bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood Groups and their Association with Academic Performance among Medical Students in a Nepalese Medical College
Authors: Mahat Barun , Shrestha Lava , Adhikari Shailesh , Thapa Bikalp , Limbu Prakesh , Banstola Dinesh , Dhungel Sunil
Published: June 2021

Introduction Knowing a person’s blood type is not only important in transfusion medicine and forensic medicine but is also useful for predicting a person’s characteristics including intelligence, knowledge, skill and behavior. It is recognized that intelligence, knowledge and skill are assessed by performance in examination. The objective of this study was to determine distribution of blood groups among students and its association with their academic performance.

MethodsThis was an analytical study that was conducted among the medical students of Nepalese Army Institutes of Health Sciences (NAIHS) in Department of Clinical Physiology from June 2014 to April 2019. This study was conducted among 738 students by using convenient sampling method. Blood group was determined on the basis of agglutination reaction. Academic performance of students was assessed by the marks obtained by them in annual final examination.

ResultsBlood group O was the most prevalent at 33.5%, followed by B at 29.5%, A at 29% and AB at 8%. Distribution of Rh positive and Rh negative were 96.6% and 3.4% respectively. The mean scores obtained in final university examination were highest in blood group A (62.9%) and lowest in blood group AB (60.3%) but the difference between different blood groups was not statistically significant.

ConclusionBlood group O was the most common blood group. Rh positive was present in 96.6%. Though mean score was highest in blood group A, significant association between blood groups and academic performance was not seen in our study.
Vein of Galen Aneurysmal Malformation Presenting with Obstructive Hydrocephalus: A Case Report
Authors: Khanal Nischal , Rajbhandari Binod , Sedain Gopal , Shilpakar Sushil K
Published: June 2021

The prognosis for children harboring vein of Galen aneurysmal malformation (VGAM) has significantly improved over the last three decades due to refinements in the interventional endovascular techniques. It is now possible to obliterate the malformation with better results. Endovascular approaches evolved as the gold standard treatment option for this disorder. A few reports were published warning about the high rate of complications associated with ventriculoperitoneal shunting (VPS) in this setting. We present a pediatric case with VGAM where an emergency ventriculoperitoneal shunt procedure was required for symptomatic obstructive hydrocephalus (HCP) and management of the subsequent complications that followed it.
Lancet Commission on Global Surgery - A Public Health Initiative
Authors: Kurlberg Göran
Published: June 2021

With the advent of the epidemiological transition, the incidence of non-communicable diseases (NCDs) presenting as cardiovascular disease, diabetes, hypertension, malignancies and injuries make up the major part of the Global Burden of Disease.Many of these conditions will require surgery and in 2015, the Lancet Commission on Global Surgery was launched. The Commission´s key findings reveal that human and economic consequences of unmet surgical needs in low and middle-income countries (LMIC) are substantial and for many years have gone unrecognised.
Experience of Hydatid Cyst Management in a Tertiary Care Center in Kathmandu Nepal
Authors: Joshi Bijendra D , Koirala Udaya , Joshi Arbin , Dhital Saroj P , Dhoubadhel Prativa
Published: June 2021

Introduction Hydatid cyst is a common disease in Asian subcontinent produced by the larval stage of Echinococcus granulosus. The most common site of involvement is the liver. The mode of presentation can vary. The management of hydatid cyst includes medical treatment with albendazole, ultrasound guided aspiration and instillation of scolicidal agents as well as surgical treatment. Surgery can be perfomed by open or laparoscopic approach. The aim of this study is to analyze the cases of hydatid cyst of liver managed in our set up.

MethodsThis is a retrospective study of 45 patients with hydatid cyst managed in Kathmandu Model Hospital over the last five years. Data were collected from the patients hospital records. Demographic parameters, chief complains, radiological findings, anti echinococcal immunglobulin findings, mode of management,complications of surgery were evaluated.

ResultsMajority of our patients were female (66.7%). Mean age of the patients were 39±17.2 years (16 to 89 years).Most common symptom of presentation was pain in right upper quadrant of abdomen.Most common site of involvement was liver (93.33%)followed by spleen (4.4%). There was one case of ruptured pulmonary hydatid cyst which was referred.Operative management was done in patients (17.77%) out of which five patients (62.5%) underwent laparoscopic partial pericystectomy and omentoplasty.No major complications were encountered in any of the cases managed surgically.

ConclusionMajority of cases occured in liver. Most cases were managed conservatively. Laparoscopic management of hydatid cyst is effective.
Profile and Outcome of Adult Spine Pathologies Managed in a Neurosurgical Tertiary Care Center in Nepal
Authors: Sah Hemant K , Shrestha Dipendra K , Rajbhandari Binod , Sedain Gopal , Pradhanang Amit B , Shilpakar Sushil K , Sharma Mohan R
Published: June 2021

Introduction Spine pathology involves a wide spectrum of diseases and needs a multidisciplinary approach including surgery, rehabilitation and psychological support. It increases the burden to the family and society. This study describes diseases related to spine and spinal cord from a neurosurgical department of a tertiary hospital in Nepal.

MethodsThis is a retrospective study of all spinal cases admitted between April 2019 to February 2019, in the Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. All adult patients of ≥16 years, diagnosed with various spinal diseases were included. Based on the spectrum of causative pathologies, the study population was broadly categorized into trauma, degenerative, tumor, vascular and infection. Demographics, other variables, and outcome at 1 month were assessed.

ResultsA total of 71 patients were included in this study. Male preponderance was observed in all categories. Twenty three patients (32.4%) had traumatic spine injury and fall from height was the most common mode of injury, accounting for two-third of the total spinal trauma patients. Cervical segment was involved in two-third patients. More than one-third of the spinal patients (36.6%) had a degenerative disorder involving lumbar (57.7%) and cervical regions (42.3%). Spinal infection was diagnosed in 11.2% of the patients with 62.5% diagnosed as Pott’s spine. Overall complications were seen in 20%. Pain improved in all patients while overall good outcome was noted in 63.2% of the patients.

ConclusionOur study demonstrated a large patient burden and a clinical profile dominated by preventable causes such as RTA and fall injury. With early treatment and rehabilitation, significant improvement can be achieved. Further large scale multicenter studies are required to generalize the findings of this study to the whole population of Nepal.
Anesthetic Management of a Case of Hemophagocytic Lymphohistiocytosis
Authors: Shrestha Gentle S , Gulati Harmeet , Acharya Binita , Poudyal Bishesh S
Published: June 2021

Hemophagocytic Lymphohistiocytosis (HLH) is characterized by an overwhelming activation of histiocytes and T lymphocytes leading to fulminant hemophagocytosis and organ damage. Anesthetic management of patients with HLH is associated with challenges such as pancytopenia, hemodynamic instability and infections. In addition to sepsis, metabolic acidosis, disseminated intravascular coagulation, multi-organ involvement with an exacerbation of symptoms with the use of anesthetic agents poses significant risk perioperatively. We present a case planned for excision of pilonidal sinus. The surgery was performed after thorough workup and with the patient in remission. Elective procedures should ideally be performed with patients in remission. Cases receiving concurrent therapy with immunomodulators and steroids require special attention due to possible interaction with anesthetic agents and the need for perioperative steroid supplementation.
Clinical Overview of Cancer Patients in Province Two of Nepal: A Single Center Experience
Authors: Thakur Anshu K , Shah Anish , Ray Barun K
Published: June 2021

Introduction The incidence of cancer is rising in Nepal. It is estimated to reach 38.5 per 100,000 for males and 41.5 per 100,000 for females by 2020. The studies to determine the cancer burden in Nepal at provincial level have been insufficient and those that have been done are more inclined to Province 3. With establishment of a dedicated cancer facility in this area, we present an overview of clinical scenario of cancer patients in Province 2.

MethodsWe performed a single centered, retrospective review of 118 patients who were registered in Oncology Clinics between May 2019 and February 2020. Demographics, diagnoses and the treatment strategies were obtained from the medical records.

ResultsMedian age of presentation for cancer was 55 years (range, 6 to 83 years) with maximum number of patients falling within range of 50-60 years (31.4%). 71 patients (60.2%) were female and 47 patients (39.8%) were male. The common presenting cancers were gastrointestinal (27.1%), breast (16.9%), head and neck (15.3), gynecological (13.6%), hematological (11.9%) and others (15.2%). Among the gastrointestinal cancers, carcinoma of gallbladder with 15 cases (46.9%) was the most frequently occurring, followed by colorectal cancer with 6 cases (18.8%) and esophageal cancer with 4 cases (12.5%). Among all, 78 patients (66.1%) received palliative care only, 25 patients (21.2%) received chemotherapy only, 8 patients (6.8%) underwent surgery only, 3 patients (2.5%) underwent surgery and received chemotherapy as well, 2 patients (1.7%) received both chemotherapy and palliative care and 2 patients (1.7%) were reassured and observed.

ConclusionThe most common age of presentation for cancer of any type was 50-60 years, with most common cancer being gastrointestinal in origin. Most of the patients received palliative care owing to their advanced stage at presentation.
Relationship Between Ossicular Chain Erosion and Facial Canal Dehiscence in Chronic Otitis Media Squamous
Authors: Kharel Bijaya , Shreepaili Ashok , Tripathi Prashant , Neupane Yogesh , Gurung Urmila , Pradhananga Rabindra B , Rayamajhi Pabina , Bhattarai Hari
Published: June 2021

Introduction Chronic otitis media squamous is a gradually expanding destructive lesion and leads to complications by eroding the adjacent structures. Facial canal and ossicles are in close proximity in the middle ear space and they share the same pathogenesis of the bony erosion. Ossicular chain erosion found intraoperatively due to cholesteatoma, may suggest the likelihood of facial canal dehiscence. This study was conducted to assess the relationship between ossicular chain erosion and facial canal dehiscence in chronic otitis media squamous.

MethodsIt is a retrospective chart review of patients who had mastoidectomy done for chronic otitis media squamous in Tribhuvan University Teaching Hospital from January 2014 to December 2018. The operative findings of facial canal dehiscence were correlated with ossicular chain status.

ResultsAmong 158 cases, facial canal dehiscence was seen in 20 (12.7%), of which, 19/20 (95%) had ossicular erosion. Majority (90%) of dehiscence was in the horizontal segment. Incus was the most common ossicle to be eroded. Among the ossicles, stapes erosion was related to the facial canal dehiscence with odds ratio of 3.216 (1.235-8.374) and p-value 0.03.

ConclusionAmong the ossicles, there is a relationship between the stapes erosion and the facial canal dehiscence in chronic otitis squamous. Erosion of ossicular chain especially stapes should alert surgeons towards the possibility of facial canal dehiscence.
Predictors of Multiple Micronutrient Powder Intake Adherence among Children Aged 6-23 Months in Rasuwa District, Nepal: A Cross-sectional Study
Authors: Timalsina Ashish , Paudel Rajan , Upadhyaya Dipak P , Bhattacharya Sujay , Kuikel Bihari S , Joshi Naresh P , Adhikari Sunil , Aung Aye A
Published: June 2021

Introduction Breastfeeding would not be sufficient to meet the micronutrient requirement of children after six months and more prone to iron deficiency anemia. Micronutrient powder (MNP) can be mixed with semi-solid food to feed the children aged 6-23 months, contains 12 different micronutrients, one of the appropriate strategies. The study’s objective was to assess adherence to MNP and its predictors among children aged 6-23 months in Rasuwa district of Nepal.

MethodsA cross-sectional study was conducted in the Uttargaya rural and the Kalika rural municipality of Rasuwa district among 200 mothers of children aged 6-23 months who were fed MNP. Proportionate random sampling was used to select eligible mothers for interviews, and a semi-structured questionnaire was employed for data collection. Multivariate logistic regression was used to obtain adjusted odds ratio with 95% C.I.

ResultsSample mean was calculated among 155 mothers who received 60 sachets of MNPs;41.3% had adhered to 60 sachets intake of MNP. The mean age of the mother was 25. 29±5.3 years and the mean age of children was 14. 66±5.2 months. In bivariate analysis, the mother having one child less than five years (COR=0.5, 95% CI: 0.24-1.0) and MNP received from the health facility (COR=1.96, 95% CI: 1.02-3.76) were statically significant. Further, multivariate analysis, a mother who accepted the properties of MNP (AOR=2.52, 95% CI: 1.27-5.00), was associated with high adherence.

ConclusionAcceptability of MNP by the mother is the key to increase adherence to MNP. The distribution of MNP from a health facility, tailored with nutrition education is essential to improve adherence to MNP.
Correlation of Hypoechoic Lesions in Trans-rectal Ultrasound of Prostate with Histopathology in Prostate Cancer
Authors: Chataut Dinesh , Basnet Babin , Lohani Benu , Suwal Sundar , Paudel Sharma , Kayastha Prakash
Published: June 2021

Introduction Prostate cancer is one of the most common cancer in elderly male. Suspicion of prostate cancer is based on increased Prostate Specific Antigen (PSA) level and abnormal digital rectal examination (DRE) findings. Transrectal ultrasonography (TRUS) can detect and localize hypoechoic lesions in prostate which are considered as suspicious for malignancy. TRUS can also guide for prostate biopsy, which is the gold standard for diagnosis of prostate cancer. The study was aimed to find out TRUS findings in suspected prostate cancer patients and correlate these findings with histopathological findings.

MethodsProspective study was done in 66 males of age >40 years, sent for prostate biopsy in suspicion for prostate cancer (PSA >4 ng/ml, and/or abnormal DRE findings). Prostate was evaluated with TRUS and subsequently underwent TRUS guided six core biopsy of prostate. Total 396 cores of biopsy were taken. Histopathology reports were collected and correlated with the TRUS findings.

ResultsTwenty three patients were positive for prostate cancer and 14 of them showed hypoechoic lesions in TRUS. Total 81 suspicious hypoechoic lesions were seen in prostate of all the patients and among them 42 lesions matched with histopathology report for cancer. Cancerous focus detection rate of TRUS was 51.85%.

ConclusionTRUS is a supplementary tool in diagnosis of prostate cancer, however when used alone it has less sensitivity for detection of prostate cancer.
Separate Consent for Anesthetic Practice: Need of the Moment
Authors: Shrestha Anil , Shrestha Gentle S , Pradhan Saurabh , Joshi Pankaj
Published: June 2021

Decades of refinement and modifications have led the modern anaesthetic practice to be conducted so smoothly and safely, that sometimes we take for granted the enormous amount of risks involved with it. Furthermore, with the evolution of monitoring techniques, and discovery of safer drugs, anesthesia has facilitated the conduction of complex surgeries on sicker patients, and older patients. The expansion to critical care and pain management services has added another dimension to this field, with anesthesiologists not just working as facilitators for another procedure, but acting as primary physicians. Anesthesiologists are among the few clinicians, who are involved in patient morbidity and mortality in their daily routine. With the ever-changing ethical and legal background, the significance of obtaining a separate consent for anesthesia needs to be timely evaluated. In this review, we have discussed the significance of a separate consent for anesthesia and highlight its various aspects.
Comparison of Round Window Anatomy between Pediatric and Adult Population: A Perspective from Cochlear Implantation Surgery
Authors: Pradhananga Rabindra B , Gyawali Bigyan R , Rayamajhi Pabina
Published: June 2021

Introduction The round window is thought to be an ideal port for inserting electrodes during cochlear implantation. Considering its complex anatomy with an individual variation, this study aims to review the anatomy of round window based on the visibility of round window niche and round window membrane via posterior tympanotomy in pediatric and adult population who underwent cochlear implantation.

MethodsThis was a retrospective observational study conducted at the Department of ENT-HNS, Institute of Medicine, Kathmandu, Nepal. Surgical notes of adult (>15 years) and pediatric cases (<15years) who underwent primary cochlear implantation from January 2015 to January 2018 were assessed for different grading of round window niche and round window membrane visibility via posterior tympanotomy. Cases with revision surgery and with incomplete documentation of intra-operative findings were excluded from the study. Statistical analysis was done using SPSS software version 25. We used Chi-square and Fisher’s exact tests to analyze the statistical association.

ResultsType B round window niche (partially visible) was the most common variant seen in the pediatric group while in adults, both Type B (partially visible) and Type C (fully visible) round window niche were common. Compared to the adults, the pediatric group had good visibility of RWM. However, there was no statistical association between these observations.

ConclusionThe round window has a wide range of anatomical variations with different levels of visibility of RWN and RWM in the different age groups. Although statistically insignificant, RWM visibility seemed to be better in pediatric cases compared to adults.
Comparative Study on Effectiveness and Safety of Atorvastatin with Rosuvastatin in Hyperlipidemic Patients at a Tertiary Care Hospital in Nepal
Authors: Raut Binod , Paudel Nimesh , Shrestha Deepti , Bhosekar Anant
Published: June 2021

Introduction Hyperlipidemia is one of the most contributing factors to coronary heart diseases. Statins have become standard medicine in clinical practice to reduce total cholesterol, low density lipoprotein and to increase high density lipoprotein cholesterol. This study is conducted to compare the effectiveness and safety of atorvastatin with rosuvastatin in hyperlipidemic patients.

MethodsThis is a prospective observational study involving 150 patients conducted in the Department of Internal Medicine of Kathmandu Medical College and Teaching Hospital from July 2019 to March 2020. Patients newly diagnosed with hyperlipidemia were enrolled. Patients that were prescribed with 10 mg of atorvastatin and 5 mg of rosuvastatin by the treating physician once daily for 6 weeks were divided into two groups. Data was recorded in the customized proforma and the SPSS package version 20 was used for analysis.

ResultsPatients that were prescribed with atorvastatin were put in group I and those prescribed with rosuvastatin were included in group II with 75 participants in each group. The mean age of the patients were 50.56± 10.08 years in group I and 52.45±10.20 years in group II with male to female ratio of 3:1. The mean BMI of group I was 25.36±1.74 and that of group II was 26.48±2.21 before therapy. There was a significant main effect of duration (F1,74=401.02, p<0.001) on the TG and TC levels (F1,74=1134.23, p<0.001) as well as (F1,74=614.99, p<0.001) on the LDL and HDL levels (F1,74=146.38, p<0.001).

ConclusionRosuvastatin was significantly more effective than atorvastatin in reducing levels of TG, TC and LDL-C. Rosuvastatin also significantly increased the level of HDL.
Prevalence of Stunting among 6-59 Months Children and its Association with Water, Sanitation and Hygiene Practice in Urban Slums of Kathmandu, Nepal
Authors: Singh Sarswoti , Dhital Nil P , Paudel Rajan , Sah Dipak K , Hamal Arjun , Shrestha Junu
Published: June 2021

Introduction Childhood malnutrition is a critical public health concern in Nepal. Slums are supposed to have poor water, sanitation and hygiene practices. This study has aimed to examine association between water, sanitation and hygiene (WASH) variables and stunting among 6 to 59 months children of slums of Kathmandu metropolitan city.

MethodsDescriptive cross-sectional study design was employed where 335 households were included in the study. Data were collected using standard questionnaire and observation checklist. Weight and height of children were taken using seca digital weighing scale and wooden height board of UNICEF respectively. Anthropometric analysis was done using WHO Anthro version 3.2.2 software and other statistical analysis was conducted using SPSSversion 22 software.

ResultsThe prevalence of stunting was 23%. Four out of five household (80%) in slum used to drink water from unimproved source. Absence of handwashing station (AOR=2.109, 95% CI:1.05-3.27) and absence of water storage covering (AOR=2.46, 95% CI: 1.16–5.23) were found to be significantly contributing to stunting status.

ConclusionThis study highlights the importance of good WASH practices, and the potential of WASH interventions, to contribute for the improved childhood stunting living in urban slums in Nepal. Also, the findings recommend the need of strategies on purification of water, improvement of toilets, behaviour change and awareness related activities to improve the stunting among children.
Patterns and Causality Assessment of Adverse Drug Reactions in Inpatients of a Tertiary Care Hospital, Nepal
Authors: Mudvari Anish , Yadav Dipendra , Ghimire Rakesh , Prasad Pravin
Published: June 2021

Introduction Adverse drug reaction (ADR) is a leading cause of morbidity and mortality around the world. Causality assessment is done to establish relation of drug exposure with undesired clinical events. This study conducted in tertiary care hospital was undertaken to evaluate the patterns of ADR and causality assessment using Naranjo causality algorithm.

MethodsData on suspected ADR cases were collected retrospectively from Medicine and Dermatology wards of Tribhuvan University Teaching Hospital, Kathmandu from April 2018 to April 2019. Naranjo causality assessment was performed. Statistical analysis was done using SPSS version 18.

ResultsOf 34 suspected ADR, occurrence of ADR was more in females (18) as compared to males (16). Skin and integumentary system was the most common organ affected (35.29%). Pyrazinamide induced hepatitis was found to be the most common suspected ADR. Causality assessment was performed and ADRs were categorized as possible 17 (50%), probable 16 (47.06%) and definite 1 (2.94%).

ConclusionThe patients are commonly admitted at the hospital due to suspected ADRs. Pyrazinamide induced hepatitis was the most common suspected ADR.
Risk Score for Prediction of Severe Postoperative Complications After Pancreaticoduodenectomy
Authors: Shah Surendra , Bhandari Ramesh S , Vaidya Pradeep , Singh Yogendra P , Joshi Lakhey Paleswan
Published: June 2021

Introduction Morbidity after pancreaticoduodenectomy (PD) still remains high. Postoperative pancreatic fistula (POPF) is the most common cause of increased morbidity after PD. Assessment of predictability of risk score for severe postoperative complications was the objective of this study.

MethodsThis was a retrospective observational study. Patients undergoing pancreaticoduodenectomy at Tribhuvan University Teaching Hospital (TUTH) between January 2017 to December 2017 were included in the study. Variables were recorded from case sheets of the patients. The “Risk Score” was calculated using the pancreatic duct diameter and body mass index (BMI). Association of risk score and severe postoperative complications were analyzed.

ResultsA total number of patients were 43, including 23 (53.5%) males and 20 (46.5%) females. The mean age was 57.09 ± 11.85 years ranges from 29 years to 76 years. The POPF and delayed gastric emptying (DGE) was 23.3% (10/43); and post-pancreaticoduodenectomy hemorrhage (PPH) was 11.6% (5/43). Severe postoperative complications were present in 13.9% (6/43) patients. In univariate analysis, pancreatic duct diameter (p=0.045) and Risk Score (p=0.02) were significantly associated with severe postoperative complications after PD. However none of them were significant in multivariate analysis.

ConclusionRisk score failed to predict severe postoperative complication after pancreaticoduodenectomy.
A Tale of β-Lactamases and Multidrug Resistance in Pseudomonas aeruginosa Isolated from Inpatients in a University Hospital
Authors: Yadav Santosh K , Sharma Sangita , Mishra Shyam K , Sherchand Jeevan B
Published: June 2021

Introduction In this era of modern medicine, antimicrobial resistance can be regarded as a major health calamity. The emergence of multidrug-resistant (MDR) Pseudomonas aeruginosa strains poses therapeutic challenges and lead to treatment failure in hospitalized patients. This study was conducted to determine various types of β-lactamases among MDR P. aeruginosa isolates recovered from hospitalized patients.

MethodsThis study was conducted at Tribhuvan University Teaching Hospital, Maharajgunj, Nepal. The clinical samples collected from inpatients were processed for detection of P. aeruginosa isolates and antibiotic susceptibility profile was determined. The MDR strains were identified and ceftazidime-resistant isolates were subjected for detection of extended-spectrum-β-lactamase (ESBL), metallo-β-lactamase (MBL), and Klebsiella pneumoniae carbapenemase (KPC).

ResultsA total of 161 P. aeruginosa isolates were recovered during the study period encompassing 73.3% (n=118) MDR isolates. The MDR isolates included 50.0% (n=59) from lower respiratory tract infections; and 39.8% (n=47) were from the intensive care unit patients. The MDR isolates showed a high resistance profile towards piperacillin, cephalosporins, and fluoroquinolones (>85%). Resistance to carbapenems and aminoglycosides were up to 80% and 60% respectively. Extended spectrum-β-lactamase, MBL, and KPC mediated resistance were seen in 34.7%, 43.6%, and 14.4% MDR isolates, respectively.

ConclusionMultidrug resistance as well as resistance mediated by β-lactamases production were high among P. aeruginosa isolates.  Therefore, early detection of antimicrobial resistance and rational use of antibiotics play a critical role to fight against this MDR pathogen.
Correlation of Status of Mastoid with Outcomes of Myringoplasty with Cortical Mastoidectomy in Mucosal Otitis Media with High Risk Perforation
Authors: Shrestha Asmita , Bhattarai Hari , Rayamajhi Pabina , Pradhananga Rabindra B
Published: June 2021

Introduction Chronic mucosal otitis media is one of the common disease prevalent in our society. This study was done to correlate the status of mastoid with outcomes of myringoplasty with cortical mastoidectomy in mucosal otitis media with high risk perforation.

MethodsThis prospective, observational study was done at Department of Otorhinolaryngology and Head and Neck Surgery, Tribhuvan University Teaching Hospital. Thirty-four patients of ag|e 15 and above with chronic mucosal otitis media having high-risk perforation undergoing cortical mastoidectomy with myringoplasty were included. The status of middle ear, aditus, and mastoid air cells were assessed. Post-operatively, patients were assessed for graft uptake and hearing after three months. The post-operative graft uptake and hearing results were correlated with the peroperative status. Four patients who had preoperative sensorineural hearing loss were studied in terms of graft uptake only.

ResultsThe graft success rate in patients with normal mastoid air cells was 90% whereas in diseased cases was 71.4% which was statistically not significant with p value 0.20. The success rate in terms of hearing was 68.8% in normal mastoid whereas it was 64.3% in diseased mastoid which was statistically not significant with p-value of 1.

ConclusionIn correlation with the status of mastoid air cells with graft uptake and hearing result, the observed differences were not statistically significant. However, averages of post-operative air conduction threshold and air-bone gap of all cases were better as compared to preoperative levels.
Investigation of the Substituting Effect of Se on the Physical Properties and Performances of Cd〖Se〗_x 〖Te〗_(1-x)and Zn〖Se〗_x 〖Te〗_(1-x) Materials for Semiconductor Radiation Detectors
Authors: Radia Malki , Abdelghani Tebboune , ElHouari Galouci , Asmaa Saim , Ahmed Hafid Belbachir
Published: June 2021

The structural and electronic properties of  and semiconductor detectors at various concentrations x = 0, 0.25, 0.5, 0.75 and 1 of Selenium (Se) were determined by using the full potential-linearized augmented plane wave (FP-LAPW) based on the density functional theory (DFT). The compositional dependence of such properties was analysed and discussed. The concentration dependence of lattice parameter and bulk modulus show nonlinearity. All the investigated alloys have a direct bandgap (Γ-Γ) which decreasesnonlinearly with increase in Se concentration. On the other hand, Geant4 simulations have been performed for studying the absolute and full-energy peak detection efﬁciencies and energy resolution at 1.5”×1.5” of these alloys as semiconductor detectors in the 511-1332 keV gamma-ray energy range. Ours findings are in a good agreement with the available theoretical and experimental data. We hope that our results serve as are reference for future theoretical and experimental researches.
Forms of infectious complications after use of metal foreign bodies of the auricle and determination of the ability of detected microorganisms to biofilm formation
Authors: Mishina M. M. , Bondarenko O. V.
Published: June 2021

Ear or nose are quite vulnerable to foreign bodies. Foreign bodies cause various side effects in the body. A special category consists of foreign bodies that are introduced for aesthetic purposes, in particular piercing products. Decoration implanted in the tissues of the ear or nose is a foreign body and is a field of increased contamination and reproduction of pathogenic and opportunistic microorganisms. The aim of the study was to determine the infectious forms of complications that occurred after prolonged use of metal foreign bodies and to study the ability of biofilms by microorganisms isolated from the pathological contents of the foreign body of the auricle. 93 patients who applied to the ENT department of Kharkiv Regional Hospital for complications after implantation of metal foreign bodies and 10 people, control group, which had no foreign bodies, and were randomly selected from healthy individuals, were examined, to determine the qualitative composition of the microbiocenosis of the auricle skin. The material for the study was pathological discharge from a foreign body of the auricle. The microbiological study was performed using MICRO-LA-TEST identification kits. Studies of the formation of biofilms were studied by determining the ability of bacterial strains to adhere to the surface of polystyrene. The obtained cultures were washed with suspension media individual for each family of bacteria. The optical density of bacterial suspensions was measured using a microplate reader "MultiskanEX" (type 355). Statistical analysis of the obtained data was performed using MSExcel, Statisica 10 software. As a result of the conducted researches the dependence between the development of infectious complications of the auricle in the presence of metal foreign bodies and the microbiocenosis of the pathological focus was revealed. The study allowed to establish the structure of the microbial landscape of the skin of the auricle in the area of the metal foreign body, to determine the dominant forms of complications of infectious origin, after prolonged use of metal foreign bodies and to study the ability to form biofilms by microorganisms from different metals. The ability of various types of microorganisms to form biofilms when using products from different types of metals has been studied. It is established that the use of metal foreign bodies made of silver and gold reduces the risk of purulent-inflammatory process. It is proved that the optical density of biofilms of most microorganisms isolated from the pathological contents of the area of foreign bodies made of silver and gold is significantly lower than when using steel and titanium products.
STOCHASTIC MODEL OF EVOLUTION OF HOMOTOPY TYPE OF PHASE
Authors: Malkhaz M.
Published: June 2021

In this paper, we introduced the concepts of full number invariant for homotopy type and entropy of homotopy type of some topological spaces. 

Based on this concept discrete random process describing evolution of the homotopy type of phase space of c closed dynamical system there is built.

In this paper we introduced also the entropy of trajectory of evolution of homotopy type of phase space of closed dynamical system, constructed random value on set this trajectories, proved that the mathematical expectation of this random value coincide to sequence of mathematical expectations in the phase spaces of the constructed random process with respect to the corresponding random values.
Still Just Hegemonic After All These Years?
Authors: Eckstein Jessica J. , Sabovik Erika
Published: June 2021

Men and boys are commonly viewed as perpetrators and/or facilitators of relational violence, but this biological essentializing oversimplifies “masculinity” as “bad.” Connell illustrated the complex roles of bodies, structural order maintenance, and “pupils as agents, school as setting” (Connell 2000: 161) in shaping masculinity processes. Our study examined these factors by examining how peer perceptions of gendered identity threats relate to beliefs negatively affecting power relations. Students (N = 87; n = 36 males, 51 females) from four classes at two high schools in Connecticut provided pre- and post-test data for a Sexual Violence Prevention Program. Results show unhealthy attitudes related to peer perceptions as a basis for violence scenarios. We discuss primary-prevention curricular implications by addressing masculinities as social relationships involved in adolescents facilitating healthy relational practices.
Boyhood, Sport, and the Mild Brutalization of the Body
Authors: Hearn Jeff
Published: June 2021

In this contribution, I consider some appreciative links and qualified connections between Raewyn Connell’s work and my own. In particular, I use the example of sport, a key area in the making of boys and young men in many parts of the world, with special reference to body, practice, and theoretical and empirical conceptualizations of masculinity.
Masculinity, Fun, and Social Change
Authors: Pascoe C.J.
Published: June 2021

Raewyn Connell’s theorizing in The Men and the Boys shaped my analysis of young men’s engagements with masculinity, and my thinking about gender inequality more generally. The claims about relationships between global inequalities and gender relations in that text shifted my focus away from types of boys—gay boys, straight boys, nerdy boys, popular boys—to a focus on gender relations among boys themselves, processes by which boys both robbed others of precious indicators of masculinity and attempted to claim said indicators for themselves. This shift highlights the centrality of interaction, practice, and institutions to gender inequality among American teenagers. The essay concludes by discussing how Connell’s focus on global inequalities provided a foundation from which to argue that many of the same gendered dynamics we see among American teenagers—what I came to call masculinity contests—are also deeply woven into political discourses and practices.
Analysis of ESL Students' Activities during Summer Holidays in Pakistan
Authors: Ibrahim Muhammad , Ahmad Masood , Javed Muhammad Latif
Published: June 2021

Education is a continuous process, and students need to focus on their academic activities uninterruptedly throughout the academic calendar to achieve their targets. The current study aims to analyze ESL students' activities during the summer holidays in Pakistan. The target population for the current study was secondary school ESL students from the private sector. Sixteen participants were selected by using a convenient sampling technique. The participants were interviewed for gathering qualitative data. The data were analyzed by using interpretive and data reduction techniques. The findings indicate that the participants take part in different co-curricular and extra-curricular activities during the summer holidays. Some challenges faced by students are also highlighted. Based on the results, some implications for ESL students are suggested.
Factors Influencing the Successful Curriculum Implementation in Secondary Schools of Punjab
Authors: Mukhtar Sajida , Hameed Abdul , Arif Seema
Published: June 2021

The role of the principal has been explored through using Goleman's leadership styles and leadership strategies in curriculum implementation. However, there are certainly other factors as well which influence successful curriculum implementation, such as teaching characteristics and provision of facilities. The data was collected from 600 teachers and 36 headteachers across Punjab using multistage sampling. The data were organized and recorded with SPSS 21. Descriptive and inferential analysis was used to determine the interactive effect of factors (leadership styles, teaching characteristics, and leadership strategies) in curriculum implementation. The results indicate that both dissonant and resonant leaders achieve their objectives in different ways. Resonant leaders adopt more visionary and coaching style to be successful with progressive teachers; whereas, dissonant leaders use the more commanding style with traditional teachers. Content analysis has been used to analyze structured interviews with headteachers; comparison between the responses of teachers and school principals helped us to identify gaps in leadership and successful implementation of the curriculum.
Impact of Fasting on Students' Exam Preparation at University Level
Authors: Saifi Imran Latif , Saleem Aqsa , Batool Rubab
Published: June 2021

Fasting is included in the five pillars of Islam and obligatory when a child becomes an adult (have approximately 15 years of age). Examination preparation is the process or acts to prepare oneself for taking part in an examination. The study explored students' beliefs regarding Fasting in Ramadan towards exam preparation at the university level. This study was designed to explore students' beliefs regarding Fasting in Ramadan towards exam preparation at the university level. A quantitative method was used in this study; a survey was adopted to complete the study. Students studying in different programs of BS, M.Phil and PhD of The Islamia University of Bahawalpur (IUB) were the population of the study. 125 students (25 from each department) were selected conveniently. The questionnaire was used as a tool to collect data from randomly selected respondents, which was consisted of 12 statements. It was recommended that Students might keep fast in Ramadan even they have an exam as they may be able to learn their fasting in Ramadan has a positive impact as results in the semester during Ramadan is better than the previous result of the respondents.
Investigating the Priorities of Youth for the Selection of Media for News Consumption
Authors: Tareen Hannan Khan , Nazmine  , Tareen Manan Khan
Published: June 2021

This study examined the priority of a young generation regarding the selection of medium for news consumption of Multan city. The rationale of the research was to explore the authority of Social Networking Medium (SNM) and explored the comparison between both genders about the consumption of media for repeated information seeking. Moreover, a survey questionnaire methodology used to explore the priorities of the youth and the sample size was five hundred in total using the purposive sampling technique. The study gave a clear hint that the use of Social Networking Medium (SNM) for news acquiring was 56 percent which is greater than the traditional media (print media), which was 44 percent. The study also pinned the point that the youth is consuming the newspaper for relevant information more than Facebook. Overall findings of the study illustrated that Social Network Medium (SNM) is the foremost source of news and information among the youth of Multan.
Concomitant central venous sinus thrombosis and subdural hematoma in acute promyelocytic leukemia: middle meningeal artery embolization enables safe anticoagulation. Illustrative case
Authors: Maini Kushagra , Afzal Feroze , Giurgiutiu Dan-Victor , Rahimi Scott Y. , Shah Manan , Switzer Jeffrey A. , Vale Fernando L. , Garcia Klepper Alfredo
Published: June 2021

BACKGROUND

Acute promyelocytic leukemia (APL) has long been associated with coagulation disorders. The proposed mechanism is a combination of fibrinolysis, proteolysis, platelet dysfunction, thrombocytopenia, and possibly disseminated intravascular coagulation. Hemorrhagic complications are prominent.

OBSERVATIONS

In this case, a 25-year-old female with newly diagnosed APL developed extensive cerebral venous thrombosis (CVT) and was initiated on a protocol with idarubicin and all-trans retinoic acid. The general recommendation for treating CVT is anticoagulation to stabilize the existing thrombus and prevent propagation. The patient was initiated on a heparin drip, but her clinical course was complicated by subdural hemorrhage (SDH) and epidural hemorrhage in the setting of thrombocytopenia. Anticoagulation was held, and her CVT propagated on follow-up imaging. To restart anticoagulation for CVT with a limited risk of SDH, the authors pursued middle meningeal artery (MMA) embolization. The patient was transitioned to apixaban and discharged to home.

LESSONS

MMA embolization enables safe anticoagulation in patients with concomitant CVT and SDH. The authors report the complex clinical course and effective management of this rare clinical scenario.
Pandemi sürecinin posta pulları üzerinden değerlendirilmesi
Authors: AYCİL Serkan
Published: June 2021

Çalışmanın amacı, pandemi sürecine ait temel bilgileri düşünsel boyuta indirgeyerek, filateli biliminin sektörel bileşenleri açısından anlamlandırmaya çalışmaktır. Araştırma kapsamında, pulun tanımı yapılarak; ortaya çıkışı, önemi, işlevleri, iletişim özellikleri ve nitelikleri hakkında bilgiler verilmiştir. Ayrıca pandemi sürecine görsellik atfeden çalışmada; Covid-19 kavramı ile düşünsel boyut ilişkisi, filateli biliminin sektörel yeterliliği, farklı uluslara ait filateli nesneleri, ilginç tasarım örnekleri ve sürece dair yaklaşımlar konusunda çıkarımda bulunularak Covid-19 kavramına, sosyal bilimler açısından yeni bir yorum kazandırılmaya çalışılmıştır. Araştırma sonunda filateli alanına ve Covid-19 salgınına ilişkin önerilerde bulunulmuştur.
UNGA as the Anchor: Global Environmental Conferencing
Authors: Matz-Lück Nele , Christiansen Liv
Published: June 2021

The global environmental conferences convened by the United Nations General Assembly (UNGA) during the last fifty years have contributed to the development of international environmental law and institution-building. Yet, given the deteriorating state of the global environment they are but one element of international environmental governance. While they were important to bring environmental issues to the attention of states, the time for agenda-setting seems over. Rather the international community must move on to the implementation of existing binding and non-binding rules and principles. While the UNGA continues to play an important role in the context of sustainable development and the Agenda 2030 process and is, indeed a stable platform for international cooperation on environmental issues, it seems that the time for comprehensive global environmental conferences may have come to an end, unless more innovative mechanisms for the implementation of international environmental law and policy are brought forward.
ICTs as the New Environmental Sentinels1
Authors: Desai Bharat H.
Published: June 2021

This article seeks to place under scanner the role of international courts and tribunals (ICTs) as important agents for the peaceful settlement of international disputes through the instrumentality of law. The rapid upswing in the number of specialized international courts and tribunals (in areas such as trade, human rights, law of the sea, criminal justice and environment) can be perceived as an attempt by the sovereign states to maintain viability of the ICTs in light of perplexity in international relations, growing recognition of peaceful co-existence, quest for institutionalized cooperation and emergence of some of the ‘Common Concerns of Humankind’ and the ‘Duty to Cooperate’. It has sought to make sense of emergence of ICTs as the ‘New Environmental Sentinels’. Do we need a specialized International Environmental Court (IEC) as an ‘ideal’? What does it portend for our common future?
Boletín Económico Regional : Noroccidente, I trimestre de 2021
Authors:   Sección de Sucursales Regionales de Estudios Económicos
Published: June 2021

La economía de la región Noroccidente en el primer trimestre de 2021 mostró incremento anual, dados los mejores resultados en la mayoría de los indicadores de seguimiento. Los aumentos más representativos se dieron en el comercio, incluidas las ventas de automóviles y motocicletas, así como en la industria y en la construcción en casi todas sus variables. A su vez, siguen reduciéndose los descensos en transporte y turismo. En el sector agropecuario, creció el sacrificio de ganado porcino y bovino, pero hubo menores niveles de abastecimiento, acopio de leche y producción de pollo. En el frente externo, aumentaron las exportaciones, las importaciones y el ingreso de remesas. Finalmente, la tasa de desempleo creció en Medellín por una mayor participación laboral y se redujo en Quibdó, aunque ésta última fue la tercera más alta del país; en tanto, la inflación en la capital antioqueña permaneció dentro del rango meta del Banco de la República.
Aplikasi Asuransi Kesehatan Pada Mahasiswa Keperawatan
Authors: Haq Zia Ul , Kodriyah Lailatul , Herawati Ida , Aditya Ronal Surya
Published: June 2021

Health insurance from the government, known as Askes, was renamed BPJS. One of the residents of Indonesia are students who take part in the program. The purpose of this study was to determine the experience of students becoming users of health insurance. Method This research is a qualitative research with a descriptive phenomenological design, data obtained through in-depth interviews. Stages of analysis Data obtained by in-depth interviews can be analyzed the process of data analysis with Interpretative Phenomenological Analysis (IPA). The study population was 15 nursing student respondents. The results showed that there were 8 themes: 1) Health Insurance Services 2) Welfare 3) Hospital Costs 4) Social Health Insurance 5) Economic Problems 6) Time 7) Increase 8) Pain. The conclusion of this study is that students consider that current health services were not good, for example long waiting times and health insurance have an influence on welfare and the economy.