bluuebunny/crossref_metadata_2025 huggingface dataset:
Entre os nós do trabalho financeiro: modernizações em Buenos Aires e São Paulo
Authors: Creuz Villy
Published: April 2022

O sistema de objetos instalado em Buenos Aires e São Paulo autoriza uma vigorosa expansão de atores sociais ligados às finanças. Trataremos sobre as empresas de intermediação de pagamentos digitais e das redes físicas de operacionalização de pagamentos que elaboram uma divisão social e territorial do trabalho complexa. Destacam-se, em especial, a participação de firmas como Casas Lotéricas, Bancos Postais, Rapipago, Pago Fácil, Prisma Medios de Pago, PagSeguro e Western Union. Nesse contexto, também o envio de remessas de dinheiro é um importante mercado a ser considerado. A técnica produz novos conteúdos nas cidades e, nesse enredo, a circulação da moeda integra, pelo consumo e pela prestação de serviços, aos atores sociais com menores graus capital, organização e tecnologia.
O território e a região na política de saúde brasileira: entre as concepções teóricas e as práticas de gestão
Authors: Feitosa Luciana da Costa
Published: April 2022

O artigo tem por objetivo demonstrar as concepções e divergências teóricas e operacionais que fundamentam os princípios da territorialização e da regionalização na Política de Saúde brasileira. Desde os anos 1970, quando o raciocínio geográfico passou a ser inserido no embasamento do conceito ampliado de saúde – base do planejamento do Sistema Único de Saúde (SUS) em escala nacional –, que o debate sobre a importância do território e da região vem ganhando espaço nas estratégias de promoção e operacionalização de uma política que leve em consideração as particularidades das condições de vida e dos lugares para ser plenamente eficaz. No entanto, o fundamento teórico e metodológico desses dois conceitos seguiu lógicas distintas durante o processo de construção e implementação da Política de Saúde brasileira, o que causa descompassos e assimetrias nas práticas de gestão do SUS.

O artigo tem por objetivo demonstrar as concepções e divergências teóricas e operacionais que fundamentam os princípios da territorialização e da regionalização na Política de Saúde brasileira. Desde os anos 1970, quando o raciocínio geográfico passou a ser inserido no embasamento do conceito ampliado de saúde - base do planejamento do Sistema Único de Saúde (SUS) em escala nacional - que o debate sobre a importância do território e da região vem ganhando espaço nas estratégias de promoção e operacionalização de uma política que leve em consideração as particularidades das condições de vida e dos lugares para ser plenamente eficaz. No entanto, o fundamento teórico e metodológico desses dois conceitos seguiu lógicas distintas durante o processo de construção e implementação da Política de Saúde brasileira, o que causa descompassos e assimetrias nas práticas de gestão do SUS.
A atividade seguradora marítima no Brasil, regulação do território e a questão da porosidade
Authors: Barros Rita
Published: April 2022

Neste trabalho, propusemos observar o seguro marítimo como um segmento da atividade seguradora e resseguradora brasileira que se conecta, enquanto serviço financeiro especializado, diretamente à circulação de mercadorias em escala internacional, buscando compreender em que medida tal segmento se relaciona com a produção de normas que regulam o território. As análises a seguir tratarão, assim, de apresentar os principais marcos regulatórios da atividade no contexto da formação socioespacial em que se inseriram, caracterizando algumas das empresas que ofereceram, ao longo do tempo, seguros de transportes marítimos no país, e buscando, ao mesmo tempo, observar em que medida esse segmento de serviços – ao se associar ao estabelecimento de normas que regulam as atividades produtivas, a evasão de divisas e as políticas de investimento do governo federal – pode ser interpretado como um agente regulador da porosidade territorial.
Entrevista: Stefan Ouma
Authors: Nascimento Rodrigo Cavalcanti do
Published: April 2022

O geógrafo Stefan Ouma conversa sobre a atual fase financeira e o recente processo de “corrida” por terras em escala global denominado land grabbing ou land rush. Dentro de uma perspectiva dos territórios africanos, especialmente na Tanzânia, no Quênia, no Sudão, na Etiópia e na África do Sul, nesta entrevista ele expõe as diferentes formas com que os representantes do capital financeiro buscam oportunidades mais lucrativas ao longo de toda a cadeia produtiva das commodities agrícolas e não exclusivamente através da aquisição de terras, como vem sendo amplamente divulgado pelos relatórios internacionais e artigos acadêmicos.
Os centros de comando das notícias e a rede urbana brasileira
Authors: Pasti André
Published: April 2022

Este artigo busca analisar desdobramentos da organização dos círculos de informações noticiosas para a atual configuração da rede urbana brasileira, identificando os pontos nevrálgicos dessa rede e discutindo suas funções no que se refere ao comando da informação no território brasileiro. Para isso, privilegia a análise das redes das agências transnacionais de notícias – agentes privilegiados do comando dos fluxos informacionais globais – e dos grupos de mídia controladores dos veículos de maior audiência no território brasileiro.
Considerações acerca das articulações federativas na implementação do Programa Minha Casa, Minha Vida em contextos metropolitanos
Authors: Nobre Carlos Eduardo
Published: April 2022

Neste trabalho, apresentamos uma discussão sintética que resultou de nossa tese acerca das articulações federativas para implementação do Programa Minha Casa, Minha Vida na Região Metropolitana de São Paulo (RMSP). Tivemos como objetivo compreender a implementação do referido programa habitacional em municípios que integram regiões metropolitanas levando em conta o contexto da organização política do território pela federação. A problemática proposta diz respeito ao fato de que ao tempo em que os municípios metropolitanos se articulam e cooperam verticalmente com o Governo Federal, no sentido de promoverem habitação de interesse social, esses mesmos municípios se desarticulam horizontalmente e competem entre si em torno dos recursos e investimentos. O resultado desse processo consistiria em desintegração e fragmentação sociais e territoriais da metrópole.
A pedagogia das competências e o ensino de Geografia no estado de São Paulo: um olhar crítico para a orientação pedagógica dos documentos oficiais
Authors: Aversa Vinicius de Oliveira , De Bairro Gabriel Pinto
Published: April 2022

Este artigo tem o intuito de analisar de maneira comparativa e amparados pelas concepções da pedagogia histórico-crítica, quais as aproximações existentes entre os posicionamentos teórico-pedagógicos presentes nos discursos dos documentos oficiais do Estado de São Paulo, e na recém lançada Base Nacional Comum Curricular (BNCC), revelando a adoção por esses documentos de um ideário valorativo baseado em um conjunto de teorias de cunho imediatista, adaptativo e reacionário. Deste modo, buscamos trazer a discussão acerca da formação do indivíduo frente a esta tendência pedagógica, que pretende o desenvolvimento de competências e habilidades nos sujeitos, para que os mesmos se adequem da melhor maneira ao seu cotidiano, atendendo as demandas mercadológicas essenciais para a manutenção da ordem social vigente.
Geografia da Infância e sua importância na ação educativa
Authors: Carvalho André Luiz Silva , Maia Diego Corrêa
Published: April 2022

A participação infantil na sociedade, paulatinamente vem assumindo seu protagonismo que lhe é de direito, no entanto, é preciso percorrer um longo caminho para que a infância seja encarada como um elemento social relevante e atuante em sua vivência. Sob a perspectiva histórico-cultural, este artigo objetiva examinar as experiências vivenciadas em uma escola municipal pública da educação básica, sediada na periferia da área urbana de Rio Claro (SP). Através da pesquisa etnográfica, procedeu-se o desenvolvimento de práticas pedagógicas que propiciaram à apreensão elementar dos conceitos de lugar, território, região e paisagem. Com o auxílio de visitas técnicas, mapas mentais e rodas de conversa com o uso de imagens, atingimos o objetivo proposto, ao abordarmos a Geografia da Infância nos anos iniciais.
As rodas de samba do Distrito Federal brasileiro como patrimônio-territorial: uma construção metodológica
Authors: Alves Vitor João Ramos
Published: April 2022

Ao considerar as rodas de samba do Distrito Federal brasileiro como fenômeno produzido pela ação humana (a partir dos negros), expressadas como manifestação artística popular, que visibilizam e reforçam a presença e a participação dos negros no processo de formação da América Latina, da formação socioespacial brasileira e da formação do território do Distrito Federal, buscou-se com o presente trabalho apresentar a construção do percurso metodológico da tese de doutoramento intitulada “Patrimônio-territorial na América Latina: as rodas de samba como expressão de resistência negra no Distrito Federal brasileiro”, iniciada em 2017, na Universidade de Brasília, pelo Departamento de Pós-graduação em Geografia. Revelando os principais conceitos geográficos que serão trabalhados e os caminhos metodológicos adotados para a efetivação da pesquisa, o trabalho apresenta ainda a realização de uma devolutiva pública, como parte do compromisso firmado entre o pesquisador e a comunidade investigada.
Nota: 14º Encontro Nacional de Prática de Ensino em Geografia “Políticas, Linguagens e Trajetórias”
Authors: Rafael Pedro Henrique de Souza , Dias Gabriela Klering , Gonçalves de Lima Renan Pessina , Da Cruz Neto Manoel Félix , Vieira de Oliveira Pinto Igor Cauê
Published: April 2022

A presente nota busca relatar os acontecidos durante o 14º Encontro Nacional de Práticas de Ensino em Geografia (ENPEG): Políticas, Linguagens e Trajetórias, realizado nos dias 29 de junho a 4 de julho de 2019 nas dependências da Universidade Estadual de Campinas (UNICAMP). Buscando a congregação de estudantes de graduação e pós-graduação, professores da rede básica e universitária, o ENPEG foi organizado com palestras, mesas redondas, grupos de trabalho, forúns livres, trabalhos de campo, oficinas e minicursos, todos com o objetivo de refletir sobre as políticas, linguagens e trajetórias no âmbito do Ensino de Geografia. Com 565 trabalhos submetidos ao evento e 652 participantes de todas as regiões do Brasil, o evento mostra a importância e relevância do Ensino de Geografia no cenário nacional atual.
A abordagem dinâmica no ensino de climatologia
Authors: De Oliveira Araujo Larissa Romana , Da Silva Oscar Júnior Antônio Carlos
Published: April 2022

A disciplina de Geografia tem como desafio aproximar as escalas global e local, em especial no que se refere à climatologia. Para compreender a abordagem desse tema no ensino básico, é necessário atentar para como os documentos educacionais normativos estruturam os conteúdos de Geografia. Com este mote, o presente artigo objetiva analisar como a Climatologia está presente nos currículos da Educação Básica a partir das políticas públicas educacionais, compreendendo as temáticas a serem discutidas bem como as habilidades e competências a serem exploradas. Para tanto, foram explorados a Base Nacional Comum Curricular, os Parâmetros Curriculares Nacionais para o Ensino Médio e o Currículo Mínimo de Geografia produzido pela Secretaria de Estado de Educação do Estado do Rio de Janeiro (SEEDUC). Como resultado contatou-se que o ensino de Climatologia está concentrado nos currículos do 6o ano do Ensino Fundamental e do 1º ano do Ensino Médio. Enfim, percebem- se orientações para abordagem dinâmica do clima, superando a superficialidade da descrição e classificação.
Geografia e Comércio Internacional: breve revisão bibliográfica
Authors: Arroyo Mónica
Published: April 2022

Este artigo apresenta uma revisão bibliográfica que busca indagar como o comércio internacional tem sido abordado pelos geógrafos. Selecionamos autores sobretudo da geografia anglo-saxã e, em menor medida, francesa. Os trabalhos analisados foram agrupados da seguinte maneira: 1) textos de uma fase inicial, quando imperavam a descrição e o inventário; 2) textos escritos nas décadas de 1980 e 1990, quando cresce o debate sobre a globalização; e 3) textos mais recentes, escritos nas primeiras duas décadas do século XXI, atendendo à complexidade crescente do mundo contemporâneo e preocupados em avançar no caminho da teorização geográfica.
As geometrias do poder do ciberespaço
Authors: Zusman Perla
Published: April 2022

Texto originalmente intitulado “Las geometrías del poder del ciberespacio”, revisado e atualizado pela autora. Traduzido da versão publicada no livro “Pantallas, derechos, cultura y conocimiento: nuevos desafíos para las humanidades”, com coordenação geral de Alejandro Spiegel (Editorial de la Facultad de Filosofía y Letras de la Universidad de Buenos Aires, 2017). Tradução: Melissa Steda (USP). Agradecemos a Perla Zusman e à Editora da Faculdade de Filosofia e Letras da Universidade de Buenos Aires por permitirem que o presente artigo fosse traduzido e publicado nesta edição do Boletim Campineiro de Geografia.
Pulled by God: Sound and Altered State of Consciousness in the Hälqä-Sohbät Ritual of Uyghur Sufis
Authors: Mu Qian
Published: April 2022

In Xinjiang, northwestern China, the Uyghur Sufi Muslims practice a localised samāʿ ritual called hälqä-sohbät, which involves dhikr, singing and dancing. Participants in hälqä-sohbät sometimes enter an altered state of consciousness called jäzba, which literally means pulled by God. The hälqä-sohbät includes various sounds such as the singing of hikmät, muqam and mäshräp, as well as instrument playing. However, Uyghur Sufis often deny the role of sound as a decisive factor in triggering jäzba, but attribute its causation to the practice of dhikr, especially silent dhikr. Based on ethnographic data from Khotan, southern Xinjiang, and inspired by Leman’s research framework for music, gesture and embodied meaning, I study the relationship between sound and jäzba in hälqä-sohbät in three perspectives: a first-person perspective from the point of view of the practitioners; a second-person perspective in which hälqä-sohbät is viewed as a way of social interaction in a “me to you” way; and a third-person perspective in which I, the researcher, try to disclose and analyse the various factors at work in triggering the altered state of consciousness, such as timbre, rhythm, and physical movements.
Terminal Archive? Taking and Returning Sound recordings: Two Examples from the Vienna Phonogrammarchiv
Authors: Lechleitner Gerda
Published: April 2022

An overall assumption might express that music in general and songs in particular belong to the performers – researchers are interested in any music and “take” songs or instrumental pieces (as sound recordings) with them, often also to an archive. Metaphorically speaking, the sounds of a region leave their original place, captured by interested persons, enthusiasts or researchers, to be then studied, listened to and stored elsewhere.
The stories behind the recorded music will be shown. Unequal recording situations give rise to recordings of different content and context – in that respect, the moving around of what was recorded where and by whom will be retraced from early expeditions showing a “standard” field research situation, in contrast to an “exceptional” research situation as conducted in prisoner-of-war camps during WWI. Two examples, a recording of instrumental music performed by a Crimean Tatar and a well-known story spoken in a special South Italian dialect, underline the process of taking and returning sound recordings.
Finally, the discussion is related to what happened with the music and what the role of the performer or the source community, researcher and archivist is. What are the consequences of their relationship with each other?
Choir transhumance in the Filipino Catholic community in Rome
Authors: Facci Serena , Tuzi Grazia
Published: April 2022

The article is part of a research project (2014-2018) among Christian immigrants in Rome and focuses particularly on the Filipino community. Serena Facci presents the general context of the migrant church experience of Rome, a city historically considered as central to the wider transnational community of Catholic Christians, where, thanks to the hosting politics of the Vicariate, there are several ‘national’ and ‘multinational’ churches, characterised by liturgies in different languages and by repertoires of chants in different geocultural styles. The migrants’ position in the holy city is juxtaposed with the multicentricity of the diaspora and the mediation between the motherland and the new places of residence. Grazia Tuzi shows how the Filipinos in Rome represent this multicentricity through the liturgical services of musical groups and choirs from the peripheral churches surrounding Rome. On Sundays, the Filipino micro-communities proceed in a kind of “transhumant” movement according to a predetermined schedule, from their parishes to the Chaplaincy located in the Basilica of Santa Pudenziana, which is the gathering place of all Filipinos living in Rome. Here they accompany the Sunday liturgy and religious Festivals in performances that bear witness to a remarkable musical variety.
The analysis of these musical practices and the complex organization of the choir’s "transhumance" from the periphery to the centre can facilitate the understanding of the processes used by this migrant community in the re-articulation and maintenance of their own identity in the new socio-cultural spheres.
Sikh Religious Music in a Migrating Context: The Role of Media
Authors: Tiramani Thea
Published: April 2022

The aim of this article is to provide an initial study of the relationship between music and media in the Sikh communities in migration.
It is easy to notice the great connection between Sikhs all over the world and the homeland: social media, television, Internet, and web radio greatly help Sikhs to create networks and to preserve a strong religious identity.
Technologies also allow musical tendencies from India to be gathered and reproduced in the migratory context. Music is a fundamental aspect in the Sikh religion: it is necessary for the religious rites, but also takes on a dominant role in cultural transmission.
Based on field research conducted in Sikhs communities in Northern Italy, this article offers practical and concrete examples of how social media and Internet are employed by musicians in the construction and definition of a musical Sikh identity abroad. This can help to develop a more comprehensive view of the music functions in such a complex diaspora community.
Migration of People and Melodies in the Taiga Area of Southern Siberia
Authors: Sychenko Galina
Published: April 2022

The article focuses on the song tradition of the Chalkans – a small Turkic-speaking population living in a taiga zone of southern Siberia. The main objectives are: analysis of archival collections; comparison of the results of this analysis with historical data; and possible reconstruction of the historical process of the spreading of melodies in the area.The introduction examines different concepts of transhumance as applied to cultural artefacts. This concept is then discussed with regard to the Chalkan culture. Natural, social, economic and historical contexts are briefly described prior to the analysis of Chalkan songs. After discussing materials and methodology, historical strata of the song tradition are described, and the category of lyric songs with modal tunes is examined in greater detail. A general description is provided of its grammar as well as the conceptualisation of the songs, followed by analysis of the distribution of two main versions of tunes (3H- or “major” and 3L- or “minor”) according to local and gender criteria.Preliminary conclusions are provided on the presence of two local traditions (Suranash, or Lebed’, and Kurmach-Baigol, or Baigol) and male and female performance styles.
Franceschino Back Home
Authors: Bravi Paolo , Carboni Salvatore
Published: April 2022

Francesco Demuro is a 43-year-old accomplished opera singer from Sardinia. In the present days his career as a tenor singer takes him to famous concert halls all over the world. He took his first steps in the world of singing, however, not as an opera singer, but as a folk singer in the Sardinian tradition of a chiterra song. He debuted as a mini-cantadore (‘little singer’) on the stages of the local festivals and TVs in Sardinia and, ever since, has come to be known amongst the enthusiasts of a chiterra song with the diminutive of Franceschino, ‘little Francesco’.
After having reached the most prominent position in this Sardinian traditional style, Demuro started studying as an opera singer. Later he abandoned his career as a folk singer to pursue opera singing once and for all, while always proudly declaring his origins as a singer of Sardinian traditional music.
In this paper, some aspects mastered by Demuro with regard to the different vocal styles – as a singer of Sardinian music and as an opera singer – will be examined through both a detailed analysis of his vocal style in the two genres over the years and by gathering Demuro’s personal memoirs and accounts of his evolution as a professional singer.
KNOWLEDGE, ATTITUDE AND PRACTICE OF ABORTION IN SLUM AREA OF KATHMANDU
Authors: Manandhar Naresh , Pokhrel Milan , Yadav Ramananda , Satyadharm  , Gautam Komal Prasad , Raj Rishabh , Pokhrel Diksha , Joshi Sunil Kumar
Published: April 2022

Background: Abortion is legal up to 12 weeks’ gestation period in Nepal. Due to a lack of proper abortion services and socio cultural stigma, every year many women died due to abortion. The aim of this study was to asses the knowledge, attitude and practice of abortion in the residents of slum area of Kathmandu district.
Methods: The cross-sectional study was conducted in slum area of Kathmandu district from 20th December, 2020 to 15th January, 2021. The sample size was 255 and convenient sampling technique was used to select the participant aged above 15years. The collected data were enter in MS excel and analysis was performed using SPSS version 22.
Results: The prevalence of abortion was 25.27%.The level of knowledge was found significant with education status. Age, marital status, ethnicity were found significant with attitude of the respondents. Ten percentages of the female respondents had done unsafe abortion. The complications after abortion were the bleeding (54.3%), trauma (15.20%), loss of consciousness (13.0%) and abdominal pain (2.20%).
Conclusions: The level of knowledge of participants of the present study found to be satisfactory but attitude was less satisfactory with compared to the knowledge about the abortion.
LAPAROSCOPIC REMOVAL OF FOREIGN BODY- A CASE REPORT
Authors: Jha Santosh , Dangal Ganesh
Published: April 2022

Iatrogenic disease is defined as an illness caused by diagnostic procedures or treatment given by health care professionals. Iatrogenic foreign bodies are not uncommon in the medical literature. It is primarily as a result of human error and is reported rarely due to medico legal implications it car­ries. The varieties of foreign bodies like sponge, gauze, surgical instruments have been retrieved. Retained surgical sponge or gauze after operation is called Gossypiboma. It has varied and vague presentation and is also difficult to detect by radiological investigations.
STATUS OF ANXIETY AND DEPRESSION AMONG ELDERLY RESIDING IN A COMMUNITY OF TARAKESHWOR MUNICIPALITY, KATHMANDU
Authors: Bhattarai Tilarupa , Sharma Muna , Sharma Chandrakala , Bista Archana Pandey
Published: April 2022

Background: Together with increase in lifespan of human beings, mental health problems among elderly people are also being noticed more. The common problems are anxiety and depression. Timely identification and treatment improve the quality of life of elderly. This may prevent suicide and premature death too. This study aimed to find out anxiety and de­pression among elderly in a community of Tarakeshwor Municipality, Kathmandu.
Methods: Descriptive cross-sectional survey was done among 84 elderly, aged 65 years and above, residing in rural communities of Kathmandu. Data was collected through interview method in the household survey using tool translated in Nepali language including Geriatric Depression Scale short version (GDS-15) and Geriatric Anxiety Scale (GAS-10). Data analysis was done using SPSS version 22 for window. Descriptive findings were presented in tables including frequency, percent­age, mean and standard deviation. Chi-square test was used to measure the association between variables.
Results: The mean age of the elderly was 72.29±6.96 years. Proportion of females (59.4%) was greater than male (40.6%). Among the surveyed elderly, 14.3% were having depression and 27.4% were having anxiety where 13.1%, 3.6% and 10.7% had mild, moderate and severe anxiety respec­tively. Anxiety and depression were not associated with any socio-demographic characteristics, except anxiety was significantly associated with their ability to move (p=0.006). Anxiety and de­pression among elderly were positively correlated (r=0.388, p=<0.001)
Conclusions: Few elderly residing in a community have symptoms of depression but more than one forth have anxiety symptoms. Elderly with problem in movement should be assessed and cared for potential anxiety.
SURGICAL OUTCOME OF THE SUPERIOR MESENTERIC ARTERY FIRST TECHNIQUE COMBINING POSTERIOR AND UNCINATE PROCESS APPROACH TO PANCREATICODUODENECTOMY FOR THE PANCREATIC HEAD AND THE PERIAMPULLARY CANCER
Authors: Shrestha Anup , Thakur Binay , Devkota Mukti , Bhattarai Abhishek , Chand Manoj , Katwal Gaurav , Neupane Harish Chandra
Published: April 2022

Background: Pancreaticoduodenectomy is the only curative treatment for periampullary and head of pancreas cancers. Various approaches have been described as the superior mesen­teric artery (SMA) first technique. This study aimed to report the surgical outcome of the SMA first technique combining posterior and uncinate process approach to pancreaticoduo­denectomy.
Methods: This retrospective study was done at the Department of Surgical Oncology at BP Koirala Memorial Cancer Hospital. The data was collected from January 2015 to September 2020. All the patients underwent pancreaticoduodenectomy for pancreatic head cancer and periampullary can­cer with the technique combining posterior and uncinate process approaches.
Results: A total of 85 patients underwent pancreaticoduodenectomy with 42.4% male and 57.6% female. Fifty-nine (69.4%) cases were classified as resectable and 26 (30.6%) as borderline re­sectable. The median operative time was 300 minutes. The median intraoperative blood loss was 391ml. Intra-operative blood transfusion was done in 8.5%. The median total number of dissected lymph nodes was 13. The postoperative pancreatic fistula was seen in 8 patients while 4 patients had a post-pancreatectomy hemorrhage. Delayed gastric emptying was seen in 12 patients. There were overall 8 (9.4%) in-hospital mortality. R0 resection was achieved in 84 patients (98.82%).
Conclusions: The combined posterior and uncinate process approach SMA first technique for pan­creaticoduodenectomy is a safe and standard technique. It decreases intraoperative blood loss, to­tal operative time, and increases R0 resection compared to posterior or uncinate process approach only. It plays a key role in lowering the postoperative complication rate.
DIAGNOSIS AND MANAGEMENT OF GALLBLADDER PERFORATION: A SINGLE-CENTER EXPERIENCE
Authors: Bhattarai Abhishek , Devkota Pragya , Shrestha Anup , Gurung Keshmaya , Tamrakar Kishor Kumar , Neupane Harish Chandra
Published: April 2022

Background: Gall bladder perforation is one of the uncommon serious complications of cholelithiasis and cholecystitis with high morbidity and mortality. Presentation of gall bladder perforation may vary from that of similar to acute calculus cholecystitis, perforation peritonitis, palpable gall bladder mass to gall stone ileus. Here, we present our experience on the diagnosis and management of the case of gall bladder perforation.
Methods: This is the retrospective review of the records of 24 patients who received medical and/or surgical treatment with the diagnosis of gall bladder perforation at Chitwan Medical College from January 2016 to December 2020. All the patients with suspicion of gall bladder perforation underwent contrast enhanced CT scan before an operation or prior intervention.The parameters including age, gender, type of perforation, comorbidities, symptoms, diagnostic procedures, treatment modalities, morbidity, and mortality were evaluated.
Results: A total of 24 patients were included in the study during the study period. Among them 62.5% (n=15) were male and 37.5% (n=9) were female.The median age of presentation was 69 years. One patient (4.1%) had type I, 87.5% (n= 21) had type II, and 8.3 % (n=2) had type III gall bladder perforation. CT scan visualizes the defect in gall bladder wall and identifies perforation in all cases. Operative management was done in 12.5% (n=3) patients and percutaneous drainage of gallbladder was done in 87.5% (n=21). The comorbid disease was present in 83.3 % (n=20) of the cases. The median duration of hospital stay was 7 days and there was no mortality.
Conclusions: Gall bladder perforation is commonly seen in patients with acute cholecystitis and associated comorbidities. Type II gall bladder perforation is the most common type. Contrast-enhanced CT has an important role in diagnosing gallbladder perforation. Early suspicion, diagnosis, and appropriate management are of crucial importance for a better outcome in patients with gall bladder perforation.
RESEARCH ORIENTED MEDICAL SCHOOL CURRICULA TO NURTURE UNDERGRADUATES IN PREPARATION FOR THE FUTURE PHYSICIAN SCIENTISTS: RELEVANCE FOR DEVELOPING COUNTRIES
Authors: Shah Jay , Baral Gehanath , Dangal Ganesh , Neupane Harish Chandra
Published: April 2022

N/A
ASSESSMENT OF POSTOPERATIVE PAIN AND ANALGESIC USE IN PATIENTS UNDERGOING ORTHOPEDIC SURGERY
Authors: Sharma Bishnu Dev , Sitaula Jyoti
Published: April 2022

Background: Pain is an unpleasant sensation and occurs frequently in the post-operative period. Pain impairs treatment and recovery of patients and thus should be adequately managed. This study aimed to assess the intensity of pain in the post-operative patients undergoing orthopedic surgery and to evaluate the adequacy of the analgesics used.
Methods: This was a prospective observational study conducted at Chitwan Medical College, Department of Orthopedics from May to August 2019. Ninety-six patients who underwent orthopedic surgery were evaluated upto 72 hours after surgery and assessed for pain using interview, Visual Analogue Scale and medical record analysis. Type of analgesic used and its adequacy, using Pain Management Index, were also studied.
Results: There were 58 male and 38 female patients with age 18-79 years (mean 38.16 ± 16.34 years). 97.9% patients complained of pain in immediate, 91.7% in 1st and 82.3% in 2nd post-operative period with mean Visual Analogue Scale scores of 6.68, 3.74 and 2.68 respectively. Non-steroidal anti-inflammatory drug was the most frequently prescribed analgesic followed by its combination with opioid. Pain management was inadequate in immediate post-operative (61.5%), but there was significant improvement in 1st and 2nd post-operative period (inadequate Pain Management Index in 28.1% and 12.5% respectively).
Conclusions: Most patients experienced pain in the post-operative period, but the intensity decreased as the post-operative hours passed by. Pain management in the immediate post-operative period was inadequate in our study and therefore proper attention should be given to manage pain in the post-operative period.
DIABETIC RETINOPAHTY: KNOWLEDGE, ATTITUDE AND PRACTICE
Authors: Giri Puspa , Sah Ranjeet , Shrestha Manisha , Husain Mansuri Raja , Dhital Bishnu Mani , Ranabhat Sudha
Published: April 2022

Background: Diabetes Mellitus is a metabolic disorder with a multisystemic involvement such as heart, blood vessels, kidneys, nerves including eyes where, hyperglycemia causes loss of pericytes and thus damages retinal capillaries leading to diabetic retinopathy. The aim of this study was to access knowledge, attitude and practice pattern in diabetes patients residing in Chitwan and neighboring districts.
Methods: A community based cross-sectional study was carried out involving diabetes mellitus patients in three districts namely Chitwan, Nawalpur and Gorkha province along with patients who were referred to the hospital. Questionnaire were provided to the patients that accessing knowledge about the ocular complications, attitude and practice concerning diabetes and diabetic retinopathy. General systemic and ocular examinations were performed, including assessment of random blood sugar. The data was collected from March 2019 to June 2019. The collected data analyzed using Statistical Package for Social Studies (SPSS) version 11 (Armonk, IBM, USA).
Results: This study included 500 patients, ranging from 30-85years. Diabetes mellitus was diagnosed at an average age of 60.52±11.47 years (32-89 years) who were mostly being treated with an oral-hypoglycemic agents. About 95.2% of the patients in the screening camp and 96.4% from hospital were aware regarding the ocular complication in diabetes. Diabetic retinopathy prevalence was observed in 28% of the patients out of which 26% were from screening camp and 14.8% were from hospital, in whom bilateral ocular involvement were frequently observed.
Conclusions: The knowledge and attitude of the patient in our study were found to be adequate towards the diabetes and diabetic retinopathy. Nonetheless, this was not executed well in daily practice by the respondents.
DISTAL TIBIA INTEROSSEOUS OSTEOCHONDROMA WITH FIBULA DEFORMITY
Authors: Panta Sunil , Thapa Shrawan Kumar , Paudel Krishna Prasad
Published: April 2022

Osteochondroma, one of the commonest bone tumors, is a cartilage capped exostosis. It occurs commonly in rapidly growing ends of long bones. It’s rare in slowly growing regions of long bones. Osteochondroma present in distal tibial interosseous border causing fibular deformity is very uncommon. Osteochondroma is usually managed conservatively till the age of skeletal maturity, but distal tibial osteochondromas are managed surgically to prevent deformity, impending fibula fracture, ankle pain, syndesmotic injury irrespective of skeletal maturity. It is a case report of an 18-year-old male with gradually increasing, painless mass at the distal leg for 6 years, increasing bowing deformity since 2 years with no functional limitations. Clinical and radiological findings were consistent with distal tibial osteochondroma with deformity of the adjoining fibula. Exostosis was excised successfully leaving a thin deformed distal fibula. The result was painless, stable, and non-progressive residual ankle deformity. Histopathology confirmed the diagnosis with no malignant transformation.
CLINICAL EFFICACY AND SAFETY BETWEEN CONTINUOUS ROTARY AND RECIPROCATING ROOT CANAL INSTRUMENTATION SYSTEMS
Authors: Chaudhary Govind Kumar , Alam Md. Shamsul , Hossain Mozammal
Published: April 2022

Background: The single file reciprocating system prepares the canal quickly with a better centric ability and has increased resistance to cyclic fatigue compared to the continuous rotary file system. However, the former file system was associated with more postoperative pain than the latter. The goal of the present study was to evaluate and compare the clinical efficacy and safety between continuous rotary and reciprocating instrumentation systems.
Methods: Fifty patients who fulfilled specific inclusion criteria were assigned into 2 groups according to the root canal instrumentation technique used, ProTaper Gold and WaveOne Gold. Endodontic treatment was performed in a single visit. Patients were instructed to rate the intensity of postoperative pain on Visual Analog Scale and to record the quantity of prescribed analgesic medication taken after 24 hours, 48 hours, 72 hours, and 7 days. Time of root canal preparation, duration of pain, and incidence of procedural errors such as ledging, transportation, root perforation, and instrument separation were recorded. The data was collected from October 2018 to September 2019. SPSS version 24 was used for data analysis.
Results: This study revealed no statistically significant difference between instrumentation groups with relevance to postoperative pain and analgesic medication intake (P > 0.05). Canal preparation time was significantly shorter in reciprocating group compared to rotary group (P < 0.001). Further, the incidence of procedural errors in both instrumentation group was found statistically insignificant (P > 0.05).
Conclusions: Continuous rotary and reciprocating systems were both found to have similar clinical efficacy and safety and hence can be used to instrument the root canals.
ORAL HEALTH STATUS AMONG PREGNANT AND NONPREGNANT WOMEN: A COMPARATIVE STUDY
Authors: Kafle Shristi , Singh Harender , Sharma Basant
Published: April 2022

Background: Physiological alterations manifesting during pregnancy may influence oral health of women by increasing the susceptibility to oral infections. This study was carried out to assess oral hygiene status, gingival status, periodontal status and treatment needs (TNs) among pregnant and nonpregnant women.
Methods: A comparative cross-sectional study was conducted in patients attending Outpatient Depart­ment of Obstetrics and Gynaecology, Chitwan Medical College and Teaching Hospital, Bharatpur, Chit­wan, Nepal from December 2020 to June 2021. A total of 102 pregnant (34 in each trimester) and 102 nonpregnant women of 15-49 years fulfilling all inclusion criteria were evaluated for oral health status by various indices including oral hygiene index-simplified (OHI-S), gingival index (GI), and community periodontal index and treatment needs (CPITN). Convenience sampling technique was done. Data was analysed in SPSS v.26.0.
Results: The mean scores of OHI-S, GI and CPITN were statistically (p value<0.001) higher in pregnant women compared to nonpregnant women; highest in third trimester followed by second and first tri­mesters. In both groups, majority were found to have score 2 for treatment needs. TN2, encompassing oral hygiene instructions and oral prophylaxis was required by 92.2% of nonpregnant women, 100% of pregnant women in first trimester, 88.2% and 5.9 % in second and third trimesters respectively. Majority (94.1%) of pregnant women in third trimester required TN3 complex treatment.
Conclusions: Pregnant women found to have poor oral hygiene status, more gingivitis and periodontal diseases as compared to nonpregnant women. Implementation of proper oral hygiene practices can pre­vent oral diseases and its further complications.
VAGINAL EXTRUSION OF HUGE DECIDUAL CAST: AN EXCEPTIONAL CASE REPORT
Authors: Rana Apariharya , Bhardwaj Manisha , Prajapati Sarmila , Rana Ashma
Published: April 2022

Infrequent, irregularly irregular delayed menstrual period accompanied by heavy bleeding prolonged for weeks to months was treated with oral norethisterone 5mg tablet in 5mg – 30mg daily divided dose resulted in painful vaginal extrusion of huge fleshy mass (10 x7 x 5 cm) retaining the shape uterus histopathologically confirmed as decidual cast, a rare, as well as incomparable case, is described in an unmarried nulligravida in late twenty’s to alert the association of progesterone to membranous dysmenorrhea.
Everyone under the hormonal treatment for menstrual disorders must be educated and made aware of the underlying dreadful possibility of painful vaginal expulsion of decidual cast ascribed to membranous dysmenorrhea to cope or overcome the fright.
UNIVERSITY STUDENT’S ATTITUDE TOWARDS VIRTUAL LEARNING DURING COVID-19 PANDEMIC IN NEPAL
Authors: Upadhyay Hari Prasad , Koirala Pallavi , Sedain Prativa
Published: April 2022

Background: COVID-19 has put huge impact on our day to day life. Needless to say, the lockdown has hugely affected the education system as well. The purpose of this study was to assess students’ perceptions and attitude toward virtual learning among undergraduate and graduate students of Nepal.
Methods: A web-based cross-sectional study using Google form was conducted among 438 undergraduate and postgraduate students of various universities of Nepal under various academic programs. A structured questionnaire consisting of 15 items (5-point Likert scale) was distributed to the students using Google Form. Data was collected from October 2020 to December 2020. Data was analyzed by using SPSS and analyzed using descriptive statistical tools.
Results: Among 438 students, more than half of the students had a positive attitude towards virtual learning. Most of the students used Zoom as a mode of application in virtual learning. More than one-third of the students found online classes effective only for theoretical subjects rather than numerical and practical subjects. More than 70% of students agreed that virtual learning could be taken as an alternative source for learning in the future. More than half of the students faced the problem of the internet during virtual learning.
Conclusions: The significance of virtual learning is rising as the academic year has been disrupted due to COVID-19. Although online learning is a new method of learning that is being adapted due to COVID-19, the satisfaction level of most of the students was found to be good. The students agreed on using the distance learning approach in the future to enhance their knowledge.
HEART FAILURE WITH LOW EJECTION FRACTION AS A PRESENTATION OF SEVERE PRIMARY ADRENAL INSUFFICIENCY
Authors: Khatiwada Saurav , Singh Bishnu , Mandal Laxman , Mittal Rahul , Jaiswal Rupesh
Published: April 2022

Addison’s disease or primary adrenal insufficiency is a condition where there is decreased production of glucocorticoid and mineralocorticoid from adrenal cortex and it’s prevalance is around 100- 140 cases per millions in western societies. It has wide range of clinical features and is a serious condition. If diagnosed and treated in time, patient’s condition can improve significantly. Here we present 37 years old female who presented with wide range of vague clinical features and was in shock and on investigation, her serum sodium was low and potassium level was high. With usual treatment of shock, patient condition didn’t improve. So, echocardiography was done which showed global Left Ventricular wall hypokinesia with left ventrical ejection fraction of 25- 30%. She was also taking treatment for hypothyroidism. Endocrinology consultation was done for her hypothyroidism, hyponatremia and possible adrenal crisis. Serum Cortisol was sent which was found low. With treatment with glucocorticoids and mineralcorticoids, patient improved significantly. She recovered from shock, her serum sodium and potassium became normal and after one month, left ventricular ejection fraction improved to 50%. So, with timely diagnosis and proper treatment, Addison’s disease can be treated easily.
BACTERIOLOGY AND ANTIBIOTIC SENSITIVITY PATTERNS IN VENTILATOR-ASSOCIATED PNEUMONIA
Authors: Ranjit Srijana , Katuwal Nishan , Ranjit Sangina
Published: April 2022

Background: Ventilator-Associated Pneumonia is the most common cause of hospital-acquired infections among patients admitted in Intensive Care Unit with mechanical ventilation. Identification of bacteria and their susceptibility to commonly used antibiotics is very essential for the treatment of the patients. The aim of this study was to determine the bacteriological profile and antibiotic sensitivity patterns in the Endotracheal Aspirate cultures that were sent in Microbiology laboratory.
Methods: A hospital-based 3-year retrospective analysis on culture of Endotracheal Aspirate was done. Data from Intensive Care Unit was collected from January 2018 to January 2021, and the laboratory reports were used to determine Ventilator-Associated Pneumonia, pathogen profile and antimicrobial sensitivity patterns. Data entry and analysis was done using Statistical Package for Social Sciences version 16.
Results: Out of 147 ventilated patients in Intensive Care Unit, 115 samples were sent to microbiology laboratory with suspected Ventilator-Associated Pneumonia among which 95 (82.60 %) were positive cultures. The most common etiological agent causing Ventilator-Associated Pneumonia was found to be Klebsiella pneumoniae with 24 isolates (25.26%) and multidrug resistance was also mainly found with Klebsiella pneumoniae in 17 samples (70.83%). All of the gram-negative isolates were sensitive to colistin and resistant to ampicillin. All gram-positive isolates were sensitive of linezolid and vancomycin and most were resistant to penicillin.
Conclusions: Klebsiella pneumoniae is one of the most common organisms that is associated with nosocomial infection like Ventilator-Associated Pneumonia. The emergence of multidrug resistance is still a great threat and hindrance for the treatment of Ventilator-Associated Pneumonia.
FIBULARIS TERTIUS MUSCLE AMONG PRE-CLINICAL STUDENTS OF A MEDICAL COLLEGE: A DESCRIPTIVE CROSS-SECTIONAL STUDY
Authors: Pandit Ruku , Upadhyay Hari Prasad , Sharma Nitasha
Published: April 2022

Background: The fibularis tertius muscle (FTM) is a variant muscle of the crural compartment of the leg that is thought to have evolved in human as a result of the development of the bipedal gait. The Fibularis tertius muscle, as an ankle dorsiflexor and foot evertor, plays an important physiological role in effective terrestrial locomotion related to midfoot biomechanical stabilization. The objective of this study is to determine the occurrence of the fibularis tertius muscle using a surface anatomical examination of the foot in medical and dental students of a medical college.
Methods: This was a descriptive cross-sectional study comprising 294 pre-clinical medical and dental students of College of Medical Sciences, Chitwan, Nepal. In each student, the fibularis tertius muscle was palpated on both lower limbs for their presence or absence. The data was collected in terms of age and gender and was analyzed using the Statistical Package for Social Science version 20.
Results: The prevalence of fibularis tertius muscle was 50.68%, with females accounting for 23.13% and males accounting for 27.55%. Fibularis tertius muscle was more common bilaterally (37.07%) than unilaterally (13.61%). Among unilateral fibularis tertius muscle, 24 (8.16%) were found only on the right foot and 16 (5.44%) on the left foot only. The bilateral prevalence of the fibularis tertius muscle was 17.01 % in females and 20.07 % in males, while its unilateral prevalence in females and males was 6.12 % and 7.48 %, respectively.
Conclusions: The involvement of the fibularis tertius muscle in affecting midfoot stabilization and its potential role in delaying the healing process of John’s fracture cannot be ignored. Hence, understanding the theory behind foot biomechanics requires awareness of the existence of the fibularis tertius muscle.
ONLINE LEARNING DURING AND AFTER THE PANDEMIC
Authors: Shankar Pathiyil Ravi
Published: April 2022

NA