bluuebunny/crossref_metadata_2025 huggingface dataset:
Prescription writing skills of preclinical medical and dental students in a medical college
Authors: Shrestha D , Thapa R , Gurung RS , Tuladhar LR , Shrestha L
Published: July 2024

Introduction: Prescription is a clinician’s written order to dispense drugs. Prescription writing is one of the basic competencies to be learned by medical and dental students, who are more prone to make prescription errors during the early stages of their training.
Methods: It was a cross sectional study conducted in NMCTH, Jorpati, Kathmandu. Medical and dental students in the first and second year were included in the study. Students were given common clinical conditions to write prescriptions. Prescriptions were analyzed for physician and drug related components.
Results: The total number of medical and dental students that participated in this study was 326. The percentage of different physician related components in the prescriptions of first year medical students ranged from 61.4 to 100%, from 74.1 to 100% in second year medical students, from 55 to 100% in first year dental students and from 66.7 to 100% in second year dental students. The percentage of different drug related components of prescriptions was from 73.7% to 90% in first year medical students, from 79.3 to 94.8% in second year medical students, from 57.5 to 80% in first year dental students and from 74.1 to 92.6% in second year dental students.
Conclusion: Prescription writing skills of preclinical medical and dental students are lacking in its various components. Evaluation of their prescription writing skill should be done frequently to find out the deficiencies which must be corrected by better training to reduce prescription errors and to increase adherence to improve rational prescribing.
Atrial septal defect closure with axillary mini thoracotomy and total peripheral cannulation: a novel approach
Authors: Bhattarai A , Pradhan B
Published: July 2024

Ostium secundum atrial septal defect (ASD II) is one of the most common congenital heart defects (CHDs), occurring in 5% to 10% of children (1) and in 30% of adult patients with CHD (2,3). Surgical closure has been considered for many years the gold standard treatment for patients with an ASD II. Operative mortality is low (0% to 3%) (4–6) and long-term survival is high (25-year survival of 92%) (7). Here, we describe our initial experience with minimally invasive approach using total peripheral cannulation (TPC) and an axillary minithoracotomy (AMT) 4-5 cm long incision for surgical closure of an ASD. In our knowledge ASD closure with axillary mini-thoiracotomy is for the first time in the country.
Depression and its association with glycemic control in Nepalese adults with diabetes mellitus
Authors: Pant SB , Ojha SP , Chapagain M , Tulachan P , Dhungana S
Published: July 2024

Introduction: Depression is reported more common among people with diabetes mellitus which if not addressed, may lead to poor diabetes outcomes. The purpose of the study was to explore depression among people with diabetes mellitus attending endocrinology outpatient department of Tribhuvan University Teaching Hospital and to find its association with glycemic control.
Methods: Patients with diabetes mellitus (n=158) attending endocrinology OPD of Tribhuvan University Teaching Hospital were chosen by simple random sampling technique. A self- designed semi structured proforma was devised to obtain the socio- demographic characteristics of the study population. 'General health questionnaire -12' was applied and those with a score of three or more considered as achieving 'psychiatric caseness and among them depression was diagnosed with ICD-10 DCR criteria and HAM-D scale was used to verify it objectively.
Results: Among the patients, 122(77.2%) belonged to type 2 diabetes and 36 (22.8%) belonged to type 1 diabetes. Estimate of depression was found to be 29.11% (n=46) which was almost similar in both types of diabetes. The duration of diabetes were less than 5 years in 38% of patients. Level of depression showed significant associationand a positive correlation with glycemic control.
Conclusion: This study concluded that depression is common in both type 1 and type 2 diabetes patients and calls the need for screening of depression for comprehensive diabetes management.
Retinoblastoma at a tertiary level eye centre, Nepal
Authors: Shrestha JB , Shrestha GB , Joshi SN
Published: July 2024

Introduction: Retinoblastoma is the most common intraocular malignant tumor in children occurring in approximately 1 in 18,000 live births. With early detection and management, lives of many children can be saved, eyes can be preserved and vision can be restored. The study was aimed at finding out the clinical features, methods of management and outcome of the disease in a tertiary eye care centre of institute of medicine in Nepal.
Methods: A prospective case series study was done between 2014 -2017 at BP Koirala Lions Centre for Ophthalmic Studies, Institute of medicine, Nepal. The diagnosis of retinoblastoma was made on the basis of history and clinical examination. Additional information was obtained from radiological procedure whenever required. International classification of retinoblastoma (Shields) was used to clinically classify the retinoblastoma lesion and the management depended on the stage of the disease.
Results: A total of 36 patients with retinoblastoma fulfilled the inclusion criteria of the study, 23 males and 13 females with sex ratio: 0.57. Median age at diagnosis was 36±13.825 months. In 19.4% of cases the disease was bilateral. Leukocoria, red eye and proptosis were common signs observed in 46.5%, 33.3 % and 16.3% of case respectively. Enucleation and exenteration were the commonest modality of treatment. Six patients died during the course of treatment and during follow up period and 8 patients were lost before one year of follow up.
Conclusions: Despite the advances in the field of retinoblastoma, the prognosis still remains poor due to delay in presentation in our centre.
Prevalence of Dental Deep bite in Nepalese Adolescents of Kathmandu Valley
Authors: Yadav R , Shrestha BK , Yadav N , Basel P
Published: July 2024

Introduction: Deep bite is defined as vertical overlap of upper teeth on the labial surface of lower teeth in centric occlusion when exceeds the normal range of 1-2 mm. Deep bite can be classified into skeletal and dental deep bite. Skeletal deep bites are usually of genetic origin. Dental deep bites occur due to over-eruption of anterior teeth, infra-occlusion of molars or its combination. It may jeopardize the periodontal support, occlusion itself or TMJ.
Methods: It is a cross-sectional descriptive study. The study population included 14–18-year-old adolescents studying in high school of all three districts of Kathmandu Valley. An evaluation form was developed categorizing different levels of deep bite following WHO guidelines 1985 and accordingly data were recorded on it.
Results: Out of 935 screened students 80.4% had Normal bite and 19.6% had Deep bite.2.7%had Severe deep bite but no trauma to palatal mucosa whereas 3.8% had traumatic bite. Normal overbite in Female was 84% and male was 77.7%. Deep bite in male was 22.3% and female was 16%.
Conclusion: The prevalence of dental deep bite was found to be 1/4th of normal overbite in Nepalese adolescents of Kathmandu valley. Prevalence of severe deep bite with trauma to palatal mucosa was relatively higher than with to trauma. Females showed higher prevalence of normal overbite than males whereas males showed higher prevalence of deep bite than females.
Intestinal Parasitic Infection with Nutritional Status among Orphan Children in three cities of Nepal: Prevalence and Associated risk factors
Authors: Chaudhary RB , Bhattachan B , Thapa Magar D , Dhami RS , Karki AB , Sherchand JB
Published: July 2024

Introduction: Intestinal parasitosis and malnutrition are common health problems among children in developing countries like Nepal. The aim is to determine the prevalence of intestinal parasites along with nutritional status in orphan children and find out its risk factors.
Methods: National Institute of Tropical Medicine and Public Health Research Laboratory, Kathmandu, Nepal had approved this research. Cross sectional study was conducted from January to June, 2014. Stool samples were collected in clean wide mouthed plastic container from ≤ 15 year’s children of different orphanages in Chitwan, Kaski and Kathmandu Valley of Nepal. Sociodemographic information was collected using a structured questionnaire. Formalin-ether-sedimentation technique was done for detection of cyst and eggs of parasites. For nutritional status, anthropometric measurements were taken at the time of interview.
Results: In total of 309 orphan children (male: 167, female: 142), 20.3% (63/309) had some kinds of cysts or eggs of parasites. Altogether six different parasites were detected; in which infection rate of Entamoeba coli was highest 5.2% (16/309), followed by Giardia lamblia 3.6% (11/309), Entamoeba histolytica 3.6% (11/309), Trichuris trichiura 2.9% (9/309), Hymenolepis nana 2.3% (7/309) and Ascaris lumbricoides 1.2% (4/309). 1.6% had multiparasites. The prevalence of malnutrition was found to be 16.1% (50/309). Among those malnutrited children, infection rate of parasites in obesity and thinness children were found 31.3% (5/16), and 25.8% (8/31) respectively.
Conclusion: Intestinal parasites and malnutrition are associated each other in orphan children with its risk factor like age, sex and other behavioral activities. Prevalence of protozoa was found higher than helminthes. Obesity was predominance in malnutrition children.
Dialysis adequacy in ESRD patients on maintenance hemodialysis in a tertiary care center
Authors: Baral S , Pant V , Shah DS
Published: July 2024

Introduction: Assessment of the hemodialysis adequacy is one of the key factors for measurement of quality of life in end stage renal disease since it can predict the outcome of this disease. In this study, we aimed to evaluate hemodialysis adequacy in Institute of Medicine, Kathmandu. This would provide a good background for effective future planning by healthcare authorities.
Methods: This is a cross-section observational study done in Hemodialysis Unit, Tribhuvan university teaching hospital, Kathmandu, a tertiary level referral hospital in Nepal. Hemodialysis sessions of 50 patients on maintenance hemodialysis were evaluated after written consent Demographic data along with length of hemodialysis, reuse of hemodialyzer, hemodialysis sessions per week and hemodialyzer membrane type were recorded for each patient. Urea reduction ratio (URR) and single pool kT/v (spKt/v) were calculated to determine hemodialysis adequacy.
Results: Bicarbonate-based solutions and low-flux membranes was used in all patients. Length of each hemodialysis sessions was 240 minutes. Thirty-nine (78%) patients were male and eleven (22%) patients were female. The mean spKt/V and URR were found to be (1.15 ±40.3) and (60.35 ±9.26%) respectively. A spKt/V more than 12 and urea reduction rate more than 65% were found in 42% and 34% of the end stage renal disease patients respectively.
Conclusions: This study showed hemodialysis inadequacy in more than half of the patients. Adequacy of hemodialysis can be obtained by increasing its frequency, avoiding multiple use of dialyzer and increasing blood flow rate.
Common Health Problems and their contributing factors among elderly residing in Changu VDC
Authors: Khadka A , Darai A
Published: July 2024

Introduction: Aging is a normal biological phenomenon, and with the aging process different health issues started. The elderly population experience social isolation due to breakage of various bonds like work relationship, loss of relative and friends. The situation worsens when aged suffer with chronic diseases; lose their physical capabilities and financial insecurity. The objective of the study was to find out the common health problems and their contributing factors residing in Changu.
Methods: This is a descriptive study which was conducted among 50 resident of ward number 3 of Changu VDC. A semi-structured questionnaire related to health problems and factors affecting health problems was used to collect information from the respondents. The information was collected by interview technique. Data were analyzed and interpreted according to frequency and percent.
Results: The study showed that the majorities (66%) of the respondents were from the age group of 60-69 years and majorities (58%) were female. Among the total respondents, 56% had their spouse alive and most of the respondents had good relationship with their spouse (64%) and offsprings (69%). Few of the respondents (38%) had habit of smoking and only 12% had habit of drinking. The common health problems revealed through this study were gastritis (29%), followed by Asthma (27%), Hypertension (27%), Arthritis (13%), Diabetes Mellitus (10%), Heart disease (5%) and others. Psychological problems were found in few respondents. Depression was found only in 2% and boredom and loneliness in 10% and 5% respectively. The overall common health Problems among elderly were Asthma, Arthritis, Gastritis, Hypertension Diabetes Mellitus and Boredom as answered by the respondents.
Conclusion: The above study concludes that most of the respondents were suffered from varieties of problems associated to physical, social, psychological and economic aspect of health.
Abnormal Uterine Bleeding: Comparison of Transabdominal and Transvaginal Sonography
Authors: Solih M , Jha A , Joshi BR
Published: July 2024

Introduction: Transabdominal (TAS) and transvaginal sonography (TVS) are the preferred modalities for initial imaging evaluation of abnormal uterine bleeding (AUB). The main causes of such bleeding in perimenopausal patients are endometrial polyp, adenomyosis, leiomyoma and endometrial hyperplasia. The aim of this study was to evaluate the findings and compare TAS and TVS in perimenopausal and menopausal patients with AUB.
Method: A prospective cohort study was performed and fifty nine perimenopausal and postmenopausal patients with AUB meeting the inclusion criteria were invited to participate in this study. TAS and TVS was done, findings recorded in proforma and analyzed.
Result: Mean endometrial thickness at various uterine levels was more on TVS compared to TAS. Abnormal findings like adenomyosis and nabothian cysts were detected on TVS than TAS. On TAS 41% of patients had bulky uterus while only 2.5 % had bulky uterus on TVS. Diagnosis of intramural fibroid on TVS and TAS was comparable; however, submucosal fibroids were better visualized on TVS.
Conclusion: TVS is better to diagnose endometrial polyps, submucosal fibroids, nabothian cysts and adenomyosis while TAS is superior in cases of bulky uterus. In cases with intramural fibroids and endometrial hyperplasia, both were comparable. TAS should still be used as the initial monitoring method for gynecologic abnormalities due to its greater depth penetration and thus wider field of view and should be followed by TVS.
Can ParaSight-F be used for rapid diagnosis of Falciparum malaria in Nepal ?
Authors: Sherchand Jeevan B , Hommel Marcel
Published: July 2024

The dipstick, ParaSight-F, is a commercial dignostic test for Plasmodium falciparum,based on antigen capture. This test was used in a survey in rural endemic areas ofSouthern Nepal compared to thick blood film examination. In 101 P. falciparum thickfilm positive samples, 94 (93.1%) were positive with ParaSight-F. However, in 122 P.vivax blood film positive samples, 32 (26.2%) were also positive by ParaSight-F test andthere was 15.1% false ParaSight-F positivity where no parasites could be found bycareful examination of thick blood films. While this study confirms that ParaSight-F iseasy to perform in field conditions, the unpredictable cross-reactivity with P. vivax mayrender it difficult to use in situations where P. vivax is the predominant species.However, the possibility of an early diagnosis of Falciparum malaria and the possibilityof preventing the development of severe malaria may outweigh this disadvantage.
Preference of Objective Based Learning among Medical Students in a Teaching Hospital
Authors: Joshi BR
Published: July 2024

In objective based learning, students are presented with an objective. It is in a form of question. By answering the question, the students learn the facts in an active way. A descriptive analytical study was conducted among undergraduate medical students of Institute of Medicine from Mar-Aug of 2017. Data was collected by using self administered questionnaire. The accumulated average marks were 33% and 72% after lecture and objective based learning methods respectively. All participants thought objective based learning is different and more effective method of learning. The objective based learning is more effective method than conventional lecture method of learning.
Knowledge, Attitude and Practice regarding Diabetes among Diabetes Patients at a Tertiary Teaching Hospital in Nepal
Authors: Gupta SK , Yadav RS , Gupta RK , Shrestha S , Shakya YL , Prasad PN
Published: July 2024

Introduction: Diabetes is a chronic metabolic disease which is prevalent all over the world. Its burden has immensely increased in the last two decades. The problem in young people is equally worrisome. Its number in Nepal is estimated to reach 6,38,000 by the year 2025. Many lifestyle and environmental factors have contributed to its rapid rise. It has several microvascular and macrovascular along with systemic complications. There is lack of public awareness on diabetes in our communities. This study aims to assess knowledge, attitude and practice about diabetes among diabetic patients.
Methods: This study was conducted in Tribhuvan University Teaching Hospital General Practice OPD. All the diabetic cases attending to OPD were taken for a sample size of 120. Diabetic cases were followed and informed written consent was taken from each patient. All statistical tests were performed using 0.05 as level of significance.
Results: Among 120 study patients, 59.16% were male and 40.83% were female. Majority of cases belonged to 41-60 years. More male (40.83%) were literate than female (10%). Knowledge regarding dryness of mouth, urinary frequency, kidney failure as complication, effect of high blood pressure, blood pressure measurement, foot care and exercise was 36.67%, 19.17%, 47.5%, 73.33%, 85%, 19.17% and 43.33% respectively. Practice of diet plan was found in 56.67%. Practice of blood pressure monitoring and eye checkup at an interval of one month was 30% and 20% respectively whereas 41.67% had never had their eye checkup. Compliance to antidiabetic medicines was found in 71.66%. Knowledge on exercise among age group (P=0.032), knowledge on effects of high blood pressure among male and female (P=0.009) as well as literacy among male and female (P=<0.001) were found statistically significant.
Conclusion: This study shows that patient’s knowledge about foot care and practice of diet plan was not appreciable. Patient’s attitude and practice about diabetes was also not significant. Diabetes health knowledge need to be improved for better health promotion.
Pulmonary aspergillosis in a renal transplant recipient
Authors: Nepali R , Shah DS
Published: July 2024

Aspergilloma, one of the spectrum of pulmonary aspergillosis, is the most common and best-recognised form of pulmonary involvement by Aspergillus species. It usually develops in a pre-existing cavity in the lung secondary to tuberculosis. Here, we present a case of live non related renal transplant recipient with aspergilloma with bronchiectasis with tuberculosis who underwent left upper lobectomy with antitubercular treatment and voriconazole with complete resolution.
Comorbid psychiatric illness and its association with glycemic control among adults with diabetes mellitus: a hospital based cross sectional study in Nepal
Authors: Pant SB , Ojha SP , Chapagain M , Tulachan P , Dhungana S
Published: July 2024

Introduction: People diagnosed with diabetes are more likely than people without diabetes to have psychiatric illness, the management of which is important for the management of diabetes itself. The aim of the study was to estimate psychiatric illness among people with diabetes mellitus attending endocrinology outpatient department of Tribhuvan University Teaching Hospital.
Methods: Patients with diabetes mellitus attending endocrinology OPD of Tribhuvan University Teaching Hospital were selected by simple random sampling technique. Patients were assessed using semi structured sociodemographic data form followed by General health questionnaire -12 (GHQ-12), which was used to screen psychiatric illness. Those with a score of three or more were considered as having psychiatric caseness which designated over all psychiatric illness.
Results: Among 158 patients, 122 (77.2%) were cases of type 2 diabetes while 36 (22.8%) were type 1 diabetes and overall estimate of psychiatric illness among them was 48.7% (n = 77) Significant relationship was found between psychiatric caseness and meal plan (p = 0.007) psychiatric caseness and regular exercise (p = 0.031) psychiatric caseness and type of diabetes medication used (p < 0.001) . psychiatric caseness and diabetes medication doses missed per week (p < 0.001) psychiatric caseness and glycemic control. (p < 0.001)
Conclusion: This study showed that comorbid psychiatric illness is common in patients with diabetes which affects overall glycemic control. Hence, screening for psychiatric illness is an indispensable component of diabetes management plan
Intestinal obstruction by congenital band
Authors: Bhandari A , Bhandari R , Dahal G
Published: July 2024

Congenital bands are rare cause of intestinal obstruction. We report a case of eight year female with features of intestinal obstruction. The patient had no history of abdominal surgery, inflammation and trauma in the past while clinical examination was not diagnostic. Gastrograffin study done revealed no passage of contrast below third part of duodenum. An emergency exploratory laparotomy was subsequently performed which revealed a band compressing the small bowel 10 cm distal to the duodenojejunal flexure which was released. The bowel was examined and found to be healthy. Postoperative course was uneventful.
Prevalence of anaemia among females of the reproductive age group visiting Chisapani dispensary
Authors: Bhatia V. , Manandhar N. , Mishra B. , Bista S. , Shah M.
Published: July 2024

Anaemia is one of the major health problems in Nepal. Nutritional anaemia is oneof the commonest forms of anaemia and affects chiefly the females in the reproductiveage group. The available data from the hospital records and small-scale studies putthe estimate to more than 50%. There are other figures that project the range from 60-75% among this group. The present study was conducted on females of thereproductive age group visiting the dispensary attached to Nepalgunj Medical College,Chisapani. The total number of females included in the study was 71. Nearly 65% wereless than 30 years of age. The literacy rate was around 39.4%. Among the 66 marriedfemales, the number of children ranged from 0-7. Among the subjects, 79% were foundto be anaemic. The proportion of female with anaemia was not associated withincreasing age or education of the subjects but some degree of association could beobserved with increasing number of children. Usage of temporary contraceptive wasalso found to be associated with a larger proportion of females being anaemic. Thedegree of contribution made by hookworm infestation to the present figures of anaemiacannot be commented upon in numerical terms but could be high.
Triple vessel diseasetreated funcitional endoscopic sinus surgery
Authors: Gautam N , Pradhan B , Thapa N , Hira
Published: July 2024

Triple vessel disease, a coronary artery disease caused by narrowing of plagues which is cholesterol deposit on the vessel wall resulting abnormal and gradual ticking-off the lining of the heart arteries condition known as atherosclerosis. The narrowing usually develops slowly over many years. Thishigh-risk case was operated by the team in TUTH ENT Operation theater. We report a 75-year-old man with triple vessel diseasewith diagnosisof right allergic fungal rhinosinusitis with left deviated nasal septumsuccessfully undergone right Functional Endoscopic Sinus Surgery and recovered. It had emergent condition.
Anatomical Variations of Renal Artery in Nepalese Live Kidney Donors
Authors: Thakur DK , Sedhain S , Luitel BR , Chalise PR , Sharma UK , Gyawali PR
Published: July 2024

Introduction: Donor nephrectomy is unique surgery to predispose the surgeon on stress as healthy donors have major surgery purely for others’ benefit. Renal vessels are known with the wide range of variations which can lead to major complications or life threatening events if unrecognized. A thorough knowledge of anatomic variations in renal artery facilitates surgeons to anticipate and manage these potential risks and prevent the complications. Here we present anatomical variations in RA in Nepalese live kidney donors.
Methods: This prospective observational study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Live kidney donors over a period of 17 months (From June 2013 to October 2014) presenting for donation were evaluated for renal vasculature with 64- slice multidetector computed tomography and the findings were correlated with intraoperative findings during donor nephrectomy.
Results: Sixty three donors were enrolled in the study. Male & female ratio was 1:2.1. Age ranged from 18 years to 64 years (Mean 44.58 years).Anomalous RA was seen in 25 cases (39.7%). Fifty six percentages of anomalies were seen in female and 44% in male. Majority of anomalies were on left side (22.2%). The most common anomaly was supernumerary RA seen in 16 cases (25.5%) Accessory RA was seen in 11 cases (17.5%). Prehilar bifurcation was seen in 11 cases (17.5%). Aberrant RA was seen in 5 cases (8%). Preoperative CT angiographic findings correlated with intraoperative findings in all cases (r = 1, p = 0). Polar branch was transected accidentally in two cases which were repaired at bench surgery.
Conclusion: Anatomical variations of renal artery in Nepalese donors are comparable with other populations. Thorough knowledge of the variations can minimize complications and improve outcome during nephrectomy.
Triclosan Coated Suture Inhibits colonization of Bacteria Responsible for Surgical Site Infection – An in Vitro Efficacy Study
Authors: Shah NP , Shah RK
Published: July 2024

Introduction: Surgical site infection is one of the common healthcare associated infections, has significant impact on associated morbidity, mortality and exerts economic burden on the patient as well as on health care system. In addition to other measures, local inhibition of colonization of bacteria would provide clinical benefits. Antibacterial suture such as Triclosan coated suture prevents local growth of bacteria during critical initial stage of wound healing. At the end of 24 hrs of incubation at 37°C, 17-19 mm of zone of inhibition was seen for both S aureus and MRSA for Triclosan coated suture, while no zone was found around for non-coated suture.
Methods: The study evaluated in vitro efficacy of antibiotic coated Triclosan suture using zone of inhibition model against commonly reported organisms in SSI (Staphylococcus aureus, Methicillin resistant Staphylococcus aureus.
Results: Triclosan coated suture prevents colonization of bacteria at the surgical site, thus reduce the risk of SSI, also it would have positive financial impact such as minimizing the treatment cost and reduced hospital stay. We believe the clinical effectiveness of Triclosan coated suture in minimizing the risk of SSI would be beneficial to health care settings in Nepal.
Conclusion: The use of Triclosan coated suture for wound closure would be highly beneficial in controlling the SSI, morbidity, mortality and short hospital stay.
Glue therapy for bleeding gastric varices: a single tertiary center experience in Nepal
Authors: Jha A , Sharma S , Khadga PK , Pathak R , Poudyal S , Hamal R
Published: July 2024

Introduction: Bleeding is a common presentation in the Department of Gastroenterology, Institute of Medicine, Tribhuvan University Teaching Hospital. Of the varied causes of upper gastrointestinal bleed, bleeding gastric varices pose a major challenge to the endoscopist and the treating physician. Endoscopic injection of N-butyl-2-cyanoacrylate is the standard of care for treating gastric varices at present.
Methods: We retrospectively evaluated the efficacy and safety of cyanoacrylate in patients presenting with gastric variceal bleed. Between May 2016 to April 2017, 25 patients (14-M, 11-F) who presented to Institute of Medicine, Tribhuvan University Teaching Hospital with gastric variceal bleeding underwent endoscopic treatment with N-butyl-2-cyanoacrylate.
Results: Eleven patients had cirrhosis secondary to alcohol, 9 had non-cirrhotic portal hypertension, cirrhosis due to hepatitis B-1, hepatitis C-1, NASH-1, and cryptogenic- 2. Child-Pugh score at presentation for patients was Child A-52%, Child B-36% and Child C-12. Successful hemostasis. rebleeding rate and complications were reviewed. Immediate hemostasis was observed in 100 of the cases and carly rebleeding rate of 8% was seen in 2 patients. Complications included post procedure pain 16%, fever 16% and pulmonary embolism 4%.
Conclusion: N-butyl-2-cyanoacrylate is an effective, lifesaving modality for immediate hemostasis of gastric variceal bleeding with an acceptable rebleeding rate.
Osteochondroma Arising from Base of 1st Metacarpal Bone- A case report
Authors: Lamichhane A , Mahara D
Published: July 2024

Osteochondroma is the common benign tumor of bone. They probably are developmental malformations rather than true neoplasms and are thought to originate within the periosteum as small cartilaginous nodules. Osteochondromas may occur on any bone preformed in cartilage, but usually are found on the metaphysis of a long bone near the physis. The incidence of a solitary osteochondroma in the metacarpals is less than 1%. Here we present a case of solitary osteochondroma arising from base of 1 metacarpal in a 22 years old lady
WAGR syndrome in a Nepalese male child
Authors: Chaudhary RP , Chaudhary M
Published: July 2024

WAGR syndrome which includes Wilms' tumor, aniridia, genitourinary anomalies and mental retardation is a rare, sporadic, genetic disorder characterized by de nova deletion in the distal band of 11p13chromosome. Here, we report first case of WAGR from Nepal of a 5 year old male child with hypospadias, right Wilms' tumor and bilateral aniridia treated successfully by surgery and chemotherapy.
Second malignancy following successful treatment for Hodgkin's disease: case report and literature review
Authors: Singh Yogendra , Vaidya Pradeep , Shrestha Uttam , Sayami Geeta , Kumar Anil , Khakurel Prof. Mahesh
Published: July 2024

A 32-year-old male with a low grade non-Hodgkin's lymphoma (NHL) of the ascending colon presented 5 years after the successful treatment of Hodgkin's disease HD). According to the literature, the occurrence of a second primary cancer is a great problem in the survivors of HD, which is the result of immunosuppression due to the disease itself or following chemotherapy and/or radiotherapy for it. Therefore, patients with HD must be followed-up regularly and for lifelong.
Bilateral Peritonsillar Abscess: a case report
Authors: Dongol K
Published: July 2024

Although unilateral peritonsillar abscess is a common problem in otorhinolaryngology, case of bilateral peritonsillar abscess is very rare. Not a single case of bilateral peritonsillar abscess has been reported from Nepal till date. This is a case report of a 52 years old lady who presented with bilateral peritonsillar abscess in emergency and was managed with incision and drainage and antibiotics.
Orthodontic Traction of a Buccally Impacted Maxillary Canine with missing lateral: A case report
Authors: Shrestha BK
Published: July 2024

A 14-year-old girl presented with complains of space in the right upper quadrant and teeth. On intra-oral examination, she had missing right upper permanent lateral and upper permanent canine had taken the place of lateral incisor. On the left upper qua had retained deciduous lateral incisor and canine. On radiographic examination, left permanent canine was impacted and was lying high up and there was no sign incisor. She had severe crowding in the lower arch with all permanent teeth pre deciduous lateral incisor and the canine were extracted and more than a year was for spontaneous eruption of permanent canine. As the spontaneous eruption of not occur, surgical exposure and orthodontic traction was done and canine was occlusion satisfactorily and converted into lateral. This experience proves that spontaneous eruption may take place in majority of cases after extraction of deciduous surgical exposure and orthodontic traction is also needed at times. This is very be such a case with missing lateral as this provides an opportunity to have natural tee artificial prosthesis in addition to having acceptable esthetics.
#D Caramel Floating Denture: A salvage from high interarch space
Authors: Dahiya Dr Mansi ,   Manav Rachna International Institute of Research and Studies, Saxena Dr. Vidushi , Singh Dr Nidhi , S Dr Suruchi ,   Manav Rachna International Institute of Research and Studies,   Manav Rachna International Institute of Research and Studies,   Manav Rachna International Institute of Research and Studies
Published: July 2024

In day to day clinical practise encountering completely edentulous patient with abnormal jaw relation in adjunct with highly resorbed residual ridge is a challenging scenario. As it consequently result into compromised retention, support and stability of prosthesis. Varied material and techniques are available in literature to maximize stability in patient with abnormal jaw relation and increased inter arch space. Though, the key to success remains the same, a customised treatment planning according to the demand of the remaining oral condition. Thus this article describes a practically easy, convenient and precise technique for managing small maxillary arch and wide mandibular arch with high restorative space by cross arch teeth arrangement and use of novel 3D caramel spacer technique for the fabrication of hollow denture.
The Implications of Disagreement between Hadith Schools
Authors: Al-Hassoun Asmaa
Published: July 2024

When the disagreement occurred among the Fiqh schools in methodology and deduction, particularly between the school of Ahl Al-Hadith and the school of Ahl Al-Ra’y, it was important to examine and extrapolate the approach of each school in order to identify the points of agreement and disagreement between them. This research aims to identify Ahl Al-Hadith and the concept of Ahl Al-Hadith’s school, clarify the meaning of Ahl Al-Ra’y and the concept of Ahl Al-Ra’y’s school, deduce the methodology that each school adhered to and elucidate their contributions to the Sunnah and its sciences, and conduct a comparison between the two schools to highlight the points of agreement and disagreement between them. To this regard, I combine the inductive, analytical, and comparative approaches. The research is arranged into an introduction, three treatises, a conclusion, a list of bibliography and references. Then the research ends with several findings, including: Ahl Al-Hadith refers to those who have a close connection with the traditions (Athar) through seeking, collecting, understanding, memorizing, narrating, following, and acting accordingly, both outwardly and inwardly, and they possess the critical faculty and the fine discernment to distinguish between authentic and unauthentic narrations of the Prophet (PBUH). Meanwhile, Ahl Al-Ra’y refers to those who consider issues and engage in Ijtihad (Shariah-based-reasoning), and use analogical deduction (Qiyas) in matters of creed and Fiqh, whether their Ijtihad is reprehensible or praiseworthy. As for the recommendations, the most significant among them is the need to understand that disagreement among the four schools of Fiqh pertains to subsidiary matters, while they agree on the fundamental principles of issues.
Serum Anti-Müllerian Hormone and Cytokine Profiling of Bubalus bubalis (Murrah buffalo) Calves for Puberty Prediction
Authors: Sneha S.H. , Singh Prahlad , Singh Navdeep , Singh Chanchal , Honparkhe Mrigank
Published: July 2024

The present study incorporated ten buffalo calves aged 0 to 6 months, with an average weight of 35 kg, and ten buffalo heifers aged 12 months, with an average weight of 200 kg, to study the cytokine and AMH profile in relation to pubertal advancement. Venous blood samples (5ml) were collected from buffalo calves on the day of birth (day 0), day 15, day 30, day 60, day 90, day 120, day 150, and day 180. A single blood sample was collected from Buffalo heifers (1 year age). Cytokines: IFN-γ, IL-6, IL-1, IL-13, TNF-α, and TGF-β, and anti-Müllerian hormone: AMH were estimated using respective ELISA kits. At birth, cytokine levels in serum showed a varied pattern, with lower levels of IFN-γ, IL-6, and IL-13, whereas IL-1, TNF-α, and TGF-β were higher. Throughout the study, IFN-γ, IL-13, and TGF-β levels remained relatively stable, whereas IL-1, IL-6, and TNF-α increased notably by day 180. IL-1, TNF-α, and IL-6 levels were higher (P<0.01) from birth to 180 days as well as on day 365. AMH levels remained consistent from birth to 180 days, indicating a marked increase at Day 15 (33.49 ± 12.63 ng/L), followed by a decline to 4.60 ± 1.55 ng/Lat the end of the first year. Implications of the Karl Pearson correlation coefficient revealed a negative correlation between AMH levels and IFN-γ and TNF-α. AMH was positively correlated with IL 13 and TGF-β. Hence, it was concluded that IFN-γ and TNF-α are predictive markers for a reduction in AMH levels and hence, setting up puberty in buffalo heifers.
Russia’s Invasion of Ukraine and National Cyber Security Strategies: Quantitative Compar-ison
Authors: Vinhas de Souza Olesya
Published: July 2024

Shared understanding of the operational environment
in the cyber domain is the key enabler of NATO’s cyber posture.
However, there have been no attempts to evaluate empirically the
impact of the war in Ukraine on intra-Alliance coherence. This study
applies a novel methodology based on computation text analysis
to evaluate the trends within the recently adopted national cyber
strategies with regards to the description of threats, risks, and
actors involved in carrying out these threats – in particular, Italy,
Latvia, the United Kingdom, and the United States. The analysis
shows that before the large-scale invasion, the congruence was low
between the two continental European states vis-a-vis the UK and
the US on threat and risk assessment. After the invasion, these dif-
ferences became smaller and the language of the updated National
Cyber Security Strategies became more homogeneous as mea-
sured by the cosine similarity scores. There are still differences in
the discussion of relevant actors in cyberspace. The methodology
applied here can be extended to measure the cohesiveness of the
Alliance’s cyber posture along other dimensions.
Farmers’ Interest and Economics Model of Agrosilvofishery Restoration on Degraded Peatland in OKI Regency South Sumatra Indonesia
Authors: Ema Ema pusvita , Mulyana Andy , Adriani Dessy , Antoni Mirza
Published: July 2024

The sustainability of peatlands required sustainable thinking to protect the existing ecosystem. One of the restoration efforts was the application agrosilvofishery model with 3R (Rewetting, Revegetation and Revitalization) on peatlands. The research objective was to examine the economic value of application agrosilvofishery model on peatlands with a combination of jelutung, chilies and catfish. The research method used purposive sampling method where research location was selected in OKI Regency, South Sumatra. The sample of research was 10 who has their own degraded peatlands, then empowerment them to cultivate peatlands, to obtain the optimal benefits. It was selected based on quota in action research. Farmers selected forest and fruit plants to plant on peat based on their interests. In economic study, the acceptance value was obtained from the agrosilvofishery model, namely jelutung Rp. 716,473,469/m3/30 years, jelutung sap 2,782,080,000/kg/30 years, chilies received Rp. 40,000,000/year, and the average income for catfish was Rp. 1,836,000,000/year. Sensitivity analysis of jelutung-chili-catfish agrosilvofishery obtained an NPV of Rp. 13,413,797,049, IRR (+) 60%, Net B/C 7.1, Gross B/C 3.7, and PP 0.01/year. From the results of this study, farming on peatland with the agrosilvofishery model was feasible. The development strategy by using the business canvas model agrosilvofishery provided an overview of peatlands sustainability in future. Further, this research provided an illustration that to provide for a decent life, farmers need to think about short, medium and long term businesses.
 
Keywords: Agrosilvofishery, Chili, Jelutung, Catfish, Canvas Business
Single Exponential Smoothing on Pangasius Production Forecasting in South Sumatera
Authors: Perwita Sari Lia , Yamin Muhammad , Antoni Mirza , Riswani
Published: July 2024

The product of inland waters in South Sumatra which is very potential, namely Patin fish (Pangasius). South Sumatra is working on the export potential of pangasius because production has penetrated the first rank in Indonesia. Sumatra Island is the largest contributor, namely 68.07% of the total national pangasius production, while South Sumatra is recorded as the largest pangasius aquaculture producer in Indonesia, which is around 47.4% of the total national production. As one of the production centers for pangasius in Indonesia, every year it is hoped that there will be an increase in production to meet local and national demand. This study aims to predict pangasius production in South Sumatra on 2023 using the Single Exponential Smoothing Method. The data used is secondary data from the Ministry of Maritime Affairs and Fisheries and the Central Statistics Agency for South Sumatra in the form of pangasius production data in South Sumatra from 2006 to 2022. Forecasting results are carried out by calculating the average error value using the MAPE method. The results showed that the MAPE value of the pangasius production forecasting model in South Sumatra was 43,58%. Forecasting pangasius production in South Sumatra in 2023 is 53.111,15 tons.
Enforcement of decisions of the Constitutional Court of Ukraine: issues of legal doctrine
Authors: Bielova Miroslava , Byelov Dmytro
Published: July 2024

It is indicated that the key problem in the activity of the Constitutional Court of Ukraine is ensuring the implementation of its decisions. Without solving this issue, it is impossible to guarantee the supremacy of the Constitution, the principle of separation of powers and the existence of an independent judicial branch of government as a separate institution. Ignoring the decisions of the constitutional control body undermines the very system of checks and balances, the authority of the Basic Law and the constitutional order in the country in general. These principles underlie the implementation of decisions of constitutional courts, the purpose of which is to ensure constitutional legality. In Ukraine, the mechanism for the implementation of the decisions of the Central Committee of Ukraine has already been developed in general, but there are problems related to the non-implementation of some of its decisions for a long time. Therefore, the task of further improvement of this mechanism and its proper legislative regulation remains relevant.
The authors claim that Ukraine has already developed a mechanism for implementing decisions of the Constitutional Court. However, this system is not perfect, which is evidenced by the fact of non-execution of individual court decisions. Therefore, the issue of continuing the work on improving the existing mechanism for implementing decisions of the body of constitutional jurisdiction, securing it properly at the legislative level, remains urgent. At the same time, the problem of the quality of such execution comes to the fore, for the solution of which it is necessary to develop criteria for the effectiveness of the execution of court decisions, which will allow to assess the quality of the legal acts that are introduced and the work of the responsible entities. Both outlined problems definitely need further thorough scientific research.
In addition, according to the authors, it should be noted that the issues of the legal nature of the legal positions of the Constitutional Court of Ukraine and the criteria for the effective implementation of its decisions remain interacting categories and, therefore, require thorough scientific study. At the same time, clarifying the legal force of the Court’s legal positions is complicated by the lack of their legislative definition, by a certain difficulty in understanding the role and place of the body of constitutional jurisdiction in the system of state power. At the same time, the legal positions have a normative and mandatory character, reflected in the acts of the KSU. The need to ensure their immutability follows from the principles of legal certainty and stability of the Constitution. However, the possibility of revising some legal positions in connection with the change in the socio-political structure of the state is gaining relevance.
Reto del Ingeniero a ser Docente de Ingeniería en la Industria 5.0
Authors: Haro Esquivel Gisela , Ayala Hernández Pablo
Published: July 2024

La transición de ingeniero a docente en el contexto de la Industria 5.0 implica un cambio significativo tanto en la carrera profesional como en la metodología de enseñanza. Esta nueva era industrial, caracterizada por tecnologías avanzadas como la inteligencia artificial (IA), la robótica y el Internet de las Cosas (IoT), permite a los educadores crear entornos de manufactura personalizados e inteligentes. A su vez, esto no solo mejora las metodologías de enseñanza, sino que dota a la próxima generación de ingenieros con las habilidades necesarias para liderar en el panorama industrial en evolución. La integración de estas tecnologías y el enfoque en prácticas sostenibles y centradas en los humanos son cruciales para cerrar la brecha entre la academia y la industria, asegurando que los estudiantes estén bien preparados para enfrentar los futuros desafíos de la ingeniería. Se empleo un enfoque cualitativo, con un nivel descriptivo-reflexivo en este artículo sobre los retos que tienen los ingenieros como nuevos docentes en Industria 5.0. En paralelo, las universidades enfrentan el reto de adaptarse a los profundos cambios de la Sociedad 5.0, donde se requieren profesionales con competencias digitales y habilidades competitivas. Este proceso de adaptación incluye el análisis de desarrollos tecnológicos actuales y su impacto en los nuevos profesionales, resaltando herramientas como la IA, el IoT, la robótica y el Big Data. Además, la utilización de tecnologías inteligentes y el cultivo de habilidades digitales están revolucionando los procesos de trabajo y la interacción entre humanos y tecnología. La integración efectiva de profesionales con estas nuevas tecnologías y el fomento de competencias ético-tecnológicas son esenciales para mejorar la ventaja competitiva de las organizaciones y asegurar un crecimiento profesional.