bluuebunny/crossref_metadata_2025 huggingface dataset:
Language Evolution: A brief overview
Authors: Cuskley Christine
Published: June 2020

This article provides a very brief overview of the study of language evolution, targeted at students early on in their studies in any field. The article begins by arguing that to understand language we must understand its evolution, and briefly shows how interest in the topic has expanded, particularly in the last 30 years. This leads to a closer look at what we now understand about language evolution, focusing on consensus and looking at major themes, particularly complimentary biological and cultural approaches. The article concludes with a look at the interacting genetic, cultural, and developmental timescales at play in the evolution of language.
Effects of flywheel training on strength-related variables in female populations. A systematic review
Authors: González Javier Raya , de Keijzer Kevin , bishop Chris , Beato Marco
Published: June 2020

ABSTRACTBackground: This study aimed to evaluate the effect of flywheel training on female populations, report practical recommendations for practitioners based on the current available evidence, underline the limitations of current literature, and establish future research directions.Methods: Studies were searched through the electronic databases (PubMed, SPORTDiscus, and Web of Science) following the preferred reporting items for systematic reviews and meta-analysis statement guidelines.Results: The methodological quality of the 7 studies included in this review ranged from 10 to 19 points (good to excellent), with an average score of 14-points (good). These studies were carried out between 2004 and 2019 and comprised a total of 100 female participants. The training duration ranged from 5 weeks to 24 weeks, with volume ranging from 1 to 4 sets and 7 to 12 repetitions, and frequency ranged from 1 to 3 times a week. Discussion: The literature suggests that flywheel training is a safe and time effective strategy to obtain lower limb performance enhancements and positive muscle morphological adaptations with elderly and young females. The present literature, although limited, supports the use flywheel training for the prevention of falls and the enhancement of physical capabilities in young and elderly female populations. Nonetheless, a lack of clarity still exists regarding appropriate flywheel training volume, frequency, and intensity. Further high-quality investigation into this topic is warranted to establish clear guidelines about the use of flywheel training methodologies with female populations.
2º Formato de Tesis FACEAC - Universidad Nacional Pedro Ruiz Gallo (Perú)
Authors: Mocarro Jorge Vicente Niño
Published: June 2020

Es un formato de Tesis para la obtención del título profesional de Economista en la Facultad de Ciencias Económicas, Addministrativas y Contables (FACEAC) - Universidad Nacional Pedro Ruiz Gallo. (Perú)
Neonatal hyperbilirubinaemia and its early outcome
Authors: Nepal D. , Banstola D. , Dhakal A. K. , Mishra U. , Mahaseth C.
Published: June 2020

Introduction: Jaundice is an important cause of morbidity in the neonatal period, especially in the 1st week of life. our Objective of the study was to find out early outcome of babies admitted in Kanti Children Hospital with neonatal jaundice (NNJ) and its association with other co-morbidities. Methods: This is a retrospective study conducted in tertiary care paediatric hospital from 1st March to1st June 2009. Altogether 73 babies were included in the study. Results: Male babies outnumbered females (72.6% vs. 27.4%). Only 2.4% babies were near-term. Low birth weight (LBW) babies constituted 19.2% of the study population. Clinical sepsis as defined by WHO criteria was observed in 86.3% of babies. Nearly 50% of the babies had serum bilirubin of 15-19.9 mg/dl. Most of the babies (94.5%) improved with 5.5% of mortality. Conclusions: Hyperbilirubinaemia is one of the most common causes of hospital admission in our nursery and it is associated with various other clinical morbidities. Phototherapy is effective in most of the time, but exchange transfusion should also be carried out when phototherapy fails. Causes of hyperbilirubinaemia should be searched extensively especially to rule out haemolysis Key words: Hyperbilirubinaemia, kernicterus, neonates, phototherapy DOI: 10.3126/joim.v31i3.2990 Journal of Institute of Medicine, December, 2009; 31(3) 17-20
Small Cell Carcinoma of Ethmoid Sinus
Authors: Adhikari P. , Bhatta R. , Pradhan B. , Thapa N. , Bhandari R. , Karki R. , Shrestha A. , Sayami G.
Published: June 2020

Extrapulmonary small cell carcinoma is a rare entity. Here, we report a case of small cell carcinoma of left ethmoid sinus, in a 32 years old female. She underwent left medial maxillectomy and excision of the mass via lateral rhinotomy approach with post operative chemoradiation. Keywords: Ethmoid Sinus, lateral rhinotomy, maxillectomy, small cell carcinoma. DOI: 10.3126/joim.v31i3.2999Journal of Institute of Medicine, December, 2009; 31(3) 59-60
Profile of unaccompanied, unconscious patients in the emergency department
Authors: Singh DP , Acharya RP , Singh S
Published: June 2020

Introduction: The burden of unknown and unconscious patient is a common challenge to provide medical care in the emergency department of the hospitals. As the social security systems like insurance does not exist and poverty is rampant, it will continue in the future too. In this context this study is an attempt to analyze the morbidity & mortality as well as the types of illness, causes of unconsciousness and the source of unconsciousness in these patients without any identity. Methods: A retrospective analysis of the unaccompanied, unconscious patients attending the emergency department of Bir hospital during the Nepali year 2066 Bikram Sambat (14 April 2009 to 13 April 2010) was carried out. Results: Two-thirds of these patients were brought to hospital by the police. The next category (20%) were brought by unknown person and left without any information. Conclusions: Use of the type of substance and their nature remains unclear and there is a need to develop a trend to identify these substances so that specific treatment and hence preventive measures can be implemented effectively. Keywords: Destitute; unconscious; unknown substance DOI: http://dx.doi.org/10.3126/joim.v32i2.4936 Journal of Institute of Medicine, August, 2010; 32:2-4
Cardiac workload of dressers in underground manual coal mines
Authors: Saha R , Samanta A , Dey NC
Published: June 2020

Introduction: Occupational disorders invite absenteeism amongst the miners. Though rapid technological advancement has happened, yet assessment of cardiac workload was largely ignored in underground coal mines in India. Methods: Physiological stress was evaluated in terms of working heart rate, net cardiac cost and relative cardiac cost. Heart rate was measured during their course of work by heart rate monitor at the coal face. Recovery heart rates and environmental heat load were also assessed. Results: Heart rate was found to be 117 and 122 beats/min respectively in first and second spell. NCC (49.7 and 54.8 beats /min) and RCC (47% and 52%) exhibit significant variations between spells, whereas rate of recovery had been very poor amongst the workers who regularly exceeded recommended levels of cardiac strain indices. The nature of work depicted it as a heavy job although recovery trend categorizes it heavier than that. ET and WBGT were above the recommended limits as per the guidelines of WHO and ACGIH. Conclusions: High physiological demand of the job with towering heat stress was found to hinder the recovery process and may cause deleterious impacts on the workers. Ergonomic interventions were highly felt towards job organization and up gradation of environmental conditions. Keywords: Coalmines; dressers; workload DOI: http://dx.doi.org/10.3126/joim.v32i2.4938 Journal of Institute of Medicine, August, 2010; 32: 11-17
IOM Smart Health Line: Giving back
Authors: Vaidya Pradeep
Published: June 2020

DOI: http://dx.doi.org/10.3126/joim.v32i3.4951 Journal of Institute of Medicine, December, 2010; 32:3 1
Factors determining self-harm
Authors: Shakya YL , Acharya R , Gupta MP , Banjara MR , Prasad PR
Published: June 2020

Introduction: Self-harm forms a significant proportion of patient attending in emergency departments, typically 10-30 per 100000 people commit suicide annually. The objective of this study was to find out the factors responsible for self harm. Methods: This is a cross sectional study of 100 patients of self harm coming to Emergency Department of Tribhuvan University Teaching Hospital from 1stOctober 2007 to 31stMarch, 2008. Questionnaire about demographic information of patient along with details about cause of self harm, and any other illnesses associated was filled. Information about duration of arrival in emergency department, place of self harm was gathered. Patients were clinically examined and hematological and biochemical tests including liver function test and the type of poison used and its level in blood were examined. Results: Total number of patients with self harm was 100 (female - 71%; male- 29%).Among female, 16-30 years age group to be the largest (76%). Mean duration of arrival in emergency department was 3.08 hour. Metacid ingestion (29%) was found to be the most common cause for self harm. There is no difference of self harm for suicide and threat cause. Only 5% of patient with self harm has psychiatry illness in the past. Conclusions: Self harm forms a significant proportion of patient attending the Emergency department and the most common form of self harm used was metacid ingestion. There is compelling evidence for the need to improve delivery of care for patients who inflict self harm. Key words: Cause; emergency department; self harm. DOI: http://dx.doi.org/10.3126/joim.v32i3.4954 Journal of Institute of Medicine, December, 2010; 32:3 14-17
Taste disturbances following middle ear surgery
Authors: Gurung U , Bhattarai H , Shrivastav RP
Published: June 2020

Introduction: Iatrogenic chorda tympani nerve (CTN) injury during middle ear surgery is quite common. The objective of ours study is to observe frequency & types of CTN injury during middle ear surgery and assess types of post-operative taste disturbances and their functional recovery. Methods: Patients who underwent middle ear surgery from 1st October 2005 to 1st January 2007 in Tribhuvan University Teaching Hospital were divided into 6 groups according to intraoperative CTN manipulation as; seen but not handled, handled but not stretched, stretched but intact, cut while stretching, cut while using burr and clean cut with scissors. Subjective assessment of taste disturbance was done after 2 days & 2, 4 & 6 months post-operatively and categorized as altered taste sensation/metallic taste, tongue numbness and dry mouth. Results: Amongst 260 patients, CTN was seen but not handled in 52/260 (20%), handled but not stretched in 54/260 (20.75%), stretched but intact in 66/260 (25.38%), cut while stretching in 17/260 (6.5%), cut while using burr in 29/260 (11.15%) and clean cut with scissors in 42/260 (16.15%) patients. Eleven out of 260 patients (4.2%) symptomatic amongst which 6/11 (54.5%) had altered taste sensation, 4/11 (36.3%) had tongue numbness and 1/11 (9%) had dry mouth. Complete recovery occurred in 9/ 11 (81.8%) patients by 6 months. Conclusion Though iatrogenic CTN injury was common during middle ear surgery, frequency of taste disturbance was comparatively less, commonest type of CTN injury being stretched but intact. The most common post-operative taste disturbance was altered taste sensation/metallic taste. Most patients recovered completely by 6 months. Functional recovery was earlier when CTN was preserved than when sectioned. Keywords: CTN; middle ear surgery; taste disturbance DOI: http://dx.doi.org/10.3126/joim.v32i3.4955 Journal of Institute of Medicine, December, 2010; 32:3 18-23
Studies on anti-hypercholesterolemic activity of Indanyl tetrazoles
Authors: Adak M
Published: June 2020

Introduction: Clinically useful non-steroidal antihyperlipidemic drugs are now in the market for the treatment of patients suffering from hypercholesterolemia. Indan acids, which belong to non-steroidal aryl alkanoic acids class acids have been reported to possess varying degrees of cholesterol lowering activity. Keeping the above points in view exploration for better anti-hypercholesterolemic activity of indanyl tetrazole derivatives was undertaken. Methods: Five-week-old male albino Charles Foster rats (120± 10 g) for normocholesterolemic and seven-week-old rats (130±10g) for hypercholesterolemic studies were used. On the 0-day and 14th day, tail vein blood was drawn from the overnight fasted animals respectively. Biochemical measurements were carried out using biochemical kits (Span, India) and an automated biochemical analyzer (Vitros-250, Johnson and Johnson Co. USA). Results: The compound - V and VI exhibited almost same significant level of cholesterol lowering (p<0.01) activity. On closer look its reveal that the compound-VI exhibit triglyceride lowering (p<0.01) activity among the groups around 14 days of treatment on normocholesterolemic rats. Test compound- V (p<0.05) and compound-VI (p<0.001) have significant anti-hyper-cholesterolemic activity while clofibrate has no such activity on hypercholesterolemic rats. Conclusions: Indanyl tetrazole derivatives, 5-(62 -methoxyindan-12 -yl) methyltetrazole (V) and 5- (52 , 62 -dimethoxyindan-12 -yl) methyltetrazole (VI) were more promising than their analogs in respect to their anti-hypercholesterolemic activity. DOI: http://dx.doi.org/10.3126/joim.v32i3.4956 Journal of Institute of Medicine, December, 2010; 32:3 24-29
Non-alcoholic fatty liver disease (NAFLD) and immune response
Authors: Adhikari Khem Bahadur , Tirosh Oren
Published: June 2020

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease that affects a high proportion of world.s population. This review aims to update latest advances in epidemiology, clinical aspects, pathogenesis, mechanism, immune responses and therapies of NAFLD. Methods: This paper was prepared with reviews of published articles and books. Results: NAFLD, the commonest liver disorder in the world, is closely associated with metabolic syndrome, particularly obesity and insulin resistance. Sedentary lifestyle and poor dietary choices are leading to obesity, subsequently increasing risk for developing metabolic syndrome and NAFLD. NAFLD is characterized with increased lipogenesis, defective mitochondrial and peroxisomal boxidation and/or disability to lipid export from the liver. It can progress to cirrhosis, hepatocellular carcinoma, and liver failure. The development and progression of NAFLD are also affected by diet and genetic factors. Poor immune system cannot overcome proinflammatory cytokines and reactive oxygen species (ROS) which cause oxidative liver injury. Up regulation of perioxisome proliferator activated receptor (PPAR) and disruption of sterol regulatory element binding protein (SREBP) are important targets for pharmacological intervention accompanied with lifestyle modifications. Conclusions: People with obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome are likely to suffer from NAFLD. Keywords: Cytokine; inflammation; NAFLD; obesity DOI: http://dx.doi.org/10.3126/joim.v32i3.4960 Journal of Institute of Medicine, December, 2010; 32:3 43-53
Responding to the need of the Society: Nepal Ambulance Service
Authors: Gongal R , Vaidya P
Published: June 2020

DOI: http://dx.doi.org/10.3126/joim.v34i1.9114 Journal of Institute of Medicine, April, 2012; 34:1 1
Cost of treating Insulin-requiring diabetes in children and adolescents
Authors: Onyiriuka N , Ezomo OO , Onyiriuka RC
Published: June 2020

Background: Childhood diabetes care imposes a heavy economic burden on the patient’s family and all those involved in the provision of this care need to be aware of what factors drive cost. Methods: Using an interviewer-administered questionnaire data was obtained from eleven respondents (parents of diabetic children) on their expenditure on items of direct cost such insulin, syringes, cotton wool, methylated spirit, transportation, consultation, and glucometer with the test strips. Data was also obtained on income of the household, ability to cope with payment for medical care and sources of money used for such payment. Results: The estimated mean monthly direct cost of routine diabetes care was ten thousand nine hundred and fifty Naira [(N10,950+4,698); 95% Confidence Interval, CI = 8,674-13,726] with purchase of insulin accounting for 51.1% of this cost. Money spent on purchase of insulin alone represented 43.7% of the average monthly household income. Eighty percent of the parents expressed varying degrees of difficulty coping with payment of direct cost of diabetes care. Conclusion: Insulin-requiring diabetes imposes a heavy economic burden on the family of the patient with cost of purchase of insulin contributing the highest proportion among items of direct cost. DOI: http://dx.doi.org/10.3126/joim.v34i1.9115 Journal of Institute of Medicine, April, 2012; 34:1 2-8
Prevalence and Antibiotic Sensitivity Pattern of Methicillin- Resistant- Staphylococcus aureus in Kathmandu Medical College -Teaching Hospital
Authors: Pandey S , Raza MS , Bhatta CP
Published: June 2020

Introduction: Staphylococcus aureus is found to be a major source of community as well as hospital acquired infection. Staphylococcal isolates from tertiary care hospital are found to be resistant to commonly used antimicrobial agents. Methicillin resistant S. aureus (MRSA) with intrinsically developed antimicrobial resistance has been associated with an increase in morbidity and mortality of the patients in the hospital. This study was undertaken to know the antibiotic sensitivity pattern of staphylococcal isolates with special reference to Methicillin resistant S. aureus. Methods: Clinical specimens received from July 2009 to July 2010 in Kathmandu Medical college-Teaching Hospital were processed and all S. aureus isolates were included in the study. The isolates were identified by standard laboratory procedure. The antibiotic susceptibility pattern of all staphylococcal strain was determined by modified Kirby Bauer antibiotic sensitivity method. Results: Of 111 S .aureus isolates 29(26.12%) were identified to be MRSA. The rate of multi drug resistance was 75.86% for MRSA and 6.09% for MSSA. All the staphylococcal isolates were resistant to penicillin. However, all strains were sensitive to vancomycin. Conclusions: This study showed a high prevalence of MRSA in tertiary care hospital of Kathmandu valley. Regular surveillance of hospital-associated infection and monitoring of antibiotic sensitivity pattern is mandatory to reduce MRSA prevalence in hospital and its spread to community as well. Present study conclusively shows that vancomycin remains the first choice of treatment for MRSA infection. To preserve its value, use of vancomycin should be limited to those cases where there are clearly needed. DOI: http://dx.doi.org/10.3126/joim.v34i1.9117 Journal of Institute of Medicine, April, 2012; 34:1 13-17
Midazolam as an induction agent in comparison with propofol as a safe and effective alternative
Authors: Singh J
Published: June 2020

Introduction: Propofol produce rapid and smooth induction of anesthesia, with rapid metabolism, which would allow it to be used for the maintenance of anesthesia and free from the risk of anaphylactic reactions. Midazolam a new short acting water soluble Benzodiazepine with cardio vascular effects similar to that of diazepam may be an effective alternative for induction of anesthesia. Methods: In this randomized study, all together 48 patients undergoing various surgical procedures belonging to Orthopedic, General Surgery and Gynecological Surgeries constituted the study group. Group-I (Midazolam Group) received intra-venous Midazolam 0.15mg/Kg for induction of anesthesia and Group-II (Propofol Group) received 2mg/kg intravenous Propofol for Induction of Anesthesia. Induction time, Heart Rate, Non invasive blood Pressure is recorded at 1minute interval for 5 minutes and after that at an interval for 5 minutes for another 30 minutes. Demographic data was analyzed by Student’s t-test. Results: The study showed no statistical significance in hemodynamic responses with either Midazolam or Propofol as an induction agent for General Anesthesia but there was statistically difference with respect to heart rate (P=0.001). Conclusion: Midazolam was proven effective compared to Propofol as an induction Agent. DOI: http://dx.doi.org/10.3126/joim.v34i1.9119 Journal of Institute of Medicine, April, 2012; 34:1 25-32
Hypertension, as an iceberg disease in the high hilly areas of Nepal
Authors: Lamsal KS , Kafle MP
Published: June 2020

Introduction: Hypertension simply is usual blood pressure of 140/90 mm Hg or higher in otherwise normal individuals and even lower for certain high-risk patients. Its a common medical condition worldwide. It is the most important, commonest and correctible cardiovascular risk factor and one of the leading causes of death. M any factors like dietary, behavioral, psychological, environmental, genetic etc have direct or indirect influence on hypertension. In this study we have analyzed the prevalence and different stages of hypertension in a remote and high hilly area of Nepal. Methods:  The study was conducted in high hilly area adjoined to Solukhumbu and Dolakha districts. Altogether 600 participants were enrolled in the study. Participants having age more 18 years, regardless of symptoms, willing to give consent were involved. Demograghic data and blood pressure was recorded twice. The 1st reading was taken by trained nursing staff using standard Riva Rocci Sphygnomanometer after five minutes rest. The 2nd reading was taken by Physician and mean was calculated from both readings. Results: A mong 600 patients involved in the study, the mean age was 48 years. A mong them, 92 patients were having prehypertension including 53 male and 39 female. The stage I hypertension was found in 130 cases, out of them 77 were male and 53 were female. Whereas stage II hypertension was found in 84 cases, including 40 males and 44 females. Prehypertension was commonest among 40-49 years of age, stage I and stage II hypertension was commonest among 50-59 years. Systolic hypertension was more common in younger and elderly participants whereas diastolic hypertension was more common in middle age adults. Conclusion: In the study, the incidence of hypertension increases whose age was found between 50-59 with age till 50-59 years age group. Systolic hypertension was more common than diastolic hypertension in less than 30 years age group where as between 30-59 years diastolic blood pressure was more commonly found than systolic blood pressure. In the elderly of more than 60 years, again systolic hypertension is more predominant than diastolic hypertension.DOI: http://dx.doi.org/10.3126/joim.v34i3.8906 Journal of Institute of Medicine, December, 2012; 34:4-7
Diagnostic efficacy of ultrasonography in acute appendicitis
Authors: Lohani B , Gurung G , Paudel S , Kayastha P
Published: June 2020

Introduction: Acute appendicitis is the most common acute condition of the abdomen requiring surgery in both adults 1,2 and children. 3.5 The overall frequency of appendicitis for symptomatic patients younger than 20 years is 41%; the frequency for those older than 20 years is 59%. Methods:  This was a prospective cross sectional study involving 104 patients aged between 8 and 68 years with clinical suspicion of acute appendicitis. Patients with suspected acute appendicitis were evaluated with high frequency linear transducer using graded compression technique. Peroperative findings were noted and histopathological examination were carried out in all the cases for confirmation of acute appendicitis. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of ultrasonography were calculated by using statistical method. Results: Among 104 patients (61 males and 43 females) with clinical diagnosis of acute appendicitis, ultrasonography was positive for acute appendicitis in 79 patients (75.96%). On histopathological examination, 94 appendices (90.38%) were acutely inflamed. The sensitivity of ultrasonography for the diagnosis of acute appendicitis was 78.72% with specificity of 60%. Positive predictive value, negative predictive value and accuracy of ultrasonography were 94.87%, 23.07% and 76.92% respectively. Conclusion: Ultrasonography is a useful method of diagnosing clinically suspected acute appendicitis especially in doubtful cases. DOI: http://dx.doi.org/10.3126/joim.v34i3.8908   Journal of Institute of Medicine, December, 2012; 34:8-11
Neurovascular injury in supracondylar fracture of Humerus
Authors: Shrestha KR , Sapkota R , Rajbhandari N , Thapa B , Shrestha UK
Published: June 2020

Introduction: Supracondylar fractures of the humerus are the commonest upper limb fractures in children, accounting for up to 70% of all pediatric elbow fractures. Supracondylar fractures of the humerus can be managed in outpatient setting but are often complicated by neurovascular injury. Methods: Retrospective study including 187 patients who had presented with supracondylar fracture of humerus with 47 neurovascular injuries during the period of July 2007 to June 2011. Out of 142 patients with Gartland type III fracture 107 underwent immediate open reduction, exploration and internal fixation. Results: Vascular injury is commonly associated with type II supracondylar fracture with posterior displacement. Twenty two patients had vascular injury and all of them had satisfactory outcome after surgery. Conclusion: A careful clinical evaluation, urgent surgical treatment and adequate fracture reduction can prevent lifelong handicap. DOI: http://dx.doi.org/10.3126/joim.v34i3.8909 Journal of Institute of Medicine, December, 2012; 34:12-16
Rapid assessment of expansion of nursing, paramedical and public health education and it?s implication on quality of education
Authors: Talukder Md HK , Nazneen R , Hossain Md Z , Akther N , Chowdury IJ , Parvin IA
Published: June 2020

Introduction: Bangladesh is facing many challenges in health care that are similar to other developing countries. In Bangladesh standard of paramedical, nursing, pharmacy and public health education are expanding rapidly which needs to call for assessment and evaluation to be up to date in the respective fields. Study aims to assess the expansion of Nursing, Paramedical & Public health Education in Govt. & non Govt. sectors & its implication on quality of education. Methods: This was a descriptive type of cross sectional explorative study, conducted among the teachers and student of different institutes. Questionnaire was developed and a FGD was done. Then the data was analyzed. Results: At present situation, the numbers of non govt. organizations are more than govt. organizations (127 vs. 85). SWOT analyses showed the overall strength of the institutions were the scope for further improvements and the political commitments for expansion. Weaknesses lie in the lack of adequate infrastructure, suboptimal technical and laboratory facilities and teaching staffs. Opportunities were, increasing demand and provision of jobs at home and abroad. Possible threats were loss of quality services, recognition and registration of the institutes. Regarding the overall organization of the courses, 43% of the students voted as good and 100% of the teachers showed positive opinion. Regarding the teaching-learning procedure, 41% of the teachers strongly agreed about the perfect selection of the students. 48.3% teachers agreed about the adequacy of the number of teachers. 47.8% students also agreed with the competency of the teachers. Nearly one third teachers as well as students agreed about the good physical environment of the institute. About 35% and 36% of the teachers and the students respectively agreed about the transparency of the assessment systems. Conclusions: Present Bangladesh Govt. has implemented various initiatives regarding health sector reform. Proper funding, management, monitoring and evaluation can improve present situation and thus help in the development of better institutional output. DOI: http://dx.doi.org/10.3126/joim.v34i3.8912   Journal of Institute of Medicine, December, 2012; 34:21-27
Management of posterior cruciate ligament avulsion by cannulated screw fixation
Authors: Lamichhane A , Mahara DP
Published: June 2020

Introduction: Posterior cruciate ligament (PCL) is the main posterior stabilizer of the knee. The PCL also plays a role as a central axis controlling and imparting rotational stability to the knee. The most effective management of posterior cruciate ligament (PCL) injuries remains unclear and the natural history of untreated PCL injuries is controversial. The need for surgical repair of displaced bony PCL avulsions is less controversial. Here we present repair of PCL avulsion by screw fixation. Methods: There were total of 18 patients (Male 12 and Female 6) operated for isolated PCL avulsion from tibia during the period from 2002 to 2010. Preoperative evaluation was done clinically and radiologically .MRI was advised for suspected other ligaments and meniscal injuries. Patients with other ligaments and meniscal injury were not included in this series. All cases operated by simplified approach described by Burks and Schaffer. Avulsed fragment was reduced and xed with 4 mm a cannulated screw. Evaluation of the patients were done clinically, radilologically and using functional scale of Tegner-Lysholm. Results: Out of 18 patients, 12 patients were male and 6 patients were female. Average age of the patients was 29yrs (range 18-47 yrs). Average period of follow up was 31 months (ranging 12 - 52 m). Range of movement was found full in all patients at the last follow up. Grade 1-2 laxity was found in 8 patients but subjectively they were not aware of the laxity. Average Lysholm score was 91 (range 87-97). Conclusion: Improvised approach by Burk and Schaffer is safer and easier than the classical one. Open reduction and fixation with cannulated screw is one of the excellent techniques for tibial avulsion of posterior cruciate ligament. DOI: http://dx.doi.org/10.3126/joim.v34i3.8914 Journal of Institute of Medicine, December, 2012; 34:28-31
Incidence of Bacteremia and Septicemia in patients attending in tertiary care center, Nepal
Authors: Chaudhary R , Karmacharya S , Shrestha S , Dahal RK , Mishra SK , Banjade NR , Kattel HP , Rijal BP , Sherchand JB , Pokhrel BM
Published: June 2020

Introduction: Bacteremia and septicemia is life threatening condition resulting in major cause of mortality and morbidity.The aim of study was to determine the etiology of bacteremia and septicemia with antibiotic sensitivity profile of those organisms. Methods: A prospective study was carried out among the suspected cases from both inpatient and outpatient of TUTH from October 2009 .March 2010. Blood samples were collected and processed according to standard methodology. Results: Out of 2259 samples only 237 (10.49 %) showed bacterial growth. The most common isolates among Salmonella group was Salmonella enterica serotype typhi 71(29.95%) followed by Salmonella enterica serotype Paratyphi A 45(18.98%). Among non Salmonella group Pseudomonas aeruginosa 34(14.34%), Klebsiella pneumoniae 22(9.28%), Acinetobacter spp 15 (6.32%), Citrobacter spp 5(2.10%), Escherichia coli 3(1.26%) while Staphylococcus aureus 34 (14.3%) was most common followed by Enterococcus spp 3(1.26%), Streptococcus spp 2(0.84%), Coagulase Negative Staphylococcus 2(0.84%) and Listeria spp 1(0.42%) among Gram Positive organisms. Antibiogram revealed Cefotaxime, Ceftazidime, Azithromycin and Chloramphenicol for Salmonella group while for non Salmonella Imipenem, Meropenem and Amikacin as most effective antibiotics while Clindamycin, Cipro!oxacin and O!oxacin for gram positive. Conclusion: Gram negative bacteria was the predominant organism causing bacteremia and septicemia. Among them salmonella typhi and salmonella paratyphi were the leading aetiology. DOI: http://dx.doi.org/10.3126/joim.v34i3.8915   Journal of Institute of Medicine, December, 2012; 34:32-38
Papillary carcinoma of thyroid and pregnancy
Authors: Rawal S , Gurung G
Published: June 2020

Two cases of Papillary carcinoma of thyroid and pregnancy were managed, one with the existing disease diagnosed during pregnancy and the other with a history of near total thyroidectomy. A multidisciplinary approach in the management of both the mothers lead to an uneventful pregnancy, caesarean section with good outcome and were discharged in good health. DOI: http://dx.doi.org/10.3126/joim.v34i3.8919   Journal of Institute of Medicine, December, 2012; 34:54-57
Giant cell tumor of patella
Authors: Paudel S , Kayastha P , Pokhrel P , Shah A , Ghimire RK , Ansari MA
Published: June 2020

Giant cell tumor of bone also known as osteoclastoma is a distinct clinical, roentgenographic and pathologic entity with specific characteristics. It is a benign but locally aggressive neoplasm of the epiphyseal or metaphyseal-epiphyseal region of long tubular bones extending to the articular surface. It usually occurs after skeletal maturation and is one of the rare bone tumors that more frequently affects women. We report here a case of giant cell tumor originating from the right patella diagnosed on ne needle aspiration cytology. DOI: http://dx.doi.org/10.3126/joim.v34i3.8920   Journal of Institute of Medicine, December, 2012; 34:58-60
Microalbuminuria as a Marker of Preclinical Diastolic Dysfunction in Newly Diagnosed and Never-Treated Essential Hypertension
Authors: Gajurel RM , Sayami A
Published: June 2020

Introduction: Hypertension (HTN) is a global public health problem with one fourth adults worldwide estimated to have high blood pressure (BP)1 The incidence of hypertension continues to increase in all developed and developing societies as the population grows older and more obese. The Framingham Study and other epidemiological surgeys have clearly defined HTN as an important cause of morbidity and mortality. The aim of this study was to determine the spot urine Microalbuminuria as a marker of preclinical cardiac structural and functional changes in the form of left ventricular diastolic dysfunction in newly diagnosed and never treated essential hypertensive subjects. Methods: A cross sectional study was used for those patients who were attended outpatient clinic of MCVTC with diagnosis of newly diagnosed and never treated hypertension over a period of October 2011 to November 2012. Results: A total of 130 essential hypertensive patients underwent for spot urine for microalbuminuria estimation and Echocardiography for evaluation of left ventricular diastolic function. Among 56 (43.1%) urine samples showed negative test [(Microalbuminuria -); ( UACR 30 mg/Gm)] and those 74 (56.9%) samples revealed positive test [(Microalbuminuria+); (UACR 30 to 300 mg/Gm)]. Patients with microalbuminuria positive was found to have more left ventricular diastolic dysfunction than those who were negative for Microalbuminuria. Conclusion: Microalbuminuria was found to have early preclinical marker of myocardial dysfunction in the form of left ventricular diastolic dysfunction in new and never treated essential hypertension. DOI: http://dx.doi.org/10.2126/joim.v35i1.8890  Journal of Institute of Medicine, April, 2013; 35:3-8
Prognostic factors in endometrial cancer
Authors: Bajracharya SR , Juan FY
Published: June 2020

Introduction: Endometrial cancer (EC) is the most common malignancy of the female genital tract. It is now the fourth most common gynecological cancer among women and the sixth worldwide cancer in Western countries. It is the most curable of the 10 most common cancers in women and the most frequent and curable of the gynecologic cancers. The incidence is increasing when life expectancy rise. This study was carried out to evaluate the prognostic factors of Endometrial Cancer. Methods: Clinico-pathological characteristics and follow-up cases of endometrial cancer were analysed retrospectively between January 2000 to December 2007 with its prognostic factors influence were statistically analysed. Results: During the study period total 180 patients were taken. Univariate model revealed that the menopausal status, the FIGO stage, grade, histological type, myometrial invasion, ER, PR, peritoneal cytology, lymph node metastases, adjuvant therapy, and the method of operation were related with the prognosis significantly. The multivariate analysis Cox proportion hazards regression model showed that the ER (P=0.004), PR (P=0.000), myometrial invasion (P=0.006) and lymph node metastases (P=0.049) were related with the prognosis significantly. Conclusion: The clinico-pathological character of endometrial cancer is responsible for patient’s better survival. If the patients had early detection and treated in proper modalities, this might improve the good prognosis. DOI: http://dx.doi.org/10.2126/joim.v35i1.8891    Journal of Institute of Medicine, April, 2013; 35:9-17
Bronchiectasis in a positive HIV child: a case report
Authors: Shrestha L , Basnet S , Kanskar P
Published: June 2020

DOI: http://dx.doi.org/10.2126/joim.v35i1.8903   Journal of Institute of Medicine, April, 2013; 35:74-77
Bagaimana Psychological well being Pada Remaja ? Sebuah Analisis Berkaitan Dengan Faktor Meaning In Life
Authors: Hardjo Suryani , Aisyah Siti , Mayasari Sri Intan
Published: June 2020

Psychological well being merupakan unsur penting yang perlu ditumbuhkan pada individu agar dapat menguatkan keterikatan secara penuh dalam menghadapi tanggung jawab dan mencapai potensinya. Konsep Psychological well being telah dimulai sejak tahun 2006 pada International School Psychology Association (ISPA), dengan membentuk kerangka konseptual untuk Mempromosikan Kesejahteraan Psikologis secara global dimulai dengan pertemuan psikolog sekolah/pendidikan pada 12 negara, salah satu program ini adalah memandang penting kesejahteraan psikologis anak/remaja untuk meningkatkan potensi yang dimiliki individu secara bervariasi dalam budaya dan bahasa pada pandangan dunia yang lebih luas. Ketercapaian Psychological well being ditandai dengan berfungsinya aspek-aspek psikologis positif dalam prosesnya mencapai aktualisasi diri. Psychological well being akan dicapai individu apabila dia mampu mencapai atau mewujudkan kebahagiaan disertai pemaknaan hidup. Makna dalam hidup mengacu pada gagasan bahwa individu itu sangat termotivasi untuk menemukan makna dalam hidup mereka, yaitu untuk dapat memahami sifat keberadaan pribadi mereka, dan pentingnya rasa/suasana dan terarah/penuh arti. Filsafat makna dalam hidup didasarkan pada asumsi bahwa hidup memiliki makna tanpa syarat yang tidak bisa lenyap dalam keadaan apa pun. Makna hidup memainkan peran utama dalam menjaga kesehatan mental yang positif dan pencapaian Psychological well being.
Pengaruh Kepemimpinan Transformasional dan Iklim Organisasi terhadap Perilaku Knowledge Sharing di PT T
Authors: Sarah Cut
Published: June 2020

Penelitian ini bertujuan untuk mengetahui pengaruh kepemimpinan dan iklim organisasi terhadap perilaku knowledge sharing. Berdasarkan hasil uji regresi berganda pada 92 karyawan dengan menggunakan Multifactor Leadership Questionnaire (Form 5x-Short), Organizational Climate Instrument, dan Knowledge Sharing Behavior Questionnaire menunjukkan adanya pengaruh yang signifikan dari kepemimpinan dan iklim organisasi terhadap knowledge sharing. Hasil uji regresi berganda menunjukkan nilai R Squared dengan koefisien determinasi sebesar 0,261 = 26,1% yang berarti pengaruh kepemimpinan dan iklim organisasi terhadap knowledge sharing adalah sebesar 26,1% dan sisanya dipengaruhi oleh variabel lainnya. Jika dilihat lebih rinci menunjukkan bahwa variabel yang paling signifikan sumbangannya (nilai β) terhadap variabel knowledge sharing adalah iklim organisasi, diikuti oleh laissez faire, kepemimpinan tansformasional dan terkecil kepemimpinan transaksional. Hal ini menunjukkan penting untuk memperhatikan iklim organisasi untuk menunjang perilaku knowledge sharing di organisasi. Di samping itu hasil kepemimpinan transformasional menunjukkan koefisien negatif pada variabel laissez faire yang mengindikasikan pemimpin dan manajemen yang pasif terhadap bawahannya akan menurunkan tingkat knowledge sharing dalam organisasi.
Pelatihan Universal Design for Learning untuk Meningkatkan Efikasi Diri Guru Sekolah Menengah Pertama Islam Terpadu dalam Mengajar
Authors: Dalimunthe Hairul Anwar , Dewi Salamiah Sari , Faadhil Faadhil
Published: June 2020

Efikasi diri guru merupakan salah satu aspek yang penting untuk dimiliki oleh setiap guru. Semakin tinggi efikasi diri guru dalam mengajar maka akan memberikan efek yang positif terhadap diri guru, kualitas mengajar guru, dan prestasi akademik siswa. Pengabdian kepada masyarakat ini bertujuan untuk meningkatkan efikasi diri guru sekolah menengah pertama islam terpadu (SMPIT) melalui pemberian pelatihan Uiversal Design for Learning (UDL). Untuk mengukur efektivitas pelatihan tersebut digunakan metode kuasi eksperimen dengan pendekatan one-group pretest-posttest design. Partisipan dalam pelatihan ini sebanyak 11 orang guru SMPIT, pengukuran efikasi diri guru dilakukan dengan menggunakan Ohio State Teacher Efficacy Scale (OSTES), dan data hasil pengukuran dianalisis menggunakan Wilcoxon signed rank test.  Berdasarkan hasil pengukuran dan evaluasi dapat disimpulkan bahwa pelatihan UDL dapat meningkatkan efikasi diri guru SMPIT dalam mengajar (p = 0,008, p < 0,01), pelatihan UDL bermanfaat bagi pekerjaan para guru di SMPIT, pelatihan UDL dapat diterapkan dalam kegiatan belajar mengajar di SMPIT, dan pelatihan UDL dapat membantu para guru SMPIT untuk bekerja lebih baik.
Analysis of Factors Affecting Effective Tax Rates of Companies Listed on the Indonesia Stock Exchange 2009-2018
Authors: Dailimi Lili Fajri , Setyowati Milla Sepliana
Published: June 2020

Stock Exchange This study aims to determine whether company size, profitability, leverage, the proportion of independent commissioners and government ownership have an influence on the company's effective tax rates both jointly and partially. This was tested on companies listed on the Indonesia Stock Exchange by means of statistical testing through a panel data regression model that was processed using the STATA 12.0 application. Secondary data used in this research were collected using content analysis techniques. The research sample was determined by a purposive sampling technique on companies in the sectoral index consisting of 10 sectors listed on the Indonesia Stock Exchange with the study period 2009-2018. The independent variables used in this study are company size, profitability, leverage, the proportion of independent commissioners and government ownership, while the dependent variable is the company's effective tax rate. The results showed that the size of the company, the level of profitability of return on assets and corporate governance that are proxied by the proportion of independent directors have a significant effect on effective tax rates, although with different correlations. Where firm size is negatively correlated, while the level of profitability and corporate governance has a positive effect on effective tax rates. Meanwhile, leverage and government ownership variables tend not to have a significant effect on effective tax rates.
Policy Implementation of Solid Waste Management by The Environmental Office of Bekasi Regency
Authors: Rahman Arif , Myrna Rita , Karlina Nina
Published: June 2020

Policy implementation of solid waste management is a part of public policy to implement in order to create a safe, sound environment and public space for the people. Bekasi Regency government contributes to solid waste management in their region that they assign the Environmental Office to hold the main role in implementing the policy. Thus, this study sought to profoundly describe the policy implementation of solid waste management by the Environmental Office of Bekasi Regency. This study used qualitative approach with “single instrumental case study” strategy by selecting a relevant case and focusing on the given phenomena and problems. The results show that policy implementation of solid waste management by the Environmental Office of Bekasi Regency has not been optimized due to the limited capacity of the Office in providing resources and budgets, creating new innovations, and influencing people’s mindset. However, it can be said that Environmental Office has been good enough in making policies and efforts for solid waste management since they have been sinergyzed with those of the above level.
Political Reform in the General Election
Authors: Yusriadi Yusriadi , Anwar Armin , Enni Enni
Published: June 2020

A country can be called upholding the values of democracy if, in that country, there is a guarantee in freedom of thought and opinion. And, of all of that, one of them was realized by the existence of elections. As a country that adheres to the principle of democracy, it is important for Indonesians to have a process for selecting people to fill certain political positions. 2019 Election becomes a new chapter for Indonesia in holding general elections, more than 187 million voters both domestically and abroad for the first time will elect simultaneously legislative and vice-presidential candidates. This study illustrates political reform in elections in Indonesia, In the 2019 Election, the competition of political parties to qualify for the House of Representatives was increasingly difficult. The parliamentary threshold that must be achieved by political parties to place their cadres in the House of Representatives rose to 4 percent in the 2019 Election. That number rose 0.5 percent compared to the 2014 legislative elections of 3.5 percent.
The Role of Semiotic in Translating Symbols for Biblical Texts
Authors: Erfiani Ni Made Diana , Sukarsih Ni Nyoman Tri , Susanto Putu Chris
Published: June 2020

Semiotics, which is the science of signs, has become an increasingly interesting interdisciplinary area of study. As such, semiotics can also be used as both structural and pragmatic approach for translation studies, especially for studies in which meanings are difficult to comprehend including symbolic texts. This paper aims to uncover the role of semiotics in the translation of symbolic languages, especially religious texts. The study employs descriptive qualitative method to describe and interpret the data in the form of an analysis of symbolic text translation. This is to uncover the various attitudes and perspectives about the roles of semiotic science in the translation of religious texts. The findings of this study indicate that the semiotic perspective is able to reveal the dimensions of referential or conceptual meaning of the symbols through the appearance of a supplementary component, which connects literal and figurative meanings conventionally. This effort is carried out through the use of structural semiotic analysis tools, namely by exploring the relationships between symbolic meanings, both syntagmatically and paradigmatically.