bluuebunny/crossref_metadata_2025 huggingface dataset:
An Intellectualist Dilemma
Authors: Mosdell Matthew
Published: May 2022

Lewis Carroll's famous puzzle leads to an explanatory challenge: what must we know to grasp the logical necessity of deductive arguments? This paper argues that intellectualism lacks a philosophically satisfying explanation to that puzzle.
Does Hope Require Belief?
Authors: Milona Michael
Published: May 2022

This paper interrogates a widely accepted view about the nature of hope. The view is that hoping that p involves a belief about the prospects of p. It is argued that taking hope to require belief is at odds with some forms of recalcitrant hope and certain ways in which hope patterns similarly to other emotions. The paper concludes by explaining why it matters whether hope requires belief.
Reati culturalmente motivati e ignorantia legis: a margine della prima sentenza di legittimità sulle mutilazioni genitali femminili (nota a Cass. pen., sez. V, 2 luglio 2021, n. 37422)
Authors: Sciutteri Dario
Published: May 2022

SOMMARIO: 1. Considerazioni introduttive - 2. Il caso oggetto delle sentenze in commento - 3. Le mutilazioni genitali femminili: notazioni socio-antropologiche - 4. Le mutilazioni genitali femminili come esempio paradigmatico di reato culturalmente motivato - 5. I riflessi sulla tipicità - 6. I riflessi sull’antigiuridicità: il consenso dell’avente diritto - 7. segue: l’esercizio di un diritto - 8. I riflessi sulla colpevolezza: l’oggetto del dolo - 9. segue: la conoscibilità del precetto - 10. La dosimetria sanzionatoria - 11. Considerazioni conclusive - Bibliografia - Appendice.

Cultural crimes and ignorantia legis: about the first judgment of Italian Corte di Cassazione as regards female genital mutilation

ABSTRACT: The essay analyzes the first judgment of Italian Corte di Cassazione about female genital mutilation. After the sociological and anthropological analysis of the causes of female genital mutilation, deals with the evolution of Italian criminal law against this cultural crime. In particular, the essay underlines the relation between culture and the main elements of crimes, investigating necessary adaptments of theoretical reconstructions to female genital mutilation and others cultural crimes too.
USE OF X-RAY MICRO-COMPUTED TOMOGRAPHY ON SELECTED UPPER TRIASSIC (RHAETIAN) FORAMINIFERA FROM THE WESTERN BLACK SEA SHELF, OFFSHORE ROMANIA
Authors: GRĂDINARU EUGEN , MARINŠEK MIHA , KORAT LIDIJA , GALE LUKA
Published: May 2022

Upper Triassic (Rhaetian) foraminifera belonging to the species Glomospira charoides (Jones & Parker), Gaudryinopsis kelleri (Tappan), G. triadica (Kristan-Tollmann), Ammobaculites zlambachensis Kristan-Tollmann, Verneuilinoides racema (Trifonova), and Trochammina cf. jaunensis Brönnimann & Page were investigated using X-ray micro-computed tomography. Foraminifera were recovered from the drill core CM31 of the 817 Lebăda Vest borehole, located off the coast of Romania on the western Black Sea shelf, from depths of 2623 m to 2625 m. Tomographic data was used to generate digital models, which were then virtually sectioned in desirable ways. The acquired transects can be used for comparison with specimens viewed in thin sections, providing a better connection between specimens recovered from residues and those observed in thin sections using transmitted light microscopy.
AMBER DROPLETS IN THE SOUTHERN ALPS (NE ITALY): A LINK BETWEEN THEIR OCCURRENCES AND MAIN HUMID EPISODES IN THE TRIASSIC
Authors: FORTE GIUSEPPA , KUSTATSCHER EVELYN , RAGAZZI EUGENIO , ROGHI GUIDO
Published: May 2022

The Anisian amber from the “Voltzia beds” of the Recoaro area, produced by Voltzia recubariensis, represents the most ancient Triassic amber known so far. The discovery of amber in the Anisian localities of Kühwiesenkopf/Monte Prà della Vacca and Piz da Peres, in the Dolomites area, fills a gap in the amber fossil record and gives an important contribution to the knowledge of Triassic amber. The finding of amber droplets, both dispersed in the sediment and anatomically connected to shoot fragments of V. recubariensis, demonstrates that during the Anisian this species was a major resin-producer and that the favorable conditions for the preservation of resin and plant remains were present at regional scale. The contribution of Voltziales to Middle Triassic resin production in Northern Italy is also testified by the Ladinian amber from the “Wengener Schichten” of Wengen/La Valle, produced by Voltzia ladinica, whereas the Late Triassic amber was mainly produced by cheirolepidiaceous conifers. The finding of organic body trapped in the amber of Kühwiesenkopf/Monte Prà dalla Vacca is noteworthy, although difficult to interpret, and shows once again its capability to entrap and preserve witnesses of past life. Moreover, the correspondence between the Triassic amber occurrences and regional/global scale humid shifts, suggests a cause-and-effect relationship, in which the rise of amber production/preservation potential is related to climate/environmental changes, particularly in marginal marine/costal environments.
OSTRACODS FROM THE LATE TRIASSIC (NORIAN) OF YUKON, CANADA: NEW TAXONOMIC AND PALAEOBIOGEOGRAPHIC INSIGHTS
Authors: FOREL MARIE-BÉATRICE , DEL PIERO NICOLO' , RIGAUD SYLVAIN , MARTINI ROSSANA
Published: May 2022

The present work investigates the significance of Late Triassic ostracods from the Yukon Territory, Canada, and adds to the scientific knowledge of the taxonomy of these organisms during the Norian, which remain poorly documented and understood. Fifteen limestone samples representing distinct marine palaeoenvironments cropping out at Lime Peak, Stikinia terrane, provided 90 species, including 9 newly described: Alatobairdia? sohni n. sp., Bairdia aksala n. sp., B. taan n. sp., B. yukonensis n. sp., Cornutobairdia yukonella n. sp., Lobobairdia whitella n. sp., Mirabairdia canadia n. sp., Hungarella limella n. sp., Leviella riedeli n. sp. Most assemblages point to neritic conditions in the photic zone. A similarity analysis demonstrates the distinct composition of reef-related and algae-related ostracod assemblages. The ostracod-algae associations in Lime Peak reveal that the affinity of Bairdiidae for algae (Dasycladaleans in the case of Lime Peak) was already established in the Norian. A faunal link is identified during the Norian between eastern and western Panthalassa and Japan, in line with studies on other taxa. The flux of species between eastern Panthalassa and Tethyan areas appears very unbalanced in the Late Triassic with most migrations originating from the Tethys. Further data from other Middle and Upper Triassic Panthalassan localities and stages (i.e. Ladinian and Carnian) are needed to confirm whether this apparent trend is due to sampling bias or reflects real dispersal fluxes.
حصر المفصليات الأرجل التي تصيب ثمار النخيل في ليبيا
Authors: بطاو على عبد القادر , بن سعد عبد المجيد ابو بكر
Published: May 2022

اظهرت الدراسة أن ثمار النخيل في ليبيا تصاب بعدد 22 آفه في مراحل نموها المختلفة ، سواء البلح والرطب أو التمر منها 6 تسجل لأول مرة. وقد اختلفت شدة الإصابة من الحقل إلى المخزن؛ فبالرغم من أن أغلب الإصابة كانت في الحقل ، إلا أن التمور المخزونة كانت أشد إصابة. وبينت الدراسة أن الحشرات من رتبة حرشفية الاجنحه هي أكثر الأنواع ضررا بالتمور ، يليها رتبة غمدية الأجنحة. وأعطت الدراسة صورة واضحة عن واقع افات التمور وأماكن تواجدها في ليبيا.
Habitat and life form analysis of endemic plants of Rajiv Gandhi National Park, Karnataka
Authors: Manikandan R. , Lakshminarasimhan P.
Published: May 2022

During the botanical exploration of Rajiv Gandhi National Park between 1999 and 2004, a total of 107 endemic plants were collected which are listed here with detailed information. Of these, 72 angiosperms and 1 pteridophyte are restricted to Peninsular India and the remaining 34 species occur in other parts of India (including Peninsular India).
Swertia teres (G. Don) J. Shah: A new record for Arunachal Pradesh, India
Authors: Ranjan Vinay , Kumar Anant
Published: May 2022

The occurrence of Swertia teres (G. Don) J. Shah (Gentianaceae) has been recorded for the first time from Tawang, Arunachal Pradesh, India. Detailed taxonomic description along with illustration is provided.
Indigofera Karaiyarensis, a new species of Fabaceae from Tirunelveli district, Tamil Nadu, India
Authors: Rajakumar T.J.S. , Selvakumari R. , Murugesan S. , Chellaperumal N.
Published: May 2022

A new species, Indigofera karaiyarensis is described and illustrated.
Business Intelligence for Risk Management: A Review
Authors:   Department of Mathematics, Faculty of Science, Damietta University, New Damietta, Egypt, Darwiesh Abdelaziz ,   Department of Computer Science, Faculty of Computers and Artificial Intelligence, Damietta University, New Damietta, Egypt,   Department of Mathematics, Faculty of Science, Damietta University, New Damietta, Egypt,   University of Sharjah, Sharjah, UAE, .. A.H. El , Tarabia A.M.K. , Elhoseny Mohamed
Published: May 2022

This paper provides a quick review about business intelligence approaches and techniques in risk management. The important research articles from 2007 to 2021 are involved in this review. We found a little contribution from researchers in this research direction, however the vital role of business intelligence in risk management. Moreover, we provide a novel business approach for risk management. This approach includes deploying the trendiest techniques in this era which are social media and big data analysis. Social media represents the source of identifying risks through the discussions of social media users as well as big data analysis techniques which represent the control tool for potential risks. The new approach will help firms and organizations in many sectors to manage risks efficiently and make the best decisions. Further, we provide the challenges of the new framework and the further research points.
Dissolution of Cultural Diversity, Morality and Immigrants’ Dreams in John Lanchester’s Capital
Authors: P Vijay , M Vijayakumar
Published: May 2022

Immigrants from colonised countries live in many European countries, including Portugal, England, Germany and France. The prime reason for their immigration is to make money. Many post-colonial novels reflect the terrible condition of the immigrants in the world. In general, they highlight the ruin of multi-culturalism, morality and kindness in the prevailing society. The European countries focus on the fundamental needs and their expectations. They fail to protect the young immigrants and their aims. John Lanchester’s Capital boastfully describes the impact of the inevitable immigration of Asians and Africans to London. It is observed from the study that some immigrants are attracted by the life of aristocratic Londoners. This influences them to involve in criminal and immoral activities to live a luxurious life. As a result, London becomes a place of immorality. The dreams and cultures of the immigrants are entirely dissolute. On the one hand, the immigrants are considered to be slaves and criminals and on the other hand, they are exploited in sports, education and business contexts. This article brings out the condition of the immigrants in Europe with special reference to John Lanchester’s Capital through a qualitative study.
A simple system for continuous measurement of average wind speed and its digital display
Authors: BHARGAVA B. , JAUHARI N. P.
Published: May 2022

The paper describes a simple system for measurement of average wind speed at a remote place. The average wind speed is computed as frequently as desired by transistor binaries from the pulses received from a photo-transistor anemometer during each ten-minute interval and is registered on transistor decade units. Diode decoders transfer this figure to digital  display tubes. The display on the indicating tubes is held through relays. The average wind speed is thus continuously displayed.
Long term characteristics of aerosols over Pune, central India - Effect on radiative forcing
Authors: BHASKAR V. VIZAYA , SONI V. K. , PANICKER A. S.
Published: May 2022

Sun photometer (MICROTOPS II) and Sun-sky radiometer (POM-02, Prede) data for 2003-2013 period are used to study the optical and temporal characteristics of aerosols and their effect on radiative forcing over Pune, central India. The daily mean aerosol optical thickness at 500 nm (AOT500) and Angstrom exponent for the study period were 0.77 ± 0.22 0.92 ± 0.24 respectively. Short wave aerosol radiative forcing (ARF) computed for the year 2013 using Santa Barbara Discrete-ordinate Atmospheric Radiative Transfer (SBDART) model, showed ARF at surface (SUF) and top of the atmosphere (TOA) was negative indicating dominance of scattering type aerosols. AOT, single scattering albedo (SSA) and asymmetry parameter (ASP) derived from Sun sky radiometer showed more AOT and ASP and less SSA during April / May to August indicating prevalence of absorbing soil dust in this period. Atmospheric heating varied from +14.3 to 20.5 W/m2 and was more in monsoon (+ 35.4 W/m2). ARF at SUF was found to be a strong function of AOT500 (R2= 0.90). The radiative forcing efficiency inferred to scattering nature of aerosols at SUF (-66.2 W/m2/ AOT), TOA (- 0.2 W/m2 / AOT) and atmosphere (ATM) (+ 66.0 W/m2 /AOT). The atmospheric heating rates varied from 0.94 K/day in post monsoon to 2.78 K/day in monsoon. Monthly, seasonal and diurnal variability of AOT500 and with role of meteorological factors are also discussed.
Domingos Vandelli e o déficit no real erário português no final dos setecentos
Authors: Costa Ricardo Dalla
Published: May 2022

Este trabalho tem por objetivo discutir as difíceis condições econômicas e as recomendações de política econômica sugerida por Domingos Vandelli para equacionar e promover o equilíbrio fiscal de Portugal no final dos setecentos. Iniciando com uma prévia proposta de Vandelli sobre institucionalização do conhecimento na Sciencia das Finanças para posteriormente expor as dificuldades na manutenção do Reino em momentos não justificáveis como ordenados onerosos e mesmo gastos militares, investimentos em manufatura, artes e ciência sem que houvesse naquele momento uma real economia de guerra. Como resultado, não se concretizou a ideia de uma Sociedade Econômica portuguesa uma vez que fora transmutado em uma Academia de Ciências. No que diz respeito ao déficit no Real Erário, verificou-se aumento dos gastos do Estado português concomitantemente com a queda na arrecadação do além-mar, e por fim, o oportunismo por trás das dificuldades financeiras da metrópole levava Vandelli a fazer duras críticas aos gestores financeiros e usurários que tiravam proveito de uma situação emblemática e sugerir políticas econômicas para equilibrar as finanças públicas.
Christianity in East and Southeast Asia
Authors: PEH Andrew
Published: May 2022

This book was published just as a pandemic was fanning out from Asia to the rest of the world in the early part of 2020.   Asia seemed to the locus of global attention as the effects of the pandemic rippled across the globe.  Interestingly, this part of the world is undoubtedly one of the geopolitical centers of the “clash of civilisations,” where the rise of China has become the catalyst for the possible escalations of economic, political, and theological changes in this decade.
DETERMINANTS OF MODERN CONTRACEPTIVE METHODS USE IN PIPLE, CHITWAN OF NEPAL
Authors: Shah Rajani , Malla Dinesh Kumar
Published: May 2022

Background: Family planning contributes in preventing maternal and child mortality and empowers women. For the past ten years contraceptive prevalence rate has remained stagnant. This study aimed at identifying the use and factors associated with modern contraceptive methods in Piple, Chitwan, Nepal.

Method: It was a cross-sectional study. Piple village development committee was selected purposively, in which two wards were randomly selected. Married women of reproductive age (n=332) of each household were interviewed. Descriptive, bivariate and multivariate analysis were performed.

Result: About half (49%) of the respondents had used a modern method of FP. Women in the age groups 25-39 years [aOR: 2.39; 95% CI: 1.16 - 4.92] and 40-49 years [aOR: 4.67; 95% CI: 1.71 - 12.70] were more likely to use modern contraceptives compared to the women in the age group 15-24 years. Similarly, women having 3 or more living children [aOR: 2.98; 95% CI: 1.19 - 7.50] were more likely to use the modern contraceptives than women with upto two children. Women whose husbands would approve of using the contraceptives [aOR: 11.33; 95% CI: 3.93-32.62] were more likely to use the methods than those who got or perceived no approval from husband.

Conclusion: Information and service on modern contraceptive methods should be focused to younger women. Involvement of husbands in family planning program would contribute to use of modern contraceptives by women.
AN UNUSUAL CASE OF BURIED BROKEN EXODONTIA INSTRUMENT IN INFERIOR ALVEOLAR CANAL
Authors: Mishra Ravish , Yadav Deepak , Kandel Laxmi , Tripathi Shashank , Singh Sunil Kumar , Shuvam Snigdha , Dutta Kishor
Published: May 2022

Exodontia is a routine procedure in dental practice. Despite of adequate effort to perform the pro­cedure with proper technique, some mishap may happen when defective or substandard instru­ments are used. This article reports a symptomatic case of lip paresthesia since 1 month who had undergone attempted surgical extraction of third molar in remote dental hospital. On examination there was presence of retained fractured third molar with exodontia instrument tip in inferior alveolar canal and is very uncommon surgical complications and not much reported in literatures. Patient was not aware of the condition till Orthopantomogram (OPG) was done which revealed presence of approximately 1.5 cm instrument tip in inferior alveolar canal. Third molar and in­strument tip were successfully retrieved from canal under local anesthesia. Rarely, instruments breakage may occur during surgical procedures. It is the duty of every operating dental surgeon to check surgical instruments for signs of breakage and be prepared to solve a possible emergency. Retained fragments should be carefully studied prior to attempt of removal.
ENDODONTIC MICROSURGERY: NEW PROSPECTIVE TO DEAL WITH FAILED ROOT CANAL TREATMENT
Authors: Tiwari Sanjay Kumar
Published: May 2022

Dental pulp is sterile structure which becomes contaminated when bacteria from oral cavity invade inside, colonized and produce immune stimulatory compounds those gets leaked to periapical area through apical foramen. The stimulated immune system starts inflammatory reaction which is observed as bone loss in periapical area on radiographs.

Root canal treatment (RCT) is performed to eradicate bacteria from root canal. With evolution of new technologies and new materials, the RCT has become most predictable with success rate ranging from 82-95%. Despite of high success rate, the failure still exists. The analysis has shown that failures are not due to material but are due to complexity of tooth anatomy. The unsealed area by filling materials acts as communication channel between residual bacteria inside root canal and periapical tissue. Previously, due to lack of knowledge of such communicating channels has bought frustrations both to dentist and patients. Now, we have latest diagnostic technologies such as cone-beam computed tomography (CBCT) and micro-computed tomography (µ-CT), those have expanded the horizon of variations in anatomy of tooth structure that can act as communication channels. This has encouraged researchers and dentists to invent and implement methodologies that can prepare and seal these communication channels.

Endodontic microsurgery is latest evolution in field of endodontics to deal with these anatomic communication channels with predictable result. Conventional endodontic surgeries were blind procedures performed before evolution of endodontic microsurgery [3]. Endodontic microsurgery is performed with microinstruments and most importantly under direct vision through dental operating microscope. Dental operating microscope gives magnified view of operating area with direct illumination, this make preparation and sealing of communication easy and treatment becomes predictable. The success of endodontic microsurgery is about 98% in compare to conventional endodontic surgery which was 54%. All these facts show that the endodontic microsurgery can be adopted to save tooth that were once though impossible to restore back to functional state.
PAIN EXPERIENCE AND NURSING APPROACHES TO PAIN CONTROL AMONG PATIENTS UNDERGONE ABDOMINAL SURGERY AT TERTIARY HOSPITAL
Authors: Rana Mana Maya , Shakya Nona
Published: May 2022

Background: Pain is the most common problem found in postoperative patients. Even with im­proved and advanced surgical techniques, people still feel some pain and discomfort after surgery.

Methods: The descriptive study was carried out to assess pain experience and nursing approaches to pain control among 111 post- operative patients at surgical ward of Manipal Teaching Hospital, Pokhara. The data was collected in the month of May to July, 2019. Wong Baker Pain rating scale and structured questionnaire were used to collect data. The collected data was analysed by using descriptive and inferential statistic.

Results: Almost all the patients experienced pain after surgery, the most common site of pain was at surgical incision. Majority (90.1%) of them felt more pain while changing position. Conversely, 88.3% of patients reported least pain during rest. While 55% of them had reported moderate level of pain. Mean severity of pain experienced by patients was 4.8±2.4. Regarding nursing approaches, 82% of patients told that nurse had frequently asked whether they had pain, 80.2% of them re­ported that the nurse administered pain killer drugs when they required. However, none of them told non-pharmacological methods such as massage, listening music, imagination to distraction of pain were performed. The significant association was seen in level of pain with post-operative day.

Conclusions: The findings of study indicate that the majority of patients experienced pain in the first day of surgery, and it is clear that effective pain management is essential in early day of opera­tion.
MAYOEPITHELIAL CARCINOMA OF MAXILLARY SINUS: A CASE REPORT
Authors: Liaquat Ahmad , Riaz Nabeela , Shah Arun Kumar
Published: May 2022

Mayoepithelial carcinoma of the salivary gland is extremely rare malignancy. It may arise either in recurrent or pre existing pleomorphic adenoma or de novo in salivary glands. We herein  present the case report of 35 years old  male patient who presented to us with myoepithelial carcinoma of minor salivary gland of right maxillary sinus. Right total maxillectomy  with functional neck dissection was done with orbital floor reconstruction with titanium mesh.
KNOWLEDGE REGARDING PREVENTIVE MEASURES OF PRESSURE ULCER AMONG NURSES
Authors: Neupane Gita , Chanda Sah
Published: May 2022

Background: Pressure ulcer is a preventable medical complication. Nurses are primarily respon­sible in pressure ulcer prevention. This study was designed to find out knowledge regarding pre­ventive measures of pressure ulcer among nurses.

Methods: Descriptive study was conducted among 100 nurses, selected by using non-probability convenience sampling technique. Pretested Self-administered semi-structured questionnaire was used and collected data were analyzed by using descriptive and inferential statistics with Statistical Package for Social Sciences software version 20.0.

Results: The findings of the study revealed that nearly half (48%) of the respondents had low knowledge regarding pressure ulcer. Regarding age, majority (52%) of the respondents were of age group 18-27 years. Regarding qualification, 48% of the respondents were PCL nursing and 47% had working experience of 1-5 years. Similarly, 17% of respondents were working in Gynecology ward and 85% had exposed to managed patients with pressure ulcer. Among them, 76% of the respondents had knowledge regarding meaning and 96% had knowledge regarding signs of pres­sure ulcer. Ninety two percent of the respondents had knowledge that position of patients should be changed every 2 hourly, 38% had knowledge that patient’s head should be elevated at or below 300 and 73% had knowledge that normal saline is the best solution to cleanse pressure ulcer. There was statistically significant association of respondents’ level of knowledge regarding ulcer with working department (p=0.001).

Conclusions: The study concluded that nearly half of the nurses have low knowledge regarding pressure ulcer. It is recommended to hospital management to conduct in-service education for nurses.
STUDY OF DENTAL DISEASE PATTERN AND DRUG UTILIZATION EVALUATION AMONG PATIENTS VISITING DENTAL OUTPATIENT DEPARTMENT OF TERTIARY CARE CENTER
Authors: Ruchi Shrestha  , Sony Shakya Shrestha  , Sushmit Koju  , Manoj Humagain
Published: May 2022

Background: Oral health has been an integral component of general health, with a serious impact on the quality of life and the overall well-being. Limited availability and accessibility of oral health services are risk factors for poor oral health and diseases. This study aimed to observe common dental disease pattern and to evaluate drug utilization pattern among patients visiting Dental Outpatient Department of Dhulikhel Hospital- Kathmandu University Hospital.

Methods: A descriptive, cross-sectional study was conducted from October 2018 to January 2019 in Dental Outpatient Department of Dhulikhel Hospital-Kathmandu University Hospital. Two hundred forty prescriptions were collected and analyzed. Descriptive statistical analysis was carried out to find out common dental disease pattern and to evaluate drug utilization pattern.

Results: Total 240 prescriptions were analyzed. Pulpitis 54 (22.5%) was the most common diagnosis, followed by periapical abscess 34 (14.16%). Out of 411 drugs prescribed, 166 (40.38%) were analgesics, 116 (28.22%) were antibiotics and 93 (22.62) were topical agents. Combination of paracetamol with ibuprofen was most commonly prescribed analgesics 133 (80.12%) and combination of amoxicillin with clavulanic acid was most commonly prescribed antibiotics 51 (43.97%). Out of all drugs prescribed, fixed dose combination was given in 194 (47.20%). Only 260 (63.26%) drugs were given by generic name and 133 (32.36%) drugs were from National List of Essential Medicines-Nepal.

Conclusions: Awareness among dental doctors for prescribing drugs by generic name and from essential drug lists should be encouraged.

 

Conclusions: Awareness among dental doctors for prescribing drugs by generic name and from essential drug lists should be encouraged. Use of fixed dose combination should be minimized.
POSTNATAL CARE SERVICES UTILIZATION IN BHARATPUR SUB METROPOLITAN CITY, CHITWAN, NEPAL
Authors: Shrestha Niki , Tiwari Binita , Piryani Suneel , Khanal Gayatri
Published: May 2022

Background: Postnatal period is a critical phase in the lives of mothers and newborn infants. 2.9 million neonatal deaths occur in the first week of life on an annual basis globally. In Nepal, the level of postnatal care coverage remains low despite the efforts and research on factors influencing the Post-natal care (PNC) services utilization is limited. Hence this study was conducted to explore the predictors of PNC utilization among mothers who had under one-year child.

Methods:A community-based cross-sectional study was conducted in Bharatpur Sub Metropolitan city, Chitwan among mothers having a child of less than one year age. Data was collected through face-to-face interview using interview-schedule. Descriptive (frequency and percentage), Bivariate (Chi-squre) and Multivariate (logistic regression) analyses were performed. 

Results:This study showed that the proportion of recommended PNC services utilization is low in comparison with those utilizing ANC services in Nepal. The percentage of women attending all the three recommended PNC visits was only 17.5%. The utilization of PNC services was associated with mother’s educational status, parity, place of PNC services received and awareness about PNC services. The mode of delivery, danger signs seen in postnatal mothers, and danger signs seen in newborn were statistically significantly associated with PNC services utilization.

Conclusion:The findings of this study suggest context specific evidence which might be taken into consideration while planning to develop new policies to increase PNC utilization.
EARLY MANAGEMENT OF MALARIA IN THE CONTEXT OF ELIMINATION: OBSERVATIONS FROM CHITWAN MEDICAL COLLEGE, NEPAL
Authors: Lamsal Daya Ram , Mirdamadi Shirin
Published: May 2022

Background: Nepal is entering a malaria elimination phase with the target for no indigenous cases set for 2025. The elimination phase is known to be a challenge due to knowledge and skills reduction as cases become rarer.

Methods: We audited all malaria parasitology tests in Chitwan Medical College from January 2017 to December 2018. Slide positive rate, case treatment and timings were identified from case note review.

Results: Over the 2 years, 1455 malaria tests were performed, 12 were positive, making the positive test rate at 0.83%. Eleven of these 12 case files were found. They were reviewed to find the case details. All cases were >16 years old. Four cases had P. falciparum, six cases had P. vivax,and in one case, the species was not identified. Four of the 12 cases fulfilled criteria for severe malaria. All P. falciparum cases had travelled outside Nepal in the past year. Median time from symptom onset to treatment was 170 hours. Median time from attendance to anti-malarial treatment was 9 hours. Three cases did not receive guideline antibiotics according to Nepal National Protocol.

Conclusions: In conclusion, immediate testing with malaria RDT in all febrile patients presenting to CMC for early diagnosis and prompt treatment is recommended. In addition, we urge to inform colleagues on the features of severe malaria and the national treatment protocol including use of Primaquine for progressing to elimination target.
KNOWLEDGE ON MENSTRUATION AND MENSTRUAL HYGIENE PRACTICES AMONG ADOLESCENTS GIRLS OF SELECTED SCHOOLS, CHITWAN
Authors: Sharma Mamata , Sharma Kalpana , Pandey Bista Archana , Subedi Subash , Lamichhane Sandesh
Published: May 2022

Background: Menstrual hygiene is very important aspect for adolescent girls and proper men­strual hygiene has not been sufficiently addressed in developing countries including Nepal. This study aimed to assess the knowledge on menstruation and menstrual hygiene practices among adolescent girls.

Methods: Descriptive cross-sectional study was conducted among adolescent girls studying in selected schools of Chitwan district. A total 193 girls who had menstrual flow experience for at least three consecutive menstrual cycles were selected as sample using the consecutive sampling technique. Data were analyzed in Statistical Package for Social Sciences (SPSS) version 16.0 using descriptive and inferential statistics.

Results: Most of the girls knew about menstruation as physiological process, normal age of men­struation, and causes of menstruation as hormonal change. Overall, 66.8% of girls had adequate level of knowledge on menstruation. Regarding practice, 94.8% cleaned their genitalia properly, 93.8% used the sanitary pads, and 97.4% wrapped and disposed the pads in dustbin after use. Over­all, 72.5% of girls had good level of menstrual hygiene practices. Adolescent girl’s age and grade, and occupation status of their father were significantly associated (p < 0.05) with menstrual hygiene practice. Further, significant positive relationship found between knowledge on menstruation and menstrual hygiene practice.

Conclusions: One third of adolescent girls have inadequate knowledge on menstruation and one fourth have poor menstrual hygiene practice. Therefore, an awareness and advocacy programs on menstruation and menstrual hygiene practices are needed for the adolescent girls to safeguard themselves against reproductive tract infections.
INTERNET ADDICTION AMONG STUDENTS OF SELECTED SCHOOLS OF POKHARA, NEPAL
Authors: Singh Sakun , Shrestha Sandhya
Published: May 2022

Background: Internet is accessed by over billion users worldwide and continues to rise every year. A huge number of these users belong to teenagers and young adults that uses internet on daily basis for different purposes. The present study was conducted with the purpose to assess the internet addiction among adolescence.
Methods: A cross-sectional study was conducted among students studying in selected schools of Pokhara, Nepal. A total 144 students were selected as sample using purposive sampling dur­ing April/May 2019. Data collection was done using structured demographic proforma, Modified young 20 item internet Addiction Test. Self-administered method was used for data collection. Data were analyzed using descriptive and inferential statistics.
Results: The study revealed among the 144 students mean age was 15.52 +1.17, two third 60.7% were from 16-20 years of age, 61.1 % were male, more than half 51.1% were from grade nine and starting mean age of the respondents was 11.78+2.4.Majority 85.4 % were using internet from more than one year,43.8% were spending one to two hour with internet users,65.3% of the respondents were using internet for recreation purpose, all most respondents 96.5 were using in­ternet in home,74.23% were using internet in mobile, starting mean age was 11.78+2.4.More than half 51.2% of the respondents had moderate to severe level of Internet addiction.
Conclusions: Study findings shows moderate to severe level of Internet addiction. There was sig­nificant association between internet addiction and Internet using year, duration of internet use, spent with internet user and purpose of internet use.
COMPARATIVE STUDY OF CAST IMMOBILIZATION OF WRIST IN FUNCTIONAL POSITION VERSUS CONVENTIONAL PALMAR FLEXION IN COLLES’ FRACTURE
Authors: Shrestha Shriraj , Bhandari Parash , Dahal Saurav , Maharjan Basanta , Bajracharya Suraj
Published: May 2022

Background: Colles’ fracture is a common injury in the elderly population. Although it can be easily reduced, it is difficult to maintain the reduction in the conventional position of the wrist in palmar flexion with a poor functional outcome. Thus our study aimed to compare the radiological and functional outcome of such fractures with the wrist in two different posi­tions of dorsiflexion and palmar flexion.
Methods: A prospective, observational study was conducted from April 2019 to March 2020 in the Orthopedics and Emergency department of KIST Medical College Teaching Hospital, Lalitpur, Ne­pal. Sixty-two patients, 31 in each group, all above 45 years with Colles’ fracture underwent close reduction and below elbow cast immobilization under hematoma block. Maintaining palmar flex­ion and ulnar deviation at the fracture site, the wrist was immobilized in dorsiflexion and palmar flexion attitude alternatively. During the respective follow-ups, the Demerit Scoring System of Saito was evaluated. Data collection and entry was done using the statistical package for social science version 16 and analyzed by using descriptive and inferential statistics. Results: All fractures were united. At the end of twelve weeks, Saito Scoring System of good to ex­cellent was markedly better in dorsiflexed group 29(93.5%) patients as compared to palmar flexed group 22(71.0%) patients, similarly grip power was also superior in dorsiflexed group 19(61.3%) patients than in palmar flexed group 11(35.5%) patients. Conclusions: Cast immobilization of Colles’ fracture with the wrist in dorsiflexion prevents re-dis­placement of the fragments resulting in significantly better radiological and functional outcomes.
RELATIONSHIP BETWEEN SELF-EFFICACY AND ACADEMIC MOTIVATION AMONG NURSING STUDENTS
Authors: Shrestha Sandhya , Tuladhar Jyoti Badan
Published: May 2022

Background: Self-efficacy and academic motivation are both essential component for nursing profession which have a direct influence on academic success therefore this study aimed to investigate the relationship between Self-efficacy and Academic motivation among Nursing Students of Nepal.
Methods: A cross-sectional study was conducted among 203 Proficiency Certificate Level and Bachelor of Science in nursing students of, Pokhara, Nepal during February 2020. Self -adminis­tered Demographic Performa, Jerusalem and Schwarzer Self-efficacy, Modified vallerend Academic motivation was used for data collection. Data were analyzed using Descriptive statistics and infer­ential statistics.
Results: The study revealed among 203 nursing students. Majority (76.5%) were from age group 16-25 years, mean age was 18.96 ± 1.96, majority (82.8%) were Hindu. Most of all (98.0%) were unmarried, majority (85.7%) were from nuclear family. More than half (57.1%) were from pro­ficiency certificate level student, one third (31.5%) were from third year. The mean self-efficacy score was 30.22±4.2 and mean total academic motivation was 95.19±13.71.
Conclusions: Study findings showed that majority of nursing students have average level of self -efficacy and average level of academic motivation. Self- efficacy was significantly correlated with academic motivation so that nurse educators should help to boost self- efficacy.
SPECTRUM OF ABO AND RH BLOOD GROUP IN NEPALI MEDICAL STUDENTS
Authors: Joshi Bishal , Kar Sanjit Kumar , Shrestha Laxmi , Yadav Shankar
Published: May 2022

Background: ABO and Rh systems are most important types of blood group systems that should be taken into consideration during blood transfusion. Many studies have been done across the globe to determine the distribution of these blood groups among different strata of population. But there are very few studies done in Nepali population. Therefore, in this study we aimed to find out the distribution of blood groups among Nepali medical students and to compare it with the other studies done in Nepal and other countries of the World.

Methods: This was a retrospective study, containing the data of ABO and Rh blood groups of medi­cal students recorded over a period of 21 years in Department of Physiology of Universal College of Medical Sciences, Bhairahawa, Nepal. The blood group was determined by open slide test method by using commercially available standard monoclonal antibody.

Results: A total of 2031 Nepali medical students were included in the study. Among them 1147 were male and 884 were female. In the present study we found that the most common blood group was O (739, 36.4%) followed by B (624, 30.7%) and A (522, 25.7%) and least common blood group was AB (146, 7.2%). Among all participants 96.8% of the people were Rh positive and 3.2% were Rh negative.

Conclusions: This study done in Nepali medical students can provide a new insight for the further study of distribution of blood groups in Nepali population. A study with high sample size, repre­senting every zones of Nepal is the demand of future.
MAGNITUDE OF REFRACTIVE ERRORS IN CHILDREN IN TERTIARY CARE HOSPITAL OF WESTERN NEPAL
Authors: Godar Srijana Thapa
Published: May 2022

Background: Refractive error is one of the most common causes of the visual impairment and second leading cause of treatable blindness. The objective of the study was to determine the mag­nitude of refractive errors in children.

Methods: This was a hospital based cross-sectional study conducted on 254 children attending Ophthalmology OPD of Manipal Teaching Hospital, Pokhara. The children whose visual acuity was worse than 6/6 but improved with pinhole were included in this study. Vision test, retinoscopy and subjective refraction was done in all subjects and cycloplegic refraction was done when needed. Statistical analysis was carried out using Epi-info version 7.

Results: The commonest type of refractive error was astigmatism (46.06%) followed by myopia (42.31%). Majority of children had low grade of refractive errors (46.85%). Among the children, “with the rule astigmatism” was maximum (27.56%). Majority of children were in the age between 11 to 15 years (77.95%). The refractive error was seen more in female (63.78%). Among the chil­dren of refractive errors, 29.13% had family history, 33.46% had given the history of wearing spec­tacles and 10.24% children had amblyopia. There was statistically significant association between refractive errors and age groups, history of wearing spectacles, amblyopia and grading of refractive errors. However, there was no statistically significant association of refractive error with gender, residence and family history.

Conclusions: Astigmatism was the common type of refractive error followed by myopia. This study emphasizes the importance of detection of refractive error in children.
FACTORS AFFECTING JOB SATISFACTION AMONG NURSES WORKING IN TEACHING HOSPITAL, CHITWAN, NEPAL
Authors: Poudel Sashi , Sharma Kalpana
Published: May 2022

Background: Job satisfaction is a major factor in nurse retention and the delivery of high quality care. Hence, aim of this study was to find out the factors affecting job satisfaction among nurses working in the teaching hospital, Chitwan.

Methods: A descriptive, cross-sectional research design was used and a total 135 nurses who were working for at least 3 months in the Chitwan Medical Teaching Hospital were taken as study sample. Simple random sampling technique was used to select the desired sample. Pre-tested structured self-administered questionniare with job satisfaction scale consisting eight domains was used to collect the data. Obtained data were entered into SPSS version 20.0 for window and analyzed using descriptive statistics and inferential statistics (chi-square test).

Results: The findings of the study revealed that more than half (57.85%) of the nurses were satisfied with their job. Nurses’ job satisfaction was higher on organization and administration policies (4.18±0.04) and least on salary and benefits (3.01±0.19) they were receiving from the institution. The significance influencing factors of job satisfaction were professional qualification (p=0.04), total work experience in nursing (p=0.004), working ward/unit (p=0.014), designation (p=0.007), number of patient assigned in general ward (p=<0.001) and leadership style in the ward (p=<0.001).

Conclusion: Considerable percentage of nurses is not satisfied with their job. Hence hospital management and professional associations need to address the identified factors to enhance the job satisfaction among nurses working in a teaching hospital.
USE OF ULTRASONOGRAPHY IN REDUCTION OF ISOLATED ZYGOMATIC ARCH FRACTURE
Authors: Dhungel Safal , Singh Ashutosh Kumar
Published: May 2022

Background: Isolated zygomatic arch fractures, managed by closed methods, can be inadequate leading to facial asymmetry. Assessment of the reduction and ensuring correct alignment of frac­tured fragments in the operation table always avoids next surgery. This study aims to determine intraoperative, adequacy of reduction of by use of ultrasound in isolated zygomatic arch fracture.

Methods: During the closed reduction of isolated zygomatic arch linear probe of ultrasound was used to check the continuity of the echogenic line. The intraoperative ultrasound finding was com­pared with the gold standard CT scan.

Results: Ultrasound has 100% sensitivity and 80 % specificity. It also has high precision and accu­racy to determine the reduction of the fractured bone.

Conclusions: Ultrasound is a handy tool in the reduction of zygomatic arch fracture. It not only shows but also guides to adequate reduction.
COVID-19 TESTING: ESSENTIAL FOR TRACKING INFECTION AND HELPING AUTHORITY TO OVERCOME THE CHALLENGES OF SPREAD
Authors: Piryani Rano Mal , Piryani Suneel , Piryani Shomeeta , Dangal Ganesh , Huq Muzaherul , Shakya Dhana Ratna
Published: May 2022

COVID-19 is mainly transmitted through droplet infection and spread very fast compared to SARS-CoV and MERS-CoV. For the countries, it is important to know at what stage the COVID-19 epidem­ic is? So, as to take appropriate steps to contain the epidemic. This will only be known by testing the suspects and contacts of confirmed cases. If there is poor testing, then most of the infected people may remain undetected, however they could spread the virus to hundreds of other people and potential contacts, which could not be known and quarantined in time continuing the spread. If there is quality assured, highly sensitive and specific testing along with adequate isolation and quarantine, then the spread will be limited. There are two types of tests available for COVID-19: the tests directly detecting the viral ribonucleic acid (RNA) collected in nasopharyngeal or throat swabs, and tests detecting antibodies from the blood sample. At this point in time, the polymerase chain reaction (PCR) tests are used for confirmation of the disease while antibodies tests may provide information regarding the prevalence of infection. World Health Organization advices the countries to increase the testing and get to know the level of epidemic and act accordingly for containment of infection.
RECURRENCE AND PROGRESSION OF NON-MUSCLE INVASIVE BLADDER CANCER FOLLOWING TRANS-URETHRAL RESECTION OF BLADDER TUMOUR WITH ADJUVANT INTRAVESICAL CHEMO-IMMUNOTHERAPY
Authors: Kunwar Ashok Kumar , Tiwari Kabir , Shrestha Sanjesh Bhakta , Thapa Srijana , Panthee Ashish Kumar , Parajuli Sharmila , Upadhyay Amit Mani
Published: May 2022

Background: Trans-urethral resection of bladder tumor is an essential diagnostic tool as well as effective treatment modality for non-muscle invasive bladder cancer. We aimed to evaluate the recurrence and progression of the non-muscle invasive bladder cancer in Nepalese patients.
Methods: This was a retrospective study of 43 patients with non-muscle invasive bladder cancer, who underwent trans-urethral resection of bladder tumour followed by adjuvant intravesical instilla­tion of chemo or immunotherapy between January, 2013 to December, 2018. Patients were divided into low, intermediate and high-risk groups according to the clinical and pathological factors used by the European Organization for Research and Treatment of Cancer scoring system. Outcomes were calculated in terms of recurrence and progression in each group.
Results: Out of 43 patients, 11 (25.58%) patients had low risk, 18 (41.86%) patients had intermediate risk and 14 (32.56%) patients had high risk of recurrence categories. No recurrence and progression of the disease noted in low risk group. In the intermediate risk group, out of 18 patients, 4 (22.2%) patients developed recurrence and 2 (11.1%) patients had progression of disease. In high risk group, out of 14 patients, 4 (26.8%) patients developed recurrence and 2 (14%) patients developed progres­sion of the disease.
Conclusions: Even in a low volume centre of bladder cancer, effective treatment for non-muscle inva­sive bladder cancer with trans-urethral resection of bladder tumour followed by adjuvant intravesical chemo or immunotherapy can be given safely to reduce recurrence and progression of the disease.
OMENTAL LYMPHANGIOMA: A RARE CASE REPORT
Authors: Dahal Geha Raj
Published: May 2022

Lymphangioma is a common pediatric problem. Most of the lymphangiomas occur in head and neck region. Lymphangioma arising from omentum is extremely rare. It is a benign condition but is locally invasive. Symptoms usually arise from its mass effect or complications. Complete excision including removal of all loculi is necessary for cure. We report such a case of omental lymphan­gioma in a six-year boy.