmentation
Authors: Narasimhulu D.M. , Zhu L.
Published: February 2017

Breast stimulation for inducing uterine contractions has been reported in the medical literature since the 18th century. The American college of Obstetricians and Gynecologists (ACOG) has described nipple stimulation as a natural and inexpensive nonmedical method for inducing labor.We report on a 37 year old P2 with a singleton pregnancy at 40 weeks gestation who developed tachysystole with a prolonged deceleration after nipple stimulation for augmentation of labor. Initial resuscitative measures, including oxygen by mask, a bolus of intravenous fluids and left lateral positioning, did not restore the fetal heart rate to normal. After the administration of Terbutaline 250 mcg subcutaneously, the tachysystole resolved and the fetal heart rate recovered after five minutes of bradycardia.Most trials of nipple stimulation for induction or augmentation of labor have had small study populations, and no conclusions could be drawn about the safety of nipple stimulation, though its use is widespread. While there have been a few reports of similar complications during nipple stimulation for contraction stress testing, there are no previous reports of tachysystole with sustained bradycardia following nipple stimulation for labor augmentation.In this report, we draw attention to the dangers of nipple stimulation so that providers will be aware of this potential complication.
Sydenham’s Chorea as Presentation of Rheumatic Heart Disease
Authors: Joshi A. , Shrestha R.P.B. , Shrestha P.S. , Dangol S. , Shrestha N.C. , Poudyal P. , Shrestha A.
Published: February 2017

Sydenham’s chorea is the most common type of acquired chorea in childhood which is a major neurological manifestation of rheumatic fever. We describe a 13 years old girl who presented with weakness and purposeless involuntary movements of upper and lower limbs. The symptoms slightly affected the child’s daily activities and had an unstable gait on walking which was aggravated during stress. Grade II ejection systolic murmur was noticed on cardiovascular examination. Echocardiography evaluation showed thickened aortic and mitral valve leaflets with mild to moderate degree of mitral regurgitation. Anti-streptolysin O titer was positive (≥200 IU/ml). CT scan of brain was normal. Subsequently child was diagnosed as Rheumatic heart disease with Sydenham’s chorea and kept on regular Benzathine penicillin prophylaxis. Symptoms subsided spontaneously after 3 months without any further complications. Although decreasing, early diagnosis and management of Sydenham’s chorea and Rheumatic heart disease are very crucial and should be considered with such presentation.
Significance of Crime Scene Visit by Forensic Pathologist in Cases of Atypical Firearm Injuries
Authors: Thejaswi H.T. , Kumar A. , Krishna K.
Published: February 2017

Deaths due to firearms are some of the interesting and contentious cases that a forensic pathologist/autopsy surgeon encounters in his practice. Whenever there is ‘ambiguity’ regarding the nature or sequence of events any unnatural deaths including those caused by firearms the practice of visiting crime scene should be encouraged especially in a country like India where autopsy surgeons often neglect it. Here we present a case report in which there were inconsistencies in the autopsy findings with the alleged history. The witnesses heard about four to six gunshot sounds, whereas only two spent cartridge cases were retrieved from the crime scene. Authors identified the atypical nature of firearm injuries sustained by the victims that were possible by just two bullets. Crime scene visit was undertaken where we discovered the possibility of the echo effect behind the production of four to six sounds. Further by using computer software program, positions of the gunman, victims and the bullet trajectory of the two bullets was created.
Comparison of Hysterosalpingography and Combined Laparohysteroscopy for the Evaluation of Primary Infertility
Authors: Nigam A. , Saxena P. , Mishra A.
Published: February 2017

Background Hysterosalpingography (HSG) is a useful screening test for the evaluation of female infertility. Laparoscopy has proven role in routine infertility work up but role of hysteroscopy in an infertile patient with normal HSG for additional information is a subject of debate. Hysteroscopy permits direct visualization of the cervical canal and the uterine cavity and thereby helping in the evaluation of shape, and cavitary lesion.Objective To detect uterine abnormalities in infertile women by various approaches i.e. HSG and hysteroscopy and evaluating the role of combining hysteroscopy with laparoscopy for the evaluation of tubo-uterine factor for primary infertility.Method One twenty eight infertile women were evaluated and HSG was performed as a basic test for evaluation of tubes and uterine cavity. Women were subjected to combined laparoscopic and hysteroscopic examination on evidence of HSG abnormalities. In absence of any HSG abnormality, women were subjected to ovulation induction for three to six months and if they did not conceive during this period they were undertaken for combined laparo-hysteroscopic evaluation.Result The positive predictive value of HSG for detecting the intrauterine abnormalities was 70% among 126 patients where the hysteroscopy could be performed successfully. The diagnostic accuracy of HSG for intrauterine abnormalities revealed false negative rate of 12.96%. The most frequent pathologies encountered by laparoscopy were tubal and/or peritoneal and were found in 68% (87/128) of women. Total 64.06% infertile women had some abnormality on laparoscopy. This detection rate has been increased from 64.06% to 71.86% on including the concomitant hysteroscopy.Conclusion HSG is a good diagnostic modality to detect uterine as well as tubal abnormalities in infertile patient. HSG and hysteroscopy are complementary to each other and whenever the patient is undertaken for diagnostic laparoscopy for the infertility, hysteroscopy should be combined to improve the detection rate of abnormalities especially in communities where there is enormous risk of pelvic infection.
Sonographic Assessment of the Normal Dimensions of Liver, Spleen, and Kidney in Healthy Children at Tertiary Care Hospital
Authors: Thapa N.B. , Shah S. , Pradhan A. , Rijal K. , Pradhan A. , Basnet S.
Published: February 2017

Background Ultrasonography is one of the most common imaging modality to measure dimensions of visceral organs in children. However, the normal limit of size of visceral organs according to age and body habitus has not been specified in the standard textbooks. This might result in under detection of organomegaly in pediatrics population.Objective The objective of this study was to determine the normal range of dimensions for the liver, spleen, and kidney in healthy children.Method This is prospective cross-sectional, hospital-based study done at Tertiary-care teaching hospital. Participants included 272 pediatric subjects (152 male and 120 female) with normal physical or sonographic findings who were examined because of problems unrelated to the measured organs. The subjects were one month to 15 year (180 months) old. All measured organs were sonographically normal. Relationships of the dimensions of these organs with sex, age, body weight and height were investigated. Limits of normal dimensions of these organs were defined.Result Normal length of liver, kidneys and spleen were obtained sonographically for 272 children (152 male [55.9%] and 120 female [44.1%]) in the age group from 1 months to 15 (180 months) years. The mean age was 45.78 months (SD, 44.73). The measured dimensions of all these organs showed highest correlation with height and age so the descriptive analysis of the organ dimensions (mean, minimum, and maximum values, SD and 5th and 95th percentiles) were expressed in 10 age groups along with height range of the included children. The mean length of right kidney was shorter than the left kidney length, and the difference was statistically significant (p = 0.001).Conclusion This study provides practical and comprehensive guide to the normal visceral organ dimension in pediatric population. The normal range limit of the liver, spleen, and kidney determined in this study could be used as a reference in daily practice in local radiology clinics.
Knowledge, Attitude and Practice of Contraception among Postpartum Women Attending Kathmandu Medical College Teaching Hospital
Authors: Bajracharya A.
Published: February 2017

Background Failure to plan a pregnancy can adversely affect the health of the family as a whole. High parity is related to increased maternal, perinatal and infant deaths and is associated with nutritional problems of both mother and child. Hence, good knowledge, attitude and practice of family planning among women are important. This study is aimed to determine the knowledge, attitude and practice of contraception among the postpartum women attending Kathmandu Medical College Teaching Hospital.Objective To determine the knowledge, attitude and the practice of various contraceptive methods among the postpartum women.Method A cross-sectional observational study was conducted in the department of Obstetrics and Gynecology on 400 postpartum women (within 42 days of delivery) who delivered and came for follow-up in this institution. All the postnatal women were interviewed with pre-designed questionnaire and information on sociodemographic variable, awareness and knowledge of various contraceptive methods, previous and current use of family planning methods, source of information, utilization and reasons for use/non-use of family planning methods were obtained. Data collected were entered and analyzed using SPSS 20. The results were presented as percentages, means, tables and charts.Result Majority of the participants 363 (90.8%) were aware of contraceptive usage. Amongst 60.5% of women who had previously used contraception, OCPs were the commonest one. Maximum number of participants (60.35%) had used modern contraceptives in the past. The most common source of information on contraception was media (55.7%). The reason of using contraception was spacing between the subsequent pregnancies, while the most common reason of discontinuation or not willing to use family planning methods was husband being abroad, fear of side effects and not knowing which contraceptives to use.Conclusion The contraceptive awareness and knowledge among the postpartum women was high but their usage was low. Hence, efforts should be made to educate the public about safety and convenience of modern methods of contraceptives. Health care personnels should also counsel the clients for adopting the contraceptives according to their need.
Study of Microorganism Growth Pattern in Nasal Pack of Patients Visiting the Department of ENT, Head and Neck Surgery
Authors: Shrestha I. , Pokharel M. , Dhakal A. , Amatya R.C.M. , Madhup S. , Sherchan J.B.
Published: February 2017

Background Nasal packs are utilized nearly by otorhinolaryngologists for controlling epistaxis and post nasal procedures. Complications have been reported due to them; therefore the use of antibiotics is a common practice among otorhinolaryngologists.Objective To detect microbiological flora associated with nasal packing and find evidence to support the benefit of systemic antibiotics with it.Method A prospective, analytical study was conducted on 51 patients presenting to the Department of ENT, KUSMS from June to September 2015 who required nasal packing. Approval of the local Institutional review committee (IRC) was taken. The mid part of the pack was collected in a sterile bottle under aseptic technique and sent to microbiology department. Specimen collection, culture, identification tests were done according to the guidelines by American Society for Microbiology. Data were collected using the individual patient records and Microsoft Office Excel 2007. Statistical analysis was performed with SPSS 16.0.Result Among the 51 cultures; 33 (64.7%) were positive. In 18 (35.3%) cultures no organism was grown. Statistical analysis did not show significance between duration of pack kept with microbial growth (p=0.051) or the type of pack kept (p=0.212) .It showed significance with foul smell of the pack to the growth (p=<0.001).Conclusion Microbiological flora was associated with nasal pack. Antibiotic soaked nasal packs have lesser incidence of positive bacterial growth when compared with plain nasal packs. Nasal packs kept for less than 48 hours have lesser incidence of positive bacterial growth when compared with nasal packs kept for more than 48 hours. Therefore, administering systemic antibiotics in cases when we plan to keep the pack for longer duration is recommended.
Perceptions and Attitudes towards Evidence Based Practice among Nurses and Nursing Students in Nepal
Authors: Karki S. , Acharya R. , Budhwani H. , Shrestha P. , Chalise P. , Shrestha U. , Gautam K , Wilson L.
Published: February 2017

Background As the evidence based practice (EBP) movement expands, there is a need for health leaders and educators in each country to assess the extent to which health professional students and practitioners are prepared to locate, evaluate, and apply evidence to guide their practice.Objective The study objective was to explore nurses’ and nursing students’ perceptions and attitudes towards EBP.Method This was a descriptive cross-sectional survey administered to all 273 nurses and nursing students from Nepal who attended an EBP conference. The survey instrument that was used by Majid in Singapore was adapted for use in this study with permission from the author.Result In total, 121 nurses participated in the study. The majority (93%) of respondents reported that they had no previous training in EBP. The respondents’ perceptions of their EBP knowledge and skills were variable, but most of them demonstrated positive attitudes toward EBP. Respondents identified a number of barriers that limit the implementation of EBP in Nepal. The greatest barriers were lack of time and resources, difficulty understanding research articles and translating the findings to practice, and limited autonomy to change practice based on evidence.Conclusion Although respondents had positive attitudes towards EBP, their knowledge and skills were limited and barriers to implementation existed. Nursing faculty can use the findings to guide implementation of EBP into curricula, and nursing administrators and clinicians can use the findings to guide practice to promote EBP.
School Teachers’ Knowledge about Epilepsy in Kathmandu Metropolitan City
Authors: Khanal K. , Maharjan R. , Pokharel B.R. , Sanjel S.
Published: February 2017

Background Studies on Knowledge towards epilepsy among school teachers are very limited on developing countries especially with reference to Nepal. Level of knowledge of schoolteachers plays an important role on providing a greater educational support for epileptic child and to maintain good communication skills between epileptic and normal child.Objective Objective of this study is to assess the level of knowledge about epilepsy and its associated factors among school teachers.Method A cross sectional study was conducted from 10th June to 4th July, 2014 among 165 teachers teaching in six different schools of Kathmandu Metropolitan City. A self-administrated questionnaire consisting of structured and multiple choice questions were designed to collect information on the teacher’s socio-demographic profile and knowledge about epilepsy. A scoring system was developed for each question: each correct answer was given a score of 1, and a score of 0 for wrong answer. Total score was categorized on two categories: Good Knowledge and Poor Knowledge.Result Teacher’s age did not correlate significantly with their knowledge about epilepsy but total years of teaching experiences and knowledge about epilepsy were found to be positively correlated (ρ= 0.165, p= 0.01). Academic qualification of teachers and different teaching level were associated with level of knowledge (p= 0.023, p= 0.021). Significant difference on knowledge score was found among teachers having different academic qualification (p= 0.019).Conclusion All teachers were aware about epilepsy, but their knowledge about epilepsy was not sufficient therefore, health education training program about epilepsy is needed for teachers.
Acoustic Analysis Before and After Voice Therapy for Laryngeal Pathology
Authors: Chhetri S.S. , Gautam R.
Published: February 2017

Background Voice problems caused by pathologies in vocal folds are well known. Some types of laryngeal pathologies have certain acoustic characteristics. Objective evaluation helps characterize the voice and voice problems providing supporting evidences, severity of disorders. It helps assess the response to the treatment and measures the outcomes.Objective The objective of the study is to determine the effectiveness of the voice therapy and quantify the results objectively by voice parameters.Method Study includes 61 patients who presented with different types of laryngeal pathologies. Acoustic analyses and voice assessment was done with Dr. Speech ver 4 (Tiger DRS Inc.). Acoustic parameters including fundamental frequency, jitters, shimmers, Harmonic to noise ratio (HNR), Normalized noise energy (NNE) were analyzed before and after voice therapy.Result Bilateral vocal nodules were the most common pathologies comprising 44.26%. All acoustic parameters showed a significant difference after the therapy (p<0.05) except for NNE. Dysphonia due to vocal fold polyp showed no improvement even after voice therapy (p>0.05).Conclusion Acoustic analysis provides an objective, recordable data regarding the voice parameters and its pathologies. Though, few pathology require alternative therapy rather than voice therapy, overall it has a good effect on glottic closure. As the voice therapy can improve the different indices of voice, it can be viewed as imperative part of treatment and to monitor progression.
Oral Hygiene and Gingival Health in Patients with Fixed Prosthodontic Appliances - A Six Month Follow-up
Authors: KC Basnyat S , Sapkota B. , Shrestha S.
Published: February 2017

Background Gingival inflammation and periodontal disease are the common complications of fixed dental prosthesis. They can be overcome by good oral hygiene maintenance.Objective The objective of this study was to assess the oral hygiene and gingival condition in patients after placement of fixed dental prosthesis for a period of six months. It was also analyzed how factors like type of fixed dental prosthesis (Single crown, fixed partial denture) and material (Metal, Porcelain fused to metal) are statistically associated with oral hygiene and gingival health.Method The sample consisted of 50 patients visiting the Dental Outpatient Department of Dhulikhel Hospital. The oral examinations were conducted using basic diagnostic tools (Mouth mirror, periodontal probe and explorer). Teeth and gingiva were examined using the Plaque and Gingiva Index by Silness and Löe. The examinations were conducted after 14 days and six months after placement of fixed dental prosthesis along with the oral hygiene instructions. Paired sample t-test were done to find statistical association using SPSS 16.0.Result Our results revealed no significant difference in plaque index among patients with single crown whereas fixed partial denture showed statistical significance. No significant differences were found for type of material. The statistical analysis showed similar results for gingival index.Conclusion Our research showed that single crown had no significant difference on Plaque index and Gingival index of the patient after 14 days and six months, whereas, Fixed partial denture showed significant difference. Both metal and porcelain fused to metal crown revealed no statistically significant difference on Plaque index and Gingival index.
Study of Clinical Variables Affecting Long Term Outcome after Microdisectomy for Lumbar Disc Herniation
Authors: Shrestha D. , Shrestha R. , Dhoju D. , Kayastha S.R. , Jha S.C.
Published: February 2017

Background Outcome of lumbar disc herniation are influenced by various clinical, socioeconomic and psychological factors. In the absence of provision of medical insurances, worker’s compensation and sick leave, predictors for outcome after lumbar disc herniation surgery will be different in Nepalese population.Objective To evaluate different clinical variables that can affect outcome after lumbar disc herniation surgery.Method Among 88 patients who underwent microdisectomy for lumbar disc herniation, 63 patients (43 male, 20 female) with follow up at least six months were retrospectively evaluated for clinical variables which can affect Oswestry disability index (ODI) score, its interpretation and Mcnab classification of post operative outcome.Result Average age of patients was 42.54±8.60 years. Mean follow up period was 34.89±23.80 months (range 6 -111 months). Thirty four patients had follow up period > 24 months. Mean ODI score before surgery and at final follow up was 37.87±8.76 vs 7.78±7.7; (p=0.00). Success rate was 90.47% (change in ODI score at least by 10), 93.65% (ODI score interpretation <40%), and 85.71%. (Mcnab outcome excellent and good). Significant correlation was found between age and ODI at final follow up but not with duration of symptoms. Male, non alcoholic, low level of education, numbness as a predominant symptom, disc at L4-L5 were significantly associated with better ODI at final follow up. For ODI score interpretation, gender, smoking habit, presence of leg pain as a predominant symptom were statistically significant factors whereas smoking and drinking habit, level of education, occupation, back pain and numbness as predominant pre-operative symptom, types of disc in MRI were significantly related to Mcnab outcome. There was 9.5% peri- or post-operative complications and recurrence in seven patients.Conclusion Age, gender, smoking and drinking habit, level of education, occupation, types of disc in MRI are important variables for ODI score, ODI score interpretation and Mcnab outcome.
Prevalence of Obesity in Medical students and its correlation with cardiovascular risk factors: Emergency Alarm for Today?
Authors: Purohit G. , Shah T. , Harsoda J.M.
Published: February 2017

Background It is predicted that the prevalence of overweight and obesity will rise significantly by 2015 in young population. Problem of overweight and obesity has been recognized as public health problem worldwide due to the fact that it increases the risk of chronic diseases such as Cardiovascular Diseases (CVD), stroke, diabetes, sleep apnoea, osteoarthritis etc.Objective To assess the body mass index in medical students and its association with various cardiovascular risk factors like blood pressure, dietary habits, and family history of cardiovascular diseases.Method A university based cross-sectional analytical study was conducted in Department of Physiology, Smt. B.K. Shah Medical Institute & Research Center, Vadodara, Gujarat. Data was collected through convenient sampling technique by using self-administered questionnaire followed by anthropometric measurement. Body Mass Index (BMI) of 138 first year medical students was assessed. Systolic blood pressure, diastolic blood pressure, pulse pressure, mean blood pressure, pulse rate and arterial oxygen saturation were measured.Result Data was compiled in excel sheet, analyzed for percentage and proportion. Chi square and Pearson correlation test were also applied and alpha error was set at 5% level. In comparison to the students with normal BMI, students with BMI >25 kg/m2 (N=49) showed significantly high blood pressure indices. Dietary habits and family history of cardiovascular diseases were also noted. Highly significant association of high BMI was found with elevated blood pressure (X2=7.4042***, p<0.001) and presence of family history of cardiovascular diseases X2=9.8625***, p<0.001). BMI is negatively correlated with SpO2 (r= -0.0504, p<0.05) and pulse rate, while positively correlated with systolic blood pressure (r=0.2736) and diastolic blood pressure (r=0.0275).Conclusion In conclusion, majority (more than 35%) of medical students were overweight, high prevalence of cardiovascular risk factors like family history, elevated blood pressure and less SpO2.
Prevalence and Associated Factors of Hypertension among Adults in Rural Nepal: A Community Based Study
Authors: Chataut J. , Khanal K. , Manandhar K
Published: February 2017

Background Hypertension is a major health problem throughout the world and is one of the major risk factors for cardiovascular mortality. It is important to detect and manage prehypertension and hypertension to reduce the risk of correlated complications especially cardiovascular diseases.Objective The objective of the study was to find the prevalence and risk factors of hypertension among the adults in rural Nepal.Method A community based cross-sectional study was conducted among 648 respondents. The information was obtained using pre-tested questionnaire which included demographic information of individuals and other risk factors like alcohol and tobacco use, physical activity and diet preference. Height, weight and blood pressure were recorded and hypertension was defined as per Joint National Committee (JNC) VII guidelines.Result The overall prevalence of hypertension was 20.5 % and pre-hypertension was 46.6%. The males had higher prevalence of hypertension (30.6%) compared to females (13.8%). Bivariate analysis showed male gender, smoking and non vegetarian diet have association with hypertension. Male gender [OR 2.50 (1.68 – 3.74)] and non vegetarian diet [OR 0.11 (0.01 – 0.85)] were found to be significantly associated with hypertension in multivariate analysis.Conclusion The prevalence of hypertension and prehypertension was high in the study population. In absence of life style modification and risk reduction the individuals categorized as prehypertension have great risk of developing hypertension in the future which may pose a great challenge in the future. Hence, there is a big scope for screening and primary prevention strategies to curb the epidemic of hypertension.
Assessment of Critical Knowledge on Maternal and Newborn care Services among Primary Level Nurse Mid-wives in Kapilvastu District of Nepal
Authors: Acharya D. , Paudel R.
Published: February 2017

Background Despite greater emphasis on maternal and neonatal health through policy and programming in Nepal, maternal and neonatal health is still not impressive. Health care providers’ knowledge assessment on maternal and neonatal care has been well documented elsewhere, but it is very little understood in Nepal.Objective The primary objective of this study was to assess the critical knowledge of primary level nurse- midwives on maternal and newborn care in Kapilvastu District of Nepal.Method This was an Institution based cross-sectional study, conducted in Kapilvastu district, Nepal among sixty eight nurse-midwives. The participants were selected using simple random sampling technique. For collecting the data, health institutions were visited by enumerators for a month from 1st October to 1st November 2012. Data were entered into Microsoft Excel, cleaned and analyzed using SPSS version 17.0.Result More than 3/4th of the nurse-midwives had 10-20 years of experience. Majority of them (89.7%) had poor knowledge in taking action to prevent mother to child transmission for HIV positive women. More than half of them (54.4%) had some knowledge in performing the active management of third stage of labor whereas almost half (51.5%) had poor knowledge to actions needed on post-partum haemorrhage (PPH). Similarly, more than two third (69.1%) had poor knowledge in newborn care.Conclusion Majority of the nurse-midwives were found to have either poor or some level of knowledge in most of the components of maternal and newborn care services. So, greater emphasis should be given to upgrade the knowledge of nurse mid-wives.
Histopathological Changes in the Chorionic Villi and Endometrial Decidual Tissues in the Product of Conception of Spontaneous Abortion Cases
Authors: Makaju R. , Shrestha S. , Sharma S. , Dhakal R. , Bhandari S. , Shrestha A. , Tamrakar S.
Published: February 2017

Background Spontaneous abortion refers to a pregnancy that ends spontaneously before the fetus has reached a viable gestational age or expulsion or extraction of an embryo or fetus weighing 500 g or less from its mother. The Maternal Mortality Morbidity Survey of Nepal 2008/09 reported that 7% of maternal deaths in Nepal were due to complications related to abortion.Objective The main objective of this study was to examine the histopathological changes in the chorionic villi and endometrial decidual tissue in products of conception obtained from women with spontaneous abortion.Method This is a retrospective study of 111 patients admitted in the Department of Obstetrics and Gynecology at Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH) with the diagnosis of spontaneous abortion during the period of January 2013 to January 2014.Result Among 111 cases of spontaneous abortions, products of conception was seen in 73 (65.77%) and with only one cases of choriocarcinoma. Majority of cases belongs to age group 21-30 years. The most common decidual changes were inflammation (41.4%) followed by fibrin deposition 29.7%. Majority of the cases shows hydropic changes as histopathological changes in chorionic villi. In the present study, minimum age of lady was 15 years and the maximum age was 45 years and the mean age was 25.09±5.58 years at the time of abortion. Among the cases, maximum 69 (62.2%) of them belonged to age group 21-30 years. Correlating the age group with number of abortions was found to be significantly different (Chi-square= 92.35, df= 3, p < 0.001) among four different age groups.Conclusion The histopathological diagnosis of spontaneous abortion will help in further management of the patient. Further study is required to know the cause of different histopathlogical changes in villi as well as in the decidua.
The Analgesic Effectiveness of Ipsilateral Transversus Abdominis Plane Block in Adult Patients Undergoing Appendectomy: A Prospective Randomized Controlled Trial
Authors: Ghimire A , Bhattarai B. , Prasad J.N. , Shah S.P.
Published: February 2017

Background Transversus abdominis plane block (TAP) has been shown to produce effective pain relief following lower abdominal surgeries but is yet to be routinized in different type of surgeries including appendectomy. The main risk of visceral injury can be logically avoided when the block is performed with the abdomen open using landmark technique in the absence of ultrasound guidance.Objective To assess the effectiveness of TAP block with bupivacaine for postoperative analgesia using landmark technique (performed with the abdomen open) in adult patients undergoing appendectomy.Method Forty patients undergoing appendectomy were randomized to undergo ipsilateral TAP block with bupivacaine (n=20) versus control (n=20) in addition to standard postoperative analgesia. All patients received standard general anaesthesia. The block was performed using the landmark technique with 20 ml of 0.5% bupivacaine or isotonic saline on ipsilateral side just before abdominal closure. Pain severity was measured using Visual Analogue Scale (VAS). Tramadol 50 mg was administered as rescue analgesic intravenously when VAS was four or more postoperatively. The duration of analgesia and the requirement of tramadol in 24 hours postoperatively were recorded.Result Mean duration of analgesia in the TAP block with bupivacaine was longer as compared with placebo (724.00±299.07 min vs 168.25±55.18 min; p< 0.01). The TAP block with bupivacaine compared with saline significantly reduced postoperative VAS pain scores. Mean tramadol requirement in the first 24 hours was also reduced (42.50±37.25 mg vs 120.00±55.18 mg; p<0.01). There were no significant complications attributable to the TAP block.Conclusion Ipsilateral TAP block with bupivacaine using landmark technique with the abdomen open in appendectomy provides effective postoperative analgesia and opioids sparing effect.
Hereditary Spherocytosis with Splenomegaly and Cholelithiasis in a Young Male of Western Region of Nepal - A Case Report
Authors: Ghimire P. , Gurung N.V. , Shrestha S. , Gurung A. , Poudel S.R. , Chapagain A.
Published: February 2017

See the PDF for the abstract.
Oblique Retro-Aortic Left Renal Vein and its Clinical Importance
Authors: Bhagavath P. , Nayak B.S. , Monteiro N.P.F. , Kumar G.P.
Published: February 2017

Kidneys are the organs that remove the waste products of the metabolic activities. A smooth blood flow to the kidneys is essential to maintain their function. Abnormalities of the renal vasculature may result not only in impairing the renal function but can lead to conditions like varicocele. During an autopsy of an adult male, we observed renal vascular variations. The left renal vein had a retro-aortic course before its termination into the inferior vena cava. It was joined with the inferior vena cava at the level of inferior mesenteric artery with an acute angle. The left testicular vein joined the left renal vein with an acute angle. The right kidney was supplied by two renal arteries. The knowledge about retro-aortic course of the left renal vein may be important during renal transplantation. The oblique course of left renal vein and the termination of left testicular vein into it with an acute angle may increase the chances of left sided varicocele.
Complete Heart Block in Hypertrophic Cardiomyopathy: A Rare Association
Authors: Dubey L. , Guruprasad S. , Battacharya R. , Subramanyam G.
Published: February 2017

Ventricular tachyarrhythmias are common in hypertrophic cardiomyopathy that may lead to syncope and sudden death. Bradyarrhythmia such as atrioventricular conduction disturbance, a relatively rare complication associated with hypertrophic cardiomyopathy, may also cause syncope and sudden death in hypertrophic cardiomyopathy. We report a 28-year old man who was diagnosed as a case of hypertrophic cardiomyopathy presented with syncope and complete heart block. Subsequently, a permanent pacemaker was implanted to the patient.
Repeatable Procedure for Determining a Representative Average Rail Profile
Authors: Regehr Sean , Grande Giuseppe , Regehr Jonathan D. , Bachinsky Gordon
Published: March 2017

The use of rail profile measurements for the planning and specification of rail-grinding activities normally involves comparing the existing and desired rail profiles within a rail segment. In current practice, a somewhat subjective approach is used to select a measured profile—usually located near the midpoint of the segment—that represents the profiles throughout the rail segment. Industry-standard rail profile data were used to develop an automated procedure for calculating a representative average (mean) rail profile for a rail segment. The procedure was verified by comparing the calculated average with an expected profile. Then, it was validated by comparing the calculated average profiles of 42 in-service rail segments (10 tangents and 32 curved segments) with the Corresponding median rail profiles for each segment, chosen subjectively. Validation results indicated that the coordinates comprising the mean and median profiles differed by less than 1%, on average. Agreement was stronger for tangent rail segments than for curved rail segments, as expected. Therefore, validation demonstrated that the procedure yields results comparable with current practice while it improves the objectivity and repeatability of the decisions that support rail-grinding activities. The procedure also offers the opportunity for integration with existing software tools to help automate the specification of grinding activities that minimize metal removal and prolong rail life.
Developing a Web-Based Tool to Track Highway Safety Planning Progress in California
Authors: Chen Katherine L. , Oum Sang Hyouk , Cooper Jill F.
Published: March 2017

A strategic highway safety plan (SHSP) is a comprehensive, statewide, data-driven safety plan that coordinates activities across agencies to reduce traffic fatalities and serious injuries on all public roads. In 2015, California updated its SHSP with the input of hundreds of stakeholders. To implement a multiyear effort that involves many primary actors, the challenge is to track decisions and progress in an efficient manner as well as to have in place a state safety program that is accountable and transparent to its stakeholders. The Safe Transportation Research and Education Center at the University of California, Berkeley, developed a tracking tool for California’s updated SHSP. The steering committee and other key stakeholders involved in the SHSP implementation phase provided substantial input. The SHSP tracking tool is a user-friendly, low-cost, easily maintained resource that multiple stakeholders update. Written in PHP on a single-page website, the SHSP Tracking Tool is a mechanism that allows users to contact leaders, track progress, run reports, and review performance measures on all SHSP projects. As activities move forward, the tool will provide a primary repository of SHSP internal documents and a community forum through which to evaluate progress and advance the efforts of California’s SHSP safety stakeholders. The tool reflects federal and state transportation calls to ensure that safety efforts are data and performance driven and can be adapted for use with any state’s SHSP.
Roadway Safety Policy and Leadership: Case Study of Six Midwest States
Authors: Munnich Lee W. , Schmit Matthew P.
Published: March 2017

This study examined various factors that determine policy and political leadership in the adoption of evidence-based policy countermeasures and integrated, performance-based approaches such as Toward Zero Deaths to reduce road fatalities and serious injuries. Specifically, the study sought to increase understanding of the policy context for safety and to engage policy and political leaders and institutions at the state and local level in the application of these approaches. The study focused on six states in the Midwest region—Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin—and engaged legislators and policy safety policy leaders to better understand the challenges and opportunities to improve roadway safety through public policy. In a comparison of the extent of policy adoption and political leadership from one state to another, the study developed, applied, and tested an assessment tool of Toward Zero Deaths and roadway safety programs for each of the six states under review.
Dose- and time-related platelet response with apheresis platelet concentrates and pooled platelets
Authors: Rahman Mohammad Mizanur , Khan Lutfunnahar , Saha Debashish
Published: February 2017

This study was carried out to compare the post-transfusion platelet increment between the apheresis platelet concentrate (n=74) and pooled platelets (n=54). Pre- and post-transfusion platelet count of the recipient were carried out by automated hematology analyzer. In apheresis platelet concentrate group, the mean 24 hours post-transfusion platelet increment was 47 x 109/L which was statistically significant (p<0.001). On the other hand, in pooled platelets group, the mean 24 hours posttransfusions platelet count increment was 11.0 x 109/L which was also statistically significant (p<0.001). This study concluded that the transfusion of apheresis platelet concentrate was more useful than the transfusion of pooled platelets in terms of platelet count increment and requirement of donor.
Heat Flow Characteristics of a Newly-Designed Cooling System with Multi-Fans and Thermal Baffle in the Wheel Loader
Authors: Liao Yidai , Zhuo Jiwen , Zhang Yinliang , Guan Honger , Huang Heting , Cai Huikun
Published: March 2017

In the traditional cooling case, there is usually one fan in charge of heat transfer and airflow for all radiators. However, this seems to be inappropriate, or even insufficient, for modern construction machinery, as its overall heat flow density is increasing but thermal distribution is becoming uneven. In order to ensure that the machine works in a better condition, this paper employs a new cooling system with multiple fans and an independent cooling region. Based on the thermal flow and performance requirements, seven fans are divided into three groups. The independent cooling region is segregated from the engine region by a thermal baffle to avoid heat flowing into the engine region and inducing an overheat phenomenon. The experiment validates the efficiency of the new cooling system and accuracy of simulation. After validation, the simulation then analyzes heat transfer and flow characteristics of the cooling system, changing with different cross-sections in different axis directions, as well as different distances of the fan central axes. Finally, thermal baffles are set among the fan groups and provided a better cooling effect. The research realizes a multi-fan scheme with an independent cooling region in a wheel loader, which is a new, but high-efficiency, cooling system and will lead to a new change of various configurations and project designs in future construction machinery.