bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19 appropriate behavior: Are the health care workers of Arunachal Pradesh competent enough to fight the pandemic?
Authors: Boro Pallavi , Debarshi Paul  , Mandula Prashanth Kumar  , Kimo Ori  , Anoop Dev
Published: October 2022

Background: COVID-19 is caused by coronavirus, first identified in Wuhan, China in December 2019, spread rapidly across international borders, and was declared pandemic on March 11, 2020. Occupation hazards such as close patient contact, suboptimal hand washing, inadequate use of personal protective equipment (PPE), and breach in infection control measures pose higher risk to health care workers (HCWs).
Aims and Objectives: The objectives of the study are as follows: (1) To assess knowledge, beliefs, and practices of HCWs of a tertiary care hospital in Arunachal Pradesh regarding COVID appropriate behavior. (2) To create awareness and thereby prevent the spread of infections.
Materials and Methods: A stratified sampling technique was applied to identify the study participants. A pre-tested and semi-structured questionnaire was administered to assess their knowledge, beliefs, and practices toward COVID-19. All departments (study units) were enlisted, all the HCWs were stratified according to their profession, for example, doctors, nurses, pharmacists, laboratory technician, and other HCWs. From each stratum, HCWs were randomly selected using simple random sampling and interviewed.
Results: We found, 96.18% wore mask properly, 74.81% maintained physical distancing, and 55.34% greeted without physical contact while only 24.05% maintained respiratory hygiene. Mask was observed to be the most commonly known preventive measure (85.5%), followed by hand hygiene (69.47%), physical distancing (56.49%), and PPE kits (17.56%). It was observed that 53.44% of HCWs relied on government source of information.
Conclusion: Most of the HCWs were practicing COVID appropriate behavior and the vaccination coverage was high among the HCWs (up to 2nd dose).
Seroprevalence of brucellosis among the high-risk population in Ujjain district, Madhya Pradesh
Authors: Riddhi Pradhan  , Anand Bhadkariya  , Vidit Khandelawal  , Vishal Diwan  , Waghe SR  , Deepak Saxena  , Shah H  , Manju Purohit
Published: October 2022

Background: Brucellosis is the most common zoonotic disease caused by Gram-negative coccobacillus belonging to genus Brucella. It is a recognized public health problem in developing countries including India.
Aims and Objectives: The aims of these study were to determine the seroprevalance of brucellosis in population having occupation dealing with animals and thus are in close contact of animals.
Materials and Methods: The study was conducted in semi-urban areas of central India. Blood samples were collected from personnel working in slaughter houses, meat shops, and veterinarians and their close contact and who are willing to participate in study. A total 102 samples collected randomly from butchers (n=20), veterinarians (n=29), and animal handlers (n=53) and were tested for Brucella abortus and Brucella melitensis by a commercial kit which allows the detection of both complete (IgG and IGM) and incomplete antibodies.
Results: A total 102 subjects were included in the study and overall prevalence of brucellosis among high-risk group was found to be 2.9%. One veterinarian doctor was also found positive for both B. melitensis and B. abortus. Highest prevalence of brucellosis was found in veterinarians (6.8%) followed by animal handlers (1.8%), and none of the butcher was tested positive for any of the Brucella antibody.
Conclusion: The present study screened all possible known high-risk groups for brucellosis and revealed that veterinarians have high chances of getting the infection. Occupation-related disease like brucellosis needs regular surveillance and integration into control and prevention program at a local and national level.
Role of pectoral nerve block (PECS II) in post-operative pain management for breast surgeries
Authors: Mili Yadav  , Amey Dixit  , Arvind Kumar Rathiya  , Subhash Kumar Agrawal
Published: October 2022

Background: Pain after breast surgeries is a major problem which costs both in patient comfort and duration of hospital stay. Uncontrolled post-operative pain may produce a range of detrimental acute and chronic effects. Optimal pain relief and minimal side effects following surgery have a major impact on patient outcome, including patient satisfaction and earlier mobilization, as well as fulfilling the needs for streamlined surgical services with lower costs.
Aims and Objectives: The aim of the study was to assess for the pain score during the first 24 h with time of the first request for rescue analgesic and total analgesic requirement and also to assess the patient‘s satisfaction for post-operative pain relief and consequences if any during the first 24 h.
Materials and Methods: This prospective study was conducted in 60 patients of ASA status I or II considering for mastectomy categorized into two groups, the first group with 30 patients who received Bupivacaine drug and second group with 30 patients who received normal saline. In the PACU, each patient’s VAS score and tramadol use were evaluated. The pectoral nerve block is a less invasive interfacial plane block used for post-operative pain relief in breast surgeries that involves deposition of local anesthetic between the pectoralis major and minor muscles, in addition to the serratus anterior and pectoralis minor muscles and the intercostal muscles, blocking the lateral branches of the intercostal nerves and the long thoracic nerve.
Results: We found a significant difference in total rescue analgesia intake among control and PECS II block groups, in an initial 24 h of surgery. In the control group, mean VAS score and total rescue analgesia intake in 24 h were statistically significant greater (P<0.05).
Conclusion: We concluded that pectoral nerve block is an effective and easy technique for pain control and fast recovery in post-operative period following breast surgeries.
Efficacy of clonidine as an additive to levobupivacaine for epidural anesthesia and post-operative analgesia in infraumbilical surgeries – A randomized and double blind study
Authors: Arunkumar Arumugam  , Bharti Badlani  , Singh Puja , Tripathi Sonali
Published: October 2022

Background: Epidural anesthesia as a safe alternative to general anesthesia is commonly used for inducing anesthesia and post-operative analgesia in patients undergoing infraumbilical surgeries. The addition of an adjuvant not only increases the effectiveness of a local anesthetic by prolonging and intensifying the sensory blockade but also causes reduction in the dose of rescue analgesic agent in post-operative period. Clonidine is a potent and selective α-2-adrenoceptor agonist with analgesic potency.
Aims and Objectives: This study was conducted to evaluate the efficacy of clonidine as an additive to levobupivacaine in infraumbilical surgeries.
Materials and Methods: One hundred patients of American Society of Anesthesiologists Grade I or II who were undergoing infraumbilical surgery were randomly divided into two groups as levobupivacaine (L) and levobupivacaine with clonidine (LC). Patients were allocated to one of the two groups by computer generated random selection. Group L received 0.5% levobupivacaine (1.5 mg/kg) and Group LC received 0.5% levobupivacaine (1.5 mg/kg) with clonidine (2 μg/kg). The onset time for sensory, motor blockade, duration of anesthesia and duration of analgesia, and Visual Analog Scale (VAS) score were observed in both the groups. The hemodynamic variables such as heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation at various time intervals were measured. Any untoward side effects were noted in both groups.
Results: The onset of sensory (7.8±1.7 min) and motor blockade (10.9±1.9 min) were significantly faster in clonidine group. Duration of anesthesia and duration of analgesia were prolonged in Group LC (234.5±16.1 min, 412.8±48.3 min) compared to Group L (173.56±12.78 min, 269.2±24.2 min) which was statistically significant (P<0.05). Similarly, clonidine group had less VAS score compared to control group. There was no significant change in the hemodynamic variables between the two groups. Hypotension and bradycardia were found more in clonidine group compared to the control group.
Conclusion: Clonidine as an adjuvant to levobupivacaine prolongs the post-operative analgesia and the duration of anesthesia for infraumbilical surgeries.
Comparative evaluation of “in-the-bag” intraocular lens implantation with cionni ring versus pars plana lensectomy–vitrectomy with anterior chamber IOL implantation in subluxated lenses in pediatric eyes
Authors: Sweta Singh  , Anju Rastogi  , Jaidrath Kumar  , Vartika Srivastava
Published: October 2022

Background: Subluxation of the crystalline lens has various surgical management options. In moderate zonular dialysis, the capsular bag may be preserved and used for intraocular lens (IOL) implantation using a capsular tension ring or Cionni ring or Capsular tension segment. It is technically demanding and associated with high incidence of complications such as IOL decentration, dislocation, and posterior capsular opacification (PCO). Advantages of the combined pars plana lensectomy–vitrectomy (PPL/PPV) with anterior chamber IOL (ACIOL) approach include a closed ocular surgical system, minimal corneal trauma, limited iris trauma, and good vitreous control. Therefore, in this study, we aim to study the outcomes of inthe-bag IOL implantation with Cionni ring versus PPL/PPV with ACIOL in subluxated lenses in children.
Aims and Objectives: The aims of this study were to compare “in-the-bag” IOL implantation with Cionni ring versus PPL/PPV with ACIOL implantation in subluxated lenses in children.
Materials and Methods: In this prospective, comparative, and interventional case series, 20 eyes (18 children, 8–18 years) with 90–210° subluxation were randomly allocated into two groups (ten eyes each). Group A underwent single eyelet Cionni Ring with in-the-bag PCIOL implantation and Group B underwent PPL/PPV with ACIOL. Outcome measures included best-corrected visual acuity (BCVA), endothelial cell count (ECC), intraocular pressure, fundus evaluation, and intraoperative/post-operative complications.
Results: The etiology of subluxation included trauma (40%), Marfan’s syndrome (20%), myopia (20%), and others (20%). In Group A, intraoperative difficulties were encountered in capsulorrhexis, irrigationaspiration, and increased duration of surgery. Two eyes in Group B had intraoperative lens fragment drop in vitreous. At 3 months, no statistically significant difference in BCVA was noted. About 90% eyes in Group A and 80% eyes in Group B had final BCVA of ≥6/18. ECC and PCO were significantly higher in Group A at 3 months.
Conclusion: Implantation of planned open-loop ACIOL is viable surgical alternative to Cionni ring with PCIOL implantation in large lens subluxation and good pre-operative ECC.
Role of power Doppler and gray-scale ultrasound of the median nerve in the evaluation of carpal tunnel syndrome: A comparative analysis between sonographic and surgical measurements of the median nerve
Authors: Mohammad Farooq Mir  , Shazia Bashir  , Hilal Ahmad Lone  , Tahir Ahmad Dar
Published: October 2022

Background: Carpal tunnel syndrome (CTS) is the prevalent cause of pain, numbness, tingling, and weakness. It is known that whenever the median nerve, a major peripheral nerve of the upper limb, originating from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist, it leads to a condition commonly known as CTS.
Aims and Objectives: The present study has been objectively conducted to assess the role of grey scale and power Doppler ultrasound of the median nerve at the wrist in evaluating CTS. The comparative analysis between USG findings and surgical findings of median nerve in CTS will also be made.
Materials and Methods: The present prospective study has been conducted at the SKIMS-MC, Srinagar for a period of 6 months from January 2022 to June 2022 in the Department of Radio diagnosis and Imaging in association with the Department of Orthopedics. A total of 30 patients have been included in the study. The cases were referred from Department of Orthopedics with clinically characterized CTS.
Results: Out of total 30 patients; 03 (10%) were males and 27 (90%) were females with a male to female ratio of 1:9. We observe that vascularity of median nerve was present in (56.7%) and absent in (43.3%) patients. The median nerve thinning and indentation were reflected by (80%) patients and the same was absent among (20%) patients, we did not find any agreement between surgical and sonographic parameters with the mean difference of 2.527 mm between sonographic and intraoperative perimeters, the difference was statistically significant (P<0.001, CI 95%).
Conclusion: The present study demonstrated that ultrasonography aided with power Doppler precisely detected CTS cases. Evidently, we find a significant difference between surgical and sonographic parameters with the mean difference of 2.527 mm between sonographic and intraoperative perimeters.
The study of association of serum ischemia-modified albumin and prediabetes in women: A case–control study
Authors: Ahirwar Ashok Kumar , Jain Rashmi , Choubey Udit , Jain Ankit , Takhelmayum Roshan , Sakarde Apurva , Pawar Akash Mahadeo , Rathod Bharatsing Deorao
Published: October 2022

Background: Prediabetes, diabetes, and their associated complications adversely affect women’s health worldwide. Women in the reproductive age group are more prone for developing diabetes and its associated complications such as gestational diabetes and infertility. Hence, it is the need of the hour to diagnose women at risk of pre-diabetes. Oxidative stress, ischemia, and hypoxia have been suggested as important factors in developing prediabetes and its sequels.
Aims and Objectives: The present study aimed to study the association of serum ischemia-modified albumin (IMA), namely, a marker of oxidative stress, ischemia, and hypoxia with prediabetes in the women of reproductive age group.
Materials and Methods: The present study was carried out in 50 females in the reproductive age group of 19–45 years. The study population was further sub-divided into two groups: Group I consisted of 25 prediabetic patients and Group II consisted of 25 healthy controls. Serum samples of the subjects were analyzed for serum IMA, blood sugar profile, and other routine biochemistry tests.
Results: The present study showed that mean serum IMA was raised in prediabetic group as compared to healthy controls. The serum IMA also positively correlated with blood sugar profile.
Conclusion: Increased serum IMA could be used as a biomarker for predicting prediabetes in females of reproductive age group. This, in turn, would be helpful in preventing the burden of various complications known to occur in the natural course of prediabetes and diabetes.
A study to observe the effects of infusion of 6% Hydroxyethyl starch (130/0.4) on renal function in cardiac surgical patients
Authors: Pradeep Kumar Das  , Bhyravajosula Koumudi  , Danda Vijaya Kumar  , Rajeswara Rao S
Published: October 2022

Background: The possibility of nephrotoxic effect caused by hydroxy ethyl starch (HES) used as volume therapy in this particular setting is of major clinical concern. We conducted this retrospective study to look for the possible nephrotoxic effects and other systemic adverse effects if any, of 6% HES 130 kD, 0.4 DS used as intraoperative volume expander in the cardiac surgery setting.
Aims and Objectives: This study aims to determine whether the infusion of 6% hydroxyethyl starch (130/0.4) harms renal function in cardiac surgical patients.
Materials and Methods: The present study was a retrospective study. Sixty-six patients who received crystalloids with hydroxyethyl starch and a matched control of 66 patients based on age and sex and other baseline parameters who received crystalloids only were part of the study. The data extracted from the electronic medical record include patient demographics, details for additive EURO score, and pre-operative data that include details of comorbid illnesses, namely, hypertension and diabetes, plasma hemoglobin, serum creatinine, and eGFR.
Results: There is no statistically significant difference in serum creatinine and incidence of post-operative renal dysfunction between the study groups. There was a higher rate of re-exploration and duration of intensive care unit, and hospital stay.
Conclusion: In our study, HES 130/0.4 in the dose used as a plasma expander did not adversely affect renal function in cardiac surgical patients undergoing CABG. The study recommends further detailed studies in this area involving multiple centers.
Brunner’s Gland Lesions: An uncommon entity mimicking malignancy
Authors: Sarika More  , Madhubala Swarnakar  , Rajendra Kumar Chandrakar  , Manjula Lader
Published: October 2022

Brunner’s gland hyperplasia (BGH) or adenoma is an uncommon benign lesion which mimics malignancy in the duodenum. In the present study, five cases of BGH were reported, out of which one case was presented with large size measuring 5.54×4.05 cm, which has not been yet reported. Computed tomography demonstrated a large obstructing polypoidal mass, on esophagogastroduodenoscopy demonstrated polypoidal growth, and histologic examination revealed brunner’s gland adenoma. Most of the cases presented with gastric outlet obstruction and upper gastrointestinal bleeding with other non-specific symptoms. BGH is an uncommon benign condition of the duodenum, patients were usually asymptomatic or may present with non-specific symptoms or present as an incidental finding on endoscopy. Endoscopic and/or surgical resection represents the ideal approach. Brunner’s gland described by the Swiss anatomist Johann Conrad Brunner in 1688, predominantly present within the submucosa, begin just distal to the gastroduodenal junction, and gradually decrease in size and number distally and are often used as a histological marker of the duodenum. A Brunner’s gland adenoma (BGA), also known as BGH or hamartoma, is an uncommonbenign lesion in the duodenum.
Pancreatic Beta-cell function and degree of Insulin resistance among newly detected type 2 diabetics and their correlation with anthropometric, glucose, and lipid parameters: An Observational cross-sectional study
Authors: Saha Avijit
Published: October 2022

Background: Insulin resistance is a major cause for developing type 2 diabetes. However, simultaneously pancreatic beta-cell dysfunction must coexist in for clinical occurrence of type 2 diabetes (T2D). Hence, knowledge regarding residual beta-cell function and degree of insulin resistance is required while treating type 2 diabetic patients.
Aims and Objectives: The present study was done to estimate degree of insulin resistance (homeostatic model assessment insulin resistance - HOMA-IR) and pancreatic beta-cell functional capacity (HOMA-B%) among newly detected type 2 diabetics and correlation of these with anthropometric, glucose, and lipid parameters.
Materials and Methods: This was an observational cross-sectional study conducted in 100 newly diagnosed type 2 diabetic patients. Detailed anthropometric and clinical examination were carried out. Venous blood samples were drawn for fasting plasma glucose, c-peptide, fasting insulin level, hemoglobin A1C (HbA1C), lipid profile, and postprandial glucose. HOMA-IR and HOMA-B% were calculated using HOMA 2 calculator and correlations were calculated between the study variables.
Results: The mean age of the study population was 45.55±11.64 years and 58% of study participants were male. The mean HOMA-IR and HOMA-B% were 2.55±1.75 and 40.67±23.55%, respectively. HOMA-IR positively correlated with abdominal circumference, triglyceride to HDLc ratio, and negatively correlated with HDLc. There were statistically significant negative correlations between HOMA-B% and fasting glucose(r=−0.48, P<0.001), 2 hr post prandial glucose (r=−0.37, P<0.001 and HbA1C (r=−0.24, P=0.01).
Conclusion: This study found more reduced beta-cell function compared to reduced insulin sensitivity in new T2D mellitus patients. Hence, this kind of functional assessment needs to be done while selecting appropriate anti-diabetic drugs for a particular patient.
Demographic and Mortality Trends across three COVID-19 waves in Kashmir Division, India
Authors: Magray Tahir Ahmad , Nazir Umar , Rather Rouf Hussain , Wani Feroz Ahmad
Published: October 2022

Background: The demographic profile and fatality varied across different waves with the appearance of new variants. Further the trends varied from country to country and within the country. We have analyzed the trends from a selected geographic area.
Aims and Objectives: To assess the trends in COVID-19 cases and deaths and to compare the characteristics of three different COVID-19 waves in Kashmir Division.
Materials and Methods: It is a cross sectional study based on secondary data.
Results: The mean age of deaths increased from 64.53 years in first wave to 65.02 years in the second wave and further to 69.23 years in the third wave (p-value = 0.006). An overall CFR of 0.85% was observed in our population with a maximum case fatality of 1.67% in first wave followed by 0.79% in second wave and only 0.13% in third wave (p < 0.0001). Lowest CFR of 0.04% was observed in the age group of <20 years and maximum CFR of 6.12% was observed in the subjects with age more than 60 years. It was also observed that the CFR increased with the increase of age across all the three waves (p < 0.0001).
Conclusion: Our study suggests that the Case Fatality Ratio declined with time despite new variants appearing which spread at very fast rate. The mortality remained higher in elderly and in males in all the three waves.
Association of uric acid as a risk factor in ischemic stroke – A hospital-based observational study
Authors: Jegan Mohan Yogiswaran  , Sasthanathan Ganesan  , Sathyan Elangovan
Published: October 2022

Background: The second most prevalent cause of mortality globally, next to coronary artery disease, is stroke. In humans, uric acid is the final catabolite in the metabolism of purine.
Aims and Objectives: The aims of this study were to determine the importance of blood uric acid levels in stroke patients in South Indian population.
Materials and Methods: In this observational study, we evaluated acute stroke patients who were admitted to Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research (MAPIMS) Hospital from December 2021 to May 2022. One hundred patients meeting the inclusion standards were enrolled and divided into two groups randomly following acquisition of ethical approval and informed consent.
Results: In our study consisting of both study and control groups, low-density lipoprotein cholesterol (P=0.034), non-high-density lipoprotein cholesterol (HDL-C) (P=0.0127), total cholesterol (P=0.0196), HDL-C (P=0.042), and triglyceride (P=0.0266) were found to be statistically significant. Mean serum uric acid (SUA) level between cases (6.94±1.97 mg/dL) and controls (5.49±1.27 mg/dL) were also statistically significant (P=0.0306 and P=0.049).
Conclusion: Our study showed that stroke patients had a significant occurrence of hyperuricemia. In keeping cardiovascular risk factors such as diabetes, hypertension, triglyceride level, total cholesterol level, coronary heart disease, and tobacco use under control, SUA was observed to be substantially linked with the initial phase of ischemic stroke.
Impact of polypharmacy in older patients with type 2 diabetes in rural population in South India
Authors: Sanjeev Kumar Adepu  , Madhukar Sirasu  , Gudas Ravinder
Published: October 2022

Background: The World Health Organization describes polypharmacy as a safe and efficient treatment that complies with evidence-based medicine and uses at least five different medications.
Aims and Objectives: The aim of our study was to investigate the impact of polypharmacy in older patients with type 2 diabetes mellitus (T2DM) in rural population in South India.
Materials and Methods: The study comprised a total of 100 patients, who were referred to the Government General Hospital, Nizamabad, between January 2020 and March 2022. The records of 50 randomly chosen non-diabetic patients who visited our hospital for other ailments were compared to those of the 50 T2DM patients.
Results: In this study, a total of 100 patients were enrolled, out of which 62 were male (62%) and 38 were female (38%). The duration of diabetes was noted to be 0–5 years in 28 patients, 6–10 years in52 patients and >10 years in 20 patients. In our study, we observed that more than five drugs were prescribed to 45 patients in the case group and only ten patients in the control group.
Conclusion: Our study shows that older adults with diabetes have a high prevalence of polypharmacy and that this condition may have a significant impact on a number of health-related outcomes. Each patient should receive a customized course of treatment with the right number of medications for their particular ailment. The danger of side effects increases with the number of medications.
Neglected tropical disease: Why we need to prioritize them more
Authors: Dhar Ruby , Arun Kumar  , Subhradip Karmakar
Published: October 2022

Neglected tropical diseases (NTDs) are those that are commonly found in several low-income countries in Africa, Asia, and Latin America and where people do not have access to hygiene, clean water, or safe ways to dispose of human waste. NTDs comprise a diverse group of diseases that is highly prevalent in tropical countries and is caused by a variety of pathogens, including bacteria viruses, parasites, and fungi. Although there are debates on what is included under NTD, few that are listed are ascariasis, Buruli ulcer, Chagas disease, dracunculiasis, hookworm infection, human African trypanosomiasis, Leishmaniasis, leprosy, lymphatic filariasis (LF), onchocerciasis, schistosomiasis, trachoma, and trichuriasis, though this list. keeps on changing. They are called “neglected,” because they are hardly represented in the global health agenda of the developed countries and are often associated with stigma, blind faith, and social exclusion. The epidemiology of NTDs is quite complex and often related to environmental conditions. Many of them are vector-borne, have a zoonotic origin with well characterized animal reservoirs, and are associated with complex life cycles. All these factors make their public health control challenging.
With a population of over 1.3 billion, India accounts for nearly one-half of the world’s prevalent cases of visceral leishmaniasis and one-half of the global incident cases of dengue, one-third, or more of the prevalent cases of leprosy, LF, cysticercosis, and visual impairment due to trachoma. India also accounts for 25% world’s burden of ascariasis and hookworm cases. Unfortunately in India, we don’t have a uniform distribution of neglected diseases. It was found to be very much dependent on the geographical locations as well as biased on the socialeconomic status, with more prevelant amongst the lower income groups. NTDs are not just any regular disease but were reported to cause permanent disabilities, impacting mental health and thereby posing a serious threat to livelihood and standard of living.
Challenges in studying NTDThe primary challenge is adequate research funding and efforts. Affecting emerging economies, NTD severely suffers from the limelight that other lifestyle diseases such as cardiovascular, diabetes, and oncology enjoys. There was not much research output from the Western world too as NTD mostly affects the poorer nations. NTD related technologies are not considered profitable. This trend is slowly changing with larger participation from the government to aid in NTD research. We hope that future days will show more effort and awareness toward a better solution.
Evaluation of diabetic foot ulcer with reference to demography, clinical presentation, and imaging modalities for diagnosis: An observational study
Authors: Maitra Sanjay , Biswas Kaushik , Mandal Sangita , Chowdhury Aditya , Mandal Mohanchandra
Published: October 2022

Background: Demography and clinical presentation of diabetic foot ulcer varies across geographical location. Multiple imaging modalities such as plain radiography and magnetic resonance imaging (MRI) are used to evaluate osteomyelitis or neuroarthropathy in diabetic foot. Plain radiography is a low cost and easily available test while MRI is reported to be of higher sensitivity and specificity for delineating the extent of soft tissue and bone involvement.
Aims and Objectives: The study was designed to determine the spectrum of demographic and clinical findings and to find the utility of different diagnostic modalities such as clinical, plain radiography, and MRI that were used to differentiate between osteomyelitis and neuroarthropathy.
Materials and Methods: After obtaining permission of Institute’s Ethics Committee’s permission, this observational study was carried out among patients, males and females aged 13 years and above, who presented with diabetic foot ulcer for treatment. The study spanned from March 2020 to August 2021 to reach a sample of 50 patients following non-random purposive sampling. A pro forma (containing history, physical examination findings, and laboratory investigations) was used to explore patient data. Besides clinical diagnosis, plain radiography and MRI were used to evaluate the clinical findings.
Results: In the study, most of the subjects were between 51 and 70 years of age having diabetes for a duration of 5–15 years. The basis of complications observed is infections, ischemia, and neuroarthropathy. Among the diagnostic modalities used to reach a diagnosis of osteomyelitis or neuroarthropathy, MRI was able to pick up the diagnosis in a greater number of patients for above two entities. Osteomyelitis was identified in 24 (48%) patients and neuroarthropathy was identified in 22 (44%) patients. Use of plain radiography helped in reaching diagnosis in 30% of patients for each category. Clinical diagnosis about osteomyelitis or neuroarthropathy was made in 22% and 26% of patients, respectively. However, on analysis, it was not significant.
Conclusion: The present study showed a male preponderance. Moreover, MRI was able to categorically diagnose different pathological parameters of osteomyelitis and neuroarthropathy. Marrow edema was detected in a larger proportion of patients among the MRI-diagnosed cases of osteomyelitis and neuroarthropathy. MRI appears to be more useful than plain radiography for clinical diagnosis.
Impact of Monetary Policy on Economic Growth in Nepal: An Empirical Analysis
Authors: Joshi Uttam Lal
Published: October 2022

This research study investigates the impact of monetary policy on economic growth in Nepal. Data was taken from the sources of national account of World Bank from the year 1965 to 2020 for this purpose. Augmented Dickey- Fuller unit root test was performedto avoid spurious regression. Johansen co-integration test was applied after conforming all variables were integrated in order I (1) then Vector Error Correction model was used to find out the speed of adjustment towards long run equilibrium. The coefficient of VECM was negative and significant that shows long run relationship between monetary policy and GDP Growth. Granger Causality results show two-way causality between money supply andGDP Growth. The result supports the impact of monetary policy on economic growth of the country. It can reduce unemployment, promote investments and stabilize the economy so monetary authorities and policy makers should focus on healthy monetary policy for economic growth of the country.
Examining the Adequate Content of Antenatal Care for Empowered Women in Nepal
Authors: Shrestha Bidhya
Published: October 2022

The most crucial aspects whenever we discuss antenatal care services are the coverage of antenatal care contacts and the contents of antenatal care during pregnancy. During the ANC contact, women get counselling and medical check-upfor their pregnancy which preventsnot only women but also the newborn babiesfrom preventable death. It is a window of opportunity for offering preventive measure to save the mother and newborn’s life. But despite the significance of antenatal care content in Nepal, many women are still being left behind, either directly or indirectly. Women empowerment and adequate content of care during ANC visits are both concerns about women's reproductive rights. Women who have greater power usually use antenatal care facilities. In this regard, the goal of this study is to look into the relationship between women empowerment and adequate content of care. This study is completely based on Nepal Demographic Health Survey, 2016. The main target populations of this study were women who weree currently married and had had at least one child in the two years before the survey. The content of care was found to be inadequate. Thus, women who had been left behind should be empowered to increase the adequate use of ANC services. Likewise, policies and activities should be tailored to serve the most marginalized, poor and vulnerable populations to offer sufficient, timely, and adequate ANC services in Nepal.
Understanding Civil-Military Relations for better Civilian Control of the Military in Nepal
Authors: Rawal Surendra Singh
Published: October 2022

Conducive civil-military relations (CMR) is essential for political stability, good governance, and the country's prosperity. However, there has been a misunderstanding or misinterpretation of this concept in some quarters in Nepal. The CMR is the relationship between the government and the military, especially the higher echelon of the officer corps, generally expressed as civilian control of the military. Good CMR is vital for national security and defence, which calls for organizing the military by balancing the societal and functional imperatives. While there are many existing theories in CMR, Nepal must focus on democratic civilian control as the country has embarked on a democratic political system. The features of democratic civilian control include division of authority between the state's organs and the military, parliamentary oversight, subordination of the military to civil society, and maintaining the credibility and accountability of the military. This qualitative study concludes that the MOD is a crossroads where military expertise and civilian legitimacy intersect and establish a power relationship between democratically-elected civilian representatives and the military. The civilians must have authority and capabilities in determining the military's policy issues, where the MOD and the legislatures must play an essential role in controlling and oversight the military. Specifically, the Parliamentary Defence Committee and the empowered Ministry of Defence must decide the military's size, roles, higher-level promotion, budget, procurement, and foreign relations.
Mapping Nepal's Foreign Policy Behaviour towards Great Power Politics: A Study of Nepal's Foreign Policy Response to the Russia-Ukraine Crisis
Authors: Bhattarai Gaurav , Pulami Manish Jung
Published: October 2022

A country's foreign policy is characterised by continuity and change. A stark divergence, however, between stated foreign policy objectives and practically implemented foreign policy behaviours cannot be convincingly vindicated as a routine transformation. Nepal's foreign policy objectives and principles are laid down in the Constitution and various foreign policy documents, particularly in the integrated foreign policy of 2020. A series of perceptible deviations from those guiding principles, without any justifiable reason, may label Nepal's foreign policy behaviour as an adventurist project. Today, while the residue of Cold War politics has enveloped the Russia-Ukraine crisis, Nepal has divulged traceable foreign policy responses over the same. Taking the case study of Nepal's foreign policy responses to the Russia-Ukraine crisis, the study aims to map Nepal's foreign policy behaviour toward great power politics. Surveying Nepal's foreign policy behaviour towards the United Nations and the great powers, particularly the United States and Russia, this study, firstly, identifies the sources of key changes and detectible transformations in Nepal's foreign policy behaviour. Secondly, drawing a critical analysis of Nepal's responses to the great power politics to understand the foreign policy behaviour of Nepal that has been ambiguous, ambivalent, and uncertain. Methodologically, this qualitative study has employed the framework of Foreign Policy Analysis (FPA) along with inductive as well as deductive methods of reasoning per the nature of non-numerical data.
Assessment of Environmental Policies and Institutions for Effective Air Quality Management in Nepal
Authors: Chauhan Raju , Shrestha Archana
Published: October 2022

Air pollution is a serious environmental threat in major cities of Nepal. The major emission source of air pollutants is vehicular emission, resuspension of street dust litter during dry climatic conditions, black smoke plumes from brick kilns, and refuse burning. Effective plans and policies are required for the effective management and monitoring of air pollution. This study aims to review environmental policies and plans prevalent in Nepal and assess their effectiveness in controlling air pollution. The study is based on the literature review and a questionnaire survey using Najam's 5C framework for policy analysis. Although several national policies, plans, laws and standards have been formulated and international agreements have been ratified for the management of air pollution, separate policy dedicated to air pollution management has not been formulated in Nepal. According to Najam's framework, the content, context, and commitment of the overall policies, plans, and agreements for managing air quality in Nepal were assessed as effective. However, the capacity of the implementor, client support, and management coordination was found ineffective. This study recommends that a separate policy on air quality management is required, while the capacities of stakeholders and coordination mechanisms should be strengthened to improve the country's air quality.
Evolving Trend of Domicile and Nationality in Private International Law with special reference to Nepal
Authors: Baral Sagar
Published: October 2022

Understanding the domicile and nationality is the key to properly adjudicating a case involving a foreign element by the judiciary. In this milieu, this paper aspires to analyse the concept of domicile and nationality with its evolving trend and evaluate the Nepalese judicial and legal policy on domicile and nationality through observation of international and local practices. Furthermore, this paper aims to trace the current policy gap in the legal and judicial interpretation of the domicile and nationality in the Nepalese context, including the citizenship bill. The paper concludes that connecting factors need to be used contextually on a case-to-case basis with proper policy genesis. It also prescribes key recommendations to address existing gaps, such as interpreting the habitual residence and nationality, domesticating the various Convention on the PIL such as Hague Conference on PIL, Law Applicable to Matrimonial Property Regimes, 1978, Celebration and Recognition of the Validity of Marriage, 1978, etc.
Functionality of Rural Community Water Supply Systems and Collective Action: a Case of Guras Rural Municipality, Karnali Province
Authors: Rajouria Alok , Wallace Tina , Joshi Deepa , Raut Manita
Published: October 2022

Ensuring the long-term functionality of community-managed rural water supply systems has been a persistent development challenge. It is well established that the technicalities of keeping the systems going are impacted by complex political, social, financial, and institutional challenges. While the shift to federal, three-tiered governance allocates concurrent responsibility for drinking water management to the local government with federal and provincial governments, water and sanitation user groups continue to shoulder the management of local supply systems voluntarily. All three levels have jurisdiction over water-related services resulting in confusion of roles. This study focuses on the local level, where community management of water and sanitation decentralisation is the key approach in this complex tangle of diverse institutions with different actors managing and governing water. User Groups and their Committees in the Guras Rural Municipality of Dailekh district, Karnali province, in West Nepal, provided the case study, which was analysed using Ostrom's well-recognised Eight Principles for Sustainable Governance of Common-Pool Resources. The community-based model, established formally through the Water Resource Act 1992 (2049 BS), is critically analysed in light of the changing socio- economic context through the intervening years. The results highlight the need for stronger collaboration between the rural municipality and users to achieve good water supplies and the risks of losing access and voice in water management for women and marginalised people when inactive user groups are replaced by private or group interests taking control of the water access.
Policy Problems and Progressive Solutions to Halt Increasing Social Harms on Disadvantaged Rural Communities from Current Neo-Colonial Land Grabbing Policy in Nepal: Insights and Opinions
Authors: Dhakal Bhubaneswor , Adhikari Kedar
Published: October 2022

Many critical problems are intensified in rural Nepal despite the policy advice and financial support from international agencies to alleviate them. This study attempted to explain the causes and policy solutions to the problems based on secondary sources of data and the authors’ insights. It identified that international agencies involved actively in policymaking and guided the land resource management policy to result in the best benefits to the people in privileged regions and other countries. The policies ruined institutions, resource conditions, social-ecological systems, and social environments essential for sustaining mountain farming and the rural economy in the country. The destructions exacerbated emigration, farming land abandonment, indigenous farming practice loss, food insecurity, and cultural heritage degradation. Adverse impacts of the policy interventions are exposed higher in disadvantaged areas and especially in the regions of indigenous ethnic communities. Those policies have institutionally placed the communities suffering for generations and increased risks of out-breaking interethnic conflicts and national security threats on many dimensions. This study explained some pragmatic policy measures to manage the agriculture and forestry resources for community wellbeing and national security. It also demonstrated how the national expert-driven policies would be for addressing the current problems in rural areas and the holistic development of the nation.
Governance of Asta-Ja Resources in Nepal
Authors: Poudel Durga Dutta
Published: October 2022

Nepal is endowed with vast natural and human resources, collectively called "Asta-Ja" resources. Asta-Ja means eight Ja, Nepali letter "Ja", Jal (water), Jamin (land), Jungle (forest), Jadibuti (medicinal and aromatic plants), Janashakti (human resource), Janawar (animals), Jarajuri (crop plants), and Jalabayu (climate). Sustainable management of Asta- Ja resources constitutes the major goal of the government of Nepal. Governance of Asta- Ja resources must enhance accelerated economic growth and fast-paced socio-economic transformation of the society while addressing the issues of social and climate justice, inclusion, and other inequalities. A step-by-step, theoretically grounded, inclusive, participatory, and comprehensive Asta-Ja Governance Framework (Asta-Ja GF) are proposed for the best governance of Asta-Ja resources in Nepal. The Asta-Ja GF consists of seven steps, 1) status and linkages of Asta-Ja resources, 2) resources ownership, 3) policies and practices, 4) community engagement, 5) incentives and revenue sharing, 6) infrastructure investment, and 7) monitoring, evaluation, and reporting are proposed. Institution building at the local, regional, and national levels for effective governance of Asta-Ja resources is emphasised. This paper thus studies the Asta-Ja Framework in the purview of laws, policies and plans adopted by the country for the sustainable development and utilisation of natural resources. The paper also enlists the reasons why there is a need for effective governance of Asta-Ja.
स्वास्थ्य क्षेत्रको समयानुकूल रूपान्तरणका लागि अनुसन्धान {Research for timely transformation of the health sector}
Authors: Pandey Mrigrendra Raj
Published: October 2022

डा. मृगेन्द्र राज पाण्डेले पाच दसक भन्दा बढी नेपालको स्वास्थ्य क्षेत्रमा विशिष्ट योगदान गर्नु भएको छ । उहाँले नेपालको स्वास्थ्य नीति निर्माण, जनचेतना फैलाउने र अनुसन्धानमा महत्त्वपूर्ण योगदान पुर्‍याउनु भएको छ । उहाँले नेपालमा स्वास्थ्य अनुसन्धान परिषद स्थापना, विर अस्पतालमा मेडिकल र सर्जरी विभाग स्थापना लगायत स्वास्थ्य क्षेत्र सुधारमा पनि महत्त्वपूर्ण योगदान पुर्‍याउनु भएको छ ।
नेपाली भाषा, कला र सांस्कृतिक सम्पदाको संरक्षण तथा विकास {Protection and development of Nepali language, art and cultural heritage}
Authors: Joshi Satya Mohan
Published: October 2022

नेपाली भाषा, कला र संस्कृतिको संरक्षण, संवर्द्धन र विकासका लागि निरन्तर रूपमा लागि रहनुभएका संस्कृतिविद् सत्यमोहन जोशीले नेपालको संस्कृति र सम्पदा संरक्षणमा अतुलनीय योगदान दिनुभएको छ । साथै उहाँको नेवारी भाषा र संस्कृति प्रवर्द्धनमा पनि महत्त्वपूर्ण योगदान छ । राष्ट्रिय संस्कृति नीति तर्जुमामा पनि विज्ञको रूपमा उहाँको महइभ्वपूर्ण योगदान छ ।
Financial Growth Assessment of Private Life Insurers in India: An Aggregative Study
Authors: Basu Tamal , Aithal P.S.
Published: October 2022

Presently, Indian insurance industry has 57 insurance companies, out of which 24 are in the life insurance sector. Among all the life insurers, only LIC is the public insurer and the remaining 23 companies are private insurers. The entire route of allowing private insurance companies in India had begun in the early 1990s. A well-developed insurance sector with participation from both private and public players is the key to economic development as it delivers a source of long-term funds for infrastructure development.
In this background, the study aims to examine the trend growth rates and the differences in growth rates of earnings and financial health indicators during the period 2010-11 to 2019-20.
The findings of the study show mixed results with respect to earnings and financial health performance of private life insurers in India. To arrive at a meaningful conclusion, overall earnings and financial health indicators are measured. The overall results show that there has been no change in the overall earnings and financial health indicators as revealed by Chow test during the period under study.
On the whole, it may be stated that in spite of significant positive growth in FDIR, the private life insurers have not shown satisfactory performance (i.e., no significant impact due to FDI hike) with respect to earnings and financial health indicators during the study period.